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Background: The authors updated a previously published systematic review to assess the effects of low-level laser therapy (LLLT) on reducing complications after the removal of impacted mandibular third molars., Types of Studies Reviewed: The authors searched for randomized clinical trials in which the investigators evaluated the efficacy of LLLT compared with that of placebo or no treatment. Two reviewers independently screened studies, extracted data, and assessed risk of bias. The authors used random effects model meta-analysis and the Grading of Recommendations Assessment, Development and Evaluation approach to rate the certainty of evidence., Results: The authors included 21 studies. There was low-certainty evidence that LLLT results in less pain at 2 days after surgery (mean difference [MD], -1.42 on a 10 point scale; 95% confidence interval [CI], -2.18 to -0.67) and moderate certainty that it results in negligibly less pain at 7 days (MD, -0.59; 95% CI, -0.96 to -0.22); moderate-certainty evidence that LLLT has a negligible benefit on reducing trismus at 2 days (MD, -3.42 millimeters; 95% CI, -5.34 to -1.50) and at 7 days after surgery (MD, -2.30 mm; 95% CI, -3.96 to -0.64); lastly, there was moderate-certainty evidence that LLLT results in less postoperative swelling at 2 days (standardized MD, -0.82; 95% CI, -1.28 to -0.35) and low-certainty evidence that LLLT results in negligibly less postoperative swelling at 7 days after surgery (standardized MD, -0.17; 95% CI, -0.4 to 0.07). Low-quality evidence suggests that LLLT will not cause adverse effects., Conclusions and Practical Implications: LLLT probably has negligible benefits but may not result in adverse events. Evidence does not support the use of LLLT in clinical practice to reduce complications after impacted mandibular third-molar surgical extractions., (Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine the impact of secondary versus primary closure techniques on the frequency and severity of pain, facial swelling, trismus, infectious complications, and postoperative bleeding after impacted mandibular third molar extraction., Materials and Methods: Randomized controlled trials were identified through MEDLINE, EMBASE, and CENTRAL, ongoing trial registers, meeting abstracts, doctoral and masters theses, and manual searching of the reference lists of eligible studies. Study selection, data extraction, risk of bias, and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) rating of confidence in effect estimates were undertaken independently in duplicate., Results: Of 1,721 identified citations, 14 studies proved eligible. Pain and facial swelling at postoperative days 3 and 7 and infectious complications at day 7 did not differ between techniques. Patients receiving secondary closure had less trismus (in millimeters) at postoperative days 3 (mean difference, 3.72; 95% confidence interval, 1.42 to 6.03, P = .002) and 7 (mean difference, 2.35; 95% confidence interval, 0.37 to 4.33; P = .02). Four randomized controlled trials reported bleeding: in 2, there was no bleeding in either group; the numbers of bleeding events with primary and secondary closures were 22 and 16 and 5 and 15, respectively, in the other 2. Because of the risk of bias and inconsistency in results, the evidence warranted, at best, low confidence in the estimates of effect across all outcomes., Conclusions: Although differences between primary and secondary closure techniques after impacted mandibular third molar extraction are likely to be small, available evidence provides only low confidence in the effect estimates. The results do not support a preference for either approach., (Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the efficacy and safety of low-level laser energy irradiation (LLEI) for decreasing pain, swelling, and trismus after surgical removal of impacted mandibular third molars (IMTMs)., Materials and Methods: MEDLINE, EMBASE, and the Central Register of Controlled Trials of the Cochrane Library were searched from their inception, and conference proceedings, cross-references, and gray literature were searched for the last 5 years for randomized and quasi-randomized controlled trials that evaluated the effects of any type of LLEI, compared with active or inactive treatments, in patients undergoing surgical removal of IMTMs. Risk of bias in included studies was assessed by 2 independent evaluators using the Cochrane Risk of Bias tool. A random-effects model meta-analysis was used to estimate the mean difference of trismus between the groups. Heterogeneity was assessed using Cochran χ(2) and I(2)., Results: Ten eligible trials were included in this systematic review. The included studies overall had a moderate risk of bias. Because of heterogeneity in the intervention and outcomes assessments, pain and swelling outcomes were only qualitatively summarized and indicated no beneficial effects of LLEI over placebo. Patients receiving LLEI had an average of 4.2 mm (95% confidence interval, 1.2 to 7.2) and 5.2 mm (95% confidence interval, 1.8 to 8.2) less trismus than patients receiving no active treatment on the second and seventh day after the surgery, respectively., Conclusions: There was no benefit of LLEI on pain or swelling and a moderate benefit on trismus after removal of IMTMs. It is necessary to standardize the intervention and outcomes assessment and to conduct adequately powered, well-designed trials to evaluate the efficacy of LLEI., (Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)