A randomized controlled trial to assess parental satisfaction with computerized intraosseous anesthesia versus inferior alveolar nerve block in children.

This study aimed to compare parental satisfaction between two pediatric dental anesthesia techniques, computerized intraosseous anesthesia (CIA) and inferior alveolar nerve block (IANB). This study was designed as a split-mouth randomized controlled clinical trial. A total of 52 parents of children undergoing dental treatment were enrolled in the study. Each participant received both CIA and IANB anesthesia, with the order of administration randomized. Parental satisfaction was evaluated using the parental satisfaction of dental local anesthetic techniques scale (PSLAS). Statistical analysis revealed that parental satisfaction regarding CIA was higher than that for IANB with a significant difference (P ˂ 0.05). However, there was no difference regarding the age, gender or the education level of the parents. (P > 0.05). This study provides insights into parental satisfaction with pediatric dental anesthesia techniques and highlights the influence of socioeconomic factors on anesthesia decision-making. Within the limitations of this trial, it was concluded that CIA was significantly superior to IANB in overall parental satisfaction. However, parental satisfaction values were lower in CIA group regarding costs and concern from complications. In addition, it was concluded that there was no difference in satisfaction levels regarding the gender, age and education level of the parents.

Occurrence of neurosensory disturbance after the use of articaine and lidocaine in the inferior alveolar nerve block: a double-blind randomised clinical trial.

This double-blind, randomised clinical trial aimed to find out whether there is a difference in the prevalence of neurosensory disturbance (NSD) between patients who received 2% lidocaine and those who received 4% articaine during inferior alveolar nerve blocks (IANBs). Patients who underwent third molar extraction were randomised into two groups. IANB was performed using 2% lidocaine in Group 1 and 4% articaine in Group 2. The occurrence of NSD was documented. Patients were visited within 48 hours and one week after the tooth was removed. The type of anaesthetic drug (4% articaine versus 2% lidocaine) was the study's predictive factor. A total of 2400 patients were studied in two groups (1200 in each group). The mean (range) age of the patients was 28.40 (18-44) years. Five patients (0.41%) in the lidocaine group and seven (0.58%) in the articaine group had NSD after injection (p = 0.77). The prevalence of NSD after IANB was no higher in the articaine group than in the lidocaine group.

A comparative evaluation of the efficiency of warm local anesthetic solution delivered on precooled injection sites with the conventional local anesthetic technique in 7-9-year-old children: A randomized split-mouth cross-over trial.

BACKGROUND: Both precooling the site and injecting a warm anesthetic solution have proven to be efficient in reducing pain individually. However, there is insufficient data on evaluating the efficiency of precooling the site of injection along with the simultaneous administration of a warm local anesthetic solution on the same site in a single patient. AIM: The aim of this study was to evaluate and compare the efficacy, pain perception, hemodynamic changes, and adverse effects of a warm local anesthetic solution injected on precooled injection sites using 2% lignocaine with the conventional local anesthetic technique during inferior alveolar nerve block in 7-9-year-old children. METHODS: A split-mouth, double-blinded, randomized clinical trial was conducted on 70 children who received 2% lignocaine with either technique A or B during the first or second appointment of the treatment procedure. The pain perception, anesthetic efficacy, pulse rate, oxygen saturation levels, and adverse events were evaluated. RESULTS: Pain during injection and treatment after administration of the warm local anesthesia (LA) technique was less as compared to the conventional block technique. Anesthetic success was observed with a faster onset of action (212.57 ± 32.51 s) and shorter duration of LA (165.16 ± 33.09 min) in the warm local technique as compared to the conventional technique. No significant differences were found with regard to heart rate and oxygen saturation levels between the two techniques. Administrating warm LA solutions at precooled injection sites revealed fewer adverse events. CONCLUSION: Injecting warm LA solution on precooled injection sites causes less discomfort and anxiety in children, which makes it more suitable for the child as well as the pediatric dentist.

Inferior alveolar nerve block anesthesia in children: The effect of ibuprofen and phentolamine mesylate on pain perception.

CONTEXT: For successfully managing pediatric dental patients, local anesthesia is essential to eliminate pain during or after the operative period. An early recovery from soft-tissue anesthesia after an inferior alveolar nerve block (IANB) should benefit a young child patient by avoiding the risk of inadvertently biting the soft tissues. AIMS: Hence, the purpose of the study was to (1) evaluate and compare the efficacy of pre- and postoperative ibuprofen on pain perception in children who undergo IANB anesthesia with or without the use of PM and (2) evaluate the average time required for reversal of anesthesia symptoms using phentolamine mesylate. METHODS: The present study was a randomized, clinical trial performed among 60 children between 6 and 8 years of age using a convenient sampling method. The children were randomly assigned into four equal groups of 15 each using the computer-generated randomization sequence. IANB anesthesia was performed using 2% lignocaine with 1:100,000 epinephrine, and a mandibular primary molar pulpotomy was performed on each group. Group 1: the ibuprofen tablet was taken 1 h before the onset of the procedure. Group 2: ibuprofen tablet 30 min after the pulpotomy procedure. Group 3: the ibuprofen tablet was taken 1 h before the onset of the procedure, and the Phentolamine mesylate (PM) injection was administered. Group 4: immediately after the pulpotomy, the PM injection was administered, and an ibuprofen tablet was taken 30 min after the pulpotomy procedure. All children were assessed for the duration of soft-tissue anesthesia, their behavior scores and pain rating, as well as the incidence of postoperative self-inflicted injuries. STATISTICAL ANALYSIS USED: A one-way ANOVA was used to compare the average time needed for the reversal of anesthetic symptoms between groups. The effects of phentolamine, local anesthetics, and ibuprofen on the child's behavior and pain scores were compared using the Student's t-test. For the study, P < 0.05 was accepted as statistically significant. RESULTS: The time needed for the full reversal of anesthetic symptoms to manifest on the tongue and lip was substantially reduced by the injection of phentolamine (P < 0.001). The use of phentolamine for reversal or the intake of ibuprofen pre- or postoperatively did not exhibit any significant variation in the behavior, pain experience, or incidence of self-inflicted injuries in the child. CONCLUSION: It is evident that although phentolamine injections shorten the duration of anesthesia, the adjunctive use of pre- or postoperative ibuprofen did not significantly alter pain scores.

Comparative effectiveness of preemptive administration of ibuprofen and ibuprofen-arginine on the anesthetic success of inferior alveolar nerve block in teeth with symptomatic irreversible pulpitis - A double-blind randomized clinical trial.

OBJECTIVES: This study examined the impact of premedication with ibuprofen and ibuprofen-arginine and the influence of preoperative pain and anxiety on inferior alveolar nerve block (IANB) efficacy in cases of symptomatic irreversible pulpitis. MATERIALS AND METHODS: The study involved 150 SIP patients who were randomly assigned to receive ibuprofen (600 mg), ibuprofen-arginine (1,155 mg), or a placebo 30 min before IANB. Preoperative anxiety and pain levels were assessed using the Modified Dental Anxiety Scale and the Heft-Parker visual scale. IANB efficacy was determined by the absence of or mild pain during the procedure. Statistical analysis included chi-square, z-tests, Analysis of Variance, and Student's t tests. RESULTS: The ibuprofen and ibuprofen-arginine groups exhibited significantly higher IANB success rates (62% and 78%, respectively) compared to the placebo group (34%). However, no significant difference was observed between the ibuprofen and ibuprofen-arginine groups. Patients with successful IANB in the ibuprofen and ibuprofen-arginine groups displayed lower median anxiety scores (8) than those with failed blocks (15) and lower mean preoperative pain scores (118.3). CONCLUSION: In cases of symptomatic irreversible pulpitis the preemptive medication with ibuprofen-arginine effectively increased the efficacy of the inferior alveolar nerve block The inferior alveolar nerve block efficacy was influenced by preoperative anxiety levels and the intensity of pain. CLINICAL RELEVANCE: This research underscores the potential benefits of oral premedication with ibuprofen and ibuprofen-arginine in improving anesthesia outcomes in cases of symptomatic irreversible pulpitis.

The anterior loop of the inferior alveolar nerve within the mentonian foramen: a scoping review.

PURPOSE: The aim of this study is to delineate the safety zone concerning the anteriorization of the AL and correlate it with the behavior of the AL, analyzing its feasibility. METHODS: Adhering to the Joanna Briggs Institute (JBI) manual guidelines, both the protocol and this review were conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. MeSH terms, combined with free terms, were utilized to search for articles in the following databases: Embase, LILACS, LIVIVO, PubMed/MEDLINE, Scopus, Web of Science, and grey literature. RESULTS: Fifteen articles were select following the eligibility criteria. An average safe zone of 4.75 mm in humans was observed, with a prevalence 60.8% and average anterior length of the AL of 2.09 mm in humans. CONCLUSION: The AL has varied patterns across different populations, then, it could not be asserted a 100% safe zone. Preoperative analysis of the AL with CBCT is always necessary. While it could be stated that a safe zone should be employed as an inviolable region, stipulated measures of a safe zone should be regarded as an area of greater attention in preoperative planning.

Expediting the reversal of inferior alveolar nerve block anesthesia in children with photobiomodulation therapy.

In pediatric dentistry, complications arising from extended soft tissue anesthesia can negatively impact patient comfort and trust in dental care. This study evaluates the clinical efficacy of diode laser-based photobiomodulation therapy (PBMT) in expediting the resolution of anesthesia in children aged 6-9 receiving inferior alveolar nerve block (IANB) injections. In this split-mouth double-blind randomized clinical trial, 36 pediatric subjects aged 6-9, requiring pulpotomy procedures on both sides of the mandible, received IANBs (single cartridge of 2% lidocaine/1:100,000 epinephrine). PBMT and sham laser were alternately applied to each side of the mandible, in two separate sessions, with the envelope method determining treatment allocation and intervention side on the first treatment day. During the laser session, laser (808 nm, 250 mW, 23s continuous, 0.5 cm², 11.5 J/cm², direct contact) irradiated two points at the injection site, five intra-oral and five extra-oral points along the infra-alveolar nerve's pathway. Soft tissue anesthesia reversal was quantified through tactile assessment. Soft tissue trauma was also assessed by the researcher and reported by parents 24 h post-dental visit. All data were analyzed using IBM SPSS Statistics v25.0 via Paired T-test, two-way repeated measures ANOVA, and McNemar's test. The laser group exhibited a mean lip anesthesia duration of 122.78 ± 2.26 min, while the sham laser group experienced 134.44 ± 21.8 min, indicating an 11.66-minute reduction in anesthesia duration for the laser group. (P < 0.001) Soft tissue trauma occurred in two sham laser group patients and one laser group patient, with no significant difference. (P = 1) The findings indicate that employing laser with defined parameters can reduce the length of IANB-induced anesthesia.

Identification of the Incisive Branch of the Inferior Alveolar Nerve of Edentulous Mandibles Using Cone-Beam Computerized Tomography.

This study explored the average length of the incisive branch (IB) of the inferior alveolar nerve on cone-beam computerized tomography (CBCT) with regard to patient demographics in patients with edentulous mandibles. CBCT was used in a retrospective study of edentulous mandibles to assess the presence and anatomical variation for the IB. Three independent observers measured bilateral IB lengths. In addition to demographics, IB length and port of exit data were obtained. A 1-way analysis of variance was used to test whether IB length varied by sex or port of exit, and a standard Pearson correlation was used to test for IB length and age significance, with a significance level of P < .05. Intraclass correlation coefficients showed significant agreement in IB length across all observers. No significant difference was noted between the exit port and IB length. An important effect was reported for sex, indicating women have generally shorter IB lengths (9.43 ± 3.99 vs 10.55 ± 3.92). There was a significant correlation with age, but the relationship was weak. Edentulous mandibles have an altered anatomic landscape, and establishing predictive IB dimensions aids practitioners in surgical planning.

Frequency of Inferior Alveolar Nerve Injury During Third Molar Extraction.

OBJECTIVE: To determine the frequency of inferior alveolar nerve injury during third molar extraction and the associated factors. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of Oral and Maxillofacial Surgery, Ayub Teaching Hospital, Abbottabad, Pakistan, from July to December 2021. METHODOLOGY: A total of 163 patients with third molar surgery were included. Patients were followed up after one week, one month, and three months of duration. The frequency of inferior alveolar nerve injury was determined as well as its relationship with other surgical variables like age, gender, type of impaction, buccal flap retraction, bone cutting, tooth splitting, and duration of surgery via Chi-square test. RESULTS: The frequency of inferior alveolar nerve injury was found to be 1.2% (n = 02). None of the surgical variables had a statistically significant association with it (p >0.05). CONCLUSION: The frequency of nerve injury of the inferior alveolar nerve during extraction of the third molar was 1.2%. Proper treatment planning, using advanced radiography, experienced surgeon, and proper technique can help in lowering nerve injury risk. KEY WORDS: Inferior alveolar nerve injuries, Molar, Tooth extraction, Paraesthesia.

Efficacy for Lidocaine and Articaine in Inferior Alveolar Nerve Block - A Comparative Study.

AIMS: Compare the efficacy of 2% lidocaine with adrenaline (1:200,000) and 4% articaine with adrenaline (1:100,000) in inferior alveolar nerve block prior to extraction of bilateral teeth posterior to canine in interval of one week. METHODS AND MATERIAL: Thirty-five patients were selected for the study. Patients were divided into two different groups: Group 1 - (2% lignocaine with adrenaline (1:200,000)) and Group 2 - (4% articaine with adrenaline (1:100,000)) solution. The study variables for each anaesthetic agent were: onset of action and depth of anaesthesia. A pulp tester was used to demonstrate quantitative values and a visual analogue scale (VAS) was used for qualitative evaluation of the two anaesthetic drugs in 2 min cycle for 10 min with respect to test canine. Anaesthesia was considered successful when pulp tester value 64 was achieved in 10 min for both the anaesthetic agent. STATISTICAL ANALYSIS USED: The difference in the efficacy of lignocaine and articaine was analysed using Student's t test. Within group comparison of the response to the pulp vitality test and VAS over various time periods was analysed using repeated measures Analysis of Variance (ANOVA) with post-hoc Bonferroni test. RESULTS: Data analysis showed statistical differences in onset and depth of anaesthesia between the two groups (P < 0.05). CONCLUSIONS: 4% Articaine with adrenaline (1:100,000) onset of action is faster and depth of anaesthesia is better compared to 2% lignocaine with adrenaline (1:200,000). Many previous studies reported onset of anaesthesia, but this study evaluates onset and depth of both the anaesthetic agent quantitatively and qualitatively.

Comparison of perineural and systemic dexamethasone use in impacted third molar surgeries in terms of anesthesia duration and postoperative complaints: a controlled, randomized observational study.

BACKGROUND: Surgical extraction of impacted third molars (ITM) often leads to postoperative discomfort including pain, swelling, and limited function. Steroids like dexamethasone (DXN) are commonly used in oral surgery to manage pain and inflammation. Various administration routes for DXN exist, including intravenous (IV), perineural (PN), and oral applications, each with its advantages. Previous studies have shown that adding DXN to local anesthetics can prolong anesthesia duration and reduce postoperative sequelae. However, comparative studies on IV and PN applications with inferior alveolar nerve block (IANB) of DXN in ITM surgeries are limited. METHODS: This controlled, randomized observational study involved patients undergoing Class II position B ITM extraction. Patients were divided into three groups. IANB (1.8 ml of articaine hydrochloride + 1 ml of saline) was performed 1 h after IV-DXN (4 mg/ml DXN) was administered to the IV group. DXN along with IANB (1.8 ml of articaine hydrochloride + 1 ml of 4 mg/ml DXN) was applied to the PN group. Only IANB (1.8 ml of articaine hydrochloride + 1 ml of saline) was applied to the control group. Anesthesia duration was assessed as primary outcomes. Anesthesia duration was evaluated using a vitalometer from the molars. Secondary outcomes included postoperative pain and edema measured on the 1st, 3rd, and 7th days after surgery. Pain was evaluated postoperatively by using a visual analog scale. A p-value < 0.05 was considered statistically significant. RESULTS: The study included 45 patients with similar demographic characteristics across groups. IV application significantly prolonged anesthesia duration compared to the control group. (p = 0.049) Both IV and PN administration of DXN reduced postoperative edema at 3rd (p = 0.048) and 7th day (p = 0.01). Post-procedure pain reduction was significant in the IV group (p = 0.011). On the other hand, it was observed that the pain did not decrease in the PN group at 3rd and 7th days compared to the control and IV groups. CONCLUSIONS: PN and IV DXN administration prolonged anesthesia duration and reduced postoperative edema in ITM surgeries. However, PN DXN administration was associated with increased postoperative pain compared to IV DXN and control groups. Further studies comparing different doses and administration routes of DXN are needed to determine optimal strategies for managing postoperative discomfort in ITM surgeries. TRIAL REGISTRATION: This study was conducted at Ahmet Kelesoglu Faculty of Dentistry with the permission of Karamanoglu Mehmetbey University Faculty of Medicine Ethics Committee (#04-2022/101). Trial registration is also available at clinicaltrail.gov. (NCT06318013, 26/05/2024).

The Effect of Delayed Photobiomodulation Therapy on Inferior Alveolar Nerve Recovery After Third Molar Removal: A Triple-Blinded Randomized Clinical Trial.

Background: Third molar removal is the primary reason for inferior alveolar nerve (IAN) damage, with 2% causing persistent neurosensory deficits. This study aimed to investigate how delayed photobiomodulation therapy affects long-lasting neurosensory disturbances. Methods: This study was conducted on patients with neurosensory disturbances lasting longer than 6 months. Patients were randomly allocated to the study and control groups, with the study group receiving a low-power diode laser (continuous wavelength of 810 nm, power of 200 mW) on 16 points (30 sec at each) for 12 sessions (2 sessions/week), while the control group received a placebo treatment by switched-off laser probe. Visual analog scale (VAS; ranging from 1 to 5), static light touch, two-point discrimination, direction discrimination, pinprick, and thermal discrimination tests were performed on each visit up to 9 months post-therapy to evaluate the recovery status. Results: Each group comprised 18 participants. The mean time since injury was 8.26 ± 2.05 and 8.38 ± 1.98 months for the control and intervention groups, respectively (p = 0.81). There was a significant improvement in the intervention group on the static light touch (p = 0.041), two-point discrimination (p = 0.028), VAS (p = 0.031), and pinprick (p = 0.014) tests on the 11th session and subsequent visits and also on direction discrimination test on the 12th session (p = 0.044) and after that. There was no significant difference in the thermal discrimination tests between the two groups (p > 0.05). Conclusion: Photobiomodulation demonstrated potential benefits in resolving persistent neurosensory deficits of the IAN, with noticeable improvements typically observed after around 35 days of treatment initiation (10 sessions).

Assessment of traumatic mandibular nerve using MR neurography sequence: a preliminary study.

BACKGROUND: Iatrogenic mandibular nerve damage resulting from oral surgeries and dental procedures is painful and a formidable challenge for patients and oral surgeons alike, mainly because the absence of objective and quantitative methods for diagnosing nerve damage renders treatment and compensation ambiguous while often leading to medico-legal disputes. The aim of this study was to examine discriminating factors of traumatic mandibular nerve within a specific magnetic resonance imaging (MRI) protocol and to suggest tangible diagnostic criteria for peripheral trigeminal nerve injury. METHODS: Twenty-six patients with ipsilateral mandibular nerve trauma underwent T2 Flex water, 3D short tau inversion recovery (STIR), and diffusion-weighted imaging (DWI) acquired by periodically rotating overlapping parallel lines with enhanced reconstruction (PROPELLER) pulse sequences; 26 injured nerves were thus compared with contra-lateral healthy nerves at anatomically corresponding sites. T2 Flex apparent signal to noise ratio (FSNR), T2 Flex apparent nerve-muscle contrast to noise ratio (FNMCNR) 3D STIR apparent signal to noise ratio (SSNR), 3D STIR apparent nerve-muscle contrast to noise ratio (SNMCNR), apparent diffusion coefficient (ADC) and area of cross-sectional nerve (Area) were evaluated. RESULTS: Mixed model analysis revealed FSNR and FNMCNR to be the dual discriminators for traumatized mandibular nerve (p < 0.05). Diagnostic performance of both parameters was also determined with area under the receiver operating characteristic curve (AUC for FSNR = 0.712; 95% confidence interval [CI]: 0.5660, 0.8571 / AUC for FNMCNR = 0.7056; 95% confidence interval [CI]: 1.011, 1.112). CONCLUSIONS: An increase in FSNR and FNMCNR within our MRI sequence seems to be accurate indicators of the presence of traumatic nerve. This prospective study may serve as a foundation for sophisticated model diagnosing trigeminal nerve trauma within large patient cohorts.

Mental foramen and apical foramen: A dangerous anatomical proximity.

The study evaluated the spatial position of the mental foramen (MF) using 300 cone-beam computed tomography. The spatial position was analyzed with the horizontal location and relative location (distance between apical foramen and MF). The horizontal location was assessed through three positions (positions 1, 2, and 3). The relative location was determined with the x, y, and x coordinates of the root apex of mandibular premolars and the MF. Student's t-test and chi-square were performed. The most common horizontal location (52%) was position 2, which means between the premolars (p < 0.05). The relative location of the MF to the root apex of the second premolar was closer than the first premolar (p < 0.05). The distance between the root tip of the second premolar and the MF was 5.27 mm, with a minimum value of 1.87 mm. Clinicians should be aware of the possible neural results to the mental nerve of an endodontic infection and the extrusion of irrigation solutions.

Effect of Back-Pressure Anesthesia on Postoperative Pain after the Endodontic Treatment in Patients with Symptomatic Irreversible Pulpitis: Randomized Double-Blind Clinical Trial.

INTRODUCTION: The present study evaluated the effect of 2 different back pressure-based supplemental anesthesia on postoperative pain in patients receiving endodontic treatment for a mandibular molar with symptomatic irreversible pulpitis. METHODS: One-hundred-thirty-five adult patients with symptomatic irreversible pulpits in a mandibular first or second molar, received an initial inferior alveolar nerve block (IANB) injection with 2% lidocaine with 1:80,000 epinephrine. Ten minutes following the injection, access to cavity preparation began. Lip numbness was a must for all patients. The Heft-Parker visual analogue scale (HP-VAS) was used to measure pain during endodontic therapy. Success of primary injections was defined as no or mild pain (less than 55 mm on HP-VAS) during access preparation. The patients with initial successful anesthesia served as control and received endodontic treatment. Ninety-five patients with unsuccessful primary anesthesia randomly received either intraligamentary injections of 2% lidocaine with 1:80,000 epinephrine or intrapulpal injections with similar anesthetic solution. Endodontic treatment was re-initiated and canals were instrumented till working length under copious irrigation. Intracanal medicament of calcium hydroxide was placed and teeth received a temporary restoration. Postoperative pain was measured at 2 hours, 4 hours, 6 hours, 24 hours, and 3 days. Data were analyzed using the Pearson chi-square test, one-way analysis of variance, and one-way repeated measures analysis of variance. RESULTS: The initial initial inferior alveolar nerve block was successful in 40 cases (out of 135). The intraligamentary injections were successful in 33 out of 47 cases (70%), and intrapulpal injections were successful in all cases (45/45). The patients receiving intraligamentary injections reported significantly higher pain scores at all intervals till 24 hours. After 3 days, the pain significantly reduced in all the groups with no significant difference between them. CONCLUSIONS: Patients receiving supplementary intraligamentary injections can experience increased postoperative pain till 24 hours after the endodontic treatment. The pain scores reduced to the level of the control group after 3 days.

Fully automated deep learning model for detecting proximity of mandibular third molar root to inferior alveolar canal using panoramic radiographs.

OBJECTIVE: This study endeavored to develop a novel, fully automated deep-learning model to determine the topographic relationship between mandibular third molar (MM3) roots and the inferior alveolar canal (IAC) using panoramic radiographs (PRs). STUDY DESIGN: A total of 1570 eligible subjects with MM3s who had paired PR and cone beam computed tomography (CBCT) from January 2019 to December 2020 were retrospectively collected and randomly grouped into training (80%), validation (10%), and testing (10%) cohorts. The spatial relationship of MM3/IAC was assessed by CBCT and set as the ground truth. MM3-IACnet, a modified deep learning network based on YOLOv5 (You only look once), was trained to detect MM3/IAC proximity using PR. Its diagnostic performance was further compared with dentists, AlexNet, GoogleNet, VGG-16, ResNet-50, and YOLOv5 in another independent cohort with 100 high-risk MM3 defined as root overlapping with IAC on PR. RESULTS: The MM3-IACnet performed best in predicting the MM3/IAC proximity, as evidenced by the highest accuracy (0.885), precision (0.899), area under the curve value (0.95), and minimal time-spending compared with other models. Moreover, our MM3-IACnet outperformed other models in MM3/IAC risk prediction in high-risk cases. CONCLUSION: MM3-IACnet model can assist clinicians in MM3s risk assessment and treatment planning by detecting MM3/IAC topographic relationship using PR.

The TSAR-osteotomy, a total subapical and ramus osteotomy: A technical note.

There are several treatment options to treat a class II dentofacial deformity with a pronounced chin. A total subapical osteotomy is one of these options. This type of osteotomy was refined to total subapical and ramus (TSAR) osteotomy. In this technical note, a detailed and schematic presentation of the TSAR osteotomy is presented step by step. The surgical approach to the TSAR osteotomy is divided into three parts. The first part consists of the horizontal osteotomy at the level of the ramus, the second part approaches the corticotomy to release and protect the mental nerve and the third part consists of connecting the horizontal ramus osteotomy and the local corticotomy around the mental nerve. In this third part, it is important that the inferior alveolar nerve (IAN) is actively sought and protected.

Is 3T MR nerve-bone fusion imaging a viable alternative to MRI-CBCT to identify the relationship between the inferior alveolar nerve and mandibular third molar.

OBJECTIVES: To investigate the feasibility of MRI nerve-bone fusion imaging in assessing the relationship between inferior alveolar nerve (IAN) / mandibular canal (MC) and mandibular third molar (MTM) compared with MRI-CBCT fusion. MATERIALS AND METHODS: The MRI nerve-bone fusion and MRI-CBCT fusion imaging were performed in 20 subjects with 37 MTMs. The Hausdorff distance (HD) value and dice similarity coefficient (DSC) was calculated. The relationship between IAN/MC and MTM roots, inflammatory, and fusion patterns were compared between these two fused images. The reliability was assessed using a weighted κ statistic. RESULTS: The mean HD and DSC ranged from 0.62 ~ 1.35 and 0.83 ~ 0.88 for MRI nerve-bone fusion, 0.98 ~ 1.50 and 0.76 ~ 0.83 for MRI-CBCT fusion. MR nerve-bone fusion had considerable reproducibility compared to MRI-CBCT fusion in relation classification (MR nerve-bone fusion κ = 0.694, MRI-CBCT fusion κ = 0.644), direct contact (MR nerve-bone fusion κ = 0.729, MRI-CBCT fusion κ = 0.720), and moderate to good agreement for inflammation detection (MR nerve-bone fusion κ = 0.603, MRI-CBCT fusion κ = 0.532, average). The MR nerve-bone fusion imaging showed a lower ratio of larger pattern compared to MR-CBCT fusion (16.2% VS 27.3% in the molar region, and 2.7% VS 5.4% in the retromolar region). And the average time spent on MR nerve-bone fusion and MRI-CBCT fusion was 1 min and 3 min, respectively. CONCLUSIONS: Both MR nerve-bone fusion and MRI-CBCT fusion exhibited good consistency in evaluating the spatial relationship between IAN/MC and MTM, fusion effect, and inflammation detection. CLINICAL RELEVANCE: MR nerve-bone fusion imaging can be a preoperative one-stop radiation-free examination for patients at high risk for MTM surgery.

Determining the position of the lingula and the mandibular foramen using the antilingula in orthognathic surgery.

BACKGROUND: The antilingula located on the lateral surface of the mandibular ramus has been served as a surgical landmark for the mandibular foramen on the medial surface for decades. However, whether the antilingula truly represents the lingula which is the bony prominence overlapping the mandibular foramen, or the foramen itself, is still unclear. This study thus aimed to examine the position of the antilingula in relation to three reference points: the lingula, the anterior and the posterior borders of the mandibular foramen, as well as to the reference plane used in the inferior alveolar nerve block, and to the posterior border of the mandible. METHODS: This observational study was performed in 113 Thai dry mandibles. The antilingula were identified followed by transferring the reference points to the lateral surface. The distances from the antilingula to the reference points, the reference plane and the posterior border of the ramus were then measured. Chi-square test was calculated for side-dependency of the antilingula. Paired t-test was calculated for difference in measurements in left and right sides. RESULTS: The antilingula could be identified in 92.48% of the mandibles with 86.67 - 90.00% accuracy and 86.67% reliability. There was no significant difference in the presence of the antilingula on left and right sides (p = 0.801). Only 2.5% and 0.83% of the antilingula correspond to the lingula and the anterior border of the mandibular foramen, respectively. However, 85% of the reference points were located within 11 mm radius. The antilingula was found located 2.80 mm inferior to the reference plane and 16.84 mm from the posterior border of the ramus. CONCLUSIONS: The antilingula does not concur with the reference points on the medial surface. Our study also suggests that the safe area for vertical osteotomy is 11 mm posterior to the antilingula or at 30% of the length from the posterior border parallel to the occlusal plane. The use of more accurate techniques in localizing the mandibular foramen combined with the antilingula is more recommended than using the antilingula as a sole surgical guide.

Biomechanical analysis and comparison between 'Zeta' miniplate design and conventional miniplate system for fixation of fracture segments in transition zone of parasymphysis body region of mandible - an in vitro study.

The parasymphysis area of the mandible is highly dynamic because it is subjected to both occlusal and muscular forces. As a result, the fractures in this transition zone have a special pattern, posing a challenge for surgeons whether to use one miniplate versus two miniplates, as per Champy's recommendations. The commonest complication resulting to treat this area is mental nerve paraesthesia due to the dissection and stretching of the nerve. Hence, an in vitro research study of a newly designed 'Zeta' miniplate is performed, to evaluate the biomechanical behaviour using finite element (FE) analysis and biomechanical analysis along with a comparison study with the conventional miniplate configurations. The results showed that the Zeta miniplate produces the lowest stresses 17.511 MPa and the least total structural deformation of 0.0011 mm after applying the maximum occlusal bite force. On application of torsional load, total structural deformation was 0.0004 mm and von Mises (VM) stress value was 0.24 MPa which was lowest when compared with the two miniplate system. Hence, the newly developed Zeta miniplate is superior in terms of stability. Another benefit of its design is that it helps in preventing mental nerve paraesthesia and tooth root damage while fixing and stabilising the fractured bony segments.