Assessment of titanium release following non-surgical peri-implantitis treatment: A randomized clinical trial.

BACKGROUND: Peri-implantitis is a frequent finding. Initial treatment involves non-surgical debridement of the implant surface. Recent studies have found a correlation between titanium (Ti) particle release and peri-implantitis, yet there is a dearth of information regarding the effect of various non-surgical instrumentation on particle release or peri-implantitis resolution. METHODS: Patients with peri-implantitis were recruited for a randomized, blinded, parallel-group clinical trial. The implants were randomized to treatment composed of Ti curettes ("Mech" group) or implant-specific treatment composed of rotary polymer microbrushes ("Imp" group). Ti release in submucosal peri-implant plaque pre- and 8 weeks posttreatment was assessed as the primary outcome. Peri-implant probing depth, bleeding on probing, and suppuration on probing were evaluated and compared between groups. RESULTS: Thirty-four participants completed treatment; 18 were randomized to the Mech group and 16 to the Imp group. The groups were comparable for Ti levels and probing depths at baseline. A trend was noted for 10-fold greater Ti dissolution in the Mech group posttreatment compared to the Imp group (p = 0.069). The Imp group had a significant reduction in probing depth posttreatment (p = 0.006), while the Mech group reduction was not significant. CONCLUSION: Peri-implantitis treated non-surgically with implant-specific instruments (Imp group) had a significantly greater decrease in probing depth versus the Mech treatment group. This improvement was linked with a trend for less Ti release to the peri-implant plaque by the non-abrasive treatment.

Qualitative Assessment of Titanium versus Carbon Fiber/Polyetheretherketone Pedicle Screw-Related Artifacts: A Cadaveric Study.

BACKGROUND: Dorsal instrumentation and decompression are the mainstays of spinal tumor treatment. Replacing titanium screws with carbon fiber-reinforced polyetheretherketone (CFRP) screws can reduce imaging artifacts on neural structures and perturbations of radiation dose. Further reduction of metal content in such screws might enhance the benefit. The aim of this study was to assess the artifacts produced by all-titanium screws (Ti-Ti), CFRP thread-titanium screw heads (C-Ti), and all-CFRP screws (C-C). METHODS: A cadaveric spine was used to place Ti-Ti, C-Ti, and C-C consecutively from T2 to S1. Computed tomography and 1.5T and 3T magnetic resonance imaging were performed for each screw system. Axial T1- and T2-weighted sequences of representative thoracic and lumbar regions were assessed for artifacts. The artifacts were classified as not relevant, considerable, or severe. RESULTS: We evaluated 92 screws and made 178 artifact assessments. The artifacts were clearly visible in computed tomography scans but did not influence the visualization of intraspinal structures. Severe magnetic resonance imaging artifacts were found in 28% (17/60, mostly in the thoracic spine) of Ti-Ti, 2% (1/60, all T1 sequences) of C-Ti, and 0% of C-C, and considerable artifacts were found in 47% (28/60) of Ti-Ti, 10% (6/60, only 1 T2 sequence) of C-Ti, and 0% of C-C screws (P < 0.001). CONCLUSIONS: CFRP pedicle screws reduced the artifact intensity in spinal structures compared with titanium screws, and may be beneficial for planning radiotherapy and for follow-up imaging. C-C demonstrated an enhanced effect on dorsal structures.

Performance Assessment of Biocompatible Metals Used in the Treatment of Femoral Neck Fractures.

Femoral neck fractures (FNFs) are among the most common types of hip fractures. Particularly in young patients, these fractures require adequate fixation. These fractures, which are prevalent in elderly patients, are usually treated with implant applications. In implant applications, it is possible to find many different fixation configurations with various implant materials. The purpose of this study is to investigate the effects of metallic implant materials on fixation performance in the application of cannulated screws in an inverted triangle (CSIT), which are most preferred by orthopedic surgeons. Therefore, a femur bone with a type 2 fracture was numerically modeled and performances of CSIT implants with different biocompatible metals were investigated over nonlinear finite-element analyses (FEA). Within the study, stainless steel (SS), pure titanium (pTi), titanium alloy (Ti6Al4V), cobalt-chromium alloy (Co-Cr), and magnesium alloy (WE43) materials, frequently used as biocompatible implant materials, were taken into consideration and their performances were evaluated under static, vibration, and fatigue analyses. Throughout the comparison of analysis results and an optimality indicator formula, the optimum material was found to be the Co-Cr alloy on the basis of considered performance characteristics.

Titanium Elastic Nailing has Superior Value to Plate Fixation of Midshaft Femur Fractures in Children 5 to 11 Years.

BACKGROUND: American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guidelines for pediatric femoral shaft fractures indicate titanium elastic nails (TENs) for children 5 to 11 years old. Growing evidence suggests these fractures may also be treated with open or submuscular plating. The purpose of this study was to compare estimated blood loss (EBL), operative time, fluoroscopy time, cost, and subjective and objective pain scores between TENs and plating techniques used in 5- to 11-year-old children with midshaft femur fractures based on length stability. We hypothesized that EBL, operative time, and fluoroscopy time would be greater and pain would be lower with plate fixation. METHODS: We retrospectively identified all pediatric midshaft femur fractures treated with TENs, submuscular plating, or open plating between 2004 and 2014. Demographic, injury, and surgical data were obtained for analysis. Cost data were obtained from Synthes Inc. Outcomes were determined using the TEN outcome scoring system. Variables were compared between the 3 fixation methods using paired t tests or Fisher exact test as appropriate. Cost data were compared with Mann-Whitney nonparametric test. RESULTS: There were 65 midshaft femur fractures in 63 patients included. TENs accounted for 77% and plating 23%. There were no statistical differences in injury severity score, length of stay, length unstable fractures, open fractures, fluoroscopy time, or pain. However, there was a significantly greater operative time (P=0.007) and a notably greater EBL (P=0.057) for the plating technique compared with TENs. Patient outcomes were found to be equivalent. Implant cost was not significantly different although increased surgical costs were seen in plating (P=0.0007). CONCLUSIONS: This study supports the use of TENs or plating for midshaft femur fractures in children 5 to 11 years old, regardless of length stability. The use of plates resulted in higher EBL, longer operative time, increased cost, and equivalent pain compared with TENs. To our knowledge, this study represents the first direct comparison of the common fixation methods specifically for midshaft femur fractures and favors the use of TENs. LEVEL OF EVIDENCE: Level III.

Comparative Cost Analysis of Single and Mutli-Stage Temporal Deformity Correction Following Neurosurgical Procedures.

PURPOSE: Temporal hollowing deformity (THD) is a visible concavity/convexity in the temporal fossa; a complication often seen following neurosurgical/craniofacial procedures. Although numerous techniques have been described, no study to date has shown the healthcare costs associated with temporal hollowing correction surgery. Thus, the purpose here is to compare and contrast the direct costs related to temporal cranioplasty using various methods including: liquid poly-methyl-methacrylate (PMMA) implants with screw fixation, prebent, modified titanium mesh implants, and customized cranial implants (CCIs) with dual-purpose design. Understanding the financial implications related to this frequently encountered complication will help to motivate surgeons/healthcare facilities to better prevent and manage THD. METHODS: This is a single-surgeon, single-institution retrospective review of 23 THD patients randomly selected from between 2008 and 2015. Cost analysis variables include length of hospital stay, facility/professional fees, implant material fees, payer information, reimbursement rate, and net revenue. RESULTS: Of the 23 patients, ages ranged from 23 to 68 years with a mean of 48.3 years (SD 11.6). Within this cohort, 39.1% received dual-purpose PMMA CCIs (CCI PLUS), 17.4% received modified titanium mesh implants, and 43.5% received hand-molded, liquid PMMA implants with screw fixation. Total facility and/or professional charges ranged from $1978.00 to $126478.00. Average total facility charges per patient with dual-purpose CCIs were $34775.89 (SD ±â€Š$22205.09) versus $35826.00 (SD ±â€Š$23509.93) for modified titanium mesh implants and $46547.90 (SD ±â€Š81061.70) for liquid PMMA implants with screws. Mean length of inpatient stay was 5.7 days (SD = 8.1), and did not differ between implant types (P = 0.387). CONCLUSION: Temporal hollowing deformity is an expensive complication post-neurosurgery, and in the most severe form, requires a revision surgery for definitive correction. Therefore, surgeons should take further initiatives to employ reconstructive methods capable of minimizing risk for costly revision surgery, reducing morbidity related to visible deformity and accompanying social stigmata, and improving overall patient satisfaction.

Assessment of antibacterial and cytotoxic effects of orthodontic stainless steel brackets coated with different phases of titanium oxide: An in-vitro study.

INTRODUCTION: Our objective was to assess the antibacterial and cytotoxic effects of orthodontic stainless steel brackets coated with different phases of photocatalytic titanium oxide. METHODS: From a total sample of 115 brackets, 68 orthodontic stainless steel brackets were coated with titanium oxide using a radiofrequency magnetron sputtering machine. The coated brackets were then converted into 34 each of the anatase and rutile phases of titanium oxide. These brackets were subdivided into 4 groups for antibacterial study and 3 groups for cytotoxicity study. Brackets for the antibacterial study were assessed against the Streptococcus mutans species using microbiologic tests. Three groups for the cytotoxicity study were assessed using the thiazolyl tetrazolium bromide assay. RESULTS: The antibacterial study showed that both phases were effective, but the rutile phase of photocatalytic titanium oxide had a greater bactericidal effect than did the anatase phase. The cytotoxicity study showed that the rutile phase had a greater decrease in viability of cells compared with the anatase phase. CONCLUSIONS: It is recommended that orthodontic brackets be coated with the anatase phase of titanium oxide since they exhibited a significant antibacterial property and were only slightly cytotoxic.

Comparison of the use of silastic with titanium prefabricated implant in type I thyroplasty.

INTRODUCTION: Type I thyroplasty is the treatment of choice for unilateral vocal cord palsy with no spontaneous recovery. OBJECTIVES: To compare the use of silastic implant with titanium vocal fold medializing implant (TVFMI®) in type I thyroplasty for unilateral vocal cord palsy with respect to subjective and objective improvement in voice, endoscopic changes in vocal cords, surgical time, and cost effectiveness. METHODOLOGY: This was a prospective study conducted on 40 patients with unilateral vocal cord paralysis who underwent type I thyroplasty with either silastic implant or TVFMI®. Pre-operative and four-week post-operative assessment and statistical comparison were performed by videolaryngoscopy, stroboscopy, perceptual assessment (GRBAS), subjective (voice handicap index) analysis of voice, and computer-assisted acoustic and electroglottographic assessment. The duration of surgery and cost of implant were also recorded. RESULTS: Although both implants showed improvement in quality of voice following thyroplasty, TVFMI® presents slightly better results in objective voice analysis. The surgery time for TVFMI®insertion was shorter, but the costs were higher. CONCLUSION: TVFMI® may be preferred for medialization thyroplasty as it presents better voice results and demands less surgical time; however, it is costlier than silastic implant.

Comparação do uso de implante de Silastic(r) com titânio pré-fabricado na tireoplastia tipo I / Comparison of the use of silastic with titanium prefabricated implant in type I thyroplasty

Introdução: A tireoplastia tipo I é o tratamento de escolha nas paralisias unilaterais das pregas Análise de custo-bene-vocais que não se recuperam espontaneamente. fício. Objetivos: Comparar o uso de implante de Silastic® com o uso de titânio pré-fabricado TVFMI® (Titanium Vocal Fold Medializing Implant) na tireoplastia tipo I para o tratamento da paralisia unilateral das pregas vocais com relação à melhora subjetiva e objetiva da voz, às alterações endoscópicas nas pregas vocais, ao tempo de cirurgia e à relação custo-benefício. Método: Trata-se de um estudo prospectivo com 40 pacientes portadores de paralisia unilateral das pregas vocais submetidos à tireoplastia tipo I com implante de silastic® ou TVFMI®. A avaliação e comparação estatística foram realizadas antes e quatro semanas depois da cirurgia por meio de videolaringoscopia, estroboscopia, análise perceptiva (escala GRBAS-Grade, Roughness, Breathiness, Asthenia, Strain) e subjetiva (IDV-índice de desvantagem vocal) da voz e avaliação eletroglotográfica e avaliação acústica computadorizada. Também foram observados o tempo de cirurgia e o custo do implante. Resultados: Embora os dois implantes mostrem melhora na qualidade da voz após a tireoplastia, o TVFMI® teve um resultado ligeiramente melhor na análise objetiva da voz. O TVFMI® levou menos tempo de cirurgia para ser inserido, porém foi mais caro. Conclusão: O TVFMI® poderá ser preferencial na tireoplastia de medialização, já que possui melhores resultados vocais e leva menos tempo de cirurgia, porém é mais caro que o implante de Silastic®. .

Introduction: Type I thyroplasty is the treatment of choice for unilateral vocal cord palsy with no spontaneous recovery. Objectives: To compare the use of silastic implant with titanium vocal fold medializing implant (TVFMI®) in type I thyroplasty for unilateral vocal cord palsy with respect to subjective and objective improvement in voice, endoscopic changes in vocal cords, surgical time, and cost effectiveness. Methodology: This was a prospective study conducted on 40 patients with unilateral vocal cord paralysis who underwent type I thyroplasty with either silastic implant or TVFMI®. Pre-operative and four-week post-operative assessment and statistical comparison were performed by videolaryngoscopy, stroboscopy, perceptual assessment (GRBAS), subjective (voice handicap index) analysis of voice, and computer-assisted acoustic and electroglottographic assessment. The duration of surgery and cost of implant were also recorded. Results: Although both implants showed improvement in quality of voice following thyroplasty, TVFMI® presents slightly better results in objective voice analysis. The surgery time for TVFMI®insertion was shorter, but the costs were higher. Conclusion: TVFMI® may be preferred for medialization thyroplasty as it presents better voice results and demands less surgical time; however, it is costlier than silastic implant. .

Assessment of sternal closure using titanium plate.

INTRODUCTION: The use of plates and screws for more rigid fixation of the sternum, without maintaining contact between the upper portion of the sternum and mediastinum. The present study seeks new choice of plate with a significant difference, the same does not need to be removed in order to proceed to open when necessary sternal emerging opening of the bone. OBJECTIVE: The current study aims to evaluate the efficacy and safety of this procedure. METHODS: To this end, we selected ten patients with coronary artery disease have shown no significant risk factors for mediastinitis. The surgery was thus performed in the usual way that all patients with coronary artery disease surgeries are done at the institution. Only at the time of sternal closure is that there was a change, with the combination of steel wires and plates. RESULTS: All cases had sternal closure properly with good outcome in the medium term. CONCLUSION: The use of plates ENGIMPLAN proved safe and effective for sternal closure.

Assessment of sternal closure using titanium plate / Avaliação do fechamento esternal com placa de titânio

INTRODUCTION: The use of plates and screws for more rigid fixation of the sternum, without maintaining contact between the upper portion of the sternum and mediastinum. The present study seeks new choice of plate with a significant difference, the same does not need to be removed in order to proceed to open when necessary sternal emerging opening of the bone. OBJECTIVE: The current study aims to evaluate the efficacy and safety of this procedure. METHODS: To this end, we selected ten patients with coronary artery disease have shown no significant risk factors for mediastinitis. The surgery was thus performed in the usual way that all patients with coronary artery disease surgeries are done at the institution. Only at the time of sternal closure is that there was a change, with the combination of steel wires and plates. RESULTS: All cases had sternal closure properly with good outcome in the medium term. CONCLUSION: The use of plates ENGIMPLAN proved safe and effective for sternal closure.

INTRODUÇÃO: A utilização de placas e parafuso para a mais rígida fixação do esterno, sem manter contato entre a porção superior do esterno e o mediastino. O estudo atual busca nova opção de placa, com um diferencial importante; a mesma não precisa ser retirada para que se proceda à abertura esternal em caso de necessidade emergente de abertura do osso. OBJETIVO: O presente estudo tem por objetivo avaliar a eficácia e a segurança de tal procedimento. MÉTODOS: Para tal, foram selecionados dez pacientes portadores de doença arterial coronária que não apresentassem importantes fatores de risco para mediastinite. As cirurgias foram, portanto, realizadas da maneira habitual, a todas os procedimentos em portadores de coronariopatias são feitas na Instituição. Somente no momento do fechamento esternal é que houve uma modificação, com a associação de fios de aço e placas. RESULTADOS: Todos os casos apresentaram fechamento esternal de forma adequada com boa evolução a médio prazo. CONCLUSÃO: O emprego das placas ENGIMPLAN se mostrou seguro e eficaz no fechamento esternal.

Introducing the external link model for studying spine fixation and misalignment: current procedures, costs, and failure rates.

OBJECTIVE: This is the last article in a series of 3 articles introducing a new animal model, the external link model (ELM), that permits reversible, nontraumatic control of the cardinal biomechanical features of the subluxation: fixation and misalignment. A detailed description of current ELM procedures is presented and practical issues are reviewed such as expense (dollars and time) and construct failure rates during and after the surgical implant procedure. METHOD: Descriptive report of current ELM procedures, refinements to the spinous attachment units (SAUs), and tabulation of costs and failure rates drawn from recent studies. RESULTS: In contrast to the older, 1-piece stainless steel SAUs, new 3-piece titanium SAUs may be reimplanted many times without failure. Consequently, the cost per ELM ranges from $579 to $69, depending on whether the SAUs, links, and screws must be purchased or are already available for implanting. The SAU implant procedure requires between 0.5 and 1.25 hours, depending on the experience of the surgeon. The total construct failure rate for the ELM is 24.2% (6.6% at surgery failure + 17.8% postsurgery failures). This rate is consistent with that reported in spine implant studies with other devices. To date, more than 500 male Sprague-Dawley rats (350-450 g) have been implanted with SAUs for ELM studies at the Palmer Center for Chiropractic Research and the National University of Health Sciences. CONCLUSION: It has been our experience that individuals with basic animal research training will become proficient at producing the ELM after observing 3 to 4 implant procedures and performing 4 to 6 procedures on their own.

[A comparative assessment of modern suture materials in stomach resection]. / Sravnitel'naia otsenka sovremennykh shovnykh materialov pri rezektsii zheludka.

Results of stomach resection by Bilrot-II in 30 experimental animals and 369 patients with gastric and duodenal ulcers were analyzed. Gastroenteroanastomoses were created with various sutures: capron, polysorb, titanium clips. Pneumopression, bacteriologic and morphologic examinations of anastomosis, fibroesophagogastroduodeno- and intestinoscopy, peripheral computed electrogastroenterography were used. It was revealed that mechanical suture with titanium clips was the best. Polysorb thread is inferior in tissue reaction to mechanical suture but superior to capron. Use of polysorb reduced rate of complications in immediate postoperative period 4 times. Taking into consideration high cost of suture devices it is reasonable to introduce polysorb in practice of abdominal surgery.

Radiographic assessment of anterior titanium mesh cages.

Carbon fiber and titanium cage implantation for anterior column support during spinal fusions is an alternative to the use of more traditional structural allografts and autografts. The authors report instrumentation and cage failure for patients who underwent spinal fusion with structural titanium mesh cages implanted into the anterior column a minimum of 2 years after surgery. They wanted to determine whether plain radiographic techniques can be used to critically assess disk space and corpectomy fusions after implantation of these radioopaque cages. Fifty patients having undergone spinal fusions using structural titanium mesh cages in the anterior column had 99 anterior levels fused with at least 1 (maximum of 2) titanium mesh cage, resulting in a total of 131 cages used. The cages were examined for evidence of settling, migration, or failure. The anterior and posterior instrumentation was assessed for evidence of failure, and the spine was examined for evidence of successful fusion. Radiographic cage settling (>2 mm) into the vertebral body end plates was observed, but cage migration or failure were not. An average lordotic correction of 10 degrees was observed, with loss of correction into kyphosis from immediately after operation to final follow-up averaging 2 degrees. As an average of all reviewers, using a strict radiographic fusion assessment, definite or probable anterior fusion was graded at 81% of the levels, probably not or no at 5% of the levels, and could not be assessed at 14% of the levels. Definite or probable posterior fusion as an average of all reviewers was graded at 44% of the posterior fusion levels, questionable at 4%, no at 5%, and could not be assessed at 47%. The use of anterior-only, posterior-only, or anterior and posterior instrumentation with structural titanium mesh cages in the anterior spine along with proper autogenous bone grafting techniques provided anterior column support with a low rate of radiographic complications. Acceptable anterior spinal fusion rates, as assessed by a consensus agreement of reviewers, were observed primarily by evaluation of the fusion mass around the cages (extracage fusion), because intracage fusion was difficult to assess.