What do systematic reviews say?

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

It is very uncertain whether 4% articaine, 1:200,000 epinephrine changes speed of onset of anaesthesia (pulpal, electric pulp tester; healthy… compared with 2% lidocaine, 1:100,000 epinephrine (very low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  MD 0.19 [-2.06, 2.45]
  2 studies · 40 participants
  Very low

4% articaine, 1:200,000 epinephrine vs 0.5% bupivacaine, 1:200,000 epinephrine

The review found no eligible studies for this question.

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: Not measured.
  0 studies
  No studies found

4% articaine, 1:100,000 epinephrine vs 2% mepivacaine, 1:100,000 epinephrine

The review found no eligible studies for this question.

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: Not measured.
  0 studies
  No studies found

4% articaine, 1:100,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

It is very uncertain whether 4% articaine, 1:100,000 epinephrine changes speed of onset of anaesthesia (pulpal, electric pulp tester; healthy… compared with 2% lidocaine, 1:100,000 epinephrine (very low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  MD -0.63 [-1.69, 0.42]
  6 studies · 202 participants
  Very low

4% articaine, 1:100,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

4% articaine, 1:100,000 epinephrine showed no clear difference in adverse effects: pain on injection (solution deposition),… compared with 2% lidocaine, 1:100,000 epinephrine (moderate certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes

  0-1 minute following needle insertion
  MD 4.74 [-1.98, 11.46]
  3 studies · 157 participants
  Moderate

4% articaine, 1:100,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

4% articaine, 1:100,000 epinephrine probably leads to higher adverse effects: pain following injection, Heft-Parker VAS 0-170 mm compared with 2% lidocaine, 1:100,000 epinephrine (moderate certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes

  Measured at the time anaesthesia wore off
  MD 6.41 [1.01, 11.8]
  3 studies · 156 participants
  Moderate

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

It is very uncertain whether 4% articaine, 1:200,000 epinephrine changes success of local anaesthesia, absence of pain (clinical testing of… compared with 4% articaine, 1:100,000 epinephrine (very low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes

  5 minutes post-injection to end of clinical procedure
  RR 0.85 [0.71, 1.02]
  3 studies · 930 participants
  Very low

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

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: See comment, not estimable; 63 participants, 187 interventions (1 study); 1 case of urticaria occurred (unclear which anaesthetic). Not pooled/graded.
  1 study · 63 participants
  GRADE not reported

4% articaine, 1:100,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

4% articaine, 1:100,000 epinephrine may leads to higher duration 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 56.88 [44.08, 69.69]
  2 studies · 422 participants
  Low

4% articaine, 1:200,000 epinephrine vs 0.5% bupivacaine, 1:200,000 epinephrine

It is very uncertain whether 4% articaine, 1:200,000 epinephrine changes duration of anaesthesia (soft tissue, simulated) compared with 0.5% bupivacaine, 1:200,000 epinephrine (very low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  MD -172.61 [-239.69, -105.53]
  2 studies · 39 participants
  Very low

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

It is very uncertain whether 4% articaine, 1:200,000 epinephrine changes speed of onset of anaesthesia (pulpal, electric pulp tester; healthy… compared with 4% articaine, 1:100,000 epinephrine (very low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  MD 0.15 [-0.42, 0.73]
  5 studies · 162 participants
  Very 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 (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 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

2% mepivacaine, 1:100,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

The review found no eligible studies for this question.

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: Not measured.
  0 studies
  No studies found

2% mepivacaine, 1:100,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  'Other comparisons with 100% success': IANB - Allegretti 2016 22/22 vs 22/22; Visconti 2016 21/21 vs 21/21. Both formulations 100% successful; no meta-analysis (no difference).
  2 studies · 43 participants
  GRADE not reported

2% mepivacaine, 1:100,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

2% mepivacaine, 1:100,000 epinephrine showed no clear difference in success of local anaesthesia, absence of pain (clinical testing of… compared with 2% lidocaine, 1:100,000 epinephrine (low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes

  10-14 minutes post-injection to end of clinical procedure
  RR 1.16 [0.25, 5.45]
  2 studies · 68 participants
  Low

2% mepivacaine, 1:100,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

The review found no eligible studies for this question.

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: Not measured.
  0 studies
  No studies found
• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: See comment (orphan study; unclear whether data relate to just solution deposition); 48 participants, 48 interventions (1 study). Not pooled/graded.
  1 study · 48 participants
  GRADE not reported