Effectiveness of Drainage in Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis

Abstract

Purpose: The purpose of this study was to provide an evidence-based evaluation of the impact of surgical drainage after the removal of mandibular third molars.

Materials and methods: The Medline (PubMed), Cochrane Library, and Web of Science databases were searched to identify randomized controlled trials up to September 1, 2017. Postoperative variables, including facial swelling, trismus, and pain, were calculated early (2 to 3 days) and late (5 to 7 days) after the removal of impacted mandibular third molars. Weighted mean differences for trismus and standardized mean differences (SMDs) for swelling and pain were pooled for the included studies.

Results: The samples consisted of 592 extractions (297 with surgical drainage and 295 controls) in 409 participants. The included studies were published from 1988 to 2016. Participants who received surgical drainage had significantly less facial swelling during the early stage (SMD, -0.46; 95% confidence interval [CI], -0.67 to -0.26; P < .0001) and the late stage (SMD, -0.36; 95% CI, -0.55 to -0.16; P = .0004) after the removal of an impacted mandibular third molar. They also had better mouth opening than controls during the early and late stages (early MD, 5.55 mm; 95% CI, 2.31-8.79; P = .0008; late MD, 2.38 mm; 95% CI, 1.47-3.29; P < .0001). The level of pain was significantly different between the 2 groups in the early stage (SMD, -0.55; 95% CI, -1.00 to -0.10; P = .01); however, there were no significant differences in the late stage (SMD, -0.13; 95% CI, -0.38 to 0.12; P = .30).

Conclusion: The use of surgical drainage has an obviously positive effect on postoperative reactions after the removal of a mandibular third molar. Given the need for additional time for clinic visits, surgical drainage presents an alternative for the perioperative management of impacted mandibular third molar surgery, especially in cases of a fully bony tooth with poor drainage.