TITLE:
Intrasocket Articaine-Epinephrine on Collagen after Mandibular Third-Molar Surgery: A Technical Note and Validation Pathway
AUTHORS:
Ali R. Elyassi, Cameron Hamidi
KEYWORDS:
Articaine, Collagen, Mandibular Third Molar, Postoperative Pain, Local Drug Delivery
JOURNAL NAME:
Open Journal of Stomatology,
Vol.16 No.11,
October
30,
2026
ABSTRACT: Postoperative analgesia after mandibular third-molar surgery should remain anchored in evidence-based systemic therapy. A local carrier could provide an adjunct, but injected-articaine evidence does not validate direct socket delivery. This technical note describes a dose-defined intervention used in the authors’ practice and a staged pathway for its formal evaluation, without claiming efficacy. A sterile 10 × 20 mm absorbable collagen plug (CollaPlug®, ZimVie) is wetted with 0.85 mL (half of a 1.7-mL cartridge) of 4% articaine with 1:100,000 epinephrine, corresponding to a nominal loading of 34 mg articaine hydrochloride and 8.5 μg epinephrine. Nominal loading must be distinguished from the amounts retained by the carrier, released into the wound, and systemically absorbed. Proposed safeguards include a fresh single-dose cartridge, dedicated sterile preparation, loose coronal-to-middle socket placement, exclusion of exposed neurovascular contact, cumulative-dose accounting, and unchanged standard analgesia. Across more than 1,000 mandibular third-molar sites treated in routine practice, the authors’ clinical impression has been of minimal postoperative bleeding and pain, with no recognized paresthesia; these observations were uncontrolled and not prospectively collected, and they cannot establish efficacy or safety. The retention capacity, release profile, and local tissue compatibility of this specified combination require characterization before controlled clinical testing. Collagen is a biologically active component, and an identical saline-wetted collagen control would estimate the incremental effect of the complete articaine-epinephrine formulation, not articaine alone. A feasibility study should precede a powered efficacy trial and incorporate prospective registration, informed consent, explicit progression criteria, rescue-analgesia handling, and wound-healing surveillance. The contribution is a dose-defined, testable technique with transparent evidence boundaries, not a validated sustained-release system or an evidence-based recommendation for routine adoption.