Bite force changes after surgical correction of mandibular prognathism in subjects with increased vertical dimension : A prospective clinical trial.

PURPOSE: Occlusal bite force (OBF) is the most important parameter in assessing biting efficiency. The aim of this study was to record OBF changes after surgical correction of high angle maxillary/mandibular (Max/Mand) class III patients and to compare these with that recorded in class III patients with average Max/Mand angle. MATERIALS AND METHODS: Initially included were 42 patients with severe class III skeletal malocclusion who were scheduled for orthodontic surgery: group 1-22 patients with increased vertical relationship scheduled for bimaxillary surgery; group 2-20 patients with average vertical relationship scheduled for mandibular setback only. OBF measurements before surgery (T0), at debonding (T1) and at least 3 months after debonding (T2) were recorded using a portable occlusal force gauge. The following were also measured: maximum OBF (MOBF) achieved by the subject on each side, averaged OBF on each side (AOBF) and maximum OBF at the incisal region (MIOBF). At T2, only 33 patients (group 1: 17 and group 2: 16) were included in the analysis due to loss to follow-up. RESULTS: MOBF increased significantly in group 1, while no significant changes were detected in group 2. MIOBF increased after surgical correction in both groups. Significant increase in MIOBF was observed at T1 (P < 0.001) followed by an insignificant decrease during the observation period (3-6 months after treatment; P > 0.05). The two groups differed significantly in MOBF at T1 and T2, while no statistically significant differences were detected between the groups for MIOBF changes at the various time intervals (P > 0.05). The number of posterior teeth with occlusal contacts increased in both groups. Relapse was detected in group 1 where the number of posterior teeth in contact decreased during the observation period (T1-T2). CONCLUSION: OBF greatly improved after surgical correction of the vertical morphology. Correction of high angle mandibular prognathism improves oral function in addition to esthetics.

NSAID chronotherapy after impacted third molar extraction: a randomized controlled trial.

OBJECTIVES: Postoperative pain management impacts patients' quality of life and morbidity. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are widely used for this following a 3-doses-per-day regime. However, pain and inflammation follow a circadian rhythm, and animal models assessing the scheduling of NSAID administration (e.g., chronotherapy) have shown that while their use during the active phase of the day enhances postoperative recovery, their administration during the resting phase could have detrimental effects. This observation has led us to hypothesize that night administration of NSAID might be unnecessary in post-surgical scenarios. Therefore, a randomized clinical trial was conducted to test this hypothesis in surgical third molar extractions. MATERIALS AND METHODS: Seventy (18-35 years) healthy participants requiring surgical removal of impacted lower third molars were recruited and randomized into a double-blind placebo-controlled study. For three days postoperatively, the treatment group (n = 33) received ibuprofen (400 mg) at 8 AM, 1 PM, and a placebo at 8 PM, while the control group (n = 37) received ibuprofen (400 mg) at 8 AM, 1 PM, and 8 PM. Pain severity was assessed by visual analog scale (VAS) and healing indicators including facial swelling, mouth opening, and C-reactive protein blood levels were also measured. RESULTS: Pain VAS measures showed a circadian variation peaking at night. Also, no significant differences were observed between the two groups of the study in terms of postoperative pain scores (estimate: 0.50, 95% CI = [- 0.38, 1.39]) or any other healing indicator. CONCLUSIONS: Postoperative pain follows a circadian rhythm. Moreover, night administration of ibuprofen might not provide any significant benefits in terms of pain management and control of inflammation, and two doses during the day only could be sufficient for pain management after surgical interventions. KNOWLEDGE TRANSFER STATEMENT: Even though this study cannot rule out the possibility that a reduced regime is different than a standard regime, nocturnal doses of ibuprofen seem to have no clinical significance in the short term, and the results of this study provide evidence in favor of reducing ibuprofen administration from three doses to two doses only after third molar surgery.

Efficacy of serratiopeptidase after impacted third molar surgery: a randomized controlled clinical trial.

BACKGROUND: Serratiopeptidase has been clinically used in controlling surgical and non-surgical inflammatory conditions. This study was conducted to assess the therapeutic effect of Serratiopeptidase in patients undergoing surgical removal of impacted mandibular third molar. METHODS: This randomized clinical trial investigated the efficacy of Serratiopeptidase and Paracetamol after surgical removal of impacted third molar for 5 days (n = 67) as compared with an equivalent dose of placebo and Paracetamol (n = 66). Outcome measures were reported pain, trismus and swelling using Laskin method. All outcome measures were recorded on days 0, 1, 2, 4, and 5 post-surgeries. RESULTS: In this clinical trail 133 patients (mean age 23 years, 54% female) completed the study. Baseline characteristics were comparable across treatment groups. Serratiopeptidase significantly improved trismus compared with control on the 4th day (27.30 ± 7.3 mm and 32.06 ± 7.7 mm, respectively (P < 0.001) Swelling markedly improved, The distance from the lower edge of the earlobe to the midpoint of the symphysis for cases vs control were 111.49 ± 8.1 mm and 115.39 ± 9.9 mm, respectively (P < 0.001). Reported pain, showed no statistical significance difference. CONCLUSION: Serratiopeptidase resulted in better inflammation improvement than placebo over 5 days. Further studies are warranted to assess longer-term and clinical outcomes, as well as safety. CLINICAL RELEVANCE: Serratiopeptidase administered postoperatively helps in improving trismus and swelling after removal of impacted lower third molars. Trial registration The study was registered in ClinicalTrial.gov under the number NCT02493179. Registered 1st of June 2015, https://clinicaltrials.gov/ct2/results?cond=serratiopeptidase .

Prevalence of Dental Fluorosis among Southern Jordanian Population.

INTRODUCTION: Jordan is one of the Middle Eastern countries that is classified as a poor water resource country. People in Jordan consume any available water. In the south of Jordan, water resources are limited. The drinking water contains high levels of fluoride, which in turn leads to augmented danger of both skeletal and dental fluorosis. AIMS: This study is focused on evaluating the pervasiveness of dental fluorosis among patients of Karak City and assessing the degree and distribution of fluorosis. MATERIALS AND METHODS: This research focuses on 2,512 patients ranging from 12 to 52 years old seeking dental treatment in the Dental Department at "Prince Ali ben Al Houssin Hospital" in Karak City. Dental fluorosis status was assessed by using Modified Dean's Fluorosis Index." The data collected were subjected to statistical analysis. RESULTS: The dental fluorosis prevalence within our sample was 39.9% in Karak City. Females were more influenced than males, and fluorosis was detected more often in those who drank tap water and was more common in a very mild and localized form. CONCLUSION: Fluorosis necessitates constant observation, and future study in terms of the intake in Jordan is recommended in terms of all sources. It would not be too soon to note that the supply of drinking water needs to be changed in South Jordan.

Dental implants in a patient with suspected leucocyte adhesion deficiency.

Aggressive periodontitis and premature tooth loss in leucocyte adhesion deficiency (LAD) have adverse functional and psychological consequences on affected individuals. Dental implant rehabilitation might become necessary to overcome the functional and psychological adverse effects of LAD periodontitis, especially in patients with milder forms who are expected to have a relatively normal life expectancy. Outcome of dental implants in patients with LAD has not been previously reported; we describe the dental rehabilitation of a 24-year-old man with clinical features of LAD using endosseous dental implants.

Osteonecrosis of jaws related to intravenous bisphosphonates: the experience of a Jordanian teaching hospital.

INTRODUCTION: We describe our experience with oncology patients on a frequent dosing schedule of intravenous (i.v.) bisphosphonates at the Jordan University Hospital (JUH). PATIENTS AND METHODS: Patients treated by i.v. bisphosphonates in the medical oncology unit at the JUH were examined for bisphosphonate-related osteonecrosis of the jaws (BRONJ). Diagnosis was made according to the guidelines of the American Association of Oral and Maxillofacial Surgeons (AAOMS) original position paper. RESULTS: Of the 41 patients, four developed BRONJ, two in maxilla, one in mandible and one bimaxillary. Patients with BRONJ were older; mean age was 69.3 +/- 3.1 years compared to 62.8 +/- 12.5 years (P = 0.022). Dental co-morbidities were more commonly present in patients with the disease (P = 0.038). Patients who developed BRONJ were on treatment for a longer duration of time; the mean duration of treatment was 23.5 +/- 8.4 months compared to 11.9 +/- 13.4 months (P = 0.10). CONCLUSIONS: The results of this case series demonstrated that age and poor oral health status are significant risk factors of BRONJ for oncology patients on long-term frequent dosing schedule of i.v. bisphosphonates.