Mandibular injections
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Transcript of Mandibular injections
Techniques of Mandibular Anesthesia
Mandibular AnesthesiaLower success rate than Maxillary anesthesia -
approx. 80-85 %
Related to bone density
Less access to nerve trunks
Indication For Special TechniqueAnatomic variation Complete nerve trunk
Selective pulpal / soft tissue anesthesia
Mandibular Nerve BlocksInferior alveolarMental - Incisive BuccalLingualGow-GatesAkinosi
Mandibular AnesthesiaMost commonly performed technique
Has highest failure rate (15-20%)
Success depends on depositing solution within 1 mm of nerve trunk
Inferior Alveolar Nerve BlockNot a complete mandibular nerve block.
Requires supplemental buccal nerve block
May require infiltration of incisors or mesial root of first molar
Inferior Alveolar Nerve Block
Nerves anesthetized Inferior Alveolar Mental Incisive Lingual
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
Inferior Alveolar Nerve Block
Indications Multiple mandibular teeth
Buccal anterior soft tissue
Lingual anesthesia
Inferior Alveolar Nerve Block
Contraindications Infection/inflammation at injection site
Patients at risk for self injury (eg. children)
Inferior Alveolar Nerve Block
10%-15% positive aspiration
Inferior Alveolar Nerve BlockAlternatives
Mental nerve block
Incisive nerve block
Anterior infiltration
Inferior Alveolar Nerve BlockAlternatives (cont.)
Periodontal ligament injection (PDL)
Gow-Gates
Akinosi
Intraseptal
Inferior Alveolar Nerve BlockTechnique 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)
Inferior Alveolar Nerve Block Target Area Inferior alveolar nerve, near mandibular
foramen Landmarks Coronoid notch Pterygomandibular raphe Occlusal plane of mandibular posteriors
Inferior Alveolar Nerve BlockPrecautions Do not inject if bone not contacted
Avoid forceful bone contact
Inferior Alveolar Nerve BlockFailure of Anesthesia Injection too low Injection too anterior Accessory innervation -Mylohyoid nerve -contralateral Incisive nerve innervation
Inferior Alveolar Nerve BlockComplications Hematoma
Trismus
Facial paralysis
Long Buccal Nerve BlockAnterior branch of Mandibular nerve (V3)
Provides buccal soft tissue anesthesia adjacent to mandibular molars
Not required for most restorative procedures
Buccal Nerve BlockIndications Anesthesia required - mucoperiosteum buccal to
mandibular molars
Contraindications Infection/inflammation at injection site
Buccal Nerve BlockAdvantages Technically easy High success rate
Disadvantages Discomfort
Buccal Nerve BlockAlternatives Buccal infiltration Gow-Gates PDL Intraseptal
Buccal Nerve BlockTechnique Apply topical Insertion distil and buccal to last molar Target - Long Buccal nerve as it passes anterior border of ramus Insert approx. 2 mm, aspirate Inject 0.3 ml of solution, slowly - 25-27 gauge needle
Area of insertion:
- Mucosa adjacent to most distal
Buccal Nerve BlockLandmarks Mandibular molars
Mucobuccal fold
Buccal Nerve BlockComplications Hematoma (unusual)
Positive aspiration 0.7 %
Mental Nerve BlockTerminal branch of IAN as it exits mental foramen
Provides sensory innervation to buccal soft tissue anterior to mental foramen, lip and chin
Mental Nerve BlockIndication Need for anesthesia in innervated area
Contraindication Infection/inflammation at injection site
Mental Nerve BlockAdvantages Easy, high success rate Usually atraumatic
Disadvantage Hematoma
Mental Nerve BlockAlternatives Local infiltration PDL Intraseptal Inferior alveolar nerve block Gow Gates
Mental Nerve BlockComplications Few Hematoma
Positive aspiration 5.7 %
Incisive Nerve BlockTerminal branch of IAN Originates in mental foramen and proceeds
anteriorly
Good for bilateral anterior anesthesia Not effective for anterior lingual anesthesia
Incisive Nerve BlockNerves anesthetized Incisive
Mental
Incisive Nerve BlockAreas Anesthetized Mandibular labial mucous membranes
Lower lip / skin of chin
Incisor, cuspid and bicuspid teeth
Incisive Nerve BlockIndication Anesthesia of pulp or tissue required anterior to mental
foramen
Contraindication Infection/inflammation at injection site
Incisive Nerve BlockAdvantages High success rate Pulpal anesthesia w/o lingual anesthesia
Disadvantages Lack of lingual or midline anesthesia
Incisive Nerve BlockComplications Hematoma
Positive aspiration 5.7 %
Gow-Gates Mandibular Block
Developed to improve success rate.
True mandibular nerve block.
Has a lower rate of positive aspiration (2% vs. 10%-15% for IAN).
Technique dependent.
Gow-Gates Mandibular BlockTarget Area
Neck of condyle, below insertion of lateral pterygoid muscle
Gow-Gates Mandibular BlockLandmarks Mesiolingual cusp of maxillary 2nd molar
Intertragic notch
Corner of the mouth
Gow-Gates Mandibular BlockTechnique Coordinate intraoral & extraoral landmarks
Align barrel of syringe over premolars and with extraoral landmarks
Gow-Gates Mandibular BlockTechnique (cont.) Penetrate mucosa distil to 2nd molar
Advance needle to bone (avg. 25 mm)
Aspirate, deposit 1.8 ml of solution slowly
Gow-Gates Mandibular BlockTechnique (cont.) Patient’s mouth must be fully open during
injection and for 1-2 mins afterward
May require reinforcement with second injection
Gow-Gates Mandibular BlockComplications Hematoma (< 2%)
Trismus
Akinosi Closed Mouth Mandibular Block
Alternative for mandibularblock when limited openingis present
( eg. trismus, closed lock, etc..)
Akinosi Closed Mouth Mandibular Block
Advantages Not necessary to open widely High success rate Relatively atraumatic Few complications, few positive aspirations
Akinosi Closed Mouth Mandibular Block
Disadvantages Visualization of path and depth of insertion is
difficult
No bony contact
Traumatic if needle hits periosteum
Akinosi Closed Mouth Mandibular Block
Target Area Soft tissue medial to ramus Above foramen, below condyle
Landmarks Mucogingival junction of maxillary 2nd or 3rd
molar Maxillary tuberosity
Akinosi Closed Mouth Mandibular Block
Area of insertion Soft tissue overlying medial ramus, adjacent to
tuberosity
At height of mucogingival junction of maxillary 2nd or 3rd molar
Akinosi Closed Mouth Mandibular Block
Technique Retract soft tissues, have patient occlude
Apply topical
Penetrate to 25 mm, parallel to maxillary occlusal plane, in a posterior and lateral direction
Akinosi Closed Mouth Mandibular Block
Technique (cont.) Aspirate, deposit 1.8 ml slowly
Motor paralysis will develop first, allowing patient to open more widely
Akinosi Closed Mouth Mandibular Block
Complications Hematoma (<10%)
Facial nerve paralysis (Bell’s Palsy)
Trismus (rare)
Akinosi Closed Mouth Mandibular Block
Failures of anesthesia Lateral flaring of mandible
Insertion too low
Penetration too deep or shallow (adjust for patient size)
Done By :
Ghadah SidqiG (3) , L(5) .