Comparing anesthetic efficacy of intraosseous injection versus buccal infiltration in mandibular first molar

Abstract

Aim: To compare the anesthetic efficacy between intraosseous injection and buccal infiltration when used as a primary anesthesia technique for mandibular first molars. Methodology: Using a crossover design, 20 adult subjects randomly received intraosseous injection of 1.7 mL 4% articaine with 1:100,000 epinephrine or buccal infiltration of 3.4 mL 4% articaine with 1:100,000 epinephrine at 2 separate appointments. The mandibular first molars were tested with an electric pulp tester at 3-minute cycles for 60 minutes after the injections. Successful pulpal anesthesia was defined as no response from the subject on two consecutive pulp tester readings of 80. Pain ratings for each injection were recorded. The data were analyzed using the McNemar and Wilcoxon signed ranks tests. Results: The success rate for the intraosseous injections and buccal infiltrations were 95% and 80%, respectively. There was no significant difference in success rate between the anesthetic techniques (P > 0.05). However, the onset of pulpal anesthesia was significantly faster with the intraosseous injections (P < 0.05). No significant differences were found between the two techniques for injection pain or postoperative pain (P > 0.05). Conclusions: The anesthetic success rate of buccal infiltration using 2 cartridges of 4% articaine with 1:100,000 epinephrine is comparable to that of intraosseous injection using a single cartridge of 4% articaine with 1:100,000 epinephrine in asymptomatic mandibular first molars. Both techniques can be useful alternatives for inducing mandibular first molar anesthesia.