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Technology and Health Care : Official... 2023The minimally invasive endodontics could retain more peri-cervical dentin (PCD) and other important dental structures, thus realizing the minimal loss of teeth...
BACKGROUND
The minimally invasive endodontics could retain more peri-cervical dentin (PCD) and other important dental structures, thus realizing the minimal loss of teeth structures and preserving the strength and function of the endodontically treated tooth (ETT). The search for abnormal root canals or calcified root canals could be quite time-consuming and increase the risk of perforation.
OBJECTIVE
This study introduced a novel multifunctional 3D printing guided splint inspired by the dice, which can achieve the minimally invasive access cavity preparation and canal orifice identification.
METHOD
Data were collected from an outpatient with dens invaginatus. Cone-beam Computed Tomography (CBCT) revealed a type III invagination. The CBCT data of the patient were imported into a computer-aided design (CAD) software (Exocad 3.0; Exocad GmbH) for the 3D reconstruction of jaw bones and teeth. The dice-inspired 3D printing guided splint consists of the sleeve and guided splint. The sleeve with minimal invasive opening channel and orifice locating channel were designed with a reverse-engineering software (Geomagic Wrap 2021). The reconstructed models in the Standard Template Library (STL) format were imported into a CAD software. The design of the template was aided by the dental CAD software in Splint Design Mode. The sleeve and splint were exported into the STL files separately. A 3D printer (ProJet® 3600 3D Systems) was used to separately generate the sleeve and guided splint, and was made by stereolithography and processed in a medical resin (VisiJet M3 StonePlast).
RESULTS
The novel multifunctional 3D printing guided splint could be set in position. The opening side in the sleeve was selected and the sleeve was inserted in place. The minimal invasive opening was made in the crown of the tooth to access the pulp. The sleeve was draw out and turned to the orifice location side, and then inserted in place. The target orifice was located rapidly.
CONCLUSION
This novel dice-inspired multifunctional 3D printing guided splint allow dental practitioners to gain accurate, conservative, and safe cavity access from teeth with anatomical malformations. Complex operations might be carried out with less reliance on the operator's experience than with conventional access preparations. This novel dice-inspired multifunctional 3D printing guided splint would have a broad application in the dental field.
Topics: Humans; Cone-Beam Computed Tomography; Dentists; Printing, Three-Dimensional; Professional Role; Root Canal Preparation; Splints; Minimally Invasive Surgical Procedures; Dental Cavity Preparation
PubMed: 37302052
DOI: 10.3233/THC-230002 -
Healthcare (Basel, Switzerland) May 2023Most mandibular second molars are usually found to have either one or two roots. However, mandibular second molars can also present with variations in the number of...
Most mandibular second molars are usually found to have either one or two roots. However, mandibular second molars can also present with variations in the number of roots as well as differences in the morphology of their root canals. An 18-year-old male presented to the Department of Graduate Endodontics clinic with a morphologically variable mandibular second molar with three roots-two mesial and one distal. Two periapical radiographs were taken at different angles, revealing that there were three different canals in separate roots, each with independent portals of exit. This is a rare anatomical configuration. The success of endodontic treatment depends on accurate diagnosis, careful examination, identification of additional roots and canals, as well as detection of variations in root canal morphology. Failing to recognize these variations may lead to failures of root canal treatments and thus unsuccessful endodontic treatment.
PubMed: 37297668
DOI: 10.3390/healthcare11111528 -
Frontiers in Oncology 2023Because of its significant advantage of fast postoperative recovery, natural orifice specimen extraction surgery (NOSES) has attracted increasing attention worldwide....
Case Report: Transvaginal specimen extraction following totally laparoscopic D2 distal gastrectomy for gastric cancer in a patient with situs inversus totalis: with video.
Because of its significant advantage of fast postoperative recovery, natural orifice specimen extraction surgery (NOSES) has attracted increasing attention worldwide. However, the NOSES in gastric cancer (GC) treatment still needs more clinical practice, especially for the rare anatomical anomaly. Situs inversus totalis (SIT) is a rare autosomal recessive anatomical anomaly with an incidence ranging between 1/8,000 and 1/25,000 births. We present a video of transvaginal specimen extraction following totally laparoscopic D2 distal gastrectomy performed in a 59-year-old woman known to have SIT. Preoperative investigations revealed that the patient had early GC at the antrum. A gastroscopy report from the local hospital showed signet-ring cell carcinoma. The preoperative computed tomography scan revealed irregular thickening of the gastric wall at the junction of the greater curvature and antrum without metastasis to the lymph nodes. In total, laparoscopic D2 distal gastrectomy was performed with transvaginal specimen extraction. Billroth II with Braun anastomosis was performed for reconstruction. The length of the operation was 240 min without intraoperative complications and with minimal blood loss of 50 ml. The patient was uneventfully discharged on postoperative Day 7. The final pathology confirmed signet-ring cell carcinoma confined to the mucosal muscle without metastasis in 16 lymph nodes. Transvaginal specimen extraction following totally laparoscopic D2 distal gastrectomy can be safely performed in patients with SIT and has similar surgical outcomes to usual laparoscopic gastrectomy.
PubMed: 37287912
DOI: 10.3389/fonc.2023.1189948 -
Journal of Minimal Access Surgery 2023Transverse colon cancer accounts for about 10% of all colonic cancers. The resection of cancers in the transverse colon is technically more challenging, compared with...
Transverse colon cancer accounts for about 10% of all colonic cancers. The resection of cancers in the transverse colon is technically more challenging, compared with other cancer locations in the colon because the variable anatomy of the middle colic vessels demands excellent surgical skills and the anatomical location of the transverse colon is related to major organs. We report a novel laparoscopic technique for the first time used in surgery of transverse colon cancer which combines a total intracorporeal anastomosis with natural orifice specimen extraction to solve the problems of traditional laparoscopic surgery. A 48-year-old male patient, whose diagnosis was transverse colon adenocarcinoma, was admitted to the hospital. The surgery was performed in accordance with the procedure of totally laparoscopic right hemicolectomy and the specimen was extracted by opening the rectum. Natural orifice specimen extraction surgery has many advantages, including less pain, better cosmesis and minimising risks of complications and also has comparable long-term outcomes compared to conventional laparoscopic surgery.
PubMed: 37282427
DOI: 10.4103/jmas.jmas_13_22 -
Frontiers in Medicine 2023Although previous studies have shown that vaginal natural orifice transluminal endoscopic surgery (vNOTES) has the advantages of causing less pain, faster recovery, and...
INTRODUCTION
Although previous studies have shown that vaginal natural orifice transluminal endoscopic surgery (vNOTES) has the advantages of causing less pain, faster recovery, and better concealment of surgical incisions, which aligns with the concept of the day-care procedure, this approach poses a greater risk of damaging adjacent organs (i. e., rectum and bladder) due to its anatomical specificity. Moreover, the day-care procedure may lead to relatively less preoperative evaluation and postoperative care. Hence, it is necessary to explore the safety and effectiveness of vNOTES for ovarian cystectomy in the day-care procedure, to provide a theoretical basis for the wider development of vNOTES surgery.
MATERIALS AND METHODS
This retrospective study included 131 patients at our hospital who underwent ovarian cystectomy from September 2021 to October 2022. Based on the surgical approach, patients were classified into transumbilical laparoendoscopic single-site surgery (LESS) and vNOTES groups. The patients' demographic characteristics and follow-up data were collected during the perioperative period and 1-month postoperatively.
RESULTS
Vaginal natural orifice transluminal endoscopic surgery has less postoperative exhaust time, a lower postoperative 6-hour pain score, and a lower incidence of analgesic drug use, with higher surgical conversion incidence. Multiple linear regression analysis showed that the surgical conversion, chocolate cyst, bilateral cyst, and pelvic adhesion increased the operation duration by ~43 (95% CI: 10.309, 68.152, < 0.001), 15 (95% CI: 6.342, 45.961, = 0.036), 10 (95% CI: 3.07, 40.166, = 0.019), and 8 (95% CI: 4.555, 26.779, = 0.035) min, respectively. Interestingly, vNOTES decreased the operation duration by ~8.5 min (95% CI: -18.313, -2.699, = 0.033).
CONCLUSION
Vaginal natural orifice transluminal endoscopic surgery was equally safe and effective for ovarian cystectomy compared to LESS. vNOTES aligned with the concept of the day-care procedure due to its reduced postoperative pain, shorter exhaust time, and absence of scarring. However, surgeons should conduct a comprehensive preoperative evaluation and exclude patients suspected to have severe pelvic adhesions.
PubMed: 37275379
DOI: 10.3389/fmed.2023.1164970 -
Clinical Oral Investigations Aug 2023This study aimed to evaluate changes on root canal morphology in patients with different ages using micro-CT technology.
OBJECTIVE
This study aimed to evaluate changes on root canal morphology in patients with different ages using micro-CT technology.
MATERIALS AND METHODS
Mandibular first molars (n = 150) were scanned at a pixel size of 13.68 µm, categorized into 3 groups according to patient's age and analyzed regarding configuration, orifices, apical foramina, root length, canal volume, and surface area. Morphological 2D and 3D parameters were evaluated in distal roots with Type I configuration (n = 109) as well as the morphology of isthmuses Types I and III in 68 mesial roots. One-way ANOVA post hoc Tukey and Kruskal-Wallis tests were used for statistical analyses (α = 5%).
RESULTS
A great variation in the canal configuration was found. No difference was observed in roots' length (p > 0.05). Canal volume reduced with age (p < 0.05), while surface area increased (p < 0.05) in patients ≤ 30 years. There was no difference in canal/root length, area, and from foramen to the apex in distal roots with Type I configuration (p > 0.05), but 2D and 3D parameters significantly decreased with age (p < 0.05). Overall, the diameter of the isthmuses' roof reduced with age (p < 0.05). In patients ≥ 31 years with Type III isthmus the distance from the isthmus floor to the foramen of the mesiolingual canal also decreased (p < 0.05).
CONCLUSION
Overall, the internal morphology of the mesial roots of mandibular first molars was more affected by aging than distal canals. The most relevant tested parameter that significantly reduced in both roots was the volume of the root canal systems.
CLINICAL RELEVANCE
A detailed evaluation of fine anatomical aspects of the root canal system of mandibular first molars of patients with different ages showed that the internal morphology of mesial roots is more affected by aging than distal canals.
Topics: Humans; Dental Pulp Cavity; X-Ray Microtomography; Mandible; Root Canal Therapy; Molar; Tooth Root
PubMed: 37247087
DOI: 10.1007/s00784-023-05093-0 -
Bioengineering (Basel, Switzerland) May 2023: To develop a methodology for the measurement of balloon dilation (BD) effects on Eustachian Tube (ET) structure using Computerized Tomography (CT) images. : The BD of...
: To develop a methodology for the measurement of balloon dilation (BD) effects on Eustachian Tube (ET) structure using Computerized Tomography (CT) images. : The BD of the ET was performed on three cadaver heads (five ears) through the nasopharyngeal orifice. The axial CT images of the temporal bones were obtained before dilation, while an inflated balloon was in the lumen of ET, and after balloon removal in each ear. Utilizing Dicom images captured by the ImageJ software 3D volume viewer function, the anatomical landmark coordinates of the ET were matched with their pre- and post-dilation counterparts, and the longitudinal axis of the ET was captured with serial images. The histograms of the regions of interest (ROI) and three different lumen width and length measurements were obtained from captured images. The densities of air, tissue, and bone were determined with histograms as a baseline to determine the BD rate as a function of increased air in the lumen. : The small ROI box included the area of prominently dilated ET lumen after BD and best represented the visually obvious changes in the lumen, compared to the ROIs that extended the wider areas (longest and longer). Air density was the outcome measure for comparison with each corresponding baseline value. The average increase in air density in the small ROI was 64%, while the longest and long ROI boxes showed 44 and 56% increases, respectively. This study describes a method to image the ET and quantify the outcomes of BD of the ET using anatomical landmarks.
PubMed: 37237662
DOI: 10.3390/bioengineering10050592 -
Vestnik Otorinolaringologii 2023The article describes clinical cases of invasive cholesteatoma of the temporal bone pyramid, leading to a massive destruction of the surrounding structures. Paying...
The article describes clinical cases of invasive cholesteatoma of the temporal bone pyramid, leading to a massive destruction of the surrounding structures. Paying attention to the importance of knowing the microsurgical anatomy of critical structures of temporal bone (the anterior bony plate (cog), the tensor tympani fold and the tendon, the tympanic orifice of the eustachian tube, the pretympanic recess, tympanic sinuses) bearing a significance and helping to improve the removal of the invasive cholesteatoma.
Topics: Humans; Cholesteatoma; Ear, Middle; Tympanic Membrane; Eustachian Tube; Temporal Bone; Cholesteatoma, Middle Ear
PubMed: 37184559
DOI: 10.17116/otorino20228802180 -
Journal of Interventional Medicine Feb 2023This study investigated the anatomical and histological characteristics of the rat Eustachian tube (E-tube) and the feasibility of Eustachian tubography in a rat model.
PURPOSE
This study investigated the anatomical and histological characteristics of the rat Eustachian tube (E-tube) and the feasibility of Eustachian tubography in a rat model.
MATERIALS AND METHODS
Fifteen male Wistar rats were used in this study, and the bilateral E-tubes of each rat were examined. Ten E-tubes were used for anatomical studies, another ten for histological analysis, and the other ten for Eustachian tubography. Five rats were euthanized and decapitated, and ten E-tubes were dissected to describe the anatomy of the E-tube. Ten E-tube specimens obtained from five other rats were sectioned to investigate E-tube histology. Eustachian tubography was performed on the bilateral E-tubes of the other five rats using the -tympanic approach.
RESULTS
The rat E-tubes consisted of bony and membranous parts. Cartilage and bone tissue covered only the bony part. The E-tubes' mean diameter and overall length were 2.97 mm and 4.96 mm, respectively. The tympanic orifices' mean diameter was 1.21 mm. The epithelium of E-tubes was mainly composed of pseudostratified ciliated and goblet cells. Eustachian tubography was successfully performed on both sides of the E-tube for each rat. The technical success rate was 100%, the average running time was 4.9 min, and no procedure-related complications occurred. On tubography images, the E-tube, tympanic cavity, and nasopharynx could be identified because of the visualization of bony landmarks.
CONCLUSION
In this study, we described the anatomical and histological features of rat E-tubes. With the aid of these findings, E-tube angiography was successfully performed using a transtympanic approach. These results will facilitate further investigation of E-tube dysfunction.
PubMed: 37180372
DOI: 10.1016/j.jimed.2022.12.002 -
Clinical Case Reports May 2023Clinicians should be aware of the variations in the number of roots and root canals and the peculiar or eccentric location of root canals. An intraoperative CBCT can be...
KEY CLINICAL MESSAGE
Clinicians should be aware of the variations in the number of roots and root canals and the peculiar or eccentric location of root canals. An intraoperative CBCT can be very useful in improved visualization of the anatomical variations.
ABSTRACT
This case report describes the unusual location of the distobuccal root canal in a maxillary second molar with root fusion. On access opening, three distinct root canal orifices, the mesiobuccal canal, palatal canal, and a third orifice closer to the palatal canal, were seen, giving an illusion of an additional palatal canal. An attempt was made to search for the distobuccal canal in its usual position, leading to the gouging of the pulp chamber floor. An intraoperative limited field of view cone-beam computed tomography (CBCT) revealed the root orifice adjacent to the palatal canal was the distobuccal canal. CBCT also revealed fusion of both the buccal and palatal roots in the root's coronal and middle third region, but they were not fused apically.
PubMed: 37151948
DOI: 10.1002/ccr3.7312