Search Results (1,185)

Postpartum patients experience a 60-fold increased risk for venous thromboembolism (VTE). We present a postpartum patient with severe pre-eclampsia, gestational diabetes, and a recent Cesarean delivery, who was diagnosed with a VTE hours after a Nexplanon insertion on venous duplex ultrasound. She was started on anticoagulation, had the Nexplanon removed, and recovered well. This case highlights the importance of clinical suspicion for VTE in the postpartum period, presenting a postpartum VTE coinciding with a subdermal implant placement. Full article

Background and Objectives: Adequate buccal bone thickness is critical for long-term peri-implant health and stability. When residual alveolar bone volume is insufficient, guided bone regeneration (GBR) is a widely adopted technique. While non-resorbable membranes provide structural support, they carry a higher risk of complications and require secondary surgery. Resorbable collagen membranes, offer promising biological properties and easier clinical handling, yet clinical data remain limited. This prospective cohort study aimed to evaluate the clinical and radiographic outcomes of horizontal GBR using a native, non–cross-linked resorbable porcine pericardium membrane fixed with titanium pins, in conjunction with simultaneous implant placement. Materials and Methods: Eighteen patients (26 implants) with horizontal alveolar defects (<6 mm) underwent implant placement and GBR with deproteinized bovine bone mineral and a porcine pericardium collagen membrane. Horizontal bone gain and buccal bone thickness were measured at baseline and 6 months post-operatively. Post-operative complications, patient-reported outcomes (PROMs), and peri-implant tissue health were assessed up to 1 year post-loading. Results: Mean bone gain was 2.95 ± 0.95 mm, and all sites achieved a buccal bone thickness ≥ 1.5 mm. No membrane-related complications occurred. PROMs revealed low morbidity. At 1-year follow-up, marginal bone loss averaged 0.54 ± 0.7 mm, mean probing depth was 2.79 ± 0.78 mm, 92% of sites exhibited keratinized mucosa ≥ 2 mm. Conclusions: Native resorbable porcine pericardium membranes, when combined with DBBM and mechanical stabilization, seem to be effective for horizontal bone regeneration. Full article

Arthroscopic treatment of acromioclavicular (AC) joint separations has evolved significantly over the past two decades. Modern anatomical repair methods frequently rely on suspensory fixation devices to reconstruct the coracoclavicular ligaments and, in some cases, to stabilize the AC joint itself. Background/Objectives: Arthroscopy offers a minimally invasive option that ensures excellent visualization of the joint, facilitates management of concomitant intra-articular injuries, and provides direct access to the undersurface of the coracoid process for implant placement. Methods: Over the past seven years, we have managed 30 AC separation cases using this arthroscopic approach. Results: The distinctive feature of our technique is the use of only two portals—one posterior and one anterosuperior—which proved adequate for optimal visualization and accurate implant positioning. Conclusions: In this article, we outline the benefits and limitations of the technique, identify current knowledge gaps, and propose avenues for future clinical research. Full article

Background and Objectives: Primary vesicoureteral reflux (VUR) is a common pediatric urological disorder that can lead to significant renal morbidity if undetected or improperly managed. Ultrasound (US) plays a pivotal role in its assessment, providing a radiation-free tool to prenatal assessment, diagnosis, treatment, and long-term follow-up. This study aims to systematically review the literature on the use of US in pediatric primary VUR, emphasizing its applications in prenatal and postnatal diagnosis, intraoperative guidance, and follow-up monitoring. Methods: A systematic review of the literature was performed on PubMed in accordance with PRISMA guidelines. The research strategy used the following keywords: Ultrasound Vesicoureteral reflux, VUR Ultrasound, and VUR Sonography. A total of 2222 records were initially identified. After screening titles and abstracts for relevance, 2165 studies were excluded because they did not focus on ultrasound procedures, did not specify age limits, were redundant, involved non-homogeneous populations, or were unavailable in full text. Results: Prenatal US enables early identification of urinary tract anomalies suggestive of VUR, facilitating targeted postnatal evaluation. Postnatally, contrast-enhanced voiding ultrasound (CEVUS) offers a non-ionizing method for VUR confirmation or exclusion. Intraoperatively, US improves the accuracy and efficacy of bulking agent placement, potentially enhancing surgical outcomes. In follow-up, US remains essential for both conservatively managed and surgically treated patients, enabling timely detection of complications or recurrence. Conclusions: Ultrasound represents a useful tool in the management of pediatric primary VUR, applicable across all clinical stages, avoiding radiation exposure, and improving surgical effectiveness and follow-up management. Full article

Background: Breast reconstruction following mastectomy plays a crucial role in breast cancer management, restoring physical form and significantly impacting psychological well-being and quality of life. Implant-based breast reconstruction (IBBR) is the most performed technique worldwide due to its relative simplicity, shorter operative times, and avoidance of donor site morbidity. Achieving satisfactory aesthetic outcomes, however, remains challenging, as multiple factors—including patient characteristics, surgical technique, implant selection, timing of reconstruction, and adjuvant therapies—can influence the final appearance. Methods: Literature research was performed via PubMed, Scopus and Cochrane Library Database, focusing on studies examining aesthetic outcomes in implant-based breast reconstruction published between 2015 and 2025. Data on type of study, sample size, aesthetic evaluation methods, and duration of follow-up were collected and summarized. Results: Among 747 articles identified, only 25 articles fulfilled inclusion criteria, including mostly retrospective studies, but also prospective studies, randomized clinical trials, and reviews. Factors such as BMI, inframammary fold management, and implant selection were consistently reported to influence aesthetic outcomes. Surgical techniques including ADM use, axillary advancement sutures, hybrid reconstruction with fat grafting, and prepectoral implant placement were associated with improved patient satisfaction. Patient satisfaction often differs from surgeon-assessed outcomes, emphasizing the importance of subjective evaluation. Conclusions: Despite the heterogeneity and retrospective nature of many studies, evidence indicates that optimizing aesthetic outcomes in IBBR relies on careful patient selection, tailored surgical planning, and meticulous use of evidence-based techniques, including implant selection, flap-based support, and adjunctive strategies. Patient-reported outcomes are essential for evaluating success, and future research should focus on standardized outcome measures and prospective studies to further refine reconstructive approaches and maximize both cosmetic satisfaction and quality of life. Full article

Aerodigestive fistulas represent a major challenge in clinical practice. This problem is burdened with severe morbidity and mortality, despite recent advantages in endoscopic endoluminal repair techniques. Special problems are fistulas localized higher, engaging the proximal esophagus and trachea, which in adults most often result from post-intubation injury. Surgery is generally demanding and reserved for the patients in whom other, less invasive options fail. Hereby, we present a case of post-intubation tracheoesophageal fistula, successfully treated with endoscopic vascular plug placement. Full article

Background/Objectives: Total hip arthroplasty (THA) is a widely accepted and effective intervention for advanced degenerative hip disease. However, prosthetic dislocation remains one of the most common postoperative complications. This study aimed to evaluate the biomechanical consequences of implant positioning variations and their influence on prosthetic stability. Methods: A three-dimensional finite element model (FEM) of the pelvis and hip joint was developed using SolidWorks Professional 2025, based on CT imaging of an anatomically normal adult. Multiple implant configurations were simulated, varying acetabular cup inclination and anteversion angles, femoral stem depth, and femoral offset. Muscle force vectors replicating single-leg stance conditions were applied according to biomechanical reference data. The mechanical performance of each configuration was quantified using the safety factor (SF), defined as the ratio of allowable material stress to calculated stress in the model. Results: The configuration with 45° cup inclination, 15° anteversion, standard femoral offset, and optimal stem depth demonstrated the highest SF values (9–12), indicating a low risk of mechanical failure or dislocation. In contrast, malpositioned implants—particularly those with low or high anteversion, excessive offset, or shallow stem insertion—resulted in a marked decrease in SF values (2–5), especially in the anterosuperior and posterosuperior quadrants of the acetabular interface. Conclusions: The findings underscore the critical importance of precise implant alignment in THA. Even moderate deviations from optimal positioning can substantially compromise biomechanical stability and increase the risk of dislocation. These results support the need for individualized preoperative planning and the use of assistive technologies during surgery to enhance implant placement accuracy and improve clinical outcomes. Full article

This study aimed to examine the proximal effects of blood flow restriction (BFR) training on shoulder muscle function and subjective discomfort during low-intensity external rotation exercise. Twenty-four healthy adults were randomly assigned to a BFR group or a control group and performed shoulder stabilization exercises with or without BFR. Outcome measures included shoulder external rotation range of motion, maximal isometric strength, muscle endurance, electromyographic activity of the rotator cuff muscles, and perceived discomfort. Both groups demonstrated significant within-group improvements in all outcomes except posterior deltoid and supraspinatus activity (p < 0.05). Between-group comparisons showed significantly greater gains in maximal strength and infraspinatus and teres minor activation in the BFR group than in the control group (p < 0.05), while discomfort and fatigue scores were also higher in the BFR group (p < 0.05). These findings suggest that BFR applied at the proximal upper arm can enhance the strength and activation of key rotator cuff muscles even when cuff placement near the shoulder is limited by anatomy. Proximal BFR may serve as an effective intervention for improving shoulder function when high-intensity exercise is contraindicated, although strategies to minimize discomfort are needed to improve clinical feasibility. Full article

Osseodensification (OD) has emerged as a favorable osteotomy preparation technique that preserves and compacts autogenous bone along the osteotomy walls during site preparation, enhancing primary stability and implant osseointegration. While OD has demonstrated promising results in low-density trabecular bone, especially when used in conjunction with acid-etched (AE) implant surfaces, its efficacy in high-density cortical bone remains unclear—particularly in the context of varying implant surface characteristics. In this study, Grade V titanium alloy implants (Ti-6Al-4V, 4 mm × 10 mm) with deep threads, designated bone chambers and either as-machined (Mach) or AE surfaces were placed in 3.8 mm diameter osteotomies in the submandibular region of 16 adult sheep using either OD or conventional (Reg) drilling protocols. Insertion torque values (N·cm) were measured at the time of implant placement to evaluate primary stability. Mandibles were harvested at 3-, 6-, 12-, or 24-weeks post-implantation (n = 4 sheep/time point), and histologic sections were analyzed to quantify bone-to-implant contact (BIC) and bone area fractional occupancy (BAFO). Qualitative histological analysis confirmed successful osseointegration among all groups at each of the healing time points. No statistically significant differences were observed between OD and conventional drilling techniques in insertion torque (p > 0.628), BIC (p > 0.135), or BAFO (p > 0.060) values, regardless of implant surface type or healing interval. The findings indicate that neither drilling technique nor implant surface treatment significantly influences osseointegration in high density cortical bone. Furthermore, as the osteotomy was not considerably undersized, the use of OD instrumentation showed no signs of necrosis, inflammation, microfractures, or impaired osseointegration in dense cortical bone. Both OD and Reg techniques appear to be suitable for implant placement in dense bone, allowing flexibility based on surgeon preference and clinical circumstances. Full article

This study reviews the scientific use of chest-strap wearables, analyzing their advantages and limitations, following PRISMA guidelines. Eligible studies assessed chest-strap devices in adults and reported physiological outcomes such as heart rate, heart rate variability, R–R intervals, or electrocardiographic waveform morphology. Studies involving implanted devices, wrist-worn wearables, or lacking validation against reference standards were excluded. Searches were conducted in PubMed, Scopus, Web of Science, and ScienceDirect for studies published in the last 10 years. The quality of the studies was assessed using the Mixed Methods Appraisal Tool, and results were synthesized narratively. Thirty-two studies were included. The most frequently evaluated devices were the Polar H10 and Zephyr BioHarness 3.0, which showed strong correlations with electrocardiography at rest and during light-to-moderate activity. Reported limitations included motion artefacts, poor strap placement, sweating, and degradation of the skin–electrode interface. None of the devices had CE or FDA approval for clinical use, and most studies were conducted in controlled settings, limiting generalizability. Ergonomic concerns such as discomfort during prolonged wear and restricted mobility were also noted. Overall, chest-strap sensors showed good validity and were widely used in validation studies. However, technical refinements and large-scale field trials are needed for broader clinical and occupational application. This review is registered in PROSPERO and is part of the SIREN project. Full article

This study aimed to evaluate how different insertion angles of titanium orthodontic miniscrews (30°, 45°, and 90°) influence stress distribution and displacement in surrounding alveolar bone using three-dimensional finite element analysis (FEA), with a focus on biomechanical outcomes at the titanium–bone interface. The 90° insertion angle generated the highest stress in cortical bone (58.2 MPa) but the lowest displacement (0.023 mm), while the 30° angle produced lower stress (36.4 MPa) but greater displacement (0.052 mm). The 45° angle represented a compromise, combining moderate stress (42.7 MPa) and displacement (0.035 mm). This simulation-based study was conducted between January and April 2025 at the Department of Orthodontics, Kocaeli Health and Technology University. A standardized 3D mandibular bone model (2 mm cortical and 13 mm cancellous layers) was constructed, and Ti-6Al-4V miniscrews (1.6 mm × 8 mm) were virtually inserted at 30°, 45°, and 90°. A horizontal orthodontic load of 2 N was applied, and von Mises stress and displacement values were calculated in ANSYS Workbench. Stress patterns were visualized using color-coded maps. The 90° insertion angle generated the highest von Mises stress in cortical bone (50.6 MPa), with a total maximum stress of 58.2 MPa, followed by 45° (42.7 MPa) and 30° (36.4 MPa) insertions (p < 0.001). Stress was predominantly concentrated at the cortical entry point, especially in the 90° model. In terms of displacement, the 90° group exhibited the lowest mean displacement (0.023 ± 0.002 mm), followed by 45° (0.035 ± 0.003 mm) and 30° (0.052 ± 0.004 mm), with statistically significant differences among all groups (p < 0.001). The 45° angle showed a balanced biomechanical profile, combining moderate stress and displacement values, as confirmed by post hoc analysis. From a biomimetics perspective, understanding how insertion angle affects bone response provides insights for designing bio-inspired anchorage systems. By simulating natural stress dissipation, this study demonstrates that insertion angle strongly modulates miniscrew performance. Vertical placement (90°) ensures rigidity but concentrates cortical stress, whereas oblique placement, particularly at 45°, offers a balanced compromise with adequate stability and reduced stress. These results emphasize that beyond material properties, surgical parameters such as insertion angle are critical for clinical success. Full article

(1) Introduction: The clinical success of dental implants depends on rapid osseointegration, which can be impaired by hydrocarbon contamination and biological aging of titanium surfaces. Chairside plasma surface treatment has emerged as a practical method to restore surface hydrophilicity and enhance early bone–implant integration. (2) Materials and Methods: This retrospective cohort study evaluated 73 plasma-treated implants placed in 47 patients from June 2023 to October 2024. Non-thermal atmospheric pressure plasma was applied immediately before placement using the ACTILINK™ Reborn system. Implant stability was assessed baseline, weekly for the first four weeks, and again at week 8 using resonance frequency analysis (ISQ). Subgroup analyses were conducted according to initial ISQ, jaw location, implant length/diameter, and final insertion torque. (3) Results: All implants healed uneventfully without a stability dip. Mean ISQ increased from 78.97 ± 5.52 at placement to 83.74 ± 4.36 at week 8 (p < 0.001). Implants with lower initial stability demonstrated the greatest relative gains, while those with very high initial stability showed minimal changes. Mandibular and shorter implants demonstrated higher stability gains compared to maxillary and longer fixtures. (4) Conclusions: Chairside plasma surface treatment was associated with progressive ISQ increases during the 8-week healing period. The greatest gains occurred in implants with lower initial stability, while very stable implants showed little change. Stability improvements were also greater in mandibular sites, shorter fixtures, and those with higher insertion torque. These findings are limited to short-term ISQ outcomes and require validation in prospective controlled trials with standardized protocols. Full article

Background and Objectives: Immediate implant placement in the esthetic zone presents challenges in maintaining peri-implant tissues due to post-extraction remodeling. Bone grafting has been proposed to support tissue preservation and improve esthetic outcomes. This article reviews the role of grafting in clinical studies and case reports. Materials and Methods: A literature search on PubMed and Google Scholar identified studies focusing on immediate implant placement with grafting. The search strategy included articles from 2012 to 2025, in English, from peer-reviewed journals. Results: Implant survival is possible without grafting in ideal cases, but grafting is often essential in patients with thin biotypes or esthetic demands. Technique and material selection are critical. The socket shield technique shows promise in preserving buccal tissues despite its complexity. Case reports demonstrated stable soft tissues and favorable esthetic outcomes. Conclusions: Grafting should be tailored to the clinical situation. While not always necessary, it is often crucial in compromised sites to ensure long-term esthetic success. Current literature supports predictable outcomes with appropriate grafting protocols. Full article

Background/Objectives: Robotic procedures are becoming a standard component of modern protocols in some fields of surgery, given that they present many advantages in terms of accuracy among surgical options. However, in the field of pelvic trauma, limited knowledge is available as concerns robot-assisted surgery. Methods: In this study, a review of the literature was undertaken, and based on the available knowledge and our own clinical experience, we performed urethral repair and pelvic ring reconstruction using a da Vinci SP robot. Results: Given that, to the best of our knowledge, no report on urethral repair in severe trauma via robot-assisted osteosynthesis using a single-port robot has been published thus far, we present a novel study on the use of a single-port robot in pelvic traumatology, including its advantages and limitations. Conclusions: Single-port robotic urethral repair in cases of severe pelvic trauma is feasible and presents great advantages, with findings indicating that even single-port robotic-assisted reconstruction of the anterior pelvic ring is possible. However, our study contained limitations, and additional small incisions for reposition and screw placement purposes were necessary during surgery. Full article

Background/Objectives: The maintenance of peri-implant soft tissue health is critical for the long-term success of implant therapy, particularly in edentulous patients rehabilitated with mandibular overdentures. Leukocyte- and platelet-rich fibrin (L-PRF) has been proposed as an autologous biomaterial to enhance peri-implant tissue quality. This randomized controlled clinical trial evaluated the effect of L-PRF on peri-implant mucosal thickness in edentulous patients treated with mandibular implant-retained overdentures. Methods: Edentulous patients received two interforaminal implants to retain a mandibular overdenture and were randomly assigned to a test group (L-PRF applied during surgery) or a control group (standard protocol without L-PRF). Clinical measurements of keratinized mucosal thickness and width were recorded at baseline, 12 weeks, and 24 weeks. Volumetric analyses of soft and hard tissue changes were performed using digital superimposition of STL models. The trial was conducted in accordance with the Declaration of Helsinki and approved by the Scientific Ethics Committee of the Aconcagua Health Service. All participants provided written informed consent. Results: A significant increase in keratinized mucosal thickness was observed in the L-PRF group at 12 and 24 weeks compared with baseline (p < 0.01). No significant differences were detected between the groups in soft tissue volume (p = 0.12) or bone volume (p = 0.45). Mucosal width remained stable in both groups throughout follow-up. Conclusions: The application of L-PRF at implant placement resulted in a significant gain in peri-implant mucosal thickness, suggesting a soft tissue modulating effect. Enhancing keratinized mucosal thickness during implant surgery may improve peri-implant tissue quality and support long-term stability of mandibular overdentures. Full article