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Assessment of the Operative Course in Connection With Removal of Lower Third Molars
This study is currently recruiting participants.
Verified by University of Aarhus, December 2008
First Received: December 8, 2008   No Changes Posted
Sponsors and Collaborators: University of Aarhus
Tandlaegeforeningen, Calcin fonden
Information provided by: University of Aarhus
ClinicalTrials.gov Identifier: NCT00805298
  Purpose

The aim of this study is to compare postoperative complications after removal of lower third molars using two different types of anaesthetics and two different treatments against swelling and inflammation (methylprednisolone and placebo). The hypothesis is that a combination of a long-duration anaesthetic combined methylprednisolone will result in significantly less postoperative pain and inflammation.

Patients will have both lower third molars removed on two separate occasions. Each patient is randomly assigned to receive one type of local anaesthetic the first time and the other type the second time. Furthermore patients are randomised to receive either methylprednisolone or placebo the first time and the opposite treatment the second time. During the week after surgery patients fill out a questionnaire with questions about level of pain and swelling at different times as well as the patients' perception of other postoperative complications. The patient is examined by a dentist on the 2nd and 7th day after surgery, where postoperative complications are recorded and thermographic images of the patient's face are taken to assess the degree of inflammation.


Condition Intervention
Postoperative Pain
Inflammation
Drug: methylprednisolone
Drug: placebo
Drug: xyloplyin adrenalin
Drug: marcain adrenalin

MedlinePlus related topics: Anesthesia Edema Surgery
Drug Information available for: Prednisolone Epinephrine bitartrate Epinephrine Prednisolone acetate Depo-medrol Bupivacaine hydrochloride Bupivacaine Medrol veriderm Methylprednisolone Prednisolone sodium phosphate Prednisolone Sodium Succinate Methylprednisolone Sodium Succinate Methylprednisolone hemisuccinate 6-Methylprednisolone
U.S. FDA Resources
Study Type: Interventional
Study Design: Supportive Care, Randomized, Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Crossover Assignment, Efficacy Study
Official Title: Assessment of the Operative Course in Connection With Removal of Lower Third Molars With Particular Consideration to the Occurence of Pain and Swelling

Further study details as provided by University of Aarhus:

Primary Outcome Measures:
  • postoperative pain [ Time Frame: within the first week after surgery ] [ Designated as safety issue: No ]
  • postoperative inflammation [ Time Frame: within the first week after surgery ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • use of analgesics [ Time Frame: within one week after surgery ] [ Designated as safety issue: No ]
  • absence from work [ Time Frame: within one week after surgery ] [ Designated as safety issue: No ]
  • trismus [ Time Frame: within one week after surgery ] [ Designated as safety issue: No ]
  • alveolitis (dry socket) [ Time Frame: within one week after surgery ] [ Designated as safety issue: No ]
  • sensory disturbance [ Time Frame: within one week after surgery ] [ Designated as safety issue: No ]

Estimated Enrollment: 148
Study Start Date: August 2008
Estimated Study Completion Date: May 2010
Estimated Primary Completion Date: April 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
methylprednisolone: Active Comparator Drug: methylprednisolone
32 mg before surgery, 16 mg twice daily the day after surgery
placebo: Placebo Comparator Drug: placebo
two tablets before surgery, one tablet twice daily on the day after surgery
lidocaine: Active Comparator Drug: xyloplyin adrenalin
lidocaine local anaesthetic lidocaine 20 mg/ml, adrenalin 12,5 µg/ml maximum dosage 10 ml.
bupivacaine: Active Comparator Drug: marcain adrenalin
bupivacaine local anaesthetic bupivacaine 5 mg /ml, adrenaline 5 µg/ml maximum dosage 10 ml

Detailed Description:

Background: After removal of lower third molars complications can occur, including pain, swelling, infection and sensory disturbances. As pain intensity has been shown to be worst during the first 4-8 hours post surgery, it might be relevant to use a local anaesthetic with long duration, e.g. bupivacaine, instead of the traditionally used lidocaine. Several studies have focussed on the effect of non-steroid anti-inflammatory drugs (such as glucocorticoids, e.g. methylprednisolone) to reduce postoperative swelling. However, no studies comparing the effect of bupivacaine combined with methylprednisolone and lidocaine combined with methylprednisolone have been conducted. Aim: To compare postoperative complications after removal of lower third molars using 1) lidocaine, 2) lidocaine combined with methylprednisolone, 3) bupivacaine and 4) bupivacaine combined with methylprednisolone. Methods: The study compares type end extension of postoperative complications after removal of lower third molars using four different combinations of local anaesthetics and anti-inflammatory treatment. The study is conducted as a double blinded, split mouth crossover trial, where each patient has both lower third molars removed at two different occasions. Patients are randomised to receive one type of local anaesthetic the first time and the other type the second time. Furthermore patients are randomised to receive either methylprednisolone or placebo the first time and the opposite treatment the second time.

An objective assessment of postoperative swelling and inflammation is made by means of thermographic imaging of the operated side compared to the opposite side after the operation and at 2 and 7 days post surgery. Each patient fills out a questionnaire, where the patients' perception of pain, swelling and other complications is registered. Furthermore, complications are recorded objectively by a dentist at the 2- and 7-day post-surgery visits

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • age ≥ 18 years
  • two impacted or semi-impacted lower third molars with indication for removal
  • signed informed consent

Exclusion Criteria:

  • allergy to study drugs or ingredients
  • need for sedation
  • pregnancy
  • systemic disease besides asthma/hay fever
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00805298

Contacts
Contact: Jennifer H Christensen, DDS +45 8942 4056 jennifer.heather.christensen@odontologi.au.dk
Contact: Søren Schou, DDS, dr. odont +45 8942 4133 sschou@odont.au.dk

Locations
Denmark
School of Dentistry, Aarhus University Recruiting
Aarhus, Denmark, 8000
Contact: Jennifer H Christensen, DDS     +45 8942 4056     jennifer.heather.christensen@odontologi.au.dk    
Contact: Søren Schou, DDS, Dr. odont     +45 8942 4133     sschou@odont.au.dk    
Sponsors and Collaborators
University of Aarhus
Tandlaegeforeningen, Calcin fonden
Investigators
Principal Investigator: Jennifer H Christensen, DDS Aarhus University
  More Information

Publications:
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Bouloux GF, Punnia-Moorthy A. Bupivacaine versus lidocaine for third molar surgery: a double-blind, randomized, crossover study. J Oral Maxillofac Surg. 1999 May;57(5):510-4; discussion 515.
Bouloux GF, Punnia-Moorthy A. Bupivacaine versus lidocaine for third molar surgery: a double-blind, randomized, crossover study. J Oral Maxillofac Surg. 1999 May;57(5):510-4; discussion 515.
Bruce RA, Frederickson GC, Small GS. Age of patients and morbidity associated with mandibular third molar surgery. J Am Dent Assoc. 1980 Aug;101(2):240-5.
Bystedt H, Nordenram A. Effect of methylprednisolone on complications after removal of impacted mandibular third molars. Swed Dent J. 1985;9(2):65-9.
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Chiapasco M, De Cicco L, Marrone G. Side effects and complications associated with third molar surgery. Oral Surg Oral Med Oral Pathol. 1993 Oct;76(4):412-20.
de Boer MP, Raghoebar GM, Stegenga B, Schoen PJ, Boering G. Complications after mandibular third molar extraction. Quintessence Int. 1995 Nov;26(11):779-84.
Esen E, Taşar F, Akhan O. Determination of the anti-inflammatory effects of methylprednisolone on the sequelae of third molar surgery. J Oral Maxillofac Surg. 1999 Oct;57(10):1201-6; discussion 1206-8.
Holland CS. The influence of methylprednisolone on post-operative swelling following oral surgery. Br J Oral Maxillofac Surg. 1987 Aug;25(4):293-9.
Leone M, Richard O, Antonini F, Rousseau S, Chabaane W, Guyot L, Martin C. Comparison of methylprednisolone and ketoprofen after multiple third molar extraction: a randomized controlled study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Jan;103(1):e7-9. Epub 2006 Oct 6.
Marković AB, Todorović L. Postoperative analgesia after lower third molar surgery: contribution of the use of long-acting local anesthetics, low-power laser, and diclofenac. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Nov;102(5):e4-8. Epub 2006 Aug 10.
Mellor DJ, Mellor AH, McAteer EM. Local anaesthetic infiltration for surgical exodontia of third molar teeth: a double-blind study comparing bupivacaine infiltration with i.v. ketorolac. Br J Anaesth. 1998 Oct;81(4):511-4.
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Micó-Llorens JM, Satorres-Nieto M, Gargallo-Albiol J, Arnabat-Domínguez J, Berini-Aytés L, Gay-Escoda C. Efficacy of methylprednisolone in controlling complications after impacted lower third molar surgical extraction. Eur J Clin Pharmacol. 2006 Sep;62(9):693-8. Epub 2006 Aug 11.
Moore PA. Bupivacaine: a long-lasting local anesthetic for dentistry. Oral Surg Oral Med Oral Pathol. 1984 Oct;58(4):369-74. Review.
Nayyar MS, Yates C. Bupivacaine as pre-emptive analgesia in third molar surgery: Randomised controlled trial. Br J Oral Maxillofac Surg. 2006 Dec;44(6):501-3. Epub 2006 Feb 2.
Neal JA, Welch TB, Halliday RW. Analysis of the analgesic efficacy and cost-effective use of long-acting local anesthetics in outpatient third molar surgery. Oral Surg Oral Med Oral Pathol. 1993 Mar;75(3):283-5.
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Renton T, Hankins M, Sproate C, McGurk M. A randomised controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars. Br J Oral Maxillofac Surg. 2005 Feb;43(1):7-12.
Schultze-Mosgau S, Schmelzeisen R, Frölich JC, Schmele H. Use of ibuprofen and methylprednisolone for the prevention of pain and swelling after removal of impacted third molars. J Oral Maxillofac Surg. 1995 Jan;53(1):2-7; discussion 7-8.
Sisk AL, Hammer WB, Shelton DW, Joy ED Jr. Complications following removal of impacted third molars: the role of the experience of the surgeon. J Oral Maxillofac Surg. 1986 Nov;44(11):855-9.
Skjelbred P, Løkken P. Effects of naloxone on post-operative pain and steroid-induced analgesia. Br J Clin Pharmacol. 1983 Feb;15(2):221-6.
Song F, O'Meara S, Wilson P, Golder S, Kleijnen J. The effectiveness and cost-effectiveness of prophylactic removal of wisdom teeth. Health Technol Assess. 2000;4(15):1-55. Review.
UStün Y, Erdogan O, Esen E, Karsli ED. Comparison of the effects of 2 doses of methylprednisolone on pain, swelling, and trismus after third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Nov;96(5):535-9.

Responsible Party: School of Dentistry, Aarhius University ( Søren Schou, dr. odont )
Study ID Numbers: 2008-000866-22, 01.01.08Jen
Study First Received: December 8, 2008
Last Updated: December 8, 2008
ClinicalTrials.gov Identifier: NCT00805298     History of Changes
Health Authority: Denmark: Ethics Committee;   Denmark: Danish Medicines Agency

Keywords provided by University of Aarhus:
third molar
postoperative pain
thermography
postoperative inflammation
methylprednisolone
local anaesthetic
postoperative pain after removal of lower third molars
inflammation after removal of lower third molars

Study placed in the following topic categories:
Anti-Inflammatory Agents
Neurotransmitter Agents
Adrenergic Agents
Methylprednisolone
Hormone Antagonists
Hormones, Hormone Substitutes, and Hormone Antagonists
Antiemetics
Anesthetics
Edema
Prednisolone acetate
Pain
Hormones
Neuroprotective Agents
Adrenergic Agonists
Signs and Symptoms
Vasoconstrictor Agents
Epinephrine
Pain, Postoperative
Methylprednisolone Hemisuccinate
Adrenergic alpha-Agonists
Antineoplastic Agents, Hormonal
Adrenergic beta-Agonists
Lidocaine
Central Nervous System Depressants
Anti-Asthmatic Agents
Methylprednisolone acetate
Cardiovascular Agents
Glucocorticoids
Anesthetics, Local
Inflammation

Additional relevant MeSH terms:
Anti-Inflammatory Agents
Respiratory System Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Adrenergic Agents
Antineoplastic Agents
Methylprednisolone
Physiological Effects of Drugs
Hormones, Hormone Substitutes, and Hormone Antagonists
Antiemetics
Anesthetics
Prednisolone acetate
Pain
Hormones
Neuroprotective Agents
Adrenergic Agonists
Signs and Symptoms
Pathologic Processes
Sensory System Agents
Therapeutic Uses
Vasoconstrictor Agents
Epinephrine
Pain, Postoperative
Methylprednisolone Hemisuccinate
Adrenergic alpha-Agonists
Antineoplastic Agents, Hormonal
Adrenergic beta-Agonists
Sympathomimetics
Gastrointestinal Agents
Central Nervous System Depressants

ClinicalTrials.gov processed this record on May 07, 2009