**3. Modified direct inferior alveolar nerve block technique**

#### **3.1. Overview**

This modified direct technique is easier and more practical than the conventional technique described by Malamed in the handbook of local anesthesia [18]; also it is easier to learn and teach dental students. We have used this technique in practice for many years with a high success rate (up to 98%).

### **3.2. Technique**


Novel Modifications in Administration of Local Anesthetics for Dentoalveolar Surgery http://dx.doi.org/10.5772/59235 63

**Figure 9.** The modified direct technique.

#### **4. Conclusion**

from the line of sight of the patient. When standing in front of the patient it is easier for the patient to see the needle whereas when standing behind the patient it is unlikely for him or

Mental-incisive nerve block injection distal to the second premolar from behind the patient

This modified direct technique is easier and more practical than the conventional technique described by Malamed in the handbook of local anesthesia [18]; also it is easier to learn and teach dental students. We have used this technique in practice for many years with a high

**d.** Needle penetration occurs at the point one centimeter above the occlusal plane of the mandibular molar and parallel to it just at the lateral border of pterygomandibular raphe. In this situation, the needle touches the medial aspect of the ramus at about a 90 angle. When entering the pterygomandibular space injury to the medial pterygoid muscle should be avoided. The pterygomandibular fold may serve as a landmark for the anterior border of the muscle. The needle pierces the mucous membrane lateral to the pterygo‐ mandibular fold and injury to the medial pterygoid muscle is avoided easily [18-21]

**e.** While slowly advancing, the needle contacts bone; then we withdraw the needle about 1 mm to prevent subperiosteal injection. If aspiration is negative, we slowly deposit 1.5 ml of anesthetic within 60 seconds; the remaining solution is deposited for lingual nerve anesthesia while withdrawing the needle. The average depth of needle penetration to bony contact depends on soft tissue thickness of the area on the medial aspect of the ramus. This will be approximately 8-10 mm or less, it is not necessary to advance the needle in the posterior direction at all or you will be far from the exact injection site. In this technique using the thumb or finger is not necessary, a dental mirror or Minnesota retractor can be used; however there is really no need to use these instruments. With this technique the inferior alveolar and lingual nerves are anesthetized. The long buccal nerve should be

was more successful than between premolars from the front.

**a.** A 27 gauge short or long needle is recommended.

**b.** The mouth should be open wide.

**3. Modified direct inferior alveolar nerve block technique**

**c.** Placement of the syringe barrel at the first molar of the opposite side.

anesthetized separately for molar extraction (Figure 9).

her to visualize the needle. [17]

62 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2

**2.6. Conclusion**

**3.1. Overview**

**3.2. Technique**

success rate (up to 98%).

With regard to the high success rate of the technique and because of simplicity and easy learning curve by dental students it can be placed into the academic curriculum.

#### **Author details**

Esshagh Lassemi1 , Fina Navi1\*, Mohammad Hosein Kalantar Motamedi1,2, Seyed Mehdi Jafari1 , Kourosh Taheri Talesh1,3, Kamal Qaranizade1 and Reza Lasemi4

\*Address all correspondence to: fina\_navi@yahoo.com

1 Department of Oral and Maxillofacial Surgery, Dental School, Azad Islamic University of Medical Sciences, Tehran, Iran

2 Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

3 Department of Oral and Maxillofacial Surgery,Dental School, Tabriz University of Medical Sciences, Tabriz, Iran

4 Medical University of Vienna, Austria

#### **References**

[1] Uckan S, Dayangac E, Araz K. Is permanent maxillary tooth removal without palatal injection possible? *Oral Surg Oral Med Oral Pathol Oral RadiolEndod*2006; 102: 733-735.


[19] Gray`s Anatomy (2008).(39thed), Elsevier Ltd,USA,Chap 32:574

[2] Malamed (2013) Local Anesthesia. (5thed), Elsevier Mosby Publications, USA, and

[3] Meechan J G, Day P F, McMillan A S. Local anesthesia in the palate: a comparison of

[4] Meechan J G, Howlett P C, Smith B D. Factors influencing the discomfort of intraoral

[5] Lassemi E, Motamedi M. H. K., Jafari S. M, TaleshK. T., Navi F. Anesthetic efficacy of alabial infiltration method on the nasopalatine nerve.Br Dent J. 2008 Nov 22;

[6] Malamed S (2004) Hand book of local anesthesia (5thedn), Mosby Publications, Mis‐

[7] Potocnik I, Bajrovic F (1999) Failure of inferior alveolar nerve block. Endod Dent

[8] Williams D, Bannister L, Berry M (2008) Gray's Anatomy(39thedn) Churchill Living‐

[9] Joyce A, Donnely J (1992) Evaluation of effectiveness and comfort of incisive nerve

[10] Moiseiwitsch JR (1998) Position of the mental foramen in North American white pop‐

[11] Green R (1987) The Position of the mental foramen: A comparison between the southern Chinese and other ethnic and racial groups. Oral Surg Oral Med Oral Path‐

[12] Phillips JL, Weller RN, Kulid JC (1992) The mental foramen: Part 3, size and position

[13] Henry Hollinshead. Anatomy For Surgeons: The Head and Neck. (3rd ed) Harper &

[14] Wesley E Shankland (1994) The position of the Mental Foramen in Asian Indians. J

[15] Al Jasser NM, Al Nwoku (1998) Radiographic study of the mental foramen in a se‐

[17] Lassemi E, Kalantar Motamedi MH, Alemi Z (2013) Anesthetic Efficacy Assessment of Two Mental Nerve Block Techniques for Tooth Extraction. Anaplastology S6: 003.

[18] Malamed (2013) Local Anesthesia. (5thedn), Elsevier Mosby Publications, Chap14: 228

[16] Sicher H (1970) Oral Anatomy. (5thedn), Mosby Publications, USA, chap 1: 44-48.

lected Saudi population. Dento maxillofacial Radiology 27: 341-343.

anesthesia inside or outside the mental foramen. J Endod 18: 409-411.

ulation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 85: 457-460.

on panoramic Radiographs, J Endod 18: 383-386.

Row, Publishers Philadelphia 1: 358.

Oral Implantology 20: 118-122.

doi: 10.4172/2161-1173.S6-003

techniques and solutions. *AnesthProg*2000; 47: 139-142.

needle penetration. *AnesthProg*2005; 52: 91-94.

205(10):E21. doi: 10.1038/sj.bdj.2008.872.

souri, USA 14: 228-252.

Traumatol 15: 247-251.

ol 63: 287-290.

stone Publications 33: 601.

Chap13:190-191

64 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2


**Basic and Advanced Surgical Orthodontics**

**Chapter 5**
