Skip to main content
NCBI home page
Anesthesia Progress logoLink to Anesthesia Progress
. 2002 Spring;49(2):49–55.

Anesthetic efficacy of an infiltration in mandibular anterior teeth following an inferior alveolar nerve block.

Kenneth Clark 1, Al Reader 1, Mike Beck 1, William J Meyers 1
PMCID: PMC2007388  PMID: 15384292

Abstract

The purpose of this prospective, randomized, blinded study was to measure the degree of pulpal anesthesia obtained with an inferior alveolar nerve (IAN) block followed by an infiltration in mandibular anterior teeth. Through use of a repeated-measures design, 40 patients randomly received 3 injection combinations at 3 separate appointments: an IAN block followed by a mock lingual infiltration and a mock labial infiltration, an IAN block followed by a mock lingual infiltration and a labial infiltration, and an IAN block followed by a mock labial infiltration and a lingual infiltration. Each IAN block used 3.6 mL of 2% lidocaine with 1:100,000 epinephrine, and each infiltration used 1.8 mL of 2% lidocaine with 1:100,000 epinephrine administered over the lateral incisor apex. Mandibular anterior teeth were blindly pulp tested at 2-minute cycles for 60 minutes following the IAN-infiltration injections. No response from the patient to the maximum output (80 reading) of the pulp tester was used as the criterion for pulpal anesthesia. Anesthesia was considered successful when 2 consecutive 80 readings were obtained within 15 minutes and the 80 reading was sustained for 60 minutes. Anesthesia was considered a failure if 2 consecutive 80 readings were not obtained during the 60 minutes. The results of this study showed that 100% of the patients had lip numbness with all IAN blocks. For the lateral incisor, the success rate of the IAN block alone was 40% and the failure rate was 30%. For the IAN block plus labial infiltration, the success rate was 62% and the failure rate was 12% for the lateral incisor. There was a significant difference (P < .05) between the IAN block alone and the IAN block plus labial infiltration. In conclusion, a labial infiltration, over the lateral incisor apex, of 1.8 mL of 2% lidocaine with 1:100,000 epinephrine following an IAN block significantly improved pulpal anesthesia for the lateral incisor compared with the IAN block alone.

Full text

PDF
49

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BERNS J. M., SADOVE M. S. Mandibular block injection: a method of study using an injected radiopaque material. J Am Dent Assoc. 1962 Dec;65:735–745. doi: 10.14219/jada.archive.1962.0337. [DOI] [PubMed] [Google Scholar]
  2. Certosimo A. J., Archer R. D. A clinical evaluation of the electric pulp tester as an indicator of local anesthesia. Oper Dent. 1996 Jan-Feb;21(1):25–30. [PubMed] [Google Scholar]
  3. Chaney M. A., Kerby R., Reader A., Beck F. M., Meyers W. J., Weaver J. An evaluation of lidocaine hydrocarbonate compared with lidocaine hydrochloride for inferior alveolar nerve block. Anesth Prog. 1991 Nov-Dec;38(6):212–216. [PMC free article] [PubMed] [Google Scholar]
  4. Clark S., Reader A., Beck M., Meyers W. J. Anesthetic efficacy of the mylohyoid nerve block and combination inferior alveolar nerve block/mylohyoid nerve block. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999 May;87(5):557–563. doi: 10.1016/s1079-2104(99)70133-2. [DOI] [PubMed] [Google Scholar]
  5. Coggins R., Reader A., Nist R., Beck M., Meyers W. J. Anesthetic efficacy of the intraosseous injection in maxillary and mandibular teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996 Jun;81(6):634–641. doi: 10.1016/s1079-2104(96)80067-9. [DOI] [PubMed] [Google Scholar]
  6. Dagher F. B., Yared G. M., Machtou P. An evaluation of 2% lidocaine with different concentrations of epinephrine for inferior alveolar nerve block. J Endod. 1997 Mar;23(3):178–180. doi: 10.1016/S0099-2399(97)80271-3. [DOI] [PubMed] [Google Scholar]
  7. Donohue D., Garcia-Godoy F., King D. L., Barnwell G. M. Evaluation of mandibular infiltration versus block anesthesia in pediatric dentistry. ASDC J Dent Child. 1993 Mar-Apr;60(2):104–106. [PubMed] [Google Scholar]
  8. Dreven L. J., Reader A., Beck M., Meyers W. J., Weaver J. An evaluation of an electric pulp tester as a measure of analgesia in human vital teeth. J Endod. 1987 May;13(5):233–238. doi: 10.1016/s0099-2399(87)80097-3. [DOI] [PubMed] [Google Scholar]
  9. Fiset L., Getz T., Milgrom P., Weinstein P. Local anesthetic failure: diagnosis and management strategies. Gen Dent. 1989 Sep-Oct;37(5):414–417. [PubMed] [Google Scholar]
  10. Frommer J., Mele F. A., Monroe C. W. The possible role of the mylohyoid nerve in mandibular posterior tooth sensation. J Am Dent Assoc. 1972 Jul;85(1):113–117. doi: 10.14219/jada.archive.1972.0285. [DOI] [PubMed] [Google Scholar]
  11. Galbreath J. C. Tracing the course of the mandibular block injection. Oral Surg Oral Med Oral Pathol. 1970 Oct;30(4):571–582. doi: 10.1016/0030-4220(70)90176-3. [DOI] [PubMed] [Google Scholar]
  12. Haas D. A., Harper D. G., Saso M. A., Young E. R. Comparison of articaine and prilocaine anesthesia by infiltration in maxillary and mandibular arches. Anesth Prog. 1990 Sep-Oct;37(5):230–237. [PMC free article] [PubMed] [Google Scholar]
  13. Hannan L., Reader A., Nist R., Beck M., Meyers W. J. The use of ultrasound for guiding needle placement for inferior alveolar nerve blocks. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999 Jun;87(6):658–665. doi: 10.1016/s1079-2104(99)70156-3. [DOI] [PubMed] [Google Scholar]
  14. Hinkley S. A., Reader A., Beck M., Meyers W. J. An evaluation of 4% prilocaine with 1:200,000 epinephrine and 2% mepivacaine with 1:20,000 levonordefrin compared with 2% lidocaine with:100,000 epinephrine for inferior alveolar nerve block. Anesth Prog. 1991 May-Jun;38(3):84–89. [PMC free article] [PubMed] [Google Scholar]
  15. McLean C., Reader A., Beck M., Meryers W. J. An evaluation of 4% prilocaine and 3% mepivacaine compared with 2% lidocaine (1:100,000 epinephrine) for inferior alveolar nerve block. J Endod. 1993 Mar;19(3):146–150. doi: 10.1016/s0099-2399(06)80510-8. [DOI] [PubMed] [Google Scholar]
  16. Nist R. A., Reader A., Beck M., Meyers W. J. An evaluation of the incisive nerve block and combination inferior alveolar and incisive nerve blocks in mandibular anesthesia. J Endod. 1992 Sep;18(9):455–459. doi: 10.1016/S0099-2399(06)80849-6. [DOI] [PubMed] [Google Scholar]
  17. Oulis C. J., Vadiakas G. P., Vasilopoulou A. The effectiveness of mandibular infiltration compared to mandibular block anesthesia in treating primary molars in children. Pediatr Dent. 1996 Jul-Aug;18(4):301–305. [PubMed] [Google Scholar]
  18. Rood J. P. The analgesia and innervation of mandibular teeth. Br Dent J. 1976 Apr;140(7):237–239. doi: 10.1038/sj.bdj.4803742. [DOI] [PubMed] [Google Scholar]
  19. Sharaf A. A. Evaluation of mandibular infiltration versus block anesthesia in pediatric dentistry. ASDC J Dent Child. 1997 Jul-Aug;64(4):276–281. [PubMed] [Google Scholar]
  20. Vreeland D. L., Reader A., Beck M., Meyers W., Weaver J. An evaluation of volumes and concentrations of lidocaine in human inferior alveolar nerve block. J Endod. 1989 Jan;15(1):6–12. doi: 10.1016/S0099-2399(89)80091-3. [DOI] [PubMed] [Google Scholar]
  21. Wilson S., Johns P., Fuller P. M. The inferior alveolar and mylohyoid nerves: an anatomic study and relationship to local anesthesia of the anterior mandibular teeth. J Am Dent Assoc. 1984 Mar;108(3):350–352. doi: 10.14219/jada.archive.1984.0005. [DOI] [PubMed] [Google Scholar]
  22. Yonchak T., Reader A., Beck M., Clark K., Meyers W. J. Anesthetic efficacy of infiltrations in mandibular anterior teeth. Anesth Prog. 2001 Spring;48(2):55–60. [PMC free article] [PubMed] [Google Scholar]
  23. Yonchak T., Reader A., Beck M., Meyers W. J. Anesthetic efficacy of unilateral and bilateral inferior alveolar nerve blocks to determine cross innervation in anterior teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001 Aug;92(2):132–135. doi: 10.1067/moe.2001.115720. [DOI] [PubMed] [Google Scholar]

Articles from Anesthesia Progress are provided here courtesy of American Dental Society of Anesthesiology

RESOURCES