Journal of Cranio-Maxillo-Facial Surgery 48 (2020) 127e131

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Journal of Cranio-Maxillo-Facial Surgery

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Kinesio taping use to reduce pain and edema after third molar
extraction surgery: A randomized controlled split-mouth study
~o da Rocha Heras a, Danieli Maciel Streling de Oliveira a,
Ana Carolina Trista
Marcos Heidy Guskuma a, Marília Carolina de Araújo a, Karen Barros Parron Fernandes b,
Rubens Alexandre da Silva Junior b, c, Rodrigo Antonio Carvalho Andraus b,
Luciana Prado Maia a, Thais Maria Freire Fernandes a, *
a
School of Dentistry, University of Northern Parana (UNOPAR), Londrina, Brazil
b
Rehabilitation Science Program, University of Northern Parana (UNOPAR), Londrina, Brazil
c
University du Qu  Chicoutimi (UQAC), DSS, Lab BioNR, Saguenay, QC, Canada
ebec a

a r t i c l e i n f o a b s t r a c t

Article history: Objective: Evaluating Kinesio Taping (KT) use to reduce pain and edema in individuals subjected to
Paper received 5 August 2019 surgical extraction of impacted mandibular third molars.
Accepted 2 December 2019 Materials and methods: Thirteen individuals (5 men and 8 women, mean age: 23.25 years) were sub-
Available online 17 December 2019
jected to mutual extraction of two mandibular third molars based on the same surgical protocol and
pharmacological approach. All individuals were subjected to kinesio taping application on one side of
Keywords:
patients' face (test group - KT), in the immediate postoperative period. The other side of the face was not
Pain
subjected to KT application, and it was used as control (No KT). An examiner assessed individuals’ pain
Edema
Third molar
and edema based on the visual analog scale (VAS) and on the Todorovi c-Markovic method, respectively,
Mandible at the preoperative, immediate postoperative, and second and fifth postoperative days. Statistical anal-
Tooth extraction ysis was based on the ScheirereRayeHare test.
Elastic bandage Results: Edema (48 h and 120 h after surgery) and pain intensity (24 h, 48 h and 120 h after surgery)
were lower on the KT side (p < 0.05). Moreover, edema and pain intensity fully reduced on the KT side
120 h after surgery (p < 0.05).
Conclusion: Kinesio taping adopted in the current study was effective in reducing edema and post-
operative pain in patients subjected to oral surgery.
Clinical relevance: KT enables patients to experience a more comfortable postoperative period and helps
improving their quality of life.
© 2019 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights
reserved.

1. Introduction
Patients subjected to surgical extraction of third molars often
experience pain, trismus and facial edema in the postoperative
period (Seymour et al., 1996). Several factors contributing to these
symptoms can derive from inflammatory processes resulting from
initial surgical trauma (Capuzzi et al., 1994). The postoperative
period of patients subjected to surgical extraction of impacted third
molars is often characterized by limited mouth opening, pain,
* Corresponding author. University of North Paran a, Alameda Ipe Rosa, 956,
Londrina, CEP: 86055-782, Paran
a, Brazil. Fax: þ55 43 3371 7991.
E-mail address: thaismaria@hotmail.com (T.M.F. Fernandes).
reduced chewing ability and varying edema degree. Such edema
degree variation is a serious issue, since it affects patients' ability to
interact with others, as well as to resume work and daily life ac-
tivities, mainly during the first three postoperative days (Colorado-
Bonnin et al., 2006; Grossi et al., 2007; Slade et al., 2004).
Taping therapy has shown effectively satisfactory results in
restoring muscle function and in decreasing pain (Akbas et al.,
2011); besides, it has a variety of physiological effects such as
analgesia, easy blood and lymphatic circulation, musculoskeletal
imbalance compensation or correction, and joint correction (Briem
et al., 2011; Fu et al., 2008). However, some studies did not find
effectiveness in kinesio taping (KT) application in patients diag-
nosed with musculoskeletal disorders (Parreira et al., 2014).

https://doi.org/10.1016/j.jcms.2019.12.003
1010-5182/© 2019 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
128 A.C.T. da Rocha Heras et al. / Journal of Cranio-Maxillo-Facial Surgery 48 (2020) 127e131
Fig. 1. Flow diagram of the progress through the phases of study.
Overall, despite the lack of scientific evidence in postoperative
facial surgery, elastic taping is used to stimulate the skin, as well as
to increase blood and lymph flow based on the elimination of
lymph congestion and hemorrhagic material. Some authors believe
that KT can help improving blood and lymphatic circulation
depending on bandage shape and application mode (Ristow et al.,
2014a,b,c). Taping can also promote sensory motor stimulus
across skin receptors and mechanoreceptors found in joints or
muscles, which, in their turn, can help minimizing the nociceptive
pain caused by peripheral nerve fiber stimulation (Ristow et al.,
2014a,b,c). Some specific studies focused on investigating third
molar extraction (Ristow et al., 2014a,b,c), orthognathic surgery
(Tozzi et al., 2016; Hunt and Cunningham, 1998), and zygomatic-
orbital fractures presented favorable results after the use of
elastic taping. However, it should be investigated whether the use
of elastic taping (herein called kinesio taping) is useful in the
postoperative management of facial surgeries.
It is plausible assuming that KT application can mitigate the
postoperative morbidity of third molar extraction by accelerating
the drainage of tissue reaction or hemorrhages. The aim of the
current study was to evaluate Kinesio Taping use to reduce pain and
edema in individuals subjected to surgical extraction of impacted
mandibular third molars.
2. Materials and Methods
The present study has followed a prospective randomized
controlled split-mouth model to assess the effects of kinesio taping
in reducing pain and inflammatory processes in individuals sub-
jected to surgical extraction of third molars. Thirteen individuals
were selected at the Surgery Clinic of University of North Parana
(UNOPAR). The study was implemented after the Research Ethics
Committee of the aforementioned institution issued its approval
under protocol number 053359. All individuals signed the
informed consent form prior to any procedure. Inclusion criteria
comprised individuals presenting asymptomatic bilateral impacted
mandibular third molars in position C, based on Pell and Gregory
classification (Garcia et al., 2000), and mesioangular impacted third
molars, based on Winter classification (Khojastepour et al., 2019),
which justified tooth extraction. Exclusion criteria comprised the
incidence of skin lesions, local infections, individuals with systemic
diseases, individuals who could not make use of any of the products
included in the adopted drug protocol, smoking habit, and preg-
nant and lactating women. Seventy individuals were assessed;
however, only 15 of them met the inclusion criteria and were
randomized into groups based on tooth extraction side and
sequence (Fig. 1).
Intraoral antisepsis was preoperatively held based on mouth-
wash with 0.12% chlorhexidine, whereas extra-oral antisepsis was
based on topical application of 1% povidone-iodine. All individuals
were subjected to the same standardized surgical protocol, which
was always performed by the same maxillofacial surgeon. Surgery
was performed under sterile conditions and followed a standard
surgical protocol. Osteotomy (and crown sectioning, whenever
necessary) was performed by using sterile low-speed hand pieces
and sterile saline irrigation. Teeth were extracted with the aid of
dental elevator or extraction forceps. Next, socket curettage was
carried out and irregular bone edges of the dental alveolus were
evened out. Wound closure was performed with the aid of buccal
mucoperiosteal flap and resorbable sutures (3e0, Viryl; ethicon®)
(Leonard, 1992). All patients were subjected to the extraction of the
two selected third molars in a single surgery session. The adopted
drug protocol comprised 750 mg of Paracetamol every 8 h, for pain
relief; 4 mg of Dexamethasone every 12 h, for 2 days - the first dose
was administered 1 h before surgery-; 500 mg of Amoxicillin every
8 h, for seven days - the first 2 g dose was administered 1 h before
surgery -; 0.12% of chlorhexidine, for gentle mouthwash every 8 h,
for seven days.
One side of patients’ face, herein standardized as test group (KT),
was subjected to beige tape application (Leukotape KeBNS medical
GMBH- HamburgeGermany, made in Thailand) in the immediate
postoperative period, whereas the other side of their faces, herein
defined as control (No KT), was not subjected to KT application.
Microsoft Excel and simple random allocation procedures were
adopted; one investigator prepared the lists used by another
investigator to assign patients either to the experimental (KT) or
control (No KT) side groups and surgery sequence. A single quali-
fied professional performed KT application. Values recorded for
pain and edema were analyzed by a calibrated examiner at four
 A.C.T. da Rocha Heras et al. / Journal of Cranio-Maxillo-Facial Surgery 48 (2020) 127e131 129

enable better adherence to patients’ skin after the fixation pro-

cedure was over, and remained there for five days.
Individuals were instructed to apply ice packs for the first 48 h
after surgery, to eat doughy and cold food for the first two post-
operative days, to maintain absolute bed rest for 24 h, as well as to
gently brush and floss around the surgical area until suture removal
(7 days after surgery).
Pain intensity and edema were evaluated in the following pe-
riods: pre-operative, immediate postoperative, as well as second
and fifth postoperative days. Pain intensity was bilaterally assessed
based on the visual analogue scale (VAS) - lack of pain was classified
as level 0; and maximum pain, as level 10 (Hawker et al., 2011).
Edema was bilaterally assessed by using measuring tape; mea-
surements were based on the relative distance between the
mentum apex and the lowest part of the ear lobe. Pre- and post-
operative measurements were used to calculate edema ratio (Ec),
based on Markovic and Todorovic (2007).

postoperative distance  preoperative distance  100

Fig. 2. Application of Kinesio Taping. Ec ¼
Preoperative distance
Statistical analysis was performed in the Statistica 7.0 software
specific time points: before surgery, immediately after surgery (version 7.0, STATSOFT. Inc. Tulsa, OK, USA). The ScheirereRayeHare
baseline (T0), as well as 48 (T1) and 120 (T2) hours after surgery. test at significance level 5% was used to compare dependent variables
The tape used in the current study was made of cotton and such as pain intensity and edema between sides.
polyurethane; its composition did not include medication addition.
Tape positioning covered from the labial commissure region of the
test side to the area below the ear lobe, tangential to the base of the
3. Results
jaw along its entire length (Fig. 2). The length of the tape was
individually evaluated; a fixed 5-cm point was established, the tape
The present study comprised 13 individuals, in total (5 men and
was cut into 5 strips (1 cm thick) and all the edges were rounded.
8 women at mean age 23.25 years) who presented asymptomatic
The tape was applied on clean and dry skin, and patients were
third molars. Mean operative time between KT (48 ± 19.87 min)
asked to turn their faces to the opposite side in order to generate a
and No KT (52 ± 19.04 min) sides was similar; ecchymosis was
slight tension at the beginning of the application; they returned
observed in four individuals (31%) from control side group (Table 1)
their faces to resting position in each of the five consecutive cuts.
120 h after surgery.
Tape application started from the basis of the mandible in the
Table 2 presents all data about edema and pain intensity. None
submandibular ganglion chain region (fixed point), where strips
of the patients presented edema or pain at the preoperative period.
were and covered the area below the ear lobe, towards the entire
KT sides presented lower edema rate at T1 (0.8) and T2 (0.0) than
labial commissure extension. The tape was slightly rubbed to
the No KT side (22.3 and 7.4, respectively). Both sides presented

Table 1
Operative time and ecchymosis.

KT No KT p

Operative time (min) 48.69 52.92 0.584

Preoperative T0 (Immediate T1 (48 h) T2 (120 h)
postoperative)
KT NoKT KT No KT KT No KT KT No KT
Ecchymosis 0(0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 4 (30.8%)

KT: therapy taping side; No KT: control side.

Table 2
Results of ScheirereRayeHare test comparing the sides regard to edema and pain intensity.

Post-Operatory evaluation Median (1oQ e T0 T1 T2

3oQ) (Immediate (48 h) (120 h)
Preoperative postoperative)

KT No KT KT No KT KT No KT KT No KT

Edema 0 (0) 0 (0) 7.9 14.8 0.8 22.3 0.0 7.4

(0e21.4) (0e22.2) (0e23.6) (14.9e34.1) (0e0) (0e15.7)
ScheirereRayeHare test Time Side Time x Side
0.04* 0.01* 0.28
Pain intensity (100 mm) 0 (0) 0 (0) 23.0 45.0 0.0 20.0 0.0 2.0
(3e40) (18e61) (0e8) (5e34) (0e5) (0.6e12)
ScheirereRayeHare test Time Side Time x Side
0.01* 0.01* 0.43

* Statistically significant difference, p < 0.05.

KT: therapy taping side; No KT: control side.
130 A.C.T. da Rocha Heras et al. / Journal of Cranio-Maxillo-Facial Surgery 48 (2020) 127e131
reduced edema 120 h after surgery, except for the No KT side, which
presented increased edema 48 h after surgery.
Pain intensity assessment (based on VAS) results have shown
reduced pain intensity in both sides over the experimental periods.
However, the KT side recorded significantly higher pain intensity
reduction rate at T0 and T1, a fact that reinforced the possible
taping therapy effect on pain. In addition, none of the analyzed
cases had late complications.
4. Discussion
The current study has evaluated clinical parameters such as pain
and edema in a group of individuals subjected to surgical extraction
of both included mandibular third molars patients themselves were
used as control group. Although taping therapy has potential influ-
ence on swelling and pain reduction in different injured areas
(Williams et al., 2012), its application in dentistry is relatively new.
Given the lack of clinical studies about it, as well as of standardiza-
tion in edema measurement and application in human facial region,
it is possible stating that the current study is an original research that
has potential to help clinical decision making processes.
Maximum edema is mostly seen around the second postoperative
day, as observed on the No KT side in the present study. However,
taping therapy application has reduced the edema significantly faster
on the KT side than on the No KT side. Edema reduction on the KT side
reached approximately 90% within 48 h after taping therapy applica-
tion the amount of edema reported by individuals at the second
postoperative day was almost significant. On the other hand, the No KT
side recorded significant edema increase in the same period. According
to Ristow et al. (2013, 2014a,b,c) and Tozzy et al. (2016), patients sub-
jected to taping therapy reduced the edema by 60%, after the second
postoperative day.
The satisfactory results recorded in the present study may be
associated with the fact that the elastic bandage was applied in a
more localized way, which included the submandibular ganglion
chain in its fixed point, as well as extending the 5 strips from the
labial commissure region of the operated side to the region below
the ear lobe (in all its extension) - this procedure has significantly
reduced the edema and enabled its drainage through the sub-
mandibular gland. Edema reduction rate was higher on the KT side
than on the control side (No KT). These findings are consistent with
other studies about KT use after face surgeries, which observed
edema reduction peak in KT-treated groups after the second post-
operative day, as well as faster edema reduction on the KT side
(Ristow et al., 2014a, 2014b, 2014c, Williams et al., 2012).
Constant pain decrease was observed on the KT side in com-
parison to the control side; this outcome meets the results by
Ristow et al. (2014a,b,c), who recorded low-to-moderate pain in
both groups, according to VAS-based measurements. The present
study has also observed minor pain on the KT side right after sur-
gery and 48 h after it. Similar results were observed in clinical
studies about orthognathic surgery (Tozzi et al., 2016). According to
several researchers, postoperative pain reduction may be associ-
ated with the analgesic protocol adopted in each clinical study;
they also suggested that investigations should be carried out
without using painkillers (Ristow et al., 2013, Ristow et al.,
2014a,b,c) or based on the split-mouth model. The current study
has maintained the use of analgesics by all individuals in the
postoperative period; both third molars were extracted in a single
surgery session, although only one side of patients' face was sub-
jected to taping therapy. Pain intensity was lower on the KT side,
thus suggesting that this outcome resulted from the taping therapy,
rather than from the systemic use of analgesics. Pain decreased by
100% on the KT side 48 h after surgery, whereas the No KT side
recorded pain decrease by approximately 56% at the same period. It
is possible stating that KT use has significantly reduced patients'
pain in comparison to No KT use. The taping extension movement
adjusts its length to the skin to a certain extent. The constant skin
stimulation can divert patients’ perception about pain. All in-
dividuals assessed in the current study reported improved pain, as
well as greater satisfaction and comfort on the KT side, in the
postoperative period, this outcome was also observed in other
studies (Ristow et al., 2013; Ristow et al., 2014a,b,c; Tozzi et al.,
2016; Williams et al., 2012).
Ecchymosis at the base of mandible on the No KT side was
observed in 30.8% of patients, 120 h after surgery; this outcome was
not observed onthe KT side, a fact that emphasized the beneficial
effects of taping therapy application.
Taping therapy application can irritate patients’ skin in some
cases and some individuals may experience allergic reactions.
Although adverse reactions were not observed in patients during
the current study, such possibility must be confirmed before the
widespread and routine use of taping therapy.
The current study was the first to report results of clinical KT use
after surgical extraction of impacted mandibular third molars in a
single surgery session, based on the split-mouth model. A new tape
positioning form was developed, and it differed from the one
adopted in previous studies (Ristow et al., 2013; Ristow et al.,
2014a,b,c; Tozzi et al., 2016). Therefore, a more aesthetic, local-
ized and functional bandage application way was herein suggested
to assure that its use will not emotionally interfere in patients’ daily
activities. Furthermore, it is an alternative low-cost therapy of easy
access and implementation.
One cannot neglect the possibility of placebo effect as a limi-
tation of the current study. Thus, it is not possible stating, with
100% certainty, that the taping therapy can significantly reduce
pain perception (Ristow et al., 2013). Another limitation of the
present study lies on the fact that the examiner was not blind to
the experiment. This factor may be a methodological limitation,
since KT application and measurement procedures could not be
blinded. However, the examiner was very experiment. Results
should be carefully interpreted, since the adopted measuring
techniques are very delicate and can lead to measurement errors.
Further studies focused on removing the effect of standard sys-
temic analgesics or on controlling placebo effects should be car-
ried out to substantiate the current results and to help better
understanding whether KT is a valid postoperative edema and
pain management method.
5. Conclusion
Kinesio taping therapy used in the current study was effective in
reducing edema and postoperative pain in patients subjected to
oral surgery. Thus, it should be taken into consideration as an
adjuvant therapy, whenever possible, due to its easy application
and potential beneficial effects.
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