Non-Cochrane · intervention · PM41613590
Evaluation of the effectiveness of local anesthesia approaches for symptomatic irreversible pulpitis: a systematic review and meta-analysis.
Li Xu, Chen Xin, Wang Qian, et al. · Frontiers in dental medicine · 2025 · PubMed · doi:10.3389/fdmed.2025.1679706
Findings
Population Adults (18 years or older) with symptomatic irreversible pulpitis of mandibular teeth
11 findings
| Modified anesthetic protocols (articaine, supplemental infiltrations, additives, increased volume) | Conventional inferior alveolar nerve block (IANB) with 2% lidocaine with epinephrine | Anesthesia success (adequate pain control during endodontic treatment) During endodontic treatment | OR 3.34 [2.49, 4.48] High 16 studies |
| Modified anesthetic protocols (articaine, supplemental infiltrations, additives, increased volume) | Conventional inferior alveolar nerve block (IANB) with 2% lidocaine with epinephrine | Anesthesia success (adequate pain control during endodontic treatment) During endodontic treatment · Region: United States | OR 3.62 [2.91, 4.27] GRADE not reported 3 studies |
| Modified anesthetic protocols (articaine, supplemental infiltrations, additives, increased volume) | Conventional inferior alveolar nerve block (IANB) with 2% lidocaine with epinephrine | Anesthesia success (adequate pain control during endodontic treatment) During endodontic treatment · Region: India | OR 3.26 [1.70, 6.28] GRADE not reported 3 studies |
| Modified anesthetic protocols (articaine, supplemental infiltrations, additives, increased volume) | Conventional inferior alveolar nerve block (IANB) with 2% lidocaine with epinephrine | Anesthesia success (adequate pain control during endodontic treatment) During endodontic treatment · Region: United States (DerSimonian-Laird random effects, Supplementary Figure B) | OR 3.36 [1.44, 7.85] GRADE not reported 3 studies |
| Modified anesthetic protocols (articaine, supplemental infiltrations, additives, increased volume) | Conventional inferior alveolar nerve block (IANB) with 2% lidocaine with epinephrine | Anesthesia success (adequate pain control during endodontic treatment) During endodontic treatment · Region: Iran | OR 4.31 [3.59, 5.17] High 6 studies |
| Modified anesthetic protocols (articaine, supplemental infiltrations, additives, increased volume) | Conventional inferior alveolar nerve block (IANB) with 2% lidocaine with epinephrine | Anesthesia success (adequate pain control during endodontic treatment) During endodontic treatment · Common (fixed) effect model | OR 3.79 [3.24, 4.44] GRADE not reported 16 studies |
| Modified protocols using an IANB-based technique | Conventional inferior alveolar nerve block (IANB) with 2% lidocaine with epinephrine | Anesthesia success (adequate pain control during endodontic treatment) During endodontic treatment · Injection technique: IANB | OR 4.03 [3.38, 4.81] High 8 studies |
| Modified protocols using buccal infiltration (BI) | Conventional inferior alveolar nerve block (IANB) with 2% lidocaine with epinephrine | Anesthesia success (adequate pain control during endodontic treatment) During endodontic treatment · Injection technique: BI | OR 3.12 [1.57, 6.18] GRADE not reported 3 studies |
| Modified protocols using other anesthetic agents (e.g. mepivacaine, prilocaine, bupivacaine, additives) | Conventional inferior alveolar nerve block (IANB) with 2% lidocaine with epinephrine | Anesthesia success (adequate pain control during endodontic treatment) During endodontic treatment · Anesthetic agent: other agents | OR 3.13 [1.70, 5.77] GRADE not reported 3 studies |
| Modified protocols using 2% lidocaine | Conventional inferior alveolar nerve block (IANB) with 2% lidocaine with epinephrine | Anesthesia success (adequate pain control during endodontic treatment) During endodontic treatment · Anesthetic agent: 2% lidocaine | OR 3.94 [2.42, 6.44] Moderate Downgraded: inconsistency 4 studies |
| Modified protocols using 4% articaine | Conventional inferior alveolar nerve block (IANB) with 2% lidocaine with epinephrine | Anesthesia success (adequate pain control during endodontic treatment) During endodontic treatment · Anesthetic agent: 4% articaine | OR 4.18 [2.85, 6.16] Moderate Downgraded: imprecision 8 studies |
Included primary studies 32
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Shrimanikandan 2021 [Lipoproteins as serum inhibitors in rubella hemagglutination inhibition test and their elimination (author's transl)]. PMID:202112 | 1977 | 2 other reviews | Anesthesia success (adequate pain control during endodontic treatment) | not extracted yet |
| Hassan 2023 Comparison of Efficacy of Lidocaine and Articaine as Inferior Alveolar Nerve Blocking Agents in Patients with Symptomatic Irreversible… PMID:37893558 | 2023 | 1 other review | not stated | not extracted yet |
| Abazarpoor 2015 A Comparison of Different Volumes of Articaine for Inferior Alveolar Nerve Block for Molar Teeth with Symptomatic Irreversible Pulpitis DOI:10.1016/j.joen.2015.05.015 | 2015 | this review only | Anesthesia success (adequate pain control during endodontic treatment) | not extracted yet |
| Afkhami 2021 DOI:10.3290/j.qi.b1864321 | NR | this review only | Anesthesia success (adequate pain control during endodontic treatment) | not extracted yet |
| Afkhami 2021 Comparative evaluation of anesthetic efficacy of inferior alveolar nerve block and inferior alveolar nerve block plus buccal or lingual… PMID:34369941 | 2021 | this review only | not stated | not extracted yet |
| Afkhami 2023 Studies on the orientations of the mitochondrial redox carriers. I. Orientation of the hemes of cytochrome c oxidase with respect to the… PMID:202315 | 1978 | this review only | Anesthesia success (adequate pain control during endodontic treatment) | not extracted yet |
| Aggarwal 2011 Comparative Evaluation of Local Infiltration of Articaine, Articaine Plus Ketorolac, and Dexamethasone on Anesthetic Efficacy of Inferior… DOI:10.1016/j.joen.2011.01.016 | 2011 | this review only | Anesthesia success (adequate pain control during endodontic treatment) | not extracted yet |
| Aggarwal 2012 Comparative Evaluation of 1.8 mL and 3.6 mL of 2% Lidocaine with 1:200,000 Epinephrine for Inferior Alveolar Nerve Block in Patients with… DOI:10.1016/j.joen.2012.02.003 | 2012 | this review only | Anesthesia success (adequate pain control during endodontic treatment) | not extracted yet |
| Aggarwal 2024 Effect of Intraligamentary Tramadol Hydrochloride on Anesthetic Success During Endodontic Management of Mandibular Molars: A Randomized… DOI:10.14744/eej.2023.48343 | 2024 | this review only | Anesthesia success (adequate pain control during endodontic treatment) | not extracted yet |
| Ashraf 2013 Efficacy of Articaine versus Lidocaine in Block and Infiltration Anesthesia Administered in Teeth with Irreversible Pulpitis:… DOI:10.1016/j.joen.2012.10.012 | 2013 | this review only | Anesthesia success (adequate pain control during endodontic treatment) | not extracted yet |
| Dianat 2019 The efficacy of supplemental intraseptal and buccal infiltration anesthesia in mandibular molars of patients with symptomatic irreversible… DOI:10.1007/s00784-019-03006-8 | 2019 | this review only | Anesthesia success (adequate pain control during endodontic treatment) | not extracted yet |
| Eskandarinezhad 2023 Comparison of the success of inferior alveolar nerve anesthesia in the mandibular first molars with symptomatic irreversible pulpitis… DOI:10.4103/1735-3327.372661 | 2023 | this review only | Anesthesia success (adequate pain control during endodontic treatment) | not extracted yet |
| Farzaneh Afkhami 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Gao 2020 Comparison of articaine, lidocaine and mepivacaine for buccal infiltration after inferior alveolar nerve block in mandibular posterior… DOI:10.1038/s41415-020-1434-9 | 2020 | this review only | Anesthesia success (adequate pain control during endodontic treatment) | not extracted yet |
| Hassan 2023 Comparison of Efficacy of Lidocaine and Articaine as Inferior Alveolar Nerve Blocking Agents in Patients with Symptomatic Irreversible… DOI:10.3390/medicina59101840 | 2023 | this review only | Anesthesia success (adequate pain control during endodontic treatment) | not extracted yet |
| Hengameh Ashraf 2013 Efficacy of articaine versus lidocaine in block and infiltration anesthesia administered in teeth with irreversible pulpitis: a… PMID:23228249 | 2013 | this review only | not stated | not extracted yet |
| Kreimer 2012 Anesthetic Efficacy of Combinations of 0.5 mol/L Mannitol and Lidocaine with Epinephrine for Inferior Alveolar Nerve Blocks in Patients… DOI:10.1016/j.joen.2012.02.016 | 2012 | this review only | Anesthesia success (adequate pain control during endodontic treatment) | not extracted yet |
| Mahsa Eskandarinezhad 2023 Comparison of the success of inferior alveolar nerve anesthesia in the mandibular first molars with symptomatic irreversible pulpitis… PMID:37180689 | 2023 | this review only | not stated | not extracted yet |
| Michael R. Shapiro 2018 Efficacy of Articaine versus Lidocaine in Supplemental Infiltration for Mandibular First versus Second Molars with Irreversible Pulpitis:… PMID:29397214 | 2018 | this review only | not stated | not extracted yet |
| Mohammadreza 2023 Studies on the orientations of the mitochondrial redox carriers. II. Orientation of the mitochondrial chromophores with respect to the… PMID:202316 | 1978 | this review only | Anesthesia success (adequate pain control during endodontic treatment) | not extracted yet |
| Mohammadreza 2023 Primary and supplementary anesthetic efficacy of a modified two-step buccal infiltration of 4% articaine in mandibular molars with… PMID:38147088 | 2023 | this review only | not stated | not extracted yet |
| Omid Dianat 2019 The efficacy of supplemental intraseptal and buccal infiltration anesthesia in mandibular molars of patients with symptomatic irreversible… PMID:31302768 | 2020 | this review only | not stated | not extracted yet |
| Ramin Abazarpoor 2015 A Comparison of Different Volumes of Articaine for Inferior Alveolar Nerve Block for Molar Teeth with Symptomatic Irreversible Pulpitis. PMID:26149210 | 2015 | this review only | not stated | not extracted yet |
| Roberta Moura Sampaio 2012 Comparison of the anesthetic efficacy between bupivacaine and lidocaine in patients with irreversible pulpitis of mandibular molar. PMID:22515885 | 2012 | this review only | not stated | not extracted yet |
| Sampaio 2012 Comparison of the Anesthetic Efficacy between Bupivacaine and Lidocaine in Patients with Irreversible Pulpitis of Mandibular Molar DOI:10.1016/j.joen.2012.01.008 | 2012 | this review only | Anesthesia success (adequate pain control during endodontic treatment) | not extracted yet |
| Shapiro 2018 Efficacy of Articaine versus Lidocaine in Supplemental Infiltration for Mandibular First versus Second Molars with Irreversible Pulpitis:… DOI:10.1016/j.joen.2017.10.003 | 2018 | this review only | Anesthesia success (adequate pain control during endodontic treatment) | not extracted yet |
| Shrimanikandan 2021 Anaesthetic Efficacy of Lidocaine and Articaine in Inferior Alveolar Nerve Block Combined with Buccal Infiltration in Patients with… PMID:34447191 | 2021 | this review only | not stated | not extracted yet |
| Timothy Kreimer 2012 Anesthetic efficacy of combinations of 0.5 mol/L mannitol and lidocaine with epinephrine for inferior alveolar nerve blocks in patients… PMID:22515886 | 2012 | this review only | not stated | not extracted yet |
| Vivek Aggarwal 2011 Comparative evaluation of local infiltration of articaine, articaine plus ketorolac, and dexamethasone on anesthetic efficacy of inferior… PMID:21419287 | 2011 | this review only | not stated | not extracted yet |
| Vivek Aggarwal 2012 Comparative evaluation of 1.8 mL and 3.6 mL of 2% lidocaine with 1:200,000 epinephrine for inferior alveolar nerve block in patients with… PMID:22595107 | 2012 | this review only | not stated | not extracted yet |
| Vivek Aggarwal 2024 Effect of Intraligamentary Tramadol Hydrochloride on Anesthetic Success During Endodontic Management of Mandibular Molars: A Randomized… PMID:38219030 | 2024 | this review only | not stated | not extracted yet |
| Xuan Gao 2020 Comparison of articaine, lidocaine and mepivacaine for buccal infiltration after inferior alveolar nerve block in mandibular posterior… PMID:32332962 | 2020 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults (>=18 years) with symptomatic irreversible pulpitis confirmed by cold test and electric pulp testing | Adults with symptomatic irreversible pulpitis (n=16 RCTs) |
| Intervention | Buccal, lingual, intraligamentary or intraseptal infiltration, or combinations | Modified anesthetic protocols: articaine, supplemental infiltration, additives, larger volumes |
| Comparison | Inferior alveolar nerve block (IANB) | Conventional IANB with 2% lidocaine with epinephrine |
| Outcomes | Success rate of anesthesia | Success rate of anesthesia (n=16) |
| Study designs | Parallel-group triple-blind RCTs | RCTs (n=16) |
| Timing | Not specified | Not specified |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | Yes | Yes | yes |
| 4Comprehensive literature searchcritical | No | Partial Yes | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | RCT: Yes · NRSI: N/A | yes |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: No · NRSI: N/A | RCT: Yes · NRSI: N/A | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Low | no |