Analgesic Efficacy of Magnesium in Lower Third Molar Surgery: A Systematic Review and Meta-Analysis

Achieving an optimal analgesic effect in patients undergoing lower third molar surgery from the administration of an inferior alveolar nerve block (IANB) remains unclear. Magnesium, a N-methyl-D-aspartate receptor antagonist, has shown positive results in reducing pain following surgery. This systematic review and meta-analysis aimed to study whether the use of magnesium is effective in lower third molar surgery. We conducted a comprehensive search on PubMed, Web of Science, Scopus, and the Cochrane Library from inception to September 2023 for randomized controlled trials (RCTs) assessing the use of magnesium as an oral tablet or as an adjuvant to IANB in patients undergoing lower third molar surgery. The primary outcome was the pain scores following surgery at 24 hours, 48 hours, and 72 hours. Secondary outcomes included the number of analgesics consumed and the frequency of patients receiving supplemental analgesia. We calculated the standardized mean difference (SMD) and risk ratio along with their 95% confidence intervals (CIs) using a random-effects model. All analyses were performed using STATA 19MP. We included five RCTs with 299 patients in the analysis. Oral magnesium was associated with lower pain scores at 24 hours, 48 hours, and 72 hours following the surgery, with the following values, respectively: SMD = -0.7, 95% CI = -1.03 to -0.37, p < 0.001; I² = 0%; -0.59, 95% CI = -0.92 to -0.26, p < 0.001; I² = 0%; and -0.68, 95% CI = -1.01 to -0.35, p < 0.001; I² = 0% compared to the control group, with no significant difference between the adjuvant magnesium and the control group. The oral use of magnesium resulted in a significant reduction in pain scores at 24 hours, 48 hours, and 72 hours post-procedure compared to the control group. Further long-term RCTs with standardized protocols are recommended to confirm the current findings.