In this video Dr. Stephen Buchanan offers advice to achieve profound anesthesia during endodontic treatment.

According to Stephen, block anesthesia knocks out approximately 80% of sensory innervation to a mandibular molar and infiltration is needed to anesthetize the remaining accessory innervations. Dr. Buchanan prefers the Gow Gates Block as opposed to the traditional inferior alveolar nerve block.

Lidocaine is still preferred for block anesthesia as it is affordable and long lasting; however a lidocaine inferior alveolar nerve block is typical not enough to provide profound anesthesia to mandibular molars requiring endodontic therapy. Here, Dr. Buchanan recommends administering 4% Articaine via buccal infiltration.

For teeth not completely anesthetized by a successful nerve block and infiltration, interosseous anesthesia is indicated. 3 systems are referenced in the video:

• Stabident
• X-Tip
• Anesto

For maxillary molars, Dr. Buchanan recommends palatal and buccal infiltration. Prior to painful palatal injections, apply firm pressure for 20 seconds with an ice stick as gel topical is not effective. After 20 seconds of ice application, continue to apply pressure with the ice stick and slowly inject approximately 0.5 carpules of lidocaine, followed by about 1.5 carpules of lidocaine via buccal infiltration.