Efficacy and Safety of Pulpal Anesthesia Strategies during Endodontic Treatment of Permanent Mandibular Molars with Symptomatic Irreversible Pulpitis: A Systematic Review and Network Meta-analysis

Zanjir, Maryam; Lighvan, Nima Laghapour; Yarascavitch, Carilynne; Beyene, Joseph; Shah, Prakesh S.; Azarpazhooh, Amir

doi:10.1016/j.joen.2019.09.002

Cited by 38 publications

(42 citation statements)

References 77 publications

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“…Recent NMA has suggested that mepivacaine is better than lidocaine in eliciting pulpal anesthesia when delivered as IANB to teeth with irreversible pulpitis [ 8 63 ]. We could not conclude whether this is also true in vital asymptomatic teeth because the interventions in the present NMA are categorized by the type of anesthetic as well as its concentration of vasoconstrictor.…”

Section: Discussionmentioning

confidence: 99%

“…Conflicting findings were found for the effect of doubling the volume of several LA. In irreversible pulpitis, increasing the volume of LA to more than one cartridge does not improve the success of IANB [ 8 ]. The additional volume may appear beneficial when profound anesthesia after the second injection is observed.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, NMA was used to identify efficacious strategies to anesthetize mandibular molars with irreversible pulpitis. Lidocaine 2% with epinephrine 1:100,000 delivered using intraosseous injection, or articaine 4% with 1:100,000 epinephrine delivered using intraosseous injection or buccal and lingual infiltrations were recommended [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Anesthetic efficacy in vital asymptomatic teeth using different local anesthetics: a systematic review with network meta-analysis

et al. 2021

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Objectives This study aimed to evaluate the efficacy of various local anesthesia (LA) in vital asymptomatic teeth. Materials and Methods Randomized controlled trials comparing pulpal anesthesia of various LA on vital asymptomatic teeth were included in this review. Searches were conducted in the Cochrane CENTRAL, MEDLINE (via PubMed), EMBASE, ClinicalTrials.gov, Google Scholar and 3 field-specific journals from inception to May 3, 2019. Study selection, data extraction, and risk of bias assessment using Cochrane Risk of Bias Tool were done by 2 independent reviewers in duplicate. Network meta-analysis (NMA) was performed within the frequentist setting using STATA 15.0. The LA was ranked, and the surface under the cumulative ranking (SUCRA) line was plotted. The confidence of the NMA estimates was assessed using the CINeMA web application. Results The literature search yielded 1,678 potentially eligible reports, but only 42 were included in this review. For maxillary buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than lidocaine 2% with epinephrine 1:100,000 (odds ratio, 2.11; 95% confidence interval, 1.14–3.89). For mandibular buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than various lidocaine solutions. The SUCRA ranking was highest for articaine 4% with epinephrine when used as maxillary and mandibular buccal infiltrations, and lidocaine 2% with epinephrine 1:80,000 when used as inferior alveolar nerve block. Inconsistency and imprecision were detected in some of the NMA estimates. Conclusions Articaine 4% with epinephrine is superior when maxillary or mandibular infiltration is required in vital asymptomatic teeth.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Anesthetic efficacy in vital asymptomatic teeth using different local anesthetics: a systematic review with network meta-analysis

et al. 2021

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“…The use of local anesthetic agents in pain management plays a vital role. It is the safest and most effective medications to prevent and manage pain during dental treatment [8]. Today's availability of a variety of local anesthetic agents allows dentists to choose an anesthetic with specific properties such as time of onset and duration, hemostatic control, and degree of cardiac side effects that are suited for each individual patient and dental operation [9].…”

Section: Local Anestheticsmentioning

confidence: 99%

Tackling Local Anesthetic Failure in Endodontics

Janani¹,

Teja²,

Harini³

et al. 2022

Topics in Regional Anesthesia

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Achieving anesthesia in a hot tooth or tooth with inflamed pulp is challenging, especially during endodontic treatment. In the presence of symptomatic irreversible pulpitis, mainly in mandibular teeth, pose even more challenge to attain profound anesthesia. Tetradoxin resistant channel is a class of sodium channel that is found to be increased in such condition and is found to resist local anesthesia. The pH also determines the success of local anesthesia. In inflammatory conditions, the surrounding area\'s pH, which eventually decreases the amount of base form of local anesthetic penetration into the nerve membrane, thereby causing anesthetic failure. In such conditions, the excitability threshold is reduced, leading to failure in achieving anesthesia. This chapter highlights and discusses the cause of anesthetic failure and its management in obtaining profound anesthesia during endodontic treatment.

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“…It is clinically classified as reversible or irreversible (Rôças et al, 2015). Irreversible pulpitis (IP), usually develops when the pulp is exposed to caries biofilm causing necrosis or death of pulp tissues, indicating the need for endodontic treatment (Li et al, 2012;Zanjir et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of 4% articaine vs 2% lidocaine in mandibular and maxillary block and infiltration anaesthesia in patients with irreversible pulpitis: a systematic review and meta-analysis

Miglani

Ansari

Patro³

et al. 2021

PeerJ

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Objective The goal of this systematic review and meta-analysis is to determine the performance of 4% Articaine vs. 2% Lidocaine for mandibular and maxillary block and infiltration anaesthesia in patients with irreversible pulpitis (IP). Methods PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Google Scholar, and Open Gray were used to conduct a thorough literature search. A manual search of the reference lists of the publications found was also carried out. Two reviewers critically evaluated the papers for inclusion and exclusion criteria, and data extraction was done on the selected publications. The Cochrane Collaboration Tool and the Minors checklist were used to assess the quality of the selected studies for randomised controlled trials (RCTs) and non-randomised studies, respectively. The RevMan software was used to perform a meta-analysis of the pooled data and subgroups according to the technique of anaesthetic solution delivery, as well as a sensitivity analysis (P < 0.05). Results A total of twenty-six papers were included in the qualitative synthesis, with twenty-two of them being included in the meta-analysis. There were fifteen studies with a low potential for bias, three with a moderate potential for bias, and seven with a high potential for bias. The combined results of the 19 trials in the tooth level unit revealed that 4% articaine had a success rate 1.37 times greater than 2% lidocaine for mandibular teeth (RR, 1.37; 95% CI [1.17–1.62]; P = 0.0002). For the maxillary buccal infiltration method, the combined results from the three trials revealed that 4% articaine resulted in a success rate 1.06 times greater than 2% lidocaine (RR, 1.06; 95% CI [0.95–1.2]; P = 0.3). Excluding subgroups with a single study in sensitivity analysis for mandibular teeth revealed a substantial improvement in the success rate of the articaine group in treating IP when compared to the lidocaine group. Conclusion The findings of this meta-analysis back up the claim that articaine is more effective than lidocaine in providing anaesthesia in patients with IP. PROSPERO Registration No.: CRD42020204606 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020204606).

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Efficacy and Safety of Pulpal Anesthesia Strategies during Endodontic Treatment of Permanent Mandibular Molars with Symptomatic Irreversible Pulpitis: A Systematic Review and Network Meta-analysis

Cited by 38 publications

References 77 publications

Anesthetic efficacy in vital asymptomatic teeth using different local anesthetics: a systematic review with network meta-analysis

Anesthetic efficacy in vital asymptomatic teeth using different local anesthetics: a systematic review with network meta-analysis

Tackling Local Anesthetic Failure in Endodontics

Efficacy of 4% articaine vs 2% lidocaine in mandibular and maxillary block and infiltration anaesthesia in patients with irreversible pulpitis: a systematic review and meta-analysis

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