Effect of Advanced Platelet-Rich Fibrin (A-PRF) on Postoperative Level of Pain and Swelling Following Third Molar Surgery.

BACKGROUND: Postoperative pain and swelling following third molar (M3) removal can be debilitating, and there is interest in using advanced platelet-rich fibrin (A-PRF) to reduce their severity. PURPOSE: This study compared postoperative pain and swelling between A-PRF and gelatin dressing in extraction sockets following mandibular M3 removal. METHODS, SETTING, SAMPLE: This split-mouth, single-blinded, randomized controlled trial was completed at the Oral Surgery clinic of University of Otago between November 2020 and July 2021. Patients aged between 16 and 40 years with bilaterally impacted mandibular M3 of similar Pederson index difficulty and deemed to be American Society of Anesthesiologists (ASA) I or II comprised the study sample. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: The exposure variable was M3 socket management. One socket received A-PRF and 1 gelatin dressing, while the other received 2 gelatin dressings. MAIN OUTCOME VARIABLE(S): The outcome variables were postoperative pain and swelling over 7 days. Pain was measured using the visual analog scale (VAS), and swelling using stereophotogrammetry. COVARIATES: Demographic characteristics (gender, ethnicity, and age), dental anxiety, smoking status, Pederson index, and intraoperative surgical time were the covariates. ANALYSES: The two sides were compared using cross-tabulations and the McNemar test for categorical and paired t-tests for continuous variables. Statistical analysis used IBM SPSS Statistics for Windows (version 28).The Alpha level was 0.05. RESULTS: 76 (87.3%) of 87 patients who met the eligibility criteria participated in the study, and 70 patients (65.7% female; age range 16-30 years) were included in the analysis. Mean visual analog scale scores showed no statistically significant difference between the A-PRF and control sides, being 29.6 (95% CI 23.9, 35.3) and 29.5 (95% CI 23.5, 35.5) on day 2, and falling to 12.6 (95% CI 8.7, 16.5) and 14.2 (95% CI 10.0, 18.4) by day 7. Likewise, mean peak facial swelling on day 2 was recorded as 6.3 cm3 (95% CI 4.9, 7.7) and 6.6 cm3 (95% CI 5.5, 7.7), and by day 7 they were 1.1 cm3 (95% CI 0.5, 1.7) and 1.0 cm3 (95% CI 0.3, 0.7) on the A-PRF and control sides, respectively. CONCLUSIONS: A-PRF placement in M3 sockets did not reduce postoperative pain and swelling over gelatin dressing alone.

Risk Assessment of Alcohol Consumption for Oral Cancer: A Case-Control Study in Patients Attending the National Cancer Institute (Apeksha Hospital, Maharagama) of Sri Lanka.

BACKGROUND: Oral squamous cell cancer (OSCC) is one of the commonest cancers in Sri Lanka. OBJECTIVES: This study aimed to determine the use of alcohol, its duration and consuming pattern in relation to the risk of developing OSCC in patients attending the National Cancer Institute of Sri Lanka. METHODS: A case-control study was carried out on 105 patients with a histologically confirmed primary OSCC and 210 age-sex matched controls. Information on alcohol consumption was obtained via an interviewer-administered questionnaire. RESULTS: Participants who had consumed alcohol at some point in their life had a 3.8-fold risk of developing OSCC (p=0.000). Current consumers had a higher risk compared to who have consumed previously. Former consumers had a lower risk of developing OSCC compared to current consumers. Individuals who had consumed alcohol for more than 20 years had a greater risk [Odds ratio (OR)=4.69] of developing OSCC compared to those who had consumed alcohol for less than ten years (OR=3.25). Those who consumed the locally-made illicit liquor (Kasippu) had the greatest risk (OR=8.45; p<0.05) of developing OSCC when considering the type of alcohol consumed. CONCLUSIONS: Alcohol consumption is a risk factor for OSCC. The OSCC risk increased with longer duration of alcohol use, the consumption of locally-made illicit liquor and current consumers of alcohol.

Vascular Endothelial Growth Factor A (VEGF-A) and Vascular Endothelial Growth Factor Receptor 2 (VEGFR-2) as Potential Biomarkers for Oral Squamous Cell Carcinoma: A Sri Lankan Study.

BACKGROUND: The incidence of oral squamous cell carcinoma (OSCC) is very high in South Asia and Vascular endothelial growth factor (VEGF) is one of the key factors essential for cancer growth. The importance of VEGF-A and VEGF Receptor 2(VEGFR-2) in oral cancer pathophysiology is yet to be decided. Vascular Endothelial Growth Factor A (VEGF-A) is the main factor concerned in angiogenesis in tumors, but its role in Oral Squamous Cell Carcinoma (OSCC) is still debatable. Our study aimed to determine the role of VEGF-A and VEGFR-2 in OSCC. METHODS: Blood from 30 patients with primary OSCC and 1:1 age-sex-matched controls was subjected to qPCR and ELISA to detect VEGF-A gene expression and serum level. Tumors of the 30 patients were investigated for VEGF Receptor-2 (VEGFR-2) expression and were analyzed using Image J software version 1.52 for DAB percentage (DAB-P) area and optical density (OD). RESULTS: VEGF-A relative gene expression among patients was 2.43-fold higher compared to the healthy control group. Well-differentiated had a 1.98-fold increment, while poorly differentiated had a 3.58-fold increment. Serum VEGF-A was significantly elevated among the patients compared to controls (458.7 vs 253.2, p=0.0225). Poorly differentiated had a higher serum VEGF concentration (1262.0±354.7pg/ml) compared with other two. Mean VEGFR-2 DAB-P level in OSCC was 42.41±5.61(p=0.15). Well-differentiated had a DAB-P of 41.20±5.32 while poorly differentiated had DAB-P 46.21±3.78. The mean OD in OSCC was 0.54±0.16. VEGFR-2 OD in well and poorly differentiated OSCC were 0.48±0.12 and 0.68±0.17, respectively. CONCLUSIONS: VEGF-A gene expression, serum levels, and tissue VEGFR-2 levels correlated linearly with the stage and grade of the tumor. This study justifies the value of VEGF-A as a potential biomarker in OSCC in early detection of OSCC. More studies are needed to accept the use of VEGF-A.

The Risk of Oral Cancer among Different Categories of Exposure to Tobacco Smoking in Sri Lanka

Background: The global incidence of oral squamous cell carcinoma (OSCC) is on the rise with no improvement seen in survival rates. Tobacco consumption varies depending on geographic location, ethnicity and culture. The present case-controlled study aimed to determine the relative risk of OSCC for different tobacco consumption patterns in a selected Sri Lankan population. Methods: One hundred and five patients with histopathologically confirmed OSCC attending the National Cancer Institute (Apeksha Hospital) of Sri Lanka and 210 age and gender-matched controls from the community responded to an interviewer-administered questionnaire regarding their smoking and betel-quid chewing (with/ without smokeless tobacco) habits were included in the study. The odds ratios (OR) and 95% confidence intervals (CI) were calculated. p<0.05 was considered as statistically significant. Results: The overall risk of OSCC increased 2.93-fold for smokers. Those smoking two packets of cigarettes or more per day (OR=5.56; 95% CI-2.822- 10.984; p=0.000) had more than double the risk of OSCC than those smoking 1-2 packets per day. Smoking for more than 20 years had a 3.4-fold risk of OSCC. Consumption of betel quid containing tobacco (smokeless tobacco) had a 4.26-fold higher risk for OSCC (OR=4.26; 95% CI-2.21-8.21; p=0.000), and the risk increased when all four ingredients (betel leaf, slaked lime, areca nut, and tobacco) were consumed together (OR=4.26; 95% CI-2.34-7.74; p=0.000). The combined effect from concurrent smoking and betel chewing emerged as the highest risk for OSCC (OR=15.34) which significantly exceeded the risks evident for the two habits practised in isolation from each other. Conclusions: Use of smokeless tobacco, consumption of all four ingredients together, duration of smoking, the number of cigarettes smoked per day and combined consumption of betel quid and smoking are significant risk factors in the development of OSCC among Sri Lankans.

Third Molar Surgery Outcomes: A Randomized Clinical Trial Comparing Submucosal and Intravenous Dexamethasone.

OBJECTIVE: Swelling, pain, and trismus after third molar surgery have a negative impact on patients' quality-of-life in the days following surgery. The study aims to compare the efficacy of submucosal (SM) dexamethasone and intravenous (IV) dexamethasone in reducing these outcomes. METHODS: The single-center study was designed as a randomized, controlled, double-blinded trial with a total of 130 participants evenly allocated into 2 treatment groups. All participants underwent the surgical removal of at least 2 mandibular third molars under intravenous sedation. The outcome variables studied were swelling, pain, and maximum incisal distances. The swelling was measured using a 3-dimensional camera (3dMD Inc, Atlanta, GA). The pain was quantified using a 100 mm visual analog scale (VAS). Maximum incisal distances were measured using a caliper. Participants completed the short-form Oral Health Impact Profile (OHIP-14). The 2 groups were compared using cross-tabulations and chi-square tests for categorical variables and analysis of variance for continuous variables. RESULTS: The participants had a mean age of 22.6 years, 56.8% females and 12.4% smokers. There were no statistically significant differences in the distribution of study variables between the 2 groups. On day 2, mean facial swelling measurements were 7.3 cm3 in the IV group and 7.8 cm3 in the SM group (P > .05). The mean pain score was 31 in the IV group and 33 in the SM group (P > .05). The mean maximum incisal distances were 33.7 mm in the IV group and 34.5 mm in the SM group (P > .05). Both groups experienced poorer quality-of-life relative to baseline scores and were affected to a similar extent. CONCLUSIONS: There are no differences in swelling, pain, and trismus between submucosal and intravenous dexamethasone in third molar surgery. Submucosal dexamethasone is a straightforward and accessible route of steroid administration in patients having third molar surgery under local anesthesia only.

Efficacy of Codeine When Added to Paracetamol (Acetaminophen) and Ibuprofen for Relief of Postoperative Pain After Surgical Removal of Impacted Third Molars: A Double-Blinded Randomized Control Trial.

PURPOSE: The use of opioids in combination with nonopioids is common practice for acute pain management after third molar surgery. One such combination is paracetamol, ibuprofen, and codeine. The authors assessed the efficacy of codeine when added to a regimen of paracetamol and ibuprofen for pain relief after third molar surgery. MATERIALS AND METHODS: This study was a randomized, double-blinded, placebo-controlled trial conducted in patients undergoing the surgical removal of at least 1 impacted mandibular third molar requiring bone removal. Participants were randomly allocated to a control group (paracetamol 1,000 mg and ibuprofen 400 mg) or an intervention group (paracetamol 1,000 mg, ibuprofen 400 mg, and codeine 60 mg). All participants were treated under intravenous sedation and using identical surgical conditions and technique. Postoperative pain was assessed using the visual analog scale (VAS) every 3 hours (while awake) for the first 48 hours after surgery. Pain was globally assessed using a questionnaire on day 3 after surgery. RESULTS: There were 131 participants (36% men; control group, n = 67; intervention group, n = 64). Baseline characteristics were similar for the 2 groups. Data were analyzed using a modified intention-to-treat analysis and, for this, a linear mixed model was used. The model showed that the baseline VAS score was associated with subsequent VAS scores and that, with each 3-hour period, the VAS score increased by an average of 0.08. The treatment effect was not statistically meaningful, indicating there was no difference in recorded pain levels between the 2 groups during the first 48 hours after mandibular third molar surgery. Similarly, the 2 groups did not differ in their global ratings of postoperative pain. CONCLUSION: Codeine 60 mg added to a regimen of paracetamol 1,000 mg and ibuprofen 400 mg does not improve analgesia after third molar surgery.

The thickness of parietal bones in a new zealand sample of cadaveric skulls in relation to calvarial bone graft.

Objectives To evaluate the average thickness of the parietal bones in their different regions to identify the ideal site(s) for calvarial bone graft harvest. Methods and Materials Thickness of the parietal bones of 25 wet cranial vaults of New Zealand European origin was measured in 135 different locations using an electronic caliper. Analyses to identify the ideal harvest sites were conducted so that the sites fit the features of an ideal harvest site described in the literature as: (1) 6 mm of minimum thickness and (2) 2 cm away from the midline. Results and Conclusion The overall average thickness was 6.69 ± 0.22 mm. The average thickness at different sites within the same bone ranged from 2.85 to 6.93 mm. In keeping with previous studies, the report observed a progressive thickening of the parietal bone in medial and posterior directions. Of the 135 different locations measured, only 20% exceeded an average thickness of 6 mm as well as being 2 cm away from the sagittal midline. These locations were mainly located between 6 to 11 cm posterior to the coronal suture and 2 to 5 cm away from the sagittal suture. Conclusion Harvesting the calvarial bone graft in the area 6 to 11 cm posterior to the coronal suture and 2 cm away from the midline is recommended based on our study using cadaveric cranial vaults of New Zealand Europeans.

Facial attractiveness of skeletal Class II patients before and after mandibular advancement surgery as perceived by people with different backgrounds.

The purpose of this study was to determine the perceived level of improvement in facial attractiveness as assessed by people with different backgrounds in skeletal Class II patients treated by mandibular advancement with bilateral sagittal split osteotomy (BSSO). The frontal and lateral pre- and post-operative photographs of 10 Caucasian patients were selected. Changes in frontal and profile attractiveness were assessed by 10 orthodontists, 10 art students, and 10 laypersons. Frontal and lateral pre- and post-operative photographs were randomly distributed throughout two surveys. For each photograph, the evaluators ranked the attractiveness of face, chin, and lips on visual analogue scales. A third survey was administered to orthodontists only, by presenting the same pre and post-operative photographs but paired side-by-side with pre- and post-operative status disclosed. Overall, attractiveness scores after BSSO showed an 11.5 per cent improvement (95 per cent confidence intervals: 9.4-13.5 per cent) on the lateral post-operative photographs and a 7.5 per cent improvement (95 per cent confidence intervals: 5.4-9.5 per cent) on the frontal post-operative photographs. Attractiveness scores differed significantly between the groups (P = 0.015), with orthodontists being more generous with their improvement ratings and the art students tending to give a more critical assessment. There were no significant differences between male and female evaluators (P > 0.05). Ratings of before-after attractiveness almost doubled when the pre- and post-operative status was disclosed as compared to blinded evaluations, thus indicating that prior knowledge of pre- and post-treatment status markedly influences aesthetic evaluations, with a bias towards a more favourable outcome.

A case series of odontogenic keratocysts from a New Zealand population over a 20-year period.

PURPOSE: To report on the clinicopathological aspects of odontogenic keratocysts (OKC)/keratocystic odontogenic tumours (KCOT) presenting in a New Zealand population. METHODS: Information on defined areas--including age at presentation, gender, anatomical sub-location, presenting features, histological subtype and the recurrence pattern--were extracted from the histopathological data available in the Oral Pathology database of the University of Otago School of Dentistry. RESULTS: Two hundred and twenty three cases of OKC/ KCOT were identified over the period ranging from 1987 to 2008. Mean age at presentation was 37.0 years (males 38.6 years, females 34.4 years), with 61.0% of cases being male. The mandible was the dominant jaw affected, with 65.9% of lesions, with the angle of mandible being the commonest anatomical sub-location (with 32.4% of lesions). One-fifth of the cases were asymptomatic incidental findings, while the majority of problems were related to the third molar tooth and/or pain and swelling. The overall recurrence rate was 18.3%, with the majority (62.2%) in the mandible and more males (67.5%) affected. Recurrence was highest in the first 5 years of follow-up, and decreased sharply thereafter. CONCLUSION: This study is the first to describe the frequency, distribution, presentation and recurrence rates of OKC/KCOT in New Zealand and shows that these are similar to those reported from other populations.

A nine-year review of orthognathic surgery at the University of Otago.

OBJECTIVE: To describe the demographic characteristics of patients undergoing orthognathic surgery at the University of Otago over a nine-year period. METHODS: The case notes of patients who underwent orthognathic surgery procedures at the University of Otago from 2001 to 2009 were reviewed retrospectively. This was augmented with a brief literature review of surgical considerations and complications in orthognathic surgery among older patients. RESULTS: The 92 patients included in the study were aged 15 to 56 years. The mean patient age increased over the nine-year observation period, from 22.1 years (sd, 9.4) during 2001-2003, 25.0 years (sd, 12.7) during 2004-2006, to 27.7 years (sd, 11.4) during 2007-2009. Most patients were from New Zealand European or European backgrounds, with only 5.5% identifying as Maori, and 3.3% as Asian. A female preponderance was observed (with a female:male ratio of 1.6:1). Complications were encountered with 24 patients (26.1%). Ten patients had long-term (lasting for one year or more) sensory nerve disturbance; all of those had undergone a mandibular bilateral sagittal split osteotomy (BSSO) procedure (they comprised 12.7% of all BSSO patients treated); half of those patients were over 35 years old, and four were over 40 years old. CONCLUSIONS: There has been an increase in the proportion of older patients undergoing orthognathic surgery at the University of Otago. Observations from this case series support findings from other studies demonstrating a higher rate of sensory nerve disturbance among older BSSO patients.

Concordance between clinical and histopathologic diagnoses of oral mucosal lesions.

PURPOSE: To study the epidemiology of oral soft tissue lesions in New Zealand from 2002 to 2006 and to determine the concordance between the clinical diagnosis and the definitive histopathologic diagnosis achieved by general dental practitioners and by specialists. MATERIALS AND METHODS: The details from biopsy referrals and the corresponding histopathologic reports of oral soft tissue lesions were recorded into a statistical software package, and the concordance between the clinical diagnosis and histopathologic diagnosis was determined for all the lesions. RESULTS: Most biopsies were benign lesions, and both clinician groups achieved a high diagnostic concordance for these lesions. However, when considering all lesion types, the overall concordance for both groups was a moderate 50.6%, with little difference between specialists and general dental practitioners, although specialists were more accurate in diagnosing a malignant or premalignant lesion. CONCLUSIONS: The clinical and histopathologic concordance achieved by oral health practitioners in New Zealand appears to be moderate.