Efficacy of Articaine with Single Buccal Infiltration in Extraction of Maxillary Molars in Pediatric Patients

extraction of primary maxillary molars in pediatric patients.Given the differences in pediatric bone morphology-specifically, thinner and more porous maxillary bone-buccal infiltration of articaine may provide sufficient anesthesia without the need for additional palatal injections.7 The present study aims to evaluate and compare the efficacy of articaine administered via buccal infiltration alone for the extraction of deciduous maxillary molars.This investigation seeks to determine whether articaine can offer effective, less invasive anesthesia in pediatric dental practice, potentially reducing the need for multiple injections and improving patient comfort. IntroductIonPain management during pediatric dental procedures, especially extractions, is critical for ensuring patient cooperation and reducing procedural anxiety.Local anesthesia is the mainstay of pain control during extractions of deciduous teeth, with lidocaine commonly used in both infiltration and nerve block techniques. 1 In spite of many advances in drug delivery systems, administering local anesthesia through a needle is still the most common practice, which in children provokes anxiety, triggering a cascade of behavioral reactions.The various factors contributing to pain during local anesthesia injection include the size of the needle, the local anesthetic agent, and the rate of injecting local anesthesia.However, achieving profound anesthesia in the maxillary molar region of children often requires both buccal and palatal infiltrations, the latter of which is frequently painful and distressing for pediatric patients due to dense vascularization, innervation of the palatal mucosa, and its strong attachment to bone. 2 Articaine, an amide-type local anesthetic formulated by Rusching et al. in 1969 with a thiophene ring and an ester group, has been shown to possess enhanced lipid solubility and bone penetration properties compared to lidocaine.3 These pharmacological advantages allow articaine to diffuse effectively through soft and hard tissues, potentially enabling successful anesthesia with buccal infiltration alone, even in areas traditionally thought to require palatal injections.4 It was reported by Winther and Nathalang 5 that articaine with buccal administration seems to have penetrated the bone to the opposite palatal side, resulting in effective anesthesia in adults, thus reducing the need for palatal infiltration, which could be advantageous for children's experience and cooperation.Although several studies in adult populations support the efficacy of articaine buccal infiltration for posterior maxillary teeth extractions, 6 limited data exist regarding its performance in the