Most effective local anesthetic technique for mandibular posterior teeth with irreversible pulpitis: A systematic review and meta-analysis

Abstract

Introduction: Achieving profound pulpal anesthesia is considered as a keystone in endodontic practice as it benefits both the patient and the dentist for smooth delivery of care. A tooth that has irreversible pulpitis causes severe pain and poses an additional challenge. The aim of the present systematic review is to compare the standard inferior alveolar nerve block with other local anesthesia techniques for effectively anesthetizing the mandibular posterior teeth that present with irreversible pulpitis. Materials and Methods: A systematic review protocol was registered at Prospero. The following databases were searched: PubMed, CINAHL, Cochrane, EBSCO Oral and Dentistry Database, and Trip Database using strict inclusion and exclusion criteria. All randomized control trials on the topic published in the English language only were included. Results: The first search yielded 1213 articles, and after going through extensive screening and eligibility process, only 8 articles were finally selected for the review. There were six articaine infiltration technique groups; two were based on intraosseous technique and one each on Gow-Gates and Vazirani–Akinosi methods. The standard inferior alveolar nerve block was compared with other mandibular anesthesia techniques pooled together. A meta-analysis was carried out to compare inferior alveolar nerve block with the articaine infiltration. The difference among two sets of techniques was found to be nonsignificant (P = 0.07). However, the overall results of the meta-analysis favor articaine infiltration. The study is first of its kind comparing multiple anesthetic techniques in mandibular posterior teeth with irreversible pulpitis. Studies with the highest level of evidence, i.e., randomized controlled trials, were included only. No conclusive inference regarding Gow-Gates block and Vazirani–Akinosi techniques could be drawn on account of limited data. Conclusions: Infiltration and intraosseous appeared to be viable alternative to standard inferior alveolar nerve block in the posterior teeth with irreversible pulpitis.