Clinical insights into the three-dimensional anatomy of cheek teeth in alpacas based on micro-computed tomography - Part 2: Maxillary cheek teeth

Background Scientific knowledge regarding alpaca dentistry is relatively limited despite its clinical implications. The present gap in available supportive data leads to limited treatment options for dental pathology in alpacas in comparison to other species. The main goal of this study was to gain novel insights into the general and pulp morphology of maxillary cheek teeth to allow development of more advanced treatment strategies in the future. Also, the risk of causing pulp exposure when floating maxillary cheek teeth was of particular interest. Concurent research focusing on the anatomy of mandibular cheek teeth has been performed accordingly. The results obtained in mandibular teeth are expected to be non-extrapolatable because of the structural differences between mandibular and maxillary teeth. Results Pulp morphology of maxillary cheek teeth showed great variation. A common pulp chamber was identified in 46/83 (55.4%) teeth with a mean dental age of 2 years and 7 months (± 2 years and 5 months). Pulpal segmentation was more commonly observed in teeth of increasing age. Full columnar segmentation was seen in 33/69 teeth (47.8%), whereas within-column segmentation was observed in 36/83 teeth (43.4%). Age and degree of segmentation of the pulpal tissue varied greatly according to Triadan position. Physical contact between roots of adjacent teeth was found in the majority of examined molars (range 82–94%) which resulted in morphological adaptations at the level of the root tips. The measured sub-occlusal dentinal thickness was as low as 0.46 mm above pulp horn 2 in a 14 years and 11 months old Triadan 09, emphasizing the risk of pulp exposure attributed to dental floating. Conclusion This study offers an objective description of age-dependent maxillary cheek teeth pulp morphology in alpacas. Current findings are of great value to provide a basis for the development of tooth-saving techniques as a treatment for dental disease in this species. Observed physical contact between the roots of different examined molars may be a facilitating factor in the spread of apical infection in chronically diseased cases. Finally, a conservative approach regarding dental floating is recommended in order to avoid iatrogenic damage to pulp tissue.

Retrospective Evaluation of Variations in Root Canal Morphology of Permanent Maxillary Premolars Among the Emirate Population

Background: This research aims to identify the most common morphology of the upper premolars in a group of local and nonlocal people in the UAE using cone-beam computed tomography (CBCT).Methods: CBCT images of a total of 214 intact maxillary premolars were analysed with 3D reconstruction GALAXIS viewer software. The Pearson Chi squared test and the two samples t test were applied.Results: In all, 90% of the maxillary first premolars had two roots (92% females, 88% males, 83% locals, 96% nonlocals). A total of 52% of maxillary second premolars had two roots (47% females, 56% males, 38% locals, 67% nonlocals). Two cases had three roots among local males. A significant difference of one root in the maxillary second premolar was observed between locals (63%) and nonlocals (33%), while two roots were higher among nonlocals (67%) than locals (37%, p = 0.002). Three roots were discovered in two teeth of the local UAE first premolar. The most common canal morphology in the maxillary first premolar group among local UAE subjects was type V (52%), and among nonlocal UAE subjects was type V (59%). Additional types included 7 (13.2%) identified and unrelated to the Vertucci classification. The dominant canal morphology in the maxillary second premolar among local UAE subjects was type II (32%), and among nonlocal UAE subjects was type V (25%); among the additional types, 12 (23.1%) were identified and not related to the Vertucci classification. There was a significant difference in the distance from the pulp chamber roof to the cementoenamel junction (CEJ) and the measurement between the single-rooted maxillary premolar CBCT for local UAE subjects was 1.36 mm (SD ±0.75) and for nonlocal subjects was 1 mm (SD ±0.27, p = 0.049). There were statistically significant differences in all measurements between multiple rooted maxillary premolar CBCTs for local UAE and South Asian subjects (p < 0.05)Conclusions: The results suggest a more quantitative approach to maxillary first and second premolar access cavity preparation in the UAE population to prevent errors and iatrogenic damage when identifying the canals; using CBCT measurements for more precise access preparations may be advantageous.

Effectiveness of different fiber post removal techniques and their influence on dentinal microcrack formation

Objectives The aim of this study was to evaluate the effectiveness of different fiber post removal techniques and to correlate dentinal loss with microcrack formation. Materials and methods Forty-five extracted single-rooted teeth were root canal treated and fiber posts were adhesively luted. Specimens were divided into three groups (n = 15) according to the removal technique: long-shaft round bur (EndoTracer #08, Komet, Lemgo, Germany), SonicFlex Endo (KaVo, Biberach, Germany), DT Post Removal Kit (VDW, Munich, Germany). Roots were scanned before post cementation and after post removal using micro-computed tomography. Dentin loss, residual luting material, working time, and the induction of microcracks were assessed. Statistical analysis was performed by using multiple contrast tests (max-t tests, α = 0.05). Correlations between parameters dentin loss/new microcracks and dentin loss/residual material were calculated using Kendall’s tau. Results Post removal with SonicFlex Endo resulted in the highest amount of removed dentin with significant differences to the round bur and the DT Post Removal Kit. No technique was found to completely remove the post and luting material. All techniques induced microcracks with the DT Post Removal Kit presenting the highest number of new defects. No correlation between dentin loss and new microcracks was observed. Deviations from the original root canal occurred in all groups, but no perforation was observed. Conclusions All techniques resulted in dentin loss, residual luting material, and the formation of microcracks. However, no correlation between dentin loss and the induction of microcracks was observed. Clinical relevance As all techniques resulted in microcrack formation and dentin loss, this study emphasizes the risk of iatrogenic damage due to post removal procedures.

Features of TLIF/PLIF in lumbar spine nerve root anomalies. The literature review and own experience

Introduction. Anomalies of the roots of the lumbar spine are often not diagnosed at the preoperative stage and may cause technical difficulties during performing decompression‑stabilization surgeries of spine.Purpose of the study. To study the clinical features of patients with anomalies of the lumbar roots on the background of de‑ generative diseases of the spine, to develop techniques to protect abnormal nerve roots from damage during TLIF/PLIF.Materials and methods. Performed retrospective analysis of the results of treatment of 9 patients whom were done TLIF/PLIF for degenerative‑dystrophic diseases of the lumbar spine in the period from 2018–2019 was. The distribution of changes detected in the spine was carried out according to the classification of Schizas, Meyerding and Neidre & Macnab.Results. The study group of patients was 0.63 % of all operated patients using the TLIF/PLIF technique (n = 1432). Developmental anomalies of the nerve roots were not identified during routine MRI in all patients. In six patients (66.7 %), radicular pain manifested in two dermatomes; intraoperatively, these patients had conjoint roots (Ia). Three pa‑ tients (33.3 %) had radicular pain in several (>2) dermatomes. The root tension sign (Lasegue sign) was negative in eight (88.9 %) patients. The intensity of the preoperative pain syndrome in the leg averaged 6.44 (VAS), in the back 6.11, and in the postoperative period it decreased to 0.7 and 2.1, respectively.Conclusion. Clinical preoperative markers for the presence of root anomalies can be two‑dermatomal radicular mani‑ festations in the presence of a single‑level process, as well as the absence of a Lasegue sign in severe radiculopathy. Intraoperative detection of anomalies requires a balanced approach to the choice of the method of surgical intervention from the surgeon. To prevent iatrogenic damage of anomaly roots at the stage of surgical treatment, it is necessary to change the preoperative planning strategy in favor of choosing the contralateral side for interbody fusion. In addition, root traction and interbody distraction should be minimal.

Surgical Modalities of Repair of Intra Articular Fractures of Proximal Interphalangeal Joint: A Meta-analysis

Background The proximal interphalangeal (PIP) joints of the fingers are extremely important for gripping things with hands, more specifically, what is called the ‘power grip’. Aim of the Work To compare the different modalities of repair of intra-articular fractures of PIP joint. Materials and Method A systematic review and meta-analysis were performed in accordance to the recommendations of the “Preferred Reporting Items for Systematic Reviews and MetaAnalyses” (PRISMA). PRISMA is reporting checklists for the authors, the editors, and the reviewers of Meta-analyses of the interventional and the observational studies. According to the International committee of medical journal association (ICJME), the reviewers must report their findings according to each of the items listed in those checklists. Results The results of this study includes the search results and data extraction results which includes summary characteristics and baseline characteristics of the included Studies, outcome measures and Complications of the included studies. Conclusion There is no consensus regarding the most effective technique for management of unstable PIPJ fractures. The extension block pinning, closed reduction and percutaneous pinning of the fracture fragments, dynamic distraction and external fixation, open reduction and internal fixation, and hemihamate reconstruction arthroplasty are safe and reliable and reduce the risk of iatrogenic damage when used to treat unstable dorsal fracture-dislocations of the PIP joint.

Iatrogenic hepatic damage as a problem of modern surgery (literature review)

Iatrogenic damage to the extrahepatic bile ducts occurs in a fairly large number of observations, despite constant work aimed at improving surgical interventions. The most optimal chosen therapeutic tactics, as well as the timing of the revealed damage to the bile ducts, determine the effectiveness and quality of care provided to this category of patients. We also have to state that, to date, in the Russian Federation there is no unambiguously generally accepted and approved therapeutic and diagnostic algorithm for iatrogenic damage to the extrahepatic bile ducts. One of the main aspects of the effectiveness of the applied treatment tactics is the level of quality of life of patients who underwent surgical treatment. Treatment and management of patients with iatrogenic damage to the extrahepatic bile ducts still have a fairly large number of controversial issues, the solution of which should improve the immediate results of surgical treatment of this category of patients.

Debonding Techniques - A Review

BACKGROUND The overall success of orthodontic treatment depends on both bonding as well as debonding techniques. The debonding procedure in orthodontics consists of removal of the attachments (brackets, bondable tubes & buttons) as well as all the adhesive resin from the teeth without causing any permanent damage and to restore the teeth to their pre-treatment stage. The demand for more aesthetic appliance led to the introduction of direct bonding techniques and has made banded attachments almost obsolete in present-day orthodontics. These procedures should not be painful to the patient or damaging to enamel and to obtain these objectives a correct debonding technique is of fundamental importance. The debonding procedure is as essential as bonding for the overall success of the orthodontic treatment. In an attempt to increase the bond strength of orthodontic appliances, we have neglected the fact that these appliances have to be debonded at the end of the treatment. In orthodontics debonding refers to debracketing that is removal of brackets, bondable tubes, buttons, and the adhesive used to bond as well as to restore the form and surface of tooth to its best possible original form by avoiding any type of iatrogenic damage. For achieving such objectives, an accurate debonding procedure is of utmost importance, else it could be needlessly lengthy and painful to the patient and damaging to the enamel. Many researches have been carried out to conclude the best techniques for debonding which will give an ideal finish for the tooth when treatment is terminated. The debonding procedure is mostly done by mechanical means, but its technique should be varied according to the bracket material and type. KEY WORDS Debonding Techniques, Metal Brackets, Ceramic Brackets, Enamel Damage

Articular Cartilage of the Syndesmosis: Avoiding Iatrogenic Cartilage Injury During Syndesmotic Fixation

Background: The optimal surgical management of syndesmosis injuries consists of internal fixation between the distal fibula and tibia. Much of the available data on this joint details the anatomy of the syndesmotic ligaments. Little is published evaluating the distribution of articular cartilage of the syndesmosis, which is of importance to minimize the risk of iatrogenic damage during surgical treatment. The purpose of this study is to describe the articular cartilage of the syndesmosis. Methods: Twenty cadaveric ankles were dissected to identify the cartilage of the syndesmosis. Digital images of the articular cartilage were taken and measured using calibrated digital imaging software. Results: On the tibial side, distinct articular cartilage extending above the plafond was identified in 19/20 (95%) specimens. The tibial cartilage extended a mean of 6 ± 3 (range, 2-13) mm above the plafond. On the fibular side, 6/20 (30%) specimens demonstrated cartilage proximal to the talar facet, which extended a mean of 24 ± 4 (range, 20-31) mm above the tip of the fibula. The superior extent of the syndesmotic recess was a mean of 10 ± 3 (range, 5-17) mm in height. In all specimens, the syndesmosis cartilage did not extend more than 13 mm proximal to the tibial plafond and the syndesmotic recess did not extend more than 17 mm proximal to the tibial plafond. Conclusion: Syndesmosis fixation placed more than 13 mm proximal to the tibial plafond would have safely avoided the articular cartilage in all specimens and the synovial-lined syndesmotic recess in most. Clinical Relevance: This study details the articular anatomy of the distal tibiofibular joint and provides measurements that can guide implant placement during syndesmotic fixation to minimize the risk of iatrogenic cartilage damage.

885 Surgical Removal of Unerupted Ectopic Maxillary Central Incisors - A Case Report

Introduction Maxillary incisors have a significant role on the facial aesthetics of an individual. Following trauma to the primary dentition, the maxillary incisors are vulnerable to eruption failure and occasionally root dilaceration. These teeth can be challenging to treat. Discussion This case report demonstrates the complex management of a 10-year-old male who presented with severely displaced and unerupted maxillary central incisors, following a history of dental trauma when he was 4 years old. Cone beam computed tomography revealed the upper maxillary central incisors to be lying transversely across the maxillary arch with the crowns directed superiorly and significantly close to the floor of the nose. The incisal edges of both crowns perforated the labial cortex of the maxilla. The roots of the maxillary central incisors were dilacerated with the apices directed superiorly. A multi-disciplinary approach was taken, with involvement from both maxillofacial surgery and orthodontic teams. Maxillofacial surgeons completed the surgical removal of the ectopic maxillary central incisors, rather than the more common approach of surgical exposure and orthodontic repositioning. In this case, full alignment of these teeth would most likely have led to perforation of the labial cortical plate of bone. Conclusions Although surgery was complex and technique sensitive, both teeth were successfully removed under general anaesthesia with no iatrogenic damage. The patient underwent fixed orthodontics to align the maxillary lateral incisors as central incisors. A multidisciplinary approach along with careful surgical planning and effective communication with the patient and his mother helped to achieve a satisfactory outcome.

Litigation in Anesthesia and Intensive Care Units: An Italian Retrospective Study

Anesthesiologists consider professional insurance and its medico-legal problems as a remarkable aspect of their job. “Associazione Anestesisti Rianimatori Ospedalieri Italiani—Emergenza ed Area Critica” (AAROI-EMAC) is the Italian professional association of anesthesiologists and intensivists that works to train its subscribers on safety measures. This is a retrospective observational study on an insurance complaints database for anesthetic accidents that result in injuries to patients. The analyzed period runs from 1 January 2014 to 31 December 2016. A total of 1309 complaints related to 873 insurance claims were analyzed. Criminal complaints comprised 805 (64.4%) of the total, and civil complaints were 445 (35.6%). The iatrogenic damage claimed included: death (58% of the cases); peripheral nerve damage (8%); spinal cord injuries (5%); unspecified injuries (7%); dental damage (4%); infections (3%); needing second surgical procedure (2%); and other injuries (13%). There is a statistical significance between the size of the hospital and the number of the claims: small hospital complaints comprised 40.1% of the cases, while complaints against medium-sized and large hospitals constituted 20.6% of the cases (χ2GL = 8 = 39.87, p = 0.00). In Italy, anesthesiologists and intensivists are often involved in litigation even when they are not directly responsible for iatrogenic injuries, and the most frequent claims in ICU are related post-operative complications.