Oral surgery

  1. Dimensions of 3D usage
A literature review sought to answer the following questions: Who uses 3D printing in maxillofacial surgery (MFS) and is it routine or not? What are the main clinical indications and what are the kinds of objects used? Are these objects printed by an official medical device (MD) manufacturer or made directly within the department or the lab? What are the advantages and drawbacks? Articles (n=297) from 35 countries met the criteria, the most represented was the People's Republic of China (16%) and 2,889 patients benefited from 3D printed objects. The most frequent clinical indications were dental implant surgery and mandibular reconstruction. The most frequently printed objects were surgical guides and anatomic models of which 45% were professionally printed. The main advantages were improvement in precision and reduction of surgical time. The main disadvantages were the cost of the objects and the manufacturing period when printed by the industry. The authors conclude that although 3D printed objects are easily available they will never replace a surgeon’s skill and should only be considered as useful tools.

Louvrier A et al. How useful is 3D printing in maxillofacial surgery? J Stomatol Oral Maxillofacial Surg 2017 Jul 18.

Q What are the main disadvantages to the use of 3D printing in maxillofacial surgery?
A Cost and time to manufacture
B Replacement of surgeons’ skills and reduction of accuracy
C Increased surgical time and no application to dental implants
D Mainly available in China and not very precise

  1. Concentration is key
This study aimed to evaluate the efficacy and safety of 2% lidocaine with 1:80,000 or 1:200,000 epinephrine for surgical extraction of bilateral impacted mandibular third molars.
Sixty-five healthy participants underwent the procedure in two separate visits with 2% lidocaine at the different epinephrine concentrations in a double-blind, randomised, crossover trial. Visual analogue scale pain scores were obtained immediately after surgical extraction and 2, 4, and 6 hours after administering the anaesthetic. Onset and duration of analgesia, onset of pain, intraoperative bleeding, operator’s and participant’s overall satisfaction, drug dosage, and hemodynamic parameters were evaluated. There were no statistically significant differences between the groups in any measurements except that systolic blood pressure and heart rate following anaesthetic administration were significantly greater in the group receiving 1:80,000 epinephrine. The study concluded that difference in epinephrine concentration did not affect the medical efficacy of the anaesthetic but that 2% lidocaine with 1:200,000 epinephrine has better safety in hemodynamically unstable patients.

Karm MH et al. Comparison of the efficacy and safety of 2% lidocaine HCl with different epinephrine concentration for local anesthesia in participants undergoing surgical extraction of impacted mandibular third molars: A multicenter, randomized, double-blind, crossover, phase IV trial. Medicine 2017 96: e6753.

Q The main difference between using 2% lidocaine with 1:80,000 or 1:200,000 epinephrine is:
A Onset of anaesthesia
B The former is more painful to administer
C There are no differences
D The latter has better safety for patients with blood pressure concerns or heart conditions