Comparison of laser-assisted and intrapulpal local anesthesia for intra- and postoperative pain management in mandibular molars: A randomized clinical trial.

Background: Intraoperative pain control in mandibular molars with symptomatic irreversible pulpitis remains a challenge, particularly when nerve blocks fail. This study aimed to compare the effectiveness of intrapulpal and laser-assisted local anesthesia in controlling intraoperative and postoperative pain during single-visit root canal treatment. Materials and Methods: One hundred and forty-three patients with symptomatic irreversible pulpitis in mandibular molars expressing pain on access opening were included. Patients were randomly allocated to receive either intrapulpal or laser-assisted anesthesia. Pain was assessed using the Visual Analog Scale (VAS) at predefined time points. Data were analyzed using statistical tests. Results: Both groups produced a marked reduction in intraoperative pain. Mean VAS scores decreased from 6.69 ± 1.22 to 1.23 ± 1.40 in the laser group and from 6.31 ± 1.35 to 1.32 ± 1.40 in the intrapulpal group. Pain levels were low during biomechanical preparation in both groups, with no significant difference. At 24 h, pain scores were comparable between both groups, but at 48 h, the laser group demonstrated significantly lower scores. Conclusion: Both intrapulpal and laser-assisted local anesthesia are effective techniques for managing intraoperative pain in mandibular molars with symptomatic irreversible pulpitis. Laser-assisted anesthesia may serve as a better-tolerated alternative, with significantly less postoperative pain at 48 h.