Comparative Assessment of Autogenous Cancellous Bone Graft and Bovine-Derived Demineralized Bone Matrix for Secondary Alveolar Bone Grafting in Patients With Unilateral Cleft Lip and Palate.

OBJECTIVE: Comparison between bovine-derived demineralized bone matrix (DMBM) and iliac crest graft over long term for secondary alveolar bone grafting (SABG) in patients with unilateral cleft lip and palate (UCLP) in terms of radiological and clinical outcomes. DESIGN: Prospective, randomized, parallel groups, double-blind, controlled trial. SETTING: Unit of Oral and Maxillofacial Surgery, Oral Health Science Centre, Postgraduate Institute of Medical Education & Research, Chandigarh. PARTICIPANTS: Twenty patients with UCLP. INTERVENTIONS: Patients were allocated into group I (Iliac crest bone graft) and group II (DMBM) for SABG. Outcomes were assessed at 2 weeks, 6 months, and then after mean follow-up period of 63 months. OUTCOMES MEASURES: Volumetric analysis of the grafted bone in the alveolar cleft site was done through cone beam computed tomography using Cavalieri principle and modified assessment tool. Clinical assessment was performed in terms of pain, swelling, duration of hospital stay, cost of surgery, alar base symmetry, and donor site morbidity associated with iliac crest harvesting. RESULTS: Volumetric analysis through Cavalieri principle revealed comparable bone uptake at follow-up of 6 months between group I (70%) and group II (69%). Modified assessment tool showed no significant difference between horizontal and vertical bone scores over short- and long-term follow-up. In group II, there was higher cost of surgery, but no donor site morbidity unlike group I. CONCLUSIONS: Demineralized bone matrix proved analogous to iliac crest bone graft as per volumetric analysis over shorter period. However, although statistically insignificant, net bone volume achieved was lower than the iliac crest graft at longer follow-up.

Comparaison of Efficacy and Safety of Fentanyl Transdermal Patch with Oral Ketorolac for Pain Management in Dry Socket: A Randomized Clinical Trial.

Objectives: The aim of this study was to compare the efficacy and safety of transdermal Fentanyl patch with oral Ketorolac for pain management in dry socket patients. Study design: Sixty patients who were diagnosed with dry socket (VAS > 40 mm) were recruited in this prospective randomized controlled trial. Patients were divided into two groups. Group1 (n = 30) Transdermal Fentanyl patch (25mcg/hr) was given and in Group 2 (n = 30) Ketorolac 10 mg Oral tablet was prescribed for pain management. The primary endpoint was the mean pain scores within 72 h evaluated by visual analog scale (VAS). Secondary measures included the safety and tolerability, amount of rescue medication (analgesic and antiemetic) and effectiveness of treatment interventions by Brief Pain Inventory Questionnaire (BPI). Results: The mean VAS pain scores were significantly less in group 1 (Fentanyl) as compared to group 2 (ketorolac) on all follow-up days. Significant difference was noted in the mean amount of rescue analgesic medication. It was 2.16 + 1.53 in group 1 and 8.50 + 3.98 in group 2. Side effects were seen in both the groups. Nausea (46%) and vomiting (43%) were reported in group 1 while headache (36.6%) and epigastric pain (53.3%) in group 2. Conclusions: Thus, transdermal Fentanyl was better in pain control than Ketorolac with less need for rescue analgesic medication in dry socket.

Comparison of Efficacy and Safety of Hybrid Arch Bar with Erich Arch Bar in the Management of Mandibular Fractures: A Randomized Clinical Trial.

Study Design: A clinical randomized control trial. Objective: To compare the efficacy and safety of Hybrid arch bar (HAB) with Erich arch bar (EAB) in fracture management of the mandible. Methods: In this randomized clinical trial, 44 patients were divided into 2 groups:- Group 1, N = 23 (EAB group) and Group 2, N = 21 (HAB group). The primary outcome was time taken for the application of arch bar, while the inner and outer glove puncture, operator prick, oral hygiene, arch bar stability, complications of HAB, and cost comparison were secondary outcomes. Results: The time taken for the application of arch bar in group 2 was significantly shorter than group 1 (55.66 ± 17.869 min vs 82.04 ± 12.197 min) and the frequency of outer glove puncture was also significantly lesser for group 2 (0 punctures vs 9 punctures). Better oral hygiene was found in group 2. EAB was cost-effective than HAB (Rs 700 ± 239.79 vs Rs 1742.50 ± 257.14). The stability of the arch bar was comparable in both groups. Group 2 had associated complications of root injury in 2 out of 252 screws placed and the screw head got covered by soft tissue in 137 out of 252 screws placed. Conclusions: Thus, HAB was better than EAB with a shorter time of application, less risk of prick injury, and improved oral hygiene.Clinical trial registry name- clinical trials registry- India, URL-http://ctri.nic.in, registration number- CTRI/2020/06/025966.

Open Treatment with Ultrasound Activated Resorbable Pins Versus Closed Treatment of Adult Mandible Condylar Head Fractures.

Purpose: The purpose of the study was to investigate whether open reduction and internal fixation (ORIF) with ultrasound activated resorbable pins (UARPs) is superior to closed treatment of condylar head (CH) fractures. The investigators hypothesized that fixation with UARPs is superior to closed treatment of CH fracture. Methods: It was a prospective pilot study on CH fracture patients. Patients in closed group were managed conservatively with arch bar fixation and elastic guidance. Fixation in open group was done with UARPs. Assessment was done for primary objective of stability of fixation by UARPs and secondary objectives of functional outcome and complications. Results: The study sample included 20 patients (10 in each group). 10 patients (11 joints) in closed group and 9 patients (10 joints) in open group were available for final follow-up. 5 joints showed re-dislocation of fractured segment, 1 joint showed slightly imperfect but adequate fixation and 4 joints showed adequate fixation in open group. In the closed group, displaced fragment was fused with mandible at displaced position in all the joints. All the joints showed resorption of medial condylar head at 3 months follow-up in open group. There was minimal resorption of condyle in closed group. Occlusion was deranged in 3 patients in open group and 1 patient in closed group. MIO, pain scores and lateral excursions were equal in both the groups. Conclusion: The results of the present study rejected the hypothesis that fixation of CH with UARPs was superior than closed treatment. There was resorption of medial CH fragment in open group as compared to closed group.

Effect of Orthognathic Surgery on Temporomandibular Disorders: A Prospective Study.

Purpose: The relationship of orthognathic surgery and temporomandibular disorders (TMD) has always been a topic of debate. The results have varied from mild/moderate improvement to actual worsening in some cases. The purpose of this study was to evaluate the effects of orthognathic surgery on TMD in patients with dentofacial deformities. Method: An observational study was conducted on 56 patients (112 condyles) of patients with dentofacial deformities with age range of 19-35 years who underwent orthognathic surgery. TMD was evaluated using seven types of disorders in diagnostic criteria for TMD (DC/TMD, 2010) pre-operatively and after 6-month follow-up. Results: There was minimal decrease in unassisted mouth opening without pain, maximum unassisted mouth opening and maximum assisted mouth opening after surgery. There was significant improvement in joint sounds and headache in 18 patients. Overall, there was improvement in 29 cases (33.93%), worsening in 8 cases (14.29%) and no change in 19 cases (33.93%). Conclusion: There was high prevalence of TMDs in dentofacial deformity patients. Most of the patients with pre-operative TMD improved with orthognathic surgery, whereas a small percentage of patients who were asymptomatic pre-operatively developed TMD after surgery and in some patients TMD worsened. The risk of developing TMD and worsening of severity conditions is low.

Analysis of maximum bite force and chewing efficiency in unilateral temporomandibular joint ankylosis cases treated with buccal fat pad interpositional arthroplasty.

There is limited knowledge about masticatory function after the release of temporomandibular joint (TMJ) ankylosis. In this study, masticatory function was evaluated by measuring maximum voluntary bite force (MVBF) and chewing efficiency in 30 unilateral TMJ ankylosis patients who were treated with buccal fat pad (BFP) interpositional arthroplasty. Eighteen subjects over 12 years of age were included in study Group A and 12 subjects below 12 years of age in study Group B. Patients in the study groups had completed a minimum follow up of one year after surgery. Control groups C (over 12 years of age, n = 18) and D (under 12 years of age, n = 12) consisted of age, sex, and weight-matched normal subjects. The mean MVBF was measured between occluding molar teeth with a strain gauge transducer. Chewing efficiency was measured with two different coloured chewing gum strips. These were chewed for 5, 10, 20, 30, and 50 strokes. Compared with normal subjects, the study groups (A and B) could generate 64.7% (p = 0.004*) and 89.8% (p = 0.121) of MVBF, respectively. Overall chewing efficiency was 88.7% in Group A and 92.9% in Group B (p = 0.014* and p = 0.138, respectively) when compared with normal subjects. The study has shown that BFP interpositional arthroplasty effectively restores masticatory function.

Changes in condylar position after orthognathic surgery and its correlation with temporomandibular symptoms (TMD)- a prospective study.

The aim of the study was to assess the changes in the condylar position after orthognathic surgery (OGS) and its effect on temporomandibular disorders (TMD). A total of 37 dentofacial deformity patients included in the study who had undergone OGS were divided into three groups: Group I, Le Fort I maxillary advancement; Group II, bilateral sagittal split osteotomy (BSSO) mandibular advancement ± Le Fort I; and Group III, BSSO mandibular setback ± Le Fort I. Patients were evaluated clinically using Diagnostic Criteria for TMD and by radiography preoperatively and 6 months postoperatively. The positional changes in condyle were correlated with signs and symptoms of TMD. A total of 37 patients in three groups (Group I, 8 patients; Group II, 10 patients; and Group III, 19 patients) were evaluated. Overall, condyles had anterio-medio-inferior movement with 7 of 8 patients in Group I, 6 of 10 patients in Group II and 13 of 19 patients in Group III having ≤2 mm displacement. In angular changes, inward-anterio-medial movement was observed with 6 of 8 patients in Group I; about 5 of 10 patients, and 10 of 19 patients in Group II and III respectively had ≤5° change. Intragroup and intergroup comparisons showed insignificant changes in TMD and linear/angular movement (p ≥ 0.05). Pearson correlation coefficient was found to be nonsignificant on the radiographic and clinical comparison (p ≥ 0.05). Intrarater reliability (Kappa value) was found to be 0.83, confirming the results. Within the limitations of the study it seems that there are minimal linear and angular changes in condyle after orthognathic surgery that were not responsible for the development of temporomandibular disorders in the postoperative course.

Autogenous Fat as an Ideal Interpositional Material in Temporomandibular Joint Surgery.

Interpositional gap arthroplasty has established itself as the the standard surgical treatment of Temporomandibular joint (TMJ) ankylosis. The autogenous tissue has replaced the alloplastic and other xenografts materials owing to its bioavailability, easy uptake, and no additional cost. Commonly used autogenous tissue has been temporalis muscle and fascia, fascia lata, skin graft, auricular and costal cartilage, the masseter and/or medial pterygoid muscle. With the turn of the century, TMJ surgeons started using autogenous fat from the lower abdomen and today it has taken over as the most favored autogenous filler material in TMJ ankylosis surgery or total joint replacement (TMJ-TJR). The use of buccal fat pad (BFP) has increased in the last decade due to its local availability and pedicled nature. This paper will discuss various autogenous tissues used in interposition and bring forth the journey of the autogenous fat as the preferred interpositional material now and rest the case in its favor.

Does Intraoperative Computed Tomography Improve the Outcome in Zygomatico-Orbital Complex Fracture Reduction?

PURPOSE: Zygomatico-orbital (ZMO) fractures pose considerable difficulty in intraoperative assessment during open reduction and internal fixation (ORIF), and this can be attributed to its three-dimensional complex anatomy and articulations. Recent advancements in the form of intraoperative imaging and navigation have led to an adequate assessment and correct reduction of these fractures minimizing chances of any revision surgery. The purpose of this study was to evaluate the advantage of intraoperative computerized tomography (CT) scan in the management of ZMO/isolated orbital complex fracture and further to develop a protocol for managing such fractures. METHODS: Twenty-three cases of ZMO/isolated orbital fractures were managed with ORIF, followed by an intraoperative CT scan. The evaluation was focused on the articulations of the zygoma and orbital wall reconstruction. The score of 0 and 1 was given for inadequate and adequate reduction, respectively. Necessary corrections were performed in case of improper reduction followed by a repeat CT scan if required. The reduction score was statistically correlated with number of incisions. RESULTS: In 8 (35%) out of 23 patients, clinical judgment was inaccurate when radiologically assessed with an intraoperative CT scan. In 6 out of 8 cases, a repeat CT scan was done after revision of reduction. The reduction score improved with additional incision and revision in the second CT scan. CONCLUSION: Intraoperative CT has an important role in assessing the accuracy of reduction and confirming implant position in ZMO/isolated orbital fractures. This can avoid the need for secondary corrective surgery and postoperative imaging. Intraoperative CT is an important tool to improve surgical outcomes in the management of ZMO orbital fractures.

Congenital Maxillomandibular Syngnathia: Review of Literature and Proposed New Classification System.

PURPOSE: Maxillomandibular fusion (syngnathia) is a rare craniofacial anomaly. It occurs as either fibrous (synechiae) or bony (synostosis) fusion of jaw or fusion of mandible to zygoma, tuberosity, hard palate and temporal bone. There are several documentations delineating this condition but owing to its varying presentation, association with both intraoral and extraoral anomalies and syndromes, reviewing it has been as uphill task. The non-unanimous description of cases in the literature and the use of different nomenclatures make it difficult to classify this condition. METHODS: Extensive search of the literature was done from the year 1936 to 2018 which included a total of 118 cases with 62 cases of bony fusion, 48 cases of fibrous fusion and 8 cases of combined fusion, i.e., fibrous on one site and bony on another side. RESULTS: This paper proposes a novel, simple and explicit classification system on the basis of nature of fusing tissues, location and extent, association with syndrome after reviewing the existing literature. Furthermore, this review reports 4 new cases of syngnathia along with their clinical, radiographic features and their management protocol. CONCLUSIONS: This classification can be generalized to all the cases of syngnathia and can further facilitate in its appropriate diagnosis and treatment plan.

"Signs and Symptoms Tell All"-Pseudoaneurysm as a Cause of Postoperative Bleeding after Orthognathic Surgery-Report of a Case and a Systematic Review of Literature.

PURPOSE: Pseudoaneurysms are one of the rare complications that can be encountered after the orthognathic surgery. We are presenting a new case of pseudoaneurysm of bilateral sphenopalatine artery after Bijaw Surgery in a young male and a systematic review of all the cases in the literature emphasizing on signs and symptoms, epistaxis or bleeding episodes and treatment outcomes. METHODS: A systematic research strategy was planned according to the PRISMA guidelines, and articles were taken from 1986 to September, 2019. A total of 899 articles were selected for screening, out of which only 26 articles met our inclusion and exclusion criteria. These were included in the study for qualitative analysis. RESULTS: Most PAs were associated with Lefort I osteotomy (69.7%), followed by sagittal split osteotomy (24.24%). Average intraoperative blood was 635 ml. Maximum number of episodes of epistaxis/swelling or bleeding occurred in second week. Mean bleeding episodes were 2.58 ± 0.996. The arteries commonly affected were internal maxillary artery (42%), sphenopalatine artery (27.27%), facial artery (15.15%), descending palatine artery (12.12%), internal carotid artery (9.09%) and infraorbital artery (3.03%). Embolization was treatment of choice in 81.81% cases. CONCLUSION: If a patient has recurrent epistaxis or swelling after orthognathic surgery, it is advisable to go for diagnostic imaging like angiography without any delay. In recent times, advanced techniques and expertise are readily available for early diagnosis and management of pseudoaneurysm.

Fungal Necrotizing Fasciitis of Craniofacial Region: A Diagnostic Challenge.

Necrotizing fasciitis is a rare rapidly progressive, devastating surgical emergency that results in necrosis of superficial fascia, and subcutaneous tissue. It most commonly affects the abdominal wall, extremities and perineum, while the involvement in the head and neck region is relatively rare. Here, we report a successfully treated case of necrotizing fasciitis of the craniofacial region caused by Mucor in an uncontrolled diabetic patient. Early diagnosis, early surgical intervention with radical excision of infected tissue, management of underlying predisposing medical condition and supportive therapy (antimicrobials, rehydration, proper rest and nutrition) can reduce the morbidity and mortality associated with this condition.

Development and validation of temporomandibular joint ankylosis quality of life questionnaire.

The patient-reported outcome measures are endorsed for better evaluation of disease impact and treatment outcomes. Temporomandibular joint (TMJ) ankylosis has been observed to adversely impact the quality of life (QoL) of the patients, affecting both the physical and psychosocial aspects of their lives. The study was conducted to develop and validate a TMJ ankylosis specific QoL questionnaire (TMJAQoL). It had two phases. Phase 1 was associated with the development of the questionnaire while phase 2 examined its psychometric properties and validated the instrument. In phase 1, a 65 item pool was generated and was eventually reduced to a 37 item pool after sequential evaluation by two expert groups. The 37 item draft was subjected to item reduction by the impact method, resulting in a 12 item draft divided into 4 domains, which formed the TMJAQoL questionnaire. In phase 2, the TMJAQoL was completed by 51 TMJ ankylosis patients and was found to have optimum validity, reliability and internal consistency. 44 of these patients completed the TMJAQoL again after the surgery. A significant change in mean cumulative TMJAQoL scores (pre-op = 14.10, post op = 4.05, p = .001) was found after the surgery. This change was significantly correlated to the improvement in the maximal incisal opening and the right and left lateral movements (r > .30). Amongst the TMJAQoL domains, significant improvement was seen in functional limitation (p = .026), psychological well being (p = .017) and social wellbeing domains (p = .038). Overall, improved QoL was observed after the TMJ surgery. The TMJAQoL demonstrated optimum psychometric properties and promises to be an effective QoL instrument for the TMJ ankylosis patients.

Traumatic Posterior Dislocation of Bilateral Mandible Condyles into External Auditory Canal Treated with Midline Mandibulotomy: A Rare Case Report and Review of Literature.

BACKGROUND: Posterior dislocation of the condyle from the glenoid fossa fracturing the anterior wall of the canal and ultimately restricting lower jaw movements is a rare condition. It may occur due to lax intra-articular ligaments or periarticular tissue or as a result of injury to the chin region. Very few cases of this condition are reported in the literature. PURPOSE: The purpose of this article is to present a rare case report and review of literature related to posterior dislocation of bilateral mandible condyles to the external auditory canal, its diagnosis, and treatment with midline mandibulotomy. METHOD: We used conservation methods to reduce it initially but not succeeded. Then we used midline mandibulectomy to reduce the individual condyle to its original position without opening the condyle region. RESULTS: We achieved a successful reduction of the dislocation and achieved with good occlusion and postoperative mouth opening. No complications like recurrence and TMJ ankylosis occurred. CONCLUSION: Bilateral posterior dislocation is a rare condition; proper clinical, radiographic diagnosis, and early treatment with manual or surgical intervention are required to avoid complications.

Comprehensive review of guidelines to practice prosthodontic and implant procedures during COVID-19 pandemic.

OBJECTIVES: To present a comprehensive review of current literature available on Corona virus disease and dentistry, modifications required in dental and laboratory settings; and recommended disinfection protocols in current scenario. Special emphasis has been given to discuss guidelines for handling different prosthodontic procedures and implications of this pandemic on prosthodontic practice, education and research. MATERIALS AND METHODS: Relevant literature pertaining to COVID-19 and dentistry was scrutinized on electronic search engines including PubMed, EMBASE and Cochrane. Guidelines given by various organizations, institutions, national and international regulatory bodies and Indian Prosthodontic Society were also consulted to gather information pertaining to the objectives of our review. RESULTS: and observations: A total of 160 articles including cross-sectional studies, in vitro study, narrative reviews, letters to the editor and opinions were found to be relevant in accordance with our search strategy. Documented literature revealed that Covid-19 pandemic has culminated in serious clinical, financial and psychological implications in the field of dentistry. Certain steps such as adoption of teledentistry, judicious use of protective equipment, use of rubber dams, pre-procedural rinses have been suggested unanimously. However, there is a dearth of evidence-based recommendations in literature. Data regarding consequences of delaying prosthodontic procedures and patients' perspectives is also sparse. CONCLUSION: The COVID-19 necessitates the need to adopt a balanced approach while treating patients and safeguarding the dental professionals at the same time. Risk-benefit ratio has to be assessed along with stringent following of guidelines and disinfection protocols to combat this unprecedented situation.

Efficacy of Feracrylum as Topical Hemostatic Agent in Therapeutically Anticoagulated Patients Undergoing Dental Extraction: A Comparative Study.

AIMS AND OBJECTIVE: To compare the efficacy of feracrylum with tranexamic acid (TXA), following dental extraction in patients who are therapeutically anticoagulated with warfarin. STUDY DESIGN: Sixty patients on warfarin were randomly divided into three groups. Groups 1 and 2 patients were given feracrylum (1%), and TXA (5%) solution pressure pack and a control group (Group 3) was given normal saline (NS) pressure pack after extraction. Postoperative bleeding was assessed and graded numerically and periodically (0, 1, 2, 5 and 7 days). The values were statistically analyzed. RESULTS: Sixty patients (M:F::37:23) with a mean age of 56 years who were therapeutically anticoagulated for different medical conditions were included. The mean warfarin dosage was 3.5 mg, and the mean INR was 2.83. Out of 27 patients who showed bleeding on day of extraction, eight, ten and nine patients belonged to groups I, II and III, respectively, and the difference was nonsignificant. Out of 15 patients who showed bleeding on post-extraction day 1, one, five and nine patients belonged to groups I, II and III, respectively. The difference was statistically significant on day 1 and nonsignificant in the next follow-ups. CONCLUSION: Local hemostatic agents like TXA and feracrylum arrest bleeding without having any systemic action and without the necessity of altering the anticoagulant regimen. Feracrylum has an added advantage of a single application, formation of a mechanical barrier and an additional antimicrobial effect. These agents should be incorporated in the protocol for managing patients on oral anticoagulants.

Efficacy of Chitosan in promoting wound healing in extraction socket: A prospective study.

PURPOSE: Chitosan has been shown to promote wound healing and induce bone formation. The aim of this split-mouth study was to evaluate the effectiveness of chitosan based dressing in wound healing after lower third molar extraction. METHOD: Asymptomatic symmetrical mandibular third molars were extracted simultaneously in 27 patients and Chitosan dressing was placed into the extraction socket in the test side. Pain scores were recorded on VAS using a 0 to 10 pain score. Wound healing was compared between right and left side. Radiographic findings were evaluated by observing lamina dura and density of extraction socket. RESULTS: Test group had more pain than control at all time intervals and unerupted tooth sites showed mean pain score significantly more than erupted tooth sites. Test group was superior to control in event of wound healing. Healing was significantly better in erupted tooth than unerupted tooth. At second week 12 sites showed better radiographic findings in chitosan treated group compared to 3 sites in the control group. At third month, 14 sites showed improved bone formation in chitosan treated group compared to 4 in control group. None of the unerupted teeth group showed better radiographic finding in test side at 2 week and 3 month compared to erupted teeth group. CONCLUSION: Chitosan is effective in promoting wound healing and early osteogenesis in erupted tooth socket after extraction. We recommend that chitosan dressing should be used in the sockets of erupted tooth after extraction but should be avoided in unerupted or impacted teeth cases.

Spontaneous Regeneration of Bone in Segmental Mandibular Defect.

AIM: To highlight the spontaneous regeneration of mandibular segmental defects in young and pediatric cases and to review the literature of this unusual and rare phenomenon. METHODOLOGY: Two case reports of a 17-year old male and a 8-month-old infant has been presented who underwent resection of mandible for benign tumors. These two cases have been compared with the existing literature of 61 cases published till date. INFERENCE: Spontaneous regeneration of mandible as a viable reconstructive option is not practically feasible. The consistency and predictability of the phenomenon is questionable. Bone grafting should probably be done immediately in all cases, even in young patients if a delay would interfere with quality of life. In infants and small children though, we propose that immediate reconstruction may be avoided to allow some regeneration at the defect site. If it does not occur, secondary reconstruction may then be considered.

Conservative management of Oral Submucous Fibrosis in early and intermediate stage.

AIMS & OBJECTIVE: To evaluate the efficacy of combined intralesional injection of Hyaloronidase and Triamcinolone with third molar removal in early and intermediate stage (Stage II & III) of Oral Submucous Fibrosis (OSMF) for improvement in mouth opening and hypersensitivity to food. STUDY DESIGN: 48 patients in stage II & III OSMF were selected for the study. All the third molars were extracted in each patient followed by 6-8 doses of combined intralesional injection of Hyaloronidase and triamcinolone at 10 days interval targeting the fibrotic bands. Mouth opening and improvement in hypersensitivity to food was noted by numerical grading. The patients were followed for one year at regular intervals. The data was expressed as mean ± SD, and a probability (p) value of <0.05 was considered significant. RESULTS: The initial mouth opening in Stage II patients (n = 27) was 30 ± 3.0 mm and in Stage III patients (n = 21) was 19 ± 3.5 mm and the increase in mouth opening at the end of treatment was 11.3 ± 1.9 mm and 10.2 ± 2.3 mm respectively. The mean improvement in hypersensitivity to food in both the groups was 2.9 and 2.2 respectively. CONCLUSION: There is significant improvement in grade II patients in mouth opening and hypersensitivity to food. Grade III patients show variable improvement or no improvement wherein surgery becomes the only option. Third molar extraction helps in reducing inflammation and fibrosis in the retromolar region thus easing in mouth opening. This combined approach for moderately staged OSMF can be proposed as a viable conservative modality.