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

Abstract

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.