- The bevel is best placed so that it faces distally.
- The needle is inserted into the groove surrounding the papilla.
- The landmarks are the central incisors and the incisive papilla.
- The target area is the incisive foramen, located beneath the incisive papilla.
- The area of insertion is tissue lateral to the incisive papilla.
Nasopalatine Nerve Block:
- The greater palatine foramen can be located by finding the midpoint between the mid-palatine raphe and the palatal gingival margin of the second molar.
- The landmarks are the greater palatine foramen and the junction of the maxillary alveolar process and palatine bone.
- The area of insertion is soft tissue slightly anterior to the greater palatine foramen.
Greater Palatine Nerve Block:
- This point is midway between the gingival crest bisecting the premolars and the median palatine raphe.
- The site of penetration is on the palatal side of the premolars, at the intersection of the horizontal and vertical aspects of the palate.
Anterior Middle Superior Alveolar Nerve Block:
- The needle tip is placed above the apex of the second premolar.
- The bevel of the needle is oriented towards the bone.
- The needle is inserted at the height of the mucobuccal fold above the maxillary second premolar.
Middle Superior Alveolar Nerve Block:
- The needle is positioned in the depth of the sulcus close to the pterygomaxillary fissure.
- The finger is passed posteriorly over the buttress until it dips in a sulcus posterior to the buttress, at an angle of 90 degrees to the occlusal surface of the maxillary teeth and 45 degrees to the sagittal plane.
- The fingertip is rotated so that the fingernail is facing the attached gingiva.