Does methylprednisolone improve postoperative outcomes after mandibular third molar surgery? A systematic review and meta-analysis

Nagori, Shakil Ahmed; Jose, Anson; Roy, Indranil; Chattopadhyay, P. K.; Roychoudhury, Ajoy

doi:10.1016/j.ijom.2018.09.005

Cited by 12 publications

(9 citation statements)

References 48 publications

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“…Another meta-analysis on the evaluation of the effect of submucosal dexamethasone injection as against in M3M surgery suggested that dexamethasone was more effective for reducing postoperative complications such as pain and edema, with no significant effect on trismus [ 24 ]. However, another meta-analysis that evaluated the effectiveness of methylprednisolone against placebos in M3M surgery suggested that methylprednisolone significantly reduced pain, edema, and trismus in the early postoperative period [ 25 ]. Another meta-analysis evaluating the effectiveness of methylprednisolone against other anti-inflammatory drugs showed that methylprednisolone was significantly better in reducing trismus after 7 postoperative days [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Preemptive Dexamethasone versus Methylprednisolone in the Management of Postoperative Discomfort and Pain after Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis

Singh

Pentapati

Kodali

et al. 2023

The Scientific World Journal

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The corticosteroids have been used for preemptive management of surgical sequelae after mandibular third molar extraction. The aim of this article was to review the efficacy of methylprednisolone versus dexamethasone in the management of postsurgical pain, swelling, and trismus after mandibular third molar surgery. Randomized, double-blinded studies from PubMed, CINAHL, Scopus, DOSS, Cochrane central, and Web of Science were identified by using a search strategy. Randomized controlled trials evaluating the efficacy of use of dexamethasone versus methylprednisolone for mandibular third molar extraction were only considered. The studies involving the use of any other corticosteroid agent were excluded. Outcomes assessed were postoperative pain, the number of rescue analgesics required, swelling, trismus, and adverse events. The search strategy yielded 1046 articles for title and abstract screening, out of which only seven studies were included in the systematic review after full text screening. There was considerable heterogeneity between the studies with regards to the method as well as the parameters assessed. Risk of bias was low in three studies and unclear in other four studies. On pooled analyses, there was no significant difference with respect to pain, rescue analgesics, and swelling in the test and the control group. Forest plot analysis showed that dexamethasone had lesser trismus in early postoperative period (postoperative day 2) as compared to methylprednisolone. None of the included studies reported any adverse effects. Both the corticosteroids have similar efficacy in reducing the postoperative pain and swelling; however, dexamethasone showed statistically significant difference from methylprednisolone in reducing trismus (estimated standardized mean difference of −0.69 mm; 95% CI: −1.01 to −0.38; p < 0.0001 ) in the early postoperative period. However, due to statistical heterogeneity, quality of the evidence for the review was low to moderate. Hence, more studies with larger study sample and low risk of bias are needed to confirm these results.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Preemptive Dexamethasone versus Methylprednisolone in the Management of Postoperative Discomfort and Pain after Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis

Singh

Pentapati

Kodali

et al. 2023

The Scientific World Journal

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“…However, these authors included data from a clinical trial without blinding participants, personnel, and outcome assessment [ 16 ]. On the other hand, Nagori et al (2019) assessed the efficacy of methylprednisolone and prednisolone for control of postoperative complications following third molar surgery [ 18 ]. However, the effect of both drugs was included in the same treatment group and compared to placebo in a pooled statistical analysis.…”

Section: Discussionmentioning

confidence: 99%

“…In this sense, a meta-analysis assessed the efficacy of prednisolone and methylprednisolone versus placebo for post-surgical complication control after third molar surgery. However, that meta-analysis did not assess the efficacy of methylprednisolone alone versus other drugs in third molar removal [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Methylprednisolone Compared to Other Drugs for Pain, Swelling, and Trismus Control after Third Molar Surgery: A Meta-Analysis

González-Morelos¹,

Torre²,

Franco-González³

et al. 2022

Healthcare

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The purpose of this systematic review and meta-analysis was to assess the efficacy of methylprednisolone compared to other drugs to control postoperative complications following third molar surgery. PubMed and Google Scholar were used for article searching. Thereafter, the trials meeting the selection criteria and with high methodological quality, according to the Cochrane Collaboration’s risk of bias tool, were included in this study. The inverse variance test and mean difference using the Review Manager Software 5.3 for Windows were used to carry out data analysis. Qualitative analysis shows that methylprednisolone is more effective than NSAIDs, but inferior to dexamethasone, for controlling postoperative complications after third molar removal. The quantitative analysis showed no statistical difference for pain control, while trismus evaluation showed a statistical difference after 7 postoperative days in favor of methylprednisolone, when compared to other drugs. In conclusion, methylprednisolone was more effective for trismus control compared to other drugs after lower third molar surgery.

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“…However, there is a paucity of evidence on the influence of different routes of administration of other corticosteroid drugs on mandibular third molar surgeries. In a comprehensive review, Nagori et al ( 38 ) have demonstrated the MP administered via any route results in a reduction of early postoperative edema. However, no comparative analysis between SM and IV or IM routes could be carried out due to a lack of studies.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Submucosal With Intramuscular or Intravenous Administration of Dexamethasone for Third Molar Surgeries: A Systematic Review and Meta-Analysis

Hou¹,

Li²,

Liu³

2021

Front. Surg.

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Objective: The study aimed to review evidence on the efficacy of submucosal (SM) administration vs. intravenous (IV) or intramuscular (IM) route of injections of dexamethasone for improving outcomes after mandibular third molar surgery.Methods: PubMed, Embase, CENTRAL, and Google Scholar were searched for randomized controlled trials (RCTs) up to 20th May 2021. Early (2–3 days) and late (7 days) outcomes were compared between SM vs. IV or IM dexamethasone. Quality of evidence was assessed based on GRADE.Results: Thirteen trials were included in the systematic review and 10 in the meta-analysis. Meta-analysis indicated a significant reduction in early pain with IV dexamethasone but no such difference for late pain compared to the SM group. There was no difference in early and late swelling scores between the SM and IV groups. Pooled analysis indicated no significant difference in early and late trismus between SM and IV groups. Comparing SM with IM dexamethasone, there was no significant difference in early and late pain scores. Swelling in the early and late postoperative periods was not significantly different between the two groups. There was no significant difference in early and late trismus between SM and IM groups. The quality of evidence was low for all outcomes.Conclusion: Low-quality evidence suggests that SM infiltration of dexamethasone results in similar outcomes as compared to IV or IM administration of the drug after third molar surgeries. Further high-quality RCTs are needed to corroborate the current conclusions.

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Does methylprednisolone improve postoperative outcomes after mandibular third molar surgery? A systematic review and meta-analysis

Cited by 12 publications

References 48 publications

Efficacy of Preemptive Dexamethasone versus Methylprednisolone in the Management of Postoperative Discomfort and Pain after Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis

Efficacy of Preemptive Dexamethasone versus Methylprednisolone in the Management of Postoperative Discomfort and Pain after Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis

Efficacy of Methylprednisolone Compared to Other Drugs for Pain, Swelling, and Trismus Control after Third Molar Surgery: A Meta-Analysis

Comparison of Submucosal With Intramuscular or Intravenous Administration of Dexamethasone for Third Molar Surgeries: A Systematic Review and Meta-Analysis

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