Nasal profile changes after LeFort I osteotomy (maxillary advancement) with and without ANS reduction in class III skeletal patients: a study protocol for a randomized clinical trial.

BACKGROUND: Dentofacial malformation is a common condition that affects a significant portion of the population, resulting in functional and aesthetic defects. Orthognathic surgeries, such as LeFort I osteotomy, are performed to correct these abnormalities. However, the impact of these surgeries on nasal profile changes remains unclear. Additionally, the role of anterior nasal spine (ANS) reduction in maxillary advancement surgeries of 3-5 mm range is yet to be determined. This study aims to investigate the effect of ANS reduction on soft tissue profile changes following LeFort I osteotomy with a maxillary advancement range of 3-5 mm in class III skeletal patients. The hypothesis is that the changes in nasolabial angle and upper lip length will not significantly differ between patients who undergo LeFort I osteotomy with and without ANS reduction. METHOD AND DESIGN: This study is designed as a randomized controlled trial. A total of 26 class III skeletal patients with maxillofacial abnormalities will be recruited from the maxillofacial clinic of Bu-Ali and Farahikhtegan Hospitals in Tehran, Iran. Patients meeting the inclusion criteria will be randomly assigned to two groups: one group will undergo LeFort I osteotomy with ANS reduction, and the other group will undergo LeFort I osteotomy without ANS reduction. The soft tissue profile changes, specifically the nasolabial angle and upper lip length, will be evaluated and compared between the two groups. DISCUSSION: Achieving facial harmony through orthognathic surgery requires careful planning and consideration of the impact on surrounding soft tissue. The primary objective is to predict and plan for the effects on the nasolabial region. LeFort I osteotomy is a common procedure used to correct dentofacial deformities, particularly in class III patients. Maxillary advancement during this surgery can lead to changes in nasal tip position, width, and rotation, potentially due to repositioning of the anterior nasal spine and soft tissue dissection. In this study, soft tissue changes will be assessed in non-growing class III patients using cephalometric radiographs. The impact of reducing the anterior nasal spine (ANS) on nasal profile changes will be investigated for maxillary advancements of 3-5 mm. Objective measurements and patient-reported outcomes will be evaluated to gain insights into the aesthetic outcomes of orthognathic surgery. The findings will provide valuable guidance for treatment decisions and alternative options based on expected nasal profile changes. TRIAL REGISTRATION: This project was registered at The Iranian Registry of Clinical Trials (Identifier No. IRCT20210928052625N1, Website: https://www.irct.ir/trial/59171 ) and Open Science Framework (OSF) (Registration https://doi.org/10.17605/OSF.IO/X3HD4 ). 2021-06-09.

Local heating of the wound with dressings soaked in saline at 42°C can reduce postoperative bleeding: a single-blind, split-mouth, randomised controlled clinical trial.

Control of bleeding is essential during oral procedures. Although various chemical agents have been introduced and tested, hot water dressing has not to our knowledge been assessed before. Studies of operations for epistaxis or sinus conditions have suggested that irrigation with hot water can reduce bleeding, so we hypothesised that it might be effective in reducing bleeding after extraction too. Ten patients who required bilateral extractions took part in this split-mouth, randomised, single-blind, controlled clinical trial. After extraction, sockets were packed with similar gauze dressings soaked in normal saline 4 ml at room temperature (control) and warmed to 42°C (experimental). The extent of bleeding on each side was measured by subtracting the original weight of the gauze from its weight after absorption of blood. The difference between the weights was compared using Student's paired t test (α=0.05, ß<0.05). Mean (SD) weights were 22.1(2.2) g and 18.4 (2.5) g in the control and experimental groups, respectively, indicating an 18% reduction in the experimental group (p=0.002). Soaking gauze in normal saline heated to 42°C can reduce bleeding after extraction.

The influence of endodontic broken stainless steel instruments on the urinary levels of iron.

Previous studies on the endodontic broken stainless steel instruments have mainly focused on retrieval of specimens. However, the systemic consequences of the retained separated instruments need an investigation. The current study aimed to evaluate the correlation between broken stainless steel instruments inside the root canal space and the urinary level of iron (Fe) in patients. Sixty near-aged and same-gender patients were selected. Thirty patients in the control group had no endodontic treatment in their history, while the other 30 patients in the endodontic group had broken stainless steel instrument. The urine samples were collected in iron-free containers. All specimens were refrigerated for 1 day and then subjected to Fe level measurement by electrothermal atomic absorption spectrometry. Data were analyzed by Kolmogorov-Smirnov and t tests at P < 0.05. The correlation coefficients of age and sex were also evaluated in relation with Fe levels in the urine. The level of Fe did not show any significant increase in the experimental group (P > 0.05). There was a positive correlation between age and Fe levels of endodontic and control groups. However, the joint effects of age and sex on Fe levels were different for the two groups. The presence of broken stainless steel instruments inside the root canal space did not elevate the level of Fe in the urine of patients. However, this value was positively correlated with the patient age.

Single-dose intra-alveolar chlorhexidine gel application, easier surgeries, and younger ages are associated with reduced dry socket risk.

PURPOSE: Although dry socket (DS) is commonly investigated, many of its risk factors remain highly controversial. In addition, few studies are available to show the preventive effect of chlorhexidine gel on DS. Moreover, multivariable analyses of DS risk factors are scarce, and their interactions have not been assessed previously. Therefore, the simultaneous effect of chlorhexidine gel and 4 DS risk factors and their interactions were analyzed within a multivariable framework. MATERIALS AND METHODS: Using a split-mouth randomized clinical trial design, the investigators enrolled a cohort of patients requiring extraction of 2 mandibular third molars. The primary predictor variable was extraction socket treatment status, classified as experimental or standard. Experimental treatment was the insertion of chlorhexidine gel (0.2%) into the extraction socket. Each patient had 1 third molar randomly selected as the treatment site. The contralateral third molar served as the control socket and was treated in the usual manner. The primary outcome variable was DS status, present or absent, assessed on postoperative day 3. Other study variables were categorized as demographic, smoking, and surgical difficulty according to the Pederson scale. Appropriate bivariate and multiple logistic regression statistics were used to measure the association between risk for DS and chlorhexidine gel use, age, gender, smoking, and surgical difficulty and their interactions (α = 0.05). RESULTS: The sample consisted of 90 bilateral extraction sockets in 45 patients (24 men; 21 smokers; mean age, 21.1 ± 2.7 yr). Regression analysis showed that when other factors and their interactions were controlled for, chlorhexidine gel application lowered the risk of DS (odds ratio [OR] = 0.05; P = .004). Increasing age (OR = 2.9; P = .030) was associated with an increased risk for DS. A similar association existed between increased difficulty level of extraction and DS risk (OR = 3.8; P = .051). The effect of gender was marginally significant (P = .091), whereas smoking did not have a significant influence (P = .4). CONCLUSIONS: Intra-alveolar application of chlorhexidine gel and practicing less traumatic surgeries are advocated, particularly in older patients. Smoking seems unlikely to affect DS frequency. The role of gender is inconclusive.

Effects of intra-alveolar placement of 0.2% chlorhexidine bioadhesive gel on dry socket incidence and postsurgical pain: a double-blind split-mouth randomized controlled clinical trial.

AIMS: To assess the effects of intra-alveolar application of chlorhexidine gel on the incidence of alveolar osteitis (dry socket) and the severity of postsurgical pain. METHODS: A total of 160 impacted mandibular third molars were extracted in 80 patients enrolled in this trial. In each subject, a socket was randomly selected and packed to the crest of the alveolar ridge with a gelatin sponge dressing saturated in 0.2% chlorhexidine gel. The contralateral socket was packed with a dry dressing as the placebo. None of the included patients took antibiotics or analgesics. The occurrence of dry socket and patients' pain levels were assessed at the first and third postoperative days. The data were analyzed using Spearman correlation coefficient, McNemar, Wilcoxon, and chi-square tests. RESULTS: Chlorhexidine gel significantly reduced dry socket incidence from 32.6% to 11.3% (P ≤ .001 [McNemar and chi-square], absolute risk reduction = 21.2%, relative risk reduction = 65.4%, odds ratio = 0.263, relative risk = 0.345). It also significantly relieved postoperative pain on both sides in all the patients (P ≤ .001 [Wilcoxon]) and also in the 54 subjects who did not develop dry socket (P ≤ .001 [Wilcoxon]). CONCLUSIONS: Besides decreasing the incidence of dry socket, chlorhexidine gel can reduce postsurgical pain in patients with and without dry socket.

Radiographic localization of the mental foramen and mandibular canal.

OBJECTIVE: Accurately localizing the mental foramen and mandibular canal is important when administering local anesthesia and performing surgery; therefore, knowing the normal range of the possible locations is essential. Our purpose was to assess the location of the mental foramen and mandibular canal in an Iranian population using panoramic radiography. MATERIALS AND METHODS: Standard panoramic radiographies were performed. The positions of 100 mental foramens were evaluated. The distances from the center of the mental foramen to the superior and inferior borders of the mandible and to the apexes of the first and second premolar were measured. The distance of the mental foramens from the mandibular midline and the diameter of the mandibular canal in the mental foramen connection were also measured. RESULTS: Among 100 mental foramens, 6% were positioned under the first premolar, 24% were between the first and second premolars, 67% were under the second premolar, and the remaining 3% were behind the second premolar. The mean distance from the mental foramen to the mandibular midline was 27.77±3.20 mm. The mean diameter of the mandibular canal in the mental foramen connection was 3.09±0.69mm. CONCLUSION: The mental foramen was near the second premolar and the inferior border of the mandible. This information can be used to perform safer mental nerve blocks in surgical interventions.

Effect of plasma rich in growth factors on alveolar osteitis.

INTRODUCTION: The high prevalence of dry socket or alveolar osteitis (AO) is of concern in surgical removal of third molars. The aim of the present study was to assess the preventive effect of plasma rich in growth factors (PRGF) on AO and also its effect on pain management and healing acceleration in third molar extraction sockets of high-risk patients. MATERIALS AND METHODS: This split-mouth, double-blind clinical trial included 40 bilateral third molar extractions (80 sockets) with at least one identified risk factor for AO. PRGF was obtained from patient's own blood, based on manufacturer's instruction, and blindly placed in one of the two bilateral sockets (PRGF group; n = 20) of each patient. The contralateral socket was treated with a placebo (control group; n = 20). Samples were evaluated for AO and pain incidence on days 2, 3 and 4 and healing and infection on days 3 and 7. Data were analyzed in SPSS v16 using Wilcoxon test. RESULTS: There was a significant difference in dry socket and pain incidence and healing rate between the two groups. Intensity of pain and occurrence of dry socket in the study group was lower than the controls. Also the healing rate was higher (P < 0.05) for the PRGF group. No sign of infection was seen in either group. CONCLUSION: The application of PRGF may significantly reduce the incidence of AO or its associated pain and may accelerate healing. The prophylactic use of PRGF following third molar extraction may be suggested especially in the patients at risk of AO.

The effects of miniscrew with Class III traction in growing patients with maxillary deficiency.

The aim of this study was to compare the effects of face mask and miniscrew combined with Class III traction on Class III malocclusion maxillary deficiency in growing patients. 10 patients were treated with facemask and 10 other patients were treated by means of miniscrew and Class III traction. Pre- and post-treatment cephalometric data were analyzed and compared between the two groups. Both groups were successfully treated; however, IMPA increased in miniscrew group while it decreased in facemask group.

Can flap design influence the incidence of alveolar osteitis following removal of impacted mandibular third molars?

This study sought to evaluate the influence of flap design (that is, modified triangular flap or buccal envelope flap) on alveolar osteitis (AO) and on healing following the surgical removal of an impacted mandibular third molar. A double-blind split-mouth clinical trial examined 17 patients who were candidates for extraction of a bilaterally impacted mandibular third molar with the same difficulty index; a modified triangular flap was placed on one side and a buccal envelope flap (control) was placed on the other side. AO and healing were assessed at three and seven days after surgery. Data were analyzed with the McNemar and Wilcoxon signed-rank tests. The modified triangular flap decreased the incidence of AO and expedited healing at seven days postsurgery. In addition, statistically significant differences were observed in terms of both AO and postoperative healing.

Causes and incidence of miniplate removal following Le Fort I osteotomy.

AIM: This study assessed the causes and incidence of miniplate removal during a 5-year period after Le Fort I osteotomy. PATIENTS AND METHODS: One hundred forty-two patients had plates inserted for fixation of the maxilla after Le Fort I osteotomy between 2001 and 2004. The Le Fort I segment was rigidly fixed with four 2-mm titanium miniplates and 16 screws. They were followed 1 to 5 years for plate complications and need for plate removal. RESULTS: Fifteen of 142 patients (10.6%), 9 females and 6 males, required plate removal. The minimum time period between insertion and removal was 4 months and the maximum period was 18 months. Causes for removal were as follows: infection (40%), pain (13.3%); sinusitis (13.3%); sensitivity to temperature change (13.3%); palpability of plate (13.3%); and phobia (6.8%). CONCLUSION: In this study, the number of miniplates removed was small and required removal no sooner than 4 months postoperatively (after complete bony union), thus not compromising healing. There is no evidence from this study to support the routine removal of titanium miniplate after Le Fort I osteotomy, rather they should be removed when indicated.