Open AccessOriginal Article Anesthetic Efficacy of Supplemental Buccal Infiltration as Compared to Intraligamentary Injection in Treating Mandibular Second Molars with Irreversible Pulpitis
DOI:
https://doi.org/10.51253/pafmj.v75iSUPPL-6.13193Keywords:
Anesthetic efficacy, Buccal infiltration, Intraligamentary injection, Irreversible pulpitis, Mandibular molars, Visual Analogue Scale.Abstract
Objective: To compare the anesthetic efficacy of supplemental buccal infiltration (BI) and intraligamentary (IL) injections in treating mandibular second molars with irreversible pulpitis in the Pakistani population.
Study Design: Quasi experimental study.
Place and Duration: Department of Operative Dentistry and Endodontics, Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, from Apr 2024 to Oct 2024.
Methodology: This study included 100 participants (median age: 30 years) divided into two groups: IL group and BI group. Patients received standardized local anesthesia protocols, and pain levels were recorded using the Visual Analog Scale (VAS). Pain levels were classified as mild, moderate, or severe, and the success rate of anesthesia was evaluated.
Results: The IL group showed significantly lower pain levels (median VAS: 38.00(31.00–41.00)) compared to the BI group (median VAS: 65.50(40.00–87.00)). Severe pain was reported by 21(42.0%) participants in the BI group versus none in the IL group (p<0.001). The IL technique had a higher success rate of 45(90.0%) compared to 22(44.0%) in the BI group (p<0.001), indicating its superior efficacy.
Conclusion: Intraligamentary injections with 4% Articaine provide more effective anesthesia and higher success rates compared to buccal infiltrations for mandibular second molars with irreversible pulpitis. These findings suggest that IL injections are a preferable supplemental technique for profound anesthesia in such cases. Further studies are recommended to validate these findings.
Downloads
References
1. Falatah AM, Almalki RS, Al-Qahtani AS, Aljumaah BO, Almihdar WK, Almutairi AS. Comprehensive Strategies in Endodontic Pain Management: An Integrative Narrative Review. Cureus 2023; 15(12): e50371.
https://doi.org/10.7759/cureus.50371
2. Santos-Puerta N, Peñacoba-Puente C. Pain and Avoidance during and after Endodontic Therapy: The Role of Pain Anticipation and Self-Efficacy. Int J Environ Res Public Health 2022; 19(3).
https://doi.org/10.3390/ijerph19031399
3. Maurya S, Kaur CK, Rajput A, Kumar U. Pain management during endodontic treatment of mandibular posterior teeth: a narrative review. Journal of Oral and Maxillofacial Anesthesia. 2024; 3
4. Grant R, Brown T, Young L, Lamont T. How can local anaesthesia be improved in the management of irreversible pulpitis? Evid Based Dent. 2021; 22(1): 26-27.
https://doi.org/10.1038/s41432-021-0151-9
5. Gufran K, Mirza MB, Robaian A, Alqahtani AS, Alqhtani NR, Alasqah M et al. A Prospective Clinical Study Evaluating the Efficacy of Intra-Ligamentary Anesthetic Solutions in Mandibular Molars Diagnosed as Symptomatic Irreversible Pulpitis with Symptomatic Apical Periodontitis. Healthcare (Basel) 2022; 10(8).
https://doi.org/10.3390/healthcare10081389
6. Saber SM, Hashem AA, Khalil DM, Pirani C, Ordinola-Zapata R. Efficacy of four local anaesthesia protocols for mandibular first molars with symptomatic irreversible pulpitis: A randomized clinical trial. Int Endod J 2022; 55(3): 219-30.
https://doi.org/10.1111/iej.13667
7. Gandhi N, Shah N, Wahjuningrum DA, Purnomo S, Nooshian R, Arora S et al. Evaluation of pulpal anesthesia and injection pain using IANB with pre-heated, buffered and conventional 2% lignocaine in teeth with symptomatic irreversible pulpitis-a randomized clinical study. PeerJ 2022; 10: e14187.
https://doi.org/10.7717/peerj.14187
8. Penukonda R, Choudhary S, Singh K, Sharma A, Pattar H. Intrapulpal anesthesia in endodontics: an updated literature review. J Dent Anesth Pain Med 2024; 24(4): 265-72. https://doi.org/10.17245/jdapm.2024.24.4.265
9. Gopakumar R, Jayachandran M, Varada S, Jayaraj J, Ezhuthachan Veettil J, Nair NS. Anesthetic Efficacy of Endo-Ice and Intrapulpal Ice Sticks After Inferior Alveolar Nerve Block in Symptomatic Irreversible Pulpitis: A Randomized Controlled Study. Cureus 2023; 15(7): e42135.
https://doi.org/10.7759/cureus.42135
10. Monteiro MR, Mourão CF, Volpato MC, Groppo FC, Haiter-Neto F, Sacco R et al. Clinical Evaluation of Buccal Infiltration with Articaine for Endodontic Anesthesia in Mandibular Molars with Irreversible Pulpitis. Oral 2024; 4(4): 525-537.
11. Alayfan G, Alshebel A, Sayed FR, Peeran SA, Ustad F, Bhavikatti SK et al. A Comparative Evaluation Of The Anesthetic Efficacy Of Buccal Infiltration And Intraligamentary Injection Using 4% Articaine In Adult Patients With Irreversible Pulpitis of maxillary first molar teeth: an in-vivo study. Turkish Journal of Physiotherapy and Rehabilitation.32:3
12. Gazal G, Bahabri R, Alolayan AB, Alkayyal M, Al-Ghamdi R, Salamah R et al. How Successful is Supplemental Intraseptal and Buccal Infiltration Anaesthesia in the Mandibular Molars of Patients Undergoing Root Canal Treatment or Tooth Extraction? J Oral Maxillofac Res 2020; 11(1): e5.
https://doi.org/10.5037/jomr.2020.11105
13. Dianat O, Mozayeni MA, Layeghnejad MK, Shojaeian S. The efficacy of supplemental intraseptal and buccal infiltration anesthesia in mandibular molars of patients with symptomatic irreversible pulpitis. Clin Oral Investig 2020; 24(3): 1281-1286.
https://doi.org/10.1007/s00784-019-03006-8
14. Fowler S, Drum M, Reader A, Beck M. Anesthetic Success of an Inferior Alveolar Nerve Block and Supplemental Articaine Buccal Infiltration for Molars and Premolars in Patients with Symptomatic Irreversible Pulpitis. J Endod 2016; 42(3): 390-392.https://doi.org/10.1016/j.joen.2015.12.025
15. Nusstein J, Claffey E, Reader A, Beck M, Weaver J. Anesthetic effectiveness of the supplemental intraligamentary injection, administered with a computer-controlled local anesthetic delivery system, in patients with irreversible pulpitis. J Endod 2005; 31(5): 354-358.
https://doi.org/10.1097/01.don.0000140565.88940.60
16. Parirokh M, Sadr S, Nakhaee N, Abbott PV, Askarifard S. Efficacy of supplementary buccal infiltrations and intraligamentary injections to inferior alveolar nerve blocks in mandibular first molars with asymptomatic irreversible pulpitis: a randomized controlled trial. Int Endod J 2014; 47(10): 926-933.
https://doi.org/10.1111/iej.12236
17. Shahi S, Rahimi S, Yavari HR, Ghasemi N, Ahmadi F. Success Rate of 3 Injection Methods with Articaine for Mandibular First Molars with Symptomatic Irreversible Pulpitis: A CONSORT Randomized Double-blind Clinical Trial. J Endod 2018; 44(10): 1462-1466.
https://doi.org/10.1016/j.joen.2018.07.010
18. Fan S, Chen WL, Pan CB, Huang ZQ, Xian MQ, Yang ZH, et al. Anesthetic efficacy of inferior alveolar nerve block plus buccal infiltration or periodontal ligament injections with articaine in patients with irreversible pulpitis in the mandibular first molar. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108(5): e89-93. https://doi.org/10.1016/j.tripleo.2009.06.012
19. Zargar N, Shojaeian S, Vatankhah M, Heidaryan S, Ashraf H, Akbarzadeh Baghban A et al. Anesthetic efficacy of supplemental buccal infiltration versus intraligamentary injection in mandibular first and second molars with irreversible pulpitis: a prospective randomized clinical trial. J Dent Anesth Pain Med 2022; 22(5): 339-348.
https://doi.org/10.17245/jdapm.2022.22.5.339
20. Dias-Junior LCL, Bezerra AP, Schuldt DPV, Kuntze MM, de Luca Canto G, da Fonseca Roberti Garcia L, et al. Effectiveness of different anesthetic methods for mandibular posterior teeth with symptomatic irreversible pulpitis: a systematic review and meta-analysis. Clin Oral Investig 2021; 25(12): 6477-500.
https://doi.org/10.1007/s00784-021-04145-7
21. Kanaa MD, Whitworth JM, Meechan JG. A prospective randomized trial of different supplementary local anesthetic techniques after failure of inferior alveolar nerve block in patients with irreversible pulpitis in mandibular teeth. J Endod 2012; 38(4): 421-425. https://doi.org/10.1016/j.joen.2011.12.006
Downloads
Published
License
Copyright (c) 2025 Syed Shan E Haider Naqvi, Nadeem Ahmad Rana, Hafiz Rabbi ul Ehsan, Shumaila Maryum, Talha Khurshid, Naseem Azad

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.