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...Central international journal of clinical anesthesiology bringing excellence in open access corresponding author hironori tsuchiya department dental basic education review article asahi university school dentistry hozumi mizuho gifu japan tel fax email anesthesia the submitted september accepted presence inflammation published october issn copyright pharmacological mechanisms for reduced efficacy keywords local anesthetics anesthetic failure mechanism abstract profound analgesia or pain control with is essential most procedures endodontic and restorative treatments tooth extraction minor oral surgery however clinicians frequently experience that it difficult infiltration nerve block injections to achieve clinically acceptable pupil periapical failures are well documented especially when treating mandibular posterior teeth inflamed pulps successful patients irreversible pulpitis continually challenging a variety have been hypothetically proposed such among mechanistic hypotheses technic...