Comparative Study of the Efficacy of 4% Articaine vs 2% Lidocaine in Surgical Removal of Bilaterally Impacted Mandibular Third Molars

J Contemp Dent Pract. 2018 Jun 1;19(6):743-748.


Aim: The aim of this study was to evaluate the safety and efficacy of 4% articaine with epinephrine (1:200,000) vs 2% lidocaine with epinephrine (1:200,000) during surgical removal of impacted mandibular third molars.

Materials and methods: The present study was undertaken in 20 patients belonging to American Society of Anesthesiologists (ASA) class I, of the age group between 18 and 30 years with bilaterally impacted mandibular third molars. Each patient underwent similar surgical procedure. In the first appointment, the patient was randomly selected to receive either 4% articaine or 2% lidocaine (both with epinephrine 1:200,000). Intraoperative and postoperative evaluation was done for both the anesthetic solutions. Following parameters were evaluated: total volume of anesthetic solution used during the surgery, onset of action of the anesthetic agent, duration of anesthesia, duration of postoperative analgesia, incidence, type and severity of adverse reactions, any need to reanesthetize the surgical zone and quality of anesthesia provided by the local anesthetic. Subjective pain evaluation was done with the aid of 100 mm length visual analog scale (VAS) both intraoperatively and postoperatively.

Results: In the present study, 4% articaine was found to have a significantly shorter onset of action than 2% lidocaine. Duration of anesthesia and postoperative analgesia of 4% articaine with epinephrine 1:200,000 was found to be significantly (1.44 and 1.28 times respectively) longer than 2% lidocaine with epinephrine 1:200,000. But no significant difference was found in other parameters.

Conclusion: 4% articaine in comparison with 2% lidocaine (both with epinephrine 1:200,000) provided a shorter onset of action and longer duration of anesthesia.

Clinical significance: No significant difference was recorded in the anesthetic efficacy between the two solutions.

Keywords: Articaine; Impacted mandibular third molar; Inferior alveolar nerve block; Lidocaine Mandibular nerve block..

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Anesthesia, Dental / methods*
  • Anesthetics, Local* / administration & dosage
  • Carticaine* / administration & dosage
  • Humans
  • Lidocaine* / administration & dosage
  • Mandible / surgery
  • Molar, Third / surgery*
  • Pain Measurement
  • Pain, Postoperative / prevention & control
  • Tooth Extraction* / methods
  • Tooth, Impacted / surgery*


  • Anesthetics, Local
  • Lidocaine
  • Carticaine