{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T21:55:05Z","timestamp":1770155705416,"version":"3.49.0"},"reference-count":41,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,11,10]],"date-time":"2020-11-10T00:00:00Z","timestamp":1604966400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Endodontic J"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The scientific literature is contradictory in relation to selecting the appropriate volume of local anaesthetic solution for inferior alveolar nerve blocks (IANB) when attempting to anaesthetize mandibular teeth with irreversible pulpitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To compare the efficacy of 1.8 and 3.6\u00a0mL of the same anaesthetic solution for IANBs when treating mandibular teeth with irreversible pulpitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A literature search was performed in PubMed, Scopus and EBSCOhost databases until May 2020. Randomized clinical trials published in English, comparing 1.8 with 3.6\u00a0mL of the same anaesthetic solution for IANBs in permanent mandibular teeth with irreversible pulpitis, were included. The risk of bias of the included trials was appraised using the revised Cochrane risk of bias tool. A meta\u2010analysis was performed using the random\u2010effects model. The effect of random errors on the results of the meta\u2010analysis was evaluated by trial sequential analysis and the quality of evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Four clinical trials involving 280 teeth from patients with ages ranging from 18 to 65\u00a0years were included. Among the four trials, three were categorized as having a \u2018low\u2019 risk of bias and one was categorized as having \u2018some concerns\u2019. The primary meta\u2010analysis revealed that 3.6\u00a0mL of anaesthetic solution when administered for IANBs was associated with significantly greater success rates compared with 1.8\u00a0mL (RR\u00a0=\u00a01.94; 95% CI, 1.07, 3.52; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a077%). Similarly, the results of the sensitivity analysis (restricting trials only to those that used the Heft\u2010Parker visual analogue pain scale) revealed that the use of 3.6\u00a0mL significantly increased the success of IANBs compared with 1.8\u00a0mL. The trial sequential analysis confirmed the evidence for the beneficial effect of 3.6\u00a0mL to achieve success for IANBs was \u2018conclusive\u2019. The quality of evidence was graded as \u2018high\u2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Increasing the volume of anaesthetic solution from 1.8 to 3.6\u00a0mL improved the success rate for IANBs in mandibular molars with irreversible pulpitis. The quality of the evidence was \u2018high\u2019. Future high\u2010quality clinical trials are required with different types of anaesthetic solutions and other types of teeth.<\/jats:p><\/jats:sec>","DOI":"10.1111\/iej.13428","type":"journal-article","created":{"date-parts":[[2020,10,11]],"date-time":"2020-10-11T08:02:25Z","timestamp":1602403345000},"page":"331-342","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["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\u2010analysis with trial sequential analysis"],"prefix":"10.1111","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3783-3156","authenticated-orcid":false,"given":"V.","family":"Nagendrababu","sequence":"first","affiliation":[{"name":"Division of Clinical Dentistry School of Dentistry International Medical University Kuala Lumpur Malaysia"},{"name":"Department of Preventive and Restorative Dentistry College of Dental Medicine University of Sharjah Sharjah UAE"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5727-4211","authenticated-orcid":false,"given":"P. V.","family":"Abbott","sequence":"additional","affiliation":[{"name":"UWA Dental School University of Western Australia Nedlands Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5727-8255","authenticated-orcid":false,"given":"S. J.","family":"Pulikkotil","sequence":"additional","affiliation":[{"name":"Division of Clinical Dentistry School of Dentistry International Medical University Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. K.","family":"Veettil","sequence":"additional","affiliation":[{"name":"Department of Pharmacotherapy, College of Pharmacy University of Utah Salt Lake City USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0726-7467","authenticated-orcid":false,"given":"P. M. 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