BACKGROUND: Treatment of teeth affected with molar incisor hypomineralization (MIH) in young patients is challenging due to chronic subclinical pulpal inflammation caused by porous enamel and exposed dentin. Hypersensitivity of the teeth and difficulty in achieving local anesthesia due to altered nerve potential affects the successful completion of the treatment.
OBJECTIVE: The aim of the study was to compare the anesthetic efficacy of the intraosseous (IO) anesthetic technique with conventional local infiltration technique in anesthetizing first permanent molars (FPMs) affected by MIH for restorative procedures in children.
METHODS: This randomized controlled clinical trial recruited 54 MIH-affected mandibular or maxillary FPMs requiring restorations or stainless steel crowns. The teeth were randomly allocated to two equal groups to receive either IO injection or buccal infiltration (control), both using 4% articaine. Onset, time required, and pain experienced for administration, need for repeat, efficacy of anesthetic technique, heart rate, and postoperative complications were recorded in both the groups. Collected data were subjected to statistical analysis.
RESULTS: Onset was significantly faster and pain experienced during administration was significantly lower with IO technique. Need for repeat of anesthesia was significantly more with infiltration (44.4% vs. 7.4% in IO, P = 0.004). Local infiltration failed to produce profound anesthesia in 74.1% MIH-affected teeth. IO anesthesia profoundly anesthetized 88.9% MIH-affected teeth. Anesthetic efficacy was significantly better with IO anesthesia (P < 0.001). Postoperative complications were significantly lower with IO anesthesia (P = 0.003).
CONCLUSIONS: IO local anesthesia was found to be an effective and safe technique to achieve profound anesthesia in MIH-affected teeth in children in comparison to local infiltration.

BACKGROUND: The inferior alveolar nerve block (IAN) is the most frequently used mandibular injection technique for achieving local anesthesia in endodontics. Supplemental injections are essential to overcome failure of IAN block in patients with irreversible pulpitis.
OBJECTIVE: To evaluate the anesthetic efficacy of X-tip intraosseous injection (2% lidocaine with 1:80,000 epinephrine) in patients with irreversible pulpitis in mandibular posterior teeth when conventional IAN block failed.
METHODS: Thirty emergency patients diagnosed with irreversible pulpitis in a mandibular posterior tooth received an IAN block and experienced moderate to severe pain on endodontic access or initial instrumentation. The X-tip system was used to administer 1.8 ml of 2% lidocaine with 1:80,000 epinephrine. The success of X-tip intraosseous injection was defined as none or mild pain (Heft-Parker visual analogue scale ratings < 54 mm) on endodontic access or initial instrumentation.
RESULTS: Ninety-three percent of X-tip injections were successful and 7% were unsuccessful. Discomfort rating for X-tip perforation: 96.66% patients reported none or mild pain, whereas 3.34% reported moderate to severe pain. For discomfort rating during solution deposition, 74.99% patients reported none or mild pain and 24.92% reported moderate to severe pain. Ninety-six percent of the patients had subjective/objective increase in heart rate.
CONCLUSIONS: Supplemental X-tip intraosseous injection using 2% lignocaine with 1:80,000 epinephrine has a statistically significant influence in achieving pulpal anesthesia in patients with irreversible pulpitis.