The present study was conducted to compare between extraoral and intraoral approach for botulinum toxin type A (BTX-A) injection into the lateral pterygoid muscle (LPM) in patients suffering from anterior disc displacement with reduction (ADDWR). Fourteen patients suffering from ADDWR were included in this prospective cohort study. Patients were enrolled randomly into 2 groups according to injection approach; where extraoral used in group I, while intraoral approach used in group II. The LPM was injected with 20 IU BTX-A under electromyography (EMG) guidance. Postoperative evaluation of the patients included: mouth opening assessment, LPM tenderness, temporomandibular joint TMJ (clicking), and tenderness. The LPM insertional EMG activity was assessed. Also, magnetic resonance imaging (MRI) was performed to evaluate disc position. Descriptive and inferential analysis was conducted to compare between groups. There was significant patient's convenience during injection and significant injection time reduction in group II. A slight decrease in mouth opening immediate post-injection followed by significant improvement from 8th weeks post-injection was reported in both approaches. There was a significant improvement in TMJ clicking from 1st-week post-injection with no group difference. The EMG assessment documented LPM hyperactivity pre-injection followed by significantly decreased muscle activity at 8 and 16 weeks post-injection without statistical difference. The MRI showed no change in disc position after injection. Conclusion: The BTX-A injection into LPM is a simple technique that can be used with high success and low complication rate for treatment of ADDWR. The intraoral approach was superior to the extraoral concerning patient convenience and injection duration with no statistical difference regarding other clinical outcomes.

Background: This study aimed to evaluate the midline mandibular lingual canals and foramina and their anatomic variations using CBCT scans. Methods: This study used retrospective analysis. A total of 320 CBCT scans were used to evaluate the study parameters, which comprised the presence or absence of the mandibular lingual foramen (MLF)/mandibular lingual canal (MLC) and its category, the distance between the buccal cortex and the start of the MLC, the distance between the inferior border of the mandible and the superior border of the foramen at its lingual and buccal terminals. The length and diameter of each canal at its lingual and buccal terminals. Results: MLC was found in all included CBCT scans. Out of 320 included CBCT scans, a single canal was represented by 30.9%, double canals (Supra with Infra -spinosum) configuration appeared in 54.7%, and triple canals (Supra-Inter-Infra) represented 14.7%. The supraspinosum canals averaged 5.81 ± 2.08 mm in length and 0.87 ± 0.30 mm in diameter at the lingual terminal. In terms of the number of canals, there was a significant difference between men and women (p ≤ 0.001), with 60% of the men in the sample having double canals and 43.1% of the women having single canals. Moreover, the male gender had a higher prevalence of triple canals (21.3% vs. 8.1%) than females. Males and females were distributed equally among the supraspinosum canals, with no statistically significant difference (p ≤ 0.7). A considerable increase in the finding of interspinosum and infraspinosum canals was seen in the male sample (p ≤ 0.001). Conclusions: midline mandibular canals were found in all investigated CBCTs of the sample of both sexes; however, the anatomy and location of the MLF and canals varied significantly among the Saudi population.

Introduction: Gummy smile (GS) is a nonesthetic condition that affects the confidence of many young people. The present study aimed to compare the results of two approaches used in the management of GS in a group of Egyptian females. Materials and Methods: This comparative cohort study included 24 female patients aged 25–35 years, divided into two groups. Group A included patients treated with diode dental laser gingivectomy, while Group B included patients who were treated with Botox injection. The clinical assessment of the pre-and post-operative measurements of exposed gums in millimetres on an active full smile was analyzed and compared for both groups. The paired t-test was used to compare pre and post measurements in each group, and the mean difference between the groups was compared using the independent t-test. Results: Group A showed instant improvement, while Group B results appeared 1 week later. The variation between preoperative and postoperative GS measurements in both groups was statistically significant. The preoperative and postoperative mean ± standard deviation was (5.17 ± 0.9 and 1.89 ± 0.5) in Group A and (4.27 ± 1.0 and 1.79 ± 1.0) in Group B. Comparison between the two groups revealed a highly significant greater mean difference of 3.27 ± 0.5 mm in Group A than Group B (P < 0.001). The findings were satisfactory in all cases of both approaches, and there were no complications. Discussion: Using a diode laser to treat gummy smiles for oro-dental genetics case with gingival hypertrophy saves time and effort compared to conventional surgical techniques. Diode dental laser is a safe fast and effective method of treatment giving more superior results than Botox injection which showed a less invasive alternative temporary GS therapy that is easily guaranteed and more patient-favored.