A Clinical Study for Removal of Impacted Mandibular Third Molar under Local Anaesthesia, with and without Ketamine - A Split Mouth Comparative Study.

Introduction: Disimpaction is one of the most common operations done by oral and maxillofacial surgeons around the world. Ketamine is a well-known general anaesthetic and short-acting intraoperative analgesic. The aim of this study was to measure the efficacy of anaesthesia using combined treatment with local anaesthetic plus a subanaesthetic dose of ketamine and local anaesthetic alone in bilaterally impacted mandibular third molar surgery. Methods and Materials: A total of 24 patients who consented were taken up for a split-mouth study. In the control group, surgical extraction of the impacted lower third molar was done using local anaesthesia (lignocaine 2% with 1:80,000 adrenaline) only, and in the study group, local anaesthesia with ketamine extraction was done using ketamine (0.2 mg/kg) along with local anaesthesia (LA). The time of onset and the duration of anaesthesia intraoperatively were recorded using a digital stopwatch. The depth of anaesthesia was noted on the 10th, 30th and 60th min. After extraction, the post-operative pain on the first, fourth, eighth and 12th hour was evaluated using a Visual Analogue Scale (VAS) score rating of 1-10. The pulse was also noted and compared for any differences in either of the groups. Results: A statistically significant (P < 0.005) difference in result was obtained for the onset, duration, depth and pain score after surgical extraction in both the evaluated groups. The pain index score by the ketamine group was significantly low as compared to the local anaesthesia-only group. Intraoperative onset, duration and depth of anaesthesia obtained had a significant difference. Discussion: Ketamine can be used as a viable option for surgical third molar extractions with reduced discomfort and post-operative pain.

Hemostasis and Post-operative Care of Oral Surgical Wounds by Hemcon Dental Dressing in Patients on Oral Anticoagulant Therapy: A Split Mouth Randomized Controlled Clinical Trial.

INTRODUCTION: Hemostasis is a fundamental management issue post-operatively in minor oral surgical procedures. To ensure safety and therapeutic efficacy in patients, under oral anti coagulant therapy, is complicated by necessity for frequent determination of prothrombin time or international normalised ratio. AIM: The aim of the study was to determine whether early hemostasis achieved by using Hemcon Dental Dressing (HDD) will affect post-operative care and surgical healing outcome in minor oral surgical procedures. MATERIALS AND METHODS: A total of 30 patients, aged 18 years to 90 years, except those allergic to seafood, who consented to participate, were enrolled into this study. Patients were required to have two or more surgical sites so that they would have both surgical and control sites. All patients taking Oral Anticoagulation Therapy (OAT) were included for treatment in the study without altering the anticoagulant regimens. Institutional Review Board approval was obtained for the same. The collected data was subjected to statistical analysis using unpaired t-test. RESULTS: All HDD surgically treated sites achieved hemostasis in 1.49 minutes and control wounds in 4.06 minutes (p < 0.001). Post-operative pain at HDD treated sites (1.87,1.27 on 1st and 3rd day respectively) was significantly lower than the control sites (4.0,1.87 on 1st and 3rd day respectively) p-value (0.001, 0.001 respectively). HDD treated oral surgery wounds achieved statistically significant improved healing both at 1st and 3rd post-operative days (p <0.0001). CONCLUSION: The HDD has been proven to be a clinically effective hemostatic dressing material that significantly shortens bleeding time following minor oral surgical procedures under local anaesthesia, including those patients taking OAT. Patients receiving the HDD had improved surgical wound healing as compared to controls.

Clinical and histological comparison of polyglycolic acid suture with black silk suture after minor oral surgical procedure.

UNLABELLED: Any suture material, absorbable or nonabsorbable, elicits a kind of inflammatory reaction within the tissue. Nonabsorbable black silk suture and absorbable polyglycolic acid suture were compared clinically and histologically on various parameters. MATERIALS AND METHODS: This study consisted of 50 patients requiring minor surgical procedure, who were referred to the Department of Oral and Maxillofacial Surgery. Patients were selected randomly and sutures were placed in the oral cavity 7 days preoperatively. Polyglycolic acid was placed on one side and black silk suture material on the other. Seven days later, prior to surgical procedure the sutures will be assessed. After the surgical procedure the sutures will be placed postoperatively in the same way for 7 days, after which the sutures will be assessed clinically and histologically. RESULTS: The results of this study showed that all the sutures were retained in case of polyglycolic acid suture whereas four cases were not retained in case of black silk suture. As far as polyglycolic acid suture is concerned 25 cases were mild, 18 cases moderate and seven cases were severe. Black silk showed 20 mild cases, 21 moderate cases and six severe cases. The histological results showed that 33 cases showed mild, 14 cases moderate and three cases severe in case of polyglycolic acid suture. Whereas in case of black silk suture 41 cases were mild. Seven cases were moderate and two cases were severe. Black silk showed milder response than polyglycolic acid suture histologically. CONCLUSION: The polyglycolic acid suture was more superior because in all 50 patients the suture was retained. It had less tissue reaction, better handling characteristics and knotting capacity.