Lasers in Medical Science

, Volume 30, Issue 6, pp 1779–1788 | Cite as

A systematic review and meta-analysis on the efficacy of low-level laser therapy in the management of complication after mandibular third molar surgery

  • W. L. He
  • F. Y. Yu
  • C. J. Li
  • J. Pan
  • R. Zhuang
  • P. J. DuanEmail author
Review Article


The successful reduction of postoperative discomfort is of great significance. This review aims to evaluate the efficacy of low-level laser therapy (LLLT) for the reduction of complication caused by impacted mandibular third molars extraction. An extensive literature search up to October 2013 for randomized controlled trials (RCTs) was performed through CENTRAL, PubMed, Embase, Medline, and CNKI. Six RCTs in which involves 193 participants are included in the meta-analysis. Among them, three RCTs exhibit a moderate risk of bias, while the other three show a high bias risk. Compared with placebo laser/control group, pain is significantly reduced with LLLT on the first day (mean difference [MD] = −2.63, 95 % confidence interval [CI] −4.46 to −0.79, P = 0.005). The superiority of LLLT in pain control persists on the second day (MD = −2.34, 95 % CI −4.61 to −0.06, P = 0.04) and the third day (MD = −3.40, 95 % CI −4.12 to −2.68, P < 0.00001). Moreover, LLLT reduces an average of 4.94 mm (MD = 4.94, 95 % CI 1.53 to 8.34, P = 0.004) of trismus compared with placebo laser irradiation in the first 3 days. On the seventh day, the superiority of LLLT also persists (MD = 3.24, 95 % CI 0.37 to 6.12, P = 0.03). In the first 3 days after surgery, extraoral irradiation (MD = −0.69, 95 % CI −1.30 to −0.08, P = 0.03) and intraoral combined with extraoral irradiation (MD = −0.65, 95 % CI −1.15 to −0.15, P = 0.01) reduced facial swelling significantly. On the seventh day, the intraoral combined with extraoral irradiation group (MD = −0.32, 95 % CI −0.59 to −0.06, P = 0.02) still showed benefit in relieving facial swelling. However, because of the heterogeneity of intervention and outcomes assessment and risk of bias of included trials, the efficacy is proved with limited evidence. In the future, well-designed RCTs with larger sample size will be required to provide clearer recommendations.


Low-level laser therapy Impacted mandibular third molars Pain Trismus Swelling Systematic review Meta-analysis 


  1. 1.
    Lago-Méndez L, Diniz-Freitas M, Senra-Rivera C, Gude-Sampedro F, Gándara Rey JM, García-García A (2007) Relationships between surgical difficulty and postoperative pain in lower third molar extractions. J Oral Maxillofac Surg 65(5):979–983PubMedCrossRefGoogle Scholar
  2. 2.
    Kreisler MB, Haj HA, Noroozi N, Willershausen BD (2004) Efficacy of low level laser therapy in reducing postoperative pain after endodontic surgery—a randomized double blind clinical study. Int J Oral Maxillofac Surg 33(1):38–41PubMedCrossRefGoogle Scholar
  3. 3.
    Lanzafame RJ, Stadler I, Coleman J, Haerum B, Oskoui P, Whittaker M, Zhang RY (2004) Temperature-controlled 830-nm low-level laser therapy of experimental pressure ulcers. Photomed Laser Surg 22(6):483–488PubMedCrossRefGoogle Scholar
  4. 4.
    Pallotta RC, Bjordal JM, Frigo L, Leal Junior EC, Teixeira S, Marcos RL, Ramos L, Messias Fde M, Lopes-Martins RA (2011) Infrared (810-nm) low-level laser therapy on rat experimental knee inflammation. Lasers Med Sci 27(1):71–78PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Pires D, Xavier M, Araújo T, Silva JA Jr, Aimbire F, Albertini R (2010) Low-level laser therapy (LLLT; 780 nm) acts differently on mRNA expression of anti- and pro-inflammatory mediators in an experimental model of collagenase-induced tendinitis in rat. Lasers Med Sci 26(1):85–94PubMedCrossRefGoogle Scholar
  6. 6.
    Silveira PC, Silva LA, Freitas TP, Latini A, Pinho RA (2010) Effects of low-power laser irradiation (LPLI) at different wavelengths and doses on oxidative stress and fibrogenesis parameters in an animal model of wound healing. Lasers Med Sci 26(1):125–131PubMedCrossRefGoogle Scholar
  7. 7.
    Brignardello-Petersen R, Carrasco-Labra A, Araya I, Yanine N, Beyene J, Shah PS (2012) Is adjuvant laser therapy effective for preventing pain, swelling, and trismus after surgical removal of impacted mandibular third molars? A systematic review and meta-analysis. J Oral Maxillofac Surg 70(8):1789–1801PubMedCrossRefGoogle Scholar
  8. 8.
    Higgins JPT, Green S (2009) Cochrane handbook for systematic reviews of interventions. Wiley, ChichesterGoogle Scholar
  9. 9.
    Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    National Institute for Clinical Excellence. Guidance on the Extraction of Wisdom Teeth (Technology Appraisal Guidance - No. 1). Available from
  11. 11.
    Buyukkurt MC, Güngörmüş M, Kaya O (2006) The effect of a single dose prednisolone with and without diclofenac on pain, trismus, and swelling after removal of mandibular third molars. J Oral Maxillofac Surg 64(12):1761–1766PubMedCrossRefGoogle Scholar
  12. 12.
    Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (Version 5.0.1). Chichester, Wiley, 2008, p 7.1Google Scholar
  13. 13.
    Higgins J, Altman D, Sterne J: Assessing risk of bias in included studies. In Higgins J, Green S (eds): Cochrane handbook for systematic reviews of interventions. Cochrane Collaboration 2011, Chapter 8Google Scholar
  14. 14.
    Sterne JAC, Egger M, Moher D: Addressing reporting biases, in Higgins J, Green S (eds): Cochrane handbook for systematic reviews of interventions. Cochrane Collaboration 2008, chapter 10Google Scholar
  15. 15.
    Marković AB, Todorović L (2006) Postoperative analgesia after lower third molar surgery: contribution of the use of long-acting local anesthetics, low-power laser, and diclofenac. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 102(5):e4–8PubMedCrossRefGoogle Scholar
  16. 16.
    Marković AB, Todorovic LJ (2007) Effectiveness of dexamethasone and low-power laser in minimizing oedema after third molar surgery: a clinical trial. Int J Oral Maxillofac Surg 36(3):226–229PubMedCrossRefGoogle Scholar
  17. 17.
    Aras MH, Güngörmüş M (2009) The effect of low-level laser therapy on trismus and facial swelling following surgical extraction of a lower third molar. Photomed Laser Surg 27(1):21–24PubMedCrossRefGoogle Scholar
  18. 18.
    Aras MH, Güngörmüş M (2010) Placebo-controlled randomized clinical trial of the effect two different low-level laser therapies (LLLT)—intraoral and extraoral—on trismus and facial swelling following surgical extraction of the lower third molar. Lasers Med Sci 25(5):641–518PubMedCrossRefGoogle Scholar
  19. 19.
    Fikácková H, Navratilova B, Dylevsky I (2003) Assessment of the effect of non-invasive laser on the process of healing of an extraction wound by infrared thermography: preliminary study. J Appl Biomed 1:6Google Scholar
  20. 20.
    Amarillas-Escobar ED, Toranzo-Fernández JM, Martínez-Rider R (2010) Use of therapeutic laser after surgical removal of impacted lower third molars. J Oral Maxillofac Surg 68(2):319–324PubMedCrossRefGoogle Scholar
  21. 21.
    López-Ramírez M, Vílchez-Pérez MA, Gargallo-Albiol J, Arnabat-Domínguez J, Gay-Escoda C (2012) Efficacy of low-level laser therapy in the management of pain, facial swelling, and postoperative trismus after a lower third molar extraction. A preliminary study. Lasers Med Sci 27(3):559–566PubMedCrossRefGoogle Scholar
  22. 22.
    Kazancioglu HO, Ezirganli S, Demirtas N (2013) Comparison of the influence of ozone and laser therapies on pain, swelling, and trismus following impacted third-molar surgery. Lasers Med Sci(Mar 14)Google Scholar
  23. 23.
    Neckel C, Kukiz P (2001) Biostimulation. A comparative study in the postoperative outcome of patients after third molar extraction. J Oral Laser Appl 1:215–219Google Scholar
  24. 24.
    Goyal M, Marya K, Jhamb A, Chawla S, Sonoo PR, Singh V, Aggarwal A (2012) Comparative evaluation of surgical outcome after removal of impacted mandibular third molars using a Piezotome or a conventional handpiece: a prospective study. Br J Oral Maxillofac Surg 50(6):556–561PubMedCrossRefGoogle Scholar
  25. 25.
    Pesevska S, Nakova M, Ivanovski K, Angelov N, Kesic L, Obradovic R, Mindova S, Nares S (2010) Dentinal hypersensitivity following scaling and root planing: comparison of low-level laser and topical fluoride treatment. Lasers Med Sci 25(5):647–650PubMedCrossRefGoogle Scholar
  26. 26.
    He WL, Li CJ, Liu ZP et al (2013) Efficacy of low-level laser therapy in the management of orthodontic pain: a systematic review and meta-analysis. Lasers Med Sci 28(6):1581–1589PubMedCrossRefGoogle Scholar
  27. 27.
    Lievens PC (1991) The effect of the combined HeNe and IR laser treatment on the regeneration of the lymphatic system during the process of wound healing. Lasers Med Sci 6:189–191CrossRefGoogle Scholar
  28. 28.
    Alghamdi KM, Kumar A, Moussa NA (2011) Low-level laser therapy: a useful technique for enhancing the proliferation of various cultured cells. Lasers Med Sci 27(1):237–249PubMedCrossRefGoogle Scholar
  29. 29.
    Carrillo JS, Calatayud J, Manso FJ (1990) A randomized double blind clinical trial on the effectiveness of helium–neon laser in the prevention of pain, swelling and trismus after removal of impacted third molars. Int Dent J 40(1):31–36PubMedGoogle Scholar
  30. 30.
    Oikarinen K (1991) Postoperative pain after mandibular third molar surgery. Acta Odontol Scand 49:7–13PubMedCrossRefGoogle Scholar
  31. 31.
    Fikácková M, Petrini M, Trentini P, Perfetti G, Spoto G (2013) Effect of low-level laser therapy after extraction of impacted lower third molars. Lasers Med Sci 28(3):845–849CrossRefGoogle Scholar
  32. 32.
    Taube S, Piironen J, Ylipaavalniemi P (1990) Helium–neon laser therapy in the prevention of postoperative swelling and pain after wisdom tooth extraction. Proc Finn Dent Soc 86(1):23–27PubMedGoogle Scholar
  33. 33.
    Fernando S, Hill CM, Walker R (1993) A randomised double blind comparative study of low level laser therapy following surgical extraction of lower third molar teeth. Br J Oral Maxillofac Surg 31(3):170–172PubMedCrossRefGoogle Scholar
  34. 34.
    Røynesdal AK, Björnland T, Barkvoll P, Haanaes HR (1993) The effect of soft-laser application on postoperative pain and swelling. A double-blind, crossover study. Int J Oral Maxillofac Surg 22(4):242–245PubMedCrossRefGoogle Scholar
  35. 35.
    Braams JW, Stegenga B, Raghoebar GM, Roodenburg JL, van der Weele LT (1994) Treatment with soft laser. The effect on complaints after the removal of wisdom teeth in the mandible. Ned Tijdschr Tandheelkd 101(3):100–103PubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  • W. L. He
    • 1
  • F. Y. Yu
    • 2
  • C. J. Li
    • 2
  • J. Pan
    • 1
  • R. Zhuang
    • 1
  • P. J. Duan
    • 1
    Email author
  1. 1.Guangdong Provincial Stomatological HospitalSouthern Medical UniversityGuangzhouChina
  2. 2.State Key Laboratory of Oral Diseases, West China Stomatological Hospital, West China School of StomatologySichuan UniversityChengduChina

Personalised recommendations