Does the presence of third molars during sagittal split mandibular ramus osteotomy favour complications? Systematic review and meta-analysis.

The aim of this systematic review and meta-analysis was to assess whether the presence of inferior third molars during sagittal split mandibular ramus osteotomy increases the risk of intraoperative and postoperative complications. The PRISMA protocol was followed in this study, and the review was registered in the PROSPERO database (CRD42020147642). A search was conducted in the MEDLINE (PubMed), Web of Science, Cochrane Central, and Scopus databases on November 1, 2021. Nineteen articles were included, and the variables analysed were unfavourable fractures, infection, neurosensory disturbance, removal of osteosynthesis material, and duration of surgery. Meta-analyses were performed for the variables unfavourable fractures (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.58-1.57, P = 0.84), infection (RR 0.75, 95% CI 0.48-1.18, P = 0.21), and neurosensory disturbance (RR 1.55, 95% CI 0.61-3.91, P = 0.35); no statistically significant difference in the risk of these variables was found between the groups with and without third molars. The third molars did not increase the need to remove fixation material, but increased the surgery time. The presence of the third molar during sagittal split mandibular ramus osteotomy appears not to increase the risk of intraoperative and postoperative complications. The results presented here must be interpreted with caution due to the heterogeneity presented by the observational studies included.

Is bromelain an effective drug for the control of pain and inflammation associated with impacted third molar surgery? Systematic review and meta-analysis.

The aim of this systematic review was to determine whether bromelain is an effective drug for the control of pain and inflammation associated with third molar surgery. Randomized, controlled clinical trials on the subject were identified through a systematic search of the literature using the PubMed/MEDLINE, Scopus, and Cochrane Library databases. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two independent, blinded reviewers selected studies based on the inclusion criteria. Divergences of opinion were resolved by consensus. A meta-analysis was performed for the outcomes pain and trismus and was based on the inverse variance method for continuous outcomes, considering the mean difference (MD) and corresponding 95% confidence interval (CI). A total of 186 articles were initially retrieved from the databases. After the different stages of the selection process, five articles reporting data for a total 252 patients remained and were included in the review. Bromelain proved to be effective at controlling postoperative pain at 48-72h after surgery (P=0.03; MD -0.89, 95% CI -1.70 to -0.09), but did not achieve a significant effect in comparison to the control group with regard to oedema or trismus.