Comparative evaluation of anesthetic efficacy of 4% articaine with 1:100,000 adrenaline and 2% lignocaine with 1:80,000 adrenaline as intraligamentary injection by using star pen after an ineffective inferior alveolar nerve block in mandibular molars with acute irreversible pulpitis of patient aged 18-50 years: A Randomised controlled trial.

Sampling technique: Simple random sampling technique will be used. VI. Methods of selection of study subjects: 1.Inclusion criteria : 1)Patient having no systemic diseases 2)Patients between 18-50 years of age 3)Mandibular molars with a diagnosis of acute irreversible pulpitis. 2. Exclusion criteria:

1. Teeth with periodontal defects.
2. Patients with hypersensitivity to lidocaine and /or articaine.
3. Pregnancy or lactation.
4. Teeth with any periapical pathology.
5. Teeth with immature root apex.
6. Patient on any kind of medication example NSAIDS, sedatives, antidepressants. VII. Operational definitions: A) Intraoperative pain: Intraoperative pain is defined as the intensity of pain perceived by the patient during endodontic treatment, specifically from the initiation of access cavity preparation to completion of canal instrumentation. B) Visual analog scale: Pain levels will be recorded using a Visual Analog Scale (VAS) immediately after the procedure, with scores ranging from 0 (no pain) to 10 (worst imaginable pain), based on the patient’s subjective experience during the treatment phase. VIII. Method of measurements: The visual analogue scale (VAS): The Visual Analogue Scale (VAS) is a 10 cm line with anchor statements on the left (no pain) and on the right (extreme pain). The patient will be asked to mark their current pain level on the line. They will be asked to mark their maximum, minimum, and average pain. The examiner scores the VAS by measuring the distance in either centimeters (0 to 10) or millimeters (0 to 100) from the “no pain” anchor point. IX. Study instrument/ Data collection tool: - The visual analogue scale (VAS): X. Method of Data collection: - 24 subjects with failed inferior alveolar nerve block will be choosen for the study. A detailed medical history will be taken from each patient followed by clinical examination. Radiographic examination will be done to confirm. Patients will be informed about the details of study procedure and informed consent form will be obtained from them. Before administration of intraligamentary injection intraoperative pain will be recorded from all subjects. These subjects will be randomly divided into two groups of 12 samples each. Groups will be as follows:- Group I: Administration of 2% lignocaine with 1:80000 adrenaline by intraligamentary injection technique (n=12) using star pen. GroupI II: Administration of 4% articaine with 1:100,000 adrenaline by intraligamentary injection technique (n=12) using star pen. Patient will be administered 1.8ml of either 2% lignocaine with 1:80000 adrenaline or 4% articaine with 1:100,000 adrenaline intraligamentary using star pen. After 5 mins of intraligamentary injections, access cavity preparation will be prepared and canals will be located. #10 K- file will be inserted in each canal. Working length will be determined using apex locator. Then complete pulp extirpation will be done followed by normal saline irrigation. After this step intraoperative pain will be assessed on VAS and will be noted down.