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Randomized Controlled Trial
. 2022 Dec;26(12):6941-6960.
doi: 10.1007/s00784-022-04649-w. Epub 2022 Aug 11.

Effect of preemptive photobiomodulation associated with nimesulide on the postsurgical outcomes, oxidative stress, and quality of life after third molar surgery: a randomized, split-mouth, controlled clinical trial

Edson Luiz Cetira Filho  1   2 , Paulo Goberlânio Barros Silva  3 , Deysi Viviana Tenazoa Wong  4 , Celia Choquenaira-Quispe  5 , Francisco Rafael Alves Santana Cesário  6   7 , Gisele de Sousa Nogueira  8 , Alan Vieira Costa de Sousa  8 , Andréa Silvia Walter de Aguiar  9 , Said Goncalves da Cruz Fonseca  10 , Fabio Wildson Gurgel Costa  11
Affiliations
Randomized Controlled Trial

Effect of preemptive photobiomodulation associated with nimesulide on the postsurgical outcomes, oxidative stress, and quality of life after third molar surgery: a randomized, split-mouth, controlled clinical trial

Edson Luiz Cetira Filho et al. Clin Oral Investig. 2022 Dec.

Abstract

Objective: The aim of this study is to compare the effect of photobiomodulation with low-level laser therapy (LLLT) and nimesulide on inflammatory parameters, biomarkers of oxidative stress and inflammation, and quality of life after lower third molar (L3M) surgery.

Material and methods: A randomized, two-factor, triple-blind, controlled, split-mouth clinical trial was performed with 40 volunteers who required bilateral L3M removal. Patients were allocated depending on the use or not of 100 mg nimesulide 1 hbefore surgery, as well as the use or not of LLLT in the preoperative period.

Results: Pain peaks occurred after 6 h (nimesulide-placebo [N-P] group) and 8 h (nimesulide group). In the N-P group, LLLT resulted in significantly lower mean pain scores than the subgroup without LLLT after 4 h (p = 0.009) and 6 h (p = 0.048). As for edema, a shorter distance between the mandibular angle and the outer canthus of the eyes after 7 days (p = 0.037) and a smaller cumulative effect (p = 0.036) were observed in the N-P group associated with LLLT. A direct effect between LLLT (p = 0.047) and a reduction in the mean scores of overall dissatisfaction with quality of life was detected.

Conclusions: Preemptive use of nimesulide only delayed peak pain. LLLT reduced edema, trismus, and contributed to a better perception of quality of life. Nimesulide inhibits peroxidation by increasing GSH and stopping neutrophil migration. The benefit of the association of both strategies was not superior to the use of LLLT alone.

Clinical relevance: Translational study with impact on clinical-surgical protocols involving L3M surgery related to pharmacological and non-pharmacological methods.

Keywords: Analgesia; Anti-inflammatory agents, Non-steroidal; Low-level light therapy; Oxidative stress; Quality of life; Third molar.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Linear measurements used to assess postoperative edema, from the mandibular angle (MA) to (1) tragus (MA-Tr distance), (2) outer canthus of the eye (MA-OCE distance), (3) ala of the nose (MA-AN distance), 4) labial commissure (MA-LC distance), and (5) soft pogonion (MA-SP distance)
Fig. 2
Fig. 2
Flow diagram of patients recruited according to the CONSORT guidelines
Fig. 3
Fig. 3
Pain scale measurements throughout the postoperative period. Data expressed as Mean ± SD
Fig. 4
Fig. 4
GSH concentration by group and surgical time
Fig. 5
Fig. 5
MPO concentration by group and surgical time
Fig. 6
Fig. 6
MDA concentration by group and surgical time
Fig. 7
Fig. 7
Total protein concentration by group and surgical time
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