Allograft bone banking experience in Pakistan.

To share our experience of establishing a bone bank in Pakistan, and the clinical use of these indigenously produced bone grafts. We retrospectively reviewed our experience of the procurement, processing, and storage of bone grafts at a bone bank in Karachi, Pakistan, the first bone bank to be established in a public sector hospital in Pakistan. The bone bank was established at Sindh Institute of Urology and Transplantation (SIUT), Karachi, in collaboration with Department of Orthopaedic Surgery, Dow University of Health Sciences/Civil Hospital, Karachi (CHK) in May, 2015. Since then, a large number of bone grafts from the tissue bank have been used for various orthopedic procedures. This paper describes the problems and challenges faced in establishing and running a tissue bank in a Muslim and a developing country and the progress of the bone bank over the first 4 years. A total of 93 bone grafts were retrieved and preserved in the bone bank over the 4-year period. Among these, 56 (60.2%) bones were retrieved from male donors and 37 (39.8%) from females. The mean age of all donors was 55.9 ± 15.34 years (range: 16-90 years). All bone donors were living patients. No c bones were obtained from deceased donors. Types of bone grafts included: femoral heads, 68; head with neck of femur, 19; radius and ulna, 1; lower femur, knee joint, lower leg and foot bones, 4; and skull bone, 1. All grafts were subjected to aerobic and anaerobic bacterial cultures, as well as fungal cultures. Microbiological contamination was observed in 18/93 (19.35%). All culture positive bones were discarded. Bone grafts issued from the bank and transplanted were 51/93 (54.8%) in all. Bone grafts were used in a variety of tumor and non-tumor orthopaedic procedures in CHK. Nine bone grafts were donated to the other hospitals to be used for revision total hip replacement and tumor surgeries. There were no service charges. Two patients (3.92%) developed infections postoperatively, one superficial and one deep. No other complications were noted. This is the preliminary report on the establishment and functioning of a bone bank in a public sector hospital in Pakistan. The favorable outcome has inculcated confidence in orthopedic surgeons for greater use of bone allografts for a variety of indications in this country.

The quality assessment of the University hospital bone bank in Central Serbia: the second audit after fourteen years.

We analyzed the prevalence and predisposing factors for the overall rejection rate after retrieval of 267 fresh femoral head allografts over the past 7 years. The present study aimed to assess the quality system of institutional bone banking that can provide high-standard allografts with a low infection rate. Retrospective analysis of bone banking from June 2013 to December 2019 was conducted on 267 donors and 153 recipients. Of the 267 donated femoral heads, 74 were rejected, giving an overall rejection rate of 27.71%. The leading cause of allograft rejection was the inability to perform serology tests due to donor death; the absence of serological tests itself, and the donor refusal to perform the serology 6-month retest in 42 donors (15.72%). At retrieval, 12 allografts were positive, giving an overall contamination rate of 4.49%. Seven (2.62%) of the 267 allografts failed the blood screening tests. Thirteen allografts (4.86%) were discarded because of suspected damage to the packaging or disuse during surgery. An infection rate of 1.30% was found following transplantation. Over the past 7 years of bone banking, our results show that the overall rejection rate and the allograft-related infection rate correlate with international standards. The leading cause of allograft rejection was the inability to perform serology tests due to donor death and their refusal to perform the serology retests. Besides stringent aseptic allograft handling, donor motivation to participate in bone banking is extremely important for its efficient functioning.

Uso de aloinjerto estructural e infecciones posquirúrgicas / Use of structural allograft and post-surgical infections

Introducción: El uso de aloinjertos conlleva el riesgo de complicaciones. Una de las más frecuentes es la infección. Un importante factor de riesgo de infección con el uso de injertos óseos es la transmisión de gérmenes a través del injerto. Nuestros objetivos fueron determinar si existe una relación entre la posible contaminación de los injertos de este Banco y las infecciones posquirúrgicas; demostrar cómo la selección del donante, la procuración y el procesado del injerto adecuados disminuyen la tasa de contaminación e informar otras complicaciones relacionadas con la calidad del injerto. Materiales y métodos: Se seleccionaron pacientes que recibieron injerto óseo estructural de nuestro Banco. Todos los injertos fueron estudiados microbiológicamente. Se revisaron las historias clínicas, y los pacientes fueron sometidos a una anamnesis y un examen físico, y se les tomaron radio-grafías para detectar infección y otras complicaciones. Se utilizó la Escala de Osteointegración ISOLS. Resultados: En ninguno de los injertos, se detectó contaminación. Se identificó un caso (7,7%) de infección por Klebsiella pneumoniae productora de carbapenemasas y 3 casos (23%) de falta de integración. La integración fue entre buena y excelente en el 77% de los casos, satisfactoria en el 8% y pobre en el 15%. No hubo otras complicaciones. Conclusiones: Existe riesgo de transmisión de infecciones con el aloinjerto estructural. Los criterios reglados de selección de donantes y el control de los procedimientos dentro del banco de huesos disminuyen el riesgo de infección por contaminación del injerto y de otras complicaciones relacionadas con la calidad del injerto. Nivel de Evidencia: IV

Introduction: The use of allografts carries the risk of various complications. Among the most frequent is infection. An important risk factor for infection with the use of bone grafts is the transmission of germs through the graft itself. Our objectives are to determine if there is a relationship between possible contamination of the grafts from this bank and postoperative infections; demonstrate how the proper donor selection, procurement, and processing of the graft decrease the rate of contamination; and report other complications related to the quality of the graft. Materials and methods: We selected patients who received structural bone grafts from our bank. All grafts were microbiologically studied. A review of the health records, anamnesis, physical examination, and radiographs was performed to evaluate infection and other complications. The ISOLS Osseointegration Scale was used to assess the consolidation of the grafts.Results: No graft contamination was detected. One case (7.7%) of infection by carbapenemase-producing Klebsiella pneumoniae (KPC) and 3 cases (23%) of nonunion were identified. Consolidation was good to excellent in 77% of cases, satisfactory in 8%, and poor in 15%. No other complications were found. Conclusion: There is a risk for infection transmission with structural allograft. Regulated donor selection criteria and control of bone bank procedures reduce the risk of infection due to graft contamination and other complications related to graft quality. Level of Evidence: IV

Management of regional bone bank during declaration of a state of emergency concerning the COVID-19 in Japan.

Bone banks are necessary for providing biological allografts for a series of orthopedic procedures. As nations cope with new realities driven by the 2019 coronavirus disease (COVID-19) pandemic, health-care providers, institutions, and patients share a particular concern about the effect of COVID-19 on organ donation and transplantation. Here, we describe the management of the Kitasato University Bone Bank during the state of emergency declared in response to COVID-19. Living donors received pre-operative screening by PCR, and allograft bone from COVID-19-negative donors was cryopreserved as transplantable tissues. The weekly rate of infection gradually increased from February 2-9 to April 5-11 in the dead donor-derived allograft bone-harvesting region covered by the Bank. It is becoming clear that the virus can be transmitted by asymptomatic patients, and that this route may have facilitated the spread of COVID-19. Therefore, the Bank stopped dead donor donation to consider the safety of medical staff. Three recipients received bone allografts following pre-operative COVID-19 screening by PCR. All patients were asymptomatic after bone allograft. Our experience may provide helpful information for the management of tissue banks.

The contamination of allografts in multi-organ donors: a bone bank experience.

As a consequence of the preference for homologous tissues, bone banks are the primary source of bone and tendon grafts. However, the bacterial, viral, and fungal contamination of these grafts remains a considerable challenge in bone banks and often results in high rates of graft discarding and infections in patients. This study intended to investigate bacterial contamination in 509 bone grafts harvested from 110 multiorgan donors. Specimen collection included bone and soft tissue retrieved from culture-swabbing as well as bone and capsule for histopathology. Microbiological, histopathological, and radiographic analyses were carried out. Secondary sterilization was also conducted using cobalt 60 at the dose of 2.5 × 104 Gy. There were 106 multi-organ donors. Of the 506 grafts, there were 54 Hemi pelvis, 191 femur, 142 tibia, and 119 fibulae. The surface swab contamination rate for all the grafts retrieved was 16.6%, and bone culture from all the grafts was 6.1%. When we looked at the incidence of contamination according to the location than the surface swab contamination rate for hemipelvis was 18 (33.3%), femur 30 (15.7%), tibia 21(14.7%) and fibula 15 (12.6%). The bone cultures were hemipelvis 12 (22.2%) femur 8 (4.1%), tibia 5 (3.5%) and fibula 6 (5.04%). These findings suggest that separate harvesting of the grafts in reverse order may help prevent contamination. The study also recommends discarding all grafts contaminated even with low pathogenicity organisms. However, bioburden needs to be further investigated to be detected and reduced.

Principles of bone and tissue banking in Saudi Arabia: 10-year experience report.

BACKGROUND: The role of bone and tissue banking is well known to meet the ever-growing need of bone and soft tissue allografts. Strict guidelines have been established to ensure high standard and minimize complications related to bone transplantation. METHODS: The Bone Bank in King Faisal Specialist Hospital and Research Centre (KFSH&RC), affiliated with the Saudi Council of Organ Transplantation, was inaugurated in 2010, and it has since been an integral part of the KFSH&RC organ retrieval team. The bank has a very strict regulations which were described. RESULTS: Between January 2010 and January 2020, there were 143 multi-organ donors (mean age: 36 years, range: 24-55 years). The total number of allografts used was 2191 which were utilized in 1047 patients. CONCLUSIONS: In this paper, we present our 10-year experience of administrative structure, donor and recipient testing protocols, allograft retrieval, processing procedures, and the internal audit safety arrangements. The utilization of allografts in various pathologies such as revision joint replacement, spine surgery, and tumor surgery is discussed with our results over a 10-year period.

A Technique for the Reconstruction of the Limbs of Osteomuscular Tissue Donors / Técnica para reconstrução de membros de doadores de tecidos osteomusculares

Abstract The donation of bone and tendon tissues is an important source of biological material used in several surgical techniques. The removal of such tissues generates an important aesthetic sequel in the donor that requires limb reconstruction before returning the corpse to the relatives. The technique used by the Banco de Ossos do Paraná (Bone Bank from Paraná), Brazil, employs metal rebar, silicone tubes and nylon clamps to rebuild the limbs, it is easy to perform and has satisfactory aesthetic results.

Resumo A doação de tecidos ósseos e tendíneos é uma importante fonte de material biológico empregado em diversas técnicas cirúrgicas. A remoção destes tecidos gera uma importante sequela estética no doador, sendo necessária a reconstrução dos membros antes da devolução do corpo aos familiares. A técnica utilizada pelo Banco de Ossos do Paraná faz uso de vergalhões metálicos, tubos de silicone e abraçadeiras de náilon para reconstruir os membros, uma técnica de fácil execução e com resultado estético satisfatório.

Living donor bone bank: Costa Rican experience / Banco de huesos a partir de donantes vivos: experiencia costarricense

Resumen Objetivo: El uso de injertos óseos es una práctica común en cirugías ortopédicas. Sin embargo, el problema diario en traumatología es el acceso limitado a injertos óseos adecuados. Estos injertos permiten proporcionar estabilidad mecánica en el área del defecto óseo, así como reparar y regenerarvlos defectos a través de sus propiedades osteoinductivas, osteogénicas y osteoconductivas. El objetivo principal de este trabajo fue proporcionar información a la población sobre las experiencias y la importancia de establecer un Banco de Huesos en Costa Rica. Metodología: Se recopiló toda la información relevante para proporcionar un breve resumen del establecimiento de un banco de huesos en Costa Rica. En primer lugar, se tomó en cuenta consideraciones legales, seguido por la definición de los criterios de exclusión de donantes de acuerdo a los estándares internacionales. Los potenciales donantes se definieron como los pacientes sometidos a reemplazo de cadera y de rodilla. Con el fin de elegir los donantes adecuados, a todos los 78 Acta méd costarric Vol 61 (2), abril-junio 2019 potenciales donantes se les realizaron pruebas de sangre para detectar enfermedades transmisibles. Los tejidos óseos se obtuvieron en sala de operaciones para, posteriormente, ser procesados bajo condiciones estrictas estandarizadas. Una vez que se procesaron los tejidos, los aloinjertos se almacenaron a -80 °C hasta que se llevó a cabo el procedimiento de trasplante. Resultados: entre los años 2016 y 2019, el Banco de Huesos tuvo un total de 69 donantes y 258 receptores de aloinjertos óseos, todos ellos pacientes del Hospital Trauma. Conclusión: El establecimiento del banco de huesos en Costa Rica ha sido un gran desafío para el Instituto Nacional de Seguros (INS). El objetivo es hacer que el mismo esté disponible para la comunidad médica en general, a fin de fortalecer la red de donación y trasplantes de tejidos en Costa Rica.

Abstract Aim: The use of bone grafts is a common practice in orthopedic surgeries. However, the daily problema in traumatology is the limited access to adequate bone grafts. These grafts provide mechanical stability in the affected area of the bone, as well as repair and regeneration of weaknesses through osteoinductive, osteogenic and osteoconductive properties. The main objective of this report is to provide information about the experiences and the importance of establishing a Bone Bank in Costa Rica. Method: All relevant information was gathered to provide a brief overview of the establishment of a Bone Bank in Costa Rica. First, legal issues were taken into consideration; followed by the definition of the donor exclusion criteria according to international standards. Potential donors were defined as all patients undergoing hip or knee replacement surgeries. In order to select the right donors, blood samples from all potential donors were tested for transmittable diseases. Bone tissues were obtained in the operating room to be processed later, under strict standardized conditions. Once the tissues were processed, allografts were stored at -80°C until the transplantat procedures were carried out. Results: Between 2016 and 2019, the bone bank had a total of 69 donors and 258 bone allograft recipients, all of them were patients at the Trauma Hospital. Conclusion: The establishment of the bone bank in Costa Rica has been a challenge for the National Insurance Institute (INS). The goal is to make the Bone Bank available to the medical community in general, in order to strengthen the tissue donation and transplant network in Costa Rica.

ESTABLISHMENT OF THE BONE TISSUE BANK AT MOSTAR UNIVERSITY CLINICAL HOSPITAL.

Bone tissue banks are necessary for collection, production, testing, packaging, storage and delivery of bone transplants. Bone tissue bank is a link between the donor and the recipient by which the donation becomes a medium of health improvement for both the donor and the recipient. At the Department of Orthopedics, Mostar University Clinical Hospital, about 200 total hip replacements are performed per year. Most patients undergoing total hip replacement surgery (90%) have been diagnosed with osteoarthritis, and they are suitable donors, having in mind their age and comorbidities. In the same Department, around 50 procedures that require bone transplants are performed per year. A team of highly competent surgeons are working on an intensive process of adaptation oriented to quality improvement and intensification of the activity, both with the goal of meeting the standards of excellence in orthopedic surgery. The presence of a bone tissue bank has a favorable impact on the quality of health care owing to bone transplant availability, as well as on the scientific role of a highly specialized institution that examines the properties of bone tissue.

Alveolar splitting with Piezosurgery®, bone bank grafts and NobelActive implants as an alternative to major bone grafting for maxillary reconstruction.

BACKGROUND: Piezosurgery® represents a novel alternative technique. The Piezosurgery® is well tolerated and permits a large number of applications in described literature. The principle of Piezosurgery® consists into inducing micro-vibrations to a metallic insert with a particular custom. The aim of this article is to study and to evaluate the use of NobelActive implants in combination with piezosurgical split-crest technique in severe atrophy of the upper maxilla. This approach allows avoiding the use of onlay grafts, due to rise the trasversal width of the crestal bone, which could have more complications and uncertain prognosis. This technique allows reducing timing of implant insertion because it is not necessary to wait for the graft to heal. METHODS: Ten patients (age 45-58) are selected, presenting from class 4 to 5 by Cawood and Howell of jaws. Those underwent piezosurgical split-crest technique and simultaneous implants surgery and bone grafts. Preoperative X-ray evaluation included standard X-panoramic and CT Dental-scan. Standard chemoprophylaxis was administered to each patient. The piezosurgical split-crest procedure was combined with tissue bank fresh frozen chips and double-layer collagen membrane to improve the thickness of alveolar bone and simultaneous implant surgery. Every patient received simultaneously from 3 to 6 implants which diameter was 4.3 mm and length 10-11.5 mm. Healing abutments have been applied at 5 months from the first procedure. RESULTS: Patients were clinically monitored, and marginal bone changes were calculated using periapical radiographs, which were taken with O-ring technique at placement and upon subsequent appointments and a 1-mm measurement grid for marginal bone remodeling, again at baseline and thereafter 3 months within loading. Cumulative implant survival was 97.8% (N.=45). Mean marginal bone resorption (SD) was 1.19 (1.01) mm for the early loading group after 1 year. The use of NobelActive implants seem to reduce peak stress in both cortical and trabecular bone. CONCLUSIONS: The use of NobelActive implants was revealed ideal in patients presenting jaw atrophy. The tapered designs show an ability to dissipate the interfacial stresses of bone, therefore improving the stability and the osteointegration if used in association to split crest made with piezosurgical device.

Creation of the bone bank of the Rabat and Casablanca region in Morocco.

For a long time the use of bone grafting has demonstrated its interest in orthopedic surgery and traumatology. The autografts which are still very frequently used present various problems. On the one hand, it is necessary to find a correct mechanical quality and a sufficient quantity of bone. On the other hand, the graft removal lengthens the operative time and generally painful in postoperative. These disadvantages of autografts have led to the development of bone allografts. Indeed, the low immunogenic power of the bone, the good integration of the graft and the ease of bone preservation techniques make it possible to overcome the various problems posed by bone autografts. The increasing use of bone allografts has resulted in the need for a structure allowing the management of graft stocks. The purpose of this work is to demonstrate the mode of operation of a bone bank, whose conservation activity is limited to the femoral heads treated by cryopreservation and without secondary sterilization process. The bank collaborates with all orthopedic surgeons in the Rabat and Casablanca city at first and then with all orthopedic surgeons in Morocco. It provides allografts in quality and safety.

[Bone banks : The state-of-the-art]. / Knochenbanken : State-of-the-Art.

Bone banks are responsible for the collection, production, testing, packaging, storage and delivery of osseous grafts. In compliance with legal and quality requirements, it is their main task to ensure the biological properties and the microbiological safety of the transplants as well. German legal requirements for bone banking are explained and current standards with respect to donor selection, laboratory tests and tissue processing, as well as labeling are discussed. Production and preparation procedures should include a validated microbiological inactivation method that largely preserves the biological properties of the tissue.

[Allogeneic bone transplantation in hip revision surgery : Indications and potential for reconstruction]. / Allogene Knochentransplantation in der Hüftrevisionsendoprothetik : Indikationen und Rekonstruktionsmöglichkeiten.

The increasing number of people having joint replacements will lead to increasing numbers of revision operations. The transplantation of allogeneic bones might reconstruct bone defects and improve long-term anchorage of the implant. A sufficient primary stability of the implanted construct is necessary to achieve osseous incorporation as well as tight contact between the implanted allogeneic and host bones. Transplantation of bone can contribute to downgrading acetabular defects and so avoid bigger reinforcement implants. An improvement of bone stock due to reconstruction of femoral bony defects might also reduce the size of the stem necessary since the indication might be limited in case of extensive bone defects. According to good longterm results of modular revision stems the Impaction-Bone-Grafting has not yet generally been established.

[Improve the Rate of Bone Collection at Human Tissue Banks].

BACKGROUND: Lack of familiarity with collection and inspection procedures, incorrect bone-packaging procedures, and unclear instructions for bone placement during storage are primary reasons for the resultant low bone collection pass rate of bone banks. Moreover, 8 cases / operations were directly affected by this problem, which caused bone-nail dislocations during the post-operative period that nearly caused medical disputes. PURPOSE: The present project was designed to improve the pass rate of the bone of the human organ to 95%. METHODS: Education and training programs were planned, visual-aid posters depicting standard procedures were produced, the repository was remarked and relabeled, and a regular audit system was established with the medical team. RESULTS: The pass rate for the collection of the bone of the human organ increased from 71.4% pre-intervention to 96% post-intervention. CONCLUSIONS: The project reduced patient complaints and raised the accuracy of the bone collection process.

Quality control processes in allografting: A twenty-year retrospective review of a hospital-based bone bank in Taiwan.

Musculoskeletal allografts are now commonly used. To decrease the potential risks of transmission of pathogenic bacteria, fungi, or viruses to the transplant recipients, certain issues regarding the management of patients who receive contaminated allografts need to be addressed. We aimed to clarify the incidence and extent of disease transmission from allografts by analyzing the allografting procedures performed in the bone bank of our hospital over the past 20 years. We retrospectively reviewed the data from our allograft registry center on 3979 allografts that were implanted in 3193 recipients throughout a period of two decades, from July 1991 to June 2011. The source of the allografts, results of all screening tests, dates of harvesting and implantation, and recipients of all allografts were checked. With the help of the Center for Infection Control of our hospital, a strict prospective, hospital-wide, on-site surveillance was conducted, and every patient with healthcare-associated infection was identified. Fisher's exact test was used to compare the infection rate between recipients with sterile allografts and those with contaminated allografts. The overall discard and infection rates were, respectively, 23% and 1.3% in the first decade (1991-2001); and 18.4% and 1.25% in the second decade (2001-2011). The infection rate of contaminated allograft recipients was significantly higher than that of sterile allograft recipients (10% vs. 1.15%, P < 0.01) in the second decade. Both infection and discard rates of our bone bank are comparable with those of international bone banks. Strict allograft processing and adequate prophylactic use of antibiotics are critical to prevent infection and disease transmission in such cases.

Efficient use of a limited resource femoral head allograft: A comparison of allograft preparation methods.

PURPOSE: The purpose of the study was to compare the yield and compressed volume of femoral head allograft prepared by either hand morselization or a bone mill. METHODS: Twenty human femoral head allografts were donated from a bone bank and morselized by two different methods. The heads were divided in half and split into two sample groups. One group underwent hand morselization with large bone nibblers, while the other was prepared using a bone mill. The volume of graft produced was measured. Ten-gram aliquots of each sample then underwent 30 impactions in a contained cavity, with the volume of graft compression measured. RESULTS: Bone milling yielded approximately 31% more usable graft than hand morselization (81% to 50%; p = 0.0001). There was no difference between the compressed volume of graft prepared by either method ( p = 0.14). CONCLUSION: This study demonstrates the efficacy of preparation of allograft with a bone mill and assists the clinician in determining the yield of graft by the weight of femoral head, thereby potentially minimizing excessive ordering and wastage.

Automatic allograft bone selection through band registration and its application to distal femur.

Clinical reports suggest that large bone defects could be effectively restored by allograft bone transplantation, where allograft bone selection acts an important role. Besides, there is a huge demand for developing the automatic allograft bone selection methods, as the automatic methods could greatly improve the management efficiency of the large bone banks. Although several automatic methods have been presented to select the most suitable allograft bone from the massive allograft bone bank, these methods still suffer from inaccuracy. In this paper, we propose an effective allograft bone selection method without using the contralateral bones. Firstly, the allograft bone is globally aligned to the recipient bone by surface registration. Then, the global alignment is further refined through band registration. The band, defined as the recipient points within the lifted and lowered cutting planes, could involve more local structure of the defected segment. Therefore, our method could achieve robust alignment and high registration accuracy of the allograft and recipient. Moreover, the existing contour method and surface method could be unified into one framework under our method by adjusting the lift and lower distances of the cutting planes. Finally, our method has been validated on the database of distal femurs. The experimental results indicate that our method outperforms the surface method and contour method.

A newly assembled human skeletal reference collection of modern and identified Filipinos.

A collection of 75 modern skeletons from the Philippines has recently been created, and is being housed at the Archaeological Studies Program of the University of the Philippines, Diliman, Philippines. All individuals lived during the 20th century, and almost all died within the 21st century. These individuals were accessioned from exhumed and abandoned tombs at the Manila North Cemetery, and most have documented age and sex from tombstone inscriptions. This paper describes the first season of recovery and the collection's current demographic composition, with the future addition of more individuals to the collection expected to follow. The Philippines has an immediate need for forensic resources given its large vulnerable population, widespread diaspora, and exposure to natural disasters. Having a collection of modern Filipinos available for study is critical to the advancement of forensic anthropology and skeletal biology, especially for this heavily understudied population and region of the world.

Effect of bone bank processing on bone mineral density, histomorphometry & biomechanical strength of retrieved femoral head.

BACKGROUND & OBJECTIVES: Standard processing of the bone grafts involves deep-freezing and sterilization with gamma irradiation which may alter mechanical properties of the bone graft. This study was aimed at measuring the effect of bone bank processing on the mechanical properties of bone allograft and its correlation with bone mineral density [BMD, dual-energy X-ray absorptiometry (DEXA Scan)] and histomorphometric indices. METHODS: Femoral heads retrieved from patients undergoing hip replacement surgeries were used as the material. Twenty femoral heads were under taken in the study. Each femoral head was cut into two equal cubes. One cube was subjected to BMD measurement using DEXA Scan followed by unilateral compression test. Histomorphometric indices such as trabecular number (Tb. N.), trabecular separation (Tb. S.), trabecular thickness (Tb. T.) and bone volume (B.V.) were calculated on the same specimen by a computer software. The other cube was kept in deep freezer (-76°C) for a minimum of three weeks, followed by gamma irradiation and subjected to similar tests. RESULTS: Results were compared in pre- and post-processed bone specimens. A significant loss of biomechanical strength (P<0.001) with mean a loss of 18.90 per cent was found in post-processed samples in uniaxial compression tests. Similarly, BMD (mean decrease by 13.8%, P<0.01) and histomorphometric indices such as Tb. T. (mean decrease by 12.37%, P<0.01), Tb. S. (mean increase by 12.60%, P<0.001) and B.V. (mean decrease by 20.84%, P<0.01) were found. However, Tb. N. was not significantly affected. INTERPRETATION & CONCLUSIONS: The current method of processing of bone allografts i.e. deep-freezing and gamma irradiation appeared to cause a significant reduction in the biomechanical strength of allogenic bone which was more suitable to be use in the morselized form. Appropriate consideration for decreased strength needs to be given when using allogenic bone graft as a structural graft.

Utilização de enxerto ósseo proveniente de banco de ossos na Implantodontia / Use of bone graft of bone bank in Implantology

Muitas vezes é necessário o uso de enxerto ósseo em cirurgias para instalação de implantes. A utilização de ossos homógenos provenientes de banco de ossos passou a despertar interesse devido inúmeras vantagens em relação aos outros tipos de enxertos ósseos. O objetivo deste estudo foi realizar uma busca sistemática da literatura para avaliar a utilização de osso homógeno na reabilitação de pacientes com altura e espessura ósseas insuficientes para a instalação de implantes dentários. Os artigos foram procurados através de uma estratégia de busca nas bases de dados eletrônicas Pubmed - Biblioteca nacional de Medicina US, Bireme - Biblioteca virtual em saúde e Biblioteca Cochrane. Foram encontrados 594 estudos, destes 590 foram excluídos após a leitura de títulos de resumos, e 4 foram selecionados para leitura completa do artigo e incluídos. Todos os estudos incluídos foram avaliados em relação à qualidade dos estudos e todos foram classificados com alto risco de viés. Concluiu-se que a utilização de homoenxertos demonstra ser uma ferramenta bastante útil para a Odontologia, com a finalidade de regenerar o tecido ósseo perdido dos maxilares, no entanto, serão necessários estudos futuros com mais critérios metodológicos para verificar os riscos e benefícios em utilizar enxertos de ossos homógenos provenientes de bancos de ossos na instalação de implantes (AU).

Many times the use of bone graft in surgeries for implant placement is necessary. The use of homogenous bone from bone bank began to awaken interest due to numerous advantages over other types of bone grafts. The aim of this study was to perform a systematic literature search to assess the use of homogenous bone in the rehabilitation of patients with insufficient bone height and thickness for the installation of dental implants. Articles were sought through a searching strategy in PubMed electronic databases - National Library of Medicine US, Bireme - Virtual Library in Health and Cochrane Library. As a result, 594 studies were found, 590 were excluded after reading abstract titles, and 4 were selected for complete article reading and were included. All included studies were assessed for their quality and all them were classified as high risk of bias. It was concluded that the use of homografts proves to be a useful tool for Dentistry, in order to regenerate lost bone jaw, however, it will require future studies with more methodological criteria to verify the risks and benefits of using homogenous bone from bone banks in implant placement (AU).