ATEF EID MADKOUR ELSAYED, MAJED EMAD HASSAN ALRASHEED, MOHAMMED MAJED HABHAB, MOHAMED MOHAMED MAHMOUD ABOSHETAIH, MUATH MANSOUR MOHAMMED ALWEHAIBI, MOHAMMAD ABDULMUHSEN A ALSALEH, ,NOUF ADNAN ALI ALMALKI, NJOOD KHALID ALI BINJAHLAN, BAYAN SIDDIQ MOHAMMED ALSSUM, ABDULHADI MOHAMMED ALQAHTANI, OSAMA AL SHAMRANI, MUNTATHIR A ALKHALIFAH, RAZAN HATEM ALOTAIBI, AHAD ZAID BIN JUWAID
DOI: https://doi.org/Background: Surgical extraction of mandibular third molars frequently results in pain, swelling, and trismus, impairing recovery and patient comfort. Hyaluronic acid (HA), a biocompatible glycosaminoglycan with anti-inflammatory and wound-healing properties, has been investigated as an adjunctive therapy to mitigate these complications.
Objective: To systematically review the evidence from clinical trials evaluating the efficacy of HA in reducing post-operative pain, swelling, and trismus following mandibular third molar extraction.
Methods: Following PRISMA 2020 guidelines, electronic databases (PubMed, Scopus, Web of Science, Embase, and Cochrane Library) were searched for studies published between 2014 and 2025. Eligible trials included adult patients undergoing mandibular third molar extraction with local HA application compared against placebo or alternative adjuncts. Data on pain, swelling, trismus, and secondary outcomes were extracted, and study quality was assessed using the Cochrane Risk of Bias 2.0 and JBI tools.
Results: Fifteen clinical trials comprising ~945 patients were included. HA significantly reduced post-operative pain in 11 studies, swelling in 8 studies, and improved mouth opening in 7 studies. Several trials demonstrated reductions in alveolitis incidence and analgesic consumption. However, inconsistencies were observed due to variations in HA formulations and application protocols.
Conclusion: Current evidence suggests that HA is an effective adjunct for reducing common complications after mandibular third molar surgery. While most trials report positive outcomes, methodological heterogeneity underscores the need for standardized, large-scale RCTs to confirm its clinical utility.
