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Objective <p>To compare the efficacy of a combination of proteolytic enzymes (trypsin, bromelain, rutoside) with diclofenac, serratiopeptidase with diclofenac, and diclofenac alone in managing postoperative pain, swelling, and trismus following surgical extraction of impacted mandibular third molars.</p> Materials and Methods <p>A prospective, randomized, double-blind clinical trial was conducted on 60 ASA I patients (18–40 years) undergoing extraction of mandibular third molars. Patients were randomly allocated into three groups (<i>n</i> = 20): Group A received tab. Phlogam (trypsin, bromelain, rutoside) plus diclofenac 50 mg; Group B received serratiopeptidase 15 mg plus diclofenac 50 mg; Group C received diclofenac 50 mg alone. Pain, swelling and trismus were assessed on postoperative days 1, 3, 5, and 7.</p> Results <p>Group A demonstrated significantly lower pain scores at all time points (<i>p</i> &lt; 0.01) and greater reduction in swelling by days 5 and 7 compared to Groups B and C. No significant intergroup difference in trismus was observed by day 7, although Group A showed faster early recovery.</p> Conclusion <p>The combination of trypsin, bromelain, and rutoside with diclofenac showed better results in terms of pain and swelling control compared to serratiopeptidase with diclofenac or diclofenac alone, supporting its adjunctive use in third molar surgery.</p>

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Comparative Evaluation of Efficacy of Proteolytic Enzyme Combinations and Diclofenac Regimens in Impacted Mandibular Third Molar Surgery with Similar Pederson’s Difficulty Index–A Double-Blind Randomized Control Trial

  • 期刊论文

  • 发表日期：

    2026年7月2日

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  • Sanjay Jadwani,
  • Naved Khan,
  • Ramkrishna Yadav,
  • Bathri Elangovan

摘要

Objective

To compare the efficacy of a combination of proteolytic enzymes (trypsin, bromelain, rutoside) with diclofenac, serratiopeptidase with diclofenac, and diclofenac alone in managing postoperative pain, swelling, and trismus following surgical extraction of impacted mandibular third molars.

Materials and Methods

A prospective, randomized, double-blind clinical trial was conducted on 60 ASA I patients (18–40 years) undergoing extraction of mandibular third molars. Patients were randomly allocated into three groups (n = 20): Group A received tab. Phlogam (trypsin, bromelain, rutoside) plus diclofenac 50 mg; Group B received serratiopeptidase 15 mg plus diclofenac 50 mg; Group C received diclofenac 50 mg alone. Pain, swelling and trismus were assessed on postoperative days 1, 3, 5, and 7.

Results

Group A demonstrated significantly lower pain scores at all time points (p < 0.01) and greater reduction in swelling by days 5 and 7 compared to Groups B and C. No significant intergroup difference in trismus was observed by day 7, although Group A showed faster early recovery.

Conclusion

The combination of trypsin, bromelain, and rutoside with diclofenac showed better results in terms of pain and swelling control compared to serratiopeptidase with diclofenac or diclofenac alone, supporting its adjunctive use in third molar surgery.