I personally believe you should do intra-osseous on every hot molar or you shouldn't touch it. You will cause a lot of unnecessary patient discomfort/pain if you don't use it. Block technique has literally nothing to do with it unless you are just completely missing the block.
The sleeve can be a little tough to remove but as long as you're careful you should be okay. The stabident doesn't have that problem but if you have to go below attached gingiva to place it, it can be very difficult to find the perforation. You also can't give a supplemental intra-osseous if the case is running longer than ideal at a later time like you can with the sleeve still in place, which is an issue because you are often using carbocaine instead of lido.
PDL's are decent as a substitute but they will not work as well as intra-osseous and the patient will have more discomfort due to transient PDL damage.
Trying to access these teeth that are not profoundly numb, then doing painful injections like intra-pulpals is not doing a service to your patient. Go straight to intra-osseous after your blocks before causing unnecessary pain, your patients will thank you.
