mandibular injection technique
DESCRIPTION
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MANDIBULAR INJECTIONTECHNIQUES
Chinthamani Laser Dental Clinic
INFERIOR ALVEOLAR NERVE BLOCK
OTHER COMMEN NAME: MANDIBULAR BLOCK
NERVES ANESTHETISED:1.Inferioralveolar2.Incisive3.Mental 4.Lingual
AREAS ANESTHETISED:1.Mandibular teeth 2.Body of the mandible3.Buccal mucoperiosteum4.Ant 2/3 tongue & floor of oral cavity5.Lingual soft tissues &periosteum
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
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%
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
TECHNIQUES 25 gauge long needle area of insertion target area landmarks
Coronoid notch Pterygomandibular raphae Occlusal plane
Orientation of needle bevel
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
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
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
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.
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
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
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
3rd position: Inferior alveolar nerve is anesthetised from the opp side
Landmarks: Technique:
1st position 2nd position 3rd position
Signs and symptoms
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
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
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
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
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
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
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
+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
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
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.