For third molar surgery, articaine seems to be the best option for optimal anesthesia when the primary distress of the patient/dentist is intraoperative comfort. But, bupivacaine seems to be a better option if the patient/dentist is most concerned about postoperative pain alleviation.

A study was carried out for determining hemodynamic, anesthetic, and analgesic effects of two  anesthetic solutions (bupivacaine and articaine) during extraction of bilaterally symmetrical impacted third molars.

In this randomized triple-blind trial, 26 people (mean age 22.1 years) who underwent the removal of third molars were randomized to either the bupivacaine group or articaine group in a split-mouth design. Postoperative pain, the total amount of solution utilized, hemodynamic parameters, anesthetic action, intraoperative bleeding, intraoperative comfort, duration of postsurgery anesthesia and analgesia, and rescue analgesic usage were examined.

The articaine group exhibited a prompt onset of anesthetic activity, better intraoperative comfort, and minimized need for the local anesthetic solution. On the other hand, the bupivacaine group exhibited a considerably longer duration of postsurgery anesthesia and analgesia, besides reduced visual analog scale (VAS) values at six and forty-eight hours after surgery.

In terms of hemodynamics, intraoperative bleeding, and rescue analgesic medication usage, no profound differences were noted between bupivacaine and articaine.

In patients undergoing third molar surgery, articaine displayed superiority over bupivacaine in terms of intraoperative anesthesia, intraoperative comfort, onset of anesthetic action, and the total amount of anesthetic solution utilized. But, bupivacaine was better in terms of postsurgery anesthesia. It improved duration of postsurgery anesthesia and analgesia while mitigating postsurgery pain.