The goal of this clinical trial is to compare anesthetic success rates of intraligamentary dexamethasone, diclofenac sodium, and chymotrypsin administered prior to buccal 4% articaine infiltration in mandibular molars with symptomatic irreversible pulpitis. Do these drugs lower the number of times participants need to be administrated with more local anesthesia? Researchers compared intraligamentary dexamethasone, diclofenac sodium, and chymotrypsin to a placebo (a look-alike substance that contains no drug) to see if interventional drugs work to achieve successful anesthesia.

• Participants were intraligamentary injected by drugs or a placebo once prior to buccal infiltration anesthesia
• Participants reported pain intensity using VAS at baseline (pre-injection), during access, and at 6, 24, 48 hours post-operative (patient diary / phone follow-up).
• Participants reported the onset time to subjective numbness (time from buccal infiltration to lip/tongue numbness).

Inclusion Criteria:

• Systemically healthy male patients (ASA I or II)
• Aged 18 to 50 years
• Presenting with symptomatic irreversible pulpitis in a restorable mandibular molar
• Preoperative moderate to severe pain (VAS ≥45 mm)
• Normal periapical tissue (no radiolucency, pocket depth ≤5 mm, mobility ≤ Grade I)

Exclusion Criteria:

• Medically compromised patients (ASA III or higher)
• History of allergy or intolerance to chymotrypsin, dexamethasone, diclofenac sodium, articaine.
• Vertical root fracture
• External or internal root resorption
• Periodontal pocket depth >5 mm
• Tooth mobility Grade II or III
• Presence of periapical lesion (radiolucency)