Effect of the local administration of betamethasone on pain,swelling and trismus after impacted lower third molar extraction. A randomized,triple blinded,controlled trial

Objectives: The aim of this study is to compare the analgesic and anti-inflammatory effects of the local postoperative administration of a single 12-mg dose of betamethasone after the surgical removal of impacted lower third molars. Study Design: A split-mouth, triple-blind, randomized, placebo-controlled clinical trial of 25 patients requiring the surgical removal of symmetrical lower third molars was performed. In the experimental side, a 12-mg dose of betamethasone was administered submucosally after the surgical procedure, while in the control side a placebo (sterile saline solution) was injected in the same area. To assess postoperative pain, visual analogue scales and the consumption of rescue analgesic were used. The facial swelling and trismus were evaluated by measuring facial reference distances and maximum mouth opening. Results: There were no significant differences between the two study groups regarding postoperative pain, facial swelling and trismus. Conclusions: The injection of a single dose of betamethasone does not seem to reduce pain, facial swelling and trismus after impacted lower third molar removal when compared to placebo. Key words:Third molar extraction, corticosteroids, betamethasone.     

A randomized double-blind clinical trial on the effectiveness of helium-neon laser in the prevention of pain, swelling and trismus after removal of impacted third molars

The effect of helium-neon (He-Ne) laser on the prevention of pain, swelling and trismus following the removal of an impacted third molar was studied in 100 patients randomly allocated to receive He-Ne laser, ibuprofen or placebo in a prospective double-blind parallel clinical trial. Trismus was significantly reduced in the He-Ne laser and ibuprofen treatment groups. Pain was significantly less in the ibuprofen group with regard to He-Ne laser and placebo groups. Swelling was the same in the three treatment groups.     

Antibacterial suture vs silk for the surgical removal of impacted lower third molars. A randomized clinical study

Background

The aim of this study was to evaluate the clinical and microbiological impact of an antibacterial suture (Monocryl® Plus) in the surgical removal of I3M.

Material and Methods

A “split-mouth”, prospective pilot clinical study was designed involving 20 patients programmed for the surgical removal of I3M. Each side was randomly sutured with Monocryl® Plus or silk suture and removed for microbiological study 72 hours and 7 days after surgery. Presence of SSI, wound bleeding and the degree of discomfort associated with each type of suture material (scored by means of a visual analog scale) were evaluated. The level of contamination of each material was observed under the scanning electron microscope.

Results

Wound bleeding upon suture removing was slightly greater after 72 hours and 7 days with black silk suture, though the differences were not statistically significant (p=0.752 and p=0.113, respectively). Patient discomfort was very similar with both types of suture material (p=0.861). Only one case of SSI was recorded with black silk suture after 72 hours. Microbiologically, the antibacterial suture showed a lesser presence of microorganisms (p<0.001, at 72h and p=0.033 at 7th day, respectively). The most common bacterial species included grampositive cocci (Streptococcus viridans group, Neisseria spp., Coagulasenegative Staphylococcus and Peptostreptococcus), gramnegative cocci (Veillonella), grampositive Bacilli (Lactobacillus), and gramnegative Bacilli (Prevotella).

Conclusions

The greatest antibacterial effect of Monocryl Plus suture was observed after 72 hours. According to most authors, there is no doubt that this antibacterial suture can provide little safety in the control of SSI. Key words:Antibacterial suture, monocryl® plus, vicryl® plus, third molar surgery, postoperative infection, surgical site infection (SSI).     

The effect of methylprednisolone on pain, trismus, and swelling after removal of third molars

Thirty-one healthy patients whose third molars needed to be removed were randomly placed into two groups. Before sedation the control group (n = 16) received normal saline solution and the experimental group (n = 15) received 125 mg of methylprednisolone intravenously. Swelling was measured by photographic and face-bow techniques, trismus was determined by measuring maximal interincisal opening, and pain was evaluated by asking the patients to report the number of pain pills they used and assess th severity of their pain daily. The swelling and pain, but not the trismus, that developed after third molar removal were significantly reduced by a single dose of methylprednisolone.     

Oral dexamethasone decreases postoperative pain,swelling, and trismus more than diclofenac following third molar removal: a randomized controlled clinical trial

Purpose

The aim of this study was to compare the anti-inflammatory potential of two pharmacotherapy protocols based on the parameters of pain, trismus, and swelling, after extraction of third molars.

Methods

Thirty patients selected with symmetrical impaction of third molars were submitted to surgical procedures in both sides in different times. For one group, dexamethasone was used for 3 days, and for another group diclofenac sodium was also used for the same period. The main variables analyzed were the visual analogue pain scale (VAS), but others were also analyzed such as swelling and trismus, which were submitted to statistical analysis.

Results

The results had no difference regarding the length of procedures (p = 0.986) and the pain in the immediate and 4-h postoperative period (p = 0.723 and 0.541). The rescue analgesic consumption was higher (p < 0.05) when using the protocol with diclofenac sodium. The variables mouth opening (p < 0.05) and swelling (p < 0.05) were significantly better when using the protocol with dexamethasone in the postoperative period.

Conclusions

Medical protocol with the use of dexamethasone in the postoperative period was more effective in controlling pain, trismus, and swelling, after the extraction of third molars, when compared to diclofenac sodium.

     

Effect of the intra-alveolar administration of dexamethasone on swelling,trismus, and pain after impacted lower third molar extraction: a randomized,double-blind clinical trial

Background To evaluate the efficacy of intra-alveolar administration of dexamethasone 4 mg in the control of edema, trismus, and pain resulting from the extraction of impacted lower third molars and the drug permeability through the oral mucosa by in silico prediction.Material and Methods The randomized, double-blind, split-mouth clinical trial included patients who had both impacted lower third molars in equivalent positions. Hemiarches were divided into control side when dexamethasone was administered orally and experimental side when dexamethasone was administered using the intra-alveolar route. Patients were evaluated considering edema, trismus, and pain. The permeability of dexamethasone through the oral mucosa was assessed by in silico prediction. Student’s t-test was selected for comparative analysis of edema and trismus, and the chi-square test analyzed the distribution of postoperative pain between the sides.Results There were no significant differences between the routes of administration in measuring symptoms between the pre and postoperative times (p>0.05). In silico prediction suggested that dexamethasone molecular characteristics facilitate intra-alveolar administration.Conclusions Intra-alveolar administration had similar efficacy to oral administration in controlling symptoms of post-surgical inflammation of impacted lower third molars. Key words:Molar, third, tooth, impacted, oral surgical procedures, dexamethasone.     

Effect of preoperative ibuprofen on pain and swelling after lower third molar removal: a randomized controlled trial

The aim of this study was to compare the analgesic and anti-inflammatory effects of preoperative and postoperative administration of ibuprofen after the surgical removal of impacted lower third molars. A triple-blind, randomized, placebo-controlled clinical trial of 120 patients requiring the surgical removal of lower third molars was performed. The subjects were randomized into the experimental group (patients were administered 600 mg of ibuprofen (p.o.) 1h before the surgical procedure, followed by placebo just after the end of the operation) or into the control group (subjects received the same medication but the administration sequence was reversed). Pain was assessed using visual analogue scales, and consumption of rescue analgesic. The facial swelling and trismus were evaluated by measuring facial reference distances and maximum mouth opening. There were no significant differences between the two study groups regarding postoperative pain, rescue analgesics consumption, facial swelling and trismus. There was a slightly higher need for rescue analgesics in the experimental group. The preoperative intake of ibuprofen does not seem to reduce pain, facial swelling and trismus after impacted lower third molar removal when compared to the postoperative administration of the same drug.     

Prediction of postoperative facial swelling,pain and trismus following third molar surgery based on preoperative variables

Objective: This paper investigates the relationship between preoperative findings and short-term outcome in third molar surgery. Study design: A prospective study was carried out involving 80 patients who required 160 surgical extractions of impacted mandibular third molars between January 2009 and December 2010. All extractions were performed under local anesthesia by the same dental surgeon. Swelling and maximal inter-incisor distance were measured at 48 h and on the 7th day postoperatively. Mean visual analogue pain scores were determined at four different time periods. Results: One-hundred eight (67.5%) of the 160 extractions were performed on male subjects and 52 (32.5%) were performed on female subjects. Median age was 22.46 years. The amount of facial swelling varied depending on gender and operating time. Trismus varied depending on gender, operating time and tooth sectioning. The influence of age, gender and operating time varied depending on the pain evaluation period (p < 0.05). Conclusions: Short-term outcomes of third molar operations (swelling, trismus and pain) differ depending on the patients’ characteristics (age, gender and body mass index). Moreover, surgery characteristics such as operating time and tooth sectioning were also associated with postoperative variables. Key words:Third molar extraction, pain, swelling, trismus, postoperative findings, prediction.     

Evaluation of the efficacy of celecoxib and ibuprofen on postoperative pain,swelling, and mouth opening after surgical removal of impacted third molars: a randomized,controlled clinical trial

The objective of this study was to compare the efficacy of celecoxib and ibuprofen in reducing postoperative sequelae following the surgical removal of impacted mandibular third molars. Ninety-eight subjects who needed surgical extraction of an impacted mandibular third molar were selected for the study. All subjects were randomly allocated to receive one of the following treatments twice a day for 5 days after surgery: placebo (n = 32), ibuprofen (n = 33), or celecoxib (n = 33). The primary outcome chosen was postoperative pain, which was evaluated using the visual analogue scale (VAS) score recorded by each patient. The secondary outcomes chosen were changes in postoperative swelling and maximum mouth opening values compared to preoperative ones. Compared to placebo, treatment with celecoxib and ibuprofen resulted in improvements in the primary outcome. Furthermore, when compared to the other groups, patients in the celecoxib group showed a significant reduction in postoperative pain scores at 6 h (P < 0.001), 12 h (P = 0.011), and 24 h (P = 0.041) after surgery. Regarding swelling and maximum mouth opening values, there were no significant differences between the groups at each follow-up session. This study demonstrated that treatment with celecoxib decreased the incidence and severity of postoperative pain following third molar surgery compared to ibuprofen and placebo.     

Effects of tube drain with primary closure technique on postoperative trismus and swelling after removal of fully impacted mandibular third molars.

OBJECTIVE: Surgical removal of impacted mandibular third molars with primary wound closure may result in postoperative edema, facial swelling, pain, and restriction of mouth opening. The type of closure may be a cause of these complications. The aim of this study was to compare the effects of placement of a surgical tube drain before primary closure with the effects of primary closure alone after removal of fully impacted mandibular third molars. METHOD AND MATERIALS: The study group included 13 patients aged 15 to 39 years with bilateral fully impacted mandibular third molars. The insertion of a small surgical tube drain before primary closure (drain group) was compared to a simple primary closure procedure (no drain group) after removal of the impacted third molars in a randomized crossover design. The duration of the operation was recorded. Patients were evaluated 1, 2, 3, and 7 days postoperatively for facial swelling and trismus. RESULTS: The facial swelling experienced by the drain group was significantly less than that experienced by the no drain group. The degree of trismus was greater in the no drain group than in the drain group, but the difference was not statistically significant. CONCLUSION: Use of a surgical drain, especially after removal of fully impacted third molars, will reduce postoperative facial swelling.     

Effect of the proteolytic enzyme serrapeptase on swelling, pain and trismus after surgical extraction of mandibular third molars

The aim of this study was to investigate the ability of serrapeptase to reduce postoperative swelling, pain and trismus after third molar surgery. Twenty-four healthy individuals with symmetrically impacted mandibular third molars underwent surgical removal in a prospective, intra-individual, randomized, double-blind, cross-over study. Teeth were removed in 2 sessions by the same surgeon. At each session, one third molar was removed under local anaesthesia via a buccal osteotomy. All patients received a combination of either serrapeptase 5mg or placebo tablets and 1000 mg paracetamol tablets at either the 1st or 2nd operation in accordance with the randomization plan. Cheek thickness, pain and interincisal distance were measured preoperatively, and on the 1st, 2nd, 3rd and 7th postoperative days. Cheek thickness and maximum interincisal distance were measured using calipers. Pain intensity was assessed clinically using a numeric scale. There was a significant reduction in the extent of cheek swelling and pain intensity in the serrapeptase group at the 2nd, 3rd and 7th postoperative days (P<0.05), but no significant difference in mean maximal interincisal distance was found between the 2 groups (P>0.05).     

Therapeutic efficacy of cryotherapy on facial swelling,pain, trismus and quality of life after surgical removal of mandibular third molars: A systematic review

The objective was to test the hypothesis of no difference in facial swelling, pain, trismus and immediate quality of life after surgical removal of mandibular third molars, with or without post‐operative cryotherapy. A MEDLINE (PubMed), EMBASE database and Cochrane library search in combination with a hand search of relevant journals were conducted by including human randomised controlled trials published in English until 17 July 2018. The search identified 37 titles. Six studies with low or unclear risk of bias fulfilled the inclusion criteria. Intermittent cryotherapy for 30 minutes during the first post‐operative days significantly diminished facial swelling, pain and trismus compared with no cryotherapy. Patient's satisfaction and perception of recovery were significantly increased with cryotherapy. Therapeutic efficacy of intermittent cryotherapy on post‐operative facial swelling, pain and trismus seems to be improved compared with continuous cryotherapy. Considerable variations in study design, diversity of used evaluation methods, outcome measures and various methodological confounding factors posed serious restrictions to review the literature in a quantitative systematic manner. Thus, conclusions drawn from the results of this systematic review should be interpreted with caution. Further well‐designed randomised controlled trials including standardised protocol, larger patient sample, blinded outcome assessors, patient‐reported outcome measures and three‐dimensional volumetric analysis of facial swelling are required before evidence‐based recommendations can be provided.     

Compliance of postoperative instructions following the surgical extraction of impacted lower third molars: A randomized clinical trial

Objectives: The understanding and adherence to postoperative care instructions are factors that influence the recuperation process after any surgical procedure. The aim of this study was to determine the percentage of patients who strictly follow the postoperative instructions after the extraction of an impacted lower third molar in relation to sociocultural level, preoperative anxiety scores and how postoperative information is provided to the patient. Study Design: Patients were randomly assigned to one of three different test groups according to how the postoperative instructions were presented: verbal, written and a group that received additional information. Before surgery, patients were required to complete the Corah Dental Anxiety Scale and personal information (age, gender and educational level) was also collected. P<0.05 was considered significant. Patients were surveyed a week after surgery regarding their adherence to postoperative instructions. Results: 84 patients (45 women and 39 men with an average of 28.23 ± 7.41 years) completed the study. There were no statistically significant differences regarding adherence of postoperative care instructions depending on the manner of instruction presentation, preoperative anxiety level and sociocultural level (p> 0.05). Quitting smoking or drinking of alcoholic/carbonated beverages were the main influential factors for the lack of adherence to postoperative care instructions during the week after surgery. Conclusions: Presentation of postoperative instructions, preoperative anxiety scores and sociocultural level do not appear to be key factors that promote the adherence to postoperative instructions. Key words:Compliance, postoperative instructions, treatment, third molar.     

Value of penicillin in the prevention of pain, swelling and trismus following the removal of ectopic mandibular third molars

A double-blind randomised placebo-controlled study of the value of systemic penicillin in preventing pain, swelling and trismus following the removal of impacted mandibular third molars and indicates that penicillin may be used justifiably in the more difficult cases.     

Photobiomodulation therapy reduces postoperative pain after third molar extractions: A randomized clinical trial

Background To assess the efficacy of PBMT on reducing postoperative pain scores in patients submitted to third molar extractions. Material and Methods A randomized controlled trial (ReBEC:RBR-94BCKZ) was designed according to the SPIRIT and followed the CONSORT. Patients were randomly allocated according to control or PBMT groups. PBMT consisted of the application of GaAlAs laser (808nm;50mW) applied in six points (1.23 min;11 J/cm2) after extraction. Pain scores were assessed using the Visual Analogue Scale (VAS) in millimeters evaluated after 6 (T6), 24 (T24), and 48 (T48) hours. The Wilcoxon Mann–Whitney test was used to check for possible associations between VAS scores and treatment groups. Results A total of 101 third molar extractions were performed in 44 patients. The mean age was 28 years old(SD±11.54). Comparing control and intervention, PBMT group showed a significant effect on the reduction of postoperative pain at T6(mean VAS=0.9; C.I:0.63–1.16) compared to control (mean VAS=2.5;C.I:2.1–2.88)(p<0.001). The same statistically significant effect on the reduction of postoperative pain was observed at T24 (PBMT mean VAS=0.72;C.I:0.51–0.93; control mean VAS=2.86;C.I:2.40–3.31;p<0.001) and T48 (PBMT mean VAS=0.64;C.I:0.36–0.92; control mean VAS=2.86;C.I:2.37–3.34;p<0.001). Conclusions PBMT significantly reduce the postoperative pain scores when assessed 6, 24, and 48 hours after third molar extractions. Key words:Controlled clinical trial, gallium aluminium arsenide lasers, third molar.     

Clinical postoperative findings after removal of impacted mandibular third molars: prediction of postoperative facial swelling and pain based on preoperative variables

PURPOSE: This paper is intended as an investigation of the relationship between preoperative findings and short-term outcome in third molar surgery. MATERIAL AND METHODS: We assessed 153 consecutive surgical extractions of mandibular third molars performed in 140 patients between April 1998 and March 2001. RESULTS: Fifty-four (35%) of the 153 extractions were performed in male subjects and 99 (65%) in female subjects. The median age was 27 years. The amount of facial swelling varied depending on age and sex. Severe pain was associated with depth and preoperative index of difficulty. Average pain was associated with preoperative index of difficulty. CONCLUSION: In conclusion, we consider that the short-term outcomes of third molar operations (swelling and pain) differ depending on patients' characteristics (age and sex) and preoperative index of difficulty. Further mega-trial studies of the association between preoperative findings and short-term outcome will help to elucidate the true nature and magnitude of the association.     

Efficacy of hyaluronic acid spray on swelling,pain, and trismus after surgical extraction of impacted mandibular third molars

The aim of this study was compare the efficacies of two oral sprays in reducing swelling, pain, and trismus after the extraction of impacted mandibular third molars. This prospective double-blind, randomized, crossover clinical trial included 34 patients with bilateral symmetrically impacted mandibular third molars of similar surgical difficulty. Hyaluronic acid or benzydamine hydrochloride spray was applied (two pumps) to the extraction area, three times daily for 7 days. Swelling was evaluated using a tape measure method, pain with a visual analogue scale (VAS), and trismus by measuring the maximum inter-incisal opening. Assessments were made on the day of surgery and on days 2 and 7 after surgery. Statistically significant differences were detected for the swelling and trismus values between the two treatment groups on the second postoperative day (P = 0.002 and P = 0.03, respectively). However, there was no statistically significant difference in VAS scores between the two groups. The administration of hyaluronic acid spray was more effective than benzydamine hydrochloride spray in reducing swelling and trismus. Although no evidence of a reduction in pain levels was detected, hyaluronic acid appears to offer a beneficial effect in the management of swelling and trismus during the immediate postoperative period following impacted third molar surgery.