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

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 3^rd 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 3^rd 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 3^rd 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 3^rd 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.

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

Surgical extraction of mandibular left 3^rd 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

Surgical extraction of mandibular right 3^rd 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

Reported VAS pain score on Days 2, 4, and 7.