Comparative split-mouth study of the anesthetic efficacy of 4% articaine versus 0.5% bupivacaine in impacted mandibular third molar extraction

Abstract

Objective: The purpose of this study was to compare the clinical efficacy of articaine at 4% (epinephrine 1:100,000) with bupivacaine at 0.5% (epinephrine 1:200,000) for surgical extraction of impacted mandibular third molars. Study Design: This was a randomized, double blind, split-mouth, clinical trial. Thirty-six patients took part and underwent extraction of 72 lower third molars. The variables studied were: anesthetic latency time, intra-operative bleeding, anesthetic quality, hemodynamic changes during the surgical intervention, anesthetic duration in the soft tissues, post-operative analgesia and post-operative pain at 2, 6, 12 and 24 hours using a visual analogue scale, as well as any need for additional rescue medication. Results: Latency time was 2.0 minutes for articaine and 3.1 minutes for bupivacaine, with statistically significant difference (p<0.05). Bleeding was greater when bupivacaine was used (p<0.05) and anesthetic quality was greater with articaine (p<0.05). The duration of soft tissue anesthesia was longer with bupivacaine (p<0.05). Differences in post-operative analgesia, haemodynamic changes, post-operative pain and the quantity of rescue medication consumed were not statistically significant (p>0.05). Conclusions: Articaine showed greater clinical efficacy than bupivacaine, reducing latency time, bleeding, anesthetic duration in the soft tissues and achieving higher anesthetic quality, requiring less reinforcement during surgery than bupivacaine. Key words:Articaine, bupivacaine, anesthetic efficacy, impacted mandibular third molar.

Comparative Study between the Combination of Dexamethasone and Bupivacaine for Third Molar Surgery Postoperative Pain: A Triple-Blind, Randomized Clinical Trial

“…Statistically, our study is different from those by Pellicer-Chover et al [ 39 ] and Brković et al [ 5 ], which found no clear statistically significant differences in postoperative pain after the extraction of wisdom teeth using different types of anaesthetics. In our study, the patients who received only the articaine block reported initial pain immediately after the anaesthetic wore off, while those with bupivacaine reported it later.…”

Comparison of the effects of articaine and bupivacaine in impacted mandibular third molar tooth surgery: a randomized, controlled trial

“…In this study, the onset of action in the articaine group was faster than that in the bupivacaine group, which is compatible with previous reports in the literature [ 8 14 ]. Anesthetic action starts faster when the pKa of local anesthetic agents is close to the pH of the tissue where they are injected.…”

“…In the present study, systolic and diastolic blood pressure did not differ between the two groups. Heart rate and blood oxygen saturation decreased in the postoperative period, but a statistically significant difference was not found between groups, which was in accordance with the results obtained in other studies [ 14 15 ]. One of the main reasons for this could be that the present and similar studies in the literature were performed in younger patients without systemic diseases [ 14 15 16 17 ].…”

“…Heart rate and blood oxygen saturation decreased in the postoperative period, but a statistically significant difference was not found between groups, which was in accordance with the results obtained in other studies [ 14 15 ]. One of the main reasons for this could be that the present and similar studies in the literature were performed in younger patients without systemic diseases [ 14 15 16 17 ]. Another reason may be the use of low doses of local anesthetics due to the extraction of only one impacted tooth.…”

“…The duration of postoperative anesthesia was significantly higher in the bupivacaine group, with a mean duration of 426 minutes. Similar to this study, some researchers have presented results demonstrating that bupivacaine provides long-lasting anesthetic action [ 5 8 14 15 16 17 20 ]. The possible causes are not only the high pKa of bupivacaine but also its high protein-binding capacity.…”