Volume and effectiveness assessment of articain 4% versus mepivacaine 2% used in third molar surgery: randomized, double-blind, split-mouth controlled clinical trial.

BACKGROUND: The different indications for extraction of the lower third molars, require resources to manage pain and discomfort, such as, for example, adequate anesthetic techniques, and the type of anesthetic used can influence the management of pain in tooth extractions. Few studies in the literature compare the anesthetics 4% articaine hydrochloride and 2% mepivacaine hydrochloride showing evidence that both allow for successful pain management. This study sought to compare the volume, efficacy and safety of these two anesthetic drugs, both associated with epinephrine at a ratio of 1:100,000, used in the extraction of lower third molars. MATERIAL AND METHODS: A controlled, clinical, split-mouth compared these both local anesthetics in a sample of 20 patients requiring bilateral extraction of teeth. Pain was the main parameter to be assessed by means of the visual analogue scale (VAS) applied during and immediately after the surgery. Hemodynamic parameters, adverse events, presence of paresthesia and satisfaction of patients and surgeon were also analysed. RESULTS: Pain management was more effective with mepivacaine up to two hours after surgery (p=0.014), whereas the surgeon was more satisfied with the use of articaine during divulsion and suture (p<0.05). However no statistically significant differences were found between both anesthetics regarding pain perception. CONCLUSIONS: It was observed that both anesthetics are efficient and safe in the management of pain for extraction of third molars, in which less amount of mepivacaine is needed. The satisfaction of patients and surgeon was the same for both anesthetics, with articaine being highlighted during divulsion and suture.

Is there a correlation between arthroscopic findings and the clinical signs and symptoms of patients with internal derangement of the temporomandibular joint? A prospective study.

The aim of this study was to evaluate the correlation between clinical signs and symptoms of patients with internal derangement of the temporomandibular joint (TMJ) and arthroscopic findings. The study included a sample of 67 patients who underwent TMJ arthroscopy. The variables evaluated were the arthroscopic findings of synovitis, chondromalacia, adhesion, and roofing. The Spearman correlation index was used to correlate these findings with the clinical signs and symptoms of internal derangement of the TMJ, namely maximum mouth opening, pain (visual analogue scale, VAS), and the Wilkes classification. The mean age of the population was 36.16 years, and 85% were female. There was a correlation between pain and synovitis (P=0.0029, r=0.3508), between mouth opening limitation and the amount of adhesion (P=0.0004, r=-0.4084), and between Wilkes classification and the presence of chondromalacia and disc displacement (P=0.001, r=0.374 and P=0.0045, r=-0.3357, respectively). No correlation was found between age and the presence of chondromalacia (P=0.3444, r=0.1147). Patients who had worse pain symptoms had more advanced stages of synovitis, and the increased presence of adhesions was associated with limitations in mouth opening. Furthermore, those with more advanced Wilkes stages had greater disc displacement and more severe stages of chondromalacia.

Comparison of five different fixation techniques of sagittal split ramus osteotomy using three-dimensional finite elements analysis.

The aim of this study was to compare the mechanical stress over hemimandible substrate and hardware after sagittal split ramus osteotomy (SSRO) fixed with five different techniques using three-dimensional (3D) finite element analysis. A 3D finite element model of a hemimandible was created and a 5mm advancement SSRO was simulated on a computer model. The model was fixed with five different techniques: 3 linear 60° screw arrangement; 3 linear 90° screw arrangement; 3 inverted L screw arrangement; 1 conventional miniplate; and 1 locking miniplate with four monocortical screws. Load was applied until 3mm displacement was reached and the results were compared with previous mechanical and photoelastic tests, thus analysing the mechanical stresses developed in the proximity of miniplates and screws and within the fixation system itself. The maximum principal stress values demonstrate a lower mechanical stress rate in bone and in the fixation system with the inverted L arrangement, followed by the linear 90° and linear 60° arrangements. The locking miniplate/screw system presented lower maximum principal stress and better stress distribution compared with the conventional system. Under the conditions tested, the reversed L arrangement provided the most favourable stress dissipation behaviour.