Chlorhexidine, Povidone Iodine, or Normal Saline: Which Irrigating Solution Optimizes Recovery After Mandibular Third Molar Surgery? A Systematic Review and Meta-Analysis.

Abstract

Purpose: This systematic review aimed to compare the efficacy of different irrigating solutions, normal saline, povidone-iodine, and chlorhexidine in reducing postoperative sequelae following surgical extraction of mandibular third molars.

Methods: An electronic search of PubMed/MEDLINE, Cochrane Central, Google Scholar, and EBSCO Host was conducted (Jan 2000-Apr 2024). Included were RCTs and comparative clinical studies. Predictor variables were irrigants: chlorhexidine, povidone-iodine, and normal saline. Primary outcomes were pain, swelling, trismus, dry socket, and infection. Odds ratios (OR) and 95% confidence intervals were calculated, and p < 0.05 was considered statistically significant. A fixed effects model was used.

Results: 598 participants from 10 studies were included. Meta-analysis was possible for the incidence of dry socket and infection between the povidone-iodine and normal saline groups. Other outcomes, including postoperative pain, swelling, and trismus were summarized narratively. The odds of dry socket (OR = 2.28, 95% CI = 1.05-4.92, p = 0.04) and infection (OR = 1.33, 95% CI = 0.56-3.14, p = 0.51) were higher with povidone-iodine than with normal saline. Chlorhexidine showed improved outcomes in some studies, but quantitative synthesis was not possible due to heterogeneous study design and reporting.

Conclusion: Based on the available evidence, no irrigating solution was found to be clearly superior. Though some studies reported favourable outcomes with chlorhexidine, the findings were inconsistent due to the heterogeneity of the included studies and the limited number of outcomes suitable for quantitative synthesis. Further well-designed RCTs with standardized protocols are needed.