Handpiece speed and postoperative outcomes in third molar surgery.

OBJECTIVE: This study was performed to assess surgical outcomes when externally irrigated slow-speed surgical handpieces (30,000 rpm) were compared to externally irrigated high-speed handpieces (90,000 rpm) in the removal of impacted lower third molar teeth. STUDY DESIGN: One hundred patients with bilater ally impacted third molar s were enrolled in the study; 53 remained to completion. Each patient served as his/her own control. The experimental side was treated using a 30,000 rpm electric rotary drill incorporating irrigation, while the control side was treated using the same drill system, but with a 90,000 rpm handpiece. Drill speeds used were alternated between the right and left sides of patients to avoid bias introduced by the dominant hand of the surgeon. Patients were blinded to drill speed, and were asked to complete a standardized pain/swelling questionnaire for seven days immediately following surgery. Data was analyzed to determine differences in pain, swelling, and complications in relation to the drill type used. RESULTS: No statistically significant differences were found in degree of pain, swelling, or complications when the slower drill was compared to the high-speed instrument. CONCLUSIONS: The study suggests that there is no difference in postoperative outcome when impacted third molar teeth are removed with either slow- or high-speed instrumentation, and that the choice of the drill type should be determined solely by the preference of the operator.

Comparison of the postsurgical stability of the Le Fort I osteotomy using 2- and 4-plate fixation.

PURPOSE: This study was conducted to evaluate the postoperative stability of Le Fort I osteotomies accomplished with 2-plate versus 4-plate fixation. METHODS: This is a retrospective study involving 32 patients who underwent Le Fort I 1-piece osteotomy concurrent with orthodontic therapy. All patients were treated by 1 attending surgeon during an 18-month period. Sixteen patients were treated by plate and screw fixation consisting of 4 miniplates (group I), and an additional 16 patients were treated using 2 miniplates (group II). In group I, fixation was accomplished with 2.0-mm low-profile Lorenz (Walter Lorenz Surgical Inc, Jacksonville, FL) plates and screws placed at the piriform aperture and at the maxillary buttress. Four screws were placed in each of the plates. In group II, fixation was accomplished with 2.0-mm low-profile Lorenz plates and screws placed at the piriform aperture. Again, 4 screws were placed in each of the plates. RESULTS: Serial cephalometric evaluation at arbitrary anterior nasal spine and posterior nasal spine for both groups showed that postoperative skeletal changes in the direction of the surgical movement were seen in approximately 20% of cases; these changes averaged less than 1 mm. Postoperative skeletal changes opposite to the direction of the surgical movement were seen in approximately 30% of cases; these changes also averaged less than 1 mm. No postoperative skeletal changes were seen in approximately 50% of cases. For all measured changes about arbitrary anterior nasal spine and posterior nasal spine, there was no significant difference between groups I and II. CONCLUSION: This study suggested that postoperative skeletal changes associated with the use of 2-plate fixation do not appear to differ significantly from those seen with 4-plate fixation.