Efficacy of articaine vs lignocaine in maxillary and mandibular infiltration and block anesthesia in the dental treatments of adults: A systematic review and meta‐analysis

Abstract

Local anesthesia provides the backbone of pain control in dentistry.Local anesthetics give rise to a reversible loss of sensation in a circumscribed area when injected or topically applied, without causing loss of consciousness. Local anesthetics are commonly administered in injectable form in dentistry as a supraperiosteal/infiltration, a field block, or a nerve block. 1 Because of the porous nature of the maxilla, infiltration anesthesia is commonly employed in maxillary injections. The infiltration technique is easy and simple, and causes less discomfort to the patient compared to that of a block. The understanding of clinicians is that mandibular infiltration does not guarantee successful pulpal anesthesia of the teeth because of the thick cortical bone, making it necessary to perform block injections, such as the Halsted technique, and higher blocks, such as the Gow-Gates and Vazirani-Akinosi techniques. Block injection techniques are relatively difficult than the infiltration technique, and have added disadvantages, such as possible nerve damage, positive aspiration, and anesthetic failure due to accessory nerve supply. Most importantly, the success rates of an inferior alveolar nerve block (IANB) AbstractThe aim of the present systematic review and meta-analysis was to address the following Population, Intervention, Comparison, and Outcome question: Is the efficacy of articaine better than lignocaine in adults requiring dental treatment? Four percent articaine was compared with 2% lignocaine for maxillary and mandibular infiltrations and block anesthesia, and with the principal outcome measures of anesthetic success. Using RevMan software, the weighted anesthesia success rates and 95% confidence intervals (CIs) were estimated and compared using a random-effects model.For combined studies, articaine was more likely to achieve successful anesthesia than lignocaine (N = 18, odds ratio [OR]: 1.92, 95% CI: 1.45-2.56, P < 0.00001, I 2 = 32%).Maxillary and mandibular infiltration studies showed obvious superiority of articaine to lignocaine (N = 8, OR: 2.50, 95% CI: 1.51-4.15, P = 0.0004, I 2 = 41%). Maxillary infiltration subgroup analysis showed no significant difference between articaine and lignocaine (N = 5, OR: 1.69, 95% CI: 0.88-3.23, P = 0.11, I 2 = 19%). For combined mandibular anesthesia studies, articaine was superior to lignocaine (N = 14, OR: 1.99, 95% CI: 1.45-2.72, P < 0.0001, I 2 = 32%), with further subgroup analysis showing significant differences in both mandibular block anesthesia (N = 11, OR: 1.55, 95% CI:1.19-2.03, P = 0.001), I 2 = 0%) and mandibular infiltration (N = 3, OR: 3.87, 95% CI: 2.62-5.72, P < 0.00001, I 2 = 0%), indicating that articaine is more effective than lignocaine in providing anesthetic success in routine dental procedures. K E Y W O R D Sarticaine, lignocaine, local anesthesia, mandibular infiltration

Articaine in dentistry: an overview of the evidence and meta-analysis of the latest randomised controlled trials on articaine safety and efficacy compared to lidocaine for routine dental treatment

“…10 Out of 1022 study participants, Brandt et al 43 found articaine superior to lidocaine for all dental infiltrations and for mandibular block anaesthesia in healthy teeth. 43 Soysa et al 44 found articaine superior to lidocaine for all mandibular interventions. 44 None of the reviews reported any short or long-term paraesthesia.…”

“…43 Soysa et al 44 found articaine superior to lidocaine for all mandibular interventions. 44 None of the reviews reported any short or long-term paraesthesia.…”

“…The most recent systematic review by Soysa et al in 2019 reviewed RCTs of articaine from 2000 to 2018. 44 Soysa et al included eighteen studies for meta-analysis. Twelve of these studies were excluded by this systematic review because one involved non-routine third molar extraction and one involved the non-standard Gow-Gates block technique.…”

“…Both reviews note the potential effect of medium-tohigh rates of heterogeneity on the review outcomes. 44 Paxton and Thome 8 and Yapp et al 11 conducted literature reviews of articaine both recognising a general trend of articaine outperforming lidocaine in anaesthetic efficacy. 8,11 Yapp et al stated that articaine is a safe and effective LA for all routine dental procedures for patients of all ages, and that no conclusive evidence demonstrates articaine neurotoxicity over any other dental anaesthetic.…”

Does the presence and amount of epinephrine in 2% lidocaine affect its anesthetic efficacy in the management of symptomatic maxillary molars with irreversible pulpitis?

“…Maxillary anesthesia is affected by various factors, the most important being the local anesthetic solution [ 6 7 8 9 ]. Lidocaine has an inherent vasodilatory effect that increases the absorption of the anesthetic solution.…”