Articaine 88mg/2.2ml / Adrenaline (base) 11micrograms/2.2ml (1 in 200,000) solution for injection cartridges

Objective This meta-analysis assessed the efficacy of various anesthetic protocols for symptomatic irreversible pulpitis, comparing techniques and agents to identify the optimal anesthesia approach. Methods We conducted a comprehensive search of the Cochrane Library, PubMed, Web of Science, Scopus, and Embase databases up to July 10, 2025, identifying relevant studies based on predefined inclusion and exclusion criteria. The primary outcome was the success rate of anesthesia. Data extraction and quality assessment were performed using a pre-designed form and the revised Cochrane Risk of Bias Tool. A fixed-effect model was used for meta-analysis when heterogeneity was low ( I 2 ≤ 50%, p ≥ 0.1); otherwise, a random-effects model was adopted. Additionally, another model was employed for validation, and the results from both models were compared to derive more reasonable conclusions. Publication bias was assessed using funnel plots and the Egger test. Results Fourteen RCTs were included in the meta-analysis. Pooled analysis showed that modified anesthetic protocols for SIP were 3.62 times more successful than conventional inferior alveolar nerve block (IANB) using standard 2% lidocaine with epinephrine (OR = 3.34; 95% CI: 2.49–4.48). Studies conducted in Iran had the highest success rate (OR = 4.31; 95% CI: 3.59–5.17, p < 0.001). Inferior alveolar nerve block (IANB) was more effective than buccal infiltration (OR = 4.03; 95% CI: 3.38–4.81, p < 0.001), and 4% articaine demonstrated the highest efficacy (OR = 4.18; 95% CI: 2.85–6.16, p < 0.001). Conclusion This meta-analysis assessed the efficacy of various anesthetic protocols for SIP, comparing techniques and agents to identify the optimal anesthesia approach. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/recorddashboard , PROSPERO database CRD42025638427.

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Despite widespread use of articaine and lidocaine, their comparative efficacy remains debated. A systematic search of PubMed, Web of Science, Cochrane Library, and Embase was conducted through July 2025. Outcomes were stratified by anesthesia technique: infiltration anesthesia and nerve block anesthesia. Primary outcomes included anesthetic onset time, anesthetic duration, pain intensity (Visual Analog Scale, VAS), and anesthetic success rate. Continuous variables were expressed as mean differences (MD) with 95% confidence intervals (CI). For dichotomous outcomes, risk ratio (RR) with 95%CI were computed. Thirty-six randomized controlled trials (RCTs) with 3,088 cases were included. In infiltration anesthesia, articaine showed shorter onset (MD = − 1.34 min; 95%CI [-2.21, -0.47]; P = 0.002; I²=98%; Low certainty), longer duration (MD = 18.68 min; 95%CI [3.05, 34.30]; P = 0.02; I²=97%; Moderate certainty), and lower pain scores (MD = − 4.41; 95%CI [-7.62, -1.21]; P = 0.007; I²=63%; Moderate certainty) than lidocaine, with no significant difference in anesthetic success rate (RR = 1.03; 95%CI [0.98, 1.08]; P = 0.30; I²=15%; Moderate certainty). In nerve block anesthesia, articaine showed shorter onset (MD = − 0.27 min; 95%CI [-0.40, -0.13]; P < 0.001; I²=69%; Moderate certainty) and longer duration (MD = 53.63 min; 95%CI [29.64, 77.62]; P < 0.001; I²=96%; High certainty) than lidocaine, while the two anesthetics performed similarly in terms of pain intensity (MD = 1.13; 95%CI [− 0.49, 2.75]; P = 0.17; I²=0%; Moderate certainty) and anesthetic success rate (RR = 1.06; 95%CI [0.90, 1.24]; P = 0.49; I²=33%; Low certainty). Subgroup analyses indicated that, for infiltration anesthesia, articaine had shorter onset time (P < 0.001) and longer duration (P = 0.003) in premolars, and lower pain scores in molars (P < 0.001) compared with lidocaine. For nerve block, conventional-dose articaine had shorter onset time (P = 0.02) and longer duration (P < 0.001) than lidocaine, while high-dose articaine showed no difference in duration (P = 0.07), and the direction of key findings was consistent when stratified by study methodological quality (SCI-indexed journals vs. non-SCI-indexed journals). Compared with lidocaine, articaine was associated with slightly faster onset and longer anesthetic duration in both infiltration and nerve block anesthesia, and with lower pain scores in infiltration anesthesia. However, anesthetic success rates were comparable between the two agents across techniques and subgroups. CRD420251110177

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Background: The inability in achieving complete pulpal anesthesia with standard buccal infiltration especially in cases with SIP used for maxillary teeth. The study aimed to compare the anesthetic efficacy of buccal and buccal plus palatal infiltration technique using 2% lidocaine and 4% articaine in permanent maxillary first molars with the diagnosis of symptomatic irreversible pulpitis (SIP). Material and method: One hundred and twenty-three patients with clinical diagnosis of SIP, aged 18-50 years were randomly allocated to three treatment groups (N = 41). Group 1(BIL): Buccal infiltration technique using 2% lidocaine with 1:80,000 adrenaline. Group 2(BPIL): combination of buccal plus palatal infiltration using 2% Lidocaine with 1:80,000 adrenaline. Group 3(BIA): Buccal infiltration using 4% articaine with 1:100,000 adrenaline. Pain intensity of patients were recorded before and after the administration of local anesthesia during endodontic procedure that is during caries removal, access preparation and pulp removal using Heft-Parker Visual Analog Scale (HP-VAS). Success was defined by "no pain (0 mm)" or "mild pain (0-54 mm)" during endodontic procedure. The anesthetic efficacy rates were analyzed using chi-square tests, age differences using one-way ANOVA. Results: The final analysis included total of 117 patients. Higher success was observed in group II (85%) in comparison to group I (69%) and group III (74%), but the difference was statistically nonsignificant (p > 0.05). Our results demonstrated a nonsignificant difference between genders in all three groups (p > 0.05). Conclusion: The use of buccal plus palatal infiltration and 4% articaine can provide effective anesthesia as standard buccal infiltration and 2% lidocaine for patients with SIP in maxillary first molars.

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The use of local anesthesia is essential for pain control during the treatment of MIH-affected molars. This study aimed to compare injection-related pain and anesthetic efficacy between 2% lidocaine with epinephrine (LE) and 4% articaine with epinephrine (AE) in the MIH-affected maxillary molars of pediatric patients. Twenty-six children aged 6 to 12 years requiring restorative treatment of MIH-affected maxillary molars were enrolled. Participants randomly received one of the two anesthetic solutions (LE or AE) at the first visit; the other solution was administered at the second visit. Injection-related pain and anesthetic efficacy were evaluated subjectively using the Wong-Baker Faces® pain rating (WBF) scale and behaviorally using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale. No statistically significant difference was found between LE and AE in injection-related pain on either scale (P > 0.05). Similarly, no statistically significant difference was recorded between the two solutions in the anesthetic efficacy for MIH-affected maxillary molars, according to both scales (P > 0.05). These findings indicate that both LE and AE provide comparable clinical outcomes, supporting the use of either solution as a local anesthetic for MIH-affected maxillary molars in pediatric patients.

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Background: Effective pain control is fundamental to successful pediatric dental care. However, intraoral injections cause significant anxiety, due to burning sensations from the acidic pH of anesthetic solutions. Buffering with sodium bicarbonate raises pH closer to physiological levels, reducing pain and accelerating anesthesia onset. Aim: To evaluate the effectiveness of buffered and non-buffered lignocaine and articaine in children aged 6 to 12 years undergoing invasive dental procedures in terms of pain perception on injection, onset of action, and duration of action. Materials and methods: This was an in vivo, four-arm, concurrent, randomized clinical trial. Eighty healthy children requiring buccal and palatal infiltration meeting inclusion criteria were enrolled and randomized into four groups (n = 20) namely, Group I (2% Non-buffered Lignocaine), Group II (4% Non-buffered Articaine), Group III (2% Buffered Lignocaine) and Group IV (4% Buffered Articaine). Clinical parameters evaluated included pain perception (Wong-Baker Faces Pain Rating Scale and Sound-Eye-Motor scale), onset of anesthesia and duration of action. Result: Buffered local anesthetic groups demonstrated significantly lower subjective and objective pain scores compared to non-buffered groups. Buffered articaine group showed significantly lower pain perception, the fastest onset of anesthesia, and the longest duration of anesthetic effect followed by buffered lignocaine. Conclusion: Among the four groups evaluated, buffered articaine demonstrated consistently lower subjective and objective pain scores, more rapid onset of anesthesia, and prolonged duration of action. These findings indicate that buffering, particularly when used in combination with articaine, enhances anesthetic efficacy and improves patient comfort during pediatric dental procedures.

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Aim: To evaluate the anesthetic efficacy of inferior alveolar nerve block (IANB) with 4% articaine versus laser-assisted articaine supplementation for profound pulpal anesthesia during single-visit root canal treatment (RCT) of the mandibular molars with symptomatic irreversible pulpitis. Materials and Methods: This prospective double-blinded randomized controlled trial enrolled 64 patients (aged 18–55 years) with clinically/radiographically confirmed symptomatic irreversible pulpitis in the mandibular molars. After standard IANB (1.8 mL 4% articaine 1:100,000 epinephrine), patients with persistent moderate–severe pain (Visual Analog Scale [VAS]: ≥4) were randomized into two groups ( n = 32 each). The laser group received a 980-nm diode laser (1.5 W, continuous wave, noncontact, 60–180 s/canal, 10–30 J/cm²) at the apical third. The control group received supplementary intraligamentary (0.2–0.4 mL/canal) and buccal infiltration with articaine. Primary outcomes were pre operative and intraoperative pain (VAS:0-10). Secondary outcomes were supplemental anesthesia needs and treatment success. Wilcoxon signed-rank test (intragroup) and Mann–Whitney U -test (intergroup) tests ( P &lt; 0.05, SPSS v. 25) were used for statistical analysis. Results: The mean age was 33.97 ± 12.07 years in the diode laser group and 38.66 ± 12.22 years in the articaine group, with comparable gender distribution between groups. Preoperative pain scores were similar (median = 8; P = 0.320). Intraoperatively, the laser group demonstrated significantly lower pain scores (median = 0, IQR 0–1) compared with the articaine group (median = 3, IQR 2–4; P &lt; 0.01). Both groups showed a significant reduction in pain from preoperative to intraoperative periods ( P &lt; 0.01). All cases completed single-visit without adverse effects. Conclusion: The 980-nm diode laser significantly enhances IANB over articaine infiltration, providing superior pain control for single-visit RCT in irreversible pulpitis.

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Local anesthetics are essential in dental practice, but their systemic effects can pose significant risks for medically compromised patients. This review aims to identify and evaluate the safest local anesthetic agents for use in dental procedures in patients with systemic medical conditions to minimize adverse outcomes and improve clinical safety. To achieve this, a comprehensive literature search was performed in PubMed, Scopus, Web of Science, and Google Scholar for studies published from January 2000 to April 2025. Thirty-five studies addressing local anesthetic use in patients with cardiovascular disease, hepatic or renal impairment, diabetes, thyroid disorders, bleeding tendencies, pregnancy, elderly populations, and amide allergies were included. Data were synthesized to develop clinical recommendations for anesthetic selection based on systemic conditions. Lidocaine remains the standard amide anesthetic, with a strong safety profile in pregnancy and diabetes. Mepivacaine, due to minimal vasodilation, is preferred in cardiovascular and thyroid disorders. Articaine's rapid plasma metabolism benefits patients with liver or kidney impairment. Prilocaine is effective for hepatic impairment but poses methemoglobinemia risks, especially in pregnancy. Chloroprocaine, an ester anesthetic, is recommended for patients with confirmed amide allergies. Emerging strategies, such as buffered formulations, low epinephrine anesthetics, and ultrasound guided techniques, may enhance safety in high risk groups. Local anesthetic selection must be tailored to each patient's medical status. Mepivacaine, lidocaine, and articaine are among the safest agents for various systemic conditions. An evidence based, condition specific approach enhances safety and treatment outcomes in medically compromised dental patients.

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Introduction Local anesthesia plays a crucial role in ensuring patient comfort during orthodontic extractions. Among the various local anesthetic agents commonly used in the field of oral surgery are articaine and lidocaine, which differ in their duration of action and pain effectiveness (pain control) during surgical procedures. This article aimed to analyze the characteristics of 2% lignocaine with 1:80000 adrenaline and 4% articaine with 1:100000 adrenaline regarding duration of action and pain control in patients undergoing bilateral orthodontic maxillary premolar extractions. Materials and methods A split-mouth comparative study was conducted at Saveetha Dental College and Hospitals, Chennai, for which 50 patients of age less than 30 years and who required bilateral orthodontic premolar extractions were selected. Approximately 4% articaine hydrochloride solution was administered on one side, and 2% lignocaine hydrochloride was administered on the contralateral side. Palatal infiltration was not given in the articaine group. The degree of extraction difficulty was similar in both groups, with no discernible variation. In each patient, the duration of anesthesia and pain control were assessed. The IBM Statistical Package for Social Sciences (SPSS version 24.0, IBM SPSS Statistics for Windows, Armonk, NY) was used to perform the student's paired t-test for detecting the difference in outcome parameters between the two groups. Results Upon comparing both groups, it was concluded that the articaine group had a longer mean anesthetic duration of action of 217 minutes, whereas for the lignocaine group, it was 169 minutes, and greater pain reduction was present with the articaine group. The articaine group exhibited less pain (superior pain control) with a mean visual analogue scale (VAS) score of 1.07 compared to that of the lignocaine group with a mean VAS score of 1.53 during orthodontic premolar extractions. Both the results were statistically significant (P=0.001). Conclusion This split-mouth comparative study concludes that articaine is a more effective local anesthetic in terms of duration of action and pain reduction than that of lignocaine, and it can be used as a local anesthetic of choice for orthodontic maxillary premolar extractions.

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