EVALUATING THE EFFICACY OF DIFFERENT SUPPLEMENTARY LOCAL ANESTHETIC TECHNIQUES FOLLOWING FAILED INFERIOR ALVEOLAR NERVE BLOCK IN PATIENTS WITH IRREVERSIBLE PULPITIS: A SYSTEMATIC REVIEW

Background: Profound anesthesia during endodontic procedures for irreversible pulpitis remains a clinical challenge, particularly in mandibular molars where inferior alveolar nerve block (IANB) frequently fails. This systematic review aimed to evaluate and compare the efficacy of supplementary anesthetic techniques employed following unsuccessful IANB. Methods: A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Embase in accordance with PRISMA 2020 guidelines. Twelve peer-reviewed clinical trials and randomized studies published between 2009 and 2025 were included. Eligible studies assessed supplementary anesthetic methods—buccal infiltration (BI), intraligamentary (IL), intraosseous (IO) injections, or pharmacological adjuncts—after failed IANB in patients diagnosed with irreversible pulpitis. Results: The review revealed variable success rates among supplementary techniques. Articaine buccal infiltration consistently demonstrated the highest efficacy, achieving success rates between 67% and 90%, while intraligamentary and intraosseous techniques showed comparable success (approximately 80–92%). Premedication with ibuprofen and dexamethasone significantly improved IANB effectiveness. Articaine’s superior bone diffusion and rapid onset contributed to better clinical outcomes than lidocaine or mepivacaine. Conclusion: Supplementary anesthetic techniques significantly enhance pulpal anesthesia success in patients with irreversible pulpitis. Articaine buccal infiltration and intraosseous injection represent the most reliable adjuncts following failed IANB. A multimodal approach combining optimal anesthetic selection, injection site, and adjunctive pharmacotherapy is recommended for achieving predictable anesthesia.