ArticleCureus2025
Comparative Effects of 4% Articaine and 2% Lignocaine on Salivary Biomarkers of Pain and Stress in Surgical Extraction of Impacted Mandibular Third Molars: A Prospective Observational Study.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionSurgical extraction of impacted mandibular third molars is a common dental procedure associated with significant pain and stress, which can be modulated by local anesthetics. This study aimed to assess the influence of 2% lignocaine versus 4% articaine on salivary biomarkers of pain and stress in patients undergoing surgical extraction of impacted mandibular third molars. The specific objective was to measure and compare the baseline and postoperative levels of cortisol and salivary alpha-amylase (sAA), along with the pain and anxiety scores, between the two anesthetic groups. MATERIALS AND
methodsThis prospective observational study was conducted at the Department of Oral and Maxillofacial Surgery between January and December 2022. 40 patients (aged 18-40 years, American Society of Anesthesiologists (ASA) I/II) with mesioangular impacted third molars were allocated to receive 2% lignocaine (n = 20) or 4% articaine (n = 20) based on clinical practice. Baseline pain (Visual Analog Scale (VAS) <10 mm), anxiety (Modified Dental Anxiety Scale (MDAS) 5-14), and unstimulated saliva (5 mL, 8-10 AM) were assessed. Saliva was collected at baseline (T0), 1-h post injection (T1), and 24-h post extraction (T24). The cortisol (enzyme-linked immunosorbent assay) and sAA (kinetic colorimetric assay) levels were measured in salivary samples. Pain was assessed using the VAS at same time intervals. Surgical complexity was standardized and data were analyzed using independent t-tests, repeated-measures (RM) analysis of variance (ANOVA), and two-way ANOVA (p < 0.05).
resultsBaseline characteristics were comparable (p > 0.05). RM ANOVA showed significant changes over time in pain, cortisol, and sAA levels in both groups (p = 0.001). Two-way ANOVA revealed significant group effects for cortisol (p = 0.008) and sAA (p = 0.021), and interactions (cortisol: p = 0.038; sAA: p = 0.047). 4% articaine showed lower pain (16.25 ± 5.72 vs. 20.5 ± 3.68, p = 0.008), cortisol (0.15 ± 0.06 µg/dL vs. 0.24 ± 0.13 µg/dL, p = 0.009), and sAA reductions (T24-T0) (22.63 ± 8.6 units/mL vs. 45.03 ± 16.01 units/mL, p = 0.001) compared to 2% lignocaine.
conclusionCompared to 2% lignocaine, 4% articaine demonstrated superior modulation of pain and stress biomarkers, supporting its preferential use in impacted mandibular third molar extraction.
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