Abstract
BackgroundThis study aimed to review translational studies focusing on third molar removal surgeries through a systematic analytical approach.Material and MethodsA PROSPERO-registered systematic review (CRD42017060455) was conducted following the PRISMA statement to summarize current knowledge on gene expression in third molar surgeries. A search was performed in PubMed’s Medline and Scopus databases, without date or language restrictions, using the logical expression {[(Third molar) OR (preemptive) OR (cyclooxygenase inhibitors) OR (acute inflammation) AND (gene expression)]}.ResultsAll studies included in the analysis evaluated gene expression in a third molar extraction model, using the preemptive analgesia methodology in seven investigations. The sample analyzed was obtained from gingival tissue biopsy (n=4), blood (n=1), transudate (n=1) and gingival tissue biopsy/transudate (n=1). There were differences with respect to evaluated genes, drug protocol, sample studied, and method for evaluating gene expression.ConclusionsThird molar surgeries were found to be associated with different COX-related gene expression patterns. Although inflammatory events following the surgical procedure are associated with COX isoforms, data from preemptive analgesia studies are scarce, especially from studies correlating gene expression and clinical parameters. In the future, from a clinical perspective, identifying the molecular targets of a drug based on individual gene expression may be helpful to delineate specific third molar, surgery-related, preemptive analgesia protocols. Key words:Third molar, gene expression, preemptive analgesia, systematic review.
Highlights
The evaluation of specific gene expression has been widely used as an important tool in studies in the field of dentistry, including translational investigations to determine diagnostic approaches, as well as to evaluate pharmacology-based drug protocols commonly utilized in clinical situations (1,2)
From a clinical perspective, identifying the molecular targets of a drug based on individual gene expression may be helpful to delineate specific third molar, surgery-related, preemptive analgesia protocols
Third molar surgery is a routine clinical procedure performed at dental practices, and it has been the subject of studies evaluating the use of preoperative medications (NSAIDs) to minimize inflammatory events observed during the postoperative period (7)
Summary
The evaluation of specific gene expression has been widely used as an important tool in studies in the field of dentistry, including translational investigations to determine diagnostic approaches, as well as to evaluate pharmacology-based drug protocols commonly utilized in clinical situations (1,2). Removal of third molars is an invasive procedure capable of triggering varying levels of pain and other related inflammatory events, which can significantly affect the patient’s quality of life (6) These factors have contributed to the routine use of third molar surgery as a useful clinical model to analyse the efficacy of conventional prescribed analgesics and anti-inflammatory drugs in order to minimize the effects of inflammation arising from surgical intervention until the postoperative period (7,8). As pain and edema are expected following the surgical procedure, it is predicted that these events, elicited by inflammation, would be correlated with gene-related increases of key pro-inflammatory cytokines released at the site of the injury, e.g. interleukin 1 beta (IL-1β) and tumor necrosis factor alpha (TNF-α) These markers have been shown to have significantly increased levels after the extraction of third molars (3) and are directly linked to cyclooxygenase isoform gene expression during the inflammatory process (9). There were differences with respect to evaluated genes, drug protocol, sample studied, and method for evaluating gene expression
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