Efficacy of Hydrocortisone, Povidone-Iodine, and Normal Saline as an Irrigating Solution During Surgical Removal of Impacted Mandibular Third Molars: A Randomized Controlled Trial.

Background The surgical removal of mandibular third molars is one of the most common procedures in dentistry. Researchers have extensively studied the treatment of postoperative sequelae such as pain, edema, trismus, and alveolar osteitis throughout the past six decades. Many approaches have been used to address clinical difficulties after third molar surgery, including various flap designs and irrigating solutions. The aim of this study was to compare the effects of three irrigating solutions, hydrocortisone, povidone-iodine, and normal saline, on pain, trismus, and edema following surgical removal of the impacted mandibular third molar. Methodology The study involved 105 participants who required surgical extraction of mandibular third molars. The patients' ages ranged from 18 to 40 years, and they fulfilled the inclusion criteria. Using a simple random sampling technique, they were divided into three groups (group 1: hydrocortisone, group 2: povidone-iodine, group 3: normal saline). The parameters evaluated were edema, pain, and trismus on the second and seventh postoperative days. All data were input into Microsoft Excel (Microsoft® Corp., Redmond, USA) worksheets and analyzed using Stata 17.0 (StataCorp LLC, College Station, USA). The visual analog scale (VAS) score was used to measure postoperative pain, and postoperative swelling was measured using linear measurements from four fixed anatomical points and compared to preoperative values. To assess trismus, the inter-incisal distance was measured in millimeters with a caliper. A p-value of <0.01 was considered statistically significant. Results The mean VAS score for pain in group 1 was lower than the other two groups. The effect of group 1 was significant on the second postoperative day but insignificant on the seventh postoperative day for swelling. The effect of all three groups on trismus was significant on the second and seventh days. Conclusions Hydrocortisone as an irrigating solution showed promising results in managing postoperative swelling in the first 48 hours, but its effect gradually declined by the seventh postoperative day. Additionally, it was effective in controlling postoperative pain and trismus. This suggests that utilizing hydrocortisone as an irrigating solution, compared to povidone-iodine, has been proven to be a significantly effective option in reducing postoperative pain, edema, and trismus resulting from the surgical removal of impacted teeth.

Comparison Between Primary and Secondary Method of Closing Surgical Wound After Tooth Extraction: A Split-Mouth Study

ABSTRACT Objective: To compare and assess the primary and secondary closure techniques following extraction of impacted third molars for post-operative complications. Material and Methods: In total, 30 patients ranging between 18-30 years of age and of either sex who had bilaterally impacted mandibular third molars were randomly selected. Split mouth study method was used so that the participants served as their own control. Group 1 consisted of primary closure of left mandibular impacted third molars and Group 2 consisted of secondary closure of right mandibular impacted third molars. Basement evaluations were recorded for each patient along with subjective and objective evaluations for postoperative 7 days. Data analysis was carried out by SPSS 17.0 software using Mann-Whitney U test, Wilcoxon matched-pairs test and t-test. A p-value ≤ 0.05 was assigned as statistically significant. Results: When compared to group 1, group 2 revealed statistically less pain and swelling following the secondary closure of wound from day 1 to 7. There was a significant improvement in mouth opening in Group 2 at day 1 (p=0.0005) and at day 7 (p=0.00001). Conclusion: Secondary wound closure after disimpaction of mandibular third molar results in better postoperative recovery than primary closure.

Importance of Clinical and Radiological Parameters in Assessment of Surgical Difficulty in Removal of Impacted Mandibular 3rd Molars: A New Index.

OBJECTIVE: The aim of the study is to assess the clinical and radiological factors that increase the surgical difficulty in removal of mandibular impacted 3rd molar and design a new difficulty predictive index. METHODS: The data was collected from 100 patients with impacted mandibular 3rd molar who presented to Department of Oral and Maxillofacial Surgery, K.L.E's Institute of Dental Sciences. Clinical and radiological parameters included in the New Index were noted. The tooth was then removed under local anesthesia and time taken for the removal was noted. The Pederson Index, New Index and time taken were co-related using kappa statistical analysis. RESULTS: The kappa agreement between Pederson Index and time taken was 66.50 % (0.2231) whereas between New Index and time was 89 % (0.7177) indicating that New Index is a better predictor of the difficulty. CONCLUSION: The New Index is a reliable tool in predicting the difficulty in the removal of mandibular impacted third molar.

Pentoxifylline in patients with oral submucous fibrosis-a randomized clinical trial.

BACKGROUND AND AIM: As far as research regarding any disease is concerned, each and every aspect poses a challenge. One such entity that poses a challenge in our arena is oral submucous fibrosis (OSF) as no effective treatment is available for this progressively disabling condition with high malignant potential. Hence the present study was undertaken with the aim to determine the use of pentoxifylline (PTX) on the clinical and histopathologic course of OSF. METHOD: Thirty clinically confirmed OSF patients were categorized randomly into group I and group II. In group I, drug PTX was administered as an adjunct along with other conventional therapies. Group II patients were advised conventional therapies only. Pre- and post-treatment biopsies were obtained for the following parameters:Micro-vascular density (MVD),Area percentage of blood vessels,Severity of fibrosis, andInflammatory components. RESULTS:  On comparing MVD in groups I and II there was no significant difference in pre- and post-treatment.On comparing the average area percentage occupied by blood vessels, significant difference was seen in pre- and post-treatment biopsies in group I.On assessment of mouth opening and tongue protrusion, there was no significant improvement in either of the groups individually or in comparison. But when burning sensation of mucosa was assessed, pre- and post-treatment, both groups showed quite significant improvement individually. CONCLUSION: Use of pentoxifylline seemed to be questionable, and taking into consideration the long administration time, its use is not recommended for the treatment of OSF patients.

Assessment of changing patterns of Le fort fracture lines using computed tomography scan: an observational study.

OBJECTIVES: To assess the changing mid-face fracture patterns using a computed tomography scan. METHODOLOGY: Fifty patients with mid-face trauma requiring open reduction and fixation were studied using 1.6 mm axial, sagittal, coronal and 3D images. Images were evaluated clinically, intra-operatively and finally were compared with standard Le Fort lines. Results. The male population dominated the female at a ratio of 11.5:1. The majority of the mid-face fractures were seen in the age group of 21-30 years. Road traffic accident (78%) was the major etiological factor followed by work-related accidents (12%) and assaults (10%). The CT scan analysis included categorizing the patients into three groups: (1) Fracture patterns resembling Le Fort lines (24%); (2) Fracture patterns partially resembling Le Fort lines (56%); and (3) Fracture patterns that do not resemble Le Fort lines (20%). CONCLUSION: With the change in the velocity of wounding object, there is a change in the mid-face fracture patterns. The majority of the cases present as a variant of classical Le Fort fractures. Computed tomography is a valuable diagnostic tool in assessing the fractures of the mid-face. 2D images are more sensitive than 3D images. However, both the images are required in delivery of an optimal treatment plan.

The evaluation of efficacy of post-operative antibiotics in the open reduction of the zygomatic and mandibular fracture: a prospective trial.

INTRODUCTION: The administration of pre and post-operative antibiotics for open reduction and internal fixation of facial fracture is the usual norm followed. Although the benefit of antibiotic has been established in the literature, the value of post-operative administration has been questioned and yet not extensively studied or investigated. There are rising concerns over the duration and undesired effects of antibiotics. The purpose of the study was to evaluate necessity and/or efficacy of post-operative antibiotics in the open reduction of zygomatic and mandibular fracture. METHODS: Sixty patients who underwent open reduction and internal fixation were divided into two groups for the trial. Ab group (30 patients) received pre, intra and post-operative antibiotics. Non-Ab group (30 patients) did not receive post-operative antibiotics though pre and intra-operative antibiotics were administered. Patients were evaluated for post-op infection at the end of 1st and 3rd week after operation. RESULTS: Among 60 patients, 2 patients (1 from Ab group and 1 from non-Ab group) were infected; so statistically no significant difference in result was obtained (Fisher's exact test, P value = 1). CONCLUSION: In this trial, the use of post-operative antibiotics in the open reduction and internal fixation of facial fracture was shown to confer no benefit/efficacy in reducing the chances of infection.

Accidental Implant Screwdriver Ingestion: A Rare Complication during Implant Placement.

One of the complications during a routine dental implant placement is accidental ingestion of the implant instruments, which can happen when proper precautions are not taken. Appropriate radiographs should be taken to locate the correct position of foreign body; usually the foreign body passes asymptomatically from gastrointestinal tract but sometimes it may lead to intestinal obstruction, perforations and impactions. The aim of this article is to report accidental ingestion of 19 mm long screw driver by a senile patient.

Transnasal Fixation of NOE Fracture: Minimally Invasive Approach.

PURPOSE: Nasal fractures may occur in association with other facial injuries like Le-forte II and III and also severe comminuted midface fractures or by themselves. Bony fractures of the nose may involve one or both nasal bones, the frontal process of the maxilla, the bony septum, and in severe trauma the nasal-orbital-ethmoid complex. Treatment of these fractures range from closed reduction and support to open reduction and miniplate osteosynthesis. Purpose of this article is to describe a technique of managing nasal bone fractures associated with midface fractures. PATIENTS AND METHODS: Four consecutive patients who sustained nasal bone fracture associated with multiple midfacial fractures were included in the study. RESULTS: Postoperatively, results showed symmetry in the intercanthal to lateral canthal width. Nasofronal angle and nasal prominence was established to the expected position in most of the cases. CONCLUSION: This technique can be used for Le forte II and III cases where nasal bones to be addressed. This method has shown predictive results with minimal intervention.

Nevoid-basal cell carcinoma syndrome: a case report and overview on diagnosis and management.

Nevoid Basal Cell Carcinoma Syndrome (NBCCS) is a rare condition characterized by varied clinical manifestations like multiple Basal Cell Carcinomas (BCC), multiple Keratocystic Odontogenic Tumours (KCOT), palmar and/or plantar pits and ectopic calcification of the falx cerebri, which are considered as the major criteria for diagnosis. The occurrence of jaw manifestations makes it an important diagnostic problem for oral and maxillofacial surgeons and often clinicians encounter this aspect which finally leads to the diagnosis of this syndrome. This paper reports a case of NBCCS and provides an overview on the diagnosis and management of this enigmatic entity.