Abstract
Background:Postoperative Endodontic Pain is a major concern for dentists and their patients, with pain having been reported to occur in 25%–40% of patients treated. Therefore, the aim of this systematic review and Network Meta-analysis (NMA) was to identify the safety and efficacy of pre- and post-medication for reducing postoperative endodontic pain.Methods:A literature search was performed in the SCOPUS, MEDLINE, and ScienceDirect, and Cochrane Central databases until December 2019 with no language restriction. Randomized controlled trials evaluating the efficacy of pre- or post-medications compared with other agents, placebo, or no treatment in adult patients who underwent endodontic surgery for postoperative pain were included. The mean difference of postoperative pain was measured using the Standardized Mean Difference (SMD) with its 95% confidence interval (95% CI).Results:This Systematic Review included 62 Articles. Of them, 50 studies were included in the NMA. Among all medications, corticosteroids were ranked as the best treatment for the reduction of postoperative pain at 6 and 12 hours with a significant reduction in postoperative pain scores [SMD= -1.18, 95% CI (-1.51: -0.85)] and [SMD= -1.39, 95% CI (-1.77: -1.02)], respectively. Cyclooxygenase-2 (COX-2) inhibitors were ranked as the best treatment for the reduction of postoperative pain at 8 and 24 hours with a significant reduction in postoperative pain scores [SMD= -2.86, 95% CI (-6.05: -1.66)] and [SMD= -1.27, 95% CI (-2.10: -0.43)], respectively. Non-steroidal anti-inflammatory drugs (NSAIDs) significantly reduced the postoperative pain scores in all durations. For postoperative pain at 6 hours, Indomethacin, Novafen, Naproxen, Prednisolone, Ketorolac, Betamethasone, Dexamethasone, Deflazacort, Rofecoxib, Piroxicam, and Ibuprofen significantly reduced the pain score when compared with a placebo. All of these drugs demonstrated a significant reduction at 12 hours except Ketorolac.Conclusion:The current evidence suggests that pre- and post-medication can reduce postoperative pain after nonsurgical root canal treatment. Corticosteroids and COX-2 inhibitors showed significant control of the pain up to 12 hours after administration. However, NSAIDs demonstrated a high efficacy from administration and until two days after treatment. Indomethacin, Novafen, prednisolone, and Naproxen were ranked first in most analyzed durations.
Highlights
Postoperative pain during root canal therapy is a major undesirable complication for dentists and their patients
In this systematic review and network meta-analysis, we aimed to summarize current evidence on the efficacy of pre- and postmedication for the treatment of postoperative endodontic pain and rank the available drugs according to their efficacy
Postendodontic pain was substantially reduced by 10 cm preoperative administration of a single oral dose of prednisolone compared with placebo
Summary
Postoperative pain during root canal therapy is a major undesirable complication for dentists and their patients. Anxiety and fear of pain during root canal treatment are the main reasons that prevent patients from attending dental offices [1]. It was estimated that the prevalence of post-endodontic pain ranges from 3% to 58% [2 - 4]. This condition is linked with the exacerbation of inflammatory response and the activation of inflammatory mediators such as prostaglandins, which cause the periapical activation of sensitive nociceptors [5]. Endodontic treatment consists of restoring the form and function of teeth and controlling symptoms that address the primary concern of the patient as well as long-term possible complications, such as chronic pain [7]. The aim of this systematic review and Network Meta-analysis (NMA) was to identify the safety and efficacy of pre- and postmedication for reducing postoperative endodontic pain
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