Restor Dent Endod.  2021 Aug;46(3):e41. 10.5395/rde.2021.46.e41.

Anesthetic efficacy in vital asymptomatic teeth using different local anesthetics: a systematic review with network meta-analysis

• Liew AKC
• Yeh YC
• Abdullah D
• Tu YK

• KMID: 2548085
• DOI: http://doi.org/10.5395/rde.2021.46.e41

Abstract

Objectives
This study aimed to evaluate the efficacy of various local anesthesia (LA) in vital asymptomatic teeth.
Materials and Methods
Randomized controlled trials comparing pulpal anesthesia of various LA on vital asymptomatic teeth were included in this review. Searches were conducted in the Cochrane CENTRAL, MEDLINE (via PubMed), EMBASE, ClinicalTrials.gov, Google Scholar and 3 field-specific journals from inception to May 3, 2019. Study selection, data extraction, and risk of bias assessment using Cochrane Risk of Bias Tool were done by 2 independent reviewers in duplicate. Network meta-analysis (NMA) was performed within the frequentist setting using STATA 15.0. The LA was ranked, and the surface under the cumulative ranking (SUCRA) line was plotted. The confidence of the NMA estimates was assessed using the CINeMA web application.
Results
The literature search yielded 1,678 potentially eligible reports, but only 42 were included in this review. For maxillary buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than lidocaine 2% with epinephrine 1:100,000 (odds ratio, 2.11; 95% confidence interval, 1.14–3.89). For mandibular buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than various lidocaine solutions. The SUCRA ranking was highest for articaine 4% with epinephrine when used as maxillary and mandibular buccal infiltrations, and lidocaine 2% with epinephrine 1:80,000 when used as inferior alveolar nerve block. Inconsistency and imprecision were detected in some of the NMA estimates.
Conclusions
Articaine 4% with epinephrine is superior when maxillary or mandibular infiltration is required in vital asymptomatic teeth.

Keyword

Inferior alveolar nerve block; Local anesthetic; Maxillary infiltration; Meta-analysis; Systematic review

Figure

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  Figure 1 Preferred Reporting Items for Systematic Review and Meta-Analyses flow diagram.

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  Figure 2 Network plots of local anesthetic solutions used for (A) maxillary infiltration, (B) mandibular infiltration, and (C) inferior alveolar nerve block. LAs forming a separate cluster from the main network are not displayed here. Abbreviation codes were used to represent the intervention. The first number indicates the number of cartridges used. This is followed by the type of LA (Art = articaine, Lid = lidocaine, Bup = bupivacaine, Rop = ropivacaine, Mep = mepivacaine, Pri = prilocaine, Lev = levobupivacaine) and its concentration (%). The third part denotes the vasoconstrictor (nil = plain, E = epinephrine, L = levonordefrin, Fel = felypressin) and its concentration (one in hundred thousand, e.g., E100 = epinephrine 1:100,000 or tenth of iu/mL, e.g., Fel3 = 0.03 iu/mL).LA, local anesthesia.

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