What do systematic reviews say?

4% prilocaine, 1:200,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

4% prilocaine, 1:200,000 epinephrine showed no clear difference in speed of onset of anaesthesia (soft tissue, simulated) compared with 2% lidocaine, 1:100,000 epinephrine (low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  MD -0.01 [-0.14, 0.11]
  2 studies · 421 participants
  Low

4% prilocaine, 1:200,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

It is very uncertain whether 4% prilocaine, 1:200,000 epinephrine changes duration of anaesthesia (soft tissue, simulated) compared with 2% lidocaine, 1:100,000 epinephrine (very low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  MD -11.80 [-27.76, 4.16]
  2 studies · 533 participants
  Very low

4% prilocaine, 1:200,000 epinephrine vs 4% prilocaine plain

4% prilocaine, 1:200,000 epinephrine may leads to higher duration of anaesthesia (soft tissue, simulated) compared with 4% prilocaine plain (low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  MD 18.78 [9.02, 28.54]
  2 studies · 506 participants
  Low

4% prilocaine, 1:200,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

4% prilocaine, 1:200,000 epinephrine showed no clear difference in speed of onset of anaesthesia (pulpal, electric pulp tester; healthy… compared with 2% lidocaine, 1:100,000 epinephrine (low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  MD -1.19 [-3.08, 0.70]
  2 studies · 39 participants
  Low

4% prilocaine, 1:200,000 epinephrine vs 4% articaine, 1:100,000 epinephrine

4% prilocaine, 1:200,000 epinephrine may leads to higher success of local anaesthesia (pulpal, electric pulp tester; healthy… compared with 4% articaine, 1:100,000 epinephrine (low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  RR 1.74 [1.16, 2.60]
  2 studies · 78 participants
  Low

4% prilocaine, 1:200,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

4% prilocaine, 1:200,000 epinephrine showed no clear difference in success of local anaesthesia (pulpal, electric pulp tester; healthy… compared with 2% lidocaine, 1:100,000 epinephrine (low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  RR 1.14 [0.91, 1.43]
  2 studies · 48 participants
  Low

4% prilocaine, 1:200,000 epinephrine vs 4% prilocaine plain

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  No data available for meta-analysis; data summarized in Table 5 (orphan). Not pooled/graded.
  Studies not reported
  GRADE not reported