Comparison of the buccal injection versus buccal and palatal injection for extraction of permanent maxillary posterior teeth using 4% Articaine—A split mouth study

Abstract In spite of the development of modern injection techniques, palatal injection is still a painful experience for patients. A plethora of techniques have been tested to reduce the same. One such technique that has been claimed to work is administering Articaine on the buccal side alone for extraction of maxillary teeth due to its ability to diffuse through soft and hard tissues more reliably than other local anaesthetics. This split mouth study evaluated the efficacy of 4% Articaine with 1:100000 Adrenaline in avoiding the painful palatal injection for bilateral permanent maxillary tooth extraction on 50 patients. The 100 mm 10 point Visual Analog Scale/ Wong Baker Facial Pain Scale was used to rate the amount of pain felt on injection, on probing the tissues prior to or during extraction and 1 hour post-operatively. Although the buccal injection alone resulted in lower pain while injecting the anesthetic, it did not result in absence of pain before tooth extraction as suggested by various studies. 74% patients required a palatal injection on the study side. We conclude that in most cases, using a buccal injection alone one cannot rely on the diffusion of Articaine for effective palatal anaesthesia. Albeit, we suggest that in young patients, the operator as an initial option can consider avoiding the painful palatal injection by the use of Articaine to prevent aversion to dental treatment. Post-operatively, the difference in pain levels was not statistically significant and no patient showed signs of lesions at the injection sites.