Effective pain management is a cornerstone of modern dental practice, and nowhere is this more evident than in procedures involving the mandible.
Owing to the dense cortical bone of the mandibular region and the deep positioning of its neural structures, achieving profound anesthesia in this area can be challenging for both novice and experienced clinicians.
Unlike maxillary anesthesia—which benefits from relatively porous bone allowing for successful infiltration—the mandible often requires nerve block techniques to access the inferior alveolar nerve, lingual nerve, buccal nerve, and others.
Mastery of these techniques is essential not only for conventional dental procedures like restorations, extractions, and endodontics but also for managing complex cases in oral surgery and implantology.
The success of mandibular anesthesia is influenced by anatomical variability, the choice of technique, the clinician’s skill, and the patient's individual response.
Over time, various approaches have been developed and refined to increase success rates and reduce complications, including direct and indirect nerve blocks, intraligamentary, intraosseous, and computer-assisted delivery systems.
Let’s explore the most commonly used techniques for achieving mandibular anesthesia, their indications, advantages, and key anatomical considerations.
Main Mandibular Anesthetic Techniques
1. Inferior Alveolar Nerve Block (IANB)
Also known as the standard mandibular block, this is the most widely taught and practiced technique. It aims to anesthetize the inferior alveolar, lingual, and often the mental and incisive nerves.
✔ Target: Mandibular foramen
✔ Landmarks: Coronoid notch, pterygomandibular raphe, occlusal plane
✔ Applications: Most posterior and anterior mandibular dental treatments
Note: This technique has a reported success rate of only 80–85%, largely due to anatomical variability.
2. Gow-Gates Technique
A high mandibular block technique developed in the 1970s, the Gow-Gates block anesthetizes nearly the entire V3 branch of the trigeminal nerve, including the auriculotemporal, buccal, and mylohyoid nerves.
✔ Target: Neck of the condyle, just below the insertion of the lateral pterygoid muscle
✔ Advantages: Higher success rate (~95%), broader coverage
✔ Drawbacks: Slower onset (~5–10 minutes)
3. Akinosi-Vazirani Technique (Closed-Mouth Block)
This technique is especially useful in patients with limited mouth opening due to trismus or temporomandibular disorders.
✔ Target: Medial surface of the mandibular ramus
✔ Advantages: Does not require mouth opening
✔ Indications: Trismus, multiple quadrant treatment
4. Mental and Incisive Nerve Block
Indicated for anterior procedures, this block anesthetizes the buccal soft tissues and lower lip anterior to the mental foramen.
✔ Target: Mental foramen (between premolars)
✔ Applications: Soft tissue surgery, anterior restorations
5. Buccal Nerve Block
Often used as an adjunct to IANB for procedures involving the buccal mucosa of the molars.
✔ Target: Mucosa distal and buccal to the last molar
✔ Applications: Extractions, surgical flaps
6. Intraligamentary (PDL) and Intraosseous Techniques
These supplemental techniques deliver anesthetic directly into the periodontal ligament or bone, ideal for isolated tooth anesthesia or when conventional blocks fail.
✔ Advantages: Fast onset, minimal soft tissue anesthesia
✔ Technology: Often used with computer-assisted devices
Tips for Successful Mandibular Anesthesia
✔ Always palpate anatomical landmarks precisely.
✔ Use a long needle (25-27 gauge) for deep blocks.
✔ Wait at least 3–5 minutes before assessing efficacy.
✔ Consider alternative techniques if the patient shows incomplete numbness after 10 minutes.
✔ Always aspirate to avoid intravascular injection.
📚 Further Reading
- Krishna S, Selvarasu K, Kumar S P, et al. (January 31, 2024) Efficacy of Different Techniques of the Inferior Alveolar Nerve Block for Mandibular Anesthesia: A Comparative Prospective Study
Conclusion
Proficiency in mandibular anesthetic techniques is vital for dental clinicians aiming to deliver safe, comfortable, and effective care.
With a firm grasp of anatomical landmarks, injection protocols, and potential complications, practitioners can significantly increase the reliability of their mandibular blocks.
As new technologies and techniques emerge, continuing education remains key to refining clinical outcomes and enhancing patient experience.
