Middle Superior Alveolar Nerve Middle Superior Alveolar Nerve BlockBlock

Nerve Anesthetized Nerve Anesthetized ::

Middle Superior Alveolar NerveMiddle Superior Alveolar Nerve

- Maxillary premolars and buccal tissues- Maxillary premolars and buccal tissues

Areas AnesthetizedAreas Anesthetized

Pulpal anesthesia of first & second premolars Pulpal anesthesia of first & second premolars and mesiobuccal root of first molarand mesiobuccal root of first molar

Buccal soft tissues and bone over same teethBuccal soft tissues and bone over same teeth

IndicationsIndications

Anesthesia of maxillary premolars onlyAnesthesia of maxillary premolars only

Infraorbital nerve block failureInfraorbital nerve block failure

ContraindicationsContraindications

Infection /inflammation in area of injectionInfection /inflammation in area of injection

AdvantageAdvantage

Minimized number of injectionsMinimized number of injections

Minimized volume of solutionMinimized volume of solution

DisadvantageDisadvantage

MSA nerve is only present 28% of the time MSA nerve is only present 28% of the time

AlternativesAlternatives

Local infiltration (supraperiosteal)Local infiltration (supraperiosteal)

Periodontal ligament injection (PDL)Periodontal ligament injection (PDL)

Infraorbital nerve block Infraorbital nerve block

Landmarks / Area of InsertionLandmarks / Area of Insertion

Mucobuccal fold above second premolarMucobuccal fold above second premolar

Apex of second premolarApex of second premolar

Signs and SymptomsSigns and Symptoms

Numb upper lipNumb upper lip

Pain free dental therapyPain free dental therapy

Safety Features Safety Features

Anatomically safe (no signifcant structures)Anatomically safe (no signifcant structures)

Relatively avascular areaRelatively avascular area

positive aspirations - negligible (< 3%)positive aspirations - negligible (< 3%)

Complications are rareComplications are rare

Technique - MSATechnique - MSA

Apply topicalApply topical

Position patient and identify landmarksPosition patient and identify landmarks

Insert needle 5-10 mmInsert needle 5-10 mm

AspirateAspirate

Inject 0.9 ml of solution, slowlyInject 0.9 ml of solution, slowly

Failures of AnesthesiaFailures of Anesthesia

Needle inserted too high, or not high enoughNeedle inserted too high, or not high enough

Deposition of solution too far laterally Deposition of solution too far laterally

Infraorbital Nerve BlockInfraorbital Nerve Block

Nerves AnesthetizedNerves Anesthetized

Anterior Superior Alveolar NerveAnterior Superior Alveolar Nerve

Middle Superior Alveolar NerveMiddle Superior Alveolar Nerve

Superior Labial NerveSuperior Labial Nerve

alsoalso

Inferior Palpebral NerveInferior Palpebral Nerve

Lateral Nasal NerveLateral Nasal Nerve

Areas AnesthetizedAreas Anesthetized

Pulpal anesthesia of maxillary anterior teethPulpal anesthesia of maxillary anterior teeth

Pulpal anesthesia of premolars and mesiobuccal Pulpal anesthesia of premolars and mesiobuccal root of first molarroot of first molar

Buccal soft tissue and bone of same teethBuccal soft tissue and bone of same teeth

Lower eyelid, lateral nose, and upper lipLower eyelid, lateral nose, and upper lip

IndicationsIndications

Anesthesia of more than two maxillary teethAnesthesia of more than two maxillary teeth

Supraperiosteal injections ineffectiveSupraperiosteal injections ineffective

Inflammation/infection contraindicating local Inflammation/infection contraindicating local infiltrationinfiltration

ContraindicationsContraindications

Discrete treatment areas (1-2 teeth only)Discrete treatment areas (1-2 teeth only)

HemostasisHemostasis

Bleeding problems (eg. hemophelia, etc..)Bleeding problems (eg. hemophelia, etc..)

LandmarksLandmarks

Mucobuccal fold above first premolarMucobuccal fold above first premolar

Infraorbital notchInfraorbital notch

Infraorbital foramenInfraorbital foramen

Area of InsertionArea of Insertion

Mucobuccal fold above first premolarMucobuccal fold above first premolar

Target areaTarget area

Infraorbital foramenInfraorbital foramen

Neurovascular bundleNeurovascular bundle

AdvantagesAdvantages

Comparatively simple, safe techniqueComparatively simple, safe technique

Minimized volume of solutionMinimized volume of solution

Minimized number of needle puncturesMinimized number of needle punctures

DisadvantagesDisadvantages

PsychologicalPsychological

Administrator- fear of eye involvementAdministrator- fear of eye involvement

Patient- apprehension of extraoral approachPatient- apprehension of extraoral approach

AnatomicalAnatomical

Difficulty defining landmarksDifficulty defining landmarks

AlternativesAlternatives

Supraperiosteal injection for each toothSupraperiosteal injection for each tooth

Maxillary nerve blockMaxillary nerve block

Signs and SymptomsSigns and Symptoms

Tingling and numbness of lower eyelid, Tingling and numbness of lower eyelid, side side of nose, and upper lipof nose, and upper lip

Numbness in teeth and soft tissuesNumbness in teeth and soft tissues

No pain during dental therapyNo pain during dental therapy

Safety FeaturesSafety Features

Needle contacting boneNeedle contacting bone

Finger over infraorbital foramenFinger over infraorbital foramen

TechniqueTechnique

Apply topicalApply topical

Position patient and identify landmarksPosition patient and identify landmarks

Insert needle to Insert needle to upperupper rim of infraorbital rim of infraorbital foramenforamen

AspirateAspirate

Inject 0.9 ml of solution, slowlyInject 0.9 ml of solution, slowly

Failures of AnesthesiaFailures of Anesthesia

Bone contact below infraorbital foramenBone contact below infraorbital foramen

Needle deviates laterally or mediallyNeedle deviates laterally or medially

ComplicationsComplications

Hematoma (rare)Hematoma (rare)

Positive aspirations - 0.7 % Positive aspirations - 0.7 %