Effect of Pre-emptive Injection-based Corticosteroid Administration and Its Routes on Post-Endodontic Pain: A...

Area of Science:

• Endodontics
• Pharmacology
• Pain Management

Background:

• Post-endodontic pain (PP) is a common complication after root canal treatment (RCT).
• Acute inflammation is the primary cause of PP.
• Pre-emptive corticosteroid administration is investigated to mitigate inflammation and reduce PP.

Purpose of the Study:

• To systematically review and meta-analyze the efficacy of injection-based corticosteroids in minimizing PP.
• To compare different administration routes (infiltrative, intraligamentary, intramuscular) and postoperative intervals.

Main Methods:

• A comprehensive literature search was performed across multiple databases up to March 2025.
• Included randomized controlled trials (RCTs) evaluating pre-emptive corticosteroid injections.
• Risk of bias was assessed using Cochrane RoB 2.0; meta-analyses were conducted using Review Manager 5.4.

Main Results:

• Nine RCTs involving 917 participants were analyzed.
• Corticosteroid injections (dexamethasone, methylprednisolone, betamethasone) significantly reduced PP compared to placebo.
• The most significant reduction was observed within 12 hours, with benefits extending up to 72 hours.
• Infiltrative injections showed greater efficacy than intraligamentary routes.

Conclusions:

• Pre-emptive corticosteroid injections are effective in reducing post-endodontic pain.
• Dexamethasone, administered via infiltrative or intraligamentary routes, provides significant pain relief, particularly within the first 24 hours post-treatment.