Clinical Oral Investigations

, Volume 23, Issue 3, pp 1061–1065 | Cite as

Anesthetic efficacy of an inferior alveolar nerve block in soft tissue and correlation between soft tissue and pulpal anesthesia

  • Sin-Yeon Cho
  • Wonwoo Choi
  • Junyoung Kim
  • Sung-Taek Kim
  • Hee-Jin Kim
  • Il-Young JungEmail author
Original Article



This study was aimed at evaluating the anesthetic success rates in various regions of soft tissue after inferior alveolar nerve (IAN) block and comparing the success rates of soft tissue anesthesia with those of pulpal anesthesia to find correlations.

Materials and methods

Fifty-nine dental students received an IAN block injection. A total of four test sites were used for soft tissue anesthesia using a pressure algometer (PA): the corner of the lower lip vermilion border (LL); the buccal-attached gingiva of the lateral incisor (BGI), the molar (BGM), and the lingual gingiva (LG). The lateral incisor (LI) and the first molar (M1) were evaluated for pulpal anesthesia using an electric pulp tester. To evaluate whether soft tissue anesthesia can be an indicator of pulpal anesthesia, the positive predictive value (PPV) and negative predictive value (NPV) were calculated.


The highest success rate for soft tissue anesthesia was seen on the LG (93.9%), followed by LL (79.6%), BGI (53.1%), and BGM (14.3%). The PPVs of LL for the M1 and Ll were 74.4 and 59.0%. The NPVs for the M1 and LI were much higher in the LL (90.0 and 100%, respectively) than in the BGI (56.5 and 69.6%, respectively).


The highest success rate was found in the LG. Lip numbness was not an indicator of pulpal anesthesia of M1 and LI. However, if the LL was not anesthetized, the probabilities of failed pulpal anesthesia were very high in the LI and M1.

Clinical relevance

The clinicians need to consider not doing an additional lingual nerve block after IAN block.


Inferior alveolar nerve block Predictive value Pressure algometer Soft tissue anesthesia 



This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2017R1D1A1B03033315).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article contains study with human participants. Approval for this study was obtained from the Institutional Review Board of Yonsei University Dental Hospital (Seoul, Korea) (IRB 2-2015-0002).

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Hur MS, Kim HC, Won SY, Hu KS, Song WC, Koh KS, Kim HJ (2013) Topography and spatial fascicular arrangement of the human inferior alveolar nerve. Clin Implant Dent Relat Res 15:88–95CrossRefGoogle Scholar
  2. 2.
    Vreeland DL, Reader A, Beck M, Meyers W, Weaver J (1989) An evaluation of volumes and concentrations of lidocaine in human inferior alveolar nerve block. J Endod 15:6–12CrossRefGoogle Scholar
  3. 3.
    Hinkley SA, Reader A, Beck M, Meyers WJ (1991) An evaluation of 4% prilocaine with 1:200,000 epinephrine and 2% mepivacaine with 1:20,000 levonordefrin compared with 2% lidocaine with:100,000 epinephrine for inferior alveolar nerve block. Anesth Prog 38:84–89Google Scholar
  4. 4.
    Lai TN, Lin CP, Kok SH, Yang PJ, Kuo YS, Lan WH, Chang HH (2006) Evaluation of mandibular block using a standardized method. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 102:462–468CrossRefGoogle Scholar
  5. 5.
    Malamed SF (2004) Techniques of mandibular anesthesia. Handbook of local anesthesia. Elsevier/Mosby, St. Louis, pp 227–234Google Scholar
  6. 6.
    Balasubramanian S, Paneerselvam E, Guruprasad T, Pathumai M, Abraham S, Krishnakumar Raja VB (2017) Efficacy of exclusive lingual nerve block versus conventional inferior alveolar nerve block in achieving lingual soft-tissue anesthesia. Ann Maxillofac Surg 7:250–255CrossRefGoogle Scholar
  7. 7.
    Khoury J, Mihailidis S, Ghabriel M, Townsend G (2010) Anatomical relationships within the human pterygomandibular space: relevance to local anesthesia. Clin Anat 23:936–944CrossRefGoogle Scholar
  8. 8.
    Venkat Narayanan J, Gurram P, Krishnan R, Muthusubramanian V, Sadesh Kannan V (2017) Infiltrative local anesthesia with articaine is equally as effective as inferior alveolar nerve block with lidocaine for the removal of erupted molars. Oral Maxillofac Surg 21:295–299CrossRefGoogle Scholar
  9. 9.
    McMillan AS (1995) Pain-pressure threshold in human gingivae. J Orofac Pain 9:44–50Google Scholar
  10. 10.
    Ogimoto T, Ogawa T, Sumiyoshi K, Matsuka Y, Koyano K (2002) Pressure-pain threshold determination in the oral mucosa: validity and reliability. J Oral Rehabil 29:620–626CrossRefGoogle Scholar
  11. 11.
    Fowler S, Reader A, Beck M (2015) Incidence of missed inferior alveolar nerve blocks in vital asymptomatic subjects and in patients with symptomatic irreversible pulpitis. J Endod 41:637–639CrossRefGoogle Scholar
  12. 12.
    Rodriguez-Wong L, Pozos-Guillen A, Silva-Herzog D, Chavarria-Bolanos D (2016) Efficacy of mepivacaine-tramadol combination on the success of inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis: a randomized clinical trial. Int Endod J 49:325–333CrossRefGoogle Scholar
  13. 13.
    Parirokh M, Sadr S, Nakhaee N, Abbott PV, Askarifard S (2014) Efficacy of supplementary buccal infiltrations and intraligamentary injections to inferior alveolar nerve blocks in mandibular first molars with asymptomatic irreversible pulpitis: a randomized controlled trial. Int Endod J 47:926–933CrossRefGoogle Scholar
  14. 14.
    Mikesell P, Nusstein J, Reader A, Beck M, Weaver J (2005) A comparison of articaine and lidocaine for inferior alveolar nerve blocks. J Endod 31:265–270CrossRefGoogle Scholar
  15. 15.
    Jung IY, Kim JH, Kim ES, Lee CY, Lee SJ (2008) An evaluation of buccal infiltrations and inferior alveolar nerve blocks in pulpal anesthesia for mandibular first molars. J Endod 34:11–13CrossRefGoogle Scholar
  16. 16.
    De Jong RH (1970) Kinetics of nerve block physiology and pharmacology of local anesthesia. Thomas, Springfield, pp 114–136Google Scholar
  17. 17.
    Lee MH, Kim HJ, Kim DK, Yu SK (2015) Histologic features and fascicular arrangement of the inferior alveolar nerve. Arch Oral Biol 60:1736–1741CrossRefGoogle Scholar
  18. 18.
    Tan VL, Andrawos A, Ghabriel MN, Townsend GC (2014) Applied anatomy of the lingual nerve: relevance to dental anaesthesia. Arch Oral Biol 59:324–335CrossRefGoogle Scholar
  19. 19.
    Wongsirichat N, Pairuchvej V, Arunakul S (2011) Area extent anaesthesia from buccal nerve block. Int J Oral Maxillofac Surg 40:601–604CrossRefGoogle Scholar
  20. 20.
    Drum M, Reader A, Beck M (2011) Long buccal nerve block injection pain in patients with irreversible pulpitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 112:e51–e54CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Conservative DentistryNational Health Insurance Service Ilsan HospitalGoyangSouth Korea
  2. 2.Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of DentistryYonsei UniversitySeoulSouth Korea
  3. 3.Department of Oral Medicine, TMJ and Orofacial Pain Clinic, College of DentistryYonsei UniversitySeoulSouth Korea
  4. 4.Division in Anatomy and Developmental Biology, Department of Oral Biology, College of DentistryYonsei UniversitySeoulSouth Korea

Personalised recommendations