Techniques of Mandibular Anesthesia Faisal A. Quereshy, M.D., D.D.S., F.A.C.S. Assistant Professor / Residency Director Case Western Reserve University School of Dental Medicine Dept. Oral & Maxillofacial Surgery Monday March 5, 2007
Mandibular Anesthesia Lower success rate than Maxillary anesthesia - approx. 80-85 % Related to bone density Less access to nerve trunks March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Mandibular Nerve Blocks Inferior alveolar Mental - Incisive Buccal Lingual Gow-Gates Akinosi March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Mandibular Anesthesia Most commonly performed technique Has highest failure rate (15-20%) Success depends on depositing solution within 1 mm of nerve trunk March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
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 March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Inferior Alveolar Nerve Block Nerves anesthetized Inferior Alveolar Mental Incisive Lingual March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
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 March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Inferior Alveolar Nerve Block Indications Multiple mandibular teeth Buccal anterior soft tissue Lingual anesthesia March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Inferior Alveolar Nerve Block Contraindications Infection/inflammation at injection site Patients at risk for self injury (eg. children) March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Inferior Alveolar Nerve Block 10%-15% positive aspiration March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Inferior Alveolar Nerve Block Alternatives Mental nerve block Incisive nerve block Anterior infiltration March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Inferior Alveolar Nerve Block Alternatives (cont.) Periodontal ligament injection (PDL) Gow-Gates Akinosi Intraseptal March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Inferior Alveolar Nerve Block 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) March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Inferior Alveolar Nerve Block Target Area Inferior alveolar nerve, near mandibular foramen Landmarks Coronoid notch Pterygomandibular raphe Occlusal plane of mandibular posteriors March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Inferior Alveolar Nerve Block Precautions Do not inject if bone not contacted Avoid forceful bone contact March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Inferior Alveolar Nerve Block Failure of Anesthesia Injection too low Injection too anterior Accessory innervation -Mylohyoid nerve -contralateral Incisive nerve innervation March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Inferior Alveolar Nerve Block Complications Hematoma Trismus Facial paralysis March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Long Buccal Nerve Block Anterior branch of Mandibular nerve (V3) Provides buccal soft tissue anesthesia adjacent to mandibular molars Not required for most restorative procedures March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS Buccal Nerve Block Indications Anesthesia required - mucoperiosteum buccal to mandibular molars Contraindications Infection/inflammation at injection site March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS Buccal Nerve Block Advantages Technically easy High success rate Disadvantages Discomfort March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS Buccal Nerve Block Alternatives Buccal infiltration Gow-Gates PDL Intraseptal March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS Buccal Nerve Block Technique 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 March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS Buccal Nerve Block Landmarks Mandibular molars Mucobuccal fold March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS Buccal Nerve Block Complications Hematoma (unusual) Positive aspiration 0.7 % March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS Mental Nerve Block Terminal branch of IAN as it exits mental foramen Provides sensory innervation to buccal soft tissue anterior to mental foramen, lip and chin March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS Mental Nerve Block Indication Need for anesthesia in innervated area Contraindication Infection/inflammation at injection site March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS Mental Nerve Block Advantages Easy, high success rate Usually atraumatic Disadvantage Hematoma March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS Mental Nerve Block Alternatives Local infiltration PDL Intraseptal Inferior alveolar nerve block Gow Gates March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS Mental Nerve Block Complications Few Hematoma Positive aspiration 5.7 % March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS Incisive Nerve Block Terminal branch of IAN Originates in mental foramen and proceeds anteriorly Good for bilateral anterior anesthesia Not effective for anterior lingual anesthesia March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS Incisive Nerve Block Nerves anesthetized Incisive Mental March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS Incisive Nerve Block Areas Anesthetized Mandibular labial mucous membranes Lower lip / skin of chin Incisor, cuspid and bicuspid teeth March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS Incisive Nerve Block Indication Anesthesia of pulp or tissue required anterior to mental foramen Contraindication Infection/inflammation at injection site March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS Incisive Nerve Block Advantages High success rate Pulpal anesthesia w/o lingual anesthesia Disadvantages Lack of lingual or midline anesthesia March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS
Faisal A. Quereshy, MD, DDS, FACS Incisive Nerve Block Complications Hematoma Positive aspiration 5.7 % March 5, 2007 Faisal A. Quereshy, MD, DDS, FACS