Mandibular Nerve block and mental nerve /orthodontic courses by IDA

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats. Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics, Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call 0091-9248678078

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Techniques of Mandibular Anesthesia:

Techniques of Mandibular Anesthesia www.indiandentalacademy.com

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www.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com

Mandibular Anesthesia:

Mandibular Anesthesia Lower success rate than Maxillary anesthesia - approx. 80-85 % Related to bone density Less access to nerve trunks   www.indiandentalacademy.com

Mandibular Nerve Blocks:

Mandibular Nerve Blocks Inferior alveolar Mental - Incisive Buccal Lingual Gow-Gates Akinosi www.indiandentalacademy.com

Mandibular Anesthesia:

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

Inferior Alveolar Nerve Block:

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 www.indiandentalacademy.com

Inferior Alveolar Nerve Block:

Inferior Alveolar Nerve Block Nerves anesthetized Inferior Alveolar Mental Incisive Lingual www.indiandentalacademy.com

Inferior Alveolar Nerve Block:

Inferior Alveolar Nerve Block Areas Anesthetized Mandibular teeth to midline Body of mandible, inferior ramus Buccal mucosa anterior to mandibular first molar. Anterior 2/3 tongue & floor of mouth Lingual soft tissue and periosteum www.indiandentalacademy.com

Inferior Alveolar Nerve Block:

Inferior Alveolar Nerve Block Indications Multiple mandibular teeth Buccal anterior soft tissue Lingual anesthesia www.indiandentalacademy.com

Inferior Alveolar Nerve Block :

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

Inferior Alveolar Nerve Block:

Inferior Alveolar Nerve Block 10%-15% positive aspiration www.indiandentalacademy.com

Inferior Alveolar Nerve Block:

Inferior Alveolar Nerve Block Alternatives Mental nerve block Incisive nerve block Anterior infiltration www.indiandentalacademy.com

Inferior Alveolar Nerve Block:

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

Inferior Alveolar Nerve Block:

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) www.indiandentalacademy.com

Inferior Alveolar Nerve Block :

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

Inferior Alveolar Nerve Block:

Inferior Alveolar Nerve Block Precautions Do not inject if bone not contacted Avoid forceful bone contact www.indiandentalacademy.com

Inferior Alveolar Nerve Block:

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

Inferior Alveolar Nerve Block:

Inferior Alveolar Nerve Block Complications Hematoma Trismus Facial paralysis www.indiandentalacademy.com

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Mental nerve block It is the terminal branch of the I A N. Comes out of mental foramen at or near the mandibular premolars. Area suppiled: sensory innervations to the buccal soft tissues lying anterior to the foramen. Soft tissues of the lower lip & the chin. www.indiandentalacademy.com

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Indication: Soft tissues biopsy Suturing of soft tiissues Contraindications:actue inflammation at site of injection. Advantages:1)high success rate . 2)easy technically. 3) atraumatic . Disadvantage: hematoma www.indiandentalacademy.com

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Chances of positive aspiration:5.7% Alternatives: Technique: 25-27gauge niddle Area of insertion : mucobuccal fold at or just anterior to the mental foramen Target area : mental nerve as it exist from foramen Land mark : mandibular premolars & mucobuccal fold. Orientation of the bevel : towards the bone. www.indiandentalacademy.com

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INCISIVE NERVE BLOCK Incisive nerve: Terminal branch of the I. A .N. Originates as a direct continuation of the I.A .N at the mental foramen& continues anteriorly in the incisive canal. Area suppied: premolars ,canines,incisors & there buccal soft tissue and bone It provide sensory innervation to those teeth located anterior to the mental foramen. www.indiandentalacademy.com

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Indication of Incisive nerve block: 1)dental procedures requiring pulpal anesthesia on the mandibular teeth anterior to mental foramen. 2)while treating premolar to premolar Contra indication: acute inflammation, Area anesthetized: Buccal mucosa anterior to the mental foramen Lower lip &skin of the chin. Pulpal nerve fibers of premo lars,canines, anteriors. www.indiandentalacademy.com

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Advantage: 1)provides pulpal and hard tissue anesthesia with out lingual anesthesia. 2)used in case of bilateral I.A.N 3)high succes rate Disadvantage: 1)Dose not provide lingual anasthesia 2) Partial anasthesia may develop at the mid line because of nervefibers mayover lap with opposite side Positive aspiration: 5.7% www.indiandentalacademy.com

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Positive aspiration:5.7% Alternatives: 1) local infitration ofbuccal tissues&pulpal anesthesia of central& lateral incisors 2)Inferior alveolar nerve block . 3)Gow-gates mandibular nerve block. 4)Vazirani-akinosis mandibular nerve block. 5)Periodontal ligamental injection. www.indiandentalacademy.com

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Technique: 1)25-gague needle is recommended but most commonly we use 27 gague needle. 2)area of insertion:mucobuccal at or just anterior to the mental foramen. 3)target area:mental foramen through whichthe mental nerve exit and in which Incisive nerve is located. 4)land mark:mandibular premolars and mucobuccal flod. 5)orientation of the bevel: towards the bone. Procedure: www.indiandentalacademy.com

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www.indiandentalacademy.com Thank you www.indiandentalacademy.com Leader in continuing dental education

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