Does the Use of 4% Articaine and 1:100,000 Adrenaline, Rather Than 2% Lidocaine and 1:100,000 Adrenaline, Increase the Risk of Nerve Damage When Administered for Inferior Alveolar Nerve Blocks in Patients Undergoing Local Anaesthesia for Dental Treatment? A Mini Systematic Review of The Literature

Abstract

This mini systematic review seeks to analyse the available literature and determine if a 4% articaine solution poses a greater risk of inferior alveolar and/or lingual nerve damage compared to that of 2% lidocaine when administered for an inferior alveolar nerve block.
After a mini systematic review search of the published literature, seven suitable studies were identified, one double blind random controlled trial (DBRCT) and six retrospective cohort studies.
The DBRCT and 2 of the cohort studies concluded that 4% articaine poses no greater risk of nerve damage.
The remaining 4 cohort studies suggested that caution should be exhibited when using a 4% local anaesthetic solution rather than a 2% solution. However, these studies also concluded that no evidence exists to explain the reasons for their results.
The included articles present no conclusive evidence to suggest that 4% articaine causes more nerve damage than 2% lidocaine although some authors advise caution when using this agent.
All studies conclude that further quality research is required and it is therefore suggested that dental practitioners exhibit caution when choosing to use 4% articaine in an inferior alveolar nerve block until further scientific research has been performed