Periapical Microsurgery: The Effects of Locally Injected Dexamethasone on Pain, Swelling, Bruising, and Wound Healing.
BACKGROUND
The purpose of this prospective, double-blind, randomized clinical trial was to evaluate the postoperative healing of endodontic periapical microsurgery after local administration of dexamethasone.


METHODS
Sixty patients were divided into 2 groups. The dexamethasone group received a single local submucosal injection of 4 mg dexamethasone, and the placebo group received a submucosal injection of saline solution at the conclusion of standardized periapical microsurgery. Acetaminophen and hydrocodone/acetaminophen were prescribed for pain relief. A Likert-like 6-point scale was used for self-evaluation of pain, bruising, swelling, and wound healing at 24, 48, 72, 96 hours and at 1 week. The number of tablets taken was registered. Data were analyzed using the chi-square and Fisher exact tests at a significance level of P < .05.


RESULTS
No improvements in pain, bruising, and wound healing were registered at any time interval. No difference was found in the number of tablets taken for pain relief. Subjects who received the dexamethasone injection reported less swelling 24 hours after periapical microsurgery (P < .05) but showed no significant benefit for the longer follow-up periods.


CONCLUSIONS
This study shows that a 4-mg dose of dexamethasone administered through a local submucosal injection after periapical microsurgery has minimal impact on pain, bruising, and apparent wound healing at any time over a 7-day interval, and the impact on swelling seems limited.
Department of Endodontics, University of North Carolina School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Elena
E
Kan
Department of Endodontics, University of North Carolina School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Marcelo Santos
MS
Coelho
Department of Periodontology, University of North Carolina School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Jonathan
J
Reside
Department of Endodontics, University of North Carolina School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Steven J
SJ
Card
Department of Endodontics, University of North Carolina School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: pzt@unc.edu.
Peter Z
PZ
Tawil
D000082:Acetaminophen / Q000008:administration & dosage; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000772:Anesthesia, Local / Q000379:methods; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001047:Apicoectomy; D003288:Contusions / Q000517:prevention & control*; D003907:Dexamethasone / Q000008:administration & dosage*; D004311:Double-Blind Method; D004338:Drug Combinations; D004487:Edema / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006853:Hydrocodone / Q000008:administration & dosage; D007249:Inflammation / Q000517:prevention & control; D008297:Male; D008866:Microsurgery / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control*; D010486:Periapical Tissue / Q000601:surgery*; D011446:Prospective Studies; D014945:Wound Healing / Q000187:drug effects*
D000305:Adrenal Cortex Hormones; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000893:Anti-Inflammatory Agents; D004338:Drug Combinations; C083640:acetaminophen, hydrocodone drug combination; D000082:Acetaminophen; D006853:Hydrocodone; D003907:Dexamethasone
Apicoectomy; corticosteroids; dexamethasone; endodontic microsurgery; inflammation