Randomized prospective clinical study of external infrared photobiomodulation and ice application in the postoperative extraction of lower third molars

Abstract

The dental extraction of third molars is a common procedure in dental practice that causes considerable tissue trauma, triggering an inflammatory response unpleasant for the patient. In a previous study, it was observed that the application of photobiomodulation in the immediate postoperative period extra oral of impacted third molars surgery has positive effect to decrease the edema and improvement of mouth opening. The use of ice in the postoperative period is recommended routinely, but there are no clinical studies that prove their real effects. There are alsono studies showing the effects of the photobiomodulation associated with the controlled application of ice packs for the control of pain, edema and trismus in the postoperative period of third molar extraction. This study aims to assess whether the extra oral application of low power laser immediately after surgery can enhance the therapeutic action of the ice. Thus, through a randomized clinical trial type "Split-mouth" set out to verify that the action of the ice applied physiotherapy in a controlled manner, intermittent, assisted and standardized for 60 minutes can be increased by applying extra oral in single session of photobiomodulation for low power infrared laser diode of gallium arsenete aluminum (AsGaAl) with 808 nm wavelength can reduce swelling and pain and limitation of mouth opening in the postoperative period of third molar extraction. 25 patients will be selected randomly among those patients from surgery clinic for dental extractions of third molars. Following eligibility criteria as the presence of bilateral third molar with similar surgical difficulty. In the group Laser-ice (LG) photobiomodulation will be employed in 4 equidistant points on the skin between the insertion and the origin of the masseter muscle on the side where the tooth was extracted, totaling 12 J. In the Group Placebo-Laser + Ice (LPG) the region operated will be subject to application of the laser tip with the equipment turned off, without the knowledge of the patient, at the same points of the LG group. An infrared digital thermometer will monitor the skin temperature in eight different periods before and after the ice and applications of irradiation by the laser. Mouth opening (interincisal distance) will be measure through digital caliper immediately preoperative (E0) and post-operative of 24hours (E1) and 7 days (E2). The swelling will be measured through the distances in mm between tragus and mouth commissure (Tr-Cl), goniac angle and ocular canthus(Ag-Co) and goniac angle and mouth commissure (Ag-Cl) in same periods of mouth opening measurement. The patient will be instructed to fill out a diary post-operative pain assessment by a scale EVA in 5 periods: immediately after the surgical procedure (D1), 6 hours after the surgical procedure (D2), 8 hours after the surgical procedure (D3), 24 hours After the surgical procedure (D4) and 48 hours after the surgical procedure (D5). The parameters of analysis will be the differences between the averages of the measures on both pre and postoperative moments for continuous variables. Data distribution will be verified by normality test and application of parametric statistical tests (t Test) or nonparametric (Mann-Whitney)will be applied. The p significance level 0.05 will be elected as significant.