What do systematic reviews say?

2% mepivacaine, 1:20,000 levonordefrin vs 2% lidocaine, 1:100,000 epinephrine

It is very uncertain whether 2% mepivacaine, 1:20,000 levonordefrin 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 4.43 [-10.63, 19.48]
  2 studies · 458 participants
  Very low

3% mepivacaine plain 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 3% mepivacaine plain): infraorbital block - Berberich 2009 40/40 vs 40/40; IANB - Cohen 1993 27/27 vs 34/34, McLean 1993 30/30 vs 30/30. Both 100% successful.
  3 studies · 121 participants
  GRADE not reported

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

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

It is very uncertain whether 4% prilocaine plain 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 -33.95 [-48.05, -19.84]
  3 studies · 698 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 speed of onset 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 -0.23 [-0.45, -0.01]
  6 studies · 637 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 plain vs 2% lidocaine, 1:100,000 epinephrine

4% prilocaine plain 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 0.02 [-0.10, 0.14]
  2 studies · 406 participants
  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

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

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

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 speed of onset 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 0.02 [-1.07, 1.10]
  3 studies · 79 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 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% 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

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

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

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

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

4% prilocaine plain may leads to lower 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

  5-30 minutes
  RR 0.86 [0.75, 0.99]
  2 studies · 228 participants
  Low

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

4% articaine, 1:200,000 epinephrine showed no clear difference in success of local anaesthesia, absence of pain (clinical testing of… compared with 0.5% bupivacaine, 1:200,000 epinephrine (low certainty).

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

  10 minutes post-injection to end of clinical procedure
  OR 0.87 [0.27, 2.83]
  2 studies · 37 participants
  Low