Corticosteroids reduce postoperative morbidity after third molar surgery: a systematic review and meta-analysis.

Abstract

PURPOSE:

The purpose of this study was to apply meta-analytical methods to measure the effect of corticosteroids (CS) on edema, trismus, and pain at early and late postoperative periods after third molar (M3) removal.

MATERIALS AND METHODS:

A systematic search of the literature was carried out to identify eligible articles. The primary predictor variable was perioperative CS exposure (yes or no). The 3 outcome variables were edema, trismus, and pain assessed during the early (1-3 days) and late (>3 days) postoperative time periods. Standardized mean differences (SMD) for edema and weighted mean differences (WMD) for trismus and pain were pooled across studies. Differences between the 2 treatment groups were assessed using random effects models and metaregressions for both early and late postoperative assessments.

RESULTS:

Twelve trials met the inclusion criteria. Subjects receiving CS had significantly less edema during both early (SMD, 1.4; 95% confidence interval [CI], 0.6, 2.2; P < .001) and late (SMD, 1.1; 95% CI, 0.1, 2.0; P = .03) time periods after surgery and less trismus than controls during the early and late postoperative periods (early WMD, 4.1 mm; 95% CI, 2.8 mm, 5.5 mm; P < .001; late WMD, 2.7 mm; 95% CI, 0.8 mm, 4.6 mm; P = .005). Average pain levels were not significantly different between the 2 groups (early WMD, 0.4 visual analog scale [VAS]; 95% CI, -0.04 VAS, 0.9 VAS; P = .07; late WMD, 0.5 VAS; 95% CI, -0.6 VAS, 1.5 VAS; P = .4).

CONCLUSIONS:

The findings of this study suggest that perioperative administration of corticosteroids produces a mild to moderate reduction in edema and improvement in range of motion after M3 removal.

• Authors: Michael R Markiewicz, Mark F Brady, Eric L Ding, Thomas B Dodson
• Journal: Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons (J Oral Maxillofac Surg) Vol. 66 Issue 9 Pg. 1881-94 (Sep 2008) ISSN: 1531-5053 [Electronic] United States
• PMID: 18718396 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)

Chemical References

• Adrenal Cortex Hormones
• Glucocorticoids
• Pregnadienetriols

Topics

• Adrenal Cortex Hormones (therapeutic use)
• Edema (etiology, prevention & control)
• Glucocorticoids (therapeutic use)
• Humans
• Mandible
• Maxilla
• Molar, Third (surgery)
• Pain, Postoperative (etiology, prevention & control)
• Postoperative Complications (etiology, prevention & control)
• Pregnadienetriols (therapeutic use)
• Range of Motion, Articular (drug effects)
• Tooth Extraction (adverse effects)
• Trismus (etiology, prevention & control)