Mandibular nerve block and mental nerve / oral surgery courses

INDIAN DENTAL ACADEMY
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Mandibular Anesthesia
Lower success rate than Maxillary anesthesia approx. 80-85 %
Related to bone density
Less access to nerve trunks


Mandibular Nerve Blocks
Inferior alveolar
Mental - Incisive
Buccal
Lingual
Gow-Gates
Akinosi


Mandibular Anesthesia
Most commonly performed technique
Has highest failure rate (15-20%)
Success depends on depositing solution within 1 mm
of nerve trunk


Inferior Alveolar Nerve Block
Not a complete mandibular nerve block.
Requires supplemental buccal nerve block
May require infiltration of incisors or mesial root of
first molar


Nerves anesthetized
Inferior Alveolar
Mental
Incisive
Lingual


Areas Anesthetized
Mandibular teeth to midline
Body of mandible, inferior ramus
Buccal mucosa anterior to mandibular first molar.
Anterior 2/3 tongue & floor of mouth
Lingual soft tissue and periosteum


Indications
Multiple mandibular teeth
Buccal anterior soft tissue
Lingual anesthesia


Contraindications
Infection/inflammation at injection site
Patients at risk for self injury (eg. children)


10%-15% positive aspiration


Alternatives
Mental nerve block
Incisive nerve block
Anterior infiltration


Alternatives (cont.)
Periodontal ligament injection (PDL)
Gow-Gates
Akinosi
Intraseptal

Technique
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)

Target Area
Inferior alveolar nerve, near mandibular foramen
Landmarks
Coronoid notch
Pterygomandibular raphe
Occlusal plane of mandibular posteriors


Precautions
Do not inject if bone not contacted
Avoid forceful bone contact


Failure of Anesthesia
Injection too low
Injection too anterior
Accessory innervation
-Mylohyoid nerve
-contralateral Incisive nerve innervation


Complications
Hematoma
Trismus
Facial paralysis


Mental nerve block
It is the terminal branch of the I A N.
Comes out of mental foramen at or near the mandibular premolars.
Area suppiled:
sensory innervations to the buccal soft tissues lying
anterior to the foramen.
Soft tissues of the lower lip & the chin.

Indication:
•
•

Soft tissues biopsy
Suturing of soft tiissues

Contraindications:actue inflammation at site of injection.
Advantages:1)high success rate .
2)easy technically.
3)atraumatic.
Disadvantage: hematoma


Chances of positive aspiration:5.7%
Alternatives:
Technique:

foramen

25-27gauge niddle
Area of insertion :mucobuccal fold at or just anterior to the mental
Target area : mental nerve as it exist from foramen
Land mark : mandibular premolars & mucobuccal fold.
Orientation of the bevel : towards the bone.


INCISIVE NERVE BLOCK
Incisive nerve:
Terminal branch of the I. A .N.
Originates as a direct continuation of the I.A .N at the mental
foramen& continues anteriorly in the incisive canal.
Area suppied: premolars ,canines,incisors & there buccal soft tissue
and bone
It provide sensory innervation to those teeth located anterior to the
mental foramen.

Indication of Incisive nerve block:
1)dental procedures requiring pulpal anesthesia on the
mandibular teeth anterior to mental foramen.
2)while treating premolar to premolar
Contra indication: acute inflammation,
Area anesthetized:
Buccal mucosa anterior to the mental foramen
Lower lip &skin of the chin.
Pulpal nerve fibers of premolars,canines, anteriors.

Advantage:
1)provides pulpal and hard tissue anesthesia with out lingual
anesthesia.
2)used in case of bilateral I.A.N
3)high succes rate
Disadvantage:
1)Dose not provide lingual anasthesia
2) Partial anasthesia may develop at the mid line because of
nervefibers mayover lap with opposite side

Positive aspiration:5.7%
Alternatives:
1) local infitration ofbuccal tissues&pulpal anesthesia of
central& lateral incisors
2)Inferior alveolar nerve block .
3)Gow-gates mandibular nerve block.
4)Vazirani-akinosis mandibular nerve block.
5)Periodontal ligamental injection.

Technique:
1)25-gague needle is recommended but most commonly we use 27
gague needle.
2)area of insertion:mucobuccal at or just anterior to the mental
foramen.
3)target area:mental foramen through whichthe mental nerve exit
and in which Incisive nerve is located.
4)land mark:mandibular premolars and mucobuccal flod.
5)orientation of the bevel: towards the bone.
Procedure:

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Mandibular nerve block and mental nerve / oral surgery courses

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