Techniques of Mandibular

Anesthesia

Mandibular Nerve Blocks

Inferior alveolar
Mental
Buccal
Lingual
Gow-Gates
Vazirani-Akinosi

Inferior Alveolar Nerve Block

Nerves anesthetized

Inferior Alveolar
Mental
Incisive
Lingual

Inferior Alveolar Nerve Block

Areas Anesthetized
Mandibular teeth to midline
Body of mandible, inferior portion of the
ramus
Buccal mucosa anterior to mental foramen
Anterior 2/3 tongue & floor of mouth
Lingual soft tissue and periosteum

Inferior Alveolar Nerve Block

Indications
1.
Procedures on multiple mandibular teeth in one
quadrant
2.

3.

When Buccal soft tissue anesthesia is

necessary
When Lingual soft tissue anesthesiais necessary

Inferior Alveolar Nerve Block

Contraindications
1.
2.

Infection/inflammation at injection site

Patients at risk for self injury (eg. Children,lip or tongue biting )

Inferior Alveolar Nerve Block

Alternatives
Mental nerve block
Incisive nerve block
Anterior infiltration

Inferior Alveolar Nerve Block

Alternatives (cont.)
Periodontal ligament injection (PDL)
Gow Gates Block
Vazirani Akinosi Block

Inferior Alveolar Nerve Block

Technique
Apply topical

Area of insertion:

Mucus membrane on the medial side of the

ramus, -At the intersection of two lines Horizontal- representing height of injection
Vertical- representing anteroposterior plane of
injection

Inferior Alveolar Nerve Block

Target Area
Inferior alveolar nerve, near mandibular foramen
Landmarks
Coronoid notch
Pterygomandibular raphe
Occlusal plane of the mandibular posterior teeth

Procedure-

Inferior Alveolar Nerve Block

Precautions
Do not inject if bone not contacted
Avoid forceful bone contact

Inferior Alveolar Nerve Block

Failure of Anesthesia
Injection too low
Injection too anterior
Accessory innervation
-Mylohyoid nerve
-contralateral Incisive nerve innervation

Inferior Alveolar Nerve Block

Complications
Hematoma
Trismus
Transient Facial paralysis

Buccal Nerve Block

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

Area Aanesthetized- soft tisue& periosteum

buccal to mandibular molars

Buccal Nerve Block

Indications
When Anesthesia is required in the mandibular
molar region
Contraindications
Infection/inflammation at injection site
Nerve Anesthetized- Buccal

Buccal Nerve Block

Advantages
Technically easy
High success rate
Disadvantages
Discomfort

Buccal Nerve Block

Alternatives
Buccal infiltration
Gow-Gates
PDL injection
Intraseptal injection
Vazirani - Akinosi

Buccal Nerve Block

Technique
Apply topical
Insertion distal and buccal to last molar

Target Area - Long Buccal nerve,-as it passes along

anterior border of ramus

Area of insertion-

Mucosa adjacent to most distal molar-(distal & bucally)

Buccal Nerve Block

Landmarks
Mandibular molars
Mucobuccal fold

Procedure-

ComplicationsHematoma

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

Mental Nerve Block

Indication
When buccal soft tissue anesthesia is necessary
for procedures in the mandible anterior to
mental foramen
Contraindication
Infection/inflammation at injection site

Mental Nerve Block

Advantages
Easy, high success rate
Usually atraumatic
Disadvantage
Hematoma

Mental Nerve Block

Alternatives
Local infiltration
Intraseptal injection
Inferior alveolar nerve block
Gow Gates

Mental Nerve Block

Complications
Few
Hematoma

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

Incisive Nerve Block

Nerves anesthetized
Incisive
Mental

Incisive Nerve Block

Areas Anesthetized
Mandibular labial mucous membranes
Lower lip / skin of chin
Incisor, cuspid and bicuspid teeth

Incisive Nerve Block

Indication
Anesthesia of tissue required anterior to mental
foramen
Contraindication
Infection/inflammation at injection site

Incisive Nerve Block

Advantages
High success rate
Pulpal anesthesia w/o lingual anesthesia
Disadvantages
Lack of lingual or midline anesthesia
Complications
Hematoma

Gow-Gates Technique
The

Gow-Gates technique is useful alternative to

the inferior alveolar nerve block
it is often used when the latter fails to provide
adequate anesthesia.
Advantages of this technique versus the inferior
alveolar technique are its low failure rate and
low incidence of positive aspiration.

 The

Gow-Gates technique anesthetizes the

auriculotemporal, inferior alveolar, buccal,
mental, incisive, mylohyoid and lingual nerves.

Contraindications

to this procedure include

acute inflammation and infection over the site of
injection and trismatic patients.

The patient is asked to open mouth maximally. The

mesiolingual cusp of the maxillary 2nd molar is the reference
point for the height of the injection: The needle is then moved
distally and is held parallel to an imaginary line drawn from the
intertragic notch to the corner of the mouth

Vazirani-Akinosi Closed Mouth

Mandibular
Block

The Vazirani-Akinosi closed mouth mandibular block is a useful

technique for patients with limited opening due trismus or
ankylosis of the temporomandibular joint
Other advantages to this technique are the minimal risk of
trauma to the inferior alveolar nerve, artery, vein, and pterygoid
muscle, low complication rate and minimal discomfort upon
injection
Contraindications to this technique are acute inflammation and
infection in the pterygomandibular space, deformity or tumor in
the maxillary tuberosity region.