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A new type of prefabricated abutment with a weak connection is proposed. The longitudinal load (like banking force, earth pressure) distribution of this new type of prefabricated abutment was analyzed based on the hinge-joined slab method. A simplified method for calculating the stiffness parameters of the panels was introduced. The influence lines of the longitudinal load on the prefabricated abutment of an actual bridge were calculated by using the proposed theoretical method and finite element method. The comparison between theoretical calculation and simulation results shows that the theoretical calculation method proposed in this paper is correct. In order to investigate the influence of the different thicknesses of the cap beam and dimensions of prefabricated panels on the calculation error of the theoretical calculation method. The influence lines of the prefabricated abutments with different parameters were calculated theoretically and simulated. All calculation errors of the central values of influence lines were less than 20% when the thickness of the cap beam changes from 0.8 to 2.4 m, the errors were all less than 10% when the thickness of the cap beam was 1.2–1.575 m. This calculation further verified that the theoretical calculation method proposed in this paper is suitable for longitudinal load distribution of a weakly connected Prefabricated bridge abutment. It provides a reference for the design and theoretical calculation of prefabricated abutment.

Objectives To evaluate a dental nurse-led triage system at a private dental practice in England after the cessation of face-to-face care during the COVID-19 pandemic; to assess types of presenting problems and their management upon practice reopening at alert level 4; and to explain the benefits of dental nurse-led triage and its relevance to other practices. Methods This retrospective service evaluation used anonymised data gathered for the purpose of assessing and triaging patients when they could not be seen face-to-face. Effectiveness of the triage system was assessed using predetermined criteria. Results Seventy patients were triaged during a 12-week period; 68.5% of patients were managed by the triaging dental nurse without escalation to a dentist and 77% of patients called only once. The most common presenting complaint was pain, followed by loose crown/bridge and fractured crown/tooth/bridge. Sixty-one percent of all patients accepted a face-to-face appointment upon reopening of the dental practice. Conclusions This study demonstrates the effectiveness of a dental nurse-led triage model where dental nurses have the skills and experience required to manage patients at first contact. This model would be applicable to other practices in the case of future emergency closures, as well as a routine out-of-hours service., Key points Demonstrates the effectiveness of a dental nurse-led triage model during the cessation of face-to-face care in the COVID-19 pandemic.Outlines the presenting problems of patients and their uptake of treatment upon practice reopening.Suggests that this model is applicable to a routine out-of-hours service as well as at times of practice closures, and that other practices may wish to adopt it.

Resin materials are commonly used in various dental treatments in patients with metal allergies. Recently, some reports have revealed the association between resin materials and allergic reactions. However, no study has assessed the association between dental adhesive resin cements and allergic reactions. We present the case of a 56-year-old woman with a history of allergic reaction to pollen, iodine, and platinum and some metals. She received periodontal and prosthodontic treatments for 4 years. In the middle of May 2019, a zirconia bridge was cemented to the right molar region of the upper jaw using a dental adhesive resin cement. Two days later, she complained of pain in the tongue, swelling and blistering of the lips, and respiratory stenosis. At the end of May, her temporary bridge was adjusted, and she immediately experienced symptoms similar to those she had after the zirconia bridge cementation. The patient was suspected to have an allergic reaction to the resin. Thus, she underwent an allergy patch test for different dental materials, including some adhesive resin cements. The patch test results revealed a positive allergic reaction to tooth primer on days 2, 3, and 7 and to light-cured adhesive resin paste on day 7. Additionally, the test revealed a false-positive reaction to a self-cured acrylic resin on day 7. However, there were no positive reactions to other adhesive resin cements and glass ionomer cements. Some types of adhesive resin cement may induce an allergic reaction in patients sensitive to different materials. In such a case, we should choose a glass-ionomer cement instead of adhesive resin cement.

The objective of this study was to evaluate the feasibility and safety of a minimally invasive percutaneous plate osteosynthesis (MIPPO) procedure for proximal humeral shaft fractures using lateral minimal proximal and distal approaches and lateral bridge plating with primary radial nerve control, and to assess its clinical and radiographic outcomes. A retrospective review was done for the medical records of adult patients admitted for fracture of the proximal humeral shaft without associated injury to the ipsilateral upper limb and who consented to undergo a novel MIPPO technique herein reported. Patients were reviewed at regular follow-up periods and assessed at a final follow-up for evaluation of Constant, normalized Constant, and QuickDASH scores. There were 21 adult patients with mean age of 56 years. Three patients were lost from early follow-up; one of them had post-operative radial nerve paralysis. Eighteen patients were reviewed for the purpose of this study at a mean of 20 months of final follow-up; among them, one patient developed post-operative radial nerve paralysis with complete recovery after three months. Bone healing was achieved without any malalignment in 17 patients at a mean of 15 weeks, and one patient developed nonunion. At final assessment (mean, 20 months), the mean values of Constant, normalized Constant, and QuickDASH scores were 84 (range, 59 to 100), 95 (range, 73 to 100), and 5 (range, 0 to 18.2) respectively. Compared to pre-reported methods of MIPPO, this technique of lateral proximal and distal mini-approaches with lateral bridge plating after primary control of the radial nerve seems safe and feasible for proximal humeral shaft fractures. It gives good clinical and radiographic results with excellent restoration of upper limb function, very low incidence of post-operative radial nerve injury, and high rate of bone union in good alignment.

An important issue in river engineering is to control scour around bridge piers and abutments using either a collar or a slot. This study examines the use of a slot or a collar, either alone or in conjunction with one other, to reduce scour at bridge abutments. In research on abutments equipped with slots only, collars only, and a combination of both were tested 15, 9, and 18 times, respectively. According to the results, in abutments equipped with slots only, the closer the slot is to the channel wall, the better the performance. At the same time, according to the results of research on collars, mere protection of the upstream face of the abutment is not sufficient to prevent down flows due to the presence of horseshoe and wake vortices, but the downstream faces of collars play a substantial role in reducing scour. With an increase in collar length, the scour depth decreases and the scour hole shifts downstream farther away from the abutment. Finally, it was found that the slot–collar combination model takes a more proactive role in reducing scour compared to collars only or slots only. The most robust combinatorial model used managed to fully control scour around abutments. For combinatorial models, scour showed a 42–100% decrease under different flow conditions in an erodible bed.

Background To describe our scrotal bridge flap technique in reconstructive surgery for extensive penile paraffinoma, a debilitating late complication of penile subcutaneous foreign material injection intended to achieve penile augmentation. Case presentation We reviewed the medical records of 10 patients who underwent reconstructive surgery with the scrotal bridge flap technique for penile paraffinoma at our center between 2016 and 2019. Complete excision of fibrotic tissue and the overlying skin was performed, and penile resurfacing was achieved by mobilizing the scrotal skin superiorly to wrap around the penile shaft, leaving a skin bridge at the median raphe. All 10 patients successfully underwent scrotal bridge flap penile reconstruction with satisfying results. The mean operation duration was 286.1 min (range 213–363 min). No immediate major complications were observed in any of the patients, and no patients required revision surgery. Conclusion The scrotal bridge flap technique is a reliable method for reconstructive surgery after the excision of penile paraffinoma.

Introduction A patient requested dental implant therapy to replace his missing upper left central incisor. Pre-operative cone beam computed tomography (CBCT) imaging revealed a complex neurovascular supply to the anterior maxilla.Discussion Imaging demonstrated accessory neurovascular canals around the nasopalatine foramen which directly communicate with canalis sinuosus. They are, therefore, most likely to carry branches of the anterior superior alveolar nerve and vessels. One of these canals was directly in the path of proposed dental implant placement. A review of the dental literature suggests that such anatomical variation is relatively common. Some authors have proposed that injury to these structures is a cause of intractable pain following dental implant placement. Following discussion with the patient, it was agreed that the provision of an adhesive bridge was a realistic alternative in this case.Conclusion The availability of CBCT imaging in recent years has shown that complex neurovascular anatomy in the anterior maxilla is not uncommon. Evidence is lacking regarding the relevance of this to dental implant placement but it is possible that injury to these structures explains some cases of postoperative intractable pain.

Design This study is a monocentre cohort study with a primary aim to assess the five-year survival of alumina-toughened zirconia (ATZ) implants (Metoxit AG, Thayngen, Switzerland). Secondary aims were to evaluate peri-implant marginal bone loss (MBL), soft tissue health and patient-reported outcome measures (PROMs). The implants were placed into healed ridges and, following a period of temporisation, were restored with either IPS e.max CAD LT or IPS e.max ZirCAD veneered with IPS e.max ZirPress (Ivoclar Vivadent, Schaan, Liechtenstein). Patients were followed up at prosthetic delivery, one-year and five-years post-implant placement. The clinical parameters recorded were clinical attachment levels (CAL), probing depth (PD), gingival recession (GR), modified bleeding index (mBI) and modified plaque index (mPI). MBL was evaluated using standardised radiographs. PROMs were used to assess patients' satisfaction utilising a visual analogue scale (VAS) to rate function, aesthetics, sense, speech and self-esteem. The null hypothesis assumed there was no difference in implant survival between one and five years post-operatively. This study was approved by the ethics committee at the University of Freigburg, Germany (No. 354/07).Cohort selection Forty patients from the Department of Prosthetic Dentistry requiring either an implant supported single crown or a three-unit implant-supported bridge were included in the study. Patients ranged from age 18 to 70 and were selected on a 'convenience basis'. Inclusion criteria stipulated patients must have good oral hygiene, compliance and be systemically healthy. Additionally, they were to have a stable occlusion, no signs of significant bruxism and sufficient bone volume to allow implant placement without the need for larger augmentative procedures.Data analysis Implant success was defined by three main criteria: (1) no local or systemic reactions; (2) no signs of radiolucency on an intraoral radiograph; and (3) provides support to a functional restoration. The MBL was classified as successful when at a one-year follow-up, implants demonstrating no clinical or radiographic signs of pathology are assigned a grade I success with

© 2018, Nature Publishing Group. All rights reserved. Introduction In the UK, one in 600–700 infants is born with a cleft lip and/or palate (CL/P). Previous research has identified patients with CL/P to be at high risk of long-term oral health issues. Yet, few of these patients are currently accessing community dental care. Aims To assess patients’ dental treatment experiences and their suggestions for improving services. Materials and methods Five focus groups were conducted with 24 adults with CL/P. Thematic analysis was performed on the data. Results Participants perceived local dental practitioners to lack knowledge about CL/P and its treatment. Consequently, some participants had stopped visiting a dental practice altogether. Participants were also largely unaware of the specialist CL/P services they are entitled to. Discussion Suggestions are made for the integration of improved training and resources for local dental practitioners. Closer communication between specialist cleft teams and local dental practitioners could also help to bridge the gap in knowledge and improve patients’ engagement with dental services. The tertiary sector has a crucial role to play in empowering patients to take more control of their oral health and dental treatment.

The aim of the present study is to provide a detailed macroscopic mapping of the palatal and tuberal blood supply applying anatomical methods and studying specific anastomoses to bridge the gap between basic structural and empirical clinical knowledge. Ten cadavers (three dentate, seven edentulous) have been prepared for this study in the Department of Anatomy, Semmelweis University, Budapest, Hungary, and in the Department of Anatomy of the Medical University of Graz. All cadavers were fixed with Thiel’s solution. For the macroscopic analysis of the blood vessels supplying the palatal mucosa, corrosion casting in four cadavers and latex milk injection in other six cadavers were performed. We recorded major- and secondary branches of the greater palatine artery (GPA) and its relation to the palatine spine, different anastomoses with the nasopalatine artery (NPA), and lesser palatal artery (LPA) as well as with contralateral branches of the GPA. Penetrating intraosseous branches at the premolar-canine area were also detected. In edentulous patients, the GPA developed a curvy pathway in the premolar area. The blood supply around the maxillary tuberosity was also presented. The combination of different staining methods has shed light to findings with relevance to palatal blood supply, offering a powerful tool for the design and execution of surgical interventions involving the hard palate. The present study provides clinicians with a good basis to understand the anatomical background of palatal and tuberal blood supply. This might enable clinicians to design optimized incision- and flap designs. As a result, the risk of intraoperative bleeding and postoperative wound healing complications related to impaired blood supply can be minimized.

Gear modification is the key technology to design and manufacture gears with high power density, low vibration and low noise. The tooth profile modification can not only compensate the base pitch error, but also can improve the load distribution and reduce the meshing stiffness and meshing impact to achieve the purpose of reducing vibration and noise. Therefore, a method of optimization of tooth profile modification based on dynamic characteristics of helical gear pair is proposed. Firstly, the tooth profile equation of modified rack cutter is given. According to the gear machining process, the parabolic equation on the cutting edge of rack cutter is finally transformed into the surface of pinion. Secondly, tooth contact analysis (TCA), loaded tooth contact analysis (LTCA) and dynamic model of helical gear pair are provided. By TCA and LTCA, dynamic model is solved and dynamic responses are obtained. Finally, the least root-mean-square value of vibration acceleration is taken as the optimization objective; the optimum modification parameter of rack cutter can be obtained. An example is provided to demonstrate the implementation of proposed optimization method. The proposed method establishes the bridge between gear modification, TCA, LTCA and dynamic analysis of helical gear pair.

Bone grafts are implanted materials that support or promote bone healing through an osteogenic, osteoconductive and/or osteoinductive mechanism to the local site. Acetabular bone deficiencies encountered during acetabular hip arthroplasty revision vary from cavitary or segmental defects to complete discontinuity. Several techniques exist to manage these defects. In this review we present the current surgical techniques for reconstructing the acetabular socket which includes a cementless acetabular component with morselised bone, structural allograft, reinforcement rings and bone cages. Segmental acetabular defects involving both columns with more than 50% of the graft supporting the cup suggest the application of ilioischial devices. The aim is to bridge areas of bone loss, providing immediate mechanical fixation. Acetabular reconstruction with the use of the antiprotrusion cage and allografts has to be considered as a reliable procedure to manage severe periprosthetic deficiencies with highly successful long-term outcomes in revision arthroplasty.

Background The purpose of this prospective clinical study was to evaluate clinical results of the passive fit of the substructure in the Toronto bridge and the chipping or delamination of the ceramic veneering on the zirconia-support, after 5 years, in nine patients rehabilitated with zirconia crowns cemented on titanium bars using CAD/CAM technology. Methods A total of nine healthy patient fully edentulous in the upper and lower jaws with non-contributory past medical anamnesis needing full fixed total prosthesis maxilla and mandible were included in this clinical study, where a total 9 mandibles and 9 jaws were treated. The inclusion criteria in order for a patient to participate in the study were: a signed consent form, fully edentulous in the upper and lower jaws, required a full fixed total prosthesis restoration. The exclusion criteria were age limitation of less than 18 years old, chemotherapy, head and neck radiation therapy, diabetes or periodontal disease, smoking and severe illness. All patients received zirconia crowns cemented on titanium bars using CAD/CAM technology. The primary outcome of this study was to examine the survival rate of the zirconia crowns cemented on titanium bars using CAD/CAM technology during the observation period. Any chipping or delamination of the zirconia crowns of the restorations was considered as failure. The secondary outcome was to evaluate the passive fit of the substructure on the implants, loose of occlusal screws, implant survival and satisfactory occlusion. Results In 5 years of follow-up no evidence of chipping or delamination of the ceramic veneering on the zirconia crown supported were observed. Fifteen finished protesis (93.75%) showed satisfactory occlusion and only one case (6.25%) required significant occlusal adjustment. During the first year recall all bars were stable (100%) no mobility of protheses was recorded. After 5 years all bars were stable (100%) and no mobility of protheses was recorded. Conclusion The computerized workflow for the process of building bar and prosthesis ensures reproducible results and excellent adaptation and passive insertion of them, as well as conditions for avoiding mechanical complications and guarantees stability of screw-implant abutments.

This paper presents an application of ultraseismic waveform tomography for condition evaluation (determination of elastic properties) and the unknown depth of a concrete bridge abutment. A newly developed waveform tomography technique for bounded medium (e.g. thin plate) was applied to an ultraseismic dataset collected on a 30-m long bridge in New York City. The dataset was measured on the top of abutment using 24 100-Hz vertical geophones uniformly spaced at 1.2 m apart, and a 3-lb hammer source to induce wave energy. The results revealed that the waveform analysis was able to characterize both the S-wave and P-wave velocities (Vs and Vp) of the abutments and the supporting soils. The true abutment depth of 5.7 m was generally identified in both inverted Vs and Vp profiles. The main advantages of this approach include: (1) data acquisition on top of the abutment is more convenient and cost effective compared to measurements from the ground, boreholes, or river-beds for water bridges; and (2) abutment concrete physical elastic properties are characterized at high resolution in cells. To our best understanding, this is the first reported study using the waveform tomography on field data for assessment of concrete abutments or wall-type structures.

Implant treatment is one of the most important surgical processes in teeth which reduces the difficulties in teeth by providing the interface between bone and jaw. The established implant treatment used to support the denture, bridge and teeth crown. Even though it supports many dental related activities, the successive measure of implant treatment is fail to manage because it fully depends on the patient's personal activities and health condition of mouth tissues. So, the successive rate of implant treatment process is identified by applying the memetic search optimization along with Genetic scale recurrent neural network method. The introduced method analyzes the patient characteristics which helps to recognize the successive and failure rate of implant treatment process. The quality of the implant treatment of using simulation results in terms of sensitivity, specificity and accuracy metrics.

Tooth contact analysis (TCA) technology is an approach for computerized simulation of meshing of aligned and misaligned gear, which has been widely used in the design of gears. In TCA technology, the gear modification is completed by first modifying the cutter and then using the cutter to cut the gear blank. The obtained results are the modification parameters of cutter rather than those of gear. With the rapid development of numerical control technology, directly modifying tooth profile becomes more convenient than modifying cutter to the complete tooth profile modification. However, at present, there is no bridge between TCA technology and tooth profile direct modification. Therefore, a calculation method of tooth profile modification for TCA technology is proposed in this paper. Firstly, the simulation process of machining gear by standard rack cutter is introduced. The profile equation and coordinates for standard gear tooth profile are given. Secondly, the simulation process of machining gear by modified rack cutter is introduced. The profile equation and coordinates for modified gear tooth profile are derived. Finally, by comparing the standard tooth profile with the modified tooth profile, the modification of tooth profile is calculated. Thus, the modification parameters of rack cutter obtained by TCA technology can be converted into the modification of tooth profile. An experiment which verified the accuracy of method is provided by the comparison between measuring curve of tooth profile of actual modification and theoretical curve of modified tooth profile.

Background Volar locking plating through the flexor carpi radialis is a well-established technique for treating unstable distal radial fractures, with few reported complications. In certain circumstances, including metaphyseal comminuted fractures, bridge plating through a pronator quadratus (PQ)-sparing approach may be required to preserve the soft tissue envelope. This study describes our prospective experience with bridge plating through indirect reduction. Methods Thirty-three wrists (four 23A2, six 23A3, 15 23C1, and eight 23C2) underwent bridge plating through a PQ-sparing approach with indirect reduction from June 2006 to December 2010. Mean patient age was 56.8 years (range, 25–83 years), and the mean follow-up period was 47.5 months (range, 36–84 months). Changes in radiologic parameters (volar tilt, radial inclination, radial length, and ulnar variance) were analyzed, and functional results at final follow-up were evaluated by measuring the Modified Mayo Wrist Score (MMWS) and Modified Gartland-Werley Score (MGWS). Results All wrists achieved bone healing without significant complications after a single operation. At final follow-up, radial length was restored from an average of 3.7 mm to 11.0 mm, as were radial inclination, from 16.4° to 22.5°, and volar tilt, from − 9.1° to 5.5°. However, radial length was overcorrected in three wrists, and two experienced residual dorsal tilt. Excellent and good results on the MGWS were achieved in 30 wrists (90.9%). The average MMWS outcome was 92.6 (range, 75–100). Conclusion Our experience with bridge plating was similar to that previously reported in the earlier publications. Compared with the conventional technique, bridge plating through a PQ-sparing approach may help in managing metaphyseal comminuted fractures of both cortices with a reduced radio-ulnar index.

This report shows a long-term follow-up of a mandibular reconstruction with a composite graft, consisting of an allogeneic bone crib packed with autogenous particulate bone and cancellous marrow (PBCM). In this patient, segmental mandibulectomy including exarticulation of the temporomandibular joint (TMJ) had been necessary, due to recurrent odontogenic myxoma including the TMJ. Reconstruction was performed with an allogeneic freeze-dried hemimandible with TMJ, packed with compressed autogenous PBCM. Oral rehabilitation was completed with a fixed bridge on two dental implants in the distal part of the graft. During the early follow-up, osteolysis at the mandibular angle and gradual resorption of the temporomandibular joint was observed. Long-term follow-up revealed stable incorporation of the graft with consolidation of defects. A class I occlusion and uninhibited maximum mouth opening remained present. Twenty years after reconstruction with the composite graft, the patient is very satisfied, with high functional success. This implies the composite graft can be a successful treatment option in specific cases of mandibular reconstruction.

In this study, the behavior of a steel box semi-integral abutment bridge affected by the earth pressure depending on temperature change were analyzed using installed thermocouples, strain gauges, earth pressure meters, and LVDTs, and the behavioral characteristics were evaluated and compared based on the structural analysis. According to the measurement and structural analysis results, the low earth pressure from the abutment was caused by the low height of its abutment and the noncompacted abutment backfilling. Earth pressure, however, did not increase or decrease the strain of the steel box girder or influence the temperature displacement, and such strain and displacement of the steel box girder were similar to the case of pure temperature change without earth pressure. Therefore, it can be thought that the measured semi-integral bridge has been shown to be similar behavioral characteristics to the conventional bridge, and that the earth pressure from temperature changes can be ignored because of their minimal influence to structural behaviors of a steel box semi-integral abutment bridge.

The name of the author was incorrectly spelled as "Filippo Carannant". The correct spelling is "Filippo Carannante" and is now presented correctly in this article.

This study examined the fracture strength of 3-unit all-ceramic zirconia bridges treated with a melt-infiltration process of borosilicate glass. The zirconia specimens were milled with presintered yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) blocks. Before veneering the porcelain, borosilicate glass was infiltrated into the zirconia at 1,100°C for 1 hr. A 3-point flexural test was carried out at crosshead speed of 0.1 mm/min. The fracture surface and interface between the zirconia and veneer porcelain were observed by scanning electron microscopy. The fracture strength of the Y-TZP specimens was increased significantly by the melt-infiltration process of borosilicate glass (P < 0.05). The bond strength of the porcelain on zirconia was also improved significantly by meltinfiltration process of borosilicate glass (P < 0.05). The resistance to the initial chipping of the veneered porcelain in the 3-unit allceramic zirconia bridges was increased significantly by melt-infiltration process of borosilicate glass (P < 0.05). According to the microscopic observations of the fracture surface of porcelain, the glass-infiltrated zirconia group showed a rough fracture surface, whereas the sintered zirconia group showed a smooth fracture surface containing many pores.

Bridges are commonly used to replace missing teeth. Periodontal health may, however, be compromised by ill-fitting margins and excess cement. This case report describes the conservative management of chronic gingival inflammation adjacent to the resin-bonded retainers of an anterior bridge by gingival remodelling via a removable prosthesis. This avoided the need for surgical intervention and re-established a suitable gingival profile before placement of a definitive cantilever resin-bonded bridge.

Overpass bridge girders are susceptible to impact damage of over-height vehicles, creating a traffic hazard and structural deficiency. The repair for a damaged girder has to meet adequate criteria for the safety, repair time and economy. This paper presents a case study for the repair of such an impact damaged concrete girder on the Lyndon B. Johnson Express construction project, located on I-635 and I-35 freeways in Dallas, Texas. The impact caused concrete loss and exposed several prestressing strands on the exterior girder. The overpass had been completed while the old route was open below, causing a temporary vertical lower clearance than the final design, leading to the impact. The novel and innovative repair process involved fiber glass (GFRP) rebars, bonding epoxy and repair mortar. These rebars enhanced the flexural capacity of the repaired section and supplemented the mortar strength. Onsite load testing was employed to verify the performance of the repaired structure. Theoretical model of the composite girder before and after repair was employed. The strain data from the model compared well with the load testing data. The repair scheme drastically increased the stiffness of the damaged girder, resulting in about 50 % reduction in the bottom strains. The beneficial effect of the repair resulted in large increases in the net compressive stresses (200–300 %) at the girder bottom through the increase of the section stiffness and reduction of the gravity load stresses. Stresses remained well below the elastic range for concrete and the GFRP rebars.

For distal radial fractures with metaphyseal comminution and radial shortening, the key treatment goal, aside from anatomic reduction of the articular surface, is maintenance of radial length, in order to maintain the normal biomechanics of the wrist. Our distractive bridge plating technique, applied via a pronator sparing approach, was expected to be effective in maintaining the radial length of distal radial fractures with metaphyseal comminution treated with volar plating. However, there were some disadvantages to this approach, namely exposure of the surgeon to additional radiation as compared with conventional plating, satisfactory reduction except radial length by manual manipulation, and provisional fixation is a prerequisite to plating. Our technique has important benefits, in particular, the ability to preserve vascular supply and restore radial length.

Reconstruction of the anterior cruciate ligament using the double bundle technique provides better covering of the anatomic insertion site areas and fiber length change behavior. Biomechanical studies and intraoperative measurements with computer navigation systems document increased stability in particular due to rotational stability. To date the impact of the posterolateral bundle is questioned and clinical studies have reported divergent outcomes. In favor of enhanced rotational stability, some techniques leave the basic principles of aperture or central graft fixation, decreasing primary stability and running the risk of tunnel widening especially on the femoral site. Additional use of interference screws means increased implants and costs and bone void in cases of revision is challenging. A technique for anatomic double-bundle reconstruction without the use of implants is presented, which allows for femoral aperture fixation with high primary stability of both bundles. In terms of the knot/press-fit technique of Paessler in the U-shaped tendons, a knot is created at the free end, which serves as a rigid press-fit anchoring in bottleneck shaped femoral drill holes at the insertion site of the anteromedial and posterolateral bundles. The drill holes are prepared in flexion of 110-115 degrees using common offset and target drill devices. Mersilen tapes are applied to introduce the grafts from femoral to tibial and to fix the tendons over a bony bridge on the tibial site after preconditioning. The gracilis tendon mimics the posterolateral bundle and is fixed in 20 degrees of flexion, the semi- tendinosus tendon is used for the anteromedial bundle and is fixed in 40 degrees of flexion. The advantages of the presented technique are the central, rigid femoral anchoring without hardware, the thin bone tunnels which show no tunnel widening and allow for an optimal bone tendon contact to enhance bony ingrowth. The technique is cost-efficient and provides anatomic double bundle reconstruction of the anterior cruciate ligament. The sacrifice of hardware ensures easy revisions. The disadvantages are the peripheral tibial fixation, the preparation of the tendons needs tendon length and the creation of tendon knots providing high stability requires practice. The two femoral bone tunnels have proved to be safe regarding the stability of the lateral femoral condyle.

Introduction Between 1998 and 2008, 16 adults patients underwent unilateral transtibial amputation and had the distal ends of the tibia and fibula linked using the Ertl bony bridge technique. The patients ranged in age from 18 to 55 years and had a mean postoperative follow-up of 6.8 years.

The standard procedure used to repair partial-thickness tears involves initial progression of the lesion to a full-thickness tear prior to tendon repair. However, the option for a bursal-side partial-thickness rotator cuff tear includes the preservation of as much of the remaining intact fibers as possible. Instead of inserting suture anchors in the medial row, as in the conventional suture-bridge technique, two mattress sutures are inserted into the rotator cuff. Full-thickness access is achieved using a percutaneous spinal needle and medial mattress sutures to preserve the articular bone attachment of the remnant fibers and to compress the repaired tendon on the footprint. Our method can help preserve the remnant rotator cuff tendon without tissue damage and can restore the normal rotator cuff footprint.

The aim of this study was to evaluate the impact of different widths of the bony bridge between the femoral AM and PL bundle tunnel and different fixation techniques on the structural properties of the graft/femur complex in double-bundle ACL reconstructions. Double-bundle ACL reconstruction with a bony bridge between AM and PL bundle tunnel of 1 mm results in significantly lower structural properties of the graft/femur complex when compared to a bridge of 2 and 3 mm. Interference screw fixation significantly lowers the structural properties when compared to cortical fixation. Controlled laboratory study. Double-bundle ACL reconstructions using different bridge widths (1 mm, 2 mm, and 3 mm bridge) were loaded to failure after a cyclic loading protocol (1,000 cycles 0–200 N) and the structural properties were compared to a single-bundle ACL reconstruction group (n = 10 in each group). The structural properties of using a cortical button fixation were then compared to interference screw fixation (2 mm bridge). Statistical analyses were performed using a Mann–Whitney test (P

NOTES cholecystectomy, may eliminate complications related to abdominal incisions. However, the nonmandatory gastrotomy and its safe closure is the main controversy accompanying this approach. Transvaginal access has minimal closure consequences but the safety of inserting extralong instruments between the intestines and having the angle of approach from below rather than from above is questionable. We conducted a study for performing cholecystectomy using a single laparoscopic trocar.The single-trocar cholecystectomy technique was developed on five porcine animal models weighing 35-40 kg each. A 15-mm trocar was used, inserted transumbilicaly. Retraction of the gallbladder was achieved using an endoloop and transabdominal anchoring. Hartman's pouch was manipulated with an endoscopic grasper, which was passed through the working channel of the endoscope, while dissection of the triangle of Callot was performed using articulating laparoscopic instruments.Single-trocar cholecystectomy was successfully performed in four of five porcine models. Average surgery time was 90 min (35-180 min). The technique was modified and improved throughout the study. No intraoperative complications occurred.Single-trocar cholecystectomy is feasible and offers safe approach to this procedure. We assume that a single incision at the umbilicus generates minimal somatic pain, and achieves excellent cosmetic results. The translation of this technique to human subjects seems straightforward and raises the question of whether NOTES is the preferred technique for cholecystectomy.

While ACL reconstruction using single-tunnel and single-bundle techniques generally yields good clinical results, more and more studies are now reporting results that are not entirely satisfactory, as this type of reconstruction only exerts control over forward tibial shifting, not tibial rotation, when activities that exert high functional demands are undertaken. As a result, recent years have seen the appearance of numerous techniques for anatomic ACL reconstruction that reproduce both the anteromedial and posterolateral bundles of the ligament and therefore offer potentially improved rotational control. This article outlines a technique for anatomic ACL reconstruction. Said technique uses central and anteromedial portals, which afford a better perspective of the intercondylar notch. The main features of this technique are: (1) Double bone tunnels in the femur and tibia. The femoral tunnels are created using the out-in technique. (2) Double bundles with hamstring tendon grafts. (3) Tibial fixation by means of interference screws. (4) Femoral fixation in which the graft is supported by a cortical bone bridge and an interference screw in one of the tunnels. We feel that the main advantage of this technique is precisely that it introduces a new feature (a cortical femoral bone bridge) and is not necessarily dependent on specific double-bundle instrumentation, using only regular drill guides to create out-in femoral tunnels. This enables said tunnels to be located with ease and precision. The femoral fixation model itself, with the support provided by the cortical bone bridge, potentially guarantees a level of resistance that can be further increased with the aid of one or two interference screws, thus avoiding the need for post fixation techniques that require the use of screws or buttons.

Accurate estimation of the maximum possible depth of scour at bridge abutments is important in decision-making for the safe depth of burial of footings. Besides, investigation of the geometric features of scour holes around abutments provides useful information for the degree of scour counter-measure to be implemented against excessive scouring. Experiments have been performed to investigate time-dependent characteristics of scour holes around vertical wall abutments under clear water conditions with uniform bed materials. Temporal variations of scour depth and scour contours were measured. Using this information, an empirical relation was developed for temporal variation of scour depth. Additional relations were also derived for time-dependent volume and surface area of the scour holes around abutments. The findings of this study may provide useful information for preliminary design of abutment footings and placement details of armoring counter-measures, such as riprap.

A retrospective clinical audit of the role and survival of 69 Rochette bridges used as immediate provisional restorations for single tooth, implant-retained crowns was carried out over the period between February 1991 and May 2001. In each case the extracted tooth was immediately temporised using a Rochette bridge with a single wing and pontic and cemented to the abutment tooth without any tooth preparation (Phase I). This bridge was removed at the time of implant placement and recemented (Phase II). At the implant exposure stage the bridge was removed and discarded. In Phase I, 15.9% of the bridges required recementation and 27.5% of the bridges required recementations in phase 2; 7.2% of the bridges required recementations in both phases. An 80% probability of survival was noted after an interval of 200 days for phase I and a 78% probability of survival over the same time interval was observed for Phase II. A significant debond rate was observed when the retainer was a canine in comparison to the other bridges in Phase I. In Phase I the spring cantilever debond rate was significantly higher than that observed on the other bridges. More debondings were observed in males (25.8%) compared with females (7.9%) in Phase I. More debondings were noted in the maxilla than in the mandible in Phase II. The performance characteristics of the metal acrylic Rochette bridge observed in this report supports the conclusion that this type of restoration is an effective means of immediate temporisation for patients undergoing single tooth implant retained restorations.

Context Removable partial dentures used to restore the shortened lower dental arch may adversely affect the remaining natural teeth and are associated with a low prevalence of use. Objective To report the findings for caries incidence 2 years after restoration of lower shortened arches with bilateral cantilever resin-bonded bridges (RBBs) and conventional partial dentures (RPDs). Design Randomised controlled trial. Setting Secondary care Patients 25 male and 35 female subjects of median age 67 years. were randomly allocated to 'bridge' and 'denture' treatment groups of 30 patients each matched for age and sex. Caries incidence was recorded during dental examinations 3 months, 1 and 2 years after insertion of new lower prostheses. Interventions Cantilever RBBs and conventional RPDs with cast metal frameworks. Results There was a highly significant difference in the frequency of new caries lesions, 11 and 51 in the bridge and denture groups respectively (P < 0.01). 20 out of 27 bridge patients and 9 of 23 denture patients had no caries experience. Multivariate modeling identified treatment group as the only significant predictor of caries occurrence. Conclusions Two years after restoration of lower shortened arches for an elderly sample of patients, there was a significantly greater incidence of new and recurrent caries lesions in subjects restored with RPDs compared with cantilever RBBs.

We report a case of traumatic rupture of the thoracic aorta immediately treated with endovascular covered stent placement. Follow-up demonstrated a small endoleak, and because of the improved overall condition of the young patient a conventional repair was performed. The stent-graft provided an acute, minimally invasive therapeutic option.

Variations in treatment planning and prescription have been described in relation to routine restorative dentistry. This study examined dentists' decisions regarding treatment planning for fixed bridgework. Fifty five dentists who attended a Continuing Education course on fixed bridgework were given standard information about a patient in the form of study casts, photographs of radiographs and a clinical history. They were asked to design a bridge where a previous one had failed and to complete a proforma which was returned to the course organisers in advance of the event. The response rate was 65%. The data showed wide variation in identification of features of diagnostic importance. Seventy percent of respondents chose to use again as abutments teeth which were extensively damaged and had failed to retain the previous bridge: while only 30% noted features of the occlusion which if left unchanged would have precluded a successful bridge from being made. A further feature was that nearly 70% chose to use multiple abutments to support the bridge. The implications of these results were discussed with respect to current concepts of bridge design.

Following Simpson Grade 1 excision of large convexity meningioma there is often a need for synthetic dural substitutes.One problem with some of these grafts is that they lack tensile strength when wet and therefore sink into the cavity left following removal of the meningioma.A simple method to prevent 'sinking' or sagging of such synthetic dural grafts is described and illustrated.

Underdimensioning may adversely affect the clinical use of a crown or bridge. Insufficient dimensions may be due to inadequate modelling or deficiencies caused by the casting process. The dimensions of cast objects are measured mechanically using a calliper. This method has often proved to be insufficient in detecting areas of too small dimensions. This paper presents a non-destructive method of inspecting dental castings using radiography. The occlusal thickness of a random sample of 150 crowns made during regular clinical treatment in our department was inspected mechanically and radiographically. We found that 19% of the crowns were only 0.1 mm thick or less at the thinnest spot, 18% were between 0.1 and 0.2 mm and 9% were between 0.2 and 0.3 mm. In comparison to mechanical examination, radiographic inspection usually showed smaller values.

A compromise is often necessary when choosing the most appropriate material in the construction of crowns and bridges. The most commonly used material is porcelain fused to metal since it is aesthetic and has acceptable physical characteristics to be used in the restoration of both anterior and posterior teeth. Unfortunately, to achieve a predictable and durable result extensive tooth preparation is invariably necessary. More conservative alternatives such as dentine-bonded crowns may have inferior physical characteristics and allow less predictable control over the occlusal contour. This paper describes the construction of fixed restorations which use both lost wax and refractory die techniques in their construction. This results in a restoration which has the combined advantages of both traditional porcelain fused to metal and dentine-bonded crowns and bridges.

Resin-bonded restorations have many advantages over conventional alternatives. Advances in adhesive technology together with a better understanding of the clinical function of such restorations have allowed resin-bonded bridges to play an important role in everyday clinical practice. This paper highlights the role and importance of the single abutment, single pontic cantilever resin-bonded bridge. Clinical experience might suggest that the cantilever design offers a viable alternative to other designs. Furthermore, the paper suggests that when cantilever resin-bonded bridges fail initially, re-bond often leads to predictable long-term success. Factors such as patient selection, abutment preparation, retainer design and the aesthetic limitations of resin-bonded bridges are also discussed. The authors can claim that further clinical studies are necessary to identify exactly what factors influence the success of cantilever and other resin-bonded designs.

Absence of the maxillary lateral incisor creates an aesthetic problem which can be managed in various ways. The condition requires careful treatment planning and a consideration of the options and outcomes following either space closure or prosthetic replacement. Recent developments in restorative dentistry have warranted a re-evaluation of the approach to this clinical situation. Factors relating both to the patient and to the teeth, including the presenting malocclusion and the effect on the occlusion, are considered. This review considers the possible options: no treatment; orthodontic space closure with canine modification; space maintenance and replacement of the missing tooth with denture, bridge (adhesive and conventional), or implant.

Laboratory studies have demonstrated high bond strengths between a number of resin systems to metal and porcelain, as well as to tooth substance. In circumstances where fracture of a porcelain bridge or crown has occurred, it may appear reasonable to attempt a repair using one of these systems in conjunction with abrasion of the fractured surface, although current knowledge does not allow an accurate prediction of the longevity of the repair under oral conditions.

Surgical Principles Tumors involving the metadiaphyseal region around the knee are often treated by intraarticular resection (and reconstructed by prosthesis or osteoarticular allografts) even when the subchondral bone could be saved and an intercalary reconstruction applied. This is due to problems associated with the reconstruction of the subarticular diaphyseal bone defects by conventional methods. Intercalary allografts (as well as cortical autografts) have significant complication rates in terms of delayed union or graft fracture: these would be significantly increased in those patients in whom an adequate osteosynthesis for support is not feasible. The use of a vascularized fibula alone is contraindicated because it cannot provide sufficient stability for the epiphysis and is too weak to allow early weight bearing. The Ilizarov technique (bone transportation) is extremely time consuming and it may be at risk in patients under aggressive chemotherapy (pin tract infection, possible interference with callus formation). Furthermore, the thin subarticular segment requires an additional ring across the joint, causing knee stiffness. The authors describe a new surgical technique to manage this surgical problem. The basic idea consists to bridge the bone defect using a massive allograft as a peripheral shell supporting a centrally placed micro-vascular fibular autograft. This technique was introduced by the first author in 1988 and preliminary results first described by Capanna et al. in 1989 and in 1991 [1, 2].

Background The purpose of the present study was to evaluate different types of maxillary pre-prosthetic surgery using autogenous bone graft and suggest a guideline for maxillary reconstruction to place implant. Methods 181 patients (125 females and 56 males), age range from 16 to 76 years old, were operated at the Maxillo-Facial Service of the Lille's 2 Universitary Hospital Center (Chairman Pr Joël Ferri). Different techniques were used, but always with autogenous bone grafting. 21 patients underwent a Lefort 1 procedure, 139 underwent sinus graft with or without vestibular onlay graft and 21 underwent onlay graft. This surgical procedure was made to allow the insertion of 685 implants. Results The patients were evaluated by clinical and radiological assessment. In the cases of Lefort 1, the rate of successful osteointegration was higher when the implants were placed in the second part of a two stages procedure: 92%, against 81% for one stage. In cases of sinus lift procedure, the rate of implant success was 98%. The infection rate was 3.5%. There was no significant resorption and the type of prosthesis used was a denture retained by a bar or fixed bridge. In cases of onlay graft, the implant insertion success was 97% and there was no infection. The amount of resorption was more significant in the pre-maxilla than in the other areas and the type of prosthesis used was fixed dentures. Conclusion These observations demonstrate that: the aetiology of the bone defect indicate the type and number of the surgical procedures to re-established good jaws relationship and give the bone conditions to implant insertion successful. Clinical Relevance A guideline for surgical decision in the maxillary reconstruction for oral rehabilitation by implants may help to prevent failures of osseous resorption disorders and to foresee the investment of the bone in quality and necessary quantity.

Background With advances in arthroscopic surgery, many techniques have been developed to increase the tendon-bone contact area, reconstituting a more anatomic configuration of the rotator cuff footprint and providing a better environment for tendon healing. Methods We present an arthroscopic rotator cuff repair technique which uses suture bridges to optimize rotator cuff tendon-footprint contact area and mean pressure. Results Two medial row 5.5-mm Bio-Corkscrew suture anchors (Arthrex, Naples, FL), which are double-loaded with No. 2 FiberWire sutures (Arthrex, Naples, FL), are placed in the medial aspect of the footprint. Two suture limbs from a single suture are both passed through a single point in the rotator cuff. This is performed for both anchors. The medial row sutures are tied using the double pulley technique. A suture limb is retrieved from each of the medial anchors through the lateral portal, and manually tied as a six-throw surgeon's knot over a metal rod. The two free suture limbs are pulled to transport the knot over the top of the tendon bridge. Then the two free suture limbs that were used to pull the knot down are tied. The end of the sutures are cut. The same double pulley technique is repeated for the other two suture limbs from the two medial anchors, but the two free suture limbs are used to produce suture bridges over the tendon, by means of a Pushlock (Arthrex, Naples, FL), placed 1 cm distal to the lateral edge of the footprint. Conclusion This technique maximizes the advantages of two techniques. On the one hand, the double pulley technique provides an extremely secure fixation in the medial aspect of the footprint. On the other hand, the suture bridges allow to improve pressurized contact area and mean footprint pressure. In this way, the bony footprint in not compromised by the distal-lateral fixation, and it is thus possible to share the load between fixation points. This maximizes the strength of the repair and provides a barrier preventing penetration of synovial fluid into the healing area of tendon and bone.

A solution of the problem of rational design of cermet dental bridges is presented. An analysis of the stress-strain state and a computer-aided solution of the boundary nonuniform elastic-plastic problem give the proportion of the bridge span size to the height of the bridges of the metallic carcass at which the denture functions reliably up to the appearance of irreversible changes in it (cleavages and cracks of the ceramic coating).

There are several methods available for the replacement of missing anterior teeth. These include a removable prosthesis, a conventional fixed bridge, an adhesive bridge or a dental implant. The choice of the most suitable technique depends on several factors, such as the condition of the adjacent teeth, the occlusion, the patient's wishes and the financial implications of the proposed treatment.

Restoration of a composite nasal defect with an aesthetically acceptable vascularized full-thickness soft tissue cover and a primary bone graft in a surgically unscarred area at the same stage requires that the flap have a complete formal inset from all the sides, for enhancement of the milieu interior. This article addresses such a situation, which required the use of a cantilever bone graft simultaneously with an interpolated midline forehead flap based on the supratrochlear vessel and transferred on a deepithelialized bridge segment, which allowed an absolute inset from all the sides. The eventual aesthetic outcome was satisfactory after a secondary surgery for nasal tip correction using conchal cartilage graft for tip framework. The procedure has allowed placement of the bone graft in an unscarred bed, with a complete inset of the vascularized full-thickness soft tissue cover. This provided the graft with the ideal vascular milieu for survival and consolidation and achieved an aesthetically acceptable soft tissue reconstruction of the nose with minimal donor-site morbidity. It obviated the need for the staged procedures and provided a secure vascular milieu for the primary bone graft.

A crown root fracture of a tooth in a young person may necessitate the removal of the root and the placement of a space-maintaining partial denture followed by provision of a bridge. A case is reported of an alternative approach to treatment, in which the root fragment is retained in situ until the end of the pubertal growth spurt, in order to preserve alveolar bone, following which it is removed and replaced by an implant.