Efficacy of anti-inflammatory drugs in third molar surgery: a randomized clinical trial

This was a double-blind randomized clinical trial to assess the effect of different pharmacological regimens on the level of prostaglandin E2 (PGE2) in urine and saliva, and to correlate the findings to the clinical course after removal of impacted lower third molars. Eighty patients were randomly divided into four groups: group 1 received placebo; group 2 received preoperative ibuprofen, which was continued for a week; group 3 received intraoperative dexamethasone; and group 4 received preoperative ibuprofen, which was continued for a week, in addition to intraoperative dexamethasone. Saliva and urine samples were taken at scheduled intervals. Patients receiving ibuprofen fared significantly better in most parameters. A single dose of dexamethasone alone had a potent but transient beneficial effect when compared to the results with ibuprofen, which showed significant improvement in both subjective and objective parameters. Use of a single dose of intravenous steroids perioperatively helped reduce untoward sequelae, although to a lesser degree and for a shorter duration than continuous ibuprofen. Combining ibuprofen with perioperative dexamethasone added some benefit in some of the measured parameters, but without a statistically significant advantage over using ibuprofen only.