Suggestions

Fabio Gorni
Root canal procedures have the reputation of being painful; without effective pain control, an endodontic treatment cannot be performed in a calm, precise fashion. Achieving clinically acceptable anesthesia in the maxilla is rarely a problem, while anesthesia of mandibular teeth is more difficult to achieve on a consistently reliable basis. Patients who are experiencing pulpal pain, particularly in mandibular molars, have additional anesthetic problems. The inferior alveolar nerve block does not always provide profound pulpal anesthesia in mandibular molar with pulpitis, and supplemental local anaesthesia is often required. A “bull’s eye approach” is useful in difficult cases: inferior alveolar nerve - buccal / lingual - intraligamental - intraosseous - intrapulpal. Other problems arise with apprehensive patients, who report a history of previous difficulty with anesthesia; because of technical problems or individual factors, sometimes a larger dose of anesthetic is required. A “rule of the thumb” for remembering maximal dosages with currently formulated local anesthetic cartridges (Mepivacaine3%, Mepivacaine2% with ephinephrine 1:100.000, Articaine 4% with ephinephrine 1:100.000) is to use one cartridge of local anesthetic for every 12 kg of patient weight. Anyway, the inferior alveolar nerve block unfortunately has an high percentage of failures, even when properly administered. Mandibular teeth may receive innervation from more ......
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