Search Results (22)

Background: Although cemented total knee arthroplasty (TKA) is considered the standard fixation technique, the emerging trend toward cementless fixation has created the need for a detailed comparison. In a previous study, we reported the 5-year results comparing cementless and hybrid cemented TKAs using the same implant design. The purpose of this study was to assess the long-term follow-up at a minimum of 10 years. Methods: A retrospective analysis was performed on 120 TKAs (60 cementless, 60 hybrid cemented) conducted between 2003 and 2007 using the e.motion posterior cruciate-retaining knee prosthesis with a floating-platform mobile polyethylene bearing (Aesculap, Tuttlingen, Germany). Demographic and clinical data were collected; radiographic follow-up was performed with attention to signs of loosening, while complications and revision surgery were assessed using competing risk analysis. Operative time was recorded as an indicator of surgical efficiency. Results: At 10 years, 59 TKAs (54 patients) were available for long-term follow-up. Both fixation groups demonstrated significant improvement in Knee Society Scores (KSSs) compared to preoperative values (p < 0.001). However, there was no significant difference in KSSs between the two groups at 10 years follow-up (p = 0.480). The 10-year cumulative incidence of revision was 8.4% in both groups (p = 0.721), and that of aseptic loosening was identical at 3.4% (p = 0.967). Although radiolucent lines were noted in three tibial components of the cementless group, the difference was not statistically significant (p = 0.075). Notably, the cementless group demonstrated a significantly shorter operative time with a mean difference of 10 min (p = 0.017). Conclusions: At a minimum follow-up of 10 years, there were no significant differences between the hybrid cemented and cementless groups in revision rates, cumulative incidences, clinical scores, or radiological signs of loosening, confirming the long-term effectiveness of both fixation methods in clinical practice. Full article

Background/Objectives: Our study aimed to determine the accuracy of the artificial intelligence-based Diagnocat system (DC) in detecting periapical lesions (PL) on panoramic radiographs (PRs). Methods: 616 teeth were selected from 357 panoramic radiographs, including 308 teeth with clearly visible periapical radiolucency and 308 without any periapical lesion. Three groups were generated: teeth with radiographic signs of caries (Group 1), teeth with coronal restoration (Group 2), and teeth with root canal filling (Group 3). The PRs were uploaded to the Diagnocat system for evaluation. The performance of the convolutional neural network in detecting PLs was assessed by its sensitivity, specificity, and positive and negative predictive values, as well as the diagnostic accuracy value. We investigated the possible effect of the palatoglossal air space (PGAS) on the evaluation of the AI tool. Results: DC identified periapical lesions in 240 (77.9%) cases out of the 308 teeth with PL and detected no PL in 68 (22.1%) teeth with PL. The AI-based system detected no PL in any of the groups without PL. The overall sensitivity, specificity, and diagnostic accuracy of DC were 0.78, 1.00, and 0.89, respectively. Considering these parameters for each group, Group 2 showed the highest values at 0.84, 1.00, and 0.95, respectively. Fisher’s Exact test showed that PGAS does not significantly affect (p = 1) the detection of PL in the upper teeth. The AI-based system showed lower probability values for detecting PL in the case of central incisors, wisdom teeth, and canines. The sensitivity and diagnostic accuracy of DC for detecting PL on canines showed lower values at 0.27 and 0.64, respectively. Conclusions: The CNN-based Diagnocat system can support the diagnosis of PL on PRs and serves as a decision-support tool during radiographic assessments. Full article

Background/Objectives: Classical reverse shoulder arthroplasty (RSA) with a high neck–shaft angle (NSA) of 155° has shown satisfactory outcomes. However, newer RSA designs aim to improve results by modifying the stem design. This study evaluates the 5-year outcomes of a stem design featuring a rectangular metadiaphyseal fixation and a 135° NSA. Methods: This prospective bicentric case series included and longitudinally followed up patients that were treated for cuff arthropathy, massive irreparable rotator cuff tears, or eccentric osteoarthritis using a non-cemented rectangular metadiaphyseal fixation stem with a 135° NSA (Univers Revers, Arthrex, Naples, FL, USA). Subjective and objective functional outcome scores (Constant–Murley Score (CS), Shoulder Pain and Disability Index (SPADI), and Subjective Shoulder Value (SSV)), range of motion (ROM), radiographic outcome, adverse events, complications, and quality of life were investigated. Results: This study enrolled 132 patients (59% female, mean age 75 years, SD 6). At the 5-year follow-up, subjective and objective outcomes significantly improved compared to baseline: CS (32.9 to 71.7, p < 0.001), SPADI (38.7 to 86.2, p < 0.001), and SSV (43.0 to 84.1, p < 0.001). ROM improved in flexion (80° to 142.4°, p < 0.001), abduction (71.5° to 130.2°, p < 0.001), internal rotation (p < 0.001), internal rotation at 90° abduction (12.7° to 45.0°, p < 0.001), and abduction strength (0.8 kg to 5.2 kg, p < 0.001). External rotation remained unchanged (32.1° to 32.0°, p = 0.125), but external rotation at 90° abduction improved (20.9° to 52.7°, p < 0.001). No signs of implant migration, subsidence, shift, tilt, alignment loss, or wear were observed, but scapular bone spur formation (11%), scapular notching grade 1 (10%), bone resorption (10%), and partial humeral radiolucent lines (1%) were reported. Conclusions: Rectangular stems with metadiaphyseal fixation and a 135° neck–shaft angle in RSA consistently improve shoulder function, showing no aseptic loosening and minimal radiological changes at 5 years. Full article

Background: Burkitt lymphoma (BL) is an aggressive non-Hodgkin lymphoma (NHL), subdivided into endemic, sporadic, and immunodeficiency-associated forms. While jaw lesions are common in endemic BL, they are infrequent in sporadic cases, only rarely constituting the first manifestation of the disease. The aim of this study is to present a rare pediatric case of sporadic BL first manifesting as gingival swellings and tooth hypermobility and provide a review of all the published sporadic BL case reports as the first sign of disease. Case report: An 11-year-old Caucasian female was referred for the evaluation of hypermobility of posterior lower teeth, associated with painful gingival swellings of 20 days duration. Clinical examination revealed right facial asymmetry and bilateral prominent swellings of the posterior lower gingiva. A panoramic radiograph revealed ill-defined radiolucent lesions in the posterior mandible bilaterally. On computed tomography, soft-tissue masses were identified along the mandibular ramus extending into the maxillary sinus bilaterally. The histopathologic and immunohistochemical analyses of the lesions led to a diagnosis of Burkitt lymphoma (BL). The patient underwent a full staging work-up, revealing bone marrow involvement and widespread disease. A multi-chemotherapy regimen was initiated with the regression of oral lesions and symptoms within a few weeks and complete disease remission after nine chemotherapy cycles. The patient remains free of disease 11 years later. Conclusions: This case underscores the critical importance of the timely diagnosis and life-saving referral of rapidly growing jaw lesions, which may represent the first sign of an underlying lymphoreticular malignancy with aggressive course, such as BL. Full article

Background: Metastatic tumors of the oro-facial tissuesare rare, with an incidence ranging between 1% and 8% of all oral malignant tumors. Generally reported with a peak of incidence in the 5–7th decades but possibly occurring at any age, metastases may represent the first sign of an occult cancer or manifest in patients with an already known history of a primary carcinoma, mostly from the lungs, kidney, prostate, and colon/rectum in males, and the uterus, breast, lung, and ovary in females. In the oro-facial tissues, the most involved sites are the oral mucosa, gingiva/jawbones, tongue, and salivary glands. Methods: A broad and deep literature review with a comprehensive analysis of the existing research on oro-facial metastases from renal-cell carcinoma (RCC) was conducted by searching the most used databases, with attention also paid to the clear-cell histological variant, which is the most frequent one. Results: Among the 156 analyzed studies, 206 cases of oro-facial metastases of renal cancer were found in patients with an average age of 60.9 years (145 males, 70.3%; 61 females, 29.6%). In almost 40% of the cases, metastasis represented the first clinical manifestation of the primary tumor, and 122 were histologically diagnosed as clear-cell renal-cell carcinoma (ccRCC) (59.2%). The tongue was involved in most of the cases (55 cases, 26.7%), followed by the gingiva (39 cases, 18.9%), mandible (35 cases, 16.9%), maxilla (23 cases, 11.1%), parotid gland (22 cases, 10.6%), buccal mucosa (11 cases, 5.3%), lips (7 cases, 3.3%), hard palate (6 cases, 2.8%), soft palate, masticatory space, and submandibular gland (2 cases, 0.9%), and lymph nodes, tonsils, and floor of the mouth (1 case, 0.4%). Among the 122 ccRCCs (84 males, 68.8%; 38 females, 31.1%), with an average age of 60.8 years and representing in 33.6% the first clinical manifestation, the tongue remained the most frequent site (31 cases, 25.4%), followed by the gingiva (21 cases, 17.2%), parotid gland (16 cases, 13.1%), mandibular bone (15 cases, 12.2%), maxillary bone (14 cases, 11.4%), buccal mucosa and lips (6 cases, 4.9%), hard palate (5 cases, 4%), submandibular gland and soft palate (2 cases, 1.6%), and lymph nodes, tonsils, oral floor, and masticatory space (1 case, 0.8%). The clinical presentation in soft tissues was mainly represented by a fast-growing exophytic mass, sometimes accompanied by pain, while in bone, it generally presented as radiolucent lesions with ill-defined borders and cortical erosion. Conclusions: The current comprehensive review collected data from the literature about the incidence, site of occurrence, age, sex, and survival of patients affected by oro-facial metastases from renal-cell carcinoma, with particular attention paid to the cases diagnosed as metastases from clear-cell renal-cell carcinoma, which is the most frequent histological variant. Clinical differential diagnosis is widely discussed to provide clinicians with all the useful information for an early diagnosis despite the effective difficulties in recognizing such rare and easily misdiagnosed lesionsTheir early identification represents a diagnostic challenge, especially when the clinical work-up is limited to the cervico–facial region. Nevertheless, early diagnosis and recently introduced adjuvant therapies may represent the key to better outcomes in such patients. Therefore, general guidelines about the clinical and radiological identification of oro-facial potentially malignant lesions should be part of the cultural background of any dentist. Full article

Background: Tooth infraocclusion is a process in which a completely or partially erupted tooth gradually moves away from the occlusal plane. Submerged teeth can lead to serious complications. Treating teeth with infraocclusion is very challenging. One of the procedures allowing for the replacement of a missing tooth is autotransplantation. The aim of this paper is to review the literature on teeth autotransplantation, supported by a case report involving the autotransplantation of a third mandibular molar into the site of an extracted infraoccluded first mandibular molar, as well as the utilization of advanced platelet-rich fibrin (A-PRF) alongside autogenous dentin grafts for bone tissue regeneration. Methods: A severely infraoccluded first permanent right mandibular molar was extracted and then ground to obtain the dentin graft. A-PRF clots (collected from the patient’s peripheral blood) were added to the autogenous dentin graft, to create the A-PRF membrane. An atraumatic extraction of the lower left third molar was performed and then it was transplanted into the socket of tooth no. 46. Immediately after transplantation, tooth no. 38 was stabilized with orthodontic bracket splints for 3 months. The patient attended regular follow-up visits within 12 months. Results: After one year, the patient did not report any pain. In the clinical examination, the tooth and surrounding tissues did not show any signs of infection. However, radiographically, cervical inflammatory resorption, unchanged pulp canal dimensions, absent root growth, periapical radiolucency, and lack of apical and marginal healing were observed. Reconstruction of the bone defect was obtained and the alveolar ridge of the mandible was preserved. Due to poor stability of the tooth and severe resorption, the tooth needed to be extracted. Conclusions: This study is designed to critically evaluate the efficacy of autotransplantation, the application of growth factors, and the integration of autogenous dentin grafts in remedying dental deficiencies resulting from reinclusion. We aim to point out the possible causes of treatment failure. Full article

This retrospective cohort study assesses the effectiveness of straight-stem cementless versus cemented prostheses in hip replacement surgeries for elderly patients with femoral neck fractures. We analyzed 80 patients aged 70 and over who underwent surgery between 2018 and 2021. Clinical outcomes were evaluated using the Harris Hip Score, WOMAC Score, and Visual Analogue Scale, alongside radiological assessments through Brooker’s classification. Preoperative Dorr classification and five postoperative criteria (subsidence, cortical hypertrophy, pedestal sign, radiolucent lines, and stress shielding) were used to assess implant efficacy. The results demonstrated satisfactory mid-term outcomes for both groups, with slightly higher clinical scores observed in the cementless stem group. The Harris Hip Score (HHS) averaged 74.4 ± 6.7 in the cemented group and 79.2 ± 10.4 in the cementless group, with a statistically significant difference (p = 0.0146). The WOMAC Score showed an average of 30.1 ± 4.6 in the cemented group compared to 27.1 ± 6.9 in the cementless group, also indicating a statistically significant improvement (p = 0.0231). However, radiographic findings call for a re-evaluation of long-term stability. Our statistical analysis, which included power calculation and multivariate analysis to adjust for confounding variables, offers a comprehensive assessment of implant effectiveness. The findings contribute to the ongoing debate on the choice between cemented and cementless prostheses, indicating that both are viable options catering to different patient needs. Further research overcoming this study’s limitations is crucial for a deeper understanding of optimal treatment strategies in hip replacement surgery for the elderly. Full article

(1) Background: The aim of this study was to evaluate short- to mid-term clinical and radiological results in patients undergoing primary total hip arthroplasty (THA) with the use of a Selective Laser Melting 3D-printed highly porous titanium acetabular cup (Jump System Traser^®, Permedica Orthopaedics). (2) Methods: We conducted a retrospective study and collected prospective data on 125 consecutive patients who underwent primary THA with the use of highly porous titanium cup. Each patient was evaluated preoperatively and postoperatively with a clinical and radiological assessment. (3) Results: The final cohort consisted of 104 patients evaluated after a correct value of 52 (38–74) months. The median Harris Hip Score (HHS) significantly improved from 63.7 (16–95.8) preoperatively to 94.8 (38.2–95.8) postoperatively (p < 0.001), with higher improvement associated with higher age at surgery (β = 0.22, p = 0.025). On postoperative radiographs, the average acetabular cup inclination and anteversion were 46° (30°–57°) and 15° (1°–32°), respectively. All cups radiographically showed signs of osseointegration with no radiolucency observed, or component loosening. (4) Conclusions: The use of this highly porous acetabular cup in primary THA achieved excellent clinical, functional, and radiological results at mid-term follow-up. A better clinical recovery can be expected in older patients. The radiological evaluation showed excellent osseointegration of the cup with complete absence of periprosthetic radiolucent lines. Full article

Purpose: The glandular odontogenic cyst (GOC) is considered a rare developmental cyst, with an odontogenic origin and both epithelial and glandular characteristics, with less than 200 reported cases in the literature. Methods: In the present case, a 29-year-old man was referred for evaluation of an asymptomatic slow-growing swelling in the anterior region of the mandible, with one-year history. The patient’s medical history did not reveal any systemic alteration. The extraoral examination did not show enlargement of the facial contour and the intraoral examination showed vestibular and lingual swelling. Panoramic radiography and CT scan revealed a well-defined unilocular radiolucent lesion involving the inferior incisors and canines bilaterally. Results: Histopathological analysis revealed multiple cysts lined by stratified epithelium with varying thickness and characteristics, in addition to duct-like structures filled with PAS-positive amorphous material, suggestive of GOC. Conservative treatment was performed through surgical curettage, peripheral ostectomy of the surgical site and apicectomy of the teeth involved in the lesion. There was one recurrence, which was detected in postoperative follow-up, leading to a new surgical approach. Conclusions: Fifteen months after the second procedure, no signs of recurrence were identified, and bone neoformation within the surgical site occurred, supporting that a conservative approach for the treatment of GOC is viable. Full article

Bitewing radiographic examination of the Class II composite restorations is commonly performed for diagnosis and preoperative planning of posterior teeth. The purpose of this study was to describe the prevalence; location; and characteristics of radiolucency findings associated with proximal class II composite restorations. Bitewing radiographs of proximal composite restorations of healthy adult patients (18 to 88 years old) who underwent restorative care at predoctoral clinics at the University of Maryland School of Dentistry from August 2016 to July 2019 were identified. Atypical radiographic features were categorized by location and associated material (adhesive or composite). In addition, demographic and clinical details (tooth position; restored surface) were recorded. Out of the 669 radiographically examined bitewings of restorations; 16.5% of radiographs showed no atypical findings; and 83.5% had unusual radiographic signs. The atypical radiographic findings were distributed as 16.5% internal voids; 3% overhang; 7.8% interlayer lines; 12.6% secondary caries; 20.7% interfacial gaps; and 23.1% multiple atypical findings. Class II composite restorations have a high prevalence of atypical radiolucency; particularly in the body of the composite; premolars; and disto-occlusal restorations. The information reported here emphasizes the clinical challenge of ascertaining an appropriate diagnosis of the radiolucencies underneath composite restorations. Full article

Background and Objectives: The uncemented threaded DELTA ST-C cup was introduced in last few years. It has a hemispheric shell, consisting of Ti6Al4V titanium alloy. The MINIMA S stem was developed according to the principles of proximal-loading and extended metaphyseal geometry applied to a short stem. The purpose of the study was to assess the clinical and radiographic outcomes and the short- and mid-term survivorship of the DELTA ST-C cup and MINIMA S stem in patients undergoing total hip arthroplasty (THA). The present is the first study to report outcomes and implant survivorship of the DELTA ST-C cup coupled with the MINIMA S femoral stem. Materials and Methods: The present study is a retrospective observational cohort study of a prospectively maintained database, evaluating clinical outcomes and implant survivorship in 95 patients undergoing THA with the MINIMA stem coupled with the DELTA ST-C cup with at least a 3-year follow-up. The clinical evaluation was assessed with a change in the Harris hip score (HHS), while the radiographic evaluation included anteroposterior views of the pelvis and lateral views of the affected hip. Results: The enrolled population’s mean age was 69.3 years and most patients were female (64%). The MINIMA S standard stem was implanted in 68 patients (72%), the lateralized stem was implanted in 27 (28%), and the mean acetabular inclination was 48.2°. The HHS improved significantly from the preoperative value (median 46, IQR: 38–55), already at 1 month after surgery (median 76, IQR: 66–77), reaching excellent results at 1 year and 3 years postoperatively (median 96, IQR: 91–100). X-rays demonstrated good implant stability and biomechanics parameter restorations revealed no sign of subsidence, and the presence of radiolucent lines greater than 2 mm in the short stem area in five cases and in the acetabulum in one were not clinically significant. No revisions have been performed so far. Conclusions: The MINIMA S stem coupled with the DELTA ST-C cup demonstrated very good clinical and radiological results with a significant increase of the Harris hip score at short- and mid-term follow-up. This is the first study evaluating the DELTA ST-C cup, showing promising outcomes during the study’s follow-up. The MINIMA S stem has been evaluated in a very few studies. However, the combination with this particular cup had not yet been studied. The design of the stem and the cup ensures primary stability and excellent early term outcomes, moreover the study demonstrates extraordinary implant survivorship, equal to 100%. Full article

We describe two clinical cases of occasional radiographic findings on orthopantomography (OPG) that were performed routinely, for which the definitive diagnosis may be uncertain. After an accurate remote and recent anamnesis, for reasons of exclusion, we hypothesize a rare case of the retention of a contrast medium in the parenchyma of the major salivary glands (parotid, submandibular, and sublingual) and their excretory ducts as a consequence of sialography examination. In the first case we analyzed, we found it difficult to classify the radiographic signs on the sublingual glands, left parotid, and submandibular, while in the second case, only the right parotid was involved. Using CBCT, the spherical findings were highlighted, with multiple having different dimensions, as well as radiopaque in their peripheral portion and more radiolucent inside them. We could immediately exclude salivary calculi, which usually have a more elongated/ovoid shape and appear homogeneously radiopaque without radiolucency areas. These two cases (of hypothetic medium contrast retention with unusual and atypical clinical-radiographic presentation) have very rarely been comprehensively and correctly documented in the literature. No papers have a follow-up longer than 5 years. We conducted a review of the literature on the PubMed database, finding only six articles reporting similar cases. Most of them were old articles, demonstrating the low frequency of this phenomenon. The research was performed using the following keywords: “sialography”, “contrast medium”, “retention” (six papers) and “sialography”, and “retention” (13 papers). Some articles were present in both searches, and the really significant ones (defined after a careful reading of the entire article and not only of the abstract) resulted only in six occurrences in a time span from 1976 to 2022. Full article

The study investigated allogenic pulp transplantation as an innovative method of regenerative endodontic therapy. Three patients were selected for the endodontic treatment of single-root teeth, who also had a son/daughter with deciduous teeth or third molars scheduled for extraction. Receptor teeth were endodontically instrumented and irrigated using a tri-antibiotic solution. During the transplant procedures, the teeth from the son/daughter were extracted, sectioned, and the pulp was carefully removed. The harvested pulp from the donor was inserted into the root canal of the host tooth (father/mother), followed by direct pulp capping and resin composite restoration. The teeth were followed-up with for 2 years and were surveyed with computed tomography, the electric pulp vitality test, and Doppler ultrasound examination. At the 6-month follow-up, positive pulp vitality and the formation of periapical lesions were verified in cases 1 and 2. Case 3 showed remarkable periapical radiolucency before transplantation, but after 1 year, such lesions disappeared and there was positive vitality. All teeth were revascularized as determined by Doppler imaging after 2 years with no signs of endodontic/periodontal radiolucency. In conclusion, although this was a case series with only three patients and four teeth treated, it is possible to suppose that this allogenic pulp transplantation protocol could represent a potential strategy for pulp revitalization in specific endodontic cases. Full article

Objective: The aim of this cross-sectional cohort study was to evaluate a comprehensive dental examination and referral concept for patients prior to endoprosthesis (EP) implantation in an interdisciplinary setting. Methods: Patients, who were prepared for EP surgery in the clinic for orthopaedics, were referred to the dental clinic for a dental examination. Thereby, dental and periodontal treatment need, radiographic and temporomandibular joint findings were assessed. Based on oral and radiographic investigation, a risk classification for potential source of prosthetic infection was performed. If potential oral foci of EP infection were present (e.g., apically radiolucent teeth, severe periodontitis or additional inflammatory findings), patients were classified as at high risk for EP infection with oral origin. Those individuals were allocated to their family dentist or special clinic for dental treatment prior to EP surgery. Results: A total of 311 patients were included (mean age: 67.84 ± 10.96 years, 51% male). A dental treatment need of 33% was found, while the periodontal treatment need was 83%. Thirty-one percent of patients showed at least one apical radiolucency (a sign of chronic infection/inflammation). Furthermore, additional findings such as radiographic signs of sinusitis maxillaris were found in 24% of patients. Temporomandibular disease was probable in 17% of individuals. One-third (34%) were assigned to the high risk group for an EP infection with oral origin. Conclusion: German patients before EP have a high periodontal treatment need and show frequently (34%) a potential oral focus of infection, underlining the necessity of including dental examination and risk stratification as part of the pre-operative assessment prior to EP implantation. Therefore, an approach as applied in this study appears reasonable for those individuals. Full article

Nowadays, total knee arthroplasty (TKA) is widely considered to be the gold standard for treatment of end-stage knee osteoarthritis. Although the optimal mode of fixation in TKA continues to be an important area of investigation, cementless fixation offers the possibility to gain biologic fixation, preserve bone stock and mineral density, and potentially improve survivorship. The purpose of this retrospective study was to evaluate the clinical results of a posterior-stabilized total knee arthroplasty with cementless tibial component in porous tantalum, comparing two groups: Group A (30 patients), TKA with a monoblock component and two pegs, and Group B (22 patients), with a modular component and three pegs. Knee Society Score (KSS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were submitted to the patients, and radiographs were collected at the last follow-up. The mean follow-up was 26.32 (20–40) months. Significant differences were not detected between the postoperative KSS values in the two groups (p = 0.44). Evaluating KOOS outcomes, we found in Group A that the rating system showed a statistically significant improvement from a preoperative average rating of 51.4 (SD ± 15) to an average of 72.66 (SD ± 19) at final follow-up (p < 0.05). In Group B, the KOOS rating system showed a statistically significant improvement from a preoperative average rating of 48.3 (SD ± 18) to an average of 79.54 (SD ± 17) postoperatively (p < 0.05). Comparing KOOS final outcomes between groups, we found no statistically significant difference at the mean final follow-up (p = 0.20), with the exception of the sport-related section (p < 0.05). Radiological evaluation at the final follow-up did not show any sign of polyethylene wear, radiolucency, septic or aseptic loosening, or change in alignment in either group. The current study demonstrates an excellent survivorship of cementless tibial components in porous tantalum and the possibility of osseous integration, without significant differences between the two groups under investigation. Full article