Supraperiosteal MSA ASA PSA

Nerves
Term. Branches of Middle Sup. Alveolar Anterior sup. Alveolar Posterior sup. Alveolar
anesthetized
dent. plexus

Teeth #6 (-MBrt 28%),

1-2 teeth (root, Teeth #4,5. B/lab. Teeth #1-3, adjacent
Area anesthetized #7/8’s, B/L soft tiss +
pulp), B tiss., Soft tiss. + bone B/Lab soft tiss. + Bone
adjacent bone
Periosteum, bone
SubG Debride in
Tx of 1-2 teeth /sm Tx of 2+ ant. Teeth Tx of 2+ Teeth, can’t infil,
Indications sext. 4/5
area (unilat.) or infil fails
restorations
Infection/inflamm,
Infection/inflamm, infil
dense bone (Md Inflamm, other
Contraindications possible, if hemostasis is Risk of bleeding
post) anesthesia
req.

Easy, atraumatic, Localized, min. # of High rate of success, Min LA, atraumatic, 95%
Advantages
successful injections Min. LA, safe. success

Risk of
bleeding/hematoma, no
Sm area, limited DH Sensitive area w/many
Disadvantages N/A bony landmarks,
use nerves in the nose area
sometimes don’t freeze
MB 6

Topical (non-inject), Infil./ IO Block/PDL Infil./ IO Block/PDL

Alternatives PDL, infil, intraosseous
nerve block/alt inj. injections. injections.

MB. Fold of tooth to Posterior, and superior to

be anesthetized, to MB fold @ Apex of MX tuberosity – Heigh of
Landmarks/ MB fold @ apex of #3 –
the apex of the #5 – parallel to Long MB fold of #7’s.
Technique parallel to long axis
target tooth, needle axis - Pt opens halfway &
parallel to tooth swing jaw towards OP.

>3.1% (Aspirate 4x. 2x

Aspiration >1% <3% <0.7% w/45 rotation, and 2x in
same plane)

Hitting bone (pain), Hematoma, Pt may feel

Complications Hematoma Hematoma (rare)
pain on insertion. mand/L lip freeze

Hit bone = too far inwards

Too far from apex, Too far from target, not
Zygomatic arch angle. Some pt may not
Failure too far from bone enough LA, contralat.
prevents diffusion “feel numb” b/c loc. Not
innervation
high enough.
27G short (16mm - 3/4 of
Needle 27G Short 27G Short 27G Short
the needle)
Amt of LA 1/3 cart – 20s 0.9-1.2ml (1/2 - 1/3) 0.9-1.2ml (1/2 - 1/3) 0.9ml – 1.8ml (1/2 – 1)
 30-40s deposit 30-40s deposit 30s-1min
Advance UP, IN, And
backwards. 45-degree
angles. Sm adults/children
only advance 10-12mm.
Do not advance too DO NOT Over-advance (+
RH = 8-10 clock. far, and keep away May be more difficult to +risk of hem.)
Notes/tips
from periosteal fulcrum High risk of hematoma.
bone - Some pt L lip/tongue
may freeze (V3 is lateral
to PSA)
- Have pt swing jaw
towards you