Anaesthesiology Dentistry

Techniques of Mandibular Anesthesia

Techniques of Mandibular Anesthesia including Inferior Alveolar Nerve Block

Mandibular Anesthesia

  • Lower success rate than Maxillary anesthesia (approx. 80-85 %)
  • Related to bone density
  • Less access to nerve trunks

Mandibular Nerve Blocks

  • Inferior alveolar
  • Mental – Incisive
  • Buccal
  • Lingual
  • Gow-Gates
  • Akinosi

Mandibular Anesthesia

  • Most commonly performed technique
  • Has highest failure rate (15-20%)
  • Success depends on depositing solution within 1 mm of nerve trunk

Inferior Alveolar Nerve Block

  • Not a complete mandibular nerve block.
  • Requires supplemental buccal nerve block
  • May require infiltration of incisors or mesial root of first molar

Nerves anesthetized

  • Inferior Alveolar
  • Mental
  • Incisive
  • Lingual

Areas Anesthetized

  • Mandibular teeth to midline
  • Body of mandible, inferior ramus
  • Buccal mucosa anterior to mental foramen
  • Anterior 2/3 tongue & floor of mouth
  • Lingual soft tissue and periosteum

Indications of inferior Alveolar nerve block

  • Multiple mandibular teeth
  • Buccal anterior soft tissue
  • Lingual anesthesia

Contraindications of inferior Alveolar nerve block

  • Infection/inflammation at injection site
  • Patients at risk for self injury (eg. children)
  • 10%-15% positive aspiration

Alternatives for inferior Alveolar nerve block

  • Mental nerve block
  • Incisive nerve block
  • Anterior infiltration
  • Periodontal ligament injection (PDL)
  • Gow-Gates
  • Akinosi
  • Intraseptal

Technique for of inferior Alveolar nerve block

  • Apply topical anaesthesia
  • Area of insertion:
  1. Medial ramus, mid-coronoid notch,
  2. Level with occlusal plane (1 cm above),
  3. 3/4 posterior from coronoid notch to pterygomandibular raphe
  4. Advance to bone (20-25 mm)
Techniques of Mandibular Anesthesia
Techniques of Mandibular Anesthesia
Techniques of Mandibular Anesthesia
Techniques of Mandibular Anesthesia
Techniques of Mandibular Anesthesia
Techniques of Mandibular Anesthesia
Target Area

Inferior alveolar nerve, near mandibular foramen

Landmarks

Coronoid notch
Pterygomandibular raphe
Occlusal plane of mandibular posteriors

Inferior Alveolar Nerve Block

Precautions
  • Do not inject if bone not contacted
  • Avoid forceful bone contact
Failure of Anesthesia in inferior Alveolar nerve block
  • Injection too low
  • Injection too anterior
  • Accessory innervation
    -Mylohyoid nerve
    -Contra lateral Incisive nerve innervation
Complications of inferior Alveolar nerve block
  • Hematoma
  • Trismus
  • Facial paralysis
  • Mandibular nerve block

Other Techniques of Manidilar nerve block

Long Buccal Nerve Block

  • Anterior branch of Mandibular nerve (V3)
  • Provides buccal soft tissue anesthesia adjacent to mandibular molars
  • Not required for most restorative procedures

Buccal Nerve Block

Indications

Anesthesia required – mucoperiosteum buccal to mandibular molars

Contraindications

Infection/inflammation at injection site

Advantages
  • Technically easy
  • High success rate
Disadvantages

Discomfort

Alternatives
  • Buccal infiltration
  • Gow-Gates
  • PDL
  • Intraseptal
Techniques of Mandibular Anesthesia
Techniques of Mandibular Anesthesia
Technique

Apply topical
Insertion distil and buccal to last molar

  • Target – Long Buccal nerve as it passes anterior border of ramus
  • Insert  approx.  2 mm, aspirate
  • Inject 0.3 ml of solution, slowly
  • 25-27 gauge needle
Area of insertion

Mucosa adjacent to most distal

Landmarks
  • Mandibular molars
  • Mucobuccal fold
Complications
  • Hematoma (unusual)
  • Positive aspiration-0.7 %

Mental Nerve Block

Terminal branch of IAN as it exits mental foramen
Provides sensory innervation to buccal soft tissue anterior to mental foramen, lip and chin

Indication

Need for anesthesia in innervated area

Contraindication

Infection/inflammation  at injection site

Advantages
  • Easy, high success rate
  • Usually atraumatic
Disadvantage

Hematoma

Alternatives
  • Local infiltration
  • PDL
  • Intraseptal
  • Inferior alveolar nerve block
  • Gow Gates
Techniques of Mandibular Anesthesia
Techniques of Mandibular Anesthesia
Complications
  • Few
  • Hematoma
  • Positive aspiration-5.7 %

Incisive Nerve Block

  • Terminal branch of IAN
  • Originates in mental foramen and proceeds anteriorly
  • Good for bilateral anterior anesthesia
  • Not effective for anterior lingual anesthesia
Nerves anesthetized
  • Incisive
  • Mental
Areas Anesthetized
  • Mandibular labial mucous membranes
  • Lower lip / skin of chin
  • Incisor, cuspid and bicuspid teeth
Techniques of Mandibular Anesthesia
Techniques of Mandibular Anesthesia
Indication

Anesthesia of pulp or tissue required anterior to mental foramen

Contraindication

Infection/inflammation at injection site

Advantages
  • High success rate
  • Pulpal anesthesia w/o lingual anesthesia
Disadvantages

Lack of lingual or midline anesthesia

Complications
  • Hematoma
  • Positive aspiration-5.7 %

Mandibular nerve block (other techniques)