Enhancing Mandibular Block Anesthesia

By William R. Bachand, DDS
Block anesthesia can be achieved in both the maxillary and mandibular divisions, although mandibular blocks tend to be used more frequently. The mandibular division has a motor branch that innervates the muscles of mastication, but it is the multiple sensory branches that are targets of interest in dentistry. These branches include the auriculotemporal, mylohyoid, mental, lingual, incisive, buccal and inferior alveolar. The inferior alveolar nerve — the most frequent target for these techniques — is the largest branch of the largest division of the largest cranial nerve — and yet its exact location is often elusive when it comes to getting within 1 mm to provide adequate anesthesia. The reasons are varied. Among other barriers, anatomical variation, the depth of soft tissue overlying the nerve, and operator inconsistency contribute to a sometimes challenging injection.
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