Comparative clinical effects of extraoral photobiomodulation using laser and LED on pain, swelling, and quality of life following impacted mandibular third molar surgery: a randomized split-mouth trial
Clinical Snapshot
PICO Framework
| P — Population | 72 patients with bilaterally symmetrical impacted mandibular third molars requiring surgical extraction |
| I — Intervention | Extraoral photobiomodulation therapy using either low-level laser therapy (810 nm GaAlAs diode laser) or LED therapy (618 nm OsseoPulse) applied on postoperative days 0, 2, and 7 |
| C — Comparator | Split-mouth design where each patient served as their own control, with one side receiving treatment and the contralateral side serving as control |
| O — Outcomes | Primary: postoperative pain (VAS), facial swelling (standardized facial measurements), oral health-related quality of life (OHIP-14). Secondary: comparative effectiveness between laser and LED modalities |
Bottom Line
This split-mouth RCT suggests that extraoral photobiomodulation therapy, particularly LED at 618 nm, may provide clinically meaningful benefits for pain control and swelling reduction following impacted third molar surgery. LED therapy demonstrated superior early pain relief and late-phase swelling reduction compared to laser therapy. Both modalities improved quality of life measures. However, the inability to blind participants and operators introduces performance bias, and the lack of detailed effect sizes limits clinical interpretation. While the split-mouth design strengthens internal validity by controlling for patient-level factors, clinicians should consider the additional cost and time requirements of multiple postoperative photobiomodulation sessions. The evidence supports considering photobiomodulation as an adjunctive therapy for high-risk patients or those particularly concerned about postoperative discomfort, though more robust blinded studies with detailed cost-effectiveness analyses would strengthen the evidence base.
Key Findings
P Value: p < 0.05 for significant findings
Effect Size: Not specified in abstract
Primary Outcome: LED therapy significantly reduced pain at 4 hours and postoperative days 3-6; LED showed greater swelling reduction from baseline to day 7 in LLLT-LED group comparison
Nnt Or Sensitivity: Not calculable from available data
Confidence Interval: Not reported
Clinical Application
Requires specialized photobiomodulation equipment and trained personnel; treatment protocol involves multiple postoperative visits Third molar extraction commonly performed by oral surgeons and dentists; photobiomodulation devices would require TGA approval; cost-effectiveness considerations for private practice implementation Patients undergoing impacted mandibular third molar extraction, particularly those at higher risk for postoperative complications
Abstract
This study aimed to compare the clinical effectiveness of extraoral photobiomodulation using laser and light-emitting diode (LED) in reducing postoperative pain, swelling, and improving oral health-related quality of life following impacted mandibular third molar surgery. This randomized, split-mouth clinical trial included 72 patients with bilaterally symmetrical impacted mandibular third molars. Participants were allocated into three groups: low-level laser therapy (LLLT), LED, and LLLT-LED. Each patient received PBM treatment on one side and served as their own control. LLLT (810 nm GaAlAs diode laser) and LED (618 nm OsseoPulse) were applied extraorally on postoperative days 0, 2, and 7. Pain was assessed using a visual analog scale (VAS) at 4h and daily up to day 7. Swelling was measured via standardized facial distances at baseline, day 2, and day 7. Quality of life was evaluated using the OHIP-14 questionnaire preoperatively and on day 7. LED therapy significantly reduced pain at the 4th hour and on postoperative days 3 to 6 (p < 0.05). Regarding postoperative swelling, a significant difference was observed only in the LLLT-LED group, where the LED-treated side showed greater overall swelling reduction from preoperative to postoperative day 7 (p < 0.05). Quality-of-life scores improved in both groups, with more domains showing significant change in the LLLT group (10 vs. 7). LED was more effective for early postoperative pain control and showed greater late-phase swelling reduction in the side-to-side comparison. Quality-of-life scores improved in both groups, with a larger number of significantly improved domains in the LLLT group.
References
- 1.Albayrak, D., Bulut, E., & Singer, E. A. (2026). Comparative clinical effects of extraoral photobiomodulation using laser and LED on pain, swelling, and quality of life following impacted mandibular third molar surgery: a randomized split-mouth trial. Lasers in Medical Science. https://doi.org/10.1016/j.joms.2005.12.046
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