Reliability of the Linear Measurement (Contact) Method Compared with Stereophotogrammetry (Optical Scanning) for the Evaluation of Edema after Surgically Assisted Rapid Maxillary Expansion

TWIN-MIX INJECTION REDUCES POSTOPERATIVE COMPLICATIONS AFTER LOWER THIRD MOLAR REMOVAL-A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

BACKGROUND

The aim of this systematic review and meta-analysis was to assess whether pain, swelling and trismus following surgical removal of the lower third molar could be reduced by twin-mix injection.

MATERIALS AND METHODS

MEDLINE, Embase and Cochrane Trials were searched for randomized controlled trials (RCTs) until 17th November 2022. Eight RCTs were included in the systematic review, and 7 in the meta-analysis. In this study, the twin-mix was compared with the conventional anesthetic solution. Outcomes were assessed on postoperative days 1, 3 and 7. Primary outcomes were swelling and trismus. Secondary outcomes were postoperative pain, pain score on local anesthetic injection, duration of soft tissue anesthesia, and latency of anesthesia. Risk of bias was assessed using the Cochrane ROB2 tool. Certainty of evidence was evaluated with the GRADE tool.

RESULTS

On postoperative day 1, the twin-mix group showed significant reductions in facial swelling (MD: -3.51 mm; [-5.04 to -1.97]), trismus (MD: -1.7 mm; [-2.48 to -0.92]) and pain (MD: -1.07; [-1.49 to -0.65]). On day 3, swelling (MD: -4.64 mm; [-6.34 to -2.94]), trismus (MD: -1.08 mm; [-1.55 to -0.61]) and pain (MD: -0.62; [-1.09 to -0.15]) remained significantly reduced. On day 7, differences persisted for swelling (MD: -0.58 mm; [-0.76 to -0.40]) and trismus (MD: -0.42 mm; [-0.72 to -0.12]), but no significant difference was found in pain (MD: -0.29; [-0.65 to 0.07]). The twin-mix also significantly reduced pain under local anesthesia, shortened latency and prolonged duration of anesthesia.

CONCLUSION

In conclusion, the use of twin-mix is highly beneficial for pain relief, facial swelling and trismus following mandibular third molar surgical removal.

Validity and Responsiveness of Measuring Facial Swelling With 3D Stereophotogrammetry in Patients After Bilateral Sagittal Split Osteotomy-A Prospective Clinimetric Study

Introduction: This study is aimed at determining the validity and responsiveness of three-dimensional (3D) stereophotogrammetry as a measurement instrument for evaluating soft tissue changes in the head and neck area. Method: Twelve patients received a bilateral sagittal split osteotomy (BSSO). 3D stereophotogrammetry, tape measurements, and a global perceived effect scale were performed within the first, second, and third postoperative weeks and at 3 months postoperatively. Distance measurements, mean and root mean square of the distance map, and volume differences were obtained from 3D stereophotogrammetry. Validity and responsiveness were assessed by correlation coefficients. Results: Significant correlations between distances from 3D stereophotogrammetry and tape measurements varied from 0.583 to 0.988, meaning moderate to very high validity. The highest correlations were found for the total sum of distances (r ≥ 0.922). 3D stereophotogrammetry parameters presented weak to high responsiveness, depending on the evaluated head and neck region. None of the parameters for 3D stereophotogrammetry significantly correlated with the global perceived effect scale outcomes for all measurement moments. Conclusion: 3D stereophotogrammetry has high to very high construct validity for the total sum of distances and weak to high responsiveness. 3D stereophotogrammetry seems promising for measuring soft tissue changes after surgery but is not interchangeable with subjective measurements.

Effect of Preoperative Administration of Dexamethasone vs. Methylprednisolone in Surgical Extraction of Impacted Lower Third Molars: Randomized Controlled Clinical Trial

Background/Objectives: Glucocorticoids are drugs that are increasingly used in oral surgery to reduce trismus, inflammation, and postoperative pain, three frequent complications after the surgical extraction of impacted lower third molars. The aim of this study was to compare the effect of 8 mg dexamethasone versus 40 mg methylprednisolone in the prevention of postoperative complications after third molar surgery. Methods: A randomized double-blind clinical trial was conducted following CONSORT guidelines. In detail, 84 patients were included in the study, who randomly received a single preoperative submucosal dose of dexamethasone (8 mg) or methylprednisolone (40 mg). The variables analyzed, as primary outcomes, were trismus, inflammation, and postoperative pain. The measurements were performed at baseline (0 h), 3 h, 7 h, 24 h, 48 h, and 7 th day using a Visual Analog Scale (VAS), Verbal Rating Scale (VRS), and the Gabka-Matsumara method. Results: Dexamethasone reduced trismus, inflammation, and postoperative pain significantly better than methylprednisolone. Conclusions: Preoperative submucosal administration of 8 mg dexamethasone is effective and safe in reducing the severity of postoperative complications following surgical extraction of impacted lower third molars.

Reliability of 3D Stereophotogrammetry for Measuring Postoperative Facial Swelling

This study aimed to determine the reliability of three-dimensional (3D) stereophotogrammetry as a measurement instrument for evaluating soft tissue changes in the head and neck area. Twelve patients received a bilateral sagittal split osteotomy (BSSO). Test and retest 3D photographs were captured within the first three postoperative weeks, and a reference 3D photograph was capture at three months postoperatively. Distance measurements, mean and root mean square of the distance map, and volume differences were obtained. Reliability of these parameters was assessed by intraclass correlation coefficients (ICCs), standard error of measurement (SEM), and smallest detectable change (SDC). All distance measurements had an ICC > 0.91, and the distance map parameters and volume differences showed ICCs > 0.89. The neck region presented the largest SEMs (5.09 mL) and SDC (14.1 mL) for the volume difference. In conclusion, 3D stereophotogrammetry is reliable for distance and volume measurements of soft tissues in patients after a BSSO advancement.

Novel Digital Measurement Technique to Analyze the Palatine Suture Expansion after Palatine Rapid Maxillary Expansion Technique

The aim of the study was to validate a novel digital measurement method to quantify the volume of the midpalatal suture after rapid maxillary expansion (RME). Material and methods: Eight patients with maxillary skeletal transverse deficiency were submitted to palatine suture expansion using the McNamara orthodontic appliance during a period of nine months. After 30 days of treatment, all patients were exposed postoperatively to a cone-beam computed tomography (CBCT) scan. Afterwards, the scans were uploaded into the three-dimensional orthodontic-planning software to allow the volumetric assessment of the palatine suture expansion through palatine rapid maxillary expansion using a McNamara appliance. The repeatability was analyzed by repeating twice the measures by a single operator and reproducibility was analyzed by repeating three times the measures by two operators, and Gage R&R statistical analysis was performed. Results: The expansion of the midpalatal suture by means of the rapid maxillary expansion technique, in terms of digital volume measurement, showed a repeatability value of 0.09% and between the two operators a reproducibility value of 0.00% was shown. Conclusions: The novel measurement technique demonstrated a high repeatability and reproducibility rate for volume assessment of the palatine suture expansion through palatine rapid maxillary expansion technique.