4. • The ester linkage is primarily hydrolyzed by
plasma cholinesterases before going through
further metabolism by the liver. The esters
are excreted by the kidneys, nearly all as
metabolites.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26. INFERIOR ALVEOLAR NERVE
BLOCK
The inferior alveolar nerve block (IANB), commonly
(but inaccurately) referred to as the mandibular nerve
block, is the most frequently used and possibly the
most important injection technique in dentistry
28. Area of
insertion
mucous membrane on the medial side of
the mandibular ramus, at the intersection
of two lines: one horizontal, representing
the height of injection, and the other
vertical, representing the anteroposterior
plane of injection
29.
30. BUCCAL NERVE
BLOCK
Nerve Anesthetized. Buccal (a branch of the anterior
division of the mandibular)
Area Anesthetized. Soft tissues and periosteum
buccal to the mandibular molar teeth
38. Local infiltration
Small terminal nerve endings in the area of the dental treatment are
flooded with local anesthetic solution.
Field block
Local anesthetic solution 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
Nerve block
Local anesthetic is deposited close to a main nerve trunk,
usually at a distance from the site of operative intervention.
Posterior superior alveolar, inferior alveolar, and nasopalatine
injections are examples of nerve blocks.
39.
40. Supraperiosteal Injection
Other Common Name: Local infiltration,
paraperiosteal injection
Nerves Anesthetized: Large terminal branches of
the dental plexus
Areas Anesthetized: The entire region innervated
by the large terminal branches of this plexus: pulp
and root area of the tooth, buccal periosteum,
connective tissue, mucous membrane.
41.
42. Local Palatal Infiltration
The administration of local anesthetic for the palatal
anesthesia of just one or two teeth is common in clinical
practice. When a block is undesirable, local infiltration
provides effective palatal anesthesia of the individual teeth
to be treated. Contraindications include acute inflammation
and infection over the area to be anesthetized. A 25- or 27-
gauge short needle is preferred for this technique.
43.
44. Posterior Superior Alveolar Nerve
Block
Other Common Names: Tuberosity block, zygomatic block
Nerves Anesthetized. Posterior superior alveolar and
branches
Areas Anesthetized
1. Pulps of the maxillary third, second, distobuccal and
palatal roots of first molars
2. Buccal periodontium and bone overlying these teeth
Indications
1. When treatment involves two or more maxillary molars
2. When supraperiosteal injection is contraindicated
3. When supraperiosteal injection has proved ineffective
45.
46. Middle Superior Alveolar Nerve Block
Nerves Anesthetized. Middle superior alveolar
and terminal branches
Areas Anesthetized
1. Pulps of the maxillary first and second
premolars, mesiobuccal root of the first molar
2. Buccal periodontal tissues and bone over
these same teeth
47.
48. Anterior Superior Alveolar Nerve
Block
The anterior superior alveolar (ASA) nerve block is a local
anesthesia that anesthetizes the maxillary canine, the central
and lateral incisors, and the mucosa above these teeth, with
occasional crossover to the contralateral maxillary incisors
49. Infraorbital nerve block
Infraorbital nerve is a branch of the maxillary nerve,
which is a branch off the trigeminal nerve (CN V2).
Travels through the orbit and enters the infraorbital
canal to exit onto the face through the infraorbital
foramen. Infraorbital nerve innervates the ipsilateral
lower eyelid, side of the nose, and upper lip .Regional
blocks provide anesthesia without distorting soft
tissues as in local infiltration
50.
51.
52. Nasopalatine Nerve
Block
The nasopalatine nerve block, otherwise known as the
incisive nerve block or sphenopalatine nerve block,
anesthetizes the nasopalatine nerves bilaterally. In this
technique, the anesthetic solution is deposited in the area
of the incisive foramen. This technique is indicated when
treatment requires anesthesia of the lingual aspect of
multiple anterior teeth. A 25- or 27-gauge short needle is
preferred for this technique.
53.
54. Greater Palatine Nerve
Block
The greater palatine nerve block is useful when treatment is
necessary on the palatal aspect of the maxillary premolar and molar
dentition. This technique targets the area just anterior to the greater
palatine canal. The greater palatine nerve exits the canal and
travels forward between the bone and soft tissue of the palate.
Contraindications to this technique are acute inflammation and
infection at the injection site. A 25- or 27-gauge long needle is
preferred for this technique
68. trismus
primary cause-trauma to muscle ,blood vessels in
infratemporal fossa
secondary causes
injection of LA containing irritating soln.(alcohol,cold sterilising soln.)
LA have mild myotoxic properties (aids to progressive necrosis of exposed
muscle fibers)
hematoma –(leads to irritation of muscle fibers
low grade infection
excessive deposition of LA-distension of tissues-post inj trismus
