Reduced Depth Technique with the Posterior Superior Alveolar Block

Abstract

Purpose: The posterior superior alveolar (PSA) block is one of many techniques used to provide profound anesthesia for invasive dental procedures. This technique has a long history, with a high success rate, but is not without complication risks. The purpose of this study was to determine if pulpal anesthesia of the maxillary second molar could be achieved using a posterior superior alveolar block with a reduced depth of penetration of 10 mm compared to the current suggested depth of 16 mm.

Methods: Using a cold refrigerant, a thermal test was conducted using the buccal surface of a maxillary second molar of 43 participants. Positive neural responses were obtained from 100% of the participants (n=43) during the pretest. Each participant received a posterior superior alveolar block using a short (20mm), 27-gauge needle with the penetration depth reduced to 10mm. Post-test neural responses of these molars were evaluated using same cold thermal test technique.

Results: Study results demonstrated that the reduced depth technique for the PSA block was successful in 88% (n=38) of the participants; pulpal anesthesia of the maxillary second molar had been achieved. Furthermore, there were zero positive aspirations and zero hematomas observed in the participants.

Conclusion: The reduced needle depth technique showed promise in achieving desired results of pulpal anesthesia coupled with decreasing risk and complications associated with the PSA block. Additional blinded, randomized clinical studies are recommended to achieve evidence-based support for this reduced depth PSA block technique.