Mandibular Injection Technique

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Chinthamani Laser Dental Clinic & Implant Centre
1/464,Mount Poonamallee High Road,
Iyyapanthangal,
Chennai-56
Phone no.044-43800059 , 92 83 786776
Email:
[email protected],
[email protected]
Website:
www.chinthamanilaserdentalclinic.com

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:
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:
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
25 gauge long needle
area of insertion
target area
landmarks
Coronoid notch
Pterygomandibular raphae
Occlusal plane
Orientation of needle bevel

7. Procedure:
Assume the correct position
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

11. SIGNS AND SYMPTOMS:
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.

12. 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
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

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

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

15. BUCCAL NERVE BLOCK
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

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

17. 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
Techniques

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

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

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

22. 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

23. +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

24. TECHNIQUES:
25 gauge long needle
Area of insertion
Target area
Landmarks
Extra oral:
Intraoral
Orientation of bevel
Procedure:
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

26. 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.

27. THANK
YOU
Email.id:[email protected]
044-43800059 , 92 83 786 776
www.chinthamanilaserdentalclinic.com