Photobiomodulation Therapy Improves Postoperative Pain and Edema in Third Molar Surgeries: A Randomized, Comparative, Double-Blind, and Prospective Clinical Trial.

PURPOSE: Laser light has biological effects that can modulate inflammatory processes. Thus, this study aimed to evaluate the effects of photobiomodulation (PBM) therapy on pain, edema, and trismus after the extraction of retained third molars. METHODS: A split-mouth, double-blind, randomized clinical trial (RCT) was conducted in 13 patients with similar bilateral third molars who received intraoral application PBM therapy at 4 points with a diode laser at 810 nm wavelength, 6 J (100 mW, 60 seconds/point) on 1 side (the PBM side); and laser irradiation simulation on the other side (SHAM side). The pain was assessed through visual analog scale (VAS) at 0, 12, 24, 48, and 72 hours, number of analgesic-relief (NAR), and mean time of first analgesic use; edema, through VAS, and linear facial measurements at 0, 24, 48, and 72 hours; and trismus, through the mouth opening measurements at 0, 24, 48, and 72 hours. The repeated-measures analysis was applied to assess the effect of the treatment, followed by Tukey's post hoc test for multiple comparisons (P < .05). RESULTS: Thirteen patients (61.77% male and 38.63% female) with age of 24.16 ± 2.06 participated in this research. VAS showed that PBM controlled pain better (7.56 ± 6.25) than SHAM (32.25 ± 22.78) at 24 hours (P < .001) and 48 hours (19.47 ± 9.27 and 39.87 ± 4.21, respectively) (P = .011). VAS also showed that PBM controlled edema better (19.7 ± 13.27) than SHAM (32.38 ± 15.28) at 24 hours (P = .037) and 48 hours (19.47 ± 13.11 and 39.87 ± 22.77, respectively) (P = .002). CONCLUSION: The PBM therapy in this study resulted in pain and edema reduction after third molar surgery and may be considered as adjuvant therapy after the surgical procedure.

Effect of Oral Administration of Bromelain on Postoperative Discomfort After Third Molar Surgery.

INTRODUCTION: The purpose of this prospective randomized controlled clinical trial was to evaluate the effect of oral administration of bromelain on discomfort after mandibular third molar surgery. MATERIALS AND METHODS: Eighty-four consecutive patients requiring surgical removal of a single mandibular impacted third molar under local anesthesia were randomly assigned to receiving no drug (control group, Group A), postoperative 40 mg bromelain every 6 hours for 6 days (Group B), preoperative 4 mg dexamethasone sodium phosphate as a submucosal injection (Group C), and preoperative 4 mg dexamethasone sodium phosphate as a submucosal injection plus postoperative 40 mg bromelain every 6 hours for 6 days (Group D). Standardized surgical and analgesic protocols were adopted. Maximum interincisal distance and facial contours were measured at baseline and on postoperative days 2 and 7. Pain was measured objectively by counting the number of analgesic tablets required. Patient perception of the severity of symptoms was assessed with a follow-up questionnaire (PoSSe scale). RESULTS: On postoperative day 2, there was a statistically significant reduction in facial edema in both Groups C and D compared with the control group, but no statistically significant differences were observed between Group B and the control group. At evaluation on postoperative day 7, Group D showed a statistically significant reduction in postoperative swelling compared with the control group. The combined use of bromelain and dexamethasone (Group D) induced a statistically significant reduction in the total number of analgesic tablets taken after surgery compared with the control group. The treatment groups had a limited, nonsignificant effect on trismus when compared with the control group. CONCLUSIONS: Bromelain used singly showed moderate anti-inflammatory efficacy, reducing postoperative swelling, albeit not to any significant extent compared with no drug administration. The combined use of bromelain and dexamethasone sodium phosphate yielded the best results in terms of control of postoperative discomfort.

Radiographic evaluation of regenerated bone following poly(lactic-co-glycolic) acid/hydroxyapatite and deproteinized bovine bone graft in sinus lifting.

Although numerous biomaterials are used for maxillary sinus-lift surgery, the ideal material for such procedures has not yet been identified. Both heterologous and alloplastic bone substitutes have a solely osteoconductive effect and lack the osteoinductive properties of the bone morphogenetic proteins typical of autologous bone. Our group assessed a new alloplastic graft material, poly(lactic-co-glycolic) acid/hydroxyapatite (PLGA/HA), implanted in a human model of maxillary sinus-lift surgery. For this prospective, random, double-blind trial, we used deproteinized bovine bone (DBB) as the comparison material. Radiographic bone vertical height and density were assessed at approximately 28 weeks after grafting using cone-beam computed tomography. The vertical dimension of the regenerated bone was equivalent between the 2 groups. The density of the bone regenerated using PLGA/HA was significantly lower than that obtained with DBB. Despite clinical assessments demonstrating that PLGA/HA has sufficient characteristics for use in sinus-lift surgery, DBB provided greater bone density and an equivalent vertical dimension of grafted bone. Further studies are needed to supplement the radiologic findings with histologic and micromorphometric examinations.

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

PURPOSE: The purpose of this study was to evaluate the effect of submucosal administration of dexamethasone sodium phosphate on discomfort after mandibular third molar surgery. PATIENTS AND METHODS: Sixty-one consecutive patients requiring surgical removal of a single mandibular impacted third molar under local anesthesia were randomly placed into 3 groups. After the onset of local anesthesia, the experimental groups received dexamethasone at 2 different doses (4 or 8 mg) as submucosal injection, and the control group received no drug. Standardized surgical and analgesic protocols were followed. Maximum interincisal distance and facial contours were measured at baseline and at postsurgery days 2 and 7. Pain was objectively measured by counting the number of analgesic tablets required. The patients' perception of the severity of symptoms was assessed with a follow-up questionnaire (PoSSe scale). RESULTS: On the second postoperative day, facial edema showed a statistically significant reduction in both dexamethasone 4-mg and dexamethasone 8-mg groups compared with the control group, but no statistically significant differences were observed between the 2 dosage regimens of dexamethasone. By contrast, there was no statistically significant difference between all groups when postoperative swelling was evaluated at day 7 (P > .50). The treatment group had a limited and nonsignificant effect on pain and trismus when compared with the control group at the 2 times of evaluation. CONCLUSIONS: Parenteral use of dexamethasone 4 mg, given as an intraoral injection at the time of surgery, is effective in the prevention of postoperative edema. Increasing the dose to 8 mg provides no further benefit.

Maxillary and mandibular bone reconstruction with hip grafts and implants using Frialit-2 implants.

Many types of osseointegrated implants that are very reliable and supported by scientific medium- and long-term studies are presently available. Often, unfavorable anatomic situations require bone augmentation procedures either prior to or at the same time as implant placement. Some of these procedures present limits. Using versatile implant systems is desirable in cases such as advanced osseointe-. gration, intraoral bone grafts or guided bone regeneration techniques, or major surgical reconstruction with bone grafts from the hip. The aim of this study was to evaluate the efficacy of the Frialit-2 implant in 29 clinical cases of maxillary and mandibular reconstruction using different bone augmentation techniques, and to consider its success ratio through a 1- to 5-year follow-up.