Corticosteroids reduce postoperative morbidity following third molar surgery: A meta-analysis

Objectives: The study's primary objective was to conduct a meta-analysis assessing the role of corticosteroids (CSs)in 3rd molar (M3) subjects. The primary analyses were comparing pooled mean differences for edema, trismus, and pain between subjects administered CSs and controls during the early (1-3 days) and late (>3 days) postoperative periods following M3 removal.

Methods: The investigators performed a systematic review of the literature to identify articles eligible for the planned meta-analysis. The primary predictor variable was perioperative CSs exposure (yes or no). The primary outcome variables were edema, trismus, and pain assessed during the early and late postoperative time periods. Standardized mean differences (SMD) for edema and weighted mean differences (WMD) for trismus and pain were pooled. Differences between treatment groups were assessed using random effects models and meta-regressions for both early and late postoperative assessments.

Results: Twelve trials met inclusion criteria for analysis. Subjects receiving CSs had significantly less edema than controls at both early (SMD 1.4; 95% CI 0.6, 2.2; p< 0.001) and late (SMD 1.1; 95% CI 0.1, 2.0; p=0.03) time periods following surgery. Subjects receiving CSs had significantly less trismus than controls at both early (WMD 4.1 mm; 95% CI 2.8 mm, 5.5 mm; p<0.001) and late (WMD 2.7 mm; 95% CI 0.8 mm, 4.6 mm; p=0.005) time periods following surgery. There were no statistically significant differences between the two groups in early and late postoperative periods for pain. The WMDs were 0.4 VAS (95% CI -0.04 VAS, 0.9 VAS; p=0.07) and 0.5 VAS (95% CI -0.6 VAS, 1.5 VAS; p= 0.4) for the early and late postoperative periods, respectively.

Conclusions: The findings of this study suggest that perioperative administration of corticosteroids produces a moderate, but statistically significant, reduction in edema and improvement in range of motion following M3 removal.