Post exenteration surgery rehabilitation with orbital prosthesis – A case report

Orbital defects with total loss of eyelids and the eyeball cannot be satisfactorily repaired by reconstructive surgery. Therefore, a prosthetic placement is the treatment of choice to return the individual’s confidence by producing an acceptable and lifelike appearance. Male patient, 31 years old, came with history of exenteration surgery four months ago on right eye because of infection few years before. Patient wanted orbital prosthesis to improve esthetic and self-confidence. He lost his right eye ball and some part of right eyelid. Treatment of choice that would be fabricated was orbital prosthesis with medical adhesive retention support. Orbital prosthesis was one of the alternative that can be chose to reconstruct orbital defect. The success of the prosthesis was determined by the exactness of diagnosis, treatment plan determination, material selection, determination of prosthesis retention, and technique in processing the prosthesis.

Dental Implant Abutments and Their Selection - A Review

Dental implants have become the most promising and accepted prosthetic alternative to missing teeth. Innovative and technological advances in implant dentistry have improved the performance and long term prognosis of dental implants. The growing demand for dental implants has led many manufacturers to enter the industry. With this growth in implant dentistry various implant brands and their components are made available in the markets that vary in terms of design and other features. Success of implant restorations is related to various components involved with the prosthesis. Implant abutment is the link between implant and restoration; right selection of this abutment is vital for the success of implant prosthesis. There are varieties of implant abutments available in the market. Clinician should have adequate knowledge about these abutments and various factors that affect abutment selection, to choose the right one. Each implant case is different and clinician should be able to identify requirements of every individual case and choose the best suitable abutment available in the market. These abutments vary in implant abutment connection, material, type of retention, and fabrication methods. Though the ideal concept is prosthetically driven implant placement, many times anatomical features, esthetic requirements, soft tissue profile, axial load distribution, malpositioned implants, and many other patient factors do not allow ideal implant placement. Such cases can be managed by careful selection of abutments by assessing the clinical requirements, thus offering better treatment outcome. This paper is an attempt to contemplate various factors affecting abutment selection, and throw light on various implant abutments available in the market, thus guiding the clinician in abutment selection. Hence this article summarizes complete information about the implant abutments, including introduction, types, selection, and different abutments available in market. KEY WORDS Abutment Material, Implant Abutments, Implant Abutment Connection, Prosthesis Retention

Comparative Effect between Silesian Suspension and Total Elastic Suspension on GRF Loading in Subjects with Trans-Femoral Prosthesis: A Biomechanical Study

Background: The major function of all Suspension systems is Prosthesis retention. The suspension system prevents rotation, translation and vertical movement of the prosthesis in relation to the residual limb. The Silesian suspension and TES system that are commonly prescribed for Transfemoral amputees are believed to provide a better suspension. Nevertheless, their effect on Transfemoral amputees’ gait performance has not yet been fully investigated. The main intention of this study was to understand the potential effects of the Silesian suspension and TES systems on Transfemoral amputees on gait kinetics. Aim & Objective: To find out the effect of two types of suspension system on Gait Kinetics in subject with unilateral transfemoral amputee. Study Design: Two group post-test Comparative Experimental study design. (Quasi Experimental). Methods: 30 subjects with two different suspension systems such as Silesian suspension (Group-A) and Total Elastic Suspension (Group-B) was included in this study by convenient sampling method. All subjects walked with Endo skeletal design Trans femoral Prostheses gait training given called after 3 weeks. After that data regarding gait kinetics parameters was evaluated by Kistler Force Plate in dynamic position. Result: The results revealed that there is significant difference in gait kinetics parameters that GRF (Fx) mean shows no significantly difference between Group-A and Group-B (p= 0.582), GRF (Fy) mean shows non-significantly difference between Group-A and Group B (p=0.163) and GRF (Fz) mean shows non-significantly difference between Group-A and Group-B. Conclusion: The findings concluded that the study support the hypothesis that there were significant difference with two different suspension system on kinetic gait parameters. Key words: Transfemoral prosthesis, TES, Silesian suspension, Gait Kinetics.

Recent Advances in Myoelectric Control for Finger Prostheses for Multiple Finger Loss

The loss of one or multiple fingers can lead to psychological problems as well as functional impairment. Various options exist for replacement and restoration after hand or finger loss. Prosthetic hand or finger prostheses improve esthetic outcomes and the quality of life for patients. Myoelectrically controlled hand prostheses have been used to attempt to produce different movements. The available articles (original research articles and review articles) on myoelectrically controlled finger/hand prostheses from January 1922 to February 2021 in English were reviewed using MEDLINE/PubMed, Web of Science, and ScienceDirect resources. The articles were searched using the keywords “finger/hand loss”, “finger prosthesis”, “myoelectric control”, and “prostheses” and relevant articles were selected. Myoelectric or electromyography (EMG) signals are read by myoelectrodes and the signals are amplified, from which the muscle’s naturally generated electricity can be measured. The control of the myoelectric (prosthetic) hands or fingers is important for artificial hand or finger movement; however, the precise control of prosthetic hands or fingers remains a problem. Rehabilitation after multiple finger loss is challenging. Implants in finger prostheses after multiple finger loss offer better finger prosthesis retention. This article presents an overview of myoelectric control regarding finger prosthesis for patients with finger implants following multiple finger loss.

Controversy about the Role of Rifampin in Biofilm Infections: Is It Justified?

Rifampin is a potent antibiotic against staphylococcal implant-associated infections. In the absence of implants, current data suggest against the use of rifampin combinations. In the past decades, abundant preclinical and clinical evidence has accumulated supporting its role in biofilm-related infections.In the present article, experimental data from animal models of foreign-body infections and clinical trials are reviewed. The risk for emergence of rifampin resistance and multiple drug interactions are emphasized. A recent randomized controlled trial (RCT) showing no beneficial effect of rifampin in patients with acute staphylococcal periprosthetic joint infection treated with prosthesis retention is critically reviewed and data interpreted. Given the existing strong evidence demonstrating the benefit of rifampin, the conduction of an adequately powered RCT with appropriate definitions and interventions would probably not comply with ethical standards.

Screwed and cement implant prosthesis: current clinical considerations

ABSTRACT Introduction: There is no consensus as to which cemented or screwed retention system is best to avoid bone loss around the implant from a fixed implant-supported restoration. Objective: To evaluate the prosthesis retention systems on screw and cemented implants, regarding: bone loss, survival and failure rate, biological complications and microbiological analysis. Methods: A search was made for scientific articles that contemplated the subject through the databases Pubmed and SciELO, without period restriction. The titles, abstracts and then access to the full text has been verified. Results: It was found that excess cement may play an important role in the development of peri-implant disease. Technical failures are most seen in prosthesis retained by screws, and biological complications in cemented crowns. The success rate for both restraint systems is high, and retention-independent implant prosthesis treatment provides predictability. Conclusion: The appropriate retention system for the patient depends on several factors, including indication, advantages and disadvantages, retention provided, aesthetics and clinical performance.

Assessing the Role of Daptomycin as Antibiotic Therapy for Staphylococcal Prosthetic Joint Infection

Background: The role of daptomycin, a potent, safe, convenient anti-staphylococcal antibiotic, in treatment of prosthetic joint infection (PJI) is unclear. We evaluated our experience with the largest cohort of patients with staphylococcal PJI managed with daptomycin.Methods: A cohort of staphylococcal hip and knee PJI treated with daptomycin was identified by hospital records from 2009 to 2016. All cases met Musculoskeletal Infection Society International Consensus criteria for PJI. The primary endpoint was 2 year prosthesis retention. Univariate analyses and regression statistics were calculated.Results: 341 patients with staphylococcal PJI were analyzed. 154 two-stages (77%) and 74 DAIR procedures (52%) met criteria for treatment success at 2 years. 77 patients were treated with daptomycin, of which 34 two-stages (68%) and 15 DAIRs (56%) achieved treatment success. Pairwise and regression analysis found no association between treatment success and daptomycin use. Organism (DAIR only) and Charlson Comorbidity Index scores (DAIR and two-stage) were significantly associated with treatment outcome. Six daptomycin patients (7.8%) had adverse side effects.Discussion: Daptomycin fared no better or worse than comparable antibiotics in a retrospective cohort of staphylococcal hip and knee PJI patients, regardless of surgical strategy.Conclusion: The convenient dosing, safety, and potency of daptomycin make it an attractive antibiotic for staphylococcal PJI. However, these advantages must be weighed against higher costs and rare, but serious side effects.

Rates of periprosthetic infection and surgical revision in Beijing (China) between 2014 and 2016: a retrospective multicenter cross-sectional study

Background Periprosthetic joint infection (PJI) is a rare but devastating complication after total joint arthroplasty. There is a paucity of data on the incidence and prevalence of periprosthetic infection in mainland China. This study aimed to analyze the rates of surgical revision after arthroplasty due to PJI and the procedures followed in Beijing, China. Methods The study involved a retrospective multicenter cross-sectional survey of patients undergoing revisions for periprosthetic infection after hip/knee arthroplasty at nine hospitals in Beijing from 2014 to 2016. Age, gender, body mass index, primary diagnosis, comorbidity, primary surgery, treatment methods, and post-revision complications were analyzed. Results A total of 38,319 hip/knee arthroplasties and 366 (0.96%) revisions for PJI were identified. Of these, 161 (161/14,110; 1.14%) revisions involved hip arthroplasty, whereas 205 (205/24,209; 0.85%) revisions were due to knee arthroplasty. Procedures for revisions of infected hip included 7 (4.3%) cases of open debridement and prosthesis retention, 32 (19.9%) cases of one-stage exchange, 121 (75.2%) cases of two-stage exchange, and 1 (0.007%) case of hip dissection. As for the infected knee, the procedures included 45 (22.0%) cases of open debridement and prosthesis retention, 13 (6.3%) cases of one-stage exchange, 143 (69.8%) cases of two-stage exchange, and 4 (0.02%) cases of knee fusion. Conclusions The study found the rates of revision due to PJI to be low. Nonetheless, the incidence of PJI in mainland China could be higher and calls for more elaborate studies in geographically and socioeconomically diverse health institutions.

Mini-dental implants for definitive prosthesis retention — A synopsis of the current evidence

Background: This narrative review provides an evidence-based overview of the comparison between mini-dental implants (MDI) and conventional dental implants for definitive prosthesis retention. In addition, recommendations are made on whether the use of reduced diameter dental implants is more appropriate. Method: A literature review was conducted via electronic search addressing the following topics: (1) osseointegration, (2) peri-implant soft tissue characteristics, (3) biomechanics, (4) implant survival and (5) implant success. Conclusion: The procedure for dental implant prosthetic rehabilitation should preferentially include conventional dental implants (i.e. [Formula: see text][Formula: see text]mm fixture diameter). Small (3–3.25[Formula: see text]mm) and narrow (3.3–3.5[Formula: see text]mm) dental implants should primarily be used in non-load-bearing regions. MDI ([Formula: see text][Formula: see text]mm) should be considered to retain definitive prosthesis, only for reasons of anatomy or patient-centred preferences and as a last resort. If MDI are to be used, patients should be made aware of the lack of long-term, high-quality evidence as a part of the informed consent process and that most of the prospective data available pertain to MDI retaining complete dentures.