ReviewJournal of clinical and experimental dentistry2026
Cardiovascular Effects of 4% Articaine with 1:100,000 versus 1:200,000 Epinephrine during Inferior Alveolar Nerve Block: A Prospective Randomized Double-Blind Clinical Study.
Review in Journal of clinical and experimental dentistry, 2026. 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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Authors and funding
6 authors.
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Abstract
Background: Local anesthetic solutions containing epinephrine are widely used in oral surgery to prolong anesthesia and improve hemostasis; however, their sympathomimetic effects may influence cardiovascular parameters. Evidence comparing different epinephrine concentrations in articaine during third-molar surgery remains limited. This randomized clinical trial compared the cardiovascular effects and clinical performance of 4% articaine with epinephrine 1:100,000 (A100) and 1:200,000 (A200) during mandibular third-molar extraction. Material and Methods: A prospective, randomized, split-mouth, double-blind clinical trial was conducted in 40 healthy patients undergoing bilateral impacted mandibular third-molar extraction. Each participant received A100 on one side and A200 on the contralateral side in randomized order with a 15-day interval. Heart rate (HR), blood pressure (BP), and oxygen saturation (SpO2) were recorded at baseline, immediately after injection, and at 5 and 15 minutes. Intraoperative bleeding, pain (VAS), and need for supplemental anesthesia were also assessed. Paired statistical tests were applied ( = 0.05). Results: Eighty procedures were analyzed. Intraoperative bleeding incidence was similar between A100 (10%) and A200 (12.5%) (p = 1.000). Supplemental anesthesia was required in 3.8% of procedures, with no difference between concentrations (p = 1.000). HR increased with both formulations but was significantly higher with A100 at 5 and 15 minutes (p = 0.035 and p = 0.003). BP showed no significant differences at any time point. SpO2 remained within normal limits, with slightly higher values for A200 at intermediate times. Pain scores did not differ significantly. Conclusions: Both epinephrine concentrations in 4% articaine provided comparable anesthetic efficacy and hemostasis with minimal cardiovascular effects in healthy patients undergoing mandibular third-molar extraction. The 1:200,000 concentration produced a smaller heart-rate increase, suggesting a potential advantage in patients with cardiovascular risk, while 1:100,000 remains suitable when greater vasoconstriction is desired.
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