Therapeutic management of dexamethasone in patients undergoing endodontics: a randomized clinical trial

Optimal postoperative analgesia remains pivotal in endodontic success, particularly under acute inflammatory conditions. Although glucocorticoids such as dexamethasone exhibit potent anti-inflammatory efficacy, their prophylactic application in endodontics has not been extensively validated. This study assessed whether preoperative dexamethasone offers superior analgesia to postoperative ibuprofen in endodontic pain control. A randomized, controlled Phase IV clinical trial was undertaken at the Faculty of Dentistry, University of Salamanca, involving 82 ASA I patients undergoing single-visit root canal treatment. Subjects were equally randomized into two arms: the experimental group received 4 mg oral dexamethasone one hour preoperatively, while the control group was administered 400 mg ibuprofen at four-hour intervals post-treatment. Postoperative pain was evaluated using the Visual Analog Scale (VAS) at 4, 6, 8, 12, and 24 h. Intergroup differences were analyzed using the Mann-Whitney U test. The dexamethasone cohort demonstrated statistically significant reductions in VAS scores between 6- and 24-h post-intervention (p < 0.001), with no adverse events or need for rescue analgesia observed. Gender-based variation in pain perception was not significant. A single 4 mg preoperative oral dose of dexamethasone markedly enhances early postoperative analgesia in root canal treatment relative to standard ibuprofen regimens. These results support its integration into preemptive root canal protocols, contingent upon further multicenter validation. Approved by the Bioethics Committee (Ref. 2025_01/345; March 10, 2025). Clinical trial registration: NCT069063150 (April 1, 2025).The study adhered to the ethical standards of the 1964 Declaration of Helsinki and its later amendments.