Effectiveness of Dermis Fat Graft Versus Temporalis Myofascial Flap for Interposition in Temporomandibular Joint Ankylosis: A Systematic Review.

Background: Temporomandibular joint ankylosis is a disabling condition which affects joint movements causing difficulty in speech, mastication and hygiene. Over time various interposition materials like meniscus, muscle, fascia, skin, cartilage, fat, dura and alloplastic materials have been used for the treatment of ankylosis and improve joint functions. Objective: The objective of this systematic review is to evaluate the effectiveness of dermis fat graft and temporalis myofascial flap as an interpositional material in treatment of temporomandibular joint ankylosis and to compare the effectiveness of the two materials. Materials and Methods: PubMed, Google scholar, and Cochrane library search in combination with hand search of relevant journals were conducted published in English from January 2000 to August 2021. Randomized controlled trials, prospective and retrospective cohort studies were included. Outcome measure included improvement in mouth opening. Risk of bias assessment was assessed using Cochrane risk of bias tool and Newcastle-Ottawa scale. Results: A total of 144 articles were found from the primary search which on thorough assessment, duplicate and exclusion removal resulted in 9 cohort studies and 1 randomized controlled trial that fulfilled the inclusion criteria. All the studies included reported significant improvement in mouth opening after interposition of the 2 materials. Four studies compared temporalis myofascial flap with dermis fat graft, 2 studies reported dermis fat graft gives better outcomes, whereas 1 study reported temporalis myofascial flap to be better and 1 study has been inconclusive. Conclusion: Definitive conclusions cannot be drawn as there are number of limitations in the studies included. However a general consensus has been toward dermis fat graft owing to fewer complications. Supplementary Information: The online version contains supplementary material available at 10.1007/s12663-023-01869-9.

Clinical efficacy of 0.75% ropivacaine vs. 2% lignocaine hydrochloride with adrenaline (1:80,000) in patients undergoing removal of bilateral maxillary third molars: a randomized controlled trial.

BACKGROUND: Lignocaine with adrenaline is routinely used as a local anesthetic for dental procedures. Adrenaline was added to increase the duration of anesthesia. However, epinephrine containing a local anesthetic solution is not recommended in conditions such as advanced cardiovascular diseases and hyperthyroidism. Recently, ropivacaine has gained popularity as a long-acting anesthetic with superior outcomes. The goal of this study was to assess and compare the effectiveness of 0.75% ropivacaine alone and 2% lignocaine with adrenaline (1:80,000) in the removal of bilateral maxillary wisdom teeth using the posterior superior alveolar nerve block technique. METHODS: This was a single-blind, randomized, split-mouth, prospective study assessing 15 systemically sound outpatients who needed bilateral removal of maxillary third molars. We randomly allocated the sides and sequences of ropivacaine and lignocaine with adrenaline administration. We evaluated the efficacy of both anesthetics with regard to the onset of anesthesia, intensity of pain, variation in heart rate, and blood pressure. RESULTS: The onset of anesthesia was faster with lignocaine (138 s) than with ropivacaine (168 s), with insignificant differences (p = 0.001). There was no need for additional local anesthetics in the ropivacaine group, while in the lignocaine with adrenaline group, 2 (13.3%) patients required additional anesthesia. Adequate intraoperative anesthesia was provided by ropivacaine and lignocaine solutions. No significant difference was observed in the perioperative variation in blood pressure and heart rate. CONCLUSION: Ropivacaine (0.75%) is a safe and an adrenaline-free local anesthetic option for posterior superior alveolar nerve block, which provides adequate intraoperative anesthesia and a stable hemodynamic profile for the removal of the maxillary third molar.

To evaluate the Efficacy of Buprenorphine and 2% lignocaine with adrenaline as postoperative analgesia following mandibular third molar surgery: A Comparative Study.

Introduction: Opioid analgesics have an advantage over nonsteroidal anti-inflammatory drugs in that they do not cause direct organ damage. Buprenorphine has an antinociceptive potency approximately 25-50 times greater than that of morphine. Hence, in this study, buprenorphine was added to local anaesthesia in relieving postoperative pain after lower third molar surgery when given as inferior alveolar nerve block. The aim of this study was to evaluate the efficacy of buprenorphine in managing postoperative pain after lower third molar surgery. Materials and Methods: Fifty patients requiring lower third molar surgery were randomly divided into two groups. Group A received buprenorphine added to 2% lignocaine with 1:80,000 adrenaline and Group B received 2% lignocaine with 1:80,000 adrenaline. Parameters assessed were onset of anaesthesia, depth of anaesthesia, intraoperative monitoring of adverse effects, duration of analgesia, and number of analgesics consumed. Statistical analysis was carried out using SPSS software version 21. The data were compared using Student's t-test. The level of significance was set at 0.05. Results: There was a significant difference in onset of anaesthesia between Group A and Group B (P < 0.05). Depth of anaesthesia and duration of analgesia were greater in Group A (56 h 36 min) than Group B (3 h 24 min). Analgesics consumed by Group A (0.9) were significantly less compared to Group B (9.2) and it was highly significant (P = 0.000). Discussion: Buprenorphine when added to local anaesthesia can prolong postoperative analgesia with minimum or no side effects. Hence, buprenorphine can be safely used for lower third molar surgery.

A Study to Evaluate the Efficacy of Honey in the Management of Dry Socket.

BACKGROUND: Natural products have been used for several years in folk medicine. Honey was used to treat infected wounds as long ago as 2000 years before bacteria was discovered to be the cause of infection. It has been reported from various clinical studies on the usage of honey as a dressing for infected wounds that the wound become sterile in 3-6 days. AIM: This study aimed to find out the efficiency of naturally occurring honey in alveolar osteitis. METHODOLOGY: Fifty patients of dry socket were selected from the outpatient department of oral and maxillofacial surgery. A diagnosis of dry socket was made clinically. Honey was used as a dry socket dressing in all these patients. Parameters such as mucosal edges, pain, and formation of granulation tissue were assessed in the postoperative period for a week. STATISTICAL ANALYSIS USED: Analysis was done by paired t-test method using SPSS software version 17. RESULTS: In this study, there was a significant reduction in inflammation, hyperemia, and mucosal edges that resulted in the reduction of pain and discomfort to the patient. There was no side effect of honey observed in our study, so it can be used as an alternative for the management of dry socket. Change in distance between mucosal edges when compared from the day of clinical presentation to 5th day postplacement was statistically significant (P < 0.001). CONCLUSIONS: There are no side effects of honey. Excess use of eugenol can lead to necrosis of bone. Thus, honey can be used as a medicament for the management of dry socket.

Evaluation of Effect of Glucosamine-Chondroitin Sulfate, Tramadol, and Sodium Hyaluronic Acid on Expression of Cytokine Levels in Internal Derangement of Temporomandibular Joint.

AIM: Evaluation of the effect of glucosamine-chondroitin combination, tramadol, and sodium hyaluronic acid in temporomandibular joint (TMJ) disorders and its impact on the expression of various cytokines such as IL-6, IL-1ß, TNF-α, and PGE2. MATERIALS AND METHODS: The present study was conducted on 60 patients (males-30, females-30) suffering from internal derangement such as disc displacement with reduction of TMJ. The patients were divided into three groups of 20 each. Group I received a combination of 1.5g of glucosamine and 1.2 g of chondroitin sulfate per day and group II received 50 mg tramadol HCL peroral. Group III received sodium hyaluronate 10 mg/mL, 2 mL injection syringe on each joint. Pain (VAS) scale and maximum mouth opening (MMO) was measured. The level of IL-6, IL-1ß, TNF-α, and PGE2 levels were measured using Enzyme-linked immuno sorbent assay (ELISA). RESULTS: There was an improvement in maximum mouth opening in all three groups (p < 0.05). There was a reduction in pain in all groups. IL- 1ß, TNF-α, and PGE2 leve ls showed reduction while IL-6 showed an increase in value in group II and III. CONCLUSION: The efficacy of glucosamine chondroitin sulfate , tramadol and hyaluronic acid in TMJ disorders has been found to be effective. CLINICAL SIGNIFICANCE: IL-6, IL-1ß, TNF-α, and PGE2 levels indicate the risk of TMJ disorders. Thus earlier assessment of their levels helps in diagnosis, and better management may be done.

A comparative study to assess the effect of oral alprazolam as premedication on vital parameters of patients during surgical removal of impacted mandibular third molars.

PURPOSE: The aim of this study was to evaluate and monitor the changes in vital parameters of patients during surgical removal of impacted mandibular third molars. METHODS: This was an in vivo study conducted in Oral and Maxillofacial Surgery Department of Terna Dental College. Sixty patients were randomly selected. Thirty patients were given a preoperative single dose of oral tablet alprazolam 0.5 mg as premedication (test group), whereas the other thirty were treated without any premedication (control group). RESULTS: It was found that the mean systolic blood pressure during surgical removal of impacted mandibular third molar was raised in the control group and exhibited minimal fluctuation in the test group. CONCLUSION: The use of tablet alprazolam as premedication before surgical removal of impacted mandibular third molars resulted in stability of vital parameters, secondary to reduced patient anxiety.