Association of 4% Articaine with Profound Inferior Alveolar Nerve Block Success in Third Molar Surgery Performed by Dental Students: 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 Heft–Parker VAS pain scale (HPS); p < 0.001). Postoperative pain through Day 7 and complication rates were comparable among anesthetics, with no serious adverse events reported. Conclusions: Within the limitations of this observational study, four percent articaine was associated with higher profound IANB success rates and lower intraoperative pain observed in this cohort. These observed associations with higher success and tissue diffusion properties may mitigate the impact of novice technical variability within this cohort.