Comparison of the Effectiveness of Dexamethasone Injection into Two Different Sites in Preventing the Postoperative Complications after Mandibular Third Molar Surgery: A Randomized Clinical Trial

Background and Objectives: Extreme inflammation after the surgical removal of bony impacted teeth can result in complications which will reduce patient s quality of life. Corticosteroids are widely used to prevent this, but the recommendations are still empiric. This study aims to compare the effectiveness of injecting dexamethasone into the medial pterygoid and gluteal muscles in obviating postoperative complications of the said procedure. Materials and Methods: This parallel randomized clinical trial included 77 patients requiring surgical removal of a bony impacted mandibular third molar. Patients were randomly assigned to 3 groups ( dexamethasone free , dexamethasone injection into the gluteal , dexamethasone injection into the medial pterygoid ) and evaluated in terms of postoperative pain, swelling and general satisfaction by telephonic interview 48 hours and 7 days after the surgery and also in terms of changes in daily life function by telephonic interviewby on day 4 and 7 after surgery. The questionnaire s content validity was verified by two experienced surgeons. Findings: Compared with the dexamethasone free group, the two dexamethasone groups had significantly less postoperative pain, swelling and change in appearance 48 hours after the surgery. P-values for the following items was significant: Pain VAS at 48h (0.001), Swelling at 48h (0.001), General patient satisfaction within 48h (0.09), Chew foods (0.05), Mouth opening (0.006), Mouth smell (0.03) and Changed appearance (0.001). Conclusion: The results indicate that the effect of injecting dexamethasone into the medial pterygoid muscle in preventing postoperative pain, swelling and changes in appearance is comparable to that of dexamethasone injected into the gluteus muscle, while it also has benefits such as being convenient for the surgeon and the patient, better absorption in the thin lingual cortex of the mandibular ramus area (compared with the thick buccal cortex) and minimum gastrointestinal adverse effects (compared with oral administration).

Keywords:

Dexamethasone injection , third molar , impacted tooth , postoperative complications