Complementary and alternative therapies for managing postoperative pain after lower third molar surgery: a systematic review and network meta-analysis.

OBJECTIVE: The objective of this study was to evaluate the impact of complementary and alternative treatments on postoperative pain following lower third molar surgeries. METHODS: A comprehensive search of Electronic databases (Embase, MEDLINE via PubMed, and Cochrane Library) and grey literature was conducted up until May 2022. Randomized clinical trials investigating the effect of acupuncture, ozone therapy, laser (LLLT), drainage tube, kinesio-taping, ice therapy, and compressions on pain after LTM surgeries were included. The estimated mean differences (MD) for alternative therapies were pooled using the frequentist approach to random-model network meta-analysis NMA. RESULTS: Eighty-two papers were included in the qualitative analysis; 33 of them were included in the quantitative analyzes. NMA revealed that drainage tube and kinesio-taping were superior in controlling pain 24-hours postoperatively than no-treatment. At 48-hours follow-up, kinesio-taping and LLLT more effective than placebo and drainage tube; and kinesio-taping and LLLT were superior to no treatment. At 72 h postoperatively, ozone therapy was superior to placebo; and drainage tube, kinesio-taping, and LLLT were better than no treatment. At 7-days follow-up, ozone and LLLT were superior to placebo; and LLLT and kinesio-taping were superior to no treatment. The SUCRA-ranking placed drainage tube as top-ranking intervention at 48-hours (98.2%) and 72-hours (96%) follow-ups, and ozone (83.5%) at 7-days follow-up. CONCLUSION: The study findings suggest that these alternative and complementary therapies may be useful in reducing postoperative pain after LTM surgeries, and may offer advantages when combined to traditional pain management methods. CLINICAL RELEVANCE: Non-pharmacological therapies are gaining popularity among healthcare professionals and patients. This study found that some of these therapies, specifically kinesio-taping and drainage tube were effective in controlling postoperative pain after third molar surgeries. These findings have important implications for clinical practice, as they highlight the potential benefits of incorporating these therapies into postoperative pain management plans.

Comparative Effectiveness of the Homeopathic Preparation Traumeel S in Third Molar Extraction Surgery: A Preliminary Triple-Blind Clinical Trial.

BACKGROUND AND AIM: This preliminary study aimed to evaluate whether a homeopathic preparation (Traumeel S) might be a good option to control post-operative outcomes (pain, edema and trismus) associated with surgical removal of mandibular third molar teeth. The null hypothesis was that Traumeel S is not different from dexamethasone (gold standard) in controlling these post-operative inflammatory complications. METHODS: A randomized, "split-mouth", triple-blind clinical trial was conducted. Seventeen healthy patients with a mean age of 20.94 ( ± 5.83) years had their lower asymptomatic bilateral third molars removed. Patients were randomized to receive Traumeel S or dexamethasone pre-operatively by injection into the masseter muscle; each patient acted as his/her own control. At 24, 48, 72 hours and 7 days after the surgery, the pain was evaluated according to a visual analog scale, edema through linear measurements of the face, and trismus through the maximum buccal opening. Wilcoxon statistics or paired t-test were used, and a significance level of 95% was adopted. RESULTS: For pain, the results for Traumeel S were not different (p > 0.05) from those of dexamethasone after 24 hours, 72 hours, and 7 days. For edema, the results for Traumeel S were not different (p > 0.05) from those of dexamethasone at all post-operative evaluations. For mouth opening, the results for Traumeel S were not different (p > 0.05) from those of dexamethasone at 72 hours and 7 days after third molar extraction. CONCLUSION: With the exception of some early post-operative findings, the null hypothesis is not rejected. Traumeel S might be a good alternative approach to dexamethasone for controlling pain, edema and trismus after third molar removal.

Influence of ozonized water on pain, oedema, and trismus during impacted third molar surgery: a randomized, triple blind clinical trial.

BACKGROUND: This study aimed to evaluate the efficacy of ozonized water on pain, oedema and trismus after impacted third molar mandibular surgeries when compared to double distilled water. A randomized triple blind trial was conducted. METHODS: Patients with third molars class II-B of Pell-Gregory were included, and surgical extraction was performed. Irrigation was done with ozonized (group 1) or double distilled water (group 2). The type of irrigation and the side to be operated were randomized. Neither the patients nor the operator or evaluator were aware of the irrigation solution. Pain, oedema and trismus were evaluated at baseline, 24-h, 48-h, 72-h and 7-days after treatment. The data were evaluated by Friedman, Wilcoxon, Mann-Whitney tests, and size effect. RESULTS: It was included 8 men and 12 women, with a mean age of 20.9y.o. The initial pain mean was 7.94 (±12.81) (group 1) and 5.50 (±9.12) (group 2) (p > 0,05). There was a statistically significant reduction of pain, oedema and trismus in intragroup analysis (p < 0.05). There was no statistically significant difference (p > 0.05) when comparing the oedema and trismus between groups. The size effect ranged from small (0.23) to large (1.29). CONCLUSIONS: It was concluded that ozonized water was compatible as irrigation method, not inferior to double distilled water, and had satisfactory effects on management of pain, oedema and trismus after surgical removal of the third molar. TRIAL REGISTRATION: This clinical trial was registered in ClinicalTrials.gov NCT03501225 on April 18, 2018.

Systematic review of biological therapy to accelerate orthodontic tooth movement in animals: Translational approach.

OBJECTIVES: To systematically review and evaluate what is known regarding contemporary biological therapy capable of accelerating orthodontic tooth movement (OTM) in animal model. MATERIALS AND METHODS: MedLine, Scopus, Web of Science and OpenGrey were searched without restrictions until June 2019. Following study retrieval and selection, relevant data was extracted using a standardized table. Risk of bias (RoB) assessment was performed using the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) tool. RESULTS: Fifty-one animal studies were included. Two biological therapies were identified as capable of accelerating the OTM: chemical methods (49 studies) and gene therapy (2 studies). The main substances that increased the OTM rate were cytokines (13 studies), followed by growth factors (6 studies) and hormones (5 studies). Most studies were assessed to be at unclear or high RoB. The application protocols, measurement and reporting of outcomes varied widely and methodologies were not adequately reported. CONCLUSIONS: Although biological therapies to accelerate OTM have been widely tested and effective in preclinical studies, the validity of the evidence is flawed to support translational of these results. There is a need for well-designed experimental studies to translate these methods for clinical field.

Is bromelain effective in controlling the inflammatory parameters of pain, edema, and trismus after lower third molar surgery? A systematic review and meta-analysis.

The aim of this systematic review was to evaluate the clinical evidences of the bromelain in minimizing inflammatory parameters such as pain, edema, and trismus after lower third molar surgeries. An electronic search was conducted in six databases through November 2017. The eligibility criteria included randomized and non-randomized clinical trials and/or comparative studies that used bromelain after lower third molar surgeries. The search strategy resulted in 117 articles. Following the selection process, seven studies were included in the systematic review and four in the meta-analysis. In terms of the risk of bias analysis, all the evaluated studies were classified as low or unclear risk of bias in the following criteria: selection bias, detection bias, and reporting bias. The final quantitative analysis of the variables showed that the use of bromelain resulted in greater reduction of pain levels (mean difference [MD]: -0.38; 95% confidence interval [CI; -0.66 to -0.09]), edema (MD: -0.34; 95% CI [ -0.68 to -0.01]), and trismus (MD: -2.01; 95% CI [ -3.99 to -0.02]) among the analyzed groups. The results suggest that the bromelain appears to be effective in the control of pain, edema, and trismus after lower third molar surgeries; however, further high-quality studies are needed to confirm this finding.

Effectiveness of orofacial myofunctional therapy in orthodontic patients: a systematic review.

OBJECTIVE: The aim of the present systematic review was to determine the existence of scientific evidence demonstrating the effectiveness of orofacial myofunctional therapy (OMT) as an adjuvant to orthodontic treatment in individuals with orofacial disorders. A further aim was to assess the methodological quality of the studies included in the review. METHODS: An electronic search was performed in eight databases (Medline, BBO, LILACS, Web of Science, EMBASE, BIREME, Cochrane Library and SciELO) for papers published between January 1965 and March 2011, with no language restrictions. Selection of articles and data extraction were performed by two independent researchers. The quality of the selected articles was also assessed. RESULTS: Search strategy resulted in the retrieval of 355 publications, of which only 4 fulfilled the eligibility criteria and qualified for final analysis. All papers selected had a high risk of bias. CONCLUSIONS: The findings of the present systematic review demonstrate the scarcity of consistent studies and scientific evidence supporting the use of OMT in combination with orthodontic treatment to achieve better results in the correction of dentofacial disorders in individuals with orofacial abnormalities.

Effectiveness of orofacial myofunctional therapy in orthodontic patients: A systematic review

OBJECTIVE: The aim of the present systematic review was to determine the existence of scientific evidence demonstrating the effectiveness of orofacial myofunctional therapy (OMT) as an adjuvant to orthodontic treatment in individuals with orofacial disorders. A further aim was to assess the methodological quality of the studies included in the review. METHODS: An electronic search was performed in eight databases (Medline, BBO, LILACS, Web of Science, EMBASE, BIREME, Cochrane Library and SciELO) for papers published between January 1965 and March 2011, with no language restrictions. Selection of articles and data extraction were performed by two independent researchers. The quality of the selected articles was also assessed. RESULTS: Search strategy resulted in the retrieval of 355 publications, only four of which fulfilled the eligibility criteria and qualified for final analysis. All papers selected had a high risk of bias. CONCLUSIONS: The findings of the present systematic review demonstrate the scarcity of consistent studies and scientific evidence supporting the use of OMT in combination with orthodontic treatment to achieve better results in the correction of dentofacial disorders in individuals with orofacial abnormalities. .

OBJETIVO: o objetivo dessa revisão sistemática foi verificar se existem evidências científicas que comprovam a efetividade da TMO como agente coadjuvante do tratamento ortodôntico de indivíduos com distúrbios orofaciais. Além disso, avaliar a qualidade metodológica dos estudos incluídos nessa revisão. MÉTODOS: uma busca eletrônica foi realizada em 8 bases de dados (MEDLINE, BBO, LILACS, Web of Science, EMBASE, BIREME, Cochrane Library e Scielo), sem restrição de idioma. A busca foi realizada com artigos publicados no período compreendido entre janeiro de 1965 a março de 2011. A seleção dos artigos e extração dos dados foi realizada por dois revisores independentes. Avaliação da qualidade dos artigos também foi realizada. RESULTADOS: a estratégia de busca resultou em 355 publicações. Após seleção baseada nos critérios de elegibilidade, quatro artigos foram qualificados para análise final. A todos os artigos incluídos nessa revisão foram atribuídos um alto risco de viés. CONCLUSÇÕES: os resultados do presente estudo demonstram a escassez de estudos consistentes e de evidências científicas que indicam a utilização da TMO em associação ao tratamento ortodôntico com a finalidade de promover melhores resultados na correção de desordens dentofaciais em indivíduos com distúrbios orofaciais. .