Techniques of Mandibular Techniques of Mandibular AnesthesiaAnesthesia

Dr V.RAMKUMARDr V.RAMKUMAR

CONSULTANT DENTAL&FACIOMAXILLARY SURGEONCONSULTANT DENTAL&FACIOMAXILLARY SURGEON

REGNO:4118.TAMILNADU-INDIA(ASIA)REGNO:4118.TAMILNADU-INDIA(ASIA)

Mandibular AnesthesiaMandibular Anesthesia

Lower success rate than Maxillary anesthesia Lower success rate than Maxillary anesthesia - approx. 80-85 %- approx. 80-85 %

Related to bone densityRelated to bone density

Less access to nerve trunks  Less access to nerve trunks  

Mandibular Nerve BlocksMandibular Nerve Blocks

Inferior alveolarInferior alveolar

Mental - Incisive Mental - Incisive

BuccalBuccal

LingualLingual

Gow-GatesGow-Gates

AkinosiAkinosi

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 Success depends on depositing solution within 1 mm of nerve trunkwithin 1 mm of nerve trunk

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 mesial May require infiltration of incisors or mesial root of first molarroot of first molar

Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

Nerves anesthetizedNerves anesthetized

Inferior AlveolarInferior Alveolar

MentalMental

Incisive Incisive

LingualLingual

Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

Areas AnesthetizedAreas Anesthetized

Mandibular teeth to midlineMandibular teeth to midline

Body of mandible, inferior ramus Body 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

Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

IndicationsIndications

Multiple mandibular teethMultiple mandibular teeth

Buccal anterior soft tissueBuccal anterior soft tissue

Lingual anesthesiaLingual anesthesia

Inferior Alveolar Nerve Block Inferior 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)

Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

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

Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

AlternativesAlternatives

Mental nerve blockMental nerve block

Incisive nerve blockIncisive nerve block

Anterior infiltrationAnterior infiltration

Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

Alternatives (cont.)Alternatives (cont.)

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

Gow-GatesGow-Gates

Akinosi Akinosi

IntraseptalIntraseptal

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 to 3/4 posterior from coronoid notch to pterygomandibular raphepterygomandibular raphe

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

Inferior Alveolar Nerve Block Inferior Alveolar Nerve Block

Target AreaTarget Area

Inferior alveolar nerve, near mandibular Inferior alveolar nerve, near mandibular foramenforamen

LandmarksLandmarks

Coronoid notchCoronoid notch

Pterygomandibular raphePterygomandibular raphe

Occlusal plane of mandibular posteriorsOcclusal plane of mandibular posteriors

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

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

Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

ComplicationsComplications

HematomaHematoma

TrismusTrismus

Facial paralysisFacial paralysis