Tumor de células gigantes esternal: esternectomía total y reconstrucción con barras de titanio más malla de polipropileno / Sternal Giant Cell Tumor: Total Sternectomy and Reconstruction with Titanium Rods Plus Polypropylene Mesh

El tumor de células gigantes (TCG) constituye un tumor óseo benigno relativamente frecuente. Se caracteriza por ser localmente agresivo y el lugar de presentación más frecuente es a nivel del esqueleto axial (fémur distal o tibia proximal). Hasta la actualidad, existen escasos informes de presentaciones atípicas, como a nivel del esternón. En este informe, se presenta el caso de una paciente mujer de 24 años que presenta tumoración indurada a nivel de la región esternal de crecimiento progresivo asociado a dolor. Los hallazgos radiológicos revelan tumoración osteolítica que tiene como origen el cuerpo del esternón y lo compromete casi en su totalidad. Este se proyecta hacia las partes blandas y llega al plano superficial. Debido a la extensión de la enfermedad y al compromiso extenso en el cuerpo del esternón, se realiza la resección del cuerpo y manubrio esternal. El defecto es reconstruido con malla de polipropileno, barras de titanio, parche de epiplón y autoinjerto de piel; se obtiene una adecuada estabilidad de la caja torácica y resultados estéticos favorables. El caso tiene un adecuado manejo oncológico puesto que la resección es completa con márgenes microscópicos libres (resección R0).

Giant cell tumor (GCT) constitutes a relatively common benign bone tumor, characteri-zed by its local aggressiveness. The most frequent site of occurrence is in the axial ske-leton (distal femur or proximal tibia). To date, there have been few reports of atypical presentations, such as at the level of the sternum. In this report, we present the case of a 24-year-old female patient who presented with an indurated mass in the sternal region, progressively growing and associated with pain. Radiological findings revealed an osteolytic mass originating from the body of the sternum, involving almost its entire extent and projecting into the soft tissues, reaching the superficial plane. Due to the extent of the disease and the extensive involvement of the sternal body, resection of the body and manubrium of the sternum was performed. The surgical defect was reconstructed with polypropylene mesh, titanium bars, an omental patch and a skin graft, achieving adequate stability of the thoracic cage and favorable cosmetic results.

Toxina botulínica y neumoperitoneo secuencial en el manejo de hernia inguinoescrotal gigante: Reporte de caso / Botulinum toxin and sequential pneumoperitoneum in the management of giant inguinoscrotal hernia: Case report

Introducción. Las hernias gigantes con pérdida de domicilio son aquellas cuyo saco herniario alcanza el punto medio del muslo en bipedestación y su contenido excede el volumen de la cavidad abdominal. Estas hernias son un reto quirúrgico dada la difícil reducción de su contenido y del cierre primario de la fascia. Tienen mayor riesgo de complicaciones asociadas al síndrome compartimental abdominal, así como mayor tasa de recurrencia y morbilidad en los pacientes. Caso clínico. Paciente masculino de 81 años, reconsultante por hernia inguinoescrotal derecha gigante, de dos años de evolución, sintomática, con índice de Tanaka de 24 %. Se decidió aplicar el protocolo de neumoperitoneo secuencial (hasta 11.000 ml en total en cavidad) además de toxina botulínica en pared abdominal (dos sesiones). Resultados. Se logró la corrección exitosa de la hernia inguinoescrotal gigante, sin recaídas de su patología abdomino-inguinal. El paciente manifestó satisfacción con el tratamiento un año después del procedimiento. Conclusiones. El protocolo de neumoperitoneo secuencial es una alternativa en casos de hernias complejas, con alto riesgo de complicaciones, que requieren técnicas reconstructivas adicionales. La aplicación previa de toxina botulínica es un adyuvante considerable para aumentar la probabilidad de resultados favorables. Sin embargo, debe incentivarse la investigación en esta área para evaluar su efectividad.

Introduction. Giant hernias with loss of domain are those whose hernial sac reaches the midpoint of the thigh in standing position and whose content exceeds the volume of the abdominal cavity. These hernias are a surgical challenge given the difficult reduction of their contents and the primary fascial closure, with a higher risk of complications associated with abdominal compartment syndrome, as well as a higher rate of recurrence and morbidity in patients. Clinical case. A 81-year-old male patient with comorbidity, reconsulting due to a symptomatic giant right inguinoscrotal hernia of two years of evolution, with a Tanaka index of 24%, eligible for a sequential pneumoperitoneum protocol (up to a total of 11,000 cc in cavity) plus application of botulinum toxin (two sessions) in the abdominal wall. Results. Successful correction of the patient's giant inguinoscrotal hernia was achieved using this protocol, without recurrence of his abdomino-inguinal pathology and satisfaction with the procedure after one year. Conclusion. The sequential pneumoperitoneum protocol continues to be an important alternative in cases with a high risk of complications that require additional reconstructive techniques, while the previous application of botulinum toxin is a considerable adjuvant to further increase the rate of favorable results. However, research in the area should be encouraged to reaffirm its effectiveness.

Perforación colónica por endoprótesis biliar impactada / Colonic perforation due to impacted biliary stent

Introducción. La colocación de endoprótesis biliares es cada día más frecuente por ser actualmente una de las mejores opciones para el tratamiento de patologías de la vía biliar. La migración de las endoprótesis es una de las complicaciones que puede ocurrir en hasta un 10,8 % de los pacientes, pero en muy raras ocasiones llegan a causar una perforación intestinal. Caso clínico. Se trata de una paciente de 61 años, a quien cinco años atrás se le realizó una colangiopancreatografía retrógrada endoscópica por coledocolitiasis. Consultó por presentar dolor abdominal, y al examen físico se encontraron abdomen agudo y plastrón en fosa ilíaca izquierda a la palpación. La tomografía computarizada informó un cuerpo extraño a nivel del colon descendente, con perforación del mismo. Se realizó laparotomía exploratoria y colostomía por perforación del colon sigmoides secundaria a prótesis biliar migrada. Resultados. La paciente evolucionó favorablemente y a los seis meses se realizó el cierre de la colostomía, sin complicaciones. Conclusión. Los pacientes a quienes se les colocan prótesis biliares requieren un seguimiento adecuado para evitar complicaciones que, aunque raras, pueden ocurrir, como la migración intestinal con perforación. El tratamiento de dichas complicaciones se hace por vía endoscópica, laparoscópica o laparotomía en caso de complicación severa.

Introduction. Endoscopic placement of biliary stents is becoming more common every day, as it is currently one of the best options for the treatment of bile duct pathologies. One of the complications that can occur is the migration of the endoprostheses in up to 10.8% of patients, which in very rare cases can cause intestinal perforation. Clinical case. This is a 61-year-old female patient, who underwent endoscopic retrograde cholangiopancreatography five years ago for choledocholithiasis. She consulted due to abdominal pain, with a physical examination that upon palpation documented an acute abdomen and a palpable plastron in the left iliac fossa. The computed tomography revealed a foreign body at the level of the descending colon, with perforation. Exploratory laparotomy and colostomy were performed due to perforation of the sigmoid colon secondary to migrated biliary prosthesis. Results. The patient progressed favorably and six months later the colostomy was closed without complications. Conclusions. Patients who receive biliary stents require adequate follow-up to avoid complications that, although rare, may occur, such as intestinal migration with intestinal perforation. The treatment of these complications can be endoscopic, laparoscopic or laparotomy in case of severe complication.

Impresión 3D aplicada a la planificación y la resolución quirúrgicas en la cirugía ortopédica. Serie de casos / 3D printing for surgical planning and resolution in orthopaedic surgery. Case series

Introducción: La popularidad de la cirugía asistida con impresión 3D ha crecido en los últimos 10 años. El poco empleo en nuestro medio no permite aprovechar para el paciente todas las aplicaciones y los beneficios de esta herramienta. Materiales y métodos: Estudio retrospectivo sobre enfermedad del miembro inferior en pacientes tratados en nuestra institución analizando cada etapa del proceso y su utilidad en la planificación, la ejecución quirúrgica y el desarrollo de implantes. Resultados: Se describen 12 casos en los que se utilizó la impresión 3D para tratar defectos acetabulares, resecciones tumorales óseas y secuelas en huesos largos. Conclusiones: Nuestra serie y la bibliografía revisada demuestran que la cirugía asistida con impresión 3D mejora la predictibilidad con lo planificado y reduce los tiempos quirúrgicos, el sangrado y la radiación intraoperatoria, a un costo accesible. Además, no se han comunicado complicaciones asociadas a esta tecnología. Nivel de Evidencia: IV

Introduction: The popularity of 3D printing-assisted surgery has surged over the previous decade. The tool's limited use in our context prevents us from taking advantage of all of its applications and benefits for the patient. materials and methods: A retrospective study on lower limb disease in patients treated at our institution, analyzing each stage of the procedure and its applicability in planning, surgical execution, and implant development. Results: We describe 12 cases in which 3D printing was used to treat acetabular defects, bone tumor resections, and long bone sequelae. Conclusions: Our series and the literature reviewed demonstrate that 3D printing-assisted surgery improves plan predictability while also reducing surgical times, bleeding, and intraoperative radiation at a reasonable cost. Furthermore, no complications from this technology have been reported. Level of Evidence: IV

Comparative Assessment of Contact Osteogenesis at the Titanium Implant-Bone Junction in Male Rabbits with Dissimilar Femoral Defects / Evaluación Comparativa de la Osteogénesis de Contacto en la Unión entre el Hueso y el Implante de Titanio en Conejos Macho con Defectos Femorales Diferentes

SUMMARY: Traumatized bone tissue has the capacity to repair itself so that it eventually regains its almost original form, even in the case of artificially inserted implants. The process that stays at the base of the regeneration is represented by osteogenesis or remote osteogenesis. The major difference between the two types of bone formation is the location of the cement line, which is located on the surface of the implant for contact osteogenesis and on the surface of the bone defect for remote osteogenesis. The aim of the present study was to assess the contact osteogenesis in the case of inserted titanium screws in holes with diameters of 1.8 mm and 1 mm respectively. The obtained results show, in the case of the groove with 1.8 mm that the newly proliferated bone represents 73.85 % of the total area, while in the case of the groove with 1 mm in diameter the value of the newly proliferated bone is 26.15 %. In conclusion, the insertion of titanium screws by self-tapping into the hole smaller than the core of the screw is accompanied by bone proliferation by contact osteogenesis much more modest than in the case of insertion into the hole larger than the core of the screw.

El tejido óseo traumatizado tiene la capacidad de reparar en forma espontánea, de modo que eventualmente recupera su forma casi original, incluso en el caso de implantes insertados artificialmente. El proceso que queda en la base de la regeneración está representado por la osteogénesis u osteogénesis a distancia. La principal diferencia entre los dos tipos de formación ósea es la ubicación de la línea de cemento, que se encuentra en la superficie del implante para la osteogénesis de contacto y en la superficie del defecto óseo para la osteogénesis remota. El objetivo del presente estudio fue evaluar la osteogénesis de contacto en el caso de tornillos de titanio insertados en forámenes con diámetros de 1,8 mm y 1 mm respectivamente. Los resultados obtenidos muestran, en el caso del surco de 1,8 mm que el hueso neoproliferado representa el 73,85 % del área total, mientras que en el caso del surco de 1 mm de diámetro el valor del hueso neoproliferado es del 26,15 %. En conclusión, la inserción de tornillos de titanio por autorroscantes en el foramen menor que el núcleo del tornillo se acompaña de una proliferación ósea por osteogénesis de contacto mucho más modesta que en el caso de la inserción en el foramen mayor que el núcleo del tornillo.

Associated short and regular implants for complete denture retention in an atrophic mandible: clinical follow-up / Implantes corto y regular asociados para retención de prótesis completa en mandíbula atrófica: seguimiento clínico / Implantes curto e regular associados para retenção de prótese total em mandíbula atrófica: acompanhamento clínico

Objective: to present the radiographic clinical follow-up of the prosthetic rehabilitation of a patient with an atrophic mandible, with the installation of short implants associated with an implant of regular length. Method: case report of a completely edentulous patient with an atrophic mandible and a 6-year radiographic clinical follow-up conducted at the dental clinic of the Federal University of Piauí, Teresina, from February 2011 to January 2020. After collecting sociodemographic data, health records, clinical radiographic examinations, and prosthetic surgical planning, four dental implants were installed between the mental foramina. After three months, mini-conical abutments and a fixed prosthesis screwed onto the implants were installed and monitored every six months for a period of six years. Results: the clinical evaluation revealed tissue stability without significant peri-implant changes after the follow-up period. Radiographically, bone resorption was not observed around the implant. Stability of the prosthesis and absence of prosthetic complications were observed during the follow-up period. Conclusion: short implants associated with regular-length implants can be placed in the anterior region of an atrophic mandible for rehabilitation with fixed complete dentures.

Objetivo: apresentar o acompanhamento clínico radiográfico da reabilitação protética de um paciente com mandíbula atrófica com a instalação de implantes curtos associados a um implante de comprimento regular. Método: relato de caso de uma paciente desdentada total com mandíbula atrófica, e acompanhamento clínico radiográfico de seis anos, realizado na clínica odontológica da Universidade Federal de Piauí, Teresina, no período de fevereiro de 2011 a janeiro de 2020. Após coleta de dados sociodemográficos e registro de saúde, exames clínicos radiográficos e planejamento cirúrgico protético, foram instalados quatro implantes dentários entre os forames mentonianos. Após o período de três meses foram instalados mini pilares cônicos e uma prótese fixa aparafusada sobre os implantes que foi acompanhada a cada seis meses por um período de seis anos. Resultados: as avaliações clínicas mostraram estabilidade tecidual sem alterações peri-implantares significativas após o período de acompanhamento. Radiograficamente foi observada a manutenção sem reabsorção óssea ao redor dos implantes. A estabilidade da prótese e a ausência de complicações protéticas foram observadas clinicamente durante o período de acompanhamento. Conclusão: os implantes curtos associados a implante de comprimento regular podem ser colocados na região anterior da mandíbula atrófica para reabilitação com prótese total fixa.

Technique for Foot Reconstruction with Custom-made Calcaneal Prosthesis in Primary Malignancy - A Case Report / Técnica de reconstrução do pé com prótese de calcâneo feita sob medida em câncer primário - Relato de caso

Abstract The foot is an uncommon location for osseous tumors, comprising ~ 3% of all skeletal tumors, which occur particularly around the calcaneum. Radical surgery creates a void in the foot which adversely affects the ability to salvage it. Calcaneal replacement surgeries are not commonly performed due to factors involving instability of the prosthesis, soft-tissue defects, and resultant failure, which can occur in the postoperative period. Thus, we herein report a rare case of synovial sarcoma arising from the sheath of the tibialis posterior tendon, with secondary involvement of the calcaneus bone. Considering the previous experiences of different surgeons, a custom-made prosthesis was designed with relevant modifications.

Resumo O pé é um local incomum para tumores ósseos, e compreende cerca de 3% de todos os tumores esqueléticos, em especial ao redor do calcâneo. A cirurgia radical cria um vazio no pé, o que afeta de forma negativa a capacidade de resgate do membro. As cirurgias de reconstrução do calcâneo não são comumente realizadas por causa da instabilidade da prótese, defeito de partes moles, e consequente possibilidade de insucesso pósoperatório. Assim, apresentamos aqui um caso raro de sarcoma sinovial originário da bainha do tendão tibial posterior com acometimento secundário do osso calcâneo. Considerando as experiências prévias de diferentes cirurgiões, projetamos uma prótese sob medida com modificações relevantes.

Uso de endoprótesis para el tratamiento de enfermedades no neoplásicas de la rodilla / Use of endoprosthesis for the treatment of non-neoplastic pathologies of the knee

Introducción: Las endoprótesis son el método de elección para la reconstrucción luego de las resecciones oncológicas. Los avances en los materiales y diseños permitieron expandir las indicaciones a enfermedades no neoplásicas. Su montaje intraoperatorio simple y rápido, y su estabilidad mecánica inmediata permiten una rehabilitación y una recuperación funcional tempranas. Sin embargo, la tasa de fallas es elevada, aunque distinta de la de las enfermedades oncológicas. Las causas predominantes son diferentes. Objetivos: Analizar nuestra experiencia con el uso de endoprótesis de rodilla y compararla con los estudios publicados, evaluando los resultados funcional y radiográfico, la supervivencia del implante y las causas de su eventual falla. Materiales y Métodos: Se seleccionaron pacientes con enfermedad no neoplásica compleja de rodilla que requirieran una reconstrucción con endoprótesis. Para el examen clínico y la evaluación funcional se utilizó el puntaje de la Musculoskeletal Tumor Society, y para las fallas de los implantes, la clasificación de Henderson y cols. modificada. Resultados:Se estudiaron 12 endoprótesis, con un seguimiento promedio de 3.8 años. Se registraron 2 fallas (18%), con un tiempo promedio hasta la falla de 47.5 meses. Una fue tipo 2 (aflojamiento aséptico) y la otra, tipo 4 (infección). No hubo otras complicaciones. En la evaluación funcional, el puntaje final medio fue del 76,6%. Conclusión: Nuestros resultados respaldan el uso de endoprótesis para enfermedades complejas no neoplásicas de rodilla en pacientes cuidadosamente seleccionados, pese a ser un procedimiento quirúrgico complejo y con muchas complicaciones. Nivel de Evidencia: IV

Introduction: Endoprosthesis is the gold standard for reconstruction after oncological resections. The advances regarding its materials and designs allowed for the expansion of the indications to non-neoplastic pathologies. Its simple and fast intraoperative assembly and its immediate mechanical stability allow for early rehabilitation and functional recovery. However, the failure rate is high, although it is different from oncological pathologies. The predominant causes are varied. Objectives: To analyze our experience in the use of knee endoprosthesis and compare it with the literature, evaluating functional outcomes, radiographic outcomes, implant survival and causes of eventual failure. Materials and Methods: Patients with complex non-neoplastic knee pathology that required reconstruction with endoprosthesis were selected. Clinical history, anamnesis, physical examination, and radiographs were reviewed. For clinical examination and functional evaluation, the MusculoSkeletal Tumor Society Score (MSTS Score) was used. For implant failures, the modified Henderson et al. classification was used. Results: 12 endoprostheses were studied, with an average follow-up of 3.8 years. Failures were recorded in 2 (18%), with a mean time to failure of 47.5 months. One type 2 failure (aseptic loosening) and one type 4 failure (infection) were recorded. No other complications were noted. For the functional evaluation, the mean final score was 76.6%. Conclusion: Our results support the use of endoprostheses for complex non-neoplastic knee diseases in carefully selected patients, despite being a complex surgical procedure with many complications.Keywords: Endoprosthesis; knee; infection; complications. Level of Evidence: IV

¿Son los implantes "personalizados" una solución en la cirugía de revisión acetabular? A propósito de un caso / Are customized implants a solution in acetabular revision surgery? A case study

Se presenta a un paciente de 73 años que había sido sometido a dos revisiones de prótesis de cadera debido a una infección crónica por un microorganismo multirresistente. Acude a nuestro centro tras un primer tiempo quirúrgico. En la radiografía simple y la tomografía computarizada, se observan un defecto femoral tipo IV y un defecto acetabular tipo IIIA de Paprosky. Tras un control clínico y análisis de laboratorio, se decide la reconstrucción acetabular mediante un implante "personalizado" y un vástago tumoral. A los 2 años, el paciente evoluciona favorablemente: deambula con bastón y sin dolor. El implante está estable y en posición normal, no hubo recidiva infecciosa. Nivel de Evidencia: IV

We present the case of a 73-year-old patient, previously treated with two hip prosthesis revisions due to a chronic infection caused by a multidrug-resistant microorganism, who consulted after the first surgical procedure. Radiographic and computed tomography studies revealed a Paprosky type IV femoral defect and a type IIIA acetabular defect. Following clinical and laboratory monitoring, it was decided to perform acetabular reconstruction using a custom-made implant and a tumor stem. Two years later, the patient shows a favorable evolution: he is able to walk with a cane and without pain. The implant is stable and properly positioned, with no recurrent infection. Level of Evidence: IV

Biomechanical analysis of narrow dental implants for maxillary anterior rehabilitation / Análise biomecânica de implantes de diâmetro reduzido para reabilitação da região anterior da maxila

Introdução: O conhecimento da biomecânica de implantes de diâmetro reduzido indica dimensões seguras para uso clínico. Objetivo: O objetivo do presente estudo foi comparar biomecanicamente implantes de diâmetro regular e reduzido para suporte de próteses implantossuportadas unitárias na região anterior da maxila por meio de análise de elementos finitos 3D (3D-FEA). Material e método: Quatro modelos 3D-FEA foram desenvolvidos a partir de recomposição de tomografia computadorizada e dados da literatura: um bloco ósseo na região incisiva lateral superior direita com implante e coroa. M1: 3,75 x 13 mm, M2: 3,75 x 8,5 mm, M3: 2,9 x 13 mm e M4: 2,9 x 8,5 mm. Foi aplicada carga de 178 N nos ângulos 0, 30 e 60 graus em relação ao longo eixo do implante. Foram avaliados mapas de tensão de Von Mises, tensão principal máxima e microdeformação. Resultado: M3 e M4 apresentaram maiores valores de tensão e microdeformação que M1 e M2, principalmente quando foram aplicadas forças inclinadas. Porém, M3 apresentou comportamento biomecânico melhor do que M4. Conclusão: Pode-se concluir que reduzir o diâmetro dos implantes pode prejudicar a biomecânica durante a aplicação de forças, mas a distribuição e intensidade das tensões, bem como os valores de microdeformação podem ser melhorados se o comprimento do implante for aumentado

Introduction: Narrow diameter implants biomechanics knowledge indicates safe dimensions for clinical use. Objective: Purpose of the present study was biomechanically to compare regular and narrow diameter implants to support single implant-supported prosthesis in the anterior region of the maxilla by 3D finite element analysis (3D-FEA). Material and method: Four 3D-FEA models were developed form CT scan recompositing and literature data: a bone block in the right upper lateral incisive region with implant and crown. M1: 3.75 x 13 mm, M2: 3.75 x 8.5 mm, M3: 2.9 x 13 mm and M4: 2.9 x 8.5 mm. It was applied load was of 178 N at 0, 30 and 60 degrees in relation to implant long axis. Von Mises stress, maximum principal stress and microdeformation maps were evaluated. Result: M3 and M4 did show higher tension and higher microdeformation values than M1 and M2, especially when inclined forces were applied. However, M3 presented enhanced biomechanical behavior than M4. Conclusion: It can be concluded that reduce the diameter of the implants can disadvantage to the biomechanics during the application of forces, but the distribution and intensity of the stresses, as well as the micro deformation values can be improved if the length of the implant is increased

Discussion and Concern on Animal Study for Orthopaedic Implantable Devices / 中国医疗器械杂志

In recent years, new orthopaedic implantable devices continue to emerge, which require higher requirements for technical evaluation. Animal study is an important part of the research and development process for the new orthopedic implantable devices, which provides relevant evidence for product design and stereotyping. By introducing the purpose of animal study, and the application of 3R principle (replacement, reduction, refinement) in this field, we summarize the concern on the animal study, in order to provide reference for the development and research of new orthopedic implantable devices and biomaterials. At the same time, the application of evidence-based research methods such as systematic review in the field is introduced, which provides new tools and approaches for the technical review and regulatory science.

Observation of the Curative Effect of the Dexamethasone Vitreous Cavity Implant for the Treatment of Irvine-Gass Syndrome / 生物医学与环境科学（英文）

OBJECTIVE@#To investigate the clinical efficacy of dexamethasone vitreous cavity implants (Ozurdex) for the treatment of macular edema (Irvine-Gass Syndrome) after cataract surgery.@*METHOD@#Eight patients (eight eyes) with Irvine-Gass syndrome were enrolled for vitreous injections with Ozurdex. The patients included six men (six eyes) and two women (two eyes) with a mean age of 67.12 ± 11.92 years. Changes in the patients best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure were compared before and after treatment.@*RESULT@#The mean visual acuity BCVA of the patients was 0.81 ± 0.26 before implantation, which improved to 0.20 ± 0.12, 0.13 ± 0.09, and 0.15 ± 0.13 at 2 weeks, 1 month, and 3 months after implantation, respectively ( P < 0.001). The patient's mean CMT before implantation was 703.00 ± 148.88 μm, and it reduced to 258.87 ± 37.40 μm, 236.25 ± 28.74 μm, and 278.00 ± 76.82 μm at 2 weeks, 1 month, and 3 months after implantation, respectively ( P < 0.001).@*CONCLUSION@#The dexamethasone vitreous cavity implant (Ozurdex) is a safe and effective treatment, which can effectively improve patient's visual acuity and reduce macular edema associated with cataract surgery.

Peri-implant bone level assessment of early loaded dental implants submitted to different prosthetic protocols: a case report / Avaliação do nível ósseo peri-implantar de implantes dentários com carregamento antecipado submetidos a protocolos protéticos diferentes: relato de caso

Aim: The present split-mouth case report aims to describe the clinical and radiographic long-term outcomes of the implant rehabilitation of two mandibular premolars in which the digital workflow was used to apply different prosthetic protocols. Case description: A female 42-year-old patient with the absence of both mandibular second premolars was submitted to guided surgery for the placement of platform-switching Grand Morse connection implants. Digital workflow was used for implant and prosthetic planning, applying early loading protocol 21 days after surgery. The implant on the right side received the final abutment at the time of surgery (without loading), whereas the implant on the left side had a healing abutment placed, which was replaced by a temporary abutment and then by a final abutment. Two months after surgery, both implants had final ceramic restorations delivered. The patient was followed clinically and radiographically for 30 months, presenting excellent hard and soft tissue outcomes, with bone level changes lower than 2mm for both implants. Conclusion: The use of digital workflow and early loading, made the present implant-supported rehabilitation predictable, safe and time-efficient, resulting in total patient satisfaction. Peri-implant bone level was observed to be stable after early loading protocol for both platform-switching connection implants inserted, despite the prosthetic protocol applied.(AU)

Objetivo: O presente relato de caso de boca dividida tem como objetivo descrever os resultados clínicos e radiográficos a longo prazo da reabilitação com implante de dois pré-molares inferiores em que o fluxo de trabalho digital foi usado para aplicar os conceitos de "one abutment-one time" em uma das reabilitações e troca de componente no outro. Descrição do caso: Paciente do sexo feminino, 42 anos, com ausência de ambos os segundos pré-molares inferiores, foi submetida à cirurgia guiada para colocação de implantes de conexão Grand Morse plataforma-switching. Foi utilizado fluxo de trabalho digital para planejamento de implante e prótese, aplicando protocolo de carga antecipada 21 dias após a cirurgia. O implante do lado direito recebeu o componente protético definitivo no momento da cirurgia (sem carga), enquanto o implante do lado esquerdo recebeu um cicatrizador, que foi substituído por um pilar provisório e depois por um componente definitivo. Dois meses após a cirurgia, ambos os implantes tiveram restaurações cerâmicas finais entregues. A paciente foi acompanhada clínica e radiograficamente por 30 meses, apresentando excelentes resultados de tecidos duros emoles, com alterações do nível ósseo inferiores a 2mm para ambos os implantes. Conclusão: O fluxo de trabalho digital e carregamento precoce, tornou a presente reabilitação implantossuportada previsível, segura e eficiente em termos de tempo, resultando em total satisfação do paciente. O nível ósseo peri-implantar foi observado como estável após o protocolo de carregamento inicial para ambos os implantes de conexão plataforma-switching inseridos, independente do protocolo protético aplicado. (AU)

Biomechanics of implant-supported restorations / Biomecânica das restaurações implantossuportadas

The rehabilitation of patients with dental implant-supported restorations is an ideal treatment option in contemporary dentistry. The aim of this review was to compile and to demonstrate the mechanical response during loading condition, on the stress distributions of implant-supported prostheses. The findings show that the majority of stresses were concentrated in the cervical region of the implant/abutment interface and that they can be affected by several clinical parameters and loading conditions. Finally, the final prosthetic design should combine superior mechanical response, long-term survival rate and allow patient satisfaction. (AU)

A reabilitação de pacientes com restaurações implanto-suportadas é uma opção de tratamento ideal na odontologia contemporânea. O objetivo desta revisão foi compilar e demonstrar a resposta mecânica durante a aplicação de carga, na distribuição de tensão de próteses implanto-suportadas. Os achados mostram que a maioria das tensões se concentram na região cervical da interface implante/pilar e pode ser afetada por diversos parâmetros clínicos e condições de carregamento. Por fim, o desenho protético final deve combinar uma melhor resposta mecânica, taxa de sobrevida a longo prazo e permitir a satisfação do paciente. (AU)

Comparação entre os resultados do implante de um segmento de arco longo versus dois segmentos de arco tradicional no tratamento de pacientes com ceratocone / Comparison between the results of implanting a long-arch segment versus two standard arch segments for treatment of keratoconus patients

RESUMO Objetivo: Analisar retrospectivamente as alterações na ceratometria e no astigmatismo corneano obtidas após cirurgia de implante de anel intraestromal, comparando o uso de um segmento de arco longo versus o implante de dois segmentos de comprimento de arco tradicional. Métodos: A partir de um estudo transversal, obtivemos os dados de 94 olhos de pacientes diagnosticados com ceratocone, que foram submetidos ao implante de anel corneano. Eles foram divididos em dois grupos, dependendo do tipo de implante recebido: Grupo A, um segmento de arco longo; Grupo B, dois segmentos tradicionais. Todos os segmentos implantados possuíam 250µ de espessura. Os dados do pré-operatório dos dois grupos foram comparados, para garantir que as amostras eram similares (as diferenças encontradas entre os dois grupos não eram estatisticamente significativas). As variáveis analisadas no pré e no pós-operatório foram acuidade visual com correção, ceratometria, astigmatismo corneano e refração. Resultados: A amostra que recebeu apenas um segmento de arco longo (Grupo A) obteve redução da ceratometria média de 4,42D (8,7%) e do astigmatismo corneano de 2,43D (40,4%). Já na amostra dos olhos que receberam dois segmentos de arco tradicional (Grupo B), houve redução média de 2,66D (5,1%) em relação à ceratometria média e redução média de 2,11D (34,8%) em relação ao astigmatismo corneano. A redução obtida na ceratometria média no Grupo A foi maior que a obtida no Grupo B (diferença estatisticamente significativa). A redução obtida no astigmatismo do Grupo A não foi estatisticamente significante, se comparada com o resultado obtido no Grupo B (considerando p≤0,05). Conclusão: Foi demonstrado que o uso de um segmento de arco longo possui maior capacidade de aplanação corneana, se comparado com o uso de dois segmentos com comprimento de arco tradicional. Em relação à redução do astigmatismo, os dois grupos mostraram resultados equivalentes.

ABSTRACT Purpose: To retrospectively analyze the changes in corneal keratometry and astigmatism after intrastromal ring surgery, comparing the use of one long arch segment versus two traditional arc length segments. Methods: A cross-sectional study obtained data from 94 eyes of patients diagnosed with keratoconus that underwent surgical treatment with corneal ring implant. They were divided into two groups according to the type of implant received: one long-arch segment (Group A) or two traditional segments (Group B), both 250 microns thick. Preoperative data from the two groups were compared to ensure that the samples were similar (the differences between the two groups were not statistically significant). The variables (pre and post-operatively) analyzed were: best corrected visual acuity, keratometry, corneal astigmatism and refraction. Results: Group A, which received one long arch segment, showed a Km decrease of 4.42D (8.7%) and a corneal astigmatism reduction of 2.43D (40.4%). Group B, where the eyes acquired two traditional arch segments, showed an average Km decrease of 2.66D (5.1%) and corneal astigmatism reduction of 2.11D (34.8%). The mean keratometry (Km) reduction obtained was statistically significant (p≤0.05) when comparing both groups (A and B). The mean corneal astigmatism reduction was not statistically significant (p≤0.05) when comparing both groups (A and B). Conclusions: One long-arch segment has been demonstrated to have a greater capacity to reduce corneal curvature when compared to the use of two traditional-sized arch segments. No significant differences were found regarding the reduction of corneal astigmatism after comparing the results obtained in both groups.

Restauration prothétique amovible partielle et implantologie dans la qualité de vie orale des patients: revue narrative / Restoration of partial removable prosthetic and implantology in oral quality of life of patients: narrative review

L'association des implants aux prothèses amovibles partielles (PAP) ne sont pas bien perçues contrairement à la prothèse amovible complète. Cet article examine les connaissances actuelles sur la qualité de vie orale des patients porteurs de Prothèses amovibles partielles supra implantaires (PAPSI), en prenant en compte les performances cliniques, la comparaison des PAP versus les PAPSI et le taux de survie des implants. Les édentements mandibulaires en extension sont les plus concernés par les PAPSI avec une utilisation prépondérante de piliers axiaux. Le passage de la PAP à la PAPSI augmente de manière significative la satisfaction du patient. Le taux de survie des implants varie de 91.6% à 100% sur une durée de 2.5 à 7 ans. Au total, l'utilisation des PAP associée à des implants améliore la qualité de vie orale des patients. Des études cliniques prospectives sont davantage nécessaires pour évaluer cette approche.

The association of implants with partial removable prostheses (RPPs) is not well perceived in contrast to complete removable prostheses. This article reviews the current knowledge on the oral quality of life of patients with supra-implant removable partial dentures (SIRPDs), considering clinical performance, comparison of RPPs versus SIRPDs and implant survival. Extended mandibular edentulous teeth are the most concerned by PAPSI with a preponderance of axial abutments used. The switch from RPDs to SIRDs significantly increases patient satisfaction. The survival rate of the implants varies from 91.6% to 100% over a period of 2.5 to 7 years. Overall, the use of RPPs in combination with implants improves the oral quality of life of patients. More prospective clinical studies are needed to evaluate this approach.

One-stage revision using intra-articular vancomycin infusion effectively treats chronic prosthetic joint infection caused by Enterococcal / 中华外科杂志

Objective: To investigate the clinical effects of one-stage revision combined with intra-articular infusion of vancomycin in the treatment of chronic prosthetic joint infection (PJI) caused by Enterococcal. Methods: From May 2013 to June 2020,the clinical data of 9 patients (2 males and 7 females) with chronic Enterococcal PJI treated with one-stage revision using intra-articular infusion of vancomycin at Department of Orthopaedics,First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed,including 8 hips and 1 knee.A total of 9 patients with age of (63.9±11.7)years (range:43 to 76 years) were included, and the body mass index was (23.6±4.3)kg/m2 (range:18 to 30 kg/m2).There were 6 cases with antibiotic history and 5 cases with sinus tract.The joint fluid,infected tissue around the prosthesis and ultrasonic shock fluid of the prosthesis were collected during operation for microbial culture identification and drug sensitivity test.After thorough debridement of the infected site and removal of the infected prosthesis,a new prosthesis was implanted,then the drainage tube in the operation area was placed.After surgery,vancomycin(1.0 g,q12 h) was combined with intra-articular vancomycin(0.5 g,qd) in monomicrobial PJI,and vancomycin(1.0 g,q12 h) was combined with intra-articular vancomycin (0.5 g,qd) and imipenem/meropenem (0.5 g,qd),and the interval between the two drugs was 12 hours in polymicrobial PJI.Hip and knee functions were evaluated by Harris Hip Score or Knee Society Score(KSS),respectively.The comparison of hip function scores before and after operation was performed by paired t-test. Results: All patients were followed up for (60±39)months(range:24 to 110 months).Two cases were infected with Enterococcus faecium and 7 cases were infected with Enterococcus faecalis.There were 7 cases of monomicrobial infection and 2 cases of polymicrobial infection.Erythromycin(5/9),tetracycline(4/9),ciprofloxacin and β-lactam antibiotics(3/9) were the top three antibiotics in Enterococci resistance rate.The sensitive antibiotics for Enterococcal were vancomycin,linezolid and tigecycline.The average duration of intravenous antibiotics was (14±1)days (range:13 to 17 days),and the average duration of antibiotics in articular cavity was (15±2)days(range:11 to 20 days).Mean duration of oral antibiotic use after discharge was (2±1)months(range:1 to 3 months).One case of polymicrobial PJI treatment failed,with a failure rate of 1/9.At last follow-up,the Harris score of patients with hip PJI increased from (43±6)points to (84±6)points(t=-11.899, P<0.01). KSS score of knee function was improved from 33 point pre-operatively to 85 point post-operatively;overall function score was improved from 35 point pre-operatively to 80 point post-operatively.During the treatment,no formation of sinus tract of the hip joint caused by a catheter,skin necrosis at the knee puncture site or leakage of joint fluid;no complications such as deep vein thrombosis and pulmonary embolism occurred. Conclusions: One-stage revision combined with intra-articular infusion of vancomycin can achieve acceptable infection control rate and joint function in patients with chronic Enterococcus PJI.However,the treatment of polymicrobial PJI still needs to be further verified.

Research status and development of biodegradable zinc alloy as orthopedics implant / 生物医学工程学杂志

Znic (Zn) alloys with good cytocompatibility and suitable degradation rate have been a kind of biodegradable metal with great potential for clinical applications. This paper summarizes the biological role of degradable Zn alloy as bone implant materials, discusses the mechanical properties of different Zn alloys and their advantages and disadvantages as bone implant materials, and analyzes the influence of different processing strategies (such as alloying and additive manufacturing) on the mechanical properties of Zn alloys. This paper provides systematic design approaches for biodegradable Zn alloys as bone implant materials in terms of the material selection, product processing, structural topology optimization, and assesses their application prospects with a view to better serve the clinic.

Progress in antibacterial/osteogenesis dual-functional surface modification strategy of titanium-based implants / 中国修复重建外科杂志

OBJECTIVE@#To review antibacterial/osteogenesis dual-functional surface modification strategy of titanium-based implants, so as to provide reference for subsequent research.@*METHODS@#The related research literature on antibacterial/osteogenesis dual-functional surface modification strategy of titanium-based implants in recent years was reviewed, and the research progress was summarized based on different kinds of antibacterial substances and osteogenic active substances.@*RESULTS@#At present, the antibacterial/osteogenesis dual-functional surface modification strategy of titanium-based implants includes: ① Combined coating strategy of antibiotics and osteogenic active substances. It is characterized in that antibiotics can be directly released around titanium-based implants, which can improve the bioavailability of drugs and reduce systemic toxicity. ② Combined coating strategy of antimicrobial peptides and osteogenic active substances. The antibacterial peptides have a wide antibacterial spectrum, and bacteria are not easy to produce drug resistance to them. ③ Combined coating strategy of inorganic antibacterial agent and osteogenic active substances. Metal ions or metal nanoparticles antibacterial agents have broad-spectrum antibacterial properties and various antibacterial mechanisms, but their high-dose application usually has cytotoxicity, so they are often combined with substances that osteogenic activity to reduce or eliminate cytotoxicity. In addition, inorganic coatings such as silicon nitride, calcium silicate, and graphene also have good antibacterial and osteogenic properties. ④ Combined coating strategy of metal organic frameworks/osteogenic active substances. The high specific surface area and porosity of metal organic frameworks can effectively package and transport antibacterial substances and bioactive molecules. ⑤ Combined coating strategy of organic substances/osteogenic active substancecs. Quaternary ammonium compounds, polyethylene glycol, N-haloamine, and other organic compounds have good antibacterial properties, and are often combined with hydroxyapatite and other substances that osteogenic activity.@*CONCLUSION@#The factors that affect the antibacterial and osteogenesis properties of titanium-based implants mainly include the structure and types of antibacterial substances, the structure and types of osteogenesis substances, and the coating process. At present, there is a lack of clinical verification of various strategies for antibacterial/osteogenesis dual-functional surface modification of titanium-based implants. The optimal combination, ratio, dose-effect mechanism, and corresponding coating preparation process of antibacterial substances and bone-active substances are needed to be constantly studied and improved.

Long-term effectiveness of uncemented allograft-prosthesis composite for reconstruction of bone defects after proximal femur tumor resection / 中国修复重建外科杂志

OBJECTIVE@#To investigate the long-term effectiveness of uncemented allograft-prosthesis composite (APC) for reconstruction of bone defects after proximal femur tumor resection.@*METHODS@#Between June 2007 and March 2014, 21 patients who underwent uncemented APC reconstruction of proximal femur after tumor resection were retrospectively evaluated. There were 9 males and 12 females with an average age of 33.2 years (range, 19-54 years). There were 9 cases of giant cell tumor of bone, 5 cases of osteosarcoma, 4 cases of osteoblastic osteosarcoma, 2 cases of chondrosarcoma, and 1 case of undifferentiated pleomorphic sarcoma. Thirteen cases of benign bone tumors were all classified as stage 3 by Enneking staging; and 8 cases of malignant bone tumors were classified as grade ⅡB in 7 cases and grade ⅡA in 1 case according to the American Joint Committee on Cancer (AJCC) staging system. Among them, 7 patients underwent reoperation after recurrence, and the rest were primary operations; 8 patients presented with pathological fractures. The preoperative Harris hip score (HHS) and American Musculoskeletal Tumor Society (MSTS) score was 40 (30, 49) and 9.1±3.5, respectively. The length of osteotomy was 80-154 mm, with an average of 110 mm. At 1 year after operation and last follow-up, HHS and MSTS scores were utilized to evaluate the function of hip joint; the gluteus medius strength score was used to evaluation of the hip abduction function. Image examinations were taken at 1, 3, 6, 9, and 12 months after operation and every year thereafter to assess the union of allograft-host bone interfaces. Intra- and post-operative complications were also recorded.@*RESULTS@#All patients were followed up 84-163 months (mean, 123.5 months). At 1 year after operation and last follow-up, the HHS and MSTS scores significantly improved when compared with the preoperative scores ( P<0.05). However, there was no significant difference in the HHS score, MSTS score, and gluteus medius strength score between the two time points after operation ( P>0.05). Image examination showed that all allograft-host bone interfaces achieved union after 5-10 months (mean, 7.6 months). At last follow-up, all patients had bone resorption, including 11 severe cases, 4 moderate cases, and 6 mild cases; the bone resorption sites included Gruen 1, 2, and 7 regions. Complications included 10 fractures and 1 prosthetic fracture. Local recurrence occurred in 3 patients and pulmonary metastasis in 3 patients.@*CONCLUSION@#Uncemented APC is a reliable method for the reconstruction of bone defects after proximal femur tumor resection. It has the good long-term effectiveness and possesses obvious advantages in the union at the bone-bone surface.