In hot mandibular molars, IAN blocks fail roughly a third of the time; my quickest rescue during RCT is an intraosseous injection with 2% lidocaine 1:100,000, which usually takes effect in under a minute. What’s your go-to backup when the block fizzles?
If the block tanks, I go straight to a tight intrapulpal with firm back‑pressure — ‘pressure is the anesthetic’ — pre‑bend a 27G so it binds in the orifice; onset is instant and I get right to shaping. Your <1‑min IO is great, but I skip it unless I can’t get a good bind; do you find IO more comfortable for patients than that brief intrapulpal sting?
And pDL with 4% articaine 1:100,000; [redacted] per root, onset “under a minute.” Work for you?
I switch the IO solution to 3% mepivacaine — onset’s still about 30 seconds and patients don’t get the epi jitters; you seeing the same, @elliott_jones?