Mandibular Injections 2e4m6b

Techniques of Mandibular Anesthesia

Mandibular Nerve Blocks Inferior alveolar Mental Buccal Lingual Gow-Gates Vazirani-Akinosi

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 portion of the ramus  Buccal mucosa anterior to mental foramen  Anterior 2/3 tongue & floor of mouth  Lingual soft tissue and periosteum 

Inferior Alveolar Nerve Block Indications 1. Procedures on multiple mandibular teeth in one quadrant 2.

3.

When Buccal soft tissue anesthesia is necessary When Lingual soft tissue anesthesiais necessary

Inferior Alveolar Nerve Block Contraindications 1. 2.

Infection/inflammation at injection site Patients at risk for self injury (eg. Children,lip or tongue biting )

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 Block Vazirani – Akinosi Block

Inferior Alveolar Nerve Block Technique  Apply topical 

Area of insertion:

Mucus membrane on the medial side of the ramus, -At the intersection of two lines Horizontal- representing height of injection Vertical- representing anteroposterior plane of injection

Inferior Alveolar Nerve Block Target Area Inferior alveolar nerve, near mandibular foramen Landmarks Coronoid notch Pterygomandibular raphe Occlusal plane of the mandibular posterior teeth

Procedure-

Inferior Alveolar Nerve Block Precautions Do not inject if bone not ed Avoid forceful bone

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 Transient Facial paralysis

Buccal Nerve Block Anterior branch of Mandibular nerve (V3) Provides buccal soft tissue anesthesia, adjacent to mandibular molars Not required for most restorative procedures

Area Aanesthetized- soft tisue& periosteum buccal to mandibular molars

Buccal Nerve Block Indications When Anesthesia is required – in the mandibular molar region Contraindications Infection/inflammation at injection site Nerve Anesthetized- Buccal

Buccal Nerve Block Advantages Technically easy High success rate Disadvantages Discomfort

Buccal Nerve Block Alternatives Buccal infiltration Gow-Gates PDL injection Intraseptal injection Vazirani - Akinosi

Buccal Nerve Block Technique Apply topical Insertion distal and buccal to last molar

Target Area - Long Buccal nerve,-as it es along anterior border of ramus

Area of insertion-

Mucosa adjacent to most distal molar-(distal & bucally)

Buccal Nerve Block Landmarks Mandibular molars Mucobuccal fold

Procedure-

•Complications­ Hematoma

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

Mental Nerve Block Indication When buccal soft tissue anesthesia is necessary for procedures in the mandible anterior to mental foramen Contraindication Infection/inflammation at injection site

Mental Nerve Block Advantages Easy, high success rate Usually atraumatic Disadvantage Hematoma

Mental Nerve Block Alternatives Local infiltration Intraseptal injection Inferior alveolar nerve block Gow Gates

Mental Nerve Block Complications Few Hematoma

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

Incisive Nerve Block Nerves anesthetized Incisive Mental

Incisive Nerve Block Areas Anesthetized Mandibular labial mucous membranes Lower lip / skin of chin Incisor, cuspid and bicuspid teeth

Incisive Nerve Block Indication Anesthesia of tissue required anterior to mental foramen Contraindication Infection/inflammation at injection site

Incisive Nerve Block Advantages High success rate Pulpal anesthesia w/o lingual anesthesia Disadvantages Lack of lingual or midline anesthesia Complications Hematoma

Gow-Gates Technique  The

Gow-Gates technique is useful alternative to the inferior alveolar nerve block  it is often used when the latter fails to provide adequate anesthesia.  Advantages of this technique versus the inferior alveolar technique are its low failure rate and low incidence of positive aspiration.

 The

Gow-Gates technique anesthetizes the auriculotemporal, inferior alveolar, buccal, mental, incisive, mylohyoid and lingual nerves.

 Contraindications

to this procedure include acute inflammation and infection over the site of injection and trismatic patients.

The patient is asked to open mouth maximally. The mesiolingual cusp of the maxillary 2nd molar is the reference point for the height of the injection: The needle is then moved distally and is held parallel to an imaginary line drawn from the intertragic notch to the corner of the mouth

Vazirani-Akinosi Closed Mouth Mandibular Block  



The Vazirani-Akinosi closed mouth mandibular block is a useful technique for patients with limited opening due trismus or ankylosis of the temporomandibular t Other advantages to this technique are the minimal risk of trauma to the inferior alveolar nerve, artery, vein, and pterygoid muscle, low complication rate and minimal discomfort upon injection Contraindications to this technique are acute inflammation and infection in the pterygomandibular space, deformity or tumor in the maxillary tuberosity region.