<p>The use of local anesthesia is essential for pain control during the treatment of MIH-affected molars. This study aimed to compare injection-related pain and anesthetic efficacy between 2% lidocaine with epinephrine (LE) and 4% articaine with epinephrine (AE) in the MIH-affected maxillary molars of pediatric patients. Twenty-six children aged 6 to 12 years requiring restorative treatment of MIH-affected maxillary molars were enrolled. Participants randomly received one of the two anesthetic solutions (LE or AE) at the first visit; the other solution was administered at the second visit. Injection-related pain and anesthetic efficacy were evaluated subjectively using the Wong-Baker Faces^® pain rating (WBF) scale and behaviorally using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale. No statistically significant difference was found between LE and AE in injection-related pain on either scale (<i>P</i> &gt; 0.05). Similarly, no statistically significant difference was recorded between the two solutions in the anesthetic efficacy for MIH-affected maxillary molars, according to both scales (<i>P</i> &gt; 0.05). These findings indicate that both LE and AE provide comparable clinical outcomes, supporting the use of either solution as a local anesthetic for MIH-affected maxillary molars in pediatric patients.</p>