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Techniques of MandibularTechniques of Mandibular

AnesthesiaAnesthesia

Prepared byPrepared by

Dr shabeel pnDr shabeel pn

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Mandibular AnesthesiaMandibular Anesthesia

Lower success rate than MaxillaryLower success rate than Maxillary

anesthesia - approx. 80-85 %anesthesia - approx. 80-85 %

Related to bone densityRelated to bone density

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Mandibular Nerve BlocksMandibular Nerve Blocks

Inferior alveolarInferior alveolar

Mental - IncisiveMental - Incisive

BuccalBuccal

LingualLingual

Gow-GatesGow-Gates

AkinosiAkinosi

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Mandibular AnesthesiaMandibular Anesthesia

Most commonly performed techniqueMost commonly performed technique

Has highest failure rate (15-20%)Has highest failure rate (15-20%)

Success depends on depositing solution withinSuccess depends on depositing solution within

1 mm of nerve trunk1 mm of nerve trunk

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Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

Not a complete mandibular nerve block.Not a complete mandibular nerve block.

Requires supplemental buccal nerve blockRequires supplemental buccal nerve block

May require infiltration of incisors or mesialMay require infiltration of incisors or mesial

root of first molarroot of first molar

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Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

Nerves anesthetizedNerves anesthetized

Inferior AlveolarInferior Alveolar

MentalMental

IncisiveIncisive

LingualLingual

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Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

Areas AnesthetizedAreas Anesthetized

Mandibular teeth to midlineMandibular teeth to midline

Body of mandible, inferior ramusBody of mandible, inferior ramus

Buccal mucosa anterior to mental foramenBuccal mucosa anterior to mental foramen

Anterior 2/3 tongue & floor of mouthAnterior 2/3 tongue & floor of mouth

Lingual soft tissue and periosteumLingual soft tissue and periosteum

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Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

IndicationsIndications

Multiple mandibular teethMultiple mandibular teeth

Buccal anterior soft tissueBuccal anterior soft tissue

Lingual anesthesiaLingual anesthesia

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Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

ContraindicationsContraindications

Infection/inflammation at injection siteInfection/inflammation at injection site

Patients at risk for self injury (eg. children)Patients at risk for self injury (eg. children)

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Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

10%-15% positive aspiration10%-15% positive aspiration

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Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

AlternativesAlternatives

Mental nerve blockMental nerve block

Incisive nerve blockIncisive nerve block

Anterior infiltrationAnterior infiltration

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Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

Alternatives (cont.)Alternatives(cont.)

Periodontal ligament injection (PDL)Periodontal ligament injection (PDL)

Gow-GatesGow-Gates

AkinosiAkinosi

IntraseptalIntraseptal

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Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

TechniqueTechnique

Apply topicalApply topical

Area of insertionArea of insertion::

medial ramus, mid-coronoid notch,medial ramus, mid-coronoid notch,

level with occlusal plane (1 cm above),level with occlusal plane (1 cm above),

3/4 posterior from coronoid notch to3/4 posterior from coronoid notch to

pterygomandibular raphepterygomandibular raphe

advance to bone (20-25 mm)advance to bone (20-25 mm)

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Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

Target AreaTarget Area

Inferior alveolar nerve, near mandibularInferior alveolar nerve, near mandibular

foramenforamen

LandmarksLandmarks

Coronoid notchCoronoid notch

Pterygomandibular raphePterygomandibular raphe

Occlusal plane of mandibular posteriorsOcclusal plane of mandibular posteriors

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Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

PrecautionsPrecautions

Do not inject if bone not contactedDo not inject if bone not contacted

Avoid forceful bone contactAvoid forceful bone contact

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Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

Failure of AnesthesiaFailure of Anesthesia

Injection too lowInjection too low

Injection too anteriorInjection too anterior

Accessory innervationAccessory innervation

-Mylohyoid nerve-Mylohyoid nerve

-contralateral Incisive nerve innervation-contralateral Incisive nerve innervation

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Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

ComplicationsComplications

HematomaHematoma

TrismusTrismus

Facial paralysisFacial paralysis

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