TECHNIQUES FOR MANDIBULAR ANAESTHESIA
- The inferior alveolar nerve block (IANB) - this is a frequently used technique in mandibular anaesthesia . However, it is not an easy technique and has one of the highest percentages of failure. IANB is used to numb :
· Teeth on one side of mandible
· A dense layer of vascular connective tissue (periosteum) of the mandible
· Lingual soft tissue
· Some anterior inner lining of cheek (buccal) soft tissue
· Bone from the inferior portion of ramus to the midline
- The Gow-Gates mandibular nerve block – this technique was developed to overcome the failure rate of IANB. One study reported a mandibular anaesthesia success rate of 99% . It is also reported to have a lower risk for positive aspiration than IANB.
- Vazirani-Akinosi - this is an alternative technique for IANB and the Gow-Gates technique . It is also commonly known as “tuberosity approach” and “closed mouth mandibular nerve block”. It is used when the patient has a limited range for mouth opening or spasms in the masticatory muscles.
- The Buccal nerve block – this technique induces anaesthesia to the buccal gingiva, mucosa, and an area of the cheek in the mandibular molar region with a success rate of 100 percent . The buccal nerve is not anaesthetised when using IANB.
- Mental and incisive nerve block - this is a technique used to anaesthetise the terminal branches of the inferior alveolar nerve. One main difference is that the incisive nerve block requires the application of pressure to direct the anaesthetic solution in the right direction .
MAXILLARY ANAESTHESIA TECHNIQUES
- Supraperiosteal injection - commonly referred to as “local infiltration”, this is a frequently used technique that achieves pulpal anaesthesia. It is an easy technique with high success rates . However, a regional nerve block is more effective when multiple teeth require anaesthesia, or if inflammation or an infection are present . Paediatric patients benefit from infiltration for anaesthetising mandibular primary teeth.
- The maxillary nerve block – this technique is meant to anaesthetise the hemimaxilla. It can be achieved through several approaches such as high tuberosity approach, greater foramen approach, posterior superior alveola nerve block, middle superior alveolar nerve block, anterior superior alveolar nerve block, greater palatine nerve block, nasopalatine nerve block, anterior middle superior alveolar nerve (AMSA) block, and palatal anterior superior alveolar nerve block [1, 8, 9].
NEW AND UNCONVENTIONAL TECHNIQUES
- Electronic dental anaesthesia is a technique in which electronic waves block transmission of pain to the brain .
- PED-O-JET, SYRIJET and MED-E-JET are needle-free injection systems that use piston pressure and produce less pain than normal injections. Phobia of needles is common among patients. A needle-free injection could ease the apprehension associated with dental procedures.
- Iontophoresis is a technique that administers lidocaine transdermally. Electrodes on the skin control the passage of ionized lidocaine into the dermis .
TECHNIQUES TO ENHANCE THE PATIENT EXPERIENCE
Choosing the right technique can increase the effectiveness of anaesthesia while increasing patient comfort. In turn, patients are less likely to have a negative association with dental procedures. This makes patients more likely to return to the same dentist and seek oral treatment in a timely manner.
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5. Oral and Maxillofacial Surgery. Lars Andersson, Karl-Erik Kahnberg, M. Anthony Pogrel. Published by Wiley Blacwell.
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