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OBJECTIVE@#To investigate the clinical efficacy of percutaneous screw fixation combined with minimally invasive transpedicular bone grafting and non-bone grafting in the treatment of thoracolumbar fractures.@*METHODS@#From Janury 2021 to June 2022, 40 patients with thoracolumbar fracture were divided into the experimental group and the control group. There were 26 patients in the experimental group, including 21 males and 5 females with an aberage age of (47.3±12.3) years old, who underwent percutaneous pedicle screw fixation combined with transpedicular autogenous bone grafting. In the control group, 14 patients received percutaneous pedicle screw fixation only. including 7 makes and 7 females with an average age of (50.2±11.2) years old. The operative time, intraoperative blood loss, anterior height ratio of injured vertebrae, Cobb angle, visual analogue score (VAS), MacNab scores, loosening or broken of the implants. were compared and analyzed.@*RESULTS@#There was no significant difference in operation time, intraoperative blood loss, VAS and anterior height ratio of injured vertebrae between the two groups. Compared with the preoperative results, VAS and anterior height ratio of injured vertebrae were improved statistically(P<0.05). For Cobb angle of injured vertebra, there was no significant difference between the two groups before surgery (P=0.766). While at 1 week, 3 months and 12 months after surgery, there were statistically differences between the two groups (P values were 0.042, 0.007 and 0.039, respectively). The Cobb angle of injured vertebrae one year after operation was statistically decreased in both groups compared with that before surgery (P<0.001). One year after surgery, the excellent and good rate of Macnab scores was 96.15% in the experimental group and 92.86% in the control group, and there was no statistical differences between the two groups (P=0.648). There was one patient in the control group suffering superficial wound infection on the third day, which was cured by dressing change and anti-infection treatment. There were no postoperative screw loosening and broken in both groups.@*CONCLUSION@#The two surgical methods have the advantages of less trauma, less pain and quicker recovery, which can restore the height of the injured vertebra, reconstruct the spinal sequence and reduce the fracture of the vertebral body. Transpedicular autogenous bone grafting can increase the stability of the fractured vertebra and maintain the height of the vertebra better after surgery, thus reducing the possibility of complications such as kyphosis, screw loosening and broken.
Subject(s)
Male , Female , Humans , Adult , Middle Aged , Pedicle Screws , Bone Transplantation , Blood Loss, Surgical , Lumbar Vertebrae/injuries , Thoracic Vertebrae/injuries , Fracture Fixation, Internal/methods , Spinal Fractures/surgery , Treatment Outcome , Retrospective StudiesABSTRACT
Objective To investigate the feasibility of emergency thumb reconstruction for traumatic thumb amputation with bone and tendon from the amputated part, when the soft tissue is severely damaged and the amputated thumb is not replantable. Methods When the soft tissues of the amputated thumb was severely damaged and replantation was not applicable, thumb reconstruction as phase one emergency management was proceeded. The skin and nail bed of the amputated thumb was removed. The bone was in situ replanted, and the tendon was repaired. The nail flap from the ipsilateral toe was grafted and the bone and tendon was wrapped around to reconstruct the thumb. Results A total of 5 patients underwent surgical treatment. All reconstructed thumbs survived with an appearance similar to the contralateral sides. The patients were followed up for 10 months on average (range, 4 to 18 months). The result of two-point discrimination test was 10.1 mm on average (range, 9.2-12.0 mm). The preserved joints possessed partial function. The average range of motion of the metacarpophalangeal joint was 69.6° (range, 20° to 90°). The range of motion of interphalangeal joint was 15° and 20° in 2 patients, respectively. No infection or bone resorption occurred. The injury was healed successfully in 4 patients, and delayed union occurred in one patient. Conclusion Complete bone and tendon from the nonreplantable amputated part combined with wrap-around flap can be used for emergency thumb reconstruction and it can achieve good clinical results.
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Objective: To summarize the management principle and clinical suggestions of the osteotomy gap of opening wedge high tibial osteotomy (OWHTO). Methods: The related literature of the osteotomy gap of OWHTO in recent years was reviewed, summarized, and analyzed. Results: Delayed union and non-union of the osteotomy gap are main complications of OWHTO. Tomofix plate, as locking steel plate, has the characteristics of angular stability and can better maintain the stability of the osteotomy gap, promote bone healing, and avoid loss of correction. There are some treatment options for the osteotomy gap site, such as, without bone, autologous bone graft, allogeneic bone graft, bone substitute materials graft, and augment factor graft to enhance bone healing. When the osteotomy gap is less than 10 mm, it achieves a good outcome without bone graft. For the obesity, lateral hinge fracture, large osteotomy gap, or correction angle more than 10°, the bone graft should be considered. In cases whose osteotomy gap is nonunion or delayed union, the autologous bone graft is still the gold standard. When the osteotomy gap repaired with the allogeneic bone graft, it is better to choose fragmented cancellous or wedge-shaped cancellous bone, combining with the locking plate technology, also can achieve better bone union. The bone substitute material of calcium-phosphorus is used in the osteotomy gap, which has the characteristics of excellent bone conduction, good biocompatibility, and resorption, combining with the locking plate technology, which can also achieve better bone union in the osteotomy gap. The augment factors enhance the bone healing of the osteotomy gap of OWHTO is still questionable. The bone union of the osteotomy gap is also related to the size of the osteotomy gap and whether the lateral hinge is broken or not. Conclusion: No matter what type of materials for the osteotomy gap, OWHTO can improve the function and relieve pain for knee osteoarthritis. More randomized controlled trials are needed to provide evidence for clinical decision to determine which treatment option is better for the osteotomy gap of OWHTO.
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Objetivos: Avaliar e comparar o comportamento do Fosfato de Cálcio Bifásico (FCB) na forma granulada e em pasta enxertados em seios maxilares de humanos, através da análise histomorfometrica e imunoistoquímica. Metodologia: Este estudo é do tipo Split mouth com radomização controlada, em que 10 pacientes participaram do estudo, 10 seios maxilares foram enxertados com FCB na forma de pasta e 10 com FCB na forma de grânulos. Aos 6 meses após a enxertia, foi colhida a biópsia para as análises histomorfometrica e imunoistoquímica. O teste de normalidade mostrou resultados paramétricos para todas as análises, portanto foi aplicado o teste t. Resultados: A média de quantidade de tecido ósseo foi de 1923705,9 ± 364393 µm2 para o grupo Grânulos e 1532468,7 ± 334892 µm2 para o grupo Pasta (p=0,0223), a média da quantidade de biomaterial foi de 1468571 ± 230879 µm2 para o grupo Grânulos e 1658428 ± 122324 µm2 (38,60%) para o grupo Pasta (p=0,0338) e a média da quantidade de tecido mole foi de 897786 ± 270137,9 µm2 para o grupo Grânulos e 1099166,5 ± 221947,3 µm2 para o grupo Pasta (p=0,0852), as marcações para a osteocalcina foi intenso para ambos os grupos. Conclusão: O FCB em forma de pasta, assim como o FCB em grânulos, pode ser utilizado adequadamente como substituto ósseo para enxerto em seio maxilar de humanos(AU)
Objectives: To evaluate and compare the behavior of Biphasic Calcium Phosphate (BCP) in granulated and paste form grafted on maxillary sinuses of humans, through histometric and immunohistochemical analysis. Metodology: This study is of the Split mouth type with controlled radomization, in which 10 patients participated in the study, 10 maxillary sinuses were grafted with BCP in the form of paste and 10 with BCP in the form of granules. At 6 months after grafting, a biopsy was taken for histometric and immunohistochemical analysis. The normality test showed parametric results for all analyzes, so the t test was applied. Results: The mean amount of bone tissue was 1923705.9 ± 364393 µm2 for the Granules group and 1532468.7 ± 334892 µm2 for the Pasta group (P = 0.0223), the average biomaterial amount was 1468571 ± 230879 µm2 for the Granules group and 1658428 ± 122324 µm2 (38.60%) for the Pasta group (P = 0.0338) and the average amount of soft tissue was 897786 ± 270137.9 µm2 for the Granules group and 1099166.5 ± 221947.3 µm2 for the Pasta group (P = 0.0852), the markings for osteocalcin were intense for both groups. Conclusion: BCP in paste form, like BCP in granules, can be used properly as a bone substitute for grafting in the maxillary sinus of humans(AU)
Subject(s)
Humans , Male , Female , Calcium Phosphates , Bone Substitutes , Sinus Floor Augmentation , Biocompatible Materials , Bone and Bones , Bone Transplantation , Maxillary Sinus/surgeryABSTRACT
Objective@#The aim of the present study was to evaluate the clinical outcomes of implant-supported prostheses for oral function rehabilitation in patients with ectodermal dysplasia.@*Methods @#Thirteen patients were included in the present study. After bone augmentation, zygomatic implants (ZIs) or regular implants (RIs) were placed, fabrication of dental prostheses were applied, and psychological and oral education was carried out. Implant survival rates, patient satisfaction and other related evaluation indicators were assessed. @*Results@#The ilium was chosen for autogenic bone grafts in two patients. The fibula was used in two other patients and the mandibular ramus in one other patient. One patient was treated through alveolar distraction osteogenesis of the mandible. Guided bone regeneration was applied in seven other patients. Bone graft resorption in the maxilla was observed in one patient; bone augmentation of the mandible was successful in all patients, and no obvious bone resorption was observed. One hundred and eighteen implants were placed, among which 22 were ZIs, and 96 were RIs. Five RIs failed and were removed. The survival rate for ZIs was 100%, and the survival rate for RIs was 94.79%, in a follow up after 3 years. All patients were satisfied with the restoration of their oral function. More than 50% of the patients exhibited self-confidence.@*Conclusion@# Oral function can be restored in edentulous ectodermal dysplasia patients using bone augmentation and implant-supported prostheses, and patient self-confidence can be enhanced. However, the resorption of grafted bone in the anterior region of the maxilla cannot be ignored.
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Objective To investigate the effect of platelet-rich plasma(PRP) combined with bone graft in the treatment of humeral condylar bone defect.Methods A total of 135 patients with humeral condylar bone defect in Ankang central hospital from January 2012 to December 2015 were divided into the PRP combined group(n =69) and the conventional group(n =66) according to the order of admission time.The patients of PRP combined group were treated with platelet-rich plasma combined with autologous bone graft,and patients of conventional group received autologous bone graft,respectively.The surgery time,hospitalization time,wound healing,fracture union and the motion of elbow joint at postoperative 1 year between two groups were compared.The Kaplan-Meier survival curve was used to reflect the bone healing in both groups,and the log-rank test was used to compare the result.Results There was no statistically significant difference in the surgery time,hospitalization time,wound healing and motion of elbow joint at postoperative 1 year between the two groups(P ＞ 0.05).But the average time of wound healing (3.8 ± 0.72) weeks and the time of bone union (18.8 ± 3.50) weeks in PRP combined group were significantly shorter than (6.4 ±0.58) weeks and (22.7 ± 1.55) weeks in the conventional group(P =0.000),the differences were significant.The KaplanMeier survival curve of the bone union in the PRP combined group was also significantly better than that in the conventional group.Conclusion PRP can promote the healing of fracture in patients with humeral condylar bone defect after autologous bone graft,which contributes to the recovery of elbow function.
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OBJECTIVES: The purpose of this study was to introduce our three experiments on bone morphogenetic protein (BMP) and its carriers performed using the critical sized segmental defect (CSD) model in rat fibula and to investigate development of animal models and carriers for more effective bone regeneration. MATERIALS AND METHODS: For the experiments, 14, 16, and 24 rats with CSDs on both fibulae were used in Experiments 1, 2, and 3, respectively. BMP-2 with absorbable collagen sponge (ACS) (Experiments 1 and 2), autoclaved autogenous bone (AAB) and fibrin glue (FG) (Experiment 3), and xenogenic bone (Experiment 2) were used in the experimental groups. Radiographic and histomorphological evaluations were performed during the follow-up period of each experiment. RESULTS: Significant new bone formation was commonly observed in all experimental groups using BMP-2 compared to control and xenograft (porcine bone) groups. Although there was some difference based on BMP carrier, regenerated bone volume was typically reduced by remodeling after initially forming excessive bone. CONCLUSION: BMP-2 demonstrates excellent ability for bone regeneration because of its osteoinductivity, but efficacy can be significantly different depending on its delivery system. ACS and FG showed relatively good bone regeneration capacity, satisfying the essential conditions of localization and release-control when used as BMP carriers. AAB could not provide release-control as a BMP carrier, but its space-maintenance role was remarkable. Carriers and scaffolds that can provide sufficient support to the BMP/carrier complex are necessary for large bone defects, and AAB is thought to be able to act as an effective scaffold. The CSD model of rat fibula is simple and useful for initial estimate of bone regeneration by agents including BMPs.
Subject(s)
Animals , Humans , Rats , Bone Morphogenetic Proteins , Bone Regeneration , Collagen , Fibrin Tissue Adhesive , Fibula , Follow-Up Studies , Heterografts , Models, Animal , Osteogenesis , PoriferaABSTRACT
OBJECTIVE To explore the application value of the cortical bone packing in external auditory bony canal and attic reconstruction in tympanoplasty.METHODS A total of 30 patients admitted during the period of middle ear cholesteatoma patients in our hospital from March 2014 to March 2016,were randomly divided to observation group and control group,the radical mastoidectomy with canal wall down was adopted in the control group,the radical mastoidectomy with canal wall down combined with bone autograft in the external auditory meatus and bony powder mastoid obliteration in observation group,the postoperative out-come between two groups were compared.RESULTS There was no significant difference between the speech frequency average air bone conduction and air conduction threshold before the treatment in two groups.There was significant difference between the speech frequency average air bone conduction and air conduction threshold after the treatment(P＜0.05),the air conduction threshold significantly reduced,the patients in the observation group were significantly lower than the control group,there was no recurrence of cholesteatoma in two groups of patients before and after the treatment during follow-up period;the dry ear time in observation group was significantly lower than that of the control group,and dry ear the incidence was significantly higher than that of the control group,the difference is statistically significant(t=2.758,4.865,P＜0.05).CONCLUSION Radical mastoidectomy with canal wall down combined with the cortical bone packing in external auditory bony canal and attic reconstruction,can effectively presesre the patient hearing,it should be recommended.
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Context: Both intraoral autogenous bone grafting (ABG) and platelet-rich fibrin (PRF) offer a useful treatment modality for periodontal regeneration of intrabony defects (IBDs). However, predictable regeneration in patients with severe attachment loss is a challenge to the practitioners. Aim: The aim of this study was to compare the clinical efficacy of PRF with ABG for the treatment of IBDs in chronic periodontitis. Settings and Design: This is a randomized controlled trial. Materials and Methods: Twenty chronic periodontitis patients with IBDs were randomly treated by PRF or ABG. Probing pocket depth (PPD), relative attachment level (RAL), surgical reentry bone fill, and radiographic bone fill (RBF) were recorded at baseline, 3, 6, and 9 months postsurgery, respectively. Statistical Analysis: Student's t-test was used for continuous variables. All means were expressed as mean ± standard deviation and proportions were expressed in percentage. The level of significance was set at P < 0.05. Results: Both PRF and ABG sites produced a significant improvement from baseline to 9 months for all the parameters. However, there was no significant difference between the two treatment modalities in the reduction of PPD and RAL gain at 9 months. In addition, ABG showed significantly greater RBF (30.34%) as compared to PRF (20.22%). Similar findings were supported by surgical reentry, where a surgical reentry of 65.31% at ABG sites and 43.64% at PRF sites was seen. Conclusion: Both ABG and PRF can be used predictably to reconstruct lost periodontal structures as indicated by PPD reduction and RAL gain. However, in terms of osseous defect fill, ABG yields more definitive outcome than PRF.
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Use of autologous bone grafts is common in orthopedic reconstruction. The most common source for autologous bone graft is the iliac crest. This procedure, however, may be associated with considerable morbidity. We reported a case of lumbar incisional hernia following prior anterior iliac crest bone harvesting in a female patient who had undergone bilateral total hip arthroplasty 2 years ago. She was hospitalized for acute pain in abdomen with vomiting and constipation, found to have herniation of left colon with incarceration through the abdominal wall defect above the iliac crest. She underwent successful mesh hernia repair. Despite its rarity, these hernias should be included within the differential diagnosis of flank masses.
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OBJECTIVE: To explore the effectiveness of stage I anterior approach debridement and autologous iliac crest graft with single self-locked titanium plate internal fixation for the treatment of lumbosacral tuberculosis. METHODS: Seven cases of lumbosacral tuberculosis were treated by stage I anterior approach debridement, autologous iliac crest graft, and single self-locked titanium plate internal fixation between February 2010 and October 2014. There were 5 males and 2 females, aged 18-65 years (mean, 41.6 years). The disease duration was 5-21 months (mean, 8 months). The patients had signs and symptoms of pain in lumbosacral region, radiating pain in unilateral lower limb or bilateral lower limbs, decreased muscular strength and disorders of superficial sensation. According to Frankel classification for spinal injury, 1 case was rated as grade C, 3 cases as grade D, and 3 cases as grade E. Preoperative imaging examination suggested L5, S1 lesions in line with the manifestations of tuberculosis; the lumbosacral angle was 16.4-28.5° (mean, 18.6°). The erythrocyte sedimentation rate was 28-105 mm/1 hour (mean, 61 mm/1 hour). All patients received 4-drug antituberculosis therapy. RESULTS: All patients underwent the operation successfully and all incisions healed at stage I, without relevant complication. All patients were followed up 14-70 months (mean, 25.6 months). All symptoms of tuberculosis disappeared and the erythrocyte sedimentation rate returned to normal. At last follow-up, Frankel classification was returned to E from D in 3 cases, returned to D from C in 1 case. Two cases suffered from pains in the lumbosacral region and at the donor site, 1 case suffered from upper abdominal discomfort and poor appetite,but these symptoms disappeared after symptomatic treatment. At last follow-up, X-ray examination indicated that the lumbosacral angle was 23.4-34.2° (mean, 28.6°). According to Bridwell criteria, 5 cases gained grade I bone fusion, and 2 cases gained grade II bone fusion, without migration of bone graft, or loosening or breakage of titanium plate or bolt. CONCLUSIONS: Stage I anterior approach debridement and autologous iliac crest graft with single self-locked titanium plate internal fixation is safe and effective in treating lumbosacral tuberculosis. It can achieve good bone fusion and stable lumbosacral stability, and maintain good deformity correction.
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Objective To explore the clinical effect of autogenous bone,allograft bone and BMP synthetic bone in the treatment of lum-bar spondylolisthesis,and provide more basis to choose transplant material.Methods A total of 96 patients with lumbar spondylolisthesis were chosen as research subjects,who were cured in our hospital from January 2014 to January 2015.They were divided into group A(who were treated with autogenous bone),group B(who were treated with allograft bone)and group C(who were treated with BMP synthetic bone), according to prospective study method.The indicators of the operation,postoperative adverse reactions,change of intervertebral disc height and bone graft fusion rate of three groups were compared.Results Difference of the operation indexes of three groups had no statistical sig-nificance(P >0.05).The incidences of adverse reactions in group A and group C had no statistically significant difference(P >0.05),but both less than that in group B,with statistically significant difference(P 0.05),but both more than that in group B,with statistically significant difference(P 0.05).And the fusion rates of group A and C in each period were significantly higher than that of group B,with statistically significant difference(P 0.05),but both better than that of group B,with statistically significant difference (P <0.05).Conclusion BMP synthetic bone used in lumbar spondylolisthesis has the same clinical effect as autologous bone.But BMP synthetic bone has faster bone graft fusion rate than autologous bone.And it is beneficial to patients’recovery.
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Neste relato de caso clínico, uma paciente de 63 anos de idade apresentou-se totalmente edêntula e usuária de prótese totais há mais de 40 anos, com mordida cruzada posterior unilateral e insatisfação estética. Após uma explanação sobre as opções de tratamento existentes, a paciente optou pelos implantes dentários e novas próteses totais fixas. Após a realização dos exames radiográficos e levantamento bilateral do seio maxilar para enxertia com osso do ramo mandibular, oito implantes foram colocados nas regiões posteriores, e cinco implantes colocados entre os forames mentuais, sendo as próteses reembasadas com material macio. Após a osseointegração, foram realizados os procedimentos de transferência e montagem dos dentes artifi ciais. Ambas as infraestruturas foram desenhadas para a individualização das coroas, sendo fundidas em liga de Ni-Cr, e recebendo o suporte labial em porcelana rosa. Após a prova intraoral, o aspecto metálico foi mascarado com agente opacificador, as embocaduras dos parafusos selados com fita teflon, e as coroas cerâmicas de dissilicato de lítio cimentadas com agente resinoso dual. Além da possibilidade de higienização e troca individual das coroas em momentos de falhas, o que evita um custo elevado se a infraestrutura fosse completamente em cerâmica, esta modalidade de tratamento resgata com segurança a harmonia e a naturalidade do sorriso.
In this clinical case report, a 63 years-old patient presented with complete conventional dentures (more than 40 years of use), having posterior unilateral crossbite and esthetic failure. After explaining the available treatment options, dental implants and new complete fixed prostheses were selected. Upon radiographic and bilateral sinus grafting with autogenous bone from the mandibular ramus, 8 dental implants were placed at the posterior maxillary regions and 5 dental implants between the mental foramina, being the prostheses relined with a soft material. After the osseointegration period, the transferring procedures were made for artifi cial tooth setup. Both maxillary and mandibular infrastructures were designed to receive individual crowns, cast in Ni-Cr alloy, and receive labial support with pink porcelain. After intra-oral try-in, the metallic aspect was masked with opaque paste, the screw access channels sealed with Tefl on tape, and the lithium disilicate crowns cemented with a dual resin agent. Besides the chance for homecare oral cleaning and individual crown replacement in case of failures to avoid excessive costs compared to complete ceramic infrastructures, this treatment modality provides safety and harmony for a more natural-looking smile.
Subject(s)
Aged , Bone Transplantation , Tooth Crown , Dental Implantation , Dental Prosthesis, Implant-Supported , Dental Prosthesis DesignABSTRACT
As fenestrações das paredes alveolares são relativamente comuns durante o procedimento cirúrgico para instalação de implantes. O objetivo do presente trabalho foi relatar um caso clínico de reconstrução de fenestração peri-implantar imediatamente após a instalação de implante osseointegrável, através de enxerto ósseo autógeno em bloco obtido do ramo mandibular. Paciente do sexo masculino procurou o Departamento de Cirurgia e Clínica Integrada para trocar sua prótese parcial removível classe IV de Kennedy por prótese parcial fixa implantossuportada. Foram instalados dois implantes nos espaços protéticos correspondente aos dentes 12 e 21. Houve uma fenestração peri-implantar da parede vestibular durante a instalação do implante correspondente ao dente 12, que foi reconstruídapor meio de enxerto autógeno em bloco obtido do ramo mandibular e fixado por meio de parafuso bicortical. Após seis meses de concomitante período de incorporação do enxerto ósseo autógeno e osseointegração, iniciou-se o processamento para confecção da prótese parcial fixa implantossuportada. Diante da reabilitação protética alcançada, concluiu-se que o enxerto ósseo autógeno obtido da área doadora ramo mandibular constitui uma alternativa segura e eficaz para reconstrução de defeitos peri-implantares em forma de fenestração óssea...
Alveolar wall fenestrations are common during implant placement. The aim of this paper is to report a case where a peri-implant bone fenestration was reconstructed immediately after implant placement by an autogenous mandibular bone block. A male patient was referred to the Department of Surgical and Integrated Clinics to substitute his Kennedy´s Class IV removable partial denture for an implantsupported fixed prosthesis. A peri-implant bone fenestration at the buccal wall was seen at the region of 12, being reconstructed by a mandibular bone block secured by a bicortical screw. Six months later the surgical procedures, an implant-supported complete fixed partial prosthesis was developed. The autogenous bone block harvested from the mandibular ramus was a safe alternative to reconstruct the peri-implant bone defect such as fenestration types...
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Humans , Male , Adult , Bone Transplantation , Dental Implants , Mandibular Reconstruction , Mouth RehabilitationABSTRACT
A proposta deste estudo foi avaliar a capacidade osteocondutora da forma sólida do copolímero de PLA/PGA em um modelo experimental de enxerto em seio maxilar . Vinte coelhos machos, branco, da raça Nova Zelândia, cada um pesando cerca de 3,0 kg, foram utilizados e foram divididos em dois grupos de acordo com o material de preenchimento do seio, como segue: ósseo autógeno particulado e copolímero PLA/PGA . A área aumentada diferiu entre os grupos após 3, 7 e 15 dias (p = 0,004) . No entanto, os valores tornaram-se semelhante aos 40 dias (p = 0,458). Depois de 3 e 7 dias, a porcentagem óssea foi estatisticamente significativa entre osso autógeno e PLA / PGA copolímero (P = 0,004 e P = 0,004). Após 15 e 40 dias os valores foram semelhantes nos dois períodos (P = 0,087 e P = 0,087 ). Imunohistoquímica confirma os resultados sobre os dados histomorfométricos. Em conclusão, o copolímero de PLA/PGA parece ser adequado como material reabsorvível capaz de induzir o crescimento do osso em defeitos ósseos. Esta observação sugere que o material tem propriedades osteocondutoras também apropriado para aplicação em cirurgia maxilo-facial...
The proposition of this study was evaluate the osteoconductive capability of the solid form of PLA/PGA copolymer in an experimental model of maxillary sinus grafting. Twenty male white New Zealand rabbits, each weighing about 3.0kg, were used and were divided into two groups, according to the sinus filling material, as follows: autogenous bone chips and PLA/PGA copolymers. Augmented area differ between the groups after 3, 7 and 15 days (P=0.004). However, the values became similar on day 40 (P=0.458). After 3 and 7 days the percentage of bone was statistically significant between autogenous bone and PLA/PGA copolymer (P=0.004 and P=0.004). After 15 and 40 days the values were comparable in the two periods (P=0.087 and P=0.087). Immunohistochemistry confirms the results on the histomorphometric data. In conclusion, PLA/PGA copolymer seems to be suitable as resorbable material able to induce bone growth in bone defects. This observation suggests that the material have osteoconductive properties also suitable for application in maxillofacial surgery...
Subject(s)
Animals , Rabbits , Bone Transplantation , Maxillary Sinus , Polyglycolic AcidABSTRACT
Este relato de caso clínico descreve o uso da rhBMP-2/ACS para reconstrução de defeitos ósseos na região mandibular anterior. Paciente do sexo feminino, 63 anos de idade, mostrava esplintagem dos elementos 31 e 41 com resina composta e sinais de periodontite. Uma perda óssea alveolar extensa em forma de sela (15 mm de altura x 10 mm de largura) foi detectada nos exames radiográficos 2D e 3D (TCFC). O plano de tratamento incluiu: extração dentária, colocação de osso autógeno mentoniano, osso mineral anorgânico homógeno, rhBMP-2/ACS e tela de titânio, na mesma sessão. Após seis meses, uma nova cirurgia foi realizada para colocação de dois implantes de titânio (torque fi nal de inserção 35 Ncm), que foram deixados submersos. Uma biopsia, 12 meses após o enxerto, foi realizada e os resultados histológicos mostraram tecido ósseo viável sem sinais inflamatórios. A única intercorrência pós-operatória foi o edema esperado (dez dias). Duas coroas metalocerâmicas individuais foram confeccionadas sobre os cilindros calcináveis e entregues ao paciente. Dentro dos limites do caso e da extensão do defeito, resultados clínicos excelentes foram obtidos pela combinação dos biomateriais e dos implantes osseointegrados
This case report describes the use of rhBMP-2/ACS to reconstruct anterior mandibular bone defects. A 63 years-old female patient presented with a composite resin splinting at teeth 31 and 41 showing signs of periodontitis. A saddle-like extensive bone loss (15 mm in height x 10 mm in length) was detected on 2-D and 3-D (CBCT) image examination. The treatment planning included tooth extraction, chin bone graft, annorganic mineral graft, rhBMP-2/ACS, and a titanium mesh in the same clinical procedure. Six months later, the site was opened for dental implant placement (final insertion torque: 35 Ncm) and submersed healing. A biopsy was taken after 12 months and the histological results demonstrated viable bone tissue with no signs of inflammation. However, as expected, postoperative complications included edema in the grafted region. Finally, two metalloceramic restorations over burnout prosthetic cylinders were delivered to the patient. Within the limits of the bone defect, excellent clinical outcomes were observed by combining different biomaterials and osseointegrated implants.
Subject(s)
Humans , Female , Middle Aged , Alveolar Bone Loss , Dental Implantation , Dental Implantation, EndosseousABSTRACT
PURPOSE: Fibrous dysplasia is related to the mutation of gene encoding the alpha-subunit of a signal-transducing G-protein and has variable clinical course. Operation can be performed to prevent functional disorder or structural deformity. After curettage, autologous bone graft were used to fill the defects after curettage. The aim of this study is to compare the result of autogenous cancellous bone grafting and allogenic bone grafting for fibrous dysplasia. MATERIALS AND METHODS: Among the patients who visit our hospital during the period of April, 1997 to October, 2013, we selected 34 patients who diagnosed fibrous dysplasia and visited our clinic over 1 year. There were 13 males and 21 females. Average age was 26.4 (range 2 to 57) years old. Autogenous bone graft (group I) in 5 cases, Non-autogenous bone graft (group II) in 30 cases. Iliac bone is used in all cases of autogenous bone graft. There were no significant difference in age, follow-up period, preoperational laboratory finding between two groups. Radiographic image was done to evaluate the recurrence of fibrous dysplasia or secondary degeneration. RESULTS: There were four cases in recurrence (group I: 1 case, group II: 3 cases, p=0.554). In all recurrent cases, reoperations were done using curettage and autogenous iliac bone graft. There was no re-recurrence after reoperation. One case of secondary aneurysmal bone cyst was confirmed (group II) and 1 cases of pathologic fractures had developed (group I: 0 case, group II: 1 cases, p=0.559). No malignant change occurred. CONCLUSION: There were no significant difference between autogenous bone graft group and non-autogenous bone graft group. Our result suggested that autogenous bone graft seems to be good method to treat fibrous dysplasia, in the case of small volume of tumor lesion or non-weight bearing portion.
Subject(s)
Female , Humans , Male , Aneurysm , Bone Cysts , Bone Transplantation , Congenital Abnormalities , Curettage , Follow-Up Studies , Fractures, Spontaneous , GTP-Binding Proteins , Recurrence , Reoperation , TransplantsABSTRACT
Objective The purpose of this study was to evaluate the outcome of autogenous bone grafts in unilateral cleft lip and palate patients following early orthodontic tooth movement,and to determine the volume of new bone formation in the bone grafted region with spiral computed tomography.Methods Computed tomography scans of 12 patients were taken immediately preoperatively and at 6 months postoperatively.The patients underwent bone grafting between 9 and 13 years of age were divided into two groups based on whether postoperative orthodontic tooth movement were initiated or not.Three-dimensional models were created in each period,and the defect of alveolar cleft and volume of the newly formed bone were calculated in each patient.The roots of the moved teeth and their positions to the alveolar bone were also observed.Results The preoperative cleft width and cleft volume were not significantly different between both groups.The volume of the newly formed bone in group A was (0.98±0.23) mm3,significantly higher than that in group B,which was (0.73± 0.15) mm3.The rate of newly formed bone in group A was (72.5 ± 11.9)％,significantly higher than that in group B,which was (53.2±9.7)％.The cleft adjacent teeth could move smoothly into the bone grated area,with no root resorption observed in the computed tomography scans.Conclusions Early orthodontic tooth movement can reduce bone resorption in autogenous bone grafted unilateral cleft lip and palate patients through the observation of spiral computed tomography.It plays an active role in the bone remolding process after bone grafting.
ABSTRACT
Surgical procedures involving the rehabilitation of the maxillofacial region frequently require use of bone grafts. Bone graft follow-up is generally done through clinical analysis and especially through image tests, although few studies specifically correlate both. The object of this research was to establish a relation between radiographic exams and the bone repair process stage in created defect with autogenous bone, blood clot and anorganic bovine bone matrix. Three 8 mm diameter defects were performed in the parietal bone of 6 male adult beagle dogs, choosing the selected graft for each defects; 3 and 6 week period were used for radiographic and histological analyses. The result show that autogenous bone and blood clot were similar between histological and radiograph analyses; for heterogeneous bone was present areas described how bone in radiograph that were residual particles in histological exam. We concluded that radiographic tests could be used as a parameter for reconstruction follow-up only when autogenous bone graft is used.
Los procedimientos que envuelven la rehabilitación de la región maxilofacial frecuentemente requieren el uso de injertos óseos. El seguimiento de la evolución del injerto óseo frecuentemente es realizado con análisis clínico y especialmente a través de estudios de imágenes, aunque pocos estudios han correlacionado ambos. El objetivo de esta investigación fue establecer la relación entre radiografías y las etapas de la reparación ósea en defectos creados con hueso autógeno, coagulo sanguíneo y matriz ósea de hueso bovino. Tres defectos de 8 mm de diámetro fueron realizados en el parietal de 6 perros adultos, escogiendo el injerto seleccionado para cada defecto; 3 y 6 semanas después fueron realizados los estudios histológicos y radiográficos. Los resultados mostraron que el hueso autógeno y el coágulo sanguíneo presentaron semejanzas en los análisis histológico y radiográfico; para el hueso bovino se observó áreas decritas como hueso en la radiografia mientras realmente fueron partículas de hueso heterogeno descritas en el análisis histológico. Concluimos que el test radiográfico puede ser usado como parámetro para la reconstrucción y seguimiento preferentemente cuando es usado el injerto autógeno.
Subject(s)
Animals , Dogs , Autografts , Biocompatible Materials , Bone Regeneration , Bone Transplantation/methods , Blood Coagulation , Cattle , Bone Matrix/transplantation , Transplantation, AutologousABSTRACT
Objetivo: A proposta deste estudo foi avaliar a regeneração óssea de defeitos criados cirurgicamente e naturais circunferenciais (gap) de implantes pósexodônticos. Materiais e método: Para este estudo foram utilizados 8 cães da raça labrador, nos quais foram instalados implantes imediatos (pós-exodônticos) nos alvéolos dos dentes P2 (2o pré-molar) e M1 (1o molar) inferiores bilaterais. Nos implantes da região dos 2º pré-molares bilaterais foram criados cirurgicamente defeitos peri-implantares vestibulares que foram preenchidos de um lado por osso autógeno OA e do outro por osso bovino inorgânico Bio-Oss®- OB. Nos alvéolos correspondentes aos primeiros molares (M1) os implantes foram instalados e os gaps (defeitos naturais) existente entre a tábua óssea vestibular e o implante, foram preenchidos por Bone Ceramic® - (grupo BC) ou somente coágulo (grupo COA). Todos os sítios cirúrgicos foram posteriormente recobertos por membrana de colágeno reabsorvível (Biogide ®) e mantidos com cicatrizador. Após 4 meses de pós-operatório, os animais foram eutanasiados e os blocos ósseos processados laboratorialmente para análise histomorfométrica. Resultados: Os resultados obtidos nos implantes instalados na região do P2 mostraram que os valores do IS-C foram ligeiramente maior (2.3±0.8mm) no grupo OA, comparado ao grupo OB (1.7± 0.7 mm), enquanto o IS-B dos grupos OA e OB foram respectivamente de 2.7±0.7mm e 2.2±1.0 mm no lado vestibular e de 1.6±0.8mm e 0.8±0.5mm no lado lingual. As médias dos valores de PM-C, PM-B e PM-IS no grupo OA e OB foram respectivamente de 4.3±0.9mm, 4.7±0.9mm, 2.0±1.6mm e 4.3±0.6mm, 4.8±0.6mm, 2.5±0.8mm. A diferença estatística significativa foi observada somente na espessura da crista óssea vestibular de 2 a 5 mm em direção ao IS (pescoço do implante), incluindo o biomaterial (S-OCbt) que se apresentou maior no grupo OB. Nos implantes instalados na região do M1, o gap vestibular horizontal foi de 1.1 (COA) e 1.4 mm (BC) e vertical de 3 e...
Objective: The purpose of these studies were to evaluate bone regeneration at natural or surgically-created buccal defects at implants placed immediately into extraction sockets (IPIES). Material and methods: Eight Labrador dogswere used and implants were placed immediately into the extraction sockets of P2 (second premolar) and M1 (first molar), bilaterally. At P2, the buccal wall of the extraction sockets was removed bilaterally to create a standardized defect, 4 mm wide coronally, 2 mm wide apically, and 6 mm height. At P2 sites, Bio-Oss at the test (OB) or autogenous bone at the control (OA) sites were used to fill the defects. At M1 sites, Bone Ceramic ® at the test (BC) or the clot alone (COA) were used to fill the defects. All surgical sites were subsequently covered by a resorbable collagen membraneand a non-submerged healing was allowed. After 4 months the animals were euthanized, bone blocks harvested and processed for histomorphometric analysis. Results: at P2 sites, IS- C values were slightly higher (2.3±0.8mm) in the OA compared to the OB (1.7±0.7 mm). IS- B were 2.7 ± 0.7mm and 2.2 ± 1.0mm on the buccal side and 1.6 ± 0.8mm and 0.8 ± 0.5mm on the lingual side at OA and OB groups, respectively. The average values of PM- C , B - PM and PM -IS in OA and OB groups were 4.3 ± 0.9mm , 4.7 ± 0.9mm , 2.0 ± 1.6mm and 4.3 ± 0.6mm , 4.8 ± 0.6mm , 2.5 ± 0.8mm, respectively. A statistically significant difference was only observed in the thickness of the buccal bony crest at 2-5 mm apically to IS (the implant neck) when the biomaterial (S -OCbt) was included in the measurement, which appeared to be higher in the OB group. At M1 sites, at the time of installation, the horizontal buccal gap was 1.1 at the COA and 1.4 mm at the BC sites while the vertical remaining defect was 3 mm and 4 mm deep in the control and test sites, respectively. At the buccal aspect, IS-C was higher in the COA (0.6 ± 1.6mm) compared to the BC (0.1 ± 1.8mm) groups and IS- B was...