Revista de Odontologia da UNESP
https://revodontolunesp.com.br/article/doi/10.1590/1807-2577.20260032
Revista de Odontologia da UNESP
Original Article

Comparative assessment of pain and paresthesia using articaine and mepivacaine in mandibular third molar surgery: a split-mouth randomized clinical trial

Avaliação comparativa da dor e parestesia com o uso de articaína e mepivacaína em cirurgia de terceiro molar inferior: um ensaio clínico randomizado com boca dividida

Júlio César Silva de OLIVEIRA; Izabela Fornazari DELAMURA; Douglas Sadrac de Biagi FERREIRA; Arthur Henrique Alécio VIOTTO; Guilherme Alexandre Silva PRADO; Ana Paula Farnezi BASSI

http://dx.doi.org/10.1590/1807-2577.20260032 Rev. odontol. UNESP, vol.55, e20260032, 2026
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Abstract

Introduction: Mandibular third molar surgery may cause postoperative pain and neurosensory disturbances. The choice of local anesthetic may influence these outcomes.

Objective: To compare postoperative pain intensity and the occurrence of paresthesia following mandibular third molar surgery using 4% articaine or 2% mepivacaine as local anesthetics.

Material and method: A randomized, double-blind, split-mouth clinical trial was conducted with 30 healthy patients undergoing bilateral mandibular third molar extractions. All procedures were performed by a single surgeon. According to a randomized sequence, each patient received 2% mepivacaine on one side and 4% articaine on the contralateral side. Postoperative pain intensity was assessed at 6, 12, and 24 hours using a validated pain scale. Paresthesia was evaluated through patient questionnaires and neurosensory testing at 7 and 30 days after surgery.

Result: No cases of persistent paresthesia were observed in either group. Pain intensity did not differ significantly between anesthetic solutions at 6 or 12 hours postoperatively. However, at 24 hours, patients receiving mepivacaine reported significantly higher pain scores than those receiving articaine (p < 0.05). Both anesthetics provided adequate intraoperative anesthesia.

Conclusion: Both anesthetic solutions were safe and effective for mandibular third molar surgery. However, 4% articaine provided superior postoperative analgesia at 24 hours without increasing the risk of persistent paresthesia.

Keywords

Third molar; local anesthesia; articaine; mepivacaine; paresthesia; pain

Resumo

Introdução: A cirurgia de terceiros molares inferiores pode causar dor pós-operatória e alterações neurossensoriais. A escolha do anestésico local pode influenciar esses desfechos.

Objetivo: Comparar a intensidade da dor pós-operatória e a ocorrência de parestesia após a cirurgia de terceiros molares inferiores utilizando articaína a 4% ou mepivacaína a 2% como anestésicos locais.

Material e método: Foi realizado um ensaio clínico randomizado, duplo-cego e de desenho *split-mouth* (boca dividida) com 30 pacientes saudáveis ​​submetidos à extração bilateral de terceiros molares inferiores. Todos os procedimentos foram realizados por um único cirurgião. Seguindo uma sequência aleatória, cada paciente recebeu mepivacaína a 2% em um lado e articaína a 4% no lado contralateral. A intensidade da dor pós-operatória foi avaliada às 6, 12 e 24 horas utilizando uma escala de dor validada. A parestesia foi avaliada por meio de questionários aplicados aos pacientes e testes neurossensoriais aos 7 e 30 dias após a cirurgia.

Resultado: Não foram observados casos de parestesia persistente em nenhum dos grupos. A intensidade da dor não diferiu significativamente entre as soluções anestésicas às 6 ou 12 horas de pós-operatório. No entanto, às 24 horas, os pacientes que receberam mepivacaína relataram escores de dor significativamente mais altos do que aqueles que receberam articaína (p < 0,05). Ambos os anestésicos proporcionaram anestesia intraoperatória adequada.

Conclusão: Ambas as soluções anestésicas foram seguras e eficazes para a cirurgia de terceiros molares inferiores. Contudo, a articaína a 4% proporcionou analgesia pós-operatória superior às 24 horas, sem aumentar o risco de parestesia persistente.

Palavras-chave

Terceiro molar; anestesia local; articaína; mepivacaína; parestesia; dor

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Submitted date:
06/10/2026

Accepted date:
08/10/2026

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