Articaine Enhances the Success of Profound Inferior Alveolar Nerve Block in Third Molar Surgery Performed by Dental Student: A Three-Anesthetic Observational Study

Background/Objectives: An effective inferior alveolar nerve block (IANB) is critical for mandibular third molar surgery, especially for novice student operators who face steep learning curves. This study compared the clinical efficacy and safety of 4% articaine, 2% lidocaine, and 2% mepivacaine in an undergraduate setting. Methods: A prospective observational study was conducted with 189 patients undergoing third molar surgery performed by dental students. Patients received either 4% articaine (n=69), 2% lidocaine (n=61), or 2% mepivacaine (n=59). Anesthetic efficacy was evaluated using a two-stage assessment comprising Vincent’s sign (Stage 1) and profound surgical anesthesia (Stage 2). Intra- and postoperative pain, anesthetic volume, surgical duration, and postoperative complications were recorded and compared among anesthetic groups. Results: Baseline demographics, impaction patterns, and difficulty indices did not differ significantly among groups. Stage 2 profound success rate was significantly higher with articaine (76.8%) than with lidocaine (55.7%) and mepivacaine (61.0%) (p=0.031). Articaine was also associated with a longer duration of anesthesia (261.7 vs. 164.6 and 192.6 min; p < 0.001), a lower total anesthetic volume (2.1 vs. 2.4 and 2.3 mL; p = 0.007), and significantly lower intraoperative pain scores (14.3 vs. 31.0 and 29.8 mm on the HPS; p < 0.001). Postoperative pain through Day 7 and complication rates were comparable among anesthetics, with no serious adverse events reported. Conclusions: Four percent articaine appeared to be superior to 2% lidocaine and 2% mepivacaine in student-led third molar surgery. Its high efficacy and enhanced tissue diffusion may partially compensate for technical inexperience and prolonged surgical duration, supporting its routine use to improve patient comfort and student confidence in the dental education setting.