Does mallampati score affect the technical success of the inferior alveolar nerve block and posterior mandibular surgical procedures?

Background and Aim: The aim of this randomized prospective study was to assess the effect of Mallampati score on the technical success of the inferior alveolar nerve block and posterior mandibular surgical procedures. Material and Methods: A total of 150 adult patients who required inferior alveolar nerve blocks for dental surgery in the lower posterior region were included in this study. A research fellow documented the Mallampati score, age, gender, and body mass index of patients. A resident blinded to the Mallampati scoring performed the local anaesthesia and surgical procedures and documented the technical difficulty scores during the inferior alveolar nerve block and surgical procedures, latent period of local anaesthesia, and total volume of injected anaesthetic solution. The data were statistically analyzed. Results: There were statistically significant differences between the patients with different Mallampati scores in terms of age, technical difficulty score of inferior alveolar nerve block, and technical difficulty score of surgical procedure (p<0.05). Technical difficulty scores of the inferior alveolar nerve block were significantly higher in Mallampati class III and IV patients than in class I patients. Technical difficulty scores of the surgical procedure were significantly higher in Mallampati class II, III, and IV patients than in class I patients. Conclusions: The knowledge and/or clinical assessment regarding Mallampati classification in the field of dentistry is scarce and should be improved. Dental clinicians should be aware of the possible relationship between high Mallampati score and unsuccessful inferior alveolar nerve block or technical difficulty of a posterior mandibular surgical procedure

Changes in the lower lip soft tissue after bone graft harvesting from the mandibular symphysis

WOS: 000392039700021PubMed ID: 27688167Following the surgical release of the mentalis muscle, lip incompetence and/or an increase in lower incisor exposure may be seen due to undesirable attachment of the muscle fibres. The aim of this study was to evaluate the extent of lip ptosis, lower incisor exposure, and other soft tissue changes following bone graft harvesting from the mandibular symphysis when the mentalis muscle is reapproximated precisely to its original position. Seventeen consecutive patients who underwent bone graft harvesting from the mandibular symphysis were included in this study. The mentalis muscle was isolated, identified, marked, and reapproximated precisely during the bone harvesting operation. Digital lateral cephalograms obtained preoperatively and at 6 months postoperative were analyzed and compared by paired samples t-test to determine the horizontal and vertical soft tissue changes in the lower lip and chin. Although the soft tissue thickness at soft tissue point B and at soft tissue pogonion had increased significantly at 6 months after chin bone graft harvesting, there were no significant changes in lower incisor exposure or other positional alterations of the lower lip (P < 0.05). Precise reattachment of the mentalis muscle in its original position helps to avoid significant vertical positional changes in the lower lip. Increases in soft tissue thickness can be observed following bone graft harvesting from the mandibular symphysis.Baskent University Institutional Review Board [D-KA15/16]This study was approved by Baskent University Institutional Review Board (Project No. D-KA15/16)

Alveolar ridge splitting versus autogenous onlay bone grafting: Complications and implant survival rates

WOS: 000398802400017PubMed ID: 28114264Purpose:To compare the complications and implant survival rates of localized alveolar ridge deficiencies in the horizontal dimension reconstructed by alveolar ridge splitting (ARS) or autogenous onlay bone grafting (OBG).Materials and Methods:Twenty-eight ARS and 28 OBG were performed. The survival rate of the all included implants was evaluated using the clinical and radiographical evaluation criteria of Misch et al. Temporary exposure of graft, mild infection, temporary paresthesia, and bad split were defined as minor complications; permanent exposure of graft, loss of graft, and permanent paresthesia were defined as major complications. Major and minor complications of ARS and OBG groups were statistically compared.Results:When the minor and major complication rates are considered, there was not any statistically significant difference between OBG (P = 0.099) and ARS (P = 0.241) groups. The satisfactory survival rate of OBG group was 92% and was 100% in the ARS group, and the difference was not statistically significant (P = 0.116).Conclusion:When reconstructing vertically sufficient but horizontally insufficient alveolar ridges, ridge splitting technique could shorten the treatment period, decrease postoperative swelling and pain, eliminate the need for a second surgical site, reduce the treatment cost, and ease the patient cooperation to the surgery

Comparison of success rate of dental implants placed in autogenous bone graft regenerated areas and pristine bone

Autogenous bone grafting still has been considered as the "gold standard" and wildly used in the case of alveolar bone reconstruction. The aim of the present study is to evaluate the success rate of implants placed in autogenous block augmented ridges and implants placed in pristine bone (PB). This study included 113 patients. Fifty-three patients were treated with autogenous block grafts and particulate bone, after 6 months of healing implant placements were performed in autogenous bone augmented (ABA) areas. In 60 patients implant placement was performed, with no need for grafting and implants were placed into the PB. Follow-up data (pain, mobility, exudation from peri-implant space, success rate, marginal bone resorption) were collected after 5 years of prosthetic loading. The cumulative implant success rate at the 5-year examination was 92.45% for the ABA group and 85% for PB group. There were 3 failed implants in the ABA group and 3 in PB group. Average marginal bone loss was 1.47 mm on ABA group and 1.58 mm on PB group. No statistically significant differences for pain, exudation from peri-implant space, implant mobility, implant success, peri-implant bone loss parameters, and patient satisfaction level were found between groups. The obtained data demonstrated that the success rate of implants placed in regenerated areas are very similar to the success rate of implants those placed in PB

Changes in difficult airway predictors following mandibular setback surgery

WOS: 000363826000005PubMed ID: 26206397The aim of this study was to determine the effect of surgical mandibular backward movements on the predictors of a difficult airway. Thirty-seven skeletal class III patients were included in this study. The Mallampati score, body mass index (BMI), maximal inter-incisal distance, and thyromental and sternomental distances of these patients were evaluated preoperatively and at 6 months and 2 years postoperatively. A sagittal split ramus osteotomy (SSRO) without genioplasty was performed in all patients by the same surgical team, and anaesthesia was provided by the same anaesthesiologist using nasotracheal intubation. The paired samples t-test and Wilcoxon signed-rank test were used for statistical comparisons of the data. There were no statistically significant changes in BMI or sternomental and thyromental distances after SSRO. The maximal inter-incisal distance was significantly reduced at 6 months postoperatively (P < 0.05), but no statistical difference was found between the values obtained preoperatively and at 2 years postoperative. A statistically significant increase in Mallampati score was observed postoperatively (P < 0.05). Both the patient and practitioner should be aware of the risks associated with an increased postoperative Mallampati score in mandibular setback patients. The amount of mandibular setback in skeletal class III patients with a high preoperative Mallampati score should be limited to prevent potential postoperative airway problems