1.
Techniques of Mandibular Anesthesia

2.
Mandibular Anesthesia <ul><li>Lower success rate than Maxillary anesthesia (approx. 80-85 %) </li></ul><ul><li>Related to bone density </li></ul><ul><li>Less access to nerve trunks </li></ul>

3.
Mandibular Nerve Blocks <ul><li>Inferior alveolar </li></ul><ul><li>Mental - Incisive </li></ul><ul><li>Buccal </li></ul><ul><li>Lingual </li></ul><ul><li>Gow-Gates </li></ul><ul><li>Akinosi </li></ul>

4.
Mandibular Anesthesia <ul><li>Most commonly performed technique </li></ul><ul><li>Has highest failure rate (15-20%) </li></ul><ul><li>Success depends on depositing solution within 1 mm of nerve trunk </li></ul>

5.
Inferior Alveolar Nerve Block <ul><li>Not a complete mandibular nerve block. </li></ul><ul><li>Requires supplemental buccal nerve block </li></ul><ul><li>May require infiltration of incisors or mesial root of first molar </li></ul>

6.
Inferior Alveolar Nerve Block <ul><li>Nerves anesthetized </li></ul><ul><li>Inferior Alveolar </li></ul><ul><li>Mental </li></ul><ul><li>Incisive </li></ul><ul><li>Lingual </li></ul>

7.
Inferior Alveolar Nerve Block <ul><li>Areas Anesthetized </li></ul><ul><li>Mandibular teeth to midline </li></ul><ul><li>Body of mandible, inferior ramus </li></ul><ul><li>Buccal mucosa anterior to mental foramen </li></ul><ul><li>Anterior 2/3 tongue & floor of mouth </li></ul><ul><li>Lingual soft tissue and periosteum </li></ul>

8.
Inferior Alveolar Nerve Block <ul><li>Indications </li></ul><ul><li>Multiple mandibular teeth </li></ul><ul><li>Buccal anterior soft tissue </li></ul><ul><li>Lingual anesthesia </li></ul>

9.
Inferior Alveolar Nerve Block <ul><li>Contraindications </li></ul><ul><li>Infection/inflammation at injection site </li></ul><ul><li>Patients at risk for self injury (eg. children) </li></ul>

10.
Inferior Alveolar Nerve Block <ul><li>10%-15% positive aspiration </li></ul>

11.
Inferior Alveolar Nerve Block <ul><li>Alternatives </li></ul><ul><li>Mental nerve block </li></ul><ul><li>Incisive nerve block </li></ul><ul><li>Anterior infiltration </li></ul>

12.
Inferior Alveolar Nerve Block <ul><li>Alternatives (cont.) </li></ul><ul><li>Periodontal ligament injection (PDL) </li></ul><ul><li>Gow-Gates </li></ul><ul><li>Akinosi </li></ul><ul><li>Intraseptal </li></ul>

13.
Inferior Alveolar Nerve Block <ul><li>Technique </li></ul><ul><li>Apply topical </li></ul><ul><li>Area of insertion : </li></ul><ul><li>medial ramus, mid-coronoid notch, </li></ul><ul><li>level with occlusal plane (1 cm above), </li></ul><ul><li>3/4 posterior from coronoid notch to pterygomandibular raphe </li></ul><ul><li>advance to bone (20-25 mm) </li></ul>

14.
Inferior Alveolar Nerve Block <ul><li>Target Area </li></ul><ul><li>Inferior alveolar nerve, near mandibular foramen </li></ul><ul><li>Landmarks </li></ul><ul><li>Coronoid notch </li></ul><ul><li>Pterygomandibular raphe </li></ul><ul><li>Occlusal plane of mandibular posteriors </li></ul>

15.
Inferior Alveolar Nerve Block <ul><li>Precautions </li></ul><ul><li>Do not inject if bone not contacted </li></ul><ul><li>Avoid forceful bone contact </li></ul>

16.
Inferior Alveolar Nerve Block <ul><li>Failure of Anesthesia </li></ul><ul><li>Injection too low </li></ul><ul><li>Injection too anterior </li></ul><ul><li>Accessory innervation </li></ul><ul><li>-Mylohyoid nerve </li></ul><ul><li>-contralateral Incisive nerve innervation </li></ul>

17.
Inferior Alveolar Nerve Block <ul><li>Complications </li></ul><ul><li>Hematoma </li></ul><ul><li>Trismus </li></ul><ul><li>Facial paralysis </li></ul>