2. LOCAL INFILTRATION – Small terminal nerve endings in the
area of the dental treatment are flooded with local anesthetic.
FIELD BLOCK – Local Anesthetic is deposited near the larger
terminal nerve branches so the anesthetized area will be
circumscribed, preventing the passage of impulses from the tooth
to the Central Nervous System (CNS)
NERVE BLOCK – Local anesthetic is deposited close to a main
nerve trunk, usually at a distance from the site of operative
intervention
6. SUPRAPERIOSTEAL INJECTION
OTHER COMMON NAMES – Local Infiltration, Paraperiosteal Injection
NERVES ANESTHETIZED – Large terminal branches of the dental plexus
INDICATIONS –
1.Pulpal Anesthesia of the maxillary teeth when treatment is limited to one or two
teeth.
2. Soft Tissue Anesthesia when indicated for surgical procedures in a circumscribed
area.
7. SUPRA PERIOSTEAL TECHNIQUE
CONTRAINDICATIONS –
1. Infection or Acute inflammation in the area of injection
2. Dense Bone covering the apices of teeth
ADVANTAGES –
1. High success rate
2. Technically easy injection
3. Entirely atraumatic
DISADVANTAGES – Not recommended for large areas because of need of multiple needle insertion, and the
necessity to administer larger total volume of local anesthetic.
8. LANDMARKS –
a) Mucobuccal Fold
b) Crown of the tooth
c) Root Contour of the tooth
Signs And Symptoms –
1. Subjective:feeling of numbness in the areaof administration
2. Objective: no pain during therapy
Complication – Pain on needle while insertion.
SUPRA PERIOSTEAL INJECTION
9. SUPRA PERIOSTEAL INJECTION
Technique
1. Lift the lip, pulling the tissuetaut.
2. Holdthe syringeparallelto the longaxisof the tooth
3. Insert the needleat the height of the mucobuccalfold over the
targettooth
4. Advance the needle until its bevel is at or above the apical
region of the tooth
5. Aspirate, if –ve, deposit0.6ml slowlyover20seconds.
10.
11. POSTERIOR SUPERIOR ALVEOLAR NERVE BLOCK
Other Common Names – Tuberosity Block, Zygomatic Block
Nerves Anesthetized – Posterior Superior Alveolar and branches
Areas Anesthetized –
Pulp of 3rd ,2nd and 1st Maxillary molars (72% but not mesiobuccal root.)
Buccal Periodontium and bone overlying these teeth.
INDICATIONS –
1. When treatment involves 2 or more maxillary molars.
2. Where supraperiosteal injection is contra – indicated.
3. When supraperiosteal injection has proved ineffective.
12. POSTERIOR SUPERIOR ALVEOLAR NERVE BLOCK
Anatomical landmark :
1. Mucobuccal fold and it’s concavity.
2. Zygomatic process of the maxilla.
3. Infratemporal surface of the maxilla.
4. Anterior border and coronoid process of the ramus of mandible.
5. Maxillary tuberosity.
Sign And Symptom –
Subjective – Usually none.
Objective – Instrumentation is necessary to demonstrate the absence of pain.
Complication –
1. Hematoma
2. Mandibular Anesthesia
13. LANDMARKS -
1. Mucobuccal fold and it’s concavity
5. Maxillary Tuberosity
4. Anterior border and coronoid process of ramus of mandible
2. Zygomatic process of maxilla 3. Infratemporal surface of maxilla
14. POSTERIOR SUPERIOR ALVEOLAR NERVE BLOCK
Technique –
1. Area of insertion – Height of mucobuccal fold of 2nd maxillary molar.
2. Target Area – PSA nerve – posterior superior and medial to posterior border of maxilla.
3. Pull the tissues at the injection site taut.
4.Insert the needle at the mucobuccal fold over the second molar.
5.Advance the needle slowly in Upward Inward and Backward direction.
- Upward – Superiorly at 45degree to occlusion plane.
- Inward – Medially towards the midline at 45 degree to occlusion plane.
- Backward – posteriorly at 45degree to the long axis of second molar.
6.Aspirate in 2 planes
7.Deposit 0.9 to 1.8ml of anesthetic solution over 30-60 seconds
15. POSTERIOR SUPERIOR ALVEOLAR NERVE BLOCK
ADVANTAGES –
1. Atraumatic .
2. High Success rate.
3. Minimum number of injections.
4. Minimizes the total volume of local anesthetic solution administered.
Disadvantages –
1. Risk of hematoma
2. No bony landmarks during insertions – Technique is arbitrary.
3. Second injection may be necessary in treatment of 1st molar (28% patients).
16.
17.
18. MIDDLE SUPERIOR ALVELOAR NERVE BLOCK
NERVE ANESTHETIZED – Middle superior alveolar and terminal
branches
AREAS ANESTHETIZED –
1. Pulps of maxillary 1st and 2nd premolar, Mesiobuccal root of
the 1st molar.
2. Buccal Periodontal tissues and bone over these same teeth
INDICATION –
1. Where ASA nerve block fails to provide pulpal anesthesia distal to
maxillary canine
2. Dental procedures involving both maxillary premolars only.
19. MIDDLE SUPERIOR ALVELOAR NERVE BLOCK
TECHNIQUE –
1. AREA OF INSERTION – Height of mucobuccal fold above the maxillary 2nd premolar.
2. Target Area – Maxillary bone above the apex of the maxillary 2nd premolar
3. Insert the needle into the height of the mucobuccal fold above 2nd maxillary premolar with the bevel directed
toward bone.
4. Aspirate
5. Slowly deposit 0.9 to 1.2ml in 30 to 40 seconds.
ANATOMICAL LANDMARKS –
Mucobuccal fold above the 2nd maxillary pre-molar.
SIGN AND SYMPTOMS –
SUBJECTIVE – Upper lip numb.
Objective - Instrumentation is necessary to demonstrate the absence of pain.
22. ANTERIOR SUPERIOR ALVELOAR NERVE BLOCK
OTHER COMMON NAME – INFRA ORBITAL NERVE BLOCK
NERVE ANESTHETIZED –
1. Anterior Superior Alveolar
2. Middle Superior Alveolar
3. Infra Orbital Nerve
- Inferior Palpebral
- Lateral Nasal
- Superior labial
Areas Anesthetized -
1. Pulp of the maxillary central incisior through the canine on the injected side.
2. In about 72% of patients, pulp of the maxillary premolars and mesiobuccal root of the first molar.
3. Buccal (Labial) Periodontium and bone of these same teeth.
4. Lower eyelid, latera aspect of nose, upper lip.
23. ANTERIOR SUPERIOR ALVELOAR NERVE BLOCK
ANATOMICAL LANDMARKS
1. Mucobuccal Fold
2. Infraorbital notch
3. Infraorbital depression
4. Infraorbital ridge
5. Supraorbital notch
6. Anterior teeth
7. Pupil of the eye
Complications –
Hematoma – may occur on the lower eyelid.
24. ANTERIOR SUPERIOR ALVELOAR NERVE BLOCK
Technique –
1. Area of insertion – Height of mucobuccal fold over the 1st premolar
2. Target area– infraorbital foramen.
3. Locate the infraorbital foramen –
- Feel the infraorbital notch.
- Move the finger downwards applying pressure to the tissues.
- The bone inferior to notch is convex(felt as outward bulge) that represents lower border of orbit and roof of the
infraorbital foramen.
- As the finger continues inferiorly a concavity is felt that is infraorbital foramen.
4. Insert the needle to the height of mucobuccal fold over 1st premolar
5. Needle should be parallel to the long axis of the tooth
6. Aspirate in 2 planes.
7. Deposit 0.9 to 1.2 ml over 30 to 40 seconds.
25.
26. ANTERIOR SUPERIOR ALVELOAR NERVE BLOCK
ADVANTAGES –
Comparatively simple technique
Comparatively safe, minimizes the volume of solution used.
POSITIVE ASPIRATION – 0.7%
SIGNS AND SYMPTOMS –
SUBJECTIVE – Numbness over
1. Lower eyelid
2. Lateral wall of nose
3. Upper lip
Objective – Probing does not lead to pain in the mucosa opposite to anterior teeth and premolars
27.
28.
29. ANTERIOR MIDDLE SUPERIOR ALVEOLAR NERVE BLOCK
OTHER COMMON NAMES:PALATAL APPROACH ANTERIOR MIDDLE SUPERIOR
ALVEOLAR(AMSA).
NERVES ANESTHETIZED:
1. Anterior Superior Alveolar
2. Middle Superior Alveolar
3. Subneural dental nerve plexus of anterior and middle superior
alveolar nerves.
AREAS ANESTHETIZED:
1. Pulpal anesthesia of maxillary incisors, canine, premolars
2. Buccal attached gingiva of same teeth.
3. Attached palatal tissue from midline to free gingival margin on
associated teeth.
30. ANTERIOR MIDDLE SUPERIOR ALVEOLAR NERVE BLOCK
ANATOMICAL LANDMARK
.On hard palate about halfway along an imaginary line connecting
midpalatal suture to free gingival margin.
.Contact point is between first and second premolars.
COMPLICATION:
.Local anesthetic is deposited on palate, muscles of facial expression
and upper lips are not anesthetized.
31. MAXILLARY NERVE BLOCK
Other common name – Second division block , V2 nerve block
Nerve Anesthetized – Maxillary division of the trigeminal nerve
Areas Anesthetized –
1. Pulpal anesthesia of the maxillary teeth on the side of the block.
2. Buccal Periodontium and bone overlying the teeth.
3. Soft tissues and bone of the hard palate and part of the soft palate,medial to
midline.
4. Skin of the lower eyelid.
32. MAXILLARY NERVE BLOCK
Indication –
1. Pain control before extensive surgical, periodontal or restorative procedures.
2. When tissue inflammation or infection precludes the use of other regional nerve
blocks(eg – PSA,ASA)
3. Diagnostic and therapeutic procedure for neuralgia .
Contra Indication –
1. Inexperienced Administrator.
2. Pediatric patients.
3. Uncooperative patients.
4. Inflammation or infection of tissues overlying the injection site.
5. In hemophilia
34. HIGH TUBEROSITY APPROACH
1. Area Of Insertion – Height of mucobuccal fold above the distal aspect of the maxillary
second molar.
2. Target Area – Maxillary nerve as it passes through pterygopalatine fossa.
3. Retract the cheek and pull the tissues and make them taut.
4. Place the needle into the height of the mucobuccal fold over the maxillary second molar.
5. Advance the needle slowly in upward inward and backward direction as described for
the PSA nerve.
6. Aspirate in 2 planes.
7. Deposite 1.8ml in more than 60 seconds.
35.
36. GREATER PALATINE CANAL APPROACH
1. Area of insertion – Palatal soft tissues directly over the greater palatine foramen.
2. Target Area – Maxillary nerve as it passes through pterygopalatine fossa.
3. Locate the greater palatine foramen
4. Advance the needle in the greater palatine canal to a dept of 30mm
5. Aspirate in 2 planes
6. Deposit 1.8ml in minimum of 1 minute
37.
38. GREATER PALATINE NERVE BLOCK
Other Common Names – Anterior Palatine Nerve Block
Nerve Anesthetized – Greater Palatine
Area Anesthestized – Palatal mucosa of molars and premolars.
INDICATIONS –
1. When palatal soft tissue anesthesia is necessary for
restorative therapy on more than 2 teeth.
2. For pain control during periodontal or oral surgical
procedures involving the palatal soft and hard tissues
Contraindications –
1. Inflammation or infection at the injection site.
2. Smaller areas of therapy
39. GREATER PALATINE NERVE BLOCK
SIGN AND SYMPTOMS –
Subjective – Numbness in the posterior portion of the palate.
Objective – No pain during dental therapy.
COMPLICATIONS –
1. Ischemia and necrosis of soft tissues.
2. Hematoma
40. GREATER PALATINE NERVE BLOCK
ADVANTAGES –
1. Minimizes needle penetration and volume of
solution.
2. Minimize patient discomfort.
Disadvantages –
1. No hemostasis except in the immediate area
of injection
2. Potentially traumatic
Positive Aspiration – Less than 1%
41. GREATER PALATINE NERVE BLOCK
TECHNIQUE –
1. Area of insertion – Soft tissue slightly anterior to greater palatine foramen.
2. Direction of needle insertion – From the opposite side at right angle.
3. Palpate the position of greater palatine foramen till u feel depression.
4. Apply topical antiseptic followed by topical anesthetic.
5. A 27 gauze needle is inserted from the opposite side approaching the site of injection at right
angle.
6. Aspirate.
7. Deposit 0.45 to 0.6ml in minimum 30 seconds.
ANATOMICAL LANDMARK
Palatogingival Margin of 2nd and 3rd maxillary molar.
Approximately 0.8-1cm from palatogingival margin close to midline
42.
43. NASOPALATINE NERVE BLOCK
Other Common Names – Incisive nerve block , Sphenopalatine nerve block.
Nerve Anesthetized – Nasopalatine nerves bilaterally.
Area Anesthetized – The mucosa of anterior part of hard palate.
INDICATION –
1. Palatal soft tissue anesthesia is necessary.
2. Pain control during periodontal or oral surgical procedures.
Contraindication –
1. Minimizes needle penetration and volume of solution.
2. Minimize patient discomfort from multiple needle penetration.
44. NASOPALATINE NERVE BLOCK
Technique-
Areaof insertion – palatal mucosajust lateral to the incisivepapilla
Target area –incisiveforamen beneath the papilla
Path–approachthe injection site at 45degree angletoward thepapilla.
Slowlyadvancethe needle towards the foramen until bone isgently contacted (depth approx. 5mm)
Slowlydeposit 0.45 ml in 15-30 second minimum.
ANATOMICAL LANDMARK –
Central Incisor
Incisive Papilla
45.
46.
47. NASOPALATINE NERVE BLOCK
ADVANTAGES –
1. Minimal needle penetration and volume of solution.
2. Minimal patient discomfort from multiple needle
penetration.
DISADVANTAGES –
1. No hemostasis except in the immediate area of injection.
2. Potentially the most traumatic intraoral injection.
COMPLICATION –
1. Hematoma.
2. Necrosis.
3. Squirt Back of the needle.
