Rolf Wilhem Consolandich Cirisola, Luis Eduardo Pascuali Moya, María Victoria García Olazabal, Daniela Anat Amzallag Wagmann, Guendalina Palermo Suarez, Carolina Wince, Laura Hermida Bruno, Daniel Rodriguez Salaberry, Sandra Kalil Bussadori, Cinthya Cosme Gutierrez Duran, Kristianne Porta Santos Fernandes, Raquel Agnelli Mesquita Ferrari, Anna Carolina Ratto Tempestini Horliana
Postoperative PBM did not demonstrate superior pain reduction to ibuprofen at 24 hours after conventional apical surgery. Improvements in soft-tissue healing and fistula prevalence were secondary findings requiring confirmation in larger trials.
INTRODUCTION: Endodontic surgeries have a high clinical success rate, but postoperative pain may occur and can be clinically relevant during the early postoperative period. NSAIDs such as ibuprofen are commonly prescribed but carry risks for patients with cardiovascular disease. Photobiomodulation (PBM) has been shown to reduce postoperative pain and edema in oral surgeries, yet its use following endodontic surgery remains underexplored. This study evaluated whether PBM reduces postoperative pain after endodontic surgery compared to ibuprofen.
METHODS: This randomized, double-blind, placebo-controlled clinical trial included 36 patients requiring endodontic surgery in the maxillary region (teeth 15 to 25 according to the FDI World Dental Federation two-digit notation [ISO 3950]; i.e., from the maxillary right second premolar to the maxillary left second premolar). Participants were randomized into two groups: PBM Group (PBM + placebo ibuprofen, n=18) and Ibuprofen Group (PBM simulation + ibuprofen, n=18). PBM was applied at 808 nm, 100 mW, and 4 J/cm² immediately post-surgery, at 24 hours, and at 7 days. The primary outcome was postoperative pain assessed by the visual analog scale (VAS) at 24 hours. Secondary outcomes included analgesic consumption (paracetamol), temperature, edema, ecchymosis, soft tissue healing, and bone repair assessed on periapical radiographs at 1, 2, and 3 months.
RESULTS: No significant differences were found between groups in postoperative pain, analgesic consumption, ecchymosis, edema, or percussion at any time point. Bone repair and lesion size reduction were similar between groups. The PBM group showed significantly better soft tissue healing at 7 days (P=0.013) and lower fistula prevalence at 24 hours (P=0.006).
CONCLUSIONS: Postoperative PBM did not demonstrate superior pain reduction to ibuprofen at 24 hours after conventional apical surgery. Improvements in soft-tissue healing and fistula prevalence were secondary findings requiring confirmation in larger trials.