Is coadministration of preemptive medications an effective strategy for reducing inflammatory clinical events and the need for rescue medication after mandibular third molar surgery? A systematic review of randomized clinical trials.

This study aimed to evaluate the scientific evidence on the effect of preemptive drug coadministration (PDC) for relieving inflammatory events (pain, swelling, and trismus) in mandibular third molar surgery. A PROSPERO-registered systematic review (CRD42022314546) was conducted according to the PRISMA guide. The searches were carried out in six primary databases and the gray literature. Studies not written in languages with the Latin alphabet (Roman) were excluded. Potential randomized controlled trials (RCTs) were screened for eligibility. Cochrane's Risk of Bias-2.0 (RoB) tool was assessed. A synthesis without meta-analysis (SWiM) based on a vote counting and an effect direction plot. Nine studies (low RoB) fulfilled the eligibility criteria and were included for data analysis, with a total of 484 patients. PDC mostly involved corticosteroids (Cort) and non-steroidal anti-inflammatory drugs (NSAIDs). PDC of Cort and other drugs mainly reduced pain scores (6 and 12 h postoperatively) and swelling (48 h postoperatively). PDC of NSAIDs and other drugs mainly reduced pain scores at 6, 8, and 24 h follow-up; swelling and trismus intensity ameliorated at 48 h postoperatively. The most frequently prescribed rescue medication was paracetamol, dipyrone, and paracetamol plus codeine. Results from individual studies have shown reduced consumption of ingested rescue analgesics. In summary, the available evidence from clinical trials included in this SWiM suggests that PDC may provide benefits in reducing the severity of inflammatory outcomes related to mandibular third molar surgery, especially the pain scores in the first hours after surgery, and the rescue analgesic consumption during the postoperative period.

CONSORT compliance in randomized surgical trials assessing the analgesic and anti-inflammatory effectiveness of preoperative drug management of patients undergoing mandibular third molar surgery: a scoping review

Background: Investigate methodological quality of clinical trials in mandibular third molar surgery and its compliance with the consort statement. Material and methods: An electronic search was performed in five journal websites, chose the five scientific journals with the greatest impact factor in oral and maxillofacial surgery according to the SCImago Journal Rank. The compliance of studies with the CONSORT statement was assessed. Also, the risk of bias of each study was evaluated. Results: Twenty-nine studies were included. The average CONSORT compliance score was 25.50 (79.68%). Most studies were performed in the Americas (n = 14, 48.3%) and Asia (n = 10, 34.5%). Parallel-group (n=15, 51.7%) and split-mouth RCTs (n=11, 38%) were the most prevalent study design. An inverse correlation was observed between the year of publication and the number of Scopus citations (p<0.001), time between acceptance and publication (p<0.001), and time between study completion and publication (p=0.040). Conclusions: Understanding the correct use of guidelines, such as the CONSORT statement, is necessary to reduce methodological errors and possible bias, thereby ensuring reliable knowledge dissemination. (AU)