Hot mandibular molar at 7 p.m. — what gets you reliably profound? I’ve been buffering 2% lidocaine (1:100k), adding a 4% articaine buccal infiltration, and using a quick PDL or intraosseous shot if needed; patients usually leave numb and do fine post-op with ibuprofen/acetaminophen.
For 7 p.m. hot mandibular molars, I go straight to a buffered Gow-Gates, then add buccal and lingual 4% articaine infiltrations — more reliable pulpal depth for me than a standard IANB. > quick PDL or intraosseous shot if needed; patients usually leave numb — IO is more predictable for me with 3% mepivacaine (no epi jitters), and if it still screams I’ll do a firm intrapulpal. Do you buffer the articaine or keep it straight?
At 7 p.m., I start IO with 3% mepivacaine plain; intrapulpal last resort. @OP, do you pre-op dexamethasone?