{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T23:03:30Z","timestamp":1791414210235,"version":"4.3.3"},"reference-count":38,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Endodontic J"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This systematic review with meta\u2010analysis 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2010effects meta\u2010analysis was used to calculate pooled effect risk ratios (RRs) with 95% confidence intervals (CIs). The primary meta\u2010analysis was conducted by including all the trials whilst sensitivity analyses were conducted only on trials with a low risk of bias. Sub\u2010group analyses were performed to assess the dose\u2013response effect. A TSA was performed to evaluate the risks of random errors in the meta\u2010analysis. The overall certainty of evidence was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 8 trials were included in the review. The primary meta\u2010analysis demonstrated that oral premedication with dexamethasone significantly increased the success rate of inferior alveolar nerve blocks (IANB) compared with a placebo (RR\u2009=\u20091.80; 95% CI, 1.35\u20132.41). The sensitivity analysis demonstrated a similar result compared to the primary analysis. The sub\u2010group analysis suggested that doses of both 0.5\u2009mg and 4\u2009mg were effective. Oral premedication with dexamethasone had the same effect on IANB success rates when compared to NSAIDs. The TSA confirmed that the evidence for a beneficial effect of oral dexamethasone premedication when compared to placebo for enhancing the anaesthetic efficacy of IANB in teeth with irreversible pulpitis was conclusive. The GRADE was rated as \u2018moderate\u2019 and \u2018high\u2019 when oral corticosteroids were compared with placebo and NSAID, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Oral corticosteroid premedication improves the efficacy of IANB compared to placebo and has a similar effect when compared to NSAIDs in mandibular teeth diagnosed with irreversible pulpitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Registration<\/jats:title>\n                    <jats:p>PROSPERO (CRD42024508463)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/iej.70162","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T04:35:41Z","timestamp":1776227741000},"page":"1766-1777","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effect of Oral Corticosteroid Premedication on the Success of Anaesthetising Mandibular Teeth With Irreversible Pulpitis: A Systematic Review With Meta\u2010Analysis and Trial Sequential Analysis of Randomized Clinical Trials"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7870-1403","authenticated-orcid":false,"given":"Nandini","family":"Suresh","sequence":"first","affiliation":[{"name":"Faculty of Dentistry, Department of Conservative Dentistry and Endodontics Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research (MAHER)  Chennai TamilNadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0103-1024","authenticated-orcid":false,"given":"Monika","family":"Arulalan","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, Department of Conservative Dentistry and Endodontics Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research (MAHER)  Chennai TamilNadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2165-4524","authenticated-orcid":false,"given":"Geethanjali Ravindra","family":"Raj","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, Department of Conservative Dentistry and Endodontics Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research (MAHER)  Chennai TamilNadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2878-6837","authenticated-orcid":false,"given":"Velmurugan","family":"Natanasabapathy","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, Department of Conservative Dentistry and Endodontics Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research (MAHER)  Chennai TamilNadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1930-8625","authenticated-orcid":false,"given":"Sheela B.","family":"Abraham","sequence":"additional","affiliation":[{"name":"Department of Restorative Dentistry College of Dental Medicine, University of Sharjah  Sharjah UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sajesh K.","family":"Veettil","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice School of Pharmacy, IMU University  Kuala Lumpur Malaysia"},{"name":"School of Medicine, Taylor's University  Selangor Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8464-0288","authenticated-orcid":false,"given":"Thiago C\u00e9sar da Silva","family":"Lima","sequence":"additional","affiliation":[{"name":"Restorative Dentistry Department School of Dentistry, Universidade Federal de Minas Gerais  Belo Horizonte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2062-2566","authenticated-orcid":false,"given":"Juliana Vilela","family":"Bastos","sequence":"additional","affiliation":[{"name":"Restorative Dentistry Department School of Dentistry, Universidade Federal de Minas Gerais  Belo Horizonte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaju Jacob","family":"Pulikkotil","sequence":"additional","affiliation":[{"name":"Prof. Shaju Jacob Pulikkotil Group, Oral Health Research, School of Dentistry, Riga Stradins University  Riga Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3783-3156","authenticated-orcid":false,"given":"Venkateshbabu","family":"Nagendrababu","sequence":"additional","affiliation":[{"name":"Department of Restorative Dentistry College of Dental Medicine, University of Sharjah  Sharjah UAE"},{"name":"Department of Conservative Dentistry and Endodontics Dr. D. 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