Assessment of the osteogenic effect after maxillary sinus floor elevation and simultaneous implantation with or without bone grafts by analyzing trabecular bone parameters: a retrospective study

Abstract Objective: The aim of this population-based retrospective study was to compare the osteogenic effect of newly formed bone after maxillary sinus floor elevation (MSFE) and simultaneous implantation with or without bone grafts by quantitatively analyzing trabecular bone parameters. Methodology: A total of 100 patients with missing posterior maxillary teeth who required MSFE and implantation were included in this study. Patients were divided into two groups: the non-graft group (n=50) and the graft group (n=50). Radiographic parameters were measured using cone beam computed tomography (CBCT), and the quality of newly formed bone was analyzed by assessing trabecular bone parameters using CTAn (CTAnalyzer, SkyScan, Antwerp, Belgium) software. Results: In the selected regions of interest, the non-graft group showed greater bone volume/total volume (BV/TV), bone surface/total volume (BS/TV), trabecular number (Tb. N), and trabecular thickness (Tb. Th) than the graft group (p<0.001). The non-graft group showed lower trabecular separation (Tb. Sp) than the graft group (p<0.001). The incidence of perforation and bleeding was higher in the graft group than in the non-graft group (p<0.001), but infection did not significantly differ between groups (p>0.05). Compared to the graft group, the non-graft group showed lower postoperative bone height, gained bone height and apical bone height (p<0.001). Conclusion: MSFE with and without bone grafts can significantly improve bone formation. In MSFE, the use of bone grafts hinders the formation of good quality bone, whereas the absence of bone grafts can generate good bone quality and limited bone mass.

Uso de Sistema Vivostat® como hemoderivado sellador de abordajes en cirugía ortognática y reconstrucciones de los maxilares, reporte de 23 casos / Use of the Vivostat® system as a sealing blood product for approaches in orthognathic surgery and maxillary reconstructions, report of 23 cases

El presente trabajo tiene como propósito presentar 23 casos operados en distintas prácticas privadas, donde se utilizaron adhesivos de fibrina para: cirugía ortognática bimaxilar, expansión palatina rápida asistida quirúrgicamente (SARPE), y reconstrucciones de rebordes atróficos maxilares y mandibulares empleando injertos e implantes. El uso del adhesivo de fibrina del sistema Vivostat® permitió no solo sellar los abordajes quirúrgicos, sino también fue un excelente complemento en estas cirugías para la cobertura de la mucosa de fosas nasales y mucosa antral que se dañan durante las osteotomías y accesos quirúrgicos. Junto con adquirir ventajas, como variabilidad de factores de crecimiento y protección de los injertos subyacentes en las regiones operadas, se obtienen asimismo una posible disminución de la incidencia en los sangramientos postoperatorios, principalmente epistaxis; con lo cual se brinda al paciente una mejor recuperación en el postoperatorio y evita la posibilidad de dehiscencias y, o aperturas de heridas operatorias con exposición de injertos y de elementos de osteosíntesis subyacentes.

The purpose of this paper is to present 23 operative cases in different private practices, where fibrin adhesives were used for: bimaxillary orthognathic surgery, surgically assisted rapid palatal expansion (SARPE), and maxillary and mandibular atrophic ridge reconstructions using grafts and implants. The use of the fibrin adhesive of the Vivostat® system allowed not only sealing the surgical approaches, but was also an excellent complement in these surgeries for covering the mucosa of the nasal passages and antral mucosa that are damaged during osteotomies and surgical accesses. Along with acquiring advantages, as well as growth factors and protection of the underlying grafts in the operated regions, a possible decrease in the incidence of postoperative bleeding was obtained, mainly epistaxis; with which the patient is given a better recovery in the postoperative period and avoids the possibility of dehiscences and/or openings of surgical wounds with exposure of grafts and underlying osteosynthesis elements.

Fracturas del platillo tibial con hundimiento articular. Comparación entre reconstrucción con injertos óseos y sustitutos sintéticos. Revisión bibliográfica sistematizada / Depressed tibial-plateau fractures, a comparison between bone graft reconstruction and synthetic substitutes. Systematic bibliographic review / Fraturas do platô tibial com afundamento da articulação: comparação entre reconstrução com enxerto ósseo e substitutos sintéticos

Objetivo: comparar si existe diferencia en resultados clínicos, radiológicos y funcionales con el uso de diferentes tipos de injertos óseos o sustitutos sintéticos, así como tiempo quirúrgico y consolidación para el tratamiento de fracturas de platillo tibial con hundimiento articular en pacientes mayores de 18 años. Material y método: se realizó una búsqueda sistematizada en bases de datos de literatura médica, PubMed, Lilacs, Scielo, Cochrane y portal Timbó. Se utilizaron términos "tibial plateau fracture", "bone grafting", "bone substitutes". Se incluyeron estudios comparativos en seres humanos, pacientes mayores de 18 años, fracturas de platillo tibial que asociaron hundimiento articular, en los cuales se realizó aporte de injerto óseo o material sintético. Artículos en español, inglés, portugués. Publicaciones enero 1980 y diciembre 2021. Se obtuvieron 10 artículos. Resultados: los tipos de injertos y sustitutos óseos encontrados fueron 10. Las muestras en sumatoria total 524 pacientes. La edad promedio fue 49 años. El promedio de seguimiento fue de 12 meses. Se dividieron los estudios en tres grupos: comparación entre injerto autólogo (IOA) e injerto alogénico, IOA con sustitutos sintéticos, y los que comparan sustitutos sintéticos entre sí. El aloinjerto y los sustitutos sintéticos demostraron no ser inferiores en resultados clínicos, funcionales e imagenológicos, mejorando los tiempos intraoperatorios y disminuyendo complicaciones en el sitio donante con respecto al IOA. Conclusiones: el IOA continúa siendo el gold standard a pesar de sus posibles complicaciones vinculadas al sitio donante. El aloinjerto y los sustitutos sintéticos representan una opción válida para tratar estas lesiones.

Objective: to find out whether there are clinical, radiological and functional differences when using different types of bone grafts or synthetic substitutes, as well as surgical times and consolidation to treat depressed tibial-plateau fractures in patients older than 18 years old. Method: a systematized search was conducted in medical literature, PubMed, Lilacs, Scielo, Cochrane and Timbó portal databases using the following terms: "tibial plateau fracture", "bone grafting", "bone substitutes". The study included comparative studies in human patients older than 18 years old with depressed tibial-plateau fractures who were treated with bone grafts or synthetic materials. Publications in Spanish, English and Portuguese, between January, 1980 and December, 2021 were included in the search, what resulted in 10 articles found. Results: there were 10 kinds of bone grafts and bone substitutes found. Samples added up to 524 patients. Average age was 49 years old. Average follow up was 12 months. Studies were divided into 3 groups: comparison between autologous bone grafts and allogenic bone grafts, comparison between autologous grafts and synthetic substitutes and studies comparing synthetic substitutes with one another. Allogenic grafts and synthetic grafts proved at least equivalent in terms of clinical, functional and imaging studies results, improving intraoperative times and reducing complications in donor site when compared to autologous grafts. Conclusions: autologous grafts continue to be the gold standard despite possible complications associated to the donor site, and allogenic grafts and synthetic substitutes constitute a valid option to treat these lesions.

Objetivo: comparar os resultados clínicos, radiológicos e funcionais com o uso de diferentes tipos de enxertos ósseos ou substitutos sintéticos, bem como tempo cirúrgico e consolidação para o tratamento de fraturas do platô tibial com colapso articular em pacientes com mais de 18 anos. Material e método: foi realizada busca sistemática nas bases de dados da literatura médica, PubMed, Lilacs, SciELO, Cochrane e portal Timbó. Utilizaram-se os termos "tibial plateau fracture", "bone grafting", "bone substitutes". Foram incluídos estudos comparativos incluindo seres humanos maiores de 18 anos e fraturas do platô tibial associadas a colapso articular, nas quais foi realizado enxerto ósseo ou sintético, publicados entre janeiro de 1980 e dezembro de 2021 em espanhol, inglês e português. Foram obtidos 10 artigos. Resultados: foram identificados 10 tipos de enxertos e substitutos ósseos. 524 pacientes com idade média de 49 anos foram estudados. O seguimento médio foi de 12 meses. Os estudos foram divididos em 3 grupos: comparação entre enxerto autólogo (IOA) e enxerto alogênico, IOA com substitutos sintéticos e substitutos sintéticos entre si. O aloenxerto e os substitutos sintéticos mostraram-se não inferiores nos resultados clínicos, funcionais e de imagem, melhorando os tempos intraoperatórios e reduzindo as complicações da área doadora em relação à IOA. Conclusões: o IOA continua a ser o padrão ouro apesar de suas possíveis complicações relacionadas ao local doador; tanto o aloenxerto como os substitutos sintéticos representam uma opção válida para tratar essas lesões.

Bone Augmentation in Extrusive Teeth Repositioned Using Bone Grafts

ABSTRACT@#Extrusive luxation is a traumatic dental injury (TDI) due to the action of forces, especially in the oblique angle. Partial displacement of the tooth is one of its characteristics. Repositioning is the treatment of choice for this type of trauma. The mechanism of bone augmentation and splint in managing the post extrusive luxation teeth reposition was explored and reported. An 18-year-old male with a history of traffic accident which caused extrusive luxation of 11 and 21 with no alveolar bone fracture. The patient was managed by repositioning the teeth and applicating arch-bar on anterior maxillary teeth. After eight weeks of evaluation, periapical radiograph showed the distal bone of 21 had radiolucent appearance followed by Class 1 mobility. The arch-bar was removed, and the periosteal flap was made on the buccal side of 21 and the distal part was curetted then irrigated with 0.9% sodium chloride, then supplemented with bone graft material and pericardium membrane. Lastly, the flap was returned, the tooth was then stabilised using self-curing adhesive resin cement (Super-Bond). The tooth was kept under observation for two months. It was observed that the tooth was asymptomatic and still in function with no radiographic signs of pathosis. These results suggested that tooth reposition might be an alternative to prosthetic or implant dentistry. However, further human research is recommended with long standing follow-up periods and comparative studies to be carried out to identify whether dental implant replacement or reposition is the cost-effective treatment for extruded tooth.

Retrospective study on the merits of bone grafts and the influence of implant protrusion length after osteotome sinus elevation surgery / 华西口腔医学杂志

OBJECTIVES@#This study aims to evaluate the endo-sinus bone remodeling of dental implants placed via osteotome sinus floor elevation (OSFE) after 6 months and using different implant protrusion lengths and bone grafts through cone beam computed tomography (CBCT).@*METHODS@#Ninety-six patients with 124 implants were included and assigned into four groups. Group 1: implant protrusion length4 mm with bone graft; group 3: implant protrusion length4 mm without bone graft. Apical bone gain (ABG), cortical bone gain (CBG), bone density gain (BDG), and marginal bone loss (MBL) were observed and analyzed at baseline and 6 months after implant surgery.@*RESULTS@#The CBG in grafted groups 1 and 2 was higher than that in non-grafted groups. The ABG and BDG were higher in non-grafted groups 3 and 4 than in grafted groups, and the levels in group 3 were higher than those in group 4. The CBG in grafted group 2 was higher than that in group 1. No significant difference was observed in MBL analysis.@*CONCLUSIONS@#The BDG of IPL4 mm implant when bone grafts were not applied. No relevance was observed between IPL and CBG. Bone grafts can accelerate endo-sinus bone remodeling by increasing CBG and dissipating the influence of IPL on BDG.

Utilización de biomateriales e injertos óseos autólogos en pacientes con atrofia alveolar / Bibliographic update on the use of biomaterials and autologous bone grafts in patients with alveolar atrophy

RESUMEN El material de elección para el reemplazo del hueso perdido por traumatismos, procesos patológicos congénitos o adquiridos y atrofia, son los injertos óseos autógenos o autólogos (hueso del propio paciente). A partir de la introducción del concepto de osteointegración por Branemark, los implantes dentales son parte de la terapéutica diaria para rehabilitar áreas edéntulas. La atrofia alveolar es quizás una de las condiciones bucales más incapacitantes; la razón reside en que es crónica, progresiva, acumulativa e irreversible, altera las relaciones maxilomandibulares, reduce la cantidad de hueso del área dentosoportada y la profundidad del surco. El material de injerto óseo ideal no debería ser sólo un sustituto óseo, sino un material de regeneración que se reabsorba completamente de modo simultáneo a la formación de hueso nuevo. Evaluar el éxito y fracaso de una terapia permite tomar decisiones para un mejoramiento continuo de la práctica clínica. El objetivo de la investigación fue demostrar la importancia de la utilización de biomateriales e injertos óseos autólogos en pacientes con atrofia alveolar (AU).

SUMMARY The elective material for replacing the bone lost by trauma, congenital or acquired pathological processes and atrophy are the autogenic or autologous bone grafts (the patient´s own bones). From the introduction of the concept of osseointegration by Branemark on, dental implants are part of the daily therapeutic for rehabilitating edentulous areas. Alveolar atrophy is perhaps one of the most disabling oral conditions, because it is chronic, progressive, cumulative and irreversible. It alters maxilla-mandibular relations, reduces the bone quality of the dentosupported area and the depth of the sulcus. The ideal bone graft material should not be only a bone substitute, by a regenerative material that could be completely reabsorbed simultaneously with the new bone formation. To assess the success and failure of a therapy allows taking decisions for the continuous improvement of the clinical practice. The aim of the research was to prove the importance of using biomaterials or autologous bone grafts in patients with alveolar atrophy (AU).

Região metafisária da tíbia de coelhos: uma opção para estudos dos substitutos ósseos / Metaphyseal region of the tibia of rabbits: an option for bone substitutes studies

Apresenta-se um modelo experimental de ostectomia de tíbia em coelhos para estudo de biomateriais em processos de reparação óssea. Foi realizada falha segmentar de 6mm de diâmetro na região metafisária medial proximal de tíbia de 72 coelhos as quais foram preenchidas com substituto ósseo e avaliadas clinicamente, por exame radiográfico e por meio de tomografia computadorizada feixe cônico, em diferentes tempos. Conclui-se que a metáfise medial proximal de tíbia de coelhos é adequada como modelo para estudos que avaliem o comportamento de enxertos e/ou biomateriais em falhas ósseas.

Is presented an experimental model of tibial ostectomy in rabbits to study biomaterials during bone repair process. Segmental failure of 6 mm diameter was performed in the medial proximal tibial metaphyseal region of 72 rabbits, which were filled with bone substitute and evaluated by clinical exam, X-ray, and cone beam computed tomography at different times. It is concluded that the medial proximal tibial metaphysis region of rabbits is suitable as a model for studies that evaluate the behavior of grafts and/or biomaterials on bone defects.

Região metafisária da tíbia de coelhos: uma opção para estudos dos substitutos ósseos / Metaphyseal region of the tibia of rabbits: an option for bone substitutes studies

Apresenta-se um modelo experimental de ostectomia de tíbia em coelhos para estudo de biomateriais em processos de reparação óssea. Foi realizada falha segmentar de 6mm de diâmetro na região metafisária medial proximal de tíbia de 72 coelhos as quais foram preenchidas com substituto ósseo e avaliadas clinicamente, por exame radiográfico e por meio de tomografia computadorizada feixe cônico, em diferentes tempos. Conclui-se que a metáfise medial proximal de tíbia de coelhos é adequada como modelo para estudos que avaliem o comportamento de enxertos e/ou biomateriais em falhas ósseas.

Is presented an experimental model of tibial ostectomy in rabbits to study biomaterials during bone repair process. Segmental failure of 6 mm diameter was performed in the medial proximal tibial metaphyseal region of 72 rabbits, which were filled with bone substitute and evaluated by clinical exam, X-ray, and cone beam computed tomography at different times. It is concluded that the medial proximal tibial metaphysis region of rabbits is suitable as a model for studies that evaluate the behavior of grafts and/or biomaterials on bone defects.

Outcomes of quadriceps tendon autograft versus bone-patellar tendon-bone autograft for anterior cruciate ligament reconstruction:a Meta-analysis / 中国骨伤

OBJECTIVE@#To evaluate clinical effect of quadriceps tendon autograft and bone-patellar tendon-bone autograft on anterior cruciate ligament reconstruction by Meta-analysis.@*METHODS@#From the time of building databases to May 2019, literatures on case control study on quadriceps tendon and bone-patellar tendon-bone autograft on anterior cruciate ligament reconstruction were searched form PubMed, EMbase, the Cochrane library, Wanfang and CNKI database. Literature screening, quality evaluation and data extraction were carried out according to include and exclude standard. Difference of forward displacement between the affected and health knee, Lachman test, axial shift test, Lysholm score, international knee documentation committee (IKDC) objective grade, anterior knee joint pain and transplant failure rate were analyzed by Meta analysis.@*RESULTS@#Totally 6 literatures were included, including 915 patients with anterior cruciate ligament reconstruction, 495 patients with quadriceps tendon autograft and 420 patients with bone patellar tendon bone autograft. There were no statistical differences in anterior displacement of tibia was less than 3 mm[=1.53, 95%CI(0.68, 3.44), =0.31], 3 to 5 mm [=0.64, 95%CI(0.31, 1.35), =0.24], greater than 5 mm[=1.18, 95%CI(0.33, 4.22), =0.80], negative rate of Lachman test[=0.88, 95%CI(0.38, 2.02), =0.76], negative rate of axial shift test[=0.63, 95%CI(0.24, 1.68), =0.36] between two groups. There were no differences in Lyshlom score[=-0.56, 95%CI(-2.00, 0.89), =0.45], IKDC objective grade A and B[=0.87, 95%CI (0.47, 1.60), =0.66], and transplant failure rate [=0.76, 95%CI (0.28, 2.02), = 0.58]. In reducing anterior knee pain, quadriceps tendon autograft was better than that of bone patellar tendon bone autograft [=0.16, 95%CI (0.09, 0.29), <0.000 01].@*CONCLUSION@#Quadriceps tendon autograft and bone patellar tendon bone autograft on anterior cruciate ligament reconstruction has equal clinical and functional outcomes, transplant failure rate, quadriceps tendon autograft could reduce anterior knee pain. For patients with anterior cruciate ligament reconstruction, quadriceps tendon autograft could be seen as suitable alternative bone graft substitutes for anterior cruciate ligament reconstruction.

Utilización de injertos óseos autólogos y biomateriales en pacientes con atrofia alveolar. Matanzas / Use of autologous bone grafts and biomaterials in patients with alveolar atrophy.Matanzas

RESUMEN Introducción: los injertos óseos constituyen una de las técnicas más utilizadas en la cirugía reconstructiva implantológicas, son muy utilizadas para el reemplazo del hueso perdido por traumatismos, procesos patológicos congénitos o adquiridos y atrofia, son los injertos óseos autógenos o autólogos. Objetivo: caracterizar los pacientes con rebordes atróficos que necesitaron ser rehabilitados en implantología oral como alternativa de tratamiento en la consulta de Cirugía Máxilo Facial del Hospital Universitario "Faustino Pérez" y la Clínica "III Congreso del PCC", municipio Matanzas de septiembre del 2014 a julio de 2016. Material y Método: estudio prospectivo longitudinal. El universo fue de 20 pacientes mayores de 18 años de ambos sexos, que presentaron el diagnóstico de edentulismo parcial y atrofia alveolar. Se determinó por el interrogatorio, el examen clínico y los medios diagnósticos los síntomas y signos que caracterizaron esta entidad. Resultados: los traumatismos alveolares fue la causa que predominó en la pérdida dentaria, en el sexo masculino y en las edades de 18 a 37 años. La zona de mayor afectación fue la región anterior del maxilar superior y predominó la perdida de hueso en altura y en anchura y un gran número de injertos conservaron la cresta alveolar. Conclusiones: el uso de biomateriales en el tratamiento de pacientes con atrofia alveolar junto al injerto óseo fue satisfactorio en pacientes que necesitaron una base de sostén sobre la cual se colocaron los implantes dentales osteointegrados (AU).

SUMMARY Introduction: autogenous and autologous bone grafts are the elective material for replacing bones lost by trauma, congenital or acquired pathologic processes and atrophy. Objective: to characterize patients with atrophic rims needing rehabilitation in oral grafting as an alternative treatment in the Maxilla-Facial Surgery consultation of the University Hospital "Faustino Perez" and the Clinic "III Congreso del PCC", municipality of Matanzas, from September 2014 to July 2016. Materials and Methods: longitudinal prospective study. The universe was 20 patients aged 18 years and older, males and females, who presented the diagnosis of partial lack of teeth and alveolar atrophy. The symptoms and signs characterizing this entity were stated by questioning, physical examination and diagnostic means. Results: alveolar traumas were the predominant cause of dental lost in male patients aged 18-37 years. The most affected zone was the anterior region of the upper maxilla; bone lost in height and width predominated, and a great number of grafts conserved the alveolar crest. Conclusions: the use of biomaterials in the treatment of patients with alveolar atrophy together with bone graft was satisfactory in patients who needed a base support on which to put dental grafts (AU).

Comparative Study of the Osteointegration of Irradiated and Non-irradiated Bone Grafts Used in Patients with Revision Hip Arthroplasty / Estudo comparativo da osteointegração de enxertos ósseos irradiados e não irradiados utilizados em pacientes com revisão de artroplastia do quadril

Abstract Objective To evaluate and compare the osteointegration of irradiated and nonirradiated frozen bone grafts used in 21 patients undergoing revision hip arthroplasty procedures with the Exeter technique. Methods A retrospective study of 21 patients undergoing revision hip arthroplasty with the Exeter technique using bone tissues treated or not with gamma radiation between 2013 and 2014. The patients were divided into two groups according to the use of grafts treated or not with ionizing radiation (gamma rays); as such, these groups were classified as irradiated or non-irradiated. The osteointegration results determined by radiographic analysis of these grafts were compared in the postoperative period of 6 and 12months. Results Comparing the graft osteointegration in all patients at 6 and 12months postoperatively, we noticed a significant difference in the radiographic evaluations in this period (p = 0.031). Out of the patients studied, 7 were from the irradiated group, and 14 belonged to the non-irradiated group. No statistically significant differences were observed (p = 0.804) regarding osteointegration when we compared the irradiated and non-irradiated groups. Conclusion There was no significant difference in the use of irradiated or nonirradiated grafts in revision hip arthroplasty procedures with the Exeter technique.

Resumo Objetivo Avaliar e comparar a osteointegração dos enxertos ósseos congelados irradiados e não irradiados utilizados em 21 pacientes submetidos a revisão de prótese do quadril pela técnica Exeter. Métodos Foi realizado estudo retrospectivo de 21 pacientes submetidos a revisão de artroplastia do quadril pela técnica Exeter comutilização de tecidos ósseos tratados ou não com radiação gama no período entre 2013 e 2014. Dividimos os pacientes em dois grupos, de acordo com o uso do enxerto tratado ou não com radiação ionizante (raios gama), que foram, portanto, classificados como: grupo irradiado e não irradiado. Os resultados da osteointegração por análise radiográfica destes enxertos foram comparados no pós-cirúrgico de 6 e 12 meses. Resultados Quando comparamos a osteointegração dos enxertos no pós-cirúrgico de 6 e 12 meses de todos os pacientes, notamos que houve diferença significativa entre as avaliações radiográficas neste período (p= 0,031). Dos pacientes estudados, 7 pertenciam ao grupo irradiado, e 14, ao grupo não irradiado. Não foram observadas diferenças estatisticamente significativas (p= 0,804) quando a osteointegração entre os grupos irradiados e não irradiados foi comparada. Conclusão Não houve diferença significativa no uso de enxerto irradiado e não irradiado nas revisões de artroplastias do quadril pela técnica Exeter.

Calcium sulfate-based bioactive cement for periodontal regeneration: An In Vitro study

Background and Objective: Various types of osteoconductive graft materials are used for the management of alveolar bone defects arising out of periodontal disease. Inorganic, self-setting, bioactive bone cements are suggested to be most appropriate because they can conformally fill the bone defect and resorb progressively along with the regeneration of the host site. A new calcium sulfate-based bioactive bone cement (BioCaS) is developed, having simplicity and effectiveness for bone grafting applications. The response of primary human periodontal ligament (hPDL) cells to this material is investigated through in vitro cell culture model so as to qualify it for the repair of periodontal infrabony defects. Method: The BioCaS was designed as powder-liquid combination with in-house synthesized high purity calcium sulfate hemihydrate incorporating hydrogen orthophosphate ions. hPDL cells were isolated, cultured and characterized using optimized primary cell culture techniques. The cytotoxicity and cytocompatibility of the BioCaS samples were evaluated using the hPDL cells, with hydroxyapatite ceramic material as control. Osteogenic differentiation of the hPDL cells in presence of BioCaS was also evaluated using Alizarin red staining, Alizarin red assay, Von Kossa staining and Masson's trichrome staining. Results: The primary cell culture techniques yielded a healthy population of periodontal ligament cells, with fibroblast morphology and characteristic marker expressions. The hPDL cells exhibited good viability, adhesion and spreading to the BioCaS cement in comparison to sintered hydroxyapatite. In addition, the cells differentiated to osteogenic lineage in the presence of the BioCaS cement, without extraneous osteogenic supplements, confirming the inherent bioactivity of the cement. Conclusion: The new BioCaS cement is a potential candidate for the repair of periodontal defects.

Clinical Evaluation of Regenerative Potential of Xenogenic Bone Grafts in The Treatment of Periodontal Intrabony Defects

The primary goal of periodontal therapy is to restore the tooth supporting tissues lost due to periodontal disease. The aim of the present study was to evaluate the efficacy of xenogenic bone graft with open flap debridement (OFD) in treatment of periodontal intrabony defects. Methods: Twenty intrabony defects were surgically treated. The defects were randomly assigned to treatment with OFD + bone graft (Group B) or OFD alone (Group A). The clinical efficacy of two treatment modalities was evaluated at 9months postoperatively clinically and radiographically. Results: Statistically significant intra group improvements were seen with all the hard tissue and soft tissue parameters in both test and control groups. Statistically significant improvements were seen in group B with clinical parameters and the mean defect fill (AC-BOD) when intergroup comparisons were made. Conclusion: Treatment with bone graft + OFD led to a significantly more favorable clinical outcome in intrabony defects as compared to OFD alone.

Beta-Tricalcium Phosphate Block for Donor Site Morbidity of the Patella in Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Graft

PURPOSE: This study aimed to investigate anterior knee symptoms in patients who underwent anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) graft followed by implantation of a beta-tricalcium phosphate (β-TCP) block as a bone void filler. MATERIALS AND METHODS: We retrospectively reviewed 84 cases of synthetic bone grafting using a β-TCP block for the patellar bone defect in ACL reconstruction with a BPTB autograft. Computed tomography of the operated knee was performed immediately after the surgery to evaluate whether the grafted β-TCP block protruded forward from the anterior surface of the patella. On the basis of the results, the cases were divided into a protrusion group (n=31) and a non-protrusion group (n=53). Anterior knee symptoms at 12 months postoperatively and absorption of the grafted β-TCP block were compared between the two groups. RESULTS: Except for patellofemoral crepitus, there was no significant difference in anterior knee symptoms between the two groups (p>0.05). The incidence of patellofemoral crepitus was significantly lower in the protrusion group than in the non-protrusion group (p=0.027). The groups showed no significant difference in β-TCP absorption. CONCLUSIONS: The present study demonstrated that the protrusion of β-TCP that was used as a bone void filler had no adverse effects.

Growth dynamic of allogeneic and autogenous bone grafts in a vertical model

Abstract Several techniques have been proposed for vertical bone regeneration, and many of them use bone autogenous and allogeneic grafts. The purpose of this study was to compare demineralised freeze-dried bone allografts (DFDBA), fresh-frozen (FF) allografts, autogenous bone grafts to find differences between volumetric and histological quantity of bone formation and vertical bone growth dynamic. A vertical tissue regeneration bone model was performed in rabbit calvarias under general anaesthesia. Four hollow cylinders of pure titanium were screwed onto external cortical bone calvarias in eight rabbits. Each one of the cylinders was randomly filled with one intervention: DFDBA, FF, autogenous bone, or left to be filled with blood clot (BC) as control. Allogeneic grafts were obtained from a ninth animal following international standardised protocols for the harvesting, processing, and cryopreservation of allografts. Autogenous graft was obtained from the host femur scraping before adapting hollow cylinders. Animals were euthanized at 13 weeks. Vertical volume was calculated after probe device measurements of the new formed tissue inside the cylinders and after titanium cylinders were removed. Histomorphometry and fluorochrome staining were used to analyse quantity and dynamic of bone formation, respectively. Results showed that DFDBA and fresh-frozen bone improved the velocity and the quantity of bone deposition in distant portions of the basal plane of grafting. Remaining material in allograft groups was more intense than in autogenous group. Both allografts can be indicated as reliable alternatives for volume gain and vertical bone augmentation.

Resumo Várias técnicas foram propostas para regeneração óssea vertical, e muitas delas usam enxertos ósseos e alogênicos ósseos. O objetivo deste estudo foi comparar os aloenxertos ósseos congelados desmineralizados (DFDBA), os aloenxertos congelados frescos (FF) com os enxertos ósseos autógenos para encontrar diferenças entre o volume, a histologia da formação óssea e a dinâmica do crescimento ósseo vertical. Um modelo ósseo de regeneração tecidual vertical foi realizado em calvarias de coelho sob anestesia geral. Quatro cilindros ocos de titânio puro foram parafusados nas calvarias de osso cortical externo em oito coelhos. Cada um dos cilindros foi preenchido aleatoriamente com uma intervenção: DFDBA, FF, osso autógeno ou com coágulo sanguíneo (BC) como controle. Os enxertos alogênicos foram obtidos a partir de um nono animal seguindo protocolos internacionais padronizados para a coleta, processamento e criopreservação de aloenxertos. O enxerto autógeno foi obtido da raspagem do fêmur do hospedeiro antes de adaptar os cilindros ocos. Os animais foram eutanasiados após 13 semanas. O volume vertical foi calculado após a medição, por meio de sonda milimetrada, do novo tecido formado dentro dos cilindros e após a remoção dos cilindros de titânio. Histomorfometria e coloração com fluorocromios foram utilizados para analisar a quantidade e a dinâmica da formação óssea. Os resultados mostraram que DFDBA e osso fresco congelado melhoraram a velocidade e a quantidade de deposição óssea em porções distantes do plano basal de enxerto. O material remanescente nos grupos de aloenxerto foi mais intenso do que em grupo autógeno. Ambos os aloenxertos podem ser indicados como alternativas confiáveis para ganho de volume e aumento ósseo vertical.

Clinical evaluation of implant-supported prostheses for edentulous patients with ectodermal dysplasia / 口腔疾病防治

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.

How to Avoid Graft-Tunnel Length Mismatch in Modified Transtibial Technique for Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Graft

BACKGROUND: We conducted this study to determine the optimal length of patellar and tibial bone blocks for the modified transtibial (TT) technique in anterior cruciate ligament (ACL) reconstruction using the bone-patellar tendon-bone (BPTB) graft. METHODS: The current single-center, retrospective study was conducted in a total of 64 patients with an ACL tear who underwent surgery at our medical institution between March 2015 and February 2016. After harvesting the BPTB graft, we measured its length and that of the patellar tendon, patellar bone block, and tibial bone block using the arthroscopic ruler and double-checked measurements using a length gauge. Outcome measures included the length of tibial and femoral tunnels, inter-tunnel distance, length of the BPTB graft, patellar tendon, patellar bone block, and tibial bone block and graft-tunnel length mismatch. The total length of tunnels was defined as the sum of the length of the tibial tunnel, inter-tunnel distance and length of the femoral tunnel. Furthermore, the optimal length of the bone block was calculated as (the total length of tunnels − the length of the patellar tendon) / 2. We analyzed correlations of outcome measures with the height and body mass index of the patients. RESULTS: There were 44 males (68.7%) and 20 females (31.3%) with a mean age of 31.8 years (range, 17 to 65 years). ACL reconstruction was performed on the left knee in 34 patients (53%) and on the right knee in 30 patients (47%). The optimal length of bone block was 21.7 mm (range, 19.5 to 23.5 mm). When the length of femoral tunnel was assumed as 25 mm and 30 mm, the optimal length of bone block was calculated as 19.6 mm (range, 17 to 21.5 mm) and 22.1 mm (range, 19.5 to 24 mm), respectively. On linear regression analysis, patients' height had a significant correlation with the length of tibial tunnel (p = 0.003), inter-tunnel distance (p = 0.014), and length of patellar tendon (p < 0.001). CONCLUSIONS: Our results indicate that it would be mandatory to determine the optimal length of tibial tunnel in the modified TT technique for ACL reconstruction using the BPTB graft. Further large-scale, multi-center studies are warranted to establish our results.

The effects of bone graft combined with enamel matrix derivative in the treatment of periodontal osseous defects compared with that of bone graft alone: A meta-analysis / 实用口腔医学杂志

Objective: To analyze the efficacy of enamel matrix derivative (EMD) combined with bone grafts in the treatment of periodontal osseous defects comparied with that of bone grafts alone by Meta-analysis. Methods: The randomized controlled trials(RCTs) about the efficacy of enamel matrix derivative and bone grafts for the treatment of periodontal osseous defects were collected from Cochrane Library,EMBASE,PubMed,CNKI,Wanfang databases and Google scholar from inception may,2016 by electronic search,scored literatures with the methodological index for non-randomized studies(MINORS) evaluation tool. Revman 5. 3 was used for the Meta-analysis. Results: 5 RCTs articles with 145 cases were included. Meta-analysis showed that: at 6 months of follow-up, PD reduction and CAL gain was found more in test group than in control group(WMD = 0. 40,95％ CI =[0. 01,0. 79],P ＜ 0. 05) and (WMD = 0. 50,95％ CI =[0. 12,0. 88],P ＜ 0. 05) respectively. At 12 months of follow-up,there was no statistical significant difference in PD reduction and CAL gain respectively between the 2 treatments. Conclusion: The combined use of EMD and bone grafts may improve PD reduction and CAL gain in the early stage of convalescence following treatment of periodontal osseous deffects.

Ruptura traumática aguda del tendón del cuádriceps tratado con sutura de alambre transpatelar / Acute traumatic rupture of the quadriceps tendon treated with transpatellar wire suture

Fundamento: La ruptura traumática aguda del tendón del cuádriceps es una entidad poco frecuente con una incidencia de 1,37/100 000 pacientes por año. Los hombres son los más afectados y la edad media de aparición ronda los 50 años. La cirugía ofrece los mejores resultados. Objetivo: Presentar un paciente con ruptura traumática aguda del tendón del cuádriceps derecho, con evolución favorable luego de una reparación primaria precoz con sutura transpatelar de alambre. Reporte de caso: Paciente masculino de 58 años de edad, con antecedentes de diabetes mellitus tipo II, que sufrió caída de sus pies. Acudió al servicio de urgencias con dolor intenso a nivel de la rodilla derecha, e imposibilidad para la marcha. A la exploración física se encontró impotencia absoluta para la extensión de la pierna derecha y signo del surco en la zona del tendón del cuádriceps. En la ultrasonografía de la rodilla derecha se apreció una solución de continuidad total del tendón del cuádriceps, a nivel del polo superior de la rótula lo que corroboró el diagnóstico de una ruptura traumática aguda del tendón del cuádriceps derecho. Se decidió tratamiento quirúrgico que consistió en perforaciones en la rótula y reinserción del tendón mediante alambres de acero, con buena evolución clínica Conclusiones: La reparación primaria precoz con sutura transpatelar de alambre en la ruptura traumática aguda del tendón del cuádriceps es un proceder quirúrgico efectivo cuando se realiza en los primeros diez días de la lesión.

Background: The acute traumatic rupture of the quadriceps tendon is a rare diseases with an incidence of 1.37 / 100 000 patients per year. Men are the most affected and the average age of appearance is around 50 years old. Surgery offers the best results. Objective: to present a patient with acute traumatic rupture of the right quadriceps tendon, with a favorable evolution after an early primary repair with transpatellar wire suture. Case report: a 58-year-old male patient with a personal history of type II diabetes mellitus, who suffered a fall in his feet. He arrived to the emergency room with severe pain in the right knee and impossibility to walk. At physical examination showed an absolute impotence for the extension of the right leg and a depression sign in the area of ​​the quadriceps tendon. In the right knee ultrasonography, a complete continuity solution of the quadriceps tendon was observed at the level of the superior pole of the patella, which corroborated the diagnosis of an acute traumatic rupture of the right quadriceps tendon. Surgical treatment consisted of perforations in the patella and reinsertion of the tendon through steel wires, with good clinical evolution Conclusions: early primary repair with transpatellar wire suture in acute traumatic rupture of the quadriceps tendon is an effective surgical procedure when it is done in the first ten days of the lesion.

Avaliação retrospectiva das características dos implantes instalados na faculdade Ingá entre 2005 e 2014 / Retrospective evaluation of the characteristics of dental implants installed in the University Inga between 2005 and 2014

Objetivo: avaliar retrospectivamente as características dos implantes colocados no curso de especialização do Centro Universitário Ingá (Uningá). Material e métodos: os prontuários dos pacientes que realizaram tratamento entre 2005 e 2014 na Uningá foram analisados quanto à saúde sistêmica, sexo, idade, local de colocação, uso de enxertos, diâmetro e comprimento dos implantes, e complicações. Resultados: neste centro, 108 pacientes receberam 307 implantes de quatro marcas comerciais diferentes (154 na maxila e 160 na mandíbula). Os implantes foram instalados mais em mulheres (67,6%), principalmente na região posterior (76,7%), tanto de maxila (49%) quanto de mandíbula (51%), com o uso de enxertos ósseos em cerca de 20% dos casos da maxila e somente 1% dos casos de mandíbula. Além disso, ainda são realizados muitos implantes longos (38,6% > 13 mm), de diâmetro regular (83,6% entre 3,75 mm e 4 mm) e com plataforma do tipo hexágono externo (97,7%). Conclusão: no local pesquisado, ainda são instalados muitos implantes na região posterior, longos e de diâmetro regular, com plataforma do tipo hexágono externo. Além disso, os enxertos ósseos são usados em um em cada dez casos de implantes, principalmente na maxila.

Objective: to retrospectively evaluate the characteristics of implants placed in the specialization course of the Inga University Center (Uningá). Material and methods: the medical records of patients who underwent treatment between 2005 and 2014 at Uningá were analyzed for systemic health, gender, age, area of installation, use of grafts, diameter and length of the implants and complications. Results: in this center, 108 patients received 307 implants (four different brands, 154 in maxilla and 160 in mandible). The implants were installed more frequently in women (67.6%), mainly in the posterior region (76.7%), in both maxilla (49%) and mandible (51%), with the use of bone grafts in 20% of maxillary cases and only 1% of cases in mandible. The prevalence of long (38.6%, 13 mm), regular diameter (83.6% between 3.75 mm and 4 mm), and external hex implants (97.7%) was great. Conclusion: at the Uningá, many implants in the posterior region, long and of regular diameter with external hexagonal platform are still installed. Moreover, bone grafts are used in 1 of each 10 cases of implants, mainly in th e maxilla.