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Objectives:

  • Correctly identify landmarks associated with local anesthesia administration.

  • Apply landmarks to correctly identify target sites for each anesthesia injection.

Supraperiosteal

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  • Mucobuccal fold: fold in the vestibule where the labial or buccal mucosa meets the alveolar mucosa

  • Crown of tooth: the anatomical area of teeth covered by enamel that is visible int he mouth after developing below the gingiva

  • Root contour of tooth: curve, convexity, or bulge in relation to root of tooth; varies tooth to tooth

  • Area of insertion: height of the mucobuccal fold above the apex of the tooth being anesthetized

Posterior Superior Alveolar

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  • Mucobuccal fold: fold in the vestibule where the buccal mucosa meets the alveolar mucosa

  • Maxillary tuberosity: elevation on posterior aspects of the maxilla just posterior to the most distal molar

  • Zygomatic process of the maxilla: rough triangular eminence, situated at the angle of separation of the anterior, zygomatic, and orbital surfaces

  • Area of insertion: height of mucobuccal fold above the maxillary second molar

Middle Superior Alveolar

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  • Mucobuccal fold above the maxillary second premolar: fold in the vestibule above the maxillary second premolar where the buccal mucosa meets the alveolar mucosa

  • Area of insertion: height of mucobuccal fold above the maxillary second premolar

Anterior Superior Alveolar

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  • Mucobuccal fold: fold in the vestibule where the labial mucosa meets the alveolar mucosa

  • Infraorbital foramen: opening in the maxillary bone of the skull located below the infraorbital margin; transmits the infraorbital artery and vein, and the infraorbital nerve, a branch of the maxillary nerve

  • Area of insertion: height of mucobuccal fold between the maxillary lateral and canine  

Greater Palatine

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  • Greater palatine foramen: opening in the posterior hard palate of the greater palatine canal, which is formed between the articulation of maxillary bone and the greater palatine sulcus of palatine bone

  • Junction of maxillary alveolar process and palatine bone: area where the horizontal and vertical palate meet

  • Area of insertion: soft tissue slightly anterior to the greater palatine foramen

Nasopalatine

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  • Maxillary central incisors

  • Incisive papilla: small bulge of tissue at most anterior part of the hard palate, lingual to the anterior teeth

  • Area of insertion: palatal mucosa just lateral to the incisive papilla (located in the midline behind the central incisors); tissue in this area is more sensitive than other palatal mucosa

Inferior Alveolar/Lingual

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  • Coronoid notch: the greatest concavity on the anterior border of the ramus; upon injection, the thumb, finger, or mirror head should be placed here to mark the most anterior border of the injection site 

  • Pterygomandibular raphe (vertical portion): fold of tissue that extends from junction of hard and soft palates on each side down to the mandible, just posterior to the most distal mandibular molar; stretches when the patient opens their mouth as wide as possible

  • Area of insertion: mucous membrane on the medial (lingual) side of the mandibular ramus, at the intersection of two lines- horizontal (height of needle insertion and vertical (anteroposterior plane of injection)

Mental/Incisive

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  • Mandibular premolars

  • Mucobuccal fold: fold in the vestibule where the buccal mucosa meets the alveolar mucosa

  • Area of insertion: mucobuccal fold at or just anterior to the mental foramen

Long Buccal

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  • Mandibular molars

  • Mucobuccal fold: fold in the vestibule where the buccal mucosa meets the alveolar mucosa

  • Area of insertion: mucous membrane distal and buccal to the most distal molar tooth in the arch

Interdental Infiltration

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  • Base of papilla: triangular in shape and located between two teeth; the base corresponds to a line connecting the gingival margin to the adjacent teeth

  • Alveolar crest: the portion of the alveolar bone extending beyond the edge of the socket, lying interproximally

  • Area of insertion: base of the interdental papilla adjacent to the tooth being treated

L A N D M A R K S 

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