Department of Dentistry, Federal University of Santa Catarina (UFSC), Campus Reitor João David Ferreira Lima, Florianópolis, SC, 88040-900, Brazil.
Brazilian Centre for Evidence Based Research, Department of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil.
Clin Oral Investig. 2021 Dec;25(12):6477-6500. doi: 10.1007/s00784-021-04145-7. Epub 2021 Aug 28.
This systematic review aimed to assess the effectiveness of anesthetic methods for mandibular posterior teeth with symptomatic irreversible pulpitis, comparing to the inferior alveolar nerve block (IANB) by meta-analysis.
Studies were identified from Cochrane Library, Embase, Lilacs, PubMed, Scopus, and Web of Science databases up to May 2021. Randomized clinical trials comparing the anesthetic success rate of IANB and any other alternative anesthetic method were included. The quality of the selected studies was assessed by the Cochrane Risk of Bias 2.0 tool. Meta-analyses using Mantel-Haenszel method and random-effect models were performed to find the pooled estimates of risk ratio (RR) with 95% confidence interval (CI). The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach.
Twenty-two studies were selected, which included fourteen anesthetic methods. Two studies were classified as high risk of bias, five as uncertain risk and fifteen as low risk. Vazirani-Akinosi nerve block (VANB) [RR = 1.27; p = 0.007; 95% CI, 1.07-1.52; I = 0%] and intraosseous injection (IOI) [RR = 1.48; p = 0.04; 95% CI, 1.02-2.15; I = 46%] had superior effectiveness compared to IANB, with low certainty of evidence, as well as buccal infiltrations associated with IANB (BI + IANB) [RR = 1.84; p = 0.004; 95% CI, 1.22-2.79; I = 52%], with very low certainty.
Evidence suggests that buccal infiltrations associated with IANB, VANB, and IOI are more effective than IANB at anesthetizing posterior mandibular teeth with symptomatic irreversible pulpitis.
Alternative primary methods of anesthesia might be indicated for mandibular posterior teeth presenting symptomatic irreversible pulpitis.
本系统评价通过荟萃分析评估了用于治疗有症状不可复性牙髓炎的下颌后牙的各种麻醉方法的效果，以比较下牙槽神经阻滞麻醉（IANB）。
研究人员从 Cochrane 图书馆、Embase、Lilacs、PubMed、Scopus 和 Web of Science 数据库中检索截至 2021 年 5 月的研究。纳入了比较 IANB 与任何其他替代麻醉方法的麻醉成功率的随机临床试验。使用 Cochrane 偏倚风险 2.0 工具评估所选研究的质量。使用 Mantel-Haenszel 方法和随机效应模型进行荟萃分析，以找到风险比（RR）的汇总估计值及其 95%置信区间（CI）。使用推荐评估、制定与评价（GRADE）方法评估证据质量。
共选择了 22 项研究，其中包括 14 种麻醉方法。两项研究被归类为高偏倚风险，五项研究为不确定风险，十五项研究为低偏倚风险。Vazirani-Akinosi 神经阻滞（VANB）[RR=1.27;p=0.007;95%CI,1.07-1.52;I=0%]和骨内注射（IOI）[RR=1.48;p=0.04;95%CI,1.02-2.15;I=46%]与 IANB 相比具有更好的效果，证据确定性为低，而与 IANB 联合使用的颊侧浸润麻醉（BI+IANB）[RR=1.84;p=0.004;95%CI,1.22-2.79;I=52%]则具有极低的确定性。
有证据表明，与 IANB 联合使用的颊侧浸润麻醉、VANB 和 IOI 比 IANB 更有效地麻醉有症状不可复性牙髓炎的下颌后牙。
对于有症状不可复性牙髓炎的下颌后牙，可能需要采用替代的主要麻醉方法。
