Abstract
Introduction
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).
Methods
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.
Results
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.
Conclusions
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.
Key Words
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© 2019 American Association of Endodontists.
