4% articaine without epinephrine is a suitable anaesthetic agent for mandibular extractions

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Articaine is a common local anaesthetic agent that shows  greater lipid solubility than lidocaine, allowing enhanced diffusion through nerve sheaths. It also has an increased potency compared with lidocaine.   The aim of this study was to compare the anaesthetic efficacy of 4% articaine with epinephrine (1:100,000) and without epinephrine in inferior alveolar nerve block anaesthesia for extractions of mandibular teeth.

Eighty-eight patients in need of a single tooth extractions were randomised to receive intraoral inferior alveolar nerve blocks using 4% articaine with 1:100,000 epinephrine (n = 41) or without epinephrine (n = 47) for extractions of mandibular teeth.

The main objectives were to compare the differences in onset as well as in length of soft tissue anaesthesia.  Secondary objectives were to compare the amount of anaesthetic solution, need of a second injection, pain while injecting, pain during treatment, postoperative pain, and possible complications were surveyed.

They found that

  • Anaesthesia was sufficient for dental extractions in both groups.
  • Those receiving 4% articaine with 1:100,000 epinephrine, had a significantly faster onset of the anaesthetic effect (7.2 min vs. 9.2 min; P = .001) and a significantly longer duration of soft tissue anaesthesia (3.8 h vs. 2.5 h; P < .0001) .
  • There was no significant difference in the amount of anaesthetic solution needed, in the need for a second injection, in the injection pain, in pain during treatment, or in postoperative analgesia. In both groups, no complications were seen.

The authors concluded

To minimize the epinephrine-induced side effects, 4% articaine without epinephrine is a suitable anaesthetic agent for dental extractions in the mandible after inferior alveolar nerve block anaesthesia. There could be less postoperative discomfort due to the shorter duration of anaesthesia without increased postoperative pain.

Kämmerer PW, Palarie V, Daubländer M, Bicer C, Shabazfar N, Brüllmann D, Al-Nawas B. Comparison of 4% articaine with epinephrine (1:100,000) and without epinephrine in inferior alveolar block for tooth extraction: double-blind randomized clinical trial of anesthetic efficacy. Oral Surg Oral Med Oral Pathol  Oral Radiol Endod. 2011 Aug 6. [Epub ahead of print] PubMed PMID: 21821443.

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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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