Inferior Alveolar Nerve Block Technique

Overview

• Commonly used in dentistry.
• Success rate: 80-85% (according to Malamed).
• Importance of correct execution to avoid significant drop in success rate.

Steps for Correct Technique

1. Initial Palpation and Identification

• Identify anterior border of the mandibular ramus.
  • Patient mouth: maximum opening.
  • Index finger: ~1 cm above occlusal plane.
• Identify pterygomandibular raphe.
  • Draw imaginary line from fingertip center to deepest part of pterygomandibular raphe.
  • Line starts from retromolar trigone to hamulus of medial pterygoid plate, deepens at certain places.

2. Division of Imaginary Line

• Divide line into four parts.
• Puncture point: three-quarters from the anterior border to the deepest part of the raphe.

3. Correct Syringe Positioning

• Syringe body: level with premolar teeth on opposite side.
  • Mandible very divergent: position posteriorly (almost on opposite molar).

4. Needle Insertion

• Insert needle until bone resistance is felt. Do not force.
  • Needle: 25 or 27 gauge long.
  • Small segment of needle remains outside oral tissues.
• Adjust puncture point if needle doesn't touch bone.
  • Too posterior: syringe body too anterior at first premolar level.
  • After touching bone, retract needle ~1mm to avoid mandibular foramen.

5. Aspiration Maneuver

• Ensure needle not inside any blood vessel or artery.
  • Rapid intravascular injection risks: overdose reaction, failed anesthesia.

6. Administration of Anesthetic Solution

• Administer slowly and steadily (~1 min).
  • Leave small amount (~0.1 ml) for lingual nerve anesthesia.
  • Withdraw needle halfway, deposit remaining solution for lingual nerve.

7. Wait for Anesthesia Onset

• Recommended wait time: at least 5 mins, ideally 10-15 mins.
  • Early initiation: common mistake, wait for full anesthesia.

Conclusion

• Follow correct steps to achieve effective anesthetic outcome.
• More educational videos to follow.
• Feedback and questions invited for future content.