STUDIES

      Here you will find published clinical research, studies pending publication, laboratory evidence, surveys and professional perspectives relating to TuttleNumbNow. 


Please reach out if you are interested in performing research or clinical studies regarding TuttleNumbNow.

We are happy to help in any way.

Please note: IANB = inferior alveolar nerve block; BI = buccal infiltration; IO = intraosseous. 

Evidence at a glance 

  • Clinical use without IANB - published TNN study. A 2026 retrospective review found that 129 of 137 mandibular first-molar procedures requiring anesthesia (94.2%) were completed without IANB using the sequential TNN protocol. This measures completion without a block, not success of one isolated IO injection. [Entry 1] 


  • Faster onset and less injection pain - Detroit Mercy, pending publication. In 23 healthy volunteers, TNN onset averaged 1.5 versus 8.7 minutes with IANB, and pain scores were 1.96 versus 3.74/10 (both P<.001). Success was 100% versus 87%, without a significant difference. Different anesthetic agents were compared. [Entry 2] 


  • Comparison with BI - AAE abstract; full study pending publication. In 24 adults, the Detroit Mercy abstract reported 75% TNN versus 33.33% BI success with equal solution volumes. Time to maximum percentage of 80/80 readings was one versus ten minutes; the authors reported longer duration and similar injection pain. This was described as supplemental anesthesia. [Entry 3] 


  • Needle durability and penetration force - laboratory studies. The 2023 guide-assisted bending study tested 48 needles, with a mean of 40.33 bends before failure. Steele et al. found approximately 29% lower insertion force for the novel bevel in a silicone-block test. Neither result directly measures clinical injury risk or bone penetration force. [Entries 6-8] 


  • Third-party clinical coverage - Clinicians Report, November 2026. CR discusses IO for supplemental use and as a potential alternative to IANB, and identifies TNN among predictable, economical options. The article is a clinical report rather than a new head-to-head TNN trial. [Detailed citation follows] 


  • Evidence in context - A published 104-person TNN trial found no significant success difference versus BI; broader IO trials show benefits that vary by system, population and outcome. Provider surveys and endorsements add experience and adoption perspectives. Together these sources support outcome-specific advantages, not universal superiority. [Entries 4, 9 and 12-18]

Clinical Publication

CR Foundation. Gordon J. Christensen

Intraosseous Injections: Optional Backup or Essential Staple?

An independent, non-profit, dental education and product testing foundation, Clinicians Report®, November 2026;19(11):2 and continuation. ISSN 2380-0429. 

For the full report click this link

  • Discusses IO as both supplemental anesthesia and a possible alternative to conventional IANB for mandibular molars. Highlights rapid onset, limited peripheral-tissue numbness and usefulness when conventional techniques are inadequate. 
  • Explicitly includes TuttleNumbNow in its systems comparison and identifies TNN and X-Tip as predictable options with low to moderate cost.
  • Includes an image of the TuttleNumbNow intraosseous injection. 
  • This is third-party clinical coverage relevant to TNN's clinical rationale and visibility.
  • Reported IO success of 90% or more is a general IO statement in the article, not a TNN-specific trial result.
  • The article also discusses positioning, thick cortical bone and transient heart-rate effects. 
  • Technical clarification for readers: the article describes TNN needles as "tri-bevel" and labels the guide "Septodont." 
    • Tuttle's prior material specifies the Evolution as a scalpel bevel. See the needle-design section.
    • The historical Septodont relationship does not establish current ownership or affiliation. TNN is  independent of Septodont, according to Gregory Tuttle. 


Direct TNN clinical research 

1. Tuttle GK, Newell CK, Boucher L, Taylor J, Tuttle JJ.

Efficacy of the TuttleNumbNow anesthesia protocol for mandibular first molars: a retrospective study

J Dent Anesth Pain Med. 2026;26(2):133-141. https://doi.org/10.17245/jdapm.2026.26.2.133 

  • Published retrospective observational study of 184 procedures, including 137 requiring anesthesia. Of those 137, 129 (94.2%) were completed without IANB; eight required IANB. 
  • Supports effectiveness of the sequential protocol, which can include infiltration. No concurrent IANB or BI control; not proof of comparative superiority. The author group includes founder/company involvement. 

2. Smith C, Paurazas S, Ahmad M, Askar M.

Anesthetic Efficacy of TuttleNumbNow Intraosseous Injection vs Inferior Alveolar Nerve Block Injection on Mandibular First Molars

University of Detroit Mercy. Pending publication. Source: supplied manuscript. 

  • Randomized within-person comparison in 23 healthy volunteers. TNN onset 1.5 versus 8.7 minutes and injection pain 1.96 versus 3.74/10 (both P<.001). Success 100% versus 87%, not statistically significant (P=.073). 
  • TNN: 0.85 mL articaine 4%; IANB: 1.7 mL lidocaine 2%; both with epinephrine 1:100,000. Half the solution volume, but equal anesthetic mass (34 mg) and different agents. 

3. Rillaban S, Askar M, Ahmad M, Paurazas S.

Comparison of Anesthetic Efficacy of TuttleNumbNow Intraosseous Injection vs Buccal Infiltration on Healthy Mandibular First Molars.

University of Detroit Mercy School of Dentistry, Michigan. AAE 2026 conference abstract OR19. Full study pending publication, as confirmed by Gregory Tuttle on November 3, 2026. 

  • Original abstract supplied as a photograph. Prospective randomized crossover study, 24 adults, contralateral healthy mandibular first molars; each technique used 0.9 mL Septocaine 4% with epinephrine 1:100,000.
  • Success 75% TNN versus 33.33% BI. Time to maximum percentage of 80/80 readings: one versus ten minutes. At 45 minutes: 41.67% versus 8.33%. Pain VAS 4.04 versus 3.08; authors describe pain as similar. 
  • Authors conclude significantly greater TNN effectiveness, faster onset and longer duration. Abstract calls this secondary/supplemental anesthesia. Exact P values are not provided in the supplied abstract. 

4. Dolphin T, Fowler S, Drum M, Nusstein J, Reader A, Draper J.

Efficacy of the TuttleNumbNow Intraosseous Method for Pulpal Anesthesia in the Mandibular First Molar: A Prospective, Randomized, Crossover Study.

J Endod. 2024;50:406-413. https://doi.org/10.1016/j.joen.2024.01.003  

  • Published randomized crossover study, 104 healthy participants. Success 49% TNN versus 42% BI (P=.2115); does not establish superiority. 
  • Gregory Tuttle disputes whether the tested technique represented the taught protocol.
  • The published results and the founder's methodological concerns are distinct. 

5. Letter to the Editor regarding the Dolphin TNN study.

J Endod. 2024;50:878. https://doi.org/10.1016/j.joen.2024.04.010 

  • Published correspondence, not an independent trial. 

Needle mechanics and design evidence 

6. Tuttle JJ, Davidson AD, Tuttle GK.

Bending 30-gauge needles using a needle guide: fatigue life evaluation.

J Dent Anesth Pain Med. 2023;23(5):281-285. https://doi.org/10.17245/jdapm.2023.23.5.281 

  • Published laboratory study: 48 needles tested at Element Materials Technology. Mean 40.33 bends before failure, range 20-54; lumen remained patent until fracture. 
  • Supports mechanical durability under the tested conditions. Not a clinical estimate of injury/fracture risk or authorization for repeated clinical reuse. 

7. Steele AC, German MJ, Haas J, Lambert G, Meechan JG.

An in vitro investigation of the effect of bevel design on the penetration and withdrawal forces of dental needles.

J Dent. 2013;41(2):164-169. https://doi.org/10.1016/j.jdent.2012.10.016 

  • Original published laboratory experiment. Ten-mm insertion into polyvinyl siloxane required 1.80 N with the novel bevel versus 2.54 N with standard design, approximately 29% less (P<.001). 
  • Septodont's Evolution brochure reproduces the values and attributes them to Steele et al. Source: https://www.septodont.it/wp-content/uploads/sites/19/2022/12/Septoject-Evolution-Brochure-EN.pdf 
  • Effect depends on test conditions: novel bevel required more force in perpendicular thin-membrane testing. Does not establish 29% less bone penetration force or pain. Do not extend the exact percentage to TransCort or OsteoCentrale without product-specific evidence. 

8. Boynes SG.

Evaluating the advances and use of hypodermic needles in dentistry.

Compend Contin Educ Dent. 2014;35(9):649-654; quiz 656. https://pubmed.ncbi.nlm.nih.gov/25455611/ 

Patent and intellectual property documentation 

  • U.S. Patent No. 11,020,538 - "Anesthesia Needle Assembly & Methods."
    • Patent number and title supplied by Gregory Tuttle. Patent record: https://patents.google.com/patent/US11020538B2/en 
  • Included as intellectual property documentation relevant to the TNN needle assembly and development history.
    • This is identification of the patent, not an assessment of legal status or claim scope. 
  • A patent documents an invention and its claims; it is not clinical evidence of safety, efficacy, or superiority over IANB, BI, or other IO systems. 
  • Cross-references: needle-bending fatigue study (entry 6) and published product/clinical perspectives (entries 19-20).
    • The patent and these publications serve different evidentiary purposes. 

Surveys and supporting observations 

9. TNN 2017 provider survey. Internal survey with publicly reported results: 

https://tuttlenumbnow.com/pages/product-research-results 

  • 47% daily IO use after TNN;
  • 81% preference for TNN over Stabident/X-Tip among IO users;
  • 95% describe it as innovative;
  • 86% favor dental-school teaching;
  • 84% say learning was worthwhile. 
  • Internal, self-reported adoption survey; not a controlled clinical-effectiveness comparison. 

10. TNN Net Promoter Score 74.

  • Previously reported by Gregory Tuttle; provisional until date, respondent count, survey question and promoter/detractor counts are documented. 

11. Kent Tuttle CT documentation, February 26, 2020.

  • Clinical images described in Evaluation of Intraosseous Systems.
  • Potential anatomical feasibility observation; not a controlled efficacy comparison. 

Broader published IO evidence 

12. Farhad A, Razavian H, Shafiee M.

Effect of intraosseous injection versus inferior alveolar nerve block as primary pulpal anaesthesia of mandibular posterior teeth with symptomatic irreversible pulpitis: a prospective randomized clinical trial.

Acta Odontol Scand. 2018;76:442-447. https://pubmed.ncbi.nlm.nih.gov/29374995/ 

  • Sixty patients; IO success 56.7% versus IANB 23.3% (P=.008).
  • Injection pain did not differ significantly.
  • Supports an IO advantage in this setting, not a TNN-specific result. 

13. Gaudin A et al.

Comparing intraosseous computerized anaesthesia with inferior alveolar nerve block in the treatment of symptomatic irreversible pulpitis: a randomized controlled trial.

Int Endod J. 2023. https://doi.org/10.1111/iej.13935 

  • Seventy-two teeth randomized; reported success 91.43% IO versus 69.44% IANB (P=.0034). 
  • Greater maximum heart-rate increase with IO. Different delivery system from TNN.

TNN | Research & Supporting Evidence

14. Remmers T, Glickman G, Spears R, He J.

The efficacy of IntraFlow intraosseous injection as a primary anesthesia technique.

J Endod. 2008;34:280-283. https://pubmed.ncbi.nlm.nih.gov/18291275/ 

  • Thirty participants; success 87% IO versus 60% IANB, not statistically significant (P=.2148). 

15. Siwawut S, Panitvisai P.

Anesthetic efficacy of intraosseous and buccal infiltration techniques.

Chulalongkorn University Dental Journal. 2018;41(1). https://digital.car.chula.ac.th/cudj/vol41/iss1/1/ 

  • Twenty-person crossover trial: IO 1.7 mL versus BI 3.4 mL articaine.
  • Success 95% versus 80%, not significant; faster IO onset (P=.004). 

16. Efficacy and Safety of Pulpal Anesthesia Strategies during Endodontic Treatment of Permanent Mandibular Molars with Symptomatic Irreversible Pulpitis: A Systematic Review and Network Meta-analysis.

2019. https://pubmed.ncbi.nlm.nih.gov/31601433/ 

  • Forty-six studies; supplemental IO strategies ranked among the most effective, with very low to moderate confidence. Not proof of primary TNN superiority. 

17. KC K, Bhattarai BP, Subedi S.

Comparison of anesthetic efficacy of intraosseous injection with conventional inferior alveolar nerve block in mandibular third molar surgery: a systematic review and meta-analysis.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2022;133:e33-e42. https://pubmed.ncbi.nlm.nih.gov/34511344/ 

  • Four trials, 242 surgeries; no significant difference in success, onset or injection/surgical pain; IO duration approximately 56 minutes shorter. Context for benefits and limits. 

Professional endorsement 

18. Engar RC, DDS, CEO, Professional Insurance Exchange Mutual, Inc.

Signed letter to Gregory Tuttle, February 11, 2016. https://tuttlenumbnow.com/blogs/tuttle-numb-now-news/an-alternative-local-anesthesia-technique

  • Endorses TNN and identifies perceived advantages in adverse effects, waiting time, lip/tongue numbness, volume requirements and articaine use; emphasizes training/equipment.
  • Professional opinion at that date, not an insurer claims analysis or controlled comparative study. 

Published clinician perspective 

19. Tuttle GK.

Septoject Evolution: Local Anesthesia with Less Force, Less Pain

Dental Product Shopper. "Why I Use…" feature, p. 90. 

  • Founder-authored clinical perspective on needle selection, TNN development and use. Not independent clinical research.
  • The 29% insertion-force statement is now cross-referenced to Steele et al., 2013 (entry 7) and Septodont's brochure. Boynes provides a supporting review (entry 8).
  • Online article located: https://www.dentalproductshopper.com/article/why-i-use-septoject 

20. Tuttle G.

Safely Bend Needles for Improved Injections

Greg Tuttle, DDS, on Septodont's TNN Needle Guide. Inside Dentistry. January 2020. "Product Insights / Peer to Peer." 

  • Founder-authored clinical/product perspective describing TNN development beginning in 2003 and the guide's intended roles in visibility, stability, control and needle handling for mylohyoid, PDL and IO injections.
  • Describes use with Septoject Evolution 30-gauge short needles and guide-assisted bending. Documents the product's clinical rationale and historical use, rather than measured comparative safety or efficacy.
  • Cross-reference the Patent and intellectual property documentation section for U.S. Patent No. 11,020,538 and entry 6, the later 2023 needle fatigue experiment, for laboratory evidence. The two publications are separate evidence types; the 2020 feature does not itself provide fracture-rate or controlled patient-outcome data. 

Other supporting research and references 

21. Reader A, Nusstein J, Drum M.

Successful Local Anesthesia for Restorative Dentistry and Endodontics.

2nd ed. Quintessence Publishing; 2017. 

  • Textbook background on IO and supplemental anesthesia; not a direct TNN comparison. 

22. Dau M, Buttchereit I, Ganz C, Frerich B, Anisimova EN, Daubländer M, Kämmerer PW.

Influence of needle bevel design on injection pain and needle deformation in dental local infiltration anaesthesia - randomized clinical trial.

Int J Oral Maxillofac Surg. 2017;46(11):1484-1489. 

https://doi.org/10.1016/j.ijom.2017.06.013 

  • Relevant clinical research on bevel design, pain and deformation; not a TNN versus IANB/BI comparison.

23. Isen D. Product Profile:

A New Method for Intraosseus Injection: The X-Tip.

Oral Health. July 2000. 

24. Reader AW.

Successful Local Anesthesia: What Endodontists Need to Know.

American Association of Endodontists; January 24, 2017. 

25. Thangavelu K, Kannan R, Senthil Kumar N.

Inferior alveolar nerve block: Alternative technique.

Anesth Essays Res. 2012;6(1):53-57. https://doi.org/10.4103/0259-1162.103375 

  • Alternative IANB approach, not an IO or TNN study; retain as background on block technique/reliability. 

Podcast interviews and professional education 

26. Farran H, host; Tuttle GK, guest.

TuttleNumbNow with Gregory K. Tuttle, DDS.

Dentistry Uncensored with Howard Farran. Episode 913, January 3, 2018. Approximately 48 minutes.