Anaesthesia for mandibular premolars with symptomatic irreversible pulpitis - which nerve block is best?
1Department of Oral & Maxillofacial Surgery, Dumfries & Galloway Royal Infirmary, Dumfries, Scotland, UK. ellis.hayes2@nhs.scot.
Evidence-Based Dentistry
|April 21, 2025
Summary
The Mental Nerve Block (MNB) and Inferior Alveolar Nerve Block (IANB) show similar effectiveness for anaesthetizing mandibular premolars with symptomatic irreversible pulpitis (SIP). MNB was more effective for first premolars, while about 30% of patients required additional anaesthesia.
Area of Science:
- Endodontics
- Dental Anesthesia
- Pain Management
Background:
- Symptomatic irreversible pulpitis (SIP) in mandibular premolars presents challenges for achieving adequate local anesthesia.
- Inferior Alveolar Nerve Block (IANB) is a common technique, but its efficacy can be variable.
- Alternative techniques like the Mental Nerve Block (MNB) are explored to improve anesthetic success rates.
Purpose of the Study:
- To compare the anesthetic effectiveness of MNB versus IANB in mandibular first and second premolars with SIP.
- To determine if one technique is superior for facilitating endodontic treatment in these teeth.
- To investigate potential differences in efficacy between first and second premolars for each block technique.
Main Methods:
- A randomized, double-blinded, parallel-group clinical trial involving 120 patients with SIP in mandibular premolars.
- Patients were randomly assigned to receive either MNB or IANB using 1.8ml Articaine 4% with 1:100,000 epinephrine.
- Pain scores were assessed using the Numerical Rating Scale (NRS) during various stages of endodontic treatment.
Main Results:
- Both MNB and IANB achieved an overall success rate of approximately 70%, with no statistically significant difference between the techniques.
- MNB demonstrated a statistically significant higher success rate for first premolars (76.9%) compared to second premolars (64.7%).
- IANB showed comparable success rates for first (71.4%) and second (68.8%) premolars. Approximately 30% of patients in both groups required supplementary anesthesia.
Conclusions:
- MNB and IANB exhibit comparable overall efficacy for achieving anesthesia in mandibular premolars with SIP.
- The MNB technique may be more advantageous for anesthetizing first premolars compared to second premolars.
- A significant proportion of patients (around 30%) require supplementary anesthesia regardless of the primary nerve block technique used.
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