🌹‏إِنَّ رَبِّي لَسَمِيعُ الدُّعَاءِ🌹 - Statistics & analytics of Telegram channel @densitysecond99

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middle superior

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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 .

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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

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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

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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

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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,

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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

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