Search Results (250)

Aim: This study aimed to compare two-piece zirconia and two-piece titanium implants inserted into the anterior mandible for removable overdentures in a 3-year randomized split-mouth clinical trial. Methods: Twenty fully edentulous mandibular patients received two zirconia and two titanium implants allocated by computer-generated randomization. The primary endpoint was bleeding-on-probing (BOP) at 12 months. Secondary outcomes included implant survival and success (Albrektsson criteria), marginal bone level changes, peri-implant cytokines (IL-1β, IL-6, and TNFα), prosthetic complications, and patient-reported outcomes (PROMs). Results: After 3 years, overall survival was 98.61% and overall success was 84.72%. Titanium implants showed higher success compared with zirconia implants (91.70% vs. 77.78%), while survival was 100% and 97.22%, respectively. Marginal bone loss was significantly greater around zirconia implants at 36 months (p < 0.01). No significant differences were observed in IL-1β, IL-6, or TNFα levels up to 12 months. PROMs revealed a trade-off, with zirconia favored for esthetics and cleaning perception, while titanium was rated superior for stability. Conclusions: Within the limitations of this split-mouth RCT, zirconia implants demonstrated reduced success and inferior marginal bone stability compared with titanium implants in overdenture therapy. Careful case selection and close follow-up appear essential when zirconia implants are used in this indication. Full article

Objective: To report a rare case of pulp space tissue growth in a mature mandibular molar with severe endo-periodontal involvement after conservative endodontic treatment and to discuss the possible biological explanations, including regeneration and granulation tissue healing. Severe endo-periodontal lesions are challenging, particularly as endodontic regeneration is usually observed in immature teeth, while revascularization in mature teeth, especially in cases of advanced periodontal disease, is rare, as demonstrated in this case. Methods: This study reports a rare case of tissue regeneration versus granulation tissue healing in the pulp space, occurring alongside periodontal healing, in a mature mandibular molar with necrotic pulp and severe periodontal involvement. A 52-year-old patient presented with a mature mandibular molar (tooth #19) exhibiting necrotic pulp with severe endo-periodontal involvement, including grade-3 mobility, tenderness to percussion, a 12 mm probing depth, and extensive periradicular radiolucency. The tooth was diagnosed with necrotic pulp and symptomatic apical periodontitis and was deemed hopeless, with extraction planned. Results: Following patient refusal, endodontic treatment was initiated, including cleaning, shaping, and placement of the intracanal medicament, Ledermix. The patient canceled the extraction due to symptom resolution and disappeared for 12 months. On return, the patient presented with spontaneous pain exacerbated by thermal stimuli, consistent with symptoms of irreversible pulpitis. Clinical examination revealed significant clinical and radiographic improvements, including reduced probing depth (3 mm), no mobility, resolution of apical translucency, radiographic findings suggestive of canal narrowing, and a positive pulp sensibility response. Re-entry elicited profuse bleeding with newly formed vital tissue beneath the medicament. Sodium hypochlorite irrigation failed to achieve hemostasis; inflamed tissue was removed; root canals were cleaned, shaped and obturated; and treatment was completed with placement of a permanent coronal resin composite restoration. A forty-month follow-up showed an asymptomatic tooth with clinical and radiographic healing. Conclusions: This case demonstrates that conservative endodontic management may result in favorable clinical and radiographic outcomes in mature teeth with severe endo-peroidontal involvement, influencing extraction decisions. It provides clinical evidence suggestive of tissue regeneration and periodontal healing in a mature tooth with necrotic pulp and severe periodontal compromise, challenging conventional prognosis. The observed pulp space tissue growth may be suggestive of regeneration; however, alternative explanations, including granulation tissue healing or repair processes, cannot be excluded. Healing by granulation tissue in the pulp space remains possible. Root canal treatment in advanced endo-perio lesions can yield favorable outcomes and may influence extraction decisions. Further clinical and histological studies are needed to clarify underlying mechanisms and optimize treatment strategies. Full article

Background/Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a rare but severe complication of antiresorptive therapy for osteoporosis. This study investigated bacterial adhesion and microbial composition on two suture materials and their potential impact on early wound healing following tooth extraction in patients receiving antiresorptive therapy. Methods: In this prospective exploratory clinical study with partially randomized allocation, female patients undergoing antiresorptive therapy were evaluated for clinical parameters, including the Mombelli Plaque Index (MPI), Mombelli Bleeding Index (MBI), oral smear analysis, and Early Wound Healing Score (EHS). Suture samples (Vicryl and Monocryl, Ethicon, Germany) were removed after 10 days, measured, and weighed. Bacterial DNA was isolated and quantified by qPCR targeting the albumin and 16S rRNA genes. In addition, 16S rRNA gene amplicon sequencing was performed to assess the microbial community composition. Statistical and bioinformatic analyses were conducted to compare materials and evaluate the clustering patterns. Results: Fifty-two suture samples were analyzed. Vicryl exhibited significantly higher 16S rRNA gene copy numbers than Monocryl, indicating increased bacterial colonization, whereas albumin gene copy numbers were significantly higher in Monocryl. The suture weight correlated primarily with albumin gene copy numbers. Amplicon sequencing revealed no material-dependent differences in the microbial composition; instead, samples clustered predominantly by patient, particularly in split-mouth cases. The wound healing outcomes based on the EHS were comparable between materials. Conclusions: Although Vicryl and Monocryl differ in bacterial load and host material deposition, the microbial community composition is primarily patient-specific and the clinical healing outcomes are similar. Surgical management and patient-related factors appear more critical than suture material selection. Full article

Background and Clinical Significance: Vascular lesions of the face, particularly arteriovenous malformations (AVM) and mixed hemangiomas (MH), pose significant diagnostic and therapeutic challenges because of their complex anatomy, unpredictable behavior, and high risk of bleeding. Surgical planning should be individualized and often requires a staged approach with meticulous interdisciplinary coordination to ensure patient safety. The presence of a concomitant odontogenic infection further complicates management, as local inflammation may exacerbate vascular instability and increase the risk of life-threatening complications. Local inflammation and infection might cause some life-threatening conditions, especially when an abscess occurs in the area of any vascular lesion. Ensuring that the oral cavity is free from potential odontogenic infections is a particularly important issue in many complex cases, especially in patients treated for oral, head, and neck cancer or in those with other coexisting morbidities affecting the oral and facial regions. Case Presentation: A 72-year-old man was referred for management of a severe odontogenic infection associated with an extensive facial vascular lesion. The patient’s medical history was significant for arterial hypertension and chronic liver dysfunction (CLD) of unclear etiology. Complete blood testing, including coagulation assessment and liver ultrasonography, was performed, with no contraindication to surgery identified. The scope of odontogenic-related infections was scheduled for simultaneous removal during initial surgery. Preparation for surgery included the local application of sclerotherapy agents. Conclusions: Quite often, a routine panoramic radiograph can help in assessing the status of bone and dentition to undertake all necessary treatment. Severe odontogenic disease, including multiple retained roots, periapical infections, and odontogenic cystic lesions in the context of poor oral hygiene, may lead to the occurrence of possible inflammation. In case of any vascular lesion, a careful diagnostic and therapeutic strategy is needed. This case report highlights that maintaining an infection-free oral environment is a critical component of care in patients with complex facial MH and should be regarded as an essential element of overall treatment planning. Full article

Background and Clinical Significance: Uterine smooth muscle tumors range from benign leiomyomas to highly aggressive leiomyosarcomas. Smooth muscle tumors of uncertain malignant potential (STUMP) represent an intermediate and diagnostically challenging category defined by borderline or discordant histological features. Their clinical management remains complex due to limited possibilities for reliable preoperative differentiation and the absence of clearly established surveillance protocols. The situation becomes particularly sensitive in postmenopausal patients, in whom tumor growth or abnormal bleeding raises concern for malignancy. Case Presentation: We report a 66-year-old postmenopausal woman presenting with persistent uterine bleeding and interval growth of a previously presumed leiomyoma. Transvaginal ultrasound demonstrated a heterogeneous intramural mass measuring approximately 5–7 cm, while endometrial sampling revealed inactive, atrophic endometrium without evidence of malignancy. Given the patient’s postmenopausal status and progressive symptoms, total abdominal hysterectomy with bilateral adnexectomy was performed. Histopathological examination identified moderate cytological atypia, focal coagulative tumor necrosis, and mitotic activity of up to five mitoses per ten high-power fields, findings insufficient for leiomyosarcoma but exceeding those expected for a benign leiomyoma. A diagnosis of STUMP was established. Postoperative staging showed no residual or metastatic disease, and structured long-term follow-up was initiated. Discussion: This case illustrates the limitations of current preoperative diagnostic tools in distinguishing between benign and borderline or malignant uterine smooth muscle tumors. Clinical presentation, imaging, and endometrial sampling were not predictive of the final diagnosis. In postmenopausal women, enlargement of a presumed leiomyoma should prompt careful evaluation, as histological assessment after complete surgical removal often remains the only reliable method of diagnosis. The unpredictable biological behavior of STUMP and reported cases of late recurrence support the need for prolonged surveillance, even after apparently adequate surgical treatment. Conclusions: STUMP remains primarily a postoperative diagnosis and represents a persistent gray zone in gynecologic oncology. Postmenopausal tumor growth and abnormal bleeding warrant an individualized and cautious approach. Careful histopathological evaluation and long-term follow-up are essential to ensure early detection of possible recurrence and optimal patient management. Full article

Background: Despite the clinical significance of circumcision, traditional suturing is frequently compromised by intraoperative bleeding and lengthy recovery periods. While high-frequency electric welding (HFEW) presents a compelling alternative, its utility in foreskin removal procedures remains unexplored. Methods: Employing freshly excised human foreskin tissues, this study simulated the circumcision procedure to benchmark HFEW against standard suturing techniques. Critical performance metrics, encompassing tensile integrity, thermal injury scope, and operative efficiency, were rigorously quantified. Results: HFEW demonstrated exceptional time efficiency, averaging 2.01 ± 0.9 min—a 77.02% reduction relative to conventional suturing (p < 0.001). However, mechanical testing revealed disparities in tissue adhesion; the HFEW cohort recorded lower forces for initial tearing (4.42 ± 1.02 N) and complete rupture (6.15 ± 1.65 N) compared to the superior tensile resistance of the suturing group (7.91 ± 3.26 N and 14.22 ± 6.91 N, respectively). Conclusions: Although HFEW yields comparatively lower tensile strength, its remarkable operational efficiency positions it as a viable technical innovation for circumcision. These preliminary findings support the pursuit of further in vivo investigations to confirm its clinical applicability. Full article

Background: NexoBrid^® (NXB; MediWound Ltd., Yavne, Israel) (anacaulase-bcdb) is a bromelain-based enzymatic debriding agent approved for eschar removal in burn care. Despite widespread clinical use, histological evidence of tissue-level changes after enzymatic debridement remains limited. This systematic review aimed to evaluate preclinical and clinical studies describing histological findings following bromelain-based enzymatic debridement of thermal burns. Methods: Following PRISMA 2020 guidelines, we performed parallel systematic searches of preclinical (animal) and clinical (human) studies across PubMed, Embase, CENTRAL, Web of Science, and Scopus. Included studies reported thermal burns treated with bromelain-based enzymatic debridement and tissue biopsies with histological analysis. Quality was assessed using the SYRCLE Risk of Bias Tool (preclinical) and JBI Critical Appraisal Checklists (clinical). Results: Six preclinical studies (five porcine, one rat) met inclusion criteria. Findings included: selective eschar removal with dermal preservation; protection of the zone of stasis (67% partial- vs. 100% full-thickness necrosis; p = 0.05); viable dermal thickness of 1.1 ± 0.7 mm; and accelerated re-epithelialization (7.4 ± 0.8 vs. 9.1 ± 2.1 days; p < 0.05). Only two clinical studies (n = 9 patients) met the inclusion criteria: one case series (n = 8) and one case report. Clinical findings showed upper dermal homogenisation with preserved deep dermis, vascular congestion correlating with pinpoint bleeding, and pseudoeschar formation via transepidermal elimination. Conclusions: Preclinical evidence supports selective enzymatic debridement with dermal preservation. However, clinical histological data are limited to nine patients after over 13 years of use. This highlights a critical translational gap and underscores the need for prospective clinical histological studies. Full article

Background: Most of the public hospitals in Hong Kong provide a regular colorectal endoscopic submucosal dissection (ESD) service. The current retrospective study aims to review the long- and short-term outcomes of these services, so as to identify areas for improvement. Method and Results: From January 2017 to March 2020, 634 lesions in 623 patients were removed by an ESD technique in seven endoscopic units. The mean lesion size was 31 mm (SD 13 mm, range 10–95 mm), and the mean procedure time was 121 min (SD 67 min). En bloc resection and R0 resection could be achieved in 91.3% and 79.3% of the lesions, respectively. The intra-procedure perforation rate was 12.3%. The delayed bleeding rate was 2.1%, and the delayed perforation rate was 0.8%. Only 0.9% (6/634) of the procedures needed emergency surgical salvage due to complications. Most of the lesions were adenomas (564/634), and 55 of them were adenocarcinomas. The cumulative local recurrence rate was 4.0% at a mean follow-up of 34 months. In multivariate analysis, longer procedure time, submucosal fibrosis, hybrid ESD and piecemeal removal were associated with intra-procedure perforation. Risk factors for failed en bloc resection included non-granular and polypoid morphology, colonic location, longer procedure time and low centre volume. Malignant pathology without salvage surgery was the only independent risk factor for local recurrence. Conclusions: Colorectal ESD has been carried out in Hong Kong with acceptable short-and long-term outcomes despite the technique still being in the learning phase in some centres. Potential areas for improvement should include targeted training to speed up the procedure and enable better handling of difficult cases, aiming to decrease the perforation rate and local recurrence. Full article

Background and Clinical Significance: Embolization of septal occluder devices after patent foramen ovale (PFO) closure is uncommon but potentially serious, as migrated devices may lodge in the arterial system and require urgent management. Cross-sectional imaging may reveal delayed migration incidentally, and endovascular snare retrieval represents a minimally invasive first-line strategy in stable patients. Case Presentation: An 18-year-old woman presented with acute abdominal pain one month after percutaneous PFO closure performed for preventive purposes in the setting of migraine with visual aura. Contrast-enhanced computed tomography (CT), obtained for suspected intra-abdominal bleeding, demonstrated hemoperitoneum from a hemorrhagic ovarian cyst and incidentally identified the Amplatzer occluder lodged in the infrarenal abdominal aorta with preserved renal artery patency. Transthoracic echocardiography confirmed device absence at the interatrial septum. Endovascular retrieval was performed via right common femoral artery access (5 Fr upsized to 12 Fr) using a 20 mm snare system, with successful removal of the device through the introducer and no intra-procedural complications. Conclusions: Delayed migration of a PFO occluder can be detected incidentally during evaluation for unrelated symptoms. In hemodynamically stable patients, transfemoral endovascular snare capture and re-sheathing through a large-bore introducer can achieve safe and effective device retrieval while preserving aorto-iliac patency. Full article

In cardiorenal Syndrome (CRS), diuretic resistance is frequent and congestion predominates in acute forms. In refractory cases, non-pharmacological ultrafiltration therapies have shown effectiveness on fluid removal, improved diuresis, and reduced rehospitalizations. However, the choice of modality remains individualized and resource-dependent. Both continuous renal replacement therapy (CRRT) and peritoneal dialysis (PD) offer hemodynamic advantages, but CRRT carries risks such as infection, bleeding, and high cost. PD has also demonstrated benefits in acute settings, providing effective sodium removal, and no need for anticoagulation, though it is not considered first-line therapy. There are few studies comparing different renal replacement therapies (RRT) in patients with acute CRS and there is no evidence on diuretic resistance. So, the question arises: could there be an advantage of a modality beyond fluid removal? The scarcity of comparative studies underscores the need for randomized trials that move beyond the cardiocentric perspective and include patients at risk of diuretic resistance. Full article

Acute respiratory distress syndrome (ARDS) is a major cause of morbidity and mortality despite decades of progress in ventilatory support. Mechanical ventilation, while essential for oxygenation, may exacerbate lung injury through excessive mechanical power delivery, even when using lung-protective strategies. Extracorporeal carbon dioxide removal (ECCO₂R) was conceived to enable “ultra-protective” ventilation, allowing for further reductions in tidal volume and respiratory rate by selectively removing CO₂ at low extracorporeal blood flows, typically between 0.3 and 1.0 L/min. This physiological decoupling of ventilation and gas exchange aims to mitigate ventilator-induced lung injury (VILI) while maintaining adequate acid–base homeostasis. Although early physiological studies demonstrated feasibility, large, randomized trials have failed to show a survival benefit and have raised concerns about bleeding and technical complications. Recent evidence suggests that these neutral outcomes may stem from the biological and physiological heterogeneity of ARDS rather than from inefficacy of the intervention itself. Patients with high driving pressures, poor compliance, or hyperinflammatory phenotypes may derive greater benefit from ECCO₂R-mediated mechanical unloading. Ongoing technological improvements, including circuit miniaturization, enhanced biocompatibility, and integration with renal replacement therapy, have improved safety and feasibility, yet the procedure remains complex and resource-intensive. Future research should focus on phenotype-enriched trials and the integration of ECCO₂R into precision ventilation frameworks. Ultimately, ECCO₂R should be regarded not as a universal therapy for ARDS but as a targeted physiological tool for selected patients in experienced centers. Full article

Objectives: Due to the rarity of primary vaginal carcinoma, standardized treatment approaches are limited. Radical surgery is rare, especially in advanced stages. This report evaluates the feasibility, technical aspects and outcomes of laparoscopic en bloc resection in advanced vaginal carcinoma. Case presentation: A 67-year-old woman presented with pain and vaginal bleeding. Clinical examination revealed a stenosing vaginal tumour up to 2 cm above the introitus, extending to the urethra and right vulva. Biopsies confirmed invasive squamous cell carcinoma with VAIN/VIN III. Imaging revealed enlarged pelvic lymph nodes, but no distant metastases. Methods: The surgical procedure comprised laparoscopic en bloc resection, including bilateral pelvic lymphadenectomy, radical hysterectomy with bilateral salpingo-oophorectomy, and total vaginal excision down to the pelvic floor. Additionally, inguinal bilateral ICG-guided sentinel lymph node dissection, vulvectomy with clitoral preservation, and partial urethral resection were performed, followed by transvaginal specimen removal. Vaginal closure was achieved via combined transvaginal and laparoscopic pelvic floor reconstruction. The postoperative course was uneventful, with early recovery of urinary and bowel function. Final histology confirmed complete tumor resection with clear margins (pT3, pN0, L0, V0, Pn0, R0). Functional outcomes remained excellent, with no recurrence or functional impairment at one-year follow-up. Conclusions: Laparoscopic en bloc resection appears to be a feasible option for selected patients with locally advanced vaginal carcinoma, enabling complete tumour removal with preservation of pelvic floor function and resulting in favourable postoperative and oncological outcomes. Full article

Background: Rising cancer incidence and mortality have increased the use of central venous catheters (CVCs), including peripherally inserted central catheters (PICCs) and port-a-cath systems (PCSs), which play an important role in treatment administration. However, CVCs are associated with mechanical, infectious, and thrombotic complications. This study evaluates PCS-related complications and their management in oncological patients at The Oncology Institute “Prof. Dr. Ion Chiricuță,” Cluj-Napoca, Romania. Methods: This non-randomized, observational, retrospective study included cancer patients who had a PCS implanted at The Oncology Institute “Prof. Dr. Ion Chiricuță,” Cluj-Napoca, between 1 January 2024 and 31 December 2024 and were enrolled in a follow-up protocol to monitor and manage PCS-related complications. This study evaluated the incidence of complications, their association with predefined prognostic factors, and their management. Results: In the study cohort (n = 124 patients), complications related to the PCS were observed in 20% of the patients, with a mean interval to complication onset of 47 days. Early-onset complications were observed in 40% of patients, while the remaining 60% developed late-onset complications. PCS infection was the most common complication (10 patients), followed by wound dehiscence and thrombosis (6 patients each). Bleeding, extravasation, catheter migration, port malfunction, and torsion were each documented in a single patient. No prognostic factors were significantly associated with early or late PCS complications, with thrombosis approaching significance (p = 0.051). Conclusions: PCSs are generally safe in oncology patients; infections and thrombosis predominate as PCS-related complications, but rarely require removal, and standardized care enables long-term use, improving patient quality of life. Full article

Background: Retained products of conception (RPOC) after term delivery are uncommon but may lead to persistent abnormal uterine bleeding and other complications. Hysteroscopic removal is considered the optimal management strategy, and technological advances have increasingly enabled operative procedures to be performed safely in an office setting. Clinical case: We report the case of a 43-year-old woman who presented with intermittent spotting four months after spontaneous vaginal delivery. Transvaginal ultrasound revealed a small, avascular hyperechoic intrauterine lesion consistent with retained amniochorionic tissue. She underwent office hysteroscopic removal using a 16 Fr bipolar mini-resectoscope under nitrous oxide (N₂O) buccal–nasal analgesia. The procedure was performed using a vaginoscopic, no-touch approach without speculum, tenaculum, or cervical dilation. Complete resection was achieved in a seven-minute procedure, with a postoperative pain score of 2/10 on the VAS and no complications. At 30-day follow-up, the patient was asymptomatic, and an ultrasound confirmed complete resolution. Conclusion: This case demonstrates that retained amniochorionic tissue can be safely and effectively treated in a fully ambulatory setting using mini-resectoscopic technology and N₂O analgesia. The combination of minimally invasive instruments, patient-centered procedural strategies, and well-tolerated analgesia supports the growing role of office operative hysteroscopy for selected complex intrauterine conditions. Full article

Background/Objectives: The novel wave electric toothbrush is considered potentially helpful in removing subgingival plaque to prevent the occurrence of periodontal diseases. This study aimed to assess the cleaning efficacy of a novel wave electric toothbrush on subgingival plaque and its safety profile for oral soft tissues. Methods: In vitro cleaning efficacy evaluations were conducted using oral dental models. The wave electric toothbrushes were divided into low-, medium-, and high-swing parameter groups, with manual brushing (Bass technique) as the control. Simulated plaque was applied to the buccal and gingival sulcus sites of the four first molars, and the plaque removal area and sulcus cleaning depth were measured. For safety evaluation, Sprague Dawley (SD) rats were brushed on their molars daily for 30 days, with bleeding incidents recorded. Oral soft tissues were analyzed through H&E staining and immunohistochemical analysis. Statistical analysis included ANOVA and Kruskal–Wallis (p < 0.05). Results: Medium- and high-swing groups demonstrated superior gingival sulcus cleaning efficacy, showing significant differences compared with the low-swing and control groups (p < 0.05). All swing parameters achieved complete plaque removal on buccal surfaces. No significant differences were observed between the low-swing and manual groups, or between the medium- and high-swing groups, regarding sulcus cleaning efficacy and maximum sulcus depth. During the 30-day in vivo experiment, medium- and high-swing groups showed low bleeding frequencies, primarily at the palatal gingiva and vestibule. Histological analyses indicated that higher swing parameters increased the likelihood of soft tissue injury. Conclusions: Wave electric toothbrushes enhance subgingival plaque removal, with higher swing parameters improving gingival sulcus cleaning. However, stronger parameters may increase the risk of soft tissue damage. Further clinical studies are required to establish optimal guidelines. Full article