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Techniques of Mandibular Anesthesia
Techniques of Mandibular Anesthesia
Faisal A. Quereshy, M.D., D.D.S., F.A.C.S.Assistant Professor / Residency Director
Case Western Reserve University School of Dental Medicine
Dept. Oral & Maxillofacial Surgery
Monday March 5, 2007
Faisal A. Quereshy, M.D., D.D.S., F.A.C.S.Assistant Professor / Residency Director
Case Western Reserve University School of Dental Medicine
Dept. Oral & Maxillofacial Surgery
Monday March 5, 2007
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Mandibular Anesthesia
Lower success rate than Maxillary anesthesia - approx. 80-85 %
Related to bone density
Less access to nerve trunks
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Mandibular Nerve Blocks
Inferior alveolarMental - Incisive BuccalLingualGow-GatesAkinosi
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Mandibular Anesthesia
Most commonly performed technique
Has highest failure rate (15-20%)
Success depends on depositing solution within 1 mm of nerve trunk
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
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
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Inferior Alveolar Nerve Block
Nerves anesthetized Inferior Alveolar Mental Incisive Lingual
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
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
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Inferior Alveolar Nerve Block
Indications Multiple mandibular teeth
Buccal anterior soft tissue
Lingual anesthesia
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Inferior Alveolar Nerve Block
Contraindications Infection/inflammation at injection site
Patients at risk for self injury (eg. children)
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Inferior Alveolar Nerve Block
10%-15% positive aspiration
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Inferior Alveolar Nerve Block
Alternatives Mental nerve block
Incisive nerve block
Anterior infiltration
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Inferior Alveolar Nerve Block
Alternatives (cont.) Periodontal ligament injection (PDL)
Gow-Gates
Akinosi
Intraseptal
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
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)
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Inferior Alveolar Nerve Block
Target Area Inferior alveolar nerve, near mandibular
foramen Landmarks Coronoid notch Pterygomandibular raphe Occlusal plane of mandibular posteriors
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Inferior Alveolar Nerve Block
Precautions Do not inject if bone not contacted
Avoid forceful bone contact
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Inferior Alveolar Nerve Block
Failure of Anesthesia Injection too low Injection too anterior Accessory innervation -Mylohyoid nerve -contralateral Incisive nerve innervation
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Inferior Alveolar Nerve Block
Complications Hematoma
Trismus
Facial paralysis
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
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
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Buccal Nerve Block
Indications Anesthesia required - mucoperiosteum buccal to
mandibular molars
Contraindications Infection/inflammation at injection site
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Buccal Nerve Block
Advantages Technically easy High success rate
Disadvantages Discomfort
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Buccal Nerve Block
Alternatives Buccal infiltration Gow-Gates PDL Intraseptal
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Buccal Nerve BlockTechnique 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 needleArea of insertion:
- Mucosa adjacent to most distal
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Buccal Nerve Block
Landmarks Mandibular molars
Mucobuccal fold
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Buccal Nerve Block
Complications Hematoma (unusual)
Positive aspiration 0.7 %
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
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
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Mental Nerve Block
Indication Need for anesthesia in innervated area
Contraindication Infection/inflammation at injection site
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Mental Nerve Block
Advantages Easy, high success rate Usually atraumatic
Disadvantage Hematoma
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Mental Nerve Block
Alternatives Local infiltration PDL Intraseptal Inferior alveolar nerve block Gow Gates
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Mental Nerve Block
Complications Few Hematoma
Positive aspiration 5.7 %
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
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
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Incisive Nerve Block
Nerves anesthetized Incisive
Mental
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Incisive Nerve Block
Areas Anesthetized Mandibular labial mucous membranes
Lower lip / skin of chin
Incisor, cuspid and bicuspid teeth
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Incisive Nerve Block
Indication Anesthesia of pulp or tissue required anterior to mental
foramen
Contraindication Infection/inflammation at injection site
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Incisive Nerve Block
Advantages High success rate Pulpal anesthesia w/o lingual anesthesia
Disadvantages Lack of lingual or midline anesthesia
March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Incisive Nerve Block
Complications Hematoma
Positive aspiration 5.7 %
