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).

Detection and classification of mandibular fractures in panoramic radiography using artificial intelligence.

PURPOSE: This study aimed to assess the performance of a deep learning algorithm (YOLOv5) in detecting different mandibular fracture types in panoramic images. METHODS: This study utilized a dataset of panoramic radiographic images with mandibular fractures. The dataset was divided into training, validation, and testing sets, with 60%, 20%, and 20% of the images, respectively. An equal number of control panoramic radiographs, which did not contain any fractures, were also randomly distributed among the three sets. The YOLOv5 deep learning model was trained to detect six fracture types in the mandible based on the anatomical location including symphysis, body, angle, ramus, condylar neck, and condylar head. Performance metrics of accuracy, precision, sensitivity (recall), specificity, dice coefficient (F1 score), and area under the curve (AUC) were calculated for each class. RESULTS: A total of 498 panoramic images containing 673 fractures were collected. The accuracy was highest in detecting body (96.21%) and symphysis (95.87%), and was lowest in angle (90.51%) fractures. The highest and lowest precision values were observed in detecting symphysis (95.45%) and condylar head (63.16%) fractures, respectively. The sensitivity was highest in the body (96.67%) fractures and was lowest in the condylar head (80.00%) and condylar neck (81.25%) fractures. The highest specificity was noted in symphysis (98.96%), body (96.08%), and ramus (96.04%) fractures, respectively. The dice coefficient and AUC were highest in detecting body fractures (0.921 and 0.942, respectively), and were lowest in detecting condylar head fractures (0.706 and .812, respectively). CONCLUSION: The trained algorithm achieved promising performance metrics for the automated detection of most fracture types, with the highest performance observed in detecting body and symphysis fractures. Machine learning can provide a potential tool for assisting clinicians in mandibular fracture diagnosis.

Bleeding After Dental Extraction in Patients Undergoing Percutaneous Coronary Intervention During Uninterrupted Single and Dual Antiplatelet Therapy.

Purpose: This study aimed to assess bleeding risk after exodontia in patients with recent percutaneous coronary intervention during uninterrupted single or dual antiplatelet therapy. Study design: A total of 100 patients who had a history of percutaneous stent insertion during the past year candidate for extraction of teeth were included in the study. Fifty patients took aspirin 100mg (monotherapy group), and 50 patients took a combination of aspirin 100mg and clopidogrel 75mg (dual therapy group). After exodontia, the bleeding status was categorized as "complete hemostasis," "persistent bleeding," and "delayed bleeding." Personal data, underlying diseases, number of teeth and roots extracted, and type of procedure required for exodontia were statistically analyzed. Results: No significant difference was observed in the status of bleeding between the two groups regarding sex, age, underlying diseases, number of teeth and roots extracted, and type of procedure (p > 0.05). 39/50 (78%) of monotherapy patients and 32/50 (64%) of dual therapy patients achieved complete hemostasis. Persistent bleeding was noted in 11/50 (22%) of monotherapy participants, and 14/50 (28%) of dual therapy patients. Only 4/50 (8%) of dual therapy patients experienced delayed bleeding. However, these differences were not significant (p = 0.08). All persistent and delayed bleeding was easily controlled via local measures. Conclusion: Simple or complicated extraction of multiple teeth can be performed safely during the first year after percutaneous coronary intervention without interruption of antiplatelet therapy.

Do Platelet-Rich Concentrates Improve the Adverse Sequelae of Impacted Mandibular Third Molar Removal?

BACKGROUND: Several measures have been implemented to minimize the side effects of impacted third molar (M3) removal including the use of platelet-rich fibrin (PRF). PURPOSE: This study compared the effects of three modifications of PRF (leukocyte-PRF [L-PRF], advanced-PRF [A-PRF], and advanced-PRF plus [A-PRF +]) on the side effects of impacted M3 removal. STUDY DESIGN, SETTING, AND SAMPLE: This double-blinded randomized controlled trial was conducted at the Oral Surgery Department of Kashan University between September 2022 and May 2023 on patients undergoing mandibular impacted M3 removal. Exclusion criteria were age over 30, local inflammation and infection, medication usage, and systemic disease. INDEPENDENT VARIABLE: The independent variable was the PRF product grouped into four categories (control, L-PRF, A-PRF, and A-PRF+). Study subjects were randomly distributed among the four groups. MAIN OUTCOME VARIABLE(S): The main outcome variables were postoperative sequelae including measures of soft tissue healing, pain, analgesic use, alveolar osteitis, trismus, and swelling. Subjects were assessed at baseline and on days 1, 2, 3, and 7 postsurgery. COVARIATES: Age, sex, duration of surgery, and side of surgery were the covariates. ANALYSES: Changes at different time points were analyzed using repeated measures analysis of variance. Pairwise comparisons were performed if significant. P values ≤.05 were considered statistically significant. RESULTS: The sample consisted of 64 subjects (16 per group). All three modifications of PRF yielded significantly better soft tissue healing index than the control group on days 2, 3, 7, and 14 postoperatively (P > .05). A-PRF and A-PRF + had significantly better healing index than L-PRF on the third day (P = .02, P = .01). All the study groups significantly reduced visual analog scale pain score than the control group on days 1, 2, and 3. A-PRF and A-PRF + had significantly lower visual analog scale scores than L-PRF on the second day (P = .003, P = .02). No significant difference was found in maximum mouth opening during follow-up sessions (P = .2). Study groups had less facial swelling on days 2 and 3 than the control group (P < .05). CONCLUSION AND RELEVANCE: L-PRF, A-PRF, and A-PRF + can improve postoperative outcomes after M3 removal but may not impact trismus. A-PRF and A-PRF + may be more effective than L-PRF in promoting soft tissue healing and reducing pain. A-PRF and A-PRF + have comparable results.

The effect of augmented reality book on the proficiency of local anesthesia administration of the inferior alveolar nerve.

BACKGROUND/OBJECTIVE: Advancements in augmented reality (AR) technology enable developers to create augmented reality books (AR Books). AR Books can show interactive 3D objects and multimedia content to the user. The purpose of this study was to investigate the effect of a developed AR Book on the theoretical and practical abilities in the administration of local anesthesia of the inferior alveolar nerve block. METHODS: An exclusive AR Book was developed based on Chapter 14, Handbook of Local Anesthesia, seventh edition, Stanley F. Malamed, which enabled students to use their book (printed or electronic) as an AR Book. Forty dental students were randomly divided into control and study groups. In the control group, students were asked to use regular books, while in the study group, students were instructed to use interactive AR Books. All students took the written exam, scoring 0 to 10. Also, the administration of mandibular local anesthesia was evaluated in students. The level of concentration during the study, the written exam score, the practical score, the success rate of local anesthesia, and the needed time for injection were compared between the two groups. RESULTS: There was a significant difference in the level of concentration during the study (p < 0.001), practical skill score (p = 0.037), and needed time for injection (p = 0.040) between the two groups. Conversely, the success rate of local anesthesia was almost similar (p = 0.705). Although the written exam score was higher in the study group than in the control group, the difference was not significant (p = 0.414). CONCLUSION: Using AR Books can engage students and help them to remain focused during the study. AR Books may be beneficial in enhancing the practical abilities of dental students.

Prevalence and pattern of maxillofacial injuries associated with domestic violence: A retrospective study at a major trauma center.

BACKGROUND/AIM: This study aimed to analyze the frequency and pattern of maxillofacial injuries associated with domestic violence. MATERIALS AND METHODS: Medical records of victims of domestic violence between May 2016 and May 2023 were scrutinized retrospectively. The following data were analyzed: gender and age, history of previous abuse, hospital admission, pregnancy, type of facial injuries, anatomical location of injuries, side of injuries, concomitant injuries, mechanism of impact, treatment modality, and history of drug and alcohol abuse. RESULTS: Seventy-eight patients were included, comprising of 75 (96.2%) women and 3 (3.8%) men. Domestic violence was an etiology of 2.7% of all maxillofacial injuries. The mean age was 27.06 ± 5.5 years. 33.3% of cases had a history of previous domestic violence. The assailant was drug addicted in 47.4% of cases. The attacker was the current partner of the victim in 79.5% of the victims. Soft tissue injuries were found in 96.1% of cases. Maxillofacial fracture was observed in 52.6% of victims among which zygoma was the most common (16.7%) followed by the nose and mandible (15.4%). Isolated fracture was observed in 85.3% of patients and 71.8% of the injuries were observed on the left. Concomitant injuries were present in 51.3% of patients with arms/hands being the most frequent (48.7%). Punch (67.9%) constituted the majority of the mechanism of impact. Based on the statistical analysis, punches resulted in significantly higher soft tissue contusion (p = .046), and injuries that required no intervention were significantly higher in punched victims (p = .002). CONCLUSION: Maxillofacial soft tissue injuries with or without isolated fracture on the left side of the zygoma, mandibular angle, or nose in association with arms/hands injuries in young adult women could be clues of domestic violence. Appropriate care such as preventive programs for drug or alcohol abuse should be implemented to reduce domestic violence, thereby reducing these injuries.

The pattern of maxillofacial fractures associated with rollover accidents: A 7-year retrospective study.

BACKGROUND/AIM: This study aimed to assess the incidence and pattern of maxillofacial fractures and related demographic data in the victims of rollover crashes. PATIENTS AND METHODS: This retrospective study was based on medical records of patients who sustained maxillofacial injuries following rollover accidents. Investigated data included age, gender, accident date and time, accident cause, seat belt usage, airbag deployment, road type, anatomical location of the facial fracture, and treatment approach. RESULTS: Among the 147 patients who met the inclusion criteria, the most prevalent age groups were 20-30 (36.7%) and 30-40 (32.7%) years, with a mean age of 33.6 ± 9.7 years. The male-to-female ratio was 6:1. Most crashes occurred in March, August, and July. These accidents involved 69.4% light vehicles and 39.6% heavy vehicles. The leading causes of rollover crashes were speeding (58.5%) followed by distracted driving (21.1%) and traffic rule violations (13.6%). The most prevalent injuries were fractures of the maxillary sinus wall (40.8%), nasal bones (39.5%), zygomaticomaxillary complex (36.1%), and the mandible (32.6%). Surgical intervention was necessary for 44.2% of patients, while 12.9% of cases underwent close reduction, and 42.9% did not require any surgical intervention. The occurrence of nasal bone fractures was significantly lower in cases where seat belts were worn and zygomatic arch fractures were less frequent in incidents with airbag deployment. CONCLUSIONS: In rollover crashes, the midface is the most vulnerable anatomical location. Utilization of seat belts and airbag deployment has the potential to prevent nasal bone and zygomatic arch fractures.

Risk factors associated with early implant failure: A retrospective review.

PURPOSE: The purpose of this study was to investigate the association between possible risk factors and early implant failure. PATIENTS AND METHODS: This retrospective cohort study included consecutive patients receiving dental implant treatment in a four-year timeframe. Patient-related variables (age, sex, smoking, and systemic disease), local factors (area, reason for tooth extraction, and bone quality), surgical variables (bone augmentation, time of implant placement, staging, and antibiotic prophylaxis), and implant-related factors (brand, length, and diameter) were analyzed. Bivariate analyses and multivariate logistic regression model were used to determine the variables associated with early implant failure. RESULTS: The study group comprised 1323 implants in 738 patients with a mean of 1.8 implants/patient of which, 53 failed in 52 patients in the early stage (before final prosthetic loading). According to the multivariate model, smoking (Odds Ratio=1.836, P=0.031), posterior maxillary region (OR=2.958, P=0.006), implantation in place of teeth extracted due to periodontal problems (OR=2.531, P=0.004), bone type IV (OR=2.881, P=0.008), implant in previously augmented site (OR=2.239, P=0.014), and immediate provisional prosthesis (OR=3.418, P=0.019) were associated with a significantly higher risk of early implant failure. Narrow implants showed a significantly higher risk of early failure in bivariate analyses (P=0.012). However, the effect was no longer significant in the multivariate model (OR=2.322, P=0.068). CONCLUSION: Early implant failure would be more expected in smokers, posterior maxilla, history of periodontal problems, type IV bone, augmented bone, and immediately loaded cases.

Marginal fit of monolithic versus layered zirconia crowns assessed with 2 marginal gap methods.

STATEMENT OF PROBLEM: Zirconia can be used either monolithically or veneered with porcelain. However, whether veneering zirconia affects marginal fit is unclear. PURPOSE: The purpose of this in vitro study was to evaluate the marginal fit of the monolithic and layered zirconia prostheses using 2 different assessment methods. MATERIAL AND METHODS: An ideal complete crown with a chamfer finish line was prepared on an extracted maxillary central incisor. Two prosthesis designs, a framework and a monolithic design, and 2 marginal fit evaluation methods, the silicone replica and the triple scanning techniques, were used. In the first group, 10 crowns were fabricated with the framework design followed by porcelain veneering, and 10 crowns were fabricated monolithically in the second group. The marginal gap in each group was evaluated with both the silicone replica and triple scan methods. Data were statistically analyzed with a 2-way repeated measures ANOVA (α=.05). RESULTS: A significant difference was found in the mean marginal gap by design type (P=.003), with the monolithic prostheses having lower mean marginal gaps (31.0 and 84.0 µm). However, both groups showed clinically acceptable marginal fit. No significant difference was found between the assessment methods (P=.092). CONCLUSIONS: Monolithic zirconia crowns had a better marginal fit than veneered zirconia frameworks. Both the replica and triple scan techniques for marginal gap assessment yielded similar results.

Accuracy of maxillary repositioning surgery in teaching hospitals using conventional model surgery.

PURPOSE: The aim of this study was to assess the accuracy of maxillary repositioning surgery in teaching hospitals using conventional model surgery. MATERIALS AND METHODS: A total of 73 patients undergoing single-piece LeFort I osteotomies in the maxilla and bilateral sagittal split osteotomies in the mandible were included in the study. Preoperative and immediate postoperative cone-beam CT were compared in computer software (Dolphin3D©). Maxillary landmarks relative to the vertical and horizontal reference lines were evaluated. The difference between the planned and achieved maxillary positions was measured. Distance error in millimeters and achievement ratio (achieved displacement/planned displacement*100) were calculated for different maxillary movements. RESULTS: Midline correction and advancement were the most accurate movements with an overall mean distance error of 0.53 mm and 0.63 mm respectively while posterior impaction and setback were the least accurate movements with 1.38 mm and 1.76 mm mean discrepancies, respectively. A significant difference was observed only in setback movement regarding the discrepancy value (P < .05). Although setback and down-graft movements tended to under-correction, all other movements were overcorrected. As the magnitude of maxillary movements increases, the accuracy decreases. In severe displacements (≥ 8 mm), the accuracy declines significantly (P < .05). CONCLUSION: Classic cast surgery and manually fabricated intermediate splints in teaching hospitals yield accurate and acceptable results in the majority of cases (84.6%). The accuracy of maxillary repositioning decreases as the magnitude of displacement increases.

Finite-Element Analysis of Stress and Strain in Mandibular Overdentures Supported by Splinted versus Nonsplinted Implants.

The objective of the current study is to investigate the relative effect of splinted and nonsplinted implants on stress and strain in the supporting tissue around implants in two-implant-supported mandibular overdentures. Two models of mandibular overdentures using locators (nonsplinted implants) and bar locators (splinted implants) were constructed, and a vertical load of 100 N was placed on the central fossa of the mandibular first molar. Stress and strain values were obtained using three-dimensional finite-element analysis (ANSYS R18.0). Splinting reduced stress in peri-implant bone in the ipsilateral implant by half and in the contralateral implant by a quarter. Greater stress and a rise in strain from 59 to 79 µÎµ in the posterior ridge were also observed with splinting. The model with splinted implants showed more favorable stress distribution in peri-implant bone, perhaps due to better distribution through the bar and the posterior ridge. These findings should be corroborated with clinical studies.