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PubMed2006

Are titanium clips for control of the renal hilar vessels as unsafe as generally presumed?

Controlled ligation and division of renal vessels is a critical step during any nephrectomy procedure. It is generally been presumed that titanium clip ligation of renal vessels is risky and insecure. We report our experience over 5 years with ligaclips 10-mm titanium clips for secure ligation of renal hilum during laparoscopic nephrectomy. Titanium clips of 10 mm were used to secure renal vessels in 86 patients. We managed to get across the entire width of renal vein with a 10-mm titanium clip by crimpling the vein with the help of the clip applicator before firing the clips. In all except 2 cases ligaclips alone were enough to ensure secure occlusion of renal hilum. There was no incidence of slippage or dislodgement of clips applied on renal vessels. On cost analysis, it was found that the Hem-o-lok clip and gastrointestinal anastomosis stapling device were approximately 6-fold and 12-fold costlier than ligaclips. We also reviewed literature on different modalities available for renal hilar control during laparoscopic nephrectomy.

Equipment Design↗
PubMed2003

Histology of tissues within retrieved human titanium mesh cages.

STUDY DESIGN: Histologic documentation of contents within retrieved, failed human titanium mesh cages. OBJECTIVES: The purpose of this study is to describe the contents of a series of retrieved, clinically failed titanium mesh cages from human patients. SUMMARY OF BACKGROUND DATA: The use of interbody fusion cages is gaining rapid acceptance, but there is little histologic documentation of tissue within retrieved cages. METHODS: Eleven Titanium Surgical Mesh Cages (Harms; DePuy AcroMed, Raynham, MA) retrieved from 10 patients were histologically analyzed. Indications for cage retrieval included failed fusion or failed fusion with instrumentation failure. The cages had been in situ from 2 to 47 months. Histologic sections were reviewed qualitatively, and the approximate percent of area in the cage occupied by viable bone, necrotic bone, fibrocartilage, hyaline cartilage, fibrous tissue, and bone graft substitute was visually estimated. Particles of metal debris were estimated by a semiquantitative scoring system. RESULTS: All cages except one showed evidence of vascular ingrowth and areas of histologically viable bone, representing incorporating bone graft. At least a few particles of debris were present in 9 of 11 cages. Fibrocartilage of probable intervertebral disc origin ranged from 0% to 70% of the available area. Several cages contained small seams of fibrocartilage connecting segments of bone in a pattern that suggested a response to motion. CONCLUSIONS: Mean viable bone area within 11 retrieved, human titanium mesh cages was approximately 31%. Seams of fibrocartilage within the cages may represent tissue differentiation in response to bending or compressive load.

Adult↗
PubMed2006

Anterior thoracic spine reconstruction using a titanium mesh cage and pedicled rib flap.

STUDY DESIGN: A retrospective clinical study. OBJECTIVES: To evaluate the safety and efficacy of using an integrated titanium mesh cage and pedicled rib flap for thoracic spine reconstruction in patients at high risk of pseudarthrosis. SUMMARY OF BACKGROUND DATA: A variety of materials are available for interbody thoracic reconstruction; however, the optimal treatment of patients at high risk of pseudarthrosis remains a challenging problem. Free or pedicled bone flaps have been shown to be highly effective in terms of promoting fusion and titanium mesh cages provide excellent structural support. METHODS: Eleven patients who underwent anterior thoracic corpectomy and spinal reconstruction using an integrated titanium mesh cage and pedicled rib flap were analyzed with a mean follow-up of 37 months (range, 25-55 months). The etiology of spinal disease was infection in 7 (64%) patients and tumor in the remaining 4 (36%) patients. Seven (64%) patients were treated with only an anterior approach while the remaining 4 (36%) patients underwent circumferential spinal reconstruction. RESULTS: All patients demonstrated clinical and radiographic evidence of spinal fusion at the time of follow-up. All patients had stable or improved Frankel grades after surgery. There was a mean kyphosis correction of 7 degrees for both the focal and regional thoracic kyphosis. There were three significant postoperative complications: bilateral pleural effusion, gram-negative bacteremia, and transient right lower extremity weakness requiring reoperation and pedicle screw revision. Two patients died after surgery: one from aneurysmal subarachnoid hemorrhage and the other from complications of breast cancer. CONCLUSIONS: The use of an integrated rib flap and titanium mesh cage construct appears to be a safe and effective means of providing immediate and substantial anterior column support as well as achieving arthrodesis in challenging fusion candidates.

Adult↗
PubMed2007

Comparison of multisegment anterior cervical fixation using bone strut graft versus a titanium rod and buttress prosthesis: analysis of outcome with long-term follow-up and interview by independent physician.

STUDY DESIGN: A retrospective study of 73 consecutive patients who underwent cervical corpectomy and anterior strut fixation over 3 or more disc levels between July 1989 and May 1999. OBJECTIVE: To compare the efficacy of cervical spine fixation by autologous strut graft from iliac crest or fibula versus a titanium prosthesis without bone graft. SUMMARY OF BACKGROUND DATA: Strut grafting after multilevel anterior cervical corpectomy remains a challenging procedure, with published dislocation rates from 0% to 71%, and nonunion from 0% to 54%. This paper describes a quicker and easier alternative to the use of a bone strut, imparting a very high degree of immediate spinal stability, and osseous integration equivalent to bone fusion. METHODS: Thirty-eight bone-graft operations and 38 titanium prosthesis operations were performed on 73 patients between July 24, 1989 and May 20, 1999. Average follow-up was 53.2 months (range 19.8-134). RESULTS: The group of patients who received the prosthesis was significantly older than the bone-grafted group and required significantly more segments excised, but operation times were significantly shorter than for the bone strut operation. The titanium prosthesis had a lower incidence of dislodgement in the early postoperative period (1/38 vs. 4/38 for bone struts) but a higher rate of late reoperation (4/38 vs. 1/38 for bone struts). The SF-36 scores in the domain of Physical Function (only) were significantly higher in the bone-grafted group (P = 0.016, Mann Whitney), consistent with the difference in mean ages of the 2 groups. The groups were indistinguishable by Odom criteria, patient verdict, pain scores, analgesic intake, length of hospital stay, radiologic fusion rate, and residual symptoms. CONCLUSION: A titanium rod and buttress prosthesis may be a faster and easier alternative to conventional iliac crest/fibula autograft after multisegmental cervical vertebral corpectomy.

Adult↗
PubMed2006

Delayed reconstruction by titanium mesh-bone graft composite in pyogenic spinal infection: a long-term follow-up study.

OBJECTIVE: Use of instrumentation in spinal osteomyelitis remains controversial because of the perceived risk of persistent infection related to a devitalized graft and spinal hardware. Particularly, limited information is available regarding the long-term follow-up of patients. We retrospectively reviewed the use of titanium mesh-bone graft composite after corpectomy in pyogenic spinal infection with a minimum 3-year follow-up outcome. METHODS: Four patients, two men and two women, with cervical and thoracic myelopathy caused by cervical (two cases) and thoracic (two cases) osteomyelitis and epidural abscess, were treated. Their age ranged from 49 to 74 years (mean age 58 years). In one case, the coexisting medical condition was diabetes. Neurologic deficits caused by direct spinal cord compression due to epidural abscess, segmental deformity, and instability were observed in all cases. After infection was clinically controlled by intravenous antibiotics, anterior debridement and fusion using titanium mesh cage along with anterior plate were performed. Two-stage treatment was performed in two cases. RESULTS: The postoperative course was uneventful; all patients experienced relief of symptoms. No evidence of recurrence or residual infection was observed in any patient during the average follow-up period of 42-56 months (average 49.0 months). CONCLUSIONS: Once infection is clinically controlled, a titanium mesh-bone graft composite and plate in combination with aggressive debridement might provide an effective therapy for spinal osteomyelitis requiring surgery. Despite studying a small number of patients, we can conclude that titanium mesh reconstruction can be useful as a surgical method in selected low-risk patients with vertebral osteomyelitis.

Bone Transplantation↗
PubMed2005

Postoperative radiotherapy after titanium plate mandibular reconstruction for oral cavity cancer.

OBJECTIVE: To study the impact of postoperative radiotherapy (RT) on titanium plate mandibular reconstruction. METHODS: Between 1997 and 2002, 66 patients with oral cavity cancers had immediate titanium plate mandibular reconstruction. Thirty-four patients (51.5%) received postoperative RT and 32 patients were treated with surgery alone. Follow-up ranged from 12 to 58 months (median, 24 months). RESULTS: Sixteen of 66 patients (24.2%) had major complications. Ten of 34 patients (29.4%) who received RT had complications compared with 6 of 32 patients (18.8%) after surgery alone (P = 0.312). The plate was removed in 11 patients (16.7%). The success rate of titanium plate reconstruction was 27 of 34 patients (79.4%) who received RT and 28 of 32 patients (87.5%) after surgery alone (P = 0.378). CONCLUSION: The addition of postoperative RT did not increase the risk of complications or the likelihood of successful titanium plate reconstruction.

Aged↗
PubMed2005

Influence of titanium surface roughness on attachment of Streptococcus sanguis: an in vitro study.

The purpose of the present study was to investigate the efficacy of the decontamination protocol for bacterial removal in titanium surfaces with three different levels of roughness using a high-pressure sodium bicarbonate device for 1 minute under aseptic conditions. Group 1 was composed of 10 as-machined titanium sheets and Groups 2 and 3 of titanium sheets blasted with aluminum oxide (Al2O3, alumina) particles with different diameters: Group 2 was blasted with 65-microm particles and Group 3 with 250-microm particles. The titanium specimens were sterilized and incubated in tubes containing a suspension of Streptococcus sanguis. The colony-forming units were counted before and after the application of the decontamination protocol. The arithmetic mean roughness (R(a)) per group was: Group 1, 0.17 microm +/- 0.01; Group 2, 1.14 microm +/- 0.15; and Group 3, 3.17 microm +/- 0.23. After the contamination period, Group 1 remained with 49 x 10(3) bacterial cells, and the bacterial concentrations of Groups 2 and 3 were 11 x 10(4) and 35 x 10(5), respectively. After the application of the decontamination protocol, no viable bacteria were detected. With the increase of the surface roughness, an exponential increase in bacterial cells was observed. The results showed that the decontamination protocol treatment with a high-pressure sodium bicarbonate device efficiently removed all bacterial cells in all surfaces tested. This indicates that high-pressure sodium bicarbonate spray should be used in the maintenance phase of implant treatment.

Bacterial Adhesion↗
PubMed2006

Titanium membranes in prevention of alveolar collapse after tooth extraction.

BACKGROUND AND PURPOSE: The resorption of alveolar bone following tooth extraction results in a narrowing and shortening of the residual ridge, which leads to esthetic and restorative problems, and reduces the bone volume available for implant therapy. The aim of this study was to evaluate the prevention of alveolar collapse after tooth extraction, using titanium membrane (Frios Boneshield; DENTSPLY Friadent, Mannheim, Germany), associated (or not) with autologous bone graft. MATERIALS AND METHODS: A total of 10 nonsmoking healthy subjects, ranging from 35 to 60 years old, were selected for this study. Each patient had a minimum of 2 uni-radicular periodontally hopeless teeth, which were scheduled for extraction. After the procedure, 2 titanium pins were fixed on the vestibular bone surfaces that were used as references for the initial measures (depth, width, and height) of the socket. Of the sockets,1 was randomly chosen to be filled with autologous bone graft (test) removed from superior maxillary tuber, and the other one did not receive the graft (control). A titanium membrane was adapted and fixed, covering the sockets, which remained for at least 10 weeks. After a 6-month healing, the final measures were performed. RESULTS: There was exposure of the membrane in 5 of the 10 treated subjects. Average bone filling (+/-standard deviation) among the 10 subjects was 8.80 +/- 2.93 mm (range 4-13) in the control group and 8.40 +/- 3.35 mm (range 4-13) in the test group. Average bone loss in width in both group was 1.40 +/- 1.97 mm (range -4-1) in the control group and 1.40 +/- 0.98 mm (range -4-0) in the test group. There was no significant statistical difference between groups considering the evaluated standards. CONCLUSION: The use of titanium membrane, alone or in association with autogenous bone, favored the prevention of alveolar ridge after tooth extraction. This membrane seems to be a possible and safe alternative to other nonresorbable membranes when the prevention of alveolar ridge resorption is the objective.

Adult↗
PubMed2006

Simple reconstruction with titanium mesh and radial forearm flap after globe-sparing total maxillectomy: a 5-year follow-up study.

BACKGROUND: Reconstruction of eye globe-sparing total maxillectomy defects is one of the major challenges to reconstructive surgeons. In 1994, the authors developed an uncomplicated and easy reconstructive method, where a titanium mesh is applied for the support of orbital contents, a radial forearm free flap for covering the mesh and the cheek lining, and an obturator prosthesis for palatal and dental rehabilitation. METHODS: Five patients who underwent primary reconstruction with the authors' method after globe-sparing maxillectomy with loss of the orbital floor from 1994 to 1999 and who were followed up for more than 5 years were retrospectively reviewed for (1) the presence of diplopia, (2) the shape of the reconstructed orbital floor assessed by coronal section magnetic resonance imaging, and (3) the presence of infection/exposure of the titanium mesh. RESULTS: Only one of the five patients developed slight diplopia. Coronal magnetic resonance imaging showed that the orbital floor restored with titanium mesh had in all cases maintained a proper shape and position for more than 5 years. No infection or exposure of the titanium mesh had developed in any of the cases, despite exposure to irradiation of not less than 30 Gy. All the patients had well-retentive obturator prostheses. CONCLUSION: This long-term follow-up study demonstrated that the authors' method attained a long-lasting successful outcome functionally and is the method of choice for reconstruction after globe-sparing total maxillectomy.

Aged↗
PubMed2006

Skeletal stability in bimaxillary orthognathic surgery: P(L/DL)LA-resorbable versus titanium osteofixation.

BACKGROUND: One-year skeletal stability following bimaxillary orthognathic surgery was assessed by comparing poly(L-lactide-co-DL-lactide) to titanium osteofixation. METHODS: Thirty patients underwent osteofixation with poly(L-lactide-co-DL-lactide) copolymer and 30 had 2.0-mm titanium-miniplate osteosyntheses. Lateral cephalograms were analyzed preoperatively, postoperatively, and at 1-year follow-up. Average +/- SD values were as follows in resorbable plate-osteosyntheses (number of cases/titanium controls): for maxillary advancement, 3.5 +/- 4.1 mm (n = 19)/5.4 +/- 3.5 mm (n = 21); setback, 2.8 +/- 3.7 mm (n = 9)/1.9 +/- 1.8 mm (n = 8); elongation, 4.2 +/- 3.6 mm (n = 18)/3.7 +/- 5.2 mm (n = 14); and intrusion, 1.9 +/- 1.7 mm (n = 12)/3.3 +/- 2.7 mm (n = 13); for mandibular advancement, 4.6 +/- 3.6 mm (n = 10)/6.3 +/- 8.8 mm (n = 18); setback, 7.5 +/- 8.3 mm (n = 20)/7.2 +/- 3.2 mm (n = 12); enlargement of the mandibular angle, 11.8 +/- 9.9 degrees (n = 19)/7.9 +/- 6.6 degrees (n = 21); and reduction, 4.5 +/- 3.2 degrees (n = 9)/6.3 +/- 6.6 degrees (n = 9). RESULTS: Preoperative to postoperative landmark positions within the study and control groups differed highly significantly (p = 0.008, paired t test), yet the amount of operative movement was comparable between the study and control groups (p = 0.5, two-sided t test). Absolute instability at the advanced A-point was (study group/controls) 2.3 +/- 1.8/2.4 +/- 2 mm, setback was 2.3 +/- 1.9 mm/2.5 +/- 1.7 mm, elongation at the anterior nasal spine was 3.8 +/- 3.1 mm/3.1 +/- 3.6 mm, intrusion was 2.1 +/- 1.9 mm/2.2 +/- 1.5 mm, advancement instability at the B-point was 4.9 +/- 4.3 mm/5.1 +/- 8.2 mm, setback was 3.0 +/- 2 mm/1.7 +/- 2 mm, mandibular angle enlargement instability was 6.7 +/- 8.9 degrees/8.2 +/- 9.6 degrees, and angle narrowing was 6.8 +/- 5.2 degrees/4.2 +/- 5.9 degrees. Absolute postoperative instability did not differ significantly between the study and control groups (p = 0.6). CONCLUSIONS: Resorbable osteofixation as tested proved to be as reliable as titanium, but as the study and control groups were not matched, the results have to be interpreted as preliminary. Resorbable materials permitted clinically faster occlusal and condylar settling than standard titanium osteosyntheses, as bone segments showed slight clinical mobility up to 6 weeks postoperatively.

Absorbable Implants↗
PubMed1996

A comparison of stainless steel and nickel-titanium K-files in curved root canals.

The purpose of this study was to determine the effects of hand instrumentation using traditional stainless steel K-files and nickel-titanium K-files on the final shape of curved root canals. A total of 24 moderately curved canals in the mesial roots in extracted human mandibular first molars were randomly divided into two groups. These were instrumented manually using either stainless steel or nickel-titanium, K-files with the stepdown technique. The cross-sectional shape of each canal at three different horizontal levels were captured, before and after instrumentation, into a computer for comparison using image analyser software. Three parameters at each level were evaluated: (i) amount of dentine removed; (ii) least remaining dentine thicknesses on mesial and furcal aspects; and (iii) the amount and direction of canal transportation. The results showed that the two file types removed similar amounts of dentine at all three levels examined. The nickel-titanium files left a thicker layer of dentine on both the mesial and furcal aspects than stainless steel files. However, the difference was not significant (pooled T-test, P > 0.05). Both types of files transported the centre of the canals but the nickel-titanium instrument seemed to be safer because of the reduced amount of transportation towards the danger areas.

Dental Instruments↗
PubMed2006

Influence of phase transformation on the torsional and bending properties of nickel-titanium rotary endodontic instruments.

AIM: To investigate the relationship between the functional properties and the phase transformation of nickel-titanium endodontic instruments. METHODOLOGY: Five types of rotary nickel-titanium endodontic instruments with a 0.30 mm diameter tip (EndoWave, HERO 642, K3, ProFile.06, and ProTaper) were selected to investigate torsional and bending properties, and phase transformation behaviour. A torsional test was performed according to ISO publication 3630-1, and maximum torque and angular deflection at fracture were measured. Bending load of the instruments was measured in a cantilever-bending test at 37 degrees C with the maximum deflection of 4.0 mm. A stainless steel K-file was used for reference. Phase transformation behaviour was measured by differential scanning calorimetry (DSC). From the DSC curve, transformation temperatures were calculated. Data were analysed by anova and the Tukey-Kramer's test. RESULTS: The maximum torsional torque values of HERO, K3 and ProTaper were significantly higher (P < 0.05) than those of EndoWave, ProFile and K-file. The K-files had the lowest torque value. Angular deflection at fracture was significantly higher (P < 0.05) for K-files than that for any nickel-titanium instrument. The bending load values of HERO and K3 were significantly higher (P < 0.05) than those of EndoWave, ProFile, ProTaper and K-file. The K-files had the lowest load value, although residual deflection remained. The transformation temperatures of HERO and K3 were significantly lower (P < 0.05) than those of EndoWave, ProFile and ProTaper. CONCLUSIONS: The functional properties of nickel-titanium endodontic instruments, especially their flexible bending load level, were closely related to the transformation behaviour of the alloys.

Calorimetry, Differential Scanning↗
PubMed1995

Biocorrosion study of titanium-cobalt alloys.

The present work provides experimental results of corrosion behaviour in Hank's physiological solution and some other properties of in-house fabricated titanium-cobalt alloys with cobalt ranging from 25-30% in weight. X-ray diffraction (XRD) shows that, in water-quenched (WQ) alloys, beta-titanium is largely retained, whereas in furnace-cooled (FC) alloys, little beta-titanium is found. Hardness of the alloys increases with increasing cobalt content, ranging from 455 VHN for WQ Ti-25 wt% Co to 525 VHN for WQ Ti-30 wt% Co. Differential thermal analysis (DTA) indicates that melting temperatures of the alloys are lower than that of pure titanium by about 600 degrees C. Potentiodynamic polarization results show that all measured break-down potentials in Hank's solution at 37 degrees C are higher than 800 mV. The breakdown potential for the FC Ti-25 Wt% Co alloy is even as high as nearly 1200 mV.

Biocompatible Materials↗
PubMed1995

Adhesive bonding of titanium with a methacrylate-phosphate primer and self-curing adhesive resins.

The adhesive bonding of titanium was evaluated with the use of a metal primer and three types of self-curing luting agent. The primer contained 10-methacryloyloxydecyl dihydrogen phosphate (MDP). One luting agent was a composite material that contained the MDP monomer in its liquid part. The other luting agent was based on methyl methacrylate (MMA), initiated with tri-n-butylborane derivative (TBB), and contained 4-methacryloxyethyl trimellitate anhydride (4-META). The MMA-TBB resin without 4-META was used for the control. Pure titanium metal specimens were bonded with various combinations. Shear bond strengths were determined after repeated thermocycles in water. Both MDP and 4-META were effective in bonding titanium. The decrease in bond strength was minimum when the titanium was primed with MDP and then bonded with the TBB-initiated resins.

Acrylic Resins↗
PubMed1995

Three-dimensional distortion of gold alloy castings and welded titanium frameworks. Measurements of the precision of fit between completed implant prostheses and the master casts in routine edentulous situations.

Thirty routine patients, provided with fixed prostheses supported by osseointegrated Brånemark implants in edentulous lower jaws, were arranged into three different groups with regard to design of the metal framework. Ten patients received cast gold alloy frames and the other two groups were provided with two different designs of welded titanium frames. The fit of the completed prostheses was measured in three dimensions (3-D) in relation to the master cast, by means of a photogrammetric technique, prior to insertion. Mean 3-D distortion of the centre point of the gold cylinder was 42 (s.d. 8) microns for the cast framework. The corresponding mean distortion for the two designs of titanium frameworks was 43 (s.d. 16) and 36 (s.d. 10) microns, respectively. Least distortion was observed in vertical direction for all three designs. None of the different designs of metal frames showed a significantly better fit (P > 0.05), but the cast and oldest titanium framework design presented a much wider range of distortion. This indicated a higher risk of sectioning and resoldering during the fabrication of the prostheses as compared to the more consistently fabricated prostheses, with a new titanium framework design.

Dental Casting Technique↗
PubMed2003

Corrosion susceptibility of titanium covered by dental cements.

Titanium has become a material of great interest in prosthodontics in recent years because of its excellent biocompatibility, corrosion resistance and desirable physical and mechanical properties. In this study, we determined the influence of dental cements on the passivation of titanium. We developed experimental electrodes that associate titanium and dental cements. Polarization resistance of titanium electrodes has been determined for uncovered metal and electrodes covered with five different dental cements. Coverage with zinc eugenate led to more resistance to corrosion, but fluorinated composite such as glass-ionomer and zinc phosphate coverage increased the corrosion susceptibility.

Corrosion↗
PubMed2004

The effect of Goldbonder on the adhesion between porcelain and pure titanium.

The present study examines the effect of a Goldbonder on the adhesion between titanium and porcelain as measured by the strain energy release rate (G) associated with the interfacial fracture of porcelain and titanium. The influence of surface treatment of titanium prior to Goldbonder application was also examined. The porcelain side of the specimens was notched to the interface with a thin diamond saw, and then a pre-crack was made at the metal-porcelain interface by a special jig. The samples were subjected to a four-point bending test resulting in stable crack extension from which G was calculated. Both the cracked cross-section of interface and peeled fracture surface were examined with scanning electron microscope (SEM). The mean G values were 81.57 +/- 10.34, 46.01 +/- 14.83, and 15.98 +/- 1.76 J m(-2) for the sandblasted surface with the Goldbonder, polished surface with the Goldbonder, and sandblasted surface with the Pastebonder, respectively. The G values revealed significant differences (P < 0.01) between Goldbonder and Pastebonder, and between the sandblasted and polished surfaces with Goldbonder. The SEM photographs and elemental analysis showed that Goldbonder developed both chemical and mechanical bonding to titanium and porcelain.

Dental Bonding↗
PubMed1986

Titanium dioxide deposition and adenocarcinoma of the lung.

A case of titanium dioxide pneumoconiosis accompanied by lung cancer is reported. The patient was a fifty-three-year-old male, who was engaged in packing titanium dioxide for about thirteen years. At autopsy, a papillary adenocarcinoma was located in the right lung. Titanium was diffusely deposited in the lung and was engulfed by macrophages in the interstitium and alveolar spaces. Slight fibrosis of the interstitium around bronchioles and vessels was noticed as an effect of titanium deposition.

Adenocarcinoma↗