Introduction: Achieving successful anesthesia and performing pain-free Root Canal Treatment are important aims in dentistry. This is not always achievable and therefore, practitioners are constantly seeking newer techniques, equipments, and anesthetic solutions for this very purpose.The aim of this review is to introduce strategies to achieve profound anesthesia particularly in difficult cases.Materials and Methods: A review of the literature was performed by electronic and hand searching methods for anesthetic agents, techniques, and equipment. The highest level of evidence based investigations with rigorous methods and materials were selected for discussion.Results: Numerous studies investigated to pain management during Root Canal Treatment; however, there is still no single technique that will predictably provide profound pulp anesthesia. One of the most challenging issues in endodontic practice is achieving a profound anesthesia for teeth with irreversible pulpitis especially in mandibular posterior region.Conclusion: According to most investigations, achieving a successful anesthesia is not always possible with a single technique and practitioners should be aware of all possible alternatives for profound anesthesia.

This case report highlights a rare complication of Root Canal Treatment involving the inadvertent extrusion of sodium hypochlorite solution, resulting in a sodium hypochlorite-induced facial hematoma. A 44-year-old female patient presented significant right hemifacial swelling and ecchymosis following Root Canal therapy. Computed tomography imaging confirmed a hematoma involving the facial region without active signs of bleeding. Sodium hypochlorite, a potent cytotoxic agent commonly used in Root Canal procedures, was identified as the causative agent. Treatment consisted of prednisone, antibiotics, and NSAIDs, resulting in gradual improvement over a month. The cytotoxic properties of sodium hypochlorite, its variable concentrations, and risk factors associated with facial hematomas are discussed. It is essential to emphasize the rarity of such hematomas and highlight the need for precise technique, vigilant monitoring, and interdisciplinary collaboration to mitigate risks and prioritize patient safety.