Effectiveness of Low Level Laser Therapy (LLLT) and Dexamethasone Phonophoresis in Minimizing Postoperative Swelling Versus Trismus following Surgical Removal of Mandibular Impacted Third Molar: A Clinical Comparative Study

Background and review: The quality of life experienced by patients following third molar surgery is increasingly becoming a health concern; surgical removal of wisdom teeth under local anaesthesia is widely carried out in general dental practice. This procedure is usually associated with postoperative pain, swelling, and trismus as direct and immediate consequences of the surgical procedure. Many clinicians have, emphasized the necessity for better pain, swelling and trismus control in patients who undergo third molar surgery, American Academy of Craniomandibular disorders and the Minnesota Dental Association recommendations have been cited as the most commonly employed methods of physiotherapy treatment such as; short wave diathermy, ultrasound (US) and Low level laser therapy (LLLT). (1)Objective: The aim of this study is to evaluate the effectiveness of Low Level Laser Therapy (LLLT) and Dexamethasone phonophoresis on the post-operative clinical outcomes (facial swelling & trismus) following lower third molar surgical removalPatients & Methods: The study was performed on 30 patients (16 males & 14 females) aged 25-45 suffering from impacted mandibular third molar. They were divided into two equal groups; Group (A) received low level laser therapy immediately after third molar surgical extraction for (The laser has been given as output power 15mW, pulsed 80% and dose 4.3J/sq.cm for 6minutes for 7 days after surgery), Group (B) received phonophoresis of dexamethasone ampoule (in each session with half of 8mg ampule and 35 g ultrasound gel immediately after third molar surgical extraction (7 minutes session over the masseter muscle area for 7 days). Maximum inter-incisal opening MIO and facial swelling measurements were evaluated on pre-operative, 2nd day and 7th day postoperatively. Results: Results showed that there is no significant difference between administration of dexamethasone phonophoresis and (LLLT) for the reduction of postoperative edema and trismus. Also this study demonstrates that both Low level Laser Therapy and Dexamethasone Phonophoresis were significantly effective in decreasing trismus following third molar surgery as manifested by the highly increased Maximum Inter-incisal Opening MIO, but only dexamethasone phonophoresis has a significant effect on reduction of edema as manifested by significant decreasing of measurements (FM) while there was no significant difference on edema at 7th day post-operatively in laser group. Conclusion: This study demonstrates that there is no significant difference between LLLT and dexamethasone phonophoresis for reduction of edema and trismus but only dexamethasone phonophoresis has a significant effect on decreasing edema on seventh postoperative day.