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.

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.

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