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

Abstract

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.

Assessment of Low-Level Laser Therapy Effects After Extraction of Impacted Lower Third Molar Surgery

“…They reported that extraoral laser therapy has better effects on improving pain intensity and trsimus after impacted third molar surgery. 19 Modulation of inflammatory process and relieve of acute pain in the short period by LLLT is well-demonstrated. LLLT energy absorption by tissues and interaction of its photons with cellular structures cause partial production of LLLT biological effects.…”

Is Adjuvant Laser Therapy Effective for Preventing Pain, Swelling, and Trismus After Surgical Removal of Impacted Mandibular Third Molars? A Systematic Review and Meta-Analysis

“…Several cointerventions were identified in the included studies. In 8 trials patients received analgesics postoperatively, [34][35][36]39,47,48,51,52 in 6 trials patients received postoperative antibiotics, [34][35][36]39,47,48 and in 1 trial patients received preoperative corticosteroids. 35 However, these cointerventions were administered to all patients in the study, and thus the differences between the intervention and control groups can be attributed to the effects of the LLEI.…”

“…However, it was noted that 2 trials by 1 author reported the same data for the control group, so after contacting this author to clarify this aspect, it was learned that the data came from only 1 trial that had been reported in 2 different articles. 34,36 Therefore, 10 trials were included in this systematic review. The trial publication dates ranged from 1990 46,47 through 2011.…”

“…[29][30][31][32] Therefore, some investigators have stated that LLEI decreases pain and swelling after surgery, and that it would contribute to a faster recovery of the patients. 33 The effect of LLEI on the most common complications after IMTM removal also has been studied, [33][34][35][36][37][38][39][40] and the results have been variable. The lack of agreement among surgeons about the postoperative indications to minimize pain, swelling, and trismus after IMTM surgical removal is evident in the literature and in clinical practice, which results in different perioperative actions that range from premedication to different surgical techniques.…”

Comments on “Comparison of the influence of ozone and laser therapies on pain, swelling, and trismus following impacted third-molar surgery”

“…Within excellent study design, the handpiece in the placebo group has to be inserted intraorally or extraorally as in the laser group, but the laser is not activated, so that the participants are blinded as to which treatment they received [4,5]. However, Kazancioglu [1] simply used no treatment in the control group, which obviously undermined the reliability of pain assessment and increased detection bias as the participants are easily aware of which intervention they received.…”