Cochrane · intervention · CD006487
Injectable local anaesthetic agents for dental anaesthesia
St George, G, Morgan, A, Meechan, J, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
112
current version
GRADE rated
57
No studies
39
Included studies
123
as reported
No studies 39 · 34.8%Ungraded 16 · 14.3%Very low 30 · 26.8%Low 23 · 20.5%Moderate 4 · 3.6%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Participants regardless of age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which dental local anaesthesia was tested; adults defined as over 16 years; excluded participants taking regular medications that may alter pain perception | 19,223 participants in 123 RCTs (ages 4-81 years; 95 studies mixed sex, 6 male-only); undergoing extraction/surgery (30 studies), endodontic treatment of irreversible pulpitis (20), restorative procedures (8), periodontal/root canal or various procedures, and volunteers in simulated scenario testing (electric pulp tester/cold/soft tissue); 68 studies (6615 participants) pooled for meta-analysis (n=123) |
| Intervention | All commercial preparations of dental local anaesthetic (e.g. lidocaine, articaine, mepivacaine, prilocaine, bupivacaine at various concentrations, with or without vasoconstrictor) versus all other commercial preparations; one dosage versus a different dose by the same injection technique; one concentration versus a higher concentration by the same injection technique; primary infiltration and block anaesthesia only (supplemental anaesthesia excluded) | 14 formulations of lidocaine, articaine, mepivacaine, prilocaine and bupivacaine at various concentrations and vasoconstrictor levels (n=123) |
| Comparison | All other commercial preparations of dental local anaesthetic/A different dose/A higher concentration | Comparator local anaesthetic formulation in each head-to-head comparison (n=123) |
| Outcomes | Success of local anaesthesia (absence of pain on VAS or other method, or pulpal anaesthesia via electric pulp tester or cold stimulus); speed of onset; duration; adverse effects (pain on injection, pain following injection, paraesthesia, allergy); participants' experience including preference and overall experience (secondary) | Success of anaesthesia - clinical, electric pulp tester, and soft tissue testing (graded); speed of onset (simulated only; no clinical study met the definition); duration (simulated only); adverse effects - pain on injection, pain following injection, paraesthesia, allergy (rare, mostly not poolable); participants' experience (no data) (23 comparisons, 57 pooled outcomes) |
| Study designs | Randomized controlled trials (parallel or cross-over) testing different formulations of local anaesthetic in clinical procedures or simulated scenario studies | RCT: parallel design (n=54); cross-over design (n=68); design unclear (n=1) |
| Timing | Not specified | Follow-up varied and was often not reported (e.g. 5-30 minutes post-injection to end of the clinical procedure; onset/duration measured in minutes) |
Search date: 2018-01. Databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2018 Issue 1); MEDLINE (Ovid SP); Embase (Ovid SP); CINAHL PLUS (EBSCOhost); ISI Web of Science; IndMED; KoreaMED; Panteleimon; Australian New Zealand Clinical Trials Registry (ANZCTR); Ingenta Connect
Questions and results
Current version only4% articaine, 1:100,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine
Population: Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which dental local anaesthesia was tested
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Speed of onset of anaesthesia (soft tissue, simulated) | MD -0.23 [-0.45, -0.01] | 6 studies · 637 participants | Very low Downgraded: risk of bias, inconsistency, indirectness |
Adverse effects: paraesthesia following injection | SoF: Not measured. | 0 studies | No studies |
Success of local anaesthesia (pulpal, electric pulp tester; healthy pulps) | OR 2.71 [1.74, 4.22] | 8 studies · 309 participants | Low Downgraded: risk of bias, indirectness |
Duration of anaesthesia | SoF: Not measured. | 0 studies | No studies |
Duration of anaesthesia (pulpal, electric pulp tester; healthy pulps) | MD 21.87 [-10.96, 54.71] | 3 studies · 52 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Success of local anaesthesia, absence of pain (clinical testing of diseased pulps with irreversible pulpitis) 10 minutes post-injection to end of clinical procedure | RR 1.6 [1.1, 2.32] 309 per 1000 vs 494 per 1000 | 4 studies · 203 participants | Low Downgraded: risk of bias, imprecision |
Participants' experience of the procedures | No data from the included studies were available. | 0 studies | No studies |
Success of local anaesthesia (soft tissue, self-reported) | RR 1.03 [0.99, 1.07] | 6 studies · 355 participants | Moderate Downgraded: indirectness |
Adverse effects: allergy to local anaesthetic | SoF: Not measured. | 0 studies | No studies |
Speed of onset of anaesthesia | SoF: Not measured. | 0 studies | No studies |
Adverse effects: pain on injection (solution deposition), Heft-Parker VAS 0-170 mm 0-1 minute following needle insertion | MD 4.74 [-1.98, 11.46] 4.74 [-1.98, 11.46] mm (higher = more pain) | 3 studies · 157 participants | Moderate Downgraded: imprecision |
Speed of onset of anaesthesia (pulpal, electric pulp tester; healthy pulps) | MD -0.63 [-1.69, 0.42] | 6 studies · 202 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Adverse effects: pain following injection, Heft-Parker VAS 0-170 mm Measured at the time anaesthesia wore off | MD 6.41 [1.01, 11.8] 6.41 [1.01, 11.8] mm (higher = more pain) | 3 studies · 156 participants | Moderate Downgraded: imprecision |
Duration of anaesthesia (soft tissue, simulated) | MD 56.88 [44.08, 69.69] | 2 studies · 422 participants | Low Downgraded: risk of bias, indirectness |
3% prilocaine, 0.03 IU felypressin vs 2% lidocaine, 1:100,000 epinephrine
Population: Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which dental local anaesthesia was tested
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects: pain on injection (solution deposition) | SoF: Not measured. | 0 studies | No studies |
Duration of anaesthesia | SoF: Not measured. | 0 studies | No studies |
Adverse effects: paraesthesia following injection | SoF: Not measured. | 0 studies | No studies |
Adverse effects: allergy to local anaesthetic | SoF: Not measured. | 0 studies | No studies |
Speed of onset of anaesthesia | SoF: Not measured. | 0 studies | No studies |
Success of local anaesthesia, absence of pain (clinical testing of healthy pulps, hard and soft tissues) Not reported (estimated < 2 hours) | RR 0.86 [0.79, 0.95] 763 per 1000 vs 656 per 1000 | 2 studies · 907 participants | Moderate Downgraded: risk of bias |
Adverse effects: pain following injection | SoF: Not measured. | 0 studies | No studies |
4% articaine, 1:200,000 epinephrine vs 4% articaine, 1:100,000 epinephrine
Population: Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which dental local anaesthesia was tested
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Duration of anaesthesia | SoF: Not measured. | 0 studies | No studies |
Adverse effects: paraesthesia following injection | SoF: Not measured. | 0 studies | No studies |
Duration of anaesthesia (pulpal, electric pulp tester; healthy pulps) | MD -8.98 [-15.17, -2.79] | 5 studies · 162 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Adverse effects: pain on injection (solution deposition) | SoF: See comment (orphan study); 86 participants, 172 interventions (1 study). Not pooled/graded. | 1 study · 86 participants | Ungraded |
Speed of onset of anaesthesia | SoF: Not measured. | 0 studies | No studies |
Success of local anaesthesia (pulpal, electric pulp tester; healthy pulps) | RR 0.97 [0.87, 1.08] | 5 studies · 248 participants | Low Downgraded: risk of bias, indirectness |
Success of local anaesthesia, absence of pain (clinical testing of healthy pulps, hard and soft tissues) 5 minutes post-injection to end of clinical procedure | RR 0.85 [0.71, 1.02] 940 per 1000 vs 799 per 1000 | 3 studies · 930 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Adverse effects: allergy to local anaesthetic | 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 | Ungraded |
Adverse effects: pain following injection | SoF: See comment (orphan study; exact time of follow-up not reported); 86 participants, 172 interventions (1 study). Not pooled/graded. | 1 study · 86 participants | Ungraded |
Speed of onset of anaesthesia (pulpal, electric pulp tester; healthy pulps) | MD 0.15 [-0.42, 0.73] | 5 studies · 162 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
4% prilocaine plain vs 2% lidocaine, 1:100,000 epinephrine
Population: Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which dental local anaesthesia was tested
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Success of local anaesthesia (pulpal, electric pulp tester; healthy pulps) | RR 0.93 [0.75, 1.17] | 2 studies · 60 participants | Low Downgraded: imprecision, indirectness |
Adverse effects: pain following injection | SoF: Not measured. | 0 studies | No studies |
Speed of onset of anaesthesia | SoF: Not measured. | 0 studies | No studies |
Adverse effects: allergy to local anaesthetic | SoF: Not measured. | 0 studies | No studies |
Duration of anaesthesia (soft tissue, simulated) | MD -33.95 [-48.05, -19.84] | 3 studies · 698 participants | Very low Downgraded: risk of bias, inconsistency, indirectness |
Adverse effects: pain on injection (solution deposition) | SoF: Not measured. | 0 studies | No studies |
Duration of anaesthesia | SoF: Not measured. | 0 studies | No studies |
Speed of onset of anaesthesia (soft tissue, simulated) | MD 0.02 [-0.10, 0.14] | 2 studies · 406 participants | Low Downgraded: risk of bias, indirectness |
Speed of onset of anaesthesia (pulpal, electric pulp tester; healthy pulps) | MD -0.96 [-2.87, 0.95] | 2 studies · 52 participants | Low Downgraded: imprecision, indirectness |
Adverse effects: paraesthesia following injection | 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 |
Success of local anaesthesia, absence of pain (clinical testing of healthy pulps, hard and soft tissues) 5-30 minutes | RR 0.86 [0.75, 0.99] 828 per 1000 vs 712 per 1000 | 2 studies · 228 participants | Low Downgraded: risk of bias, imprecision |
4% articaine, 1:200,000 epinephrine vs 0.5% bupivacaine, 1:200,000 epinephrine
Population: Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which dental local anaesthesia was tested
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Duration of anaesthesia | SoF: Not measured. | 0 studies | No studies |
Adverse effects: paraesthesia following injection | SoF: Not measured. | 0 studies | No studies |
Adverse effects: pain on injection (solution deposition) | SoF: See comment (orphan study; unclear whether data relate to just solution deposition; SDs not reported); 18 participants, 36 interventions (1 study). Not pooled/graded. | 1 study · 18 participants | Ungraded |
Adverse effects: pain following injection | SoF: Not measured. | 0 studies | No studies |
Speed of onset of anaesthesia | SoF: Not measured. | 0 studies | No studies |
Success of local anaesthesia, absence of pain (clinical testing of healthy pulps, hard and soft tissues) 10 minutes post-injection to end of clinical procedure | OR 0.87 [0.27, 2.83] 481 per 1000 vs 446 per 1000 | 2 studies · 37 participants | Low Downgraded: risk of bias, imprecision |
Speed of onset of anaesthesia (soft tissue, simulated) | MD -0.85 [-1.26, -0.44] | 2 studies · 69 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Adverse effects: allergy to local anaesthetic | SoF: Not measured. | 0 studies | No studies |
Duration of anaesthesia (soft tissue, simulated) | MD -172.61 [-239.69, -105.53] | 2 studies · 39 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
0.5% bupivacaine, 1:200,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine
Population: Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which dental local anaesthesia was tested
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects: allergy to local anaesthetic | SoF: Not measured. | 0 studies | No studies |
Adverse effects: pain following injection | SoF: Not measured. | 0 studies | No studies |
Success of local anaesthesia, absence of pain (clinical testing of healthy pulps, hard and soft tissues) 10 minutes post-injection to end of clinical procedure | OR 0.58 [0.07, 5.12] 611 per 1000 vs 477 per 1000 | 2 studies · 31 participants | Low Downgraded: risk of bias, imprecision |
Duration of anaesthesia (soft tissue, simulated) | MD 222.88 [135.99, 309.76] | 6 studies · 232 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Speed of onset of anaesthesia | 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 | Ungraded |
Adverse effects: pain on injection (solution deposition) | SoF: See comment (orphan study; unclear whether data relate to just solution deposition; SDs not reported); 18 participants, 36 interventions (1 study). Not pooled/graded. | 1 study · 18 participants | Ungraded |
Speed of onset of anaesthesia (soft tissue, simulated) | MD 0.02 [-1.07, 1.10] | 3 studies · 79 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Speed of onset of anaesthesia (pulpal, electric pulp tester; healthy pulps) | MD 3.32 [0.27, 6.37] | 2 studies · 63 participants | Low Downgraded: imprecision, indirectness |
Duration of anaesthesia | SoF: Not measured. | 0 studies | No studies |
Success of local anaesthesia (pulpal, electric pulp tester; healthy pulps) | RR 0.80 [0.62, 1.05] | 3 studies · 90 participants | Low Downgraded: imprecision, indirectness |
Success of local anaesthesia (soft tissue, self-reported; 100% success in all studies) | 'Other comparisons with 100% success': IANB - Sampaio 2012 35/35 vs 35/35; Fernandez 2005 39/39 vs 39/39. Both formulations 100% successful; no meta-analysis (no difference). | 2 studies · 74 participants | Ungraded |
Adverse effects: paraesthesia following injection | SoF: Not measured. | 0 studies | No studies |
4% articaine, 1:100,000 epinephrine vs 2% mepivacaine, 1:100,000 epinephrine
Population: Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which dental local anaesthesia was tested
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects: pain following injection | SoF: Not measured. | 0 studies | No studies |
Adverse effects: allergy to local anaesthetic | SoF: Not measured. | 0 studies | No studies |
Speed of onset of anaesthesia | SoF: Not measured. | 0 studies | No studies |
Success of local anaesthesia (soft tissue, self-reported) | RR 1.07 [0.73, 1.59] | 2 studies · 68 participants | Very low Downgraded: imprecision, inconsistency, indirectness |
Success of local anaesthesia, absence of pain (clinical testing of healthy pulps, hard and soft tissues) 10-20 minutes | OR 3.82 [0.61, 23.82] 931 per 1000 vs 996 per 1000 | 2 studies · 110 participants | Low Downgraded: risk of bias, imprecision |
Duration of anaesthesia | SoF: Not measured. | 0 studies | No studies |
Adverse effects: pain on injection (solution deposition) | SoF: See comment; 147 participants, 147 interventions (2 studies); unclear whether data relate to just solution deposition. Not pooled/graded. | 2 studies · 147 participants | Ungraded |
Adverse effects: paraesthesia following injection | SoF: Not measured. | 0 studies | No studies |
2% mepivacaine, 1:100,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine
Population: Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which dental local anaesthesia was tested
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Speed of onset of anaesthesia | SoF: Not measured. | 0 studies | No studies |
Adverse effects: pain following injection | SoF: Not measured. | 0 studies | No studies |
Success of local anaesthesia (soft tissue, self-reported; 100% success in all studies) | '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 | Ungraded |
Success of local anaesthesia, absence of pain (clinical testing of diseased pulps with irreversible pulpitis) 10-14 minutes post-injection to end of clinical procedure | RR 1.16 [0.25, 5.45] 231 per 1000 vs 268 per 1000 | 2 studies · 68 participants | Low Downgraded: imprecision, inconsistency |
Adverse effects: paraesthesia following injection | SoF: Not measured. | 0 studies | No studies |
Duration of anaesthesia | SoF: Not measured. | 0 studies | No studies |
Adverse effects: pain on injection (solution deposition) | 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 | Ungraded |
Adverse effects: allergy to local anaesthetic | SoF: Not measured. | 0 studies | No studies |
2% lidocaine, 1:50,000 epinephrine vs 2% lidocaine, 1:80,000 epinephrine
Population: Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which dental local anaesthesia was tested
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Success of local anaesthesia (pulpal, electric pulp tester; healthy pulps) | RR 0.81 [0.65, 1.01] | 2 studies · 60 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Success of local anaesthesia (soft tissue, self-reported; 100% success in all studies) | '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 | Ungraded |
2% lidocaine, 1:50,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine
Population: Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which dental local anaesthesia was tested
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Success of local anaesthesia (pulpal, electric pulp tester; healthy pulps) | RR 0.99 [0.88, 1.12] | 7 studies · 210 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Success of local anaesthesia (soft tissue, self-reported; 100% success in all studies) | '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 | Ungraded |
Speed of onset of anaesthesia (pulpal, electric pulp tester; healthy pulps) | MD -0.44 [-1.66, 0.79] | 4 studies · 92 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
2% lidocaine, 1:80,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine
Population: Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which dental local anaesthesia was tested
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Success of local anaesthesia (pulpal, electric pulp tester; healthy pulps) | RR 1.27 [1.01, 1.59] | 2 studies · 60 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
2% lidocaine, 1:200,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine
Population: Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which dental local anaesthesia was tested
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Success of local anaesthesia (pulpal, electric pulp tester; healthy pulps) | RR 0.89 [0.63, 1.26] | 3 studies · 70 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
3% mepivacaine plain vs 2% lidocaine, 1:100,000 epinephrine
Population: Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which dental local anaesthesia was tested
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Speed of onset of anaesthesia (pulpal, electric pulp tester; healthy pulps) | MD -1.23 [-2.31, -0.16] | 3 studies · 85 participants | Low Downgraded: imprecision, indirectness |
Success of local anaesthesia (soft tissue, self-reported; 100% success in all studies) | '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 | Ungraded |
Success of local anaesthesia (pulpal, electric pulp tester; healthy pulps) | RR 0.92 [0.83, 1.02] | 6 studies · 208 participants | Low Downgraded: imprecision, indirectness |
3% mepivacaine plain vs 2% lidocaine, 1:50,000 epinephrine
Population: Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which dental local anaesthesia was tested
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Success of local anaesthesia (pulpal, electric pulp tester; healthy pulps) | RR 0.97 [0.88, 1.07] | 2 studies · 70 participants | Low Downgraded: imprecision, indirectness |
Speed of onset of anaesthesia (pulpal, electric pulp tester; healthy pulps) | MD -0.56 [-1.54, 0.42] | 2 studies · 58 participants | Low Downgraded: imprecision, indirectness |
2% mepivacaine, 1:20,000 levonordefrin vs 2% lidocaine, 1:100,000 epinephrine
Population: Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which dental local anaesthesia was tested
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Duration of anaesthesia (soft tissue, simulated) | MD 4.43 [-10.63, 19.48] | 2 studies · 458 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Success of local anaesthesia (clinical; orphan data) | No data available for meta-analysis; orphan clinical success data summarized in Table 6 (e.g. clinical anaesthesia success 2% lidocaine 1:100,000 64/110 vs 2% mepivacaine 1:20,000 levonordefrin 99/113). Not… | NR | Ungraded |
4% articaine, 1:200,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine
Population: Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which dental local anaesthesia was tested
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Success of local anaesthesia (pulpal, electric pulp tester; healthy pulps) | RR 1.33 [0.33, 5.36] | 2 studies · 28 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Duration of anaesthesia (pulpal, electric pulp tester; healthy pulps) | MD 10.33 [-22.08, 42.74] | 2 studies · 40 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Speed of onset of anaesthesia (pulpal, electric pulp tester; healthy pulps) | MD 0.19 [-2.06, 2.45] | 2 studies · 40 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
4% articaine, 1:100,000 epinephrine vs 2% lidocaine, 1:80,000 epinephrine
Population: Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which dental local anaesthesia was tested
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Speed of onset of anaesthesia (soft tissue, simulated) | MD -0.78 [-1.04, -0.52] | 2 studies · 116 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Success of local anaesthesia (clinical; orphan data) | No data available for meta-analysis; orphan data summarized in Table 6. Not pooled/graded. | NR | Ungraded |
4% articaine, 1:200,000 epinephrine vs 4% prilocaine, 1:200,000 epinephrine
Population: Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which dental local anaesthesia was tested
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Success of local anaesthesia (pulpal, electric pulp tester; healthy pulps) | RR 1.15 [0.93, 1.41] | 3 studies · 97 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
4% prilocaine, 1:200,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine
Population: Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which dental local anaesthesia was tested
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Speed of onset of anaesthesia (soft tissue, simulated) | MD -0.01 [-0.14, 0.11] | 2 studies · 421 participants | Low Downgraded: risk of bias, indirectness |
Duration of anaesthesia (soft tissue, simulated) | MD -11.80 [-27.76, 4.16] | 2 studies · 533 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Speed of onset of anaesthesia (pulpal, electric pulp tester; healthy pulps) | MD -1.19 [-3.08, 0.70] | 2 studies · 39 participants | Low Downgraded: imprecision, indirectness |
Success of local anaesthesia (pulpal, electric pulp tester; healthy pulps) | RR 1.14 [0.91, 1.43] | 2 studies · 48 participants | Low Downgraded: imprecision, indirectness |
4% articaine plain vs 4% articaine, 1:100,000 epinephrine
Population: Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which dental local anaesthesia was tested
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Success of local anaesthesia (pulpal, electric pulp tester; healthy pulps) | RR 0.61 [0.38, 0.97] | 2 studies · 134 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Speed of onset of anaesthesia (pulpal, electric pulp tester; healthy pulps) | MD 0.13 [-0.54, 0.80] | 2 studies · 100 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Duration of anaesthesia (pulpal, electric pulp tester; healthy pulps) | MD -37.08 [-60.95, -13.21] | 2 studies · 100 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
4% articaine plain vs 4% articaine, 1:200,000 epinephrine
Population: Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which dental local anaesthesia was tested
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Duration of anaesthesia (pulpal, electric pulp tester; healthy pulps) | MD -28.36 [-42.06, -14.65] | 2 studies · 102 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Success of local anaesthesia (pulpal, electric pulp tester; healthy pulps) | RR 0.58 [0.33, 1.01] | 2 studies · 134 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Speed of onset of anaesthesia (pulpal, electric pulp tester; healthy pulps) | MD 0.03 [-0.66, 0.71] | 2 studies · 102 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
4% prilocaine, 1:200,000 epinephrine vs 4% prilocaine plain
Population: Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which dental local anaesthesia was tested
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Duration of anaesthesia (soft tissue, simulated) | MD 18.78 [9.02, 28.54] | 2 studies · 506 participants | Low Downgraded: risk of bias, indirectness |
Success of local anaesthesia (clinical/EPT; orphan data) | No data available for meta-analysis; data summarized in Table 5 (orphan). Not pooled/graded. | NR | Ungraded |
4% prilocaine, 1:200,000 epinephrine vs 4% articaine, 1:100,000 epinephrine
Population: Participants of any age and gender undergoing dental procedures, and volunteers who took part in simulated scenario studies in which dental local anaesthesia was tested
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Success of local anaesthesia (pulpal, electric pulp tester; healthy pulps) | RR 1.74 [1.16, 2.60] | 2 studies · 78 participants | Low Downgraded: imprecision, indirectness |
One injectable local anaesthetic formulation (a commercial preparation, dose, or concentration; infiltration or block) vs A different injectable local anaesthetic formulation, dose, concentration, or injection technique
Population: Adults (>16 years) and children undergoing dental procedures, or volunteers in experimental studies requiring dental local anaesthesia; excluding participants on regular medications altering pain perception
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Success/degree of anaesthesia (absence of pain during a procedure on a VAS or other method, or pulpal anaesthesia on an electric pulp tester) | Protocol (2007): planned outcome only; no studies included at protocol stage. | 0 studies | No studies |
Duration of anaesthesia | Protocol (2007): planned outcome only; no studies included at protocol stage. | 0 studies | No studies |
Adverse effects: local | Protocol (2007): planned outcome only; no studies included at protocol stage. | 0 studies | No studies |
Adverse effects: systemic | Protocol (2007): planned outcome only; no studies included at protocol stage. | 0 studies | No studies |
Patients' experience of the procedures (preference, overall experience) | Protocol (2007): planned outcome only; no studies included at protocol stage. | 0 studies | No studies |
Speed of onset of anaesthesia | Protocol (2007): planned outcome only; no studies included at protocol stage. | 0 studies | No studies |