Discussion
Edema, postoperative pain, trismus, pain
DRUG INTERACTIONS, EDEMA, TRISMUS
The LPL therapies have gained greater notoriety in recent years, but so far there has been protocol standardization applied by all authors, raising the question of which of the protocols presents the expected results for the use of LPL The first study on this topic found in the literature was Roynesdal et al. Aras et al. More recently, Santos et al. Systematic reviews on the subject A single surgeon who was unaware of which group the procedure would fit performed the surgeries in this research. The patient was also unaware of whether or not he was receiving therapy with LPL, because he was receiving a simulation with the same sound stimuli as in the real LPL procedure. In addition, the statistician responsible for the analyses received the data tabulated in codes (Test group = X, Placebo group = Y). In view of these precautions, this study produced a transparent methodological approach (without permitting data or interference from the researchers involved), which is fitting for a high-quality, randomized, and a triple-blind clinical trial, with a low risk of bias. The approach used is thus legitimate for evaluating the different post-operative pain protocols.Domah et al.In another systematic review, Hosseinpour et al.The LPL in our research was applied using a device called Therapy XT from the company DMC (São Carlos/SP, Brazil), with infrared technology, at a wavelength of 808nm +/- 10nm, fiber diameter of 600μm, an irradiation dosage of 3J/cmAs to postoperative pain, a recent systematic review A split-mouth clinical trial Finally, although a statistically significant difference was evidenced only in a portion of the parameters studied, the lower use of analgesics by patients who received LPL applications is important; it implies more patient comfort, less spending on medication, and a lower risk of negative drug interactions during the postoperative period. The time spent to perform the study was 1 year (due to the COVID-19 pandemic). The costs involving laser therapy device, surgical instruments and dental materials were in the order of U$ 1064,00.With regard to mouth opening, the test group receiving LPL application presented values ​​closer to the original mouth opening measurements (during the postoperative periods of 48 hours and 7 days) than the placebo group. Although these data are not statistically significant, the explanation for the greater mouth opening in the test group may be due to LPL´s analgesic and anti-inflammatory activity. LPL was applied to the muscles responsible for opening the mouth. A study using a methodology similar to ours and with a smaller sample (30 surgeries), carried out in 2016 by Alan and collaborators Edema measurements varied between favoring the placebo group to favoring the test group. In any case, the data were not statistically significant. As found in previous studies Despite the absence of a standardized protocol for applying LPL, we cannot rule out the effects of LPL in reducing postoperative discomfort. We observed a considerable and statistically significant decrease in postoperative rescue medication use by the test group on postoperative days four and five, in addition to the improvement in mouth opening on the second and seventh postoperative days. Several studies have already corroborated our findings In this clinical trial, as compared to the placebo group, reductions in pain (statistically significant on days four and five) and trismus were found for the group that received LPL at intraoral and extraoral points. In addition, the use of LPL as a complementary therapy is considered safe and effective in helping to reduce pain and trismus after complex third molar extractions, and its use is indicated.The laser was effective in reducing pain on the fourth and fifth postoperative days, a period in which the patient feels the greatest discomfort. Other studies also show the effectiveness of the laser in reducing pain in the postoperative period, so we believe that its application in the postoperative period in third-molar surgeries is important. The biggest limitation of our study was the small sample size, due to the COVID-19 pandemic, which made access to patients difficult. More triple-blind, randomized, split-mouth clinical trials are needed to provide better indications for LPL use.