Objective <p>To compare the anaesthetic efficacy and safety of the posterior superior alveolar (PSA) nerve block versus buccal infiltration for the extraction of maxillary second and third molars.</p> Materials and methods <p>This prospective, double-blind, randomized controlled trial included 150 healthy adults (ASA I) scheduled for non-surgical maxillary molar extractions. Participants were randomly assigned to receive either a PSA block (<i>n</i> = 75) or buccal infiltration (<i>n</i> = 75) using 1.8 mL of 2% lidocaine with 1:100,000 epinephrine. Pain was assessed using the Visual Analog Scale (VAS) and the Verbal Descriptor Scale (VDS). Primary outcomes included intraoperative pain scores and the need for supplemental anesthesia. Secondary outcomes included positive aspiration, postoperative complications, and rescue analgesic use within 3&#xa0;h.</p> Results <p>There was no significant difference in VAS (PSA: 2.11 ± 1.21 vs. Infiltration: 2.02 ± 1.30; <i>p</i> = 0.71) or VDS scores (<i>p</i> = 0.96) between groups. Supplemental anesthesia was required in 10.7% (PSA) and 12.0% (infiltration) of patients (<i>p</i> = 0.74). Complications, including hematoma, trismus, and positive aspiration, occurred only in the PSA group (4.0%), with a statistically significant difference in overall complication rate (<i>p</i> = 0.03). Analgesic use within 3&#xa0;h was comparable between groups (<i>p</i> = 0.48).</p> Conclusion <p>Buccal infiltration provides anesthetic efficacy equivalent to PSA block with significantly fewer complications. It is safer, simpler, and better tolerated, supporting its use as the preferred technique for routine maxillary molar extractions.</p>