Osteotomy combined with the trephine technique for invisible implant fracture:A case report

BACKGROUND Implant fracture is one of the most serious mechanical complications of dental implants.Conventional treatment necessitates visibility of the apical portion of the fractured implant,whereas for deep and invisible implant fractures,the traditional trephine method has been ineffective.Surgical removal of the marginal bone to expose the fracture surface would be a time-consuming and extensively damaging procedure.Here,we propose a novel technique to address invisible implant fractures.CASE SUMMARY A 50-year-old woman was referred to our department with the chief complaint that her right mandibular implant tooth had fallen out 3 mo earlier.Cone-beam computed tomography examination showed an implant fracture with a fracture surface 5.1 mm below the crestal ridge.The patient was treated with osteotomy combined with the trephine technique to expose the surgical field and remove the implant.The invisible fractured implant was successfully removed,with minimal trauma.A modified Wafer technique-supported guided bone regeneration treatment was then administered to restore the buccal bone wall and preserve the bone mass.Six months later,fine regenerative bone and a wide alveolar crest in the edentulous area were observed,and a new implant was placed.Four months later,restoration was completed using a cemented ceramic prosthesis.Clinical and radiographic examinations 12 mo after loading fulfilled the success criteria.The patient reported no complaints and was satisfied.CONCLUSION Osteotomy combined with the trephine technique can be effectively used to address deep and invisible implant fractures.

Bone Marrow Aspirate and Trephine Biopsy Procedure in a Teaching and Referral Hospital in Kenya

Introduction: Bone marrow aspiration and biopsies are carried out principally to permit cytological assessment of marrow. The procedure is also indicated for immunophenotypic, cytogenetic, molecular and other specialized investigations. The skill to perform bone marrow aspirate and biopsy is usually acquired by the medical personnel through apprenticeship during their training. The training includes performing the procedure, indications, contraindications, and associated hazards. Moi Teaching and Referral Hospital (MTRH) being a specialized Hospital in Western Kenya has several staff trained on performing the procedure. Objective: To assess the performance of bone marrow procedure by clinicians at a teaching and referral hospital. Materials and methods: A descriptive cross-sectional study was done involving 40 clinicians working in the hematology clinic and medical wards from June to December 2019. A structured questionnaire was used to collect the data and data analysis was done using frequency tables. Approval to carry out the study was sought from the institutional IRB. Results: Patients attended to were predominantly adults 33 (83%). The superior posterior iliac crest was the commonest site for the procedure and disposable needles were routinely used in 33 (83%) of the patients. Pain and excessive bleeding 18 (45%) were the commonest complications associated with the procedure. Conclusion: Most of the clinicians involved doing the procedure were residents/registrars. Most of the patients attended to were adults (83%) and majority of the clinicians performed the procedure on the posterior iliac site (96%) using disposable needles (83%). Local anesthesia was commonly used during the procedure (88%). The common complications associated with the bone marrow procedure were pain and excessive bleeding (45%).

Comparison of long-term results after manual and femtosecond assisted corneal trephination in deep anterior lamellar keratoplasty for keratoconus

AIM: To compare long-term postoperative outcomes of manual and femtosecond assisted corneal trephination in deep anterior lamellar keratoplasty(FS-DALK) for keratoconus.METHODS: In the retrospective study, 17 consecutive eyes that underwent vertical side cut incision FS-DALK and 22 eyes that underwent trephine incision DALK were collected over a 2-year period. Main measurements included postoperative uncorrected-visual acuity(UCVA), corrected distance visual acuity(CDVA), refractive sphere and cylinder, manifest refraction spherical equivalent(MRSE), flat and steep corneal keratometry(K1 and K2), endothelial cell density(ECD), and time of epithelium healing and suture removal.RESULTS: Groups were comparable for diagnosis and preoperative visual acuity. Follow-up averaged 23 mo(range, 12-36 mo). At 12 mo, the mean UCVA was better in the manual-DALK group(P=0.039), and the refractive sphere was lower in the FS-DALK group(P=0.040). MRSE between groups differed at 1, 6, and 12 mo postoperatively(P=0.047, 0.025, 0.042, respectively). Mean CDVA, cylinder, K1, K2,corneal astigmatism, ECD, and time of epithelium healing were similar between groups. Stability of MRSE, ECD, and K1 returned sooner after FS-DALK. Initial loosened suture removal time was earlier in the manual-DALK group(P=0.042) while complete suture removal time was similar(P=0.122).CONCLUSION: Manual and femtosecond assisted corneal trephination in DALK are options for advanced keratoconus. FS-DALK do not result in improved visual acuity but it is more stable during the follow-up period. FSDALK in the present form show limited benefit, so surgical design and parameters still need to be optimized and explored.