Journal of Maxillofacial and Oral Surgery

, Volume 17, Issue 2, pp 122–128 | Cite as

Role of Serratiopeptidase After Surgical Removal of Impacted Molar: A Systematic Review and Meta-analysis

  • Gowri Sivaramakrishnan
  • Kannan Sridharan
Review Paper



Serratiopeptidase for pain, facial swelling and trismus associated with surgical removal of impacted molar is under investigation. However conclusive evidence on the use of serratiopeptidase is lacking. Hence a systematic review and meta-analysis of randomized controlled studies was carried out.


Electronic databases were searched for eligible studies and necessary data extracted. The data were analysed using non-Cochrane mode in RevMan 5.0. 95% confidence interval (95% CI) was used to represent the deviation from the point estimate. The heterogeneity between the studies was assessed using Forest plot visually, I2 statistics and Chi square test with a statistical P value of <0.10 to indicate statistical significance. Random-effect models were used in case of moderate to severe heterogeneity.


Five studies were included for final review. Serratiopeptidase improved trismus better than corticosteroids with the MD, 95% as 4.42 [3.84, 5]. As regards to swelling, no significant difference was observed for serratiopeptidase when compared to corticosteroids. Paucity of studies precludes any conclusion for other outcome measures as well as for other comparator drugs.


Serratiopeptidase could be used safely and effectively to improve trismus and facial swelling after surgical removal of impacted molar.


Serratiopeptidase Impacted molar Serrapeptase 



We acknowledge Cochrane reviews for utilizing RevMan software for generating the pooled results and Forest plots.

Compliance with Ethical Standards

Conflict of interest

None of the authors have any conflict of interest.


  1. 1.
    Joshi KK, Nerurkar RP (2012) Anti-inflammatory effect of the serratiopeptidase–rationale or fashionable: a study in rat paw oedema model induced by the carrageenan. Indian J Physiol Pharmacol 56:367–374PubMedGoogle Scholar
  2. 2.
    Selan L, Papa R, Tilotta M et al (2015) Serratiopeptidase: a well-known metalloprotease with a new non-proteolytic activity against S. aureus biofilm. BMC Microbiol 15:207. doi: 10.1186/s12866-015-0548-8 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Seymour RA, Blair GS, Wyatt FA (1983) Post-operative dental pain and analgesic efficacy. Part I. Br J Oral Surg 21:290–297CrossRefPubMedGoogle Scholar
  4. 4.
    Sannino G, Gigola P, Puttini M et al (2013) Combination therapy including serratiopeptidase improves outcomes of mechanical-antibiotic treatment of periimplantitis. Int J Immunopathol Pharmacol 26:825–831CrossRefPubMedGoogle Scholar
  5. 5.
    Passariello C, Lucchese A, Pera F (2012) Clinical, microbiological and inflammatory evidence of the efficacy of combination therapy including serratiopeptidase in the treatment of periimplantitis. Eur J Inflamm 10:463–472CrossRefGoogle Scholar
  6. 6.
    Kastury N, Singh S, Ansari KU (1999) An audit of prescription for rational use of fixed dose drug combinations. Indian J Pharmacol 31:367Google Scholar
  7. 7.
    Mead SV (1930) Incidence of impacted teeth. Int J Orthodo Oral Surg Radiog 16:885–890CrossRefGoogle Scholar
  8. 8.
    Grover PS, Lorton L (1985) The incidence of unerupted permanent teeth and related clinical cases. Oral Surg Oral Med Oral Pathol 59:420–425CrossRefPubMedGoogle Scholar
  9. 9.
    Sisk AL, Hammer WB, Shelton DW (1986) Complications following removal of impacted third molars: the role of the experience of the surgeon. J Oral Maxillofac Surg 44(11):855–859CrossRefPubMedGoogle Scholar
  10. 10.
    Fisher SE, Frame JW, Rout PJ et al (1988) Factors affecting the onset and severity of pain following the surgical removal of unilateral impacted mandibular third molar teeth. Br Dent J 164:351–354CrossRefPubMedGoogle Scholar
  11. 11.
    Merten HA, Muller K, Drubel F et al (1991) Volumetric verification of edema protection with serrapeptase after third molar osteotomy. Dtsch Z Mund Kiefer Gesichtschir 15:302–305PubMedGoogle Scholar
  12. 12.
    Bhagat S, Agarwal M, Roy V (2013) Serratiopeptidase: a systematic review of the existing evidence. Int J Surg 11:209–217CrossRefPubMedGoogle Scholar
  13. 13.
    Higgins JPT, Green S (editors) Cochrane handbook for systematic reviews of interventions, 5.1.0 edn. Accessed on 15 Oct 2015
  14. 14.
    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. J Clin Epidemiol 62:1006–1012CrossRefPubMedGoogle Scholar
  15. 15.
    GRADE Working Group (2004) Grading quality of evidence and strength of recommendations. BMJ 328:1490CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Chopra D, Rehan HS, Mehra P et al (2009) A randomized, double-blind, placebo-controlled study comparing the efficacy and safety of paracetamol, serratiopeptidase, ibuprofen and betamethasone using the dental impaction pain model. Int J Oral Maxillofac Surg 38:350–355CrossRefPubMedGoogle Scholar
  17. 17.
    Al-Khateeb TH, Nusair Y (2008) Effect of the proteolytic enzyme serrapeptase on swelling, pain and trismus after surgical extraction of mandibular third molars. Int J Oral Maxillofac Surg 37:264–268CrossRefPubMedGoogle Scholar
  18. 18.
    Murugesan K, Sreekumar K, Sabapathy B (2012) Comparison of the roles of serratiopeptidase and dexamethasone in the control of inflammation and trismus following impacted third molar surgery. Indian J Dent Res 23:709–713CrossRefPubMedGoogle Scholar
  19. 19.
    Chappi DM, Suresh KV, Patil MR et al (2015) Comparison of clinical efficacy of methylprednisolone and serratiopeptidase for reduction of postoperative sequelae after lower third molar surgery. J Clin Exp Dent 7:e197–e202CrossRefGoogle Scholar
  20. 20.
    Kannan R, Kavitha R (2015) A comparative study of anti-inflammatory properties of bromelain/serratiopeptidase as an add on therapy to conventional treatment following impacted third molar surgery. World J Pharm Res 4:2595–2607Google Scholar
  21. 21.
    Woodley JF (1994) Enzymatic barriers for GI peptide and protein delivery. Crit Rev Ther Drug Carrier Syst 11:61–95PubMedGoogle Scholar
  22. 22.
    Klein G, Kullich W (2000) Short-term treatment of painful osteoarthritis of the knee with oral enzymes. A randomized, double-blind study versus diclofenac. Clin Drug Invest 19:15–23CrossRefGoogle Scholar
  23. 23.
    Sasaki S, Kawanami R, Motizuki Y et al (2000) Serrapeptase-induced lung injury manifesting as acute eosiniphilic pneumonia. Nihon Kokyuki Gakkai Zasshi 38:540–544 (Japanese) PubMedGoogle Scholar
  24. 24.
    Mazzone A, Catalani M, Costanzo M et al (1990) Evaluation of Serratia-peptidase in acute or chronic inflammation of otorhinolaryngology pathology: a multicentre, double-blind, randomized trial versus placebo. J Int Med Res 18:379–388CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Oral and Maxillofacial Surgeons of India 2017

Authors and Affiliations

  1. 1.Department of Oral Health, College of Medicine, Nursing and Health SciencesFiji National UniversitySuvaFiji
  2. 2.Department of Health SciencesFiji National UniversitySuvaFiji

Personalised recommendations