Articaine versus lidocaine for local anesthesia in pediatric dental procedures: an umbrella review of systematic reviews and meta-analyses

Articaine has been proposed as an alternative to lidocaine for local anesthesia in pediatric dentistry. Several systematic reviews have compared articaine with lidocaine in children; however, their conclusions vary by procedure, injection technique, outcome scale, and safety definition. We conducted an umbrella review of systematic reviews, with or without meta-analyses, comparing articaine and lidocaine in pediatric dental procedures. PubMed, Embase, and the Cochrane Library were searched without a lower date restriction until June 22, 2026. The study protocol was prospectively registered in PROSPERO (CRD420261430185). Eligible reviews included children or adolescents undergoing dental procedures and directly compared the efficacy and safety outcomes of articaine with those of lidocaine. Methodological quality was assessed using the A MeaSurement Tool to Assess Systematic Reviews 2, risk of bias with Risk Of Bias In Systematic reviews, certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation approach, and primary study overlap with the corrected covered area. Twenty records remained after removal of duplicates. Eleven full-text reports were assessed, and eight systematic reviews were included. Six reviews were rated as low and two as critically low confidence using the A MeaSurement Tool to Assess Systematic Reviews 2. Six systematic reviews had a low risk of bias, and two had a high risk of bias. Across eight reviews, 21 unique primary studies generated 55 occurrences, yielding a corrected covered area of 23.1%, indicating very high overlap. Articaine is generally comparable to lidocaine and may provide minor advantages in selected infiltration-based procedures. Safety-focused reviews found no significant difference in overall adverse events between articaine and lidocaine. The outcome-level certainty was low or very low, mainly due to risks of bias, inconsistency, indirectness, imprecision, and concerns about publication bias. Primary study overlap was very high and was considered separately when assessing the independence of the review-level conclusions. Current review-level evidence suggests that articaine is a reasonable alternative to lidocaine for pediatric dental local anesthesia and may offer modest advantages in selected infiltration-based procedures but does not establish universal clinical superiority. The short-term safety appears broadly comparable in available pediatric trials, although rare adverse events and their use in very young children remain insufficiently studied.