Rujirawan Thanatpong, Osiri Sittichoke, Chotvorrarak Kanet
Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.
Int Endod J. 2025 Jul 29. doi: 10.1111/iej.70007.
Achieving effective anaesthesia in mandibular molars with symptomatic irreversible pulpitis is challenging. Various strategies involving the inferior alveolar nerve block (IANB) have been investigated, such as supplementing with additional injections after IANB failure (SUPP) or combining injections with IANB as primary injections (COMB). However, studies directly comparing SUPP and COMB are still lacking.
This study aims to assess and compare the anaesthetic effectiveness of different IANB strategies-SUPP and COMB-in mandibular posterior teeth with symptomatic irreversible pulpitis using a systematic review and network meta-analysis.
A comprehensive search was conducted in the PubMed, Embase, Cochrane Library, CINAHL and Scopus databases to identify relevant studies up to October 2024. Eligible randomised clinical trials (RCTs) were analysed using pairwise meta-analysis and network meta-analysis with a random-effects model to estimate treatment effects. Results were reported as risk ratios (RRs) with 95% confidence intervals (CIs) and surface under the cumulative ranking curve (SUCRA) values. The quality of the evidence was assessed using the CINeMA (Confidence in network meta-analysis) software (University of Bern, Bern, Switzerland).
A total of 28 studies involving five interventions were identified. Compared with IANB alone, both SUPP (RR = 2.02; 95% CI: 1.55-2.30; SUCRA: 85.1%) and COMB (RR = 1.86; 95% CI: 1.50-2.30; SUCRA: 64.9%) significantly improved anaesthetic success. However, there was no significant difference in effectiveness between SUPP and COMB.
The quality of evidence ranging from low to high suggests that both SUPP and COMB are comparable in anaesthetic efficacy during endodontic treatment of mandibular molars with symptomatic irreversible pulpitis. However, both SUPP and COMB strategies showed significantly superior effectiveness compared to IANB alone.
在下颌磨牙伴有症状性不可逆性牙髓炎时实现有效的麻醉具有挑战性。已经研究了各种涉及下牙槽神经阻滞（IANB）的策略，例如在IANB失败后补充额外注射（SUPP）或将注射与IANB联合作为主要注射方式（COMB）。然而，直接比较SUPP和COMB的研究仍然缺乏。
本研究旨在通过系统评价和网络荟萃分析，评估和比较不同IANB策略（SUPP和COMB）在下颌后牙伴有症状性不可逆性牙髓炎时的麻醉效果。
在PubMed、Embase、Cochrane图书馆、CINAHL和Scopus数据库中进行全面检索，以识别截至2024年10月的相关研究。使用随机效应模型的成对荟萃分析和网络荟萃分析对符合条件的随机临床试验（RCT）进行分析，以估计治疗效果。结果以风险比（RRs）及其95%置信区间（CIs）和累积排名曲线下面积（SUCRA）值报告。使用CINeMA（网络荟萃分析置信度）软件（瑞士伯尔尼大学）评估证据质量。
共识别出28项涉及五种干预措施的研究。与单独使用IANB相比，SUPP（RR = 2.02；95% CI：1.55 - 2.30；SUCRA：85.1%）和COMB（RR = 1.86；95% CI：1.50 - 2.30；SUCRA：64.9%）均显著提高了麻醉成功率。然而，SUPP和COMB之间的有效性没有显著差异。
证据质量从低到高表明，在伴有症状性不可逆性牙髓炎的下颌磨牙根管治疗期间，SUPP和COMB在麻醉效果方面具有可比性。然而，与单独使用IANB相比，SUPP和COMB策略均显示出显著更高的有效性。
