M B Alsharif, N Alqadi
Inferior alveolar nerve block (IANB) is the most common technique for anesthetizing mandibular posterior teeth but has a high failure rate and potential complications, such as trismus, toxicity, and nerve injury. While alternative anesthetic techniques have been investigated for mandibular molars, limited research exists for mandibular premolars with symptomatic irreversible pulpitis. As the mental nerve innervates these teeth, the mental/incisive nerve block (MINB) may represent a suitable alternative. This systematic review evaluates the current evidence regarding the anesthetic efficacy of MINB compared to IANB for mandibular permanent premolars diagnosed with symptomatic irreversible pulpitis. A literature search was performed using the following databases: PubMed/MEDLINE, Web of Science, and the Cochrane Library, in addition to Google Scholar, ClinicalTrials.gov, and manual searching. Randomized clinical trials involving human subjects with mandibular premolars diagnosed with symptomatic irreversible pulpitis requiring non-surgical root canal treatment, comparing the anesthetic efficacy of MINB to IANB, conducted in adults, and published in the English language were selected. Studies published up to September 5, 2025, were included. Data extraction and risk-of-bias assessment were completed by two reviewers independently. Five studies met the inclusion criteria. They demonstrated a superior anesthetic success rate for MINB, reaching up to 93%, compared to IANB in anesthetizing symptomatic mandibular premolars diagnosed with irreversible pulpitis; however, the difference was not statistically significant. Although the difference was not statistically significant, it remains clinically relevant, particularly given that MINB provides a significantly quicker onset of anesthesia and significantly less injection pain.