Inferior alveolar nerve block is otherwise known as mandibular nerve block.The The inferior nerve block is the most useful of all nerve blocks.Bilateral nerve block ia rarely indicated because of the extreme patient discomfort produced by the bilateral soft tissue anaesthesia of the tongue which persists for several hours after injection.During this time the patient feels unable to swallow and because of the lack of all sensation is unable to enunciate well.
1.Inferior alveolar nerve:bransh of the posterior division of the mandibular nerve.
1.Mandibular teeth to midline.
2.Body of mandible and inferior portion of ramus.
3.Buccal mucoperiosteum and mucous membrane anterior to mandibular first molar.
4.Anterior two thirds of tongue and floor of oral cavity.
5.Lingual soft tissues and periosteum.
Procedures on multiple mandibular teeth in one quadrant.
2.When buccal soft tissue anaethesia is required.
3.When soft tissue anesthesia is required.
1.Infection or acute inflammation in area of injection.
2.Young children who might bite either the lip or tingue and also physically or mentally handicapped patients.
One injection provides wide area of anaesthesia.
1.Wide area of anaesthesia for localized procedures.
2.Rate of inadequate anaesthesia.
3.Intraoral landmarks not consistently reliable.
4.Positive aspiration rate is the highest.
5.Lingual and lower lip anaesthesia discomforting to many patients.
6.Partial anesthesia is seen in bifid mandibular canals.
Alternatives to inferior alveolar nerve block:
1.Mental nerve block.
2.Incisive nerve block.
3.Supraperiosteal injection for central and lateral incisors and canine.
4.Gow-Gates mandibular block.
5.Periodontal ligament injection for pulpal anaesthesia.
6.Intraseptal injection for osseous and soft tissues.
25 gauge needle is requied for this anaesthesia.Area of insertion is the mucous membrane on the medial border of ramus of mandible and at a point of intersection between two lines – one horizontal representing height of injection and the other vertical representing anterior-posterior plane of injection.The target area will be the inferior alveolar nerve as it passes downward toward mandibular foramen but before it enters the foramen.
The landmarks are the coronoid notch which is the greatest depression on the anterior border of the ramus,the pterygomandibular raphe and the occlusal plane of mandibular posterior teeth.For the right alveolar nerve block,the dentist should sit in a 8 o’clock position.For the left inferior alveolar nerve block,the dentist should sit in 10 o’clock position.The position of the patient should be supine or semi supine during the injection.
Swelling of tissues of the medial side of ramus of mandible following deposition of local anaesthetic solution.
Muscle soreness or limitation of movement of muscle.
3.Transient facial paralysis:
This is produced by deposition of local anaesthetic solution on posteromedial aspect of the parotid gland.