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Dental implants are commonly used to replace missing single teeth. However, esthetic rehabilitation of an adjacent tooth may also be required due to diastemas, crowding, or existing large direct restorations to improve the final esthetic outcome. With the advancements in ceramics and bonding techniques, minimally invasive esthetic approaches have become viable for compromised spacing issues. This case report describes a dental technique for the esthetic rehabilitation of compromised anterior spacing with a customized zirconia implant abutment at a maxillary central incisor site and a partial ceramic veneer bonded to the adjacent central incisor. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the effectiveness of biomaterials in bone healing of critical bone defects created by piezoelectric surgery in rat calvaria. Method and materials: Histomorphologic analysis was performed to assess bone regeneration and tissue response. Fifty animals were randomized into five groups with one of the following treatments: Control group (n = 10), spontaneous blood clot formation with no bone fill; BO group (Bio-Oss, Geistlich Pharma; n = 10), defects were filled with bovine medullary bone substitute; BF group (Bonefill, Bionnovation; n = 10), defects were filled with bovine cortical bone substitute; hydroxyapatite group (n = 10), defects were filled with hydroxyapatite; calcium sulfate group (n = 10), defects were filled with calcium sulfate. Five animals from each group were euthanized at 30 and 45 days. The histomorphometry calculated the percentage of the new bone formation in the bone defect. Results: All data obtained were evaluated statistically considering P < .05 as statistically significant. The results demonstrated the potential of all biomaterials for enhancing bone regeneration. The findings showed no statistical differences between all the biomaterials at 30 and 45 days including the control group without bone grafting. Conclusion: In conclusion, the tested biomaterials presented an estimated capacity of osteoconduction, statistically nonsignificant between them. In addition, the selection of biomaterial should consider the specific clinical aspect, resorption rates, size of the particle, and desired bone healing responses. It is important to emphasize that in some cases, using no bone filler might provide comparable results with reduced cost and possible complications questioning the very frequent use of ridge presentation procedures. [ABSTRACT FROM AUTHOR]

Objective: This retrospective study analyzed radiographic bone levels of 10,871 dental implants in a cohort of 4,247 patients over a 22-year period. The objectives of the study were to assess and explore risk factors associated with the radiographic bone level of dental implants. Method and materials: A longitudinal observational cohort study based on data collected from 1995 to 2019 was conducted on implants placed by a single periodontist. Inclusion criteria included both partially and fully edentulous sites. Exclusion criteria were patients who were considered ASA 3 or greater. Information on medical and dental status prior to implant placement such as diabetes and smoking were included in the analysis. Implant factors such as the implant characteristics (length and diameter) and surgical site were recorded. The outcome assessed was the prevalence of bone loss around implants and any associative factors related to the bone loss. Results: Overall, dental implants lost an average of 0.05 ± 0.38 mm of bone 2 to 3 years after placement and 0.21 ± 0.64 mm 8 years after placement. The soft tissue condition was evaluated using the Implant Mucosal Index (IMI), and bone loss around dental implants was significantly higher when bleeding on probing was multi-point and moderate, multi-point and profuse, and when infection with suppuration was recorded. The mean difference in bone level between smokers and nonsmokers was 0.26 mm (P < .01) over a 4-year period. A mean difference of 0.10 mm (P = .04) in bone loss over 4 years was found between those with an autoimmune disease compared to those without. The diameter of the implant and immediate loading of the dental implant did not influence the radiographic bone levels over time. Conclusions: This large dataset of dental implants highlights predictive risk factors for bone loss around dental implants and the impact these risk factors have on the implant bone level. Consideration of these risk factors by both the dental team and the patient prior to dental implant placement will promote success of the treatment. [ABSTRACT FROM AUTHOR]

The design and manufacture of a stackable surgical guide for implant placement with immediate prosthetic loading of completely edentulous cases is described in this dental technique. To achieve this, the stackable attachment is designed using free-form designing software, which is later joined to the implant placement guide and the dental prosthesis. This technique should provide the patient with a same-day implant and an esthetic restoration accurately placed in the predesigned position of the centric occluding relationship. It also reduces the number of visits and prosthetic complications related to the improper implant position. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Clinical Considerations Conclusions Clinical Significance This article describes a clinical protocol utilizing soft tissue augmentation alone or in combination with guided bone regeneration (GBR), introducing simultaneous application of the one abutment one time concept for three‐dimensional reconstruction of the deficient ridge.Soft and hard tissue quality and dimensions are fundamental elements for long lasting results in implant dentistry. Different techniques have been described for soft and hard tissue augmentation at time of implant placement presenting favorable results. However, multiple abutment disconnections during the prosthetic phase of treatment can compromise the results achieved during surgery. The purpose of this article is to present a surgical protocol that allows three‐dimensional ridge reconstruction involving soft tissue augmentation alone, or in combination with hard tissue augmentation in one single step with the use of an one‐time intermediate abutment as an anchorage device for the regenerative materials. Two clinical cases utilizing the proposed protocol are also presented, demonstrating favorable results.The application of the proposed protocol simplifies the surgical phase of treatment, protects the achieved result and enables a favorable outcome in decreased time.Utilising an intermediate abutment as an anchorage device at time of surgery can be proven an easy to apply and biologically favorable alternative way to other methods of soft tissue graft stabilization proposed in the past. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Purpose/Aim Materials and Method Results Conclusion For edentulism, an implant supported removable complete overdenture (IOD) is an attractive solution to restore patients' chewing capacity, aesthetics, and self‐esteem, however, treatment is expensive and time consuming.To estimate the decline in costs for digitally designed and CAD/CAM fabricated IODs (3D‐IODs) compared to conventionally fabricated IODs (C‐IODs) at comparable general health related quality of life (GHRQoL).A randomized crossover study enrolled 36 fully edentulous patients, in whom six maxillary implants were placed together with two mandibular implants, if not already present.At the start of the study, a set of C‐IODs and 3D‐IODs was fabricated for each patient. All patients wore each IOD‐type for 1 year: first the 3D‐IOD and the second year a C‐IOD, or vice versa. At all three‐time points patients general QoL was assessed using the EQ‐5D‐5L questionnaire as well as the SF‐36 from which the SF‐6D was obtained, to research the anticipation of no significant difference.To enable cost consequence analysis (CCA), both costs made within healthcare and patient costs were assessed. Subsequently, a budget impact analysis (BIA) was performed to demonstrate the potential savings.No differences in general GHRQoL were seen between C‐IOD (M = 0.840, SD = 0.177) and 3D‐IOD (M = 0.837, SD = 0.156) (paired t‐test (N = 31): p = 0.880).With respect to the total costs for a complete IOD, however, the digital approach showed a reduction in initial total costs of 14.2% (€4700.33 vs. €4030.61: p < 0,001), in treatment time of 41.1% (309 vs. 182 min: p < 0.001), and in number of treatment sessions of 47.1% (5.68 vs. 3.0: p < 0.001). For repairs for an IOD in both the upper and lower jaw, the C‐IOD and 3D‐IOD scored similar for treatment time as well as additional costs.Implementing a 3D workflow in the production of IOD's supplies patients with a high‐quality 3D‐IOD at lower costs.Trial Registration: NL‐OMON44248 https://onderzoekmetmensen.nl/en/trial/44248 [ABSTRACT FROM AUTHOR]

Early osteoimmune microenvironment disorder at the interface between bone and implant can lead to implant loosening, which prolongs patient convalescence, exacerbates postoperative complications, and potentially results in implant failure. The timely regulation of macrophages primarily orchestrates the entire long‐term regeneration process. Here, it is proposed to precisely direct macrophage polarization using localized photoelectrical signals generated by an excitable surface in response to remote stimulation via near‐infrared light (NIR). The photocurrent generated from the n–n heterojunction between calcium titanate (CaTiO3) and defective titanium dioxide (TiO2‐Vo) on the excitable surface can accurately direct macrophage polarization, suppressing acute inflammation at the early stage of post‐implantation and establishing a favorable osteoimmune microenvironment that promotes bone‐to‐implant integration. Mechanistic study reveals that photoelectric signals initiate increased calcium influx via voltage‐gated calcium ion channels, subsequently modulating calcium/calmodulin‐dependent protein kinase kinase 2 (Camkk2) and calcium/calmodulin‐dependent protein kinase I (Camk1) expression to regulate macrophage polarization. This optimization of the osteoimmune microenvironment results in enhanced mesenchymal stem cells (MSCs) recruitment and osteogenesis, ultimately accelerating bone‐to‐implant integration within 14 days post‐implantation. This research presents a novel method for adjusting in vivo spatiotemporal immune responses through the use of noninvasive and externally‐controlled targeted stimulations. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Clinical Considerations Conclusions Clinical Significance These two clinical case reports show the use of the Triple Layer Graft procedure along with the Decoronation procedure to help restore normal contour and height of tissue The procedure was highly effective at restoring the esthetics that the patients needed on their implants. Short and long term results along with the step by step technique are shown.Two patients of 33 and 25 years of age both had significant reduction in the height over their implants in the #7 and #10 locations. The first patient had the implants placed 15 years ago and the second patient had them done 5 years before our treatment. Current techniques to remedy esthetic issues created by malpositioned implants consist of soft and/or hard tissue grafting but tend to be utilized independently of each other in discrete procedures as opposed to being combined in one surgical protocol. The Triple Layer Graft (TLG) surgical protocol is novel in that it incorporates all three layers of grafting to address both soft and hard tissue deficits in one procedure done at one time after doing a decoronation technique. The TLG surgical and prosthetic protocol has been previously published by these authors, but this article will discuss the rationale along with the technique and indications and contraindications, illustrated via case reports. The authors will also report on the long‐term results of this technique.The Triple Layer Graft TLG) in combination with the Decoronation technique is an effective method in managing mild as well as severe esthetic defects over the facial of previously placed implants.The Triple Layer Graft will allow implants that were previously removed in order to place a new implant along with ridge augmentation may be able to be saved. This is a wonderful procedure for the patient since the implant does not have to be removed and replaced. [ABSTRACT FROM AUTHOR]

The general trend of increasing life expectancy will consistently drive the demand for orthopedic prostheses. In addition to the elderly, the younger population is also in urgent need of orthopedic devices, as bone fractures are a relatively common injury type; it is important to treat the patient quickly, painlessly, and eliminate further health complications. In the field of traumatology and orthopedics, metals and their alloys are currently the most commonly used materials. In this context, numerous scientists are engaged in the search for new implant materials and coatings. Among the various coating techniques, plasma electrolytic oxidation (PEO) (or micro-arc oxidation—MAO) occupy a distinct position. This method offers a cost-effective and environmentally friendly approach to modification of metal surfaces. PEO can effectively form porous, corrosion-resistant, and bioactive coatings on light alloys. The porous oxide surface structure welcomes organic molecules that can significantly enhance the corrosion resistance of the implant and improve the biological response of the body. The review considers the most crucial aspects of new combined PEO-organic coatings on metal implants, in terms of their potential for implantation, corrosion resistance, and biological activity in vitro and in vivo. [ABSTRACT FROM AUTHOR]

Ophthalmic treatment demands precision and consistency in delivering therapeutic agents over extended periods to address many conditions, from common eye disorders to complex diseases. This diversity necessitates a range of delivery strategies, each tailored to specific needs. We delve into various delivery cargos that are pivotal in ophthalmic care. These cargos encompass biodegradable implants that gradually release medication, nonbiodegradable implants for sustained drug delivery, refillable tools allowing flexibility in treatment, hydrogels capable of retaining substances while maintaining ocular comfort, and advanced nanotechnology devices that precisely target eye tissues. Within each cargo category, we explore cutting-edge research-level approaches and FDA-approved methods, providing a thorough overview of the current state of ophthalmic drug delivery. In particular, our focus on nanotechnology reveals the promising potential for gene delivery, cell therapy administration, and the implantation of active devices directly into the retina. These advancements hold the key to more effective, personalized, and minimally- invasive ophthalmic treatments, revolutionizing the field of eye care. [ABSTRACT FROM AUTHOR]

This study addresses this issue by exploring the effectiveness of abrasive water jet drilling (AWJD) as an unconventional machining approach for UHMWPE. The research employs a full factorial analysis to examine various hole characteristics, including machining time (MT), surface roughness (Ra), taper angle (TA), material removal rate (MRR), and taper ratio (TR). The study aims to understand the effect of the process features, namely abrasive water jet pressures (p), traverse rates (v), and abrasive mass flow rates (ma), on the geometry and position of the drilled holes. The results show that (v) and (p) affect the drilled hole characteristics of surface morphology, roughness, MT, MRR, TA, and TR. The microstructural characteristics of the drilled-hole surfaces are analyzed by scanning electron microscopy (SEM). It revealed that the smooth surface is attained at the lower v of 150 mm/min and ma of 250 g/min. [ABSTRACT FROM AUTHOR]

Objectives: Despite the absence of ionizing radiation, magnetic resonance (MR) has inherent risks in clinical practice that can have serious health consequences if overlooked. At an international level, there are MR safety guidelines that help define the organization of a radiology department to minimize the risks for patients and personnel. However, competing guidelines exist and not every country and institution adheres to the same standards. In this work, we aim to understand the current situation regarding MR safety practices across Europe, and to identify the points where harmonization, coordination, or further education is needed. Methods: An anonymous survey questionnaire was distributed between April and June 2023 through ESR member societies to healthcare professionals, aimed to assess personnel training, local policies, scanning practices, and accidents. Results: Seven hundred and ninety-three responses were obtained from 44 different countries. The majority of respondents from five countries reported that MR safety is mandated by law, but we could only confirm two (Italy and Austria). While 77% of the responses said that their institution had a clear MR safety guideline, 52% said that nobody in their institution had received specific MR safety training. MR-conditional cardiac devices are mostly scanned in university hospitals (reported by 75% of respondents from this type of institution) but in only 42% of outpatient facilities. MR-unsafe cardiac devices are only scanned off-label in 27% of university hospitals, and in an even smaller share of other institutions. Approximately 12% of the respondents reported MR-related accidents resulting in patient or personnel injury. Overall, there is the sentiment that MR safety education and regulation are needed. Conclusions: The European landscape in terms of MR safety is very heterogeneous, with different regulations across countries, and different procedures for MR safety training and their application in clinical routine. The European Society of Radiology is optimally positioned to play an active role in the harmonization of MR safety education and practices across Europe, and we are proposing a four-tiered framework for the development of a teaching curriculum for MR safety training. Critical relevance statement: There is room for raising awareness of MR safety issues to ensure patient safety, reduce accidents, and benefit more patients. We advocate for radiologist-led standardization and improvement of MR safety training as a way to address this problem. Key Points: Our survey of MR safety practices across Europe revealed significant heterogeneity in regulations, training, and scanning practices. There is a widespread lack of awareness and implementation of MR safety guidelines and diffuse uncertainty, under-scanning of eligible patients, and preventable accidents. The ESR proposes a harmonized, four-tiered MR safety training curriculum to standardize, and improve safety practices across Europe. [ABSTRACT FROM AUTHOR]

Periapical radiographs are routinely used in dental practice for diagnosis and treatment planning purposes. However, they often suffer from artifacts, distortions, and superimpositions, which can lead to potential misinterpretations. Thus, an automated detection system is required to overcome these challenges. Artificial intelligence (AI) has been revolutionizing various fields, including medicine and dentistry, by facilitating the development of intelligent systems that can aid in performing complex tasks such as diagnosis and treatment planning. The purpose of the present study was to verify the diagnostic performance of an AI system for the automatic detection of teeth, caries, implants, restorations, and fixed prosthesis on periapical radiographs. A dataset comprising 1000 periapical radiographs collected from 500 adult patients was analyzed by an AI system and compared with annotations provided by two oral and maxillofacial radiologists. A strong correlation (R > 0.5) was observed between AI perception and observers 1 and 2 in carious teeth (0.7–0.73), implants (0.97–0.98), restored teeth (0.85–0.89), teeth with fixed prosthesis (0.92–0.94), and missing teeth (0.82–0.85). The automatic detection by the AI system was comparable to the oral radiologists and may be useful for automatic identification in periapical radiographs. [ABSTRACT FROM AUTHOR]

Introduction: Different protocols and procedures for sinus lift and implant placement are available, generally involving the use of grafts to increase the tissue volume and/or prevent the Schneiderian membrane from collapsing. Among xenografts, deproteinised bovine bone graft (DBBP) is frequently used in sinus lift procedures. Leaving an ungrafted space following membrane elevation has proven to have a bony regenerative potential as well. This study aimed to compare the clinical and histological features of sinus lift surgery performed with or without biomaterials. Methods: Patients with severe maxillary posterior atrophy (residual bone height 2–6 mm and residual crest thickness ≥4 mm), and in need of sinus lift surgery to allow the placement of three implants were enrolled and randomly divided into two groups. They underwent sinus lifts with DBBP (control) or with a graftless technique (test) and immediate placement of two implants (a mesial and distal one). After 6 months, a bone sample was retrieved from the area between the previously inserted fixtures, and a third, central implant was placed. The collected bone samples were analyzed morphologically and histomorphometrically. The patients were provided with prosthetic restorations after 6 months and followed up for 5–12 years. Results: Ten patients were enrolled in the test and nine in the control group. The 6‐month follow‐up showed in the control group an average augmentation of 10.31 mm (±2.12), while in the test group it was 8.5 mm (±1.41) and a success rate of 96.3% in the control and 86.7% in the test group (p > 0.05). The histological analysis evidenced the presence of new bone tissue surrounded by immature osteoid matrix in the test group, and a variable number of DBBP particles surrounded by an immature woven bone matrix in the control group. Conclusion: The results of the present trial indicate that, with residual bone height of 2–6 mm and residual crest thickness ≥4 mm, sinus lift surgery with or without biomaterials followed by implant restoration, produces similar clinical and histological outcomes. [ABSTRACT FROM AUTHOR]

Objectives: The aim of our study was to evaluate the cooccurrence of capsular liver lesions along with peritoneal carcinomatosis and hematogenous metastases in other regions of the body in ovarian cancer patients on follow-up F-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/ computed tomography (PET/CT) studies. Methods: Consecutive 18F-FDG PET/CT studies of 54 women with ovarian cancer between August 2012 and January 2020 and a total of 192 scans were analysed retrospectively. All patients had at least one hepatic and/or capsular lesion with high 18F-FDG uptake and at least two PET/ CT examinations. Results: According to interpretation, of 54 patients with hepatic or capsular lesions, 44 (81.4%), 5 (9.3%) and 5 (9.3%) of them were concluded as perihepatic implants, hematogenous liver metastases and both, respectively. Accompanying peritoneal carcinomatosis on follow-up PET/CT images was found in 42 (95.4%) and 3 (60%) patients with solely capsular lesions and solely hematogenous liver metastases, respectively. Extrahepatic hematogenous organ metastases on follow-up PET/CT images were seen in 4 (9.0%) and 3 (60%) patients with solely capsular lesions and solely hematogenous liver metastases, respectively. Lungs, bones, spleen and brain were detected metastases sites. Conclusion: Cooccurrence of peritoneal carcinomatosis in other regions of abdomen was found to be higher in comparison to hematogenous organ metastases on consecutive PET/CT studies of ovarian cancer patients with capsular liver lesions. The primary opinion of the nuclear medicine physician is essential along with the other patient data for differential diagnosis and treatment approach in this particular patient group. [ABSTRACT FROM AUTHOR]

Introduction Smokers have a higher chance of developing peri-implant diseases and are therefore considered an at-risk population. Our aim was to compare peri-implant characteristics in users of electronic cigarettes (EC), waterpipes (WP), cigarettes (CS), smokeless tobacco (ST), and nonsmokers (nonusers of any nicotine and tobacco product; NS). Aims and Methods A systematic search of four electronic databases (PubMed, EMBASE, Web of Science, and CENTRAL) was performed until April 2023, restricted to English language. Thirty-nine observational studies were included in the qualitative synthesis, of which 32 studies were included in a Bayesian network meta-analysis. Using a predesigned form, two researchers independently collected data about marginal bone loss (MBL), probing pocket depth (PPD), plaque index, bleeding on probing, modified plaque index, probing pocket depth > 4 mm (PPD > 4), gingival index, peri-implant sulcular fluid volume, and TNF-α and IL-1β levels. QUIPS and CINeMA were used to evaluate the risk of bias and certainty of evidence. Results Nonsmokers had the smallest MBL. Most nicotine-containing product users had significantly higher MBL (CS, mean difference [MD]: 1.34 credible interval [CrI]: 0.85, 1.79; WP, MD: 1.58 CrI: 0.84, 2.35; ST, MD: 2.53, CrI: 1.20, 3.87) than NS. Electronic cigarettes did not show significant difference compared to NS (MD: 0.52 CrI: −0.33, 1.36). In secondary outcomes, NS were ranked in first place. Subset analysis based on smoking habit, implant duration, and maintenance control revealed no differences in ranking probability. Conclusions Most nicotine-containing product users presented worse peri-implant parameters compared to NS, while EC users did not show significant differences to NS in many outcomes. Implications Alternative nicotine-containing products are gaining popularity and are often considered less harmful by the general public compared to traditional cigarettes. This is the first network meta-analysis comparing users of four nicotine-containing products and NS. This study shows that CS, WP, and ST have a detrimental effect on the overall health of peri-implant tissues. EC users also presented inferior parameters compared to NS; however, the difference was not significant in many outcomes. It is essential to educate patients who are using nicotine-containing products, and to provide proper maintenance and appropriate cessation support. Well-designed multiarmed studies are needed for direct comparison of different products, including heated tobacco products. Greater transparency of confounding factors is needed regarding smoking habit and oral hygiene. [ABSTRACT FROM AUTHOR]

Background While immediate breast reconstruction rates in breast cancer are increasing, they remain low in women over 65 years old. The aim was to investigate surgical outcomes in women older than 65 years receiving implant-based immediate breast reconstruction. Method The population-based Stockholm Breast Reconstruction Database includes all adult women with breast cancer receiving an implant-based immediate breast reconstruction in Stockholm, Sweden, 2005–2015. Primary outcomes within 30 days from immediate breast reconstruction were: infection requiring antibiotics and reoperation on. Implant removal was a secondary outcome. Women more than 65 years were compared with younger age groups. Chi-square tests and multivariable logistic regression were applied for the primary outcomes, and Kaplan–Meier analysis for the secondary outcome. Results Among 1749 cases of immediate breast reconstruction, 140 (8.0%) were in women more than 65 years. Median follow-up was 74 months (1–198). Postoperative infection was not more common in women older than 65 years old (22 of 140, 15.7%) than in women under 65 years old (303 of 1609, 18.8%; P = 0.221). Reoperation on was more frequent in women older than 65 years than in other age groups (more than 65: 8.6%; 50–64: 6.5%; 40–49: 3.5%; less than 40: 1.6%; P < 0.001), however, age older than 65 years was not an independent risk factor in the multivariable analysis (OR 1.00, 95% c.i. 0.44 to 2.28). Overall, 6-year probability of implant removal was 11.4%, (8.1% due to complications and 3.3% due to patient preference). There was no statistically significant difference between age groups for either reason (P = 0.085 and P = 0.794 respectively). Conclusion Older age alone was not associated with worse surgical outcomes after implant-based immediate breast reconstruction in highly selected patients older than 65 years when compared with their younger counterparts. [ABSTRACT FROM AUTHOR]

Bacterial cellulose is a unique biomaterial produced by various species of bacteria that offers a range of potential applications in the biomedical field. To provide a cost‐effective alternative to soft‐tissue implants used in cavity infills, remodeling, and subdermal wound healing, in vitro cytotoxicity and in vivo biocompatibility of native bacterial cellulose were investigated. Cytotoxicity was assessed using a metabolic assay on Swiss 3T3 fibroblasts and INS‐1832/13 rat insulinoma. Results showed no cytotoxicity, whether the cells were seeded over or under the bacterial cellulose scaffolds. Biocompatibility was performed on Sprague–Dawley rats (males and females, 8 weeks old) by implanting bacterial cellulose membranes subcutaneously for 1 or 12 weeks. The explanted scaffolds were then sliced and stained with hematoxylin and eosin for histological characterization. The first series of results revealed acute and chronic inflammation persisting over 12 weeks. Examination of the explants indicated a high number of granulocytes within the periphery of the bacterial cellulose, suggesting the presence of endotoxins within the membrane, confirmed by a Limulus amebocyte lysate test. This discovery motivated the development of non‐pyrogenic bacterial cellulose scaffolds. Following this, a second series of animal experiments was done, in which materials were implanted for 1 or 2 weeks. The results revealed mild inflammation 1 week after implantation, which then diminished to minimal inflammation after 2 weeks. Altogether, this study highlights that unmodified, purified native bacterial cellulose membranes may be used as a cost‐effective biomedical device provided that proper endotoxin clearance is achieved. [ABSTRACT FROM AUTHOR]

This study assessed the effects of titanium (Ti) surface modification with sodium hydroxide (NaOH) associated or not with Naringenin (NA) citrus flavonoid-coating on osteoblastic-like cells (Ob) metabolism. Ti discs were submitted to alkalinization by NaOH solution (5 M, 60 °C) for 24 h; then, the discs were impregnated or not with 100 µg/mL of NA and dried for 1 h at room temperature. The chemical composition, surface topography, and NA release were evaluated. For the biological assays, the discs were placed on 24-well cell culture plates and Ob (Saos-2; ATCC HTB-85) was seeded onto the discs. After different periods, cell adhesion and viability, alkaline phosphatase activity (ALP), and mineralized nodules deposition (MND) were assessed. In addition, cells stimulated with tumor necrosis factor-alpha (TNF-α) were submitted to matrix metalloproteinase (MMP)-2 synthesis and ALP gene expression assessment. Since data presented normal distribution and homogeneity (Shapiro-Wilk; Levene), Student's t-test or one-way ANOVA/post-hoc tests were selected for data analysis (α = 0.05). Higher roughness was observed on Ti discs submitted to NaOH treatment, while the chemical and NA release evaluations indicated the successful adsorption of NA to alkali-treated Ti surface. Higher cell adhesion, cell viability (after 7 days of culture), ALP activity, and MND were observed on Ti NaOH coated with NA compared to the control group (Ti NaOH) (p < 0.05). Moreover, NA coating also promoted decreased MMP-2 synthesis and increased ALP gene expression in the presence of the inflammatory stimulus TNF-α (p < 0.05). The modification of Ti disks with NaOH associated with NA-coating enhanced bone cell metabolism, suggesting that this type of surface modification has a promising potential to accelerate bone repair and formation around dental implants. [ABSTRACT FROM AUTHOR]

Background A subset of females with breast implants have reported a myriad of nonspecific systemic symptoms collectively termed systemic symptoms associated with breast implants (SSBI). SSBI symptoms are similar to manifestations associated with autoimmune and connective tissue disorders. Breast tissue is rich in adipose cells, comprised of lipids. Insertion of an implant creates an oxidative environment leading to lipid oxidation. Oxylipins can influence immune responses and inflammatory processes. Objectives In this study we explored the abundance of a spectrum of oxylipins in the periprosthetic tissue surrounding the breast implant. Because oxylipins are immunogenic, we sought to determine if they were associated with the SSBI patients. We have also attempted to determine if the common manifestations exhibited by such patients have any association with oxylipin abundance. Methods The study included 120 patients divided into 3 cohorts. We analyzed 46 patients with breast implants exhibiting manifestations associated with SSBI; 29 patients with breast implants not exhibiting manifestations associated with SSBI (control cohort I, non-SSBI); and 45 patients without implants (control cohort II, no-implant tissue). Lipid extraction and oxylipin quantification were performed with liquid chromatography mass spectrometry (LC-MS/MS). LC-MS/MS targeted analysis of the breast adipose tissue was performed. Results Of the 15 oxylipins analyzed, 5 exhibited increased abundance in the SSBI cohort when compared to the non-SSBI and no-implant cohorts. Conclusions The study documents the association of the oxylipins with each manifestation reported by the patient. This study provides an objective assessment of the subjective questionnaire, highlighting which symptoms may be more relevant than the others. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

Background Capsular contracture is a significant complication following mammaplasty, with varying incidence rates and symptoms. The etiology of capsular contracture is multifactorial, with postoperative hematoma recognized as a potential contributing factor. Objectives In this study we aimed to investigate the impact of postoperative hematoma on capsular contracture following mammaplasty, utilizing pig models and modified biomechanical testing. We sought to compare the severity of capsular contracture between smooth and textured implants in the presence of hematoma, assess the biomechanical properties of the capsules, and explore the histological and molecular changes associated with the condition. Methods The study involved 5 female miniature pigs, implanted with both smooth and textured implants. Hematoma models were established, and various methods were employed to evaluate the impact of the prosthesis surface and hematoma on capsular contracture, including ultrasound assessment, biomechanical tests, scanning electron microscopy, histological analysis, and transcriptome sequencing. Results Capsules in hematoma groups were classified as Baker III/IV, with significantly unfavorable thickness, elastic modulus, and relaxation and creep amounts compared to nonhematoma groups. Smooth implants under hematoma conditions exhibited increased muscle content and biomechanical strength of the capsule. Transcriptomic analysis highlighted differential gene expression related to muscle development and contraction in smooth implants with hematomas. Conclusions Hematomas increase the risk of capsular contracture, with smooth implants exacerbating this effect by enhancing pathways related to muscle development and contraction. This underscores the importance of hematoma prevention and treatment strategies, particularly when placing smooth implants, to minimize the occurrence of capsular contracture. The study provides insights into the mechanisms underlying capsular contracture and offers evidence to guide surgical and postoperative management strategies. [ABSTRACT FROM AUTHOR]

Background In 2021, the US FDA issued a new checklist, labeling, and rupture-screening recommendations for breast implants to improve the decision-making process. Objectives The aim of this study was to understand plastic surgeons' perspective on these changes and their perceived impact on clinical practice. Methods In September 2023, a 27-question multiple-choice cross-sectional survey was distributed to 4352 active members of the American Society of Plastic Surgeons to evaluate attitudes on the FDA's black-box warning, informed decision checklist, and updated rupture-screening recommendations. Results A total of 591 responses were collected (13.6%). The majority of respondents were between the ages of 45 and 64 years (58%) and had been in practice for more than 20 years (52%). Surgeons felt that some additions were appropriate; however, the majority (57%) stated that the informed decision checklist did not have a positive impact on workflow; 66% were also neutral or disagreed with the reported incidence rates related to complications and cancer. Nearly half of respondents (47%) did not feel the black-box warning improved their patients' understanding of the risks and benefits. Additionally, 47% of respondents also believed these requirements, in combination, did not improve the overall patient experience with implants. Conclusions Respondents had an overall positive response towards the addition of risk information provided by the FDA-issued guidance and updates to rupture-screening recommendations. However, they remained divided as to whether the black-box warning and patient decision checklist had an overall positive impact on clinical practice patterns. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

Background Implant malposition is a well-recognized complication of prosthetic breast implants. However, to date, no objective classification system has been described. Objectives The aim of this study was to perform a prospective trial of an objective and reproducible classification system for implant malposition formulated by analyzing retrospective data from a large cohort of patients with implant malposition. Methods The authors retrospectively analyzed the degree of medial/lateral and inferior/superior implant malposition relative to their optimal position within the breast footprint in a series of 189 breasts (n = 100 patients). An objective classification system for implant malposition was devised and then applied to a prospective cohort of 53 breasts in 28 patients with implant malposition. Results The degree of malposition in a single or combination of axes was categorized according to the distance (measured in centimeters) from the ideal breast footprint. The classification system incorporated the axis of malposition and distance to generate a treatment decision-making guide. Cases of Grade 1 malposition did not warrant surgical intervention, whereas surgical correction was warranted in all Grade 3 cases. In the combined patient cohort (n = 242 breasts, 128 patients), lateral, inferior, medial, and superior displacement ranged between Grades 1 and 3. There was no interobserver variability in the grades assigned to 9 out of 10 patients in the prospective group. Conclusions A simple and reproducible classification system for implant malposition has been created that allows surgeons to objectively record the extent of malposition, guides surgical decision-making, and can be used to document the results of any intervention. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Introduction Materials and methods Results Conclusion In cases of atrophy in the maxillary posterior region, characterized by reduced vertical bone volume, implant placement becomes challenging. Augmentation procedures like sinus lifts are often needed to address insufficient bone volume. This study aims to explore if alveolar ridge preservation, using a bovine bone substitute and a porcine collagen membrane, significantly decreases the need for sinus lifts compared to natural wound healing after tooth extraction.In this comparative clinical study, 40 patients requiring a total of 53 extractions were assigned to one of the following groups: a test group with bovine bone substitute material (Straumann® XenoFlex) and a porcine collagen membrane (Jason® membrane), or a control group with spontaneous socket healing. After 6 months, digital volume tomography was performed for implant planning.For seven patients from the control group (n = 22 extracted sites) sinus lift augmentations were performed while only four sinus lift procedures were performed in the test group (n = 31 extracted sites), indicating a higher need for sinus augmentation procedures in the control group, however not statistically different on a p value of 0.05 (p = 0.168). In the control group, the mean value of the radiographically measured bone height (mesial and distal) was 11.13 ± 2.12 mm preoperatively before tooth extraction, while it was 11.3 ± 2.17 mm postoperatively after implant placement. In contrast, the mean value in the test group was 11.78 ± 3.09 mm preoperatively and 11.92 ± 2.79 mm postoperatively. Statistical analysis revealed no significant difference between the two groups (odds ratio 0.32; 95% CI: 0.08, 1.26; p = 0.951). The implant survival rate in the control group was 100%, compared to 96.77% in the test group.Within the limits of this study, the use of bovine bone substitute and a porcine resorbable membrane after tooth extraction in the posterior maxilla seems to reduce the need for sinus augmentation in comparison to spontaneous healing although the difference was not statistically significant. Additionally, the Alveolar Ridge Preservation in the test group made external sinus floor elevation unnecessary compared to the control group. The change in radiographically measured bone height pre‐ and postoperatively showed no significant difference between the two groups. [ABSTRACT FROM AUTHOR]

AbstractPolyetheretherketone (PEEK) is a lightweight, bioinert, high-performance thermoplastic that is beginning to see clinical use in orthopedic applications. PEEK outperforms conventional metallic counterparts in terms of reduced stress shielding and improved chemical resistance, making it highly suitable for implantable applications. However, despite its excellent mechanical properties, the elevated melting point (343 °C) presents significant challenges during manufacturing. Furthermore, PEEK requires surface modifications to enhance antibacterial, bioactive, and osseointegration properties suitable for in vivo applications. In this context, the present manuscript highlights current manufacturing challenges for implantable PEEK biomaterials and typical fiber reinforced PEEK composites. Emphasis is placed on reinforcements such as carbon fiber (CF), hydroxyapatite (HA) and titanium dioxide (TiO2), along with multi-material PEEK composites and their applications. Opportunities are identified to address these challenges, contributing toward the development of synergetic, multi-functional PEEK biomaterials suitable for long-term implantable applications. [ABSTRACT FROM AUTHOR]

Simple Summary: Breast cancer is a huge problem in modern medicine, even surpassing breast cancer in women. A very common method of treatment is mastectomy which is, in most cases, followed by breast reconstruction, the course of which changes dynamically. The process is aimed at improving patient satisfaction, minimizing the risk of tumor recurrence, and preventing complications. That is why we decided to look at the trend in the abovementioned procedures. We have described important types of surgical treatment of breast cancer, such as modified radical mastectomy, breast-conserving surgery, contralateral prophylactic mastectomy, and robotic mastectomy. We have also discussed breast reconstruction, focusing on implants, acellular dermal matrix, autologous reconstruction, robotic breast reconstruction, and fat grafting. Background: Breast cancer continues to be a significant diagnostic and therapeutic problem. Mastectomy is still a frequently used treatment method, but its form is changing with progress in medicine. Methods: We have described important types of surgical treatments for breast cancer, such as modified radical mastectomy, breast-conserving surgery, contralateral prophylactic mastectomy, and robotic mastectomy. Breast reconstruction is also a very important element of treatment because it directly affects the mental state of patients after the procedure. We have also described types of breast reconstruction, such as implants, acellular dermal matrices, autologous reconstruction, robotic breast reconstruction, and fat grafting. Results: The aim of our study was to compare available types of surgical treatment for breast cancer and breast reconstruction to help tailor personalized treatment to patients. [ABSTRACT FROM AUTHOR]

Introduction The cervical spine, pivotal for mobility and overall body function, can be affected by cervical spondylosis, a major contributor to neural disorders. Prevalent in both general and military populations, especially among pilots, cervical spondylosis induces pain and limits spinal capabilities. Anterior Cervical Discectomy and Fusion (ACDF) surgery, proposed by Cloward in the 1950s, is a promising solution for restoring natural cervical curvature. The study objective was to investigate the impacts of ACDF implant design on postsurgical cervical biomechanics and neurorehabilitation outcomes by utilizing a biofield head-neck finite element (FE) platform that can facilitate scenario-specific perturbations of neck muscle activations. This study addresses the critical need to enhance computational models, specifically FE modeling, for ACDF implant design. Materials and Methods We utilized a validated head-neck FE model to investigate spine–implant biomechanical interactions. An S-shaped dynamic cage incorporating titanium (Ti) and polyetheretherketone (PEEK) materials was modeled at the C4/C5 level. The loading conditions were carefully designed to mimic helmet-to-helmet impact in American football, providing a realistic and challenging scenario. The analysis included intervertebral joint motion, disk pressure, and implant von Mises stress. Results The PEEK implant demonstrated an increased motion in flexion and lateral bending at the contiguous spinal (C4/C5) level. In flexion, the Ti implant showed a modest 5% difference under 0% activation conditions, while PEEK exhibited a more substantial 14% difference. In bending, PEEK showed a 24% difference under 0% activation conditions, contrasting with Ti's 17%. The inclusion of the head resulted in an average increase of 18% in neck angle and 14% in C4/C5 angle. Disk pressure was influenced by implant material, muscle activation level, and the presence of the head. Polyetheretherketone exhibited lower stress values at all intervertebral disc levels, with a significant effect at the C6/C7 levels. Muscle activation level significantly influenced disk stress at all levels, with higher activation yielding higher stress. Titanium implant consistently showed higher disk stress values than PEEK, with an orders-of-magnitude difference in von Mises stress. Excluding the head significantly affected disk and implant stress, emphasizing its importance in accurate implant performance simulation. Conclusions This study emphasized the use of a biofidelic head-neck model to assess ACDF implant designs. Our results indicated that including neck muscles and head structures improves biomechanical outcome measures. Furthermore, unlike Ti implants, our findings showed that PEEK implants maintain neck motion at the affected level and reduce disk stresses. Practitioners can use this information to enhance postsurgery outcomes and reduce the likelihood of secondary surgeries. Therefore, this study makes an important contribution to computational biomechanics and implant design domains by advancing computational modeling and theoretical knowledge on ACDF–spine interaction dynamics. [ABSTRACT FROM AUTHOR]

Introduction Cervical spondylosis in the warfighter is a common musculoskeletal problem and can be career-ending especially if it requires fusion. Head-mounted equipment and increased biomechanical forces on the cervical spine have resulted in accelerated cervical spine degeneration. Current surgical gold standard is anterior cervical discectomy and fusion (ACDF). Posterior cervical foraminotomy (PCF) is a nonfusion surgical alternative, and this can be effective in alleviating radiculopathy from foraminal stenosis caused by disc-osteophyte complex. Biomechanical studies have not been done to analyze motion associated with military aircrew personnel following PCF. The aim of this study was to compare the biomechanical responses of the effects of ACDF and PCF with different grades of facet resection under simulated military aircrew conditions using range of motion, disc pressure, and facet loads at the index and adjacent levels. Materials and Methods A validated 3D finite element model of the human cervical spinal column was used to simulate various graded PCF and ACDF. All surgical simulations were performed at the most commonly operated level (C5-C6) in warfighters. Pure moment loading under flexion, extension, and lateral bending, and in vivo follower force of 75 N were applied to the intact spine. Hybrid loading protocol was used to achieve 134 degrees of combined flexion-extension and 83 degrees of lateral bending in intact and surgical models to reflect military loading conditions. Segmental motions, disc pressure, and facet load were obtained and normalized with respect to the intact model to quantify the biomechanical effect. Results Anterior cervical discectomy and fusion decreased range of motion at the index and increased motion at the adjacent levels, while all graded PCF responses had an opposite trend: increased motion at the index and decreased motion at adjacent levels. The magnitude of changes depended on the level of resection, spinal level, and loading mode. Disc pressure increased at the index level and decreased at the adjacent levels after PCF. These changes were exaggerated with increasing extent of facet resection. Facet load increased at the index level after PCF especially with extension and right (contralateral) lateral bending. Complete facetectomy led to facet load increases greater than ACDF at the adjacent levels in both flexion and extension. Conclusions Posterior cervical foraminotomy is a motion-preserving implant-free surgical alternative to ACDF for warfighters with cervical radiculopathy after failure of conservative management. The treating surgeon must pay close attention to the extent of facet resection to avoid potential spinal instability and future disc and facet degeneration after PCF. Posterior cervical foraminotomy can be more advantageous than ACDF in terms of adjacent segment degeneration, motion preservation, reoperation rate, surgical cost, and retention of warfighters. [ABSTRACT FROM AUTHOR]

Osseodensification enhances the stability of endosteal implants. However, pre-clinical studies utilizing osseodensification instrumentation do not account for the limited presence of trabeculae seen clinically. This study aimed to evaluate the effect of osseodensification instrumentation on osteotomy healing in scenarios with and without the presence of trabecular bone. A ~10 cm incision was made over the hip of twelve sheep. Trabecular bone was surgically removed from twelve sites (one site/animal; negative control (Neg. Ctrl)) and left intact at twelve sites (one site/animal; experimental group (Exp.)). All osteotomies were created using the osseodensification drilling protocol. Each osteotomy received an endosteal implant and was evaluated after 3 or 12 weeks of healing (n = 6 animals/time). Histology revealed increased woven and lamellar bone surrounding the implants in the Exp. group relative to the Neg. Ctrl group. The Exp. group demonstrated the presence of bone fragments, which acted as nucleating sites, thereby enhancing the bone formation and remodeling processes. Bone-to-implant contact (%BIC) and bone area fractional occupancy (%BAFO) were significantly higher in the Exp. group relative to the Neg. Ctrl group both at 3 weeks (p = 0.009 and p = 0.043) and 12 weeks (p = 0.010 and p = 0.008). Osseodensification instrumentation in the presence of trabecular bone significantly improved osseointegration. However, no negative influences such as necrosis, inflammation, microfractures, or dehiscence were observed in the absence/limited presence of trabeculae. [ABSTRACT FROM AUTHOR]

Titanium currently has a well-established position as the gold standard for manufacturing dental implants; however, it is not free of flaws. Mentions of possible soft-tissue discoloration, corrosion, and possible allergic reactions have led to the development of zirconia dental implants. Various techniques for the surface modification of titanium have been applied to increase titanium implants' ability to osseointegrate. Similarly, to achieve the best possible results, zirconia dental implants have also had their surface modified to promote proper healing and satisfactory long-term results. Despite zirconium oxide being a ceramic material, not simply a metal, there have been mentions of it being susceptible to corrosion too. In this article, we aim to review the literature available on zirconia implants, the available techniques for the surface modification of zirconia, and the effects of these techniques on zirconia's biological properties. Zirconia's biocompatibility and ability to osseointegrate appears unquestionably good. Despite some of its mechanical properties being, factually, inferior to those of titanium, the benefits seem to outweigh the drawbacks. Zirconia implants show very good success rates in clinical research. This is partially due to available methods of surface treatment, including nanotopography alterations, which allow for improved wettability, bone-to-implant contact, and osteointegration in general. [ABSTRACT FROM AUTHOR]

Introduction: Testicular tumors are the most common malignancies in young adults and their incidence is growing. The implantation of a testicular prosthesis, for example, during orchiectomy is a standard procedure but its frequency in Germany is unknown. This study aims to analyze trends of testicular prosthesis implantation in recent years in Germany. Material and methods: The nationwide German hospital billing database and the German hospital quality reports from 2006 to 2021 were studied. Results: A total of 12,753 surgical procedures with implantation of testicular prosthesis and 1,244 procedures with testicular prosthesis explantation were included. Testicular prosthesis implantation increased in total from 699 cases in 2006 to 870 cases in 2020 (+11.4 cases/year; p < 0.001). The share of implantation of testicular prosthesis due to testicular tumor decreased from 72.6% in 2006 to 67.5% in 2020 (p < 0.001). The share of implantation due to gender affirming surgery increased from 6.8% in 2006 to 23.3% in 2020 (p < 0.001). The share of implantation due to testicular atrophy decreased from 11.4% in 2006 to 3.4% in 2020 (p < 0.001). Simultaneous implantation of testicular prosthesis during orchiectomy for testicular cancer increased from 7.8% in 2006 to 11.4% in 2020 (p < 0.001). In 2006, 146 hospitals (85%) performed < 5 testicular prosthesis implantation, while 20 hospitals (12%) performed 5–15 implantation procedures and 6 hospitals (3%) performed > 15 testicular implantation surgeries. In 2021, 115 hospitals (72%) performed < 5 testicular prosthesis implantation, while 39 hospitals (25%) performed 5–15 implantation procedures and 5 hospitals (3%) performed > 15 testicular implantation surgeries. Conclusion: This study shows that implantation of testicular prostheses is steadily increasing. Explantation rates are low. Besides testicular cancer transgender surgeries were the main driver for increasing case numbers in recent years. [ABSTRACT FROM AUTHOR]

Introduction The invasion of Ukraine by Russian troops on February 24, 2022, and the beginning of the full-scale war had huge humanitarian consequences. The major challenges facing the Ukrainian health care system included the disruption of medical infrastructure and logistics, the termination of the supply of expendable materials, significant migration, and a dramatic increase in high-velocity blast and gunshot injuries among combatants and civilians. The aim of the present study was to analyze the challenges and solutions in patient care faced by the Ukrainian system of maxillofacial surgery during the war in different regions of the country. Materials and Methods A cross-sectional study was designed and implemented as an online survey to collect national data concerning maxillofacial surgeons' experiences and professional activities. The study was initiated and supported by Bogomolets National Medical University (Kyiv, Ukraine), the Ukrainian representative of AO CMF (Arbeitsgemeinschaft für Osteosynthesefragen Craniomaxillofacial Surgery) and the University of Helsinki (Finland). The questionnaire was developed by specialists in maxillofacial surgery and sociologists and contained 65 close-ended questions. Surgeons who had not worked in this specialty in inpatient departments of hospitals since at least the beginning of the full-scale war were excluded from the study. We received and analyzed 97 responses that met the abovementioned criteria. The geography of respondents covered all the regions and the main cities of Ukraine, expect for the occupied territories. Results After a year of warfare, the percentage of surgeons who treated patients with blast and gunshot injuries increased from 43.4% to 86.6%. This percentage was higher in military hospitals and in regions located in the vicinity of the front line. We found that, during the war, 78.6% of respondents performed osteosynthesis in cases of high-velocity multifragmented facial bone fractures (in such cases, 58.3% of them strictly followed AO CMF recommendations, while 41.7% performed the fixation based on available hardware, existing technical possibilities and their own preferences). We found that 70.2% of respondents had the opportunity to apply Computer-Aided Design/Computer-Aided Manufacture technology and patient-specific implants for the treatment of gunshot injuries, 38.1% reported that their hospitals were able to perform microsurgical reconstructions for facial defects, 79.4% of respondents reported that their departments received humanitarian aid and support from volunteer organizations (either Ukrainian or international), which significantly facilitated the treatment process. Conclusions According to this nationwide survey of Ukrainian maxillofacial surgeons during a year of the full-scale war, 86.6% of respondents were involved in the treatment of gunshot and ballistic injuries in civilians and combatants. The main problems reported by the respondents were (1) a lack of experience and knowledge related to the treatment of severe wounds, especially by secondary reconstruction, and (2) a deficit of resources (equipment, materials, and medications) under conditions of disrupted logistics and changes in the numbers and nosological distribution of patients. There were the opportunity to transfer the patients to European clinics (29.9%), online consultations (45.4%), collaboration with foreign surgeons who come to Ukraine asvolunteers (32%). [ABSTRACT FROM AUTHOR]

Introduction: The Norwegian Government introduced in 2002 a reimbursement scheme for hormonal contraceptives to adolescents at the same time as public health nurses and midwives received authorization to prescribe hormonal contraceptives. This study examines the impact of increased accessibility and public funding on hormonal contraceptive use among adolescents. Material and Methods: The Norwegian Prescription Database, Statistics Norway, and Norwegian Institute of Public Health served as data sources for this cohort study. The study population comprised 174 653 Norwegian women born 1989–1990, 1994–1995, and 1999–2000. We examined use of hormonal contraceptives through dispensed prescriptions from age 12 through age 19 with duration of first continuous use as primary outcome. The statistical analyses were done in SPSS using chi‐squared test, survival analysis, and Joinpoint regression analysis with p‐values < 0.05. Results: By age 19, ~75% of the cohorts had used at least one hormonal method. The main providers of the first prescription were general practitioners and public health nurses. Starters of progestogen‐only pills (POPs) have increased across the cohorts, while starters of combined oral contraceptives (COCs) have decreased. The use of long‐acting reversible contraceptives (LARCs) has increased since its inclusion in the reimbursement scheme (2015). Most switchers shifted from COCs or POPs as a start method to implants after LARCs became part of the reimbursement scheme. There has been a significant increase across the cohorts in the number of women who continuously used hormonal contraceptives from start to the end of the calendar year they became 19 years with the same method and after switching methods. We could not correlate changes in decreasing trends for teenage births or induced abortions (Joinpoint analysis) to time for implementation or changes in the reimbursement of hormonal contraceptives from 2002. Conclusions: Primarily public health nurses and to a lesser extent midwives became soon after they received authorization to prescribe COCs important providers. The expansion of the reimbursement scheme to cover POPs, patches, vaginal ring, and depot medroxyprogesterone acetate in 2006 had minor impact on increasing the proportion of long‐term first‐time users. However, the inclusion of LARCs in 2015 significantly increased the proportion of long‐term first‐time hormonal contraceptive users. [ABSTRACT FROM AUTHOR]

Advanced manufacturing techniques such as Additive Manufacturing (AM) have grown rapidly in major industries such as aerospace, automotive, and biomedical device manufacturing. Biomedical industry has benefitted immensely from AM because of its flexibility in design and its rapid production cycle. Powder bed processes are the major production technique for metal-based AM implants. This paper serves as a comprehensive review on the research efforts being made using AM to develop new patient centered medical devices. This review focuses on AM of the most common metals for biomedical applications, Magnesium alloys, Cobalt-Chromium alloys, pure Titanium, Titanium alloys. Several different aspects are discussed including biocompatibility and osseointegration, application of specific metals in different types of implants, their advantages and disadvantages, mechanical properties in comparison to bone, and their production technologies. Regulatory and quality assurance hurdles that are facing new innovations made using AM are discussed. [ABSTRACT FROM AUTHOR]

Background Nanotextured implants, an innovation in implant technology, are designed to enhance tissue interaction, reduce inflammation, and mitigate complications of traditional implants. Objectives The aim of the study was to evaluate the aesthetic potential and safety profile of nanotextured breast implants in breast augmentation from a single-surgeon experience. Methods This prospective cohort study included 1000 patients who underwent breast augmentation with nanotextured implants. Aesthetic outcomes were assessed with direct measurements and BCCT.core software, focusing on breast projection, symmetry, and upper pole fullness. Patient satisfaction was measured with BREAST-Q and overall satisfaction surveys. Safety profiles were evaluated based on the incidence of complications such as infection, hematoma, capsular contracture, and implant rupture. Statistical analyses were conducted to assess the outcomes. Results The study found significant improvements in aesthetic outcomes, with 92.8% of cases achieving substantial aesthetic enhancements. Patient satisfaction was high, with 96.4% of patients reporting enhanced self-esteem and contentment. The safety profile was favorable, with a low incidence of complications (0.7% requiring revisional surgery) and no major complications reported. Long-term follow-up data indicated sustained aesthetic outcomes and a stable safety profile. Conclusions The synergistic quality of nanotextured implants in relation to the natural breast gland tissue is defined by a significantly wider range of aesthetic options. The findings of this study underscore the positive impact of nanotextured breast implants on enhancing the aesthetic potential of breast augmentation and their contribution to a low incidence of complications. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Background Despite increasing demand for breast capsular surgery to treat various benign and malignant implant-related pathologies, high-quality evidence elucidating complication profiles of capsulectomy and capsulotomy is lacking. Objectives The aim of this study was to provide the largest-scale analysis of associated outcomes and complications using the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database, and to investigate clinical scenarios that may subject patients to increased risks for complications, most notably extent of capsular surgery (complete vs partial) and index indication of implantation (aesthetic vs reconstructive). Methods An analysis of the TOPS database from 2008 to 2019 was performed. CPT codes were used to identify complete capsulectomy and partial capsulectomy/capsulotomy cases. Breast implant exchange procedures constituted procedural controls. Results In total, 7486 patients (10,703 breasts) undergoing capsulectomy or capsulotomy were assessed. Relative to controls, capsulectomy (4.40% vs 5.79%), but not capsulotomy (4.40% vs 4.50%), demonstrated higher overall complication rates. Both capsulectomies (0.83% vs 0.23%) and capsulotomies (0.56% vs 0.23%) also had greater rates of seroma relative to controls. Subgroup analyses demonstrated that reconstructive patients, relative to aesthetic patients, experienced greater overall complications (6.76% vs 4.34%), and increased risks for seroma (1.06% vs 0.47%), dehiscence (0.46% vs 0.14%), surgical site infections (1.03% vs 0.23%), and implant loss (0.52% vs 0.23%). A detailed synthesis of 30-day outcomes, including all patient- and breast-specific complications, for both capsulectomy and capsulotomy, stratified according to all potential confounders, is presented herein. Conclusions Surgeries on the breast capsule are safe overall, although complete capsulectomies and reconstructive patients are associated with significantly increased operative risks. The present findings will enhance patient selection, counseling, and informed consent. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Background Polyurethane (PU)-coated breast implants are known for their strong integration into breast tissue and the formation of capsules around them. However, capsular contracture can pose both aesthetic and clinical challenges. Objectives The objectives of this study were to analyze the biological and morphological characteristics of the capsular tissue surrounding PU-coated implants, irrespective of their contracture status, and to assess their potential suitability as a flap in revisional breast surgery for capsular contracture. Methods A total of 23 tissue samples were harvested from the capsules surrounding PU-coated breast implants in 12 female patients during replacement or revisional surgery. We evaluated collagen abundance, cellular and vascular density, inflammation, collagen band types and alignment, synovial metaplasia, capsule thickness, and the expression of inflammatory biomarkers and myofibroblasts with immunohistochemical techniques. Scanning electron microscopy was employed to assess implant surface characteristics over time. Results We found a significant association of capsule contraction with longer implantation durations and greater implant surface roughness (P =.018 and P =.033, respectively). Synovial metaplasia was significantly more frequent in noncontracted capsules (P =.0049). Both capsule types consisted of paucicellular, type I collagen-rich compact fibrous tissue with low vascularization. There was a marked reduction in inflammatory cells within the foreign body granuloma. The expression of inflammatory biomarkers in the capsular tissue was negligible. Conclusions Given the reduced levels of inflammatory and vascular components within the dense, fibrous capsular tissue, we consider them to be viable alternatives for capsular flaps in revisional surgery. This strategy has the potential to mimic the reconstruction achieved with acellular dermal matrix. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

Introducing dental implants into a patient's oral health plan requires a collaborative effort between all members of the care team, including the "implant dentist" and referring general dental practitioner (GDP), should the treatment be carried out in a referral practice. This article aims to discuss the pivotal role referring general dental practitioners (GDPs) play in preparing patients for dental implant placement, whatever the setting for the planned treatment. An overview of the patient referral process is outlined, as is the role of GDPs in the ongoing maintenance of the dental implants and the patient's oral health. Furthermore, this article may be viewed as a road map for GDPs who refer patients to an "implant dentist" as part of their treatment plan. [ABSTRACT FROM AUTHOR]

Edentulism (total tooth loss) can be managed with four possible options: no prosthetic replacement, conventional complete dentures, implant-retained overdentures (removable), or implant-supported bridgework (fixed). Selection of these choices is influenced by social, medical, anatomical, technical, and economic factors. The care team involved in the decision-making process (be it patients, clinicians and occasionally commissioners of services) should be aware of the different treatment options and their potential impact on the patient's quality of life (QoL). The cost effectiveness of this impact can also be evaluated. Knowledge of the life-long sequelae of edentulism will also help practitioners guide patients in their treatment planning decisions when they may be approaching an edentulous state, preparing them for the challenges that may lie ahead. This paper aims to address the impact that edentulism has on QoL and the treatment options, focusing on the patient perspective. [ABSTRACT FROM AUTHOR]

Abstract Background Different bar construction techniques will affect the bar passive fitness, which may induce stresses or strain on the implant and/or tightening screw and sequentially may affect the biting force and patient satisfaction. Aim of the study This clinical investigation assessed patient satisfaction and maximum biting force (MBF) using three differently constructed (conventional casting, milling, and 3D printing CAD/CAM techniques) cobalt-chromium (Co-Cr) bar-retained implants mandibular overdentures over a one-year period of follow-up. Materials and methods Thirty edentulous patients seeking for two implants bar-retained mandibular overdentures were randomly assigned into three groups as the following: Group I: 10 patients received a Co-Cr conventional casting bar, Group II: 10 patients received a Co-Cr CAD/CAM milled bar, and Group III: 10 patients received a Co-Cr CAD/CAM 3D-printed bar. All the bar groups were connected to two implants in the canine area bilaterally. Within the first two weeks following implant placement, patients received the definitive prosthesis. Patient satisfaction was evaluated by using the (OHIP-EDENT-19) questionnaire form after 6, and 12 months. Additionally, the maximum biting force was tested at after delivery, 3, 6, and 12 months for each group. The results were collected, tabulated, and statistically analyzed. Trial registration: This study was recorded on ClinicalTrials.gov retrospectively registered (ID: NCT06401187) on 30/04/2024. Results After one year follow up, regrading patient satisfaction the three groups showed no statistically significant difference. Although, the functional limitation domain was in favor of the milled bar. Regarding the maximum biting force, no statistically significant difference was found among three groups. However, at 12 mouths follow-up the milled bar showed statistically value. Conclusion Within the limitations of this study, the conventional, milled and 3D printed bar overdentures groups can be used as a satisfactory treatment modality for edentulous mandible in terms of patient satisfaction and maximum biting force.

Abstract Objectives Despite the absence of ionizing radiation, magnetic resonance (MR) has inherent risks in clinical practice that can have serious health consequences if overlooked. At an international level, there are MR safety guidelines that help define the organization of a radiology department to minimize the risks for patients and personnel. However, competing guidelines exist and not every country and institution adheres to the same standards. In this work, we aim to understand the current situation regarding MR safety practices across Europe, and to identify the points where harmonization, coordination, or further education is needed. Methods An anonymous survey questionnaire was distributed between April and June 2023 through ESR member societies to healthcare professionals, aimed to assess personnel training, local policies, scanning practices, and accidents. Results Seven hundred and ninety-three responses were obtained from 44 different countries. The majority of respondents from five countries reported that MR safety is mandated by law, but we could only confirm two (Italy and Austria). While 77% of the responses said that their institution had a clear MR safety guideline, 52% said that nobody in their institution had received specific MR safety training. MR-conditional cardiac devices are mostly scanned in university hospitals (reported by 75% of respondents from this type of institution) but in only 42% of outpatient facilities. MR-unsafe cardiac devices are only scanned off-label in 27% of university hospitals, and in an even smaller share of other institutions. Approximately 12% of the respondents reported MR-related accidents resulting in patient or personnel injury. Overall, there is the sentiment that MR safety education and regulation are needed. Conclusions The European landscape in terms of MR safety is very heterogeneous, with different regulations across countries, and different procedures for MR safety training and their application in clinical routine. The European Society of Radiology is optimally positioned to play an active role in the harmonization of MR safety education and practices across Europe, and we are proposing a four-tiered framework for the development of a teaching curriculum for MR safety training. Critical relevance statement There is room for raising awareness of MR safety issues to ensure patient safety, reduce accidents, and benefit more patients. We advocate for radiologist-led standardization and improvement of MR safety training as a way to address this problem. Key Points Our survey of MR safety practices across Europe revealed significant heterogeneity in regulations, training, and scanning practices. There is a widespread lack of awareness and implementation of MR safety guidelines and diffuse uncertainty, under-scanning of eligible patients, and preventable accidents. The ESR proposes a harmonized, four-tiered MR safety training curriculum to standardize, and improve safety practices across Europe.

Article Summary: Introduction: Breast implants are under recent scrutiny owing to concerns about their potential for inducing immunological diseases, namely breast implant-associated anaplastic large cell lymphoma and breast implant illness. However, the impact of silicone on biologic systems remains unclear. Therefore, we performed a systematic literature review to evaluate the information available on silicone breast implants and their effect on one arm of the adaptive immune response—B lymphocytes and antibody formation. Methods: We conducted a systematic review in EMBASE/PUBMED in accordance with the PRISMA guidelines, with search entry terms requiring discussion of silicone and immunity. The initial review returned 1079 citations. Manual screening was performed to include studies that were specific to the humoral response after exposure to silicone. Secondary full text review was performed. The extracted data included animal models and findings pertinent to B cells/antibodies in response to breast implant silicones. Results: In total, 39 studies on B cells/antibodies and breast-implant-associated silicones were identified. Among them, 23 studies were in humans, 14 in animal models, and 2 were in vitro. Common themes included identification of antisilicone antibodies in women with breast implants, anticollagen antibodies, presence of activated B cells or immunoglobulin G in implant capsules, and sensitization of lymphocytes to silicone in vitro. Conclusion: Despite controversial findings in the literature, there is evidence that silicone breast implants activate B cells in the breast implant capsule and may have systemic effects on the production of autoantibodies and/or sensitization of B lymphocytes to silicone. Further research is needed on how breast implants impact other arms of the immune system to understand their long-term biological impact.

Starting clinical practice is an exciting, but stressful, time in a new surgeon's career. The operating room can be an intimidating place, particularly in a new practice or during difficult cases. Each surgical center has a different way of scheduling and preparing for cases and understanding these processes early can help communication with operating room staff. Planning to ensure that all implants, supplies, and instruments are available is critical to a successful procedure and can help with the preoperative planning process. [ABSTRACT FROM AUTHOR]

Purpose: To quantify the extent of gradient‐induced vibrations, and the magnitude of motion‐induced displacement forces ("Lenz effect"), in conductive nonmagnetic orthopedic prostheses. Methods: The investigation is carried out through numerical simulations, for a 3 T scanner. For gradient‐induced torques and vibrations, a knee and a shoulder implant are considered, at dB/dt equal to 42 T/s (rms). For motion‐induced forces associated with the Lenz effect, a knee and a hip implant are studied, considering a patient who translates on the examination couch, or walks next to it. Results: Gradient‐induced torques may be within the same order of magnitude as the worst case gravitational torque defined in the ASTM standards. However, for all investigated cases, they result to be lower. In vacuum, the extent of the corresponding vibration reduces with frequency. At the lowest investigated frequency (270 Hz), it keeps below 25 μm. For an implant partially embedded in bone, the extent of the vibration increases with frequency. Nevertheless, the displacement is far lower than the worst case observed in vacuum (negligible in contact with the bone; ˜1 μm or less where the implant emerges from the bone). The Lenz effect induced by the motion of the patient through the stationary magnetic field produces forces on the order of a few millinewtons (i.e., at least two orders of magnitude lower than the implant weight). Conclusion: Comparing the results with mechanical loads caused by ordinary activities of daily living, and with the levels of tolerable micromotions, a good safety margin is confirmed. [ABSTRACT FROM AUTHOR]

Besides enhancing osseo- and soft tissue integration, modulating inflammation at the implant site is also crucial for dental implant success. Uncontrolled peri-implant inflammation can cause significant loss of surrounding tissue and implant failure. It was recently shown that microvesicles (MVs), a less-studied type of extracellular vesicles, play a crucial role in cell-to-cell communication and may modulate angiogenesis and inflammatory response. The effect of MVs on regulating inflammation at an implant site, however, remains unexplored. In the current study, MVs were isolated and characterised from human primary gingival fibroblasts (hGFs) and loaded within titania nanotubes (TNTs, fabricated via anodisation on 3D Ti wire implants) towards their local release. The modified implants were characterised using SEM and confocal imaging to confirm the loading and local release of MVs from TNTs. In vitro studies demonstrated the internalisation of hGFs-MVs by human gingival keratinocytes (OKF6/TERT2 cell line), which caused a significant reduction in the production of pro-inflammatory cytokines. The results support MVs-releasing TNTs as a promising implant surface modification strategy to reduce inflammation, paving the way for further advancements in therapeutic dental implants. [ABSTRACT FROM AUTHOR]

Peri-implant bone tissue regeneration involves complex processes that are not yet fully understood at the cellular and molecular levels, leaving significant gaps in our knowledge that require further investigation. Aim. The study aimed to compare peri-implant osteogenesis on titanium femoral implants with alumina composite coatings applied by different methods to conventional titanium implants in an animal model. Materials and methods. Implants underwent sandblasting with silicon carbide, plasma torch treatment, and coating with titanium, corundum, sprayed titanium wire, or hydroxyapatite, resulting in seven different surfaces. 105 female Wistar rats received implants in their right femurs and were divided into 7 groups based on implant type and exposure duration (1, 2, or 4 weeks). Implant fragments were analyzed using scanning electron microscopy and energy dispersive X-ray spectroscopy to quantify chemical elements. Ratios of carbon to nitrogen and calcium to phosphorus were calculated. Data were analyzed using the U-Mann–Whitney test, with р < 0.05 as a significant value. Results. The energy dispersive X-spectrometry results confirmed morphological analysis findings by quantitatively and qualitatively assessing implants surface chemical composition. The key elements were evaluated, relevant for identifying bone tissue components like collagen (C and N) and hydroxyapatite (Ca and P), as well as implant coatings (Ti, Al, Ca, and P). Carbon and phosphorus showed fluctuations over time, with notable differences among groups. Aluminum appeared stable in some groups but varied in others. Calcium levels remained low initially and increased steadily in hydroxyapatite coated implants. Titanium levels were high initially, decreasing slightly over time. Morphological analysis correlated with surface roughness measurements. Notably, fibrin, collagen, and bone tissue presence varied among groups over time, with some groups showing significant mineralized bone tissue accumulation. After four weeks, blood clots persisted in some groups, while others exhibited bone tissue remodeling with the presence of osteoblasts and osteoclasts. Alumina-based coatings showed signs of degradation, with alumina cement scales found among macrophages and fibers. Conclusions. Our study found that stable bone implants outperform alumina-composite coatings in long-term osseointegration due to mechanical stability. Although ceramic composites initially enhance osteoinductive properties, better attachment to titanium substrates is needed.