A prospective comparative study of radiological outcomes after instrumented posterolateral fusion mass using autologous local bone or a mixture of beta-tcp and autologous local bone in the same patient.

BACKGROUND: We previously reported a retrospective analysis of radiographic changes in instrumented posterolateral fusion mass (PLF) established using a mixture of local autologous bone and beta tricalcium phosphate (b-TCP) in lumbar spinal fusion surgery. Here, we report a prospective study to compare the use of local bone and a mixture of local bone and b-TCP in PLF in degenerative spinal surgery. METHODS: Radiological changes in the PLF mass in 42 patients were analyzed for 12 months. All patients had degenerative lumbar spinal disease and underwent instrumented fusion. Local autologous bone was used for PLF on the left side, and a mixture of local autologous bone and b-TCP was used for PLF on the right side. Lumbar spinal anterior-posterior (AP) images were performed immediately postoperative and at 1, 3, 6, and 12 months. Computed tomography (CT) was also done immediately postoperative and at 12 months. Fusion rate, radiodensity, and the dimensions of the PLF mass bilaterally on the AP X-ray were compared. The change in volume in both fusion bridges in the CT image was also compared. RESULTS: The overall fusion rates were 31/42 (73.8 %) and 24/42 (57.1 %) on the left and right sides, respectively. The decrease in radiodensity at 1 month postoperative was significantly greater on the left side than on the right side (from 0.79 to 0.74 versus from 0.81 to 0.78; p = 0.002). The mean immediate postoperative volume on the left side measured with CT was 5.1 cc (95 % CI, 4.94-5.34) and on the right side was 5.2 cc (95 % CI, 4.97-5.37). The mean volume at 12 months had decreased to 2.2 cc (95 % CI, 1.85-2.64) on the left side and 1.87 cc (95 % CI, 1.48-2.67) on the right side. The volume decrease on the right side was statistically greater than on the left side (p = 0.048). CONCLUSIONS: Based on the changes in radiodensity and fusion rate during follow-up, local bone seems to undergo earlier resorption and stabilization than the mixture of local bone and b-TCP..

Minimally invasive anterior transarticular screw fixation and microendoscopic bone graft for atlantoaxial instability.

PURPOSE: Even though transarticular screw (TAS) fixation has been commonly used for posterior C1-C2 arthrodesis in both traumatic and non-traumatic lesions, anterior TAS fixation C1-2 is a less invasive technique as compared with posterior TAS which produces significant soft tissue injury, and there were few reports on percutaneous anterior TAS fixation and microendoscopic bone graft for atlantoaxial instability. The goals of our study were to describe and evaluate a new technique for anterior TAS fixation of the atlantoaxial joints for traumatic atlantoaxial instability by analyzing radiographic and clinical outcomes. METHODS: This was a retrospective study of seven consecutive patients with C1-C2 instability due to upper cervical injury treated by a minimally invasive procedure from May 2007 to August 2009. Bilateral anterior TAS were inserted by the percutaneous approach under Iso-C3D fluoroscopic control. The atlantoaxial joint space was prepared for morselized autogenous bone graft under microendoscopy. The data for analysis included time after the injuries, operating time, intraoperative blood loss, X-ray exposure time, clinical results, and complications. Radiographic evaluation included the assessment of atlantoaxial fusion rate and placement of TAS. Bone fusion of the atlantoaxial joints was assessed by flexion extension lateral radiographs and 1-mm thin-slice computed tomography images as radiographic results. Clinical assessment was done by analyzing the recovery state of clinical presentation from the preoperative period to the last follow-up and by evaluating complications. RESULTS: A total of 14 screws were placed correctly. The atlantoaxial solid fusion without screw failure was confirmed by CT scan in seven cases after a mean follow-up of 27.5 months (range 18-45 months). All patients with associated clinical presentation made a recovery without neurologic sequelae. Postoperative dysphagia occurred and disappeared in two cases within 5 days after surgery. There were no other complications during the follow-up period. CONCLUSIONS: Percutaneous anterior TAS fixation and microendoscopic bone graft could be an option for achieving C1-C2 stabilization with several potential advantages such as less tissue trauma and better accuracy. Bilateral TAS fixation and morselized autograft affords effective fixation and solid fusion by a minimally invasive approach.

Volume changes of iliac crest autogenous bone grafts after vertical and horizontal alveolar ridge augmentation of atrophic maxillas and mandibles: a 6-year computerized tomographic follow-up.

PURPOSE: To evaluate by computerized tomography the long-term volume resorption of autogenous corticocancellous grafted bone harvested from the ilium and used in an alveolar augmentation procedure followed by endosseous dental implant placement. PATIENTS AND METHODS: Eleven maxillary grafts (8 positioned horizontally) and 13 mandibular grafts (10 positioned vertically) were placed in 16 patients. Using software programs, pre- and postsurgical computerized tomographic scans were used to compare volumes of grafts over time (up to 6 yr) to determine the annual percentage of remaining bone and the overall percentage of bone resorption that could be expected. Yearly measurements of volumes and percentages of remaining bone were then compared statistically. RESULTS: At the 6-year survey for blocks grafted in the mandible, an average resorption rate of 87% was obtained; for maxillary grafts at the same survey, complete resorption of the grafts (mean, 105.5%) was recorded. In general, bone resorption appeared slow, except for that recorded in the first 2 years of healing, the only period in which statistical comparisons among all time points showed significant differences for all variables. CONCLUSIONS: Volumetric measurements of the grafts and their related percentages of remaining bone attested to a progressive and unavoidable bone resorption of almost all the grafted bone in the maxilla and mandible. Although the present data were from a heterogeneous group of defects treated with horizontal and vertical procedures, clinicians, when performing alveolar bone augmentation with an autogenous hip bone, should aim at titanium dental implant osseointegration, not only in the augmented bone but also in the native bone below the graft.

Platelet-rich plasma promotes angiogenesis of prefabricated vascularized bone graft.

PURPOSE: The objective was to assess the impact of platelet-rich plasma (PRP) on angiogenesis and bone formation of tissue-engineered bone in the prefabricated stage. MATERIALS AND METHODS: Both thighs of New Zealand white rabbits were used as prefabricated vascularized bone grafts using a combination of bone mesenchymal stem cells and vascular bundles in a titanium cage filled with ß-tricalcium phosphate ceramic. PRP was applied in the test group, and the same procedure was performed in the control group without the application of PRP. After 4, 8, and 12 weeks, delayed static bone scanning with technetium-99m methylene diphosphonate was performed before sacrifice, and the tissue-engineered bone samples were collected for immunohistochemical analysis using a monoclonal antibody against CD31 and histologic analysis. RESULTS: The results showed superior angiogenesis in the PRP group compared with the control group at each time point as determined by bone scintigraphy and immunohistochemical examinations. The results of histologic analysis also showed that there was more bone formation in the PRP group than in the control group at each time point. CONCLUSIONS: The application of autologous PRP was an effective strategy for increasing angiogenesis and bone formation in tissue-engineered bone and had potential significance for clinical applications.

Use of an autogenous cortical graft in combination with guided tissue regeneration for treatment of an infrabony defect.

Infrabony periodontal defects are common findings encountered during complete oral examinations. Treatment options for infrabony lesions are aimed at meeting client demands as well as patient needs. Deciding on how to treat these lesions depends on the nature and degree of disease present as well as having the materials available to improve the chances of achieving the greatest clinical success. Bone grafting of an infrabony defect of the left mandibular first molar tooth of a dog using an autogenous cortical graft harvested with a reusable bone grafter in combination with guided tissue regeneration is described.

The influence of perforating the autogenous block bone and the recipient bed in dogs. Part I: a radiographic analysis.

OBJECTIVES: This study evaluated radiographically the integration and volume maintenance of grafted autogenous block bone under various cortical bone perforation conditions in dogs. MATERIAL AND METHODS: Five mongrel dogs were used. Each dog received four differently prepared onlay block bone grafts: a solid block graft was fixed on either (1) a cortically perforated recipient bed (SGPR) or (2) a nonperforated recipient bed (SGNPR), a perforated block graft was fixed on either (3) a nonperforated recipient bed (PGNPR) or (4) a cortically perforated recipient bed (PGPR). The animals were sacrificed at 1 day, 4 days, 10 days, 4 weeks, and 8 weeks after surgery. Specimens were prepared and radiographic analysis was conducted by using micro-computed tomography. The residual bone volume (RBV; mm(3) ), cross-sectional bone area (BA; mm(2)), and residual height (RH; %) of the grafted block bone were measured radiographically. RESULTS: The interface between the recipient bed and the graft showed no signs of bone integration at 1, 4, and 10 days of healing. However, at 4 weeks of healing, bone integration was observed in all groups. The RBV, BA, and RH of the grafts gradually decreased by 4 weeks of healing. At 8 weeks, the PGPR condition exhibited a higher RBV, BA, and RH than the other conditions, whereas the SGNPR condition exhibited the lowest RBV, BA, and RH. CONCLUSION: Within the limitations of this study, it can be concluded that intentional cortical perforation on the recipient bed and block bone graft may influence volume maintenance of the graft.

Opening-wedge high tibial osteotomy with and without bone graft.

Medial opening-wedge has gained popularity in comparison to other techniques of high tibial osteotomy. This technique involves the creation of a gap in the tibia. Filling the gap with autologous iliac bone graft was recommended in the classic description, to prevent complications such as correction loss or delayed bone union. No previous reports have compared grafted and nongrafted osteotomies. This study hypothesized that the use of autologous bone graft in medial opening-wedge high tibial osteotomy (MOWHTO) less than 12.5 mm is unnecessary. A prospective randomized clinical trial was conducted. Forty-six opening-wedge high tibial osteotomies were carried out between April 2007 and December 2008. All had fixation with a type of Puddu stainless steel plate and screws. Patients were randomly divided by software analysis into two groups: group A had osteotomies that were filled with autologous bone graft and group B had osteotomies that were unfilled. Autologous iliac bone graft was harvested in both groups. Clinical and radiographic evaluations were performed twice monthly by blinded investigators. The rates of complications were compared between the groups. There was no difference in demographic data. Mean time to clinical bone union in group A was 12.4 weeks (confidence interval [CI] 11.2-13.6) and in group B was 13.7 weeks (CI 12.5-14.9), but this difference was not significant (P = 0.13). Signals of correction loss occurred in one patient (4.35%) in group A, and in two patients (8.70%) in group B. All osteotomies had achieved bone union. It was concluded that time to bone union was not statistically different between the group with bone graft and the group without graft.

Reconstruction of mandibular defects using a custom-made titanium tray in combination with autologous cancellous bone.

PURPOSE: To esthetically and functionally restore a 40-mm canine mandibular discontinuity defect using a custom-made titanium bone-grafting tray packed with autologous iliac bone. MATERIALS AND METHODS: Individualized titanium bone-grafting trays were made using a reverse engineering, computer-aided design, and rapid prototyping technique. A 40-mm discontinuity defect in the right mandibular body was created in 10 hybrid dogs. The defect was restored immediately using the tray that was densely packed with autologous cancellous iliac particles and covered with trimmed iliac chips. Sequential radionuclide bone imaging was performed postoperatively at 2, 4, 8, 12, and 24 weeks. The ratio of activity between the grafted mandible and the contralateral native mandible on each transaxial slice was calculated. The mean activity ratio was analyzed at each time point to evaluate the bone metabolism and reconstitution of the grafts. The subjects were sacrificed at 4, 12, and 24 weeks after grafting. The specimens were evaluated by postmortem gross dissection, biomechanical testing, 3-dimensional microcomputed tomographic scanning, and histologic examination. RESULTS: All the subjects tolerated the grafting operation well. Over an observation period of 24 weeks, tray extrusion occurred in 3 of the 10 subjects. Bony continuities were reconstructed in 9 of the 10 subjects. Radionuclide bone imaging revealed that the tracer uptake increased in the grafted mandible, and the radionuclide ratio between the graft and the native mandible decreased with time. Gross evaluation, microcomputed tomographic examination, biomechanical testing, and histologic examination demonstrated corticalization of the grafts. CONCLUSIONS: The use of a customized technique using reverse engineering, computer-aided design, and rapid prototyping tray containing autologous cancellous bone is a potentially powerful grafting technique for the reconstruction of mandibular discontinuity defects.

Scintigraphic, histologic, and histomorphometric analyses of bovine bone mineral and autogenous bone mixture in sinus floor augmentation: a randomized controlled trial--results after 4 months of healing.

PURPOSE: To test our null hypothesis stating that the mixture of autogenous cortical bone scrapings and bovine bone mineral (BBM) in a ratio of 1:4, compared with BBM alone, would have no significant effect on new bone formation 4 months after maxillary sinus floor augmentation. PATIENTS AND METHODS: Twenty-four patients presenting with alveolar bone height of less than 5 mm in the narrowest zone between the sinus floor and alveolar crest were randomly assigned to 2 treatment groups in this randomized controlled trial. We augmented 12 maxillary sinuses with a mixture of BBM and cortical autogenous bone graft, which was collected from the lateral wall of the maxillary sinus by a bone scraper, and 12 maxillary sinuses with BBM alone. Four months postoperatively, new bone formation in the augmented sinus sites was evaluated through bone scintigraphy, as well as histologic and histomorphometric analyses of the biopsy specimens obtained during implant placement. Data were statistically analyzed by independent-samples t test. RESULTS: Scintigraphically detectable new bone formation did not differ significantly between the groups (P > .05). Histologic findings showed that the new bone bridged between BBM particles and BBM underwent resorption by osteoclasts with or without the addition of autogenous bone graft. According to histomorphometric findings, the difference between the percentages of newly formed bone in the sinuses augmented with graft mixture (25.73%) and BBM alone (24.19%) was statistically nonsignificant (P > .05). CONCLUSIONS: The addition of autogenous cortical bone scrapings to BBM in a ratio of 1:4, compared with BBM alone, does not markedly increase new bone formation 4 months after maxillary sinus lifting.

Resorbable screw fixation for cortical onlay bone grafting: a pilot study with preliminary results.

PURPOSE: The current "gold standard" in alveolar ridge augmentation is autogenous bone grafting. Autologous cortical onlay grafts provide predictable increases in bone volume when used for alveolar ridge augmentation; however, rigid fixation of the graft to the recipient site is essential. Titanium screws are commonly used to provide rigid fixation for onlay grafting but have potential drawbacks including the need for a second surgery for removal before implant placement and screw fracture during removal. The present study investigated the efficacy of resorbable fixation screws to secure autologous cortical onlay grafts to the maxilla or mandible to augment alveolar bone height and/or width before implant placement. PATIENTS AND METHODS: Eleven patients requiring alveolar ridge augmentation were enrolled in this study. All patients received autologous cortical onlay grafts. Patients were randomly assigned to receive grafts fixated with 2.0-mm resorbable (experimental) or 1.5-mm titanium (control) screws. Integration and survivability of the graft was assessed using cone-beam computed tomography. Graft resorption was calculated at 4 to 7 months postoperatively and used as a quantitative outcome measurement. Statistical analysis was performed using NCSS/PASS (Dawson edition; Kaysville, UT) for Windows XP. Data are presented as mean ± standard error of the mean. Intergroup differences were assessed using Student's t test. RESULTS: Nine of the 11 patients initially enrolled completed the study. In these patients, 12 bone grafts were placed, 4 fixated with 2.0-mm resorbable screws and 8 fixated with 1.5-mm titanium screws. Integration and survivability of the grafts was 100% regardless of fixation type. Cone-beam computed tomographic data indicated that all grafts integrated regardless of fixation type. At 5 to 7 months postoperatively, cone-beam computed tomographic analysis indicated there were 28.07 ± 3.15% and 40.03 ± 3.67% bone resorption in grafts fixated with 2.0-mm resorbable and 1.5-mm titanium screws, respectively (P > .05). CONCLUSION: These data suggest that cortical onlay graft integration and survivability are similar using 2.0-mm resorbable or 1.5-mm titanium screw fixation. Therefore, use of resorbable fixation devices in alveolar ridge augmentation will obviate screw removal, which may result in screw breakage and may be difficult if bony overgrowth occurs. Further studies need to be performed with a larger sample to confirm these data.

Radiographic analysis of extracorporeally irradiated autografts.

OBJECTIVE: To analyse the long-term radiographic findings of intercalary, pure osteoarticular, and composite bone grafts in patients with primary bone sarcoma who were treated by reimplantation of the bone as an orthotopic autograft. MATERIALS AND METHODS: For this observational clinical study, 107 patients who presented with 108 malignant or locally aggressive benign bone tumours were treated by resection, extracorporeal irradiation (300 Gy), and reimplantation and fixation of the autograft. Bone healing features were evaluated with the International Society of Limb Salvage (ISOLS) graft evaluation method, which assesses fusion, resorption, fracture, graft shortening, fixation, subluxation, joint narrowing, and subchondral bone. A description of normal and abnormal healing patterns and complications comprised the secondary endpoint. RESULTS: Seventy-seven patients with complete radiographic data were selected for review. The mean ISOLS score was 78.2% (range 25.0-100%, median 79.2%). Three patient subgroups were created: intercalary graft, pure osteoarticular graft, and composite reconstruction consisting of an intercalary graft augmented with a prosthesis; the mean ISOLS scores were 81.3%, 70.7%, and 77.4%, respectively. Each item was scored individually, and no significant difference was observed (P = 0.225). CONCLUSION: This reconstruction technique is valid for the three methods described; bone stock is retained and, once the graft has healed, it behaves as normal bone. Close radiographic follow-up detects complications early, allowing timely interventions if necessary.

Can bone scintigraphy predict the final outcome of pasteurized autografts?

OBJECTIVE: As pasteurization is becoming more widely used in limb salvage reconstruction, more study is required to understand about host-graft junction healing, graft revascularization and incorporation, and the incidence and type of complications among pasteurized autografts. This was mainly achieved by follow-up radiography. We aimed to clarify whether Tc99m bone scanning can be considered a reliable method in determining these three parameters. MATERIALS AND METHODS: Twenty-seven osteosarcoma patients with pasteurized autograft reconstructions were retrospectively reviewed using available scintigraphic and radiographic follow-up every 6 months postoperatively for 36 months. Follow-up of the unhealed cases was continued for the maximum follow-up period available for each case beyond the original study period, ranging from 1 to 15 months. Tc99m uptake was classified as cold, faint, moderate and high uptake. Junction healing was classified as none, partial and complete healing. RESULTS: Seventy percent of junctions united with a mean of 22 months. Ninety to 100% of junctions showed increased uptake (high or moderate) at one time of the study regardless of final outcome. 85% of the pasteurized grafts showed the characteristic "tramline appearance". Four grafts (15%) were complicated: pseudoarthrosis and implant failure (1), fractured plate (1), intramedullary nail (IMN) fracture (1), and prosthesis stem loosening in the host bone (1), with underlying unhealed junctions in all cases. CONCLUSION: Bone scanning can determine the stages of the graft's rim revascularization and incorporation; however, it cannot detect or predict junction healing or occurrence of complications. Supplementary treatment of unhealed junctions showing either decreased junctional uptake or graft quiescence may be warranted. Otherwise, detection of distant metastasis and early local recurrence remains the main application of Tc99m scanning in the management of bone sarcomas.

Comparison of clinical, periapical radiograph, and cone-beam volume tomography measurement techniques for assessing bone level changes following regenerative periodontal therapy.

BACKGROUND: Intraoral radiographs (IRs) provide a two-dimensional view of osseous structures, whereas cone-beam volumetric tomography (CBVT) images are viewable in three dimensions. The aim of this investigation was to compare the measurements from digital IR and CBVT images to direct surgical measurements for the evaluation of regenerative treatment outcomes. METHODS: Digital IR and CBVT images were taken prior to initial bone grafting and at the 6-month reentry surgery for 35 intrabony defects. After defect debridement, direct bony defect measurements were made with a periodontal probe. These same measurements were made on the IR and CBVT images and then compared to the direct surgical values. RESULTS: CBVT correlated strongly with surgical measurements (r = 0.89 to 0.95), whereas IRs correlated less favorably (r = 0.53 to 0.67). IR measurements were significantly less accurate compared to CBVT for all parameters investigated and underestimated surgical measurements from 0.6 +/- 2.3 mm to 1.5 +/- 2.3 mm. No significant difference for the distance from the cemento-enamel junction (CEJ) to the alveolar crest (P = 0.66 for initial measurement and P = 0.92 for reentry), defect fill (P = 0.14), or defect resolution (P = 0.09) was seen between CBVT and surgical measurements; however, there was a significant difference for the distance from the CEJ to the base of the defect, with CBVT measurements underestimating the surgical measurements by 0.5 +/- 1.1 mm for reentry (P <0.01) and 0.9 +/- 0.8 mm for the initial measurement (P <0.01). CONCLUSIONS: Overall, compared to direct surgical measurements, CBVT was significantly more precise and accurate than IRs. If supported by further research, CBVT may obviate surgical reentry as a technique for assessing regenerative therapy outcomes.

Bone microbial contamination influences autogenous grafting in sinus augmentation.

BACKGROUND: The oral occurrence of putative microbial pathogens in humans has been documented in health and disease. The presence of periodontopathogens in patients with a history of periodontal disease may have a negative impact on bone regeneration. This investigation was conducted to confirm the presence of periodontal pathogens in bone particles harvested intraorally for maxillary sinus augmentation and to assess the clinical and radiographic outcomes 6 to 12 months after bone augmentation. METHODS: Culture and polymerase chain reaction (PCR)-based identification were performed by paper-point sampling of intraorally harvested bone particles in a group of 12 maintenance patients undergoing maxillary sinus augmentation. Radiographs were taken to assess and compare bone healing and volume gain at baseline and at 6 to 12 months after augmentation. RESULTS: The presence of periodontal pathogens (Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans [previously Actinobacillus actinomycetemcomitans], Prevotella intermedia, Tannerella forsythia [previously T. forsythensis], Fusobacterium nucleatum, Parvimonas micra [previously Peptostreptococcus micros or Micromonas micros], Campylobacter rectus, enteric Gram-negative rods, and Dialister pneumosintes) was identified in 10 of 12 patients (83%) by culture, PCR, or both and was associated with greater bone volume loss at 6 months postaugmentation. The PCR-positive triad, P. gingivalis, A. actinomycetemcomitans, and P. intermedia, was associated with pronounced volume loss of the grafted sinus at 6 months. CONCLUSIONS: To the best of our knowledge, this is the first study to confirm osseous microbial contamination with major periodontopathogens in individuals undergoing maxillary sinus augmentation with a history of periodontitis. The effect on the grafting outcome translated into bone volume loss in the grafted sinus 6 months postaugmentation. Specific microbial contamination may have an impact on osteogenesis in osseous regeneration.

Implant survival in maxillary and mandibular osseous onlay grafts and native bone: a 3-year clinical and computerized tomographic follow-up.

PURPOSE: This article discusses a 3-year retrospective survey of implant clinical survival and computerized tomographic analysis of bone remodeling in atrophic alveolar crests reconstructed via various autogenous bone grafting procedures and in similar regions of native bone. MATERIALS AND METHODS: The retrospective chart review included consecutive edentulous patients with severe alveolar crest atrophy treated between 2000 and 2002 with onlay autogenous bone grafts in the mandible and anterior maxilla (as needed) and implant insertion. Implant recipients were followed for 3 years. Defective areas were reconstructed by bone graft harvested from the chin or iliac crest. Implants in reconstructed areas were divided into two groups according to graft source. Implants in corresponding native areas served as controls. Cumulative survival rate (CSR), survival rate, and confidence interval (CI) were calculated, and linear measurements of bone remodeling around implants were assessed on computerized tomographic scans. Results were compared for statistically significant differences by Wilcoxon signed-rank test with a significance level a = .05. RESULTS: Forty patients were treated with 109 screw-type, root-form, rough-surfaced implants inserted in 48 onlay grafts; 88 implants were placed in native bone. The implant 3-year CSRs were 98.9% (CI 96.7% to 100%) in native bone and 99.1% (CI 97.3% to 100%) in onlay grafts, irrespective of bone source. Mean resorption in the maxilla was 4.6 +/- 0.9 mm buccally and 3.8 +/- 0.8 mm palatally in areas reconstructed with chin grafts, 3.4 +/- 1.7 mm buccally and 2.6 +/- 1.4 mm palatally in areas reconstructed with iliac crest grafts, and 3.2 +/- 1.2 mm buccally and 2.1 +/- 0.9 mm palatally in native areas. CONCLUSIONS: Similar implant CSRs were seen in native and grafted sites. Maximal implant CSR was observed in onlay grafts from the chin despite more marked linear bone remodeling in this group as compared to iliac crest grafts or native bone.

Alternative applications of guided surgery: precise outlining of the lateral window in antral sinus bone grafting.

Computed tomography (CT) and the application of CT-based guided implant surgery allow clinicians to provide enhanced precision and accuracy in implant surgery. Because of the difficulty in transferring a patient's often complex anatomic sinus configurations, as viewed on a preoperative CT scan, into precise osteotomy cuts at antral bone graft surgery, a prototype cutting guide was developed. The surgical guide was developed through the use of CT imaging, SimPlant module Oral and Maxillofacial Surgery computer software (Materialise Dental, Glen Burnie, MD), and the stereolithographic process to precisely position the lateral window, facilitating Schneiderian membrane elevation. This report demonstrates the step-by-step method to perform precise guided sinus window preparation using computer software and a stereolithographically generated surgical guide.

Maxillary sinusitis resulting from ostium plugging by dislodged bone graft: case report.

PURPOSE: To report an unusual case of severe maxillary sinusitis resulting from ostial plugging by dislodged bone graft material used for sinus elevation procedure. PATIENTS AND METHODS: A 49-year-old female presented to the oral surgery clinic with severe right maxillary sinusitis after a sinus elevation procedure and placement of a dental implant. She had completed an extended course of multiple antibiotics without culture and sensitivity studies or resolution of sinusitis. RESULTS: A CT scan was obtained which showed a dental implant protruding into the right maxillary sinus, sinusitis of the right ethmoid and maxillary sinuses, and dislodged bone graft material obstructing the ostium into the middle nasal meatus. The dental implant was removed, the patient was referred for functional endoscopic sinus surgery, and her sinusitis subsequently rapidly resolved. CONCLUSIONS: Surgeons performing this or similar procedures should be aware of the possible complications that can arise from foreign debris introduced into the maxillary sinuses. Also, the avoidance of empirically changing antibiotic regimens and the early use of CT scans should be considered.

Plating in microvascular reconstruction of the mandible: can fixation be too rigid?

OBJECTIVE: Determine long-term loss of mandible height with use of stress-shielding reconstruction plates for free fibula flap mandible reconstruction. DESIGN: Retrospective single-blinded medical record review. SUBJECTS: Seventy patients who had fibula free flap mandible reconstructions performed for 10 years. Patients who underwent radiotherapy were excluded. METHODS: Review of 70 fibula free flap mandible reconstructions performed for the last 10 years in a city hospital revealed 7 patients (10%) who had resections for benign odontogenic diseases. All had a three-dimensional cast model made, on which the reconstruction plate was bent to the desired shape preoperatively. Free fibula height on panoramic x-ray images taken preoperatively and at 2 and 12 months postoperatively. RESULTS: Seven (10%) patients met criteria for the study. Bone height was maintained at 2 months postoperatively, but at 12 months, there was a statistically significant loss of fibular bone height averaging 20% in the anterior, body, and ramus areas (P < 0.05). Despite this, all patients were considered eligible for dental rehabilitation, and 4 of 7 patients have had osseointegrated implants placed. CONCLUSIONS: As opposed to miniplates, increased resorption may have been due to the stress-shielding phenomenon unique to a reconstruction plates. However, this did not seem to affect the ability to place osseointegrated implants.

The expense for one implantation of a banked bone allograft from a cadaveric donor and the issues affecting current advanced medical treatment in the Japanese orthopaedic field.

Demand for banked bone allografts is increasing in Japan; however, there are too few bone banks and the bone bank network is not well-established. One reason for this was lack of funding for banks. Bone banks had to bear all material expenses of banked bone allografts themselves because this was not designated a covered expense. In December 2004, the Japanese government started a new "Advanced Medical Treatment" administration system which allowed an approved institution to charge the expense of authorized advanced medical treatments directly to patients. The treatment named "Cryopreserved allogenic bone and ligamentous tissue retrieved from cadaveric donor" was approved as an advanced medical treatment in March 2007. We present the calculation method and the expense per implantation of a banked bone allograft from a cadaveric donor under this treatment and raise issues which affect this advanced medical treatment and remain to be resolved in the Japanese orthopaedic field.

Fresh cortical autograft versus fresh cortical allograft effects on experimental bone healing in rabbits: radiological, histopathological and biomechanical evaluation.

Bone grafting is used to enhance healing in osteotomies, arthrodesis, and multifragmentary fractures and to replace bony loss resulting from neoplasia or cysts. They are source of osteoprogenitor cells and induce bone formation and provide mechanical support for vascular and bone ingrowth. Autografts are used commonly but quantity of harvested bone is limit. This study was designed to evaluate fresh cortical autograft and allograft effects on bone healing process. Twenty male White New Zealand rabbits were used in this study. In autograft group the defect was filled by fresh autogenous cortical graft, in allograft group the defect was filled by a segment of fresh allogenous cortical bone which was harvested at the time of surgery during the creation of radius bone defect. Then all surface soft tissue, such as muscle attachments, were removed from the harvested bone and changed between rabbits as a fresh allogenous cortical bone graft and was fixed by cercelage wire. Radiological, histopathological and biomechanical evaluations were performed blindly and results scored and analyzed statistically. Statistical tests did not support significant differences between two groups at the 14th and 56th postoperative day radiographically (P > 0.05). There was a significant difference radiologically for the 28th and the 42nd postoperative (P < 0.05). Autograft was superior to allograft at the 28th and 42nd postoperative day in radiological evaluation (P < 0.03). Histopathological and biomechanical evaluation revealed no significant differences between two groups.