Posterior Superior Alveolar Nerve Block (PSA)

Maxillary

Field of anesthesia: Posterior Superior alveolar nerve,—Pulp of 3rd maxillary molar, —2nd molar, —Distal and palatal roots of first molar, Osseous tissue, —Buccal gingiva, —PDL.

The penetration site for inserting your needle:

Apex of 3rd molar.

Landmarks to help identify target:Maxillary tuberosity, Mucobuccal fold

What length of needle is recommended:Short or long; 

Angle of insertion: 45 degree medially to midsagittal plane, 45 degrees superior to occlusal plane

Penetration: 1/3 length of long needle; ½ of short needle

Recommended amount of anesthesia: ½ - 2/3 carpule

Middle Superior alveolar nerve
(MSA)

Maxillary

Field of Anesthesia: Middle Superior alveolar nerve, Pulp of maxillary 1st and 2nd premolars, Mesiobuccal root of first molar, Osseous tissue, —Buccal gingiva, —PDL. 

Penetration Site:Apex of 2nd molar

Landmarks to Help Identify Target: Mucobuccal fold, 2nd premolar

Length of Needle Recommended: Short

Angle of Insertion: 20 degrees medially, bevel toward bone

Penetration: 1/2 length of short needle

Recommended Amount: 1/2 - 2/3 carpule

Anterior Superior alveolar nerve
(ASA)

Maxillary

Field of Anesthesia: Anterior Superior alveolar nerve, —Pulp of maxillary, central, lateral, canine, Facial Periodontal tissue, —Osseous tissue

Penetration Site: Apex of canince

Landmarks to help Identify Target:Mucobuccal fold, canine eminence, fossa just  mesial to canine

Length of Needle Recommended: Short

Angle of Insertion: 25 degrees medially,  bevel toward bone

Penetration: 1/2 length of short needle

Recommended Amount: 1/3 - 1/2 carpule

Greater Palatine Nerve Block (GP)

Maxillary

Field of Anesthesia:Hard Palate, Overlying soft tissue from 3rd molar to 1st premolar

Penetration Site for Inserting Needle: Bevel of needle anterior to greater palatine foramen

Landmarks to Help Identify Target:Greater palatine foramen, fossa/2nd molar palatal root, tissue indentation from pressure anesthesia

Length of Needle Recommended: Short

Angle of Insertion: from opposite side of mouth at right angle to target area, bevel toard palate

Penetration: contact palatal bone

Recommended Amount of Anesthesia: 2-3 drops, 1/4 of carpule (tissue will blanch)

Nasopalatine Nerve Block (NP)

Maxillary

Field of Anesthesia:Hard Palate, —Overlying soft tissue canine to canine

Penetration Site for Inserting Needle:Over and mesial or distal incisive papilla near incisive foramen

Landmarks to help Identify Target: Incisive papillae, central incisors

Length of Needle Recommended: Short

Angle of Insertion: 45 degree angle, angle bevel toward palate

Penetration: Contact palatal bone

Recommended Amount of Anesthesia: 2 – 3 drops/ 8 carpule (tissue will blanch

Inferior Alveolar Nerve Block
IA

Mandibular

Field of Anesthesia: Inferior alveolar nerve, mental incisive nerve, Mandibular teeth to mid-line, body of mandible, facial soft tissue, lower lip.

Penetration Site for Inserting Needle: must contact bone

Landmarks to Identify Target: Coronoid Notch; occlusal plane, pterygomandibular triangle, and the pterygomandibular raphe.

Length of Needle Recommended: Long

Angle of Insertion: Bevel toward bone

Penetration: 2/3  - 3/4 length of long needle

Recommended Amount of Anesthesia: 1/2 - 1 full carpule

Buccal Nerve Block
(long buccal)

Mandibular

Field of Anesthesia:Buccal nerve, Soft tissue buccal to the mandibular molars

Penetration Site for Inserting Needle: Contact bone

Landmarks to Help Identify Target: Mandibular molars, retromolar pad, vestibule

Length of Needle Recommended: Long

Angle of Insertion: syringe parallel to occlusal plane, lateral to teeth, bevel toward bone

Penetration: less than or equal to 4 mm, bevel under tissue, bevel toward bone

Recommended Amount of Anesthesia: 1/8 carpule

Mental Nerve Block
(Mental)

Mandibular

Field of Anesthesia:Terminal branches of the inferior alveolar nerve, Facial soft tissue from second premolar anterior to midline of lower lip

Penetration Site for Inserting Needle: Mental Foreman

Landmarks to Help Identifty Target: Mandibular premolars, mental foramen

Lenth of Needle Recommended: Long

Angle of Insertion: 20 degrees to long axis of premolars, bevel toward bone

Penetration:1/4 length of needle

Recommended Amount of Anesthesia: 1/3 carpule

Local Infiltration

Mandibular

Field of Anesthesia:selected soft tissue, gingival or apex of tooth

Penetration Site for Inserting Needle: muccobuccal fold, buccal to tooth

Landmarks to Identify Target: muccobuccal fold

Length of Needle Recommended: exra short or short

Angle of Insertion: 20 degrees to long axis of tooth, directed toward apex of tooth, bevel toward bone

Penetration: 3-6 mm to apex

Recommended Amount of Anesthesia: .6 mm

Nasopalatine

Palatal

Field of Anesthesia:palatal to incisor and canine

Penetration Site for Inserting needle: incisive foreman, beneath incisive papilla

Landmarks to Help Identify Target: incisive papilla

Length of Needle Recommended: extra short or short

Angle of Insertion: 45 degrees to anterior palate, bevel toward palate

Penetration: infiltration- 3-5 mm; block- 6-10 mm

Recommended Amount of Anesthesia: less than or equal to 4 mL