Abstract
This study aimed to perform a systematic review and meta-analysis to evaluate the preemptive action of the combination of corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) or both drugs singly after third molars surgery. It was performed a search on the PubMed/MEDLINE, Scopus, and Cochrane databases, according to the PRISMA criteria, with no time restrictions up to March 2020. The postoperative pain was evaluated, qualitatively, through the visual analogue scale (VAS) and the number of rescue analgesics (NRA). The edema and trismus were evaluated in a qualitative way through linear measures. Besides that, a meta-analysis of the post-operative pain (VAS) was performed. It was found 103 articles, which four articles were selected according to the inclusion and exclusion criteria. A total of 208 patients was evaluated and the combination of corticosteroids and NSAIDs showed great behavior in the preemptive action after third molars surgery for all the parameters evaluated when compared to both drugs singly. Meta-analysis about the VAS showed that the combination of drugs reduced significantly the postoperative pain when compared to the NSAIDs singly (P<0.05). It was concluded that the combination of NSAIDs and corticosteroids improved postoperative pain, edema, and trismus after third molars surgery.
Highlights
It is still a challenge for oral surgeons to control the pain, edema, and trismus in the postoperative period after third-molar surgery
This study aimed to perform a systematic review and meta-analysis to evaluate the preemptive action of the combination of corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) or both drugs singly after third molars surgery
Postoperative pain evaluation is a study model extensively used to create drug clinical protocols that minimize the pain symptoms after dental surgeries (Mojsa et al, 2017; Barden, Edwards, McQuay, & Andrew Moore, 2004; BrignardelloPetersen, 2017) Corticosteroids are the most widely used drugs for preemptive analgesia in surgical practice, and several clinical trials have showed their effectiveness in reducing postoperative pain, edema, and trismus (Antunes, Avelar, Martins Neto, Frota, & Dias, 2011; Darawade, Kumar, Mehta, Sharma, & Reddy, 2014; Paiva-Oliveira et al, 2016; Simone, Jorge, Horliana, Canaval, & Tortamano, 2013)
Summary
It is still a challenge for oral surgeons to control the pain, edema, and trismus in the postoperative period after third-molar surgery. Drugs have been administered prior to this surgical procedure to minimize inflammatory complications (Bamgbose et al, 2005; Ong, Seymour, Chen, & Ho, 2004). Corticosteroids are widely used in preemptive administration for third molar removal to decrease the production of inflammatory mediators (Bamgbose et al, 2005). LaureanoFilho (Laureano Filho, Maurette, Allais, Cotinho, & Fernandes, 2008) and Alcântara et al (Alcântara, Falci, Oliveira-Ferreira, Santos, & Pinheiro, 2014) concluded that an 8 mg dose of dexamethasone administered in the preemptive period showed better control of postoperative edema and trismus after third-molar surgery. It seems corticosteroids alone were unable to decrease pain or suppress prostaglandins, an important inflammatory cytokine related to pain (Dionne, Gordon, Rowan, Kent, & Brahim, 2003)
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