Injury Risk Estimation in Mandible-Related Surgical Procedures: A CBCT Study Based on Vital Interforaminal Anatomical Structures.

The mandibular interforaminal region has been considered safe for surgical procedures; nevertheless, the risk of injury to neurovascular structures, such as the mental foramen (MF) and its related structures (anterior loop [AL] and lingual foramina [LF]) should not be overlooked. The study aimed to evaluate the relative risk of injury to these structures during surgical procedures in the anterior region of the mandible based on cone-beam computed tomography (CBCT) scans. A retrospective cross-sectional and observational study was performed on 250 CBCTs from adults (18-69 years) with dentate jaws. Linear measurements of the MF, AL, and LF were evaluated to estimate the risk of injury to these structures during chin-related surgical procedures. The most frequent distance between the base of the mandible (BM) and MF was 8 mm (30.2%). In addition, 20.4% of the CTs had 6 mm from the vestibular cortical bone to the LF. The commonly found measurement from LF to the apex of the nearest tooth was 7 mm (24.0%); 64.2% of the CTs showed a 2-mm distance between the most distal point of the dental implant site to the most anterior point of the AL. Safety distances for genioplasty techniques (MF to mandible base > 6 mm, 96.6% [CI 95%, 95.0%-98.2%]) were observed. Considering the 5-mm cut-off point between the lower limit of a hypothetical bone graft and the chin, 65.4% (CI 95%, 58.9%-71.9%) of CTs were within this distance. Regarding the safety margin of 8 mm, 85.6% (CI 95%, 80.8%-90.4%) were up to this value. This study found safety margins for genioplasty and chin bone grafting surgical techniques that adopt a 5-mm cut-off point. Further similar studies assessing other surgical methods and employing larger samples from different geographical origins may contribute to this field of investigation.

Is coadministration of preemptive medications an effective strategy for reducing inflammatory clinical events and the need for rescue medication after mandibular third molar surgery? A systematic review of randomized clinical trials.

This study aimed to evaluate the scientific evidence on the effect of preemptive drug coadministration (PDC) for relieving inflammatory events (pain, swelling, and trismus) in mandibular third molar surgery. A PROSPERO-registered systematic review (CRD42022314546) was conducted according to the PRISMA guide. The searches were carried out in six primary databases and the gray literature. Studies not written in languages with the Latin alphabet (Roman) were excluded. Potential randomized controlled trials (RCTs) were screened for eligibility. Cochrane's Risk of Bias-2.0 (RoB) tool was assessed. A synthesis without meta-analysis (SWiM) based on a vote counting and an effect direction plot. Nine studies (low RoB) fulfilled the eligibility criteria and were included for data analysis, with a total of 484 patients. PDC mostly involved corticosteroids (Cort) and non-steroidal anti-inflammatory drugs (NSAIDs). PDC of Cort and other drugs mainly reduced pain scores (6 and 12 h postoperatively) and swelling (48 h postoperatively). PDC of NSAIDs and other drugs mainly reduced pain scores at 6, 8, and 24 h follow-up; swelling and trismus intensity ameliorated at 48 h postoperatively. The most frequently prescribed rescue medication was paracetamol, dipyrone, and paracetamol plus codeine. Results from individual studies have shown reduced consumption of ingested rescue analgesics. In summary, the available evidence from clinical trials included in this SWiM suggests that PDC may provide benefits in reducing the severity of inflammatory outcomes related to mandibular third molar surgery, especially the pain scores in the first hours after surgery, and the rescue analgesic consumption during the postoperative period.