anatomical correlation of local anesthesia in dentistry

Anatomical Anatomical correlationcorrelation

of of

Local anesthesia Local anesthesia

in in

DentistryDentistry

Dr.B.B.Gosai Dr.B.B.Gosai

Pre-Lecture Quiz

1 Identify technique of local anesthesia





Identify technique of local anesthesia

44 Identify technique of local anesthesiaIdentify technique of local anesthesia

77Identify technique of local

anesthesiaIdentify technique of local

anesthesia

Techniques of Maxillary Anesthesia

Supraperisoteal infiltration : for limited treatment protocol Periodontal ligament injection as adjunct to other techniques Intraseptal injection: for periodontal surgical techniques Intraosseous injection: for single teeth Posterior superior alveolar nerve block: for several molar teeth in

one quadrant Middle superior alveolar nerve block: for premolar in one quadrant Anterior superior alveolar(Infraorbital ) nerve block: for anterior

teeth in one quadrant Maxillary (Second division) nerve block: for extensive buccal,

palatal and pulpal management in one quadrant Greater (Anterior ) palatine nerve block: for palatal soft and

osseous tissue treatment distal to canine in one quadrant Nasopalatine nerve block:for palatal soft and osseous tissue

treatment from canine to canine bilaterally

Supraperiosteal injection

Indication: pulpal amesthesia for one or two maxillary

teeth and soft tissue surrounding themProcedure:

syringe should be parallel with long axis of the tooth and inserted at the height of mucobuccal fold over the tooth

Supraperiosteal injectionSupraperiosteal injection

Area anesthetized

Posterior superior alveolar nerve block

Indication: Treatment involving two or more maxillary molars

Area anesthesised: Pulp of maxillary 3rd, 2nd and 1st molar ( entire tooth in 72% and

mesiobuccal root not anesthesised in 28 % as it may be supplied by MSAN)

Procedure: Insert needle at height of mucobuccal fold over 2nd Molar . Advance upward (45 degrees to occlusal plane), Inwards

(medially at 45 degrees to occlusal plane) and backwards ( at 45 degrees to long axis of 2nd molar )

Advance depth of 16 mm to reach Alveolar foramina. For smaller adult and children depth of 14 mm.

Complication: Hematoma


Area anesthetized


Insert needle at height of mucobuccal fold over 2nd Molar

Advance upward (45 degrees to occlusal plane), Inwards (medially at 45 degrees to occlusal plane) and backwards ( at 45 degrees to long axis of 2nd molar )

Middle superior alveolar nerve block

Present in 28 % of populationIndication:

When infraorbital block failsArea anesthesised:Pulp of maxillary 1st and 2nd premolar and

mesiobuccal root of 1st molar Procedure:

Insert needle at height of mucobuccal fold over 2nd premolar .

Advance till tip of needle reach well above the apex of 2nd premolar

Middle superior alveolar nerve block

Needle reach well above the apex of 2nd premolar

Area anesthetized

Anterior superior alveolar nerve block (Infraorbital nerve block)

Indication: Treatment involving two or more maxillary teeth

Area anesthetized: Pulp of maxillary central incisors to canine, in 72 % maxillary

premolars and mesiobuccal root of 1st molar, buccal periodontium of same teeth

Procedure: Locate infraorbital notch at infraorbital margin. Move finger downwards>> convex feeling is roof of

foramen >> further downwards concave feeling is Infraorbital foramen pulpated on face.

Insert needle at height of mucobuccal fold over 1st premolar with needle held parallel to long axis of tooth till 16 mm depth and correlated with external landmark.

Anterior superior alveolar nerve block (Infraorbital nerve block)

Area anesthetized

Locate infraorbital notch at infraorbital margin and palpate downwards to located foramen

Mucobuccal fold over 1st premolar with needle held parallel to long axis of tooth

Palatal anesthesia

Traumatic experience for patient with complains of extreme pain while performing anesthesia.

This can be reduced by applying topical anesthesiapressure anesthesiacontrol over needleslow deposition of anesthetic

Greater palatine nerve block

Indication: Dental procedures involving palatal soft tissues distal to canine.

Area anesthesised: Posterior part of hard palate and overlying soft tissue till 1st premolar

anteriorly and medially midline. Procedure:

Path of insertion from opposite aside of the mouth at a right angle to target area.

Locate greater palatine foramen by placing cotton swab at junction of maxillary alveolar process and hard palate in the groove. Press firmly posteriorly from first maxillary molar. Swab will fall in the “Depression” created by greater palatine foramen which is located usually distal to maxillary 2nd Molar .

Complication: Ischemia and necrosis due to concentrated vasocontrictor solution

used for hemostasis.

Greater palatine nerve block

Locate greater palatine foramen by placing cotton swab at junction of maxillary alveolar process and hard palate in the groove. Press firmly posteriorly from first maxillary molar. Swab will fall in the “Depression” created by greater palatine foramen which is located usually distal to maxillary 2nd Molar .

Nasopalatine nerve block

Indication: Restorative therapy for more than two teeth.

Area anesthetized: Anterior portion of the hard palate and overlying soft tissue from

mesial of right 1st premolar to mesial of left 1st premolar. Procedure: Single needle penetration

Insert needle at incisive papilla and advance towards incisive foramen till the depth of 6-10 mm.

Multiple needle penetration First injection at labial frenulum Second injection labial aspect of papilla between central incisors Third injection if second injection has failed then to lateral

aspect of insicive papilla.


Area anesthetized

Single needle penetration at incisive papilla

Nasopalatine nerve blockMultiple Needle Penetration

First injection at labial frenulum

Nasopalatine nerve blockMultiple Needle Penetration

Second injection labial aspect of papilla between central incisors

Third injection if second injection has failed then to lateral aspect of insicive papilla.

Maxillary nerve block

Indication: Extensive oral surgical, periodontal or restorative procedures requiring

anesthesia of whole maxillary division. Area anesthetized: Hemimaxilla including soft and hard tissues. Procedure: High tuberosity approach:

Insert needle at height of mucobuccal fold over maxillary 2nd molar tooth. Advance needle like PSAN block but depth should be 30 mm. At this depth

needle tip is in proximity to maxillary nerve in pterygopalatine fossa. Greater palatine approach:

Locate greater palatine foramen Advance needle into canal to a depth of 30 mm.

Complication: Maxillary artery injury with hematoma Penetration into the orbit with ophthalmoplegia. Due to septa in greater palatine canal procedure may not be successful.

Maxillary nerve block

Area anesthetizedNeedle at height of mucobuccal fold over maxillary 2nd molar tooth

Inferior alveolar nerve block

Also known as Mandibular block Indication:

Procedures on multiple mandibular teeth in one quadrant. Area anesthetized: Mandibular teeth, body and ramus of mandible, buccal mucoperiosteum and

anterior two third of tongue(lingual nerve). Procedure:

Height of injection determined by imaginary line extend posteriorly from coronoid notch to pterygomandibular raphe as it turns upwards towards maxilla.

Anteroposterior site on injection: about three fourths the distance from anterior border of ramus

Penetration depth: till bone is touched usually 20-25 mm. Complication:

Trismus Transient facial palsy. Hematoma.

Mandibular landmarks

1. Lingula2. Posterior border of ramus3. Coronoid notch4. Coronoid process5. Masseteric notch6. Condylar process


Area anesthetized


Height of injection determined by imaginary line extend posteriorly from coronoid notch to pterygomandibular raphe as it turns upwards towards maxilla.

Buccal nerve block

Indication: When buccal soft tissue anesthesia is required for

dental procedures in the mandibular molar region.Area anesthetized:Soft tissues and periosteum buccal to mandibular molar

teeth.Procedure:

Injection at distal and buccal to last molar near anterior border of ramus of mandible.

Depth usually 1-2 mm rarely above 2-4 mm.Complication:

Hematoma - bluish discolouration at the injection site..

Buccal nerve block

Area anesthetized

Buccal nerve block

Injection at distal and buccal to last molar near anterior border of ramus of mandible

Mental nerve block

Indication: Dental procedures requiring pulpal anesthesia on

mandibular teeth anterior to mental foramen.Area anesthetized:

Pulpal nerve fibres supplying premolars, canine and incisors.

Buccal mucous membrane anterior to mental foramen to the midline and skin of lower lip and chin.

Procedure: Injection at mucobuccal fold at mental foramen

located between apices of two premolars or canine and deposit the content at the foramen.

Mental nerve block

Area anesthetized

Incisive nerve block

Indication: When buccal soft tissue anesthesia is required for

procedures in the mandible anterior to the mental foramen like biopsy and suturing of tissue.

Area anesthetized:Buccal mucous membrane anterior to mental foramen to

the midline and skin of lower lip and chin.Procedure:

Injection at mucobuccal fold at mental foramen located between apices of two premolars.

Complication: Hematoma - bluish discolouration at the injection site..

Incisive nerve block

Area anesthetizedbetween apices of two premolars

Mandibular nerve block:The Gow-Gates Technique

Higher success rate Indication:

Procedures on multiple mandibular teeth in one quadrant and inferior alveolar nerve block fails.

Area anesthetized: Mandibular teeth to midline, body and ramus of mandible, buccal mucoperiosteum

and anterior two third of tongue(lingual nerve). Landmarks and procedure:

Extraoral: lower border of tragus and corner of mouth (Imaginary line joining these two points)

Intraoral: Height of injection determined by tip of needle just below the mesiolingual (mesiopalatal) cusp of maxillary second molar.

Penetration just distal to maxillary second molar tooth aligning needle to line mentioned in Extraoral landmark with average depth about 25 mm.

Complication: Trismus Temporary paralysis of III, IV and VI. Hematoma.


Area anesthetized


Extraoral landmark: lower border of tragus and corner of mouth (Imaginary line joining these two points)

Direction of needle in Gow-Gates Technique

Vazirani-Akinosi Mouth Mandibular nerve block:

Indication: Limited mandibular opening.

Area anesthetized: Mandibular teeth to midline, body and ramus of mandible, buccal

mucoperiosteum and anterior two third of tongue(lingual nerve). Landmarks and procedure:

Insert needle at mucogingival junction of maxillary third molar. Advance needle slightly laterally and posteriorly with average

depth about 25 mm. Complication:

Temporary paralysis of VII. Trismus (rare) Hematoma.


Area anesthetized

Post-lecture QUIZ!!!!!


Identify technique of local anesthesia



anesthesia

5: Identify technique of local anesthesia




77 Identify technique of local anesthesiaIdentify technique of local anesthesia



anesthesia

99Identify landmarks at 1

and 3Identify landmarks at 1

and 3

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anatomical correlation of local anesthesia in dentistry

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