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-2930 أيام
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5) 🇾🇪palatal anesthesia :
1- don't provide any pulpul anesthesia .
2 - Provide extensive area of pulpal and palatal anesthesia .
A. Pressure anesthesia can be produced at the site of injection by applying
considerable pressure to tissue adjacent to the injection site with a firm object
such as : ( cotton applicator stick ) which is use to apply the topical anesthetic
B. Slow injection of the local anesthesia :
Slow injection is important not for softly feature only but also as a means of providing an atrumatic injection .PALATAL ANESTHESIA
Greater Palatine Nerve Block:
- Anterior Palatine Nerve .
-Posterior portion of hard palate and overlying soft tissues .
-Anteriorly to 1st premolar .
-Medially to midline .
Indications :
-Pain control in posterior palatal hard and/or soft tissues .
Contraindications :
-Inflammation / infection at injection site .
- Only small area necessary (eg. 1-2 teeth )
🇾🇪Advantages:
1- Minimizes penetrations and discomfort
2- -Minimizes volume of s
🇾🇪) Posterior superior alveolar nerve black :🇾🇪
- It is the directly branch from maxillary n within ptrygopalatine fossa
trigeminal nerves .
Area anesthetized :
1- Pulps of the maxillary third molar , second and (first molar only 28% ).
2- Buccual soft tissue of the same teeth .Indication
1- When treatment involve two or more maxillary
teeth .
2- When Supraperostial injection is
contraindicated
Contraindication :
1- Risk of hemorrhage is too great :
- خاصة االشخاص الذين يعانون من الـ ( hemophilia(
- Hemophilia : it is a disorder in which the blood don't clot normally because it
lacks sufficient blood clotting protein ( clotting factors ) .
- عبارة عن ( anticoagulants : ( Coumadin-
Advantage :
1. Atrumatic .
2. High success rate > 95 % .
3. Minimum or less number of injection .
4. Minimize amount of local used .
Disadvantage :
1. Risk of hematoma .
2. Doesn't anesthetized first molar
completely .
- Because the first mesiobuccal root
anesthetize by MSA n block .
Techniques of Maxillary anesthesia
- Local infiltration :
anesthetize the terminal nerve ending in the area of dental treatment .
- Field block :
Anesthetize near the larger terminal nerve branch.
- Nerve block : Close the main nerve trunk .
Maxillary injection technique :
1. Supraperiosteal ( infiltration ) .
2. Periodontal ligament ( PDL ) .
3. Intraseptal injection .
4. Posterior superior alveolar nerve block .
5. Middle and anterior superior alveolar nerve block .
6. Maxillary nerve block .
7. Greater palatine nerve block .
8. Nasopalatine nerve block .1) Supraperiostial injection :
- anesthetize by infiltration .
Q /
what is the difference between supraperiostial and infraperiostial injection ?
- The supraperiostial injection does not contact with bone it is only above the
periosteal layer , but the infraperiostial injection it makes contact with the
bone ( penetrate the periostial layer ).
Indication :
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
-Contraindication :
1. Infection or acute inflammation in the area
2. Dense bone covering apices of teeth
-Advantages :
1. High success rate ( 95% ).
2. Technically easy injection .
3. Usually entirely atraumatic .
-Disadvantages :
Not recommended for large areas because of the need for multiple needle
insertions and the necessity to administer larger total volumes of local
anesthetic.
-Areas anesthetized :
1- Tooth pulp .
2. Root area .
3. Buccal periostium .
4. Mucous membrane and connective tissue .
5. Buccal gum .
-Percent positive Aspiration :
Negligible , but possible ( <1% )Alternatives :
1- Periodontal ligament injection ( PDL ) below .
2- Regional nerve .
-Technique :
1- Apply topical
2- Landmarks mucobuccal fold ( vestibule ) long axis of tooth
3- Target area : apex of tooth .
4- Aspiration .
5- Deposit approx. 0.6 – 1ml solution .
6- Waite for 3-5 min
🇾🇪🇾🇪Middle superior alveolar nerve block :
- It is branch from infraorbital nerve Maxillary nerve Trigeminal nerve.
Indications :
1- Anesthesia of maxillary premolars only.
2- Infraorbital nerve block failure .
Contraindications :
- Infection / inflammation in area of injection .
Advantage :
1- Minimize number of injection .
2- Minimize volume of solution
Disadvantage :
MSA n is still using only by 28% of population in this time
-.
Alternatives :
1- local infiltration ( supraperiosteal ) .
2- periodontal ligament injection ( PDL ) .
3- infraorbital nerve block .
infraorbital n black use when we want anesthetize the maxillary teeth from
central to second premolar .Area anesthetized :
1- Pulpal anesthesia of first & second premolar .
2 - Mesiobuccal root of first molar .
3- Buccal soft tissue and bone over the same
teeth.
we can anesthetize the 1st premolar alone by
-infiltratio
technique as we mentioned before.
Technique :
1 - 25 or 27 gauge short or long needle is recommended
2- Landmarks and Area of insertion : height of the mucobuccal fold Between
the maxillary 1st / 2 nd premolar, until it arrive to the bone above the apex of
the max.2nd premolar.
3- Procedure :Patient position .
4- Insert needle 5 – 10 mm .
5- Aspirate .
6- Slowly inject 0.9 ml of solution .
1- treatment 1 or 2 teeth just
2- Hemostasis
3- ( hemophelia )
Advantage :
1 . comparatively simple , safe technique
2 . Minimized volume of solution .
3 . Minimized number needle punctures .
Disadvantage :
1- Psychological :
- Administrator – fear of eye involvement .
- Patient – apprehension of extra oral approach .
2 - Anatomical ( Difficulty defining landmarks ) .
Alternative :
- Supraperiositeal ( infiltration ) .
- infraorbital .
6) Incisive nerve block :
-Terminal branch of inf. Alveolar nerve .
- Originates in mental foramen and proceeds anteriorly .
- Good for bilateral anterior anesthesia .
- It must be remembered that the incisive nerve does not provide
lingual soft tissue anesthesia , thus lingual infiltration may be
necessary .
-لما نخدر الـ incisive لازم نعرف ان منطقه الـ lingual للاسنان الامامية لم يحصل لها تخدير لذلك الابد من تخدير منطقة الـ lingual .
- Area anesthetized :
1. Buccal mucous membrane anterior to the mental foramen , usually from the
second premolar to the midline .
2. Lower lip and skin of chin .
3. Pulpal nerve fibers to the premolars , canines and incisors .
- Indication :anesthesia of pulp or tissue required anterior to mental foramen .
-Contraindication : infection or inflammation at injection site .Advantages :
1- High success rate .
2- Provide pulpal and hard tissue anesthesia without lingual anesthesia .
-Disadvantages : Lack of lingual
-Complications: Hematoma.
Positive aspiration
5) Mental nerve block :
-Terminal branch of inf.alveolar nerve as it exits mental foramen .
-Provide sensory innervation to buccal soft tissue anterior mental foramen and the soft tissue of the lower lip and chin .
-🇾🇪 Area anesthetized :
Buccal mucous membrane anterior to mental foramen(around the second
premolar) to the midline and skin of the lower lip and chin .
🇾🇪-Indication :
Need for anesthesia in innervated area :
1-soft tissue biopsies .
2-suturing of soft tissue .
- Contraindication :
infection or inflammation at injection site .
🇾🇪-Advantage :
1. High success rate .
2. Technically easy .
3. Usually entirely atraumatic (causing minimal tissue injury ) .
-Disadvantage : hematoma .
-Position aspiration : 5.7%
-Alternative :
1. Local infiltration.
2. PDL
3. Intraseptal .
4. Inf. Alveolar nerve block ( above ) .
5. Gow – Gates ( above ) .
6. Vazirani – Akinosi nerve block ( above ).
- Complication :
a. Few of consequences .
b. Hematoma .Technique :
a. A 25 or 27 – gau
4- Long Buccal Nerve Block :
-Anterior branch of Mandibular nerve (V3) .
-Provides buccal soft tissue anesthesia
adjacent to mandibular molars.
Not required for most restorative
-procedures
من الخد ويغذي superior branches of mandibular N يعتبر long buccal N ويغذي الـ vestibule buccal و الـ tissue soft لأاسنان إلى عند الـforamen mental
3rd molarومكانة distobuccal to
- Indications:
- Anesthesia required - mucoperiosteum buccal to mandibular molars.
- Contraindications:
- Infection/inflammation at injection site.
- Advantages:
1-Technically easy .
2-High success rate.
- Disadvantages:
1- Discomfort : potential for pain if the needle
contact the periosteum during injection.
- Alternatives:
1- Buccal infiltration .
2- Gow-Gates.
3- PDL .
4- Intraseptal .
5- Vazirani - akinosi mandibular nerve block ( above ) .Technique:
A. A 25 or 27 – gauge long needle is recommended this is most used because
the buccal nerve block is usually administrated immediately after an inferior
3-The AKINOSI :
- closed-mouth mandibular block.
- The needle is advanced posteriorly and slightly laterally, at the level of the
molar mucogingival junction about 25 mm into the tissues.
- The bevel should face medially, to deflect the needle more laterally.
- The needle advanced posteriorly and slightly laterally at the level of molar mucogingival junction .
- تستخدم هذه الطريقة عند عدم القدرة على فتح الفم نتيجة تشوه خلقي او ضربه قوية للفك .
-Nerves anesthetize :
Inferior alveolar nerve . .1
2. Incisive nerve .
3. Mental nerve .
4. Lingual nerve .
5. Mylohyoid nerve .
- Technique :
1. 25 or 27-gauge long needle is
recommended .
2. Area of insertion : soft tissue overlying the medial ( lingual )
Border of the mandibular ramus directly adjacent to the maxillary
tuberosity at the height of mucogingival junction adjacent to the maxillary
3rd molar .
3. Target area : soft tissue in the medial ( lingual ) border of the ramus in
the region of the inferior alveolar, lingual,
2-The GOW-GATES technique blocks
- most of the mandibular division of the trigeminal nerve. The object is to
place the tip of the needle by the lateral side of the condylar neck.
- injection near condylar neck at the level of maxilla ( use as
ulternative way to IANB when there is infection in inferior alveolar
nerve area .
- The needle is inserted at the level of the occlusal plane, just distal to the
third molar tooth, with the barrel of the syringe lying over the opposite
premolars.
- The needle should be advanced along a line parallel to a line connecting the
corner of the mouth with the intertragic notch (incisor) of the ear, until it
contacts the neck of the condyle.
- يجب أن ترتطم او نالمس العظم او لا نحقن لان في هذه المنطقة يوجد شريان الفك العلوي اذا انقطع
هذا الشريان يموت المريض في 5 دقائق
nerves are blocked in the Gow-Gates injection:
1. Inferior alveolar.
2. Mental .
3. Incisive .
4. Lingual .
5. Mylohyoid .
6. Auriculotemporal .
7. Buccal .
-Technique :
A. 25-gauge l
#Surgery
#oral_surgery_anasthasia
Mandibular Anasthesia
♦️mandibuler anesthesia
-inferior alveolar nerve block
-akinosis closed mouth
-mental nerve block
-intraosuosse injection
