Incisive Nerve Block Technique
What it numbs:
The incisive nerve block provides pulpal and facial anesthetic to the teeth anterior to the mental foramen the incisors, canines, first premolars and most of the time second premolars. Lower lip and skin on the chin are also anesthetized. However, the incisive nerve block does not provide lingual anesthesia.
The incisive nerve block is a valuable alternative to the inferior alveolar nerve block when treatment is limited to these areas.
A 25-gauge short needle is recommended although a 27-guage short is more commonly used and is perfectly acceptable.
Patient position is supine or semi-supine with mouth partially open.
For the right incisive nerve block and right handed operator, sit at an 8 or o'clock position directly facing the patient.
For the left incisive nerve block and right handed operator, sit at an 10 or o'clock position directly facing the patient.
The landmarks are the mandibular premolars, mucobuccal fold, and the mental foramen.
The target area and injection site is located at the mucobuccal fold just anterior to the mental foramen where the mental nerve enter to join the incisive nerve. Radiographs will easily help locate the mental foramen.
Dry the tissue and apply topical with a q-tip for one minute.
Move your index finger or a cotton tip along the fold until you feel a depression created by the mental foramen.
The bevel of the needle should be toward the bone and inserted at a depth of 5-6 mm with the buccal soft tissue lateral and taut have the patient close slightly. There is no need for the needle to enter the mental foramen. The syringe should be parallel to the long axis of the tooth.
Aspirate, if negative slowly inject 1/3 of the carpule over 20 seconds.
Maintain gentle finger pressure over the site to increase the volume of solution entering the foramen the tissue will balloon slightly. Apply pressure for 1-2 minutes.
Wait about three minutes before starting treatment.
If isolated areas of the lingual tissue require anesthetic, local infiltration can be accomplished by inserting the short needle though the interdental papilla on both the mesial and distal of the tooth being treated. This will provide adequate anesthetic for scaling, root planning and curettage with out the patient having to experience anesthesia of the tongue.
Document in patient record, what injection you gave, who gave it, what kind of anesthetic, how much anesthetic, negative aspiration, no complications, ect.
For more information and references:
Handbook of Local Anesthesia by Malamed