5. Mandibular Anesthesia
Most commonly performed technique
Has highest failure rate (15-20%)
Success depends on depositing solution within 1 mm of
nerve trunk
6. 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
8. 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
14. 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)
15. Inferior Alveolar Nerve Block
Target Area
Inferior alveolar nerve, near mandibular
foramen
Landmarks
Coronoid notch
Pterygomandibular raphe
Occlusal plane of mandibular posteriors
16. Inferior Alveolar Nerve Block
Precautions
Do not inject if bone not contacted
Avoid forceful bone contact
17. Inferior Alveolar Nerve Block
Failure of Anesthesia
Injection too low
Injection too anterior
Accessory innervation
-Mylohyoid nerve
-contralateral Incisive nerve innervation
26. 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
30. Buccal Nerve Block
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
35. 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
44. 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
50. Gow-Gates Mandibular Block
Developed to improve success rate.
True mandibular nerve block.
Has a lower rate of positive aspiration
(2% vs. 10%-15% for IAN).
Technique dependent.
54. Gow-Gates Mandibular Block
Technique (cont.)
Penetrate mucosa distil to 2nd molar
Advance needle to bone (avg. 25 mm)
Aspirate, deposit 1.8 ml of solution slowly
55. Gow-Gates Mandibular Block
Technique (cont.)
Patient’s mouth must be fully open during
injection and for 1-2 mins afterward
May require reinforcement with second
injection
62. Akinosi Closed Mouth Mandibular
Block
Alternative for mandibular
block when limited opening
is present
( eg. trismus, closed lock, etc..)
63. Akinosi Closed Mouth Mandibular
Block
Advantages
Not necessary to open widely
High success rate
Relatively atraumatic
Few complications, few positive aspirations
64. Akinosi Closed Mouth Mandibular
Block
Disadvantages
Visualization of path and depth of insertion is
difficult
No bony contact
Traumatic if needle hits periosteum
65. Akinosi Closed Mouth Mandibular
Block
Target Area
Soft tissue medial to ramus
Above foramen, below condyle
Landmarks
Mucogingival junction of maxillary 2nd or 3rd
molar
Maxillary tuberosity
66. Akinosi Closed Mouth Mandibular
Block
Area of insertion
Soft tissue overlying medial ramus, adjacent to
tuberosity
At height of mucogingival junction of maxillary
2nd or 3rd molar
67. Akinosi Closed Mouth Mandibular
Block
Technique
Retract soft tissues, have patient occlude
Apply topical
Penetrate to 25 mm, parallel to maxillary
occlusal plane, in a posterior and lateral
direction
68. Akinosi Closed Mouth Mandibular
Block
Technique (cont.)
Aspirate, deposit 1.8 ml slowly
Motor paralysis will develop first, allowing
patient to open more widely
70. Akinosi Closed Mouth Mandibular
Block
Failures of anesthesia
Lateral flaring of mandible
Insertion too low
Penetration too deep or shallow (adjust for patient
size)