Metastatic malignant melanoma of the conjunctiva: a case report

BACKGROUND: Malignant melanoma of the conjunctiva is an extremely rare non-cutaneous neoplasm with infrequent skeletal metastatic spread. CASE PRESENTATION: We present the case of a 54 year old female Caucasian patient with osseous metastases originating from a malignant melanoma of her right conjunctiva. Metastatic deposits were identified in the left humeral diaphysis and left tibial metaphysis. Clinical, radiological and scintigraphic evaluation necessitated prompt stabilisation of both long bones. Following reamed intramedullary nailing and post-operative radiotherapy she remains asymptomatic six months post-operatively. CONCLUSION: This unusual pattern of metastatic spread to the appendicular skeleton of an extremely rare melanomatous lesion requires diagnostic vigilance as well as a multidisciplinary approach for accurate diagnosis, staging and management. Due to the poor prognosis, treatment goals should be directed to palliation of symptoms and prolongation of the quality of life

A three-year prospective cohort study evaluating implant stability utilising the Osstell® and Periotest™ devices

ObjectivesTo investigate implant stability measurements from two different devices and at three different time points in order to determine their level of correlation. To also evaluate the influence of a range of clinical characteristics on the values produced by the devices at these three time points.Materials & MethodsMeasurements were recorded at implant placement (T1), implant exposure (T2) and at 3 years from implant placement (T3). A range of clinical data was collected including patient demographics and site characteristics. Stability measurements and clinical characteristics were recorded for 29 patients and 68 dental implants at T1, subsequent stability measurements were recorded for 67 implants at T2 and 58 implants at T3. Correlation testing between the Osstell® and Periotest™ devices was carried out utilising Spearman's rank correlation for each time point. Analysis of the difference between clinical factors and stability measurements was compared using Kruskal-Wallis test for each variable and time point.ResultsA single dental implant failed shortly after second stage surgery for an overall survival rate of 98% during the study timeline. The median ISQ value was 73.25 (IQR 67–75) at T1 and 74 (IQR 70.5–77) at T3. The median Periotest value was −4 (IQR −6, −2) at T1 and −6 (IQR −7, −5) at T3. The range of ISQ values observed was 50 (39–89) ISQ at T1 and decreased to 21 (61–82) ISQ at T3. The Periotest values ranged from 37 (29 to −8) at T1 and decreased to 6 (−2 to −8) at T3. A weak to moderate correlation was observed between mean ISQ and Periotest values across time points T1, T2 and T3, (r = −0.26, p = 0.05), (r = −0.35, p < 0.01) and (r = −0.28, p = 0.04) respectively.ConclusionsBased on the results of this study there was a weak to moderate level of correlation between values recorded between the two measurement devices at implant placement, implant exposure and three years following placement. For both the Osstell® and Periotest™ a narrowing of the range of stability values was observed from T1 to T3. In general, Periotest™ seemed to be more sensitive in highlighting differences in measurements affected by local conditions

Primary prevention of peri-implantitis: Managing peri-implant mucositis

Abstract AIMS: Over the past decades, the placement of dental implants has become a routine procedure in the oral rehabilitation of fully and partially edentulous patients. However, the number of patients/implants affected by peri-implant diseases is increasing. As there are--in contrast to periodontitis--at present no established and predictable concepts for the treatment of peri-implantitis, primary prevention is of key importance. The management of peri-implant mucositis is considered as a preventive measure for the onset of peri-implantitis. Therefore, the remit of this working group was to assess the prevalence of peri-implant diseases, as well as risks for peri-implant mucositis and to evaluate measures for the management of peri-implant mucositis. METHODS: Discussions were informed by four systematic reviews on the current epidemiology of peri-implant diseases, on potential risks contributing to the development of peri-implant mucositis, and on the effect of patient and of professionally administered measures to manage peri-implant mucositis. This consensus report is based on the outcomes of these systematic reviews and on the expert opinion of the participants. RESULTS: Key findings included: (i) meta-analysis estimated a weighted mean prevalence for peri-implant mucositis of 43% (CI: 32-54%) and for peri-implantitis of 22% (CI: 14-30%); (ii) bleeding on probing is considered as key clinical measure to distinguish between peri-implant health and disease; (iii) lack of regular supportive therapy in patients with peri-implant mucositis was associated with increased risk for onset of peri-implantitis; (iv) whereas plaque accumulation has been established as aetiological factor, smoking was identified as modifiable patient-related and excess cement as local risk indicator for the development of peri-implant mucositis; (v) patient-administered mechanical plaque control (with manual or powered toothbrushes) has been shown to be an effective preventive measure; (vi) professional intervention comprising oral hygiene instructions and mechanical debridement revealed a reduction in clinical signs of inflammation; (vii) adjunctive measures (antiseptics, local and systemic antibiotics, air-abrasive devices) were not found to improve the efficacy of professionally administered plaque removal in reducing clinical signs of inflammation. CONCLUSIONS: Consensus was reached on recommendations for patients with dental implants and oral health care professionals with regard to the efficacy of measures to manage peri-implant mucositis. It was particularly emphasized that implant placement and prosthetic reconstructions need to allow proper personal cleaning, diagnosis by probing and professional plaque removal

Diagnosis and non-surgical treatment of peri-implant diseases and maintenance care of patients with dental implants - Consensus report of working group 3

The following consensus report is based on four background reviews. The frequency of maintenance visits is based on patient risk indicators, homecare compliance and prosthetic design. Generally, a 6-month visit interval or shorter is preferred. At these visits, peri-implant probing, assessment of bleeding on probing and, if warranted, a radiographic examination is performed. Diagnosis of peri-implant mucositis requires: (i) bleeding or suppuration on gentle probing with or without increased probing depth compared with previous examinations; and (ii) no bone loss beyond crestal bone level changes resulting from initial bone remodelling. Diagnosis of peri-implantitis requires: (i) bleeding and/or suppuration on gentle probing; (ii) an increased probing depth compared with previous examinations; and (iii) bone loss beyond crestal bone level changes resulting from initial bone remodelling. If diagnosis of disease is established, the inflammation should be resolved. Non-surgical therapy is always the first choice. Access and motivation for optimal oral hygiene are key. The patient should have a course of mechanical therapy and, if a smoker, be encouraged not to smoke. Non-surgical mechanical therapy and oral hygiene reinforcement are useful in treating peri-implant mucositis. Power-driven subgingival air-polishing devices, Er: YAG lasers, metal curettes or ultrasonic curettes with or without plastic sleeves can be used to treat peri-implantitis. Such treatment usually provides clinical improvements such as reduced bleeding tendency, and in some cases a pocket-depth reduction of --1 mm. In advanced cases, however, complete resolution of the disease is unlikely.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151295/1/idj12490_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151295/2/idj12490.pd

Conservative treatment of an anterior-lateral ankle dislocation without an associated fracture in a diabetic patient: a case report

Anterior or anterior-lateral dislocation of the ankle is a rare condition that can be treated conservatively as well as any other similar types of ankle dislocations without associated fractures. We present a case report of an anterior-lateral ankle dislocation with a concomitant avulsion injury of the ankle's anterior capsule in a diabetic patient that was treated conservatively. At the patient's visit 12 months after the initial injury, he was asymptomatic with full range of motion of the ankle joint. To our knowledge, we could not identify this type of an injury in a diabetic patient that was treated successfully with conservative treatment in the existing literature

Cowden syndrome. Managing multiple skeletal metastases of different origin: a case report

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The use of a combined bipedicled axial perforator based fasciocutaneous flap for the treatment of a traumatic diabetic foot wound: a case report

The axial and perforator vascularised fasciocutaneous flaps are reliable and effective treatment methods for covering lower limb post-traumatic, septic, Charcot, and diabetic foot wounds. The authors describe the unique utilisation of a hybrid flap as an axial-perforator flap combination for the treatment of a traumatic diabetic foot wound