PDF(Pubmed)
Abstract：
Mandibular third-molar extraction is a frequently executed minor oral surgical procedure, with a subsequent recovery period lasting several days. Typically, preemptive administration of non-steroid anti-inflammatory drugs (NSAIDs) and steroids has been employed, resulting in a notable decrease in postoperative complications like pain, facial swelling, trismus, and alveolar osteitis. This systematic review\'s primary goal was to investigate the efficacy of preemptive analgesia with dexamethasone and diclofenac in minimizing the post-surgical complications following the surgical extraction of the mandibular third molars. The systematic search was carried out to identify relevant literature in digital databases including PubMed®, Cochrane Library, Web of Science, and Scopus, from January 1990 to January 2022. The search used specific keywords. The randomized clinical trials assessing the efficacy of dexamethasone and diclofenac or dexamethasone alone compared to diclofenac or placebo as preemptive analgesics were considered inclusion criteria for this systematic review. Case reports, literature reviews, letters to the editor, and non-English publications were not included. Two authors screened the titles and abstracts, and articles fulfilling the study criteria were included. After reading the full text and data collection, analysis was performed. The included article\'s bias was evaluated by the Risk of Bias 2 (RoB 2) tool. A digital database search yielded a total of 207 articles. After excluding duplicates and articles written in languages other than English, 90 were removed. Based on the title and abstract, out of 177, 95 studies were excluded. After full-text reading of 22 articles, 17 were eliminated because they did not meet the inclusion and exclusion criteria. The remaining five studies were found eligible and included in the systematic review. Four studies were of low risk, while one study had some concerns. Two studies evaluated the combination of dexamethasone with diclofenac, while three evaluated dexamethasone alone. Total samples included samples of 436 third-molar surgeries in 420 patients. There was a substantial decrease in the mean pain score and swelling measurement when diclofenac alone was compared with coadministration of diclofenac and dexamethasone. Preemptive administration of dexamethasone and diclofenac has been shown to effectively reduce pain and facial swelling, with the exception of trismus, in third-molar surgeries when compared to diclofenac alone. As a result, it is recommended to administer these drugs prior to the commencement of third-molar extraction. However, further research is mandatory, specifically good quality randomized controlled trials involving large cohorts, in order to assess any significant variations and validate these findings.
摘要：
下颌第三磨牙拔除是一种经常执行的小型口腔外科手术，随后的恢复期持续了几天。通常,非甾体抗炎药（NSAIDs）和类固醇的抢先给药已被采用，导致术后并发症如疼痛的显著减少，面部肿胀,刺耳,和牙槽骨炎.本系统评价的主要目的是研究地塞米松和双氯芬酸超前镇痛在减少下颌第三磨牙手术拔除术后并发症中的作用。进行了系统的搜索，以识别数字数据库中的相关文献，包括PubMed®，科克伦图书馆,WebofScience,还有Scopus,从1990年1月到2022年1月。搜索使用特定的关键字。评估地塞米松和双氯芬酸或单独地塞米松与双氯芬酸或安慰剂作为先发镇痛药的疗效的随机临床试验被认为是该系统评价的纳入标准。病例报告,文献综述，给编辑的信，非英文出版物不包括在内。两位作者筛选了标题和摘要，并纳入符合研究标准的文章.在阅读全文和数据收集之后，进行了分析。纳入文章的偏倚通过风险偏倚2（RoB2）工具进行评估。数字数据库搜索共产生207篇文章。在排除以英语以外的语言编写的副本和文章后，90人被删除根据标题和摘要，177,95项研究被排除.全文阅读22篇文章后，17人被淘汰，因为他们不符合纳入和排除标准。其余5项研究被认为是合格的，并纳入系统评价。四项研究是低风险的，虽然一项研究有一些担忧。两项研究评估了地塞米松与双氯芬酸的组合，而三人单独评估地塞米松。总样本包括420例患者的436例第三磨牙手术的样本。当双氯芬酸单独与双氯芬酸和地塞米松共同给药时，平均疼痛评分和肿胀测量值显着降低。预先给药地塞米松和双氯芬酸已被证明可以有效减轻疼痛和面部肿胀，除了三联子,与单用双氯芬酸相比，在第三磨牙手术中。因此,建议在第三磨牙提取开始之前施用这些药物。然而,进一步的研究是强制性的，特别是涉及大型队列的高质量随机对照试验，为了评估任何重大变化并验证这些发现。
