Journal of dentistry · 2025
Is there a direct relationship between the cost and effectiveness of local anesthetics in lower molars with irreversible pulpitis? Systematic review, meta-analysis and cost-effectiveness evaluation.
СтатьяСистематический обзорМетаанализПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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de Carvalho Luísa Figueredo, Dugaich Adriana Poli Castilho, Schiefler Alexandra Maria de Melo, Ribeiro Letícia Cristine Ramos, Barboza Andressa da Silva, Stolf Sheila Cristina, Lund Rafael Guerra, de Andrade Juliana Silva Ribeiro
Аннотация
OBJECTIVE: This review evaluates the efficacy and cost-effectiveness of local anesthetics in managing symptomatic irreversible pulpitis in mandibular molars.
METHODS: Following PRISMA guidelines, it was registered in PROSPERO (CRD42024615858). Six databases (PubMed, Scopus, Web of Science, Cochrane Library, Embase, and Virtual Health Library) were searched without restrictions in January 2025. Studies comparing the efficacy of local anesthetics for irreversible pulpitis in mandibular molars were included. Data extraction and risk of bias assessment using the Cochrane RoB 2 tool were performed independently by two reviewers. A random-effects meta-analysis was conducted. Cost-effectiveness was subsequently assessed by the authors using efficacy estimates derived from the meta-analysis combined with market prices, based on the Incremental Cost-Effectiveness Ratio (ICER).
RESULTS: Twelve studies (1262 participants) were included. No significant differences in efficacy were observed among lidocaine 2%, articaine 4%, bupivacaine 0.5%, and mepivacaine 2% for inferior alveolar nerve block. Lidocaine 2% with epinephrine was the most cost-effective, presenting negative ICER values. Bupivacaine 0.5% was the least cost-effective despite its prolonged duration.
CONCLUSION: Lidocaine 2% with epinephrine emerged as the most cost-effective option, offering an optimal balance between efficacy and affordability. While articaine 4% is recognized for its superior tissue diffusion, a key pharmacological advantage influencing its clinical application, and considerations of patient safety are paramount, our meta-analysis did not quantify these as primary outcomes. Nonetheless, articaine's higher cost, despite its diffusion advantages, limits its routine first-line use, and potential for adverse effects, as discussed in the literature, must always be weighed during anesthetic selection.
CLINICAL RELEVANCE: This review bridges the gap between efficacy and affordability, providing clinicians with clear, evidence-based guidance for anesthetic selection in one of the most challenging endodontic scenarios.
METHODS: Following PRISMA guidelines, it was registered in PROSPERO (CRD42024615858). Six databases (PubMed, Scopus, Web of Science, Cochrane Library, Embase, and Virtual Health Library) were searched without restrictions in January 2025. Studies comparing the efficacy of local anesthetics for irreversible pulpitis in mandibular molars were included. Data extraction and risk of bias assessment using the Cochrane RoB 2 tool were performed independently by two reviewers. A random-effects meta-analysis was conducted. Cost-effectiveness was subsequently assessed by the authors using efficacy estimates derived from the meta-analysis combined with market prices, based on the Incremental Cost-Effectiveness Ratio (ICER).
RESULTS: Twelve studies (1262 participants) were included. No significant differences in efficacy were observed among lidocaine 2%, articaine 4%, bupivacaine 0.5%, and mepivacaine 2% for inferior alveolar nerve block. Lidocaine 2% with epinephrine was the most cost-effective, presenting negative ICER values. Bupivacaine 0.5% was the least cost-effective despite its prolonged duration.
CONCLUSION: Lidocaine 2% with epinephrine emerged as the most cost-effective option, offering an optimal balance between efficacy and affordability. While articaine 4% is recognized for its superior tissue diffusion, a key pharmacological advantage influencing its clinical application, and considerations of patient safety are paramount, our meta-analysis did not quantify these as primary outcomes. Nonetheless, articaine's higher cost, despite its diffusion advantages, limits its routine first-line use, and potential for adverse effects, as discussed in the literature, must always be weighed during anesthetic selection.
CLINICAL RELEVANCE: This review bridges the gap between efficacy and affordability, providing clinicians with clear, evidence-based guidance for anesthetic selection in one of the most challenging endodontic scenarios.