Avaliação dos efeitos da fotobiomodulação sobre a dor, edema, parestesia e regeneração óssea após disjunção cirúrgica maxilar: estudo clínico controlado randomizado duplo cego

Abstract

The postoperative period of a surgical maxillary disjunction (DCM) is usually accompanied by pain, edema and paresthesia. Photobiomodulation (FBM) with the use of lasers has shown good results in the postoperative period of oral surgeries, but in larger surgeries there is a need for application of a large number of points, which makes it difficult to apply. LED devices can reach larger areas as well as being safer, easier to apply, and at a lower cost. This study evaluated the effect of FBM with LED on pain control, edema, paresthesia and bone repair after DCM. Secondly, the degree of anxiety and the occurrence of headache, otalgia, nausea, hematoma, nasolacrimation, epistaxis, dysphagia, temperature change, use of analgesics and anti-inflammatory drugs, and the impact of surgery on quality of life were evaluated. This controlled, randomized and double-blind clinical trial would involve 72 participants, but with the pandemic it was only possible to follow 28 cases that were operated on by three surgeons. Two examiners (blind to the experimental group) performed the pre- and post-surgical evaluations and another applied FBM. Before each surgery, 5 facial measurements were taken, periapical radiographic examination, sensitivity and anxiety tests (Beck questionnaire and dosage of IL-1β, IL-6, TNF-α and salivary cortisol). Immediately after surgery, the participant was inserted into the placebo group or the FBM group, according to randomization. In the FBM group, participants received 9 applications (immediate postoperative period, 1, 2, 7, 14, 30, 60, and 90 days) with a facial LED device (57 660 LEDs and 74 850 nm LEDs, both 5 mW, 6J per point) and one intraoral (3 660 nm LEDs, 5mW, 2J per point). In the placebo group, irradiations were simulated. Data were collected in periods of up to 120 days after surgery. With regard to edema, throughout the follow-up, the FBM group had a lower average facial measurement than that presented by the control group, but with no statistical difference. In the Global Sensitivity Index, the groups did not differ at any of the evaluation times for lower eyelid, cheek, nose wing and vestibular mucosa. In the upper lip, a significant difference was observed between the groups in 60 days, with the worst result being in the FBM group. In the palatal mucosa there was a significant difference between the groups at 7 days, with the worst result being for the FBM group. No statistical differences were observed between the groups in the evaluations of optical density in the region of the anterior palatal suture, use of analgesics and anti-inflammatory drugs, anxiety (in the Beck inventory, dosages of cortisol, IL-1β, IL-6), local and systemic temperature, presence of intraoral hematoma, headache, otalgia, nausea, nasolacrimation, epistaxis, dysphagia and impact of the surgical procedure on quality of life, at any of the evaluation times. There was also no significant difference between the groups in extraoral hematoma at 1, 2 and 7 days, while on the 14th day all patients in the control group did not have extraoral hematoma, but in the FBM group, 31% of the patients still had it. The dosimetric parameters and methodology used in this study did not make it possible to show significant differences regarding the effect of FBM in the postoperative period of DCM.