Anesthetic techniques

of lower jaw

LECTURER: DR. NINO CHICHOA

STUDENT: ALIREZA FARHADIEH
 Which nerves innervates mandible?
Totally facial nerves are divided into tree part :
ophthalmic , maxillary and mandibular nerves
 Mandibular nerve (third division of trigeminal nerve)
divide mainly into two branch when it
comes out from foramen ovale.

 Motor nerves: connect to muscle of

mastication (maseter,temporalis,L&M pterygoid)

 Sensory nerves: which include inferior

alveolar nerve, lingual nerve, buccal nerve,
auriclotemporal nerve
 Nerve supply for mandibular teeth

 Mandibular premolars & molars

(pulp, investing structures) innervated by
inferior alveolar nerve.

 Mandibular incisors & canines (pulp,

investing structures) innervated by
incisive nerve.
 Type of injection procedures

 Nerve block: depositing the local

anesthesia solutions within close
location to a main nerve trunk

 Field block: depositing near to the

large nerve branches

 Local infiltration: small terminal nerve

ending are insensitive to pain and
anesthetized (it is useful for minor dental
procedures , specially on anterior mandible
because of thin cortical layer of spongy bone
above.)
 Type of mandibular nerve block

 Inferior alveolar nerve block:

 enters the mandible throw the mandibular
foramen, goes out throw mental foramen
and gives branches to mental and incisive
nerve so anesthetizes areas will be:

 Mandibular teeth to the midline

 Anterior two thirds of the tongue and floor

of the oral cavity (lingual nerve)

 Mucosa and skin of the lower lip and chin

 Gingiva on the labial and lingual surface of

the mandible
 Type of mandibular nerve block
 Procedure:

 For right side IANB we will stay at 8 o’clock position

and for left side at 10 o’clock position

 retract the lips then use thump on the anterior

surface of the ramus (coronoid notch)

 From the opposite site, cotra lateral premolar region,

6 – 10 mm from the occlusal plane, at the deepest
part of the pterygomandibular raphe

 we have to insert about 2/3 of needle until it touch

the bone then release approximately 1.5 ml of
anesthetics over a minimum 60 seconds
 Type of mandibular nerve block
 Long buccal nerve block:

 Mostly we use this type of anesthesia beside IANB

 it is the branch of V3 nerve which innervates buccal

soft tissue around the molars, areas which anesthetize
are Soft tissues and periosteum buccal to the
mandibular molar teeth.

 Procedure:

 Insert about 2 mm of needle at the level of occlusal

plan of second premolar

 release 0.3 ml of anesthetics

 Type of mandibular nerve block
 Mental nerve block:

 Its form the last part of the IAN which exit from
mental foramen, area which will be anesthetize
are buccal mucosa of anterior to the mental
foramen and also mucosa of the lower lip and
chin. (provide no anesthesia for teeth)

 Procedure:

 retract the lip and insert the needle at

mucogingival junction of buccal side of
premolars ( between premolars, between 2nd
premolar and 1st molar )
 Type of mandibular nerve block
 Incisive nerve block:
 Terminal end of IAN, exit from mental foramen anteriorly and anesthetize lower lip/
skin of chin /Incisor, canine premolar
 Procedure
 Between canine and lateral incisor we will insert 5-6 mm of the needle parallel to long
axis of teeth and release 0.6 ml of anesthetic over 20-30 seconds.
 Thank you

Any questions?