Postoperative Pain Management Using Supplemental Bupivacaine After Mandibular Orthognathic Surgery: A Triple-Blind Randomized Controlled Clinical Trial.

PURPOSE: The objective of this triple-blind, randomized, placebo-controlled trial was to assess the clinical analgesic efficacy of 0.5% bupivacaine in acute postoperative pain management after bilateral sagittal split ramus osteotomy (BSSO). METHODS: Patients were randomly allocated into the experimental (0.5% bupivacaine with 1:200000 epinephrine) or control group (normal saline - placebo) using block randomization. The interventions were administered at the inferior alveolar nerve block and buccal nerve block sites bilaterally after the BSSO surgery. Analgesic efficacy was assessed in terms of the patient's pain perception measured by a numerical rating scale (0 to 10), rescue drug requirement, and duration of analgesia for 24 hours after the surgery. The statistical analysis was blinded to the allocation groups, and P-value of <.05 was considered as a significant difference for all tests. RESULTS: In total, 28 patients underwent BSSO (ie, 14 in each group). There was no significant difference in pain perception of patients injected with 0.5% bupivacaine and those administered with placebo during the 24 hours after the surgery (P > .05). Three patients in the bupivacaine group took the rescue drug after the surgery (mean duration - 268 minutes) and 1 patient in the placebo group took the rescue drug after 27 minutes. CONCLUSIONS: Postoperative use of bupivacaine did not show a superior analgesic efficacy when compared with normal saline in controlling acute postoperative pain after BSSO.

Three-Dimensional Analysis of Definitive Secondary Unilateral Cleft Rhinoplasty Using Cartilage Graft.

OBJECTIVE: Three-dimensional assessment of nasal morphology in patients with unilateral cleft lip nose treated by cartilage graft augmentation. DESIGN: Retrospective study. PATIENTS AND INTERVENTION: Thirteen patients with unilateral cleft lip nose underwent definitive secondary rhinoplasty and postsurgical changes were examined using a three-dimensional (3D) laser scan. MAIN OUTCOME MEASURE: Nasal dorsum length, nasal tip, alar width, and alar base width in frontal view; nasion depth, nasal tip projection, nasal dorsal angle, and nasal tip angle in lateral view; nostril width, nostril height, and nasal tip height in basal view were measured at preoperative (T1: within 6 months), short follow-up (T2: 2-10 weeks), and long follow-up (T3: 9-14 months). RESULTS: A significant change in alar width, alar base width, nostril width, and nostril height at the cleft side, nasal dorsum length, nasion depth, nasal tip projection, and nasal tip height was observed from T1 to T3 follow-up after rhinoplasty (P < .05), whereas the nostril height at the noncleft side was also significantly increased at T2 follow-up but the mean change in height relapsed at T3 follow-up. Alar width, alar base width, and nostril width at the noncleft side, and nasal tip angle did not change significantly after surgery at any follow-up period. CONCLUSIONS: 3D imaging evaluation after secondary cleft rhinoplasty demonstrated improved functional and aesthetic outcomes using a septal or conchal graft.

Comparison of anesthetic efficacy of intraosseous injection with conventional inferior alveolar nerve block in mandibular third molar surgery: a systematic review and meta-analysis.

OBJECTIVE: This review focused on comparing the anesthetic efficacy of intraosseous injection and conventional inferior alveolar nerve block in mandibular third molar surgery. STUDY DESIGN: Three electronic databases (PubMed, Scopus, and Web of Science) were accessed to identify randomized controlled trials comparing intraosseous injection with conventional inferior alveolar nerve block in mandibular third molar surgery. The outcome measures included onset of anesthesia, success of anesthetic technique, pain during injection of anesthesia, pain during surgery, and duration of anesthesia. RESULTS: Four studies met the inclusion criteria and consisted of 242 mandibular third molar surgeries. No significant differences were found between the anesthetic techniques in terms of onset of anesthesia, success of anesthetic technique, pain during injection of anesthesia, and pain during surgery. However, the intraosseous technique revealed a significantly shorter duration of anesthesia than the inferior alveolar nerve block (mean difference, -56.34 minutes; 95% confidence interval, -70.72 to -41.97; P < .001). CONCLUSIONS: Despite having anesthetic efficacy similar to that of the conventional inferior alveolar nerve block, intraosseous injection has an added benefit of early recovery of sensation owing to its shorter duration of anesthesia.

EFFECT OF LOCALLY DELIVERED BISPHOSPHONATES ON ALVEOLAR BONE: A SYSTEMATIC REVIEW AND META-ANALYSIS.

OBJECTIVE: To assess the effect of locally applied bisphosphonate drugs on alveolar bone defects caused by periodontitis and marginal bone level after placement of dental implants. MATERIALS AND METHODS: Three electronic databases (PubMed/MEDLINE, Web of Science, and Scopus) were searched from January 2010 until May 2020 for randomized controlled clinical trials reporting the effect of locally delivered bisphosphonates on alveolar bone. The risk of bias was assessed and quantitative synthesis was conducted with both fixed and random-effects meta-analyses by using RevMan version 5.3. Subgroup and sensitivity analyses were performed whenever required. RESULTS: Among the included studies, the effect of locally delivered bisphosphonates on alveolar bone regeneration in periodontitis was measured by 15 studies and on marginal bone level after installation of dental implants by three studies. Bisphosphonates showed significantly higher intrabony defect depth reduction than placebo/control in vertical bone defects treated with non-surgical approach (MD = 1.69mm; 95% CI, 1.32-2.05; P < 0.00001; I²=93%) or surgical approach (MD = 0.70mm; 95% CI, 0.23-1.16; P = 0.003; I²â€¯= 78%) and in class II furcation defects treated with non-surgical approach (MD = 1.61mm; 95% CI, 1.15-2.07; P < 0.00001; I²â€¯= 99%) or surgical approach (MD = 0.24mm; 95% CI, 0.05-0.42; P = 0.01; I²â€¯= 62%). Clinical attachment loss increased by 1.39mm (95% CI, 0.92-1.85; P < 0.01; I²=93%) and 1mm (95% CI, 0.75-1.26; P < 0.001; I²â€¯= 0%) in vertical bone defects after non-surgical and surgical treatments, respectively, and by 1.95mm (95% CI, 1.37-2.53; P < 0.00001; I²â€¯= 96%) and 0.84mm (95% CI, 0.58-1.10; P < 0.01, I²â€¯= 47%) after non-surgical and surgical treatment in class II furcation defects, respectively. Lesser marginal bone loss during pre-loading (MD = -0.18 mm; 95% CI, -0.24- -0.12; P<0.00001; I²=0%) and 1-year post-loading (MD = -0.33 mm; 95% CI, -0.59-0.07; P = 0.01; I²â€¯= 0%) periods was observed when bisphosphonate coated dental implants were used. CONCLUSION: Locally delivered bisphosphonates induce bone regeneration in periodontal defects and decrease the rate of marginal bone loss after dental implant therapy.

Effectiveness of dexamethasone injection in the pterygomandibular space before and after lower third molar surgery.

BACKGROUND: Previous studies have investigated the effects of dexamethasone injections into the pterygomandibular space and compared them to those of controls; however, the effects of dexamethasone injections before and after lower third molar surgery on postoperative complications have not been studied. This research investigated the postoperative sequelae of dexamethasone injections before and after surgery into the pterygomandibular space. The aim of this study was to evaluate the effects of preoperative and postoperative injections of 4 mg of dexamethasone into the pterygomandibular space on postoperative pain, facial swelling, and the restriction of mouth opening following lower third molar surgical removal. METHODS: Twenty-seven participants with bilateral symmetrical lower impacted third molars were included in this study. Each participant was randomly allocated to one of two groups. Group A received injections of 1 ml dexamethasone (4 mg/mL) and 1 mL placebo into the pterygomandibular space before and after surgery, respectively. Group B received the same doses of placebo before surgery and dexamethasone after surgery. RESULTS: A significant restriction of mouth opening on the second postoperative day was observed in both groups. Nonetheless, the postoperative restriction of mouth opening, facial swelling, postoperative pain, and analgesic consumption after lower third molar surgical removal were not significantly different in the two groups. CONCLUSIONS: Regardless of the time of administration, dexamethasone injections into the pterygomandibular space resulted in satisfactory control of the postoperative sequelae of the mandibular third molar surgical removal.

Do corticosteroids reduce postoperative pain following third molar intervention?

BACKGROUND: Corticosteroids have been widely used by oral surgeons for reducing swelling caused by wisdom teeth surgery. However, they have not been proven to decrease pain. This study was aimed at analyzing previous studies pertaining to corticosteroids and pain reduction following wisdom teeth surgery. METHODS: The Science Direct, PubMed, and MEDLINE databases were searched for relevant journals according to a systematic search strategy (Patient Intervention Comparison Outcome Study). Randomized controlled trials published in English from 1998 to 2017 were extracted. RESULTS: Twenty-seven articles were included, with a total of 36 comparative cases. Methylprednisolone and dexamethasone were the most commonly used corticosteroids. Intramuscular injections of corticosteroids were optimal for pain reduction, regardless of the time of administration. CONCLUSIONS: Corticosteroids can be used as an adjuvant for pain reduction following wisdom teeth surgery. Methylprednisolone and dexamethasone delivered via the intramuscular route is the best method for effective pain reduction. The ideal time for administration of corticosteroids is the preoperative period.