ID study and study design
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Treatments (n)
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Details of patients, dental procedure, and evaluation
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Important results of conclusion
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Aggarwal et al. 2011 [8].
Randomized, double-blind, parallel, clinical investigation.
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Group A: Dexamethasone 4 mg / 1 mL (n=23)
Group B: 4% Articaine and 1:100000 epinephrine / 1.8 mL (n=24).
Group C: 4% Articaine plus ketorolac 30 mg / 1 mL (n=24).
Group D: Patients received no any treatment (n=23).
All treatments were done as pre-anesthetic supplemental buccal injection.
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ASA I or II patients with pain in a lower molar (moderate and severe pain) and diagnosis of SIP with a normal periapical radiograph.
Patients without NSAIDs, at least 12 h before the study.
All patients were given an IANB using lidocaine 2% and 1: 200,000 epinephrine.
Success rate was evaluated.
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Administration of dexamethasone increased the success index of local anesthesia.
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Aggarwal et al. 2021 [9].
Randomized, double-blind, parallel, clinical assay.
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Group A: 1.8 mL of Dexamethasone 4 mg / 1mL (n=37).
Group B: 1.8 mL of Diclofenac from a vial with 75mg / 3mL (n=38).
Group C: Normal saline 0.9% / 1.8 mL (n=37).
All treatments were performed as pre-anesthetic intraligamentary administration.
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ASA I or II patients with pain in a lower molar (moderate and severe pain) and diagnosis of SIP with a normal periapical radiograph.
Patients with prolonged positive response to cold tests.
For all patients, IANB was performed using lidocaine 2% and 1: 200,000 epinephrine was employed.
The anesthetic success index and the heart rates were assessed.
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Intraligamentary dexamethasone administration increased the success rate of anesthesia.
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Aksoy and Ege, 2020 [10].
Randomized, double-blind, parallel, clinical trial.
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Group A: Dexamethasone 8 mg /2 mL (n=30).
Group B: Tramadol 100 mg / 2mL (n=30).
Group C: Normal saline 0.9% / 2 mL (n=30).
All treatments were given (2 mL volume) across the mucobuccal fold of the mandibular molar after anesthesia.
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Healthy patients aged 18 to 65 years old with a diagnosis of SIP (moderate to severe pain) in a mandibular molar, radiographically normal periapical area, and no pain on percussion were included.
Patients without analgesic medication, at least 12 h before the study.
Patients with prolonged positive response to cold tests.
All patients were administered an IANB using 4% articaine with 1: 200,000 epinephrine.
Postoperative pain intensity, rescue analgesic medication, and adverse effects were evaluated.
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Dexamethasone was more effective for pain control when compared to saline.
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Aksoy et al. 2021 [11].
Randomized, double-blind, parallel, clinical assay.
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Group A: Dexamethasone 8 mg / 2 mL (n=30).
Group B: Tramadol 100 mg / 2 mL (n=30).
Group C: Articaine 4% / 1.8 mL (n=30).
Group D: Normal saline 0.9% / 2 mL (n=30).
All treatments were given (2 mL volume) across the mucobuccal fold of the mandibular molar after anesthesia.
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Healthy patients aged 18 to 65 years old with a diagnosis of SIP (moderate to severe pain) in a mandibular molar, radiographically normal periapical area and no pain on percussion were included.
Patients without analgesic medication, at least, 24 h before the study.
Patients with prolonged positive response to cold tests.
All patients were given an IANB using 4% articaine with 1: 200,000 epinephrine.
Anesthesia was successful when the pain level of patients included no pain or mild pain.
Sensory blockade, duration of anesthesia, success index, and adverse effects were assessed.
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Dexamethasone increased the duration of anesthetic activity when compared to saline.
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Bidar et al. 2017 [14].
Randomized, double-blind, parallel, clinical investigation.
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Group A: Dexamethasone 4 mg (n=26).
Group B: Ibuprofen 400 mg (n=26)
Group C: Placebo (n=26).
All treatments were administered by oral route.
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Good health in patients over 18 years old and a lower first or second molar with a diagnosis of SIP (moderate to severe pain) were included.
Patients with prolonged positive response to cold tests.
Patients without analgesic medication, at least 8 h before the study.
Standard IANB using 2% lidocaine and 1:80,000 epinephrine was used.
Anesthesia was successful when the pain level of patients was no pain or mild pain.
The anesthetic success and side effects were evaluated.
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Dexamethasone increased the anesthetic success versus placebo.
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El-Glil et al. 2021 [15].
Randomized, double-blind, parallel, clinical assay.
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Group A: 0.4 mL of Dexamethasone 8 mg / 2 mL (n=14).
Group B: 0.4 mL Piroxicam 20 mg / mL (n=14).
Group C: 0.4 mL of Mepivacaine 2% and 1:20,000 levonordefrin (n=14).
A intraligamentary injection was used for the administration of the drugs.
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ASA I or II patients (20 to 60 years old) with pain in a lower molar (moderate and severe pain) and diagnosis of SIP with a normal periapical radiograph.
Patients without analgesic medication or corticosteroids, at least 24 h before the study.
IANB with mepivacaine 2% and 1:20,000 levonordefrin was employed.
Post-endodontic pain was evaluated.
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Dexamethasone was more effective than mepivacaine/levonordefrin for pain control at 4, 6, 12, 24, and 48 postoperative hours.
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Kaushik et al. 2020 [16].
Randomized, double-blind, parallel, clinical trial.
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Group A: Dexamethasone 4 mg / 1 mL (n=34).
Group B: Distilled water / 1 mL (n=35).
Treatments were given by the submucosal route.
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Patients diagnosed with SIP (moderate and severe pain) involving the mandibular molars without associated pathology.
Patients with prolonged positive response to cold tests.
IANB 2% lidocaine with 1:200,000 epinephrine was used.
Anesthesia success was evaluated.
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A similar anesthetic success index between dexamethasone and distilled water was observed.
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Kumar et al. 2021 [17].
Randomized, double-blind, parallel, clinical investigation.
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Group A: Dexamethasone 0.5 mg (n=21).
Group B: Ibuprofen 800 mg (n=21).
Group C: Dexamethasone-ibuprofen combination (n=23).
Group D: Placebo (n=20).
Oral premedication.
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ASA I or II patients with pain in a lower molar (moderate and severe pain) and diagnosis of SIP with a normal periapical radiograph.
Patients taken not any analgesics for at least 12 hours before the study.
Patients with prolonged positive response to cold tests.
For all subjects, IANB was performed using lidocaine 2% and 1: 200,000 epinephrine.
Overall anesthesia success rate was assessed.
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A similar anesthesia rate for dexamethasone and placebo was reported.
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Mehrvarzfar et al. 2008 [19].
Randomized, double-blind, parallel, clinical study.
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Group A: Dexamethasone 8 mg / 2 mL (n=50).
Group B: Placebo (lidocaine 2% / 1.8 mL) (n=50).
All treatments were given like a supraperiosteal injection (periapical region) after anesthesia.
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ASA I or II patients aged 21 to 58 years old with a diagnosis of SIP (moderate to severe pain) in an incisor or premolar.
Patients with positive thermal and electrical tests.
The local anesthetic used in all patients was not indicated.
Post-endodontic pain was evaluated using VAS.
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Dexamethasone is more effective for post-endodontic pain control during the first 24 h than placebo.
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Mehrvarzfar et al. 2016 [18].
Randomized, double-blind, parallel, clinical trial.
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Group A: 0.2 mL of Dexamethasone 8 mg / 2 mL (n=20).
Group B: 0.2 mL of Lidocaine 2% / and 1:80,000 epinephrine mL (n=20).
Group C: 0.2 mL of saline (n=20).
All treatments were administered using a periodontal intraligamentary injection after anesthesia.
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ASA I or II patients aged 18 to 65 years old and clinical manifestation of SIP (moderate to severe pain) without radiographic periapical lesion.
Patients with prolonged positive response to cold tests.
Intake of opioid analgesics, NSAIDs, corticosteroids, and three-cyclic antidepressants 12 h before treatment.
Administration of 1.8 mL of 2% lidocaine with 1: 80,000 epinephrine was used to obtain the block of maxillary molars or achieving IANB for mandibular molars.
Post-endodontic pain intensity, the rescue analgesic intake, and adverse effect were recorded.
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Dexamethasone reduced the postoperative pain when compared to placebo.
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Shahi et al. 2013 [20].
Randomized, double-blind, parallel, clinical assay.
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Group A: Dexamethasone 0.5 mg (n=55).
Group B: Ibuprofen 400 mg (n=55).
Group C: Placebo (n=55).
All patients received the experimental treatments orally.
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Good health in patients (aged ≥ 18) with SIP on mandibular first or second molar and a normal periapical radiograph.
Patients not taking any analgesics for at least 12 hours before the study.
Patients with prolonged positive response to cold tests.
IANB with 2% lidocaine with 1:80,000 epinephrine was used.
The anesthesia success and side effects were assessed.
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Dexamethasone increased the anesthetic success in comparison to placebo.
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Shokri et al. 2018 [21].
Randomized, double-blind, parallel, clinical investigation.
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Group A: Dexamethasone 4 mg (n=25).
Group B: Ibuprofen 400 mg (n=25).
Group C: Placebo (n=25).
All treatments were administered using the oral route.
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Emergency patients diagnosed with SIP of a mandibular posterior tooth.
IANB was done. However, the anesthetic agent used was not informed.
The anesthesia success was analyzed.
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Dexamethasone increased the anesthetic success when compared to placebo.
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Suresh et al. 2020 [22].
Randomized, double-blind, parallel, clinical study.
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Group A: Dexamethasone 4 mg (n=40).
Group B: Piroxicam 20 mg (n=40).
Group C: Prednisolone 20 mg (n=40).
Group D: Placebo (n=40).
All patients took oral treatments.
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Systemic healthy patients aged 18 to 60 years old with diagnosed with SIP at a maxillary or mandibular tooth and a normal periapical radiograph.
Patients with prolonged positive response to cold tests.
Patients taken not any analgesics, steroids, or antibiotics for at least 24 hours before the study.
Lidocaine 2% and epinephrine 1:100,000 were used to perform the IANB.
Post-endodontic pain was assessed at 6, 12, 24, 48, and 72 h.
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Dexamethasone reduced the postoperative pain when compared to placebo.
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Yavari et al. 2019 [23].
Randomized, double-blind, parallel, clinical trial.
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Group A: 0.7 mL of Dexamethasone 4 mg / mL (n=64)
Group B: 0.7 mL of long-acting dexamethasone 4 mg / mL (n=66).
Group C: 0.7 mL of saline 0.9% (n=64).
All treatments were administered via the submucosal route after anesthesia.
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Healthy individuals aged 20 to 50 years old and presenting a diagnosis of symptomatic and asymptomatic irreversible pulpitis with a normal periapical condition.
Ibuprofen 1.6 g during 2 previous days was used.
Patients with prolonged positive response to cold tests.
For all subjects, the IANB was performed using lidocaine and 1: 100,000 epinephrine.
Post-treatment pain was evaluated with VAS.
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Both dexamethasone groups had better postoperative pain relief than saline.
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