Application of socket-shield technique for immediate implant placement and provisionalization in esthetic zone: a case report and literature review / 口腔疾病防治

Objective@#To investigate the effect of the socket-shield technique (SST) concurrent with immediate implant placement and provisionalization (IIPP) in the aesthetic restoration of anterior teeth.@*Methods@#A case of maxillary anterior tooth stumps with a thin labial bone wall was treated with SST for preservation of labial soft and hard tissue fullness, combined with an immediate implant placement and immediate provisional crown for restoring the shape of the tooth and gingival molding@*Results@#Immediate implant placement and provisionalization restored the morphology and function of the affected tooth in the shortest possible time. The patient's labial soft and hard tissue contours in the affected tooth area were well preserved in the 18-month follow-up after the application of the SST, which presented a better aesthetic result. The literature review indicates that the indications for SST are unrestorable maxillary anterior teeth, whose dental, periodontal and periapical tissues are healthy and intact. In the esthetic zone, root shielding is effective in maintaining the soft and hard tissue contour on the labial side of the implant. However, there is no consensus on the technical details of SST, such as the ideal coronal height and thickness of the shield, and the management of the gap between the shield and the implant. Thus, more clinical studies and histologic evidence are needed to provide a reference for clinical decision-making. In addition, digital technology can improve the accuracy of implant placement and shield preparation.@*Conclusion@#The correct application of SST combined with IIPP in the esthetic zone can ensure esthetic results. However, more high-quality evidence-based medical evidence is needed for its long-term efficacy, and indications should be strictly controlled during clinical application.

Application of the socket shield technique and its potential risks / 口腔疾病防治

@#The rapid absorption of labial alveolar bone after tooth extraction not only reduces the aesthetic effect of implant repair but also affects the long-term success rate of implants. The socket shield technique is reported as the latest alveolar preservation technique in the aesthetic zone from both domestic and international case reports and shows a high success rate of short-term osseointegration and excellent aesthetic effects. However, some investigations have shown short- and long-term complications with the socket shield technique, such as failure of osseointegration, loss of crestal bone and buccal bone, inflammation, etc. In this review, the socket shield technique will be reported in detail with its pros and cons. Although the socket shield technique has achieved good clinical effects and short-term success rates in many cases, there are still no conclusions regarding the surgical procedure, such as the thickness, the position of the shield, whether to put the graft material between the shield and implant, etc. Due to the lack of long-term research or a large amount of clinical literature support and technical sensitivity, the socket shield technique should be carefully used in clinical application to reduce unexpected risks.

Efficacy of Autogenous Tooth Bone Graft Material for Patients with Alveolar Bone Deficiency in Orthodontic Treatment / 中国医科大学学报

Objective To evaluate the clinical effect of alveolar bone augmentation by applying autogenous tooth bone graft material to patients with alveolar bone deficiency in orthodontic treatment. Methods Four patients with a stable periodontal condition managed with fixed orthodontic treatment were included, and the number of graft sites was 17. Cone beam computed tomography (CBCT) showed labial alveolar bone deficiency. The treatment plan included extraction, and the extracted teeth were used to prepare autogenous tooth bone material. The alveolar bone width was measured at the same site at multiple heights prior to operation and at 3 and 6 months post-operation.Results The alveolar bone width was higher at both 3 and 6 months post-operatively (P ＜ 0.05) than that pre-operatively. The alveolar bone width at 6 months post-operation was lower than that at 3 months post-operation (P ＜ 0.05). Conclusion Applying autogenous tooth bone graft material to patients with alveolar bone deficiency in orthodontic treatment can expand the range of tooth movement and result in good clinical outcomes.

Accuracy evaluation of digital surgical template in angled implantation in the maxillary posterior region / 口腔疾病防治

Objective@#To evaluate the accuracy of digital surgical guide in tilted implant in the maxillary posterior region.@*Methods @# Jaw data from 14 patients were scanned using cone beam computed tomography (CBCT), and digital models were acquired by scanning maxillary plaster models. Implant software was employed to process jaw data and digital models in order to design the surgical template. Then the stereolithographic (SLA) surgical template was created to guide the surgery. After that CBCT data was collected again and compared with the data collected before. Deviations between the actual implant position and the planned implant position were analyzed. @*Results@#Central deviation at the hex and apex between the actual implant and the planned implant was almost constant with a mean of (0.625 ± 0.183) mm and (0.820 ± 0.208) mm. Mean value of horizontal deviation at the hex was (0.314 ± 0.070) mm, horizontal deviation at the apex was (0.509 ± 0.139) mm, vertical deviation at the hex was (0.538 ± 0.178) mm, vertical deviation at the apex was (0.638 ± 0.178) mm. @*Conclusion@#Angled implantation in the maxillary posterior region can reduce risks and trauma as well as the difficulties and duration of surgery. However, our data suggested that significant deviations existed in the actual implant position and the planned implant position.

Split hand/foot malformation with long-bone deficiency and BHLHA9 duplication: A prenatal diagnosis report

Distal limb deformities are congenital malformations with phenotypic variability and high genetic heterogeneity. Split hand/foot malformation, also known as ectrodactyly, is a congenital limb malformation characterized by a defect of the central rays of the hands and/or feet. Split hand/foot malformation with long-bone deficiency (SHFLD) is a rare condition related to a 17p13.3 duplication. Recently, genomic duplications encompassing BHLHA9 have been associated with SHFLD. We report a case of SHFLD presenting with campomelia of the right femur, bilateral agenesis of fibulae, bilateral club feet, and oligosyndactyly of the hands and feet, that was associated with a 17p13.3 duplication, as determined prenatally using array comparative genomic hybridization.

Risk Factors Related to Modular Femoral Stem Failures in Revision Hip Arthroplasty / 대한고관절학회지

PURPOSE: The purpose of this study was to analyze failure rates and causes of hip arthroplasty revisions associated with the use of cementless modular femoral stems. MATERIALS AND METHODS: This study comprised 93 patients(100 hips) that were followed up for more than two years after revision involving modular femoral stem arthroplasty. The clinical results were evaluated using the Harris Hip Score and the radiologic results were evaluated using leg length discrepancy, subsidence and bone formation assessments. We analyzed the relationship between the number of hip surgeries performed and the bone deficiencies and failures observed. Preoperative femoral bone deficiencies were described by Paprosky Grade; Grade I or II were identified in 24 hips, IIIa in 4 hips, IIIb in 28 hips and IV in 3 hips. RESULTS: We observed 80 hips with aseptic loosening, 10 hips with infection after previous revision, 8 hips with periprosthetic fractures and 2 hips with dislocations. Clinical results improved from a preoperative score of 42 (HHS) to a postoperative mean score of 81.5. The cause of early failure in 4 hips was identified as femoral stem subsidence, and the cause of late failure in 3 hips was due to infection. According to the comparison analysis, there was no statistical significance between femoral bone deficiency (P=0.727) and application of cement (P=0.087), but hips with previous revision surgery showed a higher rate of failure (P=0.024). CONCLUSION: Cementless modular stems produced satisfactory results. The main cause of failure was subsidence. A significant risk factor for failure was hips which had undergone previous revision surgery.

Mini-implants to restore missing teeth in severe ridge deficiency and small interdental space

Revision Total Hip Arthroplasty using Allogenic Impaction Bone Grafts and Cemented Cup in Acetabular Bone Deficiency: Minimum Seven Years Clinical and Radiological Analysis

PURPOSE: This study examined the minimum seven years clinical and radiological results of revision total hip arthroplasty using an allogenic impaction bone graft and a cemented cup in an acetabular bone deficiency. MATERIALS AND METHODS: Fifty two revision total hip arthroplasty procedures performed on forty nine patients between March 1992 and June 1998 and followed for more than minimum seven years were examined. The clinical and radiological results were evaluated by Harris hip score and roentgenography including anterior-posterior view of pelvis and lateral view of operated hip. RESULTS: The mean Harris hip score was 47 points preoperatively, 81 points at three years after revision, and 84 points at seven years. The radiological evaluation revealed osseous union that trabeculated between grafted bone and host bone within four months in 47 hips, a complete grafted bone-cement radiolucent line of two millimeters or more in at least one zone in 5 hips at two years and in 7 hips at the seven year follow-up. CONCLUSION: We recommend the technique using an allogenic impaction bone graft and cemented cup to reconstruct an acetabular cavitary defect in revision total hip arthroplasty.

Morsellized Allograft and Acetabular Reconstruction Cage: Follow up of 2 to 9 years

We report the outcome of 32 patients who underwent total hip replacement (THR) augmented with morsellized fresh frozen femoral head allografts and acetabular reconstruction cages. Nine patients underwent primary THR and 23 patients underwent revision THR. Follow up ranged from two to 9 years. Two most common indications for the procedures as reported in literature were rheumatoid arthritis and aseptic loosening of the hip. All but one patient achieved good outcome with radiographs showing full incorporatio

Revision total hip arthroplasty using acetabular reinforcement device with grafting for the massive bone defects / 中国矫形外科杂志

[Objective]To introduce the technology of bone grafting with acetabular reinforcement device for the massive bone defects in the revision total hip arthroplasty.[Method]The massive acetabular bone defects were reconstructed in 8 cases from 2002 and 2007.The defects were classified according to the system of D'Antonio,ⅡB defects in 1 case,ⅡC defects in 2 cases,and Ⅲ defects in 5 cases.Methods:the reinforcement device with the morsellised impaction bone grafting in 3 cases,the reinforcement device with the morsellised impaction bone grafting and the structural autograft in 5 cases.Clinical and radiological evaluations were conducted for each patient.[Result]The follow-up duration averaged to 2.7 years,the Harris score were inoreased by 35 points in average.No hip required further revision of the acetabular component because of aseptic loosening.[Conclusion]The cavitary bone loss could be reconstructed by the bone-impaction grafting;the segmental bone loss could be reconstructed by the structural autograft.The acetabular reinforcement device can fix the grafted bone and support the cup.The massive periacetabular bone loss could be effectively reconstructed by reinforcement device with bone grafting.

Structural Allograft for Femoral Deficiency in Revision Total Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: We investigated the results and the effectiveness of structural allografts, which were obtained from a donated cadaver for femoral deficiency in revision total hip arthroplasty. MATERIALS AND METHODS: We reviewed 27 patients who received a structural allograft for femoral deficiency in revision total hip arthroplasty with a minimum follow-up of 2 years. All allografts were fresh frozen bone obtained from donated cadavers. Whole proximal femur was used in 3 patients and strut or cortical onlay graft in the others. The results were evaluated by using Harris hip scores and by the presence of complications, clinically and stability of stem, osteolysis, radiolucent line, and by the radiographic union of the allograft. RESULTS: The average Harris hip score improved from 40.1 preoperatively to 86.9 postoperatively, and the stem showed bony stability in 18 patients, fibrous stability in 8 patients, and instability in 1 patient due to the recurrence of infection. Radiologically, osteolysis was observed in 4 patients (14.8%), radiolucent line over 2 mm in 1 patient, and union of allografts in 25 patients (92.6%) that showed stable stem. The average union time was 7.5 months. Nonunion of allografts were observed in 2 patients revised with a cancellous bone autograft. Complications were infection in 1 patient, dislocation in 2 patients, and heterotopic ossification in 1 patient. CONCLUSIONS: Structural allografts obtained from cadaveric donor were used for large femoral deficiency in revision total hip arthroplasty. Our results show that satisfactory union and can successfully restore the bone stock for further surgery.

Revision Total Hip Arthroplasty using Morselized Femoral Head Allograft and Cementless Cup in Acetabular Bone Deficiency / 대한정형외과학회잡지

PURPOSE: This study was aimed to evaluate the clinical and radiologic results of revision total hip arthroplasty using a cementless cup and a morselized femoral head allograft in acetabular bone deficiency. MATERIALS AND METHODS: From January 1992 to December 1999, the authors performed 37 revision total hip arthroplasties using morselized femoral head allografts and cementless cup. This study evaluated the clinical and radiologic results, at a mean follow-up of 50 months. We evaluated the Harris hip score clinically, and the displacement of acetabular cup by Yoder's criteria. Location and progression of radiolucent area within acetabular zone, which was defined by DeLee and Charnley was observed and recorded. RESULTS: Mean Harris hip score was improved from 50.6 preoperative to 89.2 at final follow-up. A radiolucent zone between host bone and graft bone was observed in 5 cases, and between graft bone and cup in 7 cases, but all of these were less than 2 mm. The change of cup angle more than 4 degrees were observed in 3 cases in Gross type 4, 4 mm superior migration of acetabular cup was observed in 1 case in Gross type 3 and 5 mm horizontal migration was observed in 1 case in Gross type 4. CONCLUSION: Although the early results in revision total hip arthroplasty have been encouraging to date except for Gross type 4, a more long term follow-up study with a larger size cases are needed.

Development of osteogenic protein-1 and it's application in reconstructive surgery of the hip / 医学研究生学报

Osteogenic protein-1(OP-1),also referred to as bone morphogenetic protein-7(BMP-7),has the effective osteoinduction.In reconstructive surgery of the hip,OP-1 could induce greater and earlier new bone formation,accelerate the incorporation of the graft and host-bone,and enfance the fixation of the plant.The characteristics in the molecular biology and it's application in reconstructive surgery of the hip was reviewed.

Development of materials in repairing bone deficiency in the revision of total hip arthroplasty / 医学研究生学报

Bone loss is often presented in the revision of total hip arthroplasty.The selection of appropriate materials to repair bone deficiency in the revision of total hip arthroplasty requires an understanding of the special bioactivity of the materials.The materials provide the bioactivity of osteogenesis,osteoinduction,osteoconduction and mechanical support.The article give a review of the bioactivity and future applications of the materials in repairing bone deficiency in the revision of total hip arthroplasty.

Revision Total Hip Arthroplasty Using Cementless Acetabular Cup / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical and radiological results of revision total hip arthroplasty using cemetless acetabular cup and several kinds of morseled bone grafts. MATERIALS AND METHODS: We performed 20 cases of revision total hip arthroplasties between July 1993 and June 1996. Acetabular bone deficiency was classified as type I in 4 hips, type II in 13 hips, type III in 2 hips and type IV in one hip by AAOS classification. Autogenous bone graft was used in 10 cases, heterograft in 5 cases, allograft in 2 cases and a mixture with autografts and allografts in 2 cases. The average contact rate between cup and host bone was 33.5% in type I acetabular deficiency, 65.1% in type II, 50% in type III and 39% in type IV. RESULTS: The mean Harris hip score was 82.9 points at the last follow-up. Osseous union between host bone and graft bone occurred within 6 months in 14 cases. Radiological failure was noted in 8 cases at the last follow-up. Three cases were revised during the follow-up period. Five cases out of 7 cases in which the contact rate between acetabular cup and host bone was less than 50% were determined to be a radiologic failure. Only 2 cases of the 10 cases in which autogenous bone graft had failed grafts. The rate of complication was 7cases (35%). CONCLUSIONS: The usage of the hemispherical cementless acetabular cup with autogenous bone graft and increasing the contact rate between the acetabular cup and host bone could be a safe management method in revision total hip arthroplasty. We recomrnend avoiding the use of heterograft in cementless cup revision arthroplasty.

Revision of total Hip Arthroplasty Using Allogenic Bone Graft in Acetabular Deficiency / 대한정형외과학회잡지

Patients with severe acetabular bony deficiency in total hip revision arthroplasties need the use of autogenous or allogenic bone grafts. The Authors performed 28 cases of total hip revision arthroplasties between June 1991 and January 1995 with femoral head allograft for acetabular bony deficiencies and evaluated the clinical and radiological results according to AAOS classification. The clinical result was evaluated by D'Aubigne and Postel score. The mean score was improved from 3.9 points to 5.1 points at follow-up. In radiological evaluation, osseous union of graft was achieved within 12 month and rerevision were performed in two cases (92.8% survival rates) but radiological radiolucent line in at least one zone was seen in five hips in two year follow up. In conclusion, the results of hemispherical microporocoat cup with allogenic bone in segmental or cavitary defect using with acetabular reinforcement ring in combined deficiency were encouraging to date. Success rate of allograft reconsruction of the acetabulum results from a variety of acetabular defect. In our studies, only 40% showed stable bony fixation over short period.