This systematic review compared the anesthetic efficacy between Gow-Gates (GG), Vazirani-Akinosi (VA), and mental incisive (MI) nerve blocks (NBs) with inferior alveolar nerve blocks (IANBs) in mandibular teeth with irreversible pulpitis using meta-analysis and trial sequential analysis (TSA).
Studies were identified from 4 electronic databases up to June 2019. Randomized clinical trials (RCTs) comparing the anesthetic success rate of GG, VA, and MI NBs with IANBs in mandibular premolars and molars with irreversible pulpitis were included. The quality of selected RCTs was appraised using the revised Cochrane risk of bias tool. Random-effects meta-analyses of risk ratio (RR) and 95% confidence intervals (CIs) were calculated, and random errors were evaluated by TSA. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach.
Five RCTs were included; 2 of them were classified as low risk of bias. No significant difference was observed in the anesthesia success rate compared between GG and IA NBs (RR = 1.10; 95% CI, 0.82–1.48; I2 = 0%). Similarly, no difference was evident between MINB and IANB (RR = 1.15; 95% CI, 0.97–1.36; I2 = 0%). Overall, the cumulative success rates for the 3 anesthetic techniques were low. TSA showed a lack of firm evidence for the results of the meta-analysis between GG NB and IANB. The Grading of Recommendations, Assessment, Development and Evaluation approach evaluation showed that the evidence was of moderate quality for GG NB and IANB compared with low quality for MI and IA NBs. Because only 1 study was available comparing VA NB and IANB, a meta-analysis was not performed. The adverse effect associated with MI NB was swelling, whereas it was prolonged numbness for IANB.
GG NB and IANB showed similar anesthetic efficacy compared with IANB in mandibular teeth with irreversible pulpitis. However, the success rates for each technique indicate the need for supplemental anesthesia. Further well-designed RCTs evaluating different anesthetic techniques with and without supplemental injection are required to provide stronger evidence.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Endodontics
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Strategies for managing pain during endodontic treatment.Aust Endod J. 2018; 44: 99-113
- Comparative evaluation of anesthetic efficacy of Gow-Gates mandibular conduction anesthesia, Vazirani-Akinosi technique, buccal-plus-lingual infiltrations, and conventional inferior alveolar nerve anesthesia in patients with irreversible pulpitis.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 109: 303-308
- Comparative evaluation of mental incisal nerve block, inferior alveolar nerve block, and their combination on the anesthetic success rate in symptomatic mandibular premolars: a randomized double-blind clinical trial.J Endod. 2016; 42: 843-845
- Efficacy of IANB and Gow-Gates techniques in mandibular molars with symptomatic irreversible pulpitis: a prospective randomized double blind clinical study.Iran Endod J. 2018; 13: 143-148
- Anesthetic efficacy of Gow-Gates nerve block, inferior alveolar nerve block, and their combination in mandibular molars with symptomatic irreversible pulpitis: a prospective, randomized clinical trial.J Endod. 2018; 44: 384-388
- Anesthetic efficacy of mental/incisive nerve block compared to inferior alveolar nerve block using 4% articaine in mandibular premolars with symptomatic irreversible pulpitis: a randomized clinical trial.Clin Oral Investig. 2019; 23: 839-845
- A basic review on the inferior alveolar nerve block techniques.Anesth Essays Res. 2014; 8: 3-8
- Anesthetic efficacy of the supplemental intraosseous injection of 3% mepivacaine in irreversible pulpitis.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997; 84: 676-682
- Anesthetic efficacy of the supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in irreversible pulpitis.J Endod. 1998; 24: 487-491
- The significance of needle deflection in success of the inferior alveolar nerve block in patients with irreversible pulpitis.J Endod. 2003; 29: 630-633
- Effect of sublingual triazolam on the success of inferior alveolar nerve block in patients with irreversible pulpitis.J Endod. 2008; 34: 1167-1170
- Anesthetic success of an inferior alveolar nerve block and supplemental articaine buccal infiltration for molars and premolars in patients with symptomatic irreversible pulpitis.J Endod. 2016; 42: 390-392
- Comparative evaluation of anesthetic efficacy of 2% lidocaine, 4% articaine, and 0.5% bupivacaine on inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a prospective, randomized, double-blind clinical trial.J Oral Facial Pain Headache. 2017; 31: 124-128
- variant inferior alveolar nerves and implications for local anesthesia.Anesth Prog. 2016; 63: 84-90
- Effect of preoperative oral analgesics on pulpal anesthesia in patients with irreversible pulpitis-a systematic review and meta-analysis.Clin Oral Investig. 2017; 21: 43-52
- Mandibular conduction anesthesia: a new technique using extraoral landmarks.Oral Surg Oral Med Oral Pathol. 1973; 36: 321-328
- Evaluation of the Gow-Gates and Vazirani-Akinosi techniques in patients with symptomatic irreversible pulpitis: a prospective randomized study.J Endod. 2015; 41: 16-21
- Anesthetic efficacy of the Gow-Gates injection and maxillary infiltration with articaine and lidocaine for irreversible pulpitis.J Endod. 2008; 34: 656-659
- Handbook of Local Anesthesia.Elsevier Mosby, St Louis, MO2013: 241
- Comparison of the anesthetic efficacy of the conventional inferior alveolar, Gow-Gates, and Vazirani-Akinosi techniques.J Endod. 2008; 34: 1306-1311
- The use of the mandibular infiltration anesthetic technique in adults.J Am Dent Assoc. 2011; 142: 19S-24S
- An evaluation of the incisive nerve block and combination inferior alveolar and incisive nerve blocks in mandibular anesthesia.J Endod. 1992; 18: 455-459
- Preferred reporting items for systematic reviews and metaanalyses: the PRISMA statement.Ann Intern Med. 2009; 151: 264-269
- A revised tool for assessing risk of bias in randomized trials.Cochrane Database Syst Rev. 2016; 10: 29-31
- Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature.J Clin Epidemiol. 2000; 53: 1119-1129
- User manual for trial sequential analysis (TSA).2011: 1-115 (Available at:)Accessed December 16, 2018)
- Grading quality of evidence and strength of recommendations.BMJ. 2004; 328: 1490-1494
- Comparative evaluation of effect of preoperative alprazolam and diclofenac potassium on the success of inferior alveolar, Vazirani-Akinosi, and Gow-Gates techniques for teeth with irreversible pulpitis: randomized controlled trial.J Conserv Dent. 2016; 19: 390-395
- Local anesthetic failure in endodontics: mechanisms and management.Endod Topics. 2002; 1: 26-39
- Vanilloid receptor expression and capsaicin excitation of rat dental primary afferent neurons.J Dent Res. 2001; 80: 1518-1523
- Effect of oral premedication on the anaesthetic efficacy of inferior alveolar nerve block in patients with irreversible pulpitis - a systematic review and network meta-analysis of randomized controlled trials.Int Endod J. 2018; 51: 989-1004
- Effect of nonsteroidal anti-inflammatory drug as an oral premedication on the anesthetic success of inferior alveolar nerve block in treatment of irreversible pulpitis: a systematic review with meta-analysis and trial sequential analysis.J Endod. 2018; 44: 914-922.e2
- Trial sequential analysis may establish when firm evidence is reached in cumulative meta-analysis.J Clin Epidemiol. 2008; 61: 64-75
- Trial sequential analysis in systematic reviews with meta-analysis.BMC Med Res Methodol. 2017; 17: 39
- Anesthetic efficacy of supplemental buccal and lingual infiltrations of articaine and lidocaine after an inferior alveolar nerve block in patients with irreversible pulpitis.J Endod. 2009; 35: 925-929
© 2019 American Association of Endodontists.