SYSTEMATIC REVIEW article
Front. Dent. Med.
Sec. Endodontics
Evaluation of the effectiveness of local anesthesia approaches for symptomatic irreversible pulpitis: a systematic review and meta-analysis
Provisionally accepted
Xu Li
Xin ChenYuqing GuiQian Wang
Fengqing HuangLijun XiongMengyan XiaoDinghao Zhong
Zining LuoJunxian GuXinyu Xu
Jiebin Xie*- North Sichuan Medical College, Nanchong, China
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Objective: This meta-analysis assessed the efficacy of various anesthetic protocols for symptomatic irreversible pulpitis, comparing techniques and agents to identify the optimal anesthesia approach. Methods: We conducted a comprehensive search of the Cochrane Library, PubMed, Web of Science, Scopus, and Embase databases up to July 10, 2025, identifying relevant studies based on predefined inclusion and exclusion criteria. The primary outcome was the success rate of anesthesia. Data extraction and quality assessment were performed using a pre-designed form and the revised Cochrane Risk of Bias Tool. A fixed-effect model was used for meta-analysis when heterogeneity was low (I² ≤ 50%, p ≥ 0.1); otherwise, a random-effects model was adopted. Additionally, another model was employed for validation, and the results from both models were compared to derive more reasonable conclusions. Publication bias was assessed using funnel plots and the Egger test. Results: Fourteen RCTs were included in the meta-analysis. Pooled analysis showed that modified anesthetic protocols for SIP were 3.62 times more successful than conventional inferior alveolar nerve block (IANB) using standard 2% lidocaine with epinephrine (OR = 3.34; 95% CI: 2.49–4.48). Studies conducted in Iran had the highest success rate (OR = 4.31; 95% CI: 3.59–5.17, p < 0.001). Inferior alveolar nerve block (IANB) was more effective than buccal infiltration (OR = 4.03; 95% CI: 3.38–4.81, p < 0.001), and 4% articaine demonstrated the highest efficacy (OR = 4.18; 95% CI: 2.85–6.16, p < 0.001). Conclusion: This meta-analysis assessed the efficacy of various anesthetic protocols for SIP, comparing techniques and agents to identify the optimal anesthesia approach.
Keywords: Anesthesia, Articaine, Inferior alveolar nerve block (IANB), Meta - analysis, symptomatic irreversible pulpitis(SIP)
Received: 12 Aug 2025; Accepted: 09 Dec 2025.
Copyright: © 2025 Li, Chen, Gui, Wang, Huang, Xiong, Xiao, Zhong, Luo, Gu, Xu and Xie. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jiebin Xie
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.