Pain and anxiety Control Mandibular Injection
Techniques
Paul H. Kwon D.D.S
University of Minnesota
Oral and Maxillofacial Surgery
Mandibular Injection Technique Anatomy
Inferior Alveolar N. Block (IAN)
Gow-
Gow-Gates (V3)
Vazirani-
Vazirani-Akinosi
Mental N. Block
Icisive N. Block
Long Buccal N. Block
Anatomy
1
The Needle The Cartridge
1.) Cylindrical glass tube
Gauge: the larger the gauge the smaller
the internal diameter of the needle 2.) Stopper
-25g red cap 3.) Aluminum cap
-27g yellow cap 4.) Diaphragm
-30g blue cap
Long Needle:32mm
Short Needle:20mm
Differences by manufacturer
Injection technique
Inferior alveolar nerve block
Inferior Alveolar N. Block Inferior Alveolar N. Block
(IAN) (IAN) cont.
Most frequently used Target area : Before alveolar N.
Positiveaspiration 10 – 15% enter into the foramen
Depth: 20 – 25mm
Height of injection: 6 – 10mm
If bone is contacted too soon:
above the occlusal plane If bone is not contacted:
Landmark:coronoid notch, Lingual N:Deposit small amount of
– Pterygomandibular raphe anesthetic upon withthrouing to
anesthtized lingual N.
– Occlusal plane etc
Remember lower incisor region overlaps of
sensory fibers from the contralateral side.
2
Inferior Alveolar N. Block(IAN)
Clinical failure rate : 15-
15-20%
(anatomical variation, depth of soft
tissue)height of mandibula foramen
Avoid, if possible, bilateral IAN
Anesthetized area:
Position of patient: supine or
semisupine
Location of needle tip:superior to the
mandibular foramen
Deposit = 1.5mL
Signs and Symptoms IAN
Tingling and numbness of lower lip
Tingling and numbness of tongue
Elimination of pain
3
Failure of Anesthesia
Injection technique
(IANB)
Remember – Always aspirate 1).Deposition of anesthetic too
before injection! low, too anteriorly
2).Accessory innervation
- Mylohyoid Nerves
- Overlapping fibers of the
contralateral alveolar nerve
Complications of IANB Injection Technique
1). Hematoma
Gow-
Gow-Gates Block
2). Trismus
3). Transient facial paraylsis
Mandibular Nerve Block Gow-Gates Technique
(Gow – Gates technique) Distribution of V3
Target area: Lateral side of the condylar neck
1973 : George Gow-
Gow-Gates from Landmark: Intertragic notch, corner of the
mouth, mesiolingual cusp of maxillary 2ndmolar
Australia described true Penetration:Distal to the Mx 2nd or 3rd molar
mandibular n. block Height:Mesiolingual cusp of Mx 2nd molar
(10 – 25mm from occlusal plane)
Success rate : >95% (IAN:80-
(IAN:80-85%) Depth: 25mm
Deposit: 1.8ml
Aspiration rate: < 2%(IAN 10-
10-15%) Time of onset:5-
onset:5-10”
10”(IAN 3-
3-5”)
Bone is not contact:no deposit anesthetics
move the syringe distally
Keep the mouth open:1-
open:1-2”
4
Gow-Gates Gow-Gates
Varizani-
Varizani-Akinosi Closed-
Closed-
mouth Mandibular Block Akinosi
Trismus:Extraoral mandibular block
1960 : Varizani described technique
1977 : Dr. Joseph Akinosi – Useful for
patient with trismus
Insertion : height of the mucogingival
junction adjacent to the maxillary 3rd
molar
Depth :25mm
Deposit : 1.5-
1.5-1.8mL
5
Akinosi
Akinosi Injection technique
Long buccal block
Long Buccal Nerve Block
Anesthetized: Soft tissue and periosteum
buccal to the mandibular molar teeth
Indications:Scaling,curettage,the use of
rubberdam clamp,subgingival tooth
preparation,place of matrix band
Insertion: Distal,Buccal of last molar
Length of needle penetration : 1-1-2 mm
Deposit : 0.3mL
Vevel : Toward the bone
Landmark:Mucobuccal fold
6
Long Buccal
Injection Technique
Mental nerve block
Mental Nerve
Block
Indications:when buccal soft tissue
anesthesia is necessary for procedures
in the mandible anterior to the mental
foramen
Area anesthetized:buccal mucous
membrane anterior to the mental
foramen,
Lower lip and chin.
Technique:25-
Technique:25-27 gauge short needle
Least frequently employed
7
Menatl Nerve Block
Mental Nerve Block
Area of insertion:mucobuccal fold at or just
anterior to the mental foramen
Target area: between the apices of the two
premolars
Patient`s mouth: partially clsed
Located the mental foramen
Radiograph
Clinical exam
Deoth:5-
Deoth:5-6mm
Deposit:0.6ml
Bevel:Toward the bone
Indications
Pulpul anesthesia to teeth anterior to
mental foramen
Incisive Nerve Block When inferior alveolar nerve block is
not indicated
Supplemental Injection
Incisive N. Bloc
Techniques
Lingual soft tissue are not anesthetized
Local infiltration through the interdental Periodontal ligament injection (PDL)
papilla or partial lingual N. blick Intraseptal
Not necessary for the needle to enter into the
foramen Intraosseous (IO) technique
Area anesthetized : buccal mucosa, lower lip, Intrapulpal injection
pulp of the teeth
Deposit = 0.6 mL
Depth of penetration : 5- 5-6mm
8
Chart Notation for Local
Anesthsia
Thank You
Give drug name
Give volume
Give dosage
Give location of injection
Give concentrations
– local anesthetic agent
– vasoconstrictor
