Comparison of Computer-Assisted and Conventional Local Anesthesia in Children With Molar-Incisor Hypomineralization

This randomized split-mouth clinical trial will compare computer-controlled local anesthesia with conventional local anesthesia in children aged 8-12 years with molar-incisor hypomineralization (MIH).

Each child will receive both anesthesia methods during separate restorative treatment visits on comparable affected permanent molars. Pain will be evaluated using child-reported and behavioral pain scales. Dental anxiety, heart rate, oxygen saturation, anesthesia onset time, injection duration, need for additional anesthesia, and patient preference will also be assessed.

The study aims to determine whether computer-controlled local anesthesia provides a more comfortable and effective option than conventional anesthesia for children with MIH.

• Computer-Controlled Local Anesthesia (Device), also known as SleeperOne, Digital Anesthesia: Local anesthesia will be administered using the SleeperOne computer-controlled local anesthetic delivery system according to the manufacturer's pediatric protocol. The device electronically controls the flow rate and pressure of the anesthetic solution. A 4% articaine solution with 1:100,000 epinephrine will be administered before restorative treatment of the MIH-affected permanent molar.
• Conventional Local Anesthesia (Procedure), also known as Traditional Local Anesthesia: Local anesthesia will be administered using a conventional dental syringe. Buccal infiltration will be used for maxillary teeth, and an inferior alveolar nerve block will be used for mandibular teeth. A 4% articaine solution with 1:100,000 epinephrine will be administered before restorative treatment of the MIH-affected permanent molar.

Primary outcomes

• Injection pain assessed using the Wong-Baker Faces Pain Rating Scale [Immediately after completion of local anesthetic injection at each treatment visit]: Pain intensity will be assessed during local anesthetic injection using the Wong-Baker Faces Pain Rating Scale (score range: 0-10; higher scores indicate greater pain).
• Injection pain assessed using the Visual Analog Scale (VAS) [Immediately after completion of local anesthetic injection at each treatment visit]: Pain intensity will be assessed immediately after local anesthetic injection using a 100-mm Visual Analog Scale (0=no pain, 100=worst imaginable pain; higher scores indicate greater pain).
• Behavioral pain assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) Scale [Periprocedural (during local anesthetic injection at each treatment visit)]: Behavioral pain will be assessed during local anesthetic injection using the Face, Legs, Activity, Cry, Consolability (FLACC) Scale (score range: 0-10; higher scores indicate greater pain).
• Successful local anesthesia during restorative treatment [Immediately after completion of restorative treatment at each treatment visit]: Successful local anesthesia will be defined as completion of cavity preparation and restorative treatment without the need for supplemental local anesthesia and without interruption of treatment because of pain. The outcome will be reported as the percentage of treatment visits with successful local anesthesia.
• Absence of response to electric pulp testing [Immediately after completion of local anesthetic injection at each treatment visit]: The proportion of treatment visits in which no response is obtained using an electric pulp tester after local anesthetic administration.
• Anesthesia Onset Time [Immediately following local anesthetic injection at each treatment visit.]: Anesthesia onset time will be compared between computer-controlled and conventional local anesthesia. It will be defined as the time from completion of the injection until the child reports numbness and no response is obtained with electric pulp testing. The time will be recorded in seconds.

Sex: All, ages: 8 Years to 12 Years, accepts healthy volunteers

Inclusion Criteria:

* Children aged 8-12 years
* Children with no systemic disease
* Children with no pathology involving the oral region, such as trauma, cysts, or tumors
* Children who have not used antibiotics within the past month
* Children who have not used nonsteroidal anti-inflammatory drugs (NSAIDs) within the past month
* Children with at least two homologous permanent molars affected by molar-incisor hypomineralization (MIH) and indicated for restorative treatment due to dentin caries
* Children with a Frankl Behavior Rating Scale score of 3 or higher will be included in the study

Exclusion Criteria:

* Children in whom local anesthesia cannot be administered due to lack of cooperation
* Children who require pulp treatment after enrollment in the study will be withdrawn from the study.