Root Repair Research Articles

Assessment of All-Inside Sutures to the Posteromedial Capsule in Medial Meniscus Posterior Root Repair: Findings From a Retrospective Three-Dimensional Magnetic Resonance Imaging Study

Assessment of All-Inside Sutures to the Posteromedial Capsule in Medial Meniscus Posterior Root Repair: Findings From a Retrospective Three-Dimensional Magnetic Resonance Imaging Study

Arthroscopic meniscal posterior root repair combined with centralization reduces medial menicus extrusion associated with posterior root tears: One-year clinical outcomes.

This study aimed to assess the short-term clinical efficacy of combining posterior meniscal root repair with meniscal centralization technology in the treatment of medial meniscus posterior root tears (MMPRTs) and notable meniscus extrusion. In this retrospective analysis, patients aged 43-76 years with only chronic posterior root tears of the medial meniscus and notable extrusion were followed up for 12-14 months. (1) persistent medial knee joint pain affecting daily life, presenting with joint space tenderness; (2) showing the ineffectiveness of conservative treatment for a minimum of 3 months; conservative treatment includes non-invasive methods such as nonsteroidal anti-inflammatory drugs, physical therapy and massage, but does not include intra-articular injections. (3) Kellgren-Lawrence Grades 0-II osteoarthritis (OA) of the knee joint; and (4) diagnosis of a posterior root tear of the medial meniscus with notable meniscus extrusion confirmed through knee-joint plain magnetic resonance imaging (MRI) scans, where coronal image revealed a meniscus body extrusion of ≥3 mm. (1) Kellgren-Lawrence Grades III-IV OA in the knee joint; (2) presence of knee joint infection or other structural damage to the knee joint; (3) history of previous knee joint surgery; (4) demonstrating joint instability or abnormal lower-limb alignment (varus deformity >5°); and (5) presence of severe mental illness, coagulation disorders, or other serious medical conditions. The Lysholms score, the Hospital for Special Surgery (HSS) knee score, the visual analogue scale (VAS) score and meniscal extrusion values were evaluated before and after surgery in 23 patients through a comparative analysis. The results of the follow-up conducted 12-14 months post-operatively indicated a significant improvement in the patients' conditions. In particular, the Lysholms scores (preoperative: 50.9 ± 10.2; 1-year post-surgery: 72.0 ± 8.4), HSS knee scores (preoperative: 45.9 ± 10.6; 1-year post-surgery: 79.1 ± 11.1) and VAS scores (preoperative: 4.0 ± 1.1; 1-year post-surgery: 0.9 ± 0.7) exhibited notable enhancements. Furthermore, compared to the preoperative values, the degree of meniscus extrusion measured by coronal MRI of the knee joint significantly improved post-operatively (preoperative: 3.7 ± 0.8 mm; 1-year post-surgery: 2.2 ± 0.6 mm). These findings all yielded a p < 0.05, signifying statistical significance. In patients with chronic MMPRTs and notable extrusion, a combination of posterior meniscal root repair and centralization technology can effectively restore meniscus function and rectify the medial meniscus displacement, resulting in favourable short-term clinical outcomes. Level IV.

Diagnostics-LLaVA

The recent advancements in the area of Large language models (LLMs) has opened horizons for conversational assistant-based intelligent models capable of interpreting images, and providing textual response, also known as Visual language models (VLMs). These models can assist equipment operators and maintenance technicians in the complex Prognostics and Health Management (PHM) tasks such as diagnostics of faults, root cause analysis and repair recommendation. Significant open source contributions in the area of VLMs have been made. However, models trained on general data fail to perform well in complex tasks in specialized domains such as diagnostics and repair of industrial equipment. Therefore, in this paper we discuss our work on development of Diagnostics-LLaVA, a VLM suitable for interpreting images of specific industrial equipment and provide better response than existing open source models in PHM tasks such as fault diagnostics and repair recommendation. We introduce Diagnostics-LLaVA based on the architecture of LLaVA, and created one instance of the Diagnostics-LLaVA for the automotive repair domain, referred to as Automotive-LLaVA. We demonstrate that our proposed Automotive-LLaVA model performs better than the state-of-the-art open source visual language models such as mPlugOWL and LLaVA in both qualitative and quantitative experiments.

Successful surgical repair of aortic root rupture during transcatheter aortic valve implantation: a case report

BackgroundAortic root rupture is a rare but potentially fatal complication of transcatheter aortic valve implantation (TAVI). Herein, we report a case of aortic root rupture during TAVI that was successfully managed with partial aortic root repair and aortic valve replacement.Case presentationAn 83-year-old woman with severe bicuspid aortic stenosis underwent transfemoral TAVI using a 26 mm SAPIEN 3 Ultra RESILIA valve. Soon after valve implantation, transesophageal echocardiography detected pericardial effusion, which was accompanied by immediate hemodynamic instability. Subxiphoid pericardial drainage was performed, and extracorporeal membrane oxygenation was promptly initiated. Owing to the eruptive hemorrhage, we converted to open-heart surgery. Direct visualization enabled the detection of the aortic root rupture and the performance of partial aortic root repair using bovine pericardium and aortic valve replacement using a 19 mm INSPIRIS RESILIA valve. The patient was transferred to a different hospital 60 days after surgery without complications and is currently doing well as an outpatient.ConclusionsIn the present case, prompt treatment decisions and smooth cooperation among the institutional heart team led to the successful repair of aortic root rupture during TAVI and good clinical outcomes.

Hemostatic Properties of Aortic Root Preservation versus Root Replacement for Acute Type A Aortic Dissection: A Pooled Analysis.

We reviewed the available literature on patients undergoing aortic repair for acute type A aortic dissection (ATAAD) with either aortic root preservation (RP) or root replacement (RR). Original research studies that evaluated short- and mid-term hemostatic properties of RP versus RR groups were identified, from 2000 to 2024. Intraoperative transfusions of red blood cells (RBCs), reoperation for bleeding, strategy of hemostatic sealing of the anastomosis in root repair following the reapproximation of the dissected layers of the aortic wall (with/without biological glue), and operative mortality were the primary endpoints. Postoperative morbidity and overall and reoperation-free survival at one and five years were the secondary endpoints. A sensitivity analysis was performed using the leave-one-out method. Ten studies were included in the qualitative and quantitative synthesis, incorporating data from 6850 patients (RP: 4389 patients; RR: 2461 patients). Root preservation demonstrated a lower median transfusion of RBCs (WMD: -1.00; 95% CI: -1.41, -0.59; p < 0.01) and incidence of reoperation for bleeding compared to root replacement (OR: 0.67; 95% CI: 0.58, 0.77; p < 0.01). The majority of studies did not use biological glue in root repair to avoid the risk of an anastomotic pseudoaneurysm. No difference was found regarding postoperative morbidity, along with mid-term overall and reoperation-free survival. Root preservation without the use of biological glue during aortic repair is associated with enhanced hemostatic traits compared to the root replacement approach. A future well-designed Randomized Controlled Trial should further validate our outcomes.

Biomechanical Comparison of Suture-Relay All-Suture Anchors and Conventional Suture Anchors for Posterior Medial Meniscus Root Repair in Porcine Models.

Posterior medial meniscus root (PMMR) tears (PMMRTs) can be repaired using various techniques to promote healing. However, the biomechanical properties of suture-relay all-suture anchor (ASA) versus conventional suture anchor (CSA) and loop-locking transtibial pullout (TTP) have not been well established. To compare the biomechanical properties of PMMR repairs using suture-relay ASA, CSA, and loop-locking TTP. Controlled laboratory study. A total of 33 fresh-frozen porcine knee joints with intact medial menisci were randomly divided into 3 groups, with 11 specimens in each group: ASA, CSA, and TTP. The study involved cyclic loading, with displacement measurements taken after 100, 500, and 1000 cycles. Subsequently, the specimens were loaded until clinical failure (defined as 3-mm displacement) and then to ultimate failure of the construct, with data recorded for displacement after cyclic loading, load to 3-mm displacement, and ultimate load to failure. After 1000 cyclic loadings, the suture-relay ASA group showed considerably less displacement than the loop-locking TTP group (1.8 ± 0.7 mm vs 2.9 ± 0.3 mm; P < .001), but the displacements did not differ considerably between the suture-relay ASA and CSA groups (2.2 ± 0.9 mm; P > .05). The mean loads to clinical failure were significantly greater in the suture-relay ASA and CSA groups (61.3 ± 6.5 and 57.5 ± 9.7 N, respectively) than in the loop-locking TTP group (38.3 ± 9.4 N; P < .05). The ultimate load to failure was significantly greater in the suture-relay ASA group than in the loop-locking TTP group (153 ± 55.1 N vs 102 ± 12.9 N; P < .05). All specimens in the loop-locking TTP group failed by suture elongation mode, whereas only 2 specimens (18%) in the suture-relay ASA group and 5 specimens (45%) in the CSA group failed by suture elongation. Nine specimens (82%) in the suture-relay ASA group and 6 specimens (55%) in the CSA group failed due to suture cutout through the meniscal tissue. The biomechanical properties after PMMR repair did not statistically differ between the suture-relay ASA and CSA groups. The suture-relay ASA technique had a higher load to failure than the loop-locking TTP technique. The suture-relay ASA technique is a promising option for the repair of PMMRTs; its repairing strength is also comparable to that of the CSA technique. Notably, the suture-relay ASA technique can be utilized without establishing a posteromedial portal, resulting in decreased procedure time and mitigating challenges associated with working from the posterior aspect of the knee.

Comparative evaluation of various biomaterials as pulpotomy agents in molars with symptomatic irreversible pulpitis: A randomized single-blinded single-center control trial

Abstract Introduction: Untreated tooth decay in mature permanent dentition is a prevalent global issue, affecting 34.1% of people with 2.5 billion cases annually. Extensive decay often leads to irreversible pulpitis, characterized by pulp inflammation and pain. Pulpectomy, the standard treatment, involves complex procedures with potential complications. Modern endodontics favors minimally invasive treatment such as pulpotomy, which preserves pulp vitality. This study aims to compare the clinical as well as radiographic outcomes of different pulpotomy agents: Biodentine, mineral trioxide aggregate (MTA), Bio-C repair, and Endosequence Bio-ceramic root repair material (BCRRM) in mature permanent molars. Methodology: This single-blind, single-center study involved 80 participants randomly assigned to four groups, each receiving one of the biomaterials. Ethical approval was obtained. Participants aged 14–60 years with symptomatic irreversible pulpitis were selected. Pulpotomy procedures were performed, and follow-up evaluations occurred at 24 h, 1 week, 4 weeks, 3, 6, and 12 months. Clinical success was measured by the absence of pain, sensitivity, and tenderness. Radiographic evaluation used the periapical index (PAI) scoring system. Results: Pulpotomy significantly reduced postoperative pain in all groups. Endosequence BCRRM showed the maximum pain reduction at 24 h with a statistically significant difference from all the groups (at 1% probability level), followed by Bio-C repair, Biodentine, and MTA. At 1 week, Bio-C repair led in pain reduction with statistically nonsignificant results. All groups reported no pain at 3, 6, and 12 months. Endosequence BCRRM had the highest improvement in periapical findings at 1 year. Sensitivity to hot and cold improved significantly in all groups, with Endosequence BCRRM performing best. Conclusion: Endosequence BCRRM provided the best overall outcomes, emphasizing the importance of material choice in pulpotomy treatments. Further research on biomaterials’ long-term clinical and radiographic outcomes is needed to enhance treatment efficacy.

Posterior Lateral Meniscal Root Repair Through Lateral Tunnel and Anterior Cruciate Ligament Revision: How to Avoid Tunnel Overlapping

Posterior lateral meniscal root (PLMR) tears are commonly observed in conjunction with anterior cruciate ligament (ACL) injuries. The presence of PLMR tears exacerbates knee instability, increasing stress on ACL grafts and accelerating joint degeneration if left untreated. Anatomical repair of PLMR tears is therefore crucial for restoring native knee kinematics and reducing tibiofemoral contact pressures, thereby safeguarding the ACL graft. However, the standard use of a single medial tunnel approach for concomitant PLMR and revision ACL reconstruction may require reconsideration to prevent the potential risks of tunnel overlapping, which could undermine graft anatomical integrity. This article, to prevent the risk of tunnel overlapping, introduces a surgical approach that employs an additional lateral tibial tunnel for PLMR repair, instead of the typically used single medial one, for PLMR repair during simultaneous revision ACL reconstruction.

Evaluation Of Lateral Root Resorption In Maxillary Teeth Among First Premolar Extraction Cases After Space Closure- A CBCT Study

Background: Orthodontic treatment usually involves usage of light continuous forces but when heavy forces are used it leads to apical root resorption. External apical root resorption refers to reduction in root structure involving the apices. This resorption is of transient inflammatory type. 2D images are commonly used for diagnostic purposes in orthodontics but it cannot detect root resorption on lingual or buccal surfaces thus cannot measure the volume of root loss. Cone beam computed tomography which can provide 3D images was introduced in late 1990s. Images provided by CBCT are more more accurate than panoramic and periapical radiographs . Therefore in this study , CBCT is used to evaluate lateral root resorption in maxillary teeth after after space closure among first premolar extraction cases . Materials and Methods: CBCTs of 20 patients fulfilling inclusion and exclusion criteria were taken before the start of orthodontic treatment and after space closure. Post treatment root width was substracted from the pre treatment root width at three levels from CEJ (3mm,6mm,9mm). The normality test (Shapiro-Wilk Test) was performed to analyze the data, and the results were expressed as frequency with percentage and mean with standard deviation. Difference between means were assessed using paired t test for before and after the procedure. All the statistical analyses were carried out at a 5% level of significance, and results with a P value &lt; 0.05 were considered statistically significant. Results: Considering all the three levels the least tooth resorption was observed in the case of central incisor (0.1750 ± 0.0444, p &lt;0.001) and highest in the canine tooth (5.900± 0.0000, p &lt;0.001) . Conclusion: When root resorption is detected, it is recommended to pause the treatment for about 6 months to allow for root repair. Intermittent forces, which provide rest periods between applications, are more tissuefriendly and can help reduce the risk of further resorption

The Effects of Photobiomodulation Therapy on Tensile-Cultured Cementoblasts Cells.

Background: Studies show that photobiomodulation therapy (PBMT) boosts cellular ATP production and cell growth and reduces inflammation. Additionally, mechanical tension affects gene expression, impacting cellular functions like proliferation and migration. Objective: We investigated the impact of PBMT on OCCM-30 cementoblast cells under tensile stress, focusing on cell survival, differentiation, and inflammatory responses, particularly relating to orthodontic tooth movement and root resorption. Methods: Cultured OCCM-30 cells under negative pressure received PBMT with a 10.6 μm wavelength in continuous mode at 1.0 W power for 3, 5, or 10 sec, corresponding to energy densities of 3, 5, or 10 J/cm2. We assessed cell viability with the Presto Blue assay and inflammatory markers Interleukin 6 (IL-6), inducible nitric oxide synthase (iNOS), and cyclooxygenase-2 (COX-2) through western blots at 1, 12, 24 h, and 7 days post-irradiation. Results: PBMT improved cell viability over time while maintaining levels of inflammatory markers. alkaline phosphatase levels dropped initially but increased after 7 days, suggesting enhanced cementoblast differentiation. IL-6 levels rose gradually, with 3J and 5J treatments showing significantly higher levels than the control. iNOS levels spiked within the first 24 h, then declined by day 7. COX-2 levels consistently rose, with the 5J treatment showing greater increases. Conclusions: PBMT appears to support cementoblast survival and differentiation while managing inflammation, potentially aiding root repair during orthodontic treatments and reducing inflammatory root resorption.

Fast rehabilitation does not worsen clinical, radiological, and arthroscopic outcomes after medial meniscus posterior root repair: A retrospective comparative study

Background/ObjectiveThe main surgical treatment for medial meniscus posterior root tear (MMPRT) has shifted from meniscectomy to meniscus repair; however, there is no clear consensus regarding the optimal postoperative management strategy after MMPRT repair. This study aimed to perform a comparative analysis of patients who received conventional rehabilitation or fast rehabilitation following MMPRT repair. MethodsThe current retrospective cohort study compared clinical, radiological, and arthroscopic outcomes after conventional rehabilitation (group A, January 2020 to April 2020, 24 patients) with those after fast rehabilitation (group B, May 2020 to August 2020, 24 patients) in patients who underwent pullout repair for MMPRT. Partial weight-bearing and range of motion exercises were allowed 2 weeks postoperatively in group A and 1 week postoperatively in group B. In patients with an average weight of approximately 60 kg, full weight bearing was allowed 4 weeks postoperatively in group A and 3 weeks postoperatively in group B. ResultsAt 12 months postoperatively, the clinical scores, including International Knee Documentation Committee and Japanese Knee Injury and Osteoarthritis Outcome Score, significantly improved in both groups (p < 0.01). Although meniscus healing was achieved in both groups, medial meniscus extrusion significantly progressed by 0.9 mm in group A and 0.8 mm in group B (p < 0.01, compared with preoperative extrusion). There were no significant differences in clinical scores, arthroscopic meniscal healing status, or medial meniscus extrusion progression on magnetic resonance images between the groups. ConclusionA fast rehabilitation protocol can be safely implemented without compromising patient outcomes after pullout repair for MMPRT.

Impact of different disinfection protocols on the bond strength of NeoMTA 2 bioceramic sealer used as a root canal apical plug (in vitro study)

IntroductionTreatment of an immature permanent tooth required a special disinfection protocol due to the presence of thin radicular walls, which are prone to fracture. Mineral Trioxide Aggregate (MTA) has been proposed as a root repair material for root canal treatment. The aim of this in vitro study was to compare the push-out bond strength of conventional White MTA cements and second generation NeoMTA 2 in imitated immature roots treated with different disinfection protocols, which are 5.25% sodium hypochlorite (NaOCl), followed by 17% ethylenediaminetetraacetic acid (EDTA), and NaOCl, followed by 20% etidronic acid (HEBP).MethodsThe root canals of freshly extracted single-root teeth were manually prepared until 90 K-file to imitate immature roots. Roots were randomly divided into four groups (G) according to the disinfection protocol (n = 15 per group). where G1 (NaOCl + EDTA + White MTA) and G2 (NaOCl + EDTA + NeoMTA 2) While G3 (NaOCl + HEBP + White MTA) and G4 (NaOCl + HEBP + NeoMTA 2) All groups were activated with manual agitation. All specimens were incubated for 48 h. The apical third of each root was perpendicularly sectioned to attain a slice of 3 mm thickness. Push-out bond strength values were assessed using a two-way ANOVA and a Student’s t test.ResultsG3 and G4 that were treated with HEPB showed higher significant push-out bond strength mean values than G1 and G2 treated with an EDTA chelating agent. Irrespective of the chelating agent used, it was found that both NeoMTA 2 and White MTA had no significant influence on push-out bond strength mean values (p ≤ 0.05).ConclusionThe combined use of 5.25% NaOCl and 20% HEBP increased the push-out strength values of both NeoMTA 2 and White MTA, rendering them suitable to be used as an alternative chelating agent to EDTA.

Partial weight-bearing and range of motion limitation significantly reduce the loads at medial meniscus posterior root repair sutures in a cadaveric biomechanical model.

The aim of this study was to investigate the influence of medial meniscus posterior root avulsion (MMPRA) before and after surgical treatment on the biomechanics of the knee joint, including suture repair forces during daily and crutch-assisted gait movements. MMPRA were investigated in eight human cadaver knee joint specimens by a dynamic knee joint simulator with daily (normal gait, gait with additional rotational movement, standing up, sitting down) and rehabilitation-associated movements (crutch-assisted gait with limited flexion range of motion [30°] and 30% [toe-touch weight-bearing, TTWB] and 50% of body weight [partial weight-bearing, PWB]) with simulated physiologic muscle forces. Each specimen was tested in intact, torn and repaired (transtibial suture) state. The biomechanical parameters were: medial mean contact pressure and area, knee joint kinematics, medial displacement of the posterior meniscus horn and loading on the anchoring suture. Significant reduction of the contact area due to the avulsion was observed in all movements except for PWB and sitting down. MMPRA repair significantly increased the contact areas during all movements, bringing them to levels statistically indistinguishable from the initial state. MMPRA resulted in a medial displacement up to 12.8 mm (sitting down) and could be reattached with a residual displacement ranging from 0.7 mm (PWB) to 5.7 mm (standing up), all significantly (p < 0.001) reduced compared to the torn state. The mean peak anchoring suture load increased from TTWB (77 N), PWB (91 N) to normal gait (194 N), gait rotation (207 N), sitting (201 N; p < 0.01) and to standing up (232 N; p = 0.03). Surgical treatment of MMPRA allows restoration of physiological knee joint biomechanics. Crutch-assisted movements reduce the loading of the repair suture, thus likewise the risk for failure. From a biomechanical point of view, crutch-assisted movements are recommended for the early rehabilitation phase after MMPRA repair. Level V.

Arthroscopic Centralization of the Medial Meniscus Reduces Load on a Posterior Root Repair Under Dynamic Varus Loading: A Biomechanical Investigation

Background: In addition to the integrity of the meniscal hoop function, both the anterior and posterior meniscus roots as well as the meniscotibial and meniscofemoral ligaments are crucial in restraining meniscal extrusion. However, the interaction and load sharing between the roots and these peripheral attachments (PAs) are not known. Purposes: To investigate the influence of an insufficiency of the PAs on the forces acting on a posterior medial meniscus root repair (PMMRR) in both neutral and varus alignment and to explore whether meniscal centralization reduces these forces. Study Design: Controlled laboratory study. Methods: In 8 fresh-frozen human cadaveric knees, an arthroscopic transosseous root repair (step 1) was performed after sectioning the posterior root of the medial meniscus. The pull-out suture was connected to a load cell to allow measurement of the forces acting on the root repair. A medial closing-wedge distal femoral osteotomy was performed to change the mechanical axis from neutral to 5° of varus alignment. The meniscus was completely released from its PAs (step 2), followed by transosseous arthroscopic centralization (step 3). Each step was tested in both neutral and varus alignment. The specimens were subjected to nondestructive dynamic varus loading under axial compression of 300 N in 0°, 15°, 30°, 45°, and 60° flexion. The changes in force acting on the PMMRR were statistically analyzed using a mixed linear model. Results: Axial loading in neutral alignment led to an increase of the force of root repair of 3.1 ± 3.1 N (in 0° flexion) to 6.3 ± 4.4 N (in 60° flexion). In varus alignment, forces increased significantly from 30° (3.5 N; 95% CI, 1.1-5.8 N; P = .01) to 60° (7.1 N; 95% CI, 2.7-11.5 N; P = .007) flexion, in comparison with neutral alignment. Cutting of the PAs in neutral alignment led to a significant increase of root repair forces in all flexion angles, from 7.0 N (95% CI, 1.0-13.0 N; P = .02) to 9.1 N (95% CI, 4.1-14.1 N; P = .003), in comparison with the intact state. Varus alignment significantly increased the forces in the cut states from 4.8 N (95% CI, 1.0-8.5 N; P = .02) to 11.1 N (95% CI, 4.2-18.0 N; P = .006) from 30° to 60° flexion, in comparison with the neutral alignment. Arthroscopic centralization led to restoration of the native forces in both neutral and varus alignment, with no significant differences between the centralized and intact states. Conclusion: An insufficiency of the PAs of the medial meniscus, as well as varus alignment, led to increased forces acting on a PMMRR. These forces were reduced via an arthroscopic meniscal centralization. Clinical Relevance: Performing arthroscopic meniscal centralization concomitantly with PMMRR may reduce failure of the repair by reducing the load of the root.

Medial meniscal posterior root tear – A current concept review

Menisci are crucial structures in the knee joint for the adequate distribution of hoop stresses. Their significance in preventing early knee osteoarthritis has been acknowledged due to the rapid progression of osteoarthritis in knees following meniscectomy. The anatomy of menisci has been studied in detail with an increased understanding of the importance of meniscal root attachments. This review aims to provide an evaluated summary of the anatomical, biochemical, and functional aspects that are relevant in the clinical context of meniscus root attachments, alongside contemporary strategies for accurately diagnosing and treating common injuries affecting these attachments. We also propose an algorithm for managing medial meniscus root tears which may be beneficial for the readers. We did an up-to-date literature search on PubMed, Scopus, and Google Scholar database, using the keywords ‘meniscus’, ‘meniscal root’, ‘sports injury’, and ‘arthroscopy’ in April 2024 and filtered out the relevant literature for this review on the articles that were published in English. The management of root tears requires a high level of suspicion which is crucial for diagnosis, identifying subtle signs on radiology, and employing specific methods for root repair. The tears or avulsions within one centimeter of the tibial attachment of the medial meniscus posterior root are called medial meniscus posterior root tears. These injuries cause a functional meniscal deficiency, resulting in knee problems unfavorable to biomechanics. Numerous methods have been created to tackle meniscus root tears., with many demonstrating promising outcomes in terms of complete healing.

Comparative Analysis of Calcium and Hydroxyl Ion Release from Pulp Dressing Materials in Pulpotomized Premolars.

BACKGROUND The aim of this study was to evaluate the time-dependent release of calcium (Ca⁺⁺) and hydroxyl (OH⁻) ions from 3 different pulp dressing materials used to cap root canal orifices in pulpotomized premolars. MATERIAL AND METHODS Freshly extracted (n=40) premolars were subjected to standardized pulpotomy procedure and finally restored in 5 groups using resin-modified glass ionmmer liner (RMGI) and bonded resin composite directly against the pulp chamber's floor (Control, G2) and over 3 different orifices' capping materials - Dycal (G3), Endo Sequence root repair material (ESRRM, G4), and mineral trioxide aggregate (MTA) Angelus (G5). Another 10 sound premolars served as the Reference group (G1). The restored teeth were incubated at 37±1°C in sealed containers filled with deionized water to assess Ca⁺⁺ and OH⁻ ions release after 24 h and at 1, 4, and 8 weeks. Two-way ANOVA and Tukey's comparisons at alpha=0.05 were used to statistically analyze the collected data. RESULTS Two-way ANOVA revealed significant differences in Ca⁺⁺ ions between test groups at different testing time intervals (P<0.05). Despite the constant (Tukey's, P<0.05) pH levels (OH⁻ release), Group 5 specimens exhibited higher Ca⁺⁺ ion release in comparison to Groups 4 and 3 at different testing timepoints (Tukey's, P<0.05). CONCLUSIONS Although all the assessed pulp dressing materials had equivalent and stable pH levels, ESRRM and MTA-Angelus had the highest Ca⁺⁺ ion release at the assessment intervals.

Long-term Results of Valve-Sparing Aortic Root Replacement in Acute Type A Aortic Dissection

BackgroundValve preservation in acute type A aortic dissection (ATAAD) can be accomplished with root repair or replacement. Long-term valve durability with root repair has been established, but limited data exist regarding long-term durability of valve-sparing root replacement (VSRR). In this study, long-term results of VSRR were compared with root repair in ATAAD. MethodsFrom 2005 to 2023, 866 patients underwent ATAAD repair, of which 675 underwent root repair and 191 underwent root replacement (VSRR, n = 65; Bentall, n =126). VSRR patients were compared with 123 patients who underwent valve resuspension and root repair with postoperative echocardiograms ≥1 year. ResultsVSRR patients were younger (VSRR, 44 ± 11 years vs root repair, 55 ± 13 years; P < .001). Preoperatively, 57% of VSRR and 35% of root repair patients had moderate or more aortic insufficiency. Cardiopulmonary bypass and myocardial ischemia times were significantly longer in VSRR (P < .001). Postoperative echocardiograms with ≥1 year follow-up were analyzed in 58 VSRR patients with median follow-up of 4.8 years (interquartile range, 3-12 years) and in 123 root repair patients with median follow-up of 3.6 years (interquartile range, 3-8 years). At 10 years, VSRR patients had superior freedom from more than mild aortic insufficiency (VSRR, 91% vs root repair, 49%; P < .001). At 10 years, freedom from aortic valve replacement was equivalent (VSRR, 98% vs root repair, 92%; P = .269). ConclusionsVSRR provides equivalent long-term valve durability as root repair in ATAAD, even in patients with moderate or severe aortic insufficiency. In select young patients who require root replacement during ATAAD repair, VSRR represents an ideal therapy.

Comparative Evaluation of Marginal Adaptation and Dimensional Stability of Three Bioceramic Root Repair Materials: A VP-SEM Analysis

Comparative Evaluation of Marginal Adaptation and Dimensional Stability of Three Bioceramic Root Repair Materials: A VP-SEM Analysis

Evaluation of Surface Microstructure and Compressive Strength of Mineral Trioxide Aggregate and Biodentine in the Existence and Absence of Oral Tissue Fluids.

Calcium silicate cement like mineral trioxide aggregate (MTA) and Biodentine are known for their biocompatibility and are effectively used as retrograde filling materials. During their placement, the materials interact with oral tissue fluids like saliva and blood, so the aim of the present study was to assess the effect of distilled water, saline, and blood on the surface microstructure and compressive strength of MTA and Biodentine. In this experimental study, a total of 84 custom-made cylindrical molds were randomly allocated into two main cement groups (n = 42) MTA and Biodentine. Each group was further subdivided into three subgroups (n = 14) as per the testing conditions, that is, samples exposed to distilled water, saline, and fresh blood. Around 10 samples from each subgroup were tested for compressive strength using a universal testing machine (UTM), and the remaining four samples were used to examine the surface characteristics of MTA and Biodentine using a scanning electron microscope (SEM). One-way analysis of variance (ANOVA) and Tukey's post hoc tests were employed to calculate the mean compressive strength and standard deviation values. There was a significant difference in the compressive strength between MTA and Biodentine, especially in the presence of blood. During the SEM analysis, it was found that samples contaminated with blood or saline were devoid of acicular crystals in both groups. MTA group showed a more porous matrix with few hexagonal crystals than Biodentine. Biodentine may be advantageous as a root-end filling or root repair material in the presence of blood. Bhullar KK, Gupta V, Sapra M, et al. Evaluation of Surface Microstructure and Compressive Strength of Mineral Trioxide Aggregate and Biodentine in the Existence and Absence of Oral Tissue Fluids. Int J Clin Pediatr Dent 2024;17(S-1):S1-S5.

Poster 269: Radiographic Outcome of Meniscal Root Repairs: Evaluating Osteoarthritic Progression Over Two Years

Objectives: Root tears account for 10-21% of meniscal injuries, defined as radial tears occurring within 1 cm of the meniscal attachment horn. Menisci play a critical role in load transmission and shock absorption, with the goal of surgical intervention to retain knee functionality over time. While meniscal root repairs demonstrate better clinical outcomes to meniscectomies, total knee replacements, or non-surgical intervention, current literature suggests progression of knee osteoarthritis following repair. The purpose of this study is to evaluate osteoarthritic impacts, specific to joint space narrowing (JSN) and Kellgren Lawrence grades, through pre- and post-operative radiographs of root repair patients. We hypothesize root repair radiographs will demonstrate both anatomic narrowing of joint space and increased KL Grades over a 2-year follow-up. The purpose of this study was to evaluate osteoarthritic impacts of meniscal root repairs by using standardized protocol to measure JSN and KL Grades through pre- and postoperative patient radiographs. Methods: Patients who underwent meniscal root repairs during the study period of 2012 to 2022 at our academic center were identified. Inclusion criteria included patients who received a weightbearing preoperative, 1-year postoperative, and/or 2-year postoperative radiograph. Joint space and KL scores, including evaluation of osteophytes, sclerosis, and definite deformity of boney ends, were assessed by two separate independent readers with protocol consistent with previously published grading scale literature. Results: Forty-nine patients (35 females and 12 males) with an average age of 47.7 (± 9.06) years and BMI of 32.73 (±6.75) underwent meniscal root repairs and proper imaging during the study period. Preliminary data indicates significant (p &lt;.005) medial joint space narrowing across medial, lateral, and bilateral repairs from preoperative measurements (4.79 ± 0.7 mm) to 1-year postoperative (4.24 ± 0.7 mm), as well as 2-year postoperative (4.24± 1.0 mm). Over 2-year follow-up, 47.4% patients went on to hold the same KL grade, 44.7% patients increased by 1 grade, 7.9% patients increased by 2 grades, and two patients were converted to arthroplasty (i.e. 1 total knee, 1 unicompartmental). Overall, KL scores demonstrate an average 51.9% increase in pre-op grading (1.29 ± 0.4) to 2-year post-op grading (1.96 ± 0.29) respectively. Conclusions: Radiographic images of meniscal root repairs indicate mild progression of osteoarthritic knee characteristics over a 2-year follow-up. Quantified joint space narrowing was shown in most patients and over 50% had an increase in Kellgren Lawrence grade. Despite successful repair in most patients, osteoarthritic progression occurs in post patients.