Efficacy of Systemic and Local Premedication on Anesthetic Success of Teeth with Irreversible Pulpitis: An Umbrella Review

This umbrella review summarized evidence from systematic reviews of randomized clinical trials regarding the efficacy of systemic and local premedication on anesthetic success in nonsurgical root canal treatment of teeth with symptomatic irreversible pulpitis. Searches were conducted in PubMed, Scopus, Web of Science, Cochrane Library, EMBASE, LILACS/BBO, and gray literature sources up to February 2025. Methodological quality was assessed using AMSTAR-2. The risk of bias was evaluated using the ROBIS tool. The Corrected Covered Area (CCA) was calculated to quantify the primary study overlap. Data regarding risk ratios and anesthetic success rates were synthesized qualitatively. Sixteen systematic reviews were included. The narrative synthesis suggests that oral NSAIDs (particularly ibuprofen > 400 mg and ketorolac 10–20 mg) and corticosteroids (dexamethasone) are associated with increased anesthetic success compared to placebo, with no significant difference between systemic and local administration. However, the reliability of these findings is impacted by the quality of the primary evidence: according to the appraisal, 13 reviews presented a high overall risk of bias/low methodological quality, while only three were classified as having low risk of bias. Furthermore, the CCA was 19.5%, indicating a high degree of redundancy among reviews. Consequently, while premedication appears effective, these conclusions must be interpreted with caution due to the substantial overlap and predominantly high risk of bias in the available literature.