Palatal Injection For The Removal of Maxillary Teeth: Current Practice Amongst Oral and Maxillofacial Surgeons

Publication date: Available online 4 February 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): E.K. Badenoch-Jones, M. David, T. Lincoln
PurposeConventional teaching regarding palatal injection for the removal of maxillary teeth dictates that both a buccal and palatal injection are to be administered. Recently, some authors have questioned the necessity of the palatal injection, suggesting that contemporary local anaesthetics might diffuse sufficiently across the buccal-palatal cortical bone distance. It has been suggested that since the buccal-palatal cortical bone distance increases anteriorly to posteriorly in the maxilla, the success of maxillary extractions with buccal injection only, might be related to anterior-posterior position of the tooth.Evidence from clinical trials has only relatively recently become available. Since 2006, fifteen clinical trials that examined outcomes of maxillary tooth extractions performed with buccal injection of local anaesthetic only, have been published. However, there is limited data available regarding the clinical practice of surgeons.Patients and MethodsAn online survey was sent to 276 full members of the Canadian Association of Oral and Maxillofacial Surgeons. Respondents were asked about their use of palatal injection for the removal of maxillary teeth under local anaesthesia, including how often they administer a palatal injection for maxillary extractions in each region of the maxilla.Results92 responses were received (33%). Most practitioners deliver a palatal injection for every maxillary tooth extraction under local anaesthetic. However, there is a significant number who do not always administer a palatal injection (i.e. they give it 'most of the time', 'occasionally' or 'never'). This number decreased in a linear fashion anteriorly to posteriorly in the maxilla: incisors: 17/89; canines: 16/88; premolars: 13/88; first and second molars: 10/89; third molars: 10/88.ConclusionThere are a number of surgeons who do not always administer a palatal injection for extraction of maxillary teeth under local anaesthetics. The number is greater for anterior compared to posterior teeth.



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