Efficacy of Serratiopeptidase after Surgical Removal of Mesioangular Mandibular Third Molar- Randomized Controlled Trial

Abstract

Background: Surgical extraction of mesioangular lower third molars commonly results in restricted mouth open-ing after surgery, which can significantly affect recovery. Objectives: To determine the effectiveness of serratiopeptidasein minimizing postoperative trismus after surgical extraction of mesioangular mandibular third molar.

Materials and Methods: A randomized controlled trial was carried out in our Department of Oral and Maxillofa-cial Surgery, Sharif Medical City Hospital, Lahore from 6 June 2025 to 2 September 2025. A combined total of 110 patients (aged 18–50 years) were allocated randomly to two treatment groups using a single-blind lottery-based assignment: Group A received serratiopeptidase 10 mg twice daily for five days along with standard therapy, which consisted of oral paracetamol (500 mg every 8 hours) and Enziclor mouthwash (chlorhexidine). Group B received only the standard therapy. Exclusion criteria included concurrent oral surgical procedures, impactions close to the inferior alveolar nerve, anticoagulant use, smoking, pregnancy or lactation, peptic ulcer disease, or recent NSAID use within the past week. Measurement of mouth opening was recorded preoperatively and on post-operative days 1, 3, and 5 using the maximum interincisal distance in millimeters.

Results: At baseline, both groups had comparable mouth opening (42.8 ± 4.3 mm vs. 43.1 ± 4.1 mm, p = 0.71). On 1stpostoperative day, Group A had significantly higher mouth opening than Group B (28.6 ± 5.2 mm vs. 24.9 ± 4.8 mm, p < 0.001). This difference remained significant on day 3 (32.9 ± 5.0 mm vs. 28.7 ± 4.9 mm, p < 0.001) and day 5 (37.1 ± 5.6 mm vs. 30.5 ± 5.3 mm, p < 0.001). More patients in the serratiopeptidase group achieved clinically acceptable mouth opening (>35 mm) by day 5 as compared to controls (69.1% vs. 25.5%, p < 0.001).

Conclusion: The use of serratiopeptidase significantly reduces postoperative trismus and accelerates recovery fol-lowing the surgical removal of mesioangular mandibular third molars. The consistent effectiveness and good safe-ty record of the drug support its value as an adjunctive therapy in postoperative management. Further multicenter trials are recommended to confirm these findings