TECHNIQUES OF MANDIBULAR
ANESTHESIA
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.co...
L A SUCCESS RATE
MAXILLA VS MANDIBLE

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TECHNIQUES
 INFERIOR ALVEOLAR NERVE BLOCK
 BUCCAL NERVE BLOCK
 THE GOW GATES TECHNIQUE
 EXTRA ORAL
 VAZIRANI-AKINOSI ...
INFERIOR ALVEOLAR NERVE
BLOCK
 Most frequently used
 Commonly called MANDIBULAR NERVE BLOCK

Nerves anesthetized
1. Infe...
 Areas anesthetized
1. Mandibular teeth to the midline

2. Body of the mandible, inferior portion of
the ramus
3. Buccal ...
Indications
1. Procedures on multiple mandibular teeth in one quadrant
2. When buccal soft tissue anesthesia (anterior to ...
Advantages
One injection provides a wide area of anesthesia
Disadvantages
1. Wide area of anesthesia (not necessary for lo...
 It has a significantly lower success rate because

of
(1) anatomical variation in the height of the
mandibular foramen.
...
Methods
 Direct
 In Direct

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 Technique
1. A 25-gauge long needle recommended

2. Area of insertion: mucous membrane on the medial side
of the mandibu...
 The needle is located too far anteriorly (laterally)
 Overinsertion with no contact of bone.
 The needle is usually po...
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 Insert the needle. When bone is contacted,

withdraw approximately I mm to prevent
subperiosteal injection.
 Aspirate. ...
 Signs and symptoms
1. Tingling or numbness of the lower lip

indicates anesthesia of the mental nerve,. It
is a good ind...
 Precautions

1. Do not deposit local anesthetic if bone is not
contacted.
2. Avoid pain by not contacting bone too force...
BUCCAL NERVE BLOCK
 The buccal nerve is a branch of the anterior

division of V3
 The sole indication for administration...
 Area of insertion: mucous membrane distal

and buccal to the most distal molar tooth in
the arch
3. Target area: buccal ...
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The Gow-Gates technique
 The Gow-Gates technique is a true mandibular nerve

block since it provides sensory anesthesia t...
 Nerves anesthetized

1. Inferior alveolar
2. Mental
3. Incisive
4. Lingual
5. Mylohyoid
6. Auriculotemporal
7 Buccal (in...
 Areas anesthetized (Fig. 14-15)

1. Mandibular teeth to the midline
2. Buccal mucoperiosteum and mucous
membranes on
the...
 Indications

1. Multiple procedures on mandibular teeth
2. When buccal soft tissue anesthesia, from the
third molar to t...
Contraindications
 Patients who are unable to open their mouth
wide
Advantages
1. Requires only one injection;
2. High su...
Technique
1. 25-gauge long needle
recommended
2. Area of insertion: mucous
membrane on the mesial of
the mandibular ramus,...
Failures of anesthesia
 Rare with the Gow-Gates mandibular block,

once the administrator becomes familiar with the
techn...
 The technique has a very high success rate,

has minimal toxic effects, shows very low
positive blood aspiration, Unlike...
Vazirani-Akinosi technique.
 Its primary indication remains those situations in

which limited mandibular opening preclud...
 Technique
 Area of insertion: soft tissue

overlying the medial (lingual)
border of the mandibular
ramus directly
 adj...
 Target area: soft tissue on the medial (lingual)

border of the ramus in the region of the inferior
alveolar, lingual, a...
Landmarks
a. Mucogingival junction of the maxillary third (or
second) molar
b. Maxillary tuberosity
c. Coronoid notch on t...
EXTRA ORAL

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Comparison of the Anesthetic
Efficacy

www.indiandentalacademy.com

JOE—Volume 34, Number 11, November 2008
www.indiandentalacademy.com

JOE—Volume 34, Number 11, November 2008
Speed of Injection Influences Efficacy
of Inferior Alveolar
Nerve Blocks

www.indiandentalacademy.com

JOE — Volume 32, Nu...
MENTAL NERVE BLOCK
Areas anesthetized
 Buccal mucous membranes anterior to the mental
foramen (around the second premolar...
www.indiandentalacademy.com
 Technique

1. A 25- or 27-gauge short needle recommended
2. Area of insertion: mucobuccal fold at or just
anterior to th...
INCISIVE NERVE BLOCK
 Areas anesthetized

1. Buccal mucous membrane anterior to the mental
foramen, usually from the seco...
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THANK YOU

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Techniques of mandibular anesthesia new /certified fixed orthodontic courses by Indian dental academy

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  • There is a significant relationship between the rate ofinjection and pressure rise when depositing the anestheticsolution, consequently affecfing its retention within theregion. It is claimed that depositing 2 ml of an anestheticsolution at the lingula in 18.3 sec increases hydrostaticpressure from 14.5 to 469 mm Hg.18 Such a greatimbalance between intra- and extravascular pressure andthe resulting loss of the anesthetic through the pores ofthe capillary walls affects its concentration at the nervemembrane and may result in a partial or complete failureof the block.The inject
  • Techniques of mandibular anesthesia new /certified fixed orthodontic courses by Indian dental academy

    1. 1. TECHNIQUES OF MANDIBULAR ANESTHESIA INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    2. 2. L A SUCCESS RATE MAXILLA VS MANDIBLE www.indiandentalacademy.com
    3. 3. TECHNIQUES  INFERIOR ALVEOLAR NERVE BLOCK  BUCCAL NERVE BLOCK  THE GOW GATES TECHNIQUE  EXTRA ORAL  VAZIRANI-AKINOSI CLOSED MOUTH  MENTAL NERVE BLOCK  INCISIVE NERVE BLOCK www.indiandentalacademy.com
    4. 4. INFERIOR ALVEOLAR NERVE BLOCK  Most frequently used  Commonly called MANDIBULAR NERVE BLOCK Nerves anesthetized 1. Inferior alveolar, 2. Incisive 3. Mental 4. Lingual www.indiandentalacademy.com
    5. 5.  Areas anesthetized 1. Mandibular teeth to the midline 2. Body of the mandible, inferior portion of the ramus 3. Buccal mucoperiosteum, mucous membrane anterior to the mandibular first molar 4. Anterior two thirds of the tongue and floor of the oral cavity 5. Lingual soft tissues and periosteum www.indiandentalacademy.com
    6. 6. Indications 1. Procedures on multiple mandibular teeth in one quadrant 2. When buccal soft tissue anesthesia (anterior to the first molar) is required 3. When lingual soft tissue anesthesia is required Contraindications 1. Infection or acute inflammation in the area of injection 2. Patients who might bite either the lip or the tongue www.indiandentalacademy.com
    7. 7. Advantages One injection provides a wide area of anesthesia Disadvantages 1. Wide area of anesthesia (not necessary for localized procedures) 2. Rate of inadequate anesthesia (15% to 20%) 3. Intraoral landmarks not consistently reliable 4. Positive aspiration -10% 5. Lingual and lower lip anesthesia, www.indiandentalacademy.com
    8. 8.  It has a significantly lower success rate because of (1) anatomical variation in the height of the mandibular foramen. (2) the greater depth of soft tissue penetration required www.indiandentalacademy.com
    9. 9. Methods  Direct  In Direct www.indiandentalacademy.com
    10. 10.  Technique 1. A 25-gauge long needle recommended 2. Area of insertion: mucous membrane on the medial side of the mandibular ramus, at the intersection of two lines— horizontal-height of injection, vertical- anteroposterior plane of injection 3. Target area: inferior alveolar nerve as it passes downward toward the mandibular foramen but before it enters into the foramen www.indiandentalacademy.com
    11. 11.  The needle is located too far anteriorly (laterally)  Overinsertion with no contact of bone.  The needle is usually posterior (medial)  Early contact of bone www.indiandentalacademy.com
    12. 12. www.indiandentalacademy.com
    13. 13.  Insert the needle. When bone is contacted, withdraw approximately I mm to prevent subperiosteal injection.  Aspirate. If negative, slowly deposit 1.5 ml of anesthetic over a minimum of 60 seconds.  Slowly withdraw the syringe.  If negative, deposit a portion of the remaining solution (0.1 ml) to anesthetize the lingual nerve. www.indiandentalacademy.com
    14. 14.  Signs and symptoms 1. Tingling or numbness of the lower lip indicates anesthesia of the mental nerve,. It is a good indication that the inferior alveolar nerve is anesthetized, 2. Tingling or numbness of the tongue indicates anesthesia of the lingual nerve, 3. 3. No pain is felt during dental therapy. www.indiandentalacademy.com
    15. 15.  Precautions 1. Do not deposit local anesthetic if bone is not contacted. 2. Avoid pain by not contacting bone too forcefully. Failures of anesthesia  The most common causes of absent or incomplete inferior alveolar nerve block follow: 1. Deposition of anesthetic too low (below the mandibular foramen). To correct: Reinject at a higher site. 2. Deposition of anesthetic too far anteriorly) on the ramus www.indiandentalacademy.com 3. Accessory innervation to the mandibular teeth
    16. 16. BUCCAL NERVE BLOCK  The buccal nerve is a branch of the anterior division of V3  The sole indication for administration of a buccal nerve block, therefore, is when manipulation of these tissues is contemplated www.indiandentalacademy.com
    17. 17.  Area of insertion: mucous membrane distal and buccal to the most distal molar tooth in the arch 3. Target area: buccal nerve as it passes over the anterior border of the ramus 4. Landmarks: mandibular molars, mucobuccal fold 5. Orientation of the bevel: toward bone If negative, slowly deposit 0.3 ml over 10 seconds www.indiandentalacademy.com
    18. 18. www.indiandentalacademy.com
    19. 19. The Gow-Gates technique  The Gow-Gates technique is a true mandibular nerve block since it provides sensory anesthesia to virtually the entire distribution of V3.  Significant advantages of the Gow-Gates technique over the inferior alveolar nerve block include  its higher success rate,  Its lower incidence of positive aspiration (approximately 2% versus 10% to 15% with the inferior alveolar nerve block), and  the absence of problems with accessory sensory innervation to the mandibular teeth. www.indiandentalacademy.com
    20. 20.  Nerves anesthetized 1. Inferior alveolar 2. Mental 3. Incisive 4. Lingual 5. Mylohyoid 6. Auriculotemporal 7 Buccal (in 75% of patients) www.indiandentalacademy.com
    21. 21.  Areas anesthetized (Fig. 14-15) 1. Mandibular teeth to the midline 2. Buccal mucoperiosteum and mucous membranes on the side of injection 3. Anterior two thirds of the tongue and floor of the oral cavity 4. Lingual soft tissues and periosteum 5. Body of the mandible, inferior portion of the ramus 6. Skin over the zygoma, posterior portion of the www.indiandentalacademy.com cheek, and temporal regions
    22. 22.  Indications 1. Multiple procedures on mandibular teeth 2. When buccal soft tissue anesthesia, from the third molar to the midline, is required 3. When lingual soft tissue anesthesia is required 4. When a conventional inferior alveolar nerve block isunsuccessful www.indiandentalacademy.com
    23. 23. Contraindications  Patients who are unable to open their mouth wide Advantages 1. Requires only one injection; 2. High success rate (> 95%), with experience 3. Minimum aspiration rate 4. Few postinjection complications (i.e., trismus) 5. Provides successful anesthesia where a bifid inferior alveolar nerve and bifid mandibular canals are present www.indiandentalacademy.com
    24. 24. Technique 1. 25-gauge long needle recommended 2. Area of insertion: mucous membrane on the mesial of the mandibular ramus, on a line from the intertragic notch to the corner of the mouth, just distal to the maxillary second molar 3- Target area: lateral side of the condylar neck, just below the insertion of the www.indiandentalacademy.com lateral pterygoid muscle
    25. 25. Failures of anesthesia  Rare with the Gow-Gates mandibular block, once the administrator becomes familiar with the technique 1. Too little volume. The greater diameter of the mandibular nerve may require a larger volume of anesthetic solution. Deposit up to 1.2 ml in the second injection if the depth of anesthesia is inadequate following the initial 1.8 ml. 2. Anatomical difficulties. Do not deposit anesthetic unless bone is contacted. www.indiandentalacademy.com
    26. 26.  The technique has a very high success rate, has minimal toxic effects, shows very low positive blood aspiration, Unlike the conventional inferior alveolar technique,  provided the mouth is fully opened, the Gow- Gates Technique allows for the deposition of the anesthetic solution in the relatively avascular region at the neck ofthe condyle. www.indiandentalacademy.com Anesth Prog 34:142-149 1987
    27. 27. Vazirani-Akinosi technique.  Its primary indication remains those situations in which limited mandibular opening precludes the use of other mandibular injection techniques www.indiandentalacademy.com
    28. 28.  Technique  Area of insertion: soft tissue overlying the medial (lingual) border of the mandibular ramus directly  adjacent to the maxillary tuberosity  at the height of the mucogingival junction adjacent to the maxillary third molar www.indiandentalacademy.com
    29. 29.  Target area: soft tissue on the medial (lingual) border of the ramus in the region of the inferior alveolar, lingual, and mylohyoid nerves as they run inferiorly from the foramen ovale toward the mandibular foramen  The height of injection -below that with the Gow-Gates but above that with the inferior alveolar nerve block  Orientation of the bevel (bevel orientation in theclosed-mouth mandibular block is very significant): www.indiandentalacademy.com  the bevel must be oriented away from the bone
    30. 30. Landmarks a. Mucogingival junction of the maxillary third (or second) molar b. Maxillary tuberosity c. Coronoid notch on the mandibular ramus www.indiandentalacademy.com
    31. 31. EXTRA ORAL www.indiandentalacademy.com
    32. 32. Comparison of the Anesthetic Efficacy www.indiandentalacademy.com JOE—Volume 34, Number 11, November 2008
    33. 33. www.indiandentalacademy.com JOE—Volume 34, Number 11, November 2008
    34. 34. Speed of Injection Influences Efficacy of Inferior Alveolar Nerve Blocks www.indiandentalacademy.com JOE — Volume 32, Number 10, October 2006
    35. 35. MENTAL NERVE BLOCK Areas anesthetized  Buccal mucous membranes anterior to the mental foramen (around the second premolar)to the midline and skin of the lower lip and chin Indication When buccal soft tissue anesthesia is required for proceduresin the mandible anterior to the mental foramen, such as 1. Soft tissue biopsies 2. Suturing of soft tissues Contraindication Infection or acute inflammation in the area of injection www.indiandentalacademy.com
    36. 36. www.indiandentalacademy.com
    37. 37.  Technique 1. A 25- or 27-gauge short needle recommended 2. Area of insertion: mucobuccal fold at or just anterior to the mental foramen 3. Target area: mental nerve as it exits the mental foramen (usually located between the apices of the first and second premolars) 4. Landmarks: mandibular premolars and mucobuccal fold www.indiandentalacademy.com
    38. 38. INCISIVE NERVE BLOCK  Areas anesthetized 1. Buccal mucous membrane anterior to the mental foramen, usually from the second premolar to the midline 2. Lower lip and skin of the chin 3- Pulpal nerve fibers to the premolars, canine, and incisors  Indications 1. pulpal anesthesia on mandibular teeth anterior to the mental foramen 2. When inferior alveolar nerve block is not indicated a. When six or eight anterior teeth www.indiandentalacademy.com
    39. 39. www.indiandentalacademy.com
    40. 40. THANK YOU www.indiandentalacademy.com

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