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Mandibular nerve block

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Mandibular nerve block

Mandibular nerve block

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  • 1. Techniques of Mandibular Anesthesia
  • 2. Mandibular Anesthesia
    • Lower success rate than Maxillary anesthesia (approx. 80-85 %)
    • Related to bone density
    • Less access to nerve trunks  
  • 3. Mandibular Nerve Blocks
    • Inferior alveolar
    • Mental - Incisive
    • Buccal
    • Lingual
    • Gow-Gates
    • Akinosi
  • 4. Mandibular Anesthesia
    • Most commonly performed technique
    • Has highest failure rate (15-20%)
    • Success depends on depositing solution within 1 mm of nerve trunk
  • 5. 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
  • 6. Inferior Alveolar Nerve Block
    • Nerves anesthetized
    • Inferior Alveolar
    • Mental
    • Incisive
    • Lingual
  • 7. 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
  • 8. Inferior Alveolar Nerve Block
    • Indications
    • Multiple mandibular teeth
    • Buccal anterior soft tissue
    • Lingual anesthesia
  • 9. Inferior Alveolar Nerve Block
    • Contraindications
    • Infection/inflammation at injection site
    • Patients at risk for self injury (eg. children)
  • 10. Inferior Alveolar Nerve Block
    • 10%-15% positive aspiration
  • 11. Inferior Alveolar Nerve Block
    • Alternatives
    • Mental nerve block
    • Incisive nerve block
    • Anterior infiltration
  • 12. Inferior Alveolar Nerve Block
    • Alternatives (cont.)
    • Periodontal ligament injection (PDL)
    • Gow-Gates
    • Akinosi
    • Intraseptal
  • 13. 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)
  • 14. Inferior Alveolar Nerve Block
    • Target Area
    • Inferior alveolar nerve, near mandibular foramen
    • Landmarks
    • Coronoid notch
    • Pterygomandibular raphe
    • Occlusal plane of mandibular posteriors
  • 15. Inferior Alveolar Nerve Block
    • Precautions
    • Do not inject if bone not contacted
    • Avoid forceful bone contact
  • 16. Inferior Alveolar Nerve Block
    • Failure of Anesthesia
    • Injection too low
    • Injection too anterior
    • Accessory innervation
    • -Mylohyoid nerve
    • -contralateral Incisive nerve innervation
  • 17. Inferior Alveolar Nerve Block
    • Complications
    • Hematoma
    • Trismus
    • Facial paralysis
  • 18.  
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  • 23.