Evaluation of Clinical Safety of 4% Articaine in Inferior Alveolar Nerve Block for Non-surgical Mandibular Third Molar Extractions.

Abstract

Introduction: Achieving profound local anesthesia during mandibular third molar extraction can be challenging because of dense cortical bone and anatomical variations. Articaine has gained increasing attention due to its superior tissue penetration, faster onset, and longer duration of action, but concerns regarding its potential neurotoxic effects when used in mandibular nerve blocks, remain controversial.

Method: Fifty patients aged 18-60 years were enrolled following strict inclusion and exclusion criteria, ensuring the absence of radiographic proximity of the third molar to the inferior alveolar nerve and the absence of periapical pathology. Clinical parameters, including onset and duration of anesthesia, intra-operative pain assessed using the Visual Analog Scale (VAS), and postoperative neurosensory responses, were evaluated using standardized tests (brush stroke directional discrimination, two-point discrimination, and pin-prick nociception) on days 1, 3, and 5 post-operatively.

Results: The mean onset and duration of anesthesia were 1.30 ± 0.33 min and 4.22 ± 1.09 h, respectively, and the mean intra-operative pain score was 1.10 ± 0.78. No neurosensory deficits were observed during the 5-day follow-up period; however, long-term complications cannot be excluded.

Conclusion: Within the limitations of this single-arm study without a comparator group and involving low-risk, non-surgical extractions, 4% Articaine with 1:100,000 epinephrine demonstrated effective anesthesia with no clinically detectable neurosensory impairment.