Data sources: Cochrane Central, Medline, Embase, and ProQuest Health and Medical Complete, the metaRegister of the controlled trials database and a leading manufacturer.
Study selection: Randomised controlled trials in patients requiring non-complex routine dental treatments comparing 4% articaine (1:100,000 epinephrine) with 2% lignocaine (1:100,000 epinephrine) for maxillary and mandibular infiltrations and block anaesthesia were included. The principal outcome measures were anaesthetic success, onset of action, post-injection adverse events or post-injection pain.
Data extraction and synthesis: Following data abstraction a meta-analysis was performed using random-effects model.
Results: Eight studies were included in a meta-analysis. Articaine is more likely than lignocaine to achieve an anaesthetic success in the posterior first molar area, with a relative risk for success of 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.
Conclusions: 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 exist to support such usage.