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290 OPERATIVE DENTISTRY

ten resulting in false unilateral ankylosis, generally temporary,
but sometimes more or less permanent and always to be avoided.
If anesthesia of only the pulps of the teeth is desired, the special
part of the injection for the lingual nerve should be omitted, as
there is less liability of injecting bundles of muscle fibers. In case
injection is made for surgical purposes, as the extraction of the
first molar and bicuspid, an infiltration injection had best be made
buccal to the tooth or teeth to be extracted to include the descend-
ing branch of the buccal branch of the third division of the fifth,
which is given off just above the pterygoideus internus and ener-
vates the soft tissues of the biscuspids and molars buccally. An-
esthesia occurs in fifteen to twenty minutes and lasts about one
hour, sometimes longer. If longer anesthesia is desired, the amount
of the injection is to be increased up to four cubic centimeters.
The first sign of anesthesia is the numbness of the side of the
tongue if the injection for the lingual nerve has been included and
of the lip above the mental foramen on that side. These are the
signs of a successful injection and occur in a very short time, yet
^,
the deepest state of the anesthesia may not work back to the pos-
terior molars for twenty to thirty minutes, as frequently happens
Avith operations for the extraction of lower third molars.
(O Mental Injection. The mental injection is made Avith a one or
two centimeter needle passed as shown in Fig. 155. The operator
,
,
should compress the mucous membrane and over the
( ' tissues
''
foramen. When the needle is felt under the finger (see Fig. 156)
one cubic centimeter should be injected while pressing which will
(1)
' , direct the solution through the foramen into the mandibular canal,
(
-> ' anesthetizing the first bicuspid, cuspid and incisors of the respec-
'
tive side.
Infra-Orbital Injection. This injection is made in the same way
as that described for the mental foramen, using the same length of
needle and one cubic centimeter of the solution. Dental and surgi-
cal anesthesia is obtained in the bicuspids, cuspid and incisors of
the respective side.
Zygomatic Injection. The long needle is inserted over the roots
of the second superior molar progressing upward, backAvard and
inward, depositing some of the solution as the needle progresses,
until the position of the needle is as shoAvn in Fig. 158 Avhere the
last of the solution is deposited, in all tAvo cubic centimeters. This
injection will reach the posterior superior alveolar nerve and the
middle superior alveolar in case it is given off before the maxillary