Non-Cochrane · systematic review · PM42233242
Comparative efficacy and safety of bupivacaine versus articaine in third molar surgery: a systematic review and meta-analysis of randomized controlled trials.
Zeng Zhimei, Wang Linlin, Ding Guanfu, et al. · Acta odontologica Scandinavica · 2026 · PubMed · doi:10.2340/aos.v85.45787
Findings
Population Patients undergoing third molar surgery
41 findings
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Postoperative pain score (VAS, 0 to 10) 72 h · Assessment time point: 72 h | MD -0.02 [-0.54, 0.5] GRADE not reported 2 studies · 88 participants |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Onset time of anesthesia (min) Sensitivity analysis omitting Tokuc (2021) | MD 0.87 [0.42, 1.32] GRADE not reported 4 studies |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Duration of postoperative anesthesia (min) Sensitivity analysis omitting Gregorio (2008) | MD 250.57 [151.46, 349.67] GRADE not reported 2 studies |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Surgical difficulty score (1 to 3) | MD 0.02 [-0.04, 0.09] Low Downgraded: risk of bias, imprecision 3 studies · 158 participants |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Duration of soft tissue anesthesia (min) Sensitivity analysis omitting Pellicer-Chover (2013) | MD 165.34 [56.05, 274.63] GRADE not reported 3 studies |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Duration of soft tissue anesthesia (min) Sensitivity analysis omitting Tenglikar (2022) | MD 159.96 [42.14, 277.79] GRADE not reported 3 studies |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Duration of postoperative anesthesia (min) | MD 183.03 [47.42, 318.65] Very low Downgraded: risk of bias, inconsistency 3 studies · 158 participants |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Time to first rescue analgesia (h) | MD 5.13 [-15.58, 25.85] Very low Downgraded: risk of bias, imprecision, inconsistency 2 studies · 54 participants |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Onset time of anesthesia (min) Sensitivity analysis omitting Tenglikar (2022) | MD 0.85 [0.36, 1.35] GRADE not reported 4 studies |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Duration of postoperative anesthesia (min) Sensitivity analysis omitting Kaur (2024) | MD 122.16 [-4.27, 248.6] GRADE not reported 2 studies |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Onset time of anesthesia (min) | MD 0.74 [0.36, 1.12] Very low Downgraded: risk of bias, inconsistency 5 studies · 269 participants |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Postoperative pain score (VAS, 0 to 10) 12 h · Assessment time point: 12 h | MD -0.43 [-1.12, 0.25] GRADE not reported 6 studies · 291 participants |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Systolic blood pressure (mmHg) | MD 0.58 [-2.75, 3.9] Low Downgraded: risk of bias, imprecision 5 studies · 274 participants |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Onset time of anesthesia (min) Sensitivity analysis omitting Trullenque-Eriksson (2011) | MD 0.74 [0.33, 1.14] GRADE not reported 4 studies |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Intraoperative bleeding score (1 to 3) | MD 0.05 [-0.01, 0.11] Low Downgraded: risk of bias, imprecision 3 studies · 158 participants |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Postoperative pain score (VAS, 0 to 10) 4 h · Assessment time point: 4 h | MD -2.59 [-3.41, -1.77] Low Downgraded: risk of bias, imprecision 2 studies · 79 participants |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Operative time (min) | MD 2.1 [1.52, 2.69] Low Downgraded: risk of bias, imprecision 4 studies · 208 participants |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Postoperative pain score (VAS, 0 to 10) 8 h · Assessment time point: 8 h | MD -1.02 [-1.97, -0.07] GRADE not reported 2 studies · 79 participants |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Diastolic blood pressure (mmHg) | MD 2.31 [0.19, 4.43] Low Downgraded: risk of bias, imprecision 4 studies · 238 participants |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Postoperative pain score (VAS, 0 to 10) 10 h · Assessment time point: 10 h | MD -1.14 [-2.19, -0.09] GRADE not reported 2 studies · 79 participants |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Duration of soft tissue anesthesia (min) | MD 137.2 [47.22, 227.18] Very low Downgraded: risk of bias, inconsistency 4 studies · 220 participants |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Duration of soft tissue anesthesia (min) Sensitivity analysis omitting Trullenque-Eriksson (2011) | MD 130.48 [17.13, 243.84] GRADE not reported 3 studies |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Duration of soft tissue anesthesia (min) Sensitivity analysis omitting Kaur (2024) | MD 76.47 [61.61, 91.32] GRADE not reported 3 studies |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Need for rescue analgesia | OR 1.24 [0.73, 2.1] Low Downgraded: risk of bias, imprecision 3 studies · 224 participants |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Duration of postoperative anesthesia (min) Sensitivity analysis omitting Tokuc (2021) | MD 178.77 [-48.19, 405.73] GRADE not reported 2 studies |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Duration of postoperative analgesia (min) Sensitivity analysis omitting Gregorio (2008) | MD 99.65 [-23.13, 222.43] GRADE not reported 4 studies |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Duration of postoperative analgesia (min) | MD 91.22 [-5.13, 187.57] Very low Downgraded: risk of bias, imprecision, inconsistency 5 studies · 287 participants |
| Bupivacaine (0.5%) local anesthesia | Articaine (4%) local anesthesia | Postoperative pain (VAS 0-10) 96 hours · Postoperative assessment timepoint | MD -0.74 [-1.40, -0.08] GRADE not reported 1 study · 36 participants |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Onset time of anesthesia (min) Sensitivity analysis omitting Kaur (2024) | MD 0.5 [0.41, 0.58] GRADE not reported 4 studies |
| Bupivacaine (0.5%) local anesthesia | Articaine (4%) local anesthesia | Postoperative pain (VAS 0-10) 168 hours · Postoperative assessment timepoint | MD -0.08 [-0.78, 0.62] GRADE not reported 1 study · 52 participants |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Postoperative pain score (VAS, 0 to 10) 2 h · Assessment time point: 2 h | MD -1.38 [-2.27, -0.49] GRADE not reported 3 studies · 151 participants |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Postoperative pain score (VAS, 0 to 10) 24 h · Assessment time point: 24 h | MD -0.46 [-0.86, -0.05] Low Downgraded: risk of bias, inconsistency 8 studies · 363 participants |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Postoperative pain score (VAS, 0 to 10) 48 h · Assessment time point: 48 h | MD -0.17 [-0.87, 0.52] GRADE not reported 5 studies · 205 participants |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Duration of postoperative analgesia (min) Sensitivity analysis omitting Kaur (2024) | MD 32.67 [3.36, 61.98] Low Downgraded: risk of bias, imprecision 4 studies |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Duration of postoperative analgesia (min) Sensitivity analysis omitting Tokuc (2021) | MD 89.14 [-31.47, 209.74] GRADE not reported 4 studies |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Duration of postoperative analgesia (min) Sensitivity analysis omitting Tenglikar (2022) | MD 111.4 [-3.17, 225.98] GRADE not reported 4 studies |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Heart rate (bpm) | MD 1.19 [-1.7, 4.07] Low Downgraded: risk of bias, imprecision 5 studies · 274 participants |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Postoperative pain score (VAS, 0 to 10) Immediately after surgery · Assessment time point: Immediately after surgery | MD -0.05 [-0.22, 0.11] GRADE not reported 2 studies · 107 participants |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Duration of postoperative analgesia (min) Sensitivity analysis omitting Pellicer-Chover (2013) | MD 111.9 [-2.11, 225.9] GRADE not reported 4 studies |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Onset time of anesthesia (min) Sensitivity analysis omitting Pellicer-Chover (2013) | MD 0.67 [0.25, 1.1] GRADE not reported 4 studies |
| Bupivacaine 0.5% local anesthetic | Articaine 4% local anesthetic | Postoperative pain score (VAS, 0 to 10) 6 h · Assessment time point: 6 h | MD -0.65 [-1.84, 0.53] GRADE not reported 6 studies · 291 participants |
Included primary studies 11
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Aggarwal 2017 Comparative Evaluation of Anesthetic Efficacy of 2% Lidocaine, 4% Articaine, and 0.5% Bupivacaine on Inferior Alveolar Nerve Block in… PMID:28437508 | 2017 | 1 other review | not stated | not extracted yet |
| Abdulwahab 2009 The efficacy of six local anesthetic formulations used for posterior mandibular buccal infiltration anesthesia. PMID:19654255 | 2009 | this review only | not stated | not extracted yet |
| Ahmed 2021 Evaluation of the Prehospital Index, presence of high-velocity impact and judgment of emergency medical technicians as criteria for trauma… PMID:20219158 | 2010 | this review only | not stated | not extracted yet |
| Gregorio 2008 A comparison of the clinical anesthetic efficacy of 4% articaine and 0.5% bupivacaine (both with 1:200,000 epinephrine) for lower third… PMID:18420431 | 2008 | this review only | not stated | not extracted yet |
| Kaur 2024 Evaluation of Anesthetic Efficacy of 4% Articaine, 0.5% Bupivacaine and 0.5% Ropivacaine During Surgical Removal of Impacted Mandibular… PMID:38911429 | 2024 | this review only | not stated | not extracted yet |
| Olmedo-Gaya 2018 Double-blind, randomized controlled clinical trial on analgesic efficacy of local anesthetics articaine and bupivacaine after impacted… PMID:29450738 | 2018 | this review only | not stated | not extracted yet |
| Pellicer-Chover 2013 Comparative split-mouth study of the anesthetic efficacy of 4% articaine versus 0.5% bupivacaine in impacted mandibular third molar… PMID:24455059 | 2013 | this review only | not stated | not extracted yet |
| Sancho-Puchades 2012 Bupivacaine 0.5% versus articaine 4% for the removal of lower third molars. A crossover randomized controlled trial. PMID:22143739 | 2012 | this review only | not stated | not extracted yet |
| Tenglikar 2022 A Comparative Evaluation of Anesthetic Effectiveness of 4% Articaine vs 0.5% Bupivacaine for Lower Molar Tooth Extraction. PMID:36654637 | 2022 | this review only | not stated | not extracted yet |
| Tokuc 2021 Comparison of the effects of articaine and bupivacaine in impacted mandibular third molar tooth surgery: a randomized, controlled trial. PMID:34909475 | 2021 | this review only | not stated | not extracted yet |
| Trullenque-Eriksson 2011 Comparative study of two local anesthetics in the surgical extraction of mandibular third molars: bupivacaine and articaine. PMID:21196829 | 2011 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
| Review | Shared studies | Jaccard |
|---|---|---|
| Efficacy comparison of articaine versus lidocaine in dental anesthesia: a meta-analysis of randomized controlled trials. (2026) | 1 | 0.02 |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients undergoing third molar surgery | Patients undergoing third molar surgery, mostly young adults (n=749) |
| Intervention | Bupivacaine local anesthetic | Bupivacaine 0.50% (n=367) |
| Comparison | Articaine local anesthetic | Articaine 4% (n=382) |
| Outcomes | Postoperative pain (VAS), duration of postoperative analgesia, need for rescue analgesia, time to first rescue analgesia; onset time, duration of anesthesia, operative time, surgical difficulty, bleeding, hemodynamic parameters | Postoperative pain at 12 timepoints, rescue analgesia, time to first rescue analgesia, durations of analgesia, anesthesia and soft tissue anesthesia, onset time, bleeding, operative time, surgical difficulty, SBP, DBP, heart rate |
| Study designs | Randomized controlled trials | 11 RCTs (double or triple blind) |
| Timing | Not specified | Immediately after surgery to 168 hours |