Systemic Use of Arnica Montana for the Reduction of Postsurgical Sequels following Extraction of Impacted Mandibular 3rd Molars: A Pilot Study

Hani Mawardi, Shaima Ghazalh, Ahmad Shehatah, Amnah Abdelwahid, Amin Aljohani, Osama Felemban, Soulafa Almazrooa, Lena Elbadawi, Hazem Shawky, Hani Mawardi, Shaima Ghazalh, Ahmad Shehatah, Amnah Abdelwahid, Amin Aljohani, Osama Felemban, Soulafa Almazrooa, Lena Elbadawi, Hazem Shawky

Abstract

Background: Postsurgical sequels (PSS) are a group of complications commonly encountered following invasive dental surgical procedures such as bone grafting procedures, external sinus grafting, and 3rd molar extractions. These include pain, intraoral and extraoral bruising, and edema. The aim of this study is to evaluate the clinical efficacy of arnica montana (AM) in the management of PSS following extraction of impacted mandibular 3rd molars. The investigators null hypothesis includes no significant role of AM in reducing PSS following dental extraction.

Materials and methods: The investigators implemented a case-control pilot study enrolling twenty-three patients with impacted mandibular 3rd molars. These patients were allocated to AM or control group. Baseline clinical measurements were collected and included: (1) length of the surgical procedure, (2) pain score, (3) maximum mouth opening, and (4) facial measurements to evaluate edema levels. Subjects in active group received systemic AM tablets following the manufacturer instructions. All study subjects were followed up on Days 2, 4, and 7. Data was analyzed for statistical significance.

Results: A total of 30 impacted mandibular 3rd molars were extracted, in which 22 completed with AM. There were 16 females, and the average age was 26 years. On Day 2, subjects in the AM group reported significantly lower VAS compared to control group (3.09 ± 2.22 versus 4.75 ± 1.28). In addition, bleeding, extraoral bruising, edema, and decrease in maximum mouth opening were significantly less reported in the AM group.

Conclusions: This study describes the potential benefit of AM in reducing PSS following dental extractions.

Conflict of interest statement

The authors declare that there are no conflicts of interest regarding the publication of this article.

Copyright © 2020 Hani Mawardi et al.

Figures

Figure 1
Figure 1
Facial landmarks and distances to angle of the mandible used to evaluate study subjects for facial edema at baseline and Day 7 (A = distance to tragus, B = distance to lateral canthus, C = distance to alar base, D = distance to lip commissure, and E = distance to pogonion).
Figure 2
Figure 2
Surgical extraction of mandibular left 3rd molar for Case 1. Presurgical evaluation included panoramic (a) and periapical (b) radiographic assessment in addition to clinical examination. The procedure was started by a pyramidal flap incision followed by mucoperiosteal flab elevation (c). Next, bone removal to expose the impacted molar was completed as needed followed by guttering buccally and distally. The site was sutured with simple interrupted sutures using 3-0 silk and hemostasis achieved (d).
Figure 3
Figure 3
Surgical extraction of mandibular right 3rd molar for Case 2. Presurgical evaluation included panoramic (a) and periapical (b) radiographic assessment in addition to clinical examination. The procedure was started by a pyramidal flap incision followed by mucoperiosteal flab elevation (c). Next, bone removal to expose the impacted molar was completed as needed followed by guttering buccally and distally. The site was sutured with simple interrupted sutures using 3-0 silk and hemostasis achieved (d).
Figure 4
Figure 4
Reported VAS pain score on Days 2, 4, and 7.

References

    1. Glera-Suarez P., Soto-Penaloza D., Penarrocha-Oltra D., Penarrocha-Diago M. Patient morbidity after impacted third molar extraction with different flap designs. A systematic review and meta-analysis. Medicina oral, patología oral y cirugía bucal. 2020;25(2):e233–e239. doi: 10.4317/medoral.23320.
    1. Yamada S. I., Hasegawa T., Soutome S., et al. Prevalence of and risk factors for postoperative hemorrhage after lower third molar extraction on Warfarin therapy: a multicenter retrospective study in Japan. Odontology. 2019;108(3):462–469. doi: 10.1007/s10266-019-00474-y.
    1. Zhang W., Li J., Li Z. B., Li Z. Predicting postoperative facial swelling following impacted mandibular third molars extraction by using artificial neural networks evaluation. Scientific Reports. 2018;8(1):p. 12281. doi: 10.1038/s41598-018-29934-1.
    1. Shoohanizad E., Parvin M. Comparison the dexamethasone administration effects on post-operative sequelae before and after “third molar” extraction surgeries. Endocrine, Metabolic & Immune Disorders—Drug Targets. 2019;20(3):356–364. doi: 10.2174/1871530319666190722120405.
    1. Brignardello-Petersen R. Similar pain, swelling, and trismus after third-molar surgical extraction when receiving a phytotherapeutic drug, ibuprofen, or a placebo. The Journal of the American Dental Association. 2019;150(5):p. e50. doi: 10.1016/j.adaj.2018.12.020.
    1. Brignardello-Petersen R. There are probably no added benefits of intravenous ketamine for postoperative pain in patients undergoing third-molar extraction who receive perioperative antibiotics, ibuprofen, and dexamethasone. The Journal of the American Dental Association. 2020;151(1):p. e1. doi: 10.1016/j.adaj.2019.07.027.
    1. Brucoli M., De Andreis M., Bonaso M., Boffano P., Benech A. Comparative assessment of dexamethasone administration routes for the management of postoperative symptoms following third molar surgery. Journal of Stomatology, Oral and Maxillofacial Surgery. 2019;120(6):529–533. doi: 10.1016/j.jormas.2019.03.004.
    1. Sortino F., Cicciu M. Strategies used to inhibit postoperative swelling following removal of impacted lower third molar. Dental Research Journal. 2011;8(4):162–171.
    1. Knackstedt R., Gatherwright J. Perioperative homeopathic arnica and bromelain. Annals of Plastic Surgery. 2020;84(3):e10–e15. doi: 10.1097/sap.0000000000002043.
    1. Kriplani P., Guarve K., Baghael U. S. Arnica montana L.—a plant of healing: review. Journal of Pharmacy and Pharmacology. 2017;69(8):925–945. doi: 10.1111/jphp.12724.
    1. Sutovska M., Capek P., Kocmalova M., et al. Characterization and pharmacodynamic properties of Arnica montana complex. International Journal of Biological Macromolecules. 2014;69:214–221.
    1. Ho D., Jagdeo J., Waldorf H. A. Is there a role for arnica and bromelain in prevention of post-procedure ecchymosis or edema? A systematic review of the literature. Dermatologic Surgery. 2016;42(4):445–463. doi: 10.1097/dss.0000000000000701.
    1. Pell G. B. Impacted mandibular third molars:classification and modified techniques for removal. The Dental Digest. 1933;39:330–338.
    1. Neupert E. A., III, Lee J. W., Philput C. B., Gordon J. R. Evaluation of dexamethasone for reduction of postsurgical sequelae of third molar removal. Journal of Oral and Maxillofacial Surgery. 1992;50(11):1177–1182. doi: 10.1016/0278-2391(92)90149-t.
    1. Lotter R. Periodontal considerations in the extraction of retained wisdom teeth. Varying technics. Le Chirurgien-dentiste de France. 1984;54(252):35–44.
    1. Friedman J. W. The prophylactic extraction of third molars: a public health hazard. American Journal of Public Health. 2007;97(9):1554–1559. doi: 10.2105/ajph.2006.100271.
    1. Laino L., Troiano G., Dioguardi M., et al. Patient discomfort during and after surgically assisted rapid maxillary expansion under local anaesthesia. Journal of Craniofacial Surgery. 2016;27(3):772–775. doi: 10.1097/scs.0000000000002535.
    1. Ali A., Shah S. J., Shah A. A., Aslam S. Comparison of comma incision with Ward’s incision in third molar extraction in terms of postoperative sequel—a clinical study. National Journal of Maxillofacial Surgery. 2019;10(2):200–205.
    1. Brignardello-Petersen R. Inconsistent evidence regarding the benefits of cryotherapy in minimizing postoperative complications after third-molar extraction. The Journal of the American Dental Association. 2019;150(9):p. e134. doi: 10.1016/j.adaj.2019.05.001.
    1. Patil C., Jadhav A., Borle R. M., Mishra A. Piezosurgery vs bur in impacted mandibular third molar surgery: evaluation of postoperative sequelae. Journal of Oral Biology and Craniofacial Research. 2019;9(3):259–262. doi: 10.1016/j.jobcr.2019.06.007.
    1. Dos Santos Canellas J. V., Ritto F. G., Medeiros P. J. D. A. Efficacy of platelet-rich fibrin after mandibular third molar extraction: a systematic review and meta-analysis. Journal of Oral and Maxillofacial Surgery. 2017;75(8):1576–1577. doi: 10.1016/j.joms.2017.03.060.
    1. Al-Khanati N. M., Al-Moudallal Y. Effect of intrasocket application of Manuka honey on postsurgical pain of impacted mandibular third molars surgery: split-mouth randomized controlled trial. Journal of Maxillofacial and Oral Surgery. 2019;18(1):147–152. doi: 10.1007/s12663-018-1142-z.
    1. Soltani R., Haghighat A., Fanaei M., Asghari G. Evaluation of the effect of green tea extract on the prevention of gingival bleeding after posterior mandibular teeth extraction: a randomized controlled trial. Evidence-Based Complementary and Alternative Medicine. 2014;2014:4. doi: 10.1155/2014/857651.857651
    1. Brignardello-Petersen R. Submucosal dexamethasone reduces pain, swelling, and trismus after impacted third-molar extraction. The Journal of the American Dental Association. 2017;148(5):p. e64. doi: 10.1016/j.adaj.2017.02.048.
    1. Chaiet S. R., Marcus B. C. Perioperative Arnica montana for reduction of ecchymosis in rhinoplasty surgery. Annals of Plastic Surgery. 2016;76(5):477–482. doi: 10.1097/sap.0000000000000312.
    1. Tsintzas D., Vithoulkas G. Treatment of postoperative sore throat with the aid of the homeopathic remedy Arnica montana: a report of two cases. Journal of Evidence-Based Complementary & Alternative Medicine. 2017;22(4):926–928. doi: 10.1177/2156587217735986.
    1. Kotlus B. S., Heringer D. M., Dryden R. M. Evaluation of homeopathic Arnica montana for ecchymosis after upper blepharoplasty: a placebo-controlled, randomized, double-blind study. Ophthalmic Plastic & Reconstructive Surgery. 2010;26(6):395–397. doi: 10.1097/iop.0b013e3181cd93be.
    1. Kaziro G. S. N. Metronidazole (Flagyl) and Arnica montana in the prevention of post-surgical complications, a comparative placebo controlled clinical trial. British Journal of Oral and Maxillofacial Surgery. 1984;22(1):42–49. doi: 10.1016/0266-4356(84)90007-x.
    1. Lee W., Mack W., Seiff S., Kang J., Tran K. Assessing the effectiveness of Arnica montana and Rhododendron tomentosum (Ledum palustre) in the reduction of ecchymosis and edema after oculofacial surgery: preliminary results: Erratum. Ophthalmic Plastic and Reconstructive Surgery. 2018;34(2):p. 188. doi: 10.1097/IOP.0000000000001085.
    1. Sorrentino L., Piraneo S., Riggio E., et al. Is there a role for homeopathy in breast cancer surgery? A first randomized clinical trial on treatment with Arnica montana to reduce postoperative seroma and bleeding in patients undergoing total mastectomy. Journal of Intercultural Ethnopharmacology. 2017;6(1):1–8. doi: 10.5455/jice.20161229055245.
    1. Yilmaz N., Demirtas N., Kazancioglu H. O., Bayer S., Acar A. H., Mihmanli A. The efficacy of hyaluronic acid in postextraction sockets of impacted third molars: a pilot study. Nigerian Journal of Clinical Practice. 2017;20(12):1626–1631. doi: 10.4103/1119-3077.224131.
    1. Akbulut N., Ustuner E., Atakan C., Colok G. Comparison of the effect of naproxen, etodolac and diclofenac on postoperative sequels following third molar surgery: a randomised, double-blind, crossover study. Medicina Oral Patología Oral Y Cirugia Bucal. 2014;19(2):e149–e156. doi: 10.4317/medoral.19518.
    1. Lima T. C., Bagordakis E., Falci S. G. M., Dos Santos C. R. R., Pinheiro M. L. P. Pre-emptive effect of dexamethasone and diclofenac sodium associated with codeine on pain, swelling, and trismus after third molar surgery: a split-mouth, randomized, triple-blind, controlled clinical trial. Journal of Oral and Maxillofacial Surgery. 2018;76(1):60–66. doi: 10.1016/j.joms.2017.06.012.
    1. Bamgbose B. O., Akinwande J. A., Adeyemo W. L., Ladeinde A. L., Arotiba G. T., Ogunlewe M. O. Effects of co-administered dexamethasone and diclofenac potassium on pain, swelling and trismus following third molar surgery. Head & Face Medicine. 2005;1:p. 11. doi: 10.1186/1746-160x-1-11.
    1. Bellavite P., Marzotto M., Bonafini C. Arnica montana experimental studies: confounders and biases? Journal of Integrative Medicine. 2018;16(2):72–76. doi: 10.1016/j.joim.2018.01.001.
    1. Bellavite P., Marzotto M., Bonafini C. Critical comments and methodological variations in Arnica montana’s research studies. Journal of Ayurveda and Integrative Medicine. 2018;9(3):238–239. doi: 10.1016/j.jaim.2018.05.005.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj