Supplementary techniques for pain control during root canal treatment of lower posterior teeth with irreversible pulpitis: A systematic review and meta-analysis

The purpose of this systematic review and meta-analysis was to evaluate utilisation of supplementary techniques for pain control during root canal treatment of lower molars with irreversible pulpitis. The literature was searched
using electronic databases up to year 2012. Seventeen studies with 1504 participants were included and each study compared experimental interventions
with a standard treatment, i.e. the inferior alveolar nerve block. Changing the
injection techniques or supplemental injection had no significant effect on
pulp anaesthesia compared to the standard treatment (P = 1.00 or P = 0.14),
whereas changing anaesthetic features and increasing anaesthetic volumes
resulted in significantly higher rates of anaesthesia than those of the standard
treatment (P = 0.03 and P = 0.007, respectively). Premedication with nonsteroidal
anti-inflammatory drugs (NSAIDs) also significantly increased the success rate of anaesthesia (P = 0.001). Taken together, increased anaesthetic volumes and premedication with NSAIDs provide predictable anaesthesia and more pain control during endodontic treatment of lower molars with irreversible
pulpitis.