Distolingual Infiltration Verses Conventional Nerve Block in Mandibular Third Molar Extraction

Comparison of Efficacy of Distolingual Infiltration in Conjugation With Conventional Inferior Alveolar Nerve Block to Conventional Inferior Alveolar Nerve Block Alone for Extraction of Mandibular Third Molar

This randomized controlled trial will compare the effectiveness of adding distolingual infiltration to conventional inferior alveolar and buccal nerve blocks for mandibular third molar extraction. A total of 120 patients will be allocated into two groups. Pain during flap elevation and bone guttering will be assessed using the Visual Analogue Scale.

Study Overview

• Status: Recruiting
• Conditions: Pain (Visceral, Somatic, or Neuropathic)
• Intervention / Treatment: Procedure: Conventional Inferior Alveolar and Buccal Nerve Block; Procedure: Distolingual Infiltration plus Conventional Nerve Block

Detailed Description

Mandibular third molar extraction is a common oral and maxillofacial surgery procedure that requires profound local anesthesia. Despite conventional inferior alveolar, lingual and buccal nerve blocks, the distolingual gingiva may remain non-anesthetized due to accessory innervation via the mylohyoid and other nerves. Distolingual infiltration may improve anesthesia in this area.

This randomized controlled trial will enroll 120 patients requiring mandibular third molar extraction. Participants will be randomized into two groups: conventional inferior alveolar and buccal nerve block (Group A) and the same technique with additional distolingual infiltration (Group B). Pain during mucoperiosteal flap elevation and bone guttering will be recorded on a 0-10 Visual Analogue Scale. The primary objective is to determine whether distolingual infiltration improves pain control compared to the conventional technique.

• Study Type: Interventional
• Enrollment (Estimated): 120
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: dr aimen zafar Aimen zafar, bds; Phone Number: +923361056720; Email: aimenali216@gmail.com

Study Locations

• Pakistan
  • Islamabad, Pakistan
    • Recruiting
    • Dr Aimen Zafar
    • Contact: aimen zafar zafar masood, bds; Phone Number: 00923361056720; Email: aimenali216@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Healthy individuals

  • Male and female
  • Age 18-45 years
  • Mandibular third molar impaction - all positions
  • Mandibular third molar impaction - all classes

Exclusion Criteria:

• ASA status III and above

  • Patients requiring multiple extractions in the same appointment
  • Allergy to lignocaine
  • Patients in whom adrenaline is contraindicated
  • Medically compromised individuals e.g. poorly controlled diabetes, hypertension

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: conventional nerve block injection; Inferior alveolar and buccal nerve block using 2% lignocaine with adrenaline (1:80,000) without distolingual infiltration.	Procedure: Conventional Inferior Alveolar and Buccal Nerve Block; Standard inferior alveolar and long buccal nerve block for mandibular third molar extraction.
Experimental: conventional inferior alveolar with distolingual infilterate injection; Inferior alveolar supplemented with distolingual infiltration using 2% lignocaine with adrenaline (1:80,000).	Procedure: Distolingual Infiltration plus Conventional Nerve Block; Distolingual infiltration (0.2 ml) administered in addition to conventional inferior alveolar during mandibular third molar extraction.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain during mucoperiosteal flap elevation	Pain intensity experienced during flap elevation will be assessed using the Visual Analogue Scale (VAS). This is a 0-10 point numerical scale where participants indicate the pain level experienced at the time of flap elevation. Measurement Tool: Visual Analogue Scale (VAS) Scale: Minimum score: 0 (no pain); Maximum score: 10 (worst possible pain); Directionality: Higher scores indicate worse pain	During mucoperiosteal flap elevation on the day of surgery
Pain During Bone Guttering	Pain intensity during bone guttering will be recorded using the Visual Analogue Scale (VAS). Measurement Tool: Visual Analogue Scale (VAS) Scale: Minimum: 0 (no pain); Maximum: 10 (worst pain); Higher scores = worse pain	During bone guttering on the day of surgery.

Collaborators and Investigators

• Sponsor: Watim Medical & Dental College

Study record dates

Study Major Dates

• Study Start (Actual): August 15, 2024
• Primary Completion (Estimated): February 15, 2026
• Study Completion (Estimated): April 15, 2026

Study Registration Dates

• First Submitted: November 26, 2025
• First Submitted That Met QC Criteria: December 8, 2025
• First Posted (Estimated): December 22, 2025

Study Record Updates

• Last Update Posted (Actual): January 6, 2026
• Last Update Submitted That Met QC Criteria: December 30, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neurologic Manifestations; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain
• Other Study ID Numbers: DSG-2023-335-4631-A

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No