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Starting with anesthesia/nerve supply:
For all maxillary (upper) teeth we generally need to perform two separate injections to extract teeth. This is because there are always two different nerves that need to be anesthetized for upper teeth. One nerve runs to the actual tooth and outside (buccal) gums, the other to the roof of the mouth (palatal) gingiva.
The easiest and safest way to numb any upper tooth and it's outside (buccal) portion of gingiva is through local infiltration. This puts anesthetic directly over the bone where the nerve supplying the tooth enters the apex (bottom) of the root. As a general rule, this technique is only effective in maxillary teeth. Mandibular (lower) teeth have a dense cortical bone layer over the bony surface, which prevents diffusion through the bone.
Technique:
1. You perform an infiltration just over the apex (where you think the bottom of the root would be inside the bone/the ending or tip of the root) of the tooth you want to extract on the "outside" of its gums.
The aiming point for placing the needle is identified by placing your finger inside the patient’s cheek and slightly retracting out away from the patient’s teeth. This creates tension on the mucosa, and a trough can be identified where the mucosa attached to the bone joins with the mucosa covering the inside of the cheek. This trough (mucobuccal fold) is where the needle is placed and advanced into the mucosa a few mm. You are trying to angle the needle parallel with the angle of the tooth into the bone. I diagrammed a photo showing the Aiming point (dotted line) and the needles angle that would be taken to numb up a first molar (blue star).
2. Then you simply aspirate then inject 1/2 carpule SLOWLY... and wait a few minutes
3. This technique is used on all top teeth with a success rate of @95%. There is very little complication risk.
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