Prosthetic Treatment Research Articles

Biologically Oriented Preparation Technique Through a Digital Workflow, a Case Report.

In every prosthetic treatment, the final purpose of the restoration is to restore function and esthetics for the patient, respecting biology and anatomical parameters. Regarding full coverage restorations, there are some factors to take into consideration: like the finish line (chamfer, shoulder, featheredge, etc.), the management of the provisional restoration and tissue healing, the material for the final restoration, and the impression technique. All these aspects will determine the treatment process and its possible results. In recent years, vertical preparation and more specifically biologically oriented preparation technique has generated great interest since its introduction in prosthodontics, changing the periodontal tissues, and providing long-term stability. With this technique, the objective is to change the position of the gingival margin, moving it more apically or coronally, depending on the modifications of the provisional. The relining of the provisional is a fundamental step of this technique: the intrasulcular part of the provisional is modified giving a new emergence profile and providing an augmentation of the tissue in the healing process. In vertical preparation, there is no predetermined margin. The dental technician should position the finish line more apically or coronally, depending on the depth of the sulcus and on the esthetic needs. Ceramic restorations should not invade the epithelial attachment, otherwise it may cause biological and mechanical problems, repetition of the impression, and of the crown restoration, which lead to increased clinical and laboratory time usage as well as expenses. One challenge is communicating the shape and contour of the temporary restoration to the dental lab to ensure accurate information for the final restoration. Finally, the objective of this article is to describe a technique for transferring all necessary information of the provisional and obtaining a predictable result for the final restoration by using an intraoral scanner system and the fabrication of two 3D printed prototypes. One for the final volume of the crowns and the other for the finish line position. The fabrication of 3D printed prototypes allows for a more predictable final restoration, reducing possible communication errors between clinician and technician when restoring with biologically oriented preparation technique. In any esthetic treatment where the restoration does not have a predetermined margin, it is possible with this additional clinical step to provide a more esthetic outcome.

Benign Soft Tissue Tumors of oral cavity, relevance to prosthodontics – Laconic Review.

The influence of oral soft tissue tumors on the surrounding structures and oral tissues makes them a considerable problem in prosthodontic treatment, regardless of their malignancy. Maintaining functional rehabilitation with prosthetic devices while addressing the tumor pathology is a delicate balance in the therapy of malignant tumors. Prosthodontics is relevant in this situation in a number of ways. Long-term side effects from cancer therapies, especially radiation therapy, can include mucositis, osteoradionecrosis, and xerostomia. The efficacy of prosthetic treatments may be significantly impacted by these negative effects. Patients with soft tissue tumors in the mouth cavity can greatly benefit from prosthodontic treatment, despite its difficulties. There is not much literature is available on the relevance of soft tissue tumors in various prosthodontic treatment procedures. Hence this laconic review aimed to discuss about various soft tissue tumors which are related to prosthodontic treatment and different precautions to be taken during prosthodontic procedures.

Oral Health-Related Quality of Life Improvement After Treatment With Fixed and Removable Dental Prostheses.

Missing teeth negatively affect oral functions and masticatory efficiency, which in turn can reduce a person's quality of life (QoL). This study is aimed at evaluating the effect of dental prostheses on oral health-related quality of life (OHRQoL) in adults. This is an observational study to measure patients' OHRQoL using a cohort study design before and after treatment with different dental prostheses (fixed and removable). Ninety-seven patients who received dental prostheses responded to a questionnaire before dental prosthetic treatment and then after the completion of the treatment. The conduction was face-to-face or via telephone interviews. The questionnaire is divided into two parts to verify the demographic and the patient's related factors and to measure OHRQoL using the Oral Health Impact Profile-5 (OHIP-5). Descriptive statistics, inferential statistics, and multivariable analysis were conducted using Stata Statistical Software: Release 14.2 (2016; StataCorp LLC, College Station, Texas, United States) and were at a 0.05 significance level. Data were collected from the 97 patients, of which 70% were male with a mean age of 39.5 and 30% were female with a mean age of 43. The educational level showed that only 15% of the patients received a bachelor's degree and that the remaining 85% stopped at a high school general educational level. The received prosthetic treatment consisted of 23% single crowns, 29% fixed partial dentures (FPD), 20% removable partial dentures (RPD), and 28% complete dentures. Self-reported overall health indicated that 64% of the patients had very good health and 36% had good health or a lower quality of health. There was a significant difference in OHIP scores before prosthetic treatment (M=5.4, SD=0.57) and after prosthetic treatment (M=3.2, SD=0.49) with no significant difference in the reduction in OHIP scores between fixed prostheses (M=-2.8, SD=0.64) and removable prostheses (M=-1.5, SD=0.74). The amount of improvement in OHIP answers after wearing a prosthesis was significant (p<0.0001). Linear regression indicated that having a history of discomfort from general oral health improved (decreased OHIP score) by 2.2 after prosthetic dental treatment compared to participants without a history of general oral health discomfort when all other variables are held constant. Within the limitations of this study, it can be concluded that restoration of missing teeth with a dental prosthesis has an immense impact on individuals' QoL, regardless of the type of dental prosthetic restoration.

A Case of Simultaneous Sinus Augmentation and Oroantral Fistula Closure for Implant Preparation.

An oroantral communication (OAC) may form in the upper molar region after tooth extraction. The patient is a 59-year-old female, who is a non-smoker. At the initial visit, teeth #14, #15, and #17 were missing. After tooth #16 was extracted due to apical periodontitis, a bone defect with a diameter of approximately 4 mm was observed, leading to the formation of an oroantral fistula (OAF). Another window was created in the lateral wall adjacent to the superior part of the bone defect at the fistula site to achieve closure of the OAF through bone formation and simultaneously perform sinus floor elevation (lateral approach) for implant placement. Through this lateral window, instruments were inserted into the maxillary sinus towards the bone defect at the fistula site. During this process, the remaining bone between the lateral window and the bone defect at the fistula site was carefully removed with instruments, connecting the two bone defects to facilitate the manipulation of the instruments. The Schneiderian membrane was elevated without enlarging the tear. Six months after these surgeries, a CBCT scan confirmed the closure of the fistula with hard tissue and the elevation of the sinus floor. Subsequently, three implants were placed, and prosthetic treatment was completed. Follow-up data is provided, including periapical X-ray and CBCT images taken two years and three months after surgery (one year and three months after the placement of the final prosthetic structure). The progress so far has been favorable.

Prosthetic Treatment Severely Damaged Teeth: A Case Report

Prosthetic Treatment Severely Damaged Teeth: A Case Report

New Assessment Model of Financing Treatment of Patients with Complete Tooth Loss

According to the World Health Organization, the global prevalence of complete tooth loss is estimated to be 7% among individuals aged 20 years and older, while for those aged 60 and over, this rate significantly increases to 23%. This study is relevant due to the psychological trauma, social challenges, and functional limitations caused by tooth loss, as well as the uneven availability of dental care worldwide. The goal of this research is to develop and implement a new model to assess the socioeconomic feasibility of investing in digital technologies for diagnosing and treating patients with complete tooth loss using removable polymer prostheses produced through additive 3D printing. The study employs scenario analysis, the clustered rankings coordination method, statistical methods, expert opinion assessment using Kendall’s coefficient of rank concordance, system analysis and design, questionnaires, sociometry, and functional modeling. The practical significance of this research lies in providing a quantitative assessment of economic opportunities for effectively using RPDs in three groups: RPDs without additional fixation means; those with special adhesive agents for improved fixation; and implant-supported prosthetics with conditionally removable dentures similar to RPDs. The scientific novelty of this study is the development of a new evaluation model that justifies the choice of prosthetic treatment technology for patients with complete tooth loss, enabling the most rational use of resources. Doi: 10.28991/ESJ-2024-08-05-014 Full Text: PDF

Prosthetic treatment of a patient with vertical dimension loss

Prosthetic treatment of a patient with vertical dimension loss

Recent Advances In Complete Dentures – A Narrative Review On Digital Complete Denture Clinical Workflows

Complete dentures are one of the most challenging prosthetic treatments to be performed throughout history. It has undergone transformation during the last decade tremendously with introduction of digital dentistry. The efforts are being focused at reducing the duration and number of clinical appointments, making the process more predictable and repeatable. The milled pre-polymerized PMMA has superior physical and mechanical properties, better biological properties and polishability. It is necessary to understand the clinical workflow of the digital dentures to be able to apply them clinically, giving patients the best possible outcome.

Dimensional Stability and Compressive Resistance of Three Interocclusal Record Materials: A Comparative In Vitro Study.

Accurate interocclusal records are crucial for a successful prosthetic treatment as they ensure the correct replication of a patient's jaw movements and relationships. The dimensional stability and compressive resistance of interocclusal record materials are essential factors influencing the quality of the final prosthesis. This study aims to evaluate and compare the dimensional stability and compressive resistance of three commonly used interocclusal recording materials: Ramitec (polyether; 3M ESPE, St. Paul, MN), Bona-Bite (polyvinyl siloxane; DMP Dental, Markopoulo, Greece), and O-Bite (polyvinyl siloxane; DMG Dental, Hamburg, Germany). An in vitro study was conducted using 108 samples prepared from three interocclusal record materials: Ramitec, Bona-Bite, and O-Bite, with each material tested at three different thicknesses (2, 4, and 6mm). A master stainless steel die was used to create the samples. The compressive resistance of each material was measured by applying a static load of 25N using a universal testing machine for one minute. Linear dimensional stability was assessed by comparing the diameters of the samples before and after compression using a vernier caliper. Bona-Bite exhibited the highest compressive resistance with mean values of 0.315±0.066 (6mm), 0.319±0.065 (4mm), and 0.306±0.065 (2mm). It also showed the least linear dimensional change, with mean values of 0.073±0.040 (6mm), 0.105±0.057 (4mm), and 0.080±0.036 (2mm). In comparison, Ramitec and O-Bite demonstrated lower compressive resistance and higher dimensional changes. Statistical analysis revealed significant differences between Bona-Bite and the other materials in both compressive resistance and dimensional stability. Bona-Bite (polyvinyl siloxane) outperformed Ramitec (polyether) and O-Bite (polyvinyl siloxane) in terms of compressive resistance and dimensional stability. Therefore, Bona-Bite is recommended for use in interocclusal recording to achieve more accurate and reliable prosthetic outcomes.

COMPREHENSIVE ASSESSMENT OF TREATMENT SATISFACTION WITH COMPLETE DENTURES ARTICULATED WITH THE T-SCAN SYSTEM AND ARTICULATION PAPER

Background: Prosthetic treatment in case of complete edentulism has the task of restoring the lost chewing function, speech and breathing and preventing the appearance or deepening of the reduction changes of both the soft tissues and the bones in the maxillofacial region, as well as restoring the aesthetic appearance and improving the psyche of the patient The aim of the present pilot study is to evaluate the satisfaction with treatment with complete dentures articulated with articulation paper and the T-SCAN system, which will serve as the basis for a large-scale cross-sectional study. Material and methods: The study includes a sample of 20 completely edentulous patients. The sample consisted of 10 women and 10 men. The studied patients were randomly divided into two groups of 10 people each. The patients were interviewed post treatment [at 5 weeks], a validated questionnaire about oral health-related quality of life in edentulous people [OHIP-EDENT] was applied. Results: The digital occlusal analysis provides more accurate information on the articulation of the prostheses, as it indicates the teeth with increased force in percentages and also the sequence of occurrence of the occlusal contacts. Analysis of occlusal contacts is subjective, and articulating them with this method carries error risks.When using the T-Scan system, patients are more satisfied than the treatment with total patients, as they feel the prostheses are much more comfortable and in much fewer visits. Conclusion: This quantitative methodology can be used as the method of choice for control of occluso-articulation relationships in treatment with total dentures in any dental practice, if technically possible

FACIAL PARAMETERS AS SUPPLEMENTARY LANDMARKS FOR DETERMINATION OFVERTICAL DIMENSIONS OF OCCLUSION: DISTANCE ECTOKANTHION - CHEILION

Background: The successful recovery of the functions and the aesthetics appearance of the edentulous patients often is a kind of challenge. The use of correlation between facial parameters could facilitate the determination of the vertical occlusion dimensions. The purpouse of this research was to investigate the interrelation between vertical dimensions of occlusion and distance external ocular angle (Ectokanthion) - labial commissure (Cheilion) among persons with natural dentition. Material and Methods: In the study were examined 120 persons from Bulgarian origin (59 male and 61 female), aged 20 to 25. The head of each and every participant was hold up into position so that the occlusal plane is parallel to the horisontal plane. The teeth were closed in central occlusion. Four reference points were marked: Ectokanthion, Cheilion, Subnasale and Gnathion. The researched distances were measured with the assistance of Vernier digital caliper. Statistical analysis of the obtained data was performed. Results: Moderate correlation was found between the distance Ectokanthion-Cheilion and the vertical occlusion dimension. The dataanalysisshows that coefficients of correlation are: 0.5681 for male and 0.5481 for female. Conclusions: It was found moderate correlation between the distance Ectokanthion-Cheilion and vertical dimensions of occlusion defined between point Subnasale and point Gnathion. The use of distance Ectokanthion-Cheilion as basic point of reference is not reliable, but it could be applied combined with other clinical methods or as part of mathematical models for determination of optimal vertical occlusion dimensions during prosthetic treatment of edentulous patients.

Influence of Silver Nanoparticle Integration on the Composition and Surface Properties of Acrylic Dental Resins Employed in Temporary Bridges

Background: Recognized widely for its irreversible effects, periodontal disease stands as one of the most prevalent conditions, particularly emphasizing the potential for permanent damage caused by gingivitis, extending to encompass the entirety of the supportive complex, including the connective tissue and alveolar bone. Patients necessitating comprehensive periodontal and prosthetic treatments require an interdisciplinary approach, involving the coordination of pre-treatment procedures and appropriate prosthetic strategies. The adoption of advanced materials and techniques can prove beneficial in addressing complex dental issues. (2) Methods: Forty specimens were prepared using the prescribed procedure, with 20 acting as controls and the other 20 integrating AgNPs. The initial step involved crafting wax patterns of distinct shapes: dumbbell shapes for tensile testing and rectangular shapes for roughness assessments. These dimensions were aligned with ASTM D-638 and ISO 527-2 standards and adjusted to match the specifications of the analysis device for mechanical properties. (3) Results: In this case, the results indicate minimal differences in heat-curing acrylic resins compared to the control samples at a 5% concentration. However, notable disparities arise at concentrations of 10% and 20%. (4) Conclusions: Temporary prosthetic constructions are essential for preventing functional imbalances and complications. Incorporating AgNPs at a 5% concentration maintains mechanical properties while providing antibacterial effects for long-term interim prosthodontic restorations. Higher nanoparticle concentrations may reduce resin mechanical properties without affecting material surface condition

Characteristics of the Occlusal Plane Associated with Unilateral and Bilateral Articular Eminence Inclination: A Cross-Sectional CBCT Study.

The characteristics of the temporomandibular joint (TMJ) are essential in orthodontic and prosthetic treatments. Previous studies have suggested an association between articular eminence inclinations (AEI) and occlusal plane characteristics using radiographs, but no bilateral analysis has been conducted using cone beam computed tomography (CBCT). Objective: This study aimed to investigate the specific characteristics of the occlusal plane inclinations associated with unilateral and bilateral AEI using CBCT. Methods: We conducted a cross-sectional study to evaluate 200 temporomandibular joints (TMJs) from 100 records obtained at the orthodontic department. We evaluated the association between the AEI, and occlusal plane characteristics like the cant of the occlusal angle, occlusal plane angles, inclination of the upper incisor to the Frankfort plane and palatal plane using both bivariate and multivariate analyses both unilaterally and bilaterally. Results: Our findings suggested statistically significant associations (p < 0.050) between AEI (bilateral) and occlusal inclination parameters, including the cant of the occlusal plane (Coef. -0.38; 95%CI -0.70:-0.06; p = 0.017), occlusal plane angle (Coef. -0.39; 95%CI -0.740:-0.05; p = 0.024), and position of the upper incisor relative to the palatal plane (Coef. -0.34; 95%CI -0.63:-0.06; p = 0.016). Conclusion: This study suggests an association between dental inclinations and AEI, which reflects the anatomical characteristics of TMJ and its related dental structures.

Exploring Intra-Articular Administration of Monoclonal Antibodies as a Novel Approach to Osteoarthritis Treatment: A Systematic Review.

Biological drugs, including monoclonal antibodies, represent a revolutionary strategy in all fields of medicine, offering promising results even in the treatment of osteoarthritis (OA). However, their safety and efficacy have not been fully validated, highlighting the need for in-depth studies. Therefore, we provided a comprehensive systematic review of the intra-articular use of monoclonal antibodies for the treatment of OA in animal models, reflecting ongoing efforts to advance therapeutic strategies and improve patient outcomes. A systematic literature search was conducted in December 2023 following the PRISMA guidelines, using the Web of Science, Google Scholar, and PUBMED databases. Out of a total of 456, 10 articles were included in the study analyzing intra-articular antibodies and focusing on various targets, including vascular endothelial growth factor (VEGF), nerve growth factor (NGF), interleukin 4-10 (IL4-10), tumor necrosis factor α (TNF-α), a disintegrin and metalloproteinase with thrombospondin motifs 5 (ADAMTS5), and matrix metalloproteinase 13 (MMP-13). Most studies administered the antibodies weekly, ranging from 1 to 10 injections. Animal models varied, with mean follow-up periods of 8.9 ± 4.1 weeks. The methods of assessing outcomes, including pain and morpho-functional changes, varied. Some studies reported only morphological and immunohistochemical data, while others included a quantitative analysis of protein expression. In conclusion, monoclonal antibodies represent a promising avenue in the treatment of OA, offering targeted approaches to modulate disease pathways. Further research and clinical trials are needed to validate their safety and efficacy, with the potential to revolutionize the management of OA and reduce reliance on prosthetic interventions.

Changes in the levels of cytokines IL-1β, IL-4, IL-8, and IL-10 in dental orthopedic fixed prosthetics

Despite significant advances in materials science, introduction of new methods and principles of prosthetic treatment into the practice of dentists, complications after prosthetics with fixed structures are encountered. The result of dental prosthetics of patients with defects of hard tissues of teeth depends not only on the chosen construction and materials from which they are made, but is closely connected with the functional activity of the immune system. Cytokines are an important factor of mucosal immunity. The cytokine system represents one of the key components of mucosal immunity. It regulates normal physiological functions, restoration of haemostasis in the interaction of physical, chemical and biological factors on the body and participates in the pathogenesis of allergic, autoimmune, and autoinflammatory processes. The aim of the study is to compare the content of IL-1â, IL-8, IL-10, and IL-4 in unstimulated saliva and gingival fluid in patients during adaptation to metal-ceramic and oxide ceramic tooth-supported constructions. In the period from 2021-2024, we examined 3 groups of patients aged 46±2 years: group 1 – comparison group, patients without dental constructions in the oral cavity (25 people); group 2 – patients treated with tooth-supported metal-ceramic (MC) crowns (25 people); and group 3 – patients treated with tooth-supported zirconium dioxide (ZrO2) crowns (25 people). On the basis of IL-1â, IL-8, IL-10, and IL-4 we concluded that the mucosal immunity of oral mucous membranes is less affected by the structures made of oxide ceramics compared to the crowns made of metal-ceramics. Similar patterns of changes in the levels of IL-1â, IL-8, and IL-4 in saliva and gingival fluid in patients who underwent dental rehabilitation were found, which allows us to use only saliva in order to eliminate the complexity and specificity of gingival fluid sampling. Also, changes in cytokine indices in saliva and gingival fluid at different stages of prosthodontics reflect the level of reaction of oral mucosal immunity, which can serve as a criterion of the quality of the performed dental treatment.

Edentulism complications in patients eligible for hybrid prosthetic treatment. A cross-sectional study

Edentulism complications in patients eligible for hybrid prosthetic treatment. A cross-sectional study

Relationship Between Oral Hypofunction and Nutritional Status in Patients Treated With Maxillofacial Prostheses.

Introduction Patients who have jaw or tongue defects owing to head and neck cancer or congenital disease suffer from oral dysfunction such as speech, swallowing, and mastication. Although maxillofacial prostheses are applied to improve oral functions, their oral functions remain compromised compared to those of patients without jaw or tongue defects. On the other hand, it has been reported that oral hypofunction could lead to malnutrition in the general elderly. However, to date, no reports have evaluated the relationship between oral function and nutritional status in patients with maxillofacial prostheses. In this study, we comprehensively evaluated oral function according to the examination items for oral hypofunction. We assessed which functions were related to nutritional status in patients with jaw defects caused by tumors or congenital diseases who are candidates for maxillofacial prosthetic treatment. Methods Patients who underwent prosthetic treatment at the Department of Maxillofacial Prosthodontics, Aichi-Gakuin University Dental Hospital, between May 2021 and January 2024 and who were doing well were included in the study. Oral function was assessed with seven tests according to the criteria of the Japanese Society of Geriatric Dentistry, and nutritional status was evaluated using the Mini Nutritional Assessment Short-Form (MNA-SF). Patients were classified according to age and type of deficiency. Additionally, the presence or absence of oral hypofunction and malnutrition or risk of malnutrition were assessed. The impact of oral hypofunction tests and defect status on the risk of malnutrition was evaluated using a logistic regression model. Results Oral hypofunction and malnutrition or risk of malnutrition were more frequent in the elderly group by age. Regarding the type of defect, the rate of oral hypofunction and malnutrition or risk of malnutrition was highest in the tongue defect group. Results of the logistic regression analysis indicated that nutritional status was associated with tongue deficiency, tongue-lip motor function, tongue pressure, and swallowing function. Conclusion The nutritional status of maxillofacial prosthetic wearers was associated with oral hypofunction. Particularly, malnutrition and risk of malnutrition were increased with tongue defects and deficiencies in tongue-lip motor function, tongue pressure, and swallowing.

Analysis of Dental Prosthetic Treatment in Patients with Cancer Aged 65 Years and Older after Expanded Health Insurance Coverage: A Retrospective Clinical Study.

Background and Objectives: With increases in cancer incidence and the number of cancer survivors, the demand for cancer management is growing. However, studies on dental prosthetic treatment for patients with cancer are rare. We aim to investigate the dental prosthetic treatment in patients with cancer aged ≥65 years after expanded health insurance coverage. Materials and Methods: This retrospective study included patients who were treated with implants and removable dentures at Ulsan University Hospital in South Korea between June 2015 and June 2023. Data on age, sex, cancer location, comorbid systemic diseases, number of remaining teeth, dental prosthetic treatment history, type of dental prosthetic treatment, and insurance coverage status were extracted from patient medical records and panoramic radiographs. The influence of multiple variables on dental prosthetic treatment was analyzed using the Chi-square and Fisher's exact tests. Results: The study included 61 patients with cancer (32 men, 29 women; average age: 70.9 years). Among them, 56 (91.8%) had insurance coverage benefits, and 34 (55.7%) received treatments such as implants, removable partial dentures, or complete dentures for the first time. Treatment types included 37 (60.7%) cases of implant prostheses and 24 (39.3%) conventional removable dentures. No statistical differences were observed in the type of dental prosthetic treatment according to sex, age, cancer location, number of systemic diseases, and dental prosthetic treatment history (p > 0.05). Patients with <10 remaining teeth received treatment with conventional removable dentures, which was statistically significant (p < 0.001). Conclusions: Of the 61 patients, 56 (91.8%) received insurance benefits, and 34 (55.7%) underwent dental prosthetic treatment for the first time. Within the limitations of this retrospective study, the expanded health insurance coverage alleviated the unmet demand for dental prosthetic treatment. As cancer prevalence continues to increase, expanding customized health insurance coverage is crucial to meet this demand.

Implant-Supported Vertical Soft Tissue Augmentation for Severe Hard and Soft Tissue Deficiencies at Malpositioned Implants: A Case Report of a Mucogingival and Restorative Approach.

The management of severe mucogingival deformities surrounding malpositioned implants represents a complex issue with a high risk of aesthetic failure. The present case report describes a mucogingival and restorative approach for the treatment of severe localized peri-implant tissue deficiencies with interproximal bone loss combined with an interproximal gingival recession on the adjacent natural tooth. This consists of maintaining a non-restorable malpositioned implant, submerging it through one or multiple vertical soft tissue augmentations, according to the defect severity, and delivering a tooth supported bridge involving the adjacent natural teeth. The step-by-step surgical technique adopted for implant submergence and vertical soft tissue grafting, as well as the subsequent surgical and prosthetic interventions, are described, presenting results at 5 years from implant submergence and 3 years from prosthetic finalization.

Fractures around the knee in elderly patients: Balancing fixation and arthroplasty approaches, a multicenter experience.,

IntroductionIn recent years, a discernible shift has occurred in the approach to knee pathologies, specifically in the management of acute fractures. Traditionally, fractures were primarily treated through osteosynthesis, whereas prosthesis replacement was primarily reserved for degenerative issues. Outcomes of this investigation aim to elucidate the potential indications and contraindications for the use of prosthetic interventions in the management of such fractures and to propose a scoring system that can be adopted for the choice between the two different approaches. MethodsA retrospective observational study was conducted on patients treated for periarticular knee fractures, with a focus on elderly patients. Patients aged older than 65 years treated in three Italian centers were recruited. Inclusion criteria comprised fractures around the knee, including distal femur types 33-A, 33-B, and 33-C, and proximal tibia types 41-A, 41-B, and 41-C, in accordance with the AO/OTA classification. Surgical treatment with osteosynthesis or arthroplasty was required and investigated. ResultsBetween August 2017 and October 2022, 91 patients with periarticular knee fractures underwent surgical treatment, 23.1 % males and 76.9 % females, with 78 % undergoing osteosynthesis and 22 % acute total knee replacement. Distal femoral fractures constituted 37.4 %, while 62.6 % were proximal tibial fractures. Average age at surgery was 76.4 years. Patient outcomes were assessed using PROMs, revealing generally positive results, including survivorship of 95 % at the final follow-up for both groups using the Kaplan Meier survival estimate. The study introduces a novel Total Knee Replacement Indication Scoring System (TKRISS) based on the AO Classification. ConclusionsNowadays osteosynthesis remains the main treatment for fractures around the knee.In a geriatric patient's population and in carefully selected patients replacement can be a valid option for early weight bearing and quicker recovery comparing to fixation. The Total Knee Replacement Indication Scoring System provides a useful tool for healthcare to assess the potential indication for TKR in the context of knee fractures. It integrates a range of relevant factors, acknowledging the complex nature of patient care. Further clinical research and validation are essential to refine and optimize this scoring system.