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Effectiveness of Hyaluronic Acid Local Application in the Socket after Surgical Extraction of Impacted Lower Third Molars. A Prospective Randomized Controlled Clinical Study

Journal of Research in Medical and Dental Science
eISSN No. 2347-2367 pISSN No. 2347-2545

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Research Article - (2022) Volume 10, Issue 10

Effectiveness of Hyaluronic Acid Local Application in the Socket after Surgical Extraction of Impacted Lower Third Molars. A Prospective Randomized Controlled Clinical Study

Kadhim Hussain Jalal* and Auday M. Al-Anee

*Correspondence: Kadhim Hussain Jalal, Department of Oral and Maxillofacial Surgery, Dental Teaching Hospital, College of Dentistry, University of Baghdad, Baghdad, Iraq, Email:

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Abstract

Background: Hyaluronic Acid (HA) has been investigated for a long time in various applications. It has been found practically in multiple tissues in humans and other animals. HA is a versatile material. These unusual physicochemical features have been used for various medical objectives.

Aims: Evaluate effectiveness of the local application of Hyaluronic Acid (HA) gel in reducing pain and edema after impacted mandibular third molars removal.

Materials and methods: Fifty patients who met the inclusion criteria whose mean age (25.28) years were randomly allocated to one of two groups. Patients in Group I (study group) had hyaluronic acid gel inserted in the socket after surgical removal of the mandibular third molar (N=25). Group II (control group) had no H.A. put in the socket after surgical removal of the mandibular third molar (N=25). Pernambucco index was used as difficulty scoring to evaluate the cases, decrease bias of results and to give fact results. Type of impaction in our study (62% vertical and 38% mesioangular). Preoperative measurements and postoperative measurements (1st, 3rd and 7th days) for swelling was taken using (Gabka and Matsumara method), and postoperative pain (1st, 3rd and 7th days) was recorded subjectively by (visual analogue scale). The statistical analysis of results was done using the Mann-Whitney U test.

Results: Fifty patients (39 female and 11 male) contributed to this study. No Significant difference has been found between the two groups in pain and facial swelling at different days of assessment during the study (day 1, day 3 and day 7) (p>0.05).

Conclusion: Hyaluronic acid gel decreases pain clinically but is non-significant statistically and has no effect on facial swelling after surgical extraction of impacted lower third molars.

Keywords

Hyaluronic acid, Pain, Swelling, Impacted mandibular third molar

Introduction

The most prevalent procedure in oral and maxillofacial surgery has been surgical removal of impacted teeth. However, complications such as discomfort, oedema, trismus, nerve injury, bone fractures, adjacent tooth damage, delayed healing, and inflammation can occur during and after surgical extraction of impacted mandibular third molars [1-3]. Multiple factors, including the patient's age, sex, health status, tooth impaction level, surgeon's experience, operation time, smoking, contraceptive medication use, oral hygiene, and surgical technique, may influence the complication rates associated with impacted mandibular third molar extraction. Compared to older people, the amount of discomfort experienced following an operation is more diminutive in younger people. If the surgical procedure is prolonged, the intensity of pain, oedema, and trismus will all rise. In general, the occurrence and severity of these consequences are most closely related to the depth of the impaction and the patient's age [4,5].

All of these issues harm the patient's quality of life. Corticosteroids are commonly used to reduce oedema and trismus associated with third molar surgery. However, if used for a long time, corticosteroids can cause delayed wound healing, increased susceptibility to infection, and adrenal suppression [6,7].

Hyaluronic Acid (HA) is one biomaterial proven to be an effective option for hastening wound healing and preventing or reducing postoperative inflammation [8]. In all living species, HA is found in synovial fluid, embryonic mesenchyme, skin, and a range of other organs and tissues [9]. In addition, HA interacts with growth factors and regulates osmotic pressure and tissue lubrication. HA binds to a variety of receptors involved in mitosis, cell motility, tumour metastasis, and inflammation. It also contains antibacterial, antifungal, anti-inflammatory, anti-edematous, osteogenic and proangiogenetic characteristics, causing wound healing to improve in a range of tissues. HA has been used in dentistry to speed up the healing process in tooth sockets following tooth extraction [10].

Hyaluronic acid has been used to decrease complications after surgical extraction of impacted mandibular third molars. However, there are minor works of literature on evaluating the effect of hyaluronic acid after surgical removal of the third mandibular molar tooth.

Results

Fifty patients contributed to this study, including 39 females and 11 males (78% vs 22%). All of the pain indices have no significant difference between the two groups on different days of assessment through the study (p>0.05), as shown in (Table 1). Day 1 (p=0.846), day 3 (p=0.689), and day 7 (p=0.845) demonstrate no significant difference in swelling ratings between the two groups (Table 2).

  Study group Control group p Sig
Pain (days) Mean score Median score Mean rank Mean score Median score Mean rank
P1 2 2 25.2 2.04 2 25.8 0.878 N
P2 0.84 1 23.42 1.2 1 27.58 0.287 N
P3 0.2 0 22.46 0.52 0 28.54 0.061 N

Table 1: Pain parameters of the two groups on different days.

  Study group Control group p Sig
swelling (days) Mean score Median score Mean rank Mean score Median score Mean rank
P1 12.55 12.5 25.9 12.57 12.5 25.1 0.846 N
P2 12.29 12.3 26.32 12.32 12.3 24.68 0.689 N
P3 12.05 12 25.9 12.03 12 25.1 0.845 N

Table 2: Swelling parameters of the two groups on different days.

Pain parameters in different days regarding to preoperative difficulty according to pernumbucco difficulty scoring system.

There no significant difference between two groups in pain regarding preoperative difficulty in day 1, day 3, except day 7 there is significant difference in low degree between two groups (Table 3).

Pain
Days     Mean Median Mean Rank P* Sig
P1 Low Study 1.71 2 11.79 0.882 N
Control 1.67 2 11.37
Moderate Study 2.19 2 12.25 0.461 N
Control 2.44 3 14.33
High Study 2 2 1.5 0.157 N
Control 3 3 3
P2 Low Study 1.14 1 13.71 0.217 N
Control 0.47 0 10.47
Moderate Study 1.31 1 12.91 0.93 N
Control 1.33 1 13.17
High Study 0.5 0.5 1.5 0.221 N
Control 2 2 3
P3 Low Study 0.43 0 13.71 0.034 S
Control 0 0 10.47
Moderate Study 0.56 0 13.44 0.65 N
Control 0.44 0 12.22
High Study 0.5 0.5 1.75 0.48 N
Control 1 1 2.5

Table 3: Pain parameters of the two groups on different days according to pernumbucco difficulty scoring system.

Swelling parameters in different days regarding to preoperative difficulty according to pernumbucco difficulty scoring system.

There no significant difference between two groups in pain regarding preoperative difficulty in day 1, day 3 and day 7 (Table 4).

Swelling
Days     Mean Median Mean Rank P* Sig
P1 Low Study 12.36 12.3 9.79 0.396 N
Control 12.57 12.7 12.3
Moderate Study 12.71 12.7 13.41 0.712 N
Control 12.56 12.2 12.28
High Study 12.25 12.25 2 1 N
Control 12.3 12.3 2
P2 Low Study 12.11 11.8 9.64 0.358 N
Control 12.3 12.5 12.37
Moderate Study 12.47 12.3 13.63 0.569 N
Control 12.27 12 11.89
High Study 11.9 11.9 1.75 0.48 N
Control 12.3 12.3 2.5
P3 Low Study 11.99 11.8 10 0.456 N
Control 12.14 12.3 12.2
Moderate Study 12.11 12 14.03 0.345 N
Control 11.97 11.8 11.17
High Study 11.6 11.6 2 1 N
Control 11.5 11.5 2

Table 4: Swelling parameters of the two groups on different days according to pernumbucco difficulty scoring system.

Discussion

There was no statistically significant difference in pain scores between the control and study groups from 1 to 7 days in the current study. According to Yilmaz, et al. local application of H.A. gel into the extraction socket may result in a minor reduction in pain. This outcome could be due to several factors, including individual differences in pain thresholds and a small sample size pilot trial involving only 25 patients. This study was in agreement with our study.

In contrast to our findings [11,12], demonstrated an analgesic action of HA that includes covering bradykinin receptors in synovial tissues. The evidence suggested that HA could be used as a pain reliever. In the first, third, and seventh days following extraction, there was no statistically significant difference in postoperative oedema between the control and experimental groups.

HA appears to have a favourable effect on the control of oedema in the initial postoperative period following impacted third molar surgery, according to Merchant, et al. and can be advised for the patient's postoperative comfort. Postsurgical oedema induced by inflammatory processes triggered by surgical trauma to the underlying tissues is better controlled with HA According to Erickson and Stern and Longinotti, et al. the antiedematous actions of HA may be connected to its osmotic buffering ability (2014) [12,13]. It was discovered that the anti-edematous properties of H.A. may be linked to its osmotic buffering ability.

In contrast, Gocmen G, et al. found that HA gel lengthened bleeding time and increased early postoperative oedema between the periods of (2-3 days) after removal of vertical half impacted lower third molars [14]. This could be because HA, at high concentrations, reduces platelet aggregation and adhesion.

Conclusion

1-Hyaluronic acid gel decreases pain clinically but is nonsignificant statistically. Hyaluronic acid may be of some benefit for pain relief following impacted third molar surgery.

2-Hyaluronic acid has no effect for decreasing swelling after surgical extraction of the impacted mandibular third molar.

References

Author Info

Kadhim Hussain Jalal* and Auday M. Al-Anee

Department of Oral and Maxillofacial Surgery, Dental Teaching Hospital, College of Dentistry, University of Baghdad, Baghdad, Iraq
 

Citation: Kadhim Hussain Jalal, Auday M. Al-Anee, Effectiveness of Hyaluronic Acid Local Application in the Socket after Surgical Extraction of Impacted Lower Third Molars. A Prospective Randomized Controlled Clinical Study, J Res Med Dent Sci, 2022, 10 (10): 117-121.

Received: 02-Aug-2022, Manuscript No. JRMDS-22-58785; , Pre QC No. JRMDS-22-58785(PQ); Editor assigned: 04-Aug-2022, Pre QC No. JRMDS-22-58785(PQ); Reviewed: 18-Aug-2022, QC No. JRMDS-22-58785; Revised: 03-Oct-2022, Manuscript No. JRMDS-22-58785(R); Published: 13-Oct-2022

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