Landmarks:

• Extraoral - Intertragic notch and corner of the mouth

• Intraoral - The mesiolingual cusp of the maxillary second molar

Target:

The anteromedial border of the mandibular condylar neck.

Procedure:

Place the needle just below the mesiolingual cusp of the maxillary second molar to assess the approximate vertical location for the injection site. The needle is then placed distal to the maxillary second molar maintaining the height established in the previous step. The barrel of the needle is maintained over the contralateral canine/premolar region such that the angulation of the syringe parallels a line connecting the corner of the mouth and the intertragic notch of the corresponding side. The orientation of the bevel of the needle tip in this injection is not crucial for the block to be successful. The needle is inserted parallel to the intertragic line determined in the previous step until bony contact is made.

Nerves anesthetized:

• Inferior alveolar

• Mental

• Incisive

• Lingual

• Mylohyoid

• Auriculotemporal

• Buccal (in 75 per cent of patients)

Areas anesthetized:

• Mandibular teeth to midline

• Buccal mucoperiosteum and mucous membranes in the area

• Anterior two thirds of tongue and floor of mouth

• Lingual soft tissues and periosteum

• Body of mandible

• Inferior ramus

• Skin over zygoma

• Posterior cheek and temporal regions

Indications:

• Quadrant dentistry

• Buccal soft tissue anesthesia from third molar to midline and lingual soft tissue anesthesia if conventional inferior alveolar nerve block is unsuccessful

Contraindications:

• Infection at the site of the injection

• Patients with the potential to bite their lip or tongue (children or patients with disabilities)

• Patients with limited mouth opening

  Advantages:

• Greater than 95 per cent success rate

• Buccal nerve block is not necessary

• Minimum aspiration rate of 2 per cent

• Good for accessory innervations associated with the inferior alveolar nerve

Disadvantages:

• Anesthesia of the lower lip and temporal and lingual areas

• Longer time for the anesthetic to take effect