Manual Instrumentation Research Articles

Better restoration of joint line obliquity in tibia first restricted kinematic alignment versus mechanical alignment TKA.

In total knee arthroplasty (TKA), suboptimal restoration of joint line obliquity (JLO) and joint line height (JLH) may lead to diminished implant longevity, increased risk of complications, and reduced patient reported outcomes. The primary objective of this study is to determine whether restricted kinematic alignment (rKA) leads to improved restoration of JLO and JLH compared to mechanical alignment (MA) in TKA. This retrospective study assessed patients who underwent single implant design TKA for primary osteoarthritis, either MA with manual instrumentation or rKA assisted with imageless navigation robotic arm TKA. Pre- and post-operative long standing AP X-ray imaging were used to measure JLO formed between the proximal tibial joint line and the floor. JLH was measured as the distance from the femoral articular surface to the adductor tubercle. Overall, 200 patients (100 patients in each group) were included. Demographics between the two groups including age, sex, ASA, laterality, and BMI did not significantly differ. Distribution of KL osteoarthritis classification was similar between the groups. For the MA group, pre- to post-operative JLO significantly changed (2.94° vs. 2.31°, p = 0.004). No significant changes were found between pre- and post-operative JLH (40.6mm vs. 40.6mm, p = 0.89). For the rKA group, no significant changes were found between pre- and post-operative JLO (2.43° vs. 2.30°, p = 0.57). Additionally, no significant changes were found between pre- and post-operative JLH (41.2mm vs. 42.4mm, p = 0.17). Pre- to post-operative JLO alteration was five times higher in the MA group compared to the rKA group, although this comparison between groups did not reach statistical significance (p = 0.09). rKA-TKA results in high restoration accuracy of JLO and JLH, and demonstrates less pre- and post-operative JLO alteration compared to MA-TKA. With risen interest in joint line restoration accuracy with kinematic alignment, these findings suggest potential advantages compared to MA. Future investigation is needed to correlate between joint line restoration accuracy achieved by rKA and enhanced implant longevity, reduced risk of post-operative complications, and heightened patient satisfaction.

Artificial intelligence model for automated surgical instrument detection and counting: an experimental proof-of-concept study

BackgroundRetained surgical items (RSI) are preventable events that pose a significant risk to patient safety. Current strategies for preventing RSIs rely heavily on manual instrument counting methods, which are prone to human error. This study evaluates the feasibility and performance of a deep learning-based computer vision model for automated surgical tool detection and counting.MethodsA novel dataset of 1,004 images containing 13,213 surgical tools across 11 categories was developed. The dataset was split into training, validation, and test sets at a 60:20:20 ratio. An artificial intelligence (AI) model was trained on the dataset, and the model’s performance was evaluated using standard object detection metrics, including precision and recall. To simulate a real-world surgical setting, model performance was also evaluated in a dynamic surgical video of instruments being moved in real-time.ResultsThe model demonstrated high precision (98.5%) and recall (99.9%) in distinguishing surgical tools from the background. It also exhibited excellent performance in differentiating between various surgical tools, with precision ranging from 94.0 to 100% and recall ranging from 97.1 to 100% across 11 tool categories. The model maintained strong performance on a subset of test images containing overlapping tools (precision range: 89.6–100%, and recall range 97.2–98.2%). In a real-time surgical video analysis, the model maintained a correct surgical tool count in all non-transition frames, with a median inference speed of 40.4 frames per second (interquartile range: 4.9).ConclusionThis study demonstrates that using a deep learning-based computer vision model for automated surgical tool detection and counting is feasible. The model’s high precision and real-time inference capabilities highlight its potential to serve as an AI safeguard to potentially improve patient safety and reduce manual burden on surgical staff. Further validation in clinical settings is warranted.

Robotic Assisted TKA achieves adjusted mechanical alignment targets more consistently compared to manual TKA without improving outcomes.

Robotic total knee arthroplasty (rTKA), with its purported advantages of more accurate alignment, greater functional outcomes and patient satisfaction, is gaining popularity in patients undergoing TKA. The purpose of our study was to compare these parameters along with gait pattern and kneeling ability in a cohort of patients who underwent simultaneous TKA with manual instrumentation (mTKA) and rTKA in contralateral knees at a 1-year follow-up. This was a retrospective review of 135 consecutive patients who underwent simultaneous bilateral TKA using robotic assistance on one side and manual instrumentation on the contralateral side between January 2022 and June 2022. The target alignment in both cohorts was adjusted mechanical. Patients were followed up at 3, 6 and 12 months to assess and compare alignment, range of motion (ROM) and patient-reported outcome measures (PROM) data. Gait parameters and kneeling ability were assessed at 1-year follow-up. While adjusted mechanical alignment was achieved in all rTKA patients, we recorded five outliers (≥3° with relation to 180° HKA axis) in the mTKA cohort (three varus and two valgus). There were no significant differences between both cohorts with regards to ROM, PROM scores, gait analysis parameters and kneeling ability at 1-year follow-up. rTKA helps in achieving the adjusted mechanical alignment more consistently than mTKA. This, however, does not contribute to better functional outcomes and patient satisfaction at 1-year follow-up. Level III.

Early Clinical and Economic Outcomes for the VELYS Robotic-Assisted Solution Compared with Manual Instrumentation for Total Knee Arthroplasty.

Robotic-assisted total knee arthroplasty (TKA) has been developed to improve functional outcomes after TKA by increasing surgical precision of bone cuts and soft tissue balancing, thereby reducing outliers. The DePuy Synthes VELYS robotic-assisted solution (VRAS) is one of the latest entrants in the robotic TKA market. Currently, there is limited evidence investigating early patient and economic outcomes associated with the use of VRAS. The Premier Healthcare Database was analyzed to identify patients undergoing manual TKA with any implant system compared with a cohort of robotic-assisted TKAs using VRAS between September 1, 2021 and February 28, 2023. The primary outcome was all-cause and knee-related all-setting revisits within 90-day post-TKA. Secondary outcomes included number of inpatient revisits (readmission), operating room time, discharge status, and hospital costs. Baseline covariate differences between the two cohorts were balanced using fine stratification methodology and analyzed using generalized linear models. The cohorts included 866 VRAS and 128,643 manual TKAs that had 90-day follow-up data. The rates of both all-cause and knee-related all-setting follow-up visits (revisits) were significantly lower in the VRAS TKA cohort compared with the manual TKA cohort (13.86 vs. 17.19%; mean difference [MD]: -3.34 [95% confidence interval: -5.65 to -1.03] and 2.66 vs. 4.81%; MD: -2.15 [-3.23 to -1.08], respectively, p-value < 0.01) at 90-day follow-up. The incidence of knee-related inpatient readmission was also significantly lower (53%) for VRAS compared with manual TKA. There was no significant difference between total cost of care at 90-day follow-up between VRAS and manual TKA cases. On average, the operating room time was higher for VRAS compared with manual TKA (138 vs. 134 minutes). In addition, the discharge status and revision rates were similar between the cohorts. The use of VRAS for TKA is associated with lower follow-up visits and knee-related readmission rates in the first 90-day postoperatively. The total hospital cost was similar for both VRAS and manual TKA cohort while not accounting for the purchase of the robot.

Robotic-assisted total knee arthroplasty reduces soft-tissue releases which improves functional outcomes: A retrospective study

BackgroundThere is increasing use of Robotic-Assisted (RA) and personalized alignment techniques in total knee arthroplasty (TKA). The hypothesis of this study was that RA TKA would result in fewer soft-tissue releases, and that fewer soft-tissue releases would be associated with improved clinical outcomes. MethodsA retrospective review of an internal company registry was conducted for all primary TKAs performed from Jan 1, 2014, through a database extract date of Nov 4, 2022. These were grouped by whether there was an intentional soft-tissue release performed (STR) during the surgery or not (NSTR) and whether RA was utilized. The incidence of STR was compared between RA-TKAs and those performed with manual instrumentation. Knee Society Score (KSS) and Knee Society Function Scores (KSFS) were collected at 6 months, 1 year and 2 years. Kaplan-Meier survivorship was performed. ResultsThe incidence of STR was significantly lower for RA vs. Manual (43.81% Vs 86.62%, p < 0.0001). The TKAs with NSTR had higher KSFS compared to those with STR at 6 months (84.73 Vs. 77.51, p < 0.0001), 1 year (89.87 Vs. 83.54, p < 0.0001) and 2 years (90.09 Vs. 82.65, p < 0.0001). There was no difference in survivorship, or KSS at any time point. However, the NSTR group had improved KSS pain sub score at 2 years. ConclusionThe results of this observational, retrospective analysis found that the incidence of soft-tissue release was lower with RA-TKA. Further, regardless of if RA was used, avoiding releases was associated with improved KSFS and KSS pain scores through 2 years post-operatively.

Robotic-assisted Total Hip Arthroplasty and Spinopelvic Parameters: A Review.

Total hip arthroplasty (THA) is an effective treatment for osteoarthritis, and the popularity of the direct anterior approach has increased due to more rapid recovery and increased stability. Instability, commonly caused by component malposition, remains a significant concern. The dynamic relationship between the pelvis and lumbar spine, deemed spinopelvic motion, is considered an important factor in stability. Various parameters are used in evaluating spinopelvic motion. Understanding spinopelvic motion is critical, and executing a precise plan for positioning the implant can be difficult with manual instrumentation. Robotic and/or navigation systems have been developed in the effort to enhance THA outcomes and for implementing spinopelvic parameters. These systems can be classified into three categories: X-ray/fluoroscopy-based, imageless, and computed tomography (CT)-based. Each system has advantages and limitations. When using CT-based systems, preoperative CT scans are used to assist with preoperative planning and intraoperative execution, providing feedback on implant position and restoration of hip biomechanics within a functional safe zone developed according to each patient's specific spinopelvic parameters. Several studies have demonstrated the accuracy and reproducibility of robotic systems with regard to implant positioning and leg length discrepancy. Some studies have reported better radiographic and clinical outcomes with use of robotic-assisted THA. However, clinical outcomes comparable to those for manual THA have also been reported. Robotic systems offer advantages in terms of accuracy, precision, and potentially reduced rates of dislocation. Additional research, including conduct of randomized controlled trials, will be required in order to evaluate the long-term outcomes and cost-effectiveness of robotic-assisted THA.

Using Cut-to-Length (CTL) Harvester Production Data in Forest Inventories

Determining forest stand characteristics after thinning, in order to assess the quality of the work and update the inventory data of the thinned stand, is one of the few forest management tasks for which an efficient and accurate automation solution has not yet been developed. Currently, forest stand characteristics are determined by a certified inventory expert using manual instruments such as a range finder, digital or manual calliper, and a Bitterlich gauge. Manual measurements add a significant cost to forest management, and automating this process could increase the competitiveness of forest owners in the global timber market, helping reduce human error and providing more detailed information on the condition of stands and the distribution of trees of different dimensions in a stand.The aim of the study is to adapt a method developed in Sweden for the automated estimation of forest stand characteristics after thinning using the HprGallring software to Latvian conditions and to determine accuracy of the modelling-based prediction of stand characteristics.In the study, the height, number, diameter, and species of individual trees after thinning were determined using the sample plot method (according to methods applied in forest resources monitoring) and using photogrammetry as reference data for the study. In some felling areas, the diameters of all trees were measured before and after felling. The data obtained using different methods were compared with updated stand characteristics in the Forest resource database updated by certified inventory experts using plot measurement method.According to the results of the study, HprGallring can provide the data necessary for updating the forest inventory database after thinning, but the accuracy of the modelled projections, as compared to manual measurements, are not yet within the uncertainty range as required by the forest inventory regulations. The average tree height, as indicated in the State Forest Register, matches the HprGallring estimates within the regulatory uncertainty limits in 67% of Scots pine (Pinus sylvestris L.) stands, 65% of Norway spruce (Picea abies (L.) H.Karst.) stands, and 48% of Birch (Betula sp.) stands. The diameter of an average tree after thinning estimated by the HprGallring is larger than that according to the manual measurement. The average diameter estimated using HprGallring in pine stands matches the data in State Forest Register in 40% of the assessed areas, in 47% for spruce stands, and 35% of birch stands. The accuracy of the predictions needs to be improved to make HprGallring usable in forest inventory, but even now it provides valuable spatial information about the distribution of trees of different dimensions and species within stands, enabling more accurate planning of management methods and spatial redesigning of the forest compartments.

Instrument fracture in periodontal therapy: ethical disclosure and clinical management - a case report

Periodontal instrument fractures are rare events in dentistry, with limited literature available on their occurrence and management. This case report highlights an incident involving the fracture of a periodontal sickle scaler blade during manual instrumentation for the removal of calculus. The fracture occurred during instrumentation on the mesial surface of the maxillary right second molar, and the separated blade was subsequently pushed into the sulcus. A radiographic assessment was performed to verify the precise location of the fractured segment. Following confirmation, the broken blade was subsequently retrieved using curved artery forceps. The case report highlights factors contributing to instrument fractures, emphasizing the importance of instrument maintenance, sterilization cycles, and operator technique. Ethical considerations regarding patient disclosure, informed consent, and instrument retrieval methods are well discussed. This case underscores the importance of truthful communication, the proper use of instruments, equipment maintenance in dentistry, and the significance of ongoing professional development to enhance treatment safety, proficiency, and ethical standards in dental care.

Passive Root Coverage Through Creeping Attachment of the Gingiva Before and After Scaling and Root Planning Therapy in the Mandibular Anterior Teeth: A Clinical Study.

Introduction Root coverage is one of the most imperative procedures in periodontal therapy. The demands from patients for aesthetics and sensitivity are some of the complaints in root exposure cases. Creeping attachment is a passive apical migration of the marginal gingiva and can be proposed as a noteworthy root coverage technique. The purpose of this study was to evaluate the position of the marginal gingiva and quantify the creeping attachment before and after the scaling and root planning (SRP) procedure. Materials and methods The present study was based on a single-centreclinical trial in which 30 sites from 10 patients were selected. Patients with Miller's class I gingival recession were selected. The plaque index, gingival biotype, and gingival margin position were measured at baseline and then at 10 and 21 days after SRP. The gingival biotype was measured with an endodontic file with a stopper and a digital vernier calliper. The gingival margin position was measured from the incisal surface of the tooth to the marginal gingiva with the help of a University of North Carolina (UNC) 15 periodontal probe. After recording the clinical parameters, a thorough SRP was performed using an ultrasonic scaler and manual instruments. Results The results were compared clinically at baseline and after 10 days and 21 days postoperatively. Statistical analysis was conducted for pre-SRP and post-SRP findings using the IBM SPSS Statistics for Windows, Version 19 (Released 2010; IBM Corp., Armonk, New York) software. A statistically significant improvement was seen in all the clinical parameters at baseline, at 10 days, andat 21 days postoperatively after the procedure (P < 0.01). Conclusion The position of the gingival margin was shifted towards the crown, and the creeping attachment was significantly observed from baseline to 10 and 21 days. Clinical significance Creeping attachment after the SRP procedure can be considered a significant root coverage technique. The genetic memory of the gingiva may playan important role in achieving root coverage. Once local irritants are removed, the gingiva attempts to regain its original position. In addition, the gingival phenotype plays an important role in gingival marginal positioning after basic therapy and root coverage procedures.

Effect of treatment variables on apical extrusion of debris during root canal retreatment: A systematic review and meta-analysis of laboratory studies.

This study aimed to systematically and comprehensively review the effect of various treatment variables on apically extruded debris (AED) during non-surgical root canal retreatment (NSRCRT). The study protocol is shared in the Open Science Framework database (https://osf.io/kjtdg/?view_only=17060180705745ec9dae9a01614f3880). An electronic search was conducted up to July 2022 to reveal related studies. Two reviewers critically assessed the studies for eligibility against inclusion and exclusion criteria and data extraction. Quantitative data synthesis was performed, and the risk of bias in the studies was also evaluated. Forty-six studies were included in the systematic review and 14 in the meta-analysis. Conflicting or limited evidence was found for the effect of sealer type, obturation technique, and solvent use. The manual instrumentation increased the amount of AED compared to rotary instrumentation during the removal of filling materials (P<0.001). There was no significant difference in the amount of AED between the use of rotary and reciprocating files during the removal of filling materials (P=0.181). Rotary instruments can be recommended instead of manual instruments during the removal of filling materials to control the amount of AED. Further studies with a low risk of bias are needed to clarify the effect of other treatment variables on AED during NSRCRT.

Bi-cruciate retaining total knee arthroplasty is here to stay: A consecutive series transitioning from manual instrumentation to enabling technologies.

Bicruciate-retaining (BCR) total knee arthroplasty (TKA) has seen renewed interest due to the potential for more natural knee kinematics with anterior cruciate ligament (ACL) retention. The present study attempts to determine differences in the 2-year survivorship and patient-reported outcomes between two surgical strategies (traditional instrumentation versus robotics) applied to the extensive use of a modern, 2nd generation BCR TKA design. We performed a retrospective study with prospectively collected data of 113 patients who underwent primary TKA between 2018 and 2020 using a 2nd generation BCR TKA implant. Patient demographics, PROMS, and intra/post-operative complications were collected. Patients were also evaluated according to the use or not of robotics. A Kaplan-Meier analysis was used to evaluate revision-free survival at follow up. 102 patients were enrolled: 90 received traditional surgery and 12 robotic-assisted surgery. The mean age was 68years (SD 7.76) with an average BMI of 29.6 kg/m2 (SD 3.56). The mean follow up (FU) was 32.4 ± 6.2 months (range 24-45months). Survivorship at 2 years was 98% (95% CI: 92.4-99.5). Revisions/reoperations were performed for anterior cruciate ligament (ACL) tear (1/4), pain (1/4), arthrofibrosis (1/4) and acute periprosthetic joint infection (PJI) (1/4). At final FU, 92 patients (90.2%) considered themselves satisfied, showing a mean OKS of 40.6 (SD 5.1) and a mean FKS of 76.7 (SD 11.8). No differences in the outcome were found between traditional and robotic-assisted procedures. The modern BCR design evaluated in this study achieved excellent results in terms of implant survivorship, low rate of reoperation and clinical results, independently from the use of enabling technologies.

Robotic Total Knee Replacement: Our Experience with First 200 Knees

Total knee replacement (TKR) is a commonly done surgery in cases of high-grade arthritis of knee affecting activity of daily living in patients. Conventional zig based TKR (CTKR) with manual instruments provides a balanced knee according to the surgeons’ subjective assessment of ligament balance, still some percentages of patients are found to have dissatisfaction in regards to persistent pain, lack of range of motion and walking unaided. In this study we are sharing our experience in a consecutive series of 200 Robotic-Assisted Primary TKRs. Robotic assisted TKR (RATKR) has multiple advantages over conventional jig based TKR (CTKR), such as it improves the accuracy of implant positioning and reduces outliers in achieving the planned limb alignment, minimal soft tissue dissection, thus reducing pain and need of analgesia, early recovery and giving a natural arc of motion postoperatively. Robotic assisted TKR is associated with reduced iatrogenic injury to the periarticular soft tissue envelope compared to conventional jig-based TKR. A clear advantage of robot-assisted TKR seems to be the ability to execute a highly precise preoperative plan based on computed tomography (CT) scans, minor modification up to submillimetre accuracy in implant positioning can be done which is impossible to differentiate with human eyes. Due to improved alignment of the prosthetic components and improved boneimplant fit, implant loosening is anticipated to be reduced. Limitations of robotic TKR include high installation costs, increased surgical time, implant specificity of the robots and nonavailability of long-term literature due to being a recently evolved technology.

Digital-based Career Specialization Service is an Innovative Counseling Service for Counseling Teachers of Junior High Schools

Choosing the right career specialization significantly affects students' future life prospects. However, the career specialization service provided by the Guidance and Counselling (GC) teachers remains suboptimal due to the continued reliance on manual instruments, which results in protracted analysis periods. One challenge GC teachers face is their limited proficiency in utilizing technology to digitize instruments. The objective of providing training on digital-based career guidance services is to assist counseling teachers in analyzing career guidance instruments. Digital-based career guidance service training was provided to 26 counselling teachers who are MGBK SMP Barito Kuala Regency members with brain storming and hands-on practice methods guided by the Mandatory Research Lecturer Program team. The training yielded a 75% improvement in technology-related proficiencies, meaning counseling teachers are capable of implementing this digital career specialization service within their respective academic institutions.

Comparative Evaluation of Clinical Instrumentation Time and Quality of Obturation of Two Different Pedo Rotary File Systems in Primary Mandibular Molars: An In Vivo Study.

The preferred treatment for primary teeth that are necrotic has been pulpectomy. Despite being the gold standard for years, using hand files can be difficult because of the longer chairside periods. Technology advancements have made it possible to reduce the need for manual dexterity and enhance pulpectomy care. Pediatric rotary files are now available specifically for use with primary teeth. This study's goal was to assess and contrast the instrumentation time and obturation quality of manual H files and pediatric rotary file systems (Prime Pedo™ and DXL-Pro™ rotary file systems) in primary mandibular molars. A total of 51 deciduous mandibular molars that were evenly distributed for instrumentation were subjected to pulpectomy. Group I included the Prime Pedo™ rotary file system, group II included the DXL-Pro™ rotary file system, and group III included manual H files. A stopwatch was used to record the instrumentation time, and a postoperative radiograph was used to record the obturation quality. When comparing pediatric rotary file systems to manual H files, there was a statistically significant reduction in instrumentation time (p = 0.000). When comparing the pediatric rotary file systems to the manual H files, there was no discernible difference in the obturation quality (p = 0.534). In all three file groups, the quality of obturation produced results that were comparable. On the other hand, a significant difference was observed in the instrumentation time between rotary and manual instrumentation for deciduous teeth. Thakur S, Dhanasekaran M, Singhal P. Comparative Evaluation of Clinical Instrumentation Time and Quality of Obturation of Two Different Pedo Rotary File Systems in Primary Mandibular Molars: An In Vivo Study. Int J Clin Pediatr Dent 2024;17(3):303-306.

Effectiveness of Ultrasonic and Manual Instrumentation in Nonsurgical Periodontal Therapy: Are Additional Therapies More Effective? A Systematic Review

Nonsurgical periodontal therapy aims to remove supragingival and subgingival biofilm to restore periodontal health. This systematic review aims to assess the clinical effectiveness of manual and/or ultrasonic instruments and to determine whether other therapies can improve periodontal clinical outcomes. Case-control, cross-sectional and cohort studies and clinical trials of patients undergoing nonsurgical periodontal therapy with ultrasonic and/or manual instruments (and any adjunctive therapies, such as glycine, erythritol, ozone, laser and glycine) from 2013 to 2023 were analyzed using Pub-med/MEDLINE, Scopus and Google Scholar. To assess the risk of bias in this review, blinding, randomization, allocation concealment, outcome data and outcome recording were assessed. No differences between treatments were found; all methods, including manual and ultrasound, were helpful in improving clinical parameters (primary outcome). Although the results were mixed, adjunctive therapies seemed to be helpful in the treatment of periodontal disease. The results of this systematic review are consistent with the previous scientific literature and have shown that both manual and ultrasonic instruments are effective in nonsurgical periodontal therapy. This review could not show how complementary therapies could further improve nonsurgical periodontal therapy. For future research, it would be good to standardize the sample with regard to the degree and stage of periodontal disease and to evaluate the risks and benefits of the instruments (manual and ultrasonic scalers).

The Alignment of the Tibial Component in Total Knee Arthroplasty: Is a Technology-Assisted System Better Than Conventional Instrumentation?

Background Technologies such as navigation and robotics are aimedat improving tibial alignment in total knee arthroplasties (TKA) and eliminating the errors resulting from the use of manual instrumentation. Methods This prospective study analyzed 130 arthroplasties in order to determine whether navigation can improve the frontal mechanical axis of the tibia and whether the postoperative angulation of this axis differs from the preoperative one. The mean patient age was 71.8 years, and the mean BMI was 31.17. Eighty-six patients were female. The same cemented TKA model and the same imageless navigation system were used in all cases. Results The mean postoperative tibial angle following implantation was 87.65°, without any statistically significant differences with respect to the previous angulation. However, navigation was seen to result in a nearly neutral tibial axis, a larger number of cases (41.5%-60.8% {p = 0.002}) aligned within the safe zone (90° ± 3°), a smaller number of outliers, and a clustering of values around the mean. Conclusions Navigation improves the frontal positioning of the tibial component in total knee arthroplasties but does not offer any advantages as compared with conventional instrumentation.

A Comparative Evaluation of Root Surface Roughness After Instrumentation with Gracey Curettes, Ultrasonic and Piezo-Surgery Driven Diamond Coated Tips: An In-Vitro SEM Study

Background To evaluate root surface roughness after instrumentation with Gracey curettes Ultrasonic scaler and diamond coated piezo-surgery tips using scanning electron microscope SEM.Methods Sixty-six mandibular premolar teeth indicated for extraction were collected stored mounted and analysed. These were divided randomly into three groups with 22 samples in each group. In Group A instrumentation was done with Gracey curettes Group B with ultrasonic scaler and Group C with piezosurgery driven diamond coated tips. The samples were then subjected to SEM analysis at a magnification of 1500x. The collected data was analysed using both descriptive and inferential statistics. Chi-square test t test ANOVA and other necessary statistical tests were used. P lt0.05 was considered to be significant. The analysis of the data was carried out using SPSS version 20 software.Results Multiple comparisons of mean surface roughness scores showed no significant difference between Gracey curette and Ultrasonic scaler tip P0.063. No statistical significant difference was found between Gracey curette and Piezo surgical unit P0.984. However there was a statistically significant difference between Ultrasonic scaler tip and Piezo surgical unit P lt0.004. It can be inferred from the results that the surface roughness is different in both Ultrasonic scaler tip and Piezo surgical unit groups.Conclusion The use of diamond-coated tips tends to produce more surface roughness than routinely used ultrasonic scaler tips and manual instrumentation.

Efficacy of ultrasonics and Er,Cr:YSGG laser on root surface calculus removal: A comparative in vitro field emission scanning electron microscope study.

Scaling and root planing (SRP) is an inevitable primary step in non-surgical periodontal therapy. Debridement carried out with manual instruments and ultrasonics results in the removal of tooth structure. Current research revolves around laser as an efficient adjunct to SRP. This study evaluated and compared the effectiveness of root surface calculus removal between ultrasonics and Er,Cr:YSGG laser. Twenty-eight single-rooted teeth extracted due to periodontal disease were selected for the study. The specimens were randomly assigned to two groups (n=14). Group I underwent ultrasonic instrumentation using a piezo ultrasonic scaler, and group II was subjected to laser instrumentation using Er,Cr:YSGG laser (Waterlase). The specimens were processed, fixed, viewed under a field emission scanning electron microscope and evaluated using the remaining calculus index (RCI) and loss of tooth substance index (LTSI). Ultrasonics-treated specimens revealed more remaining calculus (1.57±0.65) and lost tooth substance (1.71±0.61) compared to the Er,Cr:YSGG laser-treated specimens, with significantly lower RCI (0.71±0.61) and LTSI (1.00±0.56). There was a statistically significant difference (P<0.05) in the efficacy of root surface calculus removal between the two groups. Compared to ultrasonics, Er,Cr:YSGG laser demonstrated superior results by causing precise removal of root surface calculus without significantly affecting tooth structure and aiding in new attachment.

DIGITAL APPLICATION OF LIFESTYLE PROMOTION PROGRAM FOR PREDIABETES

Introduction: Prediabetes is a condition characterized by blood glucose levels higher than normal values but below blood glucose levels. Diabetes mellitus is a very significant global health problem today, where the prevalence in the three countries is highest in the world, namely Chin==a (48.6 million), the United States (36.8 million), and Indonesia (27.7 million), and collectively equal one third of the prevalence of prediabetes in the world. The potential for using program technology combining interactive mobile computing, remote monitoring, so that the use of digital applications will make it easier to make lifestyle changes for prediabetes by being able to be applied using smartphone devices which are currently used in daily life in the Bandung city area.&#x0D; Method: this research is experimental research, d The type of research used is Research and Development (R&amp;D) or development research. using the ADDIE model approach by designing an Android-based digital application for lifestyle changes for prediabetes.&#x0D; Objectives: To obtain a digital application for lifestyle changes in prediabetes in the Bandung City area.&#x0D; Result: Analysis of media needs is divided into 5 aspects, namely design, material, language, illustrations and typography used on smartphones. Design of materials used to create software or a software program that can be run via smartphone regarding prediabetes screening. The development received an assessment by material experts of 73% with feasible criteria and by media experts of 77% with very feasible criteria. Implementation showed that the number of respondents who gave a very easy assessment of the Prediabetes application was 73.53%, while the manual instrument was 26.67%. The Prediabetes evaluation showed that all respondents using the Prediabetes application had correct results, while using manual instruments there were still 2.97% who entered incorrectly. that the Prediabetes application has good accuracy and faster filling time.&#x0D; Conclusion: analysis of the location of letters and images in the middle of the media, software design smartphone screening, Development is suitable for use, Implementation is easy to implement, Evaluation has good accuracy and charging time is faster.

Multicenter, prospective cohort study: immediate postoperative gains in active range of motion following robotic-assisted total knee replacement compared to a propensity-matched control using manual instrumentation

BackgroundRange of motion (ROM) following total knee replacement (TKR) has been associated with patient satisfaction and knee function, and is also an early indicator of a successful procedure. Robotic-assisted TKR (raTKR) is considered to reproduce more precise resections, and, as a result, may be associated with improved early patient satisfaction compared to manual TKR (mTKR). The purpose of this study was to evaluate the early postoperative active ROM (aROM) between raTKR and mTKR.MethodsA total of 216 mTKR patients were propensity-matched, in terms of age, gender, comorbidities, and BMI, to 216 raTKR cases. Intraoperative and immediate postoperative adverse events were collected. Knee flexion and extension aROM were measured preoperatively and at one- and three months after operation.ResultsChanges in flexion aROM were significantly greater in raTKR vs. mTKR at one- (6.9°, 95% CI: 3.5, 10.4°) and three months (4.9°, 95% CI: 2.1, 7.7°). Flexion aROM was greater at three postoperative months compared to preoperative aROM only in the raTKR group, and raTKR patients had higher odds of achieving ≥ 90° of flexion at one month after operation (OR: 2.15, 95% CI: 1.16, 3.99). There were no significant differences between groups in intraoperative (P > 0.999) or postoperative adverse events.ConclusionsCompared with mTKR, raTKR resulted in less loss of aROM immediately after operation and a faster recovery of aROM within three months after operation.Trial registrationClinicaltrials.gov (NCT# 03737149).