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.

Barbed Broach in the Maxillary Sinus: A Report of Unusual Complication in Craniofacial Area.

ABSTRACT: The upper posterior teeth are usually in close relation to the maxillary sinus (MS). This proximity may lead to serious complications throughout different dental procedures. Early diagnosis and management play a significant role in preventing the sequelae of sinusitis and/or cysts. This article presented an extremely unusual case of barbed broach (BB) displacement into the MS, during endodontic treatment, together with the optimal surgical management. Searching the databases has revealed that it was be the first case reported in the literature. It seemed that the modified Caldwell-Luc approach used in this case was very safe, effective, and associated with minimal post-operative side effects.

The success of using 2% lidocaine in pain removal during extraction of mandibular premolars: a prospective clinical study.

BACKGROUND: The purpose of this study was to evaluate the anesthetic effectiveness of a buccal infiltration technique combined with local massage (using 2% lidocaine) in the extraction of mandibular premolars to be utilized as an alternative to the conventional inferior alveolar nerve block. METHODS: Patients eligible included any subject with a clinical indication for tooth extraction of the mandibular 1st or 2nd premolars. All patients were anesthetized buccally by local infiltration technique followed by an external pressure applied for 1 min directly over the injection area. In each case, another local injection was given lingually. All operations were started at approximately 5 min after the buccal injection. The collected data included age, gender, pain perception and its intensity during treatment at three checkpoints, apical tenderness, and the type of extraction. Any associated complications or difficulties were also recorded. Then the results were analyzed and interpreted using appropriate statistical tests. The significance level was set at P ≤ 0.05. RESULTS: A total of 247 cases (1st premolar, n = 119; 2nd premolar, n = 128), predominantly male, were included. In 95% of study sample, the patients were satisfied with the dental extraction without any pain. However, in 5% of cases, pain was reported at the stage of tooth removal. Apical tenderness was found to be present in 11% of the total cases. Three teeth required surgical removal. Upon analysis, no significant differences in the success rates were detected between the 2 premolar groups or amongst the various age groups. Minor and transient side effects were reported in this study. CONCLUSION: The technique is simple and effective as well. It might be considered as an alternative anesthetic injection to the inferior alveolar nerve block for dental extraction of the mandibular premolars.

The reliability of surgeons to avoid traumatic insertion of dental implants into high-risk regions: a panoramic radiograph study.

BACKGROUND: The posterior regions of the jaws usually represent a significant risk for implant surgery. A non-valid assessment of the available bone height may lead to either perforation of the maxillary sinus floor or encroachment of the inferior alveolar nerve and consequently to implant failure. This study aimed to evaluate the reliability of surgeon's decision in appraising the appropriate implant length, in respect to vital anatomical structures, using panoramic radiographs. METHODS: Only implants that are inserted in relation to the maxillary sinus (MS) or the mandibular canal (MC) were enrolled (first premolars [1P], second premolars [2P], first molars [1M], and second molars [2M]). All preoperative panoramic radiographs were evaluated under standard conditions. The postoperative estimation (under/over) was determined depending on the available bone height (ABH) measured from the apical end of the implant to the floor of the MS and the roof of the MC using cone beam computed tomography (CBCT). Any complication or side effect that associated with overestimated implants insertion was recorded. RESULTS: The study sample included 73 patients (predominantly females) who had consecutively received 148 implants, of which 68 were inserted in the posterior maxilla and 80 in the posterior mandible. Underestimation was recorded in 93.2% of the measurements. The remaining bone height after implants insertion was < 2 mm in the majority of underestimated cases (73.9%); they were significantly (P < 0.01) more than sites with remaining bone ≥ 2 mm (26.1%). In the posterior mandible, overestimation was significantly higher than posterior maxilla. Five cases with transient paresthesia were reported in the mandibular overestimated implants. CONCLUSIONS: This study specified that surgeon's choice of implants length, based on panoramic radiographs, was reliable regarding the incapability to insert implants with further length in the majority of underestimated cases, the low percent of overestimated measurements, and the minor associated complications.

Pain Reduction in Extensive Apical Surgery of the Anterior Maxilla: A Comparative Clinical Study.

PURPOSE: The purpose of this study was to compare the outcomes of 2 different anesthetic techniques (local infiltration vs infraorbital nerve block) for eliminating pain during apical surgeries that are associated with extensive periapical pathology in the anterior maxilla. MATERIALS AND METHODS: Patients were randomly divided into 2 groups: patients in group I were anesthetized labially by local infiltration injections, whereas those in group II received a single infraorbital nerve block. Palatal injections were given for the 2 groups. Once the pain was initiated during surgery, the procedure was discontinued until profound anesthesia was secured. The studied variables were age, gender, onset of anesthesia, operative time, and intraoperative pain. Any complication associated with the injection techniques, intraoperatively and postoperatively, also was assessed and recorded. Then, the collected data were analyzed using proper statistical methods. The significance level was set at a P value less than or equal to .05. RESULTS: One hundred patients (50 per group; age range, 16 to 43 yr), predominantly men, were enrolled in this study. The results showed rapid onset of anesthesia in group II with a highly significant difference from group I (P ≤ .05). Duration of the operation ranged from 44 to 57 minutes. Pain during the surgical procedure was reported by most patients in group I (92%). Collateral anesthesia (82%) and increased numbness of the upper lip (72%) were reported in group I. Ecchymosis at the infraorbital foramen or rim (8%) and paresthesia in the skin over the infraorbital region (6%) and cheek (4%) were observed in group II. CONCLUSIONS: In apical surgeries, the anesthetic efficiency of the infraorbital nerve block was superior to that of local infiltration. It had rapid onset, longer duration, and greater potency and avoided multiple transmucosal injections. Furthermore, it was associated with minor and transient side effects.

Novel Application of Platelet-Rich Fibrin as a Wound Healing Enhancement in Extraction Sockets of Patients Who Smoke.

The objectives of this study were to assess the potential of platelet-rich fibrin (PRF) on acceleration of soft tissue healing after tooth extraction and to evaluate its effectiveness in reducing the prevalence of dry socket among smoker patients. Twenty smoker male patients aged (18-72) years with multiple teeth extraction were participated in this clinical research. They underwent trans-alveolar extraction of 40 teeth. The extraction sockets were divided in each patient into 2 groups: the study group in which extraction sockets were treated with PRF and the control group: in which extraction sockets left to heal naturally without PRF. Platelet-rich fibrin enhanced soft tissue healing and reduced inflammatory process within the study group compared with control group as the 2-tailed P value equaled 0.0035 which was very statistically significant. Pain level according to visual analog scale in control group had average of (1.8), while in the study group had average of (0.65) and the P value equaled 0.1511 which was not statistically significant. Degree of epithelization was recorded by dental caliper for both groups and the 2-tailed P value equaled 0.7134 which was insignificant. The results from this study showed that PRF enhanced the quality of soft tissue healing of extraction socket among smoker patients but it did not show significant difference regarding pain reduction, dry socket prevention, and socket closure. Future clinical trials are required to clearly identify the effectiveness of PRF regarding this subject.

Lateral Ridge Splitting (Expansion) With Immediate Placement of Endosseous Dental Implant Using Piezoelectric Device: A New Treatment Protocol.

Many treatment modalities have been introduced for correction of deficient alveolar ridge width. Bone expansion through the ridge split procedure is one of them. This technique was initiated in order to overcome many problems that usually associated with grafting procedures. The present study evaluated the effectiveness of piezoelectric device in performing ridge split using single-stage approach and assessed the outcomes during a period of about 4 months after surgery. A total of 23 patients aged in range between 18 and 60 years underwent ridge split procedure with immediate insertion of dental implants. A panoramic radiograph was obtained before surgery. The gained bone was measured and surgical complications were recorded. Implants stability was measured using Osstell device. Postoperative clinical complications were assessed. After a healing period of 16 weeks, all the implants were uncovered and evaluated regarding clinical, radiographic, and resonance frequency analysis findings. The totally implemented ridge split procedures were 26 cases including 57 implants inserted immediately at the time of surgery. The initial ridge width varied between 1 and 3.5 mm while the final width ranged from 5.5 to 8 mm. The minimum bone gain was 2.5 mm and the maximum value reached up to 7 mm. Few and insignificant clinical complications were recorded during the whole study. The survival rate was 100%. The study results indicated that piezoelectric ridge splitting technique is an effective, safe, and minimally invasive procedure. This technique has showed to be very successful in reducing the overall treatment period.