MAXILLARY INJECTION TECHNIQUES

LOCAL INFILTRATION:
Other Common Names:
Supraperiosteal, 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, and mucous membrane.
Indications :
1)Pulpal anesthesia of the maxillary teeth when treatment is
limited to one or two teeth.
2) Soft tissue anesthesia when indicated for surgical procedures
in a circumscribed area.
Technique :
1)A 27-gauge short needle is recommended.
2)Area of insertion: height of the mucobuccal fold above the
apex of the tooth being anesthetized.
3)Target area: apical region of the tooth to be anesthetized
4)Landmarks: Mucobuccal fold ,Crown of the tooth and Root
contour of the tooth.
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, and first molars (entire
tooth = 72%; mesiobuccal root of the maxillary first molar
not anesthetized = 28%).
2) Buccal periodontium and bone overlying these teeth.
Indications :
1)When treatment involves two or more maxillary molars.
2) When supraperiosteal injection is contraindicated (e.g., with
infection or acute inflammation).
3) When supraperiosteal injection has proved ineffective.
Technique:
1)A 27-gauge short needle recommended,
2) Area of insertion: height of the mucobuccal fold above the
maxillary second molar.
3) Target area: PSA nerve—posterior, superior, and medial to
the posterior border of the maxilla.
4)Landmarks: Mucobuccal fold, Maxillary tuberosity and
Zygomatic process of the maxilla.
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.
Indications :
1) Where the ASA nerve block fails to provide pulpal
anesthesia distal to the maxillary canine.
2) Dental procedures involving both maxillary premolars only.
Technique:
1) A 27-gauge short or long needle is recommended.
2) Area of insertion: height of the mucobuccal fold above the
maxillary second premolar.
3) Target area: maxillary bone above the apex of the maxillary
second premolar.
4) Landmark: mucobuccal fold above the maxillary second
premolar.
ANTERIOR SUPERIOR ALVEOLAR NERVE BLOCK
Other Common Name:
Infraorbital nerve block (technically, the infraorbital nerve
provides anesthesia to the soft tissues of the anterior portion of the face,
not to the teeth or intraoral soft and hard tissues; therefore it is
inaccurate to call the ASA nerve block the infraorbital nerve block).
Nerves Anesthetized:
1) Anterior superior alveolar
2) Middle superior alveolar
3) Infraorbital nerve ( Inferior palpebral , Lateral nasal ,
Superior labial)
Areas Anesthetized :
1) Pulps of the maxillary central incisor through the canine
on the injected side.
2) In about 72% of patients, pulps of the maxillary
premolars and mesiobuccal root of the first molar,
3) Buccal (labial) periodontium and bone of these same
teeth.
4) Lower eyelid, lateral aspect of the nose, upper lip
Indications:
1) Dental procedures involving more than two maxillary
teeth and their overlying buccal tissues.
2) Inflammation or infection (which contraindicates
supraperiosteal injection)
3) When supraperiosteal injections have been ineffective
because of dense cortical bone.
Technique:
1) A 25- or 27-gauge long needle is recommended,
although the 27-gauge short also may be used,
especially for children and smaller adults.
2) Area of insertion: height of the mucobuccal fold
directly over the first premolar.
3) Target area: infraorbital foramen (below the
infraorbital notch).
4) Landmarks: Mucobuccal fold , Infraorbital notch
and Infraorbital foramen.
 NASOPALATINE NERVE BLOCK

Other Common Names:

Incisive nerve block, sphenopalatine nerve block. Nerves
Anesthetized Nasopalatine nerves bilaterally.
Areas Anesthetized:
Anterior portion of the hard palate (soft and hard tissues)
bilaterally from the mesial of the right first premolar to the mesial of the
left first premolar.
Indications:
1) When palatal soft tissue anesthesia is necessary for
restorative treatment on more than two teeth (e.g.,
subgingival restorations, insertion of matrix bands
subgingivally)
2) For pain control during periodontal or oral surgical
procedures involving palatal soft and hard tissues.

Technique (Single-Needle Penetration of the Palate):

1) A 27-gauge short needle is recommended.
2) Area of insertion: palatal mucosa just lateral to the
incisive papilla (located in the midline behind the
central incisors); the tissue here is more sensitive than
other palatal mucosa.
3) Target area: incisive foramen, beneath the incisive
papilla.
 1) Landmarks: central incisors and incisive papilla
Technique (Multiple Needle Penetrations) :
1) A 27-gauge short needle is recommended.
2) Areas of insertion: a) Labial frenum in the midline
between the maxillary central incisors. B) Interdental
papilla between the maxillary central incisors. C) If
needed, palatal soft tissues lateral to the incisive
papilla.
3) Target area: incisive foramen, beneath the incisive
papilla
4) Landmarks: central incisors and incisive papilla 5
Path of insertion: a) First injection: infiltration into
the labial frenum.
b) Second injection: needle held at a right angle to the
interdental papilla.
c) Third injection: needle held at a 45-degree angle
to the incisive papilla.
 GREATER PALATINE NERVE BLOCK
Other Common Name:
Anterior palatine nerve block.
Nerve Anesthetized :
Greater palatine.
Areas Anesthetized :
The posterior portion of the hard palate and its
overlying soft tissues, anteriorly as far as the first premolar and medially
to the midline.
Indications:
1) When palatal soft tissue anesthesia is necessary for
restorative therapy on more than two teeth (e.g., with
subgingival restorations, with insertion of matrix
bands subgingivally).
2) For pain control during periodontal or oral surgical
procedures involving the palatal soft and hard tissues.
Technique :
1) A 27-gauge short needle is recommended.
2) Area of insertion: soft tissue slightly anterior to the
greater palatine foramen.
3) Target area: greater (anterior) palatine nerve as it
passes anteriorly between soft tissues and bone of the
hard palate.
4) Landmarks: greater palatine foramen and junction of
the maxillary alveolar process and palatine bone
Recommended volumes of local anesthetic solution for maxillary
injection technique
TECHNIQUE VOLUME ml
INFILTRATION 0.6
POSTERIOR SUPERIOR ALVEOLAR 0.9-1.8
MIDDLE SUPERIOR ALVEOLAR 0.9-1.2
ANTERIOR SUPERIOR ALVEOLAR 0.9-1.2
NASOPALATINE 0.4
GREATER PALATINE 0.4-0.6