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

Resumen

Abstract

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.