Comparison of Submucosal With Intramuscular or Intravenous Administration of Dexamethasone for Third Molar Surgeries: A Systematic Review and Meta-Analysis.

Chengyu Hou,Chengbin Liu,Feng Liu

doi:10.3389/fsurg.2021.714950

Chengyu Hou, Chengbin Liu + Show 1 more

Open Access

PDF Available

https://doi.org/10.3389/fsurg.2021.714950

Copy DOI

Export

Save

Cite

Journal: Frontiers in Surgery	Publication Date: Aug 10, 2021
Citations: 7	License type: CC BY 4.0

Affiliation: Zaozhuang Municipal Hospital

Abstract
Highlights/Summary
Full-Text PDF
Similar Papers

Abstract

Listen

Objective: The study aimed to review evidence on the efficacy of submucosal (SM) administration vs. intravenous (IV) or intramuscular (IM) route of injections of dexamethasone for improving outcomes after mandibular third molar surgery.Methods: PubMed, Embase, CENTRAL, and Google Scholar were searched for randomized controlled trials (RCTs) up to 20th May 2021. Early (2–3 days) and late (7 days) outcomes were compared between SM vs. IV or IM dexamethasone. Quality of evidence was assessed based on GRADE.Results: Thirteen trials were included in the systematic review and 10 in the meta-analysis. Meta-analysis indicated a significant reduction in early pain with IV dexamethasone but no such difference for late pain compared to the SM group. There was no difference in early and late swelling scores between the SM and IV groups. Pooled analysis indicated no significant difference in early and late trismus between SM and IV groups. Comparing SM with IM dexamethasone, there was no significant difference in early and late pain scores. Swelling in the early and late postoperative periods was not significantly different between the two groups. There was no significant difference in early and late trismus between SM and IM groups. The quality of evidence was low for all outcomes.Conclusion: Low-quality evidence suggests that SM infiltration of dexamethasone results in similar outcomes as compared to IV or IM administration of the drug after third molar surgeries. Further high-quality RCTs are needed to corroborate the current conclusions.

Highlights

Mandibular third molar extraction is one of the most common surgical procedures in any oral surgical practice
Meta-analysis indicated a statistically significant reduction in early pain scores in patients receiving IV dexamethasone compared to those receiving SM dexamethasone (MD: 0.58 95% confidence intervals (CI): 0.27, 0.88 I2 = 28% p = 0.0002) (Figure 2)
Pooled analysis of all six studies indicated no statistically significant difference in early trismus between SM and IV dexamethasone groups (MD: −0.37 95% CI: −1.25 to 0.50 I2 = 60% p = 0.40) (Figure 6)

Summary

Introduction

Mandibular third molar extraction is one of the most common surgical procedures in any oral surgical practice. While many of the times, impacted mandibular third molars are asymptomatic, pathologies like recurrent pericoronitis, caries, and bone loss can necessitate early surgical extraction of these teeth [2]. Dexamethasone for Third Molar Surgeries indicates that asymptomatic third molars need to be extracted when the tooth is partially impacted in the horizontal or vertical position and with incomplete roots growing close to the mandibular canal [3]. Owing to the anatomical location of the impacted third molar, any surgical procedure leads to significant soft and hard tissue trauma [4]. The tissue injury inflicted on account of the surgery results in an inflammatory response leading to significant pain, swelling, and edema in the postoperative period. The surgical procedure affects the quality of life of the individual leading to impairment of routine activities [6]

Methods

Results

Discussion

Conclusion