PSA

Maxillary Injection

Posterior Superior Alveolar

Field of anesthesia: Teeth: maxiallary molars except mesiobuccal root of first molar. Periodontium/soft tissue: buccal to affected teeth.

Penetration Site: height of mucobuccal fold above second molar.

Landmarks: slightly above and distal to distobuccal root of the last molar, second or third if present. Posterior to the zygomatic process of the maxilla and generally superior to the distobuccal root of the maxillary second molar. 

Length of Needle: short 25/27 gauge

Angle of Insertion: needle advanced along a path 45 degrees medially to midsaggital plane, 45 degress superior to occlusal plane.

Penetration (depth of insertion): 16mm.

Amount of anesthesia: 0.9-1.8ml

MSA

Maxillary Injection

Middle Superior Alveolar

Field of anesthesia: Teeth: maxillary premolars and mesiobuccal root of first molar. Periodontium/soft tissue: facial to effected teeth.

Penetration Site: height of mucobuccal fold above the second premolar.

Landmarks: Well above apex of second molar.

Length of Needle:  short 25/27 gauge

Angle of Insertion: needle directed 20 degrees medially bevel toward bone.

Penetration (depth of insertion): variable, needle tip insterted to a point well above apex of second premolar. 

Amount of anesthesia: 0.9-1.2ml

ASA

Maxillary Injection

Anterior Superior Alveolar

Field of anesthesia:  Teeth: canine, lateral, central. Periodontium/soft tissue: facial to affected teeth.

Penetration Site:  height of mucobuccal fold above canine.

Landmarks: above apex of canine.

Length of Needle: short 25/27 gauge.

Angle of Insertion: needle directed 25 degrees medially bevel toard bone. 

Penetration (depth of insertion):  variable, needle tip inserted to a point above apex of canine.

Amount of anesthesia:  0.9-1.2ml

GP

Maxillary Palatal Injection

Greater Palatine

Field of anesthesia:  Teeth: none Periodontium/soft tissue: palatal tissue of posterior teeth.

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

Landmarks: greater palatine foramen.

Length of Needle: extra short or shor 30/27 gauge

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

Penetration (depth of insertion): needle inserted to 4-6mm (<10mm) to boney resistance

Amount of anesthesia: 0.4-0.6ml

NP

Maxillary Palatal Injection

Nasopalatine

Field of anesthesia:  Teeth: none Periodontium/soft tissue: palatal to incisors and canines.

Penetration Site: just lateral to incisive papilla at widest aspect.

Landmarks: incisive forament beneath incisive papilla.

Length of Needle: extra short or short 30/27 gauge.

Angle of Insertion: approach at 45 degres to anterior palate bevel toward palate.

Penetration (depth of insertion): infiltration: 3-5mm Block: 6-10mm

Amount of anesthesia: less than or equal to 0.4ml

PASA

Maxillary Palatal Injection

Palatial Anterior Superior Alveolar

Field of anesthesia:  Teeth:central, lateral, canine. Periodontium/soft tissue: to affected teeth.

Penetration Site: Infiltration: just lateral to incisive papilla. Block: center of papilla on midline.

Landmarks: benneath incisive papilla, slightly into incisive foramen.

Length of Needle: extra short or short 30/27 gauge.

Angle of Insertion: approach at 45 degree angle bevel toward palate.

Penetration (depth of insertion): 6-10mm

Amount of anesthesia: 1.4-1.8ml

IA

Mandibular Injection

Inferior Alveolar with Lingual

Field of anesthesia:  Teeth:all teeth in mandibular quadrant. Periodontium/soft tissue: all periodontium, buccal mucosa premolars to midline, floor of mouth and 1/2 tongue in quadrant. (not soft tissues buccal to molars).

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

Landmarks: On medial surface of ramus, slightly superior to mandibular foramen. 

Length of Needle: long 25/27 gauge.

Angle of Insertion: 2/3 to 3/4 length of needle, until contact with bone, bevel toward bone.

Penetration (depth of insertion): 2/3/ to 3/4 length of needle, until contact with bone, bevel toward bone.

Amount of anesthesia: 1.5-1.8ml

MENTAL

Mandibular Injection

Field of anesthesia:  Teeth: Pulpal limited to tooth at site of infiltration. Periodontium/soft tissue: permolars to midline.

Penetration Site: mucobuccal fold at or just anterior to mental foramen.

Landmarks: slightly superior to mental foramen (keep pressure over foramen for 1 minute after injection).

Length of Needle: short 25/27 gauge

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

Penetration (depth of insertion): 5-6mm

Amount of anesthesia: 0.6ml

INFILTRATION

Mandibular Injection

Field of anesthesia:  Teeth:at injection site. Periodontium/soft tissue: at injection site.

Penetration Site: mucobuccal fold buccal to tooth.

Landmarks: selected soft tissue, gingival or apex of tooth.

Length of Needle:  extra short or short 25/27/30 gauge

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

Penetration (depth of insertion): 3-6mm to apex

Amount of anesthesia: 0.6ml

INFILTRATION

Maxillary Injection

Field of anesthesia:  Teeth:at injection site. Periodontium/soft tissue: at injection site.

Penetration Site: mucobuccal fold buccal to tooth.

Landmarks: selected soft tissue, gingival or apex of tooth.

Length of Needle:  extra short or short 25/27/30 gauge

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

Penetration (depth of insertion): 3-6mm to apex

Amount of anesthesia: 0.6ml

LB

Buccal

Mandibular Injection

Field of anesthesia:  Teeth: none Periodontium/soft tissue: buccal to molars.

Penetration Site: mucosa membrane distal and lateral to most posterior molar. 

Landmarks: supraperiosteal, distal, and buccal to most posterior molar.

Length of Needle:  short when given alone, or long when given following IA 25/27 gauge.

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

Penetration (depth of insertion): less than or equal to 4mm, bevel under tissue, bevel toward bone. 

Amount of anesthesia: 0.2-0.3ml (width of rubber stopper)