TY - JOUR
T1 - Comparative efficacy and safety of different corticosteroids to reduce inflammatory complications after mandibular third molar surgery
T2 - A systematic review and network meta-analysis
AU - Canellas, João Vitor dos Santos
AU - Ritto, Fabio Gamboa
AU - Tiwana, Paul
N1 - Publisher Copyright:
© 2022 The British Association of Oral and Maxillofacial Surgeons
PY - 2022
Y1 - 2022
N2 - 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.
AB - 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.
KW - Corticosteroids
KW - Network meta-analysis
KW - Oedema
KW - Systematic review
KW - Third molar
UR - http://www.scopus.com/inward/record.url?scp=85132801701&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85132801701&partnerID=8YFLogxK
U2 - 10.1016/j.bjoms.2022.05.003
DO - 10.1016/j.bjoms.2022.05.003
M3 - Review article
C2 - 35728984
AN - SCOPUS:85132801701
SN - 0266-4356
JO - British Journal of Oral and Maxillofacial Surgery
JF - British Journal of Oral and Maxillofacial Surgery
ER -