Anaesthesia & Exodontia Third Year

2. 1- Intraoral techniques:
a) Local infiltration of nerve
endings (submucosal
analgesia).
b) Block of the terminal
branches (infiltration
anesthesia).
c) Anterior and middle superior
alveolar nerve block
(infraorbital).

3. 1- Intraoral techniques:
d) Posterior superior alveolar nerve block (zygomatic).
e) Nasopalatine nerve block (incisive canal injection).
f) Anterior (greater) palatine nerve block.
g) Maxillary nerve block.

4. 2- Extraoral techniques:
a) Anterior and middle
superior alveolar nerve
block
(infraorbital).
b) Maxillary nerve block.

5. Nerves anesthetized.
Areas anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia:
a) Subjective symptoms.
b) Objective symptoms.

6. Basic Injection Technique
 Position the patient
 Communicate with the patient
 Prepare the tissue
 Dry the area
 Apply antiseptic
 Apply topical anesthetic
 Check flow of local anesthetic

7. Maxillary Injection Techniques
Nerve Block
 Posterior superior alveolar nerve block
 Middle superior alveolar nerve block
 Anterior superior alveolar nerve block
 Maxillary (second division) nerve block
 Greater (anterior) palatine nerve block
 Nasopalatine nerve block

8. Maxillary Anaesthesia
 Maxillary bone is porous
and mainly cancellous.
 Roots of the maxillary
teeth are covered only by
a thin layer of buccal
bone.
 Highly vascular

9. Maxillary nerve distribution and LA
• Infiltration A.:
• Buccal Infiltration
• Palatal Infiltration
• Block A.:
• Posterior superior alveolar
NB
• Middle superior alveolar NB
• Infra orbital NB (Int. Ext.
oral).
• Greater Palatine NB
• Nasopalatine NB
• Maxillary NB (Int. Ext. oral).

10. Maxillary infiltration anaesthesia
1. Buccal Infiltration A.:
• For all Maxillary teeth
• Slow supraperiosteal injection
• Opposite to the tooth apex, at a
point made by the long axis of
the tooth and the buccal
vestibule
• Needle bevel toward the bone
• Onset is 3-5mn. and working
time is 20 – 30 minutes.

11. .Maxillary labial infiltration A. 2
• Opposite to the
tooth apex, at a
point made by the
long axis of the
tooth and the
labial vestibule

12. Palatal Anaesthesia
((infiltration & block
 Nasopalatine nerve
 infiltration
 block
 Greaterpalatine nerve
 infiltration
 block
 No need for lesser
palatine A.

13. Infiltration - Palate
 Nerves
 Terminal branches - Greater Palatine nerve
 Nasopalatine nerve
 Area
 Palatal soft tissue in area of injection

14. Infiltration - Palate
 Indications
 Limited area
 Hemostasis
 Contraindications
 More than 2 teeth
 Inflammation/infection
at site
 Advantages
 Hemostasis
 Minimal area affected
 Disadvantages
 Potentially traumatic

15. Infiltration - Palate
 Technique
 Apply topical, pressure
 Insert into gingiva in center of area
 - 5-10 mm from gingival margin
 Aspirate (positive results are rare)
 Inject 0.2-.3 ml, slowly

16. Failures of Anesthesia
 Quite rare
 Failure of hemostasis
 Inflammation
 Lack of vasoconstrictor

17. Complications
 Necrosis or sloughing of the palatal soft
tissue
(due to excess vasoconstriction)

18. Greeter palatine nerve block
 Between upper 2nd
and 3rd molars.
Midway between
the median palatine
raphae and the free
gingival margin.

19. Posterior superior nerve block
Distal to the 2nd
molar, posterior to the
tuberosity, at 45
degrees
 Aspirate first,
Pterygoid plexus of
veins.
Maxillary N B
Post. Sup. Alv.NB
Maxillary infiltration

20. Posterior Superior Alveolar Nerve
Block
 Nerve Anesthetized:
 Posterior Superior
Alveolar Nerve (PSA)
 For maxillary molars
and buccal tissue

21. Indications for PSA Block
 First or second maxillary molar
 Supraperiosteal injection has proved
ineffective
 Contraindication
 Risk of hemorrhage is too great
 (eg. hemophilia, coumadin)