Delphi Consensus on Diagnostic Criteria for LUMBAR Syndrome.

OBJECTIVE: To develop consensus on diagnostic criteria for LUMBAR syndrome, the association of segmental infantile hemangiomas that affect the Lower body with Urogenital anomalies, Ulceration, spinal cord Malformations, Bony defects, Anorectal malformations, Arterial anomalies and/or Renal anomalies. STUDY DESIGN: These diagnostic criteria were developed by an expert multidisciplinary and multi-institutional team based on analysis of peer-reviewed data, followed by electronic-Delphi consensus of a panel of 61 international pediatric specialists. RESULTS: After 2 Delphi rounds, a 92% or higher level of agreement was reached for each Delphi statement. 98% of panelists agreed with the diagnostic criteria, and 100% agreed the criteria would be useful in clinical practice. The diagnosis of LUMBAR requires the presence of a segmental, or patterned, infantile hemangioma of the lumbosacral, sacrococcygeal, or pelvic cutaneous regions plus one additional criterion of the urogenital, spinal, bony, anorectal, arterial, or renal organ systems. CONCLUSIONS: These diagnostic criteria will enhance clinical care by improving screening, detection, and overall awareness of this poorly understood neurocutaneous disorder. The criteria can be utilized by a wide variety of pediatric subspecialists. In addition, formal criteria will improve phenotypic uniformity among LUMBAR syndrome cohorts and a patient registry, allowing investigators to assess clinical features, long-term outcomes, and results of genetic sequencing in a standardized manner. Finally, these criteria will serve as a starting point for prospective studies to establish formal screening and management guidelines.

Instructions for the use of L-PRF in different clinical indications.

Autologous platelet concentrates (APCs) have demonstrated clear benefits across various clinical applications, including alveolar ridge preservation, guided tissue regeneration, guided bone regeneration, sinus floor elevation (both lateral window approach and transcrestal technique), endodontic surgery, the treatment of medication-related osteonecrosis of the jaw bones, and periodontal plastic surgery. To ensure an optimal clinical outcome, clinicians must adhere strictly to the protocol to prepare the APCs and, especially follow evidence-based surgical guidelines, often simple but crucial, to minimize the likelihood of errors. The majority of clinical trials reported on second-generation APCs [the leukocyte- and platelet-rich fibrin (L-PRF) family, including its modifications (A-PRF, A-PRF+, CGF, T-PRF, H-PRF, etc.)]. These second-generation APCs offer additional benefits compared to the first-generation APCs, making them the preferred choice for the development of clinical recommendations. These recommendations have been formulated through a meticulous examination of the available clinical data and the clinical experience of the authors of this paper.

Do autologous platelet concentrates (APCs) have a role in intra-oral bone regeneration? A critical review of clinical guidelines on decision-making process.

In the past decades, personalized regenerative medicine has gained increased attention. Autologous platelet concentrates (APCs) such as PRP, PRGF, and L-PRF, all serving as a source of a large variety of cells and growth factors that participate in hard and soft tissue healing and regeneration, could play a significant role in regenerative periodontal procedures. This narrative review evaluated the relative impact of APCs in alveolar ridge preservation, sinus floor augmentation, and the regeneration of bony craters around teeth, both as a single substitute or in combination with a xenograft. L-PRF has a significant beneficial effect on alveolar ridge preservation (bone quality). The data for PRGF are less convincing, and PRP is controversial. L-PRF can successfully be used as a single substitute during transcrestal (≥3.5 mm bone gain) as well as 1-stage lateral window sinus floor elevation (>5 mm bone gain). For PRGF and especially PRP the data are very scarce. In the treatment of bony craters around teeth, during open flap debridement, L-PRF as a single substitute showed significant adjunctive benefits (e.g., >PPD reduction, >CAL gain, >crater depth reduction). The data for PRP and PRGF were non-conclusive. Adding PRP or L-PRF to a xenograft during OFD resulted in additional improvements (>PPD reduction, >CAL gain, >bone fill), for PRGF no data were found. Autologous platelet concentrates demonstrated to enhance bone and soft tissue healing in periodontal regenerative procedures. The data for L-PRF were most convincing. L-PRF also has the advantage of a greater simplicity of production, and its 100% autologous character.

Clinical and radiographic evaluation of low-speed platelet-rich fibrin (PRF) for the treatment of intra-osseous defects of stage-III periodontitis patients: a randomized controlled clinical trial.

AIM: The current randomized controlled trial assessed for the first time the effect of a low-speed platelet-rich fibrin (PRF) with open flap debridement (OFD) versus OFD alone in the treatment of periodontal intra-osseous defects of stage-III periodontitis patients. METHODS: Twenty-two periodontitis patients with ≥ 6 mm probing depth (PD) and ≥ 3 mm intra-osseous defects were randomized into test (PRF + OFD; n = 11) and control (OFD; n = 11) groups. Clinical attachment level (CAL)-gain (primary outcome), PD-reduction, gingival recession depth (GRD), full-mouth bleeding scores (FMBS), full-mouth plaque scores (FMPS), radiographic linear defect depth (RLDD), and radiographic bone fill (secondary-outcomes) were examined over 9 months post-surgically. RESULTS: Low-speed PRF + OFD and OFD demonstrated significant intra-group CAL-gain and PD- and RLDD-reduction at 3, 6, and 9 months (p < 0.01). Low-speed PRF + OFD exhibited a significant CAL-gain of 3.36 ± 1.12 mm at 6 months (2.36 ± 0.81 mm for the control group; p < 0.05), and a significantly greater PD-reduction of 3.36 ± 1.12 mm at 3 months, of 3.64 ± 1.12 mm at 6 months and of 3.73 ± 1.19 mm at 9 months (2.00 ± 0.89 mm, 2.09 ± 1.04 mm, and 2.18 ± 1.17 mm in the control group respectively; p < 0.05). No significant differences were notable regarding GRD, FMPS, FMBS, RLDD, or bone fill between both groups (p > 0.05). CONCLUSIONS: Within the current clinical trial's limitations, the use of low-speed PRF in conjunction with OFD improved CAL and PD post-surgically, and could provide a cost-effective modality to augment surgical periodontal therapy of intra-osseous defects of stage-III periodontitis patients. CLINICAL RELEVANCE: Low-speed PRF could provide a cost-effective modality to improve clinical attachment gain and periodontal probing depth reduction with open flap debridement approaches.

Tooth survival and clinical outcomes up to 26 years after guided tissue regeneration therapy in deep intra-bony defects: Follow-up investigation of three randomized clinical trials.

AIM: To investigate tooth survival and clinical long-term outcomes up to 26 years following guided tissue regeneration (GTR) therapy in deep intra-bony defects. METHODS: Patients from three prospective clinical split-mouth studies, which investigated the outcomes of GTR therapy, were re-evaluated 21-26 years after surgery independent of the membrane type used, and tooth survival was assessed according to several site-specific and patient-related factors. RESULTS: About 50 patients contributing 102 defects were available for this long-term follow-up. After up to 26 years (median 23.3 years), 52.9% of the teeth were still in situ. The median survival of the extracted teeth was 13.8 years. Patients with diabetes mellitus and/or smoking history lost significantly more teeth in the long term. Compared to the 1-year situation, there was no new median CAL loss after up to 26 years in the teeth which were still in situ. CONCLUSIONS: Within the limitations of this study, our data show that more than 50% of the initially seriously diseased teeth were still in situ up to 26 years following GTR therapy despite an overall limited adherence to SPT. In the majority of these teeth, the CAL gain 1 year after GTR could be maintained over this long period.

Cone beam computed tomography (CBCT) in periodontal diseases: a Systematic review based on the efficacy model.

BACKGROUND: Periodontal diseases are prevalent among adult populations. Its diagnosis depends mainly on clinical findings supported by radiographic examinations. In previous decades, cone beam computed tomography has been introduced to the dental field. The aim of this study was to address the diagnostic efficacy of cone-beam computed tomographic (CBCT) imaging in periodontics based on a systematic search and analysis of the literature using the hierarchical efficacy model. METHODS: A systematic search of electronic databases such as PubMed, Scopus, Web of Science, and Cochrane was conducted in February 2019 to identify studies addressing the efficacy of CBCT imaging in Periodontics. The identified studies were subjected to pre-identified inclusion criteria followed by an analysis using a hierarchical model of efficacy (model) designed for an appraisal of the literature on diagnostic imaging modality. Four examiners performed the eligibility and quality assessment of relevant studies and consensus was reached in cases where disagreement occurred. RESULTS: The search resulted in 64 studies. Of these, 34 publications were allocated to the relevant level of efficacy and quality assessments wherever applicable. The overall diagnostic accuracy of the included studies showed a low or moderate risk of bias and applicability concerns in the use of CBCT. In addition, CBCT is accurate in identifying periodontal defects when compared to other modalities. The studies on the level of patient outcomes agreed that CBCT is a reliable tool for the assessment of outcomes after the treatment of periodontal defects. CONCLUSION: CBCT was found to be beneficial and accurate in cases of infra-bony defects and furcation involvements.

Comparative study of DFDBA and FDBA block grafts in combination with chorion membrane for the treatment of periodontal intra-bony defects at 12 months post surgery.

The goal of periodontal therapy is to prevent periodontal disease progression and to regenerate lost periodontal tissues. Various bone grafts are used alone or in combination with other treatment modalities for periodontal therapy. In literature no reports are presented with block allografts in the treatment of intrabony defects in periodontitis. Hence the study aimed to evaluate and compare clinically and radiographically freeze dried bone and demineralized freeze dried bone block allografts with chorion membrane in intra-bony defects at 12 months post-surgery. Eighteen intra-bony defects (9 intra patient pairs) in 9 patients with chronic periodontitis were randomly assigned to group 1 (FDBA + Chorion membrane) and group 2 (DFDBA + Chorion membrane) for periodontal therapy. Clinical and radiographic (RVG) measurements were made at base line and 12 months. Data obtained was subjected to statistical analysis. At 12 months on intra-group comparison both the groups showed statistically significant improvement in the plaque and gingival indices with reduction in the mobility, probing pocket depth and gain in clinical attachment (p value < 0.001). Radiographs showed significant bone fill and increased bone density (p value < 0.001). On inter-group comparison no statistical difference were observed at 12 months in clinical parameters and bone fill among both the groups. However, group 1 (FDBA) showed increase in the bone density which was statistically significant (p value < 0.001). The use of the FDBA and DFDBA block allografts showed significant improvement in the periodontal prognosis of teeth with intra-bony defects. Within the limitation of the present study, both the groups showed similar results with significant increase in bone density in FDBA group.

Influence of autogenous platelet concentrate on combined GTR/graft therapy in intra-bony defects: A 13-year follow-up of a randomized controlled clinical split-mouth study.

AIM: To investigate the clinical long-term outcomes 13 years following guided tissue regeneration (GTR) in deep intra-bony defects with and without additional application of autogenous platelet concentrate (APC). METHODS: In 25 patients, two deep contra-lateral intra-bony defects were treated according to GTR using ß-TCP and bio-resorbable membranes. In test defects, APC was applied additionally. After 13 years, clinical healing results were assessed and compared to results at baseline and after 1 year. Furthermore, a tooth survival analysis was carried out. RESULTS: After 13 years, 22 patients were available for tooth survival analysis showing 81.8% of test and 86.4% of control teeth still in situ. Based on the 15 patients still available for split-mouth analysis, median CAL was 10.0 mm in test and 12.0 mm in control sites at baseline. After 1 year, both groups revealed significant CAL gains of 5.0 mm, followed by a new CAL loss of 1.0 mm in the following 12 years. There were no significant differences between test and control sites. CONCLUSION: Within the limits of this study, the data show that most of the CAL gain following GTR can be maintained over 13 years. The additional use of APC had no positive influence on the long-term stability.

Periodontal regeneration compared with access flap surgery in human intra-bony defects 20-year follow-up of a randomized clinical trial: tooth retention, periodontitis recurrence and costs.

AIM: Compare the long-term outcomes and costs of three treatment modalities in intra-bony defects. MATERIALS AND METHODS: Forty-five intra-bony defects in 45 patients had been randomly allocated to receive: modified papilla preservation technique with titanium-reinforced expanded-polytetrafluoroethylene (ePTFE) membranes (MPPT Tit, N = 15); access flap with expanded-PTFE membranes (Flap-ePTFE, N = 15) and access flap alone (Flap, N = 15). Supportive periodontal care (SPC) was provided monthly for 1 year, then every 3 months for 20 years. Periodontal therapy was delivered to sites showing recurrences. RESULTS: Forty-one patients complied with SPC. Four subjects were lost to follow-up. Clinical attachment-level differences between 1 and 20 years were -0.1 ± 0.3 mm (p = 0.58) in the MPPT Tit; -0.5 ± 0.1 mm (p = 0.003) in the Flap-ePTFE and -1.7 ± 0.4 mm (p < 0.001) in the Flap. At 20 years, sites treated with Flap showed greater attachment loss compared to MPPT Tit (1.4 ± 0.4 mm; p = 0.008) and to Flap-ePTFE (1.1 ± 0.4 mm; p = 0.03). Flap group lost two treated teeth. Five episodes of recurrences occurred in the MPPT Tit, six in the Flap-ePTFE and fifteen in the Flap group. Residual pocket depth at 1-year was significantly correlated with the number of recurrences (p = 0.002). Sites treated with flap had greater OR for recurrences and higher costs of re-intervention than regenerated sites over a 20-year follow-up period with SPC. CONCLUSIONS: Regeneration provided better long-term benefits than Flap: no tooth loss, less periodontitis progression and less expense from re-intervention over a 20-year period. These benefits need to be interpreted in the context of higher immediate costs associated with regenerative treatment. These initial observations need to be extended to larger groups and broader clinical settings.

Regenerative potential of leucocyte- and platelet-rich fibrin. Part A: intra-bony defects, furcation defects and periodontal plastic surgery. A systematic review and meta-analysis.

AIM: To analyse the regenerative potential of leucocyte- and platelet-rich fibrin (L-PRF) during periodontal surgery. MATERIALS AND METHODS: An electronic and hand search were conducted in three databases. Only randomized clinical trials were selected and no follow-up limitation was applied. Pocket depth (PD), clinical attachment level (CAL), bone fill, keratinized tissue width (KTW), recession reduction and root coverage (%) were considered as outcome. When possible, meta-analysis was performed. RESULTS: Twenty-four articles fulfilled the inclusion and exclusion criteria. Three subgroups were created: intra-bony defects (IBDs), furcation defects and periodontal plastic surgery. Meta-analysis was performed in all the subgroups. Significant PD reduction (1.1 ± 0.5 mm, p < 0.001), CAL gain (1.2 ± 0.6 mm, p < 0.001) and bone fill (1.7 ± 0.7 mm, p < 0.001) were found when comparing L-PRF to open flap debridement (OFD) in IBDs. For furcation defects, significant PD reduction (1.9 ± 1.5 mm, p = 0.01), CAL gain (1.3 ± 0.4 mm, p < 0.001) and bone fill (1.5 ± 0.3 mm, p < 0.001) were reported when comparing L-PRF to OFD. When L-PRF was compared to a connective tissue graft, similar outcomes were recorded for PD reduction (0.2 ± 0.3 mm, p > 0.05), CAL gain (0.2 ± 0.5 mm, p > 0.05), KTW (0.3 ± 0.4 mm, p > 0.05) and recession reduction (0.2 ± 0.3 mm, p > 0.05). CONCLUSIONS: L-PRF enhances periodontal wound healing.

Single-flap approach versus without concentrate growth factor in the treatment of periodontal supra-osseous defects: A randomized controlled clinical trial.

Objectives: We aimed to compare treatment outcomes of periodontal supra-bony defects using single flap (SFA) plus concentrate growth factor versus SFA alone. Methods: 32 supra-bony periodontal defects were randomly assigned to test and control groups. Outcome variables were clinical attachment level (primary outcome). Probing pocket depths, gingival recessions, bone gain, post-surgical pain using visual analogue scale and wound healing index were recorded as secondary outcomes. Clinical and radiographic assessments were recorded at baseline and 6 months after treatment, whereas pain score and wound healing index were recorded within 10 days after surgery. Results: Test group showed a significant improvement in all tested parameters compared to control group (P-value ≤ 0.05). Better patient centered outcomes (wound healing and pain scores) were highly achieved in the test group compared to controls. Conclusion: The tested combined approach offers better periodontal and patient centered treatment outcomes in management of periodontal supra-bony defects.

Evaluation of Osteogenic Potential of Fucoidan Containing Chitosan Hydrogel in the Treatment of Periodontal Intra-Bony Defects-A Randomized Clinical Trial.

Periodontal diseases significantly impact about half of the global population, and their treatment often encompasses relieving symptoms as well as regenerating the destroyed tissues. Revolutionary research in the management of periodontal disease includes biomaterials, a boon to re-generative dentistry owing to their excellent biological properties: non-toxicity, anti-inflammatory, biocompatibility, biodegradability, and adhesion. This study aimed to fabricate an injectable fucoidan containing chitosan hydrogel and prove its effectiveness in periodontal bone regeneration. The injectable hydrogel was prepared using the sol-gel method and was subjected to various physical, chemical, and biological characterizations to understand its efficacy in formation of new bone. The effectiveness of the developed hydrogel was assessed in periodontal bony defects to study the soft and hard tissue changes. A total of 40 periodontitis patients with bony defects were recruited and randomized into two groups to receive fucoidan-chitosan hydrogel and concentrated growth factor, respectively. Customized acrylic stents were used to guide the hydrogel placement into the defect site. Post-surgical changes in clinical parameters were assessed at 3, 6, and 9 months to appreciate the soft and hard tissue changes using repeated measures analysis of variance and Bonferroni's post hoc test. Significance was kept at 5%. The porosity, water uptake of the prepared hydrogel showed good efficacy, with particle size of the fucoidan containing chitosan hydrogel of 6.000 nm. The MG-63 osteoblasts cell line revealed biocompatibility, biodegradability and showed slow and sustained drug release, increased cell proliferation, and enhanced alkaline phosphatase secretion. Mineralization assay was greatest in the fucoidan containing chitosan hydrogel. Clinically, it exhibited significantly lower probing depth values and a higher mean improvement in clinical attachment level as compared to the concentrated growth factor (CGF) group at the end of 3 and 6 months (p < 0.05). The mean of the defect fills in the fucoidan containing chitosan group was 1.20 at the end of 9 months (p < 0.001) as compared with defect fills observed in the CGF group. The presence of fucoidan in the hydrogel significantly contributed to bone regeneration in humans, thus strengthening its potential in tissue engineering. Fucoidan-chitosan will be a promising biomaterial for bone tissue regeneration.

Comparing efficacies of autologous platelet concentrate preparations as mono-therapeutic agents in intra-bony defects through systematic review and meta-analysis.

Aim: This systematic review and meta-analysis aimed to assess individually the regenerative potential of PRF (Platelet-rich Fibrin), PRP (Platelet-rich Plasma), and PRGF (Plasma Rich in Growth Factors) in comparison to OFD (Open Flap Debridement) alone for treating Intrabony defects, by calculating pooled effect sizes. Background: Relevant randomized controlled trials on humans were searched in PUBMED, COCHRANE CENTRAL, and GOOGLE SCHOLAR. Mean differences (MD) of Clinical Attachment level (CAL), Probing Pocket depth (PPD), and Defect Depth Reduction (DDR) between the Experimental and Control groups were used for calculating pooled effect sizes. Risk of bias was assessed using Cochrane's tool, and publication bias was evaluated through Funnel plots, Trim & Fill Method, and Rosenthal's Fail-Safe N Test. Review result: A total of 23 studies were identified for qualitative and quantitative analysis. These studies were categorized into PRF, PRP, and PRGF groups based on the type of APC used. PRF showed the highest CAL gain (1.60 mm, 95% CI = 0.963-2.232 mm, P < 0.001, I2 = 93.83%) and PPD reduction (1.76 mm, 95% CI = 1.056 to 2.446, P < 0.001, I2 = 96.05%). However, PRP exhibited the greatest DDR (3.42 mm, 95% CI = -13.67 to -20.50, P = 0.011, I2 = 87.27%). PRF and PRP demonstrated large effect sizes, while PRGF showed a small effect size. Conclusion: The use of PRF, PRP, and PRGF showed advantages in treating intrabony defects. However, caution is advised when interpreting the results due to heterogeneity and publication bias among the studies.

Nanocrystalline hydroxyapatite in periodontal bone regeneration: A systematic review.

Background: Periodontal diseases when persistent, results in periodontal pockets, attachment loss and progressive destruction of the alveolar bone. Grafting periodontal bone defects with bone substitute biomaterials has proven clinical success for accomplishing reconstruction of lost attachment apparatus, especially in deep intra-bony defects. Nanoparticles (NPs) have been considered indispensable in the future of health sciences and NP based alloplastic graft materials such as nanocrystalline hydroxyapatite (NCHA) hold great promise for regeneration of periodontal defects. Therefore the aim of this review is to evaluate the role of NCHA as an effective substitute for periodontal bone regeneration. Material & methods: Popular scientific databases such as PubMed (Medline), Cochrane database of clinical trials, Scopus (Elsevier), Web of science (Clarivate Analytics) and Google Scholar, were searched. The literature search was restricted to published reports in English, between January 2000 and December 2021. Database search returned 1227 results which were screened based on title, author names and publication dates. Results: Data from the 14 included studies were reviewed and tabulated. In the present review, all the studies reported using commercially available NCHA for periodontal bone regeneration. Conclusion: NCHA is a suitable bone substitute material for periodontal bone regeneration, with outcomes comparable to that of conventionally used graft materials such as bovine xenograft and other synthetic alloplastic materials. While grafting with NCHA in intrabony periodontal defects, after any form of periodontal flap surgery or debridement, significantly improves bone regeneration by 6 months, addition of adjuncts like EMD and PRF further enhance the outcomes.

Expression of Vascular Endothelial Growth Factor Using Platelet Rich Fibrin (PRF) and Nanohydroxyapatite (nano-HA) in Treatment of Periodontal Intra-Bony Defects - A Randomized Controlled Trial.

The study aims to assess the concentration of vascular endothelial growth factors (VEGF) with platelet rich fibrin (PRF) biomaterial, while using it separately or in combination with nanohydroxyapatite (nano-HA) for treating intra-bony defects (IBDs) using radiographic evaluation (DBS-Win software). Sixty patients with IBD (one site/patient) and chronic periodontitis were recruited randomly to test either autologous PRF platelet concentrate, nano-HA bone graft, a combination of PRF platelet concentrate and nano-HA, or alone conventional open flap debridement (OFD). Recordings of clinical parameters including probing depth (PD), gingival index (GI), and clinical attachment level (CAL) were obtained at baseline and 6 months, post-operatively. One-way analysis of variance (ANOVA) was used to compare four groups; whereas, multiple comparisons were done through Tukey's post hoc test. The results showed that CAL at baseline changed from 6.67 ± 1.23 to 4.5 ± 1.42 in group I, 6.6 ± 2.51 to 4.9 ± 1.48 in group II, 5.2 ± 2.17 to 3.1 ± 1.27 in group III, and 4.7 ± 2.22 to 3.7 ± 2.35 in group IV after 6 months. The most significant increase in bone density and fill was observed for IBD depth in group III that was recorded as 62.82 ± 24.6 and 2.31 ± 0.75 mm, respectively. VEGF concentrations were significantly increased at 3, 7, and 14 days in all groups. The use of PRF with nano-HA was successful regenerative periodontal therapy to manage periodontal IBDs, unlike using PRF alone. Increase in VEGF concentrations in all group confirmed its role in angiogenesis and osteogenesis in the early stages of bone defect healing.

Association between superior semicircular canal dehiscence and other dehiscences in temporal bone.

BACKGROUND: The study of the association between superior semicircular canal and other dehiscences in the temporal bone. MATERIALS AND METHODS: We have studied computed tomography of radiologically diagnosed people with superior or posterior semicircular canal dehiscences, in four health centres. In addition, we have studied one isolated human temporal bone, one skull and one cadaver head belonging to the collection of the Department of Human Anatomy and Histology of the University of Zaragoza that had dehiscence in the superior semicircular canal. RESULTS: The most frequent association that we observed was between superior semicircular canal dehiscence and tegmen tympani dehiscence (37.33%). Three cases (two clinical cases and one isolated temporal bone) showed multiple associated dehiscences (tegmen tympani, mastoid antrum, posterior semicircular canal, internal auditory canal, glenoid cavity, tympanum bone and geniculate ganglion) associated with superior semicircular canal dehiscence. CONCLUSIONS: When the superior semicircular canal dehiscence is associated to other in the petrous bone (tegmen tympani, mastoid antrum, posterior semicircular canal, internal auditory canal) could be grouped into the same syndrome called "otic capsule syndrome", since they have the same origin and common aetiology (otic capsule).

Femoral revision knee Arthroplasty with Metaphyseal sleeves: the use of a stem is not mandatory of a structural point of view.

PURPOSE: Although metaphyseal sleeves are usually used with stems, little is known about the exact contribution/need of the stem for the initial sleeve-bone interface stability, particularly in the femur, if the intramedullary canal is deformed or bowed. The aim of the present study is (1) to determine the contribution of the diaphyseal-stem on sleeve-femur interface stability and (2) to determine experimentally the strain shielding effect on the metaphyseal femur with and without diaphyseal-stem. It is hypothesised that diaphyseal-stem addition increases the sleeve-femur interface stability and the strain-shielding effect on the metaphyseal femur relatively to the stemless condition. MATERIAL AND METHODS: The study was developed through a combined experimental and finite-element analysis approach. Five synthetic femurs were used to measure cortex strain (triaxial-rosette-gages) behaviour and implant cortex micromotions (Digital Image Correlation) for three techniques: only femoral-component, stemless-sleeve and stemmed-sleeve. Paired t-tests were performed to evaluate the statistical significance of the difference of cortex strains and micromotions. Finite-element models were developed to assess the cancellous bone strain behaviour and sleeve-bone interface micromotions; these models were validated against the measurements. RESULTS: Cortex strains are significantly reduced (p < 0.05) on the stemmed-sleeve with a 150 µstrain mean reduction at the medial and lateral distal sides which compares with a 60 µstrain mean reduction (p > 0.05) on the stemless condition. Both techniques presented a mean cancellous bone strain reduction of 700 µstrain (50%) at the distal region and a mean increase of 2500 µstrain (4x) at the sleeve proximal region relative to the model only with the femoral component. Both techniques presented sleeve-bone micromotions amplitude below 50-150 µm, suitable for bone ingrowth. CONCLUSIONS: The use of a supplemental diaphyseal-stem potentiates the risk of cortex bone resorption as compared to the stemless-sleeve condition; however, the stem is not essential for the enhancement of the initial sleeve-bone stability and has minor effect on the cancellous bone strain behaviour. Based on a purely structural point view, it appears that the use of a diaphyseal-femoral-stem with the metaphyseal sleeve is not mandatory in the revision TKA, which is particularly relevant in cases where the use of stems is impracticable.

Evaluation of bone formation using recombinant human bone morphogenetic proteins-7 in small maxillofacial bony defects.

CONTEXT: Bone morphogenetic proteins (BMP) are multifunctional molecules of transforming growth factor-ß superfamily that induces the differentiation of fibroblasts into osteoblasts to form bone. AIMS: This study was undertaken to evaluate the effects of recombinant human BMP-7 (rhBMP-7) in bone healing of small maxillofacial bone defects and assess the serum levels of osteopontin (OPN) and receptor activator of nuclear factor kappa-B ligand (RANKL) biomarkers for bone remodeling. MATERIALS AND METHODS: Twenty patients with small maxillofacial bony defects were enrolled in this study and randomly allocated to two groups; wherein after apicoectomy of the involved teeth, the control group had defect filled with collagen sponge only while the experimental group had rhBMP-7 impregnated collagen sponge placed in the defect. RESULTS: The clinical parameters showed no significant difference between the two groups (P > 0.05). The radiographic parameters showed a significantly slower rate of reduction in bone defect volume (P < 0.01) in control group than the experimental group when followed at 2, 4 and 24 postoperative weeks. RANKL and OPN serum levels showed no significant changes in pre- and post-operative stage. CONCLUSION: This study confirms that rhBMP-7 in collagen definitely accelerates bone healing in maxillofacial bone defects and minimizes postoperative complications. RANKL and OPN biomarkers in serum may not show bone remodeling, hence tissue samples may be used to assess their levels.

The effects of autologous platelet concentrate on the healing of intra-bony defects: a randomized clinical trial.

PURPOSE: The present study aimed to evaluate the clinical and radiographic effects of autologous platelet concentrate (APC) on the healing of intra-bony defects filled with ß-tricalcium phosphate (ß-TCP) and covered with collagen membranes. SUBJECTS AND METHODS: This study included 30 defects of 14 systemically healthy subjects. All of them had, at least, two deep intra-bony, inter-proximal periodontal defects. Minimum probing pocket depth (PPD) was 6 mm. Clinical and imaging examination was performed both at baseline and at 3, 6, and 9 months after surgery. RESULTS: Both the test and control group revealed a significant reduction in all variables when compared with the base line. Mean reduction of the PPD in two groups at each follow-up time point showed no significant difference. Means of the clinical attachment gain of the same groups were significantly different (p<0.05). Mean gingival recession at 3 month was not significant. However, the means of gingival recession coverage of two groups were significantly different at 6 and 9 months (p<0.05 for both). CONCLUSION: Sites treated with APC are more likely to demonstrate more clinical attachment gain and recession coverage at the end of 9 month compared to those without APC.

Clinical and radiographic evaluation and comparison of bioactive bone alloplast morsels when used alone and in combination with platelet-rich fibrin in the treatment of periodontal intrabony defects-A randomized controlled trial.

BACKGROUND: The present study aims to evaluate and compare the clinical and radiographic changes obtained through Bioactive Glass (BG) with and without autologous platelet-rich fibrin (PRF) in the treatment of intrabony defects in chronic periodontitis patients. METHODS: The present study was a split-mouth randomized controlled clinical trial comprising 20 chronic periodontitis patients (mean age: 35.9 years) having at least one pair of bilateral intrabony defect. Group 1 included 20 sites treated with a combination of BG and autologous PRF whereas 20 sites in Group 2 were treated with BG alone. Probing pocket depth (PPD), clinical attachment level (CAL) and gingival recession (GR) were evaluated at 3 and 6 months and bone fill at 6 months by using cone beam computed tomography (CBCT) analysis. Primary study outcomes were changes in PPD, CAL, GR, and bone fill. RESULTS: CAL gain was greater in Group 1 (5.05 ± 1.09 mm) when compared with Group 2 (4.2 ± 1.70 mm). Furthermore, a significantly greater bone fill was found in Group 1. At 6 months, statistically significant reduction in PPD in Group 1 and Group 2 was evident. CONCLUSION: BG morsel when used in combination with PRF is found to be more effective in gain in CAL, reduction in PPD and achieving greater bone fill as compared with treatment with BG alone in periodontal intrabony defects and is indicative of enhanced periodontal regeneration.