Ultrasound-aided resorbable osteosynthesis of fractures of the mandibular condylar base: an experimental study in sheep.

We evaluated the osteosynthesis of condylar fractures using resorbable mini plates and ultrasound-aided insertion of pins clinically and histologically. Stability was greater than that with resorbable screws because of the fusion of pin and plate. Long term evaluation showed complete resorption of the polymeric osteosynthesis material.

Comparative evaluation of ten different condylar base fracture osteosynthesis techniques.

The aim of this study on the mandibles of minipigs was to compare the biomechanical stability of different methods of osteosynthesis that are used in the operative treatment of fractures of the base of the condyle. Ten different systems of osteosynthesis were used to fix 164 fractures, which were tested by a two-point bending test after repositioning and fixing. This stress test was applied in four directions: lateral to medial, anterior to distal, distal to anterior, and medial to lateral. The Eckelt lag screw, one or two 2.0mm miniplates, one miniplate with bar (KLS Martin), minicompression plates (Medicon), zygoma compression plates (Medartis), condylus fracture plates (Medartis), square 4-hole plates (KLS Martin), and either one or two resorbable 4-hole miniplates (Resorb-X, Martin) were used for osteosynthesis. A total of 164 tests were done using a universal test machine that measured forces until the osteosynthesis failed. Advantages in mechanical load capacity were also measured for the Eckelt lag screw when force was applied from medial to lateral. Fixation with one resorbable miniplate was not functionally stable. Irrespective of the direction of force applied, two miniplates were the most stable technique. There were pronounced differences depending on the direction of force applied. The results suggest that treatment with a single resorbable miniplate is not functionally stable.

Suitability of differently designed matrix-based implant surface coatings: an animal study on bone formation.

INTRODUCTION: The aim of the present study was to assay how bone formation around dental implants is influenced by differently composed collagen matrices and RGD peptide as implant surface coatings compared to a sandblasted titanium surface. MATERIAL AND METHODS: Five different implant surface coatings were designed: titanium (sandblasted), collagen type I, collagen type I&III, RGD-peptide, and mineralized collagen. Sixty experimental implants of a square-shaped design were inserted into the mandibles of 12 minipigs, 3 months following extraction of the premolar teeth. During the 6-month study period, sequential polyfluorochrome labeling was performed. After sacrifice, bone implant contact (BIC) was evaluated using histologic and histomorphometric methods. RESULTS: New bone formation was observed against all implant surfaces. Polyfluorochrome labeling showed that bone growth started from the host bone in the majority of samples. The highest BIC was measured for collagen I and collagen I/III coated implants; however, significant differences between the coatings could not be found. CONCLUSION: Osseointegration was achieved for all implant surfaces. Although a statistically significant increase in BIC could not be demonstrated for the experimental coatings after the 6 months study period, there was also no discernible detrimental effect of the coatings in comparison to the uncoated titanium surfaces.

Histologic study of incorporation and resorption of a bone cement-collagen composite: an in vivo study in the minipig.

OBJECTIVE: Calcium phosphates are clinically established as bone defect fillers. They have the capability of osseoconduction and are characterized by a slow resorption process. The present study evaluated the suitability of a newly developed calcium phosphate cement modified with collagen type I. STUDY DESIGN: The modified cement paste was inserted in differently designed defects of 10 minipigs. Further, an alveolar ridge augmentation was performed, applying the cement paste. The cement hardened in situ during the operation, forming a hydroxyapatite collagen composite. Animals were sacrificed after 1, 3, 6, 12, and 18 months. The tissue integration and resorption process was then evaluated using nondecalcified microsections. All animals were evaluated for histology. RESULTS: The implanted material showed osseoconductive characteristics. Resorption started from the edge of the defect zone, and bone substitution followed rapidly. Twelve months after placement of the cement, complete remodeling was observed. CONCLUSION: It can be concluded that the applied hydroxyapatite-collagen cement composite shows good resorption and bone integration.

Experimental investigations for mechanical joint strength following ultrasonically welded pin osteosynthesis.

The purpose of this study was to determine whether fixation of cranial bone segments using ultrasonically welded pin osteosynthesis showed differences in mechanical stability as compared to fixation of cranial bone segments using screw osteosynthesis. Right and left cranial bone segments from each of 16 young sheep were obtained by craniotomy and re-fixed: on the right with a mesh plate and pins, and on the left with a mesh plate and screws. All osteosynthesis materials consisted of PDLLA, fully amorphous polyactid. A total of 167 cranial bone / mesh plate segments from 16 animals were investigated; 84 segments were pin-fixed and 83 segments were screw-fixed. The implantation time of the re-fixed segments ranged from 1 day to 196 days. The mechanical methods chosen for simulation of stress on the bone segment bonds were two bending tests (horizontal and vertical directions) and a tensile test. The values obtained in the mechanical tests indicate differences in the bond strength between the pin- and screw- fixation methods over the length of in vivo implantation time. The mechanical stability of the ultrasonically welded pin osteosynthesis bonds over the screw osteosynthesis bonds proved to be statistically significant. The implication of these findings should also be relevant in the field of medicine.

Effect of biological implant surface coatings on bone formation, applying collagen, proteoglycans, glycosaminoglycans and growth factors.

OBJECTIVES: The aim of the present study was to evaluate six different implant surface coatings with respect to bone formation. Being major structural components of the extracellular matrix, collagen, the non-collagenous components decorin/chondroitin sulphate (CS) and the growth factors TGF-beta1/BMP-4 served in different combinations as coatings of experimental titanium implants. MATERIALS AND METHODS: Eight miniature pigs received each six implants in the mandible. The implant design showed two circular recesses along the length axis. Three, four, five and six weeks after implant placement, the animals were sacrificed in groups of two. Bone-implant contact (BIC) was evaluated along the outer implant surface and within the recesses. Bone volume was determined by synchrotron radiation micro computed tomography (SRmicroCT) for one implant of each surface state, 6 weeks after placement. RESULTS: At each week of observation, collagen/CS or collagen/CS/BMP-4 coated implants showed the highest BIC of all surface states. This was statistically significant at week five (p=0.030, p=0.040) and six (p=0.025, p=0.005). SRmicroCT measurements determined the highest bone volume for a collagen/CS coated implant. CONCLUSION: The results indicate that collagen/CS and collagen/CS/BMP-4 lead to a higher degree of bone formation compared to other ECM components.

Ultrasound aided pin fixation of biodegradable osteosynthetic materials in cranioplasty for infants with craniosynostosis.

AIM: Biodegradable osteosynthesis materials are often used for fixation of bone fragments when repairing craniosynostoses. When compared with titanium plates they have the disadvantage of difficult handling and time-consuming thread cutting. A new method of using resorbable pins inserted with the aid of ultrasound (bone welding) and not requiring thread cutting was applied in patients for the first time. METHOD: In eight patients with craniosynostoses, the biodegradable material Resorb-X was fixed with resorbable pins inserted with the aid of ultrasound. The patients were followed up for 12 months. RESULTS: Pin fixation was stable in all cases. The time required for applying the osteosynthesis materials was reduced by about 50% since handling of the material was easier and no thread cutting was required. CONCLUSIONS: Due to fixation in cortical as well as cancellous bone ultrasound aided fixation using resorbable osteosynthesis materials is more stable than screw fixation. The time required for application is considerably shortened as no thread cutting is required.

Bone welding--a histological evaluation in the jaw.

The expansion of biodegradable osteosynthesis systems in clinical application correlates well to the progress in development of new materials as to the improvement of application methods. One of those new application methods is the ultrasound-aided insertion of Resorb-X pins. The aim of this study was the histological evaluation of possible thermal damage to bone due to the ultrasound insertion. For this purpose, condylar neck fractures in 12 sheep were produced, repositioned and fixed by Resorb-X plates and pins. The animals were sacrificed in two groups, one after 2 weeks and one after 9 weeks. The bone-pin interlinkage and the structure of the bone were histologically evaluated. After 2 weeks a tight bone-polymer interlinkage was seen. Neither a pronounced foreign body reaction nor an interposition of fibrous tissue at the interface or a thermally induced necrosis was observed. The late phase of wound healing after 9 weeks showed pathomorphological characteristics within the normal range of bone healing. The bone seemed to be free of any alteration caused by process engineering. We conclude that thermal stress caused by ultrasound-aided pin insertion does not lead to cellular reaction in the bone. The fast and easy application of this improved biodegradable osteosynthesis system will bring a clear advantage in clinical use.

Influence of extracellular matrix coatings on implant stability and osseointegration: an animal study.

Aim of the present study was to test the hypothesis that the application of components of the extracellular matrix such as glycosaminoglycans used as implant surface coatings in combination with collagen, with and without growth factor, can lead to enhanced ossification and thus improve implant stability compared with collagen coatings alone. Twenty miniature pigs received 120 experimental titanium implants in the mandible. Three types of surface coatings were created: (1) collagen type I (coll), (2) collagen type I/chondroitin sulphate (coll/CS), (3) collagen type I/chondroitin sulphate/BMP-4 (coll/CS/BMP). Periimplant bone formation was assessed within a defined recess along the length axis of the implant. Bone-implant contact (BIC) and bone volume density (BVD) were determined, using both histomorphometry and synchrotron radiation micro computed tomography (SRmicroCT). To measure implant stability, resonance frequency analysis was applied after implantation and 1, 3, 7, and 22 weeks after placement. BIC was highest for coll/CS coated implants, followed by coll, p = 0.082. Histomorphometric BVD did not significantly change for any coating. SRmicroCT analysis showed an increased BVD for collagen coated implants, compared with the other two surface coatings. Implant stability showed a decrease for all coatings up to the third week. At 22 weeks, all coatings showed an increase in stability without reaching their initial level. Highest stability was reached for coll coated implants, p = 0.051. It was concluded that collagen and coll/CS implant coatings have advantageous characteristics for peri-implant bone formation, compared with the further integration of BMP-4.

Minimally invasive fracture treatment with cannulated lag screws in intracapsular fractures of the condyle.

PURPOSE: We examined the use of cannulated lag screw osteosynthesis for the treatment of fractures of the mandibular condylar head in providing a high-quality durable fixation, while at the same time reducing the trauma necessary for an open approach to the fracture site. PATIENTS AND METHODS: A preauricular approach was used for exposure, reduction, and osteosynthesis in 5 cases of type B condylar fractures. A cannulated screw system was used that allowed optimum placement of the self-cutting cannulated lag screw following insertion of a guiding wire and using clinical control to ensure its correct position. The joints were submitted to functional exercises immediately following surgery and postoperative radiologic, axiographic, and clinical follow-ups were performed. RESULTS: Radiologic follow-up revealed correct reduction and fixation in all 5 cases. Axiographic and clinical follow-up showed an initial limitation, but normal mobility of the condyles was achieved within 3 months postoperatively, with a maximum mouth opening of 41.2 +/- 9.4 mm after 6 months. There were no occlusal disturbances, no trismus, no lateral deviations of the mandible, and no nerve lesions. Intraoperatively, the method applied shortened the time necessary for and simplified the procedure of reduction and osteosynthesis. CONCLUSION: By using a cannulated lag screw, it was shown that the major factor in the extent of the trauma relating to surgical access was the reduction of the fracture fragments. The method ensured stable fixation of the fracture with a minimum of osteosynthesis material, while reducing the operative time. In combination with intraoperative imaging techniques it can also successfully be applied to other fractures in maxillofacial surgery.

Comparison of the predicted surgical results following virtual planning with those actually achieved following bimaxillary operation of dysgnathia.

AIM: To simulate the surgery of dysgnathia, several forms of computer software allowing two-dimensional 'virtual' planning are frequently used. However, in many cases it is not possible to transfer the virtual plan accurately to the surgical site. It is the purpose of this study to find the errors likely to occur when transferring the data. METHODS: In 22 bimaxillary osteotomies for dysgnathia, the results of preoperative planning were compared with the surgical outcomes. The programme WinCeph 4.19 (Compudent) was used for cephalometric analyses and simulation of the operations. RESULTS: Six major skeletal parameters were evaluated when comparing both the planned and the actual outcome, and the following results were recorded: Delta-SNA 1.53 degrees (+/-1.20), Delta-SNB 1.67 degrees (+/-1.29), Delta-ANB 1.62 degrees (+/-1.47), Delta-NL-NSL 3.9 degrees (+/-2.30), Delta-ML-NSL 3.6 degrees (+/-3.7) and Delta-ArGoMe 6.1 degrees (+/-4.6). CONCLUSION: It was anticipated that the most important differences between planned and surgical outcomes were found to be in the vertical changes. Planning and data transfer was comparatively accurate with regard to sagittal data. Apart from several mechanical methods for data transfer, systems using navigation are therefore being discussed and used increasingly. They ensure accurate data transfer to the surgical site.