Caption

Naso-Palatine nerve block

Guided by:- Presented By:-
Dr. Snehal bansod sir Rohit kumar
Dr. Dev sen sir Bds final yr
Dr. Arpita maam
Roll no 56
 Contents
- Introduction
- Nerves anaesthetised
- Areas anaesthetised
- Area of insertion
- Indications
-Contraindications
- Advantages
- Disadvantages
- Target area
- Landmark
- Techniques
 Introduction
* Nasopalatine nerve block is an invaluable technique for palatal pain
control in that, with administration of a minimum volume of anesthetic
solution, a wide area of palatal soft tissue anesthesia is achieved, thereby
minimizing the need for multiple palatal injections.

, the nasopalatine nerve block has the distinction of being a potentially highly traumati
injection.
 Other Common
Names

* sphenopalatine nerve
block.

* Incisive canal nerve block

 Nerves
Anesthetized

Right and left nasopalatine

nerves bilaterally
 Areas Anesthetized

Anterior portion of the hard palate (soft

and hard tissues) bilaterally from the
mesial aspect of the right first premolar to
the mesial aspect 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
restoration)

2. For pain control during periodontal or oral surgical

procedure involving palatal soft and hard tissues
 Contraindications

1. Inflammation or infection at the injection site

2. Smaller area of therapy (one or two teeth)

 Advantages

1. Minimizes needle penetrations and volume of solution

2. Minimal patient discomfort from multiple needle

penetrations
 Disadvantages
1. No hemostasis except in the immediate area of injection.

2. Potentially the most traumatic intraoral injection; how- ever, the

protocol for an atraumatic injection or use of a C-CLAD system or a
buffered local anesthetic solution can minimize or entirely eliminate
discomfort

3. There are chances of positive aspiration (1%)

 Area of insertion

Tissues lateral to incisive papilla

 Target area

Incisive foramen located benath

incisive papilla
 Landmarks

Central incisors and incisive

papilla
 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).

3. Target area: incisive foramen, beneath the incisive papilla

4. Landmarks: central incisors and incisive papilla.

5. Path of insertion: approach the injection site at a 45-degree angle

toward the incisive papilla.
6. Orientation of the bevel: toward the palatal soft tissues

7. Procedure: a. Sit at the 9 or 10 o’clock position facing in the same direction as the
patient.

b. Request the patient to do the following: - i.

Open the mouth wide. ii. Extend the neck iii. Turn the head to the left or right, as
needed, for improved visibility .

c. Prepare the tissue just lateral to the incisive papilla

i. Clean and dry it with sterile gauze.

ii. Apply topical anesthetic for 2 minutes.

d. After 2 minutes of topical anesthetic application, move the swab directly onto the
incisive papilla

i. With the swab in your left hand (if right-handed), apply pressure to the area of the
papilla.

ii. Note ischemia at the injection site.

e. Place the bevel against the ischemic soft tissues at the injection site. The needle must
be well stabilized to prevent accidental penetration of tissues

f. With the bevel lying against the tissue:

i. Apply enough pressure to bow the needle slightly.

ii. Deposit a small volume of anesthetic. The solution will be forced against the mucous
membrane.
g. Straighten the needle and permit the bevel to penetrate the mucosa.

i. Continue to deposit small volumes of anesthetic throughout the procedure.

ii. Observe ischemia spreading into adjacent tissues as solution is deposited.

h. Continue to apply pressure with the cotton applicator stick while injecting the anesthetic.

I . Slowly advance the needle toward the incisive foramen until bone is gently contacted

i. The depth of penetration is normally not greater than 5 mm.

ii. Deposit small volumes of anesthetic while advancing the needle. As the tissue is entered,
resistance to the deposition of solution is significantly increased; this is normal with the
nasopalatine nerve block.
j. Withdraw the needle 1 mm (to prevent subperiosteal injection). The bevel now lies
over the center of the incisive foramen.

k. Aspirate in two planes.

l. If negative, slowly deposit (minimum of 15 to 30 sec) not more than one-fourth of a

cartridge (0.45 mL).

m. Slowly withdraw the syringe

n. Wait 2 to 3 minutes before commencing the dental procedure.

 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.

6. Orientation of the bevel:

a. First injection: bevel toward bone.

b. Second injection: bevel orientation not relevant.

c. Third injection: bevel orientation not relevant.

7. Procedure:

a. First injection: infiltration of 0.3 mL into the labial frenum

i. Prepare the tissue at the injection site.

ii. Retract the upper lip to stretch tissues and improve the visibility.

iii. Gently insert the needle into the frenum and deposit 0.3 mL of anesthetic in
approximately 15 seconds. (The tissue may balloon as solution is injected. This is
normal.)

iv. Anesthesia of soft tissue develops immediately. The aim of this first injection is
to anesthetize the inter-dental papilla between the two central incisors.
b. Second injection: penetration through the labial aspect of the
papilla between the maxillary central incisors toward the incisive
papilla

i. Retract the upper lip gently to increase visibility

ii. A right-handed administrator should sit at the 11 or 12 o’clock

position facing in the same direction as the patient. Tilt the
patient’s head toward the right to provide a proper angle for
needle penetration.
iii . Holding the needle at a right angle to the interdental papilla, insert it into the
papilla just above the level of bone. And, Direct it toward the incisive papilla

iv . Aspirate in two planes when ischemia is noted in the incisive papilla. If

negative, administer no more than 0.3 mL of anesthetic solution in approximately
15 seconds.

v. Use of a finger from the other hand to stabilize the needle and Slowly withdraw
the syringe.

vi. If the area of clinically effective anesthesia proves to be less than adequate
(as frequently happens), proceed to the third injection.
c. Third injection:

i. Dry the tissue just lateral to the incisive papilla.

ii. Ask the patient to open the mouth wide.

iii. Extend the patient’s neck.

iv. Place the needle into soft tissue adjacent to the (diamond-shaped) incisive papilla, aiming toward
the most distal portion of the papilla.

v. Advance the needle until contact is made with bone.

vi. Withdraw the needle 1 mm to avoid subperiosteal injection.

vii. Aspirate in two planes.

viii. If negative, slowly deposit not more than 0.3 mL of anesthetic in approximately 15 seconds.
 ix. Withdraw the syringe.

x. Make the needle safe.

xi. Wait a minimum of 2 to 3 minutes for the onset of

anesthesia before beginning dental treatment
Thank you