Clinical Evaluation of Periodontal Ligament Anesthesia using a Pressure Syringe

A Prospective Randomized Trial of Different Supplementary Local Anesthetic Techniques after Failure of Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis in Mandibular Teeth

“…After a second intraligamentary injection, success rose to 92%. Smith et al (12) noted similar success (93%) for intraligamentary injections in patients in whom conventional (6) reported that there was no significant difference between IANB alone (63%) and IANB plus intraligamentary injection (78%) with 2% lidocaine with 1:100,000 epinephrine in mandibular first molars. Nusstein et al (7) noted that 56% of mandibular teeth with irreversible pulpitis that had failed anesthesia after IANB became anesthetized when 1.4 mL of 2% lidocaine with 1:100,000 epinephrine was administered as an intraligamentary injection by using a computerized delivery system.…”

Articaine for Supplemental Buccal Mandibular Infiltration Anesthesia in Patients with Irreversible Pulpitis When the Inferior Alveolar Nerve Block Fails

“…Reinjection, if the first intraligamentary injection failed, was shown to be successful in 71% of the patients for an overall success rate of 92%. Smith et al (21) reported an 83% success rate for the supplemental intraligamentary injection in endodontic patients. Reinjection was required in 33% of the patients to achieve the 83% success rate.…”

How to overcome failed local anaesthesia

“…It has limitations as a principal method of anaesthesia (such as variable duration) but has been used to overcome failed conventional methods. 9,10 The technique is equally effective with conventional or specialised syringes. Glass cartridges are used in this method as the plastic type deform under the pressures produced.…”

“…A 12 mm 30 gauge is recommended although efficacy is independent of needle diameter. 9,10 Ideally the bevel should face the bone although effectiveness is not impaired with different orientations. 12 The needle does not penetrate deeply into the periodontal ligament but is wedged at the crest of the alveolar ridge.…”