Eficácia clínica de anestésicos locais em exodontia de terceiros molares: Uma série de estudos, controlados, randomizados em modelo de boca dividida

Abstract

This study compared the anesthetic efficacy of 4% articaine with epinephrine (1:100,000) to 2% lidocaine with epinephrine (1:100,000), 2% mepivacaine with epinephrine (1:100,000), and 0.5% bupivacaine with epinephrine (1:200,000) in third molar extractions. This series of randomized, controlled clinical trials using a split-mouth design included 128 patients who underwent extraction of all four third molars, with articaine serving as the reference anesthetic in each comparison. Patients were allocated into three comparison groups: 60 for articaine versus lidocaine, 32 for articaine versus bupivacaine, and 36 for articaine versus mepivacaine. Outcomes evaluated included onset and duration of anesthesia, trans- and postoperative pain (measured by VAS), and the need for anesthetic supplementation. Articaine demonstrated a significantly faster onset of action compared to the other anesthetics (p < 0.05). Bupivacaine showed a longer duration of anesthetic effect; however, patients reported greater discomfort during the procedure. The need for supplementation was lower on the side anesthetized with articaine (p < 0.05) compared to the other agents, although no significant differences were observed in pain perception among groups. No adverse effects were reported in any of the patients. Articaine was the best-performing anesthetic, providing rapid onset, adequate duration, and reduced need for supplementation in third molar surgeries.