This document discusses local anesthesia techniques for dental procedures. It begins by outlining the importance of local anesthesia and describing local anesthetic agents. It then reviews the anatomy of the trigeminal nerve and its branches. The rest of the document describes various local anesthesia injection techniques for the maxilla and mandible, including infiltration, nerve blocks of the greater palatine nerve, nasopalatine nerve, inferior alveolar nerve, and mental nerve. Proper needle placement, angulation, dosage, and administration technique are emphasized for each injection.

1. Local anesthesia
anatomy review & injection technique
Dr. Haydar Muneer Salih
B.D.S., F.I.B.M.S

2. Nothing that is done by a dentist for
patient is of greater importance than
the administration of a drug for
prevention of pain during dental
treatment yet the act of administration
of local anesthesia frequently
associated with great anxiety and pain

3. Local Anesthetics
• Role:
• Decrease intraoperative and
postoperative pain
• Increase patients cooperation
• Diagnostic testing/examination

4. Anatomical considerations:
• Trigeminal nerve:
– Sensory divisions:
• Ophthalmic division V1
• Maxillary division V2
• Mandibular division V3
– Motor division:
• Muscles of mastication- masseter,
temporalis, medial and lateral pterygoids
• Mylohyoid, Anterior belly of the digastric ,
Tensor tympani, Tensor veli palatini

5. Maxillary division of trigeminal nerve

6. Mandibular division of trigeminal nerve

7. Local anesthetic instruments:
• Anesthetic carpule
• Syringe
• Needle

8. Anesthetic carpule
1. Local anesthetic
agent
2. Vasoconstrictor
agent
3. Preservation for
vasoconstrictor
(anti-oxidant)
4. Vehicle to make
solution isotonic
NaCl 0.9%

9. Anesthetic syringe

10. Anesthetic needle

12. Injection technique
1. Use sterile sharp needle
2. Check the follow of the solution
3. Warm the anesthetic carpule and syringe to
the room temperature
4. Position the patient
5. Dry the tissue
6. Apply topical anesthesia
7. Communicate with the patient

13. 8. Establish a firm hand rest
9. Make the tissue taut
10. Keep the syringe out of patient line of
sight
11. Insert the needle to the mucosa
12. Watch and communicate with patient
13. Slowly advance and withdraw
14. Observe the patient after injection

15. Maxillary anesthesia:
• Infiltration:
Able to be performed in the maxilla due to the
thin cortical nature of the bone
• Target area: apical region of the tooth to be
anesthetize
• Land marks:
a. Mucosal fold
b. Crown of the tooth
c. Root contour of the tooth
• Orientation of the needle bevel so it faces
the bone

16. Maxillary anesthesia:

17. • Anesthesia of the hard palate is
necessary for dental extraction of
maxillary teeth
• For many patient palatal injection
proved to be very traumatic and for
many dentist is the one of the most
traumatic procedures

18. 1. Inform the patient that this procedure
is little uncomfortable so he will be
psychological prepared
2. Provide adequate topical anesthesia
3. Maintain control over the needle
4. Deposit the anesthesia slowly
5. Trust yourself

19. Anesthesia for greater palatine

20. Naso palatine nerve block:

21. Mandibular anesthesia:
• Infiltration techniques do not work in the
adult mandible due to the dense cortical bone
• Nerve blocks are utilized to anesthetize the
inferior alveolar, lingual, and buccal nerves
• Provides anesthesia to the pulpal, alveolar,
lingual and buccal gingival tissue, and skin of
lower lip and medial aspect of chin on side
injected

23. Inferior alveolar nerve block (IAN)
Technique involves blocking the inferior alveolar
nerve prior to entry into the mandibular lingula
on the medial aspect of the mandibular ramus.
Technique:
• Area of insertion is the mucous membrane on
the medial border of the mandibular ramus
• Height of injection injection- 6-10 mm above
the occlusal table of the mandibular teeth
• Mouth must be open for this technique

25. Inferior alveolar nerve block (IAN)
• Depth of injection: 25mm
• Approach area of injection from
contralateral premolar region
• Use the non-dominant hand to retract the
buccal soft tissue (thumb in coronoid notch
of mandible; index finger on posterior
border of extraoral mandible
• Inject ~0.5 0.5-1.0cc of local anesthetic
• Continue to inject ~0.5cc on removal from
injection site to anesthetize the lingual
branch

28. Mental nerve block
• Mental and incisive nerves are the
terminal branches for the inferior
alveolar nerve
• Provides sensory input for the lower lip
skin, mucous membrane, pulpal/alveolar
tissue for the premolars, canine, and
incisors on side blocked

31. Mental nerve block
Technique:
• Area of injection mucobuccal fold at or
anterior to the mental foramen. This lies
between the mandibular premolars
• Depth of injection ~5 5-6mm
• Inject 0.5 0.5-1.0cc of local anesthesia
• Message local anesthesia into tissue to
manipulate into mental foramen to anesthetize
the incisive branch