Beneficial effect of methylprednisolone after mandibular third molar surgery: a randomized, double-blind, placebo-controlled split-mouth trial

Effect of Preoperative Administration of Dexamethasone vs. Methylprednisolone in Surgical Extraction of Impacted Lower Third Molars: Randomized Controlled Clinical Trial

Background/Objectives: Glucocorticoids are drugs that are increasingly used in oral surgery to reduce trismus, inflammation, and postoperative pain, three frequent complications after the surgical extraction of impacted lower third molars. The aim of this study was to compare the effect of 8 mg dexamethasone versus 40 mg methylprednisolone in the prevention of postoperative complications after third molar surgery. Methods: A randomized double-blind clinical trial was conducted following CONSORT guidelines. In detail, 84 patients were included in the study, who randomly received a single preoperative submucosal dose of dexamethasone (8 mg) or methylprednisolone (40 mg). The variables analyzed, as primary outcomes, were trismus, inflammation, and postoperative pain. The measurements were performed at baseline (0 h), 3 h, 7 h, 24 h, 48 h, and 7 th day using a Visual Analog Scale (VAS), Verbal Rating Scale (VRS), and the Gabka-Matsumara method. Results: Dexamethasone reduced trismus, inflammation, and postoperative pain significantly better than methylprednisolone. Conclusions: Preoperative submucosal administration of 8 mg dexamethasone is effective and safe in reducing the severity of postoperative complications following surgical extraction of impacted lower third molars.

Three-dimensional facial swelling evaluation of pre-operative single-dose of prednisone in third molar surgery: a split-mouth randomized controlled trial

BACKGROUND

Facial swelling, pain, and trismus are the most common postoperative sequelae after mandibular third molar (M3M) surgery. Corticosteroids are the most used drugs to reduce the severity of inflammatory symptoms after M3M surgery. This study aimed to evaluate the effect of a single pre-operative dose of prednisone on pain, trismus, and swelling after M3M surgery.

METHODS

This study was designed as a split-mouth randomized, controlled, triple-blind trial with two treatment groups, prednisone (PG) and control (CG). All the parameters were assessed before the extraction (T0), two days (T1), and seven days after surgery (T2). Three-dimensional evaluation of facial swelling was performed with Bellus 3D Face App. A visual analogue scale (VAS) was used to assess pain. The maximum incisal distance was recorded with a calibrated rule to evaluate the trismus. The Shapiro-Wilk test was used to evaluate the normal distribution of each variable. To compare the two study groups, the analysis of variance was performed using a two-tailed Student t-test for normal distributions. The level of significance was set at a = 0.05. Statistical analysis was conducted using the software STATA (STATA 11, StataCorp, College Station, TX).

RESULTS

Thirty-two patients were recruited with a mean age of 23.6 ± 3.7 years, with a male-to-female ratio of 1:3. A total of 64 M3Ms (32 right and 32 left) were randomly assigned to PG or CG. Surgery time recorded a mean value of 15.6 ± 3.7 min, without statistically significant difference between the groups. At T1, PG showed a significantly lower facial swelling compared to CG (PG: 3.3 ± 2.1 mm; CG: 4.2 ± 1.7 mm; p = 0.02). Similar results were recorded comparing the groups one week after surgery (PG: 1.2 ± 1.2; CG: 2.1 ± 1.3; p = 0.0005). All patients reported a decrease in facial swelling from T1 to T2 without differences between the two groups. At T1, the maximum buccal opening was significantly reduced than T0, and no difference between PG (35.6 ± 8.2 mm) and CG (33.7 ± 7.3 mm) (p > 0.05) was shown. Similar results were reported one week after surgery (PG: 33.2 ± 14.4 mm; CG: 33.7 ± 13.1 mm; p > 0.05). PG showed significantly lower pain values compared to CG, both at T1 (PG: 3.1 ± 1.5; CG: 4.6 ± 1.8; p = 0.0006) and T2 (PG: 1.0 ± 0.8; CG: 1.9 ± 1.4; p = 0.0063).

CONCLUSION

Our results showed that pre-operative low-dose prednisone administration could reduce postoperative sequelae by improving patient comfort after M3M surgery and reducing facial swelling two days and one week after surgical procedures.

TRIAL REGISTRATION

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CLINICALTRIALS

gov - NCT05830747 retrospectively recorded-Date of registration: 26/04/2023.

Evaluation of the Efficacy of Oral and Intramuscular Administration of Dexamethasone on Postoperative Pain, Swelling, and Trismus After Surgical Removal of Impacted Third Molar: A Comparative Split-Mouth Study

Context Over the past 60 years, several researchers have conducted extensive studies on the use of dexamethasone to reduce the postoperative complications of lower third molar surgery, namely, pain, edema, and trismus. In this study, we compared the oral and intramuscular methods of dexamethasone administration. Purpose The aim of this research was to assess pain, edema, and trismus in the postoperative period following the surgical removal of the lower third molar using 8 mg of dexamethasone given orally or by intramuscular injection. Method A split-mouth technique was employed for the study, in which each of the two bilaterally impacted mandibular third molars was removed one at a time, separated by at least two weeks. There were 26 participants in this experiment. Two groups were created from the research sample: group A (injection dexamethasone) and group B (tablet dexamethasone). The pain was assessed on the first, second, and third postoperative days. On the first, third, and seventh postoperative days, the parameters, such as edema and trismus, were evaluated. Results As per our study, in terms of edema and trismus, there was less of a statistically significant difference between the two interventions at all time points. While the pain score had a significant difference between both interventions. Conclusion Hence, we conclude that oral dexamethasone is an effective alternative to intramuscular dexamethasone. Oral dexamethasone is comparatively simple, less invasive, painless, and easy for the surgeon and for apprehensive patients, and it offers a cost-effective solution for the suffering often associated with the extraction of impacted lower third molars.

Twin Mixed Local Anesthesia in Third Molar Surgery - Randomized Controlled Trial

PURPOSE

The aim of this study was to compare the clinical efficacy of injection of 2 long-acting amide local anesthetic agents - bupivacaine and ropivacaine with and without 4 mg dexamethasone in patients undergoing third molar extraction.

METHODS

A prospective randomized double blind controlled trial was conducted among 68 patients with impacted mandibular third molars. Group A and B were the control groups and received 1.8 mL of 0.5% bupivacaine hydrochloride and 0.75% ropivacaine hydrochloride, respectively. Group A1 and B1 were experimental groups and received modified twin mixes which were 1.8 mL of 0.5% bupivacaine hydrochloride + 1mL/4mg dexamethasone and 0.75% ropivacaine hydrochloride + 1 mL/4mg dexamethasone, respectively. Visual analog pain scale, mouth opening measurement and facial swelling were assessed at the time of injection and postoperative days 1, 3, and 7.

RESULTS

The mean visual analogue scale score for pain on local anesthesia injection was found to be less in both experimental groups- Group A1 (2.94) and B1 (2.41) as compared to control groups- Group A (3.59) and B (3.06). The durations of soft tissue anesthesia were higher as compared to their respective controls for both Group A1 and B1. Patients in both control groups A and B had an increased postoperative swelling, pain and trismus.

CONCLUSIONS

Intraoperative and postoperative comfort in both the experimental groups were higher than those for control groups, thereby establishing the clinical efficacy of both modified twin mixes for use in surgical extraction of mandibular third molars.

Do corticosteroids reduce postoperative pain following third molar intervention?

Background

Corticosteroids have been widely used by oral surgeons for reducing swelling caused by wisdom teeth surgery. However, they have not been proven to decrease pain. This study was aimed at analyzing previous studies pertaining to corticosteroids and pain reduction following wisdom teeth surgery.

Methods

The Science Direct, PubMed, and MEDLINE databases were searched for relevant journals according to a systematic search strategy (Patient Intervention Comparison Outcome Study). Randomized controlled trials published in English from 1998 to 2017 were extracted.

Results

Twenty-seven articles were included, with a total of 36 comparative cases. Methylprednisolone and dexamethasone were the most commonly used corticosteroids. Intramuscular injections of corticosteroids were optimal for pain reduction, regardless of the time of administration.

Conclusions

Corticosteroids can be used as an adjuvant for pain reduction following wisdom teeth surgery. Methylprednisolone and dexamethasone delivered via the intramuscular route is the best method for effective pain reduction. The ideal time for administration of corticosteroids is the preoperative period.

Efficacy of Various Routes of Dexamethasone Administration in Reducing Postoperative Sequelae Following Impacted Third Molar Surgery

Aim:

To compare the efficacy of intravenous (IV), intramassetric (IM) submucosal (SM) routes & oral routes of dexamethasone administration post impacted third molar removal surgery.

Type of Study:

Prospective randomized comparative clinical study.

Materials and Method:

This prospective comparative study included 60 patients with Class II and position B type of impaction (according to Pell and Gregory's classification). Patients were randomly divided into 4 groups. Group A, B, C & D patients received 8mg dexamethasone immediately post-surgical tooth removal via the IV, SM and IM route & oral respectively. Assessment of swelling, mouth opening and pain was done at intervals of 1st, 3rd and 7th post-op days.

Results:

The average age of the patients was 27 years. The mean time taken was 20 mins 40 seconds. The IV group showed minimal swelling and better pain control on the 3rd post op day (statistically significant). All 4 routes showed comparable mouth opening results.

Conclusion:

IV administration of dexamethasone post third molar surgery has been the traditional way because of its faster onset of action and increased efficacy; IM and SM routes are also comparably effective although oral route had the best patient acceptance.

Parecoxib Shortens the Duration of Acute Postoperative Pain After Laparoscopic-Assisted Vaginal Hysterectomy

The effect of parecoxib sodium on the duration and severity of acute postoperative pain after laparoscopic-assisted vaginal hysterectomy has been inadequately studied. This randomized, controlled trial compared the effects of parecoxib, methylprednisolone, and placebo on the duration of acute postoperative pain after elective laparoscopic-assisted vaginal hysterectomy. Ninety-four eligible patients were randomized to three groups [parecoxib sodium 40 mg (Group P), methylprednisolone 1 mg/kg (Group M), and saline (Group S)]. The duration of pain during coughing [median (interquartile range)] was significantly lower in Group P than in Group M or Group S [26.0 (5.8–48.0) vs. 48.0 (30.0–55.5) vs. 48.0 (36.0–58.5) h; p = 0.025]. The duration of pain during rest was also significantly lower in Group P than in Group M or Group S [5.5 (3.8–21.0) vs. 24.0 (6.0–28.0) vs. 22.0 (5.8–36.0) h; p = 0.009]. Compared with those in Group M and Group S, the patients in Group P reported less intense visceral pain during coughing at 12 (p = 0.050) and 24 h (p = 0.009) as well as at rest at 12 h (p = 0.008). Compared with those in Group P and Group S, the patients in Group M showed lower serum C-reactive protein levels and higher blood glucose levels after surgery. No differences were noted in nausea, vomiting, length of hospital stay, wound infection, and delayed wound healing among the groups. Thus, parecoxib sodium reduces the duration and intensity of acute postoperative pain after laparoscopic-assisted vaginal hysterectomy.

A Comparative Study on the Efficacy of Submucosal Injection of Dexamethasone Versus Methylprednisolone in Reducing Postoperative Sequelae After Third Molar Surgery

PURPOSE

To compare the efficacy of preoperative submucosal injection of 4 mg of dexamethasone versus 40 mg of methylprednisolone in reducing postoperative sequelae after surgical removal of impacted mandibular third molars.

PATIENTS AND METHODS

This prospective, randomized, double-blind study included 65 patients who required surgical removal of impacted mandibular third molars with Class II or position B impaction (Pell and Gregory classification). Patients were randomly assigned to 1 of 3 groups: dexamethasone, methylprednisolone, or placebo (control). Surgery was performed with patients under local anesthesia. Baseline measurements were obtained preoperatively, and subsequent assessments were made on postoperative day 1, 2, 5, and 7 to measure postoperative facial swelling by use of 2 linear measurements: interincisal mouth opening width and visual analog scale score for pain. The amount of analgesics consumed was recorded. Wound healing also was assessed on postoperative day 7. Descriptive and multivariate statistics were computed, and significance was set at P < .05.

RESULTS

Both methylprednisolone and dexamethasone significantly reduced swelling and trismus (P < .05, Kruskal-Wallis test), whereas the methylprednisolone group had significantly less pain (P < .05, Kruskal-Wallis test) and consumed a lower amount of analgesics (P < .05, χ² test) during the early postoperative days.

CONCLUSIONS

The study findings suggest that a single preoperative dose of dexamethasone versus methylprednisolone was equally effective in reducing postoperative swelling and trismus. Pain control by these corticosteroids, however, was variable.

Do Corticosteroids Still Have a Role in the Management of Third Molar Surgery?

INTRODUCTION

The use of corticosteroids to reduce the post-operative sequelae of lower third molar surgery, namely pain, swelling and trismus, has been well studied by many researchers over the past 6 decades. This study reviewed the reported outcome of corticosteroids used in controlling the above sequalae after third molar surgery.

MATERIALS AND METHODS

A PubMed, Medline, EMBASE and Google search was undertaken of all controlled clinical trials on the effects of corticosteroids on pain, swelling and trismus after lower third molar surgery. The review was limited to studies published over the last 10 years (2006-2015).

RESULTS

Of the 46 initially retrieved articles, 34 were finally included. Eleven studies compared the effect of 2 similar (but different dose) or different group of corticosteroids. Thirty-one studies reported the effects of corticosteroids on all sequale, 2 reported the outcome on swelling and trismus and another 1 on swelling and pain only. In 16 of the studies, corticosteroid use resulted in significant reductions in pain after third molar removal. Twenty-two out of 29 studies reported reduced swelling against negative control while 18 out of 25 studies reported improved mouth opening. Fourteen studies reported the benefit of corticosteroids on all 3 sequelae, with 71.4% resulted from the use of methylprednisolone.

CONCLUSION

Although there are some conflicting effects, the results of this analysis shows in general the benefits derived from short-term use of corticosteroids in relation to pain, swelling and trismus following third molar surgical extraction, with no side effects observed.

FUNDING

This work was supported by the University of Malaya's High Impact Research grant UM.C/625/1/HIR/MOHE/05.

Randomized Controlled Trial to Evaluate the Efficacy of Oral Dexamethasone and Intramuscular Dexamethasone in Mandibular Third Molar Surgeries

INTRODUCTION

Surgical removal of impacted third molar is the most commonly performed dento-alveolar procedure and is associated with post-operative pain, swelling and trismus.

AIM

The aim of the study was to compare the efficacy of dexamethasone administered orally with that of dexamethasone administered as an intra-masseteric injection in surgical removal of mandibular third molars.

MATERIALS AND METHODS

Sixty patients with impacted mandibular third molars were selected to undergo surgical removal of mandibular third molars. They were divided into three groups of twenty each, viz., Control Group, Group taking Oral dexamethasone and Group taking Intra-masseteric dexamethasone. Evaluation was done over a period of seven days postoperatively to study the effects of the drug in terms of swelling, trismus and pain.

RESULTS

ANOVA test was done and comparisons were made. It was found that there was a statistically significant difference with respect to the group taking oral dexamethasone in terms of resolution of trismus. It was also found that there was no statistical significance with respect to reduction in swelling in either of the groups.

CONCLUSION

Thus, it can be concluded that the oral route is superior compared to the intramuscular route when administering dexamethasone in surgical removal of mandibular third molars, with respect to drug dosage, bio-availability and resolution of trismus.

Comparison of the efficacy of low doses of methylprednisolone, acetaminophen, and dexketoprofen trometamol on the swelling developed after the removal of impacted third molar

BACKGROUND

The aim of the present study was to compare the efficacy of low doses of methylprednisolone, acetaminophen and dexketoprofen trometamol, which are among the drug groups used in our clinic, on postoperative swelling developing after removal of impacted third molar.

MATERIAL AND METHODS

The three group of patients received either 40 mg methylprednisolone or 300 mg acetaminophen or 12.5 mg dexketoprofen trometamol one hour before the procedure, according to the patient groups. The patients in the methylprednisolone group were injected with methylprednisolone at a dose of 20 mg 24 hour after the procedure and prescribed 300 mg acetaminophen as rescue analgesic. During the postoperative period, the doses that were given before the procedure were continued 3 times a day for 2 days in the acetaminophen and dexketoprofen trometamol groups. Maximal swelling was assessed preoperatively and at the postoperative 48 hours by ultrasound images.

RESULTS

Swelling was 34% lower in the methylprednisolone than in the other groups; however, no statistically significant difference was found between the groups. The acetaminophen and dexketoprofen trometamol groups exhibited clinical results close to each other.

CONCLUSIONS

Combination of low doses of methylprednisolone and acetaminophen provide a safe and adequate clinical success on swelling.

Effect of the route of administration of methylprednisolone on oedema and trismus in impacted lower third molar surgery

Due to their anatomical position, the surgical removal of impacted third molars results in oedema, pain, and trismus. The purpose of this study was to evaluate the efficacy of supraperiosteal injection of methylprednisolone compared with an oral tablet form and intravenous (i.v.) injection in the prevention of postoperative pain and oedema associated with inflammation. This randomized, prospective, and controlled study included 44 patients. The patients were randomly divided into four groups: group 1 (control; no steroids), group 2 (local injection), group 3 (oral tablets), and group 4 (i.v. injection). On days 2 and 7 following surgery, linear oedema was determined using facial landmarks, and maximal mouth opening was measured. Postoperative mouth opening and swelling were evaluated for each route of methylprednisolone administration and compared. The female (59%) to male (41%) ratio was 1.44; the mean age of the patients was 29.6 years. The level of significance was set at P<0.01 for mouth opening and P<0.05 for oedema. With regard to trismus, all three routes of administration demonstrated better efficacy in comparison to the control. While oral administration and i.v. injection of methylprednisolone achieved similar results, masseter injection provided better results in reducing oedema and trismus when compared to the control following lower third molar surgery.