Replacement Prosthesis Research Articles

Automated Identification of Dental Implants: A New, Fast and Accurate Artificial Intelligence System.

Prosthetic complications that occur to some implant prosthetics may require removal of the prosthesis for replacement or repair. Therefore, the presence of a technique to identify the type of dental implant is mandatory to provide the suitable components. Hence, the aim of the current study was to evaluate the accuracy of YOLOv8 object detection algorithm in automatic identification of the type of dental implant from digital periapical radiographs. YOLOv8m-seg object detection algorithm was used to build a model to automatically identify the type of dental implant. A set of 2573 digital periapical radiographs for six distinct dental implants manufacturers were used to train the model. The outcomes were evaluated using precision, recall, F1 score and mAP. The overall accuracy of the YOLOv8m-seg model in terms of precision, recall, F1 score and mAP revealed values of 0.919, 0.98, 0.95 and 0.972 respectively. The average detection speed of the images was 1.3 seconds. The model was able to detect and identify multiple implants simultaneously on the same image. YOLOv8m-seg object detection algorithm is promising in identification of dental implants from periapical radiographs with high detection accuracy (97.2%), fast detection results and multi-implant detection from the same image. This AI system can accurately identify the type of osseointegrated dental implants enabling dentists to provide the appropriate prosthetic components even if different implant systems are used within the same patient. This can save tremendous amounts of time, effort and cost for both the dentist and the patient.

Biocompatibility profile of aged pigmented and non-pigmented silicone elastomer for combined maxillofacial defects.

To assess the biocompatibility of platinum silicone elastomer A-2000 used in combined maxillofacial defects prosthesis, after being deteriorated by an accelerated aging process resembling both the extra and intraoral environment. This assessment was done indirectly on human-derived dermal and gingival tissues. One hundred eight samples of room-temperature vulcanized A-2000 platinum silicone were equally divided into extrinsically pigmented and non-pigmented groups to replicate combined maxillofacial defects. Accelerated aging was applied to pigmented samples to mimic extra- and intra-oral conditions, while non-aged counterparts served as controls. After isolating human cell lineages, dermal and gingival fibroblasts were indirectly exposed to silicone sample media. Cytotoxicity to cultured fibroblasts was assessed via MTT assay. Statistical significance was determined by repeated measures of one-way ANOVA (p < 0.01), evaluating cytotoxicity on dermal and gingival fibroblasts. MTT assay showed increased cytotoxicity in pigmented silicon samples subjected to extraoral aging compared to non-aged counterparts (p < 0.01). Non-pigmented silicon, modeling intraoral conditions, exhibited cytotoxicity after 48h (p < 0.05). Both aged and non-aged silicon extracts equally sensitized gingival fibroblasts at 72h (p < 0.001). Negative correlations between pigmented and non-pigmented silicon were observed in dermal cell growth (p > 0.05, except at 24h, r = 0.2), with accelerated aging showing minimal impact on the pigmentation effect (p > 0.05). The retrieved diminished cellular metabolic activity of platinum silicone elastomer was in an acceptable clinical range, pointing out the importance of periodic assessments of the maxillofacial prosthesis for replacement depending on aging and cytotoxic harmful cellular responses.

Management of osteosarcoma by total knee joint replacement with ALT-free flap transfer: Case series

In the past, surgeries to treat osteosarcoma involved amputation, but now they have become more conservative with prosthesis replacement. To reduce the incidence of complications, it is essential to consider suitable and adequate soft tissue cover. Our patients underwent surgery to resect osteosarcoma of the upper and lower head of the tibia and femur, respectively and were given knee joint prostheses. We chose the anterolateral thigh flap (ALT) as the suitable material to cover the defect and the prosthesis. All flaps were used for the surgery, two of which were fasciocutaneous, and the other two were musculocutaneous. All flaps had good blood supply, and no complications were reported. Conservative surgery for osteosarcoma has become increasingly popular, particularly for bone or joint replacement. The free ALT flaps offer many advantages when reconstructing the soft tissue defect and covering the prosthesis. The lower donor site morbidity of ALT free-flap makes it a more favorable choice for reconstruction after joint replacement.

An upconverted afterglow color conversion strategy for in-situ activated persistent luminescent imaging of medical implants

Upconverted afterglow imaging presents a promising avenue for long-term auto-fluorescence-free imaging applications without the necessity of expensive time-resolved equipment. In this research, inspired by LED design, we devised a straightforward ternary upconverted afterglow conversion (UAC) strategy that amalgamates upconversion NaYbF4: Tm0.005 (UP), afterglow ZnS:Cu,Co (AP), and color conversion CaAlSiN3:Eu phosphors (CP). This fusion resulted in a UAC composite that displays a deep-red to near-infrared (NIR) afterglow with a peak at 663 nm, following a brief activation period by 980 nm light. Importantly, an enhancement of 116 times was realized by using the UAC strategy when comparing with a typical single phase afterglow phosphor, Zn3Ga2SnO8:Cr,Yb,Er. The NIR-rechargeable afterglow sustained for a minimum of 100 min after a mere 3 s of NIR wireless charging process and is chemically stable. This makes it highly suitable for long-term luminescence imaging applications. To demonstrate its potential, we employed our ternary UAC phosphor to image medical plastic prostheses through pig skin in vitro and simulated a plastic surgery on a mouse model in vivo. Such luminescent information could prove invaluable for planning future surgical interventions, such as prosthesis replacement, removal, or necessary debris cleaning.

ACHIEVING DISTAL FIXATION AND EARLY MOBILIZATION IN PATIENTS WITH SEVERE FEMORAL BONE LOSS USING AN INTERNAL PROXIMAL FEMORAL REPLACEMENT PROSTHESIS

The management of femoral bone loss is challenging during revision hip arthroplasty. In patients with Paprosky grade IIIB and IV defects, obtaining fixation and rotational stability using traditional surgical constructs is difficult. The use of a custom-made internal proximal femoral replacement prostheses has been proposed as a solution in patients, with severe femoral bone stock loss. However, there is a paucity in the literature on their use and long-term outcomes. We report on the clinical and radiological results of our cohort.We retrospectively reviewed all patients who underwent internal proximal femoral replacement for revision hip arthroplasty between April 1996 and April 2019. All patients had at least 2 years of follow-up time.160 patients underwent limb salvage at our institution using internal proximal femoral replacement. The mean follow-up was 79.7 months (S.D 41.3). Indications for revision included periprosthetic fractures, aseptic loosening, and deep infection. The mean Oxford hip score increased from 13.8 (0–22) to 31.5 (18–43) (paired t-test, p &lt; 0.001). Kaplan-Meier prosthesis survival analysis with revision as the endpoint was 87% at 5 years. None required revision of the femoral stem. There were four dislocations (5%) and there was failure to eradicate the deep infection in four.This technique allows instant distal fixation, allowing for early mobilisation. Long-term clinical and radiological outcomes are encouraging and the complication rates are acceptable for this patient group.

Narrative review of immediate salvage for penile prosthesis infection.

Implantation of a penile prosthesis is a reliable option for men with erectile dysfunction (ED) refractory to less invasive therapies. While the frequency of penile prosthesis infections have decreased, they remain a devastating complication. Herein we discuss why immediate salvage surgery is an essential technique for the management of implant infections. We will also describe the relevant advancements to this technique. We conducted a narrative review via computer based search of PubMed for all relevant articles on penile prosthesis infection management, including guidelines, case series, reviews, and expert opinions. Search terms used included: "inflatable penile prosthesis", "IPP", "penile prosthesis", "salvage", "treatment", "delayed", "immediate". Only English peer-reviewed publications were included. Historically, patients who presented with penile prosthesis infections were exclusively managed with complete removal of the prosthesis without replacement. Although this strategy is safe, it hastens immediate ED and corporal fibrosis, resulting in loss of penile length and increased difficulty with subsequent prosthesis replacement. Previous case series have reported successful treatment of localized penile prosthesis infections with nonsurgical treatment, but the role of conservative treatment remains limited. The current standard of immediate salvage entails removal of the infected prosthesis and washout followed by immediate replacement with a new penile prosthesis. This technique has been demonstrated to be safe and effective, thus allowing patients to resume intercourse and maintain penile length. Immediate salvage surgery is safe and effective, and has emerged as the preferred strategy for the management of most patients with a penile prosthesis infection.

Electromyographic Evaluation of Masseter and Temporalis Muscle Activity in Distal Extension Edentulous Patients After Replacing with Implants—A Prospective Clinical Trial

Aim: To assess the changes in muscle activity after replacing the missing teeth or teeth with implants in distal extension edentulous patients and to evaluate the patient’s satisfaction levels. Materials and Methods: This was a single-group experimental study, based on convenience sampling with a sample size of 40 patients. Only unilateral mandibular distal extension edentulous sites were included and endo-osseous dental implants were placed in delayed protocol. Electrical activities of the masseter and temporalis muscles were recorded at rest and clench before, immediately, and one month after the cementation using electromyography. Patient satisfaction was analyzed through a questionnaire. Descriptive statistics an inferential statistics with repeated measures of ANOVA followed by the Bonferroni post hoc test were done to analyze the study data. P value &lt; .05 would be considered statistically significant for all the analyses. Results: Right temporalis showed significantly higher surface electromyography (sEMG) activity at one-month post cementation than baseline at rest and clench. Similarly, the left temporalis has shown significant sEMG activity at one-month post cementation than baseline at clench. However, there was no statistical difference with the right and left masseter. The implant-supported prosthesis was well received by the majority of patients. Conclusion: Definitive improvement in the electrical activity of the temporalis before and after the replacement of prosthesis was noticed with positive patient satisfaction levels with implant-supported prosthesis.

Mid- and long-term clinical results of the Elektra and Moovis prosthesis for trapeziometacarpal joint replacement

BackgroundTotal joint arthroplasty as a surgical treatment option for trapeziometacarpal joint arthritis is recently revived. The aim of this study is to report on mid- and long-term results of the Elektra (single-mobility) and Moovis (dual-mobility) prosthesis for treatment of primary thumb carpometacarpal joint arthritis.MethodsIn this retrospective, monocentric, descriptive cohort study, 31 prostheses were evaluated that were implanted by a single surgeon in 26 patients between 2009 and 2019. Indication for surgery was trapeziometacarpal joint osteoarthritis (Eaton/Littler Stage II and III). Clinical and radiological follow-up was performed at a minimum of 24 months. The postoperative assessment included range of motion, pain, strength as well as functional scores (DASH, MHQ). Implant survival and complications were the primary endpoints.Results10 Elektra and 21 Moovis prostheses were implanted between 2009 and 2019 with a mean follow-up of 74.2 months in the Elektra and 41.4 months in the Moovis group. The average patients’ age at surgery was 64 years. Postoperative pain levels (VAS 0–10) were below 2 at rest and under stress in both groups. Grip/pinch strength and range of motion showed results comparable to the contralateral hand. Opposition was excellent with an average Kapandji index of 9.6 in both groups. Elektra achieved slightly better functional scores in the DASH and MHQ score. Satisfaction was high in both groups, and 96% of the patients would recommend the procedure. Metacarpophalangeal hyperextension > 15° was seen in 3 patients per group preoperatively and was corrected to < 5° post-surgery. 3 Elektra prostheses were revised due to cup loosening and dislocation for cup and/or neck replacement or secondary trapeziectomy. 1 Moovis prosthesis was revised with an exchange of the neck to a larger size due to restricted movement. After the mean follow-up of 7.9 years in Elektra and 3.5 years in MOOVIS, cumulative survival was 68.6% vs. 95.2%, respectively.ConclusionsIn this mid- to long-term retrospective analysis, total joint arthroplasty in primary trapeziometacarpal joint arthritis results in low pain levels, excellent mobility and clinical function. Patient satisfaction is overall high. While revision due to cup loosening occurred more often in patients with single-mobility implants, no cases of dislocation or loosening of components were observed in the dual-mobility group.Trial registrationThe study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of the Medical Faculty of Heidelberg University, reference number S-150/2020.

Integration of 3D-printed middle ear models and middle ear prostheses in otosurgical training

BackgroundIn otosurgical training, cadaveric temporal bones are primarily used to provide a realistic tactile experience. However, using cadaveric temporal bones is challenging due to their limited availability, high cost, and potential for infection. Utilizing current three-dimensional (3D) technologies could overcome the limitations associated with cadaveric bones. This study focused on how a 3D-printed middle ear model can be used in otosurgical training.MethodsA cadaveric temporal bone was imaged using microcomputed tomography (micro-CT) to generate a 3D model of the middle ear. The final model was printed from transparent photopolymers using a laser-based 3D printer (vat photopolymerization), yielding a 3D-printed phantom of the external ear canal and middle ear. The feasibility of this phantom for otosurgical training was evaluated through an ossiculoplasty simulation involving ten otosurgeons and ten otolaryngology–head and neck surgery (ORL-HNS) residents. The participants were tasked with drilling, scooping, and placing a 3D-printed partial ossicular replacement prosthesis (PORP). Following the simulation, a questionnaire was used to collect the participants' opinions and feedback.ResultsA transparent photopolymer was deemed suitable for both the middle ear phantom and PORP. The printing procedure was precise, and the anatomical landmarks were recognizable. Based on the evaluations, the phantom had realistic maneuverability, although the haptic feedback during drilling and scooping received some criticism from ORL-HNS residents. Both otosurgeons and ORL-HNS residents were optimistic about the application of these 3D-printed models as training tools.ConclusionsThe 3D-printed middle ear phantom and PORP used in this study can be used for low-threshold training in the future. The integration of 3D-printed models in conventional otosurgical training holds significant promise.

OSSEOINTEGRATION IN LIMB REPLACEMENT SURGERY: AN ANALYSIS OF THE QUALITY AND READABILITY OF AVAILABLE INFORMATION ON THE INTERNET

IntroductionThe use of osseointegrated limb replacement prostheses for amputees are rapidly growing in popularity due to the many benefits over conventional sockets. Many institutions worldwide are beginning to provide this surgical option to their patients and are advertising the service online. The aim of this study was to assess the quality and reading level of related information available online.Materials &amp; MethodsA search was performed using the 3 most popular English language search engines reviewing the top 40 websites from each, using the term osseointegration on. Duplicates, videos, medical journal articles and dentistry websites were excluded. All included websites were assessed for reading using the FKGL, G-Fog and FRE. Quality was assessed using the JAMA benchmark criteria, HONC erificate and a novel 16-point scoring system developed specifically for limb replacement osseointegration.ResultsThe search resulted in 9,985,000 websites, 120 were assessed. 23 websites were included after removal of duplicates, medical journals and dentistry websites. None with reading grades of 6 or lower. Mean FKGL grade was 11.3/18. Mean FRE was 38.83/100. Mean G-FOG was 12.57/20. No websites had HONC. Mean JAMA score was 1.76/4. Mean HSSOIS was 5.70/16. Most provided information on indications(16/23) and explanation of osseointegration 17/23) but few discussed costs(3/23) or restrictions(9/23).ConclusionsThere is already a large amount of information available online regarding osseointegrated prostheses. However, the most accessible information may exceed most patients’ reading levels, limiting is usefulness. Further, the information available is generally of low quality, The quality of information and the readability of online content should be improved to ensure more effective patient education.

Effect of novel polyethylene insert configurations on bone-implant micromotion and contact stresses in total ankle replacement prostheses: a finite element analysis.

This study investigates the impact of elastic improvements to the artificial ankle joint insert on prosthesis biomechanics to reduce the risk of prosthesis loosening in TAR patients. CT data of the right ankle was collected from one elderly female volunteer. An original TAR model (Model A) was developed from CT images and the INBONE II implant system. The development of the new inserts adopts an elastic improvement design approach, where different geometric configurations of flexible layers are inserted into the traditional insert. The structure can be divided into continuous flexible layers and intermittent flexible layers. The flexible layers aim to improve the elasticity of the component by absorbing and dispersing more kinetic energy. The newly designed inserts are used to replace the original insert in Model A, resulting in the development of Models B-D. A finite element model of gait analysis was based by gait parameters. Discrepancies in micromotion and contact behaviour were analysed during the gait cycle, along with interface fretting and articular surface stress at 50% of the gait cycle. In terms of micromotion, the improved elastic models showed reduced micromotion at the tibial-implant interfaces compared to the original model. The peak average micromotion decreased by 12.1%, 13.1%, and 14.5% in Models B, C, and D, respectively. The micromotion distribution also improved in the improved models, especially in Model D. Regarding contact areas, all models showed increased contact areas of articular surfaces with axial load, with Models B, C, and D increasing by 26.8%, 23.9%, and 24.4%, respectively. Contact stress on articular surfaces increased with axial load, reaching peak stress during the late stance phase. Models with continuous flexible layer designs exhibited lower stress levels. The insert and the talar prosthetic articular surfaces showed more uniform stress distribution in the improved models. Improving the elasticity of the insert can enhance component flexibility, absorb impact forces, reduce micromotion, and improve contact behavior. The design scheme of continuous flexible layers is more advantageous in transmitting and dispersing stress, providing reference value for insert improvement.

Open mitral valve replacement with a balloon-expandable prosthesis using the valve-in-valve technique: a case report

Mitral defects are the most common acquired heart disturbances. The only radical treatment for severe valve stenosis or its insufficiency is surgical correction of the defects. The main challenge of implanting a mechanical mitral prosthesis is associated to its thrombosis complication that demands repeated surgical intervention on re-replacement of the mitral prosthesis. Herein, a clinical case of patient P. (58 years old) is presented, who was admitted to the Federal Center for Cardiovascular Surgery (Penza, Russia) with thrombosis of the mitral valve prosthesis and its dysfunction. The patient has already been undergone repeated surgery to replace the mitral valve. The purpose of the clinical case description is to demonstrate the using of open mitral valve replacement method based on the valve-in-valve technique with a transcatheter balloon-expandable prosthesis, its efficacy and safety.The considered method of treatment can simplify the main stage of the surgical intervention; reduce the time of artificial circulation and aortic clamping as well as the number of intraoperative complications. This type of surgical treatment can be considered as an option for re-prosthesis in patients at high surgical risk who are indicated for re-intervention due to impaired function of previously implanted heart valve prosthesis. A clinical case attests the possibility, efficacy and safety of using a balloon-expandable prosthesis for mitral valve replacement with the valve-in-valve technique upon repeated surgical interventions. Received 12 January 2024. Revised 16 February 2024. Accepted 19 February 2024. Informed consent: The patient’s informed consent to use the records for medical purposes is obtained. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsLiterature review: M.A. DenisovDrafting the article: I.Ya. SenzhapovCritical revision of the article: A.I. MikulyakSurgical treatment: V.V. Bazylev, M.G. ShmatkovFinal approval of the version to be published: V.V. Bazylev, A.I. Mikulyak, M.G. Shmatkov, I.Ya. Senzhapov, M.A. Denisov

Transplantation of cryopreserved cardiovascular homografts

Due to degeneration, homografts were since the 1950s only used strictly for replacement of complex arterial segments and lesions incl. the aortic valve, replacement of infected arterial prostheses, and vascular access for patients on haemodialysis. During the 1990s, rate-differentiated freezing methods and anti-crystallization agents proved to prevent crystallisation, and more widespread use with expanded indications incl. coronary and lower limb bypasses began justified by promising midterm results. In 2021, the first Scandinavian homograft biobank was founded in Odense in Denmark. This review summarises the history and the experiences from this biobank.

Effect of Bisoctrizole on Ultraviolet (UV) Absorption Properties of Silicone and Effect on Surface Roughness - An In Vitro Study.

Premature degradation is the problem of maxillofacial silicones, significantly affected by ultraviolet exposure, contributing to silicones photodegradation. Degradation necessitates frequent replacement of prostheses that increase the total cost of rehabilitation. This study evaluated the effect of bisoctrizole on the ultraviolet absorption properties of silicone material and the stability of this absorption over time. Also, the bisoctrizole effect on the surface roughness of silicone was evaluated. There were 60 prepared specimens of room temperature-vulcanising maxillofacial silicone equally divided into two groups according to the conducted tests: ultraviolet absorption test and the surface roughness test. Each group was further subdivided into groups of 10 specimens based on the weight concentration of the ultraviolet (UV) absorber added: 0%, 1% and 2%. The UV absorbance of coloured specimens was measured before and after artificial weathering for 100 and 200 hours. Repeated-measures analysis of variance (ANOVA) was applied for UV absorption results, and one-way ANOVA was applied for the roughness test results to test the changing significances. Bisoctrizole incorporation led to a highly significant improvement in ultraviolet absorption in all groups, maintaining a high level even after subjecting the specimens to artificial weathering. Furthermore, the addition resulted in a significant increase in surface roughness as the concentration of bisoctrizole increased. Despite the surface roughness changes, bisoctrizole demonstrated efficacy as a UV absorber for maxillofacial silicone, making it valuable for applications such as maxillofacial prosthetics that require UV protection.

Long-Term Complications of Tracheoesophageal Voice Prosthesis.

Background: The aim of our multicenter retrospective study was to evaluate the long-term complications associated with primary and secondary tracheoesophageal puncture (TEP) in patients who underwent total laryngectomy (TL) for laryngeal cancer and were subsequently rehabilitated to phonatory function with tracheoesophageal speech (TES). Materials and Methods: To evaluate the long-term outcomes and complications of TEP, the following data were collected: mean time of prosthesis replacement, mean time of onset of complications, type of complications, and type of failure. Results: Complications occurred in 18 out of 46 patients (39.2%) with primary TEP and in 10 out of 30 patients (33.4%) with secondary TEP, out of a total of 76 enrolled patients. Common complications included prosthesis leakage, fistula leakage, granulation, and prosthesis extrusion. Prosthesis replacement due to fistula leakage or prosthesis extrusion was observed exclusively in the group of patients with primary TEP. Among the 28 patients (35.7%) who experienced complications, rehabilitation with TEP failed in 10 cases, primarily due to abandonment and spontaneous fistula closure. Conclusions: TEP, both primary and secondary, represents a valid option for vocal rehabilitation in patients undergoing TL. However, identifying prognostic factors that could influence the success of TEP would be beneficial to allow a targeted rehabilitation process.

Standardized clinical evaluation of dry anophthalmic socket syndrome in a real-world approach

PurposeTo assess which signs and eye prosthesis care habits are related to subjective discomfort in patients with dry anophthalmic socket syndrome (DASS), using standardized tools from daily practice. Methods62 anophthalmic sockets were compared with their healthy fellow eye using the Standard Patient Evaluation of Eye Dryness (SPEED) score. The correlations between SPEED questionnaire and the prosthesis care, discharge characteristics score, conjunctival inflammation score, meibomian gland dysfunction (MGD) scores and Schirmer I test were studied. ResultThe anophthalmic sockets group achieved a higher SPEED test score (p < 0.01), discharge score (p < 0.01), conjunctival inflammation score (p < 0.01), MGD scores (p < 0.01) and lower Schirmer I test (p < 0.01) compared with their fellow, healthy eye. Patients with a prosthesis replacement of one year or less, those with a current fit time of one year or less and those with a cleaning frequency above one month reported better SPEED, (p < 0.01), conjunctiva inflammation (p < 0.01) and MGD scores (p < 0.01). ConclusionMost anophthalmic patients suffer mild to severe DASS, which seems related to discharge, conjunctival inflammation and MGD. Moreover, certain practices related to the care of the prosthesis such as replacing with a frequency lower than yearly, current fitting time inferior to one year and a removing and cleaning regime above one month, were related to a lower discomfort sensation, conjunctival inflammation and MGD. Clinicians should consider the DASS when facing patients with anophthalmic socket and discomfort symptoms.

Biomechanical and physical properties selection of Ti-Ha-CaCO&lt;sub&gt;3&lt;/sub&gt; biocomposite prostheses for replacement of bone atrophy

Traditional prosthetic materials often lack the desired properties to mimic the mechanical behaviour of natural bone, leading to complications and reduced implant longevity. This study aims to conduct a biomechanical and physical properties selection analysis for biocomposite prostheses' suitable for replacing bone atrophy. This involves evaluating the mechanical properties of developed biocomposites with different structures (dense, porous and gradient) to ensure compatibility with the mechanical properties of bone. The radar chart was adopted to compare and evaluate the mechanical strength of various biocomposite implants and identify the most suitable prosthesis for load-bearing bone replacement. The study utilises powder metallurgy, scanning electron microscopy (SEM), and ImageJ software to produce and characterise the pore size distribution of the biocomposites, respectively. The findings of this study revealed the gradient and porous biocomposites exhibited desired mechanical properties with porosity of 20.67 and 27.72 % pore size up to 134 and 256 μm, compressive strength of 174 and 149.29 MPa and compressive modulus of 30.42 and 28.3 GPa respectively. The SEM analysis, coupled with pore size distribution and porosity percentage measurements, offers valuable information for designing and fabricating biomaterials with enhanced properties. The gradient biocomposite was identified to be the best sample for load-bearing bone replacements by the selection analysis because of its high compressive strength and low modulus, which is within the established cortical bone mechanical properties.

Self-perception of need to replace dentures and oral health-related quality of life

Aim: With the significant increase in life expectancy over the last decades, it is important to understand how oral health can impact the oral health-related quality of life of older adults. This study aimed to investigate the association between need to replace dentures and oral health-related quality of life (OHRQoL) among older adults belonging to a Cohort in southern Brazil. Methods: This cross-sectional study was conducted with data from the 2019 Pelotas Elderly Cohort. The OHRQoL was assessed using the GOHAI. Need to replace dentures was self-report using a question dichotomized into yes/no. In the statistical analysis, unadjusted and adjusted models estimate from linear regression models were calculated. The significance level adopted was 5%. Results: A total of 493 older adults were included. On the GOHAI questionnaire, the mean score was 32.74 (SD±0.16). Individuals considering need of prosthesis replacement were 47.89%. Report of need to replace dentures was associated to lowest mean on the GOHAI score (β -1.14; 95%CI - 1.80; -0.478, and on the physical (β -0.56; 95%CI - 0.94 -0.17) and psychosocial (β -0.48; 95%CI - 0.74; -0.22) dimensions. Conclusion: Our findings highlight the importance of also considering subjective measures of oral health in the dental care of older adults, since reporting the need for denture replacement, regardless of the reason, was associated with a worse oral health-related quality of life, including physical and psychosocial aspects.

(170) Missed Urinary Leak During an Inflatable Penile Prosthesis Insertion Presenting as a Post-Operative Hydrocoele

Abstract Introduction This is a case of a revision of a three-piece penile prosthesis in a 53-year-old gentleman who had received an infrapubic implantable penile prosthesis (IPP) in Turkey over 12 months ago. He complained of an unsupported floppy shaft when the prosthesis was inflated, as well as a right hemi scrotal bulging which was exacerbated by activity but showed no signs of infection. A hydrocele had occurred 2 months following the IPP insertion and was confirmed on imaging. The MRI showed the pump within the hydrocele. He had previously had a laparoscopy gastric banding and a bilateral inguinal hernia repair with mesh. Objective Video to demonstrate the surgical case Methods This is a video demonstrating the steps of this operation. The procedure started with a transverse penoscrotal incision and dissection through the dartos muscle. The initial corporotomy allowed removal of the first cylinder of the prosthesis. Upon removing the right cylinder, the hydrocele was opened to reveal the presence of turbid fluid, 150ml of fluid was aspirated and sent for microbiology investigations. The next stage involved removal of the left cylinder and 7.5cm of rear-tip extenders (RTE) were subsequently removed intact, with further RTE from the right removed separately using a nasal speculum. Therefore, a 20cm IPP was removed with 7.5cm RTE on each side. An antibiotic salvage wash (Rifampicin/Gentamicin) was performed several times. At this point a 26cm + 1cm (13mm) malleable prosthesis was inserted as a spacer. The previous infrapubic wound was opened to remove the reservoir, 75ml of fluid was aspirated from around the reservoir prior to removal. Attempts are made to identify a possible fistula with flexible cystoscopy, but normal urethra, bladder neck and bladder are seen. Giving no evidence of any fistula into the abdominal cavity or urethral injury to explain fluid in the corporal cavities or around the components of the prosthesis. Methylene blue and distention were also used to attempt to identify a bladder leak, however this was also unremarkable. A suprapubic catheter was inserted to ensure the decompression of the urinary system to allow any small/undetected leaks to heal. This was done under direct vision using a cystoscope prior to being secured. Results The patient had a replacement of the inflatable penile prosthesis to a malleable prosthesis, a suprapubic catheter inserted and a drainage of his hydrocele. The patient recovered well from surgery and on examination the prosthesis tips were seated nicely in the glans. The fluid microbiology culture did not grow any organism. A subsequent cystogram showed no signs of any bladder leak. The patient was happy with the outcome and underwent a trial without catheter. He has a planned review and will be considered for an exchange to an inflatable device at this time. Conclusions This is an unusual presentation of a hydrocele, in the absence of any infective symptoms which is suggestive of a contained urine leak and even a missed bladder injury from the first prosthesis surgery. However, no fistula was found during the surgery or the post-operative cystogram. Disclosure No.

(262) Salvage Penile Prosthetic Surgery, Unique Surgical Technique. Institutional Experience

Abstract Introduction `-Penile prosthesis surgery represents the end-stage treatment for erectile dysfunction. It is conventionally used only in cases of erectile dysfunction refractory to pharmacological treatments. -Penile prothesis surgery is associated with a high satisfaction rate and a low complication profile. However, it must be appreciated that the complications of surgery can have devastating consequences on a patient's quality of life and satisfaction and include infection, prosthesis malfunction, penile corporal perforation and penile length loss. -This study discusses the diagnosis and management of infected penile prosthesis with highlighting special intra-operative surgical technique that might be a valuable step in Salvage penile prosthetic surgery Objective Since its introduction in 1996 Mulcahy salvage has significantly improved outcomes for the removal and replacement of infected penile prostheses. Long-term follow up data of Mulcahy salvage show an infection-free rate of 82%. In our study we evaluated the Salvage Penile Prosthetic Surgery Cases done in our tertiary institution since (2000 up to date) and introduce the unique surgical technique that resulted in reduction the re-infetion rate. Methods This is a retrospective, institutional review Results total of 13 Salvage penile prosthetic surgeries done in our tertiary center since between 2000 and 2023 out of them only one case developed reinfection and ended with penile prosthesis removal. Therefor, the rate of re-infection is 8% comparing with latest successe rate of Mulcahy technique (18%) We applied surgical step intra- operative that might be the underling reason of decreasing the the reinfection rate that will be presented in details. Conclusions This retrospective analysis of salvage procedures and replacement of infected penile prosthesis with malleable prosthesis shows a high infection-free rate. Disclosure No.