Submucosal Hydrocortisone versus Dexamethasone in Lower Third Molar Surgery

A Randomized Double-Blind Clinical Trial

نویسندگان

DOI::

https://doi.org/10.5195/d3000.2026.1536

کلمات کلیدی:

Third Molar, Dental Surgery, Clinical Trial

چکیده

A randomized, double-blind, controlled clinical trial was conducted in 30 patients undergoing impacted mandibular third molar surgery. The patients were split into three groups of 10 at random. Group A received a submucosal injection of hydrocortisone 50 mg in 1 mL, and following, the establishment of local anesthetic. Group B received a submucosal injection of dexamethasone 4 mg/mL. Group C (the placebo group) was given a submucosal injection of normal saline. Postoperative sequelae were assessed on the second and seventh days after surgery. Thirty patients were equally allocated to the hydrocortisone, dexamethasone, and placebo groups, comparable at baseline. Pain, facial swelling, and trismus improved significantly over time in all groups, but on days 2 and 7 outcomes were best with dexamethasone, intermediate with hydrocortisone, and worst with placebo (P < 0.001). Analgesic consumption was lowest with dexamethasone (50% required none) and highest with placebo (P = 0.034), and day 7 wound healing was significantly better with dexamethasone than with hydrocortisone or placebo (P < 0.001). Submucosal corticosteroids reduced postoperative pain, swelling, and trismus after impacted mandibular third molar surgery, with dexamethasone consistently more effective than hydrocortisone.

بیوگرافی نویسندگان

Lana Saeed Abdul Sada، Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Anbar, Ramadi, Iraq.

Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Anbar, Iraq. Postgraduate Student (M.Sc.).

Sabah Abdul Rasool Hammoodi، department of oral and maxillofacial surgery- college of dentistry- Anbar university-Iraq Maxillofacial surgeon in Alramadi teaching hospital- Anbar- Iraq

Asst. Prof. Sabah Abdul Rasool  Hammoodi

Department of oral and maxillofacial surgery- college of dentistry- Anbar University-Iraq

Maxillofacial surgeon in Al Ramadi teaching hospital- Anbar- Iraq

e-mail: den.sabah.abd@uoanbar.edu.iq

address: Al Jamaa district- Baghdad city- Iraq

مراجع

1. Ahmad NB. Effects of combinations of pre-operative submucosal methylprednisolone with different post-operative analgesic agents in pain control following surgical removal of impacted third molar [master's thesis]. Kuala Lumpur: University of Malaya; 2019.

2. Ahmed F, Baliga SD, Baliga SS, Rathi P, Jha G. Efficacy of hydrocortisone, povidone-iodine, and normal saline as an irrigating solution during surgical removal of impacted mandibular third molars: a randomized controlled trial. Cureus. 2024;16(2):e53370. doi:10.7759/cureus.53370.

3. Khalida B, Fazal M, Muntaha ST, Khan K. Effect of submucosal injection of dexamethasone on post-operative swelling and trismus following impacted mandibular third molar surgery. Pak Oral Dent J. 2017;37(2):231-4.

4. Canellas JVS, Ritto FG, Tiwana P. Comparative efficacy and safety of different corticosteroids to reduce inflammatory complications after mandibular third molar surgery: a systematic review and network meta-analysis. Br J Oral Maxillofac Surg. 2022;60(8):1035-43. doi: 10.1016/j.bjoms.2022.05.003.

5. Lim D, Ngeow WC. A comparative study on the efficacy of submucosal injection of dexamethasone versus methylprednisolone in reducing postoperative sequelae following third molar surgery. J Oral Maxillofac Surg. 2017;75(11):2278-86. doi:10.1016/j.joms.2017.05.033.

6. Moraschini V, Hidalgo R, Porto Barboza ES. Effect of submucosal injection of dexamethasone after third molar surgery: a meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg. 2016;45(2):232-40. doi:10.1016/j.ijom.2015.10.004.

7. Almeida RAC, Lemos CAA, Moraes SLD, Pellizzer EP, Vasconcelos BCE. 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):118-31. doi:10.1016/j.ijom.2018.05.023.

8. Arora SS, Phull T, Kumar I, Kumar A, Kumar N, Singh H. A comparative study of the effect of two dosages of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: a prospective randomized study. Oral Maxillofac Surg. 2018;22(2):225-30. doi:10.1007/s10006-018-0699-5.

9. Afreen S, Khan MZ, Parveen S, Priyadarshini I, Rehmani A, Shekokar GP. Hydrocortisone injection after mandibular impacted third molar surgical extraction: a comparative study. Afr J Biomed Res. 2024;27(Suppl 4):2101-12.

10. Vijayan A, Das JR, Gopinath A, Mahesh B. Use of corticosteroids in third molar surgery: review of literature. J Res Adv Dent. 2017;6(2):261-6.

11. Syed KB, AlQahtani FH, Mohammad AH, Abdullah IM, Qahtani HS, Hameed MS. Assessment of pain, swelling and trismus following impacted third molar surgery using injection dexamethasone submucosally: a prospective, randomized, crossover clinical study. J Int Oral Health. 2017;9(3):116-21. doi:10.4103/jioh.jioh_65_17.

12. Chugh A, Singh S, Mittal Y, Chugh V. Submucosal injection of dexamethasone and methylprednisolone for the control of postoperative sequelae after third molar surgery: randomized controlled trial. Int J Oral Maxillofac Surg. 2018;47(2):228-33.

13. Nils HJ, Arce Recatala C, Castano A, Ribas D, Flores-Fraile J. Efficacy and safety of the use of glucocorticoids in oral and maxillofacial surgery. Dent J (Basel). 2023;11(10):239.

14. Rodrigues VP, Deboni MCZ, Cecchetti MM, Ocaña RP, Frare JG, Araújo JGL, et al. Hydrocortisone irrigation for postoperative control of edema in inferior third molar removal: a pilot study. J Oral Maxillofac Surg Med Pathol. 2020;32(5):351-5. doi:10.1016/j.ajoms.2020.04.004.

15. Đorđević F, Bubalo M, Perić D, Mihailović Đ, Bukumirić Z, Dubovina D. Effectiveness of submucosal, oral, and intramuscular routes of dexamethasone administration in trismus, swelling, and pain reduction after third lower molar surgery. Vojnosanit Pregl. 2023;80(4):337-42. doi:10.2298/VSP220331062D.

16. Shah KL, Al Lbad AS, Al Anazi YM, Al Khalaf YA, Balto MM, et al. Comparison of therapeutic effects of 8 mg dexamethasone administered intramuscularly preoperatively versus postoperatively after surgical extraction of impacted mandibular third molars. J Dent Craniofac Res. 2018;3(2):9.

17. Otake H, Sato Y, Nakatani E, Hawke P, Takei S, Ogino A, et al. Oxytetracycline-hydrocortisone ointment reduces the occurrence of both dry socket and post-extraction pain after third molar extraction: an observational study. PLoS One. 2021;16(7):e0254221.

18. Hamzani Y, Chaushu G. Evaluation of early wound healing scales/indexes in oral surgery: a literature review. Clin Implant Dent Relat Res. 2018;20(4):103-10.

19. Vivek N, Thomas S, Prasannakumar GS, Nair BJ. Comparison of routes of administration of dexamethasone after third molar removal. J Adv Clin Res Insights. 2017;4(1):1-6.

20. Miroshnychenko A, Azab M, Ibrahim S, Roldan Y, Diaz Martinez JP, Tamilselvan D, et al. Corticosteroids for managing acute pain subsequent to surgical extraction of mandibular third molars: a systematic review and meta-analysis. J Am Dent Assoc. 2023;154(8):727-741.e10. doi:10.1016/j.adaj.2023.04.018.

21. Aljohani MH. The effect of dexamethasone sodium phosphate on surgical third molar extraction using pain, trismus, oedema, and quality of life as parameters: a comparative study. Open Dent J. 2024;18:e18742106354194. doi:10.2174/0118742106354194241107071240.

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چاپ شده

2026-08-18

شماره

دوره 14 شماره 2 (2026)

نوع مقاله

Adults & the Elderly

مجوز

حق نشر 2026 Lana Saeed Abdul Sada, Sabah Abdul Rasool Hammoodi

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