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Efectos de la aplicación del láser de diodo de baja potencia tras la exodoncia quirúrgica de terceros molares inferiores. Revisión sistemática y meta-análisis . Estudio piloto.

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2022-03-22
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Objetivo: La exodoncia quirúrgica de los terceros molares, siendo una intervención traumática para los tejidos vecinos, acarrea a menudo complicaciones como el dolor, el edema y el trismo. Este estudio tiene como objetivo evaluar los efectos del láser de baja potencia en reducir estos signos postoperatorios. Métodos: Una revisión sistemática y meta-análisis se ha llevado a cabo, basada sobreestudios clínicos controlados por placebo en pacientes tratados con láser de Diodo de baja potencia tras la cirugía bilateral de terceros molares. Una búsqueda exhaustiva en tres bases electrónicas de datos ha sido conducida por dos revisores. Los resultados para evaluar son: dolor, edema y trismo postoperatorios. Los datos extraídos fueron analizados estadísticamente en el meta-análisis. En base en los resultados obtenidos en la revisión sistemática, se hizo necesaria la realización de un estudio piloto llevado a cabo en la Facultad de Odontología de la Universidad Complutense de Madrid, en el cual evaluaron los efectos de la aplicación del láser de Diodo de baja potencia comparado con placebo en la reducción de dolor, edema y trismo tras la exodoncia quirúrgica bilateral de terceros molares inferiores. Resultados: Nueve artículos cumplieron los criterios de inclusión. En el meta-análisis, ha demostrado la significación estadística de los resultados del dolor y del edema mientras que al respecto del trismo, no hubo significación estadística. Estos resultados están de acuerdo con los hallazgos del estudio piloto en el cual se encontró menores niveles de dolor y edema en el grupo láser comparado al grupo placebo, mientras que en relación al trismo no hubo diferencias estadísticas entre los grupos. Conclusión: El láser de baja potencia parece ser eficiente en reducir el dolor y el edema que surgen después de la exodoncia quirúrgica de los terceros molares, mientras parece no tener efecto sobre el trismo posoperatorio. Estudios con tamaños muestrales más consistentes, y con diseño unificado en relación a los parámetros del láser, se precisan a fin de proporcionar al clínico una evidencia de calidad extrapolable en su práctica diaria.
Purpose: Surgical extraction of third molars, being a traumatic intervention for neighboring tissues, often leads to complications such as pain, edema and trismus. This study aims to evaluate the effects of Low-Level Laser Therapy in reducing these three postoperative signs. Methods: A systematic review and meta-analysis has been carried out, based on placebo-controlled clinical studies in patients treated with low-level Diode laser after bilateral third molar surgery. A comprehensive search of three electronic databases has been conducted by two reviewers. The outcomes to assess are: Pain, swelling and postoperative trismus. The extracted data were statistically analyzed in the meta�analysis. Based on the results obtained in the systematic review, it became necessary to carry out a pilot clinical study at the Faculty of Dentistry of the Complutense University of Madrid in which the effects of the application of the low-level diode laser were evaluated compared to placebo in reducing pain, edema and trismus after bilateral surgical extraction of lower third molars. Results: Nine articles satisfied the inclusion criteria. In the meta-analysis, the statistical significance of the results for pain and edema was demonstrated, while regarding trismus, there was no statistical significance. These results are in agreement with the findings of the pilot study in which lower levels of pain and edema were found in the laser group compared to the placebo group, while in relation to trismus there were no statistical differences between the groups. Conclusion: The LLLT laser appears to be efficient in reducing pain and swelling that arise after surgical extraction of third molars, while having no effect on postoperative trismus. Studies with more consistent sample sizes, and with an unified design,particularly taking into account the emission parameters and the laser exposure time, are required in order to provide the clinician with high-quality evidence that can be extrapolated in his/her daily practice.
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