Palatal + buccal infiltration along with Articaine 4% effectively anesthetizes upper first molars with symptomatic apical periodontitis, overcoming the limitations of standard buccal infiltration.

To distinguish the anesthetic effectiveness of buccal and buccal plus palatal infiltration anesthesia using Lidocaine hydrochloride 2% and Articaine 4% in treating symptomatic apical periodontitis (SAP) in maxillary first molars.

A total of 123 patients (mean age 33 years) with SIP were randomly allocated to 3 treatment groups, with 41 patients in each group.

• Group 1 (BIL group): Buccal infiltration with Lidocaine 2% with Adrenaline (Epinephrine) 1:80,000 dilution
• Group 2 (BPIL group): Buccal + palatal infiltration with Lidocaine 2% with Adrenaline (Epinephrine) 1:80,000 dilution
• Group 3 (BIA group): Buccal infiltration with Articaine 4% with Adrenaline (Epinephrine) 1:100,000 dilution

The Heft-Parker Visual Analog Scale (HP-VAS) assessed the pain levels before and after local anesthesia use during the endodontic procedure (removal of carries, access preparation and removal of pulp).

The chi-square tests examined the anesthetic effectiveness, whereas the age variations were analyzed with the help of one-way analysis of variance.

One hundred and seventeen patients were included in the final analysis. Greater success (no pain (0 mm) or mild pain (0–54 mm) during the procedure) was detected in group 2 (85%) than in group 1 (69%) and group 3 (74%), however the change was statistically non-significant (p > 0.05). No significant gender difference was also observed.

Combining palatal and buccal infiltration with Articaine 4% can offer superior anesthesia comparable to the typical buccal infiltration for patients experiencing endodontic procedures in their upper first molars.