Certainty of evidence on the effects of cryotherapy, surgical wound closure, and chlorhexidine on clinical and patient-centered outcomes after third molar surgery: evidence mapping of systematic reviews and meta-analyses

Removal of third molars often leads to complications such as pain, swelling, and trismus, impacting patient quality of life. Various strategies including cryotherapy, different suture techniques, and chlorhexidine are employed to mitigate these effects. However, the effectiveness of these interventions is still debated, as clinical trials present inconsistent and contrasting results. This study aims to assess the certainty of evidence from systematic reviews and meta-analyses regarding the effects of these interventions on clinical outcomes and patient quality of life following third molar surgery. This evidence mapping followed the Global Evidence Mapping Initiative and PRISMA guidelines, utilizing databases such as PubMed, Embase, Cochrane, Web of Science, and Google Scholar until February 2024. Methodological quality was assessed via AMSTAR-2 and the effects of these interventions on outcomes of interest were classified as "beneficial", "probably beneficial", "harmful", "no effect", or "inconclusive". Findings were mapped using the PyMeta platform. Thirteen studies were reviewed. All systematic reviews evaluated the effects of these interventions on clinical outcomes following third molar surgery, but none assessed the impact on patient quality of life. Cryotherapy was classified as probably beneficial for reducing pain and swelling within the first 72 hours post-surgery. Secondary surgical wound closure was effective in reducing pain, swelling, and trismus during the first postoperative week, but it did not mitigate the risk of bleeding, infection, or alveolitis. Chlorhexidine, especially when used as a mouthwash, is effective in preventing postoperative alveolitis. However, most reviews (76.9%) were rated as "critically low" methodological quality. Although the potential benefits of cryotherapy, secondary surgical wound closure, and chlorhexidine on clinical outcomes, this study revealed a predominantly low quality of evidence from systematic reviews and meta-analyses. Moreover, further research should expand investigations into the patient-centered outcomes to better guide clinical practice.