The Gow-Gates technique is used when the Inferior Alveolar fails to provide adequate anesthesia. Advantages of this technique versus the inferior alveolar technique are its low failure rate and low incidence of positive aspiration. A 25 gauge long needle is recommended for this technique. The right handed operator should be in the eight o'clock position whereas the left handed operator should be in the four o'clock position. The target area for this technique is the neck of the condyle below the area of insertion of the lateral pterygoid muscle. The insertion site of the needle will be just distal to the maxillary 2nd molar at the level of the mesiolingual cusp. Bring the needle to the insertion site in a plane that is parallel to an imaginary line drawn from the intertragic notch to the corner of the mouth on the same side as the injection. Advance the needle through soft tissue approximately 25mm until bone is contacted. This is the neck of the condyle. Once bone is contacted, withdraw the needle one millimeter and aspirate. Redirect the needle superiorly and reaspirate. If aspiration is negative, slowly inject one cartridge over one minute.
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