Local anesthesia in endodontics
Paul A. Rosenberg
Received: 13 March 2017 / Accepted: 16 March 2017
Ó Springer International Publishing AG 2017
Abstract Complete pulpal anesthesia is critical during endodontic treatment. The
clinical goal is for patients to have a pain-free endodontic experience. Despite
clinical signs indicating complete local anesthesia, patients may still experience
pain. This clinical challenge often requires the use of supplemental injections. This
review describes the indications, limitations, and advantages of each type of sup-
plemental injection, thus serving as a useful clinician’s guide to management of the
patient with incomplete anesthesia.
Keywords Profound local anesthesia Á Supplemental injection Á Duration
Profound local anesthesia is required to prevent pain during endodontic treatment of teeth
with vital pulps. It is especially challenging to anesthetize mandibular posterior teeth with
a history of pain and a diagnosis of irreversible pulpitis . Incomplete anesthesia results
in pain and increases the patient’s anxiety, with a concomitant drop in their pain threshold.
Procedures should be initiated only after profound anesthesia is achieved.
A variety of supplemental injections are available for use by the clinician. The
clinical situation and the clinician’s experience dictate the selection of the
supplemental injection. Supplemental injections are most often required during the
& Paul A. Rosenberg
New York University, New York, NY, USA
Clin Dent Rev (2017) 1:2