Corticosteroids reduce postoperative morbidity after third molar surgery: a systematic review and meta-analysis.
OBJECTIVE
The purpose of this study was to apply meta-analytical methods to measure the effect of corticosteroids (CS) on edema, trismus, and pain at early and late postoperative periods after third molar (M3) removal.


METHODS
A systematic search of the literature was carried out to identify eligible articles. The primary predictor variable was perioperative CS exposure (yes or no). The 3 outcome variables were edema, trismus, and pain assessed during the early (1-3 days) and late (>3 days) postoperative time periods. Standardized mean differences (SMD) for edema and weighted mean differences (WMD) for trismus and pain were pooled across studies. Differences between the 2 treatment groups were assessed using random effects models and metaregressions for both early and late postoperative assessments.


RESULTS
Twelve trials met the inclusion criteria. Subjects receiving CS had significantly less edema during both early (SMD, 1.4; 95% confidence interval [CI], 0.6, 2.2; P < .001) and late (SMD, 1.1; 95% CI, 0.1, 2.0; P = .03) time periods after surgery and less trismus than controls during the early and late postoperative periods (early WMD, 4.1 mm; 95% CI, 2.8 mm, 5.5 mm; P < .001; late WMD, 2.7 mm; 95% CI, 0.8 mm, 4.6 mm; P = .005). Average pain levels were not significantly different between the 2 groups (early WMD, 0.4 visual analog scale [VAS]; 95% CI, -0.04 VAS, 0.9 VAS; P = .07; late WMD, 0.5 VAS; 95% CI, -0.6 VAS, 1.5 VAS; P = .4).


CONCLUSIONS
The findings of this study suggest that perioperative administration of corticosteroids produces a mild to moderate reduction in edema and improvement in range of motion after M3 removal.
Markiewicz
Michael R
MR
Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Portland, OR 97239, USA. michaelmarkiewicz@gmail.com
Brady
Mark F
MF
Ding
Eric L
EL
Dodson
Thomas B
TB
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D004487:Edema / Q000209:etiology / Q000517:prevention & control*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008334:Mandible; D008437:Maxilla; D008964:Molar, Third / Q000601:surgery*; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011246:Pregnadienetriols / Q000627:therapeutic use; D016059:Range of Motion, Articular / Q000187:drug effects; D014081:Tooth Extraction / Q000009:adverse effects*; D014313:Trismus / Q000209:etiology / Q000517:prevention & control*
D000305:Adrenal Cortex Hormones; D005938:Glucocorticoids; D011246:Pregnadienetriols