DEN 035: Anesthesiology (Lecture)
Student Activity Sheet Module #12
12
Name:______________________________________________________________ Class number: _______
Section: ____________ Schedule: ______________________________________ Date: _______________
LESSON TITLE: TECHNIQUES OF MAXILLARY ANESTHESIA MATERIALS:
Ballpens, erasers, pencils,
LESSON OBJECTIVES: highlighter, scratch paper and
At the end of the module, you will be able to: module
1. Identify the different Maxillary techniques used in the field of
Dentistry. REFERENCES:
2. Relearn the oral anatomical landmarks. Handbook of Local
3. Know more about each technique with regards to the compatible Anesthesia 4th Edition,
needle to use. Stanley F. Malamed. (1997)
PRODUCTIVITY TIP:
Good day! You are about to start your module. Do short stretching and breathing exercises. After you are done, sit
down, be comfortable and say a short prayer. You are now ready to start your work. Enjoy and learn!
A. LESSON PREVIEW/REVIEW
Introduction (2 minutes)
Welcome to DEN 035: Anesthesiology (Lecture) ! The module today will focus on the basic knowledge
you need to learn about Anesthesiology with regards to the different maxillary techniques to achieve a
good local anesthesia in the injection site.
Activity 1: What I Know Chart, part 1 (3 minutes)
Kindly fill up the column “What I Know” only for Activity 1. The third column “What I Learned” should be
left blank as it will be answered later on when you reach Activity 4. Write T if the statement is true and
write F is the statement is false.
What I Know (Activity 1) Questions: What I Learned (Activity 4)
1. Lacrimal Nerve is part of
the Maxillary Nerve.
2. Mental nerve is part of the
Maxillary Nerve.
3. Posterior Superior Alveolar
nerve is a part of the Maxillary
Nerve.
This document is the property of PHINMA EDUCATION
DEN 035: Anesthesiology (Lecture)
Student Activity Sheet Module #12
12
Name:______________________________________________________________ Class number: _______
Section: ____________ Schedule: ______________________________________ Date: _______________
B.MAIN LESSON
Activity 2: Content Notes (10 minutes)
A number of injection techniques are available to aid in providing clinically adequate anesthesia of the teeth
and soft and hard tissues in the maxilla. Selection of the specific technique to be used is determined, in large
part, by the nature of the treatment to be provided. The available techniques are as follows:
1. Supraperiosteal (infiltration), recommended for limited treatment protocols.
2. Periodontal ligament (PDL, intraligamentary) injection recommended as an adjunct to other techniques or for
limited treatement protocols.
3. Intraseptal injection, recommended primarily for periodontal surgical techniques.
4. Intraosseous injection, recommended for single teeth when other techniques have failed.
5. Posterior Superior Alveolar Nerve block, recommended for management of several molar teeth in one
quadrant.
6. Middle Superior Alveolar Nerve block, recommended for management of premolars in one quadrant.
7. Anterior Superior Alveolar Nerve block (infraorbital) recommended for management of anterior teeth in one
quadrant.
8. Maxillary (2nd division) Nerve block, recommended for extensive buccal, palatal, and pulpal management in
one quadrant.
9. Greater (anterior) Palatine Nerve block, recommeneded for palatal soft and osseous tissue treatment distal
to the canine in one quadrant.
10. Nasopalatine Nerve block, recommended for palatal soft and osseous tissue management from canine to
canine bilaterally.
SUPRAPERIOSTEAL INJECTION
The supraperiosteal injection more commonly called local infiltration, is the most frequently used local
anesthetic technique for obtaining pulpal anesthesia in the maxillary teeth.
Other names: Local infiltration, paraperiosteal injection
Nerves anesthetized: Large terminal branches of the dental plexus.
Areas anesthetized: The entire region innervated by the large terminal branches of this plexus: pulp, and root
area of the tooth, buccal periosteum, connective tissue, mucuos membrane.
Indication: Pulpal anesthesia of the maxillary teeth when treatment is limited to 1 or 2 teeth. Soft tissue
anesthesia when indicated for surgical procedure in a circumscribed area.
Needle to be used: 25 or 27 gauge short needle
Area of insertion: Height of the mucobuccal fold above the apex of the tooth to be anesthetized.
POSTERIOR SUPERIOR ALVEOLAR NERVE BLOCK
Other names: Tuberosity block, Zygomatic block,PSA Nerve Block
Nerves anesthetized: . Posterior Superior Alveolar and branches
Areas anesthetized: Pulps of the Maxillary 3rd, 2nd, and 1st molar except for the Mesiobuccal root. Other areas
anesthetized are the buccal periodontium and bone overlying these teeth.
This document is the property of PHINMA EDUCATION
DEN 035: Anesthesiology (Lecture)
Student Activity Sheet Module #12
12
Name:______________________________________________________________ Class number: _______
Section: ____________ Schedule: ______________________________________ Date: _______________
Indication: When the treatment involves one or two maxillary molars, when supraperiosteal injection technique
is contraindicated and when supraperiosteal injection technique is inefffective.
Needle to be used: 25 gauge short needle is recommended, though the 27 gauge short is more likely available
and is also acceptable.
Area of insertion: Height of the mucobuccal fold above the 2nd maxillary molar.
Landmarks: Mucobuccal fold, Maxillary Tuberosity, and Zygomatic process of the Maxilla.
MIDDLE SUPERIOR ALVEOLAR NERVE BLOCK
Other names: MSA Nerve block
Nerves anesthetized: . Middle Superior Alveolar and terminal branches
Areas anesthetized: Pulps of the Maxillary 1st and 2nd premolar, mesiobuccal root of the 1st molar. Buccal
periodontal tissues and bone over these same teeth.
Indication: When the treatment involves both maxillary premolars.
Needle to be used: 25 gauge short or long needle is recommended, though the 27 gauge short is more likely
available and is also acceptable.
Area of insertion: Height of the mucobuccal fold above the 2nd maxillary premolar.
Landmarks: Mucobuccal fold above the maxillary second premolar.
ANTERIOR SUPERIOR ALVEOLAR NERVE BLOCK
Other names: Infraorbital Nerve block
Nerves anesthetized: ASA, MSA, and Infraorbital Nerve (Inferior palpebral, lateral nasal and superior labial).
Areas anesthetized: Pulps of the Maxillary Cental incisor through the canine of the injected side. Labial
periodontium and bone of the same teeth, Lower eyelid, lateral aspect of the nose and the upper lip.
Indication: When the treatment involves more than two maxillary teeth and their overlying buccal tissues. When
the supraperiosteal injection have been ineffective because of dense cortical bone.
Needle to be used: 25 gauge longneedle is recommended, though the 25 gauge short may be used especially
for children and smaller adults.
Area of insertion: Height of the mucobuccal fold directly over first premolar.
Landmarks: Mucobuccal fold, infraorbital notch, infraorbital foramen.
GREATER PALATINE NERVE BLOCK
Other names: Anterior palatine nerve block.
Nerves anesthetized: Greater palatine
Areas anesthetized: The posterior portion of the hard palate and its overlying soft tissues, anteriorly as far as
the first premolar and medially to the midline.
Indication: When the palatal soft tissue anesthesia is required for restorative therapy on more than two teeth.
For pain control during periodontal or oral surgical procedures involving the palatal soft and hard tissues.
Needle to be used: 27 gauge short needle is recommended, though the 25gauge short may also be used.
Area of insertion: Soft tissue slightly anterior to the greater palatine foramen.
Landmarks: greater palatine foramen and junction of the maxillary alveolar process and palatine bone.
This document is the property of PHINMA EDUCATION
DEN 035: Anesthesiology (Lecture)
Student Activity Sheet Module #12
12
Name:______________________________________________________________ Class number: _______
Section: ____________ Schedule: ______________________________________ Date: _______________
NASOPALATINE NERVE BLOCK
Other names: Incisive nerve block, sphenopalatine nerve block
Nerves anesthetized: Nasopalatine nerves bilaterally.
Areas anesthetized: Anterior portion of the hard palate from the mesial of the right first premolar to the mesial
of the left first premolar.
Indication: When palatal soft tissue anesthesia is required for restorative therapy on more than two teeth and
for pain control during periodontal or oral surgical procedures involving palatal soft and hard tissues.
Needle to be used: 27gauge short needle is recommended, though the 25 gauge short may be used.
Area of insertion: Palatal mucosa just lateral to the incisive papilla (located in the midline behind the central
incisors); the tissue here is more senstive than other palatal mucosa.
Landmarks: Central Incisor and incisive papilla.
LOCAL INFILTRATION OF THE PALATE
Other names: None
Nerves anesthetized:Terminal branches of the nasopalatine and greater palatine.
Areas anesthetized: Soft tissues in the immediate vicinity of injection.
Indication: Primarily for achieving hemostasis during surgical procedures.
Needle to be used: 27 gauge short needle is recommended, though the 25 gauge short is more likely available
and is also acceptable.
Area of insertion: the attached gingiva 5 to 10mm from the free gingivak margin.
Landmarks: Gingival tissue
MAXILLARY NERVE BLOCK
Other names: Second division block, V2 nerve block
Nerves anesthetized: Maxillary division of the trigeminal nerve
Areas anesthetized: Pulpal anesthesia of the maxillary teeth on the side of the block. Buccal periodontium and
bone overlying these teeth. Soft tissue and bone of the hard palate and part of the soft palate, medially to the
midline. Skin of the lower eyelid, side of the nose, cheek and upper lip.
Indication:Pain control prior to extensive oral surgerical, periodontal or restorative procedures requiring
anesthesia of the entire maxillary division. When tissue inflammation or infection precludes the use of other
regional nerve blocks or supraperiosteal injeciton. Diagnostic or therapeutic procedures of neuralgias or tics of
the second division of the trigeminal nerve.
Needle to be used: 25 gauge long needle is recommended.
Area of insertion: Height of the mucobuccal fold above thedistal aspect of the Maxillary 2nd molar.
Landmarks: Mucobuccal fold at the distal aspect of the Max. 2nd molar, Maxillary Tuberosity, and Zygomatic
process of the Maxilla.
This document is the property of PHINMA EDUCATION
DEN 035: Anesthesiology (Lecture)
Student Activity Sheet Module #12
12
Name:______________________________________________________________ Class number: _______
Section: ____________ Schedule: ______________________________________ Date: _______________
Activity 3: Skill-building Activities
Complete the table based on the given information in your content notes above. These are the following words
missing in the table: Infiltration(4), infraorbital (2), Middle Superior Alveolar(2) and Posterior Superior Alveolar
(2), Place your answers in the underlined spaces provided. This activity is worth 20 points.
Maxillary Teeth and Available Local Anesthetic Techniques
Soft Tissue
Teeth Pulpal
BUCCAL PALATAL
Infraorbital Infraorbital Nasopalatine
Incisors
Infiltration Infiltration _____________
____________ Infraorbital Nasopalatine
Canine ____________ Infiltration _____________
Infraorbital ____________ ____________
Premolars ____________ MSA Infiltration
____________ Infiltration
____________ _____________ Greater Palatine
Molars Infiltration Infiltration Infiltration
Activity 4: What I Know Chart, part 2 (2 minutes)
Go back to the “What I Know Chart” in Activity 1 and answer the “What I Learned” column.
Activity 5: Define these words for better understanding (5 minutes)
Hemostasis-
Hematoma-
This document is the property of PHINMA EDUCATION
DEN 035: Anesthesiology (Lecture)
Student Activity Sheet Module #12
12
Name:______________________________________________________________ Class number: _______
Section: ____________ Schedule: ______________________________________ Date: _______________
C. LESSON WRAP-UP
Activity 6: Thinking about Learning (5 minutes)
A. Work Tracker
You are done with this session! Let’s track your progress. Shade the session number you just
completed.
B. Think about your Learning:
Please answer the following questions:
1) Please rate your activity today by placing a check mark (/) before a choice. Please explain your
choice on the blank space beside the table:
1. Boring
2. Not informative
3. Challenging
4. Fair
5. Fun
2) “What details in the content and/or activities were not clear to you?”
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
D. FREQUENTLY ASKED QUESTIONS:
What injection is commonly used for maxillary teeth? The techniques most commonly
used in maxillary anesthesia include supraperiosteal (local) infiltration, periodontal ligament
(intraligamentary) injection, PSA nerve block, MSA nerve block, anterior superior alveolar nerve block,
greater palatine nerve block, nasopalatine nerve block, local infiltration of the palate,
Where is the maxillary nerve? The maxillary nerve is the second division of the trigeminal nerve and is
also known as the V2 division. This nerve is the middle division of the trigeminal nerve and is attached to
the distal convex border of the trigeminal ganglion. The maxillary nerve exits from the cranial cavity
through the foramen rotundum.
___________________________
AMELIE MIRA E. GRAUEL, DMD,
Associate Professor
Southwestern University PHINMA - College of Dentistry
This document is the property of PHINMA EDUCATION
