Effectiveness of buccal infiltration anaesthesia compared to inferior alveolar nerve block anaesthesia in primary mandibular molar extractions: a randomised controlled study.

Elchaghaby, M., Aly, M. & Yousry, Y. Effectiveness of buccal infiltration anaesthesia compared to inferior alveolar nerve block anaesthesia in primary mandibular molar extractions: a randomised controlled study. Br Dent J (2023).


The successful management of pain through local anaesthetic in dental treatment greatly impacts children’s perceptions of dental care. However, despite advancements in techniques, discomfort can still occur due to tissue damage and other factors. While the inferior alveolar nerve block (IANB) is commonly used, it has limitations especially in children, including higher failure rates and risks of complications such as such as haematoma, trismus and nerve paraesthesia. Single buccal infiltration (BI) is gaining popularity for its simplicity and safety, particularly in anaesthetising mandibular deciduous molars. Lidocaine has long been the standard anaesthetic, but articaine is emerging as an effective alternative, especially in paediatric patients. However, there is no consensus on the optimal anaesthetic for children, highlighting the need for further research. The current study aims to compare the effectiveness of single BI and IANB in extractions of deciduous mandibular molars.


The described research was a clinical randomised control study and used a sample size of 112 children. Inclusion criteria comprised of children with deciduous mandibular molars requiring extraction; children with an age range of 5-8 years; medically fit (ASA I); and children who cooperated in their first dental visit. Ethical approval and informed consent were gained prior to the study. The intervention of BI and intrapapillary injection with 4% articaine was compared against IANB accompanied with long buccal infiltration with 2% lidocaine.

Pain throughout the injection and extraction was assessed using

  • Wong-Baker FACES Pain Rating Scale (W-BFPRS) for the patient’s subjective pain perception
  • Faces, Legs, Activity, Cry, and Consolability (FLACC) scale for objective pain perception by two calibrated investigators

A single operator performed the injection and extraction procedures, and the onset of the anaesthesia was recorded in minutes after the completion of the injection.

Fig 1. Flow of participants during the study.

Fig 2. Bar chart showing the distribution of W-BFPRS scores during the injection in both groups.


The study compared sex distribution, onset and duration of local anaesthesia, oxygen saturation, pulse rate, and W-BFPRS scores between the buccal infiltration (BI) and inferior alveolar nerve block (IANB) groups. In terms of sex distribution, there was no significant difference between the BI and IANB groups. However, significant differences were observed in the onset and duration of local anaesthesia, with the BI group showing quicker onset and shorter duration compared to the IANB group (p ≤ 0.001). Oxygen saturation and pulse rate showed no significant differences between the two groups at various stages of the procedure. Regarding pain assessment using W-BFPRS, there were no significant differences between the BI and IANB groups during both injection and extraction procedures, with the most frequently occurring score being 0 in both groups.


In this study, two anaesthetic techniques were compared for extracting deciduous mandibular molars, each using the most suitable anaesthetic agent. The inferior alveolar nerve block (IANB) with lidocaine is considered the gold standard due to its efficacy and low side effects, while articaine buccal infiltration (BI) is gaining popularity for its safety and effectiveness. Limitations include exclusion of children with prior dental history and those under five years old, potentially limiting generalisability. Additionally, participants and assessors could not be blinded to the anaesthetic techniques used.

In conclusion, articaine infiltration was equivalent to that of IANB with lidocaine and was considered an effective alternative in the extraction of deciduous mandibular molars. The onset of anaesthesia with articaine infiltration was faster in comparison to the lidocaine IANB but articaine infiltration produced a shorter duration of action. Regarding post-operative complications, few cases reported pain in both groups, while lip biting was reported significantly in the IANB group.

Research Summary Written By: Fiza Ahmed, University of Liverpool – BDS4

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