Non-Cochrane · intervention · PM42889437
Effectiveness of NSAIDs premedication following third molar extraction: a systematic review with meta-analysis of randomized clinical trials.
Delich-Pardo Valentina, González-Zeballos Matías, Casado Valentina Veloso, et al. · Journal of dental anesthesia and pain medicine · 2026 · PubMed · doi:10.17245/jdapm.2026.26.140
Findings
Population Healthy adults undergoing third molar extraction under local anesthesia
7 findings
| Preoperative NSAID premedication | Placebo | Postoperative pain 24 hours | SMD -1.42 [-2.60, -0.25] Low Downgraded: imprecision, inconsistency 5 studies · 274 participants |
| Preoperative NSAID premedication | Placebo | Rescue medication requirement | RR 0.61 [0.40, 0.92] 939 per 1000 vs 573 per 1000 Low Downgraded: imprecision, inconsistency 4 studies · 287 participants |
| Preoperative NSAID premedication | Placebo | Postoperative pain 5 to 12 hours | SMD -0.75 [-1.35, -0.15] Low Downgraded: imprecision, inconsistency 7 studies · 569 participants |
| Preoperative NSAID premedication | Placebo | Postoperative pain Longest follow-up (8 hours to 7 days) | SMD -1.25 [-1.94, -0.56] Low Downgraded: imprecision, inconsistency 10 studies · 703 participants |
| Preoperative NSAID premedication | Placebo | Mouth opening limitation | SMD -6.76 [-21.07, 7.56] Low Downgraded: imprecision, inconsistency 2 studies · 76 participants |
| Preoperative NSAID premedication | Placebo | Postoperative pain 4 hours | SMD -1.20 [-1.67, -0.73] Low Downgraded: imprecision, inconsistency 7 studies · 497 participants |
| Preoperative NSAID premedication | Placebo | Number of rescue medication tablets consumed | SMD -0.63 [-1.10, -0.15] Low Downgraded: imprecision, inconsistency 4 studies · 234 participants |
Included primary studies 16
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Al-Sukhun 2012 Preemptive analgesic effect of low doses of celecoxib is superior to low doses of traditional nonsteroidal anti-inflammatory drugs. PMID:22421863 | 2012 | 1 other review | not stated | not extracted yet |
| Chiu 2005 Efficacy of preoperative oral rofecoxib in pain control for third molar surgery. PMID:15897845 | 2005 | 1 other review | not stated | not extracted yet |
| Albuquerque 2017 Effect of pre-emptive analgesia on clinical parameters and tissue levels of TNF-α and IL-1β in third molar surgery: a triple-blind,… PMID:28610818 | 2017 | this review only | not stated | not extracted yet |
| Borea 1996 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Costa 2015 A split-mouth, randomized, triple-blind, placebo-controlled study to analyze the pre-emptive effect of etoricoxib 120 mg on inflammatory… PMID:26144571 | 2015 | this review only | not stated | not extracted yet |
| Dionne 1978 Evaluation of preoperative ibuprofen for postoperative pain after removal of third molars. PMID:355965 | 1978 | this review only | not stated | not extracted yet |
| Hill 1987 Ibuprofen given pre- and post-operatively for the relief of pain. PMID:3117914 | 1987 | this review only | not stated | not extracted yet |
| Ilhan 2014 A comparison of the effects of methylprednisolone and tenoxicam on pain, edema, and trismus after impacted lower third molar extraction. PMID:24473372 | 2014 | this review only | not stated | not extracted yet |
| Kaczmarzyk 2010 Preemptive effect of ketoprofen on postoperative pain following third molar surgery. A prospective, randomized, double-blinded clinical… PMID:20338728 | 2010 | this review only | not stated | not extracted yet |
| Liporaci 2012 Assessment of preemptive analgesia efficacy in surgical extraction of third molars. PMID:22793965 | 2012 | this review only | not stated | not extracted yet |
| Lisboa 2013 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Lisboa and Pilatti, 2013 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Mojsa 2017 Pre-emptive analgesic effect of lornoxicam in mandibular third molar surgery: a prospective, randomized, double-blind clinical trial. PMID:28057390 | 2017 | this review only | not stated | not extracted yet |
| Morse 2006 Ibuprofen as a pre-emptive analgesic is as effective as rofecoxib for mandibular third molar surgery. PMID:16998619 | 2006 | this review only | not stated | not extracted yet |
| Orozco-Solis 2016 Single dose of diclofenac or meloxicam for control of pain, facial swelling, and trismus in oral surgery. PMID:26615509 | 2016 | this review only | not stated | not extracted yet |
| Zhao 2022 [Oral dexketoprofen tromethamine for preemptive analgesia in extraction of impacted teeth: a randomized controlled double-blind trial]. PMID:37803987 | 2023 | 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 | Healthy adults (>=18 years) undergoing third molar extraction under local anesthesia | Healthy adults undergoing third molar extraction (n=15 RCTs, 779 participants) |
| Intervention | NSAID premedication with clearly defined dose, route and timing | Preoperative ibuprofen, ibuprofen arginine, naproxen sodium, rofecoxib, celecoxib, etoricoxib, ketoprofen, dexketoprofen, lornoxicam, tenoxicam, diclofenac, meloxicam (15-90 min preoperatively; one trial 2 days before) |
| Comparison | Placebo or no premedication (identical postoperative/rescue medication protocols) | Placebo in most trials; one trial (Orozco-Solis 2016) compared diclofenac with meloxicam |
| Outcomes | Postoperative pain; inflammation (edema and trismus); rescue medication intake; adverse effects | Pain 0-4 h (n=7), 5-12 h (n=7), 24 h (n=5), longest follow-up (n=10); rescue tablets (n=4); rescue medication requirement (n=4); mouth opening limitation (n=2); facial swelling (narrative, n=3); adverse events (narrative, n=5; SoF low certainty) |
| Study designs | Randomized controlled trials | RCTs (n=15; 12 in meta-analysis) |
| Timing | Not specified | Immediate postoperative 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 | Yes | Partial Yes | no |
| 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 | Partial Yes | Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: No · NRSI: N/A | NRSI: N/A · RCT: No | 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 |