Implantation Surgery Research Articles

Tissue Classification After Bone-Anchored Hearing Implant Surgery: A Machine Learning Approach to Monitoring Skin Response.

Here, we aim to 1) expand the available evidence for the use of machine learning techniques for soft tissue classification after BCD surgery and 2) discuss the implications of such approaches toward the development of classification applications to aid in tissue monitoring. The application of machine learning techniques in the soft tissue literature has become a large field of study. One of the most commonly reported outcomes after percutaneous bone-conduction device (BCD) surgery is soft tissue health. Unfortunately, the classification of tissue around the abutment as healthy versus not healthy is a subjective process, even though such decisions can have implications for treatment (i.e., topical steroid versus surgical revision) and resources (e.g., clinician time). We built and tested a convolutional neural network (CNN) model for the classification of tissues that were rated as "green" (i.e., healthy), "yellow" (i.e., unhealthy minor), and "red" (i.e., unhealthy severe). Representative image samples were gathered from a regional bone-conduction amplification site (N = 398; 181 samples of green; 144 samples of yellow; 73 samples of red). The image samples were cropped, zoomed, and normalized. Feature extraction was then implemented and used as the input to train an advanced CNN model. Accuracy of image classification for the healthy ("green") versus not healthy ("yellow" and "red") model was approximately 87%. Accuracy of image classification for the unhealthy ("yellow") versus unhealthy ("red") model was approximately 94%. Monitoring tissue health is an ongoing challenge for BCD users and their clinicians not trained in soft tissue management (e.g., audiologists). If machine learning can aid in the classification of tissue health, this would have significant implications for stakeholders. Here we discuss how machine learning can be applied to tissue classification as a potential technological aid in the coming years.

PET/CT Recognition of Costal Cartilage Infection After Breast Implant Surgery.

Postoperative infection of breast implants can lead to implant removal and other complications. This study aimed to investigate the presence of costal cartilage infection following breast implant surgery and the diagnostic role of PET/CT in identifying this rare complication. A retrospective study included 16 patients with persistent infections after breast implant removal surgery. Patients underwent PET/CT scans before surgery, and surgical plans were made based on PET/CT findings. Surgical procedures were guided by PET/CT, and specimens were collected for pathological examination and microbiological culture. Follow-up assessments were performed at 1, 3, and 12 months postoperatively. Among the 16 patients, 11 were diagnosed with costal cartilage infection, whereas 5 had subcutaneous soft tissue infections. PET/CT accurately identified costal cartilage infection in all cases and localized the infected costal cartilage in the majority of cases. Microbiological culture results showed various pathogens. All patients were cured with one or staged surgery. Costal cartilage infection following breast implant surgery is a significant concern. PET/CT plays a crucial role in the accurate diagnosis and localization of infected costal cartilage, aiding in appropriate surgical management. Patients should be closely monitored for the possibility of costal cartilage infection when experiencing persistent symptoms after breast implant surgery.

Temperature Rise and Pain Following the Use of 810 and 980 nm Diode Lasers for Second-Stage Dental Implant Surgery: A Clinical Trial.

Introduction: Many surgical procedures in a soft tissue are performed using diodes lasers. This study aimed to assess the temperature rise and pain following the use of 810 and 980 nm diode lasers for second-stage dental implant surgery. Methods: This clinical trial was conducted on 24 osseointegrated dental implants that were randomly divided into two groups of 810 nm and 980 nm diode lasers. The temperature rise in each group was measured right after uncovering by the laser and 15 minutes later by a thermocouple, compared with the baseline temperature of gingival tissue. The level of pain was also measured at 24 hours postoperatively by using a visual analog scale. Data were analyzed by ANOVA, Tukey's test, and t test (alpha=0.05). Results: Within-group comparisons by ANOVA showed a significant difference in tissue temperature between the three time points in both groups (P<0.0001). Pairwise comparisons by Tukey's test showed that the temperature at baseline (P<0.0001) and 15 seconds after uncovering was significantly lower than that immediately after uncovering in both groups (P<0.0001). The mean tissue temperature and the mean pain score in the 980 nm laser group were significantly higher than the corresponding values in the 810 nm laser group (P<0.05). Conclusion: According to the results, temperature rise in the use of the 980 nm laser was higher than the 810 nm laser. The use of 810 nm diode laser was associated with lower temperature rise and significantly lower pain score after 24 hours.

Prediction of internal jugular vein catheter length inserted through the posterior approach of the sternocleidomastoid muscle.

This study aimed to determine an equation to estimate the optimal insertion length for catheter placement via the posterior approach of the sternocleidomastoid muscle in cancer patients. This retrospective study included patients with cancer who underwent infusion port implantation surgery in the Oncology Department of the 900th Hospital of Joint Logistic Support Force of the Chinese People Liberation Army from April 2017 to September 2023. Patient height (H), weight (W), chest length (C), and length of the internal jugular vein catheter (L) were collected from medical records. The patients were randomized 7:3 to the training and validation sets. Linear regression analyses were used in the training set to determine formulas to predict catheter length. The formula predictive value was analyzed using the Bland-Altman method in the validation set. This study included 336 patients, with a mean age of 58.27 ± 11.70 years, randomized in the training (n = 235) and validation (n = 101) sets. Linear regression analysis revealed that the equations for catheter length relative to H, body mass index (BMI), and C are L = 0.144 × H - 8.258 (R² = 0.608, P < .001), L = -0.103 × B + 17.384 (R² = 0.055, P < .001), and L = 0.477 × C + 1.769 (R² = 0.342, P < .001), respectively. The multivariable linear regression analysis showed that the equation between the length of the catheter and H and C was L = 0.131 × H + 0.086 × C-8.515 (R² = 0.614, P < .001). The Bland-Altman analysis in the validation set showed that the predicted values of internal jugular vein catheter length and the actual values showed good agreement. The optimal L might be determined by simple formulas based on patients H and C.

Biomechanical changes of the cornea after orbital decompression in thyroid-associated orbitopathy measured by corvis ST

This study aims to investigate the changes in ocular biomechanical factors in patients with inactive thyroid eye disease (TED) who undergo orbital decompression surgery. This observational prospective study include 46 eyes of 31 patients with inactive TED undergoing orbital decompression at a tertiary university hospital from October 2021 to September 2023. All participants underwent a full ophthalmic examination, and a biomechanical examination was performed using corvis ST at baseline, 1 month, and 3 months postoperatively. The study participants had a mean age of 45 ± 11.6 years, and 58.1% of them were female. The second applanation time (A2T) increased from baseline to postoperative month 1 and continued to increase to postoperative month 3 (P < 0.001). The first applanation velocity (A1V), highest concavity (HC) peak distance, and pachymetry parameters also increased from postoperative month 1 to postoperative month 3 (P = 0.035, P = 0.005, and P = 0.031, respectively). The HC time increased from baseline to postoperative month 3 (P = 0.027). Other changes were statistically insignificant. The P-values were adjusted according to biomechanically corrected intraocular pressure (bIOP). Baseline Hertel significantly influenced A2 time (P < 0.001). Our findings suggest that ocular biomechanical parameters may change following decompression surgery in patients with inactive TED. Specifically, an increase in A2T, A1V, and HC peak distance suggests a decrease in corneal stiffness, although the increased HC time contradicts this. It is recommended to postpone keratorefractive or intraocular lens implantation surgeries until corneal biomechanics stabilize after decompression surgery for optimal results.

Postural stability at activation and deactivation of the cochlear implant in adolescents with late lateral implantations: a quasi-experiment

BackgroundCochlear implantation (CI) surgery has become a prevalent method of hearing rehabilitation, since it has been acknowledged that it impacts effectively on the vestibular system. However, there is still no consensus among clinicians on the most appropriate age and area (lateral/bilateral) of CI surgery in terms of postural control. The present study aimed to assess the postural control in late lateral CI adolescents with different visual (eyes opened(EO)/eyes closed(EC)) and auditory (CI activated/deactivated) conditions and to build a theoretical model of postural control based on sensual compensatory mechanisms that are predominant in late CI individuals. It was hypothesized that kinesthetic sensation and exteroceptors of the superficial sensation are critical for neuromuscular control after late CI.MethodsA quasi-experimental study protocol was used in this study to assess the postural stability performance in the studied adolescents with different visual and auditory perceptions. 27 adolescent students with hearing loss participated in the study. A force plate (Accu Gait AMTI) with computer software (NetForce) was used in the study to assess the postural stability with four different conditions(EO)/EC), CI activated/deactivated).ResultsvCOP was found to have a significant growing tendency within the conditions of CI activated/deactivated.No statistically significant relationships were noted between the range of the displacement of feet pressure (Area) and both the visual and auditory conditions. Hearing loss etiology was statistically significantly related to the values of vCOP, within the conditions of EO, CI activated/deactivated (p < 0.01), what did not occure with the condition of EC (p > 0.05). Neuromuscular control with the condition of EC x CI deactivated was found to be based on the kinesthetic-tactual compensatory model.ConclusionsKinesthetic sensation and exteroceptors of the superficial sensation seem to be the predominant source of information to maintain postural control in late CI adolescents, regardless of the visual and auditory conditions. The etiology of hearing loss (congenital/acquired) can be a predictor of the values of the vCOP. In order to improve neuromuscular control in this population, it is recommended that the patients perform physical activity tasks, especially to develop core muscles, based on direct stimulation and rotational stability.

Intra-Cochlear Electrode Position Impacts the Preservation of Residual Hearing in an Animal Model of Cochlear Implant Surgery.

Preservation of residual hearing after cochlear implantation remains challenging. There are several approaches to preserve residual hearing, but the configuration of the implant electrode array seems to play a major role. Lateral wall electrode arrays are seemingly more favorable in this context. To date, there are no experimental data available which correlate the spatial electrode position in the scala tympani with the extent of hearing preservation. Based on micro-computed tomography (µCT) imaging data, this study analyses the exact position of a pure silicone electrode array inserted into the cochlea of four guinea pigs. Array position data were correlated with the extent of hearing loss after implantation, measured using auditory brainstem measurements in the frequency range of the area occupied by the electrode array area as well as apical to the array. The use of pure silicone arrays without electrodes resulted in artifact-free, high-resolution µCT images that allowed precise determination of the arrays' positions within the scala tympani. The electrode arrays' locations ranged from peri-modiolar to an anti-modiolar. These revealed a correlation of a lower postoperative hearing loss with a higher spatial proximity to the lateral wall. This correlation was found in the low-frequency range only. A significant correlation between the inter-individual differences in the diameter of the scala tympani and the postoperative hearing loss could not be observed. This study demonstrates the importance of the intra-cochlear electrode array's position for the preservation of residual hearing. The advantage of such an electrode array's position approximated to the lateral wall suggests, at least for this type of electrode array applied in the guinea pig, it would be advantageous in the preservation of residual hearing for the apical part of the cochlea, beyond the area occupied by the electrode array.

Analysis of the Application Value of Dynamic Navigation Guidance in Oral Implantation.

To investigate the application of dynamic navigation guidance technology in different implantation scenarios, and to provide a scientific basis for the innovation and advancement of implantation techniques. Fifteen cases of patients with malocclusions admitted between January 2021 and February 2023 were selected as the study subjects. All patients underwent dynamic navigation-guided oral implantation interventions. CBCT scans were taken after implantation surgery to record deviations of implantation points, including implantation point deviation, endpoint deviation, and angle deviation. Dynamic navigation guidance effectively improves the reliability and stability of implantation in oral implant patients. CBCT effectively evaluated the state of the patient's periodontal implant, analyzed the state of the patient's lesion area, and improved the quality of implant intervention through CBCT guidance. The implantation point deviation was (0.407±0.193) mm, the endpoint deviation was (0.492±0.201) mm, and the implant angle deviation was (2.162±0.283)°. There was no significant difference in implantation point deviation in the anterior and posterior parts of the upper and lower jaws after intervention (P>0.05). However, there were significant differences in endpoint deviation and implant angle deviation among the anterior and posterior parts of the upper and lower jaws (P<0.05). Dynamic navigation guidance effectively improves the reliability and stability of implantation in oral implant patients. However, there is relatively greater endpoint deviation and implant angle deviation in the posterior part of the upper jaw.

Effects of antiseptic irrigation solutions on osseointegration in a cementless tibial implantation mouse model.

Despite the success of standard antiseptic irrigation solutions in reducing periprosthetic joint infection (PJI) rates, there is still a need for more effective solutions. Synergistic use of povidone-iodine (PI) and hydrogen peroxide (H2O2) has shown promising results; however, the optimal solution concentration balancing bactericidal activity and osseointegration remains unknown. This study aims to evaluate the impact of these antiseptic irrigation solutions on osseointegration and the bone-implant interface strength in vivo. Forty C57BL/6 mice underwent bilateral tibial implantation surgery and were randomly allocated into three groups receiving 0.3% PI, 10% PI mixed with 3% H2O2, or saline as irrigation solutions intraoperatively. Assessments were performed on postoperative Days 1 and 28, including plain radiographs, microcomputed tomography (microCT) evaluation, histological analysis, immunohistochemistry, and biomechanical pull-out testing. No wound complications were observed. MicroCT scans revealed no differences in peri-implant trabecular bone parameters. Biomechanical pull-out testing showed no differences in the bone-implant interface strength across groups. Histological analysis indicated no differences in bone and bone marrow percentage areas among treatment groups. Immunohistochemical analysis demonstrated no differences among groups in peri-implant osteocalcin, osterix, or endomucin-positive cells. In conclusion, using either antiseptic irrigation solution showed no differences in osseointegration parameters compared to the control group, demonstrating safety and the absence of toxicity. CLINICAL RELEVANCE: Dilute 0.3% povidone-iodine and a 1:1 combination of 10% povidone-iodine mixed with 3% hydrogen peroxide can be safely used during primary and revision total joint arthroplasty without compromising osseointegration or causing wound complications.

Influence of implantable Collamer lens implantation on choroidal thickness and blood flow density

Objective: To observe the impact of implantable Collamer lens (ICL) implantation surgery on choroidal thickness and blood flow density in myopic patients. Methods: This was a prospective cohort study. Patients undergoing ICL surgery at Qingdao University Affiliated Hospital between June 2021 and May 2023 were consecutively enrolled. Patients were categorized into high myopia (HM) and super high myopia (SHM) groups based on whether their spherical equivalence power exceeded 10.00 D. Comprehensive ophthalmic examinations, including optical coherence tomography, optical coherence tomography angiography, visual acuity assessment, intraocular pressure measurement, and optometry, were performed preoperatively and at 1 week, 1 month, and 3 months postoperatively. Results: A total of 42 patients (84 eyes), with an average age of (25.27±3.18) years, comprising 11 males and 31 females, were enrolled in the study. Among them, 20 patients belonged to the HM group, while 22 patients were in the SHM group. Both choroidal thickness and blood flow density exhibited significant increases at postoperative 1 week and 1 month compared to preoperative levels (P<0.05), but returned to baseline levels by postoperative 3 months. Specifically, the subfoveal choroidal thickness increased from (169.49±61.57) μm preoperatively to (180.16±66.61) μm at 1 week, (186.69±63.32) μm at 1 month, and then reverted to (169.58±60.82) μm at 3 months. The central choroidal blood flow density showed changes from 60.03%±1.60% preoperatively to 61.04%±1.17% at 1 week, 60.42%±1.81% at 1 month, and 60.22%±1.57% at 3 months. Furthermore, the HM group exhibited more pronounced changes in both choroidal thickness and blood flow density across all time points compared to the SHM group. Significant differences were observed in choroidal thickness changes at various areas at 1 month, while changes in blood flow density in specific areas were significant. However, no significant differences were noted at 3 months postoperatively. Correlation analysis revealed a negative correlation of changes in subfoveal choroidal thickness and central choroidal blood flow density postoperatively at 1 week and 3 months with preoperative choroidal blood flow density. Notably, no correlation was found between preoperative choroidal thickness and postoperative changes. Conclusions: In the early period following ICL implantation, the increase in choroidal thickness and blood flow density may be more pronounced in HM compared to SHM, but the two parameters can return to baseline levels by 3 months. ICL implantation transiently affects the fundus microenvironment in myopic patients, with implications of preoperative choroidal blood flow.

Risk Assessment of Nasal Cavity Perforation in the Maxilla: A Virtual Implant Placement Study Using Cone Beam Computed Tomography.

Implant surgery in individuals with atrophic maxilla presents challenges, particularly concerning nasal cavity complications such as perforations, implant migration, and airway obstruction. While panoramic radiographs offer diagnostic convenience, their two-dimensional nature limits the evaluation of anatomical structures. Cone beam computed tomography (CBCT) provides a three-dimensional assessment, enhancing surgical planning accuracy and potentially reducing complications. With the aim of understanding the measurement differences between panoramic radiographs and CBCT images, this retrospective study examined CBCT images of patients with severely atrophic maxilla taken between September 2021 and December 2023 at the Ahmet Keleşoğlu Faculty of Dentistry. Virtual implants were placed in various tooth regions using OnDemand3D software. The incidence of nasal cavity perforations and vertical bone height differences between panoramic radiographs and CBCT images were evaluated. For this purpose, vertical bone length measurements in panoramic and CBCT images were compared for the virtual implant placement areas. Statistical analyses, including t-tests and ANOVA, were performed to determine significant differences among quantitative measurements, and a chi square test with Bonferroni corrected z-tests were used for possible associations between ratios. CBCT data from 59 patients, totaling 1888 virtual implants, revealed significant differences in implant depths among tooth regions (F = 9.880, p < 0.001). Canine regions showed higher perforation risks, especially with 12 mm and 14 mm implants. Panoramic radiographs often overestimated vertical bone height in canine and first premolar regions compared to CBCT measurements, which could lead to increased perforation risks. Radiographic evaluations using CBCT prior to implant surgery in atrophic maxilla cases are crucial to prevent nasal cavity complications. Panoramic radiographs may inadequately represent three-dimensional anatomy, underscoring the importance of CBCT for accurate implant placement and surgical planning. Further studies should consider varying implant sizes and brands to generalize findings.

Occlusal Reconstruction by Maxillary Bone Grafting, Dental Implants and Orthognathic Surgery After Facial Trauma.

Occlusal Reconstruction by Maxillary Bone Grafting, Dental Implants and Orthognathic Surgery After Facial Trauma.

A Comparison of Functional Endothelial Changes between Phacoemulsification with PCIOL and Manual Small Incision Cataract Surgery with PCIOL

Intraocular surgery e.g., cataract surgery with PCIOL implantation is one of the leading causes of corneal endothelial injury and change in the functionality of the cornea. This observational study was conducted in the Department of Ophthalmology of Combined Military Hospital (CMH), Dhaka Cantonment, Dhaka, Bangladesh, between January and July of 2016, to assess and compare functional changes in cornea (i.e., endothelial thickness) after phacoemulsification with posterior chamber intraocular lens (PCIOL) implantation and manual small incision cataract surgery (MSICS) with PCIOL implantation. A total of 80 patients of age-related cataract were randomly selected based on inclusion and exclusion criteria. All patients underwent complete ophthalmic evaluation pre- and post-operatively (at day 1, after 1 week and 3 months) specifically for observation of the endothelial changes in cornea. Specular microscopy was done to assess corneal endothelial change. The mean central corneal thickness was increased at day 1 (564.71±22.45μ vs. 555.10±40.57μ), after 1 week (539.43±22.16μ vs. 535.08±38.87μ) and 3 months (523.49±21.29μ vs. 520.05±33.68μ) after phacoemulsification and MSICS from their preoperative value (508.72±23.96μ vs. 503.62±32.06μ) respectively. However, the differences were not statistically significant between two groups (P&gt;0.05). The mean percentage of central corneal thickness change at day1, after 1 week and after 3 months following cataract surgery were found 11.01±6.30% and 10.22±26.54% at day 1, 6.04±7.52% and 6.25±21.24% after 1 week, 2.90±11.14% and 3.26±5.05% after 3 months in phacoemulsification and MSICS cases respectively. However, no statistically significant difference was observed in percentage of central corneal thickness change of both groups (P&gt;0.05). To summarize, an increased central corneal thickness was observed after phacoemulsification and SICS from their preoperative values. Mugda Med Coll J. 2024; 7(1): 14-18

Current Understanding of Stem Cells in Oral and Implant Surgery- A Review of the Current Literature

Current Understanding of Stem Cells in Oral and Implant Surgery- A Review of the Current Literature

Effects of ultrasound-guided serratus plane block combined with general anesthesia on postoperative early quality of recovery and analgesia in patients undergoing transapical transcatheter aortic valve implantation surgery: study protocol for a randomized controlled trial

BackgroundCompared to traditional thoracotomy, transapical transcatheter aortic valve implantation (TAVI) surgery offers reduced trauma and faster recovery, fostering the adoption of enhanced recovery after surgery (ERAS) protocols in cardiac surgery. Despite these advancements, postoperative pain management has received insufficient attention. The potential effects of multi-mode analgesia, including ultrasound-guided serratus anterior plane block (SAPB), on postoperative pain and early quality of recovery have not been widely studied, lacking comprehensive prospective evidence. Therefore, this study aims to investigate the impact of SAPB combined with general anesthesia on early recovery quality and analgesic efficacy in transapical TAVI patients.MethodsThis prospective, randomized controlled study will enroll 70 patients undergoing transapical TAVI, randomly allocated to either the SAPB group or the control group. The primary outcome, assessed using Quality of Recovery-40 (QOR-40) scale, focuses on the quality of recovery at 24 h and 48 h postoperatively. Secondary outcomes include the visual analog scale (VAS) pain scores at rest and during coughing at 6 h, 12 h, 24 h, and 48 h after surgery, frequency of patient-controlled analgesia (PCA) utilization at 24 h and 48 h, opioid consumption at 24 h and 48 h, time and frequency of rescue analgesia and severe pain at 24 h and 48 h, incidence of nausea and vomiting at 48 h after surgery, and dosage of antiemetic drugs.DiscussionThe purpose of our study is to evaluate the effects of ultrasound-guided SAPB combined with general anesthesia on postoperative early quality of recovery and analgesia in transapical TAVI patients. The results obtained may provide valuable insight for the implementation of multi-mode analgesia and enhanced ERAS in this specific patient population.Trial registrationChina Clinical Trial Register ChiCTR2300068584. Registered on 24 February 2023.

Contact Dermatitis From Biomedical Devices, Implants, and Metals—Trouble From Within

Allergic contact dermatitis is characterized by its appearance of red, raised and infiltrated, scaling or scabbed skin and intense pruritus, and distinguished from irritant contact dermatitis by its specific immune process and histopathology. Many contact allergens are low molecular weight chemicals including metals such as nickel, cobalt, and chromium, preservatives, and adhesives. When such materials are used internally in biomedical devices, they are similarly capable of causing sensitization and an inflammatory response. Sometimes the reaction remains internal, and presents as swelling, pain, stiffness, decreased range of motion, and internal itching around the implant. Such reactions may, in some cases, also extend to include a localized or, rarely, systemic contact dermatitis indicative of the same process. This review will present an overview of reported skin and local internal reactions to orthopedic implants, which are the largest category of implanted internal metal devices. Immune reactions to smaller categories of medical appliances include cardiac devices and vascular stents, neuromodulation devices, diabetic appliances, Nuss bar surgery for pectus excavatum, and dental and spinal implants. We will review the available diagnostic tools, the consensus on interpretation, and reported strategies for treatment.

Flap Versus Flapless Implant Placement in Immediate Functional Loading: A Comparative Study

ABSTRACT Background: Dental implants are now the typical tooth replacement method. Because it speeds up therapy, quick functional loading—attaching prosthetic restorations to implants following surgery—has become popular. Flapless implant implantation reduces surgical stress and expedites recovery. Methods: A prospective comparative study of 100 flap and flapless dental implant patients was done. Patient-reported outcomes, implant survival, peri-implant parameters, and surgical complications were assessed. Statistical analysis compared the two groups’ results. Results: Both flap and flapless methods exhibited good implant survival and similar peri-implant characteristics. Patients reported equal postoperative comfort and satisfaction in both groups. Surgical complications were similar for flap and flapless surgeries. Conclusion: In immediate functional loading, flap and flapless implant insertion are equally effective and safe. Both methods yield dependable implant survival, peri-implant health, patient comfort, and surgical safety. Dental professionals should evaluate patient variables and anatomical aspects while choosing an implant implantation surgery. Implant dentistry needs further study on long-term results and treatment regimens.

The Effect of a Horizontal Apical Mattress Suturing Technique on the Width and Thickness of the Keratinized Mucosa After Dental Implant Surgery: A Cohort Study.

Introduction There is general agreement that a thick zone of the keratinized tissues around implants promotes accurate prosthetic procedures, permits oral hygiene maintenance, resists recession, and enables esthetic blending with surrounding tissues. A new procedure called Choukroun's technique has been suggested, and it consists of a combination of horizontal apical mattress suture with regular suture to increase the keratinized tissue in the mandibular arch during the first stage after implantation. The proposed procedure has not been evaluated yet in a cohort of patients. Therefore, this prospective study aimed to evaluate the impact of Choukroun's technique on the width and thickness of the keratinized gingiva after oral surgery. Materials and methods A one-group prospective cohort study was conducted on patients referred to the Department of Oral and Maxillofacial Surgery at the Dental College of Al-Wataniya Private University who had been referred to undergo dental implant surgery.The inclusion criteria for the study group were as follows: patients with mandibular missing teeth, good oral health, good general health, 18-70 years old, at least 1 mm thickness of keratinized gingiva, and at least 1 mm width of the attached gingiva. A total of 14 patients aged 27-67 years were included in the study. After inserting the dental implants, the suturing was accomplished according to Choukroun's method. The width and thickness of the keratinized gingiva were assessed before surgery and at one and two months post-surgery. Repeated measures analysis of variance (ANOVA) was applied to detect significant differences between assessment times. Results The study sample comprised 14 patients, of which four were females (28.6%) and 10 were males (71.4%). Patients' ages ranged from 27 to 67 years, with a mean age of 54.86 ± 11.73 years. The surgical procedure was performed in three different regions: the upper posterior teeth with four patients (28.6%), the upper anterior teeth with three patients (21.4%), and the lower posterior teeth with seven patients (50%). The mean gingival width before surgery was 5.78 mm, whereas the mean gingival thickness was 2.82 mm. There was no significant difference between the three evaluation times in the mean gingival width (P=0.222), and there was a significant difference between the three evaluation times in the mean gingival thickness (P<0.001). The mean mean gingival thickness one month after surgery was significantly greater than its mean value before surgery (mean difference: 0.749 mm). Additionally, the mean gingival thickness two months after surgery was significantly greater than its mean value before(mean differences: 0.636 mm). Conclusions Using horizontal apical mattress sutures (Choukroun's technique) does not provide any advantage in increasing the width of the keratinized gingiva. However, it does lead to an increase in the thickness of keratinized gingiva in the surgical area. Therefore, the use of horizontal apical mattress sutures is recommended.

Preoperative Assessment Using CT and MRI Scans of the Temporal Bone to Determine the Degree of Difficulty in Cochlear Implant Surgery.

Background Cochlear implant surgery is a complex procedure influenced by the anatomical structures of the temporal bone. Preoperative imaging using CT and MRI can provide critical insights into the surgical challenges that may be encountered. This study aims to evaluate the role of CT and MRI in preoperative assessment to predict the difficulty of cochlear implant surgery in terms of surgical time. Materials and methods A retrospectiveobservational study was conducted at Saveetha Medical College and Hospital, Chennai, from April 2022 to September 2023. Ninety patients with severe to profound sensorineural hearing loss who underwent cochlear implantation were included. Preoperative high-resolution CT (HRCT) and MRI of the temporal bone were performed to assess various anatomical parameters. Surgical difficulty was evaluated intraoperatively and correlated with preoperative imaging findings. Data were analyzed using IBM SPSS Statistics for Windows, V. 21.0 (IBM Corp., Armonk, NY). Results The mean age of participants was 7.4±10.9 years, with the majority (66.7%) in the 1-5-year age group. Out of 90 participants, 50 were male and 40 were female. HRCT and MRI revealed that 35.6% of participants had hypo-/non-pneumatized mastoids, 3.3% had narrow facial recesses, and 3.3% had high-riding jugular bulbs. Significant correlations were found between surgical time and associated congenital (p=0.006) and acquired (p=0.0001) anomalies of the temporal bone, as well as the total difficulty score (p=0.0001). The mean surgical time was 103.97±25.2 minutes, with a range from 45 to 220 minutes. Conclusion Preoperative HRCT and MRI are valuable tools in predicting the degree of difficulty in cochlear implant surgery. Specific anatomical features identified in imaging studies can significantly influence the surgical approach and duration. These findings underscore the importance of detailed preoperative imaging to enhance surgical planning and outcomes in cochlear implant procedures.

IStent insertion orientation and impact on trabecular meshwork motion resolved by optical coherence tomography imaging.

The iStent is a popular device designed for glaucoma treatment, functioning by creating an artificial fluid pathway in the trabecular meshwork (TM) to drain aqueous humor. The assessment of iStent implantation surgery is clinically important. However, current tools offer limited information. We aim to develop innovative assessment strategies for iStent implantation using optical coherence tomography (OCT) to evaluate the position and orientation of the iStent and its biomechanical impact on outflow system dynamics. We examined four iStents in the two eyes of a glaucoma patient. Three-dimensional (3D) OCT structural imaging was conducted for each iStent, and a semi-automated algorithm was developed for iStent segmentation and visualization, allowing precise measurement of position and orientation. In addition, phase-sensitive OCT (PhS-OCT) imaging was introduced to measure the biomechanical impact of the iStent on the outflow system quantified by cumulative displacement (CDisp) of pulse-dependent trabecular TM motion. The 3D structural image processed by our algorithm definitively resolved the position and orientation of the iStent in the anterior segment, revealing substantial variations in relevant parameters. PhS-OCT imaging demonstrated significantly higher CDisp in the regions between two iStents compared to locations distant from the iStents in both OD ( ) and OS ( ). Our proposed structural imaging technique improved the characterization of the iStent's placement. The imaging results revealed inherent challenges in achieving precise control of iStent insertion. Furthermore, PhS-OCT imaging unveiled potential biomechanical alterations induced by the iStent. This unique methodology shows potential as a valuable clinical tool for evaluating iStent implantation.