Why Your Mandibular V3 (IAN) Blocks Are Failing | OnlineExodontia.com

Online Exodontia
14 Jun 201905:44
EducationalLearning
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TLDRThe video script focuses on improving the success rate of inferior alveolar nerve block, a commonly used yet inconsistent dental procedure. Key tips include targeting high and posterior due to the position of the lingula bone and foramen, utilizing the upper part of the thumb for injection, and allowing gravity to assist anesthesia flow. Addressing cross-innervation by using articaine for separate infiltration, considering panoramic radiography to identify bifid canals, and adjusting needle placement accordingly are also highlighted. The script advises caution with the pterygomandibular ligament to prevent anesthesia blockage and emphasizes the importance of adequate waiting time for anesthesia to take effect. Lastly, it suggests a double dose for surgical procedures or patients with previous anesthesia issues to increase the chances of a successful block.

Takeaways
  • 📍 **Location of the Lingula**: The lingula is an important landmark for the inferior alveolar nerve block, located above the mandibular foramen where the nerve enters the mandible.
  • 🎯 **Aim High and Posterior**: When injecting, aim high and posterior to avoid the anterior or lingual side, as this increases the chance of the anesthetic reaching the foramen.
  • ⬇️ **Gravity's Role**: Utilize gravity by aiming high to help the anesthetic flow down to the foramen.
  • 👍 **Thumb Positioning**: Use the upper part of the thumb for injection, resting it on the coronoid notch, which is applicable even in patients with a low coronoid notch.
  • 🔍 **Accessing Accessory Nerves**: Aiming posteriorly can help reach accessory nerves branching from the inferior alveolar nerve (IAN) for better anesthesia.
  • ⏱ **Post-Injection Rest**: Allowing the patient to rest for 5-10 minutes after the injection can help the anesthetic settle via gravity, potentially saving a block.
  • 🔄 **Cross Innervation**: Be aware of cross innervation, where nerves from the opposite side of the mandible may innervate the central or lateral incisors, requiring separate infiltration.
  • 💧 **Articaine for Cross Innervation**: Use Articaine for addressing cross innervation to eliminate any lingering sensation and proceed pain-free.
  • 🦷 **Panoramic X-ray Considerations**: When a bifid canal is observed in a panoramic X-ray, aim slightly more posteriorly to reach the nerve before it branches.
  • 💉 **Injection Technique Over Premolars**: Placing the syringe barrel over the premolars does not guarantee correct injection placement; be mindful of hitting bone too superficially or not at all.
  • 🚀 **Double Dose for Surgical Procedures**: Using a double dose of anesthesia can increase the success rate, especially for surgical procedures or in patients with a history of difficulty with anesthesia.
  • 🪢 **Sphenomandibular Ligament Barrier**: Ensure proper depth by touching bone as the sphenomandibular ligament can impede lateral anesthetic flow if the injection is medial to it.
  • ⏳ **Patience with Anesthetic Onset**: Allowing more time for the anesthetic to take effect, even up to 10-15 minutes, can turn a seemingly failed block into a successful one.
Q & A

  • What is the purpose of the video?

    -The video aims to provide tips to improve the success rate of inferior alveolar nerve block injections in the dental industry.

  • What is the significance of the lingula in the context of the inferior alveolar nerve block?

    -The lingula is an important anatomical landmark as it is a bony projection on the medial side of the mandibular branch, and it is located just above the mandibular foramen where the inferior alveolar nerve enters the mandible.

  • Why is it important to aim high and posterior when performing the injection?

    -Aiming high and posterior helps ensure that the anesthetic reaches the mandibular foramen, as gravity will assist in directing the anesthetic down to the foramen.

  • What is the recommended technique for positioning the thumb during the injection?

    -Instead of using the thumb as usual, it is suggested to use the upper part of the thumb while the thumb rests on the coronoid notch, which applies to all situations, including patients with a low coronoid notch.

  • How can aiming posteriorly improve the chances of reaching accessory nerves?

    -Aiming posteriorly increases the likelihood of reaching accessory nerves that branch off from the inferior alveolar nerve (IAI), which could provide better anesthesia.

  • What is the strategy if cross-innervation is encountered when working on the central or lateral incisor?

    -In case of cross-innervation, a separate infiltration is performed directly above the tooth in question using articaine, which helps eliminate cross-innervation and allows for a painless procedure.

  • What should be considered when observing a panoramic radiograph?

    -When observing a panoramic radiograph, it's important to note if there is a bifid inferior alveolar canal, which means the canal splits at some point in the posterior region. In such cases, aiming a bit more posteriorly can increase the chances of reaching the nerve before it branches.

  • Why is it not always advisable to place the syringe barrel over the premolars?

    -Placing the syringe barrel over the premolars does not guarantee the correct injection location. It could lead to injecting too far forward, which would result in touching very superficial bone, or too far back, where there might be no bone contact or the use of an overly long needle.

  • What is the suggestion regarding the dosage of anesthesia?

    -Using a double dose of anesthesia is recommended in cases where a patient has had previous anesthesia issues or when performing a surgical procedure. Doubling the volume of anesthesia increases the chances of a successful block.

  • What is the potential issue with the sphenomandibular ligament during the injection?

    -The sphenomandibular ligament, which connects to the lingula, can act as a barrier to anesthesia if the injection is made medial to this ligament without touching bone, preventing the anesthesia from moving laterally towards the foramen.

  • Why is it important to allow enough time for the anesthesia to take effect?

    -Giving the anesthesia enough time to work, such as 10 to 15 minutes, while performing hygiene tests, can often turn blocks that were thought to have failed into adequate anesthesia for working with the patient.

  • What is the overall goal of following the tips provided in the video?

    -The overall goal is to increase the success rate of inferior alveolar nerve blocks, making the procedure more enjoyable, predictable, and effective for dental practitioners.

Outlines
00:00
💉 Mejorando el Bloqueo del Nervio Alveolar Inferior

El primer párrafo aborda el bloqueo del nervio alveolar inferior, un procedimiento común pero a menudo inconsistente en la odontología. Se discuten varios consejos para aumentar la efectividad de la inyección, destacando la importancia de la ubicación de la língula y cómo apuntar correctamente para que la gravedad ayude a la anestesia a llegar al foramen mandibular. Se sugiere usar la parte superior del pulgar para inyectar y se aborda la importancia de permitir que el paciente descanse para mejorar la anestesia. Además, se menciona la posibilidad de inervación cruzada y la utilidad de la articaína para tratarla. Se destaca la necesidad de considerar la radiografía panorámica para identificar múltiples canales y apuntar hacia atrás para alcanzar el nervio antes de su ramificación. También se aborda la técnica de inyección entre los premolares y la importancia de tocar hueso para asegurar una inyección adecuada. Se recomienda una doble dosis de anestesia en casos de procedimientos quirúrgicos o historial de problemas con la anestesia previa.

05:02
⏱ Importancia del Tiempo en el Bloqueo del Nervio Alveolar Inferior

El segundo párrafo enfatiza la importancia de ser paciente y permitir que el bloqueo del nervio alveolar inferior funcione adecuadamente. Se menciona que, a menudo, los bloqueos que inicialmente parecen haber fallado pueden ser efectivos si se les da más tiempo, específicamente entre 10 a 15 minutos. Este tiempo adicional, mientras se realizan pruebas de higiene, puede resultar en un bloqueo exitoso. El párrafo finaliza con un mensaje de apoyo, esperando que los consejos proporcionados ayuden al lector a tener más éxito y disfrute del procedimiento de manera más predecible y placentera.

Mindmap
Keywords
💡Inferior alveolar nerve block
The inferior alveolar nerve block is a dental procedure where an anesthetic is injected to numb the lower jaw, specifically targeting the inferior alveolar nerve. It is a common yet challenging technique, as the video suggests providing tips to improve its success rate. In the script, it is mentioned as one of the most inconsistent and frequently used blocks in the industry.
💡Lingula
The lingula is a bony projection on the medial side of the mandibular branch. It is located just above the mandibular foramen, which is the entry point of the inferior alveolar nerve into the jawbone. The script emphasizes the importance of knowing the location of the lingula to successfully perform the nerve block, as it is a landmark for directing the needle.
💡Mandibular foramen
The mandibular foramen is an opening in the jawbone where the inferior alveolar nerve enters. It is a critical anatomical landmark for the inferior alveolar nerve block. The script discusses the importance of aiming the anesthetic above and behind this point to increase the likelihood of the anesthetic reaching the foramen.
💡Anesthesia gravity
The concept of using gravity to assist in the flow of anesthetic is mentioned in the script. By aiming high when injecting, gravity can help the anesthetic flow down to the mandibular foramen. This technique is suggested to increase the chances of a successful nerve block.
💡Cross-innervation
Cross-innervation refers to the phenomenon where nerves from one side of the mandible cross over to innervate areas on the opposite side. The script discusses the potential for this to occur, which may require a separate infiltration with a local anesthetic like articaine to ensure complete numbness.
💡Articaine
Articaine is a local anesthetic used in dentistry, particularly for procedures that require infiltration anesthesia. The script suggests using articaine for addressing cross-innervation issues and ensuring a painless procedure.
💡Panoramic radiograph
A panoramic radiograph is a type of dental X-ray that provides a broad view of the maxillofacial structures. The script mentions that when reviewing a panoramic radiograph, one might observe a bifid inferior alveolar canal, which can affect the approach to the nerve block. The presence of multiple canals is a factor to consider when aiming the anesthetic.
💡Sphenomandibular ligament
The sphenomandibular ligament is a structure that connects the lingula to the sphenoid bone. The script warns that if an anesthetic is deposited medial to this ligament without touching bone, it can act as a barrier to the spread of anesthesia towards the foramen, potentially leading to a failed block.
💡Double dose anesthesia
The script suggests using a double dose of anesthesia in cases where patients have had issues with anesthesia in the past or when performing a surgical procedure. Doubling the volume of anesthesia is mentioned as a strategy to increase the likelihood of a successful nerve block.
💡Premolars
The script discusses the common teaching of placing the syringe barrel over the premolars during the nerve block. However, it cautions that this does not guarantee correct injection placement and may lead to issues such as hitting bone too superficially or not hitting bone at all.
💡Waiting period
The importance of allowing a sufficient waiting period for the anesthesia to take effect is highlighted in the script. It suggests that giving the blocks more time, even up to 10-15 minutes, can turn seemingly failed blocks into successful ones, especially when combined with hygiene tests.
Highlights

The inferior alveolar nerve block is one of the most inconsistent and commonly used blocks in the industry.

Tips are provided to improve success rates for this injection.

Location of the lingula is important for the procedure.

The lingula is an osseous projection on the medial face of the mandibular branch.

The mandibular foramen is where the inferior alveolar nerve enters the mandible.

Aiming high and posterior is recommended for the injection.

Gravity aids in the flow of anesthetic towards the foramen when aimed high.

Using the upper part of the thumb for the injection is suggested.

Aiming high is recommended even for class 3 patients with a lower coronoid notch.

Aiming posterior increases the chance of reaching accessory nerves for better anesthesia.

Allowing the patient to rest after injection can help gravity filter the anesthesia towards the foramen.

Cross-innervation can occur, requiring separate infiltration.

Articaine is recommended for eliminating cross-innervation.

A bifid mandibular canal may require aiming further back for successful block.

Placing the syringe barrel over the premolars does not guarantee correct injection location.

Using a double dose of anesthesia can increase the success rate.

The sphenomandibular ligament can act as a barrier to anesthesia if not injected properly.

Ensuring proper depth and touching bone during injection is crucial.

Allowing more time for the block to take effect can improve success rates.

Transcripts

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