Clinical Research Directory

Inclusion Criteria: * Adults (≥18 years) presenting with a clinical diagnosis of symptomatic irreversible pulpitis in a permanent tooth * Diagnosis confirmed on the basis of patient-reported symptoms (spontaneous pain, lingering pain to thermal stimuli), clinical examination, and positive pulp sensibility testing (cold test and/or electric pulp test) * Absence of radiographic evidence of periapical pathology * ASA physical status I or II * No prior local anesthetic injection for the same tooth within the preceding 24 hours * No documented allergy or contraindication to amide local anesthetics Exclusion Criteria: * ASA physical status classification III or higher * Pregnancy * Confirmed radiographic periapical lesion or diagnosis of pulp necrosis * Prior local anesthetic injection for the same tooth within the preceding 24 hours * Documented allergy or contraindication to amide local anesthetics * Age under 18 years * Records with missing key predictor or outcome variables (9.2% of initially screened records excluded)