What do systematic reviews say?

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

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

It is very uncertain whether 4% articaine, 1:100,000 epinephrine changes speed of onset of anaesthesia (soft tissue, simulated) compared with 2% lidocaine, 1:80,000 epinephrine (very low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  MD -0.78 [-1.04, -0.52]
  2 studies · 116 participants
  Very low

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

3% mepivacaine plain showed no clear difference in speed of onset of 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
  MD -0.56 [-1.54, 0.42]
  2 studies · 58 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

3% prilocaine, 0.03 IU felypressin 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

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

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

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: See comment, not estimable (orphan study; duration of follow-up not reported); 100 participants, 100 interventions (1 study). Not pooled/graded.
  1 study · 100 participants
  GRADE not reported

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

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

4% prilocaine plain 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 -0.96 [-2.87, 0.95]
  2 studies · 52 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, 1:100,000 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, 1:80,000 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

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

It is very uncertain whether 0.5% bupivacaine, 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 222.88 [135.99, 309.76]
  6 studies · 232 participants
  Very low

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 duration of anaesthesia (pulpal, electric pulp tester; healthy pulps) compared with 2% lidocaine, 1:100,000 epinephrine (very low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  MD 21.87 [-10.96, 54.71]
  3 studies · 52 participants
  Very low

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

3% mepivacaine plain may leads to lower 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 -1.23 [-2.31, -0.16]
  3 studies · 85 participants
  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% prilocaine plain 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: See comment; 0 participants (0 studies); 1 case of prolonged anaesthesia recorded; no clinical studies met the outcome definition (unable to confirm whether prolonged anaesthesia = paraesthesia).
  0 studies
  No studies found