Er:YAG and Nd:YAG-based low-level laser therapy (LLLT) with medical collagen improve third-molar extraction wound healing: a randomized controlled trial

To evaluate whether Er: YAG surgery and Nd: YAG-based low-level laser therapy (LLLT), combined with medical collagen, improve early postoperative outcomes after extraction of impacted mandibular third molars. Adults undergoing surgical removal of mesioangular or horizontal impacted mandibular third molars were randomized equally (1:1:1:1) to blank control (BCG), collagen only (COL), lasers only (LAS), or collagen plus lasers (COL + LAS). Primary endpoints were pain (VAS; spontaneous and swallowing; POD1/3/7), swelling (POD1/3/7), trismus (POD1/3/7), and early mucosal healing (POD3/7). Secondary endpoints were bleeding (30 min post-extraction only), cutaneous induration/ecchymosis (POD7), alveolar osteitis (POD3/7), and local cytokines (IL-1β, IL-6, TNF-α; POD3/7). In 120 patients, COL + LAS was superior: less pain, swelling, and trismus at POD1/3 and higher early mucosal-healing rates at POD3/7 than BCG, COL, or LAS; by POD7, between-group differences in pain, swelling, and trismus were minimal. All active arms reduced 30-min bleeding versus BCG. At POD7, cutaneous induration was lowest with COL + LAS (ecchymosis not significant). Cytokines declined overall; IL-1β and TNF-α were lowest with COL + LAS at POD3/7, whereas IL-6 decreased similarly across active arms. Er: YAG surgery plus Nd: YAG-based LLLT with medical collagen improved short-term recovery after impacted mandibular third-molar surgery.