A preliminary study on local administration of dexamethasone after tooth extraction Better preservation of residual alveolar ridge ?

Background/Aim. It is important that the height of the edentulous alveolar ridge after tooth extraction remains at a reasonable acceptable level for as long as possible. The aim of this study was to report preliminary results of the clinical effect of local oral submucous administration of dexamethasone after tooth extractions in order to prepare alveolar supporting tissues for acceptance of removable dentures. Methods. In a total of 15 patients (11 partially and 4 completely edentulous) the quantity of 0.25 mL to 0.5 mL of dexamethasone was injected bucally and orally in the region of the tooth socket after complicated extractions. Results. Healing of extraction wounds was uneventful in all the patients, without pain or local inflammation. Conclusion. Dexamethasone can be locally applied to oral tissues to prevent post-extraction inflammation and extensive resorption of the residual alveolar ridge. The obtained results are promising for patients undergoing classic prosthodontic rehabilitation soon after tooth extraction, demonstrating that there are no adverse effects after local oral corticosteroids administration.


Introduction
Corticosteroids otherwise sovereign anti-inflammatory and anti-oedematous drugs, are frequently used in oral surgery to prevent, or at least minimize, postoperative pain and oedema due to surgical trauma [1][2][3] .They can be used locally or systemically, administered by injection or orally 4 .Although corticosteroids have several general effects 5 , their single use (preoperative or postoperative) is supposed not to have any undesired effect on the adrenal-pituitary regulation of steroid secretion 1 .
The problem of edentulous ridge reduction has been noted in the dental literature for many years.A number of authors have discussed this problem due to difficulties for orofacial rehabilitation by means of proper denture design 6,8 .It is well known that marked atrophy and reduction of alveolar bone following tooth loss complicate prosthodontic rehabilitation 7,[9][10][11] .Difficulties have been encountered even in taking impressions of edentulous jaws with reduced and resorbed edentulous ridges 11 , as well as in achieving and maintaining the stability of fabricated acrylic dentures, particularly in the mandible 11 .Consequently, Pošti S, Todorovi Lj.Vojnosanit Pregl 2014; 71(5): 499-502.
edentulous patients with the resorbed residual ridges have serious problems in chewing with dentures 9,11,12 .For these reasons it is crucially important that the height of the edentulous alveolar ridge, after tooth extraction, remains at a reasonable acceptable level for as long as possible.Additionally, it is necessary that fabricated acrylic dentures, through constant pressure on the edentulous ridge, do not cause delayed resorption of residual ridge.
It is possible that steroids, due to their marked local anti-inflammatory effect could lessen the ridge resorption after tooth extraction as one of the possible reasons for this event is local tissue inflammation as a consequence of tissue injury.The aim of this study was to report preliminary results of the clinical effect of local oral submucous administration of dexamethasone after tooth extractions in order to prepare alveolar supporting tissues for the acceptance of removable dentures.

Methods
A total of 15 otherwise healthy patients (without visible symptoms of local osteoporosis, or any other intraoral disorder except tooth caries or periodontal disease), 11 partially and 4 completely edentulous (9 women aged 45-52 years, and 6 men aged 54-63 years), undergoing tooth extraction prior to classic prosthodontic rehabilitation, were included into the study.Altogether, 23 teeth were removed, 3 teeth at the most in a single patient.In each patient, at least one extraction was difficult, meaning the need for a bone portion removal with burs, or removal of a part of buccal or lingual cortical plate.
To prevent an extensive post-extraction bone resorption and possible complications of extraction wound healing, immediately after the completion of difficult tooth extraction, a submucous 0.5 mL dexamethasone injection (Dexason ® , Galenika, Belgrade) was administered, bucally and orally (altogether 4 mg of dexamethasone), beside the socket of the tooth that was removed with difficulties (Figure 1).
All the patients were followed-up regularly, and prosthodontic rehabilitation with removable partial or full dentures started two weeks afterwards.

Results
After administration of dexamethasone, no symptoms of local pain or inflammation, or any other complication, were noted (Figure 2).
The bones of the alveolar ridge were solid enough to enable making of dentures without the need of any additional plastic procedure, and control radiographs (Figure 3) revealed the absence of signs of undesired bone remodelling or extensive resorption.Consequently, all the patients were successfully rehabilitated with removable dentures (Figure 5).

Discussion
The anti-inflammatory effect of corticosteroids has been proved for many local or systemic disorders 13,14 .Therefore, indications for the use of corticosteroids due to their antiinflammatory effect are wide, ranging from any kind of local inflammation to many postoperative complications in oral and maxillofacial surgery.Therefore, the use of corticosteroids has also been recommended for pain reduction, oedema, and trismus following oral surgical procedures 1,2,4 .
Dexamethasone was injected beside the post-extraction socket so that it could demonstrate maximal anti-inflammatory effect and remain locally and not rinsed by salivary flow.It was injected in a total dose that is usually used for single intraoral application when anti-inflammatory dexamethasone effect is desired [1][2][3][4] .It was considered not to use dexamethasone if patients had any possible contraindication for steroid use 5,15 , and such patients were excluded from the study.
Although the anti-inflammatory effect of dexamethasone is well-known, there are no studies investigating its possible influence on the reduction of post-extraction alveolar ridge resorption.In spite the fact that all the 15 treated patients in this preliminary study had difficult tooth extractions, the wound healing in the post-extraction period was uneventful, and the residual alveolar ridge did not demonstrate signs of excessive resorption or malformation.We believe that this is mainly due to anti-inflammatory effect of the used dexamethasone.However, the number of treated patients is relatively small, and a double-blind controlled trial is under way to confirm possible favourable effect of dexamethasone in wound healing after tooth extraction.

Conclusion
Dexamethasone can be locally applied to oral tissues to prevent post-extraction inflammation and extensive resorption of the residual alveolar ridge.The obtained results are promising for patients undergoing classic prosthodontic rehabilitation soon after tooth extraction, demonstrating that there are no adverse effects of such corticosteroids use.

Figure 4 Fig. 4 -
Figure4shows the favorable finding of the upper jaw in one patient, 2 weeks after local administration of dexamethasone.

Fig. 5 -
Fig. 5 -Local finding after the complete dentures had been made.