Maxillary Anesthesia
Techniques
•Maxillary division block
Posterior superior alveolar nerve block(tuberosity block)
• effective for maxillary
third,second and first
molar teeth (exsept the
mesiobuccal root of the
first molar)
• It numbs the pulp,
supporting alveolar
bone,buccal
mucoperiosteum of these
teeth and adjasent lining
of maxillary sinus
Posterior superior alveolar nerve block
•The needle is inserted into the mucobuccal fold over the 2nd molar
(In the absence of 2nd molar, the needle is inserted behind the zygomatic- alveolar ridge, which corresponds to the
middle of the crown of the missing second molar)
•A 25 gauge, short needle (25mm in length) is used to prevent overinsertion of
needle,wich can produce a hematoma .Use 25-gauge needle facilitates
aspiration.
•The needle is directed posteriorly, superiorly and medially at an angle of 450
•The depth of penetration is 15-20mm
•After negative aspiration deposed LA solution slowly
The greater palatine foramen
is related
• to the upper 3rd molar
tooth in(55%)
• 2nd molar in (12%)
• between the 2nd and 3rd
molar in (19%)
-Apply topical anesthetic
- Insert the needle adjacent(1cm anterior) to the greater palatine foramen,
at a right angle to the curvature of the hard palate. (A needle of 25-27
gauge and 25mm in length is recommended)
-The needle is inserted until the palatal bone is contacted.
-Aspirate to avoid intravascular injection.
-Deposit 0.25-0.5 ml of local anesthetic solution slowly.
- Do not inject more than this, because it can separate of the mucosa from
the palate and cause tissue necrosis.
Greater palatine nerve block
Anaesthetised area:
The posterior 2/3 of the hard
palate(mucoperiosteum) and
palatal gingiva of the maxillary
alveolar process at the premolars and
molars
-Nasopalatine nerve emerges from incisive foramen beneath the
incisive paplla, 1cm behind central incisors in the midline
-Because the injection in this area is very painful it is advisable
topical anesthesia before.(with a cooton swab hold pressure over the
incisive papilla)
-It is recommended that the needle should not penetrate incisive
papilla directly.
•The top of the needle should
be plased in the depression
surrounding incisive papilla and
a few drop of local anaesthetic
solution is slowly injected until
papilla blanches.(The
recommended needle gauge is
25 or 27,and length is 25mm)
•Then the needle is advanced
into the incisive foramen to an
extend of about 0.5cm into the
canal and about 0.25-0.5ml of
LA solution is injected slowly.
• anesthetised area: the
anterior portion of the hard
palate (palatal
mucoperiosteum) and palatal
gingiva from the right canine to
the left canine
Infraorbital N.Block
The aim is to deposit the anesthetic solution into the infraorbital
canal throught the infraorbital foramen
Nerves anaesthetised:
1)Ant. Sup.alveolar nerve
2)Mid. Sup. alveolar nerve
3)Terminal branches on the face
• Infraorbital foramen is
located About 5-10mm
below the infraorbital ridge,
between middle and inner
thirds
• The foramen also lies in one
line with the pupil, when the
patient gazes forwards
• The foramen is shaped like a
flattened funnel with the
openinig directed
downwards and medially.
Intraoral approaches for blocking the infraorbital nerve:
• The lip is lifted with the thumb and the index finger of the same hand feels
the infraorbital rim extraorally.
• The first method involves the needle being inserted approximately 5mm
lateraly from the alveolar process of P2supThe needle is held parallel to
the long axis of the tooth and slowly moved in the direction of the finger.
• The second method involves the needle being inserted about 5mm from
the alveolar process of Csup.The needle is directed posteriorly,superiorly
and laterally, towards the pupil of the eye.
• In either approuch, after about 16-20mm the needle makes contact with
the bone at the level of the roof of the infraorbital foramen. (long and 25
gauge needle is recommended)
(The index finger prevents the needle from being fed so far,that it touch
the eyelid or eyeball)
• after negative aspiration, approximately 1-1.2ml of LA solution is slowly
deposited in this area. You would be able to “feel” the anesthesia solution
as it is deposited beneath the finger on the foramen.
• It is recommended that pressure is kept for 1-2 min. over the site of
injection to facilitate the diffusion of anesthetic solution into the foramen.
Infraorbital nerve block
The needle inserted at the height of the mucobuccal fold above the second
premolar.
the central incisor approach