MANDIBULAR INJECTIONTECHNIQUES

Chinthamani Laser Dental Clinic

INFERIOR ALVEOLAR NERVE BLOCK

OTHER COMMEN NAME: MANDIBULAR BLOCK

NERVES ANESTHETISED:1.Inferioralveolar2.Incisive3.Mental 4.Lingual

AREAS ANESTHETISED:1.Mandibular teeth 2.Body of the mandible3.Buccal mucoperiosteum4.Ant 2/3 tongue & floor of oral cavity5.Lingual soft tissues &periosteum

INDICATIONS:

1.Multiple mand teeth in 1 quadrant

2.Buccal soft tissue anesthesia

3.Lingual soft tissue anesthesia

CONTRAINDICATIONS:

1.Infection

2.Very young child

ADVANTAGES: Wide area of Anesthesia

DISADVANTAGES: Wide area of anesthesia Inadequate anesthesia +ve aspiration(10% to 15%) Intra oral landmarks Lingual & lower lipanesthesia Partial anesthesia-bifid an &bifid mand canals +VE ASPIRATION:10% TO 15%

ALTERNATIVES: Mental nerve block Incisive nerve block Supra periosteal injection Gow gates mand n block 5.vazirani-akinosi mand n block PDL injection Intra osseous injection Intra septal injection

TECHNIQUES 25 gauge long needle area of insertion target area landmarks

Coronoid notch Pterygomandibular raphae Occlusal plane

Orientation of needle bevel

Procedure: Assume the correct position

For rt IANB 8 o’clk position For lt IANB 10 o’clk position

Position of the patient-supine Locate the needle inj site 3 parameters:

> height of the injection > antpost site of injection > penetration site

HEIGHT OF THE INJECTION: Imaginary line Finger on the coronoid notch Needle insertion point Post border of mand ramus Prepare the tissues:

Dry wid gauze Topical antiseptic Topical anesthetic

ANTPOST SITE OF INJECTION

PENETRATION DEPTH: Depth of penetration:20 to 25mm If bone is contacted soon If bone is not contacted Insert the needle Aspirate Withdraw the syringe Make the needle safe After 20 sec upright position Wait 3to5 mins to start dental procedure

SIGNS AND SYMPTOMS:

Subjective: Tingling and numbness of the lower lip. Subjective: Tingling and numbness of the tongue. Objective: No pain.

SAFETY FEATURE:

Contacting bone & preventing over insertion.

PRECAUTIONS:

Do not deposit la if bone is not contacted. Avoid pain.

FAILURES OF ANESTHESIA: Deposition of anesthetic too low. Deposition of anesthetic too far anteriorly on ramus. Accessory innervation to the mandibular teeth

Incomplete pulpal anesthesia. Accessory sensory innervation (e.g. cervical accessory &

mylohyoid nerves). To correct

Technique 25 gauge long needle. Retract the tongue toward midline Place the syringe & direct the needle tip Depth of penetration to bone:3-5mm. Aspirate:0.6ml in 20secs

Bifid inferior alveolar nerve

Incomplete anesthesia to CI & LI Due to innervation of mylohyoid To correct:

Supraperiosteal infiltration 27gauge short needle Direction of needle tip Aspirate:0.6ml in 20secs After 2-3mins start dental procedure

Complications: Hematoma Trismus Transient facial paralysis

INDIRECT MANDIBULAR TECHNIQUE OR

FISCHER 1-2-3 TECHNIQUE Needle position:

1st position: Long buccal nerve anesthetised from the opp side

2nd position: Lingual nerve anesthetised from the same side

3rd position: Inferior alveolar nerve is anesthetised from the opp side

Landmarks: Technique:

1st position 2nd position 3rd position

Signs and symptoms

BUCCAL NERVE BLOCK Other common name: Long buccal n block or

buccinator n block Nerves anesthetised: Buccal Areas anesthetised: Soft tissues & periosteum

buccal to mand molars Indication: Buccal softtissue anesthesia Contraindication: Infection Advantages:

High success rate Technically easy

Disadvantage: Pain +ve aspiration:0.7% Alternatives:

Buccal infiltration Gow gates mand n block Vazirani-akinosi mand n block PDL injection Intra osseous injection Intraseptal injection

25 gauge long needle Area of insertion Target area Landmarks Orientation of needle bevel Procedure

Assume the correct position Position of pt:supine Prepare the tissues for penetration Direct the syringe & advance the needle.

Depth of penetration:2-4mm Aspirate Withdraw the syringe Wait 1min & start dental procedure

Techniques

SIGNS AND SYMPTOMS:

Safety Feature: Min +ve aspiration Prevent over insertion

Precautions: Pain on insertion from striking unanesthetised periosteum LA soln not being retained at inj site

Failures of anesthesia: Rare

Complications: Hematoma

MANDIBULAR NERVE BLOCK THE GOW-GATES TECHNIQUE

OTHER COMMON NAME:THIRD DIVISION N

BLOCK,V3 NERVE BLOCK. Nerves anesthetised:

Inferior alveolar n Mental Incisive Lingual Mylohyoid Auriculotemporal Buccal

Areas anesthetised: Mand teeth midline Buccal mucoperiosteum Ant 2/3 tongue &floor oral cavity Lingual soft tissues Body of mandible Skin over zygoma

Indications: Multiple procedures Buccal soft tissue anesthesia Lingual soft tissue anesthesia When conventional IANB unsuccessful

Contraindications: Trismus patient & rest same as IANB

ADVANTAGES: Only one injection High success rate (>95%) Min aspiration rate Few post inj complications Successful even if bifid IAN’S & mand n’s

present

DISADVANTAGES: Lingual and lower lip anesthesia Time of onset longer 5min

+VE ASPIRATION:2%

ALTERNATIVES:

IANB & buccal n block Vazirani-akinosi closed mouth mand block Incisive n block Mental n block Buccal n block Supra periosteal injection Intra osseous technique PDL inj technique

TECHNIQUES: 25 gauge long needle Area of insertion Target area Landmarks

Extra oral: Intraoral

Orientation of bevel Procedure:

Assume the correct position Position the patient Locate extra oral landmarks Visualize intraoral landmarks Prepare tissues at site of penetration Direct the syringe Insert the needle Align the needle with the plane Slowly advance the needle Depth of penetration:25mm Withdraw the needle 1mm Aspirate:if –ve slowly deposit 1.8ml in 60-90 secs Withdraw the syringe Request the pt to keep mouth open for 1-2mins Upright position Wait for 3-5mins before starting dental procedure

SIGNS AND SYMPTOMS:SAME AS IANB

Safety feature: Very low +ve aspiration rate Needle contacting bone & preventing over insertion

Precautions: Do not deposit if bone is not contacted

Failures of anesthesia: Too little volume Anatomical difficulties

Complications: Hematoma Trismus Temporary paralysis of cranial nerves iii, iv & vi.

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