A Prospective, Randomized Comparison of the Anesthetic Efficacy of the Greater Palatine and High Tuberosity Second Division Nerve Blocks

A Prospective, Randomized, Double-blind Comparison of the Anesthetic Efficacy of Two Percent Lidocaine with 1:100,000 Epinephrine and Three Percent Mepivacaine in the Maxillary High Tuberosity Second Division Nerve Block

“…Needle depth measurements are only a guide and should be adjusted to the size of the patient. Broering et al (15) found the average depth of needle penetration for the maxillary high tuberosity second division nerve block technique was 35 mm, which was similar to needle depths in the current study. Also, it seems likely to assume that the anesthetic solution should diffuse to the nerve, and the needle tip does not need to be in contact with the maxillary nerve as it emerges from the foramen rotundum.…”

“…There was no significant difference between the 2 anesthetic formulations. Broering et al (15) showed onset times for the maxillary high tuberosity technique, by using 3.6 mL of 2% lidocaine with 1:100,000 epinephrine, were 1.2 minutes for the second molar and 3.2 minutes for the first molar. Waiting 3.5-4 minutes after using either of the local anesthetic formulations should ensure the onset of pulpal anesthesia in the molars.…”

“…Twelve percent (6 of 50) of the subjects did not achieve soft tissue anesthesia within 20 minutes of the injection but did achieve soft tissue anesthesia at a subsequent appointment. Broering et al (15) reported 8% of their subjects did not achieve soft tissue anesthesia within 20 minutes of the injection with the maxillary high tuberosity technique and were reappointed. All achieved soft tissue anesthesia at a subsequent appointment.…”

“…The high tuberosity approach to the maxillary second division nerve block described by Malamed (2), Baddour et al (3), Broering et al (15), and Martof (18) was used in this study (Fig. 1).…”

“…Broering et al (15) compared the anesthetic efficacy of the greater palatine and the high tuberosity maxillary second division nerve blocks by using 3.6 mL of 2% lidocaine with 1:100,000 epinephrine. Both injection techniques were ineffective in providing profound pulpal anesthesia (no subject response to 2 consecutive 80 readings with an electric pulp tester) of the central incisor, lateral incisor, canine, and first premolar.…”