Buffered 4% Articaine Reduces Pain and Enhances Anesthesia in Maxillary Third Molar Extractions: A Randomized, Double-Blind Split-Mouth Study

<b>Background/Objectives</b>: Buffered local anesthetics are suggested to enhance patient comfort and anesthetic efficacy during dental procedures. However, their advantages over non-buffered solutions in maxillary third molar extractions remain under-investigated. This prospective, randomized, double-blind, split-mouth study aimed to compare the efficacy of buffered versus non-buffered 4% articaine in terms of pain, anesthetic onset, and the duration of anesthesia during maxillary third molar extractions. <b>Methods</b>: Each participant randomly received two buccal infiltrations on two single appointments to extract maxillary third molars: one with 4% articaine buffered with sodium bicarbonate and the other with non-buffered 4% articaine. Pain during injection, post-extraction pain, onset time, and the duration of anesthesia were assessed using a visual analog scale (VAS; 0-10). <b>Results</b>: Fifty adult participants (23 males and 27 females) with a mean age of 21.6 years were included in the study. Buffered 4% articaine significantly reduced injection pain (mean VAS: 3.12 ± 1.36 vs. 4.2 ± 0.3, <i>p</i> = 0.0001) and post-extraction pain (mean VAS: 4.4 ± 1.75 vs. 5.76 ± 1.78, <i>p</i> = 0.0002) compared to non-buffered articaine. Additionally, buffered articaine demonstrated a faster onset of anesthesia (mean time (seconds): 85.92 ± 27.37 vs. 126.86 ± 33.15, <i>p</i> < 0.0001) and a longer duration of anesthesia (mean duration (minutes): 70.4 ± 13.64 vs. 51.4 ± 7.2, <i>p</i> < 0.0001). Regarding gender's factor, the comparisons revealed no statistically significant differences (<i>p</i> < 0.05) in pain perception between males and females for either injection pain or post-extraction pain. <b>Conclusions</b>: Buffered 4% articaine provides superior anesthetic efficacy compared to non-buffered 4% articaine, enhancing patient comfort by reducing pain, accelerating onset, and prolonging the duration of anesthesia during maxillary third molar extractions.