Comparison of dental anesthetic efficacy between the periodontal intraligamentary anesthesia and other infiltration anesthesia: a systematic review and meta-analysis

Articaine Versus Mepivacaine in Inferior Alveolar Nerve Block for Patients With Irreversible Pulpitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Inferior alveolar nerve block (IANB) as an anesthetic strategy has shown conflicting results in terms of efficacy in the treatment of patients with irreversible pulpitis. Mepivacaine and articaine are anesthetic agents commonly used in the IANB technique for pulpal anesthesia. This review aimed to compare mepivacaine and articaine regarding pain and success rate. We conducted a search on the databases PubMed, Scopus, Web of Science (WOS), and Cochrane Central for randomized controlled trials (RCTs) assessing mepivacaine versus articaine until September 2024. The primary outcome of interest was success rate, while the secondary outcomes were pain intensity assessed by a 10-point visual analog scale (VAS) and incidence of severe pain. Data were pooled as odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) in a random-effect model using STATA. Five RCTs including 568 patients were included in the final analysis. While there was no significant difference between the two studied groups regarding the success rate (OR: 0.92, 95% CI: 0.69 to 1.21, p=0.54), articaine significantly reduced the pain intensity compared to mepivacaine (MD: 0.59, 95% CI: 0.31 to 0.86], p<0.001). Moreover, no significant difference was observed regarding the incidence of severe pain. Articaine reduced the intensity of pain post-procedure, with comparable results regarding success rate and incidence of severe pain with mepivacaine. Further large-volume RCTs are warranted to study the differences between the two options in the long term.

The bevel effect: a prospective, randomized investigation into needle design in dental intraligamentary anesthesia

OBJECTIVES

This in vivo study aimed to assess the impact of needle bevel design on puncture pain, anesthetic success, and mechanical deformations in intraligamentary injection (ILA) cases, comparing a short triple facet cut (STF) to a triple lancet cut (TL) after single or repetitive use.

MATERIALS AND METHODS

In a prospective single-blind trial, 200 ILA needles (STF, n = 100; TL, n = 100) were randomly assigned for dental procedures. Patients received ILA either with STF or TL needles, used once (group A; n = 50 each) or repeatedly (group B; n = 50). Puncture pain was assessed using a numerical rating scale (NRS). Anesthetic success was determined via cold spray (yes/no), and scanning electron microscopy (SEM) analyzed needle tip deformations.

RESULTS

Puncture pain did not significantly differ between STF and TL, regardless of needle use or injection area. Success rates were comparable in single use (82% STF vs. 79% TL; p > 0.05). For repetitive use, STF exhibited a significantly higher success rate (80% vs. 69%; p = 0.012). Mechanical deformations were prevalent in 97.5% of needles, with TL showing greater deformations than STF after single and repeated uses. Barbs were more common in TL (90/100) than STF (84/100), with a higher relative risk for barbed-like deformation in TL (RR single use: 1.26; p < 0.001; multiple use: 7.87, p < 0.001).

CONCLUSIONS

The short triple facet-designed bevel demonstrated significantly less mechanical deformation, suggesting potential advantages in maintaining needle lumen patency.

CLINICAL RELEVANCE

The intraligamentary needle bevel design is linked to mechanical deformation and anesthetic success after repetitive use, but not to puncture pain.

Assessing the Impact of Mandibular Molar Root Length on Success in Supplemental Intraligamentary Injection for Irreversible Pulpitis

Introduction

This study investigates the influence of root length in mandibular molars with irreversible pulpitis on the success of supplemental intraligamentary injection following an inferior alveolar nerve (IAN) block. Various factors, including anatomical location, tooth type, and anesthetic solution, may affect supplemental anesthesia success.

Materials and Methods

A total of 251 patients diagnosed with irreversible pulpitis in mandibular first or second molars underwent buccal infiltration anesthesia (4% articaine with 1:100,000 epinephrine) after IAN block injection (3% prilocaine and 0.03 IU/mL of felypressin). Fifty patients experiencing pain during access cavity preparation received supplemental intraligamentary injection (0.3 mL of 2% lidocaine with 1:80,000 epinephrine) at each mesial and distal line angle. The root length of treated teeth was recorded using an apex locator. Data analysis involved independent t-tests, Chi-square tests, and logistic regression.

Results

Successful supplemental intraligamentary injection was observed in 21 (42%) out of 50 patients. No significant correlation was found between the mean length of mesiobuccal (P=0.61), mesiolingual (P=0.34), or distal (P=0.60) canals of mandibular molars and the injection's success. Logistic regression analysis, however, revealed a significant impact of mesiolingual canal length on the success rate [OR 0.09 (0.01-0.79), P=0.030].

Conclusion

The root length of mandibular first and second molars does not significantly affect the success of supplemental intraligamentary injection.