Mandibular anesthesia for endodontic procedures : a comparison of the mandibular block combined with a lingual supplemental injection versus the periodontal ligament injection gun delivery system

Colored photographs included.Thesis (M.Sc.D.)--Boston University. Henry M. Goldman School of Graduate Dentistry, 1983 (Endodontics)Bibliography: leaves 59-63.Profound anesthesia is of paramount importance to the endodontist when treating vital cases. Many a clinician has experienced the frustration of attempting root canal therapy upon an inadequately-anesthetized “hot” mandibular tooth. Consequently, many different methods of anesthetizing lower teeth have been proposed, including; 1. Mandibular block with a lingual supplementary injection as described by Schilder[1] 2. Periodontal ligament injection devices[2,3,4] 3. Gow Gates[5-9] 4. Akinosi[10] 5. Intraosseous[11] 6. Interseptal[12] This project studied the efficacy of the first two methods in delivering mandibular anesthesia for endodontic purposes. Its main objective was to answer the question of whether an instrument such as the Ligmaject[tm] is a beneficial addition to the endodontic armamentarium. Questionaires were completed by graduate endodontic students at B.U.S.G.D. 50 teeth were anesthetized using a mandibular block and lingual supplemental injection. 63 teeth were anesthetized using the Ligmaject[tm]. Results demonstrated that the Ligmaject[tm]; 1. Yielded faster onset of anesthesia. 2. Provided shorter duration of anesthesia (30 min. to one hour) than the mandibular block (2-4 hours). 3. Was generally more comfortable for patients than the mandibular block. However, the PDL-injection was extremely painful for some patients. 4. Was less reliable than the mandibular block and lingual supplemental in rendering vital mandibular teeth totally numb. A large number Of PDL-injected teeth needed mandibular blocks in order to obtain access for the intrapulpal injections. This required additional manipulations of the patients. 5. Should not be used on undebrided areas or teeth with suppurative periodontal 1esions. 6. Has the potential for initiating periodontal damage even on healthy periodontiums as demonstrated by a case report documented with preoperative and postoperative radiographs and photos. Preservation of the attachment apparatus is a critical element of any dental discipline. Despite its advantage of shorter anesthetic duration, the use of the Ligmaject[tm] does not seem consistent with this philosophy