Skip to main content

Advertisement

SpringerLink
Log in

The effect of hyaluronic acid addition to collagen in reducing the trismus and swelling after surgical extraction of impacted lower third molars: a split-mouth, randomized controlled study

  • Research
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Background

Removal of impacted third molars is associated with postoperative complications such as pain, swelling, ecchymosis, trismus, infection, and hematoma. Thus, contemporary surgery aims to reduce complications by applying collagen or hyaluronic acid in the socket after extracting the impacted mandibular third molars. This study aimed to study the efficacy of hyaluronic acid (HA) addition to collagen, compared to collagen application alone, on the magnitude of swelling and trismus following impacted mandibular third molar surgery.

Methods and materials

A total of 40 impacted molars of 20 participants who had completely bilateral impacted lower third molars were enrolled in this split-mouth, randomized, clinical trial. Randomization was carried out by two opaque envelops; two materials were applied topically in the socket collagen alone or with hyaluronic. The postoperative mouth-opening limitation and swelling rate were assessed on the third and seventh days after the extraction.

Results

The mean age was 22.7 ± 3.079 years (75% female and 25% male). Regarding the rate of trismus, the test sides had less values than the control sides on 3rd days (44.03 ± 12.8 vs. 52.14 ± 13.7) and 7th days (19.22 ± 12.8 vs. 32.45 ± 15.3) postoperatively but the difference is only significant on the seventh day (P = 0.005). The swelling scores of the hyaluronic acid addition group were significantly lesser than those of the collagen alone group on the third and the seventh day (P < 0.05) except for the lateral canthus to the angulus mandibulae on the third day (P = 0.133).

Conclusion

Adding hyaluronic acid to collagen could effectively reduce the severity of facial swelling and trismus following surgical extraction of impacted lower third molars.

Statement of clinical relevance

Swelling and trismus are the most sequela following impacted third molar surgical extraction. This study showed that applying hyaluronic acid with collagen can reduce the severity of facial swelling and trismus which could be useful in surgeons’ daily practice.

We should mention that this original article has a preprint edition (44).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

The data that support the findings of this study are available from the authors on request.

Abbreviations

PRF:

Platelet-rich fibrin

GAGs:

Glycosaminoglycans

ECM:

The extracellular matrix

HA:

Hyaluronic acid

3M:

Third molars

CHA:

Hyaluronic acid addition to collagen

RCT:

Randomized clinical trial

ASA:

American Society of Anesthesiologists

CO:

The collagen group

L-PRF:

Leukocyte- and platelet-rich fibrin

TPO:

Tragus to pogonion

TCO:

Tragus to labial commissure

ACA:

Angulus mandibulae to lateral canthus

VAS:

Visual analog scale

CHL:

chlorhexidine

MIMT:

mandibular impacted third molar

References

  1. Peñarrocha-Diago M, Camps-Font O, Sánchez-Torres A, Figueiredo R, Sánchez-Garcés M-A, Gay-Escoda C (2021) Indications of the extraction of symptomatic impacted third molars. A systematic review. J Clin Exp Dent. 13:e278-86. https://doi.org/10.4317/jced.56887

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kannan R, Gayathri (2021) Management of inflammatory complications in third molar surgery. International Journal of Science & Engineering Development Research 6(4):687–690. Available: http://www.ijsdr.org/papers/IJSDR2104113.pdf

  3. Elayah SA, Liang X, Sakran KA et al (2022) Effect of concentrated growth factor (CGF) on postoperative sequel of completely impacted lower third molar extraction: a randomized controlled clinical study. BMC Oral Health 22:368. https://doi.org/10.1186/s12903-022-02408-7

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kazancioglu HO, Kurklu E, Ezirganli S (2014) Effects of ozone therapy on pain, swelling, and trismus following third molar surgery. Int J Oral Maxillofac Surg 43:644–648

    Article  PubMed  Google Scholar 

  5. do Nascimento-Junior EM, dos Santos GMS, Mendes MLT, Cenci M, Correa MB, Pereira-Cenci T, Martins-Filho PRS (2019) Cryotherapy in reducing pain, trismus, and facial swelling after third-molar surgery: systematic review and meta-analysis of randomized clinical trials. J Am Dent Assoc. 150:269–77

    Article  PubMed  Google Scholar 

  6. Manafikhi M, Ataya J, Heshmeh O (2022) Evaluation of the efficacy of platelet rich fibrin (I-PRF) intra-articular injections in the management of internal derangements of temporomandibular joints–a controlled preliminary prospective clinical study. BMC Musculoskelet Disord 23:1–7

    Article  Google Scholar 

  7. Kim J-W, Seong T-W, Cho S, Kim S-J (2020) Randomized controlled trial on the effectiveness of absorbable collagen sponge after extraction of impacted mandibular third molar: split-mouth design. BMC Oral Health 20:77. https://doi.org/10.1186/s12903-020-1063-3

    Article  PubMed  PubMed Central  Google Scholar 

  8. Guazzo R, Perissinotto E, Mazzoleni S, Ricci S, Peñarrocha-Oltra D, Sivolella S (2018) Effect on wound healing of a topical gel containing amino acid and sodium hyaluronate applied to the alveolar socket after mandibular third molar extraction: a double-blind randomized controlled trial. Quintessence Int 49(10):831–840. https://doi.org/10.3290/j.qi.a41157

    Article  PubMed  Google Scholar 

  9. Cho H, Jung H-D, Kim B-J, Kim C-H, Jung Y-S (2015) Complication rates in patients using absorbable collagen sponges in third molar extraction sockets: a retrospective study. J Korean Assoc Oral Maxillofac Surg 41:26

    Article  PubMed  PubMed Central  Google Scholar 

  10. Bunyaratavej P, Wang HL (2001) Collagen membranes: a review. J Periodontol 72:215–229. https://doi.org/10.1902/jop.2001.72.2.215

    Article  PubMed  Google Scholar 

  11. Nam J-W, Kim K-W (2009) The effects of atelo-collagen sponge insertion on the periodontal healing of second molars after impacted mandibular third molar extraction. J Korean Assoc Oral Maxillofac Surg 35:112–119

    Google Scholar 

  12. Gupta RC, Lall R, Srivastava A, Sinha A (2019) Hyaluronic acid: molecular mechanisms and therapeutic trajectory. Front Vet Sci 6:192. https://doi.org/10.3389/fvets.2019.00192

    Article  PubMed  PubMed Central  Google Scholar 

  13. Koray M, Ofluoglu D, Onal EA, Ozgul M, Ersev H, Yaltirik M, Tanyeri H (2014) Efficacy of hyaluronic acid spray on swelling, pain, and trismus after surgical extraction of impacted mandibular third molars. Int J Oral Maxillofac Surg 43:1399–1403

    Article  PubMed  Google Scholar 

  14. Afat İM, Akdoğan ET, Gönül O (2018) Effects of leukocyte-and platelet-rich fibrin alone and combined with hyaluronic acid on pain, edema, and trismus after surgical extraction of impacted mandibular third molars. J Oral Maxillofac Surg 76:926–932

    Article  PubMed  Google Scholar 

  15. Castro MAA, Noronha MS, Martins-Junior PA, Mendes RM, Caliari MV, Mesquita RA, Ferreira AJ (2018) Hyaluronic acid accelerates bone repair in human dental sockets: a randomized triple-blind clinical trial. Braz Oral Res 32. https://doi.org/10.1590/1807-3107bor-2018.vol32.0084

  16. Altaweel AA, Gaber AE-H, Alnaffar MZ et al (2022) Methylprednisolone and hyaluronic acid versus each agent alone to control complication of impacted wisdom removal. Evidence-Based Complement Altern Med 2022:1–8

    Article  Google Scholar 

  17. Afat IM, Akdoğan ET, Gönül O (2019) Effects of leukocyte-and platelet-rich fibrin alone and combined with hyaluronic acid on early soft tissue healing after surgical extraction of impacted mandibular third molars: a prospective clinical study. J Cranio-Maxillofacial Surg 47:280–286

    Article  Google Scholar 

  18. Tsai S-J, Chen M-H, Lin H-Y, Lin C-P, Chang H-H (2019) Pure type-1 collagen application to third molar extraction socket reduces postoperative pain score and duration and promotes socket bone healing. J Formos Med Assoc 118:481–487

    Article  PubMed  Google Scholar 

  19. Xu Q, Torres JE, Hakim M et al (2021) Collagen-and hyaluronic acid-based hydrogels and their biomedical applications. Mater Sci Eng R Reports 146:100641

    Article  Google Scholar 

  20. World Medical Association Declaration of Helsinki (2013) Ethical principles for medical research involving human subjects. JAMA 310:2191–2194. https://doi.org/10.1001/jama.2013.281053

    Article  Google Scholar 

  21. Menon RK, Gopinath D, Li KY, Leung YY, Botelho MG (2019) Does the use of amoxicillin/amoxicillin–clavulanic acid in third molar surgery reduce the risk of postoperative infection? A systematic review with meta-analysis. Int J Oral Maxillofac Surg 48:263–273

    Article  PubMed  Google Scholar 

  22. O’Sullivan L, Ríordáin RN (2021) Variations in reporting of clinician-reported outcome measures in third molar surgery: A focused review. Surgeon 20:e43–e50

    Article  PubMed  Google Scholar 

  23. Yilmaz N, Demirtas N, Kazancioglu HO, Bayer S, Acar AH, Mihmanli A (2017) The efficacy of hyaluronic acid in postextraction sockets of impacted third molars: a pilot study. Niger J Clin Pract 20:1626–1631

    PubMed  Google Scholar 

  24. Kilinc A, Ataol M (2017) How effective is collagen resorbable membrane placement after partially impacted mandibular third molar surgery on postoperative morbidity? A prospective randomized comparative study. BMC Oral Health 17:1–8

    Article  Google Scholar 

  25. Deliverska EG, Petkova M (2016) Complications after extraction of impacted third molars-literature review. J IMAB–Ann Proc Sci Pap 22:1202–11

  26. Nariman SK (2021) AL-kamali RK: Clinical efficacy of hyaluronic acid in post-extraction sockets of impacted mandibular third molar. Erbil Dent J 4:77–84

    Article  Google Scholar 

  27. Gocmen G, Aktop S, Tüzüner B, Goker B, Yarat A (2017) Effects of hyaluronic acid on bleeding following third molar extraction. J Appl Oral Sci 25:211–216

    Article  PubMed  PubMed Central  Google Scholar 

  28. Gocmen G, Gonul O, Oktay NS, Yarat A, Goker K (2015) The antioxidant and anti-inflammatory efficiency of hyaluronic acid after third molar extraction. J Cranio-Maxillofacial Surg 43:1033–1037

    Article  Google Scholar 

  29. Muñoz-Cámara D, Pardo-Zamora G, Camacho-Alonso F (2021) Postoperative effects of intra-alveolar application of 0.2% chlorhexidine or 1% hyaluronic acid bioadhesive gels after mandibular third molar extraction: a double-blind randomized controlled clinical trial. Clin Oral Investig. 25:617–25

    Article  PubMed  Google Scholar 

  30. Kokash M, Darwich K, Ataya J (2022) Hyaluronic acid addition to collagen reduces the trismus and swelling after surgical extraction of impacted lower third molars: A Split-Mouth, randomized controlled study. Research Square. https://doi.org/10.21203/rs.3.rs-1751189/v1

Download references

Acknowledgements

A very big thank you for Damascus University for their support.

Funding

There has been no funding for this study; however, this study was supported by the Damascus University.

Author information

Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Damascus University, Damascus, Syria

    Moemeneh Kokash, Khaldoun Darwich & Jawdat Ataya

  2. Medical Education Programme, Syrian Virtual University, Damascus, Syria

    Jawdat Ataya

Authors
  1. Moemeneh Kokash
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Khaldoun Darwich
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jawdat Ataya
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MK and KD contributed to conception and design of the study, collecting and data analysis and Interpretation. MK and JA contributed to writing and drafting the manuscript and revision the final draft . All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jawdat Ataya.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kokash, M., Darwich, K. & Ataya, J. The effect of hyaluronic acid addition to collagen in reducing the trismus and swelling after surgical extraction of impacted lower third molars: a split-mouth, randomized controlled study. Clin Oral Invest 27, 4659–4666 (2023). https://doi.org/10.1007/s00784-023-05092-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-023-05092-1

Keywords

Search

Navigation