Abstract：
This systematic review aimed to assess if topical application of hyaluronic acid (HA) reduced complication rates after mandibular third molar (M3) surgery.
PubMed, CENTRAL, Embase, and Web of Science were searched for randomized controlled trials (RCTs) assessing the efficacy of topical hyaluronic acid for mandibular third molar surgery. Gray literature was also searched.
12 RCTs were included. Meta-analysis showed that pain scores were significantly reduced after M3 surgery with the use of HA on the 1st, 2nd/3rd, and 7th postoperative days. Using postoperative maximal mouth opening (MMO) data, we noted that MMO was significantly better in the HA group on the 2/3rd post-operative day but not on the 7th postoperative day. Meta-analysis of just three studies showed that swelling was significantly reduced on the 1st postoperative day with the use of HA, however, no such difference was noted on the 2nd/3rd and 7th postoperative days. Alveolitis and infection data were not reported by the majority of studies which precluded a meta-analysis. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) certainty of evidence was low to moderate.
Low-moderate quality of evidence suggests that topical application of HA may reduce pain as well as early trismus and swelling in patients undergoing M3 surgeries. The effect size of pain reduction is small thereby raising questions about its clinical significance. High inter-study heterogeneity and low-quality of trials are significant limitations. High-quality RCTs are needed to generate quality evidence.
PubMed, CENTRAL, Embase, and Web of Science were searched for randomized controlled trials (RCTs) assessing the efficacy of topical hyaluronic acid for mandibular third molar surgery. Gray literature was also searched.
12 RCTs were included. Meta-analysis showed that pain scores were significantly reduced after M3 surgery with the use of HA on the 1st, 2nd/3rd, and 7th postoperative days. Using postoperative maximal mouth opening (MMO) data, we noted that MMO was significantly better in the HA group on the 2/3rd post-operative day but not on the 7th postoperative day. Meta-analysis of just three studies showed that swelling was significantly reduced on the 1st postoperative day with the use of HA, however, no such difference was noted on the 2nd/3rd and 7th postoperative days. Alveolitis and infection data were not reported by the majority of studies which precluded a meta-analysis. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) certainty of evidence was low to moderate.
Low-moderate quality of evidence suggests that topical application of HA may reduce pain as well as early trismus and swelling in patients undergoing M3 surgeries. The effect size of pain reduction is small thereby raising questions about its clinical significance. High inter-study heterogeneity and low-quality of trials are significant limitations. High-quality RCTs are needed to generate quality evidence.
摘要：
目的：本系统综述旨在评估局部应用透明质酸（HA）是否能降低下颌第三磨牙（M3）手术后的并发症发生率。
方法：PubMed，中部,Embase,和WebofScience检索了评估局部透明质酸用于下颌第三磨牙手术疗效的随机对照试验(RCT)。还搜索了灰色文献。
结果：纳入12项随机对照试验。Meta分析显示,1日使用HA治疗M3术后疼痛评分显著降低,第二/第三，术后第7天。使用术后最大张口（MMO）数据，我们注意到,HA组的MMO在术后2/3日显著改善,但在术后第7日没有改善.仅对三项研究的荟萃分析表明，使用HA在术后第1天显着减轻了肿胀，然而,在术后第2天/第3天和第7天未发现此类差异.大多数研究没有报道肺泡炎和感染数据，这排除了荟萃分析。建议评估的分级，发展,和评估（等级）的证据的确定性是低到中等。
结论：低-中等质量的证据表明，局部应用HA可以减轻M3手术患者的疼痛以及早期的三联和肿胀。疼痛减轻的效果大小很小，因此对其临床意义提出了质疑。高研究间异质性和低质量的试验是显著的局限性。需要高质量的随机对照试验来产生高质量的证据。
方法：PubMed，中部,Embase,和WebofScience检索了评估局部透明质酸用于下颌第三磨牙手术疗效的随机对照试验(RCT)。还搜索了灰色文献。
结果：纳入12项随机对照试验。Meta分析显示,1日使用HA治疗M3术后疼痛评分显著降低,第二/第三，术后第7天。使用术后最大张口（MMO）数据，我们注意到,HA组的MMO在术后2/3日显著改善,但在术后第7日没有改善.仅对三项研究的荟萃分析表明，使用HA在术后第1天显着减轻了肿胀，然而,在术后第2天/第3天和第7天未发现此类差异.大多数研究没有报道肺泡炎和感染数据，这排除了荟萃分析。建议评估的分级，发展,和评估（等级）的证据的确定性是低到中等。
结论：低-中等质量的证据表明，局部应用HA可以减轻M3手术患者的疼痛以及早期的三联和肿胀。疼痛减轻的效果大小很小，因此对其临床意义提出了质疑。高研究间异质性和低质量的试验是显著的局限性。需要高质量的随机对照试验来产生高质量的证据。
