3. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
The main factors to be concerned are:
1. Selection of a suitable syringe and needle
2. Utilization of the proper L.A. drug
3. Insertion of the needle in the correct site for
injection
– Point of insertion
– Direction of needle injection
4. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Local Anesthesia
1. Topical anesthesia
2. Local infiltration
3. Field block
4. Nerve block
5. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Local Anesthesia
• Topical Anesthesia
– Ointments, gels, sprays and pastes on mucous
membrane or skin
– Application of a topical anesthetic agent on the
mucosa allows for the easy and painless insertion
of the sharp needle
– Affects free nerve endings
6. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Local Anesthesia
• Local Infiltration
– Flooding of the small terminal nerve endings with
local anesthetic solution
7. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Local Anesthesia
• Field Block
– Referred to as local infiltration
– local anesthetic solution is deposited in the
vicinity of larger terminal nerve fiber
– so a circumscribed area is anesthetized
– Local anesthesia injection above a tooth apex is
an example of a field block, in spite of being
referred to as paraperiosteal or supraperiosteal
infiltration anesthesia
8. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Local Anesthesia
• Nerve Block
– The anesthetic solution is deposited close to a
main nerve trunk
– Usually at a distance from the operative site
before the nerve divided into terminal branches
9. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Factors affecting selection of the
technique to be used
1. Area to be anesthetized
Depending on the type of bone (density of bone)
– Maxilla and anterior mandibular region
• Cancellous bone with thin cortical layer
• Infiltration anesthesia or field block anesthesia reaches the nerve
filaments inside the cancellous bone
– Posterior mandible
• Thick and dense cortical bone
• Nerve block anesthesia
10. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Factors affecting selection of the
technique to be used Cont.
2. Extent of surgical procedure
– Multiple extractions, nerve block anesthesia is
preferable
• Allow anesthesia of the entire operative area
• Prevent multiple needle punctures
11. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Factors affecting selection of the
technique to be used Cont.
3. Duration and profoundness of anesthesia
Nerve block anesthesia produces a more profound
and longer duration than infiltration anesthesia
4. Age of the patient
Older individuals have dense bone, thus it is more
difficult for infiltration anesthesia to penetrate into
the bone
12. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Factors affecting selection of the
technique to be used Cont.
5. Hemostasis
When required for the procedure, infiltration
anesthesia is recommended to allow the
vasoconstrictor present with the local
anesthetic to act directly on the blood vessels
and reduce bleeding
13. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Factors affecting selection of the
technique to be used Cont.
6. Presence of infection
Infiltration anesthesia should be avoided to
prevent injection into an infected area which
can spread the infection
7. Skill of the operator
15. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
The most commonly used technique
It is divided into
Soft tissue infiltration
Submucosal
Paraperiosteal
Bony infiltration
16. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Soft tissue infiltration anesthesia
In this technique anesthesia is deposited into
the soft tissue in close proximity to bone which
is then absorbed via pores in the bone surface
till it reaches the nerve filament inside the
cancellous bone
19. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Soft Tissue Infiltration
Submucosal anesthesia
Needle is inserted at a slight
depth just below the
mucous membrane
In cases just need
superficial anesthesia
Hypertrophied tissue
High muscle attachment
Paraperiosteal Anesthesia
Called local infiltration
Mostly used for anesthetizing
All maxillary teeth
Lower anterior mandibular teeth
It’s action depends on the
diffusion of the L.A. solution
through the periosteum and
the minute foramina in the
cortical bone
20. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Soft Tissue Infiltration
• Subperiosteal injection
– Not be attempted
– Because of
• Liability of needle breakage
• Difficulty of forcing the anesthetic agent between
periosteum and bone
21. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Paraperiosteal Anesthesia
Advantages
1. High success rate
2. Technically it is an easy
injection
3. Usually it is entirely
atraumatic
Disadvantages
• Not suitable for large areas
– Needs multiple punctures
– Administeration of large
amount of L.A. solution
22. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
CHAIR POSITION – DENTIST POSITION
RIGHT HANDED OPERATOR – RIGHT SIDE
Infiltration Anesthetic Techniques
24. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Adjusting the backrest
Adjust the head rest so that the
head , neck and trunk become on
the same straight line
25. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Adjusting the backrest
Adjust the head rest so that
the head , neck and trunk
become on the same straight
line
The back of the chair is tilted
so that it make a 45 degree
angle with the floor
26. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Adjusting the backrest
So that when the patient
open his mouth the occlusal
plane of the maxillary teeth
makes nearly 45 degree with
the floor
27. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
So that when the patient
open his mouth the occlusal
plane of the maxillary teeth
makes 45 degree with the
floor
The occlusal plan of maxillary
teeth near to the operator’s
shoulder
28. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Adjusting the dental
chair level
Working in maxillary
teeth
Elevate the chair from the
zero position after
adjusting the back rest the
occlusal plan of maxillary
teeth near to the
operator’s shoulder
N.B. the operator stands
infront and to the right
29. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Adjusting the dental
chair level
Working in mandibular
teeth
Elevate the chair from the
zero position after
adjusting the back rest so
that The occlusal plan of
maxillary teeth near to the
operator’s shoulder
N.B. the operator stands
infront and to the right
except during working in
lower right posterior teeth
30. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
For working in lower
right posterior teeth
the chair is lowered
and tilted enough to
enable the operator
to have a clear view
to the field from rear
right position
35. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Keep In Mind
• Chair position (right handed – right side)
• Dentist position (right handed – right side)
• Nerve to be anesthetized
• Armamentarium: Syringe (type) - Needle (size)
• Landmarks (soft tissue – bony)
• Technique
– Point of insertion
– Direction of insertion
• Confirming the anesthesia (subjective – 0bjective)
36. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Buccal infiltration anesthesia
Patient position
• Head , neck and trunk on the
same straight line
• The back of the chair is tilted so
that it make a 45 degree angle
with the floor
• So that when the patient open his
mouth the occlusal plane of the
maxillary teeth makes 45 degree
with the floor
• The occlusal plan of maxillary
teeth near to the operator’s
shoulder
Dentist position
• From infront and to the
right
38. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Buccal infiltration anesthesia Cont.
• Needle:
– 25-27 gauge
– Short needle
• Syringe
– Non-Aspirating syringe
• The target area
– The apical region of the tooth to be anesthetized
39. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Buccal Infiltration Technique Cont.
The point of needle insertion
The point of intersection of 2
imaginary lines
• 1st line is a vertical line
parallel to the long axis of
the tooth
• 2nd line is a horizontal line
along the mucobuccal fold
40. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Buccal Infiltration Technique Cont.
Direction of needle insertion
• 45° with the buccal cortical
plate of bone
43. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Steps for buccal infiltration
The lip/cheek is retracted using dental mirror or your
finger to make almost a right angle with the
labial/buccal aspect of the jaw
The point of insertion is determined as mentioned
The needle is inserted with its bevel toward the bone
and making an angle of 45° with the buccal aspect
The needle is pushed through the soft tissue until
the bone is reached (within 2mm)
44. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Steps for buccal infiltiration Cont.
The needle is held firmly and 1.5cc of the solution is
slowly deposited for buccal/labial injection, and 0.3
cc for lingual anesthesia
The needle is then withdrawn gently and recap it
Wait 2-3 minutes before starting your dental
procedure
Check your anesthesia using the dental probe
(objective finding)
45. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Confirming the Anesthesia
• Subjective findings
– No subjective findings
• Objective findings
– Probing does not lead to pain
47. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
When you are performing any dental work
except extraction then the buccal infiltration is
enough
but
when it comes to extraction then also a Palatal
injection is to be given
48. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Palatal Infiltration Technique
The point of needle insertion
Midway between the
gingival margin of the tooth
and the median palatine
raphe
Along the long axis of the
tooth
49. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Palatal Infiltration Technique Cont.
Direction of needle insertion
• 90° to the palatine bone
53. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Steps for palatal infiltration
A mirror is used to retract the tongue and reflect the
light to the point of insertion
The point of insertion is determined as mentioned
The needle is inserted from the opposite side making
90° degree with the palate
The needle is pushed through the soft tissue until
the bone is reached (within 2mm)
On touching the palatal bone deposit 0.3 ml. SLOWLY
54. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Confirming the Anesthesia
• Subjective findings
– No subjective findings
• Objective findings
– Probing does not lead to pain
55. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Variations in these techniques
Buccal anesthesia
Injection for the maxillary
third molar
Made opposite to the
maxillary second molar
tooth to avoid injury to the
pterygoid plexus of veins
upper centrals
Inject a few drops to the
apical area of the other
central incisor
Palatal anesthesia
• Injection for maxillary third
molar should be at the
palatal root of the maxillary
second molar to avoid
anesthesia of the lesser
palatine nerves which
supply the soft palate and
may lead to gagging
sensation
56. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Variations in these techniques Cont.
Buccal anesthesia Palatal anesthesia
Upper centrals and laterals
Given 0.5 mm along the
palatal long axis of the
tooth while entering from
the opposite side
57. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Bony infiltration anesthesia
• In this technique anesthesia is deposited
directly into the bone in close proximity to the
nerve filaments inside the cancellous bone
• Very rarely used
58. Maxillay Infiltration Anesthetic Techniques
Hesham El-Hawary
Bony Infiltration Anesthesia
(Intra osseous)
Techniques
• A special needle is used to
drill and pierce the outer
cortical plate
• Using rose head round bur
(#2)
Advantages
1. Very profound anesthesia
2. When other techniques have
failed
Disadvantages
1. The needle easily get clogged
2. The needle could fracture
3. Painfull
4. Cause infection inside the bone
