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Lou Y, Weng X, Hu J, Sun Z, Ying B, Yang Y. Efficacy of Dexamethasone Injection at Different Sites on Postoperative Sequelae After Extracting Mandibular Impacted Third Molars: A Randomized Controlled Trial. J Oral Maxillofac Surg 2024:S0278-2391(24)00281-7. [PMID: 38782043 DOI: 10.1016/j.joms.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Dexamethasone, an efficacious anti-inflammatory agent, is widely used after tooth extraction. However, its optimal injection site is yet to be investigated. PURPOSE We compare the efficacy of dexamethasone injection at different sites on postoperative sequelae after extracting mandibular impacted third molars (MITMs). STUDY DESIGN, SETTING, AND SAMPLE A prospective randomized controlled trial was conducted. Healthy adults with fully MITMs scheduled for extraction were included. Exclusion criteria were 1) patients with the systemic alteration that prevented the surgical procedure; 2) pregnancy, breastfeeding, and premenstrual period; 3) hypersensitivity to the drug under test; and 4) those who did not return for postoperative follow-up at 1, 3, and 7 days. EXPOSURE VARIABLE The subjects were randomized to 3 groups. An online randomization plan generator assigned each subject to a single treatment by randomly permuting blocks. Different sites for postoperative dexamethasone injections included the buccal side of the adjacent second molar and extraction sockets. Dexamethasone injection (4 mg) on the buccal side of the adjacent second molar (group 1), an injection on the buccal side of extraction sockets (group 2), and an injection of physiological saline (0.8 mL) on the buccal side of the adjacent second molar (control). MAIN OUTCOME VARIABLES The outcome variables were postoperative facial swelling, limitation of the mouth opening, postoperative pain, and postoperative quality of life evaluation. The pain was assessed using a visual analog scale at 1, 3, and 7 days, postoperatively. The quality of life was recorded throughout the Posse scale at 7 days. COVARIATES The covariates are age, sex, length of operation, and type of impacted teeth and surgery. ANALYSES The statistical analysis was performed using analysis of variance, repeated measures analysis of variance, χ2 test, or Fisher's exact tests with P values < .05 considered statistically significant. RESULTS Our study included 58 participants with a mean age of 19.48 ± 3.31 years; group 1 (n = 24), group 2 (n = 20), and control group (n = 14). On day 3 postoperative, the swelling and trismus were significantly less in group 1 than in the other 2 groups (P < .05), and group 1 had an overall postoperative quality of life compared to other groups (P < .05). Unaffected speech function was present in 73.7% of patients in group 1, while 50% of patients in group 2 had affected speech function 3 days after the operation (P < .05). The "unable to open mouth" of the "Eating subscale" and "felt tingling" had statistical significance (P < .05). CONCLUSION AND RELEVANCE Dexamethasone injections on the buccal side of the adjacent second molar can be a viable option for treating facial swelling and limitation of mouth opening after total MITMs extraction.
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Affiliation(s)
- Yiting Lou
- Doctoral Student, Department of Stomatology, The First Affiliated Hospital of Ningbo University, Ningbo First Hospital, Ningbo, China; Doctoral Student, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaoyan Weng
- Resident, The Third Affiliated Hospital of Wenzhou Medical University (Ruian People's Hospital), Zhejiang, China
| | - Jiale Hu
- Resident, Department of Stomatology, The First Affiliated Hospital of Ningbo University, Ningbo First Hospital, Ningbo, China; Resident, The Dental Outpatient Department of YiFen, Ningbo, China
| | - Zheyuan Sun
- Postgraduate Student, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, Zhejiang, China
| | - Binbin Ying
- Head of department, Professor, Department of Stomatology, The First Affiliated Hospital of Ningbo University, Ningbo First Hospital, Ningbo, China
| | - Yong Yang
- Attending Physician, Department of Stomatology, The First Affiliated Hospital of Ningbo University, Ningbo First Hospital, Ningbo, China.
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Kıraç Can SB, Berkel G, Can S. The Predictive Value of Cold Pack Test for Pain After Third Molar Surgery. J Oral Maxillofac Surg 2024; 82:218-227. [PMID: 38040027 DOI: 10.1016/j.joms.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Early identification of patients who are prone to postoperative pain may provide individualization of postoperative analgesia strategies. PURPOSE The aim of the study was to investigate whether the cold pack test is associated with postoperative pain levels after mandibular third molar surgery. STUDY DESIGN, SETTING, SAMPLE This prospective cohort study included healthy male patients admitted to Department of Oral and Maxillofacial Surgery of a tertiary health-care center between June 2022 and December 2022 and scheduled for lower third molar extraction. Those who had used any analgesic within the past 10 days or had a history of intolerance/allergy to analgesics were excluded. PREDICTOR VARIABLE The primary predictor variable was pain tolerance, measured using the endurance test score. Subjects were grouped into two categories, low tolerance test score (withdrew the hand from the cold pack in <240 seconds) and high tolerance test score (maintained the hand on the cold pack for 240 seconds). MAIN OUTCOME VARIABLES The primary outcome variable was pain measured by the patients from 0 to 10 with the visual analog scale, and the secondary outcome variables were the amount of ibuprofen and paracetamol consumed in the postoperative period. Pain measurements and ibuprofen consumption were recorded at 0-2, 8, 16, 24, 32, 40, 48, 56, 64, 72, 80, 88, and 96 hours (0-2 interval of the first 2 hours immediately after surgery). COVARIATES Age, classification and position of mandibular third molar were utilized as covariates. ANALYSES The relationship between pain tolerance and postoperative pain was analyzed using the Mann-Whitney U test and the Fisher exact test. Statistical analysis was performed using the SPSS version 28.0 software. RESULTS A total of 30 male patients with a mean age of 22.5 ± 4.8 years were included in our study. In the group with low pain tolerance, the pain scores at the first 2 hours, 32, and 48 hours after the operation (4.55 ± 3.59, 2.91 ± 2.59, 2.91 ± 2.43, respectively) were found to be significantly higher than the group with high pain tolerance (2.00 ± 2.67, 0.95 ± 1.68, 0.95 ± 1.39, respectively) (P < .05). In the first 2 hours after the operation, the amount of ibuprofen consumed was also significantly higher in the group with low pain tolerance compared to the other group, and 81.8% of this group felt the need to consume ibuprofen (P < .05). CONCLUSIONS AND RELEVANCE The cold pack test, a more practical version of quantitative sensory testing, is useful in identifying male patients at risk of developing greater pain after third molar surgery. It can be helpful to provide effective analgesia in male patients with different pain tolerance thresholds.
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Affiliation(s)
- Sinem Büşra Kıraç Can
- Specialist, Department of Oral and Maxillofacial Surgery, Marmara University Faculty of Dentistry, Istanbul, Turkey.
| | - Gülcan Berkel
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Marmara University Faculty of Dentistry, Istanbul, Turkey
| | - Serhat Can
- Specialist, Department of Oral and Maxillofacial Surgery, Private Dental Clinic, Istanbul, Turkey
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Caputo A, Rubino E, Marcianò A, Peditto M, Bellocchio AM, Nucera R, Oteri G. Three-dimensional facial swelling evaluation of piezo-electric vs conventional drilling bur surgery of impacted lower third molar: a randomized clinical trial. BMC Oral Health 2023; 23:233. [PMID: 37085833 PMCID: PMC10120228 DOI: 10.1186/s12903-023-02910-6] [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: 09/13/2022] [Accepted: 03/25/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Among the post-surgical complications of lower wisdom teeth surgery, swelling is considered by patients one of the most impairing, with both social and biological influences and impacting patients' quality of life. Aim of the study was to evaluate the swelling following the osteotomy when performed with drilling burs versus piezo-electric instruments in the mandibular impacted third molar extraction, using a facial reconstruction software. MATERIALS AND METHODS A randomized, split-mouth, single-blind study was conducted on patients, ranging between 18 and 40 years of age, requiring lower third molars extraction and referred at the Oral Surgery Unit of the School of Dentistry of the University of Messina. Twenty-two patients were recruited during an 8 months period according to the following criteria: good general health conditions; bilateral, symmetrical, impacted third molars; no use of medication that would influence or alter wound healing; no temporomandibular joint disorder history; no smoking. All patients underwent bilateral surgical removal. For each patient, a facial scan was obtained prior to the surgical procedures. The two extractions were conducted performing, in a randomized way, osteotomy with rotatory burs or use of piezo surgical instruments. Facial scans were repeated at 3 and 7 days after the surgical procedures. Volumetric differences were calculated via superimposition using a dedicated software. The data obtained were processed using paired t-test. RESULTS The results obtained from our study showed no significant differences between two groups regarding post-operative swelling. To the best of our knowledge, this study represents the first experience of using an objective method that can be reproducible on the collection of patients' clinical parameters. CONCLUSIONS The 3D digital analysis, in the evaluation of facial swelling, is a technique of simple application, objective, reproducible, reliable, decreasing the variables of error. Based on these data, it is possible to conclude that piezo surgery is a safe way for performing the osteotomies during third molar surgery. However, regarding the post-operative swelling, it does not show an advantage over classical rotary instruments. TRIAL REGISTRATION Registered on ClinicalTrials.gov (ID: NCT05488028, on 04/08/2022). Approved by Ethical Committee of Messina: (ID 01-2020, on 27/04/2020).
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Affiliation(s)
- A Caputo
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Via C. Valeria, 98125, Messina, Italy
| | - E Rubino
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Via C. Valeria, 98125, Messina, Italy
| | - A Marcianò
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Via C. Valeria, 98125, Messina, Italy
| | - M Peditto
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Via C. Valeria, 98125, Messina, Italy.
| | - A M Bellocchio
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Via C. Valeria, 98125, Messina, Italy
| | - R Nucera
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Via C. Valeria, 98125, Messina, Italy
| | - G Oteri
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Via C. Valeria, 98125, Messina, Italy
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Mordini L, Patianna GP, Di Domenico GL, Natto ZS, Valente NA. The use of corticosteroids in the lateral sinus augmentation surgical procedure: A systematic review and meta-analysis. Clin Implant Dent Relat Res 2022; 24:776-791. [PMID: 36068078 PMCID: PMC10087261 DOI: 10.1111/cid.13126] [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: 05/27/2022] [Revised: 07/13/2022] [Accepted: 07/16/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The lateral maxillary sinus augmentation (MSA) procedure has good predictability in terms of the success of bone regeneration with a low incidence of postoperative infections, estimated between 2% and 5.6%. Although the use of antibiotics is an established and standardized prophylactic measure for MSA procedures, the addition of corticosteroids still varies among clinician preference and clinical judgment. PURPOSE The aim of this systematic review was to identify whether the administration of corticosteroids during the MSA surgical procedure affects postoperative symptoms including swelling, pain, and infection rate. MATERIALS AND METHODS A literature search through PubMed, EMBASE, Ovid MEDLINE, and Web of Science indices, according to PICO criteria, was conducted to identify whether MSA peri-operative use of corticosteroids reduces the incidence of complications and patient morbidity. A single arm meta-analysis was performed due to the lack of randomized controlled trials (RCTs) comparing groups treated with or without peri-operative corticosteroids. The intracluster correlation co-efficient (ICC) and design effect were calculated to adjust for the clustering design. RESULTS In the 37 studies included, a total of 1599 patients (378 Cort, 1221 No-Cort) were analyzed. Before and after taking account of clustering, there was statistically significant effect of corticosteroids on swelling, pain, wound dehiscence, trismus, and hematoma. The complication rates postoperatively were comparable between the two study groups, however slight differences existed in the incidence of active suppuration (1.7% [95% CI 0.7-3.9] Cort vs. 3.2% [2.2-4.5] No-Cort), wound dehiscence (3.9% [1.3-11.2] Cort vs. 2.1% [1.0-4.1] No-Cort) and trismus (2.7% [0.8-8.4] Cort vs. 1.4% [0.8-2.5] No-Cort). CONCLUSIONS Although the event rate of the 1-to-2-week postoperative complications did not differ between the two groups, the lack of conclusive data and research comparing peri-operative corticosteroid use makes it impossible to draw definitive conclusions and more evidence and studies designed for this specific purpose are needed.
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Affiliation(s)
- Lorenzo Mordini
- Department of Periodontology, School of Dental Medicine, Tufts University, Boston, Massachusetts, USA
| | - Giuseppe Pio Patianna
- Division of Oral Surgery, Unit of Dentistry, Dental School, Faculty of Medicine and Surgery, Vita Salute University and IRCCS San Raffaele, Milan, Italy
| | - Giovanna Laura Di Domenico
- Division of Oral Surgery, Unit of Dentistry, Dental School, Faculty of Medicine and Surgery, Vita Salute University and IRCCS San Raffaele, Milan, Italy
| | - Zuhair S Natto
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nicola Alberto Valente
- Division of Periodontology, School of Dental Medicine, Department of Surgical Sciences, Faculty of Medicine and Surgery, University of Cagliari, Cagliari, Italy.,Department of Periodontology, School of Dental Medicine, State University of New York at Buffalo, Buffalo, New York, USA
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Efficacy of different dexamethasone routes and doses in reducing the postoperative sequelae of impacted mandibular third-molar extraction. J Am Dent Assoc 2022; 153:1154-1170.e60. [DOI: 10.1016/j.adaj.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/22/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022]
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Altaweel AA, El-Hamid Gaber A, Alnaffar MZ, Almowallad AS, Almech MH, Almuwallad AS, Alharbi RK, Arab WA. A novel therapeutic approach for reducing postoperative inflammatory complications after impacted mandibular third molar removal. Medicine (Baltimore) 2022; 101:e30436. [PMID: 36123843 PMCID: PMC9478325 DOI: 10.1097/md.0000000000030436] [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] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study was designed to compare effect of combined use of dexamethasone and honey versus each agent alone in controlling complications associated with removal of impacted mandibular third molar. METHODS This randomized clinical study included patients suffering from impacted mandibular wisdom teeth. Patients were divided randomly into 4 groups. Group I, control, group II, received dexamethasone injection preoperatively, group III, received honey locally in the wound after extraction, and group IV, received dexamethasone injection preoperatively and topical honey application. All patients were evaluated preoperatively and postoperatively to assess facial edema, interincisal distance, pain, and total analgesic dose used. RESULTS Significant edema developed in group I than other groups and improved significantly in group II and III on seventh postoperative day, and tenth postoperative day in group I. Insignificant edema developed in group IV. Significant decrease in interincisal distance occurred in all groups on third postoperative day that improved significantly on seventh postoperative days in all groups except group I, it improved on tenth postoperative day. Pain was significantly minimum in group IV than other groups and its maximum degree was in group I. CONCLUSION Both dexamethasone and honey are an effective way of minimizing swelling, pain, and trismus after removal of impacted lower third molars. Both agents either alone or in combination provide simple, safe, painless, and cost-effective method to eliminate postoperative discomfort. However, dexamethasone or honey can decrease complications related to surgical extraction of mandibular third molar, the simultaneous application of both agents is more effective method in this regard.
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Affiliation(s)
- Alaa Abdelqader Altaweel
- Oral & Maxillofacial Surgery, Faculty of Dental Medicine for Boys, Al-Azhar University, Cairo, Egypt
- Consultant of Oral & Maxillofacial Surgery, Nahdicare Clinics, Jeddah, Saudi Arabia
- *Correspondence: Alaa Abdelqader Altaweel, Faculty of Dental Medicine for Boys, Al-Azhar University, AL Mokhaym AL Daem St., Nasr City, Cairo 11751, Egypt (e-mail: )
| | - Abd El-Hamid Gaber
- Clinical Pharmacology, Department of Clinical Pharmacology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Mahmoud Z. Alnaffar
- Periodontology and Preventive Dentistry, Vision Colleges, Jeddah, Saudi Arabia
| | | | | | | | | | - Wasan A. Arab
- Dental Intern at Vision Colleges, Jeddah, Saudi Arabia
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Choudhury R, Rastogi S, Rohatgi RG, Abdulrahman BI, Dutta S, Giri K. Does pedicle flap design influence the postoperative sequel of lower third molar surgery and quality of life? J Oral Biol Craniofac Res 2022; 12:694-701. [DOI: 10.1016/j.jobcr.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/19/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022] Open
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Methylprednisolone and Hyaluronic Acid versus Each Agent Alone to Control Complication of Impacted Wisdom Removal. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1563513. [PMID: 35368756 PMCID: PMC8970876 DOI: 10.1155/2022/1563513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/14/2022] [Indexed: 11/18/2022]
Abstract
Introduction. Extraction of impacted molars is commonest operation in oral cavity and associated with complications disturbing patient’s quality of life. Hyaluronic acid is a nontoxic agent recommended for wound management due to its anti-inflammatory effects. Also, methylprednisolone sodium is used to reduce pain and edema. The aim this study was to compare the effect of combined use of corticosteroid and hyaluronic acid versus each agent alone in controlling postextraction complications of impacted mandibular third molars. Materials and Methods. This prospective randomized trial included patients suffering from impacted mandibular third molar. Patients were divided into four groups. Group I, control, and group II received methylprednisolone sodium succinate injection preoperatively, group III received hyaluronic acid applied in extraction socket, and group IV received preoperative methylprednisolone sodium succinate injection and topical hyaluronic acid in the socket. All patients were evaluated preoperatively and postoperative day to assess swelling, pain, mouth opening, and total analgesic dose. Results. Group IV showed insignificant edema along the study period, and other groups showed significant edema on third postoperative day that improved on seventh postoperative in group II and III and tenth postoperative day in group I. Significant decreased mouth opening occurred on second postoperative day in group I, while in other groups, it occurred in third postoperative day. Significant improvement occurred on seventh postoperative day in all groups except in group I which occurred on tenth postoperative day. There was less pain and analgesic dose reported in group IV than other groups. Conclusion. Combined use of methylprednisolone sodium succinate and hyaluronic acid significantly decrease postoperative complications than using each agent alone.
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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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Kandamani J, Gouthaman S, Ramakrishnan D, Kumar MPS, Muthusekar MR. Evaluation of effect of submucosal administration of depomedrol in management of postoperative sequelae in mandibular fractures: A randomized clinical trial study. Natl J Maxillofac Surg 2022; 13:84-89. [PMID: 35911819 PMCID: PMC9326196 DOI: 10.4103/njms.njms_118_20] [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: 06/18/2020] [Revised: 07/21/2020] [Accepted: 10/31/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction: The mandible is a commonly fractured bone in the face, a fact related to its prominent and exposed position. Open reduction and internal fixation (ORIF) of mandibular fractures has been associated with trauma to the surgical site and the surrounding tissues. Purpose: The purpose of this study is to evaluate the effects of immediate postoperative submucosal depomedrol administration on postoperative pain, edema, and trismus after ORIF for mandibular fractures. Materials and Methods: We conducted a prospective, randomized, controlled, double-blind study of forty patients who required ORIF for mandibular fractures under general anesthesia. The patients were divided into two groups, an experimental group who received immediate postoperative submucosal 40 mg of depomedrol injection through the surgical incision site, and a control group who did not receive any drug. Pain was assessed using a Visual Analog Scale score and the frequency of analgesic consumption at various postoperative intervals. The maximum interincisal distance and facial measurements were compared before surgery and at 24, 48, 72 h, and 7 days after surgery. Results: Statistical analysis of the data indicated a significant decrease in edema, trismus, and pain in the depomedrol group. No clinically apparent infection, disturbance of wound healing, or other corticosteroid-related complications were noted. Conclusion: The results of our study suggest that submucosal administration of depomedrol injection after ORIF for mandibular fractures is effective in reducing postoperative pain, edema, and trismus.
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Selvido DI, Bhattarai BP, Niyomtham N, Riddhabhaya A, Vongsawan K, Pairuchvej V, Wongsirichat N. Review of dexamethasone administration for management of complications in postoperative third molar surgery. J Korean Assoc Oral Maxillofac Surg 2021; 47:341-350. [PMID: 34713808 PMCID: PMC8564082 DOI: 10.5125/jkaoms.2021.47.5.341] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/11/2021] [Accepted: 02/09/2021] [Indexed: 11/13/2022] Open
Abstract
Dexamethasone has been used in oral and maxillofacial surgery for postoperative pain, swelling, and trismus following third molar surgeries. It is a potent and powerful drug that can alleviate the aforementioned postoperative sequelae. Dexamethasone is responsible for inhibiting the release of inflammatory mediators in the inflammation process to improve patient quality of life after surgical intervention. There are several available routes of administering dexamethasone. This article will help determine the suggested routes of administration, dosage, parameters, and dexamethasone timing for third molar surgeries.
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Affiliation(s)
- Diane Isabel Selvido
- Department of Oral and Maxillofacial Surgery, International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Bishwa Prakash Bhattarai
- Department of Oral and Maxillofacial Surgery, International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Nattisa Niyomtham
- Department of Oral and Maxillofacial Surgery, International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Apiwat Riddhabhaya
- Department of Oral and Maxillofacial Surgery, International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Kadkao Vongsawan
- Department of Oral and Maxillofacial Surgery, International College of Dentistry, Walailak University, Bangkok, Thailand
| | | | - Natthamet Wongsirichat
- Department of Oral and Maxillofacial Surgery, International College of Dentistry, Walailak University, Bangkok, Thailand
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Quesada-Bravo FJ, García-Carricondo AR, Espín-Gálvez F, Fernández-Sánchez C, Fernández-Ginés D, Requena-Mullor MDM, Alarcón-Rodríguez R. Comparative Study between the Combination of Dexamethasone and Bupivacaine for Third Molar Surgery Postoperative Pain: A Triple-Blind, Randomized Clinical Trial. J Clin Med 2021; 10:jcm10215081. [PMID: 34768600 PMCID: PMC8584321 DOI: 10.3390/jcm10215081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/23/2021] [Accepted: 10/26/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives: To compare the possible benefits of the combination of dexamethasone–bupivacaine with articaine–epinephrine as an anaesthetic block after third molar surgery. Materials and Methods: Triple-blind, randomized, controlled, parallel, phase 3 clinical trial. Two groups: experimental (93 patients) with standard anaesthetic block: 40/0.005 mg/mL articaine–epinephrine and submucosal reinforcement with 0.8 mg dexamethasone–5% bupivacaine; and control group (91 patients) with standard block: 40/0.005 mg/mL articaine–epinephrine. The surgery consisted of the extraction of the impacted mandibular third molar by performing a procedure following the same repeatable scheme. The visual analogue scale (VAS) was used to analyse postoperative pain. Results: Groups were homogeneous, without significant differences related to epidemiological variables. Postoperative pain among the first, second, and seventh postoperative days was statistically significantly lower in the experimental group compared to the control group (p < 0.001). Drug consumption was lower in the experimental group throughout the study period (p < 0.04). Conclusion: Bupivacaine is an alternative to articaine in oral surgery, being more effective in reducing postoperative pain by reducing patients’ scores on the VAS as well as their consumption of analgesic drugs after surgery.
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Affiliation(s)
- Francisco Javier Quesada-Bravo
- Maxillofacial Surgeons of Department of Oral and Maxillofacial Surgery, Torrecardenas University Hospital, 04009 Almeria, Spain; (F.J.Q.-B.); (A.R.G.-C.); (F.E.-G.)
| | - Ana Rocío García-Carricondo
- Maxillofacial Surgeons of Department of Oral and Maxillofacial Surgery, Torrecardenas University Hospital, 04009 Almeria, Spain; (F.J.Q.-B.); (A.R.G.-C.); (F.E.-G.)
| | - Fernando Espín-Gálvez
- Maxillofacial Surgeons of Department of Oral and Maxillofacial Surgery, Torrecardenas University Hospital, 04009 Almeria, Spain; (F.J.Q.-B.); (A.R.G.-C.); (F.E.-G.)
| | - Carmen Fernández-Sánchez
- Department of Clinical Pharmacology, Torrecardenas University Complex, 04009 Almeria, Spain; (C.F.-S.); (D.F.-G.)
| | - Damaso Fernández-Ginés
- Department of Clinical Pharmacology, Torrecardenas University Complex, 04009 Almeria, Spain; (C.F.-S.); (D.F.-G.)
| | | | - Raquel Alarcón-Rodríguez
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain;
- Correspondence: ; Tel.: +34-950-214-606
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Nourwali I. The effects of platelet-rich fibrin on post-surgical complications following removal of impacted wisdom teeth: A pilot study. J Taibah Univ Med Sci 2021; 16:521-528. [PMID: 34408609 PMCID: PMC8348291 DOI: 10.1016/j.jtumed.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Platelet-rich fibrin (PRF) is a fibrin matrix composed of cells, cytokines, and growth factors, which may be liberated from blood at specific times and act as a resorbable membrane. Many studies have demonstrated the benefits of PRF for bone healing in oral and maxillofacial implant surgery. Our study assesses the impact of PRF on postoperative complications following the extraction of impacted wisdom teeth. METHODS Twenty patients were recruited in this blind controlled randomised clinical trial, i.e. ten patients in the study group and ten patients in the control group. The patients were aged between 18 and 40 years. Surgical removal of impacted teeth #38 and #48 was performed in all the patients. The study group underwent dentoalveolar surgery with the use of PRF, while the control group underwent surgery without PRF. RESULTS All patients in the study group reported significantly less postoperative pain (p = 0.02) and excellent soft tissue healing during the follow-up period (p = 0.021). In contrast, only 80% of patients in the control group exhibited sufficient soft tissue healing. The difference in postoperative swelling between the two groups was not statistically significant. Additionally, 69% of patients in the study group reported comfortable night sleep during the first 24 h after the operation compared to 31% in the control group. This difference was statistically significant (p = 0.02). CONCLUSION Based on the outcomes of our study, implanting PRF into surgical extraction sites can be helpful in reducing postoperative pain and improving soft tissue healing. The use of PRF in extraction sockets is simple and biologically safe. The beneficial effects of PRF support its possible application in the field of dental surgery.
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Affiliation(s)
- Ibrahim Nourwali
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Taibah University, Germany
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14
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Varela-Centelles P, Seoane J, Ulloa-Morales Y, Estany-Gestal A, Blanco-Hortas A, -García-Pola MJ, -Seoane-Romero JM. Oral cancer awareness in North-Western Spain: a population-based study. Med Oral Patol Oral Cir Bucal 2021; 26:e518-e525. [PMID: 34162825 PMCID: PMC8254879 DOI: 10.4317/medoral.24401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 02/15/2021] [Indexed: 01/14/2023] Open
Abstract
Background An early diagnosis depends greatly on patient awareness. Thus, the aim of this study was to investigate general awareness of oral cancer and knowledge about its risk factors, signs and symptoms.
Material and Methods Cross-sectional population-based survey of randomly selected respondents conducted from March 1, 2015 to 30 June 2016.
Results A total of 5,727 people entered the survey (response rate: 53%). When asked what cancers participants had heard about, 20.3% mentioned oral cancer. Regarding risk factors, tobacco was mentioned by 55.3% of the sample (n=3,169), followed by alcohol (12.5%; n=708), poor oral hygiene (10.8%; n=618), diet (6.5%; n=377), and genetics (4.5%; n=248).
Conclusions General population has low awareness of oral cancer with poor knowledge of risk factors and main alarm signs. In addition, individuals in the risk group scored lower values in the main variables analysed; even those highly educated showed insufficient awareness and knowledge of oral cancer. In these circumstances, there is clear need for educational interventions tailored to the target audience and aimed at increasing knowledge and awareness of oral cancer to promote primary prevention of oral cancer and minimising the time interval of patients with symptomatic oral cancer in their path to treatment. Key words:Oral cancer, awareness, risk factors, surveys and questionnaires, Spain.
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15
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Wagner JC, Johnson TM, Gilbert WA. Should periodontists prescribe postoperative oral corticosteroids to control pain and swelling? A systematic review. Clin Adv Periodontics 2021; 12:134-142. [PMID: 33988318 DOI: 10.1002/cap.10169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/08/2021] [Indexed: 11/05/2022]
Abstract
FOCUSED CLINICAL QUESTION In generally healthy patients receiving third molar, periodontal, or dental implant surgery, do postoperative oral corticosteroids effectively limit pain and swelling compared with placebo or alternative medications?
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Affiliation(s)
- Jennah C Wagner
- Department of Periodontics, Army Postgraduate Dental School, Uniformed Services University of the Health Sciences, Fort Gordon, Georgia
| | - Thomas M Johnson
- Department of Periodontics, Army Postgraduate Dental School, Uniformed Services University of the Health Sciences, Fort Gordon, Georgia
| | - William A Gilbert
- Department of Periodontics, US Army Dental Health Activity, Joint Base Lewis McChord, Tacoma, Washington
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16
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Gulnahar Y, Alpan AL. Comparison of postoperative morbidity between piezoelectric surgery and conventional rotary instruments in mandibular third molar surgery: a split-mouth clinical study. Med Oral Patol Oral Cir Bucal 2021; 26:e269-e275. [PMID: 33772570 PMCID: PMC8141306 DOI: 10.4317/medoral.24085] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 02/01/2021] [Indexed: 01/05/2023] Open
Abstract
Background The extraction of impacted third molar teeth is a common procedure in maxillofacial surgery. The aim of this study was to compare of piezoelectric surgical technique with the one with conventional rotary instruments in terms of edema, trismus and pain, in mandibular third molar surgery.
Material and Methods 20 individuals with symmetrically impacted lower mandibular third molars and 40 teeth were included in the study. Third molars on the left side of each patient were removed with piezosurgery, while the counterparts on the right side were removed with conventional rotary instruments. Postoperatively, the same antibiotic, analgesic, and mouthwash were recommended to both groups. Ultrasound, edema, trismus measurements were performed before surgery, postoperative, postoperative day 2 and postoperative day 7. VAS scale was used to evaluate the pain.
Results The average age of 20 individuals included in the study was found to be 21.85 ± 3.08 years. The operation time of the individuals who underwent the surgery with conventional rotary instruments was found to be 12 minutes 31.70 ± 167.03 seconds, and the operation time in the Piezosurgery group was 19 minutes 10.60 ± 306.59 seconds. There was no significant difference between the two groups in terms of trismus, edema, and pain.
Conclusions Piezosurgery is a safe method that can be used in molar removal, but in this split-mouth study, it is not found advantageous in terms of postoperative morbidity due to the longer working time compared to the one performed with conventional rotary instruments. Key words:Edema, impacted third molar, pain, piezosurgery, trismus.
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Affiliation(s)
- Y Gulnahar
- Pamukkale University Faculty of Dentistry Department of Periodontology Kınıklı Campus 20160 Denizli, Turkey
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Weckwerth GM, Dionísio TJ, Costa YM, Zupelari-Gonçalves P, Oliveira GM, Torres EA, Bonjardim LR, Faria FAC, Calvo AM, Moore T, Absher DM, Santos CF. Multifocal Analysis of Acute Pain After Third Molar Removal. Front Pharmacol 2021; 12:643874. [PMID: 33935738 PMCID: PMC8082138 DOI: 10.3389/fphar.2021.643874] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: To analyze the pain modulation capacity profile in a Brazilian population, the relationship between opioid receptor (OPRM1) and Catechol-O-methyltransferase (COMT) 1polymorphisms and pain modulation capacity was determined through preoperative pain modulation tests and acute postoperative pain control evaluation, swelling, and trismus in 200 volunteers undergoing lower third molar removal. Methods: Psychologic and clinical parameters were measured. Patient DNA was sequenced for single nucleotide polymorphisms in OPRM1 and COMT, and the salivary concentration of interleukin (IL)-2 (IL)-6, interferon (IFN)-γ and tumor necrosis factor (TNF)-α was evaluated. Primary outcomes were the influence of all predictors on the fluctuation of pain intensity using a visual analogue scale (VAS), and swelling and trismus on the 2nd and 7th postoperative days. Preoperative pain modulation capacity (CPM), pain catastrophizing scale (PCS), body mass index (BMI), and surgery duration and difficulty were evaluated. Results: Salivary concentration of IFN-γ and IL-2 as well as the duration of surgery influenced the fluctuation of postoperative pain in the VAS, and in the sum of the differences in pain intensity test at 8, 48, and 96 h. BMI influenced swelling, while both BMI and COMT haplotype influenced trismus on the 2nd postoperative day. Conclusion: Polymorphisms in COMT, salivary concentrations of IL-2 and IFN-γ, BMI, and duration of surgery were predictors for pain fluctuation, swelling, and trismus on the 2nd day after lower third molar extraction. This therapy was effective in controlling inflammatory symptomatology after lower third molar extraction and ibuprofen was well tolerated by patients. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03169127.
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Affiliation(s)
- Giovana Maria Weckwerth
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Thiago José Dionísio
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Yuri Martins Costa
- Department of Biosciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Paulo Zupelari-Gonçalves
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Gabriela Moraes Oliveira
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Elza Araújo Torres
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | | | | | - Adriana Maria Calvo
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Troy Moore
- Kailos Genetics Inc., HudsonAlpha Institute for Biotechnology, Huntsville, AL, United States
| | | | - Carlos Ferreira Santos
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
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Sbricoli L, Cerrato A, Frigo AC, Zanette G, Bacci C. Third Molar Extraction: Irrigation and Cooling with Water or Sterile Physiological Solution: A Double-Blind Randomized Study. Dent J (Basel) 2021; 9:40. [PMID: 33915980 PMCID: PMC8066638 DOI: 10.3390/dj9040040] [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] [Received: 02/15/2021] [Revised: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The present study aimed to ascertain whether any significant reduction in patients' postoperative pain and inflammation could be achieved by using sterile physiological solution instead of normal water to irrigate the surgical field and cool the dental bur during third molar extractions. METHODS The study concerned 22 patients (11 females and 11 males) in good general health, who were referred to the Dental Clinic at Padova University hospital for lower third molar extractions. They were randomly assigned to two groups. Only the fluid used to irrigate the surgical field and cool the dental bur differed between the two study groups, being sterile physiological solution for group A, and mains water for group B. Postoperative pain, swelling, trismus and inflammation with high sensitivity CRP where measured and statistically evaluated. The numerosity of our sample was calculated on the grounds of an endpoint based on data in the literature. RESULTS Eighteen patients needed bilateral extractions, and 4 required only one extraction, so a total of 40 third molars were extracted. A sterile physiological solution was used to irrigate the surgical field in 20 extractions, while water was used in the other 20 cases. Data analysis with Wilcoxon test show no differences between the two groups (p < 0.05). CONCLUSIONS no differences between groups for any of the parameters considered, after third molar extraction procedures undertaken using either sterile physiological solution or water for irrigation and cooling purposes.
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Affiliation(s)
- Luca Sbricoli
- Department of Neurosciences, Section of Clinical Dentistry, Unit of Oral Surgery and Pathology, University of Padova, 35122 Padova, Italy; (L.S.); (A.C.); (G.Z.)
| | - Alessia Cerrato
- Department of Neurosciences, Section of Clinical Dentistry, Unit of Oral Surgery and Pathology, University of Padova, 35122 Padova, Italy; (L.S.); (A.C.); (G.Z.)
| | - Anna Chiara Frigo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy;
| | - Gastone Zanette
- Department of Neurosciences, Section of Clinical Dentistry, Unit of Oral Surgery and Pathology, University of Padova, 35122 Padova, Italy; (L.S.); (A.C.); (G.Z.)
| | - Christian Bacci
- Department of Neurosciences, Section of Clinical Dentistry, Unit of Oral Surgery and Pathology, University of Padova, 35122 Padova, Italy; (L.S.); (A.C.); (G.Z.)
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Martins-de-Barros AV, Barros AM, Siqueira AK, Lucena EE, Sette de Souza PH, Araújo FA. Is Dexamethasone superior to Ketorolac in reducing pain, swelling and trismus following mandibular third molar removal? A split mouth triple-blind randomized clinical trial. Med Oral Patol Oral Cir Bucal 2021; 26:e141-e150. [PMID: 33247572 PMCID: PMC7980286 DOI: 10.4317/medoral.24088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/08/2020] [Indexed: 11/17/2022] Open
Abstract
Background The preemptive use of anti-inflammatory drugs, such as corticosteroids and NSAIDs, has the potential to reduce pain, swelling and trismus following oral surgery. The aim of this study was to compare the efficacy of dexamethasone and ketorolac tromethamine in reducing pain, swelling and trismus after mandibular third molar removal.
Material and Methods The researches implemented a triple-blind, randomized clinical trial. The study was conducted with ASA I individuals aging between 18 and 35 years, which were randomized and submitted to two interventions, one with 8mg dexamethasone and the other with 20mg ketorolac tromethamine given 1h before the procedure. The primary predictor variable was the use of dexamethasone or ketorolac. The primary outcome variable was the postoperative pain level, measured with a Visual Analogue Scale. The secondary outcome variables were the amount of rescue analgesic consumed, swelling and trismus. Repeated-measures ANOVA and t-test for paired samples were used to compare the means. Significance was set at p < 0.05.
Results Fifty individuals were randomized and allocated to intervention, and the sample was composed of 40 subjects who completed the study (27 female and 13 male). Dexamethasone, when compared to ketorolac tromethamine, showed a significantly higher reduction in pain level at 8h, 16h, 24h, 32h, 40h and 72h, in swelling and trismus at 24h, 48h, 72h and 7 days and in total number of rescue analgesics taken up to 72h postoperative (p < 0.05).
Conclusions The clinical performance of dexamethasone in controlling pain, swelling and trismus after mandibular third molar removal was superior to ketorolac tromethamine’s. Key words:Third Molar, anti-inflammatory agents, dexamethasone, ketorolac.
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Affiliation(s)
- A-V Martins-de-Barros
- Hospital Universitário Oswaldo Cruz University of Pernambuco, Campus Santo Amaro Rua Arnóbio Marquês, 310 Santo Amaro, Recife, Pernambuco, Brazil
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Sugragan C, Sirintawat N, Kiattavornchareon S, Khoo LK, Kc K, Wongsirichat N. Do corticosteroids reduce postoperative pain following third molar intervention? J Dent Anesth Pain Med 2020; 20:281-291. [PMID: 33195806 PMCID: PMC7644360 DOI: 10.17245/jdapm.2020.20.5.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/05/2020] [Accepted: 08/10/2020] [Indexed: 12/03/2022] Open
Abstract
Background Corticosteroids have been widely used by oral surgeons for reducing swelling caused by wisdom teeth surgery. However, they have not been proven to decrease pain. This study was aimed at analyzing previous studies pertaining to corticosteroids and pain reduction following wisdom teeth surgery. Methods The Science Direct, PubMed, and MEDLINE databases were searched for relevant journals according to a systematic search strategy (Patient Intervention Comparison Outcome Study). Randomized controlled trials published in English from 1998 to 2017 were extracted. Results Twenty-seven articles were included, with a total of 36 comparative cases. Methylprednisolone and dexamethasone were the most commonly used corticosteroids. Intramuscular injections of corticosteroids were optimal for pain reduction, regardless of the time of administration. Conclusions Corticosteroids can be used as an adjuvant for pain reduction following wisdom teeth surgery. Methylprednisolone and dexamethasone delivered via the intramuscular route is the best method for effective pain reduction. The ideal time for administration of corticosteroids is the preoperative period.
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Affiliation(s)
- Chollathit Sugragan
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Nattapong Sirintawat
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | | | - Lee Kian Khoo
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Kumar Kc
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Natthamet Wongsirichat
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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21
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Weckwerth GM, Dionísio TJ, Costa YM, Colombini-Ishiquiriama BL, Oliveira GM, Torres EA, Bonjardim LR, Calvo AM, Moore T, Absher DM, Santos CF. CYP450 polymorphisms and clinical pharmacogenetics of ibuprofen after lower third molar extraction. Eur J Clin Pharmacol 2020; 77:697-707. [PMID: 33205280 DOI: 10.1007/s00228-020-03046-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/13/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE This study hypothesized that drugs accumulate in the bloodstream of poor-metabolizing patients and may have more adverse effects and different pain perceptions and aimed to investigate the influence of CYP450 polymorphisms on acute postoperative pain, swelling, and trismus controlled by ibuprofen (600 mg) in 200 volunteers after dental extraction. In addition, surgical outcomes can determine pain, edema, and trismus and indicate inflammatory reactions after oral surgeries. METHODS Genetic sequencing was performed to identify CYP450 polymorphisms and the surgical parameters evaluated: pre and postoperative swelling, trismus, and temperature; self-reported postoperative pain with visual analog scale (VAS); rescue medication consumed; and severity of adverse reactions. RESULTS A multiple linear regression model with independent variables [single nucleotide polymorphisms (SNPs), BMI (body mass index), duration, and difficulty of surgery] and dependent variables [postoperative pain by sum of pain intensity difference (SPID), trismus, and swelling] was used for analysis. The duration of surgery was a predictor for pain at 8 h and 96 h after surgery, and BMI was a predictor for both swelling and trismus on the 2nd postoperative day. When evaluating CYP2C8 and C9 genotyped SNPs, it was observed that normal metabolizers showed higher pain levels than the intermediate/poor metabolizers on the postoperative periods as compared with time 0 h. In another analysis, the poor metabolizers for CYP2C8 and C9 presented lower levels of postoperative pain after 8 h and used rescue medication earlier than normal metabolizers. CONCLUSION Ibuprofen 600 mg was very effective in controlling inflammatory pain after lower third molar surgeries, without relevant adverse reactions; although in a very subtle way, patients with poor metabolism had higher levels of pain in the first hours, and no longer after 8 h, and used pain relief medication earlier. TRIAL REGISTRATION The study was registered with ClinicalTrials.gov ID (NCT03169127), on March 16th, 2017.
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Affiliation(s)
- Giovana M Weckwerth
- Discipline of Pharmacology, Bauru School of Dentistry, Department of Biological Sciences, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil
| | - Thiago J Dionísio
- Discipline of Pharmacology, Bauru School of Dentistry, Department of Biological Sciences, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil
| | - Yuri M Costa
- Piracicaba Dental School, Department of Physiological Sciences, University of Campinas, Piracicaba, SP, Brazil
| | - Bella L Colombini-Ishiquiriama
- Bauru School of Dentistry, Department of Pediatric Dentistry, Orthodontics and Community Health, University of São Paulo, Bauru, SP, Brazil
| | - Gabriela M Oliveira
- Discipline of Pharmacology, Bauru School of Dentistry, Department of Biological Sciences, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil
| | - Elza A Torres
- Discipline of Pharmacology, Bauru School of Dentistry, Department of Biological Sciences, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil
| | - Leonardo R Bonjardim
- Discipline of Pharmacology, Bauru School of Dentistry, Department of Biological Sciences, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil
| | - Adriana M Calvo
- Discipline of Pharmacology, Bauru School of Dentistry, Department of Biological Sciences, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil
| | - Troy Moore
- Kailos Genetics Inc., Huntsville, AL, USA
| | - Devin M Absher
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA
| | - Carlos F Santos
- Discipline of Pharmacology, Bauru School of Dentistry, Department of Biological Sciences, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil.
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Sitthisongkhram K, Niyomtham N, Chaiyasamut T, Pairuchvej V, Kc K, Wongsirichat N. Effectiveness of dexamethasone injection in the pterygomandibular space before and after lower third molar surgery. J Dent Anesth Pain Med 2020; 20:313-323. [PMID: 33195809 PMCID: PMC7644359 DOI: 10.17245/jdapm.2020.20.5.313] [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] [Received: 08/04/2020] [Revised: 09/21/2020] [Accepted: 10/04/2020] [Indexed: 01/08/2023] Open
Abstract
Background Previous studies have investigated the effects of dexamethasone injections into the pterygomandibular space and compared them to those of controls; however, the effects of dexamethasone injections before and after lower third molar surgery on postoperative complications have not been studied. This research investigated the postoperative sequelae of dexamethasone injections before and after surgery into the pterygomandibular space. The aim of this study was to evaluate the effects of preoperative and postoperative injections of 4 mg of dexamethasone into the pterygomandibular space on postoperative pain, facial swelling, and the restriction of mouth opening following lower third molar surgical removal. Methods Twenty-seven participants with bilateral symmetrical lower impacted third molars were included in this study. Each participant was randomly allocated to one of two groups. Group A received injections of 1 ml dexamethasone (4 mg/mL) and 1 mL placebo into the pterygomandibular space before and after surgery, respectively. Group B received the same doses of placebo before surgery and dexamethasone after surgery. Results A significant restriction of mouth opening on the second postoperative day was observed in both groups. Nonetheless, the postoperative restriction of mouth opening, facial swelling, postoperative pain, and analgesic consumption after lower third molar surgical removal were not significantly different in the two groups. Conclusions Regardless of the time of administration, dexamethasone injections into the pterygomandibular space resulted in satisfactory control of the postoperative sequelae of the mandibular third molar surgical removal.
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Affiliation(s)
- Kalaya Sitthisongkhram
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Nattisa Niyomtham
- International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Teeranut Chaiyasamut
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Verasak Pairuchvej
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Kumar Kc
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Li X, Xu L, Nie H, Lei L. Dexamethasone-loaded β-cyclodextrin for osteogenic induction of mesenchymal stem/progenitor cells and bone regeneration. J Biomed Mater Res A 2020; 109:1125-1135. [PMID: 32981208 DOI: 10.1002/jbm.a.37104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/23/2020] [Accepted: 09/26/2020] [Indexed: 01/11/2023]
Abstract
Dexamethasone (DEX) is a glucocorticoid commonly used as an in vitro osteogenic inducer of mesenchymal stem/progenitor cells (abbreviated MSCs). However, several studies investigating the effects of glucocorticoids on bone regeneration through systemic injections have demonstrated negative impacts of the drugs at high concentration on the healing of hard tissues. These contrasting evidences suggest that application of glucocorticoids should be limited to low dosages but at the same time a long enough treatment period is preferred, which prompted us to evaluate the effects of different local release systems of DEX on MSC differentiation and bone repair. Two types of DEX-loaded β-cyclodextrin (CD) complexes, including CD/DEX and CD/AD-DEX, were fabricated via host-guest interactions and characterized by FTIR, 1H-NMR, MS-ESI, and UV-vis. The results demonstrated that these CD-based assemblies released DEX in differentiated profiles, with CD/DEX releasing significantly faster than CD/AD-DEX. Although CD/DEX were slightly more powerful than CD/AD-DEX in inducing rat bone marrow MSCs (rBMSCs) into osteogenic lineage in vitro, CD/AD-DEX was advantageous over CD/DEX in accelerating bone regeneration over a time period of 4 weeks in a rat tibia defect model. The results suggest that DEX-loaded assemblies via host-guest interactions are flexible in modulating DEX release patterns and have great potential in bone tissue engineering.
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Affiliation(s)
- Xing Li
- Department of Orthodontics, Central South University Xiangya Stomatological Hospital, Changsha, China
| | - Lu Xu
- Department of Biomedical Engineering, College of Biology, Hunan University, Changsha, China
| | - Hemin Nie
- Department of Biomedical Engineering, College of Biology, Hunan University, Changsha, China
| | - Lei Lei
- Department of Orthodontics, Central South University Xiangya Stomatological Hospital, Changsha, China
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Alveolar iodine tampon packing after impacted third molar surgery improves oral health-related quality of life and postoperative sequela: a randomized study. Oral Maxillofac Surg 2020; 25:181-190. [PMID: 32862256 PMCID: PMC8121736 DOI: 10.1007/s10006-020-00898-9] [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] [Received: 05/12/2020] [Accepted: 08/18/2020] [Indexed: 11/17/2022]
Abstract
Objective The aim of this study was to evaluate the effect of an iodine tampon on postoperative discomfort after surgical removal of a mandibular third molar. Material and methods Patients were randomly assigned to two groups: one group received an alveolar iodine-containing tampon in the extraction socket (N = 44), and the other group used a disposable syringe (Monoject®) to rinse the wound (N = 43). Postoperative discomfort was assessed with the Oral Health Impact Profile-14 (OHIP-14) questionnaire, Pain Intensity Numerical Rating Scale (PI-NRS), and questions about self-care and discomfort. Results This study included 87 patients (52 women and 35 men) with an average age of 26.47 years (SD, 6.36). The mean OHIP-14 sum scores were significantly lower in the iodine tampon group compared with the Monoject® syringe group. Mean PI-NRS scores significantly differed between the iodine tampon group (3.33; SE, 0.27) and Monoject® syringe group (4.46; SE, 0.27) (F (1, 85) = 8.16, p < 0.01), with no interaction effect between time and PI-NRS (F (6, 510) = 1.26, p = 0.28). Patients in the iodine tampon group reported less postoperative discomfort. Conclusions Insertion of an iodine-containing tampon in the postoperative socket reduced the pain and impact on oral health-related quality of life during the first postoperative week and positively influenced postoperative sequelae.
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Christensen BJ, Racha D, Hinkle R, Sahebi M. Risk Factors for Reoperation in Patients Hospitalized for Odontogenic Infections. J Oral Maxillofac Surg 2020; 79:141-151. [PMID: 32717213 DOI: 10.1016/j.joms.2020.06.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/21/2020] [Accepted: 06/23/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE One of the most common adverse events after treatment of severe odontogenic infections is the need for a second procedure. The identification of risk factors for reoperation could help surgeons predict the need for reoperation or even tailor treatment to avoid this complication altogether. The purpose of this study was to identify risk factors associated with reoperation in patients hospitalized with odontogenic infections. PATIENTS AND METHODS We designed a retrospective cohort study from an eligible population of all patients treated at our institution for an odontogenic infection with incision and drainage under general anesthesia from August 1, 2015, to June 30, 2019. The primary outcome variable was a return to the operating room because of treatment failure. The potential predictor variables included demographic characteristics, history or physical examination findings from admission, admission laboratory values, initial computed tomography results, and medications provided during treatment. Statistical analysis was performed using the χ2 test and logistic regression, and from these results, a multiple logistic regression model was created. RESULTS A total of 223 patients were included in the study. Men comprised 50.7% of the study population, and the average age was 38.9 ± 13.3 years. The mean number of involved spaces was 2.6 ± 1.7 spaces. Reoperation was performed in 25 patients (11.2%). In the adjusted model, an increased number of involved spaces (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.3 to 2.7) and increased age (OR, 1.05; 95% CI, 1.004 to 1.09) were associated with increased odds of reoperation, and antibiotic therapy with a penicillin-type antibiotic (OR, 0.1; 95% CI, 0.04 to 0.5) and dexamethasone use (OR, 0.9; 95% CI, 0.8 to 0.98) were negatively associated with reoperation. CONCLUSIONS Further studies could be directed at determining whether certain timing or dosing regimens of dexamethasone could be helpful in reducing adverse outcomes in patients with odontogenic infections or determining feasible strategies when penicillin allergies are reported.
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Affiliation(s)
- Brian J Christensen
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
| | - Dylan Racha
- Resident, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Ryan Hinkle
- Chief Resident, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Mishaun Sahebi
- Resident, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
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D’Amico R, Impellizzeri D, Cuzzocrea S, Di Paola R. ALIAmides Update: Palmitoylethanolamide and Its Formulations on Management of Peripheral Neuropathic Pain. Int J Mol Sci 2020; 21:ijms21155330. [PMID: 32727084 PMCID: PMC7432736 DOI: 10.3390/ijms21155330] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 02/06/2023] Open
Abstract
Neuropathic pain results from lesions or diseases of the somatosensory nervous system and it remains largely difficult to treat. Peripheral neuropathic pain originates from injury to the peripheral nervous system (PNS) and manifests as a series of symptoms and complications, including allodynia and hyperalgesia. The aim of this review is to discuss a novel approach on neuropathic pain management, which is based on the knowledge of processes that underlie the development of peripheral neuropathic pain; in particular highlights the role of glia and mast cells in pain and neuroinflammation. ALIAmides (autacoid local injury antagonist amides) represent a group of endogenous bioactive lipids, including palmitoylethanolamide (PEA), which play a central role in numerous biological processes, including pain, inflammation, and lipid metabolism. These compounds are emerging thanks to their anti-inflammatory and anti-hyperalgesic effects, due to the down-regulation of activation of mast cells. Collectively, preclinical and clinical studies support the idea that ALIAmides merit further consideration as therapeutic approach for controlling inflammatory responses, pain, and related peripheral neuropathic pain.
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Affiliation(s)
- Ramona D’Amico
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres 31, 98166 Messina, Italy; (R.D.); (D.I.); (R.D.P.)
| | - Daniela Impellizzeri
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres 31, 98166 Messina, Italy; (R.D.); (D.I.); (R.D.P.)
| | - Salvatore Cuzzocrea
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres 31, 98166 Messina, Italy; (R.D.); (D.I.); (R.D.P.)
- Department of Pharmacological and Physiological Science, Saint Louis University School of Medicine, 1402 South Grand Blvd, St Louis, MO 63104, USA
- Correspondence: ; Tel.: +39-90-6765208
| | - Rosanna Di Paola
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres 31, 98166 Messina, Italy; (R.D.); (D.I.); (R.D.P.)
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Atalay B, Şitilci AT, Onur ÖD. Analgesic and Anti-Inflammatory Effects of Articaine and Perineural Dexamethasone for Mandibular Third Molar Surgery: A Randomized, Double-Blind Study. J Oral Maxillofac Surg 2020; 78:507-514. [DOI: 10.1016/j.joms.2019.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 11/26/2022]
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Shoohanizad E, Parvin M. Comparison of the Effects of Dexamethasone Administration on Postoperative Sequelae Before and After “Third Molar" Extraction Surgeries. Endocr Metab Immune Disord Drug Targets 2020; 20:356-364. [DOI: 10.2174/1871530319666190722120405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/10/2019] [Accepted: 06/10/2019] [Indexed: 11/22/2022]
Abstract
Introduction:
Impacted third molars (ITMs) surgery, is one of the most common methods in
the field of oral and maxillofacial surgical operations. Administration of corticosteroid such as dexamethasone
diminishes the postoperative sequelae. The study aimed to compare the impact of dexamethasone
administration on pre-operative and post-operative complications in third molar surgery.
Methods:
We collected all randomized controlled trial data on the influences of pre-operative and postoperative
dexamethasone administration between 2006-2019 on third molar surgery sequelae by
searching the keywords: dexamethasone, third molar surgery, wisdom teeth, corticosteroids, oral surgery,
maxillofacial surgery, preoperative, postoperative, pain, swelling, and trismus in international
databases such as: Web of Science (ISI), PubMed, Scopus, Embase and Cochrane Library.
Results:
Twenty-three articles were included in this narrative review. Among them, 22 studies used
dexamethasone in particular and 1 study used dexamethasone with amoxicillin. Twenty studies evaluated
the prescription of dexamethasone in pre-operative and post-operative routes on pain, trismus and
edema following third molars operation. Five studies administered dexamethasone postoperatively and
15 studies administered the drug preoperatively. Two studies evaluated the preoperative and postoperative
administration method. Fourteen studies used a 4 mg dexamethasone dose and drug administration
was variable. The treatment period in postoperative studies varied between 1 to 7 days.
Conclusion:
Dexamethasone appears to be a promising agent in in reduction of post-operative complications
following third molar surgery. As a potent anti-inflammatory agent, it has an effective role in
pain, trismus and edema reduction distinguished from the routes of administration, dosage and timing,
pre or postoperative prescription.
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Affiliation(s)
- Ehsan Shoohanizad
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Taleghani Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Milad Parvin
- Assistant Professor, Oral and Maxillofacial Surgery Department, School of Dentistry, Bushehr University of Medical Sciences, Bushehr, Iran
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Sahu S, Patley A, Kharsan V, Madan RS, Manjula V, Tiwari RVC. Comparative evaluation of efficacy and latency of twin mix vs 2% lignocaine HCL with 1:80000 epinephrine in surgical removal of impacted mandibular third molar. J Family Med Prim Care 2020; 9:904-908. [PMID: 32318443 PMCID: PMC7113948 DOI: 10.4103/jfmpc.jfmpc_998_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/27/2019] [Accepted: 01/08/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction A prospective randomized double-blind controlled trial was conducted to evaluate the latency and duration of pterygomandibular nerve block with a mixture of 1.8 ml 2% lignocaine with 1:80,000 epinephrine and 1 ml of 4 mg dexamethasone and its impact on postoperative sequelae after surgical extraction of impacted mandibular third molars. Materials and Methods This study was conducted in 40 subjects referred to the department of oral and maxillofacial surgery; they were divided into 20 subjects each in group A and B with the age range of 18-72 years planned for elective surgical removal of unilateral impacted mandibular third molar. Each patient was randomly selected to receive anesthesia using 1.8 ml 2% lignocaine with 1:80,000 epinephrine in group A or 2.8 ml twin mix (1.8 ml 2% lignocaine with 1:80,000 epinephrine + 1 ml 4 mg dexamethasone) in group B. After injection of the anesthetic solution, the time to anesthetic effect, duration of anesthesia from initial patient perception of the anesthetic effect to the time when the effect subsides, need to reanesthetize the surgical site were recorded, and 10-point visual analog scale (VAS) was used to subjectively assess the overall pain intensity while injecting the study drug, during surgery, and in the postoperative period. Results Mean VAS value for pain on local anesthetic injection was less in twin-mix group. The time of onset of the local anesthetic was significantly less for the study group T, 51.35 ± 7.15 s when compared with patients in study group C (P less than 0.0001). The duration of soft tissue anesthesia was longer for all the patients in the study group T. On comparative evaluation between study group C and study group T, patients in the control group had more severe swelling and reduction in mouth opening in the postoperative period. Conclusion The addition of dexamethasone to lignocaine and its administration as an intraspace injection significantly shortens the latency and prolongs the duration of the soft tissue anesthesia, with improved quality of life in the postoperative period after surgical extraction of mandibular third molars.
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Affiliation(s)
- Swati Sahu
- Department of OMFS, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh, India
| | - Abhishek Patley
- Department of OMFS, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh, India
| | - Vinay Kharsan
- Department of OMFS, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh, India
| | - R S Madan
- Department of Oral and Maxillofacial Surgery, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh, India
| | - V Manjula
- Department of OMFS, K.G.F College of Dental Sciences and Hospital, Kolar, Karnataka, India
| | - Rahul Vinay Chandra Tiwari
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
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Al-Delayme RMA. Randomized clinical study comparing Piezoelectric Surgery with conventional rotatory osteotomy in mandibular third molars surgeries. Saudi Dent J 2019; 33:11-21. [PMID: 33473237 PMCID: PMC7801233 DOI: 10.1016/j.sdentj.2019.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 11/17/2019] [Accepted: 11/21/2019] [Indexed: 01/06/2023] Open
Abstract
Purpose The aim of this study was to evaluate the performance and to assess the postoperative sequel and quality of life after removal of impacted mandibular third molars using piezoelectric surgery compared with conventional rotatory osteotomy. Patients and methods A single blinded, randomized, control clinical study was performed. Sixty-three patients (44 males, 19 females) who presented with bilaterally asymptomatic impacted mandibular third molars were included in this analysis. Each patient was treated, at two separate sessions approximately 4 weeks apart, with a conventional rotatory hand piece on one side of the mandible and a piezoelectric device on the contralateral side. Patients were followed up on postoperative days 1, 3, 5, 7, and 15 to rate the pain, swelling and trismus. Inferior alveolar nerve paresthesia was evaluated up to 12 months postoperatively. Results The severity of the pain, trismus and swelling using the piezosurgery were significantly different from the rotary group. In both groups, pain was most intense and peaked during the first post-operative day, while swelling and trismus reached peak levels on the third postoperative day. The piezoelectric procedure resulted in a significantly longer procedural duration compared to the rotatory surgery (P < 0.001). Conclusion Piezoelectric surgery is considered a viable alternative technique compared to the conventional rotary systems and can improve a patient’s quality of life. Thus, piezoelectric surgery might be a preferred modality for patients undergoing complicated surgical extraction of impacted lower third molars.
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Effect of submucosal dexamethasone injections in the prevention of postoperative pain, trismus, and oedema associated with mandibular third molar surgery: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2019; 48:1456-1469. [DOI: 10.1016/j.ijom.2019.04.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 11/19/2022]
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Tuk JG, Lindeboom JA, Sana F, van Wijk AJ, Milstein DMJ. Alveolar Iodine Tampon Packing Reduces Postoperative Morbidity After Third Molar Surgery. J Oral Maxillofac Surg 2019; 77:2401-2411. [PMID: 31344339 DOI: 10.1016/j.joms.2019.06.175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 06/08/2019] [Accepted: 06/17/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to assess the efficacy of an iodine tampon after mandibular third molar surgery on oral health-related quality of life (OHRQoL), use of painkillers, postoperative sequelae, and self-care behaviors in the first postoperative week. MATERIALS AND METHODS This prospective, crossover, randomized controlled study included patients undergoing surgical removal of bilateral symmetrically, horizontally impacted mandibular third molars. The surgical site was randomly allocated to receive an iodine tampon after surgery or wound closure and rinsing with a Monoject syringe (Tyco/Healthcare-Kendall, Mansfield, MA). The primary outcomes measured each day during the first postoperative week were the Oral Health Impact Profile 14 score and postoperative sequelae, including pain, swelling, limited mouth opening, postoperative infection, and alveolar osteitis. The secondary outcome measures were several self-care behaviors. Data were analyzed using repeated-measures analysis of variance and paired-samples t tests. RESULTS A total of 54 patients (25 men and 29 women; mean age, 25.1 years) were enrolled, with a total of 108 surgically removed impacted mandibular third molars. The use of an iodine tampon resulted in a significantly lower impact on OHRQoL (mean of 21.5 [standard deviation (SD), 9.6] vs 26.5 [SD, 10.6]) on the first postoperative day, which was observable until the seventh postoperative day. In addition, after removal of the impacted third molar, patients with the iodine tampon condition reported less pain (mean of 5.2 [SD, 1.9] vs 6.1 [SD, 2.1] on day 1, lasting throughout the week), less use of painkillers, less limited mouth opening, fewer problems chewing, less swelling, and earlier recovery. CONCLUSIONS The use of postoperative iodine packing after the removal of impacted mandibular third molars significantly reduces OHRQoL and postoperative sequelae.
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Affiliation(s)
- Jacco G Tuk
- Associate Professor, Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, and Private Practice, Amstelland Hospital, Amstelveen, The Netherlands
| | - Jerome A Lindeboom
- Associate Professor, Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, and Private Practice, Amstelland Hospital, Amstelveen, The Netherlands.
| | - Faro Sana
- Dental Student, Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Arjen J van Wijk
- Associate Professor, Department of Social Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam, and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dan M J Milstein
- Associate Professor, Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Patil C, Jadhav A, K R, Bhola N, Borle RM, Mishra A. "Piezosurgery vs bur in impacted mandibular third molar surgery: Evaluation of postoperative sequelae". J Oral Biol Craniofac Res 2019; 9:259-262. [PMID: 31249772 DOI: 10.1016/j.jobcr.2019.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 04/30/2019] [Accepted: 06/08/2019] [Indexed: 11/15/2022] Open
Abstract
Purpose Piezosurgery is a relatively novel, precise and safe technique of ostectomy in the domain of oral and maxillofacial surgery. Our aim was to compare the inflammatory outcomes of osteotomy using piezosurgery and conventional bur in impacted mandibular third molar (IM3M) surgery. Subjects and method The study implemented a randomized, double-blind, crossover design. 120 sides in 60 patients were randomly allocated to the two interventions used, viz; conventional bur and piezosurgery. The primary outcome variables evaluated were facial swelling, trismus, pain, and paresthesia. Additionally, the duration of surgery and the frequency of soft tissue injuries with the use of two techniques were also evaluated. Results Pain, swelling, trismus, and soft tissue injuries emerged to be significantly higher with the use of bur as compared to the piezo. The duration of surgery was significantly extended in the piezo group and no significant difference was observed in the occurrence of paresthesia between the two groups. Conclusion The result suggests that piezosurgical osteotomy technique is superior to conventional bur in terms of the postoperative inflammatory outcomes in IM3M surgery.
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Affiliation(s)
- Chirag Patil
- Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, 442004, India
| | - Anendd Jadhav
- Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, 442004, India
| | - Rajanikanth K
- Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, 442004, India
| | - Nitin Bhola
- Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, 442004, India
| | - Rajiv M Borle
- Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, 442004, India
| | - Apoorva Mishra
- Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, 442004, India
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Almeida RDA, Lemos C, de Moraes S, Pellizzer E, Vasconcelos B. Efficacy of corticosteroids versus placebo in impacted third molar surgery: systematic review and meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg 2019; 48:118-131. [DOI: 10.1016/j.ijom.2018.05.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 11/25/2022]
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Gümrükçü Z. The effects of piezosurgery and submucosal dexamethasone injection on post-operative complications after third molar surgery. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 120:182-187. [PMID: 30396027 DOI: 10.1016/j.jormas.2018.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/28/2018] [Accepted: 10/28/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND A retrospective clinical study was performed to compare the post-operative effects of the conventional surgery, piezo surgery technique and submucosal dexamethasone injection in lower third molars extractions. METHODS Data from 62 patients, subjected to surgical extraction of lower third molars, were pooled and divided into three groups such as: Conventional Group (22 patients), Piezo Group (20 patients) and Dex Group (conventional surgery + 4 mg/1 mL dexamethasone) (20 patients). Pain, swelling, trismus, analgesic consumption and operation time were comparatively evaluated. RESULTS Pain values were found lower in Dex Group in comparison to Conventional Group at 7th day (P = 0.007). Edema found to be higher in Conventional Group than Dex Group at 2nd day (P = 0.025). Minimally trismus values were found in Dex Group and the difference between the Dex and Conventional Group found to be statistically significant both in 2nd (P = 0.048) and 7th days (P = 0.010). The analgesic consumption in the Conventional Group was found to be higher than Piezo Group at 2nd day (P = 0.002). CONCLUSION The better post-operative values were obtained in the Dex Group. Although longer operative time is considered to be a disadvantage for the piezo technique, piezotome may be preferred for surgical procedures due to its positive results in comparison to the conventional technique.
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Affiliation(s)
- Z Gümrükçü
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Recep Tayyip Erdoğan University, Rize, Turkey.
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In Vitro Effect of Bromelain on the Regenerative Properties of Mesenchymal Stem Cells. J Craniofac Surg 2018; 30:1064-1067. [PMID: 30358745 DOI: 10.1097/scs.0000000000004862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Bromelain belongs to a group of protein-digesting enzymes obtained commercially from the fruit or stem of pineapple. Several studies demonstrated that bromelain exhibits various fibrinolytic, anti-edematous, antithrombotic, and anti-inflammatory activities supporting its application for many therapeutic benefits. The aim of this study was to analyze the effects of bromelain on the pro-wound healing activities and the regenerative properties of mesenchymal stem cells. METHODS Mesenchymal stem cells were treated in vitro with bromelain alone or combined with dexamethasone sodium phosphate. Real-time polymerase chain reaction was performed to profile the expression of extracellular matrix components and remodeling enzymes, and cytokines. RESULTS The combination of bromelain and dexamethasone sodium phosphate induced a great activation of mesenchymal stem cells with an increase in hyaluronan and collagen production and anti-inflammatory cytokines release. CONCLUSION Based on the results of this in vitro study, the combined use of bromelain and dexamethasone sodium phosphate stimulated the pro-wound healing activities and the regenerative properties of mesenchymal stem cells better than bromelain and dexamethasone alone.
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Liu J, Hua C, Pan J, Han B, Tang X. Piezosurgery vs conventional rotary instrument in the third molar surgery: A systematic review and meta-analysis of randomized controlled trials. J Dent Sci 2018; 13:342-349. [PMID: 30895143 PMCID: PMC6388871 DOI: 10.1016/j.jds.2016.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 07/22/2016] [Accepted: 09/13/2016] [Indexed: 11/20/2022] Open
Abstract
Background/purpose The surgical removal of mandibular third molars is frequently accompanied by significant postsurgical sequelae. Different instruments such as piezosurgery and conventional rotary handpiece have been used to decrease such adverse events. There are controversial results from randomized controlled trials evaluating the effects of Piezosurgery in the mandibular third molar extraction, compared with conventional rotary instrument. This study was performed to determine the impact of piezosurgery versus conventional rotary instrument on postoperative reactions after extraction. Materials and methods A systematic review and meta-analysis was performed to combine relevant RCTs results. Results Five RCTs were eligible for this study, enrolling a total of 402 patients. Compared with conventional rotary instrument, pain score at 6 or 7 days and mouth opening at 1 day after surgery was significantly lower in Piezosurgery group (SMD -0.33, 95% CI: −0.56 to −0.10, P = 0.005), as well as swelling score at 7 days after surgery (SMD -1.95, 95% CI: −3.22 to −0.67, P = 0.003). Furthermore, mouth opening at 1 day after surgery was significantly better in patients treated with Piezosurgery (SMD 0.84, 95% CI: 0.19 to 1.49, P = 0.01). However, more operation time will be required for Piezosurgery (MD 6.23, 95% CI: 3.32 to 9.14, P < 0.0001). With regard to analgesic dosage, pooled results from two RCTs suggested there were no significant differences between Piezosurgery and conventional rotary instrument (SMD -1.45, 95% CI: −4.39 to 1.49, P = 0.33). Conclusion There might be some advantages on third mandibular molar extraction with piezosurgery compared to conventional rotary instrument. More multi-centre trials are required to get more conclusive results.
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Affiliation(s)
| | | | | | | | - Xiufa Tang
- Corresponding author. State Key Laboratory of Oral Diseases, National Clinical Research Center for Clinical Research, Department of Oral and Maxillary Surgery, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China. Fax: +028 85501428.
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Larsen MK, Kofod T, Christiansen AE, Starch-Jensen T. Different Dosages of Corticosteroid and Routes of Administration in Mandibular Third Molar Surgery: a Systematic Review. J Oral Maxillofac Res 2018; 9:e1. [PMID: 30116513 PMCID: PMC6090248 DOI: 10.5037/jomr.2018.9201] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/25/2018] [Indexed: 11/26/2022]
Abstract
Objectives The objective of the present systematic review was to test the hypothesis of no difference in facial swelling, pain and trismus after surgical removal of mandibular third molar with different dosages of corticosteroids and administration routes. Material and Methods A MEDLINE (PubMed), Embase database and Cochrane Library search in combination with a hand-search of relevant journals was conducted by including randomized controlled trials published in English until 1st December 2017. Results Seven studies fulfilled the inclusion criteria. Considerable variation in the included studies prevented meta-analysis from being performed. Preoperative submucosal injection of corticosteroids significantly diminishes facial swelling, pain and trismus compared with placebo. However, different dosages of corticosteroid and administration routes reveal contrary results indicating that administration of a higher dosage of corticosteroids do not necessarily cause a further decrease in facial swelling, pain and trismus. Conclusions Consequently, the optimal dosage of corticosteroids and administration route for diminishing postsurgical morbidity and improve quality of life after surgical removal of mandibular third molar is presently unknown. Therefore, further well-designed randomized clinical trials including a standardised protocol, patient-reported outcome measures and three-dimensional analysis of facial swelling is needed.
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Affiliation(s)
- Marie Kjærgaard Larsen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, AalborgDenmark
| | - Thomas Kofod
- Department of Oral and Maxillofacial Surgery, Rigshospitalet, Copenhagen University Hospital, CopenhagenDenmark
| | - Ann-Eva Christiansen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, AalborgDenmark
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Arora SS, Phull T, Kumar I, Kumar A, Kumar N, Singh H. A comparative study of the effect of two dosages of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: a prospective randomized study. Oral Maxillofac Surg 2018; 22:225-230. [PMID: 29752604 DOI: 10.1007/s10006-018-0699-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 05/04/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of this clinical study was to evaluate and compare the relative efficacy of two different dosages of dexamethasone, i.e., 4 and 8 mg injected submucosally to reduce postoperative discomfort after mandibular third molar surgery. METHODOLOGY A prospective randomized study was conducted on 45 patients requiring surgical removal of an impacted third molar. Selected patients were divided randomly into three groups of 15 patients each: group I patients received one regimen single dose of 4 mg dexamethasone submucosally, group II received one regimen single dose of 8 mg dexamethasone submucosally, and group III (control group), no dexamethasone was given but only received injection of normal saline submucosally after establishing local anesthesia. The postoperative sequelae were assessed on the second and seventh postoperative day. RESULT As compared to group III, groups I and II showed statistically significant reduction in pain and swelling whereas no statistically significant difference was found between the test groups. CONCLUSION It can be concluded that corticosteroids are effective in curtailing the postoperative edema of lower third molar surgery but have negligible analgesic effect. As no statistically significant difference is found between both the regimes of dexamethasone, i.e., 4 and 8 mg so within the confines of our study, it may be concluded that 4 mg dexamethasone can be given safely to reduce the postoperative edema after the third molar surgery.
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Affiliation(s)
- Srimathy S Arora
- Department of Oral and Maxillofacial Surgery, Swami Devi Dyal Hospital & Dental College, Barwala, Panchkula, India
| | - Tanvi Phull
- Department of Oral and Maxillofacial Surgery, Swami Devi Dyal Hospital & Dental College, Barwala, Panchkula, India
| | - Ish Kumar
- Department of Oral and Maxillofacial Surgery, Swami Devi Dyal Hospital & Dental College, Barwala, Panchkula, India.
| | - Arun Kumar
- Department of Oral and Maxillofacial Surgery, PGIMER, Chandigarh, India
| | - Nilesh Kumar
- Department of Oral and Maxillofacial Surgery, Swami Devi Dyal Hospital & Dental College, Barwala, Panchkula, India
| | - Hem Singh
- Department of Oral and Maxillofacial Surgery, Swami Devi Dyal Hospital & Dental College, Barwala, Panchkula, India
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Troiano G, Laino L, Cicciù M, Cervino G, Fiorillo L, D'amico C, Zhurakivska K, Lo Muzio L. Comparison of Two Routes of Administration of Dexamethasone to Reduce the Postoperative Sequelae After Third Molar Surgery: A Systematic Review and Meta-Analysis. Open Dent J 2018. [PMID: 29541264 PMCID: PMC5842398 DOI: 10.2174/1874210601812010181] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aim of this systematic review and meta-analysis was to compare the clinical efficacy of two routes of dexamethasone administration in reducing the postoperative sequelae after third molar extraction. Electronic databases (PUBMED, SCOPUS and EBSCO library) were screened in order to find both randomized and non-randomized clinical trials that directly compare the submucosal intraoral or the intramuscular extraoral administration of dexamethasone. No restriction about year of publication was imposed. About 340 titles and abstracts were screened independently by two authors. Of these [340 titles], only 4 randomized clinical trials met the inclusion criteria and were included in the meta-analysis. No statistical differences in postoperative pain, swelling and trismus were recorded comparing the intraoral submucosal and the extraoral intramuscular injection of dexamethasone in an extra-oral site.
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Affiliation(s)
- Giuseppe Troiano
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Luigi Laino
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Marco Cicciù
- Department of Biomedical, Dental Science and Morphological and Functional Images, Dental School, University of Messina, Italy
| | - Gabriele Cervino
- Department of Biomedical, Dental Science and Morphological and Functional Images, Dental School, University of Messina, Italy
| | - Luca Fiorillo
- Department of Biomedical, Dental Science and Morphological and Functional Images, Dental School, University of Messina, Italy
| | - Cesare D'amico
- Department of Biomedical, Dental Science and Morphological and Functional Images, Dental School, University of Messina, Italy
| | | | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
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Effect of Oral Administration of Bromelain on Postoperative Discomfort After Third Molar Surgery. J Craniofac Surg 2018; 28:e191-e197. [PMID: 27755433 DOI: 10.1097/scs.0000000000003154] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The purpose of this prospective randomized controlled clinical trial was to evaluate the effect of oral administration of bromelain on discomfort after mandibular third molar surgery. MATERIALS AND METHODS Eighty-four consecutive patients requiring surgical removal of a single mandibular impacted third molar under local anesthesia were randomly assigned to receiving no drug (control group, Group A), postoperative 40 mg bromelain every 6 hours for 6 days (Group B), preoperative 4 mg dexamethasone sodium phosphate as a submucosal injection (Group C), and preoperative 4 mg dexamethasone sodium phosphate as a submucosal injection plus postoperative 40 mg bromelain every 6 hours for 6 days (Group D). Standardized surgical and analgesic protocols were adopted. Maximum interincisal distance and facial contours were measured at baseline and on postoperative days 2 and 7. Pain was measured objectively by counting the number of analgesic tablets required. Patient perception of the severity of symptoms was assessed with a follow-up questionnaire (PoSSe scale). RESULTS On postoperative day 2, there was a statistically significant reduction in facial edema in both Groups C and D compared with the control group, but no statistically significant differences were observed between Group B and the control group. At evaluation on postoperative day 7, Group D showed a statistically significant reduction in postoperative swelling compared with the control group. The combined use of bromelain and dexamethasone (Group D) induced a statistically significant reduction in the total number of analgesic tablets taken after surgery compared with the control group. The treatment groups had a limited, nonsignificant effect on trismus when compared with the control group. CONCLUSIONS Bromelain used singly showed moderate anti-inflammatory efficacy, reducing postoperative swelling, albeit not to any significant extent compared with no drug administration. The combined use of bromelain and dexamethasone sodium phosphate yielded the best results in terms of control of postoperative discomfort.
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Al-Dajani M. Can Preoperative Intramuscular Single-Dose Dexamethasone Improve Patient-Centered Outcomes Following Third Molar Surgery? J Oral Maxillofac Surg 2017; 75:1616-1626. [DOI: 10.1016/j.joms.2017.03.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 03/04/2017] [Accepted: 03/19/2017] [Indexed: 01/01/2023]
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A Comparative Study on the Efficacy of Submucosal Injection of Dexamethasone Versus Methylprednisolone in Reducing Postoperative Sequelae After Third Molar Surgery. J Oral Maxillofac Surg 2017; 75:2278-2286. [PMID: 28666096 DOI: 10.1016/j.joms.2017.05.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 05/31/2017] [Accepted: 05/31/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare the efficacy of preoperative submucosal injection of 4 mg of dexamethasone versus 40 mg of methylprednisolone in reducing postoperative sequelae after surgical removal of impacted mandibular third molars. PATIENTS AND METHODS This prospective, randomized, double-blind study included 65 patients who required surgical removal of impacted mandibular third molars with Class II or position B impaction (Pell and Gregory classification). Patients were randomly assigned to 1 of 3 groups: dexamethasone, methylprednisolone, or placebo (control). Surgery was performed with patients under local anesthesia. Baseline measurements were obtained preoperatively, and subsequent assessments were made on postoperative day 1, 2, 5, and 7 to measure postoperative facial swelling by use of 2 linear measurements: interincisal mouth opening width and visual analog scale score for pain. The amount of analgesics consumed was recorded. Wound healing also was assessed on postoperative day 7. Descriptive and multivariate statistics were computed, and significance was set at P < .05. RESULTS Both methylprednisolone and dexamethasone significantly reduced swelling and trismus (P < .05, Kruskal-Wallis test), whereas the methylprednisolone group had significantly less pain (P < .05, Kruskal-Wallis test) and consumed a lower amount of analgesics (P < .05, χ2 test) during the early postoperative days. CONCLUSIONS The study findings suggest that a single preoperative dose of dexamethasone versus methylprednisolone was equally effective in reducing postoperative swelling and trismus. Pain control by these corticosteroids, however, was variable.
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Kormi E, Snäll J, Koivusalo AM, Suominen AL, Thorén H, Törnwall J. Analgesic Effect of Perioperative Systemic Dexamethasone on Blowout Fracture Surgery. J Oral Maxillofac Surg 2017; 75:1232-1237. [DOI: 10.1016/j.joms.2016.09.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/18/2016] [Accepted: 09/18/2016] [Indexed: 10/20/2022]
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Mojsa I, Pokrowiecki R, Lipczynski K, Czerwonka D, Szczeklik K, Zaleska M. Effect of submucosal dexamethasone injection on postoperative pain, oedema, and trismus following mandibular third molar surgery: a prospective, randomized, double-blind clinical trial. Int J Oral Maxillofac Surg 2017; 46:524-530. [DOI: 10.1016/j.ijom.2016.11.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 08/14/2016] [Accepted: 11/09/2016] [Indexed: 11/29/2022]
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Astramskaitė I, Juodžbalys G. Scales used to rate adult patients' psycho-emotional status in tooth extraction procedures: a systematic review. Int J Oral Maxillofac Surg 2017; 46:886-898. [PMID: 28377143 DOI: 10.1016/j.ijom.2017.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 11/27/2016] [Accepted: 03/10/2017] [Indexed: 12/14/2022]
Abstract
The aim of this study was to review scales used to assess anxiety, stress, and pain in dental patients undergoing a tooth extraction procedure and to propose a novel psycho-emotional rating scale based on the relevant literature and our own experience. An electronic literature search was conducted of the National Library of Medicine database MEDLINE (Ovid) and EMBASE databases between January 2005 and April 2016. Sequential screening at the title/abstract and full-text levels was performed. The review included all human prospective or retrospective follow-up studies and clinical trials, cohort studies, case-control studies, and case series that demonstrated at least one scale used to measure tooth extraction anxiety, stress, or pain. The search resulted in 32 articles meeting the inclusion criteria. None of the studies were found to be suitable in evaluating patient's stress, pain, and fear at once. Also, no scales were found that included both the doctor's and the patient's rating. In a few studies, vital signs as psycho-emotional status indicators were rated. Guidelines for a suitable questionnaire that could be used for rating the psycho-emotional status of patients undergoing tooth extraction are listed in the present research. Further studies are required for verification and validation of offered scale.
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Affiliation(s)
- I Astramskaitė
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - G Juodžbalys
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Gozali P, Boonsiriseth K, Kiattavornchareon S, Khanijou M, Wongsirichat N. Decreased post-operative pain using a sublingual injection of dexamethasone (8 mg) in lower third molar surgery. J Dent Anesth Pain Med 2017; 17:47-53. [PMID: 28879328 PMCID: PMC5564136 DOI: 10.17245/jdapm.2017.17.1.47] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 02/24/2017] [Accepted: 03/07/2017] [Indexed: 11/15/2022] Open
Abstract
Background Every patient who undergoes mandibular third molar surgery is concerned about post-operative pain. Indeed, previous researchers have used various methods to treat such pain. This study aimed to assess the effectiveness of sublingual injection of dexamethasone (8 mg) to treat post-operative pain after mandibular third molar surgery. Method This was a randomized, double-blind, split-mouth, clinical trial, involving 48 healthy patients who required surgical removal of two mandibular third molars with similar bilateral positions. All operations were performed by the same experienced surgeon. The patients were randomized into a study group (8 mg dexamethasone injection) and a placebo group (normal saline injection). Both interventions were injected into the sublingual space immediately after local anesthesia, 30 min before the first incision. The study group received an 8 mg dexamethasone injection, while the placebo group received a normal saline injection. The wash period between the patients' two operations was 3 to 4 weeks. Pain was assessed by recording the number of analgesic tablets (rescue drug) consumed, as well as by noting the patients' responses to the visual analog scale (VAS) on the first, second, and third days after surgery. Results The study group differed significantly from the placebo group in terms of VAS score and analgesic consumption. Conclusion Dexamethasone (8 mg), injected sublingually, significantly eased post-operative pain after surgical removal of the mandibular third molar.
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Affiliation(s)
- Peiter Gozali
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Kiatanant Boonsiriseth
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | | | - Manop Khanijou
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Natthamet Wongsirichat
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Submucosal injection of dexamethasone reduces postoperative discomfort after third-molar extraction. J Am Dent Assoc 2017; 148:81-91. [DOI: 10.1016/j.adaj.2016.09.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 11/18/2022]
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Weckwerth GM, Simoneti LF, Zupelari-Gonçalves P, Calvo AM, Brozoski DT, Dionísio TJ, Torres EA, Lauris JRP, Faria FAC, Santos CF. Efficacy of naproxen with or without esomeprazole for pain and inflammation in patients after bilateral third molar extractions: A double blinded crossover study. Med Oral Patol Oral Cir Bucal 2017; 22:e122-e131. [PMID: 27918744 PMCID: PMC5217490 DOI: 10.4317/medoral.21514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 11/04/2016] [Indexed: 02/02/2023] Open
Abstract
Background Using a double-blinded randomized crossover design, this study aimed to evaluate acute postoperative pain management, swelling and trismus in 46 volunteers undergoing extractions of the two lower third molars, in similar positions, at two different appointments who consumed a tablet of either NE (naproxen 500 mg + esomepraz ole 20 mg) or only naproxen (500 mg) every 12 hours for 4 days. Material and Methods Parameters were analyzed: self-reported pain intensity using a visual analog scale (VAS) pre- and postoperative mouth opening; incidence, type and severity of adverse reactions; total quantity consumed of rescue medication; and pre- and postoperative swelling. Results Female volunteers reported significantly more postoperative pain at 1, 1.5, 2, 3 and 4hrs after surgery while also taking their first rescue medication at a time significantly earlier when consuming NE when compared to naproxen (3.7hrs and 6.7hrs). Conversely, no differences were found between each drug group in males. Conclusions In conclusion, throughout the entire study, pain was mild after using either drug in both men and women with pain scores on average well below 40mm (VAS), although in women naproxen improved acute postoperative pain management when compared to NE. Key words:Oral surgery, third molar, pain, naproxen, esomeprazole, NSAIDs.
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Affiliation(s)
- G-M Weckwerth
- Discipline of Pharmacology, Bauru School of Dentistry, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, São Paulo, Brasil,
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Application of Dexamethasone in the Masseter Muscle During the Surgical Removal of Lower Third Molars. J Craniofac Surg 2017; 28:e43-e47. [DOI: 10.1097/scs.0000000000003188] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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