Background: Effective pain control is crucial in managing pediatric dental patients. Molar-incisor hypomineralization (MIH), marked by enamel defects and dentin hypersensitivity, often hinders effective local anesthesia. Traditional injection methods may fall short, causing discomfort and complicating treatment. Combining infiltration with intraosseous injection using an extra-short 31-G needle may offer a more effective alternative.

Purpose: To compare the effectiveness of combined infiltration and intraosseous injection with an extra-short 31-G needle versus conventional techniques in eliminating pain during

Inclusion Criteria:

• Healthy children, American Society of Anesthesiologists class I, II
• Cooperative children during preoperative assessments according to the Frankl'
• Behavioral Rating Scale (scores 3 or 4)
• Patient presenting with at least one hypersensitive SCASS 2,3 [22] (Appendix III) deeply carious, MIH-affected FPM, with caries extending to the inner third of the dentin and close to the pulp, as shown in the periapical radiograph, consistent with TNI 4c classification for MIH
• Written consent of the legal guardian.

Exclusion Criteria:

• Any physical or mental disability or psychological problems.
• Immunocompromised patients.
• Hypersensitivity to local anesthetic drugs used.
• Taking analgesics or other medications that alter the child's behavior or awareness of pain 12- hours pre-operatively
• Patients requiring emergency treatment.
• FPM with preoperative signs and symptoms of clinical failure