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Copyright (c) 2025 Ershad Hussein Ali Alnemi, Mohammed Ahmed Asiri, Mohammed Mashraqi, Abdulrahman Samir Khateiri, Ruwayda Hamed Yahya Sughayyir , Abdulaziz Abdullah Alahmari, Wahaj Awadh Matar Alsaadi, May Ayed Alanazi, Hanan Salah Almutairi, Abdallh Badr Obaid Almutiri, Ershad Hussein Ali Alnemi, Eid Mohammad Ahmed Hadi, Haifa Suliman Aljohani , Noor Naif Alaswad Alazmi
This work is licensed under a Creative Commons Attribution 4.0 International License.
Optimizing Inferior Alveolar Nerve Block: An Interdisciplinary Approach between Dentistry and Anesthesiology
Corresponding Author(s) : Ershad Hussein Ali Alnemi
Saudi Journal of Medicine and Public Health,
Vol. 2 No. 2 (2025)
Abstract
Background: The Inferior Alveolar Nerve Block (IANB) is a fundamental regional anesthesia technique in dentistry, essential for procedures on the mandibular teeth and soft tissues. Despite its widespread use, it has a reported failure rate of 15-20%, often due to anatomical complexity and technical inaccuracies in locating the mandibular foramen.
Aim: This article aims to synthesize the principles of IANB administration, advocating for an interdisciplinary approach between dentistry and anesthesiology to optimize its success, enhance patient safety, and manage complications effectively.
Methods: A comprehensive review of the IANB technique is presented, covering the relevant anatomy of the mandibular nerve and foramen, indications, contraindications, and necessary equipment. The analysis details the conventional injection technique, evidence-based modifications (e.g., Thangavelu, Gow-Gates), and the role of technology like Computer-Controlled Local Anesthetic Delivery (CCLAD) systems. Potential local, neurological, and systemic complications and their management are also examined.
Results: Mastery of the IANB requires a deep understanding of anatomical landmarks and their variations. Techniques guided by consistent bony landmarks, such as the internal oblique ridge, may improve success rates. Furthermore, a coordinated, interprofessional team approach—involving dentists, physicians, nurses, and pharmacists—is critical for pre-procedural risk assessment, safe administration, and managing emergencies like local anesthetic systemic toxicity (LAST).
Conclusion: The IANB remains a cornerstone of dental practice. Its optimization hinges on anatomical expertise, technical precision, and a collaborative healthcare model that prioritizes patient-specific care and safety.
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- Khalil H. A basic review on the inferior alveolar nerve block techniques. Anesth Essays Res. 2014 Jan-Apr;8(1):3-8.
- AlHindi M, Rashed B, AlOtaibi N. Failure rate of inferior alveolar nerve block among dental students and interns. Saudi Med J. 2016 Jan;37(1):84-9.
- Takasugi Y, Furuya H, Moriya K, Okamoto Y. Clinical evaluation of inferior alveolar nerve block by injection into the pterygomandibular space anterior to the mandibular foramen. Anesth Prog. 2000 Winter;47(4):125-9.
- Holliday R, Jackson I. Superior position of the mandibular foramen and the necessary alterations in the local anaesthetic technique: a case report. Br Dent J. 2011 Mar 12;210(5):207-11.
- Thangavelu K, Kannan R, Kumar NS, Rethish E, Sabitha S, Sayeeganesh N. Significance of localization of mandibular foramen in an inferior alveolar nerve block. J Nat Sci Biol Med. 2012 Jul;3(2):156-60.
- Ueno T, Tsuchiya H, Mizogami M, Takakura K. Local anesthetic failure associated with inflammation: verification of the acidosis mechanism and the hypothetic participation of inflammatory peroxynitrite. J Inflamm Res. 2008;1:41-8.
- Suazo Galdames IC, Cantín López MG, Zavando Matamala DA. Inferior alveolar nerve block anesthesia via the retromolar triangle, an alternative for patients with blood dyscrasias. Med Oral Patol Oral Cir Bucal. 2008 Jan 01;13(1):E43-7.
- Kim C, Hwang KG, Park CJ. Local anesthesia for mandibular third molar extraction. J Dent Anesth Pain Med. 2018 Oct;18(5):287-294.
- Boonsiriseth K, Sirintawat N, Arunakul K, Wongsirichat N. Comparative study of the novel and conventional injection approach for inferior alveolar nerve block. Int J Oral Maxillofac Surg. 2013 Jul;42(7):852-6.
- Thangavelu K, Kannan R, Kumar NS. Inferior alveolar nerve block: Alternative technique. Anesth Essays Res. 2012 Jan-Jun;6(1):53-7.
- Shirani M, Looha MA, Emami M. Comparison of injection pain levels using conventional and computer-controlled local anesthetic delivery systems in pediatric dentistry: A systematic review and meta-analysis. J Dent. 2025 Jun;157:105770.
- Flisfisch S, Woelber JP, Walther W. Patient evaluations after local anesthesia with a computer-assisted method and a conventional syringe before and after reflection time: A prospective randomized controlled trial. Heliyon. 2021 Feb;7(2):e06012.
- Araújo GM, Barbalho JC, Dias TG, Santos Tde S, Vasconcellos RJ, de Morais HH. Comparative Analysis Between Computed and Conventional Inferior Alveolar Nerve Block Techniques. J Craniofac Surg. 2015 Nov;26(8):e733-6.
- Helander EM, Kaye AJ, Eng MR, Emelife PI, Motejunas MW, Bonneval LA, Terracciano JA, Cornett EM, Kaye AD. Regional Nerve Blocks-Best Practice Strategies for Reduction in Complications and Comprehensive Review. Curr Pain Headache Rep. 2019 May 23;23(6):43.
- Tzermpos FH, Cocos A, Kleftogiannis M, Zarakas M, Iatrou I. Transient delayed facial nerve palsy after inferior alveolar nerve block anesthesia. Anesth Prog. 2012 Spring;59(1):22-7.
- Aquilanti L, Mascitti M, Togni L, Contaldo M, Rappelli G, Santarelli A. A Systematic Review on Nerve-Related Adverse Effects following Mandibular Nerve Block Anesthesia. Int J Environ Res Public Health. 2022 Jan 31;19(3)
- Silbert BI, Kolm S, Silbert PL. Postprocedural inflammatory inferior alveolar neuropathy: an important differential diagnosis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013 Jan;115(1):e1-3.
- Chevalier V, Arbab-Chirani R, Tea SH, Roux M. Facial palsy after inferior alveolar nerve block: case report and review of the literature. Int J Oral Maxillofac Surg. 2010 Nov;39(11):1139-42.
- Baart JA, van Diermen DE, van Eijden TM. [Transient paresis after mandibular block anaesthesia]. Ned Tijdschr Tandheelkd. 2006 Oct;113(10):418-20.
- Huang RY, Chen YJ, Fang WH, Mau LP, Shieh YS. Concomitant horner and harlequin syndromes after inferior alveolar nerve block anesthesia. J Endod. 2013 Dec;39(12):1654-7.
References
Khalil H. A basic review on the inferior alveolar nerve block techniques. Anesth Essays Res. 2014 Jan-Apr;8(1):3-8.
AlHindi M, Rashed B, AlOtaibi N. Failure rate of inferior alveolar nerve block among dental students and interns. Saudi Med J. 2016 Jan;37(1):84-9.
Takasugi Y, Furuya H, Moriya K, Okamoto Y. Clinical evaluation of inferior alveolar nerve block by injection into the pterygomandibular space anterior to the mandibular foramen. Anesth Prog. 2000 Winter;47(4):125-9.
Holliday R, Jackson I. Superior position of the mandibular foramen and the necessary alterations in the local anaesthetic technique: a case report. Br Dent J. 2011 Mar 12;210(5):207-11.
Thangavelu K, Kannan R, Kumar NS, Rethish E, Sabitha S, Sayeeganesh N. Significance of localization of mandibular foramen in an inferior alveolar nerve block. J Nat Sci Biol Med. 2012 Jul;3(2):156-60.
Ueno T, Tsuchiya H, Mizogami M, Takakura K. Local anesthetic failure associated with inflammation: verification of the acidosis mechanism and the hypothetic participation of inflammatory peroxynitrite. J Inflamm Res. 2008;1:41-8.
Suazo Galdames IC, Cantín López MG, Zavando Matamala DA. Inferior alveolar nerve block anesthesia via the retromolar triangle, an alternative for patients with blood dyscrasias. Med Oral Patol Oral Cir Bucal. 2008 Jan 01;13(1):E43-7.
Kim C, Hwang KG, Park CJ. Local anesthesia for mandibular third molar extraction. J Dent Anesth Pain Med. 2018 Oct;18(5):287-294.
Boonsiriseth K, Sirintawat N, Arunakul K, Wongsirichat N. Comparative study of the novel and conventional injection approach for inferior alveolar nerve block. Int J Oral Maxillofac Surg. 2013 Jul;42(7):852-6.
Thangavelu K, Kannan R, Kumar NS. Inferior alveolar nerve block: Alternative technique. Anesth Essays Res. 2012 Jan-Jun;6(1):53-7.
Shirani M, Looha MA, Emami M. Comparison of injection pain levels using conventional and computer-controlled local anesthetic delivery systems in pediatric dentistry: A systematic review and meta-analysis. J Dent. 2025 Jun;157:105770.
Flisfisch S, Woelber JP, Walther W. Patient evaluations after local anesthesia with a computer-assisted method and a conventional syringe before and after reflection time: A prospective randomized controlled trial. Heliyon. 2021 Feb;7(2):e06012.
Araújo GM, Barbalho JC, Dias TG, Santos Tde S, Vasconcellos RJ, de Morais HH. Comparative Analysis Between Computed and Conventional Inferior Alveolar Nerve Block Techniques. J Craniofac Surg. 2015 Nov;26(8):e733-6.
Helander EM, Kaye AJ, Eng MR, Emelife PI, Motejunas MW, Bonneval LA, Terracciano JA, Cornett EM, Kaye AD. Regional Nerve Blocks-Best Practice Strategies for Reduction in Complications and Comprehensive Review. Curr Pain Headache Rep. 2019 May 23;23(6):43.
Tzermpos FH, Cocos A, Kleftogiannis M, Zarakas M, Iatrou I. Transient delayed facial nerve palsy after inferior alveolar nerve block anesthesia. Anesth Prog. 2012 Spring;59(1):22-7.
Aquilanti L, Mascitti M, Togni L, Contaldo M, Rappelli G, Santarelli A. A Systematic Review on Nerve-Related Adverse Effects following Mandibular Nerve Block Anesthesia. Int J Environ Res Public Health. 2022 Jan 31;19(3)
Silbert BI, Kolm S, Silbert PL. Postprocedural inflammatory inferior alveolar neuropathy: an important differential diagnosis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013 Jan;115(1):e1-3.
Chevalier V, Arbab-Chirani R, Tea SH, Roux M. Facial palsy after inferior alveolar nerve block: case report and review of the literature. Int J Oral Maxillofac Surg. 2010 Nov;39(11):1139-42.
Baart JA, van Diermen DE, van Eijden TM. [Transient paresis after mandibular block anaesthesia]. Ned Tijdschr Tandheelkd. 2006 Oct;113(10):418-20.
Huang RY, Chen YJ, Fang WH, Mau LP, Shieh YS. Concomitant horner and harlequin syndromes after inferior alveolar nerve block anesthesia. J Endod. 2013 Dec;39(12):1654-7.