IADR Abstract Archives
Pain Management Following Non-Surgical Endodontic Treatment: A Network Meta-Analysis
Objectives: To determine the efficacy and safety of postoperative oral medications to decrease pain following non-surgical endodontic treatment using network meta-analysis.
Methods: Major databases were searched. Two review authors selected studies and extracted data. Data from eligible randomized controlled trials were meta-analyzed to estimate the treatment effects [mean difference (MD); 95% credible interval (CrI) and surface under the cumulative ranking curve (SUCRA)] at 6-8, 12, 24 and 48 hours(h) postoperatively. CINeMA was used to assess the quality of results.
Results: 13 studies involving 9 pharmacological management strategies were included. When compared to placebo, corticosteroids and the combination of NSAIDs+opioids were more effective in decreasing pain following non-surgical endodontic treatment (respectively; 6-8h: MD=-25, 95%CrI=-44 to -6.0, SUCRA=75.48%, low confidence; MD=-24, 95%CrI=-55 to 5.8, SUCRA=70.97%, low confidence; 24h: MD=-17, 95%CrI=-31 to -3.9, SUCRA=73.89%; very low confidence; and MD=-23, 95%CrI=-47 to 1.2, SUCRA=81.03%, low confidence). At 12h, corticosteroids, the combination of NSAIDs+benzodiazepines and NSAIDs were highest ranked. At 48h, antibiotics was highest ranked, followed by NSAIDs+opioids and corticosteriods. Additional subgroup analysis based on ibuprofen dosage showed that when >400mg was used, the combination of NSAIDs+opioids, NSAIDS+acetaminophen, or NSAIDs alone were superior to corticosteroids at 6-8h, 24h and 48h postoperatively. No major safety concerns with any of the treatments were reported.
Conclusions: Very low to low quality of evidence suggest that a combination of NSAIDs with opioids, acetaminophen, or benzodiazepines are the effective strategies to decrease postoperative pain following non-surgical endodontic treatment for symptomatic patients with irreversible pulpitis or necrotic teeth. Further RCTs are needed to evaluate different strategies and doses of these medications.
Methods: Major databases were searched. Two review authors selected studies and extracted data. Data from eligible randomized controlled trials were meta-analyzed to estimate the treatment effects [mean difference (MD); 95% credible interval (CrI) and surface under the cumulative ranking curve (SUCRA)] at 6-8, 12, 24 and 48 hours(h) postoperatively. CINeMA was used to assess the quality of results.
Results: 13 studies involving 9 pharmacological management strategies were included. When compared to placebo, corticosteroids and the combination of NSAIDs+opioids were more effective in decreasing pain following non-surgical endodontic treatment (respectively; 6-8h: MD=-25, 95%CrI=-44 to -6.0, SUCRA=75.48%, low confidence; MD=-24, 95%CrI=-55 to 5.8, SUCRA=70.97%, low confidence; 24h: MD=-17, 95%CrI=-31 to -3.9, SUCRA=73.89%; very low confidence; and MD=-23, 95%CrI=-47 to 1.2, SUCRA=81.03%, low confidence). At 12h, corticosteroids, the combination of NSAIDs+benzodiazepines and NSAIDs were highest ranked. At 48h, antibiotics was highest ranked, followed by NSAIDs+opioids and corticosteriods. Additional subgroup analysis based on ibuprofen dosage showed that when >400mg was used, the combination of NSAIDs+opioids, NSAIDS+acetaminophen, or NSAIDs alone were superior to corticosteroids at 6-8h, 24h and 48h postoperatively. No major safety concerns with any of the treatments were reported.
Conclusions: Very low to low quality of evidence suggest that a combination of NSAIDs with opioids, acetaminophen, or benzodiazepines are the effective strategies to decrease postoperative pain following non-surgical endodontic treatment for symptomatic patients with irreversible pulpitis or necrotic teeth. Further RCTs are needed to evaluate different strategies and doses of these medications.
