Is the Er: YAG Laser Effective in Reducing Pain, Edema, and Trismus After Removal of Impacted Mandibular Third Molars? A Meta-Analysis

Purpose: Removal of impacted third molars can be associated with complications such as pain, edema, and trismus that can increase the morbidity of the procedure. The purpose of this study is to determine whether the Erbium: yttrium aluminum garnet (Er: YAG) laser is effective in reducing pain, swelling and trismus compared to rotary instruments in removing impacted lower third molars (3Ms).Methods: For this systematic review, the searches were carried out independently by 2 researchers and the articles were selected according to the inclusion and exclusion criteria previously established. The predictor variable was the study group (Er: YAG laser versus rotary instruments). The main outcome was the analysis of post-operative pain, edema, and trismus after third molar extractions. Data analysis included the risk of bias evaluation (RoB 2 Cochrane) and meta-analysis with random effects I-2 based heterogeneity and 95% confidence.Results: In the initial results, 1,371 articles were found and 6 randomized controlled trials (RCT) were selected to compose this study. A total of 299 lower 3Ms were removed, 126 with the Er: YAG laser, 142 with a drill and 31 with a piezoelectric instrument. The results of this meta-analysis showed that in the laser group there was a significant reduction in edema (1.82 [CI95% = -3.06 to -0.57] cm (P =.004)) and complications (P =.0004), a slight reduction in pain after 2 days (P =.030) and there was no variation in trismus (P =.200) when compared to the drill group. The surgery and/or osteotomy time was shorter in the drill group. Only 1 study presented low risk of bias.Conclusions: The Er: YAG laser has been shown to be effective in reducing edema, pain and complications in impacted lower 3M surgeries. However due to the lack of standardization in Er: YAG laser therapy, new controlled and standardized studies should be performed with the aim of proving the efficacy of this therapeutic modality. (C) 2021 The American Association of Oral and Maxillofacial Surgeons.