Why Your Mandibular V3 (IAN) Blocks Are Failing | OnlineExodontia.com
HTML-код
- Опубликовано: 13 июн 2019
- Have You Been Wanting To Improve Your Confidence In Oral Surgery And Extract More Teeth? Do You Want An Experienced Dentist That You Can Contact Anytime To Support Your Efforts? Join Me. The O.S. Accelerator Course: onlineexodontia.com/store
An in-depth look at the reasons for failed anesthesia of the mandibular arches is undertaken in this video. Suggestions are made to the general practitioner on how increase their success when completing an inferior alveolar nerve block.
The lighting is great, the monologue is really crisp and concise, the visuals are optimal; a 5 minute video that teaches a lifetime of dental wisdom... Well done!
Thank you so much Mali! I appreciate your words and your support. All the best!
I’m here because I failed twice today getting my patient numb with IA. This helped so much! Can’t wait to practice this next time
Happens. Not everyone seeks a reason why and tries to improve so good on you! Thanks for watching!
Same here sir....I experienced single time today.
dental student here
i failed performaning this block for several times, i really needed help
So concise and understandable demonstration, I’m grateful 👍
This is the BEST video on IAN I have seen so far. Better than Spear videos. Awesome!! I'll be sharing this!
Oh wow - thanks so much for your kind words. Hearing that sort of thing is what keep me going! All the best and thanks for watching!
I am here after the first anesthesia session as D2! Thank you very much for your content! Your points are spot on as what we are being taught!
Glad you enjoyed it. You've chosen a great profession. All the best!
I cannot even tell you how helpful your videos are . Thank you
You just did! All the best!
Thank u so much sir......these demos are truly amazing and of course the background matters too which is great.
Straight to the point. Thank you very much !
I just started my clinical practice in uni, and I've been struggling with these a lot! even though I studied the anatomy numerous times, I lost all confidence when it comes to inferior alveolar blocks, but now I feel a little more confident, thanks
Great to hear! Best of luck and feel free to reach out to me anytime if you have questions or want any guidance. All the best!
Doc, how to ace IAN on red heads.. what anesthetic combination would you recommend following with this technique? TIA
great video. Good quality and awsome commentary
Nice explanation. Thanks for posting this video.
This was so helpful and well explained 👏🏽
Thank you for the helpful insights!
I like your suggestion; this is almost a hybrid gow-gates standard inferior alveolar block 👍
I got like halfway thru the vid and immediately knew you deserved a sub. Great teaching 👍
Thanks - great to have you along! All the best!
Awesome video and points!!
I would just add that depending on how you are trained in dental school there are different approaches. Some dentists aim directly for the lingula from the contralateral canine or first premolar. But I was taught to aim from the second premolar, make contact with the ramus, then swing the barrel over to the ipsilateral side, insert the the needle a little bit further posteriorly and then swing the barrel back to the contralateral canine to essentially follow the curvature of the medial surface of the ramus. I've found that this approach works really well and I've never missed a block since D3.
Awesome technic 👍
Thank you Very much sir
34 years of being a Dentist and every now and then I miss completely. There is virtually nothing that is more frustrating for me!
At my experience there is nothing but embarrassment when asking for help also
I think that's normal Andrew - I'm always skeptical of anyone that says they hit it every time. All the best to you and thanks for watching!
It's mind boggling how many dentists fail to successfully implement this technique only because of how badly they were instructed to it or how they neglect basic anatomy. I teach a course on anatomic variations to implanvology trainees and it still surprises me how they don't know the basics.
Thank you for shedding some light into the matter, I hope it reaches as many dentists as it can.
Thanks for your comment Alfredo! What's the name of your course? All the best!
Knowing anatomy and doing surgeries are two different things.. When you will do you will understand..
@@doctorrai6651 exactly, practice is everything , dentist need concreet situation and sometimes even failure may help to garsp the situation
Beacuse they rarely teach us clinical facts.
this is sooo helpful thanks sir
This is really good
Wow, really helpful tips
Best ian video by far
Thanks a lot!!!! this really benefitted me as a GP dentist
amazing demonstration , thank you
Glad you liked it! All the best!
Thanks v v much sir 🙏🙏🙏🙏🙏, u made it simple & cleared most of my doubts., God bless you with all happiness sir
Same to you! All the best!
Thank you teacher
I'm not practicing, not a dentist, and not a medical professional really. But I recently got my wisdom tooth out (Lower R8) (Palmer numbering). There was cavity on that tooth. Extraction was done by local anesthesia. The dentist did a first dose and I think she poked me to test and asked if I felt anything ( I did not feel anything). But when she was going to start extraction as she was pulling I felt sharp pain and had to raise my hand. She did a second dose. Then she continued but there was still pain but less than the first but I just didn't say anything. Note that the consult and extraction were done on the same day and there was no panoramic x-ray being done. Honestly the extraction was not a good experience. I'm on day 9 of recovery now (there's still pain on 2/10 scale). First to sixth day of recovery the pain was at 7-9 region. I got a dry socket. Visited second time on the 4th day of recovery. Anyways sorry this is not really related to the video because I actually do not know what the details of the video is talking about. Just the gist.
Thank you !
Great effort
Thank you very much dr
You're welcome and thanks for watching! All the best!
thank you teacher
thx for the help never got tought this in dental school
Glad to hear it my friend! All the best!
very much useful tips for me...thank you very much doctor😊😊
Great video. Another tip is practise...practise..practise.. you'l get perfect with experience
Thanks so much for taking the time out of your day to view and comment on the video! All the best!
One of the best benificial videos ever seen
Thanks VIP!
@@OnlineExodontia do u have facebook account or whatsapp?
@@vipvipsilentkiller4420 Hello - I do not have WhatsApp and although there is a Facebook account, I do not frequent it. All the best! Thanks for watching.
The Gow-Gates block have always been advocated for this difficult area.
Another great technique! I assume this is what you prefer? Any insights you can offer to the community would be great.
Thank you
Amazing video thank you
You bet Brian! Thanks for watching!
Dr.Karan good sir
Beautiful explanation short, concise and covers most difficult anatomies. Any insight on the Gow-Gates infiltration technic saw it the channel glidewell.
Thanks for your kind words! The Gow Gates video is part of my course, but I will add some tips on it in the future. All the best!
Awesome 👏
phenomenal. Thank you.
Hi doc, the video was great. Can u do Vazirani Akinosi and Gow Gates in Detail. Thanks.
Those videos are available on my website if you're interested. I've made it a goal to create some new content specifically for RUclips so I will keep that in mind! All the best!
Can you please make IANB technique please with tips
كلام جميل وصحيح ومفيد
I used to have a dentist that couldn't get me numb... tried for 2.5 hours to get me numb for a root canal on #19... which was the worst procedure i ever had. After 6 years i had to have that tooth extracted last week due to sever abscess... The surgeon got me numb first try... Gave me 30 minutes, came back to check gave me another dose and another 10 minutes... That was enough to extract the tooth, remove the bone, and clean out the abscess.... Awake... with in two hours the Novocain already started wearing off and I was good to go. Now I'm just waiting for the giant hole in the side of my jaw to heal up.
Some times exposed pulp took time to get anesthesise,, in abcess case it was totally nonvital so easily got anesthesisd... After extraction it will take nearly 20 days for healing
I know oral surgeons who dont give blocks for removals. Infiltrate and give PDL injections. Inside of the tooth doesn't have to be as numb as surrounding area for removal
How can I give intra oral IANB in hemimandibulectomy site. Where mandible land marks are not present?
Hello, what do you think about the Akinosi Vazirani technique? Is it superior to Weissbrem technique and can we practice Akinosi on a daily basis? It looks like an easier one and could be applied in patients with trismus. Thank you!
I would say that the end goal is get the anesthetic in the proper location. How you choose to do it would be secondary to that objective and a matter of what you're comfortable doing. If you wished to use the Akinosi block, it would work if done correctly. There are several approaches to doing an IAN block and this video covered the most commonly used approach. What's your preference? All the best!
Would it be good to use the first molar as a guide...and rest the barrel at the corner of the mouth...would that be a more accurate position than the premolars ?
Tooth position doesn't really matter too much Dean as it's more about the anatomy of the mandible and where the needle tip ends up. You can use the anterior ramus technique whereby you're inserting with the syringe on the same side as the injection, not over the contralateral premolars and you will still get a successful block. The best exercise in my opinion is to familiarize yourself with the shape of the ramus and position of the lingula. Then try to visualize this as you're anesthetizing a patient. All the best!
Thanks dr for your great video
My question articaine is safe in block
4% solutions like Articaine and Prilocaine have been suggested to be more neurotoxic and some are cautious with using them for blocks. I can tell you that many (especially in Canada - we like our Articaine) use it routinely for blocks without incident. Good however to be aware of it and perhaps you may wish to stay clear of using it for blocks, but I would say that comes down to personal preference.
I went to the dentist recently, who shot me 4 times around there, and all 4 shots did nothing. This dentist worked on the other side, without issue. Not coincidentally, I have pretty bad TMJD on the side that he failed to numb.
What about TMJD and swelling/inflammation could be prohibiting the anesthetic from hitting the nerve? Is there a better method?
The dentist pretty much just kicked me out and said "I can't work on you," even though he's worked on 4 other teeth in my mouth. He doesn't want to deal with me, anymore.
Any tips for when the IAN is completely blocked (lip anterior to mental foramen profoundly numb) but tooth still has sensation? I've heard of obscure innervations like mylohyoid, but not quite sure what the best approach would be to block these.
Depending on the situation you can try PDL injections on the 4 line angles of the tooth. Extra short 30 gauge needle. There are also proprietary systems that allow you to inject easier. You can try a Gow Gates block. You can go higher and more posterior with your IAN as mentioned in the video. There are also things like the X-tip for intraosseus injections. If you’re doing endo and can’t get it numb, but you have access to the pulp chamber you can inject directly into the tooth under pressure. Hopefully that helps! All the best!
Thanks eternally
use the wand and you will never fail again. I do all my blocks with the wand, injecting very slowly.
That's awesome! I've never tried it, but you like many others seem to have good things to say about it. Thanks for watching!
What’s a wand? Can you elaborate please
I usually tell them they are imagining the pain, ( I call it discomfort- never pain), especially after I've given them three or four carpules.
But seriously, great video.
PS Does this count as CE??
Haha nice - I actually thought you were serious at first! Thanks for the kind words. It’s CE if you enrol in the course as I am an AGD approved CE provider. However I’m not sure that RUclips videos would count. Have to check with your licensing body. All the best!
@@OnlineExodontia I was kidding about the CE also, but if You Tube "counted", I would already have my plumbing and electrical license.
Its quite easy for those guys to make videos- not dealing with people and malpractice, so i really do appreciate you taking the time to make the video you did. Found it by accident while showing my son a video on pin amalgams (if you remember that far.back).
Thanks again.
@@Samlol23_drrich haha, I could have used you a few months ago to wire up my house. I know all about pins and occasionally still use them! All the best!
Thanks for the knowledge. Am Emma a dentist from Uganda. I’ve encountered a situation while extracting retrained roots of the lower left third molar. I removed the distal root first and the patient was basically okay no pain all good. But when I attempted to as well remove the mesial root the patient wailed in pain just shortly after removing the distal root. Infiltrated all around the root inclusive infra-pulpal but in vain. I had to discharge the patient with antibiotics and pain meds. Where could the problem have arisen? Thanks
Thanks for watching! Difficult to say, but perhaps the root was in proximity to the IAN and the elevation was applying some compression or pressure on the area that did not occur with the distal root? All the best!
There are patients who complain of pain even after they say they are anesthetize in the tongue cheek n lip .why is it so
Great question, I typically poke just anterior to the canine with an explorer to check the anesthesia. There should be no tingling sensation remaining. If these two things check out, then it's possible there is inflammation / infection present making things hypersensitive or at times affecting the efficacy of the anesthetic. Also occasionally you may have accessory innervation as there are many branches (minor ones) that come from the IAN. Lots branch off prior to entering the lingula. Two things to try...PDL injection at all 4 line angles, total of .2ml of solution. Make sure there is pressure on the plunger and you see tissue blanching. Other approach would be to do another block, but aim higher and slightly more posterior to try to get more of the accessory innervation.
Did my first LA first IAN on my peer yesterday. Didn't work. And the next time of LA will be on patients. However many times I watch videos, asked profs, touched the skulls, or used a Q-tip to simulate, I WON'T LEARN.. The only way I can learn is to do it again, and I don't want to do it on patients until I'm ready.
Visit my course at www.local-anesthetic.com and e-mail me from the contact page. I'll see what I can do to help you out! All the best!
You mentioned articaine for local infiltration. Do you recommend any other anesthetic besides lidocaine for the IAN block?
I use Articaine routinely for blocks as well. The only time I don't is for third molars as there is some discussion in the literature about Articaine leading to paresthesias or dysesthesias. This is actually true of Prilocaine as well. The thinking is the 4% solution may be toxic to the nerve tissue. I have never (to my knowledge) had this happen to a patient where I could say that the anesthetic lead to a sensory disturbance. However, since it's in the literature and there is an elevated risk of nerve injuries with the removal of wisdom teeth, I tend to block with Lidocaine 2% 1:100 epi. in these cases while using Articaine 4% 1:200 epi. on the upper.
To answer your question however, I block with Articaine, Lidocaine, Mepivicaine, Bupivicaine (not routinely, but occasionally again for third molars). I can't say that I have noticed a difference in the effectiveness of any of them. Hope that helps? All the best!
@@OnlineExodontiaI am suffering with this sensory disturbance. It has been 3 months now. Very slowly coming back... Very frustrating! I do not wish this upon anyone. I am worried and wondering how much longer before I do not feel this weirdness in my mouth. How long before I can get another anesthesia to treat another tooth....😢
@@Missolasa Sorry to hear this...it happens sometimes although it's not super common. In my experience with it, patients often feel like nothing is happening for quite some time, then all of the sudden they start to feel some different sensations and then very rapidly it recovers. Hopefully you make a full recovery! All the best!
@@OnlineExodontia thank you for your reply. I do hope so too. My tongue feels like a frozen sponge very slowly melting away. 😪
Related (or unrelated?) -- what's your opinion of Greater Auricular Nerve blocks for tinnitus? There's a video by Dr. Yiannios on this that resolved a patient's nerve issues for a short while. Is that something I as a patient could ask my dentist to do to test a theory?
Thanks for commenting Shahab and checking out the video. I unfortunately cannot comment on this as I do not have the necessary experience with this procedure. I'm aware of it, but have never employed it in my practice. Very few general dentists would know how to carry out that block. An oral surgeon would be more able to assist you here. I will have to check out Dr. Yiannios' video as you have caught my interest. All the best!
Is this what is referred to the Gow Gate block? I am doing research into what block procedure is likely the best for a bottom rear tooth that has been unable to be anesthetised and now looking like needing root canal treatment. Be nice to know if this is an alternative to Gow Gate or is actually is this procedure being shown. Thanks...
This is not the Gow Gates injection, it's just a discussion of the IAN block and ways to produce better success with it. PDL injections are a great way to supplement your anesthetic for posterior teeth and if done correctly, they rarely fail for those situations. All the best!
@@OnlineExodontia Thank you!
Plz tell where to hit the injection..directly on hitting bone or 1mm backward after feeling bone?
This will not matter, the key is to contact bone to know you're in the right area. All the best!
Hey, got a hole from a filling that fell out of my 2nd premolar, and I'm debating when I should visit a dentist to get the tooth removed.. my breath is becoming slightly effected rn, but there's no discolouration to the tooth, pain or even sensitivity. been draining the abscess from the spot on my gum for months, and then it just disappeared one day.. just noticed a small dark red patch forming on the inside section (other side) and I'm wondering what will happen if I leave it much longer.. there's absolutely no pain in the area, just afraid it might lead to some bad things.. what should I be doing to give myself some more time?
Dan, this is a situation that requires treatment. What is happening is the bone around the tooth is being eroded due to the immune process and the root is essentially surrounded by pus that your body has to fight constantly to keep from spreading. The red patch is likely to be another exit point for the abscess that has formed. The appropriate treatment is a root canal (if possible) or extraction of the tooth. Either one would clear the infection. I wish you the best and encourage you to see someone as soon as you are able. Take care.
@@OnlineExodontia Thank you, I've come to terms mentally with either of these things happening.. it's just weird that it's been 2 years since this started and I have no pain or discolouration.. also, the red patch disappeared.. o.o lol..
Hi. Thank you for this video. I always aspirate to check there is no blood. But despite that: I find quite a few of my patients feel dizziness or sudden heart palpitations after my block
Can you give me some tips?
One thing to note is the lumen size of the needle. If you use a larger gauge needle 25 or 27 you'll get more positive aspirations or I should say you'll 'detect' more. If you're using an auto-aspirating syringe, give it a few seconds after you let up on the pressure to allow the blood to flow through the needle. If you're not in a high-pressure vessel, sometimes you won't see it right away and even though you aspirate, it's possible you're starting injecting again before you see the blood. You can also switch to using a manual aspirating syringe which will give you even better control of aspiration. Finally, aspirate in multiple planes, meaning rotate the needle after you aspirate once, then do it again before injecting. My video on aspiration talks about this. All the best!
Thank you very much. I really appreciate your reply and guidance. Have a good day.
Thanks dr for your great video my question bucall infiltration anathesia by articaine effective for aprofound pulpal anathesia for mandibular premolar
It's best to use a mental block for a filling. You can however infiltration on the buccal and lingual to extract a premolar for orthodontic reasons for example. Articaine is best for this application. You won't get away with a buccal infiltration for a root canal treatment however. All the best!
@@OnlineExodontia thanks alot doctor
Great vid! Just a quick question regarding the injection site. If your patient is lacking the pterygomandibular raphe, what can be a trustworthy index to aim for to be sure you are on point for the lingula?
Regards, a 4th year dental student
Mathias - all patients have this landmark, but I'm assuming you mean there are times where it is obscured or difficult to locate. In those cases you can have them open wider and retract the cheek more to better define the area or choose a different approach. Most dentists only get taught one way to do an IAN block, however there are alternative approaches that use the anterior ramus and coronoid notch as your landmarks. You actually penetrate above the thumbnail with the barrel of the syringe on the ipsilateral side. It's a great way to get the buccal nerve and the lingual nerve/IAN with one needle penetration. You will see oral surgeons using this technique often. I have videos on it in the course and perhaps some time I will post it on here, but that's the gist of it. Here is a video from another provider demonstrating the technique:
www.matero.net/drsc/InferiorAlveolarInjectionTechnique.mp4
Thank you so much for your response and the extra material Dr.! Very helpful and insightful to se different techniques. At my Uni we only learned an indirect injection method, quite similar to this buccal injection. But i found it rather hard and quite often with no effect because we lack any contact to bone.
Regarding your IAN block technique, do you usually put your barrel on the opposite 2nd premolar or 1st molar? What is the best direction.
And as mentioned in the video, regarding penetrating the medial pterygoid muscle, is this harmful and schould be avoided?
@@FTWNorwayFTW Not harmful to penetrate the muscle, but there can be some resulting trismus after. I often bend the needle at the hub so that I do not have to swing the barrel so far back. They tell you to try to lay the barrel (without bending the needle) between the two premolars. Again though, I discuss this in my IAN block video...you aren't guaranteed to be on point just because the barrel is located there. You can still miss posterior or anterior to the target site.
@@OnlineExodontia Thank you Dr. Have a great day😊
So if we aren't over the premolars when injecting, where do we place the syringe?
The needle tip position is most important. There are ways to do the IAN block with the syringe on the ipsilateral side.
What are the signs that confirm the action of anesthesia?
Quite frankly you’d have to test the tooth you’re about to work on and see if you get any reaction to an EPT or Endo ice. Many will poke around the soft tissue, but it’s not actually a super good indicator. More often than not however, if the lip and chin are numb (fat feeling - devoid of any tingling) patients are usually good to go. Having said this though, it doesn’t guarantee pulpal anesthesia. Hopefully this helps! All the best!
Hi. Amazing video. I have extreme trouble with this in patients with very bulky cheeks and divergent mandibles. My needle does not ever hit the bone and keeps going posteriorly in such case. Its super frustrating
I have huge trouble in retracting the fatty tissues in these patients to even palpate the coronoid notch and I can't even see the raphe. It just makes me nervous every single time I have to do a block and I am a post grad student of endodontics. Its embarassing
Hamza - I hear you on those ones! Landmarks are much tougher. Have you ever tried doing the IAN block from the ipsilateral side? It is an approach that relies more on the anterior ramus and a certain depth of needle penetration. If you visit my site at www.onlineexodontia.com and message me I can help you out if interested. All the best!
😊
Please show us How to cap the needle
There is a video on that in the complete course Ra. Thanks for your kind comments regarding the channel. All the best.
I failed my competency test today because i failed to anesthetise the mental nerve branch of IAN. Really sad today😭
Interesting - don’t get too down. When that happens to you in the real world, you just do it again! Keep your head up!
All the best!
Can Septanest Articaine be used too?
It’s widely used in our practice and know it’s popular in other parts of Canada from those I’ve spoke to. There is literature suggesting 4% solutions like Articaine and even prilocaine can cause trouble when used for lower blocks, but in reality it seems the likelihood of this is very low.
@@OnlineExodontia thanks for your reply :)
I need to show this to a certain doctor
Lo quisiera en español
I don’t know how i ended up here.
Me either, but glad to have you! All the best my friend!
👌👍👍
Subtitles plz
Sometimes even after pricking 2 to 4 times. I don't achieve a bony contact. Wat should be done in such cases??
Dr. Rahman - that's difficult to say. The video covers what I would typically recommend, so the next best thing I could offer would be to seek out an anatomical mandible/skull to look at. Place it in a similar position to how you position your patient during the injection and then practice as if you are giving an injection. It really helps to see the bony anatomy right there in front of you. Hopefully that helps? The alternative would be to search for the 'anterior ramus technique' block. This is an alternate way of delivering an IAN block. All the best!
dude you should use infiltration xD .and Use classic Brown technique, and guarantee you will hit the bone from 1 st time everytime
@@Frostysummer1337 Thanks for commenting - do you have a resource that covers the classic Brown technique? This is new to me and I'd be interested to learn more! All the best to you.
@@OnlineExodontia Sorry for the late reply. The technique what u have showed is just awesome.it never fails.works 100%.Thanks for Ur video.A big salute to u sir!!!I You have excellent teaching skills😇👍
@@Frostysummer1337 Thanks dude for d advice.may I know the resource for dat technique??.and the technique shown in this video is also awesome.m excited as it worked for me😄but would like to learn more
Isn't this basically Gow-Gates?
Gow-Gates you’re aiming for the condyle as I imagine you know. In this video I’m not presenting a technique but rather concepts to improve the success rate. Thanks for watching! Do you prefer the Gow-Gates?
@@OnlineExodontia In the textbooks I read Gow-Gates is said to have a higher success rate, however at my dental school they prefer the Halstead-Brown technique.
who still does that kind of anaesthesia? This is near 2022....hello! wake up!
What a horrible angulation, Cant see a thing... What was that!!!!
Keep going to translate Arabic
I am actually in the process of translating my entire course into Arabic! Stay tuned!