Abstract
This systematic review and meta-analysis aim to synthesize the current evidence from randomized clinical trials (RCTs) comparing the anesthetic success of mental/incisive nerve block (MINB) versus inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis affecting mandibular premolars. A thorough literature search was performed using databases such as PubMed, Web of Science, Science Direct, Cochrane Database, and Google Scholar. The search covered publications up to June 2025. The focused PICOTT question for this review was: "What is the anesthetic efficacy of mental/incisive nerve block compared to inferior alveolar nerve block in mandibular premolars with symptomatic irreversible pulpitis?". The included studies were evaluated for quality using the ROB 2 tool for non-randomized designs, while the certainty of the evidence was assessed through the GRADE approach. A meta-analysis was performed using a random-effects model to address potential variability among studies. Three RCTs were included. Overall, the risk of bias was considered low to moderate using the ROB 2 tool. The GRADE assessment indicated that the certainty of evidence was rated as very low. The overall pooled analysis showed no statistically significant difference in success rates between the MINB and IANB techniques (OR = 1.25; 95% CI: 0.74 to 2.12; P = 0.40), with low heterogeneity (I² = 0%). Subgroup analysis by premolar type showed no significant differences between techniques for either first (OR = 1.03; 95% CI: 0.64-1.65; P = 0.90; I² = 0%) or second premolars (OR = 1.23; 95% CI: 0.76-1.98; P = 0.40; I² = 0%). In conclusion, the findings of this systematic review and meta-analysis indicate no clear difference in anesthetic efficacy between MINB and IANB techniques. However, most studies suggest that achieving adequate pulpal anesthesia requires the use of supplemental anesthesia.