Clinical efficacy of hyaluronic acid in post-extraction sockets of impacted mandibular third molar
Background and Objectives: Pain and swelling are the most common complications that occur after surgical removal of impacted third molar. Aim of this study to evaluate the effectiveness of local hyaluronic acid (HA) administration to surgically remove impacted third molar sockets
to evaluate pain and swelling.
Materials and Methods: A comparative study included 50 healthy patients were subdivided into two equal sub group, aged 18-35 years with impacted lower third molars type of impaction (class II; position B according to Pell–Gregory classification). The procedure has been performed under local anesthesia. In the study group, 0.8% HA (Gengigel®) was applied in the post-extraction sockets of third molars and in the control group nothing was applied to the extraction sockets of third molars. Pain and swelling were evaluated with a visual analogue scale (VAS). Assessments were made on 1st, 2nd, 3th, 4th, 5th, 6th, 7th days after surgery.
Results: Statistically significant difference was detected for the pain values between the two treatment groups in different days of the study (p < 0.05). The swelling scores of the hyaluronic acid group were significantly lesser than those of the control group in day 1 (p = 0.008), day 3
(p = 0.006), and day 4 (p = 0.036). In the other days, the scores were less but the differences were not significant.
Conclusion: hyaluronic acid appears to offer a beneficial effect in the management of pain and swelling during the immediate postoperative period following impacted third molar surgery.
Sun R, Cai Y, Yuan Y, Zhao JH. The characteristics of adjacent anatomy of mandibular third molar germs: a CBCT study to assess the risk of extraction. Scientific reports. 2017;7(1):14154.
Bhuju KG, Shrestha S, Kaki R, Aryal S. Effect of age, gender, side and impaction types on surgical difficulty during mandibular third molar extraction. MJSBH. 2018;17(1).
Rashid MO, Talabani RM, Baban MT, Gul SS, Salih RO, Abdulkareem BN, et al. Prevalence of impacted mandibular third molars and its association with distal caries in mandibular second molars using cone beam computed tomography. J Oral Res. 2019;8(1):66-73.
Muhamad AH, Nezar W. Prevalence of Impacted Mandibular Third Molars in Population of Arab Israeli. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS). 2016;15(1): 00.
Juodzbalys G, Daugela P. Mandibular third molar impaction: review of literature and a proposal of a classification. Journal of oral & maxillofacial
Santosh P. Impacted Mandibular Third Molars: Review of Literature and a Proposal of a Combined Clinical and Radiological Classification. Annals of medical and health sciences research. 2015;5(4):229-34.
Yilmaz N, Demirtas N, Kazancioglu HO, Bayer S, Acar AH, Mihmanli A. The efficacy of hyaluronic acid in postextraction sockets of impacted third
molars: A pilot study. Nigerian journal of clinical practice. 2017;20(12):1626-31.
Santhosh Kumar MP, Vimalakshan I. Complications of Impacted Lower Third Molar Surgery and its Management. Int J Pharm Sci Rev Res. 2017;43
Cigerim L, Kaplan V, Orhan ZD. The Treatment of Complications of Impacted Wisdom Teeth. 2018.
Deliverska EG, Petkova M. Complications after Extraction of Impacted Third Molars - Literature Review. Journal of IMAB - Annual Proceeding
(Scientific Papers). 2016;22(3):1202-11.
de Santana-Santos T, de Souza-Santos a A, Martins-Filho PR, da Silva LC, de Oliveira ESED, Gomes AC. Prediction of postoperative facial swelling,
pain and trismus following third molar surgery based on preoperative variables. Medicina oral, patologia oral y cirugia bucal. 2013;18(1):e65-70.
Markovic AB, Todorovic L. Postoperative analgesia after lower third molar surgery: contribution of the use of long-acting local anesthetics, low power laser, and diclofenac. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2006;102(5):e4-e8.
Haraji A, Rakhshan V. Chlorhexidine gel and less difficult surgeries might reduce post-operative pain, controlling for dry socket, infection and analgesic consumption: a split-mouth controlled randomized clinical trial. Journal of oral rehabilitation. 2015;42(3):209-19.
Migliore A, Granata M. Intra-articular use of hyaluronic acid in the treatment of osteoarthritis. Clinical interventions in aging. 2008;3(2):365.
Allegra L, Della Patrona S, Petrigni G. Hyaluronic acid : perspectives in lung diseases. Handbook of experimental pharmacology. 2012(207):385-401.
Shuborna NS, Chaiyasamut T, Sakdajeyont W, Vorakulpipat C, Rojvanakarn M, Wongsirichat N. Generation of novel hyaluronic acid biomaterials
for study of pain in third molar intervention: a review. Journal of dental anesthesia and pain medicine. 2019;19(1):11-9.
Alcantara CEP, Castro MAA, Noronha MS, Martins-Junior PA, Mendes RM, Caliari MV, et al. Hyaluronic acid accelerates bone repair in human dental sockets: a randomized triple-blind clinical trial. Brazilian oral research. 2018;32:e84.
Shivpuri A. Effect of Primary VS Secondary Wound Closure Technique after Removal of Impacted Mandibular. Acta Scientific Dental Sciences. 2017;1(3).
Tiigimae-Saar J, Leibur E, Tamme T. The effect of prednisolone on reduction of complaints after impacted third molar removal. Stomatologija.
Sharma J, Thiboutot D, Zaenglein A. The effects of isotretinoin on wisdom tooth extraction. Journal of the American Academy of Dermatology.
Shaban B, Azimi HR, Naderi H, Janani A, Zarrabi MJ, Nejat AH. Effect of 0.2% chlorhexidine gel on frequency of dry socket following mandibular
third molar surgery: a double-blind clinical trial clinical trial. Journal of Dental Materials and Techniques. 2014;3(4):175-9.
Balakrishnan G, Narendar R, Kavin T, Venkataraman S, Gokulanathan S. Incidence of trismus in transalveolar extraction of lower third molar.
Journal of pharmacy & bioallied sciences. 2017;9( 1):222.
Merchant R, Khalid I, Natrajan S, Galinde J. Comparative Evaluation of Clinical Efficacy of hyluronic acid spray versus normal saline spray on swelling ,pain and trismus after surgical extraction of impacted mandibular third molar-A randomized contolled split mouth. International Journal of
Science and Research (IJSR). 2018;7(9).
Shahab OI. Pain and swelling after lower 3rd molar surgery. Acomparative study between three methods of wound closure. 2008.
Samad AA. Comparison between Flapless and Flap Implant Surgery. Clinical and Radiographic Study. 2012.
Woldenberg Y, Gatot I, Bodner L. Iatrogenic mandibular fracture associated with third molar removal: Can it be prevented? Medicina Oral,
Patología Oral y Cirugía Bucal 2007;12(1):70-2.
Contar C, Kanegusuku K, Berticelli R, AzevedoAlanis L, Machado M. Complications in third molar removal: a retrospective study of 588 patients. Medicina oral, patologia oral y cirugia buccal. 2010;15(1):e74-8.
Chiapasco M, Flora A, Serioli L, Zaniboni M. The removal of deeply impacted lower third molars by means of the bone lid technique with piezoelectric instruments. Italian Journal of Dental Medicine. 2017;2:13-7.
van Wijk A, Kieffer JM, Lindeboom JH. Effect of third molar surgery on oral health-related quality of life in the first postoperative week using Dutch
version of Oral Health Impact Profile-14. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2009;67(5):1026-31.
Sakamoto E, Yokoyama T. Pain and Anxiety in Dentistry and Oral and Maxillofacial Surgery Focusing on the Relation between Pain and Anxiety.
Remedy Publications LLC. 2018;1(1).
Gotoh S, Onaya J, Abe M, Miyazaki K, Hamai A, Horie K, et al. Effects of the molecular weight of hyaluronic acid and its action mechanisms on
experimental joint pain in rats. Annals of the rheumatic diseases. 1993;52(11):817-22.
Nelson FR, Zvirbulis RA, Zonca B, Li KW, Turner SM, Pasierb M, et al. The effects of an oral preparation containing hyaluronic acid on obese knee osteoarthritis patients determined by pain, function, bradykinin, leptin, inflammatory cytokines, and heavy water analyses. Rheumatology international. 2015;35(1):43-52.
Gocmen G, Gonul O, Oktay NS, Yarat A, Goker K. The antioxidant and anti-inflammatory efficiency of hyaluronic acid after third molar extraction.
Journal of Cranio-Maxillofacial Surgery. 2015;43(7):1033-7.
Koray M, Ofluoglu D, Onal EA, Ozgul M, Ersev H, Yaltirik M, et al. Efficacy of hyaluronic acid spray on swelling, pain, and trismus after surgical extraction of impacted mandibular third molars. Int J Oral Maxillofac Surg. 2014;43(11):1399-403.
Das A, Neher JO, Safranek S. Clinical inquiries. Do hyaluronic acid injections relieve OA knee pain?
The Journal of family practice. 2009;58(5):281.
Hanci D, Altun H. Effectiveness of hyaluronic acid in post-tonsillectomy pain relief and wound healing: a prospective, double-blind, controlled clinical study. International journal of pediatric otorhinolaryngology. 2015;79(9):1388-92.
Darawade DA, Kumar S, Mehta R, Sharma AR, Reddy GS. In search of a better option: dexamethasone versus methylprednisolone in third molar impaction surgery. Journal of international oral health: JIOH. 2014;6(6):14.
Longinotti C. The use of hyaluronic acid based dressings to treat burns: A review. Burns & trauma. 2014;2(4):162.
Erickson M, Stern R. Chain gangs: new aspects of hyaluronan metabolism. Biochemistry research international. 2012.
Romeo U, Libotte F, Palaia G, Galanakis A, Gaimari G, Tenore G, et al. Oral soft tissue wound healing after laser surgery with or without a pool of
amino acids and sodium hyaluronate: a randomized clinical study. Photomedicine and laser surgery. 2014;32(1):10-6.
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