A variety of corticosteroids are available as an alternative to reduce inflammatory complications after mandibular third molar surgery (3MS). However, it is unclear which are the best preoperative drugs, doses, and routes of administration. A frequentist network meta-analysis was performed to assess the comparative effectiveness of corticosteroids to reduce inflammatory complications after 3MS. We searched Embase, PubMed, and the Cochrane Library without language restrictions. Only randomised clinical trials (RCTs) were included. We obtained the relative effectiveness using network meta-analysis and an estimate of the relative ranking of interventions according to their effects. Our search yielded 2427 results, from which 61 studies involving 3561 subjects fulfilled our inclusion criteria. Five corticosteroids (dexamethasone, betamethasone, methylprednisolone, prednisolone, and triamcinolone) were compared. Dexamethasone 8mg via submucosal injection (-3.58[-6.98; -0.17]) and via pterygomandibular injection (-3.56[-6.30; -0.82]) were significantly more effective than placebo to reduce oedema after 3MS. The ranking analysis showed that dexamethasone 8mg via submucosal injection and via oral tablets were the interventions with the highest probability of being the most effective methods to reduce oedema after 3MS (p values = 0.71 and 0.75, respectively). Compared with placebo, only dexamethasone 8mg via submucosal injection effectively reduced pain in the first and second days after 3MS (-30.95[-43.41; -18.49]) and (-15.25[-23.27; -7.22]), respectively. Overall, corticosteroids reduced inflammatory complications after 3MS and did not show any serious adverse effects. Among the corticosteroids reviewed, dexamethasone 8mg was the best preoperative option to control inflammatory complications after 3MS. Further RCTs are needed to confirm the optimal route of administration.
The aim of this meta-analysis was to assess the analgesic efficacy and adverse effects of celecoxib compared to non-opioid drugs after third molar surgery. A search in PubMed and Google Scholar was performed to identify clinical trials, and then, the Cochrane Collaboration tool was used to assess the risk of bias for all clinical trials. Studies without any high-risk of bias were included in the statistical analysis. The data extraction included the pain intensity measured by the visual analogue scale (VAS), the number of patients using rescue analgesics and adverse effects of gastric (nausea and vomiting), and nervous (dizziness and headache) systems. Data were analyzed using the Review Manager Software 5.3 for Windows and the Risk Reduction Calculator. The visual analog scale, total pain relief, and the number of patients who needed rescue analgesics showed statistical significance. Moreover, celecoxib had a lower frequency of nausea and vomiting compared with ibuprofen. In conclusion, celecoxib was more effective than acetaminophen and ibuprofen for pain control after third molar surgery.
BACKGROUND: Third molar surgery is frequently associated with postoperative discomfort such as pain, edema and trismus. We aimed to evaluate the current evidence on the efficacy of adjunctive corticosteroid therapy in improving patient-centered outcomes following third molar surgery.
MATERIAL AND METHODS: This systematic review assessed and searched PubMed, Google scholar, Scopus, web of science, clinicaltrials.gov and Cochrane central for controlled trials, up to May 2021. The primary outcome measures were patient-centered outcomes such as quality of life following the use of adjunctive corticosteroid therapy in third molar removal. Only randomized controlled trials published in English language were included.
RESULTS: A total of 355 studies were initially identified, and 12 studies were finally included. The results showed that both methylprednisolone and dexamethasone decreased postoperative side effects such as pain, trismus, and edema and consequently were improving patient reported outcomes. In this regard, none of the included papers reported any significant statistical difference between these two drugs (p > 0.05). The analysis regarding the route of administration for the corticosteroids showed that local and intravenous injection of dexamethasone had equivalent effects, and both methods showed better results as compared to simple oral administration.
CONCLUSIONS: Adjunctive use of corticosteroid drugs may improve patient-centered outcomes following third molar surgery. However, there is no significant difference between drugs and routs of administration. Comparing various administration routs, local submucosal injection of dexamethasone seems to be a straightforward, painless and cost-effective adjunctive therapy.
This study aimed to evaluate and compare the pre-emptive analgesic efficacy of injected ketorolac to that of other agents for impacted third molar surgical removal in a healthy population. PubMed, Ovid SP, Cochrane databases were filtered from 1980 to July 2020 for potential papers using relevant MeSH terms and pre-specified inclusion and exclusion criteria independently by reviewers. Studies that compared pre-emptive intramuscular or intravenous administration of ketorolac to other agents were evaluated. The outcomes sought were self-reported postoperative pain (patient-perceived pain), median duration for rescue analgesic medication, total number of analgesics consumed in the recovery period, and global assessment (overall patient satisfaction) after the recovery period. Six studies were included in the final evaluation. The outcome of pain perception and the number of analgesics taken were significantly lower in the ketorolac group (intramuscular or intravenous) in most of the studies (n=5) than in the group of other drugs. The mean time for rescue analgesia intake was higher for the ketorolac group, and global assessment scores were also better in the ketorolac group. Although the included studies show significantly better outcomes such as postoperative pain, median time taken for rescue medication, total number of analgesics taken, and overall patient satisfaction with injected ketorolac group in comparison to injected diclofenac, dexamethasone, and tramadol, definitive conclusions cannot be made regarding the superiority of injected Ketorolac as a pre-emptive agent. A greater number of randomized control trials with a proper protocol are needed to make definitive conclusions.
This study aimed to systematically review the literature to assess the effect of preemptive intravenous ibuprofen on pain reduction after lower third molar surgery. Nine databases (PubMed, Scopus, LILACS, SciELO, Embase, Web of Science, Cochrane, Open Gray, and Open Thesis) were used as sources of research, including "grey literature." The protocol was registered in PROSPERO. Only randomized clinical trials evaluating the effects of preemptive intravenous ibuprofen on pain during and immediately after the extraction of lower third molars were included, without restrictions of year and language. Two reviewers independently performed the study selection, data extraction, and assessment of the risk of bias. The "Joanna Briggs Institute for Randomized Controlled Trials" tool was used to assess the risk of bias. Each study was categorized according to the percentage of positive responses to the questions corresponding to the assessment instrument. The results were measured narratively/descriptively. The initial search resulted in 3,257 records, of which only three studies (n=150 participants) met the eligibility criteria and were included in the qualitative analysis. All studies were published in 2019. The risk of bias ranged from low to moderate. Two studies found significant pain reduction within 48 h after the procedure. In conclusion, the use of preemptive intravenous ibuprofen for extracting third molars reduces pain and analgesic consumption after the surgical procedure.
Thesis»Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina
Year»2021
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The present systematic review with network meta-analysis aimed to compare the performance of preemptive analgesia by oral route in drugs evaluated in randomized clinical trials, considering the outcomes: average consumption of analgesics, pain, edema and trismus in surgeries mandibular third molars. In addition, different types of drugs have been classified based on their performance. A systematic review was carried out based on the Cochrane and PRISMA guidelines. The quality of the evidence and the network meta-analysis were conducted using the GRADE tool and Software R, respectively. Five databases were searched, in addition to a manual search in the gray literature, and the articles were selected based on the PICOs strategy. A total of 5123 articles were found. Of these, thirty-seven articles were included. Nimesulide (100mg) was the best classified drug therapy (97.8%) in relation to the average consumption of analgesics, as well as at all postoperative times for the pain outcome: 6 hours (MD: -3.55, 95% CI: -4.87 to -2.23), 12 hours (MD: -3.95 CI95% -6.62 to -1.27) and 24 hours (MD: -1.85, 95% CI: -2.94 to -0.76). Dexamethasone (8mg) associated with Nimesulide (100mg) showed a greater reduction in edema and trismus after the 3rd postoperative day. On the 1st postoperative day, Ampiroxicam (27mg) had the lowest mean of trismus (MD: -6.30, 95% CI: -7.79 to -4.81). In conclusion, Nimesulide (100mg) proves to be the best medication for the control of postoperative pain. And its association with Dexamethasone (8mg) demonstrated the best results for the control of edema and trismus after the third postoperative day.
AIM: Pain is one of the clinical problems after orofacial surgeries. There have been various studies about the analgesic effect of nonsteroidal anti-inflammatory drugs (NSAIDs) in this group of surgeries. In recent years, meloxicam has undergone clinical trials in dentistry. The purpose of this study was to review the efficacy of meloxicam on postoperative pain in dentistry. MATERIALS AND METHODS: The study design was in accordance with the PRISMA guidance. The keywords according to MeSH and related articles were searched in the EBSCO, MEDLINE (via Ovid), PubMed, Science Direct, Scopus, Web of Science and Google Scholar databases. Then eligible randomized clinical trials articles, which released up to December 2017, were thoroughly reviewed. RESULTS: The nine eligible articles were studied. Meloxicam was administered with doses of 7.5, 10 and 15 mg (oral or intramuscular) before or after the third molar extraction. Meloxicam has a similar or significantly better analgesic effect than some of the selective and non-selective NSAIDs and significantly has a better analgesic effect than some of salicylic acids and tramadol. CONCLUSION: Meloxicam can be considered as an alternative analgesic agent than some NSAIDs, tramadol and salicylic acids in patients who have undergone the third molar extraction.
PURPOSE: To investigate the effectiveness of preemptive analgesia with nonsteroidal anti-inflammatory drugs (NSAIDs) for the relief of inflammatory events (pain, edema, and trismus) after surgical removal of third molars.
MATERIALS AND METHODS: A two-phase PROSPERO-registered systematic review was conducted in accordance with the PRISMA statement. PubMed, Scopus, Web of Science, COCHRANE, LILACS, DOSS, and gray literature were searched using the following terms (MeSH) or their combinations: molar, third; anti-inflammatory agents, non-steroidal; analgesia; preoperative period; pain management.
RESULTS: From a total of 2903 articles, 31 (n = 2184 subjects) were selected. All studies presented a low risk of bias but exhibited high heterogeneity in methodology. Ten studies were selected for the meta-analysis. Preemptive analgesia for removal of third molars reduced average pain scores, especially those 1 h and 6 h after surgery (n = 151, p < 0.001, 95% CI = -2.81 to -0.97), reduced the average consumption of medication, and decreased the number of patients requiring medication without affecting the average time for its first consumption.
CONCLUSION: In summary, most NSAIDs showed good results for inflammatory events and reduced average pain scores and consumption of rescue medication. However, more homogeneous and well-delineated clinical studies are necessary to determine a possible association between NSAIDs and the relief of inflammatory events.
