It is well established that achieving profound local, anesthesia with an inferior alveolar nerve (IAN) block for patients presenting with symptomatic irreversible pulpitis has its challenges. Therefore, supplemental injections are essential to providing pain-free endodontic treatment. Webster et al from The Ohio State University conducted a study to determine the anesthetic efficacy of the supplemental intraseptal technique in mandibular posterior teeth diagnosed with symptomatic irreversible pulpitis when the conventional IAN block failed (Table 1.).

The 100 participants recruited for this study were adult emergency patients with a diagnosis of symptomatic irreversible pulpitis in a mandibular posterior tooth. Each patient received a conventional IAN block. After lip numbness had been achieved, a separate buccal nerve block was administered for the molars.

For the intraseptal injection, a 25-G 1/2-inch Luer-Lok needle was inserted through the middle of the intradental papilla on the mesial aspect of the involved tooth until bone was contacted at a 30° angle approximate to the long axis of the tooth in a buccal–lingual plane; while being placed slowly with continuous pressure, the bevel of the needle faced inferiorly. About 0.7 mL of the anesthetic solution was deposited using the slow rate setting of the controlled local anesthetic delivery unit. After 10 seconds, the needle was removed from the injection site.

The intraseptal injection was then repeated on the distal aspect of the involved tooth with another 0.7 mL of the anesthetic solution. Success was measured as the ability to perform endodontic access and instrumentation with mild to no pain (Table 2). Supplemental intraseptal injections achieved profound pulpal anesthesia in 29% of patients when the IAN block failed.



This low level of success indicates unpredictable levels of anesthesia for patients requiring emergency endodontic treatment for symptomatic irreversible pulpitis in mandibular posterior teeth.

Webster S Jr, Drum M, Reader A, et al. How effective is supplemental intraseptal anesthesia in patients with symptomatic irreversible pulpitis? J Endod 2016;42: 1453-1457.