Effect of Preoperative Corticosteroids in Patients with Symptomatic Pulpitis on Postoperative Pain after Single-visit Root Canal Treatment: A Systematic Review and Meta-analysis

This study addressed the following population, intervention, comparator, outcome, timing, study design and setting question: in patients with preoperative pain who undergo single-visit nonsurgical endodontic treatment, what is the comparative efficacy of corticosteroids compared with other analgesics or placebo in reducing postoperative pain and the incidence of adverse events. Database/electronic searches were conducted using the PubMed/MEDLINE, Scopus, and Cochrane databases to identify published articles using included key words in various combinations. Manual searching of articles was performed, and the Clinicaltrials.gov site was also searched. Two independent reviewers assessed eligibility for inclusion, extracted data, and assessed quality using the risk of bias tool. Where applicable, meta-analysis was conducted on the pooled effect size. The database search identified 481 citations and 37 citations through the manual search. After removing duplicates and going through abstracts, 28 full-text articles were perused. Five articles met the inclusion criteria; qualitative analysis revealed 4 studies had unclear risk of bias, and 1 study had low risk of bias. Only 1 study had a sizable sample size; the others had lesser sample sizes. Meta-analysis showed that prednisolone administered preoperatively was able to reduce the incidence of postoperative pain at 6, 12, and 24 hours. The patients in the studies reported no adverse effects. Corticosteroids may be more effective than placebo for the relief of postoperative endodontic pain in patients with symptomatic pulpitis undergoing single-visit root canal treatment. However, more studies need to be conducted with greater sample sizes to validate the conclusions.