Comparison of infiltration and inferior alveolar block anesthesia techniques in controlling pulpotomy pain in the primary mandibular first molars

Pain control is of utmost importance in all dentistry fields. Anesthetic injection is perhaps the most difficult part of treatment in children. The most common anesthesia technique in the mandible is the inferior alveolar nerve block. As the block injection has a lasting anesthetic effect in children and also might cause traumatic injuries to soft tissues a different injection technique is needed. This study compared infiltration and block techniques for pain control during pulpotomy in the primary first mandibular molars. In this clinical study forty 5-8 year-old children were chosen. The subjects needed bilateral pulpotomy of primary mandibular first molars. This study was conducted based on a cross-over design. The patients were randomly divided into two groups. The patients in group A received an infiltration injection on the right side and a block injection on the left during the first and second sessions, respectively. The patients in group B received a block injection on the right side and an infiltration injection on the left during the first and second sessions, respectively. The patient pain was recorded at the moment of injection and on pulp exposure based on SEM (Sound Eye Molar) scale. Data was analyzed by Mann-Whitney U and Wilcoxon signed-rank tests. Statistical significance was defined at α = 0.05. The results showed that at the moment of injection the SEM in the infiltration technique was significantly lower than that in the block technique, which demonstrates that the child can better tolerate the pain in the infiltration injection (p value < 0.001). However, the two techniques did not show significant differences in pulpal anesthesia based on the SEM scale. It seems the infiltration technique is superior to the block technique in controlling pain during pulpotomy in the mandibular primary first molars in 5-8 year-old children.