Chronologic development of the maxillary first premolar teeth.
\r\n\tThe overall objective of the book is to propose a methodological/ technological state of play and an operational assessment on the complex issues regarding the management and optimization of the multiple components of a transportation system: users, infrastructures, technologies and services.
\r\n\r\n\tThe book welcomes topics such as smart mobility, smart transportation systems, smart vehicle, smart infrastructures, smart people: citizens and users.
",isbn:"978-1-83880-823-5",printIsbn:"978-1-83880-802-0",pdfIsbn:"978-1-83880-824-2",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,hash:"ef80dab7f0350ea7cb28f40eedea2b35",bookSignature:"Prof. Stefano De Luca, Dr. Roberta Di Pace and Dr. Chiara Fiori",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/9872.jpg",keywords:"Transportation, Intelligent Information Systems, Smart Vehicles, Vehicle Management, Driving Assistance Technologies, Smart Infrastructures, Smart Transportation Systems, Sustainable Transportation Systems, Vehicle Routing, Travel Demand Modeling, Life Cycle Assessment, Environmental Impacts Modeling",numberOfDownloads:664,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:1,numberOfTotalCitations:1,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"May 6th 2020",dateEndSecondStepPublish:"May 27th 2020",dateEndThirdStepPublish:"July 26th 2020",dateEndFourthStepPublish:"October 14th 2020",dateEndFifthStepPublish:"December 13th 2020",remainingDaysToSecondStep:"8 months",secondStepPassed:!0,currentStepOfPublishingProcess:5,editedByType:null,kuFlag:!1,biosketch:"Scientific coordinator of the Transportation Planning and Modelling laboratory, a consultant for the Italian Ministry of Transportation, the Transport commission of Campania Region, of Salerno and Avellino Transportation Departments and member of the IEEE Intelligent Transportation Systems Society.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"271061",title:"Prof.",name:"Stefano",middleName:null,surname:"De Luca",slug:"stefano-de-luca",fullName:"Stefano De Luca",profilePictureURL:"https://mts.intechopen.com/storage/users/271061/images/system/271061.jpeg",biography:"Stefano de Luca, got a Ph.D. in transportation engineering at the University of Rome 'La Sapienza” and is an associate professor at the Department of Civil Engineering of the University of Salerno (Italy). He is a professor of Transportation Planning (BSc, Civil Eng. and Environmental Eng.) and Transportation Systems Theory (MSc, Civil Eng.). Currently, he is vice-coordinator of the Ph.D. course on 'Risk and sustainability”, scientific coordinator of the Transportation Planning and Modelling laboratory. He is a consultant for the Italian Ministry of Transportation, the Transport commission of Campania Region, of Salerno and Avellino Transportation Departments. His main research interest includes transportation planning techniques, travel demand modeling, users’ behavior modeling, signal settings design, traffic assignment models, air transportation. He is member of IEEE Intelligent Transportation Systems Society.",institutionString:"University of Salerno",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"University of Salerno",institutionURL:null,country:{name:"Italy"}}}],coeditorOne:{id:"271713",title:"Dr.",name:"Roberta",middleName:null,surname:"Di Pace",slug:"roberta-di-pace",fullName:"Roberta Di Pace",profilePictureURL:"https://mts.intechopen.com/storage/users/271713/images/system/271713.jpeg",biography:"Roberta Di Pace received both the MSc degree and the Ph.D. degree in transportation engineering from the University of Naples 'Federico II,” Naples, Italy, in 2005 and 2009, respectively. She is an assistant professor in Transportation Engineering at the Department of Civil Engineering of the University of Salerno (Italy). She is an aggregate professor of Technique and Transport Economics (BSc, Civil Eng. and Environmental Eng) and Transportation Systems Design (MSc, Civil Eng). Since 2010 she is a member of the Transportation Planning and Modelling Laboratory. Her main research fields include the development of analytical tools for advanced traveler information systems, the traffic flow modeling, the network signal setting design, the advanced traffic management systems. She is a member of IEEE Intelligent Transportation Systems Society and IEEE Women in Engineering.",institutionString:"University of Salerno",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"University of Salerno",institutionURL:null,country:{name:"Italy"}}},coeditorTwo:{id:"321783",title:"Dr.",name:"Chiara",middleName:null,surname:"Fiori",slug:"chiara-fiori",fullName:"Chiara Fiori",profilePictureURL:"https://mts.intechopen.com/storage/users/321783/images/system/321783.jpg",biography:"Chiara Fiori is assistant professor at the Department of Civil Engineering of the University of Salerno, Italy. She earned the Ph.D. from Sapienza University of Rome, Italy in 2015. From 2016 to 2019 she was post-doc at the Department of Civil, Architectural and Environmental Engineering, University of Naples Federico II, Italy. She was Visiting Scientist at the European Commission, Joint Research Center, Directorate for Energy, Transport and Climate Change, Ispra, Italy, from 2017 to 2018. Moreover, from 2015 to 2016 she was Visiting Scientist at the Center for Sustainable Mobility of the Virginia Tech Transportation Institute, USA, and, in 2013, Visiting Scholar at the Center for Automotive Research of the Ohio State University, USA. Her research interests include: sustainable mobility; modeling and simulation for the functional and environmental efficiency improvement of container terminals; integration of microscopic energy consumption model for EVs with traffic control systems; energy consumption modeling and simulation of hybrid and electric powertrains; integration of traffic and energy consumption modeling at microscopic scale; impact assessment of emerging powertrain technologies on route choice behaviors and development of eco-routing strategies for personal and freight mobility; impact assessment of emerging powertrain technologies and charging systems on power electric infrastructure; electric freight logistics, electrification of ports and port operations; well-to-wheels analysis of conventional, hybrid and electric vehicles; impact assessment of emerging railway services (e.g. High Speed/High Capacity services); energy systems, alternative fuels, hydrogen and renewable sources.",institutionString:"University of Salerno",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"University of Salerno",institutionURL:null,country:{name:"Italy"}}},coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"11",title:"Engineering",slug:"engineering"}],chapters:[{id:"73624",title:"BIM Approach for Smart Infrastructure Design and Maintenance Operations",slug:"bim-approach-for-smart-infrastructure-design-and-maintenance-operations",totalDownloads:115,totalCrossrefCites:0,authors:[null]},{id:"73595",title:"Advanced Vehicles: Challenges for Transportation Systems Engineering",slug:"advanced-vehicles-challenges-for-transportation-systems-engineering",totalDownloads:18,totalCrossrefCites:0,authors:[null]},{id:"73941",title:"Towards Shared Mobility Services in Ring Shape",slug:"towards-shared-mobility-services-in-ring-shape",totalDownloads:23,totalCrossrefCites:0,authors:[null]},{id:"74201",title:"Attitudes and Behaviours in Relation to New Technology in Transport and the Take-Up amongst Older Travellers",slug:"attitudes-and-behaviours-in-relation-to-new-technology-in-transport-and-the-take-up-amongst-older-tr",totalDownloads:32,totalCrossrefCites:0,authors:[null]},{id:"73973",title:"Models and Methods for Intelligent Highway Routing of Human-Driven and Connected-and-Automated Vehicles",slug:"models-and-methods-for-intelligent-highway-routing-of-human-driven-and-connected-and-automated-vehic",totalDownloads:64,totalCrossrefCites:0,authors:[null]},{id:"74412",title:"Centralised Traffic Control and Green Light Optimal Speed Advisory Procedure in Mixed Traffic Flow: An Integrated Modelling Framework",slug:"centralised-traffic-control-and-green-light-optimal-speed-advisory-procedure-in-mixed-traffic-flow-a",totalDownloads:55,totalCrossrefCites:0,authors:[null]},{id:"74333",title:"Transit Signal Priority in Smart Cities",slug:"transit-signal-priority-in-smart-cities",totalDownloads:91,totalCrossrefCites:0,authors:[null]},{id:"73356",title:"Optimal Management of Electrified and Cooperative Bus Systems",slug:"optimal-management-of-electrified-and-cooperative-bus-systems",totalDownloads:64,totalCrossrefCites:0,authors:[null]},{id:"73240",title:"Recent Progress in Activity-Based Travel Demand Modeling: Rising Data and Applicability",slug:"recent-progress-in-activity-based-travel-demand-modeling-rising-data-and-applicability",totalDownloads:138,totalCrossrefCites:0,authors:[null]},{id:"73821",title:"Driver Assistance Technologies",slug:"driver-assistance-technologies",totalDownloads:66,totalCrossrefCites:0,authors:[null]}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"297737",firstName:"Mateo",lastName:"Pulko",middleName:null,title:"Mr.",imageUrl:"https://mts.intechopen.com/storage/users/297737/images/8492_n.png",email:"mateo.p@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. 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The facial surfaces of the premolars develop from three facial lobes like anterior teeth. Likewise, the lingual surfaces of most premolars develop from one lingual lobe like anterior teeth. While mandibular first premolars develop from four lobes (mesial, distal, buccal, and lingual) just like the anterior teeth and maxillary premolars, mandibular second premolars often develop from five lobes (mesial, buccal, distal, mesiolingual, and distolingual lobes). That is why the term “bicuspid” signifies “two cusps,” widely used to describe premolars, may be inappropriate for this group of teeth since the mandibular premolars may show a variation in the number of cusps from one to three. In anterior teeth, the lingual lobe forms the cingulum of the incisors and canines. However, in premolar teeth, this lobe forms the lingual cusps. The lingual cusps of mandibular premolars are less prominent than the buccal cusps. There are no deciduous premolars. These teeth erupt at the position previously occupied by the deciduous molars.
\nTiming of teeth eruption can be affected by many factors such as gender, environmental factors and genetic conditions and differs from population to population [1, 2, 3]. The agenesis of lower second premolars and maxillary lateral incisors are the most frequent and it could be radiographically documented if the median age of emergence of these teeth was passed [1]. On the other hand, caries in primary molar teeth or early extraction of second primary molar could accelerate the eruption time of permanent premolars [1]. The classic sequences of teeth eruption in the maxillae is as follows: first molar, central incisor, lateral incisor, first premolar, canine, second premolar and second molar whereas in the mandible, central incisor, first molar, lateral incisor, canine, first premolar, second premolar and second molar [2]. In addition, generally, in girls, the maxillary canine can be expected before the second premolar, and the mandibular second premolar can be expected before second molar; in boys both orders are reversed [3].
\nThe detailed descriptions of morphologies of from all aspects, chronology of development, form and function, the common characteristics of the permanent premolar teeth were presented in this chapter. In addition, the major differences between these teeth were given in a pointwise and systematic manner [4, 5, 6, 7, 8, 9, 10, 11].
\nThe maxillary first premolar is the fourth permanent tooth from the median line in the maxillary arch, located laterally from both the maxillary canines of the mouth but mesial from both maxillary second premolars. It is the first posterior tooth. Chronologic development of the maxillary first premolar is given in Table 1.
\nDevelopment stage | \nYears | \n
---|---|
Initiation of calcification | \n1 ½–1 ¾ years | \n
Enamel completion | \n5–6 years | \n
Eruption | \n10–11 years | \n
Root completion | \n12–13 years | \n
Chronologic development of the maxillary first premolar teeth.
In the universal system of notation, the right permanent maxillary first premolar is shown as “#5,” and the left one is shown as “#12.” According to the international notation, the right permanent maxillary first premolar is shown as “14,” and the left one is shown as “24.” Besides, in the Palmer notation, the right permanent maxillary first premolar is symbolized as “
The image of maxillary first premolar from all aspects is seen in Figure 1. A. Buccal, B. Lingual, C. Mesial, D. Distal, E. Occlusal.
\nMaxillary first premolar tooth from different aspects. A. Buccal, B. Lingual, C. Mesial, D. Distal, E. Occlusal.
The buccolingual dimension is higher than the mesiodistal dimension. The buccal, lingual, and distal surfaces of the crown display convexities in different degrees.
\nThe pentagonal or trapezoidal shape of the crown is noticeable from the facial aspect. With this form of the crown, the permanent maxillary first premolar appears to be similar to those of the maxillary canine and second premolar. While the canine has a larger size crown with a more prominent cusp tip, the second premolar has a smaller crown with a less prominent cusp tip. Additionally, the crown is smaller in the cervico-occlusal dimension than any anterior tooth, but larger than that of the second premolar or permanent molars. The greatest mesiodistal width of the crown is about 2 mm less at the cervical region.
\nThe buccal surface is convex with the exception of the developmental depressions. The well-developed middle buccal lobe forms a continuous ridge from the tip of the buccal cusp to the cervical margin. This ridge is called as “buccal ridge” and demarcates the three developmental lobes. Mesiobuccal and distobuccal developmental depressions exist on both mesial and distal sides of the buccal ridge. These depressions divide the occlusal portion of the buccal surface into vertical thirds, consisting of mesiobuccal, distobuccal, and buccal lobes. Mesiobuccal and distobuccal lobes serve to emphasize strong mesiobuccal and distobuccal line angles on the crown. The imbrication lines are in parallel and semicircular forms and also common in the cervical third of the buccal surface.
\nFrom this aspect, cervical line of the crown is convex. In addition, the curvature depth is less at the cervical margin of the crown than those of anterior teeth. The crest curvature of the cervical line is almost placed at the center of the root.
\nThe mesial contour of the crown presents a shallow concavity extending from the cementoenamel junction to the mesial contact area. The highest contour of mesial curvature is at the contact area and located near the junction of the occlusal and middle thirds. The mesial margin of the buccal cusp is lying from the contact area to the tip of the buccal cusp and it creates the mesio-occlusal angle. This margin is less curved and longer than the distal slope of the buccal cusp.
\nThe buccal cusp tip is placed slightly toward the distal. Therefore, unequal two portions are seen at the buccal aspect of the crown of occlusal outlines. A concavity or notch may be observed as a result of the developmental depressions passing over the occlusal margin.
\nThe distal contour of the crown presents more concave and straighter form below the cementoenamel junction than that of mesial contour. The crest curvature of the distal contact area is located slightly more occlusally.
\nThe tooth is narrower mesiodistally at the lingual than at the buccal. Therefore, the crown converges toward the lingual cusp. The lingual ridge is barely defined. Both the buccal and lingual cusp tips are visible from this aspect, since the lingual cusp is shorter than the buccal cusp. The lingual cusp of the maxillary first premolar is the shortest of the four maxillary premolar cusps.
\nThe lingual portion of the crown is convex and has a spheroidal form. The cervical line at this aspect is regular, with symmetrical curvature toward the root and the crest of curvature is centered on the root. The proximal outlines of the crown at the lingual aspect are convex. These outlines are convex and continuous with the mesial and distal slopes of the lingual cusp. If the tooth presents the severe mesial concavity, the mesial outline may be concave.
\nThe lingual cusp tip is situated well anterior (mesial) to the mid-buccolingual diameter of the crown, so the two cusp tips are not placed on the same axis. This cusp tip is not as sharply pointed as the buccal cusp tip. The mesio-occlusal slope of the lingual cusp is shorter than the disto-occlusal slope.
\nThe developmental depressions, grooves, or pits are normally not found on the lingual surface.
\nFrom the proximal aspects, all maxillary posterior teeth are present in trapezoidal geometric form. The buccal cusp is longer than the lingual cusp by 1 mm or occasionally more. Well-marked mesial and distal ridges are seen in both cusps. The mesial surface of the crown displays a concavity toward the cementoenamel junction. This concavity extends cervically on the mesial surface and joins a deep developmental depression of the root area. This mesial developmental depression is sometimes called “the canine fossa” and located cervically to the mesial contact area. There is a groove called “mesial marginal groove,” that is usually present on the mesial surface of the crown. This groove extends across the mesial marginal ridge from the occlusal surface. Mesial developmental depression and mesial marginal groove are the specific landmarks of maxillary first premolars that help to distinguish the maxillary first premolar tooth from the maxillary second premolar. The facial contour of the crown is convex with the height of contour located at the junction of cervical and middle third. The lingual contour is also convex form of an even arc, with its crest of contour located within the middle third of the crown. The occlusal margin is formed by the mesial marginal ridge. This margin is slightly concave.
\nFrom the distal aspect, a maxillary first premolar tooth is remarkably similar to the mesial view, except this side of the crown is slightly shorter occlusocervically. There are also other differences including the general convexity of the distal surface at all directions. This surface does not exhibit the concavity, which is present on the mesial surface. However, there may sometimes be a flattening in the cervical of the contact area and buccal of the center of the distal surface. Moreover, the curvature of cervical line is occlusally less on the distal than on the mesial. The buccal outline is convex. Buccal crest curvature is in the gingival third. The lingual outline is symmetrically convex with the lingual crest curvature that is in the middle third. The distal marginal ridge is located at a more cervical level. There is normally no deep developmental groove crossing the distal marginal ridge. In the rare instances when it is present, it is shallow and insignificant.
\nThe schematic description of the occlusal table is given in Figure 2. From the occlusal aspect, the maxillary first premolar can be described as hexagonal or six-sided figure. This form is made up of the mesiobuccal, mesial, mesiolingual, distolingual, distal, and distobuccal sides. The crown is wider buccolingually than mesiodistally. In addition, the mesiobuccal and distobuccal sides are almost equal, whereas the mesial side is shorter than the distal side, and the mesiolingual side is shorter than the distolingual side.
\nThe schematic description of the occlusal table of the maxillary first premolar tooth.
The crown and root variations of the maxillary first premolar teeth.
The outline of the crown at the buccal surface is generally convex. The prominent buccal ridge contributes to this convexity. However, when the buccal developmental depressions are deep, they may create slight concavities in the outline on the mesiobuccal and distobuccal sides of the buccal ridge.
\nThe lingual outline is almost equally convex in semicircular arch form. Mesial and distal margins are relatively straight, and they converge toward the lingual. If the mesial marginal groove is prominent, a dip might be seen in the mesial outline of the crown.
\nThe cusp ridges and marginal ridges limit the occlusal surface of the maxillary first premolar. Two cusps (buccal and lingual) are placed at the occlusal table. The buccal cusp is generally sharper, longer, and wider than the lingual cusp. On the buccal cusp, the buccal ridge descends from the cusp tip cervically to the buccal surface. The mesial and distal ridges descend from the cusp tip to their respective point angles. The buccal cusp has four inclined planes. These planes are called as mesiobuccal inclined plane, distobuccal inclined plane, mesiolingual inclined plane, and distolingual inclined plane. During the active occlusion, the lingual inclines of the buccal cusps of the maxillary posterior teeth determine the path of the supporting cusps during normal lateral and protrusive working excursions.
\nThe lingual cusp is generally smaller than the buccal cusp. The lingual cusp tip is offset toward the mesial. The lingual cusp ridge extends from the cusp tip lingually to the central area of the occlusal surface. This cusp also presents four cusp ridges and four inclined planes located and named in the same manner as those of the buccal cusp.
\nThe crest of the distal contact area is somewhat buccal to that of the mesial contact area, and the crest of the buccal ridge is somewhat distal to that of the lingual ridge. The crests of curvature represent the highest points on the buccal and lingual ridges and the mesial and distal contact areas. When two triangular ridges join, after traversing the tooth buccolingually, they form a “transverse ridge.” The union of the two triangular ridges forms this transverse ridge. In other words, the lingual cusp ridge of the buccal cusp and the buccal cusp ridge of the lingual cusp form the transverse ridge of the occlusal surface.
\nFrom the occlusal aspect, close observation reveals that the mesiodistal dimension of the crown is narrower than the buccolingual dimension. The major structures, pits, and grooves are the primary anatomic features. The supplemental grooves are not present in most cases on the occlusal surface of maxillary first premolar teeth. For this reason, the occlusal surface is relatively smooth. A well-defined “central developmental groove” divides the surface buccolingually. A “mesial marginal developmental groove” extends from the central developmental groove and crosses the mesial marginal ridge and ends on the mesial surface of the crown.
\nTwo developmental grooves connect to the central groove inside the mesial and distal marginal ridges. These grooves are the “mesiobuccal developmental groove” and the “distobuccal developmental groove.” The connections of the grooves are located at opposite ends of the central developmental groove, and deeply pointed. These grooves usually end in a deep depression in the occlusal surface called the “mesial” and “distal developmental pits.”
\nThe triangular depression that harbors the mesiobuccal developmental groove is located just distal to the mesial marginal ridge and called the “mesial triangular fossa.” Likewise, the depression in the occlusal surface, just mesial to the distal marginal ridge, is called the “distal triangular fossa.”
\nRoot contour form of the maxillary first premolar from the buccal aspect still bears a close resemblance to the maxillary canine. However, it is about 3–4 mm shorter than maxillary canine. The maxillary first premolar tooth with two roots presents a smooth and convex lingual root with a blunter root apex than the buccal root apex. The root trunk is flattened at this aspect above the cervical line. The bifurcation of the roots is located near the apical third, with no developmental groove.
\nThe average measurements of the maxillary first premolar are shown in Table 2.
\nThe average measurements of the maxillary first premolar (in mm) | \n|||||||
---|---|---|---|---|---|---|---|
Cervico-occlusal length of crown | \nLength of root | \nMesiodistal diameter of crown | \nMesiodistal diameter of crown at cervix | \nBuccolingual diameter of crown | \nBuccolingual diameter of crown at cervix | \nCurvature of cervical line-mesial | \nCurvature of cervical line-distal | \n
8.5 | \n14.0 | \n7.0 | \n5.0 | \n9.0 | \n8.0 | \n1.0 | \n0.0 | \n
The average measurements of the maxillary first premolar teeth. Variations: The crown and root of this tooth exhibit some variations (Figure 3).
The permanent maxillary second premolar is the fifth tooth from the midline. The maxillary second premolars closely resemble the maxillary first premolar and supplement the latter in function. The maxillary second premolar tooth shares a mesial contact with the maxillary first premolar and a distal contact with the maxillary first molar. This tooth is a succedaneous tooth, replacing the deciduous maxillary second molar. Chronologic development of the maxillary second premolar is given in Table 3.
\nDevelopment stage | \nYears | \n
---|---|
Initiation of calcification | \n2 | \n
Enamel completion | \n6–7 | \n
Eruption | \n10–12 | \n
Root completion | \n12–14 | \n
Chronologic development of the maxillary second premolar teeth.
In the universal system of notation, the right permanent maxillary first premolar is shown as “#4,” and the left one is shown as “#13.” According to the international notation, the right permanent maxillary first premolar is shown as “15,” and the left one is shown as “25.” Besides, in the Palmer notation, the right permanent maxillary first premolar is symbolized as “
The crown of the maxillary second premolar has a less angular appearance, giving a more rounded effect than the maxillary first premolar. In addition, the crown is usually smaller in cervico-occlusal and mesiodistal dimensions. It has two cusps of nearly same size. The second premolars also vary from the first premolars in that they generally have single root. Usually, the root length of the maxillary second premolar is almost similar with that of the first premolar. More variations are observed with second premolar teeth.
\nThe image of maxillary second premolar from all aspects is seen in Figure 4; A. Buccal, B. Lingual, C. Mesial, D. Distal, E. Occlusal.
\nMaxillary second premolar tooth from different aspects. A. Buccal, B. Lingual, C. Mesial, D. Distal, E. Occlusal.
From the buccal view, the crown of the maxillary second premolar has a trapezoidal form. The buccal cusp of the second premolar is not as long as that of the first premolar. In addition, the buccal cusp appears to be less pointed. The mesial outline of the crown is slightly convex from cervix to the point where it joins the mesial slope of the buccal cusp. The distal outline is more convex than the mesial outline. The cervical outline on buccal view is slightly convex and curves in an apical direction. The tooth is thicker at the cervical portion than the maxillary first premolar.
\nThe cusp tip is offset to the mesial; hence, the mesio-occlusal slope of the buccal cusp ridge is slightly shorter than the disto-occlusal slope. The opposite is true for the first premolar. The buccal ridge of the crown may be less prominent than that of the first premolar.
\nThe crown of the maxillary second premolar has a trapezoidal form at the lingual aspect. From the lingual view, little variation can be seen except that the lingual cusp is almost having the same length as the buccal cusp. In addition, the lingual cusp tip is not quite so far offset to the mesial. The cervical outlines of the crown at this aspect present that the cervical line is less curved apically than the buccal view. The occlusal outline is formed by the lingual cusp tip and its cusp slopes.
\nThe mesial aspect shows the difference in cusp length between the first and second premolars. The cusps of the second premolar are shorter, with the buccal and lingual cusps more nearly the same length. Greater distance between the cusp tips widens the occlusal surface buccolingually.
\nDevelopmental depressions are not seen on the mesial surface of the crown as on the first premolar. The crown surface is convex. A shallow developmental groove appears on the single tapered root. There is no canine fossa or canine groove on this surface. The more equal size of the cusps is also noted. Both the contact area and marginal ridge are found at a slightly more cervical level than on the mesial of the first premolar.
\nThe distal view of the second premolars has the same features with the first premolars. Since the distal contact of second premolar is with the first molar, the contact area is slightly larger in size, when compared to the first premolar. Both the distal contact area and marginal ridge are located at a slightly more cervical level than on the distal of the first premolar. The distal root depression is deeper than the mesial depression on the maxillary second premolar.
\nThe schematic description of occlusal table is given in Figure 5. The outline of the crown of the second premolar is more rounded or oval rather than hexagonal shape at this aspect. However, there may be some exceptions about this form. More distance between the cusp tips buccolingually than on the first premolar may be noted. Hence, the lingual cusp is almost as wide as the buccal. The grooves are shorter, shallower, and more irregular than in the first premolar. The central developmental groove is also shorter and more irregular. This groove has numerous supplementary grooves radiating from the central groove. This arrangement gives the occlusal surface a more wrinkled appearance.
\nThe schematic description of occlusal table of the maxillary second premolar tooth.
The crown and root variations of the maxillary second premolar teeth.
The root is usually single and shows a longitudinal groove on the mesial and distal surfaces, but may occasionally be double. The distal root depression is deeper than the mesial depression on the maxillary second premolar. Division of the root of the second premolar is rare; in about 15%. Root length is normally as great, or slightly greater than the root structure of the first premolar. The root is wider buccolingually than mesiodistally. It is often deflected slightly to the distal in its apical portion.
\nThe average measurements of the maxillary second premolar are shown in Table 4.
\nThe average measurements of the maxillary second premolar (in mm) | \n|||||||
---|---|---|---|---|---|---|---|
Cervico-occlusal length of crown | \nLength of root | \nMesiodistal diameter of crown | \nMesiodistal diameter of crown at cervix | \nBuccolingual diameter of crown | \nBuccolingual diameter of crown at cervix | \nCurvature of cervical line-mesial | \nCurvature of cervical line-distal | \n
8.5 | \n14.0 | \n7.0 | \n5.0 | \n9.0 | \n8.0 | \n1.0 | \n0.0 | \n
The average measurements of the maxillary second premolar teeth. Variations: The crown and root of this tooth also exhibit variations and anomalies (Figure 6).
Chronologic development of the permanent mandibular first premolar is given in Table 5.
\nDevelopment stage | \nYears | \n
---|---|
Initiation of calcification | \n1 ¾–2 years | \n
Enamel completion | \n5–6 years | \n
Eruption | \n5–6 years | \n
Root completion | \n10–13 years | \n
Chronologic development of the mandibular first premolar teeth.
In the universal system of notation, the right permanent mandibular first premolar is shown as “#28,” and the left one is shown as “#21.” According to the FDI notation, the right permanent mandibular first premolar is shown as “44,” and the left one is shown as “34.” Additionally, in the Palmer notation, the right permanent mandibular first premolar is symbolized as “
The image of mandibular first premolar from all aspects is given in Figure 7. A. Buccal, B. Lingual, C. Mesial, D. Distal, E. Occlusal.
\nMandibular first premolar tooth from different aspects. A. Buccal, B. Lingual, C. Mesial, D. Distal, E. Occlusal.
The mandibular first premolar is similar to a mandibular canine and second premolar from buccal aspect. It has nearly same buccolingual measurement as a canine and has a sharp buccal cusp. The occlusocervical dimension of this tooth is less than all anterior teeth. However, this dimension is greater than that of the second premolar or any molar.
\nThe buccal surface of mandibular first premolar is convex both occlusogingivally and mesiodistally. The crown is inclined lingually, and therefore, the tip of the buccal cusp is situated on the vertical axis of the root. The buccal height of contour is in the cervical third level of the surface. There is well-developed middle buccal lobe (buccal ridge) between the developmental depressions in mesiobuccal and distobuccal sides. The mesial cusp ridge is shorter than the distal cusp ridge.
\nThe contour of the mesial margin is concave from the contact area to the cervical line joining the mesio-occlusal slope to create the mesio-occlusal angle. The outline continuing from the contact area to the cusp is convex. The height of contour (mesial contact area) is in the middle third at the center of the crown cervico-occlusally.
\nThe distal margin is slightly shorter than mesial margin. In addition, the outline is concave from the contact area to the cervical line and the contact area is broader than the mesial contact area. The height of contour (distal contact area) is approximately at the same level with the mesial contact area.
\nThe buccal cervical line is slightly curved toward the apex and in comparison with the anterior teeth; the depth of curvature is less than that of the anterior teeth.
\nThe buccal cusp tip divides the occlusal outline into two portions, the mesio-occlusal and disto-occlusal slopes, or mesial and distal cusp ridges. The disto-occlusal cusp ridge is longer than mesio-occlusal, moving the sharp cusp tip toward the mesial. Besides, both of the ridges are slightly concave.
\nSince the lingual cusp is smaller and shorter than buccal cusp, the buccal section of the occlusal surface could be seen from the lingual aspect. In addition, the crown is narrower mesiodistally on the lingual surface than on the buccal surface. Therefore, most of the mesial and distal parts could be seen from this aspect. This surface is convex in all directions and no ridge is present as seen on the buccal aspect. The lingual height of contour is in the middle third level of the surface.
\nThe most characteristic feature of this tooth is the mesiolingual developmental groove between mesial marginal ridge and lingual cusp.
\nSince the lingual surface is shorter than buccal surface, both margins are shorter in lingual surface than buccal surface. Different from other teeth, mesial marginal ridge of mandibular first premolar teeth is shorter than distal marginal ridge. Additionally, mesial contact area is more cervically located than distal contact area.
\nThe lingual cervical line is slightly curved toward the apex and narrower than buccal cervical line.
\nThe lingual cusp tip and ridges are approximately at same level with the occlusal surface. Both of cusp tips are mesially offset, and the lingual cusp tip is in alignment with the buccal triangular ridge. There are mesial and distal occlusal fossae on each sides of occlusal surface.
\nSimilarly with all the mandibular posterior teeth, the crown is in rhomboidal shape from the mesial aspect. While the buccal cusp is centered over the root, the lingual cusp tip is aligned with the lingual border of the root.
\nThe buccal outline is convex starting from the cervical line to the buccal cusp tip. In addition, the height of contour is in the cervical third of the crown.
\nWhen compared with the buccal outline, this outline has more convexity. This margin is shorter than buccal margin. The lingual height of contour is at the middle third of crown. The “mesiolingual developmental groove (mesial marginal groove)” is visible from mesial aspect near the lingual margin.
\nThe cervical line is slightly curved about 1 mm toward the occlusal surface. The occlusal outline is a concave arc inclining lingually. In addition, the buccal section of the transverse ridge is sloping to the lingual direction at an approximately 45\n
Similarly with the mesial aspect, the crown is in rhomboid shape. Additionally, buccal/lingual margins are similar. While there is no distolingual developmental groove, there is a distal marginal groove in this aspect of mandibular first premolar.
\nThe cervical line on the distal surface has less curvature than mesial cervical curvature (less than 1 mm). The distal contact area is wider than the mesial contact area, since the contact tooth is second premolar.
\nThe distal marginal ridge is not sloping lingually as the mesial. It is in a horizontal position, making the ridge perpendicular to the long axis of the tooth. It is located more occlusally than mesial marginal ridge.
\nThe schematic description of the occlusal table is given in Figure 8. The shape of the crown is rhomboid or like a diamond. Since the crown is lingually inclined, from this aspect, most of the buccal surface could be seen. The difference between buccolingual and mesiodistal dimension is approximately 0.5 mm. The cusp tip is in the mesial half, and therefore, the distal half is a little bit larger than the mesial half.
\nThe schematic description of the occlusal table of the mandibular first premolar tooth.
The crown and root variations of the mandibular first premolar teeth.
The buccal margin has a pronounced convexity. This outline is also convex. However, it is shorter than the buccal outline. It continues up to the mesiolingual developmental groove.
\nThe mesial marginal ridge has an angle less than 90° at the point that it connects with the mesiobuccal cusp ridge.
\nThe convexity of the distal outline is more apparent than the mesial outline. It forms a right angle where it meets with the distobuccal cusp ridge.
\nMandibular first premolar has two cusps, a buccal and a lingual. The buccal cusp is the functional cusp, and it is larger than the lingual cusp. Additionally, the buccal cusp tip is slightly mesial to the center and located at the buccal half of the occlusal surface. The lingual cusp is very small and is like a tubercle. It is the nonfunctional cusp as it is a mandibular tooth. The crown converges lingually. The cusp has four cusp ridges as follows: “mesiobuccal, distobuccal, mesiolingual and distolingual.”
\nThe “buccal and lingual triangular ridges” form the “transverse ridge” in the central groove area.
\n“Mesial and distal marginal ridges” are well-developed marginal ridges. Mesial marginal ridge is shorter and is interrupted by mesiolingual developmental groove. The distal marginal ridge is more prominent and joins with the distolingual cusp ridge.
\n“Mesial and distal fossae” are present on the occlusal surface. They are boarded by the transverse ridge, the marginal ridges, and the mesial and distal cusp ridges of the two cusps. While the mesial fossa is linear in shape with the mesial developmental groove, the distal fossa is more circular.
\nThe “central developmental groove” connects the “mesial pit” to the “distal pit.” “Mesiobuccal triangular groove” extends from mesial pit in a mesiobuccal direction. Similarly, “mesiolingual triangular groove” extends from the mesial pit in a mesiolingual direction. “Mesiolingual developmental groove” is between mesial marginal ridge and mesiolingual cusp ridge. Similarly, with the mesial grooves, “distobuccal triangular developmental groove” extends from distal pit in a distobuccal direction, and “distolingual triangular developmental groove” has a distolingual direction starting from distal pit.
\nIn general, a mandibular first premolar has a single and straight root with a sharp apex. The root tapers from cervical to the apical region and is often curved distally. Rarely, a buccal and a lingual root or two buccal and one lingual root are present. The buccolingual section is wider than mesiodistal section. The height of contour of buccal surface is in the center of the root. The root is approximately 3 or 4 mm shorter than that of the mandibular canine. From the mesial aspect, the root is in a tapered form from the cervical line to the apical region. Despite the convexity in mesial and distal surfaces, longitudinal grooves are present in these surfaces, mostly deepest one in the mesial surface. The lingual surface is much narrower than buccal surface allowing most of the mesial and distal surfaces of the root to be seen. The convexity of distal surface is more prominent than mesial surface.
\nThe average measurements of the mandibular first premolar are shown in Table 6.
\nThe average measurements of the mandibular first premolar (in mm) | \n|||||||
---|---|---|---|---|---|---|---|
Cervico-occlusal length of crown | \nLength of root | \nMesiodistal diameter of crown | \nMesiodistal diameter of crown at cervix | \nBuccolingual diameter of crown | \nBuccolingual diameter of crown at cervix | \nCurvature of cervical line-mesial | \nCurvature of cervical line-distal | \n
8.5 | \n14.0 | \n7 | \n5 | \n7.5 | \n6.5 | \n1 | \n0 | \n
The average measurements of the mandibular first premolar teeth. Variations: The crown and root of this tooth exhibit some variations (Figure 9).
Chronologic development of the mandibular second premolar is given in Table 7.
\nDevelopment stage | \nYears | \n
---|---|
Initiation of calcification | \n2.25–2.5 years | \n
Enamel completion | \n6–7 years | \n
Eruption | \n11–12 years | \n
Root completion | \n13–14 years | \n
Chronologic development of the mandibular second premolar teeth.
In the universal system of notation, the right permanent mandibular second premolar is shown as “#29,” and the left one is shown as “#20.” According to the FDI notation, the right permanent mandibular second premolar is shown as “45,” and the left one is shown as “35.” Furthermore, in the Palmer notation, the right permanent mandibular second premolar is symbolized as “
The image of mandibular second premolar from all aspects is seen in Figure 10. A. Buccal, B. Lingual, C. Mesial, D. Distal, E. Occlusal.
\nMandibular second premolar tooth from different aspects. A. Buccal, B. Lingual, C. Mesial, D. Distal, E. Occlusal.
The mandibular second premolar is the fifth permanent tooth from the median line in the mandibular arch, located between the mandibular first premolars and first molars. Since the occlusal table is broader and similar to that of posterior teeth, this tooth has a function more like a molar.
\nDespite the similarities in general form of the second premolar with the first premolar, there are differences between them except buccal surface. There are two common forms: three-cusp type (“Y” groove pattern) exhibiting two lingual cusps and two-cusp type (“U” and “H” groove pattern).
\nConsidering the buccal aspect, a mandibular second premolar has a larger crown and longer root than first premolar. The buccal cusp is not so long and not as sharp as first premolar. The cusp tip is approximately at the center of the tooth in mesiodistal direction, therefore the distobuccal and mesiobuccal slopes are equal in dimension.
\nThe buccal surface is convex. Furthermore, mesial and distal outlines are convex except near the cervical region. The mesiobuccal and distobuccal cusp ridges are not angulated too much.
\nThe contact areas in mesial and distal regions are situated at the middle third. Since the distal contact is a molar tooth, the distal contact area is broader than mesial contact. Additionally, the height of contour is similar to that of first premolar.
\nSince there are two different forms of mandibular second premolar, the lingual aspect of a second premolar has some variations. The lingual surface is convex and smooth. In addition, it is slightly narrower and shorter than the buccal surface. However, this surface is wider and longer than that of first premolar. The mesial, distal, and cervical outlines are similar to first premolar. The lingual cusps are as high as buccal cusp; therefore, small part or none of the occlusal surface could be seen. The height of contour of the lingual surface is found approximately at the occlusal third of the crown.
\nTwo cusps—a buccal and a lingual—are present in this form. While no lingual groove exists in the lingual surface, a lingual depression could be found in the distal portion.
\nIn this type, there are mesiolingual and distolingual cusps, where the first one is the wider and the longer one. Distolingual cusp is often sharper than mesiolingual cusp. There is a “lingual groove” between the lingual cusps extending to the lingual surface.
\nFrom the mesial aspect, the shape is rhomboidal like the proximal aspect of all mandibular posterior teeth. Besides, mesial surface is convex except the concavity situated near the gingival region.
\nThis tooth is not inclined lingually as much as the first premolar. Therefore, the tip of the buccal is not centered over the root, usually located at the junction of the buccal and middle thirds. Besides, the lingual cusp is in alignment with the lingual surface of the root.
\nThe buccal surface is more curved than lingual surface. The buccal height of contour is found slightly occlusal of the cervical line, and lingual height of contour is approximately at the occlusal third.
\nThe mesial marginal ridge lies horizontally and is perpendicular to the long axis of the tooth. Additionally, it is located more occlusally than distal marginal ridge. Therefore, limited part of the occlusal surface is visible. There is no mesiolingual developmental groove.
\nThe cervical line has a slight occlusal curvature.
\nIn two-cusp type, while no lingual groove exists in the lingual surface, a lingual depression could be found in the distal portion. In three-cusp type, only the mesiolingual cusp could be seen from this aspect.
\nIn three-cusp type, both of the mesiolingual and distolingual cusps are visible from this aspect. The distal surface is also convex and similar to the mesial surface except some differences:
The distal marginal ridge is more concave and cervically located than mesial marginal ridge. Therefore, this surface is shorter than mesial occlusocervically. The occlusal surface could be seen from this aspect to a certain extent.
The distal contact area is located similarly with the mesial contact. Since the distal contact is with the first molar, it is wider buccolingually than mesial contact area.
The schematic description of the occlusal table is given in Figure 11. There are two common forms for the occlusal morphology of the mandibular second premolar. In both types of second premolars, there is “central groove” extending between mesial pit and distal pit.
\nThe schematic description of the occlusal table of the mandibular second premolar tooth.
Three-cusp type is the more common and square-shaped one. It has a “Y” groove pattern (Figure 12A). The variation of groove patterns is presented in Figure 12. A. “H” groove pattern, B. “U” groove pattern, C. “Y” groove pattern.
\nThe variations of groove patterns of the mandibular second premolar tooth. A. ?H? groove pattern, B. ?U? groove pattern, C. ?Y? groove pattern.
The crown and root variations of the mandibular second premolar teeth.
This type of mandibular second premolar has three cusps in the following order from largest to smallest: the buccal cusp, the mesiolingual cusp, and the distolingual cusp.
\nIn both of the arches at the occlusal aspect, the tooth becomes narrower toward the lingual half and the distal half. However, three-cusp second premolars are an exception that the crown is wider in the lingual and distal half than the buccal and mesial half.
\nIn three-cusp type, “mesiolingual triangular groove, mesiobuccal triangular groove, mesial marginal groove, distolingual triangular groove, distobuccal triangular groove and distal marginal groove” exist. Each of the cusps has “mesial and distal cusp ridges” and “a triangular ridge” connecting the cusp tip with the center of the occlusal surface. There are “mesial and distal triangular fossae.” Mesial triangular fossa originates from “mesial pit.” Distal triangular fossa originates from “distal pit.” The “central pit” is in the center of the occlusal surface in the three-cusp type.
\nThere are three deep developmental grooves (mesial developmental groove, distal developmental groove, and lingual developmental groove) connecting at the central pit. “Mesial developmental groove” extends from the central pit to the mesial triangular fossa. “Distal developmental groove” runs from the central pit to the distal triangular fossa. “Lingual developmental groove” is lying between two lingual cusps.
\nTwo-cusp type is more rounded and has a “U” or “H” groove pattern (Figure 12B and C). The buccal cusp is larger than lingual cusp. No central pit and lingual developmental groove exists. The buccal and lingual cusp triangular ridges connect and create a “transverse ridge.”
\nA mandibular second premolar has a single and tapered root having a curvature to the distal side. When compared with first premolar, the root is wider and longer than that of first premolar. The apex is inclined to distal side. Buccal surface is convex. There are longitudinal grooves on the proximal sides. In distal aspect, the longitudinal grooves are in the middle third. However, longitudinal depression is rarely seen on the mesial surface. The lingual surface is slightly convex and narrower than buccal surface. Some part of the mesial and distal sides of this tooth might be seen from this aspect.
\nThe average measurements of the mandibular second premolar are shown in Table 8.
\nThe average measurements of the mandibular second premolar (in mm) | \n|||||||
---|---|---|---|---|---|---|---|
Cervico-occlusal length of crown | \nLength of root | \nMesiodistal diameter of crown | \nMesiodistal diameter of crown at cervix | \nBuccolingual diameter of crown | \nBuccolingual diameter of crown at cervix | \nCurvature of cervical line-mesial | \nCurvature of cervical line-distal | \n
8 | \n14.5 | \n7 | \n5 | \n8 | \n7 | \n1 | \n0 | \n
The average measurements of the mandibular second premolar teeth. Variations: The crown and root of this tooth also exhibit some variations (Figure 13).
There are several general characteristics, which aid in differentiating the maxillary premolars from other posterior teeth and mandibular premolars. The maxillary first and second premolars appear more alike than mandibular premolars. However, maxillary first premolar crowns are generally larger than the second premolars. In addition, in the mandible, the first premolar is considerably smaller than those. From mesial and distal aspects, mandibular premolar crowns appear to be tilted lingually relative to their roots, whereas maxillary premolar crowns are aligned more directly. Maxillary premolars possess two cusps of nearly equal size. The mandibular premolars may have more than two cusps, and the lingual cusps are normally less prominent than the facial cusps. The buccal cusp is longer than the lingual cusp/cusps in all premolar teeth. This difference is the most prominent for mandibular first premolars and the least prominent for maxillary second premolars. The maxillary first premolar frequently has two root branches, whereas the other premolars have one root.
\nTibial plateau fractures constitute 1% of all bone fractures [1]. These intra-articular fractures are rare with an incidence of 10.3/100,000 per year [1]. They occur in young adults as a result of high energy trauma (motor accident, fall) or as low energy fractures in elderly patients with poor bone quality. This type of injury has a variety of fracture patterns. Compared to women, men younger than 50 years of age show a higher incidence for these fractures. Incidence increased markedly in women older than 50 years and decreased in men older than 50 years. For both sexes, the highest frequency was between ages 40 and 60 years [1].
Seventy percent of fractures are isolated to the lateral plateau, with 10–30% bicondylar and less than 10% isolated medial condyle fractures [2]. However, after multifragmentary articular surface destruction, they are often associated with a poor postoperative outcome [1]. With bicondylar fracture involvement, arthritis rates up to 44% have been described. Moreover, the medial plateau fractures with >3 mm displacement and anteromedial or posterolateral column fractures in young patients are associated with higher risk of ACL avulsion fracture [3].
Displaced fractures are treated with open reduction and internal fixation. The goals of treatment include restoration of extremity axial alignment, joint stability, and congruity, allowing early motion and prevention of osteoarthritis. Short-term results of surgical fixation of tibial plateau fractures are good; however, longer-term outcomes have demonstrated a significantly higher risk of end-stage arthritis and necessity for total knee arthroplasty [4].
Nontraumatic management of soft tissue with careful surgical incision is crucial in order to avoid further damage of the tissues around the fractured area. The choice of surgical approach is mainly based on the morphology of the fracture and the condition of the soft tissues, the general condition of the patient and the accompanying injuries. Computed tomography has greatly assisted in assessing the pattern of tibial plateau fractures.
It is important to achieve good reduction of the fracture for better long-term results with the proper surgical incision. The ideal surgery approach helps the orthopedic surgeon to evaluate the fracture and place the orthopedic fixation implants successfully.
Lateral tibial plateau fractures are very common. Due to this reason, the anterolateral approach is the most frequently used surgical approach for tibial plateau fractures. This surgical incision can be used for simply split lateral tibial fractures with or without compression and also for comminuted bicondylar tibial fractures.
There are quite a few variations in skin incisions for the anterolateral approach. In this chapter, we will describe the two methods most commonly used. For the first one, the incision starts 2–3 cm proximal to the joint line and ends 3 cm inferior of the tibial tubercle, depending on the fracture pattern. This lazy “s” shaped incision begins directly lateral over the iliotibial band (ΙΤ), curves over Gerdy’s tubercle, and continues distally lateral to the tibial crest (Figure 1) [5]. The iliotibial band is detached from its insertion using sharp dissection with a knife and reflected anteriorly and posteriorly (Figure 2) [5]. The interval between the IT band and the joint capsule is developed with blunt dissection, and care is taken to keep the capsule intact. As far as deep dissection is concerned, the anterior tibialis muscle is retracted posteriorly revealing the anterolateral part of proximal tibia. Consequently, the joint line is identified, and submeniscal arthrotomy is made [6]. Two or three sutures are placed in the peripheral part of the meniscus, and retraction is applied to better visualize the articular surface. These sutures are also used to stabilize the lateral meniscus into the tibia or into the K-wire holes of the plate after fracture fixation.
Skin incision for anterolateral approach lazy “s”.
Iliotibial band curved over Gerdy’s tubercle.
According to the international literature, many orthopedic surgeons use the “straight” incision for the anterolateral approaches of tibial plateau fractures [7]. This is the second method most often used for the anterolateral approach. It consists of an incision that begins proximal to the lateral femoral epicondyle and continues distally behind Gerdy’s tubercle. Depending on the fracture pattern, the skin incision can be either more posterior or anterior. Regarding superficial dissection, extensive subcutaneous soft tissue must be mobilized in order to expose the fascia of the tibialis anterior. The deep dissection that follows is the same as we describe above in “s-shaped” incision, using iliotibial band and fibula head as landmarks.
Typically, the patient is positioned in either supine or lateral decubitus position. Moreover, the patient’s leg can be placed in leg-holter position for better fracture reduction due to permanent ligamentotaxis.
Structures in danger
Short saphenous vein
Superficial peroneal nerve
Anterior tibial artery and deep peroneal nerve
Posterolateral plateau fractures can neither be viewed nor adequately supported with these types of procedures. Posterolateral areas cannot be visualized via the classic anterolateral approach; consequently, other techniques are needed [8]. Several osteotomies have been described for improving exposure via a standard anterolateral approach. These osteotomies help to better visualize the posterolateral part of tibial plateau and manipulate the fragments; however, it is difficult to place the adequate posterior fixation. First, the femoral epicondyle osteotomy has been used for several orthopedic surgeries, such as total knee arthroplasty or meniscal transplantation [9]. In 2015, a case report was described in which the lateral femoral epicondyle was osteotomized for better access to the posterolateral tibial plateau fracture [10]. Second, the fibula resection osteotomy has been described in 2010 and includes resection of the medial and proximal fibula. Third, the digastric fibular osteotomy has been recently described in the literature improving both the visualization of the posterolateral articular surface and the ability to manipulate posterolateral fracture fragments.
The posterolateral approach is ideal for the lateral tibial plateau fractures which have posterior displacement. This approach was initially described by Lobenhoffer et al. [11] in 1997 and was then modified by many surgeons such as Frosch [12] and Solomon [8] either with or without fibular osteotomy.
As Lobenhoffer [11] first described, the head of the fibula and the tibial tuberosity can be used for the orientation of the skin incision. The longitudinal cut runs laterally exactly in the middle of the distance between the tibial tuberosity and the fibula tip and has approximately 10 cm length. The peroneal nerve is identified proximal to the head of the fibula and is looped. The origin of the extensor muscle is then cut away, and the incision is continued tongue-shaped over the fibular neck. If there is a subcapital fibula fracture, this fracture is carefully mobilized. If this is not the case, a fibula osteotomy is performed after careful circumvention of the fibular neck. The origin of the extensor muscles is pushed about 1 cm distally. The meniscotibial ligament is incised, and the lateral meniscus is pulled proximally using holding threads. The fixed ligament of the tibiofibular joint is released, so that the head of the fibula can be pulled upward and back. As a result, the lateral collateral ligament relaxes and enables the lateral joint gap to be opened wide. The posterolateral tibial plateau is brought into the field of the surgeon’s vision in flexion and varus as well as internal rotation. If necessary, the posterolateral tibia shaft is exposed. If extensive exposure is required, the iliotibial tract on Gerdy’s tubercle can also be detached in one layer with the meniscotibial ligament.
Structures in danger
Common peroneal nerve
Popliteal artery
Popliteal tendon
Lateral superior genicular artery
Lateral inferior genicular artery
Nowadays, a modification of the posterolateral approach is used that was described by Frosch et al. [12]. A straight incision, about 8–10 cm, is made from the medial border of the biceps femoris tendon proximally to the posteromedial part of fibula distally. Subsequently, through the skin and subcutaneous tissues, the interval between the biceps femoris tendon and the lateral gastrocnemius muscle is found. In this area, the common peroneal nerve (CPN) can be identified. In particular, it is located medial to the biceps tendon, which gives off the lateral sural cutaneous nerve (LSCN) at this level. The superficial dissection ends at the plane between lateral gastrocnemius muscle with LSCN in the lateral side and biceps femoris tendon with CPN medial. It is important to know that lateral gastrocnemius is the most medial structure in this approach. Distally, the soleus is encountered at its origin on the posterolateral tibia and fibula. Blunt elevation of the soleus will provide exposure of the proximal tibia. Moreover, the anterior tibial artery should be protected in this area, because it travels to the anterior compartment, and the common peroneal nerve. The popliteus tendon is carefully mobilized, protecting the inferolateral genicular artery from injury. Finally, submeniscus arthrotomy can be performed for better visualization of the articular surface. If more exposure is needed, transverse osteotomy of the fibular neck can be performed.
A modification of this approach was described by Solomon, with an incision along the anterior border of biceps femoris and an osteotomy of the fibula [8]. This provides the opportunity to retract the fibular head, the lateral collateral ligament, and the biceps femoris upward.
The patient may be placed in the prone, supine, or lateral decubitus position based on the patient’s other injuries and the surgeon’s preference.
The medial approach is used when an anteromedial fracture pattern of tibial plateau occurs [5]. It is difficult with this approach to obtain a good access of the articular surface without injuring the medial collateral ligament. The adductor tubercle and the medial border of the tibial crest are very important landmarks for this procedure [5].
The skin incision begins from the medial femoral epicondyle, about 2–3 cm over the joint line, and ends 2 cm posterior to the tibial crest, depending on fracture extension. The knee must be flexed about 15°–20° before proceeding with this skin incision (Figure 3). The superficial dissection includes the sartorius fascia, which is incised in a straight line similar to the skin. Next, the gracilis and semitendinosus tendons are identified, which arise posteriorly creating together with the sartorius the pes anserinus in the anteromedial tibia. In regard to the deep dissection, three layers exist in this area [5]. The first is the pes anserinus tendons posterior and proximal, the second is the superficial medial collateral ligament, and the third is the deep medial collateral ligament. The first and second layers can be cut off during this procedure and should be repaired after fracture fixation. The deep medial collateral can be incised by making an arthrotomy for articular surface visualization. In most cases, fracture reduction is carried out without an arthrotomy because it can be subsequently confirmed by fluoroscopic imaging.
Skin incision for medial approach.
Structures in danger
Infrapatellar branch of saphenous nerve
Saphenous vein
Medial inferior genicular artery
Popliteal artery
The patient’s position is either supine with the knee flexed (~50°–60°), the ipsilateral hip external rotated and abducted or in a “leg-holter” position.
The posteromedial approach is mainly used for shear or coronal fractures of the medial tibial plateau [13]. It is an ideal approach because it gives the opportunity to place an antiglide plate for better fixation of this type of fractures. Moreover, it can be done in either the supine or prone position. The prone position has the main advantage of being more comfortable for the surgeon. This is not recommended in dual approach strategies such as performed for concurrent lateral and medial plateau fractures, because of the need for the patient’s repositioning.
The asterisk is pes anserinus tendon. Above this structure is the line for the posteromedial access between pes anserinus and medial gastrocnemius.
In posteromedial approach in supine position [13], the surgeon should stand on the opposite side of the injured leg. The important landmarks for the incision are the medial femoral epicondyle proximal and the posterior tibial border distally. For this approach, it is important to obtain a 30° knee flexion and external rotation of the ipsilateral hip for better access of the posteromedial area. Regarding superficial dissection, the skin incision is about 8 cm, and the sartorius fascia is incised between the medial gastrocnemius posteriorly and the pes anserinus anteriorly (Figure 4). The saphenous nerve runs just anterior to the great saphenous vein. The medial collateral ligament lies deeper than the pes anserinus and therefore cannot be injured during this approach. The semimembranosus and the popliteus muscle insertion in the posterior tibia can be released off the bone using subperiosteal dissection for better access of the fracture area. Moreover, submeniscal arthrotomy can be done to visualize the joint directly, and sutures may be placed into the meniscus for retraction. Finally, fluoroscopic imaging is necessary to confirm the appropriate reduction of the articular surface [5].
On the other hand, the posteromedial approach in prone position was initially described in 2003 [14]. For this procedure, it is important to place a folded blanket under the ipsilateral femur allowing leg hyperextension for easier fracture reduction as mentioned by Moore. The skin incision is about 2 cm posterior and lateral than in the supine position. Its length is 8–10 cm running along the medial border of the medial gastrocnemius. The medial gastrocnemius is then retracted laterally developing the interval between the medial gastrocnemius and the semimembranosus. The pes tendons are placed intact anteriorly. The deep dissection continues with the subperiosteal elevation of the popliteus muscle off its insertion in the posterolateral area of tibia. Finally, modifications of this approach exist that provide additional lateral exposure such as the “S-type” procedure [15].
Structures in danger
Short saphenous vein
Peroneal artery and branches
Posterior tibial artery and nerve
The direct posterior approach is rarely used for tibial plateau fractures. The fracture pattern treated with this approach is a shear posterior bicondylar plateau’s fracture with the main fracture line in coronal plane. This method has an important disadvantage when compared to other surgical incisions, and there is a higher risk for iatrogenic injury of neurovascular structures in the popliteal fossa.
Structures in danger
Popliteal artery
Tibial nerve
Sural nerve and short saphenous vein
Posterior approach was first announced in 1945 as a midline incision through popliteal fossa by Abbott and Carpenter. Many variations have been published over the years of the classic technique as “S – shape” [5], “L – type” incision [16], and lastly the “FCR”’ approach to the knee [17].
An “S-shape” skin incision is made from proximal-lateral to distal-medial. In this incision, the important landmarks are the Biceps Femoris proximal, the popliteal fossa at the joint line, and the medial head of the gastrocnemius distally (Figure 5). We should be attentive in the superficial dissection because underneath the skin lies the lesser saphenous vein and the sural nerve, which rests immediately lateral to the vein (Figure 6). The deep facia is incised, and the sural nerve may be followed proximally helping the surgeon to identify the tibial nerve. The tibial nerve lies superficial and slightly lateral to the popliteal vein and artery. The popliteal fossa is recognized proximally between the medial and lateral heads of the gastrocnemius and distally between the medial border of biceps femoris and the lateral border of semimembranosus. Underneath the biceps femoris is the common peroneal nerve, which is separated from the sciatic nerve just proximal to the joint line. Depending on the fracture pattern, the deep dissection may be continued either posteromedial or posterolateral as we described above (Figure 7). The landmarks are Biceps femoris, the lateral and the medial gastrocnemius, and the semimembranosus tendon.
Skin incision for direct posterior approach.
The skin was mobilized and was identified the lesser saphenous vein and the sural nerve.
The posterior capsule of knee.
An “L-shape” incision starts superiorly and medially at the popliteus space parallel to Langer’s line. A vertical skin incision begins at the medial corner of the popliteal fossa and extends distally. Full-thickness fasciocutaneous flaps are raised protecting the sural nerve and lesser saphenous vein. The medial head of the gastrocnemius should be retracted laterally, protecting the neurovascular structures and exposing the knee capsule. The deep dissection should be done beneath the popliteus muscle in the proximal part from medial to lateral. Subsequently, the popliteus and the soleus origins are mobilized for better visualization of the posterior tibial plateau. In most cases, the entire posterior part of the tibia can be exposed without cutting the medial head of the gastrocnemius [16].
This procedure is performed with the patient in prone position and the knee slightly flexed using a bump under the ankle.
The percutaneous approach is applied to tibial fractures with either small split of the articular surface (Schatzker I classification) or a pure depression of the lateral tibial plateau (Schatzker III classification). The incisions are about 1–2 cm in length, and fluoroscopy or arthroscopy imaging is vital for this procedure.
Percutaneous reduction should be made with a bone tamp, with percutaneous application of bone-holding forceps, and with the joystick technique and ligamentotaxis [18].
Reduction of tibial plateau fractures with small split is achieved by inserting a clamp with its ends on the lateral and medial sides, approximately 1 or 2 cm below the articular surface. The 6.5–7.3 mm cannulated screws are then placed parallel to the articular line. According to the literature, the minimal number of screws required for this procedure is three [18]. Washers are a good choice for better compressing the fracture line.
The reduction of fractures with a slight depression of the articular surface is performed by the mini-open technique. This consists of a small vertical incision on the skin (2 cm) on the lateral or medial side of the tibial metaphysis (Figure 8). Through this incision, a bone window is opened into the cortex, and a bone tamp is pushed for the reduction of the articulated surface (Figure 9). The gap that is created can be filled either with bone autografts or allografts or with calcium phosphate bone cement to support the articular surface. It is recommended to overcorrect the fracture.
Skin incision for lateral plateau fracture with percutaneous approach.
Bone window in the cortex.
Radiological imaging or arthroscopic visualization of the articular surface of the tibia may be performed to evaluate adequate reduction. There are a lot of meta-analyses in the international literature, which indicate that arthroscopic fracture reduction rather than open arthrotomy achieves better functional outcomes in patients [19]. More than 10 mm of plateau depression presents an increased risk of lateral meniscus tear [20]. Therefore, slight depressed monocondylar fractures should be examined with arthroscopy after fracture reduction. It is crucial to acknowledge that knee arthroscopy can cause post-operative compartment syndrome due to fluid escaping into the tibia compartments.
Moreover, fixation plates can be used for fracture fixation, with less bone exposure. In 1989, Mast et al. [21] described the “indirect reduction” technique, thus minimizing the soft tissue damage. Subsequently, in 1997, the minimally invasive plate osteosynthesis was introduced (MIPO) by Wenda [22] and Krettek [23]. An abundance of studies followed in the international literature describes the MIPO technique and compares the advantages and disadvantages of this new method. This procedure includes small skin incisions, the application through these of the fixation plate, and furthermore percutaneous screw placing. Fracture reduction is achieved by distraction using either a distractor, a tension device, or a lamina spreader.
The main advantages of percutaneous approach and MIPO technique are risk reduction of wound complications due to minimal soft tissue damage during surgical dissection and biological fracture healing by preserving the vascularity of the bone [19]. Furthermore, this technique offers paramount benefits such as less blood loss, earlier functional rehabilitation, and shorter hospitalization [19].
Tibial plateau fractures are very common, and orthopedic surgeons should be familiar with this kind of injury. Classic surgical approaches are the lateral, the posterolateral, the medial, the posteromedial, and the direct posterior. Many variations of these techniques have been developed over the years. Nowadays, percutaneous approaches and MIPO techniques are gaining ground but only after specific indications. Before choosing the appropriate approach, it is necessary to evaluate the fracture pattern either with sufficient X-rays or CT scans.
IntechOpen implements a robust policy to minimize and deal with instances of fraud or misconduct. As part of our general commitment to transparency and openness, and in order to maintain high scientific standards, we have a well-defined editorial policy regarding Retractions and Corrections.
",metaTitle:"Retraction and Correction Policy",metaDescription:"Retraction and Correction Policy",metaKeywords:null,canonicalURL:"/page/retraction-and-correction-policy",contentRaw:'[{"type":"htmlEditorComponent","content":"IntechOpen’s Retraction and Correction Policy has been developed in accordance with the Committee on Publication Ethics (COPE) publication guidelines relating to scientific misconduct and research ethics:
\\n\\n1. RETRACTIONS
\\n\\nA Retraction of a Chapter will be issued by the Academic Editor, either following an Author’s request to do so or when there is a 3rd party report of scientific misconduct. Upon receipt of a report by a 3rd party, the Academic Editor will investigate any allegations of scientific misconduct, working in cooperation with the Author(s) and their institution(s).
\\n\\nA formal Retraction will be issued when there is clear and conclusive evidence of any of the following:
\\n\\nPublishing of a Retraction Notice will adhere to the following guidelines:
\\n\\n1.2. REMOVALS AND CANCELLATIONS
\\n\\n2. STATEMENTS OF CONCERN
\\n\\nA Statement of Concern detailing alleged misconduct will be issued by the Academic Editor or publisher following a 3rd party report of scientific misconduct when:
\\n\\nIntechOpen believes that the number of occasions on which a Statement of Concern is issued will be very few in number. In all cases when such a decision has been taken by the Academic Editor the decision will be reviewed by another editor to whom the author can make representations.
\\n\\n3. CORRECTIONS
\\n\\nA Correction will be issued by the Academic Editor when:
\\n\\n3.1. ERRATUM
\\n\\nAn Erratum will be issued by the Academic Editor when it is determined that a mistake in a Chapter originates from the production process handled by the publisher.
\\n\\nA published Erratum will adhere to the Retraction Notice publishing guidelines outlined above.
\\n\\n3.2. CORRIGENDUM
\\n\\nA Corrigendum will be issued by the Academic Editor when it is determined that a mistake in a Chapter is a result of an Author’s miscalculation or oversight. A published Corrigendum will adhere to the Retraction Notice publishing guidelines outlined above.
\\n\\n4. FINAL REMARKS
\\n\\nIntechOpen wishes to emphasize that the final decision on whether a Retraction, Statement of Concern, or a Correction will be issued rests with the Academic Editor. The publisher is obliged to act upon any reports of scientific misconduct in its publications and to make a reasonable effort to facilitate any subsequent investigation of such claims.
\\n\\nIn the case of Retraction or removal of the Work, the publisher will be under no obligation to refund the APC.
\\n\\nThe general principles set out above apply to Retractions and Corrections issued in all IntechOpen publications.
\\n\\nAny suggestions or comments on this Policy are welcome and may be sent to permissions@intechopen.com.
\\n\\nPolicy last updated: 2017-09-11
\\n"}]'},components:[{type:"htmlEditorComponent",content:'IntechOpen’s Retraction and Correction Policy has been developed in accordance with the Committee on Publication Ethics (COPE) publication guidelines relating to scientific misconduct and research ethics:
\n\n1. RETRACTIONS
\n\nA Retraction of a Chapter will be issued by the Academic Editor, either following an Author’s request to do so or when there is a 3rd party report of scientific misconduct. Upon receipt of a report by a 3rd party, the Academic Editor will investigate any allegations of scientific misconduct, working in cooperation with the Author(s) and their institution(s).
\n\nA formal Retraction will be issued when there is clear and conclusive evidence of any of the following:
\n\nPublishing of a Retraction Notice will adhere to the following guidelines:
\n\n1.2. REMOVALS AND CANCELLATIONS
\n\n2. STATEMENTS OF CONCERN
\n\nA Statement of Concern detailing alleged misconduct will be issued by the Academic Editor or publisher following a 3rd party report of scientific misconduct when:
\n\nIntechOpen believes that the number of occasions on which a Statement of Concern is issued will be very few in number. In all cases when such a decision has been taken by the Academic Editor the decision will be reviewed by another editor to whom the author can make representations.
\n\n3. CORRECTIONS
\n\nA Correction will be issued by the Academic Editor when:
\n\n3.1. ERRATUM
\n\nAn Erratum will be issued by the Academic Editor when it is determined that a mistake in a Chapter originates from the production process handled by the publisher.
\n\nA published Erratum will adhere to the Retraction Notice publishing guidelines outlined above.
\n\n3.2. CORRIGENDUM
\n\nA Corrigendum will be issued by the Academic Editor when it is determined that a mistake in a Chapter is a result of an Author’s miscalculation or oversight. A published Corrigendum will adhere to the Retraction Notice publishing guidelines outlined above.
\n\n4. FINAL REMARKS
\n\nIntechOpen wishes to emphasize that the final decision on whether a Retraction, Statement of Concern, or a Correction will be issued rests with the Academic Editor. The publisher is obliged to act upon any reports of scientific misconduct in its publications and to make a reasonable effort to facilitate any subsequent investigation of such claims.
\n\nIn the case of Retraction or removal of the Work, the publisher will be under no obligation to refund the APC.
\n\nThe general principles set out above apply to Retractions and Corrections issued in all IntechOpen publications.
\n\nAny suggestions or comments on this Policy are welcome and may be sent to permissions@intechopen.com.
\n\nPolicy last updated: 2017-09-11
\n'}]},successStories:{items:[]},authorsAndEditors:{filterParams:{sort:"featured,name"},profiles:[{id:"105746",title:"Dr.",name:"A.W.M.M.",middleName:null,surname:"Koopman-van Gemert",slug:"a.w.m.m.-koopman-van-gemert",fullName:"A.W.M.M. Koopman-van Gemert",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/105746/images/5803_n.jpg",biography:"Dr. Anna Wilhelmina Margaretha Maria Koopman-van Gemert MD, PhD, became anaesthesiologist-intensivist from the Radboud University Nijmegen (the Netherlands) in 1987. She worked for a couple of years also as a blood bank director in Nijmegen and introduced in the Netherlands the Cell Saver and blood transfusion alternatives. She performed research in perioperative autotransfusion and obtained the degree of PhD in 1993 publishing Peri-operative autotransfusion by means of a blood cell separator.\nBlood transfusion had her special interest being the president of the Haemovigilance Chamber TRIP and performing several tasks in local and national blood bank and anticoagulant-blood transfusion guidelines committees. Currently, she is working as an associate professor and up till recently was the dean at the Albert Schweitzer Hospital Dordrecht. She performed (inter)national tasks as vice-president of the Concilium Anaesthesia and related committees. \nShe performed research in several fields, with over 100 publications in (inter)national journals and numerous papers on scientific conferences. \nShe received several awards and is a member of Honour of the Dutch Society of Anaesthesia.",institutionString:null,institution:{name:"Albert Schweitzer Hospital",country:{name:"Gabon"}}},{id:"83089",title:"Prof.",name:"Aaron",middleName:null,surname:"Ojule",slug:"aaron-ojule",fullName:"Aaron Ojule",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Port Harcourt",country:{name:"Nigeria"}}},{id:"295748",title:"Mr.",name:"Abayomi",middleName:null,surname:"Modupe",slug:"abayomi-modupe",fullName:"Abayomi Modupe",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/no_image.jpg",biography:null,institutionString:null,institution:{name:"Landmark University",country:{name:"Nigeria"}}},{id:"94191",title:"Prof.",name:"Abbas",middleName:null,surname:"Moustafa",slug:"abbas-moustafa",fullName:"Abbas Moustafa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94191/images/96_n.jpg",biography:"Prof. Moustafa got his doctoral degree in earthquake engineering and structural safety from Indian Institute of Science in 2002. He is currently an associate professor at Department of Civil Engineering, Minia University, Egypt and the chairman of Department of Civil Engineering, High Institute of Engineering and Technology, Giza, Egypt. He is also a consultant engineer and head of structural group at Hamza Associates, Giza, Egypt. Dr. Moustafa was a senior research associate at Vanderbilt University and a JSPS fellow at Kyoto and Nagasaki Universities. He has more than 40 research papers published in international journals and conferences. He acts as an editorial board member and a reviewer for several regional and international journals. His research interest includes earthquake engineering, seismic design, nonlinear dynamics, random vibration, structural reliability, structural health monitoring and uncertainty modeling.",institutionString:null,institution:{name:"Minia University",country:{name:"Egypt"}}},{id:"84562",title:"Dr.",name:"Abbyssinia",middleName:null,surname:"Mushunje",slug:"abbyssinia-mushunje",fullName:"Abbyssinia Mushunje",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Fort Hare",country:{name:"South Africa"}}},{id:"202206",title:"Associate Prof.",name:"Abd Elmoniem",middleName:"Ahmed",surname:"Elzain",slug:"abd-elmoniem-elzain",fullName:"Abd Elmoniem Elzain",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Kassala University",country:{name:"Sudan"}}},{id:"98127",title:"Dr.",name:"Abdallah",middleName:null,surname:"Handoura",slug:"abdallah-handoura",fullName:"Abdallah Handoura",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"École Supérieure des Télécommunications",country:{name:"Morocco"}}},{id:"91404",title:"Prof.",name:"Abdecharif",middleName:null,surname:"Boumaza",slug:"abdecharif-boumaza",fullName:"Abdecharif Boumaza",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Abbès Laghrour University of Khenchela",country:{name:"Algeria"}}},{id:"105795",title:"Prof.",name:"Abdel Ghani",middleName:null,surname:"Aissaoui",slug:"abdel-ghani-aissaoui",fullName:"Abdel Ghani Aissaoui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/105795/images/system/105795.jpeg",biography:"Abdel Ghani AISSAOUI is a Full Professor of electrical engineering at University of Bechar (ALGERIA). He was born in 1969 in Naama, Algeria. He received his BS degree in 1993, the MS degree in 1997, the PhD degree in 2007 from the Electrical Engineering Institute of Djilali Liabes University of Sidi Bel Abbes (ALGERIA). He is an active member of IRECOM (Interaction Réseaux Electriques - COnvertisseurs Machines) Laboratory and IEEE senior member. He is an editor member for many international journals (IJET, RSE, MER, IJECE, etc.), he serves as a reviewer in international journals (IJAC, ECPS, COMPEL, etc.). He serves as member in technical committee (TPC) and reviewer in international conferences (CHUSER 2011, SHUSER 2012, PECON 2012, SAI 2013, SCSE2013, SDM2014, SEB2014, PEMC2014, PEAM2014, SEB (2014, 2015), ICRERA (2015, 2016, 2017, 2018,-2019), etc.). His current research interest includes power electronics, control of electrical machines, artificial intelligence and Renewable energies.",institutionString:"University of Béchar",institution:{name:"University of Béchar",country:{name:"Algeria"}}},{id:"99749",title:"Dr.",name:"Abdel Hafid",middleName:null,surname:"Essadki",slug:"abdel-hafid-essadki",fullName:"Abdel Hafid Essadki",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"École Nationale Supérieure de Technologie",country:{name:"Algeria"}}},{id:"101208",title:"Prof.",name:"Abdel Karim",middleName:"Mohamad",surname:"El Hemaly",slug:"abdel-karim-el-hemaly",fullName:"Abdel Karim El Hemaly",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/101208/images/733_n.jpg",biography:"OBGYN.net Editorial Advisor Urogynecology.\nAbdel Karim M. A. El-Hemaly, MRCOG, FRCS � Egypt.\n \nAbdel Karim M. A. El-Hemaly\nProfessor OB/GYN & Urogynecology\nFaculty of medicine, Al-Azhar University \nPersonal Information: \nMarried with two children\nWife: Professor Laila A. Moussa MD.\nSons: Mohamad A. M. El-Hemaly Jr. MD. Died March 25-2007\nMostafa A. M. El-Hemaly, Computer Scientist working at Microsoft Seatle, USA. \nQualifications: \n1.\tM.B.-Bch Cairo Univ. June 1963. \n2.\tDiploma Ob./Gyn. Cairo Univ. April 1966. \n3.\tDiploma Surgery Cairo Univ. Oct. 1966. \n4.\tMRCOG London Feb. 1975. \n5.\tF.R.C.S. Glasgow June 1976. \n6.\tPopulation Study Johns Hopkins 1981. \n7.\tGyn. Oncology Johns Hopkins 1983. \n8.\tAdvanced Laparoscopic Surgery, with Prof. Paulson, Alexandria, Virginia USA 1993. \nSocieties & Associations: \n1.\t Member of the Royal College of Ob./Gyn. London. \n2.\tFellow of the Royal College of Surgeons Glasgow UK. \n3.\tMember of the advisory board on urogyn. FIGO. \n4.\tMember of the New York Academy of Sciences. \n5.\tMember of the American Association for the Advancement of Science. \n6.\tFeatured in �Who is Who in the World� from the 16th edition to the 20th edition. \n7.\tFeatured in �Who is Who in Science and Engineering� in the 7th edition. \n8.\tMember of the Egyptian Fertility & Sterility Society. \n9.\tMember of the Egyptian Society of Ob./Gyn. \n10.\tMember of the Egyptian Society of Urogyn. \n\nScientific Publications & Communications:\n1- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Asim Kurjak, Ahmad G. Serour, Laila A. S. Mousa, Amr M. Zaied, Khalid Z. El Sheikha. \nImaging the Internal Urethral Sphincter and the Vagina in Normal Women and Women Suffering from Stress Urinary Incontinence and Vaginal Prolapse. Gynaecologia Et Perinatologia, Vol18, No 4; 169-286 October-December 2009.\n2- Abdel Karim M. El Hemaly*, Laila A. S. Mousa Ibrahim M. Kandil, Fatma S. El Sokkary, Ahmad G. Serour, Hossam Hussein.\nFecal Incontinence, A Novel Concept: The Role of the internal Anal sphincter (IAS) in defecation and fecal incontinence. Gynaecologia Et Perinatologia, Vol19, No 2; 79-85 April -June 2010.\n3- Abdel Karim M. El Hemaly*, Laila A. S. Mousa Ibrahim M. Kandil, Fatma S. El Sokkary, Ahmad G. Serour, Hossam Hussein.\nSurgical Treatment of Stress Urinary Incontinence, Fecal Incontinence and Vaginal Prolapse By A Novel Operation \n"Urethro-Ano-Vaginoplasty"\n Gynaecologia Et Perinatologia, Vol19, No 3; 129-188 July-September 2010.\n4- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Laila A. S. Mousa and Mohamad A.K.M.El Hemaly.\nUrethro-vaginoplasty, an innovated operation for the treatment of: Stress Urinary Incontinence (SUI), Detursor Overactivity (DO), Mixed Urinary Incontinence and Anterior Vaginal Wall Descent. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/ urethro-vaginoplasty_01\n\n5- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamed M. Radwan.\n Urethro-raphy a new technique for surgical management of Stress Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/\nnew-tech-urethro\n\n6- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamad A. Rizk, Nabil Abdel Maksoud H., Mohamad M. Radwan, Khalid Z. El Shieka, Mohamad A. K. M. El Hemaly, and Ahmad T. El Saban.\nUrethro-raphy The New Operation for the treatment of stress urinary incontinence, SUI, detrusor instability, DI, and mixed-type of urinary incontinence; short and long term results. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=urogyn/articles/\nurethroraphy-09280\n\n7-Abdel Karim M. El Hemaly, Ibrahim M Kandil, and Bahaa E. El Mohamady. Menopause, and Voiding troubles. \nhttp://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly03/el-hemaly03-ss\n\n8-El Hemaly AKMA, Mousa L.A. Micturition and Urinary\tContinence. Int J Gynecol Obstet 1996; 42: 291-2. \n\n9-Abdel Karim M. El Hemaly.\n Urinary incontinence in gynecology, a review article.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/abs-urinary_incotinence_gyn_ehemaly \n\n10-El Hemaly AKMA. Nocturnal Enuresis: Pathogenesis and Treatment. \nInt Urogynecol J Pelvic Floor Dysfunct 1998;9: 129-31.\n \n11-El Hemaly AKMA, Mousa L.A.E. Stress Urinary Incontinence, a New Concept. Eur J Obstet Gynecol Reprod Biol 1996; 68: 129-35. \n\n12- El Hemaly AKMA, Kandil I. M. Stress Urinary Incontinence SUI facts and fiction. Is SUI a puzzle?! http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly/el-hemaly-ss\n\n13-Abdel Karim El Hemaly, Nabil Abdel Maksoud, Laila A. Mousa, Ibrahim M. Kandil, Asem Anwar, M.A.K El Hemaly and Bahaa E. El Mohamady. \nEvidence based Facts on the Pathogenesis and Management of SUI. http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly02/el-hemaly02-ss\n\n14- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Mohamad A. Rizk and Mohamad A.K.M.El Hemaly.\n Urethro-plasty, a Novel Operation based on a New Concept, for the Treatment of Stress Urinary Incontinence, S.U.I., Detrusor Instability, D.I., and Mixed-type of Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/urethro-plasty_01\n\n15-Ibrahim M. Kandil, Abdel Karim M. El Hemaly, Mohamad M. Radwan: Ultrasonic Assessment of the Internal Urethral Sphincter in Stress Urinary Incontinence. The Internet Journal of Gynecology and Obstetrics. 2003. Volume 2 Number 1. \n\n\n16-Abdel Karim M. El Hemaly. Nocturnal Enureses: A Novel Concept on its pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecolgy/?page=articles/nocturnal_enuresis\n\n17- Abdel Karim M. El Hemaly. Nocturnal Enureses: An Update on the pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecology/?page=/ENHLIDH/PUBD/FEATURES/\nPresentations/ Nocturnal_Enuresis/nocturnal_enuresis\n\n18-Maternal Mortality in Egypt, a cry for help and attention. The Second International Conference of the African Society of Organization & Gestosis, 1998, 3rd Annual International Conference of Ob/Gyn Department � Sohag Faculty of Medicine University. Feb. 11-13. Luxor, Egypt. \n19-Postmenopausal Osteprosis. The 2nd annual conference of Health Insurance Organization on Family Planning and its role in primary health care. Zagaziz, Egypt, February 26-27, 1997, Center of Complementary Services for Maternity and childhood care. \n20-Laparoscopic Assisted vaginal hysterectomy. 10th International Annual Congress Modern Trends in Reproductive Techniques 23-24 March 1995. Alexandria, Egypt. \n21-Immunological Studies in Pre-eclamptic Toxaemia. Proceedings of 10th Annual Ain Shams Medical Congress. Cairo, Egypt, March 6-10, 1987. \n22-Socio-demographic factorse affecting acceptability of the long-acting contraceptive injections in a rural Egyptian community. Journal of Biosocial Science 29:305, 1987. \n23-Plasma fibronectin levels hypertension during pregnancy. The Journal of the Egypt. Soc. of Ob./Gyn. 13:1, 17-21, Jan. 1987. \n24-Effect of smoking on pregnancy. Journal of Egypt. Soc. of Ob./Gyn. 12:3, 111-121, Sept 1986. \n25-Socio-demographic aspects of nausea and vomiting in early pregnancy. Journal of the Egypt. Soc. of Ob./Gyn. 12:3, 35-42, Sept. 1986. \n26-Effect of intrapartum oxygen inhalation on maternofetal blood gases and pH. Journal of the Egypt. Soc. of Ob./Gyn. 12:3, 57-64, Sept. 1986. \n27-The effect of severe pre-eclampsia on serum transaminases. The Egypt. J. Med. Sci. 7(2): 479-485, 1986. \n28-A study of placental immunoreceptors in pre-eclampsia. The Egypt. J. Med. Sci. 7(2): 211-216, 1986. \n29-Serum human placental lactogen (hpl) in normal, toxaemic and diabetic pregnant women, during pregnancy and its relation to the outcome of pregnancy. Journal of the Egypt. Soc. of Ob./Gyn. 12:2, 11-23, May 1986. \n30-Pregnancy specific B1 Glycoprotein and free estriol in the serum of normal, toxaemic and diabetic pregnant women during pregnancy and after delivery. Journal of the Egypt. Soc. of Ob./Gyn. 12:1, 63-70, Jan. 1986. Also was accepted and presented at Xith World Congress of Gynecology and Obstetrics, Berlin (West), September 15-20, 1985. \n31-Pregnancy and labor in women over the age of forty years. Accepted and presented at Al-Azhar International Medical Conference, Cairo 28-31 Dec. 1985. \n32-Effect of Copper T intra-uterine device on cervico-vaginal flora. Int. J. Gynaecol. Obstet. 23:2, 153-156, April 1985. \n33-Factors affecting the occurrence of post-Caesarean section febrile morbidity. Population Sciences, 6, 139-149, 1985. \n34-Pre-eclamptic toxaemia and its relation to H.L.A. system. Population Sciences, 6, 131-139, 1985. \n35-The menstrual pattern and occurrence of pregnancy one year after discontinuation of Depo-medroxy progesterone acetate as a postpartum contraceptive. Population Sciences, 6, 105-111, 1985. \n36-The menstrual pattern and side effects of Depo-medroxy progesterone acetate as postpartum contraceptive. Population Sciences, 6, 97-105, 1985. \n37-Actinomyces in the vaginas of women with and without intrauterine contraceptive devices. Population Sciences, 6, 77-85, 1985. \n38-Comparative efficacy of ibuprofen and etamsylate in the treatment of I.U.D. menorrhagia. Population Sciences, 6, 63-77, 1985. \n39-Changes in cervical mucus copper and zinc in women using I.U.D.�s. Population Sciences, 6, 35-41, 1985. \n40-Histochemical study of the endometrium of infertile women. Egypt. J. Histol. 8(1) 63-66, 1985. \n41-Genital flora in pre- and post-menopausal women. Egypt. J. Med. Sci. 4(2), 165-172, 1983. \n42-Evaluation of the vaginal rugae and thickness in 8 different groups. Journal of the Egypt. Soc. of Ob./Gyn. 9:2, 101-114, May 1983. \n43-The effect of menopausal status and conjugated oestrogen therapy on serum cholesterol, triglycerides and electrophoretic lipoprotein patterns. Al-Azhar Medical Journal, 12:2, 113-119, April 1983. \n44-Laparoscopic ventrosuspension: A New Technique. Int. J. Gynaecol. Obstet., 20, 129-31, 1982. \n45-The laparoscope: A useful diagnostic tool in general surgery. Al-Azhar Medical Journal, 11:4, 397-401, Oct. 1982. \n46-The value of the laparoscope in the diagnosis of polycystic ovary. Al-Azhar Medical Journal, 11:2, 153-159, April 1982. \n47-An anaesthetic approach to the management of eclampsia. Ain Shams Medical Journal, accepted for publication 1981. \n48-Laparoscopy on patients with previous lower abdominal surgery. Fertility management edited by E. Osman and M. Wahba 1981. \n49-Heart diseases with pregnancy. Population Sciences, 11, 121-130, 1981. \n50-A study of the biosocial factors affecting perinatal mortality in an Egyptian maternity hospital. Population Sciences, 6, 71-90, 1981. \n51-Pregnancy Wastage. Journal of the Egypt. Soc. of Ob./Gyn. 11:3, 57-67, Sept. 1980. \n52-Analysis of maternal deaths in Egyptian maternity hospitals. Population Sciences, 1, 59-65, 1979. \nArticles published on OBGYN.net: \n1- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Laila A. S. Mousa and Mohamad A.K.M.El Hemaly.\nUrethro-vaginoplasty, an innovated operation for the treatment of: Stress Urinary Incontinence (SUI), Detursor Overactivity (DO), Mixed Urinary Incontinence and Anterior Vaginal Wall Descent. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/ urethro-vaginoplasty_01\n\n2- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamed M. Radwan.\n Urethro-raphy a new technique for surgical management of Stress Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/\nnew-tech-urethro\n\n3- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamad A. Rizk, Nabil Abdel Maksoud H., Mohamad M. Radwan, Khalid Z. El Shieka, Mohamad A. K. M. El Hemaly, and Ahmad T. El Saban.\nUrethro-raphy The New Operation for the treatment of stress urinary incontinence, SUI, detrusor instability, DI, and mixed-type of urinary incontinence; short and long term results. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=urogyn/articles/\nurethroraphy-09280\n\n4-Abdel Karim M. El Hemaly, Ibrahim M Kandil, and Bahaa E. El Mohamady. Menopause, and Voiding troubles. \nhttp://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly03/el-hemaly03-ss\n\n5-El Hemaly AKMA, Mousa L.A. Micturition and Urinary\tContinence. Int J Gynecol Obstet 1996; 42: 291-2. \n\n6-Abdel Karim M. El Hemaly.\n Urinary incontinence in gynecology, a review article.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/abs-urinary_incotinence_gyn_ehemaly \n\n7-El Hemaly AKMA. Nocturnal Enuresis: Pathogenesis and Treatment. \nInt Urogynecol J Pelvic Floor Dysfunct 1998;9: 129-31.\n \n8-El Hemaly AKMA, Mousa L.A.E. Stress Urinary Incontinence, a New Concept. Eur J Obstet Gynecol Reprod Biol 1996; 68: 129-35. \n\n9- El Hemaly AKMA, Kandil I. M. Stress Urinary Incontinence SUI facts and fiction. Is SUI a puzzle?! http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly/el-hemaly-ss\n\n10-Abdel Karim El Hemaly, Nabil Abdel Maksoud, Laila A. Mousa, Ibrahim M. Kandil, Asem Anwar, M.A.K El Hemaly and Bahaa E. El Mohamady. \nEvidence based Facts on the Pathogenesis and Management of SUI. http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly02/el-hemaly02-ss\n\n11- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Mohamad A. Rizk and Mohamad A.K.M.El Hemaly.\n Urethro-plasty, a Novel Operation based on a New Concept, for the Treatment of Stress Urinary Incontinence, S.U.I., Detrusor Instability, D.I., and Mixed-type of Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/urethro-plasty_01\n\n12-Ibrahim M. Kandil, Abdel Karim M. El Hemaly, Mohamad M. Radwan: Ultrasonic Assessment of the Internal Urethral Sphincter in Stress Urinary Incontinence. The Internet Journal of Gynecology and Obstetrics. 2003. Volume 2 Number 1. \n\n13-Abdel Karim M. El Hemaly. Nocturnal Enureses: A Novel Concept on its pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecolgy/?page=articles/nocturnal_enuresis\n\n14- Abdel Karim M. El Hemaly. 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