The Effect of Dexamethasone Submucosal Injection After Surgical Extraction of Lower Impacted Third Molars on Trismus and Edema

NCT ID: NCT06953440

Last Updated: 2025-05-01

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE4

Total Enrollment

66 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-02-01

Study Completion Date

2025-06-30

Brief Summary

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This clinical trial aims to investigate whether dexamethasone decreases edema and trismus in adults undergoing lower third molar surgical extraction.

The main question it aims to answer is:

Does dexamethasone submucosal injection have a positive impact on trismus and edema after third molar surgery compared to conventional postoperative prescription?

Participants will:

* Be administered with dexamethasone submucosal injection or a placebo after the surgery.
* Visit the clinic three times the week after the extraction for follow-up.

Detailed Description

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Patients will be randomly allocated to the test group or the control group by an allocation sequence that is done by the statistician.

To ensure that the patient and OMFS resident are blinded in this study, the corticosteroid and placebo injections are of the same color and size, are stored in similar bottles, and are coded as drug 1 or drug 2. Additionally, they will be placed in sealed envelopes by a dental assistant.

The OMFS resident will withdraw an envelope randomly. The number is recorded in the patient file. Then, the drug will be administered in the buccal vestibule next to the site of extraction after surgery. Thus, the patient, surgeon, and the person responsible for the assessments of swelling and trismus are masked to the type of medication used during each surgical procedure. The drugs used in the different surgeries are only revealed after the acquisition and analysis of all data. Baseline and follow-up measurements will be measured by a standardized ruler. At the first visit, interincisal distance will be recorded to measure trismus. Distance from the angle of the mandible to the outer canthus of the eye, distance from the tragus of the ear to the corner of the mouth, and distance from the tragus of the ear to soft tissue pogonion will be recorded and their mean will be calculated to measure edema. Pell and Gregory classification of the tooth and impaction angulation will be recorded. Facial symmetry and whether the angle of the mandible is palpable or not will be recorded as well. The number of drug that was given to the patient will be recorded.

At the 2nd, 4th, and 7th visits, interincisal distance will be recorded to measure trismus. Distance from the angle of the mandible to the outer canthus of the eye, distance from the tragus of the ear to the corner of the mouth, and distance from the tragus of the ear to soft tissue pogonion will be recorded to measure edema. Facial symmetry and whether the angle of the mandible is palpable or not will be recorded. Whether the patient is able to interact socially or not. If not, was it due to edema, feeling sick, or bad mood. The patient's ability to work, the patient\'s ability to eat the food he is used to eating, and the presence of sleep impairment will be recorded as well.

Surgery will be done by calibrated OMFS residents. After the surgery, the surgeon will use the preassigned randomly picked envelope and administer it in the buccal vestibule next to the surgical site. Patients will be followed up in the 2nd, 4th, and 7th postoperative days.

Conditions

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Swelling/ Edema Trismus

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

There will be two groups. The test group will receive 4mg/1ml dexamethasone submucosal injection at the buccal vestibule next to the surgical site. The control group will receive 1 ml of normal saline injection in the buccal vestibule next to the surgical site.

The primary objective of this study is to compare mean change in trismus and mean edema between 2 independent groups.
Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

TRIPLE

Participants Caregivers Outcome Assessors
To ensure that the patient and OMFS resident were blinded in this study, the corticosteroid and placebo injections were of the same color and size, were stored in similar syringes, and were coded as drug 1 or drug 2. The OMFS resident received the syringe corresponding to the patient's random allocation prior to the beginning of the procedure. The number of the drug was recorded in the patient file. Then, the drug was administered in the buccal vestibule next to the site of extraction after surgery. Thus, the patient, surgeon, and the person responsible for the assessments of swelling and trismus were masked to the type of medication used during each surgical procedure. The drugs used in the different surgeries were only revealed after the acquisition and analysis of all data.

Study Groups

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Dexamethasone Group

Patient received 4 milligrams of dexamethasone

Group Type EXPERIMENTAL

Dexamethasone Sodium Phosphate Injection

Intervention Type DRUG

Patients will receive 4 milligrams of dexamethasone submucosal injection next to the extraction site.

Control Group

Patient received 4 milligrams of normal saline solution

Group Type PLACEBO_COMPARATOR

Normal Saline (Placebo)

Intervention Type OTHER

Patients will receive 4 milligrams of normal saline solution next to the extraction site.

Interventions

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Dexamethasone Sodium Phosphate Injection

Patients will receive 4 milligrams of dexamethasone submucosal injection next to the extraction site.

Intervention Type DRUG

Normal Saline (Placebo)

Patients will receive 4 milligrams of normal saline solution next to the extraction site.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Patients with impacted lower third molars requiring surgical extraction.
* Adults over the age of 18 years old.
* American Society of Anaesthesiologists (ASA) 1, and ASA 2

Exclusion Criteria

* Patients with preoperative intraoral or extraoral swelling.
* Patients requiring simple extraction (Class I group A according to Pell and ---Gregory classification).
* Patients with uncontrolled systemic disease such as uncontrolled diabetic - patients.
* Patients who are allergic to corticosteroids.
* Patients who are contraindicated to use corticosteroids such as uncontrolled diabetic patients, and osteoporotic patients.
* Patients who require extraction of additional teeth at the same visit.
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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King Abdulaziz University

OTHER

Sponsor Role lead

Responsible Party

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Lojain Bassyoni

Oral and Maxillofacial Surgery Consultant and Assistant Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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King Abdulaziz University, Faculty of Dentistry

Jeddah, Mecca Region, Saudi Arabia

Site Status RECRUITING

Countries

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Saudi Arabia

Central Contacts

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Lojain Bassyoni, BDS, MSc, FRCDC

Role: CONTACT

00966504623553

Razan Baabdullah, BDS, MSc, FRCDC

Role: CONTACT

00966555015167

Facility Contacts

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Lojain Bassyoni, BDS, MSc, FRCDC

Role: primary

00966504623553

References

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Hou C, Liu F, Liu C. Comparison of Submucosal With Intramuscular or Intravenous Administration of Dexamethasone for Third Molar Surgeries: A Systematic Review and Meta-Analysis. Front Surg. 2021 Aug 10;8:714950. doi: 10.3389/fsurg.2021.714950. eCollection 2021.

Reference Type BACKGROUND
PMID: 34447785 (View on PubMed)

Grossi GB, Maiorana C, Garramone RA, Borgonovo A, Beretta M, Farronato D, Santoro F. Effect of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: a prospective study. J Oral Maxillofac Surg. 2007 Nov;65(11):2218-26. doi: 10.1016/j.joms.2006.11.036.

Reference Type BACKGROUND
PMID: 17954317 (View on PubMed)

Wanithanont P, Chaiyasamut T, Vongsavan K, Bhattarai BP, Pairuchvej V, Kiattavorncharoen S, Wongsirichat N. Comparative efficiency of the preoperative pterygomandibular space injection of two doses of dexamethasone in mandibular third molar surgery. J Dent Anesth Pain Med. 2021 Feb;21(1):29-39. doi: 10.17245/jdapm.2021.21.1.29. Epub 2021 Jan 29.

Reference Type BACKGROUND
PMID: 33585682 (View on PubMed)

Warraich R, Faisal M, Rana M, Shaheen A, Gellrich NC, Rana M. Evaluation of postoperative discomfort following third molar surgery using submucosal dexamethasone - a randomized observer blind prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013 Jul;116(1):16-22. doi: 10.1016/j.oooo.2012.12.007. Epub 2013 Feb 28.

Reference Type BACKGROUND
PMID: 23453611 (View on PubMed)

Mojsa IM, Pokrowiecki R, Lipczynski K, Czerwonka D, Szczeklik K, Zaleska M. Effect of submucosal dexamethasone injection on postoperative pain, oedema, and trismus following mandibular third molar surgery: a prospective, randomized, double-blind clinical trial. Int J Oral Maxillofac Surg. 2017 Apr;46(4):524-530. doi: 10.1016/j.ijom.2016.11.006. Epub 2016 Dec 21.

Reference Type BACKGROUND
PMID: 28012633 (View on PubMed)

Parhizkar P, Schmidlin PR, Bornstein MM, Fakheran O. Can adjunctive corticosteroid therapy improve patient-centered outcomes following third molar surgery? A systematic review. Med Oral Patol Oral Cir Bucal. 2022 Sep 1;27(5):e410-e418. doi: 10.4317/medoral.25177.

Reference Type BACKGROUND
PMID: 35975802 (View on PubMed)

Moraschini V, Hidalgo R, Porto Barboza Ed. Effect of submucosal injection of dexamethasone after third molar surgery: a meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg. 2016 Feb;45(2):232-40. doi: 10.1016/j.ijom.2015.09.008. Epub 2015 Oct 14.

Reference Type BACKGROUND
PMID: 26458538 (View on PubMed)

Kiencalo A, Jamka-Kasprzyk M, Panas M, Wyszynska-Pawelec G. Analysis of complications after the removal of 339 third molars. Dent Med Probl. 2021 Jan-Mar;58(1):75-80. doi: 10.17219/dmp/127028.

Reference Type BACKGROUND
PMID: 33789003 (View on PubMed)

Aljafar A, Alibrahim H, Alahmed A, AbuAli A, Nazir M, Alakel A, Almas K. Reasons for Permanent Teeth Extractions and Related Factors among Adult Patients in the Eastern Province of Saudi Arabia. ScientificWorldJournal. 2021 Feb 22;2021:5534455. doi: 10.1155/2021/5534455. eCollection 2021.

Reference Type BACKGROUND
PMID: 33688305 (View on PubMed)

Related Links

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https://drive.google.com/drive/folders/1LIwA4RHf660gjAvCJ0mFQ3bTMZx0FlDA?usp=drive_link

Google drive link that contains all information regarding the study

Other Identifiers

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225-11-23

Identifier Type: -

Identifier Source: org_study_id

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