Local Anaesthesia

Mandibular Technique
Dr Ahmed Osman
BDS,MSc Oral Surgery/Implantology
DICOI,MRCSEd,MDGZI

Adopted from
Professor G Townsend, University of Adelaide, School of Dentistry
 Infiltration

 Inferior alveolar block

▪ Rationale
▪ Level
▪ Entry point
▪ Angle
 Pterygomandibular space
 Technique
 Area anaesthetised
 Failures

Copyright © 2006/07 The University of Adelaide slide 2

 Thorough knowledge of anatomy
 Appreciation of variation
 Principles of diffusion
 Need for good rapport, confidence and correct
technique

Copyright © 2006/07 The University of Adelaide slide 3

 Premolar
Molar tooth
tooth

Alveolar socket Section of the body

of the mandible

Mental foramen

Copyright © 2006/07 The University of Adelaide slide 4

 IAN

 Buccal nerve

 Mental nerve

 Lingual nerve

Copyright © 2006/07 The University of Adelaide slide 5

Copyright © 2006/07 The University of Adelaide 6
 Coronoid process
Mandibular
Condyle

Mandibular /Coronoid notch

Mandibular foramen Alveolar margin

Lingula

Angle of the mandible

Inferior alveolar nerve & vessels in the mandibular canal

slide 8
 Incisor
plexus

Mental
Inferior
nerve Foramen containing
alveolar
communicating branch
nerve with mylohyoid nerve

INFERIOR ALVEOLAR NERVE Distribution

9
slide 10
 Accessory foramen

Mandibular foramen
Lingula

Copyright © 2006/07 The University of Adelaide slide 11

 View

Copyright © 2006/07 The University of Adelaide slide 12

slide 13
 Mouth wide open.(to stretch the pterygomandibular raphae)
 Place index finger in vestibule to locate external oblique
ridge. Slide it backward to Palpate ramus and Define
coronoid notch.
 Prepare area with topical anesthesia.
 Twist finger to be pointing medially so that ball of finger lies
in retromolar area between external and internal oblique
ridges.
 The pterygomandibular raphe is about 5 mm medial to
fingertip
 Insert needle opposite to a line bisecting your fingertip, at
least 5-10 mm medially (just lateral to the raphe)
slide 14
slide 15
 Section

Pterygomandibular space

Copyright © 2006/07 The University of Adelaide slide 16

 Syringe barrel parallel to occlusal plane, needle
inserted halfway between fingertip and PM fold -
barrel over canine/premolars.
 Advance needle slowly with minimum force until it
gently strikes bone.
 Withdraw slightly (from the bone, 1-2 mm),
aspirate, inject 1.5 mls.(the carpule is 1.8 ml)

slide 17
18
19
slide 20
slide 21
slide 22
Frontal view removing the ramus of Mandible

Lateral Pterygoid muscle

Inferior alveolar nerve

Medial Pterygoid muscle

Lingual nerve

Copyright © 2006/07 The University of Adelaide slide 23

 The lingual nerve is almost “always” blocked
adequately during IAN block is given (because its
less than 10 mm away from IAN: running parallel to
it slightly anterior and medial at the infratemporal
fossa).
 Therefore it is UNNECESSARY to give a separate
injection, and its enough to withdraw the needle
about 5-10 mm then inject the rest of the carpule
(0.3 ml). DO NOT move the needle inside the tissue.
slide 24
 Poor technique
 Anatomical variability
 Expired LA solution
 Blood vessel penetration

Copyright © 2006/07 The University of Adelaide slide 25

Precaution

slide 26
 Teeth, buccal gingivae, skin, mucous membrane lip,
chin
 Lingual gingivae and mucosa - lingual nerve

NB. Buccal gingivae alongside Second premolar,and

sometimes first premolar is through the buccal
nerve.

 Failures
 Incorrect technique
 Anatomical variations

slide 27
 Long-Buccal Block

• It passes from lingual aspect of ascending ramus,

crossing at the retromolar area, to appear laterally
into the buccal sulcus and supplies the mucous
membranes of the buccal gingiva and vestibul (from
retromolar to 2nd premolar).
• Blockage is achieved by injecting 0.5-1 ml into the
retromolar (behind 3rd molar); however practicing
infiltration of the buccal can be less painful to the
pt.(infiltration is done by inserting 2-4 mm of the
syringe opposite to or slightly distal to the tooth
concerned).
28
Long-Buccal Block

29
 Incisive nerve overlaping-
Mandibular infiltration
Buccal
aspect

Mental Mental
foramen
foramen

Incisor plexus
30
slide 31
 Calm and control patient
 Identify site – tooth and soft tissue or both
 Choose instrument
 Conduct the proper injection technique
 Wait – give enough time
 Check for anaesthesia
 Decide to start dental procedure
 Post anaesthetic advice:
 Avoid chewing on this side
 Do not eat until anesthesia subsides

 Post op review for nerve damage, bruising

Copyright © 2006/07 The University of Adelaide 32
1. A Handbook of
Local
Anaesthesia By Malamed
2. Local anaesthesia
in dentistry
check a copy at:Thiqa photocopy
centre)
By Paul D Robinsom, Thomas R Pitt,Fraser
McDonald

slide 33
Thank you

34