TechniquesofMandibular

Anesthesia

MandibularAnesthesia
LowersuccessratethanMaxillaryanesthesia
approx.8085%
Relatedtobonedensity
Lessaccesstonervetrunks

MandibularNerveBlocks
Inferioralveolar
MentalIncisive
Buccal
Lingual
GowGates
Akinosi

MandibularAnesthesia
Mostcommonlyperformedtechnique
Hashighestfailurerate(1520%)
Successdependsondepositingsolutionwithin1mmof
nervetrunk

InferiorAlveolarNerveBlock
Notacompletemandibularnerveblock.
Requiressupplementalbuccalnerveblock
Mayrequireinfiltrationofincisorsormesial
rootoffirstmolar

InferiorAlveolarNerveBlock
Nervesanesthetized
InferiorAlveolar
Mental
Incisive
Lingual

InferiorAlveolarNerveBlock
AreasAnesthetized
Mandibularteethtomidline
Bodyofmandible,inferiorramus
Buccalmucosaanteriortomentalforamen
Anterior2/3tongue&floorofmouth
Lingualsofttissueandperiosteum

InferiorAlveolarNerveBlock
Indications
Multiplemandibularteeth
Buccalanteriorsofttissue
Lingualanesthesia

InferiorAlveolarNerveBlock
Contraindications
Infection/inflammationatinjectionsite
Patientsatriskforselfinjury(eg.children)

InferiorAlveolarNerveBlock
10%15%positiveaspiration

InferiorAlveolarNerveBlock
Alternatives
Mentalnerveblock
Incisivenerveblock
Anteriorinfiltration

InferiorAlveolarNerveBlock
Alternatives(cont.)
Periodontalligamentinjection(PDL)
GowGates
Akinosi
Intraseptal

InferiorAlveolarNerveBlock
Technique
Applytopical
Areaofinsertion:
medialramus,midcoronoidnotch,
levelwithocclusalplane(1cmabove),
3/4posteriorfromcoronoidnotchto
pterygomandibularraphe
advancetobone(2025mm)

InferiorAlveolarNerveBlock
TargetArea
Inferioralveolarnerve,nearmandibularforamen

Landmarks
Coronoidnotch
Pterygomandibularraphe
Occlusalplaneofmandibularposteriors

InferiorAlveolarNerveBlock
Precautions
Donotinjectifbonenotcontacted
Avoidforcefulbonecontact

InferiorAlveolarNerveBlock
FailureofAnesthesia
Injectiontoolow
Injectiontooanterior
Accessoryinnervation
Mylohyoidnerve
contralateralIncisivenerveinnervation

InferiorAlveolarNerveBlock
Complications
Hematoma
Trismus
Facialparalysis