Therapeutic Agents in Perioperative Third Molar Surgical Procedures

Common side effects of third molar (M3) operations including pain, edema, and trismus have an adverse effect on patient quality of life. Injectable platelet-rich fibrin (i-PRF) may ameliorate some of the side effects of the operation.

The primary purpose of this study is to measure and compare differences in pain, swelling, trismus, and quality of life between i-PRF side and a control side of subjects undergoing M3 removal.

This study is a single-center, split-mouth, randomized prospective clinical trial conducted at Ordu University Faculty of Dentistry. Patients who presented between March and August 2022 for the extraction of impacted third molars due to various reasons were included in the study. The exclusion criteria were local conditions and systematic comorbidities. Additionally, patients with differences that could cause bias between the sides were excluded from the study.

The predictor variable is treatment i-PRF or control.

The outcome variables of interest are the pain level and analgesic consumption values on the Visual Analog Scale, the distance between determined reference points, maximum mouth opening, and the Postoperative Symptom Severity scale data. A Postoperative Symptom Severity scale was created using questions commonly employed in the clinical evaluation of patients following the extraction of third molars. This scale was further divided into subscales corresponding to the 7 primary adverse effects identified in a prior study.

Covariate variables, sex, age, and operation times.

The normality of the distribution of the study data was assessed using the Kolmogorov-Smirnov test. Depending on whether the data exhibited a normal distribution or not, the data were analyzed using either the paired t-test or the Wilcoxon test. A P value < .05 was considered statistically significant.

The study included 35 patients with a mean age of 19.97 ± 2.07 years. The i-PRF side significant success in postoperative edema measurements. There was a statistically significant difference observed between the control side and the i-PRF side on the second day (control: 9.74 ± 0.57 mm, i-PRF: 9.46 ± 0.51 mm) and seventh day (control: 9.33 ± 0.59 mm, i-PRF: 9.12 ± 0.50 mm) in lateral canthus-angulus measurements (P: .01 and P: .04, respectively). Additionally, on the second day, there was a statistically significant difference in tragus-commisura measurements (control: 11.53 ± 0.62 mm, i-PRF: 11.31 ± 0.58 mm) with a P value of .02. There was no significant difference observed between the sides in terms of postoperative pain (P > .05). However, analgesic consumption in the i-PRF side was significantly lower at the sixth hour (control: 1.8 ± 0.58 dose, i-PRF: 1.14 ± 0.35 dose), 24th hour (control: 1.77 ± 0.54 dose, i-PRF: 1.14 ± 0.35 dose), and second day (control: 1.8 ± 0.47 dose, i-PRF: 1.4 ± 0.73 dose) postoperatively (P: .000, P: .000, and P: .012). Mouth opening was significantly lower in the i-PRF side on the second day (control: 27.88 ± 6.48 mm, i-PRF: 25.51 ± 5.56 mm) (P: .025). However, i-PRF had no significant effect on postoperative quality of life (P > .05).

According to the study results, i-PRF had a limited effect on the management of postoperative pain, but i-PRF was effective in reducing postoperative edema. Further studies with larger patient sides are now needed to yield more detailed findings on the subject.

Laser light has biological effects that can modulate inflammatory processes. Thus, this study aimed to evaluate the effects of photobiomodulation (PBM) therapy on pain, edema, and trismus after the extraction of retained third molars.

A split-mouth, double-blind, randomized clinical trial (RCT) was conducted in 13 patients with similar bilateral third molars who received intraoral application PBM therapy at 4 points with a diode laser at 810 nm wavelength, 6 J (100 mW, 60 seconds/point) on 1 side (the PBM side); and laser irradiation simulation on the other side (SHAM side). The pain was assessed through visual analog scale (VAS) at 0, 12, 24, 48, and 72 hours, number of analgesic-relief (NAR), and mean time of first analgesic use; edema, through VAS, and linear facial measurements at 0, 24, 48, and 72 hours; and trismus, through the mouth opening measurements at 0, 24, 48, and 72 hours. The repeated-measures analysis was applied to assess the effect of the treatment, followed by Tukey's post hoc test for multiple comparisons (P < .05).

Thirteen patients (61.77% male and 38.63% female) with age of 24.16 ± 2.06 participated in this research. VAS showed that PBM controlled pain better (7.56 ± 6.25) than SHAM (32.25 ± 22.78) at 24 hours (P < .001) and 48 hours (19.47 ± 9.27 and 39.87 ± 4.21, respectively) (P = .011). VAS also showed that PBM controlled edema better (19.7 ± 13.27) than SHAM (32.38 ± 15.28) at 24 hours (P = .037) and 48 hours (19.47 ± 13.11 and 39.87 ± 22.77, respectively) (P = .002).

The PBM therapy in this study resulted in pain and edema reduction after third molar surgery and may be considered as adjuvant therapy after the surgical procedure.

We aimed to compare the effect of dexamethasone, 8 mg, and diclofenac sodium, 50 mg, associated with codeine, 50 mg, on the control of pain, swelling, and trismus after extraction of impacted third molars.

Fifteen healthy patients with a mean age of 22.8 years (SD, 12.62 years) received a single oral dose of either drug 1 hour before each surgical procedure (left and right teeth). At 24, 48, and 72 hours after surgery, swelling was determined by use of linear measurements on the face and trismus was determined by maximal mouth opening. Postoperative pain was self-recorded by the patients using a numerical rating scale at 24-hour intervals for a period of 72 hours. Data analysis involved descriptive statistics and Shapiro-Wilk, Wilcoxon, and paired t tests (P < .05).

Dexamethasone controlled pain (P = .016) and edema (P = .08) within 48 hours better than diclofenac sodium associated with codeine. No statistically significant differences were found between drugs regarding trismus and consumption of rescue analgesics (acetaminophen).

The results of this study suggest that pre-emptive administration of dexamethasone, 8 mg, showed better control of pain and swelling in bilateral extractions of third impacted mandibular molars.

This study aimed to determine the effect of the co-administration of dexamethasone 8 mg and nimesulide 100 mg given 1 h before mandibular third molar surgery. A prospective, randomized, triple-blind, split-mouth clinical trial was developed at the study institution in Pernambuco, Brazil. A pilot study was first performed (95% confidence interval, 80% test power, and 5% error), and a sample of 40 patients aged between 18 and 40 years was selected. The patients were randomized and divided into two groups: dexamethasone + placebo and dexamethasone + nimesulide. The following parameters were evaluated: pain (visual analogue scale), total number of rescue analgesics taken, time taken to first rescue analgesic consumption, oedema, trismus, and patient satisfaction. The paired t-test and the Wilcoxon test were used to compare means. Statistically significant differences were found between the groups in pain values at 2, 4, and 12 h postoperative, and in the total number of rescue analgesics and time taken to first rescue analgesic ingestion (P < 0.05), with results in favour of dexamethasone + nimesulide administration. Oedema and trismus were similar in the two treatment groups and decreased over time postoperatively. The co-administration of dexamethasone and nimesulide reduces pain intensity and the need for rescue medication after third molar surgery.

Comparar la eficacia de la administración de amoxicilina pre y posquirúrgica para prevenir la infección postexodoncia de terceros molares incluidos.

El ensayo clínico se desarrolló en el Servicio de Odontología del Hospital I El Porvenir-ESSALUD (Trujillo, Perú), entre julio y noviembre del 2013. Los 99 pacientes fueron distribuidos aleatoriamente en 3 grupos: al grupo 1 se le administró 2 g de amoxicilina 1 h antes de la intervención, al grupo 2 se le administró 500 mg de amoxicilina inmediatamente después y 500 mg cada 8 h por 4 días, y al grupo 3 no se le administró antibiótico alguno. El procedimiento quirúrgico fue estandarizado y realizado por el mismo operador, quien fue cegado para el procedimiento. La eficacia para prevenir la infección se midió mediante 3 parámetros: dolor, temperatura oral y supuración. Para el análisis se empleó la prueba de comparación de proporciones para una p < 0,005.

No se halló diferencia entre la administración de amoxicilina pre y posquirúrgica para prevenir la infección postexodoncia de terceros molares incluidos (p = 0,60). Además, tampoco se halló diferencia entre estas y la no administración del antibiótico (p = 0,35 y p = 1,00; respectivamente).

La administración pre y postoperatoria de amoxicilina no es eficaz para prevenir la infección postexodoncia de terceros molares incluidos.

To compare the efficacy of amoxicillin pre and post to prevent postsurgical removal of third molars infection.

The clinical trial was conducted in the Department of Dentistry Hospital I El Porvenir-ESSALUD (Trujillo, Peru), between July and November of 2013. The 99 patients were randomized into 3 groups: group 1 received 2 g of amoxicillin one hour before surgery, group 2 received 500 mg of amoxicillin and 500 mg immediately after and every 08 hours for 4 days, and group 3 was not given any antibiotic. The surgical procedure was standardized and performed by the same operator, who was blinded to the procedure. The efficacy in preventing infection was measured by three parameters: pain, oral temperature and discharge. To analyze the proportions comparison test was used with p < 0,005.

No difference was found between amoxicillin before and after surgery to prevent post extraction of third molars infection (p = 0,60). Furthermore, no difference between those groups and the non-antibiotic administration group was found (p = 0,35 and p = 1,00; respectively).

The pre and postoperative administration of amoxicillin are not effective to prevent post extraction of third molars infection

We investigated the effect of antibiotic prophylaxis on postoperative inflammatory complications after operations for impacted mandibular third molars in Chinese patients. A total of 207 patients had their bilateral third molars removed in a split-mouth, double-blind, self-controlled, clinical trial in two visits. For one side amoxicillin (or clindamycin) was given (antibiotic group) from one hour before operation until 3 days postoperatively. For the other side a placebo was given (placebo group) at the same time. The outcome, including alveolar osteitis, surgical wound infection, prebuccal infection, and infection of the anterior isthmus of fauces, was assessed 2 and 10 days postoperatively. A total of 192 patients completed the study, and there was no difference between the groups in the incidence of inflammatory complications. In the treatment group, there were 4 cases of alveolar osteitis (2%), 2 infections of the wound (1%), and 14 other reactions (gastrointestinal (n = 4), bleeding (n = 2), ulcer (n = 2), and fever (n = 6)). In the placebo group, there were 6 cases of alveolar osteitis (3%), 2 wound infections (1%), and 22 other reactions (bleeding (n = 6), ulcer (n = 2) and fever (n = 14)). There was no significant difference in the extraction time and postoperative reactions, except the pain score on day 10 (p = 0.005). Prophylactic amoxicillin (or clindamycin) is not effective for the prevention or reduction of postoperative inflammatory complications after the removal of impacted mandibular third molars in Chinese patients.