Anesthetic Efficiency of Articaine Versus Lidocaine in the Extraction of Lower Third Molars: A Meta-Analysis and Systematic Review

J Oral Maxillofac Surg. 2019 Jan;77(1):18-28. doi: 10.1016/j.joms.2018.08.020. Epub 2018 Sep 5.


Purpose: The purpose of this study was to evaluate whether the anesthetic efficiency of articaine is superior to that of lidocaine during lower third molar extraction (LTME).

Materials and methods: Three electronic databases (PubMed, Cochrane, and Web of Science) were searched to identify randomized controlled trials up to December, 31 2017. Five evaluation indexes were extracted, namely success rate of anesthesia, subjective onset time of anesthesia, objective onset time of anesthesia, duration time of anesthesia, and intraoperative pain assessment, to assess the anesthesia efficiency of the 2 solutions. All data analyses were conducted using Review Manager (version 5.3; The Cochrane Collaboration, London, United Kingdom).

Results: Nine studies were included in this review. The sample was composed of 770 LTMEs from 493 patients, with 382 LTMEs in the lidocaine group and 388 LTMEs in the articaine group. Compared with lidocaine, 4% articaine with 1:100,000 epinephrine showed a higher success rate of anesthesia (risk ratio, 1.10; 95% confidence interval [CI], 1.01 to 1.21; P = .03), shorter subjective onset time of anesthesia (standardized mean difference, 1.20; 95% CI, 0.50 to 1.89; P = .0007), and longer duration time of anesthesia (mean difference, 0.83 hours; 95% CI, 0.59 to 1.07 hours; P < .00001); however, for intraoperative pain assessment (mean difference, 3.12 mm; 95% CI, -0.13 to 6.37 mm; P = .06) and objective onset time of anesthesia (standardized mean difference, 0.44; 95% CI, -0.39 to 1.26; P = .30), there was no significant difference between the 2 solutions.

Conclusions: The results of this study suggest that 4% articaine with 1:100,000 epinephrine possesses superior anesthetic efficiency relative to lidocaine for inferior alveolar nerve blocks during LTME.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Anesthesia, Dental*
  • Anesthetics, Local
  • Carticaine
  • Double-Blind Method
  • Humans
  • Lidocaine
  • Molar, Third*


  • Anesthetics, Local
  • Lidocaine
  • Carticaine