Influence of customized over-scan body rings on the intraoral scanning effectiveness of a multiple implant edentulous mandibular model.

OBJECTIVES: To evaluate the effectiveness of intraoral scanning with identical multiple implant scan bodies (ISB) using customized over scan body rings (COR) as an auxiliary system. METHODS: Six printed rings with different diameters and shapes were attached at different levels to each identical ISB of an edentulous mandibular master model. The master model was scanned using an intraoral scanner (Primescan CEREC) until valid digital models for the COR group (n=10) and for the unmodified ISB (UN) group (n=10) were obtained. The total scanning times and the number of rescans required was registered. To assess differences between scanning efficiency the Student T-test and Mann Whitney U-Test were applied. A Coordinate Measuring Machine (CMM) was used to register the reference model. To evaluate accuracy discrepancies between the test scans (n=20) and the reference model, Geomagic Control X was used. Mann Whitney U-test was applied to calculate statistically significant differences. RESULTS: To achieve a valid model, an average of 4.70 rescans / repetitions were required for the UN group, whereas for the COR group required an average of 1.40 rescans (p<.001). Mean total scanning time was 201.10 s and 542.40 s for the COR and UN group, respectively (p=.001). No statistically significant differences were found between the groups in terms of accuracy (p>.05) with respectively COR and UN values; mean linear trueness 34.38 µm and 31.14 µm, mean linear precision 22.94 µm and 18.51 µm, mean angular trueness 0.12° and 0.14°, mean angular precision 0.075° and 0.08°. CONCLUSION: The use of the COR system may increase the scanning efficiency of multiple implants with similar ISBs without impacting the accuracy.

Sensory innervation of the human palmar aponeurosis in healthy individuals and patients with palmar fibromatosis.

The human palmar aponeurosis is involved in hand proprioception, and it contains different sensory corpuscle morphotypes that serve this role. In palmar fibromatosis (classically referred to as Dupuytren's disease), the palmar aponeurosis undergoes fibrous structural changes that, presumably, also affect the nervous system, causing altered perception. We analysed the various sensory nerve formation morphotypes in the palmar aponeuroses of healthy subjects and patients with palmar fibromatosis. To do this, we used immunohistochemistry for corpuscular constituents and the putative mechanoproteins PIEZO2 and acid-sensing ion channel 2. Free nerve endings and Golgi-Mazzoni, Ruffini, paciniform and Pacinian corpuscles were identified in both the healthy and the pathological conditions. The densities of the free nerve endings and Golgi-Mazzoni corpuscles were slightly increased in the pathological tissues. Furthermore, the Pacinian corpuscles were enlarged and displayed an altered shape. Finally, there was also morphological and immunohistochemical evidence of occasional denervation of the Pacinian corpuscles, although no increase in their number was observed. Both PIEZO2 and acid-sensing ion channel 2 were absent from the altered corpuscles. These results indicate that the human palmar aponeurosis is richly innervated, and the free nerve endings and sensory corpuscles within the palmar aponeurosis undergo quantitative and qualitative changes in patients with palmar fibromatosis, which may explain the sensory alterations occasionally reported for this pathology.

Accuracy of digitization obtained from scannable and nonscannable elastomeric impression materials.

STATEMENT OF PROBLEM: Elastomeric impression materials have been marketed for optimizing direct digital acquisition without requiring a stone cast. The trueness and precision of the digitization of these new elastomeric impression materials are unclear. PURPOSE: The purpose of this in vitro study was to compare the trueness and precision of digital dental casts obtained from the direct digitization of 2 types of vinylsiloxanether (VSXE) impression materials by using a laboratory laser scanner. MATERIAL AND METHODS: Thirty-eight elastomeric impressions were made of a master die with a similar morphology to a premolar crown preparation. The impression materials were Identium (IDE) and Identium Scan (SCAN), designed for direct digitalization. Each impression was digitalized by using an optical scanner to create digital casts. A computer-aided design (CAD) reference model of trueness (CRM) was created and aligned to each digital cast for digital 3-dimensional discrepancy analysis. RESULTS: The mean ±standard deviation global trueness of IDE was 53 ±16 µm and that of SCAN was 46 ±3 µm. SCAN digital casts showed higher precision (58 ±5 µm) than IDE (69 ±18 µm) (P<.05). At the margin of the preparation and at the axial surfaces, SCAN models showed higher trueness (3 ±6 µm and 1 ±5 µm) than IDE (15 ±10 µm and 2 ±37 µm), respectively. CONCLUSIONS: Scannable impressions could be digitalized with higher global precision than conventional elastomeric materials. Higher trueness could be achieved in specific impression locations such as gingival areas or axial walls of preparations, where the light emitted by the scanner was not blocked.

Terapia física en la hipofunción vestibular unilateral y bilateral / Physical therapy in unilateral and bilateral vestibular hypofunction

INTRODUCCIÓN: La rehabilitación vestibular (RV) basada en la terapia física, tiene el objetivo, en el caso de patología vestibular, de inducir la compensación del sistema nervioso central (SNC) a nivel de núcleos vestibulares y de otros niveles del SNC. Incluye ejercicios de habituación, adaptación y sustitución vestibular, ejercicios para mejorar el equilibrio y el control postural dinámico y ejercicios para el acondicionamiento general. En este capítulo discutimos los recientes avances sobre el adiestramiento del equilibrio y de la marcha, la estabilidad de la mirada y la habituación, en el contexto de los trastornos vestibulares uni y bilaterales. MÉTODO: Revisión narrativa. RESULTADOS: Los ejercicios se prescriben para mejorar la función; fortaleciendo, y favoreciendo la flexibilidad y la resistencia, a través de la adaptación del RVO, la habituación, la sustitución sensorial, la marcha y el equilibrio postural. Son más eficaces los programas personalizados que los genéricos. El cumplimiento mejora con la personalización y las visitas de seguimiento a un fisioterapeuta. Discusión/CONCLUSIONES: La RV permite mejorar el déficit funcional y los síntomas subjetivos derivados de la hipofunción vestibular periférica uni y bilateral, así como las alteraciones del equilibrio de origen central. Los objetivos de la RV consisten en reducir los síntomas para mejorar la estabilidad postural y de la mirada (particularmente durante los movimientos de la cabeza) y devolver al individuo a sus actividades normales, incluyendo la actividad física, la conducción y el trabajo habitual. Los médicos deben ofrecer la RV a quienes muestren limitaciones funcionales relacionadas con un déficit vestibular, pues actualmente se considera el tratamiento estándar en la disfunción vestibular periférica

INTRODUCTION: The vestibular rehabilitation is an exercise-based method, aiming to maximize central nervous system (CNS) compensation at vestibular nuclear and other CNS levels for vestibular pathology. Vestibular rehabilitation includes exercises to habituate symptoms, exercises to promote vestibular adaptation and substitution, exercises to improve balance and dynamic postural control, and exercises to improve general conditioning. Recent advances in balance and gait training, gaze stability training, habituation training, are discussed in this chapter in the context of unilateral and bilateral vestibular disorders. METHOD: Narrative review. RESULTS: Exercises are prescribed that address VOR adaptation, habituation, sensory substitution, gait and posture, strengthening, flexibility, and endurance to maximize functioning. Customized exercise programs have been shown to be more effective than providing a patient with a generic exercise program. It is thought that compliance is enhanced with customization and with follow-up visits with a physical therapist. Discussion/ conclusions: VR therapy is effective in improving functional deficits and subjective symptoms resulting from unilateral and bilateral peripheral vestibular hypo function, as well as from central balance disorders. The goals of vestibular rehabilitation are to reduce subjective symptoms, to improve gaze and postural stability (particularly during head movements), and to return the individual to normal activities, including regular physical activity, driving, and work. Clinicians should offer vestibular rehabilitation to persons with impairments and functional limitations related to the vestibular deficit. Vestibular rehabilitation is now considered the standard of care for persons with peripheral vestibular dysfunction

Lesión de Morel-Lavallée: la importancia del diagnóstico precoz / Morel-Lavallée lesions the importance of early diagnosis

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Aplicaciones del colgajo anterolateral de muslo en reconstrucción de extremidad superior / Use of the anterolateral thigh free flap for upper-extremity reconstruction

Antecedentes y Objetivo. El colgajo anterolateral de muslo, desde su descripción en 1984, se ha convertido en opción reconstructiva de primera elección para grandes defectos de partes blandas. En los traumatismos de la extremidad superior, la recuperación de la función es el objetivo principal, siendo necesario para ello una cobertura cutánea estable y precoz. En este estudio revisamos nuestros resultados en reconstrucción microquirúrgica de extremidad superior con colgajo anterolateral de muslo, realizando una discusión sobre indicaciones, técnica quirúrgica y resultados que pueden contribuir al éxito o fracaso del mismo. Material y Método. Presentamos una revisión retrospectiva de los pacientes tratados en el Servicio de Cirugía Plástica del Hospital Universitario Central de Asturias (Oviedo, España) entre 2003 y 2013. Analizamos la supervivencia del colgajo, su estabilidad cutánea, la posibilidad de cierre directo de la zona donante y las complicaciones postoperatorias locales y sistémicas; y empleamos la versión española del cuestionario DASH (Disabilities of Arm, Shoulder and Hand) para evaluar la recuperación funcional. Resultados. Recogimos 15 pacientes tratados con colgajo anterolateral de muslo para reconstrucción de defectos en la extremidad superior. Los accidentes industriales de alta energía fueron la etiología más frecuente (57%). La zona donante fue la extremidad inferior contralateral a la superior lesionada. Se realizó cierre directo en el 80% de los casos. La arteria receptora más usada fue la radial (73.3%). La anastomosis arterial más frecuente fue la término-terminal Todas las anastomosis venosas fueron término-terminales. Todos los colgajos sobrevivieron sin incidencias microquirúrgicas. El cuestionario DASH se aplicó a 12 pacientes, y la puntuación media para discapacidad/síntomas fue 25 con un rango entre 0 y 63. Conclusiones. La posibilidad de aportar paletas cutáneas extensas, fascia de excelente calidad, una porción de músculo vasto externo, pedículo vascular largo y su fiabilidad, convierten al colgajo anterolateral de muslo en opción ideal para el tratamiento de defectos complejos de las extremidades (AU)

Background and Objective. The anterolateral thigh flap, since its description in 1984, has become first choice reconstructive option for large soft tissue defects. In upper extremity injuries, the recovery of function should be the main goal and a stable and premature skin coverage is mandatory to achieve this aim. We present our results in upper limb microsurgical reconstruction with anterolateral thigh flap and conduct a discussion on indications, surgical technique, and results that can contribute to its success or failure. Methods. We conduct a retrospective revision of patients treated at the Plastic Surgery Unit of the University Hospital Central de Asturias (Oviedo, España), between 2003 and 2013. We analyze flap survival, skin stability, direct closure possibility in donor site, and local and systemic postoperative complications; and we use an Spanish version of DASH questionary (Disabilities of Arm, Shoulder and Hand) to evaluate functional recover. Results. We got 15 patients treated with anterolateral thigh flap for reconstruction of upper extremity defects. High energy industrial accidents were the most frequent etiology (57%). Donor site was contralateral lower extremity contralateral to the upper injured one. Direct close was achieved in 80%. Most frequent receptor artery was radial (73.3%). Most frequent arterial anastomosis was termino-terminal. All of the venous anastomosis were termino-terminal. All the flaps survived without microsurgical incidences. DASH questionary was applied to 12 patients, and themedian punctuation for incapacity/symptoms was 25 with a range between 0 and 63. Conclusions. The ability to provide extensive skin paddles, fascia of excellent quality, a portion of vastus lateralis muscle, long vascular pedicle and reliability make the anterolateral thigh flap ideal for the treatment of complex defects of the limbs option (AU)