FAILURE OF LOCAL

ANESTHESIA
Kegagalan dalam anesthesi lokal

Drg. Mohammad Gazali, Sp.BM (K), MARS

ORAL AND MAXILLOFACIAL DEPARTEMENT

FACULTY OF DENTISTRY HASANUDDIN UNIVERSITY
Supra
periosteal
Failures of Anesthesia

1. Needle tip lies below the apex (along the root) of the
tooth (see Table 13.1). Depositing anesthetic solu- tion
below the apex of a maxillary tooth results in
excellent soft tissue anesthesia but poor or absent pulpal
anesthesia.
2. Needle tip lies too far from the bone (solution
deposited
in buccal soft tissues). To correct this, redirect the needle
closer to the periosteum.
Posterior Superior Alveolar Nerve Block

Failures of Anesthesia

1.Needle too lateral. To correct this, redirect the needle

tip medially (see complication ).
2.Needle not high enough. To correct this, redirect the
needle tip superiorly.
3.Needle too far posterior. To correct this, withdraw the
needle to the proper depth.
 Middle Superior Alveolar Nerve Block

Failures of Anesthesia

Anesthetic solution is not deposited high above the apex of the second premolar.
a. To correct this, check radiographs and increase the depth of penetration.
Solution is deposited too far from the maxillary bone with the needle placed in tissues
lateral to the height of the mucobuccal fold.
b. To correct this, reinsert the needle at the height of the mucobuccal fold.
Bone of the zygomatic arch at the site of injection prevents the diffusion of anesthetic.
c. To correct this, use the supraperiosteal, ASA, or PSA injection in place of the MSA
injection.
 Anterior Superior Alveolar Nerve Block
(Infraorbital Nerve Block)

Failures of Anesthesia

1. Needle contacting bone below (inferior to) the infraor- bital foramen: Anesthesia of the lower
eyelid, lateral side of the nose, and upper lip may develop with little or no dental anesthesia; a bolus
of solution may be felt beneath the skin in the area of deposition, which lies at a distance from the
infraorbital foramen (which is still palpable after the local anesthetic solution has been injected).
These are, by far, the most common causes of anesthetic fail- ure within the distribution of the ASA
nerve. In essence, a failed ASA is a supraperiosteal injection over the first premolar. To correct this:
1.Keep the needle in line with the infraorbital foramen dur- ing penetration. Do not direct the needle
toward bone.
2.Estimate the depth of penetration before injecting anesthetic.
2. Needle deviation medial or lateral to the infraorbital foramen. To correct this:
a. Direct the needle toward the foramen immediately after inserting it and before advancing it
through the tissue.
b. Recheck needle placement before aspirating and depositing the anesthetic solution.
 Greater Palatine Nerve Block

Failures of Anesthesia

1.The greater palatine nerve block is not technically difficult to

administer failures are rare. The incidence of success is well
above 95%.
2.If local anesthetic is deposited too far anterior to the
foramen, adequate soft tissue anesthesia may not occur in the
palatal tissues posterior to the site of injection (partial success).
3. Anesthesia on the palate in the area of the maxillary first
premolar may prove inadequate because of overlapping fibers
from the nasopalatine nerve (partial success).To correct this,
local infiltration may be necessary as a supplement in the area
of inadequate anesthesia.
 NASOPALATINE NERVE BLOCK

Failures of Anesthesia
1.Highly successful injection (>95% incidence of success).
2.Unilateral anesthesia:
1. If solution is deposited on one side of the incisive canal, unilateral anesthesia may
develop.
2. To correct this, reinsert the needle into the already anes- thetized tissue and reinject
solution into the unanesthe- tized area.
3.Inadequate palatal soft tissue anesthesia in the area of the maxillary canine and first
premolar:
1. If fibers from the greater palatine nerve overlap those of the nasopalatine nerve,
anesthesia of the soft tissues palatal to the canine and the first premolar could be
inadequate.
2. To correct this, local infiltration may be necessary as a supplement in the area
inadequately anesthetized.
Anterior Middle Superior Alveolar Nerve Block

Failure of Anesthesia
1. May need supplemental anesthesia for
central and lateral incisors
a. Adequate volume of anesthetic may not reach dental
branches.
b. To correct this, add additional anesthetic solution or perform
an additional dental injection in proximity to these teeth from
the palatal approach.
 Palatal Approach Anterior Superior Alveolar Nerve Block

Failure of Anesthesia
1.Highly successful injection for maxillary incisors.
2.When failure does occur, may need additional dental injection in patients
whose canines have long roots:
a. Adequate volume of anesthetic may not reach dental branches.
b. To correct this, add additional anesthetic or perform an additional dental injection in proximity to the
canine teeth from the palatal approach.
3. Unilateral anesthesia:
a. Look for bilateral blanching.
b. To correct this, administer additional anesthetic.
 Maxillary Nerve Block

Failures of Anesthesia
1.Partial anesthesia; may result from underpenetration by needle. To correct this,
reinsert the needle to the proper depth and reinject solution.
2.Inability to negotiate the greater palatine canal. To correct this:
a. Withdraw the needle slightly and reangulate it.
b. Reinsert the needle carefully to the proper depth.
c. If you are unable to bypass the obstruction easily, with- draw the needle and terminate the
injection.
The high-tuberosity approach may prove more successful in this situation.
d. The greater palatine canal approach is usually successful if the long dental needle has been
advanced at least two- thirds of its length into the canal.
INFERIOR ALVEOLARIS NERVE
BLOCK
Failures of Anesthesia

The most common causes of absent or incomplete IANB are:

1. Deposition of anesthetic too low (below the mandibular foramen). To correct this, reinject anesthetic
at a higher site (approximately 5 to 10 mm above the previous site).
2. 2. Deposition of the anesthetic too far anteriorly (laterally) on the ramus. This is diagnosed by lack of
anesthesia except at the injection site and by the minimum depth of needle penetration before
contact with bone (e.g., the [long] needle is usually less than halfway into tissue). To correct this,
redirect the needle tip posteriorly.
3. Accessory innervation to the mandibular teeth:
a. The primary symptom is isolated areas of incomplete pulpal anesthesia encountered in the mandibular
molars (most commonly the mesial portion of the mandibular first molar).
b. Although it has been postulated that several nerves provide the mandibular teeth with accessory sen-
sory innervation (e.g., the cervical accessory and mylohyoid nerves), current thinking supports the
mylohyoid nerve as the prime candidate.33-35 The Gow-Gates mandibular nerve block, which routinely
blocks the mylohyoid nerve, is not associated with problems of accessory innervation (unlike the IANB,
which normally does not block the mylohyoid nerve).
BUCCAL NERVE BLOCK
Failures of Anesthesia
Rare with the buccal nerve block: inadequate
volume of anesthetic retained in the tissues.
Thank you