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75 Cards in this Set
- Front
- Back
Infiltration
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1. Anesthetizes the terminal nerve branches in the area of treatment
a. Dental - pulp b. Interradicular – PDL and buccal gingiva c. Interdental – PDL and buccal gingiva 2. When used on maxillary teeth, it is referred to a plexus anesthesia because of the over-lapping of fibers of the posterior, middle and anterior alveolar nerves |
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Nerve block
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1. Anesthesia is deposited along the trunk of the nerve, which will anesthetized a larger area
2. Generally used on mandibular teeth because the cortical bone is too thick for infiltration 3. May used when infections block the penetration of the anesthesia 4. Prevent multiple injections and less discomfort to the patient |
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Fiber components of trigeminal nerve
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1. Motor (to muscles of pharyngeal arch origin)
2. Sensory (general sensation) |
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Functions important to the dental profession of trigeminal nerve
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1. General sensation to the face, to the TMJ and to parts of the mucous membranes of the head
2. Motor and proprioceptive fibers to the muscles of mastication 3. Carries postganglionic parasympathetic fibers to target organs |
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Ciliary ganglion
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Ophthalmic division of trigeminal
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Pterygopalatine ganglion
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Maxillary division of V
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Otic ganglion
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Mandibular division of V
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Submandibular ganglion
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Mandibular division of V
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Location of cell bodies of Trigeminal Nerve
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1. Motor nucleus of V
2. Mesencephalic nucleus of V – proprioception 3. Trigeminal ganglion – general sensory |
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Ophthalmic Division – V1
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1. Sensory only
2. No branches associated with teeth or surrounding tissue |
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Maxillary Division – V2
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1. Sensory only
2. Review of branches a. Pterygopalatine branches b. Greater & lesser palatine nn. c. Pharyngeal nerve d. Nasopalatine nerve e. Zygomatic nerve f. Posterior superior alveolar n. h. nerve (1) Middle superior alveolar n. (2) Anterior superior alveolar n. (3) Palpebral, labial, nasal nn. |
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Branches for Intraoral Injection of Maxillary V2
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Infraorbital nerve
Anterior superior alveolar nerve Middle superior alveolar n. Posterior superior alveolar nerve Nasopalatine nerve Greater Palatine Nerve |
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Infraorbital nerve
Anatomical considerations |
(a) Palpebral, labial, nasal nn.
(b) Infraorbital vessels (c) Orbit |
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Anterior superior alveolar nerve distribution
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(a) Roots of canines and incisors of ipsilateral side with some cross-over to the contralateral incisors
(b) Periodontal ligament and alveolar periosteum (c) Buccal gingiva |
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Middle superior alveolar n distribution
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(a) Mesiobuccal root of first molar and roots of both premolars
(b) Periodontal ligament and alveolar periosteum (c) Buccal gingiva Note: In absence of the MSA, the PSA supplies the premolars approximately 25% of the time; otherwise they are innervated by the ASA |
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Posterior superior alveolar nerve distribution
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(a) Roots of all molars, with the exception of the mesiobuccal root of the first molar
(b) Periodontal ligament and alveolar periosteum (c) Buccal gingival |
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Posterior superior alveolar nerve anatomical considerations
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(a) Foramina
(b) Posterior superior alveolar a. (c) Pterygomaxillary fissure (d) Approach to the maxillary nerve |
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Nasopalatine nerve
Distribution |
(a) Mucosa of primary palate
(b) Lingual alveolar periosteum of incisors and canines (c) Lingual gingival of incisors and canines |
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Nasopalatine nerve anatomical considerations
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(a) Greater palatine foramen
(b) Greater palatine artery (c) Intraoral approach to the maxillary nerve through the pterygopalatine canal |
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Mandibular Division – V3 Anterior division
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a. Motor to muscles of mastication
b. Sensory (1) Long buccal nerve (a) Skin of cheek wall (b) Buccal mucosa (c) Buccal gingiva of mandibular molars |
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Mandibular Division – V3 Posterior Division Motor to
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(1) Mylohyoid muscle
(2) Anterior Belly of Digastric |
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Mandibular Division – V3 Posterior Division Sensory to
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Lingual nerve
Inferior alveolar nerve Auriculotemporal nerve |
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(1) Lingual nerve
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Sensory to
(a) To anterior 2/3 of tongue (b) Mucosa of floor of the mouth (c) Lingual mandibular gingiva (d) Submandibular & sublingual glands |
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(2) Inferior alveolar nerve
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Sensory to
(a) Nerve to mylohyoid m. (b) Dental branches to molar and premolars (c) Mental n. to skin of lip (d) Incisive n. - Overlap [a] Dental branches to canines and incisors |
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Auriculotemporal nerve
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sensory to
(a) TMJ (b) Parotid gland (c) Skin posterior to ear |
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Otic ganglion attached to posterior division
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(1) Postganglionic parasympathetic neurons
(2) Fibers gains access to parotid gland via auriculotemporal nerve |
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Lingual Nerve carries
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Carries taste fibers from the chorda tympani nerve that innervate the anterior 2/3 of the tongue
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Submandibular ganglion
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(1) Attached to lingual nerve
(2) Postganglionic parasympathetic neurons send fibers to submandibular and sublingual glands |
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Branches for Intraoral Injection
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a. Inferior Alveolar Nerve
b. Lingual Nerve c. Long Buccal Nerve d. Mental Nerve e. Incisive Nerve f. Nerve to the mylohyoid muscle? |
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Pterygomandibular Space
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(1) Subdivision of masticator space
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Pterygomandibular Space boundaries
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(a) Medial – medial pterygoid muscle
(b) Lateral – ramus of the mandible (c) Superior – lateral pterygoid muscle (d) Posterior – connective tissue sheath of parotid gland (e) Anterior – open – no structures |
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Pterygomandibular Space Medial boundary
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medial pterygoid muscle
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Pterygomandibular Space Lateral Boundary
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ramus of the mandible
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Pterygomandibular Space Superior Boundary
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lateral pterygoid muscle
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Pterygomandibular Space Posterior boundary
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connective tissue sheath of parotid gland
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Pterygomandibular Space Anterior boundary
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No structures-open
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Pterygomandibular Space contents
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(3) Pterygoid Plexus
(4) Inferior alveolar artery and vein (5) Muscular branches of the alveolar artery (6) Nerve and vessels to the mylohyoid muscle (7) Nerve and vessels to the medial pterygoid muscle (8) Sphenomandibular ligament |
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Sphenomandibular ligament relationship to mylohyoid nerve
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[1] Can cover mylohyoid n.
[2] May have sensory component [a] Incomplete anesthesia [b] Nerve fibers enter bone and pulp |
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Sphenomandibular ligament Relationship to the inferior alveolar nerve
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[1] Can block anesthetic to nerve
[2] Incomplete anesthesia |
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Maxillary Dental Plexus Injections sites
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1. Supraperiosteal injections
a. Along the roots by injection into the mucobuccal fold at the apices of the roots b. Anesthesia penetrates the thin cortical plate of the alveolar bone to reach the pulp 2. Intraligamentary or periodontal ligament injection 3. Intraseptal or interdental injection to anesthetize the buccal gingiva 4. Local palatal injection to anesthetize the palatal (lingual) gingiva |
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Supraperiosteal injections
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a. Along the roots by injection into the mucobuccal fold at the apices of the roots
b. Anesthesia penetrates the thin cortical plate of the alveolar bone to reach the pulp |
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Posterior Superior Alveolar Nerve Block injection site
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Over second molar directed posteriorly
Mucobuccal fold at level of second molar |
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Posterior Superior Alveolar Nerve Block Avoid
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a. Posterior superior alveolar artery & tearing periosteum
(1) Injection into vessel could cause serious cardiac arrhythmia (2) Shearing vessel could cause a hematoma – bleeding in the masticator space |
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Middle Superior Alveolar Nerve Block injection site
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Above 2nd premolar
Mucobuccal fold above 2nd premolar |
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Middle Superior Alveolar Nerve Block avoid
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tearing periosteum & blood vessels
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Anterior Superior Alveolar Nerve Block injection site
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Over lateral incisor
Mucobuccal fold above the lateral incisor |
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Anterior Superior Alveolar Nerve Block avoid
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Avoid tearing periosteum & blood vessels
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Infraorbital Nerve Block injection site
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Above the first premolar
Mucobuccal fold of the 1st premolar directed toward infraorbital foramen |
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Infraorbital Nerve Block
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(a) Avoid sticking needle into the infraorbital foramen and orbit
(b) Tearing periosteum & blood vessels |
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Greater Palatine Nerve Block injection site
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Distal border of 2nd maxillary molar
Junction between hard palate and lateral edge of alveolar distal to the 2nd molar |
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Greater Palatine Nerve Block avoid
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. Sticking needle in foramen and damaging nerve & blood vessels
b. Tearing the periosteum |
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Nasopalatine Nerve Block injection site
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Lateral to the incisive canal
Incisive papilla |
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Nasopalatine Nerve Block avoid
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a. Sticking needle in foramen and damaging nerve & blood vessels
b. Tearing the periosteum |
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Posterior Superior Alveolar Nerve Block teeth
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All roots of 1st, 2nd, 3rd molar, except mesiobuccal root of 1st molar, and their facial gingivae
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Middle Superior Alveolar Nerve Block teeth
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Mesiobuccal root of 1st molar, premolars, and their facial gingivae
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Anterior Superior Alveolar Nerve Block teeth
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Canine, incisors, their labial gingivae, and lip
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Infraorbital nerve block teeth
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Canine, incisors, and labial gingivae, lower eyelid, side of the nose and lip.
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Greater palatine nerve block palpebral tissue
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Hard palate and palatal gingiva from molars up to canines
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Nasopalatine nerve block palpebral tissue
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Palatal alveolar periosteum of anterior teeth
Palatal mucosa Palatal gingiva |
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Inferior Alveolar Nerve, Lingual Nerve and Long Buccal Nerve Block injection site
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Pterygotemporal fossa (anterior to the pterygomandibular fold)
Mucosa lateral to the pterygomandibular fold |
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Inferior Alveolar Nerve, Lingual Nerve and Long Buccal Nerve Block avoid
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Muscles, Inferior alveolar artery, branches of pterygoid plexus and sheath of parotid gland
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Gow-Gates injection site
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Mucosa medial to temporalis tendon below the occlusal plane of the second maxillary molar to the tragus
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Gow-Gates target
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Mandibular nerve near coronoid process
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Akinosi-Varian Closed Mouth Mandibular Block injection site
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Mucogingival junction of 2nd or 3rd maxillary molar lateral to the pterygomandibular fold
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Akinosi-Varian Closed Mouth Mandibular Block target site
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Lingula
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Mental Nerve block injection site
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Mental foramen
Between the roots of the first and second premolar |
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Mental nerve block avoid
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Mental artery and damage to mental nerve by thrusting needle into the foramen
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Inferior alveolar nerve block injection site
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Mucosa lateral to the pterygomandibular fold
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Inferior alveolar nerve block teeth and soft tissue
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Mandibular teeth
Buccal gingiva of incisors, canines and premolars |
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Lingual nerve block injection site
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Mucosa lateral to the pterygomandibular fold
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Lingual nerve block soft tissue
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Lingual gingiva of all teeth, floor of the mouth and tongue
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Long buccal nerve injection site
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Medial to the border of the ramus of the mandible at the occlusal plane of the maxillary molars
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Long buccal nerve block soft tissue
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Buccal gingiva and mucosa of the mandibular molars
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Incisive nerve block injection site
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Between the roots of the first and second premolar
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Incisive nerve block teeth and soft tissue
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Incisors, canines and premolars Buccal gingiva and lower lip in area of incisors, canines and premolars
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