**Modified Jorgensen and Hayden Approach to Intraoral Mandibular Anesthesia**

Flaviana Soares Rocha, Rodrigo Paschoal Carneiro, Aparecido Eurípedes Honório Magalhães, Darceny Zanetta-Barbosa, Lair Mambrini Furtado and Marcelo Caetano Parreira da Silva

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/59163

**1. Introduction**

There is a wide gap between the success rates of maxillary nerve block anesthesia and inferior alveolar nerve (IAN) block. Clinically acceptable anesthesia in the maxilla rarely represents a problem, except in cases of anatomical abnormality or pathological conditions. [1] For maxillary surgical procedures, in the vast majority of cases infiltration anesthesia is all that is required because the cortical plate of the alveolus of the upper jaw is almost always thin and porous enough to make infiltration anesthesia effective.

Procedures on the lower jaw will most often require nerve block anesthesia of the inferior alveolar, lingual, and buccal nerves. The IAN block is the most commonly used block in dentistry, having widespread applications in all fields of dentistry. Unfortunately, anesthetic block of the IAN has high failure rates, varying between 15% and 35%. [1,2] The high failure rate is frequently attributed to differences in the morphology of the mandibular ramus and also the position of the mandibular foramen, however inadequate technique is the most common cause for failure. [3,4] Specifically, improper mouth opening allows the IAN to stay relaxed preventing the close approximation of the nerve with the medial wall of the ramus. Incorrect anterior, posterior or inferior placement of the needle also leads to failure. Because the target for the conventional IAN block is very near the neurovascular bundle, this technique also has a high frequency of positive aspiration, and intravascular injection is possible. [5]

© 2015 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Achieving excellence in pain control is an intrinsic, yet challenging, goal of dentistry. Tradi‐ tionally, the inferior alveolar nerve block (IANB), also known as the "standard mandibular nerve block" or the "Halsted block," has been used to provide anesthesia in mandibular teeth. This technique, however, has a success rate of only 80 to 85 percent, with reports of even lower rates. Investigators have described other techniques as alternatives to the traditional approach, of which the Gow-Gates mandibular nerve block and Akinosi-Vazirani closed-mouth man‐ dibular nerve block techniques have proven to be reliable but each of which have merits and draw backs [5].
