Questionnaire Survey on Pain & Mini-implant Failure in Class II Female Patients after Extraction of Maxillary Second Molars Using Infra Zygomatic Mini Implants

Background: Skeletal anchorage devices have been developed for case requiring absolute anchorage during orthodontic treatment. One of these anchorage devices is the Infra-zygomatic mini-implant type. However, the pain associated with this type of appliance have not been sufficiently evaluated from the patient’s point of view. Aim: The aim of this study was to survey patients for one week after insertion of the infra-zygomatic mini-implants and 1 week following every reactivation in order to evaluate their pain and discomfort as well as the percentage of mini-screw failure. Materials and methods: 10 patients requiring infra-zygomatic mini-implants were selected. All participants completed questionnaires for 7 days after insertion and after every reactivation. The patients responded to questions by placing a mark along a 10-cm-long visual analog scale (VAS). Results: The mean of the pain score of all activations showed a normal decreasing pattern with the pain being at its highest at the day of the activation and decreasing gradually by the end of the week. As for mini-implant failure, the overall failure rate of mini-implants was 30% throughout the trial period. With an immediate failure rate of 15% following mini-implant insertion. Conclusions: Putting into perspective patient comfort and success rate of the mini-implants these results suggest that infra-zygomatic mini-implants with an 85% immediate success rate are effective as skeletal anchorage devices and are a valid option in cases requiring distalization in the maxillary arch

Evaluation of pain perception associated with maxillary first molars distalization in the presence of maxillary third molars versus extracted third molars using infra-zygomatic mini-screws: A randomized clinical trial

Aim: The purpose of this randomized clinical trial was to compare the pain associated with distalizing maxillary first molars with the presence versus extraction of unerupted third molars using infra-zygomaic mini -screws in a group of adolescent female patients. Study design: This randomized clinical trial (parallel group design) was approved by the Research Ethics Committee of the Faculty of Dentistry, Future University in Egypt Materials and methods: 30 patients requiring bilateral maxillary molar distalization using infra-zygomatic mini-implant were randomly allocated to third molar extraction (TME) or third Molar presence (TMP) groups All patients were asked to assess their pain levels on the day of the mini-implant insertion procedure and after 24 hours, 72 hours, and 1 week using a numeric pain rating scale. Additionally, Each patient completed a numeric pain rating scale form on the day of mini-screw loading, 3 days, 1 week, and 2 weeks following appliance fixation. Every patient received three copies, and the first, third, and sixth appliance activations required the same pain response. Results: At the mini-implant site, the mean pain scores in the TMP and TME on the same day for screw insertion were 5.27±2.08 and 4.89±1.99, respectively. And faded away gradually in both groups. Throughout the distalization phase, the average pain severity at the maxillary molar site on the day of mini-implant loading was 4.2±1.46 in the TMP group and 4.13±2.2 in the TME group. That subsides gradually to mild pain after one week of each appliance activation. comparable results found between both groups Conclusion: Pain experienced by the patient during maxillary molar distalization is comparable regardless of the presence or absence of the third molar. The insertion of infra-zygomatic screws caused moderate to modest discomfort in both groups. The distalization procedure was associated with mild to moderate discomfort, which progressively subsided after the loading day

Acute respiratory alkalosis occurring after endoscopic third ventriculostomy -A case report-

An endoscopic third ventriculostomy was performed in a 55-year-old man with an obstructive hydrocephalus due to aqueductal stenosis. The vital signs and laboratory studies upon admission were within the normal limits. Anesthesia was maintained with nitrous oxide in oxygen and 6% desflurane. The patient received irrigation with approximately 3,000 ml normal saline during the procedure. Anesthesia and operation were uneventful. However, he developed postoperative hyperventilation in the recovery room, and arterial blood gas analysis revealed acute respiratory alkalosis. We report a rare respiratory alkalosis that occurred after an endoscopic third ventriculostomy

Role of anatomical sites and correlated risk factors on the survival of orthodontic miniscrew implants:a systematic review and meta-analysis

Abstract Objectives The aim of this review was to systematically evaluate the failure rates of miniscrews related to their specific insertion site and explore the insertion site dependent risk factors contributing to their failure. Search methods An electronic search was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Knowledge, Scopus, MEDLINE and PubMed up to October 2017. A comprehensive manual search was also performed. Eligibility criteria Randomised clinical trials and prospective non-randomised studies, reporting a minimum of 20 inserted miniscrews in a specific insertion site and reporting the miniscrews’ failure rate in that insertion site, were included. Data collection and analysis Study selection, data extraction and quality assessment were performed independently by two reviewers. Studies were sub-grouped according to the insertion site, and the failure rates for every individual insertion site were analysed using a random-effects model with corresponding 95% confidence interval. Sensitivity analyses were performed in order to test the robustness of the reported results. Results Overall, 61 studies were included in the quantitative synthesis. Palatal sites had failure rates of 1.3% (95% CI 0.3–6), 4.8% (95% CI 1.6–13.4) and 5.5% (95% CI 2.8–10.7) for the midpalatal, paramedian and parapalatal insertion sites, respectively. The failure rates for the maxillary buccal sites were 9.2% (95% CI 7.4–11.4), 9.7% (95% CI 5.1–17.6) and 16.4% (95% CI 4.9–42.5) for the interradicular miniscrews inserted between maxillary first molars and second premolars and between maxillary canines and lateral incisors, and those inserted in the zygomatic buttress respectively. The failure rates for the mandibular buccal insertion sites were 13.5% (95% CI 7.3–23.6) and 9.9% (95% CI 4.9–19.1) for the interradicular miniscrews inserted between mandibular first molars and second premolars and between mandibular canines and first premolars, respectively. The risk of failure increased when the miniscrews contacted the roots, with a risk ratio of 8.7 (95% CI 5.1–14.7). Conclusions Orthodontic miniscrew implants provide acceptable success rates that vary among the explored insertion sites. Very low to low quality of evidence suggests that miniscrews inserted in midpalatal locations have a failure rate of 1.3% and those inserted in the zygomatic buttress have a failure rate of 16.4%. Moderate quality of evidence indicates that root contact significantly contributes to the failure of interradicular miniscrews placed between the first molars and second premolars. Results should be interpreted with caution due to methodological drawbacks in some of the included studies