Background: Postoperative Endodontic Pain is a major concern for dentists and their patients, with pain having been reported to occur in 25%–40% of patients treated. Therefore, the aim of this systematic review and Network Meta-analysis (NMA) was to identify the safety and efficacy of pre- and post-medication for reducing postoperative endodontic pain. Methods: A literature search was performed in the SCOPUS, MEDLINE, and ScienceDirect, and Cochrane Central databases until December 2019 with no language restriction. Randomized controlled trials evaluating the efficacy of pre- or post-medications compared with other agents, placebo, or no treatment in adult patients who underwent endodontic surgery for postoperative pain were included. The mean difference of postoperative pain was measured using the Standardized Mean Difference (SMD) with its 95% confidence interval (95% CI). Results: This Systematic Review included 62 Articles. Of them, 50 studies were included in the NMA. Among all medications, corticosteroids were ranked as the best treatment for the reduction of postoperative pain at 6 and 12 hours with a significant reduction in postoperative pain scores [SMD= -1.18, 95% CI (-1.51: -0.85)] and [SMD= -1.39, 95% CI (-1.77: -1.02)], respectively. Cyclooxygenase-2 (COX-2) inhibitors were ranked as the best treatment for the reduction of postoperative pain at 8 and 24 hours with a significant reduction in postoperative pain scores [SMD= -2.86, 95% CI (-6.05: -1.66)] and [SMD= -1.27, 95% CI (-2.10: -0.43)], respectively. Non-steroidal anti-inflammatory drugs (NSAIDs) significantly reduced the postoperative pain scores in all durations. For postoperative pain at 6 hours, Indomethacin, Novafen, Naproxen, Prednisolone, Ketorolac, Betamethasone, Dexamethasone, Deflazacort, Rofecoxib, Piroxicam, and Ibuprofen significantly reduced the pain score when compared with a placebo. All of these drugs demonstrated a significant reduction at 12 hours except Ketorolac. Conclusion: The current evidence suggests that pre- and post-medication can reduce postoperative pain after nonsurgical root canal treatment. Corticosteroids and COX-2 inhibitors showed significant control of the pain up to 12 hours after administration. However, NSAIDs demonstrated a high efficacy from administration and until two days after treatment. Indomethacin, Novafen, prednisolone, and Naproxen were ranked first in most analyzed durations.

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Background: Plasma calprotectin is a persistent biomarker of insulin resistance (IR), gastroenteritis, and cardiovascular disease (CVD). Elevated plasma levels of calprotectin have been reported in a variety of chronic inflammatory conditions. Elevated calprotectin levels have been reported to predict microvascular alterations in type 2 diabetic patients. Aim of the Work:To evaluate if there is a relationship between serum calprotectin and peripheral neuropathy in type 2 Diabetic patients. Patients and methods:This study is a case-control study that was conducted on 60 subjects their age range 45-60 years old, divided into 3 groups underwent full clinical , neurological assessment and laboratory tests including (s.calprotectin ,hs CRP, HbA1C,cholesterol and TGs )Results: statistically significant higher in diabetic with peripheral neuropathy than diabetic without neuropathy and controls regarding HS CRP,S calprotectin,HbA1c, FbG,2hrpp. ROC curve shows best cut off point for S. calprotectin level between diabetic without neuropathy and diabetic with neuropathy was >3.01 with sensitivity of 55.0%, specificity of 90.0% and AUC of 72.6%. Significant positive correlation between s.calprotectin and (hs.crp , age, SBP,BMI , FbG, TGs) Conclusion: High levels of calprotectin detected in type 2 diabetic patients with peripheral neuropathy suggest that this molecule may have a role in pathogenesis of neuroinflammation among these patients. Serum calprotectin levels in the future may be used as potential markers of its presence, severity and progression of the diabetic peripheral neuropathy. Therapeutic strategies for blocking S100A9 and its activity are recently under development in inflammatory diseases.