What do systematic reviews say?

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

4% articaine, 1:100,000 epinephrine may leads to higher 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 minutes post-injection to end of clinical procedure
  RR 1.6 [1.1, 2.32]
  4 studies · 203 participants
  Low

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

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

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  RR 0.58 [0.33, 1.01]
  2 studies · 134 participants
  Very low

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% lidocaine, 1:50,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

It is very uncertain whether 2% lidocaine, 1:50,000 epinephrine changes success of local 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
  RR 0.99 [0.88, 1.12]
  7 studies · 210 participants
  Very low

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

It is very uncertain whether 4% articaine, 1:100,000 epinephrine changes success of local anaesthesia (soft tissue, self-reported) compared with 2% mepivacaine, 1:100,000 epinephrine (very low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  RR 1.07 [0.73, 1.59]
  2 studies · 68 participants
  Very low

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

It is very uncertain whether 4% articaine plain changes success of local 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
  RR 0.61 [0.38, 0.97]
  2 studies · 134 participants
  Very low

2% lidocaine, 1:50,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  '100% success' (lidocaine 1:100,000 vs 1:50,000): infraorbital block - Berberich 2009 40/40 vs 40/40; mandibular BI - Dagher 1997 30/30, Yonchak 2001 40/40; IANB - Yared 1997 30/30, Wali 2010 30/30. Both 100% successful.
  5 studies · 170 participants
  GRADE not reported

3% mepivacaine plain vs 2% lidocaine, 1:50,000 epinephrine

3% mepivacaine plain showed no clear difference in success of local anaesthesia (pulpal, electric pulp tester; healthy… compared with 2% lidocaine, 1:50,000 epinephrine (low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  RR 0.97 [0.88, 1.07]
  2 studies · 70 participants
  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 success of local anaesthesia (soft tissue, self-reported) compared with 2% lidocaine, 1:100,000 epinephrine (moderate certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  RR 1.03 [0.99, 1.07]
  6 studies · 355 participants
  Moderate

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

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

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  RR 1.15 [0.93, 1.41]
  3 studies · 97 participants
  Very low

0.5% bupivacaine, 1:200,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

0.5% bupivacaine, 1:200,000 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 minutes post-injection to end of clinical procedure
  OR 0.58 [0.07, 5.12]
  2 studies · 31 participants
  Low

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

It is very uncertain whether 2% lidocaine, 1:200,000 epinephrine changes success of local 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
  RR 0.89 [0.63, 1.26]
  3 studies · 70 participants
  Very low

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

3% mepivacaine plain vs 2% lidocaine, 1:100,000 epinephrine

3% mepivacaine plain 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 0.92 [0.83, 1.02]
  6 studies · 208 participants
  Low

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

4% articaine, 1:100,000 epinephrine showed no clear difference in success of local anaesthesia, absence of pain (clinical testing of… compared with 2% mepivacaine, 1:100,000 epinephrine (low certainty).

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

  10-20 minutes
  OR 3.82 [0.61, 23.82]
  2 studies · 110 participants
  Low

2% lidocaine, 1:50,000 epinephrine vs 2% lidocaine, 1:80,000 epinephrine

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  '100% success': mandibular BI - Dagher 1997 30/30 vs 30/30; IANB - Yared 1997 30/30 vs 30/30. Both 100% successful; no meta-analysis.
  2 studies · 60 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 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
  OR 2.71 [1.74, 4.22]
  8 studies · 309 participants
  Low

4% articaine, 1:100,000 epinephrine vs 2% lidocaine, 1:80,000 epinephrine

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  No data available for meta-analysis; orphan data summarized in Table 6. Not pooled/graded.
  Studies not reported
  GRADE not reported

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 success of local 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
  RR 1.33 [0.33, 5.36]
  2 studies · 28 participants
  Very low

2% lidocaine, 1:50,000 epinephrine vs 2% lidocaine, 1:80,000 epinephrine

It is very uncertain whether 2% lidocaine, 1:50,000 epinephrine changes success of local anaesthesia (pulpal, electric pulp tester; healthy… compared with 2% lidocaine, 1:80,000 epinephrine (very low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  RR 0.81 [0.65, 1.01]
  2 studies · 60 participants
  Very low