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1.
Cient. dent. (Ed. impr.) ; 17(3): 233-237, sept.-dic. 2020. ilus
Artículo en Español | IBECS | ID: ibc-198607

RESUMEN

Atendiendo a la localización de la reabsorción radicular, ésta puede ser clasificada en externa o interna. La reabsorción interna es relativamente poco frecuente, y su etiología y patogénesis no está todavía del todo clara. Este artículo muestra la complejidad de un incisivo central superior con una reabsorción interna inflamatoria perforante. El diagnóstico definitivo lo hallamos a través del examen tridimensional, que confirmó la extensión y comunicación con la superficie externa radicular. Aunque como podremos ver a lo largo de la exposición del caso clínico, la ayuda del microscopio nos permitió abordar el caso con mayor seguridad. En todo momento pudimos eliminar el tejido inflamatorio y preparar el conducto de manera adecuada. La obturación en este tipo de casos supone un reto para el endodoncista, siendo éste, mayor cuando se realiza únicamente de manera ortógrada. Para la obturación realizamos una técnica descrita en la literatura, sellando la zona apical a la reabsorción con gutapercha adaptada mediante condensación vertical; la zona reabsortiva con material biocerámico y, por último, la zona coronal con guta-percha inyectada. Se realizó un 3D a los 26 meses para una nueva evaluación de la zona reabsortiva, y así evaluar el estado óseo alrededor de la misma. La paciente se presenta totalmente asintomática sin signos clínicos y con buena salud de los tejidos periapicales


Based on the location of the root resorption, it can be classified as external or internal. Internal resorption is relatively rare, and its etiology and pathogenesis is not yet entirely clear. This article shows the complexity of a superior central incisor with a perforating inflammatory internal resorption. The definitive diagnosis is found through the three-dimensional examination, which confirmed the extension and communication with the external root surface. Although as we can see throughout the presentation of the clinical case, the help of the microscope allowed us to address the case with greater certainty. At all times we were able to remove the inflammatory tissue and prepare the duct properly. The obturation in this type of cases supposes a challenge for the endodontist, being this one, greater when it is done only in an ortograde way. For the filling, we performed a technique described in the literature, filling the apical area with resorption with gutta-percha adapted by vertical condensation; the resorptive zone with bioceramic material and finally the coronal zone with injected gutta-percha. A 3D was performed at 26 months for a new evaluation of the resorptive zone, and thus evaluate the bone state around it. The patient presents totally asymptomatic without clinical signs and with good health of the periapical tissues


Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Resorción Ósea/cirugía , Enfermedades Periapicales/diagnóstico por imagen , Corona del Diente/diagnóstico por imagen , Corona del Diente/cirugía , Resorción Radicular/etiología , Tomografía Computarizada de Haz Cónico , Imagenología Tridimensional , Cavidad Pulpar/ultraestructura
2.
Plast Reconstr Surg ; 146(2): 147e-155e, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32740576

RESUMEN

BACKGROUND: As one of the most commonly used soft-tissue fillers, hyaluronic acid is generally considered safe and efficacious. However, evident bone resorption in mentum was observed. In this study, the authors analyzed the impact of hyaluronic acid on bone resorption in mentum and the influencing factors. METHODS: The authors retrospectively compared the computed tomographic scans of patients with or without mentum augmentation using hyaluronic acid. The body mass index- and sex-matched control group was selected randomly. Semimandibular bone resorption index was calculated as the ratio of bone thickness in the incisive fossa to that in the mandibular symphysis. Injection volume, injection interval, the number of injections, product, complication were also recorded. RESULTS: From January of 2014 to June of 2019, 80 patients (160 cases) and 80 controls were recruited. The bone resorption index in the hyaluronic acid injection cohort was significantly lower than in the controls (75.25 ± 10.02 versus 82.86 ± 6.38; p = 0.000). Patients injected with greater than or equal to 1 ml per time were more susceptible to bone erosion compared with patients injected with less (68.89 ± 10.84 versus 76.49 ± 9.42; p = 0.000). There was no significant difference between one- versus multiple-injection groups and short-injection-interval versus long-injection-interval (≥6 months) groups. Furthermore, no reduced aesthetics were realized. CONCLUSIONS: Hyaluronic acid injection could induce bone resorption in the mentum; nevertheless, the aesthetics were not impaired. The severity of the bone loss was positively correlated with the injection volume per time; therefore, large-volume injection of hyaluronic acid should be performed with caution. The patients should be fully informed about this complication preoperatively. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Asunto(s)
Resorción Ósea/inducido químicamente , Mentón/diagnóstico por imagen , Técnicas Cosméticas/efectos adversos , Rellenos Dérmicos/efectos adversos , Ácido Hialurónico/efectos adversos , Adolescente , Adulto , Grupo de Ascendencia Continental Asiática , Enfermedades Asintomáticas/epidemiología , Enfermedades Asintomáticas/terapia , Resorción Ósea/diagnóstico , Resorción Ósea/epidemiología , Resorción Ósea/cirugía , Rellenos Dérmicos/administración & dosificación , Estética , Femenino , Humanos , Ácido Hialurónico/administración & dosificación , Incidencia , Masculino , Satisfacción del Paciente , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Adulto Joven
3.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 64(4): 236-243, jul.-ago. 2020. ilus
Artículo en Español | IBECS | ID: ibc-197328

RESUMEN

OBJETIVO: Obtener continuidad ósea en un modelo experimental de resección segmentaria en la diáfisis del fémur mediante tratamiento con células mesenquimáticas indiferenciadas comprometidas al linaje osteogénico. MATERIAL Y MÉTODO: Se obtuvieron células mesenquimáticas indiferenciadas a partir de médula ósea de ratas Wistar singénicas, se diferenciaron al linaje osteogénico y se embebieron en bloques de hidroxiapatita. Se implantaron en una resección segmentaria en la diáfisis del fémur, que se sintetizó con una placa de 1,5mm de grosor. Se calcularon distribuciones binomiales estableciéndose un grupo experimental y 3 de control, constituidos por 8 elementos cada grupo. Grupo I, relleno con aloinjerto; grupo II, con hidroxiapatita; grupo III, con hidroxiapatita embebida con células osteocomprometidas; grupo IV con células osteocomprometidas mediante cultivo tridimensional. Se realizó estadística descriptiva con distribución de frecuencias mediante la prueba de Fisher, considerándose significativo el valor de p < 0,05. RESULTADOS: El grupo I presentó buena consolidación, sin rotura de placas. El grupo II mostró tejido fibroso y rotura de todas las placas. El grupo III mostró tejido óseo, pero en todos los casos se rompieron las placas. El grupo IV mostró consolidación sin rotura de placas. CONCLUSIÓN: La terapia mediante células mesenquimáticas indiferenciadas en cultivos tridimensionales produce tejido óseo y asegura una estabilización mecánica permanente. Limitaciones: antes de la inferencia humana es necesario realizar el experimento en grupos con más elementos


OBJECTIVE: To achieve bone continuity in an experimental model of segmental resection of femur bone by applying a treatment with committed to osteogenic bone linage mesenchymal stem cells. MATERIAL AND METHOD: Bone marrow mesenchymal stem cells, obtained from syngeneic Wistar murine, were committed into osteogenic lineage and embedded within a hydroxipatite block. They were implanted in an experimentally created diaphyseal femur resection model. The diaphysis was synthetized with a 1.5mm thick plate. In order to calculate binomial distributions, we stablished one experimental and 3 control groups of 8 elements each: Group I, filling the gap with allograft; group II, filling with a hydroxyapatite block without cells; group III, filling with the hydroxyapatite block embedded with committed cells, and group IV, with the hydroxyapatite embedded with osteoinduced cells in a 3 dimensions TRAP culture. Descriptive analysis was performed by frequency distribution and Fisher statistic test. Level of statistical significance was considered at P<.05. RESULTS: Group I presented good bone consolidation and no plate breakage. Group II showed fibrous but non-bone tissue, with rupture of all plates. Group III showed bone tissue in all cases, but the plates broke in all of them, while in group IV bone consolidation was achieve without any plate rupture. CONCLUSION: Cell therapy with mesenchymal stem cells, trained in a 3 dimensions cell culture, produces bone tissue and ensures the permanence of the mechanical stabilization performed in a segmental resection model. Limitations: A study with a larger sample size is necessary before planning the human inference


Asunto(s)
Animales , Ratas , Trasplante de Células Madre Mesenquimatosas/métodos , Osteogénesis/fisiología , Fémur/cirugía , Fijación de Fractura/métodos , Morfogénesis/fisiología , Ingeniería de Tejidos/métodos , Ratas Wistar , Modelos Animales de Enfermedad , Resorción Ósea/cirugía , Cementos para Huesos/uso terapéutico , Procedimientos Ortopédicos/métodos , Factor de Crecimiento Transformador beta1/metabolismo
4.
Bone Joint J ; 102-B(6_Supple_A): 116-122, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32475283

RESUMEN

AIMS: Metaphyseal cones with cemented stems are frequently used in revision total knee arthroplasty (TKA). However, if the diaphysis has been previously violated, the resultant sclerotic canal can impair cemented stem fixation, which is vital for bone ingrowth into the cone, and long-term fixation. We report the outcomes of our solution to this problem, in which impaction grafting and a cemented stem in the diaphysis is combined with an uncemented metaphyseal cone, for revision TKA in patients with severely compromised bone. METHODS: A metaphyseal cone was combined with diaphyseal impaction grafting and cemented stems for 35 revision TKAs. There were two patients with follow-up of less than two years who were excluded, leaving 33 procedures in 32 patients in the study. The mean age of the patients at the time of revision TKA was 67 years (32 to 87); 20 (60%) were male. Patients had undergone a mean of four (1 to 13) previous knee arthroplasty procedures. The indications for revision were aseptic loosening (80%) and two-stage reimplantation for prosthetic joint infection (PJI; 20%). The mean follow-up was four years (2 to 11). RESULTS: Survival free from revision of the cone/impaction grafting construct due to aseptic loosening was 100% at five years. Survival free from any revision of the construct and free from any reoperation were 92% and 73% at five years, respectively. A total of six patients (six TKAs, 17%) required a further revision, four for infection or wound issues, and two for periprosthetic fracture. Radiologically, one unrevised TKA had evidence of loosening which was asymptomatic. In all unrevised TKAs the impacted diaphyseal bone graft appeared to be incorporated radiologically. CONCLUSION: When presented with a sclerotic diaphysis and substantial metaphyseal bone loss, this technique combining diaphyseal impaction grafting with a metaphyseal cone provided near universal success in relation to implant fixation. Moreover, radiographs revealed incorporation of the bone graft and biological fixation of the cone. While long-term follow-up will be important, this technique provides an excellent option for the management of complex revision TKAs. Cite this article: Bone Joint J 2020;102-B(6 Supple A):116-122.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Resorción Ósea/cirugía , Trasplante Óseo , Prótesis de la Rodilla , Complicaciones Posoperatorias/cirugía , Reoperación , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Diáfisis/trasplante , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
5.
Niger Postgrad Med J ; 27(2): 143-146, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32295947

RESUMEN

Revision knee arthroplasty is often complicated by the presence of bone loss, making the use of conventional revision implants impossible, due to inadequate bone stock and ligamentous stability. Distal femoral replacement, although traditionally was developed for salvage surgeries for bone tumours, plays an important role in revision surgeries of elderly low-demand adults with marked bone loss and ligamentous instability. Here, we report the case of a 66-year-old female, with a history of bilateral knee replacement 5 years before the presentation, who developed left knee pain, with X-ray features of failed left knee replacement. This patient had a left distal femoral replacement and successfully returned to her pre-operative function.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Resorción Ósea/cirugía , Fémur/cirugía , Articulación de la Rodilla/cirugía , Anciano , Artroplastia de Reemplazo de Rodilla/efectos adversos , Resorción Ósea/diagnóstico por imagen , Resorción Ósea/etiología , Femenino , Fémur/diagnóstico por imagen , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Nigeria , Falla de Prótesis , Reoperación/métodos , Resultado del Tratamiento
6.
Knee ; 27(2): 572-579, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31954609

RESUMEN

BACKGROUND: Recent studies have reported the occurrence of medial tibial bone resorption following total knee replacement. One study proposed that a thick tibial tray results in stress shielding and increases the risk of bone resorption, but its findings were based on subjective radiological assessment. This study aimed to verify this hypothesis and to objectively quantify medial tibial bone density by using serial measurements with digital radiological densitometry. METHODS: This was a retrospective cohort study involving 140 patients (70 thick tray vs. 70 thin tray) with cobalt-chromium implants with at least 24 months of follow-up. Standard radiographs were reviewed to look for incidence of medial tibial bone loss. Serial measurement of medial tibial bone density was also performed using the method of digital radiological densitometry. RESULTS: There was no significant difference in the incidence of medial tibial bone loss. Both groups showed a significant drop in medial tibial bone density after operation (P < 0.01). Medial tibial bone density of the thick-tray cohort was significantly higher than the thin-tray cohort at one year (93.3 vs. 83.1 Greyscale; P = 0.04), but not at two and three years. Clinical outcomes in terms of postoperative range of motion, Knee Society score and complication rates were similar. CONCLUSIONS: Medial tibial bone resorption is a common phenomenon. Implants with thicker tibial trays suffer less than those with thinner trays at one year, but the difference is transient and does not affect clinical outcome.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Densidad Ósea/fisiología , Resorción Ósea/etiología , Articulación de la Rodilla/diagnóstico por imagen , Prótesis de la Rodilla , Rango del Movimiento Articular/fisiología , Tibia/diagnóstico por imagen , Anciano , Resorción Ósea/diagnóstico , Resorción Ósea/cirugía , Femenino , Humanos , Articulación de la Rodilla/cirugía , Masculino , Radiografía , Estudios Retrospectivos , Tibia/cirugía
7.
Am J Orthod Dentofacial Orthop ; 156(4): 531-544, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31582125

RESUMEN

Progressive condylar resorption, also known as idiopathic condylar resorption, is an uncommon, aggressive, degenerative disease of the temporomandibular joint (TMJ) seen mostly in adolescent girls and young women. This condition leads to loss of condylar bone mass, decrease of mandibular ramal height, steep mandibular and occlusal plane angles, and an anterior open bite. In 3 case reports, we review the pathogenesis of TMJ degenerative disease and the clinical management of TMJ arthrosis. We emphasize that TMJ arthritic disease should be discussed in dental circles as a pathologic entity in the same way that orthodontists discuss arthritic disease in orthopedic circles. Regarding the degenerative pathology of the TMJ, treatment goals include restored function and pain reduction. The treatment methods used to achieve these goals can range from noninvasive therapy to minimally invasive and invasive surgery. Most patients can be treated noninvasively, and the importance of disease prevention and conservative management in the overall treatment of TMJ disease must be acknowledged. The decision to manage TMJ osteoarthrosis surgically must be based on evaluation of the patient's response to noninvasive treatments, mandibular form and function, and effect of the condition on his or her quality of life.


Asunto(s)
Resorción Ósea/diagnóstico por imagen , Resorción Ósea/cirugía , Ortodoncia Correctiva/métodos , Procedimientos Quirúrgicos Ortognáticos/métodos , Osteoartritis/diagnóstico por imagen , Osteoartritis/cirugía , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/terapia , Adulto , Resorción Ósea/patología , Niño , Terapia Combinada , Progresión de la Enfermedad , Femenino , Humanos , Cóndilo Mandibular/patología , Cóndilo Mandibular/cirugía , Osteoartritis/patología , Calidad de Vida , Trastornos de la Articulación Temporomandibular/patología , Resultado del Tratamiento
8.
PLoS One ; 14(8): e0221056, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31469844

RESUMEN

OBJECTIVE: Aseptic loosening (AL) is the most frequent long-term reason for revision of total knee arthroplasty (TKA) affecting about 15-20% patients within 20 years after the surgery. Although there is a solid body of evidence about the crucial role of inflammation in the AL pathogenesis, scared information on inflammation signature and its time-axis in tissues around TKA exists. DESIGN: The inflammation protein signatures in pseudosynovial tissues collected at revision surgery from patients with AL (AL, n = 12) and those with no clinical/radiographic signs of AL (non-AL, n = 9) were investigated by Proximity Extension Assay (PEA)-Immunoassay and immunohistochemistry. RESULTS: AL tissues had elevated levels of TNF-family members sTNFR2, TNFSF14, sFasL, sBAFF, cytokines/chemokines IL8, CCL2, IL1RA/IL36, sIL6R, and growth factors sAREG, CSF1, comparing to non-AL. High interindividual variability in protein levels was evident particularly in non-AL. Levels of sTNFR2, sBAFF, IL8, sIL6R, and MPO discriminated between AL and non-AL and were associated with the time from index surgery, suggesting the cumulative character of inflammatory osteolytic response to prosthetic byproducts. The source of elevated inflammatory molecules was macrophages and multinucleated osteoclast-like cells in AL and histiocytes and osteoclast-like cells in non-AL tissues, respectively. All proteins were present in higher levels in osteoclast-like cells than in macrophages. CONCLUSIONS: Our study revealed a differential inflammation signature between AL and non-AL stages of TKA. It also highlighted the unique patient's response to TKA in non-AL stages. Further confirmation of our preliminary results on a larger cohort is needed. Analysis of the time-axis of processes ongoing around TKA implantation may help to understand the mechanisms driving periprosthetic bone resorption needed for diagnostic/preventative strategies.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/efectos adversos , Resorción Ósea/fisiopatología , Citocinas/metabolismo , Inflamación/metabolismo , Falla de Prótesis/efectos adversos , Anciano , Anciano de 80 o más Años , Resorción Ósea/complicaciones , Resorción Ósea/metabolismo , Resorción Ósea/cirugía , Femenino , Histiocitos/metabolismo , Histiocitos/patología , Humanos , Inflamación/complicaciones , Inflamación/fisiopatología , Inflamación/cirugía , Macrófagos/metabolismo , Macrófagos/patología , Masculino , Persona de Mediana Edad , Osteoclastos/metabolismo , Osteoclastos/patología , Reoperación
9.
Am J Orthod Dentofacial Orthop ; 156(1): 125-136, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31256825

RESUMEN

This case report describes the successful treatment of a 14-year-old girl with severe bilateral idiopathic condylar resorption and resultant mandibular retrusion, increased overjet, and anterior open bite. The nonextraction treatment plan included (1) aligning and leveling the teeth in both arches, (2) performing Le Fort I maxillary osteotomy, bilateral condylectomy, and mandibular joint replacement, and (3) postsurgical correction of the malocclusion. The orthodontic treatment was initiated with the use of custom lingual appliances followed by orthognathic surgery planned with virtual surgical planning. Patient-fitted and customized temporomandibular joint implants were designed and manufactured based on the patient's stereolithic bone anatomic model. Treatment was concluded with detailed orthodontic finishing. Optimum esthetic and functional results were achieved with the cooperation of 2 specialties and the use of state-of-the-art technology.


Asunto(s)
Tirantes , Prótesis Articulares , Cóndilo Mandibular/cirugía , Mordida Abierta/cirugía , Mordida Abierta/terapia , Ortodoncia Correctiva/métodos , Procedimientos Quirúrgicos Ortognáticos/métodos , Trastornos de la Articulación Temporomandibular/terapia , Adolescente , Puntos Anatómicos de Referencia , Resorción Ósea/complicaciones , Resorción Ósea/diagnóstico por imagen , Resorción Ósea/cirugía , Resorción Ósea/terapia , Cefalometría , Estética Dental , Femenino , Humanos , Imagenología Tridimensional , Mandíbula/cirugía , Cóndilo Mandibular/diagnóstico por imagen , Maxilar/cirugía , Mordida Abierta/diagnóstico por imagen , Aparatos Ortodóncicos , Aparatos Ortodóncicos Fijos , Ortodoncia Correctiva/instrumentación , Osteotomía , Planificación de Atención al Paciente , Radiografía Panorámica , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/complicaciones , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/cirugía , Resultado del Tratamiento
10.
Biomed Res Int ; 2019: 4934128, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31317031

RESUMEN

Introduction: With an increasing demand for orthodontic treatment for adult patients, orthodontic professionals are constantly seeking novel strategies and technologies that can accelerate tooth movement in order to shorten the treatment period. For instance, in recent years, the influences of different surgical techniques on orthodontic tooth movement in the ipsilateral side of surgery were intensively investigated. Here, we attempt to examine if corticotomy could also affect the rate of tooth movement in the contralateral side of the surgery by using a rodent model. Materials and Methods: 72 eight-week-old Sprague-Dawley rats were randomly divided into three groups as follows: the Control group (orthodontic treatment devices delivered only, no tooth movement), the orthodontic tooth movement (OTM) group (orthodontic treatment devices delivered and orthodontic treatment performed), and the Corticotomy + OTM group (remote corticotomy performed, orthodontic treatment devices delivered, followed by orthodontic treatment). The surgical procedure was conducted on the right side of the maxilla at the time of appliance placement and a force of 60 g was applied between the maxillary left first molar and maxillary incisors using nickel-titanium springs to stimulate OTM. The OTM distance and speed were tracked at 3, 7, 14, and 28 days post-surgery, followed by histological and immunohistochemical assessments. Results: In comparison with orthodontic treatment only, the contralateral corticotomy significantly accelerated OTM. Furthermore, animals undergoing corticotomy + OTM presented with a greater number of osteoclasts on the compression side, stronger staining of the osteogenic marker on the tension side, and higher expression of an inflammatory marker than the OTM group animals. Conclusion: Our current study demonstrates that remote corticotomy effectively accelerates alveolar bone remodeling and OTM. The study enriches our understanding of the regional acceleratory phenomenon (RAP) and offers an alternative strategy for accelerating OTM to shorten the orthodontic treatment period.


Asunto(s)
Remodelación Ósea/efectos de los fármacos , Resorción Ósea/cirugía , Incisivo/cirugía , Osteogénesis/efectos de los fármacos , Animales , Modelos Animales de Enfermedad , Humanos , Incisivo/crecimiento & desarrollo , Incisivo/patología , Maxilar/crecimiento & desarrollo , Maxilar/patología , Maxilar/cirugía , Diente Molar/crecimiento & desarrollo , Diente Molar/patología , Diente Molar/cirugía , Níquel/uso terapéutico , Alambres para Ortodoncia , Osteoclastos/metabolismo , Osteoclastos/patología , Ratas , Titanio/uso terapéutico , Técnicas de Movimiento Dental
11.
Surg Technol Int ; 34: 445-450, 2019 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-31037719

RESUMEN

Acetabular bone loss is common during revision total hip arthroplasty (THA). A new acetabular shell was developed with a goal of maintaining native hip center-of-rotation (COR) while achieving good fixation with standard instrumentation and technique. Previous radiographic studies have demonstrated the efficacy of this shell in lowering hip COR. In this case series, we demonstrate the use of this shell in patients undergoing difficult revision THAs. Based on these cases, we have presented how this offset COR acetabular shell may help bring down the hip COR in patients who undergo revision total hip arthroplasty with severe bone loss.


Asunto(s)
Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/instrumentación , Resorción Ósea/cirugía , Prótesis de Cadera , Artroplastia de Reemplazo de Cadera/métodos , Resorción Ósea/etiología , Humanos , Diseño de Prótesis , Falla de Prótesis , Reoperación , Estudios Retrospectivos , Rotación
12.
Am J Orthod Dentofacial Orthop ; 155(4): 560-571, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30935611

RESUMEN

INTRODUCTION: We report the successful treatment of a 38-year-old woman with bilateral idiopathic condylar resorption and anterior open bite. She had incompetent lips, a gummy smile, increased lower facial height, high mandibular plane angle, skeletal and dental Class II malocclusion with mild mandibular crowding, increased overjet, and mandibular midline deviation to the right. METHODS: The treatment plan included: (1) presurgical alignment and leveling of the teeth in both arches; (2) jaw motion tracking (JMT) to detect mandibular movement; (3) 3-piece maxillary osteotomies with mandibular reconstruction and bilateral coronoidectomies; and (4) postsurgical correction of the malocclusion. The orthodontic treatment was performed with the use of custom lingual braces and clear brackets and the orthognathic surgery was planned with the use of virtual surgical planning. RESULTS: The idiopathic condylar resorption and anterior open bite were treated, crowding was eliminated in the lower anterior segment, correction of skeletal and dental Class II malocclusion was obtained, mandibular plane angle was reduced, and facial profile improved. CONCLUSIONS: The results suggest that esthetic and functional results can be achieved with the cooperation of 2 specialties and with the use of state-of-the-art technology.


Asunto(s)
Resorción Ósea/cirugía , Mordida Abierta/cirugía , Aparatos Ortodóncicos Fijos , Trastornos de la Articulación Temporomandibular/cirugía , Adulto , Resorción Ósea/complicaciones , Resorción Ósea/diagnóstico por imagen , Resorción Ósea/terapia , Tomografía Computarizada de Haz Cónico , Femenino , Humanos , Imagenología Tridimensional , Mordida Abierta/complicaciones , Mordida Abierta/diagnóstico por imagen , Mordida Abierta/terapia , Aparatos Ortodóncicos , Ortodoncia Correctiva/instrumentación , Ortodoncia Correctiva/métodos , Trastornos de la Articulación Temporomandibular/complicaciones , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/terapia
13.
Acta Neurochir (Wien) ; 161(3): 483-491, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30617716

RESUMEN

BACKGROUND: Changes after reimplantation of the autologous bone have been largely described. However, the rate and the extent of resorption in cranial grafts have not been clearly defined. Aim of our study is to evaluate the bone flap resorption (BFR) after cryopreservation. METHODS: We retrospectively reviewed 27 patients, aged 18 years or older, subjected to cranioplasty (CP) adopting autologous cryopreserved flap. The BFR was derived from the percentage of decrease in flap volume (BFR%), comparing the first post-operative computed tomography (CT) and the last one available (performed at least 1 year after surgery). We also proposed a semiquantitative scoring system, based on CT, to define a clinically workable BFR classification. RESULTS: After a mean ± SE follow-up of 32.5 ± 2.4 months, the bone flap volume decreased significantly (p < 0.0001). The mean BFR% was 31.7 ± 3.8% and correlated with CT-score (p < 0.001). Three BFR classes were described: mild (14.8% of cases) consisting in minimal bone remodelling, CT-score ≤ 6, mean BFR% = 3.5 ± 0.7%; moderate (51.9% of cases) corresponding to satisfactory cerebral protection, CT-score < 13, mean BFR% = 25.6 ± 2.2%; severe (33.3% of cases) consisting in loss of cerebral protection, CT-score ≥ 13, mean BFR% = 54.2 ± 3.9%. Females had higher BFR% than males (p = 0.022). BFR classes and new reconstructive surgery were not related (p = 0.58). CONCLUSIONS: BFR was moderate or severe in 85.2% of re-implanted cryopreserved flaps. The proposed CT-score is an easy and reproducible tool to define resorption extent.


Asunto(s)
Resorción Ósea/diagnóstico por imagen , Craniectomía Descompresiva/efectos adversos , Complicaciones Posoperatorias/diagnóstico por imagen , Adolescente , Adulto , Anciano , Resorción Ósea/clasificación , Resorción Ósea/cirugía , Criopreservación , Craniectomía Descompresiva/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/clasificación , Complicaciones Posoperatorias/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Cráneo/cirugía , Colgajos Quirúrgicos/patología , Colgajos Quirúrgicos/cirugía , Tomografía Computarizada por Rayos X , Trasplante Autólogo
14.
J Biomed Mater Res B Appl Biomater ; 107(6): 2165-2177, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-30677220

RESUMEN

Human bone resorption surfaces can provide a template for endosseous implant surface design. We characterized the topography of such sites using four synergistic parameters (fractal dimension, lacunarity, porosity, and surface roughness) and compared the generated values with those obtained from two groups of candidate titanium implant surfaces. For the first group (n = 5/group): grit-blasted acid etched (BAE), BAE with either discrete calcium phosphate crystal deposition or nanotube formation, machined titanium with nanotubes, or a nanofiber surface; each measured synergistic parameter was statistically compared with that of the resorbed bone surface and scored for inclusion in a "best fit" analysis. The analysis informed changes that could be made to a candidate implant surface to render it a closer "best fit" to that of the resorbed bone surface. In a second group of either titanium or titanium alloy implants their micro-topography, created by dual acid etching, was the same for each material substrate; but their nanotopographic complexity was changed by varying the degree of calcium phosphate crystalline deposits. These implants were also used in vivo where bone anchorage was tested using a tensile disruption test; and the "best fit" of synergistic parameters coincided with the best biological outcome for both titanium and titanium alloy implants. In conclusion, the four chosen synergistic parameters can be used to guide the sub-micron surface design of candidate implants, and our "best fit" approach is capable of identifying the surfaces with the best biological outcomes. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 2165-2177, 2019.


Asunto(s)
Resorción Ósea , Fémur , Implantes Experimentales , Nanotubos , Oseointegración , Titanio , Animales , Resorción Ósea/metabolismo , Resorción Ósea/cirugía , Fémur/metabolismo , Fémur/cirugía , Humanos , Masculino , Ratones , Células RAW 264.7 , Ratas , Ratas Wistar , Propiedades de Superficie
15.
Cranio ; 37(2): 111-120, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29078737

RESUMEN

OBJECTIVE: To evaluate treatment outcomes for patients with TMJ adolescent internal condylar resorption (AICR) treated by a specific surgical protocol, including: (1) Removal of bilaminar tissue surrounding the condyle, (2) Articular disc repositioning with Mitek anchor technique, and (3) Concomitant orthognathic surgery. METHODS: This study evaluated 24 AICR patients treated by the specific surgical protocol with clinical subjective and objective examinations and lateral cephalogram assessments for surgical changes and long-term outcomes. RESULTS: Mean age at diagnosis was 16.5 years, and mean follow-up was 30.3 months. All 24 patients had significant reduction in TMJ pain, facial pain, and headaches, with improvement in jaw function, diet, and disability. Cephalometric analysis showed significant surgical changes but good long-term occlusal and skeletal stability. CONCLUSION: Patients with AICR treated with the specific surgical protocol demonstrated good skeletal and occlusal stability as well as improvement in TMJ pain, headaches, jaw function, diet, and disability.


Asunto(s)
Resorción Ósea/cirugía , Cóndilo Mandibular/cirugía , Procedimientos Quirúrgicos Ortognáticos/métodos , Disco de la Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/cirugía , Articulación Temporomandibular/cirugía , Adolescente , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
16.
Cranio ; 37(1): 35-44, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29125402

RESUMEN

BACKGROUND: Adolescent internal condylar resorption (AICR) is a temporomandibular joint (TMJ) pathology that develops predominately in teenage females during pubertal growth (onset between ages 11 and 15 years), with a distinct clinical, radiographic, and magnetic resonance imaging (MRI) presentation. Clinical and imaging presentation: The condition usually occurs bilaterally with: (1) Progressive retrusion of the mandible; (2) High occlusal plane angle facial morphology; (3) Worsening Class II occlusion; and (4) TMJ symptoms such as pain, headaches, noises, etc. MRI imaging demonstrates decreased condylar head size and anterior disc displacement. Treatment protocol: AICR can be successfully treated when the condyles and discs are salvageable with the following surgical protocol: (1) Removal of bilaminar tissue surrounding the condyle; (2) Reposition the disc with the Mitek anchor technique; and (3) Orthognathic surgery to advance the maxillo-mandibular complex in a counterclockwise direction. CONCLUSION: AICR can be successfully treated using the specific protocol presented herein to provide stable and predictable outcomes.


Asunto(s)
Resorción Ósea/cirugía , Cóndilo Mandibular/cirugía , Cirugía Ortognática/métodos , Disco de la Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/cirugía , Articulación Temporomandibular/cirugía , Adolescente , Resorción Ósea/diagnóstico , Resorción Ósea/etiología , Niño , Femenino , Humanos , Imagen por Resonancia Magnética , Radiografía Dental , Trastornos de la Articulación Temporomandibular/diagnóstico , Trastornos de la Articulación Temporomandibular/etiología
17.
J Shoulder Elbow Surg ; 28(1): e1-e9, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30201217

RESUMEN

BACKGROUND: Revision shoulder arthroplasty in the setting of glenoid bone loss poses substantial surgical challenges. This study's purpose was to compare radiographic and clinical results of patients requiring structural iliac crest bone autograft (ICBA) for severe bone loss versus patients with less severe bone loss treated with nonstructural bone allograft (NSBA) in the setting of revision reverse total shoulder arthroplasty (RSA). METHODS: A retrospective cohort of 30 patients (70% of the 43 patients who met the inclusion criteria) undergoing revision RSA with ICBA (n = 15) or NSBA (n = 15) between 2007 and 2015 were analyzed at a minimum 2-year follow-up. Radiographic assessment included bone graft integration, bone graft resorption, glenosphere tilt, glenosphere version, and the presence of scapular notching. Clinical assessment included active range of motion, Penn Shoulder Score, Veterans RAND 12-item health survey, and need for revision surgery. RESULTS: No radiographic difference was found between the ICBA and NSBA groups with regard to implant position, graft integration, scapular notching, implant shift, or failure of fixation (P > .05). Of 15 patients with ICBA, 14 (93%) had at least partial integration of the bone graft. Some degree of resorption of the bone graft was noted in 6 of 15 patients (40%). There was no significant difference in postoperative active range of motion, Penn Shoulder Score, or Veterans RAND 12-item health survey score (P > .05 for all comparisons). One patient in the ICBA group underwent revision surgery for glenoid baseplate failure. CONCLUSION: Revision RSA with glenoid bone grafting resulted in good clinical and radiographic outcomes at short-term follow-up. Patients requiring structural ICBA were not at increased risk of component failure, radiographic or clinical complications, or inferior clinical outcomes.


Asunto(s)
Artroplastía de Reemplazo de Hombro/métodos , Resorción Ósea/cirugía , Trasplante Óseo/métodos , Ilion/trasplante , Articulación del Hombro/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Rango del Movimiento Articular , Reoperación/métodos , Estudios Retrospectivos , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/fisiopatología , Trasplante Autólogo , Resultado del Tratamiento
18.
Int Orthop ; 43(1): 209-215, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30280216

RESUMEN

PURPOSE: Management of acute open tibial fractures with critical bone defect remains a challenge in trauma surgery. Few and heterogeneous cases have been reported about the treatment with the induced membrane technique. METHODS: We prospectively evaluated three patients treated with the induced membrane technique for acute Gustilo IIIB tibial fractures with critical bone defect. Success treatment was defined by bone union with patient pain free. Clinical and radiological evaluations were performed regularly until healing, then annually and with a minimum follow-up of five years. RESULTS: In all patients but one, a success was recorded, respectively, at four and six months. These two patients were pain free until the final follow-up, and no graft resorption or secondary complications related to the index surgery were observed. The third case was managed successfully with a bone transport technique. CONCLUSION: The induced membrane technique is an alternative good option for the treatment of these severe lesions.


Asunto(s)
Resorción Ósea/cirugía , Fijación de Fractura/métodos , Fracturas Abiertas/cirugía , Tibia/cirugía , Fracturas de la Tibia/cirugía , Enfermedad Aguda , Adulto , Antibacterianos/uso terapéutico , Resorción Ósea/etiología , Trasplante Óseo/métodos , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas/métodos , Fracturas Abiertas/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Colgajos Quirúrgicos/irrigación sanguínea , Tibia/patología , Fracturas de la Tibia/complicaciones , Resultado del Tratamiento
19.
Int Orthop ; 43(10): 2269-2278, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-30539219

RESUMEN

PURPOSE: Acetabular revision of failed total hip arthroplasty (THA) is often associated with severe bone loss. Therefore, a variety of revision implant systems has been developed during recent years, with the augment-and-modular-cage system being one of the newest additions to this portfolio. Together with biologic downsizing by means of impaction bone grafting, this uncemented system promises a high modularity and versatility to treat all acetabular defects up to Paprosky types IIIa and IIIb without pelvic discontinuity. The aim of the present study was to evaluate first short-term results of its clinical application, both clinical functional and patient-reported as well as radiographic. METHODS: Forty-four patients (28 female, 16 male, mean age 70.9 ± 11.5 years) could be followed for a mean of 26 ± 10 months after acetabular revision with a novel augment-and-modular-cage system. Indications for revision included aseptic loosening (68%), septic loosening (16%), or others (16%) with bone loss Paprosky IIa up to IIIb without discontinuity. The modified Harris Hip Score (mHHS) served as a primary outcome parameter. In addition, a number of patient-reported outcome measurements (PROMs) were collected including the Short Form 36 (SF-36), Hip disability and Osteoarthritis Outcome Score (HOOS), and Visual Analogue Scale for Hip Pain (VAS Hip) as well as overall satisfaction. Radiographic changes between the pre- and postoperative center of rotation (COR) and various criteria of implant failure served as secondary outcome parameters. RESULTS: No patients were lost to follow-up. Two implant-associated complications (partial flange breakage) without a need for revision surgery were detected, which represent a failure rate of 4.5%. Functional outcome as measured by mHHS increased from 49.4 ± 2.9 pre-operatively to 74.4 ± 3.1 at the latest follow-up (p < 0.001). PROMs showed significant improvements in all pain-related categories, while other quality-of-life measurements only exhibited positive tendencies towards improvement. VAS Hip significantly improved from 6.5 ± 0.7 pre-operatively to 2.2 ± 0.6 at the latest follow-up (p < 0.001). Radiographic evaluation showed that reconstruction of the COR was possible, referenced to the contralateral side. The COR could be lateralized by 5.0 mm (n.s.) and caudalized by 10.3 mm (p < 0.001) comparing pre-operative and post-operative states, with complete osseointegration in 95% of the cases. CONCLUSIONS: Treatment with the augment-and-modular-cage system significantly improved clinical functional and patient-reported outcomes in cases of acetabular revision after failed THA. In addition, a good reconstruction of the COR could also be achieved. Therefore, this highly modular system can be considered as an effective treatment option in almost all cases of acetabular bone loss except for those of pelvic discontinuity. It offers the unique possibility of intra-operative implant customization according to the existing bone defect and host bone quality.


Asunto(s)
Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/instrumentación , Resorción Ósea/cirugía , Trasplante Óseo , Prótesis de Cadera , Acetábulo/diagnóstico por imagen , Acetábulo/patología , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/métodos , Resorción Ósea/diagnóstico por imagen , Trasplante Óseo/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oseointegración , Medición de Resultados Informados por el Paciente , Recuperación de la Función , Reoperación , Resultado del Tratamiento
20.
Int Orthop ; 43(9): 2131-2139, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-30506090

RESUMEN

BACKGROUND: Severe glenoid bone loss remains a surgical challenge. This condition is known to be associated with high rates of glenoid component failure. PURPOSE: The objective of this study was to evaluate clinical and radiological outcomes of a lateralized metal-backed 15.2-mm keeled baseplate prolonged by a thin 24.8-mm metallic post fixed directly in the subscapularis fossa in primary cases of reverse shoulder arthroplasty (RSA) for severe glenoid bone loss and in revision cases. MATERIALS AND METHODS: Between January 2011 and December 2014, 51 shoulders (50 patients) underwent primary or revision RSA using this baseplate. Forty-five shoulders in 44 patients were followed for a minimum of two years (mean, 33 months; range, 24-60 months). The mean age of the patients was 76 years (range, 55-93 years). Outcome measures included pain, range of motion, Constant Score, and complications. RESULTS: The complication rate was 12% in primary cases and 25% in revision cases. One glenoid implant (4%) failed in primary cases and one glenoid implant (5%) failed in revision cases. Pain and range of motion were significantly improved in both groups. The mean Constant Score improved from 24 (± 7) to 62 (± 9) in primary cases and from 24 (± 10) to 58 (± 12) in revision cases. CONCLUSION: A lateralized metal-backed 15.2-mm keeled baseplate prolonged by a thin 24.8-mm metallic post fixed directly in the subscapularis fossa may provide satisfactory mid-term outcomes in patients with large glenoid bone defects where initial press-fit of a regular baseplate is impossible to obtain.


Asunto(s)
Artroplastía de Reemplazo de Hombro/instrumentación , Placas Óseas , Resorción Ósea/cirugía , Artropatías/cirugía , Escápula/cirugía , Articulación del Hombro/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X
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