A remote controlled haptic drilling robot for oral and maxillofacial surgery

207 Complications of sialendoscopy in Sjögren’s syndrome patients K. Karagozoglu ∗ , J. de Visscher, T. Forouzanfar, F. Maarse, E.H. van der Meij, D. Jager Department of Oral and Maxillofacial Surgery and Oral Pathology, VU University Medical Center, Amsterdam, The Netherlands Background: In literature it is suggested that sialendoscopy of the major salivary glands could possibly alleviate symptoms of Sjögren’s syndrome (SS).1 Objectives: To evaluate our experiences of sialendoscopy of the salivary glands in patients with SS. Methods: In this retrospective case series study the surgical data of patients with SS who had undergone sialendoscopy were used. Outcome measures were successful entry in the salivary gland and completion of sialendoscopy as planned. Furthermore, perand postoperative complications were scored. Findings: Data of sialendoscopic procedures in 26 patients with SS (24 females and 2 males; mean age, 57 years (range, 27–72 years) were analysed. Sialendoscopy was successfully performed in 78 salivary glands (75%), 50 parotid and 28 submandibular glands, of the 104 salivary glands in the 26 patients. Sialendoscopy failed in 26 (25%) of the 104 sialendoscopic procedures (2 parotid and 24 submandibular glands). In 16 salivary glands the ductal orifice could not be identified. In seven salivary glands sialendoscopy could not be performed due to partial or complete stenosis of salivary duct. In three salivary glands sialendoscopy was not performed because of a ductal perforation. Three patients developed a postoperative infection. Conclusion: Overall rate of complications was limited and types of complications in patients with SS could be regarded as minor. Most complications were seen in sialendoscopy of the submandibular glands. Careful preoperative selection of both patients and salivary glands may contribute to a lower rate of complications and more predictable results.

Reference 1. Jager, D. J., Karagozoglu, K. H., Maarse, F., Brand, H. S., & Forouzanfar, T. (2016). Sialendoscopy of salivary glands affected by Sjögren syndrome: a randomized controlled pilot study. J Oral Maxillofac Surg, 74, 1167–1174.

http://dx.doi.org/10.1016/j.ijom.2017.02.703 A remote controlled haptic drilling robot for oral and maxillofacial surgery H. Kawana ∗ , S. Usuda, K. Yu, T. Nakagawa, K. Ohnishi Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, School of Medicine, Keio University, Tokyo, Japan Background: Surgeons are required advanced techniques and experiences to handle drilling devices correctly. The lack of these may bring on overcuts and damages to the surrounding tissue. This situation has risks of causing the subsequent complications or life-threatening accidents by heavy bleeding and nerve damage. Objectives: In order to solve this problem for any surgeons, we developed a remote controlled haptic drilling robot.

Methods: The system consists of a master robot and a slave robot. The master robot is a robot that surgeons operate, and the slave robot is a robot that interacts with the cutting material. The force and position of robots are transmitted in both directions by bilateral remote control. Pine and Balsa wood were used as phantoms. They have same hardness of porous cortical bone and dense trabecular bone as mentioned in Misch’s bone density classification. They were drilled continuously and the value of the force scaling function was calculated from the maximum motor torque and the cutting force. Findings and Conclusion: We succeeded to send haptic sense from 15 km remote site. Although the force of master robot was increased, the force scaling function decreased the force of slave robot. It made slave robot stop around the position limitation and the error was in 60 ␮m. It was only 2.5% of 2 mm margin. The validity of the proposal was confirmed using phantoms individually. The drill could successfully stop within safe position from the position limitation. Higher accuracy was expected by fine adjustment in force scaling. http://dx.doi.org/10.1016/j.ijom.2017.02.704 Evaluation of bone grafting materials based on characterisations of surrounding multinucleated giant cells in human biopsies M. Kobayashi ∗ , R. Miron, D.D. Bosshardt University of Bern, Bern, Switzerland Background: Numerous bone grafting materials have been used for bone augmentation procedures. Multinucleated giant cells (MNGCs) have widely been detected around bone grafting materials as key contributors to bone metabolism and immunology by participating as osteoclasts (OCs) in the resorption of bone grafts or as foreign body giant cells during material rejection. Objectives: The aim of this study was to investigate their phenotypes around bone grafting materials by utilising 23 markers to identify differences between OCs and MNGCs as well as to characterise their potential to polarise towards classical tissue-inflammatory M1-macrophages or wound-healing M2macrophages. Methods: Three human bone biopsies undergoing alveolar bone augmentation procedures with either deproteinised bovine bone mineral (DBBM) or biphasic calcium phosphate (BCP) were investigated. The specimens were tested for marker-specific antibodies for MNGC, OC, general macrophage, M1, or M2 phenotypes by enzyme and immunohistochemical staining. Findings and Conclusion: It was found that giant cells around DBBM and BCP expressed not only typical OC markers (e.g. TRAP, cathepsin K, RANK) but also expressed exclusive MNGCspecific markers (e.g. CD86, CD98 and HLA-DR). Furthermore, while MNGCs around both DBBM and BCP expressed general macrophage markers (e.g. CD68, EMR1), they also showed the ability to polarise towards classical M1-(CD64, CD197) and M2(CD163, CD206) macrophages. The findings illustrate the fact that MNGCs found around bone grafting materials show specific phenotypes of macrophage lineages not found in OCs. Furthermore these MNGCs showed the potential to polarise towards M1- or M2-phenotypes. http://dx.doi.org/10.1016/j.ijom.2017.02.705