Exploration of Medicine

Table 4. Risk of bias (ROB 2.0).

Study	D1 Randomization	D2 Deviations	D3 Missing data	D4 Outcome measurement	D5 Selective reporting	Overall judgment
Singh SK, et al, 2024 [10]	-	+	+	+	-	-
de Oliveira JP, et al. 2024 [39]	+	+	+	+	+	+
Bidar M, et al. 2017 [41]	+	+	+	+	+	+
Riaz M, et al. 2023 [19]	+	+	+	+	+	+
Elnaghy AM, et al. 2023 [36]	+	+	+	+	+	+
Rodrigues GA, et al. 2024 [18]	+	+	+	+	+	+
Fullmer S, et al. 2014 [33]	-	+	+	+	-	-
Kumar U, et al. 2021 [42]	+	+	+	+	+	+
Hegde V, et al. 2023 [30]	+	+	+	+	+	+
Saha SG, et al. 2016 [16]	+	+	+	+	+	+
Elnaghy AM, et al. 2023 [43]	+	+	+	+	+	+
Nivedha V, et al. 2020 [45]	-	+	+	+	-	-
Aggarwal V, et al. 2021 [44]	+	+	+	+	+	+

Return to article view

Yellow -: some concerns; green +: low.

Declarations

Acknowledgments

During the preparation of this work, the author(s) used the Adobe Firefly tool to create Figures 1 and 2. After using the tool, authors reviewed and edited the content as needed and took full responsibility for the content of the publication.

Author contributions

ADI: Conceptualization, Methodology, Software, Formal analysis, Resources, Data curation, Writing—original draft, Writing—review & editing, Visualization, Project administration. GM: Methodology, Formal analysis, Supervision. LPZ: Conceptualization, Validation, Formal analysis, Data curation, Writing—original draft, Supervision. AS: Conceptualization, Software, Formal analysis, Writing—original draft, Writing—review & editing, Visualization, Supervision. FED: Methodology, Validation, Formal analysis, Writing—original draft, Writing—review & editing, Visualization. FI: Conceptualization, Methodology, Validation, Formal analysis, Data curation, Writing—original draft, Writing—review & editing, Visualization, Supervision, Project administration. GMT: Conceptualization, Methodology, Supervision. MDF: Methodology, Data curation, Supervision. AP: Conceptualization, Methodology, Resources, Data curation, Writing—original draft, Writing—review & editing, Visualization, Supervision. DDV: Validation, Resources, Writing—review & editing, Project administration. AMI: Conceptualization, Methodology, Validation, Formal analysis, Resources, Data curation, Writing—original draft, Writing—review & editing, Visualization, Project administration. GD: Methodology, Software, Validation, Formal analysis, Resources, Data curation, Writing—original draft, Writing—review & editing, Visualization, Project administration. All authors have read and agreed to the published version of the manuscript.

Conflicts of interest

The authors declare no conflicts of interest.

Ethical approval

Not applicable.

Consent to participate

Not applicable.

Consent to publication

Not applicable.

Availability of data and materials

The primary data for this systematic review were sourced online from databases listed in the methods. Referenced articles are accessible on Scopus, Web of Science, and PubMed. Additional supporting data are available from the corresponding author upon request.

Funding

Not applicable.

Copyright

Publisher’s note

Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.

References

Corbella S, Taschieri S, Mannocci F, Rosen E, Tsesis I, Del Fabbro M. Inferior alveolar nerve block for the treatment of teeth presenting with irreversible pulpitis: A systematic review of the literature and meta-analysis. Quintessence Int. 2017;48:69–82. [DOI] [PubMed]

Afkhami F, Pirmoazen S, Ardestani A, Fard MJK. Comparative evaluation of anesthetic efficacy of inferior alveolar nerve block and inferior alveolar nerve block plus buccal or lingual infiltration using articaine in mandibular molars with irreversible pulpitis: a preliminary prospective randomized single-blind clinical trial. Quintessence Int. 2021;52:820–6. [DOI] [PubMed]

Li L, Sun DL. Adverse effects of articaine versus lidocaine in pediatric dentistry: a meta-analysis. J Clin Pediatr Dent. 2023;47:21–9. [DOI] [PubMed]

Zargar N, Shojaeian S, Vatankhah M, Heidaryan S, Ashraf H, Akbarzadeh Baghban A, et al. Anesthetic efficacy of supplemental buccal infiltration versus intraligamentary injection in mandibular first and second molars with irreversible pulpitis: a prospective randomized clinical trial. J Dent Anesth Pain Med. 2022;22:339–48. [DOI] [PubMed] [PMC]

Yu J, Liu S, Zhang X. Can buccal infiltration of articaine replace traditional inferior alveolar nerve block for the treatment of mandibular molars in pediatric patients: A systematic review and meta-analysis. Med Oral Patol Oral Cir Bucal. 2021;26:e754–61. [DOI] [PubMed] [PMC]

Yilmaz K, Tunga U, Ozyurek T. Buccal infiltration versus inferior alveolar nerve block in mandibular 2nd premolars with irreversible pulpitis. Niger J Clin Pract. 2018;21:473–7. [DOI] [PubMed]

Yadav S. Anesthetic success of supplemental infiltration in mandibular molars with irreversible pulpitis: A systematic review. J Conserv Dent. 2015;18:182–6. [DOI] [PubMed] [PMC]

Venkat Narayanan J, Gurram P, Krishnan R, Muthusubramanian V, Sadesh Kannan V. Infiltrative local anesthesia with articaine is equally as effective as inferior alveolar nerve block with lidocaine for the removal of erupted molars. Oral Maxillofac Surg. 2017;21:295–9. [DOI] [PubMed]

Vatankhah M, Zargar N, Naseri M, Sadeghi S, Baghban AA, Dianat O, et al. Primary and supplementary anesthetic efficacy of a modified two-step buccal infiltration of 4% articaine in mandibular molars with symptomatic irreversible pulpitis: a randomized clinical trial. Clin Oral Investig. 2023;28:33. [DOI] [PubMed]

10.

Singh SK, Yadav S, Kumar A, Singh H, Rahman H, Niranjan MM, et al. Assessment of the effect of premedication on the success of inferior alveolar nerve block in tobacco chewing patients with symptomatic irreversible pulpitis: a randomized control trial. J Dent Anesth Pain Med. 2024;24:351–60. [DOI] [PubMed] [PMC]

11.

Nagendrababu V, Pulikkotil SJ, Veettil SK, Teerawattanapong N, Setzer FC. 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;44:914–22.e2. [DOI] [PubMed]

12.

Shetty KP, Satish SV, Kilaru KR, Sardar P, Luke AM. Comparison of anesthetic efficacy between lidocaine with and without magnesium sulfate USP 50% for inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis. J Endod. 2015;41:431–3. [DOI] [PubMed]

13.

Shantiaee Y, Javaheri S, Movahhedian A, Eslami S, Dianat O. Efficacy of preoperative ibuprofen and meloxicam on the success rate of inferior alveolar nerve block for teeth with irreversible pulpitis. Int Dent J. 2017;67:85–90. [DOI] [PubMed] [PMC]

14.

Serpe L, Franz-Montan M, dos Santos CP, da Silva CB, Nolasco FP, Caldas CS, et al. Anaesthetic efficacy of bupivacaine 2-hydroxypropyl-β-cyclodextrin for dental anaesthesia after inferior alveolar nerve block in rats. Br J Oral Maxillofac Surg. 2014;52:452–7. [DOI] [PubMed]

15.

Selvam TVN, Vaithilingam Y, Arumugam B, Ganesan SK, Sivanantham D, Veeramani VK. Revolutionising Third Molar Surgery: Unveiling the Superiority of Articaine and Lignocaine in Nerve Block Techniques. A Ground-breaking Triple-Blind, Randomised Clinical Trial. J Maxillofac Oral Surg. 2025;24:286–92. [DOI] [PubMed]

16.

Saha SG, Jain S, Dubey S, Kala S, Misuriya A, Kataria D. Effect of Oral Premedication on the Efficacy of Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis: A Prospective, Double-Blind, Randomized Controlled Clinical Trial. J Clin Diagn Res. 2016;10:ZC25-9. [DOI] [PubMed] [PMC]

17.

Saatchi M, Mohammadi G, Iranmanesh P, Khademi A, Farhad A, Aggarwal V, et al. Articaine buccal infiltration for mandibular first molars with symptomatic irreversible pulpitis: is it as effective as inferior alveolar nerve block with lidocaine? a systematic review and meta-analysis. Clin Oral Investig. 2025;29:146. [DOI] [PubMed]

18.

Rodrigues GA, Hizatugu R, Bronzato JD, de-Jesus-Soares A, Frozoni M. Effect of preemptive use of a nonsteroidal anti-inflammatory drug and a corticosteroid on the efficacy of inferior alveolar nerve blockade and postoperative pain control in endodontic treatment of molars with symptomatic pulpitis: A randomized double-blind placebo-controlled clinical trial. Int Endod J. 2024;57:520–32. [DOI] [PubMed]

19.

Riaz M, Zafar F, Khalid Z, Sultan T, Wali A, Siddiqui TM. Comparison of Preoperative Analgesics on the Efficacy of Inferior Alveolar Nerve Block with Patients Having Symptomatic Irreversible Pulpitis: A Double-Blinded, Randomized Controlled Trial. Eur Endod J. 2023;8:246–52. [DOI] [PubMed] [PMC]

20.

Parirokh M, Hatami N, Nakhaee N, Abbott PV. Comparing the Efficacy of Premedication with Ibuprofen in Combination with an Inferior Alveolar Nerve Block and Primary Buccal Infiltration in Mandibular Molars with Irreversible Pulpitis: A Triple-blinded Randomized Clinical Trial. Iran Endod J. 2022;17:165–71. [DOI] [PubMed] [PMC]

21.

Nicoletti M, Neri G, Maccauro G, Tripodi D, Varvara G, Saggini A, et al. Impact of neuropeptide substance P an inflammatory compound on arachidonic acid compound generation. Int J Immunopathol Pharmacol. 2012;25:849–57. [DOI] [PubMed]

22.

Nagendrababu V, Aly Ahmed HM, Pulikkotil SJ, Veettil SK, Dharmarajan L, Setzer FC. Anesthetic Efficacy of Gow-Gates, Vazirani-Akinosi, and Mental Incisive Nerve Blocks for Treatment of Symptomatic Irreversible Pulpitis: A Systematic Review and Meta-analysis with Trial Sequential Analysis. J Endod. 2019;45:1175–83.e3. [DOI] [PubMed]

23.

Nagendrababu V, Abbott PV, Pulikkotil SJ, Veettil SK, Dummer PMH. Comparing the anaesthetic efficacy of 1.8 mL and 3.6 mL of anaesthetic solution for inferior alveolar nerve blocks for teeth with irreversible pulpitis: a systematic review and meta-analysis with trial sequential analysis. Int Endod J. 2021;54:331–42. [DOI] [PubMed]

24.

Montserrat-Bosch M, Figueiredo R, Nogueira-Magalhães P, Arnabat-Dominguez J, Valmaseda-Castellón E, Gay-Escoda C. Efficacy and complications associated with a modified inferior alveolar nerve block technique. A randomized, triple-blind clinical trial. Med Oral Patol Oral Cir Bucal. 2014;19:e391–7. [DOI] [PubMed] [PMC]

25.

Monteiro MRFP, Groppo FC, Haiter-Neto F, Volpato MC, Almeida JFA. 4% articaine buccal infiltration versus 2% lidocaine inferior alveolar nerve block for emergency root canal treatment in mandibular molars with irreversible pulpits: a randomized clinical study. Int Endod J. 2015;48:145–52. [DOI] [PubMed]

26.

Mittal J, Kaur G, Mann HS, Narang S, Kamra M, Kapoor S, et al. Comparative Study of the Efficacy of 4% Articaine vs 2% Lidocaine in Surgical Removal of Bilaterally Impacted Mandibular Third Molars. J Contemp Dent Pract. 2018;19:743–48. [PubMed]

27.

Marjanovic U, Jurisic M, Brkovic B, Jakovljevic A, Milicic B, Marjanovic M, et al. Comparative clinical evaluation of two different techniques of local anaesthesia in the posterior mandible using 4% articaine with 1:100,000 adrenaline. Vojnosanit Pregl. 2017;74:1030–5. [DOI]

28.

Managutti A, Prakasam M, Puthanakar N, Menat S, Shah D, Patel H. Comparative analysis of local anesthesia with 2 different concentrations of adrenaline: a randomized and single blind study. J Int Oral Health. 2015;7:24–7. [PubMed] [PMC]

29.

Kämmerer PW, Adubae A, Buttchereit I, Thiem DGE, Daubländer M, Frerich B. Prospective clinical study comparing intraligamentary anesthesia and inferior alveolar nerve block for extraction of posterior mandibular teeth. Clin Oral Investig. 2018;22:1469–75. [DOI] [PubMed]

30.

Hegde V, Shanmugasundaram S, Shaikh S, Kulkarni V, Suresh N, Setzer FC, et al. Effect of Preoperative Oral Steroids in Comparison to Anti-inflammatory on Anesthetic Success of Inferior Alveolar Nerve Block in Mandibular Molars with Symptomatic Irreversible Pulpitis-A Double-blinded Randomized Clinical Trial. J Endod. 2023;49:354–61. [DOI] [PubMed]

31.

Hayes E. Anaesthesia for mandibular premolars with symptomatic irreversible pulpitis—which nerve block is best? Evid Based Dent. 2025;26:87–8. [DOI] [PubMed]

32.

Ghosh S, Gehlot PM, Jadhav G, Mariswamy AB, Kishan KV, Al Malwi A, et al. The efficacy of pre-operative oral aceclofenac and intra-ligamentary mepivacaine on the success of failed inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a prospective, randomised, double-blinded clinical trial. PeerJ. 2025;13:e19293. [DOI] [PubMed] [PMC]

33.

Fullmer S, Drum M, Reader A, Nusstein J, Beck M. Effect of preoperative acetaminophen/hydrocodone on the efficacy of the inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a prospective, randomized, double-blind, placebo-controlled study. J Endod. 2014;40:1–5. [DOI] [PubMed]

34.

Frydas S, Varvara G, Murmura G, Saggini A, Caraffa A, Antinolfi P, et al. Impact of capsaicin on mast cell inflammation. Int J Immunopathol Pharmacol. 2013;26:597–600. [DOI] [PubMed]

35.

Faghihian H, Faghihian R, Khademi A, Aggarwal V. Anesthetic Efficacy of Lidocaine/Ketorolac in Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis: A Randomized Clinical Trial. Eur Endod J. 2020;5:186–90. [DOI] [PubMed] [PMC]

36.

Elnaghy AM, Elshazli AH, Badr AE, Elsaka SE. Effect of preoperative tramadol, ibuprofen, ibuprofen/acetaminophen on the anaesthetic efficacy of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis. Aust Endod J. 2023;49:165–73. [DOI] [PubMed]

37.

Dianat O, Mozayeni MA, Layeghnejad MK, Shojaeian S. The efficacy of supplemental intraseptal and buccal infiltration anesthesia in mandibular molars of patients with symptomatic irreversible pulpitis. Clin Oral Investig. 2020;24:1281–6. [DOI] [PubMed]

38.

de Souza Tolentino L, Barbisan Souza A, Girardi AA, Romito GA, Araújo MG. The Anesthetic Effect of Anterior Middle Superior Alveolar Technique (AMSA). Anesth Prog. 2015;62:153–8. [DOI] [PubMed] [PMC]

39.

de Oliveira JP, de Alencar AHG, Estrela CB, Decurcio DA, Estrela CRA, Estrela C. Comparative effectiveness of preemptive administration of ibuprofen and ibuprofen-arginine on the anesthetic success of inferior alveolar nerve block in teeth with symptomatic irreversible pulpitis—A double-blind randomized clinical trial. Clin Oral Investig. 2024;28:366. [DOI] [PubMed]

40.

de Geus JL, Wambier LM, Boing TF, Loguercio AD, Reis A. Effect of ibuprofen on the efficacy of inferior alveolar nerve block in patients with irreversible pulpitis: A meta-analysis. Aust Endod J. 2019;45:246–58. [DOI] [PubMed]

41.

Bidar M, Mortazavi S, Forghani M, Akhlaghi S. Comparison of Effect of Oral Premedication with Ibuprofen or Dexamethasone on Anesthetic Efficacy of Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis: A Prospective, Randomized, Controlled, Double-blind Study. Bull Tokyo Dent Coll. 2017;58:231–6. [DOI] [PubMed]

42.

Kumar U, Rajput A, Rani N, Parmar P, Kaur A, Aggarwal V. Effect of pre-operative medication with paracetamol and ketorolac on the success of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a double-blind randomized clinical trial. J Dent Anesth Pain Med. 2021;21:441–9. [DOI] [PubMed] [PMC]

43.

Elnaghy AM, Elshazli AH, Elsaka SE. Effectiveness of oral premedication of meloxicam, ketorolac, dexamethasone, and ibuprofen on the success rate of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a prospective, double-blind, randomized controlled trial. Quintessence Int. 2023;54:92–9. [DOI] [PubMed]

44.

Aggarwal V, Singla M, Saatchi M, Gupta A, Hasija M, Meena B, et al. Preoperative Intraligamentary Injection of Dexamethasone Can Improve the Anesthetic Success Rate of 2% Lidocaine during the Endodontic Management of Mandibular Molars with Symptomatic Irreversible Pulpitis. J Endod. 2021;47:161–8. [DOI] [PubMed]

45.

Nivedha V, Sherwood IA, Abbott PV, Ramaprabha B, Bhargavi PV. Pre-operative ketorolac efficacy with different anesthetics, irrigants during single visit root canal treatment of mandibular molars with acute irreversible pulpitis. Aust Endod J. 2020;46:343–50. [DOI] [PubMed]

46.

de Freiras GC, Pozzobon RT, Blaya DS, Moreira CH. Efficacy of Benzocaine 20% Topical Anesthetic Compared to Placebo Prior to Administration of Local Anesthesia in the Oral Cavity: A Randomized Controlled Trial. Anesth Prog. 2015;62:46–50. [DOI] [PubMed] [PMC]

47.

Davidovich E, Pessov Y, Baniel A, Ram D. Levels of Stress among General Practitioners, Students and Specialists In Pediatric Dentistry during Dental Treatment. J Clin Pediatr Dent. 2015;39:419–22. [DOI] [PubMed]

48.

da Silva-Junior GP, de Almeida Souza LM, Groppo FC. Comparison of Articaine and Lidocaine for Buccal Infiltration After Inferior Alveolar Nerve Block For Intraoperative Pain Control During Impacted Mandibular Third Molar Surgery. Anesth Prog. 2017;64:80–4. [DOI] [PubMed] [PMC]