The Efficacy of Four Ways of Administrating Dexamethasone during Surgical Extraction of Partially Impacted Lower Third Molars

Abstract

Glucocorticoids are drugs noted for their potent anti-inflammatory effect and long lasting half-life. Various studies have been carried out to identify which of these molecules is best for reducing the postoperative sequelae after surgical extraction of the impacted lower third molar. This study examines four different ways of administering dexamethasone after surgical extraction of impacted lower third molars: endoalveolar application, submucous injection, intravenous administration and intramuscular injection, with the aim of identifying which method gives the least discomfort to the patient in regard to reduction of pain, edema and post-operative lock-jaw. Results show that a greater reduction of the postoperative sequelae was obtained in the group of patients treated with dexamethasone intravenously. Satisfying results were also obtained in the group treated with a topical administration of dexamethasone in powder form and in the group which was given dexamethasone through an intramuscular injection. These last two groups had similar results. Instead, the results obtained in the group that received dexamethasone through local submucous injection were not satisfactory.Excision of the third lower molar under local anesthetic is one of the most frequently performed interventions in oral surgery. This intervention is usually associated with post-operative pain, edema and trismus, as direct consequences immediately after surgery, influencing the quality of life of the patient. Various studies have therefore been carried out on the control ofthis post-operative reaction and various perioperative strategies have been proposed aimed at preventing the onset of inflammation which is the cause of pain. The introduction of NSAIDs (non-steroidal anti-inflammatory drugs) has greatly modified the way in which post-operative pain is dealt with in dentistry and medicine in general in However, the prescription of NSAIDs, in particular aspirin, is often cause for concern as these drugs cause the inhibitionof the platelet aggregation with a possible increase of intra-and post-operative bleeding and the formationof post-operativehematomas and ecchymosis. Therefore, a valid preventive strategy, as an alternative to the use of NSAIDs for limiting edema, pain and 1721-727 (2007)

Morphostructural Analysis of Human Follicular Stem Cells on Highly Porous Bone Hydroxyapatite Scaffold

“…SEM analysis of primary culture cells showed they had a mesenchymal stem cell-like morphostructure, spindle shaped, similar to the culture of mesenchymal stem cells derived from adult bone marrow (25)(26)(27). After osteogenic differentiation, SEM analysis consented also to appreciate the typical cellular morphostructure of the osteoblasts.…”

Efficacy of corticosteroids versus placebo in impacted third molar surgery: systematic review and meta-analysis of randomized controlled trials

“…After the removal of duplicates and reading of the titles and abstracts, 65 articles were selected for fulltext analysis, 48 of which were excluded for not meeting the eligibility criteria. Thus, 17 articles were included in the present systematic review [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] . Figure 1 displays the flowchart of the article selection process.…”

“…It was possible to quantify the number of male (n = 314) and female (n = 346) subjects in 15 of the studies; two of the studies did not offer a distinction of the sex of the patients 11,12 . With regard to the corticosteroids administered to the study groups, long-duration drugs were used in 11 studies, nine of which employed dexamethasone [13][14][15][16][17][18][19][20][21] and two betamethasone 22,23 . Mediumduration corticosteroids were used in six studies, five of which employed methylprednisolone 11,12,[24][25][26] and one prednisolone 27 .…”

“…In the analysis of the results of the articles included in the present review, 13 studies demonstrated a positive effect of corticosteroid use in comparison to placebo use with regard to postoperative pain [11][12][13][14]16,[19][20][21][22][24][25][26][27] , and three studies found no difference 15,17,23 . The studies by Boonsiriseth et al 20 and Chopra et al 22 demonstrated no difference in the evaluation performed at 7 days following surgery.…”

“…Eleven studies demonstrated a positive effect of corticosteroids in comparison to placebo use in the evaluation of trismus [11][12][13]17,[19][20][21][22][24][25][26] , whereas no difference was found in four studies 14,15,23,27 . Furthermore, four studies found no difference between the groups at the day 7 evaluation 17,20,24,25 .…”