Skip to main content

Techniques of Mandibular Anesthesia including Inferior Alveoar Nerve Block

Mandibular Anesthesia
  • Lower success rate than Maxillary anesthesia (approx. 80-85 %)
  • Related to bone density
  • Less access to nerve trunks  
Mandibular Nerve Blocks
  1. Inferior alveolar
  2. Mental - Incisive             
  3. Buccal
  4. Lingual
  5. Gow-Gates
  6. Akinosi
Mandibular Anesthesia
  • Most commonly performed technique
  • Has highest failure rate (15-20%)
  • Success depends on depositing solution within 1 mm of nerve trunk
Inferior Alveolar Nerve Block
Not a complete mandibular nerve block.
Requires supplemental buccal nerve block
May require infiltration of incisors or mesial root of first molar

Nerves anesthetized
  • Inferior Alveolar
  • Mental
  • Incisive   
  • Lingual
Areas Anesthetized
  • Mandibular teeth to midline
  • Body of mandible, inferior ramus   
  • Buccal mucosa anterior to mental foramen
  • Anterior 2/3 tongue & floor of mouth
  • Lingual soft tissue and periosteum
Indications of inferior Alveolar nerve block
  • Multiple mandibular teeth
  • Buccal anterior soft tissue
  • Lingual anesthesia
Contraindications of inferior Alveolar nerve block
  • Infection/inflammation at injection site
  • Patients at risk for self injury (eg. children)
10%-15% positive aspiration
Alternatives for inferior Alveolar nerve block
  1. Mental nerve block
  2. Incisive nerve block
  3. Anterior infiltration
  4. Periodontal ligament injection (PDL)
  5. Gow-Gates
  6. Akinosi  
  7. Intraseptal
Technique for of inferior Alveolar nerve block
Apply topical anaesthesia
Area of insertion:
  • Medial ramus, mid-coronoid notch,
  • Level with occlusal plane (1 cm above),
  • 3/4 posterior from coronoid notch to pterygomandibular raphe
  • Advance to bone (20-25 mm)


Target Area
    Inferior alveolar nerve, near mandibular foramen
Landmarks
    Coronoid notch
    Pterygomandibular raphe
    Occlusal plane of mandibular posteriors
Inferior Alveolar Nerve Block
Precautions
    Do not inject if bone not contacted
    Avoid forceful bone contact
Failure of Anesthesia in inferior Alveolar nerve block
    Injection too low
    Injection too anterior
    Accessory innervation
        -Mylohyoid nerve
        -Contra lateral Incisive nerve innervation
Complications of inferior Alveolar nerve block
  1. Hematoma
  2. Trismus
  3. Facial paralysis
Mandibular nerve block 
Other Techniques of Manidilar nerve block
Long Buccal Nerve Block
  • Anterior branch of Mandibular nerve (V3)
  • Provides buccal soft tissue anesthesia adjacent to mandibular molars
  • Not required for most restorative procedures
Buccal Nerve Block
Indications
    Anesthesia required - mucoperiosteum buccal to mandibular molars
Contraindications
    Infection/inflammation at injection site
Advantages
    Technically easy
    High success rate
Disadvantages
    Discomfort
Alternatives
    Buccal infiltration
    Gow-Gates
    PDL
    Intraseptal

Technique
Apply topical
Insertion distil and buccal to last molar
Target - Long Buccal nerve as it passes anterior border of ramus
  •    Insert  approx.  2 mm, aspirate
  •    Inject 0.3 ml of solution, slowly
  •    25-27 gauge needle
Area of insertion:- Mucosa adjacent to most distal
Landmarks
    Mandibular molars
    Mucobuccal fold
Complications
    Hematoma (unusual)
    Positive aspiration-0.7 %
Mental Nerve Block
Terminal branch of IAN as it exits mental foramen
Provides sensory innervation to buccal soft tissue anterior to mental foramen, lip and chin
Indication
    Need for anesthesia in innervated area
Contraindication
    Infection/inflammation  at injection site
Advantages
    Easy, high success rate
    Usually atraumatic
Disadvantage
    Hematoma
Alternatives
    Local infiltration
    PDL
    Intraseptal
    Inferior alveolar nerve block
    Gow Gates
Complications
    Few
    Hematoma
    Positive aspiration-5.7 %
Incisive Nerve Block
Terminal branch of IAN         
Originates in mental foramen and proceeds anteriorly
Good for bilateral anterior anesthesia               
Not effective for anterior lingual anesthesia  
Nerves anesthetized
    Incisive
    Mental
Areas Anesthetized
    Mandibular labial mucous membranes
    Lower lip / skin of chin
    Incisor, cuspid and bicuspid teeth
Indication
    Anesthesia of pulp or tissue required anterior to mental foramen
Contraindication
    Infection/inflammation at injection site
Advantages
    High success rate
    Pulpal anesthesia w/o lingual anesthesia
Disadvantages
    Lack of lingual or midline anesthesia
Complications
    Hematoma
    Positive aspiration-5.7 %
Mandibular nerve block (other techniques)
Labels:

Comments

Post a Comment

Popular posts from this blog

Apple Invents a new Health feature for AirPods that will provide diagnosis & monitoring of Bruxism

Today the US Patent & Trademark Office published a patent application from Apple that relates to a possible future health related feature regarding the diagnosis and monitoring of bruxism using motion sensors in AirPods. Teeth grinding and jaw clenching (bruxism) are the most common parafunctional behavior manifested during sleep and awakeness. Awake bruxism has been mostly associated with emotions like anxiety, stress, frustration or tension. During sleep it causes sleep disorders and arousals. Individuals are mostly unaware of the occurrent and severity of their bruxing habits. The unawareness results in a myriad of orofacial muscle pain and dental consequences like teeth damage, wear and fractures. Commercial devices in dental practice to monitor and treat bruxism are expensive, inconvenient for frequent daily use. For instance, Polysomnography (PSG) studies that target the monitoring of sleep bruxism, require patients to sleep in a clinical setting overnight. Further,
Post a Comment
Read more

Esthetic Oral Rehabilitation with Veneers

Porcelain veneers had long been considered to be only an esthetic solution. However, their range of indications has been steadily increasing, making ceramic veneers a highly viable alternative to classic, far more invasive forms of restorative treatment. Today, veneers can be used to handle esthetics (discolored teeth, fractured and worn teeth, diastemas, dental defects, etc.) and to restore the biomechanics of the dentition, as well as many other indications. Classifications of Veneer Preparations Referred to as no, minimal, or conventional preparation, veneer classifications—or lack there of—create a large gray zone of misunderstanding and miscommunication with patients and within the dental profession. Left unanswered, questions regarding tooth structure removal, finish lines and margins, and other aspects can cause confusion in practice. Flaws and inaccuracies in previously proposed preparation guidelines make those guidelines irrelevant . To dissolve uncertainty, this v
Post a Comment
Read more

Orthodontics for Esthetic Dental Treatment: Symbiotic Efforts for Optimal Results

Human fascination with beauty and esthetic trends is continuously evolving; moreover, public awareness and desire to improve facial appearances are at the highest level. This trend of heightened public awareness and expectation is paving a new way of dentistry toward a more comprehensive approach with esthetic principles at its core. The oral health of the patient and his or her dentition are fundamental in dental treatment. However, the final esthetic outcome should be among the first steps in treatment planning. The ideal esthetic approach in dental treatment planning often requires a multidisciplinary approach engaging various dental professionals. This process requires thorough communication among dental practitioners and a basic understanding of what each discipline can provide. FACIAL ANALYSIS Facial evaluation is an integral part of patient examination. It starts with evaluating facial symmetry, as symmetric faces are considered more beautiful than those that are n
Post a Comment
Read more