Anaesthesia & Exodontia Third Year

2. :Intraoral techniques- 1
a) Local infiltration of nerve
endings (submucosal
).
analgesia
b) Block of the terminal
branches (infiltration
).
anesthesia
c) Anterior and middle
superior
alveolar nerve
block
).(infraorbital

3. :Intraoral techniques- 1
d) Posterior superior alveolar nerve block
).(zygomatic
e) Nasopalatine nerve block (incisive canal
).injection
.f) Anterior (greater) palatine nerve block
.g) Maxillary nerve block

4. :Extraoral techniques- 2
a) Anterior and middle
superior alveolar
nerve block
).(infraorbital
.b) Maxillary nerve block

5. .Nerves anesthetized
.Areas anesthetized
.Anatomical landmarks
.Indications
.Technique
:Symptoms of anesthesia
.a) Subjective symptoms
.b) Objective symptoms

6. Basic Injection Technique
Position the patient
Communicate with the patient
Prepare the tissue
Dry the area
Apply antiseptic
Apply topical anesthetic
Check flow of local anesthetic
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7. Maxillary Injection Techniques
Nerve Block
Posterior superior alveolar nerve block
Middle superior alveolar nerve block
Anterior superior alveolar nerve block
Maxillary (second division) nerve block
Greater (anterior) palatine nerve block
Nasopalatine nerve block
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8. Maxillary Anaesthesia
 Maxillary bone is porous
and mainly cancellous.
 Roots of the maxillary
teeth are covered only by
a thin layer of buccal
bone.
 Highly vascular

9. Maxillary nerve distribution and LA
.:Infiltration A •
Buccal Infiltration
Palatal Infiltration
–
–
.:Block A •
Posterior superior alveolar
NB
Middle superior alveolar
NB
Infra orbital NB (Int. Ext.
).oral
Greater Palatine NB
Nasopalatine NB
).Maxillary NB (Int. Ext. oral
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–
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10. Maxillary infiltration anaesthesia
.:Buccal Infiltration A. 1
For all Maxillary teeth
Slow supraperiosteal
injection
Opposite to the tooth apex,
at a point made by the long
axis of the tooth and the
buccal vestibule
Needle bevel toward the
bone
Onset is 3-5mn. and working
.time is 20 – 30 minutes
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11. .Maxillary labial infiltration A. 2
Opposite to the –
tooth apex, at a
point made by
the long axis of
the tooth and
the labial
vestibule

12. Palatal Anaesthesia
)(infiltration & block
 Nasopalatine nerve
 infiltration
 block
 Greaterpalatine nerve
 infiltration
 block
 No need for lesser
palatine A.

13. Infiltration - Palate
Nerves
Terminal branches - Greater Palatine
nerve
Nasopalatine nerve
Area
Palatal soft tissue in area of injection
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14. Infiltration - Palate
Indications
Limited area
Hemostasis
Contraindications
More than 2 teeth
Inflammation/infection
at site
Advantages
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Hemostasis
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 Minimal area affected
Disadvantages
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Potentially
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traumatic
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15. Infiltration - Palate
Technique
Apply topical, pressure
Insert into gingiva in center of area
mm from gingival margin 5-10(Aspirate (positive results are rare
Inject 0.2-.3 ml, slowly
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16. Failures of Anesthesia
Quite rare
Failure of hemostasis
Inflammation
Lack of vasoconstrictor
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17. Complications
Necrosis or sloughing of the palatal soft 
tissue
(due to excess vasoconstriction (

18. Greeter palatine nerve block
Between upper 
2nd and 3rd molars.
Midway between
the median
palatine raphae
and the free
.gingival margin

19. Posterior superior nerve block
Distal to the 2nd
molar, posterior to the
tuberosity, at 45
degrees
 Aspirate first,
Pterygoid plexus of
veins.
Maxillary N B
Post. Sup. Alv.NB
Maxillary infiltration

20. Posterior Superior Alveolar Nerve
Block
:Nerve Anesthetized 
Posterior Superior 
(Alveolar Nerve (PSA
For maxillary molars 
and buccal tissue

21. Indications for PSA Block
First or second maxillary molar
Supraperiosteal injection has proved
ineffective
Contraindication
Risk of hemorrhage is too great
(eg. hemophilia, coumadin(
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