Effectiveness of low-intensity laser photobiomodulation in reducing inflammatory events (pain, edema, and trismus) after orthognathic surgery: a systematic review and meta-analysis of randomized clinical trials.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized clinical trials
PubMed 37610457 · doi:10.1007/s00784-023-05222-9
What was done
A systematic review and meta-analysis of randomized clinical trials was performed to assess whether low-level laser therapy (LLLT/photobiomodulation) applied during or shortly after orthognathic surgery reduces postoperative inflammatory events compared to pharmacologic therapy alone or no therapy. Seven databases and gray literature were searched without language or date limits. Study quality was evaluated using the Cochrane RoB 2.0 tool. Measured outcomes included edema and mouth opening (mean differences [MD]) and pain scores (standardized mean differences [SMD]). Across included trials, laser wavelengths ranged from 660 to 940 nm, and energy densities ranged from 5 to 100 J/cm² mostly applied at extraoral points.
What was found
The meta-analysis included 114 LLLT patients and 91 control patients (total n = 205). LLLT significantly reduced edema from 5 days to 2 weeks postoperatively (MD = -4.27 mm, 95% CI -5.13 to -3.41 mm, p < 0.001) and significantly reduced pain scores between 1 day and 5 weeks postoperatively (SMD = -1.37, 95% CI -1.99 to -0.75, p < 0.001). LLLT did not significantly alter mouth opening (p = 0.110).
Why it matters
Photobiomodulation offers a non-pharmacologic adjunct to reduce postoperative pain and facial swelling in orthognathic surgery patients.
Limits
The total sample size was small (205 patients), the number of included randomized trials was not specified in the abstract, and heterogeneity among studies was high (I² > 70%). Laser parameters varied widely (660–940 nm, 5–100 J/cm²), and the overall GRADE certainty of evidence was rated low.