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The supraperiosteal injection is the most frequently used technique for obtaining pulpal anesthesia in maxillary teeth.  Specifically, it is indicated whenever dental procedures are confined to a relatively circumscribed area in the maxillary or mandibular incisor region.  This is a simple procedure with a high success rate.  The nerves that are anesthetized are the large terminal branches of the dental plexus.  This includes the pulp and root area of the tooth, buccal periosteum, connective tissue, and mucous membrane. 

Proper technique:

  1. 25 or 27-gauge short needle is recommended

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

  3. Target area: apical region of the tooth to be anesthetized

  4. Landmarks:​​​​​​​​

    • Mucobuccal fold​

    • Crown of tooth

    • Root contour of the tooth

  5. Orientation of the bevel: toward bone

Procedures:

​

  1. Correct patient & clinician positioning

    • Varies significantly from tooth to tooth

    • Clinician should be comfortable, have adequate visibility of the injection site, and maintain control over the needle

  2. Prepare tissue at the injection site

    • Dry with gauze or blow air with air/water syringe​

    • Apply topical anesthetic for minimum of 1 minute

  3. Orient needle so bevel faces bone

  4. Lift lip, pulling tissue taut

  5. Hold syringe parallel with long axis of tooth

  6. Insert needle into height of mucobuccal fold over target tooth

  7. Advance needle until bevel is at or above apical region of tooth (about 3-5mm).  In most instances, depth of penetration is only a few millimeters.  Because needle is in soft tissue (not touching bone), there should be no resistance when advancing, nor should there be any patient discomfort.

  8. Aspirate two times

    • If negative, deposit approximately 0.6 mL (1/3 of cartridge) slowly over 20 seconds​

    • (Do not allow tissues to balloon)

  9. Slowly withdraw needle and safely recap

  10. Wait 3-5 minutes before starting dental procedure​

Multiple supraperiosteal injections require multiple needle penetrations, each with the potential to produce pain, either during the procedure or after the anesthetic takes effect.  This injection is used when treatment is limited to one or two teeth.

S U P R A P E R I O S T E A L  ( S P )

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