Non-Cochrane · intervention · PM42434206
Effect of Pre-emptive Injection-based Corticosteroid Administration and Its Routes on Post-Endodontic Pain: A Systematic Review and Meta-analysis of Randomized Clinical Trials.
Al-Yamoor Reem, Stefanescu Stefan Vasile, Iuga Maria Miheala, et al. · Journal of clinical and experimental dentistry · 2026 · PubMed · doi:10.4317/jced.64027
Findings
Population Adults undergoing root canal treatment (mainly symptomatic irreversible pulpitis)
9 findings
| Pre-emptive injection-based corticosteroid (dexamethasone, methylprednisolone or betamethasone; infiltrative, intraligamentary or intramuscular) | Placebo (saline, local anesthetic or no drug) | Post-endodontic pain intensity 24 hours · Root canal treatment | MD -0.73 [-0.84, -0.61] GRADE not reported 7 studies · 426 participants |
| Pre-emptive injection-based corticosteroid (dexamethasone, methylprednisolone or betamethasone; infiltrative, intraligamentary or intramuscular) | Placebo (saline, local anesthetic or no drug) | Post-endodontic pain intensity 12 hours · Root canal treatment | MD -2.07 [-2.33, -1.81] GRADE not reported 4 studies · 278 participants |
| Pre-emptive injection-based corticosteroid (dexamethasone, methylprednisolone or betamethasone; infiltrative, intraligamentary or intramuscular) | Placebo (saline, local anesthetic or no drug) | Post-endodontic pain intensity Overall (all time points) · Root canal treatment | MD -0.86 [-0.97, -0.75] GRADE not reported 7 studies · 426 participants |
| Pre-emptive injection-based corticosteroid (dexamethasone, methylprednisolone or betamethasone; infiltrative, intraligamentary or intramuscular) | Placebo (saline, local anesthetic or no drug) | Post-endodontic pain intensity 72 hours · Root canal treatment | MD -0.55 [-0.61, -0.50] GRADE not reported 3 studies · 238 participants |
| Pre-emptive injection-based corticosteroid (dexamethasone, methylprednisolone or betamethasone; infiltrative, intraligamentary or intramuscular) | Placebo (saline, local anesthetic or no drug) | Post-endodontic pain intensity Overall (all time points) · Root canal treatment | SMD -2.17 [-2.75, -1.59] GRADE not reported 7 studies |
| Pre-emptive injection-based corticosteroid (dexamethasone, methylprednisolone or betamethasone; infiltrative, intraligamentary or intramuscular) | Placebo (saline, local anesthetic or no drug) | Post-endodontic pain intensity 6 hours · Root canal treatment | MD -1.95 [-2.32, -1.58] GRADE not reported 4 studies · 278 participants |
| Pre-emptive injection-based corticosteroid (dexamethasone, methylprednisolone or betamethasone; infiltrative, intraligamentary or intramuscular) | Placebo (saline, local anesthetic or no drug) | Post-endodontic pain intensity 48 hours · Root canal treatment | MD -0.42 [-0.53, -0.30] GRADE not reported 5 studies · 358 participants |
| Pre-emptive infiltrative corticosteroid injection (mainly dexamethasone) | Placebo (saline, local anesthetic or no drug) | Post-endodontic pain intensity 24 hours · Root canal treatment · Infiltrative route | MD -2.57 [-2.90, -2.23] GRADE not reported 3 studies · 248 participants |
| Pre-emptive intraligamentary corticosteroid injection (dexamethasone or methylprednisolone) | Placebo (saline, local anesthetic or no drug) | Post-endodontic pain intensity 24 hours · Root canal treatment · Intraligamentary route | MD -1.10 [-1.42, -0.78] GRADE not reported 3 studies · 118 participants |
Included primary studies 9
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Sekhar 2024 Comparing the Effects of Intramuscular Injections of Dexamethasone and Ketorolac Tromethamine on Post-treatment Endodontic Pain: An In… PMID:38681426 | 2024 | 1 other review | not stated | not extracted yet |
| Aksoy 2020 The effect of pretreatment submucosal injections of tramadol and dexamethasone on post-endodontic pain in mandibular molar teeth with… PMID:31702056 | 2020 | this review only | not stated | not extracted yet |
| Fatima 2025 Effect of cryotherapy, laser therapy and intraligamentary dexamethasone injection on post-treatment pain after single visit RCT-A… PMID:40008073 | 2025 | this review only | not stated | not extracted yet |
| Kaufman 1994 Intraligamentary injection of slow-release methylprednisolone for the prevention of pain after endodontic treatment. PMID:8065733 | 1994 | this review only | not stated | not extracted yet |
| Mehrvarzfar 2008 Effect of supraperiosteal injection of dexamethasone on postoperative pain. PMID:18352900 | 2008 | this review only | not stated | not extracted yet |
| Mehrvarzfar 2016 Effect of Dexamethasone Intraligamentary Injection on Post-Endodontic Pain in Patients with Symptomatic Irreversible Pulpitis: A… PMID:27790253 | 2016 | this review only | not stated | not extracted yet |
| Shantiaee 2012 Efficacy comparison of periapical infiltration injection of dexamethasone, morphine and placebo for postoperative endodontic pain. PMID:22420475 | 2012 | this review only | not stated | not extracted yet |
| Sharma 2015 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Yavari 2019 The Effect of Submucosal Injection of Corticosteroids on Pain Perception and Quality of Life after Root Canal Treatment of Teeth with… PMID:30910353 | 2019 | 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 | Shared studies | Jaccard |
|---|---|---|
| The Effectiveness of Ketorolac in Relieving Pain Associated With Root Canal Therapy: A Systematic Review and Meta-Analysis. (2026) | 1 | 0.07 |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adult patients undergoing root canal treatment | Adults with symptomatic irreversible pulpitis, some with symptomatic apical periodontitis (n=917 participants) |
| Intervention | Pre-emptive corticosteroid by injection (infiltrative, intraligamentary, intramuscular) | Dexamethasone, methylprednisolone, betamethasone via intraligamentary, intramuscular or infiltrative injection (9 RCTs) |
| Comparison | Placebo | Placebo (saline, lidocaine or empty cartridge) |
| Outcomes | Postoperative pain reported as the primary outcome with a validated tool; analgesic consumption | Post-endodontic pain at 6, 12, 24, 48, 72 hours and overall; analgesic consumption (narrative) |
| Study designs | Randomized clinical trials | 9 RCTs (7 in meta-analysis) |
| Timing | Not specified | Assessment from 4 hours to 7 days |
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 | Yes | No | no |
| 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 | Yes | Yes | yes |
| 8Included studies described in detail | Partial Yes | Yes | no |
| 9Risk of bias assessed satisfactorilycritical | NRSI: N/A · RCT: Yes | RCT: Yes · NRSI: N/A | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | NRSI: N/A · RCT: No | NRSI: N/A · RCT: No | yes |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | No | No | 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 |