Effect of laser-assisted articaine local anesthesia in single visit root canal treatment for mandibular molar with symptomatic irreversible pulpitis - A randomized clinical trial

Aim: To evaluate the anesthetic efficacy of inferior alveolar nerve block (IANB) with 4% articaine versus laser-assisted articaine supplementation for profound pulpal anesthesia during single-visit root canal treatment (RCT) of the mandibular molars with symptomatic irreversible pulpitis. Materials and Methods: This prospective double-blinded randomized controlled trial enrolled 64 patients (aged 18–55 years) with clinically/radiographically confirmed symptomatic irreversible pulpitis in the mandibular molars. After standard IANB (1.8 mL 4% articaine 1:100,000 epinephrine), patients with persistent moderate–severe pain (Visual Analog Scale [VAS]: ≥4) were randomized into two groups ( n = 32 each). The laser group received a 980-nm diode laser (1.5 W, continuous wave, noncontact, 60–180 s/canal, 10–30 J/cm²) at the apical third. The control group received supplementary intraligamentary (0.2–0.4 mL/canal) and buccal infiltration with articaine. Primary outcomes were pre operative and intraoperative pain (VAS:0-10). Secondary outcomes were supplemental anesthesia needs and treatment success. Wilcoxon signed-rank test (intragroup) and Mann–Whitney U -test (intergroup) tests ( P < 0.05, SPSS v. 25) were used for statistical analysis. Results: The mean age was 33.97 ± 12.07 years in the diode laser group and 38.66 ± 12.22 years in the articaine group, with comparable gender distribution between groups. Preoperative pain scores were similar (median = 8; P = 0.320). Intraoperatively, the laser group demonstrated significantly lower pain scores (median = 0, IQR 0–1) compared with the articaine group (median = 3, IQR 2–4; P < 0.01). Both groups showed a significant reduction in pain from preoperative to intraoperative periods ( P < 0.01). All cases completed single-visit without adverse effects. Conclusion: The 980-nm diode laser significantly enhances IANB over articaine infiltration, providing superior pain control for single-visit RCT in irreversible pulpitis.