Implantes endodónticos - Vitalium vs. Titanio Caso clínico con un seguimiento de 18 años / Endodontic implants-Vitallium vs. Titanium Clinical case with 18 years follow-up

Resumen Una de las primeras consideraciones en la Odontología moderna, es preservar y mantener los dientes naturales, por lo que se han buscado técnicas alternativas que permiten conservar los órganos dentales en boca, el mayor tiempo posible. Por esta razón, se presenta un caso clínico donde se logra salvar dos piezas dentales anteriores, que poseían una movilidad grado tres, posterior a un tratamiento ortodóntico que le habían mantenido al paciente por más de dos años. Este caso, se resolvió exitosamente por medio de dos implantes endodónticos: uno de vitalium y otro de titanio, dándole un seguimiento de más de 18 años. A continuación, se expone una técnica de manejo y colocación de estabilizadores endodónticos, tomando en consideración indicaciones y contraindicaciones.

Abstract One of the first and main considerations in modern odontology, is to preserve and maintain natural teeth, reason why alternative techniques have been searched, to preserve dental organs in mouth, as long as possible. That is why this article presents a clinical case where two frontal dental pieces, that had mobility in grade three were saved, after an orthodontic treatment -maintained for more than two years- was removed. The case was successfully solved through two endodontic implants made from vitallium and titanium, with a follow-up for more than 18 years. The following is an exposition of the procedure of endodontic stabilizers, considering indications and contraindications.

The clinical application of Vitallium 2000 casting removable partial denture / 华西口腔医学杂志

The casting removable partial denture (RPD) is one of most commonly prosthesis methods in present. Vitallium is one kind of dental alloy with cobalt, chromium and molybdenum etc. It has three ranks respectively: Vitallium, Vitallium 2000 and Vitallium 2000 plus. Although the traditional casting RPD are commonly used, but it has been limited in the physical capabilities of traditional dental alloy. It would not been done to flexible design on denture especially on denture base. The elasticity of casting clasp is not good, the volume is thick. Because of the Vickers hardness and elongation of Vitallium 2000 and Vitallium 2000 plus are better than traditional dental alloys, so the RPD with Vitallium 2000 has good bending control, deformation rebound and fracture resistance. The benefit of Vitallium 2000 or Vitallium 2000 plus is the RPD with splitting can be designed for some free end clinical cases, to solve some clinical problems.

Evaluation of the castability of a Co-Cr-Mo-W alloy varying the investing technique

O objetivo deste estudo foi comparar a fusibilidade de ligas de Co-Cr-Mo-W (Remanium 2000), Ni-Cr (Durabond) e Co-Cr-Mo (Vera-PDI), incluídas em revestimentos à base de fosfato, sílica ou utilizando uma técnica mista. Uma rede de nylon quadrada (10 X 10 mm) com 100 espaços abertos serviu de modelo para construção de padrões de cera, que foram incluídos com revestimento à base de sílica, revestimento fosfatado e técnica mista (camada de revestimento fosfatado com 2 mm de espessura + revestimento à base de sílica). Quarenta e cinco espécimes (5 para cada condição experimental) foram fundidos sob chama de gás-oxigênio e a seguir jateados com óxido de alumínio. O número de segmentos fundidos completos foi contado para obter uma percentagem designada como "valor de fusibilidade", representando a precisão da liga em reproduzir os detalhes do molde. A análise estatística por meio de ANOVA a dois critérios e teste Tukey mostrou que, comparando-se as ligas, a Remanium 2000 teve fusibilidade estaticamente semelhante (p>0,05) à da Vera PDI e inferior à da liga Durabond (p<0,05). Considerando os resultados da técnica mista, a liga Remanium 2000 teve menor valor de fusibilidade (p<0,05) que as ligas Durabond e Vera PDI, que apresentaram valores estatisticamente semelhantes entre si (p>0,05). Concluindo, a fusibilidade da liga de Co-Cr-Mo-W (Remanium 2000) foi comparável à da liga de Co-Cr (Vera PDI) e inferior à da liga de Ni-Cr alloy (Durabond). À exceção da liga Remanium 2000, a técnica de inclusão mista aumentou consideravelmente a capacidade das ligas testadas de reproduzir os detalhes do molde, quando comparada à técnica de inclusão em revestimento fosfatado. A técnica de inclusão mista representa uma alternativa para melhorar a fusibilidade de ligas de metais básicos sem afetar a qualidade superficial das peças metálicas.

Rolling friction: a desing of artificial knee joint / 生物医学工程学杂志

Resorption and osteolysis of periimplant bones resulting from the wear debris of artificial joint will cause long-term loosening. A new type of rolling knee artificial joint without UHMWPE based on the mechanics of rolling friction is designed for alleviating this problem. Because of low friction force, the resistance of extension and flexion is reduced strikingly and the stress on the interface between prosthesis and bone is reduced evidently. In addition, the bio-toxicity caused by the wear debris of UHMWPE will not occur absolutely. In consequence, the rolling artificial joint can prevent the trend of long-term loosening of the prosthesis efficiently.

The effect of cryotreat on tensile properties of medium melting-point and high melting-point castable alloy / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To introduce cryotreat technique into prosthetic dentistry by testing the tensile properties of CW-H Co-Cr-Mo cast alloy before and after cryotreat and to observe the image changes by SEM to study the mechanism that changes the tensile properties of the alloy.</p><p><b>METHODS</b>15 CW-H cast alloy were divided into 3 groups, i.e. control group (G1), cryotreated group (G2) and cryotreated plus post-cryogenic treated group (G3). The gauge test technique was employed to test the modulus of elasticity. Then the strength and percentage elongation (PE) were tested. SEM images were used to analyze the mechanism that improved the tension properties of the alloy.</p><p><b>RESULTS</b>For CW-H alloy the strength and the modulus of elasticity of both G2 and G3 were effectively increased but PE effectively decreased than G1. There was no effectively difference between G2 and G3, but G3 was larger than G2. SEM images of G2 and G3 showed that secondary-carbonide separated out all over the alloy.</p><p><b>CONCLUSION</b>The results obtained above suggest that cryotreat is an effective method in enhancing tensile properties of CW-H Co-Cr-Mo cast alloy.</p>

Biocompatibilidade do "Duracrom MS" e "Vitálio Cirúrgico" / Duracrom MS and surgical vitallium biocompatibility

O objetivo desta pesquisa foi comparar "Duracrom MS" (SIMONETTI-1981) e Vitálio Cirúrgico (liga de Cr-Co) como possíveis materais de prótese interna, após testados na microestrutura pelo Instituto de Pesquisa Tecnológicas (IPT) de Säo Paulo os corpos de prova foram implantados abaixo do periósteo de 28 ratos Wistar, sendo 14 com cada uma das ligas. Os animais foram sacrificados no tempos experimentais de: 1, 3, 7, 14, 21, 28 e 90 dias. A liga "Duracrom MS" apresentou após exame histológico uma biocompatibilidade adequada como material de implante quando comparada com o padräo "Vitálio Cirúrgico"

Osteosynthesis using bioabsorbable skeletal fixation system in facial bone fracture

In the practice of modern craniomaxillofacial surgery, there is a general agreement in favor of obtaining solid bony union through the use of titanium and vitallium rigid fixation. These metallic osteosynthesis are not free from inherent drawbacks and limitation. They are liable to have an adverse effect on the growth of the craniofacial skeleton, be a cause of secondary bony resorption, increase risk of infection, result in palpability or exposure and cause artifact in radiologic imaging. These can lead to undue secondary operations necessitating their removal. To overcome there shortcomings, there had been a continuous research on the development of a bioabsorbable skeletal fixation system using polymer of polylactic and polyglycolic acid. Recently, with introduction and commercial availability of a product(Lactosorb, Walter Lorenz) with a minimized resorption period and foreign body reaction, there is an increasing acceptance of its use as an alternative fixation device in craniomaxillofacial surgery. In effort to extend its use in facial bone fractures, Tatum and Eppley were the first report in its successful application in a clinical setting. We report on the clinical experience of such bioabsorbable rigid fixation in patients with maxillofacial trauma. In included one adult and three children in their growth period, underwent open reduction of facial bone fractures. They were followed up in terms of clinical and radiologic outcome for six months. Stalbe and adequate longterm fixation was obtained and no recurrences were noted.

Estudo comparativo entre as ligas DURACROM MS e "Vitálio Cirúrgico" com vistas à utilizaçäo em implantes / Comparative study between DURACOM MS and \"Chromium-Cobalt\" alloys as implant materials

O objetivo desta pesquisa foi testar comparativamente o DURACROM MS (Simonetti, 1981) e o "Vitálio Cirúrgico" (liga de Cr-Co) como possíveis materiais para prótese interna. Os corpos-de-prova foram implantados no tecido perióstico de 28 ratos Wistar, sendo 14 com cada uma das ligas. Os animais foram sacrificados nos tempos experimentais de 1, 3, 7, 14, 21, 28 e 90 dias. Ambas as ligas apresentaram resultados histológicos semelhantes, com presença de cápsula conjuntiva fibrosa aos 90 dias, näo interferindo com o mecanismo de cicatrizaçäo e com o processo de remodelaçäo do tecido ósseo da calota craniana, servindo como material para implante

A Case of Allergic Contact Dermatitis Associated with Orthopedic Implants / 대한피부과학회지

We present herein case of allergic contact dermatitis associated with implants. A 30 year-old male patient has had oozing, crusted, eczematous lesion on the right anterior tibia for five months after tibial osteosynthesis with plate and screw made of vitalliurn. He showed positive patch test, reaction to cobalt on second and fourth days. The skin lesion disappeared after removal of T-plate.

Estudio histológico de los tejidos peri - implantarios: implantes yuxtaóseos en cromo - cobalto - molibdeno quirúrgico

Se describen los hallazgos histológicos de los tejidos periimplantarios en un caso de implante yuxtaóseo en el sector posterior de la cavidad bucal. La movilidad por enfermedad periodontal de los elementos dentarios 33 y 43, determinó el retiro de estos implantes que en su estudio clínico y radiográfico no presentaban características anormales. Mediante intervención quirúrgica se extrajo la estructura metálica acompañada por los tejidos blandos que la rodeaban en un solo block, procurando realizar todas las maniobras con un mínimo de traumatismo operatorio. Fijación formol al 10 por ciento. Impregnación en block con carbonato de plata amoniacal de Río Ortega; inclusión en metacrilato de metilo y cortes seriados con micrótomo de sierra LEITZ 1600. Los cortes con la relación metal-tejidos blandos, se analizaron en lupa estereoscópica con graduaciones entre 2 y 15,75 aumentos reales. La relación mucosa metal, constituye una hendidura gingivo metálica. El margen gingival esta recubierto por un epitelio pavimentoso que en la profundidad llega hasta un tejido conjuntivo fibroso parcialmente hialinizado que envuelve a las estructuras metálicas. No se observan procesos inflamatorios. Se plantea la posibilidad de aplicar esta metodología a los implantes osteointegrados para realizar el estudio de la interfase implante tejido óseo

Reaçäo tecidual a material de implante: estudo experimental / Tissue reaction to implant material: experimental study

Estuda-se a reaçäo tecidual a alguns materiais de implante (Aço-Inoxidável, Vitallium, Tântalo e Polietileno) através de modelo experimental em cäes. Foram realizados estudos macro e microscópico das amostras obtidas. Os resultados mostraram que o Vitalliun é o menos reativo entre os tecidos, vindo a seguir o Aço-Inoxidável e o Polietileno, sendo o Tântalo o material menos inerte entre os testados

Experimental Study for Development of New Alloy for Domestic Total Knee Prosthesis / 대한정형외과학회잡지

The total knee replacement is an excellent method for the treatment of osteoarthritis, rheumatoid arthritis, etc. of the knee joint. The tendency of the use of total knee prosthesis is increasing now in Korea. But domestic production of the prosthesis is not avaliable and all are imported from abroad. Moreover, these prosthesis are not well adapted to Korean people, and in occation, the custom-made prosthesis should be needed. So, domestic production of the prosthesis is required. For production of new prosthesis, in cooperation with KAIST(Korea Advanced Institute of Science and Technology), we developed the new alloy 15-57 for total knee prosthesis. We conducted an animal experimental study to confirm the biocompatibility of the new alloy. In this experiment, the Zimmer® company vitallium was compared with this new alloy as control study. The results are as follows: 1. Biocompatibility of the new alloy 15-57 is similar than that of Zimmer® company vitallium in histological study of metal-bone interspace area. 2. Surface corrosion of both metal was nearly absent. 3. In summary, the new alloy 15-57 is suggested as an acceptable metal for the production of total knee prosthesis.

Results of Vitallium Cup Arthroplasty: Report on 23 Hips in 20 Patients / 대한정형외과학회잡지

Interposition arthroplasty of the hip is to create a new joint by interposing an inert and durable substance between the reshapened ends of the femoral head and acetabulum, usually for the treatment of the primary and secondary osteoarthritis of the hip. The major goals of arthroplasty of the hip are to relieve pain, restore joint motion, correct deformity, and to provide stability of the joint. We reviewed the follow-up results of 23 Smith-Patersen vitallium cup arthroplasties in a consecutive series of 20 patients with various arthritides of the hip, who were treated at the National Medical Center between January 1962 and December 1970. Average duration of follow-up was 2 year and 10 months. 1. Male to female ratio was 12:8. Average of the patients was 30 years. 2. Seven patients had rheumatoid arthritis or ankylosing spondylitis and five patients had ankylotic hips. Three patients had primary osteoarthritis and another three osteoarthritis secondary to Legg-Calve-Perthes disease. There were one case each of tuberculous arthritis and traumatic dislocation. 3. Average duration of admission was 7 weeks. 4. Weight bearing was started gradually at 12 weeks post-operatively in majority of the cases. 5. Over-all results of the 20 patients were satisfactory in 12 (60%), and unsatisfactory in 8 (40%). 6. Results of cup arthroplasty in patients with primary osteoarthritis and osteoarthritis secondary to Legg-Calve-Parthes disease were satisfactory in all 6 cases, but were unsatisfactory in 5 out of the 7 cases of the rheumatoid arthritis and ankylosing spondylitis. 7. Three patients with bilateral cup arthroplasties yielded poor results. 8. Complications included eight infections and one each of early dislocation of the cup and periarticular new bone formation.

Experimental Studies on Surgery of the Ureter: Part II. An Experimental Study on Reconstruction of the Ureters by a Tube made from Pedicled Peritoneal Flaps / 대한비뇨기과학회지

A satisfactory method is needed for reestablishing continuity where the ureteral wall has been lost or compromised over a long segment. Experimental efforts to replace the ureteral segments with grafts of free fascia, skin, blood vessels and a pedicled fallopian tube have been reported; however, the results were not considered satisfactory. In 1943, Lord, Stefko and Stevens attempted to replace ureteral segments with free peritoneal flaps splinted with vitallium tubes. Slough and graft necrosis occurred prior to epithelialization. I believed that this failure was due to a disturbance of the blood supply. With this impression I utilized a pedicled peritoneal flap to develop an adequate blood supply. Mongrel dogs, weighing from 15~20kg, were used without special preoperative preparation. Pentothal sodium was administered intravenously for anesthesia. The right ureter was exposed through a paravertebral incision retroperitoneally. The middle third of the right ureter was mobilized. A 3 to 5 cm segment of the right ureter was removed. A pedicled peritoneal flap was fashioned and threaded on a thin polyethylene tubing the ends of which were then passed into the proximal and distal ureter. The ends of ureter were anastomosed with the ends of peritoneal tube using 4-0 chromic catgut. This procedure was technically difficult due to the extreme thinness of the peritoneal grafts. The wound was closed without drainage (Atlas 1: A,B,C, and D). No urinary diversion was performed. Determination of B.U.N. and creatinine were done preoperatively and just prior to sacrificing the animals. Dog No. 1 exhibited vomiting and a poor appetite on the 14th postoperative day, B.U.N. and creatinine were markedly elevated to 73.0mg% and 3.8mg% respectively on the 21st postoperative day compared with 9.8mg% and 1.4mg% preoperatively. Observations at the time of sacrifice revealed the replaced ureteral segment to be dilated and adherented to the surrounding tissues, leakage of urine into the peritoneum, no epithelialization of the peritoneal graft, and severe hydronephrosis of the right kidney. Dog No. 3 also developed a poor appetite on the 14th postoperative day and was sacrificed on the 20th postoperative day. The B.U.N. and creatinine were elevated to 75mg% and 2.8mg% respectively prior to sacrificing. The replaced segment was adherented to the surrounding tissues and showed abscess formation with leakage of urine. No organisms were found by culture. The right kidney showed marked hydronephrosis. Dog No. 4 was examined by intravenous pyelography on the 20th postoperative day when the B.U.N. elevated to 47.3mg%. There was no visualization of right collecting system at 30 minutes. The dog died on the 30th postoperative day. The replaced segment was shrunken and adherented to the surrounding tissues. Right hydronephrosis and hydroureter was found. Uremia developed in all dogs by the second or third postoperative week and severe adhesions, shrinkage and urinary leakage occurred in association with hydronephrosis and hydroureter.

Experimental Studies on Surgery of the Ureter: Part III. Homologous Ureteral Transplantation / 대한비뇨기과학회지

Short gaps in the ureter may be spanned by uretero-ureterostomy, or if in proximity to the bladder, by uretero-neocystostomy Longer defects defy such anastomoses and most surgeons have employed nephrostomy, ureterostomy and cutaneous ureterostomy or uretero-sigmoidostomy in this condition to avoid further damage to the affected kidney. These procedures are not ideal, do not solve the problem of reconstructing the ureter and often lead to a diminution of renal function. For the past several decades investigators have attempted to insert or construct a conduit that could adequately substitute for the ureter. For this purpose, inorganic tubes of polyethylene, vitallium, tantalum and autogenous tissues such as ileal loops, oviduct, bladder flaps and blood vessel grafts have been utilized without success. In 1954, Hardin attempted to reconstruct the ureteral detect by homologous ureteral transplantation. He concluded that homologous ureteral grafts failed because of stenosis, dehiscence and leakage. By the time proliferating capillary vascular buds have permeated the free graft, necrosis and scar formation have taken place. He utilized polyethylene tubing as a splint catheter for a maximum of seven days in two of five experimental dogs and no splint catheter at all in the other three. He was unable to observe the dogs for long periods since the animals died on the 30th. 65th and 70th postoperative days. Complete ureteral stenosis had occurred in all dogs. An attempt to reestablish the ureteral defect with autogenous ureteral transplantation is described. Mongrel dogs, weighing from 15~25kg were utilized without special preoperative preparation. Pentothal sodium was administered intravenously for anesthesia. The right ureter was exposed through paravertebral incision retroperitoneally in two dogs simultaneously by two operative groups. The middle third of the right ureter was mobilized. A 3 to 7cm segment of the right ureter was removed and transplantated to the other dog. In 4 of 10 dogs, a splint catheter of polyethylene tubing slightly longer than the transplanted graft was inserted. In 6 dogs, a splint catheter was inserted from the renal pelvis to the bladder making it easy to remove the polyethylene tubing subsequently. The ends of the ureter were anastomosed with 4-0 chromic catgut using for interrupted sutures. The wound was closed without drainage. The splint catheter was removed in the fourth to sixth postoperative week. The animals were sacrificed after one to six months and an autopsy was performed. The results are summarized in Table 1. Gross and microscopic changes in the graft in all dogs were contracture, shrinkage or thickening, calcification or ossification within the graft, and round cell infiltration. Hydronephrosis also was seen in all animals. Animals sacrificed after one to two months postoperatively showed epithelial loge and degenerative changes, but the animals sacrificed after six months showed partial normal epithelial lining and capillarization in the submucosal layer of the transplanted segment. No fistula was seen, and at the time of sacrifice, the NPN and creatinine were elevated.