{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:51:06Z","timestamp":1787025066533,"version":"build-2736575974"},"reference-count":64,"publisher":"American Dental Society of Anesthesiology (ADSA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Although there are conflicting data, several authors have proposed that articaine\u2019s molecular properties suggest improved perfusion capabilities over other amide anesthetics. The purpose of this prospective, randomized, crossover study was to evaluate the anesthetic efficacy of palatal soft-tissue anesthesia following a buccal infiltration of 1.8 and 3.6 mL of 4% articaine with 1:100,000 epinephrine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>One hundred eighteen adults received 1.8 or 3.6 mL of 4% articaine with 1:100,000 epinephrine as a buccal infiltration of the maxillary first molar at 2 separate appointments. Palatal soft-tissue anesthesia was evaluated with a dental explorer. Anesthetic success was defined as the absence of pain with an explorer stick. For the subjects who achieved palatal anesthesia, mapping was conducted over 70 minutes, and the overall area of palatal anesthesia was calculated. The data were analyzed using chi-square tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The highest percentage of palatal anesthetic success was 20% for the 1.8-mL volume and 32% for the 3.6-mL volume both at 30 minutes. A statistically significant difference between the 1.8- and 3.6-mL volumes was seen at 40 minutes. There was high variability in area measurements for subjects who achieved palatal anesthesia. The highest area measurements were 92 mm\n                      <jats:sup>2<\/jats:sup>\n                      for the 1.8-mL volume at 20 minutes and 113 mm\n                      <jats:sup>2<\/jats:sup>\n                      for the 3.6-mL volume at 10 minutes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Because of the low success rates (20%\u201332%) and the high variability of the area anesthetized for the subjects who achieved palatal anesthesia, the clinical efficacy of 1.8 or 3.6 mL of articaine via buccal infiltration for palatal anesthesia is of questionable value.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2344\/23-00023","type":"journal-article","created":{"date-parts":[[2024,5,9]],"date-time":"2024-05-09T08:42:32Z","timestamp":1715244152000},"page":"8-14","source":"Crossref","is-referenced-by-count":2,"title":["Efficacy of Maxillary Buccal Infiltration of Articaine for Palatal Anesthesia: A Prospective, Randomized, Crossover Study"],"prefix":"10.2344","volume":"71","author":[{"given":"Alexandra","family":"Woo","sequence":"first","affiliation":[{"name":"Private Practice, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Nusstein","sequence":"additional","affiliation":[{"name":"Division of Endodontics, College of Dentistry, The Ohio State University, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Drum","sequence":"additional","affiliation":[{"name":"Division of Endodontics, College of Dentistry, The Ohio State University, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Fowler","sequence":"additional","affiliation":[{"name":"Division of Endodontics, College of Dentistry, The Ohio State University, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Al","family":"Reader","sequence":"additional","affiliation":[{"name":"Division of Endodontics, College of Dentistry, The Ohio State University, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ai","family":"Ni","sequence":"additional","affiliation":[{"name":"Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1191","reference":[{"key":"r1","series-title":"Anesth Prog","first-page":"10","article-title":"Prospective study on PDL anesthesia as an aide to decrease palatal infiltration pain","volume":"69","author":"Crump B,","year":"2022","unstructured":"Crump B, Reader A, Nusstein J, Drum M, Fowler S, Draper J. Prospective study on PDL anesthesia as an aide to decrease palatal infiltration pain. Anesth Prog. 2022; 69:10\u201317."},{"key":"r2","series-title":"J Maxillofac Oral Surg","first-page":"252","article-title":"Comparison of the effectiveness of lidocaine in permanent maxillary teeth removal performed with single buccal infiltration versus routine buccal and palatal injection","volume":"14","author":"Kumaresan R,","year":"2015","unstructured":"Kumaresan R, Srinivasan B, Pendayala S. Comparison of the effectiveness of lidocaine in permanent maxillary teeth removal performed with single buccal infiltration versus routine buccal and palatal injection. J Maxillofac Oral Surg. 2015; 14:252-257."},{"key":"r3","series-title":"J Oral Maxillofac Surg","first-page":"737","article-title":"The anesthetic efficacy of articaine and lidocaine in equivalent doses as buccal and non-palatal infiltration for maxillary molar extraction: a randomized, double-blinded, placebo-controlled clinical trial","volume":"76","author":"Majid OW,","year":"2018","unstructured":"Majid OW, Ahmed AM. The anesthetic efficacy of articaine and lidocaine in equivalent doses as buccal and non-palatal infiltration for maxillary molar extraction: a randomized, double-blinded, placebo-controlled clinical trial. J Oral Maxillofac Surg. 2018; 76:737-743."},{"key":"r4","series-title":"J Dent Res","first-page":"1742","article-title":"Pressures created by dental injections","volume":"60","author":"Pashley EL,","year":"1981","unstructured":"Pashley EL, Nelson R, Pashley DH. Pressures created by dental injections. J Dent Res. 1981; 60:1742-1748."},{"key":"r5","series-title":"J Oral Maxillofac Surg","first-page":"1376.e1","article-title":"Palatal injection for the removal of maxillary teeth: current practice among oral and maxillofacial surgeons","volume":"75","author":"Badenoch-Jones EK,","year":"2017","unstructured":"Badenoch-Jones EK, David M, Lincoln T. Palatal injection for the removal of maxillary teeth: current practice among oral and maxillofacial surgeons. J Oral Maxillofac Surg. 2017; 75:1376.e1-1376.e5."},{"key":"r6","series-title":"Biophys Chem","first-page":"18","article-title":"Intramolecular hydrogen bonding in articaine can be related to superior bone tissue penetration: a molecular dynamics study","volume":"154","author":"Skjevik AA,","year":"2011","unstructured":"Skjevik AA, Haug BE, Lygre H, Teigen K. Intramolecular hydrogen bonding in articaine can be related to superior bone tissue penetration: a molecular dynamics study. Biophys Chem. 2011; 154:18-25."},{"key":"r7","series-title":"J Endod","first-page":"296","article-title":"Articaine and lidocaine mandibular buccal infiltration anesthesia: a prospective randomized double-blind cross-over study","volume":"32","author":"Kanaa MD,","year":"2006","unstructured":"Kanaa MD, Whitworth JM, Corbett IP, Meechan JG. Articaine and lidocaine mandibular buccal infiltration anesthesia: a prospective randomized double-blind cross-over study. J Endod. 2006; 32:296-298."},{"key":"r8","series-title":"J Am Dent Assoc","first-page":"1104","article-title":"The anesthetic efficacy of articaine in buccal infiltration of mandibular teeth","volume":"138","author":"Robertson D,","year":"2007","unstructured":"Robertson D, Nusstein J, Reader A, Beck M, McCartney M. The anesthetic efficacy of articaine in buccal infiltration of mandibular teeth. J Am Dent Assoc. 2007; 138:1104-1112."},{"key":"r9","series-title":"J Endod","first-page":"1912","article-title":"Anesthetic comparisons of 4% concentrations of articaine, lidocaine, and prilocaine as primary buccal infiltrations of the mandibular first molar: a prospective randomized, double-blind study","volume":"40","author":"Nydegger B,","year":"2014","unstructured":"Nydegger B, Nusstein J, Reader A, Drum M, Beck M. Anesthetic comparisons of 4% concentrations of articaine, lidocaine, and prilocaine as primary buccal infiltrations of the mandibular first molar: a prospective randomized, double-blind study. J Endod. 2014; 40:1912-1916."},{"key":"r10","series-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod","first-page":"733","article-title":"Is permanent maxillary tooth removal without palatal injection possible","volume":"102","author":"Uckan S,","year":"2006","unstructured":"Uckan S, Dayangac E, Araz K. Is permanent maxillary tooth removal without palatal injection possible? Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 102:733-735."},{"key":"r11","series-title":"Hua Xi Kou Qiang Yi Xue Za Zhi","first-page":"416","article-title":"Feasibility of permanent maxillary tooth removal using articaine anesthesia without palatal injection","volume":"26","author":"Peng M,","year":"2008","unstructured":"Peng M, Zhu ZM, Yang XM. Feasibility of permanent maxillary tooth removal using articaine anesthesia without palatal injection. Hua Xi Kou Qiang Yi Xue Za Zhi. 2008; 26:416-418."},{"key":"r12","series-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol","first-page":"359","article-title":"Comparison of the efficiencies of permanent maxillary tooth removal performed with single buccal infiltration versus routine buccal and palatal injection","volume":"107","author":"Fan S,","year":"2009","unstructured":"Fan S, Chen WL, Yang ZH, Huang ZQ. Comparison of the efficiencies of permanent maxillary tooth removal performed with single buccal infiltration versus routine buccal and palatal injection. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol. 2009; 107:359-363."},{"key":"r13","series-title":"Oral Maxillofac Surg","first-page":"195","article-title":"Comparison of onset and duration of action of soft tissue and pulpal anesthesia with three volumes of 4% articaine with 1:100,000 epinephrine in maxillary infiltration anesthesia","volume":"15","author":"Sreekumar K,","year":"2011","unstructured":"Sreekumar K, Bhargava D. Comparison of onset and duration of action of soft tissue and pulpal anesthesia with three volumes of 4% articaine with 1:100,000 epinephrine in maxillary infiltration anesthesia. Oral Maxillofac Surg. 2011; 15:195-199."},{"key":"r14","series-title":"J Clin Diagn Res","first-page":"ZC01","article-title":"Maxillary posterior teeth removal without palatal injection\u2014truth or myth: A dilemma for oral surgeons","volume":"8","author":"Sharma K,","year":"2014","unstructured":"Sharma K, Sharma A, Aseri M, Batta A, Singh V, Pilania D, Kumar Sharma Y. Maxillary posterior teeth removal without palatal injection\u2014truth or myth: A dilemma for oral surgeons. J Clin Diagn Res. 2014; 8:ZC01-4. 25584295"},{"key":"r15","series-title":"J Coll Phys Surg Pak","first-page":"181","article-title":"Comparison of articaine and lignocaine for uncomplicated maxillary exodontia","volume":"25","author":"Luqman U,","year":"2015","unstructured":"Luqman U, Janjua OS, Ashfaq M, Irfan H, Mushtaq S, Bilal A. Comparison of articaine and lignocaine for uncomplicated maxillary exodontia. J Coll Phys Surg Pak. 2015; 25:181-184."},{"key":"r16","series-title":"Int J Oral Maxillofac Surg","first-page":"1283","article-title":"Palatal injection for removal of maxillary teeth: is it required: a systematic review","volume":"45","author":"Badenoch-Jones EK,","year":"2016","unstructured":"Badenoch-Jones EK, Lincoln T. Palatal injection for removal of maxillary teeth: is it required: a systematic review. Int J Oral Maxillofac Surg. 2016; 45:1283-1292."},{"key":"r17","series-title":"J Oral Maxillofac Surg","first-page":"87","article-title":"Extraction of maxillary teeth using articaine without a palatal injection: a comparison between the anterior and posterior regions of the maxilla","volume":"75","author":"Bataineh AB,","year":"2017","unstructured":"Bataineh AB, Al-Sabri GA. Extraction of maxillary teeth using articaine without a palatal injection: a comparison between the anterior and posterior regions of the maxilla. J Oral Maxillofac Surg. 2017; 75:87-91."},{"key":"r18","series-title":"Oral Surg Oral Med Oral Pathol Oral Radiol","first-page":"e187","article-title":"Extraction of permanent maxillary teeth without palatal injection: a meta-analysis","volume":"126","author":"Cui L,","year":"2018","unstructured":"Cui L, Zhang Z, Huang J, Yin D, Xu L. Extraction of permanent maxillary teeth without palatal injection: a meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2018; 126:e187-e195."},{"key":"r19","series-title":"Clin Oral Investig","first-page":"3239","article-title":"Comparative study of articaine and lidocaine without palatal injection for maxillary teeth extraction","volume":"23","author":"Bataineh AB,","year":"2019","unstructured":"Bataineh AB, Nusair YM, Al-Rahahleh RQ. Comparative study of articaine and lidocaine without palatal injection for maxillary teeth extraction. Clin Oral Investig. 2019; 23:3239-3248."},{"key":"r20","series-title":"Ann Maxillofac Surg","first-page":"239","article-title":"Anesthetic efficacy of single buccal infiltration of 4% articaine and 2% lignocaine in extraction of maxillary 1st molar","volume":"9","author":"Kumar DP,","year":"2019","unstructured":"Kumar DP, Sharma M, Patil V, Subedar RS, Lakshmi GV, Manjunath NV. Anesthetic efficacy of single buccal infiltration of 4% articaine and 2% lignocaine in extraction of maxillary 1st molar. Ann Maxillofac Surg. 2019; 9:239-246."},{"key":"r21","series-title":"Br J Oral Maxillofac Surg","first-page":"281","article-title":"Comparison of the buccal injection versus buccal and palatal injection for extraction of permanent maxillary posterior teeth using 4% articaine: a split mouth study","volume":"59","author":"Iyengar AN,","year":"2021","unstructured":"Iyengar AN, Dugal A, Ramanojam S, Patil VS, Limbhore M, Narla B, Mograwala HJ. Comparison of the buccal injection versus buccal and palatal injection for extraction of permanent maxillary posterior teeth using 4% articaine: a split mouth study. Br J Oral Maxillofac Surg. 2021; 59:281-285."},{"issue":"suppl 1","key":"r22","series-title":"J Pharm Bioallied Sci","first-page":"S721","article-title":"A prospective study to assess the efficacy of 4% articaine, 0.5% bupivacaine and 2% lidocaine using a single buccal supraperiosteal injection for maxillary tooth extraction","volume":"13","author":"Chandrasekaran D,","year":"2021","unstructured":"Chandrasekaran D, Chinnaswami R, Shanthi K, . A prospective study to assess the efficacy of 4% articaine, 0.5% bupivacaine and 2% lidocaine using a single buccal supraperiosteal injection for maxillary tooth extraction. J Pharm Bioallied Sci. 2021; 13(suppl 1):S721-S24."},{"key":"r23","series-title":"Br J Oral Maxillofac Surg","first-page":"695","article-title":"Comparison of the efficacy of 4% articaine with epinephrine 1:100,000 and 2% lidocaine with epinephrine 1:100,000 buccal infiltration for single maxillary molar extraction: a double-blind, randomised, clinical trial","volume":"59","author":"Rayati F,","year":"2021","unstructured":"Rayati F, Haeri M, Norouziha A, Jabbarian R. Comparison of the efficacy of 4% articaine with epinephrine 1:100,000 and 2% lidocaine with epinephrine 1:100,000 buccal infiltration for single maxillary molar extraction: a double-blind, randomised, clinical trial. Br J Oral Maxillofac Surg. 2021; 59:695-699."},{"key":"r24","series-title":"J Oral Maxillofac Surg","first-page":"1643","article-title":"The efficacy of 4% articaine versus 2% lidocaine in inducing palatal anesthesia for tooth extraction in different maxillary regions","volume":"79","author":"Gholami M,","year":"2021","unstructured":"Gholami M, Banihashemrad A, Mohammadzadeh A, Ahrari F. The efficacy of 4% articaine versus 2% lidocaine in inducing palatal anesthesia for tooth extraction in different maxillary regions. J Oral Maxillofac Surg. 2021; 79:1643-1649."},{"key":"r25","series-title":"Clin Oral Investig","first-page":"343","article-title":"The effect of single buccal infiltration anesthesia of 4% articaine with either 1:100,000 or 1:200,000 epinephrine on pulpal blood flow and anesthesia of maxillary first molars and second premolars in humans","volume":"26","author":"Kijsamanmith K,","year":"2022","unstructured":"Kijsamanmith K, Sriworapongpun C, Pawasut N, . The effect of single buccal infiltration anesthesia of 4% articaine with either 1:100,000 or 1:200,000 epinephrine on pulpal blood flow and anesthesia of maxillary first molars and second premolars in humans. Clin Oral Investig. 2022; 26:343-351."},{"key":"r26","series-title":"J Endod","first-page":"121","article-title":"Anesthetic efficacy of 1.8 mL and 3.6 mL of 2% lidocaine with 1:100,000 epinephrine for maxillary infiltrations","volume":"34","author":"Mikesell A,","year":"2008","unstructured":"Mikesell A, Drum M, Reader A, Beck M. Anesthetic efficacy of 1.8 mL and 3.6 mL of 2% lidocaine with 1:100,000 epinephrine for maxillary infiltrations. J Endod. 2008; 34:121-125."},{"key":"r27","series-title":"Diagnostics (Basel).","doi-asserted-by":"publisher","first-page":"710","DOI":"10.3390\/diagnostics10090710","article-title":"Relationship between cortical bone thickness and cancellous bone density at dental implant sites in the jawbone","volume":"10","author":"Wang SH,","year":"2020","unstructured":"Wang SH, Shen YW, Fuh LJ, . Relationship between cortical bone thickness and cancellous bone density at dental implant sites in the jawbone. Diagnostics (Basel). 2020; 10:710. doi:10.3390\/diagnostics10090710"},{"key":"r28","series-title":"J Oral Maxillofac Surg","first-page":"1032","article-title":"Is it possible to anesthetize palatal tissues with buccal 4% articaine injection","volume":"68","author":"Oze\u00e7 I,","year":"2010","unstructured":"Oze\u00e7 I, Ta\u015fdemir U, G\u00fcm\u00fc\u015f C, Solak O. Is it possible to anesthetize palatal tissues with buccal 4% articaine injection? 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Anesth Prog. 2003; 50:159-163."},{"key":"r31","series-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod","first-page":"e16","article-title":"Comparison of topical anesthetics (EMLA\/Oraquix vs. benzocaine) on pain experienced during palatal needle injection","volume":"103","author":"Al-Melh MA,","year":"2007","unstructured":"Al-Melh MA, Andersson L. Comparison of topical anesthetics (EMLA\/Oraquix vs. benzocaine) on pain experienced during palatal needle injection. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 103:e16-e20."},{"key":"r32","series-title":"Northwest Dent","first-page":"25","article-title":"Palatal anesthesia: comparison of four techniques for decreasing injection discomfort","volume":"93","author":"Wiswall AT,","year":"2014","unstructured":"Wiswall AT, Bowles WR, Lunos S, McClanahan S, Harris S. Palatal anesthesia: comparison of four techniques for decreasing injection discomfort. 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J Maxillofac Oral Surg. 2015; 14:252-257."},{"key":"r3","series-title":"J Oral Maxillofac Surg","first-page":"737","article-title":"The anesthetic efficacy of articaine and lidocaine in equivalent doses as buccal and non-palatal infiltration for maxillary molar extraction: a randomized, double-blinded, placebo-controlled clinical trial","volume":"76","author":"Majid OW,","year":"2018","unstructured":"Majid OW, Ahmed AM. The anesthetic efficacy of articaine and lidocaine in equivalent doses as buccal and non-palatal infiltration for maxillary molar extraction: a randomized, double-blinded, placebo-controlled clinical trial. J Oral Maxillofac Surg. 2018; 76:737-743."},{"key":"r4","series-title":"J Dent Res","first-page":"1742","article-title":"Pressures created by dental injections","volume":"60","author":"Pashley EL,","year":"1981","unstructured":"Pashley EL, Nelson R, Pashley DH. Pressures created by dental injections. J Dent Res. 1981; 60:1742-1748."},{"key":"r5","series-title":"J Oral Maxillofac Surg","first-page":"1376.e1","article-title":"Palatal injection for the removal of maxillary teeth: current practice among oral and maxillofacial surgeons","volume":"75","author":"Badenoch-Jones EK,","year":"2017","unstructured":"Badenoch-Jones EK, David M, Lincoln T. Palatal injection for the removal of maxillary teeth: current practice among oral and maxillofacial surgeons. J Oral Maxillofac Surg. 2017; 75:1376.e1-1376.e5."},{"key":"r6","series-title":"Biophys Chem","first-page":"18","article-title":"Intramolecular hydrogen bonding in articaine can be related to superior bone tissue penetration: a molecular dynamics study","volume":"154","author":"Skjevik AA,","year":"2011","unstructured":"Skjevik AA, Haug BE, Lygre H, Teigen K. Intramolecular hydrogen bonding in articaine can be related to superior bone tissue penetration: a molecular dynamics study. 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J Am Dent Assoc. 2007; 138:1104-1112."},{"key":"r9","series-title":"J Endod","first-page":"1912","article-title":"Anesthetic comparisons of 4% concentrations of articaine, lidocaine, and prilocaine as primary buccal infiltrations of the mandibular first molar: a prospective randomized, double-blind study","volume":"40","author":"Nydegger B,","year":"2014","unstructured":"Nydegger B, Nusstein J, Reader A, Drum M, Beck M. Anesthetic comparisons of 4% concentrations of articaine, lidocaine, and prilocaine as primary buccal infiltrations of the mandibular first molar: a prospective randomized, double-blind study. J Endod. 2014; 40:1912-1916."},{"key":"r10","series-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod","first-page":"733","article-title":"Is permanent maxillary tooth removal without palatal injection possible","volume":"102","author":"Uckan S,","year":"2006","unstructured":"Uckan S, Dayangac E, Araz K. Is permanent maxillary tooth removal without palatal injection possible? Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 102:733-735."},{"key":"r11","series-title":"Hua Xi Kou Qiang Yi Xue Za Zhi","first-page":"416","article-title":"Feasibility of permanent maxillary tooth removal using articaine anesthesia without palatal injection","volume":"26","author":"Peng M,","year":"2008","unstructured":"Peng M, Zhu ZM, Yang XM. Feasibility of permanent maxillary tooth removal using articaine anesthesia without palatal injection. Hua Xi Kou Qiang Yi Xue Za Zhi. 2008; 26:416-418."},{"key":"r12","series-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol","first-page":"359","article-title":"Comparison of the efficiencies of permanent maxillary tooth removal performed with single buccal infiltration versus routine buccal and palatal injection","volume":"107","author":"Fan S,","year":"2009","unstructured":"Fan S, Chen WL, Yang ZH, Huang ZQ. Comparison of the efficiencies of permanent maxillary tooth removal performed with single buccal infiltration versus routine buccal and palatal injection. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol. 2009; 107:359-363."},{"key":"r13","series-title":"Oral Maxillofac Surg","first-page":"195","article-title":"Comparison of onset and duration of action of soft tissue and pulpal anesthesia with three volumes of 4% articaine with 1:100,000 epinephrine in maxillary infiltration anesthesia","volume":"15","author":"Sreekumar K,","year":"2011","unstructured":"Sreekumar K, Bhargava D. Comparison of onset and duration of action of soft tissue and pulpal anesthesia with three volumes of 4% articaine with 1:100,000 epinephrine in maxillary infiltration anesthesia. 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