Successful treatment of vertical root fracture through intentional replantation and root fragment bonding with 4-META/MMA-TBB resin.

BACKGROUND/PURPOSE: Vertical root fracture (VRF) is a complication in endodontically treated teeth. This study aimed to assess the clinical outcomes of treatment of 6 VRF teeth with intentional replantation and root fragment bonding with 4-methacryloxyethyl trimellitate anhydride/methyl methacrylate-tri-n-butyl borane (4-META/MMA-TBB) resin. METHODS: A series of 6 complete VRF teeth (one incisor, one canine, one premolar, and 3 M) were treated through intentional replantation and root fragment bonding with 4-META/MMA-TBB resin. RESULTS: This study included 6 VRF teeth in 6 patients (one man and 5 women; mean age, 44 ± 8 years). All 6 teeth had VRF in the bucco-lingual direction and one tooth had concomitant VRF in the mesio-distal direction. The root thickness was classified as thick in all 6 teeth. Of the 6 VRF teeth, 4 had biting, percussion, or palpation pain, 4 had gingival swelling, 3 had sinus tracts, 3 had discomfort, and one had tooth mobility. Radiographically, 5 of the 6 teeth had periradicular radiolucent lesions, 4 of which exhibited complete regression and one of which exhibited nearly complete regression after root fragment bonding therapy. Because all 6 treated teeth exhibited sound function in the oral cavity after a follow-up period ranging from 33 to 74 (mean, 50 ± 15) months, the clinical outcomes were all considered to be successful. CONCLUSION: For a VRF tooth, in addition to tooth extraction, intentional replantation combined with root fragment bonding with 4-META/MMA-TBB resin is a successful treatment modality that can be used to preserve a complete VRF tooth.

Importance of Three-Dimensional Modeling in Cranioplasty.

Cranioplasty is a reconstruction operation made to protect intracranial structures. It is applied for the closure of bone defects occurring due to causes such as trauma, tumor, infection, and infarct. Many different products changing from autologous bone grafts to synthetic materials are used for cranioplasty. Three-dimensional printers that are among the popular innovations of today are used gradually more in medical area as in every field of life and they make the surgical operation easier. When customizable materials are combined with technology, the authors come across successful results and less complications. The aim of the authors' study was to show a 3-dimensional modeling method in 2 patients the authors applied cranioplasty and the advantages provided by this method for the surgeon and the patient.

Intentional replantation of adhesively reattached vertically fractured maxillary single-rooted teeth.

AIM: To evaluate the clinical outcomes of intentionally replanted maxillary single-rooted teeth with vertical root fractures (VRFs) after being repaired extraorally using 4-methacryloxyethyl trimellitate anhydride/methacrylate-tri-n-butyl borane (4-META/MMA-TBB) resin cement. METHODOLOGY: Twenty-one root filled maxillary single-rooted teeth with VRFs were evaluated. After atraumatic extraction, fractured fragments were adhesively cemented. The teeth were then replanted and splinted to the neighbouring teeth for 2 weeks. Plaque index (PI), gingival index (GI), probing depth (PD) and clinical attachment level (CAL) were assessed at baseline, 6 and 12 months, and radiographic evaluations were made using PAI scores at baseline and 12 months. Mobility was evaluated using periotest values (PTV) at baseline, 1, 3, 6 and 12 months. Replanted teeth, contralateral teeth (control teeth) and adjacent teeth were analysed statistically using repeated measures one-way anova, unpaired t-tests and Wilcoxon matched-pairs signed-rank tests. RESULTS: Two teeth were extracted in the first month after surgery. PI, GI, CAL and PD scores of the replanted teeth were significantly lower at 6 month (P < 0.0001 for all) and 12 month (P < 0.0001 for all) postoperatively when compared to baseline, but the values were not significantly different from those of the control and adjacent teeth. PTV of the test teeth increased significantly (P < 0.0001) after the intervention and decreased to baseline levels by month 12. PTVs were significantly higher (P < 0.05) at baseline, 1, 3 and 6 months in the test teeth when compared with the control teeth, but were not significantly different at month 12. PAI scores of teeth with VRF were significantly lower (P < 0.05) at 12 months compared with baseline. CONCLUSIONS: Adhesive cementation and intentional replantation were an effective treatment modality for this group of vertically fractured maxillary single-rooted teeth. The clinical periodontal parameters decrease by month 6, and the mobility returned to the physiological limits of natural teeth 12 months after replantation.

The effect of temporary restorative materials on fracture resistance of endodontically treated teeth.

This study was designed to investigate the fracture strength of endodontically treated teeth temporarily restored with some commonly used interim materials. Of 90 extracted maxillary premolars used in this study, 15 were left intact as the positive control. Endodontic treatment was performed on the remaining 75 teeth. The endodontically treated teeth were then randomly assigned to 5 groups (n = 15). One group was not restored and served as the negative control. In the remaining 4 experimental groups, the teeth were restored with a temporary cement: Zonalin, IRM, Coltosol, or Fuji II LC resin-modified glass ionomer (RMGI). The fracture strengths of all teeth were measured with a universal testing machine. The fracture strength of teeth restored with RMGI was significantly greater than that of other groups (P < 0.001), including intact teeth (P = 0.025). The fracture strength of teeth restored with other temporary materials was significantly lower than that of intact teeth (P < 0.05) but not significantly different from that of the negative control. From a structural resistance standpoint, RMGI may be the best choice for short-term temporary restoration of endodontically treated teeth. Other types of temporary restorative material had no reinforcing effect on tooth structure.

Inhibition of enamel demineralization and bond-strength properties of bioactive glass containing 4-META/MMA-TBB-based resin adhesive.

We investigated the enamel demineralization-prevention ability and shear bond strength (SBS) properties of 4-methacryloxyethyl trimellitic anhydride/methyl methacrylate-tri-n-butyl borane (4-META/MMA-TBB)-based resin containing various amounts (0-50%) of bioactive glass (BG). Disk-shaped specimens were immersed in distilled water and ions released were analysed by inductively coupled plasma atomic-emission spectroscopy. Samples were also immersed in lactic acid solution (pH 4.6) to estimate acid-neutralizing ability. Brackets were bonded to human premolars with BG-containing resins and the bonded teeth were alternately immersed in demineralizing (pH 4.55) and remineralizing (pH 6.8) solutions for 14 d. The enamel hardness was determined by nanoindentation testing at twenty equidistant distances from the external surface. The SBS for each sample was examined. The amounts of ions released [calcium (Ca), sodium (Na), silicon (Si), and boron (B)] and the acid-neutralizing ability increased with increasing BG content. After alternating immersion, the specimens bonded with the BG-containing resin with high BG content were harder than those in the other groups in some locations 1-18.5 µm from the enamel surface. Bioactive glass-containing (10-40%) resin had bond strength equivalent to the control specimen. Thus, the SBS obtained for BG-containing resin (6.5-9.2 MPa) was clinically acceptable, suggesting that this material has the ability to prevent enamel demineralization.

Antibacterial activity of various root canal sealers and root-end filling materials in dentin blocks infected ex vivo with Enterococcus faecalis.

OBJECTIVE: The aim was to investigate the antibacterial activity of the root-end filling materials MTA and IRM, different endodontic sealers and calcium hydroxide [Ca(OH)2] in experimentally infected dentinal tubules. MATERIALS AND METHODS: Ninety-four human root segments were prepared and the root canals were enlarged to ISO size 90. After smear removal, the specimens were infected with Enterococcus faecalis for 3 weeks. The roots were divided into eight groups and filled either with MTA, IRM, Ca(OH)2, gutta-percha and EndoRez (ER)/GuttaFlow (GF)/AH Plus (AH+) or with Resilon and Epiphany (EpRe). One group of specimens was left unfilled for control. Half of the specimens were treated for 1 day and the other half for 7 days in humid conditions at 37°C. Dentin samples from each canal were collected by enlarging the canals to ISO size 150; thus a dentinal depth of 300 µm was sampled. The number of cultivable bacteria was determined for each specimen. Statistical significance was set to 5%. RESULTS: After 1-day or 7-days of treatment, compared to control, all materials (except ER and GF at day 7) significantly reduced the number of bacteria. At day 1 and day 7, no significant difference was found between ER and GF and between Ca(OH)2, AH+, EpRe, IRM and MTA. However, a significant difference was found between these two groups of materials (except between GF and EpRe at day 7). Significantly more bacteria were cultured in the ER, GF, EpRe and IRM groups at day 7 compared to day 1. CONCLUSIONS: All materials exerted varying degrees of antibacterial activity which generally tended to decrease with time. The most stable antibacterial effect throughout the 7-day period was for Ca(OH)2, AH+ and MTA.

Good results in postoperative and hematogenous deep infections of 89 stable total hip and knee replacements with retention of prosthesis and local antibiotics.

BACKGROUND: Deep postoperative and hematogenous prosthesis infections may be treated with retention of the prosthesis, if the prosthesis is stable. How long the infection may be present to preclude a good result is unclear. PATIENTS AND METHODS: We retrospectively studied 89 deep-infected stable prostheses from 69 total hip replacements and 20 total knee replacements. There were 83 early or delayed postoperative infections and 6 hematogenous. In the postoperative infections, treatment had started 12 days to 2 years after implantation. In the hematogenous infections, symptoms had been present for 6 to 9 days. The patients had been treated with debridement, prosthesis retention, systemic antibiotics, and local antibiotics: gentamicin-PMMA beads or gentamicin collagen fleeces. The minimum follow-up time was 1.5 years. We investigated how the result of the treatment had been influenced by the length of the period the infection was present, and by other variables such as host characteristics, infection stage, and type of bacteria. RESULTS: In postoperative infections, the risk of failure increased with a longer postoperative interval: from 0.2 (95% CI: 0.1-0.3) if the treatment had started ≥ 4 weeks postoperatively to 0.5 (CI: 0.2-0.8) if it had started at ≥ 8 weeks. The relative risk for success was 0.6 (CI: 0.3-0.95) if the treatment had started ≥ 8 weeks. In the hematogenous group, 5 of 6 infections had been treated successfully. INTERPRETATION: A longer delay before the start of the treatment caused an increased failure rate, but this must be weighed against the advantage of keeping the prosthesis. We consider a failure rate of < 50% to be acceptable, and we therefore advocate keeping the prosthesis for up to 8 weeks postoperatively, and in hematogenous infections with a short duration of symptoms.

Sodium hypochlorite versus Formocresol in primary molars pulpotomies: a randomized clinical trial.

AIM: The aim of this randomised clinical trial was to compare the clinical and radiographic success rate of 5% sodium hypochlorite (NaOCl) and 20% Formocresol (FC) as a pulpotomy medicament in carious primary molars. MATERIALS AND METHODS: Twenty-four children aged 4-8 years with at least 2 primary molars indicated for pulpotomy were included in this study. Eighty-two teeth received either 5% NaOCl or 20% FC using split mouth design, followed by restoration with IRM base/stainless steel crown (SSC). Clinical and radiographic evaluations were performed at 3, 6 and 12 months. RESULTS: NaOCl and FC groups demonstrated 100% clinical success at 3 months. At 6 months, NaOCl showed 95% and 87.5% clinical and radiographic success rate respectively, while FC showed 95% clinical and radiographic success rate. After 12 months, the clinical and radiographic success rates were 94.6% and 86.5% respectively for NaOCl, and 92.1% and 86.8% for FC. CONCLUSION: The results of this study showed the success rate for NaOCl pulpotomy to be comparable to those for FC pulpotomy.

Gentamicin serum concentrations in patients with gentamicin-PMMA beads for infected hip joints: a prospective observational cohort study.

BACKGROUND: Gentamicin-polymethylmethacrylate (PMMA) beads release gentamicin gradually, and high concentrations develop only locally. It is unclear how frequent and in which patients gentamicin serum concentrations are measurable and possibly lead to toxicity. The aim of this study was to investigate the measurability of gentamicin serum concentrations after the implantation of gentamicin-PMMA beads and to assess the nephrotoxicity of these beads. METHODS: In this observational cohort study, gentamicin and creatinine concentrations were measured in 34 serum samples of 23 patients with implanted gentamicin-PMMA beads for infected hip joints with our regular immunoassay (lower limit of quantitation 0.4 mg/L). Samples were also analyzed with an adjusted immunoassay with a lower limit of quantitation of 0.05 mg/L. RESULTS: Gentamicin serum concentrations were >0.4 mg/L in 9 of 34 (26%) of all the samples measured (both after the first implantation and change of beads) and in 5 of 23 patients (22%) after the first implantation of gentamicin-PMMA beads. Gentamicin serum concentrations were >0.05 mg/L in 31 samples (91%). Nephrotoxicity (defined as increase in serum creatinine >44 µmole/L and/or a relative increase >25%) occurred more frequently in patients with measurable gentamicin serum concentrations than in those without measurable gentamicin serum levels (57% versus 43%, P = 0.02). Both nephrotoxicity and gentamicin serum concentration could not be associated with the number of implanted gentamicin-PMMA beads. CONCLUSIONS: Gentamicin serum concentrations >0.4 mg/L can be measured after the implantation of gentamicin-PMMA beads in certain patients with infected hip joints. Furthermore, elevated (>0.4 mg/L) gentamicin serum concentrations are associated with nephrotoxicity in patients with gentamicin-PMMA beads for infected hip joints.

Periapical tissue response after use of intermediate restorative material, gutta-percha, reinforced zinc oxide cement, and mineral trioxide aggregate as retrograde root-end filling materials: a histologic study in dogs.

PURPOSE: To investigate the periapical tissue response of 4 different retrograde root-filling materials, ie, intermediate restorative material, thermoplasticized gutta-percha, reinforced zinc oxide cement (Super-EBA), and mineral trioxide aggregate (MTA), in conjunction with an ultrasonic root-end preparation technique in an animal model. MATERIALS AND METHODS: Vital roots of the third and fourth right mandibular premolars in 6 healthy mongrel dogs were apicectomized and sealed with 1 of the materials using a standardized surgical procedure. After 120 days, the animals were sacrificed and the specimens were analyzed radiologically, histologically, and scanning electron microscopically. The Fisher exact test was performed on the 2 outcome values. RESULTS: Twenty-three sections were analyzed histologically. Evaluation showed better re-establishment of the periapical tissues and generally lower inflammatory infiltration in the sections from teeth treated with the intermediate restorative material and the MTA. New root cement on the resected dentin surfaces was seen on all sections regardless of the used material. New hard tissue formation, directly on the surface of the material, was seen only in the MTA sections. There was no statistical difference in outcome among the tested materials. CONCLUSIONS: The results from this dog model favor the intermediate restorative material and MTA as retrograde fillings when evaluating the bone defect regeneration. MTA has the most favorable periapical tissue response when comparing the biocompatibility of the materials tested.

Periodontal ligament fibroblast response to root perforations restored with different materials: a laboratory study.

AIM: To compare the effect of several materials on the attachment of periodontal ligament (PDL) fibroblasts to experimentally perforated root surfaces. METHODOLOGY: Root specimens (size 5 × 5 mm) were obtained from extracted human molar teeth and perforations with a 1 mm diameter were created. One group was kept as a control and the rest were repaired with the following materials: Amalgam, Dyract, IRM, Super Bond C&B and Mineral trioxide aggregate (MTA). PDL fibroblasts were placed at a density of 8 × 10(4) cells on the root specimens, incubated on tissue culture inserts (48 h) and then transferred to 48 well-plates. MTT assays were performed at 48 and 96 h for PDL fibroblast survival. Cell attachment was observed using confocal microscopy on days 2 and 5. Total RNAs from the root specimens were isolated on day 5 and type I collagen (COL I) and Runt-related transcription factor 2 (Runx2) mRNA expressions were checked using Quantitative-Polymerase Chain Reaction (QPCR). For the MTT assay and QPCR, one-way analysis of variance (anova) and Tukey HSD multiple comparison tests were used to compare the groups. RESULTS: Mineral trioxide aggregate resulted in a significantly higher cell density (P < 0.001). Dyract, IRM and Super Bond C&B groups had a lower cell density when compared with the control and MTA groups at 48 h (P < 0.001). Confocal microscopy revealed that, among the experimental groups, the MTA group had the largest viable cell population over the restoration site when compared with the other materials; however, reduced cell attachment was noted in all groups when compared with the control. Increased Runx2 mRNA expressions were noted in MTA (P < 0.001) and IRM (P < 0.01) groups when compared with control and other tested materials. COL I transcripts were increased in IRM (P < 0.01), D, C&B and MTA (P < 0.001) when compared with the control. CONCLUSION: Mineral trioxide aggregate provided a more favorable environment for PDL cell adhesion and growth.

Long-term effectiveness of four pulpotomy techniques: 3-year randomised controlled trial.

A pulpotomy is the therapy for management of pulp exposures due to caries in symptom-free primary molars. The aim was to longitudinally compare the relative effectiveness of the Er:YAG laser, calcium hydroxide and ferric sulphate techniques with dilute formocresol in retaining symptom-free molars. Two hundred primary molars in 107 healthy children were included and randomly allocated to one technique. The treated teeth were blindly reevaluated after 6, 12, 18, 24 and 36 months. Descriptive data analysis and logistic regression analysis accounting for multiple observations per patient by generalised estimating equation were used. Additionally, various influences including tooth type, upper and lower jaws, type of anaesthesia, operator and the final restoration on treatment success were evaluated (Wald chi-square test). After 36 months, the following total (considering clinical and clinically symptom-free radiographic failures) and clinical success rates were determined (in percent): Formocresol 72 (92), laser 73 (89), calcium hydroxide 46 (75), ferric sulphate 76 (97). No significant differences were detected between formocresol and any other technique after 36 months. However, the odds ratio of failure appeared to be three times higher for calcium hydroxide than for formocresol. No significant differences in total success rates were seen regarding the aforementioned influencing clinical parameters. The correct diagnosis of the pulpal status, bleeding control and the specific technique are highly important for long-term success of pulpotomies in primary molars. According to the presented long-term data, pulpotomies using ferric sulphate revealed the best treatment outcome among the used techniques, while calcium hydroxide resulted in the lowest success rates after 3 years. Therefore, we can recommend ferric sulphate for easy and successful treatment of primary molars with caries-exposed pulps.

Clinical and radiographic success rates of mineral trioxide aggregate and ferric sulphate pulpotomies performed by dental students.

AIM: The purpose of this study was to evaluate and compare the clinical and radiographic findings of ferric sulphate (FS) and mineral trioxide aggregate (MTA) as vital pulpotomy materials in primary molars. MATERIALS AND METHODS: Participants, including 40 boys and 53 girls ranging between 5 and 10 years of age (mean age 7.7 years), were selected from the patient population at the University of Gazi Department of Paediatric Dentistry. The children were healthy and cooperative, with at least 1 symptom-free restorable and vital primary molar with deep carious lesions. The pulpotomies were performed by fifth-year undergraduate dental students. Members of the senior staff at the clinics supervised all of the procedures. Clinical and radiographic evaluations were performed at 1-, 3-, 6-, 9- and 12-month recall. The data were statistically analysed with chi-squared tests followed by a multiple comparison test. RESULTS: The follow-up evaluations revealed that the clinical success rates were 84.7% for FS and 94.7% MTA. The radiographic success rates were 78.2 % for FS and 92.1 % for MTA. No significant difference was found between the clinical and radiographic outcomes of the two groups at all follow-ups (P >0.05). CONCLUSION: The most common radiographic failure was internal resorption in both types of pulpotomies. Both MTA and FS can be suggested as an appropriate medicament for primary teeth pulpotomies.

Intentional re-plantation of a vertically fractured tooth repaired with an adhesive resin.

AIM: To present the successful treatment of a vertically fractured tooth by intentional re-plantation after root canal treatment and repair with an adhesive resin. SUMMARY: Vertical root fracture is a challenging problem in respect of diagnosis and management options. In this case, a vertically fractured maxillary premolar was treated by intentional re-plantation after repairing it with 4-Methacryloxyethyl trimellitate anhyride/methacrylate-tri-n-butyl borane (4-META/MMA-TBB) resin cement. At the 36-month follow-up, the tooth was asymptomatic, radiographically sound with reduced deep periodontal pockets and vertical bone loss. KEY LEARNING POINTS: • Intentional replantation after repairing fractured fragments with an adhesive resin extraorally is a treatment option. • Long-term follow-up is necessary to evaluate the outcome of this technique.

Dr. Paul Tessier and facial skeletal masculinization.

The male facial skeleton is larger and more angular than that of the female. The male skull has bossing in the area of the frontal sinuses (there is bossing even without presence of the sinuses--5% of people do not have a frontal sinus) and a small flat spot in the mid forehead between the areas of bossing and usually slightly above them. Also there is bossing in the superior lateral orbital angle. The chin on an average basis is 17% vertically higher in the male and there is more fullness laterally. The angle of the mandible is larger inferioro-posteriorly and generally flares out more laterally. The oblique line is fuller in the male. To date 6 males who have wanted to have a more masculine face have been operated on forehead, chin, and mandible. All 6 have done well and without complications. Their acceptance of this surgery has been great.

Incomplete caries removal in deep lesions: a 10-year prospective study.

PURPOSE: To follow-up teeth with deep caries lesions submitted to incomplete caries removal over a 10-year period. METHODS: 27 subjects (32 permanent posterior teeth) with deep caries lesions composed the sample. In this single-arm long-term prospective study, the inclusion criteria were risk of pulp exposure during caries excavation, positive response to the cold test, absence of spontaneous pain or sensitivity during percussion, and radiographic absence of a periapical lesion. Subjects were submitted to the following procedures: complete caries removal from the surrounding cavity walls, incomplete caries removal from the pulpal wall, capping with a calcium hydroxide cement, and sealing with a modified zinc oxide-eugenol cement. After 6-7 months, the temporary sealing was removed for methodological purposes (no further excavation was performed), and teeth were capped with a calcium hydroxide cement and filled with resin composite. Clinical and radiographic assessments were conducted after 6-7 months, 1.5, 3, 5 and 10 years. Success was defined as clinical and radiographic signs and symptoms of pulp sensitivity while failure was defined as endodontic treatment need. RESULTS: Over 10 years, one tooth was excluded from the sample (pulp exposure during treatment), five were lost to recall, 10 had therapy failure (five fractures and four necroses leading to endodontic treatment need, and one extraction) and 16 had therapy success (pulp sensitivity). Overall survival rates were 97%, 90%, 82% and 63% at 1.5-, 3-, 5- and 10-year follow-ups, respectively. Teeth with two or more restored surfaces failed significantly more than teeth with one restored surface (P= 0.01).

Clinical and microbiological efficacy of three different treatment methods in the management of denture stomatitis.

OBJECTIVE: This study evaluated. the effect of mouthrinses and tissue conditioner on the clinical findings and microbial flora of 60 patients with Newton's type II denture stomatitis (N2DS) BACKGROUND: Denture stomatitis is a common problem in complete denture wearers. MATERIALS AND METHODS: Sixty patients with N2DS were included in this study and divided into three groups. Two groups of patients were instructed to rinse their mouth with the designated mouthrinses DioxiDent and Corsodyl twice daily for 1 min and to soak their dentures overnight in these solutions for 15 days. For the third group, tissue conditioner was placed in each of 20 patients' existing maxillary dentures. Patients were evaluated both clinically and microbiologically at baseline and after 15 days. Palatal swabs and smears were taken from each patient before and after treatment and these samples were examined mycologically. The difference between Candida colonisation before and after treatment and the differences between pre-treatment and post-treatment clinical findings were assessed. RESULTS: DioxiDent and Corsodyl showed an improvement in palatal inflammation and a decrease in Candida colonisation compared to Visco-gel. CONCLUSIONS: The effectiveness of topical chlorine dioxide and chlorhexidine gluconate in the management of N2DS was demonstrated.

[Hip joint infections - Results of a questionnaire among 28 university orthopedic departments]. / Hüftgelenkinfektionen - Ergebnisse einer Umfrage unter 28 orthopädischen Universitätskliniken.

BACKGROUND: Despite numerous prophylactic measures infections still remain a hazardous complication in orthopedic surgery. MATERIAL AND METHODS: A questionnaire about hip joint infections was sent to all university orthopedic departments in Germany and Austria. The questionnaire included 33 questions with respect to demographic data, causative organisms, diagnostic measures, treatment options for early and late infections, antibiotic therapy and prosthesis reimplantation. RESULTS: The participation rate was 70%. The most frequent primary surgical indication was primary total hip replacement and Staphylococcus aureus and S. epidermidis were the most common pathogens identified. All departments performed a joint aspiration for diagnosis confirmation but for other diagnostic measures a great discrepancy could be observed. In the treatment of early infections removable components were always exchanged, whereas a local antibiotic therapy was not always employed. With regard to late infections a two-stage protocol was more frequently used than a one-stage treatment, whereby the implantation of a cement spacer was more commonly performed than a resection arthroplasty. The time between stages varied between 6 and 12 weeks and systemic antibiotics were administered for a mean time of 6 weeks. For prosthesis reimplantion cementless components were mostly used but no clear tendency could be determined for systemic antibiotic therapy. CONCLUSION: Treatment of hip joint infections among German and Austrian university orthopedic departments is only partly carried out in a similar manner.

Pre-packed vacuum bone cement mixing systems. A further step in reducing methylmethacrylate exposure in surgery.

OBJECTIVES: Polymethylmethacrylate bone cements are widely used in orthopaedic and trauma surgery as well as in dentistry. The toxic side effects of inhaled methylmethacrylate (MMA) fumes generated during mixing have been well studied. Vacuum cement mixing systems have been shown to reduce the risk of airborne MMA significantly compared to handmixing. In an effort to further reduce MMA exposure, the latest generation of mixing devices are pre-packed with the ingredients and thus allow preparation in nearly closed circuits. Until now, there has been no study proofing the efficacy of those systems in protecting theatre staff from MMA vapours. METHODS: A pre-packed vacuum mixing system (Optipac®) was compared with two standard systems (Palamix® and Easymix®) regarding MMA emission. The latter systems require loading with the bone cement compounds prior to mixing. Following a standardized procedure, 10 mixes were performed with each system and the emission of MMA vapours in the breathing zone was recorded using photoionization detection over a period of 3 min. RESULTS: The mean MMA exposure was reduced when using the pre-packed system compared to the devices that require filling with the components. The highest emission peaks were recorded during the mixing and preparation steps in all systems. CONCLUSIONS: Modern pre-packed vacuum mixing systems further help to reduce the occupational hazards created by bone cement preparation. However, MMA fumes can still be detected using this technique. Although this is an important step in reducing MMA exposure in the operating theatre, further technical effort has to be taken to eliminate the continuous leakage of monomer from the devices while mixing and to minimize necessary manipulation for final delivery.

Prosthetic reconstruction of the chest wall.

Chest wall reconstructions can be complex and challenging procedures, especially when huge thoracic defects have been generated by radical excisions. Nonrigid reconstructions with meshes or patches have the goal of avoiding a lung hernia caused by the chest wall defect, or preventing the impaction of the scapula in case of posterior chest wall resections, especially when the resection is extended down to the 5th and 6th ribs. Large anterior and lateral resections result in thoracic instability and alteration of pulmonary physiology, and render intrathoracic structures vulnerable to external impact. They necessitate rigid reconstructions according to several techniques using alloplastic materials (eg, methyl methacrylate-based customized plates or neo-ribs, osteosynthesis systems, or dedicated prosthesis). Nowadays, the availability of these multiple, possibly combined, more adapted, and better tolerated materials have pushed past the limits of resection to those involving soft tissue coverage.