The effect of local applications of hyaluronic acid gels on post-operative pain, trismus and soft tissue edema following third molar extraction: A systematic review

Objective

Third molar extraction is a common surgical procedure, often resulting in postoperative pain, trismus, and swelling. Hyaluronic acid (HA) is a naturally occurring biopolymer with wound-healing and anti-inflammatory properties. Due to these characteristics, HA may offer clinical benefits when applied after tooth extraction. This study aims to systematically review the literature to evaluate the effects of HA gel application on postoperative pain, trismus, and soft tissue edema following third molar extraction.

Methods

A systematic literature review followed the PRISMA guidelines. An electronic search was performed in the PubMed, ScienceDirect, and Scopus databases using keywords: ‘hyaluronic acid’ OR ‘hyaluronan’ AND ‘gel’ AND ‘extraction’. Inclusion criteria were studies published in 2019–2024, in English, with full-text access, and randomized controlled trials (RCTs). Publications involved patients who underwent third molar extraction and assessed the effects of HA application on postoperative pain, trismus, and/or soft tissue edema compared to a control group.

Results

1183 articles were identified, 1163 screened after removing duplicates, and 10 publications selected for analysis after applying inclusion criteria.

Conclusions

Local application of HA gel following third molar extraction appears to contribute to postoperative pain reduction; however, its effectiveness in managing trismus and soft tissue edema remains inconclusive. Due to high methodological heterogeneity and risk of bias in the included studies, the overall robustness of the results is limited. Further well-designed, large-scale, and homogeneous clinical trials and systematic reviews are necessary to confirm the therapeutic benefits of HA gel in oral surgery.