Non-Cochrane · intervention · PM40947958
Perioperative Anti-inflammatory Drugs and Recovery after Periodontal Surgery: A Systematic Review and Meta-Analysis.
Abusamak M, Elananza A, Alshdaifat I, et al. · JDR clinical and translational research · 2026 · PubMed · doi:10.1177/23800844251365539
Findings
Population Adults undergoing periodontal surgery
14 findings
| Perioperative steroidal anti-inflammatory drugs (SAIDs; dexamethasone) | Perioperative nonsteroidal anti-inflammatory drugs (NSAIDs; celecoxib, etoricoxib, lumiracoxib or ibuprofen) | Postoperative swelling (VAS 0-100) 24 h postoperatively · Periodontal surgery (crown lengthening, connective tissue graft) · Overall | MD -3.38 [-126.81, 120.04] Very low Downgraded: risk of bias, imprecision, inconsistency 2 studies · 48 participants |
| Perioperative steroidal anti-inflammatory drugs (SAIDs; dexamethasone) | Perioperative nonsteroidal anti-inflammatory drugs (NSAIDs; celecoxib, etoricoxib, lumiracoxib or ibuprofen) | Postoperative pain intensity (VAS 0-100) 7 h postoperatively · Periodontal surgery (open flap debridement, soft tissue grafting, crown lengthening, dental implant) · Overall | MD -0.01 [-0.36, 0.35] Low Downgraded: risk of bias, imprecision 4 studies · 190 participants |
| Perioperative steroidal anti-inflammatory drugs (SAIDs; dexamethasone) | Perioperative nonsteroidal anti-inflammatory drugs (NSAIDs; celecoxib, etoricoxib, lumiracoxib or ibuprofen) | Postoperative pain intensity (VAS 0-100) 2 h postoperatively · Periodontal surgery (open flap debridement, soft tissue grafting, crown lengthening, dental implant) · Overall | MD 1 [0.6, 1.39] Moderate Downgraded: risk of bias 4 studies · 190 participants |
| Perioperative steroidal anti-inflammatory drugs (SAIDs; dexamethasone) | Perioperative nonsteroidal anti-inflammatory drugs (NSAIDs; celecoxib, etoricoxib, lumiracoxib or ibuprofen) | Postoperative pain intensity (VAS 0-100) 8 h postoperatively · Periodontal surgery (open flap debridement, soft tissue grafting, crown lengthening, dental implant) · Overall | MD 0 [-0.45, 0.45] Low Downgraded: risk of bias, imprecision 5 studies · 218 participants |
| Perioperative steroidal anti-inflammatory drugs (SAIDs; dexamethasone) | Perioperative nonsteroidal anti-inflammatory drugs (NSAIDs; celecoxib, etoricoxib, lumiracoxib or ibuprofen) | Postoperative pain intensity (VAS 0-100) All timepoints combined · Periodontal surgery · Overall | MD 0.673 [0.28, 1.06] GRADE not reported Studies not reported |
| Perioperative steroidal anti-inflammatory drugs (SAIDs; dexamethasone) | Perioperative nonsteroidal anti-inflammatory drugs (NSAIDs; celecoxib, etoricoxib, lumiracoxib or ibuprofen) | Postoperative rescue medication consumption (number of pills) Postoperative (overall) · Periodontal surgery · Overall | MD 0.01 [-0.33, 0.36] Low Downgraded: risk of bias, imprecision 4 studies · 136 participants |
| Perioperative steroidal anti-inflammatory drugs (SAIDs; dexamethasone) | Perioperative nonsteroidal anti-inflammatory drugs (NSAIDs; celecoxib, etoricoxib, lumiracoxib or ibuprofen) | Postoperative pain intensity (VAS 0-100) 5 h postoperatively · Periodontal surgery (open flap debridement, soft tissue grafting, crown lengthening, dental implant) · Overall | MD 2.23 [0.7, 3.77] Moderate Downgraded: risk of bias 4 studies · 190 participants |
| Perioperative steroidal anti-inflammatory drugs (SAIDs; dexamethasone) | Perioperative nonsteroidal anti-inflammatory drugs (NSAIDs; celecoxib, etoricoxib, lumiracoxib or ibuprofen) | Postoperative pain intensity (VAS 0-100) 48 h postoperatively · Periodontal surgery (open flap debridement, soft tissue grafting, crown lengthening, dental implant) · Overall | MD -0.23 [-0.31, -0.14] Moderate Downgraded: risk of bias 4 studies · 190 participants |
| Perioperative steroidal anti-inflammatory drugs (SAIDs; dexamethasone) | Perioperative nonsteroidal anti-inflammatory drugs (NSAIDs; celecoxib, etoricoxib, lumiracoxib or ibuprofen) | Postoperative pain intensity (VAS 0-100) 3 h postoperatively · Periodontal surgery (open flap debridement, soft tissue grafting, crown lengthening, dental implant) · Overall | MD 1.98 [1.39, 2.56] Moderate Downgraded: risk of bias 4 studies · 190 participants |
| Perioperative steroidal anti-inflammatory drugs (SAIDs; dexamethasone) | Perioperative nonsteroidal anti-inflammatory drugs (NSAIDs; celecoxib, etoricoxib, lumiracoxib or ibuprofen) | Postoperative pain intensity (VAS 0-100) 24 h postoperatively · Periodontal surgery (open flap debridement, soft tissue grafting, crown lengthening, dental implant) · Overall | MD -0.39 [-2.09, 1.31] Very low Downgraded: risk of bias, imprecision, inconsistency 5 studies · 218 participants |
| Perioperative steroidal anti-inflammatory drugs (SAIDs; dexamethasone) | Perioperative nonsteroidal anti-inflammatory drugs (NSAIDs; celecoxib, etoricoxib, lumiracoxib or ibuprofen) | Postoperative pain intensity (VAS 0-100) 72 h postoperatively · Periodontal surgery (open flap debridement, soft tissue grafting, crown lengthening, dental implant) · Overall | MD 0 [-0.04, 0.03] Low Downgraded: risk of bias, imprecision 4 studies · 190 participants |
| Perioperative steroidal anti-inflammatory drugs (SAIDs; dexamethasone) | Perioperative nonsteroidal anti-inflammatory drugs (NSAIDs; celecoxib, etoricoxib, lumiracoxib or ibuprofen) | Postoperative pain intensity (VAS 0-100) 4 h postoperatively · Periodontal surgery (open flap debridement, soft tissue grafting, crown lengthening, dental implant) · Overall | MD 2.01 [1.62, 2.39] Moderate Downgraded: risk of bias 5 studies · 218 participants |
| Perioperative steroidal anti-inflammatory drugs (SAIDs; dexamethasone) | Perioperative nonsteroidal anti-inflammatory drugs (NSAIDs; celecoxib, etoricoxib, lumiracoxib or ibuprofen) | Postoperative pain intensity (VAS 0-100) 1 h postoperatively · Periodontal surgery (open flap debridement, soft tissue grafting, crown lengthening, dental implant) · Overall | MD 1 [0.73, 1.27] Moderate Downgraded: risk of bias 4 studies · 190 participants |
| Perioperative steroidal anti-inflammatory drugs (SAIDs; dexamethasone) | Perioperative nonsteroidal anti-inflammatory drugs (NSAIDs; celecoxib, etoricoxib, lumiracoxib or ibuprofen) | Postoperative pain intensity (VAS 0-100) 6 h postoperatively · Periodontal surgery (open flap debridement, soft tissue grafting, crown lengthening, dental implant) · Overall | MD 1.7 [0.21, 3.19] Moderate Downgraded: risk of bias 4 studies · 190 participants |
Included primary studies 6
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Bahammam 2017 Comparison Between Dexamethasone and Ibuprofen for Postoperative Pain Prevention and Control After Surgical Implant Placement: A… PMID:27562219 | 2017 | this review only | not stated | not extracted yet |
| Giorgetti 2018 Preemptive and Postoperative Medication Protocols for Root Coverage Combined with Connective Tissue Graft. PMID:29267519 | 2018 | this review only | not stated | not extracted yet |
| Peres 2012 Steroidal and non-steroidal cyclooxygenase-2 inhibitor anti-inflammatory drugs as pre-emptive medication in patients undergoing… PMID:23338252 | 2012 | this review only | not stated | not extracted yet |
| Pilatti 2006 The use of celecoxib and dexamethasone for the prevention and control of postoperative pain after periodontal surgery. PMID:17076604 | 2006 | this review only | not stated | not extracted yet |
| Steffens 2010 Preemptive dexamethasone and etoricoxib for pain and discomfort prevention after periodontal surgery: a double-masked, crossover,… PMID:20367520 | 2010 | this review only | not stated | not extracted yet |
| Zardo 2013 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients undergoing any type of periodontal surgery | Patients undergoing periodontal surgery (n=262; open flap debridement, crown lengthening, soft tissue grafts, dental implants) |
| Intervention | Perioperative steroidal anti-inflammatory drugs (SAIDs) | Dexamethasone 4 mg or 8 mg (SAIDs) |
| Comparison | Perioperative nonsteroidal anti-inflammatory drugs (NSAIDs) | Celecoxib, etoricoxib, lumiracoxib or ibuprofen (NSAIDs) |
| Outcomes | Postoperative pain (VAS), swelling, rescue medication consumption, adverse events | Postoperative pain VAS (6 RCTs), swelling at 24 h (2 RCTs), rescue medication consumption (4 RCTs in meta-analysis); adverse events not pooled |
| Study designs | Randomized controlled trials, crossover or parallel design | 6 RCTs (4 parallel, 2 crossover) |
| Timing | At least 1 follow-up assessment; pain at 1 to 8 h, 24, 48 and 72 h; swelling at 24 h | Pain at 1, 2, 3, 4, 5, 6, 7, 8, 24, 48 and 72 h; swelling at 24 h |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |