Local Anesthesia Injection Technique

2009
Division of Oral & Maxillofacial Surgery
University of Minnesota

I.

Patient Preparation
a. Medical history and physical evaluation
b. Blood pressure and pulse assessment
c. Chair position
i. Supine
ii. Semisupine
d. Operator and Patient position
e. Record event in chart

II.

Site Preparation
a. Identify landmark
b. Dry mucosa with sponge
c. Apply topical anesthetic with cotton applicator
i. Use pressure on palatal injection

III.

Technique
a. Bevel orientation
b. Insert needle
c. Aspirate
d. Monitor injection rate
i. Position of the barrel of the syringe
ii. Slow injection (1mL/min)
e. Needle should not bend
f. Needle should not be inserted all the way to the hub
g. Replace needle cover with safe technique

IV.

Maxillary Injection Technique

a. Local Infiltration (supraperiosteal injection)
i. Injection site: Mucobuccal fold of target tooth
ii. 30 gauge needle
iii. Depth: A few millimeters
iv. Anesthetized: Tooth, periosteum, mucous membrane
b. Posterior Superior Alveolar N. Block (PSA)
i. Injection site: Height of the mucobuccal fold above the maxillary 2nd
molar; 45 angle to the maxillary occlusal plane
ii. Depth: 16mm
iii. Anesthetized: All molars but 72% of mesiobuccal root of maxillary 1 st
molar
c. Middle Superior Alveolar N. Block
i. Injection site: Mucobuccal fold above the 2nd premolar
ii. Depth: A few millimeters
iii. Anesthetized: 1st and 2nd premolar and mesiobuccal root of maxillary
1st molar
d. Anterior Superior Alveolar N. Block (Intraorbital N. Block)
i. Injection site: Height of the mucobuccal fold over 1st premolar
ii. Depth: 16mm
iii. Anesthetized: Central incisal through canine, occasionally maxillary
premolars and mesiobuccal root of maxillary 1st molar
e. Nasopalatine N. Block
i. Injection site: Lateral to the incisive papillae

ii. Depth: 6 10mm

iii. 30 gauge needle
iv. Anesthetized: Anterior palatal (hard and soft tissues of mesial of 1 st
premolar to the other side of mesial of 1st premolar)
f. Greater Palatine N. Block (Anterior Palatine Block)
i. Injection site: Halfway between the alveolar crest and the midline (2 nd
and 3rd molar area)
ii. Depth: Less than 10mm
iii. 30 gauge needle
iv. Anesthetized: Posterior portion of hard palate and overlying soft
tissue to the 1st premolar and midline
g. Maxillary N. Block (V2 Block)
i. Greater palatine canal approach
ii. High tuberosity approach
V.

Mandibular Injection Technique

a. Inferior Alveolar N. Block (IAN)
b. Lingual N. Block
i. Injection site: The line of needle insertion is from the opposite
mandibular premolars
ii. 25 or 27 gauge needle, long
iii. Depth: 10 25mm; height of insertion is usually above the occlusal
plane (6 10mm)
iv. Withdraw slightly and deposit remainder of carpule for lingual nerve
anesthesia
v. Anesthetized: Pulp of the mandibular teeth to the midline, body of
the mandible, buccal mucoperiosteum and mucous membrane
anterior to the mandibular 1st molar, ipsilateral lower lip, anterior 2/3
of tongue
c. Long buccal N. block
i. Injection site: Height of the occlusal plane, posterior to the
mandibular 3rd molar into the soft tissue near the external oblique
ridge
ii. Depth: 1 or 2mm
iii. Anesthetized: Periosteum, soft tissue buccal to the mandibular
molars
d. Mental N. Block
i. Injection site: Between the mandibular premolars
ii. Depth: 5 6mm
iii. Anesthetized: Buccal mucous membrane anterior to the mental
foramen to the midline, lip and chin
e. Gow-Gates Mandibular Block (V3 Block)
i. Injection site: Height of injection; mesiopalatal cusp of maxillary
second molar.
Penetration; distal to the 2nd molar
ii. Depth: 25mm
iii. Anesthetized: Distribution of V3
f. Vazirani Akinosi Mandibular Block
i. Injection site: Mouth closed. Align the needle and syringe parallel to
and along the line of the maxillary 2nd and 3rd molar mucogingival
junction; insertion of needle to the soft tissue overlying the mesial
border of the mandibular ramus directly adjacent to the maxillary
tuberosity at the height of the mucogingival junction adjacent to the
maxillary 3rd molar
ii. Depth: 25mm
iii. Anesthetized: Distribution of IAN, lingual N., mental N., and incisive
N.