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Актуальность. В структуре всех переломов скелета человека переломы пяточной кости составляют от 2,0 до 5,7 %, в структуре переломов костей стопы — до 40–60 %, они преобладают среди физически активных лиц трудоспособного возраста. Интраартикулярными переломы пяточной кости являются в 75–92 % случаев, носят импрессионный характер и могут быть предпосылкой развития посттравматического деформирующего остеоартроза суставов заднего отдела стопы. Сохраняется высокий процент неудовлетворительных результатов лечения — 13,0–27,3 %. Цель: исследовать и проанализировать результаты хирургического лечения внутрисуставных импрессионных переломов пяточной кости с применением аутокости и биокомпозита керамического материала игольчатой структуры на основе β-трикальцийфосфата в составе гранул биомин ГТ mix. Материалы и методы. В исследовании приняли участие 47 больных с внутрисуставными импрессионными переломами 50 пяточных костей, лечившихся оперативным путем на клинических базах кафедры общей хирургии и травматологии-ортопедии Ужгородского национального университета в период 2014–2018 гг. 10 пациентам проводили открытую репозицию в сочетании с опорной остеопластикой аутотрансплантатом с гребня крыла подвздошной кости, 37 больным — с остеопластикой биомином ГТ mix. Результаты. Результаты хирургического лечения были изучены в сроки 3, 6, 12 и 18 месяцев, оценены в соответствии со шкалой American Orthopedic Foot and Ankle Society Ankle Hindfoot Score. В 18 месяцев отличные результаты достигнуты у 11 пациентов, хорошие — у 18, удовлетворительные — у 10, неудовлетворительные — у 4 человек. Выводы. Опорная остеопластика биомином ГТ mix наравне с применением аутокости является эффективным способом костной пластики при хирургическом лечении внутрисуставных импрессионных переломов пяточной кости.

Background: Platelet-rich fibrin (PRF) is the second-generation platelet concentrate first described by Choukron et al. It incorporates leukocytes, platelets, and growth factors within dense fibrin matrix, can be used in periodontal regeneration alone or in combination with bone grafts. Aim: This study assesses bone fill in intrabony defects, following the use of β tricalcium phosphate (TCP) bone graft with and without PRF. Materials and Methods: Thirty sites with intrabony defects in periodontitis patients were selected, randomly allotted into three groups: Group A open flap debridement (OFD), Group B OFD with β TCP with PRF, and Group C β TCP. Clinical parameters such as plaque index, gingival index, sulcus bleeding index, and PPD recorded at baseline and 6 months. Radiographic parameters include cementoenamel junction (CEJ) to base of defect, CEJ to alveolar crest, depth of defect, and bone fill assessed using the cone-beam computed tomography (CBCT). The comparison between the test group and control group in terms of clinical and radiographical parameters was assessed using the independent sample t-test. Results: Significant reduction in probing depth measurements, defect fill observed in both β TCP with PRF and β TCP alone groups compared to OFD. However, intergroup comparison assessed using the independent sample t-test found to be statistically nonsignificant (P < 0.05 is considered significant). Conclusion: All three treatment strategies resulted in significant reduction in probing depth and bone fill at 6 months. Bone fill achieved in β TCP with PRF was more compared to β TCP alone and OFD at 6 months follow-up. CBCT can be accurately used to assess the morphology of intrabony defect and also in evaluating bone fill.

Introduction: Unidirectional porous β-tricalcium phosphate (UDPTCP) consists of a novel porous artificial bone that is structurally different from conventional artificial bone comprised of spherical porous β-tricalcium phosphate (SPTCP). Case presentation: We present our first four clinical cases of opening-wedge high tibial osteotomy (OWHTO) using UDPTCP and SPTCP together. The patients’ mean age was 54.5 ± 5.9 years, and the mean observation period was 20.8 ± 2.8 months. In OWHTO, two wedge shaped pieces of UDPTCP and SPTCP were cut to fit the gap and implanted parallel to each other in the anterior and posterior parts, respectively. We evaluated the correction loss and bone remodeling for UDPTCP and SPTCP over time using radiography and computed tomography, and evaluated the clinical outcomes. Conclusion: There was no correction loss reported in any case, and early bone remodeling was observed with UDPTCP. All patients achieved satisfactory clinical results with no adverse events.

In this study we compared the bone remodeling of unidirectional (UDPTCP) and spherical porous β-tricalcium phosphate (SPTCP) radiologically in humans. We performed a retrospective analysis of the data of 14 patients (sex, nine men and five women; age, 37–70 years) who underwent medial opening-wedge high tibial osteotomy (MOWHTO) and were followed up for 12 months after surgery. Two wedge-shaped β-TCPs (one UDPTCP and one SPTCP) were cut and placed parallel to each other in the gap. In Group A (eight knees), UDPTCP was implanted anteriorly and SPTCP posteriorly, while in Group B (six knees), SPTCP was implanted anteriorly and UDPTCP posteriorly. Computed tomography (CT) was performed at 1 week, 6 months, and 12 months after surgery, with the CT attenuation values calculated for UDPTCP and SPTCP. In Groups A and B, the CT attenuation values for UDPTCP were significantly lower at 6 and 12 months after surgery compared to those at 1 week (P

Reducing the viscosity of high solid-loading ceramic suspensions and controlling the resolution of ceramic green parts produced by digital light processing (DLP) 3D printing are two important concerns in the ceramic additive manufacturing industry. The presence of ceramic particles within a photopolymerizable system leads to light scattering that reduces the resolution of the ceramic green scaffolds. This study introduced a graphite additive to solve these problems and focused on the effects of graphite concentration on the viscosity, curing behaviour and scaffold fabrication of β-TCP ceramic suspensions. As a result, it was found that an appropriate addition of graphite reduced the viscosity of the ceramic suspensions, and the light scattering decreased with the increase of graphite concentration. Both the cure depth (Cd) and excess width (Cex) also decreased with the increase of graphite concentration. But, graphite has a larger effect on the width curing than depth curing.

Introducction This research aimed to investigate the effect of antibacterial suspension containing TCP-β and nanosilver on these pathogens. Material and methods : Suspension containing concentrations of 4%, 2%, 1% and 0.1% was prepared with tricalcium phosphate and nanosilver. Two control suspensions for pure nanosilver and pure β-TCP were also prepared. The antibacterial activity of this suspension was investigated on two groups of bacteria, namely, P. intermedia and Aa in thioglycolate broth environment. Subsequently, the MIC was measured for each bacterium. Results The suspension containing β-TCP and nanosilver produced an antibacterial effect on P. intermedia and Aa. The effect of this solution on P. intermedia was greater than that on A. actinomycetemcomitans. Moreover, the MICs (mg/mL) for P. intermedia and A. actinomycetemcomitans were 1% and 0.1%, respectively. Conclusion Based on the results of this study adding nanosilver particles to β-TCP resulted in the antibacterial property of this substance. Specifically, reduced the growth rate of Aa and P. intermedia. Nanosilver can be used to reduce the risk of infection during or after regenerative surgery.

BACKGROUND β-Tricalcium phosphate (β-TCP) is one of the most common synthetic bone grafting materials utilized in craniofacial reconstruction; however, it is limited by a slow degradation rate. The aim of this study was to leverage 3-dimensional (3D) printing in an effort to accelerate the degradation kinetics of β-TCP. METHODS Twenty-two 1-month-old New Zealand white rabbits underwent creation of calvarial and alveolar defects, repaired with 3D-printed β-TCP scaffolds coated with 1000 μM of osteogenic agent dipyridamole. Rabbits were euthanized after 2, 6, and 18 months after surgical intervention. Bone regeneration, scaffold degradation, and bone mechanical properties were quantified. RESULTS Histological analysis confirmed the generation of vascularized and organized bone. Microcomputed tomography analysis from 2 to 18 months demonstrated decreased scaffold volume within calvarial (23.6% ± 2.5%, 5.1% ± 2.2%; P < 0.001) and alveolar (21.5% ± 2.2%, 0.2% ± 1.9%; P < 0.001) defects, with degradation rates of 54.6%/year and 90.5%/year, respectively. Scaffold-inducted bone generation within the defect was volumetrically similar to native bone in the calvarium (55.7% ± 6.9% vs 46.7% ± 6.8%; P = 0.064) and alveolus (31.4% ± 7.1% vs 33.8% ± 3.7%; P = 0.337). Mechanical properties between regenerated and native bone were similar. CONCLUSIONS Our study demonstrates an improved degradation profile and replacement of absorbed β-TCP with vascularized, organized bone through 3D printing and addition of an osteogenic agent. This novel additive manufacturing and tissue engineering protocol has implications to the future of craniofacial skeletal reconstruction as a safe and efficacious bone tissue engineering method.

Purpose Autografts, the gold standard treatment for large bone defects, present complications, especially in conditions with reduced bone-repair capacity, such as osteoporosis. Escherichia coli-derived recombinant human bone morphogenesis protein-2 (ErhBMP-2), was used in this study to improve the osteoinductivity of β-tricalcium phosphate (β-TCP). This study evaluated the bone-repair capacity of ErhBMP-2-loaded β-TCP on osteoporosis rabbit model, relative to the sole use of autograft and β-TCP treatments. Methods The osteoporosis rabbit model was induced through ovariectomy and glucocorticoid dosing; 2-cm segmental ulnar defects were created, which were treated with either autograft, β-TCP alone, or ErhBMP-2-loaded β-TCP or left untreated. The quality of newly formed ulnae was evaluated 8 weeks after ulnar surgery through micro-CT, biomechanical, histological, and histomorphometric assessments. Results The osteoporosis rabbit model was developed and maintained till the end of the study. The maximal load and stiffness in the ErhBMP-2-loaded TCP group were significantly higher than those in the autograft group, whereas the TCP-alone group performed similarly as did the untreated group in the force loading and stiffness tests. According to the micro-CT evaluation, the ErhBMP-2-loaded TCP group had significantly higher bone volume relative to the autograft and TCP-alone groups. Histological assessments revealed better defect bridging and marrow formation in the ErhBMP-2-loaded TCP group relative to the TCP-alone group. Mineral apposition rates were significantly higher in the ErhBMP-2-loaded TCP and autograft groups than in the TCP-alone and untreated groups. Conclusion Relative to autografts, ErhBMP-2-loaded TCP, as an alternative grafting material, provides better or comparable healing on critical-sized long bone defects in the osteoporosis rabbit model., Graphical abstract Unlabelled Image, Highlights • Erh-BMP-2 promoted the bone healing ability of β-TCP in osteoporosis animal model. • New bone generated by Erh-BMP-2-loaded β-TCP was stiffer than that generated by autograft. • ErhBMP-2-loaded TCP potentially being an alternative grafting material relative to autograft.

Lateral lumbar interbody fusion (LLIF) often requires the use of allograft or artificial bone. We used β-tricalcium phosphate artificial bone with a porosity of 57% consisting of a novel unidirectional porous structure (Affinos®) in patients (5 male and 9 female) who underwent LLIF from August 2015 as a substitute for autologous bone. We evaluated 60 graft windows in the cages at 30 intervertebral levels. To evaluate interbody bony fusion, CT multi-planar reconstruction coronal and sagittal images obtained 1 year after surgery were assessed. Intra-cage bony fusion was observed in 39 of 60 graft windows and so total bony fusion rate was 65%. Intra-cage bony fusion was confirmed in 17 of 29 (58.6%) graft windows with autologous bone and 22 of 31 (70.9%) graft windows with Affinos®. There was no significant difference in the rate of bony fusion between autologous bone and Affinos® (p = 0.418). In conclusion, the rate of bony fusion using Affinos® in LLIF cages was not inferior to that using autologous bone graft. Affinos® is a candidate for graft material in LLIF surgery and further exploration is warranted.

When teeth have responded poorly to conventional endodontic treatment or when they cannot be treated adequately by nonsurgical means, surgical endodontics remains the treatment of choice. Healing of apical lesions occurs by repair, most of the time. “Repair is the healing of a wound by tissue that does not fully restore the architecture or function of the affected unit”. Since this is not ideal, newer regenerative procedures that aim to restore lost tissue have been introduced. β ‑Tricalcium phosphate is an alloplastic bone graft material that forms a scaffold for closing the bony defect. It is osteoconductive. Platelet‑rich plasma (PRP) and platelet‑rich fibrin (PRF) are platelet concentrates, rich in growth factors and they promote regeneration by osteoinduction. This article describes cases of bone augmentation with a combination of PRP + β ‑TCP and PRF + β ‑TCP fortreatment of the chronic periapical lesion. The cases were followed for six months and one year and healing was evaluated quantitatively using cone beam computed tomography. Keywords: β ‑Tricalcium phosphate, cone beam computed tomography, platelet‑rich plasma, platelet‑rich fibrin

The study was conducted on 19 adult dogs referred for treatment of fracture in diaphyseal region of three long bones, viz, radius-ulna, femur and tibia-fibula. These dogs were divided randomly into three groups viz T1, T2 and T3. In group T1, the diaphyseal fractures of the long bones were immobilized by an internal fixation technique using reconstruction plate or locking compression plate. In group T2, β-tri calcium phosphate granules were incorporated at fracture site after fixation. In group T3, one milliliter of PRP was administered locally at fracture site just before the closing the first suture line. Clinical and radiographic examination were also conducted during the study. There was a significant reduction in mean inflammation score at 7th day in groups T2 and T3 and at 30th day than 0 day in all the groups. At 90th day, the mean radiographic score was highest for group T3 and it was followed by the score in group T2. At day 90th, a radiograph in both the views was not able to delineate the granules from osseous tissue. The mean weight bearing score was also higher in group T3 than in group T2 at 30th, 60th and 90th post operative day showing that restoration of the function was better and earlier in groups T2 and T3 than in group T1.

Background: A new beta-tricalcium phosphate with unidirectional pore structure (UDPTCP), Affinos®(Kurray, Okayama, Japan), has been in clinical use since 2015. To date, there have been only a few clinical studies using this material. We report here the first clinical study for distal radial fracture in the elderly population treated with UDPTCP.Methods: Consecutive patients aged 65 years or older with dorsally displaced unstable fracture of the distal radius (n = 36) were treated operatively in our department. Following reduction of the fracture site, a 7 mm size cube of UDPTCP was placed in the gap of the bony defect and the fracture stabilized with mono-axial or poly-axial type locking plates and screws. Remodeling of the UDPTCP was evaluated by plain radiograph and clinical outcomes were also assessed.Results: UDPTCP was significantly resorbed at 2 months after surgery, both at the center and periphery of the material. Complications were only observed in the post-operative period. Significant correction loss of radial alignment was seen in patients stabilized with poly-axial locking plate. The clinical outcome in all cases was excellent.Conclusions: Block UDPTCP is a safe and convenient material for the treatment of distal radius fracture and is replaced within a suitable time period after grafting into the fracture site. UDPTCP and stable internal fixation is therefore a reliable strategy for restoring and preserving anatomical position, especially in the elderly population.

Background Anterior cervical discectomy and fusion (ACDF) is an alternative to conservative therapy in the treatment of cervical spondylopathy. This study evaluated the clinical outcome of ACDF with BMP-2-adsorbed β-tricalcium phosphate granules. Methods Thirty-two patients with cervical spondylopathy received treatment of ACDF with BMP-2-adsorbed β-tricalcium phosphate granules. The clinical outcomes were evaluated with the Japanese Orthopedic Association (JOA) scores and Neck Disability Index (NDI). Meanwhile, the cervical curvature and intervertebral heights were obtained through lateral cervical X-ray films pre- and postoperatively at each interval, and the precision of cervical fusion was assessed by three-dimensional computed tomography scan. Results The follow-up averaged 15.2 months (range 13–18). Average JOA scores significantly increased from a preoperative point (7.4 ± 1.2) to each interval after surgery (P < 0.05). NDI decreased from preoperative point (43.1 ± 9.0) to each interval after surgery (P < 0.05). The angles of cervical curvature and intervertebral heights were improved postoperatively and kept throughout the follow-up period. CT scan demonstrated a fusion rate of 82.9% at 6 months postoperatively and was improved to 100% at 12 months postoperatively. In all cases, no complications appeared and reported due to any lapse in surgical procedure skills throughout the follow-up period. Conclusions Our preliminary findings suggest that BMP-2-adsorbed β-tricalcium phosphate granules will be an effective alternative to autogenous bone grafting for cervical fusion in treating cervical spondylopathy. Our surgical procedure usingβ-tricalcium phosphate granules could improve neurological function, recover intervertebral height and cervical curvature, and could be potentially exploitable in the clinical setting.

The giant cell tumor of bone (GCTB) is a locally aggressive tumor. Reconstruction methods using β-tricalcium phosphate (β-TCP) blocks with strong compression resistance in and around the knee joint for GCTB have been reported. Among six cases of GCTB treated using this method, two recurrent cases revealed osteolysis, predominantly within the β-TCP block based on plain radiographs or computed tomography, while remodeled host bones were preserved. Implanted β-TCP blocks can function as a placeholder to preserve host bone in recurrent cases, leading to a higher probability of joint preservation.

INTRODUCTION The bioresorbable polymer poly(lactide-co-glycolic acid) (PLGA) coated β-tricalcium phosphate (β-TCP) (β-TCP/PLGA) bone substitute hardens into a stable and porous hard tissue scaffold when exposed to body fluids. Effectiveness of the novel alloplast has been examined in edentulous ridge preservation (ERP) following tooth extraction with subsequent early endosseous dental implant placement; however, it is not clear that the biomaterial is capable of maintaining the edentulous ridge volume to allow for late implant placement due to the rapid bioresorption property of β-TCP. The purpose of this case series is to determine if the β-TCP/PLGA bone substitute is a desirable material for ERP followed by late implant placement. CASE PRESENTATION Two patients were treated with ERP and prepared for future endosseous dental implant placement. The β-TCP/PLGA alloplast was placed in the extraction socket. The grafted site of one of the patients was covered by a bioresorbable membrane due to the critical loss of buccal plate. Endosseous dental implant fixtures were placed in both patients 10 months following ERP. Bone core specimens were taken at the time of endosseous dental implant fixture placement and were prepared for histologic assessment. The edentulous ridge volume was successfully maintained for dental implant placement in both cases. Histomorphometric analysis showed that the β-TCP/PLGA alloplast was replaced by newly formed bone with or without guided bone regeneration membrane placement, 54.1% and 34.6%, respectively. CONCLUSION The β-TCP/PLGA bone substitute exhibited effectiveness in edentulous ridge preservation followed by late endosseous dental implant placement.

PubMed: 29654774, 2-s2.0-85047920229, Purpose: To compare the volumetric changes in successfully treated clefts with secondary alveolar grafting using recombinant human bone morphogenic protein-2 (rhBMP-2) delivered in ?-tricalcium phosphate (?TCP) scaffold versus autogenous grafts obtained from the iliac crest and mandibular symphysis. Patients and Methods: We performed a retrospective cohort study of cone-beam computed tomography scans of 25 subjects with unilateral or bilateral clefts. Of the 25 patients, 7 received an iliac crest bone graft, 9 received a mandibular symphyseal bone graft, and 9 subjects received the rhBMP-2/?TCP bone substitute. Volumetric rendering software was used to calculate the amount of new bone formation and residual bone defect present in the cleft area. The data were analyzed using Wilcoxon and Kruskal-Wallis tests and Pearson's correlation coefficient. Results: The mean percentage of new bone formation for the iliac crest, symphysis, and rhBMP-2/?TCP was 85.47, 80.56, and 81.22%, respectively (P = .0854). The initial cleft volume had a weak positive correlation with the percentage of new bone formation (r = 0.18), but the postoperative residual cleft volume had a strong negative correlation (r = 0.71). Conclusions: rhBMP2 delivered in a ?TCP scaffold in alveolar cleft patients can be a viable alternative to autogenous iliac crest and symphysis grafts, eliminating donor site morbidity. © 2018 American Association of Oral and Maxillofacial Surgeons

Unidirectional porous β-tricalcium phosphate (UDPTCP; Affinos®, Kuraray, Tokyo, Japan) has been in clinical use since 2015. Animal studies have confirmed the excellent potential of UDPTCP with regard to bone formation and material absorption. We present the first three clinical cases using UDPTCP as a bone substitute after curettage of benign bone tumors of the hand. All three patients were males, 29-, 30- and 81-years-old, two having a diagnosis of enchondroma and the other, a bone ganglion, with a pathological fracture identified in one case. Over a mean follow-up of 10 months, all patients achieved satisfactory clinical result, with no adverse events of UDPTCP noted. Radiographic evidence of good bone formation and material absorption was observable over the postoperative course. UDPTCP provided satisfactory clinical results, with good biocompatibility and fast resorption characteristics. Therefore, UDPTCP could provide a safe and reliable filling substitute for bone defects following curettage of small bone tumors.

BACKGROUND: This study is performed to evaluate anchor-related outcomes and complications after arthroscopic rotator cuff repair using 30% β-tricalcium phosphate (β-TCP) with 70% poly lactic-co-glycolic acid (PLGA) biocomposite suture anchors.METHODS: A total of 78 patients (mean age, 61.3 ± 6.9 years) who underwent arthroscopic medium-to-large full-thickness rotator cuff tear repair were enrolled. The technique employed 30% β-TCP with 70% PLGA biocomposite suture anchors at the medial row (38 patients, Healix BRTM anchor [Healix group]; 40 patients, Fixone anchor B [Fixone group]). The radiologic outcomes (including perianchor cyst formation or bone substitution) and anatomical outcomes of the healing failure rate were evaluated using magnetic resonance imaging at least 6 months after surgery, the pain visual analogue scale at 3, 6 months, and final follow-up visit, and American Shoulder and Elbow Surgeons scores at least 1 year postoperatively. Anchor-related complications were also evaluated.RESULTS: The perianchor cyst formation incidence was similar for both groups (60.5%, Healix group; 60.0%, Fixone group; p=0.967), although severe perianchor cyst incidence was slightly lower in the Fixone group (15.0%) than in the Healix group (21.1%). There was no occurrence of anchor absorption and bone substitution. No differences were observed in the healing failure rate (13.2%, Healix group; 15.0%, Fixone group; p=0.815) and functional outcome between groups (all p>0.05). Anchor breakage occurred in 5 patients (2 Healix anchors and 3 Fixone anchors); however, there were no major anchor-related complications in either group.CONCLUSIONS: No differences were observed in the clinical outcomes of the Healix and Fixone groups, neither were there any accompanying major anchor-related complications.

Statement of the problem Craniofacial injuries often require resection of necrotic hard tissue. For large bone defects, autogenous bone grafting is ideal, but as is the case with all grafting procedures, is subject to limitations on quantity. Synthetic biomaterial driven three-dimensional (3D) printing technology of solid-free form fabrication (SFF) offers an alternative engineered healing approach. This research hypothesizes that a bioactive calcium-phosphate scaffold may successfully regenerate craniofacial bony defects in vivo, and that this newly formed bone will have mechanical properties similar to native bone as healing time elapses in vivo. The aim of this study was to leverage 3D printing of β-tricalcium phosphate (β-TCP), a common synthetic bone grafting material, to accelerate degradation kinetics of β-TCP while allowing for optimal bone regeneration/remodeling and bone mechanical properties. Materials and methods Twenty-two 1-month-old New Zealand White rabbits underwent creation of calvarial and alveolar defects, repaired with 3D-printed β-TCP scaffolds coated with 1,000 μM of osteogenic agent dipyridamole. Rabbits were euthanized after 2, 6, and 18 months post-surgical intervention. Bone regeneration, scaffold degradation, and bone mechanical properties were quantified. Results Histology analysis confirmed the generation of vascularized and organized bone. Micro CT analysis from 2 to 18 months, demonstrated decreased scaffold volume within calvarial (23.6% ±2.5%, 5.1%±2.2%; P Outcomes and conclusion This study demonstrates an improved degradation profile and replacement of absorbed β-TCP with vascularized, organized bone through 3D printing, and the addition of an osteogenic agent. This novel additive manufacturing and tissue-engineering protocol has implications for the future of craniofacial skeletal reconstruction as a safe and efficacious bone tissue-engineering method.

Objective: to compare the effects of natural hydroxyapatite and β-tricalcium phosphate (β-TCP) on the dynamics of changes in the mechanical properties of experimental defect of corti­cal bone. Methods: the experiment was performed on 48 white male rats. In the middle third of the femoral shaft reproduced perforated defect 2.5 mm in diameter to the medullary canal, which the animals of the 1st group filled osteoplastic materials «Cerabone®» (GA), and 2nd — «Сalc-i-oss®» (β-TCP). Fragments of the injured bone was investigated at 15, 30, 60, and 120 days by dynamic mikroindentition with the definition of micro-hard­ness and Young’s modulus of the field of implantation and osteo­plastic materials adjacent the parent bone. Results: it was found that on the 15th day experiment microhardness and Young modu­lus of the defect area was predominantly caused by mechanical properties of the implanted material in its cavity («Cerabone®», «Сalc-i-oss®») and significantly exceeded those of the parent bone parameters. In the future, micro-hardness and Young’s modulus of implantation «Calc-i-oss®» gradually decreased and at 60 days. experiment are smaller than the parent bone in, and on the 120thday. r ose a nd caught up with her p erfor­mance. Microhardness and Young’s modulus of implantation «Cerabone®» throughout the experiment remained unchanged and significantly exceeded the value obtained for the adjacent region and the parent bone implantation «Calc-i-oss®». Con­clusions: using the «Cerabone®» area of cortical bone defect becomes high and stable mechanical properties and osteo­plastic material «Calc-i-oss®» contributes to the full restora­tion of micro-hardness and rigidity of injury bathroom bones for 4 months.

While grafting with bone substitutes has been shown to provide greater stability in maxillary advancements, infection remains a concern with any material that is placed in close proximity to the maxillary sinus. The purpose of this study was to evaluate the prevalence of infection in maxillary advancements in which a bone graft substitute (β-tricalcium phosphate; β-TCP) was placed at the time of surgery. This was a retrospective study of all maxillary osteotomies. Patients were divided into two groups: group 1 included maxillary osteotomies in which β-TCP was not used; group 2 included any maxillary osteotomy where β-TCP was used. The prevalence of infection, slow healing, and need for second surgery due to infection or non union was noted. Fisher's exact test was used to compare differences between the groups. Records were adequate for 438 patients: group 1 included 297 patients, while group 2 included 141. No infections were noted in either group. In group 2, there was one patient who had delayed union/non-union requiring a second procedure. Statically, there was no significant difference between the two groups (P=0.3219). Based on the data obtained in this study, the use of β-TCP does not increase the incidence of infection or complications when used in Le Fort I maxillary osteotomy.

Objective: To treat vertebral fractures with posterior wall injury in the elderly, vertebral bone grafting is generally performed through a posterior transpedicular approach, combined with pedicle screw fixation. An autologous bone is ideal to treat this disorder. However, harvesting autologous bones from the elderly with osteoporosis is limited by the amount and quality of available autologous bone. Thus, we developed a bone-grafting substitute. The newly developed unidirectional porous β-tricalcium phosphate, with a porosity of 57% (UDPTCP; Affinos®, Kuraray Co., Ltd., Tokyo, Japan), is used in the bone-grafting procedure. This is the first report of UDPTCP used as an artificial bone graft in patients with an acute vertebral burst fracture. Materials and Methods: UDPTCP (mean: 4.2 g) was implanted through the pedicle, and posterior instrumentation was achieved with pedicle screws in five elderly patients. Resorption of UDPTCP and substitution with the autologous bone were evaluated on computed tomography (CT) and plain X-ray performed immediately and at 3, 6, and 12 months after the operation. Results: In case 1, the pedicle screws did not loosen, and UDPTCP was completely resorbed and replaced with the autologous bone at 3 postoperative months. In the other four cases, although the pedicle screws or the caudal part loosened because of osteoporosis, resorption of UDPTCP was observed at 3 postoperative months. At 6 postoperative months, progressive substitution with the autologous bone was confirmed, and at 12 postoperative months, formation of the good autologous bone was confirmed. Conclusion: This preliminary case series demonstrated that the newly developed UDPTCP shows good clinical potential as a bone-graft substitute for acute vertebral burst fractures in the elderly, including patients with osteoporosis.

We report a case of an acetabular fracture treated using a unidirectional porous β-tricalcium phosphate artificial bone (Affinos®) to surgically repair bone defects. An 82-year-old man sustained an acetabular fracture on the left side and presented with shock on arrival along with impaired vital signs and systolic blood pressure. Upon stabilization, we performed an open reduction and internal fixation. However, there were significant bone defects, which were then fixed using Affinos® (both blocks and granules), an artificial β-tricalcium phosphate bone with a porosity of 57% (pore size: 25–300 μm), characterized by a novel unidirectional porous structure. By 18 months postoperatively, the patient was able to perform stair climbing and absorption and bone fusion around the artificial bone were observed. Affinos® has a frost-like structure, which endows it with good tissue-invasive properties because of the capillary effect. Moreover, it has excellent osteoconduction capability. In this case, both Affinos® blocks and granules showed good affinity, absorption, and bone substitution. Further prospective studies are required to confirm our findings.

Limb-sparing surgery is one of the surgical options for dogs with distal radial osteosarcoma (OSA). This case report highlights the novel application of a three-dimensional (3D)-printed patient-specific polycaprolactone/β-tricalcium phosphate (PCL/β-TCP) scaffold in limb-sparing surgery in a dog with distal radial OSA. The outcomes evaluated included postoperative gait analysis, complications, local recurrence of tumor, metastasis, and survival time. Post-operative gait evaluation showed significant improvement in limb function, including increased weight distribution and decreased asymmetry. The implant remained well in place and increased bone opacity was observed between the host bone and the scaffold. There was no complication due to scaffold or surgery. Significant improvement in limb function and quality of life was noted postoperatively. Local recurrence and pulmonary metastasis were identified at 8 weeks postoperatively. The survival time from diagnosis of OSA to death was 190 days. The PCL/β-TCP scaffold may be an effective alternative to cortical allograft in limb-sparing surgery for bone tumors.

Objective To determine the efficacy of a newly developed scaffold (col/β-TCP) in a preclinical rat model as compared with the gold standard treatment (autograft) and control scaffolds (PLLA/PCL). Design Fifty-six Sprague-Dawley rats were randomized into four experimental groups, and critical-sized alveolar defects (7 × 4 × 3 mm) were created in each animal. Group A was the blank defect group, group B received autograft, group C received col/β-TCP scaffolds, and group D received PLLA/PCL blend scaffolds to fill the bone defects. New bone formation was assessed radiomorphometrically, histomorphometrically, and molecular-biologically at 1 and 4 months following surgery. Results Radiomorphometrically, the best new bone volume rate at 1 month (43.7%) and 4 months (45.4%) was observed in the autograft group, and the difference was significantly higher than in the other three groups ( P ≤ .005, P ≤ .001, P ≤ .001 for 1 month and P = .004, P ≤ .001, P ≤ .001 for 4 months). Even though the new bone volume rate in the col/β-TCP group (21.5%) was higher than that of the PLLA/PCL group (18.2%), the difference was not significant ( P = .08). Molecular-genetic analysis revealed significantly higher BSP and ALP gene expression levels in the autograft and col/β-TCP groups than in the blank defect group ( P = .002 and P = .004). Conclusion The engineered tissue scaffolds described herein have great potential as an alternative treatment option when cost, donor region morbidity, and duration of hospitalization are considered.

Introdução: As fraturas proximais do úmero são cada vez mais frequentes, com maior tendência para o seu tratamento cirúrgico, predominado a utilização da osteossíntese com placa e parafusos bloqueados. Pela falência mecânica e biológica, apesar da evolução deste tipo de implantes, a utilização de enxertos ósseos sintéticos passaram a ser uma opção.Material e Métodos: Num período de 96 meses, avaliámos os doentes com fraturas proximais do úmero, tratados cirurgicamente com placa e parafusos bloqueados e nos quais foi usado enxerto ósseo sintético de fosfato β-tricálcico. Avaliaram-se os resultados funcionais pelo arco de mobilidade e pelos exames radiográficos.Resultados: Nos 19 doentes avaliados, para um follow-up médio de 53 meses, obteve-se um arco de mobilidade com valores médio de abdução de 140º, flexão anterior de 142º, rotação externa de 37º e rotação interna com mão a L3, para um ângulo cefalo-diafisário de 136º.Discussão: A utilização de enxerto ósseo sintético de fosfato β-tricálcico permite a estabilização da redução após fixação das fraturas proximais do úmero estabilizadas com placa e parafusos bloqueados. Esta redução que se traduz na manutenção do ângulo cefalodiafisário, permite a obtenção de bons resultados funcionais como o demonstra o arco de mobilidade nos vários planos.Conclusão: O enxerto ósseo sintético de fosfato β-tricálcico deverá ser encarado como uma terapêutica auxiliar na osteossíntese extramedular das fraturas proximais do úmero, principalmente naquelas com maior dificuldade de manutenção da redução pela maior cominução do calcar medial.

The objective of this study was to evaluate the effect of following combined treatment with parathyroid hormone (1-34) (PTH) and β-tricalcium phosphate (β-TCP) on local bone formation in a rat 3-mm critical-sized defect at the distal femur. Fourteen weeks were allowed to pass before defect surgery for the establishment of osteopenic animal models chronically fed a low-protein diet. All animals were randomly divided into four groups: group PTH; group β-TCP, group PTH + β-TCP, and a control group. All rats then underwent a surgical procedure to create bone defects in the bilateral distal femurs, and β-TCP was implanted into critical-sized defects for the groups designated as β-TCP and group PTH + β-TCP. After the defect operation, all animals from group PTH and group PTH + β-TCP received following subcutaneous injections with PTH (60 μg/kg, three times per week) until euthanasia at 4 and 8 weeks. The distal femurs and blood were collected for evaluation. The results of study showed the strongest effect on accelerating the local bone formation with treatment β-TCP and PTH at 4 weeks and 8 weeks. The results from our study demonstrate that a combination of PTH and β-TCP had an additive effect on local bone formation in osteopenic rats chronically fed a low-protein diet.

Giant cell tumor of bone (GCTB) is a locally aggressive tumor, commonly occurs in the long bones, and is rare in the talus and the foot. The talus is a weight-bearing bone and strut reconstruction is preferred. Reconstruction with low porosity β-tricalcium phosphate (β-TCP) blocks is reported for GCTB in the knee. In the current report, a 25-year-old female suffered from GCTB in the talus extending to the subchondral bone. The tumor was treated by curettage and the bone was reconstructed with low porosity β-TCP blocks, which have strong compressive strength. The implanted β-TCP blocks were incorporated successfully. The current reconstruction method can be applied for GCTB in the talus.

Bone grafting is frequently performed in orthopedic surgeries. Artificial bone is a common grafting material. We have developed an absorbable material for bone regeneration with a unique structure: unidirectional porous β-tricalcium phosphate (AffinosⓇ; Kuraray Co., Ltd., Tokyo, Japan). The most distinctive feature of this material is the ease with which blood can rapidly reach its depths by capillary action due to the unidirectional porous structure. It is also characterized by the presence of micropores, which are known to be beneficial for osteoconductivity both on the surface and inside the material. Favorable artificial bone absorption and regeneration with natural bone were observed in cases of clinical bone graft applications in the spine, extremities, benign bone tumor, trauma, and donor sites. Affinos is useful as a novel absorbable material for bone regeneration in various orthopedic surgeries.

Treacher Collins syndrome (TCS) is a rare, serious congenital malformation that mainly affects craniofacial structures, and the incidence of this syndrome is one in every 50 000 births. Craniofacial rehabilitation in patients with TCS generally includes zygomatic-orbital and maxillomandibular reconstruction. This article describes a case of TCS in which zygomatic-orbital reconstruction was performed with a third-generation, biphasic, micro–macro porous bioceramic composed of hydroxyapatite and beta-tricalcium phosphate. This method proved to be a viable alternative to autogenous grafts and led to a satisfactory aesthetic outcome.

Implants of microporous β-tricalcium phosphate (β-TCP) were developed for primarily stable supply of bone defects. A consistent stability over the healing period should be retained in sheep. β-TCP cylindrical shaped implants, with 7 mm diameter, 25 mm length, medium pore diameter 5 μm and 40% porosity were developed. Fresh bone defects of 21 sheep in the medial femur condyle were filled with the implants. At time zero, after 6, 12 and 24 weeks the knees of each 7 animals were studied. Specimens were investigated radiologically, followed by biomechanical and histological analysis. Radiological analysis showed progressive resorption. 6 weeks after surgery results of the indentation test were slightly lower, after 12 and 24 weeks higher than on the healthy opposite knee. At 6 weeks a phagocyte reaction overbalanced. After 12 weeks bone regeneration around the implant was seen. After 24 weeks a highly advanced resorption of TCP implant was realized. The trabecular structure of the new bone increased after 24 weeks. Using microporous β-TCP implants continuous stable filling of bone defects can be reached in sheep. Microporous β-TCP implants are resorbed and replaced by bone.

Objectives The purpose of this study was to confirm volume stability of biphasic calcium phosphate (BCP) through the changes of grafted volume over the time by 3D CT analyzing software program. Patients and Methods Fifteen patients, 16 sinuses who were scheduled a staged implantation through sinus floor elevation (SFE)–lateral window technique from 2009 to 2011 were included in the study. Of the 15 patients, eight were male and seven were female (mean age 50.1). For sinus floor augmentation, BCP with local blood was packed loosely into the maxillary sinus and the grafted site was covered with a collagen membrane. For the evaluation of volume change, 3D CBCT scans were taken five times at pre-operatively (To), post-op 1 week (T1), 1 month (T2), 3 months (T3), and 6 months (T4). 3D image processing software (OnDemand3DTM software) was used for this study. The time sequential change was statistically evaluated. Result 84.32% grafted BCP is maintained until post-op 6 month (T4), and the average volume loss is 207.7 mm3 (about 0.21 cc). Statistically, a significant volume change (decreasing) was observed in three groups (T2–T1, T3–T2, T4–T3). Conclusion Biphasic calcium phosphate, as a synthetic material, has high volume stability and is a predictable graft material for the successful SFE. Although some limitations of the 3D analyzing software program, it is a fast, simple, relatively accurate and promising approach to quantifying long-term changes in the grafted area.

Numerous studies on alveolar bone augmentation have been reported. However, it remains challenging to obtain favorable new bone, especially for onlay bone augmentation. For successful onlay bone augmentation, it is necessary to use a graft material with high bone-forming activity and wound stabilization. We performed onlay bone augmentation on the buccal surface of mandibular alveolar bone in dogs, using a polyethylene terephthalate (PET) case (Casing method). The aim of this study was to histologically examine the feasibility of Casing method for external onlay bone augmentation. Beagle dogs were selected for this study. At 12 weeks after tooth extraction, a PET case was placed on the buccal surface of mandibular alveolar bone and filled with a mixture of hydroxyapatite and β-tricalcium phosphate (β-TCP) particles (volume ratio 1:1) impregnated with crushed autogenous bone (superfine bone powder) suspended in plasma. At 4, 8, and 16 weeks after bone graft, nondecalcified sections were histologically examined. At 4 weeks, new bone formation on the particle surfaces was observed on the original bone side of the PET case. At 16 weeks, bone formation was observed in almost all areas inside the case. The percentage of the augmented area (including new bone and particles surrounded by new bone; was significantly greater at 16 weeks (85.7% ± 6.0%) than at 4 weeks (10.5% ± 4.8%) or 8 weeks (69.6% ± 15.6%). The results of this study suggest that onlay bone augmentation using the Casing method has considerable potential to yield histologically favorable new bone formation. Anat Rec, 301:1148-1158, 2018. © 2018 Wiley Periodicals, Inc.

Introduction We have recently used highly pure β-TCP (beta-tricalcium phosphate) as the bone grafting material to avoid highly invasive autogenous bone grafting. We evaluated the osseoconduction potential of highly pure β-TCP in sinus augmentation surgery treatment. Materials and methods The study group comprised 13 patients who underwent maxillary sinus floor augmentation with β-TCP alone. Seven patients underwent sinus augmentation and implant placement simultaneously. Six patients were treated with a staged approach. Six months after surgery, specimens were obtained from 7 patients (for lateral biopsy) and 6 patients (for vertical biopsy). Results Histological and histomorphometrical analysis showed a mean bone proportion of 30.8% (vertical) and 12.0% (lateral) for new bone formation and good integration of the β-TCP. New bone formation was lower in the lateral biopsy specimens than in the vertical. Conclusion Highly pure β-TCP is a safe bone-grafting material with superior osteoconductive properties. Histologic and radiographic examinations indicate that β-TCP is slowly resorbed, which results in unresorbed graft material remaining even 6 months after the procedure, and that new bone replacement occurs slowly for approximately 1 year.

The purpose of this study was to analyze the histological, histochemical and radiological findings gained from pre-clinical in vitro and in vivo tests and from implantation of ß-tricalcium phosphate PORESORB®-TCP (P). (P) is a bioactive, resorbable, inorganic, crystalline, non-metallic material with osseoconductive properties intended for replacement of bone tissue. The (P) granules (size 1-2mm) were implanted into the tibia of dogs for 3 and 6 months. The formation of 53% and 72% of new bone was observed after 3 and 6 months respectively.Material (P) sized 0.3-0.6 mm was used to fill in the periodontal defect and also as a carrier of growth proteins. During the study period, no undesired response to the material used was observed. The values of the plaque index showed standard hygienic conditions – the values of PlI were 0.72, 0.65 and 0.62 before treatment and 6 and 12 months after treatment, respectively.A total of 72 two-stage sinus lifts were performed in 54 patients. The autologous bone was harvested from the mandibular ramus and mixed with the (P) material sized 1-2 mm. The materials were used in a proportion ranging between 1: 1 and 1: 3. The residual allograft area was 16.21 ± 8.78 %. The connective tissue was 44.16 ± 5.85 %.This has been a retrospective review of the healing of bone defects, due to benign tumours or tumour-like lesions, using (P) material sized 1.3 mm, 0.7 mm (0.6-2 mm) as bone graft substitutes. 87 patients with bone defects (average volume 15 cm3; interval 0.4 – 144 cm3) were included. Defects with a volume up to 4 cm3 had the same successful rate of healing both for autologous bone grafts and (P). (P) sized 1.3 mm; 0.7 mm (0.6-2 mm) was successfully used in defects with volume up to 4 cm3. However, it is evident that the ratio of the size of the defect and the size of the applied granule must be kept near to 10/1 for successful treatment.

PurposeRestoration of missing teeth in a severely atrophic posterior maxilla with implant installation could, in some cases, entail problems because of injury to the maxillary sinus. This study was conducted to evaluate sinus lifting using bone grafting and installation of a dental implant at the ar

Background: An oily calcium hydroxide suspension (OCHS) has been proved to be efficient in promoting bone regeneration in periodontal intrabony defects. However, the outcome of regenerative therapy using an OCHS as an adjunct to open-flap debridement is believed to be compromised by its low consistency. Thus, the present study was carried out to evaluate an OCHS alone and in combination with β-tricalcium phosphate (β-TCP) as a bone graft material in the treatment of periodontal intrabony defects. Materials and Methods: Twenty-six intrabony defects in 10 patients were divided into experimental and control sites. The experimental sites were debrided and grafted with a combination of OCHS and β-TCP. The control sites were debrided and grafted with OCHS alone. Probing pocket depth (PPD), clinical attachment level (CAL), and gingival margin position were recorded at baseline and at 3, 6, and 9 months. Results: No differences in any of the investigated parameters were observed at the baseline between the two groups. At 9 months postoperatively, the experimental group showed a reduction in mean PPD from 7.56 ± 1.15 to 4.19 ± 1.42 mm (P Conclusion: Overall, both therapies led to significant PPD reduction and CAL gain. The combination of an OCHS and β-TCP as a bone graft material was more effective in terms of improving clinical parameters than OCHS alone.

The aim of this research was to evaluate the process of bone regeneration in rabbits, using chitosan and beta-tricalcium phosphate (β-TCP) independently and in combination. A total of 12 New Zealand rabbits of both sexes, with average weight of 3.0 ± 0.57 kg were used. Animals were randomly divided into two experimental time points, with six animals euthanized 45 days after surgery and six euthanized 90 days after surgery. We performed two osteotomies in each tibia. The left tibia was used for the chitosan (QUI) and control groups, and the right tibia was used for the β-TCP alone and in combination with chitosan (QUI+TCP) groups. Tomographic evaluation showed no statistically significant difference among groups; however radiopacity was higher in the treated groups. Comparative descriptive histological evaluation found that treatment groups stimulated a more pronounced tissue repair reaction and accelerated bone repair. Morphometric analysis showed that treatment groups presented statistically higher bone formation compared with the control group.

The main objective of the present study is to quantify doxycycline (DOX) release from β-tricalcium phosphate (β-TCP) after EDTA root surface treatment.Thirty systemically healthy patients with ≥1 paired contralateral interproximal intrabony defect ≥4 mm deep along with an interproximal probing depth ≥6 mm and clinical attachment level ≥4 mm were randomized into two groups. Group 1 (G1) consisted of sites treated with open flap debridement followed by placement of DOX blended with β-TCP (DOX-β-TCP), whereas group 2 (G2) sites were treated with flap surgery followed by the placement of DOX blended with β-TCP after EDTA etching of the exposed root surfaces (DOX-β-TCP + EDTA). Samples of gingival crevicular fluid (GCF) were obtained 1, 3, 7, 14, and 21 days after surgery. Quantitative measurements of DOX were taken with high-performance liquid chromatography. Clinical evaluation and follow-up for 6 months were performed.At 21 days, the DOX-β-TCP + EDTA-treated group showed a 194.7 µg/mL value. The DOX-β-TCP + EDTA-treated group retained more DOX during the periods of 3, 7, 10, 14, and 21 days than the DOX-β-TCP-treated group. Six months after therapy, DOX-β-TCP + EDTA-treated sites showed more significant clinical improvements compared to DOX-β-TCP-treated sites (P ≤ 0.05).EDTA root surface etching enhances DOX availability in the GCF following its release from β-TCP as a drug carrier.

To clinically evaluate proximal furcations treated with hydroxyapatite/β-tricalcium phosphate (HA/β-TCP) isolated or combined with enamel matrix derivative (EMD).Thirty patients, presenting at least one proximal class II furcation defect, probing pocket depth (PPD) ≥5 mm and bleeding on probing, were included. The defects were assigned to the HA/β-TCP group (n = 15); open-flap debridement (OFD) + HA/β-TCP filling, or, HA/β-TCP-EMD group (n = 15); OFD + HA/β-TCP + EMD filling. Plaque (PI) and gingival index (GI), PPD, relative gingival margin position (RGMP), vertical and horizontal attachment level (RVAL and RHAL), vertical and horizontal bone level (RVBL and RHBL), and furcation diagnosis were evaluated at baseline and at 6 months.Both groups presented improvements after therapies (p 0.05); however, no inter-group differences could be seen in any single parameter (p 0.05). At 6 months, the gains in rVCAL in the HA/β-TCP and HA/β-TCP-EMD groups were 1.47 ± 0.99 and 2.10 ± 0.87 mm, while the RHCAL gains were 1.47 ± 1.46 and 1.57 ± 1.58 mm (p 0.05). The RVBL and RHBL gains for the HA/β-TCP and HA/β-TCP-EMD group were 1.47 ± 1.13 and 1.70 ± 1.26 mm, and 1.90 ± 1.11 and 1.70 ± 1.37 mm respectively (p 0.05). The HA/β-TCP-EMD group showed seven closed furcations versus four in the HA/β-TCP group (p 0.05).Both treatments lead to improvements in all clinical variables studied in the present trial. However, the closure of proximal class II furcation defects is still unpredictable.