MicroRNA-122 plays a critical role in liver homeostasis and hepatocarcinogenesis.

BACKGROUND

Post-endodontic pain remains a common clinical challenge. This systematic review and meta-analysis evaluated the preemptive efficacy of NSAIDs and corticosteroids as premedication for managing postoperative pain in patients with symptomatic irreversible pulpitis undergoing non-surgical root canal treatment.

Objectives

To compare the preemptive efficacy of NSAIDs and corticosteroids as single-dose premedication in reducing postoperative pain and rescue medication use after endodontic treatment.

MATERIAL AND

METHODS

Following PRISMA 2020 guidelines, a systematic search was conducted in PubMed, Cochrane Library, and Embase up to April 2024. Eligibility criteria included randomized controlled trials comparing single-dose NSAIDs or corticosteroids with placebo. Primary outcomes were postoperative pain intensity measured by validated scales (VAS, NRS, HP-VAS) and need for rescue analgesics. Risk of bias was assessed with RoB2, and certainty of evidence with GRADE. Meta-analysis used random-effects models, with standardized mean differences (SMD) and 95% confidence intervals (CI). Protocol registered in PROSPERO (CRD42024499723).

RESULTS

Seven RCTs (n=820) published between 2009 and 2023 were included. Both corticosteroids (SMD = -1.28; 95 % confidence interval (CI): -1.96 to -0.61) and NSAIDs (SMD = -0.61; 95% CI: -1.11 to -0.10) significantly reduced postoperative pain versus placebo. NSAIDs provided rapid analgesia at 6 h, while corticosteroids achieved sustained analgesia from 12-48 h. Rescue analgesic use decreased substantially in both active groups compared with placebo (NSAIDs 4.6%, corticosteroids 5.5%, placebo 34.4%). High heterogeneity (I² = 90%) was partly explained by drug class, dose, and administration route. Sensitivity analysis excluding imputed data confirmed robustness of results.

CONCLUSIONS

Both NSAIDs and corticosteroids are effective preemptive agents for managing post-endodontic pain in symptomatic irreversible pulpitis. NSAIDs should be preferred for rapid early relief, while corticosteroids provide extended analgesia. Findings highlight their opioid-sparing potential and support their inclusion in evidence-based endodontic pain management protocols. Further multicenter RCTs are warranted to refine patient-tailored regimens.