Survival, technical and biological outcome of fixed tooth- and implant-supported restorations: A retrospective analysis of a patient cohort treated in an undergraduate dental education program.

OBJECTIVES: There is a paucity of data on the outcome of fixed tooth- and implant-supported porcelain-fused-to-metal (PFM) and ceramic-based (CB) restorations fabricated during undergraduate dental education. Therefore, this retrospective study examined the outcome of fixed restorations placed in patients participating in an undergraduate program. METHODS: Patient records were searched for data on fixed PFM and CB restorations. For these restorations, the functional period in situ and technical and biological complications, namely restoration fracture, decementation, screw loosening, secondary caries, and loss of vitality, were recorded. Periodontal parameters were also documented. Kaplan-Meier survival and complication estimates after 1 and 5 years were calculated for restoration types, materials, designs (veneered/non-veneered), cementation/retention modes and localizations with group sizes ≥ 15. Regression models were used to analyze the influence of demographic data and abovementioned restoration characteristics on restoration survival, technical and biological outcome. RESULTS: 1196 restorations with a mean observation time of 5 years were included in the analysis. The different restoration types exhibited survival rates of > 90.8% after 5 years, accompanied by a favorable biological outcome. However, monolithic resin-matrix or feldspathic ceramic restorations were found to have a higher fracture rate than lithium disilicate or zirconium dioxide ceramic restorations resulting in lower survival rates for these restorations. Additionally, resin-matrix ceramic restorations showed a higher decementation rate than lithium disilicate restorations. CONCLUSIONS: Fixed tooth- and implant-supported CB restorations fabricated from lithium disilicate and zirconium dioxide ceramics demonstrated better survival and lower complication rates than restorations fabricated from resin-matrix or feldspathic ceramics in an undergraduate dental education program. CLINICAL SIGNIFICANCE: Due to the more favorable outcome of CB restorations fabricated from lithium disilicate or zirconium dioxide ceramics, undergraduate dental education should focus on the application of these ceramics to increase restoration survival by reducing technical complications.

Lateral hypopharyngectomy with laryngeal preservation reconstructed with inlay fascio-cutaneous free flaps: clinical and functional outcomes.

Objective: Lateral hypopharyngectomy (LH) is one of the organ-preservation surgical strategies available for treatment of selected naïve early squamous cell carcinoma (SCC), as well as for rarer non-SCC tumours and persistent/recurrent/second primaries after chemoradiation of the lateral wall of the piriform sinus. Its reconstructive methods have been the subject of different approaches without a general consensus. The aim of the present study is to describe a retrospective series of LH reconstructed by inlay fascio-cutaneous free flaps, reporting on oncological and functional outcomes. Methods: Patients who underwent LH at the Department of Otorhinolaryngology - Head and Neck Surgery of the University of Brescia, Italy, between 2017 and 2023 were retrospectively reviewed. Clinical history, tumour histotype, postoperative complications, functional, and oncological outcomes were collected. Results: Seven patients (6 males, 1 female) were included. In all, 29% had a naïve neoplasm, while 71% had recurrent disease. The final histology included 3 SCC, 2 synovial sarcomas, one liposarcoma, and one single-site mucosal metastasis from cutaneous melanoma. Negative margins were achieved in 6 patients (86%). All patients had swallowing rehabilitation by speech therapists and were able to safely eat a free diet at discharge, except for one who needed a percutaneous endoscopic gastrostomy to support nutritional oral intake. After a mean follow-up of 34.3 months, all patients except one are alive. Conclusions: Our study showed that, in selected cases, it is possible to radically remove lateral hypopharyngeal tumours with laryngeal preservation and free flaps inlay reconstruction, with a low rate of complications and acceptable functional and oncological results.

Evaluating the accuracy of CEREC intraoral scanners for inlay restorations: impact of adjacent tooth materials.

BACKGROUND: The accuracy of intraoral scanning is critical for computer-aided design/computer-aided manufacturing workflows in dentistry. However, data regarding the scanning accuracy of various adjacent restorative materials and intraoral scanners are lacking. This in vitro study aimed to evaluate the effect of adjacent restorative material type and CEREC's intraoral scanners on the accuracy of intraoral digital impressions for inlay cavities. METHODS: The artificial tooth was prepared with an occlusal cavity depth of 2 mm, a proximal box width at the gingival floor of 1.5 mm, and an equi-gingival margin extended disto-occlusally at the transition line angle on both the lingual and buccal sides for an inlay restoration. The adjacent teeth were veneered with crowns made of gold and zirconia, and an artificial tooth (resin) was utilized as the control group. The inlay cavity and adjacent teeth (Gold, Zirconia, and resin) were scanned 10 times using Chairside Economical Restoration of Esthetic Ceramics (CEREC) Primescan (PS), Omnicam (OC), and Bluecam (BC). A reference scan was obtained using a laboratory scanner (3-shape E3). Scanning was performed according to the manufacturer's instructions, including powder application for the BC group. Standard tesselation language files were analyzed using a three-dimensional analysis software program. Experimental data were analyzed using a two-way analysis of variance and the Tukey's post-hoc comparison test. RESULTS: The restorative materials of the adjacent teeth significantly affected the accuracy of the intraoral digital impressions (p < .05). The zirconia group exhibited the highest trueness deviation, followed by the resin and gold groups, with each demonstrating a statistically significant difference (p < .05). The resin group demonstrated the highest maximum positive deviation and deviation in precision. Gold exhibited the lowest average deviation value for trueness compared with those of the other adjacent restorative materials. Intraoral scanner type significantly influenced the trueness and precision of the scan data (p < .05). The average deviation of trueness according to the intraoral scanner type increased in the following order: BC > PS > OC. The average deviation in precision increased in the following order: PS>OC>BC (p < .05). CONCLUSION: The restorative materials of the adjacent tooth and the type of intraoral scanner affect the accuracy of the intraoral digital impression. The trueness of the digital images of the BC group, obtained by spraying the powder, was comparable to that of the PS group. Among the adjacent restorative materials, zirconia exhibited the lowest trueness. In contrast, PS demonstrated the highest precision among the intraoral scanners, while resin displayed the lowest precision among the adjacent restorative materials.

A gender and size specific evaluation of Grammont-type inlay versus lateralizing onlay stem designs in achieving lateralization and distalization in reverse shoulder arthroplasty.

INTRODUCTION: In reverse shoulder arthroplasty (RSA) new designs enable greater amounts of lateralization to prevent instability and scapular notching and increase range of motion, however, excessive lateralization leads to stress upon the acromion that can result in scapular spine fatigue fractures. Aim of this study was to gender- and size-specifically assess the influence of glenosphere size and different humeral designs on lateralization, distalization, and bony impingement-free range of motion (ROM) in patients undergoing RSA. METHODS: Computed tomography scans from 30 osteoarthritic patients (f:15, m:15) and 20 cuff tear arthropathy patients (f:10, m:10) were used to virtually simulate RSA implantation. The efficacy of an inlay Grammont-type system vs. an onlay lateralizing system combined with different glenosphere sizes (36 mm vs. 42 mm) in achieving ROM, lateralization, and distalization was evaluated. Moreover, gender and patient's constitution were correlated to humeral size by radiologically measuring the best-fit circle of the humeral head. RESULTS: A different amount of relative lateralization was achieved in both genders using large glenospheres and onlay designs. Latter yielded a higher ROM in all planes for men and women with a 42 mm glenosphere; with the 36 mm glenosphere, an increased ROM was observed only in men. The 155° inlay design led to joint medialization only in men, whereas all designs led to lateralization in women. When adjusting the absolute amount of lateralization to humerus' size (or patient's height), regardless of implant type, women received greater relative lateralization using 36 mm glenosphere (inlay: 1%; onlay 12%) than men with 42 mm glenosphere (inlay: -3%; onlay: 8%). CONCLUSION: The relative lateralization achieved using onlay design is much higher in women than men. Small glenospheres yield greater relative lateralization in women compared to large glenospheres in men. Humeral lateralization using onlay designs should be used cautiously in women, as they lead to great relative lateralization increasing stress onto the acromion. LEVEL OF EVIDENCE: Basic Science Study, Computer Modeling.

Comparison of the biomechanical effects of the post-core crown, endocrown and inlay crown after deep margin elevation and its clinical significance.

BACKGROUND: The purpose of this in vitro study was to compare and evaluate the stress distribution of maxillary first premolar residual crowns restored with post-core crowns, endocrowns and inlay crowns after deep margin elevation, to explore the fitting restoration for residual crowns using finite element analysis. METHODS: A healthy complete right maxillary first premolar from a male adult was scanned by cone beam computed tomography (CBCT). The finite element model of the tooth was established by reverse engineering software such as Mimics, Geomagic and Hypermesh. On this basis, the residual crown model after deep margin elevation was made, and the experimental group models were divided into three groups, those restored with post core crowns, endocrowns and inlay crowns. Vertical and oblique static loads were applied to the experimental models to simulate the force on the tooth during mastication (the loading position was located in the central fossa of the occipital surface, and the load was 100 N) using Abaqus software. RESULTS: The peak value and distribution of von Mises stress in each part of the experimental model were observed. After deep margin elevation, the peak dentin von Mises stresses were lower than the tensile strength of normal dentin in the post-core crown, endocrown, and inlay crown groups; the lowest stress results were found in the post-core crown group for the dentin, restoration, enamel, and deep margin elevation (DME) layers under vertical and oblique loading. In terms of stress distribution clouds, the peak stresses in the dentin tissue were located in the apical 1/3 of the root after postcore crown restorations for both loads, while stress concentrations were evident in the cervical and root areas after endocrown and inlay crown restorations; regardless of the load and restoration method, the corresponding stress concentration areas appeared at the junction of the DME and dentin tissue at the loading site of the restorations; CONCLUSIONS: Post-core crowns, endocrowns and inlay crowns can be used to restore residual crowns after deep margin elevation, and post-core crowns can better protect the residual tooth tissue.

Early monitoring of inlay wear after total knee arthroplasty on plain radiographs using model-based wear measurement.

Wear of the ultra-high molecular-weight polyethylene (UHMWPE) component in total knee arthroplasty contributes to implant failure. It is often detected late, when patients experience pain or instability. Early monitoring could enable timely intervention, preventing implant failure and joint degeneration. This study investigates the accuracy and precision (repeatability) of model-based wear measurement (MBWM), a novel technique that can estimate inlay thickness and wear radiographically. Six inlays were milled from non-crosslinked UHMWPE and imaged via X-ray in anteroposterior view at flexion angles 0°, 30°, and 60° on a phantom knee model. MBWM measurements were compared with reference values from a coordinate measurement machine. Three inlays were subjected to accelerated wear generation and similarly evaluated. MBWM estimated inlay thickness with medial and lateral accuracies of 0.13 ± 0.09 and 0.14 ± 0.09 mm, respectively, and linear wear with an accuracy of 0.07 ± 0.06 mm. Thickness measurements revealed significant lateral differences at 0° and 30° (0.22 ± 0.08 mm vs. 0.06 ± 0.06 mm, respectively; t-test, p = 0.0002). Precision was high, with average medial and lateral differences of - 0.01 ± 0.04 mm between double experiments. MBWM using plain radiographs presents a practical and promising approach for the clinical detection of implant wear.

BCLA CLEAR Presbyopia: Management with corneal techniques.

Corneal techniques for enhancing near and intermediate vision to correct presbyopia include surgical and contact lens treatment modalities. Broad approaches used independently or in combination include correcting one eye for distant and the other for near or intermediate vision, (termed monovision or mini-monovision depending on the degree of anisometropia) and/or extending the eye's depth of focus [1]. This report reviews the evidence for the treatment profile, safety, and efficacy of the current range of corneal techniques for managing presbyopia. The visual needs and expectations of the patient, their ocular characteristics, and prior history of surgery are critical considerations for patient selection and preoperative evaluation. Contraindications to refractive surgery include unstable refraction, corneal abnormalities, inadequate corneal thickness for the proposed ablation depth, ocular and systemic co-morbidities, uncontrolled mental health issues and unrealistic patient expectations. Laser refractive options for monovision include surface/stromal ablation techniques and keratorefractive lenticule extraction. Alteration of spherical aberration and multifocal ablation profiles are the primary means for increasing ocular depth of focus, using surface and non-surface laser refractive techniques. Corneal inlays use either small aperture optics to increase depth of field or modify the anterior corneal curvature to induce corneal multifocality. In presbyopia correction by conductive keratoplasty, radiofrequency energy is applied to the mid-peripheral corneal stroma, leading to mid-peripheral corneal shrinkage and central corneal steepening. Hyperopic orthokeratology lens fitting can induce spherical aberration and correct some level of presbyopia. Postoperative management, and consideration of potential complications, varies according to technique applied and the time to restore corneal stability, but a minimum of 3 months of follow-up is recommended after corneal refractive procedures. Ongoing follow-up is important in orthokeratology and longer-term follow-up may be required in the event of late complications following corneal inlay surgery.

Rates of subacromial notching are low following reverse shoulder arthroplasty with a 135° inlay humeral component and a lateralized glenoid.

Background: Lateralization in reverse shoulder arthroplasty (RSA) decreases bony impingement and improves rotational range of motion, but has been theorized to increase the risk of subacromial notching (SaN). The purpose of this study was to evaluate the presence of SaN following RSA and its relationship with lateralization with a 135° inlay humeral component. The secondary purpose was to assess the association of SaN with functional outcomes. Methods: A retrospective review was performed from a multicenter prospectively collected database on patients who underwent primary RSA from 2015 to 2021. All RSAs were performed with a 135° inlay humeral component. SaN was defined as bony erosion with sclerotic margins on the undersurface of the acromion on final follow-up radiographs not present preoperatively. Postoperative implant positioning (inclination, distalization, and lateralization) were evaluated on minimum 1-year postoperative radiographs. Regression analyses were performed on implant and clinical variables to assess for risk factors. A separate analysis was performed to determine the association of SaN with clinical outcomes. Results: SaN was identified in 13 out of 442 shoulders (2.9%). Age, sex, body mass index, smoking status, diabetes mellitus, arm dominance had no relationship with SaN. Neither glenoid sided lateralization nor humeral offset were associated with SaN risk. Other implant characteristics such as distalization, glenosphere size, and postoperative inclination did not influence SaN risk. The presence of SaN did not affect patient-reported outcomes (American Shoulder and Elbow Surgeons: P = .357, Visual Analog Scale: P = .210) or range of motion. Conclusion: The rate of SaN is low and not associated with glenoid or humeral prosthetic lateralization when using a 135° inlay humeral component. When SaN occurs, it is not associated with functional outcomes or range of motion at short-term follow-up.

The multi-luting concept: a new approach to facilitate the adhesive luting of multiple indirect restorations.

Bonded indirect restorations can be difficult to lute in an accurate position due to the lack of preparation geometry. Furthermore, while the use of a rubberdam has been proven to be the best technique for providing the most efficient conditions for adhesive luting, its use often requires the use of secondary clamps, which do not allow the operator to lute more than two prosthetic pieces at the same time. The multi-luting concept is a pragmatic approach that of- fers the possibility to deliver several, if not all restorations, to be bonded at the same time, thus ensuring their correct positioning.

Long-term performance of ceramic in/-onlays vs. cast gold partial crowns - a retrospective clinical study.

OBJECTIVES: To assess the long-term clinical performance of ceramic in-/onlays (CIOs) and cast gold partial crowns (CGPCs) in posterior teeth in terms of success, survival, complications (biological, technical) and quality. MATERIAL AND METHODS: In a retrospective study, a total of 325 patients were recorded after up to 24.8 years (mean 13.9 ± 3.8 years) having (pre-)molars restored with CIO (Empress I, Ivoclar Vivadent, n = 161) and CGPC (Degunorm, DeguDent, n = 164) by supervised undergraduate students. A total of 296 restorations were assessed clinically and radiologically in healthy and endodontically treated teeth using modified United States Public Health Service (USPHS) criteria. Cumulative success and survival rates of the restorations were calculated using Kaplan-Meier estimates. Biological and technical complications were recorded. Status of oral health comprising caries risk and localized periodontitis were assessed. RESULTS: The cumulative success rates of CIOs were 92.1% and of CGPCs 84.2% after mean service times of 14.5 years. The annual failure rates of total service times were 0.5% in teeth restored with CIO (n = 155) and 0.7% in teeth restored with CGPC (n = 163). The cumulative survival rates of CIOs were 93.9% after a mean service time of 15.2 years and decreased to 91.7% after 23.5 years. The cumulative survival rates of CGPCs were 92.6% after a mean service time of 14.9 years and 91.8% after 23.5 years. Complications in CIOs (n = 149) were ceramic fracture (6.7%), secondary caries (4.7%), endodontic complication (2.7%) and tooth fracture (1.3%) compared to CGPCs (n = 147) with endodontic complication (8.8%), secondary caries (4.8%) and decementation (2.0%). Endodontically treated teeth restored with CIO or CGPC revealed significantly less often success compared with corresponding vital teeth (p = .02). CIOs and CGPCs revealed clinically and radiographically good and excellent qualities with 71.8% (107/149) and 68% (100/147) without any significant differences regarding type of restoration. CONCLUSIONS: Both CIOs and CGPCs achieved high survival rates up to 24.8 years when performed by supervised undergraduate students. The longevity of the restorations may benefit from the intraoral repair of accessible defects and, in case of pulp infection or necrosis, an adequate endodontic management. CLINICAL RELEVANCE: CIOs and CGPCs made by supervised undergraduate students are proper restoration types in posterior teeth in the long-term. An adequate preparation design, meticulous care in the inserting technique and constant biofilm removal due to proper oral hygiene combined with professional maintenance care are substantial. The clinical long-term performance was mostly limited by ceramic fractures in CIOs and endodontic complications in CGPCs.

A data-driven approach for the partial reconstruction of individual human molar teeth using generative deep learning.

Background and objective: Due to the high prevalence of dental caries, fixed dental restorations are regularly required to restore compromised teeth or replace missing teeth while retaining function and aesthetic appearance. The fabrication of dental restorations, however, remains challenging due to the complexity of the human masticatory system as well as the unique morphology of each individual dentition. Adaptation and reworking are frequently required during the insertion of fixed dental prostheses (FDPs), which increase cost and treatment time. This article proposes a data-driven approach for the partial reconstruction of occlusal surfaces based on a data set that comprises 92 3D mesh files of full dental crown restorations. Methods: A Generative Adversarial Network (GAN) is considered for the given task in view of its ability to represent extensive data sets in an unsupervised manner with a wide variety of applications. Having demonstrated good capabilities in terms of image quality and training stability, StyleGAN-2 has been chosen as the main network for generating the occlusal surfaces. A 2D projection method is proposed in order to generate 2D representations of the provided 3D tooth data set for integration with the StyleGAN architecture. The reconstruction capabilities of the trained network are demonstrated by means of 4 common inlay types using a Bayesian Image Reconstruction method. This involves pre-processing the data in order to extract the necessary information of the tooth preparations required for the used method as well as the modification of the initial reconstruction loss. Results: The reconstruction process yields satisfactory visual and quantitative results for all preparations with a root mean square error (RMSE) ranging from 0.02 mm to 0.18 mm. When compared against a clinical procedure for CAD inlay fabrication, the group of dentists preferred the GAN-based restorations for 3 of the total 4 inlay geometries. Conclusions: This article shows the effectiveness of the StyleGAN architecture with a downstream optimization process for the reconstruction of 4 different inlay geometries. The independence of the reconstruction process and the initial training of the GAN enables the application of the method for arbitrary inlay geometries without time-consuming retraining of the GAN.

Minimum 15-Year Survival of a Biconvex Inlay Patellar Component in Primary Total Knee Arthroplasty: An Analysis of 2,530 Total Knee Arthroplasties From a Single Institution.

BACKGROUND: Routine patellar resurfacing during primary total knee arthroplasty (TKA) remains controversial. To our knowledge, there are no studies reporting the long-term performance of a cemented biconvex all-polyethylene inlay component implanted at the time of primary TKA. The purpose of this study was to examine the 15-year survivorship and long-term clinical outcomes of this biconvex inlay patella used at our institution. METHODS: We retrospectively reviewed our prospectively collected institutional database and identified 2,530 patients who underwent cemented TKA with a single prosthetic design (from 1996 to 2007) where the patella was resurfaced using this cemented biconvex inlay patella. The mean age at surgery was 68 years (range, 29 to 93). The mean body mass index was 33.0 (range, 16.4 to 76.3), with 61.9% women. At the time of analysis, the mean time from surgery was 20.4 years (range, 15 to 26). We used Kaplan-Meier analysis to calculate survivorship at 15 years. We analyzed clinical outcomes using 3 patient-reported outcome measures collected prospectively. RESULTS: The 15-year survivorship with revision surgery for all causes as the end point was 97.1% (95% confidence interval 96.1 to 98.1%). The 15-year survivorship with revision surgery for a patella-related complication as the end point was 99.7% (95% confidence interval 99.4 to 1.0). At the final follow-up, patients showed significant improvement in scores for the Knee Society Clinical Rating System (P < .001), Western Ontario and McMaster University Osteoarthritis Index (P < .001), and Veterans Rand 12-Item Health Survey physical component (P < .001). CONCLUSIONS: Routine patellar resurfacing using a biconvex inlay patellar component has excellent survivorship and a low rate of complications at 15 years post-TKA.

Reverse shoulder arthroplasty for patients with cuff tear arthropathy: do clinical outcomes differ by inlay vs. onlay design?

BACKGROUND: The influence of position of the humeral tray (inlay or onlay) on clinical outcomes in reverse shoulder arthroplasty (RSA) is a topic of debate. The purpose of this study was to compare clinical and radiographic outcomes of patients with cuff tear arthropathy treated with RSA systems with inlay or onlay humeral tray design, similar neck-shaft angles, and lateralized glenospheres. METHODS: This was a retrospective study of prospectively obtained data from 1 tertiary care center. We identified all patients who underwent primary RSA between 2009 and 2017 (N = 511). We included 102 patients with diagnosed cuff tear arthropathy treated with RSA prostheses with a lateralized glenosphere and 135° neck-shaft angle (with either an inlay or onlay humeral tray design) who had a minimum of 2 years of follow-up (mean, 44 months; range, 24-125 months). Sixty-three patients (62%) had an inlay humeral tray (inlay group) and 39 (38%) had an onlay tray (onlay group). All patients underwent preoperative and postoperative evaluations, including measures of patient-reported outcomes (PROs), shoulder range of motion (ROM) testing, and radiographic imaging. Clinical relevance of changes in PROs and ROM was evaluated using published values for minimal clinically important differences. RESULTS: The 2 groups did not differ by demographic characteristics except for a higher proportion of women in the inlay group (75%) than in the onlay group (56%) (P = .04). Preoperative PROs and ROM were not significantly different between groups. At final follow-up, PROs and ROM were not different between groups in terms of statistical significance or clinical relevance. We found no significant differences in the rate of baseplate loosening (inlay, 3.2% vs. onlay, 5.1%, P = .63), revision surgery (inlay, 0% vs. onlay 5.1%, P = .07), acromial stress fracture (inlay, 3.2% vs. onlay, 5.1%, P = .63), prosthesis dislocation (inlay, 0% vs. onlay, 2.6%, P = .20), or scapular notching (inlay, 21% vs. onlay, 7.7%, P = .08). CONCLUSION: At 2-year minimum follow-up, the position of the humeral tray in RSA prostheses (either inlay or onlay) for cuff tear arthropathy was not associated with PROs, shoulder ROM, or rates of complications, including baseplate loosening, acromial stress fracture, and scapular notching.

The Evaluation of the Cervical Marginal Sealing of Direct vs. Indirect Composite Resin Restorations in MOD Cavities.

INTRODUCTION: The aim of this in vitro study was to compare the quality of marginal sealing at the cervical margins of indirect and direct composite resin restorations in mesio-occluso-distal (MOD) cavities. MATERIAL AND METHOD: MOD preparations were performed on 30 extracted teeth. The mesial cervical margin of each tooth was relocated using a flow composite resin (Enamel Plus HRi Flow, Micerium, Avegno, GE, Italy), then the samples were divided into three groups. In group A, the cavities were directly restored using a nanohybrid composite resin (Miris 2 Coltène Whaledent, Altstaetten, Switzerland) and a universal adhesive (ScotchBond Universal, 3M ESPE, St. Paul, MN, USA) by the etch-and-rinse strategy, for group B, the restoration procedure was similar but the self-etch strategy was used, and the samples in group C were filled using the inlay technique. Each sample was stored for 48 h in a 2% methylene blue solution, then it was cut in a mesio-distal direction using a Struers Secotom 50 device (Cleveland, OH, USA). The marginal sealing and adhesive interface were assessed for each sample at the cervical margin by optical microscopy (OM) and scanning electron microscopy (SEM). One-way ANOVA and Bonferroni post-hoc tests were used with a significance level of 0.05. RESULTS: Significant differences were recorded within groups A and C, between mesial and distal margins (p = 0.02 in group A and p = 0.043 in group C). CONCLUSIONS: The marginal sealing is more effective in MOD inlay restoration compared to direct restorations. Relocation of the cervical margin with flow composite resin and the use of different adhesive strategies do not improve the marginal sealing.

Personalized Resurfacing for Osteochondral Lesions of the Talus.

Osteochondral lesions of the talus (OLTs) are the most common cause of chronic deep ankle pain. Joint-preserving surgeries include bone marrow stimulating, chondral transporting, and cellular-based procedures. Each procedure has its advantages and disadvantages. For that reason, a focal metallic inlay was developed as a bridge between biologics and conventional joint arthroplasty. Despite promising initial results, prefabricated implants are associated with unpredictable results. This article describes a novel customized patient-specific metal inlay as a treatment option for OLTs.

Comparison of 3 Different Surgical Techniques for Rotator Cuff Repair in a Rabbit Model: Direct Suture, Inlay Suture, and Polyether Ether Ketone (PEEK) Suture Anchor.

BACKGROUND: Rotator cuff tears have been repaired using the transosseous method for decades. The direct suture (DS) technique has been widely used for rotator cuff tears; however, the retear rate is relatively high. Suture anchors are now used frequently for rotator cuff repair (RCR) in accordance with recent developments in materials. However, polyether ether ketone (PEEK) may still cause complications such as the formation of cysts and osteophytes. Some studies have developed the inlay suture (IS) technique for RCR. PURPOSE/HYPOTHESIS: To compare how 3 different surgical techniques-namely, the DS, IS, and PEEK suture anchor (PSA)-affect tendon-bone healing after RCR. We hypothesized that the IS technique would lead to better tendon-to-bone healing and that the repaired structure would be similar to the normal enthesis. STUDY DESIGN: Controlled laboratory study. METHODS: Acute infraspinatus tendon tears were created in 36 six-month-old male rabbits, which were divided into 3 groups based on the technique used for RCR: DS, IS, and PSA. Animals were euthanized at 6 and 12 weeks postoperatively and underwent a histological assessment and imaging. The expression of related proteins was demonstrated by immunohistochemistry and immunofluorescence staining. Mechanical properties were evaluated by biomechanical testing. RESULTS: At 12 weeks, regeneration of the enthesis was observed in the 3 groups. However, the DS group showed a lower type I collagen content than the PSA and IS groups, which was similar to the results for scleraxis. The DS group displayed a significantly inferior type II collagen expression and proteoglycan deposition after safranin O/fast green and sirius red staining. With regard to runt-related transcription factor 2 and alkaline phosphatase, the IS group showed upregulated expression levels compared with the other 2 groups. CONCLUSION: Compared with the DS technique, the PSA and IS techniques contributed to the improved maturation of tendons and fibrocartilage regeneration, while the IS technique particularly promoted osteogenesis at the enthesis. CLINICAL RELEVANCE: The IS and PSA techniques may be more beneficial for tendon-bone healing after RCR.

Anatomic total shoulder arthroplasty with inlay glenoid component: A systematic review.

Background: A total shoulder arthroplasty (TSA) system utilizing an inlay glenoid component has been proposed as a means of reducing glenoid component loosening while still providing patients with desirable functional and clinical outcomes. The purpose of this study was to systematically review current outcomes literature on TSA using an inlay glenoid component. Methods: A literature search was conducted using PubMed/MEDLINE, Cochrane Database of Systematic Reviews, and Web of Science databases. Studies comparing pre- and postoperative functional and clinical outcomes were included. Results: Five studies with 148 shoulders (133 patients) were included. Patient-reported outcomes improved, including the American Shoulder and Elbow Surgeons score (mean change 34.1 to 80.6), Penn Shoulder Score (mean change 43.3 to 85.5), Single Assessment Numeric Evaluation score (mean change 34.1 to 80.6), and visual analog scale-pain (mean change 6.9 to 1.6). Range of motion improved for forward elevation (mean change 109.6 to 156.2) and external rotation (mean change 21.5 to 50.8). Glenoid component loosening occurred in one shoulder (0.68%). Two revision surgeries (1.35%) were performed. Discussion: The use of an inlay glenoid component is associated with improvements in postoperative pain, function, and satisfaction while minimizing rates of glenoid component loosening and the need for revision surgery over short-term follow-up. Level of evidence: systematic review, level IV.

Myringoplasty - A Rewiev of 438 Cases.

The medical records of 438 patients who underwent myringoplasty followed up for a minimum of one year in the period of 1980 and 2015 were revised. Examination under otomicroscope was done of the ear to be operated. This was carried out with a speculum under the operating microscope to be reliably asses the tympanic membrane, site of perforation, to rule out any other pathology and assess the status of ossicular chain. All the patients submitted primary myringoplasty surgery were operated under postauricular, endaural and transcanal approach with overlay, underlay and inlay methods. In the study the patients were divided into three groups depending upon the technique utilized to repair the tympanic membrane. When we compared overlay technique group with underlay technique group, it was observed that overlay technique was no statistically significant difference between these three groups in term of age wise distribution, gender wise distribution, duration of disease and cause of disease, due to matching at the time of selection. In this study the outcome in terms of graft uptake rate was slight better in the overlay technique (94%) as compared to the underlay technique (86.2%), though the difference was statistically insignificant, P>0.05. Patients selection may have had a role in the high success rate in the present study as patients presenting with middle ear pathology were excluded. The complications rate in the present study was quite low, no case in inlay group, three cases of graft lateralization in underlay group, and 19 cases in overlay group. In this study, better results were achieved with overlay technique may probably be due to less surgical manipulation and faster healing process.

Reverse shoulder arthroplasty design-inlay vs. onlay: does it really make a difference?

BACKGROUND: The design of reverse shoulder arthroplasty (RSA) implants has evolved significantly over the past 50 years. Today there are many options available that differ in design of the glenoid and humeral components, fixation methods, sizes, and modularity. With respect to the humeral component, the literature has generally focused on the differences between inlay and onlay designs and the potential impact on outcomes. However, inlay and onlay design represents only one factor of many. METHODS: It is our hypothesis that separating onlay and inlay designs into 2 distinct entities is an oversimplification as there can be a wide overlap of the 2 designs, depending on surgical technique and the implant selected. As such, the differences between inlay and onlay designs should be measured in absolute terms-meaning combined distalization and lateralization. RESULTS: By reviewing the many factors that can contribute to the glenosphere-humerus relationship, the role of inlay and onlay humeral designs as an important distinguishing feature is shown to be limited. Preliminary studies suggest that the amount of distalization and lateralization of the construct may be the most accurate method of describing the differences in the constructs. CONCLUSIONS: Inlay and onlay humeral component design represents only one factor of many that may impact outcomes. A more accurate method of defining specific design and technique factors in RSA is the degree of lateralization and distalization.

[Dealing with early complications in unicondylar knee arthroplasty-what works, what does not?] / Umgang mit Frühkomplikationen in der unikondylären Knieprothetik ­ Was funktioniert, was nicht?

Complications in the early postoperative period following the implantation of a unicondylar knee arthroplasty (UKA) are both rare and rarely described in the literature. Often, only small case series or individual case reports are available. In this article, the most common complications of periprosthetic infection, periprosthetic tibial fracture, inlay dislocation and intra-articular cement residue in (loose bone cement body) are described and recommendations for conservative and surgical treatment are presented, including case examples. Ideally, surgical errors or an infection should be recognized at an early stage and revised as soon as possible.