Mandibular anesthesia is one of the cornerstones of dental practice, and the success of the anesthesia is essential for both patient comfort and treatment efficacy.

1. Adequate Mouth Opening: The patient is instructed to open the mouth as wide as possible. This allows clear visualization of the pterygomandibular raphe, facilitating accurate identification of the injection site.

2. Retraction of Soft Tissues: Using a mouth mirror or an appropriate retractor, the soft tissues covering the anterior border of the mandibular ramus (margo anterior) are retracted laterally to improve access and visibility.

3. Positioning and Insertion Point:

• In dentate patients, needle insertion is performed approximately 1 cm above the occlusal plane of the molar teeth. In edentulous patients, the insertion point is located 1.5 cm above the alveolar crest, 1 cm medial to the anterior border of the ramus, and aligned with the midpoint of the pterygomandibular raphe. The needle should be directed toward the contralateral oral commissure.

4. Needle Advancement and Bone Contact: After penetrating the mucosa, the needle is advanced through the tissues within the pterygomandibular space. Bone contact is typically achieved after advancing the needle approximately 2–2.5 cm.

5. Aspiration and Injection of the Anesthetic Solution

• Negative Aspiration: Before injection, the syringe plunger is gently withdrawn to perform an aspiration test. The absence of blood confirms that the needle is not within a blood vessel.

• Solution Injection: Once negative aspiration is confirmed, 1–1.5 mL of anesthetic solution is slowly injected.

Areas Affected by Standard Mandibular Anesthesia:

• All mandibular teeth up to the midline

• The body of the mandible and the anterior border of the mandibular ramus

• Vestibular mucosa extending from the mandibular central incisor to the first molar

• The anterior two-thirds of the tongue and the floor of the mouth

• Lingual soft tissues and periosteum

Need for Supplemental Anesthesia

In certain clinical situations—particularly during invasive procedures such as tooth extraction—supplemental anesthesia may be required:

• Mandibular Central Incisors: Due to bilateral innervation, additional local infiltration anesthesia at the midline is recommended to ensure complete anesthesia.

• Buccal Mucosa of Mandibular Molars: To achieve adequate anesthesia of the buccal mucosa in the mandibular molar region, a buccal nerve (n. buccalis) block may be necessary.

 

References

1. Berberoğlu HK, Köseoğlu BG, Kasapoğlu Ç. Diş Hekimliğinde Lokal Anestezi. Quintessence Publishing Türkiye.