scholarly journals Features of free skin grafting to correct post-burn neck deformities in children

2021 ◽  
Vol 9 (1) ◽  
pp. 77-86
Author(s):  
Olga V. Filippova ◽  
Konstantin A. Afonochev
Keyword(s):  
Preventive Measures ◽  
Preventive Measure ◽  
Skin Grafting ◽  
Long Term Results ◽  
Neck Extension ◽  
Scar Contracture ◽  
Aesthetic Results ◽  
Group 2 ◽  
Grade Iii ◽  
Group 1

BACKGROUND: In the literature, various methods of reconstructive plastic surgery for neck cicatricial contractures, from free skin grafting to expander dermotension and microsurgical tissue complex autotransplantation, are widely covered. However, very little attention has been paid to conservative measures aimed at stabilizing surgical treatment results. AIM: This study aims to evaluate the long-term results of free skin grafting of neck granulating wounds after burns and secondary relapsing scar contracture correction. The study also aims to analyze the causes of poor results and demonstrate the possibility of using free skin grafting to correct neck contractures with basic preventive measures. MATERIALS AND METHODS: Forty-six patients with neck burn cicatricial sequelae were treated at the clinic of trauma sequelae in H. Turner National Medical Research Center from 2017 to 2019. The patients were divided into two groups: group 1 patients with neck contractures after plasty of granulating wounds with free skin autografts, and group 2 patients with a relapse of neck contracture after corrective reconstructive surgery. Anamnestic data analysis enabled establishing the actual volume of preventive rehabilitation measures in both patient groups. The classification by N.E. Povstyany (1973) was used to determine the severity of contracture. RESULTS: The most severe neck contractures, grade III and IV, developed in group 1 patients (grade III 41.2%). In group 2 patients, there was a limitation of neck extension, corresponding to grades I (33.3%) and II (58.3%). Conservative preventive measures as immobilization and compression therapy were absent in group 1 in 100% of cases. The most common preventive measure was the prescription of topical anti-scar drugs. Two-stage skin grafting with full-thickness skin autografts combined with conservative measures made it possible to correct neck contractures of grade I-IV completely and obtain good aesthetic results. CONCLUSION: The main reason for neck contractures development is the retraction of skin autografts, which inevitably develops in the absence of appropriate preventive measures. Correction of neck contractures using free skin grafting combined with preventive immobilization using a Schantz collar and a compression half-mask allows obtaining good functional and aesthetic results.

Prediction of oligodendroglial tumor subtype and grade using perfusion weighted magnetic resonance imaging

2007 ◽  
Vol 107 (3) ◽  
pp. 600-609 ◽  
Author(s):  
Robert G. Whitmore ◽  
Jaroslaw Krejza ◽  
Gurpreet S. Kapoor ◽  
Jason Huse ◽  
John H. Woo ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Blood Volume ◽  
Tumor Grade ◽  
Grade Ii ◽  
Cytogenetic Profile ◽  
Group 2 ◽  
Oligodendroglial Neoplasms ◽  
Grade Iii ◽  
Group 1

Object Treatment of patients with oligodendrogliomas relies on histopathological grade and characteristic cytogenetic deletions of 1p and 19q, shown to predict radio- and chemosensitivity and prolonged survival. Perfusion weighted magnetic resonance (MR) imaging allows for noninvasive determination of relative tumor blood volume (rTBV) and has been used to predict the grade of astrocytic neoplasms. The aim of this study was to use perfusion weighted MR imaging to predict tumor grade and cytogenetic profile in oligodendroglial neoplasms. Methods Thirty patients with oligodendroglial neoplasms who underwent preoperative perfusion MR imaging were retrospectively identified. Tumors were classified by histopathological grade and stratified into two cytogenetic groups: 1p or 1p and 19q loss of heterozygosity (LOH) (Group 1), and 19q LOH only on intact alleles (Group 2). Tumor blood volume was calculated in relation to contralateral white matter. Multivariate logistic regression analysis was used to develop predictive models of cytogenetic profile and tumor grade. Results In World Health Organization Grade II neoplasms, the rTBV was significantly greater (p < 0.05) in Group 1 (mean 2.44, range 0.96–3.28; seven patients) compared with Group 2 (mean 1.69, range 1.27–2.08; seven patients). In Grade III neoplasms, the differences between Group 1 (mean 3.38, range 1.59–6.26; four patients) and Group 2 (mean 2.83, range 1.81–3.76; 12 patients) were not significant. The rTBV was significantly greater (p < 0.05) in Grade III neoplasms (mean 2.97, range 1.59–6.26; 16 patients) compared with Grade II neoplasms (mean 2.07, range 0.96–3.28; 14 patients). The models integrating rTBV with cytogenetic profile and grade showed prediction accuracies of 68 and 73%, respectively. Conclusions Oligodendroglial classification models derived from advanced imaging will improve the accuracy of tumor grading, provide prognostic information, and have potential to influence treatment decisions.

scholarly journals Short-Time Estimation of Fractionation in Atrial Fibrillation with Coarse-Grained Correlation Dimension for Mapping the Atrial Substrate

Entropy ◽  
2020 ◽  
Vol 22 (2) ◽  
pp. 232
Author(s):  
Aikaterini Vraka ◽  
Fernando Hornero ◽  
Vicente Bertomeu-González ◽  
Joaquín Osca ◽  
Raúl Alcaraz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Real Time ◽  
Correlation Dimension ◽  
Coarse Grained ◽  
Long Term Results ◽  
Operating Characteristics ◽  
Type Iv ◽  
Group 2 ◽  
Short Time ◽  
Group 1

Atrial fibrillation (AF) is currently the most common cardiac arrhythmia, with catheter ablation (CA) of the pulmonary veins (PV) being its first line therapy. Ablation of complex fractionated atrial electrograms (CFAEs) outside the PVs has demonstrated improved long-term results, but their identification requires a reliable electrogram (EGM) fractionation estimator. This study proposes a technique aimed to assist CA procedures under real-time settings. The method has been tested on three groups of recordings: Group 1 consisted of 24 highly representative EGMs, eight of each belonging to a different AF Type. Group 2 contained the entire dataset of 119 EGMs, whereas Group 3 contained 20 pseudo-real EGMs of the special Type IV AF. Coarse-grained correlation dimension (CGCD) was computed at epochs of 1 s duration, obtaining a classification accuracy of 100% in Group 1 and 84.0–85.7% in Group 2, using 10-fold cross-validation. The receiver operating characteristics (ROC) analysis for highly fractionated EGMs, showed 100% specificity and sensitivity in Group 1 and 87.5% specificity and 93.6% sensitivity in Group 2. In addition, 100% of the pseudo-real EGMs were correctly identified as Type IV AF. This method can consistently express the fractionation level of AF EGMs and provides better performance than previous works. Its ability to compute fractionation in short-time can agilely detect sudden changes of AF Types and could be used for mapping the atrial substrate, thus assisting CA procedures under real-time settings for atrial substrate modification.

scholarly journals Comparative Outcomes Assessment: Hip Hemiarthroplasty as an Alternative to THA in Patients with Surgically Pristine Acetabulum—Is There Still a Role?

2013 ◽  
Vol 2013 ◽  
pp. 1-6
Author(s):  
Thomas B. Pace ◽  
Brad Prather ◽  
Brian Burnikel ◽  
Brayton Shirley ◽  
Stephanie Tanner ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Rate ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Groin Pain ◽  
Long Term Results ◽  
Overall Survival Rate ◽  
Total Hip ◽  
Group 2 ◽  
Group 1

This is a retrospective review of 243 hip arthroplasties treated with either hemiarthroplasty (61 surgeries-Group 1) or total hip arthroplasty (182 surgeries-Group 2). The mid- to long-term results of relatively similar, predominately young patient cohorts were assessed annually via radiographs and the Harris Hip Scores for pain and clinical function. Groin pain persisted in 16.4% of Group 1 and 5.5% of Group 2 (). Thigh pain persisted in 11.5% of Group 1 and 2.2% of Group 2 (). Complications in Group 1 were 4/61 including 2 revisions with an overall survival rate of 96.7% versus Group 2 complication rate of 29/182 with 15 revisions and an overall survival rate of 91.8%. There were no cases of acetabular protrusio in Group 1, but 2 cases (1%) in Group 2 had cup loosening or osteolysis. Two cases were revised in Group 1 (3.2%). Both were undersized femoral stems. The fifteen revisions (8.2%) in Group 2 included loose stem (1), instability (8), infections (3), cup loosening (2), and accelerated polyethylene wear (1). Hemiarthroplasty has a higher incidence of thigh and groin pain but fewer complications compared with total hip arthroplasty.

scholarly journals A Prospective Controlled Study on Long-Term Outcomes of Facial Lacerations in Children

2021 ◽  
Vol 8 ◽  
Author(s):  
Sonja Fontana ◽  
Clemens M. Schiestl ◽  
Markus A. Landolt ◽  
Georg Staubli ◽  
Sara von Salis ◽  
...  
Keyword(s):  
Treatment Time ◽  
Trial Registration ◽  
Long Term Results ◽  
Controlled Study ◽  
Tissue Adhesives ◽  
Scar Assessment ◽  
Group 2 ◽  
Group 1

Background: Although skin adhesives have been used for decades to treat skin lacerations, uncertainty remains about long-term results, and complications.Methods: In this prospective, controlled, single-blinded, observational cohort study, outcomes were assessed by five plastic surgeons with standardized photographs at 6–12 months using a modified Patient and Observer Scar Assessment Scale (POSAS) and Vancouver Scar Scale (VSS); additionally, the POSAS was performed by the patients/caregivers and the physician; pain, requirement of anesthesia, treatment time, costs, complications, and quality of live (QoL) were assessed.Results: A total of 367 patients were enrolled; 230 were included in the main analysis; 96 wounds were closed using tissue adhesives (group 1); 134 were sutured (group 2). Assessment by the independent observers revealed an improved mean modified overall POSAS score in group 1 in comparison with group 2 [2.1, 95% CI [1.97–2.25] vs. 2.5, 95% CI [2.39–2.63]; p &lt; 0.001, d = 0.58] and mean VSS score [1.2, 95% CI [0.981–1.34] vs. 1.6, 95% CI [1.49–1.79], p &lt; 0.001, d = 0.53]. At the early follow-up, dehiscence rate was 12.5% in group 1 and 3.7% in group 2 (p &lt; 0.001); later on, one dehiscence remained per group. Mild impairment of QoL was found at the early follow-up in both groups, with no impairment remaining later on. Duration of treatment and treatment costs were lower in group 1.Conclusion: Both modalities of wound closure yield favorable esthetic results, and complications are rare. Adhesives are more cost-effective, and its application is less time-consuming; therefore, tissue adhesives offer considerable advantages when used appropriately.Trial Registration: Public trial registration was performed at www.ClinicalTrials.gov (Identifier: NCT03080467).

scholarly journals Immediate and long-term results of carotid endarterectomy in different periods of ischemic stroke

2020 ◽  
Vol 28 (3) ◽  
pp. 312-322
Author(s):  
Anton N. Kazantsev ◽  
Konstantin P. Chernykh ◽  
Nona E. Zarkua ◽  
Roman Yu. Lider ◽  
Ekaterina A. Burkova ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Long Term Results ◽  
Lethal Outcome ◽  
Group 4 ◽  
Hospitalization Period ◽  
Rehabilitation Period ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Aim. Analysis of hospital and long-term results of carotid endarterectomy (CEA) in different periods of acute cerebrovascular event (ACVE). Materials and Methods. The given study was retrospective and was conducted using the method of patients sampling. In the period from 2010 to 2019, 1113 patients with ACVE in history who were later conducted CEA, were selected. Depending on the time interval between the last ACVE and CAE, all the patients were divided into 4 groups: the 1st group in the acutest period of ACVE (1-3 days) (n=24; 2.2%); the 2nd group in the acute period of ACVE (up to 28 days) (n=493; 44.3%); the 3rd group in the early rehabilitation period of ACVE (up to 6 months) (n=481; 43.2%); the 4th group in the late rehabilitation period of ACVE (up to 2 years) (n=115; 10.3%). The long-term period was 34.812.5 months. Results. In the hospitalization period of observation the following complications were found: lethal outcome ((group 1 0%; group 2 0.4% (n=2); group 3 0.2% (n=1); group 4 0%; р=0.16)); myocardial infarction ((group 1 0%; group 2 0.4% (n=2); group 3 0%; group 4 0.9% (n=1); р=0.35)); ACVE/transient ischemic attack (TIA), ((group 1 4.2% (n=1); group 2 0.4% (n=2); group 3 0.2% (n=1); group 4 0%; р1-2=0.01; р1-3=0.009; р1-4=0.01)). By the end of hospitalization period the composite endpoint consisting of lethal outcome + myocardial infarction + ACVE/TIA made in group 1 4.2% (n=1), in group 2 1.2% (n=6), in group 3 0.4% (n=2), in group 4 2.6% (n=3), р=0.08. Complications of the long-term follow-up period were: lethal outcome from all causes ((group 1 25% (n=6); group 2 5.5% (n=27); group 3 7.3% (n=35); group 4 14% (n=16); р1-2=0.002; р1-3=0.008; р2-4=0.012)); lethal outcome from cardiovascular causes ((group 1 4.2% (n=1); group 2 3.6% (n=18); group 3 4.8% (n=23); group 4 5.2% (n=6); р=0.79)), myocardial infarction ((group 1 12.5% (n=3); group 2 3.6% (n=18); group 3 5.4% (n=26); group 4 6.1% (n=7); р=0.15)), ACVE/TIA ((group 1 16.6% (n=4); group 2 6.3% (n=31); group 3 6% (n=29); group 4 11.3% (n=13); р=0.05)); composite endpoint including lethal outcome + myocardial infarction + ACVE/TIA ((group 1 54.2% (n=13); group 2 15.4% (n=76); group 3 18.7% (n=90); group 4 31.3% (n=36); р1-2=0.0001; р1-3=0.0001; р1-4=0.005; р2-4=0.0006; р3-4=0.012)). Conclusion. Application of CEA demonstrated effectiveness and safety in the acute and early rehabilitation period of ACVE.

scholarly journals EMLA- AN EFFECTIVE TOOL FOR TOPICAL ANALGESIA IN SPLIT SKIN GRAFT HARVEST

2020 ◽  
pp. 1-4
Author(s):  
Lalit Agrawal ◽  
Fahud Khurram ◽  
Naveen Khubchandani
Keyword(s):  
Visual Analogue Scale ◽  
Skin Graft ◽  
Analogue Scale ◽  
Skin Grafting ◽  
Split Skin Graft ◽  
Emla Cream ◽  
Graft Harvest ◽  
Group 2 ◽  
Split Skin ◽  
Group 1

Background: Many patients require general anesthesia merely for skin grafting. EMLA cream which is aeutectic mixture of Lignocaine and Prilocaine provides surface anesthesia when applied on intact skin. Its role in venepuncture or IV cannula insertion in children is well documented. Aim and Objective: To compare effectiveness of EMLA over inltrative local anaesthesia in split skin graft harvest. Method: A prospective study was conducted on 64 patients who required skin grafting. Various indications for grafting were noted. The patients were randomly allocated to two groups. In one group 32 patients, graft was harvested after application of EMLA cream whereas in another group of 32 patients, graft was harvested by inltrating local anesthesia. Pain perceived during donor area preparation, graft harvesting and post-operative pain was recorded and compared between the two groups on Visual analogue scale and Likert scale. Results: Total 64 patients were included in the study with 32 patients in either group. Traumatic loss of skin was the most common indication in either group for skin graft harvest. As per visual analogue scale during the graft harvest, most of the patients were in the range of 4-7 score in either group (71.87% vs 53.12%). 75% of the patients were in the 4-7 score in both groups. As per likert scale during the graft harvest score of 4 was noted in 62.5% in group 1 vs 53.12% in group 2 patients. 81.25% patients in group 1 reported procedure as excellent versus 53.12% patients in group 2. Patients experienced more pain during inltration of local anesthesia. Whereas more bleeding was noted in EMLA group immediately after harvest of graft. Conclusions: EMLA cream can be effectively used as an alternative to local anaesthetic inltration for harvest of split thickness skin graft

scholarly journals Long-term results of surgical treatment of thyroid adenomas

2019 ◽  
Vol 100 (6) ◽  
pp. 892-897
Author(s):  
Stanislav Olegovich Artyukhin ◽  
Vladimir Georgievich Aristarhov ◽  
Denis Anatolyevich Puzin
Keyword(s):  
Surgical Treatment ◽  
Needle Aspiration ◽  
Long Term Results ◽  
Fine Needle ◽  
Thyroid Adenomas ◽  
Follicular Tumor ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Aim. To study the long-term results of surgical treatment of patients with thyroid adenomas. Methods. From 2004 to 2006, 667 patients with follicular adenomas of the thyroid gland, including 134 (20.1%) men and 533 (79.9%) women, were operated on in the surgical department №2 of city clinical hospital №11 of Ryazan. 3 groups of patients were defined: group 1 operated on for solitary adenomas of the thyroid gland, 103 patients, hemithyreoidectomy performed; group 2 operated on for multiple adenomas of the thyroid in both lobes, 101 patients, thyroidectomy performed; group 3 32 patients operated on for multiple adenomas of the thyroid in the same lobe, hemithyreoidectomy performed. Patients were examined 14 years after the surgery. Results. Hypothyroidism was diagnosed in: group 1 18 (17.5%) patients, group 2 101 (100%), group 3 0. All patients with hypothyroidism were compensated with hormone replacement therapy. Permanent hypoparathyroidism was diagnosed only in group 2 8 (4.8%) patients. Unilateral laryngeal paralysis was found in group 1 in 1 (0.9%) patient, group 2 in 2 (1.9%) patients, group 3 contained no such patients. Recurrence (node more than 1 cm according to ultrasound) was observed in group 1 in 12 (11.7%) patients; fine-needle aspiration found colloidal nodes in 8 (7.8%) patients (Bethesda II), in 4 (3.9%) follicular tumor (IV). Group 2 had no recurrences. In group 3 11 (34.3%) patients had recurrence; fine-needle aspiration found colloidal nodes in 1 (3.1%) patient (Bethesda II), in 10 (31.3%) follicular tumor (Bethesda IV). Conclusion. In solitary adenomas it is possible to perform organ-saving operations, which reduces the percentage of postoperative complications; in multiple adenomas, the optimal volume of surgery is thyroidectomy; when multiple adenomas are localized in one lobe, the chance of recurrence of the disease (31.3%) is high leading to re-surgery.

Is Antilymphocyte Globulin Useful in Conditioning Regimen of Unrelated Donor Hematopoïetic Stem Cell Transplantation?.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2067-2067
Author(s):  
Helene Esperou ◽  
Marie Lorraine Appert ◽  
Ibrahim Yacoub Agha ◽  
Noel Milpied ◽  
Norbert Ifrah ◽  
...  
Keyword(s):  
Stem Cell ◽  
Acute Gvhd ◽  
Conditioning Regimen ◽  
Multivariable Analysis ◽  
Hla Typing ◽  
Unrelated Donor ◽  
Allelic Differences ◽  
Group 2 ◽  
Grade Iii ◽  
Group 1

Abstract Between 1998 and 2004, 2141 allogeneic hematopoietic stem cell transplantations with unrelated donor (excluding cord blood) have been recorded on the SFGM-TC data base. The lack of unique behavior in regard of Anti Lymphocyte Globulin (ALG) use in unrelated donor transplants allowed us to perform a retrospective study to assess the influence of ALG in such grafts. To avoid biaises we excluded T cell depletion or monoclonal antibody use, reduced intensity conditioning and focused only on patients (pts) with acute leukemia (AL) and myelodysplasia (MDS). So we defined a study population of 553 pts. In addition, in order to analyze the actual impact of ALG on wellknown targets (engraftment, acute GvHD, relapse, survival) we choose to keep only the cases in which was available the allelic HLA typing (4 digits) for the recipient and the donor, i.e. 250 pts. There were 106 females and 144 males, allografted in 29 centers. The median age was 23 years (1–62) and there were 77 children under 15. There were 223 AL - myeloid n=120, lymphoid n=103 - and 27 MDS. The source of cells was bone marrow for 190 pts and peripheral mobilized stem cells for 60. One hundred and ninety-three pts received a conditioning regimen including Total Body Irradiation. Ninety-five pts received ALG (mainly Thymoglobulin Mérieux-Genzyme Lyon France at various doses) for a median of 3 days (group 1) and 155 did not (group 2). There were 189 donor/recipient pairs strictly HLA-matched 10/10, 49 with one allelic difference (HLA A n=13; HLA B n=8; HLA C n=13; HLA DRB1 n= 5; HLA DQB1 n=10 ), 11 with 2 allelic differences and 1 with 3 allelic differences. 238 pts have sustained engraftment at a median time of 20 days (9–41) without any influence of ALG use (97% vs 94% NS). Overall survival at 3 years was 45% in group 1 and 52% in group 2 (NS). The incidence of acute GvHD (grade II to IV) was similar in the two groups (59% vs 54%), but the incidence of acute GvHD (grade III to IV) was lower in group 1 (21% vs 32% p=0.03). Use of ALG did not affect rate relapse (18% vs 20% NS). In a multivariable analysis including HLA disparities, patient age, use of ALG, two factors appear as predictive for grade III–IV GvHD: HLA-identity (p=0.05) and use of ALG (p=0.02). These factors are not significant for survival in the same multivariable analysis but in this allelic matched population, the influence of ALG should be analyzed in regard of exact dose of ALG.

scholarly journals Duodenal Atresia: Open versus MIS Repair—Analysis of Our Experience over the Last 12 Years

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Salvatore Fabio Chiarenza ◽  
Valeria Bucci ◽  
Maria Luisa Conighi ◽  
Elisa Zolpi ◽  
Lorenzo Costa ◽  
...  
Keyword(s):  
Laparoscopic Repair ◽  
Intraoperative Complications ◽  
Down's Syndrome ◽  
Operating Time ◽  
Down’S Syndrome ◽  
Duodenal Atresia ◽  
Long Term Results ◽  
Open Approach ◽  
Group 2 ◽  
Group 1

Objective. Duodenal atresia (DA) routinely has been corrected by laparotomy and duodenoduodenostomy with excellent long-term results. We revisited the patients with DA treated in the last 12 years (2004–2016) comparing the open and the minimally invasive surgical (MIS) approach.Methods. We divided our cohort of patients into two groups. Group 1 included 10 patients with CDO (2004–09) treated with open procedure: 5, DA; 3, duodenal web; 2, extrinsic obstruction. Three presented with Down’s syndrome while 3 presented with concomitant malformations. Group 2 included 8 patients (2009–16): 1, web; 5, DA; 2, extrinsic obstruction. Seven were treated by MIS; 1 was treated by Endoscopy. Three presented with Down’s syndrome; 3 presented with concomitant malformations.Results. Average operating time was 120 minutes in Group 1 and 190 minutes in Group 2. In MIS Group the visualization was excellent. We recorded no intraoperative complications, conversions, or anastomotic leakage. Feedings started on 3–7 postoperative days. Follow-up showed no evidence of stricture or obstruction. In Group 1 feedings started within 10–22 days and we have 1 postoperative obstruction.Conclusions. Laparoscopic repair of DA is one of the most challenging procedures among pediatric laparoscopic procedures. These patients had a shorter length of hospitalization and more rapid advancement to full feeding compared to patients undergoing the open approach. Laparoscopic repair of DA could be the preferred technique, safe, and efficacious, in the hands of experienced surgeons.

scholarly journals Shear bond strength of metallic brackets bonded to enamel pretreated with Er,Cr:YSGG LASER and CPP-ACP

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yomna A. Nabawy ◽  
Tarek N. Yousry ◽  
Nadia M. El-Harouni
Keyword(s):  
Bond Strength ◽  
Shear Bond Strength ◽  
Preventive Measures ◽  
Synergetic Effect ◽  
Preventive Measure ◽  
Enamel Surface ◽  
Orthodontic Brackets ◽  
Control Group ◽  
Increased Risk ◽  
Group 2

Abstract Background Increased risk of enamel demineralization during and after orthodontic treatment raises the demand for better preventive measures including combinations of laser, CPP-ACP, and fluoride. The combination of Er,Cr:YSGG laser with CPP-ACP was proved to have a synergetic effect compared to each of them alone. Shear bond strength (SBS) of orthodontic brackets bonded to the enamel surface after being treated with preventive measures is critical. The aim of this study was to compare the SBS and failure mode of metallic brackets bonded to teeth with no pretreatment and pretreated enamel surface, either with Er,Cr:YSGG laser alone or combined with CPP-ACP. Methods Sixty sound extracted human premolar teeth were allocated randomly to 3 groups: In Group 1 (control), teeth were etched and bonded directly; in Group 2, laser pretreatment of the enamel surface was done followed by etching and bonding as in the control group; in Group 3, the enamel surface was lased then CPP-ACP was applied according to the manufacturer instructions, etched and bonded. SBS and Adhesive remnant index (ARI) were evaluated. Results No significant differences were found between the 3 groups neither in the SBS nor in the ARI scores. Conclusions The use of combined Er,Cr:YSGG laser with CPP-ACP as a preventive measure before bonding orthodontic brackets does not endanger the bracket’s bonding strength.

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