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01-03-2025 | Nerve Block | Review

Articaine buccal infiltration for mandibular first molars with symptomatic irreversible pulpitis: is it as effective as inferior alveolar nerve block with lidocaine? a systematic review and meta-analysis

Authors: Masoud Saatchi, Golshan Mohammadi, Pedram Iranmanesh, Abbasali Khademi, Alireza Farhad, Vivek Aggarwal, Jafar Kolahi

Published in: Clinical Oral Investigations | Issue 3/2025

Abstract

Objectives

This systematic review and meta-analysis aimed to compare the anesthetic efficacy of 4% articaine buccal infiltration (BI) with 2% lidocaine inferior alveolar nerve block (IANB) for mandibular first molars with symptomatic irreversible pulpitis.

Methods

Randomized clinical trials (RCTs) comparing the anesthetic efficiency of one cartridge of 4% articaine BI (as the primary injection) with one cartridge of 2% lidocaine IANB in permanent first mandibular molars with symptomatic irreversible pulpitis were searched in five databases. The risk of bias (RoB) was evaluated using the RoB2 (Cochrane Risk of Bias Tool). A fixed-effects meta-analysis was performed using STATA software. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

Results

Out of 780 records, five RCTs were included. The meta-analysis revealed no significant difference in the success rates of articaine BI and lidocaine IANB [Risk ratio (RR) = 1.06, 95% confidence interval (CI) = (0.93, 1.20), I² = 24.51%)]. The certainty of the evidence was graded as “moderate”.

Conclusions

The moderate certainty of evidence suggests that the anesthetic efficacy of 4% articaine BI is comparable to 2% lidocaine IANB for mandibular first molars with symptomatic irreversible pulpitis. However, more clinical trials are needed.

Clinical relevance

BI with 4% articaine for mandibular first molars with symptomatic irreversible pulpitis can be an alternative for clinicians compared with 2% lidocaine IANB.

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Title: Articaine buccal infiltration for mandibular first molars with symptomatic irreversible pulpitis: is it as effective as inferior alveolar nerve block with lidocaine? a systematic review and meta-analysis
Authors: Masoud Saatchi
Golshan Mohammadi
Pedram Iranmanesh
Abbasali Khademi
Alireza Farhad
Vivek Aggarwal
Jafar Kolahi
Publication date: 01-03-2025
Publisher: Springer Berlin Heidelberg
Keyword: Nerve Block
Published in: Clinical Oral Investigations / Issue 3/2025
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-025-06229-0

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Articaine buccal infiltration for mandibular first molars with symptomatic irreversible pulpitis: is it as effective as inferior alveolar nerve block with lidocaine? a systematic review and meta-analysis

Abstract

Objectives

Methods

Results

Conclusions

Clinical relevance

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Clinical relevance

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