FreshBreath

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It seems I have hit a bit of a funk administering the inferior alveolar block injection. I have missed it twice in the past three days. Has this happen to anyone, and what did you do to adjust it? Maybe I should aim a bit more superior and posteriorly. If you have some good suggestions, techniques, diagrams, or anything that could help it would be appreciated.
 

CorneliusFudge

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Some tips that I have gotten are:

1. aim high after the first missed block
2. put your thumb on the anterior border of the ramus and a finger on the posterior border. Aim for the middle of these two points. sometimes a really fat patient or a patient with unusual anatomy will fool you.
3. try the Gow Gates


I have two patients that I always missed the first block on. But now I know to aim high the first time when they are in the chair and I always get profound anesthesia with one carpule. Some people are just cut from a slightly different cookie cutter.
 

scalpel2008

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This is what I do. It's clockwork and I don't even think about it anymore. haven't found a tooth yet that has escaped this plan.

palpate the anterior border of the ramus with a retractor
visualize the pterygomandibular raphe
the 2 form a triangle
inject in the "soft" area within this triangle
try and angle it as far laterally as you can
don't go too superior or else it it will take forever to set in
forget about the gow gates

my policy now is if they aren't profoundly numb after a second carpule, i go ahead and give an ansa cervicalis block at the angle of the mandible

if i'm going to take the tooth out, PDL is my next option (if its grossly carious, intrapulpal, tell the pt to hang tight)

Sometimes I give the mylohyoid nerve block in the floor of the mouth(i think i've had about 10 patients in about a couple thousand blocks)
 
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Reconabe

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how do you give an ansa cervicalis block? just wondering
 

scalpel2008

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Reconabe said:
how do you give an ansa cervicalis block? just wondering
in the posterior mandibular buccal vestibule, insert needle towards the angle of the mandible, insert about 15-20mm.
 
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FreshBreath

FreshBreath

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scalpel2008 said:
This is what I do. It's clockwork and I don't even think about it anymore. haven't found a tooth yet that has escaped this plan.

palpate the anterior border of the ramus with a retractor
visualize the pterygomandibular raphe
the 2 form a triangle
inject in the "soft" area within this triangle
try and angle it as far laterally as you can
don't go too superior or else it it will take forever to set in
forget about the gow gates

my policy now is if they aren't profoundly numb after a second carpule, i go ahead and give an ansa cervicalis block at the angle of the mandible

if i'm going to take the tooth out, PDL is my next option (if its grossly carious, intrapulpal, tell the pt to hang tight)

Sometimes I give the mylohyoid nerve block in the floor of the mouth(i think i've had about 10 patients in about a couple thousand blocks)
thanks, the patients i struggled with i had a hard time finding that anterior border of the ramus, really think buccal mucosa!!! any suggestions for that or what i should sense for? i know the answer, but sometimes reinforcement is needed when you fail a few times.
 

DrJeff

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What works for me(and has over the last decade or so) is upon injecting, I'll contact the medial surface of the mandible with the needle, and then "walk" the needle posteriorly off the mandible, then bring the needle just back onto the medial surface of the mandible, aspirate and deposit the carpule. I find that for me atleast, this technique works the best, and I rarely will find that I miss the block this way.
 

scalpel2008

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FreshBreath said:
thanks, the patients i struggled with i had a hard time finding that anterior border of the ramus, really think buccal mucosa!!! any suggestions for that or what i should sense for? i know the answer, but sometimes reinforcement is needed when you fail a few times.
retract the think mucosa laterally with your thumb and you will be able to barely feel the ramus. then use your retractor. you can also sound it with the needle itself. i've found that excessive bone contact and scraping across the bone with the needle makes patients uncomfortable.
 
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