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Comparison of Effectiveness of Etoricoxib and Diclofenac on Pain and Perioperative Sequelae After Surgical Avulsion of Mandibular Third Molars

A Randomized, Controlled, Clinical Trial

Isola, Gaetano DDS, PhD, PG (Oral Surgery)*; Matarese, Giovanni DDS; Alibrandi, Angela MD, PhD; Dalessandri, Domenico DDS, PhD§; Migliorati, Marco DDS, PhD; Pedullà, Eugenio DDS, PhD*; Rapisarda, Ernesto MD, DDS*

doi: 10.1097/AJP.0000000000000748
Original Articles

Objective: The objective of this analysis was to compare the efficacy of etoricoxib and diclofenac in the management of perioperative sequelae following impacted mandibular third molar surgery.

Materials and Methods: Ninety-seven patients who needed surgical avulsion of an impacted mandibular third molar were chosen for the study. All patients were randomly allocated to receive one of the following treatments, twice a day for 5 days after surgery: placebo (n=33), diclofenac (n=32), or etoricoxib (n=32). The primary outcome evaluated was postoperative pain, recorded by each patient and evaluated using the Visual Analogue Scale score. The secondary outcomes chosen were, compared with preoperative ones, changes in postoperative swelling and maximum mouth opening.

Results: Compared with placebo, treatment with etoricoxib and diclofenac demonstrated an enhancement in the primary outcome. Furthermore, when compared with the other groups, patients who had undergone etoricoxib presented a significant median reduction in postoperative pain at 2 hours (P<0.001), 12 hours (P=0.025), and at 48 hours (P=0.018) after surgery. Moreover, the linear regression analysis showed that diclofenac and etoricoxib determined a significant influence on Visual Analogue Scale at 2, 6, 12, 24, 48 hours and at 10 days after surgery. There were no differences in swelling and maximum mouth opening values between groups.

Discussion: This study demonstrated that both treatments were effective. However, treatment with etoricoxib showed a greater reduction in the incidence and severity of postoperative pain following third molar surgery compared with diclofenac and placebo.

*Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Catania

Department of Biomedical and Odontostomatological Sciences and Morphological and Functional Images, School of Dentistry

Unit of Statistical and Mathematical Sciences, Department of Economics, University of Messina, Messina

§Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, Brescia

Department of Odontostomatology, School of Dentistry, University of Genova, Genova, Italy

Written informed consent was obtained from the patient for publication.

G.I. and G.M. conceived the idea of the work, and planned and performed the experimental procedures. A.A. performed the statistical analysis. G.I., M.M., D.D., E.P., and E.R. analyzed and summarized the experimental results. G.I. wrote the paper.

Supported from the Department of General Surgery and Surgical-Medical Specialties of the University of Catania, Catania, Italy and Department of Biomedical, Odontostomatological Sciences, and of Morphological and Functional Images of the University of Messina, Messina, Italy. The authors declare no conflict of interest.

Reprints: Gaetano Isola, DDS, PhD, PG (Oral Surgery), Department of General Surgery and Surgical-Medical Specialties, University of Catania, Via Plebiscito 628, 15a Building, Catania 95124, Italy (e-mail:

Received January 24, 2019

Received in revised form June 25, 2019

Accepted July 14, 2019

Online date: July 26, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.