The Only Thing That Matters

With Facebook, LinkedIn, and Instagram it’s easy to fall into the tribe mentality that if you do not place restorations with realistic staining or perfect anatomy that you are a sub-par dentist. This could be further from the truth.

The reality is that the end of the day, patients do not know what you do. Only how you do it. In dentistry, this means treatment needs to be comfortable and painless.


This means we need to have excellent anaesthesia. Patients need to feel nothing. Apart from the standard infiltration and inferior mandibular block technique, many dental schools forget other techniques that could be used if all else fails. These techniques no more difficult than a standard mandibular block. No fancy gear needed, just use your existing tools.

Long Buccal

Although it cannot be used alone, in conjunction with a standard inferior alveolar nerve block, a Long Buccal can deepen the level of anesthesia in the lower jaw.

Akinosi Block

I use this technique always when performing implant surgery in the lower jaw. I find the anesthesia to be very profound especially during longer sessions. Another advantage is that the tissues do not swell in the regions where I’m performing surgery, as the injection point and anesthesia deposit is further away. Anecdotally, patients also find this less stressful as they do not need to open wide to receive this anesthesia.

Gow Gates Block

I have yet needed to apply this technique as my Akinosi blocks have been successful so far. Gow Gates requires more landmarks to visualise, compared to the Akinosi that is considered a “blind” injection, as no bony landmarks are needed.

Intraligamentary Infiltration

This can be used in both the maxilla and mandible. I resort to this, if after several blocks or infiltration, the tooth is still painful.

Although the video shows a special intraligamentary syringe, the same injection can be applied using your standard syringe (expect with a bit more pressure)

If none of these techniques work. Try again. If you try again and it does not work, consider sending the patient home or refer. The worst thing you can do for yourself (your stress levels) and your patient is to endure performing painful treatment. It’s the worst way to represent your personal brand and your clinic. As the saying goes, Happy Patient = Happy Life.

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Dr Kevin Ho
Dr Kevin Ho
Dr Kevin Ho is Cosmetic Dentist, Clinical Professor and Entrepreneur based out of Australia and Canada.

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