This document discusses various techniques for maxillary nerve blocks and anesthesia. It begins by outlining the maxillary nerve and its branches, then describes 10 different injection techniques in detail. These include supraperiosteal, posterior superior alveolar, anterior superior alveolar, middle superior alveolar, greater palatine, nasopalatine, and maxillary nerve blocks. Each technique section explains the nerves anesthetized, areas anesthetized, anatomical landmarks, advantages and disadvantages, and procedural steps. Images are provided to illustrate the injection sites and anatomical relationships.
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Types of Injections
I. Supraperiosteal (infiltration)
II. Periodontal ligament (PDL, intraligamentary)
III. Intraseptal injection
IV. Posterior superior alveolar nerve block
V. Middle superior alveolar nerve block
VI. Anterior superior alveolar nerve block
VII. Greater (anterior) palatine nerve block
VIII. Nasopalatine nerve block
IX. Maxillary (second division) nerve block
X. Anterior meddle superior alveolar nerve block
XI. Palatal approach-anterior superior alveolar n block
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Nerves anesthetized– terminal branch of dental plexus
Areas anesthetized
Entire region innervated by the large terminal branches of this
plexus
Indications
1. Pulpal anesthesia of maxillary teeth when treatment is limited
to 1 or 2 teeth
2. Soft tissue anesthesia when indicated for surgical procedure
Contraindications
1. Infection or acute inflammation
2. Dense bone covering the apices of teeth
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Advantages
1. High success rate (>95%)
2. Easy & usually entirely atraumatic
Disadvantages
Not recommended for larger areas because of multiple
injection
Alternatives– PDL, IO, regional block
Anatomical landmark:
Mucobuccal fold
Crown of the tooth
Root contour of the tooth
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Technique
1. Lift the lip, pulling the tissue taut
2. Hold the syringe parallel to the long axis of the tooth
3. Insert the needle at the height of the mucobuccal fold over the
target tooth
4. Advance the needle until its bevel is at or above the apical
region of the tooth
5. Aspirate, if –ve , deposit 0.6 ml slowly over 20 seconds
Sighs & symptoms
1. Subjective: feeling of numbness in the area of administration
2. Objective: no pain during therapy
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Safety features
1. Minimal risk of intravascular administration
2. Slowness of injection, aspiration
Precautions
should not be used for larger areas
Complications
pain on needle insertion with the tip against periosteum
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Nerves Anesthetized-
Posterior superior alveolar
and its branches
Areas Anesthetized-
1) Pulps of the maxillary 3rd
, 2nd
and 1st
molars
2) Buccal periodontium and
bone overlying these teeth
Anatomical Landmarks-
1. Mucobuccal fold and its
concavity
2. Zygomatic process of the
maxilla
3. Infratemporal surface of the
maxilla
4. Anterior border and coronoid
process of the ramus of the
mandible
5. Maxillary tuberosity
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Technique
Two types of technique– 1.single
penetration
2. multiple penetration
Technique-1 (single)
1. Area of insertion– palatal mucosa just lateral
to the incisive papilla
2. Target area– incisive foramen beneath the
papilla
3. Path– approach the injection site at 45 degree
angle toward the papilla
4. Chair position– 9 or 10 o’clock position facing
in the same direction as the patient
5. Slowly advance the needle towards the
foramen until bone is gently contacted (depth
approx. 5 mm)
6. Slowly deposit 0.45 ml in 15-30 second
minimum
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3. Procedure
4.
a) 1st
injection: retract the upper lip to stretch
tissues & improve visibility. Gently insert in
the frenum & deposit 0.3 ml in approx. 15
seconds
b) 2nd
injection: at 11 or 12 o’clock position,
tilting the patients head in the right, &
needle at right angle to interdental papilla
needle is inserted into the papilla just
above the level of crestal bone. Aspirate
when ischemia is noted in the incisive
papilla or needle tip become visible just
beneath the tissue surface
Signs & symptoms
1. Subjective: numbness in the upper lip & anterior
portion of the hard palate
2. Objective: no pain therapy
Safety features
1. Aspiration
2. Contact with bone
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Alternatives
1. PSA nerve block
2. ASA nerve block
3. GP nerve block
4. Nasopalatine nerve block
Technique– 2-type: high tuberosity
approach & GP canal approach
High-tuberosity approach
1. Area of insertion– height of
mucobuccal fold above the distal
aspect of 2nd
molar
2. Target area– maxillary n. as it passes
through the pterygopalatine fossa
• superior and medial to the target area
of PSA n. block
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Advantages
1. Provides anesthesia of multiple teeth
with single injection
2. Minimizes volume of anesthesia & no. of
puncture
3. Allows effective soft tissue & pulpal
anesthesia for periodontal scaling 7 root
planing
4. Allows accurate smile line assessment
5. Eliminates postoperative inconvenience
of numbness to the upper lip & muscle of
facial expression
6. Can be perform comfortably with a
CCLAD
Disadvantages
1. Requires a slow administration time ( 0.5
ml/min)
2. Can cause operator fatigue with a
manual syringe
3. May need supplemental anesthesia for
C.I. & L.I.
It arises from medial part of convex anterior border of trigeminal ganglion.Then it pierces the duramater of trigeminal cave and enters into lateral wall of cavernous sinus.Finally,it entera the orbit through the superior orbital fissure and divides into three branches namely lacrimal,frontal and nasocilliary.