Clinical Evaluation of Cox-2 Inhibitor For Management of Post Operative Complications After Odontectomy of Impacted Lower Third Molar

This study compared the efficacy of the COX-2 inhibitor celebrex to the NSAID ibuprofen for managing post-operative pain, edema, and trismus following extraction of impacted lower third molars. 40 patients were randomly assigned to receive either celebrex or ibuprofen for 5 days following surgery. Results found that celebrex provided superior pain relief based on VAS scores on the first and third post-op days, but that both drugs similarly reduced edema and increased mouth opening over time with no significant differences between groups. The study concluded that celebrex had a superior analgesic effect for pain relief after surgery compared to ibuprofen.

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Clinical Evaluation of Cox-2 Inhibitor For Management of Post Operative Complications After Odontectomy of Impacted Lower Third Molar

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Muskab Jonas

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Clinical Evaluation of Cox-2 Inhibitor for

Management of Post Operative

Complications after Odontectomy of
Impacted Lower Third Molar
Shimaa. S. Ahmed; Eman. A. ElSharrawy and Tamer. A.Hamed
Oral and Maxillofacial Surgery Department, Faculty of
Dentistry, Suez Canal University
[email protected]

Journal of American Science 2014;10(11)

http://www.jofamericanscience.org
ABSTRAK
• Aim: to compare the efficacy of cox-2 inhibitor (celebrex) with
NSAID (ibuprofen) on the postoperative complications after
odontectomy of impacted lower third molar which are pain
edema and trismus.
• Patients and Methods: atotal of 40 patients (20 males, 20
females) with impacted lower third molar divided into two
equal groups.
Group I: twenty patients treated with 600 mg/12h ibuprofen
GroupII: twenty patients treated with 200mg/12 h celebrex.
• Results: the results showed that compared with
NSAID (ibuprofen) cox-2 inhibitor(celebrex) had
superior analgesic effect on all measures of
analgesic efficacy, in the 1 day post-operative it
was 4.35 ± 1.14 in the NSAID group and 3.05 ±
1.64 in the cox-2 inhibitor group with p-value
0.01 * but at the 3 days post-operative it was
1.60 ± 2.04 in the NSAID group and 0 in the cox-
2 inhibitor group with p- value 0.03 *, but there
is no significant difference in the assessment of
edema and trismus between the two groups.
• Conclusion: cox-2 inhibitor (celebrex) had
superior analgesic effect when compared with
the traditional NSAID (ibuprofen) but there is
no significant difference between them in
reduction of edema and trismus.
INTRODUCTION
• Third molars are the most likely teeth to
become impacted
• Third molar tooth removal is frequently
associated with debilitating acute
complications including pain, swelling,
trismus,and alveolar osteitis (dry socket).
• Panoramic radiography as initial evaluation
• Factors affecting postoperative morbidity
o Patient factors
o Tooth related factors
o Operative factors

• Postoperative Complications
o Pain
o Swelling
o Trismus in varying degrees
• Postoperative pain is related to alterations in
the central and perioheral nervous system
induced by surgical trauma
• Prostaglandin (PG) derived from precussor
arachidonic acid
• Arachidonic acid is a major component cell
membrane phospholipids.
• Released via cellular phospholipases, activated
by mechanical, chemical or physical stimuli.
• Metabolism of Arachidonic acid involving
cyclo-oxygenase, that converts
arachidonic acid into PG

• Medications  inhibit PG production

o Prevent primary/ secondary
hyperalgesia
o Reducing postoperative pain and
discomfort and the consumption of
rescue analgesics
• NSAIDs reduce the syntesis PG  inhibiting COX-1
and COX-2  blocking nociceptive response to
endogeus mediators of inflammation
Ibuprofen commonly used to treat chronicpain and
inflammation
• Selective inhibitor COX-2  Attractive aproach
treatment of inflammatory conditions  without
side effects of gastric and renal toxicity and
inhibition of platelet fuction
• COX-2 inhibitors metabolized by cytochrome p450
CYP 2C9 in liver, analgesia achieved in 1 hour and
anti inflammatory effect begin less than week
afterstarting therapy.
PATIENTS AND METHODS
• 40 ASA class I patients, clinic of Oral and
Maxillofacial Surgery Dept. Faculty of
Dentistry- Suez Canal University
• The selected patient required surgical
removed of an Impacted lower third molar, by
radiographic examination, the cases were
chosen as position B impaction
• Pre operative assesment
o Medical and dental examination
o Radiograph examination
o Measurment of interincisal distance
o Measurement of facial contour
• The patients randomly divided into:
o Group I : 20 patients,received postoperative ibuprofen
600mg/ 12hours for 5 days
o Group II: 20 patient, received postoperative celebrex
200mg/ 12 hours for 5 days
• All patients received Amoxicillin/ clavulanic acid
(Augmentin) 1gr/12 hours and CHX solution (Hexitol)
15ml of 0,12% chlorhexidine mouth rinse 3 times daily
• Postoperative assesment
Each patients was examined 1st, 3rd and 1 week
postoperatively for assesment of pain, trismus and
oedema
o Assesment of pain
Patient was described his pain level using 10 point visual
analog scale (VAS) anchored by verbal, descriptors ranged
from (no pain=0) to (that couldn’t tolerated=10)
o Assesment of trismus
Measuring distancd between incisal edges of the upper and
lower central incissors during maximal tooth opening
o Assesment of facial edema
Measuring the same distance on the same facial regions, by
calculating the differnce between post and pre operative.
RESULTS
• In both NSAIDs and COX-2 Inhibitors groups, Edema was
significantly increased initially at 1 day post-op, then
decreased at 3 days & 1 week post-op assesment, with no
statiscally significant difference between them.
• In both NSAIDs and COX-2 Inhibitors groups, Trismus was
significantly increased initially at 1 day post-op, then
decreased at 3 days & 1 week post-op assesment, with no
statiscally significant difference between them.
• VAS score was significanly decreased from pre-op to
post-op assesment, but celebrex showed more
decrement (i.e more pain improvement)
Discussion
• COX-2 inhibittor (celebrex) had superior
analgesic efficacy when compared with the
traditional NSAID (ibuprofen)
• Assesment of pain indicate that there was a
statiscally significant difference in VAS score
only at 1st day and 3 days post-op  Celebrex
was more effective in pain relief compare to
ibuprofen
Agreement with :
• Al-Sukhun, et al
Celecoxib demonstrated superior analgesic effect compared with
Ibuprofen
• Moghaddamnia, et al
Celecoxib had better result for pain relief in 24 hours after surgery
comparison to Prednisolone. There is insignificant difference in the
effect of prednisolone or celecoxib on the max mouth opening
• Derry, et al
Single dose oral Celecoxib is effective analgesic for postoperative pain
relief
• Saffar, Maha
Celebrex is more effective than paracetamol with less frequency of
administration and longer duration of action in reducing post operative
oral complication (swelling and trismus) with some analgesic effect after
surgical removal of third molar
Disagreement
• Cicconetti, et al
COX-2 selective inhibittors display analgesic efficacy
similar to that traditional NSAIDs in the treatment of
acute post oral surgery pain
Conclussions
• Both COX-2 inhibitor and NSAID drug improve
post operative complications after odontectomy
of impacted lower third molar.
• COX-2 inhibitor (Celebrex) had superior
analgesic efficacy when compared with
traditional NSAID (Ibuprofen)
• COX-2 Inhibitor (Celebrex) reported insignificant
improvement in oedema and trismus than
NSAID (Ibuprofen)