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Tooth extractions can result in alveolar bone dimensional changes, necessitating additional bone grafting for implant placement. Alveolar ridge preservation (ARP) aims to counteract postextraction changes. This case series evaluates the bone regenerative properties of a freeze-dried bone allograft (FDBA) and the clinical outcomes of implants in grafted extraction sites. A total of 33 patients were enrolled, undergoing single/multiple tooth extractions followed by ARP. Biopsy samples were harvested during implant placement for histologic and histomorphometric analysis. Clinical outcomes included marginal bone loss and pink esthetic score (PES). Twenty-five patients completed the study. FDBA-augmented sockets exhibited new bone formation adjacent to graft particles. Implants (n = 25) showed 100% survival and success rates at 1 and 2 years. PES improved significantly over time (P < .001), while marginal bone loss did not significantly differ at 1 and 2 years (P = .096). Specimens showed trabecular bone, residual FDBA particles, and marrow spaces. High magnification revealed immature bone and woven bone bridges around graft particles. No inflammatory cells were observed. This case series provides valuable insights into ARP performed with FDBA (as implants were placed after 3 months of healing without any additional bone augmentation), the histologic outcomes were favorable, and implants were successful after a 2-year follow-up period. [ABSTRACT FROM AUTHOR]

Purpose: To conduct a longitudinal evaluation of sites grafted with autogenous bone prior to implant placement using a dental cast with a 3D modeling system. Materials and Methods: A total of nine patients underwent implant treatment with bone grafting for anterior missing teeth. Informed consent was obtained from each patient. Casts were made and evaluated at three time periods, including before bone grafting (Pre BG), 4 or 5 months after grafting (Post BG), and 4 or 5 months after implant placement (Post IP). 3D data of these casts were acquired using a 3D digital scanner and then superimposed with reference to the remaining teeth. The volume of the anterior area of the cast was evaluated Pre BG and Post BG. Results: Accuracy of superimposition on the remaining teeth was between 20 and 50 |m. Horizontal differences Post BG and Post IP were 0.1 to 1.6 mm. The volume Post IP decreased by 14% to 38% compared to the volume Post BG. Conclusions: This 3D modeling technique allowed 3D evaluation before and after bone grafting. Results suggested that the volume of the maxilla was sequentially decreased after bone grafting. [ABSTRACT FROM AUTHOR]

Purpose: To present a sling suture technique used to stabilize a collagen membrane against the lateral bone window to improve bone substitute stability inside the sinus cavity. Materials and Methods: Maxillary sinus floor augmentation was performed on 17 patients (8 women and 9 men; mean age 58.2 years) using a lateral approach with the sling suture technique to maintain a collagen membrane against the lateral bone window. Postoperative CBCT images were captured at 6-month follow-up of each patient to monitor the bone graft stability at the level of the lateral antrostomy. Clinical postoperative pain and swelling were assessed via visual analog scale (VAS) questionnaire, measured from level 1 (low) to level 5 (acceptable) to level 10 (high) at 1 week postoperative. Results: No bone substitute displacement was observed in any clinical cases on the CBCT images at 6 months postoperative. The pain and swelling levels observed 1 week postoperatively were significantly low (mean ± SD; 1.6 ± 1.0 and 2.1 ± 0.9, respectively). Conclusions: The use of the sling suture technique to maintain a barrier membrane at the level of the lateral bone window in cases of maxillary sinus floor augmentation using a lateral approach is a predictable protocol to prevent bone substitute displacement outside the sinus cavity. [ABSTRACT FROM AUTHOR]

Implants with deficient papillae and black triangles are common findings. The treatment of these esthetic complications is considered to be challenging with limited predictability. Therefore, the present report aims to describe a novel technique for papilla augmentation: the "iceberg" connective tissue graft (iCTG) after extraction and interproximal bone reconstruction in the anterior region. A 35-year-old patient presented with a hopeless tooth with interproximal clinical attachment loss extending to the apical third of the adjacent tooth. Interproximal bone reconstruction was performed through alveolar ridge preservation by directly applying recombinant human platelet-derived growth factor-BB (rhPDGF-BB) to the exposed root surface of the adjacent tooth. A mixture of autogenous bone chips (obtained from the ramus) and bovine bone xenograft particles (previously mixed with the growth factor) was also used. The patient was able to return for implant therapy only 2 years later, at which time an incomplete regeneration of the interproximal bone was observed. Therefore, to compensate the interproximal deficiency, the iCTG approach was utilized, involving a double layer of CTG with different origins. Two small grafts from the tuberosity were sutured to the mesial and distal ends of a wider CTG harvested from the palate, aiming to gain additional volume at the interproximal sites. The composite graft was then sutured on top of the implant platform, and the flap was then released and closed by primary intention. After conditioning the peri-implant tissues, the case was finalized with a satisfactory outcome. The described iCTG could be an effective approach for reconstructing peri-implant papillae following interproximal bone reconstruction. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate a new cultivated coral graft (CCG) in an in vivo experimental guided bone regeneration (GBR) procedure. Materials and Methods: The calvarias of eight rabbits were surgically exposed, and circular defects 8 mm in diameter were prepared. One defect was filled with CCG particles (experimental group); the contralateral defect (control group) was spontaneously filled by blood clot. All defects were covered with a collagen membrane. Subjects were euthanized after 8 weeks. Results: Histologic observations of the defects showed similar bone growth patterns in both experimental and control osteotomies. In the experimental defects, no traces of coral particles were observed. Histometric analysis showed denser bone in the pristine zone (65%-66%) than in the peripheral zone for both the control (50%) and experimental defects (31%) (P = not significant). The new bone percentage was reduced from the peripheral zone toward the middle and the center of the defect (31%, 32%, and 27%, respectively) as the distance from the peripheral pristine bone borders increased. Conclusions: The existing data supports the complete degradation of CCG as a space-maintaining scaffold for GBR procedures. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the dimensional changes in the alveolar crest after buccal overbuilding was performed prior to tooth extraction in a dog model. Materials and Methods: At the test sites, alveolar crest overbuilding was performed on the buccal aspect of the distal root of the third premolar using xenograft covered with a collagen membrane. No treatment was applied at the control sites. After 3 months, the distal roots of both third premolars were extracted and implants were immediately placed into the alveolus, allowing nonsubmerged healing. After 3 months, biopsy samples were collected. Results: Upon histologic analysis, no statistically significant differences in hard tissue dimensions were found. The buccal bone plate at the test sites presented a tendency for higher resorption compared to the control sites. However, if the contribution of the residue of biomaterial is considered, a higher volumetric gain was registered at the test than at the control sites. Conclusions: The buccal overbuilding performed prior to tooth extraction did not contribute to the preservation of the alveolar crest dimensions after extraction. This could be due to failure to incorporate the graft into the newly formed bone. [ABSTRACT FROM AUTHOR]

We investigate the glassy-state properties of Mg2Ca, Al2Ca, and Al4Ca from the grafting application viewpoint. We employed classical molecular dynamics to examine the phase transition, structural, thermodynamic, transport, and mechanical properties in the amorphous state. All properties suggest successful simulations of the glass phase at and below the glass transition temperature, ranging between 550 and 689 K for Mg2Ca, Al2Ca, and Al4Ca. Computed results are compared and discussed with the reported findings and known mechanical and thermal properties of the various parts of the human bones and biocomposites. The comparison establishes that the mechanical, thermal, and transport properties significantly improve in the glass phase compared to its crystalline alloy form. At 300 K, studied glasses have densities in close agreement with human bone density. Structural analysis and heat capacity show the second-order phase transition, verifying the formation of the glass structure. The targeted glasses exhibit excellent thermal conductivity and thermal diffusivity compared to other commonly used biocomposites for bone grafting. Furthermore, the simulated elastic properties, viz., the Poisson ratio, G/B ratio, Cauchy's pressure, and yield strength, are in close agreement with the mechanical properties of various parts of human bone. The predicted ductility nature, contrary to the brittle character of Mg2Ca, Al2Ca, and Al4Ca crystalline alloys, proves the superiority of the glassy form for the implant's functioning. The minimum enthalpy of formation and thermodynamic stability of studied compounds benefit the synthesis process; hence, we propose that the studied glasses are persuasive materials for experimental synthesis aimed at bone grating applications. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of using a customized xenograft shell with a 1:1 mixture of particulate xenograft and autogenous bone for the reconstruction of horizontally deficient anterior maxillary alveolar ridges. Materials and Methods: CBCT images of the atrophic maxilla of eight patients were acquired and generated into 3D models. The data were transferred to a 3D printer for fabrication. During the surgery, xenograft blocks were manually sliced and customized on the 3D-printed models into bone shells. Then they were fixed to the atrophic site, and the gap was augmented with a 1:1 mixture of particulate xenograft and autogenous bone. Results: Clinical assessment showed no adverse effects; however, one patient exhibited wound dehiscence. The mean difference between the preoperative and 6-month postoperative CBCTs showed a net average bone gain of 4.06 mm at 2 mm from the crest and 4.34 mm at 5 mm from the crest, which was statistically significant. On the other hand, a statistically significant graft resorption of 1.41 mm at 2 mm from the crest and 2.19 mm at 5 mm from the crest was found when the mean difference between the immediate and 6-month postoperative CBCTs was calculated. Conclusions: Within the limitations of the study, the use of xenograft shells as a barrier for maxillary alveolar ridge reconstruction is a predictable technique; however, further investigations regarding the required time for graft consolidation are required. [ABSTRACT FROM AUTHOR]

Purpose: To assess histologic and imaging outcomes related to new bone formation around implants, inserted simultaneously with sinus augmentation, and compare different types of grafts. Materials and Methods: This systematic review (SR) was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Cochrane Handbook for Systematic Reviews of Interventions. LILACS/BVS, MEDLINE/PubMed, Cochrane Library, and Embase databases, including gray literature and manual investigations, were searched to identify clinical trials reporting specific requirements. The present study needed human histologic and imaging data of bone formation around implants inserted into the maxillary sinus simultaneously with elevation and augmentation procedures. Study selection, risk of bias (Rob 2.0 or ROBINS-I), quality of evidence (GRADE), and data collection were performed by two independent reviewers. Results: Of the 1,101 potentially eligible articles, 44 were retrieved, 12 were assessed for eligibility, and 5 were included (4 randomized and 1 controlled clinical trial). As a result, 130 grafted sinuses with 179 placed implants in 103 patients were analyzed. The patients were aged between 24 and 79 years and followed up between 6 and 15 months. The heterogeneity between studies did not allow the data to be combined for meta-analysis. All graft materials proved to be viable options for the intervention. The use of biphasic calcium phosphate was related to higher bone-to-implant contact. Conclusions: All of the assessed grafts are viable options for the addressed intervention. The use of some material is justified to maintain the sinus volume and allow bone formation in the apical implant site under the sinus membrane. Longer chair time and donor site morbidity should be considered when choosing autogenous bone. Synthetic biphasic materials can be selected for this intervention due to superior bone-to-implant contact compared to deproteinized bovine bone. [ABSTRACT FROM AUTHOR]

Purpose: To answer the following question: "Do recombinant, purified, and concentrated growth factors enhance the regenerative potential of particulate bone graft substitutes in maxillary sinus floor augmentation (MSA)" Materials and Methods: Human studies comparing histomorphometric data on new bone formation, residual graft material, and fibrous tissue ratio (outcomes of interest) following MSA procedures employing particulate bone grafts/substitutes in combination or not with growth factors were retrieved from PubMed/MEDLINE, Web of Science, Cochrane, and Scopus online databases and complemented with a hand search. Controlled studies published in English up to December 2022 and reporting on histomorphometric data expressed as volume percentage of the outcomes of interest were considered. Risk of bias was assessed, and a meta-analysis was performed to investigate the effects of supplementary growth factors on new bone formation, remaining graft particles, and fibrous tissue ratio. Results: Data were included from 613 samples in 477 patients reported in 22 publications. Meta-analysis showed that platelet-rich plasma or platelet-rich fibrin resulted in 49% more new bone formation than in control group areas (P = .004), and those areas supplemented with growth factors presented 57% less residual graft particles after healing (P < .0001). A significant (P = .03) 1.85-fold increase in connective tissue formation was noted in areas treated with recombinant human bone morphogenetic proteins (rhBMPs) after healing. Conclusions: Selective supplementary growth factors may enhance new bone formation and accelerate particulate graft turnover, while rhBMP may significantly increase connective tissue formation in MSA procedures in humans. [ABSTRACT FROM AUTHOR]

This article reports a case of maxillary rehabilitation with implant-supported fixed dental prostheses on six zirconia implants. A woman with impacted maxillary canines attended our dental clinic seeking a metal-free maxillary restoration. After the extraction of both impacted maxillary canines and the placement of autogenous bone graft, six two-piece zirconia implants with straight abutments were placed in the anterior maxilla. Two zirconia fixed dental prostheses with porcelain veneering, separated at the midline, were placed on these zirconia implants. The 10-year follow-up monitored the adequate evolution of both implants and restorations with no signs of peri-implant disease. [ABSTRACT FROM AUTHOR]

Bone graft materials are often used in implant treatment to optimize functional and esthetic outcomes. The requirements for bone grafting materials are the ability to maintain space for bone regeneration to occur and the capability of being resorbed by osteoclasts and replaced with new bone tissue occurring in passive chemolysis and bone remodeling. Carbonate apatite (CO3Ap) granules (Cytrans Granules, GC) are a chemically synthetic bone graft material similar to autogenous bone minerals and more biocompatible than allografts and xenografts. The aim of this report is to evaluate the efficacy of CO3Ap granules in implant treatments when used alone or in combination with autogenous bone. The clinical findings and the radiographic and histologic assessments in three cases of immediate implant placement and lateral and vertical guided bone regeneration are reported. Despite the short-term follow-ups, histologic findings showed that CO3Ap granules were efficiently resorbed and replaced bone in clinical use. Furthermore, the clinical findings showed that CO3Ap granules maintained their morphology around the implant. This limited short-term case report suggests that this bone substitute is effective. However, further clinical studies and long-term reports of this new biomaterial are needed. [ABSTRACT FROM AUTHOR]

This study assessed the effects of buccal contour augmentation for periodontally compromised teeth with horizontal bone loss. A total of 30 subjects were divided into Group A or Group B (n = 15 subjects per group). Group A received open-flap debridement (OFD) with buccal contour augmentation using deproteinized bovine bone mineral (DBBM), jointly referred to as contour augmentation for periodontal defects (CAPD; test group). Group B received only OFD (control group). Bleeding on probing (BOP), clinical attachment level (CAL), probing depth (PD), gingival recession (GR), keratinized mucosa width (WKM), keratinized mucosa thickness (TKM), and labial cortical plate thickness were compared at baseline and 1 year. BOP, CAL, PD, and GR did not show significant differences. TKM increased by 1.76 mm for Group A but decreased by 1 mm for Group B. WKM increased from 2.86 ± 0.4 mm to 3.6 ± 0.71 mm (P < .001) and from 2.93 ± 0.32 mm to 3 ± 0.7 mm (P = 0.5) for Groups A and B, respectively, which showed statistical significance. Labial cortical plate thickness increased from 0.94 ± 0.3 mm to 1.95 ± 0.54 mm (P < .001) for Group A but decreased from 0.87 ± 0.45 mm to 0.68 ± 0.31 mm for Group B. Visual analog scale scores for pain perception showed no difference between the two groups. CAPD for periodontally compromised teeth improves WKM and TKM. Long-term analyses are needed to determine its benefits in daily clinical practice. [ABSTRACT FROM AUTHOR]

Despite the various treatments proposed with barrier membranes, one of the main challenges for guided bone regeneration (GBR) is maintaining space for large defects and ensuring an adequate blood supply. The presented feasibility case series aims to introduce an original titanium frame (TF) design, customized for each defect, as a modification of well-known principles and materials for GBR to achieve an enhanced and more predictable horizontal and vertical bone augmentation. Three patients with significant horizontal defects were treated with pre-trimmed TFs to create needed space, and then a 50/50 mixture of autograft and bovine xenograft was placed and covered with a collagen membrane. After 8 months of healing, the sites were reopened, and the titanium screws were removed with the frame. An average of 8.0 ± 1.0 mm of horizontal and 3.0 ± 0.0 mm of vertical bone gain were achieved at the time of reentry and implant placement surgery. Bone core biopsy sample was obtained during the implant placement. Histomorphometric analysis revealed that 42.8% of the sample was new vital bone, 18.8% was residual bone graft particles, and 38.4% was bone marrow-like structures. After 3 to 4 months from implant placement, the implants were restored with provisional crowns and then finalized with zirconia screw-retained crowns. This case series suggests that GBR utilizing TFs with or without collagen membranes can be considered a suitable approach for horizontal and vertical bone augmentation. However, based on only three reported cases, the results should be carefully interpreted. [ABSTRACT FROM AUTHOR]

Background: Platelet-rich fibrin (PRF) is used to prepare "sticky bone" by combining it with bone graft material. The present study investigated the ability of different bone grafts to absorb growth factors from the PRF and release them over time. Materials and Methods: Human blood was collected from 10 healthy volunteers for liquid PRF preparation. Bovine bone, allograft (mineralized and demineralized), and synthetic bone were each mixed with the PRF to prepare a sticky bone. All sticky bone samples were incubated for up to 4 days. The absorption and release pattern kinetics of two selective growth factors within the PRF--platelet-derived growth factor (PDGF) and bone morphogenetic protein-2 (BMP-2)--were quantified with immunofluorescence staining and enzyme-linked immunoassay (ELISA) testing. Results: All bone graft materials adsorbed the examined growth factors from the PRF. ß-TCP showed the highest adsorption levels, followed by the xenograft, and the allografts showed the lowest adsorption levels. Furthermore, PDGF showed a fast-release pattern from the grafts, whereas BMP-2 was released at a later stage. Similar to the adsorption pattern, the ß-TCP and xenograft were better able to sustain the release of the PRF growth factors from the graft than the allografts. Conclusions: The adsorption of PDGF and BMP-2 differ between graft materials, with superior results for ß-TCP, followed by xenograft, then allograft materials. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to compare the histomorphometrically evaluated new bone formation (NB), the radiographically measured graft stability, and the clinical implant outcome for maxillary sinus augmentation grafted with deproteinized bovine bone mineral (DBBM) with either small (Bio-Oss-S, Geistlich) or large (Bio-Oss-L, Geistlich) particles. Materials and Methods: Using a split-mouth study design, bilateral maxillary sinus augmentation was performed in 13 patients either with Bio-Oss-S particles (0.25 to 1 mm) or Bio-Oss-L particles (1 to 2 mm). After a healing period of 6 months, bone biopsies were axially retrieved in the molar region for histologic/histomorphometric analysis of NB, including subsequent staged implant placement. To determine graft stability, the maxillary sinus augmentation vertical graft heights were radiographically measured immediately after sinus augmentation, at implant placement, and at the 2- and 4-year post-augmentation follow-ups. In addition, the clinical implant-prosthodontic outcome (survival/success/marginal bone loss) was assessed at 1 and 3 years post-loading. Results: A total of 22 sinuses from 11 patients with split-mouth evaluation were ultimately available for data and statistical analysis. Histomorphometric analysis of the axially retrieved bone biopsies revealed the presence of NB (S: 25.5% ± 7.0% vs L: 23.6% ± 11.9%; P = .640), residual graft particles (S: 19.6% ± 9.2% vs L: 17.5% ± 6.3%; P = .365) as well as connective tissue (S: 54.9% ± 9.2% vs L: 58.9% ± 12.5%; P = .283), without significant differences between the use of small (Bio-Oss-S) and large (Bio-Oss-L) particles. However, there was significantly (P = .021) higher bone-to-graft contact (BGC) for the small-particle graft sites (27.9% ± 14.8%) compared to the large-particle graft sites (19.9% ± 12.9%), representing a significantly higher osteoconductivity. Both particle sizes showed significant (P < .01) vertical graft height reduction over time (4 years) of about 10%, with predominant graft reduction in the time period between sinus augmentation and implant placement compared to any follow-up periods after implant placement. At the 3-year post-loading implant evaluation, all implants and prostheses survived (100%), and the peri-implant marginal bone loss (S: 0.52 ± 0.19 mm; L: 0.48 ± 0.15 mm) as well as the peri-implant health conditions (S: 87.5%, L:81.2%) did not differ between implants inserted with the two different xenograft particles used. Conclusions: The use of small and large bovine xenograft particles for maxillary sinus augmentation provides for comparable bone formation, ensuring stable graft dimensions combined with high implant success and healthy peri-implant conditions. However, small particle size resulted in a higher BGC, providing for higher osteoconductivity than with the larger particle size. [ABSTRACT FROM AUTHOR]

Objectives: This case series aimed to assess the efficacy of a novel horizontal ridge augmentation modality using histology. Combinations of "sticky bone" and tenting screws without autologous bone were used as augmentative materials. Method and materials: Five individuals presenting healed, atrophic, partially edentulous sites that required horizontal bone augmentation before implant placement were enrolled. Patients underwent the same augmentation type and 5 months of postoperative reentry procedures. The first surgery served as implant site development, whereas the biopsy and corresponding implant placement were performed during reentry. The bone was qualitatively analyzed using histology and histomorphometry and quantitatively evaluated using CBCT. Results: Four individuals healed uneventfully. Early wound dehiscence occurred in one case. Histology showed favorable bone substitute incorporation into the newly formed bone and intimate contact between de novo bone and graft material in most cases. Histomorphometry revealed an average of 48 ± 28% newly formed bone, 19 ± 13% graft material, and 33 ± 26% soft tissue components. The CBCTbased mean alveolar ridge horizontal increase was 3.9 ± 0.6 mm at 5 months postoperatively. Conclusions: The described augmentation method appears suitable for implant site development resulting in favorable bone quality according to histology. However, clinicians must accommodate 1 to 2 mm of resorption in augmentative material width at the buccal aspect. [ABSTRACT FROM AUTHOR]

Objective: Ideal implant placement in atrophied posterior mandibular regions is challenging due to surgical difficulties and anatomical limitations. This study aimed to evaluate the use of allogeneic bone rings for vertical augmentation of atrophied posterior mandibular regions with simultaneous implants compared to autogenous bone rings, while avoiding donor site morbidity. Method and materials: A total of 24 vertically atrophied posterior mandibular segments (in 14 patients) were equally randomized into a study group in which mineralized freeze-dried allogeneic bone rings were used, and a control group in which autogenous bone rings with prepared implant osteotomies were harvested from the chin and used. All augmentation sites were prepared before inserting the bone rings. Implants were simultaneously inserted, fixing the bone rings into the native bone. All patients were clinically assessed after 1 week, 2 weeks, and 1 month. Crestal bone level was radiographically assessed after lweek, 6 months, and 3 months of prosthetic loading. Results: None of the 24 bone rings showed signs of implant or graft failure. There was no significant difference in the crestal bone level between the groups. Conclusion: Allogeneic bone rings can be a viable alternative to autogenous bone rings in augmenting the posterior aspect of the mandible, mitigating the concerns associated with donor site complications. [ABSTRACT FROM AUTHOR]

Sinus membrane thickening is a common maxillary sinus disease. However, a consensus has not been reached on the effect of sinus membrane thickness on the transcrestal sinus floor elevation. This retrospective study evaluated the perforation and bone formation at transcrestal sinus floor elevation sites with different sinus membrane thicknesses. A total of 117 sites in 87 patients treated with transcrestal sinus floor elevation were included in this study. The surgical sites were divided into four groups according to the baseline sinus membrane thickness: Group A (0 to 1 mm), Group B (1 to 2 mm), Group C (2 to 4 mm), and Group D (> 4 mm). CBCT scans were taken before surgery, immediately after surgery, and 6 months after surgery. The mean baseline sinus membrane thickness was 2.16 ± 2.54 mm, and the mean residual alveolar bone height was 6.58 ± 1.85 mm. The mean endosinus new bone height was 3.76 ± 1.95 mm. The perforation rate and endosinus new bone height showed no significant difference among the groups (P > .05). The incidence rates of membrane thickening and perforation were significantly higher in smoking patients (P < .05). Membrane thickening without ostium obstruction may have little impact on transcrestal sinus floor elevation surgery in regards to perforation rate and bone formation. In addition, smoking may be a risk factor for membrane thickening, and the sinus membrane is more likely to perforate during transcrestal surgery when the patient has a history of smoking. [ABSTRACT FROM AUTHOR]

Purpose: To describe the use of digital technology to surgically guide the shell technique using allogenic cortical plates for a fully guided bone augmentation procedure. Materials and Methods: A total of 10 patients who required bone augmentation for implant placement were included in this study. Allogenic cortical plates were planned using CAD/CAM to have identical thickness to the original cortical plates, then were digitally positioned and shaped to outline the bone defect according to the existing anatomical details. A cutting pattern and a surgical template were manufactured according to the digitally preplanned bone graft and the intraoral setting. Results: A total of 12 horizontal bone grafting procedures were performed using the shell technique with allogenic cortical plates. All grafting procedures were deemed successful and allowed for ideal 3D implant positioning. Of the 12 bone grafting procedures, which used a surgical template to position the cortical plate, 3 required an adjustment to reposition the plate to a more ideal position. Conclusions: Digital technology was used to create a surgical template to guide the shell bone grafting technique with allogenic cortical plates. All surgical templates offered a fixed support to hold the cortical allogenic plate in the preplanned position, offering a predictable, simplified, and accurate guided bone grafting procedure. Further studies on a larger population of patients are necessary to assess those results and to verify the treatment approach described in this study. [ABSTRACT FROM AUTHOR]

Context: The purpose of this study was to compare short-term clinical outcomes between meniscus procedures performed with anterior cruciate ligament reconstruction (ACLR), ACLR (ACLR-only), ACLR with meniscectomy/resection (ACLR-resect), and ACLR with meniscal repair (ACLR-repair) for bone patellar tendon bone grafts (BPTB) and hamstring tendon grafts, separately. Design: This was a cross-sectional study conducted in a controlled laboratory setting as part of a large point-of-care collaborative research program. Methods: This study included 314 participants (168 females; mean [SD]: age, 19.7 [4.8]) with primary unilateral ACLR with a BPTB or hamstring tendon. Patients were divided into 3 groups depending on meniscal procedure (ACLR-only, ACLR-resect, and ACLR-repair). Postsurgical testing included: isokinetic assessment of knee extension and flexion, single-leg hop tests, and patient-reported outcomes. Multivariate analysis of covariance compared differences between meniscal procedures on the battery of tests, and for each statistically significant variable an analysis of covariance assessed the effect of meniscal procedure within each graft type. Chi-square analysis assessed the influence of meniscal procedure on tests' pass rates defined as 90% of limb symmetry index. Results: BPTB: ACLR-only had greater hamstring strength than ACLR-resect (P = .05) and ACLR-repair (P = .005). ACLR-only had the highest proportion of participants to pass the hamstring strength test (P=.02). amstring tendon: ACLR-only (P=.03) and ACLR-resect (P=.003) had higher International Knee Documentation Committee scale scores than ACLR-repair. There was a significant difference in the proportion of participants who scored >90% limb symmetry index on the timed hop test (P = .05). Conclusions: The influence of meniscal repair on clinical outcomes is dependent on the graft choice. Following an ACLR with BPTB and a meniscal procedure, hamstring function should be more closely monitored for optimal short-term recovery. [ABSTRACT FROM AUTHOR]

Traditional GBR procedures have been associated with frequent complications and compromised peri-implant esthetics. Tunneling techniques have been proposed as a promising alternative in this regard. More recently, a subperiosteal minimally invasive aesthetic ridge augmentation technique (SMART) was reported to have been clinically successful in a prospective case series. This technique includes the use of a bone graft/recombinant human platelet-derived growth factor-BB combination delivered to the site by a tunneling method. However, published histologic information regarding the nature of the regenerated tissue has been limited. The current study evaluated the histologic and histomorphometric findings of four human specimens harvested at 2, 5, 9, and 14 months after ridge augmentation using the SMART method. Evaluations of the wound healing and bone regeneration sequence over time found that the ridge augmentation was the result of extensive new bone formation that progressed through the woven bone to lamellar bone stages, with remodeling of the xenogeneic graft material and replacement by patient bone. This is the first study utilizing sequential human specimens to histologically examine the chronology of wound healing following alveolar ridge augmentation. [ABSTRACT FROM AUTHOR]

Successful rehabilitation of severely atrophic, short-span edentulous ridges in esthetic regions can seldom be done without some form of vertical ridge augmentation (VRA). The best available evidence shows that guided bone regeneration procedures may present a very predictable option with reduced potential for complications compared to alternative options. The present case series presents a novel technique to achieve predictable VRA with a low complication rate using tenting screws and cross-linked resorbable membranes. A total of 10 patients (5 men, 5 women) with severe vertical defects in the esthetic zone participated in this study. Following a mean healing time of 9.3 months, the mean defect resolution was 80%, with a mean vertical bone gain of 6.2 ± 1.61 mm. Only one case presented with reduced defect resolution (50%); however, the bone gain for this case was 6 mm. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the usefulness of ridge augmentation using a customized titanium mesh (CTM) that was preformed by trimming and bending the commercial titanium mesh on a virtually reconstructed 3D acrylic resin model using clinical, radiologic, histologic, and histomorphometric analyses. Materials and Methods: This study was designed prospectively for patients who required vertical ridge augmentation using a staged approach before implant surgery. After installation of the CTM, grafting was performed using deproteinized porcine bone mineral covered with an absorbable membrane. Computed tomography was performed preoperatively and 6 months after simultaneous/staged guided bone regeneration to measure planned, reconstructed, and lacking bone volume, and the reconstruction rate was calculated based on these values. Clinical complications were also recorded, particularly the mesh exposure rate. At re-entry, the bone core was obtained using a trephine bur, and histologic and histomorphometric analyses were performed. Results: A total of 10 sites in eight patients were used for the study analysis. The mean planned bone volume was 1.15 cm3 (range: 0.78 to 1.56 cm3), mean lacking bone volume was 0.13 cm3 (range: 0 to 0.59 cm3), and mean reconstructed bone volume was 1.02 cm3 (range: 0.56 to 1.43 cm3). The exposure rate was 30% (3 out of 10 sites). The reconstruction rate was over 80%, except for one case that showed suppuration. From histomorphometric analysis, 27.52% ± 16.87% of new bone, 7.62% ± 5.19% of residual graft, and 64.86% ± 23.76% of connective tissue were observed. The core biopsy samples demonstrated different pseudoperiosteum layer appearances based on the healing stage of the augmented sites. In the premature bone, the inner osteogenic layer consisted of multiple layers of osteoblast cells with adjacent large blood vessels. However, in the mature augmented site, there was no specific inner osteogenic layer, and the outer fibrous layer was dominant. Conclusions: The fabrication of CTM based on the application of the 3D-printing technique makes vertical ridge augmentation easier and can reduce complications and achieve target bone acquisition. In addition, it is expected that quantitative analysis of the pseudoperiosteum layer will be facilitated using the CTM. [ABSTRACT FROM AUTHOR]

Background: Macroscopic fat pulmonary embolism is extremely uncommon. Most cases occur in the context of fat grafting or long bone fractures. Macroscopic fat pulmonary embolism may be associated with cardiopulmonary compromise and is associated with high mortality. Mechanical thrombectomy is an emerging technique in interventional radiology, primarily investigated as a therapeutic approach for thrombotic pulmonary embolism. Case presentation: We present a case report of a 73-year-old woman with macroscopic fat pulmonary embolism after a neck of femur fracture. Initially, she had severe circulatory shock, requiring multiple vasopressors and admission to the Intensive Care Unit. A percutaneous large-bore mechanical thrombectomy was performed, after which notable improvements to haemodynamic function and overall clinical trajectory were observed. Conclusions: To our knowledge, this is the first report of mechanical thrombectomy in macroscopic fat pulmonary embolism. Further research is required to better delineate the role of mechanical thrombectomy in this rare condition. [ABSTRACT FROM AUTHOR]

Introduction: Aseptic nonunion is prevalent in orthopedic practice, causing persistent pain and functional impairment. Humeral shaft fractures, accounting for 3–5% of all fractures, have nonunion rates of 2–33% in nonoperative and 5–10% in surgical management. This study, the largest case series on operative management of aseptic humeral shaft nonunion (AHSN), treated with plate osteosynthesis. Materials and methods: This retrospective study, conducted at a referral center in eastern India, included 132 patients with aseptic humeral shaft nonunion from May 2002 to April 2012 and May 2015 to December 2020. Patients aged 20–70 years with nonunion more than 6 months post-trauma were included. Exclusions were open fractures, infections, gap nonunions, pathologic fractures, and concomitant upper limb injuries. Surgical techniques involved excising fibrous and unhealthy tissue, compressing the nonunion site, decorticating, shingling, autologous bone grafting, and stable fixation with dynamic or locking compression plates. Outcomes were assessed using Quick DASH, VAS, Constant Shoulder score at a minimum follow-up of 24 months. Results: The study included 132 patients, 84 males and 48 females, with a mean age of 42.3 years. Fractures were due to high-energy trauma in 78 cases and low-energy trauma in 54 cases. All patients with atrophic type of AHSN received autologous bone grafts and plating techniques. Quick DASH scores improved from 77 to 5 on average. Constant Shoulder score improved from 22 to 88 and VAS score improved from 6.7 to 1.3. Union was achieved in 21 weeks on an average, with minimal complications. Despite variations in time intervals, treatments, and follow-up durations, consistent management strategies emphasize stable fixation, bone grafts, and careful management of complications to achieve high union rates and satisfactory outcomes. Complications included seven infections, one failure needed refixation and two case of transient radial nerve palsy. Conclusion: Absolute stability using plate with or without autologous bone grafting for aseptic humeral shaft nonunion results in high union rates and satisfactory radiologic and functional outcome. [ABSTRACT FROM AUTHOR]

Purpose: Scaphocapitate fusion (SCF) is an important surgical option for carpal pathologies, which are difficult to manage as Kienböck's disease. With the advantages of arthroscopy combined with percutaneous fixation techniques, arthroscopic scaphocapitate fusion can have the best outcome for the patient from a functional perspective. This study aims to evaluate the clinical, radiological, and functional results of arthroscopic SCF. Methods: The study included thirty patients with stage IIIB and IIIC Kienböck's disease. The articular surfaces were prepared using arthroscopic burr then fixed by Herbert screw. The mean follows up period was about 29 months. Results: SCF was achieved in approximately seven weeks. There was a statistically significant difference in pre- and post-operative grip strength and Mayo wrist score. Conclusion: According to our study findings, arthroscopic SCF may be performed with significant improvements and satisfactory clinical and functional results in patients with stage IIIB and IIIC Kienböck's disease. [ABSTRACT FROM AUTHOR]

In the initial report describing the fronto-orbital distraction technique, bone segments were advanced preserving their attachments with the dura. This approach does not allow for the remodeling of the frontal segment. However, in the technique described herein, the fronto-orbital segment is separated from dura, remodeled, and advanced as a bone graft using distractors. Twenty-seven craniosynostosis patients that underwent fronto-orbital advancement and remodeling using distraction osteogenesis were retrospectively reviewed. The mean age at the time of surgery was 19.03 ± 9.19 months; the mean follow-up was 86.04 ± 34.98 months. The mean distraction amount was over 19 mm. No significant difference was found between frontal and occipital bone density measurements at the cortex and medulla. The mean total defect area was 4.79 ± 4.43 cm2 and the mean number of bone defects was 4.8 ± 2.2. The cephalic index decreased from 98.56 ± 6.39 to 87.63 ± 4.54, and 59.3% of the patients reached the normal range in the late postoperative period. Fronto-orbital advancement and remodeling using distraction osteogenesis appears to be safe and effective. Distraction of the frontal bone as a graft does not lead to bone resorption, and new bone formation and improvements in head shape can be achieved. [ABSTRACT FROM AUTHOR]

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Purpose: This study aimed to evaluate the osteogenic performance of allograft particulate bone and cortical bone blocks combined with xenograft under bovine pericardium membranes, for treating different degrees of labial bone defects in the aesthetic zone. Materials and methods: Twenty-four patients with bone defects were divided into two groups based on defect severity (Terheyden 1/4 and 2/4 groups). The Terheyden 1/4 group received granular bone grafts alone, while the Terheyden 2/4 group received cortical bone blocks combined with granular bone grafts. Cone beam computed tomography scans were taken preoperatively, immediately postoperatively, and six months postoperatively. Primary outcomes included labial bone formation, alveolar bone formation, bone resorption rate, osteogenic efficiency, and complications. Results: Labial bone thickness in both groups exceeded 2 mm after six months. Labial bone formation at the implant shoulder in the Terheyden 1/4 group was 2.35 ± 2.68 mm, and 2.26 ± 1.66 mm in the Terheyden 2/4 group (p > 0.05). Labila and alveolar bone formation at 2–5 mm below the implant shoulder was significantly greater in the Terheyden 2/4 group (p < 0.05). Alveolar bone resorption and the bone resorption rate at 2–5 mm below the implant shoulder was lower in the Terheyden 2/4 group (p < 0.05). Osteogenic efficiency was 64.43 ± 2.76%, with no significant difference between groups (p > 0.05). No complications were observed. Conclusion: Both treatment approaches achieved satisfactory bone regeneration, but combining cortical bone blocks with granular grafts provided better outcomes for larger defects, with greater bone formation and less resorption. Further research with longer follow-up is required to confirm long-term stability. Trial registration: The study was retrospectively registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn/) with the registration number ChiCTR2300070538 on April 14, 2023. [ABSTRACT FROM AUTHOR]

Background: Chondroblastoma is classified as a benign bone tumor. However, postoperative local recurrence remains a concern. We analyzed the factors contributing to chondroblastoma local recurrence and the clinical challenges associated with treating these patients. Methods: This retrospective study examined 59 patients followed up at our hospitals for ≥ 1 year after surgery during 1990–2020. The most common lesion site was the epiphyses of long bones (42 cases, 71%), including the femur, tibia, and humerus. Curettage was performed in 57 cases; 2 cases with an iliac lesion underwent resection. The median postoperative follow-up period was 47 months. Clinical features of chondroblastoma were retrospectively investigated, and local recurrence and postoperative functional outcomes were assessed. Results: Local recurrence occurred in 9% (5/57) of patients after curettage but not in the resected cases. The median time to local recurrence was 14 months. The local recurrence-free survival (LRFS) rate for all patients was 92.7% at 2 years and 88.3% at 5 years. All patients with local recurrence were aged < 17 years at the time of surgery. Local recurrence was observed in the proximal humerus in two cases and the calcaneus, acetabulum, and distal femur in one case each. None of the adjuvant procedures (high-speed burr, ablation, bone replacement materials, and preoperative denosumab) helped reduce local recurrence risk (P > 0.05). Trends toward fewer local recurrences were observed in the group treated using the high-speed burr and in the group not treated using bone replacement materials. Among the groups treated with bone replacement materials, artificial bone achieved the best LRFS rate, followed by allograft and autograft. At the final follow-up, the mean Musculoskeletal Tumor Society score was 29.8 (range: 25–30), indicating excellent postoperative functional outcomes. Joint degeneration was observed in five patients. Patients with local recurrence had a high degree of disability and joint deformity (P < 0.05). Two patients received preoperative denosumab and neither experienced local recurrence nor functional impairments. Conclusions: Good oncological and functional outcomes were achieved. Age < 17 years was associated with a high risk of local recurrence after curettage (P = 0.0198). Patients with local recurrence exhibited poorer functional outcomes. High-speed burr may help reduce the recurrence risk. If bone grafts are necessary, materials with low biocompatibility, including artificial bone, may be optimal. Managing patients with chondroblastoma should encompass curative and functional aspects. [ABSTRACT FROM AUTHOR]

Background: This study evaluates the effects of ozone on hard and soft tissue healing when a free tissue flap is used to close wound areas lacking primary closure over autogenous grafted sites. Methods: In our study, 24 male Wistar rats were divided into four groups: two control groups and two ozone-treated groups. All rats underwent the same surgical procedure. After surgery, the control groups received no additional treatment, while the ozone groups received topical ozone application. Ozone was applied for 2 min, three times per week, with one-day intervals, for a duration of 2 weeks post-surgery. Sacrifice was performed on the 14th day for one control and one ozone group, and on the 28th day for the remaining groups. All soft and hard tissue samples were then examined histopathologically. Clinical trial number: not applicable. Results: Histopathological evaluations and statistical analyses on the 14th day indicated that bone healing was significantly better in the ozone group compared to the control group (p = 0.049). For soft tissue healing, although there was no statistically significant difference between the ozone and control groups, proportional values showed better recovery in the ozone-treated groups compared to the controls. Conclusions: The present study concludes that ozone has a positive effect on new bone formation in the early stages; however, it showed no statistically significant effect on soft tissue healing. We believe that further comprehensive studies would be beneficial to confirm these findings. [ABSTRACT FROM AUTHOR]

Background/Objectives: Vascularized bone grafts have been successfully established for complex bone defects. The integration of three-dimensional (3D) simulation and printing technology may aid in more precise surgical planning and intraoperative bone shaping. The purpose of the present study was to describe the implementation and surgical application of this innovative technology for bone reconstruction. Methods: This prospective pilot study was conducted between June 2019 and June 2024. For this evaluation, patients who received vascularized bone reconstruction assisted with 3D technology were included. For reconstruction, the free medial femoral condyle (MFC) flap was used as the vascularized bone graft. Patient-specific 3D-printed templates, based on individual 3D simulations according to defect characteristics, were used for surgical planning, including flap elevation, shaping and inset. Results: A total of six patients (five male) with an average age of 39 years (range 19–62 years) and a mean follow-up time of 15 months (range 5–24 months) were analysed. The indications were as follows: avascular necrosis of the carpal bones, a metacarpal defect after tumor resection and pseudoarthrosis after a fractured ulna. Three patients received an osteochondral and three patients received a cortico-cancellous MFC flap. Conclusions: Our evaluation of clinical application revealed enhanced preoperative planning as well as intraoperative performance. Although the implementation for this technology is challenging, the new insights gained in planning and surgical guidance have led us to incorporate this technology into our standard routine. [ABSTRACT FROM AUTHOR]

Background/Objectives: Tooth extraction induces significant alveolar ridge dimensional changes and soft tissue modifications, often leading to challenges in implant placement or conventional prosthetic rehabilitation. Alveolar Ridge Preservation (ARP) strategies aim to mitigate post-extraction resorption of the alveolar ridge, enhancing both the quality and quantity of bone and soft tissue during healing. Hyaluronic acid (HYA) has emerged as a promising biological agent for ARP due to its osteoinductive, antimicrobial, and anti-inflammatory properties. However, the effects of HYA in ARP remain inconsistently reported. This study aims to assess current clinical and preclinical evidence regarding the biological effects of HYA and its application in ARP. Additionally, it evaluates HYA's impact—alone or in combination with other products—on hard and soft tissue dimensional changes, early wound healing, and implant success rates. Methods: A comprehensive electronic literature search was conducted, and studies meeting the inclusion criteria were critically evaluated. Relevant data were extracted from the final selection of articles. Results: Thirteen publications were evaluated. Some studies reported a significantly improved newly formed bone following ARP with intra-socket HYA application as a single approach (p = 0.004). Combining HYA with a bone graft and a free palatal graft resulted in significantly greater amounts of newly formed and mature bone, reduced clinical bone width changes, lower radiographic crestal bone loss (p < 0.01), and diminished radiological volumetric and linear bone resorption (p = 0.018). Short-term follow-up data indicated improved soft tissue healing associated with HYA-based ARP. While HYA appears to have a protective effect on ridge dimensional changes in ARP, other studies reported no significant differences in radiographic bone dimensional changes or soft tissue improvement. Conclusions: The addition of HYA to bone grafts may enhance some ARP outcomes. However, the variability in outcomes and methodologies across the evaluated studies precludes drawing definitive clinical conclusions. Further robust research is needed to clarify HYA's role in ARP. With respect to clinical significance enhancing the understanding of ARP management strategies and their effects on post-extraction sockets empowers clinicians to make more informed decisions. The knowledge of HYA effects facilitates the selection of personalized ARP approaches tailored to optimize outcomes for subsequent interventions. [ABSTRACT FROM AUTHOR]

Mandibular reconstruction is essential for restoring both function and aesthetics after segmental resection due to tumoral pathology. This study aimed to conduct a comparative analysis of three reconstruction strategies for defects resulting from segmental mandibular resection, utilizing finite element analysis (FEA). Methods: A digital model of the mandible was created from CBCT data and optimized for FEA. Three reconstruction scenarios were simulated: fixation with a titanium plate, reconstruction with an autogenous fibular graft stabilized with the same titanium plate, and fixation with a customized PEEK plate. Various plate thicknesses were analyzed to determine the stress and deformation patterns under masticatory loads. Results: Titanium plates provided superior mechanical stability but showed stress concentrations near screw fixation points. The addition of autogenous bone grafts reduced stress on the plate and improved structural integrity. PEEK plates exhibited reduced stress shielding and better load distribution, but thinner designs were prone to deformation. Minimum recommended thicknesses of 1.2 mm for titanium plates and 1.8 mm for PEEK plates were identified by FEA. Conclusions: This study highlights the importance of material selection and patient-specific design in mandibular reconstruction. Autogenous bone grafts combined with titanium plates demonstrated the best biomechanical outcomes, while PEEK plates offer a promising alternative, particularly for patients where grafting is contraindicated. [ABSTRACT FROM AUTHOR]

Bone tissue engineering seeks to develop treatment approaches for nonhealing and large bone defects. An ideal biodegradable scaffold will induce and support bone formation. The current study examines bone augmentation in critical‐sized bone defects, using functionalized scaffolds, with the hypothesized potential to induce skeletal cell differentiation. 3D printed, porous poly(caprolactone) trimethacrylate (PCL‐TMA900) scaffolds are applied within a murine femur defect, stabilized by a polyimide intramedullary (IM) pin. The PCL‐TMA900 scaffolds are coated with i) elastin‐like polypeptide (ELP), ii) poly(ethyl acrylate) (PEA)/fibronectin (FN)/bone morphogenetic protein‐2 (PEA/FN/BMP‐2), iii) both ELP and PEA/FN/BMP‐2, or iv) Laponite nanoclay binding BMP‐2. Sequential microcomputed tomography (µCT) and histological analysis are performed. PCL‐TMA900 is robust and biocompatible and when coated with the nanoclay material Laponite and BMP‐2 induce consistent, significant bone formation compared to the uncoated PCL‐TMA900 scaffold. Critically, the BMP‐2 is retained, due to the Laponite, producing bone around the scaffold in the desired shape and volume, compared to bone formation observed with the positive control (collagen sponge/BMP‐2). The ELP and/or PEA/FN/BMP‐2 scaffolds do not demonstrate significant or consistent bone formation. In summary, Laponite/BMP‐2 coated PCL‐TMA900 scaffolds offer a biodegradable, osteogenic construct for bone augmentation with potential for development into a large scale polymer scaffold for clinical translation. [ABSTRACT FROM AUTHOR]

Introduction Cervical Spondylodiscitis (CSD) is a serious medical condition that includes spondylitis, discitis, or both. CSD is a dilemma in spine surgery regarding the diagnosis and treatment. Major long-term morbidities or even fatalities may result from any delay in the diagnosis or treatment of the condition. This work is an account of our Institution's experience in the handling of severe and challenging situations. Methods: The current study retrospectively evaluated 15 patients who were diagnosed with primary CSD and were managed between May 2018 and July 2021, by single-stage surgical procedure (debridement, anterior corpectomy, and plate fixation with titanium cage with autogenous bone graft) in Zagazig University Hospitals, Zagazig, Egypt. With a minimum of 2 years follow-up (mean 27.4 ±3.9) months, Assessments included preoperative criteria (risk factors, affected levels, symptoms, and signs) and postoperative radiologic and clinical outcomes; VAS (Visual Analogue Scale) and ASIA (American Spinal Injury Association) impairment scale. Results: CSD in all the patients was eradicated, and their infection lab tests normalized with no recurrence by the end of the follow-up period. The fusion was achieved in 14 out of 15 patients (93.3%) in the meantime (5.6 ± 2.3SD) months, implant failure and subsequent kyphotic deformity occurred in one patient (6.6%) developed 6 months postoperative. The preoperative mean VAS (8.3 ± 0.88) decreased to a mean of (2.8 ±2) postoperatively, (P value < .001, degree of freedom DF=14). Neurological impairment was observed in 10 participants among whom 7 improved postoperatively (improvement rate was 70%). ASIA scale; improved in 7 patients (46.7%) (p=0.003, DF=14), showed no change in 8 (53.3%), and there was no worsened ASIA scale in any participant postoperative. Conclusions: Single Stage Surgical Management of primary Cervical Spondylodiscitis was successful in infection eradication with no recurrence, achieving a favorable fusion rate, realizing satisfactory VAS and ASIA results, with low overall complications. [ABSTRACT FROM AUTHOR]

It was assumed that only autogenous bone had appropriate osteoconductive and osteoindutive properties for bone regeneration, but this assumption has been challenged. Many studies have shown that synthetic biomaterials must be considered as the best choice for guided bone regeneration. The objective of this work is to compare the performances of nanohydroxyapatite/β-tricalcium phosphate (n-HA/β-TCP) composite and autogenous bone grafting in bone regeneration applications. The composite was characterized by scanning electron microscopy (SEM) and used as an allograft in bone defects formed in adult Wistar rats. The bone defects in the dorsal cranium were grafted with autogenous bone on one side and the n-HA/β-TCP composite on the other. Histomorphometry evaluation via different staining methods (Goldner trichrome, PAS, and Sirius red) and TRAP histochemistry were performed. Immunohistomorphometries of OPN, Cathepsin K, TRAP, acid phosphatase, VEGF, NFκ-β, MMP-2, MMP-9, and TGF-β were carried out. The RT-PCR method was also applied to to RANK-L, Osteocalcine, Alcaline Phosphatase, Osterix, and Runx2. The results showed that for all morphometric evaluations with the different staining methods, histochemistry, and immunohistochemistry, VEGF and NFκ-β were higher in the n-HA/β-TCP composite group than in the autogenous bone graft group. The RT-PCR markers were higher in the autogenous bone group than in the n-HA/β-TCP composite group. The n-HA/β-TCP composite exhibited enhanced cell–matrix interactions in bone remodeling, higher adhesion, proliferation, and differentiation, and increased vascularization. These results suggest that the n-HA/β-TCP composite induces faster bone formation than autogenous bone grafting. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the effects of bony increased offset (BIO) and metallic augments (MAs) on primary reverse shoulder arthroplasty (RSA) baseplate stability in cadaveric specimens with variable bone densities. Methods: Thirty cadaveric specimens were analyzed in an imaging and biomechanical investigation. Computed tomography (CT) scans allowed for preoperative RSA planning and bone density analysis. Three correction methods of the glenoid were used: (1) corrective reaming with a standard baseplate, which served as the reference group (n = 10); (2) MA-RSA (n = 10); and (3) angled BIO-RSA (n = 10). Each augment group consisted of 10° (n = 5) and 20° (n = 5) corrections. Biomechanical testing included cyclic loading in an articulating setup, with optical pre- and post-cyclic micromotion measurements in a rocking horse setup. Results: There were no differences in bone density between groups based on CT scans (p > 0.126). The BIO-RSA group had higher variability in micromotion compared to the MA-RSA and reference groups (p = 0.013), and increased total micromotion compared to the reference group (p = 0.039). Both augmentations using 20° corrections had increased variance in rotational stability compared to the reference group (p = 0.043). Micromotion correlated with the subchondral bone density in the BIO-RSA group (r = −0.63, p = 0.036), but not in the MA-RSA (p > 0.178) or reference (p > 0.117) groups. Conclusions: Time-zero baseplate implant fixation is more variable with BIO-RSA and correlates with bone density. Corrections of 20° with either augmentation approach increase variability in rotational micromotion. The preoperative quantification of bone density may be useful before utilizing 20° of correction, especially when adding a bone graft in BIO-RSAs. [ABSTRACT FROM AUTHOR]

With the implementation of bone substitute materials, regeneration strategies have inevitably evolved over the years. Histomorphometry is the optimal means of quantitative evaluation of bone structure and morphology. This systematic review focuses on determining study models, staining methods and histomorphometric parameters used for bone regeneration research on non-decalcified plastic-embedded specimens over the last 10 years. After being subjected to the inclusion and exclusion criteria, 118 studies were included in this review. The results establish the most commonly selected animal model is rat, followed by rabbit, sheep and dog. Strong preference for staining samples with toluidine blue was noted. With regard to histomorphometric parameters, terms related to bone were most frequently assessed, amounting to almost half of recorded parameters. New bone formation was the main descriptor of this category. Residual bone graft and non-bone tissue parameters were also often evaluated. With regard to dynamic histomorphometry, mineral apposition rate (MAR) was the parameter of choice for most researchers, with calcein green being the preferred dye for fluorochrome labelling. An overview of the contemporary literature, as well as weaknesses in the current research protocols have been discussed. [ABSTRACT FROM AUTHOR]

Objective: Assess whether horizontal ridge augmentation with guided bone regeneration (GBR) using deproteinized bovine bone mineral (DBBM), autologous bone, and a resorbable collagen membrane supports successful implant placement. Materials and Methods: This open, prospective, single‐cohort, multicenter clinical study included patients with ridge defects that required GBR prior to implant insertion. The primary endpoint was radiologically assessed bone gain after 8 months post‐GBR, measured at the center of planned implant sites. Secondary endpoints included implant survival and success, marginal bone levels (MBLs), MBL changes, and soft tissue health. Results: Of 45 patients evaluated 8 months post‐GBR, nine experienced dehiscence in the first 3 weeks of the healing period. GBR led to radiologically determined mean bone width gain of 4.0 ± 1.5 mm and 4.8 ± 1.7 mm, measured 1 and 3 mm from the top of the crest, respectively, allowing successful implant placement in 44 patients (97.8%). The cumulative implant survival and success rates were 98.9% and 95.5%, respectively. MBLs were stable: −1.18 ± 0.64 mm at definitive prosthesis placement (DPP) and − 1.07 ± 0.74 mm at 1 year. Soft tissue health and esthetics (plaque and bleeding indices, papilla, keratinized mucosa, and pink esthetic score) improved from DPP to 1 year. Patients were highly satisfied with implant function and esthetics, and their oral health‐related quality of life improved. Conclusions: GBR using DBBM and a collagen membrane offered a safe and effective treatment option for horizontal ridge augmentation sufficient to support implant‐based tooth rehabilitation. Trial Registration: Registered at ClinicalTrials.gov NCT03028922 (registrations sites, as above listed affiliations, first posted January 23, 2017) [ABSTRACT FROM AUTHOR]

Aim: To assess the feasibility of immediate (IIP), early (EIP) and delayed implant placement (DIP) for single tooth replacement in the premaxilla on the basis of the complete indication area of each approach in routine practice. Materials and Methods: Data from 100 patients (59 women, 41 men, all Caucasians) aged between 19 and 81 years old (mean age 51.71) who had been consecutively treated with a single implant in the premaxilla (13–23) in one private periodontal practice were retrospectively collected. Demographic data, diagnostic information and linear measurements were extracted from patient files and CBCTs. The feasibility of IIP, EIP and DIP was assessed for all cases by both authors, based on the following criteria: availability of apical bone, position of the tooth in relation to the morphology of the alveolar process, buccal bone morphology and presence of midfacial recession. The reasons for not being able to perform an approach, and the viable alternatives for each approach were secondary outcomes. DIP was considered to have been preceded by alveolar ridge preservation (ARP). Results: Ninety‐two patients could be treated by means of IIP, EIP or DIP. In eight patients none of these approaches were possible as they required bone augmentation prior to implant placement. Fifty‐two patients (95% CI: 42%–62%) could by treated with IIP, 58 (95% CI: 48%–67%) with EIP and 88 (95% CI: 80%–93%) with DIP. The feasibility proportions of IIP and EIP were significantly lower than the one of DIP (p < 0.001). All patients who could be treated with IIP could also be treated with EIP or DIP. Lack of apical bone for implant anchorage was the main reason for not being able to perform IIP and EIP. Complete loss of the buccal bone wall and the need for bone augmentation prior to implant placement were the reasons for not being able to perform DIP. Conclusion: From the results of this retrospective CBCT analysis, DIP is nearly always possible in contrast to IIP and EIP. Therefore, and since it is much easier than IIP and EIP, inexperienced clinicians should mainly focus on ARP and DIP in clinical practice deferring IIP and EIP until more surgical skills have been acquired. [ABSTRACT FROM AUTHOR]

Bone defect is a common clinical orthopedic disease. The trend in this field is to develop tissue engineering scaffolds with appropriately designed components and structures for bone repair. Herein, inspired by the organic and inorganic components of bone matrix and the natural biomineralization mechanism, a MgSiO3@Fe3O4 nanoparticle composite polycaprolactone (PCL) hybrid mineralized scaffold for bone repair is developed by microfluidic 3D printing. The incorporation of MgSiO3@Fe3O4 within the PCL scaffold can effectively improve the bioactivity. In addition, a biomimetic mineralized layer is prepared on the surface of the scaffold, which endowed it with unique microstructural characteristics, enhanced cell adhesion and osteogenic activity, and thus improved the bone repair performance. Owing to these advantages, both in vivo and in vitro experiments have demonstrated that the designed scaffold has outstanding biocompatibility and bone repair performance. These features indicate that the organic–inorganic biomineralized hybrid scaffold can be a potential bone graft substitute for clinical bone repair. [ABSTRACT FROM AUTHOR]

Background: The aim of our study is to establish whether the bone graft harvested and stored in the surgical wound by our novel technique is safe, reproducible and preserves the viability of the graft. In doing so, it promises successful bony fusion in spine and orthopaedic surgeries. Methods: A prospective clinical case series was conducted for autogenous bone graft storage in complex spine surgeries requiring staged procedures, in resource constrained settings. The bone graft harvested was morselized, wrapped in moist sterile gauze and stored in the paraspinal gutter within the operative site. Thereafter, the surgical wound was easily closed without tension. During the second stage surgery, the stored bone was retrieved and mixed with more autologous/allogenic bone (if necessary) and appropriately laid at fusion sites. Bacterial samples were sent before implantation. Results: 16 complex spinal deformity patients who underwent surgery in a resource constrained hospital over a period of 5 years were included. Duration between both stages was within 2 weeks. All patients showed successful fusion, with mean follow-up of 2.6 years. There were no cases of deep or systemic infection in our series. Surgeons found harvesting, storing and retrieval of graft to be straightforward. Conclusion: The operative site provides an ideal, safe and reproducible location for bone graft storage for staged surgeries conducted in resource constrained situations. The osteogenic potential of the autogenous bone graft is retained. This technique can be extrapolated to other orthopaedic surgeries conducted under resource limited environments like in surgical camps or combat medical facilities. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Introduction: Although sesamoid-preserving procedures have been attempted to complement sesamoidectomy for hallux sesamoid fracture nonunion, few reports document the results. Accordingly, the objective of this study was to review the outcomes of patients with hallux sesamoid fracture nonunion who underwent screw fixation with autogenous bone grafting. Materials and methods: Medical records of patients who underwent surgery between January 2013 and September 2022 were reviewed. Outcomes were assessed using the foot function index (FFI) and the visual analog scale (VAS) for pain. Fracture union was assessed using plain radiographs and computed tomography scans. Results: Ten patients (4 males and 6 females) were enrolled. The mean age was 39.4 years (standard deviation [SD], 14.0), and the mean follow-up duration was 23.4 months (SD, 14.5). The FFI score improved from 72.3 (SD, 8.7) preoperatively to 8.2 (SD, 10.7) 12 months postoperatively and to 6.6 (SD, 8.3) at the final follow-up (p < 0.01, respectively). The VAS score improved from 67.8 (SD, 13.5) preoperatively to 2.2 (SD, 3.8) 12 months postoperatively, finally improving to 3.6 (SD, 4.8) at the final follow-up (p < 0.01, respectively). Union was achieved in all patients 3 months postoperatively. Although no complications were observed, hardware removal was performed in two patients owing to discomfort and psychological anxiety. Conclusion: Given that the symptoms improved in all patients without complications, as observed in this study, screw fixation with autogenous bone grafting appears to be a viable option for treating hallux sesamoid fracture nonunion. [ABSTRACT FROM AUTHOR]