Comparison of twin mix and revamped twin mix in mandibular third molar surgery - A randomised controlled double blinded study

Abstract

Mandibular third molar surgery is one of the most common minor oral surgical procedures performed by oral and maxillofacial surgeons. It is vital to provide the most comfortable postoperative phase to the patient and for this reason dexamethasone, a corticosteroid, is popularly used in various routes. The intraspace injection of dexamethasone mixed with 2% lignocaine and 4% articaine named, Twin Mix and Modified Twin Mix respectively is gaining increasing popularity. 0.5% Centbucridine is a safe alternative to 2% lignocaine with more cardio stable properties. In this study we aimed to evaluate the comparability of Twin Mix(TM) and Revamped Twin Mix(RTM) (mixture of dexamethasone and centbucridine) with respect to its anesthetic properties and its effectiveness in managing postoperative sequelae following mandibular third molar surgery. For this, a randomised controlled double blinded study was conducted among patients reporting to the Out Patient Department of a dental college. The sample size of the population studied was 32, 16 in Group A (RTM) and 16 in Group B (TM). The primary outcomes measured were facial swelling and mouth opening on postoperative day(POD) 1, 3 and 7. The secondary outcomes were VAS score during the surgical procedure, duration and latency of anesthesia. The data were analysed descriptively and using Student’s t Test. Representations were given in graphical and tabular forms. The mean postoperative mouth opening and facial swelling on POD 1, 3 and 7 were comparable and did not show any statistically significant difference. Similarly, the VAS score during procedure, latency and duration of anesthesia were comparable with no statistically significant difference. In conclusion, RTM can be used as an alternative to TM due to its comparable properties.

Twin Mix Inferior Alveolar Nerve Anaesthesia for Transalveolar Extraction of Mandibular Third Molar Surgery: Review of Current Evidence

“…The studies relevant to the use of twin-mix solution are summarized in table 1. 9,10,11, 26,27,28,29,30,31,32 Bhargava D et al first proposed clinical use of the twin mix anaesthesia for mandibular nerve block in 2013 by evaluating this anaesthetic technique and the admixture of drugs through their prospective clinical randomized double-blind study to evaluate latency & efficacy of twin-mix solution & 2% lignocaine with 1:200,000 adrenaline for the transalveolar extraction of impacted mandibular third molars. 9 Gaur S et al conducted a randomized controlled trial evaluating the altered twin mix local anaesthesia using two long acting amide local anesthetic solutions: bupivacaine & ropivacaine with/without 4 mg/ml dexamethasone solution for patients undergoing 3 rd molar surgical extraction.…”

“…Authors concluded that RTM can be used as an alternative to TM considering its comparable properties. 28 Bhargava D et al conducted a clinical prospective randomized trial to evaluate post-operative quality of life (QoL) in patients undergoing surgical intervention for isolated vertically undisplaced parasymphysis mandibular fracture with twin mix (TM) anesthetic solution and concluded that the 'TM' solution proves to be more advantageous as compared to the conventional local anaesthetic solution as the former provides an improved clinical outcomes with enhanced the post-operative QoL in patients undergoing open reduction & internal fixation (ORIF under LA) for an undisplaced parasymphysis fractures. 29 This data is in consistence with effects observed with minor oral surgical procedures like transalveolar extractions.…”