Reasons for removal of bone plates after orthognathic surgery

The aim of this prospective clinical trial was to evaluate the reasons for removal of miniplates from patients who had orthognathic surgery over a 7-year period. Fifty consecutive patients with fixed miniplates following orthognathic surgery [11 males and 39 females] aged 20 to 43 years [mean=28 +/- 6 years] were recruited into this study. Personal information, dental and medical history, type of orthognathic operation, indications for plate removal, placement site of plates and time between insertion and removal were recorded. The site of plate insertion was classified into right, left and anterior maxilla; right, left and anterior mandible; and chin. All plates were inserted and removed intra-orally under local or general anesthesia. The association between the variables was analyzed using the Pearson correlation and Chi-Square test. For all statistical analysis, the significance level was set at P<0.05. 312 titanium miniplates were inserted in 50 patients. A total of 108 plates [34.6%] were removed. The retention period for the removed plates ranged from 4 months to 4.5 years. The most common sites for plate removal were maxilla [22 patients, 44%] followed by mandible [19 patients, 38%]. The most common cause for plate removal was palpable plates [27 patients] followed by infection [13 patients], patient discomfort and preference [7 patients] and plate exposure and wound dehiscence [3 patients]. No significant relationships were found between plate removal [including number and location of removed plates and reason for plate removal] and age and gender [p<0.05]. Reason of plate removal was significantly related to the number of plates [p=0.001, r=0.441] and the location of removed plate [p<0.001, r= 0.62]. Type of removed plate had no significant relation with reason for plate removal [p=0.576, r=-0.081] number of plates [p= 0.62, r= 0.072] and location of removed plates [p= 0.467, r= -0.105]. Reason for performing the orthognathic surgery and type of the orthognathic surgery had no significant relations with the number and location of removed plates and reason for plate removal [p<0.05]. Plate removal was attributed to palpable plates, infection, subjective discomfort and patient preference, and plate exposure and wound dehiscence. Plate-related complications caused plate removal which was more likely to occur within the first year of insertion. This should be accounted for during the process of obtaining informed consent

Relationship between route of antibiotic administration and post-surgical complications following removal of lower third molars

This prospective clinical trial aims at evaluating the effects of antibiotic therapy following different administration routes on the postoperative complications of surgical removal of lower impacted third molars. Two hundred and fourty eight consecutive patients [100 males and 148 females] aged 18 to 38 years old [mean=24 +/- 5 years] were recruited into this study. The lower third molars of all recruited patients were surgically extracted. Participants received preoperative antibiotic cover either as intravenous Cephradine injection [1 gram] or oral dose of 500 mg Cephalexin. Immediate and late complications following the surgery; including pain, swelling, trismus, paraesthesia, bleeding, dry socket, infection and fracture of mandible; were assessed 3 days and 7-14 days following the surgery. The most frequent complications were slight pain, swelling, and trismus. Oral route of antibiotic administration was associated with more immediate and late complications [p<0.001]. Oral route of antibiotic administration was associated with more pain, swelling, trismus, and dry socket [p<0.05]. Following surgical extraction of third molars, intravenous antibiotic administration was more effective in reducing the post surgical complications than oral antibiotic administration

Risk indicators of postoperative complications following surgical extraction of lower third molars

The aim of this prospective clinical trial was to evaluate the incidence of postoperative complications following surgical extraction of lower third molars [l8] and the risk factors and clinical variables associated with these complications. Three-hundred and twenty-seven consecutive patients [128 men and 199 women, mean age = 23.1 +/- 3.9 years, range 18-40] were recruited to this study. The L8 of all the patients were surgically extracted. Immediate and late complications like pain, welling, trismus, paresthesia, bleeding, dry socket, infection and fracture were assessed 3 and 7-18 days, respectively, following the surgery. The most frequent immediate and late complications were slight pain, swelling, and trismus. Thirty-nine [11.9%] patients reported dry socket and 10 [0.3%] reversible sensory nerve complications. More immediate and late complications were experienced by females [p=0.000 and 0.016, respectively]. Older subjects reported more late complications. Frequent immediate and late complications were associated with preexisting pericoronitis, longer duration of operation, extraction of two molars, flaps with vertical incision, extractions with bone removal, extractions without tooth sectioning and distoangular impactions [p

Relationship between timing of antibiotic administration and complications following surgical extraction of lower third molars

The aim of this prospective clinical trial was to evaluate the effects of antibiotic therapy following different administration times on the postoperative complications of surgical removal of lower impacted third molars. Three hundred and twenty seven consecutive patients [128 males and 199 females] aged 18 to 40 years old [mean=23.1 +/- 3.9 years] were recruited into this study. The lower third molars of all recruited patients were surgically extracted. Participants received either intravenous Velocef 1 gram or intra-oral 500 mg Cephalexin pre- [Group A, n=122], pre- [Group B, n=70] or post-operatively [Group C, n=135]. Immediate and late complications following the surgery; including pain, swelling, trismum, paraesthesia, bleeding, dry socket, infection and fracture of mandible; were assessed 3 days and 7-14 days following the surgery. The most frequent complications were slight pain, swelling, and trismus. The most frequent complications were associated with post-operative antibiotics administration and least complications were associated with pre-operative antibiotic administration [p=0.000]. post-operative administration of antibiotic was associated with more pain [r=0.186, p=0.001], swelling [r=0.181, p=0.001], trismus [r=0.277, p=0.000], and dry socket [r=0.335, p=0.000]. Following surgical extraction of third molars, preoperative antibiotic administration is more effective in reducing the post-surgical complications than pre-operative antibiotic administration which in turn is more effective than post-operative antibiotic administration