Abstract

The purpose of this study was evaluation of the effects of the corticosteroid therapy for the prevention of post operative complications after the surgical removal of impacted molar teeth. This evalulation researchwas done on 100 patients in which mandibular last molar was impacted.4mg dexamethasone & 250mg of hydrocortisone were given intravenously in straight dose after completing the surgical procedure. There was considerable impact of these medicines for prevention of post operative complications like swelling ,edema , pain ,discomfort, ecchymosis, trismus. Patients were recalled on 1st, 3rd and 7th post operative days. The post operative complications due to open extraction of  third molars can be minimized by the use of steroids

Keywords: Corticosteroids, Surgical Extraction

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Introduction

An impactedthird molar tooth is defined the tooth which is unable to achieve its normal occlusal plane in its usual eruption time1. The different causes of impacted third molar tooth are adjacent teeth, over lying dense bone and excessive soft tissue. The most common cause is insufficient space and length in jaw which does not allow the tooth to erupt. The mandibular third molar is the most frequently impacted, followed by maxillary third molar, maxillary canine and mandibular premolars. The mandibular third molars are also called wisdom teeth because their normal eruption time is 17 To 21 years and this is the age ofadulthood. The oral surgeons classify the mandibular wisdom teeth to determine the difficulty index for their removal. According to angulation impacted lower third ++molar can be classified as: mesio-angular, horizontal, vertical, disto-angular buccal version, lingual version andtransverse2. Pell & Gregory and winter lines are the mostly used classifications for calculation of difficulty index before surgical extraction of these mandibular third molars.

Relationship to anterior border of ramus: - according to pell & Gregory class 1 mandibular third molar is anterior to the anterior border of ramus. Class 2 half of mandibular third molar is covered by the anterior border of ramus.class 3 the whole of mandibular third molar is lying in the bone of ramus.

Relationship to occlusal plane: -according to pell & Gregory class a occlusalplanes of impacted tooth & 2nd molar are at thesame level. Class b impacted tooth is betweenocclusal plane & cervical line of 2nd molar. Class cocclusal plane of impacted tooth is below cervical lineof 2nd molar.Impacted third molar is not good newsfor the patient and it becomes worse when it isexplained to the patient during counseling thatsurgical procedure is required for its removal. Thesequelae of surgical procedure may be swelling,edema, discomfort, pain, ecchymosis, trismus. Theprevention of these complications is challenging fororal and maxillofacial surgeons. This was the motivation and decisionwas taken to use steroids therapy so that these postoperative complications can be minimized.the modeof action of corticosteroids isalmost same. These stop the both cyclo-oxygenasepathways ' chemo taxis by starting the production oflipocortin 1, which inhibits phospholipase a 2. All thiscycle leads to decrease synthesis of prostaglandins &leukotrines 3. These medicines suppressed theimmune system by reducing the immunoglobulin andcomplement concentrations and affecting theantigen- antibody binding 4. The difference betweentwo is, hydrocortisone is short acting having half lifeof 6 to 8 hours while the dexamethasone is longacting and its half life is 36 to 54 hours.

Methodology

Sgt dental college, gurugram (hr), in the department of oral & maxillofacial surgery, hundred patients were evaluated in this study. All these patients were diagnosed cases of impacted lower third molar and healthy. Intra oral peri apical radiograph and orthopentomogram were done for pre- operative assessment.informed consent was taken from the patients after telling about the risks and benefits of the treatment. Inferior alveolar nerve lingual nerve long buccal nerve blocks were given. After confirmation of effectiveness of anesthesia, mucoperiosteal flaps were raised. The bone cutting alone or sectioning of tooth followed by bone cutting was done for the extraction of impacted tooth. Irrigation of wound and smoothing of sharp bone margins was done. Flaps were replaced and sutured with vicryl 3/0. On completion of surgical procedure 250mg hydrocortisone and 4 mg of dexamethasone were injected intravenously in straight dose. Cap. Amoxicillin and clavullinic acid 625 mg bd tab. Metronidazole 400 mg tds, tab. Ibroufen 600 mg bd, were prescribed to the patients for 5 days. Follow up of these patients was done on 1st, 3rd and 7th post operative days. The primary sutures were removed on 10th post operative day.

Results

Out of 100 patients 40 were females and 60 were males. There the mean age of these patients was 23.7, when they presented and most patients were in their third decade of life. The details of their ages as follow.8 - 17.7-18,3-19,6-20,8-21, 10-22, 10-23 ,18-24, 6-25, 7- 26, 2-28, 3-29, 2-30,1-31,3-32,2-34,2-35,1-36,1- 45.there was no effect on treatment regarding age. All patients were examined for post operative sequelae on 1st post operative day. Out of 100 patients, 74 had moderate pain, mild edema, swelling, trismus but no ecchymosis. These complications were relieved on 3rd post operative day and medicines were discontinued. These patients were in their usual state of health on 7th post operative day and sutures were removed. In remaining 26 patients, on 1st post operative day there was only minor pain. The swelling, edema, trismus or ecchymosis was not found in these patients. This minor pain was subsided on 3rd post operative day and medications were discontinued. On 7th post operative day, sutures were removed and these patients were in normal state of health.

Discussion

Oral surgeons of entire world people are working to develop a method by which post operative complications can be reduced after surgical extraction of mandibular third molar. Use of steroids is one of them. They might be used as are pre-operatively, per-operatively or immediate after operation. The route of their administration can be oral, submucosal, intramuscular or intravenous 5, 6. The use of glucocorticoid has been analyzed which shows dexamethasone is more effective as it has longer time of action and 25-30 times more potent than cortisol 7,8,9 . We have used the combination of corticosteroids to get better results and our study is proving it. The use of glucocorticoid in combination of antibiotics give good results for prevention of post operative complications in mandibular third molar impacted tooth surgery which is supporting our study 10 . The effects of glucocorticoid and ibuprofen was evaluated to prevent pain and swelling after removal impacted third molars and this is also same for study 11. The steroid has been injected in submucosal layer or in endoalvelar which has showed good effects for the prevention of inflammatory complications in last mandibular molar but we have given intravenously and get results 6.

Conclusion

The patients of third molar surgeries can be brought to their usual state of health earlier by

Giving the steroids intravenously in immediate post operative period and no adverse effects of these

Steroids were seen in our treated patients.

References

  1. Larry j. Peterson.contemporary oral & maxillofacial surgery: 2002.principles of management of impacted teeth; p. 185.
  2. Larry j. Peterson. Contemporary oral & maxillofacial surgery: 2002. Principles of management of impacted teeth; p. 193- 196.
  3. Goodman ls, Gilman ag.the pharmacological basis of therapeutics.11th ed.new York: McGraw -hill; 2005.
  4. Dionne ra, gordon sm, rowan j, kent a , brahim js. Dexamethasone suppresses peripheral prostanoid levels without analgesia in clinical model of acute inflammation. J oral maxillofac surg.2003; 61:997-1003.
  5. Grossi GB, maiorana c, giarramone ra, borgonovo a, beretta m, farronato d, ET al.effects of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: a prospective study. J oral maxillofac surg.2007; 65:2218-26.
  6. Tiwana ps, foy sp, shugars daet al. The impact of intravenous corticoster oids with third molar surgery in patients at high risk for delayed health-delated quality of life and clinical recovery. J oral maxillofac surg. 2005; 63:55-62.
  7. Pedersen a. Decadronphosphate in the relief of complaints after third molar surgery. Int j oral surg. 1985; 14:235-40.
  8. Kim k, brar p, jakubowski j, kaltman s, lopez e.the use of corticosteroids and non steroidal anti- inflammatory medications for the management of pain and inflammation after third molar surgery: a review of theliterature.oral surg oral med oral path oral radiol.2009;107:630-40.
  9. Neuppertea, leejw, philiutcb, gordonjr.evalution of dexamethazone for reduction of postsurgical sequleof third molarremoval. J.oral maxillofacial surg.1992; 50:1977-82.
  10. Moore pa ET al.dental therapeutic practice pattenrs in the u.s.ll.analgesics, corticosteroids and antibiotics.gen dent.2006 may-jun.
  11. 11.schultze-mosgau s,schmelzeisen r,frolich jc,schmele h.use of ibuprofen and methyldnisolone for the prevention of pain and swelling after removal of impacted third molars.j oral maxillofac surg.1995;53:2-7.