Articaine Hydrochloride

This review evaluates the efficacy and cost-effectiveness of local anesthetics in managing symptomatic irreversible pulpitis in mandibular molars.

Following PRISMA guidelines, it was registered in PROSPERO (CRD42024615858). Six databases (PubMed, Scopus, Web of Science, Cochrane Library, Embase, and Virtual Health Library) were searched without restrictions in January 2025. Studies comparing the efficacy of local anesthetics for irreversible pulpitis in mandibular molars were included. Data extraction and risk of bias assessment using the Cochrane RoB 2 tool were performed independently by two reviewers. A random-effects meta-analysis was conducted. Cost-effectiveness was subsequently assessed by the authors using efficacy estimates derived from the meta-analysis combined with market prices, based on the Incremental Cost-Effectiveness Ratio (ICER).

Twelve studies (1262 participants) were included. No significant differences in efficacy were observed among lidocaine 2%, articaine 4%, bupivacaine 0.5%, and mepivacaine 2% for inferior alveolar nerve block. Lidocaine 2% with epinephrine was the most cost-effective, presenting negative ICER values. Bupivacaine 0.5% was the least cost-effective despite its prolonged duration.

Lidocaine 2% with epinephrine emerged as the most cost-effective option, offering an optimal balance between efficacy and affordability. While articaine 4% is recognized for its superior tissue diffusion, a key pharmacological advantage influencing its clinical application, and considerations of patient safety are paramount, our meta-analysis did not quantify these as primary outcomes. Nonetheless, articaine's higher cost, despite its diffusion advantages, limits its routine first-line use, and potential for adverse effects, as discussed in the literature, must always be weighed during anesthetic selection.

This review bridges the gap between efficacy and affordability, providing clinicians with clear, evidence-based guidance for anesthetic selection in one of the most challenging endodontic scenarios.

Effective anesthesia of the mandibular lateral incisor is challenging. This study compared the efficacy of lingual infiltration alone versus combined labial and lingual infiltration using 4% articaine with 1:100,000 epinephrine.

In this prospective, randomized, crossover clinical trial, 50 healthy volunteers received two infiltration techniques: (1) lingual infiltration only (3.6 mL total via two 1.8 mL injections plus a mock buccal injection), and (2) combined labial and lingual infiltration (1.8 mL each; 3.6 mL total plus a mock lingual injection). Anesthetic success was evaluated by: 1) absence of response to maximal electronic pulp tester stimulation, 2) sustained anesthesia defined as no response within 16 minutes lasting 42 minutes, and 3) anesthesia onset time (first of two consecutive no-response readings). Pain during injection was assessed via the 170-mm Heft-Parker visual analog scale (VAS). Statistical tests included McNemar's, Wilcoxon signed-rank, Friedman, and Dunn's test.

The combined technique produced an equal or higher success rate (P ≤ 0.05), significantly greater sustained anesthesia (P < 0.05), and a significantly shorter onset time (P < 0.05) compared with lingual infiltration alone. Labial infiltration was associated with higher pain scores, especially during solution deposition (P < 0.05).

The combination of labial and lingual infiltration with 4% articaine and 1:100,000 epinephrine significantly improves the anesthetic success and duration for the mandibular lateral incisor, although it is associated with increased injection-related pain.