Freda Nicolas M, Keenan Analia Veitz
NYU College of Dentistry, New York, USA.
Evid Based Dent. 2016 Jun;17(2):58-9. doi: 10.1038/sj.ebd.6401174.
Data sourcesThe electronic databases searched included: PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (Central) and Web of Science until June 2015. There was no restriction to language and the reference lists from relevant studies were searched for further articles.Study selectionRandomised and prospective controlled trials that compared the effect of submucosal injection of dexamethasone with that of placebo after impacted third molar surgery in humans. Studies involving volunteers with decompensated metabolic disease were excluded.Data extraction and synthesisStudy selection, data extraction and quality assessment (risk of bias) were assessed by two reviewers. All disagreements were resolved through discussion. A meta-analysis was performed for all continuous variables (oedema, pain and trismus) when at least two of the studies analysed the same data type.ResultsEight studies involving a total of 476 patients of which six were included in the meta-analysis. All of the surgical procedures were performed on the lower molars, submucosal injections of dexamethasone were used in concentrations of 4 mg, 8 mg, or 10 mg, and saline was used as a control. Antibiotic medications were administered prophylactically before surgery or by continuous use after the procedure. Seven of the eight studies identified the impactions according to the Pell and Gregory Classification. Oedema was measured using facial contours of pre-established reference points. The meta-analysis presented a mean difference (MD) of -2.20 (95% CI -2.70 to -1.70), with a statistically significant difference favouring dexamethasone (P< 0.00001). Trismus (assessed using inter-incisal distance upon maximum opening) had a MD of -2.92 (95% CI -7.13 to 1.29) and showed no statistically significant difference between groups. Pain was assessed using both visual analogue scales and number of analgesic taken; however, only studies including a VAS were used for meta-analysis. Pain presented with a MD of -1.79 (95% CI -3.28 to -0.30) and showed a statistically significant difference favouring dexamethasone.ConclusionsThe review found moderate quality evidence that submucosal injections of dexamethasone reduced post-operative oedema and pain compared to a placebo following impacted third molar surgery. There was no significant difference, in regards to trismus, between placebo and dexamethasone.
数据来源
截至2015年6月的PubMed/MEDLINE、Cochrane对照试验中央注册库（Central）和科学网。对语言没有限制，并检索了相关研究的参考文献列表以查找更多文章。
研究选择
比较人类阻生第三磨牙手术后黏膜下注射地塞米松与安慰剂效果的随机和前瞻性对照试验。排除涉及失代偿性代谢疾病志愿者的研究。
数据提取与合成
由两名评审员进行研究选择、数据提取和质量评估（偏倚风险）。所有分歧均通过讨论解决。当至少两项研究分析相同数据类型时，对所有连续变量（水肿、疼痛和牙关紧闭）进行荟萃分析。
结果
八项研究共涉及476例患者，其中六项纳入荟萃分析。所有手术均在下颌磨牙进行，黏膜下注射地塞米松的浓度为4mg、8mg或10mg，使用生理盐水作为对照。术前预防性使用抗生素或术后持续使用抗生素。八项研究中有七项根据Pell和Gregory分类确定阻生情况。使用预先建立的参考点的面部轮廓测量水肿。荟萃分析显示平均差（MD）为-2.20（95%CI -2.70至-1.70），有利于地塞米松的差异具有统计学意义（P<0.00001）。牙关紧闭（使用最大开口时的切牙间距离评估）的MD为-2.92（95%CI -7.13至1.29），两组之间无统计学显著差异。使用视觉模拟量表和服用的止痛药物数量评估疼痛；然而，仅将包括视觉模拟量表的研究用于荟萃分析。疼痛的MD为-1.79（95%CI -3.28至-0.30），有利于地塞米松的差异具有统计学意义。
结论
该综述发现中等质量的证据表明，与安慰剂相比，阻生第三磨牙手术后黏膜下注射地塞米松可减轻术后水肿和疼痛。安慰剂和地塞米松在牙关紧闭方面无显著差异。
