Journal of Oral and Maxillofacial Surgery
Volume 66, Issue 9 , Pages 1881-1894 , September 2008

Corticosteroids Reduce Postoperative Morbidity After Third Molar Surgery: A Systematic Review and Meta-Analysis

  • Michael R. Markiewicz, DDS, MPH

      Affiliations

    • Formerly, Predoctoral Student, University at Buffalo, School of Dental Medicine, Buffalo, NY, and Research Fellow, Center for Applied Clinical Investigation, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA; and Currently, Resident in Training, Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Portland, OR
    • Corresponding Author InformationAddress correspondence and reprint requests to Dr Markiewicz: SDOMS, Oregon Health and Science University, 611 SW Campus Dr, Portland, OR 97239
  • ,
  • Mark F. Brady, BS

      Affiliations

    • Predoctoral Student, Warren Alpert Medical School of Brown University, Providence, RI; and National Institutes of Health/Fogarty International Center Fellow with the Johns Hopkins School of Public Health in Lima, Peru
  • ,
  • Eric L. Ding, ScD

      Affiliations

    • Research Fellow, School of Public Health, Harvard University, Boston, MA
  • ,
  • Thomas B. Dodson, DMD, MPH

      Affiliations

    • Associate Professor, Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, MA; and Attending Oral and Maxillofacial Surgeon and Director, Center for Applied Clinical Investigation, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA

References 

  1. Silvestri AR, Singh I. The unresolved problem of the third molar: Would people be better off without it?. J Am Dent Assoc. 2003;134:450
  2. Hooley JR, Bradley PB, Haines M. Plasma cortisol levels following short term betamethasone therapy for oral surgical procedures. Trans Int Conf Oral Surg. 1973;4:188
  3. Van Der Zwan J, Boering G, Wesseling H. The lower third molar and antiphlogistics (Effects of betamethasone, ibuprofen, indomethacin, naproxen, niflumic acid, oxyphenylbutazone, tranexamic acid and glafenine on the patient's condition after surgical removal of a lower third molar). Int J Oral Surg. 1982;11:340
  4. Zhang EX. Prevention of swelling after removal of an impacted wisdom tooth. Zhonghua Kou Qiang Ke Za Zhi. 1982;17:85
  5. Seymour RA, Walton JG. Pain control after third molar surgery. Int J Oral Surg. 1984;13:457
  6. Szmyd L, Shannon IL, Hester WR, et al. Subjective and objective measurement of responses to third molar impaction surgery. Oral Surg Oral Med Oral Pathol. 1964;17:257
  7. Szmyd L, Shannon IL, Mohnac AM. Control of postoperative sequelae in impacted third molar surgery. J Oral Ther Pharmacol. 1965;21:491
  8. Diwanji RC, Nizami IF. Study and observations of the 3rd molar impactions in the mandible along with chemotherapeutic and surgical treatment (A preliminary report). J Indian Dent Assoc. 1967;39:162
  9. Greenfield W, Caruso WA. Systemic use of steroids following office oral surgery. N Y State Dent J. 1976;42:482
  10. Huffman GG. Use of methylprednisolone sodium succinate to reduce postoperative edema after removal of impacted third molars. J Oral Surg. 1977;35:198
  11. Spies TD, Dreizen S, Stone RE, et al. A clinical appraisal of ACTH and cortisone as therapeutic agents in dental medicine. Oral Surg Oral Med Oral Pathol. 1952;5:25
  12. Messer EJ, Keller JJ. The use of intraoral dexamethasone after extraction of mandibular third molars. Oral Surg Oral Med Oral Pathol. 1975;40:594
  13. Montgomery MT, Hogg JP, Roberts DL, et al. The use of glucocorticosteroids to lessen the inflammatory sequelae following third molar surgery. J Oral Maxillofac Surg. 1990;48:179
  14. Hooley JR, Francis FH. Betamethasone in traumatic oral surgery. J Oral Surg. 1969;27:398
  15. Skjelbred P, Lokken P. Post-operative pain and inflammatory reaction reduced by injection of a corticosteroid (A controlled trial in bilateral oral surgery). Eur J Clin Pharmacol. 1982;21:391
  16. Bystedt H, Nordenram A. Effect of methylprednisolone on complications after removal of impacted mandibular third molars. Swed Dent J. 1985;9:65
  17. Edilby G, Canniff J, Harris M. A double-blind placebo-controlled trial of the effects of dexamethasone on postoperative swelling [abstract]. J Dent Res. 1982;61:556
  18. Beirne OR, Hollander B. The effect of methylprednisolone on pain, trismus, and swelling after removal of third molars. Oral Surg Oral Med Oral Pathol. 1986;61:134
  19. Graziani F, D'Aiuto F, Arduino PG, et al. Perioperative dexamethasone reduces post-surgical sequelae of wisdom tooth removal (A split-mouth randomized double-masked clinical trial). Int J Oral Maxillofac Surg. 2006;35:241
  20. Leone M, Richard O, Antonini F, et al. Comparison of methylprednisolone and ketoprofen after multiple third molar extraction: A randomized controlled study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103:e7
  21. Markovic A, Todorovic L. Effectiveness of dexamethasone and low-power laser in minimizing edema after third molar surgery: A clinical trial. Int J Oral Maxillofac Surg. 2007;36:226
  22. Mico-Llorens JM, Satorres-Nieto M, Gargallo-Albiol J, et al. Efficacy of methylprednisolone in controlling complications after impacted lower third molar surgical extraction. Eur J Clin Pharmacol. 2006;62:693
  23. Ordulu M, Aktas I, Yalcin S, et al. Comparative study of the effect of tube drainage versus methylprednisolone after third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:e96
  24. Pedersen A. Decadronphosphate in the relief of complaints after third molar surgery (A double-blind, controlled trial with bilateral oral surgery). Int J Oral Surg. 1985;14:235
  25. Collins R, Keech A, Peto R, et al. Cholesterol and total mortality: Need for larger trials. BMJ. 1992;304:1689
  26. Freiman JA, Chalmers TC, Smith H, et al. The importance of beta, the type II error and sample size in the design and interpretation of the randomized control trial (Survey of 71 “negative” trials). N Engl J Med. 1978;299:690
  27. Thornley B, Adams C. Content and quality of 2000 controlled trials in schizophrenia over 50 years. BMJ. 1998;317:1181
  28. Koerner KR. Steroids in third molar surgery: A review. Gen Dent. 1987;35:459
  29. Mehrabi M, Allen JM, Roser SM. Therapeutic agents in perioperative third molar surgical procedures. Oral Maxillofac Surg Clin North Am. 2007;19:69
  30. Sands T, Pynn BR, Nenniger S. Third molar surgery: Current concepts and controversies. Part 2. Oral Health. 1993;83:19
  31. Alexander RE, Throndson RR. A review of perioperative corticosteroid use in dentoalveolar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90:406
  32. Gersema L, Baker K. Use of corticosteroids in oral surgery. J Oral Maxillofac Surg. 1993;50:270
  33. Key SJ, Hodder SC, Davies R, et al. Perioperative corticosteroid supplementation and dento-alveolar surgery. Dent Update. 2003;30:316
  34. Mulrow CD. The medical review article: State of the science. Ann Intern Med. 1987;106:485
  35. Oxman AD, Guyatt GH. Guidelines for reading literature reviews. CMAJ. 1988;138:697
  36. Clarke M. The QUORUM statement. Lancet. 2000;355:756
  37. The Cochrane Collaboration: C2004-2006 [cited 2007 18 2007]. Available at: http://www3.interscience.wiley.com/cgi-bin/mrwhome/106568753/HOME. Accessed July 7, 2008
  38. Laskin DM. Oral and Maxillofacial Surgery. In: St. Louis: Mosby; 1985;p. 39
  39. Album B, Olsen I, Lokken P. Bilateral surgical removal of impacted mandibular third molar teeth as a model for drug evaluation: A test with oxyphenbutazone (Tanderil). Int J Oral Surg. 1977;6:177
  40. Amin MM, Laskin DM. Prophylactic use of indomethacin for prevention of postsurgical complications after removal of impacted third molars. Oral Surg Oral Med Oral Pathol. 1983;55:448
  41. Esen E, Tasar F, Akhan O. Determination of the anti-inflammatory effects of methylprednisolone on the sequelae of third molar surgery. J Oral Maxillofac Surg. 1999;57:1201
  42. de Oliveira IR, Santos-Jesus R, Po AL, et al. Extracting numerical data from published reports of pharmacokinetics investigations: Method description and validation. Fundam Clin Pharmacol. 2003;17:471
  43. Stewart LA, Clarke MJ. Practical methodology of meta-analyses (overviews) using updated individual patient data (Cochrane Working Group). Stat Med. 1995;14:2057
  44. Pell GJ, Gregory GT. Impacted mandibular third molars: Classification and modified technique for removal. Dent Dig. 1933;39:330
  45. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions, 4.2.6. 2006. http://www.cochrane.org/resources/handbook/Accessed July 27, 2007
  46. Gotzsche PC, Hrobjartsson A, Maric K, et al. Data extraction errors in meta-analyses that use standardized mean differences. JAMA. 2007;298:430
  47. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177
  48. Cooper HM, Hedges LV. Parametric measures of effect size. In: The Handbook of Research Synthesis. New York, NY: Russell Sage Foundation; 1994;p. xvi
  49. van Houwelingen HC, Arends LR, Stijnen T. Advanced methods in meta-analysis: Multivariate approach and meta-regression. Stat Med. 2002;21:589
  50. Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629
  51. Sisk AL, Bonnington GJ. Evaluation of methylprednisolone and flurbiprofen for inhibition of the postoperative inflammatory response. Oral Surg Oral Med Oral Pathol. 1985;60:137
  52. El Hag M, Coghlan K, Christmas P, et al. The anti-inflammatory effects of dexamethasone and therapeutic ultrasound in oral surgery. Br J Oral Maxillofac Surg. 1985;23:17
  53. Vallerand WP, Vallerand AH, Heft M. The effects of postoperative preparatory information on the clinical course following third molar extraction. J Oral Maxillofac Surg. 1994;52:1165
  54. Kunz R, Oxman AD. The unpredictability paradox: Review of empirical comparisons of randomized and non-randomized clinical trials. BMJ. 1998;317:1185
  55. Begg C, Cho M, Eastwood S, et al. Improving the quality of reporting of randomized controlled trials (The CONSORT statement). JAMA. 1996;276:637
  56. Schulz KF, Chalmers I, Hayes RJ, et al. Empirical evidence of bias (Dimensions of methodological quality associated with estimates of treatment effects in controlled trials). JAMA. 1995;273:408
  57. Moher D, Pham B, Jones A, et al. Does quality of reports of randomized trials affect estimates of intervention efficacy reported in meta-analyses?. Lancet. 1998;352:609
  58. Chalmers TC, Celano P, Sacks HS, et al. Bias in treatment assignment in controlled clinical trials. N Engl J Med. 1983;309:1358
  59. Hyrkas T, Ylipaavalniemi P, Oikarinen VJ, et al. A comparison of diclofenac with and without single-dose intravenous steroid to prevent postoperative pain after third molar removal. J Oral Maxillofac Surg. 1993;51:634
  60. DerSimonian R, Levine RJ. Resolving discrepancies between a meta-analysis and a subsequent large controlled trial. JAMA. 1999;282:664
  61. LeLorier J, Gregoire G, Benhaddad A, et al. Discrepancies between meta-analyses and subsequent large randomized, controlled trials. N Engl J Med. 1997;337:536
  62. Chan AW, Hrobjartsson A, Haahr MT, et al. Empirical evidence for selective reporting of outcomes in randomized trials: Comparison of protocols to published articles. JAMA. 2004;291:2457
  63. Olson CM, Rennie D, Cook D, et al. Publication bias in editorial decision making. JAMA. 2002;287:2825
  64. Ioannidis JP. Contradicted and initially stronger effects in highly cited clinical research. JAMA. 2005;294:218
  65. Chalmers TC. Problems induced by meta-analyses. Stat Med. 1991;10:971
  66. Moher D, Fortin P, Jadad AR, et al. Completeness of reporting of trials published in languages other than English: Implications for conduct and reporting of systematic reviews. Lancet. 1996;347:363
  67. Berlin JA. Does blinding of readers affect the results of meta-analyses? (University of Pennsylvania Meta-analysis Blinding Study Group). Lancet. 1997;350:185
  68. Piper JM, Ray WA, Daugherty JR, et al. Corticosteroid use and peptic ulcer disease: Role of nonsteroidal anti-inflammatory drugs. Ann Intern Med. 1991;114:735
  69. Busti AJ, Hooper JS, Amaya CJ, et al. Effects of perioperative antiinflammatory and immunomodulating therapy on surgical wound healing. Pharmacotherapy. 2005;25:1566
  70. Langer P, Fadale P, Hulstyn M, et al. Survey of orthopaedic and sports medicine physicians regarding use of Medrol Dosepak for sports injuries. Arthroscopy. 2006;22:1263
  71. Hyrkas T. Effect of preoperative single doses of diclofenac and methylprednisolone on wound healing. Scand J Plast Reconstr Surg Hand Surg. 1994;28:275
  72. Mitchell DA, Ward-Booth P, Seymour RA. A comparative study of the efficacy of aspirin and an ibuprofen/codeine combination in patients treated pre-operatively with methylprednisolone acetate. Br Dent J. 1985;159:78
  73. Neupert EA, Lee JW, Philput CB, et al. Evaluation of dexamethasone for reduction of postsurgical sequelae of third molar removal. J Oral Maxillofac Surg. 1992;50:1177
  74. Buyukkurt MC, Gungormus M, Kaya O. The effect of a single dose prednisolone with and without diclofenac on pain, trismus, and swelling after removal of mandibular third molars. J Oral Maxillofac Surg. 2006;64:1761

PII: S0278-2391(08)00927-0

doi: 10.1016/j.joms.2008.04.022

Journal of Oral and Maxillofacial Surgery
Volume 66, Issue 9 , Pages 1881-1894 , September 2008