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Posterior superior alveolar (psa) nerve block

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Posterior superior alveolar (psa) nerve block

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brief description on posterior superior alveolar nerve block.
its uses in dentistry, technique and action. locating PSA nerve is easy and this is the most used nerve block in dentistry.

brief description on posterior superior alveolar nerve block.
its uses in dentistry, technique and action. locating PSA nerve is easy and this is the most used nerve block in dentistry.

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Posterior superior alveolar (psa) nerve block

  1. 1. Posterior superiorPosterior superior alveolar (PSA)alveolar (PSA) nerve blocknerve block Chirag M A 3rd year BDS
  2. 2. Posterior superior alveolarPosterior superior alveolar (PSA) nerve block(PSA) nerve block •The posterior superior alveolar nerve block is a most commonly used nerve block, although it is a highly successful technique (>95%) •The PSA nerve block is effective for the maxillary 3rd , 2nd and 1st molar except the mesio buccal root of maxillary 1st molar (doesn’t anesthetize in 28%of patients), which is supplied by middle superior alveolar nerve. •Therefore the second injection, usually supraperiosteal, is indicated after PSA nerve block when effective Anesthesia of 1st molar is not developed.
  3. 3. • The risk of a potential complication must be consideredThe risk of a potential complication must be considered whenever the PSA block is used .whenever the PSA block is used . • Insertion of the needle too far distally may lead to aInsertion of the needle too far distally may lead to a temporarily unesthetic hematoma.temporarily unesthetic hematoma. • When the PSA is to be administered, one must alwaysWhen the PSA is to be administered, one must always consider the patients skull size in determining the depthconsider the patients skull size in determining the depth of soft tissue penetration.of soft tissue penetration. • In order to decrease the risk of hematoma formation afterIn order to decrease the risk of hematoma formation after PSA nerve block,PSA nerve block, SHORT DENTAL NEEDLESSHORT DENTAL NEEDLES havehave been recommended.been recommended. • The average depth of soft tissue penetration is 16mm, theThe average depth of soft tissue penetration is 16mm, the short needle (=20mm) can be successfully and safely used.short needle (=20mm) can be successfully and safely used.
  4. 4. Other common names:Other common names: Tuberosity block and Zygomatic blockTuberosity block and Zygomatic block Nerves anesthetized: Posterior superior alveolar nerves and its branches Area anesthetized: 1) Pulps of maxillary 3rd, 2nd and 1st molars (entire tooth = 72%; mesio buccal root of maxillary 1st molar not anesthetized = 28%) 2) Buccal periodontium and bone overlying these teeth
  5. 5. Contraindications: 1. When the risk of hemorrhage is too great (as with a hemophiliac), in which case a supraperiosteal injection or PDL injection is recommended Indications: 1.When treatment involving two or more maxillary1.When treatment involving two or more maxillary molarsmolars 2.When supraperiosteal injection is contraindicated like2.When supraperiosteal injection is contraindicated like infections and acute inflammationsinfections and acute inflammations 3.When supraperiosteal injection has proved ineffective3.When supraperiosteal injection has proved ineffective
  6. 6. Advantages: 1. Atraumatic 2. High success rate (>95%) 3. Minimum number of injections, 1 injection compared with 3 infiltrations 4. Minimizes the total volume of local anesthetic solution administered Disadvantages: 1. Risk of hematoma 2. Technique somewhat arbitrary 3. Second injection necessary for treatment of the mesio buccal root of maxillary 1st molar in 28% of patients
  7. 7. Posterior superior alveolar nervePosterior superior alveolar nerve
  8. 8. Area of anesthetizationArea of anesthetization
  9. 9. PSA nerve (arbitrary view)
  10. 10. PSA nerve blockPSA nerve block TechniquesTechniques
  11. 11. TechniqueTechnique  PSA Nerve BlockPSA Nerve Block 1) 25 gauge1) 25 gauge shortshort needle is recommendedneedle is recommended 2) Insert needle at the height of the2) Insert needle at the height of the mucobuccal foldmucobuccal fold above theabove the maxillarymaxillary 22ndnd molarmolar 3) Target area is the PSA nerve which is3) Target area is the PSA nerve which is posteriorposterior,, superiorsuperior andand medialmedial to the posterior border of the maxillato the posterior border of the maxilla 4) Landmarks: mucobuccal fold, maxillary tuberosity and4) Landmarks: mucobuccal fold, maxillary tuberosity and zygomatic process of maxillazygomatic process of maxilla 5) Have patient open their mouth5) Have patient open their mouth half wayhalf way which makes morewhich makes more roomroom 6)6) RetractRetract the patient’s cheek with mirrorthe patient’s cheek with mirror 7) Pull the tissues at the injection site7) Pull the tissues at the injection site tauttaut
  12. 12. 8) Orient bevel8) Orient bevel towardtoward bonebone 9) Insert needle at height of mucobuccal fold over the9) Insert needle at height of mucobuccal fold over the 22ndnd maxillary molarmaxillary molar 10) Advance needle10) Advance needle upwardupward,, inwardinward andand backwardbackward directiondirection 11) Odd feeling of having no resistance whatsoever11) Odd feeling of having no resistance whatsoever 12) Penetrating to an average depth of12) Penetrating to an average depth of 1616 mm is adequate andmm is adequate and 10-1410-14mm adequate for smaller skulled patientsmm adequate for smaller skulled patients 13)13) Aspirate in two planes by rotating bevel one quarter turnAspirate in two planes by rotating bevel one quarter turn 14) Deposit 0.9-1.8ml of anesthetic solution14) Deposit 0.9-1.8ml of anesthetic solution 15)15) WaitWait 33 toto 55 minutes to start treatmentminutes to start treatment Note:Note: Goal is to deposit LA close to PSA nerve. Advance the needle inGoal is to deposit LA close to PSA nerve. Advance the needle in one movement, not three separate movements; usually atraumatic toone movement, not three separate movements; usually atraumatic to most patients. For left PSA nerve block, administrator should be at 10’omost patients. For left PSA nerve block, administrator should be at 10’o clock position and for right PSA nerve block administrator should be atclock position and for right PSA nerve block administrator should be at 8’o clock position8’o clock position
  13. 13. Signs and symptoms: 1. Absence of pain during treatment 2. Use of electrical pulp testing with no response from tooth with maximal EPT output Safety features: 1. Slow injection 2. No anatomic safety features to prevent over insertion of the needle; therefore careful observation is necessary Precautions: The depth of needle penetration should be correct: over insertion, increases the risk of hematoma and too shallow might still provide adequate Anesthesia
  14. 14. Failure of Anesthesia: 1. Needle too lateral. To correct: redirect the tip medially 2. Needle not high enough. To correct: redirect the needle tip superiorly 3. Needle too far posterior. To correct: withdraw the needle to the proper depth Complications: 1. Hematoma: commonly produced by inserting the needle too far posteriorly into pterygoid plexus of veins. 2. Mandibular anesthesia: The mandibular division of the 5th cranial nerve is located lateral to the PSA nerve. Deposition of LA lateral to the desired location may produce varying degrees of mandibular anesthesia.
  15. 15. Thank youThank you

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