The Influence of the Hyaluronic Acid Gel on the Postoperative Sequelae following Surgical Removal of the Impacted Mandibular Third Molar in Comparison with the A-PRF: A Randomized Controlled Trial.

One of the most common procedures in oral surgery is the removal of impacted mandibular third molars, often followed by pain, swelling, alveolitis, and trismus. Purpose. To compare the outcomes of the intrasocket application of 1% hyaluronic acid oral gel (HA) and advanced platelet-rich fibrin (A-PRF) on the expected postoperative complications, pain, swelling, and trismus follow the surgical extraction of the impacted mandibular third molar. Material and Methods. A randomized controlled trial was conducted at the Oral and Maxillofacial Surgery Unit, Dental Teaching Hospital. Healthy patients who required surgical removal of the impacted mandibular third molar were divided randomly into three groups. The extraction site of the group (A) patients remained without the addition of any material, just suturing of the wound with simple interrupted sutures, while in group (B) patients, the extraction site was filled with 1 cc of 1% hyaluronic acid gel (periokin®), and in group C patients, the extraction site was filled with A-PRF. Results. Sixty-six eligible patients participated in this study; both hyaluronic acid gel 1% (periokin®) and advanced platelet-rich fibrin showed a significant reduction in pain, swelling, and trismus on the 1st, third, and seventh postoperative days when compared to the control group, while the comparison between HA and A-PRF showed no significant differences except for the pain on the third postoperative day. There was a significant pain decrease in the A-PRF group than HA group. Conclusion. Intrasocket application of 1% hyaluronic acid gel (periokin®) or advanced platelet-rich fibrin can be an effective primary way to significantly reduce postoperative pain, trismus, and edema compared to the control group following mandibular third molar surgery.

The reliability of using light therapy compared with LASER in pain reduction of temporomandibular disorders: a randomized controlled trial.

BACKGROUND: Temporomandibular Disorders (TMD) refer to a group of symptoms where pain is the most leading cause to demand a treatment by the patient. Light therapies are of great importance at current times due to its biosafety and non-invasive quality when used for the management of TMD symptoms. This study aimed to evaluate the efficacy of red LED light with low-level LASER in treating TMD patients. MATERIALS AND METHODS: A double-blind randomized clinical study was conducted and included 60 patients along 3 groups (20 for each group) presented with myofascial pain related to TMD. Patients were randomly divided into 3 groups. Group A were managed by applying the LED light device into the trigger points without switching the device on. A red LED light was given to group B for 5 min at the tender muscles. Group C were treated by using low-level LASER therapy for 30 s. Patients were evaluated for any improvements regarding the pain score, presence of trigger points, and trismus along 4 visits (1 week interval between each visit). Any side effects related to the 2 devices were also assessed. RESULTS: Both group B and C patients showed a statistically significant improvement in the pain value (P < 0.05) at the 3rd and 4th visits when compared to group A. Regarding tenderness, there was a reduction in the number of trigger points in both study groups; however, the results were insignificant in group B. Statistics showed insignificant differences between group B & C patients regarding pain and number of trigger points at all visits (P > 0.05). CONCLUSION: Both LED light and LASER therapies could effectively relieve pain associated with myogenic TMD as there were no important differences between their outcomes. However, the biosafety and lower cost of the LED light device compared to the LASER should also be considered. Trial Registration This clinical trial was prospectively registered (TCTR ID: TCTR20190507002) on 07/05/2019. URL: http://www.thaiclinicaltrials.org/show/TCTR20190507002.

Efficacy of Autogenous Dentin Biomaterial on Alveolar Ridge Preservation: A Randomized Controlled Clinical Trial.

Background: After tooth extraction, alveolar bone resorption is inevitable. This clinical phenomenon challenges dental surgeons aiming to restore esthetic and function. Alveolar ridge preservation can be applied to minimize dimensional changes with a new socket grafting material, an autogenous dentin graft, produced by mechanically and chemically processing natural teeth. This study assessed the safety and efficacy of using autogenous dentin biomaterial in alveolar ridge preservation. Materials and Methods: Patients with nonrestorable maxillary anterior teeth bounded by natural sound teeth were included in this study. After a detailed clinical and tomographic examination, eligible participants were randomly allocated into two groups. The control group had spontaneous healing of extraction sockets. The study group had their extraction sockets filled with autogenous dentin biomaterial after processing their extracted retained roots with the KometaBio device. Standardized cone beam computed tomography (CBCT) scans were repeated four months later. A full-thickness mucoperiosteal flap reflection was achieved under local anesthesia to get core biopsies for histomorphometric analysis, and dental implants were placed at the same session. Results: A total of 32 eligible patients were included in this study (n = 16 in each group). Both groups had significantly higher facial soft tissue thickness after four months than baseline (p < 0.05). However, the study group showed statistically significant lesser dimensional changes than the control group according to the standardized CBCT scans. Furthermore, core biopsies confirmed an excellent remodeling of the autogenous dentin biomaterial in the study group. In comparison, only new thin bone trabeculae-filled sockets were in the control group. Conclusion: Autogenous dentin graft can be safely and successfully used for alveolar ridge preservation. Optimal graft remodeling histologically, better ridge dimensional stability, and uneventful wound healing support its clinical application. This trial is registered with TCTR20220615002.

Comparison between Rolled and Nonrolled U-Shaped Flap in the Second Stage of Dental Implant Surgery: A Randomized Clinical Trial.

Background: The presence of black triangles around the dental implant-supported prosthesis and the failure to construct adequate papillae around them bothers dental implantologists. Peri-implant surgical soft tissue management will improve esthetics, function, and implant survival. Aim: To compare the effects of rolled and nonrolled U-shaped flaps combined with a temporary crown in enhancing the soft tissue around dental implants. Materials and Methods: Forty patients were included in this study; all patients were operated on by the same maxillofacial surgeon at Al-Iraq specialized dental clinics from January 2019 to January 2020. Patients were divided randomly into two groups: group A: at the second stage of implant surgery, a U-shaped flap without rolling was used in conjunction with temporary crown placement; group B: at the second stage of implant surgery, a U-shaped flap with rolling was used in conjunction with temporary crown placement. Then, the temporary crown was fabricated for both groups and kept in place for one month. Two independent maxillofacial surgeons evaluated all patients two weeks after the cementation of the final zirconia crown for the implant soft tissue esthetic score. Results: The highest possible score assigned to the mesial papilla (2 scores) was present in 92.5% of the group A patients and only 77.5% of the group B patients. Moreover, we have found that alveolar bone contour is achieved perfectly (2 scores) in 70% of group A patients but only in 32.5% of group B patients. Conclusion: The U-shaped flap without rolling with a temporary crown is a simple technique. It has good results, especially when there is no severe resorption of the labial bone plate (in canine and premolar areas).

The Impact of Blast Implosions and Bullet Injury on Maxillary Air Sinus.

BACKGROUND: Successive waves and generations of terrorists attacked the Iraqis in the years following the fall of the regime in Iraq in 2003, after the US invasion of the country under the pretext of weapons of mass destruction. Hence, the Iraqi people enrolled in ongoing war with these armed groups which led to massive casualties due to blasts and missile injuries.Mechanism of blasts injury can be classified into primary, secondary, tertiary, and quaternary. While bullet injuries can be classified into low and high-energy injuries, the type and severity of the injury will influence the type of management, together with facilities available in the authors' hospitals.In this study the authors aim to compare between the effects of blast implosions and penetrating missiles on the maxillofacial air containing cavities, specifically the maxillary sinuses. PATIENTS AND METHODS: Twenty-eight patients (26 male patients [92.85%] and 2 [7.14%] female patients) with maxillary sinus wall fractures were admitted to the authors' maxillofacial surgery Department in the Hospital of specialized surgeries/Baghdad Medical city from July 2014 to November 2016. RESULTS: Seventy-six percent of the total bullet injuries affect the left side of the face, while shell injuries tend to affect the right side of the face by 60% than the left side.Direct maxillary sinus injuries constitute 76.9% of the injuries caused by bullets, while it constitutes only 40% of shell injuries. CONCLUSION: Bullet injuries are associated with more severe comminuted fractures in addition to involvement of multiple neighboring bones and this may lead to extensive bone loss, while postoperative complications and infection are more common with improvised explosive devices injuries.

Efficacy of the LED Red Light Therapy in the Treatment of Temporomandibular Disorders: Double Blind Randomized Controlled Trial.

BACKGROUND: Temporomandibular dysfunction syndrome (TMD) is a common disease among dental patients. It occurs as a consequence of malfunction of the tempromandibular and/or surrounding facial muscles. LED red light therapy is not been well established, and it is important to find out the role of this technique in the treatment of temporomandibular disorders. AIM OF THE STUDY: To evaluate the efficacy of the LED red light in the treatment of the tempromandibular dysfunction syndrome. MATERIAL AND METHODS: Fifty students of the College of Dentistry/University of Baghdad with myofacial pain associated with Tempromandibular Disorder volunteered to participate in this study and be evaluated during both treatment and follow-up periods. They were 40 (80%) females and 10 (20%) males. Patients were divided into 2 groups: Group A treated by TenDlite® Medical Device model 204 with a LED's of wavelength 660 nm (red light) and Group B given placebo (no treatment at all) by just putting the TenDlite device near the tender points without battery and turning ON the device. RESULTS: The changes in the pain value and number of the tender muscles in both groups were highly significant, only placebo group less but with no significant differences. CONCLUSIONS: This study showed that red LED therapy could be useful in improving patient's symptoms regarding pain, clicking, and number of tender muscles. In addition, this study showed the importance of the psychological part of treatment of those patients. This trial is registered with TCTR20190406002.

Mandibular war injuries caused by bullets and shell fragments: a comparative study.

PURPOSE: Is to compare the patterns, severity, and management of the high- and low-velocity mandibular war injuries managed at Al Shaheed Gazi Al-Hariri Hospital in Baghdad Medical City, Iraq, during a 2-year period. METHODS: Forty-one patients with a history of mandibular war injuries treated by our maxillofacial team were reviewed during a period of 2 years (2015-2017). All patients were treated in the Maxillofacial Unit of the Hospital of Specialized Surgeries in Baghdad Medical City. RESULTS: A 2-year retrospective study evaluated 41 patients with mandibular war injuries with a total of 94 fractures (comminution represents 79.06% of the bullet injuries, while it is only 62.74% with IED injuries). Management of these injuries was varied according to the severity of the injuries and resources available. Close reduction was used in 72.72% of the linear fracture cases, whereas open technique was used in 56.6% of the comminuted fractures. CONCLUSIONS: Bullet injuries were associated with a higher number of mandibular comminuted fractures, in addition to more extensive bone loss. While shell injuries of IED (improvised explosive devices), on the other hand, were associated with higher infection rate and more postoperative complication.