Comparative Evaluation of Trypsin Chymotrypsin and Serratiopeptidase Used Along with Ketorolac in Horizontally Impacted Third Molars

Abstract

Surgical extraction of third molars is among the most common procedures in oral surgery, typically involving soft tissue flap elevation, bone guttering, and odontectomy. These surgical steps trigger an inflammatory response as part of the wound-healing process, often resulting in postoperative complications such as pain, edema, and trismus, which can impair healing by restricting local microcirculation and promoting bacterial growth. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ketorolac tromethamine are routinely prescribed for their analgesic and anti-inflammatory effects. Ketorolac has shown superior efficacy in controlling postoperative swelling compared to other NSAIDs, though mild gastrointestinal discomfort or drowsiness may occur. However, its limited anti-inflammatory and antipyretic activity at analgesic doses necessitates adjunctive therapy to enhance healing. Proteolytic enzymes such as serratiopeptidase and trypsin-chymotrypsin are effective alternatives or adjuncts. Serratiopeptidase reduces pain and edema by degrading inflammatory mediators without affecting prostaglandins or causing gastrointestinal side effects. When combined with NSAIDs, it provides faster and enhanced anti-inflammatory action. Similarly, trypsin-chymotrypsin exhibits anti-inflammatory, anti-edematous, and fibrinolytic properties by maintaining plasmin activity, improving microcirculation, and reducing postoperative swelling and pain. Thus, the combined use of NSAIDs and proteolytic enzymes offers superior postoperative comfort, accelerates wound healing, and effectively minimizes inflammation following third molar surgery.