1.
MANDIBULAR
INJECTION
TECHNIQUES
Chinthamani Laser Dental Clinic

2.
INFERIOR ALVEOLAR NERVE BLOCK
OTHER COMMEN NAME: MANDIBULAR BLOCK
NERVES ANESTHETISED:
1.Inferioralveolar
2.Incisive
3.Mental
4.Lingual
AREAS ANESTHETISED:
1.Mandibular teeth
2.Body of the mandible
3.Buccal mucoperiosteum
4.Ant 2/3 tongue & floor of oral cavity
5.Lingual soft tissues &periosteum

3.
INDICATIONS:
1.Multiple mand teeth in 1 quadrant
2.Buccal soft tissue anesthesia
3.Lingual soft tissue anesthesia
CONTRAINDICATIONS:
1.Infection
2.Very young child

4.
ADVANTAGES:

Wide area of Anesthesia
DISADVANTAGES:
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Wide area of anesthesia
Inadequate anesthesia
+ve aspiration(10% to 15%)
Intra oral landmarks
Lingual & lower lipanesthesia
Partial anesthesia-bifid an &bifid mand canals
+VE ASPIRATION:10% TO 15%

5.
ALTERNATIVES:
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Mental nerve block
Incisive nerve block
Supra periosteal injection
Gow gates mand n block
5.vazirani-akinosi mand n block
PDL injection
Intra osseous injection
Intra septal injection

6.
TECHNIQUES

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25 gauge long needle
area of insertion
target area
landmarks
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Coronoid notch
Pterygomandibular raphae
Occlusal plane
Orientation of needle bevel

7.
Procedure:
 Assume the correct position
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For rt IANB 8 o’clk position
For lt IANB 10 o’clk position
Position of the patient-supine
Locate the needle inj site
3 parameters:



> height of the injection
> antpost site of injection
> penetration site

8.
HEIGHT OF THE INJECTION:
 Imaginary line
 Finger on the coronoid notch
 Needle insertion point
 Post border of mand ramus
 Prepare the tissues:
 Dry wid gauze
 Topical antiseptic
 Topical anesthetic
ANTPOST SITE OF INJECTION

9.
PENETRATION DEPTH:
 Depth of penetration:20 to 25mm
 If bone is contacted soon
 If bone is not contacted
 Insert the needle
 Aspirate
 Withdraw the syringe
 Make the needle safe
 After 20 sec upright position
 Wait 3to5 mins to start dental procedure

10.
SIGNS AND SYMPTOMS:
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Subjective: Tingling and numbness of the lower lip.
Subjective: Tingling and numbness of the tongue.
Objective: No pain.
SAFETY FEATURE:

Contacting bone & preventing over insertion.
PRECAUTIONS:


Do not deposit la if bone is not contacted.
Avoid pain.

11.
FAILURES OF ANESTHESIA:
 Deposition of anesthetic too low.
 Deposition of anesthetic too far anteriorly on ramus.
 Accessory innervation to the mandibular teeth



Incomplete pulpal anesthesia.
Accessory sensory innervation (e.g. cervical accessory &
mylohyoid nerves).
To correct
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Technique
25 gauge long needle.
Retract the tongue toward midline
Place the syringe & direct the needle tip
Depth of penetration to bone:3-5mm.
Aspirate:0.6ml in 20secs
Bifid inferior alveolar nerve

12.
Incomplete anesthesia to CI & LI


Due to innervation of mylohyoid
To correct:
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Supraperiosteal infiltration
27gauge short needle
Direction of needle tip
Aspirate:0.6ml in 20secs
After 2-3mins start dental procedure
Complications:


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Hematoma
Trismus
Transient facial paralysis

13.
INDIRECT MANDIBULAR TECHNIQUE OR
FISCHER 1-2-3 TECHNIQUE
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Needle position:
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Landmarks:
Technique:
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1st position: Long buccal nerve anesthetised from the opp
side
2nd position: Lingual nerve anesthetised from the same
side
3rd position: Inferior alveolar nerve is anesthetised from the
opp side
1st position
2nd position
3rd position
Signs and symptoms

14.
BUCCAL NERVE BLOCK
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Other common name: Long buccal n block or
buccinator n block
Nerves anesthetised: Buccal
Areas anesthetised: Soft tissues & periosteum
buccal to mand molars
Indication: Buccal softtissue anesthesia
Contraindication: Infection
Advantages:
 High success rate
 Technically easy

15.
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
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Disadvantage: Pain
+ve aspiration:0.7%
Alternatives:





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Buccal infiltration
Gow gates mand n block
Vazirani-akinosi mand n block
PDL injection
Intra osseous injection
Intraseptal injection

16.
Techniques






25 gauge long needle
Area of insertion
Target area
Landmarks
Orientation of needle bevel
Procedure
 Assume the correct position
 Position of pt:supine
 Prepare the tissues for penetration
 Direct the syringe & advance the needle.
Depth of penetration:2-4mm
 Aspirate
 Withdraw the syringe
 Wait 1min & start dental procedure

17.
SIGNS AND SYMPTOMS:

Safety Feature:



Precautions:



Pain on insertion from striking unanesthetised periosteum
LA soln not being retained at inj site
Failures of anesthesia:


Min +ve aspiration
Prevent over insertion
Rare
Complications:

Hematoma

18.
MANDIBULAR NERVE BLOCK THE
GOW-GATES TECHNIQUE
OTHER COMMON NAME:THIRD DIVISION N
BLOCK,V3 NERVE BLOCK.
 Nerves anesthetised:

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Inferior alveolar n
Mental
Incisive
Lingual
Mylohyoid
Auriculotemporal
Buccal

19.

Areas anesthetised:

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Indications:




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Mand teeth midline
Buccal mucoperiosteum
Ant 2/3 tongue &floor oral cavity
Lingual soft tissues
Body of mandible
Skin over zygoma
Multiple procedures
Buccal soft tissue anesthesia
Lingual soft tissue anesthesia
When conventional IANB unsuccessful
Contraindications:

Trismus patient & rest same as IANB

20.
ADVANTAGES:
 Only one injection
 High success rate (>95%)
 Min aspiration rate
 Few post inj complications
 Successful even if bifid IAN’S & mand n’s
present
DISADVANTAGES:
 Lingual and lower lip anesthesia
 Time of onset longer 5min

21.
+VE ASPIRATION:2%
ALTERNATIVES:

IANB & buccal n block

Vazirani-akinosi closed mouth mand block

Incisive n block

Mental n block

Buccal n block

Supra periosteal injection

Intra osseous technique

PDL inj technique

22.
TECHNIQUES:

25 gauge long needle

Area of insertion

Target area

Landmarks




Extra oral:
Intraoral
Orientation of bevel
Procedure:

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
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
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Assume the correct position
Position the patient
Locate extra oral landmarks
Visualize intraoral landmarks
Prepare tissues at site of penetration
Direct the syringe
Insert the needle
Align the needle with the plane
Slowly advance the needle
Depth of penetration:25mm
Withdraw the needle 1mm
Aspirate:if –ve slowly deposit 1.8ml in 60-90 secs
Withdraw the syringe
Request the pt to keep mouth open for 1-2mins
Upright position
Wait for 3-5mins before starting dental procedure

23.
SIGNS AND SYMPTOMS:SAME AS IANB

Safety feature:
 Very low +ve aspiration rate
 Needle contacting bone & preventing over insertion

Precautions:
 Do not deposit if bone is not contacted

Failures of anesthesia:
 Too little volume
 Anatomical difficulties

Complications:
 Hematoma
 Trismus
 Temporary paralysis of cranial nerves iii, iv & vi.

24.
THANK
YOU
Email.id:chinthamanidental@gmail.com
044-43800059 , 92 83 786 776
www.chinthamanilaserdentalclinic.com