Comparison of Anesthetic Efficacy of 2% and 4% Articaine in Inferior Alveolar Nerve Block for Tooth Extraction

Objective: The purpose of this prospective, randomised, double-blind clinical trial was to compare the anesthetic efficacy of 2% articaine and 4% articaine in inferior alveolar nerve block anesthesia for extraction of mandibular teeth. Study Design: In 95 patients, 105 lower molar and premolar teeth were extracted after intraoral inferior alveolar nerve block. In 53 cases, 2% articaine (group I) and in 52 cases, 4% articaine (group II) was administered. The primary objective was to analyse the differences in anesthetic effects between the two groups (complete/sufficient vs. insufficient/none). Furthermore, differences in pulpal anesthesia (onset and depth, examined with pulp vitality tester (min) as well as length of soft tissue anesthesia (min) were evaluated. Additionally, the need for a second injection, pain while injecting (numeric rating scale (NRS)), pain during treatment (NRS), pain after treatment (NRS), and other possible complications (excessive pain, bleeding events, prolonged deafness) were analysed. Results: Anesthesia was sufficient for dental extractions in both groups without significant differences (p=0.201). The onset of anesthesia did not differ significantly (p=0.297). A significantly shorter duration of soft tissue anesthesia was seen in group I (2.9h vs. 4h; p0.001). There was no significant difference in the need for a second injection (p=0.359), injection pain (p=0.386), and pain during (p=0.287) or after treatment (p=0.412). In both groups, no complications were seen. Conclusion: The local anesthetic effect of the 4% articaine solution is not significantly better when compared to 2% articaine. For mandibular tooth extraction, articaine 2% may be used as an alternative as well. Keywords: Dental local anesthesia, tooth extraction, articaine, nerve bloc