Abd-Elsabour Mennat Allah Ashraf, Gamal-AbdelNaser Ayat
Pediatric and Community Dentistry Department, Faculty of Oral and Dental Medicine, Ahram Canadian University, Giza, Egypt.
Department of Oral Medicine and Periodontology, Faculty of Oral and Dental Medicine, Ahram Canadian University, Giza, Egypt.
Head Face Med. 2025 Feb 3;21(1):4. doi: 10.1186/s13005-025-00481-1.
Although frequently applied, inferior alveolar nerve block (IANB) is associated with high rate of complications, beside its unpredictable success; partly due to improper needle choice. Evidence of the ideal needle contradicts in literature. Therefore, this review aims to assess the effect of needle characteristics on the outcomes of IANB.
A systematic search was performed on MedLine via Pubmed, Cochrane Library, LILACS, Science Open, EBSCOhost, Scopus, Egyptian Knowledge Bank (EKB), and Google scholar; beside searching grey literature and hand searching. The review included randomized controlled trials comparing needles of difference in any of the characteristics (gauge, length, bevel, alloy) used for IANB regarding their effects on pain, success of anesthesia and aspiration. The authors ran the search, selected the eligible studies, assessed the risk of bias using RoB 1 and extracted the data of the finally included studies. All the steps were performed in duplicates.
The search yielded a total of 2,812 records. After de-duplication and excluding ineligible studies by title and abstract then by full text, the review included nine eligible studies. The compared needle interventions included: gauges (23G, 24G, 25G, 26G, 27G and 30G), lengths (12 mm, 25 mm, 32 mm, 35 mm, 42 mm), and internal diameters (0.265 mm, 0.215 mm, 0.3 mm and 0.4 mm). All studies had high risk of bias, adopted different assessment methods for the outcomes, and included participants with differences in baseline characteristics.
The level of the available evidence introduced by primary studies hinder concluding the optimal needle characteristics; keeping the research question unanswered. However, within the limitations of the heterogenous studies, available data favors thinner needles for less pain during needle insertion; otherwise, data of the other outcomes was inconclusive.
Thinner needles are favored for less pain during insertion; but standardized future studies are essentially needed for solid conclusions. A detailed standard protocol is, therefore, proposed.
尽管下牙槽神经阻滞（IANB）经常被应用，但其不仅成功率难以预测，还伴有高并发症发生率，部分原因是针头选择不当。关于理想针头的证据在文献中存在矛盾。因此，本综述旨在评估针头特性对IANB结果的影响。
通过PubMed、Cochrane图书馆、LILACS、Science Open、EBSCOhost、Scopus、埃及知识库（EKB）和谷歌学术对MedLine进行系统检索；此外还检索了灰色文献并进行手工检索。该综述纳入了随机对照试验，比较用于IANB的任何特性（规格、长度、斜面、合金）不同的针头在疼痛、麻醉成功率和回抽方面的效果。作者进行检索、选择符合条件的研究、使用RoB 1评估偏倚风险并提取最终纳入研究的数据。所有步骤均重复进行。
检索共获得2812条记录。在通过标题和摘要然后通过全文进行重复数据删除和排除不符合条件的研究后，该综述纳入了9项符合条件的研究。比较的针头干预措施包括：规格（23G、24G、25G、26G、27G和30G）、长度（12毫米、25毫米、32毫米、35毫米、42毫米）和内径（0.265毫米、0.215毫米、0.3毫米和0.4毫米）。所有研究都有较高的偏倚风险，采用不同方法评估结果，且纳入的参与者基线特征存在差异。
初步研究提供的现有证据水平阻碍了得出最佳针头特性的结论，使研究问题仍未得到解答。然而，在异质性研究的局限性内，现有数据支持使用较细的针头以减少进针时的疼痛；否则，其他结果的数据尚无定论。
较细的针头在进针时疼痛较轻；但为得出确凿结论，未来需要进行标准化研究。因此，提出了详细的标准方案。
