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Diferenças no pós-operatório de terceiros molares consoante o instrumental de osteotomia : uma revisão sistemática
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| 2.53 MB | Adobe PDF |
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Abstract(s)
Introdução: A exodontia de terceiros molares inferiores é uma prática comum em cirurgia oral, geralmente associada a dor, edema e trismo no pós-operatório. Entre os fatores que influenciam estas complicações, destaca-se o método utilizado na osteotomia. Esta revisão sistemática tem como objetivo geral comparar os métodos rotativo, piezo-cirúrgico e laser Er:YAG de osteotomia para suportar a decisão clínica. Materiais e Métodos: Realizou-se uma pesquisa sistemática nas bases de dados PubMed, Scopus, Cochrane Library e ScienceDirect, utilizando os termos MeSH: “Third Molar”, “Osteotomy”, “Postoperative Complications” e “Postoperative Pain”. A seleção seguiu os critérios PRISMA e o risco de viés foi avaliado pela ferramenta Cochrane RoB2. Foram incluídos apenas ensaios clínicos randomizados, publicados em inglês nos últimos 20 anos. Resultados: Dos 615 estudos identificados, 11 cumpriram os critérios de inclusão. Relativamente à dor, 6 estudos demonstraram diferenças estatisticamente significativas, 5 com piezo e 1 com laser. No edema, foram observadas diferenças significativas em 8 estudos, 6 com piezo e 2 com laser. No que respeita ao trismo 6 estudos reportaram diferenças estatisticamente significativas, dos quais 4 com piezo e 2 com laser com menor limitação funcional nestes grupos. A satisfação do paciente foi analisada em 2 estudos com piezo, ambos com diferenças estatisticamente significativas positivas. O tempo cirúrgico foi significativamente superior com piezo em 5 estudos e com laser em 2, especialmente em casos complexos ou realizados por operadores com menos experiência. Conclusão: A osteotomia realizada com recurso a instrumentos piezo-eléctricos ou laser aparenta reduzir a morbilidade pós-operatória comparativamente ao método rotativo, sobretudo em cirurgias mais complexas.
Introduction: The surgical extraction of impacted mandibular third molars is a common procedure in oral surgery and is frequently associated with postoperative pain, swelling, and trismus. Among the factors influencing these complications, the osteotomy method used plays a significant role. This systematic review aims to compare the clinical outcomes of rotary instruments, piezosurgery and Er:YAG laser, in order to support clinical decision-making. Materials and Methods: A systematic search was conducted in the PubMed, Scopus, Cochrane Library, and ScienceDirect databases using the MeSH terms: “Third Molar,” “Osteotomy,” “Postoperative Complications,” and “Postoperative Pain.” Study selection followed PRISMA guidelines, and the risk of bias was assessed using the Cochrane RoB2 tool. Only randomized clinical trials, published in English within the past 20 years were included. Results: Of the 615 studies initially identified, 11 met the inclusion criteria. In terms of postoperative pain, 6 studies demonstrated statistically significant differences: 5 favoring piezosurgery and 1 favoring the Er:YAG laser. Postoperative swelling was assessed in 8 studies, with statistically significant differences observed in 6 using piezosurgery and 2 using laser. Trismus was also reported in 6 studies, all showing statistically significant differences, with less functional limitation in the piezo group (4 studies) and in the laser group (2 studies). Patient satisfaction was evaluated in 2 studies using piezosurgery, both reporting statistically significant improvements. Surgical time was significantly longer with piezosurgery in 5 studies and with laser in 2, particularly in complex procedures or those performed by less experienced operators. Conclusion: Osteotomy performed using piezo-electric and Er:YAG laser reduced postoperative morbidity compared to the rotary technique, particularly in more complex surgical cases.
Introduction: The surgical extraction of impacted mandibular third molars is a common procedure in oral surgery and is frequently associated with postoperative pain, swelling, and trismus. Among the factors influencing these complications, the osteotomy method used plays a significant role. This systematic review aims to compare the clinical outcomes of rotary instruments, piezosurgery and Er:YAG laser, in order to support clinical decision-making. Materials and Methods: A systematic search was conducted in the PubMed, Scopus, Cochrane Library, and ScienceDirect databases using the MeSH terms: “Third Molar,” “Osteotomy,” “Postoperative Complications,” and “Postoperative Pain.” Study selection followed PRISMA guidelines, and the risk of bias was assessed using the Cochrane RoB2 tool. Only randomized clinical trials, published in English within the past 20 years were included. Results: Of the 615 studies initially identified, 11 met the inclusion criteria. In terms of postoperative pain, 6 studies demonstrated statistically significant differences: 5 favoring piezosurgery and 1 favoring the Er:YAG laser. Postoperative swelling was assessed in 8 studies, with statistically significant differences observed in 6 using piezosurgery and 2 using laser. Trismus was also reported in 6 studies, all showing statistically significant differences, with less functional limitation in the piezo group (4 studies) and in the laser group (2 studies). Patient satisfaction was evaluated in 2 studies using piezosurgery, both reporting statistically significant improvements. Surgical time was significantly longer with piezosurgery in 5 studies and with laser in 2, particularly in complex procedures or those performed by less experienced operators. Conclusion: Osteotomy performed using piezo-electric and Er:YAG laser reduced postoperative morbidity compared to the rotary technique, particularly in more complex surgical cases.
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Third molar Osteotomy Postoperative complications Postoperative pain
Pedagogical Context
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