Abstract
Objective
The purpose of this study was to compare two different groups of drugs, aprotinin and dexamethasone for its efficacy in reducing post operative swelling and pain after third molar surgery.
Methods
Fifty consecutive patients requiring surgical removal of single mandibular third molar (class II position B) under local anesthesia were randomly divided into two groups, each group consisting of 25 patients. One group was administered 8 mg dexamethasone through intravenous route pre-operatively. The other group received 1 ml of Aprotinin through submucosal route in operating area after the onset of local anesthesia. Swelling was assessed by measuring facial contours at baseline and at 1st, 3rd and 7th post-operative days. Pain was measured on the 1st, 3rd and 7th post-operative days using visual analog scale. Based on statistical analysis (paired t test and Wilcoxon’s signed ranking test), the results showed statistically significant difference in post operative swelling and pain on 3rd postoperative day in dexamethasone group as compared to aprotinin group.
Results
The results of present study showed a similar reduction in the severity of pain and swelling at the aprotinin and dexamethasone sites on 1st and 7th postoperative day. It was also noticed that the aprotinin promoted a greater reduction of swelling and pain on 3rd postoperative day.
Conclusion
It appeared that, benefits of aprotinin against the risks of dexamethasone and its efficacy in controlling pain and swelling after third molar surgery makes aprotinin to be a valuable alternative to dexamethasone.
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References
Cameron JW (1980) An investigation into some of the factors concerned in the surgical removal of the impacted lower wisdom tooth, including a double blind trial of chymoral. Br J Oral Maxillofac Surg 18:112–124
Elhag M, Coghlan K, Christmas P, Harris M (1985) The anti-inflammatory effects of dexamethasone and therapeutic ultrasound in oral surgery. Br J Oral Maxillofac Surg 23:17–23
Linnenberg WB (1965) The clinical evaluation of dexamethasone in oral surgery. Oral Surg Oral Med Oral Pathol 20:6–28
Messer EJ, Keller JJ (1975) The use of intraoral dexamethasone after extraction of mandibular third molars. J Oral Surg 40:594–598
Tripathi KD (2004) Essentials of medical pharmacology, 4th edn. Jaypee Brothers, New Delhi, p 261
Asimakopoulos G, Thompson R, Nourshargh S, Lidington EA, Mason JC, Ratnatunga CP, Haskard DO, Taylor KM, Landis RC (2000) An anti-inflammatory property of aprotinin detected at the level of leukocyte extravasation. J Thorac Cardiovasc Surg 120:361–369
Alexander RE, Throndson RR (2000) A review of preoperative corticosteroid use in dentoalveolar surgery. Oral Surg Oral Med Oral Path Oral Radiol Endod 90:406–415
Brenan PA, Gariner GT, McHugh J (1991) A double blind clinical trial to assess the value of aprotinin in third molar surgery. Br J Oral Maxillofac Surg 29:176–179
Schultze-Mosgau S, Schmelzeisen R, Frölich JC, Schmele H, Heargraves KM (1995) Use of ibuprofen and methylprednisolone for the prevention of pain and swelling after removal of impacted third molars. J Oral Maxillofac Surg 53:2–8
Neupert EA III, Lee JW, Phillput GB, Gordon JR (1992) Evaluation of dexamethasone for reduction of post-surgical sequelae of third molar removal. J Oral Maxillofac Surg 50:1177–1182
Fleuchaus PT (1956) Effect of hyaluronidase on swelling and trismus after removal of impacted mandibular third molar teeth. Oral Med Oral Surg Oral Pathol 9(5):493–500
Neogi SD, Malhotra R, Kumar V (2008) Pain: assessment and measurement. Orthop Today 10(1):14–20
Sisk AL, Bonnington GJ (1985) Evaluation of methylprednisolone and flurbiprofen for inhibition of the post operative inflammatory response. Oral Surg 60:137–145
Mason DA (1972) Steroid-induced myopathy and diabetes. Oral Surg 33:533–536
Szmyd L, Colonel L, Shannon IL, Hester WR, Colonel L, Stumpf A (1964) Subjective and objective measurement of responses to third molar impaction surgery. Oral Surg Oral Med Oral Pathol 17:257–262
Fenton CF, Stepp SA (1985) Post-operative intravenous dexamethasone administration. A preliminary investigation. J Oral Surg 24:142
Claman HM (1982) Glucocorticosteroids II: the clinical responses. Hosp Pract 18:143
Axebrod L (1976) Glucocorticoid therapy. Medicine 55:39
Gilman AG, Rall TW, Nies AS (1990) The pharmacological basis of therapeutics, 8th edn. Macmillan, New York, p 1436
Menleman J, Katz P (1984) The immunologic effects, kinetics on use of glucocorticoids. Med Clin N Am 69:89
Metz SA (1981) Anti-inflammatory agents as inhibitors of prostaglandin synthesis in man. Med Clin N Am 65:71
Flower RJ, Blackwell GJ (1979) Anti-inflammatory steroids induce biosynthesis of a phospholipase, A2 inhibitor which prevents prostaglandin generation. Nature 278:456
Dollery C (1999) Aprotinin. In: Therapeutic drugs, 2nd edn. Churchill Livingstone, London, p 200
Kaddoum RN, Chidiac EJ, Zestos MM, Rajan SD, Baraka A (2007) An anaphylactic reaction after primary exposure to an aprotinin test dose in a child with a severe milk allergy. J Cardiothorac Vasc Anesth 21(2):243–244
Milano CA, Patel VA, Smith PK, Smith MS (2002) Risk of anaphylaxis from aprotinin re-exposure during LVAD removal and heart transplantation. J Heart Lung Transplant 21:1127–1130
Seymour RA, Walton JG (1984) Pain control after third molar surgery. Int J Oral Surg 13:457–485
Montgomery MT, Hogg JP, Roberts DL, Redding SW (1990) The use of glucocorticosteroids to lessen the inflammatory sequelae following third molar surgery. J Oral Maxillofac Surg 48:179–187
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Arakeri, G., Rai, K.K., Shivakumar, H.R. et al. A Randomized Clinical Trial to Compare the Efficacy of Submucosal Aprotinin Injection and Intravenous Dexamethasone in Reducing Pain and Swelling After Third Molar Surgery: A Prospective Study. J. Maxillofac. Oral Surg. 12, 73–79 (2013). https://doi.org/10.1007/s12663-012-0364-8
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DOI: https://doi.org/10.1007/s12663-012-0364-8