Irrigating Solution’s Efficacy in Third Molar Surgery: a Systematic Review

Objectives: This systematic review aims to compare different irrigating solutions and their properties to determine which one is superior in its effects on third molar surgery.
Methods: English-written articles during 2012-2021 were obtained from electronic databases: PubMed, ScienceDirect, and GoogleScholar. Keywords were verified by subject title; the effect of chlorhexidine, saline and povidone iodine at the postoperative of third molar surgery. Seventy articles were retrieved and only 18 online articles with available full-text versions were included.
Results: The result of this study indicated that Chlorhexidine reduced the incidence of pain, swelling, alveolar osteitis, trismus, dry socket, bacteremia and killed Streptococcus mutans and Porphyromonas gingivalis bacteria better than other irrigants. Povidone iodine as irrigating agent could also control bleeding, reduce swelling and act as antiseptic. However, patients with hypersensitivity would usually get skin irritation. Ozonated water and gaseous ozone (O₃) was better than saline and povidone iodine in reducing pain and dry socket. Irrigation using 10% calendula officinalis had an effect on the bone preservation. Lactated Ringer’s solution can be beneficial with respect to cutting efficiency when lower handpiece loads are required.
Conclusions: Irrigation procedure in third molar surgery is crucial. Appropriate irrigation materials can minimize post-operative incidences such as pain, swelling, alveolar osteitis, trismus, dry socket, bacteremia and antiseptic against streptococcus mutans and porphyromonas gingivalis bacteria. Chlorhexidine demonstrated superior properties than other irrigation materials: povidone iodine (polyvinylpyrrolidone iodine/ PVP-I), saline, ozonated water, drinking tap water, gaseous ozone (O₃) and 10% officinalis essence.