Pain and Supplemental Anaesthesia in Mandibular Molar Root Canal Therapy: A Prospective Cohort Analysis of Bone Anatomy and Diagnostic Variables

Published on July 16, 2026

Aust Endod J. 2026 Jul 15. doi: 10.1111/aej.70107. Online ahead of print.

ABSTRACT

Achieving profound local anaesthesia during mandibular molar root canal treatment can be challenging. This study evaluated procedural pain and supplemental anaesthesia used, considering endodontic diagnosis and buccal bone morphology. Seventy-seven patients undergoing primary root canal treatment completed a post-treatment survey questionnaire asking appointment associated questions relating to pain and fear. Providers used a standardized anaesthetic protocol with supplemental injections as needed. Data were compared with demographic, diagnostic, and radiographic variables. Supplemental anaesthesia was required in 14% of cases. Patients reported no procedural pain in the majority of cases (73%), and felt adequately numb during the procedure in nearly all cases (95%). Sixty-five percent of patients rated the experience better than expected. Buccal bone thickness showed no significant association with pain or need for supplemental anaesthesia. Overall, an inferior alveolar nerve block with lidocaine and supplemental buccal articaine infiltration achieved a high success of profound local anaesthesia.

PMID:42458676 | DOI:10.1111/aej.70107

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