Journal of Pharmacy And Bioallied Sciences

ORIGINAL ARTICLE
Year
: 2021  |  Volume : 13  |  Issue : 5  |  Page : 492--495

Factors influencing clinical after effects of post orthognathic surgery - An observational clinical study


Saba Nasreen1, Mohammed Saif Tagala2, Sandeep Kumar Samal3, Abhinav Raj Gupta4, Ram Prasad Sah1, Debarshi Bhattacharjee5,  
1 Senior Resident, Department of Dentistry, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India
2 Senior Lecturer, Guardian College of Dental Sciences & Research Centre, Ambernath, Thane, Maharashtra, India
3 Professor, Department of Oral And Maxillofacial Surgery, Hitech Dental College and Hospital, Bhubaneshwar, Odisha, India
4 Consultant Orthodontist, Department of Cleft & Craniofacial Anomalies, Patna, Bihar, India
5 Senior Lecturer, Department of Orthodontics, Avadh Dental College and Hospital, Jamshedpur, Jharkhand, India

Correspondence Address:
Ram Prasad Sah
Department of Dentistry, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar
India

Abstract

Background: For maintaining the occlusion, screws to anchor bones are needed to be used in transalveolar manner to get the intermaxillary fixation in participants with no preoperative orthodontic treatment or participants with loose or broken appliances. Aims: The present clinical trial was hence aimed to assess the postoperative complications following orthognathic surgical repair of skeletal malocclusion. Materials and Methods: Forty-two participants were divided into two groups (n = 22). In Group I, predrill was done to create the holes in transalveolar position before screw insertion. For Group II, self-cutting screws were used without the drills. The radiographs were then taken to assess the associated root injuries. To evaluate the effect of different steroid doses on the pain, nerve healing, and swelling, the participants were divided into three groups (n = 14). Plate removal and associated factors were also evaluated. Collected data were statistically analyzed. Results: In Group where no predrill was done, no root injuries were seen. Considerably less facial edema was observed in Group II and III compared to control Group I. This difference was statistically significant with a P value of 0.2057. At 1 week, 3 months, and 6-month postoperatively in Group II and Group III, no significant difference was seen. No significant difference in the postoperative pain between the groups was seen (P = 0.85103). Neurosensory Visual Analog Score measurement revealed no significant difference between three groups at 6 months with the P value of 0.81821. Conclusion: The present study concludes that risk for the root injury is possessed by the screws that require predrill, whereas the self-drilling screws had no risk for root injury.



How to cite this article:
Nasreen S, Tagala MS, Samal SK, Gupta AR, Sah RP, Bhattacharjee D. Factors influencing clinical after effects of post orthognathic surgery - An observational clinical study.J Pharm Bioall Sci 2021;13:492-495


How to cite this URL:
Nasreen S, Tagala MS, Samal SK, Gupta AR, Sah RP, Bhattacharjee D. Factors influencing clinical after effects of post orthognathic surgery - An observational clinical study. J Pharm Bioall Sci [serial online] 2021 [cited 2021 Oct 26 ];13:492-495
Available from: https://www.jpbsonline.org/text.asp?2021/13/5/492/317653


Full Text



 Introduction



Disturbances in the dental bone and face usually lead to deformities in the dentofacial complexes. These disturbances often affect occlusion, stomatognathic system, neuromuscular system, and facial esthetics. Furthermore, these changes disturb mastication, respiration, and speech along with mental health, quality of life, and confidence.[1] Orthognathic surgery aims at the correction of malocclusion, improving mental health, confidence, and quality of life for participants with dentofacial deformities. Despite high patient satisfaction postorthognathic surgery, there are reported cases with desirable outcomes where the subject reports dissatisfactory results in terms of mental satisfaction.[2]

Adequate involvement of orthodontics and surgery is essential to obtain the desirable results in orthognathic surgery. Proper planning before, during, and after orthognathic surgery play an important role to achieve the desired outcomes. These outcomes involve decrease morbidity and rapid postoperative recovery.[3],[4] Postoperative complications include pain, swelling, teeth damage, plate exposure/removal, paresthesia, altered neuromuscular coordination, and delayed healing.[5]

Anchorage achieved intra-operatively to render optimal functional occlusion is vital and requires a meticulous decisive approach during the surgical protocol. To maintain the achieved occlusion, screws to anchor bones are needed to be used in transalveolar manner to get the intermaxillary fixation in participants with no preoperative orthodontic treatment or participants with loose or broken appliances.[6] In the postoperative healing phase, steroids are usually prescribed to the patients to assist in better healing with less pain, edema, nausea, and better neurosensory healing. At times, the plate requires removal when secondarily infected, exposed, or owing to other complications. These factors require further considerations and investigations.[7]

The present clinical trial was hence aimed to assess the tooth root injury associated with two different screw types used in intermaxillary fixation. Furthermore, the effect of different steroid dose on the pain, nerve healing, and swelling following bilateral sagittal split osteotomy (BSSO) was assessed. The present trial also evaluated the factors warranting the plate removal along with its incidence.

 Materials and Methods



The present, randomized clinical trial was aimed at evaluating the outcomes of orthognathic surgery. Forty-two participants were recruited from the department of orthodontics and dentofacial orthopedics. The participants included were the ones that required the intermaxillary fixation using the screws for bone anchorage, systemically healthy participants with no contraindication to anesthesia and surgery, American Society of Anesthesiologists I or II physical state, no current long-term medication, participants warranting/treated with genioplasty, BSSO, bimaxillary surgeries, or Le Fort I osteotomies. Patients with ligatures or arch bars used in intermaxillary fixation were excluded from the study. Furthermore, the patients having relative or absolute contraindication for the steroid use were exempted from the trial.

Edema of the face was assessed by calculating the distance from chin to the earlobes (inferior border) in millimeters. Pain and neurosensory assessment was done using Visual Analog Score from the values ranging from 0 to 10, where zero indicates minimum and 10 indicates the maximum. To assess the quality of life, a questionnaire was given to all 40 participants.

To assess the tooth root injury associated with two different screw types used in intermaxillary fixation, 42 participants were divided into two groups (n = 22). Two different screw types were used in two groups with intermaxillary fixation using steel ligature. In Group I (n = 22), predrill was done to create the holes in the transalveolar position before screw insertion. For Group II, self-cutting screws were used without the drills. The radiographs were then taken to assess the associated root injuries. Intraoperatively, care was taken to protect the nerves. Postoperatively, analgesics and antibiotics were given for 3 days, and steroids were prescribed as the described schedule. The included participants were within the age range of 18 years to 30 years, with a mean age of 22.7 years. Pain scores and neural scores were significantly lesser in all the participants at 6 months and the nonsignificant difference was seen between the groups.

To evaluate the effect of different steroid doses on the pain, nerve healing, and swelling, the participants were divided into three groups (n = 14). In Group I, no steroid was administered, whereas, in Group II, 4 mg betamethasone was given to the patients 1-day presurgery and 1-day postsurgery, 8 mg betamethasone at anesthesia induction. In Group III (n = 14), only a single dose of 6 mg at anesthesia induction was given. The recording for pain, edema, and neural sensitivity was recorded at baseline (immediately before surgery), and postoperatively (at day 1, 7, 2 months, and 6 months) by a single examiner.

Concerning factors warranting the plate removal along with its incidence, retrospective data were collected. All the procedures were performed in maxilla, mandible, or chin using titanium plates. The location of the plate removal and their numbers were noted. The plates were removed which were infected or if participants had complained of discomfort added with the clinician's judgment about tenderness, infection, exposure, and esthetics were considered. All the collected data were statistically analyzed.

 Results



Tooth root injury using self-drilling and the screws where predrill was required were assessed. It was found that all the tooth root injuries were only in the participants with screws where predrill was used. In Group where no predrill was done, no root injuries were seen. These findings are narrated in [Table 1].{Table 1}

Regarding steroid intake, considerably less facial edema was observed in Group II and III compared to control Group I. This difference was statistically significant with a P value of 0.2057. Steroid intake and resulting parameters are summarized in [Table 2].{Table 2}

The plate removal was done in a total of seven participants (16.66%). Among these, the most common cause was plate infection in 28.57% participants (n = 2). With the antibiotic therapy, eight plates survived and were not removed. Out of the removed seven plates, three were removed in the first 3 months, and rest 4 were removed in 6 months. Other reasons for plate removal were tenderness, discomfort, and exposure. More plates were removed in the mandible compared to the maxilla [Table 3].{Table 3}

 Discussion



The present study showed that all the injuries to the root were associated with the screws that required the predrill and not with the self-drilling screws. At 6 months' final recall, 10 teeth were completely damaged from the screw injuries. Regarding the treatment, one tooth warranted extraction, whereas 12 required endodontic therapy and 6 recovered without any intervention. In Group where no predrill was done, no root injuries were seen. Similar findings were confirmed by Dao et al.[8] in 2009 and Coletti et al.[9] in 2007. Another study by Fabbroni et al.[10] in 2004 showed 11.2% of major root injuries were seen with twist drills. Hence, the preassessment of the screw position is needed.

Different steroid doses presurgery and postsurgery were also assessed for the clinical outcomes of orthognathic surgery in terms of pain, neural healing, and edema. Considerably, less facial edema was observed in Group II and III compared to control Group I (P = 0.02057). No significant difference in the postoperative pain between the groups was seen (P = 0.85103). Paraesthesia was seen in four patients postsurgically which improved on its own at 6 months recall. Similar findings were given by Weber et al. and Al-Bishri.[11] in 2004.

In Group I, no steroid was administered, whereas, in Group II, 4 mg betamethasone was given to the patients 1-day presurgery and 1-day postsurgery, 8 mg betamethasone at anesthesia induction. In Group III (n = 14), only a single dose of 6 mg at anesthesia induction was given. The recording for pain, edema, and neural sensitivity was recorded at baseline (immediately before surgery) and postoperatively (at day 1, 7, 2 months, and 6 months) by a single examiner. Al-Bishri[11] also reported the same findings. Ylikontiola L et al.[12] in 2000 showed neurosensory improvement following steroid intake which was not in agreement with the present study.

The plate removal was done in a total of seven participants (16.66%). Among these, the most common cause was plate infection in 28.57% participants (n = 2). With the antibiotic therapy, eight plates survived and were not removed. Out of the removed seven plates, three were removed in the first 3 months and rest 4 were removed in 6 months. Other reasons for the plate removal were tenderness, discomfort, and exposure. More plates were removed in the mandible compared to the maxilla. The most common cause had been the infection. Similar findings were shown by Alpha et al.[13] in 2006.

 Conclusion



The study concludes that risk for the root injury is possessed by the screws that require predrill, whereas, the self-drilling screws had no risk for root injury. Steroid intake before surgery showed reduced edema and pain. However, no effect of steroid intake was on neurosensory healing. The plate removal is done most commonly owing to the infection.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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