2012-3-19
Nerve Block Anesthesia
in Dentistry
Dept,of Oral & Maxillofac Surg,
Affiliated Ninth People’s Hospital
Shanghai Second Medical University
Xudong Wang,DDS,MD
2012-3-19
Local Anesthesia
REVIEW
? Topical Anesthesia(表面麻醉 )
? Local Infiltration( 局部浸润麻醉 )
? small area anesthetized (one or two teeth)
? solution deposited near terminal nerve endings
? 8 8,2 2 extractions
? Nerve Block ( 阻滞麻醉 )
? deposited near large nerve trucks
2012-3-19
Advantages of nerve block
? Larger analgesia area & avoid several injections
? Less dosage & long--lasting
? Away from the lesion -- avoid spreading of
infection & tumor seeding
? Less tissue deformity post-injection -- plastic
surgery
? Better Anesthetic Effectiveness
2012-3-19
? Ophthalmic Nerve
? Maxillary Nerve
? Mandibular Nerve
Anatomy of Trigeminal Nerve
(三叉神经 )
2012-3-19
? Maxillary Nerve Anesthesia
Posterior superior alveolar block（上牙槽后神经）
Infraorbital block (眶下神经）
Greater palatine block （腭大神经）
Nasopalatine block（鼻腭神经）
Less dense bone/ less anatomic variation
? Mandibular Nerve Anesthesia
Nerve Block Anesthesia
{
{
Buccal
Palatal
2012-3-19
Posterior Superior Alveolar Block
(PSA Block 上牙槽后神经阻滞,
Tuberosity Injection上颌结节注射法 )
? Spread of analgesia 麻醉范围
876 678
Pulp & alveolar process
Buccal
- gingiva(牙龈 )
- periodontium (牙周膜 )
- periosteum (骨膜 )
(mesiobuccal root)
2012-3-19
Posterior Superior Alveolar Block
(PSA Block)
? Injection site
7 7 distal apex
Mucobuccal fold ? Angulation
? Target area
2012-3-19
Posterior Superior Alveolar Block
(PSA Block)
? Depth of penetration
Average adult 16-20 mm
Small adult and children 14mm
1.5-2ml
? Injection amount
Pterygoid plexus(翼丛 )
? Time to effect
5-10 min
? Aspiration(回抽 )
Hematoma(血肿 )
2012-3-19
Posterior Superior Alveolar Block
2012-3-19
Infraorbital Block
(IO Block 眶下神经阻滞 )
? Indications
5 5 dental procedure
Upper lip & Paranasal Minor Surgery
? Landmark of
Infraorbital foramen(眶下孔 )
5-10mm below the infraorbital rim
1-4mm medial to the pupil of the eye
2012-3-19
Infraorbital Block
(IO Block 眶下神经阻滞 )
? Injection site
10mm lateral to the alar（鼻翼）
? Angulation
45-degree to the skin
superiorly/ posteriorly / laterally
? Depth of Penetration
1.5cm
? Injection amount
1-1.5ml
1cm
2012-3-19
Greater Palatine Block
(GP Block,anterior palatine block 腭前神经阻滞 )
? Spread of analgesia
Posterior portion of hard palate
Palatal
mucoperiosteum(粘骨膜 )
gingiva
alveolus
8-4 4-8
? Landmark of
greater palatine foramen（腭大孔）
2012-3-19
Infraorbital Block
(IO Block 眶下神经阻滞 )
2012-3-19
Greater Palatine Block
(GP Block)
Midway between the median palate raphi
and lingual gingival of the molar tooth
? Injection site
? Angulation
90-degree to the palate
from the opposite side
? Depth of penetration
≤5mm submucoperiosteally(粘骨膜下 )
? Injection amount
0.3-0.5ml
Tips
? Aspiration
? Not too backward
（ lesser palatine nerve）
2012-3-19
Greater Palatine Block
(GP Block)
2012-3-19
Nasopalatine Block
(NP Block 鼻腭神经阻滞,
Anterior Palatine Foramen Injection 腭前孔注射法 )
? Landmark of
incisive foramen
? Spread of Analgesia
? Injection Site
incisive papilla
? Angulation
? Depth of Penetration 5-7mm
? Injection amount 0.25-0.5ml
321 123
2012-3-19
Nasopalatine Block
( NP Block 鼻腭神经阻滞 )
2012-3-19
2012-3-19
Review Questions
? If the mesiobuccal root of the maxillary first
molar is not anesthetized by a PSA block,
the dental professional should
A,Reinject at the same site as for the PSA block
B,Perform a buccal block injection
C,Administer an additional infiltration injection
D,Perform a nasopalatine block injection
2012-3-19
Review Questions
? A hematoma can result from an
incorrectly
administered PSA block because the
needle was overinserted and penetrated
the
A,Parotid salivary gland
B,Pterygoid plexus of veins
C,Floor of the nose
D,Facial or cranial nerve VII
2012-3-19
Review Questions
? Which of the following tissues are
anesthetized during an IO block?
A,Bilateral anterior hard palate
B,Buccal periodontium of maxillary molars
C,Upper lip,side of nose,and lower eyelid
D,Lingual periodontium of maxillary anteriors
E,Side of face,upper eyelid,and bridge of nose
2012-3-19
? Maxillary Nerve Anaesthesia
? Mandibular Nerve Anaesthesia
Inferior alveolar block （下牙槽神经）
Lingual block （舌神经）
Buccal block （颊神经）
Mental block （颏神经）
Nerve Block Anesthesia
2012-3-19
Inferior Alveolar Block
(IA Block 下齿槽神经阻滞 )
? Target Area
slightly superior to the mandibular foramen
inferior to the lingula
? Landmark & Injection Point
the tip of buccal fat pad(颊脂垫 )
pterygomandibular raphi(翼下颌皱襞 )
2012-3-19
? Angulation
the syringe barrel over the contralateral
mandibular second premolar
the syringe barrel parallel to and 10mm
above the occlusional plane
? Depth of penetration
20-25mm,contact the bone
withdraw 1mm before injection
? Injection amount
1-1.5ml
Inferior Alveolar Block
(IA Block 下齿槽神经阻滞 )
2012-3-19
Inferior Alveolar Block
(IA Block 下齿槽神经阻滞 )
2012-3-19
Trouble-shooting the IA
block
1,Injection Point & target area
? Higher – masseter/ parotid gland
? Lower -- beneath the mandibular foramen
? Anteriorly– only anesthetize buccal nerve
? Posteriorly – parotid gland
2012-3-19
Trouble-shooting the IA
block
2,Angulation
? 45-degree to the middle line
? < 30-degree
? > 60-degree
3,Position of patient
? supine,mouth opening wide,
? the mandibular occlusional plane
2012-3-19
Trouble-shooting the IA block
? Width of ramus
--- Depth of penetration
? Width of mandible arch
--- the angulation of syringe
? Mandibular angle
---- higher injection point
4,Anatomic Variation
-- mandible morphology
2012-3-19
Lingual Block (舌神经阻滞 )
? Anatomy
Lingual nerve lies 10 mm
anterior-inferiorly to IA nerve
? Injection protocol
after IA Block,withdraw the syringe barrel
about 10mm,inject 0.5-1ml solution
2012-3-19
? Same protocol with IA block
? Injection 0.5-1ml solution
submucosal
Buccal Block (颊神经阻滞 )
2012-3-19
Block Anesthesia of IAN / LN / BN
2012-3-19
IAN
MN
MENTAL
FORAMEN
? Anatomy of
mental foramen(颏孔 )
? between the apices of
? 1cm beyond the mandible lower border
? faces posterosuperiorly
? Angulation
? forward-downward-inward
? Injection amount
? 0.5-1ml
54 45
Mental Block (颏神经阻滞 )
2012-3-19
Mental Block (颏神经阻滞 )
Extraoral approach Intraoral approach
2012-3-19
Dental
Local
Block
Anesthesia
MN xudongwang70@163.com
2012-3-19
Lao-tse
千里之行 始于足下
--- 老子
2012-3-19
Review Questions
? Which of these situations has occurred if bone is
contacted too soon in an IA block?
A,Needle tip is located too far anterior on the ramus
B,Needle tip is located too far posterior on the maxillary
tuberosity
C,Syringe barrel is mainly over the maxillary posterior teeth
D,Syringe barrel is mainly over the mandibular posterior teeth
2012-3-19
Review Questions
? In which of the following locations is the
outcome most successful when using local
infiltrations of local anesthetic?
A,Facial surface of anterior maxilla
B,Facial surface of posterior maxilla
C,Facial surface of anterior mandible
D,Facial surface of posterior mandible
2012-3-19
Review Activities
? Make a list for each injection,including
the teeth and associated structures that
are anesthetized with each one,
Nerve Block Anesthesia
in Dentistry
Dept,of Oral & Maxillofac Surg,
Affiliated Ninth People’s Hospital
Shanghai Second Medical University
Xudong Wang,DDS,MD
2012-3-19
Local Anesthesia
REVIEW
? Topical Anesthesia(表面麻醉 )
? Local Infiltration( 局部浸润麻醉 )
? small area anesthetized (one or two teeth)
? solution deposited near terminal nerve endings
? 8 8,2 2 extractions
? Nerve Block ( 阻滞麻醉 )
? deposited near large nerve trucks
2012-3-19
Advantages of nerve block
? Larger analgesia area & avoid several injections
? Less dosage & long--lasting
? Away from the lesion -- avoid spreading of
infection & tumor seeding
? Less tissue deformity post-injection -- plastic
surgery
? Better Anesthetic Effectiveness
2012-3-19
? Ophthalmic Nerve
? Maxillary Nerve
? Mandibular Nerve
Anatomy of Trigeminal Nerve
(三叉神经 )
2012-3-19
? Maxillary Nerve Anesthesia
Posterior superior alveolar block（上牙槽后神经）
Infraorbital block (眶下神经）
Greater palatine block （腭大神经）
Nasopalatine block（鼻腭神经）
Less dense bone/ less anatomic variation
? Mandibular Nerve Anesthesia
Nerve Block Anesthesia
{
{
Buccal
Palatal
2012-3-19
Posterior Superior Alveolar Block
(PSA Block 上牙槽后神经阻滞,
Tuberosity Injection上颌结节注射法 )
? Spread of analgesia 麻醉范围
876 678
Pulp & alveolar process
Buccal
- gingiva(牙龈 )
- periodontium (牙周膜 )
- periosteum (骨膜 )
(mesiobuccal root)
2012-3-19
Posterior Superior Alveolar Block
(PSA Block)
? Injection site
7 7 distal apex
Mucobuccal fold ? Angulation
? Target area
2012-3-19
Posterior Superior Alveolar Block
(PSA Block)
? Depth of penetration
Average adult 16-20 mm
Small adult and children 14mm
1.5-2ml
? Injection amount
Pterygoid plexus(翼丛 )
? Time to effect
5-10 min
? Aspiration(回抽 )
Hematoma(血肿 )
2012-3-19
Posterior Superior Alveolar Block
2012-3-19
Infraorbital Block
(IO Block 眶下神经阻滞 )
? Indications
5 5 dental procedure
Upper lip & Paranasal Minor Surgery
? Landmark of
Infraorbital foramen(眶下孔 )
5-10mm below the infraorbital rim
1-4mm medial to the pupil of the eye
2012-3-19
Infraorbital Block
(IO Block 眶下神经阻滞 )
? Injection site
10mm lateral to the alar（鼻翼）
? Angulation
45-degree to the skin
superiorly/ posteriorly / laterally
? Depth of Penetration
1.5cm
? Injection amount
1-1.5ml
1cm
2012-3-19
Greater Palatine Block
(GP Block,anterior palatine block 腭前神经阻滞 )
? Spread of analgesia
Posterior portion of hard palate
Palatal
mucoperiosteum(粘骨膜 )
gingiva
alveolus
8-4 4-8
? Landmark of
greater palatine foramen（腭大孔）
2012-3-19
Infraorbital Block
(IO Block 眶下神经阻滞 )
2012-3-19
Greater Palatine Block
(GP Block)
Midway between the median palate raphi
and lingual gingival of the molar tooth
? Injection site
? Angulation
90-degree to the palate
from the opposite side
? Depth of penetration
≤5mm submucoperiosteally(粘骨膜下 )
? Injection amount
0.3-0.5ml
Tips
? Aspiration
? Not too backward
（ lesser palatine nerve）
2012-3-19
Greater Palatine Block
(GP Block)
2012-3-19
Nasopalatine Block
(NP Block 鼻腭神经阻滞,
Anterior Palatine Foramen Injection 腭前孔注射法 )
? Landmark of
incisive foramen
? Spread of Analgesia
? Injection Site
incisive papilla
? Angulation
? Depth of Penetration 5-7mm
? Injection amount 0.25-0.5ml
321 123
2012-3-19
Nasopalatine Block
( NP Block 鼻腭神经阻滞 )
2012-3-19
2012-3-19
Review Questions
? If the mesiobuccal root of the maxillary first
molar is not anesthetized by a PSA block,
the dental professional should
A,Reinject at the same site as for the PSA block
B,Perform a buccal block injection
C,Administer an additional infiltration injection
D,Perform a nasopalatine block injection
2012-3-19
Review Questions
? A hematoma can result from an
incorrectly
administered PSA block because the
needle was overinserted and penetrated
the
A,Parotid salivary gland
B,Pterygoid plexus of veins
C,Floor of the nose
D,Facial or cranial nerve VII
2012-3-19
Review Questions
? Which of the following tissues are
anesthetized during an IO block?
A,Bilateral anterior hard palate
B,Buccal periodontium of maxillary molars
C,Upper lip,side of nose,and lower eyelid
D,Lingual periodontium of maxillary anteriors
E,Side of face,upper eyelid,and bridge of nose
2012-3-19
? Maxillary Nerve Anaesthesia
? Mandibular Nerve Anaesthesia
Inferior alveolar block （下牙槽神经）
Lingual block （舌神经）
Buccal block （颊神经）
Mental block （颏神经）
Nerve Block Anesthesia
2012-3-19
Inferior Alveolar Block
(IA Block 下齿槽神经阻滞 )
? Target Area
slightly superior to the mandibular foramen
inferior to the lingula
? Landmark & Injection Point
the tip of buccal fat pad(颊脂垫 )
pterygomandibular raphi(翼下颌皱襞 )
2012-3-19
? Angulation
the syringe barrel over the contralateral
mandibular second premolar
the syringe barrel parallel to and 10mm
above the occlusional plane
? Depth of penetration
20-25mm,contact the bone
withdraw 1mm before injection
? Injection amount
1-1.5ml
Inferior Alveolar Block
(IA Block 下齿槽神经阻滞 )
2012-3-19
Inferior Alveolar Block
(IA Block 下齿槽神经阻滞 )
2012-3-19
Trouble-shooting the IA
block
1,Injection Point & target area
? Higher – masseter/ parotid gland
? Lower -- beneath the mandibular foramen
? Anteriorly– only anesthetize buccal nerve
? Posteriorly – parotid gland
2012-3-19
Trouble-shooting the IA
block
2,Angulation
? 45-degree to the middle line
? < 30-degree
? > 60-degree
3,Position of patient
? supine,mouth opening wide,
? the mandibular occlusional plane
2012-3-19
Trouble-shooting the IA block
? Width of ramus
--- Depth of penetration
? Width of mandible arch
--- the angulation of syringe
? Mandibular angle
---- higher injection point
4,Anatomic Variation
-- mandible morphology
2012-3-19
Lingual Block (舌神经阻滞 )
? Anatomy
Lingual nerve lies 10 mm
anterior-inferiorly to IA nerve
? Injection protocol
after IA Block,withdraw the syringe barrel
about 10mm,inject 0.5-1ml solution
2012-3-19
? Same protocol with IA block
? Injection 0.5-1ml solution
submucosal
Buccal Block (颊神经阻滞 )
2012-3-19
Block Anesthesia of IAN / LN / BN
2012-3-19
IAN
MN
MENTAL
FORAMEN
? Anatomy of
mental foramen(颏孔 )
? between the apices of
? 1cm beyond the mandible lower border
? faces posterosuperiorly
? Angulation
? forward-downward-inward
? Injection amount
? 0.5-1ml
54 45
Mental Block (颏神经阻滞 )
2012-3-19
Mental Block (颏神经阻滞 )
Extraoral approach Intraoral approach
2012-3-19
Dental
Local
Block
Anesthesia
MN xudongwang70@163.com
2012-3-19
Lao-tse
千里之行 始于足下
--- 老子
2012-3-19
Review Questions
? Which of these situations has occurred if bone is
contacted too soon in an IA block?
A,Needle tip is located too far anterior on the ramus
B,Needle tip is located too far posterior on the maxillary
tuberosity
C,Syringe barrel is mainly over the maxillary posterior teeth
D,Syringe barrel is mainly over the mandibular posterior teeth
2012-3-19
Review Questions
? In which of the following locations is the
outcome most successful when using local
infiltrations of local anesthetic?
A,Facial surface of anterior maxilla
B,Facial surface of posterior maxilla
C,Facial surface of anterior mandible
D,Facial surface of posterior mandible
2012-3-19
Review Activities
? Make a list for each injection,including
the teeth and associated structures that
are anesthetized with each one,
