# Pain Management in Mandibular Molars With Symptomatic Irreversible Pulpitis: Mechanisms, Clinical Efficacy and Current Evidence: A Narrative Review

## TL;DR

This review explores effective pain management techniques for mandibular molars with severe pulpitis, focusing on improving anesthesia methods.

## Contribution

The paper synthesizes current evidence to propose optimized and supplemental anesthesia strategies for challenging endodontic cases.

## Key findings

- Increasing anesthetic volume and using supplemental injections improves anesthesia success.
- Cryotherapy and temperature-modified anesthetics enhance pain control in endodontic treatment.
- Intrapulpal anesthesia is critical when other techniques fail to achieve pulpal anesthesia.

## Abstract

Pain control remains a cornerstone in endodontic practice, particularly in cases of symptomatic irreversible pulpitis where achieving profound anaesthesia is often challenging. As the inferior alveolar nerve block (IANB) frequently fails to provide profound pulpal anaesthesia, optimizing pain control in such cases requires evidence‐based modifications to anaesthetic techniques and the use of supplemental approaches.

This narrative review aims to synthesize current evidence on clinical strategies for improving pain management in mandibular molars with symptomatic irreversible pulpitis, with particular emphasis on enhancing the efficacy of IANB and supplemental injection techniques.

A narrative review methodology was employed to synthesize clinical trials and systematic reviews published between 1975 and 2025.

Evidence indicates that increasing the anaesthetic volume and applying supplemental techniques, including intraligamentary, intraosseous and intrapulpal injections, significantly enhances anaesthesia success. Adjunctive measures such as cryotherapy and temperature modification of anaesthetic solutions further improve pain control. The integration of these methods provides a predictable and multimodal approach to managing endodontic pain in challenging clinical scenarios.

Effective pain management in mandibular molars with symptomatic irreversible pulpitis relies on a comprehensive strategy that combines optimized anaesthetic volume and supplemental techniques. Intrapulpal anaesthesia remains essential for achieving pulpal anaesthesia when all other techniques fail. Continued clinical research is essential to refine these approaches and establish standardized protocols for achieving reliable anaesthesia in endodontic practice.