Distal Molar Surgery

Periodontitis is a chronic inflammation involving tooth investing structures.1 It causes irreversible bone and attachment loss. Very often third molar impaction leads to various complications adversely influencing the entire periodontal status.2 Therefore disimpaction surgery is one of the most commonly performed procedures. Extraction of an impacted molar tends to initiate localized periodontal pockets distally to an adjacent molars.3 This favours colonization of the subgingival microbiota, due to the difficulties associated with hygiene, and leads to the appearance of progressive bone loss into an well-defined angular defect.4 The primary goal of periodontal therapy is aimed at prevention, slowing or arresting disease progression. 5 Gingivectomy is the first choice of treatment in distal pocket due bulbous fibrous tissue. It can only be the choice of treatment when adequate amount of keratinized tissue is present at the site. Nevertheless, many times inadequate keratinized tissue or an angular bony defect has been diagnosed. Then bulbous tissue is preferably reduced in bulk and not be removed completely by the distal molar surgery. 6 The technique aids in pocket management. Apart, it also facilitates access to the osseous defect. It also secures the sufficient amounts of gingival tissue to achieve coverage.

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Nonsurgical Therapies for Hepatocellular and Cholangiocellular Carcinoma

Swiss Surgery ◽

10.1024/1023-9332.5.3.116 ◽

1999 ◽

Vol 5 (3) ◽

pp. 116-121 ◽

Cited By ~ 1

Author(s):

Schmassmann

Keyword(s):

Current Trend ◽

Percutaneous Ethanol Injection ◽

Cholangiocellular Carcinoma ◽

Multidisciplinary Therapy ◽

Term Survival ◽

Ethanol Injection ◽

First Choice ◽

Tumor Stages ◽

Choice Of Treatment ◽

Advanced Stages

Surgical resection is the first choice of treatment for patients with hepatocellular (HCC) and cholangiocellular carcinomas. Prolongation of survival is, however, the only realistic goal for most patients, which can be often achieved by nonsurgical therapies. Inoperable patients with large or multiple HCCs are usually treated with transarterial chemoembolization (TACE) with lipiodol in combination with a chemotherapeutic drug and gelfoam. Three-year survival depends on the stage of the disease and is about 20%. Patients with earlier tumor stages (one or two tumor nodules less than 3cm in size) are suitable for treatment with percutaneous ethanol injection (PEI) alone or in combination with TACE. Several studies have shown that in these early stages, the 3-year survival rate is approximately 55%-70% in the actively treated patients which is significantly higher than in untreated patients. In advanced stages of the disease, TACE and PEI have no effect on survival and should not be performed. Some of these patients have been successfully treated with octreotide. Patients with inoperable cholangiocellular carcinoma are treated by endoscopic or percutaneous stent placement. If stenting does not achieve adequate biliary drainage, multidisciplinary therapy including internal / external radiotherapy or photodynamic therapy should be considered in patients with potential long-term survival. In conclusion, nonresectional therapies play an essential role in the therapy of inoperable hepato- and cholangiocellular carcinomas as they lead to satisfactory survival. Multidisciplinary therapy appears to be the current trend of management.

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Surgery of ulcus cruris venosum

Phlebologie ◽

10.1055/s-0037-1622306 ◽

2010 ◽

Vol 39 (03) ◽

pp. 156-162 ◽

Cited By ~ 6

Author(s):

C. Schwahn-Schreiber

Keyword(s):

Subcutaneous Tissue ◽

Ulcus Cruris ◽

Healing Time ◽

Ulcus Cruris Venosum ◽

Venous Stasis ◽

Morphological Alterations ◽

First Choice ◽

Choice Of Treatment ◽

Chronic Compartment Syndrome ◽

Shave Therapy

SummaryAdvanced chronic venous stasis syndrome is characterized by irreversible and self-perpetuating morphological alterations in the lower leg. A chronic inflammatory process results in sclerosis, which progresses from the skin to the subcutaneous tissue and ultimately the fascia, sometimes including muscle and ankle joint and leading to chronic compartment syndrome. To cure these severe alterations with non healing ulcers decompression of the compartments like paratibial fasciotomy with SEPS and crural fasciectomy or removal of sclerosis like shave therapy are successful surgical procedures. Indication should be adapted to the extension of ulcer. Indications of the operations and the techniques are described, complications and results are discussed. Due to ulcer extension especially shave therapy (removal of the sclerotic tissue epifascial) and crural fasciectomy (removal of sclerosis including fascia) are very successful with up to 80% healing rate, even in severe cases and even after long term (up to 8 years). Since shave therapy is easy, short and simple with short healing time, few complications and good aesthetical result it is the first choice of treatment for non healing leg ulcers. Fasci ectomy is reserved for special indications such as deep transfascial necrosis or failure of shave therapy.

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Glenoid concavity has a higher impact on shoulder stability than the size of a bony defect

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-021-06562-3 ◽

2021 ◽

Author(s):

Jens Wermers ◽

Benedikt Schliemann ◽

Michael J. Raschke ◽

Philipp A. Michel ◽

Lukas F. Heilmann ◽

...

Keyword(s):

Bone Loss ◽

Linear Model ◽

Goodness Of Fit ◽

Clinical Decision Making ◽

Defect Size ◽

Glenoid Bone Loss ◽

Bony Defect ◽

Stability Ratio ◽

Anterior Glenoid ◽

Shoulder Stability

Abstract Purpose Surgical treatment of shoulder instability caused by anterior glenoid bone loss is based on a critical threshold of the defect size. Recent studies indicate that the glenoid concavity is essential for glenohumeral stability. However, biomechanical proof of this principle is lacking. The aim of this study was to evaluate whether glenoid concavity allows a more precise assessment of glenohumeral stability than the defect size alone. Methods The stability ratio (SR) is a biomechanical estimate of glenohumeral stability. It is defined as the maximum dislocating force the joint can resist related to a medial compression force. This ratio was determined for 17 human cadaveric glenoids in a robotic test setup depending on osteochondral concavity and anterior defect size. Bony defects were created gradually, and a 3D measuring arm was used for morphometric measurements. The influence of defect size and concavity on the SR was examined using linear models. In addition, the morphometrical-based bony shoulder stability ratio (BSSR) was evaluated to prove its suitability for estimation of glenohumeral stability independent of defect size. Results Glenoid concavity is a significant predictor for the SR, while the defect size provides minor informative value. The linear model featured a high goodness of fit with a determination coefficient of R2 = 0.98, indicating that 98% of the SR is predictable by concavity and defect size. The low mean squared error (MSE) of 4.2% proved a precise estimation of the SR. Defect size as an exclusive predictor in the linear model reduced R2 to 0.9 and increased the MSE to 25.7%. Furthermore, the loss of SR with increasing defect size was shown to be significantly dependent on the initial concavity. The BSSR as a single predictor for glenohumeral stability led to highest precision with MSE = 3.4%. Conclusion Glenoid concavity is a crucial factor for the SR. Independent of the defect size, the computable BSSR is a precise biomechanical estimate of the measured SR. The inclusion of glenoid concavity has the potential to influence clinical decision-making for an improved and personalised treatment of glenohumeral instability with anterior glenoid bone loss.

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Regenerative Therapy Modality for Treatment of True Combined Endodontic-Periodontal Lesions: A Randomized Controlled Clinical Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18126220 ◽

2021 ◽

Vol 18 (12) ◽

pp. 6220

Author(s):

Reham AlJasser ◽

Sundus Bukhary ◽

Mohammed AlSarhan ◽

Dalal Alotaibi ◽

Saleh AlOraini ◽

...

Keyword(s):

Bone Graft ◽

Bone Grafting ◽

Endodontic Treatment ◽

Control Group ◽

Controlled Clinical Trial ◽

Bony Defect ◽

Keratinized Tissue ◽

Group I ◽

Significant Difference ◽

Grafting Procedure

The aim of this in-vivo study was to evaluate/compare the clinical periodontal parameters in patients with true combined endo-perio lesions (EPL), treated with gutta-percha (GP) and mineral trioxide (MTA) as an obturation material alone and with addition of bone grafting in such lesions. 120 Saudi patients (mean age = 41yrs) diagnosed with true combined EPL participated in this study. Group I (control group, n = 30) was treated with conventional endodontic treatment using GP for obturation. Group II (n = 30) was treated with conventional endodontic treatment using MTA for obturation. Group III (n = 30) was treated with conventional endodontic treatment using GP for obturation + grafting procedure to fill the bony defect. Group IV (n = 30) was treated with conventional endodontic treatment using MTA for obturation + grafting procedure to fill the bony defect. Clinical parameters (Pocket depth (PD); Clinical attachment loss (CAL); keratinized tissue width (KTW); gingival phenotype (G.Ph.) and Cone Beam Computed Tomography Periapical Index (CBCTPAI)) were recorded and compared at baseline, 3, 6, 12 months’ interval. For the groups III and IV, CBCTPAI showed significant difference (p < 0.0001) with the other groups at 6 months and 1-year interval. The group with MTA + bone graft showed 76% and 90% patients with 0 score at 6 months and 1-year follow-up, respectively. Comparison of mean values of PD among study groups at 3 months, 6 months and 1 year showed significant difference at 3 months, whereas the mean PD values of subjects in GP + bone graft showed significantly higher PD values than other 3 groups (p = 0.025). Use of GP and MTA for root canal obturation along with periodontal therapy and bone augmentation helps in resolving complex endo-perio lesions. Bone grafting in addition to obturation with MTA was found to be the best treatment strategy in management of EPL cases and is recommended for clinicians who are treating EPL patients.

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Calcium Phosphate Barrier for Augmentation of Bone in noncontained Periodontal Osseous Defects: A Novel Approach

The Journal of Contemporary Dental Practice ◽

10.5005/jp-journals-10024-1617 ◽

2014 ◽

Vol 15 (6) ◽

pp. 779-783 ◽

Cited By ~ 1

Author(s):

Aditi Chopra ◽

Karthik Sivaraman ◽

Tarun K Awataramaney

Keyword(s):

Calcium Phosphate ◽

Bone Loss ◽

Bone Grafts ◽

Good Alternative ◽

Promising Technique ◽

Novel Approach ◽

Ability To Regenerate ◽

Osseous Defect ◽

Osseous Defects ◽

Clot Stability

ABSTRACT Aim The aim of this technique is to augment bone in noncontained osseous deformities using a unique self-sustaining calcium phosphate barrier. Introduction Bone has the inherent ability to regenerate completely if it is provided with a fracture space or an undisturbed enclosed scaffold. A secluded environment is essential as it provides a secured, sterile and stable wound system that regenerates lost bone by a process of osteopromotion. Reconstructive techniques using bone grafts and barrier membranes utilize this principle for augmentation of deficient bony sites by providing a closed environment that promotes clot stability, graft retention, and facilitates correct cell repopulation. However, in noncontained bone defects like one walled infrabony periodontal defect or sites with horizontal bone loss, regeneration of bone still remains an unrealistic situation since osseous topography at such sites does not favor membrane stability or bone grafts retention. This case report presents a promising technique to augment bone in areas with horizontal loss. Technique Augmentation of bone in the interdental area with horizontal bone loss was accomplished by building a contained defect using a unique self sustaining calcium phosphate cement formulation. The calcium phosphate barrier stimulates the lost cortical plates and promotes graft retention and clot stability. At 6 months, there was a significant bone fill and trabecular formation in the interdental area and reduction in tooth mobility. Conclusion This promising technique could prove to be a good alternative to the conventional approaches for treating osseous deformities. Clinical significance Calcium phosphate is a promising barrier graft for repair of noncontained periodontal osseous defect. This technique cues both the clinicians and manufacturers to develop moldable tissue engineered constructs for osseous repair. How to cite this article Chopra A, Sivaraman K, Awataramaney TK. Calcium Phosphate Barrier for Augmentation of Bone in noncontained Periodontal Osseous Defects: A Novel Approach. J Contemp Dent Pract 2014;15(6):779-783.

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Not All Embolizations Are Created Equally in the Management of Posterior Epistaxis: Discussion of Safety Measures Avoiding Neurological Complications

Radiology Research and Practice ◽

10.1155/2020/5710313 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Mareike Franke ◽

Jasper Franke ◽

Christian Saager ◽

Sven Barthel ◽

Randolf Riemann ◽

...

Keyword(s):

Neurological Complication ◽

Neurological Complications ◽

Surgical Approaches ◽

Success Rates ◽

Artery Ligation ◽

Retrospective Data Analysis ◽

First Choice ◽

Surgical Methods ◽

Choice Of Treatment ◽

Meta Analyses

Today, there are still no uniform guidelines for the treatment of epistaxis. Furthermore, it is widely debated whether embolization or surgical approaches should be the first choice of treatment for intractable posterior epistaxis after conservative measures have failed. In several meta-analyses, it is reported that endoscopic sphenopalatine artery ligation and embolization have similar success rates, but embolization was associated with more severe neurological complications. Regarding existing literature, there are many comparative analyses of surgical methods but none for embolization protocols. Against this backdrop of a lack of uniform standards in embolization techniques, we present a retrospective evaluation of what has emerged to be best procedural practice for endovascular treatment of epistaxis in our department using microsphere particles and microcoils, in particular regarding precaution measures to avoid neurological complications. In our retrospective data analysis of 141 procedures in 123 patients, performed between 2008 and 2019, we find success rates very similar to those reported in other studies (95.1% immediate-stop-of-bleeding success and 90.2% overall embolization success) but did not encounter any major neurological complication opposed to other reports. We suggest some aspects of our protocol as precaution measure to avoid neurological complications. More generally and perhaps even more importantly, we make a strong case for standardization for embolization techniques to the level of details in surgical procedure standardization to enable an apples to apples comparison of embolization techniques to each other and of intervention vs. surgery.

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Antiperiodontitis Effects of Magnolia biondii Extract on Ligature-Induced Periodontitis in Rats

Nutrients ◽

10.3390/nu11040934 ◽

2019 ◽

Vol 11 (4) ◽

pp. 934 ◽

Cited By ~ 2

Author(s):

Hae Jin Lee ◽

Dong-Ryung Lee ◽

Bong-Keun Choi ◽

Seung Hwan Yang

Keyword(s):

Bone Loss ◽

Tissue Damage ◽

Alveolar Bone ◽

Histopathological Examination ◽

Nuclear Factor Κb ◽

Alveolar Bone Loss ◽

Gingival Tissue ◽

Protective Effects ◽

Tissue Destruction ◽

Commercial Kits

Over the past decades, periodontitis has become a rising health problem and caused various diseases. In the many studies shows that some extracts and compound to the prevention and treatment of periodontitis. This study focuses on the effects of inhibition of gingival damage and alveolar bone loss. The aim of this study was to evaluate the protective effects of Magnolia biondii extract (MBE) against ligature-induced periodontitis in rats. A ligature was placed around the molar teeth for 8 weeks, and MBE was administered for 8 weeks. Gingival tissue damage and alveolar bone loss were measured by microcomputed tomography (CT) analysis and histopathological examination. Serum Interluekin-1 β (IL-1β), tumor necrosis factor-α (TNF-α), cyclooxygenases-2 (COX-2), and receptor activator of nuclear factor–κB ligand (RANKL) levels were investigated using commercial kits to confirm the antiperiodontitis effects of MBE. We confirmed that ligature-induced periodontitis resulted in gingival tissue damage and alveolar bone loss. However, treatment for 8 weeks with MBE protected from periodontal tissue damage and downregulated serum inflammatory cytokine factors and RANKL levels. These results suggest that MBE exerts antiperiodontitis effects by inhibiting gingival tissue destruction and alveolar bone loss through regulation of anti-inflammatory cytokines in periodontitis-induced rats.

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Treatment of Intramedullary Arteriovenous Malformations of the Spinal Cord

Interventional Neuroradiology ◽

10.1177/15910199000060s133 ◽

2000 ◽

Vol 6 (1_suppl) ◽

pp. 203-207 ◽

Cited By ~ 5

Author(s):

S. Ushikoshi ◽

K. Hida ◽

Y. Kikuchi ◽

Y. Iwasaki ◽

K. Miyasaka ◽

...

Keyword(s):

Spinal Cord ◽

Arteriovenous Malformations ◽

Radical Excision ◽

Arteriovenous Fistulas ◽

First Choice ◽

Choice Of Treatment ◽

Technical Complication ◽

Surgical Manipulation ◽

Residual Lesions

We retrospectively reviewed our treatment results for spinal intramedullary arteriovenous malformations (AVMs). Fifteen consecutive patients were included in this syudy. Five patient underwent particulate embolization. Surgery was performed in ten patients (including two patient who were treated embolization initially). Five patients, at the beginning of our experience, underwent radical excision of the nidus via the posterior myelotomy. Recent five patients underwent interruption of the feeding pedicles on the surface of the spinal cord. Especially when arteriovenous fistulas (AVFs) or aneurysms were demonstrated, accurate obliteration of them were performed. Four patients, including two with residual AVM after the surgery, underwent irradiation therapy. Anatomically, four AVMs disappeared completely and the other 11 patients have a residual lesions after the treatment. Clinically, three patients improved, six remained unchanged, and six worsened. The causes of neurological deterioration after the treatment were technical complication of embolization in one patient and surgical manipulation in five. There was no patient who experienced hemorrhage during the follow-up period ranged from 6 months to 17 years, with a mean of 7.5 years. In conclusion, particulate embolization should be considered as the first choice of treatment if feasible. Surgical treatment is indicated for the dangerous anatomical features such as AVFs or aneurysms.

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Trans-Olecranon Fracture-Dislocations of the Elbow: A Systematic Review

Diagnostics ◽

10.3390/diagnostics10121058 ◽

2020 ◽

Vol 10 (12) ◽

pp. 1058

Author(s):

Chul-Hyun Cho ◽

Du-Han Kim ◽

Sang Soo Na ◽

Byung-Chan Choi ◽

Beom-Soo Kim

Keyword(s):

Systematic Review ◽

Positive Outcome ◽

Olecranon Fracture ◽

Dash Score ◽

Eligibility Criteria ◽

First Choice ◽

Retrospective Clinical Study ◽

Flexion Extension ◽

Choice Of Treatment ◽

Fracture Dislocations

The purpose of this study is to provide a systematic review of the definition, ideal surgical method, complications, and prognosis of trans-olecranon fracture dislocations. An electronic search was performed in the PubMed, EMBASE, Scopus, and MEDLINE databases. The eligibility criteria included retrospective clinical study and review article in subjects older than 18 years with trans-olecranon fracture dislocations. Trans-olecranon fracture dislocations are defined as fractures in which the stability of the ulnohumeral joint is lost due to the intra-articular fracture of the olecranon without disruption of the proximal radioulnar joint. The seven papers were included that met the eligibility criteria for the quantitative synthesis. Findings indicate that a pre-contoured plate was used in 88.3% of cases (68 of 77 reports), with no reports of complications, suggesting that the pre-contoured 3.5 mm plate is the first choice of treatment. Postoperative mean elbow range of motion for the flexion–extension arc was 121.1° and 146.5° for the pronation-supination arc. Methods for postoperative clinical scores included the Broberg/Morrey rating with a result of excellent or good in 82.9% of cases, the ASES score with a mean of 88.7, and the DASH score with a mean of 11.75. Complications included heterotopic ossification in 21.9% (23/105) of cases, arthrosis in 25.7% (27/105) of cases, nerve damage in 18.1% (19/105) of cases, and osteoarthritis in 14.3% (15/105). With better understanding of the mechanism of injury and proper diagnosis and treatment, findings of the current review suggest a positive outcome. PROSPERO registration No.: CRD42019126568.

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How to evaluate diagnosis and management of biliary atresia in the era of liver Transplantation in China

World Journal of Pediatric Surgery ◽

10.1136/wjps-2018-000002 ◽

2018 ◽

Vol 1 (1) ◽

pp. e000002

Author(s):

Jianghua Zhan ◽

Yajun Chen ◽

Kenneth K Y Wong

Keyword(s):

Liver Transplantation ◽

Survival Rate ◽

Early Diagnosis ◽

Biliary Atresia ◽

Further Education ◽

Monitoring Methods ◽

Kasai Operation ◽

First Choice ◽

Choice Of Treatment ◽

Hepatobiliary Diseases

BackgroundBiliary atresia (BA) is one of the most challenging hepatobiliary diseases in children. Notwithstanding the reasonable outcome of liver transplantation (LT), portoenteral anastomosis (Kasai operation) is still the first choice of treatment for patients with BA. How to improve the survival rate of the patients with BA in the era of LT is a new challenge.Data sourcesBased on recent original publications and the experience with the BA in China, we review many factors that influence BA survival situation, including early diagnosis and screen plan, defects of early treatment, Kasai operation, and LT and indicate present questions about BA diagnosis and treatment in China.ResultsBA diagnosis may also be delayed due to insufficient understanding of BA and lack of jaundice monitoring methods at different levels of the hospitals in China. Further education of the physicians at smaller city hospitals about BA, neonatal jaundice and cholestasis would be helpful in improving early diagnosis of BA. Early surgical intervention is still the only guarantee to improve the survival rate of BA with native liver.ConclusionsIn the era of LT, especially in China, Kasai operation can provide waiting time for living donor LT and improve the success rate of LT and minimize the rapid deterioration of liver function of the children with BA and decrease the mortality in patients with BA.

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