Low-level Laser Therapy on Postoperative Pain after Mandibular Third Molar Surgery

May Ayad Hamid, May Ayad Hamid

Abstract

Introduction: The analgesic effect of low-level laser therapy (LLLT) after mandibular third molar (MTM) extraction is controversial. The aim is to evaluate the effect of intraoral LLLT on postoperative pain after MTMs extraction.

Methods: Thirty patients with bilateral symmetrical impacted MTMs underwent surgical extractions. Experimental and control sides were randomly selected to receive LLLT or placebo. Following suturing, a dental assistant applied 810 nm gallium aluminum arsenide (GaAlAs) at three points for 30 s each with a total energy of 9 J. Pain was recorded on a visual analog scale on the 7 successive days.

Results: Data analyzed by IBM SPSS Statistics 23 for Windows with P ≤ 0.05 significance level. LLLT appeared to have a high significant effect on pain reduction; however, there was a mild increase in pain after the 4th day.

Conclusion: Intraoral 810 nm GaAlAs is effective in reducing postoperative pain when a dose of 32.86 J/cm2 is used.

Keywords: Gallium aluminum arsenides; low-level laser therapy; pain; third molar extraction; visual analog scale.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Sequel of tooth extraction
Figure 2
Figure 2
Mechanism of action of low-level laser therapy
Figure 3
Figure 3
Orthopantomographs of some cases showing the bilateral symmetrical impacted mandibular third molars
Figure 4
Figure 4
One oral surgeon performing the surgical extractions
Figure 5
Figure 5
One dental assistant applying the laser beam
Figure 6
Figure 6
A diagram illustrating the experimental design
Figure 7
Figure 7
A photograph demonstrating the surgical armamentarium used in this clinical trial
Figure 8
Figure 8
A photograph illustrating elexxion claros Pico laser device used. a: The display elements on the stand, b: The foot pedal for activation control, and c: The Pico T applicator fully threaded into the d: handpiece
Figure 9
Figure 9
A photograph demonstrating a: the Pico T applicator unthreaded from the handpiece. b: The spot size of the Pico T applicator is 6 mm in diameter with a surface beam area of 0.28 cm2
Figure 10
Figure 10
Photographs of a clinical case showing the three postoperative positions of the Pico T applicator occlusal (a), buccal (b), and lingual (c) at proximity to the soft tissue after suturing
Figure 11
Figure 11
A schematic diagram shows the visual analog scale
Figure 12
Figure 12
A graph illustrating the means of the pain intensity levels over time in the laser versus the control sides
Figure 13
Figure 13
A graph showing the average difference in interincisal opening between the low-level laser therapy treated surgical sites and the control sites. It shows that the low-level laser therapy reduced trismus postoperatively
Figure 14
Figure 14
A graph illustrating the means of number of analgesics used over time in the laser versus the control sides

References

    1. Brignardello-Petersen R, Carrasco-Labra A, Araya I, Yanine N, Beyene J, Shah PS, et al. 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. J Oral Maxillofac Surg. 2012;70:1789–801.
    1. He WL, Yu FY, Li CJ, Pan J, Zhuang R, Duan PJ, et al. Asystematic review and meta-analysis on the efficacy of low-level laser therapy in the management of complication after mandibular third molar surgery. Lasers Med Sci. 2015;30:1779–88.
    1. Amarillas-Escobar ED, Toranzo-Fernández JM, Martínez-Rider R, Noyola-Frías MA, Hidalgo-Hurtado JA, Serna VM, et al. Use of therapeutic laser after surgical removal of impacted lower third molars. J Oral Maxillofac Surg. 2010;68:319–24.
    1. Ferrante M, Petrini M, Trentini P, Perfetti G, Spoto G. Effect of low-level laser therapy after extraction of impacted lower third molars. Lasers Med Sci. 2013;28:845–9.
    1. Osunde OD, Saheeb BD. Effect of age, sex and level of surgical difficulty on inflammatory complications after third molar surgery. J Maxillofac Oral Surg. 2015;14:7–12.
    1. López-Ramírez M, Vílchez-Pérez MA, Gargallo-Albiol J, Arnabat-Domínguez J, Gay-Escoda C. Efficacy of low-level laser therapy in the management of pain, facial swelling, and postoperative trismus after a lower third molar extraction. A preliminary study. Lasers Med Sci. 2012;27:559–66.
    1. Rana M, Gellrich NC, Ghassemi A, Gerressen M, Riediger D, Modabber A, et al. Three-dimensional evaluation of postoperative swelling after third molar surgery using 2 different cooling therapy methods: A randomized observer-blind prospective study. J Oral Maxillofac Surg. 2011;69:2092–8.
    1. Batinjan G, Zore Z, Čelebić A, Papić M, Gabrić Pandurić D, Filipović Zore I, et al. Thermographic monitoring of wound healing and oral health-related quality of life in patients treated with laser (aPDT) after impacted mandibular third molar removal. Int J Oral Maxillofac Surg. 2014;43:1503–8.
    1. Abou El-Soud N, El Shenawy H. A randomized double blind clinical study on the efficacy of low level laser therapy in reducing pain after simple third molar extraction. Maced J Med Sci. 2010;3:303–6.
    1. El Shenawy H, Aboelsoud N, Zaki A, El Zawahry M, Shaibeta A. Postoperative pain control in patients after lower third molar extraction. J Am Sci. 2010;6:1068–72.
    1. Fernando S, Hill CM, Walker R. A randomised double blind comparative study of low level laser therapy following surgical extraction of lower third molar teeth. Br J Oral Maxillofac Surg. 1993;31:170–2.
    1. Oliveira Sierra S, Melo Deana A, Mesquita Ferrari RA, Maia Albarello P, Bussadori SK, Santos Fernandes KP, et al. Effect of low-level laser therapy on the post-surgical inflammatory process after third molar removal: Study protocol for a double-blind randomized controlled trial. Trials. 2013;14:373.
    1. Walsh LJ. The current status of low level laser therapy in dentistry. Part 1. Soft tissue applications. Aust Dent J. 1997;42:247–54.
    1. Mester E, Spiry T, Szende B, Tota JG. Effect of laser rays on wound healing. Am J Surg. 1971;122:532–5.
    1. Aoki A, Mizutani K, Schwarz F, Sculean A, Yukna RA, Takasaki AA, et al. Periodontal and peri-implant wound healing following laser therapy. Periodontol 2000. 2015;68:217–69.
    1. Moore K, Hira N, Kumar P, Jayakumar C, Ohshiro T. A double blind crossover trial of low level laser therapy in the treatment of post herpetic neuralgia. Laser Ther. 1989;2:7–9.
    1. Albertini R, Villaverde AB, Aimbire F, Salgado MA, Bjordal JM, Alves LP, et al. Anti-inflammatory effects of low-level laser therapy (LLLT) with two different red wavelengths (660 nm and 684 nm) in carrageenan-induced rat paw edema. J Photochem Photobiol B. 2007;89:50–5.
    1. Carroll JD, Milward MR, Cooper PR, Hadis M, Palin WM. Developments in low level light therapy (LLLT) for dentistry. Dent Mater. 2014;30:465–75.
    1. Parker S. Verifiable CPD paper: Introduction, history of lasers and laser light production. Br Dent J. 2007;202:21–31.
    1. Raman A, Srividhya S, Kumar M, Laxman A, Kumar M, Kailasam S. Low level laser therapy: A concise review on its applications. J Indian Acad Oral Med Radiol. 2013;25:291–3.
    1. Fabre HS, Navarro RL, Oltramari-Navarro PV, Oliveira RF, Pires-Oliveira DA, Andraus RA, et al. Anti-inflammatory and analgesic effects of low-level laser therapy on the postoperative healing process. J Phys Ther Sci. 2015;27:1645–8.
    1. Mozzati M, Martinasso G, Cocero N, Pol R, Maggiora M, Muzio G, et al. Influence of superpulsed laser therapy on healing processes following tooth extraction. Photomed Laser Surg. 2011;29:565–71.
    1. Røynesdal AK, Björnland T, Barkvoll P, Haanaes HR. The effect of soft-laser application on postoperative pain and swelling. A double-blind, crossover study. Int J Oral Maxillofac Surg. 1993;22:242–5.
    1. Khullar SM, Emami B, Westermark A, Haanaes HR. Effect of low-level laser treatment on neurosensory deficits subsequent to sagittal split ramus osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;82:132–8.
    1. Gasperini G, Rodrigues de Siqueira IC, Rezende Costa L. Does low-level laser therapy decrease swelling and pain resulting from orthognathic surgery? Int J Oral Maxillofac Surg. 2014;43:868–73.
    1. Markovic AB, Todorovic L. Postoperative analgesia after lower third molar surgery: Contribution of the use of long-acting local anesthetics, low-power laser, and diclofenac. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102:e4–8.
    1. Boras V, Richter I, Zorat N, Juras D, Barilo V, Rogulj A. Use of low level laser therapy in the treatment of persistent idiopathic orofacial pain and traumatic trigeminal neuropathy - A pilot study. J Regen Med Tissue Eng. 2013;2:5.
    1. Carrillo JS, Calatayud J, Manso FJ, Barberia E, Martinez JM, Donado M, et al. A randomized double-blind clinical trial on the effectiveness of helium-neon laser in the prevention of pain, swelling and trismus after removal of impacted third molars. Int Dent J. 1990;40:31–6.
    1. Paschoal MA, Santos-Pinto L. Therapeutic effects of low-level laser therapy after premolar extraction in adolescents: A randomized double-blind clinical trial. Photomed Laser Surg. 2012;30:559–64.
    1. Raouâa B, Samèh S, Nour BM, Abdellatif C, Jamil S. Effects of low-level-laser therapy versus corticotherapy on pain, trismus and edema after surgical removal of third mandibular molars: A comparative study. Family Med Med Sci Res. 2013;2:1–4.
    1. Bjordal JM, Couppé C, Chow RT, Tunér J, Ljunggren EA. A systematic review of low level laser therapy with location-specific doses for pain from chronic joint disorders. Aust J Physiother. 2003;49:107–16.
    1. Bjordal JM, Johnson MI, Iversen V, Aimbire F, Lopes-Martins RA. Low-level laser therapy in acute pain: A systematic review of possible mechanisms of action and clinical effects in randomized placebo-controlled trials. Photomed Laser Surg. 2006;24:158–68.
    1. Farina R, Trombelli L. Wound healing of extraction sockets. Endod Topics. 2012;25:16–34.
    1. Goyal M, Makkar S, Pasricha S. Low level laser therapy in dentistry. Int J Lasers Dent. 2013;3:82–8.
    1. Pirnat S. Versatility of an 810 nm diode laser in dentistry: An overview. J Laser Health Acad. 2007;4:1–9.
    1. Blondeau F, Daniel NG. Extraction of impacted mandibular third molars: Postoperative complications and their risk factors. J Can Dent Assoc. 2007;73:325.
    1. Osunde O, Saheeb B, Bassey G. Indications and risk factors for complications of lower third molar surgery in a Nigerian teaching hospital. Ann Med Health Sci Res. 2014;4:938–42.
    1. Bali A, Bali D, Sharma A, Verma G. Is Pederson index a true predictive difficulty index for impacted mandibular third molar surgery? A meta-analysis. J Maxillofac Oral Surg. 2013;12:359–64.
    1. Juodzbalys G, Daugela P. Mandibular third molar impaction: Review of literature anda proposal of a classification. J Oral Maxillofac Res. 2013;4:e1.

Source: PubMed

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