Intraligamentary anaesthesia versus inferior alveolar nerve block in paediatric patients with mandibular molars: a systematic review and meta-analysis.

BACKGROUND: Intraligamentary anaesthesia (ILA) has emerged as a promising alternative to the conventional inferior alveolar nerve block (IANB) in dental procedures, particularly among children with primary mandibular molars. This study aims to comprehensively assess the efficacy, safety, and patient-related outcomes of ILA compared with conventional IANB. METHODS: A systematic search of PubMed, MEDLINE, Scopus, Web of Science (WOS), and Cochrane CENTRAL was conducted from inception to September 2025 for randomised controlled trials (RCTs) comparing ILA and IANB in paediatric patients undergoing dental procedures on mandibular molars. The primary outcome was postoperative pain. Secondary outcomes includedd lip biting, success rates, postoperative complications, and mean changes in pain scores assessed by the Sound-Eye-Motor (SEM) scale and Visual Analogue Scale (VAS). Pooled analyses were performed using risk ratios (RR) and standardised mean differences (SMD) with corresponding 95% confidence intervals (CIs) in a random-effects model. RESULTS: Seven RCTs comprising 567 participants were included. ILA was associated with a significantly lower rate of lip biting compared with IANB (RR = 0.08, 95% CI: 0.01-0.44, p < 0.001; I2 = 0%). Moreover, ILA resulted in significantly lower mean SEM pain scores during both injection (SMD = -1.09, 95% CI: -1.98 to -0.19, p = 0.02; I2 = 89.85%) and extraction (SMD = -0.54, 95% CI: -1.02 to -0.07, p = 0.03; I2 = 58.07%) compared with IANB. No significant differences were observed in postoperative severe pain, success rates, or complication rates. CONCLUSION: ILA provides significantly lower SEM pain scores and reduced rates of lip biting compared with conventional IANB in children undergoing dental procedures on mandibular molars. Further large-scale RCTs are warranted to validate these findings and confirm the clinical applicability of ILA in paediatric dentistry.