vendex and Pain--Postoperative

The purpose of this prospective randomized study was to assess whether uncomplicated mandible fractures could be treated successfully in an open or closed fashion using maxillomandibular fixation (MMF) screws.. This was a prospective institutional review board-approved study involving 20 adult patients who presented to the university emergency department or oral and maxillofacial surgical clinic with uncomplicated mandible fractures. Patients who met the exclusion criteria consented to enter the study in the open reduction internal fixation (ORIF) or the closed (MMF) study group. Six to 8 MMF screws were used to obtain intermaxillary fixation (IMF) in the 2 groups. Screw failure was documented. All screws were removed at 5 to 6 weeks postoperatively. Insertional torque (IT) was measured at time of screw placement to assess primary stability. Clinical and photographic documentation was performed to assess fracture healing, occlusion, and gingival health. Ten-centimeter visual analog scales were used to assess patient-centered outcomes. Cone-beam computed tomography was performed to assess the long-term effects on the periodontium and roots. A cost comparison was performed to determine whether the use of screws was cost effective compared with arch bars.. Fifteen men and 5 women (mean age, 25.2 yr) entered the study. All patients displayed adequate fracture healing based on clinical examination. All patients had acceptable occlusion at 5 to 6 weeks postoperatively. Total screw failure was 27 of 106 screws (25.5%). Forty percent of screws placed in the MMF group failed compared with only 6% in the ORIF group. Gingival health scores were favorable. Factors that had a significant effect on screw failure included a lower IT (P = .002), use in closed (MMF) treatment (P < .001), and use in the posterior jaw (P = .012). Minimal pain was associated with the MMF screws and pre-existing occlusion was re-established based on patients' subjective responses. The MMF group reported a statistically significant lower quality of life (P < .001) compared with the ORIF group. There was only 1 screw site that had a facial cortical bone defect noted at 6-month follow-up CBCT examination. There were no discernible long-term root defects. Cost analysis showed that the use of MMF screws saved around $600 per patient in operating room usage cost alone compared with the estimated use of arch bars.. Uncomplicated mandible fractures were successfully treated using MMF screws in open and closed treatments. However, the utility in closed treatment was decreased because of significant screw failure and patient noncompliance. The screws were well tolerated by the patients. There was minimal long-term damage to the periodontium and dental roots. The cost of screws was more than offset by time savings.

Topics: Activities of Daily Living; Adult; Alveolar Process; Bone Screws; Cone-Beam Computed Tomography; Cost-Benefit Analysis; Dental Occlusion, Centric; Equipment Failure; Female; Follow-Up Studies; Fracture Fixation, Internal; Fracture Healing; Gingiva; Gingivitis; Humans; Jaw Fixation Techniques; Male; Mandibular Fractures; Pain, Postoperative; Photography, Dental; Pilot Projects; Postoperative Complications; Prospective Studies; Quality of Life; Tooth Root; Torque; Treatment Outcome

To compare planning and patient rehabilitation using a 3D dental planning software and dedicated surgical guides with conventional rehabilitation of partially or fully edentulous patients using flapless or mini-flap procedures and immediate loading.. Fifty-one fully or partially edentulous patients requiring at least 2 implants to be restored with a single prosthesis, having at least 7 mm of bone height and 4 mm in bone width, had their implant rehabilitation planned on three-dimensional (3D) cone beam computed tomography (CBCT) scans using a dedicated software. Afterwards they were randomised according to a parallel group study design into two arms: computer-guided implant placement aided with templates (computer-guided group) versus conventional implant placement without templates (conventional group) in three different centres. Implants were to be placed flapless and loaded immediately; if inserted with a torque over 35 Ncm with reinforced provisional prostheses, then replaced, after 4 months, by definitive prostheses. Outcome measures, assessed by masked assessors were: prosthesis and implant failures, complications, peri-implant bone level changes, number of treatment sessions, duration of treatment, post-surgical pain and swelling, consumption of pain killers, treatment time, time required to solve complications, additional treatment cost, patient satisfaction. Patients were followed up to 1 year after loading.. Twenty-six patients were randomised to the conventional treatment and 25 to computerguided rehabilitation. No patient dropped out. One provisional prosthesis failed, since one of the two supporting implants failed 11 days after implantation in the conventional group (P = 1.0). Four patients of the conventionally loaded groups experienced one complication each, versus five patients (6 complications) in the computer-guided group (P = 0.726). There were no statistically significant differences between the two groups for any of the tested outcomes with the exception of more postoperative surgical pain (P = 0.002) and swelling (P = 0.024) at conventionally treated patients.. When treatment planning was made on 3D CBTC scan using a dedicated software, no statistically significant differences were observed between computer-guided and a free-hand rehabilitations, with the exception of more postoperative pain and swelling at sites treated freehand because more frequently flaps were elevated.

Topics: Adult; Aged; Aged, 80 and over; Analgesics; Cone-Beam Computed Tomography; Dental Implantation, Endosseous; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Edema; Female; Follow-Up Studies; Humans; Imaging, Three-Dimensional; Immediate Dental Implant Loading; Jaw, Edentulous, Partially; Male; Middle Aged; Mouth, Edentulous; Operative Time; Pain, Postoperative; Patient Care Planning; Patient Satisfaction; Postoperative Complications; Surgery, Computer-Assisted; Surgical Flaps; Torque; Treatment Outcome

Our study was conducted to compare radiographic alignments and functional outcomes with 2 approaches to minimal-incision total knee arthroplasty (TKA): the minimal-incision medial parapatellar (MP) approach and the quadriceps-sparing (QS) approach with side-cutting instruments. Sixty patients (80 knees) with primary osteoarthritis were randomly assigned to receive MP or QS TKA. Postoperative alignment of the femoral component was significantly less valgus, and postoperative alignment of the tibial component was significantly more varus with the QS approach than with the MP approach. One tibial outlier and 3 femoral outliers were observed with QS TKA. The overall postoperative hip-knee-ankle axis was more varus, and surgical time was longer with QS TKA. Short-term isokinetic peak muscle torque, postoperative pain, and functional outcomes did not differ between the approaches.

Topics: Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee; Biomechanical Phenomena; Bone Malalignment; Female; Humans; Knee Joint; Knee Prosthesis; Male; Middle Aged; Minimally Invasive Surgical Procedures; Muscle Strength; Osteoarthritis, Knee; Pain, Postoperative; Prospective Studies; Quadriceps Muscle; Radiography; Single-Blind Method; Torque; Treatment Outcome

The objective of the study was assessment of the function of the knee joint after ACL reconstruction using the LARS method and autogenous graft. The study was of a retrospective character and included 96 patients who had undergone reconstruction of the torn ACL. The study was conducted within 36-48 months after surgery.. In order to compare the results of the ACL reconstruction performed with 2 types of grafts, the following instruments were used: Lysholm Knee Scoring Scale, SF 36v2 questionnaire for assessment of health-related quality of life, and Biodex System 4 for isokinetic muscle testing.. No differences in the evaluation of the quality of life measured using SF 36v2 questionnaire were observed between the LARS and ST GR groups. Using the Lysholm Scale, the distribution of knee function scores was compared according to the type of surgery. There are no grounds to confirm the differences in the distribution of knee function scores considering the type of graft (p = 0.756). Isokinetic test showed a significant weakening of muscle strength in the operated limb, compared to the strength of the healthy limb.. The type of graft used for ACL reconstruction does not exert an effect on the quality of life of patients or the level of their knee joint function. Extensor and flexor muscles strength of the knee joint was lower in the operated limb, irrespective of the type of graft used. Weak relationships were observed between the level of knee joint function and extensor muscle strength of this joint.

Topics: Adult; Anterior Cruciate Ligament Reconstruction; Female; Humans; Knee Joint; Lysholm Knee Score; Male; Middle Aged; Pain, Postoperative; Quality of Life; Range of Motion, Articular; Self Report; Torque

Pedicle screw loosening has been implicated in recurrent back pain after lumbar spinal fusion, but the degree of loosening has not been systematically quantified in patients. Instrumentation removal is an option for patients with successful arthrodesis, but remains controversial. Here, we quantified pedicle screw loosening by measuring screw insertion and/or removal torque at high statistical power (beta = 0.02) in N = 108 patients who experienced pain recurrence despite successful fusion after posterior instrumented lumbar fusion with anterior lumbar interbody fusion (L2-S1). Between implantation and removal, pedicle screw torque was reduced by 58%, indicating significant loosening over time. Loosening was greater in screws with evoked EMG threshold under 11 mA, indicative of screw misplacement. A theoretical stress analysis revealed increased local stresses at the screw interface in pedicles with decreased difference in pedicle thickness and screw diameter. Loosening was greatest in vertebrae at the extremities of the fused segments, but was significantly lower in segments with one level of fusion than in those with two or more.. These data indicate that pedicle screws can loosen significantly in patients with recurrent back pain and warrant further research into methods to reduce the incidence of screw loosening and to understand the risks and potential benefits of instrumentation removal. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2673-2681, 2017.

Topics: Adult; Aged; Electromyography; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Pain Perception; Pain, Postoperative; Pedicle Screws; Retrospective Studies; Spinal Fusion; Stress, Mechanical; Torque

It is currently unknown whether knee replacement-associated bone loss is modified by rehabilitation programs. Thus, a sample of 45 (18 men and 25 women) persons with unilateral knee replacement were recruited; age 66 years (sd 6), height 169 cm (sd 8), body mass 83 kg (sd 15), time since operation 10 months (sd 4) to explore the associations between maximal torque/power in knee extension/flexion and femoral mid-shaft bone traits (Cortical cross-sectional area (CoA, mm(2)), cortical volumetric bone mineral density (CoD, mg/mm(3)) and bone bending strength index (SSI, mm(3))). Bone traits were calculated from a single computed tomography slice from the femoral mid-shaft. Pain in the operated knee was assessed with the WOMAC questionnaire. Stepwise regression models were built for the operated leg bone traits, with knee extension and flexion torque and power, age, height, body mass, pain score and time since operation as independent variables. CoA was 2.3% (P=0.015), CoD 1.2% (P<0.001) and SSI 1.6% (P=0.235) lower in the operated compared to non-operated leg. The overall proportions of the variation explained by the regression models were 50%, 29% and 55% for CoA, CoD and SSI, respectively. Body mass explained 12% of Coa, 11% of CoD and 11% of SSI (P≤0.003). Maximal knee flexion torque explained 38% of Coa, 7% of CoD and 44% of SSI (p≤0.047). For CoD time since operation also became a significant predictor (11%, P=0.045). Knee flexion torque of the operated leg was positively associated with bone strength in the operated leg. Thus, successful rehabilitation may diminish bone loss in the operated leg.

Topics: Aged; Arthroplasty, Replacement, Knee; Bone Density; Female; Femur; Humans; Knee Joint; Male; Models, Biological; Muscle Contraction; Muscle Strength; Muscle, Skeletal; Pain Measurement; Pain, Postoperative; Range of Motion, Articular; Stress, Mechanical; Surveys and Questionnaires; Time Factors; Tomography, X-Ray Computed; Torque

To study the relationships between insertional torque values (ITVs) recorded during implant placement and implant healing times and cumulative survival rates.. This retrospective study evaluated 174 Osseotite 6.0-mm-diameter, straight-wall, threaded dental implants (BIOMET 3i, Palm Beach Gardens, FL) placed in 172 consecutive patients by the primary author. All implants were placed immediately into mandibular first or second molar extraction sockets after extraction. ITVs were recorded at placement. Implants were evaluated 3 months after surgery before discharge to restorative dentists for restoration. The post-restorative follow-up ranged from 2 years 1 month to 4 years 8 months (median and mean of 3 years 1 month [SD, 4.95]).. Of the implants, 3% (n = 5) were removed at the time of surgical placement because of perceived clinical mobility of the implants within the osteotomies. The implants that were stable at the time of implant placement (n = 169) were placed into 1 of 3 groups relative to the specific ITVs at implant placement: group 1, low ITV, 29% (n = 49); group 2, medium ITV, 23% (n = 39); and group 3, high ITV, 48% (n = 81). Cumulative survival rates for each group were 86% for low ITV, 90% for medium ITV, and 96% for high ITV (P = .0302). At the scheduled 3 months' follow-up visit, 33% of the low ITVs, 21% of the medium ITVs, and 5% of the high ITVs required an additional 3 months of healing.. In this study ITVs measured through surgical handpieces during implant placement provided meaningful real-time feedback that aided the surgeon regarding implant survival and determining unloaded healing times on a case-by-case basis.

Topics: Alveolar Bone Loss; Biomechanical Phenomena; Dental Abutments; Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Female; Follow-Up Studies; Humans; Male; Mandible; Middle Aged; Molar; Osseointegration; Pain, Postoperative; Retrospective Studies; Survival Analysis; Tooth Extraction; Tooth Socket; Torque; Treatment Outcome; Wound Healing

The aim of this case series was to evaluate the Procera Software v1.6 and the surgical templates for flapless implant placement and immediate loading in atrophic fully edentulous maxillae.. The Procera Software was used to plan the exact position of the implants, and surgical templates were made to guide flapless implant placement. To allow for immediate loading, implants had to be placed with an insertion torque > 30 Ncm. Provisional cross-arch prostheses, produced before surgery using the software planning, were delivered immediately after implant placement, and replaced by final restorations after 6 months. Outcome measures were: prosthetic and implant failures, complications, post-operative pain and swelling, consumption of analgesics, and patient satisfaction. The followup stopped at 8 months post-loading.. Thirteen consecutive patients with atrophic maxillae were treated with 89 implants (6 to 8 implants per patient). Two flaps had to be elevated in two patients. One template fractured during surgery. Three implants in two patients were not loaded immediately. In four patients, impressions had to be taken to fit the provisional prostheses onto the implants. Five implants failed in four patients. One patient dropped out, due to financial reasons, with the provisional prosthesis still in function. Eight months after loading, all prostheses were successful and 11 out of 12 patients reported their quality of life and lifestyle had improved.. This software-based treatment planning may be useful in planning and treating challenging cases such as flapless implant placement and immediate loading of maxillary cross-arch bridges, but a learning curve is necessary.

Topics: Adult; Aged; Aged, 80 and over; Analgesics; Computer-Aided Design; Dental Implantation, Endosseous; Dental Implants; Dental Restoration Failure; Denture Design; Edema; Female; Follow-Up Studies; Humans; Jaw, Edentulous; Life Style; Male; Maxilla; Middle Aged; Pain, Postoperative; Patient Care Planning; Patient Satisfaction; Pilot Projects; Postoperative Complications; Prospective Studies; Quality of Life; Surgery, Computer-Assisted; Torque; Treatment Outcome