Procedure

Periapical Block

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Periapical Block, Periapical Nerve Block, Supraperiosteal Dental Anesthesia, Buccal Anesthesia

  • Indications
  1. Tooth anesthesia for all but the molar teeth
    1. Most useful for the upper teeth
    2. Inferior alveolar Nerve Block is preferred for the lower teeth
  • Preparation
  1. Bupivicaine 0.25% with Epinephrine 2 cc in a 3 cc syringe (or dental control syringe)
  2. Needle 27 gauge 1.25"
  3. Topical benzocaine 20% gel
  • Technique
  1. Apply topical benzocaine 20% gel to injection site
  2. Grasp the upper lip with gauze and retract
  3. Insert needle into the Buccal mucosa above the affected tooth
    1. Needle insertion site is at the mucobuccal fold
    2. Fold is where the upper lip meets the Buccal mucosa
  4. Angle the needle toward the Maxilla
    1. Advance the needle until it strikes the Maxilla
    2. Withdraw the needle 1 mm
  5. Aspirate and then inject the 1-2 cc of Bupivicaine
  • References
  1. Stine (1994) Practical Approach to Emergency Medicine, 2nd ed., Little Brown, Boston, p. 1033