Techniques of Mandibular Anesthesia

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Techniques of Mandibular Anesthesia
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Mandibular Anesthesia

• Lower success rate than Maxillary anesthesia -
  approx. 80-85
• Related to bone density
• Less access to nerve trunks  

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Mandibular Nerve Blocks

• Inferior alveolar
• Mental - Incisive
• Buccal
• Lingual
• Gow-Gates
• Akinosi

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Mandibular Anesthesia

• Most commonly performed technique
• Has highest failure rate (15-20)
• Success depends on depositing solution within 1
  mm of nerve trunk

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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

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Inferior Alveolar Nerve Block

• Nerves anesthetized
• Inferior Alveolar
• Mental
• Incisive
• Lingual

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Inferior Alveolar Nerve Block

• 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

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Inferior Alveolar Nerve Block

• Indications
• Multiple mandibular teeth
• Buccal anterior soft tissue
• Lingual anesthesia

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Inferior Alveolar Nerve Block

• Contraindications
• Infection/inflammation at injection site
• Patients at risk for self injury (eg.
  children)

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Inferior Alveolar Nerve Block

• 10-15 positive aspiration

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Inferior Alveolar Nerve Block

• Alternatives
• Mental nerve block
• Incisive nerve block
• Anterior infiltration

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Inferior Alveolar Nerve Block

• Alternatives (cont.)
• Periodontal ligament injection (PDL)
• Gow-Gates
• Akinosi
• Intraseptal

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Inferior Alveolar Nerve Block

• Technique
• Apply topical
• 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)

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Inferior Alveolar Nerve Block

• Target Area
• Inferior alveolar nerve, near mandibular
  foramen
• Landmarks
• Coronoid notch
• Pterygomandibular raphe
• Occlusal plane of mandibular posteriors

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Inferior Alveolar Nerve Block

• Precautions
• Do not inject if bone not contacted
• Avoid forceful bone contact

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Inferior Alveolar Nerve Block

• Failure of Anesthesia
• Injection too low
• Injection too anterior
• Accessory innervation
• -Mylohyoid nerve
• -contralateral Incisive nerve innervation

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Inferior Alveolar Nerve Block

• Complications
• Hematoma
• Trismus
• Facial paralysis

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