A) Experimental Group (CC-ILA using Super Pen)

• CC-ILA will be administered with the Super Pen according to manufacturer instructions.
• A standard 1.8 mL Articaine carpule will be used. The injection will be initiated at the distolingual line angle of the target tooth, with the needle inserted through the gingival sulcus at approximately a 30° angle to the long axis, bevel facing the alveolar bone.
• Approximately 0.2 mL of 4% Articaine with 1:100,000 epinephrine will be delivered per root.24
• The visual pressure indicator will be monitored to ensure controlled delivery within optimal pressure ranges. Slight tissue blanching will indicate adequate deposition. The procedure will be repeated at the mesiolingual line angle.

• A 27-gauge 3 cm long needle will be used to administer Articaine 4% with 1:100,000 epinephrine via the standard IANB approach, followed by long buccal infiltration.
• After negative aspiration, approximately 1.0 mL of solution will be delivered near the inferior alveolar nerve, and 0.5 mL as a buccal infiltration distal to the second primary molar.25
• Anesthesia onset will be confirmed by gingival probing at 10-second intervals (CC-ILA) or 30-second intervals (IANB).

• A standard 1.8 mL Articaine carpule will be used. The injection will be initiated at the distolingual line angle of the target tooth, with the needle inserted through the gingival sulcus at approximately a 30° angle to the long axis, bevel facing the alveolar bone.
• Approximately 0.2 mL of 4% Articaine with 1:100,000 epinephrine will be delivered per root.
• The visual pressure indicator will be monitored to ensure controlled delivery within optimal pressure ranges. Slight tissue blanching will indicate adequate deposition. The procedure will be repeated at the mesiolingual line angle.

Heart rate will be monitored using a pulse oximeter at baseline, during LA injection, and during extraction. Readings will be recorded every two minutes and mean values will be calculated.

Oxygen saturation will be monitored using a pulse oximeter at baseline, during LA injection, and during extraction. Readings will be recorded every two minutes and mean values will be calculated.

Pain will be assessed using the Sound, Eye, and Motor (SEM) Scale. Each component will be graded from 1 (comfort) to 4 (severe discomfort) by the operator and the independent outcome assessor evaluator reviewing video recordings.

Parents will be questioned during the 24-hour follow-up regarding any unusual symptoms.