• Siwaporn Siwawut, D.D.S.
• Piyanee Panitvisai, D.D.S, M.D.Sc. (Endodontics), Diplomate, Thai Board of Endodontics*

Background/objectives This randomized controlled crossover clinical trial aimed to compare the
anesthetic efficacy between intraosseous and buccal infiltration techniques as a primary anesthesia for
mandibular first molars.

Materials and methods Twenty 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 for anesthesia with an
electric pulp tester at 3-minute cycles for 60 minutes after the injections. Pain ratings for each injection
were recorded. The data were analyzed using the McNemar and Wilcoxon signed ranks tests.

Results There was no significant difference (p = 0.250) in success rate between the intraosseous
injections (95%) and buccal infiltrations (80%). However, the onset of pulpal anesthesia was
significantly faster with the intraosseous injections (p = 0.004). No significant differences were found
for injection or postinjection pain (p > 0.05).

Conclusion The success rate of buccal infiltration using two 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.

(CU Dent J. 2018;41:1-12)