Evaluation of pre- and postoperative nutrition and oral health-related quality of life in orthognathic surgery patients.

OBJECTIVE: Orthognathic surgery is a complex orofacial surgery that can significantly impact occlusal function and effect nutritional and quality of life parameters. This study aimed to evaluate alterations in dietary intake, chewing function, physical activity, and oral health-related quality of life of patients undergoing orthognathic surgery. RESEARCH METHODS AND PROCEDURES: In this prospective longitudinal study, the assessments were conducted at: preoperatively (T0) and postoperative first week (T1), second week (T2), first month (T3), and third month (T4) between May 2021 and March 2023. Sociodemographic questionnaire, 24-h dietary recall record, chewing ability form, International Physical Activity Questionnaire, and Oral Health Impact Profile-14 (OHIP-14) was applied at face-to-face interviews. RESULTS: Seventy eligible orthognathic surgery patients were evaluated, and 37 patients (52.8%) completed this study. Energy and fat intake significantly decreased from T0 to T1 (P < 0.001) and returned to basis by T4 (P = 0.015). Fiber intake was found to be lowest at T1 and T2 compared with other time points (P < 0.001). Chewing ability showed a deterioration and then improvement; however, patients still had difficulties chewing hard foods at T4. The OHIP-14 increased at T2 and T3 from T0 (P < 0.001 and P = 0.021, respectively) and showed a significant improvement at T4 (P < 0.05). CONCLUSION: The findings indicate a temporary decline in nutritional intake and chewing ability with subsequent recovery by the third month postsurgery. These changes, along with the trends in oral health-related quality of life, underscore the need for tailored nutritional and functional rehabilitation programs following orthognathic surgery.

Evaluating risk factors and complications in mandibular ramus block grafting: a retrospective cohort study.

OBJECTIVES: This retrospective cohort study aimed to identify the complications and risk factors associated with alveolar grafting using autologous mandibular ramus grafts, guided by the research question: What are the complications encountered in patients undergoing alveolar bone grafting using autologous mandibular ramus block and what are the risk factors associated with the development of these complications? MATERIALS AND METHODS: The study included 70 patients who underwent alveolar crest augmentation with autologous mandibular ramus block grafting. Intraoperative, early postoperative, and late postoperative complications were analyzed, as were various risk factors. RESULTS: The results showed that the majority of patients had successful outcomes with minimal complications. Sex was found to significantly influence the visibility of the inferior alveolar nerve (IAN). Early postoperative complications were associated with IAN visibility and the use of a single screw for graft fixation. Late postoperative complications were significantly associated with the presence of infection. CONCLUSION: The findings emphasize the importance of careful surgical techniques, infection prevention, and patient selection in minimizing complications. CLINICAL RELEVANCE: This article may contribute to clinicians' and so patients' understanding of potential risk factors associated with over all ramus block grafting procedure. Based on this information, clinicians can also improve their ability to manage risk factors and associated complications and compare ramus block grafting with other alternatives to determine the best treatment approach for that particular patient.

Chewing difficulties, oral health, and nutritional status in adults with intellectual disabilities: A cross-sectional study.

BACKGROUND: Chewing difficulty, poor oral health, inadequate and imbalanced nutrition are serious health problems in individuals with intellectual disabilities. The participants' chewing abilities, oral health and nutritional status were analysed in this study. METHODS: Forty-five adult participants with intellectual disabilities were included. Anthropometric measurements, oral health assessments, chewing ability evaluations and dietary intake analyses were conducted. RESULTS: A 56.8% of the participants were classified as overweight or obese. Teeth grinding was reported in 33.3% of the participants, while 40.0% experienced drooling. All participants with Down syndrome and 58.6% of the participants with developmental delay had chewing difficulties. Inadequate nutrient intake was observed and the fibre, vitamins B1, B3, B9, sodium, phosphorus and iron intakes were significantly lower than reference values in those with chewing difficulty (p < .05). CONCLUSIONS: Chewing difficulties were associated with lower intake of certain nutrients, highlighting the importance of addressing oral health and dietary counselling in this population.

Piezosurgery versus conventional rotary surgeryfor impacted third molars: A randomised, split-mouth, clinical pilot trial / Piezocirugía versus cirugía rotatoria convencionalpara terceros molares retenidos: un ensayo piloto clínico aleatorizado, de boca dividida

Background: Few studies have compared the effects of piezosurgery and conventional rotary surgery for impacted wisdom teeth on the quality of life. Among these studies, the inclusion parameters and evaluation methods have varied. Material and Methods: This study aimed to compare the effects of piezosurgery and conventional rotary instruments on the quality of life using a standardised method. Patients with bilateral and symmetric mandibularimpacted wisdom teeth were included based on the Winter and Pell-Gregory scale and Yuasa difficulty index criteria. The primary objective was to assess the effects of the methods on the quality of life using the Oral Health Impact Profile-14 questionnaire. Secondary objectives included comparisons of swelling, trismus, pain, and total operative times. The study was conducted between October 2021 and March 2022. The clinical trial protocol was recorded in the United States National Library of Medicine clinical trial registry (NCT05545553). Results: We enrolled 20 patients (40 wisdom teeth) and found that the removal of impacted teeth using the piezosurgery method positively affected the quality of life and considerably improved swelling, trismus, and pain scores. However, piezosurgery may affect postoperative morbidities such as increased total operative times. Conclusions: Piezosurgery appears to have advantages over conventional rotary surgery for impacted wisdom tooth extraction in terms of quality of life and postoperative symptoms. However, further research should investigate potential drawbacks and confirm these findings.(AU)

A randomized controlled trial comparing conventional and piezosurgery methods in mandibular bone block harvesting from the retromolar region.

BACKGROUND: Although piezosurgery is now commonly used for various applications in maxillofacial surgery, its advantages over conventional rotary instruments in terms of postoperative edema, ecchymosis, postoperative morbidity, and prolonged osteotomy time have been questioned. MATERIALS AND METHODS: This study aimed to compare the efficiency, postoperative morbidity, and complication rates of piezosurgery and conventional methods in harvesting autogenous ramus grafts. In this randomized controlled trial, 21 patients (32 sides) underwent autogenous graft harvesting from the ramus area, with 16 sites treated using piezosurgery and 16 using the conventional method. The primary outcomes measured were osteotomy time, total operation time, and postoperative morbidity. Complication rates were also evaluated. RESULTS: The final analysis encompassed 19 patients, accounting for a total of 30 donor sites, following the exclusion of two patients who were unable to attend the scheduled follow-up visits. A total of 19 patients (30 donor sites) were included in the final analysis. No statistically significant difference was found in the mean osteotomy time between the piezosurgery group (mean: 10.35, SD: 2.74 min) and the conventional group (mean: 8.74, SD: 2.74 min) (95% CI: -3.67 to 0.442, p = 0.119). The total operation time, postoperative pain, and swelling were not significantly different between the two groups (p > 0.05). The complication rates, including wound dehiscence and inferior alveolar nerve exposure, were similar in both groups. CONCLUSIONS: Piezosurgery can be safely used for harvesting autogenous ramus grafts and does not increase osteotomy or total operation time compared to the conventional method. The postoperative morbidity and complication rates were also similar, indicating that both techniques can be effectively employed in clinical practice. CLINICAL TRIAL REGISTRATION: The protocol was registered on clinicaltrials.gov (ID: NCT05548049, First registration date: 21/09/2022).

Evaluating the influence of the mandibular canal trajectory on the duration of postoperative paraesthesia in patients undergoing inferior alveolar nerve lateralisation: a prospective cohort study.

This prospective cohort study aims to evaluate the influence of the mandibular canal trajectory on the duration of postoperative paraesthesia in patients undergoing inferior alveolar nerve lateralisation (IANL). Twenty patients received a total of 50 dental implants, and their postoperative paraesthesia duration, implant success rate, and anatomical variables were assessed. All patients experienced temporary neurosensory disturbances postoperatively during the first week, but none reported permanent issues at the 12-month follow up. The median paraesthesia duration was 120 days, and no significant differences were detected between genders, anaesthesia types, or patient satisfaction. No significant association was found between the mandibular canal trajectory and postoperative paraesthesia duration. The implant success rate was 100%, with all implants integrating successfully. Our findings suggest that IANL is a safe and effective method for dental implant placement in atrophic mandibles.

Effect of the level of alveolar atrophy on implant placement accuracy in guided surgery for full-arch restorations supported by four implants: an in vitro study.

BACKGROUND: A fixed screw-retained full-arch restoration supported by four implants is a popular treatment option for edentulous arches. Optimal alignment of implants is quite challenging in extremely atrophied edentulous cases, and a small amount of deviation is expected during guided surgery. This study aimed to compare implant accuracy among edentulous jaws with various levels of atrophy. METHODS: Five separate copies of each Cawood and Howell model (III-V) were produced for the maxilla and mandible. A total of 120 implants (30 models). The implant accuracy was assessed based on angular deviations at the base (angle, 3D offset, distal, vestibular, and apical) and tip (3D offset, distal, vestibular, and apical). RESULTS: The atrophy level of the jaws had a statistically significant effect on deviation; implants showed greater deviation from the planned location as the atrophy level increased. CONCLUSION: Given that implant deviation increased with the degree of atrophy, a greater safety margin from important anatomical structures is recommended when planning implant location for guided surgery in Cawood and Howell V cases.

Anthropometric and laboratory parameter alterations following bimaxillary orthognathic surgery.

The aim of this study was to investigate the impact of bimaxillary orthognathic surgery on patients' anthropometric measures and laboratory parameters. This study was conducted on patients who underwent bimaxillary orthognathic surgery. Anthropometric measurements were collected before surgery (T0) and at intervals of one week (T1), two weeks (T2), one month (T3), and three months (T4) postoperatively, and laboratory parameters at T0 and T4. Data analysis included repeated-measures ANOVA for assessing weight changes, body mass index (BMI) and fat percentage changes, the Friedman test for muscle mass changes, and independent t tests to understand gender-based differences. Significant reductions were observed in weight (mean differences ranging from 2.26 kg to 3.84 kg, 95.00% CI: 1.29 to 4.62, p < 0.01) and BMI (mean differences ranging from 0.76 to 1.32, 95.00% CI: 0.38 to 1.58, p < 0.01) postoperatively at all follow-up points. Fat percentage changes were significant between T0 - T3 (MD = 1.17, 95.00% CI: 0.26 to 2.08, p < 0.05) and T0 - T4 (MD = 1.28, 95.00% CI: 0.14 to 2.43, p < 0.05). Changes in muscle mass were significant until T3 (MD ranging from 71.00 to 107.0, p < 0.01). Also, haemoglobin levels were significantly higher at T0 than T4 (MD = 0.35, 95% CI: 0 to 0.7). These changes showed no significant gender-based differences (p > 0.05). Our study showed that orthognathic surgery prompts temporary changes in body weight, Body Mass Index, and haemoglobin levels. Future research should explore interventions to mitigate these changes and enhance postoperative recovery.

Effect of submucosal application of tramadol on postoperative pain after third molar surgery.

The aim of this study was to evaluate the effectiveness of submucosal application of tramadol, for acute postoperative facial pain, following the extraction of impacted third molar teeth. This prospective, double-blind, randomised placebo-controlled study included 60 ASA I-II patients undergoing impacted third molar surgery under local anaesthesia. Following the surgical procedure, patients were randomly divided into two groups; group T (1 mg/kg tramadol) and group S (2-mL saline). Treatments were applied submucosally after surgery. Pain after extraction was evaluated using a visual analogue scale (VAS) 0.5, 1, 2, 4, 6, 12, 24, and 48 h postoperatively. The time at which the first analgesic drug was taken, the total analgesic dose used, and adverse tissue reactions were also evaluated. In group T, postoperative VAS scores were significantly lower compared to that in group S (p < 0.05). This study demonstrated that post-operative submucosal application of tramadol is an effective method for reducing acute post-operative facial pain after impacted third molar surgery.