O uso do laser de alta potência para incisões em cirurgias de dentes inclusos e semi-inclusos : ensaio clínico randomizado, duplo-cego, controlado

Abstract

Removal of impacted teeth is a procedure routinely performed in the office of oral and maxillofacial surgeons. Because the postoperative period is considered uncomfortable, different strategies to control inflammatory events have been investigated. The use of laser technology in Dentistry has incorporated several treatment protocols and low-power, as well as high-power, devices have been used. Low-level laser therapy (LLLT) has been extensively investigated, however, due to protocol variations, the results have been controversial. Reports in the literature indicate that the benefits of laser surgery (LS) are local analgesia and hemostasis and, depending on the surgical procedure, swelling control. The question then arises whether such effects are observed in patients who undergo the removal of impacted or semi-impacted teeth. The aim of the present study was to compare the parameters of pain, medication consumption, mouth opening and swelling when LS is associated with pharmacological strategies or LLLT in surgeries to remove four third molars. The sample consisted of 152 normositemic patients, with a minimum age of 18 years, who had the indication of removal in a single session of 4 impacted or semi-impacted third molars in any position. Research participants were randomly divided into 2 groups. In the Blade15 group (B15), the incision was made with a 15-blade scalpel and, in the LS group, it was performed with a surgical laser. Each group was subdivided into three subgroups: Blade 15 Placebo (B15-P), Blade 15 Preemptive Medication (B15-PM), Blade 15 LBI (B15-LLLT), LS Placebo (LSP), LS Preemptive Medication (LS-PM) and LS LLLT (LS-LLLT). In the B15-P and LSP groups, patients were instructed to consume medications with analgesic and anti-inflammatory action in the postoperative period. In the B15-PM and LS-PM groups, patients received preemptive analgesia with glucocorticoid and NSAIDs. In the B15-LLLT and LS-LLLT groups, LLLT was instituted in the immediate postoperative period and 72 hours after surgery. The results demonstrate that patients without anti-inflammatory measures who were operated on with LS (LSP group) compared to those operated on with blade 15 (B15P group) had lower pain scores in all evaluated periods (p<0.001), as well as lower consumption of drugs in the global assessment (p<0.001). The mouth opening variation, in these same two groups, was also lower in all evaluated periods (T1 p=0.001; T2 p=0.007; T3 p=0.001 and T4 p=0.028). As for edema, the GonioTragus mean showed the greatest variation in relation to the p value in patients without anti-inflammatory measures who were operated on with LS compared to those operated on with blade 15 in all evaluated periods (T1 p=0.008; T2 p<0.001; T3 p=0.003 and T4 p=0.002). There was no increase in the antiinflammatory effect in the association of LS with preemptive medications or with LLLT. Therefore, the use of LS showed positive results for the reduction of pain and postoperative trismus in surgeries to remove four third molars, but little benefit in controlling edema.