Pain perception and anesthetic efficacy of buffered articaine in maxillary molar buccal infiltration: A randomized controlled trial

Aim: This study aimed to evaluate pain perception and anesthetic efficacy of 4% buffered articaine in maxillary molar buccal infiltration in patients with symptomatic irreversible pulpitis. Secondary objectives were to compare the burning sensation during solution deposition and the need for supplemental injections. Methods: This double-blind randomized controlled trial involved 40 patients who were randomly distributed into two groups. Group 1 was 4% articaine, and Group 2 was 4% buffered articaine. For preparation of buffered articaine, 0.17 ml of 8.4% sodium bicarbonate solution was added. Single buccal infiltration was administered. During the needle insertion and solution deposition phase, the operator notified the patient when each phase was completed, and the patient instantly rated the pain perception using Visual Analog Scale. The onset of pulpal anesthesia was checked 30 s after injecting articaine with an electric pulp tester (EPT). Data normality was tested using Shapiro–Wilk test. The mean pain scores were compared using Mann–Whitney Wilcoxon test. Statistical significance was defined as P < 0.05 with 95% confidence intervals. Results: Pain perception during solution deposition was significantly lower with buffered articaine (P < 0.0001). The average onset time for articaine was 60 s, and buffered articaine was 30 s with a statistically significant difference (P = 0.0001). Burning sensation while local anesthetic administration was completely absent with buffered articaine (P = 0.001). Conclusions: A single buccal infiltration of 4% buffered articaine in the maxillary first molar resulted in reduced injection pain, decreased burning sensation, and more rapid onset of anesthesia.