Middle Superior Alveolar Nerve

Block
Nerve Anesthetized :

Middle Superior Alveolar Nerve

- Maxillary premolars and buccal tissues

 Areas Anesthetized

Pulpal anesthesia of first & second premolars

and mesiobuccal root of first molar

Buccal soft tissues and bone over same teeth

 Indications

Anesthesia of maxillary premolars only

Infraorbital nerve block failure

 Contraindications

Infection /inflammation in area of injection

 Advantage

Minimized number of injections

Minimized volume of solution

 Disadvantage

MSA nerve is only present 28% of the time

 Alternatives

Local infiltration (supraperiosteal)

Periodontal ligament injection (PDL)

Infraorbital nerve block

 Landmarks / Area of Insertion

Mucobuccal fold above second premolar

Apex of second premolar

 Signs and Symptoms

Numb upper lip

Pain free dental therapy

 Safety Features

Anatomically safe (no signifcant structures)

Relatively avascular area

positive aspirations - negligible (< 3%)

Complications are rare

 Technique - MSA

Apply topical
Position patient and identify landmarks
Insert needle 5-10 mm
Aspirate
Inject 0.9 ml of solution, slowly
 Failures of Anesthesia

Needle inserted too high, or not high enough

Deposition of solution too far laterally

Infraorbital Nerve Block
 Nerves Anesthetized

Anterior Superior Alveolar Nerve

Middle Superior Alveolar Nerve
Superior Labial Nerve
also
Inferior Palpebral Nerve
Lateral Nasal Nerve
 Areas Anesthetized

Pulpal anesthesia of maxillary anterior teeth

Pulpal anesthesia of premolars and

mesiobuccal root of first molar

Buccal soft tissue and bone of same teeth

Lower eyelid, lateral nose, and upper lip

 Indications

Anesthesia of more than two maxillary teeth

Supraperiosteal injections ineffective

Inflammation/infection contraindicating local

infiltration
 Contraindications

Discrete treatment areas (1-2 teeth only)

Hemostasis

Bleeding problems (eg. hemophelia, etc..)

 Landmarks

Mucobuccal fold above first premolar

Infraorbital notch

Infraorbital foramen
 Area of Insertion

Mucobuccal fold above first premolar

Target area
Infraorbital foramen
Neurovascular bundle
 Advantages

Comparatively simple, safe technique

Minimized volume of solution

Minimized number of needle punctures

 Disadvantages

Psychological
Administrator- fear of eye involvement
Patient- apprehension of extraoral approach

Anatomical
Difficulty defining landmarks
 Alternatives

Supraperiosteal injection for each tooth

Maxillary nerve block

 Signs and Symptoms

Tingling and numbness of lower eyelid,

side of nose, and upper lip

Numbness in teeth and soft tissues

No pain during dental therapy

 Safety Features

Needle contacting bone

Finger over infraorbital foramen

 Technique

Apply topical
Position patient and identify landmarks
Insert needle to upper rim of infraorbital
foramen
Aspirate
Inject 0.9 ml of solution, slowly
 Failures of Anesthesia

Bone contact below infraorbital foramen

Needle deviates laterally or medially

 Complications

Hematoma (rare)

Positive aspirations - 0.7 %