Journal of Pharmaceutical Research International 32(28): 74-86, 2020; Article no.JPRI.59769 ISSN: 2456-9119 (Past name: British Journal of Pharmaceutical Research, Past ISSN: 2231-2919, NLM ID: 101631759) Comparison of Submucosal Injection of Dexamethasone and Triamcinolone Acetonide for Control of Postoperative Pain after Impacted Mandibular Third Molar Surgery- A Prospective Randomized Controlled Trial Yandeti Srinivasulu1, Abdul Wahab1 and P. Senthil Murugan1* 1Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, 162, Poonamallee High Road, Chennai 600077, Tamil Nadu, India. Authors’ contributions This work was carried out in collaboration among all authors. Author YS designed the study, performed the statistical analysis, wrote the protocol and wrote the first draft of the manuscript. Authors AW and PSM managed the analyses of the study. Author PSM managed the literature searches. All authors read and approved the final manuscript. Article Information DOI: 10.9734/JPRI/2020/v32i2830873 Editor(s): (1) Dr. Mohamed Salem Nasr Allah, Weill Cornell Medical College, Qatar. Reviewers: (1) Simone Regina Alves De Freitas Barros, Centro Universitário Tiradentes De Maceió, Brasil. (2) Tedi Purnama, Health Polytechnic of Jakarta I, Indonesia. (3) Edson Luiz Cetira Filho, Centro Universitário Christus (Unichristus), Brazil. (4) T. Habil Grigore, Popa University of Medicine and Pharmacy, Romania. Complete Peer review History: http://www.sdiarticle4.com/review-history/59769 Received 20 June 2020 Original Research Article Accepted 26 August 2020 Published 11 November 2020 ABSTRACT The aim of the study was to compare the efficacy of submucosal injection of dexamethasone and triamcinolone acetonide on postoperative pain, swelling, occurring after impacted mandibular third molar surgery. A total of 150 patients with asymptomatic, unilateral, impacted mandibular third molar, and without any systemic disease were included in this study. Patients were divided into three groups randomly, one group dexamethasone, and the second group triamcinolone acetonide third group placebo. Dexamethasone and triamcinolone acetonide were injected into submucosa at about 0.5 cm to 1 cm above the surgical area submucosally. Pain evaluation was performed by _____________________________________________________________________________________________________ *Corresponding author: E-mail: [email protected]; Srinivasulu et al.; JPRI, 32(28): 74-86, 2020; Article no.JPRI.59769 visual analog scale (VAS).There were statistically significant differences between the three groups on the different days of the postoperative period. The effect of triamcinolone acetonide works postoperatively and the effect of triamcinolone acetonide on trismus and pain was better than other groups. There was no significant difference between the effects of dexamethasone and triamcinolone acetonide regarding postoperative complications. The submucosal injection of dexamethasone and triamcinolone acetonide might be an effective treatment following impacted mandibular third molar surgery, and triamcinolone acetonide could be applied as an alternative to dexamethasone for reducing pain post operatively for impacted mandibular third molar surgery. Keywords: Dexamethasone; triamcinolone; mandibular; molar; synthetic steroids; maxillofacial surgery. 1. INTRODUCTION attempt to reduce the postoperative inflammatory response associated with lower third molar The common sequelae of mandibular third molar removal, with many published studies [6]. surgery are facial swelling, pain, and trismus, all of which arise as a result of tissue inflammation In 1965, Lingenerg employed dexamethasone, a due to surgical insult. These symptoms have synthetic adrenocortical steroid, to control been reported to severely affect patients’ quality swelling and reduce difficulty in mouth opening of life during the immediate postoperative period and pain after oral surgery. From that time [1]. onward, use of synthetic steroids in oral surgery became increasingly more popular as a function Impacted mandibular molars presents a common of their beneficial effects in the reduction of problem all over the world and its removal also postinflammatory signs and symptoms [7]. may lead to other complications like pain, swelling etc. which leads to researchers all over Several studies have investigated the influence the world to concentrate on further research. of systemic steroids administered before or after third molar removal with satisfactory results [8]. Because of their anti-inflammatory effects, corticosteroids have been widely tested to 2. MATERIALS AND METHODS counter these sequelae [2]. This idea began with an editorial in 1954, when Kenny suggested 2.1 Study Setting and Data Collection using corticosteroids to manage postoperative This is a Randomized controlled clinical sequelae of dentoalveolar surgery [3]. Before conducted in patients from June 2019 to March this, Stream and Horton and Spies et al. had 2020 who had reported to Saveetha Dental already used cortisone or hydrocortisone for the College for treatments of mandibular third molar treatment of oral diseases related to local causes impactions. Patients reporting to the Department and oral manifestations of inflammatory systemic of Oral and Maxillofacial Surgery with the disease with some success [4]. diagnosis of mandibular third molar impaction. A sample, which contains 150 patients, was Inflammation is crucial for the body’s defense as enrolled for the study and Sampling is done concerns tissue lesions, such as those using Block Randomization. associated with surgical interventions. This process includes release of inflammatory 2.2 Sampling mediators that result in vasodilation, increased vascular permeability, protein extravasation and The study population included patients who other tissue phenomena at the cellular level, underwent treatment for mandibular third molar which can cause swelling, pain, increased impaction and only Mesio Angular Impaction temperature, erythema and loss of function [5]. cases done at Saveetha Dental College by means of Systematic Sampling by Block Reduction of postoperative discomfort after third Randomization. molar removal is of interest for all oral and maxillofacial surgeons and their patients. Many 2.2.1 Inclusion criteria techniques are employed to reduce the Pain, swelling and trismus of third molar removal. Patients of all age groups and gender with Various drugs have been considered in the impacted mandibular third molars were included. 75 Srinivasulu et al.; JPRI, 32(28): 74-86, 2020; Article no.JPRI.59769 2.2.2 Exclusion criteria age group distribution, Figs. 7, 8 shows placebo gender and age group distribution. Patients with impacted teeth other than mandibular third molars, and common dental Triamcinolone has mean value of 4.08 and problems were excluded from the study. Other standard deviation of 1.209 [Table 1], exclusions are: dexamethasone has mean value of 4.86 and standard deviation of 1.129 [Table 1], placebo • Allergy has mean value of 4.90 and standard deviation • Pregnancy and breastfeeding of 1.161 [Table 1], Anova Statistical test seen in • Use of antibiotic or analgesic or anti Tables 2, 3. inflammatory drugs • taking any drug before the surgery. The removal of impacted third molars is one of the most frequently performed procedures in oral 2.3 Primary Assessment Parameter and maxillofacial surgery [9]. Extraction of impacted third molar involves trauma to the soft 2.3.1 Post-operative pain tissues and bony structures of the oral cavity resulting in pain and swelling [10]. A number of Patients were evaluated on 1st, 3rd, 5th and 7th studies have been conducted to evaluate the post-operative days and evaluated for Duplicate efficacy of corticosteroids in reducing the patient records and incomplete data were postsurgical sequelae experienced after oral excluded. Datas were reviewed by an external surgical procedures, particularly after the reviewer. Totally, n= 150 patients were included. removal of impacted third molar teeth and Demographic data such as the patient's age, impacted canine. gender were also recorded. These products rapidly found their way into the world of sports, in particular because of their 2.4 Data Analysis antiinflammatory properties [11]. Glucocorticoids are capable of suppressing the inflammatory The data obtained were tabulated in Microsoft process through numerous pathways. These anti Excel 2016 ( Microsoft office 10) and later inflammatory effects include inhibition of early exported to SPSS (Statistical Package for processes such as edema, fibrin deposition, Social Sciences) for Windows version 20.0, capillary dilatation, movement of phagocytes into SPSS Inc, Chicago IU, USA) and subjected to the area, and phagocytic activities. Later statistical analysis. One Way Anova test was processes, such as capillary production, collagen employed with a level of significance set at deposition, and keloid formation also are p<0.05. inhibited by corticosteroids [12]. 3. RESULTS AND DISCUSSION Dexamethasone is especially widely used in third molar surgical procedures for its anti There were statistically significant differences inflammatory action, and various doses of between the three groups on the different days of dexamethasone have been used in most of the the postoperative period. The effect of previous studies [13]. triamcinolone acetonide on pain