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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]

Objectives: The prevalence and the economic burden of periodontal disease are high. To save or replace diseased teeth, an objective prognosis assessment using the long-term predictability of the various treatment options should be performed. As dental implants have become a treatment of choice for replacing missing teeth, the number of implant failures and complications has also increased. The objective of this review was to compare the cost-effectiveness of saving and maintaining the teeth vs replacing them with dental implants in patients with severe periodontal disease (with hopeless or questionable teeth). Method and materials: A database search was conducted using Medline (OVID), Embase, Web of Science, and CINAHL electronic sources until July 2023. Two reviewers reviewed the papers in accordance with the specific selection criteria after choosing the abstracts that met the initial selection criterion for full article retrieval. Results: Twelve articles were included, of which nine articles discussed the cost-effectiveness of preserving teeth in severe periodontal disease and three articles discussed the effectiveness of implants that replaced the periodontally compromised teeth. It was found that placing and maintaining implants was more costly than properly treating and maintaining periodontally compromised teeth. Supportive periodontal treatment contributed the most to the cost during the periodontal treatment. Conclusions: Implants are an effective choice to replace missing teeth; however, these are not permanent, present complications, and require strict maintenance. Thus, when deciding whether to maintain a periodontally compromised tooth or to replace it with a dental implant, in terms of cost-effectiveness, implant maintenance cost as well as the cost associated with treating implant complications should be considered. This cost seems to surpass the cost of treatment and maintenance of periodontally compromised teeth. [ABSTRACT FROM AUTHOR]

Objective: The predictability and long-term success of periodontal regeneration begins with oral hygiene education, disease management, and an individually tailored periodontal maintenance protocol. The treatment outcomes could be enhanced when biologics and bone grafts are combined. The aim of this report was to describe the outcome of two complex infrabony defects in the same patient treated with recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and freeze-dried bone allograft (FDBA) over 10 years. Case presentation: Two complex infrabony defects were treated following guided tissue regeneration principles and procedures. Fullthickness flaps were raised to allow visualization of the defects. The areas were debrided, and exposed root surfaces were planed. FDBA and rhPDGF-BB were combined to fill both defects. A collagen membrane was used over the bone graft in one case. The flaps were reapproximated to achieve primary closure. The patient was seen for regular periodontal maintenance visits and clinical and radiographic follow-ups over 10 years. Throughout the examination periods, the probing depths improved without bleeding on probing, and there was radiographic evidence of bone regeneration. Conclusion: The growth factorinfused bone graft was successfully utilized for periodontal regeneration in complex bony defects. [ABSTRACT FROM AUTHOR]

Background: The current trial evaluated the midfacial gingival margin changes, volumetric, radiographic and clinical alterations 1-year following immediate implant placement with customized healing abutment (IIP + CHA) either solely, or in combination with xenograft (IIP + Bonegraft) or with connective tissue grafting (IIP + CTG) at sites with thin labial bone in the esthetic zone. Methods: Thirty-nine non-restorable maxillary teeth indicated for extraction in the esthetic zone were included. Participants were randomly assigned into three equal group; IIP + Bonegraft (Control), IIP + CTG and IIP + CHA. Midfacial gingival margin changes(mm) as primary outcome, labial soft tissue contour change(mm), interdental tissue height changes and total volume(mm3) were assessed. Amount of bone labial to the implant and crestal bone level changes were also recorded. All outcomes were measured 1-year post-operative. Results: The midfacial gingival margin changes demonstrated a significant difference (P ≤ 0.05) between the groups showing -0.98, -0.74 and -1.54 mm in sites treated with IIP + Bone graft, IIP + CTG and IIP + CHA respectively after1-year. While labial soft tissue contour change (mm), total volume (mm3) and distal interdental tissue height changes (mm) revealed a significant difference after one-year between the studied groups, yet mesial interdental tissue height changes showed no difference (P > 0.05). Both IIP + Bone graft and IIP + CHA groups revealed a significant positive correlation between the total volume loss (mm3) after 1 year and mid-facial gingival margin changes (P ≤ 0.05). However, no significant correlation was observed in the IIP + CTG group (P = 0.63). CBCT measurements showed a significant difference in crestal bone changes between the three groups (P ≤ 0.05), yet, there was no significant difference regarding mean amount of bone labial to the implant(P > 0.05). Conclusions: This investigation suggests that the mere presence of CTG simultaneous with IIP in the anterior maxilla reduced the midfacial gingival margin alterations (mm), besides, CTG decreased the overall volume loss (mm3) by 5-folds compared to the other studied groups after one year. Meanwhile, using CHA alone with IIP failed to maintain the peri-implant soft tissues contour. Trial registration: The current trial was retrospectively registered at Clinical trials.gov (ID: NCT05975515, Date: 27-July-2023). [ABSTRACT FROM AUTHOR]

Background: Immediate implant placement using vestibular socket therapy (VST) proved to offer a successful treatment option in compromised sockets. However, the presence of active signs infection complicates immediate implants in sockets with defective labial plates, due to the possible contamination of the implant or the bone graft with existing infected tissues or oral environment via the fistula. This study, therefore, aims to explore the success of immediate implant placement using VST in managing infected compromised sockets. Methods: We included 26 age- and sex-matched patients with 41 implants sites. Thirteen patients had 19 infected (group I) and 13 had 21 non-infected type 2 sockets (group N). Both groups were treated using vestibular socket therapy (VST) and a 6-day protocol. Implant survival, changes in facial bone thickness, and mid, mesial, and distal mucosal levels were evaluated 1 year after implant placement. The Mann–Whitney U test was used to compare both groups. Furthermore, the Wilcoxon signed-rank test was used to study changes with time within each group. The statistical significance level was set at P < 0.05. Results: All implants survived; no significant difference was found between groups N and I regarding apical, mid, and crestal bone thickness and soft tissue level, except at the mesial papilla, where the recession was significantly more in group N than in group I. Changes over time were statistically significant in the apical, mid, and crestal bone thickness in both groups. The mean bone thickness gain ranged from 0.85 to 2.4 mm and 0.26–1.63 mm in groups I and N, respectively. Additionally, the mean mucosal recession ranged from 0.29 to 0.51 mm and 0.39–1.47 mm in groups I and N, respectively. Conclusion: Within the limitations of this study immediate implant placement in type II infected sockets using the 6-day protocol and VST achieved 100% implant survival, while maintaining the regenerated facial bone thickness with minimal mucosal recession. Trial registration: The protocol for this study was registered on clinicaltrials.gov at 3/10/2021 (registration number NCT04787224). [ABSTRACT FROM AUTHOR]

Bone grafting in oral and maxillofacial surgery has evolved significantly due to developments in materials science, offering innovative alternatives for the repair of bone defects. A few grafts are currently used in clinical settings, including autografts, xenografts, and allografts. However, despite their benefits, they have some challenges, such as limited availability, the possibility of disease transmission, and lack of personalization for the defect. Synthetic bone grafts have gained attention since they have the potential to overcome these limitations. Moreover, new technologies like nanotechnology, 3D printing, and 3D bioprinting have allowed the incorporation of molecules or substances within grafts to aid in bone repair. The addition of different moieties, such as growth factors, stem cells, and nanomaterials, has been reported to help mimic the natural bone healing process more closely, promoting faster and more complete regeneration. In this regard, this review explores the currently available bone grafts, the possibility of incorporating substances and molecules into their composition to accelerate and improve bone regeneration, and advanced graft manufacturing techniques. Furthermore, the presented current clinical applications and success stories for novel bone grafts emphasize the future potential of synthetic grafts and biomaterial innovations in improving patient outcomes in oral and maxillofacial surgery. [ABSTRACT FROM AUTHOR]

Forearm non-union poses a challenge in orthopaedic surgery due to its intricate anatomy and functional significance. This review provides a comprehensive overview of the assessment, diagnosis and management of forearm non-union. Initial evaluation involves a meticulous history, physical examination and imaging studies to identify factors contributing to non-union, including infection. Surgical approaches are discussed, with emphasis on restoring biomechanical stability and promoting bone healing. Treatment options range from autografts to allografts, with considerations for vascularised bone transfers in complex cases. Decision-making strategies are outlined, considering patient-specific factors and individualised treatment plans. Special considerations for specific types of forearm non-unions are addressed, along with postoperative care protocols to optimise healing and functional outcomes. Overall, this review aims to provide clinicians with a comprehensive understanding of forearm non-union management based on current evidence and clinical practice. Level of Evidence: Level V (Therapeutic) [ABSTRACT FROM AUTHOR]

Particulate bone grafting material can travel from the implantation site and diminish the magnitude of required bone formation response and hence its effectiveness. An easily prepared moldable graft that rapidly sets rigid in situ would alleviate this problem and in this study, such an injectable bone graft material is presented. By combining calcium phosphate (CP) salts with a bioactive glass (BG) mixed with a 2.5% Na2HPO4 solution a novel BG‐based calcium phosphate cement (CPC) is produced. Immersion in Tris buffer and simulated body fluid (SBF) solutions result in the rapid generation of octacalcium phosphate (OCP) and hydroxyapatite (HA) phases – a pre‐requisite for "bioactivity". Cement‐conditioned media does not result in any cytotoxic potential with respect to MTT activity, DNA content, or alkaline phosphatase activity with an osteoblastic cell line. Application of the cement into standardized surgical defects in the minipig mandible results in short‐term, moderate irritation at 3 and 6 weeks and complete replacement of cement with new bone at 12 weeks. [ABSTRACT FROM AUTHOR]

Introduction: Oligodontia is a rare dental developmental pathology that requires prolonged, complex and multidisciplinary treatment. Although bone augmentation is frequently required during a complete implant treatment of oligodontia. Therefore, we evaluated the ability to predict pre-implant surgery complexity based on age, number of missing teeth, and number of implants required to achieve implant-supported prosthetic rehabilitation. Material and methods: This retrospectively registered study included all patients who underwent surgical treatment for oligodontia in our Oral and Maxillofacial Surgery Department between January 2012 and May 2023. Demographic data, number and location of missing teeth, pre- and per-implant surgical procedures, and the number of planned implants were recorded. A quantitative variable called "complexity score of pre-implant surgery" was created. This 10-point score was calculated by adding one point for each preimplant surgical procedure registered. A simple linear regression was calculated to explain the number of targeted implants based on number of missing teeth. A multiple linear regression model was used to explain the complexity score of pre-implant surgery and age, number of missing teeth and number of targeted implants. Results: 119 oligodontia patients were included in the study. The median number of tooth agenesis was 10. A total of 825 implants were placed, 14 (1.7%) of which failed. A significant regression equation was used (F(1,118) = 1098,338; p < 0.0001) to explain the number of targeted implants based on number of missing teeth, with a R2 of 0.903. A significant regression equation was found (F(3,116) = 107,229; p < 0.0001) to explain the complexity score of pre-implant surgery and age, number of missing teeth and number of targeted implants, with a R2 of 0.735. Discussion: These results based on patient data indicate that age, number of missing teeth and number of targeted implants could reliably explain the complexity of pre-implant surgery. [ABSTRACT FROM AUTHOR]

Objectives: The incorporation of retromolar bone grafts used for alveolar ridge augmentation is not well understood. This prospective observational study aims to supply histomorphometrical data from bone graft biopsies taken at the time of retrieval and after a 3‐month healing period using patient‐matched biopsies. Materials and Methods: In 17 patients, trephine biopsies of the graft were acquired at the time of graft retrieval and after a 3‐month healing period. The biopsies were compared histomorphometrically regarding the number of osteocytes, appearance of osteocyte lacunae, quantity, surface area, and activity of the Haversian canals. Results: All grafts appeared clinically stable after screw removal and 17 implants were placed. Histomorphometric analysis revealed no significant difference in the number of osteocytes (p =.413), osteocyte lacunae (p =.611), the ratio of filled/empty osteocyte lacunae (p =.467) and active Haversian canals (p =.495) between the biopsies retrieved after a 3‐months healing period with those at the time of grafting. The only significant difference was noted in the mean surface area of the Haversian canals (p =.002). Specifically, the grafts post 3‐month healing showed a significantly larger mean area (0.069 mm2) compared to the time of grafting (0.029 mm2). Conclusion: This study demonstrates, compared to other data, a high rate of vital structures in retromolar bone block grafts after 3 months of healing, exhibiting the same histological features in comparison to the biopsies from the native alveolar ridge. Standard histomorphometrical parameters, e.g., the amount of filled or empty osteocyte lacunae for the description of the vitality of the graft need to be reappraised. [ABSTRACT FROM AUTHOR]

P-15 is a 15-amino-acid-long biomimetic peptide widely demonstrated to enhance osteogenesis in vivo. Despite the prevalence of polyether-ether-ketone (PEEK) in interbody device manufacturing, a growing body of evidence suggests it may produce an unfavorable immune response. The purpose of this preliminary study was to characterize the immune response and new bone growth surrounding PEEK implants with and without a P-15 peptide-based osteobiologic. A bilateral femoral defect model was conducted using New Zealand white rabbits. A total of 17 test subjects received one implant in each distal femur, either with or without bone graft material. Animals were allowed to survive to 4 or 8 weeks, at which time the femurs were collected and subjected to micro-computer tomography (microCT) or cytokine analysis. MicroCT analysis included the quantification of bone growth and density surrounding each implant. The cytokine analysis of periprosthetic tissue homogenates included the quantification of interleukins (ILs) and TNF-α expression via ELISA kits. Improvements in bone volume were observed in the P-15 cohort for the regions of interest, 500–136 and 136–0 µm from the implant surface, at 8 weeks post-op. Concentrations of IL-1β, IL-4, and IL-6 cytokines were significantly higher in the P-15 cohort compared to the PEEK cohort at the 4-week timepoint. Significant reductions in the concentrations of IL-4 and IL-6 cytokines from the 4- to 8-week cohort were observed in the P-15 cohort only. The P-15 peptide has the potential to modulate the immune response to implanted materials. We observed improvements in bone growth and a more active micro-environment in the P-15 cohort relative to the PEEK control. This may indicate an earlier transition from the inflammatory to remodeling phase of healing. [ABSTRACT FROM AUTHOR]

Background: Bone augmentation aims to provide sufficient bone volume around dental implants. Available bone augmentation methods include autogenous bone grafts, xenografts, and alloplastic materials. All have their advantages and disadvantages. However, autogenous bone graft remains the gold standard for bone augmentation. Autogenous bone grafts are usually taken from the patient's oral donor sites such as the chin and mandibular ramus. However, there is a newly developed implant preparation protocol, known as the peripheral-bone-removal (PBR) technique, which can provide bone augmentation from the dental implant site. Purpose: This study aims to determine the need for bone substitute materials in the PBR technique in dental implant surgery. Methods: This study included 130 patients who were treated for dental implants. These patients were treated between 7.1.2018 and 3.2.2023. Six dental implant systems were used. Five of these systems (ImplantKa®, DeTech®, NeoBiotech®, Easy Implant®, and Dentaurum® Implant) used a conventional method (sequential drilling technique). The sixth (IBS®) system used the PBR protocol. Both descriptive and Chi-Square Test statistics were used for data analysis. Results: The included patients were treated with a total of 198 dental implants. Seventy patients were treated with the PBR protocol, while 60 patients were treated with the sequential drilling protocol. For the PBR protocol, only 2 cases required bone substitute material, whereas 11 cases treated with the sequential drilling protocol required augmentation materials. This difference between both drilling protocols has been statistically confirmed (P=0.008). Conclusion: The PBR technique appears to be less traumatic and more cost-effective for cases that require horizontal bone augmentation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to (a) record and evaluate the epidemiological data relevant to the fractures of the atrophic mandible in the Greek population (b) present our experience in the management of these difficult injuries and (c) compare our results to the outcomes of other similar studies and discuss the postoperative complications. Methods: A prospective analysis of all the edentulous patients with fractures of the atrophic mandible treated at the Oral and Maxillofacial Surgery Department of K.A.T General Hospital of Athens in Greece was performed from November 2012 to December 2022. Age, gender and medical history of the patient, etiology and site of the fracture, classification of atrophy, type of surgical approach, type of osteosynthesis and postoperative complication. Results: 34 patients were included in the present study and 48 fractures of the atrophic edentulous mandible were managed surgically. 22 fractures were classified as class II of atrophy, 21 fractures as class III and 5 injuries as class I. In 32 patients we used an extraoral approach and only 2 patients were treated with an intraoral access. 44 fractures were treated with a 2.0 mm locking reconstruction plate and only 4 injuries of class I atrophy were treated with mini plates. Conclusions: Clinical practice has confirmed that for these cases an extraoral approach followed by stable fixation with a 2.0 mm reconstruction locking plate can deliver excellent results. Our findings show that the routine use of primary bone grafts is not necessary and can be reserved for more complex cases. [ABSTRACT FROM AUTHOR]

Background: The surgical treatment of bony non-unions is traditionally performed with additional bone grafts when atrophic and/or stronger implants when hypertrophic. In the case of the clavicle shaft, however, in our experience, a more controversial method where no additional bone graft is needed leads to equally good consolidation rates, independent of the non-union morphology. This method requires the meticulous anatomical reconstruction of the initial fracture and fixation according to the AO principle of relative stability. Methods: A retrospective review following the STROBE guidelines was performed on a consecutive cohort of all patients who received surgical treatment of a midshaft clavicle non-union at the Medical Center of the University of Freiburg between January 2003 and December 2023. Patients were identified using a retrospective systematical query in the Hospital Information System (HIS) using the International Statistical Classification of Diseases and Related Health Problems Version 10 (ICD-10) codes of the German Diagnosis Related Groups (G-DRG). Two groups were formed to compare the consolidation rates of patients who received additional bone grafting from the iliac crest with those of patients who did not. A 3.5 mm reconstruction LCP plate was used in all patients. Consolidation rates were evaluated using follow-up radiographs and outcomes after material removal with a mean follow-up of 31.5 ± 44.3 months (range 0–196). Results: Final data included 50 patients, predominantly male (29:21); age: 46.0 ± 13.0 years, BMI 26.1 ± 3.7. Autologous bone grafts from the iliac crest were used in 38.0% (n = 19), while no bone addition was used in 62.0% (n = 30). Six patients were lost to follow-up. Radiological consolidation was documented after a mean of 15.1 ± 8.0 months for the remaining 44 patients. Consolidation rates were 94.4% (n = 17) in patients for whom additional bone grafting was used and 96.2% (n = 25) in patients for whom no graft was used. There was no relevant difference in the percentage of atrophic or hypertrophic non-unions between both groups (p = 0.2425). Differences between groups in the rate of consolidation were not significant (p = 0.7890). The complication rate was low, with 4.5% (n = 2). Conclusions: Independent of the non-union morphology, non-unions of the clavicle midshaft can be treated successfully with 3.5 mm locking reconstruction plates without the use of additional bone grafting in most cases. [ABSTRACT FROM AUTHOR]

Background: Guided bone regeneration (GBR) is a reliable technique used in vertical and horizontal bone defects. The posterior mandibular region is an area limited by anatomic constraints. The use of resorbable membranes with a cortical component could compensate for the lack of rigidity of resorbable membranes without the complications of non-resorbable membranes. The aim of this study was to evaluate the mean bone gains of a xenogeneic cortical membrane in horizontal and vertical bone defects in comparison with other membranes in the literature. Methods: A porcine cortical membrane was used to perform 7 GBR in the posterior mandibular region of five patients. Preoperative (T0) and six months postoperative (T1) cone beam computed tomography were superimposed to measure the horizontal and vertical bone gain. Implants were positioned at all sites, six months after GBR. Complications and bone resorption around the implants were also documented. Results: The mean horizontal and vertical bone gains were 3.83 ± 1.41 mm and 4.17 ± 1.86 mm, respectively. The analysis of repeatability was 0.997. As many as 40% of patients experienced pain refractory to analgesics. No exposure or infectious phenomenon was observed. Conclusions: This xenogeneic cortical membrane seemed to provide interesting results in the regeneration of horizontal and vertical bone defects. Comparative and prospective studies are necessary to validate the effectiveness of this membrane. [ABSTRACT FROM AUTHOR]

Correction of asymmetry and irregularity deformities with autologous grafts, without osteotomies, offers advantages to both plastic surgeons and patients with severe deviation. Various autologous tissues such as fat, bone, and cartilage grafts are viable options for this purpose. This study aimed to compare the efficacy of 3 autologous filling materials in patients with bone asymmetry. A retrospective evaluation was conducted on 297 patients seeking aesthetic nose surgery between 2015 and 2022. Only primary patients without prior surgery and those with bone asymmetry from trauma, with dorsum protrusion <3 mm, and without osteotomy were included. Patients were divided into fat, cartilage, and bone groups. Grafts were applied to the concave side during closed rhinoplasty, and evaluations were done 12 months after surgery by blinded plastic surgeons and patients using established assessment tools. Fat, cartilage, and bone grafts were utilized in 74, 127, and 96 patients, respectively, with a mean follow-up of 19 months. The mean graft volumes were 1.0 cc (bone), 1.3 cc (cartilage), and 1.6 cc (fat). The patient self-assessment scores were 75%, 84.9%, and 86.6%, respectively. The Asher-McDade averages were 77.2%, 86.7%, and 88.4%, respectively. Cartilage and bone graft results were statistically similar in patients' self-evaluation and significantly higher than those of fat grafts. Blinded assessments showed no significant difference between the cartilage and bone groups. Placing autologous grafts on the concave side for patients with minimal nasal bone protrusion (<3 mm) yields successful results. Cartilage grafts offer advantages in volume, result estimation, and preparation time, making them suitable for larger patient cohorts. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate, through qualitative and semi‐quantitative histological analysis, onlay autologous bone grafts fixed with ethyl‐cyanoacrylate adhesive and titanium screw, in order to verify whether the method of applying the adhesive would interfere with the graft incorporation. Materials and Methods: Fourteen rats underwent bone graft surgery: seven grafts were fixed with ethyl‐cyanoacrylate (SB group, n = 7) and seven grafts were fixed with titanium screws (TS group, n = 7). After 30 days, the grafts were histologically analysed for vitality, adhesive presence, tissue reaction with formation of osteoid matrix, bone resorption presence, capillaries formation, inflammatory infiltrate, fibroblastic proliferation, presence of osteoblasts, osteocytes and osteoclasts. The data were submitted to non‐parametric tests, Mann–Whitney, Fisher's Test, Wilcoxon and McNemar and to statistical analysis (p < 0.05). Results: No significant differences were found in the qualitative evaluations. While findings of more osteocytes (p = 0.035) in the TS group in greater inflammation (p = 0.030) and more osteoclasts (p = 0.048) in the SB. Despite the fact that the titanium screw has presented bone neoformation with welding points, there was no complete incorporation and the adhesive affected the bone repair in a way that not even neoformation points could be seen in 30 days. Conclusion: The method of applying the adhesive did not show an advantage according to the histological aspects studied, as there was the formation of a dead space at the interface of the SB group and the adhesive acted as a barrier. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate in vivo and in vitro the effectiveness of the use of fibroblast growth factor (FGF)-2 with carbonate apatite (CO3Ap) on periodontal healing. Periodontal defects created in the maxillary first molars in rats were treated with FGF-2, CO3Ap, FGF-2 + CO3Ap or left unfilled. Healing was evaluated using microcomputed tomography, histological, and immunohistochemical analyses. In vitro experiments were performed to assess cellular behaviors and the expression of osteoblastic differentiation markers in MC3T3-E1 cells. At 4 weeks, the bone volume fraction in the FGF-2 + CO3Ap group was significantly greater than that in the CO3Ap group, but there was no significant difference from the FGF-2 group. The FGF-2 + CO3Ap group demonstrated greater new bone compared with the FGF-2 or CO3Ap group. The FGF-2 + CO3Ap group showed greater levels of osteocalcin-positive cells compared with the CO3Ap group, but there was no significant difference from the FGF-2 group. In vitro, the FGF-2 + CO3Ap group exhibited a greater extent of cell attachment and more elongated cells compared with the CO3Ap group. Compared with the CO3Ap group, the FGF-2 + CO3Ap group showed significantly higher viability/proliferation, but the expressions of Runx2 and Sp7 were reduced. The results indicated that the use of FGF-2 with CO3Ap enhanced healing in the periodontal defects. FGF-2 promoted cell attachment to and proliferation on CO3Ap and regulated osteoblastic differentiation, thereby contributing to novel bone formation. [ABSTRACT FROM AUTHOR]

Abstract Background The current trial evaluated the midfacial gingival margin changes, volumetric, radiographic and clinical alterations 1-year following immediate implant placement with customized healing abutment (IIP + CHA) either solely, or in combination with xenograft (IIP + Bonegraft) or with connective tissue grafting (IIP + CTG) at sites with thin labial bone in the esthetic zone. Methods Thirty-nine non-restorable maxillary teeth indicated for extraction in the esthetic zone were included. Participants were randomly assigned into three equal group; IIP + Bonegraft (Control), IIP + CTG and IIP + CHA. Midfacial gingival margin changes(mm) as primary outcome, labial soft tissue contour change(mm), interdental tissue height changes and total volume(mm3) were assessed. Amount of bone labial to the implant and crestal bone level changes were also recorded. All outcomes were measured 1-year post-operative. Results The midfacial gingival margin changes demonstrated a significant difference (P ≤ 0.05) between the groups showing -0.98, -0.74 and -1.54 mm in sites treated with IIP + Bone graft, IIP + CTG and IIP + CHA respectively after1-year. While labial soft tissue contour change (mm), total volume (mm3) and distal interdental tissue height changes (mm) revealed a significant difference after one-year between the studied groups, yet mesial interdental tissue height changes showed no difference (P > 0.05). Both IIP + Bone graft and IIP + CHA groups revealed a significant positive correlation between the total volume loss (mm3) after 1 year and mid-facial gingival margin changes (P ≤ 0.05). However, no significant correlation was observed in the IIP + CTG group (P = 0.63). CBCT measurements showed a significant difference in crestal bone changes between the three groups (P ≤ 0.05), yet, there was no significant difference regarding mean amount of bone labial to the implant(P > 0.05). Conclusions This investigation suggests that the mere presence of CTG simultaneous with IIP in the anterior maxilla reduced the midfacial gingival margin alterations (mm), besides, CTG decreased the overall volume loss (mm3) by 5-folds compared to the other studied groups after one year. Meanwhile, using CHA alone with IIP failed to maintain the peri-implant soft tissues contour. Trial registration The current trial was retrospectively registered at Clinical trials.gov (ID: NCT05975515, Date: 27-July-2023).

Abstract Background Immediate implant placement using vestibular socket therapy (VST) proved to offer a successful treatment option in compromised sockets. However, the presence of active signs infection complicates immediate implants in sockets with defective labial plates, due to the possible contamination of the implant or the bone graft with existing infected tissues or oral environment via the fistula. This study, therefore, aims to explore the success of immediate implant placement using VST in managing infected compromised sockets. Methods We included 26 age- and sex-matched patients with 41 implants sites. Thirteen patients had 19 infected (group I) and 13 had 21 non-infected type 2 sockets (group N). Both groups were treated using vestibular socket therapy (VST) and a 6-day protocol. Implant survival, changes in facial bone thickness, and mid, mesial, and distal mucosal levels were evaluated 1 year after implant placement. The Mann–Whitney U test was used to compare both groups. Furthermore, the Wilcoxon signed-rank test was used to study changes with time within each group. The statistical significance level was set at P

Aims: Surgical approaches to cervical ossification of the posterior longitudinal ligament (OPLL) remain controversial. The purpose of the present study was to analyze and compare the long-term neurological recovery following anterior decompression with fusion (ADF) and posterior laminectomy and fusion with bone graft and internal fixation (PLF) based on > ten-year follow-up outcomes in a single centre. Methods: Included in this retrospective cohort study were 48 patients (12 females; mean age 55.79 years (SD 8.94)) who were diagnosed with cervical OPLL, received treatment in our centre, and were followed up for 10.22 to 15.25 years. Of them, 24 patients (six females; mean age 52.88 years (SD 8.79)) received ADF, and the other 24 patients (five females; mean age 56.25 years (SD 9.44)) received PLF. Clinical data including age, sex, and the OPLL canal-occupying ratio were analyzed and compared. The primary outcome was Japanese Orthopaedic Association (JOA) score, and the secondary outcome was visual analogue scale neck pain. Results: Compared with the baseline, neurological function improved significantly after surgery in all patients of both groups (p < 0.001). The JOA recovery rate in the ADF group was significantly higher than that in the PLF group (p < 0.001). There was no significant difference in postoperative cervical pain between the two groups (p = 0.387). The operating time was longer and intraoperative blood loss was greater in the PLF group than the ADF group. More complications were observed in the ADF group than in the PLF group, although the difference was not statistically significant. Conclusion: Long-term neurological function improved significantly after surgery in both groups, with the improvement more pronounced in the ADF group. There was no significant difference in postoperative neck pain between the two groups. The operating time was shorter and intraoperative blood loss was lower in the ADF group; however, the incidence of perioperative complications was higher. Cite this article: Bone Jt Open 2024;5(9):768–775.

Background: Bone augmentation aims to provide sufficient bone volume around dental implants. Available bone augmentation methods include autogenous bone grafts, xenografts, and alloplastic materials. All have their advantages and disadvantages. However, autogenous bone graft remains the gold standard for bone augmentation. Autogenous bone grafts are usually taken from the patient’s oral donor sites such as the chin and mandibular ramus. However, there is a newly developed implant preparation protocol, known as the peripheral-bone-removal (PBR) technique, which can provide bone augmentation from the dental implant site. Purpose: This study aims to determine the need for bone substitute materials in the PBR technique in dental implant surgery. Methods: This study included 130 patients who were treated for dental implants. These patients were treated between 7.1.2018 and 3.2.2023. Six dental implant systems were used. Five of these systems (ImplantKa®, DeTech®, NeoBiotech®, Easy Implant®, and Dentaurum® Implant) used a conventional method (sequential drilling technique). The sixth (IBS®) system used the PBR protocol. Both descriptive and Chi-Square Test statistics were used for data analysis. Results: The included patients were treated with a total of 198 dental implants. Seventy patients were treated with the PBR protocol, while 60 patients were treated with the sequential drilling protocol. For the PBR protocol, only 2 cases required bone substitute material, whereas 11 cases treated with the sequential drilling protocol required augmentation materials. This difference between both drilling protocols has been statistically confirmed (P=0.008). Conclusion: The PBR technique appears to be less traumatic and more cost-effective for cases that require horizontal bone augmentation.

Abstract Introduction Oligodontia is a rare dental developmental pathology that requires prolonged, complex and multidisciplinary treatment. Although bone augmentation is frequently required during a complete implant treatment of oligodontia. Therefore, we evaluated the ability to predict pre-implant surgery complexity based on age, number of missing teeth, and number of implants required to achieve implant-supported prosthetic rehabilitation. Material and methods This retrospectively registered study included all patients who underwent surgical treatment for oligodontia in our Oral and Maxillofacial Surgery Department between January 2012 and May 2023. Demographic data, number and location of missing teeth, pre- and per-implant surgical procedures, and the number of planned implants were recorded. A quantitative variable called “complexity score of pre-implant surgery” was created. This 10-point score was calculated by adding one point for each preimplant surgical procedure registered. A simple linear regression was calculated to explain the number of targeted implants based on number of missing teeth. A multiple linear regression model was used to explain the complexity score of pre-implant surgery and age, number of missing teeth and number of targeted implants. Results 119 oligodontia patients were included in the study. The median number of tooth agenesis was 10. A total of 825 implants were placed, 14 (1.7%) of which failed. A significant regression equation was used (F(1,118) = 1098,338; p

Various methods for treating long bone fractures present promising therapeutic possibilities. In the case presented, particular emphasis was placed on the significant effectiveness of local antibiotic administration combined with bone autografts. The complexity of the injury in 23-year-old patient with multifragmentation of the femur, compounded by infection, necessitated a multistage treatment approach.

This systematic review evaluated the effectiveness of combining enamel matrix derivative (EMD) with various bone grafts in periodontal regenerative surgery, specifically targeting intrabony defects. Randomized controlled trials with 12-month follow-ups were included. Clinical outcomes assessed included clinical attachment level, probing depth, gingival recession, and radiographic defect fill. Meta-analysis showed that adding bone grafts to EMD does not provide additional benefits in periodontal tissue examination, with improvement observed only in radiographic defect fill. Subgroup analyses examined the impact of different bone graft types, revealing that alloplastic bone grafts are effective in radiographic defect fill. The risk of bias assessment indicated a moderate risk across studies, with challenges in blinding owing to the nature of the surgical treatment. Furthermore, a minimal intervention surgical approach may not require additional bone grafts for optimal periodontal regeneration. These findings contribute to the ongoing dialogue in the field and guide clinicians toward evidence-based decisions for optimal periodontal outcomes, emphasizing the judicious use of bone grafts.

Objectives: This randomized controlled trial compared the outcomes of recombinant human fibroblast growth factor (rhFGF)-2 plus carbonate apatite (CO3Ap) granules with rhFGF-2 alone in the treatment of intrabony periodontal defects. Materials and methods: Patients with Stage III Grade B/C periodontitis who had completed initial periodontal therapy and had intrabony defects with a depth of ≥ 3 mm were included. Defects were treated solely with rhFGF-2 (control) or rhFGF-2 plus CO3Ap (test). Periodontal parameters and a patient-reported outcome measure (PROM) were assessed at baseline, at 6, 9 and 12 months postoperatively. The primary outcome was the change in clinical attachment level (CAL) from baseline to 12 months postoperatively. Using the Friedman test with Dunn's post-test, intragroup data were compared over time, and Mann-Whitney U test was used to assess intergroup data at each time point. Results: Forty-eight sites in 38 patients were subjected to analysis. At 12 months postoperatively, CAL in both groups showed a significant improvement from baseline (p < 0.001). CAL gain was 3.4 ± 1.3 mm in the test group and 3.2 ± 1.2 mm in the control group, with no significant intergroup difference (p = 0.567). Radiographic bone fill in the test group (67.2%) was significantly greater than in the control group (32.4%) (p < 0.001). PROM scores showed no difference between groups. Conclusions: At 12 months, the outcomes including CAL gain and PROM showed no significant differences between groups, although the combination treatment enhanced radiographic bone fill. Clinical relevance: The use of rhFGF-2 (with/without CO3Ap) could lead to significant improvement in clinical parameters in the treatment of intrabony periodontal defects. The benefit of adding CO3Ap to rhFGF-2 therapy needs further evaluation. Clinical Trial Registration Number: The University Hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) : UMIN000040783. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of maxillary sinus anatomy on sinus floor elevation (SFE) operations performed with the lateral window approach. Materials and Methods: CBCT and digital panoramic radiographs were evaluated before and at least 6 months after maxillary sinus floor elevation (SFE) operations performed in 33 maxillary sinus regions in 26 patients. Maxillary sinus volume, grafted volume (GV), sinus width (SW), residual bone height (RBH), and vertical graft resorption (VGR) were calculated. The effects of RBH and SW on GV and VGR were evaluated statistically. Results: The mean GV values in the maxillary sinuses classified as narrow, average, and wide were 2.60 ± 0.57, 3.44 ± 0.65, and 3.70 ± 0.64 cm3, respectively. The mean VGR was 2.12 ± 1.67 mm, and in the sites classified as narrow, average, and wide, the mean VGR values were 1.50 ± 0.79, 1.58 ± 1.28, and 3.46 ± 2.06 mm, respectively. A statistically significant difference in GV and VGR was found between the SW groups. The mean posterior maxillary RBH was 2.30 ± 1.05 mm, and 17 and 16 sinuses were classified as = 2 and > 2 mm, respectively. There was no statistically significant difference in the effect of RBH on GV or VGR. Conclusion: Although posterior maxillary RBH did not affect new bone formation in the sinuses grafted only with hydroxyapatite-derived inorganic bovine bone, with increasing SW, the GV decreased and the VGR increased. [ABSTRACT FROM AUTHOR]

Full-arch implant reconstructions are being utilized in clinical practice today. Very often these prostheses are prosthetically driven, but not periodontally maintainable. Often the patient presents to the general practitioner with a failing implant reconstruction, where several fixtures need to be removed and others are maintainable. The article presents a case report where a removable prosthesis is used as a transitional appliance during the retreatment of the case. A removable complete overdenture prosthesis using attachments was used to establish proper occlusion and function, prevent loading on the guided bone regeneration sites, and to assist in fabrication of a stable guide for implant placement. The staged approach facilitated laser periodontal therapy on the remaining fixtures, and allowed proper oral hygiene instruction and assessment of the patient's ability to clean the remaining fixtures properly. Although the potential to treat this case with transitional implants or immediate load fixtures was discussed, the risk versus benefit scenario favored a removable prosthesis with attachments. Success required proper communication between the surgeon, restorative dental practitioner, laboratory, and patient. [ABSTRACT FROM AUTHOR]

Abstract Background All orthopaedic procedures, comprising foot and ankle surgeries, seemed to show a positive trend, recently. Bone grafts are commonly employed to fix bone abnormalities resulting from trauma, disease, or other medical conditions. This study specifically focuses on reviewing the safety and efficacy of various bone substitutes used exclusively in foot and ankle surgeries, comparing them to autologous bone grafts. Methods The systematic search involved scanning electronic databases including PubMed, Scopus, Cochrane online library, and Web of Science, employing terms like 'Bone substitute,' 'synthetic bone graft,' 'Autograft,' and 'Ankle joint.' Inclusion criteria encompassed RCTs, case-control studies, and prospective/retrospective cohorts exploring different bone substitutes in foot and ankle surgeries. Meta-analysis was performed using R software, integrating odds ratios and 95% confidence intervals (CI). Cochrane's Q test assessed heterogeneity. Results This systematic review analyzed 8 articles involving a total of 894 patients. Out of these, 497 patients received synthetic bone grafts, while 397 patients received autologous bone grafts. Arthrodesis surgery was performed in five studies, and three studies used open reduction techniques. Among the synthetic bone grafts, three studies utilized a combination of recombinant human platelet-derived growth factor BB homodimer (rhPDGF-BB) and beta-tricalcium phosphate (β-TCP) collagen, while four studies used hydroxyapatite compounds. One study did not provide details in this regard. The meta-analysis revealed similar findings in the occurrence of complications, as well as in both radiological and clinical evaluations, when contrasting autografts with synthetic bone grafts. Conclusion Synthetic bone grafts show promise in achieving comparable outcomes in radiological, clinical, and quality-of-life aspects with fewer complications. However, additional research is necessary to identify the best scenarios for their use and to thoroughly confirm their effectiveness. Levels of evidence Level II.

Objective: This study aims to assess the effect of bone graft materials derived from pearl oyster shells on the tumor necrosis factor-alpha (TNF-α) level.

Background: High-velocity trauma causes proximal tibial fractures, which have extensive articular involvement, numerous displaced condylar fracture lines, and soft tissue injuries. Complications are possible with the standard treatment, which is open reduction and internal fixation by a dual midline incision and dual plating. Nevertheless, a single midline incision is sufficient for the procedure. That's why we decidedto conduct this intervention. Objective: To evaluate the effectiveness and outcomes of proximal tibial fracture fixation using a double plating technique through a single midline incision. Study type,settings& duration:This quasi-experimental study was conducted at Department of Orthopaedic Surgery, PAEC Hospital,Islamabad, from March 2020 to March 2023. Methodology:Patients, aged 16 or above were enrolled who presented with proximal tibial fracture and underwent dual plating by giving single midline incision. Patients were followed-up and outcomes including infection, union, needed bone grafting, additional split skin graft and flap surgery and others were noted. SPSS version 25 was used to analyse the data. Results:Total 100 patients were enrolled in the study with the mean age of 44.71±17.88 years. There were 58 (58.0%) male patients and 42 (42.0%) female patients. The mean duration of surgery was 74.11±8.91 minutes. Out of 100 patients, 57 (57.0%) patients had excellent functional outcome, 34 (34.0%) patients had good fictional outcome, while 7 (7.0%) patients had fair functional outcome and 2 (2.0%) had poor functional outcome. Out of 100 patients, union achieved in 81 (81.0%) cases. Infection occurred in 2 (2.0%) cases, Knee stiffness in 12 (12.0%) cases, body graft was applied in 1 (1.0%) cases and skin graft and flap surgery was done in 1 (1.0%) cases and deep venous thrombosis in 2 (2.0%) cases. Conclusion:Dual plating for proximal tibial fracture via single midline is an appropriate method and is more than 90% successful in achieving good to excellent results and can replace other techniques which need more incision and increases the risk of infection.

Abstract Background Autologous bone grafting is the standard treatment for the surgical management of atrophic nonunion of long bones. Other solutions, such as bone marrow mesenchymal stem cells (BM-MSC) combined with phospho-calcium material, have also been used. Here we evaluate the safety and early efficacy of a novel procedure using autologous or allogenic adipose tissue mesenchymal stromal cells (AT-MSC) seeded in a patented tricalcium phosphate-based biomaterial for the treatment of bone regeneration in cases of atrophic nonunion. Methods This was a prospective, multicentric, open-label, phase 2 clinical trial of patients with atrophic nonunion of long bones. Biografts of autologous or allogenic AT-MSC combined with a phosphate substrate were manufactured prior to the surgical procedures. The primary efficacy was measured 6 months after surgery, but patients were followed for 12 months after surgery and a further year out of the scope of the study. All adverse events were recorded. This cohort was compared with a historical cohort of 14 cases treated by the same research team with autologous BM-MSC. Results A total of 12 patients with atrophic nonunion of long bones were included. The mean (SD) age was 41.2 (12.1) years and 66.7% were men. Bone healing was achieved in 10 of the 12 cases (83%) treated with the AT-MSC biografts, a percentage of healing similar (11 of the 14 cases, 79%) to that achieved in patients treated with autologous BM-MSC. Overall, two adverse events, in the same patient, were considered related to the procedure. Conclusions The results of this study suggest that AT-MSC biografts are safe for the treatment of bone regeneration in cases of atrophic nonunion and reach high healing rates. Trial registration Study registered with EUDRA-CT (2013-000930-37) and ClinicalTrials.gov (NCT02483364).

Resumen: Introducción Las infecciones asociadas con instrumentación de columna (IAIC) son una de las principales causas de complicación posquirúrgica y comorbilidad. Nuestro objetivo fue describir las características clínicas, microbiológicas, tratamiento y pronóstico de estas infecciones. Material y métodos: Realizamos un estudio retrospectivo en nuestro hospital (2011-2018) e incluímos a pacientes adultos con cirugía instrumentada de columna, que cumplieran los criterios diagnósticos de infección confirmada. Se procesaron muestras de herida quirúrgica superficial y muestras intraoperatorias profundas para cultivo microbiológico. El equipo médico y traumatológico fue siempre el mismo. Resultados: Se diagnosticaron 41 casos, de los que 39 pacientes (95,1%) presentaron infección precoz ( 3 meses tras cirugía). El tratamiento de elección en las infecciones precoces fue la estrategia Debridement, Antibiotics and Implant Retention (DAIR) sin retirada del injerto óseo, que demostró la curación en el 84,2% de los pacientes. La principal etiología fueron los grampositivos (S. aureus: 31,7%), seguido por los gramnegativos y la flora polimicrobiana. Los antibióticos fueron optimizados según los cultivos con una duración media de 12 semanas. Conclusiones: En las infecciones precoces, el diagnóstico precoz y la estrategia DAIR (con retención del injerto óseo) demostró una tasa de curación superior al 80%. Abstract: Introduction: Spinal instrumentation-related infections (SIRI) are one of the main causes of post-surgical complication and comorbidity. Our objective was to describe the clinical and microbiological characteristics, treatment and prognosis of these infections. Material and methods: We conducted a retrospective study in our institution (2011-2018) including adult patients undergoing spinal instrumentation who met the diagnostic criteria for confirmed infection. Superficial surgical wound and deep intraoperative samples were processed for microbiological culture. The medical and orthopaedic team was always the same. Results: Forty-one cases were diagnosed of which 39 patients (95.1%) presented early infection (3 months after surgery). The treatment of choice in early infections was the Debridement, Antibiotics and Implant Retention (DAIR) strategy without removal of the bone graft, which successfully resolved 84.2% of the infections. The main etiology was gram-positive (Staphylococcus aureus: 31.7%), followed by gram-negative and polymicrobial flora. Antibiotics were optimized according to cultures with a mean duration of 12 weeks. Conclusions: In early infections, early diagnosis and DAIR strategy (with bone graft retention) demonstrated a healing rate higher than 80%.

Amaç: Diş hekimliği pratiğinde birçok farklı kemik grefti kullanılmakta ancak seçimi konusunda bazen kararsız kalınmaktadır. Bu etkenlerin araştırılması, karasızlığın ortadan kaldırılması, en az maliyetle, hem hasta tercihine en uygun hem de hekimin en rahat uygulayabileceği kemik greftini daha kolay seçebilmeye yön göstermek adına bu araştırma planlanmıştır. Gereç ve Yöntem: Çankırı Karatekin Üniversitesi Diş Hekimliği Fakültesi ve Sağlık Bilimleri Fakültesi’nde okuyan toplam 366 gönüllü katılımcıya verilen, 3 bölümden oluşan bir anket aracılığı ile Türk ve yabancı uyruklu öğrenciler arasında kemik grefti seçimi üzerine etkili olan faktörler incelenmiştir. Bulgular: Yapılan istatistiksel analiz sonucunda; vejeteryan/vegan olma, yapılacak cerrahi işlemden korkma, greftlerin pahalı olduğunu düşünme, doktor tavsiyesine göre seçim yapma ve önceden cerrahi deneyimi olma ile seçilen kemik grefti türü arasında istatistiksel olarak anlamlı bir ilişki olmadığı (p>0.05) ancak; dini inanç, hayvanların bu iş için kullanılmasını uygun görmeme, greft tiplerinden hastalık bulaşacağını düşünme ile seçilen kemik grefti türü arasındaki istatistiksel olarak anlamlı bir ilişki olduğu (p

Background Socket preservation is a surgical procedure aimed at preserving the dimensions of the alveolar bone following tooth extraction. It is performed by filling the extraction socket with bone graft material with or without a barrier membrane. Recently, dentine obtained from extracted teeth has been tried as an autograft for socket preservation. Studies have compared the use of dentin to other bone grafts, however, systematic reviews evaluating the efficacy of dentin for socket preservation are limited. Hence, this systematic review protocol is proposed to generate evidence on the efficacy of dentin as a viable alternative to other bone graft materials for socket preservation. Methods This systematic review protocol was prepared according to the Methodological Expectations of the Cochrane Intervention Reviews (MECIR) guidelines. It will be conducted using the Cochrane Handbook for Systematic Review of Interventions. PubMed, Scopus, Web of Science, EMBASE, Epistemonikos, Cochrane Central, and EBSCO databases and clinical trial registries, will be searched for all randomized controlled trials (RCTs) and non-randomized studies that have used autologous dentin graft (either in particulate/putty, or/matrix form) for socket preservation. The radiographic and clinical assessment of bone and soft tissue healing of the preserved sockets along with patient-related outcomes following surgery will be assessed. The risk of bias assessment of the RCTs and Non-RCTs will be assessed using the ‘Cochrane Risk of Bias assessment tool (ROB II) and ROBINS-I respectively. The certainty of evidence will be assessed by the GRADE approach. Discussion This evidence is important for dental clinicians and the public to make an informed decision when choosing graft material for socket preservation. The extracted teeth are considered biological waste; however, this evidence provides scope for using a less invasive autograft for bone regenerative procedures. Systematic review registration PROSPERO: CRD42021201958 (Registered on 15/02/2021).

Aim: This study aimed to evaluate the implant survival rate, marginal bone loss (MBL), and surgical complications in single dental implants placed in the atrophic posterior maxilla using a transcrestal sinus lift with injectable graft materials. Materials and Methods: A prospective longitudinal study was conducted at IRCCS San Raffaele, Milan, Italy. Fifty-four patients with single edentulous sites and residual bone heights < 5 mm were included. A transcrestal sinus lift was performed using non-cutting drills (Cosci's technique) and xenogenic bone graft in gel form (Gel40, Tecnoss, Italy). Follow-up visits were at 1 week, 3 and 6 months, and annually for 3 years. Results: The implant survival rate was 98.04%, with one implant lost. MBL values were 0.71 ± 0.94 mm at 6 months, 1.00 ± 0.99 mm at 1 year, 1.03 ± 1.00 mm at 2 years, and 1.02 ± 1.01 mm at 3 years. Our ANOVA showed a significant MBL increase from 6 months to 1 year (p = 0.015), with no significant changes thereafter. Minimal surgical complications were observed, each occurring in 1.85% of cases. Conclusion: Transcrestal sinus lifts with injectable graft materials demonstrate high implant survival, acceptable MBL, and minimal complications, making it a reliable option for posterior maxilla rehabilitation. [ABSTRACT FROM AUTHOR]

Background: All orthopaedic procedures, comprising foot and ankle surgeries, seemed to show a positive trend, recently. Bone grafts are commonly employed to fix bone abnormalities resulting from trauma, disease, or other medical conditions. This study specifically focuses on reviewing the safety and efficacy of various bone substitutes used exclusively in foot and ankle surgeries, comparing them to autologous bone grafts. Methods: The systematic search involved scanning electronic databases including PubMed, Scopus, Cochrane online library, and Web of Science, employing terms like 'Bone substitute,' 'synthetic bone graft,' 'Autograft,' and 'Ankle joint.' Inclusion criteria encompassed RCTs, case-control studies, and prospective/retrospective cohorts exploring different bone substitutes in foot and ankle surgeries. Meta-analysis was performed using R software, integrating odds ratios and 95% confidence intervals (CI). Cochrane's Q test assessed heterogeneity. Results: This systematic review analyzed 8 articles involving a total of 894 patients. Out of these, 497 patients received synthetic bone grafts, while 397 patients received autologous bone grafts. Arthrodesis surgery was performed in five studies, and three studies used open reduction techniques. Among the synthetic bone grafts, three studies utilized a combination of recombinant human platelet-derived growth factor BB homodimer (rhPDGF-BB) and beta-tricalcium phosphate (β-TCP) collagen, while four studies used hydroxyapatite compounds. One study did not provide details in this regard. The meta-analysis revealed similar findings in the occurrence of complications, as well as in both radiological and clinical evaluations, when contrasting autografts with synthetic bone grafts. Conclusion: Synthetic bone grafts show promise in achieving comparable outcomes in radiological, clinical, and quality-of-life aspects with fewer complications. However, additional research is necessary to identify the best scenarios for their use and to thoroughly confirm their effectiveness. Levels of evidence: Level II. [ABSTRACT FROM AUTHOR]

In recent years, the significance of maintaining the alveolar ridge following tooth extractions has markedly increased. Alveolar ridge preservation (ARP) is a commonly utilized technique and a variety of bone substitute materials and biologics are applied in different combinations. For this purpose, a histological evaluation and the clinical necessity of subsequent guided bone regeneration (GBR) in delayed implantations were investigated in a prospective case series after ARP with a novel deproteinized bovine bone material (95%) in combination with a species-specific collagen (5%) (C-DBBM). Notably, block-form bone substitutes without porcine collagen are limited, and moreover, the availability of histological data on this material remains limited. Ten patients, each scheduled for tooth extraction and desiring future implantation, were included in this study. Following tooth extraction, ARP was performed using a block form of C-DBBM in conjunction with a double-folded bovine cross-linked collagen membrane (xCM). This membrane was openly exposed to the oral cavity and secured using a crisscross suture. After a healing period ranging from 130 to 319 days, guided trephine drilling was performed for implant insertion utilizing static computer-aided implant surgery (s-CAIS). Cores harvested from the area previously treated with ARP were histologically processed and examined. Guided bone regeneration (GBR) was not necessary for any of the implantations. Histological examination revealed the development of a lattice of cancellous bone trabeculae through appositional membranous osteogenesis at various stages surrounding C-DBBM granules as well as larger spongy or compact ossicles with minimal remnants. The clinical follow-up period ranged from 2.5 to 4.5 years, during which no biological or technical complications occurred. Within the limitations of this prospective case series, it can be concluded that ARP using this novel C-DBBM in combination with a bovine xCM could be a treatment option to avoid the need for subsequent GBR in delayed implantations with the opportunity of a bovine species-specific biomaterial chain. [ABSTRACT FROM AUTHOR]

Application of alveolar bone graft (ABG) in alveolar augmentation is done to prevent excessive bone resorption due to tooth extraction, missing teeth, or other diseases/conditions affecting the alveolar bone. The use of autogenous dentin-derived ABG has been considered as the composition of dentin appears to be nearly analogous to that of bone. This systematic review aims to assess the efficacy of dentin-derived ABG for alveolar augmentation of post-extraction sockets or other alveolar bone defects by evaluating volume gain and histomorphometric data. A search of systematic literature was conducted in Pubmed, Scopus, Web of Science, and Embase from database inception to October 2023. The review included both randomized controlled trials (RCT), pilot studies, clinical trials, and retrospective studies reporting on dentin-derived ABG use for alveolar augmentation. Overall, 298 articles were obtained from the initial search. From these articles, 21 articles met the inclusion criteria and were included for descriptive analysis. All of the studies indicated low risk of bias. Studies of dentin-derived ABG, which used bone-derived grafts as the control group, have shown significantly higher percentages of new bone formation, gain in vertical and horizontal dimensions, and less reduction in dimensions. Dentin-derived ABG was effective in volume maintenance, indicating promising results via histomorphometric and radiographic analysis. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Autologous bone dust can be filled in bone defects to promote effective bone healing but typically it is lost when using suction during surgery. The aim of this study was to develop a novel bone collector that can be used to collect bone chips/dust of varying sizes without changing current surgical procedures. Research design and methods: This collector was designed to connect to a surgical continuous suction system and comprised a plate filter with a 3 mm hole and featured a taper filter with a mesh size of 0.27 mm for the separation and collection of both coarse and fine bone chips/dust. The bone collector was manufactured using nylon 3D printing and plastic injection with biocompatible materials. Results: The bone collector functional test revealed high bone chip collection efficiency (93%) with automatic size separation function. Low (3.42%) filtration errors showed that most of the water can be drained smoothly from the bone collector. In clinical usability testing, bone collectors can provide functions demonstrated in in vivo spinal fusion and femoral fracture surgeries with different bone grafting size requirements. Conclusions: The novel bone collector has been validated as a viable and effective surgical device, offering surgeons an additional option to enhance patient outcomes. [ABSTRACT FROM AUTHOR]

Purpose: The study is aimed at evaluating the long-term (at a minimum follow-up of 10 years) impact of non-vascularized fibular harvest on the donor limbs. Methods: There were 27 donor limbs (n = 19 children) available for retrospective radiological review. The graft was obtained bilaterally in eight patients. The following parameters were evaluated in the follow-up radiographs: continuity/non-continuity of fibular regenerate, width of the regenerated fibula, distal fibular station, medial proximal tibial angle, posterior proximal tibial angle, lateral distal tibial angle (LDTA), anterior distal tibial angle, and tibia diaphyseal angulation (interphyseal angles). For analysis and comparisons, the donor limbs were compared to the healthy limbs (controls) of the children with unilateral harvest. Additionally, the impact of continuous and non-continuous fibular regeneration was separately analyzed. Results: The mean child's age at the time of fibular harvest was four years. The mean follow-up was 12.8 years. The fibula was found regenerated in continuity in 22 limbs of 15 children (81.5%). When analyzed as a combined group (both continuous and non-continuous fibular regenerations), all the donor limb radiological parameters matched those of healthy limbs except LDTA (p = 0.04). In the subgroup analysis between non-continuous and continuous fibulae, significant abnormalities were again obvious in LDTA (p = 0.0001). The non-continuous fibulae were significantly lesser in width. All limbs with non-continuous fibular regeneration manifested ankle valgus. Conclusions: The non-vascularized fibula emerged as a relatively safe procedure in the long term with minimal affections of the knee, ankle, or tibial anatomy when longitudinal integrity of fibula was restored. The non-regenerations of the fibula may be prone to developing ankle valgus. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess membrane use with a bone substitute graft for guided bone regeneration (GBR) in experimental dehiscence defects. Materials and methods: Maxillary second incisors (I2) in 9 dogs were extracted. Six weeks later, implants were inserted and experimental dehiscence defects (5 × 3 mm) created on the buccal aspect. The defects and surrounding bone were grafted with deproteinized bovine bone mineral. One side (test) was covered with a resorbable collagen membrane whereas the contralateral side (control) was not. After 6 weeks, histomorphometrical analysis was performed to evaluate: (a) first bone-to-implant contact (fBIC), (b) buccal bone thickness at 1 mm increments from implant shoulder, (c) regenerated area (RA), (d) area and percentages of new bone (B), bone substitute (BS) and mineralized tissue (MT). Results: The histological appearance was similar between test and control sites. At central and lateral sections, there were no differences between groups for fBIC, buccal bone thickness, RA, BS, B, %B, MT and %MT. At central sections, membrane use favoured more %BS and %MT (p = 0.052). There was significantly more B, %B and MT at lateral compared to central sections. Conclusions: Membrane use tended to retain more bone substitute, but had no effect on new bone ingrowth. Lateral sections showed significantly more bone ingrowth and mineralized tissue compared to central sections, confirming that new bone ingrowth takes place mainly from the lateral walls of the defect. Clinical relevance: Preclinical research to clarify the dynamics of bone regeneration in GBR procedures is relevant in clinical practice. [ABSTRACT FROM AUTHOR]

Recently, tissue engineering has been revolutionised by the development of 3D-printed scaffolds, which allow one to construct a precise architecture with tailored properties. In this study, three different composite materials were synthesised using a combination of polylactic acid (PLA), polyhydroxyalkanoates (PHA), poly(3-hydroxybutyrate) (PHB) and hydroxyapatite (HA) in varying weight percentages. Morphological properties were evaluated by scanning electron microscopy showing a uniform distribution of HA particles throughout the matrix, indicating good compatibility between the materials. Furthermore, the printed scaffolds were tested under pressure using a load cell to examine mechanical strength. Scanning electron microscopy (SEM) analysis showed favorable dispersion, biological compatibility together with enhanced bioactivity within the PHB/PHA/PLA/HA composite matrixes. Thus, this paper demonstrates the successful design and implementation of these composite structures for tissue-engineering applications and highlights the effective development of biocompatible scaffold designs with improved functionality. [ABSTRACT FROM AUTHOR]

Allografts are the second most transplanted tissue in medicine after blood and are now increasingly used for both primary and revision surgery. Allografts have the advantages of lower donor site morbidity, availability of multiple grafts, and shorter operative time. The Banks represents the bridge between Donor and Recipient and guarantees the quality and safety of the distributed allografts Given the increasing interest in these tissues, a retrospective analysis of data collected from the Regional Musculoskeletal Tissue Bank registry over an 11-year period (2009–2019) was conducted. The statistical analyses used were the Shapiro–Wilk normality test and a Poisson regression model. From January 2009 to December 2019, a total of 14,199 musculoskeletal tissues stored in the Regional Musculoskeletal Tissue Bank were provided for surgical allograft procedures. In 2009, the number of allografts performed was 925; this figure has steadily increased to 1599 in 2019. Epiphyses were taken as the reference tissue with an almost constant trend over the period, while a significant increase was denoted for extensor mechanism allograft, ligaments, tendons and long bone corticals (p < 0.001), processed bone tissues had no change in trend (p = 0.841). There was also a gradual decrease in the rate of microbiological positivity, as determined by bacteriological and serological tests performed on the collected tissues. This phenomenon is due to improved sampling techniques and the training of a dedicated team. Thus, we have seen how the use of allografts in orthopedic surgery has increased over the past 11 years, uniformly in terms of tissue type, except for the noticeable increase in ligamentous tissue. [ABSTRACT FROM AUTHOR]

Peri-implant soft tissue deficiency (PSTD) is a significant factor impacting aesthetics, particularly in the anterior zone, where labial bone resorption and thin peri-implant phenotypes are common. The occurrence of a gray color around the implant fixture due to PSTD can be aesthetically concerning in the esthetic zone. In cases involving natural teeth, autogenous soft tissue grafts such as subepithelial connective tissue grafts (SCTGs), free gingival grafts (FGGs), and coronally advanced flaps (CAFs) are commonly utilized. However, there are limited reports of using bone grafts in conjunction with these techniques for modifying the gingival phenotype around both teeth and implants. In the presented cases where PSTD resulted in visible gray coloration of the implant fixture in the esthetic zone, mechanical and chemical decontamination of the exposed implant surface was performed using a titanium brush and tetracycline (Tc) HCl. Subsequently, to enhance peri-implant mucosa thickness and mask the titanium color, simultaneous SCTG and bone grafting procedures were conducted. Within the limitations of these case reports, successful esthetic outcomes were achieved and maintained without recurrence for 3–6 years following the simultaneous subepithelial connective tissue graft and bone graft procedures. These findings suggest the potential efficacy of this combined approach in addressing PSTD and enhancing aesthetic results around dental implants, though further studies are needed to validate these outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the esthetic outcome, as well as clinical, radiographic, and volumetric tissue alterations 1 year after immediate implant placement (IIP) with connective tissue grafting (CTG) versus dual‐zone concept (DZ) at sites with thin labial bone in the esthetic zone. Materials and Methods: This randomized clinical trial included 30 patients treated with IIP simultaneous with either CTG or DZ (n = 15 each). Pink esthetic score (PES) was assessed 6 months after crown placement as the primary outcome. Amount of bone labial to the implant, labio‐palatal ridge reduction, and crestal bone changes were measured via CBCT after 1 year. Volumetric analysis of linear labial soft tissue contour, interdental, and mid‐facial soft tissue level changes, and total volume loss (mm3) were measured after 1 year. Results: Similar PES was observed in the CTG (12.53 ± 1.13) and DZ (12.13 ± 1.55) groups, with no significant difference (p = 0.42). Likewise, there were no statistically significant differences found between the two groups in labio‐palatal bone reduction (mm&%), interdental papillae, and mid‐facial gingival levels (p > 0.05). However, the mean vertical crestal bone changes in the CTG and DZ groups were −1.1 ± 0.6 mm and 0.2 ± 1.0 mm, respectively, with a statistically significant difference (p = 0.0002). Moreover, CTG revealed less linear and total volume (mm3) loss in the labial soft tissue which was statistically significant compared to DZ (p = 0.007). Conclusion: Both groups demonstrated the same PES, nevertheless, volumetric analysis revealed twice total labial volume loss in DZ compared to CTG. It might be concluded that the use of CTG with IIP caused less horizontal reduction in the supra‐implant complex compared to the DZ. [ABSTRACT FROM AUTHOR]

Unidirectional porous hydroxyapatite (UDPHAp) was developed as a remarkable scaffold characterized by a distinct structure with unidirectional pores oriented in the horizontal direction and connected through interposes. We evaluated the radiographic changes, clinical outcomes, and complications following UDPHAp implantation for the treatment of bone tumors. Excellent bone formation within and around the implant was observed in all patients treated with intralesional resection and UDPHAp implantation for benign bone tumors. The absorption of UDPHAp and remodeling of the bone marrow space was observed in 45% of the patients at a mean of 17 months postoperatively and was significantly more common in younger patients. Preoperative cortical thinning was completely regenerated in 84% of patients at a mean of 10 months postoperatively. No complications related to the implanted UDPHAp were observed. In a pediatric patient with bone sarcoma, when the defect after fibular resection was filled with UDPHAp implants, radiography showed complete resorption of the implant and clear formation of cortex and marrow in the resected part of the fibula. The patient could walk well without crutches and participate in sports activities. UDPHAp is a useful bone graft substitute for the treatment of benign bone tumors, and the use of this material has a low complication rate. We also review and discuss the potential of UDPHAp as a bone graft substitute in the clinical setting of orthopedic surgery. [ABSTRACT FROM AUTHOR]

Tissue engineering aims to fabricate a scaffold that exhibits a suitable surface topography for a desired cellular response. Therefore, a study analyzing the characteristics of bone grafts is important for future research directions. This work aims to analyze the physical-chemical characteristics of commercially available bone grafts of human and bovine origin for dental use, using morphological analysis of the surface and chemical composition by variable pressure scanning electron microscope (VPSEM) and energy-dispersive x-ray (EDX) spectrometry. In addition, pore diameter and surface area were analyzed by degassing method using a porosimeter, and particle size by laser diffraction. The analyzed allograft and xenograft particles differ in morphological characteristics and chemical composition. The allograft particles present a cuboidal and prismatic geometric morphology with angled edges and the absence of macropores. On the contrary, the xenograft particles present an irregular morphology with macropores in their structure. There is a statistically significant difference in C, P, and Ca between the xenograft and allografts (p < 0,05). The analyzed composition of allografts showed mainly the presence of C and O. In contrast, the composition of the xenograft was mainly Ca. These differences could influence the osteogenic properties of allografts and xenografts. This analysis provides basic information to understand the physicochemical properties of allografts and xenografts that facilitate cell-graft interaction. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort. Objective: To compare the rates of all-cause surgical complications of synthetic interbody devices versus allograft or autograft in patients undergoing 1-2 levels anterior cervical discectomy and fusion (ACDF) procedures. Summary of Background Data: Cervical degenerative disorders affect up to 60% of older adults in the United States. Both traditional allograft or autograft and synthetic interbody devices (polyetheretherketone or titanium) are used for decompression and arthrodesis, with increasing utilization of the latter. However, the differences in their postsurgical complication profiles are not wellcharacterized. Patients and Methods: Patients who underwent 1-2 level ACDFs for cervical radiculopathy or myelopathy between 2010 and 2022 were identified using the PearlDiver Mariner all-claims insurance database. Patients undergoing surgery for nondegenerative pathologies, such as tumors, trauma, or infection, were excluded. 1:1 exact matching was performed based on factors that were significant predictors of all-cause surgical complications in a linear regression model. The primary outcome measure was the development of all-cause surgical complications after 1-2 level ACDFs. The secondary outcome was all-cause medical complications. Results: 1:1 exact matching resulted in two equal groups of 11,430 patients who received treatment with synthetic interbody devices or allograft/autograft. No statistically significant difference in all-cause surgical complications was found between the synthetic cohort and the allograft or autograft cohort after 1-2 level ACDFs (Relative Risk: 0.86, 95% confidence interval: 0.730–1.014, P = 0.079). No significant differences were observed regarding any specific surgical complications except for pseudoarthrosis (Relative Risk: 0.73, 95% confidence interval: 0.554–0.974, P = 0.037), which was higher in the allograft/autograft cohort. Conclusion: After 1:1 exact matching to control for confounding variables, the findings of this study suggest that all-cause surgical complications are similar in patients undergoing ACDFs with synthetic interbody devices or allograft/autographs. However, the rate of pseudarthrosis appears to be higher in patients with allograft/autographs. Future prospective studies are needed to corroborate these findings. [ABSTRACT FROM AUTHOR]

This systematic review aimed to investigate the efficacy of orthodontic tooth movement (OTM) through bone regenerated with osteoconductive grafts, together with the risk of root resorption (RR), in relation to the material and the timing of force initiation. Following PRISMA-ScR guidelines, three major electronic databases were searched (PubMed, EMBASE, and Cochrane). Only studies which reported on the primary outcome (OTM rate) were included. Investigations with fewer than 3 participants/groups and an absence of controls were excluded. The final sample consisted of 16 randomized and controlled clinical trials. Among them, 9 reported on RR (the secondary outcome). The articles showed substantial heterogeneity and low-moderate quality. Most studied OTM through alloplasts (7) and xenografts (8), 3 addressed allografts, 3 autografts and 6 analyzed 2 grafts. Timing for force initiation varied from 0 to 13 weeks post-grafting. Based on limited evidence, it can be cautiously concluded that most graft materials have either no impact or slightly impair OTM, with no significant increase in RR. Xenografts might impede OTM and increase RR risk. The optimal timing for force application depends on the state of bone healing. Future studies are mandatory for deciding on the ideal graft and timing for optimal OTM in each clinical setup. [ABSTRACT FROM AUTHOR]