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Techniques of Mandibular

Anesthesia
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
Inferior Alveolar Nerve Block

Nerves anesthetized
Inferior Alveolar
Mental
Incisive
Lingual
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
Inferior Alveolar Nerve Block

Indications
Multiple mandibular teeth

Buccal anterior soft tissue

Lingual anesthesia
Inferior Alveolar Nerve Block

Contraindications
Infection/inflammation at injection site

Patients at risk for self injury (eg. children)


Inferior Alveolar Nerve Block

10%-15% positive aspiration


Inferior Alveolar Nerve Block

Alternatives
Mental nerve block

Incisive nerve block

Anterior infiltration
Inferior Alveolar Nerve Block

Alternatives (cont.)
Periodontal ligament injection (PDL)

Gow-Gates

Akinosi

Intraseptal
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)
Inferior Alveolar Nerve Block

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


Inferior Alveolar Nerve Block

Failure of Anesthesia
Injection too low
Injection too anterior
Accessory innervation
-Mylohyoid nerve
-contralateral Incisive nerve innervation
Inferior Alveolar Nerve Block

Complications
Hematoma

Trismus

Facial paralysis