Surgical Repositioning Research Articles

Surgical luxation and elevation as treatment approach for secondary eruption failure of permanent molars

BACKGROUND. Secondary eruption failure of permanent molars is a rare disturbance that usually causes serious clinical problems to the patient. Various treatment approaches have been proposed that depend on the age of the patient, the developmental stage of the root, the position of the tooth, the severity of infraocclusion and the presence of one or more affected teeth. Surgical luxation followed by elevation and stabilization of the luxated tooth has been proposed as a first-step treatment in cases of young patients with incomplete root formation and favourable position of the tooth. CASE REPORT. A boy initially aged 7.5 years old presented with localized secondary eruption failure of the mandibular right first permanent molar (46) and infra-occlusion. The medical and dental history of the child was uneventful, while there was no history of eruption failure or ankylosis in any other family member. TREATMENT. This included surgical luxation of the tooth, followed by elevation to the occlusal plane and immobilization to the adjacent primary molar. The splint was removed after 4 weeks. FOLLOW-UP. Three years follow-up revealed a successful result with no clinical or radiological pathology of the area. Root development of the affected tooth was arrested, but there was no sign of pulp necrosis. CONCLUSION. Favourable treatment outcome using surgical luxation and repositioning of the teeth in the present case of permanent molar with secondary eruption failure was observed.

Nuestra experiencia en el implante de prótesis de pene de dos componentes tipo Ambicor®

ObjectiveWe present our experience with AMS Ambicor® 2-piece inflatable prosthesis implantation. Material and methodsFrom January 2000 to December 2008 we implanted 86 AMS Ambicor® penile prosthesis with a follow-up period of 12 to 96 months (mean: 52.4). ResultsOf the 86 implanted penile prostheses, we had two perforations of the intercavernous septum during surgery that did not prevent the implantation of the prosthesis. We had 2 infections with loss of the prosthesis, 1 decubitus of the pump at the scrotum requiring surgical repositioning and a decubitus with distal cavernous body perforation into the urethra with loss of the prosthesis.We detected 2 mechanical failures, one at 12 months and another at 74 months. Satisfaction data were evaluated by the EDITS questionnaire, and we found that satisfaction increased with the passage of time: at 6 months postoperatively it showed 84 points in males and 68.65 in the partner.Five patients were dissatisfied with the lack of length and thickness, two complained of little detumescence and one had problems with the deactivation. ConclusionsThe Ambicor® prosthesis is easy to manage and requires a short learning period. Furthermore, it is very reliable with few mechanical failures and delayed onset, which led to a high level of satisfaction in both the patient and the partner.

Longitudinal clinical and radiographic evaluation of severely intruded permanent incisors in a pediatric population

Intrusion is defined as the axial dislodgment of the tooth into its socket and is considered one of the most severe types of dental trauma. This longitudinal outcome study was undertaken to evaluate clinically and radiographically severely intruded permanent incisors in a population of children and adolescents. All cases were treated between September 2003 and February 2008 in a dental trauma service. Clinical and radiographic data were collected from 12 patients (eight males and four females) that represented 15 permanent maxillary incisors. Mean age at the time of injury was 8 years and 9 months (range 7-14 years and 8 months). Mean time elapsed to follow-up was 26.6 months (range 10-51 months). The analysis of data showed that tooth intrusion was twice as frequent in males. The maxillary central incisors were the most commonly intruded teeth (93.3%), and falling at home was the main etiologic factor (60%). More than half of the cases (53.3%) were multiple intrusions, 73.3% of the intruded teeth had incomplete root formation and 66.6% of the teeth suffered other injuries concomitant to intrusion. Immediate surgical repositioning was the treatment of choice in 66.7% of the cases, while watchful waiting for the tooth to return to its pre-injury position was adopted in 33.3% of the cases. The teeth that suffered additional injuries to the intrusive luxation presented a fivefold increased relative risk of developing pulp necrosis. The immature teeth had six times more chances of presenting pulp canal obliteration that the mature teeth and a lower risk of developing root resorption. The most frequent post-injury complications were pulp necrosis (73.3%), marginal bone loss (60%), inflammatory root resorption (40%), pulp canal obliteration (26.7%) and replacement root resorption (20%). From the results of this study, it was not possible to determine whether the type immediate treatment had any influence on the appearance of sequelae like pulp necrosis and root resorption after intrusive luxation, but the existence of additional injuries and the stage of root development influenced the clinical case outcome in a negative and positive manner, respectively.

Facial Soft Tissue: The Alpha and Omega of Treatment Planning in Orthognathic Surgery

The soft tissues of face are attached to and are draped over underlying hard tissues. Logically, then, it may be expected that there is a mutual relationship which in long run will determine appearance and balance of soft tissues. The dilemma has been that these relationships are not constant overall but appear to vary from site to site. The research on which papers in this Journal have been based has been directed at ascertaining as accurately as possible patterns between relative movements of hard and soft tissues at selected sites. These data may then be applied in a prediction analysis where surgical adjustments of hard tissues are mathematically related to resultant re-arrangement of associated soft tissues. This philosophy has evolved into a prediction system which relies upon a primary determination of most favourable objectives for soft tissue drape. Once that is known, it is practical to secondarily determine those surgical re-adjustments of supporting bony elements which will be required to achieve favoured soft tissue drape and appearance. The prediction system enables Orthodontist to produce a visual treatment objective which will readily identify treatment mechanics required, will determine whether extractions are required and will indicate most favourable extraction plan. Critically, prediction will determine most advantageous pre-operative overjet (or reverse overjet), a signal factor in allowing desired surgical jaw repositioning. The Orthodontist is truly the custodian of this important incisor relationship. This paper presents orthognathic surgical cases in which this prediction analysis has been applied. The records confirm accuracy of treatment planning and demonstrate achievement of favourable aesthetic and functional outcomes. The Orthodontist utilising prediction process will have at hand a treatment plan which will form basis of relevant discussions with Maxillo-Facial surgeon partner, and together team can plan treatment in detail.

Social integration and inclusion after pre-maxilla surgical repositioning in patients with bilateral cleft palate and lip

Bilateral alveolar process fissure causes important functional and aesthetical limitations and thus difficulties in terms of social and family integration and interaction for these patients. AIM: (A) to assess motivations and expectations Treatment-wise and (B) to assess social inclusion and integration brought about by the surgery. MATERIALS AND METHODS: retrospective observational study involving 50 participants recruited among the patients submitted to the pre-maxilla repositioning procedure from January of 2003 to July of 2005 at the Centro de Atendimento Integral ao Fissurado Lábio-Palatal in Curitiba (CAIF), Paraná, and an assessment questionnaire was used. RESULTS: as far as the care protocol is concerned, results show a 90% success rate of surgeries. As to surgical and personal satisfaction rates are concerned, 76% sought treatment for personal satisfaction reasons and 86% reported having had more self-confidence after the surgery. CONCLUSIONS: Most of the patients submitted to the maxilla repositioning saw surgery as a continuation of the care previously given, with the expectation of better looks and self-confidence and, 96% of them were pleased with the results attained, which facilitated their social inclusion and re-integration.

Solving intraocular lens–related pigment dispersion syndrome with repositioning of primary sulcus implanted single-piece IOL in the capsular bag

We describe 2 cases of pigment dispersion syndrome (PDS) after uneventful phacoemulsification and implantation of a posterior chamber single-piece intraocular lens (IOL) with a sharp-edge design. In both cases, several days after IOL implantation, marked pigment dispersion was seen on the iris and in the trabecular meshwork, associated with an elevation in intraocular pressure (IOP). Thorough examination showed that the implanted IOL was in the ciliary sulcus. After surgical repositioning of both IOLs in the capsular bag, the pigment dispersion regressed and the IOP returned to normal limits. The 2 cases suggest that particularly in PDS patients, an IOL with an anterior sharp-edge design should be implanted in the capsular bag. Implantation in the ciliary sulcus should be avoided.

Social integration and inclusion after pre-maxilla surgical repositioning in patients with bilateral cleft palate and lip

SummaryBilateral alveolar process fissure causes important functional and aesthetical limitations and thus difficulties in terms of social and family integration and interaction for these patients.Aim(A) to assess motivations and expectations Treatment-wise and (B) to assess social inclusion and integration brought about by the surgery.Materials and Methodsretrospective observational study involving 50 participants recruited among the patients submitted to the premaxilla repositioning procedure from January of 2003 to July of 2005 at the Centro de Atendimento Integral ao Fissurado Lábio-Palatal in Curitiba (CAIF), Paraná, and an assessment questionnaire was used.Resultsas far as the care protocol is concerned, results show a 90% success rate of surgeries. As to surgical and personal satisfaction rates are concerned, 76% sought treatment for personal satisfaction reasons and 86% reported having had more self-confidence after the surgery.ConclusionsMost of the patients submitted to the maxilla repositioning saw surgery as a continuation of the care previously given, with the expectation of better looks and self-confidence and, 96% of them were pleased with the results attained, which facilitated their social inclusion and re-integration.

Die Fraktur des Os nasale: Unfallmechanismen, Diagnostik, Therapie und Komplikationen

The aim of the present evaluation was to analyse a large patient population with nasal bone fractures leading to surgical reposition of the nasal bone. Special attention was paid to age summit, the distribution of the seasons, the rate of open compared to closed nasal bone fractures, accompanying injuries, diagnosis and therapy as well as to the postoperative course. A total of 300 patients was evaluated retrospectively. All patients had been treated between 1999 and 2004 regarding simple and complex nasal bone fractures. Data were analysed with regard to history, age, gender, diagnosis, therapy, results, and complications. The average age of the patients was 29.6+/-15.6 years at the time of fracture with clear predominance of the male gender (77%). Another age summit could be observed in patients of >60 years. The main reasons for nasal bone fracture were falls (30%), in elderly patients often caused by cardiac syncopes, and rows (28%). The most frequent findings were deviation of the longitudinal axis of the nose (59%) and traumatic deviation of the nasal septum (50%). 65 patients (22%) had open nasal bone fractures, in 5% of the cases septal hematoma could be observed. Closed reposition of the nasal bone is the therapy of choice in uncomplicated nasal bone fractures. Special attention has to be paid to the group of patients aged 60 years and older who often suffer from treatment requiring comorbidities. In these cases inpatient treatment must be considered.

Up-to-date approaches to the rehabilitative treatment of children with fractured long tubular bones

An optimized therapeutic rehabilitation program involved 393 patients with fractured long bones (humeral, radial/ulnar, femoral, crural) admitted to the Orthopedic Department of the Stavropol Regional Children's Clinical Hospital and the Rehabilitation Centre for Handicapped Children and Adolescents. Rehabilitation was performed in three consecutive stages, viz. immobilization, functional recovery and training. The proposed approach ensured rather fast functional recovery of the affected extremity even in cases with compound fractures. The rehabilitation program included polyenzyme therapy with wobenzym during 3-4 weeks after injury or surgical repositioning of bone fragments. Pain and oedema syndromes resolved twice as fast as after traditional treatment. The use of this program permitted to avoid development of contracture and disturbances of locomotary activity; moreover, it improved the quality of life in children with fractures of long tubular bones.

V-10: Laparoscopic correction of a slipped adjustable gastric band

Band Slippage is one of the more common major complications of laparoscopic adjustable gastric banding, possibly occurring in up to 6% of patients. Management of this complication has not been standardized. Surgical repositioning of the band by the laparoscopic approach allows alleviation of symptoms and continued weight loss. Band removal has been used to manage this complication, but will likely result in weight regain.

Descemet Stripping Automated Endothelial Keratoplasty in a Child With Descemet Membrane Breaks After Forceps Delivery

To report the use of Descemet stripping automated endothelial keratoplasty (DSAEK) and to treat visual loss in Descemet membrane (DM) breaks after forceps delivery. An 8-year-old boy presented with unilateral DM ruptures secondary to forceps delivery. Central, vertically oriented DM breaks significantly decreased visual acuity. Preoperative visual acuity was 20/80. A DSAEK was performed, the DM and endothelium were stripped from the recipient, and an 8.5-mm-diameter donor button consisting of posterior stroma and healthy endothelium was folded and implanted through a 5-mm incision. An air bubble was used to press the donor tissue against the recipient cornea, allowing it to attach without sutures. Graft dislocation in the early postoperative period required surgical repositioning of the donor lenticule, which led to excellent anatomic and functional outcomes. There was a significant and rapid improvement of the best-corrected visual acuity, which was 20/50 at the first month and 20/32 at the seventh month postoperatively. To our knowledge, this is the first report of a DSAEK in a child with DM tears after forceps delivery. Selective replacement of posterior corneal layers with DSAEK might be a promising alternative to penetrating keratoplasty to successfully treat endothelial or DM lesions during childhood.

Surgical Repositioning of the Premaxilla With Bone Graft in 50 Bilateral Cleft Lip and Palate Patients

The aim of this study was to evaluate a modified surgical technique for premaxilla repositioning with concomitant autogenous bone grafting in bilateral trans-foramen cleft lip and palate patients. The study included 50 bilateral trans-foramen cleft lip and palate patients. Bone graft was harvested from the mandibular symphysis in 24 patients. Whenever more grafting was necessary, the iliac crest bone was used as the donor site (26 patients). The premaxilla was displaced by rupturing the bone and the palatine mucosa, and repositioned in a more adequate position using a surgical guide. The premaxilla and the grafts were fixed with miniplates and screws or screws only. The surgical guide was kept in place for 2 months, whereas the miniplates and screws were removed after 6 months, together with the complete bilateral lip and nose repair. Follow-up examinations were performed at 3, 6, and 12 months by means of periapical and occlusal radiographs, and by clinical examination. Thereafter, the patients were referred for completion of the orthodontic treatment. Overall, in 48 cases (96%) the treatment achieved total graft integration, with complete closure of the bucconasal and palatal fistulas, and premaxilla stability (either at first surgery or after reoperation). In the remaining 2 patients (4%), the treatment failed, due to necrosis of the premaxilla. The procedure is complex and involves risk. However, the patient's social inclusion, especially at the addressed age group, is the best benefit achieved.

Autotransplantation of Teeth: An Overview

Autotransplantation is the surgical repositioning of a tooth within the same patient. It can be thought of as a controlled avulsion and re-implantation of a tooth in a new, surgically prepared socket. The indications for its use are discussed, as too are factors affecting the success and the clinical procedures. The preservation and regeneration of the periodontal ligament is the key to success of this treatment. A case involving the transplantation of a premolar tooth into the central incisor location in a child is presented to show the different stages of the process. Autotransplantation is an underutilized technique which, when used within a multidisciplinary team, can offer an ideal treatment option for child or adolescent patients with missing or failing anterior teeth.

Surgical repositioning of a traumatically intruded permanent incisor in a patient with rheumatic fever: case report

Intrusive luxation of permanent teeth is a relatively uncommon type of injury to the periodontal ligament. However, it is one of the most severe types of dentoalveolar trauma. By definition, intrusive luxation consists of the axial displacement of the tooth into the alveolar bone, accompanied by comminution or fracture of the alveolar bone. Here we report the treatment management of a traumatically intruded immature permanent central incisor by surgical repositioning undertaken in a 10-year-old child with rheumatic fever 10 days after sustaining a severe dentoalveolar trauma. The intraoral examination showed the complete intrusion of the permanent maxillary right central incisor and the radiographic examination revealed incomplete root formation. Prophylactic antibiotic therapy was prescribed and the intruded tooth was surgically repositioned and endodontically treated thereafter. The postoperative course was uneventful, with both clinically and radiographically sound conditions of the repositioned tooth up to 3 years and 2 months of follow-up. These outcomes suggest that surgical repositioning combined with proper antibiotic prophylaxis and adequate root canal therapy may be an effective treatment option in cases of severe intrusive luxations of permanent teeth with systemic involvement.

Glucose tolerance test in the assessment of endocrine pancreatic function in cows before and after surgical correction of left diplaced abomasum

The aim of this study was to examine the secretory capacity of endocrine pancreas beta cells in healthy cows and cows suffering from left displaced abomasum (LDA) by determination of glucose and insulin concentrations in the peripheral circulation during glucose tolerance test (GTT). A total of twenty healthy cows (Control group) and twenty cows suffering from left abomasal displacement (Experimental group) were chosen for this study. Cows in the control group were exposed to GTT once, while cows in the experimental group were exposed on the day, day 3 and day 6 after the diagnosis of LDA, as well as 3 days after surgical treatment and reposition of the abomasum. Initial blood glucose concentrations in healthy cows were significantly lower than in the cows suffering from LDA only on day 3 (P<0.05) and day 6 (P<0.01) after the disease was diagnosed. All the glucose values determined both in healthy and diseased cows at 30. minutes after the start of glucose infusion were much higher than physiological values. Regardless to the decline of glucose levels from 60 to 180 minutes after start of glucose infusion, hyperglicemia maintained in both healthy cows and cows suffering from LDA. Compared to healthy cows the rate of decline was slower in cows suffering from LDA at the day of diagnosis, as well as 3 and 6 days after the diagnosis. At the end of the experiment, 240 minutes after the start of the infusion, glucose concentrations were significantly higher in diseased cows on the day of diagnosis and day 3 and 6 after diagnosis than in the control group (P<0.001, respectively) and in diseased cows 3 days after surgery (P<0.001, respectively). Mean initial concentrations of serum insulin were significantly higher in healthy cows than in cows suffering from LDA only on day 6 after diagnosis. From 30 to 240 minutes after the start of glucose infusion, insulinemic responses to intravenous glucose administation were statistically higher in healthy cows than in experimental cows on the day of diagnosis, day 3 and day 6 after diagnosis, as well as 3 days after surgery. On the day of diagnosis and three days after, insulinemia decreased to initial levels 180 minutes after the start of the infusion. Six days after diagnosis, insulinemia decreased to initial values at 120 minutes after the start of the glucose infusion. Three days after surgery, insulinemia decrased to values similar to initial at 240 minutes after the start of the infusion. Glucose tolerance test results showed that the best validation of pancreas endocrine function was between 60 and 120 minutes, as well as 180 and 240 minutes after the glucose infusion started. Our results also confirmed that cows suffering from LDA are in the stage of pancreatic endocrine disfunction and that the rate of this disfunction was higher when the disease lasted longer. The highest rate of pancreatic endocrine disfunction was observed 6 days after diagnosis. On day 3 after surgical treatment and reposition of the abomasum, glucose tolerance test results showed that the pancreatic endocrine function recovered.

Management of intrusive luxation with immediate surgical repositioning

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. This report presents a case of severe intrusive luxation of mature maxillary central and lateral incisor in a 40-year-old male. The intruded tooth was immediately repositioned (surgical extrusion) and splinted within hours following injury. Antibiotic therapy was initiated at the time of repositioning and maintained for 5 days. Pulp removal and calcium hydroxide treatment of the root canal was carried out after repositioning. Splint was removed 2 months later. Definitive root canal treatment with Gutta percha was accomplished at a later appointment. Clinical and radiographic examination 6, 12 and 24 months after the surgical extrusion revealed satisfactory progressive apical and periodontal healing.

A study of the management of 55 traumatically intruded permanent incisor teeth in children

These were to examine the main presenting, treatment and outcome factors for intruded permanent incisors in children, the effect of apical development and degree of intrusion on decisions on repositioning, the effect of apical development status on the maintenance of pulp vitality and the time of pulp extirpation and to compare the decisions made to the advice given in existing clinical guidelines. A sample of 55 intruded incisor teeth in 40 children aged between 6 and 14 years of age was reviewed in respect of management of their intrusive dental injuries. Of these teeth 17 were intruded in females and 38 in males. Mean (+/-SD) age was 9.3 (+/-1.99) and mean follow-up time was 2.3 years (+/-1.60). Included in the sample were 42 maxillary central incisors and 13 maxillary lateral incisors. Immature apicies were noted in 34 whilst 21 teeth had mature apices. Clinical and radiographic assessment categorised 4 teeth as mildly intruded with displacement of less than 3 mms; 10 teeth, intruded by 3-6 mm, were considered as moderately intruded whilst a further 11 teeth with intrusion of more than 6 mm were considered to have experienced a severe intrusive injury. There were 19 teeth (35%) that were allowed to re-erupt spontaneously, 22 (40%) were repositioned by orthodontic means and 14 teeth (25%) received surgical repositioning. There was a statistically significant difference between the repositioning decisions with a more conservative approach for teeth with immature apices (P = 0.0009). Apical completion was a significant predictor of earlier pulp extirpation (p=0.01).

Postpneumonectomy syndrome

Postpneumonectomy syndrome is a rare postoperative complication whereby mediastinal shifting toward the pneumonectomy space results in bronchial compression between the pulmonary artery, aorta, and vertebral column. This syndrome is more common after right pneumonectomy; other risk factors include young age and female sex. Imaging studies consistently reveal massive mediastinal shifting and document airway compromise. Bronchoscopy and flow-volume loops are helpful in confirming the diagnosis. Other causes of dyspnea, including cancer recurrence, should be excluded. Definitive treatment involves surgical repositioning of the mediastinum in the midline, as well as insertion of a saline-filled silicone prosthesis into the pneumonectomy space in order to prevent recurrence.

Canine rib osteosynthesis by reinforced acrylate plate: A new surgical method for treating flail chest

Polymethylmetacrylate (PMMA) is an artificial resin that has a wide application in a number of medical disciplines, surgery included. The use of acrylate is limited due to its modest mechanical features. Hence in this study, as an 'in vivo' experiment on dogs, the usefulness of 'reinforced acrylate' in the form of armored acrylate plates in the surgery of fractured ribs in flail chest has been valued. In earlier studies we have shown that polymethylmetacrylate, when reinforced with non-alkaline glass fibers, has improved mechanical characteristics (bending, stretching and crash resistance) compared with not reinforced, or in any other way strengthened acrylate. In this study the value of armored acrylate plates (AAP) in the sanation of flail chest in dogs has been verified, as well as its good biological tolerability as a new implant material in dogs. An original approach to surgical reposition and osteosynthesis of fractured ribs in dogs has been determined. An innovative approach to rib osteosynthesis with acrylate plates can be an adequate model for its application in human patients with unstable flail chest, which is often the result of injury or tumor excision.

Dental trauma: part 2. Managing poor prognosis anterior teeth – treatment options for the subsequent space in a growing patient

Part 1 concentrated on implications of dental trauma especially prior to and during orthodontic treatment. This paper examines the literature supporting various treatment options for poor prognosis anterior teeth and subsequent space generated when these teeth are lost. The role of an interdisciplinary team in managing this clinical situation is essential to obtain optimal results and an orthodontist is an essential member. Although some treatment options are not provided by orthodontists it is important that they have some knowledge of these and the latest research that support their use. Other techniques lie very much within the orthodontic remit. Treatment options can be split into maintaining the failing tooth or extraction and restoration of the edentulous gap. This paper reviews various treatment options including periodontal regeneration, surgical repositioning and distraction osteogenesis, composite build up to incisal levels and decoronation when maintaining a failing tooth. When extraction and restoration of edentulous gap is required the following treatment modalities are discussed: extraction technique to retain bone quantity, orthodontic space closure and opening (site development), autotransplantation, partial denture, resin bonded bridge and implants. All these options should be considered and available to an interdisciplinary team to ensure optimal care of children with anterior teeth of poor prognosis.