Rehabilitation of orbital cavity after total orbital exenteration using oculofacial prostheses anchored by osseointegrated dental implants posed as a one-step surgical procedure

BACKGROUND: Total orbital exenteration is a radical surgical procedure, which typically involves the removal of the entire contents of the orbit including the periorbita, leaving the patient with a deep orbital deformity and results in devastating cosmetic, functional, and psychological consequences requiring difficult and challenging procedures for oculoplastic surgeons. Oculofacial prostheses retained by endosseous dental implants present an attractive and viable alternative when aesthetic and functional demands are beyond the capacity of local reconstructive efforts. PATIENTS AND METHODS: A 72-year-old woman presenting a malignant melanoma of the right eyelids and a 77-year-old man presenting a sebaceous carcinoma of the left upper eyelid underwent a total exenteration followed by positioning of endosseous implants (Straumann system Dental implants) as an integrated one-step combined surgical procedure. The oculofacial prosthesis was placed after epithelialization of the orbital cavity. RESULTS: The implants were perfectly osseointegrated without any complications, providing sufficient retention of the prostheses. A satisfactory aesthetic outcome has been achieved for both patients. CONCLUSIONS: Oculofacial prostheses anchored by osseointegrated dental implants placed as one-step surgical procedure ensure an adequate aesthetic result as well as a considerably decreased rehabilitation time and present a satisfactory solution when reconstruction is not a suitable option.

Mutation in the human homeobox gene NKX5-3 causes an oculo-auricular syndrome.

Several dysmorphic syndromes affect the development of both the eye and the ear, but only a few are restricted to the eye and the external ear. We describe a developmental defect affecting the eye and the external ear in three members of a consanguineous family. This syndrome is characterized by ophthalmic anomalies (microcornea, microphthalmia, anterior-segment dysgenesis, cataract, coloboma of various parts of the eye, abnormalities of the retinal pigment epithelium, and rod-cone dystrophy) and a particular cleft ear lobule. Linkage analysis and mutation screening revealed in the first exon of the NKX5-3 gene a homozygous 26 nucleotide deletion, generating a truncating protein that lacked the complete homeodomain. Morpholino knockdown expression of the zebrafish nkx5-3 induced microphthalmia and disorganization of the developing retina, thus confirming that this gene represents an additional member implicated in axial patterning of the retina.

Survival of zirconia- and metal-supported fixed dental prostheses: a systematic review

Purpose: The aim of this review was to systematically evaluate and compare the frequency of veneer chipping and core fracture of zirconia fixed dental prostheses (FOPS) and porcelain-fused-to-metal (PFM) FDPs and determine possible influencing factors. Materials and Methods: The SCOPUS database and International Association of Dental Research abstracts were searched for clinical studies involving zirconia and PFM FDPs. Furthermore, studies that were integrated into systematic reviews on PFM FDPs were also evaluated. The principle investigators of any clinical studies on zirconia FDPs were contacted to provide additional information. Based on the available information for each FOP, a data file was constructed. Veneer chipping was divided into three grades (grade 1 = polishing, grade 2 = repair, grade 3 = replacement). To assess the frequency of veneer chipping and possible influencing factors, a piecewise exponential model was used to adjust for a study effect. Results: None of the studies on PFM FDPs (reviews and additional searching) sufficiently satisfied the criteria of this review to be included. Thirteen clinical studies on zirconia FDPs and two studies that investigated both zirconia and PFM FDPs were identified. These studies involved 664 zirconia and 134 PFM FDPs at baseline. Follow-up data were available for 595 zirconia and 127 PFM FDPs. The mean observation period was approximately 3 years for both groups. The frequency of core fracture was less than 1% in the zirconia group and 0% in the PFM group. When all studies were included, 142 veneer chippings were recorded for zirconia FDPs (24%) and 43 for PFM FDPs (34%). However, the studies differed extensively with regard to veneer chipping of zirconia: 85% of all chippings occurred in 4 studies, and 43% of all chippings included zirconia FDPs. If only studies that evaluated both types of core materials were included, the frequency of chipping was 54% for the zirconia-supported FDPs and 34% for PFM FDPs. When adjusting the survival rate for the study effect, the difference between zirconia and PFM FDPs was statistically significant for all grades of chippings (P = .001), as well as for chipping grade 3 (P = .02). If all grades of veneer chippings were taken into account, the survival of PFM FDPs was 97%, while the survival rate of the zirconia FDPs was 90% after 3 years for a typical study. For both PFM and zirconia FDPs, the frequency of grades 1 and 2 veneer chippings was considerably higher than grade 3. Veneer chipping was significantly less frequent in pressed materials than in hand-layered materials, both for zirconia and PFM FDPs (P = .04). Conclusions: Since the frequency of veneer chipping was significantly higher in the zirconia FDPs than PFM FDPs, and as refined processing procedures have started to yield better results in the laboratory, new clinical studies with these new procedures must confirm whether the frequency of veneer chipping can be reduced to the level of PFM. Int J Prosthodont 2010;23:493-502

A test of Suchey-Brooks (pubic symphysis) and Buckberry-Chamberlain (auricular surface) methods on an identified Spanish sample: paleodemographic implications

Forensic Anthropology and Bioarchaeology studies depend critically on the accuracy and reliability of age-estimation techniques. In this study we have evaluated two age-estimation methods for adults based on the pubic symphysis (Suchey-Brooks) and the auricular surface (Buckberry-Chamberlain) in a current sample of 139 individuals (67 women and 72 men) from Madrid in order to verify the accuracy of both methods applied to a sample of innominate bones from the central Iberian Peninsula. Based on the overall results of this study, the Buckberry-Chamberlain method seems to be the method that provides better estimates in terms of accuracy (percentage of hits) and absolute difference to the chronological age taking into account the total sample. The percentage of hits and mean absolute difference of the Buckberry-Chamberlain and Suchey-Brooks methods are 97.3% and 11.24 years, and 85.7% and 14.38 years, respectively. However, this apparently greater applicability of the Buckberry-Chamberlain method is mainly due to the broad age ranges provided. Results indicated that Suchey-Brooks method is more appropriate for populations with a majority of young individuals, whereas Buckberry-Chamberlain method is recommended for populations with a higher percentage of individuals in the range 60-70 years. These different age estimation methodologies significantly influence the resulting demographic profile, consequently affecting the biological characteristics reconstruction of the samples in which they are applied.

Implante de cartilagem auricular autóloga no reparo de desvio de pênis de bovinos

Dezoito novilhos de diferentes raças, com idade de 18-24 meses foram submetidos a remoção do ligamento apical para ocasionar desvio de pênis. Decorridos 60 dias os animais foram colocados em presença de fêmeas em estro, sendo verificado desvio ventral e lateral direito do pênis, com incapacitade de cópula. Os animais foram submetidos ao transplante autólgo de um segmento da cartilagem do pavilhão auricular, sobre a túnica albugínea, substituindo o ligamento apical do pênis removido. Os bovinos quando em presença de fêmeas em estro não apresentaram desvio de pênis e alteração do comportamento sexual. Notou-se a presença de poucas células mononucleares, polimorfonucleares e células gigantes e formação de tecido conjuntivo fibroso, ocasionando aderências resistentes e capacidade de sustentar a extremidade livre do pênis. O método cirúrgico mostrou-se eficiente para corrigir desvios ventral e lateral de pênis de bovinos.

Caracterização da microbiota auricular de cutias (Dasyprocta aguti) criadas em cativeiro

O presente trabalho teve por objetivo identificar as principais bactérias aeróbias que compõem a microbiota natural do pavilhão auricular de cutias hígidas. Para tanto, foram utilizadas 48 cutias, criadas em cativeiro sob as condições Semiáridas do Nordeste Brasileiro. Esses animais foram distribuídos nas categorias de adultos (N=32) e filhotes (N=16), e, em ambas, distribuídos igualmente entre machos e fêmeas. Através de um swab, em cada animal coletou-se de cada orelha a secreção presente na superfície do pavilhão auricular dos animais, totalizando 96 amostras. Este material foi refrigerado, e encaminhado ao laboratório para a realização das análises microbiológicas (macroscopia das colônias, citologia e provas bioquímicas), com o intuito de isolar e identificar os microrganismos. Os principais microrganismos isolados foram Staphylococcus spp. (47,26%), Streptococcus spp. (12,80%), Bacillus spp. (22,73%) e Corynebacterium spp. (17,30%). Verificou-se também que não houve diferença entre adultos e filhotes em relação aos microrganismos retrocitados. Assim, as bactérias residentes do pavilhão auricular de cutias hígidas são essencialmente cocos e bacilos gram-positivos, similarmente ao encontrado em pequenos animais domésticos.

Clinical aspects and dynamics of auricular parasitosis in Gir cattle

We evaluated the dynamics of ear infestations caused by Rhabditis spp. and Raillietia spp., which were correlated with animal age, intensity of clinical signs and climate factors. Sixty-four Gir cattle were distributed into three groups: GA - 23 calves with 4 to 6 months of age; GB - 18 calves with 7 to 12 months of age; and GC - 23 heifers with 13 to 33 months of age. Five samplings, defined as S1, S2, S3, S4 and S5 were performed every three months from August 2008 to August 2009. The ear secretion was collected using the auricular washing method for the right ear and a swab for the left ear. A clinical assessment of the animals was performed, and they were classified according to the presence and severity of otitis. The highest relative frequency of rhabditosis was 52.2% in GC at the last sampling. In the first sampling, 42.2% of the animals were infested by Raillietia spp. The older cattle were more susceptible to infestations by both parasites. No correlation of Rhabditis spp. and Raillietia spp. parasitism with climate factors was found. The results showed that both parasites could infest Gir cattle, and in most cases, there was no co-infestation. Only older animals parasitized by the nematode showed clinical signs of the disease.

Use of fiber-reinforced composite framework and thermochromic pigment in maxillofacial prostheses

The purpose of this investigation was to evaluate the possibility to enhance certain qualities of facial prostheses. Polymethyl methacrylate is still being used as base mate¬rial or clip carrier material, but it is hard and heavy, and debonding of the silicone from the acrylic base material is a frequent problem. This thesis aims to evaluate the use of fiber-reinforced composite (FRC) as framework material for maxillofacial silicone prostheses. FRC has been used as reinforcement in removable and fixed partial dentures since the 1990s. This material is lightweight and can be fabricated to compress the margins of the prosthesis slightly, to keep it tightly against the skin during jaw movements and facial expressions. Additionally, the use of a thermochromic pigment, colorless in room temperature and red in a cold environment, was studied in order to evaluate the possibility of using this color changing pigment in facial prostheses to mimic the color change of facial skin in cold weather. The tensile bond strength between pre-impregnated, unidirectional FRC and maxillofacial silicone elastomer was studied. Three different bonding agents or primers were compared. Bond strength was improved by one of the primers and by roughening the surface. The effect of a skin compressing glass fiber-reinforced composite framework on facial skin blood flow was studied by using a face mask, constructed with a compression pad corresponding to the outer margin of a glass fiber-reinforced framework beam of a facial prosthesis. The skin blood flow of ten healthy volunteers, aged 23-25 years, was measured during touch, light, and moderate compression of the skin, by using laser Doppler imaging technique. None of the compressions showed any marked effects on local skin blood flow. There were no significant differences between blood flow during compression and at baseline. Maxillofacial silicone elastomer was colored intrinsically with conventional color pigments: a control group containing only conventional pigments was compared to two test groups with 0.2 wt% and 0.6 wt% thermochromic pigment added. The color of the material was measured with a spectrophotometer in room temperature and after storage in a freezer. The color stability of the maxillofacial silicone elastomer colored with thermo¬chromic pigment was evaluated by artificial aging. The color dif¬ference of the L* (lightness) and a* values (redness), comparing color after the samples were stored at room temperature and in a freezer (-19°C), was statistically significant for both 0.2 wt% and 0.6 wt% thermo¬chromic pigment groups. The differences in the b* values (yellowness) were statistically significant for the 0.6 wt% group. Exposure to ultraviolet (UV) radiation led to visually noticeable and statistically signifi¬cant color changes (ΔE) in all color values in both test groups. The specimens containing thermochromic pigment were very sensitive to UV radiation. In conclusion, a framework of fiber-reinforced composite can successfully be bonded to maxillofacial silicone elastomer, and a framework beam, compressing the facial skin, did not remarkably alter the skin blood flow on healthy, young adults. The thermochromic pigment showed color change in maxillofacial silicone elastomer. However, artificial aging showed that it was too sensitive to UV radiation to be used, as such, in maxillofacial prostheses.

Fiber-reinforced composite fixed dental prostheses: Studies of the materials used as pontics

Fiber-reinforced composite fixed dental prostheses – Studies of the materials used as pontics University of Turku, Faculty of Medicine, Institute of Dentistry, Department of Biomaterials Science, Finnish Doctoral Program in Oral Sciences – FINDOS, Annales Universitatis Turkuensis, Turku, Finland 2015 Fiber-reinforced composites (FRC), a non-metallic biomaterial, represent a suitable alternative in prosthetic dentistry when used as a component of fixed dental prostheses (FDPs). Some drawbacks have been identified in the clinical performance of FRC restorations, such as delamination of the veneering material and fracture of the pontic. Therefore, the current series of studies were performed to investigate the possibilities of enhancing the mechanical and physical properties of FRC FDPs by improving the materials used as pontics, to then heighten their longevity. Four experiments showed the importance of the pontic design and surface treatment in the performance of FRC FDPs. In the first, the load-bearing capacities of inlay-retained FRC FDPs with pontics of various materials and thicknesses were evaluated. Three different pontic materials were assessed with different FRC framework vertical positioning. Thicker pontics showed increased load-bearing capacities, especially ceramic pontics. A second study was completed investigating the influence of the chemical conditioning of the ridge-lap surface of acrylic resin denture teeth on their bonding to a composite resin. Increased shear bond strength demonstrated the positive influence of the pretreatment of the acrylic surfaces, indicating dissolution of the denture surfaces, and suggesting potential penetration of the monomer systems into the surface of denture teeth. A third study analyzed the penetration depth of different monomer systems on the acrylic resin denture teeth surfaces. The possibility of establishing a durable bond between acrylic pontics and FRC frameworks was demonstrated by the ability of monomers to penetrate the surface of acrylic resin denture teeth, measured by a confocal scanning type microscope. A fourth study was designed to evaluate the load-bearing capacities of FRC FDPs using the findings of the previous three studies. In this case, the performance of pre-shaped acrylic resin denture teeth used as pontics with different composite resins as filling materials was evaluated. The filling material influenced the load-bearing capacities, providing more durable FRC FDPs. It can be concluded that the mechanical and physical properties of FRC FDPs can be improved as has been shown in the development of this thesis. The improvements reported then might provide long lasting prosthetic solutions of this kind, positioning them as potentially permanent rehabilitation treatments. Key words: fiber-reinforced composite, fixed dental prostheses, inlay-retained bridges, adhesion, acrylic resin denture teeth, dental material.

Incidencia de fibrilación auricular en pacientes con dispositivos de estimulación cardiaca con cardiopatía chagásica y no chagásica

La posible asociación entre el desarrollo de fibrilación auricular (FA) con la presencia de cardiopatía chagásica en una población portadora de dispositivos cardiacos de estimulación no está descrita. Se presenta un estudio de tipo cohorte retrospectivo realizado en la FCI que recopila las principales características clínicas de una población de pacientes con cardiopatía de variada etiología y portadores de dispositivos cardiacos buscando evaluar la incidencia de FA en presencia de cardiomiopatía de origen chagásico y no chagásico. A la fecha no se cuenta con una base de datos institucional ni regional que contenga las variables analizadas. Durante los 5 meses que duró la construcción de la base de datos se incluyeron 99 sujetos de investigación. Se implantaron 42 marcapasos bicamerales, 39 cardiodesfibriladores bicamerales, 6 dispositivos correspondientes cardiodesfibrilador con función de resincronización cardiaca, 2 resincronizadores cardiacos sin función de cardiodesfibrilador y 7 cardiodesfibriladores unicamerales. De los 99 sujetos recolectados se presentaron 8 desenlaces (FA de novo) y de esos solamente 1 pertenece al grupo de pacientes con cardiomiopatía chagásica. Este número reducido de desenlaces no permitió desarrollar un modelo de regresión de Cox y ni otros tipos de análisis estadísticos planteados en el protocolo inicial debido al bajo número de casos y pobre poder estadístico. Esta dificultad es inherente a la naturaleza del problema a estudiar y al corto tiempo de seguimiento. Por lo anterior no se puede establecer si existe una relación entre la presencia de serología positiva para infección por T. Cruzi y la presencia de FA de novo.

Incidencia de fibrilación auricular en las primeras 72 horas del post operatorio de revascularización miocárdica

Determinar la incidencia de fibrilación auricular en las primeras 72 horas del post operatorio en pacientes llevados a revascularización miocárdica utilizando dos técnicas de anestésia una convencional (AC) con anestésicos inhalados y opioides y otra con dexmedetomidina (AD.). cohorte retrospectivo, en donde se seleccionarán dos grupos de estudio, un grupo de expuestos, pacientes llevados a revascularización miocárdica con utilización técnica anestésica convencional y un grupo de no expuestos pacientes llevados a revascularización miocárdica con uso de dexmedetomidina como técnica de anestesia; A estos grupos se les hizo seguimiento por 72 horas para determinar la presencia de fibrilación auricular y la terapéutica instaurada.