Prosthetic Placement Research Articles

Progress in Dentin-Derived Bone Graft Materials: A New Xenogeneic Dentin-Derived Material with Retained Organic Component Allows for Broader and Easier Application

The optimal repair of rigid mineralized tissues, such as bone, in cases of fracture, surgical resection, or prosthetic placement, is a complex process often necessitating the use of bone graft materials. Autogenous bone from the patient is generally the gold standard in terms of outcomes but also has disadvantages, which have resulted in extensive research in the field of tissue engineering to develop better and more convenient alternatives. In the dental field, several initiatives have demonstrated that the dentin material derived from extracted teeth produces excellent results in terms of repairing bone defects and supporting dental implants. Dentin is acellular and thus, in contrast to autogenous bone, cannot provide osteoblasts or other cellular elements to the grafted region, but it does contain growth and differentiation factors, and has other properties that make it an impressive material for bone repair. In this review, the beneficial properties of dentin and the ways it interacts with the host bone are described in the context of bone graft materials. Autogenous tooth material has limitations, particularly in terms of the need for tooth extraction and the limited amount available, which currently restrict its use to particular dental procedures. The development of a xenograft dentin-derived material, which retains the properties of autogenous dentin, is described. Such a material could potentially enable the use of dentin-derived material more widely, particularly in orthopedic indications where its properties may be advantageous.

Angle Accuracy of Intramedullary Bone Resection Guides for Total Knee Arthroplasty.

The importance of proper prosthetic placement has been confirmed in numerous studies. The objective of this study was to compare the planned resection angles to the verified intraoperative angles of femoral and tibial varus/valgus, tibial slope, and femoral flexion for each total knee performed using intramedullary (IM) cut guides for both distal femur and proximal tibia cuts. A total of 1,000 total knee arthroplasties (TKAs) were evaluated for this study. Intraoperative cut-check technology was used to show real-time validation of these resection angles. Assuming an acceptable range of within 2° of the planned cuts, results show the femoral varus/valgus angles were 75% accurate, the femoral flexion angles were 50.8% accurate, the tibial cuts were 95.2% accurate in the coronal plane, and the tibial slope was the least accurate with only 50.3% within the acceptable range. This showed that IM guides are reasonably accurate in producing desired angles in the coronal plane but less accurate in the sagittal plane, with a greater number of outliers in femoral flexion and posterior slope. Surgeons need to be aware of potential cutting errors when using IM guides as they affect the overall alignment of the implant, and real-time verification technology is available to verify the accuracy of the cuts.

Standard Versus Step Burs for Implant Site Preparation: A Randomized Controlled Clinical Trial.

There are several factors that may influence implant site preparation with implant design being a paramount factor; however, few studies investigate its impact. The purpose of the study was to explore the comparative efficacy of using two different drilling protocols using burs with different design for preparing implant sites, by evaluating radiographic and clinical outcomes. The present randomized controlled clinical trial with an allocation ratio of 1:1 was carried on in two private practice offices by two experienced surgeons and researchers. In the control group the surgeons followed the protocol with standard straight burs while in the test group they used step burs. In both groups the patients received the same type of implants and prosthesis. The primary outcome was the marginal bone resorption one year after the prosthetic placement. In the study were included and treated a total of 60 subjects (86 implants). At the one-year follow-up were screened 54 subjects (74 implants), and 50 at the 2-year follow-up (69 implants). This study showed no evidence of a difference in bone resorption, which increased significantly over time, between the two groups. Both clinical parameters and patientcentered outcomes revealed no difference between the two protocols of implant site preparation with two different drill shape.

Proposed Radiographic Parameters to Optimize Clinical Outcomes in Trapezio-Metacarpal Prosthesis Placement Using CT Imaging, with 1-Year Follow-Up.

Addressing trapezio-metacarpal (TMC) osteoarthritis often involves considering TMC joint replacement. Utilizing TMC prostheses offers advantages such as preserving the thumb length and more accurately replicating the thumb's range of motion (ROM). TMC prostheses have an intrinsic risk of dislocation and aseptic loosening. Analyzing pre- and postoperative imaging can mitigate complications and improve prosthetic placement, providing insights into both successes and potential challenges, refining overall clinical outcomes. We conducted a prospective analysis of 30 patients with severe TMC arthritis treated with a Touch© (Kerimedical, Geneva, Switzerland) prosthesis in 2021-2023: X-ray and CT protocols were developed to analyze A) the correct prosthesis placement and B) its correlation with clinical outcomes (VAS, Kapandji and QuickDASH scores) by performing Spearman correlation analysis. The average differences in trapezium height and M1-M2 ratio pre- and post-surgery were, respectively, 1.8 mm (SD ± 1.7; p < 0.001) and 0.04 mm (SD ± 0.04; p = 0.017). Pre-to-postoperative M1 axis length increased by an average of 2.98 mm (SD ± 3.84; p = 0.017). Trapezial cup sinking, indicated by the trapezium index, measured 4.6 mm (SD ± 1.2). The metacarpal index averaged at 11.3 mm (SD ± 3.3). The distance between the centers of the trapezium distal surface and the prosthesis cup was 2.23 mm (SD ± 1.4). The Spearman correlation analysis gave the following results: negative correlations were highlighted between postoperative VAS scores and the M1/M2 ratio and residual trapezium height (correlation coefficient: -0.7, p = 0.03 and -0.064, p = 0.03, respectively) at 6 months; a negative correlation was found at the 3-month mark between QuickDASH and the trapezium residual height (correlation coefficient: -0.07, p = 0.01); and a positive correlation was found for the trapezium index at 1 month (correlation coefficient: 0.07, p = 0.03) and 3 months (p = 0.04) using the Kapandji score. Similarly, we found a positive correlation between the distance between the prosthesis and trapezium centers and QuickDASH score at 1 and 3 months (correlation coefficient: 0.066, p = 0.03; correlation coefficient: 0.07, p = 0.05, respectively) and a positive correlation between prosthesis axis and the residual first metacarpal angle with QuickDASH score at 3 months (correlation coefficient: 0.07, p = 0.02). Pre- and postoperative systematic imaging analysis should become a method for predicting complications and guiding recovery in TMC prosthesis: CT imaging could provide us with radiographical landmarks that are intrinsically linked to clinical outcomes. Further research is necessary to fuel a protocol for the correct intraoperative TMC prosthesis implantation.

ISQ for Assessing Implant Stability and Monitoring Healing: A Prospective Observational Comparison between Two Devices

Background: With the growing use of dental implants, there is an urgent need to determine a prosthetic placement protocol by assessing implant stability and monitoring healing. Implant Stability Quotient (ISQ) values are produced using dental non-invasive devices through resonance frequency analysis, considered as indicators for measuring primary stability (i.e., at implant placement), monitoring biological stability (osseointegration), and prosthetic loading. A systematic and detailed comparison of ISQ measurement devices, for a given patient population, is lacking in the literature. This aspect is the subject of the present work, with the devices being two that are widely used in clinical practice (Osstell® and Osseo®100). The aim of this study was to evaluate the reliability of ISQ measurement using two standard devices most commonly used in clinical practice and to highlight any differences when comparing measurements at undefined time intervals. Methods: We enrolled 50 patients (16 males and 34 females) with a mean age of 55.4 years, who indicated dental implant placement and met the inclusion criteria. The sample was divided into two equal groups based on bone density: A (D1–D2 bone density) and B (D3–D4 bone density); each had 25 patients with 40 implants. ISQ was measured using two devices: Osstell® and Osseo 100®, at different time points (A: three and B: four follow-ups). Results: All enrolled patients completed the study without adverse events; all implants placed were successful, with no implant failure. In each of the study groups, ISQ values increased gradually with increasing follow-up time, and there was no significant difference between Osstell and Osseo 100 values at follow-up times except for the T1 follow-up in group A. Temporal comparisons for the two devices revealed significant differences in T0 vs. T2 in group A, whereas significant differences existed in T0 vs. T1, T2, and T3 in group B. Our findings indicated that the overall effect significantly depended on bone density rather than on the device used to measure ISQ. Conclusion: Regardless of the devices used, the ISQ measurement effectively monitors healing after implant insertion and allows prosthetic load to be modulated according to the ISQ value, especially when prosthetizing implants placed in fine trabecular bone (D4 or regenerated bone).

Translucent monolithic zirconia titanium-supported FP1 full-arch prosthesis: A novel proof of concept to address esthetic, functional, and biologic challenges.

Despite the wide clinical use of translucent zirconia for full-arch implant prostheses, reduced flexural strength and fracture toughness compared with high-strength opaque zirconia needs to be addressed. A novel proof of concept for FP1 full-arch prosthesis featured by translucent monolithic zirconia and titanium framework was presented. Computer-guided implant planning and surgery were executed and digitally designed FP1 temporary prosthesis prefabricated. Implant and prosthetic placement were achieved with a set of three-dimensional (3D)-printed templates. Implants were immediately loaded. After 4 months intraoral optical scan was taken to record implant coordinates, soft tissue anatomy, and temporary FP1 prosthesis. A novel digital workflow was used to design and mill overlaying translucent zirconia and anatomically shaped titanium framework with a scalloped soft-tissue interface. Final FP1 prosthesis was assembled cementing zirconia jacket on titanium counterpart. Translucent zirconia supported by titanium framework can address esthetic and mechanical requirements of FP1 full-arch prosthesis, minimizing risk of fracture and providing a rigid and passive joint with supporting implants. The smooth and highly polished titanium surface with an anatomic design, tightly matching scalloped soft tissue interface, can limit food impaction, air and saliva leakage and contribute to overall biologic integration of FP1 full-arch prosthesis. Translucent monolithic zirconia featured with anatomically shaped titanium framework with scalloped transmucosal part, combining a pleasant esthetic outcome with increased flexural strength and fracture toughness, may be indicated to increase the clinical performance of FP1 full-arch prosthesis.

(111) Clinical Practice Patterns for Surgical Shunts and Penile Prosthesis Placement in Men with Priapism – A Retrospective Claims Database Analysis

Abstract Introduction New AUA/SMSNA guidelines for management of acute ischemic priapism have been released, but actual practice patterns can be difficult to assess as overall incidence is low and men often seek care at multiple institutions. Objective To assess the rates of surgical shunting and prosthetic placement for acute ischemic priapism using a large multi-institutional claims database. Methods A US claims database network (TriNetX Diamond Network) was queried from 2010 to 2020. We constructed a cohort of men ages ≥16 years old with 1) a diagnosis of priapism (ICD-10: N48.4) and 2) who had undergone an irrigation of the corpora cavernosa for priapism (CPT: 54220). We assessed the number of men who then had a surgical penile shunt (corpora cavernosa-glans penis fistulation [CPT: 54435], corpora cavernosa-corpus spongiosum shunt [CPT: 54430], or corpora cavernosa-saphenous vein shunt [CPT: 54420]) or penile prosthesis placement (insertion of penile prosthesis inflatable and self-contained [CPT: 54401], insertion of semi-rigid penile prosthesis [CPT 54400], or insertion of multiple component inflatable penile prosthesis [CPT: 54405]). Time to surgical procedure and order of procedures were collected, as well as background information including age, race, diabetes status (ICD-10: E11), hyperlipidemia status (ICD-10: E78), sickle cell status (ICD-10: D57.0-1), and if men were classified to have drug-induced priapism (ICD-10: N48.33). Results 6,392 men were identified with the diagnosis of priapism and the procedure of corpora cavernosa irrigation. Of these men, 693 (11%) proceeded to surgical shunt (94 had corpora cavernosa-glans penis fistulation, 321 men had corpora cavernosa-corpus spongiosum shunt, and 78 men had corpora cavernosa-saphenous vein shunt). 144 men (2%) underwent initial penile prosthesis placement (Figure 1). Of the men undergoing initial penile prosthesis 94 (65%) occurred within the first year of the initial corpora cavernosal irrigation with the majority (81 of 94, 86%) being 3-piece inflatable penile prostheses and the majority in a “delayed” manner between 3 to 12 months after initial priapism irrigation (Table 1). Men who underwent initial penile prosthesis placement were older (55.1±13.0 vs 43.0±13.7 years, p&amp;lt;0.0001) and more often white (23% vs 16%, p=0.03), with higher rates of erectile dysfunction (56% vs 9%, p&amp;lt;0.0001), type 2 diabetes (32% vs 13%, p&amp;lt;0.0001), and hyperlipidemia (47% vs 20%, p&amp;lt;0.0001) when compared to men who underwent initial penile shunt procedure (Table 2). Finally, when assessing choice of initial shunts versus initial penile prosthesis pre- and post-2015, overall rates of initial shunt (10.0% vs 8.5%, p&amp;lt;0.0001) and initial prosthesis (3.1% vs 2.1%, p&amp;lt;0.0001) were significantly lower after 2015 when compared with rates prior to 2015. Conclusions In this US claims-based analysis of men presenting with ischemic priapism and treated with initial irrigation, we found that a small percentage (11%) continued to surgical shunting. Only 2% were managed with an initial prosthesis, most often a 3-piece device in a delayed manner. Men receiving initial prostheses were more likely to have more comorbidities, and overall surgical management of priapism has decreased overtime. In the setting of the new AUA/SMSNA guidelines, this data provides real-world practice patterns. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Urogen Pharma, Janssen Global Services, Regeneron Pharmaceuticals

Long-term performance of implants with moderately rough anodized surface supporting single-tooth restorations: Aretrospective analysis with an up to 15-year follow-up.

This retrospective study aimed to evaluate long-term clinical and radiologic performance of anodized surface implants supporting single implant restorations. Patients who received at least one anodized surface implant for a single-tooth restoration between 2003 and 2004 in the Brånemark clinic (Göteborg, Sweden) were included in the study. The assessed outcomes included implant survival, biological and technical complications, as well as marginal bone levels (MBL) based on radiographs. Baseline data on patient demographics, implant placement, and surgery details were also collected. The cumulative survival rate (CSR) was calculated using the Kaplan-Meier survival analysis. The study included 97 patients with 129 implants. Mean patient age at the time of implant placement was 31.7± 16.4 years. All implants were placed in a two-stage approach with delayed loading. The last follow-up visit was on average 13.4± 4.8 years after implant insertion. Three implants failed, yielding the implant-level 15-year CSR of 97.4%. Majority of the implants had no biological (70.5%) nor technical (81.4%) complications. The mean MBL was -1.0± 0.7 mm (n= 101) at prosthetic placement and -1.8± 1.0 mm (n= 80) at the last follow-up, while the mean marginal bone loss (MBL) from prosthetic placement to last follow-up was 0.6± 1.1 mm (n= 65). Moderately rough anodized implants have shown favorable long-term outcomessingle-tooth indication, with high survival and a low rate of technical complications. Furthermore, long-term studies are needed to present longitudinal data on peri-implantitis.

Minimal invasive horizontal ridge augmentation with Calcium Sulfate bone cement: A case series

Background: The objective of this retrospective study is to assess the minimal invasive technique for augmenting horizontal ridge or bone defects using biphasic calcium sulfate with hydroxyapatite bone cement. Methods: This study focused on 14 partially edentulous patients: 5 males and 9 females, aged between 36 and 82 years old. These patients were non-smokers and had no chronic diseases or received radiation treatment in the last 6 months. During their initial consultation, all patients underwent cone beam computed tomography. Horizontal bone augmentation was necessary for all patients to facilitate prosthetically driven implant surgery. Bond Apatite bone cement horizontal grafting was used for all patients, along with immediate or delayed implants (with or without immediate loading). One year after the final prosthetic placement, all cases were evaluated. The clinical progression of peri-implant volume and tissue quality was documented photographically, along with exams conducted every 6 months. The complete follow-up timeline for these cases ranged from 1 to 5 years. Results: A total of 34 implants were placed in the grafted zones, distributed among 14 patients. None of the patients reported any abnormal discomfort or swelling after surgery, and there were no infections or significant post-surgery complications noted. One year after the placement of various fixed prosthetic rehabilitations, all 100% of the implants remained stable with healthy peri-implant soft tissue and very satisfactory aesthetic results. Conclusion: The Bond Apatite bone cement has demonstrated exceptional effectiveness in reconstructing or augmenting horizontal defects and narrow ridges, increasing the available bone/soft tissue volume and soft enabling successful placement of implants, whether immediate or delayed, with or without immediate loading. Furthermore, the use of Bond Apatite resulted in minimal post-operative complications and an impressively low rate of postoperative infections, allowing for minimally invasive augmentation surgery, eliminating the need for extensive surgical flaps and free tension flap sutures typically associated with this type of procedure.

Inguinodynia after inguinal hernioplasty - clinical and surgical management: a literature review

Inguinodynia (chronic inguinal pain) is one of the most feared complications for surgeons after inguinal hernia repair with prosthetic mesh placement. The biopsychosocial impact of this complication can lead to a considerable decrease in patients quality of life. Chronic inguinal pain can appear at varying periods after surgery, for weeks to years after the surgical procedure. The pain is classified as neuropathic and non-neuropathic related to nerve injury and mesh, respectively. The diagnosis and clinical management of this condition is a separate challenge for medical specialists in hernia surgery, requiring a thorough knowledge of inguinal anatomy, advanced surgical knowledge, and literature references on the subject are still limited. In this article we discuss the diagnostic and therapeutic tools as well as the surgical maneuvers for the intervention of inguinodynia.

MP10-10 HEAD-TO-HEAD COMPARISON OF HYDROGEL MODELS TO CADAVERS FOR INFLATABLE PENILE PROSTHESIS (IPP) TRAINING

You have accessJournal of UrologyCME1 May 2022MP10-10 HEAD-TO-HEAD COMPARISON OF HYDROGEL MODELS TO CADAVERS FOR INFLATABLE PENILE PROSTHESIS (IPP) TRAINING Patrick Saba, Rachel Melnyk, Michael Witthaus, Christopher Wanderling, Tyler Holler, and Ahmed Ghazi Patrick SabaPatrick Saba More articles by this author , Rachel MelnykRachel Melnyk More articles by this author , Michael WitthausMichael Witthaus More articles by this author , Christopher WanderlingChristopher Wanderling More articles by this author , Tyler HollerTyler Holler More articles by this author , and Ahmed GhaziAhmed Ghazi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002532.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cadavers have long been the standard for inflatable penile prosthetic (IPP) placement training. However limited availability, biohazard risk and specialized facilities hinders their widespread use. A previously validated high-fidelity, non-biohazardous, hydrogel procedural model for IPP placement was developed to address this need. We aim to evaluate if hydrogel models can adequately perform as an equivalent training tool for IPP placement to supplement standard cadaveric simulations. METHODS: 73 participants (12 experts, 13 fellows, 48 residents) performed guided IPP simulations on a cadaver followed by a hydrogel model (Figure 1). Surveys were completed to compare tissue properties, anatomical and procedural resemblance, and educational effectiveness between the two modalities on a 5-point Likert scale. RESULTS: 86% of participants agreed the hydrogel training model replicated relevant human anatomy. 86% agreed that the hydrogel tissues resembled the appearance of cadaveric tissues with participants also agreeing the dartos (92%), scrotum (90%), pubic bone (88%), skin (86%), and corpora (71%) resembled the texture/behavior of a cadaver. 96%, 94%, 93%, 89%, 89%, 86% agreed that the model replicated procedural steps in cadavers, regarding prosthesis measurement and placement, stay suture placement, tissue closure, corporal dilation, and skin/dartos incision respectively. 100% of experts and fellows agreed the model is useful for: improving technical skills, teaching the procedure, and assessing procedural ability vs 94%, 96%, and 88% of residents respectively. 75% of experts believed that the hydrogel model was equal if not better than cadavers at these respective categories. 83% of participants agreed the model was safer than cadavers and 75% agreed the model was equal if not better than cadavers as an educational tool. 82% (75%, 92%, 81% of experts, fellows, residents, respectively) stated they wish to include the models alongside current cadaver training with 1/4 of experts stating they preferred the models over cadavers. CONCLUSIONS: This procedural simulation allows the practice of each step of IPP placement with equivalent fidelity to standard cadaveric simulations. Its non-biohazardous nature provides a safe and effective educational equivalent for IPP surgical training. Source of Funding: Coloplast Research Grant © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e150 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick Saba More articles by this author Rachel Melnyk More articles by this author Michael Witthaus More articles by this author Christopher Wanderling More articles by this author Tyler Holler More articles by this author Ahmed Ghazi More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD28-11 VALUE OF ROUTINE PRE-OPERATIVE CYSTOSCOPY PRIOR TO INSERTION OF PENILE PROSTHESIS

You have accessJournal of UrologyCME1 May 2022PD28-11 VALUE OF ROUTINE PRE-OPERATIVE CYSTOSCOPY PRIOR TO INSERTION OF PENILE PROSTHESIS Leonid Aksenov, Zachary Dionise, Faysal Yafi, and Aaron Lentz Leonid AksenovLeonid Aksenov More articles by this author , Zachary DioniseZachary Dionise More articles by this author , Faysal YafiFaysal Yafi More articles by this author , and Aaron LentzAaron Lentz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002576.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penile prosthetic implants have been used for almost 50 years for refractory erectile dysfunction, with approximately 20,000 annual implants in the United States alone. Historically, some urologists have advocated for routine pre-operative cystoscopy to evaluate for the presence of lower urinary tract obstruction prior to prosthesis placement. The rationale being that the treatment of lower urinary obstruction should supersede prosthetic placement and management of these conditions may be complicated with a prosthetic in place. Anecdotally, the risk of such significant asymptomatic urethral pathology is quite low. Cystoscopy, in addition to carrying the risk of peri-procedural infection, does have a substantial associated cost. Thus, our objective was to retrospectively evaluate the prevalence and cost of incidentally discovered urethral pathology during inflatable penile prosthesis (IPP) placement. METHODS: We retrospectively identified all inflatable IPP insertions (CPT 54405 or 54410) performed or aborted by a single surgeon (ACL) from 1/1/14 to 9/15/21. Of those, we then identified and reviewed patients who underwent intraoperative urethral dilation (CPT 52281), direct vision internal urethrotomy (CPT 55276), or cystoscopy (CPT 52000). Costs were calculated based on our institution’s cost data. Total and average cost of routine office cystoscopy for each IPP was compared to total cost of aborted IPPs. RESULTS: A total of 726 inflatable IPP placement cases were identified. An intraoperative cystoscopy was performed in 13 (1.8%) cases. Of those, 5 (0.7%) cystoscopies were planned and 8 (1.1%) were unplanned. Of the IPP cases with unplanned cystoscopies, 4 cases were aborted (0.5%); 3 cases were aborted due to a urethral stricture and 1 case was aborted due to a urethral perforation following corporal dilation. Unplanned intraoperative cystoscopies and interventions had an average supply cost of $216, totaling $1,732. The total supply cost of aborted IPPs due to urethral stricture was $4,182, an average of $1,394 per case. If every IPP case underwent a pre-operative cystoscopy, the estimated total cost would have been $234,498 ($323 per case). CONCLUSIONS: Given the rarity of incidental urethral strictures requiring aborted IPP and intervention, the cost of routine pre-operative cystoscopy far exceeded the cost of aborted IPP procedures. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e502 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leonid Aksenov More articles by this author Zachary Dionise More articles by this author Faysal Yafi More articles by this author Aaron Lentz More articles by this author Expand All Advertisement PDF DownloadLoading ...

Peri-implant bone microstructural analysis and comparison of resonance frequency analysis before prosthetic placement: a retrospective study.

ObjectivesFractal analysis is a mathematical method used for the calculation of bone trabeculation and lacunarity. This study aims to evaluate the relationship between resonance frequency analysis (RFA) and fractal dimension (FD) of peri-implant bone to determine the preload stability of implants.Materials and methodsIn this study, the results of the fractal analysis calculated from the resonance frequency analysis results taken in the 3rd month of the patients who underwent 2-stage implant by the same doctor and the radiographs taken in the same session were evaluated. A hundred implants in 20 patients were applied in this study. The implant stability quotient (ISQ) values of the implants and fractal dimension values of the peri-implant bone were calculated.ResultsThe findings showed that the ISQ1 (p = 0.008), ISQ2 (p = 0.038), ROI2 (p = 0.013), and ROI3 (p < 0.001) values were statistically significantly higher in men than women. The ISQ1 (p = 0.003), ISQ2 (p = 0.013), ROI1 (p = 0.011), and ROI3 (p < 0.001) of the mandible were statistically higher than the maxilla. The fractal dimension cut-off value to assess prosthetic loading was found 1.198.ConclusionFractal analysis is a non-invasive method that can be used in conjunction with clinical examination in the prosthetic loading decision of implants. It is a valuable parameter that can be used without the need for an extra device when it is necessary to reduce the clinical study time.Clinical relevanceCalculating the fractal dimension of the peri-implant bone is a practical, economical, and applicable method for clinicians. FD calculated from panoramic radiographs used for diagnosis in routine treatments in clinics where access to the necessary devices for ISQ measurement is not available will contribute to clinical practice.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00784-022-04464-3.

Evaluation of safety and efficacy of locally developed dental implants: A noninferiority randomized controlled trial

Statement of problemVarious dental implants are available in India, but imported devices are expensive; an affordable locally produced dental implant system would be beneficial. PurposeThe purpose of this noninferiority randomized controlled trial was to compare the safety and efficacy of a locally developed dental implant system to those of an established imported dental implant system with similar microsurface characteristics. Material and methodsA total of 136 participants with 201 partially edentulous sites, aged 18 to 65 years, were enrolled in the trial, with 134 sites receiving test implants and 67 sites control implants (n ratio, 2:1). The implants received a delayed submerged healing protocol and were loaded 3 to 6 months after surgery. Maximum insertion torque (IT) was recorded during the implant surgery, and the implant stability quotient (ISQ) was evaluated on the day of surgery and at the second-stage procedure. The mean crestal bone loss (MCBL) was measured on periapical radiographs at prosthetic placement (baseline) and at 6 months and 12 months after loading. The primary measure of outcome was the implant survival rate, and the secondary measure of evaluation was the intergroup difference in MCBL at baseline, 6 months, and 12 months. ResultsA total of 127 test and 61 control implant sites were available for follow-up 1 year after prosthesis placement. At the end of 12 months, the test and control implant groups demonstrated a survival rate of 97% and 100%, respectively. The MCBL difference was significant between the 2 groups at baseline (P<.05). However, at 6 and 12 months, the difference between the test and control groups was not significantly different (P>.05). ConclusionsThe survival rate of the test group fell within the previously assumed 10% noninferiority margin. Therefore, the null hypothesis was accepted for the trial, and the locally developed implants were noninferior to the imported implants at a sample allocation ratio of 2:1.

Surgical Antimicrobial Prophylaxis in Patients of Neonatal and Pediatric Age Undergoing Orthopedic and Hand Surgery: A RAND/UCLA Appropriateness Method Consensus Study.

Surgical site infections (SSIs) represent a potential complication in any type of surgery and can occur up to one year after the procedure in the case of implant placement. In the field of orthopedic and hand surgery, the rate of SSIs is a relevant issue, considering the need for the placement of synthesis devices and the type of some interventions (e.g., exposed fractures). This work aims to provide guidance on the management of peri-operative antibiotic prophylaxis for the pediatric and neonatal population undergoing orthopedic and hand surgery in order to standardize the management of patients and to reduce, on the one hand, the risk of SSI and, on the other, the development of antimicrobial resistance. The following scenarios were considered: (1) bloodless fracture reduction; (2) reduction of unexposed fracture and grade I and II exposed fracture; (3) reduction of grade III exposed fracture or traumatic amputation; (4) cruel fracture reduction with percutaneous synthesis; (5) non-traumatic amputation; (6) emergency intact skin trauma surgery and elective surgery without synthetic media placement; (7) elective orthopedic surgery with prosthetic and/or synthetic media placement and spinal surgery; (8) clean elective hand surgery with and without bone involvement, without use of synthetic means; (9) surgery of the hand on an elective basis with bone involvement and/or with use of synthetic means. This manuscript has been made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies and represents, in our opinion, the most complete and up-to-date collection of recommendations regarding the behavior to be adopted in the peri-operative setting in neonatal and pediatric orthopedic and hand surgery. The specific scenarios developed are aimed at guiding the healthcare professional in practice to ensure the better and standardized management of neonatal and pediatric patients, together with an easy consultation.

Post exenteration surgery rehabilitation with orbital prosthesis – A case report

Orbital defects with total loss of eyelids and the eyeball cannot be satisfactorily repaired by reconstructive surgery. Therefore, a prosthetic placement is the treatment of choice to return the individual’s confidence by producing an acceptable and lifelike appearance. Male patient, 31 years old, came with history of exenteration surgery four months ago on right eye because of infection few years before. Patient wanted orbital prosthesis to improve esthetic and self-confidence. He lost his right eye ball and some part of right eyelid. Treatment of choice that would be fabricated was orbital prosthesis with medical adhesive retention support. Orbital prosthesis was one of the alternative that can be chose to reconstruct orbital defect. The success of the prosthesis was determined by the exactness of diagnosis, treatment plan determination, material selection, determination of prosthesis retention, and technique in processing the prosthesis.

Learning curve and short-term clinical outcomes of Mako robotic-assisted direct anterior approach total hip arthroplasty

Objective: To explore the learning curve and short-term clinical outcomes of Mako robotic-assisted direct anterior approach total hip arthroplasty (THA). Methods: The preoperative basic data, surgical information and postoperative rehabilitation of 50 patients who underwent Mako robotic-assisted THA for hip diseases in Department of Orthopedic Surgery of the 6th People's Hospital Affiliated to Shanghai Jiao Tong University from December 2018 to December 2020 were analyzed retrospectively, included operation time, intraoperative blood loss, postoperative complications, postoperative imaging parameters (abduction angle, anteversion angle, lower limb length difference, eccentricity difference) and postoperative hip joint Harris score (hip Harris score, HHS). There were 16 males and 34 females, with a mean age of 50-79(67±10) years. The postoperative clinical results of Mako robotic-assisted total hip arthroplasty was analyzed. A cumulative sum analysis (CUSUM) was performed on the operation time (OT). The CUSUM learning curve was modeled by curve fitting and R² was used to testify the goodness. The different phase of the learning curve was compared with several observation indicators. Results: All patients were followed up for more than 6 months. Two patients had poor wound healing and 5 patients had symptoms of lateral femoral cutaneous nerve injury, which disappeared within 1-2 months. No serious complications such as dislocation, aseptic loosening, periprosthetic infection or revision occurred in all the patients. The average operation time was (81±16) min, and the intraoperative blood loss was (456±84) ml. The average Harris hip score at the last follow-up was 88.6±2.5. The radiological evaluation showed that the positions of the acetabular cups were all in the Lewinnnek safety zone; the limb length discrepancy was (0.15±0.50) cm, the offset was (-0.11±0.72) cm. The OT decreased with the accumulation of the cases. The CUSUM learning curve was best modeled as cubic curve,the fitting curve reached the top at the 19th case. As a cut-off point, the 19th point divided the learing curve into two phases. There were statistical differences in OT, pelvic array installation time, acetabular registration time, acetabular reaming time (all P<0.05), but there was no significant differences in Harris hip score, acetabular prosthesis anteversion angle and abduction angle between the two groups (all P>0.05). Conclusions: The learning curve of Mako robot-assisted DAA-THA is about 19 cases. Mako robot-assisted DAA-THA can ensure the accuracy of prosthetic placement and the safety of the operation during the learning curve, and the short-term clinical results after surgery is excellent.

Chevrel technique for ventral incisional hernia. Is it still an effective procedure?

Incisional hernia still represents the most frequent late complication of abdominal surgery. After a direct repair, in literature is reported a recurrence rate ranging from 31 to 49%, meanwhile after a prosthetic repair such values were much lower, with a recurrence rate up to 10%. The sites of prosthetic placement in the abdominal wall are premusculo-aponeurotic (onlay, or Chevrel technique), retromuscular-prefascial and preperitoneal (Rives technique, Stoppa technique), whereas intraperitoneal insertion can be done with open or laparoscopic surgery. The aim of this study was to evaluate the immediate and late postoperative results in patients treated with a Chevrel technique for ventral incisional hernia. A retrospective review was conducted on the medical records of patients undergoing ventral hernia repair between January 2008 and December 2018 at the Emergency Surgery Unit of the Careggi University Hospital in Florence. Between January 2008 and December 2018 at the Emergency Surgery Unit of the Careggi University Hospital in Florence, 461 patients (245 male, 216 female) with a mean age of 61,52 years were submitted to ventral incisional hernia repair with a Chevrel technique. The mean operatory time was 95.29 min (±50.48) and in 72 patients (15.61%) human fibrin glue was vaporized under the mesh using a spray device. Mean postoperative hospital stay was 5 days and all drain tubes were removed after 7.1 days as mean (±4.3). No intraoperative mortality nor postoperative mortality was reported. In our experience the Chevrel technique for ventral incisional hernia show a recurrence rate (3.2%). Parietal complications observed were seroma in 7.1% of patients, hematoma in 4.7%, localized skin necrosis in 5.2%, surgical site infection in 6.7%, data comparable with the results reported in the other studies. Most of the objections to the Chevrel procedure focus on the parietal complications and risk of infection. Chevrel procedure cannot be considered an obsolete intervention, in our series, results were very satisfactory in both immediate and late follow-up; moreover this technique is safe and easy to perform.

The Future of Penile Prosthetic Surgical Training Is Here: Design of a Hydrogel Model for Inflatable Penile Prosthetic Placement Using Modern Education Theory

BackgroundThere is a significant need for a non-biohazardous, educational platform to equip and maintain the surgical skills required by urology trainees and low-volume implanters for inflatable penile prosthetic (IPP) placement. AimTo design and develop an anatomic, hydrogel-based simulation platform for training and evaluate IPP placement using modern education theory. MethodsThe backward design concept was used as a framework in the design and development of an IPP simulation platform. Steps included delineating requirements from a physicians’ perspective, translating requirements into engineering tasks (deliverables), developing a prototype, and pilot validation. Using a combination of 3-dimensional printing and hydrogel casting, a genitourinary tract model was constructed to replicate the appropriate steps of IPP placement guided by expert feedback. Full-immersion IPP simulations were performed through both infrapubic and penoscrotal approaches by 4 expert surgeons under operative conditions. Questionnaires evaluating the simulation’s realism, value as a training tool, and further recommendations were completed. OutcomesUsing backward design educational pedagogy, a high-fidelity, full-procedural IPP simulation was fabricated and verified as an adequate educational tool for training and assessment. ResultsAn expert consensus on the anatomic landmarks, steps and substeps, instruments, and errors to be included in the model was reached using a hierarchical task analysis and was successfully translated into a prototype hydrogel model. Experts performed all appropriate steps of IPP surgery and rated the simulation highly in terms of its realism and value as a training tool. On average, experts agreed that the model could function as a training tool, assessment tool, prerequisite for IPP accreditation, and requirement before live surgery. Experts stated they would have their trainees ideally complete an average of 1.75 models before live surgical training. All experts believed an operative checklist would be an ideal assessment tool.Witthaus MW, Saba P, Melnyk R, et al. The Future of Penile Prosthetic Surgical Training Is Here: Design of a Hydrogel Model for Inflatable Penile Prosthetic Placement Using Modern Education Theory. J Sex Med 2020;17:2299–2306.

Guided rescue technique for the replacement of failing implants while preserving the existing prosthetic construction – Part 1: proposed protocol with the ins and outs of the clinical challenge

If the success rates in implantology display scores envied by many other medical and dental disciplines, the fact remains that the negative feeling is around 100% for the practitioner and for the patient in case of 'failure, especially when this failure occurs after prosthetic placement. The management of these situations rarely addresses the possible recovery of the prosthesis. This article proposes an original protocol making it possible to avoid having to redo the prosthesis following an implant loss and its replacement