Summary

One of the most important skills for dental practitioners to attain is the ability to provide safe
and effective local anesthesia. However, failure in local anesthesia in dentistry is not uncommon.
In endodontics, achieving adequate anesthesia in cases associated with acute painful pulpitis is
considered a major clinical challenge. Successful Inferior Alveolar Nerve Block (IANB) numbs
the soft tissues around the tooth to be treated, but it does not always anaesthetize the inflamed pulp
Lack of success in obtaining complete anesthesia can be due to patient-related factors or operatorrelated factors. The patient related factors can be further categorized into anatomical, pathological
or psychological factors. Management of local anesthetic failure can be through repeating the
primary injection in case of absence of positive signs of success. However, in presence of positive
signs of successful primary injection, supplemental injections should be considered. There are
several supplemental injection techniques available to help achieving proper anesthetic effect.