Comparison of Outcomes of Methylprednisolone With Serratiopeptidase in Reducing Postoperative Complications After Extraction of the Mandibular Third Molar
DOI:
https://doi.org/10.54112/bcsrj.v6i9.2141Keywords:
Methylprednisolone; Serratiopeptidase; Impacted mandibular third molar; Postoperative pain; Swelling; TrismusAbstract
Surgical extraction of impacted mandibular third molars is one of the most common oral and maxillofacial procedures and is frequently associated with postoperative pain, swelling, and limitation of mouth opening. Pharmacological agents such as corticosteroids and proteolytic enzymes are widely prescribed to minimize these complications; however, comparative evidence on their efficacy remains limited. Objective: To compare the effectiveness of methylprednisolone and serratiopeptidase in reducing postoperative pain, swelling, and trismus following surgical extraction of impacted mandibular third molars. Methods: A randomized controlled trial was conducted at the Department of Oral and Maxillofacial Surgery, Sandeman Provincial Hospital, Quetta, Pakistan, from December 2021 to June 2022. Ninety-six eligible patients were randomly allocated into two equal groups. Group A received oral methylprednisolone 4 mg every 8 hours, and Group B received oral serratiopeptidase 10 mg every 12 hours for five days postoperatively. Pain was assessed using a visual analogue scale, swelling was measured using standardized anatomical landmarks, and mouth opening was recorded using interincisal distance. Data were analyzed using SPSS version 23, with p ≤ 0.05 considered statistically significant. Results: Both groups were comparable in age, gender distribution, impaction side, and impaction classification. Methylprednisolone demonstrated significantly lower postoperative pain (1.3 ± 0.32 vs 7.3 ± 2.0, p < 0.001) and greater improvement in mouth opening (1.3 ± 2.5 vs 7.2 ± 4.1, p < 0.001) than serratiopeptidase. Serratiopeptidase showed relatively better reduction in postoperative swelling (p = 0.04). Similar outcome trends were observed among participants aged 23–30 years. Conclusion: Methylprednisolone was more effective in reducing postoperative pain and trismus, whereas serratiopeptidase provided superior reduction in swelling following third molar surgery. The predominant clinical requirement may guide the selection of either medication. Both agents appear safe and beneficial when used short-term in postoperative management.
Downloads
References
Sayed N., Bakathir A., Pasha M., & Al-Sudairy S. Complications of Third Molar Extraction: A retrospective study from a tertiary healthcare centre in Oman. Sultan Qaboos University Medical Journal 2019;19(3):e230-235. https://doi.org/10.18295/squmj.2019.19.03.009
Sukegawa S., Yokota K., Kanno T., Manabe Y., Sukegawa-Takahashi Y., Masui M.et al.. What are the risk factors for postoperative infections of third molar extraction surgery: A retrospective clinical study? Medicina Oral, Patología Oral Y Cirugía Bucal 2018:0-0. https://doi.org/10.4317/medoral.22556
Rizqiawan A., Lesmaya Y., Rasyida A., Amir M., Ono S., & Kamadjaja D Postoperative Complications of Impacted Mandibular Third Molar Extraction Related to Patient’s Age and Surgical Difficulty Level: A Cross‐Sectional Retrospective Study. International Journal of Dentistry 2022;2022(1). https://doi.org/10.1155/2022/7239339
Altaweel A., Gaber A., Alnaffar M., Alshomrani E., Alrehaili R., Alshaikh R.et al.. Methylprednisolone and Hyaluronic Acid versus Each Agent Alone to Control Complications of Impacted Wisdom Tooth Removal. Evidence-Based Complementary and Alternative Medicine 2022;2022:1-8. https://doi.org/10.1155/2022/1563513
Kandamani J., Ramakrishnan D., Gouthaman S., & Kumar S. Submucosal administration of dexamethasone versus methyl prednisolone in management of postoperative sequelae after mandibular third molar impaction - A systematic review. International Journal of Research in Pharmaceutical Sciences 2020;11(3):4479-4486. https://doi.org/10.26452/ijrps.v11i3.2674
Altaweel A., Gaber A., Alnaffar M., Almowallad A., Almech M., Almuwallad A.et al.. A novel therapeutic approach for reducing postoperative inflammatory complications after impacted mandibular third molar removal. Medicine 2022;101(37):e30436. https://doi.org/10.1097/md.0000000000030436
Xu J. and Xia R.. Influence factors of dental anxiety in patients with impacted third molar extractions and its correlation with postoperative pain: a prospective study. Medicina Oral, Patología Oral y Cirugía Bucal 2020:e714-e719. https://doi.org/10.4317/medoral.23293
Nehme W., Fares Y., & Abou‐Abbas L Piezo-surgery technique and intramuscular dexamethasone injection to reduce postoperative pain after impacted mandibular third molar surgery: a randomized clinical trial. BMC Oral Health 2021;21(1). https://doi.org/10.1186/s12903-021-01759-x
Isola G., Alibrandi A., Pedullà E., Grassia V., Ferlito S., Perillo L.et al.. Analysis of the Effectiveness of Lornoxicam and Flurbiprofen on Management of Pain and Sequelae Following Third Molar Surgery: A Randomized, Controlled, Clinical Trial. Journal of Clinical Medicine 2019;8(3):325. https://doi.org/10.3390/jcm8030325
Starzyńska A., Kaczoruk-Wieremczuk M., López M., Passarelli P., & Adamska P.. The Growth Factors in Advanced Platelet-Rich Fibrin (A-PRF) Reduce Postoperative Complications after Mandibular Third Molar Odontectomy. International Journal of Environmental Research and Public Health 2021;18(24):13343. https://doi.org/10.3390/ijerph182413343
Kirnbauer B., Jakse N., Truschnegg A., Dzidic I., Mukaddam K., & Payer M. Is perioperative antibiotic prophylaxis in the case of routine surgical removal of the third molar still justified? A randomized, double-masked, placebo-controlled clinical trial with a split-mouth design. Clinical Oral Investigations 2022;26(10):6409-6421. https://doi.org/10.1007/s00784-022-04597-5
Xu X., Shi P., Zhang P., Shen J., & Kang J Impact of platelet-rich fibrin on mandibular third molar surgery recovery: a systematic review and meta-analysis. BMC Oral Health 2019;19(1). https://doi.org/10.1186/s12903-019-0824-3
Altaweel A., Gaber A., Alnaffar M., Alshomrani E., Alrehaili R., Alshaikh R.et al.. Methylprednisolone and Hyaluronic Acid versus Each Agent Alone to Control Complications of Impacted Wisdom Tooth Removal. Evidence-Based Complementary and Alternative Medicine 2022;2022:1-8. https://doi.org/10.1155/2022/1563513
Shuborna N., Chaiyasamut T., Sakdajeyont W., Vorakulpipat C., Rojvanakarn M., & Wongsirichat N. Generation of novel hyaluronic acid biomaterials for the study of pain in third molar intervention: a review. Journal of Dental Anesthesia and Pain Medicine 2019;19(1):11. https://doi.org/10.17245/jdapm.2019.19.1.11
Tatlı U., Benlidayı İ., Salimov F., & Güzel R Effectiveness of kinesio taping on postoperative morbidity after impacted mandibular third molar surgery: a prospective, randomized, placebo-controlled clinical study. Journal of Applied Oral Science 2020;28. https://doi.org/10.1590/1678-7757-2020-0159
Wehr C., Cruz G., Young S., & Fakhouri W An Insight into Acute Pericoronitis and the Need for an Evidence-Based Standard of Care. Dentistry Journal 2019;7(3):88. https://doi.org/10.3390/dj7030088
Feslihan E. and Eroğlu C Can Photobiomodulation Therapy Be an Alternative to Methylprednisolone in Reducing Pain, Swelling, and Trismus After Removal of Impacted Third Molars?. Photobiomodulation Photomedicine and Laser Surgery 2019;37(11):700-705. https://doi.org/10.1089/photob.2019.4696
Silva S., Vasconcelos T., Spinato I., Pozza D., Cruz M., & Guimarães A Manual lymphatic drainage and muscle energy techniques after third molar surgery: A randomized split‐mouth clinical trial. Oral Surgery 2021;15(3):234-241. https://doi.org/10.1111/ors.12676
Ahmed N., Khan M., Mahmood S., Adeel M., Yasir A., & Saeed S. Removal of Partially Impacted Mandibular Third Molars with and without Flap: A Comparison of Two Surgical Techniques. Pakistan Armed Forces Medical Journal 2022;72(5):1804-07. https://doi.org/10.51253/pafmj.v72i5.8382
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Bushra Ghauri, Muhammad Rahim, Muhammad Azad Khan, Sana Kanwal, Zeenat Razzaq, Arbab Zarak Khan
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
