Mandibular teeth anesthetic block techniques

Block Anesthetic Techniques for Mandibular teeth
Innervation & Anesthesia - ELHAWARY
1.  Main
Trunk

2.  Nervous
Spimosum

3.  Nerve
to
medial
pterygoid

4.  Anterior
Division

1.  N.
to
Temporalis
msc.

2.  N.
to
Masse?er
msc.

3.  N.
to
Lateral
Pterygoid
msc.

4.  Long
Buccal
N.

5.  Posterior
Division

1.  Auriculo-‐temporal
N.

2.  Lingual
Nerve

3.  Inferior
Alveolar
N.

Mandibular

anethesia

InﬁltraJon

anesthesia

Anterior
labial

inﬂ
anesth

Anterior
lingual

inf
anesth

Long
buccal
inf

anesth

Nerve
block

anesthesia

IA
and
L
NB

Mental
NB

Long
Buccal
NB

•  Chair
posiJon

•  DenJst
posiJon

•  Syringe

•  Needle

•  Areas/Nerves
to
be
anestheJzed
-‐
Landmarks

•  Point
of
inserJon

•  DirecJon
of
injecJon

•  Checking
the
anesthesia

•  Standard
technique

•  Gaw-‐Gates
Technique

•  Akinozi
Technique

•  Aim

– To
deposit
the
anestheJc
soluJon
in
close
vicinity

to
the
Inferior
alveolar
nerve
just
before
its
entry

to
the
mandibular
foramen

– To
deposit
the
anestheJc
soluJon
in
close
vicinity

to
the
lingual
nerve
as
it
pass
anterior
and
medial

to
the
IAN

•  Chair
posi*on

•  Den*st
posi*on

•  Syringe
:
AspiraJng
syringe

•  Needle

•  Nerves
to
be
anestheJzed

•  Areas
to
be
anestheJzed

•  landmarks

•  Point
of
inserJon

•  DirecJon
of
injecJon

•  Checking
the
anesthesia

Pa*ent
posi*on

•  Head
,
neck
and
trunk
on
the

same
straight
line

•  The
back
of
the
chair
is
Jlted
so

that
it
make
a
45
degree
angle

with
the
ﬂoor

•  So
that
when
the
paJent
open
his

mouth
the
occlusal
plane
of
the

mandibular
teeth
becomes

parallel
to

the
ﬂoor

•  The
occlusal
plan
of
mandibular

teeth
near
to
the
operator’s

elbow

Den*st
posi*on

•  Right
side:

–  From
infront
and
to
the
right

•  LeY
side:

–  From
infront
and
to
the
right

using

•  Cross
hand
technique

•  Using
leY
hand

–  From
right
rear
posiJon
using

•  From
behind
technique

•  Chair
posiJon

•  DenJst
posiJon

•  Syringe
:
Aspira*ng
syringe

•  Needle

•  Nerves
to
be
anestheJzed

•  Areas
to
be
anestheJzed

•  landmarks

•  Point
of
inserJon

•  DirecJon
of
injecJon

•  Checking
the
anesthesia

•  Chair
posiJon

•  DenJst
posiJon

•  Syringe
:
AspiraJng
syringe

•  Needle
:
Long
Needle

•  Nerves
to
be
anestheJzed

•  Areas
to
be
anestheJzed

•  landmarks

•  Point
of
inserJon

•  DirecJon
of
injecJon

•  Checking
the
anesthesia

Ocland
DVD
of
Head
and
Neck
Anatomy

Ocland
DVD
of
Head
and
Neck
Anatomy

Mand

Ocland
DVD
of
Head
and
Neck
Anatomy

MP

Msc

Ocland
DVD
of
Head
and
Neck
Anatomy

B
Msc

Ocland
DVD
of
Head
and
Neck
Anatomy

IAN

Ocland
DVD
of
Head
and
Neck
Anatomy

IAN
LN

•  Chair
posiJon

•  DenJst
posiJon

•  Syringe

•  Needle

•  Nerves
to
be
anesthe*zed

–  Incisive
Nerve

–  Mental
nerve

–  Inferior
alveolar
nerve

–  Lingual
nerve

•  Areas
to
be
anestheJzed

•  landmarks

•  Point
of
inserJon

•  DirecJon
of
injecJon

•  Checking
the
anesthesia

•  Chair
posiJon

•  DenJst
posiJon

•  Syringe

•  Needle

•  Nerves
to
be
anestheJzed

•  Areas
to
be
anesthe*zed

–  All
the
pulp
and
invesJng
structures
of
lower
posterior
teeth
in
the
side
of
anesthesia

–  Buccal

mucoperiosteum
of
the
anterior
teeth
and
premolars

–  The
lingual
mucoperiosteum
of
the
same
side

–  Floor
of
the
mouth
of
the
same
side

–  Half
the
tongue
of
the
same
side

•  landmarks

•  Point
of
inserJon

•  DirecJon
of
injecJon

•  Checking
the
anesthesia

•  Chair
posiJon

•  DenJst
posiJon

•  Syringe

•  Needle

•  Nerves
to
be
anestheJzed

•  Areas
to
be
anestheJzed

•  landmarks

•  Point
of
inserJon

•  DirecJon
of
injecJon

•  Checking
the
anesthesia

•  Landmarks:

– SoY
Jssue
landmarks:

•  Muccobuccal
fold

•  Buccal
pad
of
fat

•  Retromolar
area
–
triangle

•  Pterygomandibular
raphe

•  Landmarks:

– Bony
landmarks:

•  External
oblique
ridge

•  Internal
oblique
ridge

•  Anterior
border
of
the

ramus

•  Coronid
process

•  Coronoid
notch

•  SoY
Jssue
landmarks
•  Bony
landmarks

•  Chair
posiJon

•  DenJst
posiJon

•  Syringe

•  Needle

•  Nerves
to
be
anestheJzed

•  Areas
to
be
anestheJzed

•  landmarks

•  Point
of
inser*on

•  Direc*on
of
injec*on

•  Checking
the
anesthesia

•  Right
handed
operator

•  The
operator
is
posiJoned
from
infront
and
to
the

right

Narrow
angle
of
ﬂare

Narrow
angle
of
ﬂare

Direct
more
anterior

Wide
angle
of
ﬂare

Wide
angle
of
ﬂare

Direct
more
posterior

•  Chair
posiJon

•  DenJst
posiJon

•  Syringe

•  Needle

•  Nerves
to
be
anestheJzed

•  Areas
to
be
anestheJzed

•  landmarks

•  Point
of
inserJon

•  DirecJon
of
injecJon

•  Checking
the
anesthesia

–  SubjecJve
ﬁndings

•  Numbness
of
the
lower
lip

–  ObjecJve
ﬁndings

•  Probing
does
not
lead
to
pain

•  Right
handed
operator

The
operator
is
posiJoned
on
the
right
front
of
the

paJent

–  From
infront
and
to
the
right

•  Cross
hand
technique

•  LeY
hand
technique

–  Right
rear
posiJon

•  From
behind
technique

Cross
Hand
Technique

From
Behind
Technique

LeY
Hand
Technique

•  Too
high
injec*on

•  Too
low
injec*on

•  Too
deep
injec*on

•  Too
medial
injec*on

–  A n e s t h e s i a
o f
t h e

auriclotemporal
nerve
:

Numbness
of
the
ear

–  InjecJon
into
lateral

pterygoid
muscle
:
Soreness

and
trismus

•  Too
high
injec*on

•  Too
low
injec*on

•  Too
deep
injec*on

•  Too
medial
injec*on

•  Failure
of
anesthesia

•  Too
high
injec*on

•  Too
low
injec*on

•  Too
deep
injec*on

•  Too
medial
injec*on

– Deposited
in
paroJd
gland

–  Temporary
facial
nerve

paralysis

–  ParoJJs

– D e p o s i t e d
i n t o
t h e

posterior
facial
vein
:

–  Toxicity

– Deposited
into
medial

pterygoid
muscle

–  Pain

–  Trismus

•  Too
high
injec*on

•  Too
low
injec*on

•  Too
deep
injec*on

•  Too
medial
injec*on

–  D e p o s i t e d
i n t o
t h e

constrictor
muscle
of

pharynx
:
disphagya

•  Too
high
injecJon

–  Anesthesia
of
the
auriclotemporal
nerve
:
Numbness
of
the
ear

–  InjecJon
into
lateral
pterygoid
muscle
:
Soreness
and
trismus

•  Too
low
injecJon:

–  Failure
of
anesthesia

•  Too
deep
injecJon:

–  Deposited
in
paroJd
gland

•  Temporary
facial
nerve
paralysis

•  ParoJJs

–  Deposited
into
the
posterior
facial
vein
:

•  Toxicity

–  Deposited
into
medial
pterygoid
muscle

•  Pain

•  Trismus

•  Too
medial
injecJon

–  Deposited
into
the
constrictor
muscle
of
pharynx
:
disphagya

•  This
technique
was
introduced
in
1973
by
the
Australian

operator
Dr.
George
Gow-‐gates

•  It
provides
sensory
anesthesia
to
all
branches
of
the

Posterior
Division
and
Buccal
nerve

•  This
technique
was
reported
in
1977
by
Dr.

Joseph
Akinosi

•  The
main
advantage
is
that
it
could
be

administrated
to
paJents
with
very
limited

mouth
opening

•  0.2
ml
of
anestheJc
soluJon
is
deposited
at
the
apex
of

the
retromolar
triangle
between
the
external
and
internal

oblique
ridges

•  Point
of
inserJon

–  apex
of
the
retromolar
triangle
between
the
external
and

internal
oblique
ridges

•  DirecJon
of
injecJon

–  Parallel
to
the
occlusal
plane
from
the
same
side

•  Technique

– The
same
technique
as
the
inferior
alveolar
nerve
is

followed
except
that
the
point
of
inserJon
is
just

anterior
to
the
index
ﬁnger
or
the
area
palpated
with

the
syringe
oriented
over
the
teeth
of
the
same
side
to

be
injected
and
parallel
to
the
occlusal
plane.

Thank
You

Mandibular teeth anesthetic block techniques

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