Articaine vs lidocaine

Articaine vs Lidocaine dental anesthetic

Articaine vs lidocaine – Which is better?

A JADA 2011 meta-analysis by Brandt showing what many dentists have thought for a long time….articaine works better than lidocaine.  In comparison to lidocaine, articaine is almost 4 times more likely to produce profound pupal anesthesia in some areas of the mouth.  Articaine has been shown to be superior to lidocaine for infiltration in most areas, for example supplementary infiltration of lower first molars have been shown to be about equal but lower second molars articaine is twice as effective as lidocaine Shapiro JOE 2018. The superiority of articaine for blocks is less apparent and perhaps non existent.

Comparison of articaine vs lidocaine dental anestheticStudies on blocks for articaine vs lidocaine.

Another meta-analysis shows no difference for block or maxillary infiltration.  It also found articaine to be superior in dealing with mandibular infiltration.  My thought is, if there is a difference in one area there is in all areas. However, the difference may be clinically insignificant in those other areas OR may be too small to notice in a statistical manner.  Articaine, being a smaller molecule, can absorb through bone better. Articaine can get into bone that lidocaine can not. Therefore, the mandibular infiltrations in dense bone work better and one could speculate that individuals with denser maxillary bone would have the same results.  Kung JOE 2015

Articaine block = 26% success rate adding buccal infiltration with lido goes to 37% but articaine supplemental goes to 62%.   Rogers JOE 2014

Shapiro JOE 2018 found that IANB was 25% successful. Additionally for first molars adding buccal infiltration with either lido or articaine was about the same but for second molars lidocaine was only 32% while articaine was 63%.

Meta-analysis by Santos-Sanz in JADA 2020 shows articaine to be safe and requires fewer injections and has a faster onset than other LAs.

PDL injection of articaine vs lidocaine

All anesthetics should work very close to equally as well for a PDL injection and Aggarwal JOE 2019 found that articaine and lidocaine work statistically similar for the PDL injection. However, it is best to use a lower epinephrine anesthetic. This will help to avoid tissue sloughing from necrosis resulting from the temporary loss of blood supply. Similar results will be had on the hard palate. We recommend using 1:200k epi articaine for pdl injections.

Tissue necrosis from pdl injection or lingual injection
This is likely from a straight lingual injection into the attached gingiva but similar lesions can result from pdl injections with 1:100k epi.

Toxicity of articaine vs lidocaine

The only neurotoxicity test I have ever seen that shows 2% lidocaine to be more neurotoxic than 4% articaine. Albalawi 2018 Anesthesia Progress

The issue has been brought up in court and shot down. This case also shows that consent for paresthesia due to a block is unnecessary.

Other anesthetic comparisons

A list of most of the dental anesthetics used today can be found on my dental anesthetics page.