Three-dimensional facial swelling evaluation of pre-operative single-dose of prednisone in third molar surgery: a split-mouth randomized controlled trial

Abstract

Background Facial swelling, pain, and trismus are the most common postoperative sequelae after mandibular third molar (M3M) surgery. Corticosteroids are the most used drugs to reduce the severity of inflammatory symptoms after M3M surgery. This study aimed to evaluate the effect of a single pre-operative dose of prednisone on pain, trismus, and swelling after M3M surgery. Methods This study was designed as a split-mouth randomized, controlled, triple-blind trial with two treatment groups, prednisone (PG) and control (CG). All the parameters were assessed before the extraction (T0), two days (T1), and seven days after surgery (T2). Three-dimensional evaluation of facial swelling was performed with Bellus 3D Face App. A visual analogue scale (VAS) was used to assess pain. The maximum incisal distance was recorded with a calibrated rule to evaluate the trismus. The Shapiro–Wilk test was used to evaluate the normal distribution of each variable. To compare the two study groups, the analysis of variance was performed using a two-tailed Student t-test for normal distributions. The level of significance was set at a = 0.05. Statistical analysis was conducted using the software STATA (STATA 11, StataCorp, College Station, TX). Results Thirty-two patients were recruited with a mean age of 23.6 ± 3.7 years, with a male-to-female ratio of 1:3. A total of 64 M3Ms (32 right and 32 left) were randomly assigned to PG or CG. Surgery time recorded a mean value of 15.6 ± 3.7 min, without statistically significant difference between the groups. At T1, PG showed a significantly lower facial swelling compared to CG (PG: 3.3 ± 2.1 mm; CG: 4.2 ± 1.7 mm; p = 0.02). Similar results were recorded comparing the groups one week after surgery (PG: 1.2 ± 1.2; CG: 2.1 ± 1.3; p = 0.0005). All patients reported a decrease in facial swelling from T1 to T2 without differences between the two groups. At T1, the maximum buccal opening was significantly reduced than T0, and no difference between PG (35.6 ± 8.2 mm) and CG (33.7 ± 7.3 mm) (p > 0.05) was shown. Similar results were reported one week after surgery (PG: 33.2 ± 14.4 mm; CG: 33.7 ± 13.1 mm; p > 0.05). PG showed significantly lower pain values compared to CG, both at T1 (PG: 3.1 ± 1.5; CG: 4.6 ± 1.8; p = 0.0006) and T2 (PG: 1.0 ± 0.8; CG: 1.9 ± 1.4; p = 0.0063). Conclusion Our results showed that pre-operative low-dose prednisone administration could reduce postoperative sequelae by improving patient comfort after M3M surgery and reducing facial swelling two days and one week after surgical procedures. Trial registration www.clinicaltrials.gov — NCT05830747 retrospectively recorded—Date of registration: 26/04/2023.

The effectiveness of chitosan as a hemostatic in dentistry in patients with antiplatelet/anticoagulant therapy: systematic review with meta-analysis

“…After extractions on patients taking antithrombotic drugs continuously, a study evaluated the efficacy of chitosan-based dressings [ 20 – 25 ]. In extraction sites with chitosan dressing, the results showed no instances of dry sockets or pus discharge [ 26 – 31 ]. Chitosan dressing, a hemostatic agent, can dramatically lessen post-extraction bleeding and improve pain management in individuals taking continuous oral antithrombotic medicine.…”

Full life cycle changes of low impacted mandibular third molar associated cystic lesions and adjacent tooth root resorption: a retrospective study

“…The oral cavity is a bacteria-rich environment, and the incidence rate of postoperative complications is higher after LIMTM extraction than that of after other tooth extractions [ 14 , 15 ]. Common intraoperative and postoperative complications include mandibular fractures [ 16 , 17 ], tooth tissue displacement, nerve damage, infection, dry socket syndrome, facial swelling, and bleeding [ 18 , 19 ]. Tooth tissue displacement is a common complication after extraction of low impacted third molars.…”

Comparison of the Efficacy of Corticosteroids With Enzymatic Agents in the Postoperative Sequelae for Lower Third Molar Surgery: A Prospective Study

“…Since impacted third-molar extractions are typically performed on teenagers and young adults, it is generally accepted that elderly patients have a higher chance of complications following third-molar surgery. It is widely acknowledged that men and women react to pain stimuli and perceive them differently [ 2 ]. Furthermore, there are biological variations between men and women that may influence how they react to medications.…”