Does the Use of Articaine Increase the Risk of Hypesthesia in Lower Third Molar Surgery? A Systematic Review and Meta-Analysis

Abstract

Purpose: The aim of this study was to assess the risk of hypesthesia with the use of articaine in comparison with other local anesthetics in lower third molar surgery, through a systematic review and meta-analysis.

Methods: MEDLINE/PubMed, EMBASE, Cochrane Library (CENTRAL), Web of Science, and SCOPUS databases were searched. Gray literature and manual searches were also performed.

Results: Altogether 342 articles were found; only 13 met the eligibility criteria. A total of 886 third molars were removed; 436 using articaine, 430 using other local anesthetics, and 20 using an anesthetic mixture. Altogether 5 cases of hypesthesia were found in the articaine group, with 4 temporary and 1 with no mention of nerve involved; there was no case of permanent confirmed hypesthesia. A total of 9 articles demonstrated a low risk of bias, and 4 articles showed some concern. The meta-analysis demonstrated a 3.96 relative risk for hypesthesia with the use of articaine compared with other local anesthetics, but this result was not statistically significant. The heterogeneity of the studies was low from a clinical, methodological, and statistical point of view.

Conclusions: Thus, this systematic review and meta-analysis suggests that the use of articaine does not increase the risk of hypesthesia compared with other local anesthetics in lower third molar extraction, and when present, this complication is temporary.