Effect of Pre-emptive Injection-based Corticosteroid Administration and Its Routes on Post-Endodontic Pain: A Systematic Review and Meta-analysis of Randomized Clinical Trials
Al-Yamoor R.; Stefanescu S.V.; Iuga M.M.; Espada-Salgado F.M.; Bilsborrow S.; Teja K.V.; Vasundhara K.A. · Journal of Clinical and Experimental Dentistry (2026) · DOI: 10.4317/jced.64027
Resumen
Background: Post-endodontic pain PP is a frequent complication following root canal treatment RCT, primarily resulting from acute inflammation. Pre-emptive corticosteroid administration has been proposed to attenuate this inflammatory response and reduce PP. This systematic review and meta-analysis assessed the effectiveness of injection-based corticosteroids delivered through different routes in minimizing PP at various postoperative intervals. Materials and Methods: A comprehensive search of PubMed, Scopus, Web of Science, LILACS, Cochrane Library, and Google Scholar was conducted up to March 2025, following PRISMA 2020 guidelines. Randomized controlled trials evaluating pre-emptive corticosteroid injections via infiltrative, intraligamentary, or intramuscular routes were included. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and meta-analyses were performed using Review Manager 5.4. The review was prospectively registered in PROSPERO CRD420251005886. Results: Nine RCTs comprising 917 participants were analyzed. Corticosteroid injections, including dexamethasone, methylprednisolone, and betamethasone, significantly reduced PP compared with placebo at all time points, with the most pronounced effect within the first 12 hours and sustained, though reduced, benefits up to 72 hours. Infiltrative injections demonstrated greater efficacy than intraligamentary routes. Conclusions: Pre-emptive corticosteroid injections, particularly dexamethasone via infiltrative or intraligamentary routes, effectively reduce post-endodontic pain, especially within the first 24 hours. © Medicina Oral S. L
Instituciones: Universidad Privada de Tacna; Universidad Nacional Jorge Basadre Grohmann