Anaesthetic efficacy of alternative local anaesthesia techniques in patients with irreversible pulpitis-a systematic review

Abstract

Introduction: Pain management during endodontic therapy has been a major concern among the dentists since many years. Patients often associate endodontic treatment with pain. Achieving profound local anesthesia is an important step in perform-ing root canal treatment. In fact, dental practitioners usually face challenges to achieve this goal in their daily practice. Pain is common during root canal treatment and it is mainly due to the inflammation of periodontal ligament. Patient’s anxiety level raises due to pain during treatment. Till now, various agents have tried to manage pain during endodontic treatment. Conventional techniques used to anesthetize teeth are Inferior alveolar nerve block (IANB) Posterior superior alveolar (PSA), Infraor-bital nerve block (IONB), Greater palatine (GP), Nasopalatine nerve block (NP), Middle superior alveolar nerve block (MSA), Anterior superior alveolar nerve block(ASA), Lingual nerve block(LN), Mental incisive (MI) nerve blocks (NBs). Apart from analgesics, corticosteroids, alternative local anesthesia techniques have also been reported to be effective in the management of inter appointment pain. This systematic review analyzes the anaesthetic efficacy of alternative local anaesthesia techniques in patients with irreversible pulpitis in pain management during endodontic treatment. Aim: To assess the anesthetic efficacy of alternative local anesthesia techniques in patients with irreversible pulpitis. Search Strategy: A search was performed in electronic database (i.e. PUBMED CENTRAL, Google and Hand Search) using following search terms alone and in combination by means of PUBMED search builder till October 2020. Selection Criteria: All in vivo studies that used alternative local anaesthesia techniques in patients with irreversible pulpitis during root canal treatment were selected. Data Collection and Analysis: All the studies were based on the data extraction and analysis of the studies for quality. The outcome measure was to evaluate the reduction of pain during root canal treatment after use of alternative local anesthesia techniques. Results: Two studies included for this review had high risk of bias. The included studies used alternative local anesthesia techniques. Of the 2 studies included for this review, only 1 study indicated the use of alternative local anesthesia techniques for effective pain management during endodontic treatment and other study indicated alternative local anesthesia techniques provided adequate pulpal anesthesia but the results were not statistically significant. Conclusion: This review concludes that the studies reviewed here have a high risk of quality bias. However, alternative local anesthesia techniques yielded better results compared to conventional local anesthesia techniques. The included studies were not designed properly with respect to randomization, sample size calculation, blinding. Hence further clinical trials need to be conducted with proper sample size calculation, blinding and randomization to obtain acurate results.