Non-Cochrane · intervention · PM41588508
Efficacy and safety of single-dose oral postoperative medications in reducing pain after endodontic treatment: a systematic review and meta-analysis.
Kelidari Kimia, Samani Dorsa · BMC oral health · 2026 · PubMed · doi:10.1186/s12903-025-07458-1
Findings
Population Patients undergoing non-surgical endodontic (root canal) treatment
45 findings
| Single-dose oral Diclofenac + Acetaminophen after root canal treatment | Placebo | Postoperative pain (VAS) at 6-8 h 6-8 h after treatment | MD -6.28 [-11.99, -0.56] Moderate Downgraded: inconsistency 1 study |
| Single-dose oral Diclofenac + Acetaminophen after root canal treatment | Placebo | Postoperative pain (VAS) at 24 h 24 h after treatment | MD 0.50 [-11.36, 12.36] Low Downgraded: imprecision, inconsistency 1 study |
| Single-dose oral Diclofenac + Acetaminophen after root canal treatment | Placebo | Postoperative pain (VAS) at 24 h 24 h after treatment · Sensitivity analysis excluding Islam et al | MD 0.50 [-11.30, 12.30] GRADE not reported Studies not reported |
| Single-dose oral Diclofenac + Acetaminophen after root canal treatment | Placebo | Postoperative pain (VAS) at 12 h 12 h after treatment | MD -5.50 [-14.28, 3.28] Low Downgraded: imprecision, inconsistency 1 study |
| Single-dose oral Diclofenac + Acetaminophen after root canal treatment | Placebo | Postoperative pain (VAS) at 12 h 12 h after treatment · Sensitivity analysis excluding Islam et al | MD -5.50 [-14.22, 3.22] GRADE not reported Studies not reported |
| Single-dose oral Diclofenac + Acetaminophen after root canal treatment | Placebo | Postoperative pain (VAS) at 6-8 h 6-8 h after treatment · Sensitivity analysis excluding Islam et al | MD -6.04 [-11.51, -0.56] GRADE not reported Studies not reported |
| Single-dose oral Ibuprofen after root canal treatment | Placebo | Postoperative pain (VAS) at 24 h 24 h after treatment | MD -1.32 [-2.28, -0.37] Moderate Downgraded: inconsistency 2 studies |
| Single-dose oral Ibuprofen after root canal treatment | Placebo | Postoperative pain (VAS) at 6-8 h 6-8 h after treatment | MD -1.32 [-2.46, -0.17] Moderate Downgraded: inconsistency 3 studies |
| Single-dose oral Ibuprofen after root canal treatment | Placebo | Postoperative pain (VAS) at 24 h 24 h after treatment · Sensitivity analysis excluding Islam et al | MD -0.51 [-1.28, 0.26] GRADE not reported Studies not reported |
| Single-dose oral Ibuprofen after root canal treatment | Placebo | Postoperative pain (VAS) at 6-8 h 6-8 h after treatment · Sensitivity analysis excluding Islam et al | MD -1.19 [-2.20, -0.17] GRADE not reported Studies not reported |
| Single-dose oral Ibuprofen after root canal treatment | Placebo | Postoperative pain (VAS) at 12 h 12 h after treatment | MD -1.64 [-2.57, -0.71] Moderate Downgraded: inconsistency 2 studies |
| Single-dose oral Ibuprofen after root canal treatment | Placebo | Postoperative pain (VAS) at 12 h 12 h after treatment · Sensitivity analysis excluding Islam et al | MD -1.07 [-2.35, 0.21] GRADE not reported Studies not reported |
| Single-dose oral Ibuprofen + Acetaminophen after root canal treatment | Placebo | Postoperative pain (VAS) at 6-8 h 6-8 h after treatment · Sensitivity analysis excluding Islam et al | MD -2.74 [-3.92, -1.57] GRADE not reported Studies not reported |
| Single-dose oral Ibuprofen + Acetaminophen after root canal treatment | Placebo | Postoperative pain (VAS) at 24 h 24 h after treatment | MD 2.00 [-10.21, 14.21] Low Downgraded: imprecision, inconsistency 1 study |
| Single-dose oral Ibuprofen + Acetaminophen after root canal treatment | Placebo | Postoperative pain (VAS) at 24 h 24 h after treatment · Sensitivity analysis excluding Islam et al | MD 2.00 [-10.15, 14.15] GRADE not reported Studies not reported |
| Single-dose oral Ibuprofen + Acetaminophen after root canal treatment | Placebo | Postoperative pain (VAS) at 12 h 12 h after treatment | MD -4.50 [-9.84, 0.84] Low Downgraded: imprecision, inconsistency 1 study |
| Single-dose oral Ibuprofen + Acetaminophen after root canal treatment | Placebo | Postoperative pain (VAS) at 12 h 12 h after treatment · Sensitivity analysis excluding Islam et al | MD -4.50 [-9.73, 0.73] GRADE not reported Studies not reported |
| Single-dose oral Ibuprofen + Acetaminophen after root canal treatment | Placebo | Postoperative pain (VAS) at 6-8 h 6-8 h after treatment | MD -3.05 [-4.80, -1.30] Moderate Downgraded: inconsistency 2 studies |
| Single-dose oral Ibuprofen + Alprazolam after root canal treatment | Placebo | Postoperative pain (VAS) at 6-8 h 6-8 h after treatment | MD -1.75 [-3.56, 0.07] Low Downgraded: imprecision, inconsistency 1 study |
| Single-dose oral Ibuprofen + Alprazolam after root canal treatment | Placebo | Postoperative pain (VAS) at 6-8 h 6-8 h after treatment · Sensitivity analysis excluding Islam et al | MD -1.70 [-2.86, -0.53] GRADE not reported Studies not reported |
| Single-dose oral Ibuprofen + Alprazolam after root canal treatment | Placebo | Postoperative pain (VAS) at 24 h 24 h after treatment | MD -0.62 [-1.93, 0.68] Low Downgraded: imprecision, inconsistency 1 study |
| Single-dose oral Ibuprofen + Alprazolam after root canal treatment | Placebo | Postoperative pain (VAS) at 24 h 24 h after treatment · Sensitivity analysis excluding Islam et al | MD -0.25 [-0.89, 0.39] GRADE not reported Studies not reported |
| Single-dose oral Ibuprofen + Alprazolam after root canal treatment | Placebo | Postoperative pain (VAS) at 12 h 12 h after treatment · Sensitivity analysis excluding Islam et al | MD -2.00 [-3.25, -0.75] GRADE not reported Studies not reported |
| Single-dose oral Ibuprofen + Alprazolam after root canal treatment | Placebo | Postoperative pain (VAS) at 12 h 12 h after treatment | MD -2.39 [-3.75, -1.04] Moderate Downgraded: inconsistency 1 study |
| Single-dose oral Naproxen after root canal treatment | Placebo | Postoperative pain (VAS) at 6-8 h 6-8 h after treatment | MD -2.62 [-3.97, -1.27] Moderate Downgraded: inconsistency 2 studies |
| Single-dose oral Naproxen after root canal treatment | Placebo | Postoperative pain (VAS) at 24 h 24 h after treatment · Sensitivity analysis excluding Islam et al | MD -2.50 [-3.22, -1.78] GRADE not reported Studies not reported |
| Single-dose oral Naproxen after root canal treatment | Placebo | Postoperative pain (VAS) at 12 h 12 h after treatment | MD -2.58 [-3.44, -1.73] Moderate Downgraded: inconsistency 2 studies |
| Single-dose oral Naproxen after root canal treatment | Placebo | Postoperative pain (VAS) at 24 h 24 h after treatment | MD -2.48 [-3.42, -1.54] Moderate Downgraded: inconsistency 2 studies |
| Single-dose oral Naproxen after root canal treatment | Placebo | Postoperative pain (VAS) at 12 h 12 h after treatment · Sensitivity analysis excluding Islam et al | MD -3.20 [-3.80, -2.60] GRADE not reported Studies not reported |
| Single-dose oral Naproxen after root canal treatment | Placebo | Postoperative pain (VAS) at 6-8 h 6-8 h after treatment · Sensitivity analysis excluding Islam et al | MD -4.00 [-5.54, -2.46] GRADE not reported Studies not reported |
| Single-dose oral Novafen after root canal treatment | Placebo | Postoperative pain (VAS) at 12 h 12 h after treatment · Sensitivity analysis excluding Islam et al | MD -3.00 [-3.74, -2.26] GRADE not reported Studies not reported |
| Single-dose oral Novafen after root canal treatment | Placebo | Postoperative pain (VAS) at 6-8 h 6-8 h after treatment · Sensitivity analysis excluding Islam et al | MD -4.20 [-5.73, -2.67] GRADE not reported Studies not reported |
| Single-dose oral Novafen after root canal treatment | Placebo | Postoperative pain (VAS) at 6-8 h 6-8 h after treatment | MD -3.46 [-5.27, -1.65] Moderate Downgraded: inconsistency 1 study |
| Single-dose oral Novafen after root canal treatment | Placebo | Postoperative pain (VAS) at 24 h 24 h after treatment | MD -2.89 [-4.14, -1.63] Moderate Downgraded: inconsistency 1 study |
| Single-dose oral Novafen after root canal treatment | Placebo | Postoperative pain (VAS) at 12 h 12 h after treatment | MD -2.70 [-3.87, -1.52] Moderate Downgraded: inconsistency 1 study |
| Single-dose oral Novafen after root canal treatment | Placebo | Postoperative pain (VAS) at 24 h 24 h after treatment · Sensitivity analysis excluding Islam et al | MD -2.80 [-3.50, -2.10] GRADE not reported Studies not reported |
| Single-dose oral Tramadol after root canal treatment | Placebo | Postoperative pain (VAS) at 12 h 12 h after treatment | MD -1.46 [-2.35, -0.57] Moderate Downgraded: inconsistency 2 studies |
| Single-dose oral Tramadol after root canal treatment | Placebo | Postoperative pain (VAS) at 6-8 h 6-8 h after treatment | MD -1.22 [-2.61, 0.17] Low Downgraded: imprecision, inconsistency 2 studies |
| Single-dose oral Tramadol after root canal treatment | Placebo | Postoperative pain (VAS) at 12 h 12 h after treatment · Sensitivity analysis excluding Islam et al | MD -1.60 [-2.40, -0.80] GRADE not reported Studies not reported |
| Single-dose oral Tramadol after root canal treatment | Placebo | Postoperative pain (VAS) at 6-8 h 6-8 h after treatment · Sensitivity analysis excluding Islam et al | MD -1.60 [-3.41, 0.21] GRADE not reported Studies not reported |
| Single-dose oral Tramadol after root canal treatment | Placebo | Postoperative pain (VAS) at 24 h 24 h after treatment · Sensitivity analysis excluding Islam et al | MD -1.00 [-2.09, 0.09] GRADE not reported Studies not reported |
| Single-dose oral Tramadol after root canal treatment | Placebo | Postoperative pain (VAS) at 24 h 24 h after treatment | MD -1.39 [-2.41, -0.38] Moderate Downgraded: inconsistency 2 studies |
| Any single-dose oral analgesic after root canal treatment (all drugs pooled) | Placebo | Postoperative pain (VAS) at 24 h 24 h after treatment · Overall pairwise meta-analysis of all drug arms | MD -1.752 [-2.440, -1.065] GRADE not reported 4 studies |
| Any single-dose oral analgesic after root canal treatment (all drugs pooled) | Placebo | Postoperative pain (VAS) at 6-8 h 6-8 h after treatment · Overall pairwise meta-analysis of all drug arms | MD -2.032 [-2.687, -1.376] GRADE not reported 5 studies |
| Any single-dose oral analgesic after root canal treatment (all drugs pooled) | Placebo | Postoperative pain (VAS) at 12 h 12 h after treatment · Overall pairwise meta-analysis of all drug arms | MD -2.101 [-2.606, -1.597] GRADE not reported 4 studies |
Included primary studies 10
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Menhinick 2004 The efficacy of pain control following nonsurgical root canal treatment using ibuprofen or a combination of ibuprofen and acetaminophen in… PMID:15230906 | 2004 | 1 other review | Postoperative pain (VAS) at 6-8 h | not extracted yet |
| Rogers 1999 Comparison of effect of intracanal use of ketorolac tromethamine and dexamethasone with oral ibuprofen on post treatment endodontic pain. PMID:10530266 | 1999 | 1 other review | not stated | not extracted yet |
| Akpinar 2021 Effect of different clinical practices on postoperative pain in permanent mandibular molar teeth with symptomatic apical periodontitis: A… PMID:33473019 | 2021 | this review only | not stated | not extracted yet |
| Baradaran 2014 Alprazolam role in the analgesic effect of ibuprofen on postendodontic pain. PMID:25489429 | 2014 | this review only | Postoperative pain (VAS) at 6-8 h | not extracted yet |
| Elzaki 2016 Double-blind Randomized Placebo-controlled Clinical Trial of Efficiency of Nonsteroidal Anti-inflammatory Drugs in the Control of… PMID:27080115 | 2016 | this review only | not stated | not extracted yet |
| Islam 2018 EFFECTS OF THREE ORAL ANALGESICS ON POSTOPERATIVE PAIN FOLLOWING ROOT CANAL PREPARATION: A CONTROLLED CLINICAL TRIAL DOI:10.51253/pafmj.v71i2.3391 | 2021 | this review only | Postoperative pain (VAS) at 6-8 h | not extracted yet |
| Madani 2013 Analgesic effect of etoricoxib compared to ibuprofen on post endodontic pain. PMID:24352312 | 2013 | this review only | not stated | not extracted yet |
| Makkar 2012 Efficacy of ibuprofen and paracetamol and diclofenac sodium and paracetamol combination on postoperative pain following root canal… DOI:10.4103/0976-6944.101671 | 2012 | this review only | Postoperative pain (VAS) at 6-8 h | not extracted yet |
| Mehrvarzfar 2012 Effects of three oral analgesics on postoperative pain following root canal preparation: a controlled clinical trial. PMID:21902704 | 2012 | this review only | Postoperative pain (VAS) at 6-8 h | not extracted yet |
| Nekoofar 2003 Evaluation of meloxicam (A cox-2 inhibitor) for management of postoperative endodontic pain: a double-blind placebo-controlled study. PMID:14606784 | 2003 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients receiving non-surgical endodontic treatment | Patients with moderate to severe post-endodontic pain, mostly irreversible pulpitis (10 trials, 347 participants in 5 meta-analyzed trials) |
| Intervention | Single-dose oral medication after root canal therapy (NSAIDs, corticosteroids, benzodiazepines, opioids, combinations) | Diclofenac + acetaminophen; ibuprofen; ibuprofen + acetaminophen; ibuprofen + alprazolam; naproxen; Novafen; tramadol (single dose) |
| Comparison | Placebo after root canal therapy | Placebo (n=5 trials in meta-analysis) |
| Outcomes | Postoperative pain (VAS or verbal scales) at 6-8 h, 12 h, 24 h | VAS pain at 6-8 h, 12 h, 24 h (MD vs placebo) |
| Study designs | Randomized controlled trials only | 10 RCTs qualitatively analyzed; 5 RCTs in meta-analysis (n=347) |
| Timing | 6-8 h, 12 h, 24 h after treatment | 6-8 h, 12 h, 24 h |