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OBJECTIVES This study aims to compare mechanical stability of osteosynthesis (plate and screw fixation) alone versus the same method supplemented with hip arthroplasty (hybrid solution) for double column fractures in elderly. PATIENTS AND METHODS Mechanical investigations were performed on an advanced finite element pelvis model developed for double column fractures. The following simulated implant combinations were analyzed: modular acetabular basket with a ring with polyaxial screws and U-plate; plates with polyaxial screws placed on the medial-horizontal (linea terminalis) and quadrilateral bone surfaces; modular acetabular cup with U-plates; and polyaxial screws in sizes optimized based on a finite element model (FEM). Using the models, the possible shifts in peak load positions arising in different movement patterns caused by load and tension and implant deformation were measured. RESULTS Hybrid systems resulted in minimal deformation of the implants already available on the market. We observed less possible shifts and greater stability in the acetabular fracture zones, compared to conventional osteosynthesis alone. Optimization with available and compatible implant sizes led to a further significant increase in stability. CONCLUSION Hybrid method combining osteosynthesis and prosthesis implantation provide more stability in biomechanical models in the treatment of double column fractures in elderly.

OBJECTIVES This study aims to investigate if the stabilization of iliac wing fractures influences the stability of the acetabular osteosynthesis, if surgical fixation is the choice of treatment, and which technique to be used. MATERIALS AND METHODS In the study, measurements were performed with an improved finite element model. Tension and displacement values were measured in bicolumnar acetabular fractures in the following cases: combination of cranial and medial plate fixation through the linea terminalis, or combination of cranial plate and quadrilateral surface plates. The iliac wing fracture was either not fixed, or fixed with screws or with a plate. RESULTS In cases where osteosynthesis was performed through the linea terminalis, 0.01 mm fracture gap displacement was observed with the use of a combination of cranial and quadrilateral surface plate fixations. In the combination of cranial and medial positioned plates, the displacement in the fracture gap was 0.088 mm. The fixation of the iliac wing fracture did not improve the stability of the osteosynthesis of the linea terminalis. Plate fixation of the iliac wing fracture was more stable than screw fixation alone. CONCLUSION In double column fractures, if the reduction does not require an anterior approach, it is not necessary to fix the iliac wing fracture only to improve the stability of the fixation. If the reduction does require an anterior approach, it is worth fixing the iliac wing fracture with the technically less demanding screw fixation.

A medialis combnyaktörések operatív kezeléséről napjainkban is vita folyik. Nincs egységes álláspont, osteosynthesis vagy protézis a jobban célravezető módszer? Friss törés esetében jelenleg a dislocatio típusától függően döntünk. Garden I–II-es töréseknél osteosynthesis, míg Garden IV-es töréseknél protézis a választott megoldás. A Garden III-as törés esetében mindkét út járható. Az osteosynthesisben a Manninger és munkacsoportja által kidolgozott, kettős kanülált csavarozást alkalmazzuk, az AO csavarozás mellett. Ez utóbbi kritériuma a jó csontszerkezet, ezért csak fiatal felnőtteknél jön szóba. A cikk szerzői, az osteosynthesis egy új formáját fejlesztették ki, a dinamikus HLS (HeadLessScrew) csavarozást. A csavar két fő részből áll, összeszerelt állapotban kompressziós hatást fejt ki. 27 betegnél végezték el a műtétet, majd az eredményeket a Manninger és munkacsoportja által kidolgozott módszer szerint értékelték. Eddigi tapasztalataik bizakodásra adnak okot. Nőtt a stabilitás, kevesebb lett a szövődmény.

Correction of a severe facial asymmetry presents a challenge due to the geometric complexity of the dentition, the bony structures and the soft tissues. In most asymmetric cases two-jaw surgery is recommended. Manual model surgery is an essential part of treatment planning but it can be complicated, time-consuming and may contain potential errors. We present a case of a 26-year-old male with a severe right-sided hemimandibular elongation when computerized simulation surgery was performed instead of manual model surgery. High-resolution computer tomography scan was done following presurgical orthodontics and the stack images were reformatted into a three-dimensional structure. The symmetry of the maxilla was corrected via a virtual Le Fort I osteotomy with the help of a three-dimensional planning software. A virtual intermediate surgical wafer was designed and fabricated with a three-dimensional printer. Virtual bilateral sagittal split osteotomy was performed and the mandible was rotated into the correct position to visualize the movements of the osteotomized segments. Real surgery was accomplished according to the virtual plan. The splint fitted well. There is a significant improvement in the facial symmetry; the occlusion is good and stable. This case supports the usage of computer-aided surgical planning and three-dimensional rapid prototyping for the correction of facial asymmetries.

A hagyományos, kétdimenziós kefalometriai elemzések kevés segítséget nyújtanak az aszimmetrikus fejlődési rendellenességekkezelésének tervezéséhez. A modell-műtét sokszor időigényes, bonyolult és tévedésekhez is vezethet.Tanulmányunk célja egy olyan, súlyos arc-aszimmetriával járó eset bemutatása, ahol a műtétet és az okklúziós lemeztvirtuálisan terveztük. Egy 26 éves férfit jobboldali hemimandibularis elongációval és a maxilla okklúziós síkjánakkompenzatórikus dőlésével diagnosztizáltunk. A fogszabályozó előkészítést követően nagy felbontású komputertomográffelvételeket készítettünk. A háromdimenziós struktúrák rekonstrukcióját és a virtuális műtétet saját fejlesztésű tervezőprogrammalvégeztük. A műtéti sínt virtuálisan terveztük, majd háromdimenziós nyomtatóval készítettük el. A valós műtéta számítógépes tervezés alapján történt. Az okklúziós sín a műtét közben tökéletesen illeszkedett. Az arc szimmetriájaa műtétet követően nagymértékben javult. Esetünk azt mutatja, hogy a háromdimenziós tervezőprogramok komolysegítséget adhatnak az állcsontkorrekciós műtétek tervezéséhez és elvégzéséhez. Feleslegessé tehetik a fogtechnikaihátteret, a bonyolult modell-műtét elvégzését.

Impaction of maxillary canines is a frequently encountered clinical problem. Patients' refusal to a long orthodontic treatment or ankylosis of the impacted tooth results in various treatment difficulties. The aim of this study was to evaluate the possible role of miniscrews in the management of impacted upper canines. In a series of 28 consecutive patients with a total of 31 impacted maxillary canines (12 men and 16 women aged from 14 to 63 years, mean 24 years), each impacted tooth was surgically exposed and an attachment was bonded. An intraosseous screw (1.5 mm in diameter and 8-10 mm long) with an endosseous body and intraoral neck section was inserted into the premolar-molar interradicular space. Following soft tissue healing, orthodontic traction was initiated. After correction of the angulation of the canine, the mini-screw was removed and traditional orthodontic therapy was completed. Twenty-seven canines were extruded successfully (87%), the duration of the orthodontic treatment with fixed appliances was decreased. In the 3 cases that failed due to ankylosis, the skeletal anchorage spared the patients and the clinicans the disappointment of a long-term unsuccessful traditional orthodontic treatment. In one patient, the mini-screw was removed because of inflammation and pain before the beginning of the orthodontic traction. This study shows that mini screw anchorage should be taken into consideration when extrusion of an impacted canine is planned.

Attachment loss through advanced periodontitis results in tooth mobility, and then loss of teeth. To prevent progression it is needed to eliminate any exciting agent and correct functional disorders in consequence of disease. Regeneration of periodontium is impossible and mastication is difficult because of tooth mobility. Long-term maintenance of mobile teeth is doubtful. We have to prevent the extraction of these teeth to stabilise them by a splint made of material that is inexpensive, reparable, provides sufficient support for the artificial tooth. Fiber-Reinforced Composite (FRC) fulfills the above requirements. In their case-reports the authors demonstrate the practical application of splinting with FRC materials. In these cases the FRC splints are not only periodontal splints but they act as orthodontic retainers or supports for an artificial tooth.

Treatment of cleft palate patients demands a well coordinated work of medical and dental specialists. In spite of the surgical and orthodontic therapy a prosthetic rehabilitation is often necessary because of missing teeth, maxillary hypoplasia, malocclusion and palatal defects. The prosthetic phase begins immediately after the orthodontic treatment. In this way the fixed partial denture replaces the retention appliance and stabilizes the achieved status. The aim of the prosthetic treatment is to improve the function of the masticatory apparatus, speech and aesthetic appearance of the patient. An important task of the prostheses is to support and lift up the upper lip and the base of the nose. There are several factors, which make the treatment difficult, like underdeveloped and collapsed maxillary arch, retrognath position of the maxilla, missing alveolar ridge, defects of the bone and mucosa, scars and stiffness of the upper lip. The maintenance of the oral hygiene with the fixed restorations is often difficult because of the stiffness of the upper lip, therefore the design of the pontic is very important especially in the cases, when the missing processus alveolaris has to be replaced in order to improve the harmony of the face.