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Comparative efficacy and safety of different corticosteroids to reduce inflammatory complications after mandibular third molar surgery: a systematic review and network meta-analysis

  • Author Footnotes
    1 600 N. Broad St 5, 3327 Middletown Delaware, DE 19709, United States.
    João Vitor dos Santos Canellas
    Correspondence
    Corresponding author.
    Footnotes
    1 600 N. Broad St 5, 3327 Middletown Delaware, DE 19709, United States.
    Affiliations
    Department of Research, INPLASY, Inc. - International Platform of Registered Systematic Review and Meta-analysis Protocols, Delaware, United States
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  • Author Footnotes
    2 1201 N. Stonewall Ave Oklahoma City, OK 73117, United States.
    Fabio Gamboa Ritto
    Footnotes
    2 1201 N. Stonewall Ave Oklahoma City, OK 73117, United States.
    Affiliations
    Department of Oral and Maxillofacial Surgery, College of Dentistry, The University of Oklahoma, United States
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  • Author Footnotes
    2 1201 N. Stonewall Ave Oklahoma City, OK 73117, United States.
    Paul Tiwana
    Footnotes
    2 1201 N. Stonewall Ave Oklahoma City, OK 73117, United States.
    Affiliations
    Department of Oral and Maxillofacial Surgery, College of Dentistry, The University of Oklahoma, United States
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  • Author Footnotes
    1 600 N. Broad St 5, 3327 Middletown Delaware, DE 19709, United States.
    2 1201 N. Stonewall Ave Oklahoma City, OK 73117, United States.

      Abstract

      A variety of corticosteroids are available as an alternative to reduce inflammatory complications after mandibular third molar surgery (3MS). However, it is unclear which are the best preoperative drugs, doses, and routes of administration. A frequentist network meta-analysis was performed to assess the comparative effectiveness of corticosteroids to reduce inflammatory complications after 3MS. We searched Embase, PubMed, and the Cochrane Library without language restrictions. Only randomised clinical trials (RCTs) were included. We obtained the relative effectiveness using network meta-analysis and an estimate of the relative ranking of interventions according to their effects. Our search yielded 2427 results, from which 61 studies involving 3561 subjects fulfilled our inclusion criteria. Five corticosteroids (dexamethasone, betamethasone, methylprednisolone, prednisolone, and triamcinolone) were compared. Dexamethasone 8mg via submucosal injection (−3.58[−6.98; −0.17]) and via pterygomandibular injection (−3.56[−6.30; −0.82]) were significantly more effective than placebo to reduce oedema after 3MS. The ranking analysis showed that dexamethasone 8mg via submucosal injection and via oral tablets were the interventions with the highest probability of being the most effective methods to reduce oedema after 3MS (p values = 0.71 and 0.75, respectively). Compared with placebo, only dexamethasone 8mg via submucosal injection effectively reduced pain in the first and second days after 3MS (−30.95[−43.41; −18.49]) and (−15.25[−23.27; −7.22]), respectively. Overall, corticosteroids reduced inflammatory complications after 3MS and did not show any serious adverse effects. Among the corticosteroids reviewed, dexamethasone 8mg was the best preoperative option to control inflammatory complications after 3MS. Further RCTs are needed to confirm the optimal route of administration.

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