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 In addition, the metaRegister of the controlled trials database was searched to identify dissertations and ongoing or unpublished trials, and the Australian division of Septodont (the manufacturer of articaine and lignocaine) was contacted.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: Aim In paediatric dentistry, epinephrine may contribute to systemic and local side-effects. On the other hand it is necessary to provide good and safe local analgesia. Therefore, an articaine solution with reduced epinephrine concentration was tested in a clinical setting. Methods In a non-interventional clinical study, dental treatment was performed in children and adolescents (4–17 years). For local analgesia, articaine 4 % plus epinephrine 1:400,000 was used in the technique chosen by the dentist. Efficacy and tolerance as well as duration of soft tissue analgesia and side-effects were evaluated. Results 999 patients (50.5 % male, 49.5 % female) with a mean age of 7.9 (SD 2.34) years were treated. Two hundred seventy six patients (27.6 %) received sedation prior to treatment. The mean treatment time was 15 min (SD 10). In 93.5 % of cases, initial local analgesia was sufficient to perform the planned treatment. In 99 % of cases (n = 989) the planned treatment could be completed. A second injection was necessary in 6.5 % of cases. A mean duration of soft tissue analgesia of 2.19 h (SD 1.01) was seen. Slight side-effects occurred in 3.1 % of subjects. Conclusions Due to high efficacy, tolerance and safety, the articaine 4 % solution with the reduced epinephrine concentration (1:400,000) was a safe and suitable drug for paediatric routine treatment.
    European Archives of Paediatric Dentistry. Official Journal of the European Academy of Paediatric Dentistry 04/2013; 14(2). DOI:10.1007/s40368-013-0024-9
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    ABSTRACT: Nous avons réalisé une étude (prospective, en double aveugle, en bouche partagée, sur sujets sains volontaires),comparant une solution d'articaïne à 4 % et une solution de lidocaïne à 4 %, en utilisant l'anesthésie diploïque ostéocentrale comme technique d'injection. L’articaïne et la lidocaïne à même concentration (4 %) ont un taux de succès anesthésique très voisin, mais l'articaïne procure globalement une durée d’anesthésie plus longue de 90,6 % par rapport à la lidocaïne. Il apparaît cependant que, pour 28,57 % des sujets, l'articaïne ne serait pas la molécule la plus performante. Néanmoins, les résultats sont globalement assez variables, en durée et en efficacité. Nous avons confirmation du fait qu’une anesthésie est sujet-dépendante, et qu’il y a une très grande variabilité individuelle de réceptivité aux solutions anesthésiques. Cette étude enfin montre l’aptitude de l’anesthésie diploïque à comparer 2 solutions anesthésiques.
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    ABSTRACT: Articaine is one of the most recent local anaesthetic drugs made available to dentists worldwide. Anecdotal reports advocate its superiority over other common local anaesthetic agents and controversy exists concerning its clinical safety. This article reviews the current literature on articaine use in dentistry specifically addressing the issues of efficacy and safety.
    British dental journal official journal of the British Dental Association: BDJ online 04/2011; 210(7):323-9. DOI:10.1038/sj.bdj.2011.240 · 1.08 Impact Factor


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