Maxillary PSA

(Posterior Superior Alveolar) 

a. Maxillary molars except mesiobuccal root of first molar and buccal to affected teeth are numbed

b. Penetration site: height of mucobuccal fold above second molar

c. Landmarks: the mucobuccal fold posterior to the zygomatic process and superior to the distobuccal root of the second molar

d. Length of needle: short 25/27 gauge

e.Angle of insertion: 45 degrees medially to midsaggital plane, 45 degrees superior to occlusal plane

f: Insertion depth: 16 mm

g: Recommended amount of anesthesia: 0.9-1.8 ml

Maxillary MSA

( Middle Superior Alveolar )

a. What is numb: maxillary premolars and mesiobuccal root of first molar and facial to affected teeth

b. Penetration site: Height of mucobuccal fold above the second premolar

c. Landmarks: apex of second premolar

d. Length of needle: short 25/27 gauge

e: Angle of insertion: 20 degrees medially bevel toward bone

f: Insertion depth: varies, needle tip inserted well above apex of second premolar

g: Recommended amount of anesthesia: 0.9-1.2 ml

Maxillary ASA

( Anterior Superior Alveolar )

a: What is numb: Canine, lateral, and centrals and facial to affected teeth

b: Penetration site: Height of mucobuccal fold above canine

c: Landmarks: above apex of canine

d: Length of needle: short 25/27 gauge

e: Angle of insertion: 25 degrees medially bevel toward bone

f: Insertion depth: varies, needle inserted to a point above apex of canine

g: Recommended amount of anesthesia: 0.9-1.2 ml

Maxillary GP

( Greater Palatine )

a. What is numb: Palatal tissues of posterior teeth

b. Penetration site: anterior depression of the GP foramen at the junction of the palatine bone and alveolar process above and lingual to the second molar

c. Landmarks: greater palatine foramen

d. Length of needle: extra short or short 30/27 gauge

e. Angle of insertion: from opposite side of mouth at right angle to target area bevel toward palate

f. Insertion depth: 4-6 mm

g. Recommended amount: 0.4-0.6 ml

Maxillary PASA

( Palatial Anterior Superior Alveolar )

a. What is numb: central, lateral and canine and periodontium to affected teeth

b. Penetration site: infiltration- lateral to incisive papilla 

Block- center of papilla on midline

c. Landmark: Below incisive papilla, slightly into incisive foramen

d. Length of needle: extra short or short 30/27 gauge

e. Angle of insertion: 45 degree angle bevel toward palate

f. Insertion depth: 6-10 mm

g. Recommended amount: 1.2-1.8 ml

a. What is numb: buccal tissue to molars

b. Penetration site: mucous membrane distal and lateral to most posterior molar 

c. Landmark: Supraperiosteal, distal and buccal to most posterior molar

d. Length of needle: short when given alone and long when after an IA 25/27 gauge

e. Angle of insertion: Syringe parallel to occlusal plane, lateral to teeth, bevel toward bone

f. Insertion depth: less than 4 mm

g. Recommended amount of anesthesia: 0.2-0.3 ml

Mandibular IA

( Inferior alveolar )

a. What is numb: All teeth in the quadrant and all periodontium, buccal mucosa premolars to midline, floor of mouth and 1/2 of the tongue in quadrant

b. Penetration site: Medial to internal oblique ridge, lateral to pterygomandibular raphe, at or above height of coronoid notch

c. Landmark: Medial surface of ramus, slightly above mandibular foramen

d. Length of needle: Long 25/27 gauge

e. Angle of insertion: Barrel is at the labial commissure over premolars, barrel stays paralles to and above occlusal plane of mandibular molars

f. Insertion depth: 2/3 to 3/4 the length of the needle until contact with the bone

g. Recommended amount: 1.5-1.8 ml

a. What is numb: Pulpal limited to tooth at site of infiltration and tissue from premolar to midline

b. Penetration site: Mucobuccal folf at or just anterior to mental foramen

c. Landmark: Slightly above mental foramen

d. Lenght of needle: short 25/27 gauge

e. Angle of insertion: 20 degrees to long axis of premolars

f. Insertion depth: 5-6 mm

g. Recommended amount: 0.6 ml

a. What is numb: teeth and tissue at injection site

b. Penetration site: Mucobuccal fold buccal to tooth

c. Landmark: Selected soft tissue, gingival or apex of tooth

d. Length of needle: extra short or short 25/27/30 gauge

e. Angle of insertion: 20 degrees to long axis of tooth, directed toward apex of tooth

f. Insertion depth: 3-6 mm

g. Recommended amount of anesthesia: 0.6 ml

Maxillary NP

( Nasopalatine )

a. What is numb: Periodontium palatal to incisiors and canines

b. Penetration Site: Lateral to incisive papilla at widest aspect

c. Landmark: Incisive foramen below incisive papilla

d. Length of needle: extra short or short 30/27 gauge

e. Angle of insertion: 45 degrees to anterior palate 

f. Insertion Depth: infiltration- 3-5 mm     

block- 6-10 mm

g. Recommended amount: less than 0.4 ml