1) Mandibular nerve blocks are used to provide effective pain control during dental procedures in the lower teeth and jaw. They work by depositing local anesthetic near branches of the mandibular nerve to block nerve impulses from traveling to the area. 2) There are various techniques for mandibular nerve blocks including inferior alveolar nerve blocks, lingual nerve blocks, mental nerve blocks, and incisive nerve blocks. Each technique aims to anesthetize a specific branch or area like the lower lip, lower teeth, or tongue. 3) Complications of mandibular nerve blocks can include hematoma, trismus, and temporary facial paralysis but are generally minor when performed correctly by a

1. MANDIBULAR NERVE
BLOCKS
Presented by: Gauri
Bargoti
Guided by: Dr. Vidhi
C.Rathi

2. INTRODUCTION
 Providing effective pain control is one of the most important aspect
of dentistry
It is slightly more difficult to achieve in mandibular molars
Failure of anesthesia in mandible is attributed to its thick cortical
plate.
A second difficulty is presence of consistent landmarks.

3. WHAT IS NERVE BLOCK
It consist of securing anesthesia by depositing suitable local
anesthetic solution within close proximity to main trunk and thus
restricting the impulses from travelling beyond that point.

4. TECHNIQUES OF MANDIBULAR
ANESTHESIA
Mandibular anesthetic techniques
1)Mandibular Nerve
Block
2) Mental and
incisive nerve block
Extraoral
Intraoral Technique
Open
Mouth
Closed
mouth
1) Inferior
alveolar
Nerve block
2) Lingual
3) Mental
4) Incisive
5) Long buccal
6) Gow Gates
1) Vazira
ni-
Akinosi

5. MANDIBULAR NERVE
It is the third branch of trigeminal nerve
It is both motor as well as sensory
Sensory located in semilunar or gasserian ganglion
Motor branch located in medulla oblongata and emerges out of
Foramen Ovale.

6. COURSE OF MANDIBULAR NERVE

7. INFERIOR ALVEOLAR NERVE
BLOCK
Nerves Anesthetized : Inferior alveolar and its subdivisions.

8. TECHNIQUE

9. AREAS ANESTHETIZED
Subjective sign: Tingling sensation of lower lip and tongue
Objective: Instrumentation necessary for demonstration.

10. COMPLICATIONS
Hematoma
Trismus
Transient facial paralysis

11. LINGUAL NERVE
Nerve anesthetized: Branch of mandibular nerve
Areas anesthetized: a) Anterior 2/3rd of tongue and floor
b) Mucosa and mucoperiosteum on lingual side of
mandible.
Landmarks: same as inferior alveolar nerve block
Subjective sign: Tingling and numbness of anterior 2/3rd of tongue
Objective sign: Instrumentation necessary to demonstrate pain
sensation

12. MENTAL NERVE BLOCK
Nerve anesthetized: Mental nerve a branch of inferior alveolar nerve.
Area anesthetized: Lower lip, Mucous membrane in muccolabial fold
anterior to mental foramen.
Landmarks: Mandibular premolars

13. TECHNIQUE

14. AREAS ANESTHETIZED
Symptoms of anesthesia: Tingling and numbness of lower lip on
injected side

15. COMPLICATION
Hematoma: Due to exit of blood into buccal fold.
Paresthesia of the lip and /or chin.

16. INCISIVE NERVE BLOCK
Nerves Anesthetized: Incisive nerve and mental nerve
Anatomical landmarks: Mandibular bicuspids.
Areas anesthetized: mandible and overlying labial structures anterior
to mental foramen; bicuspid, cuspids and incisors on affected site;
lower lip on affected site.

17. TECHNIQUES

18. AREAS ANESTHETIZED
Symptoms of anesthesia: Subjective: Patient will experience
numbness and tingling of lower lip
Objective: Instrumentation will demonstrate anesthesia of upper
anterior and supporting structures.

19. COMPLICATION
Hematoma
Paresthesia of the lip and/or chin.

20. LONG BUCCAL
Nerves anesthetized: Buccinator nerve, branch of mandibular nerve
Area anesthetized: Buccal mucous membrane and mucoperiosteum
of mandibular molar area.
Landmarks: External oblique ridge and retromolar triangle.

21. TECHNIQUE

22. COMPLICATIONS
Hematoma: Blood may exit the needle puncture point into buccal
vestibule.

23. GOW GATES TECHNIQUE
Nerves anesthetized: Mandibular nerve and its division.
Areas anesthetized: All the mandibular hard and soft tissues to the
midline including floor of mouth and anterior 2/3rd of tongue, skin of
zygoma, posterior portion of cheek, temporal region and portion of
external ear.
Anatomical landmarks: Anterior border of ramus, tendon of temporal
muscle, corner of mouth, intertragic notch of ear, external ear.

24. TECHNIQUE

25. COMPLICATIONS
Hematoma
Trismus
Temporary paralysis of cranial nerves III, IV, VI.

26. VAZIRANI AKINOSI TECHNIQUE
Nerves anesthetized: Inferior alveolar nerve and its subdivisions,
mental and incisive nerves and long buccal nerves
Areas anesthetized: All the mandibular hard and soft tissue to
midline, including floor of mouth and anterior 2/3rd of tongue.
Anatomical landmarks: Occlusal plane of occluding teeth;
Mucogingival junction of maxillary molar teeth; Anterior border of
ramus.

27. TECHNIQUE

28. COMPLICATION
Hematoma
Trismus

29. MANDIBULAR NERVE BLOCKS
Nerves anesthetized: Mandibular nerve and subdivisions; Inferior
alveolar nerve; Buccal nerve; lingual nerve; Mental nerve; Incisive
nerve.
Areas anesthetized: Temporal region; auricle of ear; external auditory
meatus; TMJ; Salivary gland; Anterior 2/3rd of tongue; floor of mouth;
Mandible; lower teeth,gingiva, and buccal mucosa ; lower portion if
face.
Landmarks: Midpoint of zygomatic portion; zygomatic notch;
coronoid process by opening and closing of mouth; lateral prteygoid
plate
Symptoms of anesthesia: Subjective: Tingling and numbness of lower
lip and anterior 2/3rd of tongue
Objective: Opening and closing of mandible with tapping it will
demonstrate a different sensation.

30. TECHNIQUE

31. MENTAL AND INCISIVE BLOCK
Nerve anesthetized: Mental and incisive nerve
Areas anesthetized: lower lip; mandible and overlying buccal and
labial structure anterior to mental foramen; mandibular teeth anterior
to mental foramen
Anatomical landmarks: Bicuspid teeth; lower edge of body of
mandible; Supraorbital notch; infraorbital notch; pupil of eye
Symptoms of anesthesia: Subjective: Tingling and numbness of lower
lip on the side injected
Objective: Instrumentation will demonstrate the anesthesia

32. TECHNIQUE

33. SUPPLEMENTAL INJECTION
TECHNIQUES
1) Paraperiosteal : Used when one or two teeth are to be
anesthetized. In this the LA is deposited just opposite or above the
root apex in contact with periosteum.
2) Interosseus technique: After local infiltration and paraperiosteal
injection, an incision is made and then the interosseus structure is
opened by bone drill and then LA is deposited.
3) Interseptal: LA is forced into cancellous bone from there it
penetrates into proximating pericementum and apical nerves.
4) Intraligamentary: The anesthetic agent is forced into PDL.
5) 5) Local infiltration: LA is inserted beneath mucous membrane of
the teeth to be anesthetized.

34. SUMMARY
Teeth Pulpal Buccal soft tissue Lingual soft tissue
Incisors Incisive; IANB; GG;
VA; IS; IO;
Infiltration
IANB; GG; VA;
incisive; IS; Mental;
PDL; infiltration; IO
IANB; GG; VA; PDL;
IS; infiltration; IO
Canines IANB; GG; VA; PDL;
IS; IO
IANB; GG; VA;
Incisive; PDL; IS; IO;
infiltration; Mental
IANB; GG; VA; PDL;
IS; infiltration; IO
Premolars IANB; GG; VA;
incisive; PDL; IS; IO
IANB; GG; VA;
incisive; PDL; IS;
IO; Mental;
Infiltration
IANB; GG; VA; PDL;
IS; IO; Infiltration
Molars IANB; GG; VA; PDL;
IS; IO
IANB; GG; VA; PDL;
IS; IO; Infiltration
IANB; GG; VA; PDL;
IS; IO; Infiltration

35. REFERENCES
Handbook of local anesthesia(6th edition) by Stanley F. Malamed
Monheim’s Local anesthesia and pain control in dental practice(7th
edition)