Dental Research Center and Department of Endodontics, School of Dentistry, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Endodontics, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Int Endod J. 2022 Jul;55(7):732-747. doi: 10.1111/iej.13746. Epub 2022 Apr 22.
Incorporating an additive into lidocaine is a method to enhance the efficacy of the inferior alveolar nerve block (IANB) in mandibular posterior teeth.
To assess the efficacy of incorporating additives into lidocaine in the success rate of IANB for teeth with the diagnosis of normal pulp (NP) or symptomatic irreversible pulpitis (SIP).
Randomized controlled trials (RCTs) assessing the incorporation of additives into lidocaine on the pulpal anaesthesia success rate of mandibular posterior teeth were searched in PubMed, Scopus, Web of Science, Ovid, EBSCO, Embase, and Cochrane databases up to 1 December 2021. The risk of bias (RoB) was assessed by the Cochrane Risk of Bias Tool. A random-effects model was employed to calculate the pooled risk ratio (RR) with a 95% confidence interval (CI), using STATA 16. The trial sequential analysis (TSA) was applied to calculate the required information size (RIS). The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to assess the certainty of the evidence.
Of 6966 records retrieved initially, 14 trials (8 for NP and 6 for SIP groups) were included in qualitative and quantitative syntheses. All trials were categorized as low and unclear RoB for NP and SIP groups, respectively. In the NP group, with 307 participants, no significant effect was observed for additives incorporated into lidocaine (RR: 0.84; 95% CI: 0.53-1.32; I = 98%). Subgroup analysis revealed that adding mannitol led to a higher success rate (RR = 1.24; 95% CI: 1.15-1.34; I = 7.16%). In the SIP group, with 434 participants, no significant effect was shown when the additives were incorporated (RR = 1.22; 95% CI: 0.98-1.52; I = 0%). Likewise, in subgroup analysis, incorporating mannitol or sodium bicarbonate demonstrated no significant effect (RR = 1.76; 95% CI: 0.93-3.32; I = 18.41% and RR = 1.06; 95% CI: 0.65-1.72; I = 53.5%, respectively).
TSA revealed that the outcome was "inconclusive" for each group. The certainty of the evidence was graded as "very low" and "low" for NP and SIP groups, respectively.
The very low to low certainty of evidence indicated that incorporating additives into lidocaine did not increase the efficacy of IANB and supplemental injections are still necessary to help practitioners achieve painless dentistry.
PROSPERO database (CRD42020132585).
在利多卡因中加入添加剂是增强下颌后牙下齿槽神经阻滞（IANB）效果的一种方法。
评估在诊断为正常牙髓（NP）或有症状不可复性牙髓炎（SIP）的下颌后牙中加入添加剂对IANB 牙髓麻醉成功率的效果。
在 PubMed、Scopus、Web of Science、Ovid、EBSCO、Embase 和 Cochrane 数据库中检索了截至 2021 年 12 月 1 日评估利多卡因中加入添加剂对下颌后牙牙髓麻醉成功率的随机对照试验（RCT）。使用 Cochrane 偏倚风险工具评估偏倚风险（RoB）。采用随机效应模型计算汇总风险比（RR）和 95%置信区间（CI），使用 STATA 16 进行分析。应用试验序贯分析（TSA）计算所需信息大小（RIS）。使用推荐、评估、制定和评估分级（GRADE）方法评估证据的确定性。
最初检索到 6966 条记录，其中 14 项试验（NP 组 8 项，SIP 组 6 项）纳入定性和定量综合分析。NP 组和 SIP 组的所有试验均被归类为低风险和不确定偏倚。NP 组中，307 名参与者中，加入利多卡因的添加剂无显著效果（RR：0.84；95% CI：0.53-1.32；I²=98%）。亚组分析显示，加入甘露醇可提高成功率（RR：1.24；95% CI：1.15-1.34；I²=7.16%）。SIP 组中，434 名参与者中，加入添加剂无显著效果（RR：1.22；95% CI：0.98-1.52；I²=0%）。同样，在亚组分析中，加入甘露醇或碳酸氢钠无显著效果（RR：1.76；95% CI：0.93-3.32；I²=18.41%和 RR：1.06；95% CI：0.65-1.72；I²=53.5%）。
TSA 显示每组的结果均为“不确定”。NP 组和 SIP 组的证据确定性等级分别为“非常低”和“低”。
证据的确定性从非常低到低表明，在利多卡因中加入添加剂并不能提高 IANB 的效果，仍需要补充注射以帮助从业者实现无痛牙科。
PROSPERO 数据库（CRD42020132585）。
