Comparison of Anesthetic Effectiveness of Buccal Infiltration Alone Versus Combined Buccal and Palatal Infiltration in Symptomatic Maxillary First Molars Undergoing Root Canal Treatment: A Randomized Controlled Trial
Year: 2026
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: Background: Achieving profound pulpal anesthesia in teeth with symptomatic irreversible pulpitis remains a significant challenge in endodontic practice. Although buccal infiltration is routinely used for maxillary molars, the additional benefit of palatal infiltration remains controversial. Objective: To compare the anesthetic effectiveness of buccal infiltration alone versus combined buccal and palatal infiltration during root canal treatment of symptomatic maxillary first molars diagnosed with irreversible pulpitis. Methodology: This parallel-group randomized controlled trial was conducted in the Department of Operative Dentistry, CIMS Dental College, Multan, Pakistan, from December 2024 to June 2025. A total of 226 patients aged 18–50 years with symptomatic irreversible pulpitis of a maxillary first molar were enrolled and randomly allocated into two equal groups (n = 113 each). Group A received buccal infiltration anesthesia alone, whereas Group B received combined buccal and palatal infiltration using 2% lidocaine with 1:200,000 epinephrine. Pain during access cavity preparation and root canal instrumentation was assessed using a Visual Analog Scale (VAS). Anesthetic success was defined as complete absence of pain (VAS = 0) during treatment. Data were analyzed using independent-samples t-tests and chi-square tests. Results: The study groups were comparable with respect to age (35.68 ± 9.08 vs. 34.72 ± 9.70 years; p = 0.44) and gender distribution (p = 0.59). Patients receiving combined buccal and palatal infiltration reported significantly lower pain scores compared with those receiving buccal infiltration alone (2.58 ± 1.62 vs. 4.26 ± 2.02; p < 0.001). Furthermore, anesthetic success was achieved in 69.0% of patients in the combined infiltration group compared with 52.2% in the buccal-only group (p = 0.01). Conclusion: Combined buccal and palatal infiltration provides significantly greater anesthetic effectiveness and superior pain control than buccal infiltration alone during endodontic treatment of symptomatic maxillary first molars with irreversible pulpitis. Keywords: Buccal Infiltration, Irreversible Pulpitis, Local Anesthesia, Maxillary First Molar, Palatal Infiltration, Root Canal Treatment.
Source: Journal of Saidu Medical College
Language: English
Subfield: Oral Surgery
Field: Dentistry
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7171614594