Objective:The aim of this study was to conduct a literature review to determine reasons for which local anesthesia in dentistry can fail and to assess solutions to these failures. Material and Methods:Research was carried out through searches on PubMed and ScienceDirect, manual searches in textbooks, and Internet searches for techniques, products, and devices. Results: Local anesthesia in dentistry can fail for a number of reasons including ineffective anesthetic solution, complex oral anatomy, and improper technique. In the mandible, conventional injections (e.g. IANB) often fail as the thick cortical bone prevents effective infiltration and anesthesia of nearby nerves. Recent studies however, suggest use of intraosseous anesthesia as a more effective primary alternative. When administered with a computerized device such as QuickSleeper®, intraosseousinjection (4% articaine w/ 1:100,000 epinephrine in adults and w/ 1:200,000 epinephrine in children) is fast acting, suitable in duration for conservative treatments, highly successful in mandibular molars, and preferred by most patients. Other advantages to the technique include comfort upon injection and lack of numbness in the lip and tongue. Conclusions: Computer-controlled intraosseous anesthesia is an effective primary technique for limited procedures involving one or two posterior teeth in the mandible. Compared to traditional local anesthetic techniques, intraosseous anesthesia (1.5-1.8 mL of 4% articaine with 1:100,000 epinephrine for adults and 0.6-0.8 mL of 4% articaine with 1:200,000 epinephrine for children) offers high success rates, easy administration, fast onset times, and significant patient comfort.