Consequence of Synthetic Bone Substitute Used for Alveolar Cleft Graft Reconstruction (Preliminary Clinical Study).

Background The outcome of alveolar grafting with synthetic bone substitute (Osteon III) in various bone defect volumes is highlighted. Methods A prospective study was accomplished on 55 patients (6-13 years of age) with unilateral alveolar bone cleft. Osteon III, consisting of hydroxyapatite and tricalcium phosphate, is used to reconstruct the defect. Alveolus defect diameter was calculated before surgery (V1), after 3 months (V2), and finally after 6 months (V3) postsurgery. In the t -test, a significant difference and correlation between V1, V2, and V3 are stated. A p- value of 0.01 is considered a significant difference between parameters. Results The degree of cleft is divided into three categories: small (9 cases), medium (20 patients), and large (26 cases).The bone volume of the clefted site is divided into three steps: volume 1: (mean 18.1091 mm 3 ); step 2: after 3 months, volume 2 resembles the amount of unhealed defect (mean 0.5109 mm 3 ); and the final bone volume assessment is made after 6 months (22.5455 mm 3 ). Both show statistically significant differences in bone volume formation. Conclusion An alloplastic bone substitute can also be used as a graft material because of its unlimited bone retrieval. Osteon III can be used to reconstruct the alveolar cleft smoothly and effectively.

The use of a new grafting material (b.Bone™) for the management of severely depressed tibial plateau fractures: Preliminary report of three cases.

Tibial plateau fractures are often complex injuries that result from high-energy trauma affecting the articular congruity of the knee. Managing tibial plateau fractures can be challenging because of severe depression of the subchondral cancellous bone and concomitant cartilage injury. Bone substitutes are commonly used to fill such defects as part of the surgical treatment of tibial plateau fractures. We describe three cases of tibial plateau fractures managed with a synthetic bone substitute (b.Bone™, GreenBone ORTHO S.p.A Faenza, Italy) with a highly interconnected and porous 3D structure to mimic the hierarchical architecture and morphology of natural human bone.

Chondroblastoma Affecting the Apophysis of the Greater Trochanter in a Child.

Chondroblastomas are rare primary bone tumours typically affecting the epiphyses and less frequently the apophyses of the growing skeleton. Most cases are treated by intralesional curettage with or without local adjuvants and this technique can produce good long-term outcomes. Herein, we describe a case of chondroblastoma of the greater trochanter in a 12-year-old male child that was treated by intralesional curettage and grafting with calcium phosphate bone cement (Neocement Inject® P, Bioceramed, Loures, Portugal). A brief review of the literature is also presented.

Soft-tissue dimensional change following guided bone regeneration on peri-implant defects using soft-type block or particulate bone substitutes: 1-year outcomes of a randomized controlled clinical trial.

AIM: To compare the peri-implant soft-tissue dimensional changes following guided bone regeneration between particulate (particle group) and collagenated soft-block-type (block group) biphasic calcium phosphate (BCP). MATERIALS AND METHODS: This study investigated 35 subjects: 18 in the particle group and 17 in the block group. Cone-beam computed tomography obtained at 6 months post surgery and optical impressions taken periodically (before surgery, 6 months post surgery, and 1 year post surgery) were superimposed. The ridge contour changes over time and the peri-implant mucosal thicknesses were measured diagonally and horizontally, and analysed statistically. RESULTS: The increases in diagonal (1.12 ± 0.78 mm) and horizontal (2.79 ± 1.90 mm) ridge contour of the block group were significantly higher than those in the particle group during the first 6 months (p < .05); however, the contour hardly changed thereafter (diagonal: 0.07 ± 0.75 mm; horizontal: -0.34 ± 1.26 mm), resulting in the 1-year contour changes similar between the two groups. Regardless of the type of BCP, the ridge contour increased significantly over 1 year when the dehiscence defect had a contained configuration (p < .05). CONCLUSIONS: The increase in soft-tissue dimensions for 1 year was similar between the two groups. The mucosal contour increase was larger when the surgery was conducted in a more contained defect, and this was not influenced by the type of BCP.

The use of 3D ceramic block graft compared with autogenous block graft for rehabilitation of the atrophic maxilla: a randomized controlled clinical trial.

BACKGROUND: Dental implant placement may require a bone graft for vertical and horizontal alveolar ridge augmentation. Due to its osteoconduction, osteoinductive, and osteogenesis, autogenous bone graft characteristics are considered the standard gold treatment. However, autografts can promote postoperative morbidity and implicate difficulties concerning the graft adaptation to the recipient's bone since it can eventually avoid gaps. To overcome these issues, this trial will compare the performance of Plenum® Oss 3Dß fit, an alloplastic graft, and a 3D-printed patient-specific graft based on ß-tricalcium phosphate to the autograft procedure. METHODS: This is a split-mouth randomized clinical study designed to evaluate the performance of personalized (patient-specific) bioceramic bone grafts (Plenum® Oss 3Dß fit) for bone augmentation of the atrophic anterior maxilla in comparison to the autogenous bone graft. We hypothesize that the gain and maintenance of the grafted area volume and the quality of the newly formed bone tissue after eight months postoperative with the synthetic patient-specific graft will be superior to the autogenous bone graft. To assess the quantity and the quality of bone neoformation, volumetric and histological analyses will be performed. DISCUSSION: The fabrication of medical devices by additive manufacturing presents advantages over conventional manufacturing processes, mostly related to the precision of geometry and anatomy. Additionally, the osteoconductive proprieties of ß-tricalcium phosphate enable this synthetic bone substitute as an alternative solution over autogenous graft for bone defect reconstruction. Thus, patient-specific bone grafts can potentially improve patient satisfaction, reducing the need for autogenous bone grafts, consequently avoiding implications related to this type of treatment, such as patient morbidity. TRIAL REGISTRATION: This study is registered in REBEC (Registro Brasileiro de Ensaios Clínicos): RBR-76wmm3q; UTN: U1111-1272-7773. Registration date: 14 September 2021.

Risk factors for wound-related complications after microvascular decompression.

Retrosigmoid craniotomy for microvascular decompression (MVD) has been traditionally performed via craniectomy. Various closure techniques have been described, yet factors associated with wound-related complications remain undetermined. Accordingly, herein, we sought to identify risk factors associated with wound-related complications after such procedures. An institutional retrospective case-control study was performed; outcomes of interest were cerebrospinal fluid (CSF) leak, wound dehiscence, wound infection, and pseudomeningocele. Univariate analysis was performed using Wilcoxon rank sum test for non-parametric continuous outcomes and chi-square test for categorical outcomes. Multivariate logistic regression was performed on binomial outcome variables. The study population included 197 patients who underwent MVD for trigeminal neuralgia (83.2%), hemifacial spasm (12.2%), vestibular nerve section (3.0%), and glossopharyngeal neuralgia (1.5%). The overall wound-related complication rate was 14.2% (n = 28), including twelve patients (6.1%) with CSF leak, ten patients (5.1%) with wound infection, ten patients (5.1%) with pseudomeningocele, and nine (4.6%) patients with wound dehiscence. Using multivariate logistic regression, preoperative anemia and current tobacco use were associated with significantly higher rates of complications (OR 6.01 and 4.58, respectively; p < 0.05), including CSF leak (OR 12.83 and 12.40, respectively, p < 0.05). Of note, use of synthetic bone substitute for cranioplasty was associated with a significantly lower rate of complications (OR 0.13, p < 0.01). Preoperative anemia and current tobacco use significantly increased, while synthetic bone substitute cranioplasty significantly decreased, odds of wound-related complications, the need for treatment, and CSF leaks. Additionally, higher BMI, longer operative duration, and prior radiosurgery may increase risk for wound-related complications.

Bioactive Glass/Polycaprolactone Hybrid with a Dual Cortical/Trabecular Structure for Bone Regeneration.

Organic-inorganic hybrid biomaterials stand as a promise for combining bone bonding and bone mineral-forming ability, stimulation of osteogenic cells, and adequate mechanical properties. Bioactive glass (BG)-polycaprolactone (PCL) hybrids are of special interest as they gather the ability of BG to enhance osteoblast-mediated bone formation with the slow degradation rate and the toughness of PCL. In this study, BG-PCL hybrids were synthesized in the form of scaffold, owing to a dual cortical/trabecular structure mimicking the bone architecture. Their biological potential was evaluated both in vitro using rat primary osteoblasts (RPO) and in vivo in a mice model of critical-size calvarial defects. BG-PCL scaffolds were compared to Lubboc (BTB), a commercial purified bovine xenograft widely used in orthopedics and periodontal procedures and known for its efficiency. BG-PCL hybrids were found to facilitate RPO adhesion at their surface and to enhance RPO differentiation when compared to BTB. An in vivo micro-CT study demonstrates a higher bone ingrowth with BG-PCL scaffolds and a complete chemical conversion of the remaining BG-PCL after 3 months of implantation, while histological data show the vascularization of BG-PCL scaffolds and confirm the well-advanced bone regeneration with ongoing remodeling. Finally, we evidence the complete chemical conversion of the remaining BG-PCL into a bone-like mineral.

An Active Giant Cell Tumor of the Patella: A Case Report.

Primary neoplasms of the patella account for less than 1% of all primary bone tumors of the lower extremity, the most frequent of them being the giant cell tumor of bone, the chondroblastoma, and the aneurysmal bone cyst. Herein, we report the case of a 29-year-old woman with an active giant cell tumor of the patella (GCTP) with its clinical and radiological features and a brief review of the literature.

Doped Calcium Silicate Ceramics: A New Class of Candidates for Synthetic Bone Substitutes.

Doped calcium silicate ceramics (DCSCs) have recently gained immense interest as a new class of candidates for the treatment of bone defects. Although calcium phosphates and bioactive glasses have remained the mainstream of ceramic bone substitutes, their clinical use is limited by suboptimal mechanical properties. DCSCs are a class of calcium silicate ceramics which are developed through the ionic substitution of calcium ions, the incorporation of metal oxides into the base binary xCaO-ySiO2 system, or a combination of both. Due to their unique compositions and ability to release bioactive ions, DCSCs exhibit enhanced mechanical and biological properties. Such characteristics offer significant advantages over existing ceramic bone substitutes, and underline the future potential of adopting DCSCs for clinical use in bone reconstruction to produce improved outcomes. This review will discuss the effects of different dopant elements and oxides on the characteristics of DCSCs for applications in bone repair, including mechanical properties, degradation and ion release characteristics, radiopacity, and biological activity (in vitro and in vivo). Recent advances in the development of DCSCs for broader clinical applications will also be discussed, including DCSC composites, coated DCSC scaffolds and DCSC-coated metal implants.

Simultaneous lateral bone augmentation and implant placement using a particulated synthetic bone substitute around chronic peri-implant dehiscence defects in dogs.

AIM: To determine the histological outcomes when using a highly porous synthetic bone substitute and a cross-linked collagen membrane for lateral bone augmentation of peri-implant dehiscence defects. METHODS: In eight dogs, three treatment groups were randomly allocated at each peri-implant dehiscence defect (mean height × depth = 3 × 1 mm) as follows: (i) synthetic bone substitute covered by a cross-linked collagen membrane (test group), (ii) deproteinized bovine bone mineral covered by a natural collagen membrane (positive control), and (iii) no treatment (negative control). Two healing periods (8 and 16 weeks) were applied. RESULTS: The differences in healing outcomes between the test and positive control groups were not significant at 8 weeks. Horizontal bone augmentation 2 mm below the implant shoulder was significantly greater in the test group (1.22 ± 0.53 mm) than in the positive and negative controls (0.42 ± 0.51 and 0.36 ± 0.50 mm, respectively) at 16 weeks. Similarly, the augmented tissue thickness at 0, 1, and 2 mm apical to the implant shoulder was significantly greater in the test group than in the positive control group. CONCLUSION: The test group showed significantly better histological outcomes for lateral bone augmentation and tissue thickness at 16 weeks compared to both the positive and negative control groups.

Two-year follow-up after advanced core decompression.

The so-called "Advanced Core Decompression" (ACD) is a new option that tries to remove the necrotic tissue in patients with osteonecrosis of the femoral head (AVN) in a minimally invasive way by the use of a percutaneous expandable reamer and refilling with a resorbable and osteoinductive bone-graft substitute. Seventy-two hips of sixty patients with a mean follow-up of 29.14 months after ACD have been included in this study. Patients underwent physical examination preoperatively and six weeks after surgery as well as at two further follow-ups. Certain phases in disease progression and size of the necrotic lesion were differentiated on the basis of the classification of osteonecrosis of the femoral head by Steinberg.The femoral heads had collapsed in 24 cases (33%). Analysis of the survival rates with regard to defect size revealed that the largest defects had a significantly higher rate of femoral head collapse than the smaller defects. Clinical scores were also depending on defect size but also on disease stage. The current ACD technique has not yet achieved any significant improvement in the success rate of core decompression procedures. It can be concluded that the success of ACD depends especially on the defect size. Copyright © 2015 John Wiley & Sons, Ltd.

The role of bone void fillers in medial opening wedge high tibial osteotomy: a systematic review.

PURPOSE: A variety of bone void filling materials and methods are available in opening medial wedge HTO (OWHTO). The pertinent question revolves around if and when bone void fillers are needed. The primary purpose of this study was to systematically review outcomes and complications after OWHTO with and without the use of bone void fillers. METHODS: The EMBASE, PubMed\MEDLINE, Cochrane Library and Google Scholar databases were searched to identify articles that reported OWHTO results using different bone void fillers until March 2016. Only articles reporting the exact bone void filler type, the opening gap size and the fixation method were included. The extracted data included the study design, demographic data, the radiological and clinical results and complication rates. Outcomes were analysed with regard to bone void filler type, and comparison was made between the groups (allograft, autograft, synthetic bone void filler and OWHTO without bone void filling). RESULTS: Twenty-two articles reporting the results of 1421 OWHTO met the inclusion criteria. In total, 647 osteotomies were completed with allogeneic graft as bone void filler, 367 with synthetic materials, 199 with autograft and 208 without any bone void filling material. The maximum opening gap size was similar in all groups with mean of 9.8 mm (range 4-17.5 mm). Locking plate fixation was used in 90 % of the osteotomies that were completed without bone void filler, while all allograft cases and more then 90 % of the autograft cases were done with non-locking systems. The highest rates of non-union (1.1 %) were seen in the synthetic group, compared to 0.5 % in the all the other groups. CONCLUSIONS: This systematic review showed no definitive advantages for OWHTO with any bone void filler in terms of union rates and loss of correction. Moreover, the use of autografts or allografts showed more favourable outcomes than synthetic bone substitutes. OWHTO with gaps smaller then 10 mm and rigid fixation might be successfully managed without bone grafting. However, when bone grafting is needed, autograft bone provides higher rates of clinical and radiographic union. The use of synthetic bone substitutes in OWHTO cannot be recommended. LEVEL OF EVIDENCE: III.

Bone grafting with granular biomaterial in segmental maxillary osteotomy: A case report.

INTRODUCTION: Segmental maxillary osteotomy enables correction of anterior open bites. However, the outcome can be somewhat unstable, particularly if pseudarthrosis occurs. Bone grafts can be used to prevent this complication. Among the many biomaterials available for grafting, Bio-oss(®) has been used successfully in a range of modalities, with studies to support several indications. This report describes a case of segmental maxillary osteotomy in which Bio-oss(®) granules were used as bone grafts in the surgical gap. PRESENTATION OF CASE: A 24-year-old female presented with anterior open bite, Angle class III posterior occlusion, and Angle class II anterior occlusion. Virtual surgical planning of the procedure predicted a gap of approximately 5mm in the region of the osteotomy, which was bridged with Bio-oss(®) granules. DISCUSSION: Although autogenous bone grafting is the gold standard due to its osteoconductive, osteoinductive, and osteogenic properties, it involves increased morbidity for the patient, unpredictable resorption rates, increased operative time, and risk of infection at the donor site. Use of the Bio-oss(®) material can provide good bone stability, osteoconduction, and biocompatibility, while reducing operative time and surgical morbidity. CONCLUSION: This is the first report of bone grafting with a granular biomaterial in segmental maxillary osteotomy. Successful formation of new bone with density greater than that of the surrounding tissue was achieved, preventing pseudarthrosis and postoperative instability.

Efficacy of tissue engineered bone grafts containing mesenchymal stromal cells for cleft alveolar osteoplasty in a rat model.

UNLABELLED: The development of sufficient tissue engineered bone grafts for alveolar cleft osteoplasty could reduce the necessity of autogenous bone grafts and its donor site morbidity. The aim of the study was to evaluate tissue engineered bone grafts in an artificially created bone defect. Bone grafts were created in vitro colonizing a synthetic hydroxyapatite-tricalciumphosphate scaffold (BONITmatrix(®)) with either undifferentiated mesenchymal stromal cells (group 1) or osteogenic differentiated mesenchymal stromal cells (group 2). Cells were multiplied from bone marrow of donor rats. Unmodified scaffolds (group 3) and the tissue engineered bone grafts were inserted into artificial maxillary defects of 54 Lewis rats. In 18 animals the defects remained unfilled (control). After one, three and six weeks the rats were sacrificed. The defect was evaluated radiologically and histologically with regard to the remaining defect volume and diameter. Statistical analysis followed. The bone grafts led to a specific bone formation at the defect margin. No complete reunion of any defect was observed within the healing time. After six weeks, the remaining defect volume was 6.86 ± 3.21 mm(3) (control), 4.08 ± 1.36 mm(3) (group 1), 5.00 ± 0.84 mm(3) (group 2) 5.50 ± 1.05 mm(3) (group 3). The remaining defect diameter measured 2.63 ± 0.52 mm (control), 2.39 ± 0.23 mm (group 1), 2.53 ± 0.22 mm (group 2) and 2.70 ± 0.66 mm (group 3). In all experimental groups the defect volume and diameter decreased over time, which was significant for group 1 (p = 0.014), group 2 (p = 0.025) and group 3 (p = 0.048). The defect volume and width was significantly reduced for bone grafts containing undifferentiated cells compared to control (p = 0.035) or scaffolds only (p = 0.05). CONCLUSION: Tissue engineered bone grafts induce a pronounced bone formation in artificial bone defects compared to unfilled controls or scaffolds only.

New depowdering-friendly designs for three-dimensional printing of calcium phosphate bone substitutes.

Powder-based three-dimensional printing (3DP) is a versatile method that allows creating synthetic calcium phosphate (CaP) scaffolds of complex shapes and structures. However, one major drawback is the difficulty of removing all remnants of loose powder from the printed scaffolds, the so-called depowdering step. In this study, a new design approach was proposed to solve this problem. Specifically, the design of the printed scaffolds consisted of a cage with windows large enough to enable depowdering while still trapping loose fillers placed inside the cage. To demonstrate the potential of this new approach, two filler geometries were used: sandglass and cheese segment. The distance between the fillers was varied and they were either glued to the cage or free to move after successful depowdering. Depowdering efficiency was quantified by microstructural morphometry. The results showed that the use of mobile fillers significantly improved depowdering. Based on this study, large 3DP scaffolds can be realized, which might be a step towards a broader clinical use of 3D printed CaP scaffolds.