ALVEOLAR INFERIOR NERVE BLOCK - The Best Straightforward Explanation Ever

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Inferior alveolar nerve block is the technique most frequently used for local anesthesia when performing restorative and surgical procedures in the mandible.

The inferior alveolar nerve block is the most widely used in dentistry and yet many people do it wrong. This video is very important because you will understand the step by step of the technique. But just keep in mind that, according to Malamed, the success rate of this blockade is 80% to 85%, if you apply the technique correctly. Now if the technique is wrong, then that index drops a lot. So pay attention and understand it definitively.

The first step is for you to palpate and identify the anterior border of the mandibular ramus. The patient must have the maximum mouth opening. Your index finger should be parallel and 1 cm above the occlusal plane. The second anatomical structure that you will identify is the pterygomandibular raphe. Taking these two structures into account, you will draw an imaginary straight line from the center of your fingertip to the deepest part of the pterygomandibular raphe. In this image, you are looking at the pterygomandibular raphe from a two-dimensional perspective, but if you look at it from the side, the raphe starts from the region of the retromolar trigone and goes towards one extremity to the hamulus of the medial pterygoid plate. In this path, it deepens in a certain place.

The next step is to divide this imaginary line into 4 parts. The puncture point will be 3/4 of the distance from the anterior border of the mandibular ramus concerning this imaginary line to the deepest part of the pterygomandibular raphe. A basic mistake is to make the puncture much anterior, which causes the needle to touch the bone very early and the solution is deposited in the wrong place.

The correct positioning of the syringe is with its body at the level of the premolar teeth on the opposite side. In some cases, when the mandible is very divergent, you can position the syringe a little more posteriorly, almost on the molar on the opposite side.

The next step is to insert the needle into the target area until you feel bone resistance until you touch the bone (it is important not to force the needle against the bone so as not to damage the needle bevel). The needle needs to be 25 or 27 gauge long. The needle is inserted almost in its entirety. A small segment of the needle usually remains outside the oral tissues, which is desirable because if the patient makes some sudden movement and the needle breaks, usually the needle breaks at the junction with the hub. In this way, the needle could be more easily removed.

If you inserted the entire needle and did not touch the bone, you have your puncture point too posterior or the body of the syringe too anterior to the level of 1st. premolar. Then you need to modify and reintroduce.

After touching the bone, you will retract the needle about 1mm. why retreat 1mm? to prevent the tip of the needle from being inside the mandibular foramen. Then, you will do the aspiration to make sure that you are not inside of any blood vessel or artery. (I’m going to teach you more about it in another video too). A rapid intravascular injection can lead to a relative overdose reaction in addition to the anesthesia not being installed. Keep in mind that for the nerve impulse to be prevented from being conducted through the nerve fibers, the anesthetic solution must be in contact with the nerve, which is not the case with an intravascular injection.

You will administer the anesthetic solution slowly and steadily. The glass cartridge has advantages over the plastic cartridge (we'll talk more about that in another video as well). The slow, steady injection should take about 1 minute. You don't need to time it, just keep it in mind. The deposition needs to be slow. Will you administer all the contents of the cartridge in this location? No. You will leave a small amount, something around 0.1 ml of anesthetic solution for anesthesia of the lingual nerve. Then you will withdraw the needle in half and deposit the rest of the anesthetic solution. The lingual nerve is located anterior to the inferior alveolar nerve, which is why we make this indentation with the needle. At the end of your deposition of the entire contents of the tube, the needle can be completely removed and you will wait for the latency time of the anesthetic solution. How long should you wait? at least 5 minutes. Ideally, 10 or even 15 minutes. This is also where many dentists make mistakes. They perform the technique and already try to start the procedure right after the 1st. numbness on the lips. Often the lips are numb, but pulp anesthesia is not yet fully established. Hence the importance of waiting 10 minutes or more.

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