Slashed blue circle represents insertion site of traditional IANB. 3įigure 5: Early bone contact after partial withdrawal direct barrel more anteriorly.įigure 7: Left side palpate inner ridge (black dashed line) with nondominant finger slide it posteriorly until ridge "disappears" insert just over the top of that point (white X) angle and advance per traditional IANB. 2 Some experts report the vertical line should be two-thirds of the distance.
The anatomically correct, 3-D skull is so much more helpful for feeling anatomy and practicing angulation than looking at pictures alone. I bring it on-site so that participants can see and feel the anatomy as I talk about the injections. I bought my first one several years ago when I began making my own images for CE courses. This is particularly essential for hands-on learners. If you don't own one, consider buying one.
Intersection of horizontal green line drawn from coronoid notch to the pterygomandibular raphe (PMR) and the vertical yellow line drawn three-quarters of the distance from the coronoid notch to the PMR.ĭust off your old skull from hygiene school. 2-5 Careful review of the basic technique for providing the IANB is the first step in increasing one's success rate.įigure 1: Landmarks, mandible, left side.įigure 2: Palpating the coronoid notch, right side.įigure 3: Example of a position of the mandibular foramen relative to lingula, right side.įigure 4: Mandible, left side insertion site. Anesthetizing the adult mandible is more challenging than the maxilla due to the thick cortical bone, especially in the posterior region unreliable location of landmarks and nerves (which are often asymmetrical on individual patients) potential for accessory innervation and the depth of soft-tissue penetration required to reach the target. The problem with the traditional IANB is the high failure rate. The buccal block injection is required to anesthetize the facial soft tissue in the molar region. The anterior two-thirds of the tongue, floor of the mouth, body of the mandible, and inferior portion of the ramus are also anesthetized.
Structures anesthetized include: the pulps of the mandibular teeth the associated lingual tissues and periosteum and the facial soft tissues and periosteum of the mandibular teeth anterior to the mental foramen. The IANB anesthetizes (on one side) the inferior alveolar (IA) nerve, mental nerve, incisive nerve, and lingual nerve.