Analgesic Efficacy of Celecoxib Versus Ibuprofen After Third Molar Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
TL;DR
Overall, celecoxib and ibuprofen demonstrated broadly comparable analgesic efficacy following third-molar surgery, and current evidence does not establish consistent overall superiority over ibuprofen.
Abstract
Third-molar surgery is commonly associated with acute postoperative pain, for which nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used. Celecoxib, a selective cyclooxygenase-2 inhibitor, may provide effective analgesia while potentially offering improved tolerability compared with conventional nonselective NSAIDs. We performed a systematic review and meta-analysis of randomized trials that compared celecoxib with ibuprofen following surgical extraction of the impacted mandibular third molars. Scopus, PubMed, Web of Science (WoS), and the Cochrane Central Register of Controlled Trials were searched from inception to August 2026. Ten RCTs involving 1,090 patients were included, with 671 patients receiving celecoxib and 419 receiving ibuprofen. Postoperative pain was evaluated at 4-8, 12-16, and 24 hours using the visual analog scale (VAS), total pain relief (TOPAR/TOTPAR), and sum of pain relief and pain intensity difference (SPRID/SPID). No significant differences were observed between celecoxib and ibuprofen at 4-8 or 12-16 hours across any of the pain assessment scales. At 24 hours, celecoxib was associated with significantly lower VAS pain scores (standardized mean difference [SMD], −0.35; 95% CI, −0.61 to −0.08; p = 0.01), whereas no significant difference was observed using TOPAR/TOTPAR (SMD, 0.36; 95% CI, −0.00 to 0.73; p = 0.05). Rescue analgesic use did not differ significantly between groups (RR, 1.00; 95% CI, 0.80-1.25; p = 1.00) and neither did adverse events (RR, 0.93; 95% CI, 0.65-1.32; p = 0.67). Trial sequential analysis did not provide conclusive evidence of a beneficial effect. Overall, celecoxib and ibuprofen demonstrated broadly comparable analgesic efficacy following third-molar surgery. Although celecoxib may provide a modest reduction in pain intensity at 24 hours, current evidence does not establish consistent overall superiority over ibuprofen.