The posterior superior alveolar injection technique: a report on technique variations and complications

The posterior superior alveolar (PSA) injection technique has varied over time with respect to the depth and angle of penetration, the location for deposition of anesthetic agent, and the number of injections necessary to assure adequate anesthesia to the maxillary molars. Of the standard intraoral injections, the PSA carries with it the second highest risk for anesthesia complications. With changes in armamentarium and technique, the complication rates have declined and more often are associated with anatomical considerations with respect to neurovascular compromise and/or anesthetic solution. In this study, the PSA injection technique and complication histories were investigated. Seventeen variations to the technique are reported along with 12 injection complications. A historic injection complication classification system is presented along with a management strategy based upon a review of reported provider experiences and treatment suggestions.