Mandibular nerve block and mental nerve / oral surgery courses


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Mandibular nerve block and mental nerve / oral surgery courses

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  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education
  3. 3. Mandibular Anesthesia Lower success rate than Maxillary anesthesia approx. 80-85 % Related to bone density Less access to nerve trunks
  4. 4. Mandibular Nerve Blocks Inferior alveolar Mental - Incisive Buccal Lingual Gow-Gates Akinosi
  5. 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. 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
  7. 7. Inferior Alveolar Nerve Block Nerves anesthetized Inferior Alveolar Mental Incisive Lingual
  8. 8. Inferior Alveolar Nerve Block Areas Anesthetized Mandibular teeth to midline Body of mandible, inferior ramus Buccal mucosa anterior to mandibular first molar. Anterior 2/3 tongue & floor of mouth Lingual soft tissue and periosteum
  9. 9. Inferior Alveolar Nerve Block Indications Multiple mandibular teeth Buccal anterior soft tissue Lingual anesthesia
  10. 10. Inferior Alveolar Nerve Block Contraindications Infection/inflammation at injection site Patients at risk for self injury (eg. children)
  11. 11. Inferior Alveolar Nerve Block 10%-15% positive aspiration
  12. 12. Inferior Alveolar Nerve Block Alternatives Mental nerve block Incisive nerve block Anterior infiltration
  13. 13. Inferior Alveolar Nerve Block Alternatives (cont.) Periodontal ligament injection (PDL) Gow-Gates Akinosi Intraseptal
  14. 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. 15. Inferior Alveolar Nerve Block Target Area Inferior alveolar nerve, near mandibular foramen Landmarks Coronoid notch Pterygomandibular raphe Occlusal plane of mandibular posteriors
  16. 16. Inferior Alveolar Nerve Block Precautions Do not inject if bone not contacted Avoid forceful bone contact
  17. 17. Inferior Alveolar Nerve Block Failure of Anesthesia Injection too low Injection too anterior Accessory innervation -Mylohyoid nerve -contralateral Incisive nerve innervation
  18. 18. Inferior Alveolar Nerve Block Complications Hematoma Trismus Facial paralysis
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  25. 25. Mental nerve block It is the terminal branch of the I A N. Comes out of mental foramen at or near the mandibular premolars. Area suppiled: sensory innervations to the buccal soft tissues lying anterior to the foramen. Soft tissues of the lower lip & the chin.
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  28. 28. Indication: • • Soft tissues biopsy Suturing of soft tiissues Contraindications:actue inflammation at site of injection. Advantages:1)high success rate . 2)easy technically. 3)atraumatic. Disadvantage: hematoma
  29. 29. Chances of positive aspiration:5.7% Alternatives: Technique: foramen 25-27gauge niddle Area of insertion :mucobuccal fold at or just anterior to the mental Target area : mental nerve as it exist from foramen Land mark : mandibular premolars & mucobuccal fold. Orientation of the bevel : towards the bone.
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  35. 35. INCISIVE NERVE BLOCK Incisive nerve: Terminal branch of the I. A .N. Originates as a direct continuation of the I.A .N at the mental foramen& continues anteriorly in the incisive canal. Area suppied: premolars ,canines,incisors & there buccal soft tissue and bone It provide sensory innervation to those teeth located anterior to the mental foramen.
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  37. 37. Indication of Incisive nerve block: 1)dental procedures requiring pulpal anesthesia on the mandibular teeth anterior to mental foramen. 2)while treating premolar to premolar Contra indication: acute inflammation, Area anesthetized: Buccal mucosa anterior to the mental foramen Lower lip &skin of the chin. Pulpal nerve fibers of premolars,canines, anteriors.
  38. 38. Advantage: 1)provides pulpal and hard tissue anesthesia with out lingual anesthesia. 2)used in case of bilateral I.A.N 3)high succes rate Disadvantage: 1)Dose not provide lingual anasthesia 2) Partial anasthesia may develop at the mid line because of nervefibers mayover lap with opposite side
  39. 39. Positive aspiration:5.7% Alternatives: 1) local infitration ofbuccal tissues&pulpal anesthesia of central& lateral incisors 2)Inferior alveolar nerve block . 3)Gow-gates mandibular nerve block. 4)Vazirani-akinosis mandibular nerve block. 5)Periodontal ligamental injection.
  40. 40. Technique: 1)25-gague needle is recommended but most commonly we use 27 gague needle. 2)area of insertion:mucobuccal at or just anterior to the mental foramen. 3)target area:mental foramen through whichthe mental nerve exit and in which Incisive nerve is located. 4)land mark:mandibular premolars and mucobuccal flod. 5)orientation of the bevel: towards the bone. Procedure:
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  44. 44. Thank you Leader in continuing dental education