Mandibular nerve block
- 1. Techniques of Mandibular Anesthesia Dr V.RAMKUMAR CONSULTANT DENTAL&FACIOMAXILLARY SURGEON REGNO:4118.TAMILNADU-INDIA(ASIA)
- 2. Mandibular Anesthesia Lower success rate than Maxillary anesthesia - approx. 80-85 % Related to bone density Less access to nerve trunks
- 3. Mandibular Nerve Blocks Inferior alveolar Mental - Incisive Buccal Lingual Gow-Gates Akinosi
- 4. Mandibular Anesthesia Most commonly performed technique Has highest failure rate (15-20%) Success depends on depositing solution within 1 mm of nerve trunk
- 5. 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
- 6. Inferior Alveolar Nerve Block Nerves anesthetized Inferior Alveolar Mental Incisive Lingual
- 7. Inferior Alveolar Nerve Block 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
- 8. Inferior Alveolar Nerve Block Indications Multiple mandibular teeth Buccal anterior soft tissue Lingual anesthesia
- 9. Inferior Alveolar Nerve Block Contraindications Infection/inflammation at injection site Patients at risk for self injury (eg. children)
- 10. Inferior Alveolar Nerve Block 10%-15% positive aspiration
- 11. Inferior Alveolar Nerve Block Alternatives Mental nerve block Incisive nerve block Anterior infiltration
- 12. Inferior Alveolar Nerve Block Alternatives (cont.) Periodontal ligament injection (PDL) Gow-Gates Akinosi Intraseptal
- 13. Inferior Alveolar Nerve Block Technique Apply topical Area of insertion: medial ramus, mid-coronoid notch, level with occlusal plane (1 cm above), 3/4 posterior from coronoid notch to pterygomandibular raphe advance to bone (20-25 mm)
- 14. Inferior Alveolar Nerve Block Target Area Inferior alveolar nerve, near mandibular foramen Landmarks Coronoid notch Pterygomandibular raphe Occlusal plane of mandibular posteriors
- 15. Inferior Alveolar Nerve Block Precautions Do not inject if bone not contacted Avoid forceful bone contact
- 16. Inferior Alveolar Nerve Block Failure of Anesthesia Injection too low Injection too anterior Accessory innervation -Mylohyoid nerve -contralateral Incisive nerve innervation
- 17. Inferior Alveolar Nerve Block Complications Hematoma Trismus Facial paralysis