Prosthesis, Volume 5, Issue 3 (September 2023) – 27 articles

Background: Recent meta-analyses have shown indifferent results between minimally invasive (MI) and conventional approach (CA) total hip arthroplasty (THA), not including the superior MI approach SuperPATH. The aim was to compare the surgical, functional and radiological outcomes and postoperative complications of MI THA, including SuperPATH, with CA THA in patients with hip disease or femoral neck fracture. Methods: PubMed, CNKI, The Cochrane Library, clinical trials, CINAHL and Embase were searched for randomized controlled trials (RCTs) comparing MI THA and CA THA up to 31 July 2023. Mean differences (MDs) with 95% confidence intervals (CIs) were calculated for continuous outcomes and odds ratios (ORs) with 95% CIs were calculated for dichotomous outcomes using a common effect/random effects model. The random effects model was used to present the results. Heterogeneity was assessed using the Cochrane Q test and the Higgins I² test. Results: A total of 47 RCTs with 4086 THAs in 4063 patients were included in our meta-analysis. MI THA showed better results than CA THA in 8 of 18 outcome parameters studied. MI THA showed a higher Harris Hip Score (HHS) than CA THA at 0–1.5, 3, 6 and ≥12 months postoperatively (p < 0.01; p = 0.02; p = 0.01; p = 0.01). MI THA showed an indifferent overall postoperative complication risk compared to CA THA (p = 0.61). Acetabular positioning angles were within the safe zone in all approaches. Conclusions: The results of the meta-analysis suggest that MI THA has several advantages over CA THA in terms of short-term surgical and functional outcomes, with equal postoperative complication rates. We cannot recommend a change in surgical approach based on our results, as the differences between the investigated approaches did not reach minimal clinically important differences. Level of evidence I: a systematic review of all relevant randomized controlled trials. Full article

Periprosthetic Joint Infection (PJI) is a challenging complication after joint replacements, and cement spacers are standard treatment in two-stage revision surgery. This experimental in vitro study aimed to evaluate the elution properties of different gentamicin formulations from commercially available intraoperative molded hip cement spacers. The study compared spacers prepared with premixed antibiotic bone cement, spacers with antibiotic powder added during preparation, spacers stored for two months, and spacers with an additional antibiotic. The results showed that the timing of antibiotic addition influenced gentamicin elution, with immediate elution resulting in higher levels than stored spacers. Spacers with antibiotic powder added during preparation exhibited higher elution than premixed antibiotic spacers. Furthermore, adding vancomycin to the bone cement significantly increased gentamicin elution. These findings suggest that optimizing the timing and method of antibiotic addition in cement spacers may enhance the effectiveness of antibiotic treatment in PJI. However, further research is needed to validate these findings and explore their clinical implications. Full article

Interspinous spacers are a minimally invasive surgical device for treating degenerative lumbar diseases, limiting spinal extension, and decreasing pressures within the disc and facets, relieving symptoms caused by lumbar spinal stenosis. This work uses the finite element method to calculate the stresses and deformations of an interspinous spacer with steel wire clamping. The cables also provide an easier way to set up the device. The reconstruction of the model was undertaken by computerized tomography, considering a person with average Mexican height (1.64 m) and a mass index grade of 2 (108 kg). The maximum movements reported in the literature were used for the range of motion. The interspinous spacer increases in a ratio of 2.7 times the stresses. Still, these stresses are generated in the prosthesis, which causes the vertebrae to be relieved since the forces and pressures are reduced. Deformations decrease by 53% with the reduction of the range of motion. Therefore, the prosthesis provides excellent stability for the vertebrae. Full article

(1) Background: Color changes, physical degradation, and fungal infections are challenges to the longevity of maxillofacial polydimethylsiloxane (PDMS) elastomers. This study aimed to evaluate color changes, physical properties, and antifungal properties of PDMS loaded with ZrO₂ and TiO₂ submicron- and nano-sized particles. (2) Methods: A 1% weight of 40 nm or 200 nm diameter ZrO₂ or TiO₂ nanoparticles was mixed into PDMS with 2% functional intrinsic yellow pigment and polymerized. Control materials contained 13% weight 200 nm silica. Samples were exposed to 3000 h of UVB radiation (200 µW/cm²) or darkness. Color parameters L*a*b* and ∆E_ab*, ultimate tensile strength, strain, elastic modulus, and Shore A hardness were measured. Candida albicans growth was measured using XTT and confocal microscopy, and data were analyzed with the Dunnett test (p < 0.01). (3) Results: TiO₂ 200 nm showed the least color change after 3000 h of UVB radiation, followed by TiO₂ 40 nm (p < 0.05). The silica-containing control group was superior in all physical property measurements due to higher additive content (p < 0.05). TiO₂-containing materials exhibited significantly lower C. albicans growth (p < 0.01) than those loaded with ZrO₂ or SiO₂. (4) Conclusions: TiO₂ nanoparticles of 40 nm and 200 nm, when added to pigmented PDMS at 1% weight, provided the best resistance to color change and significantly lowered C. albicans activity compared to silica- and zirconia-filled elastomers. Particle size differences rendered minor differences for most properties. The incorporation of low-level submicron- and nano-sized TiO₂ particles has the potential to improve color stability and antifungal activity in silicones designated for maxillofacial prostheses and may be extended to denture reline applications. Full article

Gaze-tracking, where the point of regard of a subject is mapped onto the image of the scene the subject sees, can be employed to study the visual attention of the users of prosthetic hands. It can show whether the user pays greater attention to the actions of their prosthetic hand as they use it to perform manipulation tasks, compared with the general population. Conventional analysis of the video data requires a human operator to identify the key areas of interest in every frame of the video data. Computer vision techniques can assist with this process, but fully automatic systems require large training sets. Prosthetic investigations tend to be limited in numbers. However, if the assessment task is well-controlled, it is possible to make a much simpler system that uses the initial input from an operator to identify the areas of interest and then the computer tracks the objects throughout the task. The tool described here employs colour separation and edge detection on images of the visual field to identify the objects to be tracked. To simplify the computer’s task further, this test uses the Southampton Hand Assessment Procedure (SHAP) to define the activity spatially and temporarily, reducing the search space for the computer. The work reported here concerns the development of a software tool capable of identifying and tracking the points of regard and areas of interest throughout an activity with minimum human operator input. Gaze was successfully tracked for fourteen unimpaired subjects and was compared with the gaze of four users of myoelectric hands. The SHAP cutting task is described and the differences in attention observed with a greater number of shorter fixations by the prosthesis users compared to unimpaired subjects. There was less looking ahead to the next phase of the task by the prosthesis users. Full article

Narrow-diameter implants (NDIs) can be inserted instead of standard dental implants (SDIs) in sites with limited space and bone availability. The aim of this study was to evaluate the effect of implant diameter on peri-implant bone, attached mucosa, and on the associated probability of implant success and survival. The implants with progressive thread design and platform switching (Ankylos^®, Dentsply Sirona; Mannheim, Germany) investigated were identified retrospectively and assigned to two groups based on their diameter: 3.5 mm (NDIs) and 4.5 mm (SDIs). Peri-implant bone loss was analyzed based on available radiographs. Descriptive and implant-associated factors were gathered from patient files. Data were statistically analyzed using the Kolmogorov–Smirnov–Lilliefors test and regression analyses. The level of significance was p ≤ 0.05. Results: In total, data for 415 implants in 194 patients were included in the study. Ten-year survival was 95.8% (NDIs) and 91.1% (SDIs). Implant diameter had no significant effect on peri-implant crestal bone loss (p = 0.098) or on the width of the attached gingiva (p = 0.052). Survival and success rates of NDIs were like or slightly better than those of SDIs. Because implant diameter had no effect on peri-implant tissue, NDIs can be recommended in selected cases. Full article

Mitral valve regurgitation is a common heart valve disorder associated with significant morbidity and mortality. Transcatheter mitral valve repair using the MitraClip device has emerged as a safe and effective alternative for patients unsuitable for conventional surgery. However, the structural and hemodynamic implications of MitraClip implantation in the left ventricle have not been extensively explored. This study aimed to assess the structural and hemodynamic performance of the MitraClip device using a high-fidelity model of the human heart, specifically focusing on a healthy mitral valve geometry. The implantation of the MitraClip device was simulated using the finite element method for structural analysis and the lattice Boltzmann method for computational flow analysis. MitraClip implantation induced geometrical changes in the mitral valve, resulting in local maxima of principal stress in the valve leaflet regions constrained by the device. Hemodynamic assessment revealed slow-moving nested helical flow near the left ventricular wall and high flow velocities in the apex regions. Vorticity analysis indicated abnormal hemodynamic conditions induced by the double-orifice area configuration of the mitral valve after MitraClip implantation. By predicting possible adverse events and complications in a patient-specific manner, computational modeling supports evidence-based decision making and enhances the overall effectiveness and safety of transcatheter mitral valve repairs. Full article

A prosthetic rehabilitation, whether supported by implants, teeth, or mucous membranes, must be functionally and aesthetically adequate, so it is essential that the oral structures are reproduced as accurately as possible. The purpose of this overview is to evaluate the accuracy, time of digital impressions, and patient preference compared to those of conventional high-precision in vivo impressions. This umbrella review was developed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement and was registered in the PROSPERO systematic review registry. The search method and study selection were based on the PEO (Population–Exposure–Outcome) model, a modified version of the PICO model. Systematic reviews regarding the dental impression technique made using an intraoral scanner versus the analog impression technique made with high-precision impression materials were searched electronically up to 1 February 2023 among articles published in English, through numerous registries and databases, such as PROSPERO e, Scopus, MEDLINE/ PubMed, BioMed Central, and Cochrane Library. The records screened totaled 2942, but only 23 systematic reviews were included in this umbrella review. The Assessing the Methodological Quality of Systematic Reviews (AMSTAR) 2 tool was used to evaluate the quality assessment of the systematic reviews included in this umbrella review. Accuracy, time, and patient preference for digital impressions were compared with those of high-precision conventional impressions. A total of 23 systematic reviews were included in this umbrella review. From the analysis of this umbrella review, the data on the accuracy between the two methods of taking the impression are conflicting, especially as regards full-arch rehabilitations. However, the digital impression seems to be preferred over the analog one as regards time and patient preference. However, there is limited high-quality evidence available for studying conventional and digital implant impressions. The results obtained are limited to the type of review performed, and the type of studies included was limited by the settings and study designs. Furthermore, another important limitation highlighted was that the digital scanners analyzed in the various studies are not the same, and the number of missing teeth or implants inserted is not the same. More in vivo clinical studies and RCTs are needed to increase the level of evidence for impression procedures. Full article

Despite the orthopedics markets in the US and the EU reaching a plateau, the market size in countries such as Brazil, Russia, India, and China is steadily growing. As a result, major orthopedic companies are shifting their focus towards these markets and developing products tailored to their needs. However, a significant challenge associated with this new opportunity is the requirement for the development of more affordable prostheses compared to those sold in the US and Europe. With the introduction of these lower-cost models into the market, this article aims to assess their performance in comparison to traditional models. A literature review was conducted, analyzing four parameters—the Hospital for Special Surgery Score, Knee Society Score, Range of Motion, and Western Ontario and McMaster Universities Arthritis Index—to evaluate different models. The findings indicated that low-cost models perform either equally well or, in some cases, slightly worse than traditional ones. It is worth to mention that the existing literature on this topic is limited, resulting in a relatively small number of models and studies included in this specific study. Nevertheless, this latter serves as a valuable foundation for future in-depth analyses and investigations. Full article

The present article aims to describe the management of a malpractice dental implant case in a patient with a history of oral bisphosphonates (BF) intake (alendronic acid every 15 days for 20 years) and to perform a narrative review of recently published articles (2019–2023) on the topic. A female patient rehabilitated with 18 nails in the mandible 20 years ago underwent two surgeries; the first one included the explantation of the nails; the second one included the insertion of two implants in the anterior region. At the last follow-up (21 months from the first surgery and 15 months from the second one) no complications nor episodes of bisphosphonate-related osteonecrosis of the jaw (BRONJ) were highlighted. Furthermore, 12 recent articles on the topic were reported and a narrative review was performed. Based on the narrative analysis, the topic related to dental implants in patients with BF intake seems to remain controversial. Most of the findings highlight how the evidence on both the safety of the treatment and the possibility to foresee the risk of onset based on preoperative factors seem to be scarce. The case described in the present article did not report any complications nor episodes of BRONJ. However, evidence from a single case report is scarce and more clinical trials are required to deepen the knowledge on the topic. Full article

Background: The purpose of this study was to evaluate the dimensional accuracy of surgical guides for static computer-aided implant placements processed using milling or 3D printing. Methods: A comprehensive literature search was performed on electronic databases inclusive of PUBMED, SCOPUS, Cochrane Database of Systematic Reviews, EBSCO host Research Databases, and Web of Knowledge were searched without restriction to date. Studies investigating the surgical guides fabricated by milling or 3D-printing, comparing them with their computer-aided design model, and reporting outcome measures about the accuracy of the internal/external surface, the angular deviation of the sleeves, and the vertical or horizontal deviations of the sleeves’ access were included. Results: From 1928 retrieved records, 33 studies were selected; 11 out of them fulfilled the eligibility criteria. All studies analyzed printed surgical guides, while only two studies analyzed both printed and milled templates. Studies were very heterogeneous in methodology and equipment; moreover, different parameters were used for accuracy measurements which made their results not comparable and quantitative synthesis not feasible. Conclusion: There is no clear evidence to address which manufacturing technology provides surgical guides with better accuracy, although milling might achieve better results, at least in terms of reduced variation. For additive technologies, several factors could influence accuracy. Since this issue has sensible clinical implications, future studies are encouraged. Full article

Orthopedic splints are external medical devices designed to support and protect the functions of the human musculoskeletal system from pathological conditions or traumatic events. Tailoring these medical solutions to the morphology of the patient’s limb is essential to ensure a correct and rapid rehabilitation pathway. Although traditional splinting techniques might achieve a unique fit, the procedures are highly dependent on the skill and experience of the medical operator, affecting the quality of the care treatment. In response to the drawbacks associated with traditional splinting techniques, the present article proposed an innovative and structured methodology to manufacture customized wrist immobilization splints, prioritizing simplicity and user-friendliness in fabrication activities. The customized splint manufacturing was based on the integration of reverse engineering (RE) and additive manufacturing (AM) techniques. The research designed a baseline model of a wrist splint, varying over different thickness values and manufacturing materials (ABS, nylon, PLA, PC, PA6-GF25, PA6-CF20). For every splint model, the production times and material costs were assessed. Technical tests were performed via finite element analysis (FEA). The conducted analysis and the resulting charts empower medical operators to select the most appropriate solution, ensuring a well-informed and effective decision-making approach. Full article

Fretting corrosion is a known failure mechanism of total hip replacement (THR) that can lead to revision surgery. Implant retrieval studies have thoroughly documented the occurrence of fretting corrosion in THR implants and its correlation with implant- and patient-related factors. Although implant retrieval studies benefit both clinicians and implant manufacturers, the limitations of these types of studies need to be acknowledged. For example, while some factors are routinely investigated for a possible correlation with failure due to fretting corrosion, other factors are often assumed to have no effect. To improve on these limitations, this review investigates the most significant patient- and implant-related risk factors for fretting corrosion of THR implants for both published retrieval studies and joint replacement registries. The findings and limitations are discussed critically. It is concluded that retrieval studies add significant insight into implant failure mechanisms and should be used in conjunction with joint replacement registry reports. It is suggested that the development of reliable predictive models based on implant failure risk factors and decision-making support systems could lead to enhanced implant longevity. Full article

Silk fibroin (SF) is a suitable material for vascular prostheses for small arteries. SF is useful not only as a base material for artificial vascular grafts but also as a coating material. This study prepared three types of transgenic SF (vascular endothelial growth factor (VEGF), Arg-Glu-Asp-Val (REDV), and Tyr-Ile-Gly-Ser-Arg (YIGSR)) incorporating expression factors that are thought to be effective for endothelialization as coating materials. We compared the contribution of these materials to early endothelialization in vivo when using them as a porous transgenic SF coating. A porous coating of transgenic SF containing VEGF, REDV, and YIGSR was applied to a silk small-diameter artificial vascular graft base with a diameter of 1.5 mm and a length of 3 cm. Two and four weeks after implantation of these artificial grafts into the abdominal aorta of rats, they were removed and evaluated by histologic examination. Transgenic SF coating incorporating VEGF and REDV demonstrated higher tissue infiltration and continuous endothelialization in the center of the graft compared to YIGSR at 4 weeks after implantation. VEGF and REDV are capable of endothelialization as early as 4 weeks after implantation, confirming the usefulness of transgenic SF when used as a porous coating. Full article

There are a wide variety of interbody devices available for use in transforaminal lumbar interbody fusion (TLIF). While traditionally these interbodies are bullet-shaped, crescent-shaped cages have become increasingly common. There is a paucity of literature comparing the effect of cage geometry with substratification for surgical approach (minimally invasive (MIS) vs. open). The aim of this study was to determine the effect of implant geometry, positioning, and surgical approach on the correction of different spinal alignment parameters in patients undergoing TLIF. A retrospective chart and imaging review was performed on 103 patients with a total of 131 instrumented segments performed by a single surgeon. Preoperative, initial postoperative, and final postoperative standing lateral lumbar radiographs were evaluated for lumbar lordosis (LL), segmental lordosis (SL), anterior disc height (ADH), and posterior disc height (PDH). Anterior-posterior implant positioning was recorded for initial and final postoperative radiographs. These measurements were compared among four groups: open bullet (OB), MIS bullet (MB), open crescent (OC), and MIS crescent (MC). SL increased in all groups by a mean of 2.9° at initial imaging and 2.2° at final imaging. The OC group had greater initial improvement in SL compared to the MB group (p = 0.02), though this effect was lost at final follow-up (p = 0.11). The OB and OC groups conferred greater initial improvement in ADH (p = 0.02; p = 0.04), while the OC group had greater final improvement in ADH compared to the MB and MC groups (p = 0.01; p = 0.01). The OC group had less initial improvement in PDH compared with the other groups (p = 0.03, p = 0.02, p < 0.01). The MB group provided greater final improvement in PDH compared with the MC and OC groups (p = 0.04, p = 0.01). Cage geometry, surgical approach, and implant position all demonstrated a statistically significant but clinically minor impact on segmental alignment for TLIF procedures. Full article

Leg prostheses specially adapted for cycling in patients with transtibial amputation can be advantageous for recreational practice; however, their required features are not fully understood. Therefore, we aimed to evaluate the efficiency of unilateral cycling with a transtibial prosthesis and the characteristics of different attachment positions (middle and tip of the foot) between the prosthetic foot and the pedal. The cycling practice was performed on an ergometer at 40 W and 60 W resistance levels while participants (n = 8) wore custom-made orthoses to simulate prosthesis conditions. Using surface electromyogram, motion tracking, and power meter pedals, biomechanical data were evaluated and compared with data obtained through regular cycling. The results showed that power delivery became more asymmetrical at lower workloads for both orthosis conditions, while hip flexion and muscle activity of the knee extensor muscles in the sound leg increased. While both pedal attachment positions showed altered hip and knee joint angles for the leg wearing the orthosis, the middle of the foot attachment presented more symmetric power delivery. In conclusion, the middle of the foot attachment position presented better symmetry between the intact and amputated limbs during cycling performed for rehabilitation or recreation. Full article

The aim of this study was to evaluate and compare the stress concentration of short dental implants supporting different conical abutments using 3D finite element analysis (3D-FEA). A tridimensional model of single-unit short dental implants (5.2 mm × 5 mm) was designed using the computer-aided design (CAD) software based on the manufacturer’s stereolithography. The short implants were positioned in a bone model to support titanium or ceramic-reinforced PEEK conical abutments considering different bone levels (supra-crestal, crestal or sub-crestal). With the aid of a computer-aided engineering (CAE) software, the finite element model was created and an axial load of 500 N was applied. Observing the mechanical response of the implant, abutment and screw, both evaluated materials resulted in homogeneous stress and could be indicated for implant-supported restorations with short fixtures. However, aiming to decrease the strain in the bone tissue, placing the implant in the sub-crestal position is a preferable option; while the supra-crestal placement decreases the stress at the screw and implant. Full article

This study compares the effect of different handpieces (turbine, high-speed electric handpiece and piezoelectric device) on surface roughness of enamel and dentin when using diamond-coated working tips and burs of the same grit size. The experiment was conducted on 15 extracted first molars from patients aged 45 to 60 years. The occlusal portion was removed using a diamond-coated water wheel and then refined with a 120–130 μm grit bur in order to obtain a flat surface with an adequate exposition of the dentin core. Each surface was divided into three portions and every portion was finished with one of the three tested instruments. The rotary burs and piezoelectric tips had the same grit size (60 μm), and the load on handpiece during preparation never exceeded 150 g. Roughness parameters (Ra, Rsk, Rku) were recorded with a profilometer, and a SEM analysis of treated surfaces and working tips was conducted. Ra and Rsk differed significantly between enamel and dentin only after using turbine (p = 0.004 and p = 0.007, respectively). No significant differences were observed in Ra, Rsk and Rku between enamel and dentin when using a high-speed electric handpiece or piezoelectric device. The turbine produced higher Ra and Rsk values on dentin than the other devices, while no significant differences were found between piezoelectric handpiece and high-speed electric contra-angle on both substrates. Summarizing, the findings of the present study demonstrated that turbine generated rougher surfaces on dentin compared to the other handpieces. Moreover, the turbine produced more asymmetrical surface profiles on both enamel and dentin. However, it should be considered that these differences in roughness (Ra) were within the range of 0.25–0.30 μm: it is still unclear if these variations, although statistically significant, will influence final clinical outcomes. Full article

Background: An effective way to objectively assess intraoperative tissue damage in total hip arthroplasty (THA) is to determine and compare postoperative serum biomarkers (laboratory parameters) such as creatine kinase (CK), C-reactive protein (CRP), and hemoglobin (Hb). This meta-analysis aims to compare the intraoperative tissue damage in THA through minimally invasive (MI) and conventional approaches (CAs) using postoperative serum biomarkers. Methods: We searched databases for randomized controlled trials (RCTs) comparing MI THA and CA THA. We calculated mean differences (MDs) with 95% confidence intervals (CIs) for continuous outcomes, using the Hartung–Knapp–Sidik–Jonkman method and a common effect/random effects model. Results: A total of 13 RCTs, involving 1186 THA patients, were included in our meta-analysis. In two out of eleven examined outcome parameters, MI THA showed better results than CA THA. In nine out of eleven examined outcome parameters, MI THA showed no significant difference compared to CA THA. MI THA had a 16 mg/L lower CRP value 3 days postoperatively than CA THA (I² = 66%, p = 0.03, MD = −15.65, 95% CI −30.10 to −1.21). MI THA had a 3 mg/L lower CRP value 4 days postoperatively than CA THA (I² = 0%, p = 0.98, MD = −3.00, 95% CI −3.27 to −2.74). Conclusions: Overall, there was no significant difference between MI THA and CA THA in terms of postoperative serum biomarkers, with a slight advantage of MI THA in CRP values. These results do not provide sufficient evidence to recommend changing the surgical approach from CA THA to MI THA. Level of evidence I: a systematic review of all relevant randomized controlled trials. Full article

The natural distribution of stress in the femur is altered when total hip arthroplasty (THA) is performed. In fact, when a stem is inserted inside the femur, there is a variation in stress due to the difference in rigidity between the material with which the stem is made and the femur. This generates the phenomenon of stress shielding. The aim of this study is to design an optimized prosthesis that guarantees an excellent rotational stability and a reduced stress shielding. Methods: Through the finite element method (FEM), the mechanical behavior of the stem subjected to the loads described by ISO 7206-4:2010 is studied. Results: Through topological optimization, there is a reduction in stress shielding in the proximal zone of 31.46%. The addition of ridges on the dorsal side of the stem also improves rotational stability by 27.82%. Conclusions: The decrease in stiffness that is recorded with the optimized stem guarantees a greater distribution of stress on the bone. The presence of dorsal ridges also favors the corticalization of the bone as it loads the bone near the dorsal, ensuring further stability. The perforated prosthesis presented in this study shows an increase in primary stability and an improvement in rotational stability as there is also a bone regrowth inside the prosthesis. Full article

Digital dentistry has gained significant attention in recent years due to its potential to improve the accuracy of implant placement and prosthesis fabrication. However, the literature on its effectiveness remains controversial, and a systematic review and meta-analysis are necessary to evaluate the available evidence. A comprehensive search was conducted across multiple online databases using MeSH keywords and Boolean operators. Data extraction was performed, and a bias assessment was conducted based on modified CONSORT guidelines. The pooled odds ratios (OR) and risk ratios (RR) and corresponding 95% confidence intervals (CI) were then calculated. Five studies met the inclusion criteria. The overall analysis showed no statistically significant difference in the accuracy of implant placement and prosthesis fabrication between digital and conventional techniques (OR: 0.95, 95% CI: 0.73 to 1.23 and RR: 0.95, 95% CI: 0.73 to 1.23). Subgroup analysis based on individual studies did not demonstrate consistent results. This review suggests that digital techniques do not significantly impact the accuracy of implant placement and prosthesis fabrication compared to conventional techniques in an in vitro setting. However, the overall evidence is limited by the small number of studies and the heterogeneity observed. Future well-designed studies, including randomized controlled trials and clinical studies, are needed to provide more robust evidence on the effectiveness of digital dentistry in clinical practice. Full article

Prosthetics and orthotics research, studies, and technologies have been evolving through the years. According to World Health Organization (WHO) data, it is estimated that, globally, 35–40 million people require prosthetics and orthotics usage in daily life. Prosthetics and orthotics demand is increasing due to certain factors. One of the factors is vascular-related disease, which leads to amputation. Prosthetic usage can increase an amputee’s quality of life. Therefore, studies of the ergonomic design of prosthetics are important. The ergonomic factor in design delivers prosthetic products that are comfortable for daily use. One way to incorporate the ergonomic design of prosthetics is by studying the human walking gait. This paper presents a multiclassification of human walking gait based on electromyography (EMG) signals using a machine learning method. An EMG sensor was attached to the bicep femoris longus and gastrocnemius lateral head to acquire the EMG signal. The experiment was conducted by volunteers during normal walking activity at various speeds and the movements were segmented as initial contact, which was labeled as initial gait; loading response to the terminal stance, which was labeled as mid-gait; and pre-swing to terminal swing, which was labeled as final gait. The EMG signal was then characterized using an artificial neural network (ANN) and compared to six training accuracy methods, i.e., the Levenberg–Marquardt backpropagation training algorithm, quasi-Newton training method, Bayesian regulation backpropagation training method, gradient descent backpropagation, gradient descent with adaptive learning rate backpropagation, and one-step secant backpropagation. The machine learning study performed well in the classification of three classes of human walking gait with an overall accuracy (training, testing, and validation) of 96% for Levenberg–Marquardt backpropagation. The gait data will be used to explore the design of lower limb prosthetics in future research. Full article

The aim of this systematic scoping review was to provide scientific evidence on the efficacy and methods of application of hyaluronic acid (HA) in the coverage of gingival recessions in terms of recession depth (RD) reduction, clinical attachment level (CAL) gain and probing depth (PD). An electronic search of the literature on the main databases was conducted. Initially, 405 articles were identified. Finally, four studies were included after the review process. It was not possible to perform a meta-analysis of the articles selected because of the differences among the surgical treatments and commercial formulations and compositions of HA. Both randomized controlled trials in this research examined type 1 gingival recessions treated with a coronally advanced flap. In the selected case series, recessions were treated with either a modified coronally advanced tunnel or laterally closed tunnel combined with a subepithelial connective tissue graft and HA. No significant variation was found in terms of PD. Modifications of CAL are connected to variations of RD; however, RD reduction is similar to the control group. HA seems to improve the clinical outcomes of gingival recession coverage in the short term, but the magnitude is limited. Formulations, surgical techniques and application methods are heterogeneous. Full article

Total knee arthroplasty (TKA) is a popular treatment for end-stage knee osteoarthritis. Advances in understanding knee biomechanics have led to the development of medial pivot (MP) prostheses, which aim to replicate natural knee kinematics. While short- and mid-term studies have shown favorable outcomes for MP-TKA, long-term follow-up studies are limited. This systematic review aims to analyze the available evidence on long-term outcomes of MP-TKA, including survivorship, complications, and patient-reported outcome measures (PROMs). A comprehensive search was conducted in PubMed, Embase, and Cochrane Database of Systematic Reviews for English language studies reporting long-term outcomes of primary MP-TKA. Nine studies with an average follow-up of 12.4 years were included. Data on survivorship, complications, and PROMs were collected and analyzed. The overall survivorship of MP-TKA was 98.2% at an average follow-up of 12.4 years. Aseptic loosening and periprosthetic joint infection (PJI) were the most common reasons for revision, with a revision rate of 0.4% for each. The overall complication rate was 6.6%, with secondary anterior knee pain and PJI being the most frequent complications. The reoperation rate was 3.1%, primarily due to PJI and knee instability. PROMs significantly improved postoperatively. MP-TKA demonstrates favorable long-term outcomes with high survivorship, low complication rates, and enhanced PROMs. The procedure provides reliable management for end-stage osteoarthritis, offering patients improved knee function and pain relief. Further research with standardized reporting and larger sample sizes is needed to validate and compare these findings to other implant designs. Full article

Background: Dental implants have become the standard for replacing missing teeth. However, patients’ demands for shorter treatment times and the desire for aesthetics in their results can complicate the rehabilitation process, particularly when poor-quality bone is involved. In order to address these challenges, new methods of treating implant surfaces have been introduced. These methods aim to make the implants superhydrophilic and bioactive, enhancing their functionality and interactions with the surrounding tissues. Aim: The aim of the study was to retrospectively examine the efficacy of a superhydrophilic and bioactive implant for treatment of the edentulous maxillary anterior area. The study also aimed to evaluate whether this improved implant surface, by enhancing the osseointegration processes, could serve as a factor in speeding up the loading protocols. Materials and Methods: For this retrospective study, a total of 13 implants were included: 6 delayed restored implants and 7 immediately loaded implants placed in the anterior maxillary area. Clinical, radiographic, and esthetic outcomes were assessed. Baseline measurements of the insertion torque value (ITV) and stability implant quotient (ISQ) were recorded for all implants. In the early-loaded group, these measurements were also taken 30 days (t30) and 45 days (t45) after the placement of the implant to monitor their changes over time. Marginal bone loss (MBL) was calculated according to the changes in marginal bone level on intraoral X-rays taken at two different time points: at baseline and one year after loading. To evaluate the esthetic results, the pink esthetic score (PES) and the white esthetic score (WES) were assessed. For this evaluation, intraoral photographs were taken one year after implant loading. Results: A total of 7 implants were immediately restored, with a mean ITV of 32.29 ± 9.01 Ncm and a mean ISQ of 72.71 ± 2.81. These implants were placed in a bone environment with a mean density of 410.00 ± 194.42 HU. On the other hand, 6 implants with delayed loading had a mean ITV of 28.50 ± 3.27 Ncm, an ISQ of 67.92 ± 8.43, and a mean bone density of 607.50 ± 140.83 HU. The mean PES and WES after 1 year were, respectively, 8.71 ± 1.89 and 8.57 ± 0.79 for immediate and 8.33 ± 1.36 and 9.17 ± 1.33 for delayed-loaded implants. At 12 months after loading, the immediately loaded group had a MBL of 0.29 ± 0.29 mm, while the delayed-loaded group had a MBL of 0.33 ± 0.25. No statistically significant differences between the two treatment groups were found for any of the evaluated outcomes. Conclusions: Despite the limitations of this study, the obtained results may support the use of a superhydrophilic and bioactive implant surface for implant-prosthetic rehabilitation in critical loading protocols with satisfactory esthetic results. Full article

Background: Training is required to achieve proficiency in airway management. Simulators are of utmost importance not only for the purpose of training novices, but also for evaluating newer airway devices and techniques. Growing evidence supports inadequate anatomic airway reproduction in adult and pediatric manikins. Methods: We conducted an observational study comparing 17 radiological anatomic airway measurements obtained via the computed tomography of three commercially available manikins with the same measurements obtained from a population of newborns/infant (range: 0–3 months) undergoing magnetic resonance imaging for diagnostic purposes. According to the reference (mean and standard deviation (SD) of the pediatric population), each manikin measurement was defined as adequate, partially adequate or inadequate (difference between means: ≤±1, 1.0–1.96 or >1.96 SD, respectively). The primary outcome was the number of measurements with an adequate reproduction of airways. Results: We included 27 pediatric patients (21 ± 19 days, 48% males, 46.6 ± 3.5 cm, 2.7 ± 0.5 Kg and 12.6 ± 2.9 kg/m²). All manikins had n = 11/17 measurements with inadequate airway anatomic reproduction. The three measurements with more adequate reproduction were the height of the soft palate, retropalatal airspace volume and tongue volume (adequate in two manikins, and partially adequate in the remaining one). Conclusions: In three manikins commonly used for training in pediatric airways, static dimensions do not seem anatomically correct in relation to those of pediatric patients. Such inaccuracies may introduce biases in airway device development as well as in training. Full article

The objective of this study was to meticulously examine the diverse vocal rehabilitation techniques that are employed following total laryngectomy, with emphasis on their implications on patients’ quality of life and on the determinants influencing the selection of one technique over another. We embarked on a comprehensive literature review, which concentrated on three primary rehabilitation approaches: tracheoesophageal puncture (TEP) accompanied by a vocal prosthesis, esophageal speech acquisition, and electrolarynx utilization. The outcomes assessed included quality of life, functional performance, communication effectiveness, patient satisfaction, and factors governing the choice of technique, such as patient demographics, disease stage, and treatment history. Our findings demonstrated that TEP with vocal prosthesis yielded the most favorable overall quality of life and patient satisfaction. Individuals who underwent TEP exhibited superior speech intelligibility, voice quality, and communication ease compared with those who employed esophageal speech acquisition or electrolarynx utilization. While esophageal speech learning exhibited inferior speech quality and functional performance, it offered cost-effectiveness and diminished maintenance advantages. Electrolarynx utilization emerged as the least preferred approach due to suboptimal speech intelligibility and voice quality. The determinants influencing the choice of vocal rehabilitation technique included patient age, sex, disease stage, and previous treatment history. Patient preferences also substantially contributed to the selection of a specific technique. It is essential for clinicians to consider individual factors and patient inclinations when deliberating on an appropriate vocal rehabilitation method following total laryngectomy. Our investigation underscores the significance of collaborative decision making between clinicians and patients to pinpoint the most fitting rehabilitation technique. Future research endeavors should be directed towards enhancing existing approaches, devising innovative methods, and probing long-term outcomes and cost-effectiveness to optimize patient care in the aftermath of total laryngectomy. Full article