Article

The efficacy and safety of articaine versus lignocaine in dental treatments: a meta-analysis.

School of Public Health, University of Sydney, Sydney NSW 2006, Australia.
Journal of dentistry (Impact Factor: 2.84). 12/2009; 38(4):307-17. DOI: 10.1016/j.jdent.2009.12.003
Source: PubMed

ABSTRACT Although articaine has been recommended for providing an improved local anaesthetic effect in patients presenting for dental treatments, a relevant meta-analysis has been lacking. Despite articaine's popularity, there is contradictory evidence to support the claims. The aim of this systematic review was to compare the efficacy and safety of articaine with lignocaine in maxillary and mandibular infiltrations and block anaesthesia in patients presenting for routine dental treatments.
The following databases were searched: Cochrane Central, Medline, Embase, and ProQuest Health and Medical Complete. In addition, the metaRegister of the controlled trials database was searched to identify dissertations and ongoing or unpublished trials, and the Australian division of Septodont (the manufacturer of articaine and lignocaine) was contacted. The bibliographies of identified articles were also searched.
Inclusion was limited to: (1) randomized controlled trials in patients requiring non-complex routine dental treatments; (2) interventions comparing 4% articaine (1:100,000 epinephrine) with 2% lignocaine (1:100,000 epinephrine) for maxillary and mandibular infiltrations and block anaesthesia; and (3) with principal outcome measures of anaesthetic success, post-injection adverse events or post-injection pain. Trial quality was evaluated by assessing randomization, allocation concealment, blinding, intention to treat analyses and how losses to follow up were addressed. Treatment effects were combined by meta-analysis using the random effects method.
Articaine is more likely than lignocaine to achieve an anaesthetic success in the posterior first molar area with a relative risk for success at 1.31 (95% CI 1.12-1.54, P=0.0009). There is no difference in post-injection adverse events between articaine and lignocaine with a relative risk of 1.05 (95% CI 0.66-1.65, P=0.85). However, articaine injection results in a higher pain score as measured by Visual Analogue Scale, than lignocaine at the injection site after anaesthetic reversal with a weighted mean difference of 6.49 (95% CI 0.02-12.96, P=0.05) decreasing to 1.10 (95% CI 0.18-2.02, P=0.02) on the third day after injection.
The results of this systematic review provide support for the argument that articaine is more effective than lignocaine in providing anaesthetic success in the first molar region for routine dental procedures. In addition, both drugs appear to have similar adverse effect profiles. The clinical impact of articaine's higher post-injection pain scores than lignocaine is negligible. Hence, articaine is a superior anaesthetic to lignocaine for use in routine dental procedures. Use in children under 4 years of age is not recommended, since no data exists to support such usage.

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    ABSTRACT: Objectives: Was to evaluate the effect of different regional anesthetics (articaine with epinephrine versus prilocaine with felypressin) on stress in the extraction of impacted lower third molars in healthy subjects. Sutdy Desing: A prospective single-blind, split-mouth cross-over randomized study was designed, with a control group. The experimental group consisted of 24 otherwise healthy male volunteers, with two impacted lower third molars which were surgically extracted after inferior alveolar nerve block (regional anesthesia), with a fortnight’s interval: the right using 4% articaine with 1:100.000 epinephrine, and the left 3% prilocaine with 1:1.850.000 felypressin. Patients were randomized for the first surgical procedure. To analyze the variation in four stress markers, homovanillic acid, 3-methoxy-4-hydroxyphenylglycol, prolactin and cortisol, 10-mL blood samples were obtained at t = 0, 5, 60, and 120 minutes. The control group consisted of 12 healthy volunteers, who did not undergo either extractions or anesthetic procedures but from whom blood samples were collected and analyzed in the same way. Results: Plasma cortisol increased in the experimental group (multiple range test, P<0.05), the levels being significantly higher in the group receiving 3% prilocaine with 1:1.850,000 felypressin (signed rank test, p<0.0007). There was a significant reduction in homovanillic acid over time in both groups (multiple range test, P<0.05). No significant differences were observed in homovanillic acid, 3-methoxy-4-hydroxyphenylglycol or prolactin concentrations between the experimental and control groups. Conclusions: The effect of regional anesthesia on stress is lower when 4% articaine with 1:100,000 epinephrine is used in this surgical procedure. Key words:Stress markets, epinephrine versus felypressin.
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    ABSTRACT: Introduction Profound pulpal anesthesia in mandibular molars with irreversible pulpitis (IP) is often difficult to obtain and often requires supplemental injections after an ineffective inferior alveolar nerve block (IANB). The purpose of this prospective, randomized, double-blind study was to compare the efficacy of 4% articaine with 2% lidocaine for supplemental buccal infiltrations (BIs) after an ineffective IANB in mandibular molars with IP. In addition, the use of articaine for IANB and intraosseous injections was investigated. Methods One hundred emergency patients diagnosed with IP of a mandibular molar were selected and received an IANB with 4% articaine. All injections were 1.7 mL with 1:100,000 epinephrine. All patients reported profound lip numbness after IANB. Patients with ineffective IANB (positive pulpal response to cold or pain on access) randomly received 4% articaine or 2% lidocaine as a supplemental BI. Endodontic access was initiated 5 minutes after deposition of the infiltration solution. Success was defined as no pain or no more than mild pain during endodontic access and instrumentation as measured on a visual analogue scale. Results Seventy-four patients failed to achieve pulpal anesthesia after IANB with 4% articaine, resulting in IANB success rate of 26%. Success rates for supplemental BIs were 62% for articaine and 37% for lidocaine (P < .05). This effect was most pronounced in second molars (P < .05). Conclusions Supplemental BI with articaine was significantly more effective than lidocaine. The IANB success rate of 4% articaine confirmed published data.
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