Mandibular Nerve Blocks 1. 2. 3. 4. 5. 6.

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 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

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 1. 2. 3. 4. 5. 6. 7. 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:

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) 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 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 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 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 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)