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Introduction: Congenital vertebral malformations are common developmental abnormalities in screw-tailed brachycephalic dog breeds. Subsequent vertebral instability and/or vertebral canal stenosis caused by these malformations can lead to spinal cord compression manifesting in pain, paraparesis, ataxia and/or paralysis. Various methods for spinal stabilization are in common use. However, these are without significant risk due to narrow margins of surgical error and variable vertebral anatomy. We evaluate a novel method for spinal stabilization where a custom 3D-printed plate is created and surgically fitted to the patient's spine using custom 3D-printed drill guides. Objective: To describe the surgical technique and short-term outcomes in patients treated with custom 3D-printed plates and drill guides. Method: A retrospective analysis of 11 dogs from two referral hospitals which underwent this procedure was undertaken. Post-operative CT scans were assessed for spinal canal screw perforation using the modified Zdichavsky classification. Pre-operative and post-operative neurological status were assessed using the Modified Frankel Scale and the surgical technique including post-operative imaging and recovery findings were described. Results: Optimal screw placement (grade I) was achieved in 63% of placed screws across the eleven dogs. Partial penetration of the medial wall (grade IIa) was observed in 3% of screws and partial penetration of the lateral wall (grade IIIa) was observed in 29% of screws. Full penetration of the lateral pedicle wall (grade IIIb) was observed in 5% of screws and no screws fully penetrated the medial vertebral wall (grade IIb). Discussion: We demonstrated that custom 3D-printed drill guides and titanium plates can provide a safe peri-operative alternative for surgical spinal stabilization of dogs with vertebral column instability due to congenital vertebral malformations. Further research is needed to describe long-term outcomes of this surgical technique on patient health. [ABSTRACT FROM AUTHOR]

This case report describes the reconstruction of a rostral maxillary defect by two custom-made titanium implants following a rostral partial maxillectomy for treatment of squamous cell carcinoma (SCC) in a seven-year-old dog. An incisional biopsy and CT scan were performed to establish the diagnosis, to plan possible surgery, and to assess the margins of the tumour. The patient had no radiographic signs of metastasis at the time of diagnosis. An oblique rostral partial maxillectomy with two custom-made titanium plates was chosen as an effective oncological treatment and to maintain the cosmetic appearance. A first custom implant was designed to support the cheek and lips, and a second implant was designed to replace part of the hard palate and serve as a base for the palatal mucosal flap. Surgical treatment combined with toceranib phosphate and cimicoxib therapy provided a survival time of at least 1700 days, as the patient is still alive at time of publication. Further research is warranted to determine the oncological and cosmetic efficacy of this surgical technique for treatment of SCC in a larger group of dogs. [ABSTRACT FROM AUTHOR]

Titanium plates and screws are common material used for rigid bone flap fixation after retrosigmoid craniotomy such as microvascular decompression (MVD). We conducted this study to evaluate outcomes of the free bone flap cranioplasty without fixation in MVD and compared its postoperative complication rate with routine methods. We retrospectively reviewed all patients who underwent MVD at our institution from May 2017 to August 2022. Patients were divided into two groups according to whether the bone flap was fixed or not. Follow-ups periods spanned 6–28 months after the operation. Of 189 patients who underwent MVDs via retrosigmoid approach, 79 cases (42%) had their bone flaps replaced without titanium fixation after craniotomies (< 3 cm x 3 cm). Compared to fixed bone flap group, free bone flap group had shorter operative time (105.56 ± 15.87 min vs. 113.72 ± 17.80 min, P = 0.001), less in-patient costs (¥23059.66 ± 4488.54 vs. ¥27714.82 ± 2705.74, P < 0.001), and less proportion of postoperative headache and incisional pain (43.0% vs. 60.9%, P = 0.015). One case of incisional cerebrospinal fluid leak happened in free bone flap group while one case of incisional infection happened in fixed bone flap group. No statistical difference in bone flap displacement, duration of postoperative hospital stays or complication rate was found between the two groups. Nineteen patients in free bone flap group received long-term CT follow-up and all were proved to have good skull union. This study proves that free bone flap cranioplasty in MVD without titanium plate fixation can shorten the operation time and reduce hospitalization expenditure without increasing complication rates. [ABSTRACT FROM AUTHOR]

IntroductionCongenital vertebral malformations are common developmental abnormalities in screw-tailed brachycephalic dog breeds. Subsequent vertebral instability and/or vertebral canal stenosis caused by these malformations can lead to spinal cord compression manifesting in pain, paraparesis, ataxia and/or paralysis. Various methods for spinal stabilization are in common use. However, these are without significant risk due to narrow margins of surgical error and variable vertebral anatomy. We evaluate a novel method for spinal stabilization where a custom 3D-printed plate is created and surgically fitted to the patient’s spine using custom 3D-printed drill guides.ObjectiveTo describe the surgical technique and short-term outcomes in patients treated with custom 3D-printed plates and drill guides.MethodA retrospective analysis of 11 dogs from two referral hospitals which underwent this procedure was undertaken. Post-operative CT scans were assessed for spinal canal screw perforation using the modified Zdichavsky classification. Pre-operative and post-operative neurological status were assessed using the Modified Frankel Scale and the surgical technique including post-operative imaging and recovery findings were described.ResultsOptimal screw placement (grade I) was achieved in 63% of placed screws across the eleven dogs. Partial penetration of the medial wall (grade IIa) was observed in 3% of screws and partial penetration of the lateral wall (grade IIIa) was observed in 29% of screws. Full penetration of the lateral pedicle wall (grade IIIb) was observed in 5% of screws and no screws fully penetrated the medial vertebral wall (grade IIb).DiscussionWe demonstrated that custom 3D-printed drill guides and titanium plates can provide a safe peri-operative alternative for surgical spinal stabilization of dogs with vertebral column instability due to congenital vertebral malformations. Further research is needed to describe long-term outcomes of this surgical technique on patient health.

Medication-related osteonecrosis of the jaw (MRONJ) is an intractable adverse event. Dental implants are one of the triggering factors of MRONJ, and implant therapy with low MRONJ risk is required. This study aimed to investigate a rat model of MRONJ induced by extraoral placement of titanium materials and the use of mesenchymal stromal cell (MSCs) sheets to prevent MRONJ. Eight-week-old male rats were administered zoledronate and dexamethasone thrice weekly until killing. A week after drug initiation, a titanium screw and a plate were placed on the left buccal side of the mandible. Allogeneic bone marrow-derived MSC sheets were co-grafted with the titanium plates in the MSC sheet (+) group. Six weeks after titanium placement, the rats were killed, and their excised mandibular bones were subjected to micro-computed tomography (CT) analysis. Histological analysis was performed after the titanium implants were removed. Empty lacunae visualized on hematoxylin and eosin staining were used as evidence of bone necrosis. Bone necrosis was reduced in the MSC sheet (+) group. Tartrate-resistant acid phosphatase (TRAP) staining revealed a decreased number of TRAP-positive cells in areas with a large number of empty lacunae in the MSC sheet (–) group. Micro-CT analyses demonstrated that the bone volume fraction (BV/TV) was not significantly different between the MSC sheet (–) and (+) groups. We conclude that MRONJ can be triggered by a titanium placement in rats, and grafting of allogeneic MSC sheets has the potential to prevent MRONJ. [ABSTRACT FROM AUTHOR]

Open reduction with internal fixation is the preferred treatment option for displaced facial bone fractures. The superior mechanical properties of metallic plates have made them the most widely used material in existing bone fixation systems. However, after the healing period, these permanent plates can cause various problems. Alternative bioresorbable materials are being investigated to reduce these potential problems. This study compares bone stability and viability by using graphene oxide (GO)-doped poly-lactic-co-glycolic acid (PLGA) nanofiber plates and titanium plates for rats with fractured mandibles. The study included 20 male Sprague-Dawley rats, divided into four groups: a control group (Group I), a mandibular fracture group with no additional application (Group II), a mandibular fracture group repaired with titanium plates (Group III), and a mandibular fracture group repaired with GO-PLGA plates (Group IV). After 2 months, all of the rats were euthanized. A bone compression test was performed to assess bone stability, and a histological examination was performed to evaluate bone healing. The osteocyte lacunae, Haversian ducts, canaliculi, and vascular structures of Group IV were found to be higher. In the compression test, vertical compression was applied to the bone axis, and Group IV had a higher maximum load and maximum stretch. GO-PLGA plates were found to be statistically superior to titanium plates in terms of both bone stability and bone healing (p < 0.05). The present study found that GO-PLGA plates are more effective than titanium plates for the treatment of mandibular corpus fractures. [ABSTRACT FROM AUTHOR]

In some cases, titanium plates could be a reservoir for harboring bacteria resulting in challenging cases of infection. Current estimates indicate that 10–12% of plates require removal due to infection, exposure, pain, and discomfort. The present investigation was conducted to evaluate the potential sustained meropenem-coated plates amalgamated with "PLGA" polylactic co-glycolic acid and chitosan polymers with the concurrent sterilization effect of gamma irradiation. After coating the plates with either M "meropenem", MP "meropenem-PLGA, or MC "meropenem-chitosan", they were divided into two groups of sterile and non-sterile coated plates. The drug release was studied over three-time intervals of 1, 3, and 7 days using ultrahigh-performance liquid chromatography. Overall, the three materials had similar drug release on day one, both in sterile and non-sterile groups, while on days 3 and 7, a noticeable increase in the drug release was perceived in favor of MP. At the same time, no statistically significant difference was observed between sterile and non-sterile groups. A statistically significant increase in drug release was observed between and within the materials over time, with no overall difference between sterile and non-sterile groups. [ABSTRACT FROM AUTHOR]

The present investigation was undertaken to evaluate the topographical and ultrastructural architecture of titanium plates coated with polylactic co-glycolic acid (PLGA), chitosan (CH), and/or meropenem (MEM) with or without Staphylococcus aureus (SA) or Pseudomonas aeruginosa (PA) bacteria. Single-hole segments of 0.4 mm thick, low-profile titanium plates were spray coated using an airbrush with polymeric carriers (PLGA or CH) loaded with MEM, in addition to the negative control group (uncoated titanium plates). The coated plates and the negative control group were subjected to bacterial biofilms through a cultivation process while being slowly stirred at 20 rpm for 24 h. The samples were fixed and processed for scanning electron microscopic study at 5, 10, and 20 k magnification. The data were statistically analyzed to compare within and between the different materials. Coating titanium plates with PLGA or CH with MEM appeared to enhance bacterial inhibition over uncoated plates, hindering biofilm formation and preventing bacterial proliferation. In the staphylococcus aureus group, the highest bacterial count was observed in the uncoated plates, whereas the lowest count was detected in meropenem-PLGA, followed by PLGA, chitosan, meropenem, and meropenem-chitosan, respectively. On the other hand, the Pseudomonas aeruginosa group with the uncoated plates had the highest bacterial count, whereas the lowest bacterial count was found related to CH, followed by PLGA, MP, MC, and MEM, respectively. [ABSTRACT FROM AUTHOR]

New digital technologies are improving the accuracy of orthognathic surgery. One of the new approaches transfers the surgical plan into real surgery without using an occlusal splint. This pilot study aims to validate the splintless approach to orthognathic surgery on a series of cases. Five patients were enrolled. Surgeries were planned using a digital surgical simulation method thanks to three-dimensional images. The splintless surgical approach was planned for maxillary reposition. This consisted of cutting guides and three-dimensionally (3D) printed custom titanium plates. These two were created using the computer-aided design and computer-aided manufacturing (CAD-CAM) technique and were used intraoperatively to guide the osteotomy and repositioning of the bony segments without the use of the surgical splint. The difference between the planned surgery and the real final position was analyzed thanks to superimposition techniques and landmark analysis. Statistical tests were performed to detect significant differences. No difference was found in any of the landmarks. Midline landmarks differed from the planned position by 0.34 mm. Higher variability was found in the posterior landmark. These findings suggest that a splintless approach is useful in transferring the surgical plan without using an occlusal splint. [ABSTRACT FROM AUTHOR]

One of the most pressing issues of maxillofacial surgery is the traumatism of the facial bones. At present, titanium plates with screw joints are the commonest for fixing jaw fragments in maxillofacial surgery. The cause of complications in osteosynthesis with titanium is the force generated by the masticatory muscles, transmitted through the plate and jaw fragments, and causing looseness of the screw joints. Moreover, plate fractures are caused by material fatigue due to plate bending occurring under surgery. The purpose of this paper is to compare the plate designs according to the maximum stresses arising under the action of masticatory loads and to check the fixation reliability with the subsequent plate development of a reduced bone-plate contact area. Ansys Workbench software package, namely the Transient Structural module, is used for calculations based on the finite element method to study the stress-strain state of the lower jaw after titanium osteosynthesis. Plates' designs for osteosynthesis metal are developed considering the strength of the masticatory muscles. The maximum stresses in the plates have been determined, which are 481 MPa for a straight plate, 487 MPa for a y-shaped plate, and 301 MPa for a square plate. Following the mentioned, these stresses do not exceed the yield strength of titanium grade -1, the smallest of them occurring in a square-shaped plate. The maximum gap has been also determined, between fragments it is 0.75 mm for a straight plate, 0.15 mm for a y-shaped plate, and 0.13 mm for a square plate. Therefore, the square plate provides the most reliable fixation of jaw fragments. [ABSTRACT FROM AUTHOR]

In some cases, titanium plates could be a reservoir for harboring bacteria resulting in challenging cases of infection. Current estimates indicate that 10–12% of plates require removal due to infection, exposure, pain, and discomfort. The present investigation was conducted to evaluate the potential sustained meropenem-coated plates amalgamated with “PLGA” polylactic co-glycolic acid and chitosan polymers with the concurrent sterilization effect of gamma irradiation. After coating the plates with either M “meropenem”, MP “meropenem-PLGA, or MC “meropenem-chitosan”, they were divided into two groups of sterile and non-sterile coated plates. The drug release was studied over three-time intervals of 1, 3, and 7 days using ultrahigh-performance liquid chromatography. Overall, the three materials had similar drug release on day one, both in sterile and non-sterile groups, while on days 3 and 7, a noticeable increase in the drug release was perceived in favor of MP. At the same time, no statistically significant difference was observed between sterile and non-sterile groups. A statistically significant increase in drug release was observed between and within the materials over time, with no overall difference between sterile and non-sterile groups.

Introduction: Laminoplasty is a widely used surgical procedure to decompress the cervical spinal cord. Recently, titanium plates (TPs) have been used instead of conventional hydroxyapatite block (HA) spacers to prevent laminar reclosure. However, no study has compared the cost-effectiveness of TP and HA. Therefore, this study aimed to compare the cost-effectiveness and postoperative outcomes of laminoplasty using TP or HA., Methods: A total of 167 patients who underwent cervical laminoplasty at our institution were included in this study. Patients with cervical spinal cord injury, epidural hematoma, or follow-up of <1 year were excluded. Of the 167 patients, 69 underwent laminoplasty using TP (the TP group), and 98 underwent laminoplasty using HA (the HA group). The surgical costs and incremental cost-effectiveness ratio (ICER) were compared between the two groups. Additionally, the operation time, complications, Japanese Orthopaedic Association score, Hirabayashi recovery rate, and pre and postoperative cervical alignment on X-ray images were investigated., Results: The surgical costs were significantly higher in the TP group than in the HA group (HA, 7255 ± 1504 USD vs. TP, 11,642 ± 2492 USD, p < 0.01). The ICER was 21,935 USD per quality-adjusted life year in the TP group. The operation time was shorter in the TP group than in the HA group (HA, 70.0 ± 22.5 min vs. TP, 63.6 ± 19.3 min, p = 0.06). The Hirabayashi recovery rate and radiographic parameters were similar between the two groups. Implant displacements were significantly more common in the HA group than in the TP group (HA, 11.2 % vs. TP, 0 %, p < 0.01)., Conclusions: The surgical costs and ICER with TPs were higher than those with HA spacers. However, no difference in the Hirabayashi recovery rate and postoperative radiological parameters was observed between the two groups, although the HA group had more implant displacements., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Introduction: Hernias following iliac bone grafting are a rare but significant complication, with the earliest case reported in 1945. Repairing these hernias is challenging. Appropriate repair techniques are needed to minimise morbidity and recurrence. We present our experience with three cases of post-iliac graft hernia repair with mesh anchored to titanium mini-plates and a systematic review of current literature., Method: We conducted a systematic review of the literature in February 2024 on two online databases, PubMed®/MEDLINE and EMBASE, in accordance with PRISMA guidelines. Keywords used were "Hernia," "Iliac," and "Graft." Data on demographics, initial pathology, time to presentation, type of hernia repair, and outcome were collected. Studies not in English and related to other types of hernia were excluded., Results: We included 30 studies out of 751 results, spanning from 1975 to 2023. There were 40 reported cases of hernias post iliac bone grafting. The age distribution ranged from 37 to 88 years, with a median age of 60. The majority of patients (40 %) presented within one year. Fracture management, accounting for 19 cases (47.5 %), was the main indication for bone grafting. Mesh repair was performed in 31 cases (77.5 %). Seven cases (17.5 %) of recurrence were reported., Conclusion: Recurrence is a common complication in patients with post-iliac graft hernias. Open mesh repair is the most frequently performed surgery and involves various techniques. While titanium mini-plates as anchors enable a pre-peritoneal plane mesh repair, long-term follow-up and comparative studies are needed to evaluate its efficacy compared to simple mesh., Competing Interests: Competing interests The authors declare that they have no financial or non-financial interests that are directly or indirectly related to the work submitted for publication. There are no conflicts of interest to disclose., (Copyright © 2024 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.)

Introduction. Flail chest can become life-threatening when accompanied by other complications of thoracic trauma. Current hospital flail chest management includes mechanical ventilation and pain control. Although mechanical ventilation management is constantly improving, prolonged intubation and intensive care lead to increased morbidity. Surgical fixation is gaining more ground against non-operative care and authors have reported better outcome and fewer complications in restricted retrospective studies, but a consensus still has to be reached regarding the guidelines for surgical fixation. In this article, we wish to present our perspective on the surgical fixation of flail chest. Materials and Method. A 39-year-old patient, known with chest trauma after a car accident for which he had undergone surgical treatment at another department, was admitted to our unit for chest instability and chronic pain. During the clinical examination of the left hemithorax, we noticed chest wall instability at the posterior arches of the 8th, 9th and 10th left ribs. CT scans of the thorax showed approximation of the ribs on the anterior fracture line and multiple displaced rib fractures, without callus formation, on the posterior fracture line. Results. The 5th to 10th left ribs were cleared of fibrotic tissue, re-approximated and repositioned using matrix RIB titanium plates and screws. After surgery, the patient was kept in the intensive care unit for two days and was discharged after another seven days. Postoperative pain was managed with opioid therapy. Conclusions. The debate regarding the operative management vs. the non-operative management of flail chest is ongoing given the relatively small number of patients included in the existing randomizedcontrolled trials. Osteosynthesis with plates and screws is easy to manage and we recommend the use of operative treatment of flail chest in patients who can withstand thoracic procedures.

This investigation was conducted to evaluate the efficacy of coated titanium plates against gram-positive Staphylococcus aureus (SA) and gram-negative Pseudomonas aeruginosa (PA) using various methods. The Colony-forming unit “CFU” was higher in chitosan (CH) in relation to PA than in poly lactic-co-glycolic acid (PLGA) in relation to SA, followed by meropenem-chitosan “MC” coated plates in relation to PA and SA. A significant difference in the zone of inhibition (ZOI) of SA was determined in MP, MC, and meropenem (MEM). PA was significantly inhibited by MP, MEM, then MC, and the largest ZOI among SA and PA groups were MP coating. Using an MTT assay, MP had the lowest bacterial viability in the SA group, followed by MC and MEM, with no statistically significant difference between the PLGA or CH alone nor the polymers augmented with MEM. Using confocal microscopy, MP-coated plates were seen to have the highest bacterial inhibition, followed by MC, MEM, PLGA, and CH. In the PA group, MP had the highest bacterial inhibition, followed by MEM, MC, CH, and PLGA. The uncoated group presented the lowest inhibition in relation to both SA and PA. Conclusively, coating titanium plates with PLGA or CH with MEM appeared to enhance the antibacterial efficacy as opposed to MEM without polymers through bacterial adhesion inhibition, hindering biofilm formation and preventing bacterial proliferation.

The present investigation was undertaken to evaluate the topographical and ultrastructural architecture of titanium plates coated with polylactic co-glycolic acid (PLGA), chitosan (CH), and/or meropenem (MEM) with or without Staphylococcus aureus (SA) or Pseudomonas aeruginosa (PA) bacteria. Single-hole segments of 0.4 mm thick, low-profile titanium plates were spray coated using an airbrush with polymeric carriers (PLGA or CH) loaded with MEM, in addition to the negative control group (uncoated titanium plates). The coated plates and the negative control group were subjected to bacterial biofilms through a cultivation process while being slowly stirred at 20 rpm for 24 h. The samples were fixed and processed for scanning electron microscopic study at 5, 10, and 20 k magnification. The data were statistically analyzed to compare within and between the different materials. Coating titanium plates with PLGA or CH with MEM appeared to enhance bacterial inhibition over uncoated plates, hindering biofilm formation and preventing bacterial proliferation. In the staphylococcus aureus group, the highest bacterial count was observed in the uncoated plates, whereas the lowest count was detected in meropenem-PLGA, followed by PLGA, chitosan, meropenem, and meropenem-chitosan, respectively. On the other hand, the Pseudomonas aeruginosa group with the uncoated plates had the highest bacterial count, whereas the lowest bacterial count was found related to CH, followed by PLGA, MP, MC, and MEM, respectively.

Treatment for mandibular fractures is commonly performed via open reduction fixation with mini titanium or resorbable plates and screws. The investigators hypothesized differences in maximum mechanical stress forces and deflection with each plating material; however, it was proposed that the experimental forces withstood by the resorbable system would be enough to withstand normal forces produced during mastication.The sample was composed of fresh cadaver mandibles that were harvested, fractured, and fixated with plates and screws. The predictor variable was fracture fixation and included a titanium plating or resorbable poly-L-lactide plating system. The primary outcome measure was maximum load withstood before plating failure measured in Newtons (N). Descriptive and bivariate statistics were computed, P value was set at .05.The sample was composed of six mandibles with and grouped by type of fixation modality, Titanium (T) (n = 3) and Resorbable (n = 3). There was a statistically significant correlation between the T group and increased maximum load (N) before failure as compared to the R group, (P = 0.023).The results suggest that fracture fixation with titanium plates and screws can withstand greater maximum forces before failure; however, the resorbable plating system withstood forces similar to/or greater than the maximum forces produced during normal mastication.

Abstract Background Orthopaedic implant infections are difficult to eradicate because bacteria adhering to implant surfaces inhibit the ability of the immune system and antibiotics to combat these infections. Thermal cycling is a temperature modulation process that improves performance and longevity of materials through molecular structural reorientation, thereby increasing surface uniformity. Thermal cycling may change material surface properties that reduce the ability for bacteria to adhere to the surface of orthopaedic implants. This study aims to determine whether thermal cycling of orthopaedic implants can reduce bacterial growth. Methods In a randomized, blinded in-vitro study, titanium and stainless steel plates treated with thermal cycling were compared to controls. Twenty-seven treated and twenty-seven untreated plates were covered with 10 ml tryptic soy broth containing ~ 105 colony forming units (CFU)/ml of bioluminescent Staphylococcus aureus (S. aureus)Xen29 and incubated at 37 °C for 14d. Quantity and viability of bacteria were characterized using bioluminescence imaging, live/dead staining and determination of CFUs. Results Significantly fewer CFUs grow on treated stainless steel plates compared to controls (p = 0.0088). Similar findings were seen in titanium plates (p = 0.0048) following removal of an outlier. No differences were evident in live/dead staining using confocal microscopy, or in metabolic activity determined using bioluminescence imaging (stainless steel plates: p = 0.70; titanium plates: p = 0.26). Conclusion This study shows a reduction in CFUs formation on thermal cycled plates in-vitro. Further in-vivo studies are necessary to investigate the influence of thermal cycling on bacterial adhesion during bone healing. Thermal cycling has demonstrated improved wear and strength, with reductions in fatigue and load to failure. The added ability to reduce bacterial adhesions demonstrates another potential benefit of thermal cycling in orthopaedics, representing an opportunity to reduce complications following fracture fixation or arthroplasty.

Background and Objectives: There are limited evidences available about the performance of biodegradable system in the treatment of linear mandibular fractures without the aid of postoperative maxillomandibular fixation (MMF). Hence, the present study was planned to evaluate the treatment outcomes in mandibular fractures, using 2.5 mm bioresorbable plates and screws without postoperative MMF. Methodology: This cohort study compares both prospective and retrospective data. The prospective study treated 20 adult patients with linear mandibular fracture using bioresorbable plates and screws, without using postoperative MMF (Group 1). Retrospective data were collected from a previous published study in which patients were treated with bioresorbable plates and screws with 2 weeks postoperative MMF (Group 2) and those treated with metal plates and screws without postoperative MMF (Group 3). Group 1 patients were followed up at 2 and 4 months to evaluate the functional outcomes in terms of fracture mobility, malocclusion, pain, and soft-tissue deformity and compared with its preoperative findings. Further, the treatment outcomes of Group 1, Group 2, and Group 3 were compared among themselves at 2-month follow-up. Results: Group 1 patients showed a significant improvement in the treatment outcomes at 2 and 4-month follow-up. In addition, when 2 months postoperative outcomes were compared among the three groups, no statistically significant difference was observed in the treatment outcomes. Conclusion: Endpoint osteosynthesis can be achieved with the bioresorbable fixation system when used in the treatment of un-displaced linear mandibular fractures, without postoperative MMF. A minor modification of using a lower size osteotomy drill can prevent screw loosening. [ABSTRACT FROM AUTHOR]

The objetive of this work is to present the literature review of the symptomatology, the parameters of the various classifications, the introduction of new imaging technologies, ancillary to the diagnosis and management of fractures of the orbito-zygomatic complex. We also present a clinical case of a 20 year-old female patient who suffers an automobile accident, causing fracture of the right orbitocigomatic complex, the clinical characteristics of the image, the surgical thechnique used in the treatment and its evolution. Concluding that the fracture traces of the orbital floor continue to be closely related to the traumatic factors, the anatomical zone involved and the arborants in the maxilla that, by allowing the transmission of force, are conjugated for the continuity solution of the osseous tissue. Concluding that the fundamental objective of the surgical treatment is to restore, as far as possible, the damage caused, to perform an adequate repositioning and fixation of the fragments with osteosynthesis material that allows the bone stability that promotes the healing process. [ABSTRACT FROM AUTHOR]

Pulmonary trauma is a significant cause of morbidity and mortality in patients with major trauma. Chest wall contusion with rib fracture is very common. Surgical stabilization of rib fracture (SSRF) has traditionally required an exploratory thoracotomy for adequate exposure. Minimally invasive approaches for SSRF are now being developed. However, preoperative localization of rib fractures and intraoperative designing of titanium plates require additional time. We present a novel technique involving three-dimensional printing for promoting SSRF with a minimally invasive approach that is efficient and provides good patient outcomes.

This study was designed to introduce and evaluate the clinical use of a surgical guide and a CAD/CAM prebent titanium plate for sagittal split ramus osteotomy (SSRO) in the correction of mandibular prognathism. We studied 14 patients who had been diagnosed, and treated by bilateral SSRO with the guide, during the period July 2015–January 2016. Surface deviations of distal segments from simulation until the end of the operation were measured on a coloured map. Deviations of position and orientation of the condyle and proximal segment from before to after operation, and those from simulation until the end of the operation, were measured with a 3-dimensional vector. All patients were followed up for at least a year. The coloured map showed that the mean (SD) distances were 0.40 (0.25) mm between the simulated and postoperative distal segments. The 3-dimensional vector showed that the mean values of mediolateral, anteroposterior, and superior-inferior translations of the condyles were less than 1 mm (p < 0.02) from before the operation until the end, and from simulation to the end of the operation, and the mean value of pitching for proximal segments was less than 1° (p < 0.02) from simulation to the end of the operation. At the one year follow-up, the occlusions were stable. Based on accurate diagnosis and simulation, this guide takes the distal segment precisely to its planned position, and the condyle and proximal segment are well-controlled. This is a useful tool, which is comparatively easy to make and operate. [ABSTRACT FROM AUTHOR]

Ameloblastoma is a benign but locally invasive odontogenic tumor that causes significant morbidity. The aim is to study an ameloblastoma treatment with reconstruction using titanium plates adapted using stereolithographic models. A 48‑year‑old female patient referred due to asymptomatic osteolytic lesion between teeth 47 and 48 discovered during routine radiographic study. The pathoanatomical study described a desmoplastic ameloblastoma. Due to the possibility of it being a malignant lesion, a computerized axial tomography scan was performed, which showed that the tumor was not malignant. A stereolithographic model was prepared to make the cutting guides and facilitate fitting of reconstruction plates. Three-dimensional printing technology enables fast, accurate mandibular reconstruction, helping to shorten operation time. [ABSTRACT FROM AUTHOR]

Hydroxyapatite (HA) has long been used as a coating material in the implant industry for orthopedic implant applications. HA is the natural inorganic constituent of bone and teeth. By coating titanium (base material of implant engineering because of its lightness and durability) with hydroxyapatite, we can provide higher biocompatibility of titanium implants, according to HA ability to form a direct biochemical bond with living tissues. This article reports a biomimetic approach for coating hydroxyapatite with titanium A method of modifying the surface of titanium by organic modifiers (for creating functional groups on the surface), followed by formation "self-assembled" layer of biomimetic hydroxyapatite in simulated body fluid (SBF). FTIR and XPS confirmed the formation of hydroxyapatite coatings on titanium surface. Comparative study of the formation of HA on the surface of titanium plates modified by different functional groups: Ti(≡OH), Ti/(≡Si-OH) and Ti/(≡COOH) is conducted. It was found that the closest to natural stoichiometric hydroxyapatite Ca/P ratio was obtained on Ti/(≡COOH) samples. DOI: http://dx.doi.org/10.5755/j01.ms.20.3.4974

Introduction. Facial trauma remains an important pathology in present days because of its effects. Facial deformities and functional alteration affect patient's life quality and his society reinsertion. First evaluation has to be thorough to avoid any secondary complications .This type of pathology involves a pluridisciplinary approach: ENT, OMF, neurosurgeon, plastic surgeon, intensive care doctor. Healing implies complex biological process .A healed bone is capable to perform normal duties without titanium plates help. Osteosynthesis allows a faster and correct recovery. Doctors need to possess profound knowledge with regard to anatomy and physiology and to be acquainted with the reconstructive methods used in craniofacial surgery. Material and methods. This study evaluates craniofacial trauma patients who suffered different types of surgical interventions at the ENT Clinic and OMF Department of Constanta County Hospital since January the 1st 2013 until June the 1st 2017. Results. The group involves 133 cases, both genders and all ages. These 2 elements play an important role in this pathology because of the fact that the vast majority of patients are young active males. The sex ratio in the study is 7:1. In most of cases, craniofacial traumas appear after aggressions and car accidents. The nose and mandibular are fractured in a higher percentage in comparison to other parts of facial structures. Discussions. Important and sensitive structures located at this level increase the risk of possible important and definitive damages. [ABSTRACT FROM AUTHOR]

Background: Alloplastic materials such as tantalum, gold plates and foils, hydroxyapatite blocks have been used for closure of oroantral fistula (OAF). However, these materials are not widely accepted in routine surgical closure of OAF due to cost, difficult handling, increased rate of infection, and exfoliation. Purpose: To overcome the above drawbacks this study aimed to use titanium plates (0.3 mm) with transalveolar wiring fixation for closure of OAF. Patients and Methods: Ten patients with OAFs who consented to undergo this trial were selected and treated under an outpatient basis in the Oral Surgery Department, Faculty of Dentistry, Mansoura University, Egypt. Results: All OAFs were successfully treated with no eventful complications. Conclusion: This study concludes that titanium plates with transalveolar wiring fixation is an excellent technique for closure of OAF. The high success rate with this technique warrants its use for closure of OAF. [ABSTRACT FROM AUTHOR]

A method has been developed of biomimetic hydroxyapatite (HA) biocompatible functional layer synthesis on the surface of the models of titanium articles of biomedical applications. Carboxyl-modified titanium surface acts as active nucleation site in biomineralization processes of HA synthesis which occurs in simulated body fluids (SBF) of different composition. A comparative study has been conducted on the influence of thermal conditions on the formation of HA in SBF of different chemical composition. The formation of hydroxyapatite coating on the surface of titanium has been confirmed by FTIR spectroscopy and XRD. [ABSTRACT FROM AUTHOR]

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Background: The malar bone represents a strong bone on fragile support and its processes - frontal, orbital, maxillary and zygomatic are frequently the site of fracture. Current study was done to compare the stability of zygomatic complex fracture using Biodegradable plates and titanium miniplates with one point fixation. Materials and Methods: Twenty patients of zygomatic complex fracture were randomly selected and divided in two groups which were further divided into two subgroups (A, B). Group I patients were treated with titanium miniplate at zygomatic buttress and Group II was treated by bio-resorbable plates. One point fixation was done either at zygomatic buttress or at frontozygomatic suture and it was observed that both the site have been the most favored site of rigid internal fixation in terms of stability, aesthetics and prevention of rotation of the fracture segment in either vertical or horizontal axis. Conclusion: There is no significant difference in post operative outcomes between two groups, but still bioresorbable system has some advantage over titanium system as these plates resorbs over a period of time and does not cause any interference with growth and post operative radiotherapy. However application of biodegradable system demands highly précised technique. [ABSTRACT FROM AUTHOR]

Nowadays, surgical interventions must treat with care the aesthetic impact on the patient, even when a malignant pathology or an patient’s advanced age could give the aesthetic issue lower priority. The cranio-facial area is probably the most important anatomical region with regard to the harmony of the human body. Consequently, a step-by-step procedure, applicable regardless of the site and the nature of the lesion, is advisable to minimize the aesthetic impact. We prospectively analyzed 65 patients during a period of 2 years. At 1-year follow-up, all patients were invited to undergo a 3D-multislice CT and to complete a questionnaire with a subjective rating scale about aesthetic impact. The 3D-multislice CT scan didn’t show dislocations, depressions or gaps of the bone flap. Nevertheless, five patients complained of some degree of aesthetic injury, or reported a psychological suffering from the aesthetic consequences of surgery. As a control group, we retrospectively reviewed 223 patients. The authors describe their surgical protocol and discuss it in the light of the results of their series. [ABSTRACT FROM AUTHOR]

The application of additive manufacturing (AM) technology has been widely used in various medical fields, including craniomaxillofacial surgery. The aim of the present study was to examine the surgical efficiency and post-operative outcomes of patient-specific titanium mandibular reconstruction using AM. Major steps in directly designing and manufacturing 3D customized titanium implants are discussed. Furthermore, pre-operative preparations, surgical procedures and post-operative treatment outcomes were compared among patients who received mandibular reconstruction using a customized 3D titanium implant, titanium reconstruction plates or vascularized autologous fibular grafting. Use of a customized titanium implant significantly improved surgical efficiency and precision. When compared with mandibular reconstruction using the two conventional approaches, patients who received the customized implant were significantly more satisfied with their facial appearance, and exhibited minimal post-operative complications in the 12-month follow-up period. Patients who underwent mandibular reconstruction using a customized titanium implant displayed improved mandibular contour symmetry, restored occlusal function, normal range of mouth opening and no temporomandibular joint related pain; all complications frequently experienced by patients who undergo conventional approaches of mandibular reconstruction. [ABSTRACT FROM AUTHOR]

Background: The adhesion ability of microorganisms to the surface of titanium miniplates and screws is one of factors in the development of purulent-inflammatory complications in the postoperative period. One of the solutions to this problem is the use of an ion-plasma coating of mini-plates and screws., Objective: The aim of the study was to prove a decrease adhesion level of pathogenic and conditionally pathogenic bacterium to samples of titanium mini-plates with ion-plasma coating, compared with samples without coating., Material and Methods: Present opinion about microbial adhesion, how the most important stage of development microbial colonization of abiotic surfaces, was been basis of this study. The strains of aerobic and facultative anaerobic pathogens, as well as the non-spore-forming (non-clostridial) obligate-anaerobic pathogens were used in the research. During the experiments the standard method for determining residual adhesion was applied. The data obtained were processed by the «Biostat 9.0» software package. For the data received by the methods of variational parametric and nonparametric statistics we used the Mann-Whitney test, taking into account the average value, error, and the number of observations (significance of differences at p <0.05)., Results: As a result, the differences between the indices residual adhesion of strains aerobic and facultative anaerobic pathogens on the samples with and without a protective coating were statistically reliable, however, the adhesion of the individual species varied. The same differences between the indices residual adhesion were obtained among the strains of obligate anaerobic pathogens. The low level of adhesion, which was observed in the case of using the protective coating, is a very promising way of development, since these microorganisms are dangerous as the may lead to the development of purulent-inflammatory complications and the rejection of implants., Conclusion: The decreased level of adhesion is a factor which reduces the microbial load during the postoperative period.

Background: Orthopaedic implant infections are difficult to eradicate because bacteria adhering to implant surfaces inhibit the ability of the immune system and antibiotics to combat these infections. Thermal cycling is a temperature modulation process that improves performance and longevity of materials through molecular structural reorientation, thereby increasing surface uniformity. Thermal cycling may change material surface properties that reduce the ability for bacteria to adhere to the surface of orthopaedic implants. This study aims to determine whether thermal cycling of orthopaedic implants can reduce bacterial growth.Methods: In a randomized, blinded in-vitro study, titanium and stainless steel plates treated with thermal cycling were compared to controls. Twenty-seven treated and twenty-seven untreated plates were covered with 10 ml tryptic soy broth containing ~ 105 colony forming units (CFU)/ml of bioluminescent Staphylococcus aureus (S. aureus)Xen29 and incubated at 37 °C for 14d. Quantity and viability of bacteria were characterized using bioluminescence imaging, live/dead staining and determination of CFUs.Results: Significantly fewer CFUs grow on treated stainless steel plates compared to controls (p = 0.0088). Similar findings were seen in titanium plates (p = 0.0048) following removal of an outlier. No differences were evident in live/dead staining using confocal microscopy, or in metabolic activity determined using bioluminescence imaging (stainless steel plates: p = 0.70; titanium plates: p = 0.26).Conclusion: This study shows a reduction in CFUs formation on thermal cycled plates in-vitro. Further in-vivo studies are necessary to investigate the influence of thermal cycling on bacterial adhesion during bone healing. Thermal cycling has demonstrated improved wear and strength, with reductions in fatigue and load to failure. The added ability to reduce bacterial adhesions demonstrates another potential benefit of thermal cycling in orthopaedics, representing an opportunity to reduce complications following fracture fixation or arthroplasty. [ABSTRACT FROM AUTHOR]

The article reviews a study related to the post operative pain after orthognathic surgery due to resorbable plates and titanium plates. It includes information on systematic reviews and randomized clinical trials conducted for comparing the outcomes of patients undergoing orthognathic surgery. It also discusses the use of assessments in making clinical decisions