Another common clinical mistake that may be made when trying to achieve profound pulpal anesthesia is only giving an infiltration around the treatment tooth. This may be effective for treating a small cavity, but not for endodontic treatment. The dentist should first administer a regional block for local anesthesia. The inferior alveolar nerve block (IANB) is a regional block for the mandibular region; for maxillary teeth, a superior alveolar nerve block (SANB) is used. If profound anesthesia cannot be achieved with a regional block alone (as determined from objective testing), supplemental anesthesia should be administered. Examples of supplemental local anesthesia injections are long buccal nerve blocks (mandibular molars), periodontal ligament, intraosseous, and intrapulpal. If supplemental anesthesia is administered before a regional block, it will either be short-acting or not effective enough to provide pulpal anesthesia. In addition, re-injection of local anesthesia in the same regional or supplemental site has shown an increased success rate in achieving pulpal anesthesia.13
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