Management of a complication with Partial Extraction Therapy: A Clinical Case Letter and Clinical Recommendations

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On the Ten-Year Success in the Application of Partial Extraction Therapy: A Systematic Review

Hürzeler presented the socket-shield technique (SST) more than 10 years ago. The partial extraction therapy (PET), a collective concept of utilizing the patient’s own tooth root to preserve the periodontium and peri-implant tissue, has been remarkably developed. PET comprises a group of novel techniques for post-extraction implant placement. Several modifications of PET and simultaneous implant placement have been presented since its inception. Since its origin, several alterations have been employed in the methodology of partial extraction of the root and the simultaneous implant placement. A repeatable, predictable protocol is needed to provide tooth replacement in esthetic dentistry. Moreover, a standardized procedure provides a good framework for clinicians to report data relating to the technique with procedural consistency. This review aims to illustrate a reproducible and systematic protocol for the PET techniques with immediate implant placement at the aesthetic zone. The most used technique is the socket-shield technique, which is potentially offers promising results, minimizing the necessity for invasive bone grafts round implants in the aesthetic area, clinical data to support this is very inadequate. The limited research data existing is cooperated by a deficiency of well-designed prospective randomized controlled investigations. The present case studies and techniques are of actual incomplete technical value. Retrospective studies published in limited records but are of inconsistent plan. At this point, it is indistinct whether the socket-shield technique will offer a stable long-time outcome or not

Partial Extraction Therapy: A Review of Human Clinical Studies

Partial extraction therapy (PET) is a collective concept encompassing a group of surgical techniques including socket shield, root membrane, proximal shield, pontic shield and root submergence. PET utilizes the patient’s own root structure to maintain blood supply derived from the periodontal ligament complex in order to preserve the periodontium and peri-implant tissues during restorative and implant therapy. This review aims to summarize current knowledge regarding PET techniques and present a comprehensive evaluation of human clinical studies in the literature. Two independent reviewers conducted electronic and manual searches until January 1 st , 2021 in the following electronic bibliographic databases: PubMed, EMBASE, and Dentistry & Oral Sciences Source. Grey literature was searched to identify additional candidates for potential inclusion. Articles were screened by a group of 4 reviewers using the Covidence software and synthesized. Systematic search of the literature yielded 5,714 results. 64 articles were selected for full-text assessment, of which, 42 eligible studies were included in the review. 12 studies were added to the synthesis after manual search of the reference lists. A total of 54 studies were examined in this review. In sum, PET techniques offer several clinical advantages: 1) preservation of buccal bone post-extraction and limitation of alveolar ridge resorption 2) mitigation of the need for invasive ridge augmentation procedures 3) soft tissue dimensional stability and high esthetic outcomes. Further randomized clinical studies with larger sample sizes are needed to improve understanding of the long-term clinical outcomes of PET.

92. Characteristics and Outcomes of Deep Brain Stimulation Device Related Infections: Experience from Quaternary Centers

Background Increasing use of deep brain stimulation (DBS) over the past 20 years is paralleled by a rise in DBS infections. There is a paucity of data on the diagnosis, management, and outcomes in such infections. We describe our center’s experience with DBS infections. Methods Adults ( >18 years) diagnosed with DBS associated infection between January 1, 2000 and May 1, 2020 were retrospectively reviewed. Data on patient demographics, clinical presentation, microbiology, and management was collected. Results Seventy cases were identified (table 1). The mean age at diagnosis was 58.9 ± 16.5 years. The bulk were free of comorbidities. Parkinson’s disease and essential tremors were the most common indications for DBS placement. The median time from implantation to infection was 4 months [IQR 1,24]. The neurotransmitter and extension wires were the most frequently infected parts. A microbiological diagnosis was made in 89% of cases, 47% of which were polymicrobial. The most commonly identified organisms were Staphylococcus aureus, Cutibacterium acnes, and coagulase-negative staphylococci. For patients with deep infection, 71% had complete device extraction, 20% partial extraction, and 9% device retention; clinical cure at 3 months occurred in 97%, 64% and 100%, respectively (figure 1). On the other hand, 93% of patients with superficial infection had device retention; cure at 3 months was seen in 64% (figure 2). Suppressive oral antibiotics were rarely used, 45% of patients with partial extraction and 26% with device retention. DBS was reimplanted in 71% of patients after complete extraction and led to reinfection in 30% at 1 year follow up. Median time to reimplantation was 2.7 months. All patients who failed at 3 months in the partial extraction and device retention cohorts subsequently underwent complete device removal leading to clinical cure sustained at 1 year follow up. Conclusion All patients who had complete extraction achieved clinical cure at 3-months follow-up, while high failure rates occurred in those with device retention. Most infections were polymicrobial and predominantly caused by gram-positive pathogens. Thirty percent of patients with re-implantation after complete device extraction developed re-infection within 1 year. Disclosures All Authors: No reported disclosures

Estimates of Victim Surface Area and Associated Extraction Force for Partial Entrapment in Grain

HighlightsEight selected anthropometric landmarks were useful for estimating victim surface area and entrapment depth.Surface area estimates for a partially entrapped male victim ranged from 0.0716 to 2.7296 m2.Partial extraction force estimates for a male victim ranged from 0.29 to 3,693 N.Partial extraction force estimates were 18% greater on average when including the arm surface area than when not including the arms.Abstract. A prediction model for estimating extraction forces on entrapped victims was enhanced and modernized in 2018 from the original 1985 model. The prediction model was divided into two conditions based on the victim’s relative position to the grain surface. The first condition was when the victim is completely below the grain surface. The second condition was when the victim’s shoulders are above the grain surface; this condition is the focus of this research. A variable in the prediction model that changes with the depth of entrapment is the surface area of the victim. A sample of 60 male models was used to approximate the human surface area at optimal discrete positions selected based on visually identifiable anthropometric landmarks. The surface area estimates for those 60 partially entrapped male models ranged from 0.0716 to 2.7296 m2. Extraction forces for twelve partially entrapped male body types with various combinations of stature and body mass index were calculated. The extraction forces were calculated for conditions when the victim’s arms were raised (above the grain) and lowered (in the grain). Results from the prediction model showed that surface area contributed less to the partial extraction force for short underweight bodies than for tall extremely obese bodies. At the lower landmarks, i.e., medial malleolus (MM) and knee crease (KN), surface area did not contribute noticeably to the partial extraction force. The contribution of surface area was not noticeable until the victim was buried up to the crotch (landmark CR). Keywords: Farm safety, Grain entrapment, Prediction model, Rescue, Safety.