title: Pulpal anaesthesia for mandibular permanent first molar teeth: a double-blind randomized cross-over trial comparing buccal and buccal plus lingual infiltration injections in volunteers.
abstract: OBJECTIVE
  To compare the efficacy of buccal and buccal plus lingual infiltration anaesthesia for permanent mandibular first molars.
  
  
  METHODS
  Thirty one healthy adult volunteers received each of the following methods of anaesthesia for a mandibular first molar tooth in a randomised order, 1) Buccal infiltration of 1.8 mL and needle penetration lingually. 2) Buccal infiltration of 0.9 mL, plus lingual infiltration of 0.9 mL. Two percent lidocaine with 1:100,000 epinephrine was used. Electrical pulp testing was performed before, and every 2 minutes for 30 minutes after injection. A successful outcome was recorded as the absence of pulp sensation on two or more consecutive maximal pulp tester stimulations (80 microA). Injection discomfort was assessed using visual analogue scales. Data were compared with McNemar and Wilcoxon Signed Ranks tests.
  
  
  RESULTS
  Buccal infiltration was successful in 38.7% of cases compared to 32.3% after combined infiltrations; the difference was not significant (P = 0.63). Buccal infiltration produced more episodes of no response to maximum stimulation than buccal and lingual infiltrations (129 and 114 respectively), this difference was not significant (P = 0.11). Peak anaesthetic effect occurred around 10-14 minutes after injection. There was no difference in injection discomfort between buccal injections of 0.9 mL and 1.8 mL of solution (P = 0.90). Lingual injection was more uncomfortable than lingual penetration (P = O.O02).
  
  
  CONCLUSIONS
  Buccal and buccal plus lingual infiltrations did not differ in their efficacy in producing anaesthesia of permanent first molar teeth.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Newcastle upon Tyne, Newcastle upon Tyne, UK. j.g.meechan@ncl.ac.uk
authors.forename: J G
authors.initials: JG
authors.lastname: Meechan
authors.forename: M D
authors.initials: MD
authors.lastname: Kanaa
authors.forename: I P
authors.initials: IP
authors.lastname: Corbett
authors.forename: I N
authors.initials: IN
authors.lastname: Steen
authors.forename: J M
authors.initials: JM
authors.lastname: Whitworth
mesh_terms: D000328:Adult; D000766:Anesthesia, Dental / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D018592:Cross-Over Studies; D003782:Dental Pulp / Q000187:drug effects*; D003791:Dental Pulp Test; D019229:Dentition, Permanent; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008036:Lingual Nerve; D008297:Male; D008334:Mandible; D008340:Mandibular Nerve; D008963:Molar; D009061:Mouth Mucosa; D012390:Root Canal Therapy; D018709:Statistics, Nonparametric; D014059:Tongue
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine