Anesthetic efficacy of primary and supplemental buccal/lingual infiltration in patients with irreversible pulpitis in human mandibular molars: a systematic review and meta-analysis
Gupta Alpa, Sahai Aarushi, Aggarwal Vivek, Mehta Namrata, Abraham Dax, Jala Sucheta, Singh Arundeep,
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( Gupta Alpa ) - Manav Racha Dental College Department of Conservative Dentistry and Endodontics
( Sahai Aarushi ) - Manav Racha Dental College Department of Conservative Dentistry and Endodontics
( Aggarwal Vivek ) - Jamia Millia Islamia Faculty of Dentistry Department of Conservative Dentistry & Endodontics
( Mehta Namrata ) - Manav Racha Dental College Department of Conservative Dentistry and Endodontics
( Abraham Dax ) - Manav Racha Dental College Department of Conservative Dentistry and Endodontics
( Jala Sucheta ) - Manav Racha Dental College Department of Conservative Dentistry and Endodontics
( Singh Arundeep ) - Manav Racha Dental College Department of Conservative Dentistry and Endodontics
Abstract
Achieving profound anesthesia in mandibular molars with irreversible pulpitis is a tedious task. This review aimed at evaluating the success of buccal/lingual infiltrations administered with a primary inferior alveolar nerve block (IANB) injection or as a supplemental injection after the failure of the primary injection in symptomatic and asymptomatic patients with irreversible pulpitis in human mandibular molars. The review question was “What will be the success of primary and supplemental infiltration injection in the endodontic treatment of patients with irreversible pulpitis in human mandibular molars?” We searched electronic databases, including Pubmed, Scopus, and Ebsco host and we did a comprehensive manual search. The review protocol was framed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. We included clinical studies that evaluated and compared the anesthetic outcomes of primary IANB with primary and/or supplementary infiltration injections. Standard evaluation of the included studies was performed and suitable data and inferences were assessed. Twenty-six studies were included, of which 13 were selected for the meta-analysis. In the forest plot representation of the studies evaluating infiltrations, the combined risk ratio (RR) was 1.88 (95% CI: 1.49, 2.37), in favor of the secondary infiltrations with a statistical heterogeneity of 77%. The forest plot analysis for studies comparing primary IANB + infiltration versus primary IANB alone showed a low heterogeneity (0%). The included studies had similar RRs and the combined RR was 1.84 (95% CI: 1.44, 2.34). These findings suggest that supplemental infiltrations given along with a primary IANB provide a better success rate. L’Abbe plots were generated to measure the statistical heterogeneity among the studies. Trial sequential analysis suggested that the number of patients included in the analysis was adequate. Based on the qualitative and quantitative analyses, we concluded that the infiltration technique, either as a primary injection or as a supplementary injection, given after the failure of primary IANB, increases the overall anesthetic efficacy.
키워드
Irreversible Pulpitis; Local Anesthesia; Mandibular Molars
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