Inferior Alveolar Nerve BlockAreas 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 BlockIndications1. Procedures on multiple mandibular teeth in one
quadrant
2. When Buccal soft tissue anesthesia is necessary
3. When Lingual soft tissue anesthesiais necessary
Inferior Alveolar Nerve Block Contraindications
1. Infection/inflammation at injection site
2. Patients at risk for self injury (eg. Children,- lip or tongue biting )
Inferior Alveolar Nerve BlockAlternatives
Mental nerve block
Incisive nerve block
Anterior infiltration
Inferior Alveolar Nerve BlockAlternatives (cont.)
Periodontal ligament injection (PDL)
Gow Gates Block
Vazirani – Akinosi Block
Inferior Alveolar Nerve BlockTechnique Apply topical
Area of insertion: Mucus membrane on the medial side of the
ramus, -At the intersection of two lines-Horizontal- representing height of injectionVertical- 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
Inferior Alveolar Nerve BlockPrecautions
Do not inject if bone not contacted Avoid forceful bone contact
Inferior Alveolar Nerve BlockFailure of Anesthesia Injection too low Injection too anterior Accessory innervation -Mylohyoid nerve -contralateral Incisive nerve innervation
Buccal Nerve BlockAnterior 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 BlockIndications When Anesthesia is required – in the
mandibular molar region
Contraindications Infection/inflammation at injection site
Nerve Anesthetized- Buccal
Buccal Nerve BlockAlternatives Buccal infiltration Gow-Gates PDL injection Intraseptal injection Vazirani - Akinosi
Buccal Nerve BlockTechnique Apply topical Insertion distal and buccal to last molar
Target Area - Long Buccal nerve,-as it passes along anterior border of ramus
Area of insertion-Mucosa adjacent to most distal molar-(distal & bucally)
Mental Nerve BlockTerminal branch of IAN as it exits mental
foramen
Provides sensory innervation to buccal soft tissue anterior to mental foramen, lip and chin
Mental Nerve BlockIndication When buccal soft tissue anesthesia is necessary
for procedures in the mandible anterior to mental foramen
Contraindication Infection/inflammation at injection site
Mental Nerve BlockAlternatives Local infiltration Intraseptal injection Inferior alveolar nerve block Gow Gates
Incisive Nerve BlockTerminal branch of IAN Originates in mental foramen and proceeds
anteriorly
Good for bilateral anterior anesthesia Not effective for anterior lingual anesthesia
Incisive Nerve BlockAreas Anesthetized Mandibular labial mucous membranes
Lower lip / skin of chin
Incisor, cuspid and bicuspid teeth
Incisive Nerve BlockIndication Anesthesia of tissue required anterior to mental
foramen
Contraindication Infection/inflammation at injection site
Incisive Nerve BlockAdvantages High success rate Pulpal anesthesia w/o lingual anesthesiaDisadvantages Lack of lingual or midline anesthesiaComplications Hematoma
Gow-Gates TechniqueThe 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 joint
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.