Individual moulds for contact pulsed dose rate brachytherapy in head and neck cancer

AimTo present three cases treated with contact pulsed dose rate (PDR) brachytherapy using individually prepared moulds.Materials/MethodsThe study group included one case of hard palate cancer treated with brachytherapy, applied as a boost to external beam radical irradiation and two cases of recurrent ethmoid and maxillary sinus cancer in which we administered palliative brachytherapy as the sole treatment for tumours located within previously irradiated areas.ResultsGood fitting of the moulds to the target was obtained. Satisfactory local control, including complete hard palate cancer remission for six years, and acceptable side effects were achieved.ConclusionsContact PDR brachytherapy using individually constructed moulds allows for the treatment of anatomical structures with difficult access. This method seems to be an effective and relatively safe treatment option for tumours located within previously irradiated areas

PDR brachytherapy: a report on one – year clinical experience at the Medical University of Gdańsk

PurposeOne-year clinical experience with pulse dose rate (PDR) brachytherapy is presented.Material and methodsBetween March 1999 and June 2000 intracavitary, intraluminal, and interstitial PDR brachytherapy was performed in 119 patients with a variety of malignancies. The dose per pulse of 0.5–4 Gy, repeated each hour, or 6 Gy per application was administered, up to the total dose of 6–70 Gy, using a microSelectron-PDR remote afterloading system with a 192Ir source of 1 Ci nominal activity. The planning system PLATO BPS (version 13) was used for dose calculations. Depending on individual applications, the algorithms of the dose point, the geometrical volume, or the geometrical point dose distribution optimization in PDR treatment planning were performed. In 40 patients therapy was given with a curative intent, and 74 cases were treated palliatively. In the remaining five patients PDR was applied as salvage therapy in the previously irradiated area.ResultsWith a median follow-up of 11 months (range 1–18 months) local control was maintained until the last follow-up or death in 39 out of 40 patients treated with radical intent. The subjective improvement was achieved in more than a half of patients with advanced esophageal and lung carcinomas presenting dysphagia and dyspnoe. Significant acute toxicity (severe esophagitis precluding subsequent POR application) occurred in only one patient. Delayed vaginal cuff necrosis was observed in one woman who received prior pelvic irradiation for gynaecological cancer.ConclusionThe PDR brachytherapy is a safe and clinically effective method in a variety of malignancies. The possibility of programme optimization combined with the use of relatively wide range of pulse doses makes it possible to deliver an optimal brachytherapy scheme

Guided Endodontics as a Personalized Tool for Complicated Clinical Cases

The aim of this paper is to present a technique to individualize root canal localization in teeth with calcified root canals using a digitally planned, 3D-printed endodontic guide. Root canal calcification is characterized by the apposition of tertiary dentin along the canal wall. The endodontic treatment of teeth with calcified canals is often challenging. However, digital dentistry meets these challenges. Merging CBCT images with an intraoral scan allows a clinician to prepare an endodontic guide. This article describes the clinical and digital workflow of the guided endodontic access approach in teeth with difficulties in terms of root canal localization due to post-traumatic pulp canal obliteration (PCO) and canal calcification in elderly patients. The path of entry into the root canal system was planned using cone-beam computed tomography (CBCT). The template was printed on a 3D printer using transparent resin. During root canal treatment (RCT), the endodontic tool was inserted through the sleeve until the desired location was reached. The use of an endodontic guide allowed for minimally invasive RCT, avoiding the excessive loss of tooth structures. Navigated endodontics enables clinicians to perform RCT in a more predictable manner and allows clinicians to avoid iatrogenic complications, which improves the treatment prognosis

Development of Custom Anatomic Healing Abutment Based on Cone-Beam Computer Tomography Measurement on Human Teeth Cross-Section

Introduction: Nowadays, the final success of implantation is not only based on obtaining osseointegration of the implant but is also determined by achieving a satisfactory aesthetic effect of the soft tissues surrounding the implant, which can be defined as an aesthetic integration. The process of obtaining this aesthetic integration already begins at the stage of placing the healing abutment, which allows us to obtain the emergence profile necessary for our prosthetic reconstruction. Materials and Methods: The study used cone-beam computer tomography (CBCT) scans of 51 patients. The measurements of the maxillary teeth (central incisor, lateral incisor, canine, first premolar, and first molar) were performed from cross-sections of the individual teeth at the transition zone to design a custom anatomic healing abutment milled from zirconium and luted to the non-index Ti-base. Results: The obtained results allowed to design and create the shape of the anatomic healing abutment. Conclusions: The use of laboratory-produced anatomical healing abutments is possible and may allow to obtain the desired and planned emergence profiles of prosthetic restorations. In addition, it might be a method of reducing work time at the dental chair but further clinical trials are necessary

PDR brachytherapy: a report on one – year clinical experience at the Medical University of Gdańsk

SummaryPurposeOne-year clinical experience with pulse dose rate (PDR) brachytherapy is presented.Material and methodsBetween March 1999 and June 2000 intracavitary, intraluminal, and interstitial PDR brachytherapy was performed in 119 patients with a variety of malignancies. The dose per pulse of 0.5–4 Gy, repeated each hour, or 6 Gy per application was administered, up to the total dose of 6–70 Gy, using a microSelectron-PDR remote afterloading system with a 192Ir source of 1 Ci nominal activity. The planning system PLATO BPS (version 13) was used for dose calculations. Depending on individual applications, the algorithms of the dose point, the geometrical volume, or the geometrical point dose distribution optimization in PDR treatment planning were performed. In 40 patients therapy was given with a curative intent, and 74 cases were treated palliatively. In the remaining five patients PDR was applied as salvage therapy in the previously irradiated area.ResultsWith a median follow-up of 11 months (range 1–18 months) local control was maintained until the last follow-up or death in 39 out of 40 patients treated with radical intent. The subjective improvement was achieved in more than a half of patients with advanced esophageal and lung carcinomas presenting dysphagia and dyspnoe. Significant acute toxicity (severe esophagitis precluding subsequent POR application) occurred in only one patient. Delayed vaginal cuff necrosis was observed in one woman who received prior pelvic irradiation for gynaecological cancer.ConclusionThe PDR brachytherapy is a safe and clinically effective method in a variety of malignancies. The possibility of programme optimization combined with the use of relatively wide range of pulse doses makes it possible to deliver an optimal brachytherapy scheme