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CHAIR POSITIONINGAND L.A. TECHNIQUESMUHAMMAD HISHAM USMANI

CHAIR POSITIONING

PRINCIPLES OF SURGERY

Visibility AccessChair positioningTo avoid strain / fatigue

MAXILLARY TEETHPosterior superior alveolar nerve block.

Left PSA

Right PSA right handed administrator should sit at the 10 o clock position facing the pt.right handed administrator should sit at the 8 o clock position facing the pt.

MAXILLARY TEETHMiddle superior alveolar nerve block.

Left MSA

Right MSA right handed administrator should sit at the 10 o clock position facing the pt.right handed administrator should sit at the 8-9 o clock position facing the pt.

MAXILLARY TEETHAnterior superior alveolar nerve block.

Right handed administrator should sit at the 10 o clock position facing the pt or facing in the same direction as the pt.

MANDIBULAR TEETH

Pt must be supine or semisupine.

3rd quadrant

4th quadrant

9-11 o clock back of pt.7-9 o clock infront of pt.

L.A. TECHNIQUES

L.A IN MAXILLA Post. Sup. AlveolarMid. Post. AlveolarAnt. Sup. Alveolar Infra-orbital nerve block Greater palatine nerve blockNasopalatine nerve block

POST. SUP. ALVEOLARAreas anesthesized corresponding alveolar bone and buccal gingival tissue to max- 1st 2nd & 3rd molar

Area of insertion: height of mucobuccal fold above the 2nd max molar

TECHNIQUE

MID. SUP. ALVEOLARUsed to anesthesize max.premolar, corresponding alveolar & buccal gingival tissue.Area of insertion: is height of mucobuccal fold in area of the apex of 1st & 2nd premolar

TECHNIQUE

ANT. SUP. ALVEOLARUsed to anesthesized max-centrals & lat. Canines & buccal gingivaArea of insertion: is height of mucobuccal fold over the max. 1st premolar targeting infra orbital foramen

TECHNIQUE

INFRAORBITAL NERVE BLOCKUse to anesthesize max. 1st & 2nd premolar, canine, laterals, centrals, corresponding alveolus bone & buccal gingivaCombines MSA & ASA blockalso cause anesthesia to lower eyelids, lat. aspect of nasal skin tissue & skin of infraorbital region

Palpate infraorbital foramen extra-orally, place thumb/index finger on region, retract the upper lip & buccal mucosa, area of insertion is mucobuccal fold over 1st premolar & canine area.

TECHNIQUE

GREATER PALATINE NERVE BLOCKCan be used to anesthesize that palatal soft tissue of teeth, post to max.canine & corresponding alveolus/ hard palate.Area of insertion is 1 cm medial from 1st/2nd max. molar on hard palate; palpate needle to find greater palatine foramen. Depth is usually < 10mmTECHNIQUE

NASOPALATINE NERVE BLOCKCan be used to anesthesize soft & hard tissue of max.anteriors, palate from canine to canineArea of insertion is incisive papilla into incisive foramen.

TECHNIQUE

SUPRA PERIOSTEAL TECHNIQUEAlso known as local infiltration Most commonIt blocks terminal nerve endings(dental plexus) near terminal branches.

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INDICATIONS

Confined to 1 or 2 teethSurgery involving 1 or 2 teeth

Major surgeryDense bone

CONTRAINDICATIONS

ADVANTAGES

Success rate is very high.90% effective. Easiest technique.

Not used in dense bone. Not used in large areas.

DISADVANTAGES

COMPLICATIONS

Allergy Paraesthesia of gingivaToxicity

LESS EFFECTIVE

InfectionAcute inflammationAbscessImproper techniqueNot a bone apexNot present at long axis of teeth

Video . . . !

L.A. IN MANDIBLEInfiltration technique donot work in adult mandible bone due to dense cortical boneNerve block are utilized to anesthesize inf. Alveolar, lingual & buccal nerve.

Inferior alveolar nerve block (IANB)Buccal nerve blockMental nerve blockIncisive nerve blockGOW gates techniqueVazirani akinosi techniqueTECHNIQUES

INF. ALVEOLAR NERVE BLOCK (IANB)

INDICATIONSMultiple extractionsMajor &minor surgeries

Young childrenHandicappedCONTRAINDICATIONS

ADVANTAGES

Whole quadrant block Major surgeries

Aspirate rate 15- 20 % Technique sensitiveLess success rate75% lingual nerve anesthesized

DISADVANTAGES

COMPLICATIONSTrismus hematomaToxicitypain

Video . . . !

LONG BUCCAL NERVE BLOCK

Can be used to anesthesize buccal soft tissues adjacent to mandibular molar.Apex of retromolar triangle between external and internal oblique ridge.

TECHNIQUE

MENTAL NERVECan be used to anesthesize mental nerve, incisive nerve and part of inferior alveolar nerve.Also anesthesizes sensory innervations to the buccal soft tissues lying anterior to the foramen and soft tissues of the lower lip and chin.

Inject the anesthetic solution in the vicinity of the mental foramen.

TECHNIQUE

INCISIVE NERVE BLOCKSame as for mental nerve.Directly over or anterior to mental foramen in the mucobuccal fold at the apices of the 1st and 2nd premolars..

GOW GATE TECHNIQUEThe needle is directed at the neck of condyle just under the insertion of lat. pterygoid muscle used for more extensive anesthesia or when there is failure of IANB.

VAZIRANI AKINOSI TECHNIQUE(closed mouth inj. tech)The syringe is advanced parallel to the max.occlusal plane at level of max.muco gingival junction. This is used when pt. cannot open his mouth

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