Search Results (86)

Background/Objectives: Nonunion after tibiotalocalcaneal (TTC) arthrodesis remains challenging, especially in revision settings where union rates are substantially lower than in primary procedures. Biological adjuncts are commonly used to enhance healing, yet most described methods employ fibular onlay struts and cancellous autograft. To our knowledge, intramedullary placement of a fibular autograft for ankle fusion has not previously been reported. This study presents a revision of TTC arthrodesis nonunion treated with this technique and summarizes existing evidence on revision ankle arthrodesis, fibular grafting, and bone marrow aspirate concentrate (BMAC). Methods: We report a revision TTC arthrodesis nonunion managed with a decorticated intramedullary fibular autograft spanning the tibiotalar canal, supplemented with cancellous iliac crest autograft and BMAC. A review of PubMed, Scopus, and Google Scholar (search date: 1 September 2025) was performed to identify studies addressing revision ankle fusion, fibular grafting techniques, and BMAC use in foot and ankle arthrodesis. Primary outcomes included union and complications, with CT-based assessment prioritized when available. Results: At 3 months, radiographs and CT demonstrated progressive osseous bridging consistent with fusion; the patient achieved pain-free weight-bearing without complications. Conclusions: Intramedullary fibular autograft in revision TTC arthrodesis is a novel biological-mechanical strategy that leverages endosteal contact and axial stability while augmenting osteogenesis with cancellous autograft and BMAC. The review supports the biological plausibility and safety of this approach and underscores the importance of CT-based assessment. Full article

Finite element analysis (FEA) is increasingly used in conservative and restorative dentistry to investigate the mechanical behavior of adhesive direct and indirect polymer-based restorations. Despite the growing number of FEA-based studies, the literature currently lacks a dedicated critical synthesis specifically addressing the methodological validity and clinical interpretability of FEA in adhesive restorative dentistry. This narrative review critically examines the current literature on the application of FEA in adhesive restorative dentistry, with particular attention to class I to class V cavities in anterior and posterior teeth restored with direct or indirect polymeric materials, including inlays, onlays, overlays, and tabletop restorations. A structured, non-systematic search of major databases was conducted, and selected studies were qualitatively appraised with emphasis on modeling assumptions, stress distribution, and clinical meaning. Unlike previous broad overviews of dental biomechanics, this review provides a clinically oriented framework for interpreting FEA findings across restorative strategies. FEA consistently identifies trends related to cavity configuration, cuspal support, restoration design, material stiffness, polymerization shrinkage, and adhesive interface behavior, helping to explain clinically observed failure patterns and supporting minimally invasive approaches. However, simplified material models, idealized bonding conditions, and static loading protocols limit prediction of long-term performance. When interpreted within these constraints and integrated with experimental and clinical evidence, FEA remains a valuable complementary tool for rational restorative decision-making. Full article

Maxillofacial skeletal reconstruction presents significant challenges due to anatomical complexity, functional requirements, and aesthetic demands. Traditional materials such as titanium and autogenous bone grafts have limitations, prompting interest in Polyetheretherketone (PEEK), a versatile thermoplastic polymer with advantages like biocompatibility, radiolucency, and elasticity similar to human bone. This multi-year case series evaluates the clinical outcomes of PEEK implants used in 56 cases on 53 patients for maxillofacial reconstruction, primarily for trauma (44 patients) and deformity (9 patients). PEEK implants were applied to various facial regions including the orbit, zygoma, mandible, and maxilla. The majority of surgeries utilised virtual surgical planning. Patient-specific implants were fabricated using 3D imaging technologies, allowing customisation for optimal fit and functionality. The mean patient age was 37 years with a split of 37 to 16 females. Some complications were noted such as infection and paraesthesia. However, the majority of patients experienced positive outcomes. The findings support PEEK implants as a safe, effective, and adaptable material for maxillofacial surgery, with potential for further advancements in material properties and surgical technologies to improve long-term outcomes. Full article

Background: Composite restorations are the standard of care for posterior teeth due to their aesthetic properties and conservative nature. However, the choice between direct and semi-direct techniques can influence clinical longevity and performance. Objectives: This study aimed to compare the clinical performance of two restorative approaches: a direct technique and the semi-direct onlay technique in terms of aesthetic quality, surface finish, wear resistance, marginal integrity, and overall clinical efficiency over a two-year period. Methods: A total of 348 composite restorations were placed in 192 patients. Each restoration was evaluated at four timepoints: baseline (T0), 6 months (T1), 1 year (T2), and 2 years (T3). Clinical performance was assessed using standardised 5-point rating scales across the five dimensions. Repeated-measures ANOVA assessed changes over time, while Wilcoxon signed-rank and Mann–Whitney U tests were used for intra- and inter-group comparisons. Results: Significant time effects were observed across all clinical parameters (p < 0.0001). The direct technique exhibited superior initial results in aesthetics and surface finish at T0 and T1 (p < 0.001), but differences diminished by T3. In contrast, the semi-direct technique demonstrated improved performance in wear resistance and marginal integrity at T2 and T3. Both techniques showed progressive deterioration, particularly in marginal adaptation. Conclusions: The direct technique offers enhanced short-term aesthetics and procedural efficiency, while the semi-direct approach provides superior long-term durability and marginal adaptation. Full article

This in vitro investigation evaluated the marginal fit of three pressable glass-ceramic onlay materials: a conventional monolithic lithium disilicate (IPS e.max Press, EM, ivoclar vivadent AG, Schaan, Liechtenstein) and two zirconia-reinforced glass-ceramics (Vita Ambria, VA, VITA Zahnfabrik, Bad Säckingen, Germany; Celtra Press, CP, Sirona Dentsply, Milford, CT, USA). A typodont maxillary first premolar was prepared for an intensive onlay design by a single operator using a milling surveyor. The master die was duplicated with silicone impressions to create 72 identical epoxy resin dies. Seventy-two onlays (n = 24 per material) were fabricated and adhesively cemented to their respective dies. Vertical marginal gaps were recorded under a stereo-electron microscope before and after thermomechanical loading (TML) in a chewing simulator. Data were analyzed with one-way ANOVA and Tukey’s post hoc tests for intergroup comparisons and paired t-tests for pre- versus post-TML values. All groups showed a significant increase in marginal gap following TML. VA exhibited mean gaps of 46.41 µm before and 57.28 µm after loading (p = 0.001). EM demonstrated 41.16 µm before and 46.63 µm after TML (p = 0.002). CP showed 45.70 µm before and 55.99 µm after TML (p = 0.003). Among the three materials, EM maintained the most accurate marginal adaptation both before and after simulated chewing. Despite the increases, all post-loading values remained within the clinically acceptable threshold for marginal discrepancy. These findings indicated that thermomechanical fatigue adversely affected the marginal integrity of pressable glass-ceramic onlays, including zirconia-reinforced formulations. Nevertheless, zirconia-reinforced ceramics (VA and CP) achieved marginal gaps comparable to conventional lithium disilicate and remained within acceptable clinical limits. IPS e.max Press provided the best overall fit, suggesting it may offer superior long-term marginal stability for onlay restorations. Full article

Background and Objectives: There are many well-described approaches to symptomatic ventral hernia management; however, there remains a significant patient population with limited options for a durable ventral hernia repair with a reasonable risk of infection and recurrence. Drawing from the orthopedic literature, we changed our approach to this clinical problem and developed a palliative ventral hernioplasty pathway. Materials and Methods: A retrospective review (2017–2019) of patients’ palliative ventral hernioplasty was performed. Results: In total, 43 patients included, with a female preponderance of 24 (58.6%) and a mean age 61.5 ± 11.5 years. The mean BMI was 38.1 kg/m² (IQR: 25.4–62), and 28 patients (65.1%) had a history of prior wound/mesh infection. Urgent repair was performed in 14 patients. Overall polypropylene prosthetic was implanted in 26 patients, and bioprosthetic/absorbable mesh was used in the remaining. The mean surface area of the implanted mesh was 561 cm². The most common wound complications identified were skin separation (30.2%) and seroma formation (48.8%). Hernia recurrence occurred in four (9.3%) patients, with a mean follow-up of 24.1 months (9–37). Three patients had central lightweight mesh rupture and one had a recurrence (bioprosthetic mesh); all were subsequently repaired. Conclusions: Despite the small number of patients, our palliative ventral hernia repair pathway offers durable repair with an acceptable risk of recurrence and mesh infection in patients who would otherwise be considered nonoperative. Full article

Background: Primary ventral hernias (PVHs) are a frequent disease that can impair quality of life. Laparoscopic intraperitoneal onlay mesh (IPOM) technique has shown good outcomes in appropriately selected cases. Methods: We report the results of a retrospective analysis involving 200 consecutive patients who underwent laparoscopic ventral hernia repair with a standardized technique using a single mesh from January 2011 to September 2024 to define the safety of laparoscopy in ventral hernia treatment. Results: The study included 147 umbilical hernias (73%) and 53 epigastric hernias (27%). The average defect measured 3 cm, with sizes ranging from 2 to 7 cm. After a mean follow-up of 1708 days (range 117–4642), no complications associated with the mesh were observed; there was only one (0.5%) recurrence documented and no bulging was observed. Conclusions: Laparoscopic repair of PVH using a standardized technique and using the same mesh, which has been proven safe over the last 15 years, offers good results. Full article

Management of complex and recurrent ureteral stricture disease remains one of the more challenging aspects of reconstructive urology. While standard techniques such as ureteroureterostomy, psoas hitch, Boari flap, and ileal ureter creation serve as the foundation of ureteral reconstruction, each technique has limitations, particularly when faced with recurrence, long strictures, and previously irradiated fields. Two alternative techniques—buccal mucosal graft (BMG) ureteroplasty and appendiceal onlay/interposition—have been previously described and are now being utilized more frequently in recent years. Furthermore, the advancement of robotic-assisted laparoscopic surgery has allowed for even more reconstructive capabilities. BMG ureteroplasty and appendiceal onlay/interposition can serve as valuable augmentations to the aforementioned surgical techniques. BMG has now long been established in urethral reconstruction and serves as a viable graft option for longer segment ureteral strictures, given its panvascular lamina propria and epithelium well-suited to a wet environment. Similarly, the appendix has other uses in urologic surgery, including the Mitrofanoff channel in pediatric surgery, and is chiefly used in right-sided ureteral stricture repair. Both of these techniques allow the surgeons to take on more complex ureteral stricture cases and avoid the morbidity of bowel harvest. In this perspective, we argue for a broader recognition and adoption of BMG and appendiceal onlay/interposition in ureteral reconstructive surgery. In this article, we highlight the rationale for use, technical considerations, outcomes, and clinical evidence suggesting their advantages over traditional approaches. By incorporating these techniques into practice, urologists can expand their ability to manage more complex ureteral stricture cases with improved outcomes. Full article

This in vitro study evaluated the fracture resistance of metal–ceramic crowns repaired with milled hybrid resin, printed hybrid resin, lithium disilicate, and direct composite resin. One hundred crowns were fabricated, fractured under controlled loading, and 80 with standardized defects were randomly assigned to four groups (n = 20). Repairs were performed using CAD/CAM onlays or direct composite, followed by compressive testing until fracture. Mean fracture resistance values ranged from 1858.95 N to 1997 N across all groups, exceeding typical posterior occlusal forces (700–900 N). No statistically significant differences were found among groups (p = 0.200). Most failures were cohesive. These results indicate that both digital (milled and printed) and direct techniques offer sufficient strength to serve as minimally invasive and cost-effective alternatives to full crown replacement. Although limited by the in vitro design, this study supports the applicability of modern repair approaches in daily practice. Full article

Objective: The aim of this study was to evaluate and compare the clinical behavior of indirect onlays/overlays made of lithium disilicate and composite resin and to investigate risk factors associated with restoration failures. Methods: 112 indirect partial coverage posterior restorations (onlays and overlays) placed in 51 adult patients between January 2014 and December 2020 were examined. The restorations were evaluated using selected FDI criteria (color match, surface gloss, anatomic form, fracture of restorative material, tooth cracks and fractures, marginal discoloration, marginal integrity and recurrence of initial pathology). The survival of the restorations was analyzed using Kaplan–Meier method. Risk factors (type of restoration, type of tooth, tooth vitality, smoking) were investigated using Cox regression analysis. Risk estimation was conducted for each evaluated criterion (p < 0.05). Results: For composite restorations, the estimated survival rate was 94.2% after 5 years, dropping to 74.3% in 7.9 years and continued falling to less than 60% after 8.2 years. On the contrary, for lithium disilicate restorations the estimated survival rate was 90.9% after 5 years, dropped to 85.2% after 5.5 years remaining stable thereafter. Lithium disilicate onlays demonstrated significantly better performance than lithium disilicate overlays. Cox regression analysis did not reveal any significant association between the survival of the indirect partial restorations and restoration material, tooth type, restoration type and history of endodontic treatment. However, smoking was found to be a statistically significant risk factor (p < 0.05). Conclusions: Lithium disilicate and composite indirect restorations exhibited comparable survival rates at the early observation period. However, lithium disilicate partial coverage restorations demonstrated more favorable clinical behavior compared to composite in the long term, with statistical significance observed in ceramic vs. composite onlays. Full article

While anatomic total shoulder arthroplasty is a successful procedure that provides reliable pain relief and restoration of function in most patients, its success has been limited by glenoid component loosening. While series reporting the outcomes of inlay glenoid components have demonstrated excellent clinical outcomes with low rates of component loosening and need for revision, surgeons have been hesitant to adopt these implants due to concerns of inadequate pain relief secondary to the remaining glenoid rim contacting the humeral head implant. The inset glenoid component, a variant of the traditional inlay components, has gained interest because its design aims to achieve similar stability to traditional inlay components through implantation within strong subchondral bone, reduce the amount of glenoid vault removed compared to inlay components, and has a glenoid face designed to limit the rocking-horse phenomenon. In limited series, the inset glenoid component has demonstrated superior biomechanical and clinical performance compared to traditional onlay glenoid components. Although there have been minimal clinical studies investigating the inset glenoid in comparison to onlay and inlay components to date, a subset of case series with short-term follow-up have demonstrated favorable outcomes. The purpose of this article was to review the design rationale, biomechanical evidence, and clinical performance of the inset glenoid component. Full article

The aim of this study was to evaluate (a) the degree of conversion (DC%), (b) film thickness, and (c) the effect of film thickness on DC% in modern light-cured resin composite restoratives [Filtek Universal (F), Clearfil Majesty ES 2 Universal (M), Tetric EvoCeram (T) and Viscalor (V)] used for luting composite onlays before/after preheating. For (a), the luting composites placed at 150 μm film thickness under the onlays (4 mm thickness, 2.9% transmittance) were light-cured for 120 s (3 × 40 s top, buccal, lingual sites) before and after preheating (54 °C/5 min-F,M,T and 65 °C/30 s-V). The DC% was measured at central, middle and side locations along the median in-length axis by ATR-FTIR spectroscopy. Specimens polymerized without onlays (40 s, top) served as controls. For (b), film thickness was measured employing a modified ISO 4049 standard (37 °C plate temperature, 5 N load) before and after preheating, using a dual-cured resin luting agent as control. For (c), onlays were luted with preheated T at 150 and 350 μm film thickness and light-cured for 2 × (3 × 40) s and 3 × (3 × 40) s, employing directly irradiated specimens (60 s, 120 s) as controls. For (a), significant differences were found in F and T before and after preheating. Before preheating, significant differences were registered between F–T, F–M, F–V and V–T, whereas after they were registered between F–M, F–T and F–V. All these values were significantly lower than the controls. For (b), significantly lower film thickness was recorded after preheating (−16.1–−33.3%, highest in V), with a ranking of F, M > V > T (before) and F, M > T, V (after). All values were significantly higher than the control. For (c), increased exposure improved DC% in the greater spacer group, with the controls providing superior values. It can be concluded that the use of modern highly filled composites as luting agents for low translucency onlays may result in suboptimal polymerization and film thickness, warranting caution. Full article

Material wear significantly impacts the clinical success and longevity of dental ceramic restorations. This in vivo study aimed to assess the wear behavior of IPS Empress^® glass-ceramic inlays and onlays over 14 years, considering the influence of different antagonist materials. Fifty-four indirect restorations of 21 patients were available for comprehensive wear analysis, with complete follow-up data for up to 14 years. Three-dimensional measurements relied on digitized epoxy resin models produced immediately post-insertion (baseline) and subsequently at 2, 4, and 14 years. The occlusal region on the baseline model was delineated for comparative analysis. Three-dimensional superimpositions with models from subsequent time points were executed to assess wear in terms of average linear wear and volumetric loss. Statistical analyses were conducted in R (version 4.4.1), employing Mann–Whitney U tests (material comparisons) and Wilcoxon signed rank tests (time point comparisons), with a significance threshold of p ≤ 0.05. During the entire study period, an increase in wear was observed at each assessment interval, gradually stabilizing over time. Significant differences in substance loss were found between the follow-up time points, both for mean (−0.536 ± 0.249 mm after 14a) and integrated distance (−18,935 ± 11,711 mm³ after 14a). In addition, significantly higher wear was observed after 14 years with gold as antagonist compared to other materials (p ≤ 0.03). The wear behavior of IPS Empress^® ceramics demonstrates clinically acceptable long-term outcomes, with abrasion characteristics exhibiting stabilization over time. Full article

This study presents a methodology for developing and validating digital models of tooth-inlay systems, aiming to trace the complete workflow from clinical procedures to simulation by involving dental professionals—dentists for manual cavity preparation and dental technicians for restoration modelling—while integrating micro-computed tomography (micro-CT) imaging with finite element analysis (FEA). The proposed workflow includes (1) the acquisition of high-resolution 3D micro-CT scans of a non-restored tooth, (2) image segmentation and reconstruction to create anatomically accurate digital twins and mesh generation, (3) the selection of proper resin and the 3D printing of four typodonts, (4) the manual preparation of cavities on the typodonts, (5) the acquisition of high-resolution 3D micro-CT scans of the typodonts, (6) mesh generation, digital inlay and onlay modelling and material property assignment, and (7) nonlinear FEA simulations under representative masticatory loading. The approach enables the visualisation of stress and deformation patterns, with preliminary results indicating stress concentrations at the tooth-restoration interface integrating different cavity alternatives and restorations on the same tooth. Quantitative outputs include von Mises stress, strain energy density, and displacement distribution. This study demonstrates the feasibility of using image-based, tooth-specific digital twins for biomechanical modelling in dentistry. The developed framework lays the groundwork for future investigations into the optimisation of restoration design and material selection in clinical applications. Full article

Background/Objectives: We aimed to review pediatric patients who underwent surgical treatment for posterior fossa tumors and to share our experience with the various types of dural grafts used in these patients. Methods: We carried out a retrospective study on pediatric patients who received surgical treatment for posterior fossa tumors and underwent duraplasty using either an autograft or a xenograft from January 2018 to December 2022. Data were gathered from patients’ medical records, encompassing demographic details. Additional information included tumor locations and the extent of resection. Factors such as postoperative complications like meningitis, pseudo-meningocele, and hydrocephalus were also noted. Results: Our cohort included 50 patients, 13 of whom underwent surgeries with autografts and 37 had xenografts. The patients’ tumors were in various areas, including intraventricular or those extending into the ventricle (31) and intracerebellar (17) and extra-axial (2) cases. Subtotal resection occurred in 8 cases, near-total resection in 9, and gross-total resection in 33. Postoperatively, meningitis occurred in 12 patients, pseudo-meningocele in 13, and hydrocephalus in 10, with 9 requiring V/P placement. Conclusions: In conclusion, techniques for dural closure hold great significance in neurosurgery, particularly during pediatric posterior fossa surgeries. Although the modest size of the autograft cohort limited statistical power, our epidural onlay fascia lata autograft produced fewer postoperative complications than the bovine xenograft and achieved outcomes comparable to those reported for watertight closure. Full article