A prospective cohort study of immediate implantation and delayed implantation for a labial bony dehiscence defect in the maxillary aesthetic area / 口腔疾病防治

Objective @# To investigate the effect of immediate and delayed implant placement on dimensional changes in hard and soft tissues as well as esthetic outcomes. @*Methods @# A total of 40 maxillary single anterior teeth with a dehiscence defect on the labial bone (≤4 mm) were categorized into two groups according to the timing of implant placement: immediate implant placement (n = 20) or delayed implant placement (n = 20). Guided bone regeneration (GBR) was conducted at the sites using a flap approach, and the implants were given immediate provisionalization. Implant survival rates, dimensional changes in hard and soft tissues during the six- and twelve-month follow-ups, and pink esthetic scores (PESs) were measured. @*Results @# The implant survival rates in both groups were 100%, and no complications occurred during the follow-up time. There was no significant difference between the two groups at the measurement sites in the dimensional change of hard and soft tissues during the six- and twelve-month follow-ups. The largest resorption was observed at the implant neck, with a loss of (1.29 ± 0.71) mm in the immediate implant placement group and (1.43 ± 0.19) mm in the delayed implant placement group. The mean PES scores were (10.95 ± 1.51) for the immediate implant placement group and (11.05 ± 1.23) for the delayed implant placement group. @*Conclusion@# Immediate implantation or delayed implantation combined with GBR and immediate provisionalization might both be a prospective treatment strategy for a maxillary single anterior tooth with a dehiscence defect on the labial bone.

Evaluation Concerns on Custom Design of Implant for Bony Defect / 中国医疗器械杂志

The evaluation concerns on custom design of implant for bony defect focus on engineered transformation of clinical needs, pre-operation performance verification and clinical validation. These concerns refer to manipulation on imageology information, tissue adhesion and fixation, surgery planning and instruments, design specification and instruction, finite element analysis, bench testing, around market clinical research et al. The evaluation integrates adaptive risk evaluation methods such as biomechanics, mechanobiology, blind crossover reproducility and dynamic design of clinical study et al.

Fibrina Rica en Plaquetas y Leucocitos en el tratamiento de defectos intra-óseos: Revisión Narrativa / Leucocyte and Platelet Rich Fibrin in the treatment of intra-bony defects. Narrative Review

RESUMEN: Diferentes técnicas quirúrgicas periodontales han surgido a lo largo del tiempo con el objetivo de lograr una regeneración periodontal y mejorar su predictibilidad. La Fibrina Rica en Plaquetas y Leucocitos (L-PRF) se ha posicionado como una alternativa para cumplir este objetivo, debido a que no requiere anticoagulantes en su preparación y muestra liberación sostenida de factores de crecimiento durante por lo menos 7 días. El objetivo de esta revisión narrativa es describir la evidencia disponible sobre el uso de L-PRF en defectos intra-óseos. Se realizó una búsqueda en las bases de datos MEDLINE y Cochrane Library, exploración manual y páginas web. De un total de 494 artículos recuperados, fueron seleccionados 12 publicaciones para esta revisión. Los resultados sugieren que L-PRF muestra beneficios al ser utilizada en el tratamiento periodontal regenerativo de defectos intra-óseos. Sin embargo, son necesarios ensayos clínicos con diseño metodológico estandarizado que permitan comparar L-PRF con biomateriales habitualmente empleados en el tratamiento de estos defectos.

ABSTRACT: Periodontal surgical techniques have emerged over time with the aim of achieving periodontal regeneration and improving its predictability. Leukocyte and Platelet-Rich Fibrin (L-PRF) has been proposed as an alternative, for not requiring anticoagulants in its preparation and for performing sustained release of growth factors for at least 7 days. The aim of this narrative review is to describe the available evidence on the use of L-PRF in periodontal intra-bony defects. An electronic and hand search was conducted in MEDLINE and Cochrane Library databases. Of 494 papers retrieved, 12 were selected for this review. The results suggest that even if L-PRF shows benefits when used in regenerative periodontal treatment of intra-bony defects, clinical trials with standardized methodological design are necessary to compare L-PRF with biomaterials usually used in these defects.

Osseous Defects Seen in Patients with Anterior Shoulder Instability

Shoulder surgeons need to be aware of the critical size of the glenoid or humeral osseous defects seen in patients with anterior shoulder instability, since the considerable size of osseous defect is reported to cause postoperative instability. Biomechanical studies have identified the size of the osseous defect which affects stability. Since engagement always occurs between a Hill-Sachs lesion and the glenoid rim, when considering the critical size of the Hill-Sachs lesion, we have to simultaneously consider the size of the glenoid osseous defect. With the newly developed concept of the glenoid track, we are able to evaluate whether a large Hill-Sachs lesion is an "on-track" or "off-track" lesion, and to consider both osseous defects together. In case of an off-track Hill-Sachs lesion, if the glenoid defect is less than 25%, no treatment is required. In this case, the Latarjet procedure or arthroscopic remplissage procedure can be a treatment option. However, if the glenoid defect is more than 25%, treatment such as bone grafting is required. This will convert an off-track lesion to an on-track lesion. After the bone graft or Latarjet procedure, if the Hill-Sachs lesion persists as off-track, then further treatment is necessitated. In case with an on-track Hill-Sachs lesion and a less than 25% glenoid defect, arthroscopic Bankart repair alone is enough.

Management of Tibial Bony Defect with Metal Block in Primary Total Knee Replacement Arthroplasty

PURPOSE: To analyze minimum 2-year clinical and radiological follow-up results of primary total knee replacement arthroplasty (TKRA) with metal block augmentation for tibial bony defect. MATERIALS AND METHODS: We analyzed 67 cases (52 patients) of primary TKRA with metal block augmentation for tibial bony defects from March 1999 and March 2008. Clinical results were evaluated using the Knee Society clinical rating system and the Western Ontario and McMaster University (WOMAC) score. Radiologic results were evaluated using the Knee Society roentgenographic evaluation system. RESULTS: The mean knee score and function score improved from 42.0 and 45.6 preoperatively to 94.5 and 85.4 postoperatively. At last follow-up, the mean WOMAC score was 16.8. The incidence of radiolucent lines was 10% (7 cases) during the follow-up period, but there was no case of progression. There were no statistically significant differences between the groups divided according to the block size (below 5 mm and over 8 mm) and between the stem and no-stem groups for all parameters. CONCLUSIONS: Primary TKRA with a metal block produced satisfactory results for the minimum 2-year follow-up and can be considered as a simple and effective method for the treatment of tibial bony defect in primary TKRA.

Effectiveness of autogenous tooth bone used as a graft material for regeneration of bone in miniature pig

INTRODUCTION: This study examined the effect of autogenous tooth bone used as a graft material for bone regeneration in an artificial bony defect of minipigs. MATERIALS AND METHODS: Four healthy minipigs, weighing approximately 35-40 kg, were used. Four standardized artificial two-walled bony defects, 5 mm in length and depth, were made on the bilateral partial edentulous alveolar ridge on the mandible of minipigs, and autogenous tooth bone was augmented in the right side as the experimental group. On the other hand, only alloplastic bone graft material HA was grafted with the same size and manner in the left side as the control group. All minipigs were sacrificed at 4 weeks after a bone graft and evaluated histologically by Haematoxylin-eosin staining. The specimens were also evaluated semi-quantitatively via a histomorphometric study. The percentage of new bone over the total area was evaluated using digital software for an area calculation. RESULTS: All specimens were available but one in the left side (control group) and two in the right side (experimental group) were missing during specimen preparation. The amount of bone formation and remodeling were higher in all experimental groups than the control. The mean percentage area for new bone in the experimental and control groups was 43.74+/-11.96% and 30.79+/-2.93%, respectively. CONCLUSION: Autogenous tooth bone is a good alternative to autogenous bone with the possible clinical feasibility of an autogenous tooth bone graft in the reconstruction of bony defects.

Arthroscopic Stabilization Using Remplissage Technique in Recurrent Shoulder Instability with Large Hill-Sachs Lesion / 대한스포츠의학회지

The glenohumeral bone deficiency plays an important role in the failure of arthroscopic shoulder stabilization procedures. Recently, several authors have described more novel approaches to treat the engaging Hill-Sachs lesion. Presented the 'Remplissage' technique that consists of an arthroscopic posterior capsulodesis and infraspinatus tenodesis to fill the Hill-Sachs lesion in addition to an arthroscopic Bankart repair. We report an arthroscopic technique in recurrent shoulder instability with large Hill-Sachs lesion with posterior capsulodesis and infraspinatus tenodesis.

Clinical Experience of the Brushite Calcium Phosphate Cement for the Repair and Augmentation of Surgically Induced Cranial Defects Following the Pterional Craniotomy

OBJECTIVE: To prevent temporal depression after the pterional craniotomy, this study was designed to examine the safety and aesthetic efficacy of the brushite calcium phosphate cement (CPC) in the repair and augmentation of bone defects following the pterional craniotomy. METHODS: The brushite CPC was used for the repair of surgically induced cranial defects, with or without augmentation, in 17 cases of pterional approach between March, 2005 and December, 2006. The average follow-up month was 20 with range of 12-36 months. In the first 5 cases, bone defects were repaired with only brushite CPC following the contour of the original bone. In the next 12 cases, bone defects were augmented with the brushite CPC rather than original bone contour. For a stability monitoring of the implanted brushite CPC, post-implantation evaluations including serial X-ray, repeated physical examination for aesthetic efficacy, and three-dimensional computed tomography (3D-CT) were taken 1 year after the implantation. RESULTS: The brushite CPC paste provided precise and easy contouring in restoration of the bony defect site. No adverse effects such as infection or inflammation were noticed during the follow-up periods from all patients. 3D-CT was taken 1 year subsequent to implantation showed good preservation of the brushite CPC restoration material. In the cases of the augmentation group, aesthetic outcomes were superior compared to the simple repair group. CONCLUSION: The results of this clinical study indicate that the brushite CPC is a biocompatible alloplastic material, which is useful for prevention of temporal depression after pterional craniotomy. Additional study is required to determine the long-term stability and effectiveness of the brushite calcium phosphate cement for the replacement of bone.

Two Cases of Spontaneous Cerebrospinal Fluid Rhinorrhea by Idiopathic Bony Defects / 대한이비인후과학회지

Cerebrospinal fluid rhinorrhea can be caused by head trauma, brain or sinus surgery or neoplastic sinonasal disease. In addition, CSF rhinorrhea may develop spontaneously in some cases. We experienced two cases of spontaneous CSF rhinorrhea caused by idiopathic bony defect. The first case was a 47-year old female who complained of a persistent rhinorrhea for 2 months without surgical or traumatic history. The second case was a 40-year old female. Having no surgical or traumatic history, she also suffered from a persistent rhinorrhea for thirteen years. For diagnosis of CSF rhinorrhea, we carried out endoscopic examination, glucose test of rhinorrhea, computed tomograph, magnetic resonance imaging and (99m)Tc-DTPA cisternography. We found bony defect in the cribriform plate of the two cases. Patients were treated successfully with endoscopic approach. Leak sites were repaired with free graft materials. There has not been any recurrence or complications since the endoscopic closure.

Nonunion with a Bony Defect of the Humerus: Treatment by Shortening

PURPOSE: To evaluate clinical results and advantage of interposition and shortening technique for the treatment of the humeral nonunion with bone defect. MATERIALS AND METHODS: Eight patients with the humeral nonunion with bone defect underwent interposition of fragments and shortening had been followed-up for more than one year (mean 70 months, 16~156). There were 4 men and 4 women with a mean age of 60.5 years (range, 48 to 75 years). There included 3 proximal, 3 diaphysis and 2 distal metaphysis according to the site, mean size of the bone defect was 3.3 cm (2~5). The time to union, discrepancy of upper extremity, functional results, cosmetic satisfaction and postoperative complications were assessed. RESULTS: All patients achieved to bone union, average union time was 10.2 weeks (range 8~14). Average limb discrepancy was 2.3 cm. All had improvement in shoulder and elbow motion after operation. Seven patients were satisfied with the cosmetic result and none had functional deficit due to limb discrepancy. CONCLUSION: Treatment by Interposition of fragments and shortening in the intractable nonunion of humerus with a bony defect can achieve not only good functional result, shortened bone union time and improved in shoulder and elbow motion.

Periodontal response according to the timing of orthodontic force application after bone graft into angular bony defect in the dog / 대한치과교정학회지

The aim of this study was to investigate the periodontal response according to the timing of orthodontic force application after bone graft into the angular bony defect. Nine dogs were divided into three groups, 2, 4, and 6 weeks, according to the timing of orthodontic force application after bone graft. Periodontal angular bony defects were created surgically at the distal aspect of both maxillary third incisors. Two weeks later, flap operation was performed to eliminate inflammation and reference notch was made on the root surface at the level of the bottom of each defect. Demineralized freeze-dried bone was implanted on the left side whereas only debridement was done on the other side. Experimental tooth movement was executed during 8 weeks on both graft and non-graft sides. After 2 weeks of retention period, animals were sacrificed for histologic specimens. The results were obtained as follows : 1. New bone formation was more pronounced in the graft side than in the non-graft side in all experimental animals. 2. In the 6-week group, new bone and cementum formation was observed in more than half from the notch to the cemento-enamel junction, and the zone of connective tissue attachment was found without apical migration of junctional epithelium. 3. In the 4-week group, the amount of new bone formation was smaller than in the 6-week group whereas the overall remodeling pattern was similar. 4. New bone formation was confined to around the notch and the junctional epithelium migrated apically to the level of the notch with no connective tissue attachment and cementum formation in the 2-week group. The results of the present study suggest that periodontal response may be influenced by the timing of orthodontic force application after bone graft into angular bony defect.

Reconstruction of Medial Canthal and Lower Lid Defect using Orbicularis Muscle Mobilization

PURPOSE: Radiation therapy after radical excision of malignant tumor causes delayed wound healing. We reconstructed successfully medial canthal area and lower lid defect including lacrimal bone which developed after radical excision and radiation therapy of lacrimal sac tumor with transpositional orbicularis muscle flap. METHODS: A 64-year-old male patient visited our clinic for right medial canthal and lower lid defect including lacrimal sac, lacrimal bone, and ethmoid bone which had developed 5 years before due to radical tumor excision and postoperative radiation therapy. RESULTS: At one-year follow-up, the shape and the function of the eyelid showed good results. CONCLUSION: Facial bony defects after radical excision of malignant tumor may cause as well loss of compartmentation between orbit, cranial fossa and nasal cavity as aesthetic problems. This loss may cause delayed wound healing and spread of infection. Orbicularis oculi muscle mobilization can be used in eyelid and periorbital reconstruction including difficult wound repair. This technique can enhance the blood supply to the reconstructed area and allow healing which might not be obtained otherwise.

Clinical Experience in Reconstruction of the Posterior Lingual Mandibular Bony Defect

Posterior lingual mandibular bony defect is rare disease entity. Diagnosis of this entity is almost incidental because it has neither symptoms nor signs. However, it has characteritic features in radiologic images that radiolucent defect located near the mandibular angle. Many of this defects are filled with sublingual salivary gland tissues and some includes fat tissue. Various terms such as aberrant salivary gland defect, mandibular embryonic defect, developmental submandibular bone defect, are available for this disease entity bacause cause of this entity is controversal. Operation for reconstruction of the defect is not necessary except this entity has symptoms or diagnosis of this is unclear. Authors experienced one case of this entity incidentally, and operated for defect reconstruction by osteotomy and filled the defect with hydroxyapatite. The result is satisfactory without any complications.

The clinical availability of lyophilized collagen implant and microplate in reconstructive surgery on the bony defects of maxillary anterior wall

Nontraumatic Cerebrospinal Fluid Rhinorrhea(via the Middle Cranial Fossa and Sphenoid Sinus): A Case Report

We describe a rare case of nontraumatic normal pressure cerebrospinal fluid rhinorrhea. A 33-year-old male was admitted to our hospital due to continuous rhinorrhea but without a history of specific trauma. We performed various radiological evaluations, and on bone-window CT, detected severe bilateral extension of the sphenoid sinus into the greater wing. MRI and CT cisternography revealed that contrast media and cerebrospinal fluid had leaked from the middle cranial fossa to the sphenoid sinus. Transethmoidal sphenoid approach and sphenoid sinus fat obliteration was successfully performed by an otolaryngologist. On postoperative day 2, however, the patient's mental condition deteriorated and CT showed the development of acute obstructive hydrocephalus. Ventriculo-peritoneal shunt was then successfully performed and the patient was discharged. Nontraumatic normal pressure cerebrospinal fluid rhinorrhea involving leakage through the middle cranial fossa is very rare, this report discussed the etiological, anatomical and surgical considerations of this case.

The effects of horizontal orthodontic tooth movement on the periodontally diseased tissue in dogs / 대한치과교정학회지

Most adults, unlike growing children, have some periodontal problems which can influence the outcome of the orthodontic treatment. In cases where periodontal disease progression resulted in marked reduction of periodontium, orthodontic treatment could result in the worsening of the periodontal conditions, and therefore orthodontic treatment planning in such adult patients requires special considerations for the periodontal problems. This study investigates the effects of horizontal orthodontic tooth movement on the changes in the mesial, distal and furcation areas of the disease affected periodontium of adult dogs with advanced bone loss. Six adult dogs with healthy periodontium were selected, and mandibular 2nd premolars were extracted. In the mandibular 3rd premolars, angular bony defects in the mesial and distal sides, and horizontal bony defects in the furcation areas were created. Those that received the flap operation and plaque control were designated as the control, those that had horizontal tooth movement without plaque control after the flap operation as Experimental group I, those that had horizontal tooth movement under plaque control without the flap operation as Experimental group II, and those that had horizontal tooth movement under plaque control after the flap operation as Experimental group III. The control group was sacrificed 2 months postoperatively, and the experimental groups were sacrificed 5 months after the initiation of tooth movement. Specimens were histologically analyzed under light microscope. The results were as follows; 1. After the horizontal tooth movements, Experimental group I and II showed angular bony defects in the mesial sides of the roots and the distal side of the furcation areas, which correspond to the pressure sides. 2. After the horizontal tooth movements, Experimental group I and II showed decreased level of alveolar bone crest in the distal sides of the roots, which correspond to the tension sides. 3. Long junctional epithelium in the control group has not been replaced by periodontal connective tissue after the horizontal tooth movements. 4. Limited formation of new bone was observed in the angular bony defects in the mesial and distal aspects of the roots in the control group. 5. Inflammatory cell infiltration in the connective tissue was most severe in the Experimental group I, followed by Experimental group II, III, and the control group in that order. These results seem to indicate that plaque control was the most influencing factor in the alteration of the periodontal tissue after the horizontal tooth movements in the periodontal tissue with alveolar bone defects.

A Case of Plexiform Neurofibroma of the Right Upper Eyelid and Orbit in Neurofibromatosis / 대한피부과학회지

We have experienced a case of plexiform neurofibrorna of the right upper eyelid and orbit in a 12-year-old girl who had typical skin features of neurofibromatosis and no family history. The non-pulsating proptosis of the right eye and diffuse thickening with hypertrophy of the upper lid, had increased insiduciusly since the birth on. Biopsy taken from eyelirl lesion showed the features of plexiform neurofibroma. Skull X-ray and brain computerized tomogram showed that the right orbit was wider, with the enlarged mass and defects in orbital roof and lesser and greater wings of the sphenoid bone. The surgical excision of the right eyelid lesion was performed.

A Case of Intrathoracic Meningocele

An intrathoracic meningocele is a saccular protrusion of the meninges through a normal or enlarged intervertebral foramen or bony defect of the thoracic vertebrae. It extends anteriorly between the ribs and into the thoracic cavity, displacing the pleura and lung and lying in the paravertebral gutter if of sufficient size. Meningocele, single or multiple, are prone to occur in cases of von Recklinghausen's neurofibromatosis, often in association with kyphoscoliosis. In this case, we found a case of intrathoracic meningocele associated with multiple lipoma of variable sizes in the back and hyperpigmentation in the anterior chest and upper back region but no evidence of neurofibromatosis. Because of rarity of this disease entity, we report a case of intrathoracic meninggocele with review of literature.