[Translated article] Mechanical properties variations of immature bone in the earliest stages of development. / [Artículo traducido] Variación de las propiedades mecánicas del hueso inmaduro en las etapas más tempranas del desarrollo.

Introduction Bone as a material varies its composition and mechanical properties throughout life. Although these variations are better understood in adulthood, there is little experimental information on the variation of these properties in early stages of development. The objective of this study is to analyze the mechanical behavior and chemical properties of cortical bone tissue from two animal species in these earliest stages. Material and methodology Twenty specimens of cortical bone were manufactured from bovine and ovine species that were in different stages of development (feeding exclusively on breast milk, in the transition period to feed or pasture, and young animals but on a solid food diet). The specimens were subjected to tensile tests, recorded with a high-speed camera to obtain deformation maps. Measurements of the tensile force until the specimen broke were also carried out. A fractographic study was carried out with a scanning electron microscope to analyze the fracture surface and an analysis of the amount of calcium in each of the specimens using X-ray dispersion spectroscopy. Results A statistically significant and positive correlation was found between the elastic modulus of the specimens and their calcium content. A trend towards more rigid behavior with age was observed. Conclusions Young bone tissue tends to stiffen with age as the calcium content increases with an increase in elastic modulus.

Mechanical properties variations of immature bone in the earliest stages of development. / Variación de las propiedades mecánicas del hueso inmaduro en las etapas más tempranas del desarrollo.

INTRODUCTION: Bone as a material varies its composition and mechanical properties throughout life. Although these variations are better understood in adulthood, there is little experimental information on the variation of these properties in early stages of development. The objective of this study is to analyze the mechanical behavior and chemical properties of cortical bone tissue from two animal species in these earliest stages. MATERIAL AND METHODOLOGY: Twenty specimens of cortical bone were manufactured from bovine and ovine species that were in different stages of development (feeding exclusively on breast milk, in the transition period to feed or pasture, and young animals but on a solid food diet). The specimens were subjected to tensile tests, recorded with a high-speed camera to obtain deformation maps. Measurements of the tensile force until the specimen broke were also carried out. A fractographic study was carried out with a scanning electron microscope to analyze the fracture surface and an analysis of the amount of calcium in each of the specimens using X-ray dispersion spectroscopy. RESULTS: A statistically significant and positive correlation was found between the elastic modulus of the specimens and their calcium content. A trend towards more rigid behavior with age was observed. CONCLUSIONS: Young bone tissue tends to stiffen with age as the calcium content increases with an increase in elastic modulus.

Relationship between vertebral vessels and cortical path screws in cortical transfixation / Relação dos vasos vertebrais com parafuso de trajeto cortical com transfixação da cortical / Relación de los vasos vertebrales con tornillo de trayectoria cortical con transfijación cortical

ABSTRACT Introduction: This study aims to evaluate the safety of using the cortical path screw with transfixation of the second cortical bone in relation to the vascular structures. Methods: This retrospective observational study (level of evidence: III, study of non-consecutive patients) analyzed data from the medical records of patients who underwent computed angiotomography scans of the abdomen at Hospital Mater Dei, measuring, in millimeters, the distance between the point of the lumbar vertebra considered the anatomical reference for the transfixation of the second cortical bone and the vascular structures adjacent to the spine (abdominal aorta, inferior vena cava, iliac vessels, segmental lumbar arteries). Results: Forty-eight patients were evaluated, with a mean age of 60 years (±8 years, 41-75), of whom 52% were male and 48% female. The measurements obtained between the pre-vertebral vessels and the possible screw exit points did not demonstrate contact in any of the vertebrae studied. Conclusions: The measurements obtained suggest the safety of using the cortical path screw transfixing the second cortical bone. Knowing the position of the vessels is essential to reduce intra- and postoperative complications related to spinal instrumentation. Level of evidence III; Study of non-consecutive patients.

RESUMO Introdução: Este trabalho objetiva avaliar a segurança do uso do parafuso de trajeto cortical com transfixação da segunda cortical óssea com relação às estruturas vasculares. Métodos: Estudo observacional retrospectivo (nível de evidência: III, estudo de pacientes não consecutivos) analisou dados de prontuários de pacientes submetidos ao exame de angiotomografia computadorizada do abdome no Hospital Mater Dei, realizando a medida, em milímetros, entre o ponto da vértebra lombar considerado a referência anatômica para a transfixação da segunda cortical óssea e as estruturas vasculares adjacentes à coluna (aorta abdominal, veia cava inferior, vasos ilíacos, artérias lombares segmentares). Resultados: Foram avaliados 48 pacientes, com média de idade de 60 anos (±8 anos, 41-75), sendo 52% do sexo masculino e 48% do feminino. As medidas obtidas entre os vasos pré-vertebrais e os pontos possíveis de saída do parafuso não demonstraram contato, em todas as vértebras estudadas. Conclusões: As medidas obtidas sugerem a segurança do uso do parafuso de trajeto cortical transfixando a segunda cortical óssea. Conhecer a posição dos vasos é essencial para reduzir as complicações intra e pós-operatórias relacionadas à instrumentação da coluna vertebral. Nível de evidência III; Estudo de pacientes não consecutivos.

RESUMEN Introducción: Este estudio tiene como objetivo evaluar la seguridad del uso del tornillo de trayectoria cortical con transfijación de la segunda cortical ósea con respecto a las estructuras vasculares. Métodos: Estudio observacional retrospectivo (nivel de evidencia: III, estudio de pacientes no consecutivos) que analizó datos de registros médicos de pacientes sometidos a examen de angiografía por tomografía computarizada de abdomen en el Hospital Mater Dei, realizando la medición, en milímetros, entre el punto de la vértebra lumbar considerado la referencia anatómica para la transfijación de la segunda cortical ósea y las estructuras vasculares adyacentes a la columna (aorta abdominal, vena cava inferior, vasos ilíacos, arterias lumbares segmentarias). Resultados: Se evaluaron 48 pacientes, con una edad promedio de 60 años (±8 años, 41-75); 52% eran hombres y 48% mujeres. Las medidas obtenidas entre los vasos prevertebrales y los posibles puntos de salida del tornillo no demostraron contacto en todas las vértebras estudiadas. Conclusiones: Las medidas obtenidas sugieren la seguridad de utilizar el tornillo de trayectoria cortical transfijando la segunda cortical ósea. Conocer la posición de los vasos es fundamental para reducir las complicaciones intra y postoperatorias relacionadas con la instrumentación espinal. Nivel de evidencia III; Estudio de pacientes no consecutivos.

Pyle's Disease: A human model of differentiated cortical and trabecular homeostasis. / Enfermedad de Pyle: un modelo humano de homeostasis corticotrabecular diferenciada.

Pyle's disease (OMIN number 265900) is a metaphyseal dysplasia of benign course, inherited with an autosomal recessive pattern. Some 30 genuine cases have been described so far. The cause of this process has been known since 2016, when its relationship to mutations in the gene encoding the sFRP protein, a known inhibitor of the Wnt pathway, was discovered. We report the case of a 58-year-old man, diagnosed with Pyle's disease based on his clinical and radiographic characteristics, whose phenotype suggested a differential control of cortical and trabecular bone homeostasis.

Corticotomia selectiva y ortodoncia: distancia y tiempo en que se logra realizar un desplazamiento. Revisión bibliografica / Corticotomia selectiva y ortodoncia: distancia y tiempo en que se logra realizar un desplazamiento. Revisión bibliografica / Corticotomia seletiva e ortodontia: distância e tempo em que um deslocamento é alcançado. Revisão bibliográfica

La corticotomía se define como una osteotomía, en la cual, se corta el hueso cortical, perforando o alterando mecánicamente de una manera quirúrgica controlada y al mismo tiempo penetrando mínimamente en la mé-dula ósea para acelerar el movimiento dental ortodóntico en respuesta a una demanda de los pacientes en cuanto a la efectividad del tratamiento y al rápido movimiento de cada zona. Objetivo: mediante una revisión bibliográfica, determinar la distancia y tiempo en que se logra realizar un desplazamiento o movimiento orto-dóntico después de haber realizado una corticotomía selectiva. Para la búsqueda, se utilizaron Plataformas como Pubmed, Scielo, Science Direct y Google Scholar, en las que se empleó palabras claves como distan-cia, tiempo, corticotomía selectiva y tratamiento de ortodoncia y se buscaron artículos publicados entre el 2001 y 2017. Resultados: se obtuvo que los movimientos se realizan en un periodo de 4 meses, respecto a la distancia y se observó que se logra desplazar un promedio de 3.5mm. Conclusiones: en pacientes adultos, ha aumentado la exigencia sobre reducir tiempos de tratamiento, la ortodoncia facilitada por corticotomía con-sigue llevar a cabo un tratamiento exitoso y disminuir los tiempos de tratamiento. Sin embargo, la evidencia es escasa, pues está basada principalmente en reportes de casos, por lo cual se requiere mayor investigación acerca de este procedimiento.

Corticotomy is defined as an osteotomy, in which the cortical bone is cut, perforated or mechanically altered in a controlled surgical way and at the same time minimally penetrating the bone marrow to accelerate orthodon-tic dental movement in response to a demand for patients regarding the effectiveness of the treatment and the rapid movement of each zone. Objective: by means of a bibliographic review, determine the distance and time in which an orthodontic movement is achieved after having performed a selective corticotomy. For the search, Platforms such as Pubmed, Scielo, Science Direct and Google Scholar were used, in which keywords such as distance, time, selective corticotomy and orthodontic treatment were used and articles published between 2001 and 2017 were searched. Results: It was obtained that the movements are carried out in a period of 4 months, with respect to the distance and it was observed that an average of 3.5mm can be moved. Conclu-sions: in adult patients, the demand for reducing treatment times has increased; orthodontics facilitated by corticotomy achieves successful treatment and decreases treatment times. However, the evidence is scarce, since it is mainly based on case reports, so more research is required about this procedure.

A corticotomia é definida como uma osteotomia, na qual o osso cortical é cortado, perfurado ou alterado mecanicamente de maneira cirúrgica controlada mais penetração mínima na medula óssea para acelerar o movimento dentário ortodôntico em resposta a uma demanda por pacientes quanto à eficiência do tratamento e ao movimento rápido de cada zona. Objetivo: por meio de uma revisão bibliográfica, determinar a distância e o tempo em que um movimento ou deslocamento ortodôntico é alcançado após a realização de uma cortico-tomia seletiva. MATERIAL Y MÉTODOS: Para a pesquisa, foram utilizadas plataformas como Pubmed, Scielo, Science Direct e Google Scholar, nas quais foram utilizadas palavras-chave como distância, tempo, corticoto-mia seletiva e tratamento ortodôntico e foram pesquisados artigos publicados entre 2001 e 2017. Resultados: se observou que os movimentos são realizados em um período de 4 meses, em relação à distância obser-vou-se que uma média de 3,5 mm pode ser movimentada. Conclusões: em pacientes adultos, a demanda por redução do tempo de tratamento aumentou, a ortodontia facilitada pela corticotomia consegue o sucesso do tratamento e diminui o tempo de tratamento. No entanto, as evidências são escassas, uma vez que se baseiam principalmente em relatos de casos, sendo necessárias mais pesquisas sobre esse procedimento.

Comparación del grosor óseo palatino bilateral para inserción de miniimplantes / Comparison of bilateral palatal bone thickness for insertion of mini implants

Objetivo: comparar el grosor óseo palatino bilateral e identificar zonas seguras para inserción de miniimplantes. Métodos: se llevó a cabo un estudio transversal que incluyó 100 tomografías de haz cónico (CBCT) pretratamiento de pacientes que asistieron a la Especialidad de Ortodoncia en la Universidad Autónoma de Nayarit (UAN). Las imágenes fueron orientadas utilizando el mismo protocolo. En el corte sagital, las mediciones se realizaron de los 0 a los 24mm, con intervalos de 3mm entre cada una, con la primera medición en el borde posterior del foramen incisivo. Las mediciones del grosor palatino se realizaron en el corte coronal a los 2, 4, 6 y 8mm de la sutura media palatina hacia ambos lados. Resultados: se encontró mayor grosor en la zona anterior en las medidas sagitales de 0 mm y 3 mm, a diferencia del resto del paladar. Se hallaron diferencias estadísticamente significativas al comparar los valores tanto sagitales como transversales. Con la prueba Post Hoc de Tukey no se encontraron diferencias estadísticamente significativas al comparar el lado derecho con el izquierdo en cada una de las medidas transversales. Conclusiones: no se encontraron diferencias significativas entre los dos lados, se determinó como zona segura la región anterior del paladar de 0mm a 6mm y es primordial la CBCT en todos los pacientes con indicación de miniimplantes en paladar.

Objective: Bilateral comparison of palatal bone thickness and identification of safe areas for insertion of mini implants. Methods: Cross-sectional Study that included 100 Cone beam computed tomography (CBCT) pretreatment, of patients who attended the Orthodontic Specialty at the Autonomous University of Nayarit (UAN). The images were oriented using the same protocol. In the sagittal plane, measurements were made from 0 to 24mm, with intervals of 3mm between each, being the first measurement at the posterior rim of the incisive foramen. Measurements of the Palatine thickness were made on the coronal plane at 2, 4, 6 and 8mm of the mid palatal suture on both sides. Results: Greater thickness was found in the anterior area in the sagittal measurements of 0mm and 3mm, unlike the rest of the palate. Statistically significant differences were found when comparing both sagittal and transverse values. With Tukey's post hoc test no statistically significant differences were found when comparing the right and left sides in each of the cross measures. Conclusions: No significant differences were found between the two sides, the anterior palatal region of 0mm to 6mm was determined to be safe and CBCT is paramount in all patients in whom mini-implants are to be placed on the palate.

Enfermedad de Caffey en una familia y trastornos relacionados con el colágeno tipo 1 / Caffey disease in a family and disorders related to collagen type 1

Introducción: La enfermedad de Caffey también se ha denominado hiperostosis cortical infantil, caracterizada por la presencia de un episodio en la infancia con neoformación subperióstica en las diáfisis de huesos largos, el maxilar inferior y las clavículas. Casos clínicos: Se evaluó a un recién nacido con hallazgos clínico-radiológicos que comprendieron deformidad angular anterior del antebrazo izquierdo y miembros inferiores. La radiografía simple del nacimiento certificó la hiperostosis cortical con curvatura anterior del radio izquierdo, asociado con importante engrosamiento cortical en la diáfisis de tibias. La radiografía de control a los tres y ocho meses de edad mostró disminución de la hiperostosis cortical. El segundo caso es el de una niña de siete años que ha presentado dos exacerbaciones de hiperostosis cortical. En el examen físico presentó hiperextensibilidad de pabellones auriculares, hipermovilidad de articulaciones pequeñas y manchas de hemosiderina múltiples difusas localizadas en las piernas. El tercer caso correspondió a un lactante menor de un mes y tres días de vida, con radiografía que evidenció la hiperostosis cortical de tibias. Conclusión: La familia con neoformación diafisiaria constituye casos de interés por tratarse de un diagnóstico infrecuente en la edad pediátrica y cuya sospecha clínica puede generarse a partir de un buen examen clínico y estudio del caso índice, complementado con la interpretación de la genealogía asociado con el estudio molecular que lo corrobora.

Introduction: Also called infantile cortical hyperostosis, characterized by the presence of an episode in childhood with subperiosteal neoformation in the diaphysis of long bones, jaw and clavicles. Case description: a newborn was evaluated with clinical-radiological findings that included anterior angular deformity of the left forearm and lower limbs. The simple bone scan birth certified cortical hyperostosis with anterior curvature of the left radius, associated with important cortical thickening in the diaphysis of tibias. The control radiograph at three months of age showed a decrease in cortical hyperostosis. The second case is a seven-year-old patient who has presented two exacerbations of cortical hyperostosis. Upon physical examination, he presented hyperextensibility of auricular pavilions, hypermobility of small joints and diffuse multiple hemosiderin spots located on the legs. The third case corresponded to an infant younger than one month three days of life, with radiography that showed the cortical hyperostosis of tibias. Conclusion: We conclude that the family with diaphyseal neoformation constitute cases of interest because it is an infrequent diagnosis in the pediatric age and whose clinical suspicion can be generated from a good clinical examination and study of the index case, supplemented with the interpretation of the genealogy associated with the molecular study that corroborates it.

Micro-implanted-anchorage safety: cortical bone thickness in the maxillary posterior region of skeletal class II malocclusion / Seguridad en el micro-implante de anclaje: espesor del hueso cortical en la región posterior del maxilar en maloclusión de clase esquelética tipo II

Cone Beam Computed Tomography (CBCT) measurement of cortical bone thickness and implantation angle in the maxillary posterior region was used to provide reference for the safety of Micro-Implanted-Anchorage (MIA) implantation in skeletal class II malocclusion. Twenty samples of CBCT images were collected from orthodontics patients (ages, 12-40 years) in Shanxi Medical University Stomatological Hospital, the thickness of cortical bone was measured at 45°, 60° and 90° from the alveolar crest, being at 4 mm, 6 mm and 8 mm, respectively. SPSS17.0 statistical software was used to analyze the data, and the one-way ANOVA and LSD method were compared. There was a significant difference in the thickness of the cortical bone obtained by implanting MIA at the same height of different angle (P≤0.05). The greater the inclination angle of the implanted MIA, the thicker the cortical bone. Also, the higher the implant site, the thicker the cortical bone thickness. Finally, the greater the thickness of the cortical bone in the maxillary posterior region of skeletal class II malocclusion, the greater the thickness of the cortical bone. At the same implantation height, implanted MIA with a tilt angle of 45º to 60º, 90º to obtain the best cortical bone thickness.

La medición del grosor del hueso cortical y del ángulo de implantación en la región posterior del maxilar por tomografía computarizada de haz cónico (TCHC) se utilizó para proporcionar una referencia para la implantación y el anclaje seguros de un Micro-Implante de Anclaje (MIA) en la maloclusión de clase esquelética tipo II. Veinte muestras de imágenes de TCHC fueron obtenidas de pacientes de ortodoncia (12-40 años) en el Hospital Estomatológico de la Universidad Médica de Shanxi. Se midió el grosor del hueso cortical a 45°, 60° y 90° de la cresta alveolar, encontrándose a 4 mm, 6 mm y 8 mm, respectivamente. Se utilizó el software estadístico SPSS 17.0 para analizar los datos, y se compararon con los métodos ANOVA y LSD de un factor. Hubo una diferencia significativa en el grosor del hueso cortical obtenido al implantar el MIA a la misma altura en diferentes ángulos (P <0,05). Cuanto mayor es el ángulo de inclinación del MIA implantado, más grueso es el hueso cortical. También, cuanto más alto es el sitio del implante, más grueso es el grosor del hueso cortical. Finalmente, cuanto mayor sea el grosor del hueso cortical en la región posterior del maxilar, en la maloclusión de clase esquelética tipo II, mayor será el grosor del hueso cortical.

Comparación de distancias interradiculares y grosor del hueso cortical en dos sectores del maxilar inferior para colocación de mini implantes / Comparison of interradicular distances and cortical bone thickness in two sectors of lower jaw for placement of mini-implants

Introducción: la colocación de mini implantes interradiculares, como alternativa para el anclaje de aparatología ortodóntica, varía acorde a la clasificación esquelética del paciente Clase I o II. Es necesario realizar la correcta identificación de la ubicación radicular y grosor cortical como parte del análisis estratégico del área a intervenir. Objetivo: comparar tomográficamente las distancias interradiculares y grosor del hueso cortical en dos sectores del maxilar inferior para colocación de mini implantes. Materiales y métodos: estudio transversal que incluyó 120 tomografías computarizadas de haz cónico, pertenecientes a pacientes Clase I (60) y Clase II (60) esquelética. Se identificó tomográficamente la distancia interradicular, el ancho bucolingual y el grosor del hueso cortical bucal, a partir de la cresta alveolar entre el segundo premolar y primer molar inferior derecho y entre el canino y lateral del mismo lado. Un análisis estadístico con prueba t Student al 95% de confianza comparó la ubicación de las estructuras anatómicas para clase I y II esquelética. Resultados: en la distancia interradicular, comparativamente entre clase I y II, se encontró significancia entre canino y lateral derecho (p=< 0.054) a los 8 mm. En este mismo sector, en el ancho bucolingual, se encontró diferencia significativa a 6mm de altura (p=<.04). En el grosor del hueso cortical no se encontraron diferencias estadísticas al comparar los valores para la Clase I y II. Conclusiones: en Clase I y II, el mayor espesor para la colocación de mini implantes se registró en el espacio interradicular a 8 mm de altura y en el ancho bucolingual a 6 mm.

Background: the placement of mini interradicular implants as an alternative for the anchoring of orthodontic appliances varies according to the skeletal classification of Class I or II patients. The correct identification of the root location and cortical thickness as part of the strategic analysis of the area to be intervened is necessary. Objective: to compare tomographically the interradicular distances and thickness of the cortical bone in two sectors of the lower jaw for placement of mini implants. Materials and methods: observational and cross-sectional study that included 120 conical beam CT scans of Class I (60) and Class II (60) skeletal patients. The interradicular distance, buccolingual width and thickness of the buccal cortical bone were measured in three dimensions from the alveolar crest between the second premolar and the first lower right molar and between the canine and the lateral side of the same side. A statistical analysis with a 95% confidence t Student test compared the location of anatomical structures for skeletal class I and II. Results: in the Interradicular Distance, when comparing the values to 95%, between Class I and II, significance was found between canine and right lateral (p = <0.054) at 8 mm. In this same sector, in the buccolingual width, significance was found at the height of 6 mm (p = <. 04). In the thickness of the cortical bone, no statistical differences were found when comparing the values for Class I and II. Conclusions: it is recommended to place mini implants in the two sectors interradicularly at the height of 8 mm in Class I and II. Considering the buccolingual width at the height of 6 mm.