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The aim of this study was to provide an evidence-based answer to the question: “Is 3.6-mL volume of an anesthetic agent more effective than 1.8-mL volume in providing anesthesia for mandibular molars?” Following formulation of research question and keyword selection, a comprehensive search of the following databases was conducted: Cochrane library, PubMed, Scopus, Google Scholar, ProQuest, and Clinicaltrials.gov. Three-phase eligibility appraisal and quality assessment of the studies were carried out by 2 independent reviewers. To reduce clinical heterogeneity, the included studies were divided into 2 groups: studies on healthy teeth and studies on teeth with pulpitis. The data of included studies were statistically combined through meta-analysis using a fixed-effects model. A total of 20,778 records were initially retrieved from the search. Following screening and eligibility assessment, 8 studies met the eligibility criteria and were included for qualitative synthesis. Of those, 5 studies were qualified for meta-analysis. In the irreversible pulpitis group, increasing the volume of anesthetic agent from 1.8 to 3.6 mL significantly increased the success rate of inferior alveolar nerve block (risk ratio = 2.45, 95% CI: 1.67–3.59, p < .001). However, there was insufficient evidence to draw a conclusion regarding healthy teeth.

Keywords: Anesthetic success; Anesthetic volume; Inferior alveolar nerve block; Mandibular molar; Meta-analysis; Systematic review
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Copyright: © 2018 by the American Dental Society of Anesthesiology
<bold>Figure 1. </bold>
Figure 1. 

Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols flow diagram of study inclusion process.


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Figure 2. 

Forest plot of risk ratios (95% CI).


Contributor Notes

Address correspondence to Dr Amin Salem Milani, Department of Endodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Daneshgah Avenue, Tabriz, Iran; Amin.salemmilani@gmail.com.
Received: Dec 14, 2016
Accepted: Mar 16, 2017