The Effectiveness of Corticosteroid Use in Reducing Postoperative Sequelae After Impacted Third Molar Removal: A Systematic Review and Meta-analysis
DOI:
https://doi.org/10.54361/LJMR.20.2.51Keywords:
corticosteroid, dexamethasone, methylprednisolone, third molar, wisdom tooth, pain, swelling, trismus, meta-analysisAbstract
Background: Surgical removal of impacted third molars is one of the most common procedures in oral surgery, often associated with postoperative sequelae including pain, swelling, and trismus. Corticosteroids have been widely used to minimize these complications, but there is no consensus regarding the optimal type, dosage, timing, or route of administration. This systematic review and meta-analysis aimed to evaluate the effectiveness of corticosteroids in reducing postoperative sequelae after impacted third molar removal. Methods: A comprehensive literature search was conducted in PubMed, Scopus, and other electronic databases for randomized controlled trials comparing corticosteroid use with placebo or alternative treatments in patients undergoing impacted third molar removal. The primary outcomes were pain, swelling, and trismus. Random-effects meta-analysis was performed to calculate pooled standardized mean differences (SMD) with 95% confidence intervals (CI),Results: Eight randomized controlled trials with a total of 498 patients were included in the meta-analysis. Corticosteroid use significantly reduced postoperative pain (SMD:-0.80; 95% CI: -0.98 to -0.62; p < 0.001), swelling (SMD: -0.97; 95% CI: -1.15 to -0.80; p <0.001), and trismus (SMD: -0.76; 95% CI: -0.93 to -0.58; p < 0.001) compared to control interventions. Heterogeneity was minimal across all outcomes (I² = 0.0%). Subgroup analyses suggested that dexamethasone and methylprednisolone were both effective, with dexamethasone showing slightly superior results. The submucosal route of administration demonstrated advantages in terms of clinical efficacy and patient convenience. Conclusions: Corticosteroids are effective in reducing pain, swelling, and trismus after impacted third molar removal. Preoperative administration appears to provide optimal benefits. Dexamethasone administered submucosally at a dose of 8 mg showed the most favorable outcomes. These findings support the routine use of corticosteroids in third molar surgery to improve patient comfort and quality of life during the postoperative period.
Downloads
References
1. Bui CH, Seldin EB, Dodson TB. Types, frequencies, and risk factors for complications after third molar extraction. J Oral Maxillofac Surg. 2003;61(12): 1379-1389.
2. Osunde OD, Adebola RA, Omeje UK. Management of inflammatory complications in third molar surgery: a review of the literature. Afr Health Sci. 2011;11(3):530-537.
3. Sortino F, Cicciù M. Strategies used to inhibit postoperative swelling following removal of impacted lower third molar. Dent Res J (Isfahan). 2011;8(4):162-171.
4. Renton T, Smeeton N, McGurk M. Factors predictive of difficulty of mandibular third molar surgery. Br Dent J. 2001;190(11):607-610.
5. Kim K, Brar P, Jakubowski J, Kaltman S, Lopez E. The use of corticosteroids and nonsteroidal antiinflammatory medication for the management of pain and inflammation after third molar surgery: a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107(5):630-640.
6. Yuasa H, Sugiura M. Clinical postoperative findings after removal of impacted mandibular third molars: prediction of postoperative facial swelling and pain based on preoperative variables. Br J Oral Maxillofac Surg. 2004;42(3):209-214.
7. Herrera-Briones FJ, Prados Sánchez E, Reyes Botella C, Vallecillo Capilla M. Update on the use of corticosteroids in third molar surgery: systematic review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116(5):e342-e351.
8. Dionne RA, Gordon SM, Rowan J, Kent A, Brahim JS. Dexamethasone suppresses peripheral prostanoid levels without analgesia in a clinical model of acute inflammation. J Oral Maxillofac Surg. 2003;61(9):997-1003.
9. Alexander RE, Throndson RR. A review of perioperative corticosteroid use in dentoalveolar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90(4):406-415.
10. Ngeow WC, Lim D. Do Corticosteroids Still Have a Role in the Management of Third Molar Surgery? Adv Ther. 2016;33(7):1105-1139.
11. Troiano G, Laino L, Cicciù M, et al. Comparison of Two Routes of Administration of Dexamethasone to Reduce the Postoperative Sequelae After Third Molar Surgery: A Systematic Review and Meta-Analysis. Open Dent J. 2018;12:181-188.
12. Dan AE, Thygesen TH, Pinholt EM. Corticosteroid administration in oral and orthognathic surgery: a systematic review of the literature and meta-analysis. J Oral Maxillofac Surg. 2010;68(9):2207-2220.
13. Markiewicz MR, Brady MF, Ding EL, Dodson TB. Corticosteroids reduce postoperative morbidity after third molar surgery: a systematic review and meta-analysis. J Oral Maxillofac Surg. 2008;66(9):1881-1894.
14. Almeida RA, Lemos CA, de Moraes SL, Pellizzer EP, Vasconcelos BC. Efficacy of corticosteroids versus placebo in impacted third molar surgery: systematic review and meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg. 2019;48(1):118-131.
15. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
16. Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.
17. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557-560.
18. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629-634.
19. Fernandes IA, de Souza GM, Pinheiro MLP, Falci SGM. Is a single dose of dexamethasone effective in reducing postoperative pain and swelling in third molar surgeries? A systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2022;51(2):190-201.
20. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.
21. Gersema L, Baker K. Use of corticosteroids in oral surgery. J Oral Maxillofac Surg. 1992;50(3):270-277.
22. Majid OW, Mahmood WK. Effect of submucosal and intramuscular dexamethasone on postoperative sequelae after third molar surgery: comparative study. Br J Oral Maxillofac Surg. 2011;49(8):647-652.
23. Kissin I. Preemptive analgesia. Anesthesiology. 2000;93(4):1138-1143.
24. Pochapski MT, Santos FA, de Andrade ED, Sydney GB. Effect of pretreatment dexamethasone on postendodontic pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(5):790-795.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Eman. H ALaqeeli, Ahmed. S. Mikael2 , Nagat Bubteina, Haytham A.K Qadafi, Mahmoud A abdoulGawy, Emna Hidoussi, Sana Mahroos Al-Shammari (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Open Access Policy
Libyan journal of medical Research (LJMR).is an open journal, therefore there are no fees required for downloading any publication from the journal website by authors, readers, and institution.
The journal applies the license of CC BY (a Creative Commons Attribution 4.0 International license). This license allows authors to keep ownership f the copyright of their papers. But this license permits any user to download , print out, extract, reuse, archive, and distribute the article, so long as appropriate credit is given to the authors and the source of the work.
The license ensures that the article will be available as widely as possible and that the article can be included in any scientific archive.
Editorial Policy
The publication of an article in a peer reviewed journal is an essential model for Libyan journal of medical Research (LJMR). It is necessary to agree upon standards of expected ethical behavior for all parties involved in the act of publishing: the author, the journal editorial, the peer reviewer and the publisher.
Any manuscript or substantial parts of it, submitted to the journal must not be under consideration by any other journal. In general, the manuscript should not have already been published in any journal or other citable form, although it may have been deposited on a preprint server. Authors are required to ensure that no material submitted as part of a manuscript infringes existing copyrights, or the rights of a third party.
Authorship Policy
The manuscript authorship should be limited to those who have made a significant contribution and intellectual input to the research submitted to the journal, including design, performance, interpretation of the reported study, and writing the manuscript. All those who have made significant contributions should be listed as co-authors.
Others who have participated in certain substantive aspects of the manuscript but without intellectual input should only be recognized in the acknowledgements section of the manuscript. Also, one of the authors should be selected as the corresponding author to communicate with the journal and approve the final version of the manuscript for publication in the LJMR.
Peer-review Policy
- All the manuscripts submitted to LJMR will be subjected to the double-blinded peer-review process;
- The manuscript will be reviewed by two suitable experts in the respective subject area.
- Reports of all the reviewers will be considered while deciding on acceptance/revision or rejection of a manuscript.
- Editor-In-Chief will make the final decision, based on the reviewer’s comments.
- Editor-In-Chief can ask one or more advisory board members for their suggestions upon a manuscript, before making the final decision.
- Associate editor and review editors provide administrative support to maintain the integrity of the peer-review process.
- In case, authors challenge the editor’s negative decision with suitable arguments, the manuscript can be sent to one more reviewer and the final decision will be made based upon his recommendations.
https://portal.issn.org/resource/ISSN/2413-6069
