1. Techniques of Mandibular Anesthesia

2. Mandibular Anesthesia
Lower success rate than Maxillary anesthesia - approx %
Related to bone density
Less access to nerve trunks  

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

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

5. 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

6. Inferior Alveolar Nerve Block
Nerves anesthetized
Inferior Alveolar
Mental
Incisive
Lingual

7. 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

8. Inferior Alveolar Nerve Block
Indications
Multiple mandibular teeth
Buccal anterior soft tissue
Lingual anesthesia

9. Inferior Alveolar Nerve Block
Contraindications
Infection/inflammation at injection site
Patients at risk for self injury (eg. children)

10. Inferior Alveolar Nerve Block
10%-15% positive aspiration

11. Inferior Alveolar Nerve Block
Alternatives
Mental nerve block
Incisive nerve block
Anterior infiltration

12. Inferior Alveolar Nerve Block
Alternatives (cont.)
Periodontal ligament injection (PDL)
Gow-Gates
Akinosi
Intraseptal

13. 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)

14. Inferior Alveolar Nerve Block
Target Area
Inferior alveolar nerve, near mandibular foramen
Landmarks
Coronoid notch
Pterygomandibular raphe
Occlusal plane of mandibular posteriors

15. Inferior Alveolar Nerve Block
Precautions
Do not inject if bone not contacted
Avoid forceful bone contact

16. Inferior Alveolar Nerve Block
Failure of Anesthesia
Injection too low
Injection too anterior
Accessory innervation
-Mylohyoid nerve
-contralateral Incisive nerve innervation

17. Inferior Alveolar Nerve Block
Complications
Hematoma
Trismus
Facial paralysis