Actigraphy-based differences in sleep in those receiving opioid versus non-opioid therapy postsurgical removal of impacted third molars: a pilot study from the opioid analgesic reduction study (OARS)

Sleep Medicine · 2026-04-09

Use of Nerve Tape for Sutureless Neurorrhaphy With Nerve Allograft in Repair of the Inferior Alveolar Nerve

Journal of Craniofacial Surgery · 2026-02-19

Reconstruction of the inferior alveolar nerve (IAN) following segmental mandibulectomy presents microsurgical challenges. Traditional neurorrhaphy using microsutures can be technically demanding, time-consuming, and may induce local trauma to the nerve graft. The authors report the case of a 52-year-old male with osteoradionecrosis of the mandible who underwent segmental mandibulectomy and immediate reconstruction of the IAN using an allogeneic nerve graft. For restoration of IAN continuity, a processed nerve allograft (Avance Nerve Graft, Axogen, Alachua, FL) was secured using Nerve Tape (BioCircuit Technologies Inc, Atlanta, GA), a sutureless coaptation device constructed with biological scaffold material and nitinol microhook technology to secure and align nerve ends. This product is composed of acellularized porcine small intestinal submucosal (SIS) tissue, like the Axoguard wrap, providing comparable handling and integration properties. This approach allowed rapid, atraumatic indirect neurorrhaphy of the IAN. Postoperative follow-up will be performed to determine whether progressive neurosensory recovery has occurred. Nerve Tape offers a promising alternative for nerve coaptation in trigeminal nerve reconstruction.

Intentional partial odontectomy and effect on inferior alveolar nerve injuries: a systematic review.

PubMed · 2026-04-02

OBJECTIVES: To synthesize current evidence comparing coronectomy (intentional partial odontectomy) and complete extraction of mandibular third molars in close radiographic proximity to the inferior alveolar nerve, focusing on neurosensory complications and other clinically relevant postoperative outcomes. DATA SOURCES: PubMed, Scopus, and Google Scholar databases were manually searched using strings combining terms such as 'coronectomy,' 'partial odontectomy,' 'root retention,' 'mandibular third molar,' 'extraction,' and 'inferior alveolar nerve injury.' Searches were conducted in accordance with PRISMA 2020 guidelines. CONCLUSION: Coronectomy significantly reduces the risk of inferior alveolar nerve injury in mandibular third molar surgery compared to extraction in cases with inferior alveolar nerve proximity. The main drawback to this technique is subsequent root migration, which is common but rarely clinically problematic. Careful patient selection and follow-up are essential in selecting this procedure.

Nonopioid vs opioid analgesics after impacted third-molar extractions

The Journal of the American Dental Association · 2025-01-04 · 9 citations

BACKGROUND: Opioids are still being prescribed to manage acute postsurgical pain. Unnecessary opioid prescriptions can lead to addiction and death, as unused tablets are easily diverted. METHODS: To determine whether combination nonopioid analgesics are at least as good as opioid analgesics, a multisite, double-blind, randomized, stratified, noninferiority comparative effectiveness trial was conducted, which examined patient-centered outcomes after impacted mandibular third-molar extraction surgery. Participants were randomized to receive 5 mg of hydrocodone with 300 mg of acetaminophen (opioid) or 400 mg of ibuprofen and 500 mg of acetaminophen (nonopioid). After an initial dose, analgesic was taken every 4 through 6 hours as needed for pain. RESULTS: In this randomized multisite clinical trial (n = 1,815 adults), those not taking opioids experienced significantly less pain (numeric rating scale ranging from 0 [no pain] through 10 [worst pain imaginable]) for first day and night (mean difference, -0.70; 95% CI, -0.94 to -0.45; P < .001) and second day and night (mean difference, -0.28; 95% CI, -0.52 to -0.04; P = .015), and experienced no more pain than participants taking opioids over the entire postoperative period (mean difference, -0.20; 98.75% CI, -0.45 to 0.05; P = .172). Participants not taking opioids had higher overall satisfaction at the postoperative visit (85.3% extremely satisfied or satisfied vs 78.9%; 95% CI, 1.21 to 1.98; P = .006). CONCLUSIONS: The ibuprofen and acetaminophen combination managed pain better for the first 2 days and led to greater satisfaction over the entire postoperative period than hydrocodone with acetaminophen. At no time did hydrocodone outperform the nonopioid. PRACTICAL IMPLICATIONS: Routine opioid prescribing after dental surgery is not supported. The results of this study confirmed the American Dental Association's recommendations that ibuprofen and acetaminophen in combination should be the first-line therapy for acute pain management. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT04452344.

What to do if a patient presents with an iatrogenic trigeminal nerve injury.

PubMed · 2025-02-26

OBJECTIVE: Injuries to branches of the trigeminal nerve can occur during various dental procedures, leading to neurosensory deficits. The aim of this article is to educate those who are not specialized in diagnosis and management of iatrogenic trigeminal nerve injuries what to do if such a situation arises in their practice. DATA SOURCES: Treatment protocols, prospective and retrospective studies, and literature reviews were reviewed. RESULTS: Patient history, neurosensory testing, and radiographic imaging are used to diagnose trigeminal nerve injuries. Based on findings, patients are either immediately referred to a specialist or managed conservatively. Conservative management includes pharmacologic treatment, neurosensory training exercises, and serial neurosensory testing. Consulting with local oral and maxillofacial surgeons or orofacial pain specialists, contacting local and state societies, or searching for providers on websites such as the American Association of Oral and Maxillofacial Surgeons, Academy for Orofacial Pain, American Board of Orofacial Pain, Oral and Maxillofacial Surgery National Insurance Company, or Axogen are different methods that can be used to find a specialist to refer to if indicated. CONCLUSIONS: Many providers are not trained to diagnose and manage iatrogenic trigeminal nerve injuries. Understanding indications for monitoring, conservative treatment, and when to refer these patients to orofacial pain specialists or oral and maxillofacial surgeons trained in trigeminal nerve microsurgery is critical to maximize positive patient outcomes and to minimize medicolegal exposure. (Quintessence Int 2025;56:154-160; doi: 10.3290/j.qi.b5984306).

Factors influencing outcomes of inferior alveolar nerve repair: a systematic review

Frontiers of Oral and Maxillofacial Medicine · 2025-06-11

Does Intra-Operative IV Dexamethasone Reduce Postoperative Pain More Effectively With Nonopioids or Opioids?

Journal of Oral and Maxillofacial Surgery · 2025-10-10

BACKGROUND: Corticosteroids reduce postoperative swelling and trismus. However, their role in pain management, particularly when combined with opioid versus nonopioid analgesics, is less understood. PURPOSE: The purpose of the study was to determine whether intra-operative corticosteroids reduce postoperative pain following third molar surgery and compare its effect on pain relief within nonopioid (NSAIDs and acetaminophen) and opioid analgesic treatment arms. STUDY DESIGN, SETTING, AND SAMPLE: This retrospective cohort study is based on the multicenter Opioid Analgesic Reduction Study (OARS) (n = 1,815). Participants who received oral corticosteroids (n = 41) were excluded. PREDICTOR VARIABLE: The primary predictor was the therapeutic treatment (opioid, nonopioid). Within each treatment arm, participants were grouped based on intra-operative steroid use (steroid, no steroid). MAIN OUTCOME VARIABLE(S): Average pain (numeric rating scale: 0 to 10) was measured on postoperative days 1, 2, and 3 and entire postoperative period. Secondary outcomes included satisfaction with pain medication, unused analgesic tablets, use of rescue opioids, and emergency clinic visits. COVARIATES: Covariates included age, sex, race/ethnicity, preoperative pain and swelling, number of teeth extracted, impaction level, anesthesia type, use of antibiotics, and the administration of 0.5% bupivacaine with 1:200,000 epinephrine. ANALYSES: Mixed-effects models estimated the interaction of analgesics by steroid use by time with random effects for study sites and participants. Differences were assessed using P < .00625 to account for multiple comparisons. RESULTS: The sample included 1,774 subjects with a mean age (SD) of 25.7(6.2) and 893(50.3%) were female. Analgesics by steroid groups were distributed as follows: nonopioid + no-steroid (626(35.3%)), opioid + no-steroid (635(35.8%)), nonopioid + steroid (265(14.9%)), and opioid + steroid (248(14.0%)). Steroid exposure was associated with lower day 1 postoperative pain in both the nonopioid group (mean difference 0.78; 99.375% CI 0.25 to 1.30; P < .001) and the opioid group (1.22; 0.68 to 1.77; P < .001). Across all days, the nonopioid + steroid group had the lowest pain scores, with a mean difference of 0.55 (-0.04 to 1.14; P = .026) compared with the nonopioid+ no steroid group. CONCLUSION: Intra-operative IV dexamethasone was associated with reduced pain for the first 24 hours following third molar surgery. Adding dexamethasone to either analgesic group improved pain control. Providers should consider incorporating intra-operative IV dexamethasone with postoperative nonsteroidal anti-inflammatory drugs and acetaminophen.

Case report: intraosseous capillary hemangioma presenting as an expansile lesion of the mandibular body with sunburst appearance with 2-year follow-up

Frontiers of Oral and Maxillofacial Medicine · 2025-03-21

Retrospective analysis of external pin fixation of mandibular fractures: A 25-year single institution experience

Journal of Cranio-Maxillofacial Surgery · 2025-02-07 · 2 citations

Analgesic Differences in Males and Females After Third Molar Surgery

JAMA Network Open · 2025-11-06 · 1 citations

This prespecified subgroup analysis of a randomized clinical trial investigates noninferiority for pain relief, treatment effects, and patient satisfaction for nonopioids vs opioids in male and female patients after impacted mandibular third molar extraction.