Effective pain management is crucial in pediatric dentistry to ensure a positive experience for young patients. The inferior alveolar nerve block (IANB) is commonly used to anesthetize mandibular teeth but has a notable failure rate, especially in children, due to anatomical variations and technical challenges. Studies indicate that IANB can fail in approximately 30% to 45% of cases, even when proper techniques are employed.

Intraosseous anesthesia (IOA) presents an alternative, involving the direct injection of anesthetic into the cancellous bone, potentially offering more reliable anesthesia for mandibular procedures. Recent advancements, such as the TuttleNumbNow (TNN) system, utilize specialized needles to facilitate this technique. Comparative studies have explored the efficacy of 4% articaine versus 2% lidocaine in pediatric patients. Some findings suggest that articaine may provide superior anesthetic success rates and faster onset compared to lidocaine.

However, very few studies have found no significant difference in efficacy between the two anesthetics when used for primary molar extractions in children. The proposed research aims to further evaluate these findings by comparing the efficacy, hemodynamic responses, and postoperative complications of 2% lidocaine via IANB and 4% articaine via IOA in children aged 6–8 undergoing mandibular primary molar procedures. The outcomes could inform best practices in pediatric dental anesthesia, potentially leading to improved patient comfort and treatment outcomes.