Long Buccal Nerve BlockLong Buccal Nerve Block

Anterior branch of Mandibular nerve (V3)Anterior branch of Mandibular nerve (V3)

Provides buccal soft tissue anesthesia adjacent to Provides buccal soft tissue anesthesia adjacent to mandibular molarsmandibular molars

Not required for most restorative proceduresNot required for most restorative procedures

Buccal Nerve BlockBuccal Nerve Block

IndicationsIndications

Anesthesia required - mucoperiosteum Anesthesia required - mucoperiosteum buccal to mandibular molarsbuccal to mandibular molars

ContraindicationsContraindications

Infection/inflammation at injection siteInfection/inflammation at injection site

Buccal Nerve BlockBuccal Nerve Block

AdvantagesAdvantages

Technically easyTechnically easy

High success rateHigh success rate

DisadvantagesDisadvantages

DiscomfortDiscomfort

Buccal Nerve BlockBuccal Nerve Block

AlternativesAlternatives

Buccal infiltrationBuccal infiltration

Gow-GatesGow-Gates

PDLPDL

IntraseptalIntraseptal

Buccal Nerve BlockBuccal Nerve BlockTechniqueTechnique

Apply topicalApply topical

Insertion distil and buccal to last molarInsertion distil and buccal to last molar

Target - Long Buccal nerve as it passes anterior border Target - Long Buccal nerve as it passes anterior border of ramusof ramus

Insert approx. 2 mm, aspirateInsert approx. 2 mm, aspirate

Inject 0.3 ml of solution, slowlyInject 0.3 ml of solution, slowly

25-27 gauge needle25-27 gauge needle

Area of insertion:- Mucosa adjacent to most distal Area of insertion:- Mucosa adjacent to most distal

Buccal Nerve BlockBuccal Nerve Block

LandmarksLandmarks

Mandibular molarsMandibular molars

Mucobuccal foldMucobuccal fold

Buccal Nerve BlockBuccal Nerve Block

ComplicationsComplications

Hematoma (unusual)Hematoma (unusual)

Positive aspirationPositive aspiration

0.7 %0.7 %

Mental Nerve BlockMental Nerve Block

Terminal branch of IAN as it exits mental Terminal branch of IAN as it exits mental foramenforamen

Provides sensory innervation to buccal soft Provides sensory innervation to buccal soft tissue anterior to mental foramen, lip and tissue anterior to mental foramen, lip and chin chin

Mental Nerve BlockMental Nerve Block

IndicationIndication

Need for anesthesia in innervated areaNeed for anesthesia in innervated area

ContraindicationContraindication

Infection/inflammation at injection siteInfection/inflammation at injection site

Mental Nerve BlockMental Nerve Block

AdvantagesAdvantages

Easy, high success rateEasy, high success rate

Usually atraumaticUsually atraumatic

DisadvantageDisadvantage

HematomaHematoma

Mental Nerve BlockMental Nerve Block

AlternativesAlternatives

Local infiltrationLocal infiltration

PDLPDL

IntraseptalIntraseptal

Inferior alveolar nerve blockInferior alveolar nerve block

Gow GatesGow Gates

Mental Nerve BlockMental Nerve Block

ComplicationsComplications

FewFew

HematomaHematoma

Positive aspirationPositive aspiration

5.7 %5.7 %

Incisive Nerve BlockIncisive Nerve Block

Terminal branch of IAN      Terminal branch of IAN     

Originates in mental foramen and proceeds Originates in mental foramen and proceeds anteriorlyanteriorly

Good for bilateral anterior anesthesia       Good for bilateral anterior anesthesia               

Not effective for anterior lingual anesthesia  Not effective for anterior lingual anesthesia  

Incisive Nerve BlockIncisive Nerve Block

Nerves anesthetizedNerves anesthetized

IncisiveIncisive

MentalMental

Incisive Nerve BlockIncisive Nerve Block

Areas AnesthetizedAreas Anesthetized

Mandibular labial mucous membranesMandibular labial mucous membranes

Lower lip / skin of chinLower lip / skin of chin

Incisor, cuspid and bicuspid teethIncisor, cuspid and bicuspid teeth

Incisive Nerve BlockIncisive Nerve Block

IndicationIndication

Anesthesia of pulp or tissue required Anesthesia of pulp or tissue required anterior to mental foramenanterior to mental foramen

ContraindicationContraindication

Infection/inflammation at injection siteInfection/inflammation at injection site

Incisive Nerve BlockIncisive Nerve Block

AdvantagesAdvantages

High success rateHigh success rate

Pulpal anesthesia w/o lingual anesthesiaPulpal anesthesia w/o lingual anesthesia

DisadvantagesDisadvantages

Lack of lingual or midline anesthesiaLack of lingual or midline anesthesia

Incisive Nerve BlockIncisive Nerve Block

ComplicationsComplications

HematomaHematoma

Positive aspirationPositive aspiration

5.7 %5.7 %