COMPARISON OF THREE DIFFERENT AMOUNTS OF LOCAL ANESTHESIA FOR LOWER BACK TOOTH REMOVAL

INTERVENTION: Intervention1: Two percent Lidocaine with one in one hundred thousand Epinephrine 1.0 mL: Group A receives 1.0 mL of two percent Lidocaine with one in one hundred thousand Epinephrine administered via conventional Inferior Alveolar Nerve Block using a 26 gauge needle over 60 seconds, followed by a standardized 0.5 mL long buccal nerve block for the extraction of mandibular first or second molars. Intervention2: Two percent Lidocaine with one in one hundred thousand Epinephrine 1.2 mL: Group B receives 1.2 mL of two percent Lidocaine with one in one hundred thousand Epinephrine administered via conventional Inferior Alveolar Nerve Block using a 26 gauge needle over 60 seconds, followed by a standardized 0.5 mL long buccal nerve block for the extraction of mandibular first or second molars. Control Intervention1: Two percent Lidocaine with one in one hundred thousand Epinephrine 1.5 mL: Group C receives 1.5 mL of two percent Lidocaine with one in one hundred thousand Epinephrine administered via conventional Inferior Alveolar Nerve Block using a 26 gauge needle over 60 seconds, followed by a standardized 0.5 mL long buccal nerve block for the extraction of mandibular first or second molars. CONDITION: Health Condition 1: K088‐ Other specified disorders of teethand supporting structures PRIMARY OUTCOME: Clinical success rate of inferior alveolar nerve block defined as the complete extraction of mandibular first or second molar without the need for supplemental rescue local anesthesiaTimepoint: Intraoperatively throughout the extraction procedure up to completion of tooth extraction SECONDARY OUTCOME: Injection discomfort assessed using the visual analogue scaleTimepoint: Assessed immediately following local anesthetic injection Objective onset time of pulpal anesthesia assessed by electric pulp tester showing no response at maximum output on two consecutive readingsTimepoint: Assessed every 2 minutes up to 15 minutes post‐injection Requirement for & total volume of supplemental rescue local anesthesiaTimepoint: Monitored intraoperatively throughout the procedure until completion of extraction Subjective onset time of lip numbness reported by the patientTimepoint: Assessed every 2 minutes up to 15 minutes post injection INCLUSION CRITERIA: 1. Adult patients aged between 18 and 55 years. 2. Systemic health status of ASA physical status I or II. 3. Clinically and radiographically indicated for the extraction of mandibular first or second molars. 4. Absence of acute infection or active inflammation at the intended injection site. 5. Patients willing to provide written voluntary informed consent.