Maxillary Anesthesia Injection Techniques | Dentsply Sirona

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5 Dec 201837:23

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TLDRThis educational video script focuses on maxillary anesthesia techniques for dental procedures, highlighting the importance of understanding the anatomy and nerves involved. It features Dr. Gregory G. Winter and Ms. Marion C. Manske, experts in their fields, who discuss various injection methods such as supraperiosteal, infraorbital nerve block, and posterior superior alveolar nerve block. The script emphasizes patient safety, comfort, and the correct use of equipment, including needles and anesthetics. It also covers the application of topical anesthesia and the critical role of visualization in successful maxillary anesthesia, aiming to provide a foundation for high-quality, pain-free dentistry.

Takeaways

🎓 Dr. Gregory G. Winter is a dental professional with extensive training and experience in dental surgery and maxillofacial surgery, emphasizing his expertise in the field.
🦷 Local anesthesia of the maxilla is typically achieved through supraperiosteal injection due to the thin nature of the alveolar bone, allowing the anesthetic to reach nerve fibers effectively.
💉 Alternative techniques to supraperiosteal injection include the infraorbital nerve block, posterior superior nerve block, and maxillary second division nerve block, which are useful for procedures involving multiple teeth.
🧠 Understanding the anatomy of the maxilla and the branches of the maxillary nerve is crucial for successful anesthesia, as it provides sensory innervation to various facial structures and the maxillary teeth.
👀 Visualization is key to maxillary anesthesia success, and using articaine can help achieve anesthesia of both buccal and palatal areas in most cases due to its diffusion properties.
🧵 The selection of the appropriate needle gauge is important; a 25 or 27 gauge needle is generally preferred for blocks, while a 30 gauge is used for infiltrations.
💧 Topical anesthesia, such as benzocaine, is applied to the injection site to desensitize the mucosa before needle insertion, enhancing patient comfort.
📍 For the infraorbital nerve block, the target site is the infraorbital foramen, and the vertical approach is the safest and most commonly used method.
⚠️ The posterior superior alveolar nerve block is technique-sensitive and carries a risk of hematoma formation; dental professionals may opt for a less invasive infiltration instead.
🌐 The maxillary nerve block anesthetizes the entire quadrant of the maxilla and can be performed using three different approaches, with the high tuberosity approach being the least likely to cause discomfort but with a higher risk of hematoma.
📚 A thorough understanding of local anesthetic techniques and their anatomical basis is essential for providing high-quality, pain-free dentistry and ensuring patient safety.

Q & A

What is the educational background of Dr. Gregory G. Winter?
-Dr. Gregory G. Winter completed his DDS from the Baltimore College of Dental Surgery, University of Maryland School of Dentistry. He received additional training at the University of Pittsburgh School of Dental Medicine and York Hospital, where he did his general practice residency.
What is the role of Dr. Winter at the University of Maryland School of Dentistry?
-Dr. Winter has a faculty appointment at the University of Maryland School of Dentistry in the Department of Oral and Maxillofacial Surgery as a clinical instructor.
How is local anesthesia of the maxilla commonly achieved?
-Local anesthesia of the maxilla is commonly achieved by supraperiosteal injection, which works well due to the comparatively thin and porous nature of the alveolar bone, allowing the anesthetic to reach the nerve fibers.
Why might supraperiosteal injections sometimes fail to achieve profound anesthesia, particularly in the region of the maxillary first molar?
-Supraperiosteal injections might fail to achieve profound anesthesia in the region of the maxillary first molar because dense bone in that area may impede the distribution of the anesthetic. Additionally, in cases of acute inflammation or infection, these injections may be ineffective or even contraindicated.
What are the three large nerve trunks originating from the trigeminal ganglion?
-The three large nerve trunks originating from the trigeminal ganglion are the ophthalmic (V1), the maxillary (V2), and the mandibular (V3) nerves.
What is the significance of understanding the density of bone in the maxilla compared to the mandible in the context of maxillary anesthesia?
-Understanding the density of bone in the maxilla, which is less dense than the mandible, is critical for maxillary anesthesia success. This is because the injections will only give anesthesia to the buccal areas unless a supplemental palatal injection is given. Visualization and the use of certain anesthetics, like articaine, can help achieve anesthesia in both buccal and palatal areas.
What are the advantages of using an aspirating breech loading reusable syringe?
-The aspirating breech loading reusable syringe has several advantages: it is long-lasting and sterilizable, allows the practitioner to visibly confirm the delivery of anesthesia through the needle, and enables visualization of a positive aspiration to ensure the needle is not in a blood vessel.
What factors should be considered when selecting a needle for local anesthesia administration?
-When selecting a needle, one should consider that it needs to be stainless steel and sterile, disposable, and the needle gauge size (diameter of the lumen), which affects the rigidity and deflection of the needle. The needle size is chosen based on the depth of penetration required for the procedure.
Why is it important to aspirate before injecting local anesthesia?
-Aspirating before injecting local anesthesia is crucial to ensure that the needle is not in a blood vessel. This helps to prevent intravascular injection, which can lead to systemic effects and complications from the anesthetic.
What is the purpose of applying topical anesthesia prior to the administration of local anesthesia?
-The purpose of applying topical anesthesia is to desensitize the mucosa before needle insertion, reducing the discomfort associated with the injection and ensuring a more comfortable experience for the patient.
What are the potential complications of the posterior superior alveolar nerve block, and how can these risks be reduced?
-Potential complications of the posterior superior alveolar nerve block include hematoma formation due to the proximity of the posterior superior alveolar artery and the pterygoid venous plexus. These risks can be reduced by using proper technique, avoiding excessive force, not redirecting the needle while embedded in tissue, and ensuring correct needle insertion points and angles.

Outlines

00:00

🎓 Dr. Gregory G Winter's Background and Maxillary Anesthesia Overview

Dr. Gregory G Winter, a clinical instructor at the University of Maryland School of Dentistry, discusses maxillary anesthesia. He explains the effectiveness of supraperiosteal injection techniques due to the thin alveolar bone of the maxilla, which allows anesthetic to reach nerve fibers. The video also covers alternative techniques such as infraorbital nerve block, posterior superior nerve block, and maxillary second division nerve block, emphasizing their utility in procedures involving multiple teeth. Additionally, the importance of understanding the maxillary bone's density and the use of artichane for effective anesthesia are highlighted.

05:01

🏥 Anatomy of the Maxillary Nerve and Patient Safety in Anesthesia Administration

The maxillary nerve, a division of the trigeminal nerve, is detailed in its anatomy and the structures it innervates, including the skin of the face, mucosa of the nasopharynx, and maxillary teeth. The video stresses the significance of the bone's density in maxillary anesthesia and the role of visualization. It also outlines objectives for patient safety and comfort during anesthesia, including the proper care and handling of contaminated needles and cartridges, and the selection of appropriate needle gauges based on the required depth of penetration.

10:02

🧵 Needle Selection and Topical Anesthesia Application

The paragraph focuses on the advantages of using an aspirating breech loading reusable syringe and the considerations for selecting a needle, such as its material, sterility, and disposability. It discusses the characteristics of different gauge needles and their applications, from blocks to infiltrations. The importance of aspiration to ensure the needle is not in a blood vessel is emphasized. Additionally, the use of topical anesthesia with benzocaine to desensitize the mucosa before needle insertion is explained, noting its low overdose risk and systemic absorption.

15:02

📍 Landmarks and Techniques for Infraorbital Nerve Block

The video describes how to perform an infraorbital nerve block, which anesthetizes all peripheral branches of the infraorbital nerve in one injection. It details the process for locating the infraorbital foramen and the vertical approach for the injection, including anatomical landmarks and the depth of penetration. The importance of correct needle orientation and the advantages it offers, such as preventing accidental eye puncture and aiding the spread of anesthetic, are also highlighted.

20:03

🦷 Posterior Superior Alveolar Nerve Block and Its Considerations

The posterior superior alveolar (PSA) nerve block is a technique-sensitive procedure that anesthetizes the mucosa and pulps of all maxillary molars. The video outlines the target site for the PSA block, the insertion site, and the potential complications, such as hematoma formation. It also discusses ways to reduce the risk of these complications, including proper needle insertion and avoiding redirection while embedded in tissue.

25:04

🌟 Middle and Anterior Superior Alveolar Nerve Blocks

The middle superior alveolar (MSA) nerve block is used to anesthetize the maxillary first and second premolars when other injections fail to do so. The video describes the anatomical landmarks for the MSA injection site and the recommended volume of solution. It also covers the anterior superior alveolar (ASA) nerve block, which anesthetizes the central, lateral, and canine areas, detailing the injection site and the recommended volume and rate of deposition.

30:05

🌈 Nasopalantine Nerve Block and Maxillary Nerve Block Techniques

The nasopalantine nerve block is used for pain management of palatal soft and osseous tissues. The video explains the technique for identifying the greater palatine foramen and the approach used for the block, including the insertion and deposition site. It also lists the structures anesthetized by the maxillary nerve block and describes the three approaches used to deliver the block injection, including the high tuberosity, terrigopalatine canal, and extra oral approaches.

35:06

🛡️ Safety and Technique in Local Anesthesia for Dentistry

The final paragraph emphasizes the importance of selecting the most appropriate technique for patient safety and the foundation of successful clinical dentistry that safe local anesthesia provides. It stresses the need for a thorough understanding of local anesthetic techniques and their anatomical basis. The video advises clinicians to consult full prescribing information before using any drugs or devices discussed in the program.

Mindmap

Keywords

💡Maxillary Anesthesia

Maxillary anesthesia refers to the process of numbing the upper jaw to eliminate pain during dental procedures. It is a critical technique in dentistry, as it ensures patient comfort and allows for a range of dental treatments to be performed without discomfort. In the video, various techniques for achieving maxillary anesthesia are discussed, including the supraperiosteal injection and the infraorbital nerve block.

💡Supraperiosteal Injection

A supraperiosteal injection is a method used to administer local anesthesia to the maxillary teeth. It involves injecting the anesthetic just above the bone, which then diffuses through the thin alveolar bone to reach the nerve fibers. This technique is highlighted in the video as a common approach for anesthetizing individual teeth or an entire quadrant of the maxilla.

💡Trigeminal Nerve

The trigeminal nerve, also known as the fifth cranial nerve, is the primary nerve responsible for sensation in the face. It has three main divisions: ophthalmic (V1), maxillary (V2), and mandibular (V3). The maxillary division is particularly relevant to the video, as it provides sensory innervation to the upper jaw, teeth, and associated structures. Understanding the anatomy of the trigeminal nerve is crucial for effectively performing maxillary anesthesia.

💡Anesthetic Cartridges

Anesthetic cartridges are sterile, single-use containers that hold the local anesthetic solution used in dental procedures. They are an essential component in the administration of local anesthesia, as they ensure the precise and safe delivery of the anesthetic. The video discusses the use of cartridges in conjunction with aspirating syringes for safe and effective anesthesia delivery.

💡Needle Gauge

The needle gauge refers to the diameter of the needle's lumen, with smaller gauge numbers indicating larger diameters. In dentistry, different gauge needles are used for various purposes, such as infiltration or nerve blocks. The choice of needle gauge can affect the depth of penetration and the patient's comfort. The video mentions 25, 27, and 30 gauge needles, with the former being more rigid and suitable for blocks, while the latter is used for infiltration.

💡Infraorbital Nerve Block

The infraorbital nerve block is a specific injection technique used to anesthetize the maxillary teeth and associated structures. It targets the infraorbital foramen, which is a small opening in the bone that houses the infraorbital nerve. By injecting the anesthetic at this site, dentists can achieve anesthesia for multiple teeth in the upper jaw. The video provides a detailed explanation of how to locate the infraorbital foramen and perform the block.

💡Posterior Superior Alveolar Nerve Block

The posterior superior alveolar (PSA) nerve block is a technique used to anesthetize the maxillary molars and their surrounding tissues. It involves injecting the anesthetic near the maxillary nerve as it enters the pterygopalatine fossa. The video discusses the anatomical considerations and the potential complications, such as hematoma formation, associated with this block.

💡Local Anesthesia Safety

Ensuring patient safety during the administration of local anesthesia is paramount. The video emphasizes the importance of proper needle care, including the use of protective shields and sharps containers, as well as the practice of aspiration to avoid intravascular injection. These measures minimize the risk of infection and other adverse effects associated with the use of local anesthetics.

💡Topical Anesthesia

Topical anesthesia is a type of anesthetic that is applied directly to the surface of the skin or mucous membranes to reduce discomfort prior to an injection or minor procedure. The video mentions the use of benzocaine, a common topical anesthetic, to desensitize the injection site. This preliminary step can enhance patient comfort and facilitate the administration of local anesthesia.

💡Anatomical Landmarks

Anatomical landmarks are specific, identifiable structures on the body that help guide medical and dental procedures. In the context of maxillary anesthesia, landmarks such as the infraorbital foramen, the zygomatic process, and the maxillary tuberosity are crucial for accurately locating injection sites. The video provides detailed instructions on how to identify these landmarks to ensure the success of various anesthesia techniques.

💡Aspiration Technique

The aspiration technique is a safety measure used during the administration of local anesthesia to prevent accidental intravascular injection. By pulling back on the syringe plunger before injecting, dentists can check for blood in the needle, which would indicate that the needle is positioned within a blood vessel. The video stresses the importance of performing two negative aspirations to ensure patient safety.

Highlights

Dr. Gregory G. Winter completed his DDS from the Baltimore College of Dental Surgery, University of Maryland School of Dentistry and received additional training at the University of Pittsburgh School of Dental Medicine and York Hospital.

Local anesthesia of the maxilla is commonly achieved by supraperiosteal injection due to the thin porous nature of the alveolar bone.

Profound anesthesia may not be obtained in the region of the maxillary first molar where dense bone may impede distribution of anesthetic.

Three alternative approaches for anesthesia in the maxilla include the infraorbital nerve block, the posterior superior nerve block, and the maxillary second division nerve block.

The maxillary nerve is exclusively sensory and innervates various facial structures including the skin, mucosa, and maxillary teeth.

Visualization is a key factor in maxillary anesthesia success, with artichane providing buccal and lingual anesthesia in almost 90% of cases.

Aspirating breech loading reusable syringe has advantages such as being long-lasting, sterilizable, and allowing visualization of anesthesia delivery.

Needle selection involves considering stainless steel, sterility, disposability, and the number of uses before dulling.

Different gauge needles (25, 27, 30) are chosen based on the depth of penetration needed for anesthesia.

Aspirating twice ensures not being in a blood vessel and is crucial for successful local anesthesia.

Proper care and handling of contaminated needles and cartridges are essential to reduce the risk of sharps exposure.

Topical anesthesia with benzocaine is used to desensitize the mucosa before needle insertion, with minimal risk of overdose.

The infraorbital nerve block anesthetizes all peripheral branches of the infraorbital nerve in one injection.

The posterior superior alveolar nerve block is technique-sensitive and has a risk of hematoma formation.

The middle superior alveolar field block is used to ensure complete anesthesia of the maxillary first molar if not achieved with other injections.

The anterior superior alveolar nerve block anesthetizes the maxillary central incisor through the canine on the injected side.

Nasopalatine nerve blocks are used for pain management of palatal soft and osseous tissue in the anterior third of the palate.

The maxillary nerve block anesthetizes the entire quadrant of the maxilla and can be performed using three different approaches.

Successful and safe local anesthesia is fundamental for providing high-quality dentistry in a pain-free environment.

Transcripts

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Dental Anesthesia Maxillary Block Patient Safety Gregory G Winter Local Anesthetic Injection Techniques Oral Surgery Dental Hygiene Anesthesia Courses Trigeminal Nerve Clinical Instructor