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Zahnheilkunde 17. Juni 2015

Twin-mix anesthesia as pterygomandibular nerve block for surgical removal of impacted mandibular third molars

Various studies have endorsed the use of corticosteroids for minimizing the postoperative sequelae including trismus and swelling following surgical extraction of mandibular third molars. The exact dosage, mode of administration, and time of administration of corticosteroids varies in the literature. In this review, we propose and discuss a novel method of administration of corticosteroids for surgical removal of impacted mandibular third molars. The time and dose required to achieve a reliable clinical effect are also discussed. This article highlights and reviews the novel technique of administration of corticosteroid via intraspace injection, the composition of the drug used for this technique, the physical and chemical evaluation of the twin-mix solution, and comparative clinical trials with a control drug.


The benefits of administering corticosteroids for improving the postoperative quality of life of patients following surgical extraction of third molars are well documented. Even with ample clinical trials and literature on the subject, clinicians remain ambiguous about the preferred route of administration of steroids. Similarly, information on administering corticosteroids before or after the surgery is vague. This ambiguity stems from the lack of clear guidelines on the use of corticosteroids in surgical extractions of third molar or minor oral surgery concerning the exact dosage to be used, the mode of administration, and the time of administration. The decision is more often based on the operating surgeon’s personal preferences than on sound evidence from the clinical literature. In this article, we propose a novel method of administering steroids for mandibular third molar surgeries with emphasis on standardizing the use of dexamethasone in terms of dosage, mode of administration, and timing of administration.

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