Efficacy comparison of articaine versus lidocaine in dental anesthesia: a meta-analysis of randomized controlled trials

Despite widespread use of articaine and lidocaine, their comparative efficacy remains debated. A systematic search of PubMed, Web of Science, Cochrane Library, and Embase was conducted through July 2025. Outcomes were stratified by anesthesia technique: infiltration anesthesia and nerve block anesthesia. Primary outcomes included anesthetic onset time, anesthetic duration, pain intensity (Visual Analog Scale, VAS), and anesthetic success rate. Continuous variables were expressed as mean differences (MD) with 95% confidence intervals (CI). For dichotomous outcomes, risk ratio (RR) with 95%CI were computed. Thirty-six randomized controlled trials (RCTs) with 3,088 cases were included. In infiltration anesthesia, articaine showed shorter onset (MD = − 1.34 min; 95%CI [-2.21, -0.47]; P = 0.002; I²=98%; Low certainty), longer duration (MD = 18.68 min; 95%CI [3.05, 34.30]; P = 0.02; I²=97%; Moderate certainty), and lower pain scores (MD = − 4.41; 95%CI [-7.62, -1.21]; P = 0.007; I²=63%; Moderate certainty) than lidocaine, with no significant difference in anesthetic success rate (RR = 1.03; 95%CI [0.98, 1.08]; P = 0.30; I²=15%; Moderate certainty). In nerve block anesthesia, articaine showed shorter onset (MD = − 0.27 min; 95%CI [-0.40, -0.13]; P < 0.001; I²=69%; Moderate certainty) and longer duration (MD = 53.63 min; 95%CI [29.64, 77.62]; P < 0.001; I²=96%; High certainty) than lidocaine, while the two anesthetics performed similarly in terms of pain intensity (MD = 1.13; 95%CI [− 0.49, 2.75]; P = 0.17; I²=0%; Moderate certainty) and anesthetic success rate (RR = 1.06; 95%CI [0.90, 1.24]; P = 0.49; I²=33%; Low certainty). Subgroup analyses indicated that, for infiltration anesthesia, articaine had shorter onset time (P < 0.001) and longer duration (P = 0.003) in premolars, and lower pain scores in molars (P < 0.001) compared with lidocaine. For nerve block, conventional-dose articaine had shorter onset time (P = 0.02) and longer duration (P < 0.001) than lidocaine, while high-dose articaine showed no difference in duration (P = 0.07), and the direction of key findings was consistent when stratified by study methodological quality (SCI-indexed journals vs. non-SCI-indexed journals). Compared with lidocaine, articaine was associated with slightly faster onset and longer anesthetic duration in both infiltration and nerve block anesthesia, and with lower pain scores in infiltration anesthesia. However, anesthetic success rates were comparable between the two agents across techniques and subgroups. CRD420251110177