Mandibular injection techniques

Mandibular injection technique

LECTURE 8

Type of mandibular injection technique

Infiltration technique (Supraperiosteal) Inferior alveolar nerve block Long buccal nerve block Mental nerve block (Incisive nerve block) Supplemental (PDL injection ,Intraosseous ,intraseptal , intrapulpal).

Inferior alveolar nerve block technique

Most widely used technique Success rate (80-85%): Little accessibility to the nerve (Greater depth of soft tissue penetration) Anatomical variation Large diameter of the nerve

Nerves anaesthetized

Inferior alveolar nerve Incisive Mental Lingual
Lingual nerve
IA nerve

Areas anesthetized

Mandibular teeth to midline. Body of mandible and inferior portion of the ramus. Anterior two thirds of the tongue , floor of mouth and lingual periosteum. Buccal mucoperiosteum and mucosa anterior to first molar (mental nerve).


Target area
Sulcus colli

Anatomical landmarks

Coronoid notch (the greatest depression on the anterior border of the ramus), also called the external oblique ridge Internal oblique ridge Occlusal plane of posterior teeth Pterygomandibular raphe Pterygomandibular depression Contralateral mandibular bicuspids

CN
Sulcus colli


IOR


OP


PMR
PMD



Technique
Place the thumb in the buccal sulcus and move it backwards with the external oblidge ridge (mouth should be widely opened)

Move the thumb up along the anterior border of the ramus

Palpate the Coronoid notch

Height of injection -Imagine the pterygomandibular depression

Pull the tissues laterally for better visibility and less pain on needle insertion

Estimate the width of the ramus

Place the barrel of syringe in the opposite corner of the mouth above the premolar teeth. Approximate the length of the injection by the middle of the palpating fingernail or thumbnail.
Imaginary line (5-10mm) above OP



Insert the needle into soft tissue in the pterygomandibular depression, which is halfway between the palpating finger or thumb and the pterygomandibular raphe.


Insert needle slowly until bone is contacted, and then withdraw ~1 mm. The depth of insertion for the average-sized adult is approximately 25 mm.

Onset and duration

Onset for hard tissue anesthesia is 3 to 4 minutes. Duration for hard tissue anesthesia is 40 minutes to 4 hours, depending on the type of local anesthetic used and whether a vasoconstrictor is used or not. It is unlikely that the long buccal nerve will be anaesthetized.

Disadvantages

Area of injection is vascular; 10 -15% chance of positive aspiration Wide area of anesthesia Rate of inadequate anesthesia (15-20%) Unlikely to anaesthetize accessory nerves Unlikely to anaesthetize long buccal nerve Difficult to see landmarks in some patients (e.g., macroglossia) Partial anesthesia where there is bifid nerves or canals.

Failure of inferior alveolar nerve block

Anatomical variation Fault technique Inadequate anesthesia

Sign of anesthesia

Subjective Paraesthesia
Objective No pain in the dental work

Long buccal nerve block

For anesthetizing area of buccal supporting tissues from retromolar area to the lower first molar region(only needed in surgical work) It is preferable to be postponded after successfull inferior alveolar block achieved to avoid misinterpratation of subjective paraesthesia at the angle of the mouth


Incisive nerve block(mental block)
Indication For anesthetizing lower anterior and premolar teeth and their buccal supporting tissue without anesthetizing whole IAN and lingual nerve Presence of infection When bilateral nerve block needed?

Other mandibular block

Gow gate block (high mandibular block) Akinosi vazirani technique(closed mouth block)

Gow gate block (high mandibular block)

Akinosi .vazirani technique(closed mouth block)

Supplemenatry injection technique

Intraligament injection

Indication

Single tooth anesthesia Avoid bilateral block When nerve block contraindicated As adjunctive for partial anesthesia
Infection primary teeth
Contraindication


Advantages
No paresthesia Low dose Rapid onset Less traumatic for tissue
Advantages
Spread of infection Tissue damage by pressure Post operative pain

Intraosseous injection

Provide effective anesthesia for single or multiple tooth similar to intraligamentary injection. Similar indications , contraindications, advantages and disadvantages to intraligamentary injection except that its need special equipments.

Intraseptal anesthesia

Intrapulpal anesthesia