Stability of immediately loaded 3 mm long miniscrew implants: a feasibility study

ABSTRACT Introduction: Shorter miniscrew implants (MSIs) are needed to make orthodontics more effective and efficient. Objective: To evaluate the stability, insertion torque, removal torque and pain associated with 3 mm long MSIs placed in humans by a novice clinician. Methods: 82 MSIs were placed in the buccal maxillae of 26 adults. Pairs of adjacent implants were immediately loaded with 100g. Subjects were recalled after 1, 3, 5, and 8 weeks to verify stability and complete questionnaires pertaining to MSI-related pain and discomfort. Results: The overall failure rate was 32.9%. The anterior and posterior MSIs failed 35.7% and 30.0% of the time, respectively. Excluding the 10 MSIs (12.2%) that were traumatically dislodged, the failure rates in the anterior and posterior sites were 30.1% and 15.2%, respectively; the overall primary failure rate was 23.6%. Failures were significantly (p= 0.010) greater (46.3% vs 19.5%) among the first 41 MSIs than the last 41 MSIs that were placed. Excluding the traumatically lost MSIs, the failures occurred on or before day 42. Subjects experienced very low pain (2.2% of maximum) and discomfort (5.5% of maximum) during the first week only. Conclusions: Shorter 3 mm MSIs placed by a novice operator are highly likely to fail. However, failure rates can be substantially decreased over time with the placement of more MSIs. Pain and discomfort experienced after placing 3 mm MSIs is minimal and temporary.

RESUMO Introdução: Mini-implantes (MIs) mais curtos são necessários para uma Ortodontia mais eficiente e efetiva. Objetivo: Avaliar a estabilidade, torque de inserção e de remoção e dor associada a MIs de 3mm instalados em humanos por um ortodontista principiante. Métodos: 82 MIs foram instalados na região vestibular da arcada superior de 26 adultos. Pares de mini-implantes adjacente receberam carga imediata de 100g. Após 1, 3, 5 e 8 semanas, os pacientes foram reavaliados para verificar a estabilidade e preencher um questionário sobre a dor e o desconforto relacionados aos MIs. Resultados: A taxa geral de falhas foi de 32,9%, sendo de 35,7% para os MIs anteriores e 30% para os MIs posteriores. Excluindo os 10 MIs que foram perdidos por trauma (12,2%), a taxa de falha nas regiões anterior e posterior foram de 30,1% e 15,2%, respectivamente e ocorreram no 420 dia ou antes. A taxa geral de falha primária foi de 23,6%. A taxa de falha foi significativamente maior (p=0,010) nos primeiros 41 MIs do que nos 41 últimos (46,3% vs. 19,5%). As experiências relacionadas à dor foram baixas (2,2% máximo), assim como ao desconforto (5,5% máximo) durante a primeira semana. Conclusão: MIs de 3mm instalados por um novato são mais propensos a falhas. Porém, as taxas de falha podem diminuir substancialmente com a instalação de mais MIs com o decorrer do tempo. A dor e o desconforto após a instalação desses dispositivos são mínimos e temporários.

Caudal block using Ropivacaine with or without Tramadol in children for lower abdominal and lower limb surgery.

Background: Caudal anaesthesia is a useful adjunct to general anaesthesia for lower abdominal surgery in children as it provides intraoperative analgesia, smooth recovery period and good post-operative pain control which reduces Perioperative narcotic requirements. Aims & Objective: This Study was designed to evaluate duration of analgesia of Ropivacaine and Ropivacaine with Tramadol administered caudally for postoperative pain relief in children. Materials and Methods: Study was conducted in 60 paediatric patients of either sex belonging to ASA grade I or II in the age group 1 to 6 years scheduled for elective lower abdominal and lower limb surgery. Patients were randomly selected by sealed envelope method and divided into two groups of thirty patients each. Group RS received 0.2% Ropivacaine, 1 ml/kg with saline 0.04 ml/kg and Group RT received 0.2% Ropivacaine, 1 ml/kg with Tramadol 2 mg/kg by caudal route immediately after induction of general anaesthesia. Vitals and oxygen level was monitored. The analgesic effect of the caudal block was evaluated by using the observational Pain discomfort Scale and Four Point Sedation Score was used for assessment of sedation after extubation at 30 minutes and at 1, 2, 4, 6, 12 and 24 hrs. The time for the first analgesic requirement and side effects in 24 hours period were recorded. Results: Duration of analgesia was longer in Group RT [19.21 ± 2.25 hours] as compared to Group RS [6.38 ± 0.897 hours] (p<0.01). There were no significant changes in heart rate, blood pressure and oxygen saturation between two groups. Conclusion: Caudal Tramadol 2 mg/kg, combined with 0.2% Ropivacaine, 1ml/kg, provides longer duration of postoperative analgesia as compared to 0.2% Ropivacaine alone in children undergoing lower abdominal and lower limb surgery.