This document discusses techniques for mandibular anesthesia. It focuses on the inferior alveolar nerve block, which anesthetizes the inferior alveolar nerve, mental nerve, and incisive nerve. The technique involves locating anatomical landmarks like the coronoid notch and pterygomandibular raphe, then inserting the needle 1 cm above the occlusal plane of the mandibular posteriors and advancing it to the bone near the mandibular foramen to deposit the solution within 1 mm of the inferior alveolar nerve. Precautions are taken to avoid forceful bone contact. Failure can occur if the injection is too low or anterior, or due to accessory innervation. Complications include hematoma, tr

1. Techniques of Mandibular Anesthesia Prepared by Dr shabeel pn

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