Journal of the Korean Association of Oral and Maxillofacial Surgeons
- P-ISSN2234-7550
- E-ISSN2234-5930
- SCOPUS, KCI, ESCI
ISSN : 2234-7550
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e-SubmissionVol.48 No.6
Abstract
This systematic review evaluates current evidence regarding the feasibility of using needleless jet injection instead of a conventional local anesthetic needle. EBSCO, ProQuest, PubMed, and Scopus databases were used to identify relevant literature published in English from 2005 to 2020. Ten stud-ies were selected. Five of them were randomized clinical trials, 3 case-control studies, and 2 equivalence trials. Using the Critical Appraisal Skills Program checklist, 6 studies scored between 67% and 100%, and 4 studies scored between 34% and 66%. According to Jadad’s scale, 2 studies were considered strong, and 8 studies were considered moderate in quality. The results of the 10 studies showed differences in patient preference for needle-less jet injection. Needleless injection technique has been found to be particularly useful in uncooperative patients with anxiety and needle phobia. Needleless jet injection is not technique sensitive. However, with needleless jet anesthesia, most treatments require additional anesthesia. Conventional needle anesthesia is less costly, has a longer duration of action, and has better pain control during dental extraction. Needleless jet anesthesia has been shown to be moderately accepted by patients with a fear of needles, has a faster onset of action, and is an efficient alternative to conventional infiltra-tion anesthesia technique.
Abstract
Objectives: The purpose of this study is to investigate the characteristics of dentigerous and radicular cysts that occur between deciduous and suc-ceeding permanent teeth and to propose considerations for differential diagnosis of cysts at the treatment planning stage in the outpatient clinic. Materials and Methods: A total of 87 patients with a cystic lesion located between a deciduous tooth and the succeeding permanent tooth partici-pated in the study. Twelve variables were analyzed to diagnose such a cyst. For data analysis, Fisher’s exact test was used to determine the statistical significance of the variables. Results: Of the total 87 patients who participated in this study, 69 were diagnosed with dentigerous cysts and 18 were diagnosed with radicular cysts. Seven of the 12 differential factors analyzed in this study were statistically significant: age, location, symptoms, dental caries, endodontic treatment, delayed eruption, and size. Conclusion: Several criteria can be considered for diagnosis of dentigerous cysts or radicular cysts. Age, location, presence of symptoms and dental caries, previous endodontic treatment, cystic size, and delayed eruption of impacted permanent teeth are reliable factors that should be considered when diagnosing dentigerous and radicular cysts.
Abstract
Objectives: To compare the vital sign stability and cost of two commonly used sedatives, midazolam (MDZ) and dexmedetomidine (DEX). Patients and Methods: This retrospective study targeted patients who underwent mandibular third molar extractions under intravenous sedation using MDZ or DEX. The predictor variable was the type of sedative used. The primary outcome variables were vital signs (heart rate and blood pres-sure), vital sign outliers, and cost of the sedatives. A vital sign outlier was defined as a 30% or more change in vital signs during sedation; the fewer changes, the higher the vital sign stability. The secondary outcome variables included the observer’s assessment of alertness/sedation scale, level of amnesia, patient satisfaction, and bispectral index score. Covariates were sex, age, body mass index, sleeping time, dental anxiety score, and Pederson scale. Descriptive statistics were computed including propensity score matching (PSM). The P-value was set at 0.05. Results: The study enrolled 185 patients, 103 in the MDZ group and 82 in the DEX group. Based on the data after PSM, the two samples had simi-lar baseline covariates. The sedative effect of both agents was satisfactory. Heart rate outliers were more common with MDZ than with DEX (49.3% vs 22.7%, P=0.001). Heart rate was higher with MDZ (P=0.000). The cost was higher for DEX than for MDZ (29.27±0.00 USD vs 0.37±0.04 USD, P=0.000). Conclusion: DEX showed more vital sign stability, while MDZ was more economical. These results could be used as a reference to guide clinicians during sedative selection.
Abstract
Objectives: A single-blinded randomized controlled trial was designed to compare and evaluate the effectiveness of the periotome and piezotome as aids for atraumatic extraction and its sequalae. Materials and Methods: The study sample comprised 48 teeth, equally allotted to the piezotome or periotome groups by random allocation, in par-ticipants aged 19-62 years. All samples in both groups had either complete tooth structure or intact roots without crowns and had mobility ≤grade II. Clinical parameters of operative duration, presence or absence of gingival laceration, reported operative and postoperative pain, and intake of analge-sics following extraction were recorded. IBM SPSS software package version 22 was used for data entry and analysis. Results: The mean operation time was significantly (P≤0.05) longer in the piezotome group than in the periotome group. However, fewer gingival lac-erations were observed with use of a piezotome than with a periotome, although no significant difference was observed. The piezotome group reported significantly (P≤0.05) higher visual analog scale (VAS) pain scores during the procedure and non-significantly higher scores thereafter until the third postoperative day. In the piezotome group, the dosage of analgesic was higher, although the periotome group had a higher percentage of participants who used analgesics postoperatively; however, these differences were not statistically significant. Conclusion: The present clinical trial favors the use of periotome over piezotome for atraumatic extraction due to shorter operating time, lower post-operative VAS pain scores, and lower dosage of analgesics despite the superior ability of the piezotome to prevent gingival laceration.
Abstract
Objectives: This study aimed to investigate the efficacy of postoperative submucosal injection of hyaluronidase (HUD) for reducing sequelae and quality of life (QOL) after mandibular third molar (M3M) surgery. Materials and Methods: Participants with bilateral impacted M3M underwent surgical extraction with a split-mouth randomized controlled study design. M3M were removed by the same surgeon in 2 sessions, one a control and the other experimental. Submucosal injection of HUD was performed in the experimental session and submucosal injection of saline in the control session. Mouth opening, facial swelling, and pain intensity were measured before surgery, and then 2 and 7 days after surgery. The QOL of participants following surgery was evaluated by means of a patient-centered outcome questionnaire (PCOQ). Results: A total of 36 patients was included in the final data analysis. There was a significant reduction in the maximal mouth opening and postopera-tive pain in the experimental side at the 2 and 7 days after surgery (P<0.05), and a remarkable difference in facial swelling was reported on the experi-mental side 7 days after surgery (P<0.05). The PCOQ demonstrated that participants reported less pain and swelling on the experimental side. Conclusion: The present study provides clinical evidence that submucosal administration of HUD immediately after M3M surgery reduced postop-erative discomfort and improved patients’ QOL.
Abstract
Objectives: This study determined the effect of platelet-rich fibrin (PRF) on extraction socket bone regeneration and assessed the patterns and deter-minants of bone regeneration after the surgical extraction of impacted mandibular third molars. Materials and Methods: This prospective study randomly allocated 90 patients into two treatment groups: A PRF group (intervention group) and a non-PRF group (control group). After surgical extractions, the PRF group had PRF placed in the extraction socket and the socket was sutured, while the socket was only sutured in the non-PRF group. At postoperative weeks 1, 4, 8, and 12, periapical radiographs were obtained and HLImage software was used to determine the region of newly formed bone (RNFB) and the pattern of bone formation. The determinants of bone regeneration were as-sessed. Statistical significance was set at P<0.05. Results: The percentage RNFB (RNFB%) was not significantly higher in the PRF group when compared with the non-PRF group at postoperative weeks 1, 4, 8, and 12 (P=0.188, 0.155, 0.132, and 0.219, respectively). Within the non-PRF group, the middle third consistently exhibited the highest bone formation while the least amount of bone formation was consistently observed in the cervical third. In the PRF group, the middle third had the highest bone formation, while bone formation at the apical third was smaller compared to the cervical third at the 8th week with this difference widen-ing at the 12th week. The sex of the patient, type of impaction, and duration of surgery was significantly associated with percentage bone formation (P=0.041, 0.043, and 0.018, respectively). Conclusion: Placement of PRF in extraction sockets increased socket bone regeneration. However, this finding was not statistically significant. The patient’s sex, type of impaction, and duration of surgery significantly influenced the percentage of bone formation.
Abstract
Congenital epulis (CE) is an extremely rare benign tumor of the gingiva that is found on the alveolar ridge of newborns, and the main treatment option is simple excision. Postoperative prognosis is very good, and spontaneous regression may occur despite incomplete excision. This report presented a rare case of CE and its healing process after surgery under local anesthesia. The treatment plan was decided upon through consultation between a medi-cal team and the patient’s family, with surgical excision for the main lesion, which benefitted from surgery, and follow-up for a very small-sized lesion, which was thought to be appropriate for a newborn. No recurrence was found after its removal, and favorable healing was observed.
Abstract
Multiple odontogenic keratocysts (OKC) are a distinguishing feature of nevoid basal cell carcinoma syndrome (NBCCS). Owing to the high recurrence rate of syndromes associated OKCs, complete surgical resection is generally recommended as a definitive treatment. Herein, we report the manage-ment of multiple OKCs with marsupialization followed by excision with peripheral ostectomy in an NBCCS patient. We then discuss lesion progres-sion over 11 years of annual follow-ups.
Abstract
Cleft lip lower-lip deformity is a secondary deformity in patients who underwent primary cheiloplasty of the upper lip, characterized by an enlarged and anteriorly rotated lower lip. In these cases, soft-tissue imbalances remain even after skeletal correction with orthognathic surgery, and additional soft tissue treatment is required for lip harmony and esthetic facial balance in CLP (cleft lip palate) patients. This study describes three cases of trans-verse myomucosal excision of the lower lip for correction of cleft lip lower-lip deformity to restore facial esthetic balance. Each patient underwent orthognathic surgery, rhinoplasty, or upper lip revision cheiloplasty according to condition. Postoperatively, volume of the lower lip decreased and lip harmony was improved in all three patients. The surgeon should fully understand the anatomical structure around the lips and be able to evaluate over-all harmony of the soft tissue. When a lower lip deformity is present, careful surgical planning and execution are important for each patient.