Effectiveness of concentrated growth factor and laser therapy on wound healing, inferior alveolar nerve injury and periodontal bone defects post-mandibular impacted wisdom tooth extraction: A randomized clinical trial.

The extraction of wisdom teeth with mandibular impact frequently results in complications including damage to the inferior alveolar nerve (IAN) and malformations of the bone. The objective of this research endeavour was to assess the efficacy of low-level laser therapy and concentrated growth factor (CGF) in facilitating nerve recovery and wound healing in such instances. A total of thirty-one patients (mean age 27.52 ± 5.79 years) who presented with IAN injury after extraction were randomly assigned to one of three groups: control group (which received oral mecobalamin), CGF group (which received CGF gel applied to the extraction sockets) and laser group (which received low-level lasers (808 nm, 30 mW, 10 J/cm2 )) at the extraction site. Patients' recovery from IAN paresthesia was evaluated seven times over the course of 14 days utilizing visual analogue scale (VAS) and the pinprick test (PP). At multiple intervals following surgery, periodontal probing and bone level measurements were utilized to assess the recovery of both soft and hard tissues. The findings revealed that, compared with the control group, both the CGF and laser treatment groups exhibited a markedly greater improvement in VAS scores and wound healing of soft tissues, as well as in PP results (p < 0.001), indicating enhanced wound healing processes. Despite these improvements, there was no significant difference in wound healing outcomes between the CGF and laser groups. Notably, the CGF group showed a statistically significant improvement in healing bone defects at 30 and 90 days post-treatment compared with the control group (p = 0.003 and p = 0.004, respectively), underscoring its effectiveness in bone healing as a critical aspect of the overall wound healing process. However, in terms of other wound healing comparisons, no significant differences were observed. CGF and laser therapy significantly enhanced the healing of wounds, including soft tissue and bone recovery, in addition to accelerating the recovery of IAN injuries following mandibular wisdom tooth extraction. Although both treatments were equally effective in nerve recovery, CGF notably excelled in promoting bone healing, suggesting its pivotal role in comprehensive wound healing. This highlights that both CGF and laser therapy are viable options for not only nerve recovery but also for overall wound healing in such dental procedures.

Treatment modalities of neurosensory deficit after lower third molar surgery: a systematic review.

PURPOSE: To conduct a systematic review to answer the clinical question, "What are the available treatment modalities and their outcomes of neurosensory deficit after lower third molar surgery?" MATERIALS AND METHODS: A systematic search, including a computer search of several databases with specific keywords, a reference search, and a manual search of 3 key maxillofacial journals were performed. Relevant articles were then evaluated and those that fulfilled the 6 predetermined criteria were chosen to enter the final review. The various treatment modalities and their outcomes of neurosensory deficit after lower third molar surgery, in the selected studies in the final review, were analyzed. RESULTS: Ten articles entered the final review. Six treatment modalities of lingual nerve or inferior alveolar nerve deficit after lower third molar surgery were identified. External neurolysis, direct suturing, autogenous vein graft, and a Gore-Tex tube as a conduit were the 4 surgical treatments. Significant improvement after surgical treatment ranged from 25% to 66.7%. Acupuncture and low-level laser therapy were 2 available nonsurgical treatment modalities that were found to have produced significant improvement in sensation after treatment in more than 50% of subjects. There was insufficient information to determine the best timing of treatment of nerve injury after third molar surgery. CONCLUSIONS: Four surgical treatments and 2 nonsurgical treatments were identified in the management of neurosensory disturbance after lower third molar surgery. Most treatments showed an improvement in sensation but the outcomes were variable. Complete recovery was uncommon in all kinds of available treatments.

Bone healing after the inferior alveolar nerve lateralization: a histologic study in rabbits (Oryctolagus cuniculus).

PURPOSE: The purpose of this article is to evaluate the bone healing around 2 different dental implant surfaces after the lateralization surgery of the inferior alveolar nerve (IAN) during an 8-week healing period in rabbits, and to check if there is any interaction between the implants and the nerve. MATERIALS AND METHODS: The IAN lateralization was performed in an experimental rabbit model. Eight adult female rabbits (Oryctolagus cuniculus) underwent the surgical procedure, and 1 implant was placed on each side of the mandible while the nerve was lateralized. On both sides, the nerve was repositioned directly in contact with the implant surface. With the intention of obtaining comparative results, smooth titanium implants were installed on the right side, and blasted Al2O3 ones were placed on the left. During the healing period, bone tracers were administered subcutaneously to check different periods of bone ingrowth. RESULTS: Histologic section, regardless of the studied surface, showed bone remodeling around the nerve, without contact between the nerve and the implanted surface. The bone blocks containing implants were histomorphometrically examined through computerized analysis, and the results obtained showed that the bone remodeling around the nerve occurred during the first weeks of healing. Through analysis of variance, the blasted Al2O3 implants showed at least 2.5-fold greater bone neoformation compared with the smooth titanium implants. CONCLUSIONS: Our results showed that there was no significant difference in the healing process concerning the nerve between the 2 studied surfaces. No interaction was detected between the nerve and the implants.

Surgical treatment of trigeminal neuralgia.

Patients who had uncontrolled pain with carbamazepine therapy and those who suffered adversely from its side effects were selected for this safe, simple and repeatable surgery. Pain-free periods were achieved for at least 2 years. Functional difficulty was not experienced in the affected numb areas. When it recurred, pain was less intense and was better controlled with a reduced dosage of carbamazepine. In four cases, after avulsion of the involved nerves, a suitable-sized titanium screw was inserted into the mental and infra-orbital foramina. Obturation of the foramen prevented nerve regeneration, which further prolonged the pain remission period.

Effects of capsaicin in temporomandibular joint arthritis in rats.

Temporomandibular joint (TMJ) arthritis was induced in female Lewis rats by unilateral injection of a suspension of heat-killed Mycobacterium butyricum in paraffin oil into the TMJ. Control rats received paraffin oil by the same route. Arthritic and control rats were pretreated either with capsaicin or denervation of the mandibular branch of the trigeminal nerve. Tissues were collected for neuropeptide extraction and analysed by radioimmunoassay and reverse-phase high-performance liquid chromatography. In all groups, the levels of substance P-(SP), calcitonin gene-related peptide- (CGRP) and neuropeptide Y- (NPY) like immunoreactivity (LI) were higher in the trigeminal ganglia than in the TMJs. In control rats, capsaicin significantly lowered the levels of SP-LI in the trigeminal ganglia and TMJ, but not CGRP-LI and NPY-LI. In the arthritic rats, capsaicin pretreatment significantly lowered the SP-LI and CGRP-LI in the trigeminal ganglia and TMJ, but not the NPY-LI. In the trigeminal ganglia the unilateral denervation significantly lowered SP-LI in control rats, and in arthritic rats SP-LI and CGRP-LI. On the denervated side of the arthritic TMJ, NPY-LI, SP-LI and CGRP- LI were significantly lowered as compared to the arthritic control rats and to the contralateral side. In this rat model, pretreatment with capsaicin and surgical denervation decreased the neuropeptide content in the trigeminal ganglia and the TMJ. The results clearly demonstrate a close interaction between increased neuropeptide release from sensory and sympathetic neurones after induction of arthritis in the rat.

Effect of capsaicin treatment or inferior alveolar nerve resection on dentine formation and calcitonin gene-related peptide- and substance P-immunoreactive nerve fibres in rat molar pulp.

The aim of this study was to investigate whether decreased sensory innervation induced by capsaicin treatment or axotomy of the inferior alveolar nerve has an effect upon dentine formation in the rat first molar. Dentine formation was visualized by intravital injection of Procion brilliant Red H8BS and denervation was verified immunohistochemically for the neuropeptides calcitonin gene-related peptide (CGRP) and substance P. The observation times were 6 weeks for the capsaicin-treated group and 11 days for the axotomized group. Capsaicin injections caused a consistent reduction in numbers of CGRP- and substance P-immunoreactive fibres in the pulps and a somewhat smaller reduction in the periodontal tissues. Unilateral axotomy of the inferior alveolar nerve induced an almost complete loss of immunoreactive fibres in the pulp and in the mesial gingiva of the first molar. Dentine formation at the mesial pulp horn and at the central pulp floor was significantly reduced in both groups compared to controls. The results suggest that sensory neuropeptides such as CGRP and substance P may play a part in dentine formation.

Microsurgical correction of the injured inferior alveolar nerve.

The pathology of inferior alveolar nerve injuries is discussed and the general and special guidelines for microsurgical reconstructive procedures are presented. Twenty-three cases are summarized: 22 cases showed marked restoration of nerve function after surgery.