Hard Tissue Surgery Research Articles

Update on suspensory suture techniques in reconstructive periodontal surgeries.

Reconstructive periodontal surgery, which has received more and more interest in modern periodontology, can help save severely compromised teeth and solve aesthetic problems caused by the destruction of periodontal tissues in periodontal diseases. Unfortunately, there is fewliteratures reviewing the use of suspensory suture techniques in reconstructive periodontal surgeries. Anelectronic search of the PubMed andWeb of Science was performed. Full-text articles were obtained from the records after screening in the title and abstracts. Effective suture is of central importance to a successful treatment outcome of periodontal surgeries, especially incremental soft or hard tissue surgeries. Limitations in suture techniques may negatively affect the intimate contact of the affected tissues, wound closure and stabilization, and successful wound healing. Suitable anchors can be selected to help achieve this objective. Suspensory sutures may be more precise suture techniques, due to the use of relatively immobile anchors. This review aims to provide key points of successful wound healing and summarize the current state of the suspensory suture techniques for reconstructive periodontal surgeries in daily practice, including their treatment application, detailed steps, advantages, and disadvantages.

High efficiency in-band pumped Tm- and Ho-doped 2-μm solid-state lasers

The expansion of laser sources operating at 2-3 μm is motivated in large by strong absorption in atmospheric gases, liquid water, and plastics, critical for applications in remote sensing, soft and hard tissue surgery, and materials processing. 2-μm novel solid-state lasers based on Tm3+-doped ceramics (Lu2O3 or Y2O3) or YAP crystals in-band pumped by a fiber laser at 1670 nm are presented in this report. CW, actively or passively Q-switch operations of the Tm3+-doped lasers are described. The Tm3+ laser characteristics are compared with parameters of an in-band fiber-laser-pumped Ho3+:YAG laser. The 2-μm output of the lasers are used to pump the Cr2+-doped ZnSe or CdSe crystals. The lasers based on the Tm3+:Lu2O3 ceramics and the Tm3+:YAP crystal are also used as pump sources for mid-IR optical parametric oscillators (OPOs) or second-harmonic generators (SHGs). The high-efficiency oscillations are obtained at 3.8-4.1 μm in the OPOs based on a fun-out PPMg:LN; the SHGs provided the repetitively-pulsed radiations at 970-983 nm.

Laser Bandage: Deal to Heal

Introduction of LASER to the field of dentistry has been proved to be a boon to the dental professionals. It can be used for a variety of treatments ranging from simple procedures like removal of caries to more complex procedures such as soft and hard tissue surgeries. The reasons for its increasing demand in dentistry includes decreased operator time enhanced efficiency and better clinical outcome. In the previous years Light Amplification by Stimulated Emission of Radiation LASER has also been used for haemostasis in which a ldquochar layerrdquo or an ldquoescharrdquo is usually formed. Recently with the advancements in LASER technology and knowledge about LASER the term LASER bandage has been proposed in which the LASER is used in the lowest settings settings of low wattage no water and some air with fewer pulses per second to put a coating on the tissues for haemostasis to decrease pain from an oral lesion or to make small alterations to a soft tissue surgery. Application of laser bandage after any surgical procedure decreases post-operative pain healing period thereby enhancing post-operative patient comfort.

Instantaneous Reaction and Vibration Suppression Using Two-Degree-of-Freedom Admittance Control with H∞ Feedback Controller in Surgical Training Simulator with Chiseling Operation

Surgical training simulators with virtual reality have been developed to enable surgeons to efficiently acquire and improve their surgical skills. In hard tissue surgery, the surgeon uses a chisel and mallet to cut a bone or tooth with large and instantaneous forces. In the previous study by present authors, to represent the force sensation of the cutting operation in the virtual training simulator, we constructed the force display device using the ball-screw mechanism to obtain high stiffness and display the large force. Additionally, we applied the two-degrees-of-freedom (2DOF) admittance control to react instantaneously to the impact force by pounding with the mallet. The feedback controller of the 2DOF admittance control is required to increase the high-frequency gain for improving the responsiveness of the force display device. However, the vibrational mode of the force display device can be excited by increasing the controller gain. Therefore, this study develops the design approach of the feedback controller using the H∞ control in the 2DOF admittance control system, which can be systematically constructed to reduce the vibrational mode and react instantaneously in the force display device. The efficacy of the proposed force display control system is verified through the virtual experience of the free movement and the hard contact operations.

Composites Containing Nanohydroxyapatites and a Stable TEMPO Radical: Preparation and Characterization Using Spectrophotometry, EPR and 1H MAS NMR

Hydroxyapatite is the main constituent of mammalian hard tissues. Basic applications of synthetic hydroxyapatites include bone and dental implantology and drug delivery systems. The study of hydroxyapatite surface properties could give greater insight into the processes of bone mineralization and degradation. Nitroxide radicals are stable radicals that exhibit anticancer and antioxidative properties and are often used as spin probes to study the dynamics of complex biological systems. In this work, we attempted to adsorb the stable 2,2,6,6-tetramethylpiperidine-1-oxyl radical (TEMPO) on two hydroxyapatites (HAs) differing in specific surface area and the degree of hydration. The adsorption was carried out from cyclohexane, 1-chlorobutane and water. The solutions after adsorption were studied spectrophotometrically, while the obtained composites were characterized via NMR and EPR spectroscopy. The results show that it is possible to reproducibly obtain fairly stable composites, where the main factors influencing the adsorbed amount of the radical are solvent polarity and specific surface area of hydroxyapatite. The Langmuir isotherm was determined to be the most suitable adsorption model. The analysis of EPR and NMR spectra allowed us to determine the distribution of the TEMPO molecules on the hydroxyapatite surface, as well as a probable adsorption mechanism. The HA/TEMPO composites could potentially be used to study certain properties of hydroxyapatite surfaces with EPR spectroscopy. They could also be used as fillers after hard tissue surgery, as well as metal-free MRI contrasts.

Oliceridine Exhibits Improved Tolerability Compared to Morphine at Equianalgesic Conditions: Exploratory Analysis from Two Phase 3 Randomized Placebo and Active Controlled Trials.

IntroductionIn the management of postoperative acute moderate-to-severe pain, opioids remain an important component. However, conventional opioids have a narrow therapeutic index and are associated with dose-limiting opioid-related adverse events (ORAEs) that can result in worse patient outcomes. Oliceridine, a new intravenous µ-opioid receptor agonist, is shown in nonclinical studies to be biased for G protein signaling (achieving analgesia) with limited recruitment of β-arrestin (associated with ORAEs). In two phase 3 randomized controlled studies of patients with moderate-to-severe acute pain following hard or soft tissue surgery, in which analgesia was measured using Sum of Pain Intensity Differences (SPID) from baseline over 48 and 24 h (SPID-48 and -24 respectively, oliceridine at demand doses of 0.1, 0.35, or 0.5 mg was highly effective compared to placebo, with a favorable safety profile compared to morphine. This exploratory analysis was conducted to determine whether the safety benefits seen with oliceridine persisted when adjusted for equal levels of analgesia compared to morphine.MethodsPresence of at least one treatment-emergent ORAE (based on Medical Dictionary for Regulatory Activities [MedDRA]-coded events: hypoxemia, nausea, vomiting, sedation, pruritus, or dizziness) was used as the composite safety endpoint. A logistic regression model was utilized to compare oliceridine (pooled regimens) versus morphine, after controlling for analgesia (using SPID-48 or SPID-24 with pre-rescue scores carried forward 6 h). This analysis excluded patients receiving placebo and was repeated for each study and for pooled data.ResultsAt a given level of SPID-48 or SPID-24, patients receiving oliceridine were less likely to experience the composite safety endpoint. Although not statistically significant at the 0.05 level in the soft tissue model, the odds ratio (OR) showed a consistent numerical trend for oliceridine, being approximately half that observed with morphine in both the hard (OR 0.499; 95% confidence interval [CI] 0.255, 0.976; p = 0.042) and soft (OR 0.542; 95% CI 0.250, 1.175; p = 0.121) tissue studies. Results from the pooled data were consistent with those observed in the individual studies (OR 0.507; 95% CI 0.304, 0.844; p = 0.009).ConclusionFindings from this exploratory analysis suggest that at comparable levels of analgesia, patients receiving oliceridine were less likely to experience the composite safety endpoint consisting of ORAEs compared to patients treated with morphine. Oliceridine Exhibits Improved Tolerability Compared to Morphine at Equianalgesic Conditions: Exploratory Analysis from Two Phase 3 Randomized Placebo and Active Controlled Trials- A Video (MP4 99188 kb)Supplementary InformationThe online version contains supplementary material available at 10.1007/s40122-021-00299-0.

Assessment of Effects of Laser Light Combining Three Wavelengths (450, 520 and 640 nm) on Temperature Increase and Depth of Tissue Lesions in an Ex Vivo Study.

Background: Lasers are widely used in medicine in soft and hard tissue surgeries and biostimulation. Studies found in literature typically compare the effects of single-wavelength lasers on tissues or cell cultures. In our study, we used a diode laser capable of emitting three components of visible light (640 nm, red; 520 nm, green; 450 nm, blue) and combining them in a single beam. The aim of the study was to assess the effects of laser radiation in the visible spectrum on tissue in vitro, depending on the wavelength and pulse width. Methods: All irradiations were performed using the same output power (1.5 W). We used various duty cycles: 10, 50, 80 and 100% with 100 Hz frequency. Maximum superficial temperature, rate of temperature increase and lesion depth were investigated. Results: Maximum superficial temperature was observed for 450 + 520 nm irradiation (100% duty cycle). The highest rate of increase of temperature was noted for 450 + 520 nm (100% duty cycle). Maximum lesion depth was observed in case of three-wavelength irradiation (450 + 520 + 640 nm) for 100, 80 and 50% duty cycles. Conclusions: The synergistic effect of two-wavelength (450 + 520 nm) irradiation was observed in case of maximum temperature measurement. The deepest depth of lesion was noted after three-wavelength irradiation (450 + 520 + 640 nm).

A recent review and a taxonomy for hard and soft tissue visualization-based mixed reality.

Mixed reality (MR) visualization is gaining popularity in image-guided surgery (IGS) systems, especially for hard and soft tissue surgeries. However, a few MR systems are implemented in real time. Some factors are limiting MR technology and creating a difficulty in setting up and evaluating the MR system in real environments. Some of these factors include: the end users are not considered, the limitations in the operating room, and the medical images are not fully unified into the operating interventions. The purpose of this article is to use Data, Visualization processing, and View (DVV) taxonomy to evaluate the current MR systems. DVV includes all the components required to be considered and validated for the MR used in hard and soft tissue surgeries. This taxonomy helps the developers and end users like researchers and surgeons to enhance MR system for the surgical field. We evaluated, validated, and verified the taxonomy based on system comparison, completeness, and acceptance criteria. Around 24 state-of-the-art solutions that are picked relate to MR visualization, which is then used to demonstrate and validate this taxonomy. The results showed that most of the findings are evaluated and others are validated. The DVV taxonomy acts as a great resource for MR visualization in IGS. State-of-the-art solutions are classified, evaluated, validated, and verified to elaborate the process of MR visualization during surgery. The DVV taxonomy provides the benefits to the end users and future improvements in MR.

Detection of Vascular Pathways of Oral Mucosa Influencing Soft- and Hard Tissue Surgeries by Latex Milk Injection.

In this methodological study, the purpose was to visualize the macroscopic vascular pathway of the oral mucosa. Corpses were injected and fixed with Thiel's solution for embalming to keep the natural color, fresh texture, and elasticity of the tissues. Latex milk injection is a technique used to stain blood vessels. A combination of Thiel's embalming method and latex milk injection allows surgeons to work on a raw specimen and identify the distribution and anastomosis of vessels macroscopically in the oral mucosa for flap/incision design in periodontal and maxillofacial surgeries. The latex milk contains radiopaque material that enables clinicians to visualize the pathway of the blood vessels radiographically. A step-by-step protocol is described for the correct adjustment of Thiel embalming and latex milk injection. The combined application of both methods allows the clinician to understand anatomical structures practically. As a result, proper incisions and flaps can be designed, which prevents neurovascular damage, intraoperative bleeding, and postoperative morbidity during patient surgery.

Is platelet rich fibrin a viable alternative to subepithelial connective tissue graft for gingival root coverage?

One of the most common aesthetic concerns associated with the periodontal tissue is gingival recession. Covering the root surface exposed during the disease process with soft and hard tissue surgeries may decrease these problems. The aim of the study was to compare the clinical outcome of coronally advanced flap (CAF) procedure in root coverage with platelet-rich fibrin (PRF) or subepithelial connective tissue graft (SCTG) for the treatment of Miller's Class-I gingival recession. The split mouth design consisted of 15 patients with a total of 30 sites with bilateral Miller's Class-I recession on anterior teeth. They were randomly assigned into PRF group (test) or SCTG group (control). The values obtained were tabulated and analyzed using Mann--Whitney U-test and repeated measure ANOVA test. All the statistical tests were carried out using SPSS software. It was observed that both the autogenous grafts healed without any complications and at the end of 6 months the grafts were stable and recession coverage between 88-100% was achieved. CAF procedure with either PRF or SCTG were both effective in the treatment of Miller's Class-I gingival recessions. CAF with SCTG showed better root coverage than CAF with PRF. Use of PRF offered additional benefit of avoiding second surgical site. Therefore, PRF can be considered as a viable alternative to SCTG in certain cases.

An application of virtual surgical planning in genial tubercle advancement using the mandibular trapezoid osteotomy

The treatment of obstructive sleep apnea includes multiple soft and hard tissue surgeries with the gold standard being orthognathic surgery. In this paper we describe a novel method of using virtual surgical planning to create custom cutting guides for the genial tubercle and associated genioglossus muscle. This then allows for precise genioglossus advancement while minimizing the risk of damage to the adjacent teeth or to the muscle itself.

Microscopic evaluation of the effect of low-level laser therapy on platelet-rich fibrin: A light microscopic histological study

Background: This study evaluated and compared the concentration of platelets/leukocytes, fibrin matrix, and its distribution in nonlaser-treated platelet-rich fibrin (PRF) and laser-treated PRF. Recently, PRF has been used for regeneration of soft and hard tissue, in periodontics and oral surgery. Low-level laser therapy (LLLT) has been used for many therapeutic purpose of tissue healing. The use of PRF treated with LLLT has shown to enhance better healing potential. Materials and Methods: In this study, we have selected five healthy controls and collected 10 ml of blood from them. All blood samples were centrifuged, and from each blood sample, two PRF clots were formed. A total of ten samples obtained were divided into two groups. Each group had five samples. One group was without LLL treatment (Group I) and other was treated with LLL (Group II). All the ten samples were processed for light microscopic examination. Results: In both the groups, the PRF membrane showed a similar macroscopic structure and microscopic distribution. In the buffy coat region, the concentration of platelets–leukocyte aggregate was little higher in Group I. In Group II, the distribution pattern of fibrin clot was slightly different with that of Group I. Conclusion: The Choukroun's PRF concept leads to specific clot architecture with platelets and fibrin meshwork, especially in the buffy coat region. Changes in the PRF components with LLLT may have an affect the healing and regenerative of soft and hard tissues.

Synthesis of β-tricalcium phosphate

Ceramics play a key role in several biomedical applications. One of them is bone grafting, which is used for treating bone defects caused by injuries or osteoporosis. Calcium-phosphate based ceramic are preferred as bone graft biomaterials in hard tissue surgery because their chemical composition is close to the composition of human bone. They also have a marked bioresorbability and bioactivity. In this work, we have developed methods for synthesis of β-tricalcium phosphate apatite (β-TCP). These products were characterized by different techniques such as X-ray diffraction, infrared spectroscopy, scanning electron microscopy and chemical analysis.

Improved Surgery Planning Using 3-D Printing: a Case Study.

The role of 3-D printing is presented for improved patient-specific surgery planning. Key benefits are time saved and surgery outcome. Two hard-tissue surgery models were 3-D printed, for orthopedic, pelvic surgery, and craniofacial surgery. We discuss software data conversion in computed tomography (CT)/magnetic resonance (MR) medical image for 3-D printing. 3-D printed models save time in surgery planning and help visualize complex pre-operative anatomy. Time saved in surgery planning can be as much as two thirds. In addition to improved surgery accuracy, 3-D printing presents opportunity in materials research. Other hard-tissue and soft-tissue cases in maxillofacial, abdominal, thoracic, cardiac, orthodontics, and neurosurgery are considered. We recommend using 3-D printing as standard protocol for surgery planning and for teaching surgery practices. A quick turnaround time of a 3-D printed surgery model, in improved accuracy in surgery planning, is helpful for the surgery team. It is recommended that these costs be within 20% of the total surgery budget.

Implant Bed Preparation with an Erbium, Chromium Doped Yttrium Scandium Gallium Garnet (Er,Cr: YSGG) Laser Using Stereolithographic Surgical Guide.

Implant bed preparation with laser is taken into consideration owing to the increased interest in use of lasers in hard tissue surgery. The purpose of this study is to determine the deviations in the position and inclination between the planned and prepared implant beds with Erbium, Chromium doped Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) laser using stereolithographic (SLA) surgical guides. After 3-dimensional (3D) imaging of six sheep lower jaws, computed tomography (CT) images were transformed into 3D models. Locations of implant beds were determined on these models. Two implant beds in each half jaw were prepared with an Er,Cr:YSGG laser system and a conventional drilling method using a total of 12 SLA surgical guides. A new CT was taken to analyze the deviation values between planned and prepared implant beds. Finally, a software program was used to superimpose the images on 3D models, then the laser and conventional drilling groups were compared. Differences of mean angular deviations between the planned and prepared implant beds were 5.17±4.91° in the laser group and 2.02±1.94° in the conventional drilling group.The mean coronal deviation values were found to be 0.48±0.25 mm and 0.23±0.14 mm in the laser group and conventional drilling group, respectively. While the mean deviation at the apex between the planned and prepared implant beds were 0.70±0.26 mm and 0.26±0.08 ,the mean vertical deviations were 0.06±0.15 mm and 0.02±0.05 mm for the laser group and the conventional drilling group, respectively. It is possible to prepare an implant bed properly with the aid of Er,Cr:YSGGlaser by using SLA surgical guide.

Effects of Facial Hard Tissue Surgery on Facial Aesthetics

Aesthetic units of the face can be divided into facial content (FC; eyes, nose, lips, and mouth), anterior facial frame (AFF; a contour line from the trichion, the temporal line of the frontal bone, the lateral orbital rim, the most lateral line of the anterior part of the zygomatic body, the anterior border of the masseter muscle, to the inferior border of the chin), and posterior facial frame (PFF; a contour line from the hairline, the zygomatic arch, to the ramus and gonial angle area of the mandible). The size and shape of each FC and the balance and proportion between FCs create a unique appearance for each person. The facial form can be determined through the combination of AFF and PFF. In the Asian population, clinicians frequently encounter problems of FC (eg, acute nasolabial angle, protrusive and everted lips, nonconsonant lip line, or lip canting), AFF (eg, midface hypoplasia, protrusive and asymmetric chin, vertical deficiency/excess of the anterior maxilla and symphysis, or prominent zygoma), and PFF (eg, square mandibular angle). These problems can be efficiently and effectively corrected through the combination of hard tissue surgery such as anterior segmental osteotomy, genioplasty, mandibular angle reduction, malarplasty, and orthognathic surgery. Therefore, the purposes of this article were to introduce the concepts of FC, AFF, and PFF, and to explain the effects of facial hard tissue surgery on facial aesthetics.

A New Highly Bioactive Composite for Bone Tissue Repair

In the last few years several attempts have been made to combine hydroxyapatite (HA) with bioactive glasses of different composition, with the aim to obtain composite materials with improved bioactivity or mechanical properties for hard tissue surgery applications. However, high‐temperature treatments are usually required in order to sinter HA‐based composites, causing the bioactive glass to crystallize into a glass–ceramic, with possible negative effects on its bioactivity. Recently, a new glass composition, named BioK and inspired by the 45S5 Bioglass®, has been formulated by substituting the sodium oxide with the potassium oxide. The potassium oxide is expected to reduce the tendency to crystallize of the parent glass. In this work, for the first time the BioK is applied to realize HA‐based composites. The novel samples can be sintered at a relative low temperature (750°C) compared with the widely studied HA/45S5 Bioglass® composites. The new glass formulation and the relatively low sintering temperature of the BioK‐based composites greatly help to preserve the amorphous nature of the glass. According to in vitro tests, this has excellent effects in terms of bioactivity. Moreover Vickers microindentation measurements show that the BioK‐containing composites preserve their local mechanical properties during immersion in body fluids.

Treatment of Midline Cleft of the Mandible-A 2-Stage Approach

Midline clefts of the lower lip and mandible are rare congenital anomalies. They may present as complete or incomplete in nature along with associated bifid tongue and ankyloglossia. Some may present with cleft of lower lip, cleft of mandible, fissured tongue, absent hyoid bone, cleft of manubrium sterni, or an extremely rare anomaly known as Tessier cleft no. 30. We present this unique case of midline cleft of the lower lip (incomplete) and mandible (complete) with initial soft-tissue surgery for the lower lip. The hard-tissue surgery for this case is deferred at a later date, and the reasons are discussed.

Improved adhesion and growth of human osteoblast-like MG 63 cells on biomaterials modified with carbon nanoparticles

Three types of materials modified with carbon particles were prepared: (1) carbon fibre-reinforced carbon composites (CFRC), materials promising for hard tissue surgery, coated with a fullerene C 60 layer, (2) terpolymer of polytetrafluoroethylene, polyvinyldifluoride and polypropylene mixed with 4 wt.% of single- or multi-walled carbon nanotubes and (3) nanostructured or hierarchically micro- and nanostructured diamond layers deposited on silicon substrates. The materials were seeded with human osteoblast-like MG 63 cells (density from 8500 cells/cm 2 to 25,000 cells/cm 2). On the fullerene layers, the cells (day 2 after seeding) adhered in numbers from 2.3 to 3.5 times lower than those on control non-coated CFRC or polystyrene dishes. However, their spreading area was larger by 68% to 145% than that on the control surfaces. These cells also assembled numerous dot-like vinculin-containing focal adhesion plaques and a rich fine mesh-like beta-actin cytoskeleton. Similar results were obtained on the terpolymers mixed with carbon nanotubes. The cells were well spread and contained distinct beta-actin filament bundles, whereas the cells on the pure terpolymer were often rounded and clustered into aggregates. An enzyme-linked immunosorbent assay revealed that the cells on the material with single-walled carbon nanotubes contained a higher concentration of vinculin and talin, i.e. components of focal adhesion plaques (by 56% and 35%, respectively, compared to the pure terpolymer). However, the concentration of osteocalcin, a marker of osteogenic differentiation, was lower in cells on the terpolymer containing multi-walled nanotubes, which was probably due to more active proliferation of these cells (on day 7, they reached a 4.5 times higher population density than cells on the unmodified terpolymer). Adding both single-and multi-walled nanotubes to the terpolymer did not increase the concentration of ICAM-1, a marker of immune activation, in MG 63 cells. On diamond layers, the number of initially adhered cells was higher on the nanostructured layers, whereas the subsequent proliferation was accelerated on the layers with a hierarchical micro-and nanostructure. Thus, all tested carbon nanoparticle-containing materials gave good support to adhesion and growth of bone-derived cells, and they can be considered as promising for construction of bone implants and bone tissue engineering.

Retrobulbar Hemorrhage: A Case Report

Retrobulbar hemorrhage is a rare complication that may occur after mid-face injuries or following soft and hard tissue surgery around the eyes. The cardinal signs and symptoms of retrobulbar hemorrhage are pain, diplopia, ophthalmoplegia, a progression of increasing proptosis, and decreasing visual acuity leading to blindness. The diagnosis can be confirmed with computed tomography (CT) of the orbit or with ocular ultrasound. These diagnostic images are also important to define the size of the hematoma. This report describes a traumatic retrobulbar hemorrhage. In this case there were no signs of acute visual loss, and conservative treatment was possible without surgical intervention.