MANDIBULAR

INJECTION
TECHNIQUES
Srijana Thapa
Roll No: 23
CONTENTS

Anatomic considerations
Mandibular injection techniques
Inferior alveolar nerve block
Buccinator nerve block
Mental nerve anesthesia
Summary
References
 ANATOMIC
CONSIDERATION

Branches of Mandibular Division

1. Undivided nerve
a. Nervus spinosus
b. Nerve to the medial pterygoid
muscle

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ANATOMIC
CONSIDERATION 2. Divided nerve
a. Anterior division
i. Nerve to the lateral pterygoid muscle
ii. Nerve to the masseter muscle
iii. Nerve to the temporal muscle
iv. Buccal nerve
b. Posterior division
i. Auriculotemporal nerve
ii. Lingual nerve
iii. Mylohyoid nerve
iv. Inferior alveolar nerve: dental branches
v. Incisive branch: dental branches
vi. Mental nerve
MANDIBULAR
INJECTION
TECHNIQUES
 INFERIOR ALVEOLAR NERVE BLOCK
Introduction

 IANB, commonly (but inaccurately) referred to as the mandibular nerve block

 Useful technique for quadrant dentistry
 A supplemental block (buccal nerve) is needed only when soft tissue anesthesia in the
buccal posterior region is necessary
 On rare occasions a supraperiosteal injection (infiltration) may be needed in the
lower incisor region to correct partial anesthesia caused by the overlap of sensory
fibers from the contralateral side
 A PDL injection might be necessary when isolated portions of mandibular teeth
(usually the mesial root of a mandibular first molar) remain sensitive after an
otherwise successful IANB
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INFERIOR ALVEOLAR NERVE BLOCK
Nerves Anesthetized

1. Inferior alveolar nerve

2. Incisive nerve
3. Mental nerve
4. Lingual nerve (commonly)

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 INFERIOR ALVEOLAR NERVE BLOCK
Areas Anesthetized

1. Mandibular teeth to the midline

2. Body of the mandible, inferior portion of the
ramus
3. Buccal mucoperiosteum, mucous membrane
anterior to the mental foramen (mental nerve)
4. Anterior two-thirds of the tongue and floor of the
oral cavity (lingual nerve)
5. Lingual soft tissues and periosteum (lingual
nerve)

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 INFERIOR ALVEOLAR NERVE BLOCK
• Indications
1. Procedures on multiple
mandibular teeth in one quadrant
2. When buccal soft tissue anesthesia
(anterior to the mental foramen) is
necessary
3. When lingual soft tissue anesthesia
is necessary
• Contraindications
1. Infection or acute inflammation in the area of
injection (rare)
2. Patients who are more likely to bite their lip
or tongue (e.g., a very young child or a
physically or mentally handicapped adult or
child)
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INFERIOR ALVEOLAR NERVE BLOCK
Technique

 Armamentarium: A 25-gauge long needle is preferred; a 27-gauge long is

acceptable

 Area of insertion: mucous membrane on the medial (lingual) side of the

mandibular ramus, at the intersection of two lines—one horizontal,
representing the height of needle insertion, the other vertical, representing
the anteroposterior plane of injection

 Target area: inferior alveolar nerve as it passes downward toward the

mandibular foramen but before it enters the foramen
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INFERIOR ALVEOLAR NERVE BLOCK
Landmarks

4
7
6
5
3
1
2

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 INFERIOR ALVEOLAR NERVE BLOCK
Correct Position
 For a right IANB, a right-
handed administrator should sit
at the 8 o’clock position facing
the patient
 For a left IANB, a right-handed
administrator should sit at the
10 o’clock position facing in the
same direction as the patient

• Patient
 Position the patient supine
(recommended) or semi supine(if
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necessary)
INFERIOR ALVEOLAR NERVE BLOCK
Parameters 1. Height Of Injection

 Place the index finger or the thumb of your left hand

in the coronoid notch

 An imaginary line extends posteriorly from the

fingertip in the coronoid notch to the deepest part of
the pterygomandibular raphe (as it turns vertically
upward toward the maxilla), determining the height
of injection
 This imaginary line should be parallel to the occlusal
plane of the mandibular molar teeth [6-10mm above
occlusal plane] 13
 INFERIOR ALVEOLAR NERVE BLOCK
Parameters 2. Anteroposterior site of injection

 Needle penetration occurs at the intersection

of two points:

• POINT 1: horizontal line from the coronoid

notch to the deepest part of the
pterygomandibular raphe as it ascends vertically
toward the palate
• POINT 2: vertical line through point 1 about
three-fourths of the distance from the anterior
border of the ramus

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 INFERIOR ALVEOLAR NERVE BLOCK
Parameters 3. Penetration depth

 The average depth of penetration to bony

contact, in the adult, is 20 to 25 mm,
approximately two-thirds to three-fourths the
length of a long dental needle

• NOTE
- In children mandibular foramen is situated at
a level lower than the occlusal plane of
primary teeth
- So injection is made at a lower level and
posteriorly
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 INFERIOR ALVEOLAR NERVE BLOCK
Deposition

 Aspirate in two planes: If negative, slowly deposit 1.5 mL of anesthetic over a

minimum of 60 seconds
 Slowly withdraw the syringe, and when approximately half its length remains within
tissues, reaspirate: If negative, deposit a portion of the remaining solution (0.2 mL) to
anesthetize the lingual nerve

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BUCCINATOR
NERVE BLOCK

• Nerves anesthetized: Buccinator nerve

• Area anesthetized: Soft tissues and periosteum, buccal to mandibular molar teeth

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 MENTAL NERVE
ANESTHESIA
 Nerves anesthetized: Mental nerve
 Area anesthetized: Soft tissues of lower lip, chin, buccal soft tissues anterior to mental
foramen are anesthetized

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 SUMMARY

 Maxillary injection techniques are anterior,

middle superior alveolar and infraorbital nerve
block, posterior superior alveolar nerve block,
nasopalatine nerve block, greater palatine nerve
block and maxillary nerve block

 Mandibular injection techniques are inferior

alveolar nerve block, buccinator nerve block,
mental nerve block, incisive nerve block,
mandibular nerve block
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 REFERENCES

 Handbook of Local Anesthesia – 7th edition

 Textbook of Pediatric Dentisry- 4th edition
THANK YOU