Hadzic's Regional Anesthesia > Part III. Clinical Practice of Regional Anesthesia > Section Four. Blocks of the Head & Neck > Chapter 20. Oral & Maxillofacial Regional Anesthesia Benaifer D. Dubash, DMD, Adam T. Hershkin, DMD, Paul J. Seider, DMD, Gregory M. Casey, DDS

Techniques of Regional Maxillary Anesthesia

"The techniques most commonly used in maxillary anesthesia include supraperiosteal (local) infiltration, periodontal ligament (intraligamentary) injection, PSA (posterior superior alveolar) nerve block, MSA (middle superior alveolar) nerve block, anterior superior alveolar nerve block, greater palatine nerve block, nasopalatine nerve block, local infiltration of the palate, and intrapulpal injection (Table 20–2). Of less clinical application are the maxillary nerve block and intraseptal injection.The supraperiosteal or local infiltration is one of the simplest and most commonly used techniques for achieving anesthesia of the maxillary dentition. This technique is indicated when any individual tooth or soft tissue in a localized area is to be treated. Contraindications to this technique are the need to anesthetize multiple teeth adjacent to one another (in which case a nerve block is the preferred technique), acute inflammation and infection in the area to be anesthetized, and, less significantly, the density of bone overlying the apices of the teeth. A 25- or 27-gauge short needle is preferred for this technique.A 25-gauge long needle is preferred for this technique...."