A Novel Zinc-Containing Palatal Stent and Topical Oxygen Therapy for Wound Protection and Healing Following Mucoperiosteal Flap Surgery in the Hard Palate: A Case Report.

In oral surgery, common surgical procedures such as the removal of impacted teeth, the treatment of intraosseous cysts and tumors, and endodontic surgery often require access through a palatal approach. Full-thickness flap surgery in the hard palate region can result in significant post-operative pain, swelling, and hematoma, adversely affecting the patient's function and well-being for several days. Moreover, post-operative infection can delay or compromise healing. Post-surgical traditional palatal stents have been shown to effectively reduce discomfort by minimizing swelling and pain during the early healing phases. Recent advances in materials with the incorporation of bioactive agents have led to the fabrication of a new generation of wound dressings that provide improved conditions for effective wound protection and healing. This case report illustrates the use of a novel, zinc-embedded, thermoplastic surgical polymer for the chairside fabrication of post-operative palatal stents. A 33-year-old female patient, who underwent mucoperiosteal flap surgery for the management of a nasopalatine duct cyst, was provided immediately post-surgery with a customized zinc-containing palatal stent. The bone defect was grafted using a fully resorbable synthetic bone substitute, and an oxygen and lactoferrin-releasing oral gel was provided post-operatively as an adjunct therapy. The innovative stent helped the patient maintain low levels of pain and minimal swelling during the initial post-operative period, resulting in uneventful healing, as documented during the one-week follow-up appointment. Further reviews at four weeks and six months post-surgery revealed successful healing and sensory recovery in the anterior palatal region. As emphasized in this report, the chairside fabrication of zinc-containing palatal stents for post-operative wound protection seems to constitute a valid, simple, time-saving, and cost-effective clinical solution. Moreover, the incorporation of zinc nanoparticles into the stent is of great clinical importance, potentially offering significant benefits in post-operative bacterial control and enhancement of the early-phase palatal soft-tissue healing.

An innovative intramedullary bone graft harvesting concept as a fundamental component of scaffold-guided bone regeneration: A preclinical in vivo validation.

Background: The deployment of bone grafts (BGs) is critical to the success of scaffold-guided bone regeneration (SGBR) of large bone defects. It is thus critical to provide harvesting devices that maximize osteogenic capacity of the autograft while also minimizing graft damage during collection. As an alternative to the Reamer-Irrigator-Aspirator 2 (RIA 2) system - the gold standard for large-volume graft harvesting used in orthopaedic clinics today - a novel intramedullary BG harvesting concept has been preclinically introduced and referred to as the ARA (aspirator + reaming-aspiration) concept. The ARA concept uses aspiration of the intramedullary content, followed by medullary reaming-aspiration of the endosteal bone. This concept allows greater customization of BG harvesting conditions vis-à-vis the RIA 2 system. Following its successful in vitro validation, we hypothesized that an ARA concept-collected BG would have comparable in vivo osteogenic capacity compared to the RIA 2 system-collected BG. Methods: We used 3D-printed, medical-grade polycaprolactone-hydroxyapatite (mPCL-HA, wt 96 %:4 %) scaffolds with a Voronoi design, loaded with or without different sheep-harvested BGs and tested them in an ectopic bone formation rat model for up to 8 weeks. Results: Active bone regeneration was observed throughout the scaffold-BG constructs, particularly on the surface of the bone chips with endochondral bone formation, and highly vascularized tissue formed within the fully interconnected pore architecture. There were no differences between the BGs derived from the RIA 2 system and the ARA concept in new bone volume formation and in compression tests (Young's modulus, p = 0.74; yield strength, p = 0.50). These results highlight that the osteogenic capacities of the mPCL-HA Voronoi scaffold loaded with BGs from the ARA concept and the RIA 2 system are equivalent. Conclusion: In conclusion, the ARA concept offers a promising alternative to the RIA 2 system for harvesting BGs to be clinically integrated into SGBR strategies. The translational potential of this article: Our results show that biodegradable composite scaffolds loaded with BGs from the novel intramedullary harvesting concept and the RIA 2 system have equivalent osteogenic capacity. Thus, the innovative, highly intuitive intramedullary harvesting concept offers a promising alternative to the RIA 2 system for harvesting bone grafts, which are an important component for the routine translation of SGBR concepts into clinical practice.

Engineering a 3-dimensional tissue construct with adipose-derived stem cells for healing bone defect: An ex vivo study with femur head.

The compatibility of bone graft substitutes (BGS) with mesenchymal stem cells (MSCs) is an important parameter to consider for their use in repairing bone defects as it eventually affects the clinical outcome. In the present study, a few commercially available BGS - ß-tricalcium phosphate (ß-TCP), calcium sulfate, gelatin sponge, and different forms of hydroxyapatite (HAP) were screened for their interactions with MSCs from adipose tissue (ADSCs). It was demonstrated that HAP block favorably supported ADSC viability, morphology, migration, and differentiation compared to other scaffolds. The results strongly suggest the importance of preclinical evaluation of bone scaffolds for their cellular compatibility. Furthermore, the bone regenerative potential of HAP block with ADSCs was evaluated in an ex vivo bone defect model developed using patient derived trabecular bone explants. The explants were cultured for 45 days in vitro and bone formation was assessed by expression of osteogenic genes, ALP secretion, and high resolution computed tomography. Our findings confirmed active bone repair process in ex vivo settings. Addition of ADSCs significantly accelerated the repair process and improved bone microarchitecture. This ex vivo bone defect model can emerge as a viable alternative to animal experimentation and also as a potent tool to evaluate patient specific bone therapeutics under controlled conditions.

Custom fabricated three-dimensional printed surgical guide for trephine bur in autogenous bone graft: A technique report.

This technique presents a workflow that designs the custom surgical guide to cover a trephine bur using simple slicer software and three-dimensional (3D) printing to perform the semilunar technique. This method in autogenous bone grafting surgery harvests a thin layer of cortical bone in the donor site with a trephine bur. Its biologically favorable, round shape can be used as a shell to reconstruct the ridge with a 3D contour acceptable for future implant placement. A 78-year-old female patient required vertical and horizontal bone grafting for future implant placement due to the infection caused by the vertically fractured root of a premolar. The patient's cone beam computed tomography (CBCT) file was translated into a standard tessellation language (STL) file, and recipient and donor site models were created. Simulated surgery was done using the software first to detect any possible complications during surgery. The trephine bur planned for use in surgery was measured in necessary dimensions, and the values were added to create a guide for surgery in slicer software. Then, it was 3D-printed with a stereolithography (SLA) printer. After testing the fit of the guide, it was further tested on a fused filament fabrication (FFF) printed donor site model to check if the desired shape and size of the plate were acquired after harvest. Then, the plates were used for model surgery on the recipient site model. After no issues from the previous steps, the final patient surgery was approved and completed with success. This technique utilizes the SLA printing method to create the custom surgical guide for a trephine bur without using commercially available products. Moreover, it could be tested on FFF 3D-printed anatomical models to ensure its validity. With this innovative technique, clinicians can efficiently perform a semilunar technique, facilitating the surgery and improving patient care.

Ginger extract loaded Fe2O3/MgO-doped hydroxyapatite: Evaluation of biological properties for bone-tissue engineering.

Since antiquity, the medicinal properties of naturally sourced biomolecules such as ginger (Zingiber officinale) extract are documented in the traditional Indian and Chinese medical systems. However, limited work is performed to assess the potential of ginger extracts for bone-tissue engineering. Our work demonstrates the direct incorporation of ginger extract on iron oxide-magnesium oxide (Fe2O3 and MgO) co-doped hydroxyapatite (HA) for enhancement in the biological properties. The addition of Fe2O3 and MgO co-doping system and ginger extract with HA increases the osteoblast viability up to ~ 1.4 times at day 11. The presence of ginger extract leads to up to ~ 9 times MG-63 cell viability reduction. The co-doping does not adversely affect the release of ginger extract from the graft surface in the biological medium at pH 7.4 for up to 28 days. Assessment of antibacterial efficacy according to the modified ISO 22196: 2011 standard method indicates that the combined effects of Fe2O3, MgO, and ginger extract lead to ~ 82 % more bacterial cell reduction, compared to the control HA against S. aureus. These ginger extract-loaded artificial bone grafts with enhanced biological properties may be utilized as a localized site-specific delivery vehicle for various bone tissue engineering applications.

Development and verification of a novel bone collector with automatic size separating function for orthopedics surgery.

BACKGROUND: Autologous bone dust can be filled in bone defects to promote effective bone healing but typically it is lost when using suction during surgery. The aim of this study was to develop a novel bone collector that can be used to collect bone chips/dust of varying sizes without changing current surgical procedures. RESEARCH DESIGN AND METHODS: This collector was designed to connect to a surgical continuous suction system and comprised a plate filter with a 3 mm hole and featured a taper filter with a mesh size of 0.27 mm for the separation and collection of both coarse and fine bone chips/dust. The bone collector was manufactured using nylon 3D printing and plastic injection with biocompatible materials. RESULTS: The bone collector functional test revealed high bone chip collection efficiency (93%) with automatic size separation function. Low (3.42%) filtration errors showed that most of the water can be drained smoothly from the bone collector. In clinical usability testing, bone collectors can provide functions demonstrated in in vivo spinal fusion and femoral fracture surgeries with different bone grafting size requirements. CONCLUSIONS: The novel bone collector has been validated as a viable and effective surgical device, offering surgeons an additional option to enhance patient outcomes.

The Osteogenic Peptide P-15 for Bone Regeneration: A Narrative Review of the Evidence for a Mechanism of Action.

Bone regeneration is a complex multicellular process involving the recruitment and attachment of osteoprogenitors and their subsequent differentiation into osteoblasts that deposit extracellular matrixes. There is a growing demand for synthetic bone graft materials that can be used to augment these processes to enhance the healing of bone defects resulting from trauma, disease or surgery. P-15 is a small synthetic peptide that is identical in sequence to the cell-binding domain of type I collagen and has been extensively demonstrated in vitro and in vivo to enhance the adhesion, differentiation and proliferation of stem cells involved in bone formation. These events can be categorized into three phases: attachment, activation and amplification. This narrative review summarizes the large body of preclinical research on P-15 in terms of these phases to describe the mechanism of action by which P-15 improves bone formation. Knowledge of this mechanism of action will help to inform the use of P-15 in clinical practice as well as the development of methods of delivering P-15 that optimize clinical outcomes.

Retrospective Study of Maxillary Sinus Augmentation Using Demineralized Tooth Block Bone for Dental Implant.

(1) Background: When placing implants in the maxillary posterior region with insufficient alveolar bone, a maxillary sinus elevation is necessary. Autogenous bone, though biologically ideal, poses risks and discomfort due to donor site harvesting. Block-type autogenous tooth bone graft material, made from the patient's own extracted tooth, offers similar biological stability without these drawbacks. (2) Methods: This study observed the progress of 19 implant patients who were treated with maxillary sinus elevation procedures using block-type autogenous tooth bone graft material at the Daegu Catholic University Medical Center. Extracted teeth were processed into demineralized tooth block bone. After elevating the sinus membrane, implants and the tooth bone graft material were placed in the space, and the bony window was repositioned. Postoperative evaluations through clinical observation and radiographic imaging assessed sinus membrane elevation, alveolar bone height increase, and implant osseointegration. (3) Results: Results showed proportional increases in alveolar bone height to the graft material size, with long-term stability. No postoperative complications occurred, even with sinus membrane perforation, and implants remained stable. (4) Conclusions: The study concludes that maxillary sinus lifts using block-type autogenous tooth bone graft material provide excellent bone induction and biocompatibility, making this a highly beneficial method for both dentists and patients.

Comparison of the efficacy of fat, cartilage, and bone grafts in traumatic and asymmetric noses.

BACKGROUND: Correction of asymmetry and irregularity deformities with autologous grafts, without osteotomies, offers advantages to both plastic surgeons and patients with severe deviation. Various autologous tissues such as fat, bone, and cartilage grafts are viable options for this purpose. OBJECTIVES: This study aimed to compare the efficacy of 3 autologous filling materials in patients with bone asymmetry. METHODS: A retrospective evaluation was conducted on 297 patients seeking aesthetic nose surgery between 2015 and 2022. Only primary patients without prior surgery and those with bone asymmetry from trauma, with dorsum protrusion <3 mm, and without osteotomy were included. Patients were divided into fat, cartilage, and bone groups. Grafts were applied to the concave side during closed rhinoplasty, and evaluations were done 12 months after surgery by blinded plastic surgeons and patients using established assessment tools. RESULTS: Fat, cartilage, and bone grafts were utilized in 74, 127, and 96 patients, respectively, with a mean follow-up of 19 months. The mean graft volumes were 1.0 cc (bone), 1.3 cc (cartilage), and 1.6 cc (fat). The patient self-assessment scores were 75%, 84.9%, and 86.6%, respectively. The Asher-McDade averages were 77.2%, 86.7%, and 88.4%, respectively. Cartilage and bone graft results were statistically similar in patients' self-evaluation and significantly higher than those of fat grafts. Blinded assessments showed no significant difference between the cartilage and bone groups. CONCLUSION: Placing autologous grafts on the concave side for patients with minimal nasal bone protrusion (<3 mm) yields successful results. Cartilage grafts offer advantages in volume, result estimation, and preparation time, making them suitable for larger patient cohorts.

Outcomes of Autologous and Synthetic Bone Grafts in Locking Plate Fixation of Comminuted Distal Radius Fractures.

Background The introduction of locking plate technology has improved the feasibility of distal radius fracture fixation without the need for bone grafting, yet challenges persist in cases of severely comminuted fractures and small, unstable intra-articular fragments. This study aimed to assess the outcomes of bone grafting in severely comminuted distal radius fractures treated with locking plates. Methods We performed a retrospective analysis involving 450 patients who underwent distal radius fracture fixations. We evaluated wrist motion, grip strength, and radiographic parameters, including radial inclination, radial tilt, ulnar variance, articular step, and fracture union at standardized intervals. In addition, at the 12- and 24-month marks, we assessed the disabilities of the arm, shoulder, and hand (DASH) questionnaire score. Results Out of the 450 patients who underwent distal radius fracture fixation using volar locking plate systems, 59 individuals (13%) required either autologous bone graft (n = 24) or synthetic bone substitutes (n = 35). In the final follow-up, all fractures had successfully united, displaying an average volar tilt of 4°, radial inclination of 18.8°, and an articular step or gap of 0.1 mm. Conclusion There was no significant difference between the use of autologous or synthetic bone grafts on clinical or radiological outcomes in the long term. Bone grafts are useful in severe metaphyseal comminution and aid in the reduction of articular fragments and bi-cortical comminution.

Experimental Study on Rats with Critical-Size Bone Defects Comparing Effects of Autologous Bone Graft, Equine Bone Substitute Bio-Gen® Alone or in Association with Platelet-Rich Fibrin (PRF).

BACKGROUND: A critical-sized bone defect (CsBD) is considered one that will not heal spontaneously and requires reconstruction. This study aims to compare the results of using different bone reconstructive techniques and to study the potential of platelet-rich fibrin (PRF) to enhance the healing properties of a bone substitute (BS). METHODS: In this experimental study on rats, the treatment of critical-sized bone defects was carried out by analysing four groups: a control group in which the bone defect was left empty; a group treated with Bio-Gen®; another group in which the defect was treated with PRF in combination with Bio-Gen®; and the last that was treated with autologous bone graft (ABG). The defects were evaluated by microcomputed tomography (µCT) and then histomorphometrically. RESULTS: From both the histological and imagistic point of view, the best results were registered in the ABG group, followed by the group treated with Bio-Gen® with PRF, Bio-Gen® group, and control group, with statistically significant differences. CONCLUSIONS: A 5 mm defect in the rat radius can be considered critical. ABG showed the best results in treating the bone defect. PRF significantly enhanced the efficacy of Bio-Gen®.

Scaphoid Fractures Requiring Bone Graft: Does Graft Source Matter?

Background: Treatment of scaphoid fractures often requires bone grafting. In such cases, bone graft is traditionally harvested from the iliac crest, but utilizing the distal radius carries less morbidity and is becoming more popular. The purpose of this study is to compare the outcomes of treatment of scaphoid waist fractures with the use of distal radius and iliac crest bone grafts. Methods: A retrospective chart review of patients undergoing repair of a scaphoid waist fracture with bone graft at our institution between 2010 and 2020 was completed. Bone graft was used in patients with nonunion, humpback deformity, or for correction of scaphoid alignment. The primary outcome was rate of union as determined by postoperative X-ray or computed tomography scan. Fisher exact tests, Student t tests, and Mann-Whitney U tests were used as appropriate. Results: Thirty-nine patients were included in the study. Twenty-nine patients were treated with distal radius bone graft, and 10 were treated with an iliac crest graft. There was no statistical difference in union rate between the distal radius and iliac crest cohorts (97% vs 80%, P = .16). There was no significant difference for complication rates, rate of unplanned secondary surgery, time to union, postoperative scapholunate angle, or duration of immobilization. Conclusions: In the fixation of scaphoid waist fractures with bone graft, there is no significant difference in union rate between distal radius and iliac crest grafts. With the well-documented morbidity associated with iliac crest grafts, surgeons should consider using distal radius grafts instead of iliac crest grafts.

An anatomical feasibility study using the first metatarsal head as a vascularized bone graft for proximal pole of scaphoid reconstruction.

A cadaveric study showed that vascularized transfer of the articular surface of the ipsilateral first metatarsal head with the lateral collateral ligament could be suitable for reconstruction of the proximal pole of scaphoid and scapholunate ligament. Further study of the technique is recommended.

Dentin-derived alveolar bone graft for alveolar augmentation: A systematic review.

Introduction: Application of alveolar bone graft (ABG) in alveolar augmentation is done to prevent excessive bone resorption due to tooth extraction, missing teeth, or other diseases/conditions affecting the alveolar bone. The use of autogenous dentin-derived ABG has been considered as the composition of dentin appears to be nearly analogous to that of bone. Objective: This systematic review aims to assess the efficacy of dentin-derived ABG for alveolar augmentation of post-extraction sockets or other alveolar bone defects by evaluating volume gain and histomorphometric data. Material and methods: A search of systematic literature was conducted in Pubmed, Scopus, Web of Science, and Embase from database inception to October 2023. The review included both randomized controlled trials (RCT), pilot studies, clinical trials, and retrospective studies reporting on dentin-derived ABG use for alveolar augmentation. Results: Overall, 298 articles were obtained from the initial search. From these articles, 21 articles met the inclusion criteria and were included for descriptive analysis. All of the studies indicated low risk of bias. Studies of dentin-derived ABG, which used bone-derived grafts as the control group, have shown significantly higher percentages of new bone formation, gain in vertical and horizontal dimensions, and less reduction in dimensions. Conclusions: Dentin-derived ABG was effective in volume maintenance, indicating promising results via histomorphometric and radiographic analysis.

Comparison of SHD-IBG and PVIBGT in ONFH including mechanical and pathological analysis of failure cases.

Currently, there is a lack of relevant research on the efficacy difference between SHD combined with IBG and PVIBGT in the treatment of osteonecrosis of the femoral head(ONFH). Firstly, this study intends to compare the effectiveness of surgical hip dislocation combined with impacting bone grafts (SHD-IBG) and pedicled vascularised iliac bone graft transfer (PVIBGT) in treating ONFH. And the study investigates patients who suffered from hip preservation failures from both groups to better comprehend failure reasons. 30 patients (34 hips) with ARCO stage IIIA femoral head necrosis were selected between January 2012 and July 2022. They were divided into group A(SHD-IBG) and group B (PVIBGT) according to different surgical methods. Firstly, compared the 1-year effect between SHD-IBG and PVIBGT at 1 year postoperatively; Secondly, assessed the medium and long-term efficacy of SHD-IBG hip preservation treatment; Lastly, based on study of the femoral head removed from patients with hip preservation failure in the two groups, the reasons for the failure of hip preservation were comprehensively analyzed in the two groups. Group A: 11 males (13 hips), 4 females (4 hips);Group B: 9 males (11 hips), 6 females (6 hips).Firstly, the average Harris scores of the two groups at 1 year after surgery: preoperative: 70.7, 1 year after surgery: 78.9 in group A; preoperative: 69.5, 1 year after surgery: 81.5 in group B. The differences were statistically significant (P < 0.05).Compared to the preoperative period, quantitative analysis by DCE-MRI showed an increase in perfusion in the necroticarea and an improvement in hyperperfusion in the repair-responsive area one year after the surgery. Secondly, in group A, the hip preservation rate was 88.2% at 2.5-11 (average of 77 months) years of follow-up, and the mean Harris score at the last follow-up was 73.2.Semi-quantitative analysis of postoperative DCE-MRI showed that the perfusion curves of necrotic and repaired areas were similar to those of the normal area. This suggests the instability within the femoral head had been effectively improved, and the perfusion had partially recovered. Thirdly, according to Micro-CT and pathologica studies of patients with hip preservation failure in these two groups, all these patients' femoral head was significantly collapsed and deformed. Their trabeculae was thin and partially disorganized, with fractures in the subchondral bone and separation of the cartilage from the subchondral bone. The necrotic areas had sparse trabeculae, disorganized arrangement, loss of continuity, and disappearance of cells in the trabecular traps. The necrotic area was covered with fibrous tissue, and partial restoration was observed in the repair area. Mechanical finite element analysis showed that the maximum equivalent force was observed in the weight- bearing area and the cortical bone surrounding the shaft of femurand. The result of DCE-MRI showed that the repair reaction area exhibited abnormal hyperperfusion. In this study, the efficacy of SHD-IBG and PVIBGT was compared at 1 year after operation, and the long-term follow-up of SHD-IBG was 2.5-11 (mean 77 months) years, combined with DCE-MRI results, we found that the short-term effect of PVIBGT was more significant than that of SHD-IBG. SHD-IBG can achieve satisfactory hip preservation in the medium and long term follow-up.

Novel artificial tricalcium phosphate and magnesium composite graft facilitates angiogenesis in bone healing.

BACKGROUND: Bone grafting is the standard treatment for critical bone defects, but autologous grafts have limitations like donor site morbidity and limited availability, while commercial artificial grafts may have poor integration with surrounding bone tissue, leading to delayed healing. Magnesium deficiency negatively impacts angiogenesis and bone repair. Therefore, incorporating magnesium into a synthetic biomaterial could provide an excellent bone substitute. This study aims to evaluate the morphological, mechanical, and biological properties of a calcium phosphate cement (CPC) sponge composed of tetracalcium phosphate (TTCP) and monocalcium phosphate monohydrate (MCPM), which could serve as an excellent bone substitute by incorporating magnesium. METHODS: This study aims to develop biomedical materials composed mainly of TTCP and MCPM powder, magnesium powder, and collagen. The materials were prepared using a wet-stirred mill and freeze-dryer methods. The particle size, composition, and microstructure of the materials were investigated. Finally, the biological properties of these materials, including 3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyltetrazolium bromide (MTT) assay for biocompatibility, effects on bone cell differentiation by alkaline phosphatase (ALP) activity assay and tartrate-resistant acid phosphatase (TRAP) activity assay, and endothelial cell tube formation assay for angiogenesis, were evaluated as well. RESULTS: The data showed that the sub-micron CPC powder, composed of TTCP/MCPM in a 3.5:1 ratio, had a setting time shorter than 15 minutes and a compressive strength of 4.39±0.96 MPa. This reveals that the sub-micron CPC powder had an adequate setting time and mechanical strength. We found that the sub-micron CPC sponge containing magnesium had better biocompatibility, including increased proliferation and osteogenic induction effects without cytotoxicity. The CPC sponge containing magnesium also promoted angiogenesis. CONCLUSION: In summary, we introduced a novel CPC sponge, which had a similar property to human bone promoted the biological functions of bone cells, and could serve as a promising material used in bone regeneration for critical bone defects.

Stackable Guide and Immediate Full Arch Loading: A Retrospective Cohort Study of 43 Edentulous Arches-The STAGE Study.

PURPOSE: As the population gets older, the prevalence of complete or partial tooth loss is increasing, significantly impacting people's quality of life. Scientific research demonstrates that implant-fixed complete dentures offer high levels of satisfaction. In certain cases, tooth loss can lead to significant bone atrophy, necessitating pre-implant bone reconstruction. We conducted a retrospective cohort study involving 43 arches, including or not bone grafts, rehabilitated using a stackable guided approach, which included an immediate loading protocol. The primary outcome measure was the survival rate of the implant at 4 months. MATERIAL AND METHODS: The digital workflow helps the design of the provisional prothesis before the implant surgery, which will be loaded immediately after the implant's placement. The stacked guides integrate both surgical and prosthetic considerations into a digital workflow. RESULT: A total of 284 implants were placed. After a 4-month follow-up period, 10 implants (3.5%) exhibited no osseointegration and were subsequently replaced, resulting in an overall success rate of 96.5%. After 1 year of follow-up, a prosthetic success rate of 100% was observed, with all patients being able to progress to the stages for the permanent fixed dentures. CONCLUSION: Our findings support the use of this protocol for all patients, whether they require bone grafts or not. However, a long-term follow-up is essential for a comprehensive evaluation of these treatment outcomes.

Periodontal Phenotype Modification of Peri-Implant Soft Tissue Deficiency Using Subepithelial Connective Tissue Grafts and Bone Grafts in the Esthetic Region.

Peri-implant soft tissue deficiency (PSTD) is a significant factor impacting aesthetics, particularly in the anterior zone, where labial bone resorption and thin peri-implant phenotypes are common. The occurrence of a gray color around the implant fixture due to PSTD can be aesthetically concerning in the esthetic zone. In cases involving natural teeth, autogenous soft tissue grafts such as subepithelial connective tissue grafts (SCTGs), free gingival grafts (FGGs), and coronally advanced flaps (CAFs) are commonly utilized. However, there are limited reports of using bone grafts in conjunction with these techniques for modifying the gingival phenotype around both teeth and implants. In the presented cases where PSTD resulted in visible gray coloration of the implant fixture in the esthetic zone, mechanical and chemical decontamination of the exposed implant surface was performed using a titanium brush and tetracycline (Tc) HCl. Subsequently, to enhance peri-implant mucosa thickness and mask the titanium color, simultaneous SCTG and bone grafting procedures were conducted. Within the limitations of these case reports, successful esthetic outcomes were achieved and maintained without recurrence for 3-6 years following the simultaneous subepithelial connective tissue graft and bone graft procedures. These findings suggest the potential efficacy of this combined approach in addressing PSTD and enhancing aesthetic results around dental implants, though further studies are needed to validate these outcomes.

Minimally invasive treatment of benign osteolytic bone lesions with a Hartmann ear speculum: A surgical technique.

This study introduces a novel and simple minimally invasive technique for treating benign osteolytic bone lesions. The standard treatment involves lesion removal and cavity filling with various materials. Minimally invasive approaches, including arthroscopy and CT-guided injection, have been described, but they pose challenges such as X-ray exposure and expansiveness. In this study, a new minimally invasive technique using a Hartmann ear speculum is presented. The technique was successfully applied in 10 patients with various benign tumors, demonstrating full healing and no recurrence at one-year follow-up. The presented approach combines simplicity, cost-effectiveness, and minimal invasiveness, making it a promising alternative option for treating benign bone lesions with low complication rates and surgical site morbidity. LEVEL OF EVIDENCE: IV.

The effect of a barrier membrane on the incorporation of deproteinized bovine bone mineral (DBBM) in experimental defects at the time of early implant placement. A preclinical study.

OBJECTIVES: This study aimed to assess membrane use with a bone substitute graft for guided bone regeneration (GBR) in experimental dehiscence defects. MATERIALS AND METHODS: Maxillary second incisors (I2) in 9 dogs were extracted. Six weeks later, implants were inserted and experimental dehiscence defects (5 × 3 mm) created on the buccal aspect. The defects and surrounding bone were grafted with deproteinized bovine bone mineral. One side (test) was covered with a resorbable collagen membrane whereas the contralateral side (control) was not. After 6 weeks, histomorphometrical analysis was performed to evaluate: (a) first bone-to-implant contact (fBIC), (b) buccal bone thickness at 1 mm increments from implant shoulder, (c) regenerated area (RA), (d) area and percentages of new bone (B), bone substitute (BS) and mineralized tissue (MT). RESULTS: The histological appearance was similar between test and control sites. At central and lateral sections, there were no differences between groups for fBIC, buccal bone thickness, RA, BS, B, %B, MT and %MT. At central sections, membrane use favoured more %BS and %MT (p = 0.052). There was significantly more B, %B and MT at lateral compared to central sections. CONCLUSIONS: Membrane use tended to retain more bone substitute, but had no effect on new bone ingrowth. Lateral sections showed significantly more bone ingrowth and mineralized tissue compared to central sections, confirming that new bone ingrowth takes place mainly from the lateral walls of the defect. CLINICAL RELEVANCE: Preclinical research to clarify the dynamics of bone regeneration in GBR procedures is relevant in clinical practice.