Various retraction techniques for laparoscopic pancreaticoduodenectomy.

The laparoscopic pancreaticoduodenectomy (LPD), introduced by Gagner and Pomp in 1994, is typically done in high-volume centers due to its technical demands. Our methods aim to provide effective traction, enabling efficient surgery despite limited staffing. A retrospective analysis of 29 patients undergoing LPD by a single surgeon between September 2021 and December 2022 showed promising outcomes: median intraoperative bleeding of 425 mL, operation time of 505 minutes, and postoperative hospital stay of 10 days. With only one case requiring open conversion, our external retraction techniques demonstrate efficacy in overcoming challenges associated with manpower constraints, highlighting potential utility for surgeons in similar settings. We share LPD external retraction techniques and outcomes.

Treatment of Multiple Gingival Recessions in Maxilla and Mandible: a Case Report / Tratamento de Recessões Gengivais Múltiplas em Maxila e Mandíbula: um Relato de Caso

This study aimed to report a treatment of multiple gingival recession in a 43-year-old female patient. After clinical and tomographic evaluation, Miller's class I and II (or Cairo RT1) gingival recessions were observed in several teeth of maxilla and mandible. Non-carious cervical lesions, poorly adapted crowns and unbalanced occlusion were also diagnosed, with the absence of canine guides. A thin gingival phenotype was also found. Orthodontic treatment was not performed, as a thin vestibular bone wall in the mandible was detected. Therefore, correction of the occlusion was performed by means of selective wear on cusps of the posterior teeth to relieve premature contacts. For root coverage, tunneling technique was used in the first, second and fourth sextants. In the fifth sextant, full covering occurred only after a second surgery. A third surgery was performed in the fourth quadrant, and the modified Bruno technique was chosen. The donor region was the palate in all the procedures. The two techniques employed reached up to 100% root coverage in all areas that received the surgery. The patient was satisfied with the final result. It was concluded that complete root coverage is possible when using tunneling technique in patients without interproximal bone loss. (AU)

Esse estudo objetivou reportar um tratamento de recessões gengivais múltiplas em uma paciente do sexo feminino de 43 anos. Após avaliação clínica e tomográfica, recessões gengivais classe I e II de Miller (ou RT1 de Cairo) foram observadas em diversos dentes da maxila e mandíbula. Lesões cervicais não cariosas, coroas mal adaptadas e oclusão desbalanceada também foram diagnosticadas, com ausência de guias caninas. Um fenótipo gengival fino foi observado. Tratamento ortodôntico não foi realizado, pois uma parede óssea vestibular fina na mandíbula foi detectada. Portanto, correção da oclusão foi realizada com desgastes seletivos de cúspides dos dentes posteriores para avaliar os contatos prematuros. Para o recobrimento radicular, técnica de tunelização foi utilizada no primeiro, secundo e quarto sextantes. No sexto sextante, recobrimento completo foi conseguido apenas após a segunda cirurgia. Uma terceira cirurgia foi realizada no quarto quadrante, e a técnica modificada de Bruno foi escolhida. O palato foi a região doara em todos os procedimentos. As duas técnicas cirúrgicas empregadas chegaram até a 100% de recobrimento radicular em todas as áreas que receberam a cirurgia. A paciente ficou satisfeita com o resultado final. Foi concluído que o recobrimento radicular complete é possível quando se utiliza a técnica da tunelização em pacientes sem perda óssea interproximal. (AU)

Estimation of cytokine levels in gingival crevicular fluid following the use of different gingival retraction systems in patients requiring fixed partial dentures - An original research.

Gingival retraction is essential to get a dry and debris free field, which enables the impression material to flow into the gingival sulcus and record the area apical to the finish line. Effective gingival retraction without damaging periodontal tissue is extremely important. Objective: To comparatively evaluate the amount of inflammation, as assessed by TNF-α in GCF induced by three different gingival retraction techniques. Methods: Ten patients with a minimum of three teeth that required biomechanical preparation for fixed prostheses and acceptable oral hygiene with no periodontal pathology were included. The patients each received an oral prophylaxis. After a washout period of 10 days patients with gingival index scores of 0 or 1 were included. Measurements of TNF-α was done at baseline, after 30 min, after 7 days and after 28 days using ELISA test kit specific to TNF-α. Results: The sample population for whom Magic Foam cord was used showed a massive reduction in the amount of TNF -α, from 78% at 7 days to 18.6% at 28 days. There was a reduction in the percentage of TNF -α produced in the samples where normal knitted cord was used and for those where Expasyl was used from 95% to 64.2% and from 70% to 48.3% respectively. Conclusion: Maximum amount of inflammatory response was seen with plain knitted gingival retraction cord. This was followed by Expasyl gingival retraction system and the least amount of inflammatory cytokine was recorded with Magic Foam retraction cord.

Effectiveness of local and topical anesthesia during gingival retraction / Eficácia da anestesia local e tópica durante a retração gingival

Objective: To compare the effectiveness of local and topical anesthesia during gingival retraction in prepared abutment teeth. Material and Methods: 72 patients desiring full mouth rehabilitation or bilateral fixed partial denture in the same arch were selected based on the inclusion criteria framed and were randomly allocated into Groups A and B of 36 each. Patients in Group A received gingival retraction with topical anesthesia and Group B received gingival retraction with infiltration anesthesia. All the patients were tested for pain, discomfort and bleeding during gingival retraction. Results: There was no significant difference in pain, discomfort and gingival bleeding (P >.05) during gingival retraction using topical and local anesthetic agents. Conclusion: Topical anesthesia was equally effective as infiltration anesthesia in managing the pain, discomfort and bleeding during gingival retraction by cord packing in prepared abutment teeth. (AU)

Objetivo: Comparar a eficácia da anestesia local e tópica durante a retração gengival previa a moldagem em dentes pilares preparados. Material e Métodos: Foram selecionados 72 pacientes indicados para reabilitação bucal total ou prótese parcial fixa bilateral na mesma arcada com base nos critérios de inclusão formulados e alocados aleatoriamente nos Grupos A e B com 36 pacientes cada. Os pacientes do Grupo A receberam retração gengival com anestesia tópica e no Grupo B receberam retração gengival com anestesia infiltrativa. Todos os pacientes foram testados para dor, desconforto e sangramento durante o procedimento. Resultados: Não houve diferença significativa na dor, desconforto e sangramento gengival (P>. 05) durante a retração gengival com anestésicos tópicos e locais. Conclusão: A anestesia tópica foi tão eficaz quanto a anestesia de infiltração no controle da dor, desconforto e sangramento durante a retração gengival com fio retrator gengival em dentes pilares preparados.(AU)

Effect of Gingival Retraction Method to Lateral Gingival Displacement Width

Abstract Objective: To analyze the efficacy of retraction cord with a hemostatic agent in comparison with retraction paste on lateral gingival displacement, to achieve the success of fixed dental prostheses (FDP). Material and Methods: Test samples included 32 teeth that required treatment with metal-porcelain FDP at RSKGM FKG Universitas Indonesia. Impressions were taken before the gingival retraction procedure. From the 32 samples, 16 teeth were retracted using a combination of retraction cord and hemostatic agent, whereas the other half were retracted with retraction paste. Impressions were then taken. The sample was made using cutting die. Lateral gingival displacement width was measured on die-cast using an optical microscope Results: The mean value of group A before gingival retraction was 0.1695 mm, and after gingival retraction was 0.4705 mm. The mean value of group B before gingival retraction was 0.1767 mm, and after gingival retraction was 0.3289 mm. Lateral gingival displacement width between a combination of cord retraction and hemostatic agent group in comparison with the retraction paste group showed a significant difference (p<0.001). The combination of cord retraction and hemostatic agent group showed higher mean value Conclusion: Gingival displacement width as a result of cord retraction with the hemostatic agent was larger compared to the retraction paste. Even though both of them are still considered to be effective in providing access for impression material.

Minimum intervention management of diastema closure using cordless displacement system and laminate veneers: A 2-year follow-up.

This case report presents a minimally invasive diastema treatment using cordless gingival displacement system allowing a very conservative intervention. A 32-year-old female patient who presented with diastema in her upper front teeth opted for a treatment using laminate veneers to ensure achieving adequate tooth proportion and gingival levels. Having a displacement material that exerts excessive pressure during the displacement process can lead to disruption of the junctional epithelium and damage to periodontal tissues. This case report focuses on the effectiveness of the use of a minimally invasive method of gingival management. Two-year follow-up no infiltration, sensitivities, or fractures were detected on teeth, and indirect restorations, the purposed treatment allowed a quick, effective, and durable resolution for diastema.

Coverage of Miller class I and II gingival recessions treated with subepithelial connective tissue graft, acellular dermal matrix, and enamel matrix proteins. Pilot study / Recobrimento de recessões gengival classe I e II de Miller com enxerto de tecido conjuntivo subepitelial, matriz dérmica acelular, e proteína derivada da matriz do esmalte. Estudo piloto

Objective: The aim of this study was to compare clinical findings obtained in the treatment of gingival recessions using subepithelial connective tissue graft (SECT), acellular dermal matrix (ADM), and enamel matrix proteins (EMP). Material and method: Twelve patients with Miller class I and II recession in the canines or upper premolars were randomly divided into groups to receive treatments using SECT, ADM, or EMP. Clinical measurements were performed before and three months after surgical procedures. The data evaluated were as follows: percentage of root coverage, height and width of gingival recession, probe depth, clinical attachment level, and height and thickness of keratinized gingiva. The Kruskal-Wallis test complemented by Dunn's test was used to perform the between-group, analysis and the Wilcoxon test was used to perform the within-groups analysis. The tests were applied at the 95% confidence level. Result: The SECT and ADM groups had a higher percentage of root coverage and greater reduction in the height and width of gingival recessions compared to the EMP group (p< 0.05). Conclusion: The SECT and ADM are more effective in treating gingival recessions than EMP.

Objetivo: O objetivo desse estudo foi de comparar os achados clínicos obtidos no tratamento de recessões gengivais utilizando o enxerto de tecido conjuntivo subepitelial (SECT), a matriz dérmica acelular (ADM) e as proteínas derivadas da matriz do esmalte (EMP). Material e método: Doze pacientes que apresentavam recessões gengival classe I e II de Miller nos caninos e pré-molares superiores foram randomicamente alocados para receber o SECT, ADM ou EMP. Análises clínicas foram executadas antes e 3 meses após os procedimentos cirúrgicos. Foram avaliados os seguintes parâmetros: porcentagem de recobrimento radicular, altura e comprimento da recessão gengival, profundidade de bolsa a sondagem, nível clínico de inserção, altura e espessura da gengiva queratinizada. O teste de Kruskal-Wallis complementado pelo teste de Dunn foram usados para avaliar as diferenças entre os grupos em cada período enquanto que o teste de Wilcoxon foi utilizado para avaliar as diferenças dentro de cada grupo variando-se o período de avaliação. Os teste foram aplicados com nível de confiança de 95%. Resultado: Os grupos SECT e ADM apresentaram maior porcentagem de recobrimento radicular e maior redução da altura e comprimento das recessões do que o grupo EMP (p<0,05). Conclusão: O SECT e a ADM são mais efetivos no tratamento de recessões gengivais que o EMP.

Review of various liver retraction techniques in single incision laparoscopic surgery for the exposure of hiatus.

BACKGROUND: The main aspect of concern for upper GI procedures has been the retraction of the liver especially large left lobes as commonly encountered in Bariatric surgery. Not doing so would compromise the view of the hiatus, hence theoretically reducing the quality of the surgery and increasing the possibility of complications. The aim of this study was to review the various liver retraction techniques in single incision surgery being done at our institute and analyze them. MATERIAL AND METHODS: A retrospective study of the various techniques and a subsequent analysis was made based on advantages and disadvantages of each method. Objectively a quantitative measure of hiatal exposure was done using a scoring system based on the grade of exposure after reviewing the surgical videos. From January 2011 to January 2013 total 104 patients underwent single incision surgery with the various liver retraction techniques with following grades of exposure -liver suspension tube technique with naso gastric tubing (2.11) and with corrugated drain (2.09) needlescopic method (1.2), Umbilical tape sling (1.95), crural stitch method (2.5). Needeloscopic method has the best grade of exposure and is the easiest to start with. The average time to create the liver retraction was 2.8 to 8.6 min.There was no procedure related morbidity or mortality. CONCLUSIONS: The mentioned liver retraction techniques are cost effective and easy to learn. We recommend using these techniques to have a good exposure of hiatus, without compromising the safety of surgery in single incision surgery.

A double-blind randomised clinical trial of two techniques for gingival displacement.

Knowledge about security and the potential damage originated by the gingival displacement techniques has not been described through randomised clinical studies. This crossover, double-blind, randomised clinical trial evaluated clinical and immunological factors related to conventional and cordless gingival displacement (GD) techniques, and patients' perceptions in 12 subjects with the employment of 2 GD techniques: conventional (gingival cord + 25% AlCl3 astringent gel) and cordless (15% AlCl3 astringent-based paste). In each subject, two anterior teeth were treated and a 10-day wash-out period separated the two treatments. Periodontal indices were evaluated before (baseline) and 1 and 10 days after GD. Interleukin 1ß, interleukin 6 and tumour necrosis factor α concentrations in gingival crevicular fluid were measured before and 1 day after GD. Subjective parameters (pain, unpleasant taste and stress) were also evaluated. Data were analysed by one-way repeated-measures analysis of variance and Tukey's test (immunological factors), the Friedman test (periodontal parameters) and Fisher's exact or chi-squared test (subjective parameters), with a significance level of 95%. Gingival bleeding index, probing depth and plaque index values did not differ significantly between groups at any timepoint. Neither technique resulted in worse periodontal indices. Both techniques yielded similar results for pain and unpleasant taste, but conventional GD was significantly more stressful than cordless GD for volunteers. Both treatments significantly increased mean concentrations of the three cytokines, with the conventional technique producing the highest cytokine levels. Cordless GD is less stressful for patients and results in lower post-treatment levels of inflammatory cytokines compared with conventional GD.

Retraction techniques in laparoscopic colorectal surgery: a literature-based review.

AIM: To systematically review the published literature and describe the various techniques of bowel and mesentery retraction available for use in laparoscopic colorectal resection. METHOD: A comprehensive search of the literature was undertaken using MESH terms 'retraction', 'laparoscopic' and 'colorectal'. All articles describing methods of retraction in laparoscopic colorectal surgery were included. RESULTS: Twelve methods of retraction in laparoscopic colorectal surgery were described. Five case-based series and three case studies were reported on 108 patients. Techniques were classified into those offering retraction of the small or large bowel or according to the mode of retraction. CONCLUSION: Many retraction methods are available to the surgeon varying in cost, invasiveness and complexity. Adequate retraction remains a challenge for optimal exposure and dissection during laparoscopic colorectal surgery.