Efficacy of topical application of hyaluronic acid in reducing complications after mandibular third molar surgery: a systematic review and meta-analysis

OBJECTIVE: This systematic re-view aimed to assess if topical application of hy-aluronic acid (HA) reduced complication rates after mandibular third molar (M3) surgery.MATERIALS , METHODS: PubMed, CENTRAL, Embase , Web of Science were searched for randomized controlled trials (RCTs) assessing the efficacy of topical hyaluronic ac-id for mandibular third molar surgery. Gray liter-ature was also searched.RESULTS: 12 RCTs were included. Meta -anal-ysis showed that pain scores were significant-ly reduced after M3 surgery with the use of HA on the 1(st), 2(nd)/3(rd), , 7(th) postoperative days. Us-ing postoperative maximal mouth opening (MMO) data, we noted that MMO was significantly better in the HA group on the 2/3(rd) post-operative day but not on the 7(th) postoperative day. Meta -anal-ysis of just three studies showed that swelling was significantly reduced on the 1st postoperative day with the use of HA, however, no such differ-ence was noted on the 2(nd)/3(rd) and 7(th) postoperative days. Alveolitis and infection data were not report-ed by the majority of studies which precluded a meta-analysis. Grading of Recommendations As-sessment, Development, and Evaluation (GRADE) certainty of evidence was low to moderate.CONCLUSIONS: Low-moderate quality of ev-idence suggests that topical application of HA may reduce pain as well as early trismus and swelling in patients undergoing M3 surgeries. The effect size of pain reduction is small thereby raising questions about its clinical significance. High inter-study heterogeneity and low-quality of trials are significant limitations. High-quality RCTs are needed to generate quality evidence.

Automated summary

This systematic review aimed to assess the efficacy of topical application of hyaluronic acid (HA) in reducing complications after mandibular third molar (M3) surgery. Twelve randomized controlled trials (RCTs) were included in the analysis. The results showed that HA significantly reduced pain scores on the 1st, 2nd/3rd, and 7th postoperative days. It also improved maximal mouth opening on the 2nd/3rd day but not on the 7th day. However, there was no significant difference in swelling between the HA and control groups on the 2nd/3rd and 7th postoperative days. The evidence quality was low to moderate according to the GRADE assessment. In conclusion, topical application of HA may reduce pain, trismus, and swelling in patients undergoing M3 surgeries, but the clinical significance of the pain reduction is questionable. High-quality RCTs are needed to generate reliable evidence.