Sample records for obturator internus pyomyositis

  1. Obturator internus pyomyositis manifested as sciatica in a patient with subacute bacterial endocarditis: A rare case report.

    PubMed

    Hsu, Wei-Ching; Hsu, Jin-Yi; Chen, Michael Yu-Chih; Liang, Chung-Chao

    2016-07-01

    Pyomyositis is a pyogenic infection of the skeletal muscles causing myalgia and fever in patients. Hematogenous seeding engendered by persistent bacteremia and septic embolism is usually the underlying cause of the disease. Trauma, intravenous drug use, and immunodeficiency are the main predisposing factors.Obturator internus pyomyositis with sciatica has not previously been reported. We report a rare case of a patient with subacute bacterial endocarditis presenting with left buttock pain and sciatica.Computed tomography confirmed the diagnosis of obturator internus pyomyositis. The patient was discharged uneventfully after successful antibiotic treatment.The mortality rate of patients who have pyomyositis comorbid with another condition or disease is extremely high. Early diagnosis and aggressive management are imperative.

  2. Primary obturator externus pyomyositis in a child presenting as hip pain: a case report.

    PubMed

    Kumar, Abhishek; Anderson, David

    2008-02-01

    Hip pain in children often poses a diagnostic dilemma. Septic arthritis, Perthes disease, and slipped capital femoral epiphysis are among the most important causes. Pyomyositis involving muscles around the hip can present with similar features as septic arthritis and are difficult to diagnose because of their rarity and indolent presentation. Obturator internus and iliopsoas muscle abscess have been most commonly reported, with only 1 such report on isolated obturator externus muscle abscess. Routine laboratory investigations are nonspecific, and the diagnosis rests on imaging modalities. Magnetic resonance scan is the most useful investigation in the diagnosis and can pick up early changes in the muscle. Treatment involves appropriate antibiotic therapy with or without drainage. Most cases resolve completely. We report here a case of isolated obturator externus muscle abscess in an 11-year-old child illustrating the similarities with septic arthritis of hip and problems encountered during diagnosis and management.

  3. Successful Treatment of Gluteal Pain from Obturator Internus Tendinitis and Bursitis with Ultrasound-Guided Injection.

    PubMed

    Chen, Boqing; Rispoli, Leia; Stitik, Todd; Leong, Michelle

    2017-10-01

    This case report describes what the authors believe is the first case of a patient with obturator internus tendinitis and bursitis successfully treated with a corticosteroid injection using a trans-tendinous lateral to medial approach. The patient presented with right gluteal pain not relieved by physical therapy or right hip and ischial bursa corticosteroid injections. Pelvic and lumbar spine MRIs and EMG/NCS findings were unremarkable. Physical examination demonstrated tenderness to palpation at the right middle lower gluteal region. Ultrasound imaging with sonopalpation identified the maximal local tender point as the right obturator internus muscle and/or its underlying bursa. A 22-gauge 3.5-inch needle was inserted in-plane to the transducer and longitudinal to the obturator internus from a lateral to medial direction, an approach previously described in cadavers. The obturator internus tendon sheath and bursa were injected with 2.5 ml of 0.5% lidocaine combined with 10 mg of triamcinolone. The patient reported immediate complete relief of pain with continued relief at 2 and 6 months post-injection. This case report demonstrates an injection of the obturator internus tendon sheath and bursa using a trans-tendinous approach, which may be successful for treatment of patients presenting with persistent gluteal pain from obturator internus tendinitis and bursitis.

  4. Obturator externus was larger, while obturator internus size was similar in ballet dancers compared to nondancing athletes.

    PubMed

    Mayes, Susan; Ferris, April-Rose; Smith, Peter; Cook, Jill

    2018-06-02

    To compare the cross-sectional area (CSA) of hip external rotators, obturator externus (OE) and obturator internus (OI), in ballet dancers and nondancing athletes, and evaluate the relationship between obturator muscle size and hip pain. Case-control study. Elite ballet and sport. 33 male and female professional ballet dancers and 33 age and sex-matched athletes. CSA's of OE and OI measured on magnetic resonance imaging (MRI) of one hip. Hip pain was scored with the Copenhagen Hip and Groin Outcome Score (HAGOS): HAGOS pain score of 100 was defined as no pain and a score less than 100 was defined as pain. Participants weight and height. Estimated marginal mean CSA of OE was 14% larger in dancers than athletes (p = 0.01, ηp2 = 0.1); the size of OI was similar (p > 0.05). Men and women in both groups had similar sized OI and OE. There was no interaction between the estimated marginal mean CSA of either obturator and hip pain. It appears that ballet selectively increases muscle size of OE, but not OI. Obturator size was not related to mild hip pain, as OE and OI size was similar in dancers and athletes with and without pain. Copyright © 2018. Published by Elsevier Ltd.

  5. Injuries of the obturator muscles in professional soccer players.

    PubMed

    Wong-On, Manuel; Turmo-Garuz, Antonio; Arriaza, Rafael; Gonzalez de Suso, Jose Manuel; Til-Perez, Luis; Yanguas-Leite, Xavier; Diaz-Cueli, David; Gasol-Santa, Xavier

    2017-02-10

    Obturator externus and internus muscular tears are uncommon injuries. Only a few case reports exist, mainly in high-level athletes. Our aim is to describe a series of obturator externus and internus muscular tears in professional soccer players. Injury data from four teams from the First Division of the Spanish Soccer League were collected over a total of four seasons. Any soccer player who sustained an injury to either the obturator externus or internus identified on magnetic resonance (MRI) was included. All injured players were treated non-operatively with a goal of returning to play as fast as possible. Sixteen players sustained injuries to the obturator externus and internus during matches or training sessions. The main complaint was anterior hip pain with a physical examination showing pain during internal rotation or external rotation of the flexed hip. The MRI documented 12 muscular tears of the obturator externus, and 4 muscular tears of the obturator internus. All injuries were treated conservatively based on physical therapy, analgesic medications, and underwent a symptoms-based rehabilitation protocol. Mean return to play was 11.5  ±  8.8 days. Although uncommon, tears of the obturator externus and internus occur in professional soccer players. The MRI scan was essential to the location, classification, and evaluation of the injury size. The clinical relevance of our investigation is based on the relatively benign prognosis of these injuries. IV.

  6. Primary pyomyositis of the pelvis in children: a retrospective review of 8 cases.

    PubMed

    Bertrand, Styles L; Lincoln, Eric D; Prohaska, Matthew G

    2011-12-06

    Primary pyomyositis of the pelvic musculature is a condition rarely seen in temperate climates, although its frequency has been increasing in the United States. The condition should be considered in the initial differential diagnosis of an adolescent presenting with fever, difficulty ambulating, and hip pain. This is a retrospective review of 8 cases of primary pelvic pyomyositis in patients aged 18 years or younger who were treated at the Children's Medical Center in Augusta, Georgia. The site of infection was the obturator internus in the majority of the cases (5). The site was the gluteus, iliopsoas, and iliacus in 1 case each. Four patients who were diagnosed early responded to intravenous antibiotics with no need for further intervention. Two patients required incision and drainage of an abscess combined with antibiotics. Two patients had prolonged hospital courses requiring intensive unit care and mechanical ventilation. Blood cultures were positive in 87.5% of patients, and all patients presented with elevated acute phase reactants. One of the most difficult diagnostic aspects of presentation is an inconclusive symptom profile. It is noteworthy that patients with pelvic pyomyositis may present with limited range of motion in a specific plane (the motion placing the infected muscle on stretch) vs global limited range of motion of the joint as is commonly seen in septic arthritis. Early diagnosis is essential to prevent systemic illness and complications associated with this condition. Magnetic resonance imaging with gadolinium is helpful to diagnose and guide treatment. Copyright © 2011, SLACK Incorporated.

  7. Gemelli-obturator complex in the deep gluteal space: an anatomic and dynamic study.

    PubMed

    Balius, Ramon; Susín, Antonio; Morros, Carles; Pujol, Montse; Pérez-Cuenca, Dolores; Sala-Blanch, Xavier

    2018-06-01

    To investigate the behavior of the sciatic nerve during hip rotation at subgluteal space. Sonographic examination (high-resolution ultrasound machine at 5.0-14 MHZ) of the gemelli-obturator internus complex following two approaches: (1) a study on cadavers and (2) a study on healthy volunteers. The cadavers were examined in pronation, pelvis-fixed position by forcing internal and external rotations of the hip with the knee in 90° flexion. Healthy volunteers were examined during passive internal and external hip rotation (prone position; lumbar and pelvic regions fixed). Subjects with a history of major trauma, surgery or pathologies affecting the examined regions were excluded. The analysis included eight hemipelvis from six fresh cadavers and 31 healthy volunteers. The anatomical study revealed the presence of connective tissue attaching the sciatic nerve to the structures of the gemellus-obturator system at deep subgluteal space. The amplitude of the nerve curvature during rotating position was significantly greater than during resting position. During passive internal rotation, the sciatic nerve of both cadavers and healthy volunteers transformed from a straight structure to a curved structure tethered at two points as the tendon of the obturator internus contracted downwards. Conversely, external hip rotation caused the nerve to relax. Anatomically, the sciatic nerve is closely related to the gemelli-obturator internus complex. This relationship results in a reproducible dynamic behavior of the sciatic nerve during passive hip rotation, which may contribute to explain the pathological mechanisms of the obturator internal gemellus syndrome.

  8. Obturator internus muscle autotransfer: a new concept for the treatment of anismus. Clinical experience.

    PubMed

    Farag, A

    1997-01-01

    In this study 20 patients suffering from chronic constipation due to spastic anal sphincters were operated upon using a new surgical technique. The technique aimed at constructing an active anal dilator mechanism using the obturator internus muscles mobilized from both sides and sutured to the side wall of the anal canal in order to overcome the spastic anal sphincters during defaecation. This series included 3 failures (15%), 16 successful cases (80%), and 1 dissatisfied patient despite normal postoperative investigations (5%). Eleven patients (55%) showed immediate postoperative normalization of their defaecation. Five patients (25%) showed normalization of their defaecation after 10 sessions of electric stimulation of the transposed muscles given 1 month postoperatively for 10 successive days. All the successful cases (16 patients) maintained their good results during the period of follow-up which ranged from 16 to 45 months (average = 30.31 months). For the successful cases, follow-up was from 16 to 42 months (average = 26.72 months). Immediate postoperative complications included 3 cases of wound infection and 2 cases of transient incontinence to gases which responded completely to postoperative Faradic stimulation. No cases of persistent incontinence of any degree were detected among the 20 patients studied. The 3 failures were mainly due to avoidable technical problems. The technique was safe, easy, and physiological, using a strictly perineal approach.

  9. Obturator externus abscess in a 9-year-old child: A case report and literature review.

    PubMed

    de Bodman, Charlotte; Ceroni, Dimitri; Dufour, Justine; Crisinel, Pierre-Alex; Bregou-Bourgeois, Aline; Zambelli, Pierre-Yves

    2017-03-01

    Obturator pyomyositis is a rare condition in children. Diagnosis is often delayed because of its rarity, and the vagaries of its presentation cause it to be easily be missed. Physicians should therefore familiarize themselves with this condition and consider it as a possible differential diagnosis in patients presenting with an acutely painful hip. Inflammatory syndrome is also frequent among sufferers and the MRI is a very sensitive diagnostic tool for obturator pyomyositis. Additionally, joint fluid aspirations and blood cultures are also useful in identifying the pathogen. The appropriate antibiotic therapy provides a rapid regression of symptoms during the early stage of pyomyositis. In cases of MRI-confirmed abscess, surgical treatment is indicated. Our report focuses on a case of obturator pyomyositis in a 9-year-old boy. The child was febrile for 5 days and could only manage to walk a few steps. His hip range of motion was restricted in all directions. In addition, the patient had presented pain and swelling of his right elbow for a day, with a restriction of motion in the joint. There was a clear inflammatory syndrome. A diagnosis of hip and elbow septic arthritis was suspected, and the child underwent joint aspiration of the both cited joints. The aspiration of the elbow returned pus. Conversely, no effusion was found in the hip aspiration. The administration of empiric intravenous antibiotherapy was started. An MRI revealed an osteomyelitis of the ischio-pubic area associated with a subperiosteal abscess. Subsequently, 3 days after elbow arthrotomy, a surgical treatment was performed on the patient's right hip in order to evacuate the subperiosteal abscess and muscular collection because of the persistence of the patient's symptoms and inflammatory syndrome despite susceptible intravenous antibiotics. Postsurgery the patient showed steady improvement. Such cases demonstrate how diagnosis can be difficult because pelvic pyomyositis is often mistaken for

  10. Escherichia coli pyomyositis in an immunocompromised host.

    PubMed

    Sharma, Umesh; Schwan, William R; Agger, William A

    2011-08-01

    Pyomyositis due to Escherichia coli (E. coil) is rarely reported in immunocompromised patients with hematological malignancy. We present a case report of a 34-year-old man who developed E. coli pyomyositis as a complication of acute myelogenous leukemia (AML). Magnetic resonance imaging (MRI) of the right hip suggested myofascial infection of the gluteal muscles, and a needle muscle aspiration grew E. coli phylogenetic group B2. The patient responded to intravenous piperacillin/tazobactam followed by prolonged oral levofloxacin. Pyomyositis should be suspected in all immunocompromised patients complaining of muscle pain and may exhibit signs of localized muscle infection. Appropriate antibiotic therapy targeting fluoroquinolone-resistant E. coli should be considered for initial empiric therapy of pyomyositis in immunocompromised patients.

  11. Escherichia coli Pyomyositis in an Immunocompromised Host

    PubMed Central

    Sharma, Umesh; Schwan, William R.; Agger, William A.

    2015-01-01

    Background Pyomyositis due to Escherichia coli (E. coli) is rarely reported in immunocompromised patients with hematological malignancy. Case Report We present a case report of a 34-year-old man who developed E. coli pyomyositis as a complication of acute myelogenous leukemia (AML). Magnetic resonance imaging (MRI) of the right hip suggested myofascial infection of the gluteal muscles, and a needle muscle aspiration grew E. coli phylogenetic group B2. The patient responded to intravenous piperacillin/tazobactam followed by prolonged oral levofloxacin. Conclusion Pyomyositis should be suspected in all immunocompromised patients complaining of muscle pain and may exhibit signs of localized muscle infection. Appropriate antibiotic therapy targeting fluoroquinolone-resistant E. coli should be considered for initial empiric therapy of pyomyositis in immunocompromised patients. PMID:22413629

  12. Pyomyositis of tensor fascia lata: a case report

    PubMed Central

    Ozkan, Korhan; Unay, Koray; Ugutmen, Ender; Eren, Abdullah; Eceviz, Engin; Saygý, Baransel

    2008-01-01

    Introduction Pyomyositis is a disease in which an abscess is formed deep within large striated muscles. Case presentation We report the case of a 10-year-old boy who presented with fever and a painful hip and was subsequently diagnosed with pyomyositis of the tensor fascia lata. In children with clinical and laboratory findings of inflammation in the vicinity of the hip joint, the differential diagnosis includes transient synovitis, an early stage of Legg-Calvé-Perthes disease, infectious arthritis of the hip, rheumatologic diseases and extracapsular infection such as osteomyelitis. Conclusion To the best of the authors' knowledge, this is the first report of pyomyositis of the tensor fascia lata. Although pyomyositis is a rare disease and the differential diagnosis includes a variety of other commonly observed diseases, pyomyositis should be considered in cases where children present with fever, leukocytosis and localized pain. PMID:18652647

  13. Pyomyositis in childhood-systemic lupus erythematosus.

    PubMed

    Blay, Gabriela; Ferriani, Mariana P L; Buscatti, Izabel M; França, Camila M P; Campos, Lucia M A; Silva, Clovis A

    2016-01-01

    Pyomyositis is a pyogenic infection of skeletal muscle that arises from hematogenous spread and usually presents with localized abscess. This muscle infection has been rarely reported in adult-onset systemic lupus erythematous and, to the best of our knowledge, has not been diagnosed in pediatric lupus population. Among our childhood-onset systemic lupus erythematous population, including 289 patients, one presented pyomyositis. This patient was diagnosed with childhood-onset systemic lupus erythematous at the age of 10 years-old. After six years, while being treated with prednisone, azathioprine and hydroxychloroquine, she was hospitalized due to a 30-day history of insidious pain in the left thigh and no apparent trauma or fever were reported. Her physical examination showed muscle tenderness and woody induration. Laboratory tests revealed anemia, increased acute phase reactants and normal muscle enzymes. Computer tomography of the left thigh showed collection on the middle third of the vastus intermedius, suggesting purulent stage of pyomyositis. Treatment with broad-spectrum antibiotic was initiated, leading to a complete clinical resolution. In conclusion, we described the first case of pyomyositis during childhood in pediatric lupus population. This report reinforces that the presence of localized muscle pain in immunocompromised patients, even without elevation of muscle enzymes, should raise the suspicion of pyomyositis. A prompt antibiotic therapy is strongly recommended. Copyright © 2013 Elsevier Editora Ltda. All rights reserved.

  14. Pyomyositis of the thigh due to Prevotella melaninogenica.

    PubMed

    Odeh, M; Oliven, A; Potasman, I; Solomon, H; Srugo, I

    2000-01-01

    Pyomyositis is an uncommon infection in temperate climates, however, it is being more frequently reported among patients with diabetes or malignancy, or those who are immunocompromised. It is predominantly caused by Staphylococcus aureus, and rarely by Bacteroides species. Pyomyositis due to Prevotella melaninogenica has not previously been reported. We describe an elderly patient with pyomyositis of the thigh due to P. melaninogenica which was successfully treated by surgical incision and drainage in combination with metronidazole therapy.

  15. Abdominal rectus muscle pyomyositis: Report of a case and review of the literature

    PubMed Central

    Fountoukis, Tilemachos; Tsatsanidis, Nikolaos; Tilkeridou, Maria; Konstantinou, Ioannis; Fytas, Pantelis; Skandalos, Ioannis

    2018-01-01

    Pyomyositis is an uncommon primary bacterial infection of skeletal muscles, usually caused by Staphylococcus aureus. Predisposing factors for pyomyositis include immunodeficiency, trauma, injection drug use, concurrent infection and malnutrition. The diagnosis, staging of the disease and differential diagnosis are established by ultrasound, CT and MRI. Treatment involves surgical drainage and antibiotic therapy. We report a case of abdominal rectus muscle pyomyositis, which constitutes, as far as we know, the second reported in bibliography, while Prevotella disiens is firstly reported as causative agent. PMID:29721242

  16. Salmonella pyomyositis complicating sickle cell anemia: a case report

    PubMed Central

    2010-01-01

    Introduction Pyomyositis is a bacterial infection of skeletal muscle and a rare complication of sickle cell anemia. It may present a difficult problem in diagnosis, leading to delay in appropriate treatment and development of complications including abscess formation and osteomyelitis. Case presentation We report the case of a 44-year-old Afro-Caribbean woman with homozygous sickle cell disease who presented with chest crisis and later developed pyomyositis of her hip and pelvic muscles. Salmonella agbeni was isolated from blood cultures and magnetic resonance imaging confirmed the diagnosis in this case. It is noteworthy of this case that there were no antecedent signs of gastroenteritis. Drainage was not appropriate and she was treated with intravenous antibiotics for six weeks. Conclusions Focal Salmonella infections are uncommon in soft tissue. Pyomyositis should be considered in patients with sickle cell anemia that continue to have muscle pain and high fevers, despite initial management of their sickle cell crisis. Radiological imaging, particularly magnetic resonance imaging, is a crucial tool in establishing the diagnosis. PMID:20591146

  17. Anatomy of the obturator region: relations to a trans-obturator sling.

    PubMed

    Whiteside, James L; Walters, Mark D

    2004-01-01

    Our objective was to determine the relationships between a trans-obturator sling and anatomic structures within the obturator region. The obturator regions of six cadavers were dissected and distances from the mid-point of the ischiopubic ramus to the muscles, nerves, and vessels of the region were measured. A trans-obturator sling was placed and distances from the device to the same anatomic structures were determined. Four additional cadavers were dissected to determine the device route of passage. The obturator canal is on average 4.4 cm from the midpoint of the ischiopubic rami. The trans-obturator sling passes on average 2.4 cm inferior-medial to the obturator canal. The anterior and posterior divisions of the obturator nerve are on average 3.4 and 2.8 cm, respectively, from a passed trans-obturator device. The device passed on average 1.1 cm from the most medial branch of the obturator vessels. Vascular and nerve structures are within 1-3 cm of the path of any device passed through the obturator foramen. A trans-obturator sling risks injury to these structures, although the small caliber of the vessels and the confined space in which they would bleed make the consequences of injury uncertain.

  18. Streptococcus pyomyositis occurring in a patient with dermatomyositis in a country with temperate climate.

    PubMed

    Soriano, E R; Barcan, L; Clara, L; Imamura, P; Catoggio, L J

    1992-08-01

    We describe a man in whom pyomyositis developed in a temperate climate. Three facts make this case unique. First the pyomyositis developed in someone with underlying dermatomyositis, this being the second reported case to our knowledge. Second, the organism involved was a Streptococcus and not a Staphylococcus as in most cases described, and the course of the disease was acute and not subacute as is usually reported. Finally, contrary to most described cases, surgical drainage was not necessary, probably because of the early diagnosis. Pyomyositis should be considered a possible cause of localized pain in patients with underlying inflammatory muscle disease.

  19. Pyomyositis of extraocular muscle: Case series and review of the literature

    PubMed Central

    Acharya, Ishan G; Jethani, Jitendra

    2010-01-01

    Pyomyositis is a primary acute bacterial infection usually caused by Staphylococcus aureus. Any skeletal muscle can be involved, but the thigh and trunk muscles are commonly affected. Only three cases of extraocular muscle (EOM) pyomyositis have been reported. We herein present four cases of isolated EOM pyomyositis. Three of our cases presented with acute onset of proptosis, pain, swelling and redness. One patient presented with mass in the inferior orbit for 4 months. One patient had central retinal artery occlusion on presentation. None of them had marked systemic symptoms. Computed tomography scan of all patients showed a typical hypodense rim enhancing lesion of the muscle involved. Three patients were started on intravenous antibiotics immediately on diagnosis and the pus was drained externally. Two patients underwent exploratory orbitotomy. In conclusion, it should be considered in any patient presenting with acute onset of orbital inflammation. Management consists of incision and drainage coupled with antibiotic therapy. PMID:20952842

  20. Dynamic Ultrasonography of the Deep External Rotator Musculature of the Hip: A Descriptive Study.

    PubMed

    Battaglia, Patrick J; Mattox, Ross; Haun, Daniel W; Welk, Aaron B; Kettner, Norman W

    2016-07-01

    No detailed reports exist describing the methodology of ultrasound image acquisition of the deep external rotator muscles of the hip. Because gluteal pain and sciatica are common, ultrasound may be a useful dynamic imaging adjunct in the evaluation of these patients. To describe dynamic ultrasonography of the deep external rotator muscles of the hip for diagnostic purposes. Descriptive. University radiology department. Participants (n = 25; 14 male) without gluteal pain or sciatica were enrolled (mean age 27.6 ± 4.7 years; mean body mass index 26.0 ± 4.1 kg/m(2)). Ultrasonographic cine clips oriented to the long axis of each deep external rotator muscle were captured. In addition, cine clips of the piriformis tendon and obturator internus tendon were obtained. Cine clips were analyzed approximately 1 week after completion of image acquisition independently by 2 blinded raters. A 5-point Likert scale to evaluate the diagnostic utility of the ultrasound image. The modal Likert scores for rater 1 were as follows: piriformis muscle = 4; piriformis tendon = 4; superior gemellus muscle = 3; obturator internus muscle = 4; obturator internus tendon = 4; inferior gemellus muscle = 4; quadratus femoris muscle = 4. The modal scores for rater 2 were: piriformis muscle = 4; piriformis tendon = 3; superior gemellus muscle = 4; obturator internus muscle = 3; obturator internus tendon = 4; inferior gemellus muscle = 3; quadratus femoris muscle = 4. Dynamic ultrasonography may be useful to image the hip deep external rotator musculature for diagnostic purposes and therefore aid in the evaluation of gluteal pain and sciatica. Future work should investigate the reliability and validity of ultrasonography in the evaluation of pathology of these muscles. Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  1. Function of obturator prosthesis after maxillectomy and prosthetic obturator rehabilitation.

    PubMed

    Chen, Cheng; Ren, Wenhao; Gao, Ling; Cheng, Zheng; Zhang, Linmei; Li, Shaoming; Zhi, Pro Ke-qian

    2016-01-01

    Maxillary defects are usually rehabilitated by a prosthetic obturator. This study aimed to evaluate the functioning of obturators prosthesis in patients with unilateral defects after maxillectomy. Of 49 patients, 28 underwent to maxillectomy as a result of tumor ablative surgery, and acquired unilateral maxillary defects. Evaluation of the function was performed by applying the Obturator Functional Scale (OFS). From a total of 49 patients, 28 were treated as follows: 9 with a conventional retained obturator prosthesis (COP), 11 (39%) with an enhanced retentive obturator prosthesis with stud attachment (POP) and 8 (28%) with an enhanced retentive obturator prosthesis with magnetic attachment (POM). The mean OFS score was 80. Scores on functions of speech, swallowing and chewing reached statistical significances (p<0.05) among these three subgroups. Comparing COP and MOP groups, the scores of OFS in the domains of "Speech-ability to speak in public" and "Swallowing-leakage with liquids" were significantly higher in AOP group. Comparing COP group, the scores of OFS in "Swallowing-leakage with solid" and "Chewing/eating" domains were increased significantly (p<0.05) both in MOP and AOP groups. Obturator prosthesis improves oral function of patients after maxillary defects; the retention of the obturator prosthesis enhanced by the addition of attachments showed more benefits in oral function. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  2. TVT-S in the U position--anatomical study.

    PubMed

    Hubka, Petr; Nanka, Ondrej; Martan, Alois; Grim, Milos; Zvarova, Jana; Masata, Jaromir

    2011-02-01

    The objective is to describe the anatomical position of tension-free vaginal tape Secur (TVT-S) in the U position regarding possible injury and fixation site. We placed TVT-S inserters bilaterally in 13 embalmed and five fresh frozen female bodies. After dissection, we measured distances from the obturator bundle. In embalmed bodies, the mean distance of TVT-S from the obturator bundle was 2.83 cm (standard deviation (SD) 0.87 cm) on the left, 2.92 cm (SD 1.24 cm) on the right. Perforation of the fascia of obturator internus muscle occurred in 38.5%. In fresh frozen bodies, results were fundamentally similar (p > 0.05). There is a risk of injury to the obturator bundle and urinary bladder during TVT-S; however, there is a significant risk of inserting the TVT-S inserter outside the obturator internus muscle (into the lesser pelvis). The position of TVT-S does not change significantly after legs mal-positioning.

  3. Segmentation of the Globus Pallidus Internus Using Probabilistic Diffusion Tractography for Deep Brain Stimulation Targeting in Parkinson Disease.

    PubMed

    Middlebrooks, E H; Tuna, I S; Grewal, S S; Almeida, L; Heckman, M G; Lesser, E R; Foote, K D; Okun, M S; Holanda, V M

    2018-06-01

    Although globus pallidus internus deep brain stimulation is a widely accepted treatment for Parkinson disease, there is persistent variability in outcomes that is not yet fully understood. In this pilot study, we aimed to investigate the potential role of globus pallidus internus segmentation using probabilistic tractography as a supplement to traditional targeting methods. Eleven patients undergoing globus pallidus internus deep brain stimulation were included in this retrospective analysis. Using multidirection diffusion-weighted MR imaging, we performed probabilistic tractography at all individual globus pallidus internus voxels. Each globus pallidus internus voxel was then assigned to the 1 ROI with the greatest number of propagated paths. On the basis of deep brain stimulation programming settings, the volume of tissue activated was generated for each patient using a finite element method solution. For each patient, the volume of tissue activated within each of the 10 segmented globus pallidus internus regions was calculated and examined for association with a change in the Unified Parkinson Disease Rating Scale, Part III score before and after treatment. Increasing volume of tissue activated was most strongly correlated with a change in the Unified Parkinson Disease Rating Scale, Part III score for the primary motor region (Spearman r = 0.74, P = .010), followed by the supplementary motor area/premotor cortex (Spearman r = 0.47, P = .15). In this pilot study, we assessed a novel method of segmentation of the globus pallidus internus based on probabilistic tractography as a supplement to traditional targeting methods. Our results suggest that our method may be an independent predictor of deep brain stimulation outcome, and evaluation of a larger cohort or prospective study is warranted to validate these findings. © 2018 by American Journal of Neuroradiology.

  4. [Cases of strangulated obturator hernia].

    PubMed

    Chakhvadze, B; Nakashidze, D; Kashibadze, K; Beridze, A

    2010-02-01

    Obturator hernias are extremely rare in surgical practice. Only about 600 cases are described in the world medical literature. To diagnose obturator hernia is very complicated. Hernial protrusion is not often observed. The strangulation of obturator hernia is accompanied by rapidly developing symptoms of intestinal obstruction, which is usually an indication for emergency surgery. The article analyzes two clinical cases of strangulated obturator hernia and one traumatic eventration and strangulation of small intestine in the obturator ring ruined by trauma. In all cases the indication of surgery was clinical picture of a growing intestinal obstruction or acute abdomen. Only in one case, despite the prevailing clinical picture of acute intestinal obstruction in the light of anamnesis and the accompanying neurological symptoms before the operation could be suspected strangulated obturator hernia, which was confirmed during surgery. As it was mentioned above, in doubtful cases to clarify the diagnosis should be applied other methods of examination of patients, including computed tomography.

  5. Comparative evaluation of fracture resistance of root canals obturated with four different obturating systems.

    PubMed

    Punjabi, Mansi; Dewan, Ruchika Gupta; Kochhar, Rohit

    2017-01-01

    The aim of this study is to evaluate and compare the fracture resistance of root canals obturated with four different obturating systems in endodontically treated teeth. One hundred and twenty single-rooted teeth were selected and decoronated at cementoenamel junction. Instrumentation of teeth (except control group) was done with Mtwo rotary files up to size 25/0.06 using a step-back technique. All teeth were divided into four experimental groups ( n = 25) and two control groups ( n = 10). In Group I (negative control), teeth were neither instrumented nor obturated, in Group II (positive control), instrumentation was done, but no obturation was performed, in Group III, obturation was done with cold lateral compaction technique, in Group IV, obturation was done with cold free-flow compaction technique, in Group V, obturation was done with warm vertical compaction technique, and in Group VI, obturation was done with injection-molded thermoplasticized technique. All prepared teeth were embedded in an acrylic resin block, and their fracture strength was measured using Universal Testing Machine. Statistical data were analyzed using one-way analysis of variance and Tukey's honestly significant difference test. Negative control Group I showed highest fracture resistance and positive control Group II had lowest fracture resistance. Among experimental groups, cold free-flow compaction technique with GuttaFlow2 (Group IV) showed higher fracture resistance as compared to the Group III, Group V, and Group VI. GuttaFlow2 has the potential to strengthen the endodontically treated roots to a level that is similar to that of intact teeth.

  6. Hip adductor pyomyositis from Streptococcus mitis in a four-year-old child.

    PubMed

    Buldu, Metin Tolga; Raman, Raghu

    2016-01-01

    The unique aspect of this case study is the unusual history, presentation, ultrasonography, MRI and blood culture results, which lead to the diagnosis and treatment of adductor pyomyositis with a rare organism in a temperate country. The patient presented with a one-day history of malaise, fever, left groin pain and inability to weight bear on the left leg. There was no history of any trauma, predisposing infections or recent travel. Plain radiograph and ultrasound of the hip was normal with no effusion. Two consecutive blood cultures suggested Streptococcus mitis bacteraemia and MRI scan confirmed pyomyositis of the left hip adductors that was too small to drain. S. mitis is a normal commensal organism however it can lead to opportunistic infections particularly endocarditis. Echocardiogram revealed no cardiac complications, in particular no endocarditic vegetation. Patient was treated with intravenous benzylpenicillin for a week followed by oral phenoxymethylpenicillin for a week. Adductor pyomyositis must be considered as a differential diagnosis in a child with unusual presentation of hip pain. When an ultrasound is normal, MRI scan is warranted to confirm diagnosis. Septic screen should include blood cultures. The commonest causative organisms are the Staphylococcus family. However if S. mitis is isolated, cardiac sources of infection resulting in septic emboli must be investigated. Repeated MRI scans are required particularly if the patient does not respond to medical management. IV.

  7. Comparative evaluation of fracture resistance of root canals obturated with four different obturating systems

    PubMed Central

    Punjabi, Mansi; Dewan, Ruchika Gupta; Kochhar, Rohit

    2017-01-01

    Aim and Objectives: The aim of this study is to evaluate and compare the fracture resistance of root canals obturated with four different obturating systems in endodontically treated teeth. Materials and Methods: One hundred and twenty single-rooted teeth were selected and decoronated at cementoenamel junction. Instrumentation of teeth (except control group) was done with Mtwo rotary files up to size 25/0.06 using a step-back technique. All teeth were divided into four experimental groups (n = 25) and two control groups (n = 10). In Group I (negative control), teeth were neither instrumented nor obturated, in Group II (positive control), instrumentation was done, but no obturation was performed, in Group III, obturation was done with cold lateral compaction technique, in Group IV, obturation was done with cold free-flow compaction technique, in Group V, obturation was done with warm vertical compaction technique, and in Group VI, obturation was done with injection-molded thermoplasticized technique. All prepared teeth were embedded in an acrylic resin block, and their fracture strength was measured using Universal Testing Machine. Statistical data were analyzed using one-way analysis of variance and Tukey's honestly significant difference test. Results: Negative control Group I showed highest fracture resistance and positive control Group II had lowest fracture resistance. Among experimental groups, cold free-flow compaction technique with GuttaFlow2 (Group IV) showed higher fracture resistance as compared to the Group III, Group V, and Group VI. Conclusion: GuttaFlow2 has the potential to strengthen the endodontically treated roots to a level that is similar to that of intact teeth. PMID:29430099

  8. Obturator hernia: A diagnostic challenge.

    PubMed

    Kulkarni, Sanjeev R; Punamiya, Aditya R; Naniwadekar, Ramchandra G; Janugade, Hemant B; Chotai, Tejas D; Vimal Singh, T; Natchair, Arafath

    2013-01-01

    Obturator hernia is an extremely rare type of hernia with relatively high mortality and morbidity. Its early diagnosis is challenging since the signs and symptoms are non specific. Here in we present a case of 70 years old women who presented with complaints of intermittent colicky abdominal pain and vomiting. Plain radiograph of abdomen showed acute dilatation of stomach. Ultrasonography showed small bowel obstruction at the mid ileal level with evidence of coiled loops of ileum in pelvis. On exploration, Right Obstructed Obturator hernia was found. The obstructed Intestine was reduced and resected and the obturator foramen was closed with simple sutures. Postoperative period was uneventful. Obturator hernia is a rare pelvic hernia and poses a diagnostic challenge. Obturator hernia occurs when there is protrusion of intra-abdominal contents through the obturator foramen in the pelvis. The signs and symptoms are non specific and generally the diagnosis is made during exploration for the intestinal obstruction, one of the four cardinal features. Others are pain on the medial aspect of thigh called as Howship Rombergs sign, repeated attacks of Intestinal Obstruction and palpable mass on the medial aspect of thigh. Obturator hernia is a rare but significant cause of intestinal obstruction especially in emaciated elderly woman and a diagnostic challenge for the Doctors. CT scan is valuable to establish preoperative diagnosis. Surgery either open or laproscopic, is the only treatment. The need for the awareness is stressed and CT scan can be helpful. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  9. Chiropractic Management of a Patient With Perineal Numbness After Arthroscopic Hip Surgery: A Case Report.

    PubMed

    Olson, Harold M; Zetocha, Andrew J; Olson, Courtney A

    2016-12-01

    The purpose of this case report is to describe the chiropractic management of a patient with postoperative perineal numbness as a result of hip arthroscopy. A female patient presented to a chiropractic clinic with 7 weeks of ongoing perineal numbness after right hip arthroscopic surgery with labral repair. The patient reported lack of sensation during urination, sexual intercourse, and the insertion and removal of female hygienic products into the vagina. Conservative care included myofascial therapy to the psoas and obturator internus muscles and instrument-assisted soft tissue mobilization over the obturator internus. Manual manipulation to the pelvis was also performed. The patient reported complete resolution of perineal numbness after 3 chiropractic treatments. With conservative chiropractic management, full resolution of sensation for this patient was achieved.

  10. Predictors of obturator functioning and satisfaction in Turkish patients using an obturator prosthesis after maxillectomy.

    PubMed

    Ozdemir-Karatas, Meltem; Balik, Ali; Evlioglu, Gülümser; Uysal, Ömer; Peker, Kadriye

    2018-03-01

    The aim of this study was to determine the sociodemographic, behavioral, and clinical factors affecting obturator function and satisfaction using the obturator functioning scale (OFS) in maxillectomy patients rehabilitated with obturator prostheses. The study sample consisted of 41 maxillectomy patients. The OFS was translated into Turkish and adapted for assessing obturator functioning and patient satisfaction among Turkish patients. Data were collected from patients' medical records and self-completed questionnaires, including the Turkish version of the OFS, sociodemographic and behavioral characteristics. Descriptive statistics, Mann-Whitney U test, Spearman's correlation coefficient, and backward stepwise multiple linear regression were used for data analysis. Internal consistency (Cronbach's alpha = 0.85) and test-retest reliability (intraclass correlation coefficient = 0.86) were acceptable for the OFS. The most frequently reported problem was "difficulty chewing." Bivariate analysis revealed significant differences in total OFS scores in terms of surgery type, defect size, and education level, except for the other clinical and sociodemographic characteristics and behavioral factors. Education level and surgery type were found to be the most important predictors of patient satisfaction and functioning of the obturator. The Turkish version of the OFS might be a useful tool for clinicians to identify patients who are at risk for poor functioning of the obturator, lack of satisfaction, and unmet needs. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Mycobacterium Tuberculosis Pyomyositis in an Infant

    PubMed Central

    Malik, ZA; Shehab, M

    2013-01-01

    Mycobacterium tuberculosis is endemic to many parts of the world. It may have variable clinical presentations, especially in the pediatric age group. Presented here is the case of a 9-month old infant who was referred for infectious disease opinion when his thigh induration failed to improve after surgical drainage and a course of oral antibiotic therapy. Mycobacterial PCR on the operative sample fluid was found to be positive; and mycobacterial culture grew M. tuberculosis. He received 9 months of treatment with anti-TB medications, with excellent results and complete recovery. This is the first report of TB pyomyositis in an infant; and highlights the need to have a high index of suspicion for unusual organisms when conventional therapy fails to demonstrate expected results. PMID:23919207

  12. Mycobacterium tuberculosis pyomyositis in an infant.

    PubMed

    Malik, Za; Shehab, M

    2013-04-01

    Mycobacterium tuberculosis is endemic to many parts of the world. It may have variable clinical presentations, especially in the pediatric age group. Presented here is the case of a 9-month old infant who was referred for infectious disease opinion when his thigh induration failed to improve after surgical drainage and a course of oral antibiotic therapy. Mycobacterial PCR on the operative sample fluid was found to be positive; and mycobacterial culture grew M. tuberculosis. He received 9 months of treatment with anti-TB medications, with excellent results and complete recovery. This is the first report of TB pyomyositis in an infant; and highlights the need to have a high index of suspicion for unusual organisms when conventional therapy fails to demonstrate expected results.

  13. Sealing maxillary titanium obturators with removable flexible caps.

    PubMed

    Reitemeier, Bernd; Schaal, Wolfgang; Wolf, Annette; Walter, Michael

    2016-03-01

    Maxillary obturator prostheses with hollow metal obturators can be made of titanium to reduce weight. To prevent perforation of the hollow obturator during modifications, the obturator is slightly undersized and covered with a replaceable cap. This cap is made of a soft copolymer to facilitate uncomplicated modifications in the resection area and to improve function. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  14. Palatal obturators in patients after maxillectomy.

    PubMed

    Cardelli, P; Bigelli, E; Vertucci, V; Balestra, F; Montani, M; DE Carli, S; Arcuri, C

    2014-01-01

    Prosthodontic management of palatal defects is fundamental to improve patient's life undergoing to a maxillary surgical treatment. A lot of maxillary defects are a direct consequence of surgical treatment of malformations, neoplasms or trauma. The obturators are prosthesis used to close palatal defects after maxillectomy, to restore masticatory function and to improve speech. The primary goals of the obturator prosthesis are to preserve the remaining teeth and tissue and to provide comfort, function, and aesthetics to the patients. Different materials and retention methods are a characteristic of new types of obturators.

  15. Palatal obturators in patients after maxillectomy

    PubMed Central

    CARDELLI, P.; BIGELLI, E.; VERTUCCI, V.; BALESTRA, F.; MONTANI, M.; DE CARLI, S.; ARCURI, C.

    2014-01-01

    SUMMARY Prosthodontic management of palatal defects is fundamental to improve patient’s life undergoing to a maxillary surgical treatment. A lot of maxillary defects are a direct consequence of surgical treatment of malformations, neoplasms or trauma. The obturators are prosthesis used to close palatal defects after maxillectomy, to restore masticatory function and to improve speech. The primary goals of the obturator prosthesis are to preserve the remaining teeth and tissue and to provide comfort, function, and aesthetics to the patients. Different materials and retention methods are a characteristic of new types of obturators. PMID:25992263

  16. Quality of life in patients with obturator prostheses.

    PubMed

    Riaz, Nabeela; Warriach, Riaz Ahmad

    2010-01-01

    Oral cancer has a profound impact on the quality of life for patients and their families. Functionally, the mouth is an important organ for speech, swallowing, chewing, taste and salivation. These functions become compromised due to surgical ablation of the tumour. Obturator prosthesis is a common prosthdontic rehabilitative option for maxillectomy patients. The purpose of this study was to investigate how patients with maxillofacial defects evaluate their quality of life after maxillectomy and prosthodontic therapy with obturator prostheses. Thirty patients were included in the study (11 female, 19 male). The patients were interviewed by using a standardised questionnaire developed by University of Washington (UW-QOL). The detailed questionnaire was adjusted for obturator patients and internalised most parts of obturator functioning scale (OFS). Quality of life after prosthodontic therapy with obturator prostheses was 54 +/- 22.9% on average. Functioning of the obturator prosthesis, impairment of ingestion, speech and appearance, the extent of therapy, and the existence of pain had significant impact on the quality of life (p<0.005). Orofacial rehabilitation of patients with maxillofacial defects using obturator prostheses is an appropriate treatment modality. To improve the situation of patients prior to and after maxillectomy sufficient information about the treatment, adequate psychological care and speech therapy should be provided.

  17. The effect of obturator bulb height on speech in maxillectomy patients.

    PubMed

    Kwon, H B; Chang, S W; Lee, S H

    2011-03-01

    The purpose of this study was to compare the speech function of low height bulb obturators with that of high height bulb obturators. Thirteen maxillectomy patients, who underwent post-operative prosthodontic rehabilitations, were included. Two obturators of the same design except for different bulb heights were fabricated for each maxillectomy patient. One of the two obturators had high bulb design and the other had low bulb design. After one of the obturators was used for a period of 3 weeks, the patient's speaking functions were evaluated by measuring nasalance scores, formant frequencies, and vowel working space areas. The same procedures were repeated with the second obturator following another 3-week period of usage. In addition, the effect of delivery sequence and anatomic conditions related to maxillectomy were analysed. The results demonstrated that the nasalance scores with the low bulb obturators were significantly higher than those with the high bulb obturators. There were no significant differences in formant frequencies based on the bulb height of the obturators. The vowel working spaces for the two obturators were similar in shape and there were no significant differences between the vowel working space areas created by the two obturators. The delivery sequence affected the results. However, there were no significant differences related to the other anatomical variables. Although low bulb obturators might function similarly with high bulb obturators in terms of the articulation of speech, they would exhibit a difficulty in controlling hypernasality in maxillectomy patients. © 2010 Blackwell Publishing Ltd.

  18. TVT ABBREVO: cadaveric study of tape position in foramen obturatum and adductor region.

    PubMed

    Hubka, Petr; Nanka, Ondrej; Masata, Jaromir; Martan, Alois; Svabik, Kamil

    2016-07-01

    The aim of the study was to describe fixation of the TVT ABBREVO and establish whether the tape penetrates through obturator muscles and membrane (obturator complex) into the adductor region and, if so, how far it penetrates. Eight formalin-embalmed female cadavers were used to simulate TVT ABBREVO surgery (totalling 16 insertions). Following tape insertion, dissection was performed and ends of the tape were identified. In cases of penetration, the length of tape penetrating into the adductor region was measured. Of the 16 cases, the tape ended in the obturator membrane in eight, in the internal obturator muscle in one, and penetrated through the obturator membrane into the external obturator muscle in five, where it remained. In two cases, it penetrated through the obturator internus muscle, obturator membrane and obturator externus muscle into the group of thigh adductors; one penetration was by 3 mm and the second by 10 mm. No contact with the obturator nerve or its branches was noted in any case. No TVT contact with the obturator nerve was noted; tape penetrated into the adductor region in two of the 16 cases.

  19. PYOMYOSITIS IN ATHLETES AFTER THE USE OF ANABOLIC STEROIDS - CASE REPORTS.

    PubMed

    Filho, Nivaldo Souza Cardozo; Gaspar, Eric Figueirido; Siqueira, Karina Levy; Monteiro, Gustavo Cará; Andreoli, Carlos Vicente; Ejnisman, Benno; Cohen, Moisés

    2011-01-01

    To report on the management of five cases of pyomyositis in athletes after the use of anabolic steroids. Over the past 10 years, five cases of athletes who developed pyomyositis after using anabolic steroids were attended at the Sports Trauma Center (CETE), EPM-UNIFESP. All the patients were diagnosed clinically and through laboratory and imaging tests. Surgical treatment was carried out (with collection of material for culturing) and antibiotic therapy was administered. In four cases, the injection sites were in the upper limbs and in one case, in the gluteus muscles bilaterally as well as in the upper limbs. In all five cases, occurrences of leukocytosis and neutrophilia were observed in the hemogram. After debridement, the germs of normal skin (S. aureus and S. viridans) were found in cultures on the secretions. Demarcation of the abscess and examination of the muscle plane in which the abscess was located were performed using ultrasound and magnetic resonance imaging. All the patients responded to broad-spectrum antibiotic therapy. Two cases required more than one surgical procedure because of the appearance of more than one abscess site with different evolution times. The use of anabolic steroids by some athletes may have grave consequences. Rapid, energetic and multidisciplinary intervention is necessary in such cases in order to avoid undesirable results. The right treatment healed the athletes completely, and they returned to their sports at the same level.

  20. PYOMYOSITIS IN ATHLETES AFTER THE USE OF ANABOLIC STEROIDS - CASE REPORTS

    PubMed Central

    Filho, Nivaldo Souza Cardozo; Gaspar, Eric Figueirido; Siqueira, Karina Levy; Monteiro, Gustavo Cará; Andreoli, Carlos Vicente; Ejnisman, Benno; Cohen, Moisés

    2015-01-01

    Objective: To report on the management of five cases of pyomyositis in athletes after the use of anabolic steroids. Method: Over the past 10 years, five cases of athletes who developed pyomyositis after using anabolic steroids were attended at the Sports Trauma Center (CETE), EPM-UNIFESP. Results: All the patients were diagnosed clinically and through laboratory and imaging tests. Surgical treatment was carried out (with collection of material for culturing) and antibiotic therapy was administered. In four cases, the injection sites were in the upper limbs and in one case, in the gluteus muscles bilaterally as well as in the upper limbs. In all five cases, occurrences of leukocytosis and neutrophilia were observed in the hemogram. After debridement, the germs of normal skin (S. aureus and S. viridans) were found in cultures on the secretions. Demarcation of the abscess and examination of the muscle plane in which the abscess was located were performed using ultrasound and magnetic resonance imaging. All the patients responded to broad-spectrum antibiotic therapy. Two cases required more than one surgical procedure because of the appearance of more than one abscess site with different evolution times. Conclusion: The use of anabolic steroids by some athletes may have grave consequences. Rapid, energetic and multidisciplinary intervention is necessary in such cases in order to avoid undesirable results. The right treatment healed the athletes completely, and they returned to their sports at the same level. PMID:27026995

  1. Determination of a Central Avascular Triangle within the Obturator Foramen: A Radioanatomic Study

    PubMed Central

    Nyangoh Timoh, Krystel; Bader, Georges; Fauconnier, Arnaud; Barrau, Vincent; Delmas, Vincent; Touboul, Cyril

    2015-01-01

    Purpose To map the vascular anatomy of the obturator foramen using fixed anatomic landmarks. Method Twenty obturator regions were dissected in 10 fresh female cadavers after vascular blue dye injection in five cadavers (50%). Furthermore, 104 obturator regions were reconstructed by angiotomodensitometry from 52 women under investigation for suspected arterial disease. The anatomy of the obturator region was mapped by measuring the distance of vascular structures from the middle of the two branches of the ischiopubic bone, which were used as fixed landmarks. Results The bifurcation of the obturator artery was at a mean (SD) distance of 30.0 mm (4.5) from the middle of the ischiopubic branch (MISP). The anterior branch of the obturator vessels was 15.2 mm (10.1) from the MISP. The posterior branch of the obturator vessels was 5.5 mm (4.0) and 23.6 mm (8.7) from the middle of the outer edge of the obturator foramen (MOE) and the MISP, respectively. Using 5° and 95° percentiles of these measurements we defined a central avascular triangle. Conclusions Our data show that, beyond inter-individual variations, a central triangular avascular area can be identified in the obturator foramen between the posterior and anterior obturator artery using fixed landmarks. PMID:26624993

  2. [Pyomyositis, sacroiliitis and spondylodiscitis caused by Staphylococcus hominis in a immunocompetent woman].

    PubMed

    Gómez Rodríguez, N; Durán Muñoz, O

    2006-12-01

    In absence of risk factors, osteoarticular infections by coagulase-negative staphylococci are very infrequent. We described the case of a immunocompetent 73-year-old-woman that suffered pyomyositis, left sacroiliitis and spondylodiscitis involving the first and second thoracic vertebrae by Staphylococcus hominis. This multifocal infection occurred five-weeks after intramuscular administration of NSAI for treatment of low back pain associated with a herniated disc L4-L5. This is the first know case of a multifocal muscle skeletal infection by Staphylococcus hominis in a patient immunocompetent.

  3. Measurement of the percentage of root filling in oval-shaped canals obturated with Thermafil Obturators and Beefill 2in1: In vitro study.

    PubMed

    Faus-Llácer, Vicente; Collado-Castellanos, Nicolás; Alegre-Domingo, Teresa; Dolz-Solsona, María; Faus-Matoses, Vicente

    2015-04-01

    The aim of the study was to measure the percentage of root canal fillings in long oval canals obturated with thermoplasticized gutta-percha techniques, Beefill 2in1® and Thermafil Obturators®. Fifty four mandibular incisors were selected after bucco-lingual and mesio-distal radiographs showed at 5 mm from apex an internal long:short diameter ≥2. Teeth were instrumented with Protaper Universal and divided in two groups of 27. Group 1 was obturated with Thermafil Obturators® and group 2 with Beefill 2in1®. Two horizontal sections were cut at 5 and 7 mm from the apex and photographed in a stereo-microscope. The total area of the canal and filled canal in cross-sections were measured with AutoCad and the percentages of gutta-percha-sealer and voids in the canal were obtained. Both systems achieved high percentage of filled canal, Thermafil 96.8% and Beefill 2in1 98.9%. The percentages of voids in both groups were very low. No significant differences were found between the two groups . The percentage obtained at 5 and 7 mm from the apex in both groups showed no significant difference. The percentages of filled canal (gutta-percha-sealer) were high and these two thermoplasticized techniques are suitable for long oval canals obturation. Key words:Long oval canal, oval canal, thermoplasticized obturation.

  4. Speech rehabilitation of maxillectomy patients with hollow bulb obturator.

    PubMed

    Kumar, Pravesh; Jain, Veena; Thakar, Alok

    2012-09-01

    To evaluate the effect of hollow bulb obturator prosthesis on articulation and nasalance in maxillectomy patients. A total of 10 patients, who were to undergo maxillectomy, falling under Aramany classes I and II, with normal speech and hearing pattern were selected for the study. They were provided with definitive maxillary obturators after complete healing of the defect. The patients were asked to wear the obturator for six weeks and speech analysis was done to measure changes in articulation and nasalance at four different stages of treatment, namely, preoperative, postoperative (after complete healing, that is, 3-4 months after surgery), after 24 hours, and after six weeks of providing the obturators. Articulation was measured objectively for distortion, addition, substitution, and omission by a speech pathologist, and nasalance was measured by Dr. Speech software. The statistical comparison of preoperative and six weeks post rehabilitation levels showed insignificance in articulation and nasalance. Comparison of post surgery complete healing with six weeks after rehabilitation showed significant differences in both nasalance and articulation. Providing an obturator improves the speech closer to presurgical levels of articulation and there is improvement in nasality also.

  5. Speech Rehabilitation of Maxillectomy Patients with Hollow Bulb Obturator

    PubMed Central

    Kumar, Pravesh; Jain, Veena; Thakar, Alok

    2012-01-01

    Aim: To evaluate the effect of hollow bulb obturator prosthesis on articulation and nasalance in maxillectomy patients. Materials and Methods: A total of 10 patients, who were to undergo maxillectomy, falling under Aramany classes I and II, with normal speech and hearing pattern were selected for the study. They were provided with definitive maxillary obturators after complete healing of the defect. The patients were asked to wear the obturator for six weeks and speech analysis was done to measure changes in articulation and nasalance at four different stages of treatment, namely, preoperative, postoperative (after complete healing, that is, 3-4 months after surgery), after 24 hours, and after six weeks of providing the obturators. Articulation was measured objectively for distortion, addition, substitution, and omission by a speech pathologist, and nasalance was measured by Dr. Speech software. Results: The statistical comparison of preoperative and six weeks post rehabilitation levels showed insignificance in articulation and nasalance. Comparison of post surgery complete healing with six weeks after rehabilitation showed significant differences in both nasalance and articulation. Conclusion: Providing an obturator improves the speech closer to presurgical levels of articulation and there is improvement in nasality also. PMID:23440022

  6. Measurement of the percentage of root filling in oval-shaped canals obturated with Thermafil Obturators and Beefill 2in1: In vitro study

    PubMed Central

    Collado-Castellanos, Nicolás; Alegre-Domingo, Teresa; Dolz-Solsona, María; Faus-Matoses, Vicente

    2015-01-01

    Background The aim of the study was to measure the percentage of root canal fillings in long oval canals obturated with thermoplasticized gutta-percha techniques, Beefill 2in1® and Thermafil Obturators®. Material and Methods Fifty four mandibular incisors were selected after bucco-lingual and mesio-distal radiographs showed at 5 mm from apex an internal long:short diameter ≥2. Teeth were instrumented with Protaper Universal and divided in two groups of 27. Group 1 was obturated with Thermafil Obturators® and group 2 with Beefill 2in1®. Two horizontal sections were cut at 5 and 7 mm from the apex and photographed in a stereo-microscope. The total area of the canal and filled canal in cross-sections were measured with AutoCad and the percentages of gutta-percha-sealer and voids in the canal were obtained. Results Both systems achieved high percentage of filled canal, Thermafil 96.8% and Beefill 2in1 98.9%. The percentages of voids in both groups were very low. No significant differences were found between the two groups . The percentage obtained at 5 and 7 mm from the apex in both groups showed no significant difference. Conclusions The percentages of filled canal (gutta-percha-sealer) were high and these two thermoplasticized techniques are suitable for long oval canals obturation. Key words:Long oval canal, oval canal, thermoplasticized obturation. PMID:26155350

  7. A Conservative Method of Retaining an Interim Obturator for a Total Maxillectomy Patient

    PubMed Central

    Bettie, Nirmal Famila

    2017-01-01

    Interim obturators are indicated during the postsurgical phases. It promotes surgical healing and serves as a temporary prosthesis to rehabilitate a patient with intra-oral surgical defect. Retention is gained by wiring, surgical suturing, and other noninvasive methods to enable functional rehabilitation and easy replacement with a permanent obturator. Interim obturators serve as an easy guide for replacing with definitive obturators by indicating prosthesis extensions and the required method of retention. A more conservative and noninvasive method of retaining an interim obturator for a maxillectomy patient is described in this case report. PMID:29284985

  8. A Conservative Method of Retaining an Interim Obturator for a Total Maxillectomy Patient.

    PubMed

    Bettie, Nirmal Famila

    2017-11-01

    Interim obturators are indicated during the postsurgical phases. It promotes surgical healing and serves as a temporary prosthesis to rehabilitate a patient with intra-oral surgical defect. Retention is gained by wiring, surgical suturing, and other noninvasive methods to enable functional rehabilitation and easy replacement with a permanent obturator. Interim obturators serve as an easy guide for replacing with definitive obturators by indicating prosthesis extensions and the required method of retention. A more conservative and noninvasive method of retaining an interim obturator for a maxillectomy patient is described in this case report.

  9. TVT and TVT-Obturator: comparison of two operative procedures.

    PubMed

    Neuman, Menahem

    2007-03-01

    To compare two anti-incontinence operations: the tension-free vaginal tape (TVT) and the TVT-Obturator for the first two 75-patient groups. One surgeon operated on two patient groups with urodynamically proven urinary stress incontinence. The first 75-patient group in 1998 included the first TVT procedures performed according to Ulmsten [Ulmsten U, Henriksson L, Johnson P, Varhos G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J 1996;7:81-6]. Follow-up lasted for 5-6 years. The second 75-patient group in 2004 included the first TVT-Obturator operations performed according to [De Leval J. Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur. Urol. 2003;44:724-30]. Follow-up lasted for 6-13 months. The two patient groups were similar from the demographic and therapeutic points of view. The TVT-Obturator procedure required neither bladder catheterization nor intra-operative diagnostic cystoscopy. TVT-related bladder penetration (8.0%), post-operative voiding difficulties (5.0%), intra-operative bleeding (4.0%), post-operative field infection (2.7%), and post-operative pelvic floor relaxation (1.3%) were not noted with the TVT-Obturator. The early therapeutic failure rates were 2.7% for the TVT and 1.3% for the TVT-Obturator, and neither bowel nor urethral injuries were recorded. The surgeons' learning curves of these two minimally invasive surgical procedures for the treatment of female urinary stress incontinence are comparable. The safety and cost-effectiveness of the TVT are well-established. The TVT-Obturator, a novel mid-urethral sling, was designed to overcome some of the TVT-related operative complications. The TVT-Obturator patients seem to have less intra-operative and post-operative surgical complications than the TVT patients. However, long-term comparative data collection is required prior to drawing solid

  10. Stress analysis in oral obturator prostheses: imaging photoelastic

    NASA Astrophysics Data System (ADS)

    Pesqueira, Aldiéris Alves; Goiato, Marcelo Coelho; dos Santos, Daniela Micheline; Haddad, Marcela Filié; Andreotti, Agda Marobo; Moreno, Amália

    2013-06-01

    Maxillary defects resulting from cancer, trauma, and congenital malformation affect the chewing efficiency and retention of dentures in these patients. The use of implant-retained palatal obturator dentures has improved the self-esteem and quality of life of several subjects. We evaluate the stress distribution of implant-retained palatal obturator dentures with different attachment systems by using the photoelastic analysis images. Two photoelastic models of the maxilla with oral-sinus-nasal communication were fabricated. One model received three implants on the left side of the alveolar ridge (incisive, canine, and first molar regions) and the other did not receive implants. Afterwards, a conventional palatal obturator denture (control) and two implant-retained palatal obturator dentures with different attachment systems (O-ring; bar-clip) were constructed. Models were placed in a circular polariscope and a 100-N axial load was applied in three different regions (incisive, canine, and first molar regions) by using a universal testing machine. The results were photographed and analyzed qualitatively using a software (Adobe Photoshop). The bar-clip system exhibited the highest stress concentration followed by the O-ring system and conventional denture (control). Images generated by the photoelastic method help in the oral rehabilitator planning.

  11. Comparison of different obturation techniques for primary molars by digital radiography.

    PubMed

    Memarpour, Mahtab; Shahidi, Shoaleh; Meshki, Razieh

    2013-01-01

    The purpose of this study was to compare six methods of root canal filling in primary mandibular second molars via digital radiography. A total of 239 canals were prepared and obturated with zinc-oxide eugenol paste. Obturation methods compared were: anesthetic syringe; NaviTip syringe; pressure syringe; tuberculin syringe; lentulo spiral; and packing with a plugger. The canals were evaluated in photostimulated phosphor radiographs for length of obturation, presence of voids, and number and sum of void sizes. The data were analyzed using chi-square, Kruskal-Wallis and Mann-Whitney tests. There were significant differences between all groups in the length of obturation (P>.01) and presence of voids (P<.001). The lentulo and tuberculin syringe groups, respectively, showed the best and worst results for length of obturation. Significant differences were also found in the number of voids (P<.001) and mean sum of void sizes in the coronal (P<.001) and middle third (P=.003). For the number and size of the voids, the NaviTip group showed the best results. Lentulo produced the best results in terms of length of obturation, while NaviTip syringe produced the best results in controlling paste extrusion from the apical foramen and having the smallest void size and lowest number of voids.

  12. Volumetric Evaluation of Different Obturation Techniques in Primary Teeth Using Spiral Computed Tomography.

    PubMed

    Nagaveni, N B; Yadav, Sneha; Poornima, P; Reddy, Vv Subba; Roshan, N M

    Various obturation techniques have been evaluated for better filling of the root canals in primary teeth using different methods. Spiral Computed Tomography (SCT) is a new revolution in the pediatric endodontics for assessment of quality of the obturation from 3 dimensions. To evaluate the efficiency of 5 different obturation methods in delivering the filling material into the canals of primary teeth using Spiral Computed Tomography scan. A total of 50 canals of primary teeth were prepared, divided into 5 groups with 10 canals in each group and obturated with Zinc Oxide Eugenol cement using 5 different obturation techniques such as Local anesthetic syringe, Tuberculin syringe, Endodontic plugger, hand held Lentulo-spiral, and Lentulo-spiral mounted on slow speed hand piece. The pre and post obturation volume and finally the Percentage of Obturated Volume (POV) were calculated using SCT scan for each group. The data obtained was statistically analyzed using One-way Analysis of Variance (ANOVA) and Tukey's post-hoc test. Lentulo-spiral hand held showed highest POV value followed by Lentulospiral mounted to hand piece, Tuberculin syringe and Endodontic plugger; whereas Anesthetic syringe had least POV (P < 0.05). Lentulo-spiral hand held is the best obturating technique among the 5 groups evaluated as the canals of this group showed maximum percentage of filled material. However, a further study with large sample size is highly essential.

  13. Enhanced retention of a maxillofacial prosthetic obturator using precision attachments: Two case reports

    PubMed Central

    Murat, Sema; Gurbuz, Ayhan; Isayev, Abulfaz; Dokmez, Bahadir; Cetin, Unsun

    2012-01-01

    The majority of maxillary defects can be rehabilitated with conventional simple obturator prosthesis. However, inadequate retention, stability and support may be associated with the use of an obturator. Precision attachments have been used to retain obturators for some time. The use of precision attachments in a dentate maxillectomy patient can yield significant functional improvement while maintaining the obturator’s aesthetic advantages. This clinical report describes the prosthetic rehabilitation of two maxillary defects with an obturator retained using extracoronal resilient precision attachments. PMID:22509126

  14. Obturator hernia: a rare case of acute mechanical intestinal obstruction.

    PubMed

    Aydin, Ibrahim; Yucel, Ahmet Fikret; Pergel, Ahmet; Sahin, Dursun Ali

    2013-01-01

    Obturator hernia is a rare type of pelvic hernia which generally occurs in elderly patients with accompanying diseases. Because it is difficult to diagnose before surgery, the morbidity and mortality rates for obturator hernia are high. The most common symptom is strangulation combined with mechanical intestinal obstruction.

  15. A hollow definitive obturator fabrication technique for management of partial maxillectomy.

    PubMed

    Patil, Pravinkumar Gajanan; Patil, Smita Pravinkumar

    2012-11-01

    Maxillary obturator prosthesis is the most frequent treatment option for management of partial or total maxillectomy. Heavy weight of the obturators is often a dislocating factor. Hollowing the prosthesis to reduce its weight is the well established fact. The alternate technique to hollow-out the prosthesis has been described in this article which is a variation of previously described processing techniques. A pre-shaped wax-bolus was incorporated inside the flasks during packing of the heat-polymerized acrylic resin to automatically create the hollow space. The processing technique described is a single step flasking procedure to construct a closed-hollow-obturator prosthesis as a single unit. To best understand the technique, this article describes management of a patient who had undergone partial maxillectomy secondary to squamous cell carcinoma rehabilitated with a hollow-obturator prosthesis.

  16. Obturator Hernia: A Rare Case of Acute Mechanical Intestinal Obstruction

    PubMed Central

    Yucel, Ahmet Fikret; Pergel, Ahmet; Sahin, Dursun Ali

    2013-01-01

    Obturator hernia is a rare type of pelvic hernia which generally occurs in elderly patients with accompanying diseases. Because it is difficult to diagnose before surgery, the morbidity and mortality rates for obturator hernia are high. The most common symptom is strangulation combined with mechanical intestinal obstruction. PMID:23738179

  17. A hollow definitive obturator fabrication technique for management of partial maxillectomy

    PubMed Central

    Patil, Smita Pravinkumar

    2012-01-01

    Maxillary obturator prosthesis is the most frequent treatment option for management of partial or total maxillectomy. Heavy weight of the obturators is often a dislocating factor. Hollowing the prosthesis to reduce its weight is the well established fact. The alternate technique to hollow-out the prosthesis has been described in this article which is a variation of previously described processing techniques. A pre-shaped wax-bolus was incorporated inside the flasks during packing of the heat-polymerized acrylic resin to automatically create the hollow space. The processing technique described is a single step flasking procedure to construct a closed-hollow-obturator prosthesis as a single unit. To best understand the technique, this article describes management of a patient who had undergone partial maxillectomy secondary to squamous cell carcinoma rehabilitated with a hollow-obturator prosthesis. PMID:23236579

  18. Inflatable hollow obturator prostheses for patients undergoing an extensive maxillectomy: a case report

    PubMed Central

    Hou, Yue-Zhong; Huang, Zhi; Ye, Hong-Qiang; Zhou, Yong-Sheng

    2012-01-01

    The presence of a large palatal or maxillary defect after partial or total maxillectomy for tumor, trauma or congenital deformation poses a challenge to prosthodontists, particularly when the use of an implant cannot be considered. This case report described the use of an air valve in a hollow silicone obturator to manufacture an inflatable obturator that could be extended further into undercut area to retain itself. The inflatable obturator exhibited adequate retention, stability and border sealing, thereby improving the masticatory, pronunciation and swallowing functions of patients. It may be a suitable alternative treatment option to an implant-retained obturator. PMID:22653550

  19. 21 CFR 868.5650 - Esophageal obturator.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...) Identification. An esophageal obturator is a device inserted through a patient's mouth to aid ventilation of the patient during emergency resuscitation by occluding (blocking) the esophagus, thereby permitting positive...

  20. Clinical Assessment of Various Obturating Techniques for Primary Teeth: A Comparative Study

    PubMed Central

    Tandon, Sandeep; Vijay, Akshat; Kalia, Garima; Rathore, Khushboo

    2017-01-01

    Introduction Lifelong preservation of tooth in a healthy state is the ultimate goal of dentistry. Premature loss of primary teeth is common due to caries, dental trauma or other causes. As the primary teeth are the best space maintainers, teeth with infected pulps should be retained until exfoliation, whenever possible. Aim The purpose of this in vivo study was to evaluate and compare the efficacy of different obturating methods used in primary teeth. Materials and Methods Forty one patients aged four to nine years with a total of 60 teeth were selected. Out of the 60 teeth, 32 were primary mandibular first molars and 28 were primary mandibular second molars, the sample was randomly divided into three groups. Disposable syringe, lentulo spiral and past inject were used for obturation. Postoperative evaluation was done for; quality of canal obturation, presence of voids using postoperative radiographs following obturation of teeth. The data were analysed to assess the success rate of the three methods used for obturation using Chi-square test. Results Among the three groups of the study, past inject exhibited the maximum number of optimally filled canals. Maximum number of underfilled canals was found with lentulospiral, and the maximum number of overfilled canals was seen with disposable syringe. Least number of voids was observed in canals filled with the past inject technique and disposable syringe. Conclusion The results suggest that the most successful technique for obturation of primary teeth was past inject. PMID:28893042

  1. Quality of life after maxillectomy and prosthetic obturator rehabilitation.

    PubMed

    Chigurupati, Radhika; Aloor, Neelam; Salas, Richard; Schmidt, Brian L

    2013-08-01

    Surgical resection of midface neoplasms and subsequent reconstruction have been shown to have significant negative effects on quality of life (QOL). The purpose of this pilot study was to assess individuals' health-related QOL after maxillectomy and reconstruction with a prosthetic obturator. The QOL of 25 of 43 patients who underwent maxillectomy and prosthetic obturator reconstruction at the University of California-San Francisco was assessed using 3 questionnaires: University of Washington Quality of Life version 4 (UWQOL), Obturator Functioning Scale (OFS), and Mental Health Inventory (MHI). The response rate to the QOL questionnaires was 92% (23 of 25 patients). Time elapsed from maxillectomy and prosthetic obturator reconstruction to the QOL survey response ranged from 0.3 to 6.6 years (mean, 2.7 years; standard deviation [SD], 1.9 years). The post-treatment mean QOL scores were 77.3 (SD, 13.6) for UWQOL, 72.0 (SD, 12.6) for OFS, and 4.5 (SD, 0.9) for Mental Health Inventory. Individuals who received adjuvant radiation scored lower for speech and appearance (OFS, P = .05, P = .03, respectively) as well as for saliva and overall QOL (UWQOL, P = .02, P = .08, respectively). There was a strong correlation between QOL scores in OFS and UWQOL questionnaires (r = 0.78, P < .001). The results of this pilot study suggest that postoperative radiation therapy was the strongest variable affecting QOL in patients with maxillectomy and prosthetic obturator reconstruction. There is further need for a multicenter trial with a larger sample to identify how factors affecting QOL of patients after maxillectomy might influence the choice of reconstruction. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Oral function after maxillectomy and reconstruction with an obturator.

    PubMed

    Kreeft, A M; Krap, M; Wismeijer, D; Speksnijder, C M; Smeele, L E; Bosch, S D; Muijen, M S A; Balm, A J M

    2012-11-01

    Maxillectomy defects can be reconstructed by a prosthetic obturator or (free) flap transfer, but there is no consensus about the optimal method. This study evaluated 32 maxillectomy patients with prosthetic obturation regarding function (mastication, subjective oral and swallowing complaints and maximal mouth opening). Outcomes were related to the extent of the resection (Brown maxillectomy classification), dentition and history of adjuvant radiotherapy. Maxillectomy defects ranged from 2-1 to 4B on the Brown classification, and most had a defect graded as 2-A or 2-B. Mean mixing ability test after 10 chewing strokes was 24.2 and after 20 chewing strokes 19.7, which compares to edentulous healthy individuals. None of the outcomes was influenced by Brown classification. Radiotherapy negatively influenced mean maximal mouth opening (29.1mm versus 40.9 mm, p=0.017) and subjective outcomes. Edentate obturated patients had worse outcomes than dentate patients, measured by mixing ability test and questionnaire. In conclusion, mastication after obturator reconstruction of a maxillectomy defect is comparable to mastication with full dentures. Size of the maxillectomy defect did not significantly influence functional outcome, but adjuvant radiotherapy resulted in worse mouth opening and self-reported oral and swallowing problems. Residual dentition had a positive influence on mastication and subjective outcomes. Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  3. [MORPHOLOGICAL CHANGES OF THE LIVER IN OBTURATION JAUNDICE, CAUSED BY CHOLEDOCHOLITHIASIS, DEPENDING ON ITS DURATION].

    PubMed

    Sipliviy, V A; Yevtushenko, D V; Naumova, O V; Andreyeshchev, S A; Yevtushenko, A V

    2016-02-01

    Abstract The results of surgical treatment of 184 patients for obturation jaundice, caused by choledocholithiasis, were analyzed. Morphological changes of the liver were studied in 20 patients. There were three groups of patients delineated, depending on the obturation jaundice duration: up to 7 days, from 8 to 14 days, more than 15 days, and also a group of patients after the bile outflow restoration. The obturation jaundice occurrence in choledocholithiasis is accompanied by significant morphological changes in the liver, severity of which is enhancing while the obturation jaundice persistence increasing. While persistence of obturation jaundice through 8 days and more the connective tissue volume is enhancing, a relative volume of hepatocytes is reducing and a stromal-parenchymatous index is increasing. The bile outflow restoration secures significant reduction of intensity of alterative and inflammatory changes in hepatic parenchyma, as well as activation of reparative processes in the tissue. In cholangitis, caused by P. aeruginosa and E. coli, according to morphological investigations data, in the liver a diffuse purulent cholangitis on background of chronic changes in accordance to duration of the obturation jaundice persists.

  4. Comparison of two vertical condensation obturation techniques: Touch 'n Heat modified and System B.

    PubMed

    Silver, G K; Love, R M; Purton, D G

    1999-08-01

    The aims of this study were firstly to compare the area of canal occupied by gutta-percha, sealer or voids using the System B heating device with that obtained by a modified vertical condensation technique using the Touch 'n Heat: and secondly to compare the temperature changes at the root canal wall and external root surface during obturation with the above techniques. Forty-five resin blocks, each with a standardized, simulated, prepared main root canal and five lateral canals, were assigned to three equal experimental groups. The canals were obturated using either the System B technique at two different temperature settings, or vertical condensation with a Touch 'n Heat instrument as the heat source. A heat transfer model was used to simultaneously record internal and external root surface temperature elevations during obturation by the three techniques. Data were analysed using unpaired Student's t-test and Mann-Whitney U-test. Both obturation techniques produced root fillings consisting of over 90% gutta-percha at most levels, although the percentages of sealer and voids 2-3 mm from the working length following System B obturation were higher than those found following modified vertical condensation. Modified vertical condensation resulted in more gutta-percha in lateral canals. Obturation was accomplished more quickly using the System B, and temperature elevations produced during obturation with the System B were significantly less (P < 0.001) than with vertical condensation. An elevation of external root surface temperature by more than 10 degrees C occurred during vertical condensation. The results suggest that the System B may produce an acceptable obturation and that the use of a Touch 'n Heat source during vertical condensation may result in damage to the periodontium.

  5. Obturator Neuromodulation with Laparoscopic Placement of an Obturator Lead for the Treatment of Intractable Opioid Dependent Chronic Pelvic Pain due to Obturator Neuralgia.

    PubMed

    Marvel, Richard P

    2018-05-12

    Chronic pelvic pain(CPP) is a common condition in women that can have a devastating effect on quality of life. Some of the most severe forms of CPP are related to peripheral nerve injuries causing persistent neuropathic pain. This is a case of a young woman with severe opioid dependent chronic pelvic and right groin pain due to obturator neuralgia. She had failed a multitude of treatments including multiple medications, manual physical therapy, nerve blocks, surgical neurolysis and spinal cord stimulation without significant benefit. She underwent a trial of peripheral neuromodulation of the obturator nerve with laparoscopic placement of a quadripolar lead. During the 6-day trial she had almost complete relief of her pain; therefore, she underwent permanent implantation of an intermittent pulse generator. Over the next 6 months she was completely weaned completely off her chronic opioids. At 23 months post implantation, she had essentially no pain and is no longer on any analgesic, antidepressant or membrane stabilizing medications. Peripheral Neuromodulation has the potential to alleviate pain and significantly improve quality of life in women with longstanding neuropathic chronic pelvic pain who have failed multimodal conservative therapy. Copyright © 2018. Published by Elsevier Inc.

  6. Effect of Post Space Preparation on Apical Obturation Quality of Teeth Obturated with Different Techniques: A Micro-computed Tomographic Study.

    PubMed

    Küçükkaya Eren, Selen; Askerbeyli Örs, Sevinc; Yılmaz, Zeliha

    2017-07-01

    The purpose of this study was to evaluate the obturation quality of root canals filled with different techniques and to determine whether post space preparation had an effect on the quality of apical obturation using micro-computed tomographic (micro-CT) imaging. The root canals of 30 human mandibular premolar teeth were instrumented, and the specimens were divided into 3 groups according to the obturation technique used: cold lateral compaction (CLC), warm vertical compaction (WVC), or single-cone (SC) techniques. The specimens were stored at 37°C and 100% humidity for 1 week. Then, the coronal root filling material was removed in order to create a post space. Micro-CT scans were performed before and after post space preparation for the volumetric analysis of voids and filling materials. Data were analyzed using repeated-measures analysis of variance and Bonferroni tests. The CLC and SC groups showed a significantly greater percentage volume of voids than the WVC group (P < .05), whereas no significant difference was found between the CLC and SC groups before and after post space preparation (P > .05). The post space preparation caused a significant increase in the percentage volume of voids in the CLC and SC groups (P < .05). No significant difference was detected in the percentage volume of voids in the WVC group after post space preparation (P > .05). No root fillings were void free. The WVC group presented the best obturation quality. The post space preparation negatively influenced the apical integrity of the filling materials in the CLC and SC groups, whereas it had no significant effect in the WVC group. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  7. Quality of Life in Patients After Maxillectomy and Placement of Prosthetic Obturator.

    PubMed

    Chen, Cheng; Ren, Wen-Hao; Huang, Rui-Zhe; Gao, Ling; Hu, Zhi-Ping; Zhang, Lin-Mei; Li, Shao-Ming; Dong, Kai; Qi, Hong; Zhi, Ke-Qian

    2016-01-01

    The aim of this study was to assess quality of life (QoL) and obturator functioning in patients having undergone a maxillectomy as a tumor ablative resection and rehabilitation with a prosthetic obturator. The University of Washington Quality of Life scale version 4 (UW-QoLv4) and the Obturator Functioning Scale (OFS) were used to evaluate the self-reported QoL and obturator functioning. The effects of demographic and treatment variables on QoL were assessed using age, defect size, postoperative radiotherapy (RT), neck dissection, and dentition. The study included 16 men and 13 women with a mean age of 48.8 years. Of the 29 patients, 16 had a Brown Class 2a or smaller defect and 13 had a Brown Class 2b or larger defect. The mean OFS score (P = .004) and the physical (P = .001) and social-emotional function scores (P = .001) of the patients who received postoperative RT were significantly lower than those who did not receive postoperative RT. The subscales for swallowing (P = .008), saliva (P = .001), pain (P = .001), and shoulder function (P = .002) correlated strongly with postoperative RT on the UW-QoL. The subscales for pronunciation (P = .007) and saliva (P = .002) correlated significantly with RT on the OFS. The mean OFS scores were significantly lower for the patients with a Brown Class 2a or smaller defect than for Brown Class 2b or larger (P = .005). Postoperative RT was the strongest variable affecting QoL in patients with maxillectomy and prosthetic obturator reconstruction. The size of the defect slightly influenced the obturator function; however, it did not influence the overall QoL.

  8. Greater inadvertent muscle damage in direct anterior approach when compared with the direct superior approach for total hip arthroplasty.

    PubMed

    Amanatullah, D F; Masini, M A; Roger, D J; Pagnano, M W

    2016-08-01

    We wished to quantify the extent of soft-tissue damage sustained during minimally invasive total hip arthroplasty through the direct anterior (DA) and direct superior (DS) approaches. In eight cadavers, the DA approach was performed on one side, and the DS approach on the other, a single brand of uncemented hip prosthesis was implanted by two surgeons, considered expert in their surgical approaches. Subsequent reflection of the gluteus maximus allowed the extent of muscle and tendon damage to be measured and the percentage damage to each anatomical structure to be calculated. The DA approach caused substantially greater damage to the gluteus minimus muscle and tendon when compared with the DS approach (t-test, p = 0.049 and 0.003, respectively). The tensor fascia lata and rectus femoris muscles were damaged only in the DA approach. There was no difference in the amount of damage to the gluteus medius muscle and tendon, piriformis tendon, obturator internus tendon, obturator externus tendon or quadratus femoris muscle between approaches. The posterior soft-tissue releases of the DA approach damaged the gluteus minimus muscle and tendon, piriformis tendon and obturator internus tendon. The DS approach caused less soft-tissue damage than the DA approach. However the clinical relevance is unknown. Further clinical outcome studies, radiographic evaluation of component position, gait analyses and serum biomarker levels are necessary to evaluate and corroborate the safety and efficacy of the DS approach. Cite this article: Bone Joint J 2016;98-B1036-42. ©2016 The British Editorial Society of Bone & Joint Surgery.

  9. Comparison of different techniques for obturating experimental internal resorptive cavities.

    PubMed

    Goldberg, F; Massone, E J; Esmoris, M; Alfie, D

    2000-06-01

    Forty extracted maxillary central incisors were instrumented at the working length to a #50 file. The roots were sectioned transversely with a diamond disk at 7 mm from the anatomical apex. At the opening of the root canal of each section, hemicircular cavities were drilled with a specially designed bur. The corresponding root sections were cemented with glue, thus obtaining root canals with similar cavities that simulated internal resorptions. Teeth were embedded in plaster casts to facilitate their handling. The specimens were randomly separated into four groups of 10. The following obturation techniques were evaluated: lateral compaction (group A), hybrid technique (group B), Obtura II (group C), and Thermafil (group D). AH26 was used as the sealer. After obturation, the plaster was removed and the teeth were radiographed in buccolingual and mesiodistal directions to evaluate the quality of the obturation at the IRC. The incisors were then cut with a scalpel at the same level as the previous section, to examine, under a stereomicroscope, the type of material that filled the IRC. Obtura II gave the best results and in most of the specimens obturated with this technique, the IRC were filled mainly with gutta-percha. Statistical analysis of the data indicated that the differences between group C and the other groups were significant (P < 0.05).

  10. In vitro resistance to fracture of roots obturated with Resilon or gutta-percha.

    PubMed

    Monteiro, Jeanne; de Ataide, Ida de Noronha; Chalakkal, Paul; Chandra, Pavan Kumar

    2011-06-01

    There have been varied results from studies comparing postendodontic fracture resistance between teeth obturated with Resilon or gutta-percha. This study was performed to evaluate the fracture resistance of roots obturated by using Resilon (RealSeal system) or gutta-percha (with AH Plus sealer). Eighty extracted human mandibular single-rooted premolars stored in 10% formalin were used in the study. They were prepared by using a crown-down technique, debrided with NaOCl, ethylenediaminetetraacetic acid, and sterile water and divided into 4 groups. Obturation was performed by using the lateral condensation method. The negative control group consisted of unfilled specimens, and the positive control group consisted of those obturated with flowable, dual-cure composite resin. All root specimens were stored for 2 weeks in 100% humidity to allow complete setting of the sealer. Each specimen was mounted in acrylic in a polyvinyl ring and tested for fracture resistance with the Universal testing machine. The loading fixture of the machine was mounted with its spherical tip aligned with the center of the canal opening of each root. A vertical loading force was applied until it fractured the root. The force values were subjected to statistical analysis including analysis of variance and Fisher least significant difference testing. Teeth obturated with Resilon were more resistant to fracture than those obturated with gutta-percha. The difference was found to be highly significant (P=.00001). Resilon increased the resistance to fracture of single-rooted teeth in vitro. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  11. Variation of distances from mid-urethra to the obturator foramen: an MRI study

    PubMed Central

    Doumouchtsis, Stergios K.; Berger, Mitchell B.; DeLancey, John O.

    2013-01-01

    Introduction and hypothesis To estimate distances from the mid-urethra to the obturator foramina and to explore correlations between pelvic dimensions and body height. Methods This is a secondary analysis of a parent case–control study on the mechanisms of stress urinary incontinence. We measured pelvic dimensions on magnetic resonance images of women with (cases, n=50) and without (controls, n=50) stress urinary incontinence. Results The mean distance from mid-urethra to the obturator membrane among cases is 31.8 mm (left) and 32.1 mm (right), with a range from 25.9 to 42.0 mm. There were no significant differences in these distances when comparing left with right, or cases with controls. Weak correlation was found between the urethra-to-obturator foramina distances and heights only in the case subjects. Conclusion There is high variability in the distance from mid-urethra to the obturator foramina. Height should not be used as a predictor of dimensions in the lesser pelvis. PMID:22543545

  12. Obturator mononeuropathy caused by lipomatosis of the nerve: a case report.

    PubMed

    Nardone, Raffaele; Venturi, Alessandro; Ladurner, Gunther; Golaszewski, Stefan; Psenner, Konrad; Tezzon, Frediano

    2008-08-01

    We report a patient who presented with the clinical features of obturator mononeuropathy. Abdomino-pelvic computed tomography revealed a fusiform mass in the right perivesical space; magnetic resonance imaging (MRI) showed characteristic "coaxial-cable-like" appearance in cross-section and "spaghetti-like" appearance in longitudinal section, pathognomonic of lipomatosis of the nerve. Nerve lipomatosis as the cause of obturator neuropathy has not been previously reported. MRI provides definite and graphic proof of the diagnosis.

  13. Closed hollow bulb obturator--one-step fabrication: a clinical report.

    PubMed

    Buzayan, Muaiyed M; Ariffin, Yusnidar T; Yunus, Norsiah

    2013-10-01

    A method is described for the fabrication of a closed hollow bulb obturator prosthesis using a hard thermoforming splint material and heat-cured acrylic resin. The technique allowed the thickness of the thermoformed bulb to be optimized for weight reduction, while the autopolymerized seal area was covered in heat-cured acrylic resin, thus eliminating potential leakage and discoloration. This technique permits the obturator prosthesis to be processed to completion from the wax trial denture without additional laboratory investing, flasking, and processing. © 2013 by the American College of Prosthodontists.

  14. [Clinical-diagnostic estimation of carbohydrates metabolism in obturation jaundice].

    PubMed

    Nychytaĭlo, M Iu; Malyk, S V

    2004-07-01

    Complex examination of 175 patients with obturation jaundice was conducted, peculiar attention was spared to the carbohydrates metabolism changes, characterizing hepatic state. It was established, that in obturation jaundice in the liver there are occurring inflammatory changes and disturbances of all kinds of metabolism, including that of carbohydrates, severity of which depends on duration of jaundice, the concurrent diseases presence, they shows lowering of the glucose and glycogen level in the blood, as well as the hepatic glycogen content, that's why they may be applied as a complex of prognostic criterions for the disease course. An early conduction of operative treatment, elimination of the biliary ducts impassability promote the rehabilitation period shortening and the hepatic functional activity normalization.

  15. A simplified technique of orthograde MTA obturation on the elected canals of posterior teeth: Two case reports.

    PubMed

    Wahengbam, Brucelee; Wahengbam, Pragya; Tikku, Aseem Prakash

    2014-01-01

    This article suggests a simplified technique of orthograde MTA obturation in less accessible canal(s) of posteriors teeth without using costly ultrasonics or specialised carrier. Essentially few finger pluggers, absorbent points and a simple canal projection method were used. The orifice(s) of the elected canal(s) to be obturated with MTA were projected onto the external occlusal surface for easy delivery and predictive instrumentation. The idea was based on 'easy access', 'working one canal with one mix at one time', 'thorough condensation' and 'removal of excess moisture'. In case I, palatal canal of tooth no. 2 with gross apical perforation and suspected VRF was obturated with MTA. And in Case II, tooth no. 19 presented with incomplete furcal fracture extending into the canal was obturated with MTA in all 3 canals unitarily. Dense homogenous MTA obturation was achieved and both cases healed uneventfully.

  16. [A comparative study on treating femal stress urinary incontinence with TVT-Abbrevo and TVT-Obturator].

    PubMed

    Li, W L; Lu, Z W; Li, F P; Yu, H Y

    2016-07-26

    To compare the effectiveness and complications of TVT-Abbrevo (tension-free vaginal tape-Abbrevo) and TVT-Obturator (tension-free vaginal tape-obturator) for the treatment of female stress urinary incontinence (SUI). From Nov.2012 to Nov.2013, 117 patients suffering from SUI were treated with TVT-Abbrebo (n=79) or TVT-Obturator (n=38) procedure, the clinical efficacy and operation-correlated complications were observed. A total of 117 cases, 107 cases of urinary incontinence symptoms disappeared completely, 10 cases were improved. 72 cases (91.1%) were cured and 7 cases (8.9%) were improved in TVT-Abbrevo group; 35 cases (92.1%) were cured and 3 cases (7.9%) were improved in TVT-Obturator group. No significant differences could be found for the curing rates between two groups (P>0.05). Compared with the TVT-Obturator group, the TVT-Abbrevo group had less patients complaining of inner thigh pain at 24 h and 1 w after surgery (P<0.05). No significant differences were observed for the incidence of inner thigh pain at 1m and 1y after surgery between TVT-Abbrevo and TVT-Obturator group (P>0.05). No intraoperative complications such as blood vessel, nerve, bladder damage were recorded and no postoperative retropubic hematoma, tape adjustment and other complications occurred in two goups. No recurrence after 1 year follow-up. The study shows that TVT-Abbrevo procedure is safe and efficacy in treatment of SUI, and associated with low incidence of recent postoperative inner thigh pain.

  17. Evaluation of a New Thermoplastic Gutta Percha Obturation Technique Using 45Ca.

    DTIC Science & Technology

    1980-10-27

    Codes A,’lzi 1 and/or D 1 Spoe 0, ’ -mi ll .. ., , N .... i I .. hl i Ii n . .. . .. INTRODUCTION In the development of endodontic therapy, many types...of filling material have been used for obturation.1-3 Various techniques of obturation have also been employed. In present day endodontic therapy, the...primary objectives of endodontic therapy.3 ,6𔄁 Various radioisotopes have been utilized to evaluate the adequacy of the apical seal. 8-13 One

  18. Comparative evaluation of three obturation techniques in primary incisors using digital intra-oral receptor and C.B.C.T-an in vitro study.

    PubMed

    Akhil, Jose E J; Prashant, Babaji; Shashibushan, K K

    2018-05-10

    Successful pulpectomy in primary teeth depends on quality of obturation. It can be evaluated using digital intra-oral receptor (D.I.O.R) and cone beam computed tomography (C.B.C.T). The purposes of this study were to compare 3 different obturation techniques such as lentulospiral, insulin syringe, and endodontic plugger in primary incisors and to evaluate its quality of obturation using D.I.O.R and C.B.C.T technique. Thirty-three extracted primary incisors were biomechanically prepared and obturated with zinc oxide eugenol cement by 3 different obturation techniques. The obturation was evaluated for length of obturation and voids using D.I.O.R and C.B.C.T methods. There was a statistically significant difference between all the groups in length of obturation (P = 0.02) in both D.I.O.R and C.B.C.T. Significant differences (P = 0.03) were present in number of voids among 3 obturation techniques in C.B.C.T. Statistically more voids were observed with D.I.O.R in lentulospiral (P = 0.04) group and in insulin syringe (P = 0.02) group. Acceptable result was obtained with lentulospiral in length of obturation compared to insulin syringe and endodontic plugger technique. Insulin syringe technique resulted in increased underfilling with least number of voids. More number of voids were seen in middle one-third and least number of voids were observed at apical one third of the root among all the 3 techniques of obturation. The study concluded that void identification is improved with D.I.O.R compared to C.B.C.T. Lentulospiral reported effective length of obturation, while insulin syringe with least number of voids. D.I.O.R (2-Dimensional) is efficient in detecting voids compared to C.B.C.T (3-Dimensional) in obturated primary teeth.

  19. Microgap Evaluation of Novel Hydrophilic and Hydrophobic Obturating System: A Scanning Electron Microscope Study.

    PubMed

    Hegde, Vibha; Murkey, Laxmi Suresh

    2017-05-01

    The purpose of an endodontic obturation is to obtain a fluid tight hermetic seal of the entire root canal system. There has been an evolution of different materials and techniques to achieve this desired gap free fluid tight seal due to presence of anatomic complexity of the root canal system. To compare the microgap occurring in root canals obturated with hydrophilic versus hydrophobic systems using scanning electron microscope. Sixty extracted human single-rooted premolars were decoronated, instrumented using NiTi rotary instruments. The samples (n=20) were divided into three groups and obturated with Group A - (control group) gutta-percha with AH Plus, Group B - C-point with Smartpaste Bio and Group C - gutta-percha with guttaflow 2. The samples were split longitudinally into two halves and microgap was observed under scanning electron microscope in the apical 3 mm of the root canal. Group A (control) showed a mean difference of 8.54 as compared to 5.76 in group C. Group B showed the lowest mean difference of 0.83 suggesting that the hydrophilic system (C-point/Smartpaste Bio) produced least microgap as compared to the hydrophobic groups. Novel hydrophilic obturating system (C-points/ Smart-paste Bio) showed better seal and least microgap as compared to gutta-percha/guttaflow 2 and gutta-percha/ AH plus which showed gap at the sealer dentin interface due to less penetration and bonding of these hydrophobic obturating system.

  20. Effect of 95% Ethanol as a Final Irrigant before Root Canal Obturation in Primary Teeth: An in vitro Study.

    PubMed

    Thiruvenkadam, G; Asokan, Sharath; John, Baby; Priya, Pr Geetha

    2016-01-01

    Successful obturation in the primary teeth demands complete dryness of the root canal system. The purpose of this study was to determine the effect of 95% ethanol as the final irrigant before root canal obturation in primary teeth. A total of 20 extracted primary mandibular canines were biomechanically prepared and pre-obturated volume of each tooth was assessed using spiral computed tomography (CT). The specimens were divided into two groups (n = 10): group 1, Metapex group; group 2, zinc oxide eugenol group. Each group was further divided randomly into two subgroups (n = 5): subgroup 1, canals were dried with 95% ethanol; subgroup 2, canals were blot dried with paper points with the last one appearing dry. All canals were obturated and the postobturated volume of each tooth was measured. The percentage of obturated volume (POV) was calculated using the formula: (postobturated volume/preobturated volume) × 100. The POV between the groups was statistically analyzed using Mann-Whitney test and Wilcoxon Signed rank test appropriately. Root canals that were dried with ethanol showed better obturation than using paper points alone and the difference was statistically significant in both group 1 (p < 0.001) and group 2 (p < 0.002). Drying of the root canal system with 95% ethanol can result in better obturation in the primary teeth. How to cite this article: Thiruvenkadam G, Asokan S, John B, Geetha Priya PR. Effect of 95% Ethanol as a Final Irrigant before Root Canal Obturation in Primary Teeth: An in vitro Study. Int J Clin Pediatr Dent 2016;9(1):21-24.

  1. Comparative evaluation of endodontic pressure syringe, insulin syringe, jiffy tube, and local anesthetic syringe in obturation of primary teeth: An in vitro study.

    PubMed

    Hiremath, Mallayya C; Srivastava, Pooja

    2016-01-01

    The purpose of this in vitro study was to compare four methods of root canal obturation in primary teeth using conventional radiography. A total of 96 root canals of primary molars were prepared and obturated with zinc oxide eugenol. Obturation methods compared were endodontic pressure syringe, insulin syringe, jiffy tube, and local anesthetic syringe. The root canal obturations were evaluated by conventional radiography for the length of obturation and presence of voids. The obtained data were analyzed using Chi-square test. The results showed significant differences between the four groups for the length of obturation (P < 0.05). The endodontic pressure syringe showed the best results (98.5% optimal fillings) and jiffy tube showed the poor results (37.5% optimal fillings) for the length of obturation. The insulin syringe (79.2% optimal fillings) and local anesthetic syringe (66.7% optimal fillings) showed acceptable results for the length of root canal obturation. However, minor voids were present in all the four techniques used. Endodontic pressure syringe produced the best results in terms of length of obturation and controlling paste extrusion from the apical foramen. However, insulin syringe and local anesthetic syringe can be used as effective alternative methods.

  2. Echocardiographic demonstration of intracardiac glue after endoscopic obturation of gastroesophageal varices.

    PubMed

    Gallet, B; Zemour, G; Saudemont, J P; Renard, P; Hillion, M L; Hiltgen, M

    1995-01-01

    Systemic embolism is an unusual complication of endoscopic obturation of gastroesophageal varices with glue. This report describes a case of cerebral embolism after this procedure. Intracardiac glue within the left atrium was demonstrated by echocardiography. Cardiac fluoroscopy demonstrated an abnormal vessel connecting periesophageal veins with the right upper pulmonary vein. Cardiac surgery was performed. Intracardiac glue was removed and the entering orifice of the abnormal vessel in the right upper pulmonary vein was sutured. To our knowledge, this is the first reported case of intracardiac glue after variceal obturation. Echocardiography is useful in the diagnosis of this rare complication.

  3. Effects of different root canal obturation techniques on bacterial penetration.

    PubMed

    Yücel, Ali Cağin; Ciftçi, Alper

    2006-10-01

    The aim of this study was to compare bacterial penetration following obturation with 5 different techniques. This study was performed on 120 teeth including negative control (n = 10), positive control (n = 10), and experimental groups (n = 100). One hundred teeth were randomly divided into 5 groups of 20 teeth each and obturated with System B (Sb), Lateral Compaction (Lc), Thermafil (T), Single ProTaper Gutta-percha (P), and laterally compacted ProTaper Gutta-percha (PLc). Enterococcus faecalis was used for determination of the bacterial penetration. Evaluation was carried out for 60 days. At 30 days, the chi2 test showed that the slowest penetration was observed in Group Sb and Group PLc, which were not significantly different from each other. The fastest penetration in the all experimental groups was observed in Group T and Group P, which were not significantly different from one another. Also, there was no statistically significance difference (P > .05) among all groups at 60 days. It may be concluded that under the conditions of this study System B and laterally compacted ProTaper Gutta-percha prevent bacterial penetration of the root canal at 30 days. Furthermore, there was no difference among obturation techniques at 60 days.

  4. An In-Vitro Evaluation and Comparison of Apical Sealing Ability of Three Different Obturation Technique - Lateral Condensation, Obtura II, and Thermafil.

    PubMed

    Emmanuel, Samson; Shantaram, Kulkarni; Sushil, Kumar C; Manoj, Likhitkar

    2013-04-01

    Success of non-surgical root canal treatment is predicted by meticulous cleaning and shaping of the root canal system, three-dimensional obturation and a well-fitting "leakage-free" coronal restoration. The techniques of obturation that are available have their own relative position in the historical development of filling techniques. Over the years, pitfalls with one technique have often led to the development of newer methods of obturation, along with the recognition that no one method of obturation may satisfy all clinical cases. A total of 120 extracted human permanent anterior maxillary and mandibular single rooted teeth were selected for the present study and divided into 3 groups based on the method of obturation technique. Following the preparation the patency at the apical foramen was confirmed by passing a file #15. After obturation of all three groups, teeth were immersed in 1% of aqueous methylene blue dye for a period of two weeks and then samples were subjected to spectrophotometric analysis. The present study was conducted to evaluate in vitro the spectrophotometric analysis to quantitatively analyze relative amount of dye penetration using lateral condensation (Group I), Obtura II (Group II ), Thermafil obturating technique (Group III) with ZOE sealer used in all groups. Teeth obturated with lateral condensation (Group I) shows mean value of 0.0243 and standard deviation of 0.0056. The Group II thermoplasticized injectable moulded Guttapercha (Obtura II) showed 0.0239 mean and standard deviation value of 0.0045 and Group III Thermafil obturation technique shows 0.0189 as mean value and 0.0035 standard deviation values. Following conclusion was drawn from the present study. Group III i.e., Thermafil obturating technique shows minimum mean apical dye penetration compared to Group II (ObturaII) and Group I (lateral condensation).Lateral condensation shows maximum mean apical dye penetration in all three groups.There is no significant difference between

  5. A comparative In vivo efficacy of three spiral techniques versus incremental technique in obturating primary teeth.

    PubMed

    Chandrasekhar, Shalini; Prasad, Madu Ghanashyam; Radhakrishna, Ambati Naga; Saujanya, Kaniti; Raviteja, N V K; Deepthi, B; Ramakrishna, J

    2018-01-01

    The aim of this study was to evaluate the efficiency of four different obturating techniques in filling the radicular space in primary teeth. This clinical trial was carried out on 34 healthy, cooperative children (5-9 years) who had 63 carious primary teeth indicated for pulpectomy. They were divided into four groups, such that in each group, a total of 40 canals were allotted for obturation with respective technique. The root canals of selected primary teeth were filled with Endoflas obturating material using either bi-directional spiral (Group 1); incremental technique (Group 2), past inject (Group 3) or lentulo spiral (Group 4) according to the groups assigned. The effectiveness of the obturation techniques was assessed using postoperative radiographs. The assessment was made for a depth of fill in the canal, the presence of any voids using Modified Coll and Sadrian criteria. The obtained data were analyzed by using ANOVA test and unpaired t-test. Bi-directional spiral and lentulo spiral were superior to other techniques in providing optimally filled canals (P< 0.05). The bi-directional spiral was superior to lentulo spiral in preventing overfill (P< 0.05). Based on the present study results, bi-directional spiral can be recommended as an alternate obturating technique in primary teeth.

  6. A quantitative and qualitative analysis of ultrasonic versus sonic endodontic systems on canal cleanliness and obturation.

    PubMed

    Kanter, Valerie; Weldon, Emily; Nair, Uma; Varella, Claudio; Kanter, Keith; Anusavice, Kenneth; Pileggi, Roberta

    2011-12-01

    The purpose of this study was to compare 2 irrigation techniques by evaluating canal cleanliness and obturation of lateral/accessory canals. Seventy-five extracted canines were instrumented to a size #40/0.06 taper. The EndoActivator (EA) was compared with an ultrasonic unit for final irrigation. Each unit was used for 1 minute each with 6.15% NaOCl and 17% EDTA. A control group received syringe irrigation. Thirty teeth were sectioned and evaluated for debris removal and open dentinal tubules at 3/5 mm from the apical foramen with a scanning electron microscope. Forty-five teeth were examined for obturation of lateral canals. The EA was significantly better in removing debris at all levels when compared with other treatment groups (P < .05) and resulted in obturation of significantly more numbers of lateral canals (P < .01.) The EA provided better obturation of lateral and accessory canals and resulted in less remaining debris. Copyright © 2011 Mosby, Inc. All rights reserved.

  7. Effects of sociodemographic, treatment variables, and medical characteristics on quality of life of patients with maxillectomy restored with obturator prostheses.

    PubMed

    Artopoulou, Ioli Ioanna; Karademas, Evangelos C; Papadogeorgakis, Nikolaos; Papathanasiou, Ioannis; Polyzois, Gregory

    2017-12-01

    Restoration of maxillary defects resulting from tumor ablative surgery presents a difficult challenge, with both functional and esthetic issues. Whether rehabilitation with an obturator prosthesis could significantly contribute to improved quality of life in patients with maxillary resection has been scarcely studied, with relatively small study samples. The purpose of this survey study was to assess the overall functioning of the obturator prosthesis and the effect of specific sociodemographic, medical, and treatment variables on obturator functioning and quality of life in patients with maxillectomy. Global quality of life (QOL) and satisfaction with the obturator prosthesis of 57 patients who underwent maxillectomy and prosthetic rehabilitation at the National and Kapodistrian University of Athens were assessed using 3 questionnaires: European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 (QLQ-C30), the EORTC QLQ-HN35, and the obturator functioning scale. The data were analyzed using the Kruskal-Wallis 1-way ANOVA on ranks, hierarchical multiple regression analysis, and the Spearman rank order correlation (α=.05). Satisfactory functioning of the obturator prosthesis was the most significant predictor of improved QOL (P<.05). QOL was significantly related to additional treatments (P<.05), the size of the primary tumor (P<.05), and the size of the maxillectomy defect (P<.05). The most significant predictors of good obturator functioning were additional treatments (P<.01), age at the time of surgery (P<.05), presence of mandibular teeth (P<.05), and previous maxillary removable prosthetic experience (P<.05). Obturator functioning scale appearance and insertion subscales (r=0.47, P<.01), followed by speech (r=0.42, P<.01), were significantly related to better QOL. A well-functioning obturator prosthesis was the most significant determinant for improved QOL in patients with maxillary resection. Age at the time of surgery

  8. Influence of root canal instrumentation and obturation techniques on intra-operative pain during endodontic therapy

    PubMed Central

    Martín-González, Jenifer; Echevarría-Pérez, Marta; Sánchez-Domínguez, Benito; Tarilonte-Delgado, Maria L.; Castellanos-Cosano, Lizett; López-Frías, Francisco J.

    2012-01-01

    Objective: To analyse the influence of root canal instrumentation and obturation techniques on intra-operative pain experienced by patients during endodontic therapy. Method and Materials: A descriptive cross-sectional study was carried out in Ponferrada and Sevilla, Spain, including 80 patients (46 men and 34 women), with ages ranged from 10 to 74 years, randomly recruited. Patient gender and age, affected tooth, pulpal diagnosis, periapical status, previous NSAID or antibiotic (AB) treatment, and root canal instrumentation and obturation techniques were recorded. After root canal treatment (RCT), patients completed a 10-cm visual analogue scale (VAS) that ranked the level of pain. Results were analysed statistically using the Chi-square and ANOVA tests and logistic regression analysis. Results: The mean pain level during root canal treatment was 2.9 ± 3.0 (median = 2) in a VAS between 0 and 10. Forty percent of patients experienced no pain. Gender, age, arch, previous NSAIDs or AB treatment and anaesthetic type did not influence significantly the pain level (p > 0.05). Pain during root canal treatment was significantly greater in molar teeth (OR = 10.1; 95% C.I. = 1.6 - 63.5; p = 0.013). Root canal instrumentation and obturation techniques did not affect significantly patient’s pain during root canal treatment (p > 0.05). Conclusion: Patients feel more pain when RCT is carried out on molar teeth. The root canal instrumentation and obturation techniques do not affect significantly the patients’ pain during RCT. Key words:Anaesthesia, endodontic pain, pulpitis, root canal instrumentation, root canal obturation, rotary files. PMID:22549694

  9. Combined ultrasound and fluoroscopic guidance for radiofrequency ablation of the obturator nerve for intractable cancer-associated hip pain.

    PubMed

    Stone, Jonathan; Matchett, Gerald

    2014-01-01

    Management of pain from skeletal metastases is notoriously difficult. Case reports and case series have described radiofrequency ablation of the obturator nerve branches to the femoral head for treatment of intractable hip pain. Ablation of the obturator branches to the femoral head is technically difficult because of bony and vascular anatomy, including close proximity of the femoral vessels. Here we present the case of a 79-year-old woman with intractable right hip pain and inability to ambulate secondary to metastatic non-small cell lung cancer in the femoral head and acetabulum, treated with thermal radiofrequency ablation of the obturator and femoral nerve branches to the femoral head. Ablation of the obturator nerve was done via anterior placement of the radiofrequency needle under combined ultrasound and fluoroscopic guidance, passing the radiofrequency needle between the femoral artery and femoral vein. Real-time ultrasound guidance was used to avoid vascular puncture. Thermal radiofrequency ablation resulted in sustained pain relief, and resumption in the ability of the patient to ambulate. From this case we suggest that an anterior approach to the obturator nerve branches to the femoral head may be technically feasible using combined ultrasound and fluoroscopic guidance to avoid vascular puncture.

  10. Efficacy of ProTaper Retreatment System in Root Canals Obturated with Gutta-Percha Using Two Different Sealers and GuttaFlow

    PubMed Central

    Siotia, Jaya; Acharya, Shashi Rashmi; Gupta, Sunil Kumar

    2011-01-01

    Objective. To compare the efficacy of ProTaper retreatment files in removing three different obturating materials. Study Design. Forty-five human, single-rooted premolars were divided into three experimental groups. Group 1 was obturated with gutta-percha and AH Plus sealer, Group 2 was obturated with gutta-percha and zinc oxide eugenol sealer, and Group 3 was obturated with GuttaFlow. Retreatment was done using the ProTaper universal rotary retreatment files. Root halves were visualized using magnifying loops at 3X magnification and optical stereomicroscope at 10X magnification. Images were analyzed using AutoCAD 2004 software to calculate area of the remaining debris in the canal. For statistical analysis were used variance test and ANOVA. Results. Total debris/canal area ratio between the three groups showed a statistically significant difference (P < 0.001). Conclusion. ProTaper retreatment system did not produce completely clean canals in any of the groups. However, it had the best efficacy towards removing silicon based obturating material GuttaFlow. PMID:22114598

  11. The obturator oblique and iliac oblique/outlet views predict most accurately the adequate position of an anterior column acetabular screw.

    PubMed

    Guimarães, João Antonio Matheus; Martin, Murphy P; da Silva, Flávio Ribeiro; Duarte, Maria Eugenia Leite; Cavalcanti, Amanda Dos Santos; Machado, Jamila Alessandra Perini; Mauffrey, Cyril; Rojas, David

    2018-06-08

    Percutaneous fixation of the acetabulum is a treatment option for select acetabular fractures. Intra-operative fluoroscopy is required, and despite various described imaging strategies, it is debatable as to which combination of fluoroscopic views provides the most accurate and reliable assessment of screw position. Using five synthetic pelvic models, an experimental setup was created in which the anterior acetabular columns were instrumented with screws in five distinct trajectories. Five fluoroscopic images were obtained of each model (Pelvic Inlet, Obturator Oblique, Iliac Oblique, Obturator Oblique/Outlet, and Iliac Oblique/Outlet). The images were presented to 32 pelvic and acetabular orthopaedic surgeons, who were asked to draw two conclusions regarding screw position: (1) whether the screw was intra-articular and (2) whether the screw was intraosseous in its distal course through the bony corridor. In the assessment of screw position relative to the hip joint, accuracy of surgeon's response ranged from 52% (iliac oblique/outlet) to 88% (obturator oblique), with surgeon confidence in the interpretation ranging from 60% (pelvic inlet) to 93% (obturator oblique) (P < 0.0001). In the assessment of intraosseous position of the screw, accuracy of surgeon's response ranged from 40% (obturator oblique/outlet) to 79% (iliac oblique/outlet), with surgeon confidence in the interpretation ranging from 66% (iliac oblique) to 88% (pelvic inlet) (P < 0.0001). The obturator oblique and obturator oblique/outlet views afforded the most accurate and reliable assessment of penetration into the hip joint, and intraosseous position of the screw was most accurately assessed with pelvic inlet and iliac oblique/outlet views. Clinical Question.

  12. Rehabilitation of a One-day-Old Neonate with Cleft Lip and Palate using Palatal Obturator: A Case Report.

    PubMed

    Bansal, Rajesh; Kumar Pathak, Ashish; Bhatia, Baldev; Gupta, Sailesh; Kumar Gautam, Keshav

    2012-05-01

    Feeding a neonate with a complete cleft lip and palate is difficult pursuit due to communication between oral cavity and nasal cavity. A multidisciplinary approach is required to manage the complex problems involved in case of such neonates and their families. Present case is of a 1-day-old neonate having complete bilateral cleft lip and palate for which palatal obturator was constructed. A stepwise simple, easy and uncomplicated procedure for making accurate impressions, maxillary cast and fabrication of palatal obturator in infants with cleft lip and palate has been presented. The objective to present this case report is to emphasize the fact that how these palatal obturators /plates help in feeding, speech/language development, presurgical orthopedics and prevent other associated otorhinolaryngeal problems. How to cite this article: Bansal R, Pathak AK, Bhatia B, Gupta S, Gautam KK. Rehabilitation of a One-day Old Neonate with Cleft Lip and Palate using Palatal Obturator: A Case Report. Int J Clin Pediatr Dent 2012;5(2):145-147.

  13. Post-Obturation pain following one-visit and two-visit root canal treatment in necrotic anterior teeth.

    PubMed

    Rao, K Nandan; Kandaswamy, Raghavendra; Umashetty, Girish; Rathore, Vishnu Pratap Singh; Hotkar, Chetan; Patil, Basanagouda S

    2014-04-01

    To investigate and compare the post-obturation pain after one-visit and two-visit root canal treatment in non-vital anterior teeth. One hundred forty eight patients requiring root canal therapy on permanent anterior non-vital teeth with single root were included in this study. Patients were randomly assigned to either the one-appointment or the twoappointment group. The standardized protocol for all the teeth involved local anesthesia, isolation and access, engine-driven rotary nickel-titanium canal instrumentation with 2.5% NaOCl irrigation and obturation. Teeth in group 1 (n = 74) were obturated during the first appointment by using laterally condensed gutta-percha and resin sealer. Teeth in group 2 (n = 74) were given closed dressing and were obturated during the second appointment, 7 to 14 days later. A modified Visual Analogue Scale was used to measure pain after 6 hours, 24 hours, 48 hours and 7 days after the treatment. Statistical analysis was done to compare groups at each interval by using an independent-samples t test. The incidence and intensity of post-obturation pain in both Group 'A' and Group 'B' gradually reduced over the study period. When the incidence of pain was compared in the single and two visit group, it was found that the single-visit group experienced slightly less pain than the two-visit group during all study intervals, but the difference found was not statistically significant. There was no difference in postoperative pain between patients treated in only one appointment and patients treated in two appointments. The majority of patients in both groups reported no pain or only minimal pain after 7 days of treatment. How to cite the article: Rao KN, Kandaswamy R, Umashetty G, Rathore VP, Hotkar C, Patil BS. Post-Obturation pain following one-visit and two-visit root canal treatment in necrotic anterior teeth. J Int Oral Health 2014;6(2):28-32.

  14. [Rehabilitation by hollow obturator prosthesis immediately after total maxillectomy for malignant tumor].

    PubMed

    Li, Xiao-ye; Yan, Ai-hui; Hao, Shuai; Li, Wei; Jiang, Xue-jun; Lu, Li; Qin, Xing-jun; Yan, Hai-xin

    2011-05-01

    The feasibility and clinical effects of hollow obturator prosthesis for the repair of maxillofacial defect immediately after maxillectomy for cancer were assessed. Thirteen patients with T3-4aN0M0 maxillary neoplasm were treated by the prostheses immediately after maxillectomy. According to the 3D-CT reconstruction of nasal sinus, the 3D stereoscopic prototype was constructed before the surgery. Simulating surgery with Surgicare 5.0 software and then the prosthesis 3D stereoscopic model was shaped. The prosthesis was made quickly and precisely with methacrylate resins according to the model and the print mold before surgery, with supplementary tooth at the bottom of prosthesis. In the surgery, the prosthesis was installed instantly after maxillectomy. The patients were followed up at 1, 3 and 6 month after the surgery, respectively. The facial features and the pronunciation clarity were examined and the questionnaires were carried out in the patients, with comparation by paired t-test. The hollow obturator prosthesis would be replaced by permanent prosthesis made of methacrylate resins at 6 month after the surgery. The hollow obturator prostheses were installed accurately and maxillofacial defects were repaired immediately after maxillectomy in the 13 patients. Postoperative follow-up showed there were significant differences in eyeball sagging (t = 4.67, P < 0.05), mid-facial region collapse (t = 5.67, P < 0.05), and pronunciation clarity (t = 16.38, P < 0.05) between patients with and without prostheses. Questionnaires showed that all the patients were satisfied with the retention of prostheses, the improvement of appearance, the improvement of the symptom of water choking and speech definition. Six months after the surgery, the hollow obturator prostheses were replaced smoothly by permanent prostheses in 11 of the 13 patients. The precise and instant repair of maxillofacial defect by prosthesis after maxillectomy can improve survival quality of patient.

  15. Management of maxillectomy defect with a hybrid hollow bulb obturator

    PubMed Central

    Singh, Kamleshwar; Singh, Saumyendra V; Mishra, Niraj; Agrawal, Kaushal Kishor

    2013-01-01

    A woman having already undergone maxillectomy came to the department complaining of difficulty in eating and speech. During the construction of an obturator, the bulb area should be hollowed to reduce weight so that the teeth and supporting tissues are not stressed unnecessarily. The conventional open design drains fluid from the adjacent mucosa, possibly increasing the weight of the prosthesis, and is difficult to clean. The closed bulb design does not drain secretions and may cause obstruction and susceptibility to infection in the paranasal and pharyngeal regions, though it is easier to maintain. An alternative to the two designs, combining their advantages, is presented in this report. As the open hollow part of the obturator was shallow, it was easy to clean. Making the inferior part of the bulb hollow and closed led to a reduction in the overall weight of the prosthesis while increasing its resonance. PMID:23436886

  16. Influence of irrigation and obturation techniques on artificial lateral root canal filling capacity.

    PubMed

    Silva, Emmanuel J; Herrera, Daniel R; Souza-Júnior, Eduardo J; Teixeira, João M

    2013-01-01

    The aim of this study was to evaluate the influence of two different irrigation protocols on artificial lateral root canal filling capacity using different obturation techniques. Sixty single-root human teeth were used. Two artificial lateral canals were created in the apical third. Root canals were instrumented up to a 45 K-file to the working length. Before each file, root canals were irrigated either with 2 mL of 2.5% NaOCl or 2% chlorhexidine gel with further irrigation with saline solution and 3 mL of 17% EDTA. Specimens were randomly divided into three groups according to the obturation technique: (1) lateral compaction technique; (2) Tagger hybrid technique; and (3) thermoplasticized technique using BeeFill 2 in 1. All groups used AH Plus as the root canal sealer. The specimens were decalcified and cleared in methyl salicylate. The total length of lateral canals was observed under X30 magnification with a stereomicroscope and measured on the buccal and lingual root surfaces using Leica IM50 software. The data were submitted to ANOVA and Tukey test (p < 0.05). Among the obturation techniques, BeeFill 2 in 1 showed deeper penetration into all lateral canals than the lateral compaction or Tagger hybrid techniques (p < 0.05). The lateral compaction group showed the worst results (p < 0.05). Irrigants did not affect the outcome; there was no difference between NaOCl and chlorhexidine when the same obturation technique was used (p > 0.05). Regardless of the irrigant used during endodontic procedures, the thermoplasticized techniques showed higher penetration behavior for filling artificial lateral canals than the lateral compaction technique.

  17. Pollen tube access to the ovule is mediated by glycoprotein secretion on the obturator of apple (Malus × domestica, Borkh)

    PubMed Central

    Herrero, Maria

    2017-01-01

    Background and Aims Within the ovary, the obturator bridges the pathway of the pollen tube from the style to the ovule. Despite its widespread presence among flowering plants, its function has only been studied in a handful of species, and the molecules involved in pollen tube–obturator cross-talk have not been explored hitherto. This work evaluates the involvement of glucans and glycoproteins on pollen tube growth in the obturator of apple flowers (Malus × domestica). Methods Pollen tube kinetics were sequentially examined in the pistil and related to changes occurring on the obturator using histochemistry and inmunocytochemistry. To discriminate between changes in the obturator induced by pollen tubes from those developmentally regulated, both pollinated and unpollinated pistils were examined. Key Results Pollen tube growth rates were slow in the stigma, faster in the style and slow again in the ovary. The arrival of pollen tubes at the obturator was concomitant with the secretion of proteins, saccharides and glycoprotein epitopes belonging to extensins and arabinogalactan proteins (AGPs). While some of these secretions – extensins and AGPs labelled by JIM13 – were developmentally regulated, others – AGPs labelled by JIM8 – were elicited by the presence of pollen tubes. Following pollen tube passage, all these glycoproteins were depleted. Conclusions The results show a timely secretion of glycoproteins on the obturator surface concomitant with pollen tube arrival at this structure. The fact that their secretion is depleted following pollen tube passage strongly suggests their role in regulating pollen tube access to the ovule. Remarkably, both the regulation of the secretion of the different glycoproteins, as well as their association with the performance of pollen tubes exhibit similarities with those observed in the stigma, in line with their common developmental origin. PMID:28137704

  18. Pollen tube access to the ovule is mediated by glycoprotein secretion on the obturator of apple (Malus × domestica, Borkh).

    PubMed

    Losada, Juan M; Herrero, Maria

    2017-04-01

    Within the ovary, the obturator bridges the pathway of the pollen tube from the style to the ovule. Despite its widespread presence among flowering plants, its function has only been studied in a handful of species, and the molecules involved in pollen tube-obturator cross-talk have not been explored hitherto. This work evaluates the involvement of glucans and glycoproteins on pollen tube growth in the obturator of apple flowers ( Malus × domestica) . Pollen tube kinetics were sequentially examined in the pistil and related to changes occurring on the obturator using histochemistry and inmunocytochemistry. To discriminate between changes in the obturator induced by pollen tubes from those developmentally regulated, both pollinated and unpollinated pistils were examined. Pollen tube growth rates were slow in the stigma, faster in the style and slow again in the ovary. The arrival of pollen tubes at the obturator was concomitant with the secretion of proteins, saccharides and glycoprotein epitopes belonging to extensins and arabinogalactan proteins (AGPs). While some of these secretions - extensins and AGPs labelled by JIM13 - were developmentally regulated, others - AGPs labelled by JIM8 - were elicited by the presence of pollen tubes. Following pollen tube passage, all these glycoproteins were depleted. The results show a timely secretion of glycoproteins on the obturator surface concomitant with pollen tube arrival at this structure. The fact that their secretion is depleted following pollen tube passage strongly suggests their role in regulating pollen tube access to the ovule. Remarkably, both the regulation of the secretion of the different glycoproteins, as well as their association with the performance of pollen tubes exhibit similarities with those observed in the stigma, in line with their common developmental origin. © The Author 2017. Published by Oxford University Press on behalf of the Annals of Botany Company. All rights reserved. For Permissions

  19. Clinical and radiographic evaluation of zinc oxide with aloe vera as an obturating material in pulpectomy: an in vivo study.

    PubMed

    Khairwa, Abhishek; Bhat, Manohar; Sharma, Rajesh; Satish, V; Maganur, Prabhadevi; Goyal, Anil Kumar

    2014-01-01

    Pulp therapy for pulpally involved primary teeth continues to be a challenge to clinicians. One of the major areas of continued research is in the area of finding obturating materials to suit the specific properties of these teeth. Zinc oxide eugenol is used frequently in pulpectomy for the obturation of the primary teeth. To evaluate clinically and radiographically a mixture of zinc oxide eugenol and aloe vera as an obturating material. A total of 50 children, aged between 4 and 9 years, who were screened for unilateral or bilateral carious deciduous molars were studied. Out of these, 15 children were randomly selected for endodontic treatment. Obturation was done with a mixture of zinc oxide powder and aloe vera gel. Clinical and radiographic evaluation was done after 7 days, 1 month, 3 months, 6 months, and 9 months. The data were statistically analyzed. Endodontic treatment using a mixture of zinc oxide powder and aloe vera gel in primary teeth has shown good clinical and radiographic success. A detailed observational study with longer follow-up will highlight the benefits of aloe vera in primary teeth as an obturating medium.

  20. Sciatica and claudication caused by ganglion cyst.

    PubMed

    Yang, Guang; Wen, Xiaoyu; Gong, Yubao; Yang, Chen

    2013-12-15

    Case report. We report a rare case that a ganglion cyst compressed the sciatic nerve and caused sciatica and claudication in a 51-year-old male. Sciatica and claudication commonly occurs in spinal stenosis. To our knowledge, only 4 cases have been reported on sciatica resulting from posterior ganglion cyst of hip. A 51-year-old male had a 2-month history of radiating pain on his right leg. He could only walk 20 to 30 m before stopping and standing to rest for 1 to 3 minutes. Interestingly, he was able to walk longer distances (about 200 m) when walking slowly in small steps, without any rest. He had been treated as a case of lumbar disc herniation, but conservative treatment was ineffective. On buttock examination, a round, hard, and fixative mass was palpated at the exit of the sciatic nerve. MR imaging of hip revealed a multilocular cystic mass located on the posterior aspect of the superior gemellus and obturator internus, compressing the sciatic nerve. On operation, we found that the cyst extended to the superior gemellus and the obturator internus, positioned right at the outlet of the sciatic nerve. At 18 months of follow-up, the patient continued to be symptom free. He returned to comprehensive physical activity with no limitations. For an extraspinal source, a direct compression on the sciatic nerve also resulted in sciatica and claudication. A meticulous physical examination is very important for the differential diagnosis of extraspinal sciatica from spinal sciatica.

  1. Sealing properties of one-step root-filling fibre post-obturators vs. two-step delayed fibre post-placement.

    PubMed

    Monticelli, Francesca; Osorio, Raquel; Toledano, Manuel; Ferrari, Marco; Pashley, David H; Tay, Franklin R

    2010-07-01

    The sealing properties of a one-step obturation post-placement technique consisting of Resilon-capped fibre post-obturators were compared with a two-step technique based on initial Resilon root filling following by 24h-delayed fibre post-placement. Thirty root segments were shaped to size 40, 0.04 taper and filled with: (1) InnoEndo obturators; (2) Resilon/24h-delayed FibreKor post-cementation. Obturator, root filling and post-cementation procedures were performed using InnoEndo bonding agent/dual-cured root canal sealer. Fluid flow rate through the filled roots was evaluated at 10psi using a computerised fluid filtration model before root resection and after 3 and 9mm apical resections. Fluid flow data were analysed using two-way repeated measures ANOVA and Tukey test to examine the effects of root-filling post-placement techniques and root resection lengths on fluid leakage from the filled canals (alpha=0.05). A significantly greater amount of fluid leakage was observed with the one-step technique when compared with two-step technique. No difference in fluid leakage was observed among intact canals and canals resected at different lengths for both materials. The seal of root canals achieved with the one-step obturator is less effective than separate Resilon root fillings followed by a 24-h delay prior to the fibre post-placement. Incomplete setting of the sealer and restricted relief of polymerisation shrinkage stresses may be responsible for the inferior seal of the one-step root-filling/post-restoration technique. Copyright 2010 Elsevier Ltd. All rights reserved.

  2. SPEECH EVALUATION WITH AND WITHOUT PALATAL OBTURATOR IN PATIENTS SUBMITTED TO MAXILLECTOMY

    PubMed Central

    de Carvalho-Teles, Viviane; Pegoraro-Krook, Maria Inês; Lauris, José Roberto Pereira

    2006-01-01

    Most patients who have undergone resection of the maxillae due to benign or malignant tumors in the palatomaxillary region present with speech and swallowing disorders. Coupling of the oral and nasal cavities increases nasal resonance, resulting in hypernasality and unintelligible speech. Prosthodontic rehabilitation of maxillary resections with effective separation of the oral and nasal cavities can improve speech and esthetics, and assist the psychosocial adjustment of the patient as well. The objective of this study was to evaluate the efficacy of the palatal obturator prosthesis on speech intelligibility and resonance of 23 patients with age ranging from 18 to 83 years (Mean = 49.5 years), who had undergone inframedial-structural maxillectomy. The patients were requested to count from 1 to 20, to repeat 21 words and to spontaneously speak for 15 seconds, once with and again without the prosthesis, for tape recording purposes. The resonance and speech intelligibility were judged by 5 speech language pathologists from the tape recordings samples. The results have shown that the majority of patients (82.6%) significantly improved their speech intelligibility, and 16 patients (69.9%) exhibited a significant hypernasality reduction with the obturator in place. The results of this study indicated that maxillary obturator prosthesis was efficient to improve the speech intelligibility and resonance in patients who had undergone maxillectomy. PMID:19089242

  3. Effect of different intraorifice barriers on the fracture resistance of roots obturated with Resilon or gutta-percha.

    PubMed

    Nagas, Emre; Uyanik, Ozgur; Altundasar, Emre; Durmaz, Veli; Cehreli, Zafer C; Vallittu, Pekka K; Lassila, Lippo V J

    2010-06-01

    This study investigated and compared the root reinforcement potential of 3 different intraorifice barriers (mineral trioxide aggregate [MTA], resin-modified glass ionomer cement [Vitremer], and fiber-reinforced composite [FRC]) placed over root canals obturated with gutta-percha or Resilon. Crowns of 80 extracted human mandibular premolars were sectioned off to obtain 14-mm-long root specimens. After preparation of root canals with nickel-titanium rotary files, the roots were obturated with either the Resilon/Epiphany system or gutta-percha + AH Plus sealer. In both obturation groups, specimens were further subgrouped with respect to the intraorifice barrier material placed after removal of 3-mm coronal portion of the root fillings: (1) MTA, (2) Vitremer, and (3) FRC. The specimens were loaded vertically at 1 mm/min crosshead speed until vertical root fracture occurred. Results were evaluated statistically with two-way analysis of variance and Tukey tests. Fracture resistance of roots was significantly affected by the type of intraorifice barrier (P < .05), but not by the type of obturation system used (P > .05). The use of Vitremer and FRC significantly improved the fracture resistance, whereas MTA did not exhibit any reinforcing effect as an intraorifice barrier. Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  4. Ability of New Obturation Materials to Improve the Seal of the Root Canal System – A Review

    PubMed Central

    Zhang, Wei; Olsen, Mark; De-Deus, Gustavo; Eid, Ashraf A.; Chen, Ji-hua; Pashley, David H.; Tay, Franklin R.

    2014-01-01

    Objectives New obturation biomaterials have been introduced over the past decade to improve the seal of the root canal system. However, it is not clear whether they have really produced a three-dimensional impervious seal that is important for reducing diseases associated with root canal treatment. Methods A review of the literature was performed to identify models that have been employed for evaluating the seal of the root canal system. Results and Significance In-vitro and in-vivo models are not totally adept at quantifying the seal of root canals obturated with classic materials. Thus, one has to resort to clinical outcomes to examine whether there are real benefits associated with the use of recently-introduced materials for obturating root canals. However, there is no facile answer because endodontic treatment outcomes are influenced by a host of other predictors that are more likely to take precedence over the influence of obturation materials. From the perspective of clinical performance, classic root filling materials have stood the test of time. Because many of the recently-introduced materials are so new, there is not enough evidence yet to support their ability to improve clinical performance. This emphasizes the need to translate anecdotal information into clinically relevant research data on new biomaterials. PMID:24321349

  5. Effectiveness of spinal anesthesia combined with obturator nerve blockade in preventing adductor muscle contraction during transurethral resection of bladder tumor

    PubMed Central

    Alavi, Cyrus Emir; Asgari, Seyed Alaeddin; Falahatkar, Siavash; Rimaz, Siamak; Naghipour, Mohammadreza; Khoshrang, Hossein; Jafari, Mehdi; Herfeh, Nadia

    2017-01-01

    Objective To determine whether spinal anesthesia combined with obturator nerve blockade (SOB) is effective in preventing obturator nerve stimulation, jerking and bladder perforation during transurethral resection of bladder tumor (TURBT). Material and methods In this clinical trial, 30 patients were randomly divided into two groups: spinal anesthesia (SA) and SOB. In SA group, 2.5 cc of 0.5% bupivacaine was injected intrathecally using a 25-gauge spinal needle and in SOB after spinal anesthesia, a classic obturator nerve blockade was performed by using nerve stimulation technique. Results There was a statistically significant difference between jerking in both groups (p=0.006). During the TURBT, surgeon satisfaction was significantly higher in SOB group compared to SA group (p=0.006). There was no significant correlation between sex, patient age and location of bladder tumor between the groups (p>0.05). Conclusion Obturator nerve blockade by using 15 cc lidocaine 1% is effective in preventing adductor muscle spasms during TURBT. PMID:29201516

  6. Finite element analysis of maxillary bone stress caused by Aramany Class IV obturator prostheses.

    PubMed

    Miyashita, Elcio Ricardo; Mattos, Beatriz Silva Câmara; Noritomi, Pedro Yoshito; Navarro, Hamilton

    2012-05-01

    The retention of an Aramany Class IV removable partial dental prosthesis can be compromised by a lack of support. The biomechanics of this obturator prosthesis result in an unusual stress distribution on the residual maxillary bone. This study evaluated the biomechanics of an Aramany Class IV obturator prosthesis with finite element analysis and a digital 3-dimensional (3-D) model developed from a computed tomography scan; bone stress was evaluated according to the load placed on the prosthesis. A 3-D model of an Aramany Class IV maxillary resection and prosthesis was constructed. This model was used to develop a finite element mesh. A 120 N load was applied to the occlusal and incisal platforms corresponding to the prosthetic teeth. Qualitative analysis was based on the scale of maximum principal stress; values obtained through quantitative analysis were expressed in MPa. Under posterior load, tensile and compressive stresses were observed; the tensile stress was greater than the compressive stress, regardless of the bone region, and the greatest compressive stress was observed on the anterior palate near the midline. Under an anterior load, tensile stress was observed in all of the evaluated bone regions; the tensile stress was greater than the compressive stress, regardless of the bone region. The Aramany Class IV obturator prosthesis tended to rotate toward the surgical resection when subjected to posterior or anterior loads. The amount of tensile and compressive stress caused by the Aramany Class IV obturator prosthesis did not exceed the physiological limits of the maxillary bone tissue. (J Prosthet Dent 2012;107:336-342). Copyright © 2012 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.

  7. Three tumor patients with total maxillectomy rehabilitated with implant-supported frameworks and maxillary obturators: a follow-up report.

    PubMed

    Örtorp, Anders

    2010-12-01

    Few reports are available on treatment using implant-supported frameworks with maxillary obturators after total maxillectomy on tumor patients. To describe, evaluate, and report the clinical and radiographic performance of implant-supported frameworks and maxillary obturators after maxillectomy during the first years of function. Three patients with cancer in the maxillary region treated by total maxillectomy were rehabilitated. Seventeen dental and two craniofacial implants were installed, and the patients each received implant-supported, screw-retained, three-unit frameworks with a U-shaped bar and obturators retained by four magnetic attachments. Clinical and radiographic data were collected up to 7 years of follow-up. The frequency of complications was low. Two craniofacial implants and one dental implant were loose and removed at abutment connection. No implants were lost after framework connection, and the mean marginal bone loss was small. Within the limitations of this report, dental implants are useful for rehabilitation of total maxillectomy patients, and a three-unit, screw-retained, implant-supported framework with maxillary obturator retained by magnetic attachment is a successful treatment concept for this patient group. © 2009, Copyright the Author. Journal Compilation © 2010, Wiley Periodicals, Inc.

  8. Neuronal activity in the globus pallidus internus in patients with tics.

    PubMed

    Zhuang, P; Hallett, M; Zhang, X; Li, J; Zhang, Y; Li, Y

    2009-10-01

    To explore the role of neuronal activity in the globus pallidus internus (GPi) in the generation of tic movements. 8 patients with Tourette's syndrome with medically intractable tics who underwent a unilateral pallidotomy for severe tics were studied. They ranged in age from 17 to 24 years; disease duration was 7-19 years. Microelectrode recording was performed in the GPi. The electromyogram (EMG) was simultaneously recorded in muscle groups appropriate for the patient's tics. The relationship between neuronal firing pattern and the EMG was studied. 232 neurons were recorded during tics from eight trajectories. Of these neurons, in addition to decreased neuronal firing rate and irregular firing pattern, 105 (45%) were tic related showing either a burst of activity or a pause in ongoing tonic activity. They could be synchronous (n = 75), earlier than EMG onset (n = 27) or following EMG onset (n = 3). The GPi neuronal bursts preceded EMG onset with decreased (n = 6) or increased activity (n = 21). The initial change in neural activity occurred about 50 ms to 2 s before the EMG onset. Although the data are descriptive and preliminary, the tic related neuronal activity observed in GPi appears to indicate that the basal ganglia motor circuit is involved in tic movements. The early neuronal activity seen in GPi may reflect premonitory sensations that precede a tic.

  9. Case Presentation of Two Maxillectomy Patients Restored with Two-piece Hollow Bulb Obturator Retained using Two Different Types of Magnets.

    PubMed

    Parameswari, B Devi; Rajakumar, M; Jagadesaan, N; Annapoorni, H

    2017-11-01

    Palatal defect can be repaired by reconstructive surgery and/or a dental prosthesis. We present prosthodontic rehabilitation of two partially edentulous patients, both with surgically induced palatal defect and explains how to achieve the goal for esthetics and phonetics. This also describes the fabrication of a hollow obturator by two piece method, which is simple and may be used as definitive obturator for maximum comfort of the patient. In both the above cases, since the mouth opening is restricted due to surgery, obturator prosthesis is given as two pieces retained with opposite poles of magnet, which facilitates the removal and insertion of the prosthesis.

  10. Novel application of internal obturator and semitendinosus muscle flaps for rectal wall repair or reinforcement.

    PubMed

    Riggs, J; Ladlow, J F; Owen, L J; Hall, J L

    2018-01-29

    Internal obturator and/or semitendinosus muscle flaps were used to reinforce primary appositional rectal wall repair in three dogs and one cat in this case series. All three dogs incurred rectal wall compromise during surgical excision of anal sac tumours. The cat sustained bite wounds to the perianal region resulting in abscessation and a rectal tear. Our results indicate that application of an internal obturator and/or semitendinosus muscle flap can reduce the risk of rectal wall dehiscence after primary repair, and consequently the risk of pararectal abscess or rectocutaneous fistula formation. © 2018 British Small Animal Veterinary Association.

  11. Effect of different root canal obturating materials on push-out bond strength of a fiber dowel.

    PubMed

    Aggarwal, Vivek; Singla, Mamta; Miglani, Sanjay; Kohli, Sarita

    2012-07-01

    During dowel space preparation, the instrumentation forms a thick smear layer along with sealer-occluded dentinal tubules. The purpose of this study was to evaluate the effect of different obturating materials on push-out bond strength of a fiber dowel. Fifty human uniradicular teeth were decoronated and prepared using the step-back technique. The specimens were divided into five groups on the basis of obturating materials: group I received no obturation; group II (ZOE) gutta-percha and zinc oxide eugenol sealer; group III (ZOAH) gutta-percha and AH plus sealer; group IV (GF) GuttaFlow; and group V (RE) with Resilon Epiphany system. Dowel spaces were made with manufacturer's provided drills, and a fiber dowel was luted. Horizontal slices were obtained from the middle third, and push-out bond strength (S) was evaluated. Statistical analysis was carried out using one-way ANOVA and post hoc Tukey's test. The push-out bond strength values in the control group, ZOE, ZOAH, GF, and RE were 9.303 ± 0.565 MPa, 8.859 ± 0.539 MPa, 8.356 ± 0.618 MPa, 9.635 ± 0.435 MPa, and 8.572 ± 0.256 MPa, respectively. There was no statistically significant difference between the S values of all the groups (p > 0.05). There was no effect of different tested obturating materials on the push-out bond strength of fiber dowels; however, further studies should be conducted. © 2012 by the American College of Prosthodontists.

  12. Bacterial entombment by intratubular mineralization following orthograde mineral trioxide aggregate obturation: a scanning electron microscopy study

    PubMed Central

    Yoo, Jun Sang; Chang, Seok-Woo; Oh, So Ram; Perinpanayagam, Hiran; Lim, Sang-Min; Yoo, Yeon-Jee; Oh, Yeo-Rok; Woo, Sang-Bin; Han, Seung-Hyun; Zhu, Qiang; Kum, Kee-Yeon

    2014-01-01

    The time domain entombment of bacteria by intratubular mineralization following orthograde canal obturation with mineral trioxide aggregate (MTA) was studied by scanning electron microscopy (SEM). Single-rooted human premolars (n=60) were instrumented to an apical size #50/0.06 using ProFile and treated as follows: Group 1 (n=10) was filled with phosphate buffered saline (PBS); Group 2 (n=10) was incubated with Enterococcus faecalis for 3 weeks, and then filled with PBS; Group 3 (n=20) was obturated orthograde with a paste of OrthoMTA (BioMTA, Seoul, Korea) and PBS; and Group 4 (n=20) was incubated with E. faecalis for 3 weeks and then obturated with OrthoMTA–PBS paste. Following their treatments, the coronal openings were sealed with PBS-soaked cotton and intermediate restorative material (IRM), and the roots were then stored in PBS for 1, 2, 4, 8 or 16 weeks. After each incubation period, the roots were split and their dentin/MTA interfaces examined in both longitudinal and horizontal directions by SEM. There appeared to be an increase in intratubular mineralization over time in the OrthoMTA-filled roots (Groups 3 and 4). Furthermore, there was a gradual entombment of bacteria within the dentinal tubules in the E. faecalis inoculated MTA-filled roots (Group 4). Therefore, the orthograde obturation of root canals with OrthoMTA mixed with PBS may create a favorable environment for bacterial entombment by intratubular mineralization. PMID:25012869

  13. Ten-Year Followup after Tension-Free Vaginal Tape-Obturator Procedure for Stress Urinary Incontinence.

    PubMed

    Ulrich, Daniela; Tammaa, Ayman; Hölbfer, Susanne; Trutnovsky, Gerda; Bjelic-Radisic, Vesna; Tamussino, Karl; Aigmüller, Thomas

    2016-10-01

    Suburethral tapes are a standard surgical treatment for stress urinary incontinence. The aim of the study was to evaluate subjective and objective cure rates 10 years after a tension-free vaginal tape-obturator procedure. All 124 patients who underwent the tension-free vaginal tape-obturator procedure at a total of 2 centers in 2004 and 2005 were invited for followup. Objective cure was defined as a negative cough stress test at 300 ml. Subjects completed KHQ (King's Health Questionnaire), IOQ (Incontinence Outcome Questionnaire), FSFI (Female Sexual Function Index Questionnaire) and PGI-I (Patient Global Impression of Improvement). Overall, 55 of 112 women (49%) who were alive were available for clinical examination and 71 (63%) completed the questionnaires. The objective cure rate in the 55 women examined clinically was 69%, 22% were not cured and 9% (5) had undergone reoperation for recurrent or persistent stress urinary incontinence. Treatment was counted as having failed in these 5 women for study purposes. Subjective cure was reported by 45 of 71 women (64%). Three patients (5%) had vaginal tape extrusion at the time of clinical examination. Extrusion in all of them was small and asymptomatic, and did not require treatment for a cumulative extrusion rate of 7%. Six women (9%) had undergone reoperation for tension-free vaginal tape-obturator associated complications and 18 (26%) experienced de novo overactive bladder. Subjective and objective cure rates 10 years after the tension-free vaginal tape-obturator procedure were 69% and 64%, respectively. The vaginal extrusion rate in this study was slightly higher than in other series but major long-term complications appeared to be rare. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  14. Oromaxillary Prosthetic Rehabilitation of a Maxillectomy Patient Using a Magnet Retained Two-Piece Hollow Bulb Definitive Obturator; A Clinical Report

    PubMed Central

    Mohamed Usman, Jafar Abdulla; Ayappan, Anuroopa; Ganapathy, Dhanraj; Nasir, Nilofer Nisha

    2013-01-01

    Resection of a malignant lesion involving the maxilla produces severe oromaxillary defect that can seriously jeopardize the normal phonetics of the patient. These defects are effectively managed by well-designed and fabricated obturator. This paper discusses the oromaxillary prosthetic rehabilitation of a maxillectomy patient using a magnet retained two-piece hollow bulb definitive obturator. PMID:23533823

  15. Postoperative pain after one-visit root-canal treatment on teeth with vital pulps: Comparison of three different obturation technique

    PubMed Central

    Alonso-Ezpeleta, Luis O.; Gasco-Garcia, Carmen; Castellanos-Cosano, Lizett; Martín-González, Jenifer; López-Frías, Francsico J.

    2012-01-01

    Objectives. To investigate and compare postoperative pain after one-visit root canal treatment (RCT) on teeth with vital pulps using three different obturation techniques. Study Design. Two hundred and four patients (105 men and 99 women) aged 12 to 77 years were randomly assigned into three treatments groups: cold lateral compaction of gutta-percha (LC), Thermafil technique (TT), and Backfill - Thermafil obturation technique (BT). Postoperative pain was recorded on a visual analogue scale (VAS) of 0 - 10 after 2 and 6 hours, and 1, 2, 3, 4, 5, 6 and 7 days. Data were statistically analyzed using multivariate logistic regression analysis. Results. In the total sample, 87% of patients experienced discomfort or pain in some moment between RCT and the seventh day. The discomfort experienced was weak, light, moderate and intense in 6%, 44%, 20% and 6% of the cases, respectively. Mean pain levels were 0.4 ± 0.4, 0.4 ± 0.3, and 1.4 ± 0.7 in LC, BT, and TT groups, respectively. Patients of TT group experienced a significantly higher mean pain level compared to other two groups (p < 0.0001). In TT group, all patients felt some level of pain at six hours after RCT. Conclusions. Postoperative pain was significantly associated with the obturation technique used during root canal treatment. Patients whose teeth were filled with Thermafil obturators (TT technique) showed significantly higher levels of discomfort than patients whose teeth were filled using any of the other two techniques. Key words:Postoperative pain, root-canal obturation, root-canal treatment, Thermafil. PMID:22322522

  16. Effect of Instrument Design and Access Outlines on the Removal of Root Canal Obturation Materials in Oval-shaped Canals.

    PubMed

    Niemi, Tuomas K; Marchesan, Melissa A; Lloyd, Adam; Seltzer, Robert J

    2016-10-01

    The aim of this study was to compare the effectiveness of TRUShape (TS) instruments with ProFile Vortex Blue (VB) instruments for the removal of obturation materials during retreatment of single-canal mandibular premolars performed through 2 access outlines. Initial root canal treatment was completed through a contracted endodontic cavity (CEC) design. Canals were instrumented to an F2 ProTaper instrument, obturated with warm lateral condensation of gutta-percha with AH Plus sealer, and allowed to set for 30 days at 37°C and 100% humidity. For retreatment, specimens were divided into 2 groups (n = 24) on the basis of access outline, CEC or traditional endodontic cavity (TEC). Retreatment was initiated by using ProTaper Retreatment instruments (D1-D3). Specimens were then stratified, further divided (n = 12), and reinstrumented up to TS 40 .06v or 40 .06 VB. Irrigation was performed by using 8.25% NaOCl and QMix 2in1. Retreatment time was recorded. Teeth were sectioned and photographed, and the percentage of remaining obturation materials was measured. Data were analyzed with Kruskal-Wallis analysis of variance for two-factor tests (α < 0.05). The interaction between access design and instrument type showed that the combination of CEC-VB presented significantly higher amounts of remaining obturation materials on the canal surface when compared with TEC-VB, CEC-TS, and TEC-TS (P ≤ .05). None of these other combinations were different from each other (P > .05). Significantly more time was required for retreatment with CEC-TS (27.68 ± 1.4 minutes) than the other groups (P < .05). Neither retreatment protocol was able to completely eliminate all obturation materials from the root canal surface of mandibular premolars. However, in the presence of a CEC access design, using TS instruments removed more obturating material in single-rooted, oval-shaped canals. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights

  17. Presence of Voids after Continuous Wave of Condensation and Single-cone Obturation in Mandibular Molars: A Micro-computed Tomography Analysis.

    PubMed

    Iglecias, Elaine Faga; Freire, Laila Gonzales; de Miranda Candeiro, George Táccio; Dos Santos, Marcelo; Antoniazzi, João Humberto; Gavini, Giulio

    2017-04-01

    The objective of this study was to assess the presence of voids in mesial root canals of mandibular molar teeth obturated by using the single-cone (SC) and continuous wave of condensation (CWC) obturation techniques, and results were analyzed by using micro-computed tomography. Twenty-four mandibular molars with fully developed roots and mesial root curvature ranging from 25° to 35° were instrumented by using Reciproc R25 files, and then they were obturated by using the SC and CWC techniques. Specimens were scanned before and after obturation for micro-computed tomography analysis (voxel size, 17.42 μm). After volumetric analysis and tridimensional reconstruction of the root canals, data were analyzed by using analysis of variance and the Tukey test. No significant differences were observed between the 2 techniques in terms of total percentage volume of voids: CWC = 3.91% ± 0.72%; SC = 6.52% ± 1.16% (P > .05). Only in the cervical third, CWC showed a significantly lower percentage of voids when compared with SC, namely 2.86% ± 0.94% vs 8.00% ± 1.86%, respectively (P < .05). The percentage volume of voids was similar in the 2 groups and was influenced by the obturation technique only in the cervical third. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  18. In vitro comparison of gutta-percha-filled area percentages in root canals instrumented and obturated with different techniques.

    PubMed

    Yilmaz, Ayca; Karagoz-Kucukay, Isil

    2017-01-01

    To evaluate the efficacy of different obturation techniques in root canals instrumented either by hand or rotary instruments with regard to the percentage of gutta- percha-filled area (PGFA). One hundred and sixty extracted mandibular premolars with single, straight root canals were studied. Root canals were prepared to an apical size of 30 by hand with a modified crown-down technique or the ProTaper and HEROShaper systems. Teeth were divided into eight groups (n=20) according to the following instrumentation and obturation techniques: G1: Hand files+lateral condensation (LC), G2: Hand files+Thermafil, G3: ProTaper+LC, G4: ProTaper+single-cone, G5: ProTaper+ProTaper-Obturator, G6: HEROShaper+LC, G7: HEROShaper+single-cone, G8: HEROShaper+HEROfill. Horizontal sections were cut at 1, 3, 5, 7, 9, 11 and 13 mm from the apical foramen. A total of 1120 sections obtained were digitally photographed under a stereomicroscope set at 48X magnification. The cross-sectional area of the canal and the gutta-percha was measured by digital image analysis and the PGFA was calculated for each section. The mean of the PGFA in Thermafil (G2), ProTaper-Obturator (G5) and HEROfill (G8) groups was significantly higher than the other groups. In G3 and G4, PGFA showed no significant difference in the apical segments whereas PGFA was significantly higher at the middle and coronal segments in G3. In G6 and G7, PGFA showed no significant difference in the apical and middle segments whereas PGFA was significantly higher at the coronal segments in G6. The carrier-based gutta-percha obturation systems revealed significantly higher PGFA in comparison to single-cone and lateral condensation techniques.

  19. [Primary pyomyositis of the psoas muscles in a temperate climate. Review of two cases in children followed up over the long term].

    PubMed

    García-Mata, S; Hidalgo, A; Esparza, J

    2006-01-01

    We review two cases of primary pyomyositis of the psoas in children that occurred in Navarre, their management and long-term evolution. Primary pyomyositis of the psoas muscle is a rare infection in a temperate climate. Its diagnosis is difficult due to the similarity of the symptoms with several infectious processes, mainly septic arthritis of the hip in children and adolescents. The rarity of the present cases is due to several facts: occurrence in children, in a temperate climate (Navarre), immunocompetent patients and without subjacent pathology, besides their monofocal situation that is contrary to the more frequent multifocal presentation. These factors, besides the poor specificity of the symptoms, constitute a diagnostic challenge. We present two patients (10 and 12 years old) with fever and a painful hip. Neither of the patients had predisposing factors. Both of them showed hip flexion with limited range of motion in rotations. Confirmation of the diagnosis was made by ultrasound, CT-scan and/or MRI. Needle aspiration of the hip, under general anaesthesia, confirmed the reactive origin of the joint effusion in both patients. In neither of the two cases was there a significant diagnostic delay. Staphylococcus aureus was isolated in the purulent material in one case and in the hemoculture in the other. Both patients have been checked in a long-term revision (follow-up of 7 and 10 years). They were successfully treated by isolated antibiotherapy in one case and surgical drainage in the other. Healing was achieved in each case without relapse or sequels in a long-term revision. We carry out a global revision of this rare infection, emphasising the difficulty of its clinical diagnosis and the different treatment modalities and the proper indication. We suggest an algorithm as a clinical guide for its clinical-therapeutic management.

  20. An ex vivo comparison of pressures within dental pulp space using conventional anesthetic technique versus needle-mounted obturator.

    PubMed

    Grubbs, S Lee; Alley, Larry W; Eleazer, Paul D

    2014-07-01

    The intrapulpal (IP) injection technique is 1 of several ways of obtaining profound anesthesia. There is evidence to suggest that pressure is the primary factor in obtaining anesthesia using IP injection. This is an ex vivo comparison of pressures within dental pulp space using the conventional anesthetic technique versus a needle-mounted obturator technique. Twenty extracted anterior and premolar teeth were accessed with a high-speed 169L bur. A saline-filled tube connected to a digital pressure gauge was attached to the apical 10 mm of each tooth in a fixed mount. One operator performed all the injections under moderate pressure. Each tooth was injected twice; first, the tooth was given an IP injection with a normal setup, and then the same tooth was given an IP injection with the modified obturator syringe. The pressure at the apex was recorded for each tooth. A paired sample t test was completed to determine statistical significance. The pressure generated was considerably higher for the obturator group in every tooth when compared with the normal group (P < .001). IP injection with the obturator resulted in increased pressure at the apex of each tooth. This pressure increase may allow for increased anesthesia when IP injections are indicated. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  1. Transfer of obturator nerve for femoral nerve injury: an experiment study in rats.

    PubMed

    Meng, Depeng; Zhou, Jun; Lin, Yaofa; Xie, Zheng; Chen, Huihao; Yu, Ronghua; Lin, Haodong; Hou, Chunlin

    2018-07-01

    Quadriceps palsy is mainly caused by proximal lesions in the femoral nerve. The obturator nerve has been previously used to repair the femoral nerve, although only a few reports have described the procedure, and the outcomes have varied. In the present study, we aimed to confirm the feasibility and effectiveness of this treatment in a rodent model using the randomized control method. Sixty Sprague-Dawley rats were randomized into two groups: the experimental group, wherein rats underwent femoral neurectomy and obturator nerve transfer to the femoral nerve motor branch; and the control group, wherein rats underwent femoral neurectomy without nerve transfer. Functional outcomes were measured using the BBB score, muscle mass, and histological assessment. At 12 and 16 weeks postoperatively, the rats in the experimental group exhibited recovery to a stronger stretch force of the knee and higher BBB score, as compared to the control group (p < 0.05). The muscle mass and myofiber cross-sectional area of the quadriceps were heavier and larger than those in the control group (p < 0.05). A regenerated nerve with myelinated and unmyelinated fibers was observed in the experimental group. No significant differences were observed between groups at 8 weeks postoperatively (p > 0.05). Obturator nerve transfer for repairing femoral nerve injury was feasible and effective in a rat model, and can hence be considered as an option for the treatment of femoral nerve injury.

  2. A comparison of root surface temperatures using different obturation heat sources.

    PubMed

    Lee, F S; Van Cura, J E; BeGole, E

    1998-09-01

    This study compared root surface temperatures produced during warm vertical obturation using the System B Heat Source (SB), the Touch 'n Heat device (TH), and a flame-heated carrier (FH). The root canals of 30 maxillary incisor, premolar, and mandibular incisor teeth were prepared; divided into three groups; and obturated using each heat source. A thermocouple placed 2 mm below the cementoenamel junction transferred the temperature rise on the external root surface to a digital thermometer. SB surface temperature rise was < 10 degrees C for all experimental teeth. TH temperature rise in maxillary incisors and premolars was < 10 degrees C; however, > 10 degrees C was observed for mandibular incisors. FH produced a > 10 degrees C surface temperature rise in all experimental teeth. The critical level of root surface heat required to produce irreversible bone damage is believed to be > 10 degrees C. The findings of this study suggest that warm vertical condensation with the SB should not damage supporting periradicular tissues. However, caution should be used with TH and FH on mandibular incisors.

  3. Neurofibroma involving obturator nerve mimicking an adnexal mass: a rare case report and PRISMA-driven systematic review.

    PubMed

    Chao, Wei-Ting; Liu, Chia-Hao; Chen, Yi-Jen; Wu, Hua-Hsi; Chuang, Chi-Mu; Wang, Peng-Hui

    2018-02-09

    Pelvic masses are a common gynecologic problem, and majority of them are diagnosed as ovarian tumors finally. Sometimes, it is hard to distinguish the origin of these pelvic masses. The following case is a solitary neurofibroma arising from the right-side obturator nerve, which was impressed as a right-side ovarian tumor initially. We reported this case, and also performed a PRISMA-driven systematic review to summary the similar cases in the literature. This review includes image, molecular and pathological findings and outcome of neurofibroma. A 33-year-old woman with a regular menstrual period denied any symptoms or signs. During her physical check-up, image examination revealed a right-side heterogeneous pelvic mass; it was suggestive of a complex of right-side ovarian tumor. A provisional diagnosis of retroperitoneal pelvic mass, probably a benign ovarian tumor, was made. Excision of the right-side pelvic mass was performed. We sent the specimens for frozen pathology, which indicated neurofibroma and lipomatous tumor and that the possibility of liposarcoma cannot be excluded. A segment of the obturator nerve was attached to the tumor and was severed. A right-side obturator nerve tear during tumor excision was observed, and a neurosurgeon was consulted for obturator nerve grafting and repair. The patient complained of mild weakness and paresthesia affecting the right leg, and we consulted a rehabilitation doctor for neuron injury. The patient's recovery was uneventful, and she was discharged eight days after the drain was removed. Further rehabilitation treatment was arranged. A neurofibroma is an uncommon pelvic retroperitoneal tumor, and it can be misdiagnosed as an adnexal mass. To our knowledge, this is a rare case of a solitary neurofibroma arising from the obturator nerve. It usually does not have any neurological deficit. We present this case to demonstrate that pelvic neurofibroma can be mistaken for an adnexal mass. This fact should be borne in mind

  4. New technique to fabricate an immediate surgical obturator restoring the defect in original anatomical form.

    PubMed

    Patil, Pravinkumar G

    2011-08-01

    The presence of oral cancer can necessitate the surgical removal of all or part of the maxilla, leaving the patient with a defect compromising the oral cavity's integrity and function. The immediate postoperative restoration of esthetics, deglutition, and speech shortens recovery time in the hospital and expedites the patient's return to the community as a functioning member. This article describes a simple technique to fabricate an immediate surgical obturator by restoring the patient's original dentition and facial and palatal tissue form. An immediate obturator fabricated with this technique supports soft tissues after surgery and minimizes scar contracture and disfigurement and thus may have a positive effect on the patient's psychology. © 2011 by The American College of Prosthodontists.

  5. An In vitro Comparison and Evaluation of Sealing Ability of Newly Introduced C-point System, Cold Lateral Condensation, and Thermoplasticized Gutta-Percha Obturating Technique: A Dye Extraction Study.

    PubMed

    Sinhal, Tapati Manohar; Shah, Ruchi Rani Purvesh; Jais, Pratik Subhas; Shah, Nimisha Chinmay; Hadwani, Krupali Dhirubhai; Rothe, Tushar; Sinhal, Neha Nilesh

    2018-01-01

    The aim of this study is to compare and to evaluate sealing ability of newly introduced C-point system, cold lateral condensation, and thermoplasticized gutta-percha obturating technique using a dye extraction method. Sixty extracted maxillary central incisors were decoronated below the cementoenamel junction. Working length was established, and biomechanical preparation was done using K3 rotary files with standard irrigation protocol. Teeth were divided into three groups according to the obturation protocol; Group I-Cold lateral condensation, Group II-Thermoplasticized gutta-percha, and Group III-C-Point obturating system. After obturation all samples were subjected to microleakage assessment using dye extraction method. Obtained scores will be statistical analyzed using ANOVA test and post hoc Tukey's test. One-way analysis of variance revealed that there is significant difference among the three groups with P value (0.000 < 0.05). Tukey's HSD post hoc tests for multiple comparisons test shows that the Group II and III perform significantly better than Group I. Group III performs better than Group II with no significant difference. All the obturating technique showed some degree of microleakage. Root canals filled with C-point system showed least microleakage followed by thermoplasticized obturating technique with no significant difference among them. C-point obturation system could be an alternative to the cold lateral condensation technique.

  6. Sabots, Obturator and Gas-In-Launch Tube Techniques for Heat Flux Models in Ballistic Ranges

    NASA Technical Reports Server (NTRS)

    Bogdanoff, David W.; Wilder, Michael C.

    2013-01-01

    For thermal protection system (heat shield) design for space vehicle entry into earth and other planetary atmospheres, it is essential to know the augmentation of the heat flux due to vehicle surface roughness. At the NASA Ames Hypervelocity Free Flight Aerodynamic Facility (HFFAF) ballistic range, a campaign of heat flux studies on rough models, using infrared camera techniques, has been initiated. Several phenomena can interfere with obtaining good heat flux data when using this measuring technique. These include leakage of the hot drive gas in the gun barrel through joints in the sabot (model carrier) to create spurious thermal imprints on the model forebody, deposition of sabot material on the model forebody, thereby changing the thermal properties of the model surface and unknown in-barrel heating of the model. This report presents developments in launch techniques to greatly reduce or eliminate these problems. The techniques include the use of obturator cups behind the launch package, enclosed versus open front sabot designs and the use of hydrogen gas in the launch tube. Attention also had to be paid to the problem of the obturator drafting behind the model and impacting the model. Of the techniques presented, the obturator cups and hydrogen in the launch tube were successful when properly implemented

  7. Prosthetic reconstruction with an obturator using swing-lock attachment for a patient underwent maxillectomy: A clinical report

    PubMed Central

    2016-01-01

    Patients who underwent resection of maxilla due to benign or malignant tumor, or accident will have defect in palatal area. They get retention, support and stability from remaining tissues which are hardly optimal. The advantage of swing-lock attachment design is having multiple contacts on labial and lingual side of the abutment teeth by retentive strut and palatal bracing component. Because the force is distributed equally to abutment teeth, abutment teeth of poor prognosis can be benefited from it. It is also more advantageous to cover soft tissue defects which are hard to reach with conventional prosthesis. A 56-year-old female patient who had undergone a maxillectomy due to malignant melanoma complaining of loose and unstable surgical obturator. Surveyed crowns were placed on #12, 26, and 27. Teeth #11, 21, 22, and 23 had lingual rest seat and #24 had mesial rest seat to improve stability and support of the obturator. This clinical report presents the prosthetic management of a patient treated with obturator on the maxilla using swing-lock attachment to the remaining teeth. PMID:27826392

  8. Sealing ability of lateral condensation, thermoplasticized gutta-percha and flowable gutta-percha obturation techniques: A comparative in vitro study.

    PubMed

    Kumar, Nallkkapalayam Somasundaram Mohan; Prabu, P S; Prabu, Neethika; Rathinasamy, Shobana

    2012-08-01

    To evaluate and compare the sealing ability between the clod lateral condensation, thermoplasticized gutta-percha, and flowable gutta-percha obturation technique, under a stereomicroscope at ×40 magnification. Sixty single rooted teeth were selected and canals were shaped with K3 NiTi files. Irrigation was performed with 5.25% NaOCl and 17% ethylenediaminetetraacetic acid (EDTA). The teeth were then separated into three groups depending on the type of obturation technique: Group A, obturated using the lateral condensation technique and AH Plus sealer; Group B, obturated with thermoplasticized gutta-percha tech (Obtura III Max) and AH Plus sealer; and Group C, obturated using flowable gutta-percha technique (GuttaFlow). After storing the teeth in 100% humidity for 7 days at 37°C, the roots of the teeth were sectioned at five levels. The sections were then observed under a stereomicroscope at ×40 magnification and the images were analyzed for area of voids (AV) and frequency of voids. The data were statistically analyzed using the SPSS version 17 software. The 95% confidence intervals (CI) were calculated. One-way analysis of variance with post hoc test and non-parametric Mann-Whitney U test were carried out to compare the means. The lowest mean of AV was recorded in the thermoplasticized gutta-percha (Obtura III Max) group [1.0% (95% CI=0.5-1.5)]. This was statistically and significantly different from flowable gutta-percha (GuttaFlow) group [3.0% (95% CI=2.1-3.9)]. There was no significant difference between the thermoplasticized gutta-percha group and lateral condensation group [1.6% (95% CI=1.0-2.2)] with regard to the AV, but there was a statistically significant difference between the lateral condensation and flowable gutta-percha groups. The flowable gutta-percha group showed the maximum number of voids [56% (95% CI=48-64)], which was significantly higher than those in the lateral condensation [26% (95% CI=19-34)] and thermoplasticized gutta-percha [15% (95

  9. Photoelastic analysis to compare implant-retained and conventional obturator dentures

    NASA Astrophysics Data System (ADS)

    Goiato, Marcelo Coelho; Prado Ribeiro, Paula do; Pellizzer, Eduardo Piza; Pesqueira, Aldiéris Alves; Haddad, Marcela Filiè; dos Santos, Daniela Micheline; Moreno, Amália

    2012-06-01

    The use of photoelastic analysis contributes to the rehabilitation of patients with oral-sinus-nasal sequelae, which in turn affect important functions such as chewing, swallowing, and speech. The prosthetic rehabilitation with implant-retained dentures is a suitable treatment option. The purpose of this study was to verify, by using a photoelastic analysis, the stress distribution in implant-retained palatal obturator dentures (relined or not) associated with different attachment systems (O-ring, bar-clip, and bar-clip associated with distally placed O-rings). Two photoelastic models were obtained from an experimental maxillary cast presenting an oral-nasal communication. One model had two 13-mm length implants placed on the left region. A total of eight colorless maxillary obturators were fabricated and subsequently four of them were relined with soft silicone soft, and three had attachment systems associated. The assembly (model/attachment system/prosthesis) was positioned in a circular polariscope and a 100-N load was applied at 10 mm/s. The results showed that the denture relining influenced the distribution and amount of stress on the models. The O-ring group displayed the lowest stress levels, followed by bar-clip system associated with distally placed O-rings and bar-clip groups.

  10. Pyomyositis of the iliacus muscle and pyogenic sacroiliitis after sacroiliac joint block -A case report-.

    PubMed

    Lee, Mi Hyeon; Byon, Hyo-Jin; Jung, Hyun Jun; Cha, Young-Deog; Lee, Doo Ik

    2013-05-01

    Sacroiliac joint block can be performed for the diagnosis and treatment of sacroiliac joint dysfunction. Although sacroiliac joint block is a common procedure, complications have not been reported in detail. We report a case of iliacus pyomyositis and sacroiliac joint infection following a sacroiliac joint block. A 70-year-old female patient received sacroiliac joint blocks to relieve pelvic pain. The patient was admitted to the emergency room two days after the final sacroiliac joint block (SIJB) with the chief complaints of left pelvic pain corresponding to a visual analogue scale (VAS) score of 9 and fever. A pelvic MRI indicated a diagnosis of myositis. After 1 month of continuous antibiotic therapy, the patient's erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level remained elevated. A (67)Ga SPECT/CT was done. Abnormal uptake was seen at the left sacroiliac joint (SIJ), and septic sacroiliitis was suspected. The CRP normalized to 0.29 mg/dl and the ESR decreased to 60 mm/hr, and the patient had no fever after 57 days of antibiotic therapy. She was directed for follow up at an outpatient clinic.

  11. T2-weighted signal intensity-selected volumetry for prediction of pathological complete response after preoperative chemoradiotherapy in locally advanced rectal cancer.

    PubMed

    Kim, Sungwon; Han, Kyunghwa; Seo, Nieun; Kim, Hye Jin; Kim, Myeong-Jin; Koom, Woong Sub; Ahn, Joong Bae; Lim, Joon Seok

    2018-06-01

    To evaluate the diagnostic value of signal intensity (SI)-selected volumetry findings in T2-weighted magnetic resonance imaging (MRI) as a potential biomarker for predicting pathological complete response (pCR) to preoperative chemoradiotherapy (CRT) in patients with rectal cancer. Forty consecutive patients with pCR after preoperative CRT were compared with 80 age- and sex-matched non-pCR patients in a case-control study. SI-selected tumor volume was measured on post-CRT T2-weighted MRI, which included voxels of the treated tumor exceeding the SI (obturator internus muscle SI + [ischiorectal fossa fat SI - obturator internus muscle SI] × 0.2). Three blinded readers independently rated five-point pCR confidence scores and compared the diagnostic outcome with SI-selected volumetry findings. The SI-selected volumetry protocol was validated in 30 additional rectal cancer patients. The area under the receiver-operating characteristic curve (AUC) of SI-selected volumetry for pCR prediction was 0.831, with an optimal cutoff value of 649.6 mm 3 (sensitivity 0.850, specificity 0.725). The AUC of the SI-selected tumor volume was significantly greater than the pooled AUC of readers (0.707, p < 0.001). At this cutoff, the validation trial yielded an accuracy of 0.87. SI-selected volumetry in post-CRT T2-weighted MRI can help predict pCR after preoperative CRT in patients with rectal cancer. • Fibrosis and viable tumor MRI signal intensities (SIs) are difficult to distinguish. • T2 SI-selected volumetry yields high diagnostic performance for assessing pathological complete response. • T2 SI-selected volumetry is significantly more accurate than readers and non-SI-selected volumetry. • Post-chemoradiation therapy T2-weighted MRI SI-selected volumetry facilitates prediction of pathological complete response.

  12. Health-related quality of life after maxillectomy: obturator rehabilitation compared with flap reconstruction.

    PubMed

    Breeze, J; Rennie, A; Morrison, A; Dawson, D; Tipper, J; Rehman, K; Grew, N; Snee, D; Pigadas, N

    2016-10-01

    Health-related quality of life (QoL) reported by patients has the potential to improve care after ablative surgery of the midface, as existing treatment algorithms still generally revolve around outcomes assessed traditionally only by clinicians. Decisions in particular relate to reconstruction with a flap compared with rehabilitation with an obturator, the need for adjuvant treatment, and morbidity related to the size of the defect. We prospectively collected health-related QoL assessments for 39 consecutive patients treated by maxillectomy between 01 January 2010 and 31 December 2014 using the University of Washington Quality of Life Questionnaire, and who had a mean (SD) duration of follow-up of 14 (4). We made sub-group analyses using paired t tests and analysis of variance (ANOVA) to compare reconstruction with a flap with rehabilitation with obturators, size of the vertical defect, and whether adjuvant treatment with radiotherapy or chemoradiotherapy adversely affected it. Overall there was a significant decrease in health-related QoL after treatment compared with before (p<0.001), but there was no significant difference in the effects of any of the paired reconstructive and rehabilitation treatments on it. Obturators remain an important option for rehabilitation in selected patients in addition to reconstruction with a flap. We found that neither increasing the size of the vertical defect (in an attempt to ensure clear margins) nor the use of postoperative radiotherapy seemed to have any adverse effect on QoL. More patients are required before we can conclude that the potential survival benefits of such measures may outweigh any adverse effects. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  13. Use of a magnetic attachment to retain an obturator prosthesis for an osseous defect.

    PubMed

    Kawamoto, Shin-ichiro; Hamamura, Syunichi; Kawahara, Hideki; Nishi, Yasuhiro; Nagaoka, Eiichi

    2009-06-01

    Tooth loss accompanied by a massive defect of the alveolar bone can cause serious problems such as food deposit and esthetic impairment. This report describes procedures for the fabrication of an osseous defect obturator prosthesis connected to a fixed partial denture by a magnetic attachment along with the clinical outcome.

  14. Comparison of post-obturation pain experience following one-visit and two-visit root canal treatment on teeth with vital pulps: a randomized controlled trial.

    PubMed

    Wang, C; Xu, P; Ren, L; Dong, G; Ye, L

    2010-08-01

    To compare the incidence and intensity of post-obturation pain after one- or two-visit root canal treatment (RCT) on anterior teeth with vital pulps and a single root and canal in a randomized controlled trial. One hundred patients requiring RCT on permanent anterior teeth with vital pulps preoperatively were included. The patients were assigned randomly into two groups of 50 patients each. After local anaesthesia, isolation, access and pulp extirpation, the canals of all teeth were prepared using engine-driven rotary ProTaper nickel-titanium instruments in a crown-down technique and irrigated with 2.5% NaOCl. The teeth in group 1 (n = 50) were filled with AH Plus sealer and gutta-percha using a lateral compaction technique at the first visit, whilst those in group 2 (n = 50) were medicated with a calcium hydroxide paste, a sterile dry cotton pellet and Caviton and scheduled for a second visit 7 days later. A modified verbal descriptor scale was used to measure preoperative pain and post-obturation pain at 6, 24, 48 h and 1 week after operation. Chi-square tests and independent-sample T-tests were used to compare the incidence and intensity of post-obturation pain of two groups at each interval. Eleven patients were excluded from the study as they failed to follow the scheduled revisit or their selected teeth had more than one root canal. Data were obtained from the remaining 89 patients. Forty-three patients were undergoing one-visit treatment (group 1) and 46 undergoing two-visit treatment (group 2). Most patients in both groups reported no pain or only slight pain within each post-obturation interval, only one in group 1 and one in group 2 had flare-ups and slight swelling. There was no statistically significant difference in the incidence and intensity of post-obturation pain experienced by two groups. The incidence and intensity of post-obturation pain experience following one- or two-visit RCT on teeth with vital pulps and a single canal were not

  15. Three-dimensional finite element analysis of the application of attachment for obturator framework in unilateral maxillary defect.

    PubMed

    Sun, J; Jiao, T; Tie, Y; Wang, D-M

    2008-09-01

    The aim of this study was to evaluate the stress on the abutment teeth and framework ina unilateral maxillary defect which was restored by an obturator retained by resin-bonded extra coronal attachment. A three-dimensional finite element model of the human unilateral maxillary defect was constructed. Traditional obturator framework with four casting circumferential clasp was established (model 1). A continuous lingual guide plane of 0.5 mm thickness on all of the remaining teeth, with Mini-SG/F attachment on the mesial surface of the central incisor was also established (model 2). The modelling and analytical processes were performed using the ANSYS technologies. Stress was transmitted to the anterior part of the palate, with stress values being lower on the anterior teeth compared with the posteriors. The highest stress value of model 1 and model 2 was 13.1 Mpa, 19.9 Mpa respectively. Stress concentrations were found at the junction of the attachment to the lingual guide plane and the anterior part of the lingual plane. The results of this study suggest that the application of a resin-bonded extra coronal attachment for obturator retention is in accordance with the design principles for the restorative treatment of maxillary defects.The design of the attachment framework needs to be further investigated. Benefit can be gained by splinting the abutment teeth.

  16. Comparative Evaluation of Sealing Ability of Three Newer Root Canal Obturating Materials Guttaflow, Resilon and Thermafil: An In Vitro Study

    PubMed Central

    H Bhandi, Shilpa; T S, Subhash

    2013-01-01

    Introduction: Microleakage continues to be a main reason for failure of root canal treatment where the challenge has been to achieve an adequate seal between the internal structure and the main obturating material. The objective of this study is to compare the sealing ability of 3 newer obturating materials GuttaFlow, Resilon/Epiphany system (RES) and Thermafil, using silver nitrate dye and observing under stereomicroscope. Methodology: Thirty single rooted teeth were divided into following groups. Group I : GuttaFlow ;Group II : Resilon /Epiphany sealer Group III : Thermafil with AH-Plus sealer. Teeth were decoronated and instrumented with profile rotary system and obturated with specified materials. Apical seal was determined by dye penetration method using silver nitrate. Then the specimens were transversely sectioned at each mm till 3 mm from the apex. Dye leakage was determined using stereomicroscope. Statistical analysis of the results was performed using Kruskall-Wallis test. Results: The results showed that Group II i.e., Resilon with Epiphany sealer showed the least amount of microleakage when compared to Group I i.e., GuttaFlow and Group III i.e., Thermafil with AH-plus sealer. Conclusion: Based on the results of this study it can be concluded that RES had higher sealing ability followed by Thermafil and GuttaFlow in vitro but further studies have to be carried out to make a direct correlation between these results and invivo situation. How to cite this article: Bhandi S H, Subhash T S. Comparative Evaluation of Sealing Ability of Three Newer Root Canal Obturating Materials Guttaflow, Resilon and Thermafil: An In Vitro Study. J Int Oral Health 2013; 5(1):54-65. PMID:24155579

  17. [Iatrogenic risks during the obturation of the root canal system].

    PubMed

    Aesaert, G

    2000-01-01

    A hermetic seal is the main goal of obturation of the root canal system. For that purpose guttapercha still remains the filling material of choice. Most filling techniques use plasticized guttapercha and a condensation technique to fulfil the requirements of hermetic seal. The heat to plasticize and the forces applied to condense that material may have an influence on the periodontal ligament and/or the remaining tooth structure. Furthermore can overfilling of guttapercha and more likely the sealer, affect the periodontal tissue. Although rare, mandibular nerve damage and adverse effects on the sinus maxillaris can be the result of inadequate treatment.

  18. Nerve block of articular branches of the obturator and femoral nerves for the treatment of hip joint pain.

    PubMed

    Yavuz, Ferdi; Yasar, Evren; Ali Taskaynatan, Mehmet; Goktepe, Ahmet Salim; Tan, Arif Kenan

    2013-01-01

    The aim of this retrospective study was to investigate the effectiveness of the nerve block of articular branches of obturator and femoral nerves in patients with intractable pain due to hip osteoarthritis. Twenty patients (8 female and 12 male; with a mean age 53.5 years) were retrospectively identified who had received nerve block of articular branches of obturator and femoral nerves for chronic hip joint pain due to hip osteoarthritis. The outcome measures (visual analogue pain scale, the level of patient satisfaction with nerve block, reduction rate of NSAID using) were assessed before the treatment and at the 1st and 3rd months after injection. Mean reduction in hip joint pain while walking and at night between the baseline and 1st month, and between the baseline and 3rd month were statistically significant (p< 0.05). At the 1st and 3rd months after treatment, the reduction rates of NSAID using were almost 67% and 71%; respectively. At the 1st and 3rd months after treatment, the level of patient satisfaction with nerve block were 73.00 ± 21.23 mm and 73.50 ± 18.14 mm; respectively. We found that nerve blocks of articular branches of obturator and femoral nerves were effective in short- and mid-term for reducing chronic hip joint pain.

  19. To evaluate the influence of smear layer with different instruments and obturation methods on microleakage of root canal filled teeth: In vitro study.

    PubMed

    Likhitkar, Manoj S; Kulkarni, Shantaram V; Burande, Aravind; Solanke, Vishal; Kumar, C Sushil; Kamble, Babasaheb

    2016-01-01

    The success of root canal treatment depends on proper debridement, instrumentation, proper accessibility, and proper restoration. The presence of a smear layer is considered to be a significant factor. This in vitro study was conducted to assess the effect of the presence/absence of a smear layer on the microleakage of root canal filled teeth using different instruments and obturation methods. One hundred extracted mandibular premolars with closed apices and single roots were chosen and then divided into six groups, A to F, consisting of 15 teeth each. The control group included 10 teeth; 5 positive and 5 negative. The teeth were decoronated at the cementoenamel junction. Groups A, B, C, and D were instrumented with engine-driven rotary Protaper NiTi files. Groups E and F were instrumented with conventional stainless steel hand files. Groups A, C, and E were flushed with 3 ml of 17% EDTA to remove the smear layer prior to obturation. All teeth were flushed with 5.25% sodium hypochlorite solution and obturated with AH-Plus sealer with lateral condensation technique for Groups C, D, E, F and with thermoplasticized gutta-percha technique for Groups A and B. Using an electrochemical technique, leakages in the obturated canals were assessed for 45 days. The results were tabulated using Student's t-test (paired and unpaired t-test) with the Statistical Package for the Social Sciences Software Version 21 (IBM Company, New York, USA). Group A showed the lowest mean value at intervals of 10, 20, 30, and 45 days. There was no current flow in the negative controls during the test period. There was leakage in the positive controls within a few minutes of immersion. The results showed that rotary instrumentation contributed toward an exceptional preparation of root canals compared to hand instrumentation. Elimination of the smear layer enhanced the resistance to microleakage; thermoplasticized gutta-percha obturation technique produced a better seal compared to the lateral

  20. Penetrating Obturator Artery Injury after Gunshot Wounds: A Successful Multidisciplinary Trauma Team Approach to a Potentially Lethal Injury.

    PubMed

    Maraqa, Tareq I; Shin, Ji-Sun J; Diallo, Ismael; Sachwani-Daswani, Gul R; Mercer, Leo C

    2017-11-17

    Obturator artery injury (OAI) from pelvic gunshot wounds (GSW) is a rarely reported condition. Hemorrhages from pelvic trauma (PT) are mostly venous. Arterial hemorrhages represent about 10-20% of PTs. When arterial hemorrhages from PT occur, they are a severe and deadly complication often causing significant hemodynamic instability and eventual shock. A  23-year-old male presented to our emergency service via a private vehicle with multiple gunshot wounds to both thighs and to the lower back, resulted in rectal and obturator artery (OA) injuries. The patient underwent a successful coil-embolization of the right OA. Given the density of structures within the pelvis, patients who sustain gunshot wounds to the pelvic region are at high risk for injury to the small bowel, sigmoid colon, rectum, bladder, and/or vascular structures. While bleeding is the major cause of early mortality in PT, rectal injuries carry the highest mortality due to visceral injuries. A high clinical index of suspicion is needed to diagnose an iliac artery injury or injury to its branches. Prompt computed tomographic angiogram (CTA) and embolization of the OA is the best method to control and stop the bleeding and improve the mortality outcome. Clinicians caring for patients presenting with pelvic gunshot wounds should pay attention to the delayed presentation of internal hemorrhage from the OAs. A multidisciplinary team approach is crucial in the successful management of penetrating injuries to the obturator artery.

  1. Biomechanical 3-Dimensional Finite Element Analysis of Obturator Protheses Retained with Zygomatic and Dental Implants in Maxillary Defects

    PubMed Central

    Akay, Canan; Yaluğ, Suat

    2015-01-01

    Background The objective of this study was to investigate the stress distribution in the bone around zygomatic and dental implants for 3 different implant-retained obturator prostheses designs in a Aramany class IV maxillary defect using 3-dimensional finite element analysis (FEA). Material\\Methods A 3-dimensional finite element model of an Aramany class IV defect was created. Three different implant-retained obturator prostheses were modeled: model 1 with 1 zygomatic implant and 1 dental implant, model 2 with 1 zygomatic implant and 2 dental implants, and model 3 with 2 zygomatic implants. Locator attachments were used as a superstructure. A 150-N load was applied 3 different ways. Qualitative analysis was based on the scale of maximum principal stress; values obtained through quantitative analysis are expressed in MPa. Results In all loading conditions, model 3 (when compared models 1 and 2) showed the lowest maximum principal stress value. Model 3 is the most appropirate reconstruction in Aramany class IV maxillary defects. Two zygomatic implants can reduce the stresses in model 3. The distribution of stresses on prostheses were more rational with the help of zygoma implants, which can distribute the stresses on each part of the maxilla. Conclusions Aramany class IV obturator prosthesis placement of 2 zygomatic implants in each side of the maxilla is more advantageous than placement of dental implants. In the non-defective side, increasing the number of dental implants is not as suitable as zygomatic implants. PMID:25714086

  2. Fabrication of a 3D Printing Definitive Obturator Prosthesis: a Clinical Report.

    PubMed

    Tasopoulos, Theodoros; Kouveliotis, Georgios; Polyzois, Grigoris; Karathanasi, Vasiliki

    2017-03-01

    Digital technologies related to imaging and manufacturing provide the clinician with a wide variety of treatment options. Stereolithography (SLA) offers a simple and predictable way for an accurate reconstruction of congenital or acquired defects. A 65-years old cancer patient with non- keratinized squamous cell carcinoma of left maxillary sinus came for a prosthetic clinical evaluation. A bilateral maxillectomy was performed and the treatment plan included definite obturator prosthesis for the upper arch. CT data and 3D planning software were used to create a 3D printing plastic model of the defect. A wax pattern of the hollow bulb was fabricated and cured with heat-cured silicone soft liner. A final impression was obtained with the hollow bulb placed intraorally. The master cast was duplicated and the new cast was invested and reflasked. The flasks were opened, wax was boiled out and some space was created in the internal part of the obturator. Transparent heat cured acrylic resin was sandwiched with, at the inner part of the bulb, improving the retention between the acrylic denture base and the silicone based soft lining material. The patient was then placed on a 6-month recall. The five-year follow up consists of a chair side relining, when needed, of the definite removable prostheses. Maxillofacial surgery patients may develop postoperative complications such as trismus and pain. In these cases, the combination of digital technology and conventional techniques provide an accurate prosthetic restoration.

  3. Fabrication of a 3D Printing Definitive Obturator Prosthesis: a Clinical Report

    PubMed Central

    Kouveliotis, Georgios; Polyzois, Grigoris; Karathanasi, Vasiliki

    2017-01-01

    Introduction Digital technologies related to imaging and manufacturing provide the clinician with a wide variety of treatment options. Stereolithography (SLA) offers a simple and predictable way for an accurate reconstruction of congenital or acquired defects. Clinical case A 65-years old cancer patient with non- keratinized squamous cell carcinoma of left maxillary sinus came for a prosthetic clinical evaluation. A bilateral maxillectomy was performed and the treatment plan included definite obturator prosthesis for the upper arch. CT data and 3D planning software were used to create a 3D printing plastic model of the defect. A wax pattern of the hollow bulb was fabricated and cured with heat-cured silicone soft liner. A final impression was obtained with the hollow bulb placed intraorally. The master cast was duplicated and the new cast was invested and reflasked. The flasks were opened, wax was boiled out and some space was created in the internal part of the obturator. Transparent heat cured acrylic resin was sandwiched with, at the inner part of the bulb, improving the retention between the acrylic denture base and the silicone based soft lining material. The patient was then placed on a 6-month recall. The five-year follow up consists of a chair side relining, when needed, of the definite removable prostheses. Conclusion Maxillofacial surgery patients may develop postoperative complications such as trismus and pain. In these cases, the combination of digital technology and conventional techniques provide an accurate prosthetic restoration. PMID:28740271

  4. Stress analysis in oral obturator prostheses, part II: photoelastic imaging

    NASA Astrophysics Data System (ADS)

    Pesqueira, Aldiéris Alves; Goiato, Marcelo Coelho; da Silva, Emily Vivianne Freitas; Haddad, Marcela Filié; Moreno, Amália; Zahoui, Abbas; dos Santos, Daniela Micheline

    2014-06-01

    In part I of the study, two attachment systems [O-ring; bar-clip (BC)] were used, and the system with three individualized O-rings provided the lowest stress on the implants and the support tissues. Therefore, the aim of this study was to assess the stress distribution, through the photoelastic method, on implant-retained palatal obturator prostheses associated with different attachment systems: BOC-splinted implants with a bar connected to two centrally placed O-rings, and BOD-splinted implants with a BC connected to two distally placed O-rings (cantilever). One photoelastic model of the maxilla with oral-sinus-nasal communication with three parallel implants was fabricated. Afterward, two implant-retained palatal obturator prostheses with the two attachment systems described above were constructed. Each assembly was positioned in a circular polariscope and a 100-N axial load was applied in three different regions with implants by using a universal testing machine. The results were obtained through photograph record analysis of stress. The BOD system exhibited the highest stress concentration, followed by the BOC system. The O-ring, centrally placed on the bar, allows higher mobility of the prostheses and homogeneously distributes the stress to the region of the alveolar ridge and implants. It can be concluded that the use of implants with O-rings, isolated or connected with a bar, to rehabilitate maxillectomized patients allows higher prosthesis mobility and homogeneously distributes the stress to the alveolar ridge region, which may result in greater chewing stress distribution to implants and bone tissue. The clinical implication of the augmented bone support loss after maxillectomy is the increase of stress in the attachment systems and, consequently, a higher tendency for displacement of the prosthesis.

  5. Modeling Laterality of the Globus Pallidus Internus in Patients With Parkinson's Disease.

    PubMed

    Sharim, Justin; Yazdi, Daniel; Baohan, Amy; Behnke, Eric; Pouratian, Nader

    2017-04-01

    Neurosurgical interventions such as deep brain stimulation surgery of the globus pallidus internus (GPi) play an important role in the treatment of medically refractory Parkinson's disease (PD), and require high targeting accuracy. Variability in the laterality of the GPi across patients with PD has not been well characterized. The aim of this report is to identify factors that may contribute to differences in position of the motor region of GPi. The charts and operative reports of 101 PD patients following deep brain stimulation surgery (70 males, aged 11-78 years) representing 201 GPi were retrospectively reviewed. Data extracted for each subject include age, gender, anterior and posterior commissures (AC-PC) distance, and third ventricular width. Multiple linear regression, stepwise regression, and relative importance of regressors analysis were performed to assess the predictive ability of these variables on GPi laterality. Multiple linear regression for target vs. third ventricular width, gender, AC-PC distance, and age were significant for normalized linear regression coefficients of 0.333 (p < 0.0001), 0.206 (p = 0.00219), 0.168 (p = 0.0119), and 0.159 (p = 0.0136), respectively. Third ventricular width, gender, AC-PC distance, and age each account for 44.06% (21.38-65.69%, 95% CI), 20.82% (10.51-35.88%), 21.46% (8.28-37.05%), and 13.66% (2.62-28.64%) of the R 2 value, respectively. Effect size calculation was significant for a change in the GPi laterality of 0.19 mm per mm of ventricular width, 0.11 mm per mm of AC-PC distance, 0.017 mm per year in age, and 0.54 mm increase for male gender. This variability highlights the limitations of indirect targeting alone, and argues for the continued use of MRI as well as intraoperative physiological testing to account for such factors that contribute to patient-specific variability in GPi localization. © 2016 International Neuromodulation Society.

  6. Comparison of quality of obturation and instrumentation time using hand files and two rotary file systems in primary molars: A single-blinded randomized controlled trial.

    PubMed

    Govindaraju, Lavanya; Jeevanandan, Ganesh; Subramanian, E M G

    2017-01-01

    In permanent dentition, different rotary systems are used for canal cleaning and shaping. Rotary instrumentation in pediatric dentistry is an emerging concept. A very few studies have compared the efficiency of rotary instrumentation for canal preparation in primary teeth. Hence, this study was performed to compare the obturation quality and instrumentation time of two rotary files systems - Protaper, Mtwo with hand files in primary molars. Forty-five primary mandibular molars were randomly allotted to one of the three groups. Instrumentation was done using K-files in Group 1; Protaper in Group 2; and Mtwo in Group 3. Instrumentation time was recorded. The canal filling quality was assessed as underfill, optimal fill, and overfill. Statistical analysis was done using Chi-square, ANOVA, and post hoc Tukey test. No significant difference was observed in the quality of obturation among three groups. Intergroup comparison of the instrumentation time showed a statistically significant difference between the three groups. The use of rotary instrumentation in primary teeth results in marked reduction in the instrumentation time and improves the quality of obturation.

  7. Clinical Evaluation of Quality of Obturation and Instrumentation Time using Two Modified Rotary File Systems with Manual Instrumentation in Primary Teeth

    PubMed Central

    Govindaraju, Lavanya; Subramanian, EMG

    2017-01-01

    Introduction Pulp therapy in primary teeth has been performed using various instrumentation techniques. However, the conventional instrumentation technique used for root canal preparation in primary teeth is hand instrumentation. Various Nickel-Titanium (Ni-Ti) instruments are available to perform efficient root canal preparation in primary teeth. These Ni-Ti instruments has been designed to aid in better root canal preparation in permanent teeth but are rarely used in primary teeth. It is necessary to assess the feasibility of using these adult rotary files with a modified sequence in primary teeth. Aim To compare the quality of obturation and instrumentation time during root canal preparation using hand files and modified rotary file systems in primary molars. Materials and Methods Forty-five primary mandibular molars were randomly assigned to three experimental groups (n=15). Group I was instrumented using k-hand files, Group II with S2 ProTaper universal file and Group III with 0.25 tip 4% taper K3 rotary file. Standardized digital radiographs were taken before and after root canal instrumentation. Root canal preparation time was also recorded. Statistical analysis of the obtained data was done using SPSS Software version 17.0. An intergroup comparison of the instrumentation time and the quality of obturation was done using ANOVA and Chi-square test with the level of significance set at 0.05. Results No significant differences were noted with regard to the quality of obturation (p=0.791). However, a statistically significant difference was noted in the instrumentation time between the three groups (p<0.05). ProTaper rotary system had significantly lesser instrumentation time when compared to that of K3 rotary system and hand file system. Conclusion The hand files, S2 ProTaper Universal and K3 0.25 tip 4% taper files systems performed similarly with respect to the quality of obturation. There was a significant difference in instrumentation time with manual

  8. Clinical Evaluation of Quality of Obturation and Instrumentation Time using Two Modified Rotary File Systems with Manual Instrumentation in Primary Teeth.

    PubMed

    Govindaraju, Lavanya; Jeevanandan, Ganesh; Subramanian, Emg

    2017-09-01

    Pulp therapy in primary teeth has been performed using various instrumentation techniques. However, the conventional instrumentation technique used for root canal preparation in primary teeth is hand instrumentation. Various Nickel-Titanium (Ni-Ti) instruments are available to perform efficient root canal preparation in primary teeth. These Ni-Ti instruments has been designed to aid in better root canal preparation in permanent teeth but are rarely used in primary teeth. It is necessary to assess the feasibility of using these adult rotary files with a modified sequence in primary teeth. To compare the quality of obturation and instrumentation time during root canal preparation using hand files and modified rotary file systems in primary molars. Forty-five primary mandibular molars were randomly assigned to three experimental groups (n=15). Group I was instrumented using k-hand files, Group II with S2 ProTaper universal file and Group III with 0.25 tip 4% taper K3 rotary file. Standardized digital radiographs were taken before and after root canal instrumentation. Root canal preparation time was also recorded. Statistical analysis of the obtained data was done using SPSS Software version 17.0. An intergroup comparison of the instrumentation time and the quality of obturation was done using ANOVA and Chi-square test with the level of significance set at 0.05. No significant differences were noted with regard to the quality of obturation (p=0.791). However, a statistically significant difference was noted in the instrumentation time between the three groups (p<0.05). ProTaper rotary system had significantly lesser instrumentation time when compared to that of K3 rotary system and hand file system. The hand files, S2 ProTaper Universal and K3 0.25 tip 4% taper files systems performed similarly with respect to the quality of obturation. There was a significant difference in instrumentation time with manual instrumentation compared to the modified rotary file systems in

  9. The Efficacy of the WaveOne Reciprocating File System versus the ProTaper Retreatment System in Endodontic Retreatment of Two Different Obturating Techniques.

    PubMed

    Jorgensen, Ben; Williamson, Anne; Chu, Rene; Qian, Fang

    2017-06-01

    This ex vivo study aimed to evaluate the efficacy of retreating GuttaCore (Dentsply Tulsa Dental Specialties, Tulsa, OK) and warm vertically condensed gutta-percha in moderately curved canals with 2 different systems: ProTaper Universal Retreatment (Dentsply Tulsa Dental) and WaveOne (Dentsply Tulsa Dental). Eighty mesial roots of mandibular molars were used in this study. The mesiobuccal canals in each sample were prepared to length with the WaveOne Primary file (Dentsply Tulsa Dental). The canals were obturated with either a warm vertical approach or with GuttaCore and divided into 4 retreatment groups with the same mean root curvature: warm vertical retreated with ProTaper, warm vertical retreated with WaveOne, GuttaCore retreated with ProTaper, and GuttaCore retreated with WaveOne. The warm vertical groups were obturated using a continuous-wave technique of gutta-percha compaction, and the GuttaCore groups were obturated according to the manufacturer's instructions. After allowing sealer to set, each specimen was retreated with either the ProTaper Universal Retreatment files D1, D2, or D3 or with the WaveOne Primary file to the predetermined working length. The time taken to reach the working length was recorded. Instrument fatigue and failure were also evaluated. The post hoc 2-sample t tests showed that the overall mean total time taken to reach the working length for the warm vertical groups was significantly greater than that observed for the GuttaCore groups (mean = 87.11 vs 60.16 seconds, respectively), and the overall mean total time taken to reach the working length for WaveOne was significantly greater than that observed for ProTaper (99.09 vs 48.18 seconds, respectively). Two-way analysis of variance showed a significant main effect for both the type of experiment groups (F 1,76  = 15.32, P = .0002) and the type of retreatments (F 1,76  = 54.67, P < .0001). Also, the WaveOne Primary file underwent more separations than the ProTaper files

  10. Two-Piece Hollow Bulb Obturator for Postsurgical Partial Maxillectomy Defect in a Young Patient Revamping Lost Malar Prominence: A Clinical Report.

    PubMed

    Vaidya, Sharad; Parkash, Hari; Gupta, Sharad; Bhargava, Akshay; Kapoor, Charu

    2016-01-01

    The most frequent type of treatment for patients diagnosed with a malignant neoplasia of the oral cavity is surgical resection of the tumor. Ablative surgery may be followed by a reconstructive phase, in which the surgeon may choose between local flaps, nonvascularized bone grafts or free vascularized flaps to close the surgical site, depending on the general conditions of the patient. Esthetic and functional results are challenging to achieve for the prosthodontist, as variable amount of hard and soft tissues are removed. This report describes the fabrication of a two-piece hollow obturator for a 19-year-old patient who underwent wide surgical excision of the osteosarcoma of the maxilla and was rehabilitated to function. In this case, the surgical site was covered with submental flap, and the second piece of the obturator provided fullness to the lost malar prominence. © 2015 by the American College of Prosthodontists.

  11. Trans-Obturator-Tape (T.O.T.) "outside-in" approach in surgical treatment of female stress urinary incontinence.

    PubMed

    Jovanović, M; Džamić, Z; Aćimović, M; Kajmaković, B; Pejčić, T

    2014-01-01

    The aim of the study was to analyzed the efficacy and safety of a minimally invasive surgical procedure using the Trans- Obturator-Tape with "outside-in" approach for treatment female stress urinary incontinence. 171 women with stress urinary incontinence (SUI) associated with urethral hypermobility, underwent the T.O.T. procedure (March 2010 to January 2014). 27 patients were previously operated for incontinence. Mean age was 59 years (37-80). 6 patients were having mixed incontinence, and 51 had SUI with urgencies. A non-elastic, polypropylene tape was placed under the mid-urethra. The surgical placement technique utilises a trans-obturator percutaneous approach. All patients underwent post-operative clinical examination, cough-stress test (full bladder), uroflowmetry, and post-voiding residual assessment. Mean follow-up was 22 months (4-45). At 12 months follow-up 91,2% of the patients were completely cured. The overall peri-operative complication rate was 6.4% with no vascular, nerve or bowel injury. 5 patients (2.9%) had post-operative urinary retention. The present study confirms the results obtained by the instigator of the technique, E. Delorme, and allows us to consider T.O.T. as an effective and safe technique for the treatment of female stress urinary incontinence.

  12. Pulsed radiofrequency treatment of articular branches of femoral and obturator nerves for chronic hip pain.

    PubMed

    Chye, Cien-Leong; Liang, Cheng-Loong; Lu, Kang; Chen, Ya-Wen; Liliang, Po-Chou

    2015-01-01

    Chronic hip pain is a common symptom experienced by many people. Often, surgery is not an option for patients with multiple comorbidities, and conventional drugs either have many side effects or are ineffective. Pulsed radiofrequency (PRF) is a new method in the treatment of pain. We attempt to compare the efficacy of PRF relative to conservative management for chronic hip pain. Between August 2011 and July 2013, 29 patients with chronic hip pain were divided into two groups (PRF and conservative treatment) according to consent or refusal to undergo PRF procedure. Fifteen patients received PRF of the articular branches of the femoral and obturator nerves, and 14 patients received conservative treatment. Visual analog scale (VAS), Oxford hip scores (OHS), and pain medications were used for outcome measurement before treatment and at 1 week, 4 weeks, and 12 weeks after treatment. At 1 week, 4 weeks, and 12 weeks after treatment initiation, improvements in VAS were significantly greater with PRF. Improvements in OHS were significantly greater in the PRF group at 1 week, 4 weeks, and 12 weeks. Patients in the PRF group also used less pain medications. Eight subjects in the conservative treatment group switched to the PRF group after 12 weeks, and six of them had >50% improvement. When compared with conservative treatment, PRF of the articular branches of the femoral and obturator nerves offers greater pain relief for chronic hip pain and can augment physical functioning.

  13. An in vitro comparative study of the adaptation and sealing ability of two carrier-based root canal obturators.

    PubMed

    Alkahtani, Ahmed; Al-Subait, Sara; Anil, Sukumaran

    2013-01-01

    The study was done to assess the sealing ability and adaptation of RealSeal 1, and to compare it with Thermafil. 65 single-rooted extracted teeth were selected and root canal treatment was performed. Root canals were obturated with RealSeal 1 or Thermafil. A double chamber bacterial leakage model using E. faecalis was developed to assess the sealing ability. Samples were monitored daily for 60 days. After the bacterial leakage test, samples were embedded in resin and sectioned horizontally at 2 and 4 mm from the apical foramen. Specimens were examined under scanning electron microscope and digitally photographed. AutoCAD software was used to measure the gap between the canal surface and obturation material. Results were statistically analyzed using nonparametric Kaplan-Meier survival analysis for the bacterial leakage and t-test to compare the means of gap in RealSeal 1 and Thermafil at 2 and 4 mm. There was no significant difference between the RealSeal 1 and Thermafil with respect to leakage over time. At 2 mm and 4 mm, RealSeal 1 had significantly more gaps than Thermafil. From the observations it can be concluded that RealSeal 1 and Thermafil have comparable performance in terms of adaptation and sealing ability.

  14. An In Vitro Comparative Study of the Adaptation and Sealing Ability of Two Carrier-Based Root Canal Obturators

    PubMed Central

    Alkahtani, Ahmed; Al-Subait, Sara; Anil, Sukumaran

    2013-01-01

    The study was done to assess the sealing ability and adaptation of RealSeal 1, and to compare it with Thermafil. 65 single-rooted extracted teeth were selected and root canal treatment was performed. Root canals were obturated with RealSeal 1 or Thermafil. A double chamber bacterial leakage model using E. faecalis was developed to assess the sealing ability. Samples were monitored daily for 60 days. After the bacterial leakage test, samples were embedded in resin and sectioned horizontally at 2 and 4 mm from the apical foramen. Specimens were examined under scanning electron microscope and digitally photographed. AutoCAD software was used to measure the gap between the canal surface and obturation material. Results were statistically analyzed using nonparametric Kaplan-Meier survival analysis for the bacterial leakage and t-test to compare the means of gap in RealSeal 1 and Thermafil at 2 and 4 mm. There was no significant difference between the RealSeal 1 and Thermafil with respect to leakage over time. At 2 mm and 4 mm, RealSeal 1 had significantly more gaps than Thermafil. From the observations it can be concluded that RealSeal 1 and Thermafil have comparable performance in terms of adaptation and sealing ability. PMID:23710141

  15. The use of cone beam computed tomography and three dimensional printing technology in the restoration of a maxillectomy patient using a dental implant retained obturator.

    PubMed

    Michelinakis, George

    2017-01-01

    This case report presents an alternative method for fabricating an obturator for patients that develop xerostomia and mild trismus following radiation to the Head and Neck region. Multiple initial impression stages are avoided leading to less irritation to soft tissues and less discomfort to the patient. A 69-year-old male patient was referred to our dental practice by the Maxillofacial Surgery Department of the local General Hospital. The patient had undergone a right maxillectomy for removal of a Squamous Cell Carcinoma 2 weeks prior. Four endosseous dental implants were placed in the remaining upper jaw and 2 implants were inserted into the canine region of his edentulous mandible 3 weeks after ablative surgery. Five months following completion of radiotherapy and chemotherapy, a cone beam computed tomography of the maxilla was obtained, and a three dimensional model was constructed using an appropriate resin. Using the model as the detailed primary cast, a custom acrylic special tray was fabricated for the final impression of the remaining maxilla and the maxillary defect. An implant retained maxillary obturator and an implant retained mandibular overdenture were constructed to restore patient's speech, mastication and deglutition. The method presented here can limit the impression stages needed for construction of a maxillary obturator prosthesis to a single impression procedure advocating a partial digital workflow process. This can be very beneficial to the patient suffering from postradiation side-effects such as trismus, mucositis, and xerostomia.

  16. Usage of a Trans-Obturator-Tape (T.O.T.) "outside-in" approach in surgical treatment of female stress urinary incontinence.

    PubMed

    Jovanovic, Mirko; Vuksanović, Aleksandar; Dzamić', Zoran; Aćimović, Miodrag; Radovanović, Milan; Djurasić, Ljubomir

    2011-01-01

    The aim of the study was to analyzed the efficacy and safety of a new minimally invasive surgical procedure using the Trans-Obturator-Tape with"outside-in" approach for treatment female stress urinary incontinence. 31 women with stress urinary incontinence (SUI) associated with urethral hypermobility, underwent the T.O.T. procedure (March 2010 to January 2011). 5 patients were previously operated for incontinence. Mean age was 59 years (37-80). 10 patients were having mixed incontinence. A non-elastic, polypropylene tape was placed under the mid-urethra. The surgical placement technique utilises a trans-obturator percutaneous approach. All patients underwent post-operative clinical examination, cough-stress test (full bladder), uroflowmetry, and post-voiding residual assessment. Mean follow-up was 5 months (1-9). At 6 months follow-up 96.7% of the patients were completely cured. The overall peri-operative complication rate was 6.4% with no vascular, nerve or bowel injury. One patients (3.4%) had post-operative urinary retention. The present study confirms the results obtained by the instigator of the technique, E. Delorme, and allows us to consider T.O.T. as an effective and safe technique for the treatment of female stress urinary incontinence.

  17. Evolution of oral cancer treatment in an andalusian population sample: Rehabilitation with prosthetic obturation and removable partial prosthesis

    PubMed Central

    Flores-Ruiz, Rafael; Castellanos-Cosano, Lizette; Serrera-Figallo, María-Angeles; Gutiérrez-Corrales, Aida; Gonzalez-Martin, Maribel; Gutiérrez-Pérez, Jose-Luis

    2017-01-01

    Background Radical surgical resection as a treatment modality for oral cancer often leads to an extensive deficit in both the maxillary and mandibular levels, where the use of a palatal obturator prosthesis (POP) or removable partial denture (RPP). The aim of this study was to evaluate the treatment with POP and RPP in patients treated for oral cancer in the Unit of Prosthetic Rehabilitation of the University Hospital Virgen del Rocío in a period of 20 years. Material and Methods Retrospective descriptive study during the years 1991 and 2011 analyzing oral cancer type, characteristics, treatment and follow-up. The sample consisted of patients whose tumor had previously been removed and who had been referred to the Oncological Rehabilitation Unit of the Oral and Maxillofacial Surgery Unit of the “Virgen del Rocío” University Hospital for rehabilitation. The inclusion criteria were patients whose underlying pathology was any type of neoplasia, which after its treatment had been referred to the aforementioned Oncological Prosthetic Rehabilitation unit. Results Of the 45 patients included in our study, 15 patients were rehabilitated with palatal obturator (33.3%) and 5 patients with removable partial denture (11.1%). The mean age of the sample of patients with POP was 57.3 ± 9.23, while the mean age of the sample of patients with RPP was 58 ± 13.5. The most common underlying pathology in patients with POP was squamous cell carcinoma (60%), whereas in patients with RPP it was 100%. The most frequent location found among POP patients was the upper jaw, while in the PRP patients there was no predominant location. The univariate and multivariate logistic regressions did not show any statistically significant association between the independent variables age, sex, smoking habit and alcoholic habit with the dependent variable type of rehabilitating prosthesis. Conclusions Based on our data, we can conclude that RPP is used in few cases of oncological rehabilitation

  18. Evolution of oral cancer treatment in an andalusian population sample: Rehabilitation with prosthetic obturation and removable partial prosthesis.

    PubMed

    Flores-Ruiz, Rafael; Castellanos-Cosano, Lizette; Serrera-Figallo, María-Angeles; Gutiérrez-Corrales, Aida; Gonzalez-Martin, Maribel; Gutiérrez-Pérez, Jose-Luis; Torres-Lagares, Daniel

    2017-08-01

    Radical surgical resection as a treatment modality for oral cancer often leads to an extensive deficit in both the maxillary and mandibular levels, where the use of a palatal obturator prosthesis (POP) or removable partial denture (RPP). The aim of this study was to evaluate the treatment with POP and RPP in patients treated for oral cancer in the Unit of Prosthetic Rehabilitation of the University Hospital Virgen del Rocío in a period of 20 years. Retrospective descriptive study during the years 1991 and 2011 analyzing oral cancer type, characteristics, treatment and follow-up. The sample consisted of patients whose tumor had previously been removed and who had been referred to the Oncological Rehabilitation Unit of the Oral and Maxillofacial Surgery Unit of the "Virgen del Rocío" University Hospital for rehabilitation. The inclusion criteria were patients whose underlying pathology was any type of neoplasia, which after its treatment had been referred to the aforementioned Oncological Prosthetic Rehabilitation unit. Of the 45 patients included in our study, 15 patients were rehabilitated with palatal obturator (33.3%) and 5 patients with removable partial denture (11.1%). The mean age of the sample of patients with POP was 57.3 ± 9.23, while the mean age of the sample of patients with RPP was 58 ± 13.5. The most common underlying pathology in patients with POP was squamous cell carcinoma (60%), whereas in patients with RPP it was 100%. The most frequent location found among POP patients was the upper jaw, while in the PRP patients there was no predominant location. The univariate and multivariate logistic regressions did not show any statistically significant association between the independent variables age, sex, smoking habit and alcoholic habit with the dependent variable type of rehabilitating prosthesis. Based on our data, we can conclude that RPP is used in few cases of oncological rehabilitation. The POP has a greater use, as long as the defect in the

  19. Texture analysis of T1-w and T2-w MR images allows a quantitative evaluation of radiation-induced changes of internal obturator muscles after radiotherapy for prostate cancer.

    PubMed

    Scalco, Elisa; Rancati, Tiziana; Pirovano, Ileana; Mastropietro, Alfonso; Palorini, Federica; Cicchetti, Alessandro; Messina, Antonella; Avuzzi, Barbara; Valdagni, Riccardo; Rizzo, Giovanna

    2018-04-01

    To investigate the potential of texture analysis applied on T2-w and postcontrast T1-w images acquired before radiotherapy for prostate cancer (PCa) and 12 months after its completion in quantitatively characterizing local radiation effect on the muscular component of internal obturators, as organs potentially involved in urinary toxicity. T2-w and postcontrast T1-w MR images were acquired at 1.5 T before treatment (MRI1) and at 12 months of follow-up (MRI2) in 13 patients treated with radiotherapy for PCa. Right and left internal obturator muscle contours were manually delineated upon MRI1 and then automatically propagated on MRI2 by an elastic registration method. Planning CT images were coregistered to both MRIs and dose maps were deformed accordingly. A high-dose region receiving >55 Gy and a low-dose region receiving <55 Gy were identified in each muscle volume. Eighteen textural features were extracted from each region of interest and differences between MRI1 and MRI2 were evaluated. A signal increase was highlighted in both T2-w and T1-w images in the portion of the obturators near the prostate, i.e., in the region receiving medium-high doses. A change in the spatial organization was identified, as an increase in homogeneity and a decrease in contrast and complexity, compatible with an inflammatory status. In particular, the region receiving medium-high doses presented more significant or, at least, stronger differences. Texture analysis applied on T1-w and T2-w MR images has demonstrated its ability in quantitative evaluating radiation-induced changes in obturator muscles after PCa radiotherapy. © 2018 American Association of Physicists in Medicine.

  20. Apical and root canal space sealing abilities of resin and glass ionomer-based root canal obturation systems.

    PubMed

    Royer, Kinga; Liu, Xue Jun; Zhu, Qiang; Malmstrom, Hans; Ren, Yan-Fang

    2013-01-01

    To investigate the apical sealing ability of glass ionomer and resin-based root canal obturation systems in comparison to a conventional vertical compaction of warm guttapercha. Forty-five extracted human teeth were randomly assigned into 3 groups of 15 each: a resin-based (EndoRez), a glass ionomer-based (Activ GP), and a conventional gutta-percha plus pulp sealer obturation system (GP/EWT). Apical and root canal space sealing abilities were assessed on five cross-sections 1.0 mm apart starting from the apex. Cross-section images were analysed using a focus-variation 3D scanning microscope and unsealed space was calculated as the percentage of total root canal space occupied by voids and debris. EndoRez had significantly higher rate of apical leakage and deeper dye penetration as compared to GP/EWT and Activ GP. EndoRez group had also more voids and debris (22.5%) in the root canal spaces as compared to GP/EWT (10.5%) and Activ GP (10.8%). Apical leakages occurred not only along the root canal walls, but also along the gutta-percha cones with EndoRez as a result of significant polymerisation shrinkage of the resin sealer. Resin-based EndoRez did not form an adequate apical seal of filled root canals. Glass ionomer-based Activ GP was comparable to a vertical compaction of warm guttapercha plus EWT sealer in sealing root canal spaces.

  1. Fabricating a tooth- and implant-supported maxillary obturator for a patient after maxillectomy with computer-guided surgery and CAD/CAM technology: A clinical report.

    PubMed

    Noh, Kwantae; Pae, Ahran; Lee, Jung-Woo; Kwon, Yong-Dae

    2016-05-01

    An obturator prosthesis with insufficient retention and support may be improved with implant placement. However, implant surgery in patients after maxillary tumor resection can be complicated because of limited visibility and anatomic complexity. Therefore, computer-guided surgery can be advantageous even for experienced surgeons. In this clinical report, the use of computer-guided surgery is described for implant placement using a bone-supported surgical template for a patient with maxillary defects. The prosthetic procedure was facilitated and simplified by using computer-aided design/computer-aided manufacture (CAD/CAM) technology. Oral function and phonetics were restored using a tooth- and implant-supported obturator prosthesis. No clinical symptoms and no radiographic signs of significant bone loss around the implants were found at a 3-year follow-up. The treatment approach presented here can be a viable option for patients with insufficient remaining zygomatic bone after a hemimaxillectomy. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  2. The inside-out trans-obturator sling: a novel surgical technique for the treatment of male urinary incontinence.

    PubMed

    de Leval, Jean; Waltregny, David

    2008-11-01

    To describe a new sling procedure for treating stress urinary incontinence (SUI) after radical prostatectomy (RP) and prospectively evaluate its short-term safety and efficacy. The sling technique uses specific instruments and a polypropylene mesh with two arms that are passed inside to outside through the obturator foramens, pulled for compressing the bulbar urethra upward, and tied to each other across the midline. Patients with detrusor overactivity were excluded. Baseline and follow-up evaluations included uroflowmetry and continence and quality of life (QoL) questionnaires. Cure was defined by no pad use and improvement by a number of pads/d 5pads/d, respectively. The procedure was preceded by an endoscopic urethrotomy in four patients. No perioperative complication was noted; three patients required suprapubic catheterization. At 6 mo, nine (45%) patients were cured and eight others (40%) were improved (1pad/d). QoL was significantly enhanced and 80% of patients were moderately to completely satisfied with the procedure. Preoperative and postoperative maximum flow rate and postvoid residual values were not statistically different. No sling infection, urethra erosion, persistent pain, or neurologic complications were observed. The inside-out trans-obturator sling procedure appears to be safe and efficient at short term. Further studies are warranted to determine long-term outcome.

  3. [IMPROVEMENT AND CHOICE OF COLOSTOMY METHOD IN THE TREATMENT OF PATIENTS, SUFFERING AN ACUTE OBTURATIVE IMPASSABILITY OF LARGE BOWEL].

    PubMed

    Kustryo, V I; Langazo, O V

    2015-11-01

    Colostomy was done in 49 patients, suffering an acute obturative impassability of large bowel (AOILB). In 28 patients (1st group) colostomy was conducted in accordance to standard method; in 21 (2nd group)--in accordance to the method, proposed by us. Application of the method proposed for surgical treatment of AOILB have guaranteed a reduction of postoperative paracolostomal complications rate in 6.8 times, of postoperative lethality--in 2.2 times, duration of the patient stationary treatment--in 1.4 times, the rate of dressings and the dressing material expanses--in 10 times.

  4. Applying extrusive orthodontic force without compromising the obturated canal space.

    PubMed

    Keinan, David; Szwec, Jerard; Matas, Avital; Moshonov, Joshua; Yitschaky, Oded

    2013-08-01

    Complicated tooth fractures can be the unfortunate result of orofacial trauma and can offer a therapeutic challenge for the dentist. A conservative solution for gaining supragingival sound tooth structure often includes orthodontic forced eruption. Usually, this procedure is carried out by applying extrusive force after placing a provisional acrylic Richmond crown on the tooth. However, this long-lasting dental treatment may jeopardize the coronal seal of the root canal space, leading to microleakage and endodontic failure. Orthodontic forced eruption demands application of force to an attachment connected to the remaining short clinical crown. In this article, the authors describe a case in which they used a new technique for orthodontic forced eruption of a traumatized tooth, using an extracanal attachment to apply extrusion force, and discuss its possible advantages and limitations. An extracanal attachment approach for orthodontic forced eruption without compromising the obturated canal space can be a solution for posttraumatic crown fracture. Practical Implications. The described procedure for forced eruption by using an extracanal pin attachment is efficient and convenient and does not require the clinician to apply force directly to the provisional crown. Therefore, during the application of force, there is less risk of loosening the provisional crown, and the canal space is kept intact with either the final restoration or dressing material.

  5. Cognition and Depression Following Deep Brain Stimulation of the Subthalamic Nucleus and Globus Pallidus Pars Internus in Parkinson's Disease: A Meta-Analysis.

    PubMed

    Combs, Hannah L; Folley, Bradley S; Berry, David T R; Segerstrom, Suzanne C; Han, Dong Y; Anderson-Mooney, Amelia J; Walls, Brittany D; van Horne, Craig

    2015-12-01

    Parkinson's disease (PD) is a common, degenerative disorder of the central nervous system. Individuals experience predominantly extrapyramidal symptoms including resting tremor, rigidity, bradykinesia, gait abnormalities, cognitive impairment, depression, and neurobehavioral concerns. Cognitive impairments associated with PD are diverse, including difficulty with attention, processing speed, executive functioning, memory recall, visuospatial functions, word-retrieval, and naming. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) or globus pallidus internus (GPi) is FDA approved and has been shown to be effective in reducing motor symptoms of PD. Studies have found that stimulating STN and GPi are equally effective at improving motor symptoms and dyskinesias; however, there has been discrepancy as to whether the cognitive, behavioral, and mood symptoms are affected differently between the two targets. The present study used random-effects meta-analytic models along with a novel p-curve analytic procedure to compare the potential cognitive and emotional impairments associated with STN-DBS in the current literature to those associated with GPi-DBS. Forty-one articles were reviewed with an aggregated sample size of 1622 patients. Following STN-DBS, small declines were found in psychomotor speed, memory, attention, executive functions, and overall cognition; and moderate declines were found in both semantic and phonemic fluency. However, GPi-DBS resulted in fewer neurocognitive declines than STN-DBS (small declines in attention and small-moderate declines in verbal fluency). With regards to its effect on depression symptomatology, both GPi-DBS and STN-DBS resulted in lower levels of depressive symptoms post-surgery. From a neurocognitive standpoint, both GPi-DBS and STN-DBS produce subtle cognitive declines but appears to be relatively well tolerated.

  6. Deep gluteal space problems: piriformis syndrome, ischiofemoral impingement and sciatic nerve release.

    PubMed

    Carro, Luis Perez; Hernando, Moises Fernandez; Cerezal, Luis; Navarro, Ivan Saenz; Fernandez, Ana Alfonso; Castillo, Alexander Ortiz

    2016-01-01

    Deep gluteal syndrome (DGS) is an underdiagnosed entity characterized by pain and/or dysesthesias in the buttock area, hip or posterior thigh and/or radicular pain due to a non-discogenic sciatic nerve entrapment in the subgluteal space. Multiple pathologies have been incorporated in this all-included "piriformis syndrome", a term that has nothing to do with the presence of fibrous bands, obturator internus/gemellus syndrome, quadratus femoris/ischiofemoral pathology, hamstring conditions, gluteal disorders and orthopedic causes. This article describes the subgluteal space anatomy, reviews known and new etiologies of DGS, and assesses the role of the radiologist and orthopaedic surgeons in the diagnosis, treatment and postoperative evaluation of sciatic nerve entrapments. DGS is an under-recognized and multifactorial pathology. The development of periarticular hip endoscopy has led to an understanding of the pathophysiological mechanisms underlying piriformis syndrome, which has supported its further classification. The whole sciatic nerve trajectory in the deep gluteal space can be addressed by an endoscopic surgical technique. Endoscopic decompression of the sciatic nerve appears useful in improving function and diminishing hip pain in sciatic nerve entrapments, but requires significant experience and familiarity with the gross and endoscopic anatomy. IV.

  7. Surgical treatment of female stress urinary incontinence with a trans-obturator-tape (T.O.T.) Uratape: short term results of a prospective multicentric study.

    PubMed

    Costa, P; Grise, P; Droupy, S; Monneins, F; Assenmacher, C; Ballanger, P; Hermieu, J F; Delmas, V; Boccon-Gibod, L; Ortuno, C

    2004-07-01

    The aim of the study was to assess the efficacy and safety of a new minimally invasive surgical procedure using the Trans-Obturator-Tape Uratape to treat female stress urinary incontinence. 183 women with stress urinary incontinence (SUI) associated with urethral hypermobility, underwent the T.O.T. procedure (October 2001 to March 2003). 26 patients were previously operated for incontinence. 26 patients were operated at the same time for their genital prolapse. Mean age was 56 years (29-87). 50/183 patients were having mixed incontinence. A non-elastic, polypropylene tape (UraTape, Mentor-Porgès) with a silicon coated central part was placed under the mid-urethra. The surgical placement technique utilises a trans-obturator percutaneous approach. All patients underwent post-operative clinical examination, cough-stress test (full bladder), uroflowmetry, and post-voiding residual assessment. Mean follow-up was 7 months (1-21). At 1 year follow-up 80.5% of the patients were completely cured and 7.5% were improved. The overall peri-operative complication rate was 2.2% with no vascular, nerve or bowel injury. 6 patients (3.3%) had post-operative urinary retention. The present multicentric study confirms the results obtained by the instigator of the technique, E. Delorme, and allows us to consider T.O.T. as an effective and safe technique for the treatment of female stress urinary incontinence, alone or in combination with prolapse repair. Copyright 2004 Elsevier B.V.

  8. Implant-Retained Obturator for an Edentulous Patient with a Hemimaxillectomy Defect Complicated with Microstomia

    PubMed Central

    2016-01-01

    Patient. A 68-year-old man was operated on for squamous cell carcinoma (T3N3M0) of the maxilla creating the hemimaxillary surgical defect on right side. The remaining arch was completely edentulous. There was remarkable limitation in the oral opening with reduced perimeter of the oral cavity due to radiation and surgical scar contracture. This article describes prosthetic rehabilitation by modifying the design of the obturator and achieving the retention with dental implant. Discussion. Severe limitation in the oral opening may occur in clinical situations following the postsurgical management of oral and maxillofacial defects. The prosthetic rehabilitation of the surgical defect in such patients becomes a challenging task due to limited access to the oral cavity. This challenge becomes even more difficult if the patient is edentulous and there are no teeth to gain the retention, stability, and support. Conclusion. In severe microstomia prosthesis insertion and removal can be achieved with modification of the maximum width of the prosthesis. Dental implant retention is useful treatment option in edentulous patients with maxillary surgical defect provided that sufficient bone volume and accessibility are there for implant placement. PMID:27843652

  9. Superior perioperative analgesia with combined femoral-obturator-sciatic nerve block in comparison with posterior lumbar plexus and sciatic nerve block for ACL reconstructive surgery.

    PubMed

    Bareka, Metaxia; Hantes, Michael; Arnaoutoglou, Eleni; Vretzakis, George

    2018-02-01

    The purpose of this randomized controlled study is to compare and evaluate the intraoperative and post-operative outcome of PLPS nerve block and that of femoral, obturator and sciatic (FOS) nerve block as a method of anaesthesia, in performing ACL reconstruction. Patients referred for elective arthroscopic ACL reconstruction using hamstring autograft were divided in two groups. The first group received combined femoral-obturator-sciatic nerve block (FOS Group) under dual guidance, whereas the second group received posterior lumbar plexus block under neurostimulation and sciatic nerve block (PLPS Group) under dual guidance. The two groups were comparable in terms of age, sex, BMI and athletic activity. The time needed to perform the nerve blocks was significantly shorter for the FOS group (p < 0.005). Similarly, VAS scores during tourniquet inflation and autograft harvesting were significantly higher (p < 0.005) in the PLPS group and this is also reflected in the intraoperative fentanyl consumption and conversion to general anaesthesia. Finally, patients in this group also reported higher post-operative VAS scores and consumed more morphine. Peripheral nerve blockade of FOS nerve block under dual guidance for arthroscopic ACL reconstructive surgery is a safe and tempting anaesthetic choice. The success rate of this technique is higher in comparison with PLPS and results in less peri- and post-operative pain with less opioid consumption. This study provides support for the use of peripheral nerve blocks as an exclusive method for ACL reconstructive surgery in an ambulatory setting with almost no complications. I.

  10. Ipsilateral obturator type of hip dislocation with fracture shaft femur in a child: a case report and literature review.

    PubMed

    Arjun, R H H; Kumar, Vishal; Saibaba, Balaji; John, Rakesh; Guled, Uday; Aggarwal, Sameer

    2016-09-01

    The incidence of traumatic hip dislocations in children is rising in this fast developing world along with increasing numbers of high-velocity road traffic accidents. Anterior dislocation of the hip has a lower incidence compared with posterior dislocation of the hip. We encountered a rare case of the obturator type of anteriorly dislocated hip associated with ipsilateral fracture of the shaft femur in an 11-year-old child. This is a highly unusual injury combination and the mechanism of injury is obscure. Only two similar cases have been reported in the English literature to date. Closed reduction of the hip using a hitherto undescribed technique and an intramedullary interlocking nail was performed in this case. At 6 months of follow-up, the fracture shaft femur has united and the child is bearing full weight on the limb.

  11. Modified prepubic TVT-obturator tape procedure versus the conventional method: a preliminary study.

    PubMed

    Long, Cheng-Yu; Wu, Ming-Ping; Wang, Chiu-Lin; Lin, Kun-Ling; Liu, Cheng-Min; Wu, Shu-Hui; Juan, Yung-Shun

    2013-12-01

    To compare the efficacy and safety of the modified prepubic tension-free vaginal tape-obturator (PTVT-O) system procedure with the original TVT-O methods. One hundred and ninety women with urodynamic stress incontinence (USI) were included in this study (93 cases in the TVT-O group and 97 in the PTVT-O group). Clinical assessments before and one year after surgery included urinalyses, 1-h pad tests, urodynamic studies, and a personal interview with the overactive bladder symptom score (OABSS) questionnaire. There were no differences between the two groups in mean age, parity, menopausal status, mean operative time and subjective cure rates (P>0.05), but the efficacy of surgery (cure and improvement) in the PTVT-O group was significantly higher than that in the TVT-O group (P=0.038). Complication rates and visual analog scale (VAS) scores were found to be similar (P>0.05). OABSS decreased significantly after surgery in both groups (P<0.05) although all urodynamic parameters revealed no significant difference after both procedures (P>0.05). Our modified procedure is a safe and effective treatment for female USI. It has an advantage over the original TVT-O with better surgical efficacy and comparable postoperative pain, although the follow-up times in this study are different. Copyright © 2013. Published by Elsevier Ireland Ltd.

  12. Root canal obturation: experimental study on the thermafil system related to different irrigation protocols

    PubMed Central

    Migliau, Guido; Sofan, Afrah Ali Abdullah; Sofan, Eshrak Ali Abdullah; Cosma, Salvatore; Eramo, Stefano; Gallottini, Livio

    2014-01-01

    Summary Aim The aim of this study was to stress the ability of a specific obturation technique (thermafil technique) to seal root canal system in presence or absence of smear layer. Methodology Sixteen monoradicular teeth, extracted for periodontal reasons, were collected for this study. All specimens were prepared with nickel-titanium rotary files, and then divided into two groups: for each group was applied a different kind of irrigation method, verifying the effectiveness in removing the smear layer, thus rendering the dentinal tubules more permeable for penetration of softened gutta-percha. Thermafil system was used to fill the root canals, and then all the specimens were observed under scanning electron microscope (SEM). Results The results showed that the Group which followed irrigation only with sodium hypochlorite exhibited significantly less gutta-percha tags when compared to the second Group, which was irrigated with sodium hypochlorite and EDTA. Conclusion The thermafil systems have a very good quality of compression and fluency that permit to gain a good seal of endodontic space; furthermore it allows the penetration of gutta-percha with the formation of numerous of gutta-percha tags inside the dentinal tubules above all when smear layer is reduced or eliminated. PMID:25506413

  13. Deep gluteal space problems: piriformis syndrome, ischiofemoral impingement and sciatic nerve release

    PubMed Central

    Carro, Luis Perez; Hernando, Moises Fernandez; Cerezal, Luis; Navarro, Ivan Saenz; Fernandez, Ana Alfonso; Castillo, Alexander Ortiz

    2016-01-01

    Summary Background Deep gluteal syndrome (DGS) is an underdiagnosed entity characterized by pain and/or dysesthesias in the buttock area, hip or posterior thigh and/or radicular pain due to a non-discogenic sciatic nerve entrapment in the subgluteal space. Multiple pathologies have been incorporated in this all-included “piriformis syndrome”, a term that has nothing to do with the presence of fibrous bands, obturator internus/gemellus syndrome, quadratus femoris/ischiofemoral pathology, hamstring conditions, gluteal disorders and orthopedic causes. Methods This article describes the subgluteal space anatomy, reviews known and new etiologies of DGS, and assesses the role of the radiologist and orthopaedic surgeons in the diagnosis, treatment and postoperative evaluation of sciatic nerve entrapments. Conclusion DGS is an under-recognized and multifactorial pathology. The development of periarticular hip endoscopy has led to an understanding of the pathophysiological mechanisms underlying piriformis syndrome, which has supported its further classification. The whole sciatic nerve trajectory in the deep gluteal space can be addressed by an endoscopic surgical technique. Endoscopic decompression of the sciatic nerve appears useful in improving function and diminishing hip pain in sciatic nerve entrapments, but requires significant experience and familiarity with the gross and endoscopic anatomy. Level of evidence IV. PMID:28066745

  14. Effect of tension-free vaginal tape and TVT-obturator on lower urinary tract symptoms other than stress urinary incontinence.

    PubMed

    Ballert, Katie N; Kanofsky, Jamie A; Nitti, Victor W

    2008-03-01

    Variable effects on lower urinary tract symptoms (LUTS) other than stress urinary incontinence (SUI) have been reported after tension-free vaginal tape (TVT). We measured the effect of TVT on LUTS using the American Urological Association Symptom Index (AUASI). Patients undergoing TVT completed the AUASI pre- and post-operatively. Total scores (TS), storage scores (SS), and voiding scores (VS) were compared overall and among patients with SUI vs mixed urinary incontinence (MUI) and those who underwent TVT vs TVT-obturator (TVT-O). The mean change in TS and SS was -3.6 and -3.0. Mean reductions in TS and SS were significant in all patient subsets with no change in VS. There was no significant difference in the mean changes in TS between patients with SUI vs MUI or those undergoing TVT vs TVT-O. LUTS are improved after TVT in most patients. In general, voiding symptoms were not adversely affected.

  15. A novel digital workflow to manufacture personalized three-dimensional-printed hollow surgical obturators after maxillectomy.

    PubMed

    Kortes, J; Dehnad, H; Kotte, A N T; Fennis, W M M; Rosenberg, A J W P

    2018-04-07

    Partial or complete resection of the maxilla during tumour surgery causes oronasal defects, leading to oral-maxillofacial dysfunction, for which the surgical obturator (SO) is an important treatment option. Traditional manufacturing of SOs is complex, time-consuming, and often results in inadequate fit and function. This technical note describes a novel digital workflow to design and manufacture a three-dimensional (3D)-printed hollow SO. Registered computed tomography and magnetic resonance imaging images are used for gross tumour delineation. The produced RTStruct set is exported as a stereolitography (STL) file and merged with a 3D model of the dental status. Based on these merged files, a personalized and hollow digital SO design is created, and 3D printed. Due to the proper fit of the prefabricated SO, a soft silicone lining material can be used during surgery to adapt the prosthesis to the oronasal defect, instead of putty materials that are not suitable for this purpose. An STL file of this final SO is created during surgery, based on a scan of the relined SO. The digital workflow results in a SO weight reduction, an increased fit, an up-to-date digital SO copy, and overall easier clinical handling. Copyright © 2018 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  16. Clinical effectiveness of the obturator externus muscle injection in chronic pelvic pain patients.

    PubMed

    Kim, Shin Hyung; Kim, Do Hyeong; Yoon, Duck Mi; Yoon, Kyung Bong

    2015-01-01

    Because of its anatomical location and function, the obturator externus (OE) muscle can be a source of pain; however, this muscle is understudied as a possible target for therapeutic intervention in pain practice. In this retrospective observational study, we evaluated the clinical effectiveness of the OE muscle injection with a local anesthetic in chronic pelvic pain patients with suspected OE muscle problems. Twenty-three patients with localized tenderness on the inferolateral side of the pubic tubercle accompanied by pain in the groin, anteromedial thigh, or hip were studied. After identifying the OE with contrast dye under fluoroscopic guidance, 5 to 8 mL of 0.3% lidocaine was injected. Pain scores were assessed before and after injection; patient satisfaction was also assessed. Mean pain score decreased by 44.7% (6.6 ± 1.8 to 3.5 ± 0.9, P < 0.001) 2 weeks after OE muscle injection as compared with pain score before injection. In addition, 82% of patients (19 of 23 patients) reported excellent or good satisfaction during 2 weeks after injection. No patients reported complications from OE muscle injection. Fluoroscopy-guided injection of the OE muscle with local anesthetic reduced pain scores and led to a high level of satisfaction at short-term follow-up in patients with suspected OE muscle problem. The results of this study suggest that OE muscle injection may be a valuable therapeutic option for a select group of chronic pelvic pain patients who present with localized tenderness in the OE muscle that is accompanied by groin, anteromedial thigh, or hip pain. © 2013 World Institute of Pain.

  17. Effect of root canal obturation with calcium silicate materials on pH change in simulated root resorption defects.

    PubMed

    Aggarwal, Vivek; Singla, Mamta; Miglani, Sanjay; Sharma, Ritu

    2018-01-01

    This study evaluated the effect of 3 commercially available calcium silicate materials (CSMs) on pH changes in simulated root resorption defects. Simulated root resorption defects were prepared on the facial root surface of 40 mandibular premolars. The depth of each defect was individually calculated to standardize the remaining dentin thickness to 1 mm. Prepared canals were obturated with the 3 CSMs. Ten specimens were kept as controls, filled with unbuffered normal saline. The pH measurements were taken at 1 hour, 6 hours, 1 day, 1 week, 2 weeks, 3 weeks, 1 month, and 2 months. All CSM groups exhibited an initial alkaline pH of 9.0-9.7. The pH decreased to 8.0-8.5 after 2 months of storage. There were no significant differences between pH measurements at other time intervals. The CSM groups exhibited higher pH levels than the control group. The results showed that intracanal placement of the CSMs maintained initial pH levels of 9.0-9.7 inside the simulated resorption defects; these measurements gradually decreased to 8.0-8.5 over the span of 2 months.

  18. FP core carrier technique: thermoplasticized gutta-percha root canal obturation technique using polypropylene core.

    PubMed

    Kato, Hiroshi; Nakagawa, Kan-Ichi

    2010-01-01

    Core carrier techniques are unique among the various root canal filling techniques for delivering and compacting gutta-percha in the prepared root canal system. Thermafil (TF), considered the major core carrier device, is provided as an obturator consisting of a master core coated with thermoplasticized gutta-percha. We have devised a thermoplasticized gutta-percha filling technique using a polypropylene core, FlexPoint® NEO (FP), which was developed as a canal filling material that can be sterilized in an autoclave. Therefore, FP can be coated onto thermoplasticized gutta-percha and inserted into the prepared canal as a core carrier. The FP core carrier technique offers many advantages over the TF system: the core can be tested in the root canal and verified radiographically; the core can be adjusted to fit and surplus material easily removed; furthermore the core can be easily removed for retreatment. The clinical procedure of the FP core carrier technique is simple, and similar that with the TF system. Thermoplasticized gutta-percha in a syringe is heated in an oven and extruded onto the FP core carrier after a trial insertion. The FP core carrier is inserted into the root canal to the working length. Excess FP is then removed with a red-hot plastic instrument at the orifice of the root canal. The FP core carrier technique incorporates the clinical advantages of the existing TF system while minimizing the disadvantages. Hence the FP core carrier technique is very useful in clinical practice. This paper describes the FP core carrier technique as a new core based method.

  19. Objective and subjective cure rates after trans-obturator tape (OBTAPE) treatment of female urinary incontinence.

    PubMed

    Deval, Bruno; Ferchaux, Jérome; Berry, Richard; Gambino, Sandro; Ciofu, Calin; Rafii, Arash; Haab, François

    2006-02-01

    To evaluate the safety and efficacy of a thermally bonded nonwoven polypropylene mesh in a transobturator suburethral tape procedure (OBTAPE), Mentor-Porges, Le Plessis Robinson, France) for women with stress urinary incontinence. Between January 2003 and January 2005, 129 consecutive women (mean age 57.2 years) underwent OBTAPE) in two academic centers. All the patients had stress urinary incontinence preoperatively. Detrusor instability was ruled out by cystometry. The women were evaluated 1, 6 and 12 months postoperatively. The objective cure rate was evaluated by clinical examination and the subjective cure rate was assessed using the KHQ and BFLUTS questionnaire. Mean follow-up was 17.2+/-4.7 months (range 4 to 28 months). The objective and subjective cure rates were respectively 89.9% and 77.5%. Most of the patients received general anesthesia (85.3%). Urinary retention was observed in two women (1.5%), necessitating tape adjustment. Voiding difficulties were observed in 7 cases (5.4%) necessitating intermittent self-catheterization for 4.2+/-2.4 days (range 1 to 7 days). Seven patients developed vaginal erosion (one with vaginal extrusion, and two with an obturator abscess). Complete mesh removal was necessary in 6 patients, four of whom had recurrent stress urinary incontinence. Our results suggest that the OBTAPE) is an effective treatment for women with stress urinary incontinence. However, vaginal mesh erosion occurred in 6.2% of women, and this implies the need for careful follow-up.

  20. Bilateral globus pallidus internus deep brain stimulation for dyskinetic cerebral palsy supports success of cochlear implantation in a 5-year old ex-24 week preterm twin with absent cerebellar hemispheres.

    PubMed

    Lin, Jean-Pierre; Kaminska, Margaret; Perides, Sarah; Gimeno, Hortensia; Baker, Lesley; Lumsden, Daniel E; Britz, Anzell; Driver, Sandra; Fitzgerald-O'Connor, Alec; Selway, Richard

    2017-01-01

    Early onset dystonia (dyskinesia) and deafness in childhood pose significant challenges for children and carers and are the cause of multiple disability. It is particularly tragic when the child cannot make use of early cochlear implantation (CI) technology to relieve deafness and improve language and communication, because severe cervical and truncal dystonia brushes off the magnetic amplifier behind the ears. Bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) neuromodulation can reduce dyskinesia, thus supporting CI neuromodulation success. We describe the importance of the order of dual neuromodulation surgery for dystonia and deafness. First with bilateral GPi DBS using a rechargeable ACTIVA-RC neurostimulator followed 5 months later by unilateral CI with a Harmony (BTE) Advanced Bionics Hi Res 90 K cochlear device. This double neuromodulation was performed in series in a 12.5 kg 5 year-old ex-24 week gestation-born twin without a cerebellum. Relief of dyskinesia enabled continuous use of the CI amplifier. Language understanding and communication improved. Dystonic storms abated. Tolerance of sitting increased with emergence of manual function. Status dystonicus ensued 10 days after ACTIVA-RC removal for infection-erosion at 3 years and 10 months. He required intensive care and DBS re-implantation 3 weeks later together with 8 months of hospital care. Today he is virtually back to the level of functioning before the DBS removal in 2012 and background medication continues to be slowly weaned. This case illustrates that early neuromodulation with DBS for dystonic cerebral palsy followed by CI for deafness is beneficial. Both should be considered early i.e. under the age of five years. The DBS should precede the CI to maximise dystonia reduction and thus benefits from CI. This requires close working between the paediatric DBS and CI services. Copyright © 2016. Published by Elsevier Ltd.

  1. TVT-Secur (Hammock) Versus TVT-Obturator: A Randomized Trial of Suburethral Sling Operative Procedures

    PubMed Central

    Hota, Lekha S.; Hanaway, Katherine; Hacker, Michele R.; Disciullo, Anthony; Elkadry, Eman; Dramitinos, Patricia; Shapiro, Alexander; Ferzandi, Tanaz; Rosenblatt, Peter L.

    2013-01-01

    Objectives This study aimed to compare TVT-Secur (TVT-S) and TVT-Obturator (TVT-O) suburethral slings for treatment of stress urinary incontinence (SUI). Methods This was a single-center, nonblinded, randomized trial of women with SUI who were randomized to TVT-S or TVT-O from May 2007 to April 2009. The primary outcome, SUI on cough stress test (CST), and quality-of-life and symptom questionnaires (Pelvic Floor Distress Inventory [PFDI-20] and Pelvic Floor Impact Questionnaire [PFIQ-7]) were assessed at 12 weeks and 1 year. Results Forty-three women were randomized to TVT-S and 44 to TVT-O. There were no differences in median baseline PFDI-20 and PFIQ-7. Twenty-two (52.4%) of 42 participants randomized to TVT-S had a positive CST result at evaluation after 12 weeks or 1 year, whereas 4 (9.1%) of the 44 in the TVT-O group had a positive CST result. The intent-to-treat analysis showed that the risk of a positive CST result was 6 times higher after TVT-S than TVT-O (risk ratio, 6.0; 95% confidence interval [CI], 2.3–16.0). Among women not lost to follow-up, the risk ratio for a positive CST result after TVT-S compared with TVT-O was 17.9 (95% CI, 2.5–128.0) at 12 weeks and 3.5 (95% CI, 1.1–11.0) at 1 year. Both TVT-S and TVT-O resulted in improved quality of life and symptoms at 12 weeks. There was no difference between the groups for PFDI-20 (P = 0.40) or PFIQ-7 (P = 0.43). A similar pattern was seen at 1 year (P = 0.85 and P = 0.36). Conclusions The TVT-S seems to have a higher risk of positive postoperative CST result; however, the procedures result in similar improvements in quality of life and symptoms. PMID:22453267

  2. TVT-Secur (Hammock) versus TVT-Obturator: a randomized trial of suburethral sling operative procedures.

    PubMed

    Hota, Lekha S; Hanaway, Katherine; Hacker, Michele R; Disciullo, Anthony; Elkadry, Eman; Dramitinos, Patricia; Shapiro, Alexander; Ferzandi, Tanaz; Rosenblatt, Peter L

    2012-01-01

    This study aimed to compare TVT-Secur (TVT-S) and TVT-Obturator (TVT-O) suburethral slings for treatment of stress urinary incontinence (SUI). This was a single-center, nonblinded, randomized trial of women with SUI who were randomized to TVT-S or TVT-O from May 2007 to April 2009. The primary outcome, SUI on cough stress test (CST), and quality-of-life and symptom questionnaires (Pelvic Floor Distress Inventory [PFDI-20] and Pelvic Floor Impact Questionnaire [PFIQ-7]) were assessed at 12 weeks and 1 year. Forty-three women were randomized to TVT-S and 44 to TVT-O. There were no differences in median baseline PFDI-20 and PFIQ-7. Twenty-two (52.4%) of 42 participants randomized to TVT-S had a positive CST result at evaluation after 12 weeks or 1 year, whereas 4 (9.1%) of the 44 in the TVT-O group had a positive CST result. The intent-to-treat analysis showed that the risk of a positive CST result was 6 times higher after TVT-S than TVT-O (risk ratio, 6.0; 95% confidence interval [CI], 2.3-16.0). Among women not lost to follow-up, the risk ratio for a positive CST result after TVT-S compared with TVT-O was 17.9 (95% CI, 2.5-128.0) at 12 weeks and 3.5 (95% CI, 1.1-11.0) at 1 year. Both TVT-S and TVT-O resulted in improved quality of life and symptoms at 12 weeks. There was no difference between the groups for PFDI-20 (P = 0.40) or PFIQ-7 (P = 0.43). A similar pattern was seen at 1 year (P = 0.85 and P = 0.36). The TVT-S seems to have a higher risk of positive postoperative CST result; however, the procedures result in similar improvements in quality of life and symptoms.

  3. Transvaginal Pelvic Floor Muscle Injection Technique: A Cadaver Study.

    PubMed

    Gupta, Priyanka; Ehlert, Michael; Sirls, Larry T; Peters, Kenneth

    Women with pelvic floor dysfunction can have tender areas on vaginal examination, which can be treated with trigger-point injections. There are no publications to evaluate the accuracy of pelvic floor muscle injections. Trigger-point injections were performed on 2 fresh cadaveric pelvises using a curved nasal cannula guide and 7-in spinal needle. This was performed using our standard template of 2 sets of injections at the 1-, 3-, and 5-o'clock positions distally and proximally. The first pelvis was dissected to examine dye penetration. Based on these results, we modified our technique and repeated the injections on the second cadaver. We dissected the second pelvis and compared our findings. The 1-o'clock proximal and distal injections stained the obturator internus and externus near the insertion at the ischiopubic ramus. The 3-o'clock injections stained the midbody of the pubococcygeus and puborectalis. The distal 5-o'clock position was too deep and stained the fat of the ischiorectal space. The proximal 5-o'clock injection stained the area of the pudendal nerve. Our goal at the distal 5-o'clock position was to infuse the iliococcygeus muscle, so we shortened the needle depth from 2 to 1 cm beyond the cannula tip. In our second dissection, the distal 5-o'clock injection again stained only the fat of the ischiorectal space. This is the first study to characterize the distribution of pelvic floor muscle injections in a cadaver model and confirms the ability to deliver medications effectively to the pelvic floor muscles.

  4. Randomized clinical trial comparing TVT Secur system and trans vaginal obturator tape for the surgical management of stress urinary incontinence.

    PubMed

    Maslow, Ken; Gupta, Chander; Klippenstein, Peter; Girouard, Lise

    2014-07-01

    This prospective randomized study aimed to compare the safety and efficacy of the TVT-Secur (TVT-S) with the trans vaginal obturator tape (TVT-O) for the treatment of stress urinary incontinence. We set out to enroll 136 patients in our study. 106 patients with stress urinary incontinence were randomized to either the TVT-S (n = 56) or TVT-O (n = 50) procedure. Patients were evaluated postoperatively at 2 months and 1 year. Our primary outcome was objective cure measured by the cough test. Secondary outcomes of subjective symptoms, questionnaires, pain scores, complications, and urodynamic studies were also included. Statistical analysis was by Chi-squared, Kruskal-Wallis, Wilcoxon, and Fisher's exact tests as appropriate. P values of <0.05 were considered significant. Objective cure rates were better for TVT-O compared with TVT-S at 1 year (86 % and 63 % respectively, p = 0.01). Subjective cure rates were 88 % for TVT-O and 63 % for TVT-S. Quality of life scores through questionnaires improved in both groups and were not statistically different. Initial post-operative groin pain was more prevalent in the TVT-O group; however, this resolved quickly with time. TVT-O was superior to TVT-S in the objective cure of stress urinary incontinence at 1-year follow-up.

  5. Postoperative groin pain and success rates following transobturator midurethral sling placement: TVT ABBREVO® system versus TVT™ obturator system.

    PubMed

    Canel, Virginie; Thubert, Thibault; Wigniolle, Ingrid; Fernandez, Hervé; Deffieux, Xavier

    2015-10-01

    Placement of a transobturator midurethral sling (MUS) is the standard surgical treatment for stress urinary incontinence. Most recent MUS procedures have been poorly evaluated. We compared the results using a "new" device expected to reduce postoperative pain, the TVT ABBREVO® system (TVT-Abb), with those using the TVT™ obturator system (TVT-O). This was a retrospective study comparing the use of the TVT-Abb (in 50 patients) and the TVT-O (in 50 patients). The main outcomes were the amount of postoperative pain, the success rate (no reported urinary leakage and negative cough test) with both MUS procedures, and the prevalence of complications. The mean follow-up time was 12 months. The preoperative characteristics of the two groups were comparable. There was less postoperative pain (VAS, 0 to 100) in the TVT-Abb group than in the TVT-O group (12.2 vs. 24.4, p < 0.01). However, at 6 weeks after surgery there was no significant difference between the two groups (p = 0.32). The incidence of de novo bladder outlet obstruction symptoms was similar in the TVT-Abb group and the TVT-O group (8 % vs. 12 %, p = 0.74). The prevalences of perioperative and postoperative complications (bladder/urethral injury, haemorrhage) in the two groups were equal. The success rates were similar at 12 months after surgery (88 % vs. 78 %, p = 0.29). The success rates with TVT-Abb and TVT-O were equal at 12 months after surgery, but there was less immediate postoperative pain with TVT-Abb.

  6. Radial forearm free flap for soft palate reconstruction.

    PubMed

    Lacombe, V; Blackwell, K E

    1999-01-01

    Defects of the soft palate resulting from head and neck oncologic surgery traditionally have been rehabilitated using a prosthetic obturator. In general, the results of soft palate obturation have been satisfactory, with most patients achieving velopharyngeal competence during speech and swallowing. However, soft palate obturators have several disadvantages. Device stability and retention are impaired in patients who are edentulous. In addition, prosthetic obturators cover large areas of sensate mucosa in the hard palate, maxillary alveolus, and oropharynx, contributing significantly to the loss of sensory feedback from the oral cavity and oropharynx. Considerable evidence suggests that sensory impairment within the oral cavity and pharynx results in impaired mastication, deglutition, and articulation. A minority of patients find palatal obturators to be unsatisfactory, secondary to either inconvenience or device discomfort.

  7. The Analgesic Effect of Obturator Nerve Block Added to a Femoral Triangle Block After Total Knee Arthroplasty: A Randomized Controlled Trial.

    PubMed

    Runge, Charlotte; Børglum, Jens; Jensen, Jan Mick; Kobborg, Tina; Pedersen, Anette; Sandberg, Jon; Mikkelsen, Lone Ramer; Vase, Morten; Bendtsen, Thomas Fichtner

    2016-01-01

    Total knee arthroplasty (TKA) is associated with severe pain, and effective analgesia is essential for the quality of postoperative care and ambulation. The analgesic effects of adding an obturator nerve block (ONB) to a femoral triangle block (FTB) after TKA have not been tested previously. We hypothesized that combined ONB and FTB will reduce opioid consumption and pain compared with those of a single FTB or local infiltration analgesia (LIA). Seventy-eight patients were randomized to combined ONB and FTB, single FTB, or LIA after primary unilateral TKA. The primary outcome was morphine consumption during the first 24 postoperative hours. Secondary outcomes included morphine consumption during the first 48 postoperative hours, pain at rest and passive knee flexion, nausea and vomiting, cumulated ambulation score, and Timed Up and Go test. Seventy-five patients were included in the analysis. The total intravenous morphine consumption during the first 24 postoperative hours was 2 mg (interquartile range [IQR], 0-15) in the combined ONB and FTB group, 20 mg (IQR, 10-26) in the FTB group (P = 0.0007), and 17 mg (IQR, 10-36) in the LIA group (P = 0.002). The combined ONB and FTB group displayed reduced pain, nausea, and vomiting compared with the other groups. The ambulation tests showed no statistically significant differences between the groups. Addition of ONB to FTB significantly reduced opioid consumption and pain after TKA compared with a single FTB or LIA, without impaired ambulation.

  8. Botox combined with myofascial release physical therapy as a treatment for myofascial pelvic pain

    PubMed Central

    Scott, Lauren; Wyman, Allison; Mora, Nelsi; Miladinovic, Branko; Bassaly, Renee; Hoyte, Lennox

    2017-01-01

    Purpose To report the effects of combined onabotulinumtoxinA (Botox) injections and myofascial release physical therapy on myofascial pelvic pain (MFPP) by comparing pre- and posttreatment average pelvic pain scores, trigger points, and patient self-reported pelvic pain. Secondary outcomes were to examine posttreatment complications and determine demographic differences between patients with/without an improvement in pain. Materials and Methods This was an Institutional Review Board approved retrospective case series on women over 18 years with MFPP who received Botox and physical therapy between July 2006 and November 2014. Presence of trigger points and pelvic pain scores were determined by digital palpation of the iliococcygeus, puborectalis, obturator internus, and rectus muscles. Average pelvic pain scores (0–10) reflected an average of the scores obtained from palpation of each muscle. Self-reported improvement in pain was recorded as yes/no. Results Fifty women met the inclusion/exclusion criteria. Posttreatment, patients had lower average pelvic pain scores (3.7±4.0 vs. 6.4±1.8, p=0.005), and fewer trigger points (44% vs. 100%, p<0.001). Fifty-eight percent of patients (95% confidence interval, 44–72) noted an improvement in self-reported pain. Patients most likely to report no improvement in pain had chronic bowel disorders, while those most likely to report an improvement in pain had a history of past incontinence sling (p=0.03). Posttreatment complications included: constipation (8%), worsening urinary retention (2%), and urinary tract infection (4%). Conclusions Botox combined with soft tissue myofascial release physical therapy under anesthesia can be effective in treating women with chronic pelvic pain secondary to MFPP. PMID:28261683

  9. Muscle Damage After Total Hip Arthroplasty Through the Direct Anterior Approach for Developmental Dysplasia of the Hip.

    PubMed

    Kawasaki, Masashi; Hasegawa, Yukiharu; Okura, Toshiaki; Ochiai, Satoshi; Fujibayashi, Takayoshi

    2017-08-01

    Total hip arthroplasty (THA) through the direct anterior approach (DAA) is known to cause less muscle damage than other surgical approaches. However, more complex primary cases, such as developmental dysplasia of the hip (DDH), might often cause muscle damage. The objective of the present study was to clarify the muscle damage observed 1 year after THA through the DAA for DDH using magnetic resonance imaging. We prospectively compared the muscle cross-sectional area (M-CSA) and fatty atrophy (FA) in muscles by magnetic resonance imaging and the Harris hip score before and at 1-year follow-up after THA through the DAA in 3 groups: 37 patients with Crowe group 1 DDH (D1), 13 patients with Crowe group 2 and 3 DDH (D2 + 3), and 12 patients with osteonecrosis as a control. THA through the DAA for D1 displayed significantly decreased M-CSA and significantly increased FA in the gluteus minimus (Gmini), the tensor fasciae latae (TFL), and the obturator internus (OI). Patients with D2 + 3 group did not have decreased M-CSA in the TFL or increased FA in the Gmini. Postoperatively, a significant negative correlation was observed between the M-CSA and FA for the OI in patients with D1 and D2 + 3. THA through the DAA for DDH caused the damage in the Gmini, the TFL, and the OI; severe damage was observed in the OI, showing increased FA with decreased M-CSA in patients with both D1 and D2 + 3. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Stretching of roots contributes to the pathophysiology of radiculopathies.

    PubMed

    Berthelot, Jean-Marie; Laredo, Jean-Denis; Darrieutort-Laffite, Christelle; Maugars, Yves

    2018-01-01

    To perform a synthesis of articles addressing the role of stretching on roots in the pathophysiology of radiculopathy. Review of relevant articles on this topic available in the PubMed database. An intraoperative microscopy study of patients with sciatica showed that in all patients the hernia was adherent to the dura mater of nerve roots. During the SLR (Lasègue's) test, the limitation of nerve root movement occurs by periradicular adhesive tissue, and temporary ischemic changes in the nerve root induced by the root stretching cause transient conduction disturbances. Spinal roots are more frail than peripheral nerves, and other mechanical stresses than root compression can also induce radiculopathy, especially if they also impair intraradicular blood flow, or the function of the arachnoid villi intimately related to radicular veins. For instance arachnoiditis, the lack of peridural fat around the thecal sac, and epidural fibrosis following surgery, can all promote sciatica, especially in patients whose sciatic trunks also stick to piriformis or internus obturator muscles. Indeed, stretching of roots is greatly increased by adherence at two levels. As excessive traction of nerve roots is not shown by imaging, many physicians have unlearned to think in terms of microscopic and physiologic changes, although nerve root compression in the lumbar MRI is lacking in more than 10% of patients with sciatica. It should be reminded that, while compression of a spinal nerve root implies stretching of this root, the reverse is not true: stretching of some roots can occur without any visible compression. Copyright © 2017 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  11. Clinical application of the right sidelying respiratory left adductor pull back exercise.

    PubMed

    Boyle, Kyndall L

    2013-06-01

    Lumbopelvic-femoral conditions are common and may be associated with asymmetrical musculoskeletal and respiratory impairments and postural mal-alignment called a Left Anterior Interior Chain (AIC) pattern. An inherent pattern of asymmetry involves the trunk/ribs/spine/pelvis/hip joints and includes the tendency to stand on the right leg and shift the center of gravity to the right which may result for example, in a tight left posterior hip capsule, poorly approximated left hip, long/weak left adductors, internal obliques (IO) and transverse abdominus (TA), short/strong/over active paraspinals and muscles on the right anterior outlet (adductors, levator ani and obturator internus), a left rib flare and a decreased respiratory diaphragm zone of apposition (ZOA). A therapeutic exercise technique that can address impairments associated with postural asymmetry may be beneficial in improving function, reducing and/or eliminating pain causation, and improving breathing. The Right Sidelying Left Respiratory Adductor Pull Back is an exercise designed to affect alignment of the lumbopelvic-femoral region by influencing the left posterior ischiofemoral ligament, ZOA and right anterior outlet and left anterior inlet (rectus femoris, sartorius), activating/shortening the left adductors, left IO/TA's and inhibiting/lengthening the paraspinals, bilaterally. The exercise technique is often used by Physical Therapists, Physical Therapist assistants and Athletic Trainers as an initial exercise to positively affect position/alignment of the lumbopelvic-femoral region, referred to as "repositioning," by clinicians who use it. Four published case studies have used similar exercises to address the above impairments associated with a Left AIC pattern and in each 100% improvement in function and pain intensity was described. This particular exercise technique is relatively new and warrants future research.

  12. Uroflowmetric changes, success rate and complications following Tension-free Vaginal Tape Obturator (TVT-O) operation in obese females.

    PubMed

    Fouad, Reham; El-Faissal, Yahia M; Hashem, Ahmed T; Gad Allah, Sherine H

    2017-07-01

    The goal of this study was to evaluate the outcome of Tension-free Vaginal Tape Obturator (TVT-O) operation in the treatment of urodynamic stress incontinence (USI) in obese females, with respect to uroflowmetric changes, success rate and postoperative complications. This prospective observational study included 26 patients with USI at the Obstetrics & Gynecology department-Cairo University hospital during the year 2015. The participants had body mass index (BMI)≥30. Patients underwent TVT-O operation. Follow up of the patients was performed by cough test and uroflowmetry after one week, one month, three months and six months. Postoperative complications such as groin pain, sense of incomplete emptying, need to strain to complete micturition and urinary tract infection were recorded. Comparisons between groups were done using Chi square, Phi-Cramer test for categorical variables. The mean age for the subjects was 43.58±9.01years. The mean BMI was 33.4±2.1. The success rate of TVT-O operation was 21 out of 26 patients (≈81%). Normal maximum flow rate was in 88% of patients at week one and was normal in 100% of patients at months three and six (p=0.101 & 0.101). Postoperative groin pain was the main complaint during the first week after operation and decreased significantly from week one to the 1st month postoperative (84.62% & 65.38%, P=0.041). TVT-O operation showed a high success rate in treatment of USI in obese patients without affecting the voiding function of the bladder as proven by the uroflowmetry. The main postoperative complaint was the groin pain which significantly improved after one month. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Incidence of post-operative pain after single visit and multiple visit root canal treatment: A randomized controlled trial

    PubMed Central

    Singh, Smita; Garg, Aniket

    2012-01-01

    Aim: To compare the incidence and intensity of post-obturation pain after single or multi visit root canal treatment on single rooted teeth in a randomized controlled trial. Materials and Methods: Two hundred patients requiring root canal treatment on permanent single rooted teeth (both vital and non vital) were included. The patients were assigned randomly into two groups of 100 patients each. The teeth in Group1 (n = 100) were obturated at the first visit, whilst those in Group 2 (n = 100) were obturated in a second visit 7 days later. A modified Heft Parker visual analog scale was used to measure pre-operative pain and post-obturation pain at 6, 12, 24 and 48 hours after obturation. Independent-sample T-tests was used for statistical analysis. Results: Twelve patients were excluded from the study as they failed to follow the scheduled revisit. Data were obtained from the remaining 188 patients. There was no statistically significant difference in the incidence and intensity of post-obturation pain experienced by two groups. Conclusions: The incidence and intensity of post-obturation pain experience following one- or two-visit root canal treatment on teeth with a single canal were not significantly different. PMID:23112477

  14. Investigation of the effect of sealer use on the heat generated at the external root surface during root canal obturation using warm vertical compaction technique with System B heat source.

    PubMed

    Viapiana, Raqueli; Guerreiro-Tanomaru, Juliane Maria; Tanomaru-Filho, Mario; Camilleri, Josette

    2014-04-01

    During warm vertical compaction of gutta-percha, root canal sealers with different chemical compositions absorb the heat generated inside the root canal. The aim of this research was to assess physicochemical modifications of sealers subjected to the System B heat source (Analytic Technology, Redmond, WA) and to evaluate the effect that the use of different sealers has on the heat transfer to the external root surface. Three proprietary brand sealers (AH Plus [Dentsply International, Addlestone, UK], Pulp Canal Sealer [Kerr Corporation, Orange, CA], MTA Fillapex [Angelus Dental Solutions, Londrina, PR, Brazil]) and a prototype sealer based on Portland cement were assessed. The heat generated on the surfaces of System pluggers and the heat dissipation at different levels (apical, midroot, and cervical) over root surface while using different sealers was assessed using thermocouples. Data were collected in 3 different environmental conditions with the tooth suspended in air, immersed in Hank's balanced salt solution, or gelatinized Hank's balanced salt solution. Chemical changes in the sealers induced by the heat were monitored by Fourier transform infrared spectroscopy. The effect of heat changes on the setting time and compressive strength of the sealers was also assessed. The continuous wave plugger sustained a rise in temperature at a maximum of 80°C at the instrument shank. The highest change in temperature on the external root surface was recorded after 1.5 minutes from the start of heating, and it was restored to body temperature by 6 minutes. Environmental conditions affected heat dissipation for all the sealers in the midroot and cervical regions and the highest increase in temperature (∼60°C) recorded in air. In the midroot and cervical regions, the type of sealer used did not affect the rise in temperature. In the apical region, AH Plus obturations resulted in a greater rise in temperature, and the chemical composition of this sealer was affected by

  15. Oral rehabilitation of a patient with sub - total maxillectomy.

    PubMed

    Soni, Romesh; Jindal, Shitu; Singh, B P; Mittal, Neelam; Chaturvedi, T P; Prithviraj, D R

    2011-01-01

    This clinical report describes oral rehabilitation of a patient with sub-total maxillectomy with palatine process of maxilla and horizontal plate of palatine bone intact to retain the maxillary obturator. Clinical examination has been performed to know the amount of favorable undercuts to be used for retention of the obturator for better functional efficiency. Successful prosthetic reconstruction of hemimaxillectomy defect is a challenging procedure that requires multidisciplinary expertise to achieve acceptable functional speech and swallowing outcomes. This article describes the oral rehabilitation of a patient with sub-total maxillectomy with a maxillary obturator. Oral rehabilitation of sub-total maxillectomy patient is a challenging task. Obturation of the defect depends on volume of the defect, and positioning of remaining hard and soft tissues to be used to retain, stabilize, and support the prosthesis. A maxillary obturator for edentulous patient must provide for retention, stability, support, patient comfort, and cleanliness.

  16. Oral rehabilitation of a patient with sub - total maxillectomy

    PubMed Central

    Soni, Romesh; Jindal, Shitu; Singh, B. P.; Mittal, Neelam; Chaturvedi, T. P.; Prithviraj, D. R.

    2011-01-01

    This clinical report describes oral rehabilitation of a patient with sub-total maxillectomy with palatine process of maxilla and horizontal plate of palatine bone intact to retain the maxillary obturator. Clinical examination has been performed to know the amount of favorable undercuts to be used for retention of the obturator for better functional efficiency. Successful prosthetic reconstruction of hemimaxillectomy defect is a challenging procedure that requires multidisciplinary expertise to achieve acceptable functional speech and swallowing outcomes. This article describes the oral rehabilitation of a patient with sub-total maxillectomy with a maxillary obturator. Oral rehabilitation of sub-total maxillectomy patient is a challenging task. Obturation of the defect depends on volume of the defect, and positioning of remaining hard and soft tissues to be used to retain, stabilize, and support the prosthesis. A maxillary obturator for edentulous patient must provide for retention, stability, support, patient comfort, and cleanliness. PMID:22114459

  17. [Trans-obturator urethral sling for surgical correction of female stress urinary incontinence: Outside-in (Monarc) versus inside-out (TVT-O). Are both ways safe?].

    PubMed

    Debodinance, P

    2006-10-01

    The originally described outside-in procedure for the trans-obturator route was later turned inside-out. We wanted to demonstrate the safety of the two techniques through personal and published experience. Non-randomized, prospective, observational, open-label, longitudinal study of 100 female patients (50 TVT-O and 50 Monarc). All the female patients presented with isolated stress urinary incontinence. Only 4 patients presented with mixed incontinence in the Monarc (MON) group. Sphincter incompetence was observed 4 times in the MON group and 3 times in the TVT-O group. All the patients underwent surgery under assisted local anesthesia in a day-hospital setting. Only those patients presenting with patent established urinary incontinence, corrected by the TVT test, underwent surgery. Post-operative control was conducted at 3 months and 1 year. The duration of hospitalization was 10 h for 48 patients in the MON group and 49 in the TVTO group. The only per-operative complication was a vaginal perforation in the lateral angle of the vagina for a MON patient. Early post-operative complications were observed in the MON group: 3 cases of urinary tract infection, 1 of transient urine retention, 3 of pain in the thighs spontaneously resolving within 4 days and 1 of permanent pain in one leg at time 1 year, which remained bearable. For the TVTO group the post-operative complications consisted in: 1 case of urinary tract infection, 1 of transient retention and 4 of pain in the thigh. No hematoma was reported in either group. Among the late complications, the de novo symptoms included 1 case of imperious urges to urinate in the TVTO group and objective dysuria in 2 cases in the MON group vs. 7 in the TVTO group. There was no statistically significant between-group difference in the complications. No tape exposure was observed. Overall, the recovery rate was 90% at 1 year for MON vs. 94% for TVTO (p = NS) with 2 cases of recurrence between 3 months and 1 year in that series

  18. [Distortion and vertical fracture of the root: effect produced by condenser design].

    PubMed

    Dang, D A; Walton, R E

    1990-01-01

    The incidence of vertical root fractures and the amount of root distortion created during lateral condensation of gutta-percha with either D11 spreaders or B-finger pluggers were evaluated in vitro. Fifty-five extracted human, single-rooted teeth were instrumented using the step-back flare technique. Ten teeth served as positive controls (obturation to the point of fracture) and five teeth as negative controls (prepared but not obtured). Strain gauges were attached to the root surfaces. In the experimental group, 20 teeth were obturated using a D11 spreader and 20 with a B-finger plugger. Recordings were made of root distortion (expansion) created during obturation. Then, after sectioning the teeth, root surfaces of obturated samples were examined for fractures under the scanning electron microscope. Only the more tapered spreader, the D11, produces vertical root fractures, although very few in number. Also, the D11 spreader caused greater root distortion than did the B-finger plugger.

  19. A new concept and classification of corona mortis and its clinical significance.

    PubMed

    Al Talalwah, Waseem

    2016-10-01

    The obturator artery and its accessory (aberrant) arising from different origins and crossing the pubic rami are vascular variations. The internal iliac artery usually provides the obturator artery which may communicates with the external iliac artery through either the accessory obturator or inferior epigastric artery. A collateral circulation between the external and internal iliac system is known as corona mortis. The aim of current study is to provide sufficient data of vascular variability crossing the pubic rami for clinical field. Present study includes 208 hemipelvises dissected in the Institution of Anatomy, Medical University of Graz. During dissection, the obturator artery and its accessory crossing the superior rami of pubic bone were found to have different origins. The obturator artery arising from the external iliac artery and from the femoral artery accounts for 9.8% and 1.1% respectively. Therefore, it passes over the superior pubic rami in 10.9%. Further, the accessory (aberrant) artery arises only from the femoral artery in 1.1%. In present study, the vascular variation crossing the superior pubic rami with or without collateral circulation between external and internal iliac system referred as corona mortis is addressed. This study includes new classification of obturator and accessory obturator arteries as well as the corona mortis. It includes a comparison of corona mortis incidence in Austria population and other populations. The corona mortis found to be in 12% of Austrian population. A great attention of clinicians, radiologists, surgeons, orthopedic surgeons, obstetricians and gynecologists has to be considered before pubic surgical procedures such as internal fixation of pubic fracture, an inguinal hernia repair. Further, traumatic pubic rami fracture may lead to massive hemor- rhage due to laceration of the obturator artery.

  20. Direct visualization of anatomic subfields within the superior aspect of the human lateral thalamus by MRI at 7T.

    PubMed

    Kanowski, M; Voges, J; Buentjen, L; Stadler, J; Heinze, H-J; Tempelmann, C

    2014-09-01

    The morphology of the human thalamus shows high interindividual variability. Therefore, direct visualization of landmarks within the thalamus is essential for an improved definition of electrode positions for deep brain stimulation. The aim of this study was to provide anatomic detail in the thalamus by using inversion recovery TSE imaging at 7T. The MR imaging protocol was optimized on 1 healthy subject to segment thalamic nuclei from one another. Final images, acquired with 0.5(2)-mm2 in-plane resolution and 3-mm section thickness, were compared with stereotactic brain atlases to assign visualized details to known anatomy. The robustness of the visualization of thalamic nuclei was assessed with 4 healthy subjects at lower image resolution. Thalamic subfields were successfully delineated in the dorsal aspect of the lateral thalamus. T1-weighting was essential. MR images had an appearance very similar to that of myelin-stained sections seen in brain atlases. Visualized intrathalamic structures were, among others, the lamella medialis, the external medullary lamina, the reticulatum thalami, the nucleus centre médian, the boundary between the nuclei dorso-oralis internus and externus, and the boundary between the nuclei dorso-oralis internus and zentrolateralis intermedius internus. Inversion recovery-prepared TSE imaging at 7T has a high potential to reveal fine anatomic detail in the thalamus, which may be helpful in enhancing the planning of stereotactic neurosurgery in the future. © 2014 by American Journal of Neuroradiology.

  1. Treating post-traumatic tremor with deep brain stimulation: report of five cases.

    PubMed

    Issar, Neil M; Hedera, Peter; Phibbs, Fenna T; Konrad, Peter E; Neimat, Joseph S

    2013-12-01

    Post-traumatic tremor is one of the most common movement disorders resulting from severe head trauma. However, literature regarding successful deep brain stimulation (DBS) treatment is scarce, resulting in ambiguity regarding the optimal lead location. Most cases support the ventral intermediate nucleus, but there is evidence to defend DBS of the zona incerta, ventral oralis anterior/posterior, and/or a combination of these targets. We report five patients with disabling post-traumatic tremor treated with DBS of the ventral intermediate nucleus and of the globus pallidus internus. Patients were referred to the Vanderbilt Movement Disorders Division, and surgical intervention was determined by a DBS Multidisciplinary Committee. Standard DBS procedure was followed. Patients 1-4 sustained severe diffuse axonal injuries. Patients 1-3 underwent unilateral ventral intermediate nucleus DBS for contralateral tremor, while Patient 4 underwent bilateral ventral intermediate nucleus DBS. Patients 1-3 experienced good tremor reduction, while Patient 4 experienced moderate tremor reduction with some dystonic posturing of the hands. Patient 5 had dystonic posturing of the right upper extremity with tremor of the left upper extremity. He was treated with bilateral DBS of the globus pallidus internus and showed good tremor reduction at follow-up. Unilateral or bilateral DBS of the ventral intermediate nucleus and bilateral DBS of the globus pallidus internus may be effective and safe treatment modalities for intractable post-traumatic tremor. Further studies are needed to clarify the optimal target for surgical treatment of post-traumatic tremor. Published by Elsevier Ltd.

  2. Effect of combined actions of hip adduction/abduction on the force generation and maintenance of pelvic floor muscles in healthy women

    PubMed Central

    Amorim, Amanda C.; Cacciari, Licia P.; Passaro, Anice C.; Silveira, Simone R. B.; Amorim, Cesar F.; Loss, Jefferson F.

    2017-01-01

    Pelvic floor muscle (PFM) force and coordination are related to urinary incontinence severity and to sexual satisfaction. Health professionals frequently combine classic PFM exercises with hip adduction/abduction contraction to treat these disorders, but the real benefits of this practice are still unknown. Based on a theoretical anatomy approach whereby the levator ani muscle is inserted into the obturator internus myofascia and in which force generated by hip movements should increase the contraction quality of PFMs, our aim was to investigate the effects of isometric hip adduction and abduction on PFM force generation. Twenty healthy, nulliparous women were evaluated using two strain-gauge dynamometers (one cylinder-like inside the vaginal cavity, and the other measuring hip adduction/abduction forces around both thighs) while performing three different tasks: (a) isolated PFM contraction; (b) PFM contraction combined with hip adduction (30% and 50% maximum hip force); and (c) PFM contraction combined with hip abduction (30% and 50% maximum hip force). Data were sampled at 100Hz and subtracted from the offset if existent. We calculated a gradient between the isolated PFM contraction and each hip condition (Δ Adduction and Δ Abduction) for all variables: Maximum force (N), instant of maximum-force occurrence (s), mean force in an 8-second window (N), and PFM force loss (N.s). We compared both conditions gradients in 30% and 50% by paired t-tests. All variables did not differ between hip conditions both in 30% and 50% of maximum hip force (p>.05). PFM contraction combined with isometric hip abduction did not increase vaginal force in healthy and nulliparous women compared to PFM contraction combined with isometric hip adduction. Therefore, so far, the use of hip adduction or abduction in PFM training and treatments are not justified for improving PFM strength and endurance. PMID:28542276

  3. Coordination of deep hip muscle activity is altered in symptomatic femoroacetabular impingement.

    PubMed

    Diamond, Laura E; Van den Hoorn, Wolbert; Bennell, Kim L; Wrigley, Tim V; Hinman, Rana S; O'Donnell, John; Hodges, Paul W

    2017-07-01

    Diagnosis of femoroacetabular impingement (FAI) is increasing, yet the associated physical impairments remain poorly defined. This morphological hip condition can cause joint pain, stiffness, impaired function, and eventually hip osteoarthritis. This exploratory study compared coordination of deep hip muscles between people with and without symptomatic FAI using analysis of muscle synergies (i.e., patterns of activity of groups of muscles activated in synchrony) during gait. Fifteen individuals (11 males) with symptomatic FAI (clinical examination and imaging) and 14 age- and sex-comparable controls without morphological FAI underwent testing. Intramuscular fine-wire and surface electrodes recorded electromyographic activity of selected deep and superficial hip muscles. A non-negative matrix factorization algorithm extracted three synergies which were compared between groups. Information regarding which muscles were activated together in the FAI group (FAI group synergy vector) was used to reconstruct individual electromyography patterns and compare groups. Variance accounted for (VAF) by three synergies was less for the control (94.8 [1.4]%) than FAI (96.0 [1.0]%) group (p = 0.03). VAF of obturator internus was significantly higher in the FAI group (p = 0.02). VAF of the reconstructed individual electromyography patterns with the FAI or control group vector were significantly higher for the FAI group (p < 0.01). Following reconstruction, VAF of quadratus femoris was significantly more reduced in controls (p = 0.04), indicating greater between-subject variability. Coordination of deep hip muscles in the synergy related to hip joint control during early swing differed between groups. This phase involves movement towards the impingement position, which has relevance for the interpretation of synergy differences and potential clinical importance. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1494-1504, 2017

  4. CLINICAL APPLICATION OF THE RIGHT SIDELYING RESPIRATORY LEFT ADDUCTOR PULL BACK EXERCISE

    PubMed Central

    2013-01-01

    Problem: Lumbopelvic‐femoral conditions are common and may be associated with asymmetrical musculoskeletal and respiratory impairments and postural mal‐alignment called a Left Anterior Interior Chain (AIC) pattern. An inherent pattern of asymmetry involves the trunk/ribs/spine/pelvis/hip joints and includes the tendency to stand on the right leg and shift the center of gravity to the right which may result for example, in a tight left posterior hip capsule, poorly approximated left hip, long/weak left adductors, internal obliques (IO) and transverse abdominus (TA), short/strong/over active paraspinals and muscles on the right anterior outlet (adductors, levator ani and obturator internus), a left rib flare and a decreased respiratory diaphragm zone of apposition (ZOA). The Solution: A therapeutic exercise technique that can address impairments associated with postural asymmetry may be beneficial in improving function, reducing and/or eliminating pain causation, and improving breathing. The Right Sidelying Left Respiratory Adductor Pull Back is an exercise designed to affect alignment of the lumbopelvic‐femoral region by influencing the left posterior ischiofemoral ligament, ZOA and right anterior outlet and left anterior inlet (rectus femoris, sartorius), activating/shortening the left adductors, left IO/TA's and inhibiting/lengthening the paraspinals, bilaterally. Discussion: The exercise technique is often used by Physical Therapists, Physical Therapist assistants and Athletic Trainers as an initial exercise to positively affect position/alignment of the lumbopelvic‐femoral region, referred to as “repositioning,” by clinicians who use it. Four published case studies have used similar exercises to address the above impairments associated with a Left AIC pattern and in each 100% improvement in function and pain intensity was described. This particular exercise technique is relatively new and warrants future research. PMID:23772350

  5. Effect of combined actions of hip adduction/abduction on the force generation and maintenance of pelvic floor muscles in healthy women.

    PubMed

    Amorim, Amanda C; Cacciari, Licia P; Passaro, Anice C; Silveira, Simone R B; Amorim, Cesar F; Loss, Jefferson F; Sacco, Isabel C N

    2017-01-01

    Pelvic floor muscle (PFM) force and coordination are related to urinary incontinence severity and to sexual satisfaction. Health professionals frequently combine classic PFM exercises with hip adduction/abduction contraction to treat these disorders, but the real benefits of this practice are still unknown. Based on a theoretical anatomy approach whereby the levator ani muscle is inserted into the obturator internus myofascia and in which force generated by hip movements should increase the contraction quality of PFMs, our aim was to investigate the effects of isometric hip adduction and abduction on PFM force generation. Twenty healthy, nulliparous women were evaluated using two strain-gauge dynamometers (one cylinder-like inside the vaginal cavity, and the other measuring hip adduction/abduction forces around both thighs) while performing three different tasks: (a) isolated PFM contraction; (b) PFM contraction combined with hip adduction (30% and 50% maximum hip force); and (c) PFM contraction combined with hip abduction (30% and 50% maximum hip force). Data were sampled at 100Hz and subtracted from the offset if existent. We calculated a gradient between the isolated PFM contraction and each hip condition (Δ Adduction and Δ Abduction) for all variables: Maximum force (N), instant of maximum-force occurrence (s), mean force in an 8-second window (N), and PFM force loss (N.s). We compared both conditions gradients in 30% and 50% by paired t-tests. All variables did not differ between hip conditions both in 30% and 50% of maximum hip force (p>.05). PFM contraction combined with isometric hip abduction did not increase vaginal force in healthy and nulliparous women compared to PFM contraction combined with isometric hip adduction. Therefore, so far, the use of hip adduction or abduction in PFM training and treatments are not justified for improving PFM strength and endurance.

  6. Sensitivity of subject-specific models to Hill muscle-tendon model parameters in simulations of gait.

    PubMed

    Carbone, V; van der Krogt, M M; Koopman, H F J M; Verdonschot, N

    2016-06-14

    Subject-specific musculoskeletal (MS) models of the lower extremity are essential for applications such as predicting the effects of orthopedic surgery. We performed an extensive sensitivity analysis to assess the effects of potential errors in Hill muscle-tendon (MT) model parameters for each of the 56 MT parts contained in a state-of-the-art MS model. We used two metrics, namely a Local Sensitivity Index (LSI) and an Overall Sensitivity Index (OSI), to distinguish the effect of the perturbation on the predicted force produced by the perturbed MT parts and by all the remaining MT parts, respectively, during a simulated gait cycle. Results indicated that sensitivity of the model depended on the specific role of each MT part during gait, and not merely on its size and length. Tendon slack length was the most sensitive parameter, followed by maximal isometric muscle force and optimal muscle fiber length, while nominal pennation angle showed very low sensitivity. The highest sensitivity values were found for the MT parts that act as prime movers of gait (Soleus: average OSI=5.27%, Rectus Femoris: average OSI=4.47%, Gastrocnemius: average OSI=3.77%, Vastus Lateralis: average OSI=1.36%, Biceps Femoris Caput Longum: average OSI=1.06%) and hip stabilizers (Gluteus Medius: average OSI=3.10%, Obturator Internus: average OSI=1.96%, Gluteus Minimus: average OSI=1.40%, Piriformis: average OSI=0.98%), followed by the Peroneal muscles (average OSI=2.20%) and Tibialis Anterior (average OSI=1.78%) some of which were not included in previous sensitivity studies. Finally, the proposed priority list provides quantitative information to indicate which MT parts and which MT parameters should be estimated most accurately to create detailed and reliable subject-specific MS models. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Geometric Evaluation of the Effect of Prosthetic Rehabilitation on Facial Asymmetry in Patients with Unilateral Maxillectomy.

    PubMed

    Aswehlee, Amel M; Hattori, Mariko; Elbashti, Mahmoud E; Sumita, Yuka I; Taniguchi, Hisashi

    This study aimed (1) to geometrically evaluate areas of facial asymmetry in patients with two different types of maxillectomy defect compared to a control group, (2) to geometrically evaluate the effect of an obturator prosthesis on facial asymmetry, and (3) to investigate the correlation between three-dimensional (3D) deviation values and number of missing teeth. Facial data from 13 normal control participants and 26 participants with two types of maxillectomy defect (groups 1 and 2) were acquired with a noncontact 3D digitizer. Facial asymmetry was evaluated by superimposing a facial scan onto its mirror scan using 3D evaluation software. Facial scans with and without obturator prostheses were also superimposed to evaluate the obturator effect. The correlation between 3D deviation values and number of missing teeth was also evaluated. Statistical analyses were performed. Facial asymmetry was significantly different between the control group and each maxillectomy defect group (group 1: P < .0001 and P = .020 without and with obturator, respectively; group 2: P < .0001 for both conditions). There were no significant differences in asymmetry between groups 1 and 2 either without or with obturator (P = .457 and P = .980, respectively). There was a significant difference in the obturator effect between groups 1 and 2 (P = .038). 3D deviation values were positively correlated with number of missing teeth in group 1 (r = 0.594, P = .032), but not in group 2. A noncontact 3D digitizer and 3D deviation assessment were effective for analyzing facial data of maxillectomy patients. Obturators were effective for improving facial deformities in these patients.

  8. Endodontic flare-ups: comparison of incidence between single and multiple visits procedures in patients attending a Nigerian teaching hospital.

    PubMed

    Oginni, Ao; Udoye, C I

    2004-12-01

    The present study was performed to compare the incidence of endodontic flare ups in single with multiple visits treatment procedures, to establish the relationship between pre-operative and post obturation pain in patients attending for endodontic therapy in a Nigerian teaching Hospital. Patients were randomly assigned to either single visit or multiple visits group. Data collected at root canal treatment appointment and recall visits (1st, 7th and 30th day post obturation) include pulp vitality status, the presence or absence of pre-operative pain, presence and degree of post obturation pain. Presence of endodontic flare-ups (defined as either patient's report of pain not controlled with over the counter medication and or increasing swelling). The compiled data were analyzed using chi-square where applicable. P level < 0.05 was taken as significant. Ten endodontic flare-ups (8.1 %) were recorded in the multiple visits group compared to 19 (18,3%) flare-ups for the single visit group, P = 0.02. For both single and multiple visits procedures, there were statistically significant correlations between pre operative and post obturation pain (P = 0.002 and P = 0.0004 respectively). Teeth with vital pulps reported the lowest frequency of post obturation pain (48.8%), while those with non vital pulps were found to have the highest frequency oh post obturation pain (50,3%), P = 0.9. Although the present study reported higher incidences for post obturation pain and flare-ups following the single visit procedures, single visit endodontic therapy has been shown to be a safe and effective alternative to multiple visits treatment.

  9. Atypical extraspinal musculoskeletal tuberculosis in immunocompetent patients: part II, tuberculous myositis, tuberculous bursitis, and tuberculous tenosynovites.

    PubMed

    Abdelwahab, Ibrahim Fikry; Bianchi, Stefano; Martinoli, Carlo; Klein, Michael; Hermann, George

    2006-12-01

    Tuberculosis involving the soft tissue from adjacent bone or joint is well recognized. However, primary tuberculous pyomyositis, tuberculous bursitis, and tuberculous tenosynovitis are rare entities constituting 1% of skeletal tuberculosis. Tuberculous tenosynovitis involves most commonly the tendon sheaths of the hand and wrist, and tuberculous bursitis occurs most commonly around the hip. The greater trochanteric bursa and the greater trochanter are the most frequent sites of tuberculous bursitis. Cases of primary tuberculous pyomyositis and tenosynovitis of the tendons of the ankle and foot are seldom reported in the radiology literature. All imaging modalities-plain radiography, bone scan, computed tomography, and magnetic resonance imaging (MRI)--provide information that is helpful in determining therapy. MRI in particular, with its multiplanar capabilities and superb contrast of soft tissue, can demonstrate the extent of the soft tissue mass and access the adjacent bones and joints. However, MRI has no diagnostic specificity in regard to tuberculosis, and in nonendemic areas, biopsy is strongly recommended. All patients in this review were permanent residents of North America or Western Europe and were immunocompetent. Examples of atypical presentations of the above entities are demonstrated.

  10. Fracture resistance exhibited by endodontically treated and retreated teeth shaped by ProTaper NEXT versus WaveOne: An in vitro study.

    PubMed

    Khalap, Neha Deepak; Hegde, Vibha; Kokate, Sharad

    2015-01-01

    To compare the fracture resistance exhibited by teeth after primary endodontic treatment and retreatment. One hundred freshly extracted human teeth were selected. 20 samples served as control (untreated). Eighty experimental samples were divided into two groups (n = 40) for instrumentation using rotary Protaper NEXT (PTN) or reciprocating WaveOne (WO) files and obturated using warm lateral compaction. Half of the samples (n = 20) from each group were subjected to a load. The remaining half were subjected to retreatment using Protaper universal retreatment files (RFs) followed by a file larger than the master apical file used in groups 1 and 2 and reobturated. Group A: Control, Group B: PTN + obturation, Group C: WO + obturation, Group D: RF + PTN + obturation and Group E: RF + WO + obturation. The retreatment specimens were also subjected to load and the readings acquired were statistically analyzed. When compared between the groups, control group exhibited the highest fracture resistance (P < 0.01). When multiple tests were performed, Group E exhibited significantly less fracture resistance (P < 0.01). Endodontic treatment and retreatment both results in lowering the fracture resistance of a tooth.

  11. In Vitro Evaluation of Apical Sealing Ability of HEROfill® Obturator Versus Cold Lateral Condensation in Curved Root Canals.

    PubMed

    Zarei, Mina; Javidi, Maryam; Kazemi, Zeinab; Afkhami, Farzaneh

    2015-08-01

    This study aimed to assess and compare the apical sealing ability of HEROfill® Soft-Core system and lateral condensation technique in fine curved canals using the fluid filtration method. Forty human mesiobuccal root canals of mandibular first molars with 25° to 40° curvatures were instrumented to an apical size 30/0.04. Roots were randomly assigned to two experimental groups of 15, designated as groups A and B. Two control groups, each containing five teeth, served as positive and negative controls. Group A was obturated using lateral condensation technique and group B with the HEROfill® Soft-Core system. The groups were tested for microleakage using an in vitro fluid filtration apparatus with 0.5 atm pressure at zero, two, four, six, eight and 10 minutes. Independent t-test was used to analyze the microleakage data. The mean and standard deviation (SD) values for fluid microleakage in the lateral condensation group were 0.58±0.49 μL/min, 0.68±0.35 μL/min, 0.74±0.22 μL/min, 0.71±0.29 μL/min and 0.60± 0.29 μL/min at two, four, six, eight and 10 minutes, respectively. The mean and SD values for fluid microleakage in the HEROfill® group were 0.53±0.42 μL/min, 0.67±0.34 μL/min, 0.69±0.26 μL/min, 0.73±0.33 μL/min and 0.63±0.26 μL/min at two, four, six, eight and 10 minutes, respectively. The difference between the lateral condensation and HEROfill® groups was not statistically significant at two (P=0.776), four (P=0.909), six (P=0.562), eight (P=0.861) or 10 (P=0.765) minutes. The HEROfill® system and cold lateral condensation technique were equally effective for apical sealing of curved canals.

  12. Evaluation of swallowing ability using swallowing sounds in maxillectomy patients.

    PubMed

    Kamiyanagi, A; Sumita, Y; Ino, S; Chikai, M; Nakane, A; Tohara, H; Minakuchi, S; Seki, Y; Endo, H; Taniguchi, H

    2018-02-01

    Maxillectomy for oral tumours often results in debilitating oral hypofunction, which markedly decreases quality of life. Dysphagia, in particular, is one of the most serious problems following maxillectomy. This study used swallowing sounds as a simple evaluation method to evaluate swallowing ability in maxillectomy patients with and without their obturator prosthesis placed. Twenty-seven maxillectomy patients (15 men, 12 women; mean age 66.0 ± 12.1 years) and 30 healthy controls (14 men, 16 women; mean age 44.9 ± 21.3 years) were recruited for this study. Participants were asked to swallow 4 mL of water, and swallowing sounds were recorded using a throat microphone. Duration of the acoustic signal and duration of peak intensity (DPI) were measured. Duration of peak intensity was significantly longer in maxillectomy patients without their obturator than with it (P < .05) and was significantly longer in maxillectomy patients without their obturator than in healthy controls (P < .025 after Bonferroni correction). With the obturator placed, DPI was significantly longer in maxillectomy patients who had undergone soft palate resection than in those who had not (P < .05). These results suggest swallowing ability in maxillectomy patients could be improved by wearing an obturator prosthesis, particularly during the oral stage. However, it is difficult to improve the oral stage of swallowing in patients who have undergone soft palate resection even with obturator placement. © 2017 John Wiley & Sons Ltd.

  13. Fracture resistance exhibited by endodontically treated and retreated teeth shaped by ProTaper NEXT versus WaveOne: An in vitro study

    PubMed Central

    Khalap, Neha Deepak; Hegde, Vibha; Kokate, Sharad

    2015-01-01

    Aim: To compare the fracture resistance exhibited by teeth after primary endodontic treatment and retreatment. Materials and Methods: One hundred freshly extracted human teeth were selected. 20 samples served as control (untreated). Eighty experimental samples were divided into two groups (n = 40) for instrumentation using rotary Protaper NEXT (PTN) or reciprocating WaveOne (WO) files and obturated using warm lateral compaction. Half of the samples (n = 20) from each group were subjected to a load. The remaining half were subjected to retreatment using Protaper universal retreatment files (RFs) followed by a file larger than the master apical file used in groups 1 and 2 and reobturated. Group A: Control, Group B: PTN + obturation, Group C: WO + obturation, Group D: RF + PTN + obturation and Group E: RF + WO + obturation. The retreatment specimens were also subjected to load and the readings acquired were statistically analyzed. Result: When compared between the groups, control group exhibited the highest fracture resistance (P < 0.01). When multiple tests were performed, Group E exhibited significantly less fracture resistance (P < 0.01). Conclusion: Endodontic treatment and retreatment both results in lowering the fracture resistance of a tooth. PMID:26752838

  14. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Subthalamic Nucleus and Globus Pallidus Internus Deep Brain Stimulation for the Treatment of Patients With Parkinson's Disease: Executive Summary.

    PubMed

    Rughani, Anand; Schwalb, Jason M; Sidiropoulos, Christos; Pilitsis, Julie; Ramirez-Zamora, Adolfo; Sweet, Jennifer A; Mittal, Sandeep; Espay, Alberto J; Martinez, Jorge Gonzalez; Abosch, Aviva; Eskandar, Emad; Gross, Robert; Alterman, Ron; Hamani, Clement

    2018-06-01

    Is bilateral subthalamic nucleus deep brain stimulation (STN DBS) more, less, or as effective as bilateral globus pallidus internus deep brain stimulation (GPi DBS) in treating motor symptoms of Parkinson's disease, as measured by improvements in Unified Parkinson's Disease Rating Scale, part III (UPDRS-III) scores? Given that bilateral STN DBS is at least as effective as bilateral GPi DBS in treating motor symptoms of Parkinson's disease (as measured by improvements in UPDRS-III scores), consideration can be given to the selection of either target in patients undergoing surgery to treat motor symptoms. (Level I). Is bilateral STN DBS more, less, or as effective as bilateral GPi DBS in allowing reduction of dopaminergic medication in Parkinson's disease? When the main goal of surgery is reduction of dopaminergic medications in a patient with Parkinson's disease, then bilateral STN DBS should be performed instead of GPi DBS. (Level I). Is bilateral STN DBS more, less, or as effective as bilateral GPi DBS in treating dyskinesias associated with Parkinson's disease? There is insufficient evidence to make a generalizable recommendation regarding the target selection for reduction of dyskinesias. However, when the reduction of medication is not anticipated and there is a goal to reduce the severity of "on" medication dyskinesias, the GPi should be targeted. (Level I). Is bilateral STN DBS more, less, or as effective as bilateral GPi DBS in improving quality of life measures in Parkinson's disease? When considering improvements in quality of life in a patient undergoing DBS for Parkinson's disease, there is no basis to recommend bilateral DBS in 1 target over the other. (Level I). Is bilateral STN DBS associated with greater, lesser, or a similar impact on neurocognitive function than bilateral GPi DBS in Parkinson disease? If there is significant concern about cognitive decline, particularly in regards to processing speed and working memory in a patient undergoing DBS

  15. Trans-obturator vaginal tape (TOT) for female stress incontinence: one year follow-up in 120 patients.

    PubMed

    Roumeguère, Thierry; Quackels, Th; Bollens, R; de Groote, A; Zlotta, A; Bossche, M Vanden; Schulman, C

    2005-11-01

    The aim of this study was to evaluate the effectiveness of a new minimally invasive surgical procedure, the Trans-obturator Vaginal Tape (TOT) in the treatment of female urodynamic stress incontinence (USI) and to analyse functional results and quality of life after one year of follow up. 120 consecutive women with stress urinary incontinence underwent the procedure since February 2002 under general or loco-regional anesthesia. Minimum follow up was one year (range 12-30 months). Mean age was 58 years (range 31-86). 70% of the patients had pure USI. 5 patients were previously operated for USI. In 10 cases, concomitant repair of pelvic floor defects was mandatory. Collection of the data included operative time, pre- and post-operative complications. Patients were post-operatively assessed at one week, one month and one year. A validated urinary incontinence-specific measure of Quality of Life (QoL) questionnaire (Contilife) was sent and completed 12 months after surgery. The mean operative time was 12 min (range 6-30) with a catheterisation time of 0,9 day (range 0-2). No severe bleeding was observed. There were 13 minor lateral tears of the vagina without any sequelae. Three perforations of the urethra and one of the bladder occurred during the learning phase. In two cases a re-intervention was necessary for tape removal when the injury was not recognised during the procedure. Two transient urinary retention needed a supra pubic catheter and tape release. Eleven women presented transient voiding outflow obstruction. After one month, 93% patients were cured with no pad and a negative cough test with a full bladder. Uroflowmetry did not show any significant changes between pre- and post-operative time in all the population. De novo urgency occurred only in 2.5% and persistent dysuria (Qmax <10 ml/s and/or post-void residual volume >120 cc) in 4%. 80% of patients were completely dry after one year and 12% were greatly improved. According to the pre-operative maximal

  16. Endodontic flare-ups: comparison of incidence between single and multiple visit procedures in patients attending a Nigerian teaching hospital.

    PubMed

    Oginni, Adeleke O; Udoye, Christopher I

    2004-11-26

    BACKGROUND: Until recently the most accepted technique of doing root canal treatment stresses multiple visit procedure. Most schools also concentrated upon teaching the multi-visit concept. However, it has now been reported that the procedure of single visit treatment is advocated by at least 70% of schools in all geographical areas. It was therefore the aims of the present study to find the incidence of post-obturation flare-ups following single and multiple visit endodontic treatment procedures, and to establish the relationship between pre-operative and post-obturation pain in patients referred for endodontic therapy in a Nigerian teaching Hospital. METHODS: Data collected included pulp vitality status, the presence or absence of pre-operative, inter-appointment and post-obturation pain. Pain was recorded as none, slight, or moderate/severe. Flare-ups were defined as either patient's report of pain not controlled with over the counter medication or as increasing swelling. The patients were recalled at three specific post-obturation periods, 1st, 7th and 30th day. The presence or absence of pain, or the appropriate degree of pain was recorded for each recall visits and the interval between visits. The compiled data were analysed using chi-square where applicable. P level obturation pain (P = 0.002 and P = 0.0004 respectively). Teeth with vital pulps reported the lowest frequency of post-obturation pain (48.8%), while those with nonvital pulps were found to have the highest frequency of post-obturation pain (50.3%), P = 0.9. CONCLUSION: The present study reported higher incidences of post-obturation pain and flare-ups following the single visit

  17. Variability of antibiotic susceptibility and toxin production of Staphylococcus aureus strains isolated from skin, soft tissue, and bone related infections.

    PubMed

    Sina, Haziz; Ahoyo, Théodora A; Moussaoui, Wardi; Keller, Daniel; Bankolé, Honoré S; Barogui, Yves; Stienstra, Ymkje; Kotchoni, Simeon O; Prévost, Gilles; Baba-Moussa, Lamine

    2013-08-08

    Staphylococcus aureus is an opportunistic commensal bacterium that mostly colonizes the skin and soft tissues. The pathogenicity of S. aureus is due to both its ability to resist antibiotics, and the production of toxins. Here, we characterize a group of genes responsible for toxin production and antibiotic resistance of S. aureus strains isolated from skin, soft tissue, and bone related infections. A total of 136 S. aureus strains were collected from five different types of infection: furuncles, pyomyositis, abscesses, Buruli ulcers, and osteomyelitis, from hospital admissions and out-patients in Benin. All strains were resistant to benzyl penicillin, while 25% were resistant to methicillin, and all showed sensitivity to vancomycin. Panton-Valentine leukocidin (PVL) was the most commonly produced virulence factor (70%), followed by staphylococcal enterotoxin B (44%). Exfoliative toxin B was produced by 1.3% of the strains, and was only found in isolates from Buruli ulcers. The tsst-1, sec, and seh genes were rarely detected (≤1%). This study provides new insight into the prevalence of toxin and antibiotic resistance genes in S. aureus strains responsible for skin, soft tissue, and bone infections. Our results showed that PVL was strongly associated with pyomyositis and osteomyelitis, and that there is a high prevalence of PVL-MRSA skin infections in Benin.

  18. Oral rehabilitation of patients after maxillectomy. A systematic review.

    PubMed

    Dos Santos, D M; de Caxias, F P; Bitencourt, S B; Turcio, K H; Pesqueira, A A; Goiato, M C

    2018-05-01

    Patients who have maxillectomy can be rehabilitated with reconstructive surgery or obturator prostheses with or without osseointegratable implants. To identify studies on possible treatments in this group, we systematically searched the Scopus, Embase, PubMed/Medline, and Cochrane databases to collect data on patients' characteristics, radiotherapy, and results related to speech, swallowing, mastication or diet, chewing, aesthetics, and quality of life. Of the 1376 papers found, six were included, and one other was included after an additional search of references. A total of 252 patients were included, and of them, 86 had reconstructive surgery, 91 were treated with obturator prostheses, 39 had reconstructive surgery or obturator prostheses associated with implants, and 36 had reconstruction plus an obturator prosthesis. Data on radiotherapy were incomplete. There is a lack of consensus about the indication for rehabilitation, as the treatment must be based on the individual characteristics of each patient. Copyright © 2018 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  19. New surgical technique for treatment of stress urinary incontinence TVT-ABBREVO from development to clinical experience.

    PubMed

    Waltregny, David; de Leval, Jean

    2012-12-01

    Tension-free suburethral tapes have revolutionized the surgical treatment of female stress urinary incontinence (SUI). These tapes are inserted by way of a retropubic or transobturator route. The inside-out tension-free vaginal tape transobturator approach, or TVT-Obturator system (TVT-O, Ethicon Women's Health and Urology, Somerville, NJ), was developed ten years ago with the aim of minimizing the risk of urinary tract injuries associated with retropubic and outside-in transobturator tapes while reproducibly ensuring minimal tissue dissection. Cadaveric studies have shown that the anatomical trajectory of the TVT-O tape is strictly perineal and courses away from neighboring obturator and pudendal neurovascular structures. Several meta-analyses have shown similar SUI cure rates after retropubic and transobturator tape procedures. Yet, the transobturator route may be associated with less voiding dysfunction, blood loss, bladder perforation, and shorter operating time. The original TVT-O procedure was modified with the aim of reducing the incidence of postoperative groin pain as well as the rather theoretical risk of obturator nerve injury. This modified procedure, named TVT-ABBREVO (Ethicon Women's Health and Urology, Somerville, NJ), utilizes a shortened, 12-cm-long polypropylene tape. In addition, perforation of the obturator membrane with the scissors and guide is avoided in order to reduce the depth of lateral dissection, and consequently, to maximize securing of the tape within the obturator muscular/aponeurotic structures. In a comparative anatomical study, it was indeed observed that the shorter tape traversed less muscular structures (with no or only a minimal amount of tape lying in the adductor muscles) than its original counterpart, while still consistently anchoring in the obturator membrane at a similarly safe distance from the obturator canal. In a single-center randomized clinical trial, after a 3-year minimum follow-up, the modified TVT-O procedure

  20. Use of Orbital Conformer to Improve Speech in Patients with Confluent Maxillectomy and Orbital Defects

    PubMed Central

    Colebeck, Amanda C.; Kase, Michael T.; Nichols, Cindy B.; Golden, Marjorie; Huryn, Joseph M.

    2016-01-01

    The basic objective in prosthetic restoration of confluent maxillary and orbital defects is to achieve a comfortable, cosmetically acceptable prosthesis that restores speech, deglutition, and mastication. It is a challenging task complicated by the size and shape of the defects. The maxillary obturator prosthesis often satisfies the objective of adequate deglutition; however, orbital defects that are not obturated in the medial septal or posterior walls allow air to escape, negatively impacting phonation. This article describes a technique to achieve favorable prosthetic rehabilitation in a patient with a maxillectomy and ipsilateral orbital exenteration. The prosthetic components include maxillary obturator, orbital conformer, and orbital prosthesis connected using rigid magnetic attachments. PMID:25953143

  1. Comparison of microtomography and optical coherence tomography on apical endodontic filling analysis.

    PubMed

    Suassuna, Fernanda Clotilde Mariz; Maia, Ana Marly Araújo; Melo, Daniela Pita; Antonino, Antônio Celso Dantas; Gomes, Anderson Stevens Leônidas; Bento, Patrícia Meira

    2018-02-01

    To comparein vitro differences in the apical filling regarding working length (WL) change and presence of voids and to validate optical coherence tomography (OCT) in comparison with computerized microtomography (µCT) for the detection of failures in the apical filling. Forty-five uniradicular teeth with round canals, divided into groups (n = 15) following the obturation protocols: LC (lateral condensation), TMC (thermomechanical compaction) and SC (single cone). Samples were scanned using µCT (parameters: 80 kV, 222 µA, and resolution of 11 µm), OCT (parameters: SSOCT, 1300 nm and axial resolution of 12 µm), and periapical digital radiography. The images were analyzsed by two blind and calibrated observers using ImageJ software to measure the boundary of the obturation WL and voids presence. Categorical and metric data were submitted to inferential analysis, and the validity of the OCT as a diagnostic test was assessed with performance and reliability tests. The WL average remained constant for all obturation techniques and image methods. OCT showed adequate sensitivity and specificity to detect voids in the WL of apical obturations in vitro in comparison with µCT. Both image methods found a higher number of voids for LC technique (µCT p = 0.011/OCT p = 0.002). OCT can be used in apical obturation voids assessment and the LC technique revealed more voids with larger dimensions.

  2. Post retention: the effect of sequence of post-space preparation, cementation time, and different sealers.

    PubMed

    Boone, K J; Murchison, D F; Schindler, W G; Walker, W A

    2001-12-01

    Many endodontic sealers contain constituents that have been shown to inhibit the polymerization of resin cements. This may be important when prefabricated posts are cemented at the same appointment as root canal obturation. This study evaluated the effects of cementing posts with a resin cement immediately or at a delayed time period after obturation using Roth's 801 Elite Grade or AH26 sealer cements. The contribution of mechanical post-space preparation was also assessed as a critical variable. One hundred twenty extracted canines were randomly divided into eight experimental groups. The variables evaluated were the order of post preparation (either before or after obturation), the type of sealer used, and the time of post cementation. All teeth received a stainless steel #6 Parapost XP cemented with a resin cement, Panavia 21. Each experimental group underwent tensile testing for retention using an Instron universal testing machine. For both sealers posts cemented in teeth in which the canal was obturated before post-space preparation and thus had sealer-contaminated dentin removed by the space preparation procedure had significantly higher retentive values than those obturated after post-space preparation in which contaminated dentin might remain. Sealer used and time of cementation had no specific effect on retention. Achieving a clean, "freshened" dentinal surface during mechanical post-space preparation seems to be a critical variable for post retention when a resin cement is used.

  3. The safety and efficacy of the "inside-out" trans-obturator TVT in elderly versus younger stress-incontinent women: a prospective study of 353 consecutive patients.

    PubMed

    Groutz, Asnat; Cohen, Aviad; Gold, Ronen; Pauzner, David; Lessing, Joseph B; Gordon, David

    2011-03-01

    To analyze the safety and efficacy of the trans-obturator tension-free vaginal tape (TVT-O) in elderly versus younger stress-incontinent women. Ninety-seven consecutive elderly, aged 70 and older, and 256 younger women (mean age 75 and 55 years, respectively) who underwent TVT-O for urodynamically confirmed stress urinary incontinence (SUI) were prospectively enrolled. Concomitant pelvic organ prolapse (POP) repair was performed in 90% of the elderly and 70% of the younger women. The surgical procedures, as well as all pre- and postoperative clinical and urodynamic evaluation, were performed in one university-affiliated medical center. Main outcome measures were operative complications, early and late postoperative morbidity, postoperative urodynamically confirmed SUI (symptomatic, or asymptomatic), persistent, or de novo overactive bladder (OAB) and bladder outlet obstruction (BOO). Mean follow-up of the patients was 30 ± 17 months (range 3-58 months). Early and late postoperative morbidity was similar in both groups, except for significantly more cases of postoperative recurrent UTI's among elderly women (13.7% vs. 6.2%). The incidence of persistent urodynamically confirmed overt SUI was similar in both age groups (5%). However, asymptomatic urodynamic SUI was significantly more common among elderly patients (19% vs. 3.7%, P<0.05). The incidence of persistent OAB was similar in elderly and younger patients (68% and 62%, respectively), while de novo OAB was significantly more common in elderly patients (11.9% vs. 4.7%, P<0.05). TVT-O is safe and efficient for both elderly and younger stress-incontinent women. However, elderly patients are in increased risk for postoperative recurrent UTI's as well as de novo OAB. Copyright © 2010 Wiley-Liss, Inc.

  4. Variability of antibiotic susceptibility and toxin production of Staphylococcus aureus strains isolated from skin, soft tissue, and bone related infections

    PubMed Central

    2013-01-01

    Background Staphylococcus aureus is an opportunistic commensal bacterium that mostly colonizes the skin and soft tissues. The pathogenicity of S. aureus is due to both its ability to resist antibiotics, and the production of toxins. Here, we characterize a group of genes responsible for toxin production and antibiotic resistance of S. aureus strains isolated from skin, soft tissue, and bone related infections. Results A total of 136 S. aureus strains were collected from five different types of infection: furuncles, pyomyositis, abscesses, Buruli ulcers, and osteomyelitis, from hospital admissions and out-patients in Benin. All strains were resistant to benzyl penicillin, while 25% were resistant to methicillin, and all showed sensitivity to vancomycin. Panton-Valentine leukocidin (PVL) was the most commonly produced virulence factor (70%), followed by staphylococcal enterotoxin B (44%). Exfoliative toxin B was produced by 1.3% of the strains, and was only found in isolates from Buruli ulcers. The tsst-1, sec, and seh genes were rarely detected (≤1%). Conclusions This study provides new insight into the prevalence of toxin and antibiotic resistance genes in S. aureus strains responsible for skin, soft tissue, and bone infections. Our results showed that PVL was strongly associated with pyomyositis and osteomyelitis, and that there is a high prevalence of PVL-MRSA skin infections in Benin. PMID:23924370

  5. [Relationship between perineal characteristics and symptoms and pelvic girdle pain: A literature review].

    PubMed

    Rejano-Campo, M; Desvergée, A; Pizzoferrato, A C

    2018-03-01

    Pelvic girdle pain (PGP) is characterized by the presence of pain in the posterior pelvic area, distally and laterally to the fifth lumbar vertebra, and/or at the pubic symphysis. PGP is a very common pain condition in women, especially during pregnancy and postpartum. After delivery, pain prevalence decreases to 7 % in the first three months. The current literature describes an association between pelvic girdle pain and different perineal characteristics and symptoms. A better understanding of perineal structures influence on PGP could assist towards the management of this condition. The aim of this review is to describe the peer-reviewed literature about perineal function in patients with PGP. A bibliographic search on PubMed was conducted. The key words used were: pelvic girdle pain, pregnacy-related low back pain, lumbopelvic pain, posterior pelvic pain, peripartum pelvic pain, pelvic girdle relaxation, pelvic joint instability, peripartum pelvic pain, sacroiliac joint pain, sacroiliac joint dysfunction, sacroiliac-joint related pelvic pain and pelvic floor. Two hundred and twenty-one (221) articles were identified. Out of them, a total of nine articles were selected. The level of evidence was determined using Oxford's scale. Patients with PGP showed increased activity of the pelvic floor muscles (P=0.05) (LE3), decreased urogenital hiatus area (PGP 12.4 cm 2 ±2.7, control 13.7 cm 2 ±2.8, P=0.015) (LE3), shorter endurance time (PGP 17.8 s; control 54.0 s, P=0.00) (LE3), significantly later onset time during affected side leg elevation (PGP 25ms, control -129ms, P=0.01) (LE3), levator ani and obturator internus tenderness (PGP 25/26; control 5/25, P<0.001) (LE3) and a higher prevalence of vesico-sphincteric disorders compared to asymptomatic subjects (LE3). This review confirms that subjects suffering PGP present particular perineal characteristics regarding morphology and biomechanics. It would be interesting to develop clinical research concerning

  6. Evaluation of complications of root canal treatment performed by undergraduate dental students.

    PubMed

    AlRahabi, Mothanna K

    2017-12-01

    This study evaluated the technical quality of root canal treatment (RCT) and detected iatrogenic errors in an undergraduate dental clinic at the College of Dentistry, Taibah University, Saudi Arabia. Dental records of 280 patients who received RCT between 2013 and 2016 undertaken by dental students were investigated by retrospective chart review. Root canal obturation was evaluated on the basis of the length of obturation being ≤2 mm from the radiographic apex, with uniform radiodensity and good adaptation to root canal walls. Inadequate root canal obturation included cases containing procedural errors such as furcal perforation, ledge, canal transportation, strip perforation, root perforation, instrument separation, voids in the obturation, or underfilling or overfilling of the obturation. In 193 (68.9%) teeth, RCT was adequate and without procedural errors. However, in 87 (31.1%) teeth, RCT was inadequate and contained procedural errors. The frequency of procedural errors in the entire sample was 31.1% as follows: underfilling, 49.9%; overfilling, 24.1%; voids, 12.6%; broken instruments, 9.2%; apical perforation, 2.3%; and root canal transportation, 2.3%. There were no significant differences (p > 0.05) in the type or frequency of procedural errors between the fourth- and fifth-year students. Lower molars (43.1%) and upper incisors (19.2%) exhibited the highest and lowest frequencies of procedural errors, respectively. The technical quality of RCT performed by undergraduate dental students was classified as 'adequate' in 68.9% of the cases. There is a need for improvement in the training of students at the preclinical and clinical levels.

  7. Decreasing transobturator sling groin pain without decreasing efficacy using TVT-Abbrevo.

    PubMed

    Shaw, Jonathan S; Jeppson, Peter C; Rardin, Charles R

    2015-09-01

    Groin pain following a transobturator (TO) midurethral sling is not uncommon and can be difficult to manage. We sought to determine if decreasing the mesh burden in the groin would decrease pain. The primary objective was to compare the incidence of post-operative groin pain following placement of full-length TVT-Obturator versus the shorter TVT-Abbrevo. Secondarily, we aimed to compare the efficacy between both devices 6 months after surgery. This is a retrospective cohort study of all women who underwent a TO midurethral sling by the division of urogynecology at one institution between 1 January 2007 and 31 October 2013. Charts were reviewed and the incidence of post-operative groin pain in the two groups dichotomized as present or absent and compared using a Chi-squared test. Validated questionnaire scores of the groups were compared using t tests. There were 125 patients who received a TVT-Obturator and 100 patients who received a TVT-Abbrevo. No differences in demographic data were present between the groups. Twelve patients (9.6 %) in the TVT-Obturator group and 1 patient (1 %) in the TVT-Abbrevo group experienced bothersome groin pain (P value = 0.007). The complete pre- and 6-month post-operative ISI, UDI-6 and PFIQ-7 scores were available for 76 (61 %), 47 (38 %), and 45 (36 %) patients following TVT-Obturator and 57 (57 %), 30 (30 %), and 28 (28 %) following TVT-Abbrevo treatment. At 6 months the mean improvement in questionnaire scores for the TVT-Obturator and TVT-Abbrevo groups were as follows: 5.0 and 5.1 for ISI (P value = 0.9), 8.3 and 7.9 for UDI-6 (P value = 0.8), and 4.8 and 6.1 for PFIQ-7 (P value = 0.4). Use of TVT-Abbrevo reduces post-operative groin pain compared with the full-length TVT-Obturator, without any reduction in efficacy.

  8. [Nonsurgical retreatment of lateral radiopacity after surgical treatment].

    PubMed

    Arias de Luxan, A

    1990-01-01

    A case report is presented of an upper central incisor with incomplete endodontic procedure evidencing a radiolucent image that was treated by apicoectomy and retroamalgam. A year later the periapical lesion had healed completely but a new lateral radiolucency is observed. A reentry of the canal is performed eliminating the old obturating material, biomechanical preparation and obturation with sealer and thermo gutta-percha. The lesion was cured in nine months.

  9. Combination prosthetic design providing a superior retention for mid-facial defect rehabilitation: A Case Report

    PubMed Central

    Nilanonth, Supassra; Shakya, Prana; Srithavaj, Theerathavaj

    2017-01-01

    Large maxillofacial defects from malignant tumor treatment are rarely rehabilitated by surgical reconstruction alone. Ameloblastic carcinoma, a rare aggressive odontogenic malignant tumor, requires wide surgical excision to gain a tumor-free margin. In the post-surgical defect, prosthetic rehabilitation is the treatment of choice to restore function and esthetics. Moreover, an intra-oral prosthesis such as an obturator restores speech, mastication and deglutition. Retention of the obturator is a major problem while rehabilitating large defects. The existing anatomical structures from the defect with the help of magnet attachments are suitable to enhance retention, stability and support of the prostheses. This case report presents a patient with an intraoral and extra-oral combination defect following surgical resection of ameloblastic carcinoma and describes the prosthetic techniques and design considerations for a magnet-retained obturator and mid-facial prosthesis. An implant-retained mid-facial prosthesis was fabricated. The retention of combined prostheses was obtained from the remaining right posterior teeth only. The patient had an unfavorable defect due to the large size and presence of scar contracture that vertically tends to dislodge the obturator. Magnet attachments were used to combine the facial and oral prosthesis, minimize the vertical dislodging forces and enhance retention. In addition, the retention was also gained from the scar band at lower border of mid-facial defect that avoided the need for more implants surgery. Magnet attachment with anatomical structure of the mid-facial defect provides an acceptable means of retention in large extraoral-intraoral combinations defects, improving the function, esthetic and the patients’ quality of life. Key words:Mid-facial prosthesis, obturator, magnet attachment, maxillectomy. PMID:28469829

  10. Assessment of the quality of life in maxillectomy patients: A longitudinal study.

    PubMed

    Kumar, Pradeep; Alvi, Habib Ahmad; Rao, Jitendra; Singh, Balendra Pratap; Jurel, Sunit Kumar; Kumar, Lakshya; Aggarwal, Himanshi

    2013-02-01

    To longitudinally assess the quality of life in maxillectomy patients rehabilitated with obturator prosthesis. Thirty-six subjects were enrolled in the span of 16 months, out of which six were dropouts. Subjects (age group 20-60 years) with maxillary defects, irrespective of the cause, planned for definite obturator prosthesis, were recruited. The Hindi version of European Organization for Research and Treatment of Cancer, Head and Neck version 1 of Quality of Life Questionnaire was used before surgical intervention and one month after definitive obturator. Questionnaire includes 35 questions related to the patient's physical health, well being, psychological status, social relation and environmental conditions. The data were processed with statistical package for social science (SPSS). Probability level of P<.05 was considered statistically significant. The quality of life after rehabilitation with obturator prosthesis was 81.48% (±13.64) on average. On item-level, maximum mean scores were obtained for items problem with teeth (1.87 ± 0.94), pain in mouth (1.80 ± 0.92), trouble in eating (1.70 ± 0.88), trouble in talking to other people (1.60 ± 1.22), problems in swallowing solid food (1.57 ± 1.22) and bothering appearance (1.53 ± 1.04); while minimum scores were obtained for the items coughing (1.17 ± 0.38), hoarseness of voice (1.17 ± 0.53), painful throat (1.13 ± 0.43), trouble in having social contacts with friends (1.10 ± 0.40) and trouble having physical contacts with family or friends (1.10 ± 0.31). Obturator prosthesis is a highly positive and non-invasive approach to improve the quality of life of patients with maxillectomy defects.

  11. Intraradicular Appearances Affect Radiographic Interpretation of the Periapical Area.

    PubMed

    Biscontine, Ana C; Diliberto, Adam J; Hatton, John F; Woodmansey, Karl F

    2017-12-01

    No research exists evaluating the influences of specific variables such as obturation length, radiodensity, or the presence of voids on interpretation of periradicular area. The purpose of this study was to evaluate the effects of obturation length, radiodensity, and the presence of voids on the radiographic interpretations of periapical areas. In a Web-based survey, 3 test image groups of variable obturation lengths, radiodensities, and numbers of voids were presented to observers for evaluation of the periapical areas. Intracanal areas of the images were altered by using Adobe Photoshop to create 3 test image groups. Each observer reviewed 2 control images and 1 image from each test image group. Responses were recorded in a 5-point Likert-type scale. Within each test image group, the periapical areas were identical. Kruskal-Wallis, Mann-Whitney U, and Cliff's delta statistical tests were used to analyze results. A total of 748 observer responses were analyzed. Significant differences (P ≤ .01) in the median Likert-type scale responses were identified between the following paired groups: 3 mm short and 1 mm short, 3 mm short and flush, lower radiodensity and higher radiodensity, lower radiodensity and intermediate radiodensity, no voids and several voids, and several voids and single void. Effect sizes ranged from 0.19 to 0.41. Significant differences were noted within all 3 test image groups: length, radiodensity, and presence of voids. Length of obturation had the largest effect on interpretation of the periapical area, with the 3 mm short radiographic obturation length image interpreted less favorably. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  12. Comparison of hand-instrumented, heated gutta-percha and engine-driven, cold gutta-percha endodontic techniques.

    PubMed

    Stein, Keith E; Manfra Marretta, Sandra; Siegel, Arthur; Vitoux, Jeanne

    2004-09-01

    An in vitro study compared two gutta-percha obturation techniques of the mandibular first molar in dogs. The mandibular first molars were instrumented and obturated using either K-files and the SuccessFil vertical compaction technique or rotary instruments and the Simplifill/guttapercha master cone technique. Instrumentation and obturation times were recorded for each tooth. Radiographs were used for evaluation of overall appearance of the final fill. A modified apical dye leakage technique was used to evaluate the ability of each method to provide an adequate barrier to apical leakage. The endodontic technique utilizing rotary instruments and Simplifill/gutta-percha master cone required less time and provided a better radiographic appearance to the endodontic fill. In addition, there was no apical dye leakage associated with this technique compared with a 44% leakage incidence in teeth treated with K-file instrumentation and SuccessFil.

  13. Simplified Prosthetic Rehabilitation of a Patient after Oral Cancer Removal

    PubMed Central

    Džakula, Nikola; Vojvodić, Denis

    2016-01-01

    The treatment of patients with oral cancer is complex: a multidisciplinary approach needs to be taken and maxillofacial and oral surgeons, an oncologist, a prosthodontist should be included, and a psychologist is often needed. This case report describes the prosthetic rehabilitation of a patient after surgical removal of oral cancer with obturator prosthesis. Resection cavity was located in central part of the hard palate and the condition belonged to Aramany class 3 maxillary defects. The two-step impression technique of denture bearing area was used and the resection of cavity was performed. A primary impression-the impression of denture bearing area was made using irreversible hydrocolloid material, while the second impression – the impression of resection cavity was made using condensation silicone material and obturator prosthesis framework. The obturator prosthesis replaced lost teeth, improved oral function and esthetics at minimal costs. PMID:27847400

  14. Simplified Prosthetic Rehabilitation of a Patient after Oral Cancer Removal.

    PubMed

    Kranjčić, Josip; Džakula, Nikola; Vojvodić, Denis

    2016-09-01

    The treatment of patients with oral cancer is complex: a multidisciplinary approach needs to be taken and maxillofacial and oral surgeons, an oncologist, a prosthodontist should be included, and a psychologist is often needed. This case report describes the prosthetic rehabilitation of a patient after surgical removal of oral cancer with obturator prosthesis. Resection cavity was located in central part of the hard palate and the condition belonged to Aramany class 3 maxillary defects. The two-step impression technique of denture bearing area was used and the resection of cavity was performed. A primary impression-the impression of denture bearing area was made using irreversible hydrocolloid material, while the second impression - the impression of resection cavity was made using condensation silicone material and obturator prosthesis framework. The obturator prosthesis replaced lost teeth, improved oral function and esthetics at minimal costs.

  15. Pathogenesis and Treatment of Cerebral Air Embolism and Associated Disorders.

    DTIC Science & Technology

    1984-04-01

    blades) 12. 7.0, 8.0 and 9.0-mm endotracheal tubes 13. Endotracheal tube stylet 14. Esophageal obturator airway 15. Tracheal suction catheters (14F) 17 r...16. Nasogastric suction tube and Tumee syringe 17. Tincture of Benzoin 18. 2-in waterproof tape 19. Precordial stethoscope 20. Esophageal stethoscope...be justified. If an endotracheal tube cannot be passed, an esophageal obturator airway may be useful. If such an airway Is used, the newer models

  16. Importance of third mesial canals in mandibular molars: report of 2 cases.

    PubMed

    Yesilsoy, Cemil; Porras, Omar; Gordon, Wanda

    2009-07-01

    Most mandibular first molars have 2 mesial canals. Two cases of failed endodontically treated first mandibular molars are presented with 2 obturated mesial canals. The cases were retreated with a third mesial canal identified, and instrumented and obturated with resolution of the patients' signs and symptoms. These cases show that consideration must be made to recognize the possibility of a third mesial canal and perform complete treatment to minimize the possibility of failure.

  17. [APPLICATION OF FISTULA PLUG WITH THE FIBRIN ADHESIVE IN TREATMENT OF RECTAL FISTULAS].

    PubMed

    Aydinova, P R; Aliyev, E A

    2015-05-01

    Results of surgical treatment of 21 patients, suffering high transsphincteric and extrasphincteric rectal fistulas, were studied. In patients of Group I the fistula passage was closed, using fistula plug obturator; and in patients of Group II--by the same, but preprocessed by fibrin adhesive. The fistula aperture germeticity, prophylaxis of rude cicatrices development in operative wound zone, promotion of better fixation of bioplastic material were guaranteed, using fistula plug obturator with preprocessing, using fibrin adhesive.

  18. Single-visit endodontic treatment of mature teeth with chronic apical abscesses using mineral trioxide aggregate cement: a randomized clinical trial.

    PubMed

    Alsulaimani, Reem Siraj

    2016-08-23

    Mature teeth with chronic apical abscesses characterized by intermittent discharge of pus through an associated sinus tract. This communication between oral mucosa and periapical inflammation is challenging for the sealing ability of root canal obturation material. Therefore, the study aim was to compare the outcomes of endodontic treatment using mineral trioxide aggregate (MTA) cement to the conventional gutta-percha cone and root canal sealer as an obturation material in mature teeth with chronic apical abscesses. Mature teeth with chronic apical abscesses referred to our clinic for root canal treatment between 2010 and 2012 were treated in a single visit and distributed among treatment (T) and control (C) groups using a predetermined randomization block (TCTC). After chemo-mechanical preparation, teeth in group T received MTA cement mixed in a 0.26 water to powder ratio, and teeth group C received gutta-percha and root canal sealer using the warm vertical technique. The treatment outcomes were defined as obturation length, periapical healing, resorption of extruded material, and survival rate at least 2.5 years after treatment. Three endodontists blinded to the type of obturation material documented treatment outcomes. Statistical analysis at P < 0.05 was conducted to measure difference between the groups. Thirty-six teeth were treated between 2010 and 2012, and 32 teeth were evaluated in 2015. Complete periapical healing was observed in 87.5 % of MTA-treated teeth and 75.0 % of gutta-percha-treated teeth. Adequate obturation length was reported in 50.0 % of MTA-treated and 37.5 % of gutta-percha-treated teeth. Complete resorption of extruded material was evident in 83.3 % MTA-treated teeth and 100.0 % gutta-percha-treated teeth. The survival rate of MTA-treated teeth was 100 % at 3, and 5 years, while the survival rate of gutta-percha-treated teeth was 83.3 % at 3, and 5 years. There was no significant difference between the groups in term of

  19. Surgeon-tailored polypropylene mesh as a tension-free vaginal tape-obturator versus original TVT-O for the treatment of female stress urinary incontinence: a long-term comparative study.

    PubMed

    ElSheemy, Mohammed S; Fathy, Hesham; Hussein, Hussein A; Elsergany, Ragheb; Hussein, Eman A

    2015-10-01

    The objective of the study was to compare the safety and efficacy of surgeon-tailored polypropylene mesh (STM) through tension-free vaginal tape-obturator (TVT-O) versus original TVT-O in the treatment of stress urinary incontinence (SUI) aiming to decrease the cost of treatment. This is important in developing countries due to limited health care resources. A retrospective cohort study was done at the Urology and Gynecology Departments (dual-center), Cairo University from May 2007 to June 2010. Women evaluated by cough stress test, Stress and Urge Incontinence and Quality of Life Questionnaire (SUIQQ), maximum flow rate (Qmax), and abdominal leak point pressure (ALPP) with follow-up for at least 48 months were included. Patients with post-void residual urine > 100 ml, bladder capacity < 300 ml, or impaired compliance were excluded. The effect of different factors on outcome was compared between both groups pre- and postoperatively using the paired t, Wilcoxon signed rank, McNemar, chi-square, Fisher's exact, independent t, or Mann-Whitney tests. STM and TVT-O were inserted in 79 and 66 women, respectively. Intrinsic sphincter deficiency, ALPP, previous surgeries, associated urgency, urgency urinary incontinence (UUI), and prolapse were comparable in both groups. Operative duration was longer in STM by 10 min. No significant difference was found between both groups in complications (p = 0.462), cure (p = 0.654), and different indices of SUIQQ. In STM, 74 (93 %) were cured and 3 (4 %) improved, while SUI persisted in 2 (2 %) patients. In TVT-O, 59 (89 %) were cured and 4 (6 %) improved, while failure was detected in 3 (4 %) patients. The 5-year outcome is comparable between STM and TVT-O. Furthermore, STM is more economical due to our resterilizable modified helical passers and the cheap polypropylene mesh.

  20. Assessment of the quality of life in maxillectomy patients: A longitudinal study

    PubMed Central

    Kumar, Pradeep; Alvi, Habib Ahmad; Rao, Jitendra; Jurel, Sunit Kumar; Kumar, Lakshya; Aggarwal, Himanshi

    2013-01-01

    PURPOSE To longitudinally assess the quality of life in maxillectomy patients rehabilitated with obturator prosthesis. MATERIALS AND METHODS Thirty-six subjects were enrolled in the span of 16 months, out of which six were dropouts. Subjects (age group 20-60 years) with maxillary defects, irrespective of the cause, planned for definite obturator prosthesis, were recruited. The Hindi version of European Organization for Research and Treatment of Cancer, Head and Neck version 1 of Quality of Life Questionnaire was used before surgical intervention and one month after definitive obturator. Questionnaire includes 35 questions related to the patient's physical health, well being, psychological status, social relation and environmental conditions. The data were processed with statistical package for social science (SPSS). Probability level of P<.05 was considered statistically significant. RESULTS The quality of life after rehabilitation with obturator prosthesis was 81.48% (±13.64) on average. On item-level, maximum mean scores were obtained for items problem with teeth (1.87 ± 0.94), pain in mouth (1.80 ± 0.92), trouble in eating (1.70 ± 0.88), trouble in talking to other people (1.60 ± 1.22), problems in swallowing solid food (1.57 ± 1.22) and bothering appearance (1.53 ± 1.04); while minimum scores were obtained for the items coughing (1.17 ± 0.38), hoarseness of voice (1.17 ± 0.53), painful throat (1.13 ± 0.43), trouble in having social contacts with friends (1.10 ± 0.40) and trouble having physical contacts with family or friends (1.10 ± 0.31). CONCLUSION Obturator prosthesis is a highly positive and non-invasive approach to improve the quality of life of patients with maxillectomy defects. PMID:23507671

  1. Implant rehabilitation of partial maxillectomy edentulous patient

    PubMed Central

    Gowda, Mahesh E.; Mohan, Murali S.; Verma, Kamal; Roy, I. D.

    2013-01-01

    Edentulous patients with maxillectomy defects present a significant challenge for prosthetic rehabilitation and the adaptive capabilities of the patient as retention is highly compromised. Hence, the option of using endosseous implants to increase obturator retention has been used. A patient of mucormycosis of the left maxilla was treated with surgical excision. After satisfactory healing, definitive implant supported magnet retained prosthesis was fabricated for the patient. Implants with magnetic units offer a practical method of improving the retention of obturators provided acceptable prosthetic protocols are followed for the rehabilitation. PMID:24124314

  2. Zygoma Implant-Supported Prosthetic Rehabilitation of a Patient After Bilateral Maxillectomy.

    PubMed

    Celakil, Tamer; Ayvalioglu, Demet Cagil; Sancakli, Erkan; Atalay, Belir; Doganay, Ozge; Kayhan, Kivanc Bektas

    2015-10-01

    Maxillectomy defects may vary from localized to extensive soft and hard tissue loss. In addition to physical and psychologic damages, functional and aesthetic aspects must be restored. This clinical report describes the rehabilitation of a patient with a zygoma implant-supported obturator prosthesis caused by a subtotal bilateral maxillectomy due to a squamous oral cell carcinoma. Prosthetic rehabilitation of this patient was performed after zygoma implant surgery. A maxillary obturator prosthesis supported by 2 osseointegrated zygoma implants was fabricated. Despite limited mouth opening and anatomic deficiencies, the patient's aesthetic and functional demands were fulfilled.

  3. The TVT Worldwide Observational Registry for Long-Term Data: safety and efficacy of suburethral sling insertion approaches for stress urinary incontinence in women.

    PubMed

    Tincello, Douglas G; Botha, Theunis; Grier, Douglas; Jones, Peter; Subramanian, Dhinagar; Urquhart, Colin; Kirkemo, Aaron; Khandwala, Salil

    2011-12-01

    We examined the clinical effectiveness of a single incision sling in women with stress urinary incontinence and obtained comparative perioperative and postoperative data on retropubic and transobturator slings. Women who underwent a cough stress test were treated with surgery using a single incision, retropubic or obturator sling (Gynecare® TVT SECUR™, TVT™ or TVT Obturator System, respectively) with the choice of sling based on surgeon preference. Objective cure was assessed by the standing cough stress test at 1 year. Subjective outcomes were assessed by the Incontinence Quality of Life Questionnaire and EQ-5D™. Perioperative data and return to normal activity were recorded. Of the 1,398 women who underwent surgery there were postoperative data on 1,334, including 32.8%, 17.8% and 49.4% who received a tension free vaginal tape, obturator tension free vaginal tape and SECUR, respectively. After obturator tension free vaginal tape surgery fewer women had a positive cough stress test than after TVT and SECUR surgery (4 of 110 or 3.6% vs 24 of 187 or 12.8% and 59 of 374 or 15.8%, respectively). Incontinence Quality of Life Questionnaire effect size was 1.87, 1.42 and 1.56, respectively, indicating a large treatment effect. Using our Incontinence Quality of Life Questionnaire response definition 85.4%, 79.0% and 85.2% of the TVT, TVT outside-in obturator system and SECUR cohorts, respectively, were treatment responders (p = 0.11).The SECUR cohort had the shortest operative time, the lowest proportion of women who required an overnight stay and the most women who underwent surgery under local anesthesia. Median time to return to employment, housework, sex life and hobbies was most rapid for SECUR. This registry demonstrates the high effectiveness of all 3 approaches. The single incision sling appeared to have objective and subjective efficacy similar to that of the retropubic sling and it can be performed under local anesthesia in an office environment

  4. ToF-SIMS images and spectra of biomimetic calcium silicate-based cements after storage in solutions simulating the effects of human biological fluids

    NASA Astrophysics Data System (ADS)

    Torrisi, A.; Torrisi, V.; Tuccitto, N.; Gandolfi, M. G.; Prati, C.; Licciardello, A.

    2010-01-01

    ToF-SIMS images were obtained from a section of a tooth, obturated by means of a new calcium-silicate based cement (wTCF) after storage for 1 month in a saline solutions (DPBS), in order to simulate the body fluid effects on the obturation. Afterwards, ToF-SIMS spectra were obtained from model samples, prepared by using the same cement paste, after storage for 1 month and 8 months in two different saline solutions (DPBS and HBSS). ToF-SIMS spectra were also obtained from fluorine-free cement (wTC) samples after storage in HBSS for 1 month and 8 months and used for comparison. It was found that the composition of both the saline solution and the cement influenced the composition of the surface of disks and that longer is the storage greater are the differences. Segregation phenomena occur both on the cement obturation of the tooth and on the surface of the disks prepared by using the same cement. Indirect evidences of formation of new crystalline phases are supplied.

  5. Micro-CT evaluation of the effectiveness of the combined use of rotary and hand instrumentation in removal of Resilon.

    PubMed

    Asheibi, Fatma; Qualtrough, Alison J E; Mellor, Anthony; Withers, Philip J; Lowe, Tristan

    2014-01-01

    This study compares the effectiveness of ProTaper rotary files with ProTaper retreatment and K-files in the removal of Resilon or gutta percha (GP) from canals filled either by cold lateral condensation or thermal obturation using micro-CT. Ninety-six teeth were prepared using ProTaper files and allocated into four groups (n=24): Group-1 was filled with GP/AH-Plus and Group-2 with Resilon/RealSeal using cold lateral condensation. Group-3 was filled with GP/AH-Plus and Group-4 with Resilon/RealSeal using System B and Obtura II. The roots were scanned by micro-CT. Each group was divided into two subgroups (n=12): A, retreated using ProTaper files and B, using ProTaper retreatment and K-files. The roots were scanned to calculate the volume of the remaining material. With thermal obturation, roots filled with Resilon had significantly more remaining material than GP. Obturation using thermal technique resulted in significantly less remaining material than cold condensation except Resilon retreated using ProTaper retreatment and K-files.

  6. Morphology of the abdominal wall in the bat, Pteronotus parnellii (Microchiroptera: Mormoopidae): implications for biosonar vocalization.

    PubMed

    Lancaster, W C; Henson, O W

    1995-01-01

    We investigated the structure of the abdominal wall of Pteronotus parnellii and made comparisons with eight other species of Microchiroptera and one megachiropteran. Similar to other mammals, the abdominal wall of bats consists of the three flank muscles laterally and the m. rectus abdominis ventrally. In Microchiroptera, flank muscles are mostly confined to dorsal portions of the wall. The mm. transversus abdominis and obliquus internus abdominis form the bulk of the wall; the m. obliquus externus is poorly developed. Ventrolaterally, a large portion of the wall is a dense, bilaminar aponeurosis, composed of collagen, elastin, and fibroblasts. The thicker, superficial lamina derives from the mm. obliquus internus and transversus abdominis. The deep lamina is a continuation of the transversalis fascia. Collagen fibers of the two fused laminae are oriented orthogonally, resulting in a resilient, composite fabric. Fascicles of the flank muscles are oriented along the margins of the aponeurosis so that their forces appear to be concentrated onto the aponeurosis. We suggest that this system is adapted for the regulation and generation of intra-abdominal pressure. The abdominal wall of Pteropus, the one megachiropteran examined, lacks the derived aponeurosis and is similar to other mammals. We consider the abdominal wall of Microchiroptera to be analogous to the diaphragma, in that it functions in the regulation of pressure within body cavities and facilitates biosonar vocalization.

  7. One-year follow-up of tension-free vaginal tape (TVT) and trans-obturator suburethral tape from inside to outside (TVT-O) for surgical treatment of female stress urinary incontinence: a prospective randomised trial.

    PubMed

    Zullo, Marzio Angelo; Plotti, Francesco; Calcagno, Marco; Marullo, Elettra; Palaia, Innocenza; Bellati, Filippo; Basile, Stefano; Muzii, Ludovico; Angioli, Roberto; Panici, Pierluigi Benedetti

    2007-05-01

    To compare tension-free vaginal tape (TVT) and trans-obturator suburethral tape from inside to outside (TVT-O) for surgical treatment of stress urinary incontinence (SUI) for complications (primary end point) and success rate (secondary end point). Seventy-two consecutive patients, with a mean age of 53.2 yr (range: 38-69 yr) and affected by SUI, were included in this randomised controlled trial. After preoperative assessment, patients were randomly allocated to the TVT or TVT-O procedure. Operative time, perioperative complications, and hospital stay were prospectively recorded. Cure of SUI was defined as no leakage of urine during the stress test at urodynamic testing at the 12-mo evaluation. The Wilcoxon signed rank sum test, Mann-Whitney U test, McNemar test, and Fisher exact test were used to verify statistical significance, set at p<0.05. All patients were evaluable at the 12-mo follow-up. The characteristics of patients were well balanced between groups after randomisation. The mean operative time was significantly shorter in the TVT-O group. Perioperative complications were significantly more common after the retropubic approach (5% and 27% in TVT-O and TVT groups, respectively, p<0.04). The groups did not differ significantly in intraoperative blood loss, hospital stays, and time to return to normal activities. Sixty-five patients (90%) were successfully treated for SUI 12 mo after the operation (89% and 91% for TVT-O and TVT groups, respectively). Both techniques appear to be equally effective in the surgical treatment of SUI. However, TVT-O had a shorter operative time and lower overall perioperative complication rate.

  8. Evaluation of the interface between gutta-percha and two types of sealers using scanning electron microscopy (SEM).

    PubMed

    Eltair, Mohamed; Pitchika, Vinay; Hickel, Reinhard; Kühnisch, Jan; Diegritz, Christian

    2018-05-01

    The aim of the present study was to evaluate the adaptation of a calcium silicate bioceramic (BC) sealer with either BC or conventional gutta-percha compared with that of AH Plus sealer in different root canal sections. Seventy-two extracted mandibular premolars were divided randomly into six groups. After standardised chemomechanical preparation, four groups were obturated with the BC sealer and BC gutta-percha or conventional gutta-percha, and the other two groups were obturated with AH Plus sealer and conventional gutta-percha either in lateral compaction or in a single cone technique. Each root was sectioned into three sections. An impression was made from each section, and replicas were then made for scanning electron microscopy (SEM) analysis. Areas and interfacial gaps were identified using image analysis software. In addition to descriptive and explorative data analyses, linear regression analysis was performed. All specimens had measurable interfacial gaps. Significantly fewer gaps were found between conventional gutta-percha and sealer compared to those observed when using the BC gutta-percha (p < 0.001). However, minor interfacial gaps between sealer and dentin were observed with the BC sealer (p = 0.04). The technique of obturation in different root canal sections did not significantly affect the sealer adaptability. The type of gutta-percha as well as the sealer had a noticeable impact on the adaptability. Different obturation techniques will result in similar outcomes. However, within the limitations of the study, there seems to be no advantage in using the BC gutta-percha.

  9. An Evaluation of GuttaFlow2 in Filling Artificial Internal Resorption Cavities: An in vitro Study.

    PubMed

    Mohammad, Yara; Alafif, Hisham; Hajeer, Mohammad; Yassin, Oula

    2016-06-01

    Obturation of root canal with internal resorption represents a major challenge in Endodontics. In spite of that, usual obturation techniques are often employed without considering the best technique to solve this problem. The goal of this study was to investigate the ability of GuttaFlow2 in filling artificial internal resorption cavities. The study sample included 36 human upper central incisors that were prepared using Protaper system (F4). Internal resorption cavities were prepared by cutting each tooth at 7 mm from the apex and preparing hemispherical cavities on both the sides and then re-attaching them. The sample was randomly separated into three groups (n = 12 in each group). In the first group, thermal injection technique (Obtura II) was employed and served as the control group. In the second group, injection of cold free-flow obturation technique with a master cone (GF2-C) was employed, whereas in the third group injection of cold free-flow obturation without a master cone (GF2) was followed. The teeth were re-cut at the same level as before and examined under a stereomicroscope. Subsequently, the captured images were transferred to AutoCAD program to measure the percentage of total filling "TF," gutta-percha "G," sealer "S," and voids "V" out of the total surface of the cross sections. All materials showed high filling properties in terms of "total filling," ranging from 99.17% (for Obtura II) to 99.72% (for GF2-C). Regarding gutta-percha percentages of filling, they ranged from 83.15 to 83.93%, whereas those for the sealer ranged from 5.71 to 15.24%. GuttaFlow2 group with a master cone appeared to give the best results despite the insignificant differences among the three groups. The GuttaFlow2 with a master cone technique seemed to be a promising filling material and gave results similar to those observed with Obtura II. It is recommended for use to obturate internal resorption cavities in clinical practice due to its good adaptability to root canal

  10. Effect of customization of master gutta-percha cone on apical control of root filling using different techniques: an ex vivo study.

    PubMed

    van Zyl, S P; Gulabivala, K; Ng, Y-L

    2005-09-01

    (i) To compare the prevalence of extrusion of root filling material when placed using different root filling techniques, with or without customization of the master gutta-percha (GP) cone; and (ii) to investigate the effects of some factors influencing root filling extrusion and presence of voids. A total of 180 roots were selected, prepared and randomly allocated to three groups. Five general dental practitioners performed the root fillings; each filled one group of roots (n = 60) using each of three techniques; 'cold lateral compaction' (n = 20), 'warm vertical compaction' (n = 20) and 'continuous-wave' (n = 20) techniques. For each obturation technique, the master GP cone was customized using chloroform in 10 samples. Two groups of the roots were recycled to allow all five operators to fulfill their remit. Two observers, blind to operator and obturation technique, examined the radiographs (master apical file, post-obturation) to determine the presence of root filling extrusion and voids within the apical 5 mm, independently. Root filling extrusion was also confirmed by direct inspection of the root apex after obturation. The data were analysed using logistic regression models. A total of 300 root fillings were performed; nine were excluded from the analysis. Most of the root fillings (80%, n = 233) were placed within 0.5 mm of the working length; only 20% (n = 58) were placed >0.5 mm beyond the working length. The odds of prevalence of extrusion (>0.5 mm) were significantly reduced by about 50% when cold lateral compaction or customization of GP were used. One operator produced 2.5 times more extruded root fillings than others. Curvature & length of root canal, apical size of prepared canal, as well as operator's preferred obturation technique had no significant influence on the prevalence of extrusion. Customization of GP was the sole factor to significantly reduce the prevalence of voids within the apical 5 mm of working length. Root filling extrusion was

  11. Definition and endodontic treatment of dilacerated canals: a survey of Diplomates of the American Board of Endodontics.

    PubMed

    Dastmalchi, Nafiseh; Kazemi, Zeinab; Hashemi, Siroos; Peters, Ove A; Jafarzadeh, Hamid

    2011-01-01

    To gather data from Diplomates of the American Board of Endodontics regarding treatment of dilacerated canals. A questionnaire addressing definition, endodontic treatment procedures and prognosis was constructed and distributed via e-mail to 708 Diplomates of the American Board of Endodontics. Data from 150 respondents, a 21% response rate, were collected by using a Web-based interface. For statistical analysis, Chi-square tests were used. More than 25% of respondents believed that a dilacerated root should have a curvature > 40°. One-visit treatment is the best therapeutic approach and transportation is the most likely complication in preparation of these canals. A crown-down technique, watch-winding motion and a master apical file # 25 are the best choices for preparation of these canals. Any warm obturation technique is preferred over lateral compaction by most respondents. A crown-down technique for root canal preparation and a thermoplastic obturation technique are recommended for canals whose curvature is more than 40°. The prognosis of the treatment of these canals is judged not lower than normal canals. Crown-down technique and thermoplastic obturation are recommended for dilacerated canals.

  12. In vitro evaluation of the accuracy of five different electronic apex locators for determining the working length of endodontically retreated teeth.

    PubMed

    Ebrahim, Aqeel Khalil; Wadachi, Reiko; Suda, Hideaki

    2007-04-01

    The aim of this study was to evaluate the accuracy of five electronic apex locators (EALs) in determining the working length (WL) of teeth after removal of the root canal obturation materials. A total of 32 extracted straight, single-rooted teeth were used. The actual canal length (AL) was determined and the WL was established by subtracting 0.5 mm from the AL. The root canals were instrumented and divided into two groups. One group (n = 6) served as control, while the other group (n = 26) was the experimental group. In the experimental group, the root canals were obturated using vertically compacted gutta-percha with AH 26 sealer. In both groups, the access cavities were restored with a provisional restoration and stored for 15 days at 37 degrees C and 100% humidity. The root canal obturation material was removed, and the teeth were then mounted in an experimental apparatus. Five EALs were used: Dentaport ZX, ProPex, Foramatron D10, Apex NRG and Apit 7. For the electronic measurement of canal length, a size 25 K-file was used. During measurement, the canal was irrigated with 2.5% sodium hypochlorite. The difference (D) between the AL and the electronically determined length (EDL), AL-EDL, was calculated and recorded for each measurement. Data were analysed by two-way anova and Fisher's PLSD test. In both groups, statistically significant differences were found among the EALs (P < 0.01). In conclusion, the Dentaport ZX, ProPex and Foramatron D10 were more accurate than the other two EALs in determining the WL in teeth after removal of the root canal obturation materials. However, the Apex NRG and Apit 7 were also reliable for determination of the WL in the majority of the cases.

  13. Effect of timing and method of post space preparation on sealing ability of remaining root filling material: in vitro microbiological study.

    PubMed

    Grecca, Fabiana Soares; Rosa, Angela Rezende Gomes; Gomes, Maximiliano Schünke; Parolo, Clarissa Fatturi; Bemfica, Jules Renan Dutra; Frasca, Luis Carlos da Fontoura; Maltz, Marisa

    2009-10-01

    To evaluate the effect of timing (immediate versus delayed) and technique of post space preparation on the ability of the residual root canal obturation to prevent coronal bacterial leakage. Sixty-six single-rooted teeth were decoronated at the cementoenamel junction. The canals were prepared according to a step-back technique and were filled with thermoplasticized gutta-percha and AH Plus endodontic sealer (Dentsply De Trey). The root segments were randomly assigned to 8 groups. The positive controls (n = 3) were instrumented but not obturated. The negative controls (n = 3) were instrumented, obturated and sealed with Cavit (3M ESPE). In the other 6 groups (n = 10 each), the post space was prepared either immediately after obturation or 7 days later using LA Axxess burs (SybronEndo) (groups 1 and 2), heated pluggers (groups 3 and 4) or solvent delivered with a hand file (groups 5 and 6). The external surface of all roots was rendered waterproof with nail varnish. Custom-made dual-chamber devices were used to evaluate leakage. The coronal third of the prepared root canal was kept in contact with artificial saliva contaminated with Enterococcus faecalis, and the root apex was submerged in tryptic soy agar medium. The root assemblies were stored at 37 degrees C and were monitored daily over a 90-day period. The occurrence of turbidity in the medium was deemed to indicate bacterial leakage, from which failure of the seal was inferred. Throughout the experimental period, there was no significant difference (p = 0.094) among the preparation techniques, either immediate or delayed, in terms of bacterial leakage. Immediate and delayed post space preparation yielded similar outcomes in terms of the canal seal. Regardless of the timing and the technique of post space preparation, coronal bacterial leakage occurred over time.

  14. Measurement of the "safe zone" and the "dangerous zone" for the screw placement on the quadrilateral surface in the treatment of pelvic and acetabular fractures with Stoppa approach by computational 3D technology.

    PubMed

    Zhang, Sheng; Su, Wanhan; Luo, Qiang; Leung, Frankie; Chen, Bin

    2014-01-01

    This study is aimed at definition of the safe and dangerous zone for screw placement with Stoppa approach for rapid identification during operation and a new way for the studies on the "safe zone." Pelvic CT data of 84 human subjects were recruited to reconstruct the three-dimensional (3D) models. The distances between the edges of the "safe zone," "dangerous zone," and specific anatomic landmarks such as the obturator canal and the pelvic brim were precisely measured, respectively. The results show that the absolute "dangerous zone" was from the pelvic brim to 3.07 cm below it and within 2.86 cm of the obturator canal, while the region 3.56 cm below the pelvic brim or 3.85 cm away from the obturator canal was the absolute "safe zone" for screw placement. The region between the absolute "safe zone" and the absolute "dangerous zone" was the relatively "dangerous zone." As a conclusion, application of computer-assisted 3D modeling techniques aids in the precise measurement of "safe zone" and "dangerous zone" in combination with Stoppa incision. It was not recommended to place screws on the absolute dangerous zone, while, for the relatively "dangerous zone," it depends on the individual variations in bony anatomy and the fracture type.

  15. Surface debris of canal walls after post space preparation in endodontically treated teeth: a scanning electron microscopic study.

    PubMed

    Serafino, Cinzia; Gallina, Giuseppe; Cumbo, Enzo; Ferrari, Marco

    2004-03-01

    To evaluate surface cleanliness of root canal walls along post space after endodontic treatment using 2 different irrigant regimens, obturation techniques, and post space preparation for adhesive bonding. Forty teeth, divided into 4 groups, were instrumented, using Ni-Ti rotary files, irrigated with NaOCl or NaOCl+EDTA and obturated with cold lateral condensation (CLC) or warm vertical condensation (WVC) of gutta-percha. After post space preparation, etching, and washing procedure, canal walls were observed using a scanning electron microscope (SEM). Amount of debris, smear layer, sealer/gutta-percha remnants, and visibility of open tubules were rated. Higher amounts of rough debris, large sealer/gutta-percha remnants, thick smear layer, and no visibility of tubule orifices were recorded in all the groups at apical level of post space. At middle and coronal levels areas of clean dentin, alternating with areas covered by thin smear layer, smaller debris, gutta-percha remnants, and orifices of tubules partially or totally occluded by plugs were frequently observed. After endodontic treatment, obturation, and post space preparation SEM analysis of canal walls along post space shows large areas (covered by smear layer, debris, and sealer/gutta-percha remnants) not available for adhesive bonding and resin cementation of fiber posts.

  16. Prevalence of Enterococcus faecalis in saliva and filled root canals of teeth associated with apical periodontitis

    PubMed Central

    Wang, Qian-Qian; Zhang, Cheng-Fei; Chu, Chun-Hung; Zhu, Xiao-Fei

    2012-01-01

    To investigate the prevalence of Enterococcus faecalis in saliva and filled root canals of patients requiring endodontic retreatment for apical periodontitis. Patients with apical periodontitis who were referred for endodontic retreatment were examined. The type and quality of the restoration, symptoms, quality of obturation were recorded. During retreatment, an oral rinse sample and root canal sample were cultured using brain-heart infusion agar and bile esculinazide agar to select for E. faecalis. The 16S rRNA technique was used to identify E. faecalis. A total of 32 women and 22 men (mean age: 38 years; s.d.: 11 years) and 58 teeth were studied. The prevalence of E. faecalis was 19% in the saliva and 38% in the root canals. The odds that root canals harbored E. faecalis were increased if the saliva habored this bacterium (odds ratio=9.7; 95% confidence interval=1.8–51.6; P<0.05). Teeth with unsatisfactory root obturation had more cultivable bacterial species in root canals than teeth with satisfactory root obturation (P<0.05). E. faecalis is more common in root canals of teeth with apical periodontitis than in saliva. The prevalence of E. faecalis in root canals is associated with the presence of E. faecalis in saliva. PMID:22422085

  17. Marginal adaptation of newer root canal sealers to dentin: A SEM study.

    PubMed

    Polineni, Swapnika; Bolla, Nagesh; Mandava, Pragna; Vemuri, Sayesh; Mallela, Madhusudana; Gandham, Vijaya Madhuri

    2016-01-01

    This in vitro study evaluated and compared the marginal adaptation of three newer root canal sealers to root dentin. Thirty freshly extracted human single-rooted teeth with completely formed apices were taken. Teeth were decoronated, and root canals were instrumented. The specimens were randomly divided into three groups (n = 10) based upon the sealer used. Group 1 - teeth were obturated with epoxy resin sealer (MM-Seal). Group 2 - teeth were obturated with mineral trioxide aggregate (MTA) based sealer (MTA Fillapex), Group 3 - teeth were obturated with bioceramic sealer (EndoSequence BC sealer). Later samples were vertically sectioned using hard tissue microtome and marginal adaptation of sealers to root dentin was evaluated under coronal and apical halves using scanning electron microscopy (SEM) and marginal gap values were recorded. The data were statistically analyzed by two-way ANOVA and Tukey's multiple post hoc test. The highest marginal gap was seen in Group 2 (apical-16680.00 nm, coronal-10796 nm) and the lowest marginal gap was observed in Group 1 (apical-599.42 nm, coronal-522.72 nm). Coronal halves showed superior adaptation compared to apical halves in all the groups under SEM. Within the limitations of this study epoxy resin-based MM-Seal showed good marginal adaptation than other materials tested.

  18. Effect of Root Canal Sealers on Bond Strength of Fiber Posts to Root Dentin Cemented after one Week or six Months

    PubMed Central

    Ruiz, Lucas; Mongruel Gomes, Giovana; Bittencourt, Bruna; Rutz da Silva, Fabrício; Mongruel Gomes, Osnara Maria; Chidoski Filho, Julio Cezar; Lincoln Calixto, Abraham

    2018-01-01

    Eugenol-based root canal sealers (RCS) have been widely used by clinicians; however, their effect on resinous materials is still questionable. The objective of this study was to evaluate the influence of RCS at 1 week and 6 months’ post obturation on the bond strength (BS) of glass fiber posts (GFP) to root dentin, using conventional and self-adhesive cementation systems (CS). The roots of 56 extracted human canines, were divided in eight groups (n=7) according to the combination of the following factors: RCS (with or without eugenol-Endofill and Sealer 26, respectively), storage period post obturation and prior GFP cementation (1 week and 6 months) and cementation systems (Variolink II - conventional resin cement or RelyX U200-self-adhesive resin cement). After one week, the specimens were transversely sectioned into six 1-mm-thick disks and were subjected to the push out BS test. The data were subjected to 3-way ANOVA and Tukey’s tests (α=0.05). The BS were not affected by the RCS, neither the CS (P>0.05). Just the period post obturation showed statistically significant differences (P 0.05), where the GFP cemented 6 months after the endodontic treatment showed higher values than those cemented 1 week after it. PMID:29692836

  19. Effect of the angle of apical resection on apical leakage, measured with a computerized fluid filtration device.

    PubMed

    Garip, Hasan; Garip, Yıldız; Oruçoğlu, Hasan; Hatipoğlu, Seda

    2011-03-01

    We determined the effect of the angle of apical resection on apical leakage using a computerized fluid filtration meter with a laser system and a digital air pressure regulator in 46 extracted single-rooted human teeth. Orthograde endodontic treatment was performed. The root canals were prepared up to a size 50 K-type file with 17% EDTA solution (Roth International, Chicago, IL) and 5% NaOCl solution as the irrigant. Gates Glidden burs (Maillefer Instruments, Ballaigues, Switzerland) were used to flare the coronal two thirds of the canal. All canals were dried with paper points and then obturated using cold lateral condensation (except for the positive controls) of gutta-percha points and AH plus (Dentsply DeTrey, Konstanz, Germany). All 40 roots were sectioned 3 mm from the apex. Forty teeth were assigned randomly into 1 of 4 experimental groups of 10 teeth each: in group 1, the teeth were resected apically (90° angle) and the cavities were obturated with mineral trioxide aggregate (MTA); in group 2, after apical resection (90° angle), a root-end cavity was prepared using ultrasonic diamond retrotips and the cavities were obturated with MTA; in group 3, the teeth were resected apically (∼45° angle) and the cavities were obturated with MTA; and in group 4, after apical resection (∼45° angle), a root-end cavity was prepared using ultrasonic diamond retrotips and the cavities were obturated with MTA. An additional 6 teeth were used as controls (3 each, negative and positive controls). Apical leakage was measured using a computerized fluid filtration meter with a laser system. The mean apical microleakage was 2.0 ± 0.4 × 10(-4), 1.6 ± 0.6 × 10(-4), 1.6 ± 0.9 × 10(-4), and 1.8 ± 0.7 × 10(-4) μL/cmH(2)O/min(-1) at 1.2 atm, in groups 1 to 4, respectively. Although the mean apical microleakage was greater in group 1, the differences among the 4 groups were not statistically significant (P > .05). The results of these in vitro studies showed that when an

  20. Responses of intra-abdominal pressure and abdominal muscle activity during dynamic trunk loading in man.

    PubMed

    Cresswell, A G

    1993-01-01

    The purpose of this study was to determine and compare interactions between the abdominal musculature and intra-abdominal pressure (IAP) during controlled dynamic and static trunk muscle loading. Myoelectric activity was recorded in six subjects from the rectus abdominis, obliquus externus, obliquus internus, transversus abdominis and erector spinae muscles using surface and intra-muscular fine-wire electrodes. The IAP was recorded intra-gastrically. Trunk flexions and extensions were performed lying on one side on a swivel table. An adjustable brake provided different friction loading conditions, while adding weights to an unbraked swivel table afforded various levels of inertial loading. During trunk extensions at all friction loads, IAP was elevated (1.8-7.2 kPa) with concomitant activity in transversus abdominis and obliquus internus muscles--little or no activity was seen from rectus abdominis and obliquus externus muscles. For inertia loading during trunk extension, IAP levels were somewhat lower (1.8-5.6 kPa) and displayed a second peak when abdominal muscle activity occurred in the course of decelerating the movement. For single trunk flexions with friction loading, IAP was higher than that seen in extension conditions and increased with added resistance. For inertial loading during trunk flexion, IAP showed two peaks, the larger first peak matched peak forward acceleration and general abdominal muscle activation, while the second corresponded to peak deceleration and was accompanied by activity in transversus abdominis and erector spinae muscles. It was apparent that different loading strategies produced markedly different patterns of response in both trunk musculature and intra-abdominal pressure.

  1. Surgical management of stress urinary incontinence in women: safety, effectiveness and cost-utility of trans-obturator tape (TOT) versus tension-free vaginal tape (TVT) five years after a randomized surgical trial

    PubMed Central

    2011-01-01

    Background We recently completed a randomized clinical trial of two minimally invasive surgical procedures for stress urinary incontinence, the retropubic tension-free vaginal tape (TVT) versus the trans-obturator tape (TOT) procedure. At one year postoperatively, we were concerned to find that a significant number of women had tape that was palpable when a vaginal examination was undertaken. Because the risk factors for adverse outcomes of tape surgery are not clearly understood, we are unable to say whether palpable tapes will lead to vaginal erosions or whether they merge into vaginal tissue. We do not know whether patients go on to have further adverse consequences of surgery, leading to additional cost to patients and healthcare system. Our current study is a 5 year follow-up of the women who took part in our original trial. Methods/Design All 199 women who participated in our original trial will be contacted and invited to take part in the follow-up study. Consenting women will attend a clinic visit where they will have a physical examination to identify vaginal erosion or other serious adverse outcomes of surgery, undertake a standardized pad test for urinary incontinence, and complete several health-related quality of life questionnaires (15D, UDI-6, IIQ-7). Analyses will compare the outcomes for women in the TOT versus TVT groups. The cost-effectiveness of TOT versus TVT over the 5 years after surgery, will be assessed with the use of disease-specific health service administrative data and an objective health outcome measure. A cost-utility analysis may also be undertaken, based on economic modeling, data from the clinical trial and inputs obtained from published literature. Discussion This study is needed now, because TOT and TVT are among the most frequently conducted surgical procedures for stress urinary incontinence in Canada. Because stress urinary incontinence is so common, the impact of selecting an approach that causes more adverse events, or is

  2. 21 CFR 884.1660 - Transcervical endoscope (amnioscope) and accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... visualize the fetus or amniotic fluid and to sample fetal blood or amniotic fluid. This generic type of device may include obturators, instruments used through an operating channel, light sources and cables...

  3. Measurement of the “Safe Zone” and the “Dangerous Zone” for the Screw Placement on the Quadrilateral Surface in the Treatment of Pelvic and Acetabular Fractures with Stoppa Approach by Computational 3D Technology

    PubMed Central

    Zhang, Sheng; Su, Wanhan; Luo, Qiang; Chen, Bin

    2014-01-01

    This study is aimed at definition of the safe and dangerous zone for screw placement with Stoppa approach for rapid identification during operation and a new way for the studies on the “safe zone.” Pelvic CT data of 84 human subjects were recruited to reconstruct the three-dimensional (3D) models. The distances between the edges of the “safe zone,” “dangerous zone,” and specific anatomic landmarks such as the obturator canal and the pelvic brim were precisely measured, respectively. The results show that the absolute “dangerous zone” was from the pelvic brim to 3.07 cm below it and within 2.86 cm of the obturator canal, while the region 3.56 cm below the pelvic brim or 3.85 cm away from the obturator canal was the absolute “safe zone” for screw placement. The region between the absolute “safe zone” and the absolute “dangerous zone” was the relatively “dangerous zone.” As a conclusion, application of computer-assisted 3D modeling techniques aids in the precise measurement of “safe zone” and “dangerous zone” in combination with Stoppa incision. It was not recommended to place screws on the absolute dangerous zone, while, for the relatively “dangerous zone,” it depends on the individual variations in bony anatomy and the fracture type. PMID:24605328

  4. Resistance to fracture of teeth instrumented using novel EndoStar E5 rotary versus ProTaper NEXT and WaveOne file systems

    PubMed Central

    Pawar, Ajinkya M.; Pawar, Mansing G.; Thakur, Bhagyashree; Banga, Kulwinder Singh; Luke, Alexander Maniangat

    2018-01-01

    Aim: The current study compared the fracture resistance of samples instrumented by two rotary files and a reciprocating file, obturated with gutta-percha and AH Plus. Materials and Methods: A total of 60 freshly extracted mandibular premolar teeth with single roots and single canals were acquired and decoronated at or below the cementoenamel junction. The samples were randomly divided into four groups (n = 15). Group 1 control (noninstrumented/obturated), and for Groups 2–4 root canal instrumentation was done by EndoStar E5 (EE5), ProTaper NEXT (PTN), and WaveOne, respectively. Following instrumentation, the samples were obturated using gutta-percha cones and AH Plus sealer using lateral compaction. A week later, vertical load was applied to the specimen's canal in each group until fracture. The loads required for fracture were recorded and statistically analyzed. Results: The mean loads required to fracture (Newton; N) for the four groups were; 388.54 (±29.93), 310.35 (±26.05), 328.40 (±20.67), and 278.54 (±34.16). The loads exhibited highly significant difference (P < 0.0001; analysis variance). The following Tukey's post hoc test confirmed, both samples in Groups 2 and 3 required similar loads for fracture (P > 0.05) and significantly higher than Group 4 (P < 0.01). Conclusion: The samples instrumented by EE5 and PTN exhibit similar fracture resistance. PMID:29628648

  5. Sealing ability of lateral compaction and tapered single cone gutta-percha techniques in root canals prepared with stainless steel and rotary nickel titanium instruments.

    PubMed

    Koçak, Mustafa M; Darendeliler-Yaman, Sis

    2012-07-01

    The aim of this study was to evaluate the sealing ability of lateral compaction and tapered single cone gutta-percha techniques in root canals prepared with stainless steel and rotary nickel titanium root canal instruments by fluid filtration method. The root canals were prepared with stainless steel (SS) and nickel titanium (NiTi) instruments. The canals prepared with SS were obturated with lateral compaction technique using .02 tapered cones and the canals prepared with NiTi instruments were obturated with lateral compaction technique using .02 tapered cones or 06 tapered single cones. The amount of leakage was evaluated by fluid filtration model. The results were statistically analyzed with one-way ANOVA. The group prepared with NiTi instruments and filled with lateral compaction technique showed significantly less coronal leakage than the group prepared with SS instruments and filled with lateral compaction technique (p<0.05). There was no statistically difference between apical leakages of groups (p>0.05). Obturation with lateral compaction of gutta-percha provides a superior coronal seal whilst canal instrumentation with engine-driven NiTi files reduces the extent of microleakage in root canals when compared with stainless steel hand instruments. Tapered single cone technique was comparable with lateral compaction technique because of easier application. Key words:Apical leakage, coronal leakage, lateral compaction technique, single cone technique.

  6. Clinical and radiographic assessment of periapical pathology in single versus multivisit root canal treatment: An in vivo study

    PubMed Central

    Chhabra, Ajay; Dogra, Aarushi; Garg, Nisha; Bhatia, Ruhani; Sharma, Shruti; Thakur, Savita

    2017-01-01

    Objective: The objective of the study was to compare and evaluate the clinical and radiographic outcome of single- versus multivisit endodontic treatment in teeth with periapical pathology at the end of 1, 3, and 6 months. Materials and Methods: Sixty single- and multi-rooted teeth indicated for root canal treatment with periapical pathology were included in the study. The teeth were assigned randomly into two groups Group I and Group II (n = 30 each), which were further subdivided into subgroup IA, subgroup IB and subgroup IIA, subgroup IIB (n = 15 each), respectively. Group I was medicated with ApexCal paste and obturated using the standardized protocol in second visit 7–10 days later, whereas Group II was obturated at the first visit. In subgroup IA and subgroup IIA, obturation was done using Apexit Plus sealer, whereas, in subgroup IB and subgroup IIB, AH Plus sealer was used. Patients were recalled at intervals of 1, 3, and 6 months to evaluate teeth for periapical healing. Results: Kruskal–Wallis and one-way ANOVA test showed no significant difference between Groups I and II, whereas Wilcoxon signed-rank test showed improvement in all the subgroups with highly significant P value (≤0.001). Conclusion: Single-visit root canal treatment can be considered as a viable option for treatment of teeth with periapical pathology. PMID:29430096

  7. Efficacy of Different Methods for Removing Root Canal Filling Material in Retreatment - An In-vitro Study.

    PubMed

    Kasam, Swetha; Mariswamy, Annapoorna Ballagere

    2016-06-01

    Although success of endodontic therapy has significantly improved in the last few decades due to the introduction of novel materials and techniques, failures of endodontic therapy requiring re-treatment still comprise a significant percentage of patients requiring root canal treatment. To evaluate and compare the effective removal of gutta percha and sealer, amount of apical debris extrusion and time required for gutta percha removal using various endodontic files. Total 48 extracted mandibular premolars were mounted on acrylic blocks and endodontic procedure was carried out using size 40 K file and obturated using guttapercha and zinc oxide eugenol sealer. After one month storage, samples were decoronated, mounted on screw capped vials and subjected to removal of obturated material by four instruments: H files, safe sided H files, protaper universal retreatment rotary system and ultrasonic retreatment tip, grouped as 1, 2, 3, and 4 respectively. Only 2mm of obturated material from the coronal part was removed using no. 3 Gates Glidden drill, guttapercha was softened with a drop of xylene for 2 mins for each canal and retreatment was performed. The retreatment procedure was said to be complete when no visible debris were observed on the instrument flutes. The samples split into two halves and examined under stereomicroscope, photographed, assessed using AUTOCAD software and percentage of remaining filling material in coronal, middle, apical thirds of the canal was calculated in mm(2). Retreatment time was recorded in seconds and apically extruded debris was assessed by microbalance in grams for each tooth. The data was analyzed by using descriptive statistics, ANOVA and Scheffe's post hoc test through SPSS for windows (v 16.0). The ultrasonic retreatment tip had less percentage of residual guttapercha/sealer, shorter mean operating time and little apical extrusion with a significant difference (p<0.05) between the other groups. All techniques retained guttapercha

  8. Efficacy of Different Methods for Removing Root Canal Filling Material in Retreatment - An In-vitro Study

    PubMed Central

    Mariswamy, Annapoorna Ballagere

    2016-01-01

    Introduction Although success of endodontic therapy has significantly improved in the last few decades due to the introduction of novel materials and techniques, failures of endodontic therapy requiring re-treatment still comprise a significant percentage of patients requiring root canal treatment. Aim To evaluate and compare the effective removal of gutta percha and sealer, amount of apical debris extrusion and time required for gutta percha removal using various endodontic files. Materials and Methods Total 48 extracted mandibular premolars were mounted on acrylic blocks and endodontic procedure was carried out using size 40 K file and obturated using guttapercha and zinc oxide eugenol sealer. After one month storage, samples were decoronated, mounted on screw capped vials and subjected to removal of obturated material by four instruments: H files, safe sided H files, protaper universal retreatment rotary system and ultrasonic retreatment tip, grouped as 1, 2, 3, and 4 respectively. Only 2mm of obturated material from the coronal part was removed using no. 3 Gates Glidden drill, guttapercha was softened with a drop of xylene for 2 mins for each canal and retreatment was performed. The retreatment procedure was said to be complete when no visible debris were observed on the instrument flutes. The samples split into two halves and examined under stereomicroscope, photographed, assessed using AUTOCAD software and percentage of remaining filling material in coronal, middle, apical thirds of the canal was calculated in mm2. Retreatment time was recorded in seconds and apically extruded debris was assessed by microbalance in grams for each tooth. The data was analyzed by using descriptive statistics, ANOVA and Scheffe’s post hoc test through SPSS for windows (v 16.0). Results The ultrasonic retreatment tip had less percentage of residual guttapercha/sealer, shorter mean operating time and little apical extrusion with a significant difference (p<0.05) between the

  9. SU-E-T-157: Evaluation and Comparison of Doses to Pelvic Lymph Nodes and to Point B with 3D Image Guided Treatment Planning for High Dose Brachytherapy for Treatment of Cervical Cancer

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Bhandare, N.

    2014-06-01

    Purpose: To estimate and compare the doses received by the obturator, external and internal iliac lymph nodes and point Methods: CT-MR fused image sets of 15 patients obtained for each of 5 fractions of HDR brachytherapy using tandem and ring applicator, were used to generate treatment plans optimized to deliver a prescription dose to HRCTV-D90 and to minimize the doses to organs at risk (OARs). For each set of image, target volume (GTV, HRCTV) OARs (Bladder, Rectum, Sigmoid), and both left and right pelvic lymph nodes (obturator, external and internal iliac lymph nodes) were delineated. Dose-volume histograms (DVH) were generatedmore » for pelvic nodal groups (left and right obturator group, internal and external iliac chains) Per fraction DVH parameters used for dose comparison included dose to 100% volume (D100), and dose received by 2cc (D2cc), 1cc (D1cc) and 0.1 cc (D0.1cc) of nodal volume. Dose to point B was compared with each DVH parameter using 2 sided t-test. Pearson correlation were determined to examine relationship of point B dose with nodal DVH parameters. Results: FIGO clinical stage varied from 1B1 to IIIB. The median pretreatment tumor diameter measured on MRI was 4.5 cm (2.7– 6.4cm).The median dose to bilateral point B was 1.20 Gy ± 0.12 or 20% of the prescription dose. The correlation coefficients were all <0.60 for all nodal DVH parameters indicating low degree of correlation. Only 2 cc of obturator nodes was not significantly different from point B dose on t-test. Conclusion: Dose to point B does not adequately represent the dose to any specific pelvic nodal group. When using image guided 3D dose-volume optimized treatment nodal groups should be individually identified and delineated to obtain the doses received by pelvic nodes.« less

  10. Comparison of semi-extended and standard lymph node dissection in radical prostatectomy: A single-institute experience.

    PubMed

    Hoshi, Senji; Hayashi, Natuho; Kurota, Yuuta; Hoshi, Kiyotsugu; Muto, Akinori; Sugano, Osamu; Numahata, Kenji; Bilim, Vladimir; Sasagawa, Isoji; Ohta, Shoichiro

    2015-09-01

    Standard lymphadenectomy for prostate cancer is limited to the obturator lymph nodes (LNs), although the internal and external iliac LNs represent the primary landing zone for prostatic lymphatic drainage. We performed anatomically semi-extended pelvic lymph node dissection (PLND) to assess the incidence of LN metastasis in cases of clinically localized prostate cancer. A total of 730 consecutive patients underwent radical prostatectomy with either semi-extended PLND, comprising 6 selective fields, namely the external iliac, internal iliac and obturator LNs bilaterally, or standard LND (obturator LNs alone). A total of 131 patients undergoing semi-extended PLND were compared with 599 patients undergoing standard LND. The patients were stratified into high-risk [prostate-specific antigen (PSA)>20 ng/ml, Gleason score (GS)≥8], intermediate-risk (PSA 10-20 ng/ml, GS=4+3) and low-risk (PSA<10 ng/ml, GS≤3+4) subgroups. Following semi-extended LND, positive LNs were detected in 12/61 (20%) of the high-risk, 1/30 (3%) of the intermediate-risk and 0/40 (0%) of the low-risk cases. Following standard LND, positive LNs were detected in 13/182 (7%) of the high-risk, 1/164 (0.6%) of the intermediate-risk and 0/253 (0%) of the low-risk cases. In high-risk patients, the detection rate of LN metastasis was significantly higher following extended LND compared with standard LND (P<0.01). In 9 of 13 patients (69%), metastases were identified in the internal and external iliac regions, despite negative obturator LNs. There were no significant differences regarding intraoperative and postoperative complications or blood loss in the two groups. There was no lymphocele formation in patients undergoing either standard or semi-extended LND. Extended pelvic LND (PLND) is associated with a high rate of LN metastasis detection outside the fields of standard LND in cases with clinically localized prostate cancer. Therefore, LND including the internal and external iliac LNs should be

  11. Comparative evaluation of the vertical fracture resistance of endodontically treated roots filled with Gutta-percha and Resilon: a meta-analysis of in vitro studies.

    PubMed

    Tan, Minmin; Chai, Zhaowu; Sun, Chengjun; Hu, Bo; Gao, Xiang; Chen, Yunjia; Song, Jinlin

    2018-06-13

    Teeth treated endodontically are more susceptible to vertical root fracture (VRF). Some studies have suggested that obturating the root canals with Gutta-percha or Resilon can reinforce endodontically treated teeth, but a few others have presented conflicting results. These inconsistent results cannot guide clinicians in determining clinical approaches. The objective of this meta-analysis is to evaluate and compare the vertical fracture resistance of endodontically treated root canals obturated with Gutta-percha/AH plus and the Resilon system. Comprehensive literature searches were performed in the PubMed, Cochrane Library, ScienceDirect, Web of Science and Embase databases. The titles and abstracts of all of the retrieved articles were independently assessed by two authors according to predefined selection criteria. Data in the included articles were independently extracted. Statistical analyses were conducted using Review Manager 5.3 and Stata 12.0 software. The pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated for the outcome indicators. The level of statistical significance was set at p < 0.05. The Cochran Q test (I 2 test) was used to test for heterogeneity among studies. Fourteen randomized controlled in vitro trials were included in the meta-analysis. The results demonstrated that the vertical root fracture resistance of unprepared and unfilled roots was significantly higher than that of roots obturated with Gutta-percha/AH plus (SMD = - 0.69, 95% CI = - 1.34 to - 0.04, p = 0.04) or the Resilon system (SMD = - 0.54, 95% CI = - 1.07 to - 0.00, p = 0.05). The differences in fracture resistance between the roots filled with Gutta-percha/AH plus and the prepared unfilled root canals was not significant (SMD = 0.59, 95% CI = - 0.02 to 1.21, p = 0.06). Roots obturated with Resilon had higher fracture resistance than instrumented unfilled roots (SMD = 0.83, 95

  12. The Comparative Efficacy of Different Files in The Removal of Different Sealers in Simulated Root Canal Retreatment- An In-vitro Study.

    PubMed

    Kanaparthy, Aruna; Kanaparthy, Rosaiah

    2016-05-01

    Root canal treatment enjoys a high success rate all over the world and has saved billions of teeth from extraction. However, there are instances of failure, the main causes being insufficient cleaning and inadequate obturation. In such cases the most conservative treatment option would be non-surgical retreatment. It requires regaining access to the entire root canal system through removal of the original root canal filling thus permitting further cleaning and re- obturation. Removal of gutta-percha and sealer becomes a critical step to gain access to the root canal system, remove necrotic tissue debris, bacteria and infected dentin. To compare and evaluate the efficacy of manual hand Hedstrom files and two rotary retreatment file systems ProTaper Universal retreatment files and Mtwo(R) (retreatment) files in the removal of root canal filling material during root canal retreatment and the influence of the type of sealers zinc oxide eugenol and AH plus on the presence of remaining debris in the reinstrumented canals in the apical, middle and coronal third. Sixty single rooted human premolar teeth were divided into 3 Groups of 20 teeth each Group I (20 Teeth): prepared using hand K Files, Group II (20 Teeth): prepared using ProTaper rotary system and Group III (20 Teeth): prepared using Mtwo rotary system. In Groups- IA, IIA, IIIA: (10 teeth each) Obturation was done using Zinc Oxide Eugenol sealer and gutta percha. In Groups- IB, IIB, IIIB: (10 teeth each) obturation was done with AH Plus sealer and gutta percha. All the teeth were subjected to retreatment. Groups IA and IB with Hedstrom files, Groups IIA and IIB with ProTaper retreatment files and for Groups IIIA and IIIB with Mtwo retreatment Files. The roots were longitudinally split and were observed under a stereomicroscope for remaining amount of filling material on the canal walls. Statistical analysis was done using One-way ANOVA (Analysis of variance) test and Tukey HSD Test. Mtwo(R) files showed

  13. A preoperative appliance for a newborn with cleft palate.

    PubMed

    Karayazgan, Banu; Gunay, Yumushan; Gurbuzer, Bahadir; Erkan, Mustafa; Atay, Arzu

    2009-01-01

    Cleft palate is a commonly observed congenital maxillofacial defect. One of the most important problems with clefts is the interference with feeding. An affected infant cannot produce negative pressure in the oral cavity and therefore cannot move the bolus backward to the pharynx. To obtain better nutritional intake prior to surgical correction, a palatal lift obturator is recommended. In this clinical report, a modified technique of obturator fabrication is presented. The new method uses a piece of tulle, a flexible and durable material that is frequently used in theater attire. With the help of this material, the bulb part is connected to the plate as a labile piece, and this connection acts like a natural velopharyngeal extension. Additionally, because of the softer property of the silicone elastomer, the posterior pharyngeal wall is less irritated.

  14. Acute haematogenous community-acquired methicillin-resistant Staphylococcus aureus osteomyelitis in an adult: Case report and review of literature

    PubMed Central

    2012-01-01

    Background Methicillin-resistant Staphylococcus aureus (MRSA) has of late emerged as a cause of community-acquired infections among immunocompetent adults without risk factors. Skin and soft tissue infections represent the majority of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) clinical presentations, whilst invasive and life-threatening illness like necrotizing pneumonia, necrotizing fasciitis, pyomyositis, osteomyelitis and sepsis syndrome are less common. Although more widely described in the pediatric age group, the occurrence of CA-MRSA osteomyelitis in adults is an uncommonly reported entity. Case presentation We describe an invasive CA-MRSA infection in a 28 year-old previously healthy male, manifesting with bacteraemia, osteomyelitis of femur, pyomyositis and septic arthritis of the knee. Initially a preliminary diagnosis of osteosarcoma was suggested by imaging studies and patient underwent a bone biopsy. MRSA was subsequently isolated from blood cultures taken on day of admission, bone, tissue and pus cultures. Incision and drainage of abscess was performed and patient was treated with vancomycin, with fusidic acid added later. It took 6 months for the inflammatory markers to normalize, warranting 6-months of anti-MRSA therapy. Patient was a fervent deer hunter and we speculate that he acquired this infection from extensive direct contact with deer. Molecular characterization of this isolate showed that it belonged to multilocus sequence type (MLST) ST30 and exhibited the staphylococcal chromosome cassette mec (SCCmec) type IV, staphylococcus protein A (spa) type t019, accessory gene regulator (agr) type III and dru type dt10m. This strain harbored Panton-Valentine leukocidin (pvl) genes together with 3 other virulent genes; sei (enterotoxin), hlg (hemolysin) and fnbA (fibronectin binding protein). Conclusion This case study alerts physicians that beyond the most commonly encountered skin and soft tissue infections, pvl

  15. Acute haematogenous community-acquired methicillin-resistant Staphylococcus aureus osteomyelitis in an adult: case report and review of literature.

    PubMed

    Dhanoa, Amreeta; Singh, Vivek Ajit; Mansor, Azura; Yusof, Mohd Yasim; Lim, King-Ting; Thong, Kwai-Lin

    2012-10-25

    Methicillin-resistant Staphylococcus aureus (MRSA) has of late emerged as a cause of community-acquired infections among immunocompetent adults without risk factors. Skin and soft tissue infections represent the majority of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) clinical presentations, whilst invasive and life-threatening illness like necrotizing pneumonia, necrotizing fasciitis, pyomyositis, osteomyelitis and sepsis syndrome are less common. Although more widely described in the pediatric age group, the occurrence of CA-MRSA osteomyelitis in adults is an uncommonly reported entity. We describe an invasive CA-MRSA infection in a 28 year-old previously healthy male, manifesting with bacteraemia, osteomyelitis of femur, pyomyositis and septic arthritis of the knee. Initially a preliminary diagnosis of osteosarcoma was suggested by imaging studies and patient underwent a bone biopsy. MRSA was subsequently isolated from blood cultures taken on day of admission, bone, tissue and pus cultures. Incision and drainage of abscess was performed and patient was treated with vancomycin, with fusidic acid added later. It took 6 months for the inflammatory markers to normalize, warranting 6-months of anti-MRSA therapy. Patient was a fervent deer hunter and we speculate that he acquired this infection from extensive direct contact with deer.Molecular characterization of this isolate showed that it belonged to multilocus sequence type (MLST) ST30 and exhibited the staphylococcal chromosome cassette mec (SCCmec) type IV, staphylococcus protein A (spa) type t019, accessory gene regulator (agr) type III and dru type dt10m. This strain harbored Panton-Valentine leukocidin (pvl) genes together with 3 other virulent genes; sei (enterotoxin), hlg (hemolysin) and fnbA (fibronectin binding protein). This case study alerts physicians that beyond the most commonly encountered skin and soft tissue infections, pvl positive CA-MRSA can lead to invasive life

  16. An evaluation of microbial leakage after using MTAD as a final irrigation.

    PubMed

    Ghoddusi, Jamileh; Rohani, Armita; Rashed, Tahereh; Ghaziani, Pari; Akbari, Majid

    2007-02-01

    Cleaning the root canal is not possible without using proper irrigation. The aim of this in vitro study was to evaluate the effect of MTAD as a final irrigant on bacterial leakage of the root canal, and its interaction with two conventional root canal sealers. We used 132 extracted human maxillary anterior teeth. The teeth were randomly divided into three experimental groups (n=40) and two groups (n=6) of positive and negative control. In group 1, the smear layer was not removed and irrigation was performed using 5.25% NaOCl. In group 2, the smear layer was removed using EDTA, and in group 3, the smear layer was removed using MTAD according to the clinical protocol of use. The teeth in each group were obturated with gutta-percha and AH-Plus or Rickert sealer. The coronal portion of each root was placed in contact with inoculum of Streptococcus mutans in Brain Heart Infusion (BHI) culture media. Each root tip was placed in one bottle containing sterile BHI. Mean duration of bacterial penetration in groups 2 and 3 was significantly greater than in group 1, but there was no significant difference between groups 2 and 3. According to our findings, it takes longer for bacteria to penetrate when either EDTA or MTAD is used for smear layer removal. The root canals obturated with AH Plus showed significantly longer duration of resistance to bacterial penetration than canals obturated with Rickert.

  17. Comparison of Masticatory and Swallowing Functional Outcomes in Surgically and Prosthetically Rehabilitated Maxillectomy Patients.

    PubMed

    Sreeraj, R; Krishnan, Vinod; V, Manju; Thankappan, Krishnakumar

    This study compared masticatory and swallowing functional outcomes in maxillectomy patients who underwent surgical and prosthetic rehabilitation or prosthetic rehabilitation only following surgical resection. This comparative cross-sectional study involved 20 maxillectomy patients and compared their masticatory and swallowing functions following combined surgical and prosthodontic management vs an exclusively prosthodontic approach. Masticatory performance was measured by an originally modified sieve method using hydrocolloid material, and video fluoroscopic examination was employed for swallowing assessments. Masticatory performance was significantly better in the patient group treated with flaps and removable denture prostheses compared to patients treated with obturator prosthesis alone. Swallowing outcomes were comparable in both groups. Flap reconstruction followed by an obturator prosthesis seems to be a preferable option when planning for functional rehabilitation in maxillectomy patients. Further research is needed to substantiate the functional outcomes noted in this study.

  18. Piriformis muscle syndrome.

    PubMed

    Kuncewicz, Elzbieta; Gajewska, Ewa; Sobieska, Magdalena; Samborski, Włodzimierz

    2006-01-01

    Sciatica is characterized by radiating pain from the sacro-lumbar region to the buttocks and down to the lower limb. The causes of sciatica usually relate to degenerative changes in the spine and lesions to the intervertebral discs. Secondary symptomatic sciatica may by caused by metastases to the vertebra, tuberculosis of the spine, tumors located inside the vertebral channel, or entrapment of the sciatic nerve in the piriformis muscle. The piriformis syndrome is primarily caused by fall injury, but other causes are possible, including pyomyositis, dystonia musculorum deformans, and fibrosis after deep injections. Secondary causes like irritation of the sacroiliac joint or lump near the sciatic notch have been described. In the general practice the so-called posttraumatic piriformis muscle syndrome is common. The right treatment can be started following a thorough investigation into the cause of symptoms.

  19. Investigation of starting transients in the thermally choked ram accelerator

    NASA Technical Reports Server (NTRS)

    Burnham, E. A.; Hinkey, J. B.; Bruckner, A. P.

    1992-01-01

    An experimental investigation of the starting transients of the thermally choked ram accelerator is presented in this paper. Construction of a highly instrumented tube section and instrumentation inserts provide high resolution experimental pressure, luminosity, and electromagnetic data of the starting transients. Data obtained prior to and following the entrance diaphragm show detailed development of shock systems in both combustible and inert mixtures. With an evacuated launch tube, starting the diffuser is possible at any Mach number above the Kantrowitz Mach number. The detrimental effects and possible solutions of higher launch tube pressures and excessive obturator leakage (blow-by) are discussed. Ignition of a combustible mixture is demonstrated with both perforated and solid obturators. The relative advantages and disadvantages of each are discussed. Data obtained from these starting experiments enhance the understanding of the ram accelerator, as well as assist in the validation of unsteady, chemically reacting CFD codes.

  20. Comprehensive approach to functional palatomaxillary reconstruction using regional and free tissue transfer: Report of reconstructive and prosthodontic outcomes of 140 patients.

    PubMed

    Urken, Mark L; Roche, Ansley M; Kiplagat, Kimberly J; Dewey, Eliza H; Lazarus, Cathy; Likhterov, Ilya; Buchbinder, Daniel; Okay, Devin J

    2018-03-14

    Palatomaxillary defects were historically restored with a prosthetic obturator; however, advances in local and free tissue transfer has provided a viable alternative for appropriately selected patients with palatomaxillary defects. A retrospective chart review of patients who underwent palatomaxillary reconstruction by the lead author between 1998 and 2016 was conducted. Patients who were restored with a palatal obturator were excluded. One hundred forty patients were reconstructed with a total of 159 local, regional, and free flaps with a 96.7% success rate. Seventy-four patients (52.8%) underwent prosthodontic rehabilitation, with 183 implants placed and an 86% success rate. Palatomaxillary reconstruction applying a systematic approach, using a multitude of techniques, is a safe and effective way to restore patients without compromising the ability to maintain surveillance. Prosthodontic rehabilitation can be achieved in a high percentage of patients using dental implants, leading to optimal aesthetic and functional results. © 2018 Wiley Periodicals, Inc.

  1. Factors associated with postoperative pain in endodontic therapy.

    PubMed

    Sadaf, Durre; Ahmad, Muhammad Zubair

    2014-12-01

    To assess postoperative pain in endodontic therapy and its association with clinical factors such as gender, age, tooth type, pulpal diagnosis, and preoperative pain, length of obturation and sealer extrusion. Cross-Sectional study. Dental section of the Aga khan university hospital, Karachi, Pakistan from January to December 2009. One hundred and forty patients (140) requiring endodontic therapy for molar and premolar teeth were included in this study. Local Anesthesia (2% Lidocain with 1:80,000 Epinephrine) was administered. The tooth was isolated with rubber dam. Access cavity was prepared with the help of round carbide No. 2 bur. Canal preparation was completed using crown-down technique. Access was sealed with sterile dry cotton pallet and restored temporarily with double layer of Glass ionomer cement and Cavit. After one week patients were recalled and access was re-opened, obturation was done using cold lateral condensation technique. Ca(OH)(2) based sealer was used. Postoperative radiographs were taken. Patients were recalled after 24 hours and postobturation pain was recorded using Visual analogue scale (VAS).Data was obtained on a structured Performa. χ(2) test was used for statistical analysis. Pain was present in 42.9% of patients. Females more frequently experienced pain (65%) than males (35%). Preoperative pain was found to be significantly associated with postoperative pain (p value < 0.001). Obturation length was not found to be significantly associated with postoperative pain (p value 1.0). Sealer extrusion was not found to be significantly associated with postoperative (P value 0.547).

  2. High-resolution metal artifact reduction MR imaging of the lumbosacral plexus in patients with metallic implants.

    PubMed

    Ahlawat, Shivani; Stern, Steven E; Belzberg, Allan J; Fritz, Jan

    2017-07-01

    To assess the quality and accuracy of metal artifact reduction sequence (MARS) magnetic resonance imaging (MRI) for the diagnosis of lumbosacral neuropathies in patients with metallic implants in the pelvis. Twenty-two subjects with lumbosacral neuropathy following pelvic instrumentation underwent 1.5-T MARS MRI including optimized axial intermediate-weighted and STIR turbo spin echo sequences extending from L5 to the ischial tuberosity. Two readers graded the visibility of the lumbosacral trunk, sciatic, femoral, lateral femoral cutaneous, and obturator nerves and the nerve signal intensity of nerve, architecture, caliber, course, continuity, and skeletal muscle denervation. Clinical examination and electrodiagnostic studies were used as the standard of reference. Descriptive, agreement, and diagnostic performance statistics were applied. Lumbosacral plexus visibility on MARS MRI was good (4) or very good (3) in 92% of cases with 81% exact agreement and a Kendall's W coefficient of 0.811. The obturator nerve at the obturator foramen and the sciatic nerve posterior to the acetabulum had the lowest visibility, with good or very good ratings in only 61% and 77% of cases respectively. The reader agreement for nerve abnormalities on MARS MRI was excellent, ranging from 95.5 to 100%. MARS MRI achieved a sensitivity of 86%, specificity of 67%, positive predictive value of 95%, and negative predictive value of 40%, and accuracy of 83% for the detection of neuropathy. MARS MRI yields high image quality and diagnostic accuracy for the assessment of lumbosacral neuropathies in patients with metallic implants of the pelvis and hips.

  3. Preservation of palatal mucoperiosteum for oronasal separation after total maxillectomy.

    PubMed

    Molumi, Charles Paki; Dubey, Siba Prasad; Apaio, Matupi Lorenzz

    2012-01-01

    Oronasal communication occurs after total maxillectomy for advanced sinonasal cancers. This results in feeding, breathing and cosmetic impairment. Various methods have been described to close off the palatal defect from the oral cavity to improve the function of speech and deglutition. The object of this article is to describe our experience of preservation of palatal mucoperiosteum for oronasal separation. Retrospective review of clinical and operative records of 31 total maxillectomy patients where oronasal separation was achieved by the conventional technique of applying a maxillary obturator. The postoperative complications arising from the use of maxillary obturator for oronasal communication after total maxillectomy in these 31 patients were analysed. To avoid the complications encountered in these 31 patients we preserved and used the ipsilateral palatal mucoperiosteum for oronasal separation. This new technique was applied in 12 patients. The results are presented and compared. A total of 43 patients underwent total maxillectomy for advanced sinonasal tumors. In 31 patients the conventional maxillary obturator was used for oronasal separation. Among these patients, 30 had crustation of the maxillary cavity, nasal regurgitation and cheek skin retraction in 15 each, trismus in eight, infection of skin graft donor site in seven, cheek movement during respiration in five and ill-fitting prosthesis in three. In 12 patients palatal mucoperiosteum was preserved and used for oronasal separation. The complications encountered in oronasal separation by palatal prosthesis were avoided in the modified procedure. We found that oronasal separation by preservation of palatal mucoperiosteum following total maxillectomy allowed excellent palatal function, prompt rehabilitation and minimal complications without compromising the prognosis.

  4. Anatomical study of the articular branches innervated the hip and knee joint with reference to mechanism of referral pain in hip joint disease patients.

    PubMed

    Sakamoto, Junya; Manabe, Yoshitaka; Oyamada, Joichi; Kataoka, Hideki; Nakano, Jiro; Saiki, Kazunobu; Okamoto, Keishi; Tsurumoto, Toshiyuki; Okita, Minoru

    2018-07-01

    Referred pain in the anterior knee joint is the most common symptom in hip disease patients. The development of referred pain is considered to be related to dichotomizing peripheral sensory fibers. However, no gross anatomical findings identify any dichotomizing fibers innervating both the hip and knee joints. We dissected the femoral and obturator nerves in human cadavers to investigate the distribution of the articular branches in the hip and knee joints. Fourteen embalmed left lower limbs from 14 Japanese adult cadavers (five from females, nine from males, average age 73.8 ± 14.1 years) were observed macroscopically. The articular branches of the femoral and obturator nerves were dissected at the anterior margin of the groin toward the thigh region. After dissections of the articular nerves of the hip joints, the femoral and obturator nerves were exposed from proximally to distally to identify the articular nerves of the knee joints. The branching pattern of the articular branches in the hip and knee joints was recorded. In six of 14 limbs (42.9%), the femoral nerve supplied articular branches to the anteromedial aspect of both the hip and knee joints. These articular branches were derived from the same bundle of femoral nerve. These gross anatomical findings suggested that dichotomizing peripheral sensory fibers innervate the hip and knee joints and these could relate to the referred pain confirmed in the anterior knee joints of patients with hip disease. Clin. Anat. 31:705-709, 2018. © 2018 Wiley Periodicals, Inc. © 2018 Wiley Periodicals, Inc.

  5. Effect of eugenol-based endodontic sealer on the adhesion of intraradicular posts cemented after different periods.

    PubMed

    Dias, Larissa Lustosa Lima; Giovani, Alessandro Rogério; Silva Sousa, Yara Teresinha Corrêa; Vansan, Luiz Pascoal; Alfredo, Edson; Sousa-Neto, Manoel Damião; Paulino, Silvana Maria

    2009-01-01

    This study evaluated in vitro the influence of an eugenol-based sealer (EndoFill) on the retention of stainless steel prefabricated posts cemented with zinc phosphate and resin-based (Panavia F) cements after different periods of root canal obturation, using the pull-out test. Sixty upper canines were decoronated and the roots were embedded in resin blocks. The specimens were distributed into 3 groups, according to the period elapsed between canal obturation and post cementation: Group I - immediately; Group II - 72 h and Group III - 4 months. The groups were subdivided according to the type of cement used for post cementation: A - zinc phosphate and B - Panavia F. Following the experimental periods, specimens were subjected to pullout test in an Instron machine with application of tensile force at a crosshead speed of 0.5 mm/min until post dislodgement. The maximum forces required for post removal were recorded (kN) and means were subjected to statistical analysis by 2-way ANOVA and Tukey-Kramer test (alpha=0.001) There were statistically significant differences (p<0.01) between the posts cemented with zinc phosphate cement (0.2112 kN) and Panavia F (0.0501 kN). However, no statistically significant differences (p>0.05) were found between the three post cementation periods, regardless of the cement. It was concluded that the eugenol-based sealer influenced the tensile strength of the posts cemented with the resin cement, but had no influence on the time waited between root canal obturation and post space preparation/post cementation.

  6. EFFECT OF EUGENOL-BASED ENDODONTIC SEALER ON THE ADHESION OF INTRARADICULAR POSTS CEMENTED AFTER DIFFERENT PERIODS

    PubMed Central

    Dias, Larissa Lustosa Lima; Giovani, Alessandro Rogério; Sousa, Yara Teresinha Corrêa Silva; Vansan, Luiz Pascoal; Alfredo, Edson; Sousa-Neto, Manoel Damião; Paulino, Silvana Maria

    2009-01-01

    Objective: This study evaluated in vitro the influence of an eugenol-based sealer (EndoFill) on the retention of stainless steel prefabricated posts cemented with zinc phosphate and resin-based (Panavia F) cements after different periods of root canal obturation, using the pull-out test. Material and methods: Sixty upper canines were decoronated and the roots were embedded in resin blocks. The specimens were distributed into 3 groups, according to the period elapsed between canal obturation and post cementation: Group I - immediately; Group II - 72 h and Group III - 4 months. The groups were subdivided according to the type of cement used for post cementation: A - zinc phosphate and B - Panavia F. Following the experimental periods, specimens were subjected to pull- out test in an Instron machine with application of tensile force at a crosshead speed of 0.5 mm/min until post dislodgement. The maximum forces required for post removal were recorded (kN) and means were subjected to statistical analysis by 2-way ANOVA and Tukey-Kramer test (α=0.001) Results: There were statistically significant differences (p<0.01) between the posts cemented with zinc phosphate cement (0.2112 kN) and Panavia F (0.0501 kN). However, no statistically significant differences (p>0.05) were found between the three post cementation periods, regardless of the cement. Conclusions: It was concluded that the eugenol-based sealer influenced the tensile strength of the posts cemented with the resin cement, but had no influence on the time waited between root canal obturation and post space preparation/post cementation. PMID:20027430

  7. [Long-term care of Parkinson patients with deep brain stimulation].

    PubMed

    Allert, N; Barbe, M T; Timmermann, L; Coenen, V A

    2011-12-01

    For more than 15 years deep brain stimulation of the subthalamic nucleus and globus pallidus internus have become therapeutic options in advanced Parkinson's disease. The number of patients with long-term treatment is increasing steadily. This review focuses on issues of the long-term care of these Parkinson's patients, including differences of the available deep brain stimulation systems, recommendations for follow-up examinations, implications for medical diagnostics and therapies and an algorithm for symptom deterioration. Today, there is no profound evidence that deep brain stimulation prevents disease progression. However, symptomatic relief from motor symptoms is maintained during long-term follow-up and interruption of the therapy remains an exception. © Georg Thieme Verlag KG Stuttgart · New York.

  8. [Improving the speech with a prosthetic construction].

    PubMed

    Stalpers, M J; Engelen, M; van der Stappen, J A A M; Weijs, W L J; Takes, R P; van Heumen, C C M

    2016-03-01

    A 12-year-old boy had problems with his speech due to a defect in the soft palate. This defect was caused by the surgical removal of a synovial sarcoma. Testing with a nasometer revealed hypernasality above normal values. Given the size and severity of the defect in the soft palate, the possibility of improving the speech with speech therapy was limited. At a centre for special dentistry an attempt was made with a prosthetic construction to improve the performance of the palate and, in that way, the speech. This construction consisted of a denture with an obturator attached to it. With it, an effective closure of the palate could be achieved. New measurements with acoustic nasometry showed scores within the normal values. The nasality in the speech largely disappeared. The obturator is an effective and relatively easy solution for palatal insufficiency resulting from surgical resection. Intrusive reconstructive surgery can be avoided in this way.

  9. Right-sided lateralisation of ovarian cancer and right bias asymmetry for involved pelvic lymph nodes by ovarian cancer cells.

    PubMed

    Dane, Senol; Borekci, Bunyamin; Kadanali, Sedat

    2008-09-01

    The aim of the present study was to investigate if there is a possible lateralisation for ovarian cancers, to re-examine left-right asymmetry in pelvic lymph nodes distribution in patients with ovarian cancer, and to investigate if pelvic lymph node involvement by metastatic invasion of ovarian cancer cells is ipsilateral or contralateral. There was right-sided lateralisation for ovarian cancer. The numbers of external iliac and hypogastric+obturator lymph nodes were higher on the right side in patients with ovarian cancer on the right side; but they were about equal for right and left sides in patients with ovarian cancer in their left side. The numbers of external iliac and hypogastric+obturator lymph nodes involved by metastatic cancer cells were higher on the right side in patients with ovarian cancer on the both right and left sides. This case may result from the stronger cell-mediated immune activity in the left sides of humans.

  10. Jaw In A Day™ – State of the Art in Maxillary Reconstruction

    PubMed Central

    Runyan, Christopher M.; Sharma, Vishal; Staffenberg, David A.; Levine, Jamie P.; Brecht, Lawrence E.; Wexler, Leonard H.; Hirsch, David L.

    2017-01-01

    Background Reconstruction of maxillary defects following tumor extirpation is challenging because of combined aesthetic and functional roles of the maxilla. One-stage reconstruction combining osseous free flaps with immediate osseointegrated implants are becoming the standard for mandibular defects, and have similar potential for maxillary reconstruction. Methods A woman with maxillary Ewing’s sarcoma successfully treated at age nine with neoadjuvant chemotherapy, right hemi-maxillectomy and obturator prosthetic reconstruction presented for definitive reconstruction, complaining of poor obturator fit and hypernasality. Her reconstruction was computer-simulated by a multi-disciplinary team, consisting of left hemi-Lefort I advancement and right maxillary reconstruction with a free fibula flap with immediate osseointegrated implants and dental prosthesis. Results Full dental restoration, midface projection and oral fistula corrections were achieved in one operative stage using this approach. Conclusions This case demonstrates a successful approach for maxillary reconstruction using computer-planned orthognathic surgery with free fibula reconstruction and immediate osseointegrated implants with dental prosthesis. PMID:28005762

  11. Clinical and ultrasonographic correlations following three surgical anti-incontinence procedures (TOT, TVT and TVT-O).

    PubMed

    Chene, Gautier; Cotte, Benjamin; Tardieu, Anne-Sylvie; Savary, Denis; Mansoor, Aslam

    2008-08-01

    The aim of this study was to compare ultrasonographic findings on tape position, angulation and mobility following three surgical anti-incontinence procedures (trans-obturator tape (TOT), tension-free vaginal tape (TVT), tension-free vaginal tape obturator (TVT-O)) and to correlate these data with clinical signs of cures and failures and de novo voiding disorders. In this prospective study, vesicourethral static and dynamic analysis of 81 patients (30 TOT, 28 TVT, 23 TVT-O) were evaluated using introital ultrasonography. Width, position and appearance of the tape were similar in all three groups, i.e. like a "V" at rest, round angulation on Valsalva and closed angulation at maximum retaining. Moreover, closer angulation on Valsalva was associated with voiding disorders. Closer angulation at retaining was associated with de novo urge incontinence. Larger angulation of the tape at rest appeared to be significantly associated with recurrent stress incontinence. Ultrasonography could a be useful tool assessing anti-incontinence procedures and investigating post-operative voiding disorders.

  12. Infiltrative cervical lesions causing symptomatic occipital neuralgia.

    PubMed

    Sierra-Hidalgo, F; Ruíz, J; Morales-Cartagena, A; Martínez-Salio, A; Serna, J de la; Hernández-Gallego, J

    2011-10-01

    Occipital neuralgia is a well-recognized cause of posterior head and neck pain that may associate mild sensory changes in the cutaneous distribution of the occipital nerves, lacking a recognizable local structural aetiology in most cases. Atypical clinical features or an abnormal neurological examination are alerts for a potential underlying cause of pain, although cases of clinically typical occipital neuralgia as isolated manifestation of lesions of the cervical spinal cord, cervical roots, or occipital nerves have been increasingly reported. We describe two cases (one with typical and another one with atypical clinical features) of occipital neuralgia secondary to paravertebral pyomyositis and vertebral relapse of multiple myeloma in patients with relevant medical history that aroused the possibility of an underlying structural lesion. We discuss the need for cranio-cervical magnetic resonance imaging in all patients with occipital neuralgia, even when typical clinical features are present and neurological examination is completely normal.

  13. The adequate rocuronium dose required for complete block of the adductor muscles of the thigh.

    PubMed

    Fujimoto, M; Kawano, K; Yamamoto, T

    2018-03-01

    Rocuronium can prevent the obturator jerk during transurethral resection of bladder tumors. We investigated the adequate rocuronium dose required for complete block of the thigh adductor muscles, and its correlation with individual responses of the adductor pollicis muscle to rocuronium. Eleven patients scheduled for transurethral resection of bladder tumors under general anesthesia were investigated. After general anesthesia induction, neuromuscular monitoring of the adductor pollicis muscle and ultrasonography-guided stimulation of the obturator nerve was commenced. Rocuronium, 0.15 mg/kg, was repeatedly administered intravenously. The adequate rocuronium dose required for complete block of the thigh muscles, defined as the cumulative dose of rocuronium administered until that time, and its correlation with the first twitch response of the adductor pollicis muscle on train-of-four stimulation after initial rocuronium administration was analyzed. The rocuronium dose found adequate for complete block of the thigh muscles was 0.30 mg/kg in seven patients and 0.45 mg/kg in the remaining four patients, which did not correlate with the first twitch response. At the time of complete block of the thigh muscles, the neuromuscular blockade level of the adductor pollicis muscle varied greatly, although the level was never more profound than a post-tetanic count of 1. Although the response of the adductor pollicis muscle to rocuronium cannot be used to determine the adequate rocuronium dose required for complete block of the thigh muscles, intense blockade, with maintenance of post-tetanic count at ≤ 1 in the adductor pollicis muscle is essential to prevent the obturator jerk. © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  14. Comparative Analysis of Calcium Silicate-based Root Filling Materials Using an Open Apex Model.

    PubMed

    Tran, Dennis; He, Jianing; Glickman, Gerald N; Woodmansey, Karl F

    2016-04-01

    Many new calcium silicate-based root filling materials have emerged in the market; however, their performance in the orthograde obturation of an open apex has not been evaluated. The purpose of this study was to compare the marginal adaptation of ProRoot MTA (Dentsply Tulsa Dental, Tulsa, OK), NeoMTA Plus (Avalon Biomed Inc, Bradenton, FL), and Endosequence BC RRM-Fast Set Putty (BC RRM-FS; Brasseler USA, Savannah, GA) after orthograde placement in roots with open apices. Palatal roots of maxillary molars were instrumented to create divergent open apices and divided into 4 groups for orthograde obturation: ProRoot MTA, NeoMTA Plus, BC RRM-FS, and BC RRM-FS + BC Sealer. Using a scanning electron microscope, the quality of material adaptation at the anatomic apex was evaluated by 5 blinded examiners; 3 mm of the root end was sectioned, and gap distance was measured at the material-dentin interface. Statistical analyses were performed using the Kruskal-Wallis test. There were no significant differences in marginal adaptation among the 4 groups at the level of the anatomic apex (P = .175). BC RRM-FS + BC Sealer had a significantly smaller gap size after 3-mm root end resection compared with the other 3 groups (P < .01). No differences were observed among the other 3 materials. All materials showed comparable marginal adaptation at the anatomic apex when used for orthograde obturation of open apices. Application of BC Sealer before the delivery of BC RRM-FS Putty enhanced the quality of adaptation coronal to the apex. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  15. Postoperative pain after endodontic retreatment: single- versus two-visit treatment.

    PubMed

    Yoldas, Oguz; Topuz, Aysin; Isçi, A Sehnaz; Oztunc, Haluk

    2004-10-01

    The purpose of this clinical study was to determine the effect of 1- or 2-visit root canal treatment on the postoperative pain in the retreatment cases. Two hundred eighteen cases that required retreatment were included in the study. Obturated and unfilled canal space and the status of periapical tissues were evaluated according to the PAI index. The patients were subcategorized in regard to the presence or the absence of preoperative pain. Approximately half of each category was treated in 1 appointment. After removing the previous root canal obturation materials and biomechanic preparation of root canals, the teeth in the 1-visit group were obturated at the first appointment by using AH 26 sealer and laterally compacted gutta-percha, and those in the 2-visit group were medicated with calcium hydroxide-chlorhexidine combination and then closed with a temporary filling material. One week after the initial appointment, patients were asked about the occurrence of postoperative pain. The level of discomfort was rated as no pain, mild pain, moderate pain, or severe pain (flare-up). Data were statistically analyzed using the chi-squared and Fischer exact tests. Eight patients from the 1-visit group and 2 patients from the 2-visit group had flare-ups. There was a statistical difference between the groups (P <.05). Two-visit root canal treatment was more effective in completely eliminating pain than 1-visit treatment of previously symptomatic teeth (P <.05). Two-visit endodontic treatment with intracanal medication was found to be effective in reducing postoperative pain of previously symptomatic teeth and decreased the number of flare-ups in all retreatment cases.

  16. Preservation of the articular capsule and short lateral rotator in direct anterior approach to total hip arthroplasty.

    PubMed

    Kanda, Akio; Kaneko, Kazuo; Obayashi, Osamu; Mogami, Atsuhiko; Morohashi, Itaru

    2018-03-09

    In total hip arthroplasty via a direct anterior approach, the femur must be elevated at the time of femoral implant placement. For adequate elevation, division of the posterior soft tissues is necessary. However, if we damage and separate the posterior muscle tissue, we lose the benefits of the intermuscular approach. Furthermore, damage to the posterior soft tissue can result in posterior dislocation. We investigate that protecting the posterior soft tissue increases the joint stability in the early postoperative period and results in a lower dislocation rate. We evaluated muscle strength recovery by measuring the maximum width of the internal obturator muscle on CT images (GE-Healthcare Discovery CT 750HD). We compared the maximum width of the muscle belly preoperatively versus 10 days and 6 months postoperatively. As clinical evaluations, we also investigated the range of motion of the hip joint, hip joint function based on the Japanese Orthopaedic Association hip score (JOA score), and the dislocation rate 6 months after surgery. The width of the internal obturator muscle increased significantly from 15.1 ± 3.1 mm before surgery to 16.4 ± 2.8 mm 6 months after surgery. The JOA score improved significantly from 50.8 ± 15.1 points to 95.6 ± 7.6 points. No dislocations occurred in this study. We cut only the posterosuperior articular capsule and protected the internal obturator muscle to preserve muscle strength. We repaired the entire posterosuperior and anterior articular capsule. These treatments increase joint stability in the early postoperative period, thus reducing the dislocation rate. Therapeutic, Level IV.

  17. Comparison of 2 fluid ingress/egress systems for canine stifle arthroscopy using computed tomography.

    PubMed

    Warnock, Jennifer J; Nemanic, Sarah; O'Donnell, Matthew D; Wiest, Jason E

    2014-11-01

    To evaluate volume of extra-articular fluid egress and complications associated with 2 fluid ingress/egress techniques for stifle arthroscopy. Ex vivo study. Canine cadavers (n = 14). Four cadavers (8 stifles) were used to validate 3D computed tomographic (CT) methods to quantify stifle joint intra- and extra-articular volumes of iodinated contrast medium. Ten canine cadavers (20 stifles) had preoperative CT, followed by stifle arthroscopy using a 10% solution of iodinated contrast enhanced ingress fluid delivered by pressure bag (2PB) or by arthroscopic peristaltic pump (3FP). All 3FP limbs had an additional fluid egress portal placed by cannula and obturator. Arthroscopy was limited to 20 minutes/joint. The volume of the contrast medium egress into the soft tissues was measured on postoperative 3D CT reconstructed images. Mean percentage of total ingress fluids administered that remained in the joint and extra-articular tissues postoperatively was 8.8 ± 1.2% in 3FP and 33.2 ± 8% in 2PB (P = .014). Two 3FP joints had 4-5 mm egress obturator tracks on the proximal medial trochlear ridge. Two 2PB joints had severe joint collapse from extracapsular fluid precluding further examination. Intermittent visual blurring by joint fluid mixing or fat pad fragmentation/dissolution was noted in 2PB joints. A superior technique was not identified: 2PB had greater egress fluid tissue accumulation, whereas 3FP had better viewing of intra-articular structures with less tissue egress fluid accumulation; however, cartilage damage was induced with the egress obturator. © Copyright 2014 by The American College of Veterinary Surgeons.

  18. Comparison of the efficacy and feasibility of laser enucleation of bladder tumor versus transurethral resection of bladder tumor: a meta-analysis.

    PubMed

    Yang, Huan; Wang, Ning; Han, Shanfu; Male, Musa; Zhao, Chenming; Yao, Daqiang; Chen, Zhiqiang

    2017-12-01

    The transurethral resection of bladder tumor (TURBT) remains the most widely used method in the surgical treatment of the non-muscle invasive bladder tumor (NMIBT). Despite its popularity, the laser technique has been widely used in urology as an alternative, via the application of transurethral laser enucleation of bladder tumor. The aim of the present study was to compare the efficacy and feasibility between transurethral laser enucleation and transurethral resection of bladder tumor. A systematic search of the following databases was conducted: PubMed, Wed of Science, Cochrane Library, EMBASE, Google scholar, and Medline. The search included studies up to the 1st of January 2017. The outcomes of interest that were used in order to assess the two techniques included operation time, catheterization time, hospitalization time, obturator nerve reflex, bladder perforation, bladder irritation, 24-month-recurrence rate, and the postoperative adjuvant intravesical chemotherapy. A total of 13 trials with 2012 participants were included, of which 975 and 1037 underwent transurethral laser enucleation and transurethral resection of bladder tumor, respectively. No significant difference was noted in the operation time between the two groups, although significant differences were reported for the variables catheterization time, hospitalization time, obturator nerve reflex, bladder perforation, bladder irritation, and 24-month-recurrence rate. In the mitomycin and epirubicin subgroups, no significant differences were observed in the laser enucleation and TURBT methods with regard to the 24-month-recurrence rate. The laser enucleation was superior to TURBT with regard to the parameters obturator nerve reflex, bladder perforation, catheterization time, hospitalization time, and 24-month-recurrence rate. Moreover, laser enucleation can offer a more accurate result of the tumor's pathological stage and grade.

  19. Locoregional recurrence following maxillectomy: implications for microvascular reconstruction.

    PubMed

    Likhterov, Ilya; Fritz, Michael A; El-Sayed, Ivan H; Rahul Seth; Rayess, Hani M; Knott, P Daniel

    2017-11-01

    Reconstruction of maxillectomy defects offers potential quality-of-life improvement, although cavity coverage may impact surveillance of recurrent malignancy. We describe the pattern of postmaxillectomy locoregional recurrence. Retrospective review. Patients from 2001 to 2011 at the University of California, San Francisco and the Cleveland Clinic. Among 75 patients with malignancy resulting in partial or total maxillectomy, 57 were treated with obturators and 18 underwent reconstructive surgery. Disease recurrence occurred primarily locally (19 of 22 cases of recurrence, 25% of the cohort) at a mean of 17 months postoperatively. Recurrence was associated with T4 disease, positive margins, and surveillance imaging. Four (5.3%) patients required flap mobilization/obturator removal to obtain biopsy. Salvage surgery was attempted in 13 of the 19 cases with recurrent disease (68%) and was successful in six (46%) patients. Of these, five patients initially had Brown type 1 or type 2 defects. The free flap had to be revised in one (1.3%) patient to achieve successful salvage. Maxillectomy provides good long-term locoregional oncologic control, with cure being correlated to disease stage at presentation and negative margins after initial surgery. Patients with recurrent disease whose initial resection resulted in a Brown class 3 defect or greater were rarely successfully salvaged. Surveillance is best performed with a combination of physical exam and imaging. Obturator removal/flap mobilization rarely impedes the diagnosis of recurrent disease, and either modality should be offered to appropriate patients in the primary setting if significant quality-of-life improvement is likely. 4. Laryngoscope, 127:2534-2538, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  20. [Deep brain stimulation in the treatment of movement disorders].

    PubMed

    Goto, Satoshi

    2007-11-01

    The introduction of deep brain stimulation (DBS) was a historical step forward for the treatment of advanced and medically intractable movement disorders that include Parkinson's disease, dystonias, essential tremor, and Holmes' tremor. DBS is able to modulate the target region electrically in a reversible and adjustable fashion in contrast to an irreversible and destructive lesioning procedure. In the treatment of movement disorders, the potential targets are the thalamic ventral intermediate nucleus (Vim), globus pallidus internus (GPi), subthalamic nucleus (STN), pedunculopontine nucleus (PPN), and thalamic Vo-complex nucleus. With the development of DBS technology and stereotactic neurosurgical techniques, its therapeutic efficacy has been increased while reducing surgical complications. DBS has become an established therapy for disabling movement disorders and is currently being used to treat neuropsychiatric disorders.

  1. Comparison of the efficacy of tension-free vaginal tape obturator (TVT-O) and single-incision tension-free vaginal tape (Ajust™) in the treatment of female stress urinary incontinence: a 1-year follow-up randomized trial.

    PubMed

    Masata, Jaromir; Svabik, Kamil; Zvara, Karel; Hubka, Petr; Toman, Ales; Martan, Alois

    2016-10-01

    The aim of this study was to compare the efficacy of the tension-free vaginal tape obturator (TVT-O) and single-incision tension-free vaginal tape (Ajust™) in the treatment of stress urinary incontinence in a randomized two-arm study with a 1-year follow-up. This single-centre randomized trial compared the objective and subjective cure rates of TVT-O and Ajust using objective criteria (cough test) and subjective criteria (International Consultation on Incontinence Questionnaire short form, ICIQ-UI SF). The objective cure rate was defined as the number of patients with a negative cough stress test. Subjective cure was defined as no stress leakage of urine after surgery based on the ICIQ-UI SF. The primary outcome was to establish differences in objective and subjective cure rates between the TVT-O and Ajust groups. We also compared postoperative pain profiles using a visual analogue scale (VAS), improvement in quality of life using the ICIQ- UI SF and the Incontinence Quality of Life questionnaire, and overall satisfaction with the surgical procedure using a VAS and a five-item Likert scale. Inclusion criteria were age over 18 years, signed informed consent, and urodynamic stress urinary incontinence. Following a power calculation, 50 patients were enrolled into each group (Ajust and TVT-O). The mean follow-up after surgery was 445 days (SD 157.6 days) in the TVT-O group and 451.8 days (SD 127.6 days) in the Ajust group (p = 76.6 %). At 1 year, 47 patients were evaluated in the TVT-O group and 49 in the Ajust group. No differences in subjective cure rates or objective cure rates were observed. In the Ajust and TVT-O groups, the rates for no subjective stress leakage were 89.8 % and 91.5 %, respectively (p = 1.0, OR 1.22, 95 % CI 0.24 - 6.58), and the rates for a negative stress test were 89.8 % and 87.2 %, respectively (p = 0.76, OR 0.77, 95 % CI 0.17 - 3.32). In the Ajust group two patients reported de novo pain during sexual

  2. Penile artery shunt syndrome: a novel cause of erectile dysfunction after penile revascularization surgery.

    PubMed

    Pavlinec, Jonathan G; Hakky, Tariq S; Yang, Christopher; Massis, Kamal; Munarriz, Ricardo; Carrion, Rafael E

    2014-09-01

    Penile revascularization is a surgical treatment option for erectile dysfunction (ED) in healthy individuals due to a focal arterial occlusion in the absence of generalized vascular disease. Most described failures have been attributed to graft stenosis or disruption of the anastomosis. We report a novel phenomenon called Penile Artery Shunt Syndrome that contributed to persistent ED in a patient after penile microvascular arterial bypass surgery. A 26-year-old man presented for evaluation of long-standing ED, which was attributed to trauma sustained 12 years earlier. He had difficulty obtaining and maintaining erections despite oral pharmacotherapy. Clinical data related to the case were studied, analyzed, and reviewed with urologic and radiologic specialists at multiple centers that collaborated in the care of this patient. Penile duplex ultrasound peak systolic velocities and five-item International Index for Erectile Function questionnaire scores were the main outcome measures. Initial diagnostic workup of the patient confirmed severe insufficiency of the left cavernosal artery, with no evidence of venous leak. The patient underwent penile microvascular arterial bypass surgery with anastomosis of the left inferior epigastric artery to the left dorsal penile artery. The patient had persistence of severe ED despite patent anastomosis by penile duplex ultrasound. Subsequent arteriography revealed an arterial shunt due to an aberrant obturator artery arising from the donor inferior epigastric artery. The patient underwent embolization of the aberrant obturator artery, with resolution of the shunt and marked improvement in erectile function. The presence of an aberrant obturator artery arising from the inferior epigastric artery may predispose to persistent ED after revascularization due to the creation of a shunt phenomenon. Pelvic arteriography may be useful in identifying anomalous anatomic considerations prior to penile revascularization and to evaluate patients

  3. Utilizing the GentleWave® System for Debridement of Undetected Apical Anatomy.

    PubMed

    Ford, Michael W

    2018-03-01

    Debriding and disinfecting complex anatomies within the root canal system pose a major challenge during root canal therapy. Even with current chemomechanical techniques, debris and bacterial remnants are commonly left behind, which are generally believed to increase the risk of endodontic failure. This case details the use of a new technique to debride complex apical anatomy in a maxillary molar. A 48-year-old female presented to the clinic with a chief complaint of increasing pain in her tooth. Clinical examination of the right first maxillary molar (#3) revealed moderate sensitivity to percussion and mild sensitivity to palpation. A pulpal diagnosis of symptomatic irreversible pulpitis and a periapi-cal diagnosis of symptomatic apical periodontitis were made. Mechanical instrumentation was performed using rotary file size #25/.04 for the mesiobuccal and distobuccal canals and size #25/.06 for the palatal canal to create a fluid path and enable obturation of the root canal system following the GentleWave® Procedure. The GentleWave Procedure was completed using Multisonic Ultracleaning™ for complete debridement and disinfection of the root canal system. The tooth was obturated using a warm vertical continuous wave obturation technique. Postoperative radiographs revealed complex anatomy within the apical third that was undetected both during pre-operative radiography and mechanical instrumentation. The palatal canal exhibited a complex apical delta with multiple points of exit, and the mesiobuccal canal revealed an undetected lateral canal within the apical third that had a separate and distinct egress. Conclusion and clinical significance: It is important for the clinician to debride and disinfect complex anatomy within the root canal system to reduce the risk of endodontic failure. This case report highlights the clinical significance of utilizing the GentleWave Procedure for detecting complex apical anatomy during endodontic therapy.

  4. Implant-prosthetic rehabilitation of hemimaxillectomy defects with CAD/CAM suprastructures.

    PubMed

    Mertens, Christian; de San Jose Gonzalez, Jose; Freudlsperger, Christian; Bodem, Jens; Krisam, Johannes; Hoffmann, Jürgen; Engel, Michael

    2016-11-01

    Patients with hemimaxillectomy defects after tumor surgery can alternatively be rehabilitated with dental obturators or microvascular flaps. When general medical or oncologic conditions do not permit microvascular surgery, dental obturators are the only solution, yet retention for edentulous patients is often poor. The aim of this study was to evaluate whether CAD/CAM suprastructures supported by implants placed in both residual alveolar ridges and contralateral zygomatic bone could enhance obturator stability and improve functional outcomes. Five edentulous patients with class IId hemimaxillectomy defects were included in the study. Implant-retained reconstructions were planned to support cross-arch CAD/CAM milled suprastructures. Patients had to rate their restorations on a 100-mm visual analogue scale before and after treatment. Additional evaluation was performed using the Oral Health Impact Profile (OHIP-EDENT) questionnaire. In the 5 patients, 7 conventional implants were placed in the remaining zygomatic bone and 16 in the remaining contralateral alveolar ridge. After 4 months of submerged healing, CAD/CAM suprastructures were fabricated that connected all respective implants with each other. All of the prosthetic restorations were removable and bar-retained. They all achieved good defect closure and showed significant improvements concerning general satisfaction (p = 0.0343), stability (p < 0.0001), ability to chew (p = 0.0077), esthetics (p = 0.0173) and foreign body sensation (p = 0.0207). According to the OHIP-EDENT questionnaire (p = 0.0036) the improvements were significant. During the observation period of 29.4 months, no mechanical or biological complications occurred. The CAD/CAM suprastructures improved retention in all treated patients without any complications. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  5. Irrigation in endodontic treatment.

    PubMed

    Basrani, Bettina

    2011-01-01

    The primary endodontic treatment goal is to optimize root canal disinfection and to prevent reinfection. Successful root canal therapy relies on the combination of proper instrumentation, irrigation, and obturation of the root canal system. In this review of the literature, various irrigants and the interactions between irrigants are discussed and new delivery systems are introduced.

  6. Prosthetic Management of Hard Palate Perforation in a Child with Acute Lymphoblastic Leukemia

    PubMed Central

    Chouksey, Gunjan C; Dholam, Kanchan P

    2017-01-01

    Palatal perforation is an uncommon complication seen in children with acute lymphoblastic leukemia undergoing chemotherapy. This may impact basic functions, such as speech, swallowing, chewing, affecting the quality of life (QOL). Prosthetic rehabilitation of the palatal perforation with obturator can optimally restore function, thereby improving and enhancing the QOL of these patients. PMID:28900336

  7. [Application of hand-use ProTaper instruments in endodontic treatment of molar canals].

    PubMed

    Ma, Sui-qi; Xie, Qian; Zhou, Yin-feng

    2010-07-01

    To evaluate the application of hand-use ProTaper instruments in endodontic treatment of molar canals. A total of 203 permanent molars were randomly divided into the experimental group (99 molars) and control group (104 molars) prepared by hand-use ProTaper instruments and standard stainless steel K-file, respectively. The molars in the two groups were obturated by cold lateral condensation technique. The root canal preparation and obturation were evaluated by radiograph, and the working time of preparation and post-operative emergencies were analyzed. The preparation time in the experimental group was obviously shorter than that in the control group (P<0.01). The rate of satisfactory effect was significantly higher in the experimental group than in the control group (P<0.01), and the rate of post-operative emergencies was significantly lower in the experimental group (P<0.01). The application of hand-use ProTaper instruments may improve the effect of root canal treatment of the molars and shorten the working time and reduce the post-operative emergencies.

  8. Pterygoid implants for maxillofacial rehabilitation of a patient with a bilateral maxillectomy defect.

    PubMed

    Bidra, Avinash S; May, George W; Tharp, Greggory E; Chambers, Mark S

    2013-02-01

    Bilateral maxillectomy is known to have serious esthetic and functional consequences. The retention and support of a maxillary obturator prosthesis in these patients is particularly challenging. Surgical placement of implants is also challenging because of the lack of available bone. Therefore, implant placement into remote sites such as zygoma has been advocated. Very few articles in the literature have discussed the use of pterygoid/pterygomaxillary implants in patients undergoing maxillectomy. This case report describes the maxillofacial rehabilitation of an elderly man who underwent a bilateral subtotal maxillectomy due to basaloid squamous cell carcinoma of the hard palate. After initial healing, the patient had a pterygoid implant placed on each side of the oral cavity. Zygomatic implants were also attempted, but they failed to osseointegrate. Both pterygoid implants showed successful osseointegration. These 2 implants significantly helped to retain a hollow maxillary obturator prosthesis that aided in improved swallowing, speech, and esthetics. To the authors' knowledge, this is the first report in the literature that describes usage of pterygoid implants for rehabilitation of a patient undergoing bilateral maxillectomy.

  9. Non-surgical root canal treatment of Dens invaginatus: reports of three cases.

    PubMed

    Cengiz, Sevi Burcak; Korasli, Deniz; Ziraman, Fatmagul; Orhan, Kaan

    2006-02-01

    Dens invaginatus is a rare developmental malformation of teeth showing a deep infolding of enamel and dentine which may extend deep into the root. To date, conventional root canal therapy, endodontic surgery and extraction have been reported as treatment modalities, when the pulpo-dentinal complex of such teeth is affected. In the present report, non-surgical endodontic treatment of three maxillary lateral incisors with invaginatus (DI) is discussed. The Tri Auto ZX rotary system was used for shaping the root canals of two affected teeth and the Profile system was used in the third. Teeth with periradicular lesions received calcium hydroxide as an interim therapy. Two teeth were obturated with gutta percha points and AH Plus sealer using cold lateral compaction. In the third case, obturation was accomplished using a coated carrier system (Thermafil) due to the specific shape of the root canal system. Twelve months postoperatively all teeth were asymptomatic with resolution of the periapical radiolucency on two affected teeth, as confirmed radiographically. Healing was achieved without any need for further surgical intervention.

  10. Stress distributions in internal resorption cavities restored with different materials at different root levels: A finite element analysis study.

    PubMed

    Aslan, Tuğrul; Üstün, Yakup; Esim, Emir

    2018-04-15

    The aim of this study was to evaluate the stresses within simulated roots with internal resorption cavities at the apical, middle and coronal root levels, after obturation with gutta-percha and/or MTA utilising finite element analysis (FEA). Mandibular premolar teeth with internal resorption cavities at different root levels were modelled. Models were restored with gutta-percha and/or MTA. An oblique force of 300 N was applied and stress evaluations were carried out. In the MTA-filled resorption models, the stresses were distributed more homogeneously than the gutta-percha filled models, and the stress concentrations were lower in the remaining dentinal tissues. If the whole root is considered, the fully gutta-percha-filled models generated the highest stress values. Differences between the fully MTA-filled models and hybrid techniques were present only in the apical resorption models. Both the MTA and combination of MTA and gutta-percha can be suggested for use in clinical practice, in cases of internal root resorption cavity obturation. © 2018 Australian Society of Endodontology Inc.

  11. Foreign Body in the Oral Cavity Mimicking a Benign Connective Tissue Tumor

    PubMed Central

    Ram, Saravanan; Sedghizadeh, Parish P.

    2013-01-01

    Foreign bodies may be embedded in the oral cavity either by traumatic injury or iatrogenically. The commonly encountered iatrogenic foreign bodies are restorative materials like amalgam, obturation materials, broken instruments, needles, and impression materials. This paper describes an asymptomatic presentation of a foreign body in the oral mucosa which clinically appeared like a benign connective tissue tumor. PMID:23634307

  12. Foreign body in the oral cavity mimicking a benign connective tissue tumor.

    PubMed

    Puliyel, Divya; Balouch, Amir; Ram, Saravanan; Sedghizadeh, Parish P

    2013-01-01

    Foreign bodies may be embedded in the oral cavity either by traumatic injury or iatrogenically. The commonly encountered iatrogenic foreign bodies are restorative materials like amalgam, obturation materials, broken instruments, needles, and impression materials. This paper describes an asymptomatic presentation of a foreign body in the oral mucosa which clinically appeared like a benign connective tissue tumor.

  13. Orofacial rehabilitation with zygomatic implants: CAD-CAM bar and magnets for patients with nasal cancer after rhinectomy and partial maxillectomy.

    PubMed

    King, Elizabeth; Abbott, Carl; Dovgalski, Lawrence; Owens, James

    2017-06-01

    Nasal carcinoma extending into the premaxilla requires radical surgical excision including rhinectomy and partial maxillectomy. Rehabilitation is complex and involves the use of removable prostheses. Three patients treated with zygomatic implants and custom-milled bars to retain an obturator and nasal prosthesis are presented. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  14. Incidence of flare-ups and evaluation of quality after retreatment of resorcinol-formaldehyde resin ("Russian Red Cement") endodontic therapy.

    PubMed

    Gound, Tom G; Marx, David; Schwandt, Nathan A

    2003-10-01

    The purpose of this retrospective study was to evaluate the quality of treatment and incidence of flare-ups when teeth with resorcinol-formaldehyde resin are retreated in a postgraduate endodontic clinic. Fifty-eight cases were included in this study. Obturated and unfilled canal space was measured on radiographs. Forty-eight percent of the total canal space was filled before retreatment; 90% was filled after retreatment. After retreatment, obturations were rated as optimal in 59%, improved in 33%, unchanged in 6%, and worse in 2%. Seven patients (12%) had postretreatment flare-ups. Data were statistically analyzed using the Cochran-Armitage Test for Discrete Variables. No statistical difference in the incidence of flare-ups was found in teeth that before treatment had more than half the canal space filled compared to teeth with less than half, cases with pre-existing periradicular radiolucencies compared to cases with normal periradicular appearance, symptomatic cases compared to asymptomatic cases, or cases with optimal fillings after retreatment compared to less than optimal cases. It was concluded that teeth with resorcinol-formaldehyde fillings might be retreated with a good prognosis for improving the radiographic quality, but a higher than normal incidence of flare-ups may occur.

  15. Effect of different root canal sealers on fracture strength of simulated immature roots.

    PubMed

    Ulusoy, Özgür İlke Atasoy; Nayır, Yelda; Darendeliler-Yaman, Sis

    2011-10-01

    The objective of this study was to compare the effects of different root canal sealers on fracture resistance of simulated immature teeth. One hundred eight roots were divided into 9 groups. The roots were instrumented except the negative controls. Four millimeters of mineral trioxide aggregate (MTA) barriers were placed apically. The roots were backfilled as follows: group 1, AH Plus+gutta-percha; group 2, EndoREZ+gutta-percha; group 3, EndoREZ+Resilon; group 4, Hybrid Root SEAL+gutta-percha; group 5, Hybrid Root SEAL+Resilon; group 6, iRootSP+gutta-percha; group 7, iRootSP+Resilon; group 8, No obturation other than MTA barrier; group 9, No instrumentation, no obturation. A compressive loading was applied at a speed of 1 mm/min. Data were compared with ANOVA and Duncan tests. Group 5 showed the highest resistance to fracture. The fracture values of group 3 were lower than those of the other experimental groups. Hybrid Root SEAL and iRootSP reinforce the simulated immature roots against fracture when used with either gutta-percha or Resilon. Copyright © 2011 Mosby, Inc. All rights reserved.

  16. Upper gastrointestinal ectopic variceal bleeding treated with various endoscopic modalities: Case reports and literature review.

    PubMed

    Park, Sang Woo; Cho, Eunae; Jun, Chung Hwan; Choi, Sung Kyu; Kim, Hyun Soo; Park, Chang Hwan; Rew, Jong Sun; Cho, Sung Bum; Kim, Hee Joon; Han, Mingui; Cho, Kyu Man

    2017-01-01

    Ectopic variceal bleeding is a rare (2-5%) but fatal gastrointestinal bleed in patients with portal hypertension. Patients with ectopic variceal bleeding manifest melena, hematochezia, or hematemesis, which require urgent managements. Definitive therapeutic modalities of ectopic varices are not yet standardized because of low incidence. Various therapeutic modalities have been applied on the basis of the experiences of experts or availability of facilities, with varying results. We have encountered eight cases of gastrointestinal ectopic variceal bleeding in five patients in the last five years. All patients were diagnosed with liver cirrhosis presenting melena or hematemesis. All patients were treated with various endoscopic modalities (endoscopic variceal obturation [EVO] with cyanoacrylate in five cases, endoscopic variceal band ligation (EVL) in two cases, hemoclipping in one case). Satisfactory hemostasis was achieved without radiologic interventions in all cases. EVO and EVL each caused one case of portal biliopathy, and EVL induced ulcer bleeding in one case. EVO generally accomplished better results of variceal obturations than EVL or hemoclipping, without serious adverse events. EVO may be an effective modality for control of ectopic variceal bleeding without radiologic intervention or surgery.

  17. Transillumination for needle localization in the larynx.

    PubMed

    Hoffman, Henry T; Dailey, Seth H; Bock, Jonathan M; Thibeault, Susan L; McCulloch, Timothy M

    2015-10-01

    Transillumination through laryngeal soft tissue may be used to direct percutaneous transcricothyroid membrane subepithelial needle placement in the larynx. Cadaver simulation (canine and human). Lighted devices, including sialendoscopes and fiberoptic cables, were tested as transilluminating obturators in trocars and needles through multiple studies to identify appropriate illumination, monitoring, and equipment for successful localization of needle/trocar tips placed within laryngeal tissue. Lighted 250-micron fiberoptic cables within 23-gauge needles were successfully placed percutaneously through the cricothyroid membrane and maneuvered submucosally into Reinke's space, the midlateral vocal fold, and through the thyroarytenoid gap with monitoring via flexible transnasal laryngoscopy. Technical adaptations in the course of study permitted successful simulation of clinical use in full cadaver study for accurate injection laryngoplasty, confirmed by laryngeal dissection following collagen injection. Small caliber fiberoptic cables are useful as transilluminating obturators to accurately direct needle position within laryngeal tissue. Clinical application of this new technique is anticipated to improve the accuracy of percutaneous needle localization in the larynx, as well as to assist in directed instrumentation of the larynx from an external approach. N/A. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  18. Initiation of combustion in the thermally choked ram accelerator

    NASA Technical Reports Server (NTRS)

    Bruckner, A. P.; Burnham, E. A.; Knowlen, C.; Hertzberg, A.; Bogdanoff, D. W.

    1992-01-01

    The methodology for initiating stable combustion in a ram accelerator operating in the thermally choked mode is presented in this paper. The ram accelerator is a high velocity ramjet-in-tube projectile launcher whose principle of operation is similar to that of an airbreathing ramjet. The subcaliber projectile travels supersonically through a stationary tube filled with a premixed combustible gas mixture. In the thermally choked propulsion mode subsonic combustion takes place behind the base of the projectile and leads to thermal choking, which stabilizes a normal shock system on the projectile, thus producing forward thrust. Projectiles with masses in the 45-90 g range have been accelerated to velocities up to 2650 m/sec in a 38 mm bore, 16 m long accelerator tube. Operation of the ram accelerator is started by injecting the projectile into the accelerator tube at velocities in the 700 - 1300 m/sec range by means of a conventional gas gun. A specially designed obturator, which seals the bore of the gun during this initial acceleration, enters the ram accelerator together with the projectile. The interaction of the obturator with the propellant gas ignites the gas mixture and establishes stable combustion behind the projectile.

  19. Endodontic retreatment of dens invaginatus presenting with gutta-percha overfilling at the attached gingiva and chronic apical periodontitis: unusual clinical report.

    PubMed

    Robazza, Carlos Roberto Colombo; Alves e Motta, Julio Cesar; de Carli, Marina Lara; de Oliveira Pedreira, Fernanda Rafaelly; Hanemann, Joao Adolfo Costa

    2013-05-01

    This work describes the retreatment of an unusual case of dens invaginatus with gutta-percha overfilling at the gingival mucosa and chronic apical periodontitis in a 34-year-old woman. Initial periapical radiograph showed the presence of type II dens invaginatus with poor quality obturation, root perforation and chronic apical periodontitis of tooth 22. Dens invaginatus is a tooth malformation caused by infolding of the dental papilla during tooth development. This anomaly has been associated with increased prevalence of pulpal and periapical diseases. Conventional endodontic retreatment was performed using rotary files and calcium hydroxide paste as intracanal dressing. After 7 days, root canal was filled with guttapercha points and Sealapex® sealer. Obturation was radiographically followed and, after 3 years, absence of fistula and periapical radiolucency was observed, thus conventional endodontic therapy proved to be successful. Conventional endodontic retreatment of type II dens invaginatus has been successful for a 3-year period, showing a better treatment alternative. Conservative endodontic retreatment of dens invaginatus should be considered to promote periapical healing with complete reconstitution of bone and periodontal ligament regeneration without signs of recurrence over a period of 3 years. Moreover, it preserves the entire tooth.

  20. Influence of moisture on the apical seal of root canal fillings with five different types of sealer.

    PubMed

    Roggendorf, Matthias Johannes; Ebert, Johannes; Petschelt, Anselm; Frankenberger, Roland

    2007-01-01

    The aim of this study was to evaluate the influence of moisture on apical leakage using five different types of sealer. There were 120 single-rooted teeth instrumented to .02/#60 and randomly assigned to 10 experimental groups, one control group (AH Plus, lateral condensation) (n = 10) or positive/negative controls (n = 5). Before obturation teeth were dried thoroughly, followed by recontamination with moisture in a wet chamber (moist groups; 37 degrees C for 7 days). The teeth of the experimental groups (a, dry; b, moist) were obturated with sealer (groups 1, AH Plus; 2, Apexit; 3, Ketac-Endo; 4, RoekoSeal; 5, Tubli-Seal) and a single gutta-percha cone .02/#55. Teeth were centrifuged (30 x g for 3 minutes) in 5% methylene blue. Linear dye penetration was measured under a stereomicroscope. Moisture led to less microleakage for Apexit, RoekoSeal, and Tubli-Seal and higher values for AH Plus and Ketac-Endo. Multifactorial ANOVA displayed a significant dependence of leakage on sealer (p < 0.001) and the combination sealer or moisture (p < 0.01). It depends on the sealer type in which way moisture affects the apical seal.

  1. An in-vitro comparison of the radiographic and actual gutta-percha terminus.

    PubMed

    Namazikhah, M S; Ghiai, M; Parkin, M J; Puccinelli, L

    2000-06-01

    The purpose of this study was to investigate the difference between the radiographic gutta-percha terminus and the actual gutta-percha terminus of human molars by comparing radiographic obturation results with actual obturation results. Forty maxillary palatal roots and 50 mandibular distal roots were randomly selected from a population of 540. They were then mounted in stone and radiographed. Conventional endodontic therapy was completed using stainless-steel K files and lateral condensation. Each radiographic gutta-percha terminus was evaluated under 4.5x magnification by three examiners following the completion of root canal therapy. These results were recorded. Each tooth was then removed from its mounting, and the actual gutta-percha terminus was evaluated under 4.5x magnification. These results were recorded and compared to the radiographic gutta-percha terminus results. In all 90 teeth examined, the actual gutta-percha terminus was equal to or longer than the radiographic gutta-percha terminus. In the 50 mandibular distal roots, the actual gutta-percha terminus averaged 0.645 mm longer than the radiographic gutta-percha terminus. In the 40 maxillary palatal roots, this difference measured 0.6375 mm.

  2. Experimental Evaluation of Cold-Sprayed Copper Rotating Bands for Large-Caliber Projectiles

    DTIC Science & Technology

    2015-05-01

    ABSTRACT A copper rotating band is the munition component responsible for both obturation and transfer of torque from the gun barrel’s rifling to the...munition, thereby causing the projectile to spin. Pure copper, copper alloy, and brass rotating bands are typically fabricated to steel munitions using...Machine Shop for fabrication; and the Transonic Experimental Facility for facilitating the gun -launch experiments. vi INTENTIONALLY LEFT BLANK

  3. A comparison of the relative efficacies of four hand and rotary instrumentation techniques during endodontic retreatment.

    PubMed

    Imura, N; Kato, A S; Hata, G I; Uemura, M; Toda, T; Weine, F

    2000-07-01

    The purpose of this study was to quantify the amount of remaining gutta-percha/scaler on the walls of root canals when two engine-driven instruments (Quantec and ProFile) and two hand instruments (K-file and Hedström file) were used to remove these materials. The amount of apically extruded debris and the time required for treatment were also recorded. One hundred extracted mandibular premolars were prepared using a modified step-back, flare technique and obturated with the lateral condensation technique. After repreparation with the test instruments, the specimens were cut transversally at the cervical, middle and apical thirds with steel discs and the three sections were split longitudinally. The amount of residual debris on the canal walls in each section was examined using a stereomicroscope. In all groups the cervical and middle thirds showed no debris. In the apical third, obturating material was observed in some specimens. No statistically significant difference was found between the two groups for incidence of debris, although the Hedström group showed a greater number of samples with remaining gutta-percha/sealer. When analysing dirty specimens only, there was a statistically significant difference between the four groups (P < 0.01) with the Hedström group having significantly less length of canal wall with remaining obturation material than the Quantec group. There was no significant difference amongst the groups for weight of extruded debris. However, there was a significant difference amongst the groups for mean treatment time with the Hedström file group requiring significantly less time than the Quantec group (P < 0.001); no significant differences were found between the other groups. Six instruments fractured in the Quantec group, four in the ProFile group, two in the Hedström group and two in the K-type group. The results showed that overall, all instruments may leave filling material inside the root canal. During retreatment there is a risk of

  4. Access-related complications - an analysis of 6023 consecutive laparoscopic hernia repairs.

    PubMed

    2001-01-01

    In order to investigate incidence rates and types of access-related complications that may occur during laparoscopic hernioplasty, we carried out a systematic analysis of our collected results. The aim was to identify risk factors and to develop useful modifications of the surgical technique and the instrumentation used. Since we first introduced laparoscopic hernioplasty in our clinic, we have carried out standardised, prospective documentation of relevant data from all consecutive operations in an electronic database. We performed a systematic analysis of access-related complications and their possible influencing factors, taking into special account the type of instruments used, port-site and prior intra-abdominal operations. Between April 1993 and March 2000, 4857 consecutive patients received a total of 6023 laparoscopic hernia repairs. In 510 patients three-edged, sharp trocars were used and in 4347 patients conical obturators were used to insert the port. The incidence of access-related complications was 0.9% (44/4857) in the total collection (incision hernias 0.5%, bleeding from abdominal-wall vessels 0.2%, bowel injury 0.06%, wound infections 0.06%). Injuries to intra-abdominal or retroperitoneal vessels were not observed. A differentiated analysis of the various trocar types, taking into consideration the number of inserted ports, showed that for incisions outside the linea alba the incidence of bleeding from abdominal-wall vessels was 12 times higher (0.7%, 7/1020 versus 0.06%, 5/8694). The incidence of incision hernias increased significantly (1.2%, 12/1020 versus 0.02%, 2/8694; p = 0.03) when three-edged trocars were used, as opposed to conical obturators. Our results demonstrate that, outside the linea alba, three-edged trocars should no longer be used for portinsertion. The results of our differentiated analysis of laparoscopic hernia repairs, taking into account the type of obturator, the port-site and number of ports inserted, also can be applied

  5. An evaluation of .06 tapered gutta-percha cones for filling of .06 taper prepared curved root canals.

    PubMed

    Gordon, M P J; Love, R M; Chandler, N P

    2005-02-01

    To compare the area occupied by gutta-percha, sealer, or void in standardized .06 tapered prepared simulated curved canals and in mesio-buccal canals of extracted maxillary first molars filled with a single .06 gutta-percha point and sealer or lateral condensation of multiple .02 gutta-percha points and sealer. Simulated canals in resin blocks with either a 30 degrees curve and radius of 10.5 mm (n = 20) or a 58 degrees curve and 4.7 mm radius (n = 20) and curved mesio-buccal canals of extracted maxillary first molars (n = 20) were prepared using .06 ProFiles in a variable tip crown-down sequence to an apical size 35 at 0.5 mm from the canal terminus or apical foramen. Ten 30 degrees and 58 degrees curved resin canals and 10 canals in the extracted teeth group were obturated with .02 taper gutta-percha cones and AH 26 sealer using lateral condensation. The time required to obturate was recorded. The remaining canals were obturated with a single .06 taper gutta-percha cone and AH 26 sealer. Excess gutta-percha was removed from the specimens using heat and the warm mass vertically condensed. Horizontal sections were cut at 0.5, 1.5, 2.5, 4.5, 7.5 and 11.5 mm from the canal terminus or apical foramen. Colour photographs were taken using an Olympus 35 mm camera attached to a stereomicroscope set at x40 magnification, and then digitized using a flatbed scanner. The cross-sectional area of the canal contents was analysed using Adobe PhotoShop. The percentage of gutta-percha, sealer or voids to the total root canal area were derived and data analysed using unpaired Student's t-test and the Mann-Whitney U-test. In the 30 degrees curved canals the levels had between 94 and 100% of the area filled with gutta-percha with no significant difference (P > 0.05) between the lateral condensation and single cone techniques. In the 58 degrees curved canals the levels had 92-99% of the area filled with gutta-percha, with the single cone technique having significantly (P < 0.05) more

  6. Dynamic MRI confirms support of the mid-urethra by TVT and TVT-O surgery for stress incontinence.

    PubMed

    Rinne, Kirsi; Kainulainen, Sakari; Aukee, Sinikka; Heinonen, Seppo; Nilsson, Carl G

    2011-06-01

    To study changes in mid-urethral function with dynamic MRI in stress urinary incontinent women undergoing either tension-free vaginal tape (TVT) or TVT-obturator sling operations. Prospective clinical study. University hospital. Forty-two parous women with stress urinary incontinence recruited to dynamic magnetic resonance imaging before and after mid-urethral sling surgery. Control group of 16 healthy women. Dynamic magnetic resonance imaging at rest, during pelvic floor muscle contraction, coughing and voiding with a bladder volume of 200-300 ml. X- and Y- coordinates were used to determine the location of the mid-urethra during these activities. Changes in mid-urethral position after TVT and TVT-obturator operations during the different activities. Postoperatively the women could elevate their mid-urethra by pelvic floor muscle contraction significantly higher than before the operation (p<0.05). Despite a different support angle between the TVT and the TVT-O mid-urethral slings, we could not see any differences in the movement patterns. Mid-urethral slings support the mid-urethra and restrict downward movement during different activities. Movement patterns are similar after TVT and TVT-O operations. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

  7. Three-dimensional evaluation of effectiveness of hand and rotary instrumentation for retreatment of canals filled with different materials.

    PubMed

    Hammad, Mohammad; Qualtrough, Alison; Silikas, Nick

    2008-11-01

    The aim of this study was to measure the remaining filling volume of different obturation materials from root-filled extracted teeth by using 2 removal techniques. Eighty single-rooted teeth were collected and decoronated, and the root canal was prepared by using the ProTaper nickel-titanium rotary files. The teeth were randomly allocated into 4 groups, and each group was obturated by using a different material. Group 1 was filled with gutta-percha and TubliSeal sealer, group 2 was filled with EndoRez points and EndoRez sealer, group 3 was filled with RealSeal points and RealSeal sealer, and Group 4 was filled with a gutta-percha point and GuttaFlow sealer. Teeth were scanned with a micro-computed tomography scan, and then root fillings were removed by using ProTaper retreatment files or hand K-files. Teeth were scanned again, and volume measurements were carried out with micro-computed tomography software. Statistical analysis showed significant differences between the 2 removal techniques for gutta-percha and for both techniques between gutta-percha and the other groups. The present study showed that all tested filling materials were not completely removed during retreatment by using hand or rotary files. Gutta-percha was more efficiently removed by using hand K-files.

  8. Fracture resistance and reinforcement of immature roots with gutta percha, mineral trioxide aggregate and calcium phosphate bone cement: a standardized in vitro model.

    PubMed

    Cauwels, Rita G E C; Pieters, Ilse Y; Martens, Luc C; Verbeeck, Ronald M H

    2010-04-01

    Endodontic treatment of immature teeth is often complicated because of flaring root canals and open apices for which apexification is needed. Long-term prognosis for these teeth is surprisingly low because of cervical root fractures occurring after an impact of weak forces. In this study, an experimental model was developed to determine the fracture resistance of immature teeth and to test the hypothesis that endodontic materials succeed in reinforcing them. Compact and hollow bone cylinders from bovine femurs were used as standardized samples. In order to evaluate the experimental model, fracture resistance in both groups was evaluated by determining the ultimate force to fracture (UFF) under diametral tensile stress. Analysis of variance (ANOVA) revealed a statistically significant difference between the mean values of UFF for both groups, independently of the sampling location or subject. In a following setting, the hypothesis that obturation with gutta percha (GP), mineral trioxide aggregate (MTA), or calcium phosphate bone cement (CPBC) reinforces the hollow bone samples was investigated. Obturation resulted in a significant reinforcement for all materials, but the degree of reinforcement depended on the material. The experimental model appeared to be suitable for in vitro investigation of reinforcement and fracture resistance in a standardized way.

  9. [Clinical observation on external humeral epicondylitis treated with back-rotation traction].

    PubMed

    Fu, Rui-yang; Wang, Ya-ling; Gu, Zhong-zhong; Wang, Bao-hu; Zhu, Qi; Li, Ye; Wang, En-ping

    2009-02-01

    To evaluate the clinical effect of manipulation on external humeral epicondylitis, and to explore the functional mechanism and ideal treatment. Eighty-six patients who had been treated with acupuncture, obturation and needle-knife were divided into routine group and treatment group randomly. In routine group, there were 42 cases (male 13, female 29, means 40.8 years); and in treatment group there were 44 cases (male 16, female 28, means 41.2 years). There's no further treatment for the routine group after the therapy above, while the treatment group was added with back-rotation traction manipulation. Taking Verhaar therapy effect appraisal system of tennis-ball elbow to evaluate elbow function. After 7 days of therapy, the results were excellent in 13 cases, good in 16, fair in 4, poor in 9 in the routine group; and excellent in 38, good in 4 and fair in 2 in treatment group; and the effect in the treatment group were better than that of the routine group (P < 0.010). Half a year later, in the routine group 38 cases recurrenced and in the treatment group 10 cases recurrenced. Making manipulation after routine acupuncture, local obturation and needle-knife has active meaning to remove trauma inflammation, prevent re-conglutination, promote recovery and prevent recurrence.

  10. Image Quality Assessment of 2D versus 3D T2WI and Evaluation of Ultra-high b-Value (b=2,000 mm/s2) DWI for Response Assessment in Rectal Cancer.

    PubMed

    Hausmann, Daniel; Liu, Jing; Budjan, Johannes; Reichert, Miriam; Ong, Melissa; Meyer, Mathias; Smakic, Arman; Grimm, Robert; Strecker, Ralph; Schoenberg, Stefan O; Wang, Xiaoying; Attenberger, Ulrike I

    2018-02-01

    The purpose of this IRB-approved, retrospective study was to compare image quality between 2D and high-resolution 3D, T2-weighted (T2WI) magnetic resonance imaging (MRI) sequences and to investigate the additional value of ultra-high b-value diffusion-weighted imaging (DWI; b=2,000 mm/s 2 ) for both rectal cancer staging and evaluating treatment response. From 12 February to 24 August 2016, 26 consecutive patients (22 males, four females; mean age: 61.9±14.0 years) with histologically-proven rectal cancer. In total 31 examinations [12 prior to and 19 after chemoradiation (CRT)] were included. The patients underwent pelvic MRI on a 3.0-T scanner (Magnetom Skyra, Erlangen, Germany). Three radiologists (3, 4, and 5 years of experience in MRI, respectively) independently assessed all images and rated the image quality of DWI (b=800 mm/s 2 ), apparent diffusion coefficient map, DWI (b=2,000 mm/s 2 ), 3D sagittal T2WI, 3D axial T2WI, 2D sagittal T2WI, and 2D axial T2WI of each patient, respectively. In addition, signal intensity ratios (SIR) were calculated between rectal cancer and obturator internus muscle (background) in all patients after CRT on DWI (b=2,000 mm/s 2 ) and correlated with histopathological regression grade (RG). Tumor delineation was significantly better by 2D T2WI than 3D T2WI both before and after CRT (before CRT: Z=-3.2, p=0.02; after CRT: Z=-4.408, p<0.001; all: Z=-5.192; p<0.001) and was the preferred method, although image quality ratings were not significantly different (3D sagittal: 4.00±0.48; 2D sagittal: 4.03±0.34, p=0.713; 3D axial: 3.85±0.61, 2D axial: 3.78±0.64, p=0.537). Independent t-test showed significantly higher SIR between those with RG 1 or 2 (moderate response: mean score=2.02) and those with RG 3+4 (good response: mean score=0.8) (t=3.044, p=0.011). In those with RG 4 (complete response), SIR of b2000 was 0.946 compared to a 1.41 average of the whole cohort. In two patients, tumor was invisible on b2000 following CRT (RG 3

  11. Management of the maxillary cancer patient--what the general dentist should know.

    PubMed

    Karunagaran, Sanjay; Markose, Sony C; Paprocki, Gregory J

    2013-01-01

    Maxillary defects are created following surgical treatment of patients with benign and malignant neoplasms, trauma or congenital defects. The size of these defects influences the degree of debilitation. This patient lacks the conventional support, stability and retention when fabrication of the prosthesis is planned. The prosthesis that is used to close this palatal defect is called the hollow bulb obturator. CLINICAL OUTCOMES: It improves speech, deglutition, esthetics and function for the patient.

  12. Comparison of Gutta Percha Filling Techniques. Part 1. Compaction (Mechanical), Vertical (Warm), and Lateral Condensation Techniques.

    DTIC Science & Technology

    1980-06-01

    endodontically and filed to a size #60 file. The tooth was soaked in a 5% sodium hypochlorite solution for 2 days,12 washed in tap water and then placed...IS. KEY WORDS (Continue on reverse side If necessary and identify by block number) Endodontics ; gutta percha; obturation; lateral condensation...Condensation Techniques M. Wong, DDS Resident, Endodontics Dept. of Dentistry - PO Box 59 Madigan Army Medical Center Tacoma, Washington 98431 D.D. Peters, BA

  13. [Nonsurgical endodontic treatment of an invaginated canine].

    PubMed

    Fernández Guerrero, F; Miñana Laliga, R; Bullon Fernandez, P

    1989-01-01

    We present a case of a maxillary canine with a dens invaginatus treated successfully. The patient had pain, swelling and a sinus tract coming from the inmature apex of the canine. The canals were enlarged and cleaned and the main canal was filled with Calcium Hydroxide to allow the root development. Seven months later, the patient was asymptomatic and the tooth was obturated with guttapercha. One year later it was confirm the success in the treatment.

  14. [Bilateral Pallidotomy for Tardive Dystonia:A Case Report].

    PubMed

    Kohara, Kotaro; Taira, Takaomi; Horisawa, Shiro; Hanada, Tomoko; Kawamata, Takakazu

    2017-11-01

    Tardive dystonia is a movement disorder related to the use of dopamine-receptor-blocking drugs. Several reports have shown that deep brain stimulation of the globus pallidus internus(GPi-DBS)is effective in treating tardive dystonia. However, a few reports demonstrated the efficacy of ablation of the GPi(pallidotomy). We herein report a case of tardive dystonia successfully treated with bilateral pallidotomy. A 32-year-old man developed severe tardive dystonia 10 years after the chronic use of antipsychotic drugs. Withdrawal of the drugs and botulinum toxin injections were ineffective. The patient underwent bilateral pallidotomy for tardive dystonia because of rejection of the implanted DBS devices. Significant improvement was observed, with a 95% decrease in the Burke-Fahn-Marsden Dystonia Rating Scale(BFMDRS)movement score, and no severe adverse events occurred. Symptomatic relief persisted for nine months. Pallidotomy is a feasible and efficacious procedure for tardive dystonia treatment without the use of hardware implantations.

  15. Basal Ganglia Contributions to Motor Control: A Vigorous Tutor

    PubMed Central

    Turner, Robert S.; Desmurget, Michel

    2010-01-01

    SUMMARY OF RECENT ADVANCES The roles of the basal ganglia (BG) in motor control are much debated. Many influential hypotheses have grown from studies in which output signals of the BG were not blocked, but pathologically-disturbed. A weakness of that approach is that the resulting behavioral impairments reflect degraded function of the BG per se mixed together with secondary dysfunctions of BG-recipient brain areas. To overcome that limitation, several studies have focused on the main skeletomotor output region of the BG, the globus pallidus internus (GPi). Using single-cell recording and inactivation protocols these studies provide consistent support for two hypotheses: the BG modulates movement performance (“vigor”) according to motivational factors (i.e., context-specific cost/reward functions) and the BG contributes to motor learning. Results from these studies also add to the problems that confront theories positing that the BG selects movement, inhibits unwanted motor responses, corrects errors online, or stores and produces well-learned motor skills. PMID:20850966

  16. Comparison of push-out bond strengths of Resilon with three different sealers.

    PubMed

    Stiegemeier, Danielle; Baumgartner, J Craig; Ferracane, Jack

    2010-02-01

    The purpose of this study was to evaluate the push-out bond strengths of different obturating materials. Forty single-rooted human extracted teeth were used in this study. The teeth were instrumented and irrigated by using 5.25% NaOCl, 15% ethylenediaminetetraacetic acid, and sterile water. The teeth were then filled with Resilon/RealSeal, Resilon/RealSeal SE, Resilon/MetaSeal , or gutta-percha/Kerr EWT sealer. The roots were then sectioned into 1-mm-thick slices and subjected to vertical loading to displace the obturating material toward the coronal side of the slice. The bond strength was then calculated and subjected to statistical analysis. Slices were examined by using a stereomicroscope at 30x to determine the mode of failure. The mean push-out bond strengths were as follows: Resilon/RealSeal, 1.45 +/- 0.99 MPa; RealSeal SE, 0.88 +/- 0.49 MPa; Resilon/MetaSeal, 2.41 +/- 1.7 MPa; and gutta-percha/Kerr EWT sealer, 2.32 +/- 0.74 MPa. The push-out bond strengths of Resilon/MetaSeal and gutta-percha/Kerr EWT were significantly (P < .05) higher than either Resilon/RealSeal or Resilon/RealSeal SE. Resilon/MetaSeal and gutta-percha/Kerr EWT did not differ significantly. Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  17. A comparison of thermocouple and infrared thermographic analysis of temperature rise on the root surface during the continuous wave of condensation technique.

    PubMed

    Mc Cullagh, J J; Setchell, D J; Gulabivala, K; Hussey, D L; Biagioni, P; Lamey, P J; Bailey, G

    2000-07-01

    This study was designed to use two methods of temperature measurement to analyse and quantify the in vitro root surface temperature changes during the initial stage of the continuous wave technique of obturation of 17 single-rooted premolar teeth with standard canal preparations. A model was designed to allow simultaneous temperature measurement with both thermocouples and an infrared thermal imaging system. Two thermocouples were placed on the root surface, one coronally and the other near the root apex. A series of thermal images were recorded by an infrared thermal imaging camera during the downpack procedure. The mean temperature rises on the root surface, as measured by the two thermocouples, averaged 13.9 degrees C over the period of study, whilst the infrared thermal imaging system measured an average rise of 28.4 degrees C at the same sites. Temperatures at the more apical point were higher than those measured coronally. After the first wave of condensation, the second activation of the plugger in the canal prior to its removal always resulted in a secondary rise in temperature. The thermal imaging system detected areas of greater temperature change distant from the two selected thermocouple sites. The continuous wave technique of obturation may result in high temperatures on the external root surface. Infrared thermography is a useful device for mapping patterns of temperature change over a large area.

  18. Incidence of Postoperative Pain after Single- and Multi-Visit Endodontic Treatment in Teeth with Vital and Non-Vital Pulp

    PubMed Central

    Ince, Bayram; Ercan, Ertugrul; Dalli, Mehmet; Dulgergil, Coruh Turksel; Zorba, Yahya Orcun; Colak, Hakan

    2009-01-01

    Objectives To assess the incidence of postoperative pain after single- and multi-visit endodontic treatment of teeth with vital and non-vital pulp. Methods In total, 306 patients with teeth requiring endodontic treatment were identified and were included in this study. Two experienced clinicians treated the patients, who were randomly assigned to two groups. While the teeth of patients in group 1 were obturated, group 2 were temporarily sealed and obturated after one week. Three days after the root canal instrumentation of each tooth, the patients were asked whether they experienced any postoperative pain and to rate the level of discomfort as no, mild, moderate, or severe pain. Data were analyzed statistically using the chi-square test. Results No significant difference in postoperative pain was found between vital and non-vital teeth (P>.01). Mild, moderate, and severe pain occurred in 31.4, 13.7, and 4.6% of vital teeth, respectively. Postoperative pain occurred in 107 (69.9%) and 106 (69.3%) teeth in the single- and multi-visit treatment groups, respectively. There was no significant difference in postoperative pain between the two groups (P>.01). Conclusions The prevalence of postoperative pain did not differ between vital and non-vital teeth. The majority of patients in either groups reported no or only mild pain. PMID:19826598

  19. Influence of different final irrigation regimens and various endodontic filling materials on vertical root fracture resistance.

    PubMed

    Sungur, D D; Altundasar, E; Uzunoglu, E; Yilmaz, Z

    2016-01-01

    The aim of this study was to evaluate the influence of different endodontic materials and final irrigation regimens on vertical root fracture (VRF) resistance. Eighty human teeth were prepared then assigned into two groups (n = 40) according to the final irrigations. G1: 5 mL, 5.25% sodium hypochlorite (NaOCl), G2: 5 mL, 2% chlorhexidine gluconate (CHX). Each group was assigned into four subgroups according to the obturation system used (n = 10): A: iRoot SP/single gutta-percha cone (SGP), B: Only iRoot SP, C: Mineral trioxide aggregate (MTA)-Fillapex/SGP, D: AH26/SGP. The specimens were embedded in acrylic molds and subjected to compressive loading at a rate of 1 mm min until VRF occurred. Data were analyzed via three-way ANOVA tests. The statistically significant difference was found among groups (P < 0.05). The G1A and G1B and G1D revealed significantly higher-VRF values than G1C (P = 0.023). The roots filled with MTA-Fillapex revealed lower-VRF values than the other subgroups (P < 0.05). Groups irrigated with NaOCl had significantly lower-VRF values than the groups irrigated with CHX (P < 0.05). Final irrigation regimens could alter VRF resistance of root canals filled with different obturation technique and root canal sealers.

  20. Analysis of pelvic rotation on the standard hip ventrodorsal extended radiographic view.

    PubMed

    Martins, João; Colaço, Bruno J; Ferreira, António J; Ginja, Mário M

    2016-01-01

    To study the symmetry of the iliac horizontal diameter (IHD) maximum obturator foramen width (OFW), ischiatic femoral overlap (IFO), pelvic horizontal radius (PHR), femoral head diameter (FHD), and obturator foramen area (OFA) parameters in the normal hip extended radiographic view and to evaluate the correlation of pelvic rotation with the magnitude of asymmetry of these parameters. Nine canine cadavers from adult, large and giant breeds were radiographed in standard hip extended views and with 2°, 4° and 6° degrees of rotation. The variables IHD, OFW, IFO, PHR, FHD, and OFA were analysed in radiographs. The IHD measurements exhibited repeatability, bilateral symmetry and 95% of confidence interval of asymmetry in different pelvic rotations without superposition (p <0.05); OFW and IFO exhibited repeatability, bilateral symmetry and a small superposition in 95% of confidence interval of asymmetry according different pelvic rotations; PHR, FHD and OFA exhibited repeatability, bilateral symmetry and unacceptable superposition in 95% of confidence interval of asymmetry depending on pelvic rotation. The IHD is the recommended variable and OFW is an acceptable variable in order to evaluate slight pelvic rotation. The data may be used in qualitative analyses of hip extended radiographic views. In the future, complementary studies should be performed to evaluate the impact of degree of pelvic rotation on the hip dysplasia score.

  1. Intraorifice sealing ability of different materials in endodontically treated teeth: An in vitro study.

    PubMed

    Parekh, Bandish; Irani, Rukshin S; Sathe, Sucheta; Hegde, Vivek

    2014-05-01

    Microbial contamination of the pulp space is one of the major factors associated with endodontic failure. Thus, in addition to a three dimentional apical filling a coronal seal for root canal fillings has been recommended. The present study was conducted to evaluate and compare the intra-orifice sealing ability of three experimental materials after obturation of the root canal system. Fourty single rooted mandibular premolars were decoronated, cleaned, shaped and obturated. Gutta-percha was removed to the depth of 3.5 mm from the orifice with a heated plugger. Ten specimens each were sealed with Light Cure Glass Ionomer Cement (LCGIC), Flowable Composite (Tetric N-Flow), and Light Cure Glass Ionomer Cement with Flowable Composite in Sandwich Technique along with a positive control respectively and roots submerged in Rhodamine-B dye in vacuum for one week. Specimens were longitudinally sectioned and leakage measured using a 10X stereomicroscope and graded for depth of leakage. According to the results of the present study LC GIC + Tetric N Flow demonstrated significantly better seal (P < 0.01) than LC GIC. However there was no statistically significant difference in leakage (P > 0.01) between Tetric N-Flow and LCGIC+Tetric N-Flow groups. In the current study LCGIC+Tetric N-Flow was found to be superior over other experimental materials as intra-orifice barriers.

  2. A Survey of Endodontic Practices among Dentists in Burkina Faso.

    PubMed

    Kaboré, Wendpoulomdé Ad; Chevalier, Valérie; Gnagne-Koffi, Yolande; Ouédraogo, Carole Dw; Ndiaye, Diouma; Faye, Babacar

    2017-08-01

    Dental surgeons must be aware of the most appropriate endodontic treatments and how to properly conduct them. The aim of this study was to evaluate the knowledge of dental surgeons in Burkina Faso in terms of endodontic treatment procedures. This descriptive, cross-sectional study was performed during the regular annual conference of the National Board of Dental Surgeons of Burkina Faso, held on February 27 and 28, 2015 in Ouagadougou, through a questionnaire. A total of 33 practitioners took part (52.4% of the dental surgeons of Burkina Faso) in the study. The majority of them (90.9%) used sodium hypochlorite as their preferred irrigation solution. Nearly half of the dental surgeons (48.5%) did not know how to use a permeabilization file, and most did not make use of nickel-titanium (NiTi) mechanized instruments (78.8%) or rubber dams (93.9%). Approximately two-thirds of participants did not perform file-in-place radiography (66.7%) or control radiography of the canal obturation (63.6%). The adjusted single-cone technique was the most commonly used (87.9%). This study highlights that the majority of dental surgeons in Burkina Faso are not using the currently recommended endodontic procedures to perform obturations. Dental surgeons in Burkina Faso must commit to regularly upgrading their knowledge and techniques. Key words: Burkina faso, Cross-sectional study, Dental surgeons, Endodontic treatments, Protocol adherence.

  3. Comparative evaluation of microleakage of various retrograde filling materials: An in vitro study.

    PubMed

    Galhotra, Virat; Sofat, Anjali; Pandit, Inder K; Gambhir, Ramandeep Singh; Srivastava, Nikhil; Gugnani, Neeraj

    2013-07-01

    The present study is envisaged to evaluate and compare the microleakage of mineral trioxide aggregate (MTA) with commonly used retrograde filling materials, like light-cured composite with dentin-bonding agents, light-cured glass ionomer cement (LC GIC) and resin-modified zinc oxide eugenol. Ninety freshly extracted non-carious single-rooted human anterior teeth were used in the study. They were randomly divided into four experimental groups and two control groups of 15 each. Following the biomechanical preparation, all teeth were obturated and then the apices of the obturated teeth were resected by removing 3 mm of each apex at 90° to the long axis of the tooth with a straight fissure bur in a high-speed air-rotor handpiece with water coolant. A 3-mm-deep root end cavity was prepared and the root end fillings were placed as per the manufacturer's instructions and according to the groups divided. The samples were then immersed in 1% methylene blue at room temperature for 72 h, 96 h and 1 week and the dye penetration was measured. All the four materials used in the study showed some microleakage throughout the experimental period. The sealing ability in terms of microleakage can be summarized as: MTA > Composite resin with dentin bonding agent > LC GIC > Resin modified zinc oxide eugenol.

  4. Rheumatic disorders in Sub-saharan Africa.

    PubMed

    McGill, P E; Oyoo, G O

    2002-04-01

    To review prevalence of rheumatic disorders in Sub-saharan Africa and in the context of current medical practice in the region assess the need for service and educational provision. Medline, (English, French). Pre-Medline literature review from the 1950's (Current contents). Various conference reports including attendance at all three AFLAR (African League Against Rheumatism) congresses in the 1990's. Author's personal database. All cited references read in full. The evidence shows rheumatoid arthritis and systemic lupus erythematosus to be increasing in frequency in the indigenous populations of East, Central and South Africa but remaining rare in West Africans. Gout is now more prevalent than ever throughout the subcontinent. HIV has spawned a variety of previously rare spondyloarthropathies (reactive arthritis, psoriatic arthritis, enthesopathy) and changed the epidemiology of pyomyositis and osteomyelitis. Osteoarthritis is a universal problem. Juvenile chronic arthritis is not rare and rheumatic fever is common. Acute and chronic locomotor problems associated with diverse entities such as leprosy, brucellosis, meningococcus, alpha viruses, parasites, fluorosis, rickets and haemoglobinopathies enhance diagnostic diversity and therapeutic and educational requirements. Suggestions made to address the challenge posed by the burden of rheumatic disorders.

  5. Fabrication of a hollow bulb prosthesis for the rehabilitation of an acquired total maxillectomy defect

    PubMed Central

    Vamsi Krishna, C H; Babu, Jaya Krishna; Fathima, Tanveer; Reddy, G V K

    2014-01-01

    The prosthodontic rehabilitation of maxillary defects is a challenging and demanding task which requires careful pre-surgical and post-surgical planning. Maxillary defects can be congenital or acquired. Acquired defects include those following trauma or surgical treatment of benign or malignant neoplasms. A prosthodontist encounters problems such as absence of support, poor retention, and lack of prosthesis stability in treating these patients. The present case report describes a procedure to fabricate a definitive hollow bulb obturator prosthesis for the rehabilitation of a total maxillectomy defect. PMID:24671313

  6. Modern Endodontic Principles Part 3: Preparation.

    PubMed

    Darcey, James; Taylor, Carly; Roudsari, Reza Vahid; Jawad, Sarra; Hunter, Mark

    2015-11-01

    The purpose of instrumentation is to facilitate irrigation and allow controlled obturation. This article will revisit methods of instrumentation of the root canal system with consideration given to length determination, apical preparation and the concept of patency filing. It will discuss hand instrumentation and rotary preparation looking at emerging technology such as reciprocating systems and the self-adjusting file. CPD/CLINICAL RELEVANCE: Mechanical preparation of the root canal system is of fundamental importance in achieving success, creating a more easily managed environment from a biological perspective.

  7. [Radiographic and histological study of a case of apexification in a human molar].

    PubMed

    Sahli, C C

    1989-01-01

    A case of apexification in a lower right second molar is described. Radiographs demonstrate apical closure with a different morphological pattern from that of the lower left second molar. Following extraction, after 15 months, serial histologic sections show calcified tissue obturating the apical foramen, well adapted to the initial dentin and cementum walls. Inside some small areas containing connective tissue with capillaries can be observed. The histologic and radiographic observations indicate that apical closure occurs as a result of differentiation of periodontal apical cells.

  8. [Analysis of violent deaths of mountaineers and tourists at high altitudes].

    PubMed

    Pigolkin, Iu I; Mechukaev, A A; Mechukaev, A M

    2012-01-01

    The principal causes of violent death of mountaineers and tourists at high altitudes are described with special reference to the character of injuries to the skin, soft tissues, bones, and internal organs inflicted by mechanical impacts. The cases of violent death from other factors are described, such as general hypothermia, atmospheric electricity, compression and obturation asphyxia of mountaineers and tourists who died in the epicenter of an avalanche. The additional criteria for forensic medical diagnostics of violent death of montaineers and tourists at high altitudes are considered.

  9. A comparative evaluation of gutta percha removal and extrusion of apical debris by rotary and hand files.

    PubMed

    Chandrasekar; Ebenezar, A V Rajesh; Kumar, Mohan; Sivakumar, A

    2014-11-01

    The aim of this study was to evaluate the efficacy of Protaper retreatment files in comparison with RaCe, K3 and H-files for removal of gutta-percha and apically extruded debris using volumetric analysis. Forty extracted single rooted maxillary incisor teeth with straight canals and mature apices were selected for the study. After access cavity preparation, apical patency was confirmed with a size 10 K-file extending 1mm beyond the point at which it was first visible at the apical end. Working lengths were determined with the use of size 15 K-file. The canals were prepared in a step-back technique and the master apical file was size 30 for all teeth. 3% sodium hypochlorite was used as an irrigant after each instrumentation. Before final rinse, size 20 K-file was passed 1mm beyond the apex to remove any dentinal shaving plugs and maintain the apical patency. Then the canals were dried with paper points. The root canal was filled using standard gutta-percha points and zinc oxide eugenol sealer under lateral condensation technique. The teeth were then randomly divided into four groups of ten teeth each based on the instrument used for gutta percha removal. All the rotary instruments used in this study were rotated at 300rpm. The instruments used were: Group 1 - RaCe Files, Group 2 - ProTaper retreatment Files, Group 3 - K3 Files and Group 4 - H Files. The volume of the obturating material was calculated before and after removal using volumetric analysis with spiral CT. The removal efficacy with each instrument was calculated and statistically analysed. The results of the study show that the ProTaper retreatment files (Group 2) (97.4%) showed the highest efficiency in the removal of obturating material, which was followed by RaCe (95.74%), K3 (92.86%) and H files (90.14%) with the efficiency in the decreasing order. Similarly the mean apical extrusion in H files (0.000 ± 0.002) was significantly lower than all the rotary instruments. However, the difference among the

  10. A Comparative Evaluation of Gutta Percha Removal and Extrusion of Apical Debris by Rotary and Hand Files

    PubMed Central

    Ebenezar, A.V. Rajesh; Kumar, Mohan; Sivakumar, A.

    2014-01-01

    Aim: The aim of this study was to evaluate the efficacy of Protaper retreatment files in comparison with RaCe, K3 and H-files for removal of gutta-percha and apically extruded debris using volumetric analysis. Materials and Methods: Forty extracted single rooted maxillary incisor teeth with straight canals and mature apices were selected for the study. After access cavity preparation, apical patency was confirmed with a size 10 K-file extending 1mm beyond the point at which it was first visible at the apical end. Working lengths were determined with the use of size 15 K-file. The canals were prepared in a step-back technique and the master apical file was size 30 for all teeth. 3% sodium hypochlorite was used as an irrigant after each instrumentation. Before final rinse, size 20 K-file was passed 1mm beyond the apex to remove any dentinal shaving plugs and maintain the apical patency. Then the canals were dried with paper points. The root canal was filled using standard gutta-percha points and zinc oxide eugenol sealer under lateral condensation technique. The teeth were then randomly divided into four groups of ten teeth each based on the instrument used for gutta percha removal. All the rotary instruments used in this study were rotated at 300rpm. The instruments used were: Group 1 – RaCe Files, Group 2 – ProTaper retreatment Files, Group 3 – K3 Files and Group 4 – H Files. The volume of the obturating material was calculated before and after removal using volumetric analysis with spiral CT. The removal efficacy with each instrument was calculated and statistically analysed. Results: The results of the study show that the ProTaper retreatment files (Group 2) (97.4%) showed the highest efficiency in the removal of obturating material, which was followed by RaCe (95.74%), K3 (92.86%) and H files (90.14%) with the efficiency in the decreasing order. Similarly the mean apical extrusion in H files (0.000 ± 0.002) was significantly lower than all the rotary

  11. Broken instrument retrieval with indirect ultrasonics in a primary molar.

    PubMed

    Pk, Musale; Sc, Kataria; As, Soni

    2016-02-01

    The separation of a file during pulpectomy is a rare incident in primary teeth due to inherently wider and relatively straighter root canals. A broken instrument hinders the clinician from optimal preparation and obturation of the root canal system invariably leading to failure, although in such teeth, an extraction followed by suitable space maintenance is considered as the treatment of choice. This case report demonstrates successful nonsurgical retrieval of a separated H file fragment in 84. A 7-year-old girl was referred to the Department of Paedodontics and Preventive Dentistry for endodontic management of a primary tooth 84 with a dento-alveolar abscess. Her medical history was noncontributory. After diagnosing a broken H file in the mesio-lingual canal, the tooth was endodontically treated in two appointments. At the first session, a broken file was successfully retrieved after using low intensity ultrasonic vibrations through a DG 16 endodontic explorer viewed under an operating microscope. After abscess resolution, Vitapex root canal obturation with a preformed metal crown cementation was completed at a second session. The patient was recalled at 3, 6, 12 and 15 month interval and reported to be clinically asymptomatic and radiographically with complete furcal healing. Integration of microscopes and ultrasonics in paediatric dental practice has made it possible to save such teeth with a successful outcome. Favourable location of the separated file, relatively straighter root canal system and patient cooperation resulted in successful nonsurgical management in this case.

  12. Radiographic changes of the pelvis in Labrador and Golden Retrievers after juvenile pubic symphysiodesis: objective and subjective evaluation.

    PubMed

    Boiocchi, S; Vezzoni, L; Vezzoni, A; Bronzo, V; Rossi, F

    2013-01-01

    The hypothesis of this study was that juvenile pubic symphysiodesis (JPS) results in pelvic changes that can be identified radiographically in adult dogs. The medical records at the Clinica Veterinaria Vezzoni were searched for standard ventro-dorsal views of the pelvis of adult Labrador and Golden Retrievers that had undergone JPS or had not undergone surgery. The objective assessment of radiographs included the analysis of various pelvic measurements. Subjective evaluation of radiographs was undertaken by 18 specialists and 21 general practitioners and was based on five criteria relating to 1) the acetabular fossae, 2) the pubic symphysis, 3) the margin of the cranial pubic area, 4) the pubic rami, and 5) the obturator foramen. The radiographs of 42 Labrador Retrievers and 16 Golden Retrievers were evaluated. The most useful criteria were the radiographic measurement of the shape of the obturator foramen and two different ratios of length to width of the pubic rami; these values were significantly smaller in dogs after JPS. The pelvic canal width was the same in both groups. All objective measurements were repeatable within and between evaluators. The most reliable subjective criterion was number 4, followed by number 5 in Golden Retrievers and by 2 in Labrador Retrievers. Our objective and subjective evaluations were simple and yielded useful and repeatable results. There was no significant difference between general practitioners and specialists with regard to subjective evaluation, which indicates that these evaluation criteria can be used by small animal clinicians after minimal training.

  13. Radiofrequency denervation of the hip joint for pain management: case report and literature review.

    PubMed

    Gupta, Gaurav; Radhakrishna, Mohan; Etheridge, Paul; Besemann, Markus; Finlayson, Robert J

    2014-01-01

    A 55-year-old male presented with severe pain and functional limitations as a result of left hip osteoarthritis. He had failed multiple treatments while waiting for a hip arthroplasty, including physical therapy, medications, and various intra-articular injections. Thermal radiofrequency lesioning of the obturator and femoral articular branches to the hip joint was offered in the interim. To our knowledge, this is the first report to describe an inferior-lateral approach for lesioning the obturator branch, the clinical application of successive lesions to increase denervation area, and outcomes in a patient receiving a second treatment with previously good results. To discuss relevant and technical factors for this specific case, we reviewed previous literature on hip joint radiofrequency and critically evaluated previous anatomic studies in the context of radiofrequency. The first treatment provided significant benefit for a period of 6 months. A second treatment was employed providing only mild to moderate benefit until his joint replacement surgery 4 months later. Literature review revealed studies of low quality secondary to small sample sizes, patient selection methodology, inclusion of patients with heterogenous etiologies for pain, variable needle placement techniques, and lack of measurement of functional outcomes. Case report and low quality studies in existing literature. Hip joint radiofrequency denervation is a promising avenue for adjunctive treatment of hip pain. Further cadaveric studies are required to clarify a multitude of technical parameters. Once these are well defined, future clinical studies should consider pain, functional, and economic outcomes in their design.

  14. Cone-beam computed tomography as advanced diagnostic aid in endodontic treatment of molars with multiple canals: Two case reports

    PubMed Central

    Kamble, Amit Pralhad; Pawar, Rohini Rangarao; Mattigatti, Sudha; Mangala, T. M.; Makandar, Saleem

    2017-01-01

    The purpose of these case reports is to emphasize the importance of knowledge regarding the root canal morphology and current diagnostic aids one should have as both of these important factors going to affect the prognosis of the endodontic treatment. These two case reports describe the maxillary and mandibular first molars with multiple canals. After clinical and radiographic diagnosis, additional help of cone-beam computed tomography (CBCT) of mandibular molar has been taken to evaluate the morphology and canal pattern; while maxillary molar was evaluated using CBCT scan to evaluate the canal configuration and obturation. In CBCT evaluation, the mandibular molar was diagnosed with six separated canals with three mesial and three distal canals and with radix paramolaris and radix entomolaris. The maxillary molar had five canals with three mesiobuccal (MB) canals. Both molars were instrumented with conventional hand and rotary file systems and obturated by conventional lateral compaction method. The axial images from CBCT show Vertucci Type VIII canal pattern in both roots of first mandibular molars and in MB root of maxillary first molar Sert and Bayirli Type XVIII canal configuration and no accessory canal in distobuccal and palatal root. With the recent innovations in diagnostic and operating aids, we can come across many variations in the root canal morphology of both mandibular and maxillary teeth, especially multi-rooted one (i.e., molars), and the knowledge of which leads to successful endodontic treatment with an excellent prognosis. PMID:29259367

  15. Argon laser application to endodontics

    NASA Astrophysics Data System (ADS)

    Blankenau, Richard J.; Ludlow, Marvin; Anderson, David

    1993-07-01

    The application of laser technology to endodontics has been studied for some time. At the present time several major problems are being investigated: (1) removal of infected tissues, (2) sterilization of canals, (3) obturation of canals, and (4) preservation of the vitality of supporting tissues. This list is not intended to imply other problems do not exist or have been solved, but it is a starting point. This paper reviews some of the literature that relates to laser applications to endodontics and concludes with some of the findings from our investigation.

  16. Simplified edentulous treatment technique for edentulous hemimaxillectomy patients: case history report.

    PubMed

    Ceruti, Paola; Bellia, Elisabetta; Gianfranco, Gassino; Carossa, Stefano

    2015-01-01

    Technical difficulties in the construction of hard palate obturators following oncologic surgery are due to the recording limitations of the entire defect area, plus prosthesis base instability during recording of maxillomandibular relationships. This article describes a time-saving technique that ensures stable and precise recording bases. A light-polymerizing acrylic resin layer is used for making the first impression of the defect, while simultaneously obtaining an acrylic resin impression tray and base for recording maxillomandibular relationships. Adhesive paper copies are used for the arrangement of the anterior teeth.

  17. The combination of a mineral trioxide aggregate and an adhesive restorative approach to treat a crown-root fracture coupled with lateral root perforation in a mandibular second molar: a case report.

    PubMed

    Wang, P; Wang, S; Ni, L

    2009-01-01

    The current paper describes a modified treatment procedure for a traumatized mandibular left second molar resulting in a crown-root fracture and root perforation with the fracture line below the gingival attachment and alveolar bone crest. After the mobile crown-root fragment was extracted, the root perforation was obturated with mineral trioxide aggregate (MTA), and the subgingival defect was directly repaired with polyacid-modified resin composites (Ionosite Baseline). A 24-month recall showed no evidence of periodontal inflammation and no adverse symptoms, and the treated tooth exhibited good healing and normal function.

  18. Principles of endodontic therapy.

    PubMed

    Lobprise, H B

    1993-08-01

    Endodontics is that branch of dentistry concerned with the treatment of damaged or diseased dental pulp. Veterinarians are now being asked to preserve tooth function and structure rather than to extract injured or diseased teeth. A variety of instruments are available that facilitate endodontic treatment. Endodontic treatment involves preparation (filing), sterilization, and obturation (filling) of the pulp cavity. Properly performed, endodontic therapy can effectively preserve dental structure and function. Complications of endodontic therapy will be discussed in "Problem Solving in Veterinary Endodontics" on page 165 in this issue.

  19. Deep brain stimulation changes basal ganglia output nuclei firing pattern in the dystonic hamster.

    PubMed

    Leblois, Arthur; Reese, René; Labarre, David; Hamann, Melanie; Richter, Angelika; Boraud, Thomas; Meissner, Wassilios G

    2010-05-01

    Dystonia is a heterogeneous syndrome of movement disorders characterized by involuntary muscle contractions leading to abnormal movements and postures. While medical treatment is often ineffective, deep brain stimulation (DBS) of the internal pallidum improves dystonia. Here, we studied the impact of DBS in the entopeduncular nucleus (EP), the rodent equivalent of the human globus pallidus internus, on basal ganglia output in the dt(sz)-hamster, a well-characterized model of dystonia by extracellular recordings. Previous work has shown that EP-DBS improves dystonic symptoms in dt(sz)-hamsters. We report that EP-DBS changes firing pattern in the EP, most neurons switching to a less regular firing pattern during DBS. In contrast, EP-DBS did not change the average firing rate of EP neurons. EP neurons display multiphasic responses to each stimulation impulse, likely underlying the disruption of their firing rhythm. Finally, neurons in the substantia nigra pars reticulata display similar responses to EP-DBS, supporting the idea that EP-DBS affects basal ganglia output activity through the activation of common afferent fibers. Copyright 2010 Elsevier Inc. All rights reserved.

  20. MRI in necrotizing fasciitis of the extremities.

    PubMed

    Ali, S Z; Srinivasan, S; Peh, W C G

    2014-01-01

    Necrotizing fasciitis is a life-threatening soft-tissue infection of bacterial origin, which involves mainly the deep fascia. Early recognition of this condition may be hampered by the uncommon nature of the disease and non-specificity of initial clinical signs and symptoms in less fulminant cases, making the role of imaging important. MRI is the most useful imaging modality in the diagnosis of necrotizing fasciitis. The presence of thick (>3 mm) hyperintense signal in the deep fascia (particularly intermuscular fascia) on fat-suppressed T2 weighted or short tau inversion-recovery images is an important marker for necrotizing fasciitis. Contrast enhancement of the thickened necrotic fascia can be variable, with a mixed-pattern of enhancement being more commonly encountered. Involvement of multiple musculofascial compartments increases the likelihood of necrotizing fasciitis. It is important to remember that T2-hyperintense signal in the deep fascia is not specific to necrotizing fasciitis and can also be seen in cases such as non-infective inflammatory fasciitis or muscle tear. In this pictorial essay, we aim to review the MRI findings in necrotizing fasciitis, discuss its limitations and pitfalls and identify differentiating features from non-necrotizing soft-tissue infections, such as cellulitis and infective myositis/pyomyositis, conditions which may clinically mimic necrotizing fasciitis.

  1. MRI in necrotizing fasciitis of the extremities

    PubMed Central

    Srinivasan, S; Peh, W C G

    2014-01-01

    Necrotizing fasciitis is a life-threatening soft-tissue infection of bacterial origin, which involves mainly the deep fascia. Early recognition of this condition may be hampered by the uncommon nature of the disease and non-specificity of initial clinical signs and symptoms in less fulminant cases, making the role of imaging important. MRI is the most useful imaging modality in the diagnosis of necrotizing fasciitis. The presence of thick (>3 mm) hyperintense signal in the deep fascia (particularly intermuscular fascia) on fat-suppressed T2 weighted or short tau inversion–recovery images is an important marker for necrotizing fasciitis. Contrast enhancement of the thickened necrotic fascia can be variable, with a mixed-pattern of enhancement being more commonly encountered. Involvement of multiple musculofascial compartments increases the likelihood of necrotizing fasciitis. It is important to remember that T2-hyperintense signal in the deep fascia is not specific to necrotizing fasciitis and can also be seen in cases such as non-infective inflammatory fasciitis or muscle tear. In this pictorial essay, we aim to review the MRI findings in necrotizing fasciitis, discuss its limitations and pitfalls and identify differentiating features from non-necrotizing soft-tissue infections, such as cellulitis and infective myositis/pyomyositis, conditions which may clinically mimic necrotizing fasciitis. PMID:24288403

  2. From files to SAF: 3D endodontic treatment is possible at last.

    PubMed

    Metzger, Zvi

    2011-01-01

    3D cleaning, shaping and obturation of root canals has always been the desired goal of endodontic treatment which in many cases is difficult to attain. The introduction of NiTi rotary files made a major change in endodontic practice, making treatment easier, safer and faster. Nevertheless, after 16 years of intensive development, most of these instruments still share several drawbacks, the major one being the inability to three-dimensionally clean and shape oval root canals. The Self-Adjusting File (SAF) System was designed to overcome many of the current drawbacks of rotary file systems. It is based on a hollow, highly compressible file that adapts itself three-dimensionally to the shape of a given root canal, including its cross section. The file is operated with vibratory in-and-out motion, with continuous irrigation delivered by a peristaltic pump through the hollow file. A uniform layer of dentin is removed from the whole circumference of the root canal, thus achieving the main goals of root canal treatment while preserving the remaining root dentin. The 3D scrubbing effect of the file, combined with the always fresh irrigant, result in unprecedentedly clean canals which facilitate in turn better obturation. More effective disinfection of flat-oval root canals is another goal which is simultaneously attained. The safety of the root-canal treatment is also greatly enhanced by the high mechanical stability of the SAF and by using a new concept of no-pressure irrigation. The SAF System gets the operator much closer to the long-desired goal of 3D root-canal treatment.

  3. Incidence of apical crack formation and propagation during removal of root canal filling materials with different engine driven nickel-titanium instruments.

    PubMed

    Özyürek, Taha; Tek, Vildan; Yılmaz, Koray; Uslu, Gülşah

    2017-11-01

    To determine the incidence of crack formation and propagation in apical root dentin after retreatment procedures performed using ProTaper Universal Retreatment (PTR), Mtwo-R, ProTaper Next (PTN), and Twisted File Adaptive (TFA) systems. The study consisted of 120 extracted mandibular premolars. One millimeter from the apex of each tooth was ground perpendicular to the long axis of the tooth, and the apical surface was polished. Twenty teeth served as the negative control group. One hundred teeth were prepared, obturated, and then divided into 5 retreatment groups. The retreatment procedures were performed using the following files: PTR, Mtwo-R, PTN, TFA, and hand files. After filling material removal, apical enlargement was done using apical size 0.50 mm ProTaper Universal (PTU), Mtwo, PTN, TFA, and hand files. Digital images of the apical root surfaces were recorded before preparation, after preparation, after obturation, after filling removal, and after apical enlargement using a stereomicroscope. The images were then inspected for the presence of new apical cracks and crack propagation. Data were analyzed with χ 2 tests using SPSS 21.0 software. New cracks and crack propagation occurred in all the experimental groups during the retreatment process. Nickel-titanium rotary file systems caused significantly more apical crack formation and propagation than the hand files. The PTU system caused significantly more apical cracks than the other groups after the apical enlargement stage. This study showed that retreatment procedures and apical enlargement after the use of retreatment files can cause crack formation and propagation in apical dentin.

  4. Interventions for the endodontic management of non-vital traumatised immature permanent anterior teeth in children and adolescents: a systematic review of the evidence and guidelines of the European Academy of Paediatric Dentistry.

    PubMed

    Duggal, M; Tong, H J; Al-Ansary, M; Twati, W; Day, P F; Nazzal, H

    2017-06-01

    This systematic review was undertaken in order to develop guidelines for the European Academy of Paediatric Dentistry for the management of non-vital permanent anterior teeth with incomplete root development. Three techniques were considered; apexification by single or multiple applications of calcium hydroxide, use of Mineral Trioxide Aggregate (MTA) for the creation of an apical plug followed by obturation of the root canal, and finally a Regenerative Endodontic Technique (RET). Scottish Intercollegiate Guideline Network (SIGN) Guidelines (2008) were used for the synthesis of evidence and grade of recommendation. Variable levels of evidence were found and generally evidence related to these areas was found to be weak and of low quality. It was not possible to produce evidence-based guidelines based on the strength of evidence that is currently available for the management of non-vital immature permanent incisors. Based on the available evidence the European Academy of Paediatric Dentistry proposes Good Clinical Practice Points as a guideline for the management of such teeth. It is proposed that the long term use of calcium hydroxide in the root canals of immature teeth should be avoided and apexification with calcium hydroxide is no longer advocated. The evidence related to the use of a Regenerative Endodontic Technique is currently extremely weak and therefore this technique should only be used in very limited situations where the prognosis with other techniques is deemed to be extremely poor. The current review supports the use of MTA followed by root canal obturation as the treatment of choice.

  5. SEM and microCT validation for en face OCT imagistic evaluation of endodontically treated human teeth

    NASA Astrophysics Data System (ADS)

    Negrutiu, Meda L.; Nica, Luminita; Sinescu, Cosmin; Topala, Florin; Ionita, Ciprian; Bradu, Adrian; Petrescu, Emanuela L.; Pop, Daniela M.; Rominu, Mihai; Podoleanu, Adrian Gh.

    2011-03-01

    Successful root canal treatment is based on diagnosis, treatment planning, knowledge of tooth anatomy, endodontic access cavity design, controlling the infection by thorough cleaning and shaping, methods and materials used in root canal obturation. An endodontic obturation must be a complete, three-dimensional filling of the root canal system, as close as possible to cemento-dentinal junction, without massive overfilling or underfilling. There are several known methods which are used to assess the quality of the endodontic sealing, but most are invasive. These lead to the destruction of the samples and often no conclusion could be drawn in respect to the existence of any microleakage in the investigated areas of interest. Using an time domain en-face OCT system, we have recently demonstrated real time thorough evaluation of quality of root canal fillings. The purpose of this in vitro study was to validate the en face OCT imagistic evaluation of endodontically treated human teeth by using scanning electron microscopy (SEM) and microcomputer tomography (μCT). SEM investigations evidenced the nonlinear aspect of the interface between the endodontic filling material and the root canal walls and materials defects in some samples. The results obtained by μCT revealed also some defects inside the root-canal filling and at the interfaces between the material and the root canal walls. The advantages of the OCT method consist in non-invasiveness and high resolution. In addition, en face OCT investigations permit visualization of the more complex stratified structure at the interface between the filling material and the dental hard tissue.

  6. The effect of retreatment procedure on the pH changes at the surface of root dentin using two different calcium hydroxide pastes.

    PubMed

    Kazemipoor, Maryam; Tabrizizadeh, Mehdi; Dastani, Milad; Hakimian, Roqayeh

    2012-10-01

    To compare pH changes at the cervical, middle and apical surfaces of root dentin in retreated and non- retreated teeth, after canal obturation with two different calcium hydroxide pastes. After instrumentation of 55 extracted teeth, three cavities with 0.75 mm depth and 1.5 mm in diameter were drilled at buccal root surface. The teeth were randomly divided into five groups. Canals in the first two groups were filled with either mixture of calcium hydroxide and saline solution and calcium hydroxide and 2% chlorhexidine (CHX). In the third and fourth groups canals were first obturated with gutta-percha and AH26 sealer, and then materials were removed. After 2 days canals were filled with two different calcium hydroxide pastes similar to the first and the second groups. The pH was measured in the prepared cavities at 1, 3, 7 and 14 days. In the non-retreated groups, pH at the surface of the roots was significantly higher in comparison to the retreated ones (P value < 0.001). pH values were significantly higher in the non-retreated teeth filling with calcium hydroxide and saline solution (P value < 0.001). Regarding to the little pH changes at the surface of dentin in retreated teeth, the hydroxyl ions cannot penetrate into the dentinal tubules. Thus, to achieve higher pH at the root surface in retreated teeth, it is clinically advisable to remove more dentin from the inner walls and to use normal saline as a vehicle for calcium hydroxide rather than acidic pH materials.

  7. New simple evaluation method of the monosyllable /sa/ using a psychoacoustic system in maxillectomy patients.

    PubMed

    Chowdhury, Nafees Uddin; Otomaru, Takafumi; Murase, Mai; Inohara, Ken; Hattori, Mariko; Sumita, Yuka I; Taniguchi, Hisashi

    2011-01-01

    An objective assessment of speech would benefit the prosthetic rehabilitation of maxillectomy patients. This study aimed to establish a simple, objective evaluation of monosyllable /sa/ utterances in maxillectomy patients by using a psychoacoustic system typically used in industry. This study comprised two experiments. Experiment 1 involved analysis of the psychoacoustic parameters (loudness, sharpness and roughness) in monosyllable /sa/ utterances by 18 healthy subjects (9 males, 9 females). The utterances were recorded in a sound-treated room. The coefficient of variation (CV) for each parameter was compared to identify the most suitable parameter for objective evaluation of speech. Experiment 2 involved analysis of /sa/ utterances by 18 maxillectomy patients (9 males, 9 females) with and without prosthesis, and comparisons of the psychoacoustic data between the healthy subjects and maxillectomy patients without prosthesis, between the maxillectomy patients with and without prosthesis, and between the healthy subjects and maxillectomy patients with prosthesis. The CV for sharpness was the lowest among the three psychoacoustic parameters in both the healthy males and females. There were significant differences in the sharpness of /sa/ between the healthy subjects and the maxillectomy patients without prosthesis (but not with prosthesis), and between the maxillectomy patients with and without prosthesis. We found that the psychoacoustic parameters typically adopted in industrial research could also be applied to evaluate the psychoacoustics of the monosyllable /sa/ utterance, and distinguished the monosyllable /sa/ in maxillectomy patients with an obturator from that without an obturator using the system. Copyright © 2010 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

  8. Repeat analysis of intraoral digital imaging performed by undergraduate students using a complementary metal oxide semiconductor sensor: An institutional case study.

    PubMed

    Yusof, Mohd Yusmiaidil Putera Mohd; Rahman, Nur Liyana Abdul; Asri, Amiza Aqiela Ahmad; Othman, Noor Ilyani; Wan Mokhtar, Ilham

    2017-12-01

    This study was performed to quantify the repeat rate of imaging acquisitions based on different clinical examinations, and to assess the prevalence of error types in intraoral bitewing and periapical imaging using a digital complementary metal-oxide-semiconductor (CMOS) intraoral sensor. A total of 8,030 intraoral images were retrospectively collected from 3 groups of undergraduate clinical dental students. The type of examination, stage of the procedure, and reasons for repetition were analysed and recorded. The repeat rate was calculated as the total number of repeated images divided by the total number of examinations. The weighted Cohen's kappa for inter- and intra-observer agreement was used after calibration and prior to image analysis. The overall repeat rate on intraoral periapical images was 34.4%. A total of 1,978 repeated periapical images were from endodontic assessment, which included working length estimation (WLE), trial gutta-percha (tGP), obturation, and removal of gutta-percha (rGP). In the endodontic imaging, the highest repeat rate was from WLE (51.9%) followed by tGP (48.5%), obturation (42.2%), and rGP (35.6%). In bitewing images, the repeat rate was 15.1% and poor angulation was identified as the most common cause of error. A substantial level of intra- and interobserver agreement was achieved. The repeat rates in this study were relatively high, especially for certain clinical procedures, warranting training in optimization techniques and radiation protection. Repeat analysis should be performed from time to time to enhance quality assurance and hence deliver high-quality health services to patients.

  9. Ultrasonic irrigation of a maxillary lateral incisor with perforation of the apical third of the root.

    PubMed

    Tsurumachi, Tamotsu; Takita, Toshiya; Hashimoto, Kazuhiro; Katoh, Takeshi; Ogiso, Bunnai

    2010-12-01

    We describe the successful use of a combination of nonsurgical root canal treatment and ultrasonic irrigation for collaborative management of a maxillary left lateral incisor with perforation of the apical third of the root. During the endodontic treatment procedure, the ultrasonically activated tip was used for intracanal irrigation. The area of perforation in the apical third of the root and the main root canal space were obturated with gutta-percha and root canal sealer, using a lateral condensation method. A follow-up clinical and radiographic examination at 5 years after treatment showed an asymptomatic tooth with excellent osseous healing.

  10. Management of an infant with cleft lip and palate with phocomelia in dental practice.

    PubMed

    Muthu, M S

    2000-12-01

    Cleft lip and palate is a severe birth defect occurring approximately one in 800-1000 newborn infants. The incidence varies widely among races. Cleft lip and palate together account for approximately 50% of all cases whereas isolated cleft lip and isolated cleft palate occur in about 25% of cases. Many of these congenital anomalies appear to be genetically determined though the majority are of unknown causes or teratogenic influences. Presented here is a 3 day old infant with bilateral cleft lip and palate and phocomelia for whom a feeding obturator was made and delivered to facilitate feeding.

  11. Arterial and venous plasma levels of bupivacaine following peripheral nerve blocks.

    PubMed

    Moore, D C; Mather, L E; Bridenbaugh, L D; Balfour, R I; Lysons, D F; Horton, W G

    1976-01-01

    Mean arterial plasma (MAP) and peripheral mean venous plasma (MVP) levels of bupivacaine were ascertained in 3 groups of 10 patients each for: (1) intercostal nerve block, 400 mg; (2) block of the sciatic, femoral, and lateral femoral cutaneous nerves, with or without block of the obturator nerve, 400 mg; and (3) supraclavicular brachial plexus block, 300 mg. MAP levels were consistently higher than simultaneously sampled MVP levels, the highest levels occurring from bilateral intercostal nerve block. No evidence of systemic toxicity was observed. The results suggest that bupivacaine has a much wider margin of safety in humans than is now stated.

  12. Patient satisfaction with maxillofacial prosthesis. Literature review.

    PubMed

    Goiato, Marcelo Coelho; Pesqueira, Aldiéris Alves; Ramos da Silva, Cristina; Gennari Filho, Humberto; Micheline Dos Santos, Daniela

    2009-02-01

    Obturators and facial prostheses are important not only in rehabilitation and aesthetics, but also in patient re-socialisation. The level of reintegration is directly related to the degree of satisfaction with rehabilitation. So, the maxillofacial prosthetics must provide patient satisfaction during treatment. This study aimed to search information in database and conduct a literature review on patient satisfaction with maxillofacial prosthesis. The problems experienced by these patients may decrease when specialists keep the patient on regular inspection. Rehabilitation through alloplasty or prosthetic restoration provides satisfactory conditions in aesthetics and well-being and reinstates individuals in familial and social environment.

  13. Unusual anatomy of a maxillary first molar with two palatal roots: a case report.

    PubMed

    Tomazinho, Flávia S F; Baratto-Filho, Flares; Zaitter, Suellen; Leonardi, Denise P; Gonzaga, Carla C

    2010-03-01

    The success of endodontic therapy is based on good endodontic access, correct cleaning and shaping, and adequate root canal obturation. However, endodontic treatment is also dependent on a sound knowledge of the internal anatomy of human teeth, especially when anatomical variations are present. Certain anatomical changes may be present to varying degrees, and it is important to report these to improve the understanding and expertise of endodontic specialists. With this aim in mind, this study reports an example of a maxillary first molar showing unusual anatomy (four roots and six root canals) and describes the endodontic treatment that was employed.

  14. Evaluation of three different rotary systems during endodontic retreatment - Analysis by scanning electron microscopy

    PubMed Central

    Vidal, Flávia-Teixeira; Nunes, Eduardo; Horta, Martinho-Campolina-Rebello; Freitas, Maria-Rita-Lopes-da Silva

    2016-01-01

    Background Endodontic therapy is considered a series of important and interdependent steps, and failure of any of these steps may compromise the treatment outcome. This study aimed to evaluate the effectiveness of three different rotary systems in removing obturation materials during endodontic retreatment using scanning electron microscopy (SEM) analysis. Material and Methods Thirty-six endodontically treated teeth were selected and divided into 3 groups of 10 and 1 control group with 6 dental elements. The groups were divided according to the rotary system used for removing gutta-percha, as follows: G1: ProTaper system; G2: K3 system; G3: Mtwo system; and G4: Control group. Thereafter, the roots were split and the sections were observed under SEM, for analysis and counting of clear dentinal tubules, creating the variable “degree of dentinal tubule patency” (0: intensely clear; 1: moderately clear; 2: slightly clear; 3: completely blocked). The data were subjected to the Friedman and Kruskal-Wallis statistical tests. Results No differences were observed in the “degree of dentinal tubule patency” neither between the root thirds (to each evaluated group) nor between the groups (to each evaluated third). Nevertheless, when the three root thirds were grouped (providing evaluation of all root extension), the “degree of dentinal tubule patency” was lower in G1 than in G3 (p<0.05), but showed no differences neither between G1 and G2 nor G2 and G3. Conclusions No technique was able to completely remove the canal obturation material, despite G1 having shown better results, although without significant difference to G2 Key words:Scanning electron microscopy, NiTi, retreatment. PMID:27034750

  15. Marginal Gaps between 2 Calcium Silicate and Glass Ionomer Cements and Apical Root Dentin.

    PubMed

    Biočanin, Vladimir; Antonijević, Đorđe; Poštić, Srđan; Ilić, Dragan; Vuković, Zorica; Milić, Marija; Fan, Yifang; Li, Zhiyu; Brković, Božidar; Đurić, Marija

    2018-05-01

    The outcome of periapical surgery has been directly improved with the introduction of novel material formulations. The aim of the study was to compare the retrograde obturation quality of the following materials: calcium silicate (Biodentine; Septodont, Saint-Maur-des-Fosses, France), mineral trioxide aggregate (MTA+; Cerkamed Company, Stalowa Wola, Poland), and glass ionomer cement (Fuji IX; GC Corporation, Tokyo, Japan). Materials' wettability was calculated concerning the contact angles of the cements measured using a glycerol drop. Cements' porosity was determined using mercury intrusion porosimetry and micro-computed tomographic (μCT) imaging. Extracted upper human incisors were retrofilled, and μCT analysis was applied to calculate the volume of the gap between the retrograde filling material and root canal dentin. Experiments were performed before and after soaking the materials in simulated body fluid (SBF). No statistically significant differences were found among the contact angles of the studied materials after being soaked in SBF. The material with the lowest nanoporosity (Fuji IX: 2.99% and 4.17% before and after SBF, respectively) showed the highest values of microporosity (4.2% and 3.1% before and after SBF, respectively). Biodentine had the lowest value of microporosity (1.2% and 0.8% before and after SBF, respectively) and the lowest value of microgap to the root canal wall ([10 ± 30] × 10 -3  mm 3 ). Biodentine and MTA possess certain advantages over Fuji IX for hermetic obturation of retrograde root canals. Biodentine shows a tendency toward the lowest marginal gap at the cement-to-dentin interface. Copyright © 2018 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  16. The effect of retreatment procedure on the pH changes at the surface of root dentin using two different calcium hydroxide pastes

    PubMed Central

    Kazemipoor, Maryam; Tabrizizadeh, Mehdi; Dastani, Milad; Hakimian, Roqayeh

    2012-01-01

    Aim: To compare pH changes at the cervical, middle and apical surfaces of root dentin in retreated and non- retreated teeth, after canal obturation with two different calcium hydroxide pastes. Materials and Methods: After instrumentation of 55 extracted teeth, three cavities with 0.75 mm depth and 1.5 mm in diameter were drilled at buccal root surface. The teeth were randomly divided into five groups. Canals in the first two groups were filled with either mixture of calcium hydroxide and saline solution and calcium hydroxide and 2% chlorhexidine (CHX). In the third and fourth groups canals were first obturated with gutta-percha and AH26 sealer, and then materials were removed. After 2 days canals were filled with two different calcium hydroxide pastes similar to the first and the second groups. The pH was measured in the prepared cavities at 1, 3, 7 and 14 days. Results: In the non-retreated groups, pH at the surface of the roots was significantly higher in comparison to the retreated ones (P value < 0.001). pH values were significantly higher in the non-retreated teeth filling with calcium hydroxide and saline solution (P value < 0.001). Conclusion: Regarding to the little pH changes at the surface of dentin in retreated teeth, the hydroxyl ions cannot penetrate into the dentinal tubules. Thus, to achieve higher pH at the root surface in retreated teeth, it is clinically advisable to remove more dentin from the inner walls and to use normal saline as a vehicle for calcium hydroxide rather than acidic pH materials. PMID:23112482

  17. Establishing Apical Patency: To be or not to be?

    PubMed

    Mohammadi, Zahed; Jafarzadeh, Hamid; Shalavi, Sousan; Kinoshita, Jun-Ichiro

    2017-04-01

    The apical portion of the root canal is very complex and challenging during endodontic treatment. Root canal preparation and obturation to the apical constriction may provide the best prognosis. Incomplete debridement, foramen transportation, and inadequate seal in the apical portion are considered to be responsible for treatment failure. The technique "apical patency" is considered as a way for maintaining the apical part the free of the debris by recapitulation, using a small K-file through the area of the apical foramen. This term was firstly proposed by Buchanan. In this technique, the smallest diameter file is set 1 mm longer than working length and recapitulated after each instrument to prevent packing of debris in the apical part. Apical patency has been found to be effective in achieving an apical seal with gutta-percha. Teeth prepared with a step back method and with maintained apical patency may show less leakage when obturated with cold lateral condensation technique. Data regarding the effect of apical patency on the healing of periapical tissue are very scarce, and it has been shown that the patency file has detrimental effect on the healing of periapical tissues in animal studies. However, using patency file in endodontic treatment is controversial and further studies are needed. The purpose of this article is to review the effect of using a patency file on the extrusion of root canal contents, the apical seal, postoperative pain, and healing of periapical tissues. Furthermore, the effect of establishing patency on reaching irrigation solutions to the apical portion of the canal and prognosis of root canal treatment are discussed. Keywords: Apical patency, Apical seal, Apical transportation, Postoperative pain, Prognosis.

  18. An Alternative Prosthetic Approach for Rehabilitation of Two Edentulous Maxillectomy Patients: Clinical Report.

    PubMed

    Yenisey, Murat; Külünk, Şafak; Kaleli, Necati

    2017-07-01

    Obturator prosthesis is a common treatment method for maxillectomy patients for maintaining their oronasal separation and resuming their social lives. After tumor resection, the remaining anatomical structures have a significant effect on prosthesis retention. The present study describes the rehabilitation of two maxillectomy patients after cancer surgery using a prosthesis consisting of a denture and a special retentive obturator that is positioned in the anatomical undercuts of the nasal cavity. These patients have undergone total and subtotal maxillectomy surgery after the diagnosis of squamous cell carcinoma. The systemic and local health status of the total maxillectomy patient was not suitable for zygomatic implant surgery. Only one osseointegrated dental implant was placed into the left maxillary tuberosity area in the subtotal maxillectomy patient. In addition, the quality, vertical height, and horizontal width of the remaining bone structures in the maxilla limited the use of osseointegrated dental implants. Mechanical prosthesis retention was provided using a multiunit retentive mechanism composed of an orthodontic forsus fatigue resistant device (OFFRD), two Herbst appliances, and an acrylic piece associated with healthy keratinized mucosa. The OFFRD could easily apply a consistent force and push the acrylic pieces toward the retentive undercut under the control of the two Herbst appliances. Two OFFRD units in different directions were designed for the total maxillectomy patient, while only one OFFRD unit was placed on the opposite side of the osseointegrated implant in the subtotal maxillectomy patient. A sufficient retention was obtained for both patients. The patients were satisfied, and no major complications were observed in periodic controls. © 2017 by the American College of Prosthodontists.

  19. Bacterial Reduction after Gutta-Percha Removal with Single vs. Multiple Instrument Systems.

    PubMed

    Xavier, Felipe; Nevares, Giselle; Gominho, Luciana; Rodrigues, Renata; Cassimiro, Marcely; Romeiro, Kaline; Albuquerque, Diana

    2018-01-01

    The aim of this study was to evaluate the effectiveness of a reciprocating single-instrument system (Reciproc-REC) compared with combined continuously rotating multiple-instrument systems [D-Race (DR) and BioRace (BR)] in reducing Enterococcus faecalis (E.f.) after gutta-percha removal. Forty-six extracted human maxillary incisors were prepared and contaminated with E.f. strain (ATCC 29212) for 30 days. The samples were obturated and randomly divided into two experimental groups for gutta-percha removal ( n =23): a REC group (R50) and a DR/BR group (DR1, DR2 and BR6). A standardized irrigation with 0.9% saline solution was performed. Root canal samples were taken with paper points before (S1) and after (S2) the removal of gutta-percha to establish bacterial quantification by culture. The time required for gutta-percha removal was also recorded. Positive and negative control groups ( n =6) were used to test bacterial viability and control asepsis, respectively. Data were analysed using t -Student and one-way ANOVA tests (5% margin of error). The mean percentage of bacterial reduction was significantly higher in DR/BR group (84.2%) than in REC group (72.3%) ( P <0.05). The mean time for obturation removal was 74.00 sec in REC group and 107.53 sec in DR/BR group ( P <0.05). The combined continuously rotating multiple-instrument system was more effective in reducing bacteria after the removal of gutta-percha than the single-instrument system. None of the tested systems was able to completely eliminate root canal infection after gutta-percha removal. Thus, additional techniques should be considered.

  20. Repeat analysis of intraoral digital imaging performed by undergraduate students using a complementary metal oxide semiconductor sensor: An institutional case study

    PubMed Central

    Rahman, Nur Liyana Abdul; Asri, Amiza Aqiela Ahmad; Othman, Noor Ilyani; Wan Mokhtar, Ilham

    2017-01-01

    Purpose This study was performed to quantify the repeat rate of imaging acquisitions based on different clinical examinations, and to assess the prevalence of error types in intraoral bitewing and periapical imaging using a digital complementary metal-oxide-semiconductor (CMOS) intraoral sensor. Materials and Methods A total of 8,030 intraoral images were retrospectively collected from 3 groups of undergraduate clinical dental students. The type of examination, stage of the procedure, and reasons for repetition were analysed and recorded. The repeat rate was calculated as the total number of repeated images divided by the total number of examinations. The weighted Cohen's kappa for inter- and intra-observer agreement was used after calibration and prior to image analysis. Results The overall repeat rate on intraoral periapical images was 34.4%. A total of 1,978 repeated periapical images were from endodontic assessment, which included working length estimation (WLE), trial gutta-percha (tGP), obturation, and removal of gutta-percha (rGP). In the endodontic imaging, the highest repeat rate was from WLE (51.9%) followed by tGP (48.5%), obturation (42.2%), and rGP (35.6%). In bitewing images, the repeat rate was 15.1% and poor angulation was identified as the most common cause of error. A substantial level of intra- and interobserver agreement was achieved. Conclusion The repeat rates in this study were relatively high, especially for certain clinical procedures, warranting training in optimization techniques and radiation protection. Repeat analysis should be performed from time to time to enhance quality assurance and hence deliver high-quality health services to patients. PMID:29279822

  1. Successful nonsurgical endodontic outcome of a severely affected permanent maxillary canine with dens invaginatus Oehlers type 3.

    PubMed

    Brooks, John K; Ribera, Michael J

    2014-10-01

    The morphogenic complexities of dens invaginatus (DI) Oehlers type 3 in maxillary canines offer significant endodontic challenges. A case report is provided of a 14-year-old female patient who presented with an anomalous-looking permanent maxillary canine associated with a sinus tract. Pulp testing revealed a normal response on the distal aspect of the tooth, whereas the mesial segment tested nonresponsive. A radiolucent lesion was seen on the mesiolateral radicular area adjacent to the severely distended pulp chamber. A gutta-percha point inserted into the sinus tract traced to this same region. The diagnosis was normal pulp coincident with DI Oehlers type 3 with pulp necrosis and chronic apical abscess. Despite a concerted effort to limit the root canal therapy to only the necrotic canal, its proximity to the normal canal obviated this possibility, entailing endodontic treatment of the entire root canal system. The necrotic pulp space was subjected to sustained irrigation with 5.25% sodium hypochlorite and then completed with 17% ethylenediaminetetraacetic acid. A bolus of gutta-percha was used to create an apical barrier, and then the remainder of the enlarged pulp space was obturated with injectable thermoplasticized gutta-percha. At a 4.5-year recall, there was no clinical and radiographic evidence of infection. Endodontic success was accomplished with meticulous efforts of disinfection. Thermoplasticized gutta-percha can offer utility for obturation of anatomically complicated pulp spaces. The use of the dental operating microscope is an invaluable aid for discernment of the intricacies of teeth affected with DI type 3 variant and can enhance clinical outcomes. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  2. Vestibular thalamus: Two distinct graviceptive pathways.

    PubMed

    Baier, Bernhard; Conrad, Julian; Stephan, Thomas; Kirsch, Valerie; Vogt, Thomas; Wilting, Janine; Müller-Forell, Wibke; Dieterich, Marianne

    2016-01-12

    To determine whether there are distinct thalamic regions statistically associated with either contraversive or ipsiversive disturbance of verticality perception measured by subjective visual vertical (SVV). We used modern statistical lesion behavior mapping on a sample of 37 stroke patients with isolated thalamic lesions to clarify which thalamic regions are involved in graviceptive otolith processing and whether there are distinct regions associated with contraversive or ipsiversive SVV deviation. We found 2 distinct systems of graviceptive processing within the thalamus. Contraversive tilt of SVV was associated with lesions to the nuclei dorsomedialis, intralamellaris, centrales thalami, posterior thalami, ventrooralis internus, ventrointermedii, ventrocaudales and superior parts of the nuclei parafascicularis thalami. The regions associated with ipsiversive tilt of SVV were located in more inferior regions, involving structures such as the nuclei endymalis thalami, inferior parts of the nuclei parafascicularis thalami, and also small parts of the junction zone of the nuclei ruber tegmenti and brachium conjunctivum. Our data indicate that there are 2 anatomically distinct graviceptive signal processing mechanisms within the vestibular network in humans that lead, when damaged, to a vestibular tone imbalance either to the contraversive or to the ipsiversive side. © 2015 American Academy of Neurology.

  3. Improvement of Isolated Myoclonus Phenotype in Myoclonus Dystonia after Pallidal Deep Brain Stimulation

    PubMed Central

    Ramdhani, Ritesh A.; Frucht, Steven J.; Behnegar, Anousheh; Kopell, Brian H.

    2016-01-01

    Background Myoclonus–dystonia is a condition that manifests predominantly as myoclonic jerks with focal dystonia. It is genetically heterogeneous with most mutations in the epsilon sarcoglycan gene (SGCE). In medically refractory cases, deep brain stimulation (DBS) has been shown to provide marked sustainable clinical improvement, especially in SGCE-positive patients. We present two patients with myoclonus–dystonia (one SGCE positive and the other SGCE negative) who have the isolated myoclonus phenotype and had DBS leads implanted in the bilateral globus pallidus internus (GPi). Methods We review their longitudinal Unified Myoclonus Rating Scale scores along with their DBS programming parameters and compare them with published cases in the literature. Results Both patients demonstrated complete amelioration of all aspects of myoclonus within 6–12 months after surgery. The patient with the SGCE-negative mutation responded just as well as the patient who was SGCE positive. High-frequency stimulation (130 Hz) with amplitudes greater than 2.5 V provided therapeutic benefit. Discussion This case series demonstrates that high frequency GPi-DBS is effective in treating isolated myoclonus in myoclonus–dystonia, regardless of the presence of SGCE mutation. PMID:26989574

  4. Movement disorders and chronic psychosis

    PubMed Central

    Morgante, Francesca

    2017-01-01

    Abstract Purpose of review: To discuss selected peer-reviewed research articles published between 2014 and 2016 and highlight 5 clinically relevant messages related to hyperkinetic and hypokinetic movement disorders in patients with chronic psychosis. Recent findings: A recent population-based study complemented data from clinical trials in showing increased risk of developing extrapyramidal symptoms with antipsychotic use. A community service–based longitudinal study showed that dopamine transporter imaging could help identify subgroups of patients with parkinsonism associated with antipsychotics with a progressive course, potentially manageable with l-dopa. Data from recent noteworthy clinical trials showed that a new VMAT-2 inhibitor and, for pharmacologically refractory tardive dyskinesia, deep brain stimulation of the globus pallidus internus are promising interventions. Finally, a population-based study has confirmed that hyperkinesias (encompassing chorea, dystonia, and stereotypies) may be early predictors of psychosis even in childhood and adolescence. Summary: Movement disorders associated with new-generation antipsychotics, including widely used agents (e.g., aripiprazole), are not rare occurrences. Better monitoring is needed to assess their true effect on patients' quality of life and functioning and to prevent underascertainment. PMID:29185545

  5. Deep brain stimulation for the treatment of uncommon tremor syndromes.

    PubMed

    Ramirez-Zamora, Adolfo; Okun, Michael S

    2016-08-01

    Deep brain stimulation (DBS) has become a standard therapy for the treatment of select cases of medication refractory essential tremor and Parkinson's disease however the effectiveness and long-term outcomes of DBS in other uncommon and complex tremor syndromes has not been well established. Traditionally, the ventralis intermedius nucleus (VIM) of the thalamus has been considered the main target for medically intractable tremors; however alternative brain regions and improvements in stereotactic techniques and hardware may soon change the horizon for treatment of complex tremors. In this article, we conducted a PubMed search using different combinations between the terms 'Uncommon tremors', 'Dystonic tremor', 'Holmes tremor' 'Midbrain tremor', 'Rubral tremor', 'Cerebellar tremor', 'outflow tremor', 'Multiple Sclerosis tremor', 'Post-traumatic tremor', 'Neuropathic tremor', and 'Deep Brain Stimulation/DBS'. Additionally, we examined and summarized the current state of evolving interventions for treatment of complex tremor syndromes. Expert commentary: Recently reported interventions for rare tremors include stimulation of the posterior subthalamic area, globus pallidus internus, ventralis oralis anterior/posterior thalamic subnuclei, and the use of dual lead stimulation in one or more of these targets. Treatment should be individualized and dictated by tremor phenomenology and associated clinical features.

  6. Bilateral presence of two root canals in maxillary central incisors: A rare case study.

    PubMed

    Kavitha, M; Gokul, Kannan; Ramaprabha, B; Lakshmi, Amudha

    2014-04-01

    Success in root canal treatment is achieved after thorough cleaning and shaping followed by complete obturation of the canal system. Therefore, endodontic therapy requires specific and complete knowledge of the internal and external dental anatomy, and its variations in presentation. The internal anatomy of the maxillary central incisor is well-known and usually presents one root canal system. This case report describes an endodontic treatment of traumatized both maxillary central incisors with two canal systems. Knowledge of dental anatomy is fundamental for proper endodontic practice. When root canal treatment is performed, the clinician should be aware that both external and internal anatomy may be abnormal.

  7. In vitro radicular temperatures produced by injectable thermoplasticized gutta-percha.

    PubMed

    Weller, R N; Koch, K A

    1995-03-01

    In vitro temperatures produced in the root canal and on the root surface were measured simultaneously as heated gutta-percha was injected into the prepared canal. The canals were obturated with the Obtura II heated gutta-percha system with temperature settings of 160, 185, and 200 degrees C. The mean intracanal temperatures ranged from 40.21 to 57.24 degrees C, whereas the mean root surface temperatures were recorded from 37.22 to 41.90 degrees C for all three temperatures tested. The rise in temperature on the root surface was below the critical level of 10 degrees C and should not cause damage to the periodontal ligament.

  8. Endodontic management of a fused mandibular third molar and distomolar: a case report.

    PubMed

    Zeylabi, Ali; Shirani, Farzaneh; Heidari, Fatemeh; Farhad, Ali Reza

    2010-04-01

    Careful management of fused teeth is essential as abnormal morphology can predispose a tooth to caries and periodontal disease. In this paper, a rare case of successful endodontic management of unilateral mandibular third molar fused to a distomolar is reported. Caries was removed from the tooth complex under local anaesthesia. The pulp chambers of the third molar and supernumerary tooth were accessed and the root canals were prepared using rotary instrumentation and copious irrigation with 2.5% sodium hypochlorite. Obturation using the lateral condensation technique with gutta-percha and AH26 sealer was subsequently performed. A 1-year recall showed a good treatment result.

  9. Three rooted, four canalled mandibular first molar (Radix Entomolaris).

    PubMed

    Parolia, Abhishek; Kundabala, M; Thomas, M S; Mohan, M; Joshi, N

    2009-01-01

    A mandibular first molar with two distal roots is an interesting example of anatomic variation. This paper describes case reports of mandibular first molar with three roots (one mesial and two distal) and four canals (two in mesial and one in each distobuccal and distolingual root). The canals were shaped with protaper rotary files and irrigated with 5.25% sodium hyochlorite, 0.2 %w/v of chlorhexidine gluconate and normal saline as the fi nal irrigant. The canals were then obturated with gutta- percha and AH plus sealer. These case reports show an anatomic variation of internal morphology of the tooth and points out the importance of searching for additional canals.

  10. [Subtotal colectomy in emergency situations].

    PubMed

    Slauf, P; Antos, F; Kálal, J; Malý, P

    1995-05-01

    One-stage subtotal colectomy is the most radical solution of ileous conditions caused by an obturating tumour of the left half of the colon. The authors report on their experience with this procedure in 10 patients operated in the course of three years. They emphasize the advantages such as oncological radicality, immediate detoxication of the organism, a favourable postoperative course with a low morbidity (10% dehiscences) and lethality (10%), shorter hospitalization period, life of the patients without a stoma, lower costs and satisfactory functional results. For an experienced surgeon, if perfect intensive postoperative care is available, this operation is the method of choice even in very old patients.

  11. Failure of endodontic treatment: The usual suspects.

    PubMed

    Tabassum, Sadia; Khan, Farhan Raza

    2016-01-01

    Inappropriate mechanical debridement, persistence of bacteria in the canals and apex, poor obturation quality, over and under extension of the root canal filling, and coronal leakage are some of the commonly attributable causes of failure. Despite the high success rate of endodontic treatment, failures do occur in a large number of cases and most of the times can be attributed to the already stated causes. With an ever increasing number of endodontic treatments being done each day, it has become imperative to avoid or minimize the most fundamental of reasons leading to endodontic failure. This paper reviews the most common causes of endodontic failure along with radiographic examples.

  12. Failure of endodontic treatment: The usual suspects

    PubMed Central

    Tabassum, Sadia; Khan, Farhan Raza

    2016-01-01

    Inappropriate mechanical debridement, persistence of bacteria in the canals and apex, poor obturation quality, over and under extension of the root canal filling, and coronal leakage are some of the commonly attributable causes of failure. Despite the high success rate of endodontic treatment, failures do occur in a large number of cases and most of the times can be attributed to the already stated causes. With an ever increasing number of endodontic treatments being done each day, it has become imperative to avoid or minimize the most fundamental of reasons leading to endodontic failure. This paper reviews the most common causes of endodontic failure along with radiographic examples. PMID:27011754

  13. Root Canal Treatment of Mandibular Second Premolar with Three Separate Roots and Canals Using Spiral Computed Tomographic

    PubMed Central

    Hariharavel, V. P.; Kumar, A. Ashok; Ganesh, C.; Aravindhan, R.

    2014-01-01

    Anatomic and internal morphology of a root canal system is more complex and differs for each individual tooth of which mandibular premolars have earned the reputation for having aberrant anatomy. The occurrence of three canals with three separate foramina in mandibular second premolars is very rare. A wider knowledge on both clinical and radiological anatomy especially spiral computed tomographic is absolutely essential for the success of endodontic treatment. These teeth may require skillful and special root canal special shaping and obturating techniques. This paper reports an unusual case of a mandibular second premolar with atypical canal pattern that was successfully treated endodontically. PMID:25101187

  14. Numerical Simulation of Fluid Dynamics and Combustion for Ram Accelerator Projectile/Obturator Interaction

    DTIC Science & Technology

    1993-09-01

    dependence obtained from tabulated data ( Stull 1971). p,/W = A, + A2T + A3T 2 + A4T3 + A5T4 (13) For N species only N - 1 specie equations must be solved...Calculations," AIAA Journal, Vol. 21, No. 4, April 1983, pp. 586-592. Stull , D.R., and Prophet, H., ".JANNAF Thermochemical Tables," 2nd ed., National Bureau of...Command Development and Engineering Center ATTN: AMCPNI-ABNIS. T. Dean ATTN: SMCAR-FSA-F. LTC R. Riddle Warien. MI 48092-2498 SMCAR-FSC. G. Ferdinand

  15. Comparison of TVT, TVT-O/TOT and mini slings for the treatment of female stress urinary incontinence: 30 months follow up in 531 patients.

    PubMed

    Stavros, Charalambous; Ioannis, Vouros; Vasileios, Sakalis I; Gkotsi, Anastasia Ch; Georgios, Salpiggidis; Papathanasiou, Athanasios; Rombis, Vasileios

    2012-09-01

    Although mid-urethral slings (MUS), have been extensively used for the treatment of female stress urinary incontinence (SUI), no published data exists for the efficiency and the complications of these methods in large patient series. This is a retrospective analysis on patients who underwent MUS surgery since 1999. 531 patients were studied and the results of preoperative assessment, perioperative, early postoperatively and each follow up were registered. Patients were classified in three groups according to the MUS used. Efficacy of each method was evaluated in terms of early postoperative course, late complications and patient's symptoms improvement based questioners, pad test, uroflowmetry, filling cystometry and ultrasonography. Evaluation took place at 7th and 30th postoperative day, 3rd and 12th month and then annually. Each patient was characterized as cured, improved or failed. Trans Obturator (TO) group prevailed in efficiency with no significant differences between trans obturator route with inside-out (TVT-O) and outside-in (TOT). Success rate at 30th month evaluation, was higher in the TO group than in Tension-free Vaginal Tape (TVT) or Single-Incision Mini Slings (SIMS) group (93.4% vs 89.5%, 93.4% vs. 91.7%). None TVT patient required reoperation for remaining/reoccurring SUI, while 1.04% of TO group and 5.48% of SIMS group did. Patients of TVT group underwent reoperation for tape related complications in 2.25%, while 2.07% of TO group and none of SIMS group did. The potential limitation of the study is its retrospective character. Even though TO tapes and SIMS seem more efficient than TVT, they carry a risk of SUI re-occurrence that must be weighted towards the risk of potential complications after TVT.

  16. Sealer penetration into dentinal tubules in the presence or absence of smear layer: a confocal laser scanning microscopic study.

    PubMed

    Kuçi, Astrit; Alaçam, Tayfun; Yavaş, Ozer; Ergul-Ulger, Zeynep; Kayaoglu, Guven

    2014-10-01

    The aim of this study was to test the dentinal tubule penetration of AH26 (Dentsply DeTrey, Konstanz, Germany) and MTA Fillapex (Angelus, Londrina, PR, Brazil) in instrumented root canals obturated by using cold lateral compaction or warm vertical compaction techniques in either the presence or absence of the smear layer. Forty-five extracted single-rooted human mandibular premolar teeth were used. The crowns were removed, and the root canals were instrumented by using the Self-Adjusting File (ReDent-Nova, Ra'anana, Israel) with continuous sodium hypochlorite (2.6%) irrigation. Final irrigation was either with 5% EDTA or with sodium hypochlorite. The canals were dried and obturated by using rhodamine B-labeled AH26 or MTA Fillapex in combination with the cold lateral compaction or the warm vertical compaction technique. After setting, the roots were sectioned horizontally at 4-, 8-, and 12-mm distances from the apical tip. On each section, sealer penetration in the dentinal tubules was measured by using confocal laser scanning microscopy. Regardless of the usage of EDTA, MTA Fillapex, compared with AH26, was associated with greater sealer penetration when used with the cold lateral compaction technique, and, conversely, AH26, compared with MTA Fillapex, was associated with greater sealer penetration when used with the warm vertical compaction technique (P < .05). Removal of the smear layer increased the penetration depth of MTA Fillapex used with the cold lateral compaction technique (P < .05); however, it had no significant effect on the penetration depth of AH26. Greater sealer penetration could be achieved with either the MTA Fillapex-cold lateral compaction combination or with the AH26-warm vertical compaction combination. Smear layer removal was critical for the penetration of MTA Fillapex; however, the same did not hold for AH26. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  17. On the surgery of the vas deferens.

    PubMed

    Michalowski, E; Modelski, W

    1971-01-01

    The most frequent indication for blocking the vas arises in prostatic surgery. By dividing the vas, the urethro-vasal reflux, an etiological factor in postoperative epididymitis, is eliminated. If infection is already present, blocking may be ineffective. Also it may be ineffective if performed at the termination of a prostatic operation because during such surgery infectious material may be pressed into the genital tract. In family planning recanalization of a divided vas has been observed. However surgical recanalization has but limited chances of success. A method of temporary reversible blockade would probably popularize this procedure. A method is described in which the stumps of the divided vas are exteriorized instead of being buried in the scrotum. Recanalization, funiculitis, and spermatic granuloma are thus avoided. Clamping of the vas was found to be unsatisfactory. Obturation of the vas with silver wire or nylon thread in the lumen was then used. The obturated vas was then exteriorized by wrapping it around with scrotal skin thus producing a "coffee handle" effect. This avoided complications following burying the occluded vas in the scrotum. Vasography with contrast fluid showed that it was necessary to adjust the calibre of the obstructing agent to the vasal lumen. Microscopic examination after 1-2 weeks showed only slight inflammatory reaction from the silver wire. After removal of the wire normal patency was restored. However the nylon thread caused destructive changes ending in complete obstruction of the lumen. Severence of the "coffee handle" permitted retraction of the stumps of the vas so that attempts at surgical reunion would be made more difficult. Ligation of the exteriorized vas in the "coffee handle" by black silk thread proved best. The blockade is thus assured and secondary recanalization facilitated if desired.

  18. Computer-aided insertion of endosteal implants in the zygoma: a pilot study

    NASA Astrophysics Data System (ADS)

    Birkfellner, Wolfgang; Watzinger, Franz; Wanschitz, Felix; Ziya, F.; Kremser, J.; Potyka, A.; Mayr, R.; Huber, Klaus; Kainberger, F.; Ewers, Rolf; Bergmann, Helmar

    2000-04-01

    Endosteal implants facilitate obturator prosthesis fixation in tumor patients after maxillectomy. Previous clinical studies shown however, that survival of implants placed into available bone after maxillectomy is generally poor. Implants positioned optimally in residual zygomatic bone provide superior stability form a biomechanical point of view as well as improved survival. In a pilot study, we have assessed the precision of VISIT, a surgical navigation system developed for research purposes at our institution. VISIT is based on the AVW-library and a number of in-house developed algorithms for communication with an optical tracker and patient-to-CT-registration. The final platform independent application was assembled within 6 man-months using ANSI-C and Tcl/Tk. Five cadaver specimens underwent hemimaxillectomy. The cadaver head was matched to a preoperative high resolution CT by using implanted surgical microscrews as fiducial markers. The position of a surgical drill relative to the cadaver head was determined with an optical tracking system. Implants were placed into the zygomatic arch where maximum bone volume was available. The results were assessed using test for allocation accuracy and postoperative CT-scans of the cadaver specimens. The average allocation accuracy of landmarks on the bony skull was 0.6 +/- 0.3 mm determined with a 5 degree-of-freedom pointer probe. The allocation accuracy of the tip of the implant burr was 1.7 +/- 0.4 mm. The accuracy of the implant position compared to the planned position was 1.5 +/- 1.1 mm. 8 out of 10 implants were inserted with maximum contact to surrounding bone, two implants were located unfavorably. However, reliable placement of implants in this region is difficult to achieve. The techqni3u described in this paper may be very helpful in the management of patients after maxillary resection without sufficient retention for obturator prostheses.

  19. Pre-prosthetic surgical alterations in maxillectomy to enhance the prosthetic prognoses as part of rehabilitation of oral cancer patient.

    PubMed

    El Fattah, H; Zaghloul, A; Pedemonte, E; Escuin, T

    2012-03-01

    After maxillectomy, prosthetic restoration of the resulting defect is an essential step because it signals the beginning of patient's rehabilitation. The obturator used to restore the defect should be comfortable, restore adequate speech, deglutition, mastication, and be cosmetically acceptable, success will depend on the size and location of the defect and the quantity and integrity of the remaining structures, in addition to pre-prosthetic surgical preparation of defect site. Preoperative cooperation between the oncologist surgeon and the maxillofacial surgeon may allow obturation of a resultant defect by preservation of the premaxilla or the tuberosity on the defect side and maintaining the alveolar bone or teeth adjacent to the defect. This study evaluates the importance of pre-prosthetic surgical alterations at the time maxillectomy on the enhancement of the prosthetic prognoses as part of the rehabilitation of oral cancer patient. The study was carried out between 2003- 2008, on 66 cancer patients(41 male-25 female) age ranged from 33 to 72 years, at National Cancer Institute, Cairo University, whom underwent maxillectomy surgery to remove malignant tumor as a part of cancer treatment. Patients were divided in two groups. Group A: Resection of maxilla followed by preprosthetic surgical preparation. Twenty-four cancer patients (13 male - 11 female). Group B: Resection of maxilla without any preprosthetic surgical preparation. Forty-two cancer patients (28 male-14 female). Outcome variables measured included facial contour and aesthetic results, speech understandability, ability to eat solid foods, oronasal separation, socializing outside the home, and return-to-work status. Flap success and donor site morbidity were also studied. To improve the prosthetic restoration of maxillary defect resulting maxillary resection as part treatment of maxillofacial tumor depends on the close cooperation between prosthodontist and surgeon, by combination of pre

  20. Thermafil: A New Clinical Approach Due to New Dimensional Evaluations

    PubMed Central

    Vittoria, G.; Pantaleo, G.; Blasi, A.; Spagnuolo, G.; Iandolo, A.; Amato, M.

    2018-01-01

    Background: There are a lot of techniques to obturate the root canals, but lateral condensation of gutta-percha is the most used one. An important aspect of thermafil is the error margin tolerated by the manufacturer in the production of plastic carriers. In literature, there is no evidence about discrepancy percentage between different carriers. It is demonstrated that the error margin of gutta-percha is 0.5% and is 0.2% for metal files (ISO standards). Objective: The aim of this study was to evaluate the real dimensions of thermafil plastic carriers observed by the stereo microscope measuring the dimensional discrepancy between them. Methods: For this study, 80 new thermafil (Dentsply Maillefer) have been selected. 40 thermafil 0.25 and 40 thermafil 0.30. Through 60X stereo microscope, the dimensions of the plastic carrier tips have been measured. The dimensions of the plastic carrier were also measured after a heating cycle. ZL GAL 11TUSM (Zetaline stereo evolution) microscope was used to observe the samples. Measurements were made through a dedicated software (Image Focus). All samples were analysed at 60X. Results: A non-parametric paired test (Wilcoxon test) was used to compare baseline and after heating values; p-values ≤ 0.05 were assumed to be statistically significant. Conclusion: The samples we measured showed a mean value of the diameters in Thermafil 25 that was 0.27 mm, for Thermafil 30 the mean value was 0.33 mm. We have measured a dimensional variable of 8% in the 25 group while in group 30 the maximum possible variation found was 4%, that’s why we propose a new protocol of obturation with thermafil. We can also conclude that a single heating process does not affect clinically the plastic carrier dimensions. PMID:29541263

  1. In vitro evaluation of the sealing ability of three newly developed root canal sealers: A bacterial microleakage study

    PubMed Central

    Sobhani, Ehsan; Samadi-Kafil, Hossein; Pirzadeh, Ahmad; Jafari, Sanaz

    2016-01-01

    Background The purpose of this study was to compare the sealing ability of MTA Fillapex, Apatite Root Canal Sealer and AH26 sealers. Material and Methods The present in vitro study was carried out on 142 extracted single-rooted human mature teeth. The teeth were randomly divided into three experimental groups (n=44) and two control groups (n=5). Three root canal sealers were MTA Fillapex, Apatite Root Canal Sealer and AH26. The teeth in the control groups were either filled with no sealer or made completely impermeable. The root canals were prepared and obturated with gutta-percha and one of the sealers. The teeth were sterilized with ethylene oxide gas prior to the bacterial leakage assessment using Enterococcus faecalis. Leakage was evaluated every 24 hours for 90 days. Data were analyzed with descriptive statistical methods and chi-squared test. If the data were significant, a proper post hoc test was used. Statistical significance was set at P<0.05. Results The positive control specimens exhibited total bacterial penetration whilst the negative control specimens showed no evidence of bacterial penetration. At the end of the study, the analysis of microleakage with chi-squared test showed no significant differences between the experimental groups (P<0.05). The results of chi-squared test analyzing the pair-wise differences between the groups considering the numerical values for leakage day indicated the lowest leakage with AH26 and the highest with Apatite root sealer. Conclusions According to the results of the present study, sealing ability of AH26 was significantly higher than that of MTA Fillapex and Apatite Root Canal Sealer. Key words:Mineral Trioxide aggregate, root canal obturation, dental seal. PMID:27957271

  2. Osseocutaneous radial forearm free tissue transfer for repair of complex midfacial defects.

    PubMed

    Chepeha, Douglas B; Moyer, Jeffrey S; Bradford, Carol R; Prince, Mark E; Marentette, Lawrence; Teknos, Theodoros N

    2005-06-01

    To evaluate the resulting aesthetics, function, and donor site morbidity of the osseocutaneous radial forearm free flap (OCRFFF) used for midface reconstruction. Prospective case series and a retrospective review of results. Ten patients from an academic practice who underwent reconstruction at the University of Michigan Hospitals between 1995 and 2001. All patients had maxillectomy defects in which the entire infraorbital rim was reconstructed with an OCRFFF. Of the 10 patients included in the study, 3 underwent a total maxillectomy with orbital exenteration, 4 had a total maxillectomy without orbital exenteration, and 3 had a limited maxillectomy that did not involve the palate. Patients with palatal defects underwent reconstruction with a prosthetic palatal obturator. Facial contour and aesthetic results, speech understandability, ability to eat solid foods, oronasal separation, socializing outside the home, and return-to-work status. Flap success, donor site morbidity, and orbital complications were also studied. Mean +/- SEM follow-up was 23.2 +/- 5.0 months. A modified Funk facial deformity scale was used, and 7 of the 10 patients had either no deformity or minimal deformity. The mean aesthetic score for these reconstructions was 2.1 +/- 0.3 on a scale of 1 to 4, with 1 representing no deformity and 4 representing a severe deformity. All patients returned to a solid diet and had understandable speech, although patients who had an orbital exenteration trended to poorer scores. All patients socialized either frequently or occasionally outside the home, and all patients not retired or disabled prior to surgery returned to work. The OCRFFF reconstruction of the infraorbital rim in patients with total maxillectomy defects and obturator of the palatal defect controls orbital complications and optimizes aesthetic outcome while achieving nearly normal palatal function.

  3. Understanding Lymphatic Drainage Pathways of the Ovaries to Predict Sites for Sentinel Nodes in Ovarian Cancer

    PubMed Central

    Kleppe, Marjolein; Kraima, Anne C.; Kruitwagen, Roy F.P.M.; Van Gorp, Toon; Smit, Noeska N.; van Munsteren, Jacoba C.; DeRuiter, Marco C.

    2015-01-01

    Objective In ovarian cancer, detection of sentinel nodes is an upcoming procedure. Perioperative determination of the patient’s sentinel node(s) might prevent a radical lymphadenectomy and associated morbidity. It is essential to understand the lymphatic drainage pathways of the ovaries, which are surprisingly up till now poorly investigated, to predict the anatomical regions where sentinel nodes can be found. We aimed to describe the lymphatic drainage pathways of the human ovaries including their compartmental fascia borders. Methods A series of 3 human female fetuses and tissues samples from 1 human cadaveric specimen were studied. Immunohistochemical analysis was performed on paraffin-embedded transverse sections (8 or 10 μm) using antibodies against Lyve-1, S100, and α-smooth muscle actin to identify the lymphatic endothelium, Schwann, and smooth muscle cells, respectively. Three-dimensional reconstructions were created. Results Two major and 1 minor lymphatic drainage pathways from the ovaries were detected. One pathway drained via the proper ligament of the ovaries (ovarian ligament) toward the lymph nodes in the obturator fossa and the internal iliac artery. Another pathway drained the ovaries via the suspensory ligament (infundibulopelvic ligament) toward the para-aortic and paracaval lymph nodes. A third minor pathway drained the ovaries via the round ligament to the inguinal lymph nodes. Lymph vessels draining the fallopian tube all followed the lymphatic drainage pathways of the ovaries. Conclusions The lymphatic drainage pathways of the ovaries invariably run via the suspensory ligament (infundibulopelvic ligament) and the proper ligament of the ovaries (ovarian ligament), as well as through the round ligament of the uterus. Because ovarian cancer might spread lymphogenously via these routes, the sentinel node can be detected in the para-aortic and paracaval regions, obturator fossa and surrounding internal iliac arteries, and inguinal regions

  4. Endoscopic Cyanoacrylate Injection with Post-injection Audible Doppler Assessment of Gastric Varices: A Single-Institution Experience.

    PubMed

    Catron, Tom D; Smallfield, George B; Kang, Le; Sterling, Richard K; Siddiqui, Mohammad S

    2017-11-01

    Gastric varices (GV) have higher rates of morbidity and mortality from hemorrhage than esophageal varices. Several studies have shown the safety and efficacy of cyanoacrylate (CA) injection for acute gastric variceal hemorrhage. We report data from our experience with CA injection for GV before and after routine use of post-injection audible Doppler assessment (ADA) for GV obturation and describe long-term outcomes after this therapy. We retrospectively identified patients who had documented GV, underwent CA injection, and had at least 2 weeks of follow-up. We recorded and analyzed the survival and rebleeding rates with patient demographics, clinical data, and endoscopy findings between two groups of patients who were categorized by CA injection prior to and after inception of the ADA technique. Seventy-one patients were identified with 16 patients analyzed in a group where ADA was not used (Pre-ADA) and 55 analyzed where ADA was used (Post-ADA). No rebleeding events were observed within 1 week of initial CA injection. No embolic events were reported after any initial CA injection within 4 weeks. The rate of bleed-free survival at 1 year was 69.6% in the Pre-ADA group and 85.8% in the Post-ADA without statistical significance. The all-cause 1-year mortality was 13.8% in the Pre-ADA group and 10.7% in the Post-ADA group without statistical significance. ADA of CA-injected GV does not appear to significantly affect adverse events or clinical outcomes; however, our findings are limited by small sample size and cohort proportions allowing for significant type II statistical error. Further prospective investigation is required to determine the impact of ADA on clinical outcomes after GV obturation.

  5. Possibilities of Nd: YAG laser utilization in medicine

    NASA Astrophysics Data System (ADS)

    Frank, Frank

    The thermic effect caused by the shrinkage and the drying of the tissues is used for cutting, denaturation, and coagulation of tissues with simultaneous filling of the blood and lymphatic vessels. The surgical Nd:YAG lasers, whose utilization is based on photothermic effects, have 120 W power and are used in neurosurgery, dermatology, gastroenterology, gynecology, urology, lung sickness, and jaw and vessel surgery. The treatment of tumors is particularly interesting because of the total destruction of the ill tissue, the homogeneity of the necrose and the obturation of the blood and lymphatic vessels. In all cases, the laser is a better solution for the patients and allows a shorter stay in hospital.

  6. Root End Generation: An Unsung Characteristic Property of MTA-A Case Report

    PubMed Central

    Dixit, Seema; Dixit, Ashutosh; Kumar, Pravin; Arora, Saurabh

    2014-01-01

    Management of immature teeth with necrotic pulp and periapical lesion has long presented a challenge. The treatment of choice for such teeth is apexification, which is induction of apical closure to produce more favorable conditions for conventional canal obturation. Traditionally, calcium hydroxide has been used for the apexification of immature permanent teeth, however, Mineral Trioxide Aggregate (MTA) holds significant promise not only as an alternative to multiple treatment visits with calcium hydroxide but also having the potential to induce root end development, eventually forming a completed root apex. This case report presents a successful healing and apexification with the use of calcium hydroxide and MTA. A 5-year follow-up revealed root development with MTA. PMID:24596800

  7. Multiple retentive means for prosthetic restoration of a large facial defect - a case report.

    PubMed

    Abdulhadi, Laith Mahmoud

    2010-01-01

    A 70-year-old man who suffered from extensive extra and intraoral defects was rehabilitated with a prosthesis using multiple retaining means. The treatment was performed in two parts: externally involving the construction of an episthesis supported only by the remaining intact boundaries of the defect and retained by mini-dental implants and spectacle frame with a modified ear hook; and intraorally by an acrylic resin obturator to restore the function of the hemi-sectioned hard and soft palate. The episthesis was securely retained with minimal movement and/or dislodgment of the prosthesis during function. Multiple retentive techniques may be used to fix heavy external prostheses as an alternative to conventional implants or biological adhesives.

  8. Root canal irrigants

    PubMed Central

    Kandaswamy, Deivanayagam; Venkateshbabu, Nagendrababu

    2010-01-01

    Successful root canal therapy relies on the combination of proper instrumentation, irrigation, and obturation of the root canal. Of these three essential steps of root canal therapy, irrigation of the root canal is the most important determinant in the healing of the periapical tissues. The primary endodontic treatment goal must thus be to optimize root canal disinfection and to prevent reinfection. In this review of the literature, various irrigants and the interactions between irrigants are discussed. We performed a Medline search for English-language papers published untill July 2010. The keywords used were ‘root canal irrigants’ and ‘endodontic irrigants.’ The reference lists of each article were manually checked for additional articles of relevance. PMID:21217955

  9. Endodontic treatment of a maxillary central incisor with two roots.

    PubMed

    Maghsoudlou, Amir; Jafarzadeh, Hamid; Forghani, Maryam

    2013-03-01

    This clinical report presents a rare case of maxillary central incisor with two separate roots. Unusual morphology of the roots and root canals may exist in any tooth. Recognition of the dental anatomy and its variations is necessary for successful endodontic therapy. It is well known that maxillary incisors are usually single-rooted teeth. The root canals were instrumented with conventional hand files and Gates Glidden and obturated by using the lateral technique. Recall radiograph after 1 year shows the healing process of the preoperative apical periodontitis. Clinicians should be aware of unexpected root canal morphology when performing root canal therapy. The present case demonstrated the importance of accurate preoperative radiograph and adequate access preparation.

  10. Endodontic Management of Maxillary First Molar With Two Palatal Canals Aided With Cone Beam Computed Tomography: A Case Report.

    PubMed

    Pamboo, Jaya; Hans, Manoj Kumar; Chander, Subhas; Sharma, Kapil

    2017-04-01

    The success of endodontic therapy is based on having sufficient endodontic access, correct cleaning and shaping, and adequate root canal obturation. However, endodontic treatment is also dependent on having a sound knowledge of the internal anatomy of human teeth, especially when anatomic variations are present. Reporting these alterations is important for improving the understanding and expertise of endodontists. The aim of this case report is to describe a unique case of maxillary first molar with 2 palatal canals within a single root, as confirmed by cone-beam computed tomography (CBCT) scans. This article also reviews recent case reports of extra palatal root canals in the maxillary first molars and the role of CBCT analysis in successfully diagnosing them.

  11. A New Approach to Implant-Based Midface Reconstruction Following Subtotal Maxillectomy.

    PubMed

    Dawood, Andrew; Kalavrezos, Nicholas; Tanner, Susan

    2016-01-01

    This case presentation describes the reconstruction of an extensive maxillary-orbital defect following subtotal resection of the maxilla en bloc with orbital exenteration in a young adult following the diagnosis of chondrosarcoma. A new approach to composite midface reconstruction with dental implants is described, in which computer-guided surgery (CGS) was used to obliquely position dental implants interradicularly in the residual maxilla, such that the implant tips lie in close proximity to the root apices of the remaining teeth. The implants were then used to fixate a milled-titanium bar, fabricated using computer-aided design and manufacture (CAD/CAM), and provided with attachments for the stabilization and retention of a maxillary obturator.

  12. Obturator Artery Injury Resulting in Massive Hemorrhage From a Low-Energy Pubic Ramus Fracture.

    PubMed

    Solarz, Mark K; Kistler, Justin M; Rehman, Saqib

    2017-05-01

    Pelvic ring fractures are common in the elderly population and are usually a result of low-energy trauma, such as falls from standing. In most cases, low-energy pelvic ring injuries can be treated with appropriate analgesia and early mobilization. Arterial injury resulting in hemodynamic instability from a low-energy pelvic ring injury is rare but, given the poor compliance of vessels in the elderly population, possible. These patients must be carefully monitored after the initial injury. The purpose of this report is to describe an elderly patient who sustained a superior pubic ramus fracture and arterial injury following a low-energy fall from standing that required angiographic intervention. Elderly patients who sustain low-energy or pelvic insufficiency fractures are unlike the younger population with high-energy pelvic fractures and hemodynamic collapse. Elderly patients can have a delayed presentation of arterial injury and require careful physical examination and close monitoring. Additionally, the authors provide a review of the literature for low-energy pelvic fractures. [Orthopedics. 2017; 40(3):e546-e548.]. Copyright 2017, SLACK Incorporated.

  13. The impact of multichannel microelectrode recording (MER) in deep brain stimulation of the basal ganglia.

    PubMed

    Kinfe, Thomas M; Vesper, Jan

    2013-01-01

    Deep brain stimulation (DBS) of the basal ganglia (Ncl. subthalamicus, Ncl. ventralis intermedius thalami, globus pallidus internus) has become an evidence-based and well-established treatment option in otherwise refractory movement disorders. The Ncl. subthalamicus (STN) is the target of choice in Parkinson's disease.However, a considerable discussion is currently ongoing with regard to the necessity for micro-electrode recording (MER) in DBS surgery.The present review provides an overview on deep brain stimulation and (MER) of the STN in patients with Parkinson's disease. Detailed description is given concerning the multichannel MER systems nowadays available for DBS of the basal ganglia, especially of the STN, as a useful tool for target refinement. Furthermore, an overview is given of the historical aspects, spatial mapping of the STN by MER, and its impact for accuracy and precision in current functional stereotactic neurosurgery.The pros concerning target refinement by MER means on the one hand, and cons including increased bleeding risk, increased operation time, local or general anesthesia, and single versus multichannel microelectrode recording are discussed in detail. Finally, the authors favor the use of MER with intraoperative testing combined with imaging to achieve a more precise electrode placement, aiming to ameliorate clinical outcome in therapy-resistant movement disorders.

  14. Deep brain stimulation for the treatment of uncommon tremor syndromes

    PubMed Central

    Ramirez-Zamora, Adolfo; Okun, Michael S.

    2016-01-01

    ABSTRACT Introduction: Deep brain stimulation (DBS) has become a standard therapy for the treatment of select cases of medication refractory essential tremor and Parkinson’s disease however the effectiveness and long-term outcomes of DBS in other uncommon and complex tremor syndromes has not been well established. Traditionally, the ventralis intermedius nucleus (VIM) of the thalamus has been considered the main target for medically intractable tremors; however alternative brain regions and improvements in stereotactic techniques and hardware may soon change the horizon for treatment of complex tremors. Areas covered: In this article, we conducted a PubMed search using different combinations between the terms ‘Uncommon tremors’, ‘Dystonic tremor’, ‘Holmes tremor’ ‘Midbrain tremor’, ‘Rubral tremor’, ‘Cerebellar tremor’, ‘outflow tremor’, ‘Multiple Sclerosis tremor’, ‘Post-traumatic tremor’, ‘Neuropathic tremor’, and ‘Deep Brain Stimulation/DBS’. Additionally, we examined and summarized the current state of evolving interventions for treatment of complex tremor syndromes. Expert c ommentary: Recently reported interventions for rare tremors include stimulation of the posterior subthalamic area, globus pallidus internus, ventralis oralis anterior/posterior thalamic subnuclei, and the use of dual lead stimulation in one or more of these targets. Treatment should be individualized and dictated by tremor phenomenology and associated clinical features. PMID:27228280

  15. Reappraisal of the ligament of Henle (ligamentum inguinale internum mediale; Henle, 1871): a topohistological study using Korean foetuses.

    PubMed

    Yang, J D; Hwang, H P; Kim, J H; Murakami, G; Rodríguez-Vázquez, J F; Cho, B H

    2013-05-01

    Ligament of Henle is one of muscle-associated connective tissues of the rectus abdominis muscle, but it has been confused with the conjoint tendon (a common aponeurosis for insertion of the inferomedial end of the obliquus internus and transversus abdominis muscles). To reconsider the inguinal connective tissue structures, we examined 20 mid-term foetuses (10 males and 10 females) at approximately 14-20 weeks of gestation (crown rump length 100-170 mm). In female horizontal sections, we consistently found the ligament of Henle asa wing-like aponeurosis extending from the lateral margin of the rectus tendon behind the superficial inguinal ring. The ligament was separated from and located behind the conjoint tendon. In all male foetuses, instead of the ligament, the conjoint tendon was evident behind the superficial ring and it winded around the posterior aspect of the spermatic cord. Therefore, although a limited number of specimens were examined, the ligament of Henle was likely to be a female-specific structure. The ligament of Henle, if developed well, may provide an arch-like structure suitable for a name "falx inguinalis" instead of the inferomedial end ofthe conjoint tendon. In addition, a covering fascia of the iliopsoas muscle joined the posterior wall of the inguinal canal in male, but not in female, specimens.

  16. The effects of neuromuscular electrical stimulation at different frequencies on the activations of deep abdominal stabilizing muscles.

    PubMed

    Cho, Hee Kyung; Jung, Gil Su; Kim, Eun Hyuk; Cho, Yun Woo; Kim, Sang Woo; Ahn, Sang Ho

    2016-01-01

    Low back pain is associated with transversus abdominis (TrA) dysfunction. Recently, it was proposed that Neuromuscular Electrical Stimulation (NMES) could be used to stimulate deep abdominal muscle contractions and improve lumbopelvic stability. The purpose of this study was to determine the optimal stimulation frequency required during NMES for the activation of deep abdominal muscles. Twenty healthy volunteers between the ages of 24 and 32 were included. The portable research-stimulator was applied using a 10 second contraction time, and a 10 second resting time at 20 Hz, 50 Hz, and 80 Hz. Changes in muscle thicknesses were determined for the TrA, obliquus internus (OI), and obliquus externus (OE) by real time ultrasound imaging. Significant thickness increases in the TrA, OI, and OE were observed during NMES versus the resting state (p < 0.05). Of the frequencies examined, 50 Hz NMES produced the greatest increase in TrA thickness (1.33 fold as compared with 1.22 fold at 20 Hz and 1.21 fold at 80 Hz) (p < 0.05). Our results indicate that NMES can preferentially stimulate contractions in deep abdominal stabilizing muscles. Most importantly, 50 Hz NMES produced greater muscle thickness increases than 20 or 80 Hz.

  17. Surgical treatment of dystonia.

    PubMed

    Cury, Rubens Gisbert; Kalia, Suneil Kumar; Shah, Binit Bipin; Jimenez-Shahed, Joohi; Prashanth, Lingappa Kumar; Moro, Elena

    2018-05-28

    Treatment of dystonia should be individualized and tailored to the specific needs of patients. Surgical treatment is an important option in medically refractory cases. Several issues regarding type of the surgical intervention, targets, and predict factors of benefit are still under debate. Areas covered: To date, several clinical trials have proven the benefit and safety of deep brain stimulation (DBS) for inherited and idiopathic isolated dystonia, whereas there is still insufficient evidence in combined and acquired dystonia. The globus pallidus internus (GPi) is the target with the best evidence, but data on the subthalamic nucleus seems also to be promising. Evidence suggests that younger patients with shorter disease duration experience greater benefit following DBS. Pallidotomy and thalamotomy are currently used in subset of carefully selected patients. The development of MRI-guided focused ultrasound might bring new options to ablation approach in dystonia. Expert commentary: GPi-DBS is effective and safe in isolated dystonia and should not be delayed when symptoms compromise quality of life and functionality. Identifying the best candidates to surgery on acquired and combined dystonias is still necessary. New insights about pathophysiology of dystonia and new technological advances will undoubtedly help to tailor surgery and optimize clinical effects.

  18. Neural targets for relieving parkinsonian rigidity and bradykinesia with pallidal deep brain stimulation

    PubMed Central

    Zhang, Jianyu; Ghosh, Debabrata; McIntyre, Cameron C.; Vitek, Jerrold L.

    2012-01-01

    Clinical evidence has suggested that subtle changes in deep brain stimulation (DBS) settings can have differential effects on bradykinesia and rigidity in patients with Parkinson's disease. In this study, we first investigated the degree of improvement in bradykinesia and rigidity during targeted globus pallidus DBS in three 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-treated rhesus macaques. Behavioral outcomes of DBS were then coupled with detailed, subject-specific computational models of neurons in the globus pallidus internus (GPi), globus pallidus externus (GPe), and internal capsule (IC) to determine which neuronal pathways when modulated with high-frequency electrical stimulation best correlate with improvement in motor symptoms. The modeling results support the hypothesis that multiple neuronal pathways can underlie the therapeutic effect of DBS on parkinsonian bradykinesia and rigidity. Across all three subjects, improvements in rigidity correlated most strongly with spread of neuronal activation into IC, driving a small percentage of fibers within this tract (<10% on average). The most robust effect on bradykinesia resulted from stimulating a combination of sensorimotor axonal projections within the GP, specifically at the site of the medial medullary lamina. Thus the beneficial effects of pallidal DBS for parkinsonian symptoms may occur from multiple targets within and near the target nucleus. PMID:22514292

  19. Surgery for Dystonia and Tremor.

    PubMed

    Crowell, Jason L; Shah, Binit B

    2016-03-01

    Surgical procedures for dystonia and tremor have evolved over the past few decades, and our understanding of risk, benefit, and predictive factors has increased substantially in that time. Deep brain stimulation (DBS) is the most utilized surgical treatment for dystonia and tremor, though lesioning remains an effective option in appropriate patients. Dystonic syndromes that have shown a substantial reduction in severity secondary to DBS are isolated dystonia, including generalized, cervical, and segmental, as well as acquired dystonia such as tardive dystonia. Essential tremor is quite amenable to DBS, though the response of other forms of postural and kinetic tremor is not nearly as robust or consistent based on available evidence. Regarding targeting, DBS lead placement in the globus pallidus internus has shown marked efficacy in dystonia reduction. The subthalamic nucleus is an emerging target, and increasing evidence suggests that this may be a viable target in dystonia as well. The ventralis intermedius nucleus of the thalamus is the preferred target for essential tremor, though targeting the subthalamic zone/caudal zona incerta has shown promise and may emerge as another option in essential tremor and possibly other tremor disorders. In the carefully selected patient, DBS and lesioning procedures are relatively safe and effective for the management of dystonia and tremor.

  20. Root canal revascularization. The beginning of a new era in endodontics.

    PubMed

    Alrahabi, Mothanna K; Ali, Mahmoud M

    2014-05-01

    Endodontic management of immature anterior teeth with necrotic pulps is a great challenge. Although there are different treatment procedures to deal with this problem such as apexification by using calcium hydroxide dressings or applying a barrier of mineral trioxide aggregate and gutta-percha obturation, the outcomes are still unsatisfactory and the root might still be weak. Recently, a new treatment protocol by revascularization of immature non-vital, infected teeth was introduced to regenerate dental structure and complete the root maturation. However, larger case series with longer follow-up periods are required to accept revascularization as the standard protocol for management of immature non-vital, infected teeth. In this review, we discuss the concept of root canal revascularization, revascularization mechanisms, and the structure of the regenerated tissues.

  1. [An atraumatic needle for the puncture of ports and pumps].

    PubMed

    Haindl, H; Müller, H

    1988-10-17

    Huber-point needles have been found to induce substantial coring during puncture of ports or pumps, which may lead to leakage or obturation of these devices. Therefore, different types of cannulas were tested in order to evaluate their applicability for this purpose. Pencil-point needles led to increased pain during puncture and thus seemed unsuitable. A newly developed port-cannula bent inwards within the length of the bevel ("protected bevel") and proved to be definitely noncoring during electron microscopy. Consequently the force required to introduce this needle was reduced by 50% in comparison with the Huber-type needle. In addition, this cannula allowed up to 3000 punctures of one port without leakage and, thus, correspondingly therefore relevantly increased the durability of this device.

  2. Cutaneous Sinus Tract from Mandibular Second Molar with C-shaped Canal System and Improper Former Root Canal Treatment: A Case Report.

    PubMed

    Gharechahi, Maryam; Dastmalchi, Parisa

    2016-01-01

    Here, we report the diagnosis and treatment of an extraoral cutaneous sinus tract originating in a mandibular second molar with a C-shaped root canal system. The patient was referred to our department by a dermatologist after a series of unsuccessful treatments, including antibiotics. Diffuse radiolucency on a preoperative radiograph revealed that earlier root canal treatment had been only partially successful. Consequently, we performed retreatment of the root canal comprising removal of the former restoration and gutta-percha, cleaning and shaping, and passive irrigation with sodium hypochlorite. The patient responded well, and the cutaneous lesion completely resolved uneventfully within 1 month postoperatively. Preoperative recognition and thorough knowledge of the root canal anatomy and conventional methods of obturation are necessary in performing successful endodontic treatment.

  3. Mineral trioxide aggregate repair of a perforating internal resorption in a mandibular molar.

    PubMed

    Meire, Maarten; De Moor, Roeland

    2008-02-01

    Internal resorption is a rare condition in permanent teeth that poses difficulties for treatment. The challenge is complicated further if the resorption extends beyond the confines of the root. This article describes treatment of a perforating internal resorption in the mesial root of a second lower molar, with adjacent destruction of the alveolar bone. After cleaning the root canal space and the resorption lacuna by mechanical instrumentation, irrigation, and interim calcium hydroxide dressing, the defect was filled with mineral trioxide aggregate, and the canals were obturated conventionally with gutta percha and epoxy resin sealer. At a 2-year follow-up examination, no clinical abnormalities were found, and complete resolution of the alveolar bone lesion and establishment of a new periodontal ligament were observed.

  4. Obturator hernia as a cause of recurrent pain in a patient with previously diagnosed endometriosis

    PubMed Central

    Browne, Hyacinth N.; Sherry, Richard; Stratton, Pamela

    2010-01-01

    Recurrent chronic pelvic pain should prompt physicians to reassess the patient. The threshold to perform laparoscopy, and to consider and surgically treat all potential disease associated with pain, even non-gynecologic etiologies, should be low, especially in those whose pain is focal or unresponsive to hormone therapy. PMID:17880958

  5. [A case of locally advanced prostate cancer with low serum testosterone associated with intake of an androgenic medicine].

    PubMed

    Sakura, Mizuaki; Tsukamoto, Tetsurou; Yonese, Junji; Nakaishi, Masayuki; Maezawa, Takuya; Takimoto, Keita; Fukui, Iwao

    2003-05-01

    A 74-year-old man was referred to our clinic for the work-up of digitally hard and irregularly surfaced prostate and elevated serum prostate-specific antigen (PSA). His serum PSA was elevated to 41 ng/ml, but testosterone and LH level were decreased to 23.5 ng/dl and 0.5 mIU/ml, respectively. He had a history of taking an androgenic medicine containing methyl-testosterone 2 to 3 times a week for 2 year and 6 months. Transrectal sextant prostatic biopsy revealed moderately differentiated adenocarcinoma (Gleason score: 3 + 4) in 6 of 6 specimens and CT scan of the abdomen showed an enlarged obturator lymph-node (15 mm), resulting in the diagnosis of stage D1 (T3aN1M0) prostate cancer. Since serum testosterone level seemed to recover around the normal level after discontinuation of the exogenous androgen, we treated him with combination androgen blockade with LHRH agonist and bicaltamide, although his testosterone level was very low. Indeed, serum PSA decreased to 0.09 ng/ml and the right obturator node was markedly reduced by the hormone treatment. After the neoadjuvant therapy of 6 months duration, radical prostatectomy and limited pelvic lymph node dissection was carried out. Histologically, viable cancer cells were not found in any of resected lymph nodes, but they remained in bilateral lobes of the prostate (pT2bN0). The histological effect of the neoadjuvant hormone therapy according to General rule for Clinical and Pathological Studies on Prostate Cancer (3rd ed.) was grade 2. The patient has been well with undetectable PSA and no evidence of clinical failure for more than 12 months, though serum testosterone level recovered to near normal (288 ng/dl) 8 months after the cessation of the hormone treatment following the operation. Combination androgen blockade or non-steroidal anti-androgen agent appears to be effective for the treatment of prostatic cancer patients who takes exogenous androgenic medicine, even with a suppressed low serum testosterone level.

  6. How accurate replicates the Thermafil System the morphology of the apical endodontic space? An ex vivo study.

    PubMed

    Stratul, S I; Didilescu, Andreea; Grigorie, Mihaela; Ianes, Emilia; Rusu, D; Nica, Luminiţa

    2011-01-01

    To evaluate the morphology of the root canal in its apical third and the capacity of the Thermafil System to reproduce the entire morphology of the cleaned and shaped root canal. Thirty-two roots of periodontally compromised teeth were prepared using the ProTaper System to an apical size 30 and filled with the Thermafil obturation technique and sealer. The roots were surgically amputated and prepared for metallographic evaluation by incremental reductions of 0.5 mm each, starting with the apical foramen. Photomicrographs of each section were taken at a magnification of 500x and 100x. The images were analyzed and processed. The position of the apical foramen with respect to the anatomical apex was identified and marked. Additional morphological details as lateral canals and recesses were also recorded. The cross-sectioned area of the canal and gutta-percha, the total perimeter, the shaped perimeter and the filled perimeter were recorded for each sample and the results were expressed as percentages. Multiple images of successive sections were used to create a 3D reconstruction of the apical anatomy of the tooth. The ANOVA test was performed to assess mean differences between evaluations of perimeters/areas at different levels. The anatomical apical foramen was found at the tip of the root in 50% of the evaluated samples. In the remaining samples, the foramen was located between 0.5 and 2.5 mm from the centre of the apex. Lateral canals, which opened in accessory foramens, were recorded in 25% of the evaluated samples. Statistical significant differences (p<0.05) were found between different levels of preparation and obturation. The complex morphology of the apical third of the root canal is satisfactory microstructurally replicated by the Thermafil System. Moreover, polarized light microscopy and the 3D reconstruction offered a discriminative vision of morphological details as lateral canals, recesses, the gutta-percha and debris.

  7. Survey of attitudes, materials and methods employed in endodontic treatment by general dental practitioners in North Jordan.

    PubMed

    Al-Omari, Wael M

    2004-09-10

    BACKGROUND: General dental practitioners provide the majority of endodontic treatment in Jordan. The aim of this study was to gather information on the methods, materials and attitudes employed in root canal treatment by dentists in North Jordan, in order to evaluate and improve the quality of current practice. METHODS: A questionnaire was posted to all registered general dental practitioners working in private practice in Irbid Governate in North Jordan (n = 181). The questionnaire included information on methods, materials and techniques used in endodontic treatment. RESULTS: Reply rate was 72% (n = 131). The results demonstrated that only five dentists used rubber dam occasionally and not routinely. The majority used cotton rolls for isolation solely or in combination with a high volume saliva ejector (n = 116). The most widely used irrigants were sodium hypochlorite and hydrogen peroxide, which were used by 32.9% (n = 43) and 33.6% (n = 44) of the respondents, respectively. Forty eight percent of the respondents (n = 61) used the cold lateral condensation technique for canal obturation, 31.3% (n = 41) used single cone, 9.9% (n = 13) used vertical condensation and 12.2% (n = 16) used paste or cement only for the obturation. The majority used zinc oxide eugenol as a sealer (72.5%). All, but one, respondents used hand instruments for canal preparation and the technique of choice was step back (52.7%). More than 50% (n = 70) of the dentists took one radiograph for determining the working length, whilst 22.9% (n = 30) did not take any radiograph at all. Most practitioners performed treatment in three visits for teeth with two or more root canals, and in two visits for teeth with a single root canal. CONCLUSIONS: This study indicates that dentists practicing in North Jordan do not comply with international quality standards and do not use recently introduced techniques. Many clinicians never take a radiograph for determining the working length and never used rubber

  8. Survey of attitudes, materials and methods employed in endodontic treatment by general dental practitioners in North Jordan

    PubMed Central

    Al-Omari, Wael M

    2004-01-01

    Background General dental practitioners provide the majority of endodontic treatment in Jordan. The aim of this study was to gather information on the methods, materials and attitudes employed in root canal treatment by dentists in North Jordan, in order to evaluate and improve the quality of current practice. Methods A questionnaire was posted to all registered general dental practitioners working in private practice in Irbid Governate in North Jordan (n = 181). The questionnaire included information on methods, materials and techniques used in endodontic treatment. Results Reply rate was 72% (n = 131). The results demonstrated that only five dentists used rubber dam occasionally and not routinely. The majority used cotton rolls for isolation solely or in combination with a high volume saliva ejector (n = 116). The most widely used irrigants were sodium hypochlorite and hydrogen peroxide, which were used by 32.9% (n = 43) and 33.6% (n = 44) of the respondents, respectively. Forty eight percent of the respondents (n = 61) used the cold lateral condensation technique for canal obturation, 31.3% (n = 41) used single cone, 9.9% (n = 13) used vertical condensation and 12.2% (n = 16) used paste or cement only for the obturation. The majority used zinc oxide eugenol as a sealer (72.5%). All, but one, respondents used hand instruments for canal preparation and the technique of choice was step back (52.7%). More than 50% (n = 70) of the dentists took one radiograph for determining the working length, whilst 22.9% (n = 30) did not take any radiograph at all. Most practitioners performed treatment in three visits for teeth with two or more root canals, and in two visits for teeth with a single root canal. Conclusions This study indicates that dentists practicing in North Jordan do not comply with international quality standards and do not use recently introduced techniques. Many clinicians never take a radiograph for determining the working length and never used rubber dam

  9. One- versus two-visit endodontic treatment of teeth with apical periodontitis: a histobacteriologic study.

    PubMed

    Vera, Jorge; Siqueira, José F; Ricucci, Domenico; Loghin, Simona; Fernández, Nancy; Flores, Belina; Cruz, Alvaro G

    2012-08-01

    This study analyzed the in vivo microbiological status of the root canal systems of mesial roots of mandibular molars with primary apical periodontitis after 1- or 2-visit endodontic treatment. Mesial root canals were instrumented by using either a combination of K3 and LightSpeed instruments (mesiobuccal canals) or the ProTaper system (mesiolingual canals), with 5% NaOCl irrigation. Patency files were used. Smear layer was removed, and a final rinse with 5 mL of 2% chlorhexidine was performed. In the 2-visit group (7 roots, 14 canals), canals were medicated with calcium hydroxide for 1 week and then obturated by using the continuous wave of compaction technique. In the 1-visit group (6 roots, 12 canals), canals were immediately obturated after chemomechanical procedures. Teeth were extracted 1 week after root canal instrumentation and processed for histobacteriologic analysis. In the 1-visit group, no case was completely free of bacteria; residual bacteria occurred in the main root canal (5 of 6 cases), isthmus (5 of 6), apical ramifications (4 of 6), and dentinal tubules (5 of 6). In the 2-visit group, 2 cases were rendered bacteria-free; residual bacteria were found in the main canal only in 2 cases (none of them with persistent dentinal tubule infection), in the isthmus (4 of 7 cases), and in ramifications (2 of 7). The 2 instrumentation techniques performed similarly. When filling material was observed in ramifications, it was usually intermixed with necrotic tissue, debris, and bacteria. The 2-visit protocol by using an interappointment medication with calcium hydroxide resulted in improved microbiological status of the root canal system when compared with the 1-visit protocol. Residual bacteria were more frequent and abundant in ramifications, isthmuses, and dentinal tubules when root canals were treated without an interappointment medication. Apical ramifications and isthmuses were never completely filled. The use of an antibacterial interappointment agent

  10. Postoperative Pain and Flare-Ups: Comparison of Incidence Between Single and Multiple Visit Pulpectomy in Primary Molars

    PubMed Central

    Gowda, Subhadra Halemane Nagaraj

    2017-01-01

    Introduction Endodontic treatment performed in either single- or multiple visit can be followed by numerous short- and long term complications. One of the short term complications include postoperative pain and flare–ups. The ability to predict its prevalence and forewarn the patient may go some way towards enabling coping strategies and help dentist in pain management treatment decisions Aim To compare the incidence and intensity of postoperative pain and flare-ups between single- and multiple visit pulpectomy in primary molars. Also, to correlate the preoperative status of the pulp to postoperative pain and flare-ups. Materials and Methods Eighty primary molars indicated for pulpectomy were included in the study and divided into two groups. Tooth treated and preoperative status of the pulp vitality was recorded. All the conventional steps in pulpectomy were followed. Teeth in Group 1 (single visit pulpectomy) were obturated on the same visit. Teeth in Group 2 (multiple visit pulpectomy) were obturated in the subsequent appointment. The recording of postoperative pain, flare-ups, use of medication were done after 24 hours, seven days and one month. Results Four cases in both the groups reported postoperative pain (10%) at 24 hour recall, p=0.74. One flare-up (2.5%) was recorded in each group p=0.67. None of the patients reported pain at seventh day and one month recall. Postoperative pain was recorded in five non-vital teeth (13.5%) and three vital teeth (6.9%). However, it was statistically not significant p=0.53. Conclusion From the perspective of our study there was a low incidence of postoperative pain. The majority of patients in both groups reported no pain or only minimal pain within 24 hours of treatment. There were no differences between single- and multi visit treatment protocols with respect to the incidence of postoperative pain. No significant correlation could be found between pulp vitality and the incidence of postoperative pain. PMID:28511499

  11. Effectiveness of Sonic, Ultrasonic, and Photon-Induced Photoacoustic Streaming Activation of NaOCl on Filling Material Removal Following Retreatment in Oval Canal Anatomy.

    PubMed

    Jiang, Shan; Zou, Ting; Li, Dongxia; Chang, Jeffery W W; Huang, Xiaojing; Zhang, Chengfei

    2016-01-01

    This study aimed to assess the effectiveness of sonic, ultrasonic and laser [photon-induced photoacoustic streaming (PIPS)] irrigation activation in removing filling remnants from oval root canals after standard canal retreatment procedures with the ProTaper universal rotary retreatment system. Twenty-eight maxillary first premolars were instrumented with ProTaper NiTi rotary instruments and obturated with gutta-percha and AH Plus sealer using the continuous wave of condensation technique. After storage at 37°C and 100% humidity for 1 week, the specimens were retreated with the ProTaper universal retreatment system for the removal of filling material. Teeth were then randomly assigned into four groups (n = 7): group 1, positive control; group 2, retreated with sonic irrigation; group 3, retreated with ultrasonic irrigation; and group 4, retreated with laser irradiation. The specimens were scanned using micro-CT before instrumentation, after obturation and mechanical retreatment, and after additional activation procedures. The percentage volume of the filling remnants was measured. Specimens were split longitudinally after micro-CT scan, canal walls were examined using scanning electron microscopy (SEM), and the amount of residual filling material was scored. The filling materials' removal efficacy in the three experimental groups was higher than that of the control group (p < 0.05), whereas filling materials ranging from 1.46 ± 0.30 to 2.21 ± 0.46 mm(3) remained in the canal in all three experimental groups. Additionally, there was a significantly greater reduction in the amount of filling remnants in the PIPS group than in the sonic and ultrasonic groups (both p < 0.05), and significantly greater reduction in the ultrasonic group than the sonic group (p < 0.05). Activation of NaOCl with PIPS showed significantly better performance than sonic and ultrasonic techniques in removing the filling remnants following mechanical retreatment of

  12. Pre-Prosthetic surgical alterations in maxillectomy to enhance the prosthetic prognoses as part of rehabilitation of oral cancer patient

    PubMed Central

    El Fattah, Hisham; Zaghloul, Ashraf; Escuin, Tomas

    2012-01-01

    Objectives: After maxillectomy, prosthetic restoration of the resulting defect is an essential step because it signals the beginning of patient’s rehabilitation. The obturator used to restore the defect should be comfortable, restore adequate speech, deglutition, mastication, and be cosmetically acceptable, success will depend on the size and location of the defect and the quantity and integrity of the remaining structures, in addition to pre-prosthetic surgical preparation of defect site. Preoperative cooperation between the oncologist surgeon and the maxillofacial surgeon may allow obturation of a resultant defect by preservation of the premaxilla or the tuberosity on the defect side and maintaining the alveolar bone or teeth adjacent to the defect. This study evaluates the importance of pre-prosthetic surgical alterations at the time maxillectomy on the enhancement of the prosthetic prognoses as part of the rehabilitation of oral cancer patient. Study Design: The study was carried out between 2003- 2008, on 66 cancer patients(41 male-25 female) age ranged from 33 to 72 years, at National Cancer Institute, Cairo University, whom underwent maxillectomy surgery to remove malignant tumor as a part of cancer treatment. Patients were divided in two groups. Group A: Resection of maxilla followed by preprosthetic surgical preparation. Twenty-four cancer patients (13 male – 11 female). Group B: Resection of maxilla without any preprosthetic surgical preparation. Forty-two cancer patients (28 male-14 female). Results: Outcome variables measured included facial contour and aesthetic results, speech understandability, ability to eat solid foods, oronasal separation, socializing outside the home, and return-to-work status. Flap success and donor site morbidity were also studied. Conclusions: To improve the prosthetic restoration of maxillary defect resulting maxillary resection as part treatment of maxillofacial tumor depends on the close cooperation between

  13. Dexmedetomidine Added to Local Anesthetic Mixture of Lidocaine and Ropivacaine Enhances Onset and Prolongs Duration of a Popliteal Approach to Sciatic Nerve Blockade.

    PubMed

    Hu, Xiawei; Li, Jinlei; Zhou, Riyong; Wang, Quanguang; Xia, Fangfang; Halaszynski, Thomas; Xu, Xuzhong

    2017-01-01

    A literature review of multiple clinical studies on mixing additives to improve pharmacologic limitation of local anesthetics during peripheral nerve blockade revealed inconsistency in success rates and various adverse effects. Animal research on dexmedetomidine as an adjuvant on the other hand has promising results, with evidence of minimum unwanted results. This randomized, double-blinded, contrastable observational study examined the efficacy of adding dexmedetomidine to a mixture of lidocaine plus ropivacaine during popliteal sciatic nerve blockade (PSNB). Sixty patients undergoing varicose saphenous vein resection using ultrasonography-guided PSNB along with femoral and obturator nerve blocks as surgical anesthesia were enrolled. All received standardized femoral and obturator nerve blocks, and the PSNB group was randomized to receive either 0.5 mL (50 µg) of dexmedetomidine (DL group) or 0.5 mL of saline (SL group) together with 2% lidocaine (9.5 mL) plus 0.75% ropovacaine (10 mL). Sensory onset and duration of lateral sural cutaneous nerve, sural nerve, superficial peroneal nerve, deep peroneal nerve, lateral plantar nerve, and medial plantar nerve were recorded. Motor onset and duration of tibial nerve and common peroneal nerve were also examined. Sensory onset of sural nerve, superficial peroneal nerve, lateral plantar nerve, and medial plantar nerve was significantly quicker in the DL group than in the SL group (P < 0.05). Sensory onset of lateral sural cutaneous nerve and deep peroneal nerve was not statistically different between the groups (P > 0.05). Motor onset of tibial nerve and common peroneal nerve was faster in the DL group than in in the SL group (P < 0.05). Duration of both sensory and motor blockade was significantly longer in the DL group than in the SL group (P < 0.05). Perineural dexmedetomidine added to lidocaine and ropivacaine enhanced efficacy of popliteal approach to sciatic nerve blockade with faster onset and longer duration

  14. Bleeding complication with the TVT-Exact procedure: a report of two cases.

    PubMed

    Masata, Jaromir; Svabik, Kamil; Martan, Alois

    2015-02-01

    Midurethral tension-free vaginal tapes (TVT), placed through the retropubic space or through the obturator foramina, are widely used for the surgical treatment of female stress urinary incontinence. Some complications are associated with retropubic tapes owing to the passage of the tape through the space of Retzius. One of the most frequent complications is bleeding, and if injury to major vessels is involved, this may be life-threatening. In 2010, the Gynecare TVT-Exact® Continence System was introduced onto the market, with a rigid trocar shaft measuring 3.0 mm in diameter. We have no clinical data regarding the complication rate, especially concerning bleeding, connected with this device; all data are related to the original size of the TVT inserter. The cases presented demonstrate that bleeding complications can occur with the TVT-Exact procedure.

  15. Bioactive Glass Scaffolds for Dental Pulp and Dentin Tissue Engineering

    NASA Astrophysics Data System (ADS)

    Shawli, Hassan Talat

    Current and historical endodontic "root canal" treatments employ inert obturating materials inserted into the teeth's pulp chambers and root canals, often saving teeth but without adequate function. Furthermore, the occurrence of pulpal necrosis in the immature permanent tooth is considered to be a challenging situation, clinically, in treatment because the thin and often short roots increase the risk of fracture. The ideal treatment would be to promote continued root development. This work demonstrated that endodontically-shaped and durable scaffolds of slowly resorbable fibrous (HT) glass and faster-resorbing small-particle Bioglass can be sintered at 900 degrees C for such placement, and that cell growth of osteoblasts in these scaffolds shows good early results. Retained bioactivity in the sintered specimen was revealed by Multiple Attenuated Internal Reflection Infrared Spectroscopy.

  16. Treatment of paraesthesia following root canal treatment by intentional tooth replantation: a review of the literature and a case report.

    PubMed

    Tsesis, Igor; Taschieri, Silvio; Rosen, Eyal; Corbella, Stefano; Del Fabbro, Massimo

    2014-01-01

    Some endodontic procedures may cause damage to the inferior alveolar nerve, leading to paraesthesia. When such complication is due to extrusion of obturation material beyond the apex, it can be managed by intentional replantation (IR). IR consists of the removal of a tooth and its re-insertion into the socket after performing a proper root end manipulation. It is a relatively conservative procedure aimed at preserving the tooth and, with correct case selection, can provide a predictable outcome. The aim of the present paper is to report a case of paraesthesia following endodontic treatment of second mandibular molar successfully treated by intentional replantation. In our opinion this treatment modality may be considered when the extrusion of root canal filling material causes irritation to the periapical tissues and endodontic retreatment is unfeasible.

  17. [Acute right-sided upper abdominal pain in a 46-year-old woman].

    PubMed

    Bauder, M; Fiala, A; Klinger, C; Kersjes, W; Caca, K

    2018-02-01

    A 46-year-old woman presented with acute abdominal pain in the right upper quadrant. Esophagogastroduodenoscopy revealed a duodenal stenosis within the horizontal part of the duodenum. Based on the findings of abdominal computed tomography (CT), endosonography, Doppler duplex sonography and angiography, the diagnosis of an aneurysm of a branch of the inferior pancreaticoduodenal artery was established. This arterial branch was part of a collateral circulation between the superior mesenteric artery and the proper hepatic artery caused by obturation of the celiac artery. The symptomatic duodenal stenosis was the result of a local hematoma due to prior rupture of an aneurysm. After successful coiling of the afferent vessels to the aneurysm follow-up examinations showed progredient resorption of the hematoma and the patient was free of complaints.

  18. Endoscopic treatments for portal hypertension.

    PubMed

    Lo, Gin-Ho

    2018-02-01

    Acute esophageal variceal hemorrhage is a dreaded complication of portal hypertension. Its management has evolved rapidly in recent years. Endoscopic therapy is often employed to arrest bleeding varices as well as to prevent early rebleeding. The combination of vasoconstrictor and endoscopic therapy is superior to vasoconstrictor or endoscopic therapy alone for control of acute esophageal variceal hemorrhage. After control of acute variceal bleeding, combination of banding ligation and beta-blockers is generally recommended to prevent variceal rebleeding. To prevent the catastrophic event of acute variceal bleeding, endoscopic banding ligation is an important tool in the prophylaxis of first bleeding. Endoscopic obturation with cyanoacrylate is usually utilized to arrest acute gastric variceal hemorrhage as well as to prevent rebleeding. It can be concluded that endoscopic therapies play a pivotal role in management of portal hypertensive bleeding.

  19. Chronic vaginal discharge and left leg edema after a transobturator tape procedure.

    PubMed

    Kim, Tae-Hee; Lee, Hae-Hyeog; Kim, Jun-Mo

    2014-05-01

    We report on a patient who underwent total vaginal hysterectomy for urinary incontinence 8 years previously with a sling operation using transobturator tape (TOT). She was admitted to our hospital after complaints of vaginal discharge, foul odor, and bleeding, left thigh pain, and edema. Magnetic resonance imaging (MRI) and computed tomography (CT) revealed a fistula tract from the vagina or urethra with remnant sling tape. We removed the remnant tape using intraoperative ultrasonography. This case exemplifies the rare occurrence of a vaginal fistula extending to the obturator, adductor, and pectineus muscles combined with myositis after TOT placement. It is important that urogynecologists recognize that TOT procedures may result in complications accompanied by common recurrent vaginal symptoms, such as vaginal odor and spotting, which can be identified by MRI or CT.

  20. In-depth morphological study of mesiobuccal root canal systems in maxillary first molars: review

    PubMed Central

    Chang, Seok-Woo; Lee, Jong-Ki; Lee, Yoon

    2013-01-01

    A common failure in endodontic treatment of the permanent maxillary first molars is likely to be caused by an inability to locate, clean, and obturate the second mesiobuccal (MB) canals. Because of the importance of knowledge on these additional canals, there have been numerous studies which investigated the maxillary first molar MB root canal morphology using in vivo and laboratory methods. In this article, the protocols, advantages and disadvantages of various methodologies for in-depth study of maxillary first molar MB root canal morphology were discussed. Furthermore, newly identified configuration types for the establishment of new classification system were suggested based on two image reformatting techniques of micro-computed tomography, which can be useful as a further 'Gold Standard' method for in-depth morphological study of complex root canal systems. PMID:23493453

  1. The Use of Three Dimensional Printed Interactive Models and a Digital Anatomy Case Study to Improve Medical Student Understanding of Pelvic and Perineal Anatomy

    NASA Astrophysics Data System (ADS)

    Solis, Laura de Jesus

    The anatomy of the pelvis and perineum is especially complex for novice students. In the Language of Medicine Module (Gross Anatomy and Embryology), medical students are expected to learn a high volume of material in a short time. The study of these regions is especially challenging due to the limited visibility of structures and difficulty of dissection. Understanding of the spatial relationships of the pelvic and perineal structures is important to acquire the foundational knowledge for future clinical application. Traditional methods such as dissection, prosected specimens, peer teaching, and radiological images are used at UT Health San Antonio to teach these regions. Emerging three dimensional technologies applied in computer based models and printed physical models serve as alternative ways to teach Anatomy. This study examines the effectiveness of adding two active learning methods that use these technologies to teach the anatomy of the pelvis and perineum in the Language of Medicine module, as assessed by exam performance and a satisfaction survey. The learning methods included female pelvic and perineal printed models with simulated anatomical contents made with arts and crafts material, and a digital anatomy case study using BodyVizRTM. In 2016, 220 medical students in four groups (A-D) rotated between demonstrations on prosected cadavers and interactive sessions with each 3D learning tool. Student exam performance was assessed as the percentage of points obtained on select written and practical exam questions relevant to the anatomy of the pelvis and perineum. Across four years, practical exam performance for all relevant pelvic and perineal tags (structures tagged with a string or pin) shows a consistent decline of averages from 2013 (83%) to 2015 (75.7%). This decline was slightly reversed in 2016 (76.6%) following the integration of the 3D learning tools. The analysis of the obturator internus muscle tag, a tag included in the practical exams across

  2. A Comparison of Vaginal Pressures and Abdominal Muscle Thickness According to Childbirth Delivery Method during the Valsalva Maneuver

    PubMed Central

    Kim, Haroo; Kak, Hwang-Bo; Kim, Boin

    2014-01-01

    [Purpose] The purpose of this study was to compare the effect of childbirth delivery method on vaginal pressure and abdominal thickness during the Valsalva maneuver (VAL). [Subjects] Thirty healthy female volunteers (26–39 years of age) were selected for this research. Their delivery histories were: nulliparous 10, vaginal delivery 10, and Cesarean delivery 10. None of the participants had a history of incontinence. [Methods] In the crook-lying position, a perineometer probe was inserted into the vagina and the transducer was placed transversely on the right side of the body during the Valsalva maneuver. [Results] There were significant differences in the thickness of the transverses abdominis (TrA) between in all the groups rest and the Valsalva maneuver, and there were significant differences in the internus oblique (IO) in the nulliparous group. During the Valsalva maneuver, there were significant differences in the TrA between the nulliparous group and the vaginal delivery group, and there were significant differences in the IO between the nulliparous delivery group and the vaginal delivery group, and between the nulliparous group and the Cesarean section group. Delivery history changed vaginal pressure, and there were significant differences between the nulliparous group and the vaginal delivery group, and between the nulliparous group and the Cesarean delivery group. [Conclusion] Pregnancy and delivery method may affect pelvic floor and abdominal muscles during the Valsalva maneuver. PMID:24707104

  3. Effects of neurostimulation for advanced Parkinson’s disease patients on motor symptoms: A multiple-treatments meta-analysas of randomized controlled trials

    PubMed Central

    Xie, Cheng-Long; Shao, Bei; Chen, Jie; Zhou, Yi; Lin, Shi-Yi; Wang, Wen-Wen

    2016-01-01

    Deep brain stimulation (DBS) is the surgical procedure of choice for patients with advanced Parkinson disease (PD). We aim to evaluate the efficacy of GPi (globus pallidus internus), STN (subthalamic nucleus)-DBS and medical therapy for PD. We conducted a systematic review and multiple-treatments meta-analysis to investigate the efficacy of neurostimulation and medical therapy for PD patients. Sixteen eligible studies were included in this analysis. We pooled the whole data and found obvious difference between GPi-DBS versus medical therapy and STN-DBS versus medical therapy in terms of UPDRS scores (Unified Parkinson’s Disease Rating Scale). Meanwhile, we found GPi-DBS had the similar efficacy on the UPDRS scores when compared with STN-DBS. What is more, quality of life, measured by PDQ-39 (Parkinson’s disease Questionnaire) showed greater improvement after GPi-DBS than STN-DBS. Five studies showed STN-DBS was more effective for reduction in medication than GPi-DBS. Overall, either GPi-DBS or STN-DBS was an effective technique to control PD patients’ symptoms and improved their functionality and quality of life. Meanwhile, the UPDRS scores measuring parkinsonian symptoms revealed no significant difference between GPi-DBS and STN-DBS. STN-DBS was more effective for reduction in medication than GPi-DBS. Alternatively, GPi-DBS was more effective for improving the PDQ-39 score than STN-DBS. PMID:27142183

  4. Cerebral venous infarction: a potentially avoidable complication of deep brain stimulation surgery.

    PubMed

    Morishita, Takashi; Okun, Michael S; Burdick, Adam; Jacobson, Charles E; Foote, Kelly D

    2013-01-01

    Despite numerous reports on the morbidity and mortality of deep brain stimulation (DBS), cerebral venous infarction has rarely been reported. We present four cases of venous infarct secondary to DBS surgery. The diagnosis of venous infarction was based on 1) delayed onset of new neurologic deficits on postoperative day 1 or 2; 2) significant edema surrounding the superficial aspect of the implanted lead, with or without subcortical hemorrhage on CT scan. Four cases (0.8% per lead, 1.3% per patient) of symptomatic cerebral venous infarction were identified out of 500 DBS lead implantation procedures between July 2002 and August 2009. All four patients had Parkinson's disease. Their DBS leads were implanted in the subthalamic nucleus (n = 2), and the globus pallidus internus (n = 2). Retrospective review of the targeting confirmed that the planned trajectory passed within 3 mm of a cortical vein in two cases for which contrast-enhanced preoperative magnetic resonance (MR) imaging was available. In the other two cases, contrasted targeting images were not obtained preoperatively. Cerebral venous infarction is a potentially avoidable, but serious complication. To minimize its incidence, we propose the use of high-resolution, contrast-enhanced, T1-weighted MR images to delineate cerebral venous anatomy, along with careful stereotactic planning of the lead trajectory to avoid injury to venous structures. © 2013 International Neuromodulation Society.

  5. Life cycles of traumatized teeth: long-term observations from a cohort of dental trauma victims - series 2.

    PubMed

    Heithersay, G S

    2016-09-01

    In this the second of a series of life cycles of dental trauma victims, the short and particularly long-term responses of four survivors of either multiple luxation injuries or avulsions have been documented over periods varying up to 41 years. The development of ankylosis, either in the short or longer term post trauma, proved a common feature in the series and management strategies have been outlined. External invasive resorption was also identified as a complicating response for which the topical application of trichloracetic acid, intracanal dressing and root canal obturation proved effective in resorption management. Long-term observations indicate that some compromised teeth can be functionally and aesthetically retained for extended periods, but follow-up examinations are important so that treatment interventions can be implemented if adverse responses are diagnosed. © 2016 Australian Dental Association.

  6. Clinical and radiographic evaluation of one- and two-visit endodontic treatment of asymptomatic necrotic teeth with apical periodontitis: a randomized clinical trial.

    PubMed

    Molander, Anders; Warfvinge, Johan; Reit, Claes; Kvist, Thomas

    2007-10-01

    The present investigation recorded the 2-year clinical and radiographic outcome of one- and two visit endodontic treatment and studied the significance of the bacteriologic sampling results on the outcome. A randomization procedure allocated 53 teeth to one-visit treatment and 48 teeth to two-visit treatment. At the end of the study period, 32 teeth (65%) in the one-visit group and 30 teeth (75%) in the two-visit group were classified as healed. The statistical analysis of the healing results did not show any significant difference between the groups (p = 0.75). Forty-nine (80%) of the 61 teeth that were obturated after a negative micobiologic sample were classified as healed. Teeth sealed after positive samples healed in 44%. The present study gave evidence that similar healing results might be obtained through one- and two-visit antimicrobial treatment.

  7. [Root canal treatment of mandibular first premolar with 4 root canals: a case report].

    PubMed

    Liu, Xin-yang; Zhan, Fu-Liang

    2015-10-01

    The mandibular first premolar can be considered one of the most challenging teeth to treat, due to the complexity of its root canal morphology and increased incidence of multiple canals. A case of endodontic treatment of a mandibular first premolar exhibiting a total of 4 distinct root canals and 4 apical foramina was described. Anatomic variation of root canal morphology should be considered in endodontic treatment to ensure a favorable healing outcome, and its identification could be enhanced by careful examination using a dental operating microscope. Obturation of root canals using a warm vertical compaction technique with a highly-radiopaque root canal sealer, such as AH Plus, after careful ultrasonic activated irrigation might allow the flow of sealer into the narrowed but unprepared part of the canal, thereby facilitating optimum chemo-mechanical debridement of the root canal system.

  8. Spiral computed tomography assessment of the efficacy of different rotary versus hand retreatment system.

    PubMed

    Mittal, Neelam; Jain, Jyoti

    2014-01-01

    The purpose of this study was to evaluate the efficacy of nickel-titanium rotary retreatment systems versus stainless steel hand retreatment system with or without solvent for gutta-percha removal during retreatment. Sixty extracted human mandibular molar teeth with single canal in a distal root was prepared with ProTaper rotary nickel-titanium files and obturated with gutta-percha and sealer. The teeth were randomly divided into six groups of 10 specimens in each groups. The volume of filling material before and after retreatment were evaluated in cm(3) using the computed tomography (CT) scanner proprietary software. Maximum amount of filling material removed during retreatment with ProTaper retreatment system with solvent and minimum with hand retreatment system with solvent. None of the technique was 100% effective in removing the filling materials, but the ProTaper retreatment system with solvent was better.

  9. Nerve injury after hip arthroplasty. 5/600 cases after uncemented hip replacement, anterolateral approach versus direct lateral approach.

    PubMed

    van der Linde, M J; Tonino, A J

    1997-12-01

    In 600 consecutive uncemented total hip replacements, 2 surgical approaches were used: the direct lateral Hardinge approach in supine position (group I: 241 cases) or in a lateral position (group II: 280 cases) and the anterolateral Watson-Jones approach in supine position (group III: 79 cases). 5 patients had clinically evident peripheral nerve injuries confirmed with EMG: none in group I, 1 lesion of the nervus ischiadicus and nervus femoralis in group II and 4 nervus femoralis lesions in group III, of which 1 was combined with an obturator nerve injury. The nerve injuries were evaluated with EMG. All 4 nervus femoralis lesions recovered spontaneously, but the one patients in group II had a persistent palsy of the peroneal nerve. The anatomical basis for the higher prevalence of nervus femoralis lesions in the anterolateral Watson-Jones approach is described.

  10. Meant to make a difference, the clinical experience of minimally invasive endodontics with the self-adjusting file system in India.

    PubMed

    Pawar, Ajinkya M; Pawar, Mansing G; Kokate, Sharad R

    2014-01-01

    The vital steps in any endodontic treatment are thorough mechanical shaping and chemical cleaning followed by obtaining a fluid tight impervious seal by an inert obturating material. For the past two decades, introduction and use of rotary nickel-titanium (Ni-Ti) files have changed our concepts of endodontic treatment from conventional to contemporary. They have reported good success rates, but still have many drawbacks. The Self-Adjusting File (SAF) introduces a new era in endodontics by performing the vital steps of shaping and cleaning simultaneously. The SAF is a hollow file in design that adapts itself three-dimensionally to the root canal and is a single file system, made up of Ni-Ti lattice. The case series presented in the paper report the clinical experience, while treating primary endodontic cases with the SAF system in India.

  11. [Analysis of accidental deaths in mountain tourism and sport according to statistics from the Republic of Kabardino-Balkariia].

    PubMed

    Mechukaev, A M; Mechukaev, A A

    2006-01-01

    Lethal cases in mountain tourism and sports in the Republic of Kabardino-Balkaria were studied for 1978-1995. A total of 152 accidental deaths were analysed. Most of the victims were males under 30 years of age. The greatest number of the accidents took place on Monday, in July and August. Many amateur visitors from abroad were among the victims. The main cause of death in the mountains of Kabardino-Balkaria for the 18 years studied was multitrauma of the body (69.7%). Hypothermia and obturation asphyxia with snow and compression asphyxia due to snowbreak account for 11.8 and 13.2% deaths, respectively; lightning killed 4%. Combination of high mountain hypoxia with exacerbated chronic somatic disease or hypothermia caused death in 1% victims. The authors propose how to improve forensic-medical expert examination of accidental death and safety in the mountains.

  12. The TVT-obturator surgical procedure for the treatment of female stress urinary incontinence: a clinical update.

    PubMed

    Waltregny, David; de Leval, Jean

    2009-03-01

    Six years ago, the inside-out transobturator tape TVT-O procedure was developed for the surgical treatment of female stress urinary incontinence (SUI) with the aim of minimizing the risk of urethra and bladder injuries and ensuring minimal tissue dissection. Initial feasibility and efficacy studies suggested that the TVT-O procedure is associated with high SUI cure rates and low morbidity at short term. A recent analysis of medium-term results indicated that the TVT-O procedure is efficient, with maintenance, after a 3-year minimum follow-up, of cure rates comparing favorably with those reported for TVT. No late complications were observed. As of July 2008, more than 35 clinical papers, including ten randomized trials and two national registries, have been published on the outcome of the TVT-O surgery. Results from these studies have confirmed that the TVT-O procedure is safe and as efficient as the TVT procedure, at least in the short/medium term.

  13. Common therapeutic mechanisms of pallidal deep brain stimulation for hypo- and hyperkinetic movement disorders

    PubMed Central

    Iriki, Atsushi; Isoda, Masaki

    2015-01-01

    Abnormalities in cortico-basal ganglia (CBG) networks can cause a variety of movement disorders ranging from hypokinetic disorders, such as Parkinson's disease (PD), to hyperkinetic conditions, such as Tourette syndrome (TS). Each condition is characterized by distinct patterns of abnormal neural discharge (dysrhythmia) at both the local single-neuron level and the global network level. Despite divergent etiologies, behavioral phenotypes, and neurophysiological profiles, high-frequency deep brain stimulation (HF-DBS) in the basal ganglia has been shown to be effective for both hypo- and hyperkinetic disorders. The aim of this review is to compare and contrast the electrophysiological hallmarks of PD and TS phenotypes in nonhuman primates and discuss why the same treatment (HF-DBS targeted to the globus pallidus internus, GPi-DBS) is capable of ameliorating both symptom profiles. Recent studies have shown that therapeutic GPi-DBS entrains the spiking of neurons located in the vicinity of the stimulating electrode, resulting in strong stimulus-locked modulations in firing probability with minimal changes in the population-scale firing rate. This stimulus effect normalizes/suppresses the pathological firing patterns and dysrhythmia that underlie specific phenotypes in both the PD and TS models. We propose that the elimination of pathological states via stimulus-driven entrainment and suppression, while maintaining thalamocortical network excitability within a normal physiological range, provides a common therapeutic mechanism through which HF-DBS permits information transfer for purposive motor behavior through the CBG while ameliorating conditions with widely different symptom profiles. PMID:26180116

  14. Abnormal neuronal activity in Tourette syndrome and its modulation using deep brain stimulation

    PubMed Central

    Israelashvili, Michal; Loewenstern, Yocheved

    2015-01-01

    Tourette syndrome (TS) is a common childhood-onset disorder characterized by motor and vocal tics that are typically accompanied by a multitude of comorbid symptoms. Pharmacological treatment options are limited, which has led to the exploration of deep brain stimulation (DBS) as a possible treatment for severe cases. Multiple lines of evidence have linked TS with abnormalities in the motor and limbic cortico-basal ganglia (CBG) pathways. Neurophysiological data have only recently started to slowly accumulate from multiple sources: noninvasive imaging and electrophysiological techniques, invasive electrophysiological recordings in TS patients undergoing DBS implantation surgery, and animal models of the disorder. These converging sources point to system-level physiological changes throughout the CBG pathway, including both general altered baseline neuronal activity patterns and specific tic-related activity. DBS has been applied to different regions along the motor and limbic pathways, primarily to the globus pallidus internus, thalamic nuclei, and nucleus accumbens. In line with the findings that also draw on the more abundant application of DBS to Parkinson's disease, this stimulation is assumed to result in changes in the neuronal firing patterns and the passage of information through the stimulated nuclei. We present an overview of recent experimental findings on abnormal neuronal activity associated with TS and the changes in this activity following DBS. These findings are then discussed in the context of current models of CBG function in the normal state, during TS, and finally in the wider context of DBS in CBG-related disorders. PMID:25925326

  15. Different mechanisms may generate sustained hypertonic and rhythmic bursting muscle activity in idiopathic dystonia.

    PubMed

    Liu, Xuguang; Yianni, John; Wang, Shouyan; Bain, Peter G; Stein, John F; Aziz, Tipu Z

    2006-03-01

    Despite that deep brain stimulation (DBS) of the globus pallidus internus (GPi) is emerging as the favored intervention for patients with medically intractable dystonia, the pathophysiological mechanisms of dystonia are largely unclear. In eight patients with primary dystonia who were treated with bilateral chronic pallidal stimulation, we correlated symptom-related electromyogram (EMG) activity of the most affected muscles with the local field potentials (LFPs) recorded from the globus pallidus electrodes. In 5 dystonic patients with mobile involuntary movements, rhythmic EMG bursts in the contralateral muscles were coherent with the oscillations in the pallidal LFPs at the burst frequency. In contrast, no significant coherence was seen between EMG and LFPs either for the sustained activity separated out from the compound EMGs in those 5 cases, or in the EMGs in 3 other cases without mobile involuntary movements and rhythmic EMG bursts. In comparison with the resting condition, in both active and passive movements, significant modulation in the GPi LFPs was seen in the range of 8-16 Hz. The finding of significant coherence between GPi oscillations and rhythmic EMG bursts but not sustained tonic EMG activity suggests that the synchronized pallidal activity may be directly related to the rhythmic involuntary movements. In contrast, the sustained hypertonic muscle activity may be represented by less synchronized activity in the pallidum. Thus, the pallidum may play different roles in generating different components of the dystonic symptom complex.

  16. Swallowing and deep brain stimulation in Parkinson’s disease: A systematic review

    PubMed Central

    Troche, Michelle S.; Brandimore, Alexandra E.; Foote, Kelly D.; Okun, Michael S.

    2013-01-01

    The purpose of this review is to assess the current state of the literature on the topic of deep brain stimulation (DBS) and its effects on swallowing function in Parkinson’s disease (PD). Pubmed, Cochrane review, and web of science searches were completed on all articles addressing DBS that contained a swallowing outcome measure. Outcome measures included the penetration/aspiration scale, pharyngeal transit time, oropharyngeal residue, drooling, aspiration pneumonia, death, hyolaryngeal excursion, epiglottic inversion, UPDRS scores, and presence of coughing/throat clearing during meals. The search identified 13 studies specifically addressing the effects of DBS on swallowing. Critical assessment of the 13 identified peer-reviewed publications revealed nine studies employing an experimental design, (e.g. “on” vs. “off”, pre- vs. post-DBS) and four case reports. None of the nine experimental studies were found to identify clinically significant improvement or decline in swallowing function with DBS. Despite these findings, several common threads were identified across experimental studies and will be examined in this review. Additionally, available data demonstrate that, although subthalamic nucleus (STN) stimulation has been considered to cause more impairment to swallowing function than globus pallidus internus (GPi) stimulation, there are no experimental studies directly comparing swallowing function in STN vs. GPi. Moreover, there has been no comparison of unilateral vs. bilateral DBS surgery and the coincident effects on swallowing function. This review includes a critical analysis of all experimental studies and discusses methodological issues that should be addressed in future studies. PMID:23726461

  17. Target Selection Recommendations Based on Impact of Deep Brain Stimulation Surgeries on Nonmotor Symptoms of Parkinson's Disease.

    PubMed

    Wang, Xiao-Hong; Zhang, Lin; Sperry, Laura; Olichney, John; Farias, Sarah Tomaszewski; Shahlaie, Kiarash; Chang, Norika Malhado; Liu, Ying; Wang, Su-Ping; Wang, Cui

    2015-12-20

    This review examines the evidence that deep brain stimulation (DBS) has extensive impact on nonmotor symptoms (NMSs) of patients with Parkinson's disease (PD). We retrieved information from the PubMed database up to September, 2015, using various search terms and their combinations including PD, NMSs, DBS, globus pallidus internus (GPi), subthalamic nucleus (STN), and ventral intermediate thalamic nucleus. We included data from peer-reviewed journals on impacts of DBS on neuropsychological profiles, sensory function, autonomic symptoms, weight changes, and sleep disturbances. For psychological symptoms and cognitive impairment, we tried to use more reliable proofs: Random, control, multicenter, large sample sizes, and long period follow-up clinical studies. We categorized the NMSs into four groups: those that would improve definitively following DBS; those that are not significantly affected by DBS; those that remain controversial on their surgical benefit; and those that can be worsened by DBS. In general, it seems to be an overall beneficial effect of DBS on NMSs, such as sensory, sleep, gastrointestinal, sweating, cardiovascular, odor, urological symptoms, and sexual dysfunction, GPi-DBS may produce similar results; Both STN and Gpi-DBS are safe with regard to cognition and psychology over long-term follow-up, though verbal fluency decline is related to DBS; The impact of DBS on behavioral addictions and dysphagia is still uncertain. As the motor effects of STN-DBS and GPi-DBS are similar, NMSs may determine the target choice in surgery of future patients.

  18. Location of Sentinel Lymph Node in Cervical Carcinoma and Factors Associated With Unilateral Detection.

    PubMed

    Wuntakal, Rekha; Papadopoulos, Andreas John; Montalto, Stephen Attard; Perovic, Milica; Coutts, Michael; Devaja, Omer

    2015-11-01

    The aims of this study were to assess locality of the sentinel lymph node (SLN) in cervical carcinoma and examine factors affecting bilateral SLN detection. This was a retrospective review of SLN data (anatomical location, count and laterality) in patients with early-stage cervical cancer (International Federation of Gynecology and Obstetrics stage IA1 with lymphovascular space invasion to stage IIA) using intraoperative gamma probe and blue dye. The preoperative single-photon emission computed tomography with computed tomography was used to detect laterality, number of the SLNs, and rare locations. Patients were treated between January 2005 to January 2015 at the West Kent Gynaecological Oncology Centre, Maidstone Hospital, Maidstone, United Kingdom. A total of 132 women were investigated. The most common SLN location was the external iliac (38.6%) followed by obturator (25.3%) and internal iliac (23.6%) regions. A small percentage was identified in presacral (1.4%) and para-aortic regions (0.7%). Older age (P = 0.01) and an elevated body mass index (P = 0.03) were associated with decreased SLN count by preoperative single-photon emission computed tomography with computed tomography, and only age affected SLN count by gamma probe (P = 0.01). Initial surgery, large loop excision of the transformation zone, or cone biopsy of the cervix had no effect on SLN count. There was no difference observed in bilateral detection with respect to surgical approach (open: n = 48/laparoscopic: n = 84). However, older age was independently associated with a decrease in bilateral SLN detection (P = 0.003). In these patients who underwent unilateral full pelvic lymphadenectomy, all the nonsentinel nodes were negative. The majority of SLNs were located in the external iliac, obturator, and internal iliac regions. Both older age and an elevated body mass index were associated with a reduced SLN count. Unilateral detection of SLN was independently associated with older age, which may be

  19. Pelvic lymph node dissection in early ovarian cancer: success of retrieval of lymph nodes by individual lymph node groups in respect to pelvic laterality.

    PubMed

    Mujezinović, Faris; Takac, Iztok

    2010-08-01

    To evaluate the differences in number of harvested retroperitoneal pelvic lymph nodes by specific lymph node regions in respect to pelvic laterality. We extracted cases of early ovarian cancer (EOC) with lymphadenectomy from the medical database which were treated at our institution in the period between 1994 and 2008. Recommendations of FIGO and EGSOC (European Guidelines for Staging in Ovarian Cancer) for staging of ovarian malignancies were followed. Stage of the disease was established on the basis of intra-abdominal condition which we found during surgery and histopathologic status of retroperitoneal lymph nodes (LN). For each case and every LN group, we subtracted the number of dissected lymph nodes on the left side from the number of dissected lymph nodes on the right side of the pelvis. The result would represent the difference between number of removed LN on each side of the pelvis for specific LN group. A negative difference means that a greater number of LN was extracted from the left side and a positive difference that the greater number of LN was extracted from the right side of the pelvis. We used Wilcoxon signed-rank test for statistical analysis of differences. 48 cases with EOC underwent lymphadenectomy. In three cases, metastatic retroperitoneal pelvic lymph nodes were found. There were 79.1%, 50.0%, 45.8%, 93.8%, 52.1%, 60.4% and 70.8% of cases with left-right difference in number of removed lymph nodes in external iliac region, common iliac region, presacralic, above obturator nerve, under obturator nerve, lateral from the external ilac vessels and lateral from the common iliac vessels nodal group, respectively. The mean differences between left and right groups were in the range from 2 to 4 lymph nodes. There was no identifiable bias toward either side of the pelvis for any of the analyzed lymph node groups. There is a right and left prevalence of retrieved LN by individual LN regions in the pelvis that could be influenced by asymmetry in right

  20. Functional evaluation of a CAD/CAM prosthesis for immediate defect repair after total maxillectomy: a case series of 18 patients with maxillary sinus cancer.

    PubMed

    Jiang, Fei-Fei; Hou, Yan; Lu, Li; Ding, Xiao-Xu; Li, Wei; Yan, Ai-Hui

    2015-01-01

    To evaluate the facial profiles and functional recovery of 18 patients treated by a computer-aided designed/manufactured hollow obturator prosthesis (CAD/CAM prosthesis) after total maxillectomy for malignant maxillary sinus tumor. A retrospective observational study was performed to evaluate the facial profiles and functional recovery of 18 patients with T3-4a N0 M0 maxillary sinus cancer, who were treated by total maxillectomy and simultaneous implantation of a computer-aided designed/manufactured hollow obturator prosthesis (CAD/CAM prosthesis). Follow-ups were performed 1, 3, 6, and 12 months after surgery. Facial measurements, speech intelligibility, and chewing and swallowing functions were examined. Thirteen patients converted to a permanent prosthesis 6 months after surgery. Comparisons were made between patients with and without the CAD/CAM or permanent prosthesis at various times using SPSS13.0 statistical software (SPSS Inc., Chicago, IL, USA). Speech intelligibility, facial depression, and eyeball prolapse results showed improvements with prosthesis use at 1, 3, and 6 months after surgery (p < 0.05). Swallowing function improved from level V to level II-IV with prosthesis use at 1, 3, and 6 months, and reached level I or II with permanent prosthesis use at 12 months after surgery. Simultaneous CAD/CAM prosthesis implantation recovered the facial profile, enhanced the speaking, swallowing, and chewing functions, and improved the quality of life of patients. Tumor recurrence can be detected by direct observation of the postoperative maxillary cavity. Therefore, this operation is recommended for simultaneous excision repair and functional reconstruction after total maxillectomy. This surgical treatment of maxillary sinus cancer is applied rarely in China, but it has a good effect based on our observation. Simultaneous CAD/CAM prosthesis implantation after total maxillectomy can recover the facial profile, enhance the speaking, swallowing, and chewing

  1. Proinflammatory Activity of Primarily Infected Endodontic Content against Macrophages after Different Phases of the Root Canal Therapy.

    PubMed

    Marinho, Ariane C S; Martinho, Frederico C; Leite, Fábio R M; Nascimento, Gustavo G; Gomes, Brenda P F A

    2015-06-01

    This study investigated the presence of target bacterial species and the levels of endotoxins in teeth with apical periodontitis. Levels of inflammatory mediators (interleukin [IL]-1β and tumor necrosis factor [TNF]-α) were determined after macrophage stimulation with endodontic content after different phases of endodontic therapy using different irrigants. Thirty primarily infected root canals were randomly assigned into 3 groups according to the irrigant used for root canal preparation (n = 10 per group): GI: 2.5% sodium hypochlorite, GII: 2% chlorhexidine gel, and GIII (control group): saline solution. Root canal samples were taken by using paper points before (s1) and after root canal instrumentation (s2), subsequently to 17% EDTA (s3), after 30 days of intracanal medication (Ca[OH]2 + saline solution) (s4), and before root canal obturation (s5). Polymerase chain reaction (16S recombinant DNA) and limulus amebocyte lysate assay were used for bacterial and endotoxin detection, respectively. Macrophages were stimulated with the root canal contents for IL-1β/TNF-α measurement using enzyme-linked immunosorbent assay. Porphyromonas gingivalis (17/30), Porphyromonas endodontalis (15/30), and Prevotella nigrescens (11/30) were the most prevalent bacterial species. At s1, endotoxins were detected in 100% of the root canals (median = 32.43 EU/mL). In parallel, substantial amounts of IL-1β and TNF-α were produced by endodontic content-stimulated macrophages. At s2, a significant reduction in endotoxin levels was observed in all groups, with GI presenting the greatest reduction (P < .05). After a root canal rinse with EDTA (s3), intracanal medication (s4), and before root canal obturation (s5), endotoxin levels reduced without differences between groups (P < .05). IL-1β and TNF-α release decreased proportionally to the levels of residual endotoxin (P < .05). Regardless of the use of sodium hypochlorite or CHX, the greatest endotoxin reduction occurs after

  2. Total laparoscopic radical hysterectomy with pelvic lymphadenectomy for endometrial cancer.

    PubMed

    Vasilescu, C; Stănciulea, Oana; Popa, Monica; Anghel, Rodica; Herlea, V; Florescu, Arleziana

    2008-01-01

    The surgical treatment of endometrial cancer is still a matter of debate. Two of the most controversial issues are the beneficial effect of lymphadenectomy and the feasibility of laparoscopy. The aim of the case report was to describe the feasibility of total laparoscopic radical hysterectomy with pelvic lymphadenectomy in a 56-years-old Caucasian woman diagnosed with endometrial cancer. After a CO2 pneumoperitoneum was created the peritoneum was incised cranially to the para-colic fossa just above the external iliac vessels until the psoas muscle is visualized. The external iliac vessels were identified and lymph nodes from the anterior and the medial surface were removed until the iliac bifurcation and placed in an Endo-bag. The procedure continued with the identification of the hypo-gastric and the umbilical artery which were pulled medially in order to open the obturator fossa and remove the lymphatic tissue superior to the obturator nerve. The next step was the opening of the para-vesical and pararectal spaces by using blunt dissection; this maneuver was facilitated by pulling the uterine fundus towards the opposite direction with the uterine manipulator. The parametrium being isolated between the two spaces can be safely divided. At the superior limit of the parametrium the uterine artery is identified and divided at its origin. Thereafter, by placing the uterine fundus in median and posterior position, the vesicouterine peritoneal fold was opened by scissors and a bladder dissection from the low uterine segment down to the vagina was performed. Then the ureter is dissected, freed from its attachments to the parametria and de-crossed from the uterine artery down to its entry into the bladder. Next the rectovaginal space is opened and the utero-sacral ligaments divided; this allows the division of para-vaginal attachments. The vagina is sectioned and the specimen is extracted transvaginally. Then the vaginal stump was sutured by laparoscopy. Total laparoscopic

  3. Persistent infection by Staphylococcus epidermidis in endodontic flare-up: a case report.

    PubMed

    Gonçalves, Simone Helena Ferreira; de Vasconcelos, Rafaela Andrade; Cavalcanti, Bruno das Neves; Camargo, Carlos Henrique Ribeiro

    2016-01-01

    Endodontic flare-ups are challenging situations and may result from selective growth of specific bacterial species; microbial cultures and antibiograms should be used to allow faster, successful management of refractory lesions. A 47-year-old man reported pain on percussion after uncomplicated retreatment of the maxillary left canine for prosthetic purposes. In the following days, pain dramatically increased, leading to removal of the filling and use of intracanal medication. After many unsuccessful attempts to resolve the problem, a microbial culture of the root canal detected the presence of Staphylococcus epidermidis. An antibiogram determined the best drug combination to control this infection: tetracycline (oxytetracycline hydrochloride, 500 mg orally) plus third-generation cephalosporin (ceftriaxone, 1 g intramuscularly). Once the infection was controlled, the root canal was obturated. There was a reduction in the area of radiolucency, and the patient reported no pain at a 2-year follow-up.

  4. Endodontic interappointment flare-ups: a prospective study of incidence and related factors.

    PubMed

    Walton, R; Fouad, A

    1992-04-01

    Severe pain and/or swelling following a root canal treatment appointment are serious sequelae. Information varies or is incomplete as to the incidence of these conditions and related factors. In this study, data were collected at root canal treatment appointments on demographics, pulp/periapical diagnoses, presenting symptoms, treatment procedures, and number of appointments. Patients that then experienced a flare-up (a severe problem requiring an unscheduled visit and treatment) had the correlating factors examined. Statistical determinations were by chi-square analysis with significance at 0.05 or less. Nine hundred forty-six visits resulted in an incidence of 3.17% flare-ups. Flare-ups were positively correlated with more severe presenting symptoms, pulp necrosis with painful apical pathosis, and patients on analgesics. Fewer flare-ups occurred in undergraduate patients and following obturation procedures. There was no correlation between patient demographics or systemic conditions, number of appointments, treatment procedures, or taking antibiotics.

  5. Sealing ability of cermet ionomer cement as a retrograde filling material.

    PubMed

    Aktener, B O; Pehlivan, Y

    1993-03-01

    An in vitro dye leakage study was performed to compare the sealing ability of high copper amalgam with cavity varnish and cermet ionomer cement with and without varnish when used as retrofilling materials. The root canals of 54 maxillary anterior teeth were instrumented and obturated with gutta-percha and sealer. The apical 3 mm of the roots were resected and apical class I cavity preparations were made. The roots were then randomly divided into three groups and retrofilled with one of the experimental materials. After 72 h of immersion in India ink, the roots were cleared and evaluated for leakage with a stereomicroscope. Statistical analysis indicated that the cermet ionomer cement with varnish group had significantly less leakage than the amalgam group (P < 0.0014) and the cermet ionomer cement without varnish group (P < 0.001). There was no significant difference between the other two groups (P > 0.05).

  6. Mandibular first premolar with four canals.

    PubMed

    Du, Yi; Lee, Angeline H C; Zhang, Chengfei

    2013-02-01

    A case of endodontic treatment of a mandibular first premolar exhibiting a total of four distinct root canals and four apical foramina is described. This occurrence in mandibular first premolar has rarely been reported in the endodontic literature. Endodontic treatment that considers the anatomic variation of root canal morphology is important to ensure a favorable healing outcome, and its identification could be enhanced by careful examination using a dental operating microscope. Obturation of root canals using a warm vertical compaction technique with a highly-radiopaque root canal sealer, such as AH Plus, after careful ultrasonic activated irrigation with ethylenediaminetetraacetic acid might allow the flow of sealer into the narrowed but unprepared part of the canal. This offers valuable adjuncts for the successful negotiation of calcified main canals, thereby facilitating optimum chemo-mechanical debridement of the root canal system. © 2013 Blackwell Publishing Asia Pty Ltd.

  7. Functional reconstruction of glossectomy defects: the vertical rectus abdominus myocutaneous neotongue.

    PubMed

    Haddock, Nicholas T; DeLacure, Mark D; Saadeh, Pierre B

    2008-07-01

    The vertical rectus abdominus myocutaneous (VRAM) flap is a valuable option for tongue reconstruction. However, the traditional inset (skin to remaining oral mucosa) obviates a more anatomic reconstruction. Eight patients underwent total or subtotal glossectomy with VRAM reconstruction. The muscle inset was supported at the inferior mandibular border attached to the remaining lingual mucosa or gingiva. The neotongue, consisting of skin and subcutaneous fat, was sutured posteriorly to the remaining tongue base, and the other surfaces were trimmed and left unsutured. Reconstruction was successful in all patients. The neotongue assumed palatal configuration, and within 2 weeks uniform granulation tissue followed by mucosalization occurred. One year postoperatively, all patients tolerated ad lib diets, spoke intelligibly, were gastrostomy tube and tracheotomy free and had no evidence of aspiration. This neotongue sits on the mandible under voluntary control, permitting effective obturation against the hard palate and providing successful speech and swallowing.

  8. Steroids reduce the periapical inflammatory and neural changes after pulpectomy.

    PubMed

    Holland, G R

    1996-09-01

    Root canal treatment, including obturation with gutta-percha and a zinc oxide and eugenol sealer, was conducted, under general anesthesia, on the canine teeth of 12 young ferrets. Six of the ferrets were given 0.5 mg/kg dexamethasone daily. Three months after the root canal treatment, under general anesthesia, the animals were perfused with fixative and the canine periapical tissues prepared for histological examination. The extent of periapical inflammation was measured and the degree of neural sprouting in the periodontal and subapical regions estimated. Periapical lesions in steroid-treated animals were 30% of the size of those in untreated animals. Innervation density in the subapical region of the steroid-treated animals was lower than that in the animals who did not receive steroids and not significantly different from controls. Reduction in periapical inflammation induced by systemic steroids is accompanied by a reduction in neural sprouting.

  9. [S. Pyogenes invasive disease in a paediatric hospital: 1996-2009].

    PubMed

    Caetano, Joana Serra; Neto, Paula; Alves, Manuela Costa; Rodrigues, Fernanda

    2010-01-01

    S. pyogenes is among the most common bacteria in Pediatrics, and is associated with a wide variety of infections and large range of severity. The aim was to evaluate trends of Group A Streptococcal invasive disease in a paediatric tertiary hospital. Retrospective analyses of the medical records of all children with group A streptococcal invasive disease (positive culture obtained from sterile sites), from January 1996 to December 2009 (14 years). There were 24 cases, with a maximum of four cases/year. Eighteen cases (75%) ocurred in the second half of the study. Sixty-seven percent were boys and the median age was three years. The most frequent clinical manifestations were fever (79%), rash (54%) and arthalgia/limbs' pain (46%). The diagnoses were bacteriemia (six), osteoarticular infection (five), celulitis (three), pyomyositis, mastoiditis, surgical wound infection, toxic shock syndrome (two each), necrotizing fasciitis and pneumonia (one each). Four cases occurred during the course of varicella. Other risk factors were present in six cases. Median neutrophyl count was 10.690 x 105/L (2.013-19.180 x 105/L) and median C reactive protein was 146 mg/L (3-425 mg/L). Bacteria were isolated mainly from blood (71%). The outcome was good for most cases but there were two deaths due to toxic shock syndrome. M typing and the presence of virulence factors genes were not assessed. Although the number is small, there was an increase of S. pyogenes invasive disease in the second half of the study. Several cases occurred in the course of varicela or in the presence of other risk factors. Fatal outcome was associated with two toxic shock syndrome cases. Microbiological investigation is essential to understand which M types or virulence factors genes are involved.

  10. Fluid control pump (in French)

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    None

    1973-10-31

    La pompe est caracterisee en ce qu'elle comporte un dispositif destine a soumettre le fluide a pomper a des impulsions repetees alors que ce fluide est renferme dans une chambre comportant des raccords d'entree et de sortie dans chacun desquels une valve fluidique est montee de maniere que les impulsions facilitent la penetration de ce fluide dans la chambre par la valve fluidique du raccord d'entree et qu'elles facilitent egalement la sortie de ce fluide de la chambre par la valve fluidique du raccord de sortie, la sortie du fluide de la chambre par la valve fluidique du raccord d'entreemore » etant cependant reduite, le dispositif comprenant un troncon d'aspiration reliant la chambre a un ejecteur qui comporte un canal relie a une alimentation en gaz comprime, et un element sur lequel le fluide pompe agit pour qu'il obture de maniere intermittente ce canal. (FR)« less

  11. Sealing ability of white and gray mineral trioxide aggregate mixed with distilled water and 0.12% chlorhexidine gluconate when used as root-end filling materials.

    PubMed

    Shahi, Shahriar; Rahimi, Saeed; Yavari, Hamid Reza; Shakouie, Sahar; Nezafati, Saeed; Abdolrahimi, Majid

    2007-12-01

    This in vitro study used dye penetration to compare the sealing ability of white and gray mineral trioxide aggregate mixed with distilled water and 0.12% chlorhexidine gluconate when used as root-end filling materials. Ninety-six single-rooted human teeth were cleaned, shaped, and obturated with gutta-percha and AH26 root canal sealer. The apical 3 mm of each root was resected, and 3-mm deep root-end cavity preparations were made. The teeth were randomly divided into 4 experimental groups, each containing 20 teeth, and 2 negative and positive control groups, each containing 8 teeth. Root-end cavities in the experimental groups were filled with the experimental materials. After decoronation of the teeth and application of nail polish, the teeth were exposed to India ink for 72 hours and longitudinally sectioned, and the extent of dye penetration was measured with a stereomicroscope. Statistical analysis showed that there were no significant differences among the 4 experimental groups.

  12. Coronal leakage inhibition in endodontically treated teeth using resin-coating technique.

    PubMed

    Maruoka, Rena; Nikaido, Toru; Ikeda, Masaomi; Ishizuka, Tomoyasu; Foxton, Richard M; Tagami, Junji

    2006-03-01

    The purpose of this study was to evaluate coronal leakage inhibition using a resin-coating technique after endodontic treatment. Thirty-six human incisors were cut at the cementoenamel junction, and endodontic obturations were performed. The specimens were randomly divided into three groups according to post space preparation (10 mm depth), resin coating, and temporization. For the resin coating, the dentin surface was coated with either a combination of Clearfil SE Bond and Protect Liner F (SE/PLF) or RZII (RZ). Then, the specimens were stored in 37 degrees C distilled water for 24 hours and placed in 1% methylene blue solution for 48 hours. After which, the specimens were sectioned faciolingually along the root canal and the length of dye penetration was measured from the cementoenamel junction. Three-way ANOVA revealed that the dye penetration scores were influenced by post space preparation, resin coating, and temporization. Resin coating with RZ significantly reduced the dye penetration score and SE/PLF completely eliminated dye penetration.

  13. Efficacy and safety of TVT-O and TVT-Secur in the treatment of female stress urinary incontinence: 1-year follow-up.

    PubMed

    Tommaselli, Giovanni A; Di Carlo, Costantino; Gargano, Virginia; Formisano, Carmen; Scala, Mariamaddalena; Nappi, Carmine

    2010-10-01

    To reduce complications of transobturator tension-free vaginal tape, single-incision devices were introduced in the last years. We here report a comparison between the tension-free vaginal tape-obturator (TVT-O) and the TVT-Secur techniques in terms of efficacy and safety. Eighty-four patients with stress urinary incontinence (SUI) were scheduled to undergo TVT-O or TVT-Secur. Duration of the procedure, subjective estimate of blood loss, intraoperative and postoperative complications, postoperative postvoidal residue (PVR), time to first voiding, and pain level were recorded. Urodynamic tests, PVR, Incontinence Questionnaire Short Form (ICIQ-SF), King's Health Questionnaire, and a urinary diary were performed before and 12 months after procedure. No differences in terms of cure rate were observed between the two groups (81.6% vs. 83.8%). Complication rate in the TVT-Secur group was lower (8.1%) than in the TVT-O group (15.8%), but not significant. Both techniques seem to be effective and safe, with a low incidence of complications in both groups.

  14. Flare-up rate in pulpally necrotic molars in one-visit versus two-visit endodontic treatment.

    PubMed

    Eleazer, P D; Eleazer, K R

    1998-09-01

    This retrospective study compared one-visit versus two-visit endodontic treatment. The same technique and materials were used before and after making the sole change to one-visit endodontic treatment in 1991. Treatment records of 402 consecutive patients with pulpally necrotic first and second molars were compared. In 201 patients, treatment was provided by debridement and instrumentation, followed by obturation at a second visit; whereas the second group received single visit therapy. Flare-ups were defined as either patient reports of pain not controlled with over-the-counter medication or as increasing swelling. Sixteen flare-ups (8%) occurred in the two-visit group versus six flare-ups (3%) for the one-visit group. This showed an advantage for one-visit treatment at a 95% confidence level. In a second comparison, one-visit patients who had previously received two-visit treatment for a different pulpally necrotic molar served as their own control. No significant differences were present in this subgroup of 17 patients.

  15. Flare-up rate in molars with periapical radiolucency in one-visit vs two-visit endodontic treatment.

    PubMed

    Akbar, Iftikhar; Iqbal, Azhar; Al-Omiri, Mahmoud K

    2013-05-01

    The objective of this study was to compare postobturation flare-ups following single and two-visit endodontic treatment of molar teeth with periapical radiolucency. A total of 100 patients with asymptomatic molar teeth with periapical radiolucency were selected. They were randomly allocated into two groups. Fifty patients received complete endodontic treatment in one-visit. Fifty patients received treatment by debridement and instrumentation at the first visit followed by obturation at the second visit. 10% of patients had flare-ups in the single visit group and 8% of patients had flare-ups in the two-visit group. Number of visits did not affect the success of endodontic treatment (p>0.05). Age, gender and tooth type had no effects on the occurrence of flare-ups regardless the number of visits (p>0.05). One-visit endodontic treatment was as successful as two-visit endodontic treatment as evaluated by rate of flareups in asymptomatic molar teeth with periapical radiolucency.

  16. Efficacy of Twisted File Adaptive, Reciproc and ProTaper Universal Retreatment instruments for root-canal-filling removal: A cone-beam computed tomography study.

    PubMed

    Akbulut, Makbule Bilge; Akman, Melek; Terlemez, Arslan; Magat, Guldane; Sener, Sevgi; Shetty, Heeresh

    2016-01-01

    The aim of this study was to evaluate the efficacy of Twisted File (TF) Adaptive, Reciproc, and ProTaper Universal Retreatment (UR) System instruments for removing root-canal-filling. Sixty single rooted teeth were decoronated, instrumented and obturated. Preoperative CBCT scans were taken and the teeth were retreated with TF Adaptive, Reciproc, ProTaper UR, or hand files (n=15). Then, the teeth were rescanned, and the percentage volume of the residual root-canal-filling material was established. The total time for retreatment was recorded, and the data was statistically analyzed. The statistical ranking of the residual filling material volume was as follows: hand file=TF Adaptive>ProTaper UR=Reciproc. The ProTaper UR and Reciproc systems required shorter periods of time for retreatment. Root canal filling was more efficiently removed by using Reciproc and ProTaper UR instruments than TF Adaptive instruments and hand files. The TF Adaptive system was advantageous over hand files with regard to operating time.

  17. Atypical anatomy of maxillary second premolar with three roots and four canals

    PubMed Central

    Izaz, Shaik; Mandava, Pragna; Bolla, Nagesh; Dasari, Bhargavi

    2017-01-01

    Knowledge and understanding the anatomical configuration of individual tooth play a significant role in success of endodontic treatment, in addition to through debridement and obturation of the canals. The canal anatomy of maxillary second premolar has been studied extensively, and the presence of a significant variety of multirooted canals is relatively rare in it. A 27-year-old female reported with a chief complaint of pain in her upper right posterior region for 10 days. On intraoral hard tissue examination, ill-defined access preparation was seen in maxillary right second premolar with exposed pulp. An intraoral periapical radiograph reveals radiolucency involving the pulp space and varied morphology in the same tooth. The occurrence of three roots with four canals in the maxillary second premolar is rare and not documented in the literature so far. This case report describes the nonsurgical endodontic management of such varied anatomical configuration using cone beam computed tomography as an evaluating diagnostic tool. PMID:29386789

  18. Management of nasal septal perforation using silicone nasal septal button

    PubMed Central

    Mullace, M; Gorini, E; Sbrocca, M; Artesi, L; Mevio, N

    2006-01-01

    Summary Nasal septal perforation may present with various symptoms: epistaxis, crusting, secondary infection, whistling and nasal obstruction. Perforation may be treated by conservative pharmacological treatment or closed by surgical approach. A useful alternative is mechanical obturation, achieved inserting a prosthesis. The present report refers to a study on 15 patients (10 male, 5 female, mean age 38.5 years) treated by insertion of a one-piece or two-piece silicone septal button (Xomed). In the follow-up period, insertion of the nasal button reduced epistaxis, eliminated whistling during inspiration, and reduced nasal obstruction and crusting around the margin of the perforation. Contraindications are presence of acute infection with osteitis, chronic septal disease (Wegener), neoplasia and extremely large perforations. The latest buttons appear to be superior to the conventional type on account of plasticity and adaptability which offer greater conformity to the septum. This study also reveals that the new septal button is well tolerated by patients. PMID:18236638

  19. Surgical treatment of mixed urinary incontinence: effect of anterior colpoplasty.

    PubMed

    Lleberia, Judith; Pubill, Josep; Mestre, Montse; Garcia, Emma; Grimau, Maria; Bataller, Eduardo

    2011-08-01

    The aims of this study are to study the surgical outcomes in patients with stress-predominant mixed urinary incontinence (MUI) treated with tension-free vaginal tape, and to evaluate the effect of concomitant anterior colpoplasty. A total of 134 women with MUI clinical and urodynamic were assessed at 6 months and annually (maximum 9 years) after surgery. As a whole, a complete healing of 49-51% at 3 years is observed, which hence could result in a tax drop of 36.8% at 5-9 years. Nevertheless, the rate of healing or improvement (subjective) is 73.7% at long term (5-9 years). There were no significant differences between the two techniques used: TVT vs TVT-Obturator. On the other hand, we have found significant differences between association of anterior colpoplasty and not (complete healing rate 34.6% vs 64.6%, p = 0.014), at 2 years of monitoring. MUI with cystocele presents better surgical results for two components of incontinence, with its physiopathogenic implications.

  20. Endoscopic Ultrasound (EUS) for Esophageal and Gastric Varices: How Can it Improve the Outcomes and Reduce Complications of Glue Injection

    PubMed Central

    Bhatia, Vikram

    2012-01-01

    A large part of portal venous system and the paragastric and para-esophageal collateral circulation is within the reach of endoscopic ultrasound (EUS). The EUS is more sensitive than gastroscopy for the detection of gastric varices (GV), and can accurately distinguish GV from thickened gastric folds. Gastric varices are depicted by serpiginous, anechoic, Doppler-positive mural channels, with larger collateral channels visible outside the gastric wall. The EUS has also been used to monitor the completeness of GV obturation after glue injection. There are limited data that this strategy may be clinically beneficial to prevent GV re-bleed. The EUS has been used to deliver glue injections under real-time monitoring into the vascular channels, with or without steel coils as scaffolding for the glue. The potential advantages of this technique include a straight scope position, lack of hindrance from pooled blood in gastric fundus, smaller glue volume requirements, and precise intra-vascular placement of glue with avoidance of intramural injections, and reduced embolic complications. PMID:25755407

  1. Evolution of the role of phototherapy during endodontic decontamination

    PubMed Central

    Muhammad, Omid Heidar; Rocca, Jean-Paul; Fornaini, Carlo

    2015-01-01

    A microbe free root canal space before obturation leads to higher success rate and conventional chemo-mechanical debridement might not achieve this goal completely. First trials of laser in dentistry started from surgical intervention on caries and bones of oral cavity and extended to prepare cavities and even shaping root canals. Afterward lasers were implicated soon into direct debridement of root canal space. Anyhow failure of laser to remove debris totally from root canal space is demonstrated recently, additionally it might lead to damages to surrounding tissues or inorganic material of root canal if be used without precaution. Nowadays the theory of light assisted protocols became another start point for laser in endodontics. Laser has been introduced as an adjuvant to conventional debridement of root canals. We used Medline search engine to collect scientific publications to edit this review article in purpose of revealing the evolution of laser position from an ultimate cleaning methodology to an adjuvant to conventional root canal disinfection protocols. PMID:26877593

  2. The effect of ultrasonic post instrumentation on root surface temperature.

    PubMed

    Huttula, Andrew S; Tordik, Patricia A; Imamura, Glen; Eichmiller, Frederick C; McClanahan, Scott B

    2006-11-01

    This study measured root surface temperature changes when ultrasonic vibration, with and without irrigation, was applied to cemented endodontic posts. Twenty-six, extracted, single-rooted premolars were randomly divided into two groups. Root lengths were standardized, canals instrumented, obturated, and posts cemented into prepared spaces. Thermocouples were positioned at two locations on the proximal root surfaces. Samples were embedded in plaster and brought to 37 degrees C in a water bath. Posts were ultrasonically vibrated for 4 minutes while continuously measuring temperature. Two-way ANOVA compared effects of water coolant and thermocouple location on temperature change. Root surface temperatures were significantly higher (p < 0.001) when posts were instrumented dry. A trend for higher temperatures was observed at coronal thermocouples of nonirrigated teeth and at apical thermocouples of irrigated teeth (p = 0.057). Irrigation during post removal with ultrasonics had a significant impact on the temperature measured at the external root surface.

  3. [Efficacy and tolerance of fenspiride in adult patients with acute respiratory tract infections].

    PubMed

    Płusa, T; Nawacka, D

    1998-12-01

    Fenspiride is an antiinflammatory drug targeted for the respiratory tract. In our study clinical efficacy and tolerance of drug were evaluated in 392 adult patients with acute respiratory tract infections. According to clinical criteria all observed symptoms were classified as mild, moderate and severe. The most of observed patients were included into moderate symptom score. Cough and nose obturation were dominant symptoms. All noticed changes in the upper respiratory tract were decreased after fenspiride therapy in 7 days trial. In 168 observed patients systemic and in 60 local acting antibiotics were successfully applied. Excellent tolerance of fenspiride was documented in 59% and good tolerance --in 34% of patients. Observed adverse reactions were classified as mild and in 20 patients fenspiride was rejected. Authors suggest that fenspiride therapy is save and successful in patient with acute respiratory tract infection. Good results in patients with bronchitis in decreasing of bronchospasm indicate fenspiride as a good tool in bronchial infection.

  4. The effect of low frequency stimulation of the pedunculopontine tegmental nucleus on basal ganglia in a rat model of Parkinson's disease.

    PubMed

    Park, Eunkyoung; Song, Inho; Jang, Dong Pyo; Kim, In Young

    2014-08-08

    The pedunculopontine nucleus (PPN) has recently been introduced as an alternative target to the subthalamic nucleus (STN) or globus pallidus internus (GPi) for the treatment of advanced Parkinson's disease with severe and medically intractable axial symptoms such as gait and postural impairment. However, it is little known about how electrical stimulation of the PPN affects control of neuronal activities between the PPN and basal ganglia. We examined how low frequency stimulation of the pedunculopontine tegmental nucleus (PPTg) affects control of neuronal activities between the PPN and basal ganglia in 6-OHDA lesioned rats. In order to identify the effect of low frequency stimulation on the PPTg, neuronal activity in both the STN and substantia nigra par reticulata (SNr) were recorded and subjected to quantitative analysis, including analysis of firing rates and firing patterns. In this study, we found that the firing rates of the STN and SNr were suppressed during low frequency stimulation of the PPTg. However, the firing pattern, in contrast to the firing rate, did not exhibit significant changes in either the STN or SNr of 6-OHDA lesioned rats during low frequency stimulation of the PPTg. In addition, we also found that the firing rate of STN and SNr neurons displaying burst and random pattern were decreased by low frequency stimulation of PPTg, while the neurons displaying regular pattern were not affected. These results indicate that low frequency stimulation of the PPTg affects neuronal activity in both the STN and SNr, and may represent electrophysiological efficacy of low frequency PPN stimulation. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  5. Coherence of neuronal firing of the entopeduncular nucleus with motor cortex oscillatory activity in the 6-OHDA rat model of Parkinson's disease with levodopa-induced dyskinesias.

    PubMed

    Jin, Xingxing; Schwabe, Kerstin; Krauss, Joachim K; Alam, Mesbah

    2016-04-01

    The pathophysiological mechanisms leading to dyskinesias in Parkinson's disease (PD) after long-term treatment with levodopa remain unclear. This study investigates the neuronal firing characteristics of the entopeduncular nucleus (EPN), the rat equivalent of the human globus pallidus internus and output nucleus of the basal ganglia, and its coherence with the motor cortex (MCx) field potentials in the unilateral 6-OHDA rat model of PD with and without levodopa-induced dyskinesias (LID). 6-hydroxydopamine-lesioned hemiparkinsonian (HP) rats, 6-OHDA-lesioned HP rats with LID (HP-LID) rats, and naïve controls were used for recording of single-unit activity under urethane (1.4 g/kg, i.p) anesthesia in the EPN "on" and "off" levodopa. Over the MCx, the electrocorticogram output was recorded. Analysis of single-unit activity in the EPN showed enhanced firing rates, burst activity, and irregularity compared to naïve controls, which did not differ between drug-naïve HP and HP-LID rats. Analysis of EPN spike coherence and phase-locked ratio with MCx field potentials showed a shift of low (12-19 Hz) and high (19-30 Hz) beta oscillatory activity between HP and HP-LID groups. EPN theta phase-locked ratio was only enhanced in HP-LID compared to HP rats. Overall, levodopa injection had no stronger effect in HP-LID rats than in HP rats. Altered coherence and changes in the phase lock ratio of spike and local field potentials in the beta range may play a role for the development of LID.

  6. Target Selection Recommendations Based on Impact of Deep Brain Stimulation Surgeries on Nonmotor Symptoms of Parkinson's Disease

    PubMed Central

    Wang, Xiao-Hong; Zhang, Lin; Sperry, Laura; Olichney, John; Farias, Sarah Tomaszewski; Shahlaie, Kiarash; Chang, Norika Malhado; Liu, Ying; Wang, Su-Ping; Wang, Cui

    2015-01-01

    Objective: This review examines the evidence that deep brain stimulation (DBS) has extensive impact on nonmotor symptoms (NMSs) of patients with Parkinson's disease (PD). Data Sources: We retrieved information from the PubMed database up to September, 2015, using various search terms and their combinations including PD, NMSs, DBS, globus pallidus internus (GPi), subthalamic nucleus (STN), and ventral intermediate thalamic nucleus. Study Selection: We included data from peer-reviewed journals on impacts of DBS on neuropsychological profiles, sensory function, autonomic symptoms, weight changes, and sleep disturbances. For psychological symptoms and cognitive impairment, we tried to use more reliable proofs: Random, control, multicenter, large sample sizes, and long period follow-up clinical studies. We categorized the NMSs into four groups: those that would improve definitively following DBS; those that are not significantly affected by DBS; those that remain controversial on their surgical benefit; and those that can be worsened by DBS. Results: In general, it seems to be an overall beneficial effect of DBS on NMSs, such as sensory, sleep, gastrointestinal, sweating, cardiovascular, odor, urological symptoms, and sexual dysfunction, GPi-DBS may produce similar results; Both STN and Gpi-DBS are safe with regard to cognition and psychology over long-term follow-up, though verbal fluency decline is related to DBS; The impact of DBS on behavioral addictions and dysphagia is still uncertain. Conclusions: As the motor effects of STN-DBS and GPi-DBS are similar, NMSs may determine the target choice in surgery of future patients. PMID:26668154

  7. The head and neck anatomy of sea turtles (Cryptodira: Chelonioidea) and skull shape in Testudines.

    PubMed

    Jones, Marc E H; Werneburg, Ingmar; Curtis, Neil; Penrose, Rod; O'Higgins, Paul; Fagan, Michael J; Evans, Susan E

    2012-01-01

    Sea turtles (Chelonoidea) are a charismatic group of marine reptiles that occupy a range of important ecological roles. However, the diversity and evolution of their feeding anatomy remain incompletely known. Using computed tomography and classical comparative anatomy we describe the cranial anatomy in two sea turtles, the loggerhead (Caretta caretta) and Kemp's ridley (Lepidochelys kempii), for a better understanding of sea turtle functional anatomy and morphological variation. In both taxa the temporal region of the skull is enclosed by bone and the jaw joint structure and muscle arrangement indicate that palinal jaw movement is possible. The tongue is relatively small, and the hyoid apparatus is not as conspicuous as in some freshwater aquatic turtles. We find several similarities between the muscles of C. caretta and L. kempii, but comparison with other turtles suggests only one of these characters may be derived: connection of the m. adductor mandibulae internus into the Pars intramandibularis via the Zwischensehne. The large fleshy origin of the m. adductor mandibulae externus Pars superficialis from the jugal seems to be a characteristic feature of sea turtles. In C. caretta and L. kempii the ability to suction feed does not seem to be as well developed as that found in some freshwater aquatic turtles. Instead both have skulls suited to forceful biting. This is consistent with the observation that both taxa tend to feed on relatively slow moving but sometimes armoured prey. The broad fleshy origin of the m. adductor mandibulae externus Pars superficialis may be linked to thecheek region being almost fully enclosed in bone but the relationship is complex.

  8. Current steering to activate targeted neural pathways during deep brain stimulation of the subthalamic region

    PubMed Central

    Chaturvedi, Ashutosh; Foutz, Thomas J.; McIntyre, Cameron C.

    2012-01-01

    Deep brain stimulation (DBS) has steadily evolved into an established surgical therapy for numerous neurological disorders, most notably Parkinson’s disease (PD). Traditional DBS technology relies on voltage-controlled stimulation with a single source; however, recent engineering advances are providing current-controlled devices with multiple independent sources. These new stimulators deliver constant current to the brain tissue, irrespective of impedance changes that occur around the electrode, and enable more specific steering of current towards targeted regions of interest. In this study, we examined the impact of current steering between multiple electrode contacts to directly activate three distinct neural populations in the subthalamic region commonly stimulated for the treatment of PD: projection neurons of the subthalamic nucleus (STN), globus pallidus internus (GPi) fibers of the lenticular fasiculus, and internal capsule (IC) fibers of passage. We used three-dimensional finite element electric field models, along with detailed multi-compartment cable models of the three neural populations to determine their activations using a wide range of stimulation parameter settings. Our results indicate that selective activation of neural populations largely depends on the location of the active electrode(s). Greater activation of the GPi and STN populations (without activating any side-effect related IC fibers) was achieved by current steering with multiple independent sources, compared to a single current source. Despite this potential advantage, it remains to be seen if these theoretical predictions result in a measurable clinical effect that outweighs the added complexity of the expanded stimulation parameter search space generated by the more flexible technology. PMID:22277548

  9. The importance of body mass normalisation for ultrasound measurements of the morphology of oblique abdominis muscles: the effect of age, gender, and sport practice.

    PubMed

    Linek, P

    2018-01-01

    Some studies have not considered body mass as a confounder in analysis of oblique abdominis muscles (OAM) (including the oblique externus [OE] and oblique internus [OI]), which may have led to improper interpretation of results. To assess the differences in the effect of age, gender, and physical activity between normalised for body mass and actual values of the OAM as well as to establish the effect of age, gender, and physical activity on normalised for body mass OAM thicknesses in adolescents. A real-time ultrasound was used to obtain images of the OAM. Body mass normalisation for OAM thicknesses was performed with allometric scaling and the following equations: Allometric-scaled OE = OE thickness/body mass0.88; Allometric-scaled OI = OI thickness/body mass0.72. Analysis showed that boys have significantly thicker OAM than girls, and those who practise sports have thicker OAM than non-active individuals. For allometric-scaled OAM, there was only a significant gender effect, where boys have thicker allometric-scaled OAM than girls. There was a significant correlation between participants' age and the actual value of the OAM. The correlations between age and allometric-scaled OAM were insignificant. An analysis of OAM without body mass normalisation can lead to improper interpretation of study results. Thus, future studies should analyse OE and OI thickness measurements after normalisation rather than actual values. In the adolescent population, there is no effect of age and physical activity on allometric-scaled OAM; males have thicker allometric-scaled OAM than females. (Folia Morphol 2018; 77, 1: 123-130).

  10. Swallowing and deep brain stimulation in Parkinson's disease: a systematic review.

    PubMed

    Troche, Michelle S; Brandimore, Alexandra E; Foote, Kelly D; Okun, Michael S

    2013-09-01

    The purpose of this review is to assess the current state of the literature on the topic of deep brain stimulation (DBS) and its effects on swallowing function in Parkinson's disease (PD). Pubmed, Cochrane review, and web of science searches were completed on all articles addressing DBS that contained a swallowing outcome measure. Outcome measures included the penetration/aspiration scale, pharyngeal transit time, oropharyngeal residue, drooling, aspiration pneumonia, death, hyolaryngeal excursion, epiglottic inversion, UPDRS scores, and presence of coughing/throat clearing during meals. The search identified 13 studies specifically addressing the effects of DBS on swallowing. Critical assessment of the 13 identified peer-reviewed publications revealed nine studies employing an experimental design, (e.g. "on" vs. "off", pre- vs. post-DBS) and four case reports. None of the nine experimental studies were found to identify clinically significant improvement or decline in swallowing function with DBS. Despite these findings, several common threads were identified across experimental studies and will be examined in this review. Additionally, available data demonstrate that, although subthalamic nucleus (STN) stimulation has been considered to cause more impairment to swallowing function than globus pallidus internus (GPi) stimulation, there are no experimental studies directly comparing swallowing function in STN vs. GPi. Moreover, there has been no comparison of unilateral vs. bilateral DBS surgery and the coincident effects on swallowing function. This review includes a critical analysis of all experimental studies and discusses methodological issues that should be addressed in future studies. Copyright © 2013 Elsevier Ltd. All rights reserved.

  11. Mental Health-Related Healthcare Use Following Bilateral Deep Brain Stimulation For Parkinson's Disease.

    PubMed

    Westbay, Lauren C; Cao, Lishan; Burnett-Zeigler, Inger; Reizine, Natalie; Barton, Brandon; Ippolito, Dolores; Weaver, Frances M; Stroupe, Kevin T

    2015-01-01

    The subthalamic nucleus (STN) and the globus pallidus internus (GPi) are both effective targets for deep brain stimulation (DBS) to relieve motor symptoms of Parkinson's disease. However, studies have reported varied effects on mental health-related adverse events and depressed mood following DBS. The current observational study sought to compare mental health healthcare utilization and costs for three years following STN or GPi DBS. For a cohort of Veterans (n = 161) with Parkinson's disease who participated in a larger multi-site randomized trial, we compared mental health outpatient visits, medication use, inpatient admissions, and associated costs by DBS target site (STN vs. GPi). Neither group nor time differences were significant for mental health outpatient or inpatient utilization following DBS. Overall costs associated with mental health visits and medications did not differ by time or by group. However, the percentage of patients with mental health medication use increased in the 6-month and 6 to 12 month periods post-surgery. The STN group had significantly greater increase in medication use at 6 to 12 months post-surgery compared to the GPi group (p <  0.05). Despite a brief increase in medication use following surgery, this study suggests that mental health healthcare use and costs are stable over time and similar between DBS targets. Prior research findings of mental health-related adverse events and mood following DBS did not translate to greater mental health service utilization in our cohort. The changes seen in the year following surgery may reflect temporary adjustments with stabilization over time.

  12. Scaling of movement is related to pallidal γ oscillations in patients with dystonia.

    PubMed

    Brücke, Christof; Huebl, Julius; Schönecker, Thomas; Neumann, Wolf-Julian; Yarrow, Kielan; Kupsch, Andreas; Blahak, Christian; Lütjens, Goetz; Brown, Peter; Krauss, Joachim K; Schneider, Gerd-Helge; Kühn, Andrea A

    2012-01-18

    Neuronal synchronization in the gamma (γ) band is considered important for information processing through functional integration of neuronal assemblies across different brain areas. Movement-related γ synchronization occurs in the human basal ganglia where it is centered at ~70 Hz and more pronounced contralateral to the moved hand. However, its functional significance in motor performance is not yet well understood. Here, we assessed whether event-related γ synchronization (ERS) recorded from the globus pallidus internus in patients undergoing deep brain stimulation for medically intractable primary focal and segmental dystonia might code specific motor parameters. Pallidal local field potentials were recorded in 22 patients during performance of a choice-reaction-time task. Movement amplitude of the forearm pronation-supination movements was parametrically modulated with an angular degree of 30°, 60°, and 90°. Only patients with limbs not affected by dystonia were tested. A broad contralateral γ band (35-105 Hz) ERS occurred at movement onset with a maximum reached at peak velocity of the movement. The pallidal oscillatory γ activity correlated with movement parameters: the larger and faster the movement, the stronger was the synchronization in the γ band. In contrast, the event-related decrease in beta band activity was similar for all movements. Gamma band activity did not change with movement direction and did not occur during passive movements. The stepwise increase of γ activity with movement size and velocity suggests a role of neuronal synchronization in this frequency range in basal ganglia control of the scaling of ongoing movements.

  13. A reevaluation of the unusual abdominal musculature of squamate reptiles (Reptilia: Squamata).

    PubMed

    Bhullar, Bhart-Anjan S

    2009-08-01

    The abdominal muscles of lizards and snakes (Squamata) have been the subject of periodic attention from anatomists, embryologists, and systematists. Until now, the presence of a superficial portion of the m. rectus abdominis, named the m. rectus abdominis lateralis, has been considered a key synapomorphy of the clade Autarchoglossa, which includes all extant squamates save Gekkota and Iguania. However, the precise anatomical relations of the m. rectus abdominis lateralis have never been fully investigated. Here, I show that the m. rectus abdominis lateralis is present in Iguania. Its absence in Gekkota represents rare gross anatomical support for recent molecular-structure-based hypotheses of squamate relationships placing geckoes as sister to the remaining squamates. Where present, it is the most superficial trunk muscle, exterior to the m. obliquus externus. The separation of the m. rectus abdominis lateralis from the m. rectus abdominis occurs as the m. obliquus externus aponeurosis and part of the m. obliquus internus aponeurosis emerge superficially to form the outer portion of the rectus sheath. In Autarchoglossa, the contralateral mm. recti abdomines laterales meet at the midline and are attached to the imbricae of the transverse scale rows characteristic of the clade, suggesting developmental, functional, and evolutionary association. Because the m. rectus abdominis lateralis is sometimes continuous with the pectoralis, its exclusive association with the m. rectus abdominis is questionable. It may be a neomorphic layer that is part of the abaxial developmental system, comprising those muscles whose connective tissue is largely derived from lateral plate as opposed to somatic mesoderm. (c) 2009 Wiley-Liss, Inc.

  14. Temporal evolution of oscillations and synchrony in GPi/muscle pairs in Parkinson's disease.

    PubMed

    Hurtado, José M; Rubchinsky, Leonid L; Sigvardt, Karen A; Wheelock, Vicki L; Pappas, Conrad T E

    2005-03-01

    Both standard spectral analysis and time-dependent phase correlation techniques were applied to 27 pairs of tremor-related single units in the globus pallidus internus (GPi) and EMG of patients with Parkinson's disease (PD) undergoing stereotactic neurosurgery. Over long time-scales (approximately 60 s), GPi tremor-related units were statistically coherent with restricted regions of the peripheral musculature displaying tremor. The distribution of pooled coherence across all pairs supports a classification of GPi cell/EMG oscillatory pairs into coherent or noncoherent. Analysis using approximately 2-s sliding windows shows that oscillatory activity in both GPi tremor units and muscles occurs intermittently over time. For brain/muscle pairs that are coherent, there is partial overlap in the times of oscillatory activity but, in most cases, no significant correlation between the times of oscillatory subepisodes in the two signals. Phase locking between coherent pairs occurs transiently; however, the phase delay is similar for different phase-locking subepisodes. Noncoherent pairs also show episodes of transient phase locking, but they occurred less frequently, and no preferred phase delay was seen across subepisodes. Tremor oscillations in pallidum and EMGs are punctuated by phase slips, which were classified as synchronizing or desynchronizing depending on their effect on phase locking. In coherent pairs, the incidence of synchronizing slips is higher than desynchronizing slips, whereas no significant difference was seen for noncoherent pairs. The results of this quantitative characterization of parkinsonian tremor provide a foundation for hypotheses about the structure and dynamical functioning of basal ganglia motor control networks involved in tremor generation.

  15. The comparison of microbial leakage in roots filled with resilon and gutta-percha: An in vitro study.

    PubMed

    Shashidhar, C; Shivanna, Vasundhara; Shivamurthy, Gb; Shashidhar, Jyothi

    2011-01-01

    The objective of this study was to compare bacterial leakage using streptococcus mutans through gutta-percha and a thermoplastic synthetic polymer based root canal filling material (Resilon) using two filling techniques. A total of 90 single-rooted extracted human teeth were subjected for the study. Teeth were divided into 6 groups of 10 and 3 control groups of 10 teeth each. All the samples were decoronated and the coronal surfaces of the roots were prepared perpendicular to the long axis of the root with a high-speed handpiece and a multipurpose bur using air water spray. The length of all the roots was prepared approximately 16 mm from the coronal surface to the apex of the root. Roots were filled using lateral and vertical condensation techniques with gutta-percha and AH26 sealer (Group 1 and 2) or with gutta-percha and epiphany sealer (Group 3 and 4). Group 5 and 6 were filled with Resilon and epiphany sealer using the lateral and vertical condensation techniques. A split chamber microbial leakage model was used in which S. mutans placed in the upper chamber could reach the lower chamber only through the filled root canal. Group 7 and 8 (positive control) were filled with Resilon and gutta-percha without sealer and tested with bacteria, whereas Group 7 (negative control) was sealed with wax to test the seal between the chambers. Data were analyzed using Kruskal-Wallis test and Mann-Whitney U test. All positive groups (Group 7 and 8) showed leakage within 1 hour of the start of the study (100%), whereas none of the negative control (Group 9) leaked. The roots obturated with Resilon and epiphany (Group 5 and 6) showed minimal leakage, i.e., each with 6 leakages, which was significantly less than gutta-percha (Group 1-4), in which approximately 80% of specimens with either sealer or techniques leaked. Kruskal-Wallis test showed statistical significance when all groups were compared (P<0.05). Mann-Whitney U test compared the respective groups and found Resilon

  16. CBVT analysis of canal configuration of the mesio-buccal root of maxillary first permanent molar teeth: An in vitro study.

    PubMed

    Shenoi, R Pratima; Ghule, Hrishikesh M

    2012-07-01

    For successful endodontic treatment, it's imperative to locate and obturate all root canals. As concluded by Ingle, the major cause for failure of root canal therapy is in ability to recognize all theexisting canals and subsequent failure in their obturation. To analyze the canal configuration of the mesio-buccal root of maxillary first permanent molar teeth. A total of 30 recently extracted human permanent maxillary first molars were collected and stored in a container with 5% Sodium Chloride solution for four days. Teeth with open apices, external resorption, improperly formed roots and teeth with previous restorations were excluded. Using the dental modeling wax, teeth were arranged in a 'U' shaped arch with roots embedded inside the wax and occlusal surface remaining free. 10 teeth were arranged in each arch and three such sample plates were prepared. Flat surface of the base encasing enabled the plate to be mounted on flat plastic bite plate. With bite plate roughly centered in the focal trough area Axial, Coronal and Sagittal section Cone-Beam Computed Tomography (CBCT) images were taken with Kodak 9000 Extra-oral Imaging System. Images displayed on a monitor were inspected by two endodontists using Kodak Dental Imaging Software 3D Module V2.2. When the data was observed, it was found that 24 teeth out of total 30 teeth examined showed some variation (i.e. possible additional canal) along the length of the mesio-buccal root canal. Out of these 24 teeth, 13 showed presence of additional canal at coronal third, 7 showed presence of additional canal at middle third and four showed presence of additional canal in apical third level. Percentage analysis was done as there was no group comparison to be done. Cone-Beam Volumetric Tomography (CBVT) evaluation positively identified the variations in mesio-buccal canal in 80% of samples. Out of these, 54.16% were in coronal 3(rd), 29.16% in middle 3(rd) and 16.66% were in apical 3(rd). Within the limitations of this

  17. The Palatal Interpterygoid Vacuities of Temnospondyls and the Implications for the Associated Eye- and Jaw Musculature.

    PubMed

    Witzmann, Florian; Werneburg, Ingmar

    2017-07-01

    A diagnostic feature of temnospondyls is the presence of an open palate with large interpterygoid vacuities, unlike the closed palate of most other early tetrapods, in which the vacuities are either slit-like or completely absent. Attachment sites on neurocranium and palatal bones in temnospondyls allow the reconstruction of a powerful m. retractor bulbi and a large, sheet-like m. levator bulbi that formed the elastic floor of the orbit. This muscle arrangement indicates that temnospondyls were able to retract the eyeballs through the interpterygoid vacuities into the buccal cavity, like extant frogs and salamanders. In contrast, attachment sites on palate and neurocranium suggest a rather sauropsid-like arrangement of these muscles in stem-tetrapods and stem-amniotes. However, the anteriorly enlarged, huge interpterygoid vacuities of long-snouted stereospondyls suggest that eye retraction was not the only function of the vacuities here, since the eye-muscles filled only the posterior part of the vacuities. We propose an association of the vacuities in temnospondyls with a long, preorbital part of the m. adductor mandibulae internus (AMIa). The trochlea-like, anterior edge of the adductor chamber suggests that a tendon of the AMIa was redirected in an anteromedial direction in the preorbital skull and dorsal to the pterygoids. This tendon then unfolded into a wide aponeurosis bearing the flattened AMIa that filled almost the complete interpterygoid vacuities anterior to the orbits. Our muscle reconstructions permit comprehensive insights to the comparative soft tissue anatomy of early tetrapods and provide the basis for a biomechanic analysis of biting performances in the future. Anat Rec, 300:1240-1269, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  18. Resting-State Pallidal-Cortical Oscillatory Couplings in Patients With Predominant Phasic and Tonic Dystonia.

    PubMed

    Yokochi, Fusako; Kato, Kenji; Iwamuro, Hirokazu; Kamiyama, Tsutomu; Kimura, Katsuo; Yugeta, Akihiro; Okiyama, Ryoichi; Taniguchi, Makoto; Kumada, Satoko; Ushiba, Junichi

    2018-01-01

    Pallidal deep brain stimulation (DBS) improves the symptoms of dystonia. The improvement processes of dystonic movements (phasic symptoms) and tonic symptoms differ. Phasic symptoms improve rapidly after starting DBS treatment, but tonic symptoms improve gradually. This difference implies distinct neuronal mechanisms for phasic and tonic symptoms in the underlying cortico-basal ganglia neuronal network. Phasic symptoms are related to the pallido-thalamo-cortical pathway. The pathway related to tonic symptoms has been assumed to be different from that for phasic symptoms. In the present study, local field potentials of the globus pallidus internus (GPi) and globus pallidus externus (GPe) and electroencephalograms from the motor cortex (MCx) were recorded in 19 dystonia patients to analyze the differences between the two types of symptoms. The 19 patients were divided into two groups, 10 with predominant phasic symptoms (phasic patients) and 9 with predominant tonic symptoms (tonic patients). To investigate the distinct features of oscillations and functional couplings across the GPi, GPe, and MCx by clinical phenotype, power and coherence were calculated over the delta (2-4 Hz), theta (5-7 Hz), alpha (8-13 Hz), and beta (14-35 Hz) frequencies. In phasic patients, the alpha spectral peaks emerged in the GPi oscillatory activities, and alpha GPi coherence with the GPe and MCx was higher than in tonic patients. On the other hand, delta GPi oscillatory activities were prominent, and delta GPi-GPe coherence was significantly higher in tonic than in phasic patients. However, there was no significant delta coherence between the GPi/GPe and MCx in tonic patients. These results suggest that different pathophysiological cortico-pallidal oscillations are related to tonic and phasic symptoms.

  19. Onset in abdominal muscles recorded simultaneously by ultrasound imaging and intramuscular electromyography.

    PubMed

    Vasseljen, Ottar; Fladmark, Anne M; Westad, Christian; Torp, Hans G

    2009-04-01

    Delayed onset of muscle activity in abdominal muscles has been related to low back pain. To investigate this in larger clinical trials it would be beneficial if non-invasive and less cumbersome alternatives to intramuscular electromyography (EMG) were available. This study was designed to compare onset of muscle activity recorded by intramuscular EMG to onset of muscle deformations by ultrasound imaging. Muscle deformations were recorded by two ultrasound imaging modes at high time resolution (m-mode and tissue velocity) in separate sessions and compared to simultaneously recorded intramuscular EMG in three abdominal muscles. Tissue velocity imaging was converted to strain rate which measures deformation velocity gradients within small regions, giving information about the rate of local tissue shortening or lengthening along the beam axis. Onsets in transversus abdominis (TrA), obliquus internus abdominis (OI) and obliquus externus abdominis (OE) were recorded during rapid arm flexions in ten healthy subjects. During ultrasound m-mode recordings, the results showed that mean onsets by EMG were detected 7 ms (95% CI of mean difference; +/-4 ms) and 2 ms (95% CI of mean difference; +/-6 ms) before concurrent ultrasound m-mode detected onsets in TrA and OI, respectively. In contrast, OE onset was recorded 54 ms (95% CI of bias; +/-16 ms) later by EMG compared to ultrasound m-mode. The discrepancy of ultrasound m-mode to accurately record onset in OE was practically corrected in the ultrasound-based strain rate recordings. However, this could only be applied on half of the subjects due to the angle dependency between the ultrasound beam and the direction of the contraction in strain rate recordings. The angle dependency needs to be further explored.

  20. The Head and Neck Anatomy of Sea Turtles (Cryptodira: Chelonioidea) and Skull Shape in Testudines

    PubMed Central

    Jones, Marc E. H.; Werneburg, Ingmar; Curtis, Neil; Penrose, Rod; O’Higgins, Paul; Fagan, Michael J.; Evans, Susan E.

    2012-01-01

    Background Sea turtles (Chelonoidea) are a charismatic group of marine reptiles that occupy a range of important ecological roles. However, the diversity and evolution of their feeding anatomy remain incompletely known. Methodology/Principal Findings Using computed tomography and classical comparative anatomy we describe the cranial anatomy in two sea turtles, the loggerhead (Caretta caretta) and Kemp’s ridley (Lepidochelys kempii), for a better understanding of sea turtle functional anatomy and morphological variation. In both taxa the temporal region of the skull is enclosed by bone and the jaw joint structure and muscle arrangement indicate that palinal jaw movement is possible. The tongue is relatively small, and the hyoid apparatus is not as conspicuous as in some freshwater aquatic turtles. We find several similarities between the muscles of C. caretta and L. kempii, but comparison with other turtles suggests only one of these characters may be derived: connection of the m. adductor mandibulae internus into the Pars intramandibularis via the Zwischensehne. The large fleshy origin of the m. adductor mandibulae externus Pars superficialis from the jugal seems to be a characteristic feature of sea turtles. Conclusions/Significance In C. caretta and L. kempii the ability to suction feed does not seem to be as well developed as that found in some freshwater aquatic turtles. Instead both have skulls suited to forceful biting. This is consistent with the observation that both taxa tend to feed on relatively slow moving but sometimes armoured prey. The broad fleshy origin of the m. adductor mandibulae externus Pars superficialis may be linked to thecheek region being almost fully enclosed in bone but the relationship is complex. PMID:23144831