Mandibular Infiltration Research Articles

A comparison between articaine mandibular infiltration and lidocaine mandibular block anesthesia in second primary molar: A randomized clinical trial

One of the most important objectives of pediatric dentistry during dental practice is pain control and effective anesthesia. Because of the limitations of inferior alveolar nerve block (IANB), other techniques such as infiltration injection are suggested. Infiltration technique by using some other solutions such as articaine is an appropriate alteration for mandibular anesthesia. The aim of this study is to compare the efficacy of IANB using lidocaine with infiltration injection by articaine in mandibular second primary molar anesthesia in 8-11-year-old children.This is a randomized, cross-over, clinical trial that was performed on 42 children aged 8-11 years, who needed extraction of both mandibular second primary molars. After clinical and radiographic investigations, block or infiltration injection was chosen randomly and treatment was performed in one side in each session. Patient's behavior was registered in two steps of injection and extraction by SEM scores. For comparison of the two sides, Wilcoxon-signed rank test was used (P < 0.05).We concluded that infiltration technique resulted in decrease of all the three SEM scores in comparison to block injection (P < 0.05). The effectiveness of two techniques during tooth extraction, although grade of lidocaine block was more than infiltrate, was not statistically significant.It seems that infiltration technique with articaine is a better substitute for block technique in the extraction of mandibular primary molars.

Functional and aesthetic outcome with free fibula osteocutaneous flap in reconstruction of anterior mandibular defects in oral malignancies: our experience

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; For anterior mandibular defects, vascularized bone flap reconstructions are the best for providing a solid arch necessary to restore form and function, especially in patients receiving tumour excision surgery in head and neck region. Our aim was to study aesthetic and functional outcome of free fibula osteocutaneous flap (FFOCF) in anterior mandibular defects in case of anterior floor of the mouth malignancies with mandibular infiltration.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The clinical data of 15 oral cavity carcinoma patients with involvement of anterior floor of mouth with mandiblular infiltration that underwent FFOCF reconstruction at our institute, government medical college, Jammu, was prospectively collected from January 2018 till January 2020. In this study, the aesthetic and functional outcome of these patients was evaluated at 6 months and 1 year post surgery.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The aesthetic result of reconstruction was excellent in most patients. Also, there was no long-term donor-site morbidity. There was no peri-operative death. Flaps survived in all patients. Functional outcomes including the ability to tolerate oral diet and speech outcome were good in all cases.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The FFOCF, in reconstruction surgery of advanced oral cavity carcinoma permits more radical resection of tumour with good functional as well aesthetic outcome.&lt;/p&gt;

Anesthetic efficacy in vital asymptomatic teeth using different local anesthetics: a systematic review with network meta-analysis.

ObjectivesThis study aimed to evaluate the efficacy of various local anesthesia (LA) in vital asymptomatic teeth.Materials and MethodsRandomized controlled trials comparing pulpal anesthesia of various LA on vital asymptomatic teeth were included in this review. Searches were conducted in the Cochrane CENTRAL, MEDLINE (via PubMed), EMBASE, ClinicalTrials.gov, Google Scholar and 3 field-specific journals from inception to May 3, 2019. Study selection, data extraction, and risk of bias assessment using Cochrane Risk of Bias Tool were done by 2 independent reviewers in duplicate. Network meta-analysis (NMA) was performed within the frequentist setting using STATA 15.0. The LA was ranked, and the surface under the cumulative ranking (SUCRA) line was plotted. The confidence of the NMA estimates was assessed using the CINeMA web application.ResultsThe literature search yielded 1,678 potentially eligible reports, but only 42 were included in this review. For maxillary buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than lidocaine 2% with epinephrine 1:100,000 (odds ratio, 2.11; 95% confidence interval, 1.14–3.89). For mandibular buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than various lidocaine solutions. The SUCRA ranking was highest for articaine 4% with epinephrine when used as maxillary and mandibular buccal infiltrations, and lidocaine 2% with epinephrine 1:80,000 when used as inferior alveolar nerve block. Inconsistency and imprecision were detected in some of the NMA estimates.ConclusionsArticaine 4% with epinephrine is superior when maxillary or mandibular infiltration is required in vital asymptomatic teeth.

Pulpal anesthesia in pediatric patients following supplemental mandibular buccal infiltration in vital permanent mandibular molars with deep caries.

Inferior alveolar nerve block (IANB) does not always provide adequate pulpal anesthesia, and supplemental techniques have been investigated in adults. This study aimed to pre- and intraoperatively evaluate the success of pulpal anesthesia following supplemental mandibular buccal infiltration (SMBI) after failure of IANB in permanent mandibular molars with deep caries of pediatric patients. Following IANB, preoperative pulpal anesthesia was assessed using the cold test, and success was defined when there was a negative response. In cases with failed IANB, SMBI was administered, and pulpal anesthesia was re-evaluated. A maximum of three SMBIs was allowed. After achieving successful preoperative pulpal anesthesia, treatment was then initiated. Intraoperatively, success of pulpal anesthesia was determined when the Wong-Baker FACES Pain Rating Scale reported by the patients was ≤ four. Sixty molars of patients aged 9.6 ± 2.3years were included in the study. The success of preoperative pulpal anesthesia following IANB was 33.3%. The overall cumulative preoperative pulpal anesthesia after three SMBIs was 95%. However, the success of intraoperative pulpal anesthesia was only 66.7%. SMBI greatly improved the success of preoperative pulpal anesthesia after failure of IANB. However, the success of preoperative pulpal anesthesia, confirmed by the cold test, does not always guarantee intraoperative pulpal anesthesia, especially in teeth with irreversible pulpitis. IANB produced low pulpal anesthesia in vital permanent mandibular molars with deep caries of pediatric patients. Clinicians should always prepare for supplemental injection both pre- and intra-operatively.

Efficacy of articaine vs lignocaine in maxillary and mandibular infiltration and block anesthesia in the dental treatments of adults: A systematic review and meta-analysis.

The aim of the present systematic review and meta-analysis was to address the following Population, Intervention, Comparison, and Outcome question: Is the efficacy of articaine better than lignocaine in adults requiring dental treatment? Four percent articaine was compared with 2% lignocaine for maxillary and mandibular infiltrations and block anesthesia, and with the principal outcome measures of anesthetic success. Using RevMan software, the weighted anesthesia success rates and 95% confidence intervals (CIs) were estimated and compared using a random-effects model. For combined studies, articaine was more likely to achieve successful anesthesia than lignocaine (N=18, odds ratio [OR]: 1.92, 95% CI: 1.45-2.56, P<0.00001, I2 =32%). Maxillary and mandibular infiltration studies showed obvious superiority of articaine to lignocaine (N=8, OR: 2.50, 95% CI: 1.51-4.15, P=0.0004, I2 =41%). Maxillary infiltration subgroup analysis showed no significant difference between articaine and lignocaine (N=5, OR: 1.69, 95% CI: 0.88-3.23, P=0.11, I2 =19%). For combined mandibular anesthesia studies, articaine was superior to lignocaine (N=14, OR: 1.99, 95% CI: 1.45-2.72, P<0.0001, I2 =32%), with further subgroup analysis showing significant differences in both mandibular block anesthesia (N=11, OR: 1.55, 95% CI: 1.19-2.03, P=0.001), I2 =0%) and mandibular infiltration (N=3, OR: 3.87, 95% CI: 2.62-5.72, P<0.00001, I2 =0%), indicating that articaine is more effective than lignocaine in providing anesthetic success in routine dental procedures.

The importance of lymph node ratio for patients with mandibular infiltration of oral squamous cell carcinoma

PurposeLymph node ratio (LNR) essentially improves assessment of prognosis and therapeutic decision making for patients with oral squamous cell carcinoma, as it considers both the number of positive lymph nodes and the number of dissected lymph nodes. Mandibular infiltration by oral squamous cell carcinoma is a vital clinicopathological feature, significantly worsens prognosis. However, to the best of our knowledge, data on the influence of LNR on prognosis for patients with OSCC and mandibular infiltration are not available. Materials and methodsA retrospective chart review of 89 patients with treatment-naive oral squamous cell carcinoma and histopathologically proven mandibular infiltration (pT4a) was performed. Exclusion criteria were primarily curative intended surgery (radical tumor resection, neck dissection and segmental mandibulectomy) with negative resection margins. Exclusion criteria were neoadjuvant chemoradiotherapy, erosive infiltration of the mandible, T4b classification, perioperative death, unresectable disease, synchronous malignancy, follow-up <3 months, and inadequate information to correctly determine clinicopathological characteristics. ResultsWe observed a significant correlation on univariate analysis between locoregional recurrence and pathologic N classification (p = 0.004), perineural invasion (p = 0.005) and lymph node ratio (p < 0.001). On multivariate analysis, lymph node ratio (p = 0.028) was shown to be an independent indicator for locoregional recurrence. ConclusionLNR predicted locoregional recurrence better than the conventional nodal staging system and therefore might serve as a more precise risk stratification tool. LNR >7% led to a 11.419-fold higher risk for locoregional recurrence of patients with mandibular infiltration due to OSCC.

Assessment of anesthetic efficacy of 4%articaine and 2%Lidocaine during implant pilot hole preparation in the mandibular posterior region infiltration

Aim.The aim of this study was to evaluate and compare the anesthetic efficacy of 4%articaine and 2% lidocaine (both with 1:100,000 epinepherine) for buccal andlingual infiltration in patients need implant placement.Materials and methods.Forty patients have edentulus regions posterier to mentalforamen were divided into 4 study groups and received buccal and lingualinfiltration of either 4% articaine or 2% lidocaine. Surgical procedure was begun5 minutes after solution deposition. Success was defined as no or milddiscomfort (VAS recordings) during during pilot hole drill.Results.The success rate for mandibular infiltration to produce anesthesia usingarticaine was 100% in premolar and molar area for the articaine solution andsuccess rate was 80% in preamolar and 30% in molar area. There was highsignificant difference between the articaine and lidocaine solutions (ANOVA P&lt; 0.001).Conclusion. The efficacy of 4% articaine was superior to 2% lidocaine formandibular posterior regoin.

A randomized controlled trial comparing nerve block and mandibular infiltration techniques in posterior mandible implant surgeries.

BackgroundTo compare global surgical pain under nerve block and mandibular infiltration anesthesia techniques, and to evaluate pain during drilling and the distance to the mandibular canal in posterior mandible implant surgeries.Material and MethodsA prospective, randomized, controlled, double-blind, clinical trial was conducted to compare nerve block (Group A) to mandibular infiltration (Group B) techniques for dental implant placement. Global surgical pain (VAS = visual analogue scale), pain during drilling or implant placement (MPQ = McGill pain questionnaire) and distance to the mandibular canal (Image J) were statically analyzed. Age, gender, anxiety levels, tooth to be replaced, implant size, adjacent teeth and duration of surgery were also analyzed.Results172 patients were included and 283 dental implants were analyzed. VAS values were significantly higher in Group B (p<0.05). In Group A, 99% of the surgeries were performed painlessly during drilling and implant placement, but in Group B, 11.6% of implant placements (17 implants) felt pain during these surgical steps. Mean distance to mandibular canal (3.8 mm, range: 0.0 to 7.0) in those 17 implants placed under mandibular infiltration was clinically and statistically similar to the mean distance (3.0 mm, range: 0.0 to 9.0) of 130 implants placed painless (p=0.10). Pain during drilling under mandibular infiltration was significantly associated with the duration of surgery (p<0.05) and to both adjacent teeth being present (p<0.05).ConclusionsAlthough both techniques are safe and effective for placing implants in the posterior mandible, nerve block provides a more profound analgesia than mandibular infiltration. When placing implants under mandibular infiltration, as getting closer to the canal does not increase the feeling of pain, it is not recommended to use the presence of pain as a preventive resource to avoid inferior alveolar nerve injuries. Key words:Dental implant, mandibular infiltration anesthesia, nerve block, pain, nerve injury.

Diagnostic accuracy of multi-detector row computed tomography and magnetic resonance imaging in assessment of mandibular involvement, cervical lymph node metastases and T parameter staging of squamous cell carcinomas of tongue and floor of mouth

Background: Tongue and floor malignancies can be diagnosed based on biopsy and clinical examination, but diagnostic imaging is essential to confirm and define the size and extent of the disease.Objectives: The aim of this study was to recognise and understand the extent and precision of the diagnostic accuracy of multi-detector row computed tomography (MDCT) and magnetic resonance imaging (MRI) in mandibular tumour involvement, cervical lymph node metastases, T staging of tongue and floor of mouth malignancies in order to represent the proper treatment plan.Methods: Fifty patients with histologically proven squamous cell carcinomas (SCC) of tongue and floor of mouth malignancies underwent both multi-detector row computed tomography and magnetic resonance imaging before surgery. Two radiologists independently, unaware of the findings, in consensus reviewed and interpreted all images to determine the extent of the primary tumour (T), mandibular tumour invasion and cervical lymph node metastasis. Imaging results obtained were correlated with postoperative histopathologic findings that represented our referencestandard. Cohen’s kappa index and McNemar test were used to verify the concordance between the two radiologists and above mentioned three study parameters.Results: Magnetic resonance imaging showed superiority to multi-detector row computed tomography in the evaluation of the T parameter staging of TNM classifi cation and medullary bone involvement while multi-detector row computed tomography was more accurate compared to magnetic resonance imaging in the visualization of small cortical bone erosions. However, both the modalities demonstrated similar diagnostic performance in detection of metastatic lymph nodes.Conclusion: Multi-detector row computed tomography and magnetic resonance imaging have nearly equal potential for detecting the tumour size, mandibular infiltration and nodal metastases.Journal of Kathmandu Medical College, Vol. 5, No. 4, Issue 18, Oct.-Dec., 2016, page:104-111

The effect of preoperative submucosal administration of tramadol on the success rate of inferior alveolar nerve block on mandibular molars with symptomatic irreversible pulpitis: a randomized, double-blind placebo-controlled clinical trial.

This randomized, double-blind, placebo-controlled, clinical trial was designed to improve the success of inferior alveolar nerve blocks (IANB) in mandibular molars with symptomatic irreversible pulpitis (SIP) by means of preoperative submucosal administration of 50mg tramadol. Forty-two patients with a mandibular molar diagnosed with SIP took part in the trial. Patients were assigned randomly to one of two groups: tramadol group (n=21), who received 50mg tramadol in 1mL by mandibular infiltration, and a placebo group (n=21), who received 1mL of normal saline administered to the affected tooth by the same means. Ten minutes later, all patients received an IANB with 4% articaine with epinephrine 1:100 000. A 10-min waiting time was established after local anaesthetic (LA) administration before carrying out three consecutive tests to assess anaesthesia of the pulp, that is two consecutive negative responses to an electric pulp test, positive or negative response to a cold test and no pain during access cavity preparation. IANB was considered successful only if the patient did not experience pain arising from these tests. Data were analysed by the Chi-squared frequency test and the Fisher's exact test, for qualitative variables, Mann-Whitney U-test for independent samples and two-way anova for more than two independent samples. In the tramadol group IANB was achieved successfully in 57% of the sample, whilst the placebo group obtained 29%. The difference between groups was not significant (P=0.06). When performing endodontic access, the anaesthetic success rate was significantly in favour of tramadol (P=0.03). Preoperative submucosal administration of 50mg tramadol in mandibular molars with SIP significantly improved the success of IANB using 4% articaine with 1:100000 epinephrine during access cavity preparation in comparison with a placebo.

Efficacy of Articaine in the Mandibular Infiltration Technique: A Systematic Review

Efficacy of Articaine in the Mandibular Infiltration Technique: A Systematic Review

Comparison of a New Auto-controlled Injection System with Traditional Syringe for Mandibular Infiltrations in Children: A Randomized Clinical Trial.

Background:Pain in the dental operatory can have a profound effect on the behavior of children.Aim:The aim of this study is to evaluate the pain perception while administering local infiltration, in children undergoing dental extractions, using a new auto-controlled injection system.Materials and Methods:Children in the age range of 6–10 years with teeth indicated for extraction were recruited and allocated to either Group I, computer-controlled injection system (auto system with special cartridge and compatible disposable 30-gauge, 10 mm needles), or Group II, traditional system (30-gauge, 10 mm needle and disposable traditional syringe). Local infiltration was administered and extraction performed after 3 min. The time of administration (TOA) of infiltrate was noted whereas anxiety and pain in both groups were assessed using the Modified Child Dental Anxiety Faces Scale simplified (MCDAS(f)), pulse rate, Faces Pain Scale-Revised (FPS-R), and Face, Legs, Activity, Cry, Consolability (FLACC) Scale.Results:The TOA was high in computer group, compared to the traditional system (P < 0.001***); however, anxiety and pain were significantly less in computer group as reported in MCDAS(f), pulse rate, FPS-R, and FLACC (P < 0.001***).Conclusions:Computer system created a positive and comfortable experience for the child, as well as the practitioner. The possibility of using buccal infiltration instead of inferior alveolar nerve block in children below 10 years was also demonstrated.

Estimation of Anesthetic Success Rates: The Efficacy of Articaine versus Lidocaine

Purpose: Multiple randomized controlled trials have compared the efficacy of 2% lidocaine with 1:100,000 epinephrine to 4% articaine with 1:100,000 epinephrine. However, there is still uncertainty about expected success probabilities with various anesthetic modalities that needs to be addressed in the literature.Methods: A search of PubMed and Google yielded over 200 potential articles. 13 randomized controlled trials met the eligibility criteria for inclusion in the analysis. Analyses compared lidocaine and articaine in teeth with and without a diagnosis of pulpitis for maxillary infiltration, mandibular buccal infiltration, and inferior alveolar nerve block (IANB).Results: Articaine demonstrated superior anesthetic efficacy regardless of the type of injection administered or pulpal status. Depending on the type of injection, the estimated probability of anesthetic success with articaine was observed to be anywhere from 9.19 percentage points to 32.48 percentage points higher than lidocaine. The comparisons favoring articaine were highly significant for mandibular infiltration (p<0.0001) and maxillary infiltration (p=0.0100). While IANB nearly missed statisticalsignificance (p=0.0656), the estimated effect was of a clinically meaningful magnitude. Clinical Implications: A synthesis of current evidence suggests that articaine has a higher success probability than lidocaine regardless of injection type or pulpal status. In addition to statistical significance, the superior anesthetic success rate of articaine is estimated to be of sufficient magnitude to make meaningful clinical impact.

Recent Techniques in Dental LA

Significant research has occurred in the area of local anesthesia in recent years. This article iscussed various newer techniques, including mandibular infiltration of articaine, local anesthetic (LA) reversal, LA buffering, and intranasal mist administration for maxillary local anesthesia.

Factors affecting the success rate of buccal infiltration anaesthesia in the mandibular molar region

To compare the anaesthetic efficacy of mandibular second premolar infiltration (SP) with that of mandibular first molar infiltration (FM) in inducing pulpal anaesthesia in the mandibular first molar. To further investigate the mechanisms of action that underlie mandibular infiltration, gender-related differences in the anaesthetic efficacy were also assessed. A total of 29 adult subjects randomly received two sets of SP and FM injections using one cartridge (1.7mL) of 4% articaine and 1:100000 adrenaline at two separate appointments. The responses of the teeth were assessed using an electronic pulp tester over a 30-min period. A comparison of the anaesthetic success between the SP and FM infiltration routes was analysed using the McNemar's test. Gender-related differences in the anaesthetic success of infiltration routes were assessed using the Fisher's exact test. For the second premolar and the first and second molar teeth, the success rates of SP were 72.4%, 62.1% and 48.3%, whereas the success rates of FM were 75.9%, 51.7% and 55.1%, respectively. There were no significant differences between the success rates of SP and FM or between the rates obtained for each tooth. Significant gender-related differences were observed for the second premolar (P<0.01) and the first molar (P<0.05) using FM. However, a significant difference was observed only for the second premolar using SP (P<0.05). The differences in the injection sites did not affect the anaesthetic success rates for the mandibular second premolar and molar teeth. However, articaine buccal infiltration produced a higher anaesthetic success rate in the second premolar and first molar teeth of Korean female patients.

Сравнение эффективноСти обезболивания пульпита временных моляров нижней челюСти артикаиновым анеСтетиком

Aim.Analyzed the effectiveness of different anaesthetic techniques in the mandible primary teeth. Material and methods. In 180 children aged 3—9 years was189 injections for 207 teeth: inferior alveolar nerve block for 81 teeth (63 injections), mandibular infiltration for 44 primary molars children up to 7 years, and intraseptal injection for 82 primary molars. Used 4% articaine with 1:200 000 epinephrine. Dental procedure included pulpectomies in primary molars. Results.Inferior alveolar nerve blockwas effective in 77,77%, mandibular infiltration in children under 7 years in 61,36%, intraseptal injection was effective in 70,73%. In other cases we had to resort to additional injection, which resulted in a generally positiveresult was obtained in 96,29% of cases. No statistically significant difference was found between the three anaesthetic techniques.

Diffusion of the local anesthetic solution in the tissues during mandibular infiltration anesthesia and the factors affecting it

Diffusion of the local anesthetic solution in the tissues during mandibular infiltration anesthesia and the factors affecting it

Aggressive juvenile mandibular fibromatosis

Aggressive juvenile fibromatosis of the jawbones is a rare tumor presenting as infiltrative mass with unpredictable evolution. We report herein a 17-year-old student with a 6-month history of radiologically proven resorption of a part of the mandible, lingual displacement of tooth 34 and malocclusion. Alveolar ridge resorption and three dark-brown foci in the bone were seen after the tooth was extracted. Histological study showed the tumor tissue to have a bundle-like structure; immunohistochemically it was positive for vimentin, smooth muscle actin, beta-catenin, Ki-67 (5%), and negative for desmin and cytokeratin 34bE12. The golden standard in the diagnostics of desmoid fibromatoses is the nuclear or membrane expression of beta-catenin, which is found in 90% of the cases. Differential diagnosis include mandibular fibroma, well-differentiated fibrosarcoma, fibrosing histiocytoma, and infiltration from adjacent soft-tissue tumor. Aggressive juvenile fibromatosis should be managed by radical excision. Local recurrences are not rare, but metastases do not develop. In rare cases this type of fibromatosis has been known to regress spontaneously. Aggressive fibromatosis is a diagnostic challenge, since it remains in the grey zone between benign and malignant lesions of the oral cavity.

Is Mandibular Molar Buccal Infiltration a Mental and Incisive Nerve Block? A Randomized Controlled Trial

IntroductionThe aim of this study was to compare the efficacies of buccal local anesthetic infiltrations at various sites of the mandible in order to elucidate the mechanism of action of articaine mandibular infiltrations. MethodsAfter a power calculation and ethical approval, 22 volunteers received 1.8 mL 4% articaine hydrochloride with 1:100,000 adrenaline as a buccal infiltration at the canine, first, or second molar in a randomized, double-blind, crossover design. The injections at the canine and first molar were considered equidistant from the mental foramen. Responses of the first and second molars, first premolar, and lateral and central incisors were assessed using an electronic pulp tester over a 47-minute period. Volunteers were asked to rate the discomfort of each injection using a visual analog scale. Data were analyzed using repeated measures analysis, McNemar, and Mann-Whitney U testing. ResultsInjections at the canine and first molar teeth produced anesthesia in all teeth tested in some volunteers. There was no significant difference between anesthetic success of the first premolar after infiltration at the canine or the first molar. Injection at the second molar failed to produce anesthesia of the incisor teeth. Anesthesia was significantly more likely after injections at an adjacent site. There was no difference in discomfort associated with injections at different sites of the mandible. ConclusionsArticaine first mandibular molar infiltrations achieve an effect via a combination of modified mental and incisive nerve block and local infiltration. Infiltration at the second molar produces anesthesia of both molar and premolar teeth, primarily via infiltration.

The use of the mandibular infiltration anesthetic technique in adults

The author describes the use of the infiltration anesthetic technique to anesthetize mandibular teeth in adults and explores its mechanism of action. The author reviewed articles describing randomized controlled trials of the mandibular infiltration anesthetic technique in healthy participants. The author found that using the mandibular infiltration anesthetic technique can produce anesthesia in adult mandibular teeth. The success was dose dependent and the choice of anesthetic solution was significant; 4 percent articaine with 1:100,000 epinephrine was more effective than 2 percent lidocaine with 1:100,000 epinephrine. Combining buccal and lingual infiltrations increased success in the mandibular incisor region. The success of the mechanism of infiltration of anesthetic at the mandibular first molar appeared to depend on the mental foramen. The mandibular infiltration anesthetic technique is an effective method of anesthetizing mandibular incisors. Four percent articaine with epinephrine appears to be the preferred solution. The choice of anesthetic solution is important when using the infiltration anesthetic technique in the adult mandible.