Comparative Clinical Evaluation of Submucosal and Intramuscular Dexamethasone In Reducing Post Operative Sequelae Following Impacted Mandibular Third Molar Surgery.

Background and Objectives: To understand the benefi ts of dexamethasone and to compare the effect of submucosal versus intramuscular administration of dexamethasone in reducing post operative sequelae following impacted mandibular third molar surgery. Materials and Methods: The study was conducted on 90 patients, who were divided into three groups of 30 each. The two experimental groups were given dexamethasone 4 mg submucosally or intramuscularly(preoperatively), and the control group did not receive any form of corticosteroid. Measurement of facial swelling, maximal interincisal distance were made pre operatively and on the fi rst, third and seventh post operative day. Pain was evaluated from patients response to visual analogue scale (VAS) and recording the number of rescue analgesic tablets taken at the end of seventh postoperative day. Results: Both dexamethasone groups showed a signifi cant reduction in pain, swelling and trismus as compared with the control group at all intervals. There was a statistically signifi cant reduction in magnitude of swelling in submucosal dexamethasone group as compared to intramuscular dexamethasone group on the 1st post operative day, but there was no signifi cant difference among two experimental groups at other times and their effects were comparable for all variables. Conclusion: Dexamethasone 4 mg is an effective therapeutic strategy for reducing post operative sequelae following surgical removal of impacted third molars and submucosal dexamethasone is an effective alternative to dexamethasone given systemically.

Potential for Osseous Regeneration of Platelet Rich Fibrin: A Comparitive Study in Mandibular Third Molar Socket.

Aims: To evaluate the effi cacy of autologous platelet- rich fi brin in regeneration of bone and to assess clinical compatibility of the material in mandibular third molar extraction socket. Materials and Methods: This study was conducted in 20 patients visiting the out patient department of Oral & Maxillofacial Surgery, Subbaiah Institute of Dental Sciences. Patients requiring extraction of bilateral symmetrical mandibular third molars were taken for the study. Following extraction, platelet rich fi brin prepared from patients own blood was placed in one extraction socket. The patients were assessed for postoperatively pain, periodontal pocket depth and bone blending and trabecular formation. Radiological assessment of the extraction site was done for a period of 6 months to evaluate the change in bone density. Results: All the local signs and symptoms of infl ammation were mild to moderate and subsided in normal course of time. Pain was less in study site compared to control site. Soft tissue healing was better in study site. Evaluation for bone blending and trabecular bone formation showed earlier in study (prf)site compared to control(non prf) site in 10 patients. The evaluation of bone density by radiological assessment showed the grey level values calculated at 4months at the prf site were comparatively higher than the average baseline value of bone density at extraction site in control site. Conclusion: The study showed that autologous PRF is biocompatible and has signifi cant improved soft tissue healing,bone regeneration and increase in bone density in extraction sockets. However a more elaborate study with a larger number of clinical cases is very much essential to be more conclusive regarding its effi cacy.

Comparison of Analgesic Efficacy of Tramadol and Tapentadol in Impacted Mandibular Third Molar Surgery: A Randomized, Double Blind Clinical Study.

Introduction: The chronological age of eruption of third molars is between 18 and 24 years with wide variation in the eruption time. The eruption failure being very common makes the extraction of impacted third molars one of the most frequent surgical procedures in the maxillofacial region. Materials and Methods: A study was conducted on one hundred patients who visited the Department of Oral and Maxillofacial Surgery, Subbiah institute of Dental Sciences for the removal of impacted mandibular third molars to compare the analgesic efficacy of tramadol and tapentadol in patients undergoing surgical extraction of impacted mandibular molars. Patients were divided into two equal groups, group A and group B. Patients were randomly assigned in either treatment groups with an assigned code. Both patient and investigator were not aware of the drug code. Group A patients received 50mg tramadol and group B patients received 50mg tapentadol orally immediately after surgery and 12 hours after surgery. Results: VAS score of group A was 6.22±0.65 and group B was 5.92±0.97 at the end of 2 hours. VAS score of group A was 6.18±1.08 and group B was 5.76±1.25 at the end of 8 hours. VAS score of group A was 6.36±0.96 and group B was 6.46±1.2 at the end of 12 hours. VAS score of group A was 6.2±1.2 and group B was 6.2±1.47 at the end of 24 hours. VAS scores, statistically were found to be in significant between two groups. All patients had moderate pain at the end of 2 hours, 92% of group A and 96% of group B patients had moderate pain at the end of 8 hours. Mild pain was noted in most patients around 24 hours according to the categorical pain scale. Conclusion: A study was conducted to compare the analgesic efficacy of tramadol and tapentadol on patients undergoing third molar surgeries. The results of the statistical analysis suggested that Tramadol and Tapentadol are effective in managing postoperative pain and neither of the drugs mentioned above were superior to other.