Propel. Connect. Smile.

Achieving profound pulpal anesthesia in teeth with Molar Incisor Hypomineralization (MIH) and deep caries is a significant clinical challenge. In young permanent teeth, porous enamel and wide dentinal tubules facilitate bacterial penetration, leading to subclinical chronic pulpal inflammation, increased neural density, and nerve sensitization. Research indicates conventional techniques, such as the inferior alveolar nerve block (IANB), often fail, with success rates as low as 26.7% in pediatric patients with deep caries.

To overcome these failures, supplemental techniques are essential. For mandibular teeth, supplemental buccal infiltration (SMBI) or intraligamentary injections (SII) improve preoperative success, though intraoperative pain still occurs. In the maxilla, intraseptal infiltration (ISI) may serve as a less painful, effective alternative to palatal injections. Pharmacological adjuncts further enhance results. Preemptive ibuprofen combined with nitrous oxide/oxygen inhalation significantly increases pulpal anesthetic success compared to standard protocols. This presentation explores integrated strategies involving advanced injection techniques and pharmacological management to ensure pain-free treatment and improved outcomes for children with MIH.