This systematic review (SR; PROSPERO database: CRD42017075160) and network meta-analysis (NMA) identified the most effective oral
premedication for anaesthetic success of inferior alveolar nerve blocks (IANB) in cases of irreversible
pulpitis. Medline and Ebscohost databases were searched up until 10/2017. Randomized controlled trials (RCT) studying the effect of oral
premedication, alone or in combination, on the success of IANB for cases of irreversible
pulpitis, compared to placebo or other oral
premedications, were included. Quality of the included studies was appraised by the revised Cochrane risk of bias tool for randomized trials. Pairwise analysis, NMA and quality of evidence assessment using GRADE criteria were performed. Nineteen studies (n = 1654 participants) were included. NMA demonstrated that compared to placebo,
dexamethasone was most effective in increasing anaesthetic success (RR, 2.92 [95% CI 1.74,4.91]; SUCRA = 0.96), followed by
NSAIDs (RR, 1.92 [95% CI 1.63,2.27], SUCRA = 0.738) and
Tramadol (RR, 2.03 [95% CI 1.18,3.49], SUCRA = 0.737).
Premedication with
acetaminophen added to
NSAIDs demonstrated similar efficacy as
NSAIDs alone (RR, 1.06 [95% CI 0.79,1.43]). Sensitivity analyses proved the superiority of
dexamethasone or
NSAIDs over any other
premedications. Subgroup analyses of specific dosages in comparison with placebo demonstrated that
dexamethasone 0.5 mg was most effective, followed by
ketorolac 10 mg,
piroxicam 20 mg,
ibuprofen 400 mg +
acetaminophen 500 mg and
Tramadol 50 mg.
Ibuprofen 400 mg, 600 mg and 800 mg had a significantly improved IANB success, while
Ibuprofen 300 mg had no effect. Oral
premedication with
dexamethasone,
NSAIDs or
Tramadol significantly increased anaesthetic success. More trials are needed to evaluate the
premedication effects of
dexamethasone or
Tramadol for improved anaesthetic success of IANB when treating irreversible
pulpitis.