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Estimation of Anesthetic Success Rates: The Efficacy of Articaine versus Lidocaine

Smith DK, Smith LE and Blume JD

Purpose: Multiple randomized controlled trials have compared the efficacy of 2% lidocaine with 1:100,000 epinephrine to 4% articaine with 1:100,000 epinephrine. However, there is still uncertainty about expected success probabilities with various anesthetic modalities that needs to be addressed in the literature.
Methods: A search of PubMed and Google yielded over 200 potential articles. 13 randomized controlled trials met the eligibility criteria for inclusion in the analysis. Analyses compared lidocaine and articaine in teeth with and without a diagnosis of pulpitis for maxillary infiltration, mandibular buccal infiltration, and inferior alveolar nerve block (IANB).
Results: Articaine demonstrated superior anesthetic efficacy regardless of the type of injection administered or pulpal status. Depending on the type of injection, the estimated probability of anesthetic success with articaine was observed to be anywhere from 9.19 percentage points to 32.48 percentage points higher than lidocaine. The comparisons favoring articaine were highly significant for mandibular infiltration (p<0.0001) and maxillary infiltration (p=0.0100). While IANB nearly missed statistical
significance (p=0.0656), the estimated effect was of a clinically meaningful magnitude. Clinical Implications: A synthesis of current evidence suggests that articaine has a higher success probability than lidocaine regardless of injection type or pulpal status. In addition to statistical significance, the superior anesthetic success rate of articaine is estimated to be of sufficient magnitude to make meaningful clinical impact.