ICP-34 Block Techniques

Question 1

What block techniques are used in mandibular teeth

Answer 1

Infiltration and regional block

Question 2

What factors guide which technique is used to anaesthetise mandibular teeth

Answer 2

• Age of patient
• Tooth of interest
• LA being used

Question 3

Whatre the main differences between block and infiltration techniques

Answer 3

Block: deposited near main nerve trunk
Used when:
- Alveolar bone is too thick to allow infiltration
- When need to avoid an area of infection
- Wider area of anaesthesia is needed with one injection

Question 4

Describe the success rates of anaesthesia in the maxilla and mandible

Answer 4

Maxilla - 95% or higher brooo

Mandible - 80-85%

Question 5

Why might the success rate for mandibular anaesthesia be lower than that of the maxilla

Answer 5

• Anatomical consideration: density of bone, variations in height of mandibular foramen
• Greater depth of soft tissue penetration needed
• Administration must accurately deposit to within 1mm of target nerve

Question 6

What needs to be done before the procedure

Answer 6

• Make sure you check medical history
• Prepare the correct equipment
• Know the anatomy of the area

Question 7

What type of needle is best for providing and IANB

Answer 7

27 gauge

Long needle

Question 8

Where do you want to deposit LA in mandibular regional blocks

Answer 8

• Near mandibular foramen in the pterygomandibular space

- Position of foramen is variable but can be seen on a DPT

Question 9

How do you want to position the patient when doing mandibular regional blocks

Answer 9

A bit more inclined when new to technique so the mandibular occlusal plane is almost horizontal so easier to identify anatomical landmarks

Question 10

Describe how to identify the point of needle entry for an IANB

Answer 10

1. Use thumb of non-dominant hand feel for coronoid notch = greatest concavity on anterior border of the ramus
2. Moving thumb medially feel for internal and external oblique ridges, pull tissues slightly laterally
3. Identify pterygomandibular raphe = fold of tissue extending from upper to lower teeth
4. Point of needle entry is midway between internal oblique ridge and pterygomandibular raphe should be able to find a roughly inverted triangular area: occlusal plane of upper teeth = base of triangle, internal oblique line = lateral border, pterygomandibular raphe = medial border

Question 11

What is appropriate LA volume for IANB

Answer 11

2ml

Question 12

How can you ensure that the needle comes into the tissue at a good angle for an IANB

Answer 12

Bringing needle over pre molars on opposite side the syringe should be at correct angle

Question 13

How deep should the needle go in an IANB

Answer 13

Needle penetrates mucosa, CT and maybe muscle and periosteum and will contact bone, then pull back some mms. to prevent deposit under periosteum

Question 14

Describe how to deliver an IANB

Answer 14

1. Topical anaesthesia: clean and dry mucosa, cotton roll, 3-4mins for anaesthesia
2. Identify landmarks: prepare needle and anaesthetic (27 gauge, long needle, 2% lidocaine+Adrenaline 1:80,000)
3. With thumb in deepest part of coronoid notch and syringe in dominant hand, bring needle in from over the opposite pre-molars
4. Stretch mucosa and insert needle about 15-25mm, stop when contact bone and retract a little
5. Aspirate and deliver 1ml/30secs
6. remove pressure from plunger, withdraw needle, place on bracket table and pull down safety sheath, check patient

Question 15

What can happen if you don’t bring the needle over the opposite premolars and you come in too straight

Answer 15

• you may not contact bone and will end up behind where you need to be and more likely to be in parotid gland

Question 16

What can happen if the needle comes in at too much of an angle

Answer 16

Hit bone v early on despite little needle inside so you hit the ramus too anteriorly, can keep needle in and realign to move along the mandible and more posteriorly over other arch and then once in about 1cm then move back over pre molars on other side

Question 17

AY BAWS CAN I HABE DE NOTE PLZ

Answer 17

In an IANB the buccal soft tissues around molars aren’t anaesthetised so need to also anaesthetise the long buccal nerve of that area if extraction

Question 18

How do we ensure the the IANB has worked

Answer 18

Ask patient if lip is numb as this is the last place that is affected by the IANB

Question 19

AY BAWS CAN I HABE DE NOTE PLZ

Answer 19

Try not to IANB both sides in same appointment or else it gets gay for patient, just try to do those in separate appointments if needed

Question 20

When is articaine infiltration used

Answer 20

To avoid need to give an ID regional block or if an ID regional block has failed

Question 21

What needle is used for articaine infiltration

Answer 21

27 gauge

Short needle

Question 22

Where do you insert the needle in an articaine infiltration

Answer 22

Inserted 5mm below the tip of the papillae an 3mm away from gingival margin

Question 23

What should you see upon injection of articaine infiltration

Answer 23

Blanching of the soft tissues should be seen

Question 24

AY BAWS CAN I HABE DE NOTE PLZ

Answer 24

Apparently articaine infiltration is good for extractions, periodontal treatment, endodontic and restorative treatment

Question 25

How do you carry out a long buccal nerve block

Answer 25

Deposit solution in buccal sulcus just distal to the tooth of interest
OR
Deposit solution at anterior aspect of mandibular ramus, the coronoid notch is palpated and needle is inserted here until bone, retracted, aspirated and then yeh

Question 26

What do greater palatine nerve blocks anaesthetise

Answer 26

The hard palate from the third molar to the canine region

Question 27

Where is the greater palatine foramen

Answer 27

Palatally to the distal aspect of the upper 2nd molar

Question 28

How much solution is needed for a greater palatine nerve block

Answer 28

0.2ml of solution

Question 29

What does the nasopalatine nerve block anaesthetise

Answer 29

The soft tissues of the anterior hard palate in the incisor region bilaterally although there is some crossover supply in the canine region from the greater palatine nerve

Question 30

Where is the needle inserted for a nasopalatine nerve block

Answer 30

Near incisive papilla

Question 31

Where do you deposit LA for a mental nerve block

Answer 31

At the mental foramen, needle wants to hit bone in the region between the premolar apices, retract and aspirate

Question 32

How much solution is required for a mental nerve block

Answer 32

1.5ml

Question 33

What radiographs can show the mental foramen

Answer 33

Peri-apical radiographs