J Dent Anesth Pain Med.  2018 Aug;18(4):205-221. 10.17245/jdapm.2018.18.4.205.

Efficacy of corticosteroids for postoperative endodontic pain: A systematic review and meta-analysis

• Nath R
• Daneshmand A
• Sizemore D
• Guo J
• Enciso R

• KMID: 2419063
• DOI: http://doi.org/10.17245/jdapm.2018.18.4.205

Abstract

This systematic review aimed to analyze the efficacy of corticosteroid premedication compared to placebo or no treatment to reduce postoperative pain in endodontic patients. Randomized controlled trials (RCTs) assessing corticosteroids via oral, intramuscular, subperiosteal, intraligamentary or intracanal route compared to passive or active placebo, or no treatment were included. Four databases were searched: PubMed, Web of Science, Cochrane Library and Embase up to 2/21/2018. Risk of bias was assessed with Cochrane Risk of bias tool. Fourteen RCTs with 1,462 generally healthy adults in need of endodontic treatment were included. 50% of the studies were at unclear risk and 50% at high risk of bias. Meta-analysis showed Visual Analog Scale (VAS) pain at 4-6 hours after Inferior Alveolar Nerve Block (IANB) was significantly lower by 21 points (0-100 scale) in the corticosteroid group compared to the control group (95% CI −35 to −7; P = 0.003), however this difference was not statistically significant after 24 hours (P = 0.116). The route of administration was oral and intraligament injection. Patients who received corticosteroids prior to IANB were 70.7% more likely to have none or mild pain 4-8 hours after treatment (P = 0.001) and 13.5% more likely 24 hours after IANB (P = 0.013) than patients in the control group. In conclusion, corticosteroid administration (oral or intraligamental) may clinically reduce the level of postoperative pain at 4-8 hours after IANB, however the quality of the evidence was low/moderate due to risk of bias and heterogeneity. Further studies are recommended.

Keyword

Corticosteroids; Endodontic; Inferior Alveolar Nerve; Meta-Analysis; Postoperative Pain

MeSH Terms

Adrenal Cortex Hormones*
Adult
Bias (Epidemiology)
Humans
Mandibular Nerve
Pain, Postoperative
Population Characteristics
Premedication
Visual Analog Scale
Adrenal Cortex Hormones

Figure

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  Fig. 1 PRISMA Flow Diagram [41].

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  Fig. 2 Summary of risk of bias of eligible RCT's.

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  Fig. 3 (A) Results of the meta-analyses comparing corticosteroids versus controls. VAS pain was significantly decreased (P = 0.003) at 4–6 hours after IANB. (B) Results of the meta-analyses comparing corticosteroids versus controls. VAS pain was not significantly decreased after 24 hours (P = 0.116).

• 

  Fig. 4 (A) Results of the subgroup analyses by route of administration comparing corticosteroids versus control group. VAS pain was significantly decreased with corticosteroids delivered via intraligamental injection (P < 0.001). (B) Results of the subgroup analyses by route of administration comparing corticosteroids versus control group. VAS pain was significantly decreased with corticosteroids via oral administration (P = 0.027).

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  Fig. 5 (A) Results of the subgroup analyses by type of corticosteroids. VAS pain after IANB was decreased but not significantly with dexamethasone (P = 0.105) and methylprednisone (P = 0.173). Oral prednisolone decreased significantly postoperatively 4–6 hours after IANB (P = 0.009).

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  Fig. 6 A) Results of the meta-analyses comparing corticosteroids versus control group. Patients who received corticosteroids prior to IANB were 70.7% more likely to have none or mild pain 4–8 hours after IANB (P = 0.001). (B) Results of the meta-analyses comparing corticosteroids versus control group. Patients who received corticosteroids prior to IANB were 13.5% more likely to have none or mild pain 24 hours after IANB (P = 0.013) than patients in the control group.

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