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Salaberry DR, Bruno LH, Cirisola RWC, Longo PL, Chavantes MC, Navarro RS, Gonçalves MLL, Sobral APT, Gimenez T, Duran CCG, Motta LJ, Bussadori SK, Horliana ACRT, Mesquita Ferrari RA, Fernandes KPS. Assessment of the pre-emptive effect of photobiomodulation in the postoperative period of impacted lower third molar extractions: A randomized, controlled, double-blind study protocol. PLoS One 2024; 19:e0300136. [PMID: 38885236 PMCID: PMC11182519 DOI: 10.1371/journal.pone.0300136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/20/2024] [Indexed: 06/20/2024] Open
Abstract
Photobiomodulation is a safe option for controlling pain, edema, and trismus when applied postoperatively in third molar surgery. However, administration prior to surgery has been under-explored. This study aims to explore the effectiveness of pre-emptive photobiomodulation in reducing postoperative edema in impacted lower third molar extractions. Two groups of healthy individuals undergoing tooth extraction will be randomly assigned: Control group receiving pre-emptive corticosteroid and simulated photobiomodulation, and Photobiomodulation Group receiving intraoral low-intensity laser and extraoral LED cluster application. The primary outcome will be postoperative edema after 48 h. The secondary outcomes will be pain, trismus dysphagia, and analgesic intake (paracetamol). These outcomes will be assessed at baseline as well as two and seven days after surgery. Adverse effects will be recorded. Data will be presented as means ± SD and a p-value < 0.05 will be indicative of statistical significance.
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Affiliation(s)
- Daniel Rodríguez Salaberry
- Postgraduate Program in Biophotonics Medicine, Nove de Julho University, Sao Paulo, Sao Paulo, Brazil
- Dentistry School, Universidad Católica del Uruguay, Montevideo, Montevideo, Uruguay
| | - Laura Hermida Bruno
- Postgraduate Program in Biophotonics Medicine, Nove de Julho University, Sao Paulo, Sao Paulo, Brazil
- Dentistry School, Universidad Católica del Uruguay, Montevideo, Montevideo, Uruguay
| | - Rolf Wilhem Consolandich Cirisola
- Postgraduate Program in Biophotonics Medicine, Nove de Julho University, Sao Paulo, Sao Paulo, Brazil
- Dentistry School, Universidad Católica del Uruguay, Montevideo, Montevideo, Uruguay
| | - Priscila Larcher Longo
- Postgraduate Program in Biophotonics Medicine, Nove de Julho University, Sao Paulo, Sao Paulo, Brazil
- Postgraduate Program in Aging Science, São Judas Tadeu University, Sao Paulo, Sao Paulo, Brazil
| | - Maria Cristina Chavantes
- Postgraduate Program in Biophotonics Medicine, Nove de Julho University, Sao Paulo, Sao Paulo, Brazil
| | | | | | - Ana Paula Taboada Sobral
- Postgraduate Program in Health and Environment, Metropolitana de Santos University, Santos, Sao Paulo, Brazil
| | - Thais Gimenez
- Postgraduate Program in Health and Environment, Metropolitana de Santos University, Santos, Sao Paulo, Brazil
| | | | - Lara Jansiski Motta
- Postgraduate Program in Biophotonics Medicine, Nove de Julho University, Sao Paulo, Sao Paulo, Brazil
| | - Sandra Kalil Bussadori
- Postgraduate Program in Biophotonics Medicine, Nove de Julho University, Sao Paulo, Sao Paulo, Brazil
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University, Sao Paulo, Sao Paulo, Brazil
| | | | - Raquel Agnelli Mesquita Ferrari
- Postgraduate Program in Biophotonics Medicine, Nove de Julho University, Sao Paulo, Sao Paulo, Brazil
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University, Sao Paulo, Sao Paulo, Brazil
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Sainz de Baranda B, Silvestre FJ, Márquez-Arrico CF, Silvestre-Rangil J. Surgical difficulty and postoperative course of the third molar extraction under general anesthesia: An intervention trial. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101663. [PMID: 37890774 DOI: 10.1016/j.jormas.2023.101663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Third molar extractions are one of the most common surgical procedures in the area of stomatology. However, we know that even if they are minor surgeries, they can cause a postoperative period with local and systemic repercussions. Thus, the aim of this intervention trial is to determine the relationship between clinical parameters (pain, inflammation and trismus) and serum parameters (C-reactive protein (CRP), IL-6 and fibrinogen) that are modified in the first postoperative week, and the appearance of complications after extraction with general anesthesia, using the Pederson scale. METHODS The research question was: Can postoperative discomfort after third molar extraction under general anesthesia be predicted using Pederson scale? An interventional trial was carried out of third molar extractions under general anesthesia in Dr. Peset University Hospital. Patient selection was performed randomized using MS Excel. Then were divided into two groups (n = 126): group A (2 complex extractions) and group B (4 extractions: 2 simple and 2 complex). All parameters were collected at the surgery and 7 days after surgery. RESULTS The clinical postoperative parameters showed significant differences in relation to surgical difficulty. In summary, the degree of surgical difficulty can be predicted with the Pederson scale before extracting mandibular third molars. CRP and fibrinogen levels increase significantly with the degree of surgical difficulty. CONCLUSION Significant differences (p < 0.001) were observed in all the intraoperative parameters according to surgical difficulty as assessed by the Pederson scale. Therefore, this scale was a good indicator to estimate the patient's postoperative period.
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Affiliation(s)
| | - Francisco Javier Silvestre
- Department of Stomatology, University of Valencia, 46010 Valencia, Spain; Department of Stomatology, University Hospital Doctor Peset-FISABIO, 46017 Valencia, Spain
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Pereira DA, Bonatto MS, Santos SDS, Mendes PGJ, Sales E Pessoa R, de Oliveira GJPL. Comparison of different dual-wavelength photobiomodulation protocols application in third molar extractions. A split-mouth randomized controlled trial. Photodiagnosis Photodyn Ther 2024; 46:104054. [PMID: 38503387 DOI: 10.1016/j.pdpdt.2024.104054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/27/2024] [Accepted: 03/15/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To compare the use of PBMT in the soft tissue and bone healing after third molar extraction using the dual-wavelength laser directly into the post-extraction alveoli (PBMT-I), or PBMT with a red laser directly into the alveoli and with an infrared laser externally on the patient's face (PBMT-IE). METHODS Twenty patients underwent extraction of four third molars were involved in this split-mouth double-blind randomized controlled trial. The Post-extraction alveoli were treated with the following protocols: PBMT-IE: Application of a red laser directly into the alveolus, and infrared laser irradiation transcutaneously and PBMT-I: Application of dual-wavelength laser intraorally. Patients were clinically evaluated 3, 7, 14, 30, and 90 days after the surgical procedure. The analyses in this study were divided into qualitative (centered on the patient's report and on the evaluators' analysis), and quantitative analyses (measurement of the vertical and horizontal dimensions of the face with the objective of measuring post-surgical edema and radiographic analyses for evaluation of the density and structure of the newly formed bone). RESULTS A progressive improvement was observed in all parameters evaluated in this study, however, this improvement was time dependent, with no distinct effect observed between the PBMT treatments applied. CONCLUSION The different dual-wavelength PBMT protocols induced a similar postoperative clinical course in third molar extraction surgeries, with a reduced occurrence of complications and a good healing pattern of hard and soft tissues.
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Affiliation(s)
- Davisson Alves Pereira
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Uberlândia, MG, Brazil
| | - Mariana Silva Bonatto
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Uberlândia, MG, Brazil
| | - Samara de Souza Santos
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Uberlândia, MG, Brazil
| | - Pedro Gomes Junqueira Mendes
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Uberlândia, MG, Brazil.
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Falci SGM, Fernandes IA, Guimarães MTBÁ, Galvão EL, de Souza GM, Al-Moraissi EA. Complementary and alternative therapies for managing postoperative pain after lower third molar surgery: a systematic review and network meta-analysis. Clin Oral Investig 2024; 28:231. [PMID: 38538810 DOI: 10.1007/s00784-024-05625-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/19/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE The objective of this study was to evaluate the impact of complementary and alternative treatments on postoperative pain following lower third molar surgeries. METHODS A comprehensive search of Electronic databases (Embase, MEDLINE via PubMed, and Cochrane Library) and grey literature was conducted up until May 2022. Randomized clinical trials investigating the effect of acupuncture, ozone therapy, laser (LLLT), drainage tube, kinesio-taping, ice therapy, and compressions on pain after LTM surgeries were included. The estimated mean differences (MD) for alternative therapies were pooled using the frequentist approach to random-model network meta-analysis NMA. RESULTS Eighty-two papers were included in the qualitative analysis; 33 of them were included in the quantitative analyzes. NMA revealed that drainage tube and kinesio-taping were superior in controlling pain 24-hours postoperatively than no-treatment. At 48-hours follow-up, kinesio-taping and LLLT more effective than placebo and drainage tube; and kinesio-taping and LLLT were superior to no treatment. At 72 h postoperatively, ozone therapy was superior to placebo; and drainage tube, kinesio-taping, and LLLT were better than no treatment. At 7-days follow-up, ozone and LLLT were superior to placebo; and LLLT and kinesio-taping were superior to no treatment. The SUCRA-ranking placed drainage tube as top-ranking intervention at 48-hours (98.2%) and 72-hours (96%) follow-ups, and ozone (83.5%) at 7-days follow-up. CONCLUSION The study findings suggest that these alternative and complementary therapies may be useful in reducing postoperative pain after LTM surgeries, and may offer advantages when combined to traditional pain management methods. CLINICAL RELEVANCE Non-pharmacological therapies are gaining popularity among healthcare professionals and patients. This study found that some of these therapies, specifically kinesio-taping and drainage tube were effective in controlling postoperative pain after third molar surgeries. These findings have important implications for clinical practice, as they highlight the potential benefits of incorporating these therapies into postoperative pain management plans.
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Affiliation(s)
- Saulo Gabriel Moreira Falci
- Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil.
| | - Ighor Andrade Fernandes
- Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | | | - Endi Lanza Galvão
- Department of Physiotherapy, Federal University of Vales do Jequitinhonha e Murcuri, Diamantina, Minas Gerais, Brazil
| | - Glaciele Maria de Souza
- Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Essam Ahmed Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Dhamar, Yemen
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Falci SGM, Guimarães MTBÁ, Canarim NM, Falci SE, Martins OBL, de Souza GM, Galvão EL. Comparison of suture and sutureless techniques on postoperative complications after third molar surgery: a systematic review. Clin Oral Investig 2024; 28:115. [PMID: 38267703 DOI: 10.1007/s00784-024-05518-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To compare, among patients undergoing third molar surgeries, whether the use or omission of sutures improves postoperative clinical parameters. METHOD A systematic literature review was conducted to identify randomized clinical trials in humans. The steps of this review were conducted following the PRISMA protocol. The risk of bias assessment was performed using the revised Cochrane tool (RoB 2). The RevMan software was employed for meta-analyses, and the quality of evidence was evaluated using GRADE. RESULT A total of seven articles were included in the systematic review; however, only one article quantitatively measured bleeding, rendering meta-analysis for this outcome unfeasible. The group of patients in whom sutures were not used presented lower pain and edema on the first day (respectively: MD - 1.08; 95% CI - 1.35 to - 0.81; MD - 1.23; 95% CI - 2.34 to - 0.11) and second day (respectively: MD - 0.50; 95% CI - 0.83 to - 0.17; MD - 10.66; 95% CI - 1.16 to - 0.16) postoperatively, compared to the group where sutures were employed. The group of patients who received sutures exhibited increased trismus on the first day postoperatively (MD 1.04; 95% CI 0.67 to 1.41). CONCLUSION The omission of postoperative sutures in third molar surgeries appears to favor pain and edema outcomes within the first 24 h after the procedure, as well as trismus within the same timeframe. CLINICAL RELEVANCE Despite the suture being the standard conduct in tooth extractions. The omission of sutures in third molar extractions may favor inflammatory outcomes of pain, edema, and trismus in the immediate postoperative period.
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Affiliation(s)
- Saulo Gabriel Moreira Falci
- Department of Dentistry, School of Biological and Health Sciences, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri, Rua da Glória, 187, Diamantina, MG, 39100-000, Brazil
| | - Marco Túllio Becheleni Ávila Guimarães
- Department of Dentistry, School of Biological and Health Sciences, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri, Rua da Glória, 187, Diamantina, MG, 39100-000, Brazil
| | - Nathalia Moore Canarim
- Department of Dentistry, School of Biological and Health Sciences, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri, Rua da Glória, 187, Diamantina, MG, 39100-000, Brazil
| | - Salomão Emanuel Falci
- Department of Dentistry, School of Biological and Health Sciences, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri, Rua da Glória, 187, Diamantina, MG, 39100-000, Brazil
| | - Olga Beatriz Lopes Martins
- Department of Dentistry, School of Biological and Health Sciences, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri, Rua da Glória, 187, Diamantina, MG, 39100-000, Brazil
| | - Glaciele Maria de Souza
- Department of Dentistry, School of Biological and Health Sciences, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri, Rua da Glória, 187, Diamantina, MG, 39100-000, Brazil.
| | - Endi Lanza Galvão
- Department of Physical Therapy, School of Biological and Health Sciences, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri, Diamantina, MG, Brazil
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Pimenta RP, Takahashi CM, Barberato-Filho S, McClung DCF, Moraes FDS, de Souza IM, Bergamaschi CDC. Preemptive use of anti-inflammatories and analgesics in oral surgery: a review of systematic reviews. Front Pharmacol 2024; 14:1303382. [PMID: 38328575 PMCID: PMC10847331 DOI: 10.3389/fphar.2023.1303382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/22/2023] [Indexed: 02/09/2024] Open
Abstract
Objectives: This review of systematic reviews evaluated the effectiveness and safety of the preemptive use of anti-inflammatory and analgesic drugs in the management of postoperative pain, edema, and trismus in oral surgery. Materials and methods: The databases searched included the Cochrane Library, MEDLINE, EMBASE, Epistemonikos, Scopus, Web of Science, and Virtual Health Library, up to March 2023. Pairs of reviewers independently selected the studies, extracted the data, and rated their methodological quality using the AMSTAR-2 tool. Results: All of the 19 studies reviewed had at least two critical methodological flaws. Third molar surgery was the most common procedure (n = 15) and the oral route the most frequent approach (n = 14). The use of betamethasone (10, 20, and 60 mg), dexamethasone (4 and 8 mg), methylprednisolone (16, 20, 40, 60, 80, and 125 mg), and prednisolone (10 and 20 mg) by different routes and likewise of celecoxib (200 mg), diclofenac (25, 30, 50, 75, and 100 mg), etoricoxib (120 mg), ibuprofen (400 and 600 mg), ketorolac (30 mg), meloxicam (7.5, 10, and 15 mg), nimesulide (100 mg), and rofecoxib (50 mg) administered by oral, intramuscular, and intravenous routes were found to reduce pain, edema, and trismus in patients undergoing third molar surgery. Data on adverse effects were poorly reported. Conclusion: Further randomized clinical trials should be conducted to confirm these findings, given the wide variety of drugs, doses, and routes of administration used.
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Affiliation(s)
- Régis Penha Pimenta
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | | | - Silvio Barberato-Filho
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | | | - Fabio da Silva Moraes
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, São Paulo, Brazil
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Coppens M, Steenhout A, De Baerdemaeker L. Adjuvants for balanced anesthesia in ambulatory surgery. Best Pract Res Clin Anaesthesiol 2023; 37:409-420. [PMID: 37938086 DOI: 10.1016/j.bpa.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/15/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023]
Abstract
Balanced anesthesia relies on the simultaneous administration of different drugs to attain an anesthetic state. The classic triad of anesthesia is a combination of a hypnotic, an analgesic, and a neuromuscular blocker. It is predominantly the analgesic pillar of this triad that became more and more supported by adjuvant therapy. The aim of this approach is to evolve into an opioid-sparing technique to cope with undesirable side effects of the opioids and is fueled by the opioid epidemic. The optimal strategy for balanced general anesthesia in ambulatory surgery must aim for a transition to a multimodal analgesic regimen dealing with acute postoperative pain and ideally reduce the most common adverse effects patients are faced with at home; sore throat, delayed awakening, memory disturbances, headache, nausea and vomiting, and negative behavioral changes. Over the years, this continuum of "multimodal general anesthesia" adopted many drugs with different modes of action. This review focuses on the most recent evidence on the different adjuvants that entered clinical practice and gives an overview of the different mechanisms of action, the potential as opioid-sparing or hypnotic-sparing drugs, and the applicability specifically in ambulatory surgery.
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Affiliation(s)
- Marc Coppens
- University Hospital Ghent, Belgium, Faculty of Medicine and Health Sciences, Department of Basic and Applied Medical Sciences, University Ghent, Belgium.
| | - Annelien Steenhout
- Department of Anesthesiology and Perioperative Medicine, University Hospital, Ghent, Belgium.
| | - Luc De Baerdemaeker
- University Hospital Ghent, Belgium, Faculty of Medicine and Health Sciences, Department of Basic and Applied Medical Sciences, University Ghent, Belgium.
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Mijailovic I, Janjic B, Milicic B, Todorovic A, Ilic B, Misic T, Markovic N, Markovic A. Comparison of preemptive etoricoxib and dexamethasone in third molar surgery - a randomized controlled clinical trial of patient-reported and clinical outcomes. Clin Oral Investig 2023; 27:5263-5273. [PMID: 37452140 DOI: 10.1007/s00784-023-05146-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES To compare preemptive single-dose etoricoxib and dexamethasone on postoperative patient satisfaction (pPS) and clinical parameters following the impacted mandibular third molar (IMTM) extraction. MATERIALS AND METHODS A parallel-group, triple-blinded, controlled clinical study included a total of 90 patients (n = 30), randomized to receive: etoricoxib 90 mg, dexamethasone 4 mg, or no premedication (control group) 1 h before surgery. Paracetamol 500 mg was prescribed as rescue medication (RM). Check-ups were scheduled at 24 h, 48 h, and day 7 post-surgery. At each time point, pPS was assessed using the 5-point Likert scale. RM parameters, swelling, trismus, and the occurrence of adverse events were also recorded, and patients were instructed to rate the perceived pain on Visual Analogue Scale. RESULTS In all the follow-up periods, data indicated significantly higher pPS scores in the preemptive medication groups when compared to the control group (p < 0.05). Both regimens delayed the first RM intake when compared to controls. In the etoricoxib group, a significantly lower total RM consumption was observed (p < 0.05). Dexamethasone significantly decreased swelling at each check-up and increased mouth opening at day 7 after the surgery (p < 0.05). CONCLUSIONS Preemptive etoricoxib and dexamethasone elevate pPS after IMTM surgery. Etoricoxib improves RM parameters, while dexamethasone ameliorates the patient's postoperative functional ability. CLINICAL RELEVANCE Preemptive etoricoxib and dexamethasone use may decrease patients' discomfort following the impacted mandibular third molar extraction. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05791721. Date of Registration: 28/03/2023 (retrospectively registered).
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Affiliation(s)
- Iva Mijailovic
- Department of Oral Surgery, School of Dental Medicine, University of Belgrade, Dr. Subotica 4, Belgrade, 11000, Serbia.
| | - Bojan Janjic
- Department of Oral Surgery, School of Dental Medicine, University of Belgrade, Dr. Subotica 4, Belgrade, 11000, Serbia
| | - Biljana Milicic
- Department of Medical Statistics and Informatics, School of Dental Medicine, University of Belgrade, Dr. Subotica 8, Belgrade, 11000, Serbia
| | - Ana Todorovic
- Department of Oral Surgery, School of Dental Medicine, University of Belgrade, Dr. Subotica 4, Belgrade, 11000, Serbia
| | - Branislav Ilic
- Department of Oral Surgery, School of Dental Medicine, University of Belgrade, Dr. Subotica 4, Belgrade, 11000, Serbia
| | - Tijana Misic
- Department of Oral Surgery, School of Dental Medicine, University of Belgrade, Dr. Subotica 4, Belgrade, 11000, Serbia
| | - Nikola Markovic
- Department of Oral Surgery, School of Dental Medicine, University of Belgrade, Dr. Subotica 4, Belgrade, 11000, Serbia
| | - Aleksa Markovic
- Department of Oral Surgery, School of Dental Medicine, University of Belgrade, Dr. Subotica 4, Belgrade, 11000, Serbia
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Myers AL, Jeske AH. Provider-directed analgesia for dental pain. Expert Rev Clin Pharmacol 2023; 16:435-451. [PMID: 37083548 DOI: 10.1080/17512433.2023.2206118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
INTRODUCTION Extraction of impacted molar teeth is a common procedure performed by oral surgeons and general dentists, with postoperative pain being a significant adverse event post-surgery. If mismanaged, pain can lead to complications that impact oral and systemic health. The current scourge of the opioid epidemic has ushered in a new era of provider-directed analgesic (PDA) therapy in dentistry. AREAS COVERED This article provides an in-depth review on the major pharmacological and therapeutic properties of established and alternative analgesics used to manage dental pain. EXPERT OPINION Substantial evidence-based literature shows combination of a non-steroidal anti-inflammatory drug (NSAID; e.g. ibuprofen) and acetaminophen provides superior pain relief than single-agent or combination opioid regimens. However, there are clinical scenarios (e.g. severe pain) when short-course opioid prescription is appropriate in select patients, in which a 2-3-day treatment duration is typically sufficient. Alternative agents (e.g. caffeine, gabapentin, phytotherapies), typically in combination with established agents, can mitigate postoperative dental pain. Some evidence suggests preemptive therapies (e.g. corticosteroids, NSAIDs) reduce amounts of postsurgical analgesic consumption and might lessen opioid prescription burden. In summary, this comprehensive review provides an opportune update on the evolving landscape of pharmacotherapy for acute postsurgical dental pain, informing best practices for PDA in the dental setting.
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Affiliation(s)
- Alan L Myers
- Department of Diagnostic & Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Arthur H Jeske
- Office of the Dean, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Jiang F, Qi X, Wu X, Lin S, Shi J, Zhang W, Jiang X. Regulating macrophage-MSC interaction to optimize BMP-2-induced osteogenesis in the local microenvironment. Bioact Mater 2023; 25:307-318. [PMID: 36844362 PMCID: PMC9947106 DOI: 10.1016/j.bioactmat.2023.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 02/12/2023] Open
Abstract
Bone morphogenetic protein (BMP-2) has been approved by the FDA to promote bone regeneration, but uncertain osteogenic effect and dose-dependent side effects may occur. Osteoimmunomodulation plays an important role in growth factor-based osteogenesis. Here, we explored how proinflammatory signals affect the dose-dependent osteogenic potential of BMP-2. We observed that the expression level of local IL-1β did not increase with the dose of BMP-2 in the mouse osteogenesis model. A low dose of BMP-2 could not promote new bone formation, but trigger the release of IL-1β from M1 macrophages. As the dose of BMP-2 increased, the IL-1β expression and M1 infiltration in local microenvironment were inhibited by IL-1Ra from MSCs under osteogenic differentiation induced by BMP-2, and new bone tissues formed, even excessively. Anti-inflammatory drugs (Dexamethasone, Dex) promoted osteogenesis via inhibiting M1 polarization and enhancing BMP-2-induced MSC osteo-differentiation. Thus, we suggest that the osteogenic effect of BMP-2 involves macrophage-MSC interaction that is dependent on BMP-2 dose and based on IL-1R1 ligands, including IL-1β and IL-1Ra. The dose of BMP-2 could be reduced by introducing immunoregulatory strategies.
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Affiliation(s)
- Fei Jiang
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No.639, Zhizaoju Road, Shanghai, 200011, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Engineering Research Center of Advanced Dental Technology and Materials, No.639, Zhizaoju Road, Shanghai, 200011, China
- Jiangsu Key Laboratory of Oral Diseases, Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing Medical University, No. 140, Han Zhong Road, Nanjing, 210029, China
- Department of General Dentistry, Affiliated Hospital of Stomatology, Nanjing Medical University, No. 136, Han Zhong Road, Nanjing, 210029, China
| | - Xuanyu Qi
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No.639, Zhizaoju Road, Shanghai, 200011, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Engineering Research Center of Advanced Dental Technology and Materials, No.639, Zhizaoju Road, Shanghai, 200011, China
| | - Xiaolin Wu
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No.639, Zhizaoju Road, Shanghai, 200011, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Engineering Research Center of Advanced Dental Technology and Materials, No.639, Zhizaoju Road, Shanghai, 200011, China
| | - Sihan Lin
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No.639, Zhizaoju Road, Shanghai, 200011, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Engineering Research Center of Advanced Dental Technology and Materials, No.639, Zhizaoju Road, Shanghai, 200011, China
| | - Junfeng Shi
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No.639, Zhizaoju Road, Shanghai, 200011, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Engineering Research Center of Advanced Dental Technology and Materials, No.639, Zhizaoju Road, Shanghai, 200011, China
| | - Wenjie Zhang
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No.639, Zhizaoju Road, Shanghai, 200011, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Engineering Research Center of Advanced Dental Technology and Materials, No.639, Zhizaoju Road, Shanghai, 200011, China
| | - Xinquan Jiang
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No.639, Zhizaoju Road, Shanghai, 200011, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Engineering Research Center of Advanced Dental Technology and Materials, No.639, Zhizaoju Road, Shanghai, 200011, China
- Corresponding author. Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No.639, Zhizaoju Road, Shanghai, 200011, China.
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11
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Singh A, Pentapati KC, Kodali MVRM, Smriti K, Patil V, Chowdhary GL, Gadicherla S. Efficacy of Preemptive Dexamethasone versus Methylprednisolone in the Management of Postoperative Discomfort and Pain after Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis. ScientificWorldJournal 2023; 2023:7412026. [PMID: 37168455 PMCID: PMC10165033 DOI: 10.1155/2023/7412026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/30/2023] [Accepted: 02/17/2023] [Indexed: 05/13/2023] Open
Abstract
The corticosteroids have been used for preemptive management of surgical sequelae after mandibular third molar extraction. The aim of this article was to review the efficacy of methylprednisolone versus dexamethasone in the management of postsurgical pain, swelling, and trismus after mandibular third molar surgery. Randomized, double-blinded studies from PubMed, CINAHL, Scopus, DOSS, Cochrane central, and Web of Science were identified by using a search strategy. Randomized controlled trials evaluating the efficacy of use of dexamethasone versus methylprednisolone for mandibular third molar extraction were only considered. The studies involving the use of any other corticosteroid agent were excluded. Outcomes assessed were postoperative pain, the number of rescue analgesics required, swelling, trismus, and adverse events. The search strategy yielded 1046 articles for title and abstract screening, out of which only seven studies were included in the systematic review after full text screening. There was considerable heterogeneity between the studies with regards to the method as well as the parameters assessed. Risk of bias was low in three studies and unclear in other four studies. On pooled analyses, there was no significant difference with respect to pain, rescue analgesics, and swelling in the test and the control group. Forest plot analysis showed that dexamethasone had lesser trismus in early postoperative period (postoperative day 2) as compared to methylprednisolone. None of the included studies reported any adverse effects. Both the corticosteroids have similar efficacy in reducing the postoperative pain and swelling; however, dexamethasone showed statistically significant difference from methylprednisolone in reducing trismus (estimated standardized mean difference of -0.69 mm; 95% CI: -1.01 to -0.38; p < 0.0001) in the early postoperative period. However, due to statistical heterogeneity, quality of the evidence for the review was low to moderate. Hence, more studies with larger study sample and low risk of bias are needed to confirm these results.
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Affiliation(s)
- Anupam Singh
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education (MAHE), Karnataka, India
| | - Kalyana Chakravarthy Pentapati
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education (MAHE), Karnataka, India
| | | | - Komal Smriti
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education (MAHE), Karnataka, India
| | - Vathsala Patil
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education (MAHE), Karnataka, India
| | - Gandham Lekha Chowdhary
- Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education (MAHE), Karnataka, India
| | - Srikanth Gadicherla
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education (MAHE), Karnataka, India
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12
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Zhou W, Liu F, Fang J, Han L. Dexamethasone in preventive analgesia alleviates pain and complications after jaw cyst enucleation: a randomized controlled trial. BMC Anesthesiol 2022; 22:344. [DOI: 10.1186/s12871-022-01895-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Dexamethasone is widely used in the prevention of postoperative complications in oral surgery and strengthening the analgesic effect after anesthesia, but the efficacy is controversial, and the relationship between postoperative complications and pain is still unclear. The purpose of this study was to evaluate the analgesic effect of dexamethasone in the treatment of jaw cyst and to explore the relationship between postoperative complications and pain.
Methods
We conducted a prospective, randomized, double-blind clinical trial. 120 patients were divided into two groups, dexamethasone group ( group D) and control group (Group C). All patients were given 0.02 mg·kg−1 of hydromorphone to relieve pain in advance at 10 min before the beginning of operation. Meanwhile, dexamethasone was injected 0.2 mg·kg−1 intravenously in group D and normal saline was injected in group C. The primary endpoint was pain intensity at 2 h, 6 h, 12 h, 24 h and 48 h after surgery. The secondary endpoints were the incidence and extent of complications after surgery, including facial swelling and trismus.
Results
Compared with group C, the visual analogue scale (VAS) scores and occurrence of painful event postoperatively in group D were significantly lower both at rest (P < 0.0001 and P = 0.0014) and during mobilization (P < 0.0001 both). The degree of facial swelling and trismus in group D were significantly lower than that in group C at 24 h (P < 0.0001 and P = 0.00022) and 48 h (P < 0.0001 and P = 0.00015) after surgery, but there was no difference at 6 h and 12 h (P = 0.137 and P = 0.083) after surgery. The C-reactive protein (CRP) level at 24 h after operation in group D was lower than group C (P = 0.012), but there was no significant difference in blood glucose concentration between the two groups (P = 0.608).
Conclusion
Dexamethasone can reduce the degree of facial swelling and trismus after jaw cyst surgery by inhibiting the production of inflammation, which alleviated the postoperative pain of patients significantly. In addition, it did not increase the risk of hyperglycemia.
Trial registration
This study was registered with the Chinese Clinical Trial Registry on May 07, 2020 (URL: http://www.chictr.org.cn/showproj.aspx?proj=53344. Registry number: ChiCTR2000032693). Registered on 07/05/2020.
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13
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Efficacy of Methylprednisolone Compared to Other Drugs for Pain, Swelling, and Trismus Control after Third Molar Surgery: A Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10061028. [PMID: 35742079 PMCID: PMC9222945 DOI: 10.3390/healthcare10061028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 02/04/2023] Open
Abstract
The purpose of this systematic review and meta-analysis was to assess the efficacy of methylprednisolone compared to other drugs to control postoperative complications following third molar surgery. PubMed and Google Scholar were used for article searching. Thereafter, the trials meeting the selection criteria and with high methodological quality, according to the Cochrane Collaboration’s risk of bias tool, were included in this study. The inverse variance test and mean difference using the Review Manager Software 5.3 for Windows were used to carry out data analysis. Qualitative analysis shows that methylprednisolone is more effective than NSAIDs, but inferior to dexamethasone, for controlling postoperative complications after third molar removal. The quantitative analysis showed no statistical difference for pain control, while trismus evaluation showed a statistical difference after 7 postoperative days in favor of methylprednisolone, when compared to other drugs. In conclusion, methylprednisolone was more effective for trismus control compared to other drugs after lower third molar surgery.
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Vitor dos Santos Canellas J, Gamboa Ritto F, Tiwana P. Comparative efficacy and safety of different corticosteroids to reduce inflammatory complications after mandibular third molar surgery: a systematic review and network meta-analysis. Br J Oral Maxillofac Surg 2022; 60:1035-1043. [DOI: 10.1016/j.bjoms.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/05/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
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15
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Stojanović S, Burić N, Tijanić M, Todorović K, Burić K, Burić N, Jovanović M, Bajagić V. The Assessment of Prolonged Inferior Alveolar Nerve Blockade for Postoperative Analgesia in Mandibular Third Molar Surgery by a Perineural Addition of Dexamethasone to 0.5% Ropivacaine: A Randomized Comparison Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031324. [PMID: 35162346 PMCID: PMC8835108 DOI: 10.3390/ijerph19031324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/13/2022] [Accepted: 01/19/2022] [Indexed: 02/01/2023]
Abstract
Background: Perineurally adding dexamethasone to local anesthetics could enable postoperative analgesia. Our aim was to investigate the efficacy of 4 mg dexamethasone and 0.5% ropivacaine on the prolonged duration of mandibular anesthesia for postoperative analgesia during third molar surgery. Materials and method: The patients of both sexes, and in the age range of 17 to 50 yrs of age, received the Gow-Gates anesthesia. Group I received 4 mL of plain 0.5% ropivacaine, with perineurally added 1 mL/4 mg of dexamethasone; group II received 4 mL of plain 0.5% ropivacaine with perineurally added 1 mL of 0.9% saline; group III received 4 mL of plain 0.5 bupivacaine with perineurally added 1 mL of 0.9% saline. The prime anesthesia outcome was the duration of conduction anesthesia (DCA); the secondary outcome was the duration of analgesia (DAN) and analgesia before analgesic intake. Results: In 45 randomly selected subjects (mean age 27.06 ± 8.20), DCA was statistically longest in group I (n = 15) (592.50 ± 161.75 min, p = 0.001), collated with groups II (n = 15) and III (n = 15) (307.40 ± 84.71 and 367.07 ± 170.52 min, respectively). DAN was significantly the longest in group I (mean: 654.9 ± 198.4 min, p = 0.001), compared with group II (345.4 ± 88.0 min) and group III (413.7 ± 152.3 min), with insignificant adverse reactions. One-third of the operated patients absented from the use of analgesics. Conclusion: A amount 0.5% ropivacaine with dexamethasone usefully served as an analgesic with a success rate of 93.4% of the given anesthesia.
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Affiliation(s)
- Simona Stojanović
- Department of Oral Surgery, School of Medicine and Stomatology, University of Niš, 18101 Niš, Serbia; (S.S.); (M.T.); (K.T.)
| | - Nikola Burić
- Department of Oral Surgery, School of Medicine and Stomatology, University of Niš, 18101 Niš, Serbia; (S.S.); (M.T.); (K.T.)
- Correspondence: ; Tel.: +381-63-40-63-86
| | - Milos Tijanić
- Department of Oral Surgery, School of Medicine and Stomatology, University of Niš, 18101 Niš, Serbia; (S.S.); (M.T.); (K.T.)
| | - Kosta Todorović
- Department of Oral Surgery, School of Medicine and Stomatology, University of Niš, 18101 Niš, Serbia; (S.S.); (M.T.); (K.T.)
| | - Kristina Burić
- School of Medicine, University of Niš, 18101 Niš, Serbia; (K.B.); (N.B.); (M.J.)
| | - Nina Burić
- School of Medicine, University of Niš, 18101 Niš, Serbia; (K.B.); (N.B.); (M.J.)
| | - Marija Jovanović
- School of Medicine, University of Niš, 18101 Niš, Serbia; (K.B.); (N.B.); (M.J.)
| | - Vukadin Bajagić
- School of Medicine, University of Podgorica, 81110 Podgorica, Montenegro;
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Does kinesio taping reduce pain, swelling, and trismus after mandibular third molar surgery? A systematic review and meta-analysis. Oral Maxillofac Surg 2022; 26:535-553. [PMID: 34981213 DOI: 10.1007/s10006-021-01025-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/28/2021] [Indexed: 10/19/2022]
Abstract
The aim of this study is to provide an evidence-based conclusion regarding the effectiveness of kinesio taping (KT) in reducing postsurgical discomforts after mandibular third molar surgery and critically appraise the available literature. Eligible clinical trials evaluating patients older than 18 years who were treated with any type of KT compared to no taping in which pain, swelling, or trismus scores were reported were included. An electronic literature search was carried out in the following databases to identify relevant papers up to May 30, 2021: Medline, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2.0). The effect sizes were calculated using mean difference (MD) and standardized mean difference (SMD). The heterogeneity analysis was conducted using (I2) statistic at alpha = 0.10 (PROSPERO; CRD42021252670). Nine randomized clinical trials with 444 participants were included in the qualitative analysis and eight in the quantitative analysis. The results of the meta-analysis revealed a statistically significant reduction in pain and swelling scores before the 7th postoperative day. On the 7th postoperative day, no significant difference was observed between KT and control groups in terms of pain and swelling. Additionally, KT led to an increase in patients' maximum mouth opening of more than 3 mm in postoperative intervals. KT is effective in reducing postoperative pain within the first 48 h after surgery and improving mouth opening during all postoperative intervals with moderate to high certainty of evidence.
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Sales PHDH, Barros AWP, Silva PGDB, Vescovi P, Leão JC. Is the Er: YAG Laser Effective in Reducing Pain, Edema and Trismus After Removal of Impacted Mandibular Third Molars? A Meta-Analysis. J Oral Maxillofac Surg 2021; 80:501-516. [PMID: 34793714 DOI: 10.1016/j.joms.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/20/2021] [Accepted: 10/10/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Removal of impacted third molars, can be associated with complications such as pain, edema, trismus, that can increase the morbidity of this procedure. The purpose of this study is to determine whether the Er: YAG laser is effective in reducing pain, swelling and trismus compared to rotary instruments in removing impacted lower third molars (3 LM`s). METHODS For this systematic review the searches were carried out independently by 2 researchers and the articles were selected according to the inclusion and exclusion criteria previously established. The predictor variable was the study group (Er: YAG laser versus rotatory instruments). The main outcome was the analysis of post-operative pain, edema and trismus after third molars extractions. Data analysis included the risk of bias evaluation (RoB 2 Cochrane) and meta-analysis with random effects I2 based heterogeneity and 95% confidence. RESULTS In the initial results, 1,371 articles were found and 6 RCT were selected to compose this study. A total of 299, 3 LM`s were removed, 126 with the Er: YAG laser, 142 with a drill and 31 with a piezoelectric instrument. The results of this meta-analysis showed that in the laser group there was a significant reduction in edema (1.82 [CI95% = -3.06 to -0.57] cm (P = .004)) and complications (P = .0004), a slight reduction in pain after 2 days (P = .030) and there was no variation in trismus (P = .200) when compared to the drill group. The surgery and/or osteotomy time was shorter in the drill group. Only 1 study presented low risk of bias. CONCLUSIONS The Er: YAG laser has been shown to be effective in reducing edema, pain and complications in impacted lower third molar surgeries. however due to the lack of standardization in Er: YAG laser therapy, new controlled and standardized studies should be performed with the aim of proving the efficacy of this therapeutic modality.
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Affiliation(s)
- Pedro Henrique da Hora Sales
- Student, Department of Prothesis and Oral and Maxillofacial Surgery, Federal University of Pernambuco (UFPE), Recife, P E, Brazil..
| | - Ana Waleska Pessoa Barros
- Student, Department of Prothesis and Oral and Maxillofacial Surgery, Federal University of Pernambuco (UFPE), Recife, P E, Brazil
| | | | - Paolo Vescovi
- Assistant Professor, Unit of Oral Medicine, Oral Surgery and Laser therapy, University Center of Dentistry - Department of Medicine and Surgery, University of Parma, Italy
| | - Jair Carneiro Leão
- Full Professor, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco (UFPE), Recife, PE, Brazil
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18
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Effect of Intraoral Drainage after Impacted Mandibular Third Molar Extraction on Non-Infectious Postoperative Complications. J Clin Med 2021; 10:jcm10204705. [PMID: 34682828 PMCID: PMC8540334 DOI: 10.3390/jcm10204705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/29/2021] [Accepted: 10/11/2021] [Indexed: 11/17/2022] Open
Abstract
Surgical removal of mandibular third molars is associated with non-infectious postoperative complications, including pain, swelling, trismus. Intraoral drains are noteworthy because of their ease of application, availability, and effectiveness. This study aimed to evaluate the use of latex and calcium–sodium alginate mouth flat drains on the severity of postoperative complications such as pain, trismus, and edema after surgical removal of mandibular third molars. Ninety patients who underwent surgical removal of wisdom teeth were studied. The patients were divided into three groups. Group A—with a latex flat drain, group B—with a sodium–calcium alginate (Kaltostat) flat drain, and group C—with a wound closed with knotted sutures. Patients were assessed for pain on a VAS scale every day from surgery to postoperative day 7. Before the procedure and on postoperative days 1, 2, and 7, the pain level, edema, and trismus were measured, respectively. Intraoral drainage with a flat drain after mandibular third molar removal does not significantly reduce pain, as measured by the VAS scale, or postoperative swelling, as measured by lines between craniometric points. Intraoral drainage with a latex drain after mandibular third molar removal does not significantly reduce trismus, while intraoral drainage with a calcium–sodium alginate drainage bag significantly increases trismus.
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19
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Hou C, Liu F, Liu C. Comparison of Submucosal With Intramuscular or Intravenous Administration of Dexamethasone for Third Molar Surgeries: A Systematic Review and Meta-Analysis. Front Surg 2021; 8:714950. [PMID: 34447785 PMCID: PMC8382880 DOI: 10.3389/fsurg.2021.714950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/13/2021] [Indexed: 12/29/2022] Open
Abstract
Objective: The study aimed to review evidence on the efficacy of submucosal (SM) administration vs. intravenous (IV) or intramuscular (IM) route of injections of dexamethasone for improving outcomes after mandibular third molar surgery. Methods: PubMed, Embase, CENTRAL, and Google Scholar were searched for randomized controlled trials (RCTs) up to 20th May 2021. Early (2–3 days) and late (7 days) outcomes were compared between SM vs. IV or IM dexamethasone. Quality of evidence was assessed based on GRADE. Results: Thirteen trials were included in the systematic review and 10 in the meta-analysis. Meta-analysis indicated a significant reduction in early pain with IV dexamethasone but no such difference for late pain compared to the SM group. There was no difference in early and late swelling scores between the SM and IV groups. Pooled analysis indicated no significant difference in early and late trismus between SM and IV groups. Comparing SM with IM dexamethasone, there was no significant difference in early and late pain scores. Swelling in the early and late postoperative periods was not significantly different between the two groups. There was no significant difference in early and late trismus between SM and IM groups. The quality of evidence was low for all outcomes. Conclusion: Low-quality evidence suggests that SM infiltration of dexamethasone results in similar outcomes as compared to IV or IM administration of the drug after third molar surgeries. Further high-quality RCTs are needed to corroborate the current conclusions.
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Affiliation(s)
- Chengyu Hou
- Department of Oral and Maxillofacial Surgery, Zaozhuang Municipal Hospital, Zaozhuang, China
| | - Feng Liu
- Department of Oral and Maxillofacial Surgery, Zaozhuang Municipal Hospital, Zaozhuang, China
| | - Chengbin Liu
- Department of Oral and Maxillofacial Surgery, Zaozhuang Municipal Hospital, Zaozhuang, China
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20
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Reyes-Fernández S, García-Verónica A, Hernández-Treviño N, Cobos-Cruz XT, Serna-Radilla VO, Romero-Castro NS. Submucosal and intramuscular dexamethasone for the control of pain, trismus and edema after third molar surgeries: ¿Is it necessary? ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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21
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Silva PUJ, Meneses-Santos D, Vieira WDA, Ramacciato JC, da Silva RP, da Silva MCP, Rode SDM, Paranhos LR. Preemptive use of intravenous ibuprofen to reduce postoperative pain after lower third molar surgery: a systematic review of randomized controlled trials. Clinics (Sao Paulo) 2021; 76:e2780. [PMID: 34190850 PMCID: PMC8221561 DOI: 10.6061/clinics/2021/e2780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022] Open
Abstract
This study aimed to systematically review the literature to assess the effect of preemptive intravenous ibuprofen on pain reduction after lower third molar surgery. Nine databases (PubMed, Scopus, LILACS, SciELO, Embase, Web of Science, Cochrane, Open Gray, and Open Thesis) were used as sources of research, including "grey literature." The protocol was registered in PROSPERO. Only randomized clinical trials evaluating the effects of preemptive intravenous ibuprofen on pain during and immediately after the extraction of lower third molars were included, without restrictions of year and language. Two reviewers independently performed the study selection, data extraction, and assessment of the risk of bias. The "Joanna Briggs Institute for Randomized Controlled Trials" tool was used to assess the risk of bias. Each study was categorized according to the percentage of positive responses to the questions corresponding to the assessment instrument. The results were measured narratively/descriptively. The initial search resulted in 3,257 records, of which only three studies (n=150 participants) met the eligibility criteria and were included in the qualitative analysis. All studies were published in 2019. The risk of bias ranged from low to moderate. Two studies found significant pain reduction within 48 h after the procedure. In conclusion, the use of preemptive intravenous ibuprofen for extracting third molars reduces pain and analgesic consumption after the surgical procedure.
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Affiliation(s)
- Pedro Urquiza Jayme Silva
- Program de Pos-Graduacao em Odontologia, Faculdade de Odontologia, Universidade Federal de Uberlandia, Uberlandia, MG, BR
| | - Daniela Meneses-Santos
- Programa de Residencia, Departamento de Cirurgia e Traumatologia Buco-Maxilo-Facial, Faculdade de Odontologia, Universidade Federal de Uberlandia, Uberlandia, MG, BR
| | - Walbert de Andrade Vieira
- Departamento de Odontologia Restauradora, Divisao de Endodontia, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas (UNICAMP), Piracicaba, SP, BR
| | - Juliana Cama Ramacciato
- Departamento de Farmacologia, Anestesiologia e Terapeutica, Faculdade de Medicina e Odontologia e Centro de Pesquisas Odontologicas Sao Leopoldo Mandic, Campinas, SP, BR
| | - Ricardo Pedro da Silva
- Program de Pos-Graduacao em Odontologia, Faculdade de Odontologia, Universidade Federal de Uberlandia, Uberlandia, MG, BR
| | - Marcelo Caetano Parreira da Silva
- Departamento de Cirurgia e Traumatologia Buco-Maxilo-Facial, Faculdade de Odontologia, Universidade Federal de Uberlandia (UFU), Uberlandia, MG, BR
| | - Sigmar de Mello Rode
- Departamento de Materiais Odontologicos e Protese, Instituto de Ciencia e Tecnologia, Universidade Estadual Paulista Julio de Mesquita Filho, Campus Sao Jose dos Campos, Sao Jose dos Campos, SP, BR
| | - Luiz Renato Paranhos
- Area de Odontologia Preventiva e Social, Faculdade de Odontologia, Universidade Federal de Uberlandia (UFU), Uberlandia, MG, BR
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22
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Santos BFE, Costa FO, Vasconcelos AMA, Cyrino RM, Cota LOM. Preemptive effects of ibuprofen and nimesulide on postoperative pain control after open flap periodontal surgeries: A randomized placebo-controlled split-mouth clinical trial. J Periodontol 2021; 93:298-307. [PMID: 34031888 DOI: 10.1002/jper.20-0887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Data on preemptive analgesia in periodontal surgeries are scarce and still diverse. The aim of this study was to evaluate and compare the analgesic effects of the preemptive administration of ibuprofen and nimesulide in open flap periodontal surgeries. METHODS The present randomized controlled clinical trial comprised 40 individuals, divided into two groups (n = 20), according to the test drug (ibuprofen and nimesulide) to be administered 1 hour preoperatively. Participants underwent bilateral periodontal surgeries at two different times, and were randomly given the test drug or placebo in a split-mouth design. Postoperative pain and rescue medication were evaluated at different times. Comparisons between ibuprofen and nimesulide were performed through a Generalized Estimation Equation model, using test drug and evaluation times, along with an interaction between these two variables as predictors. RESULTS In intergroup comparisons regarding pain control, ibuprofen showed better effects than placebo only at the first postoperative hour, whereas nimesulide showed better effects than placebo at 1, 6, 24, and 48 postoperative hours. In intergroup comparisons, nimesulide showed better effects than ibuprofen at 24, 48, and 72 postoperative hours, demonstrating a higher overall preemptive effect. No differences were observed in relation to the number of rescue medication. CONCLUSION Preemptive administration of nimesulide showed better overall preemptive effects on postoperative pain control when compared with ibuprofen.
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Affiliation(s)
- Bianca F E Santos
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Fernando O Costa
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Andrea M A Vasconcelos
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Renata M Cyrino
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Luís O M Cota
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Minas Gerais, Brazil
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Vieth MP, Deas DE, Archontia Palaiologou A, Diogenes A, Mader MJ, Mealey BL. Effect of intravenous dexamethasone on postoperative pain and swelling following periodontal flap surgery: A randomized controlled trial of patient-centered outcomes. J Periodontol 2021; 93:237-245. [PMID: 34021915 DOI: 10.1002/jper.21-0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND This randomized, crossover trial sought to determine if a preoperative intravenous (IV) dose of dexamethasone reduces pain, swelling, and analgesic usage following periodontal surgery. METHODS Thirty-seven patients planned for two similar periodontal flap surgeries under IV sedation were enrolled. Patients were randomized to receive either 2 mL (8 mg) dexamethasone sodium phosphate or 2 mL of IV solution (placebo) before the first surgery, and 2 mL of the other solution before the second surgery. Postoperative discomfort was managed with a standardized regimen of 600 mg ibuprofen and 325 mg acetaminophen. A smartphone application was used to record self-assessed pain and swelling scores using 21-point numerical (NRS-21) and 4-point verbal (VRS-4) rating scales as well as the number of analgesic medications taken at 12-, 24-, 48-, 72-, 168-, and 336-hours following each surgery. RESULTS IV dexamethasone was associated with a significant reduction in pain at 12, 24, 48, and 72 hours (P <0.05), and swelling at 12, 24, 48, and 168 hours (P < 0.05) postoperatively when compared with placebo based on NRS-21 responses. VRS-4 data showed significant reductions in pain at 12, 72, and 168 hours and swelling at 12, 24, and 168 hours postoperatively with dexamethasone. No significant differences were found in the number of tablets of ibuprofen or acetaminophen between dexamethasone and placebo surgeries. CONCLUSIONS Preoperative, intravenously administered dexamethasone reduces pain and swelling within the first postoperative week following periodontal flap surgery and should be considered a useful adjunct for perioperative management.
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Affiliation(s)
- Michael P Vieth
- Department of Periodontics, UT Health San Antonio School of Dentistry, San Antonio, TX
| | - David E Deas
- Department of Periodontics, UT Health San Antonio School of Dentistry, San Antonio, TX
| | | | - Anibal Diogenes
- Department of Endodontics, UT Health San Antonio School of Dentistry, San Antonio, TX
| | - Michael J Mader
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX
| | - Brian L Mealey
- Department of Periodontics, UT Health San Antonio School of Dentistry, San Antonio, TX
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Tirupathi S, Rajasekhar S, Maloth SS, Arya A, Tummalakomma P, Lanke RB. Pre-emptive analgesic efficacy of injected ketorolac in comparison to other agents for third molar surgical removal: a systematic review. J Dent Anesth Pain Med 2021; 21:1-14. [PMID: 33585680 PMCID: PMC7871182 DOI: 10.17245/jdapm.2021.21.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/04/2020] [Accepted: 01/13/2021] [Indexed: 01/02/2023] Open
Abstract
This study aimed to evaluate and compare the pre-emptive analgesic efficacy of injected ketorolac to that of other agents for impacted third molar surgical removal in a healthy population. PubMed, Ovid SP, Cochrane databases were filtered from 1980 to July 2020 for potential papers using relevant MeSH terms and pre-specified inclusion and exclusion criteria independently by reviewers. Studies that compared pre-emptive intramuscular or intravenous administration of ketorolac to other agents were evaluated. The outcomes sought were self-reported postoperative pain (patient-perceived pain), median duration for rescue analgesic medication, total number of analgesics consumed in the recovery period, and global assessment (overall patient satisfaction) after the recovery period. Six studies were included in the final evaluation. The outcome of pain perception and the number of analgesics taken were significantly lower in the ketorolac group (intramuscular or intravenous) in most of the studies (n=5) than in the group of other drugs. The mean time for rescue analgesia intake was higher for the ketorolac group, and global assessment scores were also better in the ketorolac group. Although the included studies show significantly better outcomes such as postoperative pain, median time taken for rescue medication, total number of analgesics taken, and overall patient satisfaction with injected ketorolac group in comparison to injected diclofenac, dexamethasone, and tramadol, definitive conclusions cannot be made regarding the superiority of injected Ketorolac as a pre-emptive agent. A greater number of randomized control trials with a proper protocol are needed to make definitive conclusions.
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Affiliation(s)
- Sunnypriyatham Tirupathi
- Department of Pedodontics & Preventive Dentistry, Malla Reddy Institute of Dental Sciences, Hyderabad, Telangana, India
| | - Srinitya Rajasekhar
- Department of Pedodontics & Preventive Dentistry, Malla Reddy Dental College for Women, Hyderabad, Telangana, India
| | | | - Aishwarya Arya
- Department of Periododntics, Malla Reddy Institute of Dental Sciences, Hyderabad, Telangana, India
| | - Pushpalatha Tummalakomma
- Department of Periododntics, Malla Reddy Institute of Dental Sciences, Hyderabad, Telangana, India
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Anti-Inflammatory Effectiveness of Oral Dexamethasone 4 mg on Mandibular Third Molar Surgeries: A Split-Mouth Randomized Clinical Trial. J Oral Maxillofac Surg 2021; 79:981-988. [PMID: 33561426 DOI: 10.1016/j.joms.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/17/2020] [Accepted: 01/03/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE This study aimed to evaluate the anti-inflammatory effect of oral dexamethasone 4 mg in a single dose preemptively administered to reduce pain, swelling, and trismus following mandibular third molar surgeries. METHODS A split-mouth randomized clinical trial was performed including 22 participants undergoing surgical removal of bilateral and symmetrically positioned third molars. A total of 44 teeth were allocated by simple randomization to either the test or nonintervention/control side. Oral dexamethasone 4 mg was administered on the test side an hour before the surgery. All of the participants were unaware of the medication studied, and only 1 surgeon, blinded to the medication intake, performed all of the procedures. Anti-inflammatory effect was evaluated using the clinical parameters of mouth opening, swelling, and rescue analgesic medication intake to control pain. The statistical analysis was blinded to the allocation groups, and a significance value P < .05 was adopted for all the tests. RESULTS Dexamethasone reduced the mean of rescue analgesic medication intake by 5 times (P = .002). Facial swelling was lower on the test side by 72h postsurgery in comparison with the control side (P = .036). No significant difference in mouth opening was found between the groups. CONCLUSIONS Preemptive use of oral dexamethasone 4 mg proved to be effective in controlling pain and reducing the need for rescue medication and had a beneficial effect in reducing swelling during a short postoperative period.
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Santos BFE, Costa FO, Pinto Júnior AAC, Araújo AVA, Cyrino RM, Cota LOM. Postoperative pain and edema control following different protocols of preemptive analgesia in the surgical removal of impacted third molars: A triple-blind parallel randomized placebo-controlled clinical trial. J Craniomaxillofac Surg 2021; 49:694-704. [PMID: 33994294 DOI: 10.1016/j.jcms.2021.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 10/25/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022] Open
Abstract
This randomized controlled clinical trial aimed to evaluate the preemptive effects of acetaminophen, ibuprofen, ketoprofen, nimesulide or dexamethasone on postoperative pain and edema in the surgical removal of impacted third molars. Participants underwent bilateral surgeries at 2 different times and were randomly given the test drug or placebo (split-mouth). Postoperative pain, edema and rescue medication were evaluated at different times. Study power was >80% for the observed effect size in the crossover repeated measures design. Differences between test drug and placebo were the response variable. Generalized Estimation Equation models were adjusted for each outcome. Sample comprised 5 groups (n = 20 each). Ibuprofen and nimesulide showed higher overall effects on pain scores over time, with no differences between them (p = 0.557). Acetaminophen showed significantly lower overall effects in edema control over time, when compared to other test drugs, that showed similar effects. Lower quantity of rescue medication were also observed for ibuprofen and nimesulide, with no differences between them (p = 0.999). Ibuprofen and nimesulide showed beneficial overall preemptive effects. Hence, in the decision-making process for preemptive analgesia in impacted third molar surgeries, ibuprofen and nimesulide should be considered on a case-by-case basis as the drugs of choice.
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Affiliation(s)
- Bianca Fernanda Espósito Santos
- School of Dentistry, Department of Dental Clinics, Oral Pathology and Oral Surgery, Periodontology Division, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fernando Oliveira Costa
- School of Dentistry, Department of Dental Clinics, Oral Pathology and Oral Surgery, Periodontology Division, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Renata Magalhães Cyrino
- School of Dentistry, Department of Dental Clinics, Oral Pathology and Oral Surgery, Periodontology Division, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Luís Otávio Miranda Cota
- School of Dentistry, Department of Dental Clinics, Oral Pathology and Oral Surgery, Periodontology Division, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Miguel MMV, Mathias-Santamaria IF, Rossato A, Ferraz LFF, Figueiredo-Neto AM, de Marco AC, Casarin RCV, Wallet SM, Tatakis DN, Mathias MA, Santamaria MP. Microcurrent electrotherapy improves palatal wound healing: Randomized clinical trial. J Periodontol 2020; 92:244-253. [PMID: 32783220 DOI: 10.1002/jper.20-0122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/07/2020] [Accepted: 05/31/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study was conducted to assess the clinical, immunological, and patient-centered outcomes of microcurrent electrotherapy on palatal wound healing. METHODS This was a parallel, double-masked randomized clinical trial, in which 53 patients with ridge preservation indications were selected and randomly assigned to one of two groups. In the control (sham) group (n = 27), palatal wounds, after free gingival grafts (FGG) harvest, received sham application of electrotherapy. In the test (electrotherapy treatment [EE]) group (n = 26), palatal wounds, after FGG harvest, received application of microcurrent electrotherapy protocol. Clinical parameters, patient-centered outcomes, and inflammatory markers were evaluated, up to 90 days postoperatively. RESULTS The EE group achieved earlier wound closure (P <0.001) and epithelialization (P <0.05; P = 0.03) at 7 and 14 days after harvest when compared with the sham group. Painful symptomatology was reported less frequently in the EE group than in the sham group at 3-day follow-up (P = 0.008). Likewise, an improvement in Oral Health Impact Profile was reported 2 days after the procedure by the EE group (P = 0.04). In addition, favorable modulation of inflammatory wound healing markers occurred when electrotherapy was applied. CONCLUSION Within the limits of the present study, it can be concluded that the use of a low-intensity electrotherapy protocol may accelerate palatal wound healing and decrease patient discomfort after FGG harvest.
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Affiliation(s)
- Manuela Maria Viana Miguel
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil
| | - Ingrid Fernandes Mathias-Santamaria
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil.,National Institute of Science and Technology-Complex Fluids, São Paulo, Brazil
| | - Amanda Rossato
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil
| | - Laís Fernanda Ferreira Ferraz
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil
| | | | - Andrea Carvalho de Marco
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil
| | - Renato Corrêa Viana Casarin
- Department of Prosthodontics and Periodontics, Division of Periodontics, University of Campinas Piracicaba Dental School Piracicaba, São Paulo, Brazil
| | | | - Dimitris N Tatakis
- College of Dentistry, Division of Periodontology, The Ohio State University, Columbus, OH, USA
| | - Marcio Antonio Mathias
- FEI University, Department of Electrical Engineering, São Bernardo do Campo, São Paulo, Brazil
| | - Mauro Pedrine Santamaria
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil
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Maria de Souza G, Elias GM, Pereira de Andrade PF, Andrade Sales KN, Galvão EL, Moreira Falci SG. The Effectiveness of Hyaluronic Acid in Controlling Pain, Edema, and Trismus After Extraction of Third Molars: Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2020; 78:2154.e1-2154.e12. [PMID: 32771444 DOI: 10.1016/j.joms.2020.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/24/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
This study aimed to evaluate the clinical evidence of hyaluronic acid (HA) in minimizing inflammatory parameters such as pain, edema, and trismus after extraction of third molar (3M). An electronic search was conducted in 4 databases. The eligibility criteria included clinical trials that used HA compared with placebo or no treatment after 3M surgeries. The search strategy resulted in 752 references, of which 5 studies were included comprising 271 patients. Regarding the risk of bias analysis, most criteria were rated as low or unclear risk of bias. All the evaluated studies were classified as low risk of bias in the selective reporting criteria. The final quantitative analysis of the variables showed that the use of HA resulted in a greater reduction of pain levels on the third (mean difference = -0.68; 95% confidence interval, -1.20 to -0.17) and seventh (mean difference = -0.36; 95% confidence interval, -0.64 to -0.09) postoperative days. There are no differences between the analyzed groups in relation to trismus. It was not possible to conduct meta-analysis for the edema variable because of the heterogeneity of the methods of measurement. The results suggest that HA seems to provide a lower average pain on the third and seventh postoperative days and has no influence on postoperative trismus after extraction of 3Ms; however, more research with stronger methodology is needed to determine its efficacy.
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Affiliation(s)
- Glaciele Maria de Souza
- PhD student, Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil.
| | - Gabriel Mariano Elias
- MSc Student, Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | | | - Késsia Nara Andrade Sales
- MSc Student, Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Endi Lanza Galvão
- Permanent Professor of the Postgraduate Program in Dentistry, Federal University of Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Saulo Gabriel Moreira Falci
- Oral and Maxillofacial Surgery Professor, Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri; Oral and Maxillofacial Surgeon, Hospital Santa Casa de Caridade de Diamantina, Diamantina, MG, Brazil
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The induction strategies administered in the treatment of multiple myeloma exhibit a deleterious effect on the endothelium. Bone Marrow Transplant 2020; 55:2270-2278. [PMID: 32404979 DOI: 10.1038/s41409-020-0947-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 02/02/2023]
Abstract
Multiple myeloma induction treatment includes proteasome inhibitors (PI) and immunomodulatory agents at present. The incidence of engraftment syndrome, a transplant complication potentially related to endothelium, has increased in the last years. Our aim was to investigate whether bortezomib (Velcade, V), thalidomide (T), and dexamethasone (D) affect the endothelium, and explore defibrotide (DF) as protective agent. Endothelial cells (ECs) in culture were exposed to the compounds separately or in combination, without (VTD) and with DF (VTD + DF). Changes in markers of: (i) inflammation (ICAM-1 expression and leukocyte adhesion), (ii) VWF production, (iii) cell permeability (VE-cadherin expression and cell monolayer integrity), and (iv) oxidative stress (ROS production and eNOS expression) were measured. ICAM-1 and VWF expression increased significantly in VTD but were similar to controls in VTD + DF. Separately, bortezomib was the main deleterious agent whereas dexamethasone showed no harmful effect. Leukocyte adhesion showed similar trends. VE-cadherin expression was lower in VTD and normalized in VTD + DF. EC permeability increased only with bortezomib. No changes were observed in oxidative stress markers. Our results demonstrate that bortezomib damages the endothelium, and DF prevents this effect. A better knowledge of the induction drugs impact will allow the design of measures to protect the endothelium.
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Rostami K, Shahaboddin MA, Niazi F, Karimi Rouzbahani A, Nadri S, Mahmoudvand H. The Effect of Hirodoid Cream on Ecchymosis and Edema around Eyes after Rhinoplasty. World J Plast Surg 2020; 9:128-134. [PMID: 32934922 PMCID: PMC7482541 DOI: 10.29252/wjps.9.2.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Several methods have been used to decrease the periorbital edema and ecchymosis after rhinoplasty. In this study, we evaluated the efficacy of hirudoid and dexamethasone in reduction of the periorbital edema and ecchymosis. METHODS Sixty patients who underwent primary rhinoplasty were randomly divided into 3 groups. Group H received hirudoid cream, 3 times per day for 5 days from postoperative-day (POD). Group D received 10 mg of dexamethasone IV, immediately before surgery; and group C (control) received neither dexamethasone nor hirudoid. Two surgeons who were unaware of administered medications rated the severity of edema and intensity of ecchymosis, on 2nd, 5th, and 7th POD. RESULTS On 2nd POD, the edema in group D was significantly lower than groups H and C; but there was no significant difference in severity and intensity of ecchymosis between 3 groups. On 7th POD, the intensity of ecchymosis was significantly lower in group H in comparison to group C. When the difference between 2nd and 7th POD was evaluated, the resolution of severity of edema and intensity of ecchymosis was significantly better in group H (p<0.001). CONCLUSION Hirudoid was shown to be effective in reducing edema and ecchymosis after rhinoplasty. The use of dexamethasone was effective in prevention of periorbital edema at early postoperative days, but it was not effective on resolution of ecchymosis.
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Affiliation(s)
- Khalil Rostami
- Department of Plastic and Reconstructive Surgery, Shahid Modares Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Shahaboddin
- Department of Plastic and Reconstructive Surgery, Shahid Modares Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Feizollah Niazi
- Department of Plastic and Reconstructive Surgery, Shahid Modares Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Sedigheh Nadri
- Department of Surgery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Hormoz Mahmoudvand
- Department of Surgery, Lorestan University of Medical Sciences, Khorramabad, Iran
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Comparison of intraosseous and submucosal dexamethasone injection in mandibular third molar surgery: a split-mouth randomized clinical trial. Int J Oral Maxillofac Surg 2020; 49:529-535. [DOI: 10.1016/j.ijom.2019.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/03/2019] [Accepted: 10/07/2019] [Indexed: 11/20/2022]
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Intramuscular injection of dexamethasone for the control of pain, swelling, and trismus after third molar surgery: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2019; 48:659-668. [DOI: 10.1016/j.ijom.2018.09.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 09/07/2018] [Accepted: 09/27/2018] [Indexed: 01/08/2023]
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Liu S, Zhao H, Wang Y, Zhao H, Ma C. Oral Bromelain for the Control of Facial Swelling, Trismus, and Pain After Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2019; 77:1566-1574. [PMID: 30986376 DOI: 10.1016/j.joms.2019.02.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/30/2019] [Accepted: 02/28/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE The purpose of this study was to evaluate whether bromelain can decrease trismus, pain, and facial swelling in patients undergoing impacted third molar surgery. MATERIALS AND METHODS Three databases were searched to identify relevant studies through November 1, 2017. Randomized controlled trials (RCTs) that compared the effect of bromelain versus placebo after mandibular third molar surgery were included. The main outcome measures, pain, facial swelling, and trismus, were assessed in the early stage (2 to 3 days) and the late stage (7 days) after surgery. Standardized mean differences (SMDs) and weighted mean differences (WMDs) were calculated using fixed-effect models. All statistical analyses were implemented using Review Manager 5.3. RESULT Six RCTs were included in this meta-analysis. The pooled results suggested that bromelain appears to be effective for decreasing facial swelling in the early and late stages after surgery (early-stage SMD, -0.24; 95% confidence interval [CI], -0.46 to -0.02; P = .03; late-stage SMD, -0.54; 95% CI, -0.84 to -0.24; P = .0004). Bromelain alleviated postoperative pain 7 days after surgery (SMD, -0.54; 95% CI, -0.87 to -0.20; P = .002), but there was no significant difference in pain levels at the early stage. For trismus, analyses showed that bromelain had no apparent effect on early or late trismus. CONCLUSION Bromelain conferred moderate relief of postoperative discomfort after third molar surgery.
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Affiliation(s)
- Shaopeng Liu
- Resident, College of Stomatology, Shandong University, Jinan, Shandong Province, China
| | - Haoming Zhao
- Resident, College of Stomatology, Shandong University, Jinan, Shandong Province, China
| | - Ye Wang
- Resident, College of Stomatology, Shandong University, Jinan, Shandong Province, China
| | - Huaqiang Zhao
- Professor, College of Stomatology, Shandong University, Jinan, Shandong Province, China
| | - Chuan Ma
- Lecturer, College of Stomatology, Shandong University, Jinan, Shandong Province, China.
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de Souza GM, Fernandes IA, Dos Santos CRR, Falci SGM. Is bromelain effective in controlling the inflammatory parameters of pain, edema, and trismus after lower third molar surgery? A systematic review and meta-analysis. Phytother Res 2018; 33:473-481. [PMID: 30484910 DOI: 10.1002/ptr.6244] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 10/20/2018] [Accepted: 11/03/2018] [Indexed: 12/11/2022]
Abstract
The aim of this systematic review was to evaluate the clinical evidences of the bromelain in minimizing inflammatory parameters such as pain, edema, and trismus after lower third molar surgeries. An electronic search was conducted in six databases through November 2017. The eligibility criteria included randomized and non-randomized clinical trials and/or comparative studies that used bromelain after lower third molar surgeries. The search strategy resulted in 117 articles. Following the selection process, seven studies were included in the systematic review and four in the meta-analysis. In terms of the risk of bias analysis, all the evaluated studies were classified as low or unclear risk of bias in the following criteria: selection bias, detection bias, and reporting bias. The final quantitative analysis of the variables showed that the use of bromelain resulted in greater reduction of pain levels (mean difference [MD]: -0.38; 95% confidence interval [CI; -0.66 to -0.09]), edema (MD: -0.34; 95% CI [ -0.68 to -0.01]), and trismus (MD: -2.01; 95% CI [ -3.99 to -0.02]) among the analyzed groups. The results suggest that the bromelain appears to be effective in the control of pain, edema, and trismus after lower third molar surgeries; however, further high-quality studies are needed to confirm this finding.
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Affiliation(s)
- Glaciele Maria de Souza
- Department of Dentistry, Section of Oral and Maxillofacial Surgery, Federal University of Jequitinhonha e Mucuri Valleys, Diamantina, Brazil
| | - Ighor Andrade Fernandes
- Department of Dentistry, Section of Oral and Maxillofacial Surgery, Federal University of Jequitinhonha e Mucuri Valleys, Diamantina, Brazil
| | - Cássio Roberto Rocha Dos Santos
- Department of Dentistry, Section of Oral and Maxillofacial Surgery, Federal University of Jequitinhonha e Mucuri Valleys, Diamantina, Brazil
| | - Saulo Gabriel Moreira Falci
- Department of Dentistry, Section of Oral and Maxillofacial Surgery, Federal University of Jequitinhonha e Mucuri Valleys, Diamantina, Brazil
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Pre-operative use of dexamethasone does not reduce incidence or intensity of bleaching-induced tooth sensitivity. A triple-blind, parallel-design, randomized clinical trial. Clin Oral Investig 2018; 23:435-444. [DOI: 10.1007/s00784-018-2452-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 04/16/2018] [Indexed: 11/25/2022]
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