Comparison of latency and efficacy of twin mix and modified twin mix in impacted mandibular third molar surgery A preliminary randomized triple blind split mouth clinical study.

Abstract

INTRODUCTION\nIntra-space drug administration have recently gained popularity in the clinical practice posing several advantages over the conventional routes of drug administration. A preliminary prospective randomized triple blind clinical study was conducted to compare the latency and duration of anesthesia with twin mix (1.8 ml 2% lignocaine with 1:2,00,000 epinephrine and 1ml/4mg dexamethasone) and modified twin mix (1.7 ml of 4% articaine with 1:1,00,000 epinephrine and 1ml/4mg dexamethasone) to two conventional local anesthesia solutions along with co-relation of clinical effects in the post-operative phase in patients undergoing extraction of impacted mandibular third molars in terms of patients comfort post-surgery.\n\n\nMATERIALS AND METHODS\nThe study was conducted among 20 patients with bilateral impacted mandibular third molars who were randomly allotted to two groups, Group A and B. Each patients in both the groups was allotted with study and control site. Among Group A, patients were further divided into Sub-group L (Control) and Sub-group TM (Twin Mix). Group B patients were divided as Sub-group A (Control) and sub-group MTM (Modified Twin Mix). Sub-group L patients received 1.8 ml of 2% lignocaine with 1:2,00,000 adrenaline and sub-group TM received twin mix. Sub-group A received 1.7ml of 4% articaine with 1:1,00,000 adrenaline and sub-group MTM received modified twin mix solution. All the procedure was performed by a single operator with a gap of 1 month between the two interventions among both the groups. Various subjective and objective parameters were measured pre-operatively and post-operatively to assess the latency and efficacy of various anesthesia solution used in this study for third molar removal.\n\n\nRESULTS\nMean (±SD) VAS scores for sting on injection and pain were found to be less in TM and MTM sub-group with a score of 2.3 (± 0.768) and 2.7 (± 0.065) respectively. The anesthetic latency was significantly less in sub-group TM, with a mean (±SD) of 52.4 (± 28.3) seconds. Sub-groups A and MTM had longer latency of anesthesia when compared with L and TM sub-groups. The duration of soft tissue anesthesia was maximum in sub-group MTM as compared to the other sub-groups. Patients from control sub-groups among both the groups had increased swelling, post-surgical pain and trismus post-operatively.\n\n\nDISCUSSION\nIntra-space administration of twin mix and modified twin mix is clinically efficacious in impacted mandibular third molars surgery with better clinical outcomes post-operatively. We observed one significant difference between TM and MTM that the latter solution provided a prolonged duration of anesthesia increasing the patient s comfort post-operatively after surgical removal of mandibular third molars.