Clinical Effects of Photobiomodulation, Corticosteroids, and Nonsteroidal Anti‐Inflammatory Drugs Following Third Molar Surgery: A Systematic Review of Randomized Clinical Trials
TL;DR
The three approaches may improve different postoperative outcomes, but the available evidence does not support a definitive hierarchy among them.
Abstract
Objective To systematically synthesize the effects and safety of corticosteroids, nonsteroidal anti‐inflammatory drugs (NSAIDs), and photobiomodulation, as evaluated within the comparisons available in randomized clinical trials, for controlling postoperative sequelae after third molar surgery. Methods This systematic review followed PRISMA 2020 and was prospectively registered in PROSPERO (CRD420251178943). PubMed/MEDLINE, Embase, Scopus, Web of Science, and Google Scholar were searched without language or publication‐date restrictions. Randomized clinical trials evaluating at least one eligible intervention and reporting pain, edema, trismus, rescue medication, or adverse events were included. Risk of bias was assessed with Cochrane RoB 2, and a structured narrative synthesis was performed by intervention class, comparator type, outcome, and follow‐up period. Results Thirty‐six randomized trials involving 1838 participants were included: 13 primarily evaluated corticosteroids, 11 NSAIDs, 7 photobiomodulation, and 5 direct or combined therapeutic comparisons. Twenty‐seven trials were judged at low risk of bias, seven raised some concerns, and two were at high risk. Corticosteroids were frequently associated with reductions in edema and trismus within placebo‐controlled and active‐comparator trials; NSAIDs showed more consistent effects on pain than on edema or trismus; and photobiomodulation produced heterogeneous, protocol‐dependent findings. Only a small number of trials directly compared different treatment classes. Substantial clinical and methodological heterogeneity precluded meta‐analysis and a valid indirect ranking. Conclusion The three approaches may improve different postoperative outcomes, but the available evidence does not support a definitive hierarchy among them. Direct head‐to‐head trials with standardized outcomes, treatment protocols, and follow‐up periods are required.