Pulpitis, a key challenge in dental care, demands reliable solutions that balance efficacy with cost. As dentists continuously seek optimal anesthetics for managing symptomatic irreversible pulpitis in mandibular molars, a new study emerges to guide their choices. This review, published ahead of print, delves into the comparison of various local anesthetics, focusing on both their therapeutic impact and economic aspects. The need to identify the most effective yet affordable anesthetic options drives this detailed analysis, ensuring practitioners have access to informed and data-backed recommendations.
Evaluation and Methods
The methodology followed PRISMA guidelines and utilized a comprehensive search across six key databases, including PubMed and Scopus, to ensure an exhaustive collection of relevant studies. These studies specifically compared the efficacy of different local anesthetics used in treating irreversible pulpitis in the mandibular molars. Two reviewers independently extracted data and assessed bias, allowing for a robust and unbiased analysis through the Cochrane RoB 2 tool. A subsequent meta-analysis underpinned the efficacy evaluations, while cost-effectiveness was measured through the Incremental Cost-Effectiveness Ratio (ICER).
Comparative Findings
The review incorporated 12 studies, encompassing over 1,200 participants to compare anesthetics such as lidocaine 2%, articaine 4%, bupivacaine 0.5%, and mepivacaine 2% for their efficacy in inferior alveolar nerve blocks. Among these, lidocaine 2% with epinephrine was distinguished not just for its efficacy but also for its notable cost-effectiveness, reflected in its negative ICER values. Despite bupivacaine 0.5%’s longer action duration, it was deemed the least cost-efficient option.
The comparative analysis indicates:
- Lidocaine 2% with epinephrine leads in cost-efficiency.
- Articaine 4% offers superior tissue diffusion yet is costly.
- Bupivacaine 0.5% fails in cost comparison despite duration.
Lidocaine 2% with epinephrine combines affordability with clinical efficacy, solidifying its status as the optimal choice for dentists dealing with difficult endodontic conditions. Although articaine 4% stands out for superior tissue diffusion, its higher costs and the risk of adverse effects discourage its routine primary usage. Insights from this study provide invaluable guidance to clinicians, favoring lidocaine as a cost-effective solution without compromising effectiveness, and it remains a cornerstone in managing irreversible pulpitis.
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