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autom=C3=A1ticamente con confianza media" style=3D"margin-top:47.7pt; mar= gin-left:398.7pt; border-style:none; position:absolute" /></a> </p= ><table style=3D"width:395.55pt; margin-bottom:0pt; padding:0pt; border-col= lapse:collapse"><tr><td style=3D"width:3.25pt; padding:0pt 5.4pt; vertical-= align:top">1</td><td sty= le=3D"width:171.95pt; padding:0pt 5.4pt; vertical-align:top">Camila Bel=C3=A9n Samaniego Maldonado</td><td style=3D"w= idth:10.5pt; padding:0pt 5.4pt; vertical-align:top"> </td><td style=3D"width= :166.35pt; padding:0pt 5.4pt; vertical-align:top">https://orcid.org/0009-0006-4616-2330</td><td style= =3D"padding:0pt; vertical-align:top"></td></tr><tr><td style=3D"width:3.25p= t; padding:0pt 5.4pt; vertical-align:top"> </td><td colspan=3D"4" style=3D"wi= dth:370.7pt; padding:0pt 5.4pt; vertical-align:top">Universidad de Cuenca (UCuenca), Cuenca,= Ecuador.Estudiante de Odontolog=C3=ADa<img src=3D"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgA= 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Roman'">https://orcid.org/0009-0008-6914-= 6098</td><td style=3D"padding:0pt; vertical-align:top"></td></tr= ><tr><td style=3D"width:3.25pt; padding:0pt 5.4pt; vertical-align:top"> </td>= <td colspan=3D"4" style=3D"width:370.7pt; padding:0pt 5.4pt; vertical-align= :top">Universidad= de Cuenca (UCuenca), Cuenca, Ecuador.Estudiante de Odontolog=C3=ADa<p= style=3D"margin-left:7.1pt; margin-bottom:0pt; text-indent:-7.1pt; text-al= ign:justify; line-height:normal"><img src=3D"data:image/png;b= ase64,iVBORw0KGgoAAAANSUhEUgAAABQAAAAUCAYAAACNiR0NAAAABHNCSVQICAgIfAhkiAAAA= AlwSFlzAAAOxAAADsQBlSsOGwAAA2lJREFUOI21lEtoXVUUhr+197n3nNzbJN6omdTWRmwbikVq= 4iMxk0ZU2oGgA1FnQcQiUhUnFqo4cGIRQUGd+KDY+Jp25ouiGCOxElqjhba0URPzsPQmuY9zzj1= nLwcnuU1iQ0f+mzXZe///Wv/aiy1cBV/83NNOPr/VWHunqO5OVNuNlQVjmZCGjCVhcPHR3q8Xrs= aVNUITu/KSlu7LFeSpNNZ+57RTjDTvqFM1IvNiGXWJvD/9x8yXB/efizYU/Hy8/0W/aA/Xq43r1= P3nOCNIFsW2XLleTd648Z/863v3nkjWCL59dp/fWSsfzOXNkShKacvfgnMRlXjqqqIrwr5vkihy= 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=3D"mailto:stephany.paucar@ucuenca.edu.ec" style=3D"text-decoration:none"><= span style=3D"font-family:'Times New Roman'; font-size:10pt; text-decoratio= n:underline; color:#1155cc">stephany.paucar@ucuenca.edu.ec</a> </td></= tr><tr><td style=3D"width:3.25pt; padding:0pt 5.4pt; vertical-align:top"><p= style=3D"margin-bottom:0pt; text-align:center; line-height:normal; font-si= ze:10pt">3</td><td style=3D"width:1= 71.95pt; padding:0pt 5.4pt; vertical-align:top">Mario= Esteban Calder=C3=B3n Calle </td><td style=3D"width:10.5pt; pad= ding:0pt 5.4pt; vertical-align:top"> </td><td style=3D"width:166.35pt; paddin= g:0pt 5.4pt; vertical-align:top">http= s://orcid.org/0000-0003-1320-2923</td><td style=3D"padding:0pt; = vertical-align:top"></td></tr><tr><td style=3D"width:3.25pt; padding:0pt 5.= 4pt; vertical-align:top"> </td><td colspan=3D"4" style=3D"width:370.7pt; padd= ing:0pt 5.4pt; vertical-align:top">Universidad de Cuenca (UCuenca), Cuenca, Ecuador.<= /p><a href=3D"mailto:marioe.calderon@ucu= enca.edu.ec" style=3D"text-decoration:none">ma= rioe.calderon@ucuenca.edu.ec</a> </td></tr><tr style=3D"height:0pt"><t= d style=3D"width:14.05pt"></td><td style=3D"width:182.75pt"></td><td style= =3D"width:21.3pt"></td><td style=3D"width:177.15pt"></td><td style=3D"width= :0.3pt"></td></tr></table> <table style=3D"width:437.15pt; marg= in-bottom:0pt; padding:0pt; border-collapse:collapse"><tr><td colspan=3D"7"= style=3D"width:151.1pt; padding:0pt 5.4pt; vertical-align:top"><s= pan style=3D"font-family:'Times New Roman'"> </td><td colsp= an=3D"2" style=3D"width:264.45pt; border-top:0.75pt solid #000000; border-b= ottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top">Art=C3=AD= culo de Investigaci=C3=B3n Cient=C3=ADfica y Tecnol=C3=B3gicaEnviado: 15/04/2026 </= span>Revisado: = 10/05/2026 Aceptado: 23/06/2026 Publicado: 15/07/2026DOI: </sp= an><a href=3D"https://doi.org/10.33262/anatomiadigital.v9i3.3692%20" style= =3D"text-decoration:none">https://doi.org/10.33262/anatomiadigital= .v9i3.3692 </a> <a href=3D"https://doi= .org/10.33262/anatomiadigital.v8i4.3568" style=3D"text-decoration:none"><sp= an style=3D"font-family:'Times New Roman'; text-decoration:underline; color= :#0563c1; background-color:#ffffff"> </a></td></tr><tr styl= e=3D"height:3.5pt"><td colspan=3D"7" style=3D"width:151.1pt; padding:0pt 5.= 4pt; vertical-align:top"> </td><td colspan=3D"2" style=3D"width:264.45pt; border-to= p:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4= pt; vertical-align:top"> </td></tr><tr><td style=3D"width:52pt; border-top:0.7= 5pt solid #000000; padding:0pt 5.4pt; vertical-align:top"> C=C3=ADtese: </td><td style= =3D"width:10.35pt; border-top:0.75pt solid #000000; padding:0pt 5.4pt; vert= ical-align:top">&#x= a0;</td><td colspan=3D"6" style=3D"width:337.8pt; border-top:0.7= 5pt solid #000000; padding:0pt 5.4pt; vertical-align:top"> Samaniego Maldonado, C. B., Paucar Mor= ocho, N. S., & Calder=C3=B3n Calle, M. E. (2026). Eficacia y seguridad = de los corticoides preoperatorios en cirug=C3=ADa de terceros molares: evid= encia actual y propuesta de protocolo de manejo cl=C3=ADnico. Anatom=C3=ADa= Digital, 9(3), 63-78. <a href=3D"https://doi.org/10.33262/anatomiad= igital.v9i3.3692" style=3D"text-decoration:none">https://doi.org/10.33262/anatomiadi= gital.v9i3.3692</a> </td><td style=3D"border-top:0.75pt solid #0000= 00; padding:0pt; vertical-align:top"></td></tr><tr><td style=3D"width:52pt;= padding:0pt 5.4pt; vertical-align:top"><img src=3D"= data:image/jpeg;base64,/9j/4AAQSkZJRgABAQEAYABgAAD/2wBDAAEBAQEBAQEBAQEBAQEB= AQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQH/2wBDAQE= BAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQ= EBAQEBAQH/wAARCAAiAEEDASIAAhEBAxEB/8QAHQAAAgMBAAMBAAAAAAAAAAAAAAcGCAkFAQIDB= P/EAD0QAAEEAgECBAIFBg8AAAAAAAQCAwUGAQcIAAkREhMhFDEVFiJxgQoaUWGR0zZBUlNXWHWT= lZehsdHW8P/EABwBAAEEAwEAAAAAAAAAAAAAAAgAAQMEAgUGB//EADYRAAIBAgQCBQoGAwAAAAA= AAAECAwQRAAUSIQYxEzJBUXEHIjM0YXSBkbGzNVOCobLRhMPw/9oADAMBAAIRAxEAPwDaOudw/Z= PM/t483Jm1VqLoVw1PSIZAlgo8pKhNnvTT6yGzxGXnVHQpYL0WpbTg8k+rKn0+VTeWMqdbnYf3r= 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publicar=C3=A1 en soporte electr=C3=B3nico tiene co= mo misi=C3=B3n contribuir a la <spa= n style=3D"line-height:115%; font-family:'Times New Roman'; font-size:8pt">= formaci=C3=B3n de profesionales competentes con visi=C3=B3n human=C3=ADsti= ca y cr=C3=ADtica que sean capaces de exponer su= s resultados investigativos y cient=C3=ADficos en la misma medida que se pr= omueva mediante su intervenci=C3=B3n cambios positivos en la sociedad.</spa= n> <a href=3D"https://anatomiadigital.org" style=3D"text-de= coration:none">https://anatom= iadigital.org</a> La revista es editada por la Editoria= l Ciencia Digital (Editorial de prestigio registrada en la C=C3=A1mara Ecua= toriana de Libro con No de Afiliaci=C3=B3n 663) <a href=3D"http://ww= w.celibro.org.ec" style=3D"text-decoration:none">www.celibro.org.ec</a> </div= ></td><td style=3D"padding:0pt; vertical-align:top"></td></tr><tr style=3D"= height:23.65pt"><td style=3D"width:52pt; border-bottom:0.75pt solid #000000= ; padding:0pt 5.4pt; 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" width=3D"77" height=3D"28" alt=3D"" style=3D"margin-top:0.15pt; margin-le= ft:0pt; position:absolute" /> </td><td style=3D"width:10.35pt; border-bottom:0.75= pt solid #000000; padding:0pt 5.4pt; vertical-align:top"> </td><td colspan=3D"6= " style=3D"width:337.8pt; border-bottom:0.75pt solid #000000; padding:0pt 5= .4pt; vertical-align:top">Esta revista est=C3=A1 protegida ba= jo una licencia Creative Commons Atribuci=C3=B3n-NoComercial-CompartirIgual= 4.0 International. Copia de la licencia: <a href=3D"https://creativ= ecommons.org/licenses/by-nc-sa/4.0/deed.es" style=3D"text-decoration:none">= https://creativecommons.org/l= icenses/by-nc-sa/4.0/deed.es</a> </td><td style=3D"pa= dding:0pt; vertical-align:top"></td></tr><tr><td colspan=3D"4" style=3D"wid= th:101.1pt; padding:0pt 5.4pt; vertical-align:top">Palabras claves: Cirug=C3=ADa de terceros molares, Corticoesteroides, </s= pan><s= pan style=3D"font-family:'Times New Roman'">Control del dolor, Dexametasona= , Trismo.</td><td colspan=3D"2" style=3D"width:0.7pt; padding:0p= t 5.4pt; vertical-align:top"> </td><td colspan=3D"2" style=3D"width:298.35pt; = border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; paddin= g:0pt 5.4pt; vertical-align:top">ResumenIntroducc= i=C3=B3n. La extracc= i=C3=B3n quir=C3=BArgica de terceros molares suele generar dolor, edema y t= rismus postoperatorios que afectan la recuperaci=C3=B3n del paciente. Los c= orticosteroides preoperatorios se utilizan para controlar la respuesta infl= amatoria, aunque persiste controversia sobre el f=C3=A1rmaco, dosis y v=C3= =ADa de administraci=C3=B3n m=C3=A1s adecuados. Objetivo. Evaluar la eficacia y seguridad del uso = preoperatorio de corticosteroides en cirug=C3=ADa de terceros molares y pro= poner un protocolo de manejo cl=C3=ADnico basado en la evidencia reciente. = Meto= dolog=C3=ADa. Se rea= liz=C3=B3 una revisi=C3=B3n de la literatura en PubMed/MEDLINE, Scopus y Co= chrane Library. Se incluyeron estudios publicados entre 2020 y 2025 sobre e= l uso preoperatorio de corticosteroides en cirug=C3=ADa de terceros molares= . Tras aplicar criterios de inclusi=C3=B3n y exclusi=C3=B3n, se seleccionar= on 19 estudios, entre ensayos cl=C3=ADnicos aleatorizados, revisiones siste= m=C3=A1ticas y metaan=C3=A1lisis. Resultados. La dexametasona fue el corticosteroide m=C3=A1s estudiado, especialment= e en dosis =C3=BAnicas de 4=E2=80=938 mg. Su uso redujo significativamente = el edema y el trismus postoperatorios, mientras que el efecto sobre el dolo= r fue variable. Las v=C3=ADas submucosa y sublingual mostraron eficacia com= parable a las v=C3=ADas sist=C3=A9micas y mejor aceptaci=C3=B3n por parte d= el paciente. No se reportaron eventos adversos graves en pacientes sanos. <= /span>Concl= usi=C3=B3n. Los cortic= osteroides preoperatorios constituyen una estrategia eficaz y segura para r= educir las complicaciones inflamatorias tras la cirug=C3=ADa de terceros mo= lares. La dexametasona en dosis de 4=E2=80=938 mg presenta el mayor respald= o cient=C3=ADfico disponible. No obstante, la heterogeneidad de los estudio= s limita la estandarizaci=C3=B3n de protocolos, por lo que su indicaci=C3= =B3n debe individualizarse seg=C3=BAn las caracter=C3=ADsticas cl=C3=ADnica= s de cada paciente. =C3=81rea de estudio general: Odontolog=C3=ADa. =C3=81rea de estudio espec=C3=ADfica:= Cirug=C3=ADa. = Tipo de estudio: Revisi=C3= =B3n bibliogr=C3=A1fica narrativa. </td><td style=3D"padding:0pt; v= ertical-align:top"></td></tr><tr style=3D"height:28.2pt"><td colspan=3D"3" = style=3D"width:98.85pt; padding:0pt 5.4pt; vertical-align:top"><s= pan style=3D"font-family:'Times New Roman'; font-weight:bold">Keywords: </s= pan><s= pan style=3D"font-family:'Times New Roman'">Dexamethasone, corticosteroids,= pain control, third molar s= urgery, trismus.<= /td><td colspan=3D"2" style=3D"width:1pt; padding:0pt 5.4pt; vertical-align= :top"> = </td><td colspan=3D"3" style=3D"width:300.3pt; border-top:0.75pt solid = #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-al= ign:top">AbstractIntroduction. Surgical extraction of third molars is c= ommonly associated with postoperative pain, swelling, and trismus, which ma= y negatively affect patient recovery. Preoperative corticosteroids are wide= ly used to control the inflammatory response; however, uncertainty remains = regarding the optimal drug, dosage, and route of administration. <sp= an style=3D"font-family:'Times New Roman'; font-weight:bold">Objective.</sp= an> <= /span>To evaluate the efficac= y and safety of preoperative corticosteroid use in third molar surgery and = to propose an evidence-based clinical management protocol. Methodology.<= span style=3D"font-family:'Times New Roman'; font-weight:bold"> </spa= n>A literature review was con= ducted using PubMed/MEDLINE, Scopus, and the Cochrane Library. Studies publ= ished between 2020 and 2025 evaluating preoperative corticosteroid use in t= hird molar surgery were included. After applying inclusion and exclusion cr= iteria, 19 studies, including randomized clinical trials, systematic review= s, and meta-analyses, were selected. Results. Dexamethasone was the most extensively studied corticosteroid, particul= arly at single preoperative doses of 4=E2=80=938 mg. Its use significantly = reduced postoperative swelling and trismus, whereas pain control outcomes w= ere less consistent. Submucosal and sublingual administration showed effica= cy comparable to systemic routes and greater patient acceptance. No serious= adverse events were reported in healthy patients. Conclusion. Preoperative corticosteroids represe= nt an effective and safe strategy for reducing inflammatory complications a= fter third molar surgery. Dexamethasone at doses of 4=E2=80=938 mg has the = strongest scientific support. However, the heterogeneity of available studi= es limits protocol standardization; therefore, its use should be individual= ized according to each patient's clinical characteristics. General Area of Stud= y: Dentistry. <= span style=3D"font-family:'Times New Roman'; font-weight:bold">Specific are= a of study: Surgery. <= /span>Type of study: Narra= tive bibliographic review. </td><td style=3D"padding:0pt; vertical-= align:top"></td></tr><tr style=3D"height:0pt"><td style=3D"width:62.8pt"></= td><td style=3D"width:21.15pt"></td><td style=3D"width:25.7pt"></td><td sty= le=3D"width:2.25pt"></td><td style=3D"width:9.55pt"></td><td style=3D"width= :1.95pt"></td><td style=3D"width:38.5pt"></td><td style=3D"width:270.65pt">= </td><td style=3D"width:4.6pt"></td></tr></table> <ol style=3D"margin:0= pt; padding-left:0pt"><li class=3D"ListParagraph" style=3D"margin-left:17.3= pt; text-align:justify; line-height:115%; padding-left:4pt; font-family:'Ti= mes New Roman'; font-size:12pt; font-weight:bold; color:#4a442a">Introducci=C3=B3n</li></ol>La extracci=C3=B3n quir=C3=BArgica de te= rceros molares es uno de los procedimientos m=C3=A1s frecuentes en la pr=C3= =A1ctica de la cirug=C3=ADa oral y maxilofacial. A pesar de su car=C3=A1cte= r rutinario, se asocia com=C3=BAnmente a una respuesta inflamatoria postope= ratoria caracterizada por dolor, edema y trismus, lo que puede afectar sign= ificativamente la calidad de vida del paciente y retrasar su reincorporaci= =C3=B3n a las actividades cotidianas (1). En este contexto, el control adec= uado de estas complicaciones representa un desaf=C3=ADo cl=C3=ADnico releva= nte.Entr= e las estrategias farmacol=C3=B3gicas empleadas, los corticosteroides han s= ido ampliamente utilizados debido a su potente efecto antiinflamatorio, med= iado por la inhibici=C3=B3n de la fosfolipasa A=E2=82=82 y la consecuente r= educci=C3=B3n en la s=C3=ADntesis de mediadores proinflamatorios (2). En ci= rug=C3=ADa de terceros molares, f=C3=A1rmacos como la dexametasona y la met= ilprednisolona han sido objeto de m=C3=BAltiples investigaciones, report=C3= =A1ndose en varios estudios una disminuci=C3=B3n del edema y el trismus en = comparaci=C3=B3n con placebo, aunque con resultados variables en el control= del dolor (1)(3)(4).En los =C3=BAltimos a=C3=B1os, la investigaci=C3=B3n se ha ori= entado no solo a evaluar la eficacia de estos f=C3=A1rmacos, sino tambi=C3= =A9n a comparar las distintas v=C3=ADas de administraci=C3=B3n. Tradicional= mente, las v=C3=ADas sist=C3=A9micas, como la intramuscular e intravenosa, = han sido las m=C3=A1s utilizadas; sin embargo, estudios recientes han mostr= ado que las v=C3=ADas locales, como la submucosa y la sublingual, pueden of= recer una eficacia comparable, con ventajas como menor invasividad y mejor = aceptaci=C3=B3n por parte del paciente (5)(6). Asimismo, la evidencia dispo= nible sugiere que la administraci=C3=B3n en dosis =C3=BAnica preoperatoria = presenta un perfil de seguridad favorable en pacientes sanos, sin increment= o significativo de eventos adversos (2).A pesar de estos avances, persiste una falt= a de consenso respecto al corticosteroide m=C3=A1s eficaz, as=C3=AD como so= bre la dosis, el momento y la v=C3=ADa de administraci=C3=B3n =C3=B3ptimos.= Esta variabilidad en la evidencia limita la estandarizaci=C3=B3n de protoc= olos cl=C3=ADnicos y puede influir en la toma de decisiones terap=C3=A9utic= as, evidenciando la necesidad de integrar y analizar cr=C3=ADticamente la i= nformaci=C3=B3n disponible.En este sentido, el presente estudio tiene como objetiv= o general evaluar la eficacia y seguridad del uso preoperatorio de corticos= teroides en la cirug=C3=ADa de terceros molares mediante la revisi=C3=B3n d= e la literatura reciente. Como objetivos espec=C3=ADficos, se plantea anali= zar los principales corticosteroides utilizados, comparar sus v=C3=ADas de = administraci=C3=B3n, identificar las dosis m=C3=A1s reportadas y proponer u= n protocolo de manejo cl=C3=ADnico basado en la evidencia disponible.</span= ><ol start=3D"2" style=3D"margin:0pt; padding-left:0pt"><li class=3D"Li= stParagraph" style=3D"margin-left:17.3pt; margin-bottom:10pt; line-height:1= 15%; padding-left:4pt; font-family:'Times New Roman'; font-size:12pt; font-= weight:bold; color:#4a442a">Metodolog=C3=ADa<= /span></li></ol>La = presente investigaci=C3=B3n corresponde a una revisi=C3=B3n bibliogr=C3=A1f= ica narrativa de enfoque cualitativo, nivel descriptivo-anal=C3=ADtico y mo= dalidad documental. Este dise=C3=B1o metodol=C3=B3gico fue seleccionado deb= ido a que el objetivo del estudio es analizar e interpretar la evidencia ci= ent=C3=ADfica disponible sobre la eficacia del uso preoperatorio de cortico= steroides, especialmente dexametasona, en el control de las complicaciones = postoperatorias asociadas a la cirug=C3=ADa de terceros molares. </p= >La b=C3=BAsqueda d= e informaci=C3=B3n se realiz=C3=B3 en las bases de datos PubMed/MEDLINE, Sc= opus y Cochrane Library, consideradas fuentes de alta calidad cient=C3=ADfi= ca en el =C3=A1mbito de las ciencias de la salud. Para la localizaci=C3=B3n= de los estudios se utilizaron los t=C3=A9rminos dexamethasone, glucocorticoid= s, pain control, third molar surgery y trismus, combinados mediante los operadores booleanos AND = y OR. La estrategia de b=C3=BAsqueda fue adaptada a las caracter=C3=ADstica= s espec=C3=ADficas de cada base de datos y se restringi=C3=B3 a publicacion= es en idioma ingl=C3=A9s y espa=C3=B1ol correspondientes al per=C3=ADodo co= mprendido entre 2020 y 2025. Con el prop=C3=B3sito de ampliar la recuperaci= =C3=B3n de evidencia relevante, tambi=C3=A9n se efectu=C3=B3 una b=C3=BAsqu= eda manual en las listas de referencias de los art=C3=ADculos seleccionados= .La sele= cci=C3=B3n de los estudios se llev=C3=B3 a cabo considerando criterios prev= iamente establecidos. Se incluyeron investigaciones realizadas en pacientes= humanos sometidos a cirug=C3=ADa de terceros molares que evaluaran la admi= nistraci=C3=B3n preoperatoria de corticosteroides y reportaran resultados c= l=C3=ADnicos relacionados con dolor, edema, trismus o calidad de vida. Asim= ismo, se consideraron ensayos cl=C3=ADnicos aleatorizados, estudios control= ados, revisiones sistem=C3=A1ticas y metaan=C3=A1lisis. Por otra parte, se = excluyeron estudios realizados en animales o modelos in vitro, reportes de = caso, cartas al editor, opiniones de expertos, investigaciones centradas ex= clusivamente en la administraci=C3=B3n postoperatoria de corticosteroides, = estudios con intervenciones combinadas que impidieran determinar el efecto = espec=C3=ADfico de los corticosteroides y art=C3=ADculos sin acceso al text= o completo.El proceso de selecci=C3=B3n se desarroll=C3=B3 en dos etapas. Inicialme= nte se revisaron los t=C3=ADtulos y res=C3=BAmenes de los registros identif= icados, eliminando aquellos duplicados o que no cumpl=C3=ADan con los crite= rios de elegibilidad. Posteriormente, se realiz=C3=B3 la lectura completa d= e los art=C3=ADculos potencialmente relevantes para determinar su inclusi= =C3=B3n definitiva. Para la organizaci=C3=B3n y gesti=C3=B3n de las referen= cias bibliogr=C3=A1ficas se utiliz=C3=B3 la plataforma digital Rayyan (</sp= an>Qatar C= omputing Research Institute), herramienta que facilit=C3=B3 la clasificaci=C3=B3n sistem=C3=A1tic= a de los estudios y la resoluci=C3=B3n de discrepancias mediante consenso.<= /span>La interp= retaci=C3=B3n de los resultados se efectu=C3=B3 mediante un an=C3=A1lisis c= r=C3=ADtico de la evidencia disponible, considerando la calidad metodol=C3= =B3gica de los estudios, la consistencia de los hallazgos reportados, las p= osibles fuentes de sesgo y las limitaciones descritas por los autores. Este= enfoque permiti=C3=B3 valorar la solidez de la evidencia cient=C3=ADfica y= discutir la aplicabilidad de los resultados en el contexto cl=C3=ADnico de= la cirug=C3=ADa de terceros molares. Asimismo, la revisi=C3=B3n facilit=C3= =B3 la identificaci=C3=B3n de tendencias actuales en la investigaci=C3=B3n,= tales como las v=C3=ADas de administraci=C3=B3n m=C3=A1s utilizadas, las d= osis con mejores resultados cl=C3=ADnicos y los aspectos que requieren futu= ras investigaciones para fortalecer el conocimiento disponible.<= p style=3D"margin-bottom:10pt; text-align:justify; line-height:115%; font-s= ize:12pt">Los datos extra=C3= =ADdos de los estudios seleccionados fueron organizados y sistematizados me= diante matrices de an=C3=A1lisis dise=C3=B1adas para la presente investigac= i=C3=B3n, lo que permiti=C3=B3 comparar de manera estructurada las caracter= =C3=ADsticas metodol=C3=B3gicas, las intervenciones evaluadas y los princip= ales hallazgos reportados. La <a href=3D"#tabla1" style=3D"text-deco= ration:none">Tabla 1</= a> presenta una s=C3=ADntesis= de las caracter=C3=ADsticas generales de los estudios incluidos en la revi= si=C3=B3n narrativa de la literatura.<a id=3D"tabla1">Tabla 1. Caracter=C3=ADsticas de = los estudios incluidos en la revisi=C3=B3n narrativa integrativa</a>= <table style=3D"width:99.16%; margin-bottom:0pt; padding:0pt; border-co= llapse:collapse"><tr style=3D"height:2.9pt"><td style=3D"width:14.48%; bord= er-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0p= t 5pt; vertical-align:top">Autor (A=C3=B1o)</td><td style=3D"width:13.1%; border-top:= 0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; = vertical-align:top">D= ise=C3=B1o del estudio</td><td style=3D"width:18.38%; border-top= :0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt;= vertical-align:top">= Corticosteroide</td><td style=3D"width:9.74%; border-top:0.75pt = solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertica= l-align:top">Dosis</s= pan></td><td style=3D"width:15.1%; border-top:0.75pt solid #000000; bor= der-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">V=C3=ADa de administraci= =C3=B3n</td><td style=3D"width:12.78%; border-top:0.75pt solid #= 000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align= :top">Desenlaces eval= uados</td><td style=3D"width:16.42%; border-top:0.75pt solid #00= 0000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:t= op">Hallazgo principa= l</td></tr><tr style=3D"height:20.75pt"><td style=3D"width:14.48= %; border-top:0.75pt solid #000000; border-right:0.75pt solid #7f7f7f; bord= er-bottom:0.75pt solid #000000; padding:0pt 4.62pt 0pt 5pt; vertical-align:= top">Parhizkar et al. (2022) (1)<= /p></td><td style=3D"width:13.1%; border-top:0.75pt solid #000000; border-b= ottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Revisi=C3=B3n sistem=C3=A1tica</td><t= d style=3D"width:18.38%; border-top:0.75pt solid #000000; border-bottom:0.7= 5pt solid #000000; padding:0pt 5pt; vertical-align:top">Corticosteroides</td><td style=3D"width:9.74%; b= order-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding= :0pt 5pt; vertical-align:top">Variable</= span></td><td style=3D"width:15.1%; border-top:0.75pt solid #000000; bo= rder-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Variada</td><td style=3D"width:12= .78%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; = padding:0pt 5pt; vertical-align:top">Dol= or, edema, trismus</td><td style=3D"width:16.42%; border-top:0.7= 5pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; ver= tical-align:top">=E2=86=93 edema y trism= us</td></tr></table> Tabla 1. Caracter=C3=ADsticas de los estu= dios incluidos en la revisi=C3=B3n narrativa integrativa (continuaci=C3=B3n= )<table style=3D"width:99.16%; margin-bottom:0pt; padding:0pt; b= order-collapse:collapse"><tr style=3D"height:20.75pt"><td style=3D"width:14= .48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; = padding:0pt 5pt; vertical-align:top">Autor (A=C3=B1o)</td><td style=3D"width:13.1%; b= order-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding= :0pt 5pt; vertical-align:top">Dise=C3=B1o del estudio</td><td style=3D"width:18.38%; = border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; paddin= g:0pt 5pt; vertical-align:top">Corticosteroide</td><td style=3D"width:9.74%; border-t= op:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5p= t; vertical-align:top">Dosis</td><td style=3D"width:15.1%; border-top:0.75pt solid #0= 00000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:= top">V=C3=ADa de admi= nistraci=C3=B3n</td><td style=3D"width:12.78%; border-top:0.75pt= solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertic= al-align:top">Desenla= ces evaluados</td><td style=3D"width:16.42%; border-top:0.75pt s= olid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical= -align:top">Hallazgo = principal</td></tr><tr style=3D"height:20.75pt"><td style=3D"wid= th:14.48%; border-top:0.75pt solid #000000; border-right:0.75pt solid #7f7f= 7f; border-bottom:0.75pt solid #000000; padding:0pt 4.62pt 0pt 5pt; vertica= l-align:top">Canellas et al. (2022) (2)<= /span></td><td style=3D"width:13.1%; border-top:0.75pt solid #000000; b= order-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">RS + metaan=C3=A1lisis</td><td s= tyle=3D"width:18.38%; border-top:0.75pt solid #000000; border-bottom:0.75pt= solid #000000; padding:0pt 5pt; vertical-align:top">Corticosteroides</td><td style=3D"width:9.74%; bord= er-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0p= t 5pt; vertical-align:top">Variable</spa= n></td><td style=3D"width:15.1%; border-top:0.75pt solid #000000; borde= r-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Variada</td><td style=3D"width:12.78= %; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; pad= ding:0pt 5pt; vertical-align:top">Inflam= aci=C3=B3n</td><td style=3D"width:16.42%; border-top:0.75pt soli= d #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-al= ign:top"><s= pan style=3D"font-family:'Times New Roman'">Dexametasona m=C3=A1s consisten= te</td></tr><tr style=3D"height:20.75pt"><td style=3D"width:14.4= 8%; border-top:0.75pt solid #000000; border-right:0.75pt solid #7f7f7f; bor= der-bottom:0.75pt solid #000000; padding:0pt 4.62pt 0pt 5pt; vertical-align= :top"><span= style=3D"font-family:'Times New Roman'">Shad et al. (2020) (3)<= /td><td style=3D"width:13.1%; border-top:0.75pt solid #000000; border-botto= m:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">ECA</td><td style=3D"width:18.38%; border-t= op:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5p= t; vertical-align:top">Dexametasona</spa= n></td><td style=3D"width:9.74%; border-top:0.75pt solid #000000; borde= r-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">4=E2=80=938 mg</td><td style=3D"widt= h:15.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #00000= 0; padding:0pt 5pt; vertical-align:top">= Submucosa</td><td style=3D"width:12.78%; border-top:0.75pt solid= #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-ali= gn:top"><sp= an style=3D"font-family:'Times New Roman'">Edema, trismus</td><t= d style=3D"width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.7= 5pt solid #000000; padding:0pt 5pt; vertical-align:top">=E2=86=93 significativo</td></tr><tr style=3D"he= ight:20.7pt"><td style=3D"width:14.48%; border-top:0.75pt solid #000000; bo= rder-right:0.75pt solid #7f7f7f; border-bottom:0.75pt solid #000000; paddin= g:0pt 4.62pt 0pt 5pt; vertical-align:top">Larsen et al. (2021) (4)</td><td style=3D"width:13.1%; border-= top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5= pt; vertical-align:top">ECA</= td><td style=3D"width:18.38%; border-top:0.75pt solid #000000; border-botto= m:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Metilprednisolona</td><td style=3D"width:9.= 74%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; p= adding:0pt 5pt; vertical-align:top">40 m= g</td><td style=3D"width:15.1%; border-top:0.75pt solid #000000;= border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top"><= p style=3D"margin-bottom:0pt; line-height:115%; font-size:9pt">Oral</td><td style=3D"width:1= 2.78%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000;= padding:0pt 5pt; vertical-align:top">Do= lor, trismus</td><td style=3D"width:16.42%; border-top:0.75pt so= lid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-= align:top">= Sin diferencia significativa<= /span></td></tr><tr style=3D"height:33pt"><td style=3D"width:14.48%; bo= rder-top:0.75pt solid #000000; border-right:0.75pt solid #7f7f7f; border-bo= ttom:0.75pt solid #000000; padding:0pt 4.62pt 0pt 5pt; vertical-align:top">= Hiriyanna & Degala (2021) (5)= </td><td style=3D"width:13.1%; border-top:0.75pt solid #000000; border-= bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">ECA</td><td style=3D"width:18.38%; bo= rder-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:= 0pt 5pt; vertical-align:top">Dexametason= a</td><td style=3D"width:9.74%; border-top:0.75pt solid #000000;= border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top"><= p style=3D"margin-bottom:0pt; line-height:115%; font-size:9pt">4 mg</td><td style=3D"width:1= 5.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; = padding:0pt 5pt; vertical-align:top">Sub= mucosa vs IV</td><td style=3D"width:12.78%; border-top:0.75pt so= lid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-= align:top">= Edema, trismus</td= ><td style=3D"width:16.42%; border-top:0.75pt solid #000000; border-bottom:= 0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Eficacia comparable</td></tr><tr style=3D"hei= ght:33pt"><td style=3D"width:14.48%; border-top:0.75pt solid #000000; borde= r-right:0.75pt solid #7f7f7f; border-bottom:0.75pt solid #000000; padding:0= pt 4.62pt 0pt 5pt; vertical-align:top">P= riyanga et al. (2022) (6)</td><td style=3D"width:13.1%; border-t= op:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5p= t; vertical-align:top">ECA</t= d><td style=3D"width:18.38%; border-top:0.75pt solid #000000; border-bottom= :0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Dexametasona</td><td style=3D"width:9.74%; b= order-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding= :0pt 5pt; vertical-align:top">4 mg</span= ></td><td style=3D"width:15.1%; border-top:0.75pt solid #000000; border= -bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Sublingual vs IM</td><td style=3D"wid= th:12.78%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000= 000; padding:0pt 5pt; vertical-align:top">Dolor, edema, trismus</td><td style=3D"width:16.42%; border-to= p:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt= ; vertical-align:top">Sublingual efectiv= a</td></tr><tr style=3D"height:33pt"><td style=3D"width:14.48%; = border-top:0.75pt solid #000000; border-right:0.75pt solid #7f7f7f; border-= bottom:0.75pt solid #000000; padding:0pt 4.62pt 0pt 5pt; vertical-align:top= ">Momesso et al. (2021) (7)</= td><td style=3D"width:13.1%; border-top:0.75pt solid #000000; border-bottom= :0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">ECA triple ciego</td><td style=3D"width:18.3= 8%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; pa= dding:0pt 5pt; vertical-align:top">Dexam= etasona + AINE</td><td style=3D"width:9.74%; border-top:0.75pt s= olid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical= -align:top">Variable</td><td = style=3D"width:15.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt= solid #000000; padding:0pt 5pt; vertical-align:top">IM</td><td style=3D"width:12.78%; border-top:0.75pt= solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertic= al-align:top">Dolor</td><td s= tyle=3D"width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt= solid #000000; padding:0pt 5pt; vertical-align:top">Mejor en combinaci=C3=B3n</td></tr><tr style=3D"hei= ght:28.2pt"><td style=3D"width:14.48%; border-top:0.75pt solid #000000; bor= der-right:0.75pt solid #7f7f7f; border-bottom:0.75pt solid #000000; padding= :0pt 4.62pt 0pt 5pt; vertical-align:top">Singh et al. (2023) (8)</td><td style=3D"width:13.1%; border-to= p:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt= ; vertical-align:top">RS + metaan=C3=A1l= isis</td><td style=3D"width:18.38%; border-top:0.75pt solid #000= 000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:to= p">Dexa vs Metilprednisolona<= /td><td style=3D"width:9.74%; border-top:0.75pt solid #000000; border-botto= m:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Variable</td><td style=3D"width:15.1%; bord= er-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0p= t 5pt; vertical-align:top">Variada</span= ></td><td style=3D"width:12.78%; border-top:0.75pt solid #000000; borde= r-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Dolor, inflamaci=C3=B3n</td><td styl= e=3D"width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt so= lid #000000; padding:0pt 5pt; vertical-align:top">Eficacia similar</td></tr><tr style=3D"height:28.2pt">= <td style=3D"width:14.48%; border-top:0.75pt solid #000000; border-right:0.= 75pt solid #7f7f7f; border-bottom:0.75pt solid #000000; padding:0pt 4.62pt = 0pt 5pt; vertical-align:top">Antonelli e= t al. (2023) (9)</td><td style=3D"width:13.1%; border-top:0.75pt= solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertic= al-align:top">ECA</td><td sty= le=3D"width:18.38%; border-top:0.75pt solid #000000; border-bottom:0.75pt s= olid #000000; padding:0pt 5pt; vertical-align:top">Prednisona</td><td style=3D"width:9.74%; border-top:0= .75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; v= ertical-align:top">25 mg</td>= <td style=3D"width:15.1%; border-top:0.75pt solid #000000; border-bottom:0.= 75pt solid #000000; padding:0pt 5pt; vertical-align:top">Oral</td><td style=3D"width:12.78%; border-top:= 0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; = vertical-align:top">Edema</td= ><td style=3D"width:16.42%; border-top:0.75pt solid #000000; border-bottom:= 0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">=E2=86=93 edema</td></tr><tr style=3D"height:= 28.2pt"><td style=3D"width:14.48%; border-top:0.75pt solid #000000; border-= right:0.75pt solid #7f7f7f; border-bottom:0.75pt solid #000000; padding:0pt= 4.62pt 0pt 5pt; vertical-align:top">Lib= =C3=B3rio et al. (2025) (10)</td><td style=3D"width:13.1%; borde= r-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt= 5pt; vertical-align:top">RS + metaan=C3= =A1lisis</td><td style=3D"width:18.38%; border-top:0.75pt solid = #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-alig= n:top"><spa= n style=3D"font-family:'Times New Roman'">Metilprednisolona</td>= <td style=3D"width:9.74%; border-top:0.75pt solid #000000; border-bottom:0.= 75pt solid #000000; padding:0pt 5pt; vertical-align:top">Variable</td><td style=3D"width:15.1%; border-t= op:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5p= t; vertical-align:top">Variada</p= ></td><td style=3D"width:12.78%; border-top:0.75pt solid #000000; border-bo= ttom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Dolor, inflamaci=C3=B3n</td><td style=3D= "width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid = #000000; padding:0pt 5pt; vertical-align:top">Beneficio variable</td></tr><tr style=3D"height:28.2pt"><t= d style=3D"width:14.48%; border-top:0.75pt solid #000000; border-right:0.75= pt solid #7f7f7f; border-bottom:0.75pt solid #000000; padding:0pt 4.62pt 0p= t 5pt; vertical-align:top">Hou et al. (2= 021) (11)</td><td style=3D"width:13.1%; border-top:0.75pt solid = #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-alig= n:top"><spa= n style=3D"font-family:'Times New Roman'">RS + metaan=C3=A1lisis= </td><td style=3D"width:18.38%; border-top:0.75pt solid #000000; border-bot= tom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Dexametasona</td><td style=3D"width:9.74%= ; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padd= ing:0pt 5pt; vertical-align:top">4=E2=80= =938 mg</td><td style=3D"width:15.1%; border-top:0.75pt solid #0= 00000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:= top">Submucosa vs sist=C3=A9mica<= /p></td><td style=3D"width:12.78%; border-top:0.75pt solid #000000; border-= bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Edema, trismus</td><td style=3D"width= :16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #00000= 0; padding:0pt 5pt; vertical-align:top">= Sin diferencias significativas</td></tr><tr style=3D"height:36.4= 5pt"><td style=3D"width:14.48%; border-top:0.75pt solid #000000; border-rig= ht:0.75pt solid #7f7f7f; border-bottom:0.75pt solid #000000; padding:0pt 4.= 62pt 0pt 5pt; vertical-align:top">Martin= s-de-Barros et al. (2021) (12)</td><td style=3D"width:13.1%; bor= der-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0= pt 5pt; vertical-align:top">ECA triple c= iego</td><td style=3D"width:18.38%; border-top:0.75pt solid #000= 000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:to= p">Dexa vs ketorolaco</td><td= style=3D"width:9.74%; border-top:0.75pt solid #000000; border-bottom:0.75p= t solid #000000; padding:0pt 5pt; vertical-align:top">Variable</td><td style=3D"width:15.1%; border-top:= 0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; = vertical-align:top">IM</td><t= d style=3D"width:12.78%; border-top:0.75pt solid #000000; border-bottom:0.7= 5pt solid #000000; padding:0pt 5pt; vertical-align:top">Dolor, edema</td><td style=3D"width:16.42%; bord= er-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0p= t 5pt; vertical-align:top">Dexa superior= </td></tr><tr style=3D"height:27.15pt"><td style=3D"width:14.48%= ; border-top:0.75pt solid #000000; border-right:0.75pt solid #7f7f7f; borde= r-bottom:0.75pt solid #000000; padding:0pt 4.62pt 0pt 5pt; vertical-align:t= op">Suleiman et al. (2024) (13)</= p></td><td style=3D"width:13.1%; border-top:0.75pt solid #000000; border-bo= ttom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">ECA</td><td style=3D"width:18.38%; borde= r-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt= 5pt; vertical-align:top">Dexa vs ketopr= ofeno</td><td style=3D"width:9.74%; border-top:0.75pt solid #000= 000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:to= p">Variable</td><td style=3D"= width:15.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #0= 00000; padding:0pt 5pt; vertical-align:top">Sist=C3=A9mica</td><td style=3D"width:12.78%; border-top:0.7= 5pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; ver= tical-align:top">Calidad de vida<= /p></td><td style=3D"width:16.42%; border-top:0.75pt solid #000000; border-= bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Dexa mejora resultados</td></tr><tr s= tyle=3D"height:25.4pt"><td style=3D"width:14.48%; border-top:0.75pt solid #= 000000; border-right:0.75pt solid #7f7f7f; border-bottom:0.75pt solid #0000= 00; padding:0pt 4.62pt 0pt 5pt; vertical-align:top">Pimenta et al. (2024) (14)</td><td style=3D"width:13= .1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; p= adding:0pt 5pt; vertical-align:top">Revi= si=C3=B3n de revisiones</td><td style=3D"width:18.38%; border-to= p:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt= ; vertical-align:top">AINEs + corticoide= s</td><td style=3D"width:9.74%; border-top:0.75pt solid #000000;= border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top"><= p style=3D"margin-bottom:0pt; line-height:115%; font-size:9pt">Variable</td><td style=3D"wid= th:15.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #0000= 00; padding:0pt 5pt; vertical-align:top">Variada</td><td style=3D"width:12.78%; border-top:0.75pt solid = #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-alig= n:top"><spa= n style=3D"font-family:'Times New Roman'">Dolor</td><td style=3D= "width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid = #000000; padding:0pt 5pt; vertical-align:top">Mejor en combinaci=C3=B3n</td></tr><tr style=3D"height:28.= 15pt"><td style=3D"width:14.48%; border-top:0.75pt solid #000000; border-ri= ght:0.75pt solid #7f7f7f; border-bottom:0.75pt solid #000000; padding:0pt 4= .62pt 0pt 5pt; vertical-align:top">Nils = et al. (2023) (15)</td><td style=3D"width:13.1%; border-top:0.75= pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vert= ical-align:top">Revisi=C3=B3n= </td><td style=3D"width:18.38%; border-top:0.75pt solid #000000; border-bot= tom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Glucocorticoides</td><td style=3D"width:9= .74%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; = padding:0pt 5pt; vertical-align:top">Var= iable</td><td style=3D"width:15.1%; border-top:0.75pt solid #000= 000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:to= p">Variada</td><td style=3D"w= idth:12.78%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #0= 00000; padding:0pt 5pt; vertical-align:top">Seguridad</td><td style=3D"width:16.42%; border-top:0.75pt s= olid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical= -align:top">Seguro en dosis =C3=BAnica</= span></td></tr><tr style=3D"height:33pt"><td style=3D"width:14.48%; bor= der-top:0.75pt solid #000000; border-right:0.75pt solid #7f7f7f; border-bot= tom:0.75pt solid #000000; padding:0pt 4.62pt 0pt 5pt; vertical-align:top"><= p style=3D"margin-bottom:0pt; line-height:115%; font-size:9pt">Satpathi et al. (2024) (16)</= td><td style=3D"width:13.1%; border-top:0.75pt solid #000000; border-bottom= :0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Revisi=C3=B3n</td><td style=3D"width:18.38%;= border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; paddi= ng:0pt 5pt; vertical-align:top">Corticos= teroides</td><td style=3D"width:9.74%; border-top:0.75pt solid #= 000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align= :top"><span= style=3D"font-family:'Times New Roman'">Variable</td><td style= =3D"width:15.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt soli= d #000000; padding:0pt 5pt; vertical-align:top">Variada</td><td style=3D"width:12.78%; border-top:0.75pt= solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertic= al-align:top">Uso cl=C3=ADnico</p= ></td><td style=3D"width:16.42%; border-top:0.75pt solid #000000; border-bo= ttom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Beneficio antiinflamatorio general</td><= /tr><tr style=3D"height:33pt"><td style=3D"width:14.48%; border-top:0.75pt = solid #000000; border-right:0.75pt solid #7f7f7f; border-bottom:0.75pt soli= d #000000; padding:0pt 4.62pt 0pt 5pt; vertical-align:top">Nehme et al. (2021) (17)</td><td style=3D"wid= th:13.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #0000= 00; padding:0pt 5pt; vertical-align:top">ECA</td><td style=3D"width:18.38%; border-top:0.75pt solid #000= 000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:to= p">Dexametasona</td><td style= =3D"width:9.74%; border-top:0.75pt solid #000000; border-bottom:0.75pt soli= d #000000; padding:0pt 5pt; vertical-align:top">Variable</td><td style=3D"width:15.1%; border-top:0.75pt= solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertic= al-align:top">IM</td><td styl= e=3D"width:12.78%; border-top:0.75pt solid #000000; border-bottom:0.75pt so= lid #000000; padding:0pt 5pt; vertical-align:top">Dolor</td><td style=3D"width:16.42%; border-top:0.75pt= solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertic= al-align:top">=E2=86=93 dolor postoperat= orio</td></tr><tr style=3D"height:28.2pt"><td style=3D"width:14.= 48%; border-top:0.75pt solid #000000; border-right:0.75pt solid #7f7f7f; bo= rder-bottom:0.75pt solid #000000; padding:0pt 4.62pt 0pt 5pt; vertical-alig= n:top"><spa= n style=3D"font-family:'Times New Roman'">Kaya & Akt=C4=B1 (2024) (18)</td><td style=3D"width:13.1= %; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; pad= ding:0pt 5pt; vertical-align:top">ECA</s= pan></td><td style=3D"width:18.38%; border-top:0.75pt solid #000000; bo= rder-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Dexametasona</td><td style=3D"wid= th:9.74%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #0000= 00; padding:0pt 5pt; vertical-align:top">Variable</td><td style=3D"width:15.1%; border-top:0.75pt solid = #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-alig= n:top"><spa= n style=3D"font-family:'Times New Roman'">Perineural vs sist=C3=A9mica</spa= n></td><td style=3D"width:12.78%; border-top:0.75pt solid #000000; bord= er-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Dolor, anestesia</td><td style=3D"w= idth:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #0= 00000; padding:0pt 5pt; vertical-align:top">Efectividad comparable</td></tr><tr style=3D"height:27.05pt"= ><td style=3D"width:14.48%; border-top:0.75pt solid #000000; border-right:0= .75pt solid #7f7f7f; border-bottom:0.75pt solid #000000; padding:0pt 4.62pt= 0pt 5pt; vertical-align:top">Kaewkumner= t et al. (2020) (19)</td><td style=3D"width:13.1%; border-top:0.= 75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; ve= rtical-align:top">ECA</td><td= style=3D"width:18.38%; border-top:0.75pt solid #000000; border-bottom:0.75= pt solid #000000; padding:0pt 5pt; vertical-align:top">Dexametasona</td><td style=3D"width:9.74%; border= -top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt = 5pt; vertical-align:top">Variable= </td><td style=3D"width:15.1%; border-top:0.75pt solid #000000; border-= bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Intra=C3=B3sea vs submucosa</td><td s= tyle=3D"width:12.78%; border-top:0.75pt solid #000000; border-bottom:0.75pt= solid #000000; padding:0pt 5pt; vertical-align:top">Edema, trismus</td><td style=3D"width:16.42%; borde= r-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt= 5pt; vertical-align:top">Resultados sim= ilares</td></tr></table>&#x= a0; = = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; <ol start=3D"3" s= tyle=3D"margin:0pt; padding-left:0pt"><li class=3D"ListParagraph" style=3D"= margin-left:17.45pt; margin-bottom:10pt; line-height:115%; padding-left:3.8= 5pt; font-family:'Times New Roman'; font-size:12pt; font-weight:bold; color= :#4a442a">Resultados </li></ol>La b=C3=BAsqueda bibliogr= =C3=A1fica identific=C3=B3 un total de 646 art=C3=ADculos, de los cuales, t= ras la eliminaci=C3=B3n de duplicados y la aplicaci=C3=B3n de criterios de = selecci=C3=B3n, se incluyeron 19 estudios en la revisi=C3=B3n. El proceso d= e selecci=C3=B3n se detalla en la <a href=3D"#fig1" style=3D"text-de= coration:none">Figura 1</span= ></a> </spa= n>y las caracter=C3=ADsticas = principales de los estudios se resumen en la <a href=3D"#tabla1" style= =3D"text-decoration:none">Tab= la 1</a>.<img src=3D"data:image/png;base64,iVBORw0KGgoAAAA= NSUhEUgAAAfoAAAFXCAYAAABKl4x5AAAABHNCSVQICAgIfAhkiAAAAAlwSFlzAAAOxAAADsQBlS= sOGwAAIABJREFUeJzEvXe4XUW5P/6Ztfbep5f0k15ISGghQhJa6AgKiBfRe0UpIlwVVEDvVQEBQ= YqgNAVRihQRRer1AkpHkAASahIIhJBCQpKTk3b6OXvvNfP7Y9o7s2btfeJ9vs9veMLZe62Zt81b= Z2atzZKEC0AAABhjEEKYv7oxxvB/aRrmEDoChIassalrQtLIBf+XaDXwfPwMWjSyMQCCgQEOrtR= 41XUHKFBDNcL0aAU6RbchC+l5YmAQEEOWp553vz/g6kZW03OgcYdwZPEPMCtrRrkK8MuY4S3UMz= R/tL/EKFI0+ng0LiFUXwZnIig9lI0UUQ5fGRIIyMeZP4nIoSlEc1jGjiAAoXU1mx6frjR9DCLD3= irpqqGRAUzQeZM0+vpGx/g0DMWvaBhRFCndBgDNk0dniPAhNH8u0valwQoIoedwh9EoYPDmTV7w= dUTSxAwe57vHJ7WFIftqB4zVL3fO9L1KYz1W/CHeNYc+AbAobQsUCVP+ODVWw2beZ0KY5ipLJln= 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/M4mNJ5QZOClv79b5Djbj+4S4y2KbtTZ7WxgFsYQHIN5yM2LuJMhL9itqizyW7zTJ5BfJjctQbD= 6Y8go8DcjlDOVOM+E04B06Cl6N16ElPr3vga1VNqclrCHop0AjJOrgPo5myVckawnjZCiUiMiX+= XhrYE06OgELpiBXYH9kXCjZmpLogRi/aGs53WUpzZGCKgkeUhvzoGDIxsQcYS4TaQ7g7SBnKMoC= qIp80hx0vpzs2fehkFjIGVlFny2Sn4FUFA1ARAOBgGLVKXgWAsLTlVKGLX4mq/Q/uWCpeJGmtqi= JLMHfRcUWYmO6QEkgZufTKimiUT5fzieSuZIAxFsufOSZaCAeC/NUkP2gQ0aCMVgKCy+Ot8oaGs= NPJgLRegY6lt+6Vggomd5NGJtUT5ptsfPcGfmaBxmjsKlOBF+ZUzNfyINO3TcSOzO53sHHJFFcO= HthbaSO43CWyUMFz4gXgnbqKyahnwU1x3jQYXFnRvCSaEzTlQbGGb0gH1K+0vk8muE6y+KZvpZi= GcK/XL4AFoIOZFItgFzqlyQyPnPqOwmYsWJdRCvpMI/lJvGdrMAJsqcxNYz1ujUJn0G8OJYdic/= 0QGrbCTjj8SSClYBweB7wSwzSf1QC0wizSabpzKaTz2D6tmza+K8eP1If5DpObDaRPbUF1b8y2t= JCf9p+2n7aftp+2n7aftr+f9f+X3lDUAZFZ6JBAAAAAElFTkSuQmCC" width=3D"506" heigh= t=3D"343" alt=3D"" /><a id=3D"fig1">Figura 1. Flujograma de revisi=C3=B3n</a>En relaci=C3=B3n con los de= senlaces cl=C3=ADnicos, el edema y el trismus fueron los par=C3=A1metros qu= e mostraron mayor consistencia en la respuesta al uso preoperatorio de cort= icosteroides, evidenciando una reducci=C3=B3n significativa en la mayor=C3= =ADa de los estudios incluidos (1)(2)(3). Por el contrario, el control del = dolor present=C3=B3 mayor variabilidad, dependiendo del tipo de f=C3=A1rmac= o, la dosis, la v=C3=ADa de administraci=C3=B3n y el uso concomitante de ot= ros analg=C3=A9sicos (7)(8).Desde el punto de vista farmacol=C3=B3gico, la dexameta= sona fue el corticosteroide m=C3=A1s ampliamente estudiado y con resultados= m=C3=A1s consistentes, especialmente en dosis =C3=BAnicas preoperatorias d= e 4 a 8 mg (1)(2). Otros f=C3=A1rmacos como la metilprednisolona y la predn= isona tambi=C3=A9n mostraron efectos favorables, aunque con evidencia m=C3= =A1s heterog=C3=A9nea (4)(9)(10)(20)(21)(22). Respecto a las v=C3=ADas de administr= aci=C3=B3n, tanto las rutas sist=C3=A9micas (intramuscular e intravenosa) c= omo las locales (submucosa y sublingual) demostraron eficacia en la reducci= =C3=B3n del edema y el trismus (3)(5)(11). No obstante, las v=C3=ADas local= es presentaron ventajas cl=C3=ADnicas adicionales, como menor invasividad y= mejor aceptaci=C3=B3n por parte del paciente (1)(6).<= span style=3D"font-family:'Times New Roman'">En la comparaci=C3=B3n con otr= os f=C3=A1rmacos, algunos estudios reportaron que la dexametasona presenta = una eficacia comparable o superior a los antiinflamatorios no esteroideos e= n el control del dolor y la inflamaci=C3=B3n postoperatoria, particularment= e cuando se administra de forma preoperatoria (12)(13). Asimismo, la combin= aci=C3=B3n de corticosteroides con AINEs mostr=C3=B3 efectos sin=C3=A9rgico= s en el control del dolor temprano (7).En t=C3=A9rminos de seguridad, los estudios = incluidos no reportaron eventos adversos graves asociados al uso de cortico= steroides en dosis =C3=BAnica preoperatoria en pacientes sanos. Sin embargo= , se observ=C3=B3 una considerable heterogeneidad metodol=C3=B3gica, especi= almente en la evaluaci=C3=B3n del edema, lo que limita la comparabilidad di= recta entre estudios (3)(9).<ol start=3D"4" style=3D"margin:0pt;= padding-left:0pt"><li class=3D"ListParagraph" style=3D"margin-top:12pt; ma= rgin-left:17.3pt; line-height:115%; padding-left:4pt; font-family:'Times Ne= w Roman'; font-size:12pt; font-weight:bold; color:#4a442a">Discusi=C3=B3n </s= pan></li></ol>La ev= idencia analizada en esta revisi=C3=B3n sistem=C3=A1tica respalda el uso pr= eoperatorio de corticosteroides como una estrategia eficaz para modular la = respuesta inflamatoria posterior a la cirug=C3=ADa de terceros molares. No = obstante, la magnitud y consistencia de este beneficio deben interpretarse = con cautela, debido a limitaciones metodol=C3=B3gicas relevantes y a la het= erogeneidad de los estudios incluidos. En este contexto, tanto Parhizkar et= al. (1) = como Canellas et al. (2)</spa= n> coinciden en se=C3=B1alar una reducci=C3= =B3n significativa del edema y el trismus con el uso de corticosteroides, p= articularmente dexametasona, hallazgos que tambi=C3=A9n son corroborados po= r Shad et al. (3). Sin embargo, estos resultados contrastan con la variabil= idad observada en otros desenlaces, especialmente en el control del dolor.<= /span>Desde una= perspectiva farmacol=C3=B3gica, la eficacia observada puede explicarse por= el mecanismo de acci=C3=B3n de los corticosteroides, los cuales inhiben la= fosfolipasa A=E2=82=82 y reducen la s=C3=ADntesis de mediadores proinflama= torios (2). Este efecto upstream en la cascada inflamatoria permite comprender por qu=C3=A9 los resu= ltados son m=C3=A1s consistentes en la reducci=C3=B3n del edema y el trismu= s que en el control del dolor. En concordancia, Pimenta et al. (14) y Singh= et al. (8) destacan que el dolor postoperatorio tiene una naturaleza multi= factorial, influenciada no solo por la inflamaci=C3=B3n, sino tambi=C3=A9n = por factores quir=C3=BArgicos y neurosensoriales, lo que limita el impacto = de los corticosteroides como monoterapia.En relaci=C3=B3n con la comparaci=C3=B3n= entre f=C3=A1rmacos, Singh et al. (8) reportan una eficacia similar entre = dexametasona y metilprednisolona en la reducci=C3=B3n del dolor y la inflam= aci=C3=B3n, mientras que Larsen et al. (4) no evidenciaron beneficios signi= ficativos con metilprednisolona frente a placebo. Por su parte, Antonelli e= t al. (9) observaron que la prednisona puede reducir el edema facial, aunqu= e con menor respaldo comparativo. En conjunto, estos hallazgos sugieren que= , si bien existen alternativas terap=C3=A9uticas, la aparente superioridad = de la dexametasona podr=C3=ADa estar influenciada tanto por sus propiedades= farmacol=C3=B3gicas como por la mayor cantidad de evidencia disponible, m= =C3=A1s que por diferencias cl=C3=ADnicas contundentes.Un aspecto cr=C3=ADtico ide= ntificado en la literatura es la falta de estandarizaci=C3=B3n en las dosis= y en la equivalencia farmacol=C3=B3gica entre corticosteroides. Aunque la = dexametasona se emplea com=C3=BAnmente en dosis de 4=E2=80=938 mg (1)(2), n= o existe una justificaci=C3=B3n farmacodin=C3=A1mica uniforme que respalde = este rango como =C3=B3ptimo. Adem=C3=A1s, otros corticosteroides, como la m= etilprednisolona y la prednisona, han sido utilizados en dosis no equipoten= tes (4)(9), lo que introduce un sesgo sistem=C3=A1tico en la comparaci=C3= =B3n de resultados y limita la interpretaci=C3=B3n de la eficacia relativa = entre f=C3=A1rmacos.En cuanto a las v=C3=ADas de administraci=C3=B3n, estudios como= los de Hiriyanna & Degala (5) y Hou et al. (11) demostraron una eficac= ia comparable entre las v=C3=ADas submucosa, intravenosa e intramuscular, m= ientras que Priyanga et al. (6) sugieren incluso una posible ventaja de la = v=C3=ADa sublingual en ciertos desenlaces. No obstante, estas diferencias n= o son cl=C3=ADnicamente concluyentes, y la variabilidad en los dise=C3=B1os= de estudio y en los m=C3=A9todos de medici=C3=B3n limita la validez extern= a de estos hallazgos. A pesar de ello, desde una perspectiva pr=C3=A1ctica,= las v=C3=ADas locales presentan ventajas relevantes en t=C3=A9rminos de me= nor invasividad, facilidad de aplicaci=C3=B3n y mayor aceptaci=C3=B3n por p= arte del paciente.En relaci=C3=B3n con el control del dolor, los resultados son men= os consistentes. Mientras que Martins-de-Barros et al. (12) reportan una ma= yor eficacia de la dexametasona frente a ketorolaco, Momesso et al. (7) evi= dencian que la combinaci=C3=B3n de corticosteroides con AINEs mejora signif= icativamente el control del dolor en el postoperatorio temprano. Estos hall= azgos sugieren que el uso aislado de corticosteroides puede ser insuficient= e para un manejo analg=C3=A9sico =C3=B3ptimo, reforzando la necesidad de en= foques terap=C3=A9uticos multimodales que integren diferentes mecanismos de= acci=C3=B3n.En t=C3=A9rminos de seguridad, la evidencia disponible, incluyendo los= trabajos de Nils et al. (15) y Canellas et al. (2) indica que la administr= aci=C3=B3n de corticosteroides en dosis =C3=BAnica preoperatoria presenta u= n perfil favorable en pacientes sanos, sin incremento significativo de even= tos adversos. Sin embargo, esta conclusi=C3=B3n est=C3=A1 condicionada por = la limitada inclusi=C3=B3n de pacientes con comorbilidades en los estudios = analizados, lo que restringe la extrapolaci=C3=B3n de los resultados a pobl= aciones m=C3=A1s complejas.En este contexto, el uso de corticosteroides en paciente= s con enfermedades sist=C3=A9micas requiere una evaluaci=C3=B3n rigurosa, y= a que sus efectos inmunosupresores y metab=C3=B3licos pueden agravar condic= iones preexistentes o descompensar patolog=C3=ADas de base. Aunque la admin= istraci=C3=B3n en dosis =C3=BAnica preoperatoria ha demostrado un perfil de= seguridad favorable en pacientes sanos, en individuos con comorbilidades i= ncluso exposiciones =C3=BAnicas pueden inducir alteraciones metab=C3=B3lica= s e inmunol=C3=B3gicas transitorias cl=C3=ADnicamente relevantes. Estos f= =C3=A1rmacos pueden favorecer la hiperglucemia, la retenci=C3=B3n de l=C3= =ADquidos, la elevaci=C3=B3n de la presi=C3=B3n arterial y una disminuci=C3= =B3n de la respuesta inmunitaria, lo que podr=C3=ADa incrementar el riesgo = de infecciones o retrasar la cicatrizaci=C3=B3n en pacientes susceptibles. = En este sentido, condiciones como la diabetes mellitus no controlada, la hi= pertensi=C3=B3n arterial descompensada, los estados de inmunosupresi=C3=B3n= o infecciones activas, as=C3=AD como trastornos gastrointestinales, hep=C3= =A1ticos o renales, representan escenarios cl=C3=ADnicos en los que su indi= caci=C3=B3n debe ser cuidadosamente valorada (2)(14)(16). En consecuencia, = aunque la seguridad de los corticosteroides ha sido ampliamente demostrada = en pacientes ASA I=E2=80=93II, la evidencia actual no permite generalizar e= stos hallazgos a poblaciones con enfermedades sist=C3=A9micas, lo que refue= rza la necesidad de individualizar su uso y evitar su indicaci=C3=B3n rutin= aria en estos pacientes.Finalmente, es importante considerar las limitaciones metod= ol=C3=B3gicas de la evidencia disponible. La heterogeneidad en las t=C3=A9c= nicas quir=C3=BArgicas, el tiempo operatorio y la experiencia del cirujano = constituye una fuente relevante de variabilidad que no siempre es controlad= a adecuadamente (17). Asimismo, la diversidad en los m=C3=A9todos de medici= =C3=B3n del edema y del trismus se=C3=B1alada por Hou et al. (11) y Antonel= li et al. (9), dificulta la comparabilidad entre estudios. A esto se suma l= a frecuente presencia de cointervenciones, como el uso concomitante de AINE= s, que introduce sesgos de confusi=C3=B3n y limita la atribuci=C3=B3n del e= fecto exclusivamente a los corticosteroides (7)(12).<= span style=3D"font-family:'Times New Roman'">En conjunto, aunque la evidenc= ia respalda el uso preoperatorio de corticosteroides, particularmente la de= xametasona, la magnitud del beneficio cl=C3=ADnico puede estar condicionada= por factores metodol=C3=B3gicos no controlados. En este sentido, se requie= ren ensayos cl=C3=ADnicos con mayor rigor metodol=C3=B3gico que incluyan la= estandarizaci=C3=B3n de dosis basada en equivalencia farmacol=C3=B3gica, e= l adecuado control de variables confusoras y la evaluaci=C3=B3n de desenlac= es cl=C3=ADnicamente relevantes. Este enfoque permitir=C3=A1 avanzar hacia = la definici=C3=B3n de protocolos cl=C3=ADnicos m=C3=A1s precisos, reproduci= bles y aplicables en la pr=C3=A1ctica cl=C3=ADnica. En concordancia con los= hallazgos de la presente investigaci=C3=B3n, se propone un protocolo para = el uso de corticosteroides en cirug=C3=ADa de terceros molares, el cual se = presenta en la <a href=3D"#tabla2" style=3D"text-decoration:none"><s= pan class=3D"Hyperlink" style=3D"font-family:'Times New Roman'; font-weight= :bold; text-decoration:none; color:#000000">Tabla 2</a>. <a id=3D"tabla2"><sp= an style=3D"font-family:'Times New Roman'; font-weight:bold">Tabla 2.</span= > Protocol= o preoperatorio de corticosteroides en la cirug=C3=ADa de terceros molares<= /span></a><table style=3D"width:419.9pt; margin-bottom:0pt; padding:0pt= ; border-collapse:collapse"><tr style=3D"height:42.05pt"><td style=3D"width= :53.8pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #00000= 0; padding:0pt 5pt; vertical-align:top">Corticosteroide</td><td style=3D"width:18.35= pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; pa= dding:0pt 5pt; vertical-align:top">Dosis</td><td style=3D"width:31.4pt; border-top:0= .75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; v= ertical-align:top">V= =C3=ADa</td><td style=3D"width:33.65pt; border-top:0.75pt solid = #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-alig= n:top">Momento</span= ></td><td style=3D"width:42.25pt; border-top:0.75pt solid #000000; bord= er-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Indicaciones principales</= span></td><td style=3D"width:48.3pt; border-top:0.75pt solid #000000; b= order-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Observaciones cl=C3=ADn= icas</td><td style=3D"width:28.8pt; border-top:0.75pt solid #000= 000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:to= p">Nivel de respaldo= </td><td style=3D"width:31pt; border-top:0.75pt solid #000000; b= order-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Calidad de evidencia (gr= ade)</td><td style=3D"width:42.35pt; border-top:0.75pt solid #00= 0000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:t= op">Consistencia de = resultados</td></tr><tr style=3D"height:31.25pt"><td style=3D"wi= dth:53.8pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #7f7= f7f; border-bottom:0.75pt solid #000000; padding:0pt 4.62pt 0pt 5pt; vertic= al-align:top">Dexametasona</= td><td style=3D"width:18.35pt; border-top:0.75pt solid #000000; border-bott= om:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">4=E2=80=938 mg</td><td style=3D"width:31.= 4pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; p= adding:0pt 5pt; vertical-align:top">Sub= mucosa</td><td style=3D"width:33.65pt; border-top:0.75pt solid #= 000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align= :top"><spa= n style=3D"font-family:'Times New Roman'">Preoperatorio inmediato</p= ></td><td style=3D"width:42.25pt; border-top:0.75pt solid #000000; border-b= ottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Edema, trismus</td><td style=3D"widt= h:48.3pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #0000= 00; padding:0pt 5pt; vertical-align:top">Alternativa eficaz y menos invasiva</td><td style=3D"width:28.= 8pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; p= adding:0pt 5pt; vertical-align:top">Alt= o</td><td style=3D"width:31pt; border-top:0.75pt solid #000000; = border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top"><p= style=3D"margin-bottom:10pt; line-height:115%; font-size:8pt">Moderada</td><td style=3D"wid= th:42.35pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #00= 0000; padding:0pt 5pt; vertical-align:top">Alta</td></tr><tr style=3D"height:39.7pt"><td style=3D"width= :53.8pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #7f7f7f= ; border-bottom:0.75pt solid #000000; padding:0pt 4.62pt 0pt 5pt; vertical-= align:top">Dexametasona</td>= <td style=3D"width:18.35pt; border-top:0.75pt solid #000000; border-bottom:= 0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">4=E2=80=938 mg</td><td style=3D"width:31.4pt= ; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padd= ing:0pt 5pt; vertical-align:top">Intram= uscular</td><td style=3D"width:33.65pt; border-top:0.75pt solid = #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-alig= n:top"><sp= an style=3D"font-family:'Times New Roman'">30=E2=80=9360 min antes</= p></td><td style=3D"width:42.25pt; border-top:0.75pt solid #000000; border-= bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Control inflamatorio global</td><td = style=3D"width:48.3pt; border-top:0.75pt solid #000000; border-bottom:0.75p= t solid #000000; padding:0pt 5pt; vertical-align:top">V=C3=ADa tradicional, ampliamente estudiada</td><= td style=3D"width:28.8pt; border-top:0.75pt solid #000000; border-bottom:0.= 75pt solid #000000; padding:0pt 5pt; vertical-align:top">Alto</td><td style=3D"width:31pt; border-top:0= .75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; v= ertical-align:top">Moderada<= /td><td style=3D"width:42.35pt; border-top:0.75pt solid #000000; border-bot= tom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Alta</td></tr><tr style=3D"height:35.25p= t"><td style=3D"width:53.8pt; border-top:0.75pt solid #000000; border-right= :0.75pt solid #7f7f7f; border-bottom:0.75pt solid #000000; padding:0pt 4.62= pt 0pt 5pt; vertical-align:top">Dexamet= asona</td><td style=3D"width:18.35pt; border-top:0.75pt solid #0= 00000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:= top"><span= style=3D"font-family:'Times New Roman'">4=E2=80=938 mg</td><td = style=3D"width:31.4pt; border-top:0.75pt solid #000000; border-bottom:0.75p= t solid #000000; padding:0pt 5pt; vertical-align:top">Sublingual</td><td style=3D"width:33.65pt; border= -top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt = 5pt; vertical-align:top">30=E2=80=9360 = min antes</td><td style=3D"width:42.25pt; border-top:0.75pt soli= d #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-al= ign:top"><= span style=3D"font-family:'Times New Roman'">Edema, trismus, dolor</= p></td><td style=3D"width:48.3pt; border-top:0.75pt solid #000000; border-b= ottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Alta aceptaci=C3=B3n, r=C3=A1pida acci=C3=B3n</= span></td><td style=3D"width:28.8pt; border-top:0.75pt solid #000000; b= order-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Moderado</td><td style=3D"wid= th:31pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #00000= 0; padding:0pt 5pt; vertical-align:top">Baja=E2=80=93moderada</td><td style=3D"width:42.35pt; border-to= p:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt= ; vertical-align:top">Variable</= p></td></tr><tr style=3D"height:35.25pt"><td style=3D"width:53.8pt; border-= top:0.75pt solid #000000; border-right:0.75pt solid #7f7f7f; border-bottom:= 0.75pt solid #000000; padding:0pt 4.62pt 0pt 5pt; vertical-align:top">Dexametasona</td><td style=3D"wid= th:18.35pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #00= 0000; padding:0pt 5pt; vertical-align:top">4=E2=80=938 mg</td><td style=3D"width:31.4pt; border-top:0.7= 5pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; ver= tical-align:top">Intravenosa= </td><td style=3D"width:33.65pt; border-top:0.75pt solid #000000; border-bo= ttom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Durante inducci=C3=B3n</td><td style=3D= "width:42.25pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid= #000000; padding:0pt 5pt; vertical-align:top">Control r=C3=A1pido del edema</td><td style=3D"width:48.= 3pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; p= adding:0pt 5pt; vertical-align:top">May= or invasividad, uso hospitalario</td><td style=3D"width:28.8pt; = border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; paddin= g:0pt 5pt; vertical-align:top">Moderado= </td><td style=3D"width:31pt; border-top:0.75pt solid #000000; b= order-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Moderada</td><td style=3D"wid= th:42.35pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #00= 0000; padding:0pt 5pt; vertical-align:top">Variable</td></tr><tr style=3D"height:35.25pt"><td style=3D"= width:53.8pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #7= f7f7f; border-bottom:0.75pt solid #000000; padding:0pt 4.62pt 0pt 5pt; vert= ical-align:top">Dexametasona= </td><td style=3D"width:18.35pt; border-top:0.75pt solid #000000; border-bo= ttom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">4 mg</td><td style=3D"width:31.4pt; bor= der-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0= pt 5pt; vertical-align:top">Intra=C3=B3= sea</td><td style=3D"width:33.65pt; border-top:0.75pt solid #000= 000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:to= p">Preoperatorio</td><td sty= le=3D"width:42.25pt; border-top:0.75pt solid #000000; border-bottom:0.75pt = solid #000000; padding:0pt 5pt; vertical-align:top">Trismus temprano</td><td style=3D"width:48.3pt; bor= der-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0= pt 5pt; vertical-align:top">Evidencia e= mergente</td><td style=3D"width:28.8pt; border-top:0.75pt solid = #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-alig= n:top"><sp= an style=3D"font-family:'Times New Roman'">Limitado</td><td styl= e=3D"width:31pt; border-top:0.75pt solid #000000; border-bottom:0.75pt soli= d #000000; padding:0pt 5pt; vertical-align:top">Baja</td><td style=3D"width:42.35pt; border-top:0.75pt = solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertica= l-align:top">Baja</td></tr><= /table>Tabla 2. Protocolo preoperatorio de corticosteroides en la cirug=C3=ADa de ter= ceros molares (continuaci=C3=B3n)<table style=3D"width:419.9pt; mar= gin-bottom:0pt; padding:0pt; border-collapse:collapse"><tr style=3D"height:= 35.25pt"><td style=3D"width:53.8pt; border-top:0.75pt solid #000000; border= -bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Corticosteroide</= td><td style=3D"width:18.35pt; border-top:0.75pt solid #000000; border-bott= om:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top"><spa= n style=3D"font-family:'Times New Roman'">Dosis</td><td style=3D= "width:31.4pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid = #000000; padding:0pt 5pt; vertical-align:top">V=C3=ADa</td><td style=3D"width:33.65p= t; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; pad= ding:0pt 5pt; vertical-align:top">Momento</td><td style=3D"width:42.25pt; border-top= :0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt;= vertical-align:top">Indicaciones principales</td><td style=3D"width:48.3pt; border-= top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5= pt; vertical-align:top">Observaciones cl=C3=ADnicas</td><td style=3D"width:28.8pt; b= order-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding= :0pt 5pt; vertical-align:top">Nivel de respaldo</td><td style=3D"width:31pt; border-= top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5= pt; vertical-align:top">Calidad de evidencia (grade)</td><td style=3D"width:42.35pt;= border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; paddi= ng:0pt 5pt; vertical-align:top">Consistencia de resultados</td></tr><tr style=3D"hei= ght:35.25pt"><td style=3D"width:53.8pt; border-top:0.75pt solid #000000; bo= rder-right:0.75pt solid #7f7f7f; border-bottom:0.75pt solid #000000; paddin= g:0pt 4.62pt 0pt 5pt; vertical-align:top">Metilprednisolona</td><td style=3D"width:18.35pt; border-top:= 0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; = vertical-align:top">40 mg</t= d><td style=3D"width:31.4pt; border-top:0.75pt solid #000000; border-bottom= :0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">IM / IV</td><td style=3D"width:33.65pt; bor= der-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0= pt 5pt; vertical-align:top">30=E2=80=93= 60 min antes</td><td style=3D"width:42.25pt; border-top:0.75pt s= olid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical= -align:top">Inflamaci=C3=B3n, trismus</= span></td><td style=3D"width:48.3pt; border-top:0.75pt solid #000000; b= order-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Resultados inconsistentes</td= ><td style=3D"width:28.8pt; border-top:0.75pt solid #000000; border-bottom:= 0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Moderado</td><td style=3D"width:31pt; border= -top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt = 5pt; vertical-align:top">Baja=E2=80=93m= oderada</td><td style=3D"width:42.35pt; border-top:0.75pt solid = #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-alig= n:top"><sp= an style=3D"font-family:'Times New Roman'">Variable</td></tr><tr= style=3D"height:35.25pt"><td style=3D"width:53.8pt; border-top:0.75pt soli= d #000000; border-right:0.75pt solid #7f7f7f; border-bottom:0.75pt solid #0= 00000; padding:0pt 4.62pt 0pt 5pt; vertical-align:top">Prednisona</td><td style=3D"width:18.35pt; borde= r-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt= 5pt; vertical-align:top">40=E2=80=9350= mg</td><td style=3D"width:31.4pt; border-top:0.75pt solid #0000= 00; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top= ">Oral</td><td style=3D"widt= h:33.65pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000= 000; padding:0pt 5pt; vertical-align:top">60 min antes</td><td style=3D"width:42.25pt; border-top:0.75p= t solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; verti= cal-align:top">Edema facial<= /td><td style=3D"width:48.3pt; border-top:0.75pt solid #000000; border-bott= om:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Menor evidencia comparativa</td><td style= =3D"width:28.8pt; border-top:0.75pt solid #000000; border-bottom:0.75pt sol= id #000000; padding:0pt 5pt; vertical-align:top">Limitado</td><td style=3D"width:31pt; border-top:0.75p= t solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; verti= cal-align:top">Baja</td><td = style=3D"width:42.35pt; border-top:0.75pt solid #000000; border-bottom:0.75= pt solid #000000; padding:0pt 5pt; vertical-align:top">Variable</td></tr></table>Nota: en concordancia con los hallazgos de l= a presente investigaci=C3=B3n, se propone un protocolo para el uso de corti= costeroides en cirug=C3=ADa de terceros molares, el cual se presenta en la = tabla 2 y se fundamenta en la evidencia reportada en estudios cl=C3=ADnicos= y revisiones sistem=C3=A1ticas recientes (1,2,4=E2=80=939,11,12,15,18,19)Asimismo, se desarroll=C3=B3 un flujograma exp= licativo que orienta la toma de decisiones cl=C3=ADnicas sobre el uso de co= rticosteroides en este contexto, el cual se presenta en la <a href= =3D"#fig2" style=3D"text-decoration:none">Figura 2</a>. <img src=3D"data:image/jpeg;base64,/9j/4AAQSkZJ= RgABAQEAYABgAAD/2wBDAAEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQE= BAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQH/2wBDAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQ= EBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQH/wAARCAHsASsDASIAAhEBAxEB/= 8QAHwAAAAYCAwEAAAAAAAAAAAAAAAECBwgJBgoDBAUL/8QAchAAAAUDAgMEBgcEBQYFCQ8VAQME= BQYCBxEAIQgxQQkSUWETFBVxgaEWFyKRscHwChgy0SYnQuHxGRojJTZSJCg3R2IzNThDVldygpI= pOURFRkhTWIOVlqK3wtI0VFVjZ3R1dneGh5OUl6SnsrbU1eL/xAAeAQABBAMBAQEAAAAAAAAAAA= AAAwQFBgECBwgJCv/EAFwRAAICAQMDAgMDBAwICQkHBQECAwQRAAUSBhMhBzEUIkEIFVEWIzJhC= 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4H19vxOtQoP2SayHeEauKy6XeAR3+iEW7247YHv+OBAAzjmHLXaM/ZMrOGJyUhnFvdmtKnNPPIT= GRaMVJyDlFJdJ5pJNRvoyzFFJBFJ1ZdFNRoEEhX3gKLCnboqrGnAhz8RyPLGOuuSkRqEBHfIfDl= 4aD6w+phxnq/czj/s3vgjkT2M8sEjPvgnWPyD6Q9/uGjn2/Rk9vGR5kPg4/H+ceNahtf7JTZCuk= KQ4rrpAAb5+iMVyGwhyEzG/UA5/PXBT+ySWRLyAcWN0hzuAfQ2K9BHIjgwR67Z8fdrb5M2zgOmf= x0ikREM+P89B9YvUwsGPV+5kgYB/c3sCPH+A9vGP1jOgdB9IAEDYaPn3+R/J8fi5/D+s61Ei/wB= kusnQWJQ8WF1O5VV3hoCIRcKe8IYGoA7+AqHbI4yIAGR2DFh/Zxdgtw99nrecy/zdcae3ZuUgaH= Rih6qTEMzQxRJG+ojG57XomtnSUqFj04N56psFY4OZ6NO3qlBadtLUGCr1fAA4HoPv0A5h7w/HT= Lc/VHr/AHnb7W17j1RuNmhdjMNuszQok8LFS8UhiiRij8QGHIBlyrZUkacU+jel6FqG7U2WlDar= sHhmRG5RuPZk5M3Fh5IPkgnI8+dGFVQAGc8g2EA5fdpI1VDsG48+lIbeI7APP+HO4dNtKq5h15/= /ANVXhrjqEQ7uOtWB92B/lqg6s2uQQHFOcZHIjyx088aLw8/lz/u0Q77DuHgO+ho0aUAZDcB3/t= eHn4e/Ok4xtz3Hfx35/HR5HlkceGdcQ1iAiG2wj4/z0aNf/9k=3D" width=3D"299" height= =3D"492" alt=3D"" /><a id=3D"fig2">Figura 2. Algoritmo cl=C3=ADnico para el uso = de corticoesteroides en la extracci=C3=B3n de tercer molar</a><o= l start=3D"5" style=3D"margin:0pt; padding-left:0pt"><li class=3D"ListParag= raph" style=3D"margin-left:17.45pt; margin-bottom:10pt; line-height:115%; p= adding-left:3.85pt; font-family:'Times New Roman'; font-size:12pt; font-wei= ght:bold; color:#4a442a">Conclusiones<= /li></ol><ul style=3D"margin:0pt; padding-left:0pt"><li class=3D"ListParagr= aph" style=3D"margin-left:32.33pt; margin-bottom:0pt; text-align:justify; l= ine-height:115%; padding-left:3.67pt; font-family:serif; font-size:12pt"><s= pan style=3D"font-family:'Times New Roman'">La presente revisi=C3=B3n narra= tiva permiti=C3=B3 alcanzar el objetivo de analizar la evidencia reciente s= obre el uso preoperatorio de corticosteroides en cirug=C3=ADa de terceros m= olares, confirmando su relevancia como estrategia para optimizar la recuper= aci=C3=B3n postoperatoria. Entre los f=C3=A1rmacos evaluados, la dexametaso= na de 4-8 mg se posiciona como la alternativa de referencia debido a la con= sistencia de los resultados reportados y al mayor respaldo cient=C3=ADfico = disponible sobre su eficacia y seguridad.</li><li class=3D"ListParag= raph" style=3D"margin-left:32.33pt; margin-bottom:10pt; text-align:justify;= line-height:115%; padding-left:3.67pt; font-family:serif; font-size:12pt">= Como aporte de esta investiga= ci=C3=B3n, se integr=C3=B3 cr=C3=ADticamente la evidencia publicada entre 2= 020 y 2025 y se propuso un protocolo orientativo para la toma de decisiones= cl=C3=ADnicas basado en la evidencia actual. Asimismo, se identific=C3=B3 = la necesidad de estandarizar dosis, v=C3=ADas de administraci=C3=B3n y m=C3= =A9todos de evaluaci=C3=B3n, con el fin de fortalecer las recomendaciones c= l=C3=ADnicas y favorecer el desarrollo de protocolos m=C3=A1s homog=C3=A9ne= os y reproducibles.</li></ul><ol start=3D"6" style=3D"margin:0pt; pa= dding-left:0pt"><li style=3D"margin-left:17.3pt; margin-bottom:10pt; text-a= lign:justify; line-height:115%; padding-left:4pt; font-family:'Times New Ro= man'; font-size:12pt; font-weight:bold; color:#4a442a">Conflicto de intereses</li></ol>Los autores declaran que no existe conflicto= de intereses en relaci=C3=B3n con el art=C3=ADculo presentado.<= ol start=3D"7" style=3D"margin:0pt; padding-left:0pt"><li style=3D"margin-l= eft:17.3pt; margin-bottom:10pt; text-align:justify; line-height:115%; paddi= ng-left:4pt; font-family:'Times New Roman'; font-size:12pt; font-weight:bol= d; color:#4a442a">Derechos de autor (copyrigt= h)</li></ol>Los autores son los= titulares de los derechos de autor (patrimoniales y/o de explotaci=C3=B3n) de los contenidos de la r= evista (copyright).</span= ><ol start=3D"8" style=3D"margin:0pt; padding-left:0pt"><li style=3D"ma= rgin-left:17.3pt; margin-bottom:10pt; text-align:justify; line-height:115%;= padding-left:4pt; font-family:'Times New Roman'; font-size:12pt; font-weig= ht:bold; color:#4a442a">Declaraci=C3=B3n de c= ontribuci=C3=B3n de los autores</li></ol>Camila Bel=C3=A9= n Samaniego Maldonado: conceptualizaci=C3=B3n del estudio, pro= puesta del tema de investigaci=C3=B3n, b=C3=BAsqueda y an=C3=A1lisis de la = literatura cient=C3=ADfica, redacci=C3=B3n del manuscrito y revisi=C3=B3n d= el contenido acad=C3=A9mico.<s= pan class=3D"Strong" style=3D"font-weight:normal">Nicole Stephany Paucar Mo= rocho: apoyo en la redacci=C3=B3n del manuscrito, organizaci= =C3=B3n y gesti=C3=B3n de referencias bibliogr=C3=A1ficas, citaci=C3=B3n de= fuentes y revisi=C3=B3n de la estructura del documento.M= ario Esteban Calder=C3=B3n Calle: tutor=C3=ADa y supervisi=C3= =B3n de la investigaci=C3=B3n, orientaci=C3=B3n metodol=C3=B3gica, revisi= =C3=B3n cr=C3=ADtica del contenido cient=C3=ADfico y aprobaci=C3=B3n de la = versi=C3=B3n final del manuscrito.Divulgaci=C3=B3n de la delegac= i=C3=B3n a la IA generativaLos autores declaran el uso de la IA generativa en el pr= oceso de investigaci=C3=B3n y redacci=C3=B3n. Seg=C3=BAn la taxonom=C3=ADa = GAIDeT (2025), las siguientes tareas fueron delegadas a las herramientas GA= I bajo supervisi=C3=B3n humana total:- Generaci=C3=B3n de ideas- Formulaci=C3=B3n de pregu= ntas e hip=C3=B3tesis de investigaci=C3=B3n- B=C3=BAsqueda y sistematizaci=C3=B3n d= e la literaturaLa herramienta GAI utilizada fue: ChatGPT 4.</spa= n>La responsabi= lidad del manuscrito final recae =C3=ADntegramente en los autores.</= p>Las herramientas = GAI no figuran como autores y no asumen responsabilidad por los resultados = finales.Declaraci=C3=B3n presentada por: Cami= la Bel=C3=A9n Samaniego Maldonado<ol start=3D"9" style=3D"margin= :0pt; padding-left:0pt"><li style=3D"margin-left:17.3pt; margin-bottom:10pt= ; text-align:justify; line-height:115%; padding-left:4pt; font-family:'Time= s New Roman'; font-size:12pt; font-weight:bold; color:#4a442a">Costos de financiamiento </li></ol>La presente investigaci=C3=B3n fue financiada en su totalidad con fond= os propios de los autores.<ol start=3D"10" style=3D"margin:0pt; = padding-left:0pt"><li style=3D"margin-left:21.3pt; margin-bottom:10pt; text= -align:justify; line-height:115%; font-family:'Times New Roman'; font-size:= 12pt; font-weight:bold; color:#4a442a">Refere= ncias Bibliogr=C3=A1ficas</li></ol>1.<= span style=3D"width:9pt; text-indent:0pt; font-family:'Times New Roman'; di= splay:inline-block"> Parhizkar P, Schmidlin PR, Bornstein MM, Fakheran O. 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style=3D"wi= dth:370.7pt; padding:0pt 5.4pt; vertical-align:top">Universidad de Cuenca (UCuenca), Cuenca,= Ecuador.Estudiante de Odontolog=C3=ADa<img src=3D"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgA= AABQAAAAUCAYAAACNiR0NAAAABHNCSVQICAgIfAhkiAAAAAlwSFlzAAAOxAAADsQBlSsOGwAAA2= lJREFUOI21lEtoXVUUhr+197n3nNzbJN6omdTWRmwbikVq4iMxk0ZU2oGgA1FnQcQiUhUnFqo4c= GIRQUGd+KDY+Jp25ouiGCOxElqjhba0URPzsPQmuY9zzj1nLwcnuU1iQ0f+mzXZe///Wv/aiy1c= BV/83NNOPr/VWHunqO5OVNuNlQVjmZCGjCVhcPHR3q8XrsaVNUITu/KSlu7LFeSpNNZ+57RTjDT= vqFM1IvNiGXWJvD/9x8yXB/efizYU/Hy8/0W/aA/Xq43r1P3nOCNIFsW2XLleTd648Z/863v3nk= jWCL59dp/fWSsfzOXNkShKacvfgnMRlXjqqqIrwr5vkihyhxbT+K2ne082AAzADZXyPj+wL8ehQ= 1NH700v0N35OAroutW0rxDF6rUUvddaJfdwM9HwqYFSa0GO1SrpfucUVUXEZCQcqQtZ0VEU1QTP= tmAkDygiEBTsTxq6hx65fWTOy7l0exjKgGrGcjTo2/oKS9EUZ2aPcf/Oo1iTI9UGqFJrzDF5+Sv= +Wvg+y+IEVXaGibsbOO5hGBSkbUUQdRT9zaQuBhE6Ct2MT7/D9OIIVnw6Ct3csfk52oNtTMwcBb= E0YteeC7we4LinSI9Z03dBNUVxTdu1eI7FcBIjHvPVU1Tjv7nn5sNMXv6WSjyFiIg17AAwqpRW9= 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Morocho= </td><td style=3D"width:10.5pt; padding:0pt 5.4pt; vertical-alig= n:top"> </spa= n></td><td style=3D"width:166.35pt; padding:0pt 5.4pt; vertical-align:t= op"><spa= n style=3D"font-family:'Times New Roman'">https://orcid.org/0009-0008-6914-= 6098</td><td style=3D"padding:0pt; vertical-align:top"></td></tr= ><tr><td style=3D"width:3.25pt; padding:0pt 5.4pt; vertical-align:top"> </td>= <td colspan=3D"4" style=3D"width:370.7pt; padding:0pt 5.4pt; vertical-align= :top">Universidad= de Cuenca (UCuenca), Cuenca, Ecuador.Estudiante de Odontolog=C3=ADa<p= style=3D"margin-left:7.1pt; margin-bottom:0pt; text-indent:-7.1pt; text-al= ign:justify; line-height:normal"><img src=3D"data:image/png;b= ase64,iVBORw0KGgoAAAANSUhEUgAAABQAAAAUCAYAAACNiR0NAAAABHNCSVQICAgIfAhkiAAAA= AlwSFlzAAAOxAAADsQBlSsOGwAAA2lJREFUOI21lEtoXVUUhr+197n3nNzbJN6omdTWRmwbikVq= 4iMxk0ZU2oGgA1FnQcQiUhUnFqo4cGIRQUGd+KDY+Jp25ouiGCOxElqjhba0URPzsPQmuY9zzj1= 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8rcfXdoT3j5fXp1+BVxdx2um+HGnuX9egX4dY01U0iVK2R80nMaELy42O7R39fz/1f8C/hZ5Yvj= pSKGwAAAABJRU5ErkJggg=3D=3D" width=3D"20" height=3D"20" alt=3D"" style=3D"m= argin-top:9.55pt; margin-left:182.5pt; position:absolute" /><a href= =3D"mailto:stephany.paucar@ucuenca.edu.ec" style=3D"text-decoration:none"><= span style=3D"font-family:'Times New Roman'; font-size:10pt; text-decoratio= n:underline; color:#1155cc">stephany.paucar@ucuenca.edu.ec</a> </td></= tr><tr><td style=3D"width:3.25pt; padding:0pt 5.4pt; vertical-align:top"><p= style=3D"margin-bottom:0pt; text-align:center; line-height:normal; font-si= ze:10pt">3</td><td style=3D"width:1= 71.95pt; padding:0pt 5.4pt; vertical-align:top">Mario= Esteban Calder=C3=B3n Calle </td><td style=3D"width:10.5pt; pad= ding:0pt 5.4pt; vertical-align:top"> </td><td style=3D"width:166.35pt; paddin= g:0pt 5.4pt; vertical-align:top">http= s://orcid.org/0000-0003-1320-2923</td><td style=3D"padding:0pt; = vertical-align:top"></td></tr><tr><td style=3D"width:3.25pt; padding:0pt 5.= 4pt; vertical-align:top"> </td><td colspan=3D"4" style=3D"width:370.7pt; padd= ing:0pt 5.4pt; vertical-align:top">Universidad de Cuenca (UCuenca), Cuenca, Ecuador.<= /p><a href=3D"mailto:marioe.calderon@ucu= enca.edu.ec" style=3D"text-decoration:none">ma= rioe.calderon@ucuenca.edu.ec</a> </td></tr><tr style=3D"height:0pt"><t= d style=3D"width:14.05pt"></td><td style=3D"width:182.75pt"></td><td style= =3D"width:21.3pt"></td><td style=3D"width:177.15pt"></td><td style=3D"width= :0.3pt"></td></tr></table> <table style=3D"width:437.15pt; marg= in-bottom:0pt; padding:0pt; border-collapse:collapse"><tr><td colspan=3D"7"= style=3D"width:151.1pt; padding:0pt 5.4pt; vertical-align:top"><s= pan style=3D"font-family:'Times New Roman'"> </td><td colsp= an=3D"2" style=3D"width:264.45pt; border-top:0.75pt solid #000000; border-b= ottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-align:top">Art=C3=AD= culo de Investigaci=C3=B3n Cient=C3=ADfica y Tecnol=C3=B3gicaEnviado: 15/04/2026 </= span>Revisado: = 10/05/2026 Aceptado: 23/06/2026 Publicado: 15/07/2026DOI: </sp= an><a href=3D"https://doi.org/10.33262/anatomiadigital.v9i3.3692%20" style= =3D"text-decoration:none">https://doi.org/10.33262/anatomiadigital= .v9i3.3692 </a> <a href=3D"https://doi= .org/10.33262/anatomiadigital.v8i4.3568" style=3D"text-decoration:none"><sp= an style=3D"font-family:'Times New Roman'; text-decoration:underline; color= :#0563c1; background-color:#ffffff"> </a></td></tr><tr styl= e=3D"height:3.5pt"><td colspan=3D"7" style=3D"width:151.1pt; padding:0pt 5.= 4pt; vertical-align:top"> </td><td colspan=3D"2" style=3D"width:264.45pt; border-to= p:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4= pt; vertical-align:top"> </td></tr><tr><td style=3D"width:52pt; border-top:0.7= 5pt solid #000000; padding:0pt 5.4pt; vertical-align:top"> C=C3=ADtese: </td><td style= =3D"width:10.35pt; border-top:0.75pt solid #000000; padding:0pt 5.4pt; vert= ical-align:top">&#x= a0;</td><td colspan=3D"6" style=3D"width:337.8pt; border-top:0.7= 5pt solid #000000; padding:0pt 5.4pt; vertical-align:top"> Samaniego Maldonado, C. B., Paucar Mor= ocho, N. S., & Calder=C3=B3n Calle, M. E. (2026). Eficacia y seguridad = de los corticoides preoperatorios en cirug=C3=ADa de terceros molares: evid= encia actual y propuesta de protocolo de manejo cl=C3=ADnico. Anatom=C3=ADa= Digital, 9(3), 63-78. <a href=3D"https://doi.org/10.33262/anatomiad= igital.v9i3.3692" style=3D"text-decoration:none">https://doi.org/10.33262/anatomiadi= gital.v9i3.3692</a> </td><td style=3D"border-top:0.75pt solid #0000= 00; padding:0pt; vertical-align:top"></td></tr><tr><td style=3D"width:52pt;= padding:0pt 5.4pt; vertical-align:top"><img src=3D"= data:image/jpeg;base64,/9j/4AAQSkZJRgABAQEAYABgAAD/2wBDAAEBAQEBAQEBAQEBAQEB= AQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQH/2wBDAQE= BAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQ= EBAQEBAQH/wAARCAAiAEEDASIAAhEBAxEB/8QAHQAAAgMBAAMBAAAAAAAAAAAAAAcGCAkFAQIDB= P/EAD0QAAEEAgECBAIFBg8AAAAAAAQCAwUGAQcIAAkREhMhFDEVFiJxgQoaUWGR0zZBUlNXWHWT= lZehsdHW8P/EABwBAAEEAwEAAAAAAAAAAAAAAAgAAQMEAgUGB//EADYRAAIBAgQCBQoGAwAAAAA= AAAECAwQRAAUSIQYxEzJBUXEHIjM0YXSBkbGzNVOCobLRhMPw/9oADAMBAAIRAxEAPwDaOudw/Z= PM/t483Jm1VqLoVw1PSIZAlgo8pKhNnvTT6yGzxGXnVHQpYL0WpbTg8k+rKn0+VTeWMqdbnYf3r= 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publicar=C3=A1 en soporte electr=C3=B3nico tiene co= mo misi=C3=B3n contribuir a la <spa= n style=3D"line-height:115%; font-family:'Times New Roman'; font-size:8pt">= formaci=C3=B3n de profesionales competentes con visi=C3=B3n human=C3=ADsti= ca y cr=C3=ADtica que sean capaces de exponer su= s resultados investigativos y cient=C3=ADficos en la misma medida que se pr= omueva mediante su intervenci=C3=B3n cambios positivos en la sociedad.</spa= n> <a href=3D"https://anatomiadigital.org" style=3D"text-de= coration:none">https://anatom= iadigital.org</a> La revista es editada por la Editoria= l Ciencia Digital (Editorial de prestigio registrada en la C=C3=A1mara Ecua= toriana de Libro con No de Afiliaci=C3=B3n 663) <a href=3D"http://ww= w.celibro.org.ec" style=3D"text-decoration:none">www.celibro.org.ec</a> </div= ></td><td style=3D"padding:0pt; vertical-align:top"></td></tr><tr style=3D"= height:23.65pt"><td style=3D"width:52pt; border-bottom:0.75pt solid #000000= ; padding:0pt 5.4pt; 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" width=3D"77" height=3D"28" alt=3D"" style=3D"margin-top:0.15pt; margin-le= ft:0pt; position:absolute" /> </td><td style=3D"width:10.35pt; border-bottom:0.75= pt solid #000000; padding:0pt 5.4pt; vertical-align:top"> </td><td colspan=3D"6= " style=3D"width:337.8pt; border-bottom:0.75pt solid #000000; padding:0pt 5= .4pt; vertical-align:top">Esta revista est=C3=A1 protegida ba= jo una licencia Creative Commons Atribuci=C3=B3n-NoComercial-CompartirIgual= 4.0 International. Copia de la licencia: <a href=3D"https://creativ= ecommons.org/licenses/by-nc-sa/4.0/deed.es" style=3D"text-decoration:none">= https://creativecommons.org/l= icenses/by-nc-sa/4.0/deed.es</a> </td><td style=3D"pa= dding:0pt; vertical-align:top"></td></tr><tr><td colspan=3D"4" style=3D"wid= th:101.1pt; padding:0pt 5.4pt; vertical-align:top">Palabras claves: Cirug=C3=ADa de terceros molares, Corticoesteroides, </s= pan><s= pan style=3D"font-family:'Times New Roman'">Control del dolor, Dexametasona= , Trismo.</td><td colspan=3D"2" style=3D"width:0.7pt; padding:0p= t 5.4pt; vertical-align:top"> </td><td colspan=3D"2" style=3D"width:298.35pt; = border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; paddin= g:0pt 5.4pt; vertical-align:top">ResumenIntroducc= i=C3=B3n. La extracc= i=C3=B3n quir=C3=BArgica de terceros molares suele generar dolor, edema y t= rismus postoperatorios que afectan la recuperaci=C3=B3n del paciente. Los c= orticosteroides preoperatorios se utilizan para controlar la respuesta infl= amatoria, aunque persiste controversia sobre el f=C3=A1rmaco, dosis y v=C3= =ADa de administraci=C3=B3n m=C3=A1s adecuados. Objetivo. Evaluar la eficacia y seguridad del uso = preoperatorio de corticosteroides en cirug=C3=ADa de terceros molares y pro= poner un protocolo de manejo cl=C3=ADnico basado en la evidencia reciente. = Meto= dolog=C3=ADa. Se rea= liz=C3=B3 una revisi=C3=B3n de la literatura en PubMed/MEDLINE, Scopus y Co= chrane Library. Se incluyeron estudios publicados entre 2020 y 2025 sobre e= l uso preoperatorio de corticosteroides en cirug=C3=ADa de terceros molares= . Tras aplicar criterios de inclusi=C3=B3n y exclusi=C3=B3n, se seleccionar= on 19 estudios, entre ensayos cl=C3=ADnicos aleatorizados, revisiones siste= m=C3=A1ticas y metaan=C3=A1lisis. Resultados. La dexametasona fue el corticosteroide m=C3=A1s estudiado, especialment= e en dosis =C3=BAnicas de 4=E2=80=938 mg. Su uso redujo significativamente = el edema y el trismus postoperatorios, mientras que el efecto sobre el dolo= r fue variable. Las v=C3=ADas submucosa y sublingual mostraron eficacia com= parable a las v=C3=ADas sist=C3=A9micas y mejor aceptaci=C3=B3n por parte d= el paciente. No se reportaron eventos adversos graves en pacientes sanos. <= /span>Concl= usi=C3=B3n. Los cortic= osteroides preoperatorios constituyen una estrategia eficaz y segura para r= educir las complicaciones inflamatorias tras la cirug=C3=ADa de terceros mo= lares. La dexametasona en dosis de 4=E2=80=938 mg presenta el mayor respald= o cient=C3=ADfico disponible. No obstante, la heterogeneidad de los estudio= s limita la estandarizaci=C3=B3n de protocolos, por lo que su indicaci=C3= =B3n debe individualizarse seg=C3=BAn las caracter=C3=ADsticas cl=C3=ADnica= s de cada paciente. =C3=81rea de estudio general: Odontolog=C3=ADa. =C3=81rea de estudio espec=C3=ADfica:= Cirug=C3=ADa. = Tipo de estudio: Revisi=C3= =B3n bibliogr=C3=A1fica narrativa. </td><td style=3D"padding:0pt; v= ertical-align:top"></td></tr><tr style=3D"height:28.2pt"><td colspan=3D"3" = style=3D"width:98.85pt; padding:0pt 5.4pt; vertical-align:top"><s= pan style=3D"font-family:'Times New Roman'; font-weight:bold">Keywords: </s= pan><s= pan style=3D"font-family:'Times New Roman'">Dexamethasone, corticosteroids,= pain control, third molar s= urgery, trismus.<= /td><td colspan=3D"2" style=3D"width:1pt; padding:0pt 5.4pt; vertical-align= :top"> = </td><td colspan=3D"3" style=3D"width:300.3pt; border-top:0.75pt solid = #000000; border-bottom:0.75pt solid #000000; padding:0pt 5.4pt; vertical-al= ign:top">AbstractIntroduction. Surgical extraction of third molars is c= ommonly associated with postoperative pain, swelling, and trismus, which ma= y negatively affect patient recovery. Preoperative corticosteroids are wide= ly used to control the inflammatory response; however, uncertainty remains = regarding the optimal drug, dosage, and route of administration. <sp= an style=3D"font-family:'Times New Roman'; font-weight:bold">Objective.</sp= an> <= /span>To evaluate the efficac= y and safety of preoperative corticosteroid use in third molar surgery and = to propose an evidence-based clinical management protocol. Methodology.<= span style=3D"font-family:'Times New Roman'; font-weight:bold"> </spa= n>A literature review was con= ducted using PubMed/MEDLINE, Scopus, and the Cochrane Library. Studies publ= ished between 2020 and 2025 evaluating preoperative corticosteroid use in t= hird molar surgery were included. After applying inclusion and exclusion cr= iteria, 19 studies, including randomized clinical trials, systematic review= s, and meta-analyses, were selected. Results. Dexamethasone was the most extensively studied corticosteroid, particul= arly at single preoperative doses of 4=E2=80=938 mg. Its use significantly = reduced postoperative swelling and trismus, whereas pain control outcomes w= ere less consistent. Submucosal and sublingual administration showed effica= cy comparable to systemic routes and greater patient acceptance. No serious= adverse events were reported in healthy patients. Conclusion. Preoperative corticosteroids represe= nt an effective and safe strategy for reducing inflammatory complications a= fter third molar surgery. Dexamethasone at doses of 4=E2=80=938 mg has the = strongest scientific support. However, the heterogeneity of available studi= es limits protocol standardization; therefore, its use should be individual= ized according to each patient's clinical characteristics. General Area of Stud= y: Dentistry. <= span style=3D"font-family:'Times New Roman'; font-weight:bold">Specific are= a of study: Surgery. <= /span>Type of study: Narra= tive bibliographic review. </td><td style=3D"padding:0pt; vertical-= align:top"></td></tr><tr style=3D"height:0pt"><td style=3D"width:62.8pt"></= td><td style=3D"width:21.15pt"></td><td style=3D"width:25.7pt"></td><td sty= le=3D"width:2.25pt"></td><td style=3D"width:9.55pt"></td><td style=3D"width= :1.95pt"></td><td style=3D"width:38.5pt"></td><td style=3D"width:270.65pt">= </td><td style=3D"width:4.6pt"></td></tr></table> <ol style=3D"margin:0= pt; padding-left:0pt"><li class=3D"ListParagraph" style=3D"margin-left:17.3= pt; text-align:justify; line-height:115%; padding-left:4pt; font-family:'Ti= mes New Roman'; font-size:12pt; font-weight:bold; color:#4a442a">Introducci=C3=B3n</li></ol>La extracci=C3=B3n quir=C3=BArgica de te= rceros molares es uno de los procedimientos m=C3=A1s frecuentes en la pr=C3= =A1ctica de la cirug=C3=ADa oral y maxilofacial. A pesar de su car=C3=A1cte= r rutinario, se asocia com=C3=BAnmente a una respuesta inflamatoria postope= ratoria caracterizada por dolor, edema y trismus, lo que puede afectar sign= ificativamente la calidad de vida del paciente y retrasar su reincorporaci= =C3=B3n a las actividades cotidianas (1). En este contexto, el control adec= uado de estas complicaciones representa un desaf=C3=ADo cl=C3=ADnico releva= nte.Entr= e las estrategias farmacol=C3=B3gicas empleadas, los corticosteroides han s= ido ampliamente utilizados debido a su potente efecto antiinflamatorio, med= iado por la inhibici=C3=B3n de la fosfolipasa A=E2=82=82 y la consecuente r= educci=C3=B3n en la s=C3=ADntesis de mediadores proinflamatorios (2). En ci= rug=C3=ADa de terceros molares, f=C3=A1rmacos como la dexametasona y la met= ilprednisolona han sido objeto de m=C3=BAltiples investigaciones, report=C3= =A1ndose en varios estudios una disminuci=C3=B3n del edema y el trismus en = comparaci=C3=B3n con placebo, aunque con resultados variables en el control= del dolor (1)(3)(4).En los =C3=BAltimos a=C3=B1os, la investigaci=C3=B3n se ha ori= entado no solo a evaluar la eficacia de estos f=C3=A1rmacos, sino tambi=C3= =A9n a comparar las distintas v=C3=ADas de administraci=C3=B3n. Tradicional= mente, las v=C3=ADas sist=C3=A9micas, como la intramuscular e intravenosa, = han sido las m=C3=A1s utilizadas; sin embargo, estudios recientes han mostr= ado que las v=C3=ADas locales, como la submucosa y la sublingual, pueden of= recer una eficacia comparable, con ventajas como menor invasividad y mejor = aceptaci=C3=B3n por parte del paciente (5)(6). Asimismo, la evidencia dispo= nible sugiere que la administraci=C3=B3n en dosis =C3=BAnica preoperatoria = presenta un perfil de seguridad favorable en pacientes sanos, sin increment= o significativo de eventos adversos (2).A pesar de estos avances, persiste una falt= a de consenso respecto al corticosteroide m=C3=A1s eficaz, as=C3=AD como so= bre la dosis, el momento y la v=C3=ADa de administraci=C3=B3n =C3=B3ptimos.= Esta variabilidad en la evidencia limita la estandarizaci=C3=B3n de protoc= olos cl=C3=ADnicos y puede influir en la toma de decisiones terap=C3=A9utic= as, evidenciando la necesidad de integrar y analizar cr=C3=ADticamente la i= nformaci=C3=B3n disponible.En este sentido, el presente estudio tiene como objetiv= o general evaluar la eficacia y seguridad del uso preoperatorio de corticos= teroides en la cirug=C3=ADa de terceros molares mediante la revisi=C3=B3n d= e la literatura reciente. Como objetivos espec=C3=ADficos, se plantea anali= zar los principales corticosteroides utilizados, comparar sus v=C3=ADas de = administraci=C3=B3n, identificar las dosis m=C3=A1s reportadas y proponer u= n protocolo de manejo cl=C3=ADnico basado en la evidencia disponible.</span= ><ol start=3D"2" style=3D"margin:0pt; padding-left:0pt"><li class=3D"Li= stParagraph" style=3D"margin-left:17.3pt; margin-bottom:10pt; line-height:1= 15%; padding-left:4pt; font-family:'Times New Roman'; font-size:12pt; font-= weight:bold; color:#4a442a">Metodolog=C3=ADa<= /span></li></ol>La = presente investigaci=C3=B3n corresponde a una revisi=C3=B3n bibliogr=C3=A1f= ica narrativa de enfoque cualitativo, nivel descriptivo-anal=C3=ADtico y mo= dalidad documental. Este dise=C3=B1o metodol=C3=B3gico fue seleccionado deb= ido a que el objetivo del estudio es analizar e interpretar la evidencia ci= ent=C3=ADfica disponible sobre la eficacia del uso preoperatorio de cortico= steroides, especialmente dexametasona, en el control de las complicaciones = postoperatorias asociadas a la cirug=C3=ADa de terceros molares. </p= >La b=C3=BAsqueda d= e informaci=C3=B3n se realiz=C3=B3 en las bases de datos PubMed/MEDLINE, Sc= opus y Cochrane Library, consideradas fuentes de alta calidad cient=C3=ADfi= ca en el =C3=A1mbito de las ciencias de la salud. Para la localizaci=C3=B3n= de los estudios se utilizaron los t=C3=A9rminos dexamethasone, glucocorticoid= s, pain control, third molar surgery y trismus, combinados mediante los operadores booleanos AND = y OR. La estrategia de b=C3=BAsqueda fue adaptada a las caracter=C3=ADstica= s espec=C3=ADficas de cada base de datos y se restringi=C3=B3 a publicacion= es en idioma ingl=C3=A9s y espa=C3=B1ol correspondientes al per=C3=ADodo co= mprendido entre 2020 y 2025. Con el prop=C3=B3sito de ampliar la recuperaci= =C3=B3n de evidencia relevante, tambi=C3=A9n se efectu=C3=B3 una b=C3=BAsqu= eda manual en las listas de referencias de los art=C3=ADculos seleccionados= .La sele= cci=C3=B3n de los estudios se llev=C3=B3 a cabo considerando criterios prev= iamente establecidos. Se incluyeron investigaciones realizadas en pacientes= humanos sometidos a cirug=C3=ADa de terceros molares que evaluaran la admi= nistraci=C3=B3n preoperatoria de corticosteroides y reportaran resultados c= l=C3=ADnicos relacionados con dolor, edema, trismus o calidad de vida. Asim= ismo, se consideraron ensayos cl=C3=ADnicos aleatorizados, estudios control= ados, revisiones sistem=C3=A1ticas y metaan=C3=A1lisis. Por otra parte, se = excluyeron estudios realizados en animales o modelos in vitro, reportes de = caso, cartas al editor, opiniones de expertos, investigaciones centradas ex= clusivamente en la administraci=C3=B3n postoperatoria de corticosteroides, = estudios con intervenciones combinadas que impidieran determinar el efecto = espec=C3=ADfico de los corticosteroides y art=C3=ADculos sin acceso al text= o completo.El proceso de selecci=C3=B3n se desarroll=C3=B3 en dos etapas. Inicialme= nte se revisaron los t=C3=ADtulos y res=C3=BAmenes de los registros identif= icados, eliminando aquellos duplicados o que no cumpl=C3=ADan con los crite= rios de elegibilidad. Posteriormente, se realiz=C3=B3 la lectura completa d= e los art=C3=ADculos potencialmente relevantes para determinar su inclusi= =C3=B3n definitiva. Para la organizaci=C3=B3n y gesti=C3=B3n de las referen= cias bibliogr=C3=A1ficas se utiliz=C3=B3 la plataforma digital Rayyan (</sp= an>Qatar C= omputing Research Institute), herramienta que facilit=C3=B3 la clasificaci=C3=B3n sistem=C3=A1tic= a de los estudios y la resoluci=C3=B3n de discrepancias mediante consenso.<= /span>La interp= retaci=C3=B3n de los resultados se efectu=C3=B3 mediante un an=C3=A1lisis c= r=C3=ADtico de la evidencia disponible, considerando la calidad metodol=C3= =B3gica de los estudios, la consistencia de los hallazgos reportados, las p= osibles fuentes de sesgo y las limitaciones descritas por los autores. Este= enfoque permiti=C3=B3 valorar la solidez de la evidencia cient=C3=ADfica y= discutir la aplicabilidad de los resultados en el contexto cl=C3=ADnico de= la cirug=C3=ADa de terceros molares. Asimismo, la revisi=C3=B3n facilit=C3= =B3 la identificaci=C3=B3n de tendencias actuales en la investigaci=C3=B3n,= tales como las v=C3=ADas de administraci=C3=B3n m=C3=A1s utilizadas, las d= osis con mejores resultados cl=C3=ADnicos y los aspectos que requieren futu= ras investigaciones para fortalecer el conocimiento disponible.<= p style=3D"margin-bottom:10pt; text-align:justify; line-height:115%; font-s= ize:12pt">Los datos extra=C3= =ADdos de los estudios seleccionados fueron organizados y sistematizados me= diante matrices de an=C3=A1lisis dise=C3=B1adas para la presente investigac= i=C3=B3n, lo que permiti=C3=B3 comparar de manera estructurada las caracter= =C3=ADsticas metodol=C3=B3gicas, las intervenciones evaluadas y los princip= ales hallazgos reportados. La <a href=3D"#tabla1" style=3D"text-deco= ration:none">Tabla 1</= a> presenta una s=C3=ADntesis= de las caracter=C3=ADsticas generales de los estudios incluidos en la revi= si=C3=B3n narrativa de la literatura.<a id=3D"tabla1">Tabla 1. Caracter=C3=ADsticas de = los estudios incluidos en la revisi=C3=B3n narrativa integrativa</a>= <table style=3D"width:99.16%; margin-bottom:0pt; padding:0pt; border-co= llapse:collapse"><tr style=3D"height:2.9pt"><td style=3D"width:14.48%; bord= er-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0p= t 5pt; vertical-align:top">Autor (A=C3=B1o)</td><td style=3D"width:13.1%; border-top:= 0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; = vertical-align:top">D= ise=C3=B1o del estudio</td><td style=3D"width:18.38%; border-top= :0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt;= vertical-align:top">= Corticosteroide</td><td style=3D"width:9.74%; border-top:0.75pt = solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertica= l-align:top">Dosis</s= pan></td><td style=3D"width:15.1%; border-top:0.75pt solid #000000; bor= der-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">V=C3=ADa de administraci= =C3=B3n</td><td style=3D"width:12.78%; border-top:0.75pt solid #= 000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align= :top">Desenlaces eval= uados</td><td style=3D"width:16.42%; border-top:0.75pt solid #00= 0000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:t= op">Hallazgo principa= l</td></tr><tr style=3D"height:20.75pt"><td style=3D"width:14.48= %; border-top:0.75pt solid #000000; border-right:0.75pt solid #7f7f7f; bord= er-bottom:0.75pt solid #000000; padding:0pt 4.62pt 0pt 5pt; vertical-align:= top">Parhizkar et al. (2022) (1)<= /p></td><td style=3D"width:13.1%; border-top:0.75pt solid #000000; border-b= ottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Revisi=C3=B3n sistem=C3=A1tica</td><t= d style=3D"width:18.38%; border-top:0.75pt solid #000000; border-bottom:0.7= 5pt solid #000000; padding:0pt 5pt; vertical-align:top">Corticosteroides</td><td style=3D"width:9.74%; b= order-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding= :0pt 5pt; vertical-align:top">Variable</= span></td><td style=3D"width:15.1%; border-top:0.75pt solid #000000; bo= rder-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Variada</td><td style=3D"width:12= .78%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; = padding:0pt 5pt; vertical-align:top">Dol= or, edema, trismus</td><td style=3D"width:16.42%; border-top:0.7= 5pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; ver= tical-align:top">=E2=86=93 edema y trism= us</td></tr></table> Tabla 1. Caracter=C3=ADsticas de los estu= dios incluidos en la revisi=C3=B3n narrativa integrativa (continuaci=C3=B3n= )<table style=3D"width:99.16%; margin-bottom:0pt; padding:0pt; b= order-collapse:collapse"><tr style=3D"height:20.75pt"><td style=3D"width:14= .48%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; = padding:0pt 5pt; vertical-align:top">Autor (A=C3=B1o)</td><td style=3D"width:13.1%; b= order-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding= :0pt 5pt; vertical-align:top">Dise=C3=B1o del estudio</td><td style=3D"width:18.38%; = border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; paddin= g:0pt 5pt; vertical-align:top">Corticosteroide</td><td style=3D"width:9.74%; border-t= op:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5p= t; vertical-align:top">Dosis</td><td style=3D"width:15.1%; border-top:0.75pt solid #0= 00000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:= top">V=C3=ADa de admi= nistraci=C3=B3n</td><td style=3D"width:12.78%; border-top:0.75pt= solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertic= al-align:top">Desenla= ces evaluados</td><td style=3D"width:16.42%; border-top:0.75pt s= olid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical= -align:top">Hallazgo = principal</td></tr><tr style=3D"height:20.75pt"><td style=3D"wid= th:14.48%; border-top:0.75pt solid #000000; border-right:0.75pt solid #7f7f= 7f; border-bottom:0.75pt solid #000000; padding:0pt 4.62pt 0pt 5pt; vertica= l-align:top">Canellas et al. (2022) (2)<= /span></td><td style=3D"width:13.1%; border-top:0.75pt solid #000000; b= order-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">RS + metaan=C3=A1lisis</td><td s= tyle=3D"width:18.38%; border-top:0.75pt solid #000000; border-bottom:0.75pt= solid #000000; padding:0pt 5pt; vertical-align:top">Corticosteroides</td><td style=3D"width:9.74%; bord= er-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0p= t 5pt; vertical-align:top">Variable</spa= n></td><td style=3D"width:15.1%; border-top:0.75pt solid #000000; borde= r-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Variada</td><td style=3D"width:12.78= %; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; pad= ding:0pt 5pt; vertical-align:top">Inflam= aci=C3=B3n</td><td style=3D"width:16.42%; border-top:0.75pt soli= d #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-al= ign:top"><s= pan style=3D"font-family:'Times New Roman'">Dexametasona m=C3=A1s consisten= te</td></tr><tr style=3D"height:20.75pt"><td style=3D"width:14.4= 8%; border-top:0.75pt solid #000000; border-right:0.75pt solid #7f7f7f; bor= der-bottom:0.75pt solid #000000; padding:0pt 4.62pt 0pt 5pt; vertical-align= :top"><span= style=3D"font-family:'Times New Roman'">Shad et al. (2020) (3)<= /td><td style=3D"width:13.1%; border-top:0.75pt solid #000000; border-botto= m:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">ECA</td><td style=3D"width:18.38%; border-t= op:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5p= t; vertical-align:top">Dexametasona</spa= n></td><td style=3D"width:9.74%; border-top:0.75pt solid #000000; borde= r-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">4=E2=80=938 mg</td><td style=3D"widt= h:15.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #00000= 0; padding:0pt 5pt; vertical-align:top">= Submucosa</td><td style=3D"width:12.78%; border-top:0.75pt solid= #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-ali= gn:top"><sp= an style=3D"font-family:'Times New Roman'">Edema, trismus</td><t= d style=3D"width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.7= 5pt solid #000000; padding:0pt 5pt; vertical-align:top">=E2=86=93 significativo</td></tr><tr style=3D"he= ight:20.7pt"><td style=3D"width:14.48%; border-top:0.75pt solid #000000; bo= rder-right:0.75pt solid #7f7f7f; border-bottom:0.75pt solid #000000; paddin= g:0pt 4.62pt 0pt 5pt; vertical-align:top">Larsen et al. (2021) (4)</td><td style=3D"width:13.1%; border-= top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5= pt; vertical-align:top">ECA</= td><td style=3D"width:18.38%; border-top:0.75pt solid #000000; border-botto= m:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Metilprednisolona</td><td style=3D"width:9.= 74%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; p= adding:0pt 5pt; vertical-align:top">40 m= g</td><td style=3D"width:15.1%; border-top:0.75pt solid #000000;= border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top"><= p style=3D"margin-bottom:0pt; line-height:115%; font-size:9pt">Oral</td><td style=3D"width:1= 2.78%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000;= padding:0pt 5pt; vertical-align:top">Do= lor, trismus</td><td style=3D"width:16.42%; border-top:0.75pt so= lid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-= align:top">= Sin diferencia significativa<= /span></td></tr><tr style=3D"height:33pt"><td style=3D"width:14.48%; bo= rder-top:0.75pt solid #000000; border-right:0.75pt solid #7f7f7f; border-bo= ttom:0.75pt solid #000000; padding:0pt 4.62pt 0pt 5pt; vertical-align:top">= Hiriyanna & Degala (2021) (5)= </td><td style=3D"width:13.1%; border-top:0.75pt solid #000000; border-= bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">ECA</td><td style=3D"width:18.38%; bo= rder-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:= 0pt 5pt; vertical-align:top">Dexametason= a</td><td style=3D"width:9.74%; border-top:0.75pt solid #000000;= border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top"><= p style=3D"margin-bottom:0pt; line-height:115%; font-size:9pt">4 mg</td><td style=3D"width:1= 5.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; = padding:0pt 5pt; vertical-align:top">Sub= mucosa vs IV</td><td style=3D"width:12.78%; border-top:0.75pt so= lid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-= align:top">= Edema, trismus</td= ><td style=3D"width:16.42%; border-top:0.75pt solid #000000; border-bottom:= 0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Eficacia comparable</td></tr><tr style=3D"hei= ght:33pt"><td style=3D"width:14.48%; border-top:0.75pt solid #000000; borde= r-right:0.75pt solid #7f7f7f; border-bottom:0.75pt solid #000000; padding:0= pt 4.62pt 0pt 5pt; vertical-align:top">P= riyanga et al. (2022) (6)</td><td style=3D"width:13.1%; border-t= op:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5p= t; vertical-align:top">ECA</t= d><td style=3D"width:18.38%; border-top:0.75pt solid #000000; border-bottom= :0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Dexametasona</td><td style=3D"width:9.74%; b= order-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding= :0pt 5pt; vertical-align:top">4 mg</span= ></td><td style=3D"width:15.1%; border-top:0.75pt solid #000000; border= -bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Sublingual vs IM</td><td style=3D"wid= th:12.78%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000= 000; padding:0pt 5pt; vertical-align:top">Dolor, edema, trismus</td><td style=3D"width:16.42%; border-to= p:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt= ; vertical-align:top">Sublingual efectiv= a</td></tr><tr style=3D"height:33pt"><td style=3D"width:14.48%; = border-top:0.75pt solid #000000; border-right:0.75pt solid #7f7f7f; border-= bottom:0.75pt solid #000000; padding:0pt 4.62pt 0pt 5pt; vertical-align:top= ">Momesso et al. (2021) (7)</= td><td style=3D"width:13.1%; border-top:0.75pt solid #000000; border-bottom= :0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">ECA triple ciego</td><td style=3D"width:18.3= 8%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; pa= dding:0pt 5pt; vertical-align:top">Dexam= etasona + AINE</td><td style=3D"width:9.74%; border-top:0.75pt s= olid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical= -align:top">Variable</td><td = style=3D"width:15.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt= solid #000000; padding:0pt 5pt; vertical-align:top">IM</td><td style=3D"width:12.78%; border-top:0.75pt= solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertic= al-align:top">Dolor</td><td s= tyle=3D"width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt= solid #000000; padding:0pt 5pt; vertical-align:top">Mejor en combinaci=C3=B3n</td></tr><tr style=3D"hei= ght:28.2pt"><td style=3D"width:14.48%; border-top:0.75pt solid #000000; bor= der-right:0.75pt solid #7f7f7f; border-bottom:0.75pt solid #000000; padding= :0pt 4.62pt 0pt 5pt; vertical-align:top">Singh et al. (2023) (8)</td><td style=3D"width:13.1%; border-to= p:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt= ; vertical-align:top">RS + metaan=C3=A1l= isis</td><td style=3D"width:18.38%; border-top:0.75pt solid #000= 000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:to= p">Dexa vs Metilprednisolona<= /td><td style=3D"width:9.74%; border-top:0.75pt solid #000000; border-botto= m:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Variable</td><td style=3D"width:15.1%; bord= er-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0p= t 5pt; vertical-align:top">Variada</span= ></td><td style=3D"width:12.78%; border-top:0.75pt solid #000000; borde= r-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Dolor, inflamaci=C3=B3n</td><td styl= e=3D"width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt so= lid #000000; padding:0pt 5pt; vertical-align:top">Eficacia similar</td></tr><tr style=3D"height:28.2pt">= <td style=3D"width:14.48%; border-top:0.75pt solid #000000; border-right:0.= 75pt solid #7f7f7f; border-bottom:0.75pt solid #000000; padding:0pt 4.62pt = 0pt 5pt; vertical-align:top">Antonelli e= t al. (2023) (9)</td><td style=3D"width:13.1%; border-top:0.75pt= solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertic= al-align:top">ECA</td><td sty= le=3D"width:18.38%; border-top:0.75pt solid #000000; border-bottom:0.75pt s= olid #000000; padding:0pt 5pt; vertical-align:top">Prednisona</td><td style=3D"width:9.74%; border-top:0= .75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; v= ertical-align:top">25 mg</td>= <td style=3D"width:15.1%; border-top:0.75pt solid #000000; border-bottom:0.= 75pt solid #000000; padding:0pt 5pt; vertical-align:top">Oral</td><td style=3D"width:12.78%; border-top:= 0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; = vertical-align:top">Edema</td= ><td style=3D"width:16.42%; border-top:0.75pt solid #000000; border-bottom:= 0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">=E2=86=93 edema</td></tr><tr style=3D"height:= 28.2pt"><td style=3D"width:14.48%; border-top:0.75pt solid #000000; border-= right:0.75pt solid #7f7f7f; border-bottom:0.75pt solid #000000; padding:0pt= 4.62pt 0pt 5pt; vertical-align:top">Lib= =C3=B3rio et al. (2025) (10)</td><td style=3D"width:13.1%; borde= r-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt= 5pt; vertical-align:top">RS + metaan=C3= =A1lisis</td><td style=3D"width:18.38%; border-top:0.75pt solid = #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-alig= n:top"><spa= n style=3D"font-family:'Times New Roman'">Metilprednisolona</td>= <td style=3D"width:9.74%; border-top:0.75pt solid #000000; border-bottom:0.= 75pt solid #000000; padding:0pt 5pt; vertical-align:top">Variable</td><td style=3D"width:15.1%; border-t= op:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5p= t; vertical-align:top">Variada</p= ></td><td style=3D"width:12.78%; border-top:0.75pt solid #000000; border-bo= ttom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Dolor, inflamaci=C3=B3n</td><td style=3D= "width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid = #000000; padding:0pt 5pt; vertical-align:top">Beneficio variable</td></tr><tr style=3D"height:28.2pt"><t= d style=3D"width:14.48%; border-top:0.75pt solid #000000; border-right:0.75= pt solid #7f7f7f; border-bottom:0.75pt solid #000000; padding:0pt 4.62pt 0p= t 5pt; vertical-align:top">Hou et al. (2= 021) (11)</td><td style=3D"width:13.1%; border-top:0.75pt solid = #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-alig= n:top"><spa= n style=3D"font-family:'Times New Roman'">RS + metaan=C3=A1lisis= </td><td style=3D"width:18.38%; border-top:0.75pt solid #000000; border-bot= tom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Dexametasona</td><td style=3D"width:9.74%= ; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padd= ing:0pt 5pt; vertical-align:top">4=E2=80= =938 mg</td><td style=3D"width:15.1%; border-top:0.75pt solid #0= 00000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:= top">Submucosa vs sist=C3=A9mica<= /p></td><td style=3D"width:12.78%; border-top:0.75pt solid #000000; border-= bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Edema, trismus</td><td style=3D"width= :16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #00000= 0; padding:0pt 5pt; vertical-align:top">= Sin diferencias significativas</td></tr><tr style=3D"height:36.4= 5pt"><td style=3D"width:14.48%; border-top:0.75pt solid #000000; border-rig= ht:0.75pt solid #7f7f7f; border-bottom:0.75pt solid #000000; padding:0pt 4.= 62pt 0pt 5pt; vertical-align:top">Martin= s-de-Barros et al. (2021) (12)</td><td style=3D"width:13.1%; bor= der-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0= pt 5pt; vertical-align:top">ECA triple c= iego</td><td style=3D"width:18.38%; border-top:0.75pt solid #000= 000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:to= p">Dexa vs ketorolaco</td><td= style=3D"width:9.74%; border-top:0.75pt solid #000000; border-bottom:0.75p= t solid #000000; padding:0pt 5pt; vertical-align:top">Variable</td><td style=3D"width:15.1%; border-top:= 0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; = vertical-align:top">IM</td><t= d style=3D"width:12.78%; border-top:0.75pt solid #000000; border-bottom:0.7= 5pt solid #000000; padding:0pt 5pt; vertical-align:top">Dolor, edema</td><td style=3D"width:16.42%; bord= er-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0p= t 5pt; vertical-align:top">Dexa superior= </td></tr><tr style=3D"height:27.15pt"><td style=3D"width:14.48%= ; border-top:0.75pt solid #000000; border-right:0.75pt solid #7f7f7f; borde= r-bottom:0.75pt solid #000000; padding:0pt 4.62pt 0pt 5pt; vertical-align:t= op">Suleiman et al. (2024) (13)</= p></td><td style=3D"width:13.1%; border-top:0.75pt solid #000000; border-bo= ttom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">ECA</td><td style=3D"width:18.38%; borde= r-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt= 5pt; vertical-align:top">Dexa vs ketopr= ofeno</td><td style=3D"width:9.74%; border-top:0.75pt solid #000= 000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:to= p">Variable</td><td style=3D"= width:15.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #0= 00000; padding:0pt 5pt; vertical-align:top">Sist=C3=A9mica</td><td style=3D"width:12.78%; border-top:0.7= 5pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; ver= tical-align:top">Calidad de vida<= /p></td><td style=3D"width:16.42%; border-top:0.75pt solid #000000; border-= bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Dexa mejora resultados</td></tr><tr s= tyle=3D"height:25.4pt"><td style=3D"width:14.48%; border-top:0.75pt solid #= 000000; border-right:0.75pt solid #7f7f7f; border-bottom:0.75pt solid #0000= 00; padding:0pt 4.62pt 0pt 5pt; vertical-align:top">Pimenta et al. (2024) (14)</td><td style=3D"width:13= .1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; p= adding:0pt 5pt; vertical-align:top">Revi= si=C3=B3n de revisiones</td><td style=3D"width:18.38%; border-to= p:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt= ; vertical-align:top">AINEs + corticoide= s</td><td style=3D"width:9.74%; border-top:0.75pt solid #000000;= border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top"><= p style=3D"margin-bottom:0pt; line-height:115%; font-size:9pt">Variable</td><td style=3D"wid= th:15.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #0000= 00; padding:0pt 5pt; vertical-align:top">Variada</td><td style=3D"width:12.78%; border-top:0.75pt solid = #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-alig= n:top"><spa= n style=3D"font-family:'Times New Roman'">Dolor</td><td style=3D= "width:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid = #000000; padding:0pt 5pt; vertical-align:top">Mejor en combinaci=C3=B3n</td></tr><tr style=3D"height:28.= 15pt"><td style=3D"width:14.48%; border-top:0.75pt solid #000000; border-ri= ght:0.75pt solid #7f7f7f; border-bottom:0.75pt solid #000000; padding:0pt 4= .62pt 0pt 5pt; vertical-align:top">Nils = et al. (2023) (15)</td><td style=3D"width:13.1%; border-top:0.75= pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vert= ical-align:top">Revisi=C3=B3n= </td><td style=3D"width:18.38%; border-top:0.75pt solid #000000; border-bot= tom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Glucocorticoides</td><td style=3D"width:9= .74%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; = padding:0pt 5pt; vertical-align:top">Var= iable</td><td style=3D"width:15.1%; border-top:0.75pt solid #000= 000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:to= p">Variada</td><td style=3D"w= idth:12.78%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #0= 00000; padding:0pt 5pt; vertical-align:top">Seguridad</td><td style=3D"width:16.42%; border-top:0.75pt s= olid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical= -align:top">Seguro en dosis =C3=BAnica</= span></td></tr><tr style=3D"height:33pt"><td style=3D"width:14.48%; bor= der-top:0.75pt solid #000000; border-right:0.75pt solid #7f7f7f; border-bot= tom:0.75pt solid #000000; padding:0pt 4.62pt 0pt 5pt; vertical-align:top"><= p style=3D"margin-bottom:0pt; line-height:115%; font-size:9pt">Satpathi et al. (2024) (16)</= td><td style=3D"width:13.1%; border-top:0.75pt solid #000000; border-bottom= :0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Revisi=C3=B3n</td><td style=3D"width:18.38%;= border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; paddi= ng:0pt 5pt; vertical-align:top">Corticos= teroides</td><td style=3D"width:9.74%; border-top:0.75pt solid #= 000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align= :top"><span= style=3D"font-family:'Times New Roman'">Variable</td><td style= =3D"width:15.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt soli= d #000000; padding:0pt 5pt; vertical-align:top">Variada</td><td style=3D"width:12.78%; border-top:0.75pt= solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertic= al-align:top">Uso cl=C3=ADnico</p= ></td><td style=3D"width:16.42%; border-top:0.75pt solid #000000; border-bo= ttom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Beneficio antiinflamatorio general</td><= /tr><tr style=3D"height:33pt"><td style=3D"width:14.48%; border-top:0.75pt = solid #000000; border-right:0.75pt solid #7f7f7f; border-bottom:0.75pt soli= d #000000; padding:0pt 4.62pt 0pt 5pt; vertical-align:top">Nehme et al. (2021) (17)</td><td style=3D"wid= th:13.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #0000= 00; padding:0pt 5pt; vertical-align:top">ECA</td><td style=3D"width:18.38%; border-top:0.75pt solid #000= 000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:to= p">Dexametasona</td><td style= =3D"width:9.74%; border-top:0.75pt solid #000000; border-bottom:0.75pt soli= d #000000; padding:0pt 5pt; vertical-align:top">Variable</td><td style=3D"width:15.1%; border-top:0.75pt= solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertic= al-align:top">IM</td><td styl= e=3D"width:12.78%; border-top:0.75pt solid #000000; border-bottom:0.75pt so= lid #000000; padding:0pt 5pt; vertical-align:top">Dolor</td><td style=3D"width:16.42%; border-top:0.75pt= solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertic= al-align:top">=E2=86=93 dolor postoperat= orio</td></tr><tr style=3D"height:28.2pt"><td style=3D"width:14.= 48%; border-top:0.75pt solid #000000; border-right:0.75pt solid #7f7f7f; bo= rder-bottom:0.75pt solid #000000; padding:0pt 4.62pt 0pt 5pt; vertical-alig= n:top"><spa= n style=3D"font-family:'Times New Roman'">Kaya & Akt=C4=B1 (2024) (18)</td><td style=3D"width:13.1= %; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; pad= ding:0pt 5pt; vertical-align:top">ECA</s= pan></td><td style=3D"width:18.38%; border-top:0.75pt solid #000000; bo= rder-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Dexametasona</td><td style=3D"wid= th:9.74%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #0000= 00; padding:0pt 5pt; vertical-align:top">Variable</td><td style=3D"width:15.1%; border-top:0.75pt solid = #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-alig= n:top"><spa= n style=3D"font-family:'Times New Roman'">Perineural vs sist=C3=A9mica</spa= n></td><td style=3D"width:12.78%; border-top:0.75pt solid #000000; bord= er-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Dolor, anestesia</td><td style=3D"w= idth:16.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #0= 00000; padding:0pt 5pt; vertical-align:top">Efectividad comparable</td></tr><tr style=3D"height:27.05pt"= ><td style=3D"width:14.48%; border-top:0.75pt solid #000000; border-right:0= .75pt solid #7f7f7f; border-bottom:0.75pt solid #000000; padding:0pt 4.62pt= 0pt 5pt; vertical-align:top">Kaewkumner= t et al. (2020) (19)</td><td style=3D"width:13.1%; border-top:0.= 75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; ve= rtical-align:top">ECA</td><td= style=3D"width:18.38%; border-top:0.75pt solid #000000; border-bottom:0.75= pt solid #000000; padding:0pt 5pt; vertical-align:top">Dexametasona</td><td style=3D"width:9.74%; border= -top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt = 5pt; vertical-align:top">Variable= </td><td style=3D"width:15.1%; border-top:0.75pt solid #000000; border-= bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Intra=C3=B3sea vs submucosa</td><td s= tyle=3D"width:12.78%; border-top:0.75pt solid #000000; border-bottom:0.75pt= solid #000000; padding:0pt 5pt; vertical-align:top">Edema, trismus</td><td style=3D"width:16.42%; borde= r-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt= 5pt; vertical-align:top">Resultados sim= ilares</td></tr></table>&#x= a0; = = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; = ; &#= xa0; <ol start=3D"3" s= tyle=3D"margin:0pt; padding-left:0pt"><li class=3D"ListParagraph" style=3D"= margin-left:17.45pt; margin-bottom:10pt; line-height:115%; padding-left:3.8= 5pt; font-family:'Times New Roman'; font-size:12pt; font-weight:bold; color= :#4a442a">Resultados </li></ol>La b=C3=BAsqueda bibliogr= =C3=A1fica identific=C3=B3 un total de 646 art=C3=ADculos, de los cuales, t= ras la eliminaci=C3=B3n de duplicados y la aplicaci=C3=B3n de criterios de = selecci=C3=B3n, se incluyeron 19 estudios en la revisi=C3=B3n. El proceso d= e selecci=C3=B3n se detalla en la <a href=3D"#fig1" style=3D"text-de= coration:none">Figura 1</span= ></a> </spa= n>y las caracter=C3=ADsticas = principales de los estudios se resumen en la <a href=3D"#tabla1" style= =3D"text-decoration:none">Tab= la 1</a>.<img src=3D"data:image/png;base64,iVBORw0KGgoAAAA= NSUhEUgAAAfoAAAFXCAYAAABKl4x5AAAABHNCSVQICAgIfAhkiAAAAAlwSFlzAAAOxAAADsQBlS= sOGwAAIABJREFUeJzEvXe4XUW5P/6Ztfbep5f0k15ISGghQhJa6AgKiBfRe0UpIlwVVEDvVQEBQ= YqgNAVRihQRRer1AkpHkAASahIIhJBCQpKTk3b6OXvvNfP7Y9o7s2btfeJ9vs9veMLZe62Zt81b= Z2atzZKEC0AAABhjEEKYv7oxxvB/aRrmEDoChIassalrQtLIBf+XaDXwfPwMWjSyMQCCgQEOrtR= 41XUHKFBDNcL0aAU6RbchC+l5YmAQEEOWp553vz/g6kZW03OgcYdwZPEPMCtrRrkK8MuY4S3UMz= R/tL/EKFI0+ng0LiFUXwZnIig9lI0UUQ5fGRIIyMeZP4nIoSlEc1jGjiAAoXU1mx6frjR9DCLD3= irpqqGRAUzQeZM0+vpGx/g0DMWvaBhRFCndBgDNk0dniPAhNH8u0valwQoIoedwh9EoYPDmTV7w= dUTSxAwe57vHJ7WFIftqB4zVL3fO9L1KYz1W/CHeNYc+AbAobQsUCVP+ODVWw2beZ0KY5ipLJln= 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/M4mNJ5QZOClv79b5Djbj+4S4y2KbtTZ7WxgFsYQHIN5yM2LuJMhL9itqizyW7zTJ5BfJjctQbD= 6Y8go8DcjlDOVOM+E04B06Cl6N16ElPr3vga1VNqclrCHop0AjJOrgPo5myVckawnjZCiUiMiX+= XhrYE06OgELpiBXYH9kXCjZmpLogRi/aGs53WUpzZGCKgkeUhvzoGDIxsQcYS4TaQ7g7SBnKMoC= qIp80hx0vpzs2fehkFjIGVlFny2Sn4FUFA1ARAOBgGLVKXgWAsLTlVKGLX4mq/Q/uWCpeJGmtqi= JLMHfRcUWYmO6QEkgZufTKimiUT5fzieSuZIAxFsufOSZaCAeC/NUkP2gQ0aCMVgKCy+Ot8oaGs= NPJgLRegY6lt+6Vggomd5NGJtUT5ptsfPcGfmaBxmjsKlOBF+ZUzNfyINO3TcSOzO53sHHJFFcO= HthbaSO43CWyUMFz4gXgnbqKyahnwU1x3jQYXFnRvCSaEzTlQbGGb0gH1K+0vk8muE6y+KZvpZi= GcK/XL4AFoIOZFItgFzqlyQyPnPqOwmYsWJdRCvpMI/lJvGdrMAJsqcxNYz1ujUJn0G8OJYdic/= 0QGrbCTjj8SSClYBweB7wSwzSf1QC0wizSabpzKaTz2D6tmza+K8eP1If5DpObDaRPbUF1b8y2t= JCf9p+2n7aftp+2n7aftr+f9f+X3lDUAZFZ6JBAAAAAElFTkSuQmCC" width=3D"506" heigh= t=3D"343" alt=3D"" /><a id=3D"fig1">Figura 1. Flujograma de revisi=C3=B3n</a>En relaci=C3=B3n con los de= senlaces cl=C3=ADnicos, el edema y el trismus fueron los par=C3=A1metros qu= e mostraron mayor consistencia en la respuesta al uso preoperatorio de cort= icosteroides, evidenciando una reducci=C3=B3n significativa en la mayor=C3= =ADa de los estudios incluidos (1)(2)(3). Por el contrario, el control del = dolor present=C3=B3 mayor variabilidad, dependiendo del tipo de f=C3=A1rmac= o, la dosis, la v=C3=ADa de administraci=C3=B3n y el uso concomitante de ot= ros analg=C3=A9sicos (7)(8).Desde el punto de vista farmacol=C3=B3gico, la dexameta= sona fue el corticosteroide m=C3=A1s ampliamente estudiado y con resultados= m=C3=A1s consistentes, especialmente en dosis =C3=BAnicas preoperatorias d= e 4 a 8 mg (1)(2). Otros f=C3=A1rmacos como la metilprednisolona y la predn= isona tambi=C3=A9n mostraron efectos favorables, aunque con evidencia m=C3= =A1s heterog=C3=A9nea (4)(9)(10)(20)(21)(22). Respecto a las v=C3=ADas de administr= aci=C3=B3n, tanto las rutas sist=C3=A9micas (intramuscular e intravenosa) c= omo las locales (submucosa y sublingual) demostraron eficacia en la reducci= =C3=B3n del edema y el trismus (3)(5)(11). No obstante, las v=C3=ADas local= es presentaron ventajas cl=C3=ADnicas adicionales, como menor invasividad y= mejor aceptaci=C3=B3n por parte del paciente (1)(6).<= span style=3D"font-family:'Times New Roman'">En la comparaci=C3=B3n con otr= os f=C3=A1rmacos, algunos estudios reportaron que la dexametasona presenta = una eficacia comparable o superior a los antiinflamatorios no esteroideos e= n el control del dolor y la inflamaci=C3=B3n postoperatoria, particularment= e cuando se administra de forma preoperatoria (12)(13). Asimismo, la combin= aci=C3=B3n de corticosteroides con AINEs mostr=C3=B3 efectos sin=C3=A9rgico= s en el control del dolor temprano (7).En t=C3=A9rminos de seguridad, los estudios = incluidos no reportaron eventos adversos graves asociados al uso de cortico= steroides en dosis =C3=BAnica preoperatoria en pacientes sanos. Sin embargo= , se observ=C3=B3 una considerable heterogeneidad metodol=C3=B3gica, especi= almente en la evaluaci=C3=B3n del edema, lo que limita la comparabilidad di= recta entre estudios (3)(9).<ol start=3D"4" style=3D"margin:0pt;= padding-left:0pt"><li class=3D"ListParagraph" style=3D"margin-top:12pt; ma= rgin-left:17.3pt; line-height:115%; padding-left:4pt; font-family:'Times Ne= w Roman'; font-size:12pt; font-weight:bold; color:#4a442a">Discusi=C3=B3n </s= pan></li></ol>La ev= idencia analizada en esta revisi=C3=B3n sistem=C3=A1tica respalda el uso pr= eoperatorio de corticosteroides como una estrategia eficaz para modular la = respuesta inflamatoria posterior a la cirug=C3=ADa de terceros molares. No = obstante, la magnitud y consistencia de este beneficio deben interpretarse = con cautela, debido a limitaciones metodol=C3=B3gicas relevantes y a la het= erogeneidad de los estudios incluidos. En este contexto, tanto Parhizkar et= al. (1) = como Canellas et al. (2)</spa= n> coinciden en se=C3=B1alar una reducci=C3= =B3n significativa del edema y el trismus con el uso de corticosteroides, p= articularmente dexametasona, hallazgos que tambi=C3=A9n son corroborados po= r Shad et al. (3). Sin embargo, estos resultados contrastan con la variabil= idad observada en otros desenlaces, especialmente en el control del dolor.<= /span>Desde una= perspectiva farmacol=C3=B3gica, la eficacia observada puede explicarse por= el mecanismo de acci=C3=B3n de los corticosteroides, los cuales inhiben la= fosfolipasa A=E2=82=82 y reducen la s=C3=ADntesis de mediadores proinflama= torios (2). Este efecto upstream en la cascada inflamatoria permite comprender por qu=C3=A9 los resu= ltados son m=C3=A1s consistentes en la reducci=C3=B3n del edema y el trismu= s que en el control del dolor. En concordancia, Pimenta et al. (14) y Singh= et al. (8) destacan que el dolor postoperatorio tiene una naturaleza multi= factorial, influenciada no solo por la inflamaci=C3=B3n, sino tambi=C3=A9n = por factores quir=C3=BArgicos y neurosensoriales, lo que limita el impacto = de los corticosteroides como monoterapia.En relaci=C3=B3n con la comparaci=C3=B3n= entre f=C3=A1rmacos, Singh et al. (8) reportan una eficacia similar entre = dexametasona y metilprednisolona en la reducci=C3=B3n del dolor y la inflam= aci=C3=B3n, mientras que Larsen et al. (4) no evidenciaron beneficios signi= ficativos con metilprednisolona frente a placebo. Por su parte, Antonelli e= t al. (9) observaron que la prednisona puede reducir el edema facial, aunqu= e con menor respaldo comparativo. En conjunto, estos hallazgos sugieren que= , si bien existen alternativas terap=C3=A9uticas, la aparente superioridad = de la dexametasona podr=C3=ADa estar influenciada tanto por sus propiedades= farmacol=C3=B3gicas como por la mayor cantidad de evidencia disponible, m= =C3=A1s que por diferencias cl=C3=ADnicas contundentes.Un aspecto cr=C3=ADtico ide= ntificado en la literatura es la falta de estandarizaci=C3=B3n en las dosis= y en la equivalencia farmacol=C3=B3gica entre corticosteroides. Aunque la = dexametasona se emplea com=C3=BAnmente en dosis de 4=E2=80=938 mg (1)(2), n= o existe una justificaci=C3=B3n farmacodin=C3=A1mica uniforme que respalde = este rango como =C3=B3ptimo. Adem=C3=A1s, otros corticosteroides, como la m= etilprednisolona y la prednisona, han sido utilizados en dosis no equipoten= tes (4)(9), lo que introduce un sesgo sistem=C3=A1tico en la comparaci=C3= =B3n de resultados y limita la interpretaci=C3=B3n de la eficacia relativa = entre f=C3=A1rmacos.En cuanto a las v=C3=ADas de administraci=C3=B3n, estudios como= los de Hiriyanna & Degala (5) y Hou et al. (11) demostraron una eficac= ia comparable entre las v=C3=ADas submucosa, intravenosa e intramuscular, m= ientras que Priyanga et al. (6) sugieren incluso una posible ventaja de la = v=C3=ADa sublingual en ciertos desenlaces. No obstante, estas diferencias n= o son cl=C3=ADnicamente concluyentes, y la variabilidad en los dise=C3=B1os= de estudio y en los m=C3=A9todos de medici=C3=B3n limita la validez extern= a de estos hallazgos. A pesar de ello, desde una perspectiva pr=C3=A1ctica,= las v=C3=ADas locales presentan ventajas relevantes en t=C3=A9rminos de me= nor invasividad, facilidad de aplicaci=C3=B3n y mayor aceptaci=C3=B3n por p= arte del paciente.En relaci=C3=B3n con el control del dolor, los resultados son men= os consistentes. Mientras que Martins-de-Barros et al. (12) reportan una ma= yor eficacia de la dexametasona frente a ketorolaco, Momesso et al. (7) evi= dencian que la combinaci=C3=B3n de corticosteroides con AINEs mejora signif= icativamente el control del dolor en el postoperatorio temprano. Estos hall= azgos sugieren que el uso aislado de corticosteroides puede ser insuficient= e para un manejo analg=C3=A9sico =C3=B3ptimo, reforzando la necesidad de en= foques terap=C3=A9uticos multimodales que integren diferentes mecanismos de= acci=C3=B3n.En t=C3=A9rminos de seguridad, la evidencia disponible, incluyendo los= trabajos de Nils et al. (15) y Canellas et al. (2) indica que la administr= aci=C3=B3n de corticosteroides en dosis =C3=BAnica preoperatoria presenta u= n perfil favorable en pacientes sanos, sin incremento significativo de even= tos adversos. Sin embargo, esta conclusi=C3=B3n est=C3=A1 condicionada por = la limitada inclusi=C3=B3n de pacientes con comorbilidades en los estudios = analizados, lo que restringe la extrapolaci=C3=B3n de los resultados a pobl= aciones m=C3=A1s complejas.En este contexto, el uso de corticosteroides en paciente= s con enfermedades sist=C3=A9micas requiere una evaluaci=C3=B3n rigurosa, y= a que sus efectos inmunosupresores y metab=C3=B3licos pueden agravar condic= iones preexistentes o descompensar patolog=C3=ADas de base. Aunque la admin= istraci=C3=B3n en dosis =C3=BAnica preoperatoria ha demostrado un perfil de= seguridad favorable en pacientes sanos, en individuos con comorbilidades i= ncluso exposiciones =C3=BAnicas pueden inducir alteraciones metab=C3=B3lica= s e inmunol=C3=B3gicas transitorias cl=C3=ADnicamente relevantes. Estos f= =C3=A1rmacos pueden favorecer la hiperglucemia, la retenci=C3=B3n de l=C3= =ADquidos, la elevaci=C3=B3n de la presi=C3=B3n arterial y una disminuci=C3= =B3n de la respuesta inmunitaria, lo que podr=C3=ADa incrementar el riesgo = de infecciones o retrasar la cicatrizaci=C3=B3n en pacientes susceptibles. = En este sentido, condiciones como la diabetes mellitus no controlada, la hi= pertensi=C3=B3n arterial descompensada, los estados de inmunosupresi=C3=B3n= o infecciones activas, as=C3=AD como trastornos gastrointestinales, hep=C3= =A1ticos o renales, representan escenarios cl=C3=ADnicos en los que su indi= caci=C3=B3n debe ser cuidadosamente valorada (2)(14)(16). En consecuencia, = aunque la seguridad de los corticosteroides ha sido ampliamente demostrada = en pacientes ASA I=E2=80=93II, la evidencia actual no permite generalizar e= stos hallazgos a poblaciones con enfermedades sist=C3=A9micas, lo que refue= rza la necesidad de individualizar su uso y evitar su indicaci=C3=B3n rutin= aria en estos pacientes.Finalmente, es importante considerar las limitaciones metod= ol=C3=B3gicas de la evidencia disponible. La heterogeneidad en las t=C3=A9c= nicas quir=C3=BArgicas, el tiempo operatorio y la experiencia del cirujano = constituye una fuente relevante de variabilidad que no siempre es controlad= a adecuadamente (17). Asimismo, la diversidad en los m=C3=A9todos de medici= =C3=B3n del edema y del trismus se=C3=B1alada por Hou et al. (11) y Antonel= li et al. (9), dificulta la comparabilidad entre estudios. A esto se suma l= a frecuente presencia de cointervenciones, como el uso concomitante de AINE= s, que introduce sesgos de confusi=C3=B3n y limita la atribuci=C3=B3n del e= fecto exclusivamente a los corticosteroides (7)(12).<= span style=3D"font-family:'Times New Roman'">En conjunto, aunque la evidenc= ia respalda el uso preoperatorio de corticosteroides, particularmente la de= xametasona, la magnitud del beneficio cl=C3=ADnico puede estar condicionada= por factores metodol=C3=B3gicos no controlados. En este sentido, se requie= ren ensayos cl=C3=ADnicos con mayor rigor metodol=C3=B3gico que incluyan la= estandarizaci=C3=B3n de dosis basada en equivalencia farmacol=C3=B3gica, e= l adecuado control de variables confusoras y la evaluaci=C3=B3n de desenlac= es cl=C3=ADnicamente relevantes. Este enfoque permitir=C3=A1 avanzar hacia = la definici=C3=B3n de protocolos cl=C3=ADnicos m=C3=A1s precisos, reproduci= bles y aplicables en la pr=C3=A1ctica cl=C3=ADnica. En concordancia con los= hallazgos de la presente investigaci=C3=B3n, se propone un protocolo para = el uso de corticosteroides en cirug=C3=ADa de terceros molares, el cual se = presenta en la <a href=3D"#tabla2" style=3D"text-decoration:none"><s= pan class=3D"Hyperlink" style=3D"font-family:'Times New Roman'; font-weight= :bold; text-decoration:none; color:#000000">Tabla 2</a>. <a id=3D"tabla2"><sp= an style=3D"font-family:'Times New Roman'; font-weight:bold">Tabla 2.</span= > Protocol= o preoperatorio de corticosteroides en la cirug=C3=ADa de terceros molares<= /span></a><table style=3D"width:419.9pt; margin-bottom:0pt; padding:0pt= ; border-collapse:collapse"><tr style=3D"height:42.05pt"><td style=3D"width= :53.8pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #00000= 0; padding:0pt 5pt; vertical-align:top">Corticosteroide</td><td style=3D"width:18.35= pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; pa= dding:0pt 5pt; vertical-align:top">Dosis</td><td style=3D"width:31.4pt; border-top:0= .75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; v= ertical-align:top">V= =C3=ADa</td><td style=3D"width:33.65pt; border-top:0.75pt solid = #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-alig= n:top">Momento</span= ></td><td style=3D"width:42.25pt; border-top:0.75pt solid #000000; bord= er-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Indicaciones principales</= span></td><td style=3D"width:48.3pt; border-top:0.75pt solid #000000; b= order-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Observaciones cl=C3=ADn= icas</td><td style=3D"width:28.8pt; border-top:0.75pt solid #000= 000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:to= p">Nivel de respaldo= </td><td style=3D"width:31pt; border-top:0.75pt solid #000000; b= order-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Calidad de evidencia (gr= ade)</td><td style=3D"width:42.35pt; border-top:0.75pt solid #00= 0000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:t= op">Consistencia de = resultados</td></tr><tr style=3D"height:31.25pt"><td style=3D"wi= dth:53.8pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #7f7= f7f; border-bottom:0.75pt solid #000000; padding:0pt 4.62pt 0pt 5pt; vertic= al-align:top">Dexametasona</= td><td style=3D"width:18.35pt; border-top:0.75pt solid #000000; border-bott= om:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">4=E2=80=938 mg</td><td style=3D"width:31.= 4pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; p= adding:0pt 5pt; vertical-align:top">Sub= mucosa</td><td style=3D"width:33.65pt; border-top:0.75pt solid #= 000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align= :top"><spa= n style=3D"font-family:'Times New Roman'">Preoperatorio inmediato</p= ></td><td style=3D"width:42.25pt; border-top:0.75pt solid #000000; border-b= ottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Edema, trismus</td><td style=3D"widt= h:48.3pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #0000= 00; padding:0pt 5pt; vertical-align:top">Alternativa eficaz y menos invasiva</td><td style=3D"width:28.= 8pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; p= adding:0pt 5pt; vertical-align:top">Alt= o</td><td style=3D"width:31pt; border-top:0.75pt solid #000000; = border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top"><p= style=3D"margin-bottom:10pt; line-height:115%; font-size:8pt">Moderada</td><td style=3D"wid= th:42.35pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #00= 0000; padding:0pt 5pt; vertical-align:top">Alta</td></tr><tr style=3D"height:39.7pt"><td style=3D"width= :53.8pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #7f7f7f= ; border-bottom:0.75pt solid #000000; padding:0pt 4.62pt 0pt 5pt; vertical-= align:top">Dexametasona</td>= <td style=3D"width:18.35pt; border-top:0.75pt solid #000000; border-bottom:= 0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">4=E2=80=938 mg</td><td style=3D"width:31.4pt= ; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padd= ing:0pt 5pt; vertical-align:top">Intram= uscular</td><td style=3D"width:33.65pt; border-top:0.75pt solid = #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-alig= n:top"><sp= an style=3D"font-family:'Times New Roman'">30=E2=80=9360 min antes</= p></td><td style=3D"width:42.25pt; border-top:0.75pt solid #000000; border-= bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Control inflamatorio global</td><td = style=3D"width:48.3pt; border-top:0.75pt solid #000000; border-bottom:0.75p= t solid #000000; padding:0pt 5pt; vertical-align:top">V=C3=ADa tradicional, ampliamente estudiada</td><= td style=3D"width:28.8pt; border-top:0.75pt solid #000000; border-bottom:0.= 75pt solid #000000; padding:0pt 5pt; vertical-align:top">Alto</td><td style=3D"width:31pt; border-top:0= .75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; v= ertical-align:top">Moderada<= /td><td style=3D"width:42.35pt; border-top:0.75pt solid #000000; border-bot= tom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Alta</td></tr><tr style=3D"height:35.25p= t"><td style=3D"width:53.8pt; border-top:0.75pt solid #000000; border-right= :0.75pt solid #7f7f7f; border-bottom:0.75pt solid #000000; padding:0pt 4.62= pt 0pt 5pt; vertical-align:top">Dexamet= asona</td><td style=3D"width:18.35pt; border-top:0.75pt solid #0= 00000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:= top"><span= style=3D"font-family:'Times New Roman'">4=E2=80=938 mg</td><td = style=3D"width:31.4pt; border-top:0.75pt solid #000000; border-bottom:0.75p= t solid #000000; padding:0pt 5pt; vertical-align:top">Sublingual</td><td style=3D"width:33.65pt; border= -top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt = 5pt; vertical-align:top">30=E2=80=9360 = min antes</td><td style=3D"width:42.25pt; border-top:0.75pt soli= d #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-al= ign:top"><= span style=3D"font-family:'Times New Roman'">Edema, trismus, dolor</= p></td><td style=3D"width:48.3pt; border-top:0.75pt solid #000000; border-b= ottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Alta aceptaci=C3=B3n, r=C3=A1pida acci=C3=B3n</= span></td><td style=3D"width:28.8pt; border-top:0.75pt solid #000000; b= order-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Moderado</td><td style=3D"wid= th:31pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #00000= 0; padding:0pt 5pt; vertical-align:top">Baja=E2=80=93moderada</td><td style=3D"width:42.35pt; border-to= p:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt= ; vertical-align:top">Variable</= p></td></tr><tr style=3D"height:35.25pt"><td style=3D"width:53.8pt; border-= top:0.75pt solid #000000; border-right:0.75pt solid #7f7f7f; border-bottom:= 0.75pt solid #000000; padding:0pt 4.62pt 0pt 5pt; vertical-align:top">Dexametasona</td><td style=3D"wid= th:18.35pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #00= 0000; padding:0pt 5pt; vertical-align:top">4=E2=80=938 mg</td><td style=3D"width:31.4pt; border-top:0.7= 5pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; ver= tical-align:top">Intravenosa= </td><td style=3D"width:33.65pt; border-top:0.75pt solid #000000; border-bo= ttom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Durante inducci=C3=B3n</td><td style=3D= "width:42.25pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid= #000000; padding:0pt 5pt; vertical-align:top">Control r=C3=A1pido del edema</td><td style=3D"width:48.= 3pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; p= adding:0pt 5pt; vertical-align:top">May= or invasividad, uso hospitalario</td><td style=3D"width:28.8pt; = border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; paddin= g:0pt 5pt; vertical-align:top">Moderado= </td><td style=3D"width:31pt; border-top:0.75pt solid #000000; b= order-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Moderada</td><td style=3D"wid= th:42.35pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #00= 0000; padding:0pt 5pt; vertical-align:top">Variable</td></tr><tr style=3D"height:35.25pt"><td style=3D"= width:53.8pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #7= f7f7f; border-bottom:0.75pt solid #000000; padding:0pt 4.62pt 0pt 5pt; vert= ical-align:top">Dexametasona= </td><td style=3D"width:18.35pt; border-top:0.75pt solid #000000; border-bo= ttom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">4 mg</td><td style=3D"width:31.4pt; bor= der-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0= pt 5pt; vertical-align:top">Intra=C3=B3= sea</td><td style=3D"width:33.65pt; border-top:0.75pt solid #000= 000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:to= p">Preoperatorio</td><td sty= le=3D"width:42.25pt; border-top:0.75pt solid #000000; border-bottom:0.75pt = solid #000000; padding:0pt 5pt; vertical-align:top">Trismus temprano</td><td style=3D"width:48.3pt; bor= der-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0= pt 5pt; vertical-align:top">Evidencia e= mergente</td><td style=3D"width:28.8pt; border-top:0.75pt solid = #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-alig= n:top"><sp= an style=3D"font-family:'Times New Roman'">Limitado</td><td styl= e=3D"width:31pt; border-top:0.75pt solid #000000; border-bottom:0.75pt soli= d #000000; padding:0pt 5pt; vertical-align:top">Baja</td><td style=3D"width:42.35pt; border-top:0.75pt = solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertica= l-align:top">Baja</td></tr><= /table>Tabla 2. Protocolo preoperatorio de corticosteroides en la cirug=C3=ADa de ter= ceros molares (continuaci=C3=B3n)<table style=3D"width:419.9pt; mar= gin-bottom:0pt; padding:0pt; border-collapse:collapse"><tr style=3D"height:= 35.25pt"><td style=3D"width:53.8pt; border-top:0.75pt solid #000000; border= -bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Corticosteroide</= td><td style=3D"width:18.35pt; border-top:0.75pt solid #000000; border-bott= om:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top"><spa= n style=3D"font-family:'Times New Roman'">Dosis</td><td style=3D= "width:31.4pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid = #000000; padding:0pt 5pt; vertical-align:top">V=C3=ADa</td><td style=3D"width:33.65p= t; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; pad= ding:0pt 5pt; vertical-align:top">Momento</td><td style=3D"width:42.25pt; border-top= :0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt;= vertical-align:top">Indicaciones principales</td><td style=3D"width:48.3pt; border-= top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5= pt; vertical-align:top">Observaciones cl=C3=ADnicas</td><td style=3D"width:28.8pt; b= order-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding= :0pt 5pt; vertical-align:top">Nivel de respaldo</td><td style=3D"width:31pt; border-= top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5= pt; vertical-align:top">Calidad de evidencia (grade)</td><td style=3D"width:42.35pt;= border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; paddi= ng:0pt 5pt; vertical-align:top">Consistencia de resultados</td></tr><tr style=3D"hei= ght:35.25pt"><td style=3D"width:53.8pt; border-top:0.75pt solid #000000; bo= rder-right:0.75pt solid #7f7f7f; border-bottom:0.75pt solid #000000; paddin= g:0pt 4.62pt 0pt 5pt; vertical-align:top">Metilprednisolona</td><td style=3D"width:18.35pt; border-top:= 0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; = vertical-align:top">40 mg</t= d><td style=3D"width:31.4pt; border-top:0.75pt solid #000000; border-bottom= :0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">IM / IV</td><td style=3D"width:33.65pt; bor= der-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0= pt 5pt; vertical-align:top">30=E2=80=93= 60 min antes</td><td style=3D"width:42.25pt; border-top:0.75pt s= olid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical= -align:top">Inflamaci=C3=B3n, trismus</= span></td><td style=3D"width:48.3pt; border-top:0.75pt solid #000000; b= order-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Resultados inconsistentes</td= ><td style=3D"width:28.8pt; border-top:0.75pt solid #000000; border-bottom:= 0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Moderado</td><td style=3D"width:31pt; border= -top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt = 5pt; vertical-align:top">Baja=E2=80=93m= oderada</td><td style=3D"width:42.35pt; border-top:0.75pt solid = #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-alig= n:top"><sp= an style=3D"font-family:'Times New Roman'">Variable</td></tr><tr= style=3D"height:35.25pt"><td style=3D"width:53.8pt; border-top:0.75pt soli= d #000000; border-right:0.75pt solid #7f7f7f; border-bottom:0.75pt solid #0= 00000; padding:0pt 4.62pt 0pt 5pt; vertical-align:top">Prednisona</td><td style=3D"width:18.35pt; borde= r-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding:0pt= 5pt; vertical-align:top">40=E2=80=9350= mg</td><td style=3D"width:31.4pt; border-top:0.75pt solid #0000= 00; border-bottom:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top= ">Oral</td><td style=3D"widt= h:33.65pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000= 000; padding:0pt 5pt; vertical-align:top">60 min antes</td><td style=3D"width:42.25pt; border-top:0.75p= t solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; verti= cal-align:top">Edema facial<= /td><td style=3D"width:48.3pt; border-top:0.75pt solid #000000; border-bott= om:0.75pt solid #000000; padding:0pt 5pt; vertical-align:top">Menor evidencia comparativa</td><td style= =3D"width:28.8pt; border-top:0.75pt solid #000000; border-bottom:0.75pt sol= id #000000; padding:0pt 5pt; vertical-align:top">Limitado</td><td style=3D"width:31pt; border-top:0.75p= t solid #000000; border-bottom:0.75pt solid #000000; padding:0pt 5pt; verti= cal-align:top">Baja</td><td = style=3D"width:42.35pt; border-top:0.75pt solid #000000; border-bottom:0.75= pt solid #000000; padding:0pt 5pt; vertical-align:top">Variable</td></tr></table>Nota: en concordancia con los hallazgos de l= a presente investigaci=C3=B3n, se propone un protocolo para el uso de corti= costeroides en cirug=C3=ADa de terceros molares, el cual se presenta en la = tabla 2 y se fundamenta en la evidencia reportada en estudios cl=C3=ADnicos= y revisiones sistem=C3=A1ticas recientes (1,2,4=E2=80=939,11,12,15,18,19)Asimismo, se desarroll=C3=B3 un flujograma exp= licativo que orienta la toma de decisiones cl=C3=ADnicas sobre el uso de co= rticosteroides en este contexto, el cual se presenta en la <a href= =3D"#fig2" style=3D"text-decoration:none">Figura 2</a>. <img src=3D"data:image/jpeg;base64,/9j/4AAQSkZJ= RgABAQEAYABgAAD/2wBDAAEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQE= BAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQH/2wBDAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQ= EBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQEBAQH/wAARCAHsASsDASIAAhEBAxEB/= 8QAHwAAAAYCAwEAAAAAAAAAAAAAAAECBwgJBgoDBAUL/8QAchAAAAUDAgMEBgcEBQYFCQ8VAQME= BQYCBxEAIQgxQQkSUWETFBVxgaEWFyKRscHwChgy0SYnQuHxGRojJTZSJCg3R2IzNThDVldygpI= pOURFRkhTWIOVlqK3wtI0VFVjZ3R1dneGh5OUl6SnsrbU1eL/xAAeAQABBAMBAQEAAAAAAAAAAA= AAAwQFBgECBwgJCv/EAFwRAAICAQMDAgMDBAwICQkHBQECAwQRAAUSBhMhBzEUIkEIFVEWIzJhC= 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4H19vxOtQoP2SayHeEauKy6XeAR3+iEW7247YHv+OBAAzjmHLXaM/ZMrOGJyUhnFvdmtKnNPPIT= GRaMVJyDlFJdJ5pJNRvoyzFFJBFJ1ZdFNRoEEhX3gKLCnboqrGnAhz8RyPLGOuuSkRqEBHfIfDl= 4aD6w+phxnq/czj/s3vgjkT2M8sEjPvgnWPyD6Q9/uGjn2/Rk9vGR5kPg4/H+ceNahtf7JTZCuk= KQ4rrpAAb5+iMVyGwhyEzG/UA5/PXBT+ySWRLyAcWN0hzuAfQ2K9BHIjgwR67Z8fdrb5M2zgOmf= x0ikREM+P89B9YvUwsGPV+5kgYB/c3sCPH+A9vGP1jOgdB9IAEDYaPn3+R/J8fi5/D+s61Ei/wB= kusnQWJQ8WF1O5VV3hoCIRcKe8IYGoA7+AqHbI4yIAGR2DFh/Zxdgtw99nrecy/zdcae3ZuUgaH= Rih6qTEMzQxRJG+ojG57XomtnSUqFj04N56psFY4OZ6NO3qlBadtLUGCr1fAA4HoPv0A5h7w/HT= Lc/VHr/AHnb7W17j1RuNmhdjMNuszQok8LFS8UhiiRij8QGHIBlyrZUkacU+jel6FqG7U2WlDar= sHhmRG5RuPZk5M3Fh5IPkgnI8+dGFVQAGc8g2EA5fdpI1VDsG48+lIbeI7APP+HO4dNtKq5h15/= /ANVXhrjqEQ7uOtWB92B/lqg6s2uQQHFOcZHIjyx088aLw8/lz/u0Q77DuHgO+ho0aUAZDcB3/t= eHn4e/Ok4xtz3Hfx35/HR5HlkceGdcQ1iAiG2wj4/z0aNf/9k=3D" width=3D"299" height= =3D"492" alt=3D"" /><a id=3D"fig2">Figura 2. Algoritmo cl=C3=ADnico para el uso = de corticoesteroides en la extracci=C3=B3n de tercer molar</a><o= l start=3D"5" style=3D"margin:0pt; padding-left:0pt"><li class=3D"ListParag= raph" style=3D"margin-left:17.45pt; margin-bottom:10pt; line-height:115%; p= adding-left:3.85pt; font-family:'Times New Roman'; font-size:12pt; font-wei= ght:bold; color:#4a442a">Conclusiones<= /li></ol><ul style=3D"margin:0pt; padding-left:0pt"><li class=3D"ListParagr= aph" style=3D"margin-left:32.33pt; margin-bottom:0pt; text-align:justify; l= ine-height:115%; padding-left:3.67pt; font-family:serif; font-size:12pt"><s= pan style=3D"font-family:'Times New Roman'">La presente revisi=C3=B3n narra= tiva permiti=C3=B3 alcanzar el objetivo de analizar la evidencia reciente s= obre el uso preoperatorio de corticosteroides en cirug=C3=ADa de terceros m= olares, confirmando su relevancia como estrategia para optimizar la recuper= aci=C3=B3n postoperatoria. Entre los f=C3=A1rmacos evaluados, la dexametaso= na de 4-8 mg se posiciona como la alternativa de referencia debido a la con= sistencia de los resultados reportados y al mayor respaldo cient=C3=ADfico = disponible sobre su eficacia y seguridad.</li><li class=3D"ListParag= raph" style=3D"margin-left:32.33pt; margin-bottom:10pt; text-align:justify;= line-height:115%; padding-left:3.67pt; font-family:serif; font-size:12pt">= Como aporte de esta investiga= ci=C3=B3n, se integr=C3=B3 cr=C3=ADticamente la evidencia publicada entre 2= 020 y 2025 y se propuso un protocolo orientativo para la toma de decisiones= cl=C3=ADnicas basado en la evidencia actual. Asimismo, se identific=C3=B3 = la necesidad de estandarizar dosis, v=C3=ADas de administraci=C3=B3n y m=C3= =A9todos de evaluaci=C3=B3n, con el fin de fortalecer las recomendaciones c= l=C3=ADnicas y favorecer el desarrollo de protocolos m=C3=A1s homog=C3=A9ne= os y reproducibles.</li></ul><ol start=3D"6" style=3D"margin:0pt; pa= dding-left:0pt"><li style=3D"margin-left:17.3pt; margin-bottom:10pt; text-a= lign:justify; line-height:115%; padding-left:4pt; font-family:'Times New Ro= man'; font-size:12pt; font-weight:bold; color:#4a442a">Conflicto de intereses</li></ol>Los autores declaran que no existe conflicto= de intereses en relaci=C3=B3n con el art=C3=ADculo presentado.<= ol start=3D"7" style=3D"margin:0pt; padding-left:0pt"><li style=3D"margin-l= eft:17.3pt; margin-bottom:10pt; text-align:justify; line-height:115%; paddi= ng-left:4pt; font-family:'Times New Roman'; font-size:12pt; font-weight:bol= d; color:#4a442a">Derechos de autor (copyrigt= h)</li></ol>Los autores son los= titulares de los derechos de autor (patrimoniales y/o de explotaci=C3=B3n) de los contenidos de la r= evista (copyright).</span= ><ol start=3D"8" style=3D"margin:0pt; padding-left:0pt"><li style=3D"ma= rgin-left:17.3pt; margin-bottom:10pt; text-align:justify; line-height:115%;= padding-left:4pt; font-family:'Times New Roman'; font-size:12pt; font-weig= ht:bold; color:#4a442a">Declaraci=C3=B3n de c= ontribuci=C3=B3n de los autores</li></ol>Camila Bel=C3=A9= n Samaniego Maldonado: conceptualizaci=C3=B3n del estudio, pro= puesta del tema de investigaci=C3=B3n, b=C3=BAsqueda y an=C3=A1lisis de la = literatura cient=C3=ADfica, redacci=C3=B3n del manuscrito y revisi=C3=B3n d= el contenido acad=C3=A9mico.<s= pan class=3D"Strong" style=3D"font-weight:normal">Nicole Stephany Paucar Mo= rocho: apoyo en la redacci=C3=B3n del manuscrito, organizaci= =C3=B3n y gesti=C3=B3n de referencias bibliogr=C3=A1ficas, citaci=C3=B3n de= fuentes y revisi=C3=B3n de la estructura del documento.M= ario Esteban Calder=C3=B3n Calle: tutor=C3=ADa y supervisi=C3= =B3n de la investigaci=C3=B3n, orientaci=C3=B3n metodol=C3=B3gica, revisi= =C3=B3n cr=C3=ADtica del contenido cient=C3=ADfico y aprobaci=C3=B3n de la = versi=C3=B3n final del manuscrito.Divulgaci=C3=B3n de la delegac= i=C3=B3n a la IA generativaLos autores declaran el uso de la IA generativa en el pr= oceso de investigaci=C3=B3n y redacci=C3=B3n. Seg=C3=BAn la taxonom=C3=ADa = GAIDeT (2025), las siguientes tareas fueron delegadas a las herramientas GA= I bajo supervisi=C3=B3n humana total:- Generaci=C3=B3n de ideas- Formulaci=C3=B3n de pregu= ntas e hip=C3=B3tesis de investigaci=C3=B3n- B=C3=BAsqueda y sistematizaci=C3=B3n d= e la literaturaLa herramienta GAI utilizada fue: ChatGPT 4.</spa= n>La responsabi= lidad del manuscrito final recae =C3=ADntegramente en los autores.</= p>Las herramientas = GAI no figuran como autores y no asumen responsabilidad por los resultados = finales.Declaraci=C3=B3n presentada por: Cami= la Bel=C3=A9n Samaniego Maldonado<ol start=3D"9" style=3D"margin= :0pt; padding-left:0pt"><li style=3D"margin-left:17.3pt; margin-bottom:10pt= ; text-align:justify; line-height:115%; padding-left:4pt; font-family:'Time= s New Roman'; font-size:12pt; font-weight:bold; color:#4a442a">Costos de financiamiento </li></ol>La presente investigaci=C3=B3n fue financiada en su totalidad con fond= os propios de los autores.<ol start=3D"10" style=3D"margin:0pt; = padding-left:0pt"><li style=3D"margin-left:21.3pt; margin-bottom:10pt; text= -align:justify; line-height:115%; font-family:'Times New Roman'; font-size:= 12pt; font-weight:bold; color:#4a442a">Refere= ncias Bibliogr=C3=A1ficas</li></ol>1.<= span style=3D"width:9pt; text-indent:0pt; font-family:'Times New Roman'; di= splay:inline-block"> Parhizkar P, Schmidlin PR, Bornstein MM, Fakheran O. 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