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Background and Objective: A narrow alveolar ridge is an obstacle to optimal rehabilitation of the dentition. There are several complex and invasive techniques to counter the ridge augmentation dilemma, with most of them exhibiting low feasibility. Hence, this randomized clinical trial aims to evaluate the effectiveness of a Minimalistic Ridge Augmentation (MRA) technique, in conjunction with low-level laser therapy (LLLT). Materials and Methods: A total of 20 patients (n = 20) were selected, with 10 assigned to the test group (MRA+LLLT) and the other 10 to the control group (MRA). A vertical incision of approximately 10 mm was placed mesial to the defect and tunneled to create a subperiosteal pouch across the entire width of the defect. At the test sites, a diode laser (AnARC FoxTM Surgical Laser 810 nm) was used to deliver LLLT (parameters: 100 mW, with a maximum energy distribution of 6 J/cm2 in the continuous wave mode for 60 s per point) to the exposed bone surface inside the pouch, followed by graft (G-Graft, SurgiwearTM, Shahjahanpur, India) deposition with a bone graft carrier. The control sites were not irradiated with a laser. Results: A horizontal ridge width gain of >2 mm was observed in both groups. The changes in bone density for the test and control groups were −136 ± 236.08 HU and −44.30 ± 180.89 HU, respectively. Furthermore, there was no statistically significant difference between the test and control groups in these parameters. Conclusion: The study findings reveal that the MRA technique is relatively simple and feasible for alveolar ridge augmentation. The role of LLLT in the process requires further elucidation.

This research aimed to assess the effect of bone allograft combined with platelet-rich plasma (PRP), recombinant human bone morphogenetic protein-2 (rhBMP-2), and zoledronic acid (Zol) on bone formation. A total of 96 rabbits were used, and femoral bone defects (5 mm) were created. The rabbits were divided into four groups: (1) bone allograft with PRP (AG + PRP), (2) bone allograft with rhBMP-2 5 μg (AG + BMP-2), (3) bone allograft with Zol 5 μg (AG + Zol), and (4) bone allograft (AG). A histopathological examination was performed to evaluate bone defect healing after 14, 30, and 60 days. The new bone formation and neovascularization inside the bone allograft was significantly greater in the AG + PRP group compared to AG and AG + Zol groups after 14 and 30 days (p < 0.001). The use of bone allograft with rhBMP-2 induced higher bone formation compared to AG and AG + Zol groups on days 14 and 30 (p < 0.001), but excessive osteoclast activity was observed on day 60. The local co-administration of Zol with a heat-treated allograft inhibits allograft resorption as well as new bone formation at all periods. In conclusion, this study demonstrated that PRP and rhBMP-2, combined with a Marburg bone allograft, can significantly promote bone formation in the early stage of bone defect healing.

U području dentalne medicine, dentalna implantologija je relativno nova disciplina. Zauspješnu primjenu ove terapije često je nužna interdisciplinarnost, kliničari morajuimati široko znanje, a stomatolozi koji se žele baviti implantologijom, moraju imati i kliničko-operativne vještine. Implantoprotetska terapija za cilj ima postići ne samo oseointegraciju, veći funkcionalne i estetski prihvatljive zahtjeve. Gubitak središnjeg gornjeg sjekutićajeklinički izazov jer ima mnogo čimbenika koji utječu na terapiju, uključujući i psihosocijalni aspekt gubitka zuba u estetskoj zoni. U svrhu postizanja predvidljivogaishoda, potrebno je imati sustavan pristup, kvalitetno razrađen plan terapije i primjenuodgovarajuće tehnike. U ovom slučaju prednost je mogućnost nadoknade središnjeg sjekutića bez brušenja susjednih zuba. U ovom su radu na praktičan način opisani postupci dijagnosticiranja, kirurške i protetske faze implantološke terapije. Opisan je slučaj vertikalne frakture gornjega lijevoga središnjeg sjekutića i postupci očuvanja alveole, izrade privremenoga nadomjestka te planiranje i ugradnja implantatauz pomoć digitalne tehnologije u protetski optimalnom položaju. In the field of dental medicine, dental implantology is a relatively new discipline. For the successful application of this therapy, interdisciplinarity is essential, the clinicians should have wide knowledge and the dentists who choose implantology as their career path should have clinical and operative skills. Implant- supported prosthetic therapy aims to achieve not only osseointegration, but also functional and aesthetically acceptable requirements. Maxillary central incisor represents a clinical challenge, as there are many factors that influence therapy, including the psycho-social aspect of a tooth loss in the aesthetic zone. For the purpose of achieving a predictable outcome it is essential to have a systematic approach, a well- developed therapy plan and the application of an appropriate technique. In this case the advantage is the possibility of replacing the central incisor without preparation of the adjacent teeth. This paper includes a practical description of diagnostic procedures, surgical and prosthetic phases of implant therapy. This paper presents the case of a vertical fracture of the upper left central incisor and the procedures for preserving alveolus, creating a temporary prosthesis, planning and placement of the implant with the help of digital technology in the optimal prosthetic position.

Dentalni implantati postaju sve uobičajeniji terapijski modalitet opskrbe bezubih područja te alternativa klasičnim protetičkim radovima. Prevalencija upalnih bolesti periimplantatnih tkiva, mukozitisa i periimplantitisa, visoka je i u kontinuiranom porastu zbog sve većeg broja postavljenih implantata. Jedinstvene, općeprihvaćene smjernice za liječenje periimplantatnih bolesti, ne postoje. Mukozitis, kao reverzibilna upala, uspješno se može liječiti nekirurškim, antiinfektivnim protokolima. Periimplantitis, koji predstavlja ireverzibilni gubitak kosti oko implantata, danas predstavlja izazov za liječenje te ima daleko lošije ishode liječenja od parodontitisa, ireverzibilne upale oko prirodnog zuba. Nekirurško liječenje periimplantitisa daje limitirane rezultate. Kirurško liječenje podrazumijeva neaugmentativne, augmentativne i kombinirane tehnike. Augmentativne tehnike podrazumijevaju upotrebu različitih koštanih nadomjesnih materijala, membrana i biološki aktivnih tvari. I dok su se autologni koštani transplantati oduvijek smatrali zlatnim standardom u augmentacijskim postupcima, kada se koriste kao jedini materijal u sklopu augmentativnog kirurškog zahvata za liječenje periimplantitisa, čini se da daju slabije rezultate u usporedbi s protokolima u kojima se miješaju sa ksenogenim ili aloplastičnim transplantatom ili u usporedbi sa samim ksenogenim transplantatom. Miješanje autologne kosti sa ksenogenim ili aloplastičnim transplantatima mogu poboljšati svojstva pojedinačnih materijala. Ksenogeni i aloplastični transplantati u slučaju miješanja s autolognom kosti osiguravaju sporiju resorpciju i osteokonduktivnost koja je pogodna u cijeljenju nakon kirurške terapije periimplantitisa. Potrebna su daljnja istraživanja za utvrđivanje optimalnog odabira materijala i kirurških tehnika u svrhu postizanja što boljih i dugotrajnih terapijskih rezultata. Dental implants are becoming an increasingly common therapeutic modality for tooth loss and an alternative to classic prosthetic treatment. The prevalence of peri-implant inflammatory diseases, mucositis and peri-implantitis, is high and continuously on the rise due to the increasing number of placed implants. There are no generally accepted guidelines for the treatment of peri-implant diseases. Mucositis as a reversible inflammation can be successfully treated with non-surgical, anti-infective protocols. Peri-implantitis, which represents the irreversible loss of bone around the implant, is still challenging to treat and has far worse treatment outcomes than periodontitis, an irreversible inflammation around the natural tooth. Non-surgical treatment of peri-implantitis gives limited results. Surgical treatment includes non-augmentative, augmentative and combined techniques. Augmentative techniques involve the use of different bone replacement materials, membranes and biologics. While autologous bone grafts have always been considered the gold standard in augmentation procedures, when used as the sole material in augmentative surgery for the treatment of periimplantitis, they appear to produce inferior results compared to protocols in which they are combined with xenogeneic or alloplastic grafts or in comparison with the xenogeneic transplant alone. Mixing autologous bone with xenogeneic or alloplastic grafts can improve the properties of individual materials. Xenogeneic and alloplastic grafts in the case of combining with autologous bone ensure slower resorption and osteoconductivity, which is convenient for healing after surgical therapy of peri-implantitis. Further research is needed to determine the optimal selection of materials and surgical techniques in order to achieve the best possible and long-lasting therapeutic results.

Background: We intended to determine if an acromion or distal clavicle bone graft could restore large glenoid defects using two novel, screw-free graft fixation techniques. Methods: Twenty-four sawbone shoulder models were divided into four groups (n = 6 per group) according to fixation technique and bone graft: (1) modified buckle-down technique with clavicle graft, (2) modified buckle-down technique with acromion graft, (3) cross-link technique with acromion graft, (4) cross-link technique with clavicle graft. Testing was performed sequentially in (1) intact models, (2) after creation of a 30% by-width glenoid defect and (3) after repair. The shoulder joint was translated anteriorly, and glenohumeral contact pressures and load were measured to quantify the biomechanical stability. Results: Maximum contact pressures were restored to 42–56% of intact glenoid using acromion and clavicle grafts with novel fixation techniques. Acromion grafts attained higher maximum contact pressures than clavicle grafts in all groups. Peak translational forces increased by 171–368% after all repairs. Conclusions: This controlled laboratory study on sawbone models found that both the acromion and distal clavicle are suitable autologous bone graft options for treating large anterior glenoid defects, having appropriate dimensions and contours for reconstructing the glenoid arc. The modified buckle-down and cross-link techniques are two graft fixation techniques that restore stability to the shoulder joint upon repairing a large glenoid defect and are advantageous in being screw-free and simple to execute.

This study aimed to assess the bone regeneration of critical-size defects in rabbit calvaria filled with freshly crushed extracted teeth, comparing them with BTCP biomaterial and empty sites. Materials and methods: Twenty-one female New Zealand rabbits were used in this study. Two critical-size defects 6 mm in size were created in the skull bone, each with a 3 mm separation between them. Three experimental groups were evaluated: Group A (human sterilized crushed teeth granules alone), Group B (Bioner Bone, Bioner Sitemas Implantológicos), and Group C (unfilled defects). The animals were sacrificed at 4 and 8 weeks. Evaluation of the samples involved histological and histomorphometric analyses with radiographic evaluation. The histological evaluation showed a higher volume reduction in Group A compared with Group B (p < 0.05) and Control. Group A showed the highest values for cortical closure and bone formation around the particles, followed by Group B and Group C (p < 0.05). Within the limitations of this animal study, we can conclude that the use of human tooth particles leads to increased bone formation and reduced connective tissue in critical-size defects in rabbit calvaria when compared to BTCP biomaterial. The calvarial model is a robust base for the evaluation of different biomaterials.

Tooth Shell Technique (TST) with the use of autologous dentin has proven to be a suitable method of grafting in the context of lateral ridge augmentation. This present feasibility study aimed to retrospectively evaluate the preservation by lyophilization of processed dentin. Thus, the frozen stored processed dentin matrix (FST: 19 patients with 26 implants) was re-examined with that of processed teeth used immediately after extraction (IUT: 23 patients with 32 implants). Parameters of biological complications, horizontal hard tissue loss, osseointegration, and buccal lamella integrity were used for evaluation. For complications, the observation period was 5 months. Only one graft was lost (IUT group). In the area of minor complications, without the loss of an implant or augmentation, there were two cases of wound dehiscence and one case with inflammation and suppuration (IUT: n = 3, FST: n = 0). Osseointegration and integrity of the buccal lamella were present in all implants without exception. Statistically, there was no difference between the groups studied for the mean resorption of the crestal width and the buccal lamella. Results of this study show that prepared autologous dentin preserved with a conventional freezer had no disadvantage compared to immediately use autologous dentin in terms of complications and graft resorption in the context of TST.

Heterotopic ossification (HO) is a condition triggered by an injury leading to the formation of mature lamellar bone in extraskeletal soft tissues. Despite being a frequent complication of orthopedic and trauma surgery, brain and spinal injury, the etiology of HO is poorly understood. The aim of this study is to evaluate the hypothesis that a sustained local ionic homeostatic imbalance (SLIHI) created by mineral formation during tissue calcification modulates inflammation to trigger HO. This evaluation also considers the role SLIHI could play for the design of cell-free, drug-free osteoinductive bone graft substitutes. The evaluation contains five main sections. The first section defines relevant concepts in the context of HO and provides a summary of proposed causes of HO. The second section starts with a detailed analysis of the occurrence and involvement of calcification in HO. It is followed by an explanation of the causes of calcification and its consequences. This allows to speculate on the potential chemical modulators of inflammation and triggers of HO. The end of this second section is devoted to in vitro mineralization tests used to predict the ectopic potential of materials. The third section reviews the biological cascade of events occurring during pathological and material-induced HO, and attempts to propose a quantitative timeline of HO formation. The fourth section looks at potential ways to control HO formation, either acting on SLIHI or on inflammation. Chemical, physical, and drug-based approaches are considered. Finally, the evaluation finishes with a critical assessment of the definition of osteoinduction. STATEMENT OF SIGNIFICANCE: : The ability to regenerate bone in a spatially controlled and reproducible manner is an essential prerequisite for the treatment of large bone defects. As such, understanding the mechanism leading to heterotopic ossification (HO), a condition triggered by an injury leading to the formation of mature lamellar bone in extraskeletal soft tissues, would be very useful. Unfortunately, the mechanism(s) behind HO is(are) poorly understood. The present study reviews the literature on HO and based on it, proposes that HO can be caused by a combination of inflammation and calcification. This mechanism helps to better understand current strategies to prevent and treat HO. It also shows new opportunities to improve the treatment of bone defects in orthopedic and dental procedures.

Background A retrospective study compared the results of a lamina with spinous process (LSP) and an iliac graft (IG) as bone grafts in single-segment lumbar pyogenic spondylodiscitis (LPS) through one-stage-posterior-only approach with radical debridement and instrumentation. Methods A LSP was placed in 17 patients (group A), and an IG was implemented in 20 patients (group B). The surgery time, surgery hemorrhage, hospital stay, drainage, and follow-up (FU) were recorded and compared. The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, visual analogue scale (VAS), Oswestry Disability Index (ODI), segmental angle, intervertebral height and bony fusion time were compared preoperatively and at the final FU. Results All patients were followed-up for a mean of 27.94 ± 2.35 months in group A and 30.29 ± 1.89 months in group B, without a difference. The mean age was younger in group A than in group B (P Aerobacter cloacae, 2 of Staphylococcus aureus, 2 of Escherichia coli, and 1 of Streptococcus viridis in group A and 1 of S. aureus, 1 of Staphylococcus warneri and 2 of Klebsiella pneumoniae in group B. Pyogenic infection was observed in the pathological findings of all patients. No significant difference was found in the mean segmental angle or mean intervertebral height preoperation and at the final FU. Conclusion The use of LSP could be an effective bone grafting for surgical management for the LPS while surgery is proposed as a good management strategy for single-segment LPS in carefully selected patients.

Background/purpose Ridge resorption after tooth extraction may result in inadequate bone volume and unfavorable ridge architecture for ideal implant placement. The use of bone substitutes has been advocated to fill extraction sites and to enhance primary implant stability. This study was made to evaluate the clinical efficacy of novel 3D printed nano-porous hydroxyapatite (3DP HA, test group) in comparison to nano-crystalline bone graft (NanoBone®, control group) in alveolar ridge preservation prior to implant placement. Materials and methods Thirty patients were randomized into two groups following tooth extraction. All extracted sockets were filled with 3DP HA or NanoBone® and covered with a non-resorbable membrane. After four months, cone-beam computed tomography (CBCT) and intraoral scanner were used to measure dimensional changes of bone and soft tissue surface. Bone core specimens were harvested for histological analysis during implant osteotomy. Implant stability was assessed using a modified damping capacity analysis. Results At four months postoperatively, dimensional changes in soft tissue surface resorption were less in the test group than in the control group; however, alveolar bone resorption was the same in both groups. Histological analysis revealed new bone formation, residual graft and fibrous connective tissue in both groups. The average primary implant stability (IST) value for both groups was approximately 70. There was no statistically significant difference in all parameters between two groups (p > 0.05). Conclusion 3DP HA could potentially be used as an alternative bone graft material for alveolar ridge preservation.

Background: The purpose of this study is to present surgical outcomes after humeral head allograft augmentation and glenoid-based procedures in patients with active, uncontrolled seizure activity and anterior shoulder instability. Methods: A retrospective review of a surgical database for patients with active seizure disorder and with recurrent shoulder instability managed with humeral head augmentation was performed. All patients underwent surgical intervention. Postoperative outcomes including Shoulder Pain and Disability Index, Simple Shoulder Test, American Shoulder and Elbow Surgeons questionnaire, and the Short Form Health Survey (SF-12) were recorded at a minimum of 2 years. We hypothesized that appropriate management of the bony defects in these bipolar injuries would result in low recurrence and satisfactory outcomes. Results: Ten patients including 8 males and 2 females (15 shoulders) with active seizure-related shoulder instability underwent surgical intervention including allograft bone grafting of the Hill-Sachs lesion for anterior shoulder instability. The average age was 27 years. All patients reported recurrent seizures postoperatively, but only one sustained a shoulder dislocation after surgery that was unrelated to seizure activity.Self-reported satisfaction was “much better” or “better” in 92% of shoulders. Average outcome scores were as follows: American Shoulder and Elbow Surgeons score = 67 (33-100), Shoulder Pain and Disability Index = 32.5 (0-83), Simple Shoulder Test = 9.4 (5-12), SF-12 PCS = 44.1 (21-65), and SF-12 MCS = 50.6 (21-61). The average follow-up was 4.8 years. Conclusion: Management of bipolar shoulder injuries with humeral head allograft augmentation and glenoid based surgery leads to low recurrence rates and good clinical outcomes in patients with uncontrolled, seizure-related shoulder instability.

Background/Aim Enchondroma is the most common primary bone tumour of the hand. When surgery is indicated, curettage with or without void augmentation has been described. However, only few comparative studies exist. The aim of this study was to compare the outcomes of hand enchondromas treated with autologous bone graft (AG) and bioactive glass S53P4 (BAG). Patients and Methods: A retrospective comparative analysis was conducted among patients surgically treated for hand enchondromas at a tertiary referral centre during a 17-year period. Results: A total of 190 patients (116 AG vs. 74 BAG) with 205 enchondromas were included. No statistically significant differences in outcome measures were observed. A reoperation was performed in five patients in the autologous bone-graft group; one patient presented a rare malignant transformation from enchondroma to chondrosarcoma after the primary operation. No reoperations were performed in the BAG group. Conclusion: Although AG is the gold standard for filling bony cavities, bone-graft retrieval can cause complications and postoperative pain. Our results suggest that S53P4 BAG is a safe and effective bone-graft material alternative for filling of enchondroma-evacuated cavities.

Contains fulltext : 288266.pdf (Publisher’s version ) (Open Access) Heterotopic ossification (HO) is a condition triggered by an injury leading to the formation of mature lamellar bone in extraskeletal soft tissues. Despite being a frequent complication of orthopedic and trauma surgery, brain and spinal injury, the etiology of HO is poorly understood. The aim of this study is to evaluate the hypothesis that a sustained local ionic homeostatic imbalance (SLIHI) created by mineral formation during tissue calcification modulates inflammation to trigger HO. This evaluation also considers the role SLIHI could play for the design of cell-free, drug-free osteoinductive bone graft substitutes. The evaluation contains five main sections. The first section defines relevant concepts in the context of HO and provides a summary of proposed causes of HO. The second section starts with a detailed analysis of the occurrence and involvement of calcification in HO. It is followed by an explanation of the causes of calcification and its consequences. This allows to speculate on the potential chemical modulators of inflammation and triggers of HO. The end of this second section is devoted to in vitro mineralization tests used to predict the ectopic potential of materials. The third section reviews the biological cascade of events occurring during pathological and material-induced HO, and attempts to propose a quantitative timeline of HO formation. The fourth section looks at potential ways to control HO formation, either acting on SLIHI or on inflammation. Chemical, physical, and drug-based approaches are considered. Finally, the evaluation finishes with a critical assessment of the definition of osteoinduction. STATEMENT OF SIGNIFICANCE: The ability to regenerate bone in a spatially controlled and reproducible manner is an essential prerequisite for the treatment of large bone defects. As such, understanding the mechanism leading to heterotopic ossification (HO), a condition triggered by an injury leading to the formation of mature lamellar bone in extraskeletal soft tissues, would be very useful. Unfortunately, the mechanism(s) behind HO is(are) poorly understood. The present study reviews the literature on HO and based on it, proposes that HO can be caused by a combination of inflammation and calcification. This mechanism helps to better understand current strategies to prevent and treat HO. It also shows new opportunities to improve the treatment of bone defects in orthopedic and dental procedures.

Two cases of bone failure after fracture of the distal region of the femur treated with the Masquelet technique are presented. The first case involves acute bone loss, and the second, pseudarthrosis. The proper management of these lesions led to consolidation and a good functional result. Resumo Dois casos de falha óssea após fratura da região distal do fêmur tratados pela técnica de Masquelet são apresentados. O primeiro caso envolve uma perda óssea aguda, e o segundo, uma pseudoartrose. O manejo adequado dessas lesões levou à consolidação e a um bom resultado funcional.

Bone fracture caused by various incident causes medical problems. Then bone restoration is required. Bone grafts can be used to solve this problem. One of the materials that can be used to produce bone graft is PMMA. PMMA requires to be combined with other materials to extend the solidification time. The material that can be used for bone graft material is sago starch. The main ingredient composition of Biocomposite [sago/PMMA] consists of sago: PMMA = 1 : 1 (w/w). The composition of the addition of MMA is 10% (v/w) of PMMA, this is to extend the curing time. Thus the material can be through from the chamber extruder to the nozzle. This research aims to obtain combinations of 3D Printer FDM Customized machine parameters for minimizing of error dimension. The 3D Printer machine uses pneumatic system to push the material from the container to the chamber and used screw extruder to push the material out through the nozzle. The experimental design method used a 2k fractional factorial design, with 3 parameters, 2 levels and 3 responses. The experimental results obtained that the layer height parameter has a significant influence on the x-dimensional error. The optimization results obtained a combination of parameters to get the smallest error dimensions, the print speed is 25 mm/s, the layer height is 2.93 mm and the fill density is 20%. The results of optimization obtained that the x-dimensional error is 0.016, the y-dimensional error is 0.069 and the z-dimensional error is 0.4539.

Background:The tissue engineering technique to bone and periodontal tissue regeneration therapy that makes use of one or more of three key factors: signaling molecules, scaffold or supporting matrix, and cells. The graft works as a scaffold and a framework for forming a structure to aid tissue regeneration. One of the most generally used graft substances is hydroxyapatite (HAp). Hydroxyapatite (HAp) is a calcium phosphate derivative that is commonly utilized in bone coatings and cements due to its exceptional biocompatibility. The topic of nano- hydroxyapatite (nHAp) in tissue regeneration therapy will be discussed in this publication. Methods:The method used in writing this article review was a literature review sourced from Google Scholar, Science Direct, and PubMed (MEDLINE). Result:The identification results from a search on Google Scholar, Science Direct, and PubMed (MEDLINE) in which the title contains one or more keywords being searched for, from the article, 55 articles are obtained that have appropriate titles and 14 data are obtained from the results of the review. Discussion:Hydroxyapatite (HAp) is a bioceramic material formed from strong chemical bonds and is included in the bone components of living organisms (in vivo). Conclusion: Hydroxyapatite (HAp) is a bioceramic substance made up of a strong chemical link that is a derivative of calcium phosphate. It is commonly used in coatings or cements on bone because of its excellent biocompatibility.&nbsp

Silk sericin is a degumming product used by the silk industry. The degumming process can affect the protein structure and molecular weight of silk sericin. The present study examined how pretreatment with 4-hexylresorcinol (4HR) affects the biomedical properties of silk sericin. Before the degumming process, silkworm cocoons were treated with 4HR solution. The protein structure of the final degumming product was evaluated by Fourier transform infrared spectroscopy (FT-IR) and scanning electron microscopy. Untreated silk sericin (S) and silk sericin pretreated with 4HR (S+4HR) were added to RAW264.7 cells, and the expression of BMP-2 was determined. The bone-regenerating capacity of S+4HR was evaluated using the critical-sized rat calvarial defect model. Compared with S, S+4HR showed an increase in β-sheet structures. Administration of S+4HR to RAW264.7 cells increased expression of BMP-2, mainly via the TLR-mediated signaling pathway. Bone volume, as measured by micro-computerized tomography, was significantly greater in the S+4HR group than in the S, gelatin alone, and unfilled control groups (p < 0.05 each). Expression of BMP-2 and runx2 in tissue specimens was significantly higher following treatment with S+4HR than with S (p < 0.05). Taken together, these findings show that 4HR pretreatment before the degumming process increased the β-sheet structure of silk sericin, as well as inducing BMP-2 expression and bone regeneration ability.

Digital, El presente proyecto de grado titulado Diseño Centrado en el Usuario para el Desarrollo de productos derivados de Matriz Ósea Desmineralizada (MOD) para el Banco de Tejidos de la Fundación Cardiovascular de Colombia (FCV) tiene como propósito, analizar las características ideales en las alternativas de diseño centrado en el usuario para el desarrollo de una Matriz Ósea Desmineralizada (MOD) por el banco de Tejido de la Fundación Cardiovascular de Colombia (FCV). Respecto a la metodología, hace referencia a un estudio descriptivo de corte transversal, se aplicaron dos instrumentos de medición, el primero para establecer las características ideales en el diseño de la MOD por parte de los especialistas en ortopedia, neurocirugía y cirugía maxilofacial y el segundo para determinar la percepción de los especialistas conforme a la alternativa de diseño de la MOD por el banco de Tejido de la FCV; como resultados más sobresalientes en la investigación, se evidencio que el 100% de los especialistas estuvieron de acuerdo que la MOD elaborada por el Banco de Tejidos de la FCV mantuvo la forma y consistencia deseada; así mismo, el 100% de los especialistas eligió la sangre sin anticoagulación como vehículo para la MOD; por lo tanto, se llegó a las siguientes conclusiones: el Diseño Centrado en el Usuario es el eje principal en el proceso de planificación, valoración y desarrollo de un nuevo producto de una propuesta de diseño; el Banco de Tejidos de la Fundación Cardiovascular de Colombia con la propuesta innovadora de la elaboración de la Matriz Ósea Desmineralizada, teniendo como base los requerimientos de los especialistas contribuye a mejorar la calidad de vida de los pacientes y el avance de la región., The purpose of this degree project entitled User-Centered Design for the Development of Demineralized Bone Matrix (DBM) derived products for the Tissue Bank of the Fundación Cardiovascular de Colombia (FCV) is to analyze the ideal characteristics in the alternatives of user-centered design for the development of a Demineralized Bone Matrix (DBM) by the Tissue Bank of the Fundación Cardiovascular de Colombia (FCV). Regarding the methodology, it refers to a descriptive cross-sectional study, two measuring instruments were applied, the first to establish the ideal characteristics in the design of the DBM by specialists in orthopedics, neurosurgery and maxillofacial surgery and the second to determine the perception of the specialists according to the design alternative of the DBM by the tissue bank of the FCV; As the most outstanding results in the investigation, it was evidenced that 100% of the specialists agreed that the DBM prepared by the FCV Tissue Bank maintained the desired shape and consistency; likewise, 100% of the specialists chose blood without anticoagulation as the vehicle for DBM; therefore, the following conclusions were reached: User-Centered Design is the main axis in the planning, evaluation and improvement process of a design proposal; the Tissue Bank of the Cardiovascular Foundation of Colombia with the innovative proposal for the elaboration of the Demineralized Bone Matrix, based on the requirements of specialists, contributes to improving the quality of life of patients and the advancement of the region., Pregrado, Instrumentador Quirúrgico, Introducción ................................................................................................................. 20 1. Planteamiento del Problema ...................................................................... 23 1.1 Descripción del Problema .......................................................................... 23 1.2 Preguntas de Investigación ........................................................................ 25 2. Justificación ............................................................................................... 26 3. Objetivos .................................................................................................... 28 3.1 Objetivo General ........................................................................................ 28 3.2 Objetivos Específicos ................................................................................. 28 4. Marco Referencial ...................................................................................... 29 4.1 Marco Histórico .......................................................................................... 29 4.2 Estado del Arte ........................................................................................... 32 4.3 Marco Conceptual ...................................................................................... 36 4.4 Marco Legal ............................................................................................... 37 4.5 Marco Teórico ............................................................................................ 42 4.5.1 Matriz Ósea Desmineralizada (MOD).. ....................................................... 44 4.5.2 Diseño Centrado en el Usuario (DCU)........................................................ 45 4.6 Marco Contextual ....................................................................................... 46 5. Metodología ............................................................................................... 49 5.1 Fase 1 ........................................................................................................ 49 5.1.1 Tipo de Estudio.. ........................................................................................ 49 5.1.2 Población y Muestra ................................................................................... 49 5.1.2.1 Universo.. ................................................................................................... 49 5.1.2.2 Muestra, Tamaño de Muestra, Muestreo.. .................................................. 50 5.1.3 Criterios de Selección ................................................................................ 50 5.1.3.1 Criterios de Inclusión.. ................................................................................ 50 5.1.3.2 Criterios de Exclusión.. ............................................................................... 50 5.1.4 Procedimientos.. ........................................................................................ 50 5.1.4.1 Instrumento de Medición.. .......................................................................... 51 5.1.4.2 Variables .................................................................................................... 51 5.1.5 Análisis Estadístico. ................................................................................... 53 5.1.6 Consideraciones Éticas.. ............................................................................ 54 5.1.7 Técnicas de Revisión Bibliográfica.. ........................................................... 54 5.2 Fase 2 ........................................................................................................ 55 5.2.1 Tipo de Estudio.. ........................................................................................ 55 5.2.2 Población y Muestra ................................................................................... 55 5.2.2.1 Universo.. ................................................................................................... 55 5.2.2.2 Muestra, Tamaño de Muestra, Muestreo.. .................................................. 55 5.2.3 Criterios de Selección ................................................................................ 55 5.2.3.1 Criterios de Inclusión.. ................................................................................ 55 5.2.3.2 Criterios de Exclusión.. ............................................................................... 55 5.2.4 Procedimientos.. ........................................................................................ 55 5.2.4.1 Instrumento de Medición.. .......................................................................... 56 5.2.4.2 Variables .................................................................................................... 57 5.2.5 Análisis Estadístico.. .................................................................................. 57 5.2.6 Consideraciones Éticas. ............................................................................. 58 5.2.7 Técnicas de Revisión Bibliográfica.. ........................................................... 58 6. Resultados ................................................................................................. 59 6.1 Establecer las Preferencias y Necesidades de los Especialistas en Cirugía Maxilofacial, Ortopedia y Neurocirugía, Para el Diseño de Productos Derivados de Matriz Ósea Desmineralizada. ................................................................................................ 59 6.2 Verificar Mediante una Plantilla de Observación que los Requerimientos de Diseño Establecidos por los Usuarios se Cumplan, en el Prototipo de la Matriz ÓSEA Desmineralizada Tipo Masilla, Propuesta por el Banco de Tejidos de la Fundación Cardiovascular de Colombia (FCV) .............................................................................. 86 6.3 Validar la Percepción de los Usuarios, con Relación a la Alternativa de la Matriz Ósea Desmineralizada Tipo Masilla, Desarrollada por el Banco de Tejidos de la Fundación Cardiovascular de Colombia (FCV). ........................................................... 88 6.3.1 Prototipo Número Uno de la MOD Tipo Masilla. ......................................... 88 6.3.2 Prototipo Número Dos de la MOD Tipo Masilla.. ........................................ 98 7. Discusión ................................................................................................... 99 8. Conclusiones............................................................................................ 102 9. Recomendaciones ................................................................................... 103 Referencias Bibliográficas.......................................................................................... 104 Anexos ....................................................................................................................... 112

Made available in DSpace on 2022-04-28T17:22:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-10-30 AOCMF Switzerland Objective: To evaluate the effects of inorganic bovine bone graft (Lumina Bone, Criteria, Brazil) and beta-tricalcium phosphate (beta-TCP) graft (ChronOS, Synthes, Brazil) in rats with the risk of developing post-extraction medication-related osteonecrosis of the jaw (MRONJ). Methods: Eighteen male Wistar rats weighing 350 to 450 g were induced to develop MRONJ using zoledronic acid for 5 weeks. In the sixth week, the right maxillary first molar was extracted. The animals in Group I (G1) did not receive bone grafts after tooth extraction, while Group II (G2) animals received inorganic bovine bone grafts, and Group III (G3) animals received beta-tricalcium phosphate (beta-TCP) grafts. Clinical evaluation and histomorphometric and immunohistochemical analyses were performed. ANOVA and Tukey's statistical tests were used and a level of significance was considered to be 5%. Results: In the clinical evaluation, animals from G2 and G3 did not present clinical manifestations of osteonecrosis, unlike the control group (G1) animals, which presented necrotic bone tissue exposure in all samples. In the histomorphometric evaluation, animals in G3 showed greater formation of bone tissue (66%) and less formation of bone lacuna (18%) than animals in G1 (58%/32%) and in G2 (59%/27%) (P < 0.05). Moderate (++) immunostaining was observed in G2 and G3 for RANKL, TRAP, and OC, while G1 showed moderate (++) labeling for OC and mild (+) immunostaining for TRAP and RANKL. Conclusions: Greater formation of bone tissue and fewer bone lacunae were found in animals treated with beta-TCP. In clinical evaluation, bone graft groups presented with the clinical manifestation of MRONJ and showed higher intensity of immunostaining for TRAP and RANKL. Despite the limitations of experimental animal studies, the results of this work may assist in the development of future clinical research for the prevention of MRONJ. Fundacao Educ Serra Orgaos, Dept Oral & Maxillofacial Surg, Av Alberto Torres 111 Alto, BR-25964004 Teresopolis, RJ, Brazil Univ Fed Fluminense, Dept Oral & Maxillofacial Surg, Nova Friburgo, RJ, Brazil Univ Estadual Paulista, Dept Oral & Maxillofacial Surg, Aracatuba, SP, Brazil Sao Paulo Estate Univ, Dept Oral & Maxillofacial Surg, Aracatuba, SP, Brazil Univ Estadual Paulista, Dept Oral & Maxillofacial Surg, Aracatuba, SP, Brazil AOCMF Switzerland: AOCMF-16-02 H.

Aims We wanted to evaluate the effects of a bone anabolic agent (bone morphogenetic protein 2 (BMP-2)) on an anti-catabolic background (systemic or local zoledronate) on fixation of allografted revision implants. Methods An established allografted revision protocol was implemented bilaterally into the stifle joints of 24 canines. At revision surgery, each animal received one BMP-2 (5 µg) functionalized implant, and one raw implant. One group (12 animals) received bone graft impregnated with zoledronate (0.005 mg/ml) before impaction. The other group (12 animals) received untreated bone graft and systemic zoledronate (0.1 mg/kg) ten and 20 days after revision surgery. Animals were observed for an additional four weeks before euthanasia. Results No difference was detected on mechanical implant fixation (load to failure, stiffness, energy) between local or systemic zoledronate. Addition of BMP-2 had no effect on implant fixation. In the histomorphometric evaluation, implants with local zoledronate had more area of new bone on the implant surface (53%, p = 0.025) and higher volume of allograft (65%, p = 0.007), whereas implants in animals with systemic zoledronate had the highest volume of new bone (34%, p = 0.003). Systemic zoledronate with BMP-2 decreased volume of allograft by 47% (p = 0.017). Conclusion Local and systemic zoledronate treatment protects bone at different stages of maturity; local zoledronate protects the allograft from resorption and systemic zoledronate protects newly formed bone from resorption. BMP-2 in the dose evaluated with experimental revision implants was not beneficial, since it significantly increased allograft resorption without a significant compensating anabolic effect. Cite this article: Bone Joint Res 2021;10(8):488–497.

Objectives: Cell therapy and tissue engineering have become core elements of regenerative medicine. Delivery of antibiotics and liquids to their intended site of action is difficult as these fluids are easily washed away during surgery or removed via natural processes. Future treatments involving cell [for full text, please go to the a.m. URL]

Amputation at the level of the distal phalanx is a common hand injury and is normally treated with replantation. However, if the level of injury is distal or the vessels of the stump have been crushed by injury, replantation cannot be a viable option. The aim of this study is to evaluate the functional and aesthetic outcomes of the “hybrid abdominal flap”, which consists of a random-pattern abdominal skin flap and an autologous bone graft. A retrospective analysis was performed on fingertip amputation patients from March 2019 to April 2021. The patients were managed by either hybrid abdominal flaps (HAFs) or homodigital neurovascular island flaps (HNIFs). The functional and aesthetic outcomes were assessed three months after the operations. In this study, a total of 20 fingers were treated with either HAFs or HNIFs. There was a significant difference in the range of motion (ROM) and the scar quality between the two groups. All of the flaps survived without flap necrosis, and non-union of the bone was not observed. The patients were satisfied with the appearance and function of their fingers, including the ROM and sensory aspects. Our novel HAF is a functionally and aesthetically valid option for fingertip amputations with crushed stumps.

Although progress is evident in the effective treatment of joint replacement-related infections, it still remains a serious issue in orthopedics. As an example, the local application of antibiotics-impregnated bone grafts supplies the high drug levels without systemic side effects. However, antibiotics in the powder or solution form could be a risk for local toxicity and do not allow sustained drug release. The present study evaluated the use of an antibiotic gel, a water-in-oil emulsion, and a PLGA microparticulate solid dispersion as depot delivery systems impregnating bone grafts for the treatment of joint replacement-related infections. The results of rheological and bioadhesive tests revealed the suitability of these formulations for the impregnation of bone grafts. Moreover, no negative effect on proliferation and viability of bone marrow mesenchymal stem cells was detected. An ex vivo dissolution test of vancomycin hydrochloride and gentamicin sulphate from the impregnated bone grafts showed a reduced burst and prolonged drug release. The PLGA-based formulation proved to be particularly promising, as one-day burst release drugs was only 15% followed with sustained antibiotics release with zero-order kinetics. The results of this study will be the basis for the development of a new product in the Tissue Section of the University Hospital for the treatment of bone defects and infections of joint replacements.

Background: Periodontal diseases lead to bone loss, crestal defects and even loss of the tooth, which also further makes it difficult to replace the tooth. Autogenous bone grafts are considered the gold standard in bone regenerative procedures. This study aimed to compare and evaluate the bone regenerative effects of i-PRF (Injectable- Platelet-rich fibrin) with a bone graft and a bone graft alone in mandibular grade II furcation defects over a period of 9 months. Method: This was a comparative study of 12 participants, who were randomly selected and grouped into two groups: test and control. Following phase I therapy, both groups were subjected to open flap debridement. In the test group, after debridement, a nano-hydroxyapatite bone graft mixed with i-PRF was inserted, whereas in the control group only a nano-hydroxyapatite bone graft was inserted. The clinical parameters such as plaque index (PI), gingival index (GI), pocket probing depth (PPD), clinical attachment level (CAL), horizontal probing depth (HPD) and vertical probing depth (VPD) were recorded at baseline, 3 months, 6 months and 9 months following the surgery. The bone area fill (BAF) was assessed using intraoral periapical radiographs (IOPARs) taken at baseline and 9 months after surgery. Results: At the baseline, there was no statistically significant difference between the tested parameters. After 9 months all the clinical parameters, PI, GI, PPD, CAL, HPD and VPD as well as radiographic bone fill showed a significant increase in both the groups (p < 0.05) (PI-TGr; CGr–VPD—3.5 ± 0.54 to 0.66 ± 0.51; 3.3 ± 0.81 to 2 ± 0.63/BAF—2.9 ± 0.88 to 5.6 ± 1.10; 3.4 ± 1.39 to 3.9 ± 1.4). On comparison the test group showed better results for each clinical parameter. Conclusion: The results showed increased improvement in clinical conditions in both groups, although better results were seen in the group where i-PRF with a nano-HA bone graft was used in the furcation defect.

Faktori rasta koji se otpuštaju iz trombocita prilikom cijeljenja imaju važnu ulogu u cijeljenju i mekih i tvrdih tkiva. Ova činjenica potaknula je razvoj trombocitnih preparata u različitim protokolima s ciljem poticanja i ubrzavanja cijeljenja. Trombocitima obogaćena plazma prva je generacija derivata krvi koja je našla primjenu u oralnoj kirurgiji. Zbog kompliciranije pripreme i intenzivnog otpuštanja faktora rasta i drugih proteina u prvih nekoliko sati nakon pripreme, što je uzrokovano stvaranjem rigidne fibrinske mreže, danas je uglavnom zamijenjena novom generacijom trombocitnih preparata – trombocitima obogaćenim fibrinom. Trombocitima obogaćen fibrin karakterizira stvaranje fleksibilne fibrinske mrežice koja omogućava postupno i dugotrajnije otpuštanje faktora rasta prilikom cijeljenja te jednostavan postupak pripreme. Novim metodama pripreme trombocitima obogaćenog fibrina mogu se izrađivati membrane i cilindri, a dolazi u obliku gela i tekućine što omogućuje široku primjenu u oralnokirurškim zahvatima. Kako bi se premostio problem nedovoljne količine kosti i koštanih defekata nastalih nakon oralnokirurških zahvata, razvijaju se koštani nadomjesni materijali. Osim dugogodišnjeg zlatnog standarda – autogenog transplantata, razvoj alogenih, ksenogenih i aloplastičnih koštanih nadomjesnih materijala omogućio je njihovu široku primjenu i dostupnost. Autogeni transplantati jedini posjeduju svojstvo osteogeneze, no neke od prednosti primjene ostalih koštanih nadomjesnih materijala su dostupnost u gotovo neograničenim količinama te mogućnost provođenja zahvata bez drugog, donorskog, operacijskog polja. Zbog nedostatka standardiziranog protokola i kontroliranih randomiziranih kliničkih istraživanja ne postoji jedinstven stav o tome koji je materijal najučinkovitiji i za koju indikaciju. Koštani nadomjesni materijali i trombocitni preparati često se koriste u kombinaciji za postizanje optimalnih rezultata u brojnim oralnokirurškim zahvatima kao što su prezervacija alveole, augmentacija alveolarnog grebena, apikotomija, cistektomija, liječenje osteonekroze čeljusti i podizanje dna maksilarnog sinusa te predstavljaju značajan iskorak u liječenju brojnih stanja, često omogućuju i skraćenje postoperativnog oporavka, mogu smanjiti invazivnost pojedinih zahvata i postoperativne komplikacije. Growth factors released from platelets during the healing play an important role in the healing of both soft and hard tissues. This fact encouraged the development of thrombocyte preparations in various protocols with the aim of stimulating and accelerating the healing. Thrombocyte enriched plasma is the first generation of blood derivatives to find its application in oral surgery. Due to the more complex preparation and the intensive release of growth factors and other proteins in the first few hours after preparation, caused by the formation of rigid fibrin mesh, it is now mainly replaced by a new generation of thrombocyte preparations – thrombocyteenriched fibrin. Thrombocyte­enriched fibrin is characterized by the formation of a flexible fibrin mesh that allows gradual and longer release of the growth factors, during the healing, and a simple preparation procedure. Membranes and cylinders can be produced by new methods of preparation of thrombocyte­enriched fibrin, which comes in the form of a gel and a liquid, allowing a wide range of application in oral surgery. In order to overcome the problem of insufficient bone quantity and bone defects caused by oral surgery, bone replacement materials are being developed. Apart from the long­standing gold standard – autogenic transplant, the development of allogeneic, xenogeneic, and alloplastic bone replacement materials enabled their wide application and availability. Autogenous transplants are the only ones that have the characteristic of osteogenesis, but some of the advantages of application of the other bone replacement materials are availability in almost unlimited quantities and possibility of the performing of operations without a second, donor, operating field. Due to the lack of a standardized protocol and controlled randomized clinical trials, the consensus of which material is the most effective and for which indication is not reached. Bone replacement materials and thrombocyte preparations are often used in combination to achieve optimal results in a number of oral surgery procedures such as alveolar preservations, alveolar reef augmentation, apicoectomy, cystectomy, jaw osteonecrosis treatment and raising of the bottom of maxillary sinus, and represent a significant step forward in the treatment of numerous conditions, often allowing faster post­operative recovery and sometimes reducing the invasiveness of some interventions and post­operative complications.

O osso autógeno representa o padrão ouro paras as reconstruções de defeito ósseo devido suas propriedades de osteoindução, osteocondução e osteogênese. A qualidade e quantidade são fatores-chave que devem ser considerados no momento da escolha do sítio doador de enxerto. As regiões doadoras de enxerto intrabucal, apesar de fornecer uma quantidade menor de enxerto, são consideradas uma alternativa para uma variedade de procedimentos reconstrutivos de defeitos menores na região maxilofacial. Entre as regiões doadoras de enxerto intrabucal, a tuberosidade da maxila tem ganhado destaque devido à quantidade de enxerto que pode ser removida deste local com menor grau de comorbidade. Neste sentido, o presente estudo tem como objetivo avaliar o volume de osso da tuberosidade da maxila a partir de imagens de tomografia computadorizada de feixe cônico (TCFC) e analisar se há uma correlação entre a varável BV/TV entre os grupos, lados e idade. Foram incluídos neste estudo, 60 imagens de TCFC da tuberosidade da maxila de 30 homens e 30 mulheres de ambos os lados. As imagens foram avaliadas com o auxíliodo Software ImageJ que forneceu a taxa de volume ósseo (BV/TV) de cada região analisada. Os dados foram tabulados e submetidos a análise estatística comparando o valores da taxa de BV/TV em relação ao sexo, idade e lados. Verificou o efeito significativo da idade (F = 8.06, p = 0.0059) e uma interação significativa entre idade esexo (F = 4.15, p = 0.045). Não foi verificado efeitosignificativo da lateralidade na variação da taxa BV/TV (F = 0.98, p = 0.325). Conclui-se que a quantidade de osso na tuberosidade da maxila representada pela taxa de BV/TV está direta diretamente relacionada com o sexo e com a idade, e que uma maior proporção de volume ósseo pode ser encontrada no sexo masculino e uma menor proporção em mulheres com idade mais avançada. Embora as imagens de TCFC quando avaliadas no Software ImageJ possam fornecer uma taxa de volume ósseo BV/TV na tuberosidade da maxila, mais estudos devem ser realizados a fim de descrever outros parâmetros que possam interferir diretamente na proporção de osso disponível nesta região. Autogenous bone represents the gold standard for the reconstruction of bone defects due to its osteoinduction, osteoconduction and osteogenesis properties. Quality and quantity are key factors that must be considered when choosing a graft donor site. Intraoral graft donor regions, despite providing a smaller amount of graft, are considered an alternative for a variety of reconstructive procedures for minor defects in the maxillofacial region. Among the intraoral graft donor regions, the maxillary tuberosity has gained prominence due to the amount of graft that can be removed from this site with a lower degree of comorbidity. In this sense, the present study aims to evaluate the bone volume in the maxillary tuberosity from cone beam computed tomography (CBCT) images and to analyze whether there is a correlation between the BV/TV variable between groups, sides and age . Included in this study were 60 CBCT images of the maxillary tuberosity of 30 men and 30 women from both sides. The images were evaluated with the aid of the ImageJ Software, which providedthe bone volume rate (BV/TV) of each analyzed region. The data were tabulated and submitted to statistical analysis comparing the values of the BV/TV rate in relation to sex, age and sides. It found a significant effect of age (F = 8.06, p = 0.0059) and a significant interaction between age and sex (F = 4.15, p = 0.045). There was no significant effect of lateralityon the variation of the BV/TV rate (F = 0.98, p = 0.325). It is concluded that the amount of bone in the maxillary tuberosity represented by the BV/TV rate is directly related to sex and age, and that a higher proportion of bone volume can be found in males and a lower proportion in older women. Although CBCT images when evaluated in ImageJ Software can provide a BV/TV bone volume ratio in the maxillary tuberosity, further studies should be carried out in order to describe other parameters that may directly interfere with the proportion of bone available in this region.

The aim of this prospective study was to assess the clinical and functional results of radial head reconstruction with an autologous bone graft from distal humerus in 12 patients, with a follow-up for a period of 24 months. From March 2017 to June 2018, we surgically treated 12 patients using an autologous bone graft from the lateral distal metaphysis of the homolateral humerus. Patients were divided into two groups: -Group A consisted of patients with previous failed ORIF for radial head fracture. Patients underwent revision surgery at an average time of 7 months (between 6 to 8 months) from the first surgery. All the patients reported pain during the elbow range of motion with no gross clinical signs or instability of the joint. They all presented standard X-ray and CT-scan of the elbow suggestive of non-union fracture. None of them presented osteoarthritic modification at the time of surgery. -Group B consisted of patients reporting acute irreparable radial head fractures. Patients were evaluated clinically at 6-, 12-, and 24-months duration according to Disabilities of the Arm. Shoulder and Hand (DASH), Mayo Elbow Performance Score (MEPS), and Visual analogue score for pain (VAS);, range of motion (ROM) was evaluated at 6 and 24 months after surgery. Plain radiographs on anteroposterior and lateral views of the elbow were evaluated at final follow-up. In both, groups (A and B) patients showed a significant improvement with regards to VAS, MEPS, and DASH at each follow-up (p

Bone graft techniques are used to compensate for bone loss in areas with deficient regeneration. However, matrix metalloproteases (MMPs) can limit bone formation by degrading extracellular matrices, which are required for bone regrowth. Noteworthily, rutin is a natural flavonoid compound that inhibits the genetic expression of various MMPs. Therefore, rutin may serve as an inexpensive and stable alternative to the growth factors used to accelerate dental bone graft healing. This study aimed to evaluate the potential of mixing rutin gel with allograft bone to accelerate the healing of bone defects in an in vivo rabbit model. Bone defects were surgically induced in New Zealand rabbits (n = 3 per group) and subsequently treated with bone grafts along with rutin or control gel. Overall, treatment with rutin significantly prevented the expression of several MMPs and increased type III collagen in the gingiva around the surgical site. Additionally, rutin-treated animals showed enhanced bone formation with higher bone marrow content in the jawbone defect area compared with the control group. Taken together, these findings demonstrate that rutin gel, when added to bone grafts, quickly enhances bone formation and may serve as a suitable alternative to expensive growth factors for the same purpose.

Background Several options for grafting exist; iliac crest bone grafting, allografts, and bone substitutes. Local bone graft (LBG) offers high-quality bone graft and no commercial cost. The aim of this study was to assess the clinical and radiologic results of adolescent idiopathic scoliosis (AIS) surgery with posterior instrumentation and fusion (PIF) in patients using only LBG and to measure the quantities harvested. Methods A total of 218 AIS patients who underwent pedicle screw PIF surgery using only LBG with a minimum 1-year follow-up were reviewed. Bone was harvested during surgery from the excised facet joints, spinous processes (not from the end instrumented vertebrae) and decortication of laminae and transverse processes in the operative field. The harvested bone graft weight of 127 patients was recorded prospectively and then computed to graft weight per kilogram body weight (GWPK) and graft weight per motion segment (GWPMS). Results The median follow-up time was 24.7 months (12.1 to 133 mo) with 128 of the 218 patients having over 2 years follow-up. A total of 280 curves were fused. One hundred fifty-six of the patients had single curve instrumentation and 62 had double curve surgery. The median preoperative primary Cobb angle was 57.0 (31 to 100) degrees and postoperatively was 20.0 (0 to 66) degrees, indicating a median correction of 65.3% (17.5% to 100%). The median graft weight was 30 g (14 to 62 g), GWPK was 0.54 g/kg (0.24 to 1.29 g/kg) and GWPMS was 3.3 g/motion segments (2.3 to 10.0 g/kg). Twelve of 218 patients (5.5%) required subsequent surgery. Only 2 patients developed pseudarthrosis (0.91%), noting that modern segmental instrumentation warrants longer follow-up for increased confidence of complete fusion. Conclusions LBG achieved successful fusion in over 99% of patients undergoing PIF for AIS. The described terms GWPK and GWPMS can be insightful for future studies. LBG offers a safe and low-cost solution for bone grafting in AIS surgery. Level of evidence Level IV.

The overall aim of this thesis was to determine if and how topography of calcium phosphates can be improved for increased efficacy as bone graft materials for maxillofacial and orthopedic surgery. To achieve this objective, we manufactured calcium phosphate bone grafts with different surface designs, i.e. topographies with different surface crystal morphology (needle-shaped vs. grain-shaped) in the micron- and submicron range, and evaluated their ability to induce ectopic bone formation in a canine intramuscular pouch model. The material with the highest osteoinductive potential, attributed to its needle-shaped submicron topography, was selected for further evaluation in pre-clinical models of orthopedic surgery (i.e. spinal fusion) and maxillofacial surgery (i.e. maxillary sinus floor augmentation). In these studies, the material was compared to the gold standard autograft and/or other synthetic bone graft substitute materials. In addition to these pre-clinical studies, the bone graft material with needle-shaped topography was evaluated in a retrospective cohort study of interbody spinal fusion and a preliminary prospective, randomized controlled trial (RCT) of maxillary sinus floor augmentation. Furthermore, to gain insight into the biological effects of calcium phosphate topography, polarization of primary human macrophages in response to calcium phosphates with submicron needle-shaped topography and conventional topography was assessed in vitro, which included an evaluation of downstream regenerative effects of macrophages on osteogenesis and angiogenesis. These findings were placed in perspective of the available literature, in a review of M2 macrophage upregulation by biomaterials with specific structural and topographical features.

The overall aim of this thesis was to determine if and how topography of calcium phosphates can be improved for increased efficacy as bone graft materials for maxillofacial and orthopedic surgery. To achieve this objective, we manufactured calcium phosphate bone grafts with different surface designs, i.e. topographies with different surface crystal morphology (needle-shaped vs. grain-shaped) in the micron- and submicron range, and evaluated their ability to induce ectopic bone formation in a canine intramuscular pouch model. The material with the highest osteoinductive potential, attributed to its needle-shaped submicron topography, was selected for further evaluation in pre-clinical models of orthopedic surgery (i.e. spinal fusion) and maxillofacial surgery (i.e. maxillary sinus floor augmentation). In these studies, the material was compared to the gold standard autograft and/or other synthetic bone graft substitute materials. In addition to these pre-clinical studies, the bone graft material with needle-shaped topography was evaluated in a retrospective cohort study of interbody spinal fusion and a preliminary prospective, randomized controlled trial (RCT) of maxillary sinus floor augmentation. Furthermore, to gain insight into the biological effects of calcium phosphate topography, polarization of primary human macrophages in response to calcium phosphates with submicron needle-shaped topography and conventional topography was assessed in vitro, which included an evaluation of downstream regenerative effects of macrophages on osteogenesis and angiogenesis. These findings were placed in perspective of the available literature, in a review of M2 macrophage upregulation by biomaterials with specific structural and topographical features.

The study aimed to evaluate the accuracy of Micro-CT in linear and volumetric measurements in native (NB) and grafted bone (GB) areas. A total of 111 biopsies of maxillary sinuses grafted with deproteinized bovine bone (DBB) in humans were evaluated. The linear measurements were performed to measure the length of the NB and GB. Furthermore, the amount of mineralized tissues at the NB and GB was performed. In the histomorphometry analysis the percentage of mineralized tissues at the NB and GB was obtained in two histological sections while the mineralized tissues were measure in the micro-CT varying the thresholds of the grayscale varying from 90-250 to 90-150 with 10 levels of variation between each one was applied. Then these data were correlated in order to check the higher r level between the histomorphometry and micro-CT thresholds intervals. The linear length of the NB was 2.44±0.91mm and 2.48±1.50mm, respectively, for micro-CT and histomorphometry (r =0.57), while the linear length of the GB was 3.63±1.66mm and 3.13±1.45mm, respectively, for micro-CT and histomorphometry (r =0.74) Histomorphometry showed 45.91±11.69% of bone in NB, and 49.57±5.59% of bone and biomaterial in the GB. The total volume of mineralized tissues that were closest to the histometric analysis were 43.75±15.39% in the NB (Threshold:90-240; r = 0.50) and 51.68±8.42% in the GB (Threshold:90-180; r =-0.028). The micro-CT analysis showed good accuracy in the linear analysis in both portions of the biopsies but for volumetric analysis just in NB. Resumo Esse estudo tem como objetivo avaliar a acurácia da análise microtomográfica em mensurações lineares e volumétricas em osso nativo (ON) e enxertado (OE). Para isso, 111 biópsias removidas de seios maxilares de pacientes enxertados com osso bovino desproteinizado foram coletadas e avaliadas. As medidas lineares foram realizadas para medir o comprimento do ON e do OE. Além disso, foi realizada a mensuração da quantidade de tecidos mineralizados em ON e OE. Na análise histomorfométrica a porcentagem de tecidos mineralizados do ON e OE foi obtida em dois cortes histológicos enquanto os tecidos mineralizados foram medidos em microtomografias variando os thresholds da escala de cinza variando de 90-250 a 90-150 com 10 níveis de variação entre cada. Em seguida, esses dados foram correlacionados para verificar o maior nível de R entre os intervalos dos thresholds testados na análise microtomográfica em relação aos dados obtidos na histomorfometria. O comprimento linear do ON foi de 2,44±0,91mm e 2,48±1,50mm, respectivamente, para análises microtomográfica e histomorfométrica (r=0,57), enquanto o comprimento linear do OE foi de 3,63±1,66mm e 3,13±1,45mm, respectivamente, para para análises microtomográfica e histomorfométrica (r =0,74) A histomorfometria detectou 45,91±11,69% de osso na porção de ON e 49,57±5,59% de osso e biomaterial na porção de OE. O volume total de tecidos mineralizados detectados pela análise microtomográfica que apresentou valores mais próximos da análise histomorfométrica foi de 43,75±15,39% no ON (Thresholds:90-240; r = 0,50) e 51,68±8,42% no OE (Thresholds:90-180; r =- 0,028). A análise microtomográfica apresentou boa acurácia na análise linear em ambas as porções das biópsias, porém a mesma apresentou boa acurácia para análise volumétrica apenas em áreas de ON.

To evaluate the potential benefit of the use of a bone substitute material in the reconstructive surgical therapy of peri-implantitis.In this multicenter randomized clinical trial, 138 patients (147 implants) with peri-implantitis were treated surgically, randomized by coin toss to either a control (access flap surgery) or a test group (reconstructive surgery using bone substitute material). Clinical assessments, including probing pocket depth (PPD), bleeding and suppuration on probing (BOPSOP) as well as soft tissue recession (REC), were recorded at baseline, 6 and 12 months. Marginal bone levels (MBL), measured on intra-oral radiographs, and patient-reported outcomes (PROs) were recorded at baseline and 12 months. No blinding to group allocation was performed. The primary outcome at 12 months was a composite measure including (i) implant not lost, (ii) absence of BOP/SOP at all aspects, (iii) PPD ≤5 mm at all aspects and (iv) ≤1 mm recession of mucosal margin on the buccal aspect of the implant. Secondary outcomes included (i) changes of MBL, (ii) changes of PPD, BOP%, and buccal KM, (iii) buccal REC and (iv) patient-reported outcomes.During follow-up, four implants (one in the test group, three in the control group) in four patients were removed due to disease progression. At 12 months, a total of 69 implants in the test and 68 implants in the control group were examined. Thus, 16.4% and 13.5% of implants in the test and control group, respectively, met all predefined criteria of the composite outcome. PPD reduction and MBL gain were 3.7 mm and about 1.0 mm in both groups. Reduction in mean BOP% varied between 45% (test) and 50% (control), without significant differences between groups. Buccal REC was less pronounced in the test group (M = 0.7, SD = 0.9 mm) when compared to controls (M = 1.1, SD = 1.5 mm). PROs were favorable in both groups without significant differences. One case of allergic reaction to the antibiotic therapy was recorded. No other adverse events were noted.Surgical therapy of peri-implantitis effectively improved the clinical and radiographic status at 12 months. While the use of a bone substitute material did not improve reductions of PPD and BOP, buccal REC was less pronounced in the test group. Patient satisfaction was high in both groups.

Nonunion occurs in 2–10% of all forearm fractures due to different mechanical and biological factors, patient characteristics, and surgeon-dependent causes. It is a condition that causes functional and psychosocial disability for the patient because it is a unique anatomical segment in which all the bones and structures involved embody a complex functional unit; therefore, it is a challenge for the orthopedic surgeon. The ultimate goal of the care of these patients is the restoration of function and limitations related to impairment and disability. The aim of this review is to provide an extended description of nonunion forearm fractures, related risk factors, diagnosis, classification systems, and the available evidence for different types of treatment as a tool to better manage this pathology.

Digital dentistry allowed the dental surgeon to perform dental procedures, in a different way, in the different specialties. In implantology, we can highlight guided surgery, which is performed after virtual planning, where the oral scanning with the patient's tomography is planned, using software. In this way, a surgical guide can be made using a 3D printer. The speed and precision of implant installation are the main advantages of this procedure, in addition to a more comfortable postoperative period for the patient, when the technique is performed without flaps (flapless). Therefore, this work aims to demonstrate to professionals in the area, the technique of guided surgery for dental implants, using virtual planning. The procedure was performed in a 66-year-old patient, in the maxillary premolar region, through digital planning, and an implant was installed using the SIN guided implant system. It was concluded that the guided surgery technique is a favorable technique, which provided greater speed, precision and faster recovery of the patient. La odontología digital permitió al cirujano dentista realizar procedimientos odontológicos, de manera diferente, en las distintas especialidades. En implantología podemos destacar la cirugía guiada, que se realiza previa planificación virtual, donde se planifica el escaneado oral con la tomografía del paciente, mediante un software. De esta forma, se puede fabricar una guía quirúrgica en una impresora 3D. La rapidez y precisión en la instalación de los implantes son las principales ventajas de este procedimiento, además de un postoperatorio más cómodo para el paciente, cuando la técnica se realiza sin colgajos (flapless). Por lo tanto, este trabajo tiene como objetivo demostrar a los profesionales del área, la técnica de cirugía guiada para implantes dentales, utilizando la planificación virtual. El procedimiento se realizó en un paciente de 66 años, en la región de premolares maxilares, mediante planificación digital, y se colocó un implante mediante el sistema de implante guiado SIN. Se concluyó que la técnica de cirugía guiada es una técnica favorable, que brindó mayor rapidez, precisión y una recuperación más rápida del paciente. A odontologia digital proporcionou ao cirurgião dentista realizar procedimentos odontológicos, de uma maneira diferente, nas diversas especialidades. Na implantologia podemos destacar a cirurgia guiada, que é realizada após o planejamento virtual, onde é planificado o escaneamento oral com a tomografia do paciente, utilizando um software. Desta maneira pode ser confeccionado, em uma impressora 3D, um guia cirúrgico. A rapidez e a precisão da instalação do implante, são as principais vantagens deste procedimento, além de um pós operatório mais confortável para o paciente, quando a técnica é realizada sem retalhos (flapless). Portanto, este trabalho tem como objetivo demonstrar aos profissionais da área, a técnica da cirurgia guiada para implantes dentários, com a utilização do planejamento virtual. O procedimento foi realizado em um paciente com 66 anos, na região do pré-molar superior, através do planejamento digital, sendo instalado um implante utilizando o sistema de implante guiado da SIN. Foi concluído que a técnica de cirurgia guiada é uma técnica favorável, que proporcionou uma maior rapidez, precisão e recuperação mais rápida do paciente.

OBJECTIVES: To assess the effect of grafting the gap (SG) between the implant surface and alveolar socket on hard and soft tissue changes following single immediate implant placement (IIP). MATERIALS AND METHODS: Two independent reviewers conducted an electronic literature search in Pubmed, Web of Science, Embase and Cochrane databases as well as a manual search to identify eligible clinical studies up to August 2021. Randomized controlled trials (RCTs) comparing IIP with and without SG were included for a qualitative analysis. Meta-analyses were performed when possible. RESULTS: Out of 3627 records, 15 RCTs were selected and reported on 577 patients who received 604 single immediate implants (IIP + SG: 298 implants in 292 patients; IIP: 306 implants in 285 patients) with a mean follow-up ranging from 4 to 36 months. Two RCTs showed low risk of bias. Meta-analysis revealed 0.59 mm (95% CI [0.41; 0.78], p

Study Design: Narrative Review. Objectives: The increasing cost of healthcare overall and for spine surgery, coupled with the growing burden of spine-related disease and rising demand have necessitated a shift in practice standards with a new emphasis on value-based care. Despite multiple attempts to reconcile the discrepancy between national recommendations for appropriate use and the patterns of use employed in clinical practice, resources continue to be overused—often in the absence of any demonstrable clinical benefit. The following discussion illustrates 10 areas for further research and quality improvement. Methods: We present a narrative review of the literature regarding 10 features in spine surgery which are characterized by substantial disproportionate costs and minimal—if any—clear benefit. Discussion items were generated from a service-wide poll; topics mentioned with great frequency or emphasis were considered. Items are not listed in hierarchical order, nor is the list comprehensive. Results: We describe the cost and clinical data for the following 10 items: Over-referral, Over-imaging & Overdiagnosis; Advanced Imaging for Low Back Pain; Advanced imaging for C-Spine Clearance; Advanced Imaging for Other Spinal Trauma; Neuromonitoring for Cervical Spine; Neuromonitoring for Lumbar Spine/Single-Level Surgery; Bracing & Spinal Orthotics; Biologics; Robotic Assistance; Unnecessary perioperative testing. Conclusions: In the pursuit of value in spine surgery we must define what quality is, and what costs we are willing to pay for each theoretical unit of quality. We illustrate 10 areas for future research and quality improvement initiatives, which are at present overpriced and underbeneficial.

Background: Orofacial clefts are common congenital malformations, with alveolar cleft as the most common [75%] of all anomalies. Many treatment modalities are available. However, our clinical experience with bone graft modality is not well addressed. The aim of the work: To evaluate the effectiveness of early [2 to 12 years; before complete eruption of the cleft canine] versus late [> 12 years; after complete eruption of the cleft canine] cancellous anterior iliac bone grafting for alveolar cleft reconstruction. Patients and Methods: Twenty-three patients with alveolar clefts who were admitted for alveolar cleft reconstruction surgery were included. They were categorized into early and late secondary grafting groups. All patients inquired about their history. Submitted to full clinical examination, laboratory and radiological examinations. The imaging studies include two-dimensional orthopantomogram for all patients, while 3-D fascial computed tomography and cone-beam computed tomography were done for selected patients. Both intraoperative and postoperative data were collected, any complications were registered and patients followed up regularly up to 6 months. Results: Both groups were comparable as regarding patient characteristics except younger age in early group, and there was a statistically significant difference between early and late groups regarding cleft side and cleft permanent canine full eruption. Males represented 69.9%. The cleft was on the left side in 56.4%. Seven patients [30.4%] had maternal risk factor [five in early and two in late group]. Blood loss was less than 80 ml in all patients in both groups. All oronasal fistulas were sealed off successfully in all patients [100%] and all had normal healthy gingival contour with vital teeth adjacent to the cleft. All showed evidence of good bone filling in the alveolar defect after 6 months postoperatively. Only one patient developed hypertrophic scars at each group . Conclusion: Alveolar cleft reconstruction is preferred to perform autologous cancellous bone grafting harvested from the iliac crest bone to repair the cleft with excellent outcome on short-term follow-up .

Objective: To histologically evaluate healing following grafting a xenogenous bone substitute in the buccal gap around the immediately placed one-piece zirconia implant. Materials and methods: The third and fourth premolars (PM3 and PM4) in both quadrants of the mandible of nine Mongrel Hound dogs were used for this experiment. They have been removed, and the recipient sites were prepared. The implants were placed in a lingual position in the socket. In one side of the jaw, the gap between the implant and the socket walls was grafted (test) while no grafting was performed in the contralateral side (control), randomly selected. After 6 months of healing, biopsies were obtained and prepared for histological analysis. Vertical and horizontal measures were recorded in buccal and lingual surface. Results: The hard tissue was in a coronal position on the test side compared with the control side. The bone thickness around ZLA (zirconia large-grit sandblasted and acid-etched surface) level was larger on the test side. On the test side, the first bone-implant contact and bone crest, at the buccal aspect, were more coronal to ZLA in PM4 while in PM3 the same happened with the bone crest. The width of the buccal bone wall was larger in PM4 than in PM3 at the ZLA level and 1 mm apical to ZLA. Conclusion: The placement of a xenograft in the gap between 1-piece zirconia implant and the buccal wall in dogs modified the process of hard tissue healing, providing additional amount of hard tissue. This project was supported by a research grant from the ITI Foundation (number 1215_2017).

Introduction Osteochondrosis dissecans (OCD) is considered to be one of the main causes for pain, discomfort and morbidity in the pediatric elbow joint. Few treatment options, such as microfracture or autologous transplantation, of osteochondral bone grafts have been described to address advanced OCD. The aim of this retrospective case series is to present preliminary clinical and radiologic findings following advanced stage OCD repair using a novel combination of a hyaluronic acid-based scaffold with autologous iliac crest bone grafting. Materials and methods Five adolescents, who underwent treatment of OCD (grade 3 or 4 according to Nelson) using a combination technique of defect debridement, transplantation of cancellous iliac crest bone and application of a HYALOFAST® membrane (Anika Therapeutics S.r.L., Italy), were re-assessed using clinical and radiologic examinations (defect diameter, depth, sclerosis, congruency, fragmentation, dissection, radiolucency, growth plate status; MRI) after a minimum of 2 years (mean, 34 months; range, 24–45) postoperatively. Dedicated outcome scores (Numeric Rating Scale [NRS], Pediatric Outcome Data Collection Instrument [PODCI], Mayo Elbow Performance Score [MEPS], and Timmerman-Andrews Score [TIMM] were collected. Results All patients reported a NRS score of 0. The mean total TIMM, MEPS and PODCI (Global Functioning Scale) scores were 189 (range 165–200), 94 (range, 70–100), and 92 (range 83–98; normative score 47; range 35–55), respectively, indicating good to excellent clinical outcomes. The radiographic analysis showed overall improvements with regard to OCD width and depth reduction (35%, − 27–100%; 52%, 4–100%), but full resolution in only 2 of 5 cases. Elbow motion improved slightly after surgery. No complications were noted. Conclusion This study showed promising clinical short- to mid-term results in adolescent patients with advanced OCD using a novel surgical treatment combination. Radiographic results showed partial healing; hence, residual changes should be monitored over a longer period.

Background: Generally, after tooth extraction, trauma is caused by bone damage, which leads to a decreased bone density. Bone damage repair should be conducted using a bone graft containing hydroxyapatite (HA). HA can be synthesised from gypsum puger powder, which is abundant and easy to obtain. Hydroxyapatite gypsum puger (HAGP) was successful with 100% hydroxyapatite purity level. Purpose: To compare the ratio of trabecular bone density in Wistar rats between HAGP scaffold application and bovine hydroxyapatite (BHA) scaffold application. Methods: This study is a laboratory experiment using 6 treatment groups, namely K (-) polyethylene glycol (PEG) 7, K (-) PEG 28, HAGP + PEG 7, HAGP + PEG 28, BHA + PEG 7, and BHA + PEG 28. HAGP scaffold freeze-drying. The rats were anaesthetised intramuscularly, and their left mandibular incisor was removed. The scaffold was applied to the mouse socket, followed by tissue decapitation after 7 and 28 days. The examination was carried out with micro-computed tomography (Micro-CT). Next, statistical analysis using a one-way analysis of variance (ANOVA) test was conducted (p

Guided bone regeneration (GBR) is a well-documented and widely-used dental surgical procedure for the treatment of various types of alveolar bone defects. The aim of the study was to evaluate the long-term effectiveness of the GBR procedure in correcting small peri-implant bone dehiscence using the xenogeneic deproteinized bovine bone mineral material and a xenogeneic native bilayer collagen membrane. The present study was designed as a retrospective study. Seventy-five bone-level tapered two-piece dental implants Conelog®, Camlog (Biotechnologies AG, Switzerland) were divided into two groups G1—no bone augmentation (no GBR)—44 implants and G2—bone augmentation (GBR)—31 implants. For both groups, the closed healing protocol with a primary wound closure was used. The incidence of peri-implantits was evaluated, the quantitative assessment of soft tissue thickness was performed using the ultrasound (USG) device, quantitative assessment of marginal bone loss (MBL) was done. The prevalence of peri-implantitis was 5.3%, with a three-fold increase in peri-implantitis comparing the groups without and with bone augmentation (G1 = 2.27%, G2 = 9.7%). The average keratinized gingiva thickness was 1.87 mm and did not differ significantly between groups. No statistically significant differences in MBL between G1 and G2 were found. When dividing patients by gender, no statistically significant differences were observed. When dividing patients by age groups, statistically significant differences were observed between the youngest and oldest groups of patients. Within the limitations of this study, it can be concluded that the use of xenogeneic bone and a xenogeneic collagen membrane in a GBR procedure can be recommended to correct small peri-implant bone dehiscence.

Background: The surgical treatment of proximal humeral fractures (PHFs) with locking plate fixation (LPF) in the elderly is associated with high complication rates, especially in osteoporotic bone. Variants of LPF such as additional cerclages, double plating, bone grafting and cement augmentation can be applied. The objective of the study was to describe the extent of their actual use and how this changed over time. Methods: Retrospective analysis of health claims data of the Federal Association of the Local Health Insurance Funds was performed, covering all patients aged 65 years and older, who had a coded diagnosis of PHF and were treated with LPF between 2010 and 2018. Differences between treatment variants were analyzed (explorative) via chi-squared or Kruskal–Wallis tests. Results: Of the 41,216 treated patients, 32,952 (80%) were treated with LPF only, 5572 (14%) received additional screws or plates, 1983 (5%) received additional augmentations and 709 (2%) received a combination of both. During the study period, relative changes were observed as follows: −35% for LPF only, +58% for LPF with additional fracture fixation and +25% for LPF with additional augmentation. Overall, the intra-hospital complication rate was 15% with differences between the treatment variants (LPF only 15%, LPF with additional fracture fixation 14%, LPF with additional augmentation 19%; p < 0.001), and a 30-day mortality of 2%. Conclusions: Within an overall decrease of LPF by approximately one-third, there is both an absolute and relative increase of treatment variants. Collectively, they account for 20% of all coded LPFs, which might indicate more personalized treatment pathways. The leading variant was additional fracture fixation using cerclages.

There are many different surgical techniques for bone reconstruction. However, biological reconstruction methods are being increasingly developed. The main purpose is not only to fill up defects, but to stimulate the processes of reconstruction and regeneration of bone as a complete organ. In this report, we describe the basic principles of orthobiology and the essential orthobiological materials. A clinical case is presented where a combination of allogeneic osteoplastic materials with autologous platelet-rich plasma is used to reconstruct a cavity defect in the tibia.

BackgroundThe volume of residual alveolar bone is critical to the survival of dental implants. When the volume of alveolar bone in the posterior maxillary region is less than 4 mm, maxillary sinus floor elevation (MSFE) with the lateral approach is an effective option. Traditionally, this standard approach is usually conducted at 4–6 months after tooth extraction (standard MSFE). However, defective dentition due to extraction can impair mastication during the period of bone remodeling, especially if the molars on both sides are severely compromised and must be extracted. MSFE before extraction (modified MSFE) can take full advantage of residual tooth strength. However, the effectiveness and practicability of the modified MSFE procedure remain unknown. Therefore, the aim of this study was to compare the clinical outcomes of modified vs. standard MSFE, in order to provide references to periodontists.Methods/designThe study cohort included 25 adult patients (50 surgery sites) recruited from Peking University Hospital and School of Stomatology who met the inclusion criteria. The two sides of each patient will be randomly divided into two groups: a test group-modified MSFE or a control group-standard MSFE. The surgical duration and patient-reported outcomes (visual analog scale for discomfort) will be documented. Clinical indicators, including implant survival rates, mucosal conditions, and complications, will be recorded every 6 months during the 5-year follow-up period. The volume of the alveolar bone and marginal bone level will be assessed radiographically (cone-beam CT and periapical films) every 6 months. Histological analysis of biopsy samples retrieved from both sides will be performed to evaluate the biological features of the bone.DiscussionThe current study will explore the implant survival rates, safety, reliability, effectiveness, and practicability of the modified MSFE procedure. Moreover, the extent of osteogenesis on the sinus floor will also be assessed. The results of this trial will provide strategies for the modified MSFE procedure to achieve ideal clinical outcomes.Trial registrationInternational Clinical Trials Registry PlatformChiCTR1900020648. Registered on 1 January 2019

Mucosal fenestration is a clinical condition wherein the root apex of an affected tooth is visible in the oral cavity due to loss of overlying alveolar bone and mucosa, while dehiscence results in denudation of the root surface due to loss of overlying alveolar bone including the marginal bone. A 25-year-old male patient reported with primary concern of defect in gums and discoloration in an upper central incisor. Examination revealed an intricate case of combined mucosal fenestration and dehiscence occurring concomitantly with an endodontic lesion in an open apex anterior tooth. Cone-beam computed tomographic scan, in addition to routine diagnostic aids, supplemented the diagnosis and facilitated meticulous treatment planning. Both conventional and surgical endodontic procedures were carried out. This was followed by periodontal plastic surgery and prosthodontic rehabilitation of the discolored tooth. Complete healing of soft tissue defect was seen in 6 months, while complete bony healing was seen at 12 months. The treatment thus aimed at correcting the pathology, handling the psychological concerns, and restoring physiologic function and aesthetics by reconstruction of the lost periodontium around the involved tooth.

© 2021 American Chemical Society.The advent of three dimensionally (3D) printed customized bone grafts using different biomaterials has enabled repairs of complex bone defects in various in vivo models. However, studies related to their clinical translations are truly limited. Herein, 3D printed poly(lactic-co-glycolic acid)/β-tricalcium phosphate (PLGA/TCP) and TCP scaffolds with or without recombinant bone morphogenetic protein -2 (rhBMP-2) coating were utilized to repair primate's large-volume mandibular defects and compared efficacy of prefabricated tissue-engineered bone (PTEB) over direct implantation (without prefabrication). 18F-FDG PET/CT was explored for real-time monitoring of bone regeneration and vascularization. After 3-month's prefabrication, the original 3D-architecture of the PLGA/TCP-BMP scaffold was found to be completely lost, while it was properly maintained in TCP-BMP scaffolds. Besides, there was a remarkable decrease in the PLGA/TCP-BMP scaffold density and increase in TCP-BMP scaffolds density during ectopic (within latissimus dorsi muscle) and orthotopic (within mandibular defect) implantation, indicating regular bone formation with TCP-BMP scaffolds. Notably, PTEB based on TCP-BMP scaffold was successfully fabricated with pronounced effects on bone regeneration and vascularization based on radiographic, 18F-FDG PET/CT, and histological evaluation, suggesting a promising approach toward clinical translation.

Aim: The aim of this study was to assess the perception, knowledge, and attitude of individuals from different regions of Saudi Arabia toward dental implants and bone grafts. Material and Methods: An online, self-oriented, and cross-sectional-based questionnaire with 21 items was given to 1622 individuals from different regions of Saudi Arabia. The questionnaire recorded the perception, knowledge, and attitude of participants and their agreement or rejection of dental implants and various kinds of bone grafts. The responses were compared with age, sex, and educational level. Descriptive statistical analysis was performed for the collected data and P < 0.05 was considered statistically significant. Results: Most of the males (35.8%) and females (39.8%) reported that the major source of data regarding dental implants is friends and families. Majority of the participants (approximately 75% males and 73% females) support the idea that dental implants last for lifetime, whereas majority of the participants (approximately 49% males and 56% females) displayed their unawareness regarding materials used for dental implants. The overall acceptance rates of participants for autografts, alloplasts, xenografts from the cow, xenografts from the horse, and allografts were 40%, 15.9%, 2.5%, 2.2%, and 1.6%, respectively. Conclusion: The expense of dental implants was considered the foremost reason for avoiding the procedure. Most of the participants think that fixed dental prostheses last longer than removable prosthesis. Autograft was the most accepted bone graft, whereas allograft was the least accepted bone graft over the responded participants.