Middle Superior Alveolar Nerve Block Nerve Anesthetized Middle

Middle Superior Alveolar Nerve Block Nerve Anesthetized : Middle Superior Alveolar Nerve - Maxillary premolars and buccal tissues

Areas Anesthetized Pulpal anesthesia of first & second premolars and mesiobuccal root of first molar Buccal soft tissues and bone over same teeth

Indications Anesthesia of maxillary premolars only Infraorbital nerve block failure

Contraindications Infection /inflammation in area of injection

Advantage Minimized number of injections Minimized volume of solution

Disadvantage MSA nerve is only present 28% of the time

Alternatives Local infiltration (supraperiosteal) Periodontal ligament injection (PDL) Infraorbital nerve block

Landmarks / Area of Insertion Mucobuccal fold above second premolar Apex of second premolar

Signs and Symptoms Numb upper lip Pain free dental therapy

Safety Features Anatomically safe (no signifcant structures) Relatively avascular area positive aspirations - negligible (< 3%) Complications are rare

Technique - MSA Apply topical Position patient and identify landmarks Insert needle 5 -10 mm Aspirate Inject 0. 9 ml of solution, slowly

Failures of Anesthesia Needle inserted too high, or not high enough Deposition of solution too far laterally

Infraorbital Nerve Block

Nerves Anesthetized Anterior Superior Alveolar Nerve Middle Superior Alveolar Nerve Superior Labial Nerve also Inferior Palpebral Nerve Lateral Nasal Nerve

Areas Anesthetized Pulpal anesthesia of maxillary anterior teeth Pulpal anesthesia of premolars and mesiobuccal root of first molar Buccal soft tissue and bone of same teeth Lower eyelid, lateral nose, and upper lip

Indications Anesthesia of more than two maxillary teeth Supraperiosteal injections ineffective Inflammation/infection contraindicating local infiltration

Contraindications Discrete treatment areas (1 -2 teeth only) Hemostasis Bleeding problems (eg. hemophelia, etc. . )

Landmarks Mucobuccal fold above first premolar Infraorbital notch Infraorbital foramen

Area of Insertion Mucobuccal fold above first premolar Target area Infraorbital foramen Neurovascular bundle

Advantages Comparatively simple, safe technique Minimized volume of solution Minimized number of needle punctures

Disadvantages Psychological Administrator- fear of eye involvement Patient- apprehension of extraoral approach Anatomical Difficulty defining landmarks

Alternatives Supraperiosteal injection for each tooth Maxillary nerve block

Signs and Symptoms Tingling and numbness of lower eyelid, side of nose, and upper lip Numbness in teeth and soft tissues No pain during dental therapy

Safety Features Needle contacting bone Finger over infraorbital foramen

Technique Apply topical Position patient and identify landmarks Insert needle to upper rim of infraorbital foramen Aspirate Inject 0. 9 ml of solution, slowly

Failures of Anesthesia Bone contact below infraorbital foramen Needle deviates laterally or medially

Complications Hematoma (rare) Positive aspirations - 0. 7 %