Exéresis de quiste nasopalatino y regeneración ósea / Excisão de cistos nasopalatinos e regeneração óssea / Nasopalatine cyst excision and bone regeneration

Introducción: El quiste nasopalatino es un quiste no odontogénico, ubicado dentro del conducto nasopalatino del maxilar, su diagnóstico en la mayoría de los casos es por hallazgo radiológico de rutina y en otros casos por la presencia de sintomatología; llegando a generar dolor, parestesia y signos visibles como deformaciones faciales. Descripción del caso: El objetivo de este artículo es la revisión de la literatura y presentación del caso de un paciente masculino de 38 años de edad, que acude a la consulta por presentar aumento de volumen en la maxila anterior, de dos años de evolución que presentó resultados favorables luego de la exéresis y colocación de injerto óseo. Consideraciones finales: El quiste nasopalatino representa menos del 5% de los quistes a nivel maxilar y su recurrencia es baja. Cuando se trata de un quiste de gran tamaño con destrucción del tejido óseo circundante, la mejor opción es la utilización de un injerto óseo dependiendo tanto de la biocompatibilidad, del sitio afectado y de los costos. Se considera como gold standard a la matriz ósea desmineralizada (DBX) debido a su capacidad de osteoinducción, osteoconducción y osteogénesis... (AU)

Introdução: O cisto nasopalatino é um cisto não odontogênico, localizado no interior do ducto nasopalatino da maxila, a lesao é descoberta na maior parte dos casos como um achado radiológico de rotina e em outros casos pela presença de sintomatologia; incluindo dor, parestesias e deformidades faciais. Descrição do caso: O objetivo deste artigo é revisar a literatura e apresentar o caso de um paciente masculino de 38 anos de idade que veio à clínica com um aumento volumétrico da região anterior da maxila, com uma evolução de dois anos, que apresentou resultados favoráveis após excisão e colocação de enxerto ósseo. Considerações finais: O cisto nasopalatino representa menos de 5% dos cistos maxilares e a recorrência é baixa. Quando se trata de uma grande lesão com destruição do tecido ósseo circundante, a melhor opção é a utilização de um enxerto ósseo dependendo da biocompatibilidade, do local afetado e dos custos. A matriz óssea desmineralizada (DBX) é considerado o material padrão para a reconstrução óssea da região afetada devido à sua capacidade de osteoindução, osteocondução e osteogénese... (AU)

Introduction: The nasopalatine cyst is a non-odontogenic cyst, located within the nasopalatine duct of the maxilla, its diagnosis in most cases is by routine radiological finding and in other cases by the presence of symptomatology; coming to generate pain, paresthesia and visible signs such as facial deformities. Case description: The objective of this article is to make a literature review and presentation of the case of a 38-year-old male patient, who comes to the consultation for presenting an increase in volume in the anterior maxilla, of two years of evolution that presented favorable results after excision and placement of bone graft. Final considerations: Nasopalatine cyst represents less than 5% of the cysts at maxillary level and its recurrence is low. When it is a large cyst with destruction of the surrounding bone tissue, the best option is the use of a bone graft depending on biocompatibility, the affected site and costs. Demineralized bone matrix (DBX) is considered the gold standard due to its capacity for osteoinduction, osteoconduction and osteogenesis... (AU)

Analysis of the Chemical Composition, Morphological Characterization, and Porosimetry of Allograft and Comparison with Xenograft for Dental Applications / Análisis de la Composición Química, Caracterización Morfológica y Porosimetría de Aloinjerto y Comparación con Xenoinjerto para Aplicaciones Odontológicas

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

La ingeniería de tejidos tiene como objetivo fabricar un andamio que muestre una topografía de superficie adecuada para una respuesta celular deseada. Por tanto, un estudio que analice las características de los injertos óseos es importante para futuros enfoques de investigación. Este trabajo tiene como objetivo analizar las características físico-químicas de injertos óseos de origen humano y bovino disponibles comercialmente para uso odontológico, mediante análisis morfológico de la superficie y composición química mediante microscopio electrónico de barrido de presión variable (VP-SEM) y x-dispersivo de energía. espectrometría de rayos (EDX). Además, el diámetro de los poros y el área superficial se analizaron mediante el método de desgasificación utilizando un porosímetro y el tamaño de las partículas mediante difracción láser. Las partículas de aloinjerto y xenoinjerto analizadas difieren en características morfológicas y composición química. Las partículas del aloinjerto presentan una morfología geométrica cúbica y prismática con bordes angulados y ausencia de macroporos. Por el contrario, las partículas de xenoinjerto presentan una morfología irregular con macroporos en su estructura. Existe una diferencia estadísticamente significativa en C, P y Ca entre el xenoinjerto y los aloinjertos (p < 0,05). La composición analizada de los aloinjertos mostró principalmente la presencia de C y O. Por el contrario, la composición del xenoinjerto fue principalmente Ca. Estas diferencias podrían influir en las propiedades osteogénicas de los aloinjertos y xenoinjertos. Este análisis proporciona información básica para comprender las propiedades fisicoquímicas de aloinjertos y xenoinjertos que facilitan la interacción célula-injerto.

Short-term clinical efficacy observation of lesion removal, bone graft fusion, and external brace treatment for late-stage wrist tuberculosis / 中国骨伤

OBJECTIVE@#To observe the clinical efficacy of lesion removal, bone grafting, fusion, and external fixation in the treatment of late-stage wrist tuberculosis.@*METHODS@#From October 2015 to May 2019, 25 patients with late-stage wrist tuberculosis were treated using lesion removal, bone grafting, fusion, and external fixation. Among these patients, there were 14 males and 11 females, aged from 40 to 74 years old, with an average age of (60.72±8.45) years old. The duration of the disease ranged from 5 to 24 months, with an average of (11.52±7.61) months. There were 11 cases of left wrist tuberculosis and 14 cases of right wrist tuberculosis, with 5 cases accompanied by sinus formation. Postoperative regular anti-tuberculosis treatment was continued. Visual analogue score (VAS), inflammatory indicators, Gartland-Werley wrist function score, and upper limb function score were observed before and after treatment.@*RESULTS@#All 25 patients were followed up for ranging from 12 to 36 months with an average of (19.7±6.3) months. At the latest follow-up, all wounds were healed satisfactorily, and there was no recurrence of tuberculosis or infection. VAS at one week before operation and three months after operation were (5.16±1.14) score and (1.68±0.80) score respectively. One week before operation and three months after operation, erythrocyte sedimentation rate (ESR) was (44.20±20.56) mm·h-1 and (14.44±1.14) mm·h-1, and C-reactive protein (CRP) was (12.37±7.95) mg·L-1 and (4.3±3.37) mg·L-1. The differences in all three data sets were statistically significant (P<0.01). According to Gartland-Werley wrist function scoring, the scores at one week before operation and one year after operation were (21.32±3.44) and (14.96±1.37) respectively, showed a statistically significant difference (P<0.01). According to the upper limb function score (disabilities of the arm, shoulder, and hand, DASH), the score was (70.52±7.95) at one week before operation and(28.84±2.30) at one year after operation. The difference was statistically significant (P<0.01). At the latest follow-up, no patient had a recurrence of tuberculosis.@*CONCLUSION@#The short-term clinical efficacy of treating wrist tuberculosis with lesion removal, bone grafting, fusion, and external fixation is satisfactory.

The impact of synthetic bone grafting for tissue regeneration: an in vivo study

Aims: This study aimed to examine the biological response of synthetic nanocomposite material on canine mandibular bone. Methods: Nine healthy adult male local breed dogs aged 12 to 18 months and weighing 10.2 to 15.2 kg were used in the study. Based on healing intervals of 1 and 2 months, the dogs were divided into 2 groups. Each group had 3 subgroups with 3 dogs each. The division was based on the grafting material used to fill the created defect: an empty defect (Control-ve), Beta-Tricalcium Phosphate, and nanocomposite (Beta-Tricalcium Phosphate and nanosilver 1%) . Surgery started after the dogs were anaesthetized. The surgical procedure began with a 5 cm parallel incision along the mandible's lower posterior border. After exposing the periosteum, a three 5mm-diameter, 5-mmdeep critical-size holes were made, 5mm between each one. Each group's grafting material had independent 3 holes. The defects were covered with resorbable collagen membranes followed by suturing of the mucoperiosteal flap. Results: Total densitometric analysis showed no significant differences between groups at 1-month intervals, with the nanocomposite group having a higher mean rank (165.66± 31.21) in comparison to other groups while at 2 months intervals that there was a highly significant difference between three groups as the P-value was (0.000) with the nanocomposite group having a higher mean rank (460.66± 26.40). Conclusions: In the current study, the use of nanocomposites improved osteoconductivity by accelerating new bone formation. Moreover, the encorporation of nanosilver enhanced growth factor activity. These attributes make nanocomposites a promising material for enhancing the bone healing process

Avaliação in vitro da fotobiomodulação das SHEDs semeadas em um scaffold de osso bovino mineral desproteinizado e colagenado / In vitro evaluation of photobiomodulation of Stem cells from human exfoliated deciduous teeth seeded in a deproteinized bovine bone mineral with 10% collagen scaffold

A regeneração óssea é um processo importante para oferecer tratamentos reconstrutivos mais rápidos e eficientes, no entanto, limitações técnicas continuam sendo um desafio, assim como a velocidade de formação e maturação óssea. Portanto, as pesquisas têm se voltado para técnicas alternativas na regeneração óssea e atualmente, a engenharia tecidual tem estudado o uso de células tronco para tratamento de perdas ósseas. A eficácia e a taxa de sucesso das diferentes técnicas e scaffolds foram avaliadas. Porém, há pouca informação sobre a eficácia combinada de carreadores xenógenos, células tronco de dentes decíduos esfoliados humano (SHEDs) e a terapia de fotobiomodulação (PBMT) na regeneração de defeitos ósseos. Baseado em estudos prévios, a proposta deste estudo foi avaliar, in vitro, a ação da PBMT, uma técnica com propriedades imunomodulatórias, angiogênicas e com capacidade de aumentar a adesão, proliferação e migração celular ao biomaterial tridimensional de osso bovino mineralizado desproteinizado com colágeno suíno a 10% (OBMDC), semeado com SHEDs, para acelerar e aumentar a taxa de formação óssea. Foi utilizado o laser de diodo, com comprimento de onda de 660nm; 40mW de potência; 3J/cm2 de densidade de energia e 2 segundos de tempo de aplicação após 24h e 72h do plaqueamento. Para avaliar a proliferação, as SHEDs foram descongeladas cultivadas, plaqueadas, semeadas no scaffold de OBMDC e divididas em 8 grupos: 1) Controle 15%; 2) Controle 5%; 3) OBMDC 15%; 4) OBMDC 5%; 5) Laser 15%; 6) Laser 5%; 7) OBMDC-L 15%; 8) OBMDC-L 5% e a análise de proliferação foi realizada por MTT. Para avaliar diferenciação celular, as amostras foram divididas em quatro grupos: 1) Grupo Controle clonogênico: SHEDs cultivadas em meio clonogênico; 2) Grupo Controle mineralizante: SHEDs cultivadas em meio mineralizante; 3) Grupo laser clonogênico: SHEDs cultivadas em meio clonogênico com aplicação de laser; 4) Grupo laser mineralizante: SHEDs cultivada em meio mineralizante com aplicação de laser. Para o grupo laser, as células foram irradiadas no período de 24h e 72h após o plaqueamento e todas as amostras fixadas para análise da formação dos depósitos de cálcio, através do ensaio de vermelho de alizarina após 23 dias de cultivo celular e os dados foram tratados estatisticamente (p0,05). Para avaliar a morfologia celular das SHEDs em todos os grupos, utilizou-se o microscópio invertido de fase em 24h e 72h após o plaqueamento. O grupo OBMDC-L 5% SFB em 72h, demonstrou maior proliferação celular que o grupo Controle (p=0.0286). O grupo laser no meio mineralizante apresentou maior formação de depósito de matriz mineralizada em comparação ao grupo controle em meio clonogênico, controle em meio mineralizante e laser em meio clonogênico (p<0,0001). Considerando as condições experimentais deste estudo, concluiu-se que, in vitro, as SHEDs, semeadas em scaffold OBMDC, proliferaram mais após 2 aplicações de PBMT e houve diferenciação osteogênica das células após 23 dias em meio mineralizante.

Rehabilitación implanto protésica en paciente con injerto mandibular de larga data / Implant-prosthetic rehabilitation in a patient with a longstanding mandibular graft / Reabilitação protética com implantes em pacientes com enxerto mandibular de longa data

En la actualidad es cada vez más frecuente la consulta de pacientes que siendo sometidos en edades tempranas a cirugías de extirpación tumoral y posterior reconstrucción con injertos presentan problemas tanto funcionales como estéticos, el uso de prótesis implantosoportadas mejora la calidad de vida, pero al mismo tiempo representan un desafío por la baja disponibilidad ósea. Se presenta un caso clínico de rehabilitación protésica implantosoportada en una paciente con gran déficit óseo mandibular como consecuencia de le extirpación de una neoplasia y posterior injerto de costilla. Se colocaron 2 implantes osteointegrados en hueso remanente y rehabilitación con prótesis removible sostenida a una barra colada. Por ser un tratamiento poco invasivo y conservador fue aceptado fácilmente por la paciente y la mejora tanto en la estética como en la función fue notoria.

Nowadays, it is becoming more and more frequent to see patients who underwent surgery for tumor removal and subsequent reconstruction with grafts at an early age, presenting both functional and esthetic problems. The use of implant-supported prostheses improves the quality of life, but at the same time represents a challenge due to the low availability of bone. A clinical case of implant-supported prosthetic rehabilitation is presented in a patient with a great mandibular bone deficit as a consequence of the removal of a neoplasm and subsequent rib graft. Two osseointegrated implants were placed in the remaining bone and rehabilitation with a removable prosthesis supported by a cast bar. Being a minimally invasive and conservative treatment, it was easily accepted by the patient and the improvement in both esthetics and function was notorious.

Atualmente, são cada vez mais frequentes os pacientes submetidos à cirurgia de remoção de tumores e posterior reconstrução com enxertos em idade precoce que apresentam problemas funcionais e estéticos. O uso de próteses implanto-suportadas melhora a qualidade de vida, mas, ao mesmo tempo, representa um desafio devido à baixa disponibilidade de osso. Apresentamos um caso clínico de reabilitação protética implanto-suportada em um paciente com grande déficit ósseo mandibular em consequência da remoção de uma neoplasia e posterior enxerto de costela. Dois implantes osseointegrados foram colocados no osso remanescente e a reabilitação foi feita com uma prótese removível suportada por uma barra de gesso. Por se tratar de um tratamento minimamente invasivo e conservador, foi facilmente aceito pelo paciente e a melhora na estética e na função foi perceptível.

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)

Análisis de impacto presupuestario de un banco de tejido óseo en un servicio de salud de Chile / Budget impact analysis of the implementation of a bone tissue bank in a Chilean health service

El objetivo de la presente investigación fue el realizar un análisis de impacto presupuestario del injerto óseo en un servicio regional de salud chileno en base a un banco de tejido óseo. Se realizó un estudio epidemiológico preliminar para obtener los datos necesarios para el análisis, específicamente sobre procedimientos de injerto óseo en un servicio de salud local del Servicio Salud Concepción (SSC). Esta búsqueda evidenció un total de 6.252 cc de injertos óseos con un costo total de USD $156.000 por año. Se encontró una capacidad potencial de 302 ± 16 cabezas femorales recuperadas por año de los procedimientos de reemplazo total de cadera y que un banco de tejido óseo puede generar un ahorro de USD $145.000 en los costos hospitalarios por año. Este análisis evidenció que en un servicio de salud representativo de Chile existe una dependencia de sustitutos óseos importados y autoinjertos que pueden ser suplidos de manera sustentable con un banco de tejido óseo basado en donaciones de cabezas femorales bajo la legislación vigente de la autoridad sanitaria chilena.

This research aimed to analyze the costs of bone grafting through a bone tissue bank in a Chilean regional health service. Methods: First, we developed a preliminary epidemiological study to obtain the necessary data for the analysis, specifically on bone graft procedures in a local health service (Servicio Salud Concepción). Next, we performed a budget impact analysis. Results: We analyzed a total of 6,252 cc of bone grafts, with a total cost of USD$156,000 per year. We found a potential recovering capacity of 302 ± 16 femoral heads per year from the total hip replacement procedures. Based on these results, bone tissue banks could save USD$145,000 hospital costs annually. Studying a representative health service from Chile, this analysis revealed a dependency on imported bone substitutes and autografts. These requirements can be supplied sustainably by a bone tissue bank based on donations of femoral heads under the current legislation of the Chilean health authority.

Osseointegration and Success in Hip Arthroplasty Acetabular Revision Using Structured Homologous Graft Average 9.6 Years Follow-up / Osteointegração e sucesso em revisão acetabular de artroplastia total de quadril com enxerto estrutural homólogo seguimento médio de 9, 6 anos

Abstract Objective To evaluate the clinical and radiographic results and survival of the acetabular revision surgery of total hip arthroplasty with cemented implant without the use of reinforcement ring, associated with structural homologous bone grafting. Methods A total of 40 patients (44 hips) operated from 1995 to 2015 were retrospectively analyzed. Radiographs were evaluated according to the classification of the acetabular bone defect, graft shape, and the presence of osseointegration. Cases were considered as failures when the migration of the implant was > 5 mm in any direction, and/or the progression of radiolucency lines around the acetabular component were > 2 mm. We verified the association of radiographic findings with cases of failure using statistical tests and analyzed survival using the Kaplan-Meier curve. Results Of the 44 hips, 45.5% of the acetabular defects were Paprosky type 3A and 50% were 3B. In 65% of the hips, the graft configuration was classified as Prieto type 1 and in 31% as type 2. No radiographic evidence of osseointegration was observed in 13.6% of the cases. We observed 9 (20.5%) reconstruction failures. A correlation was observed between reconstruction failure and the absence of radiographic signs of graft osseointegration. Conclusion We observed good clinic and radiographic results, with survival of 79.54% in a mean follow-up of 9.65 years. Also, there was an association between absence of radiographic signs of osseointegration of the structural graft and failure in this series of patients with large bone defects. The failures did not correlate with the severity of the acetabular bone defect, thickness, or graft configuration.

Resumo Objetivo Avaliarosresultadosclínicos, radiográficos e a sobrevida da cirurgia de revisão acetabular de artroplastia total de quadril com implante cimentado sem uso de anel de reforço, associado à enxertia óssea homóloga estrutural. Métodos Um total de 40 pacientes (44 quadris) operados de 1995 a 2015 foram analisados retrospectivamente. As radiografias foram avaliadas de acordo com a classificação do defeito ósseo acetabular, o formato do enxerto e à presença de osteointegração. Foram considerados casos de insucesso a migração do implante > 5 mm em qualquer direção e/ou a progressão de linhas de radioluscência em torno do componente acetabular > 2mm. Verificamos a associação dos achados radiográficos com os casos de falha utilizando testes estatísticos e analisamos a sobrevida utilizando a curva de Kaplan-Meier. Resultados Dos 44 quadris, 45,5% dos defeitos acetabulares eram Paprosky tipo 3A e 50%, 3B. Em 65% dos quadris, a configuração do enxerto foi classificada como tipo 1 de Prieto e em 31% como tipo 2. Não foi observada evidência radiográfica de osteointe-gração em 13,6% dos casos. Observamos 9 (20,5%) falhas de reconstrução. Foi observada correlação entre falha da reconstrução com a ausência de sinais radiográficos de osteointegração do enxerto. Conclusão Observamos bons resultados clínicos e radiográficos, com sobrevida de 79,54% em seguimento médio de 9,65 anos. Também houve associação entre ausência de sinais radiográficos de osteointegração do enxerto estrutural e falha nesta série de pacientes com grandes defeitos ósseos. As falhas não se correlacionaram com a severidade do defeito ósseo acetabular, espessura ou configuraçãodoenxerto.

Use of enamel matrix- derived proteins combined with bone graft for the treatment of intrabony defects: overview of reviews (FRISBEE review) / Uso de proteínas derivadas de la matriz del esmalte combinado con injerto óseo para el tratamiento de defectos intraóseos: resumen estructurado de revisiones sistemáticas (revisión FRISBEE)

Introduction: The use of enamel matrix-derived proteins (EMD) has increased in recent years due to their tissue-inducing properties that support periodontal regeneration. This study is an overview of systematic reviews with FRISBEE methodology on the use of EMD alone or combined with autologous bone graft materials (BGM) in the treatment of intrabony defects. Materials and Methods: A systematic search in the Epistemonikos database was performed. RevMan 5.3 and GRADEpro were used for data analysis and presentation Results: Four systematic reviews and two clinical trials were identified. All studies analysed change in probing depth, clinical attachment level, gingival margin level and bone defect depth (all changes in favour of EMD+BGM groups: mean difference (MD): 0.37 mm more, MD: 0.7 mm more, MD: 0.3 mm less, MD: 0.75 more, respectively). Conclusions: Adding autologous bone graft to EMD to treat intrabony defects showed better results, but not a relevant clinical difference compared to the use of EMD alone.

Introducción: El uso de proteínas derivadas de la matriz del esmalte (EMD) ha aumentado en los últimos años debido a sus propiedades inductoras de tejidos que apoyan la regeneración periodontal. Este estudio es una revisión sistemática de revisiones sistemáticas utilizando metodología FRISBEE sobre el uso de EMD solo o combinado con materiales injerto óseo autólogo (BGM) en el tratamiento de defectos intraóseos. Materiales y Métodos: Se realizó una búsqueda sistemática en la base de datos Epistemonikos. Se utilizaron RevMan 5.3 y GRADEpro para el análisis y la presentación de los datos. Resultados: Se identificaron cuatro revisiones sistemáticas y dos ensayos clínicos. Todos los estudios analizaron el cambio en la profundidad de sondaje, el nivel de inserción clínica, el nivel del margen gingival y la profundidad del defecto óseo (todos los cambios a favor de los grupos EMD+BGM: MD: 0,37 mm más, media de diferencia (MD): 0,7 mm más, MD: 0,3 mm menos, MD: 0,75 más, respectivamente). Conclusión: La adición de injerto óseo autólogo a la EMD para tratar defectos intraóseos mostró mejores resultados, pero no una diferencia clínica relevante en comparación con el uso de la EMD sola.

Efficacy of treatment of class II furcation lesions using membrane associated with bone grafting in mandibular molars compared to membrane only: a systematic review and meta-analysis / Eficacia del tratamiento de lesiones de furca grado II utilizando membrana asociada con injerto óseo en molares mandibulares en comparación con solamente membrana: revisión sistemática y metanálisis

Objective: The objective of the present systematic review and meta-analysis was to compare treatment with membrane associated with bone grafting and treatment exclusively with membrane in the approach of Class II furcation defects in mandibular molars. Materials and Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed. Searches were conducted in five databases (PubMed, Web of Science, Scopus, Ovid, and Lilacs), in Septem-ber 2021, without restriction regarding publication year or language. Studies comparing membranes associated with bone grafting and membranes exclusively in the treatment of Class II furcation lesions were included. Cross-sectional, case-control studies, and reviews were excluded. Study selection, data extraction, and risk of bias assessment (MINORS) were performed by two review authors. The certainty of the evidence (GRADE) was evaluated and meta-analysis was performed. Mean difference (MD) and 95% confidence interval (CI) were provided. Results: Four hundred eighty-six references were iden-tified and four studies were included. Greater reduction in probing depth [MD = 0.32 (CI = 0.09, 0.56)] and greater clinical attachment level gain [MD = 0.41 (CI = 0.24, 0.57)] were observed when membrane and bone grafting were used. The risk of bias of included studies was low. Conclusions: This present systematic review and meta-analysis demonstrated that treatment of Class II furcation defects in mandibular molars using membrane and bone grafing is significantly more efficacious than treatment with the exclusive use of membrane.

Objetivo: El objetivo de la presente revisión sistemática y metanálisis fue comparar el tratamiento con membrana asociado a injerto óseo y el tratamiento exclusivamente con membrana en el abordaje de lesiones de furca grado II en molares mandibulares. Materiales y Métodos: Se siguió la declaración de elementos de informe preferidos para revisiones sistemáticas y metanálisis (PRISMA). Las búsquedas se realizaron en cinco bases de datos (PubMed, Web of Science, Scopus, Ovid y Lilacs), en septiembre de 2021, sin restricción de año de publicación o idioma. Se incluyeron estudios que compararon membranas asociadas con injertos óseos y membranas exclusivamente en el tratamiento de lesiones de furca de grado II. Se excluyeron los estudios transversales, de casos y controles y las revisiones. Dos revisores realizaron la selección de estudios, la extracción de datos y la evaluación del riesgo de sesgo (MINORS). Se evaluó la certeza de la evidencia (GRADE) y se realizó un metanálisis. Se proporcionaron la diferencia de medias (DM) y el intervalo de confianza (IC) del 95%. Resultados: Se identificaron 486 referencias y se incluyeron cuatro estudios. Se observó una mayor reducción en la profundidad de sondaje [DM = 0,32 (IC = 0,09, 0,56)] y una mayor ganancia en el nivel de inserción clínica [DM = 0,41 (IC= 0,24, 0,57)] cuando se utilizaron injertos de membrana y hueso. El riesgo de sesgo de los estudios incluidos fue bajo. Conclusión: La presente revisión sistemática y metanálisis demostró que el tratamiento de los defectos de furca de grado II en molares mandibulares utilizando membrana e injertos de hueso es significativamente más eficaz que el tratamiento con el uso exclusivo de membrana.

Removal Rate of the Tomofix® System after High Tibial Osteotomy is Higher Than Reported / A taxa de remoção do sistema Tomofix® após a osteotomia tibial alta é superior à relatada

Abstract Objective Medial open wedge high tibial osteotomy (MOWHTO) significantly relieves pain in the medial joint line in medial compartment osteoarthritis of the knee. But some patients complain of pain over the pes anserinus even 1 year after the osteotomy, which may require implant removal for relief. This study aims to define the implant removal rate after MOWHTO due to pain over the pes anserinus. Methods One hundred and three knees of 72 patients who underwent MOWHTO for medial compartment osteoarthritis between 2010 and 2018 were enrolled in the study. Knee injury and osteoarthritis outcome score (KOOS), Oxford knee score (OKS), and visual analogue score (VAS) were assessed for pain in the medial knee joint line (VAS-MJ) preoperatively, 12 months postoperatively, and yearly thereafter; adding VAS for pain over the pes anserinus (VAS-PA). Patients with VAS-PA ≥ 40 and adequate bony consolidation after 12 months were recommended implant removal. Results Thirty-three (45.8%) of the patients were male and 39 (54.2%) were female. The mean age was 49.4 ± 8.0 and the mean body mass index was 27.0 ± 2.9. The Tomofix medial tibial plate-screw system (DePuy Synthes, Raynham, MA, USA) was used in all cases. Three (2.8%) cases with delayed union requiring revision were excluded. The KOOS, OKS, and VAS-MJ significantly improved 12 months after MOWHTO. The mean VAS-PA was 38.3 ± 23.9. Implant removal for pain relief was needed in 65 (63.1%) of the103 knees. The mean VAS-PA decreased to 4.5 ± 5.6 3 months after implant removal (p < 0.0001). Conclusion Over 60% of the patients may need implant removal to relieve pain over the pes anserinus after MOWHTO. Candidates for MOWHTO should be informed about this complication and its solution.

Resumo Objetivo A osteotomia tibial alta com cunha de abertura medial (MOWHTO, do inglês medial open wedge high tibial osteotomy) alivia de forma significativa a dor na linha articular medial em casos de osteoartrite do compartimento medial do joelho. Alguns pacientes, porém, se queixam de dor nos tendões dos músculos sartório, grácil e semitendinoso (pata de ganso) mesmo 1 ano após a osteotomia, o que pode exigir a remoção do implante. Este estudo define a taxa de remoção do implante após a MOWHTO devido à dor nos tendões dos músculos sartório, grácil e semitendinoso. Métodos Cento e três joelhos de 72 pacientes submetidos à MOWHTO para tratamento da osteoartrite do compartimento medial entre 2010 e 2018 foram incluídos no estudo. A pontuação de desfecho de lesão no joelho e osteoartrite (KOOS, do inglês Knee Injury and Osteoarthritis Outcome Score), a pontuação dejoelho de Oxford (OKS, do inglês Oxford Knee Score) e a escala visual analógica (EVA) de dor na linha articular medial do joelho (EVA-MJ) foram avaliados antes da cirurgia. A EVA nos tendões dos músculos sartório, grácil e semitendinoso (EVA-PA) foi adicionada a essas avaliações, também realizadas 12 meses após o procedimento e, a seguir, anualmente. A remoção do implante foi recomendada em pacientes com EVA-PA ≥ 40 e consolidação óssea adequada em 12 meses. Resultados Trinta e três (45,8%) pacientes eram homens e 39 (54,2%), mulheres. A média de idade foi de 49,4 ±8,0, e o índice de massa corpórea (IMC) médio foi de 27,0 ± 2,9. O sistema placa-parafuso tibial medial Tomofix (DePuy Synthes, Raynham, MA, EUA) foi utilizado em todos os casos. Três (2,8%) casos foram excluídos devido ao retardo de consolidação e à necessidade de revisão. Os resultados nas escalas KOOS, OKS e EVA-MJ melhoraram significativamente 12 meses após a MOWHTO. A EVA-PA média foi de 38,3 ± 23,9. A remoção do implante para alívio da dor foi necessária em 65 (63,1%) dos 103 joelhos. Três meses após a remoção do implante, a EVA-PA média diminuiu para 4,5 ± 5,6 (p < 0,0001). Conclusão A remoção do implante pode ser necessária em mais de 60% dos pacientes para alívio da dor nos tendões dos músculos sartório, grácil e semitendinoso após a MOWHTO. Os candidatos à MOWHTO devem ser informados sobre esta complicação e sua resolução.

Niveles bajos de vitamina D y su efecto en la oseointegración: revisión sistemática / Low levels of vitamin D and effect on osseointegration: a systematic review

Introducción: la vitamina D es una hormona que se sintetiza por células de la piel mediante la luz ultravioleta (UV) y se obtiene a través de la dieta. La relación que se establece entre la deficiencia de vitamina D y el fracaso en injertos óseos o implantes se basa en las alteraciones inmunológicas e inflamatorias debido al vínculo que existe con la inmunidad innata y adaptativa. Objetivo: identificar los factores que se presentan en el periodonto cuando existen niveles bajos de vitamina D y se realizan tratamientos periodontales como injertos óseos e implantes. Material y métodos: se realizó la búsqueda primaria de artículos en bases de datos PubMed y Google Académico (en español e inglés), de acuerdo con las palabras claves: deficiencia, vitamina D, implantología y oseointegración. Resultados: la vitamina D afecta y predispone al rechazo de injertos, ausencia de oseointegración en implantes debido a la inmunomodulación. Conclusión: el éxito del tratamiento se vuelve predecible cuando se encuentran niveles óptimos de vitamina D en conjunto con técnicas de abordaje quirúrgico correctas que permitan generar una integración ideal de los tejidos periodontales (AU)

Introduction: vitamin D is a hormone that is synthesized by skin cells using UV light and consumed through the diet. The relationship established between vitamin D deficiency and the failure of bone grafts or implants is based on immunological and inflammatory alterations due to the intimate link with innate and adaptive immunity. Objective: to identify the factors that occur in the periodontium when there are low levels of vitamin D and periodontal treatments such as bone grafts and implants are performed. Material and methods: a search for articles was carried out in PubMed and Google Scholar (Spanish and English). Results: vitamin D affects and predisposes to graft rejection, absence of osseointegration in implants due to immunomodulation. Conclusion: the success of the treatment becomes predictable when optimal levels of vitamin D are found together with the correct surgical approach techniques that allow the generation of an ideal integration of the periodontal tissues.(AU)

Outcomes of Extended Curettage with and without Bone Allograft for Grade II Giant Cell Tumors around the Knee. A Retrospective Comparative Study / Resultados da curetagem estendida com e sem aloenxerto ósseo para tumores de células gigantes de grau II no joelho. Um estudo comparativo retrospectivo

Abstract Objective This is the first study to establish the utility of extended curettage with or without bone allograft for Grade II giant cell tumors GCTs around the knee joint with the aim of exploring postoperative functional outcomes. Methods We retrospectively reviewed 25 cases of Campanacci grade II GCTs undergoing extended curettage between January 2014 and December 2019. The participants were divided into two groups: one group of 12 patients underwent extended curettage with bone allograft and bone cement, while the other group of 13 patients underwent extended curettage with bone cement only. Quality of life was assessed by the Revised Musculoskeletal Tumor Society Score and by the Knee score of the Knee Society; recurrence and complications were assessed for each cohort at the last follow-up. The Fisher test and two-sample t-tests were used to compare the categorical and continuous outcomes, respectively. Results The mean age was 28.09 (7.44) years old, with 10 (40%) males and 15 females (60%). The distal femur and the proximal tibia were involved in 13 (52%) and in 12 (48%) patients, respectively. There was no significant difference in the musculoskeletal tumor society score (25.75 versus 27.41; p= 0.178), in the knee society score (78.67 versus 81.46; p= 0.33), recurrence (0 versus 0%; p= 1), and complications (25 versus 7.69%; p= 0.21). Conclusions Extended curettage with or without bone allograft have similar functional outcomes for the knee without any major difference in the incidence of recurrence and of complications for Grade II GCTs. However, surgical convenience and cost-effectiveness might favor the bone cement only, while long-term osteoarthritis prevention needs to be investigated to favor bone allograft.

Resumo Objetivo Este é o primeiro estudo a estabelecer a utilidade da curetagem estendida com ou sem enxerto ósseo em tumores de células gigantes (TCGs) de grau II na articulação do joelho com o objetivo de explorar os resultados funcionais pós-operatórios. Métodos Revisamos retrospectivamente 25 casos de TCGs de grau II de Campanacci submetidos a curetagem estendida entre janeiro de 2014 e dezembro de 2019. Os participantes foram divididos em 2 grupos: um grupo de 12 pacientes foi submetido a curetagem estendida com aloenxerto ósseo e cimento ósseo, enquanto o outro grupo, com 13 pacientes, foi submetido a curetagem estendida apenas com cimento ósseo. A qualidade de vida foi avaliada pela Pontuação Revista da Musculoskeletal Tumor Society (MTS, na sigla em inglês) e pela Pontuação da Knee Society (KS, na sigla em inglês), enquanto as taxas de recidiva e complicações foram avaliadas em cada coorte na última consulta de acompanhamento. O teste de Fisher e os testes t de duas amostras foram usados para comparação de resultados categóricos e contínuos, respectivamente Resultados A média de idade dos pacientes foi de 28,09 (7,44) anos; 10 (40%) pacientes eram do sexo masculino e 15 (60%) pacientes eram do sexo feminino. O fêmur distal e a tíbia proximal foram acometidos em 13 (52%) e 12 (48%) dos pacientes, respectivamente. Não houve diferença significativa na pontuação revista da MTS (25,75 versus 27,41; p= 0,178), na pontuação da KS (78,67 versus 81,46; p= 0,33) e nas taxas de recidiva (0 versus 0%; p= 1) e complicações (25 versus 7,69%; p= 0,21). Conclusões A curetagem estendida com ou sem aloenxerto ósseo tem resultados funcionais semelhantes em pacientes com TCGs de grau II no joelho, sem qualquer diferença importante na incidência de recidivas e complicações. No entanto, a conveniência cirúrgica e o custo-benefício podem favorecer a utilização apenas de cimento ósseo, enquanto a prevenção da osteoartrite em longo prazo precisa ser investigada para favorecer o enxerto ósseo.

Clinical study on core decompression in treating osteonecrosis of the femoral head of the necrotic bone-in different site / 中国骨伤

OBJECTIVE@#To analyze the clinical effect of decompression and bone grafting on osteonecrosis of the femoral head(ONFH) at different sites of necrotic lesions.@*METHODS@#A total of 105 patients with ARCOⅡstage ONFH admitted from January 2017 to December 2018 were retrospectively analyzed. There were 71 males and 34 females, with an average age of (55.20±10.98) years old. The mean course of all patients was(15.91±9.85) months. According to Japanese Inveatigation Committee (JIC) classification, all patients were divided into 4 types:17 cases of type A, 26 cases of type B, 33 cases of type C1 and 29 cases of type C2. All four groups were treated with decompression of the pulp core and bone grafting. Visual analogue scale(VAS) and Harris hip joint score were used before and at 3, 6, 12, and 24 months after the operation, and the collapse of the femoral head was observed by X-ray examination within 2 years.@*RESULTS@#All 105 patients were successful on operation without complications, and the mean follow-up duration was (24.45±2.75) months. Harris score showed that there was no statistical difference among four groups before surgery and 3, 6 months after surgery (P>0.05);at 12 and 24 months after surgery, there were significant differences among all groups (P<0.01). There were significant differences in intragroup Harris scores at preoperative and postoperative time points among four groups (P<0.01). VAS showed that there was no statistical difference among four groups before and 3, 6 months after surgery (P>0.05);at 12 and 24 months after surgery, there were significant differences among all groups (P<0.01). There were significant differences in VAS at preoperative and postoperative time points among four groups (P<0.01). None of the patients in four groups had femoral head collapse before and 3, 6 months after surgery. At 12 months after operation, there were 3 cases of femoral head collapse in group C and 4 cases in group C2(P>0.05);At 24 months after operation, 1 case of femoral head collapse occurred in group B, 6 cases in group C1 and 8 cases in group C2(P<0.05).@*CONCLUSION@#Core decompression and bone grafting can improve the effect of ONFH and hip preservation. The effect of hip preservation for ONFH is closely related to the location of the osteonecrosis lesion, so the influence of the location of lesion on the effect of hip preservation should be considered in clinical treatment, so as to make better preoperative hip preservation plan.

Dental implant treatment in vascularized bone flaps after jaw reconstruction / 华西口腔医学杂志

Jaw defects caused by various reasons often seriously affect appearance and function. The goal of the treatment of oral and maxillofacial tumors should include the cure of the tumor and the restoration of premorbid function. The development of microsurgery and digital surgery technology has promoted the development of jaw reconstruction with vascularized free bone flap. Good appearance and improved predictability could be obtained with the help of preope-rative visual design. How to rehabilitate occlusal function on the reconstructed jaw and improve the quality of life of patients has become an important research direction. This article discusses the challenge of jaw reconstruction, the selection of vascularized bone flap, the choice of implant timing, the treatment of peri-implant soft tissue, and the influence of radiotherapy on implants after jaw reconstruction.

Two-stage alveolar bone grafting for nasal floor reconstruction in adult cleft patients / 华西口腔医学杂志

Alveolar cleft is one of the key links of cleft lip and palate reconstruction due to its close relationship with tooth and jaw coordination and nasolabial deformity. The alveolar bone graft repairs the hole in the gum ridge and stabilizes the bone arch, providing better support for the base of the nose and new bone for the roots of the developing teeth to grow into. Unfortunately, bone graft failure in the traditional way, even among minor clefts, bony hypoplasia, or absence that affects the nasal base and piriform rim, is common. Two-stage alveolar bone grafting, which has advantages in addressing the underlying skeleton and deficiency, could be an optional surgical procedure for nasal floor reconstruction in adult patients with a broad alveolar cleft.

Effectiveness of iliac cancellous bone grafting in alveolar cleft repair and analysis of factors affecting it / 华西口腔医学杂志

OBJECTIVES@#To review the effectiveness of secondary alveolar bone grafting using iliac cancellous bone in patients with unilateral complete alveolar cleft and to investigate the factors influencing it.@*METHODS@#A retrospective study of 160 patients with unilateral complete alveolar clefts who underwent iliac cancellous bone graft repair at the Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, was conducted. Eighty patients in the young age group (6-12 years) and 80 in the old age group (≥13 years) were included. Bone bridge formation was determined using Mimics software, and the volume was measured to calculate the iliac implantation rate, residual bone filling rate, and resorption rate. The factors that affected bone grafting in both subgroups were investigated.@*RESULTS@#Using bone bridge formation as the clinical success criterion, the success rate for the entire population was 71.25%, with a significant difference of 78.75% and 63.75% for the young and old age groups, respectively (P=0.036). The gap volume in the latter was significantly larger than that in the former (P<0.001). The factors that influenced bone grafting in the young group were the palatal bone wall (P=0.006) and history of cleft palate surgery (P=0.012), but only the palatal bone wall affected the outcome in the old age group (P=0.036).@*CONCLUSIONS@#The results of alveolar bone grafting for the old age group were worse than those for the young age group. The palatal bone wall was an important factor that affected alveolar bone grafting, and alveolar bone grafting in the young patients was influenced by the history of cleft palate surgery.

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.

Effectiveness of arthroscopic autologous iliac bone grafting with double-row elastic fixation for recurrent anterior shoulder dislocation with massive glenoid bone defect / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of arthroscopic autologous iliac bone grafting with double-row elastic fixation in treatment of recurrent anterior shoulder dislocation combined with massive glenoid bone defects.@*METHODS@#Between January 2018 and December 2021, 16 male patients with recurrent anterior shoulder dislocation combined with massive glenoid bone defects were treated with arthroscopic autogenous iliac bone grafting and double-row elastic fixation. The patients were 14-29 years old at the time of the first dislocation, with an average age of 18.4 years. The causes of the first dislocation included falling injury in 5 cases and sports injury in 11 cases. The shoulders dislocated 4-15 times, with an average of 8.3 times. The patients were 17-37 years old at the time of admission, with an average age of 25.1 years. There were 5 left shoulders and 11 right shoulders. The preoperative instability severity index (ISIS) score of the shoulder joint was 5.8±2.1, and the Beighton score was 4.3±2.6. The University of California Los Angeles (UCLA) score, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and Rowe score were used to evaluate shoulder function, and the degree of the glenoid bone defect repair was observed based on CT after operation.@*RESULTS@#All incisions healed by first intention, and no complication such as incision infection or neurovascular injury occurred. The patients were followed up 12 months. At 12 months after operation, UCLA score, Constant score, ASES score, and Rowe score all significantly improved when compared with the scores before operation ( P<0.05). CT imaging showed the degree of glenoid bone defect was significantly smaller at immediate, 6 and 12 months after operation when compared with that before operation ( P<0.05), and the bone blocks healed with the scapula, and bone fusion had occurred at 12 months.@*CONCLUSION@#Arthroscopic autologous iliac bone grafting with double-row elastic fixation is a safe treatment for recurrent anterior shoulder dislocation combined with massive glenoid bone defects, with good short-term effectiveness.