A Combined 2% Lidocaine Anesthetic Technique for Mandibular Molar Procedures Without Inferior Alveolar Nerve Block

This prospective, single-arm pilot study was conducted to evaluate a combined local anesthetic technique for mandibular molar procedures without the use of a conventional inferior alveolar nerve block (IANB). Patients requiring dental treatment involving mandibular molars were enrolled according to predefined eligibility criteria.

Local anesthesia was administered using 2% lidocaine with 1:100,000 epinephrine and a 27-gauge short needle. The standardized technique consisted of three components: supraperiosteal, subperiosteal, and periodontal ligament (PDL) injections. Initially, 0.2 mL of anesthetic solution was administered supraperiosteally, followed by 0.2 mL subperiosteally with deeper needle penetration. PDL anesthesia was then administered on both the mesial and distal aspects of the involved tooth, using 0.5 mL of anesthetic solution at each site.

Anesthetic effectiveness was clinically assessed before and during the planned dental procedure. If adequate anesthesia was not achieved after the initial administration, the combined anesthetic protocol was repeated once. The need for additional conventional inferior alveolar nerve block anesthesia was recorded. Participants were also followed for 48-72 hours to identify any complications associated with the anesthetic technique.

The study included mandibular molars requiring restorative treatment, root canal treatment, extraction, or immediate implant placement. The study was intended to provide preliminary clinical evidence regarding the feasibility and effectiveness of this combined local anesthetic approach and to inform the design of future controlled clinical trials.

Inclusion criteria

• Patients aged 16-60 years.
• Patients requiring dental treatment involving mandibular molars.
• Patients requiring local anesthesia for the planned dental procedure.
• Patients able and willing to provide informed consent.
• For participants younger than 18 years, informed consent was obtained from a - parent or legal guardian.

Exclusion criteria

• Known allergy or hypersensitivity to lidocaine or epinephrine.
• Medical conditions contraindicating the use of lidocaine with epinephrine.
• Presence of acute infection or significant swelling at the injection site.
• Patients unable to cooperate with the dental procedure or assessment of anesthetic effectiveness.
• Patients who declined to participate or provide informed consent.