Comparison Of Soft Tissue Chin And Lower Lip Thickness In Adult Patients With Various Mandibular Divergence Patterns.

BACKGROUND: The influence of hard tissue discrepancies on soft tissue cannot be ignored. The divergence or angle of the mandible can influence the lower lip and chin (soft tissue), similar to the influence of incisors inclinations on the pro/ retrusion of the lips. Hence this study was carried out to find out the impact of mandibular divergence patterns on the contour and thickness of lower facial soft tissues. METHODS: Using the Lateral cephalograms of 105 subjects, Lip thickness was measured between the protruding endpoint of the maxillary incisors (U1) to the stomion point (St) and between the infra dentale (Id) and labrale inferius (Li). Soft tissue chin thickness was measured between the landmarks at hard tissue bony pogonion (Pog) to its opposite point on soft tissue (Pog'), hard tissue gnathion (Gn) to soft tissue gnathion (Gn') and hard tissue menton (Me) to its opposite point on ST menton (Me'). RESULTS: Lower lip thickness from Id-Li (infradentale labrale inferius) was greater in subjects with mandibular hyperdivergent pattern (p-value 0.097) while soft tissue chin thickness was decreased in hyperdivergent and increased in individuals with mandibular hypodivergence in both genders (p-value at gnathion was 0.596, menton was 0.023, and pogonion was 0.004, respectively). CONCLUSIONS: Lower lip thickness was increased in the individuals with mandibular hyperdivergence measured from infradentale to labrale inferius. While increased soft tissue thickness was observed at points gnathion and menton in patients with mandibular hypodivergence with no obvious difference at pogonion point.

Use of Preoperative Submucosal Dexamethasone in Third Molar Surgery: A Step towards Improvement in Quality of Life.

BACKGROUND: Surgical removal of impacted mandibular third molaris one of the most common procedures performed by Oral surgeons globally. The objective of the study was to ascertain theefficacyof pre-operative administration of submucosal dexamethasone on post-operative sequelae insurgically extracted impactedmandibular third molar.It was adouble-blind randomized controlled clinical trialthat wasperformed inthe Department of Oral & Maxillofacial Surgery at Abbottabad International Dental Hospital, Abbottabad from March 2019 to March 2020. METHODS: A total of 150 patientsweredivided into two groups,each having 75 patients. Group A received a placebo after administrationof local anesthesia whereas,group B received 4mg submucosaldexamethasone. A post-operative visit was scheduled after 48 hours to evaluate pain, facial swelling,and Trismus. RESULTS: On the second postoperative day, the patients in the experimental group presented with significantly reduced pain, facial swelling,and trismus in comparison to the control group. CONCLUSION: Pre-operativeadministration of 4mg dexamethasone through the submucosal route is efficacious inthe reduction of post-operative pain, swelling,and trismus in mandibular third molarsurgerythus enabling the patient to return to daily life activities earlier.

Role Of 0.2% Bio-Adhesive Chlorhexidine Gel In Reducing Incidence Of Alveolar Osteitis.

BACKGROUND: Alveolar osteitis is a frequent postoperative complication of third molar surgery. A number of preventive methods have been tried. Chlorhexidine is most widely used antiseptic which is thought to be helpful to prevent alveolar osteitis. The objective of this study was to evaluate role of 0.2% bio-adhesive chlorhexidine gel in reducing incidence of alveolar osteitis after surgical removal of mandibular third molars which causes extra monetary burden on the patients in the form of several follow up visits.. METHODS: A randomized clinical trial was performed in the Dental Section, Ayub Medical College, Abbottabad. Approval from ethical committee was obtained. Total 180 patients were randomly divided into Group A in which patients received 0.2% bio-adhesive chlorhexidine gel and Group B where patients received placebo gel in the extraction socket after removal of mandibular third molar. RESULTS: 0.2% bio-adhesive chlorhexidine gel used after mandibular third molar removal reduced incidence of alveolar osteitis by 10% in comparison to control group with statistically significant difference, i.e., p=0.044.. CONCLUSIONS: 2.3 times reduction in the incidence of alveolar osteitis was observed after use of 0.2% bio-adhesive chlorhexidine gel.

FREQUENCY OF LINGUAL NERVE INJURY IN MANDIBULAR THIRD MOLAR EXTRACTION: A COMPARISON OF TWO SURGICAL TECHNIQUES.

BACKGROUND: Surgical removal of impacted mandibular third molar is associated with a number of complications including postoperative bleeding, dry socket, postoperative infection, and injury to regional nerves. Lingual nerve damage is one of the main complications. To prevent this complication different techniques had been used. Lingual flap reflection is one of these procedures in which lingual soft tissue is reflected and retracted deliberately, the nerve is identified and is kept out of the surgical field. The objective of this study was to evaluate a surgical technique for third molar removal which is associated with minimum frequency of lingual nerve damage. METHODS: A randomized controlled trial was performed. A total of 380 patients with impacted mandibular third molars were included in this study. Each patient was allotted randomly by blocked randomization to group A where procedure was performed by reflection and retraction of lingual flap in addition to buccal flap and group B where procedure was performed by retraction of buccal flap only. RESULTS: Lingual nerve damage occurred in 8.94% in Group A in which lingual flap retraction was performed but damage was reversible. In group B, 2.63% lingual nerve damage was observed and nature of damage was permanent. The difference was statistically significant (p=0.008). CONCLUSIONS: Lingual flap retraction poses 3.4 times increased risk of lingual nerve damage during extraction of mandibular third molar when lingual flap is retracted but the nature of damage is reversible.

Frequency of unerupted mandibular third molar in mandibular angle fractures.

BACKGROUND: Fractures of the mandibular angle are common and comprise 31% of all mandibular fractures. Multiple recent studies report a 2-3 fold increased risk for mandibular angle fractures when un-erupted mandibular third molars are present. The objective of this study was to assess the frequency of un-erupted mandibular third molar in mandibular angle fractures. METHODS: This cross-sectional study was conducted at the Department of Oral and Maxillofacial Surgery, Ayub Medical College, Abbottabad from April to October 2009. One hundred and two patients were included both from the outdoor and ward on consecutive non-probability sampling base. Data were recorded on a structured Performa and analysed using SPSS-16. RESULTS: A hemi-mandible containing un-erupted mandibular third molar was seen to have a 1.41 times the risk of mandibular angle fracture then a hemi-mandible containing an erupted mandibular third molar. CONCLUSION: The presence of unerupted mandibular third molar is associated with an increased risk for mandibular angle fracture.