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Patient’s pain perception during mandibular molar extraction with articaine: a comparison study between infiltration and inferior alveolar nerve block



The aim of this study was to investigate the effectiveness of a local anesthetic agent comprising of 4 % articaine with 1:100,000 adrenaline, administered through an infiltration technique prior to the extraction of mandibular permanent first molar teeth.

Materials and methods

The study adopted a split mouth approach and involved patients who needed simple extractions of permanent mandibular first molar teeth on both sides. A combination of buccal and lingual infiltrations was used on one side, while the conventional inferior alveolar nerve block (IANB) technique, with a 1.8-ml cartridge of 4 % articaine with 1:100,000 epinephrine, was administered to the other. The patients’ pain perception was assessed using visual analogue scale (VAS) and verbal rating scale (VRS) after the injection, followed by extraction.


As a part of the study, 104 teeth were extracted from mouths of 52 patients. The difference in pain perception was statistically insignificant (p > .05) regarding the local anesthetic injection between the two techniques. The difference in pain perception regarding the extraction between the two techniques was also statistically insignificant (p < .05).


No difference in pain perception between the two techniques among the study population was noted. This indicates that the extraction of permanent mandibular first molar teeth is possible without the administration of an IANB with the use of 4 % articaine with 1:100,000 epinephrine.

Clinical relevance

The buccal and lingual infiltrations are slightly less painful than the conventional IANB technique.

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Corresponding author

Correspondence to Anwar B. Bataineh.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


This study received no funding.

Conflict of interest

The authors declare that they have no competing interests.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Cite this article

Bataineh, A.B., Alwarafi, M.A. Patient’s pain perception during mandibular molar extraction with articaine: a comparison study between infiltration and inferior alveolar nerve block. Clin Oral Invest 20, 2241–2250 (2016).

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  • Infiltration
  • Inferior alveolar nerve block
  • Articaine
  • Mandibular first molar
  • Tooth extraction