Search Results (3,627)

Background: Left Ventricle Myocardial Work (LVMW) has shown utility in assessing patients with aortic stenosis (AS) in recent studies. In the present study, we evaluated the predictive value and optimal cut-off values of LVMW parameters measured prior to TAVI that may be associated with increased mortality in AS patients. Methods: A total of 116 consecutive patients who were qualified for TAVI between March 2021 and November 2022 were evaluated. Pre-procedural LVMW indices (GWI, GCW, GWW, and GWE) were assessed and long-term survival was analysed. Survival and influencing factors were evaluated using univariate and multivariate Cox proportional hazard models, with significant factors subsequently included in cut-off analysis. Results: The median survival time following the TAVI procedure was 1404 (1143–1549) days, with a maximum observation period of 1721 days. All-cause mortality during the follow-up period reached 29%. Multivariate analysis revealed that EF, GLS, GWI, GWE and GCW before TAVI were independent predictors of all-cause mortality. We identified 1975 mmHg, 1497 mmHg and 85% as optimal cut-off values for GCW, GWI and GWE, which allow for significant stratification of patients according to risk. Conclusions: In this analysis, baseline-assessed parameters such as GLS, GWI, GWE, and GCW emerged as independent predictors of all-cause mortality. The proposed cut-off values clearly separated patient groups with different survival outcomes. Full article

Background: Reconstruction of the proximal humerus after wide tumor resection is technically demanding, and traditional methods such as allograft–prosthetic composites, reverse shoulder arthroplasty, and metal implants are limited by graft unavailability, pediatric size mismatch, their high cost, and metal-related stress shielding. Polyether ether ketone (PEEK), with its modulus closer to cortical bone and radiolucency, offers a promising alternative. Building upon the success in craniomaxillofacial surgery and its favorable physical characteristics, we applied personalized 3D-printed PEEK implants for proximal humerus reconstruction. This study reports the first evidence of applying patient-specific 3D-printed PEEK implants in the proximal humerus. Methods: A retrospective cohort study was conducted on seven patients who underwent wide resection of primary malignant bone tumors of the proximal humerus, followed by reconstruction using patient-specific 3D-printed PEEK implants. Implant design was based on preoperative computed tomography (CT) imaging, incorporating contralateral humeral mirroring and computer-aided design. The implants were fabricated using fused deposition modeling (FDM) with medical-grade PEEK under stringent thermal control (nozzle temperature > 400 °C and heated build chamber), followed by a controlled annealing process to minimize internal stress, optimize polymer crystallinity, and enhance mechanical durability. Outcomes assessed included implant survival, oncologic control, shoulder range of motion, and functional outcomes measured using the Musculoskeletal Tumor Society (MSTS) score. The mean follow-up duration was 56.3 months. Results: All patient-specific PEEK implants were successfully manufactured and implanted with satisfactory geometric accuracy. Mechanical implant survival was 85.7% at final follow-up, with one implant fracture occurring at 28 months. No cases of deep infection, dislocation, loosening, or permanent neurovascular injury were observed. Local soft-tissue recurrence occurred in two patients (28.6%), without distant metastasis or tumor-related mortality. The limb-salvage rate was 100%. At final follow-up, the mean MSTS score was 23.0 ± 1.6. Shoulder motion was limited but comparable to outcomes reported for conventional anatomic megaprosthetic reconstructions. Conclusions: Patient-specific 3D-printed PEEK implants provide a feasible and oncologically safe option for proximal humerus reconstruction after tumor resection, with acceptable midterm implant survival and functional outcomes. The favorable elastic modulus and radiolucency of PEEK offer distinct biomechanical and imaging advantages over metallic implants. Further design optimization and larger prospective studies are warranted to enhance mechanical durability and functional restoration. Full article

Introduction: Implant-based breast reconstruction is associated with an increased risk of ischemic complications, which may result in implant loss, suboptimal aesthetic outcomes, and delays in adjuvant oncological treatment. Additionally, axillary surgery carries a risk of upper-limb lymphedema. Indocyanine green (ICG) angiography enables more accurate real-time assessment of tissue perfusion than clinical evaluation alone, while axillary reverse mapping (ARM) facilitates the preservation of upper-limb lymphatics. The integration of these techniques reduces complications and improves both functional and aesthetic outcomes. Materials and methods: A total of 208 breast cancer patients who underwent mastectomy followed by immediate implant-based breast reconstruction were enrolled in this case–control study. The prospective intervention group received intraoperative ICG angiography at three time points and underwent ARM with ICG. Conventional surgical techniques were applied in the retrospective control group. Results: ICG angiography showed excellent diagnostic accuracy for predicting postoperative ischemic complications (AUC = 0.93, 95% CI 0.82–0.99, p < 0.001). Compared with the control group, patients in the ICG group had significantly lower rates of mastectomy skin flap necrosis (11.5% vs. 30.8%, p = 0.001), seroma (4.8% vs. 14.4%, p = 0.032), hematoma (1.9% vs. 9.6%, p = 0.033), and lymphedema (2.9% vs. 17.3%, p < 0.001). They also experienced shorter hospitalization (6.2 ± 1.9 vs. 8.0 ± 2.8 days, p < 0.001), fewer delays in adjuvant treatment initiation (16.3% vs. 32.7%, p = 0.010), and higher aesthetic satisfaction scores (81.41 ± 10.12 vs. 76.03 ± 9.74, p <0.001). Conclusions: Intraoperative indocyanine green angiography is a valuable tool for predicting ischemic complications in alloplastic breast reconstruction and is associated with reduced morbidity, fewer delays in adjuvant treatment, and improved aesthetic outcomes. Preliminary evidence suggests that axillary reverse mapping is associated with lower rates of upper-limb lymphedema. Full article

Background/Objective: Root resective procedures are well established tooth-preserving techniques used when pathology is confined to one root of a multirooted tooth or in the furcation area. Although in recent years implant therapy has become a standard approach in many cases, the rising incidence of peri-implantitis has renewed interest in classical conservative treatment alternatives, such as hemisection, root resection and bicuspidization. The aim of this study is to present clinical cases in which hemisection and bicuspidization were performed to maintain compromised molars in function and achieve long-term outcomes. Methods: This retrospective case series study was conducted in a private dental practice and included three patients treated between 2009 and 2017. The presented cases involved molar teeth exhibiting a vertical fracture or extensive subgingival carries in one root while the remaining root(s) demonstrated favourable periodontal, endodontic and restorative prognosis. An interdisciplinary approach was followed in each case, involving comprehensive clinical and radiographic evaluation including cone beam computed tomography when indicated. The clinical treatment included an endodontic approach (primary treatment or retreatment if required) followed by hemisection or bicuspidization and placement of a permanent prosthetic rehabilitation with full-coverage restoration designed to optimize proper load distribution. Clinical and radiographic follow-up examination was done up to six years in case one, after six months in case two and up to six years in case three. Results: The teeth remained in function through their respective follow-up periods. Clinical and radiographic assessments, according to predefined success criteria, demonstrated periodontal stability (probing depth ≤ 4 mm), no evidence of secondary caries or root fracture, absence of clinical symptoms, normal tooth mobility and masticatory function, absence or reduction in periradicular radiolucency, and stable bone levels. Conclusions: Resective techniques require an interdisciplinary approach, namely, careful case selection, lege artis endodontic treatment, precise surgical technique, and appropriate prosthetic rehabilitation, in order to provide predictable and long-term outcomes. Within the limitations of this case series, resective techniques appeared to be a reliable and predictable alternative to extraction and implant placement in carefully selected clinical cases. Full article

Orthopaedic plates are long-established medical devices conventionally manufactured from metals, most notably titanium alloys. The introduction of Additive Manufacturing (AM) has created new opportunities to design implants with complex internal architectures, enabling precise control over infill patterns and densities that directly influence mechanical properties and fatigue performance. Biodegradable polymers such as polylactic acid (PLA) have attracted growing interest in biomedical engineering, potentially reducing the need for secondary implant-removal surgery if degradation rates are carefully controlled and clinically approved. Additionally, AM offers the ability to customise internal structure for improved mechanical performance and load-bearing, while also providing the possibility of integrating advanced functionalities, such as controlled drug delivery. Building on previous work by our research group at the University of Belgrade, this study investigates the fatigue behaviour of the best-performing AM-optimised orthopaedic plate design. Numerical models incorporating honeycomb infill structures with the full range of achievable densities were developed to assess structural integrity under fatigue loading. Fatigue crack growth was simulated in ANSYS Mechanical (ANSYS Inc., Canonsburg, PA, USA) software, employing a four-point bending configuration in accordance with the ASTM F382 standard. A validated PLA material model was implemented at a reduced load level (10%) relative to previous studies. Direct comparison with titanium plates was avoided due to fundamentally different material properties, focusing instead on infill architecture to identify optimal AM design strategies for orthopaedic plates. Full article

In implant treatment in the aesthetic zone, high aesthetic quality is required in addition to functionality and long-term stability when reconstructing defects in peri-implant tissues. Post-traumatic cases often present with extensive loss of both hard and soft tissues, making the selection of an appropriate grafting method essential. This report describes a case in which an interpositional gingival graft (IGG) and a strip gingival graft (SGG) were combined to regenerate peri-implant soft tissue following guided bone regeneration (GBR), maintaining favorable tissue morphology and aesthetics for six years. The patient was a 53-year-old woman who suffered trauma after falling down stairs, resulting in a fractured bridge in the right maxillary canine region and crown fracture. The traumatized tooth was extracted, and GBR was performed to restore hard tissue volume. Subsequently, IGG and SGG were used to improve soft tissue thickness, interproximal papilla height, and a healthy mucogingival junction (MGJ). A cantilever implant prosthesis was selected as the final restoration. Over six years, no gingival recession or marginal bone loss was observed, and excellent aesthetic stability was maintained. A mini-review of published reports on IGG and SGG demonstrated their efficacy in enhancing soft tissue volume. The findings of this case suggest that a comprehensive approach—including bone augmentation, soft tissue grafting, and prosthetic design—can provide predictable, long-term aesthetic and functional outcomes in complex post-traumatic cases (223). Full article

Granulocyte colony-stimulating factor (G-CSF) has been suggested as a supplementary approach for endometrial preparation in IVF. Clinical results continue to be inconsistent. This narrative review synthesises molecular and clinical information to elucidate the function of G-CSF in modifying endometrial receptivity and to identify patient categories most likely to benefit. A thorough assessment was conducted on published research on G-CSF administration in women with treatment-resistant thin endometrium, recurrent implantation failure, and unselected IVF populations. The research demonstrates that G-CSF has phenotype-dependent effects. Improvements in pregnancy and live birth rates are inconsistent and seem dependent on the reversibility of underlying tissue disease; nevertheless, G-CSF reliably increases endometrial thickness in instances of thin endometrium and may restore eligibility for transfer. G-CSF improves implantation and early pregnancy outcomes in repeated implantation failure patients without modifying endometrial morphology, indicating a functional mechanism linked to immune-stromal synchronisation rather than structural expansion. In contrast, randomised controlled studies show no therapeutic benefit in unselected IVF groups. Discrepancies in research outcomes may mostly be attributed to variations in patient phenotype, initial endometrial function, and the therapy setting. Thus, G-CSF should be considered a specific approach for endometrial conditioning rather than just a supplementary component of IVF. Full article

Biodegradable polymers based on poly(lactic acid) (PLA) and polyhydroxybutyrate (PHB) are widely investigated for biomedical engineering applications, particularly for temporary implants and tissue scaffolds fabricated by additive manufacturing. However, their degradation behavior is influenced not only by material composition, but also by manufacturing-related parameters, geometric design, and environmental conditions. This study investigates the in vitro degradation behavior of PLA/PHB structures fabricated using fused filament fabrication (FFF). Degradation was evaluated under two model environmental conditions over a 45 day period. Changes in specimen mass and the evolution of degradation medium pH were monitored as a function of exposure time, specimen geometry, and infill density. The results revealed a progressive degradation process, with pH values decreasing to approximately 2.7–4.1 in physiological saline solution and increasing to 8.9–9.7 in urea solution, depending on specimen geometry and infill density. After 45 days of exposure, the relative mass loss reached approximately 25–32% for type A specimens and 29–41% for type B specimens. The results revealed distinct differences between degradation environments and specimen geometries, while differences related to infill density partially overlapped within the investigated range. The findings indicate that the degradation behavior of additively manufactured PLA/PHB structures cannot be interpreted solely based on material composition, but should be considered in the context of manufacturing strategy and structural design. These results provide useful insights for the design of biodegradable polymer components with more predictable degradation behavior. Full article

Background: The medial pterygoid muscle (MPM) is frequently implicated in pain and dysfunction in patients with temporomandibular disorders (TMDs), owing to its functional complexity, susceptibility to overload, and rich neuromuscular control. Paradoxically, in patients rehabilitated with tubero-pterygoid implants, whose apices often penetrate or traverse the MPM attachment, no pain, trismus, or TMD-related symptoms are typically observed. Objective: The aim of this study was to evaluate the impact of implant penetration into the medial pterygoid muscle using CBCT and clinical examination after surgery and during follow-up visits. Methods: A retrospective observational study was conducted on 56 patients receiving a total of 116 tubero-pterygoid implants protruding beyond the pterygoid process of the sphenoid bone. Patients were divided into two groups according to implant penetration depth (<2 mm and >2 mm), with a minimum follow-up period of 12 months. Clinical outcomes related to pain, muscle disorders, and TMD symptoms were assessed. Results: Throughout the observation period, all patients remained free of pain, muscular disorders, and signs or symptoms of TMD, regardless of the degree of muscular penetration. Statistical analysis revealed no association between penetration depth and adverse clinical outcomes. Conclusions: The combined clinical and statistical evidence indicates that transmuscular penetration of the MPM by tubero-pterygoid implants is safe and well tolerated. These findings challenge traditional assumptions regarding MPM sensitivity and provide important guidance for surgical planning and maxillary rehabilitation strategies. Full article

Dental implantation affects masticatory bite and muscle forces. The temporomandibular joint (TMJ) bears a substantial amount of these masticatory forces. Thus, the objective of the current study was to investigate whether dental implantation alters the human mandibular condyle. Among 556 images, 54 and 22 CBCT scans were successfully identified from 27 patients (10 males and 17 females; 54.93 ± 19.46 years) in the control group and 11 patients (3 males and 8 females; 51.32 ± 13.13 years) in the implant group, respectively. In the control group, CBCT images were obtained longitudinally at the time of implantation and after the post-implantation healing period, both prior to crown placement. In the implant group, CBCT images were obtained at the time of crown placement on a single-tooth implant and after the functional loading period following crown placement. Left and right mandibular condyles were digitally isolated from the images. The bone mineral density (BMD) parameters and morphological changes were assessed using frequency plots of BMD and TMJ osteoarthritis (OA) counts, respectively. In the control group, BMD values were not significantly different between the first and second scans. In contrast, the implant group showed a significant decrease in BMD values, along with a marginal increase in TMJ OA counts after the functional loading period. The TMJ OA counts were highest in the anterior regions, followed by the middle and posterior regions. Most regions showed significantly reduced BMD values, except the antero-lateral and antero-central regions. The current findings give an insight that dental implantation may alter the morphology and BMD of human mandibular condyles. The TMJ OA counts increased, while BMD decreased during the functional loading period of more than 3 months following implantation. Masticatory loading associated with the dental implant likely increases the load on the TMJ, which could stimulate new bone formation to balance the load distribution on the mandibular condyle. Full article

This case report describes the esthetic and functional rehabilitation of a 45-year-old male patient presenting with a missing maxillary right lateral incisor (#12). Due to persistent insufficiency of alveolar ridge width following multiple augmentation procedures, implant placement was contraindicated. A minimally invasive prosthetic approach was therefore selected, consisting of a single-retainer lithium disilicate resin-bonded fixed dental prosthesis (RBFDP) combined with laminate veneers to optimize anterior esthetics. The cantilever design and adhesive protocol were selected based on biomechanical principles aimed at minimizing interfacial stresses and preserving enamel structure. The prosthesis was fabricated using a fully digital workflow, and adhesive bonding was performed following established ceramic and enamel surface conditioning protocols. The restoration fulfilled the patient’s esthetic and functional expectations, and clinical follow-up at 18 months demonstrated stable bonding, healthy peri-abutment tissues, and absence of technical or biological complications. This case highlights the role of lithium disilicate cantilever RBFDPs as a minimally invasive and clinically viable treatment option for the replacement of maxillary lateral incisors when implant therapy is contraindicated, with outcomes limited to short- to medium-term observation. Full article

This study aimed to quantify horizontal and vertical bone gain using superimposition of preoperative and postoperative cone beam computed tomography (CBCT) in severe alveolar ridge defects treated with a modified guided bone regeneration (GBR) technique based on customized titanium occlusive barriers with a window design, combined with autologous blood clot and β-tricalcium phosphate (β-TCP). In this prospective case series, 13 patients (28 defects) were treated. Customized titanium barriers were digitally designed based on CBCT data and manufactured by laser sintering. The barriers were fixed over the defects and filled with a mixture of an autologous blood clot and β-TCP, providing an osteoconductive scaffold within a stable regenerative compartment. A standardized window-based follow-up protocol was applied during healing, including irrigation and controlled deepithelialization. Primary outcomes were horizontal and vertical bone gain, assessed by pre- and postoperative CBCT superimposition. Histological evaluation was performed at the time of implant placement. After 8 months, significant bone gain was observed, with a mean horizontal gain of 4.50 ± 2.02 mm and a mean vertical gain of 4.40 ± 2.82 mm (p < 0.0001), confirmed by linear mixed-effects models and patient-level sensitivity analyses (p < 0.001). Histological analysis revealed well-vascularized newly formed bone with active osteoblasts and no inflammatory response. Keratinized gingiva formation was observed at all sites. One minor complication (mild screw loosening) was recorded and successfully resolved. This study is presented as a prospective case series; therefore, the results should be interpreted as exploratory evidence and do not allow direct comparisons or conclusions regarding equivalence or superiority over other GBR techniques. The present report specifically evaluates the regenerative phase prior to functional loading; therefore, although implants were placed according to protocol, implant survival and long-term functional outcomes were not assessed and cannot be inferred from these data. Within the limitations of this prospective case series, customized titanium occlusive barriers with a window design demonstrated promising results for horizontal and vertical bone augmentation and keratinized gingiva formation, without the need for autologous bone grafts or primary wound closure. Full article

Background/Objective: Activity of SGK-1 has been associated with mechanical aspects of vascular remodeling and matrix stiffening has been a known characteristic of AAA. We hypothesis that VSMC-specific SGK-1 activity is vital to growth of AAA and contributes to progressive aortic stiffness. Methods: C57Bl/6 and SMC-SGK-1KO^+/− mice underwent AAA induction vs Sham on day 0. A subset of C57Bl/6 mice had pump implantation to treat with EMD638683. Aortic ultrasound images were obtained on Day 0 and Day 21 and analyzed for mechanical parameters. At terminal procedure the infrarenal aorta was harvested for immunoblot analysis. Results: At Day 21, C57Bl/6+AAA mice showed growth of 72.27% ± 2.2% versus the C57Bl/6+Sham (p < 0.0001) with associated 3.71 ± 1.15-fold increase in SGK-1 activity (p = 0.001). C57Bl/6+AAA+EMD mice demonstrated growth of 23.68% ± 2.82% (p = 0.0452) with no significant change in SGK-1 activity. SMC-SGK1-KO^+/−+AAA mice had growth of 28.20% ± 3.74% compared to SMC-SGK1-KO^+/−+Sham (p = 0.004) with increased SGK-1 activity (p = 0.0303). Radial strain was significantly reduced in the C57Bl/6+AAA (p = 0.0062) and C57Bl/6+AAA+EMD (p = 0.0135) when compared to C57Bl/6+Sham. Distensibility was significantly reduced in C57Bl/6+AAA (p = 0.01). Pulse propagation velocity (PPV) was significantly elevated in C57Bl/6+AAA mice (p < 0.0001) but inhibited by EMD therapy (p = 0.0007 vs. C57Bl/6+AAA). SMC-SGK1-KO^+/− +AAA mice showed significant reductions in radial strain (p = 0.0011) and distensibility (p = 0.0233) with a modest, but significant, increase in PPV (p = 0.0148). Conclusions: SGK-1 inhibition attenuated AAA growth and preserved vascular function. Targeting this pathway may provide a directed medical therapy for AAA and warrants further investigation. Full article

Titanium-based alloys are widely used in dental implantology; however, the mechanical limitations of commercially pure titanium (cpTi) and unresolved concerns regarding stress shielding remain. This study evaluated the structure–property–function relationship of a novel β-type titanium–niobium–zirconium (Ti–Nb–Zr; TNZ) alloy for dental implant applications. Laboratory testing assessed the elemental composition, tensile properties, and fatigue resistance of the cpTi, compared with modified Grade 4 cpTi (MG4T). In parallel, a randomized, single-blind, controlled clinical trial was conducted over 12 months to compare the clinical performance of TNZ and MG4T implants under functional loading. A total of 80 participants (mean age: 54.2 years; 43 females, 37 males) were enrolled, with 77 completing the 12-month follow-up (TNZ: n = 38; MG4T: n = 39). Clinical outcomes included implant success and survival, peri-implant soft tissue parameters, marginal bone levels, fractal dimension (FD) analysis of trabecular bone, and adverse events. TNZ implants demonstrated superior fatigue resistance without an increase in the elastic modulus relative to MG4T. Clinically, both groups achieved 100% implant success and survival, with no implant-related adverse events. FD analysis revealed time-dependent bone remodeling without evidence of pathological adaptation. These findings support the functional viability of TNZ as a mechanically robust, biocompatible implant material. Further long-term, multicenter trials are warranted to confirm sustained clinical benefits and broader applicability. Full article

Background/Objectives: Cochlear implants (CIs) constitute a viable method for auditory rehabilitation in patients with profound sensorineural hearing loss after temporal bone fractures (TBFs). These patients comprise a challenging population due to the anatomical deformity and neural injury. Methods: By performing this systematic review, we attempted to evaluate the viability of CIs in the context of TBF. The literature search, across Pubmed/MEDLINE, Scopus and Google Scholar, was performed under the PRISMA guidelines. The selected time period was from December 1995 to September 2025. The final analysis included 11 manuscripts. The majority of the studies were retrospective case series with a moderate risk of bias. Results: The primary outcome was postoperative auditory function, evaluated with speech perception tasks and aided sound-field pure-tone audiometry. The secondary outcomes were the report of radiological and electrophysiologic prognosticators of implants’ viability, timing of surgery, procedural feasibility and complications. Across the studies, CIs conferred meaningful auditory benefit when the cochlear nerve was intact. High-Resolution Computed Tomography (CT) was utilized for TBF classification and cochlear patency, whereas Magnetic Resonance Imaging (MRI) and a promontory test were crucial for the assessment of neural integrity. Prompt placement, optimally within 12 months after trauma, was related to improved outcomes by limiting cochlear fibrosis and ossification. Despite patients’ impedance fluctuation, restricted speech perception in noise and frequent abnormal facial nerve excitation, the overall audiologic and speech discrimination results are comparable to non-trauma recipients. Conclusions: A CI appears to be the choice of treatment over auditory brainstem implants, as long as the cochlear nerve remains intact. Rapid implantation in well-selected patients coupled with ordinal mapping and follow-up can restore dysfunctional hearing and improve patients’ quality of life. Full article