Eficácia da crioterapia na redução da dor, edema e trismo após cirurgia de terceiros molares : revisão sistemática e meta-análise de ensaios clínicos randomizados

• Ano de defesa: 2019
• Autor(a) principal: Nascimento Junior, Edmundo Marques do
• Orientador(a): Martins Filho, Paulo Ricardo Saquete
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Programa de Pós-Graduação: Pós-Graduação em Odontologia
• Palavras-chave em Português: Crioterapia; Cirurgia bucal; Edema; Trismo; Dor
• Palavras-chave em Inglês: Cryotherapy; Oral surgery; Pain; Trismus
• Área do conhecimento CNPq: CIENCIAS DA SAUDE::ODONTOLOGIA
• Link de acesso: http://ri.ufs.br/jspui/handle/riufs/13160

Third molars removal is a routine procedure in oral and maxillofacial surgery and is usually related to postoperative complications such as pain, edema and trismus, interfering in patients' quality of life. Controling postoperative inflammation then becomes important and has been performed in several ways, with cryotherapy being quite common as a supporting method. There is a lack of evidence on the efficacy of cryotherapy to control pain, edema and trismus after third molars removal. The aim of this study was to investigate this efficacy through a systematic review and meta-analysis of randomized clinical trials (RCTs). We searched PubMed, Web of Science, SCOPUS, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Google Scholar and OpenThesis to select RCTs from inception to June 2018. The search string included cryotherapy, third molars, and wisdom teeth. The eligibility criteria were: (1) population: patients submitted to removal of impacted third molars; (2) intervention and control: postoperative cryotherapy versus no cold therapy; (3) outcomes: primary outcome was postoperative pain and secondary outcomes were facial swelling and trismus; (4) study type: RCTs. Eligible studies must had reported at least one of the outcomes of interest. Two reviewers selected studies, extracted data and assessed study quality according to Cochrane guidelines for RCTs. We used either the weighted mean difference (WMD) or the standardized mean difference (SMD) as effect measures and a 95% confidence intervals (CI). The strength of evidence was measured using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) rating system. To calculate the effect sizes, means and standard deviations (SD) were obtained for each study group and outcome of interest. Six RCTs were included in the meta-analysis. Differences in pain intensity were found in the second (WMD -0.72, 95% CI 1.45 to 0.01, p = 0.05, I2 = 0%) and third (WMD -0.36, 95% CI % -0.59 to 0.13, p = 0.002, I2 = 0%) postoperative days. No evidence was found that cryotherapy was effective in reducing trismus and edema after third molar surgery. Despite the improvement in pain levels when cryotherapy was used, the quality of the evidence was considered low.