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Pereira DA, Bonatto MS, Santos SDS, Mendes PGJ, Sales E Pessoa R, de Oliveira GJPL. Comparison of different dual-wavelength photobiomodulation protocols application in third molar extractions. A split-mouth randomized controlled trial. Photodiagnosis Photodyn Ther 2024; 46:104054. [PMID: 38503387 DOI: 10.1016/j.pdpdt.2024.104054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/27/2024] [Accepted: 03/15/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To compare the use of PBMT in the soft tissue and bone healing after third molar extraction using the dual-wavelength laser directly into the post-extraction alveoli (PBMT-I), or PBMT with a red laser directly into the alveoli and with an infrared laser externally on the patient's face (PBMT-IE). METHODS Twenty patients underwent extraction of four third molars were involved in this split-mouth double-blind randomized controlled trial. The Post-extraction alveoli were treated with the following protocols: PBMT-IE: Application of a red laser directly into the alveolus, and infrared laser irradiation transcutaneously and PBMT-I: Application of dual-wavelength laser intraorally. Patients were clinically evaluated 3, 7, 14, 30, and 90 days after the surgical procedure. The analyses in this study were divided into qualitative (centered on the patient's report and on the evaluators' analysis), and quantitative analyses (measurement of the vertical and horizontal dimensions of the face with the objective of measuring post-surgical edema and radiographic analyses for evaluation of the density and structure of the newly formed bone). RESULTS A progressive improvement was observed in all parameters evaluated in this study, however, this improvement was time dependent, with no distinct effect observed between the PBMT treatments applied. CONCLUSION The different dual-wavelength PBMT protocols induced a similar postoperative clinical course in third molar extraction surgeries, with a reduced occurrence of complications and a good healing pattern of hard and soft tissues.
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Affiliation(s)
- Davisson Alves Pereira
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Uberlândia, MG, Brazil
| | - Mariana Silva Bonatto
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Uberlândia, MG, Brazil
| | - Samara de Souza Santos
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Uberlândia, MG, Brazil
| | - Pedro Gomes Junqueira Mendes
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Uberlândia, MG, Brazil.
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Pessano S, Gloeck NR, Tancredi L, Ringsten M, Hohlfeld A, Ebrahim S, Albertella M, Kredo T, Bruschettini M. Ibuprofen for acute postoperative pain in children. Cochrane Database Syst Rev 2024; 1:CD015432. [PMID: 38180091 PMCID: PMC10767793 DOI: 10.1002/14651858.cd015432.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Children often require pain management following surgery to avoid suffering. Effective pain management has consequences for healing time and quality of life. Ibuprofen, a frequently used non-steroidal anti-inflammatory drug (NSAID) administered to children, is used to treat pain and inflammation in the postoperative period. OBJECTIVES 1) To assess the efficacy and safety of ibuprofen (any dose) for acute postoperative pain management in children compared with placebo or other active comparators. 2) To compare ibuprofen administered at different doses, routes (e.g. oral, intravenous, etc.), or strategies (e.g. as needed versus as scheduled). SEARCH METHODS We used standard Cochrane search methods. We searched CENTRAL, MEDLINE, Embase, CINAHL and trials registries in August 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) in children aged 17 years and younger, treated for acute postoperative or postprocedural pain, that compared ibuprofen to placebo or any active comparator. We included RCTs that compared different administration routes, doses of ibuprofen and schedules. DATA COLLECTION AND ANALYSIS We adhered to standard Cochrane methods for data collection and analysis. Our primary outcomes were pain relief reported by the child, pain intensity reported by the child, adverse events, and serious adverse events. We present results using risk ratios (RR) and standardised mean differences (SMD), with the associated confidence intervals (CI). We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included 43 RCTs that enroled 4265 children (3935 children included in this review). We rated the overall risk of bias at the study level as high or unclear for 37 studies that had one or several unclear or high risk of bias judgements across the domains. We judged six studies as having a low risk of bias across all domains. Ibuprofen versus placebo (35 RCTs) No studies reported pain relief reported by the child or a third party, or serious adverse events. Ibuprofen probably reduces child-reported pain intensity less than two hours postintervention compared to placebo (SMD -1.12, 95% CI -1.39 to -0.86; 3 studies, 259 children; moderate-certainty evidence). Ibuprofen may reduce child-reported pain intensity, two hours to less than 24 hours postintervention (SMD -1.01, 95% CI -1.24 to -0.78; 5 studies, 345 children; low-certainty evidence). Ibuprofen may result in little to no difference in adverse events compared to placebo (RR 0.79, 95% CI 0.51 to 1.23; 5 studies, 384 children; low-certainty evidence). Ibuprofen versus paracetamol (21 RCTs) No studies reported pain relief reported by the child or a third party, or serious adverse events. Ibuprofen likely reduces child-reported pain intensity less than two hours postintervention compared to paracetamol (SMD -0.42, 95% CI -0.82 to -0.02; 2 studies, 100 children; moderate-certainty evidence). Ibuprofen may slightly reduce child-reported pain intensity two hours to 24 hours postintervention (SMD -0.21, 95% CI -0.40 to -0.02; 6 studies, 422 children; low-certainty evidence). Ibuprofen may result in little to no difference in adverse events (0 events in each group; 1 study, 44 children; low-certainty evidence). Ibuprofen versus morphine (1 RCT) No studies reported pain relief or pain intensity reported by the child or a third party, or serious adverse events. Ibuprofen likely results in a reduction in adverse events compared to morphine (RR 0.58, 95% CI 0.40 to 0.83; risk difference (RD) -0.25, 95% CI -0.40 to -0.09; number needed to treat for an additional beneficial outcome (NNTB) 4; 1 study, 154 children; moderate-certainty evidence). Ibuprofen versus ketorolac (1 RCT) No studies reported pain relief or pain intensity reported by the child, or serious adverse events. Ibuprofen may result in a reduction in adverse events compared to ketorolac (RR 0.51, 95% CI 0.27 to 0.96; RD -0.29, 95% CI -0.53 to -0.04; NNTB 4; 1 study, 59 children; low-certainty evidence). AUTHORS' CONCLUSIONS Despite identifying 43 RCTs, we remain uncertain about the effect of ibuprofen compared to placebo or active comparators for some critical outcomes and in the comparisons between different doses, schedules and routes for ibuprofen administration. This is largely due to poor reporting on important outcomes such as serious adverse events, and poor study conduct or reporting that reduced our confidence in the results, along with small underpowered studies. Compared to placebo, ibuprofen likely results in pain reduction less than two hours postintervention, however, the efficacy might be lower at two hours to 24 hours. Compared to paracetamol, ibuprofen likely results in pain reduction up to 24 hours postintervention. We could not explore if there was a different effect in different kinds of surgeries or procedures. Ibuprofen likely results in a reduction in adverse events compared to morphine, and in little to no difference in bleeding when compared to paracetamol. We remain mostly uncertain about the safety of ibuprofen compared to other drugs.
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Affiliation(s)
- Sara Pessano
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - Natasha R Gloeck
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Luca Tancredi
- Geriatrie, Hessing Stiftung, Augsburg, Germany
- Medical School, Regiomed, Coburg, Germany
| | - Martin Ringsten
- Cochrane Sweden, Department of Research and Education, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ameer Hohlfeld
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Sumayyah Ebrahim
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Surgery, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | | | - Tamara Kredo
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Clinical Pharmacology, Department of Medicine and Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Matteo Bruschettini
- Cochrane Sweden, Department of Research and Education, Skåne University Hospital, Lund University, Lund, Sweden
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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Mattos-Pereira GH, Esteves-Lima RP, Cota LOM, Alvarenga-Brant R, Costa FO. Preemptive effects of etoricoxib, acetaminophen, nimesulide, and ibuprofen on postoperative pain management after single-implant surgery: A randomized clinical trial. Clin Oral Implants Res 2023; 34:1299-1308. [PMID: 37638406 DOI: 10.1111/clr.14170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 08/03/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND There is insufficient evidence for pain control in preemptive analgesia (PA) after dental implant surgery, signaling the need for further studies. The objective of this study was to evaluate the efficacy of PA in single dental implant surgeries (SDIS), seeking to identify among the etoricoxib (ETOR), ibuprofen (IBU), nimesulide (NIME), and acetaminophen (ACETA)], which one has the higher efficacy effectiveness in relieving postoperative pain and reducing the use of rescue medication compared to placebo. METHODS In this triple-blind, parallel, randomized controlled clinical trial, 135 individuals with a mean age of 57.6 years (±11.7), both genders, were randomly divided into five groups according to the test drug: I-PLACEBO; II-IBU (600 mg); III-NIME (100 mg); IV-ACETA (750 mg); and V-ETOR (90 mg). The occurrence, duration, and intensity of pain were analyzed using the Chi-square, Fisher's exact and ANOVA tests, and the generalized estimating equation models, when appropriate. RESULTS Test drugs provided a reduction in postoperative pain scores and lower use of rescue medication when compared to placebo. The ETOR group presented significantly lower pain scores, when compared to other active treatments. The IBU group showed the highest mean number of rescue medication used. CONCLUSIONS All test drugs provided a beneficial preemptive effect demonstrated by the reduced postoperative pain and reduced use of rescue medication. The ETOR group presented lower pain scores, and the IBU group showed the highest mean number of rescue medication used among the test groups.
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Affiliation(s)
- Gustavo Henrique Mattos-Pereira
- Department of Clinical Dentistry, Pathology and Oral Surgery, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Rafael Paschoal Esteves-Lima
- Department of Clinical Dentistry, Pathology and Oral Surgery, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Luís Otávio Miranda Cota
- Department of Clinical Dentistry, Pathology and Oral Surgery, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Rachel Alvarenga-Brant
- Department of Clinical Dentistry, Pathology and Oral Surgery, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Fernando Oliveira Costa
- Department of Clinical Dentistry, Pathology and Oral Surgery, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Mijailovic I, Janjic B, Milicic B, Todorovic A, Ilic B, Misic T, Markovic N, Markovic A. Comparison of preemptive etoricoxib and dexamethasone in third molar surgery - a randomized controlled clinical trial of patient-reported and clinical outcomes. Clin Oral Investig 2023; 27:5263-5273. [PMID: 37452140 DOI: 10.1007/s00784-023-05146-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES To compare preemptive single-dose etoricoxib and dexamethasone on postoperative patient satisfaction (pPS) and clinical parameters following the impacted mandibular third molar (IMTM) extraction. MATERIALS AND METHODS A parallel-group, triple-blinded, controlled clinical study included a total of 90 patients (n = 30), randomized to receive: etoricoxib 90 mg, dexamethasone 4 mg, or no premedication (control group) 1 h before surgery. Paracetamol 500 mg was prescribed as rescue medication (RM). Check-ups were scheduled at 24 h, 48 h, and day 7 post-surgery. At each time point, pPS was assessed using the 5-point Likert scale. RM parameters, swelling, trismus, and the occurrence of adverse events were also recorded, and patients were instructed to rate the perceived pain on Visual Analogue Scale. RESULTS In all the follow-up periods, data indicated significantly higher pPS scores in the preemptive medication groups when compared to the control group (p < 0.05). Both regimens delayed the first RM intake when compared to controls. In the etoricoxib group, a significantly lower total RM consumption was observed (p < 0.05). Dexamethasone significantly decreased swelling at each check-up and increased mouth opening at day 7 after the surgery (p < 0.05). CONCLUSIONS Preemptive etoricoxib and dexamethasone elevate pPS after IMTM surgery. Etoricoxib improves RM parameters, while dexamethasone ameliorates the patient's postoperative functional ability. CLINICAL RELEVANCE Preemptive etoricoxib and dexamethasone use may decrease patients' discomfort following the impacted mandibular third molar extraction. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05791721. Date of Registration: 28/03/2023 (retrospectively registered).
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Affiliation(s)
- Iva Mijailovic
- Department of Oral Surgery, School of Dental Medicine, University of Belgrade, Dr. Subotica 4, Belgrade, 11000, Serbia.
| | - Bojan Janjic
- Department of Oral Surgery, School of Dental Medicine, University of Belgrade, Dr. Subotica 4, Belgrade, 11000, Serbia
| | - Biljana Milicic
- Department of Medical Statistics and Informatics, School of Dental Medicine, University of Belgrade, Dr. Subotica 8, Belgrade, 11000, Serbia
| | - Ana Todorovic
- Department of Oral Surgery, School of Dental Medicine, University of Belgrade, Dr. Subotica 4, Belgrade, 11000, Serbia
| | - Branislav Ilic
- Department of Oral Surgery, School of Dental Medicine, University of Belgrade, Dr. Subotica 4, Belgrade, 11000, Serbia
| | - Tijana Misic
- Department of Oral Surgery, School of Dental Medicine, University of Belgrade, Dr. Subotica 4, Belgrade, 11000, Serbia
| | - Nikola Markovic
- Department of Oral Surgery, School of Dental Medicine, University of Belgrade, Dr. Subotica 4, Belgrade, 11000, Serbia
| | - Aleksa Markovic
- Department of Oral Surgery, School of Dental Medicine, University of Belgrade, Dr. Subotica 4, Belgrade, 11000, Serbia
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Pergolizzi JV, Breve F, Magnusson P, LeQuang JK, Varassi G. Current and emerging COX inhibitors for treating postoperative pain following oral surgery. Expert Opin Pharmacother 2023; 24:347-358. [PMID: 36562415 DOI: 10.1080/14656566.2022.2161364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The numerous drugs in the NSAID class are often used to treat acute postoperative pain associated with oral surgery such as impacted third-molar extractions. These drugs are effective in this setting and dental pain studies often serve as models for acute pain relief and for registration of analgesics. With numerous cyclooxygenase (COX) inhibitors available as monotherapy, for use in combination with analgesic regimens, and in different doses and formulations, it was our aim to determine if there were clear-cut distinctions among these products and dosing regimens. AREAS COVERED This is a literature review of recent randomized controlled clinical trials evaluating NSAIDs for use in postoperative pain management following oral surgery. Of particular interest were head-to-head studies, which might offer some insight into comparative effectiveness. EXPERT OPINION Postoperative oral surgery pain is largely managed in real-world clinical practice using NSAIDs, either alone or in combination, and there is good evidence supporting their use especially in multimodal therapy. Head-to-head and comparative studies do not show a clear-cut 'optimal NSAID' in this setting, although ibuprofen, ketoprofen, dexketoprofen, and naproxen have gained most acceptance. Combination therapy with other analgesics or adjuvants is largely accepted.
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Affiliation(s)
| | - Franklin Breve
- Department of Pharmacy, Temple University, Philadelphia, PA, USA
| | - Peter Magnusson
- School of Medicine, Orebro University, Örebro, SWE
- Cardiology, Center of Research and Development Region Gävleborg /Uppsala University, Gävle, SWE
- Medicine, Cardiology Research Unit, Karolinska Institutet, SWE, Sweden
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Efficacy of different dexamethasone routes and doses in reducing the postoperative sequelae of impacted mandibular third-molar extraction. J Am Dent Assoc 2022; 153:1154-1170.e60. [DOI: 10.1016/j.adaj.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/22/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022]
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Takadoum S, Douilly G, de Boutray M, Kabani S, Maladière E, Demattei C, Lapeyrie P. Sutureless socket technique after removal of third molars: a multicentric, open, randomized controlled trial. BMC Oral Health 2022; 22:256. [PMID: 35754043 PMCID: PMC9233809 DOI: 10.1186/s12903-022-02287-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 06/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although wisdom-tooth extraction is a routine intervention, the postoperative period remains marked by local inflammation classically manifesting as pain, edema and trismus. Furthermore, there is no consensus on the best operative techniques, particularly for the mucosal closure stage on impacted mandibular wisdom teeth. METHODS This parallel, randomized, non-blinded study compared pain following removal of impacted third molars, with and without sutures. Patients were electronically allocated 1:1 to extraction with versus without sutures. Patients ≥ 14 years' old scheduled for extraction of four impacted wisdom teeth under general anesthesia at three French hospitals were eligible for inclusion. Exclusion criteria included taking antiplatelet agents or anticoagulants, coagulation disorders or immunosuppression, and planned orofacial surgical procedures or emergency pain/infection. The primary objective was pain evaluated by Visual Analogue Scale on Day 3. Secondary outcomes were edema, trismus, healing, complications, painkiller consumption and quality of life on Day 3 and 31. RESULTS Between June 2016 and November 2018, 100 patients were randomized. Finally, 44 patients in the Suture group and 50 patients in the Without Suture group were analyzed. Mean age was 16.5 years and 66.6% of patients were female. After adjustment on center, age and smoking, no statistical difference was seen between groups for pain on Day 3 (p = 0.904). No differences were seen for swelling, trismus, consumption of painkillers, healing, complications or quality of life. Smokers had a 3.65 times higher complications rate (p = 0.0244). CONCLUSIONS Sutureless removal of third molars is thus a reliable technique without negative consequence on outcomes, and allows shorter operating time. Smoking is a risk factor for postoperative complications. Trial registration www. CLINICALTRIALS gov (NCT02583997), registered 22/10/2015.
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Affiliation(s)
- Sarah Takadoum
- Service de Chirurgie Orale, Department of Oral Surgery, CHU Nîmes, CHRU de Nîmes - Hôpital Universitaire Carémeau, University of Montpellier, Place du Professeur Debré, 30029, Nîmes Cedex 9, France.
| | - Grégory Douilly
- Pôle de Chirurgie Orale, 320 rue René Cassin, 84000, Avignon, France
| | - Marie de Boutray
- Department of Maxillofacial Surgery, Montpellier Regional University Hospital - Gui de Chauliac Hospital, Montpellier, France
| | - Sarah Kabani
- Department of Biostatistics, Clinical Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, University of Montpellier, Nîmes, France
| | - Eric Maladière
- Department of Maxillofacial Surgery, Perpignan Hospital Perpignan, Perpignan, France
| | - Christophe Demattei
- Department of Biostatistics, Clinical Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, University of Montpellier, Nîmes, France
| | - Philippe Lapeyrie
- Service de Chirurgie Orale, Department of Oral Surgery, CHU Nîmes, CHRU de Nîmes - Hôpital Universitaire Carémeau, University of Montpellier, Place du Professeur Debré, 30029, Nîmes Cedex 9, France
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