Depending on the complete anatomical and pathological condition, the extraction of an impacted lower third molar may represent a more or less investigative intervention. In all cases, it is essential that the surgery is performed under an appropriate anaesthetic regime, in terms of effectiveness but also duration.
Currently, the most widely used local anaesthetic drugs are lidocaine, the progenitor of the starch class, and articaine, a starch with an additional ester group, capable of partially altering its pharmacokinetics. Because of the clinical needs dictated by the surgery of the third molar, it seems interesting to compare these two drugs (or rather, the scientific evidence in this regard, possibly in terms of systematic reviews with meta-analysis) to derive useful information for clinical practice.
Several meta-analyses have compared lidocaine and articaine with the data of pulpal anaesthesia; fewer have explicitly included consideration of lower third molar surgery. l i .
In 2018, the Zhang group and colleagues published a systematic review of the literature (updated at the end of 2017) on the subject in the Journal of Oral and Maxillofacial Surgery.
Two independent reviewers surveyed the MEDLINE (PubMed), Cochrane Library and Web of Science databases. Only randomised clinical trials (RCTs) were included, comparing the use of the two drugs in the extraction of an Iower third molar requiring flap preparation, ostectomy and dentitomy. Outcomes included intraoperative pain assessment using visual analogue scales (VAS), anaesthesia success rate, onset time and/or duration of anaesthesia.
Starting from a pool of 39 works net of duplicates, 14 full texts were considered and, 9 of these met the inclusion criteria, including outcome, and were, therefore, taken to the final evaluation.
The results show a significant overall superiority of articaine 4% over lidocaine (this is available in several formulations, but almost all studies have used the 2% with epinephrine 1:100,000) in terms of success rate, duration of anaesthesia and onset time subjectively (but not objectively) evaluated; there is also no statistical significance regarding the data of intraoperative pain.
The authors concluded by establishing the superior efficacy of articaine in third molar surgery , specifying that the data does not support the recommendation of thedrug also as a substitute for lidocaine in the performance of conventional block anaesthesia. The means of SR are not able to shed light on this and other issues of collateral debate, so it is desirable to set up further clinical trials of good quality.