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