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

Introduction: Intra-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 1:200,000 epinephrine and 1 ml/4 mg dexamethasone) and modified twin mix (1.7 ml of 4% articaine with 1:100,000 epinephrine and 1 ml/4 mg dexamethasone) to two conventional local anesthesia solutions along with co-relation of clinical effects in the postoperative phase in patients undergoing extraction of impacted mandibular third molars in terms of patients comfort post-surgery. Materials and Methods: The 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 1:200,000 adrenaline and sub-group TM received twin mix. Sub-group A received 1.7 ml of 4% articaine with 1:100,000 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 postoperatively to assess the latency and efficacy of various anesthesia solutions used in this study for third molar removal. Results: Mean (+/- 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 postoperatively. Discussion: Intra-space administration of twin mix and modified twin mix is clinically efficacious in impacted mandibular third molars surgery with better clinical outcomes postoperatively. We observed one significant difference between TM and MTM that the latter solution provided a prolonged duration of anesthesia increasing the patient's comfort postoperatively after surgical removal of mandibular third molars. (C) 2019 Elsevier Masson SAS. All rights reserved.