ICP-34 Block Techniques Flashcards
What block techniques are used in mandibular teeth
Infiltration and regional block
What factors guide which technique is used to anaesthetise mandibular teeth
- Age of patient
- Tooth of interest
- LA being used
Whatre the main differences between block and infiltration techniques
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
Describe the success rates of anaesthesia in the maxilla and mandible
Maxilla - 95% or higher brooo
Mandible - 80-85%
Why might the success rate for mandibular anaesthesia be lower than that of the maxilla
- 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
What needs to be done before the procedure
- Make sure you check medical history
- Prepare the correct equipment
- Know the anatomy of the area
What type of needle is best for providing and IANB
27 gauge
Long needle
Where do you want to deposit LA in mandibular regional blocks
- Near mandibular foramen in the pterygomandibular space
- Position of foramen is variable but can be seen on a DPT
How do you want to position the patient when doing mandibular regional blocks
A bit more inclined when new to technique so the mandibular occlusal plane is almost horizontal so easier to identify anatomical landmarks
Describe how to identify the point of needle entry for an IANB
- Use thumb of non-dominant hand feel for coronoid notch = greatest concavity on anterior border of the ramus
- Moving thumb medially feel for internal and external oblique ridges, pull tissues slightly laterally
- Identify pterygomandibular raphe = fold of tissue extending from upper to lower teeth
- 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
What is appropriate LA volume for IANB
2ml
How can you ensure that the needle comes into the tissue at a good angle for an IANB
Bringing needle over pre molars on opposite side the syringe should be at correct angle
How deep should the needle go in an IANB
Needle penetrates mucosa, CT and maybe muscle and periosteum and will contact bone, then pull back some mms. to prevent deposit under periosteum
Describe how to deliver an IANB
- Topical anaesthesia: clean and dry mucosa, cotton roll, 3-4mins for anaesthesia
- Identify landmarks: prepare needle and anaesthetic (27 gauge, long needle, 2% lidocaine+Adrenaline 1:80,000)
- With thumb in deepest part of coronoid notch and syringe in dominant hand, bring needle in from over the opposite pre-molars
- Stretch mucosa and insert needle about 15-25mm, stop when contact bone and retract a little
- Aspirate and deliver 1ml/30secs
- remove pressure from plunger, withdraw needle, place on bracket table and pull down safety sheath, check patient
What can happen if you don’t bring the needle over the opposite premolars and you come in too straight
- you may not contact bone and will end up behind where you need to be and more likely to be in parotid gland
What can happen if the needle comes in at too much of an angle
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
AY BAWS CAN I HABE DE NOTE PLZ
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
How do we ensure the the IANB has worked
Ask patient if lip is numb as this is the last place that is affected by the IANB
AY BAWS CAN I HABE DE NOTE PLZ
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
When is articaine infiltration used
To avoid need to give an ID regional block or if an ID regional block has failed
What needle is used for articaine infiltration
27 gauge
Short needle
Where do you insert the needle in an articaine infiltration
Inserted 5mm below the tip of the papillae an 3mm away from gingival margin
What should you see upon injection of articaine infiltration
Blanching of the soft tissues should be seen
AY BAWS CAN I HABE DE NOTE PLZ
Apparently articaine infiltration is good for extractions, periodontal treatment, endodontic and restorative treatment
How do you carry out a long buccal nerve block
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
What do greater palatine nerve blocks anaesthetise
The hard palate from the third molar to the canine region
Where is the greater palatine foramen
Palatally to the distal aspect of the upper 2nd molar
How much solution is needed for a greater palatine nerve block
0.2ml of solution
What does the nasopalatine nerve block anaesthetise
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
Where is the needle inserted for a nasopalatine nerve block
Near incisive papilla
Where do you deposit LA for a mental nerve block
At the mental foramen, needle wants to hit bone in the region between the premolar apices, retract and aspirate
How much solution is required for a mental nerve block
1.5ml
What radiographs can show the mental foramen
Peri-apical radiographs
