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EFORT Open Reviews Oct 2021The biomechanics of the shoulder relies on careful balancing between stability and mobility. A thorough understanding of normal and degenerative shoulder anatomy is... (Review)
Review
The biomechanics of the shoulder relies on careful balancing between stability and mobility. A thorough understanding of normal and degenerative shoulder anatomy is necessary, as the goal of anatomic total shoulder arthroplasty is to reproduce premorbid shoulder kinematics.With reported joint reaction forces up to 2.4 times bodyweight, failure to restore anatomy and therefore provide a stable fulcrum will result in early implant failure secondary to glenoid loosening.The high variability of proximal humeral anatomy can be addressed with modular stems or stemless humeral components. The development of three-dimensional planning has led to a better understanding of the complex nature of glenoid bone deformity in eccentric osteoarthritis.The treatment of cuff tear arthropathy patients was revolutionized by the arrival of Grammont's reverse shoulder arthroplasty. The initial design medialized the centre of rotation and distalized the humerus, allowing up to a 42% increase in the deltoid moment arm.More modern reverse designs have maintained the element of restored stability but sought a more anatomic postoperative position to minimize complications and maximize rotational range of motion. Cite this article: 2021;6:918-931. DOI: 10.1302/2058-5241.6.210014.
PubMed: 34760291
DOI: 10.1302/2058-5241.6.210014 -
Journal of Clinical Orthodontics : JCO Mar 2016
Review
Topics: Humans; Malocclusion, Angle Class II; Maxilla; Molar; Orthodontic Anchorage Procedures; Orthodontic Appliance Design; Tooth Movement Techniques
PubMed: 27117735
DOI: No ID Found -
Zhonghua Kou Qiang Yi Xue Za Zhi =... Sep 2018Crowding and protrusion of the dentition are often the chief complaint of orthodontic patients. For patients with severe crowding or protrusion, orthodontist often... (Review)
Review
Crowding and protrusion of the dentition are often the chief complaint of orthodontic patients. For patients with severe crowding or protrusion, orthodontist often improve their profile with premolar extraction treatment. However, for patients with mild crowding and protrusion, orthodontist usually achieve treatment objective using distal molar movement with temporary anchorage devices (TAD). The present article reviewed the advances in the use of TAD in total arch distalization, including therapeutic effect measured in three-dimensions, factors that affected distal movement and the stability of curative effect.
Topics: Bicuspid; Female; Humans; Male; Malocclusion; Molar; Orthodontic Anchorage Procedures; Orthodontic Appliance Design; Tooth Movement Techniques
PubMed: 30196618
DOI: 10.3760/cma.j.issn.1002-0098.2018.09.005 -
Microsurgery Mar 2023Although aesthetic reconstruction of an amputated distal finger can be achieved through partial toe transfer, this approach often damages the weight-bearing region of...
BACKGROUND
Although aesthetic reconstruction of an amputated distal finger can be achieved through partial toe transfer, this approach often damages the weight-bearing region of the toe from which the flap is harvested. The purpose of this report is to introduce the minimum invasive surgery technique to reconstruct the distal finger aesthetically without damaging the weight-bearing region of the toe.
PATIENTS AND METHODS
Thirty-one amputated fingertips in 30 patients aged 18 to 68 years were treated using this operative technique. Operations were performed between January 2010 and December 2020. All patients were missing the distal finger beyond the PIP joint, and the amputation stump had been covered with healthy skin. A distally based finger flap was elevated at the recipient site, and a slender partial toe flap, including the nail, was harvested from the great toe. These flaps were combined to form the distal finger. In all cases, the weight-bearing region of the toe remained intact. The donor site wound was first closed with artificial dermis, and skin grafting was performed 3 weeks after the surgery. A few patients did not require skin grafting because their wounds epithelized spontaneously.
RESULTS
In most patients, the transplanted flap remained healthy and the distal finger was aesthetically restored. Two patients aged over 60 years who were smokers developed necrosis of the transplanted partial toe flap. In all patients, the weight-bearing region of the great toe was intact, and they had no trouble walking during the three-year follow-up period after surgery.
CONCLUSION
Our technique, which combines elevation of a distally-based finger flap and transplantation of a partial toe flap, was able to minimize the skin defect area in the great toe. This new distal finger reconstruction technique is minimally invasive and can be used to prevent secondary donor site issues.
Topics: Humans; Middle Aged; Aged; Toes; Surgical Flaps; Hallux; Fingers; Skin Transplantation
PubMed: 36367228
DOI: 10.1002/micr.30982 -
The Journal of Hand Surgery Feb 2016The usual treatment for flexor digitorum profundus (FDP) avulsions as well as FDP lacerations in the distal part of zone I is tendon reinsertion into bone. Although... (Review)
Review
The usual treatment for flexor digitorum profundus (FDP) avulsions as well as FDP lacerations in the distal part of zone I is tendon reinsertion into bone. Although there are several different techniques of FDP tendon reinsertion into bone, they are generally complex and have a weak tensile strength. A technique for treating these injuries is to use the volar plate of the distal interphalangeal joint as a distally based flap for tendon repair. The current communication discusses the technique and its potential complications. Initial clinical experience is encouraging and the volar plate flap technique may take its place in flexor tendon surgery.
Topics: Finger Joint; Humans; Palmar Plate; Surgical Flaps; Suture Techniques; Tendon Injuries
PubMed: 26684715
DOI: 10.1016/j.jhsa.2015.11.004 -
Dentistry Journal Sep 2022The use of traditional intra-oral devices in maxillary molar distalization is not without undesirable consequences. The aim of the present study was to compare the...
The use of traditional intra-oral devices in maxillary molar distalization is not without undesirable consequences. The aim of the present study was to compare the miniscrew-supported distal-jet appliance to a traditional distal-jet appliance by evaluating the amount of upper first molar distalization and the dentoalveolar side effects. Data of 600 subjects visited at the orthodontic unit of Sapienza University of Rom were analyzed. Only 46 patients met the inclusion criteria and were selected and treated. Subjects were assigned randomly to receive treatment either with miniscrew-supported distal-jet appliance (Group A) or with a traditional distal-jet appliance (Group B). In Group A, miniscrews were inserted using a computer-guided surgical guide. The amount of upper first molar distalization and the dentoalveolar side effects were assessed both on the digital casts and on the lateral cephalometric radiograph at the end of the distalization phase. A descriptive statistical analysis that included the mean values and the standard deviation was conducted to evaluate the molar distalization and the dentoalveolar effects in two groups. Intergroup differences were determined using the Student's -test. The significance was set at ≤ 0.05. In Group A, greater maxillary first molar distalization and a spontaneous distalization of the first premolars and a palatal inclination of central incisors were observed. By contrast, in Group B, the first premolars tipped mesially and a proclination of the maxillary central incisors was observed. In both groups, the transverse widths of the dental arch increased while a greater tendency of first premolar extrusion and of maxillary first molar rotation was observed in Group B. The skeletal anchorage device achieved greater first molar distalization and did not cause dento-alveolar side effects.
PubMed: 36285989
DOI: 10.3390/dj10100179 -
The Angle Orthodontist Jul 2018To evaluate the quantitative effects of miniscrew supported appliances for maxillary molar distalization in Class II malocclusion.
OBJECTIVES
To evaluate the quantitative effects of miniscrew supported appliances for maxillary molar distalization in Class II malocclusion.
MATERIALS AND METHODS
The systematic search included MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus, and key journals and review articles. The date of the last search was January 30, 2017. Methodological quality of the retrospective studies was graded by means of the Quality Assessment Tool for Quantitative Studies, developed for the Effective Public Health Practice Project (EPHPP) and prospective studies by means of Newcastle-Ottawa Scale.
RESULTS
In total, 298 studies were identified for screening, and 14 studies were eligible. The Quality Assessment Tool for Quantitative Studies rated all of the four included retrospective studies as moderate. The Newcastle-Ottawa Scale rated seven studies as high quality and three studies as low quality. The mean molar distalization values varied from 1.8 mm to 6.4 mm. Mean distal tipping of molars varied from 1.65° to 11.3°. The mean distal movement of premolars and incisors varied from 1.75 mm to 5.4 mm and 0.1 mm to 2.7 mm, respectively.
CONCLUSIONS
Miniscrew-supported appliances are effective in molar distalization with distal movement of premolars with minimal anchorage loss and distal tipping of the molar teeth.
Topics: Bone Screws; Humans; Malocclusion, Angle Class II; Maxilla; Molar; Orthodontic Anchorage Procedures; Tooth Movement Techniques
PubMed: 29664335
DOI: 10.2319/091717-624.1 -
Progress in Orthodontics Dec 2023The aim of this study was to evaluate the distal movement, vertical movement, distal tipping and crown buccal torque of maxillary molars after the completion of...
BACKGROUND
The aim of this study was to evaluate the distal movement, vertical movement, distal tipping and crown buccal torque of maxillary molars after the completion of distalization by comparing the predicted movement with the achieved movement using palatal rugae registration.
METHODS
The study included 22 clear aligner patients (7 males and 15 females), and 79 molars were measured. Two digital models were generated before treatment and after molar distalization and were superimposed after selecting the palatal rugae area for registration in GOM inspect suite software 2022 (GOM; Braunschweig, Germany). The predicted and achieved movements of molar distalization, intrusion, distal tip and crown buccal torque were measured and compared.
RESULT
The achieved distalization (1.25 ± 0.79 mm vs. 2.17 ± 1.03 mm, P < 0.001; 1.41 ± 1.00 mm vs. 2.66 ± 1.15 mm, P < 0.001), intrusion (0.47 ± 0.41 mm vs. 0.18 ± 0.54 mm, P < 0.01; 0.58 ± 0.65 mm vs. 0.10 ± 1.12 mm, P < 0.01), distal tip (5.30 ± 4.56° vs. 1.53 ± 2.55°, P < 0.001; 4.87 ± 4.50° vs. - 1.95 ± 4.32°, P < 0.001) and crown buccal torque (1.95 ± 4.18° vs. - 1.15 ± 4.75°, P < 0.001; 0.43 ± 4.39° vs. - 4.27 ± 6.42°, P < 0.001) were significantly different from the predicted values in the two groups (first molar, second molar). Significant regression relationships were found between the achieved distal movement and deviational intrusion (R = 0.203, P < 0.0001), distal tip (R = 0.133, P < 0.001) and crown buccal torque (R = 0.067, P < 0.05). There was a significant correlation between the deviational movements of intrusion and the distal tip (R = 0.555, P < 0.0001).
CONCLUSION
Approximately 2 mm maxillary molar distalization was achieved in this study. Deviational movement of intrusion, distal tip and crown buccal torque beyond the clear aligner virtual design appeared to a certain degree after distalization. Thus, more attention should be given to molar intrusion and distal tip and crown buccal torque as the designed distalization increases.
Topics: Male; Female; Humans; Torque; Malocclusion, Angle Class II; Maxilla; Molar; Crowns; Orthodontic Appliances, Removable; Tooth Movement Techniques
PubMed: 38151662
DOI: 10.1186/s40510-023-00500-4 -
Journal of Clinical and Experimental... Jul 2019Maxillary molar distalization is the most frequently used nonextraction treatment in the correction of Class II malocclusion. The use of traditional intra-oral devices...
BACKGROUND
Maxillary molar distalization is the most frequently used nonextraction treatment in the correction of Class II malocclusion. The use of traditional intra-oral devices shows unreliable results. Nowadays the use of miniscrew-supported appliances helps prevent anchorage loss. The aim of this pilot study is to compare the amount of upper first molar distalization and the dentoalveolar side effects using traditional distal jet appliance and miniscrew-supported distal jet appliance.
MATERIAL AND METHODS
20 patients were randomly assigned to receive a treatment with miniscrew-supported distal jet appliance (Group A) or with traditional distal jet appliance (Group B). To ensure a safe and minimally invasive miniscrew insertion a surgical guide was used. Digital models and lateral cephalograms were obtained and analyzed before orthodontic treatment and at 6-month follow-up. Intergroup differences were determined using T- test. The significance was set at ≤0.05. The intra-operator reliability was evaluated using a 2 sample T-test. The difference was not statistically significant ( ≤0.05 ), demonstrating an intra-operator reliability.
RESULTS
In Group A, a greater maxillary first molar distalization was recorded (=0.002). Considering the dentoalveolar side effects, in Group A, a spontaneous distalization of the first premolars and a retroclination of central incisors were determined. In Group B, the first premolars tipped mesially with a proclination of the maxillary central incisors.
CONCLUSIONS
Miniscrew-supported distal jet appliance achieved a greater first molar distalization at 6-month follow-up and did not cause dento-alveolar side effects, such as the mesial drift of the premolars and the incisors. Molar distalization, distal jet appliance, skeletal anchorage, miniscrew, 3D printed surgical guide.
PubMed: 31516664
DOI: 10.4317/jced.55780 -
Progress in Orthodontics 2016The aim of the present study was to test the hypothesis that bodily maxillary molar distalization was not achievable in aligner orthodontics.
BACKGROUND
The aim of the present study was to test the hypothesis that bodily maxillary molar distalization was not achievable in aligner orthodontics.
METHODS
Forty lateral cephalograms obtained from 20 non-growing subjects (9 male, 11 female; average age 29.73 years) (group S), who underwent bilateral distalization of their maxillary dentition with Invisalign aligners (Align Technology, Inc., San José, CA, USA), were considered for the study. Skeletal class I or class II malocclusion and a bilateral end-to-end class II molar relationship were the main inclusion criteria. Cephalograms were taken at two time points: (T0) pretreatment and (T2) post-treatment. Treatment changes were evaluated between the time points using 39 variables by means of paired t test. The level of significance was set at P < 0.05. Reproducibility of measurements was assessed by the intraclass correlation coefficient (ICC).
RESULTS
The mean treatment time was 24.3 ± 4.2 months. At the post-treatment point, the first molar moved distally 2.25 mm without significant tipping (P = 0.27) and vertical movements (P = 0.43). The second molar distalization was 2.52 mm without significant tipping (P = 0.056) and vertical movements (P = 0.25). No significant movements were detected on the lower arch. SN^GoGn and SPP^GoGn angles showed no significant differences between pre- and post-treatment cephalograms (P = 0.22 and P = 0.85, respectively).
CONCLUSIONS
Aligner therapy in association with composite attachments and class II elastics can distalize maxillary first molars by 2.25 mm without significant tipping and vertical movements of the crown. No changes to the facial height were revealed.
Topics: Adult; Cephalometry; Female; Humans; Male; Molar; Reproducibility of Results; Retrospective Studies
PubMed: 27041551
DOI: 10.1186/s40510-016-0126-0