ABSTRACT
@#The standardized workflow of computer-aided static guided implant surgery includes preoperative examination, data acquisition, guide design, guide fabrication and surgery. Errors may occur at each step, leading to irreversible cumulative effects and thus impacting the accuracy of implant placement. However, clinicians tend to focus on factors causing errors in surgical operations, ignoring the possibility of irreversible errors in nonstandard guided surgery. Based on the clinical practice of domestic experts and research progress at home and abroad, this paper summarizes the sources of errors in guided implant surgery from the perspectives of preoperative inspection, data collection, guide designing and manufacturing and describes strategies to resolve errors so as to gain expert consensus. Consensus recommendation: 1. Preoperative considerations: the appropriate implant guide type should be selected according to the patient's oral condition before surgery, and a retaining screw-assisted support guide should be selected if necessary. 2. Data acquisition should be standardized as much as possible, including beam CT and extraoral scanning. CBCT performed with the patient’s head fixed and with a small field of view is recommended. For patients with metal prostheses inside the mouth, a registration marker guide should be used, and the ambient temperature and light of the external oral scanner should be reasonably controlled. 3. Optimization of computer-aided design: it is recommended to select a handle-guided planting system and a closed metal sleeve and to register images by overlapping markers. Properly designing the retaining screws, extending the support structure of the guide plate and increasing the length of the guide section are methods to feasibly reduce the incidence of surgical errors. 4. Improving computer-aided production: it is also crucial to set the best printing parameters according to different printing technologies and to choose the most appropriate postprocessing procedures.
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Using digital technologies in concurrently performing missing tooth implantation and preparation of remaining teeth is a solution to reduce the number of visits and improve efficiency. This paper proposes a digital process for simultaneously implanting and preparing teeth. It integrates implant surgical guide and 3D-printed tooth preparation guide into a single guide and completes guided implant placement and precise tooth preparation. Based on "repair-oriented" virtual implant planning, the implant surgical guide can improve the efficiency and predictability of implant placement, and its linear accuracy is about 1 mm. The tooth preparation guide precisely guides tooth preparation and restoration space visualization, ensuring the quality of the tooth preparation. The two guides have different design accuracy requirements, and thus their combination improves the overall guiding accuracy requirements. The concurrent application of the two guides minimizes the clinical operation time, number of visits, and economic burden of patients.
Subject(s)
Humans , Surgery, Computer-Assisted , Dental Implantation, Endosseous , Printing, Three-Dimensional , Technology , Tooth Preparation , Computer-Aided Design , Dental Implants , Imaging, Three-Dimensional , Cone-Beam Computed TomographyABSTRACT
A 63-year-old male patient, who had a severely resorbed edentulous maxillary arch and partially edentulous mandibular arch decided on the implant-supported fixed treatment option to replace the edentulous maxillary arch. The fully guided implant placement that utilizes the computer-generated guide is more accurate than traditional surgical guides and free-hand placements. The researchers have correlated possible implant failure risk factors with age, sex, smoking, type of edentulism, bone quality and volume, implant location, angulation, diameter, length, and various systemic factors. This case report demonstrated the failure cause of virtually planned anterior implants in All-on-4 and how to manage it by free-hand surgery without surgical guides.
ABSTRACT
Não existem evidências suficientes, para recomendar um regime analgésico específico, para o controle da dor em analgesia preemptiva, após cirurgia de implante dentário. Isto sinaliza a necessidade de estudos adicionais. Esta pesquisa apresenta dois estudos com objetivos distintos: (1) avaliar a eficácia da analgesia preemptiva em cirurgias de implantes dentais por meio de uma revisão sistemática e meta-análise de ensaios clínicos randomizados. (2) avaliar e comparar por meio de um ensaio clínico randomizado (ECR), paralelo, controlado por placebo, a efetividade da analgesia preemptiva em cirurgias de implantes dentais unitários, buscando identificar dentre os analgésicos e anti-inflamatórios não esteroidais (AINES) [eterocoxibe (ETERO), ibuprofeno (IBU), nimesulida (NIME) e acetaminofeno (ACETA)], qual possui maior eficácia no alívio da dor pós-operatória e na redução do uso da medicação de resgate comparados ao uso do placebo. Esta revisão sistemática com meta-análise seguiu as diretrizes PRISMA e foi registrada no PROSPERO (CRD42020168757). Cinco estudos foram incluídos na revisão e quatro foram incorporados à meta-análise. Uma meta-análise de efeito randômico comparou a eficácia da medicação preventiva em comparação ao placebo. Para a interpretação dos resultados utlizamos a certeza da evidência usando a abordagem Grading of Recommendations, Assessment, Development and Evaluation (GRADE) e a magnitude do efeito, de acordo com as diretrizes do GRADE. Todos os estudos demonstraram que a medicação preemptiva contribuiu para uma melhora significativa da dor pós-operatória. No entanto, o desvio médio padrão (DMP) geral agrupado mostrou, que, a medicação preventiva teve um efeito pequeno em comparação com o placebo, na redução da dor (DMP: -0,43; IC: -0,71; -0,15), com baixa certeza da evidência. Essa metanálise mostrou que a magnitude do efeito foi maior seis a oito horas após a cirurgia (efeito grande), comparada ao tempo de uma a duas horas, após a cirurgia (efeito pequeno). Concluiu-se que a analgesia preventiva pode ter um efeito positivo na redução da dor em comparação ao não uso de medicação preemptiva. No entanto, as evidências são ainda insuficientes. O ECR com inserção de implante dental unitário envolveu 135 indivíduos, com média de idade de 57,1 (±11,2), de ambos os gêneros alocados em 5 grupos (ETERO, IBU, NIME, ACETA e placebo). A ocorrência, tempo e a intensidade da dor foram analisados por meio testes de teste Qui-quadrado, Exato de Fisher, ANOVA e modelos de equações de estimativas generalizadas quando adequados. Todos os medicamentos testados proporcionaram um efeito benéfico da analgesia preemptiva. Isso foi demonstrado pela redução da dor pós-operatória e do menor uso de medicação de resgaste. O grupo IBU apresentou significativamente maiores escores de dor que os outros três grupos testes (IBU>ETERO=NIME=ACETA), que foram equivalentes entre si. Apesar da ocorrência de significância estatística, do ponto de vista da relevância clínica, a diferença entre os grupos foi pequena e todos os grupos apresentaram baixos escores de dor. Assim, sugerimos que a tomada de decisão em relação à escolha do medicamento deve considerar, também, a relação de custo-benefício, efeitos adversos e características individuais dos pacientes. Em adição, estudos futuros em cirurgias implantodônticas extensas (maior número de implantes inseridos e com enxertos ósseos/gengivais) apresentando alto rigor metodológico, ainda se faz necessário. (CAEE 83534618.5.0000.5149)
There is insufficient evidence to recommend a specific analgesic regimen for pain management in preemptive analgesia after dental implant surgery, signaling the need for further studies. This research presents two studies with different objectives: (1) to evaluate the effectiveness of preemptive analgesia in dental implant surgeries through a systematic review and meta-analysis of randomized clinical trials. (2) to evaluate and compare, through a randomized clinical trial (RCT), parallel, controlled by placebo, the effectiveness of preemptive analgesia in single dental implant surgeries, seeking to identify among analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) [ eterocoxib (ETERO), ibuprofen (IBU), nimesulide (NIME) and acetaminophen (ACETA)], which is more effective in relieving postoperative pain and reducing the use of rescue medication compared to the use of placebo. The systematic review with meta-analysis was conducted by PRISMA guidelines and registered in PROSPERO (CRD42020168757). Five studies were included in the review and four were incorporated into the meta-analysis. A random-effect meta- analysis compared the effectiveness of preventive medication compared to placebo. The interpretation of the results followed the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach together with the magnitude of the effect according to the GRADE guidelines. All studies demonstrated that preemptive medication contributed to a significant improvement in postoperative pain. However, the pooled overall mean standard deviation (SMD) showed that preventive medication had a small effect compared with placebo in reducing pain (SMD: -0.43; CI: -0.71; -0.15) with low certainty of evidence. Our meta-analysis showed that the magnitude of the effect was greater six to eight hours after surgery (large effect), compared to one to two hours after surgery (small effect). It was concluded that preventive analgesia can have a positive effect in reducing pain compared to not using preemptive medication, but the evidence is still insufficient. The RCT with single dental implant insertion involved 135 individuals, with a mean age of 57.1 (±11.2), of both genders allocated into 5 groups (ETERO, IBU, NIME, ACETA and placebo). The occurrence, duration and intensity of pain were analyzed using Chi- square, Fisher's Exact, ANOVA and generalized estimating equation models when appropriate. All drugs tested provided a beneficial effect of preemptive analgesia demonstrated by reduced postoperative pain and reduced use of rescue medication. The IBU group had significantly higher pain scores than the other three test groups (ETERO, NIME and ACETA), which were equivalent to each other. Despite the occurrence of statistical significance, from the point of view of clinical relevance, the difference between the groups was small and all had low pain scores. Thus, we suggest that the decision making regarding the choice of medication should also consider the cost-benefit ratio, adverse effects and individual characteristics of patients. In addition, future studies in extensive implant dentistry surgeries (greater number of implants inserted and with bone/gingival grafts) presenting high methodological rigor are still necessary. (CAEE 83534618.5.0000.5149)
Subject(s)
Pain, Postoperative , Dental Implants , Systematic Review , AnalgesiaABSTRACT
Identifying the ideal implantation site is important for the long-term stability and effectiveness of follow-up restorations. Implant surgical guide and navigation are used to determine the implantation site in clinic and improve the precision of implantation. However, due to difficulties in digital methods, such as multiple procedures, high cost, and actual accuracy of more than 1 mm, many physicians still prefer to operate with free hand. In preoperative, intraoperative, and postoperative procedures, time-saving and practical methods for implant site evaluation are lacking. In many cases, oral physicians found that the position deviates only by cone beam CT, which was costly to modify the position. In this article, we presented a precise implantation insertion technology that is guided by a measurable technique throughout the implantation application for all implant systems. This method was guided by a dynamic control measuring ruler, which functions together with the measuring and intraoperative locating rulers. The 3D space of the operative area was measured by a measuring ruler prior to operation, and the implant plan and quantitative guidance design were conducted according to the measured and cone beam CT data. The whole implantation process was guided by the dynamic control measuring ruler, and measuring verification results were also considered. This method can realize the quantification of the entire preoperative space analysis, intraoperative precise implantation guidance, and postoperative site measurement and evaluation. This practical technique also helps to adjust the position, improve the implantation accuracy and is suitable in generalizing dental implantation.
Subject(s)
Computer-Aided Design , Cone-Beam Computed Tomography , Dental Implantation, Endosseous , Dental Implants , Imaging, Three-Dimensional , Patient Care Planning , Surgery, Computer-AssistedABSTRACT
Objective@# To explore the cause and preventive measures of floor-of-mouth hematoma after dental implant placement. @*Methods@#The prevention of hematoma of the floor of the mouth in a case of lower anterior teeth implant placement was analyzed, and the literature was reviewed.@*Results@# Four mandibular vascular canals were found on the lingual side of the anterior mandible before dental surgery in the reported case. Two of them were quite thick (1.4 mm and 1.0 mm, respectively) and were located adjacent to the crest of the alveolar bone and superior to the mental spine. These two thick endosseous branches from the sublingual artery were dissected and ligated , and there was no obvious hematoma in the patients immediately after the operation and at the postoperative 3 d review. The results of the literature review show that the incidence of endosseous branches from the lingual vascular canal of the mandible is 90%-100%. The distribution of the vessels on the lingual side of the mandible is highly variable and adjacent to the lingual cortical plate. Accidental injury of the lingual cortical plate during implant surgery would probably lead to bleeding or hematoma on the floor of the mouth. @*Conclusion @#Mastering the anatomy of blood vessels on the floor of the mouth, elaboratively examining preoperative three-dimensional radiographic imaging, and cautiously exploring the lower jaw bone morphology after flap elevation are preventive measures to avoid damage to the arterial supply on the lingual side of the anterior lower jaw and to prevent complications of hematoma in the floor of the mouth.
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@#Patients seeking implantation often have several systemic diseases, which will introduce complications to treatment. This paper reviews the risk assessments and prevention of systemic diseases in patients with oral implant therapy with the relevant literature. The patients with cardiovascular diseases are prone to stroke and cardiac arrest, and anticoagulants and antihypertensive drugs will complicate cases. The potential risks of endocrine system diseases are infections and crises caused by unstable hormone levels. The risks of respiratory diseases are dyspnea and swallowing devices. The difficulty of treating patients with neuropsychiatric diseases is attributable to poor cooperation and adverse effects of the drugs. Bone and joint system diseases may decrease the success of implantation. Hematological system, digestive system and kidney diseases may lead to hemorrhage. By inquiring about detailed medical and medication history, evaluating vital signs and detecting important objective indicators, performing targeted measures, discussing with specialists, and observing patients closely, clinicians can avoid the abovementioned risks.
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Objective To investigate the effect of touch combined with acupoint massage on relieving anxiety and pain in patients undergoing oral implant surgery. Methods Seventy-two patients undergoing implant surgery who were eligible for inclusion were randomized into a treatment group and a control group using the envelope method, 36 in each one. The control group was given routine care, and the treatment group was treated with touch combined with acupoint massage on the basis of routine care for 20 minutes. State Anxiety Inventory (SAI) in the State-Trait Anxiety Inventory (STAI) was used to measure the intraoperative anxiety status of patients in the two groups. The degree of intraoperative pain was measured by verbal rating scales in both groups. Results The mean SAI score of the patients in the treatment group and the control group was 36.5±7.6 and 46.6±12.1, respectively, and the difference was statistically significant (t=4.219, P<0.05). In addition, the pain levels in the treatment group were significantly lower than those in control group (Z=-2.009, P<0.05). Conclusion The combination of touch and acupoint massage can effectively alleviate the anxiety and pain of patients and enhance the comfort of patients during oral implant surgery, which further ensure the safe and smooth operation.
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Computer aided design and manufacturing and implant surgery using a guide template improve restoration-driven implant treatment procedures. This case utilized those digital technologies to make definitive prostheses for a patient. According to the work flow of digital dentistry, cone beam computed tomography established the treatment plan, which was followed to make the guide template for implant placement. The template guided the implants to be installed as planned. The customized abutments and surveyed fixed restorations were digitally designed and made. The metal framework of the removable partial denture was cast from resin pattern using an additive manufacturing technique, and the artificial resin teeth were replaced with the zirconia onlays for occlusal stability. These full mouth rehabilitation procedures provided functionally and aesthetically satisfactory results for the patient.
Subject(s)
Humans , Computer-Aided Design , Cone-Beam Computed Tomography , Dentistry , Denture, Partial, Removable , Inlays , Mouth Rehabilitation , Mouth , Prostheses and Implants , Tooth , WorkflowABSTRACT
Objective@#To investigate the effect of touch combined with acupoint massage on relieving anxiety and pain in patients undergoing oral implant surgery.@*Methods@#Seventy-two patients undergoing implant surgery who were eligible for inclusion were randomized into a treatment group and a control group using the envelope method, 36 in each one. The control group was given routine care, and the treatment group was treated with touch combined with acupoint massage on the basis of routine care for 20 minutes. State Anxiety Inventory (SAI) in the State-Trait Anxiety Inventory (STAI) was used to measure the intraoperative anxiety status of patients in the two groups. The degree of intraoperative pain was measured by verbal rating scales in both groups.@*Results@#The mean SAI score of the patients in the treatment group and the control group was 36.5±7.6 and 46.6±12.1, respectively, and the difference was statistically significant (t=4.219, P<0.05). In addition, the pain levels in the treatment group were significantly lower than those in control group (Z=-2.009, P<0.05).@*Conclusion@#The combination of touch and acupoint massage can effectively alleviate the anxiety and pain of patients and enhance the comfort of patients during oral implant surgery, which further ensure the safe and smooth operation.
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PURPOSE: The image registration of radiographic image and digital surface data is essential in the computer-guided implant guide system. The purpose of this study was to examine the effects of using micro-screw on the working time and convenience of operators in the process of image matching for guided implant surgery. MATERIALS AND METHODS: A mandibular dental model was prepared in partial edentulism for Kennedy class I classification. Two micro-screws were placed on the each side of retromolar area. Radiographic and scan images were taken using computed-tomography and digital scanning. The images were superimposed by 12 operators in software in two different conditions: using remaining teeth image alone and using teeth and micro-screws images. Working time, operator convenience and satisfaction were obtained, and analyzed using the Mann-Whitney U test (α=.05). RESULTS: The working time was not statistically different between image registration conditions (P>.05); however, operator convenience and satisfaction were higher in the teeth and micro-screw assisted condition than in the teeth-alone assisted condition (P<.001). CONCLUSION: The use of microscrew for the image registration has no effect in working time reduction, but improves operator convenience and satisfaction.
Subject(s)
Classification , Models, Dental , ToothABSTRACT
@#With the increasing development of digital technologies, digital surgical templates have been widely used in stomatology. However, the accuracy of digital surgical templates is always a consideration for many researchers and dentists. This article analyzed the factors affecting the accuracy of digital surgical templates and found that errors arise from six factors, including the design and manufacture of the templates, implant guide support, implant systems and guide systems, implant length, bone density and the clinical experience of the operator; this literature review aims to reduce or eliminate human factors and improve accuracy, objectivity and security in implant placement.
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A common complaint after inflatable penile prosthesis surgery is reduced penile length. We previously reported how using the Coloplast Titan inflatable penile prosthesis with aggressive new length measurement technique (NLMT) coupled with postoperative IPP rehabilitation of the implant for 1-year helped to improve patient satisfaction and erectile penile measurements. This is a 2 years follow-up of a prospective, three-center, study of 40 patients who underwent Titan prosthesis placement, with new length measurement technique for erectile dysfunction. Patient instructions were to inflate daily for 6 months and then inflate maximally for 1-2 h daily for 6-24 months. Fifteen penile measurements were taken before and immediately after surgery and at follow-up visits. Measurement changes were improved at 24 months as compared to immediately postoperative and at 12 months. 67.8% of subjects were satisfied with their length at 2 years, and 77% had perceived penile length that was longer (30.8%) or the same (46.2%) as prior to the surgery. 64.3% and 17.9% of subjects had increased and unchanged satisfaction, respectively, with penile length as compared to prior to penile implant surgery. All but one subject (96.5%) was satisfied with the overall function of his implant. This study suggests using the Coloplast Titan with aggressive cylinder sizing, and a postoperative penile rehabilitation inflation protocol can optimize patient satisfaction and erectile penile measurements at 2 years postimplant.
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Periodontitis is a one of the commonly occurring disease. Various therapies have been used and suggested for its treatment which includes nonsurgical, antimicrobial, and surgical therapy. In the recent years, lasers have been used frequently for periodontal therapy. Lasers have been applied for debridement, reshaping as well as the reduction of bacterial load in the pocket. This case series represent the use of lasers for exposure of impacted teeth, second stage surgery for dental implant, and vestibuloplasty. The surgical procedure with a 810 nm diode laser has been described. The laser-assisted procedures provided excellent results without complications as well as high patient and clinician satisfaction.
Subject(s)
Adult , Dental Implantation/methods , Dental Implants , Female , Humans , Laser Therapy/instrumentation , Laser Therapy/methods , Male , Middle Aged , Periodontitis/surgery , Periodontitis/radiotherapy , Tooth, Impacted/surgery , Tooth, Impacted/therapy , Vestibuloplasty , Young AdultABSTRACT
This article describes how to use CBCT and an intraoral scanner in a fully edentulous case that enables the clinician to place implants with flapless guided surgery and to engage prefabricated, customized implant abutments at the time of implant surgery, with only 1 clinical consultation before implant surgery. The patient's existing denture is used to simulate the teeth, the soft tissue and the vertical dimension of occlusion, and jaw relationship in the fully edentulous jaw. It provides clinicians with a fast workflow and improves clinical efficiency.
Subject(s)
Humans , Dentures , Jaw , Jaw, Edentulous , Tooth , Vertical DimensionABSTRACT
OBJECTIVES: The aim of this study is to determine the incidence, location, and orientation of maxillary sinus septa in formalin embalmed cadavers. MATERIALS AND METHODS: The study was conducted on 210 cadaveric heads available in our department. After taking the mid-sagittal section the specimens were opened from the medial aspect and the sinus cavity was explored for the presence of maxillary sinus septa, their anatomical plane, location and dimensions. RESULTS: The mean linear distance between maxillary sinus floor and its anatomical ostium was 26.76+/-5.21 mm and 26.91+/-4.96 mm on right and left side, respectively. A total of 59 maxillary sinus septa (28.1%) were observed in 210 maxillary specimens. Septae were most common, 33 septa (55.9%), in the middle region (between first and second molar tooth) of the sinus cavity. The maxillary sinus membrane (Schneiderian membrane) adhered tightly to the maxillary sinus and over the septae. Significantly more maxillary sinus septa were observed in edentulous maxillae in comparison to the dentate upper jaw. CONCLUSION: Knowledge of location of maxillary sinus ostium is mandatory for the rhinologist for drainage of secretions in maxillary sinusitis. The morphological details of maxillary sinus septa, particularly their location and anatomical planes, will guide dentists in performance of safe implant surgeries. The maxillary antrum septa of category I and II may complicate the procedure of inversion of bone plate and elevation of sinus membrane during maxillary augmentation surgeries. The category III septa observed in the sagittal plane were embedded by one of the branches of the infraorbital nerve in it, and if accidentally cut will lead to infraorbital nerve palsy in maxillary sinus surgeries.
Subject(s)
Humans , Bone Plates , Cadaver , Dentists , Drainage , Formaldehyde , Head , Incidence , Jaw , Maxilla , Maxillary Sinus , Maxillary Sinusitis , Membranes , Molar , ParalysisABSTRACT
PURPOSE: The aim of this study was to evaluate the heat generation in bone in vitro during the guided flapless drilling procedure and the effect of drilling methods on the heat generation. MATERIALS AND METHODS: A model that has missing the first and second mandibular molars bilaterally was used. In group A, classical flap implant surgery was performed. In group B, flapless implant surgery using surgical guide was performed. In group C, flapless implant surgery using surgical guide without up-and-down pumping motion was performed. Temperature was measured with k-type thermocouple and a real-time digital thermometer. The thermocouples were placed at 0.5 mm away from the osteotomy area at the depths of 3 mm and 6 mm. The measured values were evaluated with independent t-test. RESULTS: The mean temperature generated was 27.2degrees C (SD +/- 2.1degrees C) and 27.5degrees C (SD +/- 2.3degrees C) for groups A and B, respectively. These differences were not statistically significant. In group C, the mean temperature was 37.0degrees C (SD +/- 3.4degrees C). There were statistically significant differences between groups B and C with respect to the mean temperature. CONCLUSION: These findings suggest that guided flapless drilling with up-and-down pumping motion may not significantly increase the bone temperature.
Subject(s)
Dental Implants , Hot Temperature , Mandrillus , Molar , Osteotomy , ThermometersABSTRACT
La colocación de implantes dentales osteointegrados y la retención de las prótesis estomatológicas convencionales de acrílico es un grave problema en pacientes con reborde alveolar atrófico. La distracción osteogénica ofrece en la actualidad una solución potencial ante la severa pérdida de tejido óseo alveolar. Este estudio tuvo el propósito de evaluar en nuestro medio la Efectividad y Estabilidad de la osteogénesis alveolar. Se realizó un ensayo clínico Fase II. Fueron tratados 5 pacientes con atrofia del reborde alveolar mandibular o maxilar con distractores alveolares intraorales producidos por Walter Lorenz Surgical, Inc, (ROTT-NELSON-1713-06-04) para inducir osteogénesis. Los pacientes fueron atendidos de forma ambulatoria. El período de latencia fue de 5 días, la tasa de distracción de 1mm diario y el período de contención de 4 semanas . La efectividad de la distracción aplicada fue 76.3% y la estabilidad de 92.0 %. La media de la distracción total obtenida fue 7,25 mm. La Distracción osteogénica resultó ser un método eficaz para lograr incremento de la cresta alveolar en pacientes que presentaron atrofias previas.
The bone integrated dental implants placement and the conventional acrylic estomatological prosthesis is a serious problem in patients with an atrophic alveolar edge. Ostheogenic distraction currently offers a potential solution to the severe loss of alveolar bone tissue. This study had the purpose of evaluate the effectiveness and stability of alveolar ostheogenesis. A Clinical Trial Phase II was conducted. Five patients with an atrophy of the jaw bone or maxillary alveolar edges were treated with intraoral alveolar distracters produced by Walter Lorenz Surgical Inc.(Rott-Nelson-1703-06-04) to induce ostheogenesis. They were all out patients. The latency period was of 1 mm/day and the contention period of 4 weeks. The effectiveness of the applied distraction was of a 76.3% and the stability of a 92.0%. The average of the total distraction obtained was of 7,25 mm. Ostheogenic distraction was an efficacious method to achieve the alveolar dent in patients with previous atrophy.
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PURPOSE: To evaluate the change in corneal endothelial cells after Ahmed glaucoma valve implantation. METHODS: We prospectively evaluated the change in density and shape of the corneal endothelium of 35 eyes of 35 patients those underwent Ahmed glaucoma valve implantation for the treatment of refractory glaucoma. All surgeries were performed by one surgeon. The corneal specular microscopy was performed by non-contact specular microscope before surgery and 1 month, 6 months and 12 months after surgery. Evaluation was performed on the superior, superotemporal, superonasal and central area of the cornea in both eyes at each test. RESULTS: The mean follow-up was 12.1 months (range, 6~24 months). There was a statistically significant decrease in corneal endothelial cell density in operated eye compared to the other eye. Mean percentage decrease in corneal endothelial cell count of operated eye was 5.5% at 1 month, 9.7% at 6 months, and 14.8% at 12 months after surgery. The superotemporal area, which was the closest site from the tube, showed the greatest decrease of endothelial cell density by 17.4%, while the central cornea showed the lowest decrease by 12.8% in 1 year after surgery. The morphological evaluation of the endothelial cells by coefficient of variation and hexagonality suggested the cell were getting stabilized in 1 year after surgery, although the change was not statistically significant. CONCLUSIONS: There was a statistically significant corneal endothelial cell loss in operated eye compared to the other eye after Ahmed glaucoma valve implant surgery. The corneal endothelial cell loss was increased in time up to 14.8% at 1 year after surgery.
Subject(s)
Humans , Cornea , Corneal Endothelial Cell Loss , Endothelial Cells , Endothelium, Corneal , Follow-Up Studies , Glaucoma , Microscopy , Prospective StudiesABSTRACT
PURPOSE: To compare the results of mitomycin C trabeculectomy and Ahmed valve implant surgery for neovascular glaucoma (NVG). METHODS: We reviewed the medical records of 58 patients (66 eyes) with NVG who had undergone mitomycin C trabeculectomy or Ahmed valve implant surgery in the previous 5 years. Trabeculectomy (A group) was performed in 27 eyes of 24 patients and valve implant surgery (B group) in 39 eyes of 34 patients. Intraocular pressure (IOP), visual acuity, complications and the rate of surgical success of the two groups were compared. IOP under 21 mmHg without medication was considered as complete success (CS), under 21 mmHg with medication as qualified success (QS), and IOP over 22 mmHg despite medication as failure (F). RESULTS: IOP at postoperative 2 months was lower in the trabeculectomy group than in the drainage implant surgery group (16.4 +/- 11.3 mmHg, 20.9 +/- 8.7 mmHg, P=.087), but at 12 months, there was no statistically significant difference (18.4 +/- 11.5 mmHg, 17.0 +/- 6.4 mmHg, P=.608). Visual acuity also showed no significant difference. The respective rate of success between A and B groups was 66.7% and 38.5% (CS), 25.9% and 33.3% (QS), and 7.4% and 28.2% (F), at postoperative 2 months, and 47.8% and 42.3% (CS), 30.4% and 46.2% (QS), and 21.7% and 11.5% (F), at 12 months. The most common postoperative complication was hyphema in both groups, while other complications were shallow anterior chamber, valve problems, etc. CONCLUSIONS: The type of surgery had no significant effect on the success rate of neovascular glaucoma treatment at postoperative 12 months.