In: Anesthesia25 Nov 2009
The inferior alveolar nerve (IAN) block is the most frequently used mandibular injection technique for achieving local anesthesia for restorative and surgical procedures. However, the IAN block does not always result in successful pulpal anesthesia. Failure rates in anterior teeth have ranged from 10%-90%.
For IAN blocks, the theory of cross-innervation has been cited as the reason why achieving pulpal anesthesia in mandibular anterior teeth is so difficult. By administering bilateral IAN blocks, Rood demonstrated that the nerve supply to the pulps of the central incisors were bilaterally innervated. Yonchak et al also administered bilateral IAN blocks and found that cross-inner-vation seems to occur in mandibular central and lateral incisors. However, the success rate (no response to pulp testing) in the lateral and central incisors with bilateral IAN blocks was below 75%. The authors believed that failure of the IAN block to anesthetize the anterior teeth was the overriding reason for failure.
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Although mandibular infiltration anesthesia has been shown to be somewhat successful in children, Haas et al demonstrated success rates (no response to pulp testing) of only 50% and 65% for infiltrations of prilo-caine and articaine in mandibular canines of adults. Yon-chak et al studied labial and lingual infiltrations in mandibular anterior teeth. They found that success rates (no response to pulp testing) for the lateral incisor ranged from 43%-50%. Yonchak et al concluded that the low success rates and declining duration of pulpal anesthesia throughout 60 minutes indicated that a labial infiltration of either 1.8 mL of 2% lidocaine with 1:100,000 epinephrine or 2% lidocaine with 1:50,000 epinephrine or the lingual infiltration of 1.8 mL of 2% lidocaine with 1:100,000 epinephrine over the lateral incisor apex cannot be recommended clinically to provide profound pulpal anesthesia.
Rood found that a labial infiltration of 1 mL of 2% lignocaine with 1:80,000 epinephrine in combination with an IAN block resulted in complete anesthesia (no response to pulp testing) of the mandibular central incisor. Therefore, the addition of an infiltration to the IAN block may increase success. However, further research in this area is warranted because of the small number of patients enrolled in the study by Rood.
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The purpose of this prospective, randomized, blinded study was to measure the degree of pulpal anesthesia obtained with an IAN block followed by an infiltration in mandibular anterior teeth.
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