Oral and Maxillofacial Surgery (2022) 26:535–553

https://doi.org/10.1007/s10006-021-01025-y

REVIEW ARTICLE

Does kinesio taping reduce pain, swelling, and trismus

after mandibular third molar surgery? A systematic review
and meta‑analysis
Parsa Firoozi1,2 · Marina Rocha Fonseca Souza3 · Glaciele Maria de Souza3 · Ighor Andrade Fernandes3 ·
Endi Lanza Galvão3 · Saulo Gabriel Moreira Falci3

Received: 6 September 2021 / Accepted: 28 November 2021 / Published online: 4 January 2022
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021

Abstract
The aim of this study is to provide an evidence-based conclusion regarding the effectiveness of kinesio taping (KT) in reduc-
ing postsurgical discomforts after mandibular third molar surgery and critically appraise the available literature. Eligible
clinical trials evaluating patients older than 18 years who were treated with any type of KT compared to no taping in which
pain, swelling, or trismus scores were reported were included. An electronic literature search was carried out in the follow-
ing databases to identify relevant papers up to May 30, 2021: Medline, Cochrane Central Register of Controlled Trials, Web
of Science, and Scopus. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2.0).
The effect sizes were calculated using mean difference (MD) and standardized mean difference (SMD). The heterogeneity
analysis was conducted using (I2) statistic at alpha = 0.10 (PROSPERO; CRD42021252670). Nine randomized clinical tri-
als with 444 participants were included in the qualitative analysis and eight in the quantitative analysis. The results of the
meta-analysis revealed a statistically significant reduction in pain and swelling scores before the 7th postoperative day. On
the 7th postoperative day, no significant difference was observed between KT and control groups in terms of pain and swell-
ing. Additionally, KT led to an increase in patients’ maximum mouth opening of more than 3 mm in postoperative intervals.
KT is effective in reducing postoperative pain within the first 48 h after surgery and improving mouth opening during all
postoperative intervals with moderate to high certainty of evidence.

Keywords Kinesio tape · Third molar · Oral surgery · Tooth extraction · Systematic review

Introduction impacted third molars are frequently extracted as a preventa-

One of the most common procedures in the field of oral
surgery is the extraction of the third molars [1]. Caries,
pericoronitis, pulpitis, and odontogenic cysts are all pos-
sible consequences of impacted third molars. As a result,
* Parsa Firoozi
parsafir2@gmail.com
1
Department of Oral and Maxillofacial Surgery, School
of Dentistry, Zanjan University of Medical Sciences, Zanjan,
Iran
2
Student Research Committee, School of Dentistry, Zanjan
University of Medical Sciences, Zanjan, Iran
3
Department of Dentistry, Oral and Maxillofacial Surgery
Section, Federal University of Vales Do Jequitinhonha
E Mucuri (UFVJM), Rua da Glória, 187, Diamantina,
MG 39100‑000, Brazil
tive intervention [2].
In the first 7 days after surgical extraction of the third
molars, patients commonly suffer significant discomforts,
including pain, swelling, and trismus [3, 4]. These postoper-
ative squeals may have a detrimental impact on the patients’
daily quality of life [5, 6]. Many of the causes contributing
to these squeals can be traced back to inflammatory mecha-
nisms that occur as a result of surgical trauma [7]. Within
3 to 5 h after the anesthetic effect has worn off, the pain
reaches its peak, then it lasts for 2 or 3 days, and eventually
decreases until day seven. Within 12 to 48 h, the swelling
hits its peak and subsides in the following five to seven days
[5]. Trismus, on the other hand, will resolve after pain and
swelling resolution [5].
Different therapeutic approaches are described to decrease
postoperative complications. There are the traditional thera-
pies, including allopathic medicines [8–11], cooling therapy

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[12, 13], local compresses [14], and laser applications [15],
and alternative ones, such as acupuncture [16], ozonized
water [17], phytotherapy medicines like bromelain [18], and
homeopathy medicines like Traumeel [19]. These alternative
approaches are suggested to minimize the allopathic drugs’
adverse effects and their contraindications. Besides that, they
may improve the results of traditional medicines used to con-
trol inflammatory parameters after third molar surgeries. Now-
adays, the search for alternative and additional treatments, such
as kinesio taping (KT), is increasing and leading researchers to
find non-pharmaceutical therapeutic methods to manage third
molar postoperative sequels [20–24].
Kinesio taping was introduced in the 1970s, and it is one
of the adjuvant appliances of sports medicine to alleviate
morbidity following surgical procedures [25]. KT has since
gained popularity as a promising treatment option for acute
and chronic musculoskeletal complaints, such as pain, par-
esthesia, joint instability, and edema [26]. The tape is made
of elastic material, and it is fixed to the skin with a certain
degree of traction, thereby impacting the skin and various
subcutaneous layers. The pre-tension of the tape gently raises
the skin, potentially improving lymphatic drainage and lead-
ing it to less congested pathways [25, 27]. Accordingly, KT
has achieved popularity in the control of lymphedema [28].
Moreover, during active movement, the tape seems to have a
massaging effect [27]. Also, KT reduces nociceptive discom-
fort by affecting mechanoreceptors in joints and muscles [29].
Some published randomized controlled trials (RCTs) are sug-
gesting a favorable effect of KT application on postoperative
morbidities after third molar surgery as well as orthognathic sur-
gery and zygomatic-orbital surgery [20–24, 30]. Furthermore,
KT probably improves the patients’ quality of life after third
molar surgery [31]. A recently published systematic review has
examined the application of KT to reduce complications after
third molar surgery [32]. However, this review included other
comparisons groups such as allopathic medicines [33, 34] and
did not perform a meta-analysis. Another published systematic
review has not assessed the certainty of the evidence which is an
emphasized item by PRISMA 2020 guidelines and has used the
older version of the Cochrane Risk of Bias tool [35].
Therefore, the present systematic review and meta-analysis
aimed to improve the previous systematic reviews and solve
their shortcomings comprehensively and provide an evidence-
based conclusion regarding the effectiveness of KT in reducing
postsurgical complications after mandibular third molar surgery.
Methods
The protocol of this study was previously registered in the
International Prospective Register of Systematic Reviews
(PROSPERO; CRD42021252670). This systematic review
was performed based on the PRISMA (Preferred Reporting
13
Oral and Maxillofacial Surgery (2022) 26:535–553
Items for Systematic Reviews and Meta-Analysis) revised
guidelines [36].
Eligibility criteria
PICO(S) framework was employed to define the inclusion
criteria. All eligible clinical trials (Study type, S), evalu-
ating patients older than 18 years with any gender who
underwent mandibular third molar surgery (Population,
P) and were treated with any type of KT (Intervention,
I) compared to no taping (Comparator, C), in which pain,
swelling, or trismus scores were reported (Outcome, O),
were considered for inclusion. Exclusion criteria included
case reports, conference papers, narrative and system-
atic reviews, letters to the editors, and animal studies. No
restrictions regarding language or publication date were
applied.
Search strategy and study selection
A comprehensive literature search was conducted in the fol-
lowing databases to identify relevant papers up to May 30,
2021: Medline (PubMed interface), Cochrane Central Reg-
ister of Controlled Trials (CENTRAL), Web of Science, and
Scopus. The clinicaltrials.gov was accessed to identify the
register of potential ongoing clinical trials. Reference lists of
primarily included studies were manually searched to iden-
tify further eligible studies. Additionally, the first 50 hits of
Google Scholar were screened as a grey literature source. A
literature search of the aforementioned databases was con-
ducted using MeSH terms and relevant free keywords (Sup-
plementary file 1).
All records were imported into the EndNote software (ver-
sion 9.3), and duplicate records were removed. All retrieved
titles and abstracts from electronic databases were assessed
separately by four authors (PF, GMS, MRFS, IAF) to select
potentially eligible studies. The full texts of the previously
identified studies were obtained and then evaluated accord-
ing to the predetermined eligibility criteria by the same four
authors, independently. Any disagreement about eligibility and
any controversies among the reviewers were resolved through
a discussion with the fifth reviewer (SGMF) until a consensus
was reached.
Data extraction
The following epidemiological data were collected from
the included studies: authors, year of publication, country,
inclusion criteria, exclusion criteria, postoperative follow-
up, age of participants, sample size, gender, type of kinesio
tape, drug consumption, and details of outcomes.
The pain outcome was assessed through the visual ana-
logue scale (VAS), which ranged from 0 to 10 cm. When
Oral and Maxillofacial Surgery (2022) 26:535–553
this scale presented the results in millimeters, the con-
version of the values was performed. The swelling was
assessed through facial measures and the way it was per-
formed within each study was tabulated. The trismus was
measured postoperatively through interincisal distance
using a caliper. The unit of measure was considered as mil-
limeters. When centimeters were reported the conversion
of the values was performed. When any of this information
was missing in the included studies, the authors of those
studies were contacted by email to reach the missing data.
Risk of bias assessment
The risk of bias was assessed using the Cochrane risk-of-
bias tool for randomized trials (RoB 2.0) [37], which con-
sists of five main domains: randomization process, devia-
tions from intended interventions, missing outcome data,
measurement of the outcome, and selection of the reported
result. The risk of bias was assessed by four independent
authors (PF, GMS, MRFS, IAF) considering each intended
outcome. In case of disagreement, a senior author (SGMF)
was consulted.
Data analysis
The studies which had reported mean and standard devia-
tion values for pain, swelling, or trismus outcomes after
mandibular third molar surgery were considered for meta-
analysis. If several KT methods were used in a study, only
one of the techniques, which was common among other
studies, was considered for inclusion in the meta-analy-
sis. The statistical analyses were conducted through the
R software, version 3.6.2, with the “meta” package. The
effect sizes were calculated using mean difference (MD)
and standardized mean difference (SMD) and 95% confi-
dence intervals were used to present results in every case.
Heterogeneity analyses were conducted using (I2) statistic
and the fixed-effect model was used when I2 = 0, and the
random effect model was used when I2 > 0. In cases where
the studies used different measurement methods, the SMD
was assessed. Separate analyzes were performed taking into
account the postoperative evaluation time. Publication bias
was assessed by observing the symmetry of funnel plots
once at least ten studies were included in the meta-analysis
[38].
Certainty assessment
The quality of evidence was assessed using the Grading of
Recommendations Assessment, Development, and Evalua-
tion (GRADE) ranking system through five analysis criteria
(risk of bias, inconsistency, indirect evidence, imprecision,
537
and publication bias) [39]. Thus, the quality of evidence was
classified as high, moderate, low, or very low certainty of the
evidence.
Results
Study selection
From 76 initially identified entries, 9 studies with 444 par-
ticipants were included in the qualitative synthesis [20–24,
28, 40–43], and 8 papers were included in the meta-analysis
[21–24, 28, 40, 42, 43]. The entire process of study selection
and reasons for exclusion are summarized in a PRISMA flow
diagram (Fig. 1).
Study characteristics
All included papers [20–24, 28, 40–43] were RCTs pub-
lished between 2013 to 2021 in which patients followed
for periods ranging from 1 to 7 days postoperatively.
Main methodological and patients’ characteristics (age,
sample size, and gender distribution) are summarized in
Table 1. None of the included studies had participants
with pericoronitis or acute inflammation. The pain and
swelling outcomes were evaluated in all studies [20–24,
28, 40–43]. The trismus outcome was assessed in nine
studies [21–24, 28, 40–43]. From nine papers included,
eight [20–24, 28, 40, 42] reported that they performed
osteotomy and six [20–24, 28] reported that they per-
formed tooth sectioning. Three RCTs had split-mouth
design [20, 23, 24] and five had parallel design [21, 22,
28, 42, 43].
The majority of the included studies have used
50 mm × 5 m tapes and utilized the following KT tech-
niques: type I: applied the base of the KT just above the
supraclavicular nodes to the point of maximum swelling
[21, 22, 28, 42, 43]; type II: application to the masseteric
zone, which had the most significant edema [20, 24]; and
type III: applied the base of the KT just above the supra-
clavicular nodes to the point of maximum swelling + a
tape from the tragus to the mouth commissure [23]. The
KT characteristics, medication protocol, and the way
swelling was measured are displayed in Table 2.
Risk of bias in studies
Regarding the risk of bias, some concerns were found
during the randomization process for all outcomes. Only
for pain outcome, overall high risk of bias was observed
due to high risk of bias in the measurement of the out-
come. This is because the patients were responsible to fill
13
538
Fig. 1  PRISMA flow diagram
representing the study selection
process
the VAS scale and they knew about the groups of treat-
ments, different from swelling and trismus that measure-
ment was performed by the researcher. The overall risk
of bias for swelling and trismus was moderate (Fig. 2).
Results of meta‑analysis
From 9 included RCTs one was excluded from meta-analysis
due to the use of Dexamethasone preoperatively and the una-
vailability of appropriate data [20].
The KT reduced pain by 1.51 points of the VAS scale 24 h
after impacted mandibular third molar surgery (MD: − 1.51,
CI95% − 1.97 to − 1.04, I2 = 0%) (Fig. 3a), with moderate
certainty of the evidence (Supplementary material 2). Forty-
eight hours after impacted mandibular third molar surgery,
the KT reduced the pain by 1.99 points of the VAS scale
(MD: − 1.99, CI95% − 2.68 to − 1.29, I2 = 53%) (Fig. 3b)
13
Oral and Maxillofacial Surgery (2022) 26:535–553
with moderate certainty of the evidence (Supplementary
material 2). In 72 postoperative hours, the KT reduced
the pain by 1.45 points of the VAS scale (MD: − 1.45,
CI95% − 2.10 to − 0.81, I2 = 81%) (Fig. 3c), with very low
certainty of the evidence (Supplementary material 2). There
was no difference between the KT group and the control
group in reducing pain seven days after impacted mandibular
third molar surgery (Fig. 3d), with very low certainty of the
evidence (Supplementary material 2). One study [24] was
removed from the postoperative 7th-day analysis because the
KT group showed results equal to zero; accordingly, there
was no weight in the meta-analysis.
The swelling was lower in the KT group than the con-
trol group after 48 h (SMD: − 1.25, CI95% − 2.24 to − 0.26,
I2 = 89%) (Fig. 4a), with low certainty of the evidence (Sup-
plementary material 2). However, no difference between
the two groups was observed (SMD: 0.03 CI95% − 0.47 to
 Table 1  Main methodological and participants characteristics of the included randomized controlled trials
Authors, Country Inclusion criteria Exclusion Post-op Age Sample size Gender
year criteria follow-up
Patients 3M (days) KT group Control KT group Control KT group Control group
group group
Mean ± SD Mean ± SD Participants Participants Male (n) Female (n) Male (n) Female (n)
(years) (years) (n) (n)

Ristow et al., Germany Healthy Bilateral and Pregnant or 1–2-3–7 25.7 ± 6.5 28.3 ± 7.8 20 20 11 9 10 10
2013 patients impacted lactating
older than 3Ms women,
18 years Pell and sensitivity
Gregory to tapes,
classifica- unwill-
tion: class ingness
Oral and Maxillofacial Surgery (2022) 26:535–553

B and C to shave
facial hair,
allergy to
medica-
tions, and
inflamma-
tory reac-
tions after
surgery
Heras et al., Brazil Healthy Asympto- Presence 0 (immedi- 23.25 ± NR 23.25 ± NR 13 13 5 8 5 8
2019 patients matic bilat- of skin ately after
older than eral and lesions, surgery), 2
18 years impacted local and 5
mandibular infections,
3Ms in individu-
mesio- als with
angular systemic
(Winter diseases,
classifi- allergy to
cation) medica-
position tions,
(Pell and smoking
Gregory habit, and
classifica- pregnant
tion: class and lactat-
C) ing women

13
539
 Table 1  (continued)
540

Authors, Country Inclusion criteria Exclusion Post-op Age Sample size Gender
year criteria follow-up

13
Patients 3M (days) KT group Control KT group Control KT group Control group
group group
Mean ± SD Mean ± SD Participants Participants Male (n) Female (n) Male (n) Female (n)
(years) (years) (n) (n)

Tatli et al., Turkey Healthy Impacted Pregnant 2–4-7 27.2 ± 5.8 25.3 ± 3.9 20 20 5 15 3 17
2020 patients mandibular women,
older than 3Ms class sensitivity
18 years II position to tapes,
B (Pell and odon-
Gregory togenic
classifica- cyst, and
tion) presence of
pericoro-
nitis
Menzile- Turkey Healthy Impacted Acute peri- 1–2-3–4- 20.67 ± 2.8 19.66 ± 2.13 30 30 NR NR NR NR
toglu et al., patients mandibular coronitis, 5–6-7
2020 between 3Ms pathologic
the ages conditions,
of 18 and smokers
40 years and alco-
with no hol users,
medication patients
use with aller-
gies to
drugs, and
pregnant
women
Oral and Maxillofacial Surgery (2022) 26:535–553
 Table 1  (continued)
Authors, Country Inclusion criteria Exclusion Post-op Age Sample size Gender
year criteria follow-up
Patients 3M (days) KT group Control KT group Control KT group Control group
group group
Mean ± SD Mean ± SD Participants Participants Male (n) Female (n) Male (n) Female (n)
(years) (years) (n) (n)

Yurttutan Turkey Healthy Bilateral, Pregnant or 1–2-3–7 24.66 ± 3.96 24.66 ± 3.96 30 30 27 33 27 33
et al., 2020 patients symmetric, lactating
between impacted women,
the ages lower 3Ms patients
of 18 and (Pell and who are
35 years Gregory sensitive
with no classifica- to tape
Oral and Maxillofacial Surgery (2022) 26:535–553

history tion: class adhesives,

of facial I‑B and patients
trauma, II‑B) who did
no other not want
medical to shave
conditions, their face,
no peric- any drug
oronitis or allergy,
pain before opera-
surgery tion time
shorter
than
20 min or
longer than
30 min,
and inflam-
matory
reactions
after sur-
gery

13
541
 Table 1  (continued)
542

Authors, Country Inclusion criteria Exclusion Post-op Age Sample size Gender
year criteria follow-up

13
Patients 3M (days) KT group Control KT group Control KT group Control group
group group
Mean ± SD Mean ± SD Participants Participants Male (n) Female (n) Male (n) Female (n)
(years) (years) (n) (n)

Gozluklu Turkey Healthy Symmetric Pregnant or Swelling and 22.73 ± 3.5 22.73 ± 3.5 15 15 6 9 6 9
et al., 2020 patients bilateral lactating trismus:
older than impacted women, 2–7
18 years lower 3Ms smokers, Pain: 1–2-
(Pell and sensitiv- 3–4-5–6-7
Gregory ity to the
classifica- tapes,
tion: class unwill-
I, position ingness
B and C) to shave
facial hair,
allergies to
medica-
tions, and
presence of
postop-
erative
inflam-
matory
reactions
Kim et al., South Korea Patients who Impacted Patients with 1–2-3 42.35 ± NR 36.05 ± NR 20 20 15 5 14 6
2020 underwent mandibular hematoma
enuclea- 3M or infection
tion of a that could
dentigerous affect post-
cyst with operative
the extrac- swelling
tion of the
mandibular
3M
Oral and Maxillofacial Surgery (2022) 26:535–553
 Table 1  (continued)
Authors, Country Inclusion criteria Exclusion Post-op Age Sample size Gender
year criteria follow-up
Patients 3M (days) KT group Control KT group Control KT group Control group
group group
Mean ± SD Mean ± SD Participants Participants Male (n) Female (n) Male (n) Female (n)
(years) (years) (n) (n)

Jaron et al., Poland Healthy Asymp- Patients with 3–7 NR NR 50 50 14 36 12 38

2021 Caucasian tomatic, unstable
patients impacted arterial
older than mandibular hyperten-
18 years 3M sion, preg-
nancy, and
those who
Oral and Maxillofacial Surgery (2022) 26:535–553

needed
no bone
removal
during
surgery
Chiang India Patients Moder- Patients 3–5-7 27.08 ± 6.30 25.89 ± 5.99 38 38 8 30 22 16
et al., 2021 between ately and with heart,
18 and slightly hepatic, or
40 years of difficult renal dis-
age with no impactions ease; blood
systemic accord- dyscrasias,
disease, or ing to known
bleeding Pederson hypersen-
problems difficulty sitivities,
index autoim-
mune dis-
ease, bone
patholo-
gies,
periapical
patholo-
gies, and
allergy to
the tapes

3 M third molar, post-op post-operation, KT kinesio taping, SD standard deviation, NR not reported
Split-mouth study: data referring to the total sample and not by groups compared

13
543
 Table 2  Kinesio taping characteristics, medication protocol, and swelling measurements
544

Authors, year Kinesio taping Pre-medication in Post-medication in Swelling

both groups both groups

13
Type of KT Technique applied Tape size Time Measurement meth- Form of data presenta-
with the ods tion
tapes

Ristow et al., 2013 Skin colored K The base of three 50 mm × 5 m 5 days Ampicillin/Sulbactam Ice pack Five-line measure- Mean ± SD (cm)
Active Tape Clas- strips was placed Analgesic and ment
sic® above the supracla- Anti-inflammatory
vicular nodes medication
Placement of the (Diclofenac, 50 mg)
lymphatic strips
was directed by the
location of the lym-
phatic duct crossing
the cervical, sub-
mental, mandibular,
submandibular,
preauricular, and
parotid nodes to the
area of maximum
swelling
Heras et al., 2019 Cotton and polyure- Started from the basis 50 mm × 5 m 5 days Dexamethasone Paracetamol Distance between the Median (1°–3° quar-
thane tape (strips of the mandible in (4 mg) (750 mg) mentum apex and tile)
1 cm thick) the submandibular Amoxicillin (2 g) Dexamethasone the lowest part of
ganglion chain (4 mg) the ear lobe
region (fixed point), Amoxicillin (500 mg)
where strips were Chlorhexidine MW
and covered the (0.12%)
area below the ear
lobe, towards the
entire labial com-
missure extension
Tatli et al., 2020 Kinesio® Tex Gold™ The taping material NR 5 days NR Amoxicillin Three-line meas- Mean ± SD (cm)
was cut into five + clavulanate urement using a
pieces then the base Flurbiprofen benzy- flexible plastic tape
of the five-strip damine HCl + chlo- measure
taping material was rhexidine gluconate
applied slightly MW
above the supracla-
vicular lymph nodes
without tension
Oral and Maxillofacial Surgery (2022) 26:535–553
 Table 2  (continued)
Authors, year Kinesio taping Pre-medication in Post-medication in Swelling
both groups both groups
Type of KT Technique applied Tape size Time Measurement meth- Form of data presenta-
with the ods tion
tapes

Menziletoglu et al., Kinesiology Tape Tapes (1.6 cm in 50 mm × 5 m 2 days NR Amoxicillin paraceta- Three-line measure- Mean ± SD
2020 Nill Flex width) were applied mol (500 mg) ment using a ruler
between the tragus- Benzydamine measure
commissure and HCl + chlorhexidine
the clavicle and gluconate MW
the base of the
three strips was
placed just above
Oral and Maxillofacial Surgery (2022) 26:535–553

the supraclavicular
nodes
Yurttutan et al., 2020 Skin‑colored Kinesio Tapes were applied 50 mm × 5 m 7 days NR Analgesic (not speci- Three-line meas- Mean ± SD (mm)
Tex Gold to the masseteric fied) urement using a
region, that the flexible plastic tape
most severe edema measure
was observed and
the measurements
were performed
The web strip method
(where the tape has
solid ends and four
longitudinal cuts
through the center
section) was applied

13
545
 Table 2  (continued)
546

Authors, year Kinesio taping Pre-medication in Post-medication in Swelling

both groups both groups

13
Type of KT Technique applied Tape size Time Measurement meth- Form of data presenta-
with the ods tion
tapes

Gozluklu et al., 2020 Skin- or black- Technique A: Placed 50 mm × 5 m 5 days NR Amoxicillin + cla- 3dMD software Scale 0 to 100
colored Kinesio-Tex just above the vulanate (1 g), Mean ± SD
Gold supraclavicular Naproxen sodium
tape with 3 strips lymph nodes (the (500 mg)
of equal length of target area for Chlorhexidine gluco-
1.5 cm drainage) nate MW
Technique B: A
masseteric support
bandage was placed
in addition to the
tapes used in the
classic technique A
Define by the
distance (in the
stretched position)
between the clavicle
and the position
of the most severe
swelling
Kim et al., 2020 Skin-colored Nitto The base was placed 50 mm × 5 m NR NR Intravenous tramadol The swelling was Mean ± SD (cm)
Kinesio Tape above the area (50 mg/ml) assessed by the
drained by the supr- Intravenous Ceftriax- four-line measure-
aclavicular nodes. one sodium hydrate ment method using
The tape place- (1 g) Chlorhexidine a standard plastic
ment was directed (0.12%) tape placed in con-
at the appropriate tact with the skin
lymphatic ducts
crossing the cervi-
cal, submental,
submandibular, and
parotid nodes
Oral and Maxillofacial Surgery (2022) 26:535–553
 Table 2  (continued)
Authors, year Kinesio taping Pre-medication in Post-medication in Swelling
both groups both groups
Type of KT Technique applied Tape size Time Measurement meth- Form of data presenta-
with the ods tion
tapes

Jaron et al., 2021 K-Active Tape Clas- The application of the 50 mm × 5 m 5 days NR Ketoprofen (100 mg) The measurement Mean ± SD
sical tape was started in Chlorhexidine solu- was performed
the area of supra- tion (0.1%) with an elastic
clavicular lymph measuring tape.
nodes. The tape The measurements
was then advanced of swelling were
to line A (Tragus performed using
to cheilion) on the five lines mapped
Oral and Maxillofacial Surgery (2022) 26:535–553

patient’s face where out on the patient’s

the greatest edema face
was expected
Chiang et al., 2021 NR The tapes were NR NR NR Analgesics and Five-line measure- Mean ± SD (cm)
applied from the antibiotics (not ment
supraclavicular specified)
region to the point
of maximum swell-
ing

SD standard deviation, NR not reported, MW mouth wash, KT kinesio taping

13
547
548 Oral and Maxillofacial Surgery (2022) 26:535–553

13
 Oral and Maxillofacial Surgery (2022) 26:535–553
◂Fig. 2  Assessment of the risk of bias in the included studies for (A)
pain, (B) swelling, and (C) trismus outcomes
0.53, I2 = 70%) 7 days after mandibular third molar surgery
(Fig. 4b), with very low certainty of the evidence (Supple-
mentary material 2).
The mouth opening was greater in the KT group than
in the control group (MD: 5.84 mm, CI95% 1.06 to 10.62,
I2 = 67%), after 48 postoperative hours (Fig. 5a), with mod-
erate certainty of the evidence (Supplementary material 2);
after 72 postoperative hours (MD: 4.59 mm, CI95% 2.44 to
6.73, I2 = 0%) (Fig. 5b), with high certainty of the evidence,
(Supplementary material 2) and after seven postoperative
days (MD: 3.24 mm, CI95% 2.03 to 4.44, I2 = 0) (Fig. 5c),
with high certainty of the evidence (Supplementary mate-
rial 2).
The funnel plots to verify publication bias were not con-
structed because none of the analyzes included more than
10 studies.
Discussion
Qualitative and quantitative results of this study suggest that
KT can reduce postoperative complications after mandibu-
lar third molar surgical extraction. The results of this meta-
analysis are in line with the previously published systematic
reviews [32, 35] which concluded that KT is a promising
clinical method to reduce postoperative morbidity after man-
dibular third molar surgery. We decided to perform a meta-
analysis to report the results quantitatively and provide an
evidence-based conclusion based on the available literature.
Pharmaceutical therapy dominantly includes nonsteroi-
dal anti-inflammatory and steroid drugs is commonly used
to alleviate sequels after mandibular third molar surgery
[44, 45]. Although these drugs have shown clinical efficacy,
however, they lead to some complications such as gastroin-
testinal sequelae, infection, hirsutism, and increased blood
sugar [34]. KT is an alternative approach that can be used
to minimize pharmaceutical adverse effects.
The results of this meta-analysis showed that KT led to
better results than no taping for all outcomes assessed, espe-
cially for pain outcome within 48 h after surgery. It is known
that pain after mandibular third molar surgery is the main
outcome that compromises the postoperative quality of life
[6]. The results showed that KT reduces the pain up to 1.99
points of the VAS scale 48 h after surgery with moderate
certainty of evidence. The effect of the KT technique on pain
management might be linked to the gate control hypothesis
[46]. Based on this theory, afferent fibers from touch sen-
sory neurons have a larger diameter and conduction velocity
than afferent fibers corresponding to pain sensory neurons.
Accordingly, it seems that by stimulating the afferent touch
549
receptors with a light touch in the skin the transmission of
pain may be inhibited. Additionally, KT has been suggested
as a way to decrease pain by relieving pressure on the noci-
ceptors [47]. Seven days after surgery, no significant differ-
ence was observed between KT and control groups. This
result was expected because the pain decreases after three
postoperative days.
Besides pain, the KT group performed better than the con-
trol group in maintaining the mouth opening after impacted
mandibular third molar extraction. This result is important
because less trismus can improve daily quality of life [6] as
the trismus can decrease chewing and speaking capacity.
Maximum mouth opening ability returned quickly, presum-
ably as a result of the swelling decreasing more quickly and
relieving skin tension [28]. All papers included analyzed the
trismus as the postoperative mouth opening. However, the
best way to evaluate this outcome is through the differences
between baseline and postoperative moments [19]. In this
way, the mouth opening can be more accurately assessed.
Thus, the results presented in this systematic review about
this outcome should be interpreted as postoperative mouth
opening not as trismus.
Most swelling occurs around 48 h after the mandibu-
lar third molar surgery [20]. According to the performed
meta-analysis, KT quickly reduced swelling 48 h after
surgery which is consistent with the results of clinical tri-
als [28, 48]. However, because studies have used different
techniques to measure this outcome and the reported val-
ues were not numerically similar, SMD was calculated to
measure effect sizes, so the results of this outcome should
be interpreted with caution. The KT is comprised of non-
allergenic elastic cotton that allows for a 30–40% longitu-
dinal stretch [27]. With a gentle stretch, KT is applied to
the skin and then restores to its normal length when the
body components return to their original positions. This
condition causes a pulling strain on the skin, resulting
in folds under the taped region. It is thought that these
folds enhance the interstitial space between the skin and
the underlying connective tissue, allowing lymphatic fluid
and blood to flow better [27] and according to the afore-
mentioned mechanism the swelling is reduced. Similar to
pain outcome, this effectiveness subsides gradually until
the postoperative 7th day.
Although, to report the results as accurately as possible
the random-effects model was applied in presence of high
heterogeneity, however, the results of this meta-analysis
should be interpreted with caution since the amount of
heterogeneity is high in some time points. The use of
KT is uncomplicated, appears to have no negative side
effects, and assists in the healing process after third molar
removal. KT has the potential to drastically reduce the
post-op morbidity for a small expenditure (less than 2-euro
material cost each therapeutic session) [49]. Thus, we can
13
550 Oral and Maxillofacial Surgery (2022) 26:535–553

Fig. 3  Forest plots of pain

outcome (A) 24 h, (B) 48 h,
(C) 72 h, and (D) 7 days after
surgery

Fig. 4  Forest plots of swell-

ing outcome (A) 48 h and (B)
7 days after surgery

recommend KT as a promising adjuvant or alternative
treatment to control postoperative complications which
can be simply performed by dentists/surgeons. Accord-
ing to the available literature, dentists can perform KT
without a specific certificate; however, there are a number
of courses available regarding K-Taping worldwide.
Nonetheless, KT has some ignorable disadvantages
compared to its beneficial effects such as social interac-
tions due to its color and appearance.

13
Oral and Maxillofacial Surgery (2022) 26:535–553
Fig. 5  Forest plots of trismus
outcome (A) 48 h, (B) 72 h, and
(C) 7 days after surgery
Strengths and limitations
This systematic review had considerable strengths to be
addressed. Four reviewers conducted the screening, data
extraction, and risk of bias assessment, independently. The
certainty of evidence in this review was generally appro-
priate which increases the confidence in the results regard-
ing the outcomes. The highest certainty was observed in
results corresponding to mouth opening and the lowest to
swelling. Besides that, all papers included assessed only
impacted third molar, which can allow us a better level of
evidence regarding this type of third molars. If the papers
had included erupted third molars, it would make the result
more difficult to be interpreted because the postoperative
inflammatory parameters are different between erupted
and impacted third molars. Another strength is about the
short follow-up period (7 days) in the majority of included
studies, it was challenging for patients to withdraw, which
improves the quality of pooled results.
On the other hand, there were some limitations that
should be disclosed. The inability to make the partici-
pants and personnel blinded to KT is a significant issue
that should be considered in our results. Although tapes
are physical objects, maybe with the use of placebo tapes
blinding of participants and personnel may improve the
results. Thus, future studies must be careful with this tech-
nique. In addition, the included studies have not used the
same methodology to measure swelling.
551
Recommendations for future studies
Further high-quality studies with larger sample sizes focused
on removing the effect of systemic analgesic effects both in
KT and control group should be conducted to support the
current results and to help better understand whether KT is
a valid postoperative pain, swelling, and trismus manage-
ment method.
All included studies have evaluated impacted/semi-
impacted third molars; however, it seems that in cases with
easier surgical extractions better results may be observed.
Nonetheless, applying KT in other oral surgical operations
is recommended.
Researchers do not agree on when the tapes should be
removed or applied. A trial has applied the tapes for 2 days
[34], most studies have applied for 5 days [20, 22, 23, 28,
41], and another trial has applied for 7 days [24]. Accord-
ingly, providing a standardized protocol is required.
Conclusion
KT is effective in reducing postoperative pain in the first
48 h and improving mouth opening during all postoperative
times when compared to no taping. Thus, it should be taken
into consideration as adjuvant therapy, whenever possible,
due to its’ easy application and potential beneficial effects.
13
552
Supplementary Information The online version contains supplemen-
tary material available at https://​doi.o​ rg/1​ 0.​1007/s​ 10006-​021-0​ 1025-y.
Author contribution PF, SGMF, and ELG = design, conducting meta-
analysis, critical revisions. GMS, MRFS, IAF = data extraction, data
collection, quality assessment.
Data availability Not applicable.
Code availability Not applicable.
Declarations
Ethics approval Not applicable.
Consent to participate Not applicable.
Consent for publication Not applicable.
Conflict of interest The authors declare no competing interests.
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