Buccal Articaine Infiltration as a Minimally Invasive Technique for Mandibular Primary Molars: A Systematic Review

Background/Objectives: Effective pain control is essential for successful dental treatment in children. Although the inferior alveolar nerve block remains the standard technique for achieving mandibular anesthesia, it is associated with injection discomfort, prolonged soft tissue numbness, and an increased risk of postoperative self-inflicted soft tissue injury. Buccal infiltration with 4% articaine has emerged as a promising minimally invasive alternative because of its favorable diffusion properties. This systematic review aimed to evaluate the clinical efficacy of buccal infiltration with 4% articaine for local anesthesia of primary mandibular molars in pediatric patients. Methods: This systematic review was conducted according to the PRISMA 2020 guidelines. Electronic databases were searched to identify randomized controlled clinical trials evaluating buccal infiltration with 4% articaine in primary mandibular molars. Owing to methodological heterogeneity, the findings were synthesized qualitatively. Results: Five randomized controlled trials met the eligibility criteria. Buccal infiltration with 4% articaine demonstrated high anesthetic success and was generally associated with comparable pain scores, favorable patient comfort, and favorable postoperative outcomes compared with conventional anesthetic techniques. However, heterogeneity was observed in clinical procedures, comparator interventions, and outcome assessment methods. Conclusions: Current evidence suggests that buccal infiltration with 4% articaine is an effective and clinically comparable, minimally invasive anesthetic technique for selected procedures involving primary mandibular molars in children.