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1.
Zhonghua Wai Ke Za Zhi ; 58(3): 220-224, 2020 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-32187926

RESUMO

Objective: To examine the clinical effect of autologous osteochondral transplantation via biplanar osteotomy for osteochondral lesions of the talus combined with subchondral cysts. Methods: A retrospective analysis of 25 patients who underwent autogenous osteochondral transplantation via biplanar osteotomy for treatment of talus osteochondral injury combined with subchondral cysts at Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University from December 2015 to December 2018 were conducted.There were 21 males and 4 females, aged 35.5 years(range: 21 to 47 years).The extent and depth of cartilage damage of patients were evaluated under arthroscopy.The Outerbridge classification of patients were stage Ⅱ-Ⅳ. Through the anterior and medial incision of the medial malleolus, bilateral osteotomy of the medial malleolus was performed. The osteotomy block was turned down to reveal the cartilage damage site. The abnormal cartilage was completely removed and the sclerotic wall of cyst was completely removed with a spatula.Then the healthy cartilage from the same knee joint was transplanted to the talus cartilage damage area. The preoperative and postoperative visual analogue scale(VAS), American Orthopedic Foot Andankle Society-Ankle Hindfoot Scale (AOFAS-AH) and Karlsson-Peterson score and Lysholm score of knee joint were recorded. Data were analyzed by paired-samples t-test. Results: All of patients were followed up for 25.6 months (range: 12 to 48 months) .The VAS decreased from 6.5±1.3 to 1.9±1.3 (t=8.13, P=0.00) .AOFAS-AH increased from 62.4±3.3 to 88.0±2.4 (t=-31.51, P=0.00) .Karlsson-Peterson scores increased from 59.8±2.7 to 85.2±3.5 (t=-25.50, P=0.00) . While there was no statistical different in Lysholm score of knee joint (92.5±1.3 vs. 92.0±1.3, t=1.93, P=0.065) . No complications like infection, translated cartilage necrosis, cycst residual, nonunion, persistent pain in donor site. Conclusion: Autologous osteochondral transplantation via biplanar osteotomy has satisfactory effect for patients with osteochondral lesions of the talus combined with subchondral cysts.


Assuntos
Cistos Ósseos/cirurgia , Transplante Ósseo , Cartilagem Articular/transplante , Osteotomia , Tálus/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante Autólogo , Adulto Jovem
2.
Medicine (Baltimore) ; 99(9): e18950, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118708

RESUMO

RATIONALE: The iliac bone graft procedure is one of the treatment options for individuals with extremely resorbed alveolar bones. An autogenous block bone graft can allow the use of an implant-supported fixed dental prosthesis, rather than conventional removable dentures, by completely edentulous patients. However, the iliac bone graft technique is an invasive procedure and should be carefully selected based on its long-term clinical results. This case report describes 11-year long-term outcomes for implant-supported complete denture on the grafted iliac bone. PATIENT CONCERNS: A 68-year-old Asian man was referred for oral rehabilitation with fixed dental prostheses. The patient had been unsatisfied with his removable dental prostheses in masticatory performance. DIAGNOSIS: Radiographical examination revealed severely atrophied maxilla. INTERVENTIONS: The atrophied maxilla was reconstructed with an iliac block bone graft, after which an implant-supported fixed complete denture was placed. OUTCOMES: During 11 years of follow-up, several prosthetic and mechanical complications were encountered. Nevertheless, no biological complications were observed. Marginal bone levels around the implants were well-maintained on the radiographs after 11 years of prosthetic use. LESSONS: Iliac bone graft can be chosen as a predictable treatment option that allows patients with extremely atrophic maxilla to use a fixed dental prosthesis instead of a removable denture.


Assuntos
Transplante Ósseo , Prótese Total Superior , Ílio/transplante , Idoso , Autoenxertos , Humanos , Masculino
3.
Acta Chir Orthop Traumatol Cech ; 87(1): 48-51, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-32131971

RESUMO

PURPOSE OF THE STUDY Our experimental study presents a set of bone grafts harvested by a minimally invasive procedure from selected deceased donors. Our objective was to compare the concentration of red bone marrow in the cancellous bone harvested in this way from selected regions with the reference harvesting from the iliac crest. Thus, the potential of grafts to heal complicated fractures or non-unions is assessed. MATERIAL AND METHODS The Hospital Department of Pathology provided 10 cadaver preparations - 7 male and 3 female for the experiment. In the process of selection, the age limit was 18-50 years, the other exclusion criteria were severe injuries and burning to death as mechanisms affecting the condition of the skeletal system, bone diseases except for osteoporosis, and malignant diseases. From each preparation, a total of 12 samples of cancellous bone tissue were harvested from pre-defined 6 harvest sites bilaterally - proximal humerus, proximal ulna, greater trochanter of proximal femur, distal femur, proximal tibia and from the reference region of the iliac wing. The grafts were harvested using a 10 mm bone cutter. In total, 120 samples of cancellous bone of the determined diameter and uniform length of 30 mm were obtained. The obtained preparations were laboratory processed, fixed, decalcified and hematoxylin-eosin stained. The samples were assessed microscopically. The share of the bone tissue and cancellous bone was expressed as a percentage. Determined as a healing potential parameter was the concentration of red bone marrow and its ratio to the yellow bone marrow was stated. The hypothesis was tested using the ANOVA analysis of variance. RESULTS The highest concentration of red bone marrow was observed in cancellous grafts harvested from the iliac wing with 34.95%, followed by greater trochanter of proximal femur with 31.7%, distal femur with 26.9% and proximal humerus with 21.9%. Its concentration was negligible in proximal tibia with 2.55% and proximal ulna with 0.15%. By ANOVA statistical method the values of reference samples from the iliac wing and greater trochanter of the femur, distal femur and proximal humerus were compared. The differences are not statistically significant - P 0.60, 0.48 and 0.34 (p < 0.05). No significant differences were found in the concentration of red bone marrow. Statistically compared were also the values of reference samples from the iliac wing and proximal tibia, proximal ulna. This difference is statistically significant - P 0.0008 and 0.0002 (p <0.05). Thus, the difference in the concentration of red bone marrow is obvious. DISCUSSION The aforementioned results suggest that the greatest potential to heal will be achieved with the use of bone grafts from the iliac wing region, followed by greater trochanter of the femur, distal femur and proximal humerus. When testing the hypothesis by the ANOVA method, the detected differences between the selected harvest regions are not statistically significant. Therefore, the iliac wing grafts can be used in practice just as the material from greater trochanter of the femur, distal femur or proximal humerus, which is of equal quality. The other regions, proximal tibia and ulna, contain only minimum concentration of red bone marrow. CONCLUSIONS The experimental study comparing the concentration of red bone marrow in grafts harvested using a minimally invasive procedure from the region of greater trochanter, distal femur and proximal humerus concluded that these samples are comparable with the grafts from the iliac wing. The grafts harvested from proximal tibia and proximal ulna show only negligible concentration of red bone marrow and their use in clinical practice is disputable. The benefits of our experimental study for treatment shall be further evaluated in a clinical study. Key words: bone marrow, stem cells, bone healing/orthobiologics, new technology assessment, autograft harvesting.


Assuntos
Transplante de Medula Óssea , Transplante Ósseo , Osso Esponjoso , Ílio , Animais , Osso Esponjoso/transplante , Feminino , Fêmur , Masculino , Tíbia
4.
Zhongguo Gu Shang ; 33(1): 87-92, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-32115932

RESUMO

OBJECTIVE: To systematically evaluate the clinical effects of autologous bone grafting versus bone morphogenetic protein treatment for nonunion of long bone fractures in adults and provide reference for this fracture. METHODS: According to the methods of systematic review of Cochrane, the randomized controlled trials which compared autologous bone grafting with bone morphogenetic protein treatment for nonunion of long bone fractures in adults were searched in PuMed, Embase, Cochrane library, CNKI , Wangfang data and CBM from the databases were established to March 2019. Information was screened and extracted according to the inclusion and exclusion criteria by two researchers respectively, and the qualities of the included studies were assessed by the modified Jadad quality scale. The rate of infection, successful union, second operation, hospital stays and intraoperative blood loss were compared by RevMan 5.3 software from Cochrane Collaboration for Meta-analysis. RESULTS: Seven randomized controlled trials with a total of 652 patients were included, 410 in the autologous bone grafting group and 242 in the bone morphogenetic protein group. Meta analysis showed there were no statistically significant differences regarding infectionï¼»RR=1.32, 95%CI (0.90, 1.93) , P=0.16ï¼½, successful unionï¼»RR=0.95, 95%CI (0.84, 1.08) , P=0.43ï¼½, second operationï¼»RR=1.16, 95%CI (0.43, 3.12) , P=0.76ï¼½, hospital staysï¼»MD=0.69, 95%CI (-0.38, 1.75) , P=0.21ï¼½between the two groups. But compared with the bone morphogenetic protein treatment, autologous bone grafting significantly increased the intraoperative blood lossï¼»MD=223.00, 95%CI (32.72, 413.28) , P=0.02ï¼½. CONCLUSION: Since bone morphogenetic proteins can attain as the same fracture healing rate as autologous bone grafting and can significantly reduce the intraoperative blood loss, bone morphogenetic proteins may be a better choice for nonunion of long bone fractures in adults.


Assuntos
Fraturas Ósseas , Adulto , Proteínas Morfogenéticas Ósseas , Transplante Ósseo , Consolidação da Fratura , Humanos , Transplante Autólogo , Resultado do Tratamento
5.
Compend Contin Educ Dent ; 41(3): 156-163, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32125168

RESUMO

The anatomic proximity of the maxillary sinus to the apices of molar and premolar teeth is a significant factor when considering implant therapy to replace maxillary posterior teeth. An emerging field within tissue engineering is the application of xenografts capable of stimulating de novo bone regeneration. This article presents a technique using a crestal approach to sinus grafting utilizing a novel bone graft material composed of porcine, ribose cross-linked collagen seeded with a nanocrystalline hydroxyapatite mineral. This highly cohesive biomaterial is able to minimize graft migration, which is particularly important in case of undetected Schneiderian membrane perforations. The material also has been demonstrated in animal studies to be capable of osteoconduction, resulting in increased bone volume in ridge augmentation procedures.


Assuntos
Implantes Dentários , Levantamento do Assoalho do Seio Maxilar , Animais , Transplante Ósseo , Colágeno , Implantação Dentária Endo-Óssea , Humanos , Seio Maxilar , Ribose , Suínos
6.
Quintessence Int ; 51(4): 318-327, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32128527

RESUMO

Free mucous membrane grafts and connective soft tissue grafts have been considered the gold standard in oral soft tissue regeneration for a long period of time. Due to the morbidity while harvesting autogenous soft tissue grafts, xenogeneic collagen matrices of porcine origin were recently developed. Next to soft tissue regeneration, these collagen matrices have also been reported to be suitable for bone regeneration in the context of bone graft stabilization and shielding techniques. Collagen matrices are classed as medical devices, and are produced in a complex treatment and cleaning process. With respect to the individual area of indication, collagen matrices are produced from porcine dermis, pericardium, or peritoneum. The advantages and limitations of collagen matrices in comparison to autogenous soft tissue grafts in the different indication areas are controversially discussed. There might be evidence that these collagen matrices are able to reach similar outcomes to autogenous soft tissue grafts in certain indications. Currently, a final assessment of this relevant question is not possible cause of a lack of evidence-based data. Originally published (in German) in Quintessenz Zahnmedizin 2019;70:64-76).


Assuntos
Colágeno , Cicatrização , Animais , Regeneração Óssea , Transplante Ósseo , Suínos
7.
Zhongguo Gu Shang ; 33(2): 149-53, 2020 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-32133815

RESUMO

OBJECTIVE: To evaluate the clinical effects of debridement and bone grafting with internal fixation via anterior approach in treatment of tuberculosis of lower cervical vertebrae. METHODS: The clinical data of 15 patients with tuberculosis of lower cervical vertebrae who accepted the treatment of one-stage debridement and bone grafting with internal fixation from June 2010 to December 2018 were retrospectively analyzed. There were 9 males and 6 females, aged from 39 to 72 years with an average of (54.67±10.75) years. The lesion segment was C4 to C6. Pre- and post-operative neurologic functions were evaluated by ASIA grade. All the patients underwent the X-ray films of positive and lateral of cervical spine before and after the operation and accepted the periodic review of CT to evaluate the bone grafting. RESULTS: All the 15 operations were successful, no neurological or vascular injury occurred during the operation, and all patients were followed up for 18 to 52 months. The clinical symptoms improved significantly during the follow-up period and CT showed good bone grafting fusion. One patient suffered a relapse of the illness 3 years later, but was healed during the follow-up visit by strengthening the anti tuberculosis therapy. CONCLUSION: For the patients with vertebral destruction and loss of cervical stability, one-stage debridement and bone grafting with internal fixation via anterior approach has definite curative effects. On the basis of standard anti tuberculosis treatment before operation, the long-term standard anti-tuberculosis treatment after operation is the key to healing the tuberculosis of lower cervical vertebrae.


Assuntos
Fusão Vertebral , Tuberculose da Coluna Vertebral , Adulto , Idoso , Transplante Ósseo , Vértebras Cervicais , Desbridamento , Feminino , Fixação Interna de Fraturas , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vértebras Torácicas , Resultado do Tratamento
8.
Zhongguo Gu Shang ; 33(2): 166-72, 2020 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-32133818

RESUMO

OBJECTIVE: To investigate the clinical effect of One-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion for the treatment of lumbosacral tuberculosis. METHODS: The clinical data of 31 patients with lumbosacral tuberculosis treated by one-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion from January 2013 to February 2018 were retrospectively analyzed. There were 18 males and 13 females, aged from 18 to 77 years old with an average of (45.9±9.1) years. The lesion segment was form L4 to S2. The preoperative ASIA grading showed that 2 cases were grade B, 17 cases were grade C, 12 were grade D. Pre- and post-operative C reactive protein (CRP), visual analogue scale (VAS), erythrocyte sedimentation rate (ESR), ASIA grade, lumbosacral angle and intervertebral space height were analyzed, the surgery complications, stability of internal fixation, bone fusion were observed. RESULTS: All the 31 patients were followed up for 10 to 24 months with an average of (16.0±3.1) months. One patient with local infection and subcutaneous hydrops was cured by dressing change. Other 30 cases got primary healing without sinus formation and no recurrence of spinal tuberculosis. All the patients were cured, no internal fixation loosening and breakage were found. All bone fusion was successful with an average fusion time of (4.7±1.1) months. At the final follow-up, ESR and CRP were normal, the VAS was decreased from (6.13±1.21) points preoperatively to (1.92±0.57) pioints, the ASIA grading showed that 2 cases were grade C, 6 cases were grade D, and 23 cases were grade E. The lumbosacral angle and intervertebral space height was increased from preoperative (21.42±3.75) °, (7.84±0.41) mm to (27.21±3.12) °, (9.80±0.38) mm at the final follow-up, respectively. CONCLUSION: One-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion is a practicable, effective and safe method for the treatment of lumbosacral tuberculosis. It can be recommended in clinical application.


Assuntos
Fusão Vertebral , Tuberculose da Coluna Vertebral , Adolescente , Adulto , Idoso , Transplante Ósseo , Desbridamento , Feminino , Fixação Interna de Fraturas , Humanos , Ílio , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vértebras Torácicas , Resultado do Tratamento , Adulto Jovem
9.
J Biol Regul Homeost Agents ; 34(1 Suppl. 1): 139-142, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32064848

RESUMO

Prosthetic rehabilitation of atrophic maxillary implants often requires grafting owing to vertical and transversal bone deficiency. The use of this procedure in order to insert implants was introduced by Tatum and published as a clinical study by Boyne and James. It can be performed via a lateral or crestal approach. This surgery is now widespread, with good results in terms of bone augmentation and implant osseointegration. Nevertheless, there is a small proportion of patients who have infectious complications with an incidence ranging from 3.5% to 10.5%. We observe that maxillary sinus augmentation is a successful preprosthetic technique for augmentation of the edentulous posterior maxilla. Preoperative assessment of the anatomy of the sinus reduces the rate of complications considerably.


Assuntos
Implantação Dentária Endo-Óssea , Implantes Dentários , Seio Maxilar/cirurgia , Transplante Ósseo , Humanos , Maxila , Seio Maxilar/anatomia & histologia , Resultado do Tratamento
10.
J Appl Oral Sci ; 28: e20190435, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32049138

RESUMO

OBJECTIVE: To quantify the bone volume that can be safely withdrawn from 3 donor sites: (1) the mandibular symphysis, (2) the oblique mandibular line and (3) the skullcap. METHODOLOGY: For the symphysis, 200 tomographic exams were evaluated by the extension of the anterior loop of mental foramen, by the nerve, by the distance of the foramens, by the distance between the vestibular cortical and the lingual plates and by the distance between the apexes, or lower anterior teeth, and the mandibular base, using the "distance" tool of the I-CAT Vision, in the panoramic and parasagittal reformations. For the oblique line, 70 TCFC exams were analyzed retrospectively in panoramic and parasagittal reformations, evaluating the thickness of the vestibular cortical and the distance between the cortical and the mandibular canal. For the cranial bone, a hexagonal donor site located in parietal area was considered. RESULTS: The average dimensions of the bone blocks that can be safely removed from the region of the mandibular symphysis are: 32.27 mm in length, 4.87 mm in height and 4 mm in thickness, providing a volume of 628.61 mm3 available for grafting. In the oblique line, the available bone volume for grafting was 859.61 mm3. In the region of the cranial vault, multiplying the average bone thickness by the area of the hexagon, an average volume of 2,499 mm3 was obtained. CONCLUSIONS: Comparing the donor sites, the bone availability in the cranial vault is 3 times greater than in the mandibular posterior region, and at least 2 times greater than in the mandibular symphysis.


Assuntos
Transplante Ósseo/métodos , Tomografia Computadorizada de Feixe Cônico/métodos , Mandíbula/transplante , Crânio/transplante , Sítio Doador de Transplante , Adolescente , Adulto , Idoso , Pontos de Referência Anatômicos , Osso Cortical/diagnóstico por imagem , Osso Cortical/transplante , Feminino , Humanos , Masculino , Mandíbula/diagnóstico por imagem , Ilustração Médica , Pessoa de Meia-Idade , Estudos Retrospectivos , Crânio/diagnóstico por imagem , Sítio Doador de Transplante/diagnóstico por imagem , Adulto Jovem
11.
Artigo em Inglês | MEDLINE | ID: mdl-32032400

RESUMO

The aim of this histologic, single-blind, parallel, randomized clinical trial was to compare vertical bone augmentation grafting with 100% autogenous bone (group AB) vs 50% deproteinized bovine bone matrix (DBBM)/50% autogenous bone (group BOAB) using the Fence Technique in a two-stage implant placement. A biopsy was performed in the regenerated area at implant insertion 6 months after the augmentation surgery. The results reflect a sample size of four patients treated per group. At implant placement, 6 months after grafting, no significant differences were evident in the histomorphometric comparisons, even if the percentage of residual graft was obviously greater in the BOAB group (P = .0314).


Assuntos
Aumento do Rebordo Alveolar , Substitutos Ósseos , Animais , Matriz Óssea , Transplante Ósseo , Bovinos , Implantação Dentária Endo-Óssea , Humanos , Método Simples-Cego
12.
Bone Joint J ; 102-B(2): 198-204, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009433

RESUMO

AIMS: This single-centre observational study aimed to describe the results of extensive bone impaction grafting of the whole acetabular cavity in combination with an uncemented component in acetabular revisions performed in a standardized manner since 1993. METHODS: Between 1993 and 2013, 370 patients with a median age of 72 years (interquartile range (IQR) 63 to 79 years) underwent acetabular revision surgery. Of these, 229 were more than ten years following surgery and 137 were more than 15 years. All revisions were performed with extensive use of morcellized allograft firmly impacted into the entire acetabular cavity, followed by insertion of an uncemented component with supplementary screw fixation. All types of reoperation were captured using review of radiographs and medical charts, combined with data from the local surgical register and the Swedish Hip Arthroplasty Register. RESULTS: Among patients with possible follow-up of ten and 15 years, 152 and 72 patients remained alive without revision of the acetabular component. The number of deaths was 61 and 50, respectively. Of those who died, six patients in each group had a reoperation performed before death. The number of patients with a reoperation was 22 for those with ten-year follow-up and 21 for those with 15 years of follow-up. The Kaplan-Meier implant survival rate for aseptic loosening among all 370 patients in the cohort was 96.3% (95% confidence interval (CI) 94.1 to 98.5) after ten years and 92.8% (95% CI 89.2 to 96.6) after 15 years. CONCLUSION: Extensive bone impaction grafting combined with uncemented revision components appears to be a reliable method with favourable long-term survival. This technique offers the advantage of bone stock restoration and disputes the long-standing perception that uncemented components require > 50% of host bone contact for successful implant survival. Cite this article: Bone Joint J 2020;102-B(2):198-204.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Transplante Ósseo/métodos , Prótese de Quadril , Idoso , Cimentos para Ossos/uso terapêutico , Cimentação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Sistema de Registros , Reoperação
13.
Artigo em Inglês | MEDLINE | ID: mdl-32032406

RESUMO

Several approaches for horizontal ridge augmentation have been proposed, including guided bone regeneration (GBR), ridge split, and block grafts. Minimally invasive techniques for horizontal GBR have been introduced to reestablish an adequate bone volume, minimizing tissue trauma and patient morbidity. The present article describes a tunnel technique with a subperiosteal bag for horizontal GBR. A collagen membrane is partially perforated, folded, and sutured to form a bag that is filled with xenogeneic bone graft. The filled bag is inserted into a subperiosteal tunnel such that the perforated side faces the alveolar ridge and the nonperforated side faces the tunnel flap. The main advantage of this approach is the preservation of the periosteum and the enhanced blood supply to the flap, which may contribute to increased favorable wound healing and a reduced risk of flap dehiscence and membrane exposure. This novel tunnel approach for horizontal GBR using a customized bag made from a collagen membrane, specifically adapted and filled with deproteinized bovine bone, resulted in a significant ridge volume gain that allowed implant placement.


Assuntos
Aumento do Rebordo Alveolar , Processo Alveolar , Animais , Regeneração Óssea , Transplante Ósseo , Bovinos , Implantação Dentária Endo-Óssea , Regeneração Tecidual Guiada Periodontal , Humanos
14.
Instr Course Lect ; 69: 317-330, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017735

RESUMO

Scaphoid fractures are common and notorious for their troublesome healing. The aim of this review is to reevaluate the current best evidence for the diagnosis, classification, and treatment of scaphoid fractures and nonunions. MRI and CT are used to establish a "definitive diagnosis" with comparable diagnostic accuracy although neither is 100% specific. Current classifications cannot reliably predict union or outcomes; hence, a descriptive analysis of fracture location, type, and extent of displacement remains most useful. Treatment of a nondisplaced scaphoid waist fracture remains an individualized decision based on shared decision-making. Open reduction and internal fixation may be preferred when fracture displacement exceeds 1 mm, and the fracture is irreducible by closed or percutaneous means. For unstable nonunions with carpal instability, either non-vascularized cancellous graft with stable internal fixation or corticocancellous wedge grafts will provide a high rate of union and restoration of carpal alignment. For nonunions characterized with osteonecrosis of the proximal pole, vascularized bone grafting can achieve a higher rate of union.


Assuntos
Fraturas não Consolidadas , Osso Escafoide , Traumatismos do Punho , Transplante Ósseo , Fixação Interna de Fraturas , Consolidação da Fratura , Humanos
15.
Instr Course Lect ; 69: 417-432, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017743

RESUMO

Bone defects may occur after trauma, infection, or oncologic resection. A critical sized defect is any defect that is unable to spontaneously heal and will require secondary procedure(s) to obtain union. Autologous grafting is widely used, but may be insufficient to obtain union in these situations. Other options include the induced membrane technique, bone transport through distraction osteogenesis, or free vascularized bone transfer. This chapter will review options for obtaining graft, and the aforementioned special techniques for managing these challenging problems.


Assuntos
Anormalidades Musculoesqueléticas/terapia , Osteogênese por Distração , Transplante Ósseo , Humanos , Cicatrização
16.
Med Oral Patol Oral Cir Bucal ; 25(2): e291-e298, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32040468

RESUMO

BACKGROUND: This systematic literature review aimed to evaluate the efficacy of allogeneic bone blocks for ridge augmentation by assessing block survival rates and subsequent implant survival, including post-surgical complications and histomorphometric analysis. MATERIAL AND METHODS: An electronic and manual search among references, was conducted up to April 2019 by two independent authors. Inclusion criteria were: human clinical trials in which the outcomes of allogeneic bone block grafts were evaluated by means of their survival rates and subsequent implant success rates. RESULTS: Seven articles fulfilled the inclusion criteria and were analyzed. A total of 323 allogeneic block grafts were monitored for a minimum of 12 months follow-up after surgery, of which thirteen (4.02%) failed. Regarding the cumulative implant survival rate, the weighted mean was 97.36%, computed from 501 implants. Histologic and histomorphometric analysis showed that allogeneic block grafts presented some clinical and microstructural differences in comparison with autologous block grafts. CONCLUSIONS: Atrophic alveolar crest reconstruction with allogeneic bone block grafts would appear a feasible alternative to autologous bone block grafts, obtaining a low block graft failure rate, similar implant survival rate and fewer postoperative complications. Further investigations generating long term data are needed to confirm these findings.


Assuntos
Aumento do Rebordo Alveolar , Implantes Dentários , Transplante de Células-Tronco Hematopoéticas , Atrofia , Transplante Ósseo , Implantação Dentária Endo-Óssea , Humanos
17.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 38(1): 23-29, 2020 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-32037762

RESUMO

OBJECTIVE: Mandibular condyle injury usually results in malocclusion and disharmony of facial growth in growing children. This study aimed to evaluate the long-term effects of autogenous coronoid grafts on the facial growth of children with unilateral temporomandibular joint (TMJ) ankylosis who underwent mandibular condyle reconstruction. METHODS: Ten growing patients with unilateral bony TMJ ankylosis admitted in West China Hospital of Stomatology, Sichuan University between January 1st, 2008 and December 31st, 2016 were followed up and evaluated. These patients include three males and seven females with ages ranging from 5 years to 12 years at the time of surgery. Each patient underwent gap arthroplasty, condyle reconstruction with ipsilateral coronoid, and interposition of the pedicled temporalis fascial flap in a single operation. The postoperative follow-up ranged from 3 years to 8 years with an average of 4.9 years. Postoperative panoramic radiographs determined the growth of the mandibular height and length on the affected side and compared it with those of the healthy side. RESULTS: All patients recovered uneventfully after surgery. At the end of follow-up period, the maximal mouth opening ranged from 32 mm to 41 mm with an average of 35.6 mm. Mandibular height and length continued to grow after the successful treatment of ankylosis using autogenous coronoid grafts for condyle reconstruction. However, growth deficit still existed. The final ramus height and mandibular length of the affected side at the end of follow-up increased by 25.3% (P<0.05) and 26.1% (P<0.05), respectively, compared with the initial values measured immediately after surgery. Growth rates of ramus height and mandibular length of the affected side were 47.1% and 27.2% lower (P<0.05) than those of the healthy side, respectively. CONCLUSIONS: Mandibular height and length continued to grow after the successful treatment of ankylosis by using autogenous coronoid grafts for condyle reconstruction. However, growth deficit still existed. The growth rate of the affected mandible was reduced compared with that of the undisturbed side even after treatment of ankylosis.


Assuntos
Anquilose , Côndilo Mandibular , Transplante Ósseo , Criança , Pré-Escolar , China , Feminino , Humanos , Masculino , Articulação Temporomandibular , Transtornos da Articulação Temporomandibular
18.
Clin Oral Investig ; 24(3): 1073-1089, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31927693

RESUMO

OBJECTIVES: The aim of this systematic review was to investigate the predictability of the sandwich osteotomy technique to provide sufficient alveolar bone height for dental implant therapy in vertically atrophic jaws. MATERIAL AND METHODS: A MEDLINE (Pubmed), EMBASE and Cochrane Library electronic search and a manual search were performed until July 2018. Any clinical study published in English, reporting data on at least 10 patients rehabilitated with implant-supported dental prostheses after vertical ridge augmentation by means of the sandwich osteotomy technique and followed for at least 12 months after loading, was included. Data on study and patients' characteristics, interventions provided, implant and prostheses survival rates and complications were extracted from the included studies. Each study design was evaluated using the Cochrane Collaboration's tool for assessing risk of bias. RESULTS: Initially, 415 records were identified, from which 10 full-text articles could be included in the final qualitative analysis. Implant survival rate after a mean follow-up of 3.7 years (median: 3 years; range: 1-7 years) was 94% (median: 93%; range: 91-100%). Peri-implant mean marginal bone resorption was 1.6 mm (median: 1.4 mm; range: 0.6-4.7 mm). The calculated mean alveolar bone height available at the time of implant placement was 11.3 mm (median: 11.5 mm; range: 7.8-16 mm). A temporary sensory disturbance of the inferior alveolar nerve was the most commonly reported complication following the sandwich osteotomy. CONCLUSIONS: The present systematic review documents that implant survival rate after mandibular vertical ridge augmentation using the sandwich osteotomy technique is high after up to 5 years of loading. The complication rate can be considered moderate and has predominantly a transient nature. Data on the long-term behavior of the augmented bone and inserted implants are missing. CLINICAL RELEVANCE: The present technique can be considered a reliable treatment option in cases of moderate vertical bone deficiency of the posterior mandible to provide suitable conditions for later implant placement. Intra- and post-operative complications do not seem to jeopardize the final outcome.


Assuntos
Perda do Osso Alveolar , Aumento do Rebordo Alveolar , Implantação Dentária Endo-Óssea , Implantes Dentários , Osteotomia/métodos , Transplante Ósseo , Planejamento de Prótese Dentária , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Humanos , Resultado do Tratamento
19.
BMC Oral Health ; 20(1): 22, 2020 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992277

RESUMO

BACKGROUND: Periodontally accelerated osteogenic orthodontics (PAOO) is a treatment for bone defects associated with a lack of bone graft stability, especially in coronal locations. This study aimed to compare a modified technique of membrane fixation that utilizes periosteal sutures (using a pouch design) with the traditional approach, which does not use membrane fixation. METHODS: Twenty-eight patients with a total of 168 teeth treated were divided into two groups: 1-A, in which patients were treated using the modified technique (with membrane fixation), and group 2-B, in which patients were treated using the traditional technique (without membrane fixation). The postoperative bone thickness was evaluated via radiographic examination. RESULTS: Postoperative improvements in bone augmentation were detected in both groups. At 12 months, the values of the CHBT (measured from the midpoint of the coronal third to the labial cortical surface, 0.84 ± 0.33 mm) and the values of VBL (measured from the alveolar crest to the cemento-enamel junction, - 2.35 ± 0.80 mm)were significantly greater in the modified technique group than those in the traditional technique group (CHBT:0.12 ± 0.21 mm and VBL:-1.39 ± 0.99 mm; P = 0.00 and P = 0.01). CONCLUSIONS: This study shows that compared to the traditional technique, the modified PAOO technique with membrane fixation using periosteal sutures provides improved graft stabilization, superior coronal augmentation and satisfactory vertical volume.


Assuntos
Processo Alveolar/cirurgia , Transplante Ósseo/métodos , Ortodontia Corretiva/métodos , Procedimentos Cirúrgicos Ortognáticos/métodos , Osteogênese/fisiologia , Osteotomia/métodos , Aumento do Rebordo Alveolar/métodos , Humanos , Ortodontia Corretiva/instrumentação , Técnicas de Movimentação Dentária/métodos , Resultado do Tratamento
20.
Orthopade ; 49(2): 149-156, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31974630

RESUMO

BACKGROUND: The treatment of primary malignant bone tumours is interdisciplinary and individually adapted to the patient. Nowadays, limb salvage surgery is usually possible, and the subsequent reconstruction is carried out either by implantation of modular tumour megaprostheses or by biological reconstruction procedures. Special surgical and secondary complications have to be considered. OBJECTIVES: Indication and explanation of various biological reconstruction procedures and presentation of specific peri- and postoperative complications. MATERIALS AND METHODS: An adapted literature review and the contribution of our own therapy experiences and case studies for the presentation of biological reconstructions and their complication management was performed. RESULTS: In biological reconstructions, autografts, allografts or a combination of autografts and allografts are used. Stabilization is achieved with screw and plate osteosyntheses. The most common secondary complications are pseudarthrosis, interponate fracture, graft necrosis and secondary malpositions. CONCLUSION: In selected cases, particularly at the upper extremities and in dia- or metaphyseal tumour sites, biological reconstruction after extralesional tumor resection is the surgical therapy of choice. The rate of long-term revision interventions is significantly lower compared to modular tumour megaprostheses. Biological reconstructions and the treatment of specific complications have to be performed in specialized centres for musculoskeletal surgical oncology/tumor orthopedics.


Assuntos
Neoplasias Ósseas , Procedimentos Cirúrgicos Reconstrutivos , Autoenxertos , Transplante Ósseo , Humanos , Salvamento de Membro , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento
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