PREEMPTIVE INTRAVENOUS IBUPROFEN AND LOCAL KETAMINE IMPROVE POSTOPERATIVE ANALGESIA FOLLOWING THIRD MOLAR SURGERY: A DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED CLINICAL STUDY.

OBJECTIVE: To compare the efficacy of preemptive ibuprofen, local ketamine, and their combination in managing postoperative pain and trismus following third molar surgery. MATERIALS AND METHODS: One hundred patients were randomly divided into 4 groups. The Intrafen Group had their impacted third molars surgically removed under local anesthesia after receiving intravenous (IV) ibuprofen for preemptive effect. The Ketamine Group received an IV placebo before the surgery, and the extraction process was completed with a local anesthetic-ketamine combination. The Combined Group received preemptive IV ibuprofen before the procedure, and the surgery was performed with a local anesthetic-ketamine combination. The Control Group received an IV placebo before the procedure and then had their impacted third molars removed under local anesthesia. The Visual Analogue Scale (VAS) values, corresponding to the patients' pain levels at the 2nd and 12th postoperative hours and the total amount of analgesic dose used in the first 24 hours, were recorded, and evaluated. The maximum mouth opening of the patients was measured immediately before the procedure, and on the second and seventh postoperative days. The level of patient satisfaction in all groups was assessed during the procedure. RESULTS: The mean VAS value corresponding to the second-hour pain level of the combined group was statistically significantly lower than the other groups (P = .003). A statistically significant difference was found in the mean VAS values corresponding to the pain levels of the groups, favoring the combined group compared to the other groups (P ≤ .001). A significant difference was observed between the VAS difference values corresponding to the pain levels of the Intrafen group and the Ketamine group, favoring the Intrafen group (P = .038). The Ketamine group consumed the most analgesic on average over the first 24 hours, whereas the Combined group consumed the least. No statistically significant difference was found between the mean trismus levels of the groups on days 0-2 (P = .528) and days 0-7 (P = .129). The intraoperative patient satisfaction level of the combined group was significantly higher than that of the other groups (P = .030). CONCLUSION: Preemptive Intrafen is an effective regimen for postoperative pain management and is superior to the local anesthetic-ketamine regimen. The most effective method to reduce postoperative pain following third molar surgery is to use a combination of these 2 regimens. However, none of the treatment methods used in the study had a positive effect on postoperative trismus.

Does the Posterior Bending Osteotomy in Bilateral Sagittal Split Osteotomy Affect the Condyle Position in Asymmetric Patients?

PURPOSE: To measure and compare changes in postoperative condylar position following bilateral sagittal split osteotomy in patients with asymmetry treated using a posterior bending osteotomy (PBO) and conventional methods (shaving of premature contacts). METHODS: Participants were randomized to either the PBO or conventional group. The inclusion criteria were the need for bilateral sagittal split osteotomy or bimaxillary asymmetric surgery (menton deviation >4 mm). The primary outcome variable was changes in the condylar position in the axial, coronal, and sagittal planes 6 months after surgery, whereas the secondary outcome variable was changes in temporomandibular joint symptoms. Covariates included surgery type, deformity type, age, and sex. Categorical and numerical variables were analyzed using Fisher exact χ2 test and 2-way analysis of covariance. RESULTS: The study sample comprised 42 patients with a mean age of 23.3 years; 57.5% were women. The alteration in the coronal condyle angle was 0.8° ± 0.86° in the PBO and 2.72° ± 0.81° in the conventional group. The differences in the condylar position in the coronal plane were not statistically significant (P = .129). The alteration in the axial condyle angle was 2.31° ± 1.74° in the PBO group and 5.65° ± 1.65° in the conventional group. The alteration in the sagittal plane was 0.44° ± 1.52° in PBO and 0.47° ± 1.44° in the conventional group. Alterations in axial (P = .194) and sagittal (P = .976) condylar positions were insignificant. In the conventional group, statistically significant differences were found in the axial (P = .002) and coronal (P = .002) planes, and the condyle turned inward in both planes. There were no statistically significant differences between the groups or within the groups in the sagittal plane (P > 0,5). In PBO and conventional groups, joint noise examination revealed positive results in 11 and 6 patients preoperatively and 1 and 2 patients postoperatively, respectively. A statistically significant decrease in joint noise was detected in the PBO group (P = 0,04). The maximum mouth opening without pain was 5.95 ± 1.47 in the PBO group and 7.91 ± 1.39 in the conventional group, respectively. The alteration was not statistically significant between the groups but was significant within the groups (P < .001). CONCLUSIONS: PBO effectively prevents premature contact between mandibular segments in facial asymmetry.

Evaluation of trabecular changes following advancement genioplasty combined with or without bilateral sagittal split osteotomy by fractal analysis: a retrospective cohort study.

BACKGROUND: It is aimed to investigate whether there was a difference in radiographic changes in the operational areas between genioplasty alone and genioplasty combined with mandibular advancement and to evaluate the fractal dimension (FD) to assess trabecular changes after genioplasty surgery. METHODS: Preoperative-(T0) and postoperative-(T1) panoramic radiographs of 26 patients without any complications who underwent genioplasty combined with bilateral sagittal osteotomy and mandibular advancement or genioplasty alone were selected. In the panoramic radiographs of both groups, the genial segment, mandibular angulus, and surgical osteotomy line were examined using FD. The box-counting method was used for FD evaluation. RESULTS: It was determined that FD values before and after treatment were similar in both groups for all regions where measurements were made. After surgery, the FD values of the middle region of the genial segment were found to be significantly lower than the other regions. At T1, the FD values at the osteotomy area were found to be significantly higher than those in the middle region of the genial segment. CONCLUSION: Trabecular structure does not differ in patients undergoing genioplasty alone or in combination with mandibular advancement osteotomy. The middle region of the genial segment heals later than other regions.

Comparison of the accuracy of pilot-drill-guided and fully guided implant surgery with dynamic navigation. In vitro model study.

The aims of the present study are to measure and compare dental implant deviations with fully guided and pilot-drill-guided protocols using dynamic navigation systems in polyurethane models. The pilot-drill-guided group was determined to be the study group and included 12 implant applications. In this group, the pilot hole was drilled with navigation guidance, and the procedure was completed freehandedly. In the control group, all the drilling and implant placement steps were performed using the navigation system, and a total of 12 implants were placed. The pre- and postoperative images were compared to calculate the magnitude of implant deviation. The quantitative data of the two groups were compared using the independent-samples t-test and Mann-Whitney U-test. The analyses revealed that the length of the procedure significantly differed between the two groups (p < 0.001). The procedure duration was significantly shorter in the study group. The entry deviation values of the two groups were not significantly different (p = 0.079). The analysis revealed the apex deviation to be higher in the study group than in the control group (p = 0.003). However, the two-dimensional vertical apex deviation values of the implants were not significantly different between groups (p = 0.068). Angular deviation was determined to be significantly higher in the study group (p < 0.001). In the present study, all implants were successfully placed in the models using a dynamic navigation system. The results of this study may be useful for future clinical studies.

Is Ultrasonic Bone Scalpel Useful in Le Fort I Osteotomy?

PURPOSE: Safety and precision are 2 main goals in research to improve bone cutting in maxillofacial surgery. The aim of this prospective clinical study was to analyze the outcomes using an ultrasonic bone scalpel versus a piezoelectric surgical device and the conventional technique in a Le Fort I osteotomy. MATERIALS AND METHODS: We designed a prospective, randomized, single-blind cohort study. The predictor variables were the devices used to perform the Le Fort I osteotomy, divided into 3 groups: 1) ultrasonic bone scalpel (BoneScalpel; Misonix, Farmingdale, NY), 2) piezoelectric surgical device, and 3) conventional technique (Lindeman burr and reciprocal saw). The primary outcome of the study was cutting time, whereas secondary outcomes were length of the procedure, total blood loss, intraoperative complications, and postoperative edema. Other variables of interest were age and gender. Data were analyzed using 1-way analysis of variance and the Kruskal-Wallis test. RESULTS: The study sample was composed of 34 patients with a mean age of 21.5 years, and 63.3% of patients were women. The mean cutting time (P < .001) and length of the procedure (P = .012) were significantly shorter with the bone scalpel than with the other types of surgery. The ultrasonic bone scalpel showed a significant reduction in intraoperative blood loss of up to 45% compared with the piezoelectric surgical device and the conventional technique (P = .038). CONCLUSIONS: The results of this study suggest that the ultrasonic bone scalpel is an effective ultrasonic bone-cutting instrument in a Le Fort I osteotomy as evidenced by the significant decrease in the cutting time, intraoperative blood loss, and postoperative edema compared with the other techniques.

Evaluation of the Pterygomaxillary Separation Pattern in Le Fort I Osteotomy Using Different Cutting Instruments.

PURPOSE: Pterygomaxillary separation (PMS) is considered the main reason for serious complications associated with Le Fort I osteotomy. The aim of this study was to evaluate whether a piezo surgery, ultrasonic bone scalpel, or conventional bur used in Le Fort I osteotomy has an influence on PMS patterns. MATERIALS AND METHODS: Using a retrospective cohort study design, we enrolled a sample composed of patients who underwent orthognathic surgery. The primary predictor variables were the cutting instruments (ultrasonic bone scalpel, piezo surgery, and Lindeman bur) used to perform Le Fort I osteotomy. Other variables were demographic and anatomic parameters. The outcome variable was the type of PMS pattern, classified as follows: type 1, PMS at the pterygomaxillary junction (ideal PMS); type 2, PMS at the greater palatine foramen; type 3, PMS from the posterior wall of the maxillary sinus; and type 4, PMS with lateral or medial pterygoid fracture. Anatomic parameters, that is, the thickness and width of the pterygomaxillary junction and distance of the greater palatine foramen, were measured on preoperative cone-beam computed tomography images. The pattern of PMS was evaluated on postoperative cone-beam computed tomography. Data were analyzed using analysis of variance and the Pearson χ2 test. P < .05 was considered statistically significant. RESULTS: This study sample was composed of 96 PMSs in 48 patients. The most common type of PMS was type 1 (58), followed by type 4 (21), type 2 (10), and type 3 (7). A statistically significant relation was found between the cutting instrument and the ideal separation (type 1 PMS) pattern (P = .032), and the highest rate of the ideal separation pattern was seen in the ultrasonic bone scalpel group, at 24 of 32, compared with 22 of 38 in the piezo surgery group and 12 of 26 in the conventional bur group. CONCLUSIONS: According to the study, the ultrasonic bone scalpel is safer than other cutting instruments in terms of the ideal separation of the pterygomaxillary junction.

Does Single-Dose Preemptive Intravenous Ibuprofen Reduce Postoperative Pain After Third Molar Surgery? A Prospective, Randomized, Double-Blind Clinical Study.

PURPOSE: The aim of the present study was to identify the preemptive analgesic effect of intravenous (IV) ibuprofen before and after mandibular third molar surgery. MATERIALS AND METHODS: We randomly divided 75 patients into 3 groups. Group 1 received IV ibuprofen 60 minutes before surgery and IV placebo (100 mL of saline) after surgery. Group 2 received IV placebo (100 mL of saline) before surgery and IV ibuprofen 60 minutes after surgery. Finally, group 3 received IV placebo (100 mL of saline) 60 minutes before and after surgery. Postoperative pain was recorded using a visual analog scale at 1, 2, 4, 6, 8, 12, and 24 hours within the postoperative period. The total dose of rescue acetaminophen intake was recorded during the first 24 hours of the postoperative period. RESULTS: The efficacy of postoperative analgesia was greater within the preoperative IV ibuprofen group compared with the other groups (P < .001). The placebo group had required more rescue analgesia within the first hour compared with the other groups. The average dose of acetaminophen administered in group 1 was 640 mg compared with 1240 mg in group 2 and 1840 mg in group 3 within the first 24 hours after surgery (P < .001). CONCLUSIONS: The present study has shown that the preemptive use of IV ibuprofen resulted in less pain and a decrease in the requirement for rescue analgesia during the first 24 hours after third molar surgery.

Does Guided Bone Regeneration Prevent Unfavorable Bone Shapes in Distraction Gap?

PURPOSE: Complications related to distraction osteogenesis can cause degradation of newly regenerated bone. Additionally, an unfavorable shape of the regenerated bone at the distraction gap can reduce the quantity of regenerated bone. The aim of the present study was to report on the prevention of unfavorable shapes of regenerated bone using guided bone regeneration during distraction. MATERIALS AND METHODS: Bilateral alveolar distraction was performed in 10 beagle dog mandibles. One side of the mandible formed the experimental group and the other side served as the control group. In the experimental group, guided bone regeneration was performed simultaneously with distraction osteogenesis. In the control group, only alveolar distraction was applied. At the end of a 1-week latent period, all mandibles were distracted 10 mm (1 mm/day). After the distraction period, 3 months were allowed for consolidation. After consolidation, all the dogs were euthanized, and the shape of the regenerated bone was determined to be either favorable or unfavorable. Densitometric evaluation and area measurements were performed using computed tomography scans. Statistical evaluation was performed using the independent t test, with a significance level of P < .05. RESULTS: In the experimental group, no unfavorable bone shape developed in the distraction gap, and the new bone had a surface and volume similar to those of the segments. In contrast, in the control group, 4 mandibles had an unfavorable bone shape in the distraction gap and 4 showed favorable bone healing with no defect. The surface area of the regenerating bone in the experimental group was significantly greater than that in the control group. Also, the surface area differed significantly between the experimental and control groups (P < .05). However, the densitometric values did not differ between the 2 groups (P < .05). CONCLUSIONS: Concomitant use of guided bone regeneration with distraction osteogenesis could be an optimal method for generating a favorable bone shape within the distraction gap.

Closure of Oroantral Communication With Plasma-Rich Fibrin Membrane.

Oroantral communication (OAC) is the opening between the maxillary sinus and oral cavity. It may cause oroantral fistula or maxillary sinusitis if left untreated. The surgical closure of the OAC within 48 hours was recommended to avoid the complications like sinus infections. The aim of this study is to evaluate the treatment of OACs with plasma-rich fibrin (PRF) which is safe and easy to implement in the OACs.This study was conducted with the patients, who required the treatment of the OAC, which was developed after the posterior maxillary tooth extraction in the Dental and Maxillofacial Department of the Faculty of Dentistry in Adnan Menderes University.Plasma-rich fibrin membranes were inserted in layers into the tooth socket so that they covered the OAC. Then these membranes were fixated with the sutures to the surrounding gingiva. Antibiotic (amoxicillin/clavulanic acid 1000 mg), analgesic (dexketoprofen trometamol and/or paracetamol), and oral rinse (0.2% chlorhexidine digluconate) agents were prescribed to all patients. The patients were examined in the 3rd and 7th days and 2 months after the operation.All patients tolerated PRF perfectly, and the soft tissue recovery was completed without any problem. Full epithelization was observed in the defect area in all patients. The OAC did not relapse in any patient.Plasma-rich fibrin technique is a simple and effective method, which can be used in the treatment of OACs with a diameter of 5 mm or less with a low risk of complications.

Does the modified inferior border osteotomy improve the surgical outcomes in bilateral sagittal split osteotomy?

BACKGROUND: To investigate the effect of lower border osteotomy on the lingual split pattern and IAN in BSSO procedures. MATERIALS AND METHODS: The study comprised 32 patients (64 operated sides) who underwent bilateral sagittal split osteotomy (BSSO) due to dentofacial abnormalities between the periods of April 2021 and April 2022. In the mandible, 32 sides (the conventional group) received standard BSSO surgery, while 32 sides (the modified group) additionally received lower border osteotomy. Data regarding the split difficulty of the mandibular in BSSO surgery and the recovery status of the inferior alveolar nerve (IAN) one year after surgery were obtained and evaluated from patient records. The fracture line was radiographically evaluated for the lingual split pattern following surgery. RESULTS: A statistically significant difference was observed in favor of the modified group when the mandibular split difficulty of the groups was compared (p = 0.032). The split time of the modified group was found to be statistically shorter than the conventional group (p ≤ 0.001). The mean numbness level of the modified group one year after surgery was statistically significantly lower than that of the conventional group (p = 0.019). Although there was no statistically significant difference between the two groups in terms of lingual fracture pattern, the rate of type 1 (87.5 %) fracture was higher in the modified group compared to the other group (68.8 %) (p = 0.089). CONCLUSION: The lower border osteotomy performed in addition to the conventional BSSO surgery allows the split procedure easier and in a shorter time. The modification resulted in an increased incidence of type 1 lingual fracture pattern in the mandible. The neurosensory recovery capacity of the IAN in the postoperative period is higher in areas where lower-border osteotomies are performed.

Which factors affect the lingual fracture pattern in sagittal split ramus osteotomy?

The purpose of this study was to elucidate the effects of mandibular anatomy and osteotomy technique on lingual fracture patterns in SSRO. The predictor variables were: length of horizontal medial osteotomy; type of border osteotomy; buccolingual width; and vertical length of the basal cortex. The outcome variable was the type of lingual split pattern. This was categorized into four types according to a lingual split scale (LSS): LSS 1, true Hunsuck; LSS 2, fracture line to posterior border of the ramus; LSS 3, through to mandibular canal; LSS 4, unfavorable fracture pattern. Data were analyzed using analysis of variance and the Pearson χ2 test. Values of p < 0.05 were considered statistically significant. The study sample comprised 312 lingual split patterns in 156 patients. The most common type of lingual split pattern was LSS 1 (n = 204). There was a significant relationship between inferior border osteotomy type and LSS type (p = 0.001). Whilst LSS 1 was the most common among all border osteotomy types. LSS 4 was most frequently observed in cases where the lower border osteotomy remained in the buccal surface. According to the results of this study, the likelihood of an unfavorable split pattern increases when the lower border osteotomy remains in the buccal surface.

Evaluation of trabecular bone healing using fractal dimension analysis after augmentation of alveolar crests with autogenous bone grafts: a preliminary study.

OBJECTIVE: The aim of this study is to evaluate bone remodeling after alveolar crest augmentation with autogenous bone grafts. METHODS: 50 patients who were applied augmentation due to alveolar deficiency were included in this study. Fractal dimensions were measured on the radiographs in the preoperative, postoperative, follow-up periods. The ROI was selected specific to each patient, but repeated in a standardized manner on subsequent radiographs. RESULTS: A total of 50 patients were included in the study; There were 31 females and 19 males. Implants were placed in all patients without any complications. The mean fractal dimensions on the graft recipient side were statistically higher in the postoperative 5th month compared to the postoperative 1st week (p = 0.002). The mean fractal dimensions on the donor side were statistically higher in the preoperative and postoperative 5th month compared to the postoperative 1st week (p < 0.001). CONCLUSION: Any clinical imaging method cannot fully reflect the histological microstructures of the bone. Evaluating the fractal analysis together with the clinical results can demonstrate adequate bone healing and quality prior to implant placement. Fractal analysis is a non-invasive, reproducible, method but further, prospective, randomized, controlled clinical studies are needed to estimate bone quality prior to implant placement.

A comparative evaluation of parasymphyseal fracture fixation in edentulous patients performed using dynamic navigation systems and Herbert screws with the conventional two-plate method: A study on models.

PURPOSE: The investigators performed this study to compare the rigidity outcomes for minimally invasive fixation of edentulous mandibular parasymphyseal fractures without flap creation using Herbert screws with a dynamic navigation system and the conventional two-plate method. METHODS: The investigators implemented an in-vitro study design, and 20 polyurethane edentulous mandibular models covered with flexible plastic to simulate the gingiva were used. Parasymphyseal fractures were created in all models using a reciprocal saw. In the study group, the fracture segments in each model were planned to be fixed using two 30-mm Herbert screws. The Herbert screws were placed using a screwdriver with the dynamic navigation system guiding the process. In the control group, to simulate open reduction, the fracture fragments were fixed using two 4-hole straight titanium plates and 6-mm titanium screws. All mandibular models on the prepared platform were attached to the biomechanical testing machine. They were subjected to a continuous linear compression until plastic deformation occurred. Displacement resistance was measured once for every model when the displacement reached 1, 3, 5, 10, and 15 mm. Furthermore, the maximum breaking forces that the models could withstand before deformation were measured. Data were analyzed using independent samples t-test. A value of p < .05 was considered statistically significant. RESULTS: Manual examination of the models did not reveal any mobility between the fragments. In all evaluated displacement steps, the models fixed using Herbert screws showed significantly higher resistance to mechanical loading compared to the models fixed using parallel miniplates. CONCLUSION: In present study, parasymphyseal fracture of edentulous mandible models were fixed successfully using Herbert screws with the dynamic navigation system. The results of this study may encourage future clinical studies.

Effects of boric acid on bone formation after maxillary sinus floor augmentation in rabbits.

PURPOSE: Augmentation of the maxillary sinus floor with bone grafting is commonly used for successful treatment of edentulous posterior maxilla with dental implants, and it is essential to maintain good bone volume and quality for long-term success of dental implants. The aim of this experimental study was to investigate the local and systemic effects of boric acid on new bone formation after maxillary sinus floor augmentation (MSFA). MATERIALS AND METHODS: Twenty-four male, New Zealand rabbits were randomly divided into three groups with eight rabbits each, and bilateral MSFA was performed in each animal. An autogenous bone/xenograft mixture was used to augment the maxillary sinuses in each group. Group 1 was determined as control with no additional materials, whereas 3 mg/kg boric acid (BA) was added to the mixture in group 2, and 3 mg/kg boric acid solution added to drinking water daily in group 3. RESULTS: The animals were sacrificed and also histologic, histomorphometric, and immunnohistochemical analyses were performed at weeks 4 and 8. At week 4, bone regeneration was better in the local BA group than in the control and systemic BA groups (p < 0.05). However, no significant difference was found among the groups in terms of bone regeneration at the end of week 8 (p > 0.05). CONCLUSION: Significant higher new bone formation was revealed by BA at early healing especially with local application. BA may be a therapeutic option for improving the bone regeneration.