Anatomical Basis of the Palatal Injection Technique for Pulpal Anesthesia of Maxillary Teeth.

The aim of this study was to assess the effectiveness of palatal injection for managing the pulpal pain of unilateral maxillary teeth from central incisor to second premolar and to establish the anatomical basis for this technique. For this prospective observational study, 62 patients (aged 18-70 years) were included. They had been treated for carious dentine lesions, receiving prosthodontic, endodontic treatment, or extraction of any tooth/teeth in the region from central incisor to second premolar. A total of 100 teeth were treated. Cone-beam computed tomography (CBCT) scans were analyzed preoperatively to identify accessory canals (ACs) (≥ 0.5 mm in diameter) associated with canalis sinuosus (CS). The anesthetic was injected into the area of the target tooth or adjacent tooth next to the palatal openings of the AC(s) into the submucosa of the anterior hard palate. The effectiveness of anesthesia was confirmed by pulp tester readings and a survey using the Verbal descriptor and Likert scales before and during treatment. Pulpal anesthesia was successful in 100% of the treated vital teeth. In all cases, openings of ACs originating from the CS were identified on CBCT scans. Three patients underwent bilateral dental treatment under unilateral anesthesia. The bilateral communications of the CS in the midline of the upper jaw were identified in the CBCT scans of these patients. The authors have established the palatal alveolar foramen injection (PAFI) technique. Injection of an anesthetic solution into the area of the openings of CS on the palate (i.e., palatal alveolar foramina) induces pulpal anesthesia of adjacent target teeth with 100% efficiency. PAFI requires less of the anesthetic solution and is the ideal technique for restorative and prosthodontic treatment involving anterior teeth because it does not cause numbness of the lip and face.