Terapia fotodinâmica antimicrobiana no pós-operatório de exodontias de terceiros molares inferiores: um ensaio clínico randomizado e cego

Abstract

The impaction of third molars is a very recurrent condition and their extraction can result in pain, edema and infectious compromise for the patient. The aim of the present study was to evaluate the effect of protocols with local antimicrobial reduction on postoperative inflammatory-infectious events of impacted and/or impacted mandibular third molar extractions. A clinical, crossover, randomized and blind study was carried out. The sample consisted of 22 patients (36 teeth for extraction) who sought care in the Oral and Maxillofacial Surgery discipline of the Dentistry course at the Federal University of Ceará from June to November 2022. The patients underwent two surgical moments, separated by a minimum interval of 15 days. Thus, each tooth was allocated into one of the 3 experimental groups, according to the treatment received [Group 1: Antimicrobial Photodynamic Therapy (aPDT); Group 2: 0.12% chlorhexidine (CLX); Group 3: Control - Saline solution 0.9% (SF 0.9%)]. The groups received treatment immediately after tooth extraction, and the evaluated parameters were: pain, edema, maximum mouth opening and infection. The data showed that there was a statistically significant difference in edema in the distance between the gonial-tragus points. In the intragroup evaluation, only therapy with aPDT showed relevant statistical values, with T4 and T5 values lower than the other evaluated times (p = 0.022). In the measurement of mouth opening, there was a statistical difference in the intragroup evaluation of aPDT and CLX, demonstrating that there was a return to the initial mouth opening patterns (aPDT with p = 0.035, CLX with p = 0.038). There was a statistically significant difference in the presence of postoperative infection, with the aPDT and CLX groups presenting the lowest values (p = 0.039). Regarding pain; only in the intragroup evaluation it was possible to observe a clinical and statistical decrease of these symptoms in the analysis of the 7th day of follow-up of the aPDT group (P = 0.007). In conclusion; it was observed that treatment with aPDT favors a statistically significant reduction of infection, edema, pain and trismus in the postoperative period of lower third molar extractions.