Non-Cochrane · intervention · PM41716365
Efficacy of NSAIDs and corticosteroids as premedication for post-endodontic pain management: A systematic review and meta-analysis.
Mrini Radia, Salamanca-Ramos Marcela, Ledezma Priscilla, et al. · Journal of clinical and experimental dentistry · 2025 · PubMed · doi:10.4317/jced.63455
Findings
Population Adults with symptomatic irreversible pulpitis undergoing non-surgical root canal treatment
21 findings
| Single-dose corticosteroid premedication (dexamethasone, prednisolone, methylprednisolone) | Placebo | Postoperative pain intensity at 24 h 24 h · Dental clinics | SMD -2.06 [-3.20, -0.91] GRADE not reported 5 studies · 638 participants |
| Single-dose corticosteroid premedication (dexamethasone, prednisolone, methylprednisolone) | Placebo | Postoperative pain intensity at 6 h 6 h · Dental clinics | SMD -1.60 [-2.50, -0.71] GRADE not reported 5 studies · 638 participants |
| Single-dose corticosteroid premedication (dexamethasone, prednisolone, methylprednisolone) | Placebo | Postoperative pain intensity at 12 h 12 h · Dental clinics | SMD -2.13 [-3.18, -1.08] GRADE not reported 5 studies · 638 participants |
| Single-dose corticosteroid premedication (dexamethasone, prednisolone, methylprednisolone) | Placebo | Postoperative pain intensity Overall (study-level pain scores averaged across time points) · Dental clinics | SMD -1.28 [-1.96, -0.61] GRADE not reported 5 studies · 638 participants |
| Single-dose corticosteroid premedication (dexamethasone, prednisolone, methylprednisolone) | Placebo | Postoperative pain intensity at 48 h 48 h · Dental clinics | SMD -1.38 [-2.15, -0.61] GRADE not reported 4 studies · 638 participants |
| Single-dose corticosteroid premedication (dexamethasone, prednisolone, methylprednisolone) | Placebo | Postoperative pain intensity, all time points combined in one pooled total All time points (6, 12, 24, 48 h) combined · Dental clinics | SMD -1.66 [-2.04, -1.29] GRADE not reported 5 studies |
| Single-dose corticosteroid premedication (dexamethasone, prednisolone, methylprednisolone) | Placebo | Use of rescue analgesic medication Postoperative (after endodontic treatment) · Dental clinics | Rescue analgesic use: corticosteroids 5.5% vs placebo 34.4% (ANOVA and Tukey post hoc p < 0.05 vs placebo) 34.4% vs 5.5% GRADE not reported 3 studies |
| Single-dose NSAID premedication (ibuprofen, diclofenac, tenoxicam, ketorolac) | Placebo | Postoperative pain intensity at 48 h 48 h · Dental clinics | SMD -3.51 [-5.90, -1.11] GRADE not reported 4 studies · 244 participants |
| Single-dose NSAID premedication (ibuprofen, diclofenac, tenoxicam, ketorolac) | Placebo | Postoperative pain intensity at 6 h 6 h · Dental clinics | SMD -3.22 [-5.09, -1.35] GRADE not reported 4 studies · 244 participants |
| Single-dose NSAID premedication (ibuprofen, diclofenac, tenoxicam, ketorolac) | Placebo | Postoperative pain intensity Overall (study-level pain scores averaged across time points) · Dental clinics | SMD -0.61 [-1.11, -0.10] GRADE not reported 4 studies · 244 participants |
| Single-dose NSAID premedication (ibuprofen, diclofenac, tenoxicam, ketorolac) | Placebo | Postoperative pain intensity at 12 h 12 h · Dental clinics | SMD -1.73 [-3.04, -0.41] GRADE not reported 4 studies · 244 participants |
| Single-dose NSAID premedication (ibuprofen, diclofenac, tenoxicam, ketorolac) | Placebo | Postoperative pain intensity at 24 h 24 h · Dental clinics | SMD -3.86 [-6.50, -1.23] GRADE not reported 4 studies · 244 participants |
| Single-dose NSAID premedication (ibuprofen, diclofenac, tenoxicam, ketorolac) | Placebo | Postoperative pain intensity, all time points combined in one pooled total All time points (6, 12, 24, 48 h) combined · Dental clinics | SMD -2.94 [-3.81, -2.06] GRADE not reported 4 studies |
| Single-dose NSAID premedication (ibuprofen, diclofenac, tenoxicam, ketorolac) | Placebo | Use of rescue analgesic medication Postoperative (after endodontic treatment) · Dental clinics | Rescue analgesic use: NSAIDs 4.6% vs placebo 34.4% (ANOVA and Tukey post hoc p < 0.05 vs placebo) 34.4% vs 4.6% GRADE not reported 2 studies |
| Single-dose corticosteroid premedication | Single-dose NSAID premedication | Postoperative pain intensity at 24 h 24 h · Dental clinics | SMD 0.38 [-2.35, 3.11] GRADE not reported 2 studies · 137 participants |
| Single-dose corticosteroid premedication | Single-dose NSAID premedication | Postoperative pain intensity at 6 h 6 h · Dental clinics | SMD 1.25 [-0.10, 2.60] GRADE not reported 2 studies · 137 participants |
| Single-dose corticosteroid premedication | Single-dose NSAID premedication | Use of rescue analgesic medication Postoperative (after endodontic treatment) · Dental clinics | no estimate extracted GRADE not reported Studies not reported |
| Single-dose corticosteroid premedication | Single-dose NSAID premedication | Postoperative pain intensity at 48 h 48 h · Dental clinics | SMD 0.08 [-2.30, 2.46] GRADE not reported 2 studies · 137 participants |
| Single-dose corticosteroid premedication | Single-dose NSAID premedication | Postoperative pain intensity, all time points combined in one pooled total All time points (6, 12, 24, 48 h) combined · Dental clinics | SMD 0.56 [-0.36, 1.49] GRADE not reported 2 studies |
| Single-dose corticosteroid premedication | Single-dose NSAID premedication | Postoperative pain intensity Overall (study-level pain scores averaged across time points) · Dental clinics | SMD 0.25 [-1.15, 1.66] GRADE not reported 2 studies · 137 participants |
| Single-dose corticosteroid premedication | Single-dose NSAID premedication | Postoperative pain intensity at 12 h 12 h · Dental clinics | SMD 0.55 [-2.04, 3.13] GRADE not reported 2 studies · 137 participants |
Included primary studies 10
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Aksoy & Ege 2019 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Aksoy 2019 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Al-Rawhani 2020 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Arslan 2011 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Elkhadem 2018 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Elkhadem 2018 The effect of preoperative oral administration of prednisolone on postoperative pain in patients with symptomatic irreversible pulpitis: a… PMID:28560802 | 2018 | this review only | not stated | not extracted yet |
| Pochapski 2009 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Praveen 2017 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Tanwir 2022 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Tanwir 2022 Effectiveness of Single Dose Premedication of Piroxicam and Prednisolone on Post Endodontic Pain in One Visit Root Canal Treatment: A… PMID:36217645 | 2022 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults (18 years or older) with symptomatic irreversible pulpitis in permanent teeth requiring non-surgical root canal treatment under local anesthesia | Adults with symptomatic irreversible pulpitis undergoing non-surgical root canal treatment (n=820 across 7 RCTs) |
| Intervention | Single-dose premedication with NSAIDs or corticosteroids (oral, intramuscular or submucosal) before endodontic treatment | Corticosteroids (dexamethasone, prednisolone) and NSAIDs (ibuprofen, ketorolac, diclofenac, tenoxicam, piroxicam), single dose |
| Comparison | Placebo or the alternative drug class | Placebo (all trials); head-to-head corticosteroid vs NSAID in 2 trials |
| Outcomes | Postoperative pain at 6, 12, 24 and 48 h (VAS, NRS, HP-VAS); need for rescue analgesic medication | Postoperative pain (SMD) at 6, 12, 24, 48 h and overall; rescue analgesic use |
| Study designs | Randomized controlled trials | Randomized controlled trials (n=7) |
| Timing | 6, 12, 24 and 48 h postoperatively | 6, 12, 24 and 48 h |