Inferior Alveolar Nerve Block (IAN)

 Introduction

Inferior alveolar nerve anesthesia is a technique of dental anesthesia used to produce anesthesia of the mandibular teeth, gingival tissues of the mandible and the lower lip.

The proper use of local anesthesia techniques and pain management are indispensable for successful dental treatment. Although inferior dental anesthesia is a routine block injection administered regularly in dental practice, failure to achieve satisfactory levels of analgesia are noticed in few cases2.

 

What are the Mandibular Nerve Blocks

Inferior alveolar
Mental – Incisive
Buccal
Lingual
Gow-Gates
Akinosi

 

We will be discussing about Inferior Alveolar Nerve Block 

*Not a complete mandibular nerve block.
*Requires supplemental buccal nerve block
*May require infiltration of incisors or mesial root of first molar

 

NERVES THAT GET ANESTHETIZED

Nerves anesthetized
Inferior Alveolar
Mental
Incisive
Lingual

AREAS THAT GET ANESTHETIZED

Mandibular teeth to midline
Body of mandible, inferior ramus
Buccal mucosa anterior to mental foramen
Anterior 2/3 tongue & floor of mouth
Lingual soft tissue and periosteum

INDICATIONS

Multiple mandibular teeth
Buccal anterior soft tissue
Lingual anesthesia

CONTRAINDICATIONS

Infection/inflammation at injection site
Patients at risk for self injury (eg. children)

10%-15% positive aspiration

TECHNIQUE

Apply topical
Area of insertion:
medial ramus, mid-coronoid notch,
level with occlusal plane (1 cm above),
3/4 posterior from coronoid notch to
pterygomandibular raphe
advance to bone (20-25 mm)

Anatomical Landmarks For Identification

Mucobuccal fold

Anterior border of the ramus of the mandible

External oblique ridge

Retromolar triangle

Internal oblique ridge

Pterygomandibular ligament

Buccal sucking pad

Pterygomandibular space

Failure of Anesthesia

Injection too low
Injection too anterior
Accessory innervation
-Mylohyoid nerve
-Contralateral Incisive nerve innervation

Complications

Hematoma
Trismus
Facial paralysis

1. Subjective symptoms – Tingling and numbness of lower lip and when the lingual nerve is affected, the tip of the tongue.
2. Objective symptoms – Instrumentation necessary to demonstrate absence of pain sensation.

 

NERVES  INVOLVED

Check out the videos of IAN

 

 

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