title: Effects of intra-space injection of Twin mix versus intraoral-submucosal, intramuscular, intravenous and per-oral administration of dexamethasone on post-operative sequelae after mandibular impacted third molar surgery: a preliminary clinical comparative study.
abstract: BACKGROUND
  A prospective randomised double-blind study was undertaken to compare the effects of intra-space injection of 'Twin mix' versus intraoral-submucosal, intramuscular, intravenous and per-oral administration of dexamethasone on post-operative sequelae after mandibular impacted third molar surgery.
  
  
  METHODS
  A randomised double-blind clinical trial was conducted on 60 patients with class II position B impaction of mandibular third molars. Sixty transalveolar extractions were performed prospectively with ten patients randomly allocated to each of the six study groups (group T: intra-space injection of Twin mix; group S: submucosal dexamethasone; group M: intramuscular dexamethasone; group V: intravenous dexamethasone; group O: per-oral dexamethasone; group C: control group, no dexamethasone). A ten-point visual analogue scale was used to assess the overall pain intensity/patient discomfort, and specific facial measurements were recorded to assess the post-operative facial swelling. Maximal mouth opening was compared pre and post-operatively to assess the trismus.
  
  
  RESULTS
  Mean operative visual analogue scale scores did not show statistical variation, and post-operative visual scores indicated better patient comfort in the steroid groups with statistically significant difference between group T and the control group on the first, third and the seventh post-operative day. Mean increase in distances between tragus and soft tissue menton to assess facial swelling showed strong statistically significant difference between the first and the third post-operative day between the control group and group T (p value <0.0001). Association of trismus was found less with the steroid treatment groups when compared to the control group.
  
  
  CONCLUSIONS
  Steroid groups had a better clinical outcome with improved quality of life post-operatively when compared to the nonsteroid study group. Intra-space injection of dexamethasone in pterigomandibular space as Twin mix was found to have similar clinical effects as conventional methods of administering steroids via intraoral-submucosal, intramuscular, intravenous and per-oral routes. This, however, is a small study which would now benefit from larger numbers.
authors.affiliation: Department of Oral and Maxillofacial Surgery, People's College of Dental Sciences & Research Center, People's Campus, Bhanpur, Bhopal 462037, Madhya Pradesh, India, emaildarpan@gmail.com.
authors.forename: Darpan
authors.initials: D
authors.lastname: Bhargava
authors.forename: K
authors.initials: K
authors.lastname: Sreekumar
authors.forename: Ashwini
authors.initials: A
authors.lastname: Deshpande
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D003907:Dexamethasone / Q000008:administration & dosage*; D004311:Double-Blind Method; D004487:Edema / Q000517:prevention & control; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D007273:Injections, Intramuscular; D007275:Injections, Intravenous; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008334:Mandible / Q000601:surgery; D008964:Molar, Third / Q000601:surgery*; D009061:Mouth Mucosa; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D014081:Tooth Extraction / Q000379:methods; D014095:Tooth, Impacted / Q000601:surgery*; D014313:Trismus / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D003907:Dexamethasone; D008012:Lidocaine