Since it is difficult to achieve anesthesia in lower jaw and the success rate of IANB is low and there are a lot of anatomic variations for the location of inferior alveolar nerve in different races, investigators decided to compare the success rate of inferior alveolar nerve block, with and without using a panoramic radiograph in Bandar Abbas population, and see if using a panoramic radiograph can increase the preciseness of the injection.

This is a double blinded cross-over randomized controlled trial study conducted on all the patients of the dental clinic indicated for bilateral extraction or filling.

The randomization method is block balanced randomization. All patients will ask to fulfill the ethical Form. This form acquired demographic information (e.g. age, sex) about patients. A panoramic radiograph will take from those who matched the inclusion criteria and signed the agreement. Then a tooth from one side will be treated and the tooth from the other side of the mouth will treat at least 2 weeks later by the same dentist.

Inclusion Criteria:

• Patients indicated for bilateral tooth extractions of fillings.
• Physically and mentally healthy patients who could express their pain.
• having panoramic radiograph from the past six months for other dental purposes.

Exclusion Criteria:

• sensitive to the regular anesthetics containing epinephrine.
• patients with acute or chronic pericoronitis.
• pregnancy
• trismus