Nerves Anesthetized

Areas Anesthetized Landmarks Area of Insertion Target Area Needle

MANDIBULAR BLOCK (CLASSICAL INFERIOR ALVEOLAR NERVE BLOCK)

-Inferior alveolar nerve-Incisive nerve-Mental nerve-Lingual nerve-Long buccal nerve

-Mandibular teeth to midline-Body of the mandible-Buccal mucoperiosteum, mucous membrane anterior to mandibular 1st molar-Anterior 2/3 of tongue-Lingual soft tissues & periosteum

-Pterygomandibular raphe-Anterior border of ramus-External oblique line-Internal oblique line-Coronoid notch-Occlusal plane of mandibular teeth

-Mucous membrane on the medial side of the mandibular ramus, at the intersection of 2 lines:a. Horizontal (Height of injection)b. Vertical (Anteroposterior plane of injection)

Inferior Alveolar Nerve

25 gauge, long

CLOSED MOUTH APPROACH/VAZIRANI-AKINOSI

-Occlusal plane of occluding teeth-Mucogingival junction of maxillary molar teeth-Anterior border of ramus

Soft tissue overlying the medial border of the mandibular ramus directly adjacent to the maxillary tuberosity at the height of the mucogingival junction adjacent to the maxillary 3rd molar.

Soft tissue on the medial border of the ramus in the region of the inferior alveolar, lingual, mylohyoid nerve

25 gauge, long

GOW-GATES TECHNIQUE

-Nerves anesthetized by IANB-Mylohyoid nerve-Auriculotemporal nerves

-Areas anesthetized by IANB-Skin over zygoma-Posterior portion of cheek-Temporal region-Portion of external ear

A. External-Lower border of tragus of ear-Corner of mouthB. Internal-Anterior border of ramus-Mesiolingual cusp of maxillary 2nd molar

Mucous membrane on the mesial of the mandibular ramus on a line from the intertragic notch to the corner of the mouth, just distal to maxillary 2nd molar

Lateral side of the condylar neck, just below the insertion of the lateral pterygoid muscle

BUCCINATOR (LONG BUCCAL) NERVE BLOCK

Long buccal nerve Soft tissue & periosteum buccal to the mandibular molar teeth

-Mandibular molars-Mucobuccal fold

Mucous membrane distal and buccal to the most distal molar tooth in the arch

25 gauge, short

LINGUAL NERVE BLOCK

Lingual nerve -Anterior 2/3 of tongue-Floor of oral cavity-Mucosa & mucoperiosteum on lingual side of mandible

MENTAL NERVE BLOCK

Mental nerve -Buccal mucous membrane anterior to mental foramen-Lower lip-Skin of chin

-Mucobuccal fold-Mandibular premolars

Mucobuccal fold at or just anterior to mental foramen

Mental nerve as it exits the mental foramen

25 gauge, short