Comparing pre- and postoperative etoricoxib administration versus only postoperative on third molar extraction sequelae and oral health quality of life: a prospective quasi-experimental study

OBJECTIVES

This study aimed to compare the impact of pre- and postoperative etoricoxib administration versus only postoperative on third molar extraction sequelae and oral health quality of life.

MATERIALS AND METHODS

This prospective quasi experimental study involved 56 patients, divided into a study group receiving preemptive etoricoxib 120 mg before surgery and postoperative etoricoxib 120 mg (n = 28), and a control group receiving preemptive placebo before surgery and postoperative etoricoxib 120 mg (n = 28). Follow-up assessments were conducted at 3- and 7-days post-surgery, recording swelling, trismus, and adverse events. Patients rated perceived pain using the visual analog scale (VAS) and completed an oral health-related quality of life (OHRQoL) questionnaire at specified intervals. Statistical analysis employed non-parametric tests (i.e., the Mann-Whitney test, Friedman test, and Wilcoxon sign test) with P < 0.05.

RESULTS

Significantly lower VAS scores were reported in the study group throughout the follow-up period (P < 0.05). Pharmacological protocol did not have a significant impact on postoperative edema and trismus (P > 0.05). However, double etoricoxib intake significantly improved postoperative quality of life on day 3 after surgery (P < 0.05).

CONCLUSIONS

Pre- and postoperative etoricoxib 120 mg intake in third molar surgery reduced postoperative pain and enhanced postoperative quality of life on day 3 after surgery. Importantly, it was equally effective in managing swelling and trismus compared to exclusive postoperative intake.

CLINICAL RELEVANCE

Preemptive etoricoxib use may decrease patient discomfort following impacted mandibular third molar extraction.

Effect of transcutaneous electrical nerve stimulation on pain, edema, and trismus after surgical removal of impacted third molars: a split-mouth randomized clinical trial

BACKGROUND

The transcutaneous electrical nerve stimulation (TENS) stimulus inhibits the activity of nociceptive neurons of the central nervous system. Pain relief is achieved by increasing the pulse amplitude of TENS to induce a non-painful paranesthesia beneath the electrodes. This study aimed to assess the effect of TENS on acute pain, edema, and trismus after surgical removal of impacted third molars.

MATERIAL AND METHODS

This randomized, double blind, split-mouth clinical trial was conducted on 37 patients with bilaterally impacted mandibular third molars. The angle and body of mandible at the site of surgery in one randomly selected quadrant underwent TENS immediately after surgery (50 Hz, 100-µs short pulse, 15 minutes for 6 days). The TENS stimulator device was used in off mode for the placebo quadrant. The pain score (primary outcome) was measured for 7 days postoperatively, and edema and trismus (secondary outcomes) were assessed at 2, 4 and 7 days, postoperatively. The results were analyzed by repeated measures ANOVA using R software (alpha=0.05).

RESULTS

The overall mean pain score was significantly lower in the TENS than the placebo group (P<0.05). The number of taken analgesics in the first 3 days was significantly lower in the TENS group (P<0.001). Postoperative edema in the TENS group was lower than the placebo group but only the difference was not statistically significant (P>.05). The inter-incisal distance, as an index to assess trismus, was not significantly different between the two group at day 2, but it was significantly higher in the TENS group after the second day (P<0.001).

CONCLUSIONS

TENS effectively decreased pain and trismus following impacted third molar surgery, and may be recommended as a non-pharmaceutical method to relieve postoperative symptoms.

Efficacy of auriculotherapy in the control of pain, edema, and trismus following surgical extraction of the lower third molars: a split-mouth, randomized, placebo-controlled, and triple-blind study

BACKGROUND

The aim of this split-mouth, randomized, placebo-controlled, and triple-blind study was to evaluate whether auriculotherapy had any effect on the post-operative course after the extraction of third molars in terms of the control of pain, edema, and trismus.

MATERIALS AND METHODS

The study included 42 patients (84 teeth) who had undergone a surgical extraction of the lower third molars. In each patient, the two extractions were randomly assigned to two study groups. In the therapy group, the patients underwent auriculotherapy with vaccaria seeds applied with patches in 6 ear points. In the control group, the patches were applied, without seeds, to the same ear points. After the extraction, the patients were asked to stimulate the ear points three times a day and whenever they felt pain. The patients were asked to keep a diary in which they assessed their pain by means of the Visual Analog Scale (VAS) for 8 days. Edema and trismus were assessed 1, 2, 3, and 8 days after surgery.

RESULTS

The differences between the two groups were statistically significant at the 12-h control (auriculotherapy group (AG) VAS 5.5 [IQR 4.25-6.75], placebo group (PG) VAS 6 [IQR 5-8], p = 0.040), after 24 h (AG VAS 5 [IQR 4-6], PG VAS 6 [IQR 4.25-7], p = 0.024), after 2 days (AG VAS 4 [IQR 3-5], PG VAS 4.5 [IQR 4-6], p = 0.044), and after 3 days (AG VAS 3 [IQR 0-5], PG VAS 4 [IQR 3-5], p = 0.024). Throughout the observation period, the AG took a significantly lower number of painkillers than the PG (AG 6 [IQR 4.25-7]; PG 8 [IQR 8-9], p < 0.001). There were no significant differences in the levels of edema and trismus between the two groups throughout the observation period.

CONCLUSIONS

On the basis of the results of the present study, auriculotherapy can be considered as a cost-effective adjuvant pain reliever treatment in patients undergoing an extraction of the lower third molars.

PREEMPTIVE INTRAVENOUS IBUPROFEN AND LOCAL KETAMINE IMPROVE POSTOPERATIVE ANALGESIA FOLLOWING THIRD MOLAR SURGERY: A DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED CLINICAL STUDY

OBJECTIVE

To compare the efficacy of preemptive ibuprofen, local ketamine, and their combination in managing postoperative pain and trismus following third molar surgery.

MATERIALS AND METHODS

One hundred patients were randomly divided into 4 groups. The Intrafen Group had their impacted third molars surgically removed under local anesthesia after receiving intravenous (IV) ibuprofen for preemptive effect. The Ketamine Group received an IV placebo before the surgery, and the extraction process was completed with a local anesthetic-ketamine combination. The Combined Group received preemptive IV ibuprofen before the procedure, and the surgery was performed with a local anesthetic-ketamine combination. The Control Group received an IV placebo before the procedure and then had their impacted third molars removed under local anesthesia. The Visual Analogue Scale (VAS) values, corresponding to the patients' pain levels at the 2nd and 12th postoperative hours and the total amount of analgesic dose used in the first 24 hours, were recorded, and evaluated. The maximum mouth opening of the patients was measured immediately before the procedure, and on the second and seventh postoperative days. The level of patient satisfaction in all groups was assessed during the procedure.

RESULTS

The mean VAS value corresponding to the second-hour pain level of the combined group was statistically significantly lower than the other groups (P = .003). A statistically significant difference was found in the mean VAS values corresponding to the pain levels of the groups, favoring the combined group compared to the other groups (P ≤ .001). A significant difference was observed between the VAS difference values corresponding to the pain levels of the Intrafen group and the Ketamine group, favoring the Intrafen group (P = .038). The Ketamine group consumed the most analgesic on average over the first 24 hours, whereas the Combined group consumed the least. No statistically significant difference was found between the mean trismus levels of the groups on days 0-2 (P = .528) and days 0-7 (P = .129). The intraoperative patient satisfaction level of the combined group was significantly higher than that of the other groups (P = .030).

CONCLUSION

Preemptive Intrafen is an effective regimen for postoperative pain management and is superior to the local anesthetic-ketamine regimen. The most effective method to reduce postoperative pain following third molar surgery is to use a combination of these 2 regimens. However, none of the treatment methods used in the study had a positive effect on postoperative trismus.

Can Topical Agents (Arnica and Mucopolysaccharide Polysulfate) Reduce Postoperative Pain, Edema and Trismus Following Mandibular Third Molar Surgery?

BACKGROUND

Postoperative supplemental maintenance following mandibular third molar surgery remains an area of interest.

PURPOSE

Topical agents can modulate inflammatory processes. The aim of the present study was to determine if topical application of arnica or mucopolysaccharide polysulfate (MPSP) reduces pain, trismus, and edema following the removal of impacted mandibular third molars.

MATERIALS AND METHODS

A single center randomized controlled clinical trial was conducted. The patients were randomized into three groups: the control group (standard therapy [ST]: antibiotic + nonsteroidal anti-inflammatory drugs twice a day), the arnica group (arnica + ST), and the MPSP group (MPSP + ST). The patients' pain, trismus, and edema values were measured preoperatively and on postoperative days 1, 3, 5, and 10. Sex, age, and operation time were also included. Analyses included descriptive statistics, analysis of variance, post hoc tests, and determinations of intraclass correlation coefficients. Statistical significance was set at P < .05.

RESULTS

Sixty patients with a mean age of 26.98 ± 10.88 years were included in the study; 55% were females and 45% were males. The mean operation time was 23.8 ± 3.27 minutes. According to the visual analogue scale scores (in centimeter units), the arnica and MPSP groups felt less pain than the control group until day 5 (0.6 ± 0.88, 3.75 ± 1.16, 4.75 ± 1.29, and 1.05 ± 1.10, respectively, for the arnica group; 0.35 ± 0.59, 3.25 ± 1.62, 5.0 ± 1.65, and 1.50 ± 1.32 for the MPSP group; and 1.30 ± 1.17, 5.75 ± 1.37, 7.05 ± 1.10, and 3.15 ± 1.53 for the control group; P < .05). The trismus was lower on days 1, 3, and 5 in the arnica group (-8.05 ± 2.82, -12.15 ± 3.1, and -2.15 ± 1.81, respectively) than in the control group (-12 ± 3.82, -15.65 ± 4.81, and -4±2.81, respectively) (P < .05). The edema was lower on days 1 and 3 in the MPSP group (0.95 ± 2.2 and 1.75 ± 3.7, respectively) than in the control group (2.45 ± 0.9 and 3.6 ± 0.8, respectively) (P < .05). Arnica and MPSP had similar pain-relieving action, but arnica was more effective at reducing trismus, while MPSP was more effective at reducing edema.

CONCLUSIONS

Topical application of arnica or MPSP may have a beneficial effect on relieving pain 5 days after surgery, but arnica was also effective at reducing trismus, while MPSP was also effective at reducing edema. Both arnica and MPSP reduced postoperative sequelae.

Piezosurgery versus conventional rotary surgery for impacted third molars: A randomised, split-mouth, clinical pilot trial

BACKGROUND

Few studies have compared the effects of piezosurgery and conventional rotary surgery for impacted wisdom teeth on the quality of life. Among these studies, the inclusion parameters and evaluation methods have varied.

MATERIAL AND METHODS

This study aimed to compare the effects of piezosurgery and conventional rotary instruments on the quality of life using a standardised method. Patients with bilateral and symmetric mandibular impacted wisdom teeth were included based on the Winter and Pell-Gregory scale and Yuasa difficulty index criteria. The primary objective was to assess the effects of the methods on the quality of life using the Oral Health Impact Profile-14 questionnaire. Secondary objectives included comparisons of swelling, trismus, pain, and total operative times. The study was conducted between October 2021 and March 2022. The clinical trial protocol was recorded in the United States National Library of Medicine clinical trial registry (NCT05545553).

RESULTS

We enrolled 20 patients (40 wisdom teeth) and found that the removal of impacted teeth using the piezosurgery method positively affected the quality of life and considerably improved swelling, trismus, and pain scores. However, piezosurgery may affect postoperative morbidities such as increased total operative times.

CONCLUSIONS

Piezosurgery appears to have advantages over conventional rotary surgery for impacted wisdom tooth extraction in terms of quality of life and postoperative symptoms. However, further research should investigate potential drawbacks and confirm these findings.

Is Injectable Platelet-Rich Fibrin Really Effective in Reducing Expected Side Effects of Removing Impacted Third Molar Surgery?

BACKGROUND

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.

PURPOSE

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.

STUDY DESIGN, SETTING AND SAMPLE

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.

PREDICTOR VARIABLE

The predictor variable is treatment i-PRF or control.

MAIN OUTCOME VARIABLE

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.

COVARIATES

Covariate variables, sex, age, and operation times.

ANALYSES

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.

RESULTS

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).

CONCLUSIONS

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.

Efficacy of Kinesio taping in post operative sequalae after surgical removal of mandibular third molars: a split mouth randomized control study

BACKGROUND

The surgical removal of impacted lower third molars produces a significant degree of trauma to the soft tissue and bony structures of the oral cavity, which can initiate considerable inflammatory reaction. Consequently, patient experiences pain, swelling, hemorrhage, nerve paraesthesia, limited mouth opening etc. The kinesiologic tape (KT) can help with blood and lymphatic circulation and has shown acceptable outcomes in reducing pain and in managing post-operative muscle spasm.

METHODOLOGY

The study was aimed to compare the effects of kinesiologic tape on post operative pain, swelling and trismus following surgical removal of mandibular third molar when compared to control group. 15 patients with bilaterally impacted mandibular third molar were included in the split mouth study. One side was randomly assigned as Group A where patient's face was subjected to Kinesio tape application post extraction. The other was Group B where Kinesio tape was not applied. After extraction each patient was evaluated in terms of post op pain, swelling and trismus in post-op day 1,2 and 7th.

RESULTS

The pain was found to be significantly less (p = 0.042) in group A when compared to group B on the first day. The mean pain was 5.07 in KT group and 6.20 in No KT group on day 2nd. Post OP Swelling was statistically significantly less (p < 0.01) in Group A on 2nd & 3rd day. The postoperative mouth opening was more from the 2nd day in group A with mean of 26.07 mm and 20.33 mm in group B (p < 0.01).

CONCLUSION

The kinesiologic taping originates from sports medicine, but can also used therapeutically for reducing post operative sequelae as demonstrated in our study. Kinesiologic tape (KT) enables patients to have a comfortable time post-operatively and helps to regain better quality of life.

TRIAL REGISTRATION

Registered in Clinical Trial Registry-India. Registration number-CTRI/2021/05/033359, registration date - 04/05/2021.

Do blood concentrates influence inflammatory signs and symptoms after mandibular third molar surgery? A systematic review and network meta-analysis of randomized clinical trials

OBJECTIVES

To investigate, through a network meta-analysis, the effectiveness of blood concentrates in reducing pain perception, trismus, and edema after mandibular third molar extraction.

MATERIALS AND METHODS

An electronic search was performed in nine databases to locate randomized clinical trials comparing blood concentrate use after mandibular third molar extraction. Two authors selected and extracted the data independently. The individual risk of bias in the studies was assessed with the RoB v2.0 tool. A network meta-analysis compared postoperative pain and trismus scores after applying different blood concentrates, using the mean difference (MD) as an effect estimate. The GRADE approach assessed the certainty of evidence.

RESULTS

Thirty-one randomized clinical trials were included in the review and 18 in the meta-analysis. Leukocyte- and platelet-rich fibrin (L-PRF) was the most used blood concentrate, followed by platelet-rich plasma (PRP). The network meta-analysis, depending on the analyzed period, evaluated up to 1240 surgeries. Among the analyzed blood concentrates, advanced platelet-rich fibrin (A-PRF) performed better among the analyzed blood concentrates, decreasing postoperative pain in 1, 2, 3, and 7 days and reducing trismus up to the inflammatory peak compared to blood clots. Only two studies had a low risk of bias.

CONCLUSIONS

Based on very low certainty of evidence, using concentrates seemed efficient compared to blood clots in reducing pain and trismus after mandibular third molar surgeries. A-PRF decreased postoperative pain throughout the evaluated time and trismus during the acute inflammatory peak.

CLINICAL RELEVANCE

A-PRF after mandibular third molar extractions performed better among the analyzed blood concentrates and seemed efficient in improving postoperative quality by decreasing inflammatory signs and symptoms.

An Evaluation of the Effect of Using Irrigations at Different Temperatures on Pain, Edema, and Trismus during the Extraction of Bilateral Impacted Mandibular Third Molars: A Randomized Split-Mouth Clinical Trial

BACKGROUND AND AIM

The surgical extraction of impacted wisdom teeth is a standard practice in dentistry. Unfortunately, inflammatory reactions such as discomfort, edema, and trismus frequently jeopardize patients' well-being after the extraction of third molars. Saline solutions at room temperature (25°C) are routinely used in impacted tooth extraction. Refrigerated saline solutions were used to work with cold solutions, and as the refrigerator temperature was 4°C, this study was designed to have a cold solution temperature of 4°C. This study aimed to assess the influence of saline irrigation at various temperatures (4°C, 25°C) on postoperative edema, pain, and trismus after the extraction of impacted third molars.

MATERIALS AND METHODS

Eighteen patients with bilateral symmetrical mandibular impacted third molars were enrolled in this split-mouth, randomized, prospective, double-blind clinical trial. For each patient, one side was irrigated with a saline solution (% 0.9 isotonic sodium chloride) at 4°C (test), and the other side was irrigated with a saline solution at room temperature (25°C) (control). Pain, trismus, and facial edema were noted on the 2nd, 4th, and 7th days. A Mann-Whitney U-test was used to compare pairs, and a Wilcoxon signed-rank test was used to compare groups.

RESULTS

The two groups had no considerable differences in terms of pain levels and facial edema (P > 0.05). Regarding trismus, the maximum mouth opening for cold irrigation (4°C) was significantly higher than for room temperature irrigation (25°C) across all postoperative periods (P < 0.05).

CONCLUSION

Cold irrigation therapy (4°C) exerts beneficial effects more than room temperature (25°C) irrigation on the trismus after impacted mandibular third molar surgery.

Does Betamethasone Injection Into the Pterygomandibular Space Affect the Postoperative Outcomes of Impacted Lower Third Molar Surgery?

BACKGROUND

Pain, swelling, and trismus are common outcomes following impacted lower third molar surgery.

PURPOSE

The purpose of the study was to evaluate the effect of betamethasone injection into the pterygomandibular space on the aforementioned sequelae of third molar surgery.

STUDY DESIGN, SETTING, AND SAMPLE

A split-mouth, double-blind, randomized clinical trial was conducted on 40 patients with symmetrical bilateral impacted lower third molars. The surgeries were performed at an outpatient clinic under local anesthesia.

PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE

The predictor variable is the steroid treatment. The experimental group received a 1 mL (6 mg) betamethasone injection into the pterygomandibular space, while the control group received a normal saline.

MAIN OUTCOME VARIABLE(S)

The primary outcome variable was postoperative pain assessed using a visual analog scale. The secondary outcome variables were the number of analgesic tablets consumed, facial swelling, and trismus.

COVARIATES

The age and sex of the patients, the direction of impaction, and the duration of surgery were recorded.

ANALYSES

Comparisons between the groups were carried out using an unpaired t test. An analysis of variance test was used to assess intragroup differences. The significance was considered at P ≤ .05.

RESULTS

Of the 265 patients initially screened for study enrollment, the final sample included 40 subjects, with a mean age of 28.3 years (±7.4), 28 (70%) were mal and 12 (30%) were female. There was no significant difference between the two groups concerning postoperative pain or the number of consumed analgesic tablets. However, the betamethasone group exhibited significantly reduced facial swelling and increased mouth opening. On the first postoperative day, the visual analog scale pain score did not significantly differ between the betamethasone group (6.0 ± 1.7) and the control group (6.8 ± 1.4), with a P value of 0.112. On the first postoperative day, facial swelling measured 4.2 ± 1.3 mm in the betamethasone group compared to 6.0 ± 0.9 mm in the control group (P < .001). Mouth opening in the betamethasone group was 30.8 ± 6.7 mm, while in the control group, it measured 21.9 ± 5.5 mm (P < .001).

CONCLUSION AND RELEVANCE

Local betamethasone has no effect on pain after third molar surgery, but facial swelling and trismus are significantly reduced.

Effect of time-dependent ibuprofen administration on the post operatory after impacted third molar extraction: a cross-over randomized controlled trial

PURPOSE

To evaluate time-dependent administration of ibuprofen in a lower third molar extraction model.

METHODS

Eleven patients requiring bilateral surgical removal of lower third molars were recruited and randomized into a blinded crossover randomized controlled trial. For 3 days after surgery, the control group was prescribed ibuprofen 400 mg every 8 h. On the other hand, the experimental group received also ibuprofen 400 mg at breakfast and lunch, replacing the dinner intake with a placebo. Pain measurements (Visual Analog Scale from 0 to 10) were recorded at baseline, 24, 48, and 72 h postoperatively. Facial swelling and trismus were also measured at baseline, 24, and 72 h postoperatively.

RESULTS

Postoperative swelling and pain perception did not show significative difference between the control and experimental groups at 24, 48, and 72 h. Trismus was significantly lower in the control group than in the experimental group at 72 h postoperatively (p = 0.008). Rescue medication consumption seemed to be comparable between groups.

CONCLUSION

Eliminating night time ibuprofen might be insignificant for pain control after third molar extraction.

Use of Photobiomodulation to Reduce Postoperative Pain, Edema, and Trismus After Third Molar Surgery: A Systematic Review and Meta-Analysis

PURPOSE

Third molar extraction can cause surgical trauma, which is associated with pain, edema, trismus, and functional limitations. The aim of the present systematic review was to investigate the effects of photobiomodulation (PBM) following the extraction of impacted mandibular third molars.

METHODS

An electronic search was conducted in 10 databases from inception up to October 2021 and the grey literature, with no restrictions regarding language or year of publication. Randomized controlled clinical trials (RCT) were included. Studies that were not RCTs were excluded. Reviewers independently analyzed titles and abstracts, followed by full-text analysis. This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The exposure variable was the use of PBM and the outcomes were pain, edema, and trismus. Meta-analysis was performed using a random-effects model. The estimate was calculated considering standardized mean differences (SMD) and respective 95% confidence intervals (CI) obtained for each outcome on the first, second, third and seventh postoperative days. The level of evidence was assessed using the GRADE approach.

RESULTS

The search resulted in the 3,324 records. Thirty-three RCTs were included in the systematic review and 23 of these were included in the meta-analyses. The studies involved a total of 1,347 participants (56.6% female and 43.4% male) between 16 and 44 years of age. A greater reduction in pain was found in the PBM group compared to the control group on the third postoperative day (SMD: -1.09; 95% CI: -1.63; -0.55; P < .001; low certainty). Edema was discretely lower in the PBM group on the second postoperative day (SMD: -0.61; 95% CI: -1.09; -0.13; P < .001; low certainty) and trismus was discretely lower in the PBM group on the seventh postoperative day (SMD: 0.48; 95% CI: 0.00; 0.96; P < .001; very low certainty).

CONCLUSION

The evidence of the effect of PBM regarding the control of pain, edema, and trismus following third molar extractions is low or very low.

Assessment and management of radiation-induced trismus in patients with nasopharyngeal carcinoma: a best practice implementation project

INTRODUCTION AND AIMS

Intensity-modulated radiotherapy (IMRT) is the most commonly used radiotherapy technology in oncology, which enables precise conformation of the radiation dose to the target volume and reduces the risk of radiation damage to the adjacent normal structures. Nevertheless, it is still inevitable for IMRT of head and neck cancer to cause radiation-related toxic and side effects, such as dry mouth, mucositis, oral dysarthria, taste disorder, osteonecrosis, and trismus. Trismus is one of the most common late side effects caused by radiotherapy of nasopharyngeal carcinoma (NPC), which seriously affects the quality of life for patients with NPC. However, the current clinical assessment and management of trismus after radiotherapy for NPC are still imperfect. This best practice implementation project aimed to implement an evidence-based practice in assessing and managing trismus for NPC patients who underwent radiotherapy, thereby improving the compliance of clinical practice with the best evidence and the quality of life of patients with NPC.

METHODS

This evidence-based audit and feedback project was implemented using a three-phase approach at a third-class hospital in China, following JBI's Practical Application of Clinical Evidence System (PACES) and GRiP evidence application. The first phase included a baseline audit with six evidence-based audit criteria derived from the best available evidence. The second phase included analyzing the results of the baseline audit, identifying barriers to compliance with best practice principles, and developing and implementing strategies to address the barriers identified in the baseline audit. The third phase involved a follow-up audit to assess the results of the interventions implemented to improve practice.

RESULTS

After evidence application, the compliance rate for audit criterion 1 increased from 0% at baseline audit to 70% at follow-up audit. The compliance rate for audit criterion 2 increased from 0% to 100%. The compliance rate for audit criterion 3 increased from 22 to 62%. The compliance rate for audit criterion 4 increased from 88 to 100%. The compliance rate for audit criterion 5 was 100% at baseline audit and follow-up audit. The compliance rate for audit criterion 6 increased from 0 to 55%.

CONCLUSION

Implementation of the best evidence for the assessment and management of trismus of patients with NPC after radiotherapy is conducive to improving the compliance of clinical practice with the best evidence, standardizing clinical nursing practice, improving the quality of clinical nursing, and better preventing severe trismus in patients with NPC after radiotherapy.

A modified triangular flap suture method used for inferior third molar extraction: A three-arm randomized clinical trial for the assessment of quality of life

BACKGROUND

The purpose of this study is to explore whether decreasing the number of sutures can improve the quality of life after inferior third molar extraction.

MATERIAL AND METHODS

This study used a three-arm randomized design that included 90 individuals. Patients were randomized and divided into three groups-the airtight suture group (traditional), the buccal drainage group, and the no-suture group. Postoperative measurements, including treatment time, visual analog scale, questionnaire on postoperative patient quality of life, and details about trismus, swelling, dry socket, and other postoperative complications were obtained twice and the mean values were recorded. To verify the normal distribution of the data, the Shapiro-Wilk test was performed. The statistical differences were evaluated using the one-way ANOVA and the Kruskal-Wallis test with Bonferroni post-hoc correction.

RESULTS

The buccal drainage group showed a significant decrease in postoperative pain and better speech ability than the no-suture group on the 3st day, with a mean of 1.3 and 0.7 (P < 0.05). The airtight suture group also showed similar eating and speech ability, which was better than the no-suture group, with a mean of 0.6 and 0.7 (P < 0.05). However, no significant improvements were noted on the 1st and 7th days. The surgical treatment time, postoperative social isolation, sleep impairment, physical appearance, trismus, and swelling showed no statistical difference between the three groups at all measured times (P > 0.05).

CONCLUSIONS

Based on the above findings, the triangular flap without a buccal suture may be superior to the traditional group and no-suture group in less pain, and better postoperative patient satisfaction in the first 3 days and may be a simple and viable option in clinical practice.

Three-dimensional facial swelling evaluation of pre-operative single-dose of prednisone in third molar surgery: a split-mouth randomized controlled trial

BACKGROUND

Facial swelling, pain, and trismus are the most common postoperative sequelae after mandibular third molar (M3M) surgery. Corticosteroids are the most used drugs to reduce the severity of inflammatory symptoms after M3M surgery. This study aimed to evaluate the effect of a single pre-operative dose of prednisone on pain, trismus, and swelling after M3M surgery.

METHODS

This study was designed as a split-mouth randomized, controlled, triple-blind trial with two treatment groups, prednisone (PG) and control (CG). All the parameters were assessed before the extraction (T0), two days (T1), and seven days after surgery (T2). Three-dimensional evaluation of facial swelling was performed with Bellus 3D Face App. A visual analogue scale (VAS) was used to assess pain. The maximum incisal distance was recorded with a calibrated rule to evaluate the trismus. The Shapiro-Wilk test was used to evaluate the normal distribution of each variable. To compare the two study groups, the analysis of variance was performed using a two-tailed Student t-test for normal distributions. The level of significance was set at a = 0.05. Statistical analysis was conducted using the software STATA (STATA 11, StataCorp, College Station, TX).

RESULTS

Thirty-two patients were recruited with a mean age of 23.6 ± 3.7 years, with a male-to-female ratio of 1:3. A total of 64 M3Ms (32 right and 32 left) were randomly assigned to PG or CG. Surgery time recorded a mean value of 15.6 ± 3.7 min, without statistically significant difference between the groups. At T1, PG showed a significantly lower facial swelling compared to CG (PG: 3.3 ± 2.1 mm; CG: 4.2 ± 1.7 mm; p = 0.02). Similar results were recorded comparing the groups one week after surgery (PG: 1.2 ± 1.2; CG: 2.1 ± 1.3; p = 0.0005). All patients reported a decrease in facial swelling from T1 to T2 without differences between the two groups. At T1, the maximum buccal opening was significantly reduced than T0, and no difference between PG (35.6 ± 8.2 mm) and CG (33.7 ± 7.3 mm) (p > 0.05) was shown. Similar results were reported one week after surgery (PG: 33.2 ± 14.4 mm; CG: 33.7 ± 13.1 mm; p > 0.05). PG showed significantly lower pain values compared to CG, both at T1 (PG: 3.1 ± 1.5; CG: 4.6 ± 1.8; p = 0.0006) and T2 (PG: 1.0 ± 0.8; CG: 1.9 ± 1.4; p = 0.0063).

CONCLUSION

Our results showed that pre-operative low-dose prednisone administration could reduce postoperative sequelae by improving patient comfort after M3M surgery and reducing facial swelling two days and one week after surgical procedures.

TRIAL REGISTRATION

www.

CLINICALTRIALS

gov - NCT05830747 retrospectively recorded-Date of registration: 26/04/2023.

The effect of hyaluronic acid addition to collagen in reducing the trismus and swelling after surgical extraction of impacted lower third molars: a split-mouth, randomized controlled study

BACKGROUND

Removal of impacted third molars is associated with postoperative complications such as pain, swelling, ecchymosis, trismus, infection, and hematoma. Thus, contemporary surgery aims to reduce complications by applying collagen or hyaluronic acid in the socket after extracting the impacted mandibular third molars. This study aimed to study the efficacy of hyaluronic acid (HA) addition to collagen, compared to collagen application alone, on the magnitude of swelling and trismus following impacted mandibular third molar surgery.

METHODS AND MATERIALS

A total of 40 impacted molars of 20 participants who had completely bilateral impacted lower third molars were enrolled in this split-mouth, randomized, clinical trial. Randomization was carried out by two opaque envelops; two materials were applied topically in the socket collagen alone or with hyaluronic. The postoperative mouth-opening limitation and swelling rate were assessed on the third and seventh days after the extraction.

RESULTS

The mean age was 22.7 ± 3.079 years (75% female and 25% male). Regarding the rate of trismus, the test sides had less values than the control sides on 3rd days (44.03 ± 12.8 vs. 52.14 ± 13.7) and 7th days (19.22 ± 12.8 vs. 32.45 ± 15.3) postoperatively but the difference is only significant on the seventh day (P = 0.005). The swelling scores of the hyaluronic acid addition group were significantly lesser than those of the collagen alone group on the third and the seventh day (P < 0.05) except for the lateral canthus to the angulus mandibulae on the third day (P = 0.133).

CONCLUSION

Adding hyaluronic acid to collagen could effectively reduce the severity of facial swelling and trismus following surgical extraction of impacted lower third molars.

STATEMENT OF CLINICAL RELEVANCE

Swelling and trismus are the most sequela following impacted third molar surgical extraction. This study showed that applying hyaluronic acid with collagen can reduce the severity of facial swelling and trismus which could be useful in surgeons' daily practice. We should mention that this original article has a preprint edition (44).

Effectiveness of low power laser in reducing postoperative signs and symptoms after third molar surgery: a triple-blind clinical trial

The objective of this research was to evaluate the effectiveness of using LPL (Low power laser) to reduce pain, edema, and trismus after impacted lower third molar extraction. A split-mouth randomized triple-blind clinical trial was conducted at the Federal University of Ceará. For inclusion criteria, it was necessary that the patient presented a clear indication for removal of both lower third molars, in addition to both molars being in similar positions. The third molars (38 and 48) were randomly allocated to the test group that received the LPL application protocol, and to the placebo group that received a simulation of the protocol, making a total sample of 44 surgeries. Patients in the test group used an average of 50% of the amount of analgesics that was used by the placebo group, however, there was a statistically significant difference only on days four and five. Regarding trismus, the test group presented wide mouth openings, both at 48 hours and at 7 days after surgery compared to the placebo group, but without a statistically significant difference. For edema, we noted an equilibrium between the test group and the placebo group, but no measurement obtained a statistically significant difference. The use of LPL presented better pain and trismus indicators after complex extractions. The use of LPL is thus indicated as a complementary therapy to reduce postoperative discomfort caused by complex tooth extractions.

Effectiveness of adhesive taping to reduce pain, swelling and trismus after fracture mandible surgery

Swelling, pain and trismus constitute the major post-operative morbidity after surgery for mandibular fractures. We assessed the role of kinesio taping in mitigating these. Two groups of 15 patients were compared; those who had such applied to the side of the fracture and a control group of those who did not. Pain, swelling and trismus were assessed pre-operatively, and on the second, third and fifth post-operative days, and found to be significantly less in the study group. This simple technique is therefore effective. It is a simple frugal intervention without any side effects.

Efficacy of secondary vs primary closure techniques for the prevention of postoperative complications after impacted mandibular third molar extractions: A systematic review update and meta-analysis

BACKGROUND

The aim of this systematic review was to determine whether secondary closure (SC) or primary closure (PC) is better at preventing postoperative complications after impacted mandibular third-molar extraction.

TYPES OF STUDIES REVIEWED

The authors sought randomized controlled trials comparing the effects of PC and SC on pain, swelling, trismus, infection, and bleeding after impacted mandibular third-molar extraction. Screening, data extraction, and risk of bias assessments were conducted independently and in duplicate. The reviewers pooled results across studies using a random-effects meta-analysis and assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

This review identified 785 unique citations and included 40 trials. Compared with PC, SC was found to have trivial benefits for pain at day 7 and trismus within 1 week (moderate certainty). The incidence of infection and bleeding did not differ importantly between techniques (moderate certainty). However, SC is probably associated with less swelling on day 1 (standardized mean difference, -0.98; 95% CI, -1.22 to -0.73; moderate certainty) and day 3 (standardized mean difference, -0.87; 95% CI, -1.16 to -0.59; moderate certainty). There was very low certainty evidence for pain on days 1 and 3 and low certainty evidence for swelling on day 7.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Clinicians choosing between closure techniques should be aware that SC probably imparts an important benefit only for swelling at days 1 and 3. There seems to be a trivial difference between the techniques in other outcomes.

Efficacy of two dosages of dexamethasone administered by submucosal injection on postoperative sequelae after third molar surgery: A retrospective study

PURPOSE

A retrospective clinical study was performed to compare the post-operative sequelae of the submucosal administration of two different low dosages of dexamethasone, after the surgical extraction of lower third molars.

METHODS

Data regarding edema, trismus, pain and analgesic consumption were collected from 150 subjects, selecting three equal groups (n= 50): a control group with no administered dexamethasone (G1); submucosal injection of dexamethasone 2 mg/0.5 ml (G2) and submucosal injection of dexamethasone 4 mg/1 ml (G3). Collected data were evaluated at three different time points: T₀ before surgery, T₁ on the third day after surgery and T₂ on the 7th day after surgery. Patients' gender and age were also considered for statistical purposes.

RESULTS

The effects on facial swelling reduction were statistically significant in G2 at T₁ in the male subgroup. With trismus, the differences between the time points considered were statistically significant in G2 in the subgroup of subjects younger than 25 years old. Differences in analgesics taken were statistically significant when G1 and G2 were compared at T₁.

CLINICAL SIGNIFICANCE

The submucosal injection of 2 mg/0.5 ml of dexamethasone to subjects younger than 25 years old is enough to reduce trismus. For females and subjects older than 25 years old, it is preferable to administer at least 4 mg of dexamethasone to reduce edema.

Efficacy of two low-level laser therapy protocols following lower third molar surgery - a randomized, double-blind, controlled clinical trial

The aim of this study was to test two low-level laser therapy protocols by evaluating pain control, swelling and trismus in the postoperative period of lower third molar surgeries. This was a randomized, double-blind, placebo-controlled, crossover trial. Patients presenting two symmetrically impacted mandibular third molars were included. One side was randomly assigned for LLLT applied immediately after surgery (T1) and then after 24 (T2) and 48 hours (T3) (Protocol A). The other side received LLLT applied immediately after surgery and placebo after 24 and 48 hours (Protocol B). LLLT was given by intraoral application (660nm, 5 J/cm2, 10 s, 20 mW, 4 points) followed by extraoral application (789 nm, 30 J/cm2, 20 s, 60 mW, 8 points). The placebo application was similar to that of the experimental side but with laser simulation. The primary outcomes were pain control, swelling and trismus intensity at T1, T2, T3 and 7 days after surgery (T4). Data were analyzedbyANOVArepeated measures and Wilcoxon test (p<.05). The final sample consisted of 21 patients (42 teeth). There were no statistical differences for pain level between protocols A and B over time (p= .909), although the amount of analgesic medication was lower with protocol A at T2 (p=.022). There were no differences in swelling (p=.958) or trismus (p=.837) between the protocols used over time. Both protocols performed similarly for pain control, swelling and trismus. Therefore, for practical reasons, a single laser application in the immediate postoperative period could be indicated for the management of postoperative discomfort in lower third molar surgery.

Evaluation of the Efficacy of Platelet-Rich Plasma versus Platelet-Rich Fibrin in Alleviating Postoperative Inflammatory Morbidities after Lower Third Molar Surgery: A Double-Blind Randomized Study

BACKGROUND

Postoperative morbidities following impacted lower third molar (M3) surgery is of concern. The influence of platelets concentrates on postoperative inflammatory sequelae of M3 is promising. However, the comparative efficacy of platelet-rich fibrin (PRF) to platelet-rich plasma (PRP) in ameliorating postoperative morbidities remains controversial.

OBJECTIVE

The study aimed to compare the bioactive effects of PRP and PRF on postoperative pain, swelling, and trismus after impacted M3 surgery.

SUBJECTS AND METHODS

A randomized, parallel-group study of 50 subjects was designed. Preoperative and postoperative swelling, degree of mouth opening and pain were assessed on days 1, 3, and 7. Linear mixed model analysis was used to compare the effects of treatment, time-point assessment within the group, and treatment with time interaction.

RESULTS

Interaction estimates show statistically significant pain reduction with PRF (p = 0.00, 95% CI [-0.95, -0.25]. Trismus based on a time-point assessment within the PRP and PRF groups was significantly reduced (p =0.01, 95% CI [0.06, 0.38]) and (p = 0.00, 95% CI [0.12, 0.44]) respectively. Facial swelling within the PRP and PRF groups were significantly decreased (p = 0.00, 95% CI [-0.30, -0.06]) and (p = 0.00, 95% CI [-0.37, -0.13) respectively. There were no statistically significant differences between the groups for trismus and swelling. Age was a significant predictor of trismus in both groups (p = 0.04, 95% CI [-0.07, -0.01]).

CONCLUSION

PRF was more effective in reducing postoperative pain compared to PRP. Furthermore, the study shows that platelet concentrates positively modulate post-inflammatory sequelae of impacted M3 surgery.

Comparison of dexamethasone administration through sublingual and intramuscular routes for evaluation of pain, swelling, and trismus after impacted mandibular third molar surgery-a prospective randomized controlled study

PURPOSE

To compare the efficacy of dexamethasone when administered preoperatively through sublingual and intramuscular routes for evaluating the reduction in pain, swelling, and trismus after removal of impacted mandibular third molar.

METHODS

The study was conducted on patients who required surgical removal of impacted mandibular third molars under local anesthesia. A total of 150 patients were considered for the study who were divided into two groups of 75 patients each. Patients in the sublingual group were administered with 2 ml of dexamethasone 8 mg along with 2 ml of normal saline through sublingual route and patients in the intramuscular group were administered with 2 ml of dexamethasone 8 mg through intramuscular route 1 h before the commencement of mandibular third molar surgery. The subjects of all two groups were evaluated for pain, swelling, and trismus on 1^st, 3^rd, and 7^th postoperative days.

RESULTS

Patients in the sublingual group had significantly less pain and increased mouth opening on 1^st, 3^rd, and 7^th postoperative days when compared to patients in the intramuscular group (P < 0.05), while the amount of swelling in the sublingual group was significantly less only on the 3^rd and 7^th postoperative days when compared to patients in the intramuscular group (P < 0.05). Four patients in the sublingual group consumed one dose of paracetamol 500 mg as a rescue drug on the day of surgery. In the intramuscular group, 9 patients consumed one dose of the same rescue drug on the day of surgery and 11 patients consumed one dose of rescue drug both on the day of surgery and on the 1^st postoperative day.

CONCLUSION

This study concludes that preoperative administration of dexamethasone 8 mg through sublingual route had better efficacy than intramuscular route in controlling pain, swelling and trismus after mandibular third molar surgery.

Various wound closure ways after impacted lower wisdom teeth removal: A review

OBJECTIVE

Evaluate the influence of different wound closure methods in terms of pain, swelling, trismus, infection and healing time after third molar extraction.

MATERIAL AND METHODS

A literature analysis was performed according to PRISMA guidelines in search of clinical trials published between 2015 and 2020. Databases were searched using different combinations of the following keywords: mandibular impacted OR retained wisdom teeth OR third molar removal OR extraction AND surgical removal AND discomfort OR pain OR trismus OR swelling AND drain OR drainage. The literature search resulted in a total of 364 publications. Finally, 12 study articles were used in the present review, following a selection based on the preestablished eligibility criteria.

RESULTS

The significant difference between various wound closure ways and postoperative pain, swelling and trismus has been found in 8 of 12 analyzed articles. Three of five established beneficial effect of drain application. In other articles, examining different wound closure methodologies, significant benefits were found by using buccally based triangular, buccal mucosal-advancement, and modified envelope flap. Suture-less anterior releasing incision and secondary wound closure also could be favorable after removing impacted third molars.

CONCLUSION

There was no significant effect of a rubber drain on swelling, pain, trismus, or wound infections after removal of the asymptomatic impacted third molar(s). Secondary wound closure was found to ensure lower pain, swelling and trismus ratio with comparison to primary wound closure.

Effects of a mouth-opening intervention with remote support on adherence, the maximum interincisal opening, and mandibular function of postoperative oral cancer patients: A randomized clinical trial

PURPOSE

The purpose of the study was to investigate the effects of a mouth-opening intervention for postoperative trismus and remote support provided via telephone following hospital discharge for intervention adherence in patients with oral cancer.

METHODS

The study is a parallel randomized trial. Patients admitted at a general hospital for oral cancer surgery were recruited and randomly assigned to either the experimental or the active control group. Both groups underwent a 12-week intervention program, including warm compress, masticatory muscle massage, and jaw exercise. Subjects in the experimental group received additional support via telephone following hospital discharge. Data on intervention adherence maximum interincisal opening and mandibular function impairment were collected at baseline, week 4, and week 12.

RESULTS

Sixty subjects (30 in each group) that completed the study were included in the analysis. At week 12, the intervention practice time in the experimental group was 299.67 min (95% CI: 223.44-357.89) more than that of the active control group. From baseline to week 12, the change in maximum interincisal opening was 10.30 mm (95% CI: 8.22-12.37) greater in the experimental than in the active control group. The change in mandibular function impairment score was -0.36 (95% CI: -0.44 to -0.28) greater in the experimental than in the active control group.

CONCLUSIONS

The study results support the effect of remote support via telephone for enhancing adherence to the intervention protocol, and the effect of the intervention program for alleviating trismus and mandibular function impairments in patients who receive curative surgery for oral cancer.

Pharmacological Control of Complications Following to Third Molar Removal: Evidence Based on A Meta-Analysis

AIMS

The purpose of this meta-analysis was to evaluate the clinical efficacy of non-steroidal anti-inflammatory drugs and dexamethasone on the trismus, postsurgical pain, facial swelling, as well as the analgesic consumption after third molar surgery.

MATERIAL AND METHODS

The reports were identified in the most important medical databases. Those studies that met the requirements were fully assessed according to the inclusion and exclusion criteria. The quality of each report was evaluated with the Oxford Quality Scale and using the Cochrane Collaboration's risk of bias tool. Each meta-analysis was done using the technique of mean difference and 95% confidence intervals employing a random effects model with the Review Manager 5.3., from the Cochrane Library. Significant statistical difference was accepted when the p value was less than 0.05 on the test of overall effect (Z value).

RESULTS

Qualitative evaluation was done using the data of 330 patients extracted from seven articles and the quantitative assessment with data of 200 patients from three reports. It was not observed difference among non-steroidal anti-inflammatory drugs and dexamethasone in any of the clinical effectiveness indicators.

CONCLUSION

The outcomes of our meta-analysis indicate that non-steroidal anti-inflammatory drugs and dexamethasone have good therapeutic effect for the management of inflammatory complications following to third molar surgery.

Efficacy of diode-emitting diode (LED) photobiomodulation in pain management, facial edema, trismus, and quality of life after extraction of retained lower third molars: A randomized, double-blind, placebo-controlled clinical trial

BACKGROUND

In dentistry, one of the most common surgical procedures is the removal of retained third molars. This surgery generates great morbidity to the participants for causing pain, edema, and trismus due to surgical trauma. The objective of the present study is to evaluate the efficacy of photobiomodulation with light emitting diode (LED) in the control of pain, facial edema, trismus, and quality of life resulting from the extraction of retained lower third molars.

METHODS

A randomized, double-blind, placebo-controlled clinical trial involving 38 adult participants, who meet the criteria of eligibility and agree to participate in the study. Before the surgeries are performed, the facial and mouth opening measures of all the participants will be taken. Immediately after the surgeries, participants will be randomized into 2 groups. In the LED group, participants will receive LED applications (intra oral with 660 nm, 12J and extraoral with 850 nm, 108J) in the immediate postoperative, first and second days after the surgical procedure. In the control group, the participants will be attended in the same way as in the LED group, however, the person in charge of the application will simulate the irradiation. Pain (EVA and NRS-101), postoperative edema, trismus, temperature, dysphagia, and hematoma will be evaluated after 1, 2, 5, and 7 days. The oral health impact profile (OHIP-14 Questionnaire) and anxiety analysis (Beck anxiety inventory -BAI) questionnaires will be applied preoperatively and 7 days after treatment. The appropriate statistical tests will be applied for each specific analysis in a significance level of 5%.

DISCUSSION

Although the use of low-power laser in the postoperative has shown good results in the control of postoperative sequelae, this is the first study on the efficacy of the use of LED in this situation.

Comparative Study of Piezoelectric and Rotary Osteotomy Technique for Third Molar Impaction

INTRODUCTION

Bone removal is necessary for extracting the third molars that are erupted, partially erupted, and/or impacted in bone. Hence, it is necessary to choose a surgical method or instruments that conform to anatomic landmarks and are based on physiological principles. Many authors have reported injuries to the adjacent tooth, especially the distal part of periodontium after removal of second molar. Hence, the present study was undertaken to assess and compare the surgical and postsurgi-cal outcomes of third molar removal using piezoelectric surgery and rotary bur.

MATERIALS AND METHODS

A total of 30 healthy adult individuals who were in need of prophylactic removal of impacted man-dibular third molar tooth with ideal condition were included for the study. Individuals were divided randomly into study groups of 15 each, so that the difficulty of surgery will be the same in both the groups. Group I - piezoelectric osteotomy technique and group II - rotary osteotomy technique. The rotary device consists of a hand piece and a rotary speed ranging around 35,000 rpm was used. The piezoelectric device consists of a hand piece, and a frequency of 25 to 29 kHz with a microvibration of 60 to 200 mm/sec was used with a boosted working mode. Data were analyzed using unpaired t-test and qualitative data were analyzed using Fischer's exact test.

RESULTS

The average age of the study subjects in the piezo-surgery group and rotary group was 28.40 ± 2.69 and 30.06 ± 3.15 years respectively. The time taken for removal of impacted tooth by rotary bur was less than that by piezoelectric device, which was significant statistically (p < 0.05). Until the 4th postoperative day, severity of pain experienced was more in the rotary group, which was statistically significant (p < 0.005). Mouth opening was significantly better in the piezoelectric group as compared with rotary bur until the 7th postoperative day.

CONCLUSION

The piezosurgery method reduces postoperative pain, trismus, and swelling. Also, it may play an important role in increasing bone density within the extraction socket and decreasing the amount of bone loss of adjacent tooth in the distal aspect.

CLINICAL SIGNIFICANCE

In clinical practice, piezosurgery plays an important role because piezosurgery reduces postoperative pain, trismus, and also swelling.

Do Corticosteroids Still Have a Role in the Management of Third Molar Surgery?

INTRODUCTION

The use of corticosteroids to reduce the post-operative sequelae of lower third molar surgery, namely pain, swelling and trismus, has been well studied by many researchers over the past 6 decades. This study reviewed the reported outcome of corticosteroids used in controlling the above sequalae after third molar surgery.

MATERIALS AND METHODS

A PubMed, Medline, EMBASE and Google search was undertaken of all controlled clinical trials on the effects of corticosteroids on pain, swelling and trismus after lower third molar surgery. The review was limited to studies published over the last 10 years (2006-2015).

RESULTS

Of the 46 initially retrieved articles, 34 were finally included. Eleven studies compared the effect of 2 similar (but different dose) or different group of corticosteroids. Thirty-one studies reported the effects of corticosteroids on all sequale, 2 reported the outcome on swelling and trismus and another 1 on swelling and pain only. In 16 of the studies, corticosteroid use resulted in significant reductions in pain after third molar removal. Twenty-two out of 29 studies reported reduced swelling against negative control while 18 out of 25 studies reported improved mouth opening. Fourteen studies reported the benefit of corticosteroids on all 3 sequelae, with 71.4% resulted from the use of methylprednisolone.

CONCLUSION

Although there are some conflicting effects, the results of this analysis shows in general the benefits derived from short-term use of corticosteroids in relation to pain, swelling and trismus following third molar surgical extraction, with no side effects observed.

FUNDING

This work was supported by the University of Malaya's High Impact Research grant UM.C/625/1/HIR/MOHE/05.

Effects of pre-operative submucosal dexamethasone injection on the postoperative swelling and trismus following surgical extraction of mandibular third molar

OBJECTIVE

To determine the effects of pre-operative submucosal dexamethasone injection on postoperative swelling and trismus following surgical extraction of mandibular third molar.

STUDY DESIGN

Randomized controlled trial.

PLACE AND DURATION OF STUDY

Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry (AFID), Rawalpindi, from October 2009 to March 2010.

METHODOLOGY

A total of 100 patients aged 18 - 40 years with good periodontal health and mesioangular impaction were divided in two treatment groups (50 in each group). Group-A received prophylactic 4 mg submucosal dexamethasone intraoral injection and Group-B acted as control group. Facial swelling and trismus were assessed at baseline, 2nd and 7th postoperative days. Data was analyzed using SPSS-10.

RESULTS

There were 35 (70%) males and 15 (30%) females in group-A and 34 (68%) males and 16 (32%) females in group-B. Surgical time ranged from 30 - 50 minutes (mean = 40.62 ± 4.886 minutes) for group-A and 33 - 50 minutes (mean = 42.12 ± 4.543 minutes) for group-B. Administration of dexamethasone had statistically significant effect in reduction of swelling and trismus on second postoperative day (p < 0.05) in group-A.

CONCLUSION

Pre-operative 4 mg submucosal dexamethasone injection was significantly effective in reduction of postoperative swelling and trismus.

Early preventive exercises versus usual care does not seem to reduce trismus in patients treated with radiotherapy for cancer in the oral cavity or oropharynx: a randomised clinical trial

PURPOSE

In head and neck cancer patients undergoing curative radiotherapy, we investigated the benefits and harms of an early exercise regime on trismus.

MATERIAL AND METHODS

Patients with head and neck cancer undergoing radiotherapy were centrally randomised to exercises 5-6 times for 45 minutes during and after radiotherapy supervised by a physiotherapist in addition to usual care versus usual care alone. The primary outcome was change in maximal interincisor distance (MID) measured at 5 and 12 months. Secondary outcomes were change in cervical ranges of motion, tissue tightness, and health-related quality of life. Mixed model analysis of repeated measures adjusted for tumour size and operation was conducted to assess the effect of early preventive exercises across time periods.

RESULTS

Of the 100 patients included, two patients withdrew and one died before the onset of radiotherapy. The unadjusted mean difference in MID at 12 months after having completed radiotherapy was 0.83 mm (95% confidence interval (CI) -3.64-5.29, p = 0.71) in the exercise intervention group compared with the control group. When adjusted for operation and tumour size, the effect of the exercise intervention on mean MID from baseline to 12-month follow-up was 5.92 mm (95% CI -0.48-12.33, p = 0.07). Of the secondary outcomes, cervical rotation showed a statistically significant deterioration in the exercise group compared with the control group (p = 0.01). No significant effects were observed on the other secondary outcomes.

CONCLUSIONS

In patients with cancer in the oral cavity or oropharynx, early supervised exercises combined with self-care treatment focusing on mobility exercises to reduce trismus do not seem to provide additional beneficial effects compared with usual care during curative radiotherapy.

Clinical comparison of submucosal injection of dexamethasone and triamcinolone acetonide on postoperative discomfort after third molar surgery

OBJECTIVE

The aim of the study was to compare the effect of submucosal injection of dexamethasone and triamcinolone acetonide on postoperative pain, swelling, and trismus occurring after impacted mandibular third molar surgery.

METHOD AND MATERIALS

A total of 78 patients (aged 18 to 35) with asymptomatic, unilateral, impacted mandibular third molar, and without any systemic disease were included in this study. Patients were divided into three groups randomly (control, dexamethasone, and triamcinolone acetonide). In the experimental groups, dexamethasone and triamcinolone acetonide were injected into submucosa at about 1 cm above the surgical area submucosally. The control group of patients did not take any drug submucosally but the same surgical procedure was applied. Pain evaluation was performed by visual analog scale (VAS). Swelling was measured using a flexible standard ruler measuring the dimensions of the axes between certain points on the face. For trismus evaluation, maximum mouth opening was measured. Measurements taken on the preoperative, and on postoperative first, third, and seventh days were compared with each other and statistically evaluated.

RESULTS

There were statistically significant differences between the control and experimental groups on the different days of the postoperative period. The effect of triamcinolone acetonide on pain started on the first day postoperatively and the effect of triamcinolone acetonide on trismus and pain was better than other groups at the third and seventh days. However, there was no statistically significant difference between the effects of dexamethasone and triamcinolone acetonide regarding postoperative complications.

CONCLUSION

The submucosal injection of dexamethasone or triamcinolone acetonide might be an effective treatment for postoperative discomfort occurring following impacted mandibular third molar surgery, and triamcinolone acetonide could be applied as an alternative to dexamethasone.

The efficacy of 2 different doses of dexamethasone to control postoperative swelling, trismus, and pain after third molar extractions

This article addresses the effect of 2 different concentrations (4 and 12 mg) of dexamethasone to control pain, swelling, and trismus after third molar surgery. A clinical study was conducted with 27 male and female patients, all presenting with bilaterally displaced mandibular third molars. The treatment protocol required a surgical removal of each tooth in 2 separate operations. The patients were given a preoperative dose of dexamethasone-4 mg for one surgery, 12 mg for the other. The choice of which side would be operated on first and which dose of dexamethasone would be taken was performed randomly, under double-blind conditions. The trismus was assessed by measuring the interincisal distance. Pain intensity was measured both by the amount of painkillers (acetaminophen 750 mg) taken postsurgery and by the Visual Analogue Pain Scale. Data were collected 1 hour preoperative, then at 24 and 48 hours postoperative. A statistical analysis (student's t, Wilcoxon and Friedman tests) of the results showed no significant differences (α = 0.05) between the analyzed variables for the 2 doses of dexamethasone (4 and 12 mg).

Effects of intra-space injection of Twin mix versus intraoral-submucosal, intramuscular, intravenous and per-oral administration of dexamethasone on post-operative sequelae after mandibular impacted third molar surgery: a preliminary clinical comparative study

INTRODUCTION

A prospective randomised double-blind study was undertaken to compare the effects of intra-space injection of 'Twin mix' versus intraoral-submucosal, intramuscular, intravenous and per-oral administration of dexamethasone on post-operative sequelae after mandibular impacted third molar surgery.

MATERIAL AND METHODS

A randomised double-blind clinical trial was conducted on 60 patients with class II position B impaction of mandibular third molars. Sixty transalveolar extractions were performed prospectively with ten patients randomly allocated to each of the six study groups (group T: intra-space injection of Twin mix; group S: submucosal dexamethasone; group M: intramuscular dexamethasone; group V: intravenous dexamethasone; group O: per-oral dexamethasone; group C: control group, no dexamethasone). A ten-point visual analogue scale was used to assess the overall pain intensity/patient discomfort, and specific facial measurements were recorded to assess the post-operative facial swelling. Maximal mouth opening was compared pre and post-operatively to assess the trismus.

RESULTS

Mean operative visual analogue scale scores did not show statistical variation, and post-operative visual scores indicated better patient comfort in the steroid groups with statistically significant difference between group T and the control group on the first, third and the seventh post-operative day. Mean increase in distances between tragus and soft tissue menton to assess facial swelling showed strong statistically significant difference between the first and the third post-operative day between the control group and group T (p value <0.0001). Association of trismus was found less with the steroid treatment groups when compared to the control group.

CONCLUSION

Steroid groups had a better clinical outcome with improved quality of life post-operatively when compared to the nonsteroid study group. Intra-space injection of dexamethasone in pterigomandibular space as Twin mix was found to have similar clinical effects as conventional methods of administering steroids via intraoral-submucosal, intramuscular, intravenous and per-oral routes. This, however, is a small study which would now benefit from larger numbers.

Effect of low-concentration povidone iodine on postoperative complications after third molar surgery: a pilot split-mouth study

PURPOSE

Povidone iodine is used primarily as an antiseptic to decrease surgical site infection. Its hemostatic and antiedematous properties in oral surgery also have been investigated recently.

PATIENTS AND METHODS

A randomized controlled clinical trial was performed in 30 patients undergoing mandibular third molar removal in a split-mouth design. In the study group, a povidone iodine solution with a concentration of 0.5 mg/mL was used as the coolant and irrigant solution, whereas normal saline was used in the control group. Swelling (orotragus and mentotragus distances), trismus (maximum interincisal opening), and pain (visual analog scale score) were evaluated on postoperative days 2 and 7.

RESULTS

In the study group, a significant decrease in swelling and trismus was observed at the 2 postoperative visits (P = .00) compared with the control group. The decrease of pain in the study group was not statistically significant at either postoperative visit (P > .05). More patients (63%) were subjectively satisfied with the side treated with povidone iodine.

CONCLUSION

Povidone iodine irrigation is an inexpensive and safe method to lessen the postoperative sequelae of third molar surgery.

Effect of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: a prospective study

AIM

To evaluate the relative ability of 4 mg dose of intraoperative dexamethasone, administered submucosally, to reduce the postoperative discomfort after third molar surgery.

MATERIALS AND METHODS

A total of 100 patients requiring surgical removal of a single mandibular third molar were included. The experimental group (50) received dexamethasone 4 mg as submucosal injection and control group (50) received no drugs. The maximum interincisal distance and facial contours were measured at baseline and at postsurgery days 2 and 7. The measurement of pain was done using visual analog scale (VAS).

RESULTS

None of the patients developed wound infection or any serious postoperative complications. Postoperative edema tended to be less severe on the second postoperative day in the experimental group and the result was statistically significant. There were no significant differences in the reduction of pain and trismus between the two groups studied.

CONCLUSION

Submucosal administration of dexamethasone sodium phosphate (4 mg) results in reduction of postoperative edema, comparable with or greater than other routes of administration. Presumably, a higher effective drug concentration at the site of injury without loss due to distribution to other compartments may be achieved, and the submucosal route is convenient for both the surgeon and the patient.

CLINICAL SIGNIFICANCE

Submucosal route of administration of dexamethasone (4 mg) is effective in reducing postoperative discomfort after third molar surgeries.

Effect of two routes of administration of dexamethasone on pain, edema, and trismus in impacted lower third molar surgery

PURPOSE

The aim of the present study was to compare pain, edema, and trismus in the postoperative period following third molar surgery using 8 mg of dexamethasone administered either orally or through local injection.

METHODS

A prospective, controlled, randomized trial was carried out involving 60 lower third molar surgeries in 67 patients between October 2008 and June 2009. The sample was randomly divided into three groups: group A (local injection), group B (tablets), and group C (control). In all cases, either ostectomy or crown sectioning was employed. On the second and seventh day following surgery, linear edema was determined using facial landmarks, and maximal mouth opening measurements were performed. Postoperative pain was recorded using a visual analog scale.

RESULTS

Patient age ranged from 14 to 37 years (mean, 21.0 years). With regard to pain, edema, and trismus, the two administration routes tested (local injection and tablets) demonstrated similar efficacy, and both methods achieved better results in comparison to the control group.

CONCLUSION

Both the oral administration and local injection of dexamethasone proved effective in reducing pain, edema, and trismus compared to control group following lower third molar surgeries, achieving similar results.

Prophylaxis versus pre-emptive antibiotics in third molar surgery: a randomised control study

OBJECTIVES

This study was carried out to compare the efficacy of preoperative single bolus antibiotics with a 5 day- postoperative antibiotic regimen in reducing pain, swelling, and trismus, surgical site infection (SSI) and alveolar osteitis (AO) after third molar surgery.

PATIENTS AND METHODS

A randomised experiment was done involving eighty-four patients. The patients were divided into two groups consisting of 42 patients each. A preoperative group was given an oral bolus of 2g amoxycillin capsules and 1g metronidazole tablets one hour before extraction, while those in the postoperative group were given a five-day regimen oral 500mg amoxycillin capsules thrice daily and 400mg metronidazole tablets thrice daily. The occurrence of postoperative pain, swelling, trismus, SSI and AO were compared between the groups.

RESULTS

Seventy-nine patients completed the study; 38 patients in the preoperative group and 41 patients in the postoperative group. There was no difference between the groups in respect of the inflammatory complications. The four cases of AO occurred in the preoperative group.

CONCLUSION

Single bolus antibiotic prophylaxis should be adequate for most cases of third molar surgery as the degree of degree of postoperative pain, swelling and trismus was similar in both groups. The use of single bolus antibiotic prophylaxis would also help reduce the cost of treatment in developing countries as well as reduce the risk of development of resistant strains. However, a five-day postoperative antibiotic regimen is advised in patient with risk factors for AO.

Early self-care rehabilitation of head and neck cancer patients

Conclusions: No positive effects of early preventive rehabilitation could be identified. The results do not contradict the proposition that rehabilitation based on self-care can be effective but it is important to establish evidence-based training programs and identify proper instruments for selection of patients and evaluation of intervention. Objectives: Patients with head and neck cancer suffer from functional impairments due to intense treatment. In this study, we investigated the effectiveness of an experimental early preventive rehabilitation using hard, objective end points in a nonselective, longitudinal, prospective cohort study. Methods: In all, 190 patients were included in the program and received instructions for training before the start of treatment with the aim of reducing swallowing problems and reducing mouth opening and stiffness in the neck. A control group of 184 patients was recruited. Results: There was no difference in weight loss and 2-year survival between the two groups. No positive effects concerning functional impairments were found in patient-reported outcome measures.

Efficacy of nimesulide versus meloxicam in the control of pain, swelling and trismus following extraction of impacted lower third molar

This study compared the efficacy of nimesulide and meloxicam in the control of pain, swelling and trismus, following the extraction of impacted inferior third molars. Twenty patients with two impacted inferior third molars, in similar positions, were selected. The patients were designated randomly to the meloxicam group (MEL: 7.5mg twice a day for 5 days) or the nimesulide group (NIM: 100mg for 5 days). Following the extractions, swelling was more pronounced in the MEL group than in the NIM group (P<or=0.001). There were no significant differences in pain intensity between the treatment groups (P>0.05). At the 72-h evaluation, reduction was significantly larger in mouth opening in the MEL group compared with the NIM group (P<0.05). In conclusion, pain control was similar in both treatment groups. NIM was more effective than MEL in the control of swelling and trismus following the extraction of impacted lower third molars.

The effect of prednisolone on reduction of complaints after impacted third molar removal

Nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids are able to effectively reduce postoperative sequels after impacted third molar removal. The purpose of this study was to evaluate whether a single dose of prednisolone, taken orally immediately after the operation, would increase the effects of etorikoxib (Arcoxia(R)) NSAID in preventing trismus and swelling after surgical removal of impacted third molars.

PATIENTS AND METHODS

This prospective study was conducted in a half-year period on 78 patients who had undergone third molar surgery under local anaesthesia. They were divided into two groups: prednisolone group (38 patients) and control (40 patients). In the prednisolone group 30 mg prednisolone was given to each patient immediately after surgery. Both groups had received Etorikoxib 120 mg 30 minutes before operation. They had to complete a questionnaire evaluating postoperative symptoms. Postoperative pain, facial swelling and trismus were evaluated.

RESULTS

Postoperative administration of 30 mg prednisolone to the patients relieved trismus, swelling and pain more than non-administration of prednisolone in the control group. There was significantly less swelling on the first four postoperative days in the prednisolone group compared to control (p<0.05). The values of the maximal interincisal opening (MIO) and visual analogue scale (VAS) were higher for the prednisolone group than for the control group (p<0.05). No clinically apparent infection, disturbance of wound healing, or other corticosteroid-related complications were noted.

CONCLUSION

It was found that a combination of a single dose of prednisolone and Etorikoxib is well-suited for treatment of postoperative pain, trismus, and swelling after third molar surgery and should be used to diminish postoperative swelling of soft tissues.

Placebo-controlled randomized clinical trial of the effect two different low-level laser therapies (LLLT)--intraoral and extraoral--on trismus and facial swelling following surgical extraction of the lower third molar

The purpose of this study is to compare the effects of extraoral and intraoral low-level laser therapies (LLLT) on postoperative trismus and oedema following the removal of mandibular third molars. Forty-eight patients who were to undergo surgical removal of their lower third molars were studied. Patients were randomly allocated to one of three groups: extraoral LLLT, intraoral LLLT, or placebo. In the study, a Ga-Al-As diode laser device with a continuous wavelength of 808 nm was used, and the laser therapy was applied by using a 1 x 3-cm handpiece. The flat-top laser beam profile was used in this therapy. For both of the LLLT groups, laser energy was applied at 100 mW (0.1 W) for a total of 120 s (0.1 W x 120 s = 12 J). Patients in the extraoral-LLLT group (n = 16) received 12-J (4 J/cm(2)) low-level laser irradiation, and the laser was applied at the insertion point of the masseter muscle immediately after the operation. Patients in the intraoral-LLLT group (n = 16) received 12-J (4 J/cm(2)) low-level laser irradiation intraorally at the operation site 1 cm from the target tissue. In the placebo group (n = 16), the handpiece was inserted intraorally at the operation site and then was touched extraorally to the masseter muscle for 1 min at each site (120 s total), but the laser was not activated. The size of the interincisal opening and facial swelling were evaluated on the second and seventh postoperative days. At the second postoperative day, trismus (29.0 +/- 7.6 mm [p = 0.010]) and swelling (105.3 +/- 5.0 mm [p = 0.047]) in the extraoral-LLLT group were significantly less than in the placebo group (trismus: 21.1 +/- 7.6 mm, swelling: 109.1 +/- 4.4 mm). Trismus (39.6 +/- 9.0 mm [p = 0.002]) in the extraoral-LLLT group at the seventh postoperative day was also significantly less than in the placebo group (29.0 +/- 6.2 mm). However, at the seventh postoperative day in the intraoral-LLLT group, only trismus (35.6 +/- 8.5 [p = 0.002]) was significantly less than in the placebo group (29.0 +/- 6.2 mm). This study demonstrates that extraoral LLLT is more effective than intraoral LLLT for the reduction of postoperative trismus and swelling after extraction of the lower third molar.

Comparison of corticosteroids and rubber drain for reduction of sequelae after third molar surgery

INTRODUCTION

For reducing edema, trismus, and pain after impacted tooth surgery, some protocols are proposed but their relative effectiveness is controversial.

PURPOSE

The goal of this study was to evaluate and compare the effects of corticosteroids and rubber drain on the postoperative complications of impacted molar surgery.

PATIENTS AND METHODS

This study was carried out on 22 patients with bilateral symmetrical mandibular impacted third molars. For surgical removal of impacted teeth on one side of these patients, either rubber drain (11 cases) or perioperative corticosteroids (11 cases) were used (study group). The contralateral impacted teeth were removed routinely without using any drug or drain (control group). Facial edema, trismus, and pain perception of the study and control groups were recorded on the second and seventh postoperative days.

RESULTS AND DISCUSSION

This study showed that perioperative steroids reduce the trismus, facial swelling, and the severity of pain after third molar surgery. This study also revealed that the use of the drain reduces facial pain and trismus but has no effect on the facial swelling after impacted tooth surgery. Comparing the steroid and drain groups, we found that perioperative corticosteroids are more effective than the surgical drain in reducing postoperative pain and edema, but their effects on trismus are similar.

Clinical comparative study of the effectiveness of two dosages of Dexamethasone to control postoperative swelling, trismus and pain after the surgical extraction of mandibular impacted third molars

PURPOSE

The aim of this study was to evaluate the effect of two different concentrations (4 and 8 mg) of dexamethasone to decrease the swelling and trismus after the surgical extraction of mandibular impacted third molars.

METHODS

This randomized clinical trial comprised thirty (30) adult patients of both genders with no local or systemic problems, with bilateral impacted lower third molars in similar position, where surgical extraction had been indicated. They were given 4 mg and 8 mg of dexamethasone 1 hour before the surgical procedure at the first or second surgery. The choice of which side to operate first and the amount of concentration of medication to use was made randomly and double-blindly. Postoperative pain was evaluated using a visual analog scale (VAS) and the degree of swelling was evaluated through facial reference points' variation. The presence of trismus was analyzed through measurement of the interincisal distance (IID). These assessments were obtained before the operation and 24h and 48 h after the surgery.

RESULTS

Based on statistic analysis (pared t-student and Wilcoxon tests), the results showed a significant difference in the measurements of the degree of swelling and trismus of the treated sample. 8 mg of dexamethasone promoted a greater reduction of symptoms than 4 mg of dexamethasone

CONCLUSIONS

The administration of 8 mg of the dexamethasone was more effective than 4 mg of the dexamethasone to reduce the degree of swelling and trismus. However, it had no effect on pain control.

Passive drainage through the vestibular oblique incision in impacted inferior third molar surgery: a preliminary study

The aim of the present study was to clinically evaluate the variables pain, swelling and trismus when two different suture techniques were applied in surgery of impacted lower third molars. The sample comprised 20 patients of both genders participating in the clinical trial at the Division of Oral and Maxillofacial Surgery, with an indication for the removal of bilaterally impacted lower third molars. They were divided into test and control groups. Complete suture was performed on the free and attached gums in the control group and only on the attached gum of the oblique vestibular incision in the test group. The results showed that the fact that the drainage of fluid through the suture was not obliterated led to diminution of pain 48 hours after surgery. No statistically significant differences were observed in relation to swelling, which diminished gradually in both groups. As regards the variable trismus, the test group presented a greater mouth opening throughout the evaluation, being statistically significant at 7 days. The probing depth, three months postoperatively, was found to be greater in the control group. This difference reached statistical significance for the vestibular distal region of the adjacent second molar. It is concluded that the strategy of not suturing the free gum of the oblique vestibular incision in the extraction of impacted lower third molars leads to the diminution of immediate painful symptomatology, but has no influence on the swelling.

[Effect of early rehabilitation training on radiation-induced trismus in nasopharyngeal carcinoma patients]

BACKGROUND & OBJECTIVE

Many nasopharyngeal carcinoma (NPC) patients could survive for a long time after radiotherapy. But the complications of radiotherapy, such as trismus, severely influence the quality of life of NPC patients. This study was to observe the effect of early rehabilitation training on radiation-induced trismus of NPC patients.

METHODS

A total of 108 NPC patients received rehabilitation guidance by doctors at initial radiotherapy and subjected to early rehabilitation training regularly and intensively after radical radiotherapy between Dec. 2003 and Dec. 2004 at Xiangya Hospital of Central South University. They continued on rehabilitation training out of hospital as the same in hospital. According to the data of rehabilitation training obtained by questionnaire at 1 month after radiotherapy, the patients who completed the amount of rehabilitation training (>or=75%) were brought into rehabilitation training group, the others was brought into control group. The distance between two dens incivus medialis (DDIM) of the patients was measured at 1 month and 1 year after radiotherapy.

RESULTS

The difference of rehabilitation training score was significantly higher in rehabilitation training group than in control group (9.80+/-3.02. vs.4.75+/-1.90 at 1 month after radiotherapy, P<0.05û 9.00+/-2.67 vs. 2.20+/-0.82 at 1 year after radiotherapy, P<0.05). The occurrence rates of trismus were 44.1% at 1 month and 51.5% at 1 year after radiotherapy in rehabilitation training group, and 60.0% and 85.0% in control group. The reduction of DDIM was significantly smaller in rehabilitation training group than in control group [(0.50+/-0.48) cm vs. (1.20+/-0.74) cm at 1 month after radiotherapy, P<0.05û (0.58+/-0.62) cm vs. (2.42+/-0.84) cm at 1 year after radiotherapy, P<0.01].

CONCLUSIONS

Early rehabilitation training is helpful to decrease the occurrence of trismus in NPC patients after radiotherapy and improve the quality of life of NPC patients.

Single-dose and multi-dose clindamycin therapy fails to demonstrate efficacy in preventing infectious and inflammatory complications in third molar surgery

The goal of this study was to evaluate the efficacy of single- and multi-dose (5-day) clindamycin therapy for the prevention of inflammatory complications in patients undergoing lower third molar surgical extraction with bone removal. Patients who qualified for the prospective, randomized, double-masked, placebo-controlled trial were randomly divided into three groups: (1) single dose of oral clindamycin administered preoperatively (single-dose group); (2) clindamycin administered preoperatively with continued therapy for 5 days (5-day group); and (3) a placebo group. The following parameters were evaluated on the first, second and seventh days postsurgery: trismus, facial swelling, body temperature, lymphadenopathy, alveolar osteitis and subjective pain sensations. There were 86 patients (31 in the single-dose group, 28 in the 5-day group and 27 in the placebo group) enrolled in the study. There were no statistically significant differences in postoperative inflammatory complications in patients during the first and second days postsurgery. A statistically significant variation in body temperature was reported on the seventh day. Analysis of the postoperative analgesic intake did not show statistically significant differences between examined groups. Clindamycin applied in a single preoperative dose of 600 mg with or without subsequent 5-day therapy does not demonstrate efficacy in prophylaxis for postoperative inflammatory complications after third molar surgery.

A mobilization regimen to prevent mandibular hypomobility in irradiated patients: an analysis and comparison of two techniques

Radiotherapy, when used in head and neck cancer treatment, can produce side effects in the patients, such as decreased salivary production, xerostomia, opportunistic infections, radiation caries, dysphagia, local discomfort and the limitation of mouth opening. The aim of this study was to evaluate the amplitude of mouth opening in patients before and immediately after the completion of radiotherapy, comparing the effectiveness of two physiotherapy exercises. The irradiated sites included the masticatory muscles. The results demonstrated that there were no statistically significant differences between the two instituted exercises; however there was a trend towards better clinical results in group 2. The amplitude of mouth opening showed a trend towards reduction, but this was not statistically significant. When the pterygoid and sternocleidomatoid muscles were included in the irriated field, patients were observed to have more morbidity. This indicates the great importance of these muscles in mouth opening. Based on the results obtained within this study, it is not possible to conclude that physiotherapy exercies are efficacious in preventing trismus. Future longitudinal studies are required to verify the onset of trismus in radiotherapy patients.

Prophylaxis versus pre-emptive treatment for infective and inflammatory complications of surgical third molar removal: a randomized, double-blind, placebo-controlled, clinical trial with sustained release amoxicillin/clavulanic acid (1000/62.5 mg)

The most common complications after surgical extraction of the third mandibular molar are trismus, oedema or swelling, local pain, dysphagia and infection. The aim of this comparative, double-blind, randomized clinical trial was to evaluate the efficacy of two sustained release amoxicillin/clavulanate regimens in the reduction of infection after third molar extractive surgery. A total of 225 patients were randomized into three equal groups: placebo, prophylaxis with single pre-surgical dose of two tablets amoxicillin/clavulanate 1000/62.5 mg, and pre-emptive post-surgery therapy with two tablets amoxicillin/clavulanate 1000/62.5 mg BID for 5 days. A higher rate of infection (P=0.006) was found among patients receiving placebo (16%) than those receiving single-dose prophylaxis (5.3%) or 5-day pre-emptive therapy (2.7%). A relationship between both the duration (13.8% for long versus 7.4% for medium versus 1.6% for short) and difficulty (12.7% with ostectomy versus 3.5% without ostectomy; P=0.011) of surgical procedure and incidence of subsequent infection was also observed. Both prophylactic and therapeutic regimens versus placebo achieved greater reduction of pain after surgery on day 3 (P=0.001). Logistic regression analysis revealed a risk of infection of 24%, 9% and 4% for ostectomy with placebo, prophylaxis and pre-emptive treatment, respectively, whereas it was 7%, 2% and 1% if ostectomy was not performed. Pre-emptive therapy with the oral sustained release amoxicillin/clavulanate formulation reduced the rate of subsequent infection in patients undergoing ostectomy. Prophylaxis was beneficial in simpler procedures and may be indicated in cases where ostectomy is not performed.