Gerald S. Fine, D.D.S.
Oral and Maxillofacial Surgery
Several weeks ago a patient was referred to my office by his general dentist to establish regional block anesthesia to the mandible so that restorative treatment might proceed. The dentist was exceptionally talented, knowledgeable, and has enjoyed many years of successful quality practice. He told me that within his practice, this was the only patient who could not achieve full and total anesthesia in the mandibular region despite many attempts over the years. The dentist was somewhat surprised to be informed that his difficulty with regional anesthesia was not at all that uncommon. In every practice there are those new patients whom one finds almost impossible to render adequately anesthetized. I am called upon fairly often to administer regional anesthesia to the mandible for these patients.
Although my first course of action is to simply repeat the inferior alveolar injection, taking care to relocate my injection path a little higher than my initial injection if profound anesthesia is unsuccessful. I have on occasion needed to utilize alternative anesthetic methods.
Regional nerve block injections have been the standard approach to mandibular anesthesia for many years. However, many complications are associated with this approach. To avoid these problems, alternative anesthetic methods have been proposed. A new variation of interosseous anesthesia is known as crestal anesthesia technique (CAT). Use of this technique provides rapid site-specific, and minimal invasive anesthesia.
An interdental gingival papilla is chosen adjacent to the tooth or area to be anesthetized. The papilla is entered with a dental needle until periosteum is penetrated through to alveolar bone. The injection pools in a superiosteal area during injection then penetrates through nutrient canal foramina of the alveolar bone. Generally, only one papilla has to be injected, although others located near the treatment site may also be injected to ensure adequate results. Approximately 0.2 cc of anesthetic per papilla is generally sufficient. The CAT may prove to be more effective and comfortable for patients and may be a useful alternative to regional anesthetic in many instances.
Gerald S. Fine, D.D.S.
Practice limited to oral & maxillofacial surgery