Maxillary anesthesia

General rules

► Always use disposable sterile needles!

► Make sure the patient is in the correct position on the dental chair
► Antiseptic site puncture (oral rinses with antiseptic solution)
► Correct positioning of the left hand
► The needle doesn’t have to touch anything but the puncture site
► The needle is inserted with the bevel facing the bone
► The aspiration is compulsory
► Injection rate – very slow
► Patient supervision
Topical anaesthesia
It is based on mucosal permeability for anaesthetics.
Local spraying anaesthesia
Local anaesthesia by imbibitions (gel)
Indications:
• Interventions on the gingiva
• Suppressing the vomiting reflex
• Extraction of temporary teeth
• Periodontium anaesthesia (for scaling)
• Incision of superficial abscesses
• Anesthesia of the puncture site before anaesthesia by injection
• Small cauterisation of oral mucosa
• Adaptation of orthodontic rings
 Infiltration anaesthesia
Injection of the anaesthetic solution inside the tissues and blocking the peripheral
receptors.
Painful sensitivity is suppressed in a limited territory

Plexal anesthesia (periapical, supraperiostal)

Anesthetic blocking of the nervous plexus in the thickness of the alveolar process.
Anesthetized area: periosteum, bone, vestibular mucosa, 1- 2 neighboring teeth- The
puncture is made in the mucosa, without pinching of the periosteum.

INDICATION:
Anesthesia through thin cortical bone
Dental extractions
Apicectomy
Pulp removal
Dental implants insertion
Periodontal surgery
Excision of small gum tumors
NERVE BLOCK ANESTHESIA
SUPERIOR TEETH (MAXILLARY NERVE BLOCK):

POSTERIOR SUPERIOR ALVEOLAR N. (tuberosity anaesthesia)

INFRAORBITAL N.
NAZO-PALATIN N. (incisive foramen)
GREATER PALATINE N.
 INFRAORBITAL NERVE BLOCK
INDICATIONS:
► Dentoalveolar surgery in the incisive-premolar region
► Surgery of the soft tissues (lower eyelid, nose wing, superior lip, superior
cheek region) and anterior wall of maxillary sinus.
 INFRAORBITAL NERVE BLOCK

LANDMARKS:
► 6-8 mm below the inferior orbital margin
► at the union of 2/3 external with 1/3 of the internal orbital edge
► 5 mm internal to the medio-pupilar line
► the vertical between the two upper premolars
► vertical through the supraorbital hole and the mental foramen
INTRAORAL TECHNIQUE:
► The index of the left hand will
spot the infraorbital foramen and
the thumb will raise the soft parts.
The puncture is performed above
and sideways by the canine root in the mucous membrane (The height of the
mucobuccal fold directly over the first premolar -the first premolar
usually provides the shortest route to this target area).
Aspirate in two planes. Slowly deposit 0.9 to 1.2 mL (over 30 to 40 seconds)
► Needle direction: Up, back and forth, penetrating into the canal 5MM. It is
an intracanalicular and perinervous anaesthesia.
ACCIDENTS:
► Punching of infraorbital vascular elements: haemorrhages, hematoma and
ecchymosis
► Anaesthetic infiltration of the common oculomotor nerve: transient diplopia
► Anaesthetic infiltration of the optic nerve: visual
disturbances
 POSTERIOR SUPERIOR ALVEOLAR N.
(tuberosity anesthesia)
INDICATIONS:
► Anaesthesia of the gingiva distal to the zygomatic-alveolar ridge
► The posterior wall of the maxillary sinus and the mucosa of maxillary sinus
► Upper molars with alveolar bone and periosteum (at some patients plus the
premolars)
CONTRAINDICATIONS:
► The presence of lesions or inflammatory processes
► In patients with hemorrhagic risk

LANDMARKS:
► The zygomatic-alveolar ridge
► The mesio-vestibular root of the second molar
► The occlusion plan of the upper molars
INTRAORAL TECHNIQUE:
► The labial soft tissues are kept away with the index or the thumb of left hand
► Puncture is done in the mobile mucosa above the root of the second molar,
the needle has a direction up, back and forth
► At an angle of 45º, at a depth of 2-2.5 cm
► Compulsory aspiration
► Inject 1.7-2ml
► For the mesial vestibular root you must complete the anesthesia with a Plexal
puncture
 NASOPALATINE NERVE BLOCK
INDICATIONS:
► In combination with the infraorbital anaesthesia.
► Anaesthesia of the mucosa and and periosteum of the anterior 1/3 of palatal
(from the median line to the canine)
LANDMARKS:
► The retro incisor foramen is located on the median line, immediately behind
the upper central incisors, covered by the incisive papilla.
INTRAORAL TECHNIQUE:
► Insert a short and thin needle on the edge of the papilla, on the opposite side
to the anesthetized area.
► The needle has a upward, backward and outward path entering the 0.5cm
into the foramen, introducing 0.25-0.50 ml of solution.

ACCIDENTS:
► Injection under pressure can cause local ischemia and necrosis
 GREATER PALATINE N. BLOCK
INDICATIONS:
► In combination with the anaesthesia at the tuberosity
► Anaesthesia of palatal mucosa and periosteum in posterior 2/3 (premolars
and molars)
LANDMARKS:
► The last molar, 1 cm above this molar
► 0.5 cm ahead the edge of the hard palate
► 1 cm in front of the hook of the internal wing of the pterygoid apophysis
Technique:
► Using a long needle that will be directed up and outward, the syringe is at the
opposite corner of the mouth. The puncture is done in the palatal groove,
next to the second molar.
► Do not aim for the needle to go into the canal and inject 0.5ml
Accidents:
► Punching of the artery or palatal vein resulting in a submucosal hematoma.
► Breathing and swallowing disorders by anesthetize the soft palate.
► Ischemia and necrosis
Incisors and canines
 When we have a small intervention on 1 or 2 teeth in the anterior
maxilla region- we can use the Plexal anesthesia (periapical, supraperiostal)
at the level of tooth that we are going to work
 Here you can see the tissues that are anesthetized –the soft
tissue (upper lip), the periosteum and the tooth (pulp)
 All the time the plexal anesthesia should be completed with a
palatal injection- nasopalatine or local infiltration in the palatine mucosa
at the level of the tooth we need to work
 When the area we need to anesthetize is bigger than 1-2 teeth it’s
recommended to use the Infraorbital nerve block

For the palatal anesthesia –usually it’s recommended to

complete the Infraorbital nerve block with Nasopalatine nerve block and
Greater Palatine nerve block especially when we are working at the level
of premolars, because at that level the teeth have anastomoses.
Premolars
 In this case we have 2 options, the Plexal anesthesia or the
Infraorbital nerve block

For the palatine roots –we can realise the local

infiltration of palatine mucosa or we can associate the
Nasopalatine nerve block with the Greater Palatine nerve block.
Molars
 Plexal anesthesia can be easily realized if we have a small intervention.

As a alternative option for a bigger intervention we have the Tuberosity

anesthesia.

Do not forget to perform the palatal injection at the level of the needed
tooth or you can realise the Greater Palatine Nerve Block
 FACTS

► The external cortical bone of maxilla is relatively thin and in many places
porous.
► This facilitates an effective diffusion from the injection point of the oral level
to the area to be anesthetized: the root of the upper teeth.
► To achieve an effective anesthesia of the palatal roots of the molars, an
additional palatal infiltration can be done beside Nasopalatine nerve block
and Greater Palatine nerve block, we can inject the anesthetic directly at
the level of the palatine mucosa of the tooth we need to anesthesia.
► With the appearance of modern solutions of local anesthetics, the diffusion is
good and the analgesia is strong enough for routine acts