Endosonographic monitoring of Sphinkeeper® prostheses movements: does physical activity have an impact?

The Sphinkeeper® procedure for treating faecal incontinence (FI) may be associated with potential implant migration (IM) and dislocation (ID), with considerable variations regarding their occurrence and effects on consecutive functional outcome. This study assessed IM and ID following the Sphinkeeper® procedure and its correlation with physical activity. This was a prospective observational clinical study of ten patients undergoing Sphinkeeper® operation due to FI between August 2020 and November 2020 at the Medical University of Vienna. Patients were followed-up after 1, 2, 3 and 6 months and 1 year postoperatively. Each follow-up visit included endosonographic monitoring of protheses location and manometric examinations. Additionally, functional outcome and physical activity were assessed using validated standardized questionnaires. The median number of prostheses implanted was 10 (IQR 9-10). The St. Mark's incontinence (SMS) score improved significantly until the last follow-up (p = 0.049), without observing a significant effect on the physical SF-12 score. The median rate of implants leading to IM and ID was 3 (range 1-4) and 2 (range 1-2) after 3 months of follow-up. A strong association of deltaSMS with number of dislocated prostheses at one month after Sphinkeeper® implantation was observed (r = 0.654, p = 0.078). Physical activity, assessed by the international physical activity questionnaire, did not have an impact on the correct prosthesis placement (1 month: p = 0.527; 2 months: p = 0.886; 3 months: p = 0.180; 6 months: p = 0.111). IM and ID of Sphinkeeper® prostheses occurred frequently early after surgery and affected functional outcome negatively. Physical activity did not have an influence on the implants displacement.

Investigation of microleakage between titanium and porcelain

Porcelain was applied to 30 titanium and 30 Remanium CS disc-shaped frameworks in order to investigate the microleakage. Each group was divided to three subgroups each containing 10 specimens and representing the different firing cycles (10 specimens for opaque + dentine; 10 specimens for opaque + dentine + enamel; and 10 specimens for opaque + dentine + enamel porcelain + glaze application). All the specimens were stored in 37 degrees C distilled water for 2 weeks and subjected to 100 thermocycles between 5 and 55 degrees C with 30 s dwell time. The specimens were then stored in 5% basic fuchsin dye for 2 days. The washed, rinsed and air dried specimens were embedded in autopolymerizing resin and sectioned diametrically. The stereoptical investigations were performed by three independent investigators. The data were analysed by the Mann-Whitney U-test. The statistical analysis revealed that the different number of firings does not affect the amount of microleakage. However, it should be emphasized that the use of titanium would be beneficial regarding the relatively lower values obtained from the titanium-porcelain group.