High-dose vancomycin spacers provided early recovery without nephrotoxicity compared with standard-dose in MRSA-induced periprosthetic joint infection model of rats.

BACKGROUND: Periprosthetic joint infections (PJIs) are commonly treated with two-stage revision surgery utilising antibiotic-loaded spacers; however, antibiotic release from spacers is limited and usually drops below effective levels a few days after placement. This study compared high-dose and standard-dose vancomycin-loaded spacers in terms of efficacy, safety, and overall treatment duration in a rat periprosthetic joint infection model. METHODS: Thirty male Wistar albino rats (8-10 weeks old, 300-320 g) were housed individually at standard conditions. A periprosthetic infection model was established in the right knee of the rats using methicillin-resistant Staphylococcus aureus (MRSA) -contaminated Kirschner wires. Two weeks later, the infection was verified, and the Kirschner wires were removed. Rats were randomly divided into three groups (n = 10): standard-dose (SVanc) and high-dose (HVanc) vancomycin groups had 2.5 and 7.5% vancomycin in their spacers, respectively, while the control group had no spacers. All groups received intramuscular (IM) vancomycin and gentamicin for 4 weeks after spacer implantation. Microbiological counts and vancomycin levels in the blood and joint flush samples were measured, and histopathological assessments were conducted on the femur and kidneys. RESULTS: After spacer implantation, MRSA was eliminated in the HVanc group with 4 weeks of treatment, while the SVanc group required 6 weeks of treatment (P < 0.001). Histopathological findings of the femoral medulla and cortical samples were better in the HVanc group compared with other groups (P = 0.007). Vancomycin levels in serum remained within safe limits in all groups, and kidney damage was not observed. CONCLUSION: The use of high-dose vancomycin spacers might accelerate the transition period, which in turn reduces the duration of systemic antibiotic use and mitigates the risk of nephrotoxicity. Thus, this method may decrease the medical costs associated with PJI treatment.

Osteosarcoma of the Proximal Fibula: A Case Report and Review of the Literature.

Osteosarcoma is the most common primary malignant bone tumor, especially in younger patients. Diagnosis is based on the combined evaluation of radiological, clinical, and pathological examinations. It is usually located in the distal femur, proximal tibia, and proximal humerus. The fibula is a rare localization for osteosarcoma. Surgery in this region is challenging due to the complex anatomic structures around the knee. Especially the peroneal nerve, lateral collateral ligament (LCL), and popliteal vessel branches are of critical importance. However, additional structures such as the arcuate ligament, biceps femoris, and iliotibial band play an essential role in the stabilization of the knee. Thus, these structures must be protected as much as possible. This case report aims to present the diagnosis and treatment process of conventional osteosarcoma in the proximal fibula, which was located close to the peroneal nerve and required LCL reconstruction after the resection.

The Epidemiology and the Treatment of Fractures Due to Electric Scooters: A Comparison of Pediatric and Adult Age Groups.

AIM: Electric scooters (e-scooters) are widely used as alternative vehicles worldwide. These light vehicles do not need a license to drive, and it is also popular among vehicles under the age of 18 among users in Turkey. This is a new term in the literature since there is an increase in accidents resulting from this overuse. This study aims to reveal the patterns and severity of orthopedic injuries resulting from using an e-scooter, especially in the pediatric population. PATIENTS AND METHODS:  Patients who were admitted to the university hospital emergency department due to using an e-scooter and had fractures were retrospectively analyzed. Demographic data, admission times, injury mechanisms, and fracture patterns of the patients were documented. RESULTS: Forty-nine (49.4%) of 99 patients were under 18, and 50 (50.6%) were over 18. It is seen that 58.5% (58 patients) had an accident by falling spontaneously, 37.3% (37 patients) collided with vehicles in traffic, and 4.2% had an accident by colliding with a standing object. While 59.5% of the upper extremity fractures are seen, 27.2% are lower extremity fractures. Multiple fractures were observed in 13.3%. CONCLUSION: Pediatric population frequently uses these alternative means of transport. The pediatric group usually had upper extremity injuries, while adults mostly had lower extremity injuries. Care must be taken when children are drivers of e-scooters.

Multiple platelet-rich plasma injections are superior to single PRP injections or saline in osteoarthritis of the knee: the 2-year results of a randomized, double-blind, placebo-controlled clinical trial.

INTRODUCTION: The primary purposes of this study were to prove the efficacy of PRP injection therapy on knee pain and functions by comparing patients with mild to moderate OA with a placebo control group, and also to understand the effectiveness of multiple doses compared to a single dose. It was hypothesized that PRP would lead to more favorable results than the placebo at 1, 3, 6, 12 and 24 months after treatment. MATERIALS AND METHODS: 237 patients diagnosed with OA were randomly separated into 4 groups, who were administered the following: single dose of PRP (n: 62), single dose of sodium saline (NS) (n: 59), three doses of PRP (n: 63), and three doses of NS (n: 53). Clinical evaluations were made pre-treatment and at 1, 3, 6, 12 and 24 months post-treatment, using the Knee Injury and Osteoarthritis Result Score (KOOS), Kujala Patellofemoral Score, knee joint range of motion (ROM), measurements of knee circumference (KC), and mechanical axis angle (MAA) and a Visual Analog Scale (VAS) for the evaluation of pain. RESULTS: The better score values in the groups were recorded at 3 and 6 months. Patients treated with PRP maintained better scores at 3, 6 and 12 months compared to the NS groups (p < 0.05). Multiple doses of PRP were seen to be more effective than single-dose PRP at 6 and 12 months (p < 0.05). At the end of 24 months, there was no significant score difference across all the groups. The most positive change in scores was found in stage 2 OA, and the most positive change in ROM was in stage 3 OA patients. In the PRP groups, KC decreased more at 1 and 6 months (p < 0.05). Compared to other age groups, patients aged 51-65 years scored better at 6 months (p < 0.05). A negative correlation was determined with MAA scores (r = - 0.508, p < 0.001). CONCLUSION: In comparison to the placebo (NS), leukocyte-rich PRP treatment was determined to be effective in the treatment of OA. Multiple doses of PRP increase the treatment efficacy and duration. Of all the patients treated with PRP, the best results were obtained by patients aged 51-65 years, with lower MAA, and by K/L stage 2 OA patients. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. REGISTRATION: NCT04454164 (ClinicalTrials.gov identifier).

Clinical application of stereolithographic surgical guide with a handpiece guidance apparatus: a case report.

The success of implant-supported restorations depends on the treatment planning and the transfer of planning through the surgical field. Recently, new computer-aided design and manufacturing (CAD/CAM) techniques, such as stereolithographic (SLA) rapid prototyping, have been developed to fabricate surgical guides to improve the precision of implant placement. The objective of the present case is to introduce a recently developed SLA surgical guide system into the rehabilitation of a 62-year-old male patient with mandibular edentulism. After obtaining a cone-beam computerized tomography (CBCT) scan of the mandible with a radiographic template, the images were transferred into a 3-dimensional (3D) image-based software for implant planning. The StentCad Beyond SLA surgical guide system, which is a combination of a currently used surgical template with pilot hollows and a surgical handpiece guidance apparatus, was designed to transfer a preoperatively defined implant position onto the surgical site without any drill-surgical guide contact. For the fabrication of this system, a surgical handpiece was scanned by a laser optical scanner and a mucosa-supported surgical guide was designed according to the patient's 3D model, which was attained from the CBCT images. Four dental implants were inserted through the SLA surgical guide system by a torque-controlled surgical handpiece to the interforaminal region via a flapless surgical procedure. Implants were assessed 3 months after surgery, and an implant-retained mandibular overdenture was fabricated. The present case emphasizes that CAD/CAM SLA surgical guides, along with CBCT images and scanning data, may help clinicians plan and place dental implants.

Clinical accuracy of 3 different types of computed tomography-derived stereolithographic surgical guides in implant placement.

PURPOSE: Presurgical planning is essential to achieve esthetic and functional implants. The goal of this clinical study was to determine the angular and linear deviations at the implant neck and apex between planned and placed implants using stereolithographic (SLA) surgical guides. PATIENTS AND METHODS: A total of 110 implants were placed using SLA surgical guides generated from computed tomography (CT). All patients used the radiographic templates during CT scanning. After obtaining 3-dimensional CT scans, each implant insertion was simulated on the CT images. SLA surgical guides using a rapid prototyping method including a laser beam were used during implant insertion. A new CT scan was made for each patient after implant insertion. Special software was used to match images of the planned and placed implants, and their positions and axes were compared. RESULTS: The mean angular deviation of all placed implants was 4.1 degrees+/-2.3 degrees, whereas mean linear deviation was 1.11+/-0.7 mm at the implant neck and 1.41+/-0.9 mm at the implant apex compared with the planned implants. The angular deviations of the placed implants compared with the planned implants were 2.91 degrees+/-1.3 degrees, 4.63 degrees+/-2.6 degrees, and 4.51 degrees+/-2.1 degrees for the tooth-supported, bone-supported, and mucosa-supported SLA surgical guides, respectively. CONCLUSION: The results of this study suggested that stereolithographic surgical guides using CT data may be reliable in implant placement, and tooth-supported SLA surgical guides were more accurate than bone- or mucosa-supported SLA surgical guides.

Reliability of implant placement with stereolithographic surgical guides generated from computed tomography: clinical data from 94 implants.

BACKGROUND: Dental implant placement requires precise planning with regard to anatomic limitations and restorative goals. The aim of this study was to evaluate the match between the positions and axes of the planned and placed implants using stereolithographic (SLA) surgical guides. METHODS: Ninety-four implants were placed using SLA surgical guides generated from computed tomography (CT) between 2005 and 2006. Radiographic templates were used for all subjects during CT imaging. After obtaining three-dimensional CT images, each implant was virtually placed on the CT images. SLA surgical guides, fabricated using an SLA machine with a laser beam to polymerize the liquid photo-polymerized resin, were used during implant placement. A new CT scan was taken for each subject following implant placement. Special software was used to fuse the images of the planned and placed implants, and the locations and axes were compared. RESULTS: Compared to the planned implants, the placed implants showed angular deviation of 4.9 degrees+/-2.36 degrees, whereas the mean linear deviation was 1.22+/-0.85 mm at the implant neck and 1.51+/-1 mm at the implant apex. Compared to the implant planning, the angular deviation and linear deviation at the neck and apex of the placed maxillary implants were 5.31 degrees+/-0.36 degrees, 1.04+/-0.56 mm, and 1.57+/-0.97 mm, respectively, whereas corresponding figures for placed mandibular implants were 4.44 degrees+/-0.31 degrees, 1.42+/-1.05 mm, and 1.44+/-1.03 mm, respectively. CONCLUSION: SLA surgical guides using CT data may be reliable in implant placement and make flapless implant placement possible.

Determination of bone quality of 372 implant recipient sites using Hounsfield unit from computerized tomography: a clinical study.

BACKGROUND: The type and architecture of bone are very important factors in the successful implant treatment, and it is manifested that higher implant failure is more likely in the poorer quality of bone. Conventional bone classifications have recently been questioned because they are subjective and retrospective. PURPOSE: This clinical study aimed to determine the variations of the bone density in dental implant recipient sites using computerized tomography (CT). MATERIALS AND METHODS: The study group comprised of randomly selected 140 patients with 372 implant sites. Recipient sites for implant placement were determined based on CT data using implant planning StentCad software (Media Lab Software, La Spezia, Italy). The mean bone density values in Hounsfield unit (HU) of the simulated implant areas were recorded using the StentCad software. RESULTS: The HU values ranged from 68 to 1,603 HU. It was found that mean bone density values were 927 +/- 237, 721 +/- 291, 708 +/- 277, and 505 +/- 274 HU in the anterior mandible, posterior mandible, anterior maxilla, and posterior maxilla, respectively. CONCLUSION: Preoperative CT examination may be a useful method for determining the bone density of recipient areas before implant placement, and this valuable information about bone quality helps clinicians to make better treatment planning regarding the implant positions.

[Evaluation of depth of invasion and tumor diameter in relation to tumor localization in laryngeal cancer]. / Larenks kanserlerinde tümör yerlesimine göre invazyon derinligi ve tümör çapinin degerlendirilmesi.

OBJECTIVES: We investigated the relationship between tumor localization and depth of tumor invasion and tumor diameter. PATIENTS AND METHODS: Neck dissection specimens of 70 patients (mean age 61+/-10 years, range 38 to 77 years) who underwent laryngectomy for squamous cell carcinoma of the larynx were histopathologically re-examined with regard to the number and localization of metastatic lymph nodes, depth of tumor invasion, and tumor diameter. Three tumor groups (supraglottic, glottic, and transglottic) were compared with respect to depth of tumor invasion, tumor diameter, metastatic lymph nodes, and T-stage. RESULTS: The overall mean depth of tumor invasion was 7.06 mm, being 7.76 mm, 7.05 mm, and 4.06 mm in supraglottic, transglottic, and glottic tumors, respectively. Compared to glottic tumors, depth of tumor invasion and tumor diameter were significantly higher in supraglottic and transglottic tumors (p<0.05). Depth of invasion showed a significant correlation with tumor diameter (p<0.05), whereas there was no correlation between depth of invasion and lymph node metastasis (p>0.05). In supraglottic tumors, depth of invasion significantly increased in parallel with T-stage (p<0.05). In transglottic and glottic tumors, however, there was no correlation between T-stage and depth of invasion (p>0.05). CONCLUSION: Our data show that depth of tumor invasion is related with tumor location and diameter in laryngeal cancers.

An investigation of tooth/implant-supported fixed prosthesis designs with two different stress analysis methods: an in vitro study.

PURPOSE: Tooth/implant-supported fixed prostheses (TIFPs) present biomechanical design problems, because the implant is rigidly anchored within the alveolus, and the tooth is attached by the periodontal ligament that allows movement. While TIFP designs with rigid connectors (RCs) are preferred by many clinicians, the designs containing non-rigid connectors (NRCs) are suggested as a method to compensate for these mobility differences. However, studies have failed to show the advantage of one design over the other. This study examined stresses formed around the implant and natural tooth abutments under occlusal forces, using two dimensional finite element (2D-FEM) and photoelastic stress analysis methods (PSAM). MATERIALS AND METHODS: Connection of TIFP designs were investigated in distal extension situations using stress analysis interpreted with the 2D-FEM and PSAM. Three TIFP (screw type implant, 3.75 mm x 13 mm) models with various connection designs (i.e., rigidly connected to an abutment tooth, connected to an abutment tooth with an NRC, connected to an abutment implant with an NRC) were studied. The stress values of the three models loaded with vertical forces (250 N) were analyzed. RESULTS: The highest level of stresses around the implant abutment was noted on the TIFPs with the RC. On the other hand, NRCs incorporated into prostheses at the site of the implant abutment reduced the level of stresses in bone. CONCLUSION: It could be suggested that if tooth and implant abutments are to be used together as fixed prostheses supports, NRCs should be placed on the implant abutment-supported site.

Implant-supported prosthetic applications upon development of children and adolescents: a pilot study in pigs.

PURPOSE: The purpose of this study is the investigation of the application of implant-supported prosthetic restorations using 2 implants supporting a fixed prosthesis during the physical growth and the development period of growing pigs. MATERIALS AND METHODS: This study was carried out on 6 male farm pigs (1 as a control). The effect of the 2 screw-type endosseous implants inserted into the premolar area on the left mandibular arches of 5 farm pigs upon the jaw was investigated during a 3.5-8-month growth period using cephalometric radiographs. The cephalographs were taken with a specially standardized cephalostat, and a significant test of differences between 2 partners was used to evaluate them. RESULTS: The study suggested that the implants showed alveolar elevation by bone growth but could not keep pace with the natural teeth eruptions and the bone growth in the region. CONCLUSION: Although the sagittal and transverse developments of the neighboring bone region are greater than the implant-inserted region, the difference in this growth can be tolerated by corrections or modifications of implant-supported superstructures.

Temporomandibular joint clicking noises caused by a multilocular bone cyst: a case report.

When diagnosing patients with temporomandibular disorder (TMD) symptoms, the possibility of unusual causes must be considered, including neoplastic disorders, as well as infections and inflammatory disease. Therefore, radiologic examination may prove to be invaluable in the differential diagnosis of TMDs. This article describes a patient whose temporomandibular joint (TMJ) noise was initially diagnosed by another dental clinic as a TMJ anterior disc displacement with reciprocal clicking. Occlusal splint therapy was used for nearly three to four months but did not improve the TMJ noise condition. When the patient was examined clinically and imaged with magnetic resonance imaging (MRI) and computed tomography (CT), a multilocular bone cyst (MBC) was suspected. The cyst could cause surface irregularities in the posterior part of the left eminence of the temporal bone, which could be the source of the clicking noise.