Effectiveness of three different local routes of dexamethasone administration on postoperative sequelae following mandibular third molar surgery. A prospective randomised single-blind clinical study

Abstract

Objective: The aim of this study was to provide evidence for comparing the effectiveness of three different routes
of local administration of Dexamethasone on the postoperative pain, edema and trismus following surgical removal
of impacted mandibular third molar. Material and Methods: Forty-five patients underwent surgical removal of
impacted lower third molars and were randomly allocated postoperatively into 3 groups: 8 mg of dexamethasone
injected into the submucosa of the vestibule near the surgical site (group I), 8 mg of dexamethasone injected into
the pterygomandibular space (group II) and 10 mg of dexamethasone powder applied to the extraction site, after
bleeding control (group III). Facial swelling and maximal interincisal opening were measured at preoperatively.
Pain was measured by the patient response to a visual analogue scale. Pain perception, Facial edema and trismus
were evaluated for one week postoperatively. Results: There was no significant difference between the three
groups concerning pain after 1, 2, 5, 7 days of follow up. However, group II showed less pain at 3 and 4 days.
The difference between edema measurements was not significant in the three groups at 1, 5, 7 days, though in
group I and II edema subsided from day 2. As for trismus, group I and III showed statistically significant lower
maximum interincisal opening measurement than group II after two days. Conclusion: Local administration
of Dexamethasone through three different routes is beneficial in decreasing postoperative sequelae following
third molar surgery. Pterygomandibular space injection of Dexamethasone resulted in earlier resolution of pain,
and less facial edema and trismus at the second postoperative day compared to the submucosal injection and
transalveolar application. However, at one week the difference in measurements of the three variables between
the groups was not significant.
KEYWORDS
Dexamethasone; Local routes of administration; Mandibular third molar; Surgery.