Effect of Oral Corticosteroid Premedication on the Success of Anaesthetising Mandibular Teeth With Irreversible Pulpitis: A Systematic Review With Meta-Analysis and Trial Sequential Analysis of Randomized Clinical Trials
Abstract
Objectives: This systematic review with meta-analysis and trial sequential analysis (TSA) was conducted with the objective of evaluating the effectiveness of oral corticosteroid premedication to achieve profound mandibular anaesthesia in teeth diagnosed with irreversible pulpitis.
Methods: An electronic search was conducted in PubMed/MEDLINE, Cochrane Library, Embase, Scopus and Web of Science to identify randomized clinical trials that evaluated the effect of oral corticosteroid premedication on the success of mandibular anaesthesia in patients with irreversible pulpitis. The search was performed without date restrictions and limited to trials in English. The risk of bias was assessed using the Cochrane risk of bias tool for randomized trials (RoB 2.0). A random-effects meta-analysis was used to calculate pooled effect risk ratios (RRs) with 95% confidence intervals (CIs). The primary meta-analysis was conducted by including all the trials whilst sensitivity analyses were conducted only on trials with a low risk of bias. Sub-group analyses were performed to assess the dose-response effect. A TSA was performed to evaluate the risks of random errors in the meta-analysis. The overall certainty of evidence was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Results: A total of 8 trials were included in the review. The primary meta-analysis demonstrated that oral premedication with dexamethasone significantly increased the success rate…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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