Aumento do Rebordo Alveolar com Enxerto em Bloco Impresso Personalizado: Relato de Caso / Alveolar ridge augmentation with custom 3D-printed block graft: Case report

A utilização da tecnologia CAD/CAM (computer aided design/computer aided manufacturing) e 3D (tridimensional) para reconstruções alveolares na implantodontia permite o planejamento pré-operatório detalhado, o design do resultado desejado do enxerto e a avaliação virtual do resultado em relação à reconstrução protética. Este trabalho objetiva detalhar a técnica cirúrgica de enxerto ósseo sintético confeccionado por meio dessa tecnologia, seguido da instalação de implantes osseointegráveis e reabilitação protética em um defeito ósseo na mandíbula. Paciente masculino, 22 anos, compareceu à clínica por avulsão dos elementos 32, 31, 41 e 42 com significativa perda óssea vertical de rebordo alveolar. Devido à extensa perda óssea, realizou-se enxerto em bloco prototipado impresso. O escaneamento intraoral e os arquivos de imagem gerados foram enviados ao centro de planejamento virtual. Primeiramente, foi realizada a cirurgia para instalação do enxerto em bloco. Após o período de cicatrização, foi realizada cirurgia para instalação de dois implantes osseointegráveis. Esperado o período de três meses a partir da instalação dos implantes, foi realizada a confecção de próteses provisórias fixas sobre implantes a fim de realizar o condicionamento dos tecidos moles peri-implantares e o carregamento progressivo dos implantes. O aumento do rebordo alveolar através do uso de enxerto em bloco impresso personalizado apresentou-se como uma técnica com inúmeras vantagens, por não necessitar de sítio doador, reduzir tempo cirúrgico e apresentar perfeita adaptação do bloco ao defeito ósseo, resultando em menor morbidade pós-operatória. Essa técnica é uma indicação para casos de defeitos ósseos severos, visando a otimizar o resultado e a propiciar menor desconforto ao paciente.

The use of the technology CAD/CAM (computer aided design/computer aided manufacturing) and 3D (three dimensional) to alveolar reconstructions in implant dentistry allows detailed preoperative planning, the design of the desired grafting result, and the virtual evaluation of the result in relation to the prosthetic reconstruction. This paper aims to details the synthetic bone graft made through this technology, followed by the installation of osseointegrated implants and prosthetic rehabilitation in a bone imperfection in the jaw. A 22-year-old man attended the clinic due to a tooth avulsion of the four lower incisors with significant vertical bone loss of alveolar ridge. Because of the extensive bone loss, it was made a prototyped printed block graft. The intraoral scan and the generated image files were sent to the virtual planning center. First, it was necessary a surgery to install the block graft. After the healing process, it was made a surgery to put two osseointegrated implants. Three months later, temporary fixed prostheses on implants were made to conditioning the peri-implant soft tissues and the progressive loading of the implants. The increase of the alveolar ridge using personalized printed block graft was presented as a technique with numerous advantages, since it does not require a donor site, reduces the surgical time and presents perfect adaptation of the block to the bone imperfection, resulting in a less postoperative morbidity. This technique is indicated to cases of severe bone imperfections, aims to optimize results, and provide less discomfort to the patient.

Necesidad de regeneración ósea en la instalación de implantes: Análisis Retrospectivo de 7 años, Hospital San Camilo

Objetivo: Analizar la necesidad de regeneración ósea guiada en pacientes sometidos a terapia implantológica entre el año 2012 y 2019 del Hospital San Camilo, San Felipe. Material y Método: Estudio observacional retrospectivo. Se incluyeron todos los pacientes pertenecientes al programa de implantes entre el 2012 y 2019. Los pacientes fueron organizados de acuerdo a la edad, género, marca de implante, uso de injerto, tiempo de carga y tasa de pérdida. Estos datos se evaluaron empleando estadística descriptiva calculando frecuencias y porcentajes en tablas de contingencias. Resultados: Se incluyeron 182 pacientes. La distribución por sexo fue de 121 mujeres y 61 hombres. La edad promedio de los pacientes fue de 51,23 años. El 41,76% casos del total requirió ROG. El 74,3% del grupo de implantes unitarios requirió injerto óseo. Sólo un 4,71% del grupo de sobredentadura requirió de injerto óseo. El tiempo de carga promedio fue de 3,68 meses. La tasa de pérdida en implantes fue de 3,85%. Conclusiones: El conocimiento y análisis de estos datos permite replantear la distribución de los recursos con el fin de realizar tratamientos más predecibles, disminuyendo las complicaciones y generando un ahorro de presupuesto.

Objective: To determine and analyze the need for guided bone regeneration (GBR) in patients who underwent implant therapy between 2012 and 2019 at the San Camilo Hospital, San Felipe. Material and methods: Retrospective observational study. All patients belonging to the implant program were included, with the need for either single implants or overdentures, which were installed between 2012 and 2019. Patients were organized according to their age, gender, implant brand, use of graft, loading time and loss rate. These data were evaluated using descriptive statistics calculating frequencies and percentages in contingency tables. Results: A total of 182 cases of implants were included. The distribution by sex was 121 women and 61 men. The average age of the patients was 51,23 years. The percentage of cases that required GBR was 41.76%. In the single implant group, 74.3% of cases required bone grafting. In the overdenture group, only 4.71% required bone grafting. The average loading time was 3,68 months. The implant loss rate was 3,85%. Conclusions: The knowledge and analysis of these data allow us to evaluate the distribution of resources to carry out more predictable treatments to reduce complications and generate budget savings.

Reconstrução óssea de defeito crítico com a utilização de tela de titânio: relato de caso / Bone reconstruction of a critical defect using titanium mesh: case report / Reconstrucción ósea de un defecto crítico con malla de titanio: reporte de caso

Introdução: O uso de membranas de barreira de exclusão de epitélio para regeneração óssea guiada tem sido apresentado na literatura como abordagem de tratamento bem sucedida, essas barreiras irão impedir a incorporação de células de tecidos moles no enxerto ósseo ou no es paço criado pelo defeito e permitir que apenas as células osteogênicas estejam presentes. Relato de caso: Trata-se de um caso clinico de um paciente que evoluiu com perda óssea significativa por lesão Endo-periodontal levando a perda dentaria, para a reabilitação com implantes se fez necessário uma reconstrução de um defeito crítico com a utilização de tela de titânio para arcabouço ósseo de mistura de enxerto autógeno e biomaterial e recobrimento com membrana de colágeno, o enxerto autógeno foi removido de área doadora na mandíbula e utilizado de forma particulada. Conclusão: As telas de titânio apresentam viabilidade e previsibilidade no aumento ósseo vertical, horizontal e tridimensional em decorrência da sua ampla aplicabilidade, elasticidade, plasticidade adequadas e boas propriedades mecânicas. Avanços na diminuição de suas taxas de exposição e risco de complicações no período de cicatrização melhoram a cada dia a previsibilidade da técnica, bem como a associação com outros materiais como os hemoderivados... (AU)

Introduction: The use of epithelial exclusion barrier membranes for guided bone regeneration has been presented in the literature as a successful treatment approach, these barriers will prevent the incorporation of soft tissue cells into the bone graft or the space created by the defect and allow that only osteogenic cells are present. Case report: This is a clinical case of a patient who evolved with significant bone loss due to an endo-periodontal lesion leading to tooth loss, for rehabilitation with implants it was necessary to reconstruct a critical defect using mesh titanium for bone framework of mixture of autogenous graft and biomaterial and covering with collagen membrane, the autogenous graft was removed from the donor area in the mandible and used in a particulate form. Conclusion: Titanium meshes are viable and predictable in vertical, horizontal and three-dimensional bone augmentation due to their wide applicability, adequate elasticity and plasticity, good mechanical properties. Advances in reducing their exposure rates and risk of complications during the healing period improve the predictability of the technique every day, as well as the association with other materials such as blood products... (AU)

Introducción: El uso de membranas de barrera de exclusión epitelial para la regeneración ósea guiada se ha presentado en la literatura como un enfoque de tratamiento exitoso, estas barreras evitarán la incorporación de células de tejido blando al injerto óseo o el espacio creado por el defecto y permitirán que solo presencia de células osteogénicas. Reporte de caso: Este es un caso clínico de un paciente que evolucionó con una pérdida ósea importante debido a una lesión endo-periodontal que lo llevó a la pérdida de un diente, para rehabilitación con implantes fue necesario reconstruir un defecto crítico utilizando malla de titanio para armazón óseo de mezcla de injerto autógeno y biomaterial y cubriendo con membrana de colágeno, el injerto autógeno se extrajo del área donante en la mandíbula y se usó en forma de partículas. Conclusión: Las mallas de titanio son viables y predecibles en el aumento óseo vertical, horizontal y tridimensional debido a su amplia aplicabilidad, adecuada elasticidad y plasticidad, buenas propiedades mecánicas. Los avances en la reducción de sus tasas de exposición y riesgo de complicaciones durante el periodo de cicatrización mejoran día a día la predictibilidad de la técnica, así como la asociación con otros materiales como los hemoderivados... (AU)

Reconstruction Plate Fracture: Mechanism and Recent Advances

Reconstruction plates with or without bone grafts are used to restore mandibular continuity, form and function following segmental resection of mandible. Fracture of reconstruction plate is observed in 2.9 % to 10% of cases reported in the literature excluding other complications. In this case, we report the fracture of stainless steel reconstruction plate used without bone graft and its management using locking reconstruction plate with non vascularised iliac crest graft following removal of the fractured plate. Review of literature describing incidence, pattern and causes of reconstruction plate fracture and its management is discussed.

Application of Platelet?Rich Fibrin and Freeze?Dried bone Allograft Following Apicoectomy: A Comparative Assessment of Radiographic Healing

Background: Apicoectomy conceptualizes surgically maintaining a tooth with an endodontic lesion that cannot be resolved by conventional endodontic (re?) treatment. To achieve this, continuous improvement in surgical techniques, materials and instruments is being done to enhance the outcome of periapical endodontic surgeries. The purpose of this study was to compare, radiographically, the healing kinetics of platelet?rich fibrin (PRF) and mineralized freeze?dried bone allograft (FDBA) in patients undergoing apicoectomy. Materials and Methods: Nineteen patients (aged 18–40 years) were included in the study and randomly assigned to groups A or B, where they received PRF or FDBA, respectively. Following apicoectomy, PRF gel and FDBA graft were prepared and placed in the osseous defect followed by placement of PRF membrane for graft stabilization and flap closure. Radiographic follow?up was done at the 1st, 3rd, 6th and 12th months for evaluation of healing using Molven’s criteria. Statistical analysis was done with Pearson’s and McNemar’s Chi?square tests. Results: A highly significant difference (P = 0.002) in radiographic healing was observed at 6 months. Complete healing was observed in 50% of cases in Group A whereas in Group B, none of the cases presented with complete radiographic healing. However, at the end of 12 months, complete radiographic healing was observed in both groups. Conclusion: Our data suggest that PRF accelerates bone healing as compared to FDBA and is both time and cost?efficient.

Comparison of bone transport technique combined with bone grafting plus internal fixation versus simple bone transport technique for large segmental bone defects at lower limbs after trauma / 中华创伤骨科杂志

Objective:To compare the clinical efficacy between bone transport technique combined with bone grafting plus internal fixation and simple bone transport technique in the treatment of large segmental bone defects at lower limbs after trauma.Methods:A retrospective study was conducted to analyze the clinical data of 42 patients with large segmental bone defects at lower limbs after trauma who had been treated at Department of Trauma Orthopaedics, Honghui Hospital Affiliated to Medicine College, Xi'an Jiaotong University from September 2015 to September 2019. The patients were divided into 2 groups according to the different methods of repairing bone defects. In group A of 18 patients subjected to bone transport combined with bone grafting plus internal fixation, there were 11 males and 7 females with an age of (35.2±10.3) years, and 12 tibial defects and 6 femoral defects; in group B of 24 patients subjected to simple bone transport, there were 15 males and 9 females with an age of (37.3±9.4) years, and 17 tibial defects and 7 femoral defects. The external fixation time (EFT), external fixation index (EFI), total cure time and complications were recorded and compared between the 2 groups. At the last follow-up, the Ennecking score for limb functional recovery (score/total score 30) and Self-rating Anxiety Scale (SAS) were used to evaluate respectively the functional recovery of the limbs and postoperative anxiety.Results:The 2 groups were comparable because there was no significant difference between them in preoperative general data or follow-up time ( P>0.05). There was no statistically significant difference in the number of surgeries between the 2 groups ( P>0.05). The EFT [(5.9±1.5) months], EFI [(0.45±0.09) months/cm], total treatment time [(16.2±2.4) months], Ennecking score for limb functional recovery (87.0%±8.6%), SAS score [(43.2±9.0) points], and complications per capita [(0.4±0.2) times/case] in group A were significantly better than those in group B [(15.3±4.2) months, (1.19±0.28) months/cm, (19.7±3.5) months, (77.3%±9.2%), (58.2±9.3) points, and (1.2±0.5) times/case] (all P<0.05). Conclusion:In the treatment of large segmental bone defects at lower limbs, compared with simple bone transport technique, bone transport technique combined with bone grafting plus internal fixation has advantages of shorter external fixation time and overall cure time, a lower rate of complications, and better functional recovery of the limbs.

Effect of different pressure balloon dilation combined with prying reduction and bone graft fixation in the treatment of thoracolumbar fractures and the risk factors of postoperative re-fracture / 中国综合临床

Objective:To investigate the effect of different pressure balloon dilation combined with prying reduction and bone graft fixation in the treatment of thoracolumbar fractures and the risk factors of postoperative re-fracture.Methods:One hundred cases of thoracolumbar fracture patients admitted to Cangzhou Integrated Traditional Chinese and Western Medicine Hospital in Hebei Province from March 2019 to June 2021 were selected. Prospective randomized controlled study method was used and random number table method was used to divide them into three groups: incomplete expansion group (33 cases), moderate expansion group (33 cases) and complete expansion group (34 cases). All the 3 groups were treated with balloon dilation combined with prying reduction and bone graft fixation. The pressure of balloon dilation in incomplete dilation group, moderate dilation group and complete dilation group was 100 psi, 150 psi and no more than 200 psi respectively, and the volume of balloon dilation was 0.5∶1, 1∶1 and 1.5∶1 respectively. The operation time, intraoperative bleeding volume, postoperative drainage volume, vertebral anterior margin recovery rate and hospital stay, as well as local Cobb angle, visual analog scale (VAS) and Oswestry disability index (ODI) scores before and after operation were compared among the three groups. According to the follow-up of whether there is re-fracture after surgery, the clinical data of the re-fracture group and the non re-fracture group were compared, and the risk factors of the re-fracture after surgery were analyzed. The measurement data with normal distribution was expressed as: independent sample t-test was used for comparison between two groups, one-way ANOVA or repeated measurement ANOVA was used for comparison between three groups, and SNK-q test was used for comparison between two groups. Counting data were expressed in cases or cases (%), and compared between groups by χ 2 Inspection. Logistic regression was used to analyze the risk factors of refracture after thoracolumbar fracture. Results:There was no significant difference in operation time, intraoperative blood loss and postoperative drainage volume among the three groups ( P=0.096, 0.328 and 0.344, respectively). The recovery rate of vertebral anterior edge height in moderate expansion group was higher than that in incomplete expansion group and complete expansion group ((84.15±4.21)% vs (70.18±7.44)%, (75.94±6.56)%), and the hospitalization time was shorter than that in incomplete expansion group and complete expansion group ((10.38±2.35) d vs (15.18±3.44), (14.59±2.48) d) (all P<0.001). Before treatment, there was no significant difference in Cobb angle, VAS and ODI scores among the three groups (all P>0.05). After treatment, the Cobb angle, VAS and ODI scores of patients in the three groups were lower than those before treatment, and the moderate expansion group were lower than those in the incomplete expansion group and the complete expansion group ((14.08±2.15) ° vs (16.48±4.85) °, (15.06±3.45) °, (1.81±0.53)% vs (2.25±0.41), (2.31±0.42), (18.16±2.18)% vs (20.48±4.85), (20.01±4.45) points) (all P<0.001). 100 patients were followed up until the fracture was healed. They were divided into re-fracture group (15 cases) and non re-fracture group (85 cases) according to whether there was re-fracture after operation. The results of multifactor logistic regression analysis showed that body mass index and bone mineral density were protective factors for patients with thoracolumbar fracture after operation (odds ratio was 0.66 and 0.15 respectively, 95% confidence interval: 0.51~0.86, 0.05~0.42, P values were 0.006 and <0.001 respectively), The old wedge-shaped change of the vertebral body and the abnormal structure of the lumbar spine are the risk factors for postoperative re-fracture (odds ratio 4.22 and 6.36, 95% confidence interval 1.14-15.56 and 1.43-28.21, respectively, P values were 0.027 and 0.015). Conclusions:In the treatment of thoracolumbar fracture with prying reduction and bone grafting fixation, the effect of balloon expansion pressure of 150 psi is better. Body mass index (BMI) and bone mineral density (BMD) were protective factors for postoperative re-fracture of patients with thoracolumbar fracture. Old wedge-shaped change of vertebral body and abnormal lumbar structure are risk factors for postoperative re-fracture.

Correction of hemifacial microsomia using preformed titanium mesh combined with contralateral mandibular angle bone graft with CAD/CAM assistance / 口腔医学

@#Objective To explore the indications and clinical effects of simultaneous mandibular angleplasty on the unaffected side, performed using preformed titanium mesh combined with mandibular angle bone graft, for the treatment of hemifacial microsomia (HFM). Methods The study group included 11 patients between 2013 and 2021 with HFM who underwent simultaneous mandibular angle reduction of the unaffected side and augmentation of the affected side using resected bone scaffolds within the titanium mesh. A series of mandibular linear measurements such as ramus height(RH)and mandibular body length(BL), angular measurements, and asymmetry index combined with clinical photographs and postoperative complications were used to assess the therapeutic effect. Results Postoperatively, all patients were satisfied. Significant improvement in mandibular contour was shown, with no obvious complications. Postoperative data, such as BL and angular measurements, showed no statistically significant differences(P>0.05) between the affected and unaffected sides with improvement in symmetry, except for RH(P<0.05). The preoperative and postoperative asymmetry index were (17.11±4.56)% and (4.81±1.73)%, respectively, with significant improvement(P=0.002). Conclusion This approach provides satisfactory results and significantly improves facial asymmetries for unilateral HFM with hypertrophy of the contralateral mandibular angle.

Progress of research on bone grafts for implant dentistry / 口腔医学

@#With the development of dental implant techniques, dental rehabilitation of partially or totally edentulous patients with oral implants has become a common practice. Adequate bone volume in the implant area is a key factor for the success of implant restoration. However, insufficient bone volume in the implant area is very common in clinical practice, which jeopardizes the structural, functional, and esthetic outcomes of implant treatment. Bone augmentation with bone grafts is one of the methods commonly used in clinical practice to meet the requirements of implantation. Properties of bone grafts, such as biocompatibility,osteoconduction, osteoinduction and osteogenesis, are important to the success of bone augmentation. This paper reviews current research on dental bone grafts about their clinically relevant capabilities, classification and their potential development in the future, in order to provide theoretical reference for clinical application of bone grafts and successful implant restoration.

Research progress on "sandwich" osteotomy to increase alveolar bone / 口腔疾病防治

@#Lack of alveolar bone height is a major challenge for dental implants. In recent years, the use of "sandwich" osteotomy to increase alveolar bone height has become a topic of discussion within the research community. In theory, "sandwich" osteotomy is a U-shaped osteotomy in the bone defect area, to preserve the blood supply of the mucoperiosteal on the lingual side and to create an artificial "four-wall bone bag" to build a favorable space for osteogenesis and to increase the height of the alveolar bone. Histological studies have shown that the osteogenesis speed of "sandwich" osteotomy is fast, and the bone is good. Sandwich osteotomy is suitable for buccal-lingual alveolar bone height defects less than 50% of the implant length or for unilateral defects more than 50% of the implant length. In the operation of "sandwich" osteotomy, the horizonal incision should be 10-12 mm below the crest of the buccal alveolar ridge. The design of the osteotomy line should ensure the height of the osteotomy block and that the mandibular canal does not sustain damage and that it fits the shape of the bone defect. There was no significant difference in the osteogenic effect of different types of bone graft materials used for "sandwich" osteotomy. The osteotomy block was rigorously fixed by a titanium plate, titanium nail, implant and other materials, and finally, the intraoperative area was tensioned and sutured. The effect of bone augmentation was evaluated and compared with other bone augmentation techniques; the evaluation showed that sandwich osteotomy was better for moderate vertical bone defects. This technique is highly sensitive and postoperative transient sensory loss is common. With advances in technology, the application of digital technology and ultrasonic bone knives, the risk of complications is greatly reduced and advances in digital osteotomy will promote apply of "sandwich" osteotomy, which will become a popularized technique for clinical alveolar bone augmentation.

Clinical application of β-tricalcium phosphate artificial bone material for alveolar cleft repair / 口腔疾病防治

Objective@# To investigate the osteogenic effect of β-tricalcium phosphate (β-TCP) and bone morphogenetic protein-2 (BMP-2) in the repair of the alveolar cleft.@*Methods @# Fifty-nine patients with unilateral alveolar cleft who visited Capital Medical University School of Stomatology from January 2016 to May 2021 were included. They were divided into three groups according to the different bone repair materials: autologous bone, β-TCP and BMP-2 +β-TCP. The preoperative and postoperative CBCT data of the patients were imported into Mimics 21.0 software. The preoperative volume of the bone defect and the new volume of bone formation were calculated by the three-dimensional reconstruction method. The osteogenesis rate was calculated to evaluate the osteogenesis effect@*Results@#The wounds in the three groups healed well after the operation, without implant material discharge, infection, dehiscence, rejection or other symptoms. Twelve months after the operation, CBCT scanning and three⁃dimensional reconstruction images of the three groups of patients showed the formation of new bone bridges in the alveolar ridge fissure area. The image density of the new bone tissue was not significantly different from that of normal bone tissue, and the continuity of the maxilla was re⁃ stored to varying degrees. The bone rate of autogenous bone was 65.00% ± 16.66%, β⁃ TCP group and BMP⁃2+ β⁃ The bone composition rate of TCP was 69.82% ± 17.60%, 71.35% ± 17.51%, respectively, and there was no significant dif⁃ ference compared with the autogenous bone group (P = 0.382, P = 0.244). The β⁃TCP and BMP⁃2+ β⁃TCP groups had no significant differences in bone rate (P = 0.789). @*Conclusion@#β⁃TCP could be used to replace autologous bone for alveolar cleft repair. The addition of BMP⁃2 to β⁃TCP did not significantly improve the osteogenesis rate.

Research progress of bone graft resorption after Latarjet procedure for treatment of recurrent anterior shoulder dislocation / 中国修复重建外科杂志

OBJECTIVE@#To review the research progress of bone graft resorption after Latarjet procedure for the treatment of recurrent anterior shoulder dislocation, and provide a guide for further research on bone graft resorption.@*METHODS@#The relevant literature in recent years was extensively reviewed. The pathogenesis, classification, risk factors, clinical function impact, and management of bone graft resorption after Latarjet procedure for the treatment of recurrent anterior shoulder dislocation were summarized.@*RESULTS@#Bone graft resorption is the common complication after Latarjet procedure for the treatment of recurrent anterior shoulder dislocation. Stress shielding and poor blood supply may contribute to the occurrence of bone graft resorption. The absence of significant preoperative glenoid bone loss, open procedure, earlier graft healing may to be the risk factors for bone graft resorption. Various assessment methods and classification systems are used to evaluate the region and severity of bone graft resorption. Partial resorption may be considered as a natural glenoid remodeling process after the surgery, but severe and complete resorption is proved to be one of the reasons for failed procedures and there is no effective measure to prevent it, except for accepting revision surgery.@*CONCLUSION@#The pathogenesis, risk factors, clinical function impact of bone graft resorption after Latarjet procedure for the treatment of recurrent anterior shoulder dislocation has not been fully elucidated and there is a lack of effective management strategies, so further clinical and basic researches are needed.

Enucleação de cisto residual e regeneração óssea guiada com enxerto sintético a base de fosfato de cálcio bifásico e hidroxiopatita: relato de caso clínico / Enucleation of residual cyst and guided bone regeneration with synthetic graft based on biphasic calcium phosphate and hydroxyopathite: clinical case report / Enuclación de quistes residuales y regeneración ósea guiada con injerto de sintético a base de fosfato de calcio bifásico e hidroxiopato: reporte de caso clínico

Os cistos residuais são definidos como cistos inflamatórios, revestidos por epitélio e em seu interior apresentam um conteúdo semifluido ou fluido, que em sua dominância ocorrem na maxila. Em geral não apresentam sintomas e se não tratado corretamente pode ocasionar uma reabsorção óssea e enfraquecimento da maxila ou mandíbula. O principal objetivo deste trabalho é relatar o caso de uma paciente do sexo feminino, que compareceu a Clinica Odontológica relatando um cisto na região dos incisivos centrais superiores. No exame clinico, notou-se um aumento de volume na porção vestibular do processo alveolar, sendo sua consistência macia e sintomatologia dolorosa a palpação. Portanto, optou-se por sua enucleação cirúrgica da lesão, seguida de uma minuciosa descontaminação mecanica e quimica, seguida de regeneração óssea guiada utilizando um enxerto ósseo sintético a base de fosfato de cálcio e hidroxiapatia sendo seu diagnóstico confirmado através de exame histopatológico. Contudo neste relato pode-se observar que a enucleação do cisto residual seguida por uma boa descontaminação mecanica e quimica, associado a regeneração óssea guiada se mostrou eficaz no tratamento deste caso, não ocorrendo recidivas no periodo de acompanhamento. PALAVRAS-CHAVE: Cistos Residuais; Cistos Odontogênicos; Biópsia; Regeneração Óssea Guiada; Enxerto Ósseo.

Residual cysts are defined as inflammatory cysts, covered by epithelium and in their interior they have a semi-fluid or fluid content, which in their dominance occur in the maxilla. In general, they do not have symptoms and if not treated correctly, it can cause bone resorption and weakening of the maxilla or mandible. The main objective of this work is to report the case of a female patient, who attended the Dental Clinic reporting a cyst in the region of the upper central incisors. On clinical examination, an increase in volume was noted in the vestibular portion of the alveolar process, with a soft consistency and painful symptoms on palpation. Therefore, we opted for its surgical enucleation of the lesion, followed by a thorough mechanical and chemical decontamination, followed by guided bone regeneration using a synthetic bone graft based on calcium phosphate and hydroxyapathy, the diagnosis being confirmed through histopathological examination. However, in this report, it can be seen that the enucleation of the residual cyst followed by good mechanical and chemical decontamination, associated with guided bone regeneration, proved to be effective in the treatment of this case, with no recurrences occurring during the follow-up period.

Los quistes residuales se definen como quistes inflamatorios, recubiertos por epitelio y en su interior tienen un contenido semilíquido o líquido, que en su predominio se presentan en el maxilar. Por lo general, no presentan síntomas y si no se tratan correctamente, pueden causar reabsorción ósea y debilitamiento del maxilar o la mandíbula. El objetivo principal de este trabajo es reportar el caso de una paciente de sexo femenino, que acudió a la Clínica Odontológica por presentar un quiste en la región de los incisivos centrales superiores. Al examen clínico se aprecia aumento de volumen en la porción vestibular del proceso alveolar, de consistencia blanda y sintomatología dolorosa a la palpación. Por ello, se optó por su enucleación quirúrgica de la lesión, seguida de una exhaustiva descontaminación mecánica y química, seguida de regeneración ósea guiada mediante injerto óseo sintético a base de fosfato cálcico e hidroxiapatía, confirmándose el diagnóstico mediante examen histopatológico. Sin embargo, en este reporte se puede ver que la enucleación del quiste residual seguida de una buena descontaminación mecánica y química, asociada a la regeneración ósea guiada, demostró ser eficaz en el tratamiento de este caso, sin que se presentaran recurrencias durante el seguimiento período de subida.

Suckermouth catfish bone extract as bone graft raw material for bone-healing promotes bone growth in bone loss / Extrato de osso de bagre como material de reparo promove o crescimento ósseo em perda óssea

Objective: This study aimed to evaluate the properties of suckermouth catfish bone extract, which allows it to be adopted as a raw material for bone graft following its graft in an artificial defect of a rat model. Material and Methods: Hydroxyapatite (HA) from suckermouth catfish bone extract was characterized using Fourier-transform infrared spectroscopy (FTIR), and its toxicity was evaluated by Brine Shrimp Lethality Test (BSLT). This material was grafted on artificial defects in rats' femoral bones, which were observed immunologically by Enzyme-linked immunosorbent assay (ELISA) after one week and four weeks, and radiographically in the second week, and histologically in the second and fourth weeks. Results: FTIR shows that this material consists of phosphate, hydroxyl, and carbonate groups, while the BSLT results show that this material is not toxic. Observations by ELISA showed an increase in the expression of Tumor necrosis factor alpha (TNF-α) in defects with HA in the fourth week. Radiographically the defect did not show closure in the second week. In contrast, histological analysis showed a better bone healing process in the defect, which was applied with the HA of the suckermouth catfish bone. Conclusion: The HA extracted from the suckermouth catfish bone has beneficial properties as an alternative to bone graft raw material and, more investigated needed to support this biomaterial to be used in the treatment of bone loss (AU)

Objetivo: Avaliar as propriedades do extrato de osso de bagre, que permitem sua adoção como material bruto para enxerto ósseo, em um defeito ósseo artificial em ratos. Material e Métodos: A hidroxiapatita (HA) do extrato de osso de bagre foi caracterizada usando espectroscopia infravermelha por transformada de Fourier (FTIR), e sua toxicidade foi avaliada pelo Teste de Letalidade do Camarão de Sal (BSLT). Esse material foi enxertado em defeitos artificiais nos ossos femorais de ratos. Análise imunológica por meio do ensaio imunoenzimático (ELISA) foi realizada uma e quatro semanas após a colocação dos enxertos. Análises radiográficas foram feitas na segunda semana e histológica na segunda e quarta semanas. Resultados: A FTIR mostrou que esse material é composto por grupos de fosfato, hidroxila e carbonato, enquanto os resultados do BSLT mostraram que esse material não é tóxico. As observações pelo ELISA mostraram um aumento na expressão do fator de necrose tumoral alfa (TNF-α) nos defeitos com HA na quarta semana. Radiograficamente, o defeito não apresentou fechamento na segunda semana. Em contraste, a análise histológica mostrou um melhor processo de cicatrização óssea no defeito que foi aplicado com a HA do osso de bagre. Conclusão: A HA extraída do osso de bagre possui propriedades benéficas como alternativa ao material bruto para enxerto ósseo, sendo necessárias mais investigações para apoiar esse biomaterial a ser usado no tratamento da perda óssea.(AU)

Rehabilitation of a patient diagnosed with Ectodermal Dysplasia presenting hypodontia: a case report

Purpose: The study showed a patient with Ectodermal Dysplasia (ED) who was treated with implants and fixed dental prosthesis by a multidisciplinary team. Case Report: Acrylic resin dental prostheses were designed as long-term provisionals, which allowed modifications when required. After imaging and treatment planning, four implants were placed in the inter-foramenal area of the mandible and 2 years later the definitive prosthesis was fitted. In a second phase, the patient received a combination of autogenous and allogeneic bone grafts in the maxilla. The autogenous graft was removed from the retro-molar region in the mandible. He also received a fixed dental prosthesis supported by 4 implants on the position of the upper canines and second pre-molars. Conclusion: Patient reports successful outcomes and despite the long treatment, patient states is confident with his appearance and speaking improvement. Follow-up was done every six months, for 10 years, and showed encouraging post-treatment outcomes.

Eminoplastía con Injerto de Mentón. Una Alternativa de Tratamiento para la Luxación Crónica Recidivante De la Articulación Temporomandibular

La luxación de la articulación temporomandibular (ATM) implica un desplazamiento no autolimitado del cóndilo fuera de sus posiciones funcionales dentro de la fosa glenoidea y vertiente posterior de la eminencia articular. La luxación de la ATM representa el 3 % de todos los casos de articulaciones dislocadas reportadas en el cuerpo. La ATM es más flexible en las mujeres y, por lo tanto, más propensas a luxarse. Las luxaciones crónicas incluyen luxaciones agudas que no son autolimitadas y progresan sin tratamiento, además de las luxaciones crónicas recidivantes, en las que los individuos experimentan múltiples luxaciones como resultado de las actividades cotidianas. Independientemente del subtipo, la luxación crónica se puede manejar mediante modalidades de tratamiento quirúrgico o no quirúrgico. Las intervenciones quirúrgicas/invasivas tienen como objetivo la modificación anatómica de la eminencia, el cóndilo o los tejidos musculo capsulares. Reportamos el caso de una paciente femenina de 75 años de edad, quien ingresa al servicio de Cirugía Oral y Maxilofacial del Hospital de Traumatología y Ortopedia "Dr. Victorio de la Fuente Narváez" del Instituto Mexicano de Seguridad Social de la Ciudad de México por presentar luxación mandibular recidivante del lado izquierdo desde hace 3 años. Se decide realizar eminoplastía con injerto de mentón como tratamiento quirúrgico definitivo para esta condición obteniendo excelentes resultados funcionales hasta después de un año de seguimiento.

Temporomandibular joint (TMJ) dislocation involves a non-self-limited displacement of the condyle out of its functional positions within the glenoid fossa and posterior aspect of the articular eminence. TMJ dislocation accounts for 3 % of all reported dislocated joint cases in the body. The TMJ is more flexible in women and therefore more prone to dislocation. Chronic dislocations include acute dislocations that are not self-limiting and progress without treatment, as well as recurrent chronic dislocations, in which individuals experience multiple dislocations as a result of daily activities. Regardless of the subtype, chronic dislocation can be managed by surgical or non-surgical treatment modalities. Surgical/invasive interventions aim at anatomical modification of the eminence, condyle, or musculocapsular tissues. We report the case of a 75-year-old female patient who was admitted to the Oral and Maxillofacial Surgery service of the Hospital de Traumatología y Ortopedia "Dr. Victorio de la Fuente Narváez" in Mexico City for presenting recurrent mandibular dislocation on the left side for 3 years. It was decided to perform eminoplasty with chin graft as a definitive surgical treatment for this condition, obtaining excellent functional results up to one year of follow-up.

Resultados post operatorios en pacientes con prótesis total de revisión de cadera mas injerto óseo cadavérico de banco de tejidos en el Hospital de Clínicas en el periodo 2017 al 2020 / Postoperative results in patients with total hip revision arthroplasty and cadaveric bone graft of tissue bank at the Hospital de Clínicas in the period 2017 to 2020

Introducción: La artroplastia total de cadera de revisión junto con la utilización de injerto óseo cadavérico de banco de tejidos es una alternativa de tratamiento eficaz ante los procedimientos de reemplazo con déficit óseo femoral o acetabular. El presente estudio, analizó los resultados post operatorios en pacientes intervenidos quirúrgicamente en el Hospital de Clínicas. Materiales y métodos: Estudio descriptivo. Muestreo no probabilístico de casos consecutivos atendidos en la Cátedra de Ortopedia y Traumatología de la Facultad de Ciencias Médicas (U.N.A). Fueron captados pacientes con indicación de artroplastia total de cadera de revisión (ATCR) más injerto óseo cadavérico de banco de tejidos, entre diciembre 2017 - octubre 2020, previo consentimiento informado. Se relevaron datos cuya caracterización fue posible mediante un instrumento establecido previamente, ingresado en base Excel. Resultados: 12 pacientes con déficit óseo femoral y acetabular han sido tratados con artroplastia total de cadera de revisión más injerto óseo cadavérico de banco de tejidos, en donde además de la funcionalidad y a través de seguimientos radiológicos se ha determinado la osteointegración total de los aloinjertos. La relación masculino-femenina fue 1/1, siendo el diagnóstico preoperatorio para la colocación de la prótesis de revisión más injerto óseo cadavérico de banco de tejidos el aflojamiento séptico en un 75%. El motivo de consulta más frecuente fue dolor y la secreción y el tiempo quirúrgico fue en promedio de 116 minutos. Conclusión: La artroplastia total de cadera de revisión más aloinjerto presenta óptimos resultados en relación a la osteointegración total y funcionalidad.

Introduction: Revision total hip arthroplasty with use of cadaveric bone graft is an effective treatment for replacement procedures in patients with bone loss femoral or acetabular. The present study analyzed the postoperative results in patients who underwent surgery at the Hospital de Clínicas. Materials and methods: Descriptive study. Non-probabilistic sampling of consecutive cases treated at the Department of Orthopedics and Traumatology of Hospital de Clínicas. Data of patients with indication for revision total hip arthroplasty plus cadaveric bone graft from a tissue bank with prior informed consent,were analyzed between December 2017 and October 2020. Results: 12 patients with femoral and acetabular bone deficits have been treated with revision total hip arthroplasty plus cadaveric bone graft from a tissue bank. A radiological and functional follow up was made. The male-female ratio was 1/1, with the preoperative diagnosis for placement of the revision prosthesis plus cadaveric bone graft,from the tissue bank,was septic loosening in 75%. The most frequent symptom was pain, all revision total hip arthroplasties were performed through a posterior approach, and the surgical time was an average of 116 minutes,using a later approach in all cases.Two intraoperative fracture was presented, and were resolved. Conclusion: Revision total hip arthroplasty plus allograft presents optimal results in relation to total osseointegration and functionality.

Management of Bone Failure in Fracture of the Distal Region of the Femur Using the Masquelet Technique with Fibula Graft Associated with Iliac-Crest Graft: Report of Two Cases / Manejo de falha óssea em fratura da região distal do fêmur pela técnica de Masquelet com enxerto de fíbula associado a enxerto de crista ilíaca: Relato de dois casos

Abstract Two cases of bone failure after fracture of the distal region of the femur treated with the Masquelet technique are presented. The first case involves acute bone loss, and the second, pseudarthrosis. The proper management of these lesions led to consolidation and a good functional result.

Resumo Dois casos de falha óssea após fratura da região distal do fêmur tratados pela técnica de Masquelet são apresentados. O primeiro caso envolve uma perda óssea aguda, e o segundo, uma pseudoartrose. O manejo adequado dessas lesões levou à consolidação e a um bom resultado funcional.

Effect of different thresholds on the accuracy of linear and volumetric analysis of native- and grafted-bone

Abstract The study aimed to evaluate the accuracy of Micro-CT in linear and volumetric measurements in native (NB) and grafted bone (GB) areas. A total of 111 biopsies of maxillary sinuses grafted with deproteinized bovine bone (DBB) in humans were evaluated. The linear measurements were performed to measure the length of the NB and GB. Furthermore, the amount of mineralized tissues at the NB and GB was performed. In the histomorphometry analysis the percentage of mineralized tissues at the NB and GB was obtained in two histological sections while the mineralized tissues were measure in the micro-CT varying the thresholds of the grayscale varying from 90-250 to 90-150 with 10 levels of variation between each one was applied. Then these data were correlated in order to check the higher r level between the histomorphometry and micro-CT thresholds intervals. The linear length of the NB was 2.44±0.91mm and 2.48±1.50mm, respectively, for micro-CT and histomorphometry (r =0.57), while the linear length of the GB was 3.63±1.66mm and 3.13±1.45mm, respectively, for micro-CT and histomorphometry (r =0.74) Histomorphometry showed 45.91±11.69% of bone in NB, and 49.57±5.59% of bone and biomaterial in the GB. The total volume of mineralized tissues that were closest to the histometric analysis were 43.75±15.39% in the NB (Threshold:90-240; r = 0.50) and 51.68±8.42% in the GB (Threshold:90-180; r =-0.028). The micro-CT analysis showed good accuracy in the linear analysis in both portions of the biopsies but for volumetric analysis just in NB.

Resumo Esse estudo tem como objetivo avaliar a acurácia da análise microtomográfica em mensurações lineares e volumétricas em osso nativo (ON) e enxertado (OE). Para isso, 111 biópsias removidas de seios maxilares de pacientes enxertados com osso bovino desproteinizado foram coletadas e avaliadas. As medidas lineares foram realizadas para medir o comprimento do ON e do OE. Além disso, foi realizada a mensuração da quantidade de tecidos mineralizados em ON e OE. Na análise histomorfométrica a porcentagem de tecidos mineralizados do ON e OE foi obtida em dois cortes histológicos enquanto os tecidos mineralizados foram medidos em microtomografias variando os thresholds da escala de cinza variando de 90-250 a 90-150 com 10 níveis de variação entre cada. Em seguida, esses dados foram correlacionados para verificar o maior nível de R entre os intervalos dos thresholds testados na análise microtomográfica em relação aos dados obtidos na histomorfometria. O comprimento linear do ON foi de 2,44±0,91mm e 2,48±1,50mm, respectivamente, para análises microtomográfica e histomorfométrica (r=0,57), enquanto o comprimento linear do OE foi de 3,63±1,66mm e 3,13±1,45mm, respectivamente, para para análises microtomográfica e histomorfométrica (r =0,74) A histomorfometria detectou 45,91±11,69% de osso na porção de ON e 49,57±5,59% de osso e biomaterial na porção de OE. O volume total de tecidos mineralizados detectados pela análise microtomográfica que apresentou valores mais próximos da análise histomorfométrica foi de 43,75±15,39% no ON (Thresholds:90-240; r = 0,50) e 51,68±8,42% no OE (Thresholds:90-180; r =- 0,028). A análise microtomográfica apresentou boa acurácia na análise linear em ambas as porções das biópsias, porém a mesma apresentou boa acurácia para análise volumétrica apenas em áreas de ON.

Injerto de hueso calvarial envuelto en colgajo pediculado de fascia temporo-parietal para reconstrucción de reborde cigomático-maxilar e infraorbitario: reporte de caso / Calvarial bone graft wrapped in temporo-parietal fascia pedicled flap for zygomatico-maxillary and infraorbital rim reconstruction: case report

La reconstrucción posterior a una cirugía oncológica resectiva maxilar es todo un desafío. Debido a esto, existen diversas técnicas quirúrgicas cuyo objetivo apunta a mantener no solo la funcionalidad, sino también la estética facial, especialmente en el área del reborde infraorbitario. El injerto de hueso calvarial es una opción segura y versátil para realizar una reconstrucción primaria en el reborde infraorbitario. Esta técnica está indicada en aquellos pacientes en los cuales la resección cutánea y exenteración orbitaria no son necesarias. Por este motivo, a continuación, analizaremos este tipo de injerto a propósito de un caso clínico en el que se usó asociado a un colgajo pediculado de fascia temporoparietal.

Reconstruction after maxillary resective oncological surgery is a challenge. Because of this, there are many surgical techniques whose objective is to maintain not only function but also facial aesthetics, especially in the infraorbital rim area. The calvarial bone graft is a safe and versatile option to perform a primary infraorbital rim reconstruction. This technique is indicated in those patients in whom skin resection and orbital exenteration are not necessary. For this reason, we will now analyze this type of graft in relation to a case in which it was used associated with a temporo-parietal fascia flap.