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.

Erich arch bars vs intermaxillary fixation screws for mandibular fracture reduction during ORIF: a randomized clinical trial.

OBJECTIVE: This randomized clinical trial aimed to compare the efficacy of Erich arch bars (EAB) and intermaxillary fixation (IMF) screws in reducing mandibular fractures during open reduction and internal fixation (ORIF). METHODS: A total of 28 patients with mandibular fractures were randomly allocated to either the EAB group or the IMF screws group. The study evaluated various parameters including occlusal stability, complications, duration of application, oral hygiene status, quality of life, and patient characteristics. RESULTS: The study found no significant differences in occlusal stability between the EAB and IMF screw groups. However, the application and removal times were longer for EAB compared to IMF screws. The EAB group showed a higher presence of biofilm on teeth, indicating poorer oral hygiene status compared to the IMF screws group. In terms of quality of life, patients in the EAB group reported worse results in the "handicap" domain at the 15th postoperative day. No significant differences were observed in other quality-of-life parameters. Patient characteristics were well distributed between the two groups, enhancing the reliability of the results. CONCLUSION: Both EAB and IMF screws demonstrated comparable occlusal stability for minimally displaced mandibular fractures. However, IMF screws offered advantages such as shorter application and removal times, better oral hygiene maintenance, and potentially improved quality of life in the "handicap" domain. Further studies with larger sample sizes are necessary to validate these findings and explore the stability of IMF methods in cases requiring postoperative malocclusion correction or prolonged IMF.

Oral and maxillofacial trauma in women assaulted by men: Systematic review and meta-analysis.

BACKGROUND: Violence against women represents an urgent public health problem and has been an increasingly important topic in society's discussions and concerns. Although studies report a high prevalence of injuries to the face and head of women victims of intentional violence, this physical damage has never been investigated by grouped studies. Thus, the objective of this systematic review was to research the characteristics and the overall prevalence of oral-maxillofacial trauma in women victims of physical violence caused by men. METHODS: Searches were carried out on Medline (via PubMed) and Lilacs (via Virtual Health Library) and on gray literature until June 16, 2020 (updated on February 12, 2021) without restriction on the year of publication or language. RESULTS: A total of 27 studies involving 9,318 women victims of aggression by men and 3,738 oral-maxillofacial traumas were included. The prevalence of oral-maxillofacial trauma among all injuries in women was 51% (95% CI 28% - 74%). There was no significant difference in the chance of occurrence between soft tissue injuries (bruises, lacerations, abrasions, edema, erythema, and epistaxis) and hard tissue injuries (OR: 1.44, 95% CI: 0.43 - 4.80). The relationship between the victims and the aggressors was mainly that of intimate partners and relatives. CONCLUSIONS: These results highlight the need for political and ethical reflection to prevent oral-maxillofacial trauma and ensure women's health and human rights.

Does watching an informative video reduce the anxiety in patients undergoing third molar surgery: a systematic review of randomized controlled trials.

PURPOSE: Dental anxiety (DA) is characterized by the expression of tension, stress, apprehension, irritation, anger, and frustration experienced by patients during dental appointment. The objective of this study was to systematically review the literature to assess the effectiveness of the use of informative videos in reducing DA in patients undergoing 3 M surgeries. METHODS: Searches were carried out on MEDLINE (via PubMed), the Cochrane Central Registry of Controlled Trials (CENTRAL), the Virtual Health Library (VHL), and the Web of Science. Articles published until November 20, 2021, were included. There were no restrictions on the data or language of publication. RESULTS: A total of 9 randomized clinical trials were included in this review, and five studies were included in the meta-analysis, comprising 529 patients. There was no significant difference in DA between the groups in the baseline when it was evaluated by any of the tools, indicating sample balancing at the beginning of the study. After intervention (video vs. verbal and/or written orientation) in the preoperative period, DA was assessed again; however, there was no difference in DA between the groups when assessed by the MDAS or STAI-S tools. After 3 M removals, the DA was still not significantly different between the groups when measured by the different considered tools. CONCLUSION: Informative videos addressing 3 M removal surgeries used in the preoperative period did not show an influence on the reduction of pre- and postoperative DA when compared to the verbal and/or written informative presentation.

Impact of the presence of partially erupted third molars on the local radiographic bone condition.

The decision on retaining or prophylactically removing asymptomatic lower third molars is still discussed in the literature. This study aimed to verify the association between asymptomatic lower third molars and local bone conditions through periapical radiographs. Based on sample size calculations, 288 radiographs were required. Dependent variables were alveolar bone crest status and radiolucency between the distal aspect of the third molar crown and the ascending mandibular ramus. Independent variables were sex, age, Pell and Gregory and Winter's classification, angulation and distance between second and third molars, third molar side. Advanced ages (OR 1.15; CI 1.08-1.24; p < 0.001) and greater third molar angulations (OR 1.03; CI 1.01-1.04; p < 0.001) significantly increased the chance of radiographic alterations in the bone crest between second and third molars. Radiolucency distal to third molars was solely impacted by patient's age (OR 1.05; CI 1.01-1.11; p = 0.036). Older patients and lower third molars with greater angulations about adjacent second molar should be evaluated for third molar removal because of the increased chance of alveolar bone crest alterations. Older patients should also be monitored for wider radiolucent pericoronal spaces distal to lower third molars and its consequences.

Does kinesio taping reduce pain, swelling, and trismus after mandibular third molar surgery? A systematic review and meta-analysis.

The aim of this study is to provide an evidence-based conclusion regarding the effectiveness of kinesio taping (KT) in reducing postsurgical discomforts after mandibular third molar surgery and critically appraise the available literature. Eligible clinical trials evaluating patients older than 18 years who were treated with any type of KT compared to no taping in which pain, swelling, or trismus scores were reported were included. An electronic literature search was carried out in the following databases to identify relevant papers up to May 30, 2021: Medline, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2.0). The effect sizes were calculated using mean difference (MD) and standardized mean difference (SMD). The heterogeneity analysis was conducted using (I2) statistic at alpha = 0.10 (PROSPERO; CRD42021252670). Nine randomized clinical trials with 444 participants were included in the qualitative analysis and eight in the quantitative analysis. The results of the meta-analysis revealed a statistically significant reduction in pain and swelling scores before the 7th postoperative day. On the 7th postoperative day, no significant difference was observed between KT and control groups in terms of pain and swelling. Additionally, KT led to an increase in patients' maximum mouth opening of more than 3 mm in postoperative intervals. KT is effective in reducing postoperative pain within the first 48 h after surgery and improving mouth opening during all postoperative intervals with moderate to high certainty of evidence.

Postoperative oral drug regimen to control the inflammatory complications in mandibular third molar surgery: protocol for a systematic review and network meta-analysis.

OBJECTIVE: This network meta-analysis aims to rank the best postoperative drug regimen to control inflammatory complications related to mandibular third molar surgery. INTRODUCTION: Many studies of oral drugs have been proposed to control postoperative inflammatory complications after third molar surgeries with inconclusive results. A systematic review with network meta-analysis in this field may clarify the best therapeutic protocol for practice in dentistry. INCLUSION CRITERIA: This review will consider randomized clinical trials that included healthy adult patients or those who had treated and controlled systemic diseases; asymptomatic patients who were free of acute infection or inflammation at the surgical site immediately before third molar surgery; and patients submitted to surgical removal of one lower third molar at a time in which they have received oral anti-inflammatory and/or analgesics in the postoperative moment. The outcomes are pain, edema, trismus, and adverse effects. METHODS: Sources of published studies, unpublished studies, and gray literature will be searched without time or language restrictions. Titles and abstracts of all search results will be screened by two independent reviewers. The full text of potentially relevant studies will be assessed. Methodological quality of the included studies will be performed using the JBI checklist for experimental studies. Data related to specific details about the population, study methods, interventions, and outcomes will be extracted from the included studies. The findings will be presented in a narrative form and polled in network meta-analysis, when possible. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020196692.

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.

The Effectiveness of the Cold Therapy (cryotherapy) in the Management of Inflammatory Parameters after Removal of Mandibular Third Molars: A Meta-Analysis.

Introduction Cold therapy (cryotherapy) is a common procedure recommended by dental surgeons after surgical removal of third molars, which is an invasive intervention that often deals with an expressive inflammatory response. Objective To investigate whether cryotherapy interferes with clinical outcomes such as pain, edema, and trismus in the postoperative period of mandibular third molar surgeries. Data Synthesis An electronic search was conducted in the OVID, PubMed, VHL, Science Direct, Cochrane Library, and Web of Science databases, through March 2018. The eligibility criteria included clinical trials that evaluated the effect of cryotherapy in at least one of the following variables: pain, swelling, and trismus. Two independent reviewers assessed the studies. The methodological quality of each article was analyzed. The search strategy resulted in 1,088 articles. Following the selection process, 11 studies were included in the systematic review and 4 of them in the meta-analysis. High risk of bias was found in most of the studies according to the Cochrane Handbook assessment. Patients receiving cryotherapy had less edema than patients in the control group at second day follow-up (mean difference [MD]: -0.94; 95%CI [-1.49; -0.39]). There were no statistically significant results when comparing trismus between experimental and control group (MD: 0.43; 95%CI [-0.34;1.20]). There were insufficient available data to support influences in postoperative pain. Conclusions Cryotherapy applied on the first day after mandibular third molar removal can manage edema in the patients. Well-designed randomized clinical trials to test the efficacy of cryotherapy after surgical removal of third molars are needed to justify its indication.

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.

The effectiveness of the cold therapy (cryotherapy) in the management of inflammatory parameters after removal of mandibular third molars: a meta-analysis

Introduction: Cold therapy (cryotherapy) is a common procedure recommended by dental surgeons after surgical removal of thirdmolars, which is an invasive intervention that often deals with an expressive inflammatory response. Objective: To investigate whether cryotherapy interferes with clinical outcomes such as pain, edema, and trismus in the postoperative period of mandibular third molar surgeries. Data Synthesis: An electronic search was conducted in the OVID, PubMed, VHL, Science Direct, Cochrane Library, and Web of Science databases, through March 2018. The eligibility criteria included clinical trials that evaluated the effect of cryotherapy in at least one of the following variables: pain, swelling, and trismus. Two independent reviewers assessed the studies. The methodological quality of each article was analyzed. The search strategy resulted in 1,088 articles. Following the selection process, 11 studies were included in the systematic review and 4 of them in the meta-analysis. High risk of bias was found in most of the studies according to the Cochrane Handbook assessment. Patients receiving cryotherapy had less edema than patients in the control group at second day follow-up (mean difference [MD]: -0.94; 95%CI [-1.49; -0.39]). There were no statistically significant results when comparing trismus between experimental and control group (MD: 0.43; 95%CI [-0.34;1.20]). There were insufficient available data to support influences in postoperative pain. Conclusions: Cryotherapy applied on thefirstday aftermandibular third molar removal can manage edema in the patients.Well-designed randomized clinical trials to test the efficacy of cryotherapy after surgical removal of third molars are needed to justify its indication (AU)

Comparison of Bite Force with Locking Plates versus Non-Locking Plates in the Treatment of Mandibular Fractures: A Meta-Analysis

Abstract Introduction Mandibular fractures represent a high percentage of all facial fractures, and the bite force is a fundamental parameter to measure the actual mandibular function and, subsequently, the masticatory efficiency and quality of life. Objectives The purpose of the present systematic review was to verify if there is any difference in the bite forces of patients with mandibular fractures fixed by locking or non-locking plates, testing the null hypothesis of no difference in this parameter. Data Synthesis A systematic review of the literature was conducted using four databases (PubMed, Virtual Health Library,Web of Science and Science Direct) without restrictions as to publication date or language. We found 3,039 abstracts, and selected 4 articles for this review. Conclusion The overall results show better performance in bite force for the locking plates when compared with the non-locking plates in the incisor region (mean deviation [MD]: 1.18; 95% confidence interval [95%CI]: 0.13-2.23), right molar region (MD: 4.71; 95%CI: 0.63-8.79) and left molar region (MD: 10.34; 95%CI: 4.55-16.13). Although the results of this study indicated a better bite force result with the locking plates, there is still no sufficient evidence to support this information safely.

Comparison of Bite Force with Locking Plates versus Non-Locking Plates in the Treatment of Mandibular Fractures: A Meta-Analysis.

Introduction Mandibular fractures represent a high percentage of all facial fractures, and the bite force is a fundamental parameter to measure the actual mandibular function and, subsequently, the masticatory efficiency and quality of life. Objectives The purpose of the present systematic review was to verify if there is any difference in the bite forces of patients with mandibular fractures fixed by locking or non-locking plates, testing the null hypothesis of no difference in this parameter. Data Synthesis A systematic review of the literature was conducted using four databases (PubMed, Virtual Health Library, Web of Science and Science Direct) without restrictions as to publication date or language. We found 3,039 abstracts, and selected 4 articles for this review. Conclusion The overall results show better performance in bite force for the locking plates when compared with the non-locking plates in the incisor region (mean deviation [MD]: 1.18; 95% confidence interval [95%CI]: 0.13-2.23), right molar region (MD: 4.71; 95%CI: 0.63-8.79) and left molar region (MD: 10.34; 95%CI: 4.55-16.13). Although the results of this study indicated a better bite force result with the locking plates, there is still no sufficient evidence to support this information safely.

Local Flap Technique After Removing Premaxilla for Closure of Oronasal Fistula.

This letter aimed to describe a surgical technique for oronasal fistula closure that promotes efficient healing and minimizes recurrence. The oronasal fistula was repaired by buccal flap. The technique proved to be simple and efficient.