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Techniques of Mandibular Anesthesia Faisal A. Quereshy, M.D., D.D.S., F.A.C.S. Assistant Professor / Residency Director Case Western Reserve University.

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Presentation on theme: "Techniques of Mandibular Anesthesia Faisal A. Quereshy, M.D., D.D.S., F.A.C.S. Assistant Professor / Residency Director Case Western Reserve University."— Presentation transcript:

1 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 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

2 March 5, 2007Faisal A. Quereshy, MD, DDS, FACS Mandibular Anesthesia Lower success rate than Maxillary anesthesia - approx % Related to bone density Less access to nerve trunks Lower success rate than Maxillary anesthesia - approx % Related to bone density Less access to nerve trunks

3 March 5, 2007Faisal A. Quereshy, MD, DDS, FACS Mandibular Nerve Blocks Inferior alveolar Mental - Incisive Buccal Lingual Gow-Gates Akinosi Inferior alveolar Mental - Incisive Buccal Lingual Gow-Gates Akinosi

4 March 5, 2007Faisal 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 Most commonly performed technique Has highest failure rate (15-20%) Success depends on depositing solution within 1 mm of nerve trunk

5 March 5, 2007Faisal 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 Not a complete mandibular nerve block. Requires supplemental buccal nerve block May require infiltration of incisors or mesial root of first molar

6 March 5, 2007Faisal A. Quereshy, MD, DDS, FACS Inferior Alveolar Nerve Block Nerves anesthetized Inferior Alveolar Mental Incisive Lingual Nerves anesthetized Inferior Alveolar Mental Incisive Lingual

7 March 5, 2007Faisal 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 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 March 5, 2007Faisal A. Quereshy, MD, DDS, FACS Inferior Alveolar Nerve Block Indications Multiple mandibular teeth Buccal anterior soft tissue Lingual anesthesia Indications Multiple mandibular teeth Buccal anterior soft tissue Lingual anesthesia

9 March 5, 2007Faisal A. Quereshy, MD, DDS, FACS Inferior Alveolar Nerve Block Contraindications Infection/inflammation at injection site Patients at risk for self injury (eg. children) Contraindications Infection/inflammation at injection site Patients at risk for self injury (eg. children)

10 March 5, 2007Faisal A. Quereshy, MD, DDS, FACS Inferior Alveolar Nerve Block 10%-15% positive aspiration

11 March 5, 2007Faisal A. Quereshy, MD, DDS, FACS Inferior Alveolar Nerve Block Alternatives Mental nerve block Incisive nerve block Anterior infiltration Alternatives Mental nerve block Incisive nerve block Anterior infiltration

12 March 5, 2007Faisal A. Quereshy, MD, DDS, FACS Inferior Alveolar Nerve Block Alternatives (cont.) Periodontal ligament injection (PDL) Gow-Gates Akinosi Intraseptal Alternatives (cont.) Periodontal ligament injection (PDL) Gow-Gates Akinosi Intraseptal

13 March 5, 2007Faisal 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) 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 March 5, 2007Faisal 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 Target Area Inferior alveolar nerve, near mandibular foramen Landmarks Coronoid notch Pterygomandibular raphe Occlusal plane of mandibular posteriors

15 March 5, 2007Faisal A. Quereshy, MD, DDS, FACS Inferior Alveolar Nerve Block Precautions Do not inject if bone not contacted Avoid forceful bone contact Precautions Do not inject if bone not contacted Avoid forceful bone contact

16 March 5, 2007Faisal 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 Failure of Anesthesia Injection too low Injection too anterior Accessory innervation -Mylohyoid nerve -contralateral Incisive nerve innervation

17 March 5, 2007Faisal A. Quereshy, MD, DDS, FACS Inferior Alveolar Nerve Block Complications Hematoma Trismus Facial paralysis Complications Hematoma Trismus Facial paralysis

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24 March 5, 2007Faisal 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 Anterior branch of Mandibular nerve (V3) Provides buccal soft tissue anesthesia adjacent to mandibular molars Not required for most restorative procedures

25 March 5, 2007Faisal A. Quereshy, MD, DDS, FACS Buccal Nerve Block Indications Anesthesia required - mucoperiosteum buccal to mandibular molars Contraindications Infection/inflammation at injection site Indications Anesthesia required - mucoperiosteum buccal to mandibular molars Contraindications Infection/inflammation at injection site

26 March 5, 2007Faisal A. Quereshy, MD, DDS, FACS Buccal Nerve Block Advantages Technically easy High success rate Disadvantages Discomfort Advantages Technically easy High success rate Disadvantages Discomfort

27 March 5, 2007Faisal A. Quereshy, MD, DDS, FACS Buccal Nerve Block Alternatives Buccal infiltration Gow-Gates PDL Intraseptal Alternatives Buccal infiltration Gow-Gates PDL Intraseptal

28 March 5, 2007Faisal 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 gauge needle Area of insertion: - Mucosa adjacent to most distal 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 gauge needle Area of insertion: - Mucosa adjacent to most distal

29 March 5, 2007Faisal A. Quereshy, MD, DDS, FACS Buccal Nerve Block Landmarks Mandibular molars Mucobuccal fold Landmarks Mandibular molars Mucobuccal fold

30 March 5, 2007Faisal A. Quereshy, MD, DDS, FACS Buccal Nerve Block Complications Hematoma (unusual) Positive aspiration 0.7 % Complications Hematoma (unusual) Positive aspiration 0.7 %

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33 March 5, 2007Faisal 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 Terminal branch of IAN as it exits mental foramen Provides sensory innervation to buccal soft tissue anterior to mental foramen, lip and chin

34 March 5, 2007Faisal A. Quereshy, MD, DDS, FACS Mental Nerve Block Indication Need for anesthesia in innervated area Contraindication Infection/inflammation at injection site Indication Need for anesthesia in innervated area Contraindication Infection/inflammation at injection site

35 March 5, 2007Faisal A. Quereshy, MD, DDS, FACS Mental Nerve Block Advantages Easy, high success rate Usually atraumatic Disadvantage Hematoma Advantages Easy, high success rate Usually atraumatic Disadvantage Hematoma

36 March 5, 2007Faisal A. Quereshy, MD, DDS, FACS Mental Nerve Block Alternatives Local infiltration PDL Intraseptal Inferior alveolar nerve block Gow Gates Alternatives Local infiltration PDL Intraseptal Inferior alveolar nerve block Gow Gates

37 March 5, 2007Faisal A. Quereshy, MD, DDS, FACS Mental Nerve Block Complications Few Hematoma Positive aspiration 5.7 % Complications Few Hematoma Positive aspiration 5.7 %

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42 March 5, 2007Faisal 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 Terminal branch of IAN Originates in mental foramen and proceeds anteriorly Good for bilateral anterior anesthesia Not effective for anterior lingual anesthesia

43 March 5, 2007Faisal A. Quereshy, MD, DDS, FACS Incisive Nerve Block Nerves anesthetized Incisive Mental Nerves anesthetized Incisive Mental

44 March 5, 2007Faisal A. Quereshy, MD, DDS, FACS Incisive Nerve Block Areas Anesthetized Mandibular labial mucous membranes Lower lip / skin of chin Incisor, cuspid and bicuspid teeth Areas Anesthetized Mandibular labial mucous membranes Lower lip / skin of chin Incisor, cuspid and bicuspid teeth

45 March 5, 2007Faisal 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 Indication Anesthesia of pulp or tissue required anterior to mental foramen Contraindication Infection/inflammation at injection site

46 March 5, 2007Faisal 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 Advantages High success rate Pulpal anesthesia w/o lingual anesthesia Disadvantages Lack of lingual or midline anesthesia

47 March 5, 2007Faisal A. Quereshy, MD, DDS, FACS Incisive Nerve Block Complications Hematoma Positive aspiration 5.7 % Complications Hematoma Positive aspiration 5.7 %


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