Is local autogenous morselized bone harvested from decompression through a posterior-transforaminal approach sufficient for single-level interbody fusion in the lower lumbar spine?

BACKGROUND: To determine the volume and applicability of local autogenous morselized bone (LAMB) harvested and used during posterior-transforaminal lumbar interbody fusion (P-TLIF) in the lower lumbar spine. METHODS: Clinical and radiographic data of 147 patients (87 males) undergoing P-TLIF from January 2017 to December 2019 for lumbar degenerative diseases were retrospectively analyzed. Computed tomography was used to assess the fusion status (at 6 months, 1 year, and the last follow-up postoperatively), restored disc height, graft fusion area and volume, and the minimum required bone volume (MRBV). Clinical outcomes of P-TLIF were assessed using the Oswestry Disability Index (ODI) and visual analog scale (VAS) for low back pain (LBP) and leg pain (LP). RESULTS: The mean follow-up period was 28.4 ± 4.49 months. The patient's age and diagnosis were correlated to the volume and weight of LAMB (mean volume and weight: 3.50 ± 0.45 mL and 3.88 ± 0.47 g, respectively). The ratio of actual fusion area to the total disc endplate and the ratio of actual fusion volume to the total volume of the disc space were > 40%. MRBV ranged from 1.83 ± 0.48 cm3 to 2.97 ± 0.68 cm3. The proportion of grade 4 or 5 fusions increased from 60.6% at 6 months to 96.6% at the last follow-up. The ODI, VAS-LP, and VAS-LBP scores significantly improved after surgery and remained unchanged during the follow-up. CONCLUSION: When combined with a cage, the volume of LAMB harvested from decompression through the unilateral approach at a single-level is sufficient to achieve a solid interbody fusion in the lower lumbar spine with excellent clinical and radiographic outcomes.

Introduction of temporomandibular joint and skull base combined reconstruction by autogenous bone graft.

OBJECTIVE: This study introduces the application of autogenous bone graft for the reconstruction of temporomandibular joint (TMJ) and skull base combined defects. MATERIALS AND METHODS: Patients treated with autogenous bone grafts for reconstruction of the TMJ and skull base were reviewed. All patients underwent virtual surgical design to confirm the osteotomies of the combined lesion and the selections of autogenous bone graft, fabrication of surgical templates to transfer the plan to actual operation, and reconstruction of autogenous bone graft for the TMJ and/or skull base. Surgical outcomes were assessed by clinical examinations and radiological data. RESULTS: Twenty-two patients were involved in this study. Ten patients underwent reconstruction of the skull base by a free iliac or temporal bone graft and preservation of the TMJ. Twelve patients underwent skull base reconstruction by the same methods and total reconstruction of the TMJ by half sternoclavicular joint flap or costochondral bone graft. No severe complications occurred after surgery. The occlusion relationship was stable and similar to that of the preoperative state. The pain and maximal interincisal opening were significantly improved by the 101.2-month follow-up. CONCLUSION: Autogenous bone graft is a good alternative for repairing the TMJ and the skull base structure and function. CLINICAL RELEVANCE: The study introduced the application of autogenous bone graft for the reconstruction of temporomandibular joint and skull base combined defect, which is a good way to repair the defect and restore the function.

Horizontal Bone Augmentation With Autogenous and Collagenated Xenogeneic Bone Blocks: A Split-Mouth Prospective Clinical, Tomographic, and Histological Pilot Study.

The aim of this study was to compare the clinical, tomographic, and histological performance of collagenated xenogeneic bone blocks (CXBB) in horizontal bone augmentations for implant placement. Five patients with an absence of the 4 upper incisors and an HAC 3 horizontal bone defect, with a remaining of 3 to 5 mm, underwent a bone-grafting procedure with CXBB (test group [TG], n = 5) and autogenous graft (control group [CG], n = 5), with one type of graft used on the right side and other type on the left side. Changes in bone thickness and density (tomographic evaluation), levels of complications (clinically), and distribution pattern between mineralized and nonmineralized tissue (histomorphometrically) were analyzed. Tomographic analysis showed a horizontal bone increase of 4.25 ± 0.78 mm in the TG and 3.08 ± 0.8 mm in the CG between baseline and 8 months postoperatively (P < .05). The horizontal loss between the day of installation of the blocks and 8 months postoperatively was 1.02 ± 0.39 mm for the TG and 1.10 ± 0.71 mm for the CG (P > .05). With regard to bone density, the TG blocks right after installation had 440.2 ± 89.15 HU, and after 8 months, the region reached 730.7 ± 130.98 HU, representing an increase of 29.05%. For the CG blocks, bone density increased from 1052.2 ± 398.35 HU to 1222.5 ± 453.28 HU, representing an increase of 17.03%. The increase in bone density was significantly higher in the TG (P < .05). Clinically, no cases of exposure of the bone blocks and no failure of incorporation were observed. Histomorphometrically, the percentage of mineralized tissue was lower in the TG than in the CG (48.10% ± 2.88% and 53.53% ± 1.05%, respectively), and the opposite was verified for the levels of nonmineralized tissue (52.79% ± 2.88% and 46.47% ± 1.05%, respectively; P < .05). The use of CXBB achieved higher levels of horizontal gain, with lower bone density and lower levels of mineralized tissue when compared with the use of autogenous blocks.

Successful Management of Late Sinus Graft Infection via Functional Endoscopic Sinus Surgery and Press-Fit Block Bone Graft: A Case Report.

The purpose of this case report is to feature an interesting case where a staged approach was used to manage a failed implant site that led to a late sinus graft infection and sinusitis with an oroantral fistula (OAF), by using functional endoscopic sinus surgery (FESS) and an intraoral press-fit block bone graft technique. Sixteen years ago, a 60-year-old female patient underwent maxillary sinus augmentation (MSA) with 3 implants placed simultaneously in the right atrophic ridge. However, No. 3 and 4 implants were removed due to advanced peri-implantitis. The patient later developed purulent discharge from the site, headache, and complained of air leakage due to an OAF. The patient was referred to an otolaryngologist for FESS to treat the sinusitis. Two months after FESS, the sinus was re-entered. Residual inflammatory tissues and necrotic graft particles in the OAF site were removed. A block bone harvested from the maxillary tuberosity was press-fitted to the OAF site and grafted. After 4 months of grafting, the grafted bone was well incorporated with the surrounding native bone. Two implants were successfully placed in the grafted site with good initial stability. The prosthesis was delivered 6 months after implant placement. After the 2 years of follow-up, patient was functioning well without sinus complications. Within limitation of this case report, the staged approach via FESS and intraoral press-fit block bone graft is an effective method that can be used to successfully manage OAF and vertical defects at the implant site.

A comparison of three bone graft struts for interbody fusion using a posterior approach for lower lumbar spinal tuberculosis in adults: a midterm follow-up study.

BACKGROUND: This retrospective observational study was conducted to compare midterm outcomes of three bone graft struts for interbody fusion using a posterior approach in adults with lower lumbar spinal tuberculosis. METHODS: A total of 126 lower lumbar spinal tuberculosis patients were treated by one-stage posterior debridement, interbody fusion, and instrumentation. Forty-one patients (group A) were treated with autogenous bone graft for interbody fusion, 45 patients (group B) were treated with allogeneic bone grafting, and the remaining 40 (group C) patients were treated with titanium mesh cage. In addition, clinical and radiographic data were gathered and analyzed. RESULTS: At the final follow-up, all patients were completely cured. The operation period and intraoperative blood loss for groups B and C were significantly less than in group A (P = 0.000). Post-operation, neurological performance and quality of life were remarkably improved at the final follow-up. The preoperative lordosis angles of three groups were significantly improved, as evidenced by the values immediately after the operation or those at the final follow-up. The correction loss of the group C was lower than those of groups A and B (P = 0.000). All the patients obtained bone graft fusion, the fusion period of group B was longer than that of the other two groups (P = 0.000). No significant differences among the three groups in adjacent segment degeneration rates were found at the last visit (P = 0.922). CONCLUSIONS: This midterm follow-up study established that one-stage posterior debridement, interbody fusion, and instrumentation, combined with medical therapy, can effectively treat lower lumbar spinal tuberculosis. In addition, the intervertebral titanium mesh cage bone graft can provide better outcomes with regard to maintaining lordosis and preventing collapse.

Autogenous iliac crest bone grafting for tibial nonunions revisited: does approach matter?

BACKGROUND: Tibial nonunion remains a considerable burden for patients and the surgeons who treat them. In recent years, alternatives to autogenous grafts for the treatment of tibial nonunions have been sought. The purpose of this study was to evaluate the efficacy of autogenous iliac crest bone graft (ICBG) in the treatment of tibial shaft nonunions. MATERIAL AND METHODS: Sixty-nine patients were identified who underwent ICBG for repair of atrophic or oligotrophic tibial nonunion and had complete data with at least one year of follow-up (mean 27.9 months). Surgical treatments consisted of revision/supplemental fixation ± ICBG. Surgical approaches for graft placement were either posterolateral (PL), anterolateral (AL), or direct medial (DM). Healing status, time to union, postoperative pain, and functional outcomes were assessed. RESULTS: Bony union was achieved by 97.1% (67/69) of patients at a mean time of 7.8 ± 3.2 months postoperatively. There was no significant difference in mean time to union between the three surgical approach groups: (PL (44.9%) = 7.3 months, AL (20.3%) = 9.2 months, DM (34.8%) = 7.6 months; p = 0.22). Intraoperative cultures obtained at the time of nonunion surgery were positive in 27.5% of patients (19/69). Positive cultures were associated with need for secondary surgery as 8/19 patients (42.1%) with positive cultures required re-operation. Two out of four patients that developed iliac donor site hematomas/infections requiring washout had positive intraoperative cultures as well. There was no difference in final SMFA among the three surgical approach groups. CONCLUSIONS: Autogenous ICBG remains the gold standard in the management of persistent tibial nonunions regardless of surgical approach. There is a small risk for complication at the iliac crest donor site. Given the high union rate, autogenous iliac crest bone grafting for tibial nonunion remains the gold standard for this difficult condition. LEVEL OF EVIDENCE: Level III.

Evaluation of Sinus Membrane Perforation in Osteotome Sinus Floor Elevation With and Without Grafting.

The purpose of this study was to evaluate, using cone-beam computerized tomography (CBCT), the rate of sinus membrane perforation in osteotome sinus floor elevation (OSFE) performed with and without a graft material. Thirty patients with 52 OSFE sites were included in the study. Patients were divided into the control group (OSFE performed without graft material) and test groups (OSFE performed with autograft or xenograft). The autograft was harvested from the maxillary tuberosity using bone forceps. The xenograft was a commercial product originating from bovine bone. Graft volume was measured using the water displacement method. CBCT was performed at the initial examination and immediately after surgery to measure the residual bone height and to evaluate the endo-sinus bone gain and membrane perforation. The rate of sinus membrane perforation was 15.4%. Of the 52 OSFE procedures, 26.9% were performed without grafting and 34.6% and 38.5% were performed with autografts and xenografts, respectively. Membrane perforation was significantly higher in the autograft group (P = .033). The median volume of graft materials was 0.3 mL. The difference in graft volume between the autograft and xenograft was not statistically significant (P = .768). The mean endo-sinus bone gain was 6.55 mm in patients without membrane perforation and 8.71 mm in patients with membrane perforation; this difference was statistically significant (P = .035). The volume and physical properties of graft materials are important factors in membrane perforation. Further clinical studies with larger and standardized samples are needed to confirm the effect of graft materials on sinus membrane perforation in OSFE.

Evaluation of the Efficacy of Mineralized Dentin Graft in the Treatment of Intraosseous Defects: An Experimental In Vivo Study.

Background and Objectives: Dentin grafts have osteoinductive and osteoconductive properties and are considered as an alternative to autogenous graft. This study evaluates the efficacy of autogenous mineralized dentin graft (AMDG) alone or with xenograft and compares it with those of various graft materials used in the treatment of intraosseous bone defects. Materials and Methods: The third incisor teeth of six sheep (2-3 years old) were extracted and AMDG was obtained. Six defects were prepared on each tibia of these six sheep: empty defect (group E); autogenous graft (group A), dentin graft (group D), xenograft (group X), autogenous + xenograft (group A + X) and dentin + xenograft (group D + X). Three sheep in each group were sacrificed in the post-operative 3rd and 6th week and the histologic analyses were performed. Results: The D and D + X groups showed histological features similar to the other groups in the 3rd and 6th weeks. No statistically significant difference was found regarding the rates of new bone formation between the D and D + X groups (p = 1.0) and the other groups at both time intervals (p > 0.05). Conclusions: Similar results observed in this study between groups A, D, X, A + X and D + X demonstrate that AMDG can be successfully used in the treatment of intraosseous bone defects. Further experimental and clinical studies are needed to be able to evaluate the effectiveness of dentin grafts in different types of indications.

Utilizing Previously Grafted Sinus as Intraoral Donor Site for Successful Augmentation in Peri-Implant Osseous Defect: A Case Report.

The purpose of this case report is to introduce a novel guided bone regeneration (GBR) technique that utilized bone harvested from previously grafted maxillary sinus with deproteinized bovine bone mineral (DBBM) 16 years ago. The patient is a 63-year-old male with hopeless maxillary right molars due to severe bone loss. Two months after the extraction, two bone blocks were harvested with a trephine drill from the lateral wall. One was used for histologic analysis and the other was crushed into particulate forms, which was used for a GBR procedure around an implant at the time of implant placement. The grafted site was then covered with a resorbable collagen membrane. The histological specimen showed newly-formed bone containing residual DBBM particles. The DBBM in the harvested bone was mostly resorbed; DBBM particles comprised only 3.6% of the total bone volume. The final prosthesis was delivered six months post-operatively. No change in crestal bone around the implant was observed throughout the 2 year follow-up period. Within the limitation of the present case report, previously grafted sinus can be a good donor site for further harvesting for a successful GBR procedure.

Evaluation of Resorption and Osseointegration of Autogenous Bone Ring Grafting in Vertical Bone Defect With Simultaneous Implant Placement in Dogs.

The aim of this research was to evaluate the resorption and osseointegration of an autogenous bone ring, which was grafted in a local vertical alveolar defect with simultaneous implant placement. Six Beagle dogs were enrolled in the study; their 4 nonadjacent mandibular premolars were extracted, and the buccal plate was removed to create bone defects in 2 of the 4 sites. Three months after extraction, Straumann implants (Ø 3.3 mm, length of 8 mm) were placed in the bone defect sites with simultaneous autogenous bone ring grafting and in the conventional extraction sites. After a 3-month healing period and a 3-month loading period, the animals were euthanized. The harvested samples were analyzed using micro-computed tomography (CT) scanning and histological analysis. From the micro-CT measurements, the average vertical bone resorption of the bone ring was 0.23 ± 0.03 mm, which was not significantly different from that around the conventional implant, 0.24 ± 0.12 mm (P > .05). The ratio of the bone volume to the total volume of the bone ring group was 91.11 ± 0.02, which was higher than that of the control group, 88.38 ± 2.34 (P < .05). From the hard tissue section, the bone rings developed fine osseointegration with the implants and the base alveolar bone. The results suggest autogenous bone ring grafting with simultaneous implant placement can survive in a local vertical bone defect with little bone resorption and good osseointegration in dogs with strict management. A bone ring graft must be compared with guided bone regeneration, and a larger and longer observation must be confirmed in clinical patients.

May Autogenous Grafts Increase the Effectiveness of Hyalonect Membranes in Intraosseous Defects: An Experimental In Vivo Study.

Background and Objectives: Guided bone regeneration (GBR) surgeries are used for dental implant placements with insufficient bone volume. Biomaterials used in GBR are expected to produce sufficient volume and quality of bone swiftly. This study aims to histologically evaluate the effectiveness of the use of Hyalonect membranes alone or with autogenous grafts in intraosseous defects. Materials and Methods: This study is an experimental study on sheep. Surgeries were performed under general anesthesia in accordance with ethical rules. Five 10 mm defects were surgically created in each ilium of six sheep. One defect was left empty in each ilium (group ED). The defects in the experimental group were covered with Hyalonect membrane while unfilled (group HY) or after being filled with autogenous bone grafts (ABG) (group G+HY). In the control group, the defects were either covered with collagen membrane while unfilled (group CM) or after being filled with the ABG group (G+CM). The sheep were histologically and histomorphometrically evaluated after being postoperatively sacrificed in the third and sixth week (three animals in each interval). Results: All animals completed the study without any complications. No difference was found between groups in the third and sixth weeks regarding the inflammation, necrosis, and fibrosis scores. The G+CM (52.83 ± 3.06) group was observed to have a significantly higher new bone formation rate than all the other groups in the third week, followed by the G+HY group (46.33 ± 2.25). Similar values were found for HY and CM groups (35.67 ± 4.55 ve 40.00 ± 3.41, respectively, p = 0.185), while the lowest values were observed to be in group ED (19.67 ± 2.73). The highest new bone formation was observed in group G+CM (82.33 ± 4.08) in the sixth week. There was no difference in new bone formation rates between groups G+CM, G+HY (77.17 ± 3.49, p = 0.206), and CM (76.50 ± 2.43, p = 0.118). The insignificant difference was found ED group and group HY (55.83 ± 4.92, 73.50 ± 3.27, respectively, p = 0.09). The residual graft amount in the G+CM group was found to be statistically significant at 3 weeks (p = 0.0001), compared to the G+HY group, and insignificantly higher at the 6th week (p = 0.4). Conclusions: In this study, close values were observed between G+HY and G+CM groups. Further experimental and clinical studies with different graft materials are required to evaluate the effectiveness of HY in GBR.

Platelet-Rich Plasma-Incorporated Autologous Granular Bone Grafts Improve Outcomes of Post-Traumatic Osteonecrosis of the Femoral Head.

BACKGROUND: To investigate the effects of platelet-rich plasma (PRP)-incorporated autologous granular bone grafts for treatment in the precollapse stages (Association of Research Circulation Osseous stage II-III) of posttraumatic osteonecrosis of the femoral head. METHODS: A total of 46 patients were eligible and enrolled in the study. Twenty-four patients were treated with core decompression and PRP-incorporated autologous granular bone grafting (treatment group), and 22 patients were treated with core decompression and autologous granular bone grafting (control group). During a minimum follow-up duration of 36 months, X-ray and computed tomography were used to evaluate the radiological results, and the Harris hip score (HHS) and visual analog scale were chosen to assess the clinical results. RESULTS: Both the treatment and control groups had a significantly improved HHS (P < .001). The minimum clinically important difference for the HHS was reached in 91.7% of the treatment group and 68.2% of the control group (P < .05). The HHS and visual analog scale in the treatment group were significantly improved than that in the control group at the last follow-up (P < .05). Successful clinical and radiological results were achieved 87.5% and 79.2% in the treatment group compared with 59.1% and 50.0% in the control group (P < .05), respectively. The survival rates based on the requirement for further hip surgery as an endpoint were higher in the treatment group in comparison to those in the control group (P < .05). CONCLUSION: PRP-incorporated autologous granular bone grafting is a safe and effective procedure for treatment in the precollapse stages (Association of Research Circulation Osseous stage II-III) of posttraumatic osteonecrosis of the femoral head.

Bone morphogenetic protein activity preservation with extracorporeal irradiation- and liquid nitrogen freezing-treated recycled autografts for biological reconstruction in malignant bone tumor.

Recycled autografts have been commonly used in biological reconstruction in conjunction with wide bone resection. Extracorporeal irradiation (ECIR) and freezing are the two major options for pretreating tumor-bearing autografts before transplant. This study, for the first time, compared the effects of these two techniques on bone morphogenetic protein (BMP)-2 activity. Bone tissue extracted from human femoral heads were treated through either ECIR at different doses (5000, 15,000, and 30,000 rad) or liquid nitrogen (LN) freezing for different durations (5, 10, and 15 min). The amount of BMP was analyzed through enzyme-linked immunosorbent assay (ELISA assay). Furthermore, we also used tandem mass spectrometry to analyze change of BMP-2 and BMP-7 expression after high dosage of irradiation (30,000 rad) and long-time of freezing (15 min). To directly evaluate the effect of ECIR or LN freezing treatment on the activity of BMP, commercial recombinant human BMP-2 (rhBMP-2) was added to the culture of human mesenchymal stem cells (hMSCs). The post-treatment activity of rhBMP-2 was quantitated by measuring the osteogenic differentiation of hMSCs with Alizarin Red S staining. Through Western blotting, the activation of the BMP signaling pathway by phospho-Smad antibodies was analyzed. Our results showed that post-treatment levels of BMP did not differ among the ECIR and LN freezing treatments in ELISA assay, but tandem mass spectrometry showed significantly lower expression of BMP-2 after 30,000 rad of irradiation. Both ECIR and freezing lowered the expression of regulatory factors involved in the BMP-activated signaling cascades and similar results were also observed in osteogenic differentiation of hMSCs. However, LN freezing preserved better bioactivity of rhBMP-2 whereas dosage-dependent declination was observed in ECIR groups. In conclusion, considering BMP-2 activity, LN freezing-treated autografts may result in a better osteoinduction outcomes than those treated using ECIR. Further investigation of the factors involved in bone formation is required.

A novel in situ bone elevation method to achieve vertical periodontal augmentation in dogs: A pilot study.

OBJECTIVES: The purpose of this study was to investigate whether a novel in situ interdental bone elevation method could achieve vertical bone augmentation around natural teeth. METHODS: Horizontal periodontal bone defects were created at nine quadrants of mandibles in five dogs. Six weeks later, one of the nine quadrants was randomly chosen as the model control. The remaining mandibles were allocated into two experimental groups: cortical bone removing (CBR) or interdental bone elevation (IBE). For the IBE group, four millimetres of interdental bone blocks were separated and elevated from the base of alveolar bone. Then bone xenografts were implanted beneath the elevated alveolar blocks. Animals were euthanised 12 weeks post-operation. Cone beam computed tomography (CBCT) examination and histological analysis were performed to evaluate the surgical outcomes. RESULTS: Enhanced soft tissue profiles were observed in the two experimental groups as compared to the model control group. CBCT images showed that the height of alveolar bone was significantly higher in the IBE group with bone blocks seated near the cementoenamel junction. Significantly larger area of bone tissues with the highest coronal level of new bone was observed in the IBE group. New bone was observed around the elevated bone blocks with bone remodelling and neovascularisation inside the elevated blocks. CONCLUSIONS: Vertical bone augmentation at interdental sites may be performed through in situ interdental bone elevation for patients with horizontal alveolar bone resorption.

Calcaneal Bone Graft Procedures: An Analysis of Postsurgical Complications.

The purpose of this article is to examine complications in patients who underwent bone grafting from the calcaneus between December 2001 and June 2010. This retrospective, single-practice study included 247 procedures in 242 patients, including 200 (82.64%) female and 42 (17.36%) male patients, ranging in age from 13 to 89 (median 49) years. Overall, the incidence of experiencing any form of complication was 2.43% (6 of 247); these included 5 (2.02%) feet that displayed donor site sural neuritis and 1 (0.41) that displayed a painful, hypertrophic scar at the donor site. The only statistically significant risk factor associated with the development of a calcaneal donor site complication was white race (being African American was protective). These findings indicate that procurement of autogenous bone graft from the calcaneus, as described in this report, is safe and dependable with a low incidence of complications, and irritation of the sural nerve is the most common complication associated with the procedure. Further clinical and long-term follow-up studies controlling for confounding variables need to be performed to fully determine the overall safety and efficacy of this procedure.

Ridge Augmentation with Autogenous Bone Graft and Expanded Polytetrafluoroethylene Membrane using Tenting Screw: A Randomized Controlled Clinical Trial.

BACKGROUND: The study aims to compare non-tenting screw and tenting with a reinforced expanded polytetrafluoroethylene (ePTFE) membrane in horizontal ridge augmentation using an autogenous bone graft. MATERIAL AND METHODS: A randomized controlled clinical trial was conducted between 150 patients needing dental implants. The participants were randomly divided into three study groups; group 1: ridge augmentation using non-resorbable ePTFE membrane only, group2: ridge augmentation using an ePTFE and tenting screw with bone graft Bio-Oss mixed with autogenous bone particles and group 3 (control): ridge augmentation with a bone block. The initial measurement was done at the bone crest at the exact implant site and 10 mm apical to the bone crest. Repeat measurements were recorded after 6 months of healing. Statistical analysis was performed by paired sample t-test and two-way analysis of variance (ANOVA). Statistical significance was considered at p <0.05. RESULTS: There was a significant gain in the bone in all the three groups postsurgery. Group 3 recorded higher reading at the crest and apical sites when compared to groups 1 and 2 at 6 months (late measurements). The difference in the percentage gain was statistically significant after adjusting for age as well as the initial measurement. The highest gain was seen in group 3 followed by groups 2 and 1. CONCLUSION: The membrane with tenting screw group and block bone groups had a significantly higher increase in measurement when compared to the membrane only group. Tenting screw with Bio-Oss can be used in patients with autogenous bone at the donor site. CLINICAL SIGNIFICANCE: Tenting screws in combination with membranes can be used to overcome the limitations posed by the use of membranes alone. It is also a useful method for a patient not consenting for block graft for any medical reason.

Immediate and flapless implant insertion and provisionalization using autogenous bone grafts in the esthetic zone: 5-year results.

OBJECTIVES: As the 2-year results for immediately inserted and provisionalized implants have been reported, it remained an open issue, whether the initially high success rates and the esthetic outcome remain stable for longer observation periods. Therefore, this prospective study examines the 5-year hard and soft tissue changes at implants placed in the anterior maxilla. MATERIAL AND METHODS: Meanwhile, 37 microthreaded implants were placed in 21 patients into extraction sockets with and without facial bone deficiencies by a flapless approach. Facial gaps and bony defects were grafted with autogenous bone chips. The implants were immediately provisionalized. The primary outcome parameters were the interproximal marginal bone level and the thickness of the facial bony wall. Implant success and Pink Esthetic Score (PES) were considered as secondary outcome parameters. RESULTS: Two patients with four implants withdrew from the study (dropouts), and the remaining 33 implants were still in function at a follow-up period of 68 months. Marginal bone height averaged 0.04 mm coronal to the implant shoulder. The thickness of the facial bony lamellae increased significantly between pre-op examination and 1-year follow-up (p = .002) and thereafter remained stable. Within 5 years of follow-up, 24 of 33 implants were clinically stable, free of signs and symptoms, and showed bone loss less than 1 mm. The mean PES ratings improved slightly from 10.7 pre-operatively to 11.7 at the last follow-up (p = .02). CONCLUSIONS: Interproximal marginal bone levels, survival rates, and esthetic results remain stable at the 5-year follow-up in implants used in an immediate insertion, reconstruction, and provisionalization concept. Facial marginal bone levels decreased slightly; however, this reduction did not affect the PES so far.

Lantern-shaped screw loaded with autologous bone for treating osteonecrosis of the femoral head.

BACKGROUND: Treatment for osteonecrosis of the femoral head (ONFH) in young individuals remains controversial. We developed a lantern-shaped screw, which was designed to provide mechanical support for the femoral head to prevent its collapse, for the treatment of ONFH. The purpose of this study was to investigate the efficacy and safety of the lantern-shaped screw loaded with autologous bone for the treatment of pre-collapse stages of ONFH. METHODS: Thirty-two patients were randomly divided into two groups: the lantern-shaped screw group (core decompression and lantern-shaped screw loaded with autogenous bone) and the control group (core decompression and autogenous bone graft). During 36 months follow-up after surgery, treatment results in patients were assessed by X-ray and computed tomography (CT) scanning as well as functional recovery Harris hip score (HHS). RESULTS: Successful clinical results were achieved in 15 of 16 hips (94%) in the lantern-shaped screw group compared with 10 of 16 hips (63%) in the control group (p = 0.0325). Successful radiological results were achieved in 14 of 16 hips (88%) in the lantern-shaped screw group compared with 8 of 16 hips (50%) in the control group (P = 0.0221). CONCLUSION: The lantern-shaped screw loaded with autologous bone for the treatment of pre-collapse stages of ONFH is effective and results in preventing progression of ONFH and reducing the risk of femoral head collapse. TRIAL REGISTRATION: The trial registration number: ChiCTR-TRC-13004078 (retrospectively registered at 2013-11-28).

New reconstruction for bone integration of non-vascularized autogenous bone graft with better bony union and revascularisation.

INTRODUCTION: Phalangeal defects are often seen after tumor resection, infections, and in complex open hand fractures. In many cases, reconstruction is difficult and amputation is performed to avoid prolonged rehabilitation that is often associated with a poor outcome. In these cases, the maintenance of length and function presents a reconstructive challenge. METHODS: We reviewed 11 patients who underwent extensive phalangeal reconstruction with non-vascularized bone graft from the iliac crest using a key-in-slot-joint technique to provide acceptable function and bony union. RESULTS: In each case, non-vascularized bone graft with a length of 1.4-6.0 cm was used to reconstruct the phalanx. Follow-up ranged from 6 weeks to 5 months, and in all cases, there was bony union after 6 weeks. We evaluated range of motion, function, and as well pain and grip strength of the fingers. CONCLUSIONS: This case series suggests that a key-in-slot technique allows non-vascularized bone graft to be used in complex large phalangeal bone defects. Due to better bone contact, a sufficient perfusion and revascularisation of the non-vascularized bone graft can be achieved for a quicker and stable bony union. This method appears to be an alternative to amputation in selected cases with a satisfactory soft-tissue envelope.

Recombinant human platelet-derived growth factor-BB versus autologous bone graft in foot and ankle fusion: A systematic review and meta-analysis.

Today, autogenous bone graft (ABG) is still considered as the gold standard for joint fusion. Recombinant human platelet-derived growth factor-BB (rhPDGF-BB) which is of chemotactic and mitogenic to mesenchymal stem cells and possesses outstanding osteogenetic potentials has been used for ankle and foot fusion in recent years. The goal of this article is to evaluate the safety and efficacy of rhPDGF-BB versus ABG in foot and ankle fusion. The PubMed MEDLINE, EMBASE, Web of Science, and Cochrane Library were systematic searched. Finally, three randomized controlled trials (RCTs) with 634 patients were enrolled in this study. Results of radiologic effectiveness which included CT and radiographic union rates revealed that there was no significant difference between rhPDGF-BB approach and ABG approach. Analysis of clinical results held the same outcomes expect that ABG group was superior in long-term Short Form-12 physical component scores. The pooled results also demonstrated that rhPDGF-BB was as safe as ABG in foot and ankle surgery. However, autograft harvesting procedure has some drawbacks such as donor-site pain and morbidity, additional operation time, blood loss, and scarring, which can be overcome by rhPDGF-BB. Thus, rhPDGF-BB is a viable alternative to autograft in foot and ankle fusion surgery. Yet, more high-quality RCTs with long-term follow-up are still required to make the final conclusion.