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Cracked (Fractured) Tooth

Management Team

Cracked (Fractured) Tooth

Overview

A cracked tooth is associated with tooth damage caused by an external force; this damage causes a small fracture or crack on the tooth. While sometimes, the crack is and does not affect the function of the tooth, on other occasions, the tooth may split or break into pieces. A severely cracked tooth represents a dental emergency.

While any tooth is susceptible to cracking, often, the upper front teeth and those at the back of the lower jaw (mandibular molars) are most prone to fracture. Another clinical term for cracked tooth is ‘cracked tooth syndrome’ (CTS).

Teeth cracking is commonly attributed to one or more of the following causes:

  • Age: With ageing, teeth are often worn out; this is associated with a higher risk of tooth cracking. The incidence of tooth fracture is higher among subjects aged 50 years or above than among younger people.
  • Dental trauma: Blows to the mouth (for example, during a vehicular accident or fall) could cause tooth cracking.
  • Biting hard foods: Biting on hard food items, such as candy, popcorn kernels, certain fruits, or ice, can cause tooth cracks.
  • Dental treatments: Dental procedures, such as a root canal or a large dental filling, especially when a dental crown is not placed, may weaken the teeth, increasing the chances of developing tooth cracks.
  • Bruxism (teeth grinding): Psychological stress and other mental issues may result in tooth grinding, which, over time, increases the chances of tooth cracking.

Tooth fracture is not always associated with the development of symptoms; however, when symptoms, are indeed caused, they include:

  • Sharp toothache associated with chewing or biting.
  • Heightened sensitivity to temperature changes or sweet food.
  • Inflammation in areas surrounding the tooth.
  • If left untreated, infections (tooth abscesses), which may cause serious health issues, can develop.

To diagnose a fractured tooth, a dentist may perform the following steps:

  • History taking: A complete, comprehensive medical history, including details regarding possible causes/exposure to risk factors and symptoms, is collected.
  • Oral examination: The following steps may be performed by the dentists:
    • Checking for pain by requesting the patient to bite down on a stick.
    • Checking the tooth for signs of damage, such as cracks/fractures using a periodontal probe.
    • Examination of the gums for detecting inflammation (vertical fractures may cause gum irritation).
    • Transillumination: Passing light through the tooth to illuminate and visualise the crack.
    • Staining: Administration of a staining dye on the tooth for a clear view of the tooth crack.
  • Dental X-ray: X-ray imaging is performed to detect and view fractures and related issues (bone malformations or bone loss).

A 3D scanning technique called cone beam computed tomography, which can pinpoint bone loss that may be indicative of a fracture, may also be performed.

If the patients experience any of the aforementioned symptoms or suspect that they have a cracked tooth, they are advised to schedule a dental appointment.

A cracked tooth cannot heal by itself. The extent and severity of the fracture determine the course of treatment. Treatment may not be required for mild cracks, which do not cause infection or pain. The repair may take weeks to months depending on the treatment. Common methods for treating cracked teeth include: 

  • Dental bonding: The cracks are filled with tooth-coloured composite resin.
  • Dental contouring: The rough edges may be smoothened out and polished after ascertaining the areas where the affected tooth makes excessive contact with the opposite teeth.
  • Dental crown: A ceramic/porcelain/resin-based cap is fitted over the cracked tooth.
  • Dental veneers: Custom-made porcelain or plastic shells are fitted, usually permanently, over the front surface of the tooth.
  • Root canal treatment: For cases in which tooth cracks extend into the dental pulp and thus, cause infection, a root canal treatment may be performed for the removal of the infected pulp tissues.
  • Tooth extraction: For cases in which tooth cracks severely damage the root and nerves, causing pain and sensitivity, tooth removal is recommended; afterwards, the application of a dental bridge or implant as a replacement for the extracted tooth is often performed.

With timely diagnosis and treatment, repaired teeth last over the long-term, i.e., a few years, without causing any other complications. However, in some cases, even after treatment, tooth cracks may split or widen, resulting in tooth loss.

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Fluorosis

Management Team

Fluorosis

Overview

Fluorosis refers to a dental condition associated with the formation of brown or white speckles on the teeth. These speckles often range from almost-unnoticeable tiny white flecks to conspicuous dark-brown patches. Generally considered a cosmetic issue, fluorosis is not harmful to the general health; nonetheless, several treatments may be used to address the issue. Dental fluorosis primarily affects people exposed to excess levels of fluoride during their developmental years, before the eruption of the adult (permanent) teeth. Teeth that have already erupted cannot develop fluorosis.

Dental fluorosis is a consequence of the consistent ingestion of excess levels of fluoride by children while their permanent teeth continue to form. Methods of ingestion include swallowing fluoride toothpaste or the consumption of heavily fluoridated water. Given that fluorosis only affects the developing teeth (under the gums), it does not occur in adults.

Depending upon how severe fluorosis is, the extent of tooth discoloration, which is often the only symptom of fluorosis, varies. Fluorosis can be categorised as follows:

  • Questionable: Only a few light-white spots and flecks on the tooth surface.
  • Very mild: Light-white areas covering less than 25% of the tooth surface.
  • Mild: Light-white areas covering less than 50% of the tooth surface.
  • Moderate: Light-brown or white areas covering over 50% of the tooth surface.
  • Severe: Light- or dark-brown or white spots affecting the surfaces of all teeth; pitting may also be observed.

Dental fluorosis does not impact oral function or overall oral health; interestingly, fluorosis has been found to render teeth more resistant to cavities.

Fluorosis is often diagnosed during routine dental examinations.

If the fluorosis stains make patients conscious, they are advised to schedule an appointment with a dentist, who will discuss the treatment options in detail.

As brushing and flossing are generally ineffective, cosmetic dental treatments, such as the application of veneers or crowns or dental bonding, represent the only method to get rid of fluorosis. Several factors, including the severity of fluorosis and the patient’s personal preferences and budget, influence the choice of treatment. The common methods for fluorosis treatment include the following:

  • Teeth whitening: The teeth are treated with a bleaching gel for a specific time duration. Thus, the tooth enamel is lightened to a shade that matches the white specks of fluorosis. This method is often a viable for treating patients with mild fluorosis.
  • Dental bonding: A resin made from a tooth-coloured composite is used to conceal the fluorosis stains. Then, the dentist polishes and shapes the teeth to give it a natural look.
  • Dental veneers: Custom-made veneers (thin resin, ceramic, or porcelain shells that adhere permanently to the front surfaces of the teeth) are created by making a dental impression to achieve the correct size and fit.
  • Dental crowns: Similar to veneers, crowns are often custom-made. However, because crowns are fit over the entire tooth, some of the natural enamel will need to be removed to ensure that proper fitting of the crown.
  • Enamel microabrasion: A small layer of enamel is removed to eliminate several fluorosis stains. Often, enamel microabrasion is combined with teeth whitening to ensure uniformity in teeth colour.
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Diastema

Management Team

Diastema

Overview

Diastema refers to the presence of an unusual gap between teeth, most commonly occurring between the front two teeth. Diastema affects both children and adults; however, gaps between the milk teeth of children are normal and usually close once their permanent (adult) teeth erupt.

Diastema is reported to be hereditary; several people are genetically prone to this condition. Sometimes, family history serves as a risk factor for this condition. The other causes of diastema are as follows:

  • Missing teeth or reduced tooth size
  • Oversized frenum (the connective tissue band that connects the gums and lips).
  • In some cases, an abnormal swallow reflex has been linked to the development of diastema. Under normal circumstances, while swallowing, the tongue presses against the roof of the mouth. However, repeated pressure resulting from the tongue being pressed against the front teeth may result in the gradual formation of a gap between teeth.
  • In some people, advanced gum disease causes the formation of gaps between the teeth. In such cases, the infection in the gums erodes the bone underneath, thus loosening the teeth and eventually, causing the formation of a gap.

Patients with the aforementioned conditions are at a risk for developing diastema.

A gap between the teeth is the only sign of diastema, provided the teeth and gums are healthy. If the gap is caused by a gum disease, patients may notice inflammation, redness, pain, or other gum disease-specific symptoms. Given that diastema does negatively impact the oral health, it is not a matter of concern, unless it is a consequence of gum disease. Plenty of corrective cosmetic treatments are available for patients that prefer to close the gaps between their teeth.

Diastema is often diagnosed by dentists during a routine dental exam, without the need for further testing.

Patients that are bothered by gaps between their teeth are advised to schedule a dental consultation. Dentists discuss the treatment options with the patients in detail. Nonetheless, an increasing gap between teeth would require prompt action.

There are several methods to correct and/or treat diastema. The cause and nature of diastema (whether it is a result of gum disease or merely of cosmetic concern) determines the course of treatment.

  • Cosmetic treatments for diastema: Several cosmetic dental treatments are available for patients with otherwise healthy teeth simply wish to close the gaps:
    • Dental bonding: To conceal the gaps, the dentist will apply a tooth-coloured composite resin onto the tooth/teeth. Thereafter, to ensure that the teeth have a natural look/appearance, they are shaped and polished.
    • Application of porcelain veneers: Custom-made ceramic shells (veneers), when attached (often permanently) onto the front teeth, close the gaps between the teeth, offering a more uniform look.
    • Application of braces: If the gaps are large, the teeth may need to be physically moved together via the use of orthodontic treatments, i.e., clear orthodontic aligners or braces. In mild cases, diastema can usually be fixed without braces.
    • Frenectomy: The presence of an oversized/thick oral frenum causes the teeth to be pushed apart, resulting in the formation of a gap. A frenectomy serves to either remove or loosen the frenum. In many cases, frenectomy is performed along with other cosmetic procedures, such as veneer application or dental bonding.
    • Application of dental bridges: Dental bridges are often recommended by dentists if a missing tooth is the cause of diastema; the bridges serve to replace the tooth. To place a bridge, the presence of two healthy teeth on either side of the gap is necessary; these teeth are altered to serve as anchors that hold the bridge in place.
    • Application of dental implants: Similar to a dental bridge, an implant serves as a replacement for a missing tooth. However, the application of a dental implant does not necessitate the reshaping of the neighbouring teeth. Implant application involves the placement of a threaded titanium post to replace a missing tooth root; once the tissues around the implant heal, a dental crown is fixed to close the gaps between the teeth.
  • Gum disease treatment for diastema: If gum disease is cause of diastema, the dentist would need to first perform periodontal treatment to eliminate the harmful bacteria. After the infection is treated, patients can choose to get rid of the gap between the teeth using one or more of the aforementioned cosmetic treatments. Common methods for gum treatments include the following:
    • Teeth cleaning: For cases for mild gum disease, deep dental cleaning, i.e., scaling and root planing, is recommended by dental experts. This process is similar to a regular cleaning procedure; however, during deep cleaning, the gums will be numbed to provide relief from pain or discomfort while the dentist attempts to clear the bacteria present in the deeper crevices under the gums.
    • Gingival flap surgery: For cases of moderate to advanced gum disease, gum surgery may be needed. During this procedure, an incision is created along the gum line, so that the gums may be moved back temporarily and the tooth roots are visible. After the roots are thoroughly cleaned, the gums are repositioned and sutured back into place. If bone loss is observed around a tooth, a dental bone graft may also be used to aid the regeneration of bone tissues.
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Periapical Lesions or Draining Sinus

Management Team

Periapical Lesions or Draining Sinus

Overview

A periapical tooth abscess refers to the formation of a pus-filled pocket of infection around the root of the tooth. The bacterial infection often spreads to the root of the tooth, resulting in inflammation4

The invasion of bacteria into the innermost part of the tooth, i.e., the dental pulp (which is rich in blood vessels, connective tissues, and nerves), can result in the formation of periapical abscesses; the bacterial cells often enter the pulp via a cavity or a chip/crack in the tooth and spread to the root, causing inflammation around the root tip (periapical tissue). At advanced stages, an abscess, which may sometimes drain into the oral cavity through a sinus, is formed. One is most likely to develop periapical abscess in the following scenarios:

  • The patient has poor oral hygiene
  • The patient suffers from dry mouth
  • The patient consumes a lot of sugary foods and drinks4

  • Severe throbbing toothache
  • Pain while chewing and biting
  • Pain radiating to the ears, neck, or jaw  
  • Halitosis, i.e., bad breath and/or bad taste in the mouth
  • Facial swelling
  • Fever

Periapical lesions are usually diagnosed using the following methods:

  • Physical examination: The dentist may examine the oral cavity to check for the following:
    • swellings in the gums
    • tenderness of tooth to percussion
    • presence of tooth cavity
    • swollen and tender lymph nodes
  • Dental X-ray: The infected tooth or swollen region is examined via X-ray imaging to confirm the presence of periapical abscess.

If patients experience any of the aforementioned symptoms (especially, when the symptoms are persistent), they are advised to contact their dentist as soon as possible.

In case of a periapical abscess, the tooth may require the following treatments: 

  • Root canal treatment: The infected tooth pulp is cleaned and filled with a filling material.
  • Tooth extraction or removal: In severe cases where the tooth cannot be salvaged, it might need to be extracted.
  • Medication: Supportive pain killer and antibiotics may also be prescribed.
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P

Mouth (Oral) Cancer

Management Team

Mouth (Oral) Cancer

Overview

Oral cancer, often categorised as head and neck cancers, refers to cancers developing in one or more of the following parts of the oral cavity:  

  • Lips
  • The floor and/or roof of the mouth
  • Gums
  • Tongue
  • Inner lining of the cheek

Mouth cancers form as a result of changes in the DNA in cells on the lips or in the mouth; these changes dictate the cells to continue division and growth in situations where apoptosis, i.e., programmed cell death to get rid of abnormal/unnecessary cells, usually occurs. The abnormal mouth cancer cells accumulate to form a tumour. The causes underlying the changes in squamous cells that ultimately lead to mouth cancer have not yet been identified; however, the factors that have been reported to increase the risk of developing mouth cancer are as follows:

  • Frequent use of tobacco products, including cigarettes, cigars, pipes, chewing tobacco, and snuff
  • Heavy alcohol consumption
  • Exposure of the lips to excessive sunlight
  • The human papillomavirus (HPV), a sexually transmitted virus
  • A weakened immune system1

  • A sore on the mouth or lip that does not heal
  • A reddish or whitish patch or a growth or lump within the mouth
  • Loose teeth
  • Jaw and/or ear pain
  • Pain or difficulty in swallowing

If the afore-mentioned symptoms are observed to persist and last more than two weeks, patients are advised to visit their doctor as soon as possible.

The following tests are used to diagnose mouth cancer: 

  • Physical examination: The dentist checks the mouth and lips to detect abnormalities and/or areas that cause pain/discomfort, such as white patches (leucoplakia) and/or sores2
  • Biopsy: A piece of tissue or fluid is excised or aspirated from the body to be tested in the laboratory.

The stage and location of the cancer and the overall health and personal preference of the patients determine the therapeutic modality to be used for mouth cancer treatment. A patient may require one or a combination of the following treatments:

  • Surgical resection: The oral surgeon may excise the tumour; to ensure the removal of all the tumour cells, the margin of healthy tissues may also be removed. If the cancer has been observed to have spread to the cervical lymph nodes, they are also dissected. Usually, after surgical resection, to help the patient regain the ability to eat and talk, reconstructive surgery to repair and rebuild the tissues in the mouth is recommended.  
  • Radiation therapy: Cancer cells are killed by subjecting them to treatment with high-energy waves or particles, such as gamma rays, X-rays, electrons, or protons. Often, radiation therapy is used post-surgery; however, sometimes, for patients with early-stage mouth cancer, it may be used alone.  
  • Chemotherapy: Cancer cells are killed using chemicals, i.e., chemotherapy drugs. These drugs are often administered alone or in combination with other drugs/therapeutic modalities for cancer treatment. As chemotherapy has been reported to exert synergistic effects with radiation therapy, enhancing the efficacy of the latter, the two are often administered as a combination.
  • Targeted drug therapy: Targeted drugs that alter specific growth-related aspects of cancer cells can be used to eliminate these cells. Often, these drugs are used in combination with chemotherapy/radiation therapy or alone.
  • Immunotherapy: Immunotherapy is based on fighting cancer using the patient’s immune system. Because cancer cells often demonstrate immune evasion, i.e., escape from the immune system, by various techniques, such as the production of specific proteins that “blind” the immune system, the body's immune system may fail to recognise and kill these cells. Immunotherapy is based on interfering with this “immune evasion” process. Generally, immunotherapy-based treatments are reserved for patients with advanced-stage mouth cancers for which standard treatments have been ineffective4.
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M

Transcatheter Mitral Valve Repair (TMVr)

Management Team

Transcatheter Mitral Valve Repair (TMVr)

Overview

Transcatheter mitral valve repair (or “TMVr”) is a non-surgical minimally invasive procedure to repair a leaking mitral valve (mitral regurgitation) using an implanted clip (MitraClip™).

If your team of cardiologists has determined that you would benefit from having this procedure, then in the days before your procedure, it is important that you:

  • Take all your prescribed medications
  • Tell your doctor if you are taking any other medications
  • Make sure your doctor knows of any allergies you have
  • Follow all instructions given to you by your doctor or nurse

The following steps provide a general overview of the TMVr procedure with the MitraClip™ system. Your doctor will explain the procedure to you and can provide you with specific details and answer any questions you may have.

  • Your doctor will make a small incision in your upper leg, where a Steerable Guide Catheter (a hollow, flexible tube slightly larger than the diameter of a pencil) will be inserted through a vein to reach your heart.
  • The MitraClip™ implant, which is attached to the end of a Clip Delivery System, will be guided, using imaging equipment, to your mitral valve through the catheter for placement.
  • Your doctor will implant the Clip at the appropriate position on your mitral valve. The Clip will grasp the mitral valve leaflets to close the centre of the mitral valve and reduce mitral regurgitation.
  • Your doctor will then perform tests to confirm that the Clip is working properly. In some cases, your doctor may implant a second Clip for further reduction of mitral regurgitation.
  • Once the Clip is in place and working properly, it will be disconnected from the Clip Delivery System.
  • The Clip Delivery System and the Steerable Guide Catheter will then be removed from your body and the incision in your leg will be closed.

The implanted Clip will become a permanent part of your heart, allowing your mitral valve to close more tightly and reduce the backward flow of blood.

You should experience relief from your symptoms of mitral regurgitation soon after your procedure.

  • You will need to stay in the hospital from one to five days, depending on your recovery and overall health.
  • You will undergo close monitoring during this period. Your doctor will perform several tests to understand your heart function.
  • You may need to take blood-thinning medications for some time after the procedure. This is to decrease your risk of developing a dangerous blood clot.
  • You will be given instructions about your medications by your doctor or nurse before you are discharged from your hospital.
  • You will be discharged from the hospital and kept under the care of your family doctor or cardiologist, who will conduct follow-up appointments.
  • It is critical that you report for all follow-up appointments and adhere to the instructions of your doctor.
  • Most patients will not need special assistance at home following discharge from the hospital, other than for ongoing needs for any unrelated health conditions.

  • Limit strenuous physical activity (such as jogging or activities that cause shortness of breath, grunting, or straining when lifting heavy objects) for at least 30 days, or longer, if your doctor thinks it is necessary
  • Carefully follow your doctor’s instructions regarding medications you need to take, especially if blood-thinning drugs are prescribed
  • Call your doctor if you cannot keep taking your medications because of side effects, such as rash, bleeding, or upset stomach
  • Notify your doctor before any medical or dental procedure; you may need to be prescribed antibiotics to avoid potential infection

After your procedure, you will receive an Implant Identification Card, which your doctor will fill out and which you must carry with you at all times. This card identifies you as a patient who has a MitraClip™ implant.

  • Show your Implant Identification Card if you report to an emergency room.
  • If you require a magnetic resonance imaging (MRI) scan, tell your doctor or MRI technician that you have a MitraClip™ implant. Test results indicate that patients with the MitraClip™ implant can safely undergo MRI scans under certain conditions described on the card.
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T

Genetically Inherited Diseases

Management Team

Genetically Inherited Diseases

Overview

Genetic disorders are illnesses caused by alterations in a person's DNA. These anomalies may arise spontaneously as a result of alterations in the DNA sequences or they may be passed down from one or both parents. As the name implies Inherited disorders are genetic illnesses passed onto their offspring via their parents' genes.

  • Genetic disorders can affect any organ system and people from any age group. 
  • Genetic disorders can affect a person's appearance, how their organs function, their metabolism, and even their susceptibility to certain diseases.

  • X-linked disorders: occur on the X chromosome
  • Autosomal dominant: only one copy of the abnormal gene is needed for the disorder to manifest
  • Autosomal recessive: requiring two copies of the abnormal gene
  • Mitochondrial disorders: affecting the energy-producing structures within cells

Genetic disorders can have a variety of causes:

  • Changes or mutations in a single gene
  • Complex interactions between numerous genes and environmental factors
  • Environmental factors such as exposure to toxins, radiation, or specific medications, can impact the occurrence of genetic disorders

Every disorder has a different set of symptoms and individual inheritance patterns. Accordingly, methods for treating these disorders may vary. 

  • Medical Assessment: includes a thorough assessment of a person's medical history, physical examination, and family history.
  • In some cases, precision genetic testing may be suggested

These tests might be performed during pregnancy, after childbirth (neonatal and paediatric testing), or during adulthood, depending on the suspected disorder and the particular circumstance.

  • Hereditary cancers
  • Hereditary cardiac conditions
  • Chromosomal abnormalities which cause birth defects, intellectual disabilities, and/or reproductive problems
  • Inherited metabolic disorders
  • Single gene disorders, such as:
    • Thalassaemia
    • Muscular dystrophy
    • Huntington's disease
    • Sickle cell disease:
  • Birth defects associated with the involvement of a genetic component
    • Neural tube defects
    • Cleft lip
    • Cleft palate
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G

Transcatheter Aortic Valve Replacement / Implantation (TAVR / TAVI)

Management Team

Transcatheter Aortic Valve Replacement / Implantation (TAVR / TAVI)

Overview

Transcatheter aortic valve replacement (TAVR), also known as transcatheter aortic valve implantation (TAVI), is a non-surgical minimally invasive procedure to treat aortic valve stenosis, a condition in which the valve between the main artery (aorta) and the heart narrows due to thickening of the valve walls.

TAVR can provide relief for the signs and symptoms of aortic valve stenosis. It may increase survival rates for people believed to be at intermediate or high risk of surgical complications from aortic valve replacement or for those who cannot undergo open-heart surgery.

TAVR is done to replace the aortic valve in people with aortic valve stenosis.

  • Aortic valve stenosis — or aortic stenosis — occurs when the heart’s aortic valve narrows.
  • This narrowing prevents the valve from opening fully, which obstructs blood flow from your heart into your aorta and from there to the rest of your body.

  • Aortic stenosis can cause chest pain, fainting, fatigue, leg swelling and shortness of breath.
  • It may also lead to heart failure and sudden cardiac death.

TAVR may be an option if you have aortic stenosis that causes signs and symptoms.

  • People who are considered at intermediate or high risk of developing complications after aortic valve replacement surgery.
    • This includes people with lung disease or kidney disease
  • People who have an existing biological tissue replacement valve that is not functioning well anymore.

Transcatheter aortic valve replacement (TAVR) carries a risk of complications, which may include:

  • Bleeding
  • Problems with the replacement valve, such as the valve slipping out of place or leaking
  • Stroke
  • Heart rhythm abnormalities (arrhythmias)
  • Kidney disease
  • Infection
  • Death

TAVR involves replacing your damaged aortic valve or your poorly functioning existing replacement valve with one made from cow or pig heart tissue, also called a biological tissue valve.

The decision to perform TAVR is made by a multidisciplinary group of medical and surgical heart specialists. Together, they determine an individual’s best treatment options.

  • Before TAVR, you will need to undergo tests and be evaluated by a multidisciplinary team of heart valve specialists to determine if you are suitable to undergo the treatment.
  • You will undergo an evaluation to ensure there are no risk factors that may impact you during the procedure.
  • You may also be prescribed medications to decrease infection risk prior to the procedure.

  • Before the TAVR procedure, you may be administered general anaesthesia.
  • Medication will be given to you intravenously so as to avoid the formation of blood clots.
  • Your heart function and rhythm will be monitored by the TAVR team. They will also keep an eye out for any changes in heart function. These changes can be treated as required during the procedure.
  • For the TAVR procedure, the access to your heart may be provided through a blood vessel in your leg. Access can also be provided through an incision in the chest, which permits the doctors to reach the heart via a large artery or the tip of the left ventricle (the bottom left chamber of the heart).
  • If these approaches are determined to be unsuitable, doctors may access the heart through other approaches.
  • A hollow tube or catheter is passed through the access point during TAVR.
  • Advanced imaging techniques are utilized by your doctor to move the catheter along your blood vessels, into the heart, and to the aortic valve.
  • Once the catheter is positioned precisely, your doctor will expand a balloon to press the replacement valve into place inside the native aortic valve. There are some valves that can be expanded without a balloon.
  • Once the valve is securely in place, the catheter is removed from your body.

  • You may be required to stay in the intensive care unit (ICU) for a night after your TAVR procedure.
  • Typically, you will stay in the hospital for two to five days after the procedure to recover.
  • Your doctor will prescribe blood-thinning medications to you after the procedure to prevent the formation of blood clots. They will also discuss with you how long you need to continue taking these medications.
  • You may need to continue taking certain medications after your procedure.
  • Your doctor will recommend that you take medications before certain dental procedures to prevent certain infections, as you are at higher risk of certain infections with a replacement heart valve. Talk to your doctor about his or her recommendations.
  • It is important that you take your medications as prescribed.
  • You will likely need regular follow-up appointments with your doctor.
  • Let your doctor know if you have any new or worsening signs or symptoms. Your doctor may recommend that you make healthy lifestyle changes, such as eating a heart-healthy diet, exercising regularly, maintaining a healthy weight and avoiding smoking.

  • TAVR can decrease the risk of death and improve the lives of people with aortic stenosis who cannot have surgery or for whom surgery is too risky by relieving the signs and symptoms of aortic valve stenosis and improve overall health.
  • TAVR has similar mortality rates as heart valve surgery in people with aortic stenosis who have an intermediate or high risk of complications from open-heart surgery.
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T

Rotator Cuff Repair Surgery

Management Team

Rotator Cuff Repair Surgery

Rotator cuff surgery is usually advised for patients who have failed a conservative line of treatment.

The decision to perform a particular procedure depends upon factors, such as age, type and pattern of tear, general health condition, and the quality of muscle, tendon, and bone.

  • The surgeon performs a series of pre-operative blood tests to prepare for the surgery.
  • The anaesthetist discusses the various types of anaesthesia (general and/or combined with a regional block) options available to undergo this surgery.

Enhanced strength and pain reduction, improving the quality of life and mitigating the future risk of arthritis

  • Bleeding
  • Infection
  • Post-operative stiffness
  • Re-tear of the tendon

Mini-open repair

  • The procedure can be performed in isolation or arthroscopy procedure wherein the initial preparation of cuff repair and other issues like biceps tendon preparation and bony spur excision are completed using arthroscopic techniques, while the repair is done by making a small incision over the outer aspect of the shoulder without cutting the major muscles
  • The repair is achieved using non-absorbable sutures and/or various types of suture anchors available in the market

Arthroscopic repair

  • The surgeon inserts a camera and various instruments into the shoulder joint by making keyhole incisions. The repair is performed through visualisation on a computer monitor.
  • This technique has gained popularity because of its minimally invasive nature and faster recovery when compared with open procedures.

Various types of implants are available in the market, including suture anchors that are non-absorbable (titanium) or absorbable (PEEK or Bio-absorbable), non-absorbable sutures, or some newer implants (bio-inductive patches, balloon spacers) that can be used as an adjuvant to the above implants

Post-surgery

  • The operated arm is kept in a sling or shoulder immobiliser for 4–6 weeks depending on the strength of the repair, quality of the tissue, and general conditions.
  • The pain is managed with anti-inflammatory and local therapy like applying ice packs.
  • Physiotherapy is usually passive for the initial few weeks, which is then increased gradually to achieve an improved range of movements, function, and adequate muscle strength.
  • Complete recovery usually takes around 4–6 months.
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R

Robotic Partial Knee Replacement

Management Team

Robotic Partial Knee Replacement

Overview

Robotic partial knee replacement is a type of assisted partial knee replacement. It is an advanced surgical procedure that utilises robotic technology to enhance the precision of partial knee replacement surgery. This precision surgery is associated with high accuracy and enhanced patient outcomes. With early to moderate osteoarthritis (OA) who have not experienced damage in all three knee compartments. In this procedure, only the affected part of the knee is replaced while preserving the healthy sections.

Key features:

  • Robotic Precision: The robot provides real-time feedback, helping the surgeon achieve precise implant alignment and placement.
  • Minimally Invasive: Compared to traditional methods, the procedure typically involves smaller incisions, promoting quicker recovery and less tissue damage.

Robotic partial knee replacement is recommended for patients with arthritis in just one compartment of the knee, offering an alternative to total knee replacement or osteotomy. This procedure is particularly suited for older adults (usually over 60), those with a low activity level, and individuals with a body weight under 82 kg. It is effective in addressing symptoms such as

  • Localized knee pain: Pain focused in a specific part of the knee, often due to arthritis or injury.
  • Knee stiffness: Limited range of motion, especially after prolonged periods of rest or inactivity.
  • Knee swelling: Inflammation and fluid buildup in the affected knee region.
  • Difficulty with daily activities: Challenges in performing routine movements, such as walking, climbing stairs, or other common tasks.

  • Inflammatory arthritis
  • Anterior cruciate ligament (ACL) damage
  • Severe deformities in knee alignment (varus or valgus greater than specified degrees)
  • Limited knee motion (arc of motion less than 90°)
  • Severe knee contractures
  • Previous meniscus surgery in other knee compartments
  • Advanced (tricompartmental) arthritis or widespread knee pain
  • Grade IV patellofemoral arthritis (severe pain in the front of the knee)

Non-surgical treatment

Before considering surgery, patients may try non-invasive treatments to manage symptoms and improve knee function:

  • Pain relievers and anti-inflammatory medications
  • Physical therapy to strengthen muscles and increase flexibility
  • Injections, such as corticosteroids, to reduce inflammation

Surgical treatment

  • Preoperative Planning:
    • Educating the patient
    • Preparing for post-surgical rehabilitation,
    • Managing any existing health issues.

  • Surgery:

    Using the robotic system, the surgeon removes the damaged knee portion and places the implant with high precision, ensuring correct alignment and fit.

  • Postoperative Care:

    Rehabilitation begins soon after surgery, focusing on restoring strength, mobility, and function. Pain management and lifestyle adjustments are essential to promote healing and prevent complications.

  • Greater precision
  • Reduced surgical trauma
  • Faster recovery
  • Enhanced implant longevity

The procedure's success depends on careful pre-surgical planning, the skill of the surgical team, and adherence to rehabilitation and osteoarthritis care protocols.

Usually, robotic partial knee replacement is quite safe. However, depending upon the age and general health of the patient, one or more of the following complications may occur:

  • Blood clots
  • Infections at the wound site
  • Nerve and/or tissue damage
  • Instability of the new knee joint
  • Pain/difficulty while bending the knee, standing up, or walking

Generally, robotic partial knee replacement is associated with excellent outcomes, greatly alleviating knee pain and restoring a significant amount of knee mobility. Often, complete recovery requires up to 1 year; this duration varies from patient to patient. Nevertheless, patients may resume their daily activities about 6 weeks after the surgery. Surgeons often prepare customised recovery plans for each patient, involving several steps, such as avoiding high-impact activities (jumping or running), keeping the wound site covered and clean, icing and elevating the knee, and physical therapy (including home exercises). Over 90% and 85% of the replaced knee joints have been found to be functional after 15 and 25 years, respectively, this highlights the longevity of the implant after the procedure.

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