Revista de Odontologia da UNESP
https://revodontolunesp.com.br/article/doi/10.1590/1807-2577.00925
Revista de Odontologia da UNESP
Original Article

Comparison of the anesthetic effect of bupivacaine and articaine in third molar extractions: a split-mouth randomized controlled trial

Comparação do efeito anestésico da bupivacaína e da articaína em extrações de terceiros molares: um ensaio clínico randomizado e controlado em modelo de boca dividida

Samara de Souza SANTOS; Gustavo Barcellos LIMA; Mariana da Silva BONATTO; Pedro Gomes Junqueira MENDES; Davisson Alves PEREIRA; Guilherme José Pimentel Lopes de OLIVEIRA

http://dx.doi.org/10.1590/1807-2577.00925 Rev. odontol. UNESP, vol.54, e20250009, 2025
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Abstract

Introduction: The extraction of third molars is one of the most frequently performed surgical procedures in dentistry and requires effective anesthesia for adequate pain control. Among the local anesthetics used, articaine and bupivacaine stand out for their differences in onset of action, duration, and analgesic profile. Comparing these agents may contribute to selecting the most appropriate protocol for oral surgeries.

Objective: This split-mouth randomized controlled trial aimed to compare the anesthetic effectiveness of Bupivacaine and Articaine in third molar extraction.

Material and method: Thirty-two patients underwent extraction of all four third molars after approval by the Research Ethics Committee of the Federal University of Uberlândia. Each patient received two different anesthetic agents: one side with Bupivacaine 0.5% plus epinephrine (1:200,000) and the other with 4% Articaine plus epinephrine (1:100,000). Anesthesia was administered using three cartridges per hemi-arch to achieve analgesia in both upper and lower third molars. Variables analyzed included the need for anesthetic supplementation, onset and duration of anesthesia, and pain intensity assessed with the Visual Analog Scale (VAS) during and after surgery.

Result: Articaine showed a significantly faster onset and shorter duration of anesthesia compared to Bupivacaine (p < 0.05). Despite this, the number of supplementary anesthetic cartridges required was similar for both groups. Patients reported significantly higher postoperative pain on the side anesthetized with Bupivacaine (p < 0.05).

Conclusion: In conclusion, Articaine provides quicker onset and better intraoperative pain control, while Bupivacaine offers a prolonged postoperative anesthetic effect.

Keywords

Anesthesia; pain management; third molar; bupivacaine; articaine

Resumo

Introdução: A extração de terceiros molares é um dos procedimentos cirúrgicos mais executados na odontologia e exige anestesia eficaz para controle adequado da dor. Entre os anestésicos locais utilizados, a articaína e a bupivacaína se destacam por suas diferenças no início de ação, duração e perfil analgésico. Comparar essas substâncias pode contribuir para a escolha do protocolo mais adequado em cirurgias orais.

Objetivo: Este ensaio clínico randomizado do tipo boca dividida teve como objetivo comparar a eficácia anestésica da bupivacaína e da articaína em exodontias de terceiros molares.

Material e método: Trinta e dois pacientes foram submetidos à extração dos quatro terceiros molares, após aprovação pelo Comitê de Ética em Pesquisa da Universidade Federal de Uberlândia. Cada paciente recebeu dois agentes anestésicos diferentes: um lado com bupivacaína a 0,5% associada à epinefrina (1:200.000) e o outro lado com articaína a 4% associada à epinefrina (1:100.000). A anestesia foi realizada com a administração de três tubetes por hemi-arco, visando a obtenção de analgesia nos terceiros molares superiores e inferiores. As variáveis analisadas incluíram a necessidade de suplementação anestésica, o tempo de latência e a duração da anestesia, bem como a intensidade da dor avaliada por meio da Escala Visual Analógica (EVA) durante e após o procedimento cirúrgico.

Resultado: A articaína apresentou início de ação significativamente mais rápido e menor duração anestésica em comparação à bupivacaína (p < 0,05). Apesar disso, o número de tubetes suplementares necessários foi semelhante entre os grupos. Os pacientes relataram intensidade de dor pós-operatória significativamente maior no lado anestesiado com bupivacaína (p < 0,05).

Conclusão: Conclui-se que a articaína proporciona início de ação mais rápido e melhor controle da dor intraoperatória, enquanto a bupivacaína oferece um efeito anestésico prolongado no pós-operatório.

Palavras-chave

Anestesia; controle da dor; terceiro molar; bupivacaína; articaína

References

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Submitted date:
04/29/2025

Accepted date:
05/26/2025

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