The objective of the present study was to enhance the effectiveness of anesthetic support during the operation of tooth removal on the mandible with the application of various combinations of the guided and infiltration techniques for local anesthesia taking into consideration specific anatomical and topographical features of individual tooth innervation. Material and methods. The experiments were carried out making use of the anatomical preparations (n=48). The endoscopic equipment was employed to examine the nutrient holes containing the vascular-nerve bundles of the tooth lingual surface and the retromolar triangle region of the mandible. The archival X-ray images of 325 patients (169 men and 156 women) were available for the analysis. The clinical part of the study involved 273 patients in whom the third molar (group 1) or the incisors (group 2) of the mandible were extractedfor medical reasons. Results. The archival results of computed tomography indicate that the nutrient hole of the retromolar triangle occurred significantly more frequently (p≤0.01) in the presence of the third molar than in its absence (86.1% and 6.7% respectively). The anatomical material from the retromolar triangle region showed up large nutrient holes, as a rule single ones, in the distal part of the retromolar triangle; they occurred in 23.0% of the cases in the absence of the third molars and in 100% in their absence. Local anesthesia during extraction of the mandibular third molars was performed using three combinations of the methods. In the case of mandibular anesthesia and buccal infiltration anesthesia (group 1a) the operation of extraction of the third molars was absolutely painless in 69.1% of the cases. However, this combination of the methods was characterized as the least efficient one (p≤0.01). Additional infiltration anesthesia of the retromolar triangle (group 1b) ensured the totally painless operation in 84.6% of the cases. Similar result was achieved in 95% of the cases by means of intraosseous anesthesia (p≤0.01). Bilateral lingual infiltration anesthesia during incisor extraction turned out to be significantly more efficient compared with local anesthesia (85.7% and 72.2% respectively, p≤0.01). Conclusion. Local anesthesia of the retromolar triangle with the use of the infiltration and intraosseous techniques substantially enhances the effectiveness of pain relief procedures during the removal of the third molars of the mandible. Bilateral infiltration anesthesia on the lingual and vestibular sides of the alveolar part of the mandible is especially efficacious during extraction of the mandibular incisors.