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

Detalhes bibliográficos
Autor(a) principal: Gondim, Ricardo Franklin
Data de Publicação: 2022
Tipo de documento: Tese
Idioma: por
Título da fonte: Repositório Institucional da Universidade Federal do Ceará (UFC)
Texto Completo: http://www.repositorio.ufc.br/handle/riufc/67395
Resumo: 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.
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spelling O uso do laser de alta potência para incisões em cirurgias de dentes inclusos e semi-inclusos : ensaio clínico randomizado, duplo-cego, controladoAnalgesiaAnti-Inflamatórios não EsteroidesLasersTerapia a LaserTerapia com Luz de Baixa IntensidadeDente SerotinoCirurgia GeralRemoval 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.A remoção de dentes inclusos é um procedimento rotineiramente realizado no consultório de cirurgiões bucomaxilofaciais. Por ter um pós-operatório considerado desconfortável, diferentes estratégias de controle dos eventos inflamatórios têm sido investigadas. A utilização da tecnologia a laser na Odontologia tem incorporado diversos protocolos de tratamento e aparelhos de baixa e de alta potência têm sido utilizados. A laserterapia de baixa intensidade (LBI) tem sido bastante investigada, com grande variação de protocolos. Relatos na literatura indicam que o laser de alta potência (LAP) tem como benefícios analgesia local e hemostasia e, dependendo do procedimento cirúrgico, controle do edema. Surge, então, a indagação se tais efeitos são observados em pacientes que se submetem à remoção de dentes inclusos ou semi-inclusos. O objetivo do presente estudo foi comparar os parâmetros de dor, de consumo de medicação, de abertura bucal e de edema quando o LAP é associado às estratégias farmacológicas ou à LBI em cirurgias para remoção de quatro terceiros molares. A amostra foi composta por 152 pacientesnormossistêmicos, com idade mínima de 18 anos, que apresentaram a indicação de remoção em única sessão de 4 terceiros molares inclusos ou semiinclusos em qualquer posição. Inicialmente, os participantes da pesquisa foram divididos de forma aleatória em 2 grupos. No grupo Lâmina 15 (L15), a incisão foi feita com bisturi em lâmina 15 e, no grupo LAP, foi realizada com laser cirúrgico. Cada grupo foi subdividido em três subgrupos: Lâmina 15 Placebo (L15-P), Lâmina 15 Medicação Preemptiva (L15-MP), Lâmina 15 LBI (L15-LBI), LAP Placebo (LAP-P), LAP Medicação Preemptiva (LAP-MP) e LAP LBI (LAPLBI). Nos grupos L15-P e LAP-P, os pacientes receberam a orientação de consumo de medicamentos com ação analgésica e anti-inflamatória no pósoperatório. Nos grupos L15-MP e LAP-MP, os pacientes recebiam analgesia preemptiva com glicocorticoide e AINE. Nos grupos L15-LBI e LAP-LBI, a LBI foi realizada no pós-operatório imediato e com 72 horas após a cirurgia. Os resultados demonstram que os pacientes sem medidas anti-inflamatórias que foram operados com LAP (grupo LAP-P), em comparação aos operados com lâmina 15 (grupo L15-P), apresentaram menores escores de dor em todos os períodos avaliados (p<0,001), assim como menor consumo de medicamentos na avaliação global (p<0,001). A variação de abertura bucal, nesses mesmos dois grupos, também foi menor em todos os períodos avaliados (T1 p=0,001; T2 p=0,007; T3 p=0,001 e T4 p=0,028). Quanto ao edema, a media GônioTragus foi a que sofreu maior variação em relação ao p valor nos pacientes do grupo LAP-P em comparação aos do grupo L15-P em todos os períodos avaliados (T1 p=0,008; T2 p<0,001; T3 p=0,003e T4 p=0,002). Não houve aumento do efeito anti-inflamatório na associação do LAP às medicações preemptivas ou à LBI. Portanto, o uso do LAP mostrou resultados positivos para a diminuição da dor, do consumo de medicação de resgate e do trismo pósoperatório em cirurgias de remoção de quatro terceiros molares, porém benefício limitado no controle do edema.Nogueira, Renato Luiz MaiaGondim, Ricardo Franklin2022-07-25T11:22:28Z2022-07-25T11:22:28Z2022-07-21info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisapplication/pdfGONDIM. R. F. O uso do laser de alta potência para incisões em cirurgias de dentes inclusos e semi-inclusos : ensaio clínico randomizado, duplo-cego, controlado. 2022. 71 f. Tese (Doutorado em Odontologia) - Faculdade de Farmácia, Odontologia e Enfermagem, Universidade Federal do Ceará, Fortaleza, 2022. Disponível em: http://www.repositorio.ufc.br/handle/riufc/67250. Acesso em: 25/07/2022.http://www.repositorio.ufc.br/handle/riufc/67395porreponame:Repositório Institucional da Universidade Federal do Ceará (UFC)instname:Universidade Federal do Ceará (UFC)instacron:UFCinfo:eu-repo/semantics/openAccess2022-07-25T11:25:52Zoai:repositorio.ufc.br:riufc/67395Repositório InstitucionalPUBhttp://www.repositorio.ufc.br/ri-oai/requestbu@ufc.br || repositorio@ufc.bropendoar:2024-09-11T18:21:54.379508Repositório Institucional da Universidade Federal do Ceará (UFC) - Universidade Federal do Ceará (UFC)false
dc.title.none.fl_str_mv O uso do laser de alta potência para incisões em cirurgias de dentes inclusos e semi-inclusos : ensaio clínico randomizado, duplo-cego, controlado
title O uso do laser de alta potência para incisões em cirurgias de dentes inclusos e semi-inclusos : ensaio clínico randomizado, duplo-cego, controlado
spellingShingle O uso do laser de alta potência para incisões em cirurgias de dentes inclusos e semi-inclusos : ensaio clínico randomizado, duplo-cego, controlado
Gondim, Ricardo Franklin
Analgesia
Anti-Inflamatórios não Esteroides
Lasers
Terapia a Laser
Terapia com Luz de Baixa Intensidade
Dente Serotino
Cirurgia Geral
title_short O uso do laser de alta potência para incisões em cirurgias de dentes inclusos e semi-inclusos : ensaio clínico randomizado, duplo-cego, controlado
title_full O uso do laser de alta potência para incisões em cirurgias de dentes inclusos e semi-inclusos : ensaio clínico randomizado, duplo-cego, controlado
title_fullStr O uso do laser de alta potência para incisões em cirurgias de dentes inclusos e semi-inclusos : ensaio clínico randomizado, duplo-cego, controlado
title_full_unstemmed O uso do laser de alta potência para incisões em cirurgias de dentes inclusos e semi-inclusos : ensaio clínico randomizado, duplo-cego, controlado
title_sort O uso do laser de alta potência para incisões em cirurgias de dentes inclusos e semi-inclusos : ensaio clínico randomizado, duplo-cego, controlado
author Gondim, Ricardo Franklin
author_facet Gondim, Ricardo Franklin
author_role author
dc.contributor.none.fl_str_mv Nogueira, Renato Luiz Maia
dc.contributor.author.fl_str_mv Gondim, Ricardo Franklin
dc.subject.por.fl_str_mv Analgesia
Anti-Inflamatórios não Esteroides
Lasers
Terapia a Laser
Terapia com Luz de Baixa Intensidade
Dente Serotino
Cirurgia Geral
topic Analgesia
Anti-Inflamatórios não Esteroides
Lasers
Terapia a Laser
Terapia com Luz de Baixa Intensidade
Dente Serotino
Cirurgia Geral
description 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.
publishDate 2022
dc.date.none.fl_str_mv 2022-07-25T11:22:28Z
2022-07-25T11:22:28Z
2022-07-21
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/doctoralThesis
format doctoralThesis
status_str publishedVersion
dc.identifier.uri.fl_str_mv GONDIM. R. F. O uso do laser de alta potência para incisões em cirurgias de dentes inclusos e semi-inclusos : ensaio clínico randomizado, duplo-cego, controlado. 2022. 71 f. Tese (Doutorado em Odontologia) - Faculdade de Farmácia, Odontologia e Enfermagem, Universidade Federal do Ceará, Fortaleza, 2022. Disponível em: http://www.repositorio.ufc.br/handle/riufc/67250. Acesso em: 25/07/2022.
http://www.repositorio.ufc.br/handle/riufc/67395
identifier_str_mv GONDIM. R. F. O uso do laser de alta potência para incisões em cirurgias de dentes inclusos e semi-inclusos : ensaio clínico randomizado, duplo-cego, controlado. 2022. 71 f. Tese (Doutorado em Odontologia) - Faculdade de Farmácia, Odontologia e Enfermagem, Universidade Federal do Ceará, Fortaleza, 2022. Disponível em: http://www.repositorio.ufc.br/handle/riufc/67250. Acesso em: 25/07/2022.
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