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Postoperative pain and wound healing following pediatric oral soft-tissue surgery: A network meta-analysis
Kanwalpreet Kaur1, Ravinder S Saini2, Rajesh Vyas3
1Rutgers School of Dental Medicine, New Jersey, USA.
Insights
Energy-based tools like electrosurgery and Nd:YAG lasers significantly reduce postoperative pain in pediatric oral surgery. Diode lasers promote superior wound healing compared to traditional scalpels, enabling personalized surgical approaches.
Area of Science:
- Oral Surgery
- Pediatric Dentistry
- Biomedical Engineering
Background:
- Scalpels are traditionally used for pediatric oral soft-tissue procedures.
- The need for improved pain management and wound healing outcomes is critical in pediatric oral surgery.
- Energy-based devices offer potential alternatives to conventional surgical methods.
Purpose of the Study:
- To conduct a network meta-analysis comparing scalpels and energy-based tools for pediatric oral surgery.
- To prioritize surgical instruments based on postoperative pain and wound healing efficacy.
- To inform personalized technique selection for improved patient outcomes.
Main Methods:
- Systematic review and network meta-analysis following PRISMA-NMA guidelines.
- Searched PubMed, Scopus, Web of Science, ScienceDirect, and Cochrane Library up to December 2025.
- Included RCTs and prospective comparative studies on pediatric oral soft-tissue surgery using scalpels, diode laser, CO2 laser, Nd:YAG laser, or electrosurgery. Assessed risk of bias and performed frequentist/Bayesian meta-analyses.
Main Results:
- All energy-based modalities showed reduced postoperative pain compared to scalpels.
- Electrosurgery (SUCRA 71.2%) and Nd:YAG laser (SUCRA 66.8%) ranked highest for pain reduction.
- Diode laser demonstrated the best wound healing probability (SUCRA 86.6%), while electrosurgery had the lowest for healing (SUCRA 5.5%).
Conclusions:
- Energy-based modalities provide outcome-specific benefits over scalpels in pediatric oral soft-tissue procedures.
- Electrosurgery and Nd:YAG laser maximize pain reduction; diode lasers optimize wound healing.
- Findings support personalized surgical approaches in pediatric oral surgery based on desired outcomes.
Objective:
We conducted a network meta-analysis to evaluate and prioritize scalpels and energy-based soft-tissue management tools used during pediatric oral surgeries. This was based on postoperative pain levels and wound healing results.
Materials And Methods:
A systematic review and network meta-analysis were conducted. This analysis was performed following the PRISMA-NMA guidelines. The electronic databases PubMed, Scopus, Web of Science, ScienceDirect, and Cochrane Library were searched from inception to December 2025. Randomized controlled trials and prospective comparative studies of pediatric patients undergoing oral soft-tissue surgery were eligible for inclusion. The included interventions were scalpel surgery, diode laser, CO2 laser, Nd:YAG laser, and electrosurgery. The primary outcomes were postoperative pain and wound healing. The risk of bias was assessed using the Cochrane RoB 2 and ROBINS-I tools. Frequentist and Bayesian random-effects network meta-analyses were performed. Treatment ranking was estimated by reporting the surface under the cumulative ranking curve (SUCRA) values.
Results:
Twelve studies were included in this review. All energy-based modalities produced less postoperative pain than scalpel surgery. The highest ranking probability for reducing pain was observed with electrosurgery (SUCRA 71.2%), followed by Nd: YAG laser (SUCRA 66.8%) and diode laser (SUCRA 56.5%). Scalpel surgery had the lowest probability ranking (19.7%). Diode laser had the highest probability for wound healing (SUCRA 86.6%). This was followed by scalpel surgery (71.8%). Electrosurgery had the lowest ranking probabilities for all wound healing outcomes (SUCRA 5.5%). No significant inconsistency was observed between the direct and indirect comparisons. Publication bias was low for the postoperative pain.
Conclusion:
Energy-based modalities offer outcome-selective advantages over conventional scalpel surgery for minor oral soft-tissue procedures. The maximum reduction in postoperative pain was achieved using electrosurgery and Nd: YAG laser. Diode lasers offer the best wound-healing results. These results validate an approach to pediatric oral surgery that focuses on individual outcomes using personalized techniques.
