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Endodontics Supporting Your Practice

Articaine versus lidocaine for irreversible pulpitis treatment: A systematic review and meta-analysis of randomised controlled trials

This summary is based on the article published in the Australian Journal of Endodontics titled: Efficacy and safety of articaine versus lidocaine for irreversible pulpitis treatment: A systematic review and meta-analysis of randomised controlled trials (April 2016)

Naichuan Su, PhD; Chunjie Li, PhD; Hang Wang, PhD; Jiefei Shen, PhD; Wenjia Liu, PhD; and Liang Kou, MD

Read and Download the full-text version of the article courtesy of Wiley Publishing


Irreversible pulpitis (IP), which is a severe damage to the pulp via bacteria in the vital dental pulp, would cause necrosis or death to pulp tissues, and thus leads to very intolerable severe spontaneous pain and forces patients to seek immediate treatment (1). However, pain is a common phenomenon in dental treatments, so the management of pain and anxiety in dental treatment is associated with patients’ trust in their dentists (2). More than half of Americans avoid dental treatments because of fear of pain (3). Pain caused by dental treatment can be controlled with local anaesthetics and techniques that manage and reduce anxiety and increase a patient’s trust (4). Local anaesthesia seems to be of great importance in endodontic treatments.

Purpose of the Review

To assess the efficacy and safety of articaine compared with lidocaine for irreversible pulpitis (IP) treatment.

Key Messages

  • A summary of the clinical evidence concludes that 4% articaine with 1:100 000 epinephrine is superior in increasing the success rate of local anaesthesia and pain control at the injection phase and treatment phase.
  • This solution also results in shorter onset time of pulpal anaesthesia and is superior in decreasing the percentage of patients undergoing adverse events compared with 2% lidocaine with 1:100 000 epinephrine.


  1. Li C, Yang X, Ma X, Li L, Shi Z. Preoperative oral nonsteroidal anti-inflammatory drugs for the success of the inferior alveolar nerve block in irreversible pulpitis treatment: a systematic review and meta-analysis based on randomized controlled trials. Quintessence Int 2012; 43: 209–19.
  2. Cohen S, Burns RC. Pathways of the pulp. 7th ed. Saint Louis, MO: Mosby; 2004.
  3. Peretz B, Moshonov J. Dental anxiety among patients undergoing endodontic treatment. J Endod 1998; 24:435–7.
  4. Scott DS, Hirschman R. Psychological aspects of dental anxiety in adults. J Am Dent Assoc 1982; 104: 27–31.

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