1. بســم اللَـــه الرحمــن الرحيـــم

2. Prof.Dr.Ragab Shaaban

3. Local Analgesia In Dentistry

4. Maxillary nerve block
Intraoral approach

5. maxillary nerve block
Nerve anesthetized.
Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective
The entire maxillary nerve and all its sub-divisions peripheral to site of injection.

6. maxillary nerve block According to the technique used:
Nerve anesthetized.
Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective
According to the technique used:
A- high tuberosity tech.
B- Greater palatine canal tech.

7. maxillary nerve block
Nerve anesthetized.
Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective
* When anesthesia for the entire max. nerve is required for extensive surgery.
* Presence of infection.
* For diagnostic or theraputic purposes

8. Maxillary nerve block high tub. Tech. Greater palatine canal tech.

9. Extraoral maxillary block technques
A- infraorbital nerve block
B- maxillary nerve block

10. Infraorbital nerve block
Extraoral technique

11. Infraorbital nerve block
Nerve anesthetized.
Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective 1 2 3 4

12. Infraorbital nerve block

13. Maxillary nerve block
Extraoral technique

14. Maxillary nerve block Nerve anesthetized. Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective
For extensive surgery.
For all divisions with minimum amount of LA.
When it is difficult to anesthetize a terminal branch.
Diagnostic & theraputic reasons.

15. Landmarks 1 1 2 4 3

16. Technique

17. Local analgesia
Mandibular techniques

18. Techniques of regional analgesia for the mandibular nerve & its subdivisions
A- intraoral techniques

19. Nerve supply of the mandible

20. Inferior alveolar nerve block

21. Inferior alveolar nerve block
Nerve anesthetized.
Area anesthetized.
Anatomical landmarks.
. Indications
Technique.
Symptoms of anesthesia
a- subjective b- objective

22. Inferior alveolar nerve block Indirect technique
Nerve anesthetized.
Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective
Mucobuccal fold
Anterior ramus of the mandible
External oplique ridge
Retromolar triangle
Internal oplique ridge
Pterygomandibular ligament
Buccal suking pad
Pterygomandibular space

23. Inferior alveolar nerve block
Nerve anesthetized.
Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective
*Analgesia for operative dentistry on all mand. Teeth.
*Surgery on mand. teeth & supporting structures anterior to the frist molar + lingual NB
*Surgery on mand. teeth & supporting strucures posterior to the second bicuspid +lingual NB+ buccal NB.
*Diagnostic & therputic purpose

24. Inferior alveolar nerve block
Nerve anesthetized.
Area anesthetized.
Anatomical landmarks.
Indications.
Techniques.
Symptoms of anesthesia
a- subjective b- objective
Indirect technique.
Direct technique.
Gaw-Gates technique.
Closed mouth technique.
Extraoral technique.

25. Inferior alveolar nerve block
Nerve anesthetized.
Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective

26. Inferior alveolar nerve block

27. Inferior alveolar nerve block

28. Inferior alveolar nerve block

29. Inferior alveolar nerve block

30. Technique of injection

31. III. PROPER INJECTION PROCEDURES
B- REGIONAL OR BLOCK ANESTHESIA:
a- Block anesthesia in the mandible:
Errors in needle insertion:
Too high insertion:
Numbness of the ear as a result of anesthesia of the auriculotemporal nerve.
Post-injection pain & Trismus due to hitting of the insertion of the temporalis or lateral pterygoid.

32. Post-injection pain & Trismus due to hitting of the insertion of the temporalis or lateral pterygoid.

33. B- REGIONAL OR BLOCK ANESTHESIA:
a- Block anesthesia in the mandible:
Errors in needle insertion:
Too high insertion:
Temporary facial paralysis due to dissemination of the solution to the branches of the facial nerve.
Double vision or temporary blindness due to dissemination of the solution through inferior orbital fissure to the lateral rectus muscle or to the optic nerve.
Haematoma in the deep temporal spaces by hitting the pterygoid venous plexus.

34. Errors in needle insertion
Too low insertion:
Trismus due to trauma of the medial pterygoid.
Injection into the posterior
facial vein.

35. B- REGIONAL OR BLOCK ANESTHESIA
a- Block anesthesia in the mandible:
Errors in needle insertion:
Too medial insertion:
Nausea & vomiting from dissemination of solution to the pharynx.
Dysphagea due to haematoma of the lateral pharyngeal space.

36. Inferior alveolar nerve block direct technique

37. Inferior alveolar nerve block Gaw-Gates techniqe
It is considered a high mandibular block.
Landmarks are :
- angle of the mouth.
- intertragic notch .
- neck of the condyle.

38. Inferior alveolar nerve block Gow-Gates technique

39. Inferior alveolar nerve block Gow-Gates technique

40. Closed mouth technique (Vazirani tech.)

41. Causes of failure of local analgesia
Insuffecient knowledge of local anatomy of the region.
Faulty technique.
Individual anatomical variations occuring in different patients.
Intravascular injection.
Needle deflection.
Inflammation.

42. Failure of mandibular anesthsia (Anatomical variations)

43. Causes of failure (Faulty technique)

44. Lingual nerve block

45. Lingual nerve block Nerve anesthetized. Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective

46. Lingual nerve block
Nerve anesthetized.
Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective
The same land-marks of the inferior alveolar nerve block.

47. Lingual nerve block
Nerve anesthetized.
Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective
For surgery on the anterior 2/3 of the tongue ,floor of the mouth and mucous membrane on the lingual side of the mandibule.

48. Lingual nerve block Nerve anesthetized. Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective

49. Lingual nerve block

50. Lingual nerve block Nerve anesthetized. Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective

51. Long buccal nerve block

52. Long buccal nerve block
Nerve anesthetized.
Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective

53. Long buccal nerve block
Nerve anesthetized.
Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective
External oplique ridge.
* Retromolar triangle.

54. Long buccal nerve block
Nerve anesthetized.
Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective
External oplique ridge.
* Retromolar triangle.

55. long buccal nerve block
Nerve anesthetized.
Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective
* Surgery on the buccal mucosa.
* To supplement the inferior alveolar nerve block.

56. Long buccal nerve block
Nerve anesthetized.
Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective

57. Mental nerve block

58. Mental nerve block Nerve anesthetized. Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective

59. Mental nerve block * Lower lip.
Nerve anesthetized.
Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective
* Lower lip.
* mucous membrane in the mucobuccal fold anterior to the mental foramen.

60. Mental nerve block
Nerve anesthetized.
Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective
For surgery on the lower lip or mucous membrane in the mucobuccal fold anterior to the mental foramen.

61. Mental nerve block Nerve anesthetized. Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective

62. Incisive nerve block

63. Incisive nerve block Nerve anesthetized. Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective

64. Incisive nerve block The same like mental nerve block.
Nerve anesthetized.
Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective
The same like mental nerve block.

65. Incisive nerve block
Nerve anesthetized.
Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective
For anesthesia of the mandibule and labial mandibular structures anterior to the mental foramen and lower lip.

66. Incisive nerve block Nerve anesthetized. Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective

67. Extraoral mandibular block techniques
A- mental & incisive nerve block
B-inferior alveolar nerve block
C- Mandibular nerve block

68. Mental & incisive nerve block
Extraoral techniques

69. Mental & incisive nerve block
Nerve anesthetized.
Area anesthetized.
Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective
Bicuspid teeth
Lower edge of the body of the mand
Supraorbital notch
Infraorbital notch
Pupil of the eye

70. Technique Nerve anesthetized. Area anesthetized. Anatomical landmarks.
Indications.
Technique.
Symptoms of anesthesia
a- subjective b- objective
Patient looks forward
An imaginary line drown from supraorbital n.-pupil-infraorbital n., if continued downward will pass through the mental foramen
Midpoint is detected between gingival margine and lower border of the mand.
Ant.&downward insertion with gentle proping

71. Inferior alveolar nerve block
Extraoral technique
Kurt Thoma

72. Technique
This technique is only used when there is severe limitation of opening of the jaws as with TMJ ankylosis.
Complete asepsis should be considered.

73. Technique Anteroinferior border of the masseter is located & marketed
A line connecting it with the tragus of the ear is drown and bisected
This midpoint marks the mand. foramen externally
A line is drown down to the inferior border of the mand and parallel to the posterior border of the mand.

74. Technique
Needle is inserted should be parallel to this line and of equal length

75. Mandibular nerve block
Extraoral technique

76. Landmarks 1 1 2 4 3

77. Technique