Continuing Education: Accessory Innervation Anesthetic Protocol by Dr. Daniel Uzbelger Feldman

Course description
This course describes how the accessory innervation anesthetic protocol can be used for profound pulpal anesthesia of the adult posterior mandible. It will discuss how the accessory innervation theory plays a pivotal role in the inferior alveolar nerve block failure rates, as well as different clinical approaches to overcome these obstacles.

Abstract
The inferior alveolar nerve block has the highest failure rate not only in dental local anesthesia, but also among all local anesthetic blocks in medicine. The “accessory innervation to the inferior alveolar nerve” theory supports the idea that incidents of unsuccessful anesthesia may result from innervations of the adult mandible arising from the cervical plexus in addition to the auriculotemporal, buccal, mental, incisive, mylohyoid and lingual nerves. Hence, to achieve profound pulpal anesthesia in the posterior mandible, an accessory innervation anesthetic protocol that anesthetizes all the accessory nerves has been clinically proposed. Three different accessory innervation anesthetic protocol approaches are described in this article, as well as how to overcome pulpal anesthesia failure by implementing the intraoral cervical plexus anesthetic technique. This protocol will help alleviate patients’ fear to the dental chair while improving our profession’s reputation.

Learning Objectives
After reading the article, participants should be able to:

• Understand the problems associated with anesthetic failures in permanent dentition with the use of currently available anesthetic techniques.
• Identify how accessory innervation may play a pivotal role in the high percentage of anesthetic failure on the posterior mandible.
• Comprehend the cervical plexus nerve description and distribution in the mandible.
• Recognize how these variations of anatomy allow for clinical decisions for implementing supplemental anesthetic techniques.
• Administer the intraoral cervical plexus anesthetic technique to their patients.
• Provide the accessory innervation anesthetic protocol to their patients.

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