Should Maxillary Buccal Infiltration Anesthesia be Given in a Closed Mouth Technique?

Background: Local anesthesia is an essential part of dentistry. The most commonly used technique to anesthetise maxillary posterior teeth is buccal infiltration with a local anesthetic agent. The technique described in the literature focuses on the location of injection, the direction of the needle insertion in relation to the root apex, the direction of needle bevel in relation to the cortical bone plate, the size of needle and the type and amount of the local anesthetic agent used. However, there is no mention to whether the patient should open their mouth or maintain their teeth in intercuspation during the injection procedure.

Aims: This research aims to a) compare two techniques of injection (open and closed-mouth techniques) in terms of the discomfort experienced by patients during the injection procedure and b) evaluate the dentists' preference in performing either of the two techniques.

Inclusion criteria

• Adult patients (16 years old and older)
• Healthy (American Society of Anaesthesiologists (ASA) category I or II)
• A maxillary posterior tooth (excluding third molars) referred for root canal treatment and diagnosed with irreversible pulpitis and normal apical tissues

Exclusion criteria

• Psychological disorders
• Intraoral soft tissue abnormalities
• necrotic pulp with/ without apical pathology
• tenderness to palpation and/or percussion
• The use of analgesics in the preceding 12 hours before the appointment.