Efficacy and adverse events of 4% articaine compared with 2% lidocaine on primary molar extraction: A randomised controlled trial

Abstract

Background There is no consensus regarding the most effective anaesthetic solution for children; nerve block, especially mandibular, can be difficult for general dentists. Therefore, the study aims to compare the efficacy and the adverse events of articaine 4% with epinephrine 1:100 000 with lidocaine 2% with epinephrine 1:100 000 for primary molar extraction using buccal infiltration. Methods These are data from a parallel triple‐blind randomised controlled trial with a computer‐generated allocation treatment. Forty‐three children aged 6‐10 years with a clinical and radiographic indication of primary molar extraction were enrolled. The intervention was local buccal infiltration with articaine 4% compared with lidocaine 2%. The main outcome was pain during anaesthetic injection and tooth extraction. Adverse events were examined as secondary outcomes. Children were treated in a University setting from April to June 2019. Results Both solutions had similar anaesthetic efficacy in primary molar extraction when applied by the infiltrative technique (β −0.47; 95% CI −3.19 to 2.24; P = .76); however, children reported higher mean pain during articaine deposition (β 2.43; 95% CI 0.28‐4.57; P = .02). The measured lidocaine pH was 3.19 (0.15) and articaine was 2.43 (0.00) (P = .04). Post‐operative pain, oedema and nausea were observed without differences between the groups. Conclusions There was no difference in the efficacy of articaine compared to lidocaine for primary molar extraction. Articaine was more painful during the injection. Practical implications Primary molar extractions can be performed with both articaine and lidocaine buccal infiltration.

Can single buccal infiltration with 4% articaine induce sufficient analgesia for the extraction of primary molars in children: a systematic literature review

“…Screening of titles and abstracts was carried out on the remaining 539 articles (after the duplicate removal). The full texts of the 13 potentially relevant papers were evaluated [6,8,[12][13][14][15][16][17][18][19][20][21][22], and 8 of them were excluded [6,8,[13][14][15]17,18,22]; the reasons for exclusion are presented in Table 1.…”

“…Screening of titles and abstracts was carried out on the remaining 539 articles (after the duplicate removal). The full texts of the 13 potentially relevant papers were evaluated [ 6 8 12 13 14 15 16 17 18 19 20 21 22 ], and 8 of them were excluded [ 6 8 13 14 15 17 18 22 ]; the reasons for exclusion are presented in Table 1 . Therefore, five studies were included in this final systematic review [ 12 16 19 20 21 ] ( Fig.…”

“…2 ) of each study was evaluated following the Cochrane guidelines. Randomization and allocation concealment were carried out in all the five studies [ 12 16 19 20 21 ]. The blinding of participants, personnel, and observers were carried out in all the studies, except in the study by Alzahrani et al [ 12 ].…”

“…[21] and Mittal et al [20] followed the double-blind design. The triple-blind design was followed in the studies by Kolli et al [16] and Massignan et al [19]. [16,20], mandibular [12], or both [19,21].…”

“…The blinding of participants, personnel, and observers were carried out in all the studies, except in the study by Alzahrani et al [12]. Attrition bias was observed only in the study by Alzahrani et al [12]; the remaining four studies were free of attrition bias [16,[19][20][21]. Reporting bias was not observed in any of the included studies [12,16,[19][20][21].…”