Surgical Repositioning Research Articles

Delayed surgical repositioning of severely intruded permanent maxillary central incisor with completely formed root: A case report with narrative review and a decision/intervention flowchart based on the International Association of Dental Traumatology guidelines

Intrusive luxation is a severe dental injury and may result in complicated healing sequelae. Management and prognosis of these injuries depend on the factors such as severity of intrusion, stage of root development, and time elapsed between injury and treatment intervention. The aim of this article is to report the management of severe intrusion injury in an adult patient with mature apices who had delayed seeking treatment by 7 days. Three-year follow-up of the patient has shown successful radiographic and clinical outcomes in spite of limiting prognostic factors. This article also reviews the literature regarding current treatment protocols and summarizes the management strategy employed in the present case in a decision/intervention flowchart.

Clinical outcomes of 79 traumatically intruded permanent teeth in Chinese children and adolescents: A retrospective study.

Data on the clinical outcomes of traumatically intruded, young, permanent teeth in Chinese children and adolescents are absent. The aim of this study was to examine the probability of spontaneous re-eruption of injured teeth, to investigate the incidence of pulp necrosis with infection of the root canal system and replacement root resorption and to analyse possible factors related to healing complications after injury. Clinical data from 6- to 18-year-old patients who sustained intrusive luxation from 2007 to 2016 were reviewed. Teeth were treated by awaiting re-eruption, orthodontic repositioning or surgical repositioning. The incidences of spontaneous re-eruption, pulp necrosis with infection, replacement resorption and marginal bone loss were calculated, and factors related to these complications were analysed using Cox regression and Kaplan-Meier analyses. Data from 79 teeth in 58 patients (mean age 9.19±2.34years) were examined over follow-up periods from 7 to 87months (median 18months). Of the 50 teeth awaiting re-eruption, the incidences of complete re-eruption and partial re-eruption were 40.0% and 34.0%, respectively. Teeth intruded <3mm had a higher complete re-eruption rate (57.1%) than those with a 3-7mm of intrusion (18.2%) (hazard ratio [HR]=4.15). Of the 52 teeth observed for more than 12months, pulp necrosis with infection, replacement resorption and marginal bone loss occurred in 57.4%, 15.4% and 61.5% of the teeth, respectively. Teeth with 3-7mm (60.9%, HR=2.97) or >7mm (100%, HR=6.44) of intrusion and teeth with uncomplicated crown fracture (85.7%, HR=5.19) were more likely to develop pulp necrosis with infection. Teeth that received orthodontic or surgical repositioning showed higher incidences of replacement resorption (23.1%, HR=5.72; 25.0%, HR=11.68, respectively). Spontaneous re-eruption of intruded teeth was significantly related to intrusion depth. Intrusion depth and crown fracture had strong relationships with pulp necrosis with infection, whereas the choice of treatment influenced the development of replacement resorption.

Brachial plexus impingement secondary to implantable cardioverter defibrillator: A case report.

Overall complication rates of 9.1% have been reported following implantable cardioverter defibrillator (ICD) placement. Brachial plexus injury is infrequently reported in the literature. We describe a 26-year-old female experiencing left arm nerve pain, a positive Tinel’s sign, numbness in the median nerve distribution of the hand and biceps muscle weakness following revision ICD via subclavian vein approach. Nerve conduction studies identified severe partial left brachial plexopathy, which remained incompletely resolved with conservative management. Surgical exploration revealed lateral cord impingement by the ICD generator and a loop of the ICD lead, along with fibrosis, necessitating surgical neurolysis and ICD generator repositioning. As increasing numbers of patients undergo cardiac device implantation, it is incumbent on practitioners to be aware of potential increases in the prevalence of this complication.

First and second permanent molars with failed or delayed eruption: Clinical and statistical analyses

The aim of this work was to analyze data of patients with failed or delayed eruption of first and second permanent molars, to assess the effectiveness of the treatment methods used. Epidemiologic and clinical data of 125 patients (mean age 14.08±4.04years) with 197 affected molars (30 first and 167secondmolars) were retrospectively analyzed. The treatment outcome was known in 161molars after patient drop-out (20 patients with 36molars). The cases were categorized into 8 groups according to the choice of treatment: orthodontic uprighting, surgical-orthodontic uprighting, surgical uprighting, surgical repositioning, surgical exposure, first or secondmolar extraction, third molar extraction, or removal of pathologic conditions. The overall treatment outcome was positive in 141molars (87.6%). It was positive in all cases treated with orthodontic uprighting (7molars), surgical exposure (10molars), surgical uprighting (38molars), and surgical repositioning (8molars), but it was significantly lower for surgical-orthodontic uprighting (34/48molars, 70.8%). The positive outcome was significantly lower for inclusion (52/68molars, 76.5%) than for early-diagnosed condition (11/11molars, 100%) and retention (78/82molars, 95.1%), and for total bone crown coverage (21/28molars, 75.0%) than for osteomucosal or mucosal crown coverage (120/133molars, 90.2%). This study demonstrates that an early diagnosis results in a better outcome regardless of the treatment used, with the number of cases with a positive outcome being higher in younger patients.

Influence of a fully magnetically levitated left ventricular assist device on functional interrogation of implantable cardioverter defibrillators.

BackgroundElectromagnetic interference between left ventricular assist devices (LVAD) and the telemetry wand of implantable cardioverter‐defibrillators (ICD) with impairment of ICD interrogation has previously been described in HVAD and HeartMate II devices. This is the first study showing the potential influence of the LVAD model HeartMate 3 (with the unique feature of fully magnetically levitated rotor with consistent wide blood‐flow gaps) on functional interrogation of different ICD models.Methods and ResultsAmong 51 patients treated with a HeartMate 3 LVAD, 34 patients (66.7%) already had an ICD implanted prior to LVAD therapy. In this cohort, impairment of ICD interrogation was observed in five patients (14.7%) with five different device models. In patients with Biotronik ICD, stretching of the ipsilateral arm to increase the distance between both devices >10 cm was sufficient in one patients, whereas surgical contralateral repositioning was necessary in two patients; in one further patient no action could be taken, as he died early from embolic stroke. In the only patient with a MicroPort ICD, this issue was resolved by using a wireless telemetry. The distances between both devices showed no statistical significant correlation with an impaired interrogation, neither in the overall collective nor within the groups with the same manufacturer.ConclusionsIn patients with impaired ICD interrogation caused by electromagnetic interference between a HeartMate 3 LVAD and the ICD, the actions mentioned above have to be taken, to resolve this technical issue. Especially, a sufficient distance of at least 10 cm between both devices was crucial for avoiding this problem.

COMBINED ORTHODONTICS AND SURGICAL APPROACH TO CLASS III MALOCCLUSION WITH ANTERIOR OPEN BITE IN ADULTS

Skeletal anterior open bite with Class III malocclusion in adults is one of the most difficult malocclusions to treat. Surgical intervening is a must, along with orthodontics in such complex cases. The most effective treatment option in adult patients with Class III malocclusion and the skeletal anterior open bite is surgical repositioning of the maxilla or both jaws. The present case report describes the treatment protocol for Class III malocclusion with an anterior open bite in adult, a novel orthodontic- surgical approach. A 24-year old male patient with a Class III malocclusion, anterior open bite (skeletal), poor facial aesthetics, mandibular and chin protrusion. The objective was to achieve ideal overjet and overbite, to achieve class 1 incisor, canine and molar relation. To correct anterior open bite and achieve Class I skeletal jaw bases and to achieve esthetically pleasing profile and functionally stable occlusion. Therefore, by correction of the dental and skeletal jaw relationship, we hoped to improve the patient’s self- esteem, confidence and improved oral health quality of life.

Predictability of Mandibular Autorotation After Le Fort I Maxillary Impaction in Case of Vertical Maxillary Excess.

A retrospective study of 20 patients treated for vertical maxillary excess between 2009 and 2010, solely by superior surgical repositioning of the maxilla. Clinical and radiological cephalometric parameters were analyzed statistically and their impact on achieving the predicted postoperative mandibular autorotation and on relapse. According to our study, patients presenting with an anterior open bite and a low occlusal plane angle might fail to achieve the predicted mandibular autorotation and are prone to postoperative relapse. No correlation was found between the extent of maxillary impaction and the presence of autorotation.

Fracture Pattern and Periosteal Entrapment in Adolescent Displaced Distal Tibial Physeal Fractures: A Magnetic Resonance Imaging Study.

To investigate the fracture pattern and periosteal entrapment in adolescent distal tibial physeal fractures. Retrospective case series. Level I academic trauma center. Fifty patients (10-16 years of age) with displaced Salter-Harris type II, III, or IV distal tibial physeal fractures were retrospectively reviewed. Periosteal involvement, fracture pattern. We investigated the incidence and location of periosteal entrapment in those fractures and the angle of the fracture plane of metaphyseal fragments on axial plane by using magnetic resonance imaging. Of the 15 type II, 12 type III (4 malleolar and 8 Tillaux), and 23 type IV (2 malleolar and 21 triplane) fractures, 72.0% (36/50) presented with periosteal entrapment. Among all type II and triplane fractures, periosteal entrapment was observed in the anterolateral corner when there was any displacement on that corner. By contrast, only 1 of 8 Tillaux fractures presented with periosteal entrapment. In almost all supinated foot injuries of type II and triplane fractures, the metaphyseal fracture line was parallel to the intermalleolar axis on axial plane. Salter-Harris type II and triplane fractures have a high risk of periosteal entrapment especially in the anterolateral corner. Therefore, even without preoperative magnetic resonance imaging, surgical repositioning of entrapped periosteum should be considered after failed closed reduction. In cases of supinated foot injuries of type II or triplane fractures requiring surgical fixation, a metaphyseal fracture plane parallel to the oblique coronal plane connecting the medial and lateral malleoli may assist surgeons in achieving appropriate metaphyseal fixation. Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

COMPARISON BETWEEN THE USE OF PANORAMIC RADIOGRAPHY AND CONE BEAM COMPUTED TOMOGRAPHY TO LOCATE DENTAL ELEMENTS SEVERE INTRUDED DUE TO TRAUMA: CASE REPORT

Intrusive luxation is a kind of traumatic injury characterized by an axial displacement of the tooth toward the alveolar bone. Its main causes are bicycle accidents, sports/recreational activities, and falls or collisions. Treatment strategies include waiting for the tooth to return to its position, immediate surgical repositioning and repositioning through dental traction by orthodontic devices. The correct diagnosis must be based on clinical and radiographic exams and it is crucial for decision-making in the treatment of injured patients. Currently, the cone beam computed tomography (CBCT) has been widely used in orthodontics, restorative dentistry and implantology as well as in the diagnosis of complex dental trauma. This article reports a case of severe dental intrusion, in which the cone beam computed tomography (CBCT) was performed because of doubts generated after clinical examination and panoramic radiograph analyze. This case report confirmed that the CBCT is an important exam to correct diagnostic.

COMPARISON BETWEEN THE USE OF PANORAMIC RADIOGRAPHY AND CONE BEAM COMPUTED TOMOGRAPHY TO LOCATE DENTAL ELEMENTS SEVERE INTRUDED DUE TO TRAUMA: CASE REPORT

Intrusive luxation is a kind of traumatic injury characterized by an axial displacement of the tooth toward the alveolar bone. Its main causes are bicycle accidents, sports/recreational activities, and falls or collisions. Treatment strategies include waiting for the tooth to return to its position, immediate surgical repositioning and repositioning through dental traction by orthodontic devices. The correct diagnosis must be based on clinical and radiographic exams and it is crucial for decision-making in the treatment of injured patients. Currently, the cone beam computed tomography (CBCT) has been widely used in orthodontics, restorative dentistry and implantology as well as in the diagnosis of complex dental trauma. This article reports a case of severe dental intrusion, in which the cone beam computed tomography (CBCT) was performed because of doubts generated after clinical examination and panoramic radiograph analyze. This case report confirmed that the CBCT is an important exam to correct diagnostic.

Orchidopexy Results in the Recovery of Sperm in the Ejaculate of a Non-obstructive Azoospermic Adult with Bilateral Cryptorchidism — A Case Report

Cryptorchidism or undescended testis is one of the most common pediatric disorders of the male endocrine glands and the most typical congenital abnormality identified at birth. Bilateral cryptorchidism is frequently associated with azoospermia and male infertility. The standard therapy is the surgical repositioning of the testes (orchidopexy) within the scrotal sac after the age of six months to eighteen months. Current findings suggest that no sperm is recovered in the ejaculate, for patients with bilateral cryptorchidism, when the mean age at the time of orchidopexy is around 16 years and above. Here we report an unusual case of an adult patient with bilateral cryptorchidism and non-obstructive azoospermia for which orchidopexy resulted in the recovery of sperm in the ejaculate, improving his options for future fertility treatment.

Management of traumatic intrusion of permanent teeth with immediate surgical repositioning: A case report from Hasan Sadikin Hospital, Bandung-Indonesia

Introduction: Traumatic dental injuries (TDI) of permanent teeth frequently occur in children and young adults. Intrusive luxation is one of the most severe forms of traumatic injuries in which the affected tooth is forced to displace deeper into the alveolus. As a consequence of this type of injury, maximum damage occurs to the pulp and all the supporting structures. The aim of this study is for proper diagnosis, treatment planning and follow up for improving a favorable outcome. Case: A 14 years old male patient came to the emergency department of Hospital Dr. Hasan Sadikin with bleeding from mouth due to an accident. Through clinical and radiographic examination discovered there was an intrusion of teeth 11,21. The intruded teeth were immediately repositioned and splinted within hours following injury with Arch Bar. Antibiotic therapy was initiated at the time of repositioning and maintained for five days. The splint was removed one month later. Clinical and radiographic examination one month after the surgical extrusion revealed satisfactory progressive apical and periodontal healing. Intrusion injuries have the poorest prognosis and complex treatment among all tooth injuries. No consensus has been reached on the optimal treatment of this type of injuries. The recommended treatment options for intruded teeth include the following such as allowing spontaneous re-eruption of the teeth, immediate surgical repositioning, and fixation and orthodontic repositioning. The treatment has to be adaptable according to complications.Conclusion: Further surgical repositioning in the presented case with one month follow up proved to be a viable treatment method for intruded teeth without any additional risk of resorption.Â

Surgical repositioning of the impacted permanent maxillary central incisor

Clinically missing or unerupted permanent teeth manifest in early childhood itself, yet they may be misdiagnosed or left untreated due to the lack of knowledge or experience, which might have a major impact on facial esthetics and psychological aspect of the individual. Physical obstruction is the primary local cause for delayed tooth eruption. These obstacles can be due to the presence of supernumerary teeth, mucosal barrier, scar tissue, and tumors. The procurement of conventional radiographs is restricted with the advent of cone-beam computed tomography which is considered as a best tool in an localizing impacted tooth in the field of dentistry. The present case report depicts a 2-year follow-up of a horizontally impacted maxillary permanent central incisor associated with odontoma that was surgically reimplanted successfully.

Medium-term results of percutaneous pulmonary valve implantation using the Venus P-valve: international experience.

The aim of this study was to assess the international procedural and short-term to midterm experience with the new percutaneous Venus P-valve. Retrospective data of patient characteristics, clinical and imaging follow-up of Venus P-valve implantation outside China were collected. Thirty-eight patients underwent attempted Venus P-valve implantation between October 2013 and April 2017. Thirty-seven valves were successfully implanted during 38 procedures. There was one unsuccessful attempt and there were two valve migrations, one of which required surgical repositioning. The mean follow-up was 25 months with no short-term or midterm valve failure or deterioration in performance. Frame fractures occurred in 27% of patients. The cohort demonstrated a statistically significant reduction in pulmonary regurgitation fraction and indexed right ventricular diastolic volumes at six and 12 months. Implantation of the Venus P-valve has provided satisfactory short-term to midterm results with high success and low complication rates in an inherently challenging patient substrate.

Treatment of Ventricular Tachycardia Induced by Coil of Ventricular Lead of Implantable Cardioverter Defibrillator

Implantable cardioverter defibrillator (ICD) -DDD for arrhythmogenic heart disease of unknown etiology, with the induction of ventricular tachycardia by the right ventricle (RV) of the shock electrode. The arrhythmia generated by the ICD electrode itself was the cause of multiple episodes with appropriate anti-tachycardia pacing (ATP) and shock therapy. The etiology of the arrhythmia was confirmed by electrophysiological study and successful treatment was performed with ablation, without the need for surgical repositioning of the electrode.

Tratamento de Taquicardia Ventricular Induzida por Mola de Choque de Eletrodo de Cardioversor Desfi brilador Implantável

Paciente portador de cardioversor desfi brilador implantável (CDI)-DDD por cardiopatia arritmogênica de etiologia desconhecida, com induçãode taquicardia ventricular pela mola de ventrículo direito (VD) do eletrodo dechoque. A arritmia gerada pelo próprio eletrodo do CDI foi causa de múltiplos episódios com terapia apropriada por anti-tachycardia pacing (ATP) e choque. Confi rmada a etiologia da arritmia por estudo eletrofi siológico erealizado tratamento bem-sucedido com ablação, sem necessidadede reposicionamento cirúrgico do eletrodo

Prominent premaxilla management on bilateral cleft lip and palate

The treatment cleft lip and palate (CLP) should start at an early age with a multidisciplinary team and with a comprehensive approach. The aim of the management of protruded premaxilla in patients with bilateral CLP is to relocate the premaxilla to achieve surgical closure of the lip. The objective of the case report is to present the surgical-orthodontic treatment for the surgical reposition of the protruded premaxilla in a 3-year-old patient with BCLP. A patient of 3 years old with BCLP his treatment plan is a surgical reposition of the premaxilla and posterior closure of the primary lip. The surgical reposition of the premaxilla was made planning the osteotomy with dental casts. After 6 months of starting the surgical-orthodontic treatment, the patient meets bilateral lip closure satisfactorily without reported complications. Planning of the treatment allows performing a procedure that reduces the likelihood of complications and achieving the closing of the lip to reestablish the function, anatomy, and esthetics.

Surgical repositioning of infra-occluded dental implants in the orthognathic management of a Class III open-bite patient

Abstract Dental implants placed in the maxillary anterior region have a high risk of aesthetic complications caused by later infra-occlusion and may subsequently require special therapeutic considerations to achieve optimal aesthetic and functional results. Based on the severity, possible treatment options for infra-occluded implants include replacement of the implant restoration, alveolar distraction osteogenesis, repositioning by a segmental osteotomy, or the removal of the implant. The present case report describes the successful application of bi-maxillary orthognathic surgery combined with an anterior segmental osteotomy for the correction of a Class III open-bite malocclusion complicated by severely infra-occluded implants.

Temporomandibular joint dislocation: a retrospective study from a Swiss urban emergency department.

PurposeTemporomandibular joint (TMJ) dislocation is an uncommon and debilitating condition of the facial skeleton. The condition may be traumatic or nontraumatic, in an acute or chronic form, and with bilateral or monolateral expression.Patients and methodsIn this study, conducted from May 2012 to July 2016, we retrospectively analyzed TMJ dislocations treated in the Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, by focusing on the following parameters: age, gender, reason, localization, frequency, and therapy.ResultsThirty-two patients were included. The mean age was 42.06 years and there was no predominant gender. Most cases of TMJ dislocation were nontraumatic (93.7%). Dislocations were mostly bilateral (59.4%) and appeared in a chronic situation and with repetitive events (62.5%). Thirty-one patients received conservative treatment, which consists of reposition of the TMJ with (38.7%) or without (61.3%) analgosedation. Only one patient needed surgical reposition due to previous surgical treatment.ConclusionThis is the first attempt to evaluate TMJ dislocations in Switzerland in an acute hospital setting. To our knowledge, there are no other studies that systematically analyze these injuries by focusing on the patients’ characteristics. Surgical reposition is only indicated in complicated and very rare situations. Conservative approaches are commonly used and should be exhausted before any surgery.

Patient-Specific Printed Plates Improve Surgical Accuracy In Vitro

It remains unclear to what extent patient-specific printed plates can improve surgical outcomes in orthognathic procedures. This study aimed to quantify the surgical accuracy of patient-specific printed plates invitro and to compare the results with patients' actual surgical outcomes. This invitro study enrolled 20 postoperative orthognathic surgical patients, all treated with inferior maxillary repositioning. The preoperative midfaces were re-created in a 3-dimensionally printed model. The osteotomy and screw holes were placed at prespecified positions using a 3-dimensional guide. The dental segment was repositioned by means of the patient-specific plates. The primary outcome was the mean reposition at 3 dental reference points. The primary predictor variable was the obtained surgical reposition invitro compared with the virtual surgical plan. Confounding variables were gender, age, occlusion, and bimaxillary surgery. The secondary outcome was surgical accuracy, and the secondary predictor was the invitro outcomes versus the patients' surgical outcomes. Surgical accuracy was defined as the difference between the obtained reposition and the virtual surgical plan on a continuous scale. The differences were recorded in 3 dimensions according to the positive valueof the 3 axes: right, anterior, and posterior. The results were analyzed using mixed-model regression and 1-sample t tests. In the 20 patients (age, 18 to 64years; 40% of patients were women), the mean planned reposition was 2.9mm anterior and 1.8mm inferior. In all models, the osteotomy edge was rounded off to position the plate in the predetermined position. Overall, the maxilla was positioned 0.5mm anterior and 0.3mm inferior to the planned position using patient-specific plates. The patient-specific plates positioned the maxilla in close approximation to the planned position without surgically relevant differences. The osteotomy edge must be carefully inspected for interference with the patient-specific plates to avoid displacement of the planned maxillary repositioning.