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Systematic review

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Efficacy of different dexamethasone routes and doses in reducing the postoperative sequelae of impacted mandibular third-molar extraction: A network meta-analysis of randomized clinical trials

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Journal Journal of the American Dental Association (1939)
Year 2022
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This article is included in 1 Broad synthesis 34 Broad syntheses (1 reference)

This article includes 34 Primary studies 34 Primary studies (34 references)

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Background: The aim of this network meta-analysis was to assess the comparative effects of different dexamethasone (DXM) routes and doses on reducing postoperative sequelae (pain, swelling, trismus) after surgical extraction of impacted mandibular third molars. Methods: Five databases were searched on September 22, 2021, for randomized controlled trials. Risk of bias (ROB) was assessed using the Cochrane ROB 2 tool. Study heterogeneity, publication bias, and quality of evidence were investigated. Network meta-analyses were conducted (P < .05), and the P-score was used to rank comparisons of DXM doses and routes. Results: Thirty-four eligible studies were included. Eight studies had low ROB, 21 had some concerns, and 5 had high ROB. The certainty of evidence evaluated by the Confidence in Network Meta-Analysis tool indicated low to very low certainty in most comparisons. The results showed that most DXM route and dose combinations were superior to a placebo in reducing the postoperative sequelae 1 day after surgical extraction. The results also showed that a 4-mg DXM submucosal injection substantially reduces pain 3 days after extraction compared with a 4-mg twin-mix or 8-mg intramuscular injection. Overall, it appears that 4 mg DXM submucosal injection or admixed with local anesthetic is effective in reducing postoperative sequelae after surgical extraction. Conclusions: Within the limitations of this study, the administration of DXM appears to be effective in reducing the postoperative sequelae, especially in the submucosal route. However, no noteworthy differences were found between the investigated DXM route and dose comparisons. Practical Implications: Submucosal DXM injection effectively reduce postoperative sequelae of third-molar extractions. © 2022 American Dental Association

Systematic review

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Comparative efficacy and safety of different corticosteroids to reduce inflammatory complications after mandibular third molar surgery: a systematic review and network meta-analysis.

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Journal The British journal of oral & maxillofacial surgery
Year 2022
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This article is included in 1 Broad synthesis 59 Broad syntheses (1 reference)

This article includes 61 Primary studies 59 Primary studies (61 references)

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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.

Systematic review

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Analgesic effectiveness and safety of celecoxib versus non-opioid active controls after third molar surgery: A meta-analytical evaluation.

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Journal Journal of stomatology, oral and maxillofacial surgery
Year 2022
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This article is included in 1 Broad synthesis 0 Broad syntheses (1 reference)

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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.

Systematic review

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Can adjunctive corticosteroid therapy improve patient-centered outcomes following third molar surgery? A systematic review.

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Journal Medicina oral, patologia oral y cirugia bucal
Year 2022
Links Pubmed DOI PubMed Central LILACS

This article is included in 1 Broad synthesis 11 Broad syntheses (1 reference)

This article includes 12 Primary studies 11 Primary studies (12 references)

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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.

Systematic review

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Pre-emptive analgesic efficacy of injected ketorolac in comparison to other agents for third molar surgical removal: a systematic review.

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Journal Journal of dental anesthesia and pain medicine
Year 2021
Links Pubmed DOI PubMed Central

This article is included in 1 Broad synthesis 6 Broad syntheses (1 reference)

This article includes 6 Primary studies 6 Primary studies (6 references)

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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.

Systematic review

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Preemptive use of intravenous ibuprofen to reduce postoperative pain after lower third molar surgery: a systematic review of randomized controlled trials.

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Journal Clinics (Sao Paulo, Brazil)
Year 2021
Links Pubmed DOI PubMed Central LILACS

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This article is included in 1 Broad synthesis 0 Broad syntheses (1 reference)

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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.

Systematic review

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Preemptive analgesia via oral route in mandibular third molar surgeries: a network meta-analysis

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Authors Magesty RA
Thesis Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina
Year 2021

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This article is included in 1 Broad synthesis 0 Broad syntheses (1 reference)

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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.

Systematic review

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Analgesics for Dental Implants: A Systematic Review

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Journal Frontiers in pharmacology
Year 2020
Links Pubmed DOI PubMed Central

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This article is included in 1 Broad synthesis 0 Broad syntheses (1 reference)

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Postsurgical pain is commonly associated with dental and oral surgery, and the use of analgesics has been investigated in the management of postoperative pain. This systematic review summarizes available evidence on analgesics used to manage dental implant surgery postoperative pain, to identify best therapeutic protocols and knowledge gap. A comprehensive search was conducted including MEDLINE/Pubmed, EMBASE, SCOPUS, clinicaltrials.gov, and the Cochrane Database of Systematic Reviews through May 2020. Only randomized controlled trials were included. PRISMA guidelines were followed, and risk of bias was appraised using Cochrane RoB2 tool. Eleven trials (762 patients overall) were included. Some aspects limited the feasibility of a meaningful meta-analysis; thus, a narrative synthesis was conducted. Risk of bias was low in four studies and high in two studies, while five studies raised some concerns due to the randomization process. Analgesic use seemed to be associated with improved postoperative outcomes (pain, patient’s satisfaction, and need for rescue medication) when compared to placebo. Overall, this review suggests that the administration of analgesics may provide some advantages in the management of postoperative outcomes after dental implant placement, while indications about the best analgesics cannot be provided. © Copyright © 2021 Melini, Forni, Cavallin, Parotto and Zanette.

Systematic review

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Post-operative pain management with meloxicam: a systematic literature review in the field of dentistry

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Journal Oral Surgery
Year 2020
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This article is included in 1 Broad synthesis 0 Broad syntheses (1 reference)

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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.

Systematic review

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Preemptive use of oral nonsteroidal anti-inflammatory drugs for the relief of inflammatory events after surgical removal of lower third molars: A systematic review with meta-analysis of placebo-controlled randomized clinical trials.

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Journal Journal of Cranio-Maxillofacial Surgery
Year 2020
Links Pubmed DOI www.cochranelibrary.com

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This article is included in 1 Broad synthesis 0 Broad syntheses (1 reference)

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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.