2008
Division of Oral & Maxillofacial Surgery
University of Minnesota
I.
Patient Preparation a.
Medical history and physical evaluation b.
Blood pressure and pulse assessment c.
Chair position i.
Supine ii.
Semisupine d.
Operator and Patient position e.
Record event in chart
II.
Site Preparation a.
Identify landmark b.
Dry mucosa with sponge c.
Apply topical anesthetic with cotton applicator i.
Use pressure on palatal injection
III.
Technique a.
Bevel orientation b.
Insert needle c.
Aspirate d.
Monitor injection rate i.
Position of the barrel of the syringe ii.
Slow injection (1mL/min) e.
Needle should not bend f.
g.
Needle should not be inserted all the way to the hub
Replace needle cover with safe technique
IV.
Maxillary Injection Technique a.
Local Infiltration (supraperiosteal injection) i.
Injection site: Mucobuccal fold of target tooth ii.
30 gauge needle b.
iii.
Depth: A few millimeters iv.
Anesthetized: Tooth, periosteum, mucous membrane
Posterior Superior Alveolar N. Block (PSA) i.
Injection site: Height of the mucobuccal fold above the maxillary 2 nd molar; 45  angle to the maxillary occlusal plane ii.
Depth: 16mm iii.
Anesthetized: All molars but 72% of mesiobuccal root of maxillary 1 c.
Middle Superior Alveolar N. Block
premolar st molar i.
ii.
iii.
Injection site: Mucobuccal fold above the 2
Depth: A few millimeters
Anesthetized: 1 st and 2 nd nd premolar and mesiobuccal root of maxillary 1 d.
Anterior Superior Alveolar N. Block (Intraorbital N. Block) i.
Injection site: Height of the mucobuccal fold over 1 ii.
Depth: 16mm st premolar st molar iii.
Anesthetized: Central incisal through canine, occasionally maxillary
premolars and mesiobuccal root of maxillary 1 st molar e.
Nasopalatine N. Block i.
Injection site: Lateral to the incisive papillae

V.
ii.
Depth: 6 – 10mm iii.
30 gauge needle iv.
Anesthetized: Anterior palatal (hard and soft tissues of mesial of 1 to the other side of mesial of 1 st premolar)
Greater Palatine N. Block (Anterior Palatine Block) st premolar f.
i.
Injection site: Halfway between the alveolar crest and the midline (2 nd and 3 rd molar area) ii.
Depth: Less than 10mm iii.
30 gauge needle iv.
Anesthetized: Posterior portion of hard palate and overlying soft tissue to the g.
Maxillary N. Block (V i.
ii.
1 st premolar and midline
2
Block)
Greater palatine canal approach
High tuberosity approach
Mandibular Injection Technique a.
Inferior Alveolar N. Block (IAN) b.
Lingual N. Block i.
Injection site: The line of needle insertion is from the opposite mandibular premolars ii.
25 or 27 gauge needle, long iii.
Depth: 10 – 25mm; height of insertion is usually above the occlusal plane (6 –
10mm) iv.
Withdraw slightly and deposit remainder of carpule for lingual nerve anesthesia v.
Anesthetized: Pulp of the mandibular teeth to the midline, body of the mandible, buccal mucoperiosteum and mucous membrane anterior to the mandibular 1 st molar, ipsilateral lower lip, anterior 2/3 of tongue c.
Long buccal N. block i.
Injection site: Height of the occlusal plane, posterior to the mandibular 3 rd ii.
iii.
molar into the soft tissue near the external oblique ridge
Depth: 1 or 2mm
Anesthetized: Periosteum, soft tissue buccal to the mandibular molars d.
Mental N. Block i.
Injection site: Between the mandibular premolars ii.
Depth: 5 – 6mm iii.
Anesthetized: Buccal mucous membrane anterior to the mental foramen to the midline, lip and chin e.
“Gow-Gates” Mandibular Block (V
3
Block) i.
Injection site: Height of injection; mesiopalatal cusp of maxillary second molar.
Penetration; distal to the 2 nd molar ii.
Depth: 25mm iii.
Anesthetized: Distribution of V
3 f.
“Vazirani Akinosi” Mandibular Block i.
Injection site: Mouth closed. Align the needle and syringe parallel to and along the line of the maxillary 2 nd and 3 rd ii.
iii.
molar mucogingival junction; insertion of needle to the soft tissue overlying the mesial border of the mandibular ramus directly adjacent to the maxillary tuberosity at the height of the mucogingival junction adjacent to the maxillary 3 rd molar
Depth: 25mm
Anesthetized: Distribution of IAN, lingual N., mental N., and incisive N.