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

• Published in: International journal of oral and maxillofacial surgery Vol. 48; no. 1; pp. 118 - 131
• Main Authors: Almeida, R. de A.C., Lemos, C.A.A., de Moraes, S.L.D., Pellizzer, E.P., Vasconcelos, B.C.
• Format: Journal Article
• Language: English
• Published: Denmark Elsevier Ltd 01.01.2019
• Subjects: Adrenal Cortex Hormones - therapeutic use; corticosteroid; Dentistry; Edema - drug therapy; Humans; meta-analysis; Molar, Third - surgery; oedema; pain; Pain, Postoperative - drug therapy; Randomized Controlled Trials as Topic; third molar extraction; Tooth Extraction; Tooth, Impacted - surgery; trismus; Trismus - drug therapy; corticosteroid; meta-analysis; third molar extraction; pain; oedema; trismus
• ISSN: 0901-5027; 1399-0020
• DOI: 10.1016/j.ijom.2018.05.023

The aim of this systematic review was to identify randomized, placebo-controlled clinical trials investigating the effectiveness of corticosteroids in the control of pain, oedema, and trismus following third molar surgery, and to analyse the effects of the type of drug administered and the time and route of drug administration on the outcomes of interest. Searches were performed in the PubMed, Scopus, and Cochrane Library databases. This review was structured according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The search identified 1223 studies. After assessing eligibility based on the inclusion and exclusion criteria, 17 studies were selected for the qualitative analysis (a total of 730 patients aged 15–45 years). Ten studies were included in the meta-analysis, which was performed using Review Manager software. The corticosteroids were effective in controlling pain (P=0.002; mean difference −17.38, 95% confidence interval −24.81 to −9.95) and trismus (P<0.00001; mean difference 6.10, 95% confidence interval 3.42 to 8.77). With the exception of the submucosal route, the route of administration did not appear to affect the outcomes. The administration of a corticosteroid in the preoperative phase was superior to its use in the postoperative phase for the control of trismus.