PDF: SUPPLEMENTAL INJECTIONS IN DENTISTRY - Intraligamental, Intraosseous and intrapulpal injections

Failure in local anaesthesia in dentistry is not uncommon with failure rates ranging approximately between 15% and 30%, especially for the inferior alveolar nerve block (IANB).

Occasionally traditional techniques of anaesthesia like infiltration and regional block injections may not provide successful anaesthesia especially in endodontics for the so-called inflamed pulp (hot tooth) or irreversible pulpitis.

When inferior alveolar nerve block alone was used only 14-39% success rate was obtained but when supplemental injections were included, success was significantly increased to 50-65% for irreversible pulpitis. 

The term intra-ligamentary or periodontal ligament anaesthesia may be misleading as the anaesthetic injected into the periodontal ligament provides pulpal anaesthesia by penetrating the cancellous bone through natural perforations.

Intra-osseous injection consists of introducing the local anaesthetic directly into periradicular cancellous bone via specialized systems like Stabident (Fairfax Dental, USA) and X-Tip (X-Tip Technologies, USA).

In approximately 5-10% of mandibular posterior teeth with irreversible pulpitis, supplemental injections, even when repeated, do not produce profound anaesthesia; pain persists when the pulp is entered. 

This is an indication for an intrapulpal injection. 

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