MAXILLARY INJECTION TECHNIQUES

PARAPERIOSTEAL NERVES ANESTHETIZED

large terminal branches of the dental plexus

PSAN BLOCK
PSAN and branches

MSAN BLOCK
MSAN and terminal branches

INFRAORBITAL NERVE BLOCK

ASAN MSAN Infraorbital nerve (Inferior palpebral, Lateral nasal, Superior labial)

GREATER/ANTERIOR PALATINE NERVE BLOCK

Greater palatine

NASOPALATINE NERVE BLOCK

Nasopalatine nerve

PALATAL INFILTRATION
terminal branches of the nasopalatine and greater palatine nerves

AREAS ANESTHETIZED

ANATOMIC LANDMARKS

mucobuccal fold long axis of the tooth

mucobuccal fold maxillary tuberosity zygomatic process of the maxilla

mucobuccal fold above the maxillary second premolar

mucobuccal fold infraorbital notch infraorbital foramen

greater palatine foramen junction of the maxillary alveolar process palatine bone 2nd and 3rd mx molars midline of the palate

central incisor incisive papilla

gingival tissue in the estimated center of the treatment area

PATIENT/ OPERATOR POSITION

supine, heart at the level of the head, feet elevated

supine

supine

supine

PROCEDURE

1. Prepare tissue at the injection site (height of the mucobuccal fold above the apex of the tooth). Clean with sterile dry gauze. Apply topical anesthesia. 2. Orient needle so bevel faces bone. 3. Lift the lip, pulling the tissue taut. 4. Hold the syringe parallel to the long axis of the tooth. 5. Insert the needle into the height of the mucobuccal fold over the target tooth. 6. Advance the needle until its bevel is at or above

1. Prepare tissue at the injection site (height of the mucobuccal fold between the maxillary 1st & 2nd molar). Clean with sterile dry gauze. Apply topical anesthesia. 2. Orient needle so bevel faces bone. 3. Pull the tissues at the injection site taut. 4. Insert the needle into the height of the mucobuccal fold between the maxillary 1st & 2nd molar 5. Advance the needle slowly at 45-degree superiorly and medially with at least 4 mm of the needle length remaining. No resistance

1. Prepare tissue at the injection site (height of the mucobuccal fold above the maxillary second premolar). Clean with sterile dry gauze. Apply topical anesthesia. 2. Orient needle so bevel faces bone. 3. Pull the tissues at the injection site taut. 4. Insert the needle into the height of the mucobuccal fold above the second premolar. 5. Penetrate the mucous membrane and slowly advance the needle until its tip is located well above the apex of the

1. Prepare tissue at the injection site (height of the mucobuccal fold over the maxillary first premolar). Clean with sterile dry gauze. Apply topical anesthesia. 2. Feel the infraorbital notch. Move your finger downward from the notch. A concavity will be felt; this is the infraorbital foramen. 3. Retract the lip. Pull the tissues at the injection site taut. 4. Insert the needle into the height of the mucobuccal fold over the first premolar with the bevel facing the bone.

R: operator at 7 or 8 oclock position L: operator at 11 oclock position Ask the patient, who is in supine position to open wide, extend the neck; turn the head to left or right. 1. Locate the greater palatine foramen. Place a cotton swab at the junction of the maxillary alveolar process and the hard palate (between 2nd and 3rd molars). 2. Prepare the tissue at the injection site (soft tissue slightly anterior to the greater palatine foramen). Clean with sterile dry gauze. Apply topical anesthesia. 3. Move the swab posteriorly so it is directly over the greater palatine foramen. Apply considerable pressure. 4. Direct the syringe into the

supine, mouth open wide, extend head

operator at 10 oclock position Ask the patient to open wide, extend the neck, turn the head to left or right for improved visibility.

1. Prepare the tissue just lateral to the incisive papilla. Clean and dry with sterile gauze. Apply topical anesthesia. 2. Preliminary interseptal injection between central incisors 3. Identify landmarks. Needle is inserted lateral to the incisive papilla so that the solution will diffuse into the nasopalatine foramen. 4. Aspirate. If negative, slowly deposit not more than 1/4 of a cartridge (0.45 ml). 5. Slowly withdraw the syringe. 6. Make the needle safe. 7. Wait 2 to 3 minutes before commencing the dental procedure.

1. Prepare the tissue at the site of injection (the attached gingiva 5 to 10 mm from the free gingival margin). Clean and dry with sterile gauze. Apply topical anesthesia. 2. Place the bevel of the needle against ischemic soft tissue at the injection site. 3. Continue to apply pressure with cotton applicator stick throughout the injection.

Dentistry 151 - Javier

the apical region of the tooth. 7. Aspirate. If negative, deposit 1/3 of a cartridge (approx 0.6 ml) slowly. 8. Withdraw the syringe and make the needle safe. 9. Wait a minimum of 3 to 5 minutes before

should be felt. 6. Aspirate. If negative, slowly deposit 0.9 to 1.8 ml of anesthetic solution. Direct the needle superior, posterior and medial so that the needle will lie at the posterior surface of the maxilla. 7. Withdraw the syringe and make the needle safe. 8. Wait a minimum of 3 to 5 minutes before commencing the dental procedure.

second premolar. 6. Aspirate. If negative, slowly deposit 0.9 to 1.2 ml (1/2 to 2/3 cartridge) of solution. 7. Withdraw the syringe and make the needle safe. 8. Wait a minimum of 3 to 5 minutes before commencing dental therapy.

5. Orient the syringe toward the infraorbital foramen. 6. The needle should be held parallel with the long axis of the tooth as it is advanced, to avoid premature contact with bone. 7. Advance the needle slowly until bone is gently contacted. Check for the depth of needle penetration (adequate to reach the foramen) 8. Aspirate. If negative, slowly deposit 0.9 to 1.2 ml. 9. Maintain direct finger pressure over the injection site for a minimum of 1 minute after injection. 10. Wait a minimum of 3 to 5 minutes after completion of the injection before commencing dental procedure. 25- or 27-gauge long needle one-half to two-thirds of a cartridge

5.

6.

7.

8. 9. 10.

mouth from the opposite side with the needle approaching the injection site at a right angle. Place the bevel of the needle gently against the previously blanched soft tissue at the injection site. Slowly advance the needle until palatine bone is gently contacted. The depth of penetration is usually about 5 mm. Aspirate. If negative, slowly deposit not more than 1/4 to one 1/3 of a cartridge (0.45 to 0.6 ml) Withdraw the syringe. Make the needle safe. Wait 2 to 3 minutes before commencing the procedure.

ARMAMENTARIUM

VOLUME

27-gauge short needle one-third of a cartridge

27-gauge short needle 0.9 to 1.8 ml

27-gauge short needle one-half to two-thirds of a cartridge

27-gauge short needle not more than 1/4 to one 1/3 of a cartridge (0.45 to 0.6 ml)

27-gauge short needle not more than 1/4 of a cartridge (0.45 ml)

27-gauge short needle one-third of a cartridge

Dentistry 151 - Javier