Post Fracture Research Articles

Prediction of fold-of-increase in productivity index post limited entry fracturing using artificial neural network

Unified Fracture Design (UFD) bridges the gap between practices and theory in the hydraulic fracturing industry. It represents a technique to design hydraulic fracturing treatment with a particular amount of proppant. This design could provide the maximum fold-of-increase (FOI) in productivity-index (PI) after hydraulic fracturing treatment. The UFD optimization tool is very effective, but it has assumptions like any other model. One assumption of UFD optimization technique; is a single-layer assumption. This assumption does not align with the limited entry fracturing design concept. In limited entry fracturing, the frictional pressure is employed to offset the stress differences between multi-layers reservoirs to attain fluid injection through these layers, intended to deliver an optimal fracture conductivity in all layers. The drawback of this assumption is the underestimation of the actual value of FOI in PI. This paper aims to recast the original unified fracture design approach to extend the optimal UFD to a multilayer reservoir to predict the FOI in PI after limited entry fracturing treatment. The recasting tool for this problem to find the optimum solution is Artificial Neural Networks (ANN). The architected ANN model is based on actual historical data of limited entry fracturing treatments. A statistical comparison between the proposed ANN model and classical UFD technique demonstrates that ANN model solution has a more reliable estimation of FOI in PI with the actual historical data.

A Case Series: Non-vascularized Autologous Fibular Graft in the Treatment of Major Segmental Bone Defect after Post-traumatic at Diaphyseal Femur

BACKGROUND
 In the management of bony defects, autologous bone grafts can be used as the mechanical structure for reconstruction to restore aesthetics and function, Non-vascularized autologus fibular graft are often used to the treat large post traumatic defects caused by high-energy trauma with open fracture and nonunion cases for 1st and 2nd cases. Here we would like to present a 16-year-old woman and a 37-year-old man patients of major bone defect at the right femoral shaft region using 9 cm and 10 cm non-vascularized fibular autogenous grafts.
 
 OBJECTIVE
 The purpose of this case report was to determine the effectiveness of non-vascularized autologus fibular graft for major bone defect at the regio femoral shaft for the reconstruction of post traumatic case.
 
 MATERIAL AND METHODS
 We treat post traumatic of the major bone defect at the regio femoral shaft with 9 cm and 10 cm femoral non-vascularized autologus fibular graft and fixed by a limited contact dynamic compression plate and femoral locking plate methode by routine phisioteraphy.
 
 RESULTS
 The Patient have a good result with good functional outcome after open reduction internal fixation (ORIF) and using a non-vascularized autologus fibular graft for treating the major bone defect after post traumatic femoral shaft fracture.
 
 CONCLUSION
 Complete and comperhensive open reduction internal fixation (ORIF) with autologous non- vascularized fibular graft, stabilized fracture by limited contact dynamic compression plate for 1st patient and femoral locking plate for 2nd patient allowing with an early rehabilitation is an acceptable, Phisioteraphy and early mobilisation resulting better outcome for the patient, all of this are less expensive, can be accepted at the hospitals that limited facilities and health professionals for professional subspeciality and widely reproducible option to manage bone defects in open shaft femoral fractures to achieving union, preserving length and motion with no donor site morbidity, giving patients good functional outcome and radiologic result.
 
 KEYWORDS
 Major bone defect, non-vascularized autologus fibular graft, autologous bone grafts, femoral shaft fracture, Open Fracture, Muskuloskeletal Reconstruction, Bone Loss, Nonunion.

Comparison of sliding distance of lag screw and nonunion rate according to anteromedial cortical support in intertrochanteric fracture fixation: A systematic review and meta-analysis

We compared the sliding distance of the lag screw, change in neck-shaft angle (NSA), and nonunion rates according to the anteromedial cortical support on anteroposterior (AP) and lateral view radiographs post intertrochanteric fracture reduction. In this systematic review and meta-analysis, MEDLINE, Embase, and Cochrane Library databases were searched systematically for studies published before September 26, 2020. We performed synthetic analyses of the amount of lag screw sliding, change in NSA, and incidence of nonunion following reduction of intertrochanteric fractures by extramedullary reduction (EMR), neutral reduction (NR), and intramedullary reduction (IMR). The combined data of EMR and NR comprised the non-IMR group. Our study enrolled eight studies, representing 1,363 patients who underwent surgery for intertrochanteric fractures. A pooled analysis showed a larger sliding distance in the IMR group than in the non-IMR group (standard mean difference [SMD]=1.47, 95% confidence interval [CI]: 0.73-2.20; P < 0.0001 and SMD=1.27, 95% CI: 0.56-1.99; P=0.0005, respectively) in both AP and lateral views. The pooled mean difference of change in NSA in the IMR group was -3.11° and differed significantly from that of the non-IMR group (95% CI: -4.07 to -2.16; P < 0.0001). In the lateral view, the nonunion rate was significantly higher in the IMR group than in the non-IMR group (odds ratio [OR]=11.61; 95% CI, 3.32-40.62; P=0.0001). In the subgroup analysis, the NR group showed a larger sliding distance than that of the EMR group in the AP view (SMD=0.40, 95% CI: 0.04-0.76; P=0.03); however, the reverse was true in the lateral view (SMD=0.68, 95% CI: 0.38-0.97; P < 0.00001). In the current meta-analysis, larger sliding distances, more varus in NSA, and higher nonunion rates were observed in the IMR group than the non-IMR group, in both AP and lateral views. However, in the comparison between EMR and NR, it was difficult to conclude which of them was the ideal reduction method because of inconsistent results.

MRI Visualization of Polyethylene Post Fractures in Posterior Stabilized Total Knee Arthroplasty.

Polyethylene post fracture is a recognized complication of posterior stabilized total knee arthroplasty. Two radiologists retrospectively reviewed MRI examinations of 19 reported post fractures in 18 patients; all fractures were subsequently confirmed surgically with no false-positive cases. All post fractures were visualized as a combination of post deformity and signal-void fragment in a joint recess. A metal artifact reduction 3D multispectral imaging sequence improved fracture visualization versus conventional sequences in 47% of cases.

4D microstructural characterization of corrosion and corrosion-fatigue in a Ti–6Al–4V / AA 7075-T651 joint in saltwater environment

Dissimilar alloy couples are susceptible to environmentally assisted damage owing to the presence of crevices and potential difference between the constituent alloys. In this study, x-ray computed tomography has been employed to non-destructively study the corrosion behavior of a dissimilar alloy fastener-plate couple (AA7075-T651/Ti–6Al–4V) in a 3.5 wt% NaCl environment. Following this, the specimen was subjected to corrosion fatigue and post fracture failure analysis was performed. The precise locations of corrosion pitting damage in the specimen were studied with respect to corrosion time. Microstructural factors that contribute to crack initiation were identified using a correlative microscopy-based approach and are discussed.

Incidence and Risk Factors Associated with Post Tibial Plateau Fracture Deep Venous Thrombosis: A Prospective Cohort Study

Objective: The purpose behind this study was to determine the incidence and risk factors associated with post tibial plateau fracture deep venous thrombosis (DVT)&#x0D; Materials and Methods: A prospective study was conducted in a tertiary care hospital, Indus Medical College &amp; Hospital, Tando Muhammad Khan to recruit those patients who were undergoing orthopedic surgeries during the periods of eighteen months. All the adult patients of both gender planned for surgery due to tibial plateau fracture were enrolled under this study. Duplex ultrasound was performed to detect the presence of underlying postoperative DVT. Post-operatively patients were assessed for potential risk factors associated with higher incidence of DVT. &#x0D; Results: For the final analysis, 344 patients were included among them majority were males (n = 219, 63.66%) with overall mean age and SD was 47.52±12.02 years. The most common cause of fracture was road traffic accident (n = 178, 51.74%). The overall incidence of post-operative DVT observed in our study was 9.30% (n = 32). Mean age 40.19±6.10 years, increased mean duration of operation 3.01±.078 hours, increased mean duration of post-hospitalization 18.49±7.37 days, raised mean WBC counts 20.12±5.64, and increased mean D-dimer levels 3.24±3.09 (laboratory cut off value 0.5mg/L) were significantly associated with higher incidence of DVT in patients operated for tibial plateau fractures.&#x0D; Conclusion: This prospective analysis has identified the potential modifiable risk factors associated with DVT. Consideration should be given to the preventable and treatable risk factors to prevent from the DVT associated complications.

NURSING CARE IN POST OP CRURIS FRACTURE CLIENTS WITH ACUTE PAIN NURSING PROBLEMS (STUDY OF LITERATURE)

Post op fracture of the cruris is a break in the tibia and fibula. Clinically, it can be an open fracture if it is accompanied by damage to the soft tissues muscle, skin, nerve tissue, and blood vessels, allowing the connection between the broken bone fragments with the outside air and the closed fracture. The impact that trauma can have on a fracture is limited to activity, may have the change in the damaged part of the body an the anxiety that may result from pain and pain. This research method used a literature study with a case study of nursing care in post op cruris fracture patients with acute pain problems in the Asoka Pavilion of Jombang Hospital which was carried out in the 2017-2019 period. The results of the literature study show that the priority problem for post op client cruris fracture is acute pain. The literature study of 4 clients showed that there were similar factors causing pain in the post op wound fracture of the cruris which resulted in decreased muscle strength, swelling, dan CRT&gt; 2 seconds. Surgery will produce damaged cells with the consequence that it will release autanoid chemicals that can cause pain. Efforts to cope with injuries from post op cruris fracture by performing techniques in the greeting relaxation activities and listening to music and pain medication. In order to recover wounds from post op fracture, the cruris fracture should be treated routinely and increase their nutritional intake

Vertical Load and Torque during Postspace Preparation and Their Influence on Microcrack Development.

To investigate, in vitro, the magnitudes of vertical load and torque generated during post space preparation of root canal treated teeth and their influence on microcrack development. Forty extracted premolars with single canals were decoronated. The roots were prepared using ProTaper Next system (Dentsply Sirona) to X3 file, obturated, and provisionalized. After a 3-week incubation period, the roots were distributed into 2 groups according to the post drill system used(ParaPost fiber post and RelyX fiber post). During post space preparation, the vertical load, torque, and preparation time were recorded. Before and after the post space preparation, the roots were imaged with micro-computed tomography (SkyScan 1172; Bruker micro-CT) to detect new microcracks. The data were analyzed using the Mann-Whitney U-test and chi-square test. In ParaPost and RelyX, the post space was prepared in 48.31 ±25.28 and 47.71 ±13.36 seconds, respectively (p = 0.360). The peak vertical load generated with ParaPost (20.23 ±7.80 N) was significantly lower than that of RelyX (29.43 ±5.82 N) (p = 0.010). The maximum torque attained with ParaPost (1.42 ±0.61 N.cm) was found to be significantly lower than that of RelyX (3.23 ±1.58 N.cm) (p = 0.000). No post drill fracture or visible deformation was noticed throughout the experiment. New microcracks were found in three ParaPost samples only. The choice of postdrill influenced the loads and torques generated during postspace preparation. The ParaPost system showed favorably lower load and torque values during the postspace preparation compared with the RelyX system.

Micro-cracking pattern recognition of hybrid CNTs/GNPs cement pastes under three-point bending loading using acoustic emission technique

The generation of microcracks has an important influence on the behaviour of concrete structures. In this study, the acoustic emission (AE) technique was used to investigate the fracture phenomena and micro-cracking behavior of hybrid carbon nanotubes (CNTs, the 1-D allotrope of carbon atoms) and graphene nanoplatelets (GNPs, 2D monolayer of sp2-hybridized carbon atoms), cement composites under three-point bending loading. In addition, dispersion level by ultraviolet visible spectroscopy (UV–Vis), mechanical performance, and micro-structure properties by scanning electron microscopy (SEM) of hybrid cement composites were studied. Different typical AE parameters like AE hits, rise time, frequency and amplitude distribution, and b-value were used for the AE analysis. The cracking pattern and failure mechanism of the specimens were observed into three stages: initial elastic stage, pre-fracture stage, and post-fracture stage. The conclusions were drawn as follows: (1) through the UV–Vis spectrometry, it is found that GNPs act as dispersion agents for CNTs; (2) hybrid specimens experienced large deformation with the increasing wt.% of CNTs + GNPs during post fracture phase, thus showing more ductile behavior as compared to the control sample; (3) based on the average frequency (AF) and RA value (rise time divided by the amplitude), the addition of CNTs + GNPs content in cement composites shifted the failure mode from shear to tensile; (4) the AE parameters are feasible to analyze and differentiate the cracking pattern between micro and macrocracks; (5) the field emission scanning electron microscopy (FESEM) image evidence that hybrid CNTs + GNPs particles are well dispersed within cement composites. Based on the obtained results, it was concluded that the acoustic emission technique is a favorable approach to monitor and identify the microcracking pattern in brittle concrete structures.

Combined damaged elasticity and creep modeling of ceramics with wedge splitting tests

During the crack propagation in common refractory ceramics at high temperatures, creep may occur in the wake of a process zone and in front of a crack tip. To account for this phenomenon, an integrated material constitutive model was developed by combining the mechanical behavior following isotropic damaged elasticity concept and Norton-Bailey creep. The post peak fracture behavior followed the bilinear softening law and a simple criterion was defined to consider the creep asymmetricity in uniaxial tension and compression. The material constitutive model was applied to inversely identify mode I fracture parameters with wedge splitting tests of an alumina spinel material at 1200 °C. It showed that the mean ratio of the nominal notch tensile strength to the actual tensile strength was 1.93 and the mean pure fracture energy was 297.6 N/m. In addition, the creep contributed 12.9% on average into the total fracture energy.

COMPARATIVE STUDY ABOUT THE OUTCOME OF COMMINUTED FRACTURE SHAFT TIBIA FIXED WITH INTERLOCKING NAIL AND BIOLOGICAL PLATING

Incidence of tibial diaphyseal fractures (26 per 100,000 persons per year in an average population) is the highest among long bone fractures. Now-a-days closed reduction with intramedullary interlocking nailing is generally accepted by surgeons to be the most popular method for fixation of tibial fractures in adults. To compare the outcome of fixation of comminuted tibial fractures following minimally invasive plating and nailing. It is prospective study of adult patients admitted to orthopedic department of Sohag university hospitals suffering from comminuted fracture Shaft tibia. The study will be approved by Scientific and Ethical committees at Sohag Faculty of Medicine. An informed written consent will be obtained from all participants. This study is being done on 30 patients of comminuted fracture shaft tibia. The average follow up time was thirty- three weeks (range from 19 to 54 weeks). The average time of union in all our 30 patients was about 13 weeks (range from 8 to 16 weeks). Three of the thirty patients had post operative fracture angulation was less than 5 degrees in the coronal and sagittal planes and one patient had post operative valgus angulation of about 5 degrees. As regard intraoperative exposure to radiation it was less in cases of biological plating There was two patients infected and they required removal of the nail and plates and treated by external fixation they represent about 10% of patients. Out of the 30 fractures managed by this method 24 fractures showed uncomplicated healing within a reasonable period of time. The complication rate was considered minimal. Only one case of non-union, two cases of delayed infection and 4 patients of malunion in valgus or varus malalignment, however we passed through a learning curve during performing this study, with most of the complications occurring in the early cases. So MIPO could attain satisfactory results in uncomminuted tibia shaft fractures, and locked intramedullary nailing is more appropriate in comminuted fractures.

An Integrated Analysis for Post Hydraulic Fracturing Production Forecast in Conventional Oil Sand Reservoir

Hydraulic fracturing is one of the stimulation treatment in oil and gas well by creating a fractured through a proppant injection to the formation. A most critical problem in the actual oil and gas industry is that the fracturing engineers could not forecast approximately post-production performance after fracturing the job, which is a severe problem. This problem phenomenon has occurred in some cases and significantly impacts production such as oversizing or lower sizing of pumping rate setting. Integrated analysis for post job hydraulic fracturing production based on the geometry model iteration and Productivity Index (PI) comparison in the conventional oil sand reservoir is simply a method to analyze and forecast approximately incremental production performance. The fractured software generates a fractured geometry model that considers half-length of fractured parameters, width in front of perforation, average width, fractured height, and pressure net. Then we compare the Productivity Index's prediction value through the method of Cinco-Ley, Samaniego and Dominguez. A case study in the well of TM#2 (conventional oil sand reservoir) was conducted as the comprehensive study to provide the data and proceed analysis for production forecast. We found that the geometry model and iteration of PKN 2D method generated a small fractured geometry model compare to fracCADE software. The cooperation between PKN 2D method and Cinco-Ley, Samaniego, and Dominguez concept successfully predict post-production forecast. This concept could be proposed as a quick look measurement for production scenarios to overcome pump sizing.

Efektivitas Terapi Bermain Fidget Spinner terhadap Nyeri Pasca Operasi Fraktur pada Anak

Fracture is one of the most vulnerable injuries in children. Fracture is a disconnectionin bone continuity caused by trauma or physical exertion, the management of the fracture can be done with orthopedic surgery, namely by open reduction using internal fixation. Pain is a major problem in post operative fracture care Non pharmacological techniques that can be done to ward off postoperative pain in children are by doing play therapy, one of which is by using fidget spinner therapy. This literature review aims to analyze the effect of fidget spinner therapy on postoperative fracture pain.this game can distract children and give them something soothing to release pent up energy. Methods: This research explores quantitative evidence published in electronic databases such as pubmed, garuda, and google schoolar. Using a journal search strategy, I only came up with the results of one recent and relevant journal for inclusion in the final analysis. Results: I can see a significant effect in postoperative fracture pain intensity in the child after the patient was given fidget spinner therapy. Conclusion: From the results, it can be concluded that fidget spinner therapy is a non-pharmacological therapy that can reduce the pain scale in post operative fracture patients. It is hoped that parents will use this game in the handling of fracture pain in their children

Reduction of neuroinflammation alleviated mouse post bone fracture and stroke memory dysfunction

Tibia fracture (BF) enhances stroke injury and post-stroke memory dysfunction in mouse. Reduction of neuroinflammation by activation of α-7 nicotinic acetylcholine receptor (α-7 nAchR) reduced acute neuronal injury and sensorimotor dysfunction in mice with BF 1-day after stroke. We hypothesize that reduction of neuroinflammation by activation of α-7 nAchR improves long-term memory function of mice with BF 6-h before stroke. The mice were randomly assigned to saline, PHA-568487 (α-7 nAchR agonist) and methyllycaconitine (antagonist) treatment groups. The sensorimotor function was tested by adhesive removal and corner tests at 3 days, the memory function was tested by Y-maze test weekly for 8 weeks and novel objective recognition test at 8 weeks post-injuries. We found PHA-568487 treatment reduced, methyllycaconitine increased the number of CD68+ cells in the peri-infarct and hippocampal regions, neuronal injury in the infarct region, sensorimotor and long-term memory dysfunctions. PHA-568487 treatment also reduced, while methyllycaconitine treatment increased atrophy of hippocampal granule cell layer and white matter damage in the striatum. In addition, PHA-568487 treatment increased neuron proliferation in granule cell layer. Our data indicated that reduction of neuroinflammation through activation of α-7 nAchR decreased neuronal damage, sensorimotor and long-term memory dysfunction of mice with BF shortly before stroke.

Fragility fracture identifies patients at imminent risk for subsequent fracture: real-world retrospective database study in Ontario, Canada

BackgroundThe secondary fracture prevention gap in the osteoporosis field has been previously described as a ‘crisis’. Closing this gap is increasingly important in the context of accumulating evidence showing that an incident fragility fracture is associated with an increased risk of subsequent fracture within 1–2 years, known as imminent fracture risk. The objective of this study was to use health services data to characterize the time between index fragility fractures occurring at different osteoporotic sites and subsequent fractures.MethodsThis retrospective observational study used de-identified health services data from the publicly funded healthcare system in Ontario, the largest province of Canada. Patients aged > 65 with an index fragility fracture occurring between 2011 and 2015 were identified from the ICES Data Repository using International Classification of Diseases (ICD)-10 codes. We examined median time to subsequent fragility fractures for osteoporotic fracture sites until the end of follow-up (2017). BMD assessment and use of osteoporosis therapies following index fracture were also characterized.ResultsAmong 115,776 patients with an index fragility fracture, 17.8% incurred a second fragility fracture. Median time between index and second fracture occurring at any site was 555 days (interquartile range: 236–955). For each index fracture site examined, median time from index to second fracture was < 2 years. The proportion of patients with BMD assessment was 10.3% ≤1 year prior to and 16.4% ≤1 year post index fracture. The proportion of patients receiving osteoporosis therapy was 29.8% ≤1 year prior, 34.6% ≤1 year post, and 25.9% > 3 years post index fracture.ConclusionsThis cohort of Canadian patients aged > 65 years who experienced a fragility fracture at any site are at imminent risk of experiencing subsequent fracture within the next 2 years and should be proactively assessed and treated.

IL-6 signaling mediates the germinal center response, IgM production and nociceptive sensitization in male mice after tibia fracture

BackgroundUp-regulated interleukin 6 (IL-6) signaling, immune system activation, and pronociceptive autoantibodies are characteristic of complex regional pain syndrome (CRPS). IL-6 is known to promote B cell differentiation, thus we hypothesized that IL-6 signaling plays a crucial role in the development of adaptive immune responses and nociceptive sensitization in a murine tibia fracture model of CRPS. MethodsMice deficient in IL-6 expression (IL-6−/−) or B cell deficient (muMT) underwent tibia fracture and 3 weeks of cast immobilization or sham injury. The deposition of IgM in fractured limbs was followed using Western blotting, and passive serum transfer to muMT fracture mice was used to detect nociception-supporting autoantibodies. Lymph nodes were assessed for hypertrophy, IL-6 expression was measured using qPCR and ELISA, and germinal center formation was evaluated using FACS and immunohistochemistry. The therapeutic effects of exogenous neutralizing anti-IL-6 antibodies were also evaluated in the CRPS fracture model. ResultsFunctional IL-6 signaling was required for the post fracture development of nociceptive sensitization, vascular changes, and IgM immune complex deposition in the skin of injured limbs. Passive transfer of sera from wild-type, but not IL-6−/− fracture mice into muMT fracture mice caused enhanced allodynia and postural unweighting. IL-6−/− fracture mice displayed reduced popliteal lymphadenopathy after fracture. Germinal center responses were detected in the popliteal lymph nodes of wild-type, but not in IL-6−/− fracture mice. We observed that IL-6 expression was dramatically enhanced in popliteal lymph node tissue after fracture. Conversely, administration of anti-IL-6 antibodies reduced nociceptive and vascular changes after fracture and inhibited lymphadenopathy. ConclusionsCollectively, these data support the hypothesis that IL-6 signaling in the fracture limb of mice is required for germinal center formation, IgM autoantibody production and nociceptive sensitization. Anti-IL-6 therapies might, therefore, reduce pain after limb fracture or in the setting of CRPS.

Hypersensitivity in Molar Incisor Hypomineralization: Superficial Infiltration Treatment

To date, there are no standardized protocols available in the literature for hypersensitivity treatment in molar incisor hypomineralization (MIH) patients. The aim of this study was to evaluate the efficacy of erosion–infiltration treatments with resin in children with a strong hypersensitivity and also to develop a minimally invasive diagnostic–therapeutic pathway for young MIH patients. Patients with clinical signs of MIH were enrolled according to international guidelines. A total of 42 patients (8–14 years old) with sensitivity of at least one molar and patients with post eruptive enamel fractures, but without dentin involvement or cavitated carious lesions were selected. A single superficial infiltration treatment with ICON (DMG, Germany) was performed with a modified etching technique. Sensitivity was tested with the Schiff Scale and Wong Baker Face Scale and was repeated at 12 months follow-up. All patients reported lower sensitivity values at the end of the treatment. Significant differences of sensitivity according to the Schiff scale were reported between T0 and all subsequent follow-ups, p &lt; 0.05. The treatment of erosion infiltration with ICON resin is a minimally invasive preventive treatment that significantly improves the problem of hypersensitivity in permanent molars with MIH.

Stress Distribution in Maxillary Central Incisors without Ferrules: A Finite Element Analysis of Post and Core Systems

Purpose: The purpose of this study was to identify optimal post and core materials for central incisors without ferrules using three-dimensional finite element analysis and three-point bending tests. Methods: Stress analyses were performed with six models: cast metal post and core (MP), composite resin core alone, straight fiber-reinforced post-composite resin core (FSR), tapered fiber-reinforced post-composite resin core, straight titanium post-composite resin core (TSR), and tapered titanium post-composite resin core (TTR). A 100-N load was applied to the lingual surface at a 45° angle to the long axis of the tooth. Maximum von Mises stress distributions were calculated with finite element analysis software. Five samples each of composite resin, straight fiber-reinforced post, straight titanium post, straight fiber-reinforced post and composite resin, and straight titanium post and composite resin were subjected to three-point bending tests, followed by analysis of variance and Tukey’s multiple comparison test. Results: Stress distribution was optimal on TTR. Maximum von Mises stress on the cervical side of the post was greatest in TSR (693 MPa) and TTR (556 MPa). Maximum stress on the apical side of the post was greatest in MP (110 MPa). Maximum stress in surrounding dentin was lowest in MP (203 MPa) and TTR (250 MPa). Gap distance was smallest in MP (0.09 mm) and largest in FSR (0.26 mm). Mean maximum three-point bending force was lowest in composite resin (26.9 N/mm) and highest in titanium post and composite resin (97.1 N/mm). Titanium post bending strength was consistently greater than that of the fiber-reinforced post (p < 0.01). Conclusion: These results revealed optimal stress distribution and high bending strength with the tapered titanium post and resin combination, suggesting that this combination can most effectively prevent root or post fracture in an anterior tooth without a ferrule.

The Use of Modified Polyetheretherketone Post and Core for an Esthetic Lithium Disilicate Anterior Ceramic Restoration: A Clinical Report.

This clinical report presents the use of a modified polyetheretherketone (PEEK) post and core in order to support a lithium disilicate ceramic crown for a maxillary lateral incisor. When considering post-and-core restorations, material flexibility is essential to prevent root fractures. The low elastic modulus of PEEK (4 GPa) could result in lower root fracture rates, preserving tooth structure and favoring tooth re-restoration if the post fractures. PEEK is biocompatible, presents adequate bond strength with dentin when bonded with a resin cement, and can be used under ceramic restorations because of its white, esthetic color. PEEK posts and cores could also cost less when fabricated using common laboratory procedures. Polyetheretherketone (PEEK) posts and cores could be a viable alternative to rigid cast or zirconia posts, or even to fiber-reinforced composite posts, especially when combined with lithium disilicate crowns.

Effect of Occupational Therapy Intervention Inpost-operative Mandibular Fractures - A Retrospective Study

Aim: To find the effectiveness of Occupational therapy intervention in post operative mandibular fracture patients. Objective: To improve mouth opening and reduce jaw deviations (temporomandibular joint mobility). Study design: A Retrospective study. Study setting: OPD of Occupational Therapy Department In Seth G. S. Medical College, KEM Hospital, Parel, Mumbai -400012, India. Methodology: Data was retrieved from Occupational therapy department records for the last one and half years i.e from july 2019 to jan 2021. In the said period around 33 operated mandibular fractures patients had been referred to Occupational therapy dept for therapy. Out of which only 20 patients followed up. Data of these 20 mandibular fractures patients were analysed. Inclusion criteria, Both males and females, Age group 20-60 years, Operated for mandibular fractures in period July 2019 – January 2021 who were referred to occupational therapy department for therapeutic intervention. Exclusion criteria: Incomplete data, Patients who have not followed up for second visit also. Outcome measures – Mouth opening with a tape measure at 1^st, 3^rd and 5^th week respectively. All these data was already available in Occupationa therapy department records and there was no patient contact at all. Hence waiver of consent was asked for. Results: Statistical analysis (paired t-test) was used to assess the significance of difference. The calculated t value for mouth opening measurements was 17.1850 which was much much higher than the tabular t value at P=0.001, which means the increase in post treatment mouth opening measurements is just not by chance but it’s extremely significant at p= 0.001. The pre and post photograph of the patients showed a difference in jaw deviation angle too while opening mouth. The above results showed the treatment proved to be effective. Conclusion: The Occupation therapy intervention in post-operative mandibular fracture patients proved to be effective in improving mouth opening measurements and jaw deviations.