What do systematic reviews say?

Ibuprofen (single postoperative oral dose; 200 mg to 512 mg) vs paracetamol

Ibuprofen (single postoperative oral dose; 200 mg to 512 mg) leads to higher proportion of patients with >50% maximum pain relief (TOTPAR) over 6… compared with paracetamol (acetaminophen) (single postoperative oral dose; 600 mg… (high certainty).

• Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth 2013 · Cochrane All outcomes

  6 hours postdosing · Ibuprofen 400 mg vs paracetamol 1000 mg
  RR 1.47 [1.28, 1.69]
  5 studies · 646 participants
  High

Transbuccal miniplate combined with intraoral approach vs Intraoral approach alone

Transbuccal miniplate combined with intraoral approach led to lower requirement for additional (surgical) interventions (plate removal… compared with intraoral approach alone; GRADE not reported.

• Interventions for the management of mandibular fractures 2013 · Cochrane All outcomes

  90 days · Angle of mandible only
  RR 0.57 [0.33, 0.98]
  1 study · 140 participants
  GRADE not reported

Pre-radiotherapy extraction of healthy molar teeth vs Conservative treatment (leaving the teeth in place during radiotherapy, with oral health education and disease prevention: oral hygiene, fluoride, diet advice)

The review found no eligible studies for this question.

• Dental extractions prior to radiotherapy to the jaws for reducing post‐radiotherapy dental complications 2013 · Cochrane All outcomes
  no estimate extracted
  0 studies
  No studies found

Pre-radiotherapy extraction of diseased molar teeth vs Conservative treatment (restoration of the teeth and leaving them in place during radiotherapy, with oral health education and disease prevention: oral hygiene, fluoride, diet advice)

The review found no eligible studies for this question.

• Dental extractions prior to radiotherapy to the jaws for reducing post‐radiotherapy dental complications 2013 · Cochrane All outcomes
  no estimate extracted
  0 studies
  No studies found

Two lag screws vs One lag screw (with arch bars and IMF)

• Interventions for the management of mandibular fractures 2013 · Cochrane All outcomes
  Restoration of the original occlusion, assessed visually, was similar in both groups (P>0.05); occlusal correction was not achieved in one participant in the two-lag-screws group. Surrogate/proxy outcome.
  1 study
  GRADE not reported

Combined paracetamol plus ibuprofen in a single tablet (e.g. paracetamol 1000 mg/ibuprofen 400 mg or 500/200 mg) vs Single drugs given separately (paracetamol 1000 mg or ibuprofen 400 mg)

Combined paracetamol plus ibuprofen in a single tablet (e.g.… showed no clear difference in proportion of patients with >50% maximum pain relief (TOTPAR) over 2… compared with single drugs given separately (paracetamol 1000 mg or ibuprofen 400… (moderate certainty).

• Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth 2013 · Cochrane All outcomes

  2 hours postdosing · Paracetamol 1000 mg/ibuprofen 400 mg vs paracetamol 1000 mg or ibuprofen 400 mg
  RR 1.29 [0.91, 1.85]
  1 study · 170 participants
  Moderate

Transbuccal miniplate combined with intraoral approach vs Intraoral approach alone

Transbuccal miniplate combined with intraoral approach showed no clear difference in non-union compared with intraoral approach alone; GRADE not reported.

• Interventions for the management of mandibular fractures 2013 · Cochrane All outcomes

  Angle of mandible only
  RR 1.0 [0.17, 5.79]
  1 study · 140 participants
  GRADE not reported

3-dimensional (3D) miniplates vs Standard (Champy) plates

3-dimensional (3D) miniplates led to lower requirement for additional (surgical) interventions (post-operative… compared with standard (Champy) plates; GRADE not reported.

• Interventions for the management of mandibular fractures 2013 · Cochrane All outcomes
  RR 0.47 [0.25, 0.88]
  1 study · 50 participants
  GRADE not reported

2 mm titanium plates vs 2.5 mm bioresorbable plates

2 mm titanium plates showed no clear difference in moderate soft tissue deformity compared with 2.5 mm bioresorbable plates; GRADE not reported.

• Interventions for the management of mandibular fractures 2013 · Cochrane All outcomes

  1 month
  RR 6.4 [0.80, 51.3]
  1 study · 57 participants
  GRADE not reported

Pre-radiotherapy extraction of healthy molar teeth vs Conservative treatment (leaving the teeth in place during radiotherapy, with oral health education and disease prevention: oral hygiene, fluoride, diet advice)

The review found no eligible studies for this question.

• Dental extractions prior to radiotherapy to the jaws for reducing post‐radiotherapy dental complications 2013 · Cochrane All outcomes
  no estimate extracted
  0 studies
  No studies found

Pre-radiotherapy extraction of diseased molar teeth vs Conservative treatment (restoration of the teeth and leaving them in place during radiotherapy, with oral health education and disease prevention: oral hygiene, fluoride, diet advice)

The review found no eligible studies for this question.

• Dental extractions prior to radiotherapy to the jaws for reducing post‐radiotherapy dental complications 2013 · Cochrane All outcomes
  no estimate extracted
  0 studies
  No studies found

3-dimensional (3D) miniplates vs Standard (Champy) plates

• Interventions for the management of mandibular fractures 2013 · Cochrane All outcomes
  All participants in both groups in Jain 2010 had "satisfactory post-operative occlusion"; it is unclear whether a validated tool was used.
  1 study
  GRADE not reported

Combined paracetamol plus ibuprofen in a single tablet (e.g. paracetamol 1000 mg/ibuprofen 400 mg or 500/200 mg) vs Single drugs given separately (paracetamol 1000 mg or ibuprofen 400 mg)

• Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth 2013 · Cochrane All outcomes

  Study period (immediate postoperative)
  The majority of adverse events were minor in nature and usually included nausea, vomiting, headaches and dizziness. Side effect profiles have not been included in a meta-analysis as multiple adverse events were…
  2 studies
  GRADE not reported

Open (surgical) reduction and fixation vs Closed (non-surgical) treatment

The review found no eligible studies for this question.

• Interventions for the management of mandibular fractures 2013 · Cochrane All outcomes
  "There were no studies comparing different types of closed interventions with one another or comparing open and closed interventions." "We found no studies that compared surgical with non-surgical treatments."
  0 studies
  No studies found

Transbuccal miniplate combined with intraoral approach vs Intraoral approach alone

• Interventions for the management of mandibular fractures 2013 · Cochrane All outcomes

  3 months · Angle of mandible only
  Persistent malocclusion was minimal, reported in one participant in each group at the 3-month follow-up. Mean interincisor mouth opening at 3 months 37.68 mm (range 17 to 50) combined approach vs 38.19 mm (range 22 to…
  1 study
  GRADE not reported

Two lag screws vs One lag screw (with arch bars and IMF)

• Interventions for the management of mandibular fractures 2013 · Cochrane All outcomes
  Average pain scores (scale 1 to 10): week 1, 6.6 (two lag screws) vs 6.4 (one lag screw); after 2 weeks, 2.5 vs 2.1. Confidence intervals were not reported.
  1 study
  GRADE not reported

2 mm titanium plates vs 2.5 mm bioresorbable plates

• Interventions for the management of mandibular fractures 2013 · Cochrane All outcomes

  1 month
  Chronic infection per site 1/32 (3.1%) titanium vs 0/25 resorbable (RD -3.1%); higher in the titanium group. No risk ratio estimable.
  1 study · 57 participants
  GRADE not reported

Combined paracetamol plus ibuprofen in a single tablet (e.g. paracetamol 1000 mg/ibuprofen 400 mg or 500/200 mg) vs Single drugs given separately (paracetamol 1000 mg or ibuprofen 400 mg)

Combined paracetamol plus ibuprofen in a single tablet (e.g.… probably leads to higher proportion of patients with >50% maximum pain relief (TOTPAR) over 6… compared with single drugs given separately (paracetamol 1000 mg or ibuprofen 400… (moderate certainty).

• Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth 2013 · Cochrane All outcomes

  6 hours postdosing · Paracetamol 1000 mg/ibuprofen 400 mg vs paracetamol 1000 mg or ibuprofen 400 mg
  RR 1.77 [1.32, 2.39]
  1 study · 170 participants
  Moderate

Two miniplates (transbuccal approach) vs One miniplate plus two screws (intraoral approach at external oblique ridge)

Two miniplates (transbuccal approach) showed no clear difference in post-operative infection compared with one miniplate plus two screws (intraoral approach at external…; GRADE not reported.

• Interventions for the management of mandibular fractures 2013 · Cochrane All outcomes

  Angle of mandible only
  RR 1.32 [0.41, 4.22]
  2 studies · 93 participants
  GRADE not reported

Ibuprofen (single postoperative oral dose; 200 mg to 512 mg) vs paracetamol

Ibuprofen (single postoperative oral dose; 200 mg to 512 mg) leads to higher proportion of patients with >50% maximum pain relief (TOTPAR) over 2… compared with paracetamol (acetaminophen) (single postoperative oral dose; 600 mg… (high certainty).

• Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth 2013 · Cochrane All outcomes

  2 hours postdosing · Ibuprofen 400 mg vs paracetamol 1000 mg
  RR 1.30 [1.09, 1.55]
  5 studies · 645 participants
  High