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Inferior alveolar nerve block

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Mandibular anaesthesia
Mandibular anaesthesia
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Inferior alveolar nerve block

  1. 1. INFERIOR ALVEOLAR NERVE BLOCK
  2. 2. • Also referred to as - Mandibular nerve block. • Nerves anesthetized- 1. inferior alveolar, a branch of the posterior division of the mandibular division of the trigeminal nerve (V3). 2. incisive nerve . 3. mental nerve . 4. lingual (commonly). • Areas anesthetized – 1. mandibular teeth to the midline , 2. body of the mandible ,inferior portion of the ramus , 3. buccal mucoperiosteum , mucous membrane anterior to the mental foramen (mental nerve)., 4. anterior two-thirds of the tongue and floor of the oral cavity (lingual nerve). , 5. lingual soft tissues and periosteum (lingual nerve). • Indications – procedures on multiple mandibular teeth in one quadrant , when buccal soft tissue anesthesia (anterior to the mental foramen ) is necessary , when lingual soft tissue anesthesia is necessary. • Contraindications- infection or acute inflammation in the area of injection , patients who are more likely to bite their lip or tongue, for instance , a very young child or a physically or mentally handicapped adult or child. • Advantages- one injection provides a wide area of anesthesia (useful for quadrant dentistry). • Disadvantages – wide area of anesthesia (not indicated for localized procedures) , rate of inadequate anesthesia (31% to 81%), intraoral landmarks not consistently reliable, positive aspiration (10% to 15%, highest of all intraoral injection techniques ), lingual and lower lip anesthesia , discomfiting to many patients and possibly dangerous (self- inflicted soft tissue trauma ) for certain individuals, partial anesthesia possible where a bifid inferior alveolar nerve and bifid mandibular canals are present ; cross-innervation in lower anterior region.
  3. 3. • Positive aspiration – 10% to 15%. • Alternatives – mental nerve block, for buccal soft tissue anesthesia anterior to the first molar , incisive nerve block , for pulpal and buccal soft tissue anesthesia of teeth anterior to the mental foramen (usually second premolar to central incisor ), superaperiosteal injection , for pulpal anesthesia of the central and lateral incisors and sometimes the premolars and molars , Gow-Gates mandibular nerve block ,Vazirani – Akinosi mandibular neve block , PDL injection for pulpal anesthesia of any mandibular tooth, IO injection for pulpal and soft tissue anesthesia of any mandibular tooth, but especially molars. • Technique – 25-gauge long needle is preferred; a 27 gauge long is acceptable. • Area of insertion – mucous membrane on the medial (lingual) side of the mandibular ramus, at the intersection of two lines – one horizontal , representing the height of needle insertion , the other vertical , representing the anteroposterior plane of injection. • Target area – inferior alveolar nerve as it passes downward toward the mandibular foramen but before it enters into the foramen. • Landmarks – a. coronoid notch (greatest concavity on the anterior border of the ramus), b. pterygomandibular raphe (vertical portion), c. occlusal plane of the mandibular posterior teeth. • Orientation of the needle bevel – less critical than with other nerve blocks, because the needle approaches the inferior alveolar nerve at roughly a right angle. • Procedure- a. for a right IANB, a right-handed administrator should sit at the 8 o’clock position facing the patient , b. for a left IANB , a right –handed should sit at the 10 o’clock position facing in the same direction as the patient.
  4. 4. • Three parameters must be considered during administration of IANB : 1) the height of the injection , (2) the anteroposterior placement of the needle (which helps to locate a precise needle entry point ), and (3) the depth of penetration (which determines the location of the inferior alveolar nerve). • Aspirate in 2 planes . If negative, slowly deposit 1.5 mL of anesthetic over a minimum of 60 seconds .(because of the high incidence of positive aspiration and natural tendency to deposit solution too rapidly , the sequence of slow injection, reaspiration, slow injection, reaspiration is strongly recommended.) • Slowly withdraw the syringe , and when approximately half its length remains within tissues, approximately half its length remains within tissues, reaspirate . If negative , deposit a portion of the remaining solution (0.2 mL) to anesthesia the lingual nerve . • Signs and symptoms – 1. subjective – tingling or numbness of the lower lip indicates anesthesia of the mental nerve , a terminal branch of the inferior alveolar nerve .This is a good indication that the inferior alveolar nerve is anesthetized , although it is not a reliable indicator of the depth of anesthesia, tingling or numbness of the tongue indicates anesthesia of the lingual nerve, a branch of the posterior division ofV3. it usually accompanies IANB but may be present without anesthesia of the inferior alveolar nerve . • Objective – using an electrical pulp tester (EPT) and eliciting no response to maximal output (80/80) on two consecutive tests at least 2 minutes apart serves as a “guarantee” of successful pulpal anesthesia in nonpulpitic teeth, no pain is felt during dental therapy.
  5. 5. • Safety feature – the needle contacts bone, preventing over – insertion with its attendant complications. • Precautions- 1. donot deposit local anesthetic if bone is not contacted , needle tip may be resting within the parotid gland near the facial nerve (cranial nerveVII), and a transient blockade (paralysis) of the facial nerve may develop if local anesthetic solution is deposited. • 2. avoid pain by not contacting bone too forcefully. • Failures of anesthesia – the most common causes of absent or incomplete IANB – deposition of anesthetic too low (below the mandibular foramen) , deposition of the anesthetic too far anteriorly (laterally) on the ramus , accessory innervation to the mandibular teeth, incomplete anesthesia of the central or lateral incisors. • Complications – hematoma , trismus , transient facial paralysis (facial nerve anesthesia).

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