Search

The objectives of this study were to evaluate the relationship between preoperative psychologic status and attitude and postsurgical adjustment and experience of the surgical treatment. Questionnaires were sent to 140 consecutive Chinese patients with skeletal Class III malocclusion who had been treated with a combined orthodontic-surgical approach. The results showed the following: (1) immediately after the surgery 44% of patients had more pain, 57% had more numbness, and 73% had more swelling than expected; (2) most patients underwent noted marked changes in facial appearance (96%) and dental appearance (91%); (3) chewing ability improved in 71% of patients; (4) half of those with temporomandibular joint problems preoperatively experienced improvement; (5) personality and lifestyle were affected positively in about 50% of patients; (6) satisfaction with the treatment increased with time: 87% at 6 months and 92% at 24 months; and (7) a few patients (8%) regretted having undergone surgery, mainly because facial changes were not apparent. The vast majority of the present Chinese skeletal Class III patients were satisfied with the overall outcome of the continued orthodontic-surgical treatment.

We compared the amount of new bone produced by endochondral and intramembranous autogenous bone grafts in the presence of demineralized bone matrices (DBMs) prepared from intramembranous bone (DBM(IM)) or endochondral bone (DBM(EC)). Thirty-five bone defects were created in the parietal bone of 20 New Zealand White rabbits. In the experimental groups, 5 defects were grafted with endochondral bone, 5 with endochondral bone mixed with DBM(IM)) (EC-DBM(IM)), 5 with intramembranous bone mixed with DBM(IM)(IM-DBM(IM)) and 6 with endochondral bone mixed with DBM(EC)(EC-DBM(EC)). In the control groups, 10 defects were left alone (passive control) and 4 were grafted with rabbit skin collagen (active control). They were all killed on day 14 and the defects were prepared for histological study. Serial sections were cut across the whole defect. Quantitative analyses were made on 202 sections of the experimental groups by image analysis. A total of 414%, 708%, and 85% more new bone was formed in defects grafted with composite EC-DBM(IM), IM-DBM(IM)and EC-DBM(EC), respectively, than those grafted with endochondral bone alone (P<0.001). No bone was formed in either passive or active controls. In conclusion, demineralized bone matrices, particularly those derived from intramembranous bone, have extremely high osteoinductive properties and greatly improve the integration of autogenous bone grafts in the skull., (Copyright 2000 The British Association of Oral and Maxillofacial Surgeons.)

Alveolar bone defects are conditions that impede the progress of orthodontic treatment. This study compared the mechanics of the healing of autogenous intramembranous (IM) bone grafts and grafts comprising a mixture of IM and demineralised bone matrix of autogenous intramembranous origin (DBMIM), in an attempt to determine the reliability of each material. Thirty-two New Zealand white rabbits had a single defect created in their skull. Sixteen were grafted with IM bone alone (Group I: autogenous IM), and the other 16 had a combined graft of composite IM sandwiched between two layers of DBMIM (Group II: composite IM-DBMIM). A third group (Group III) of eight rabbits each had two defects created in their skull; one defect was left empty (A: passive control) and the other filled with rabbit-skin collagen (B: active control). In Groups I and II, inflammatory cells were found to be present on Days 1 and 2 of tissue retrieval. The appearance of the mesenchymal cells and preosteoblasts, osteoblasts and osteocytes was earlier (Day 3) in Group II than in Group I (Day 5). In both groups, preosteoblasts, osteoblasts and osteocytes were observed with no cartilage at the intermediate stage. In conclusion, autogenous IM bone grafts and IM bone grafts in the presence of DBMIM healed through an osteogenic ossification route.

Objective: To determine the timely ingrowth of new blood vessels of composite endochondral (EC) bone and demineralized bone matrix (DBM) prepared from intramembranous (IM) origin (EC-DBM(IM)) and to compare it with EC bone graft alone., Design: Thirty-two rabbits with 32 critical-size (10 x 5 mm), full-thickness bony defects in rabbit parietal bone were divided into two groups: composite EC-DBM(IM) group-implanted with composite autogenous EC bone and DBM(IM); EC bone group-implanted with EC bone alone. Two rabbits from each group were sacrificed-1, 2, 3, 4, 5, 6, 7, and 14 days after grafting. Neovascularization was assessed by immunohistochemical staining with antihuman angiogenesis-related endothelial cell antibodies (EN 7/44). Quantitative analysis of neovascularization, represented by percentage area of positive immunohistochemical staining, was performed on 320 sections of the experimental groups by a computer-assisted image analyzer., Results: Positive immunohistochemical staining was first identified on day 2 post grafting for the composite EC-DBM(IM) group in comparison with day 4 in the EC bone graft group. The composite EC-DBM(IM) bone graft group showed earlier and almost 100% more neovascularization when compared with the EC bone graft group., Conclusion: DBM(IM) enhances healing and integration of EC bone graft by enhancing vascularization as well as increasing the amount of new blood vessels formed. In clinical cases in which EC autogenous bone is used to graft a large defect such as in cleft palate and craniofacial surgery, DBM(IM) should allow better integration and healing of the EC bone graft to the host bone.

The aim of this study was to compare the skeletal and dental changes contributing to the correction of Class III malocclusion using a 2 x 4 appliance and reverse headgear in the mixed dentition. Seventeen consecutive patients (mean age, 9.7 years) with pseudo-Class III malocclusions and an anterior functional shift and straight or concave facial profile were treated with a simple fixed appliance. Another 20 consecutive patients (mean age, 8.5 years) with Class III incisor relationship and straight or concave facial profiles, were treated with reverse headgear. Lateral cephalometric films taken at the beginning of treatment, the end of the treatment, and 1 year after the active treatment, were analyzed with the modified Pancherz analysis. After active treatment, the overjet correction, 5.2 mm and 6.5 mm on average, respectively, were achieved using the 2 x 4 and reverse headgear. The overjet correction by the 2 x 4 appliance was due to dental changes only. In the reverse headgear group, 60% of the overjet correction was due to dental changes and 40% due to skeletal changes. During the 12 months follow-up period, the overjet was unchanged in the 2 x 4 group (1.6 mm) and decreased in the reverse headgear group, the difference being statistically significant (P <.05). The change of jaw relationship was similar between the 2 x 4 and reverse headgear groups. During the follow-up period, a decrease in overjet in the reverse headgear group was mainly due to forward growth of the mandible and proclination of lower incisors. The overjet in the 2 x 4 group was unchanged due to dental compensation (1.6 mm). To conclude there was a similar amount of overjet correction in the 2 x 4 and reverse headgear groups. Overjet correction by the simple fixed appliance was produced by dental changes whereas in the reverse headgear group, it was produced by both dental and skeletal changes.

Objective: This study was designed to detect type X collagen expression, at both gene and protein levels, in condylar cartilage during mandibular protrusion triggered by functional appliance., Methods: One hundred SD rats with age of 5 weeks were selected and divided into 5 experimental groups (n = 5) and 5 control groups (n = 5). Animals in experimental groups were imposed with bite-jumping appliances which caused identical magnitude of mandibular protrusion. The animals of experimental groups, together with their matched controls, were sacrificed 3, 7, 14, 21 and 30 days after the appliance insertion. 6 microns sections were cut from TMJ through the sagittal plane. In situ hybridization and immunohistochemical analysis were performed to detect the expression of type X collegen mRNA transcription and its protein synthesis., Results: 1. Intensive staining of type X collegen mRNA was found to distribute within the whole area of hypertrophic zone, a sharp contrast to the control groups which showed very little or no staining. 2. Type X collegen protein synthesis, which was highlighted by immunofluoscent staining, was found to spread over the whole hypertrophic zone, compared to the controls that demonstrated a very little staining., Conclusion: Expression of type X collagen in condylar cartilage indicates the onset of endochondral ossification in condyle in response to mandibular protrusion provoked by functional appliances.

The aim of this article is to introduce the composite intramembranous bone graft mixed with demineralized bone matrix to the clinician and to demonstrate its various clinical applications in the field of clinical orthodontics in the form of case reports. Understanding the mechanism of healing of this composite bone graft provides sound experimental precedent that allows this graft material to become a predictable part of our future orthodontic management. The cases highlighted here took advantage of the several properties of the composite intramembranous demineralized bone matrix graft. An accidental loss of the buccal plate of bone occurred during extraction of a buccally placed premolar for orthodontic purposes. The defect was repaired using chin bone mixed with demineralized bone matrix, and the teeth were successfully moved into the grafted area. A 5-year follow-up showed a stable gingival condition at the grafted area. In this report, ridge augmentation with intramembranous demineralized bone matrix as an adjunct to orthodontic treatment allowed successful placement of endosseous implants. In conclusion, the same graft material was successfully used in the repair of a massive alveolar cleft. Long-term follow-up of these cases showed that this graft is a promising graft material that could be integrated into our orthodontic practice.

This study was designed to investigate the dental changes and the space gained following early treatment of pseudo-Class III malocclusion, using a simple fixed appliance. Twenty-one consecutively treated patients who had a pseudo-Class III malocclusion comprised the treated group. Fifteen untreated control subjects were used as matched controls for the three-year follow-up after completion of treatment. Lateral cephalograms and study models were analysed for the treated, the control and the follow-up group. The arithmetic mean and standard deviation were calculated for each variable, and paired t-tests were performed to assess the effects of treatment on the treated group. The Mann-Whitney test was performed to evaluate the difference between the follow-up group and the control group. Anterior crossbites and mandibular displacements were eliminated after the treatment. On average, the space gained as a result of the treatment was 4.7 mm in the upper arch (p < 0.001 degree). Comparison of the space available as a result of early treatment with the space required for alignment of posterior segments in the upper arch of the untreated control group indicated that there was enough space for the eruption of the canines and premolars as a result of early treatment; whereas, lack of space was evident in the untreated controls. In conclusion, a pseudo-Class III malocclusion, proclination of the upper incisors and/or retroclination of the lower incisors contributed to the correction of anterior crossbite and the elimination of mandibular displacement. Proclination of the upper incisors, utilisation of leeway space, and arch-width increase provided the space required for eruption of the premolars and canines.

This study was designed to examine the osteogenecity of demineralized bone matrix (DBM) prepared from intramembranous (IM) bone and to quantitatively assess the amount of new bone formed by IM autogenous bone grafts with or without DBM(IM). Forty-two defects were created in 42 New Zealand White rabbits. Twenty-one defects were grafted with IM bone alone, and the other 21 defects were grafted with composite IM-DBM(IM). Eleven rabbits, 22 defects were used as controls, where 11 defects were left empty (passive control) and the other 11 defects were filled with rabbit skin collagen (active control). Tissues were retrieved on days 1, 2, 3, 4, 5, 6, 7, and 14 for qualitative and quantitative analysis. Cells involved in the healing of composite IM and IM-DBM(IM) bone grafts were identified. No cartilage cells were detected during the healing of either grafts. Appearance of small blood vessels into the newly formed matrix was seen on day 5 in IM bone grafts and on day 4 in composite IM-DBM(IM) bone graft. Quantitative analysis was performed by means of image analysis on 100 sections of tissues retrieved after 14 days. Approximately 204% more new bone was formed in defects grafted with composite IM-DBM(IM) than in those grafted with IM bone alone (P <.0001). No bone was formed across the defects in either active or passive controls. In conclusion, DBM(IM) significantly increases the osteogenicity of IM bone grafts.

The aim of this study is to identify the diagnostic criteria for pseudo-Class III malocclusion and compare it with Class I malocclusion in the southern Chinese population. Sixty-seven patients (mean age, 10.9 +/- 1.8 years) were included in this study; 36 patients represented pseudo-Class III malocclusion. Selection criteria included the following: (1) anterior crossbite (at least 2 incisors with negative overjet and overbite); (2) mandibular displacement; (3) all patients were southern Chinese who had been followed after the growth spurt, none had developed a skeletal Class III malocclusion; (4) the patients were treated for an average of 7 months to procline upper incisors and retrocline lower incisors. None of the cases received any treatment that might affect skeletal growth. Thirty-one patients with Class I malocclusion were included in the Class I malocclusion group for the comparison of dentoskeletal characteristics with the pseudo-Class III malocclusion group. Selection criteria included the following: (1) skeletal Class I malocclusion with normal overjet and overbite, (2) mild to moderate crowding with Class I molar relationship, (3) straight facial profile. The following were included in the assessment of pseudo-Class III malocclusion cases: (1) family history, (2) molar and canine relationships at habitual occlusion and centric relation, and (3) dentoskeletal morphology. The results were that 72% of the examined cases in the pseudo-Class III malocclusion group showed no family history and 75% showed Class I molar relationship at habitual occlusion. Compared with the Class I malocclusion group, subjects in the pseudo-Class III malocclusion group showed a significantly decreased midface length, increased maxillary-mandibular difference, more retroclined upper incisors, and a retrusive upper lip. In conclusion, a pseudo-Class III malocclusion is characterized by retroclined upper incisors, retrusive upper lip, decreased midface length, and increased maxillary-mandibular difference. Findings of this study showed that patients with a pseudo-Class III malocclusion exhibit certain morphologic, dental, and skeletal characteristics that should be of aid in the diagnosis of pseudo-Class III malocclusion.

The aim of the present study was to examine the healing of endochondral (EC) autogenous bone grafts in the presence of demineralised bone matrix prepared from intramembranous bone (DBMIM), or prepared from endochondral bone (DBMEC) using quantitative analysis. Thirty bone defects were created on the parietal bone of fifteen New Zealand White rabbits. In the experimental groups, five defects were grafted with EC bone, five defects were grafted with EC bone mixed with DBMIM (EC-DBMIM) and six defects were grafted with EC bone mixed with DBMEC (EC-DBMEC). In the control groups, ten defects were left empty (passive control) and four defects were grafted with rabbit skin collagen (positive control). They were all sacrificed at day fourteen post grafting, and the defects were prepared for histological analysis. Serial sections were cut across the whole defect. Quantitative analysis was performed on 152 sections of the experimental groups by image analysis. Four hundred and fourteen per cent more new bone was formed in defects grafted with composite EC-DBMIM than those grafted with EC bone alone (p < 0.001). Eighty-five per cent more new bone was formed in defects grafted with composite EC-DBMEC than those grafted with EC bone alone (p < 0.001). No bone was formed in either passive or positive controls. In conclusion, DBM, especially DBMIM, have extremely high osteoinductive properties and greatly enhance the integration of EC bone grafts with defects created in IM bone.

A case of correction of molar Class II using the pendulum appliance is described. Upper first molars were distalized into Class I, crowding was eliminated in the upper arch and space was provided to attain Class I relationship. Treatment lasted for 18 months. A two year follow up shows stability of the occlusion.

Objective: To quantify chondrogenesis in condylar cartilage in response to active forward positioning of mandible., Methods: Identical bite-jumping appliances were fixed to upper incisors of animals in experimental groups, causing a continuous mandibular forward positioning. Histological sections were performed through mandibular condyle and were stained with HE under the same condition. Chondrogenesis was quantified by measuring the area of cells in resting, proliferative, hypertrophic and erosive zones in the superioposterior region, through computer-assisted image analyzing system (Q550IW, Leica) with the advanced software (Leica Qwin Pro, V2.2). Statistical analysis was performed with GraphPad 3.0., Results: 1. comparison among experimental groups revealed a fluctuation in proliferative zone, with 21-day group being the greatest (0.058 +/- 0.004 mm2) and 14-day the least (0.012 +/- 0.001 mm2). A change in erosive zone was also depicted by a peak of 0.112 +/- 0.001 mm2 in 7-day group and a bottom of 0.018 +/- 0.002 mm2 in 14-day group (P < 0.001). 2. comparison among the control groups manifested stable zonation, except for a slump of proliferative zone descending from 0.069 +/- 0.005 mm2 in 3-day group to 0.009 +/- 0.001 mm2 in 21-day group (P < 0.001). 3. comparison between experimental and control groups demonstrated significant discrepancy in proliferative zone, hypertrophic zone and erosive zone (P < 0.001)., Conclusion: Mandibular forward positioning stimulates and accelerates cartilaginous remodeling in mandibular condyle.

Objective: To quantify the new bone formation in the glenoid fossa of the temporal bone in response to the mandibular advancement., Methods: A bitejumping appliance with guide slope was fit on the upper jaw of each rat in the experimental groups, resulting in a downward and forward displacement of condyle and continuous mandibular advancement. Sections were cut through the glenoid fossa at the sagittal plane and stained with PAS under the same condition. The new bone formation at the posterior zone of the glenoid fossa was detected by quantitative measurement through computer-assisted image analyzing system (Q550IW, Leica) with the advanced software (Leica Qwin Pro, Version 2.2). Statistical analysis was performed with GraphPad 3.0., Results: 1. a comparison among experimental groups revealed a peak of new bone deposition at the 21-day group, significantly greater than other groups (P < 0.001); 2. a comparison among control groups showed a gradual decrease of new bone deposition characterized by a peak of at the 3-day group and a bottom at the 30-day group (P < 0.001); 3. a comparison between experimental and control groups showed no significant difference statistically at the 3-day groups (P > 0.05), whereas a significant difference of new bone deposition starting from 7-day groups, with a peak at 21-day groups and a decrease towards 30-day groups (P < 0.001)., Conclusion: The advancement of mandible leads to the remodeling of the glenoid fossa indicated by the new bone deposition in growing rat.

The aim of the study was to assess quantitatively the amount of new bone formed in the early stages of healing of intramembranous and endochondral autogenous bone grafts so as to gain further insight into their integration with host bone. Eighteen critical size defects were created in the parietal bone of nine New Zealand White rabbits. In the experimental group (five rabbits), each rabbit was grafted with intramembranous bone in one defect and with endochondral bone in the other. In the control group (four rabbits), one defect was left empty (passive control) and the other was grafted with rabbit skin collagen (active control). After 14 days, the rabbits were killed and the defects were prepared for histological analysis. Serial sections were made across the whole defect. Each defect was divided into five regions spaced 1500 microns apart. Two sections were randomly drawn from each region. Quantitative analysis was performed on 100 sections using an image analyser computer software system to assess the amount of new bone formed in each defect. No bone was detected across the defect in either the active or passive controls. One-hundred-and-sixty-six per cent more new bone was formed in defects grafted with intramembranous bone than those grafted with endochondral bone. This represented an extremely significant difference (P < 0.0001, unpaired t-test) between the two groups. The results show that intramembranous autogenous bone produced more bone than the endochondral bone when grafted in the skull. Clinically, it is recommended that intramembranous bone is used to replace lost membranous bone in the oral cavity, as well as in skull defects, whenever possible.

Aim: To illustrate a simple effective method for early treatment of pseudo Class III in the mixed dentition and to highlight the advantages of early treatment by showing a 4-year follow-up of the treatment effects., Subjects: Twenty-one consecutive southern Chinese patients with a mean age of 9.6 years were included in the early treated group with pseudo Class III malocclusion., Methods: Lateral cephalometric films taken at the beginning and at the end of treatment were analysed. The arithmetic mean and standard deviation (SD) were calculated for each cephalometric variable and paired t-tests were performed to assess the statistical significance of the treatment effects., Results: Anterior crossbites and mandibular displacements were eliminated after the treatment. The angulation of the upper incisors to the maxillary plane showed an increase by a mean of 9.5 degrees (P < 0.001), while the angulation of the lower incisors to the mandibular plane showed a decrease by a mean of 4.9 degrees (P < 0.001)., Conclusion: In pseudo Class III malocclusion, proclination of upper incisors and/or retroclination of lower incisors with simple fixed appliances contribute to the correction of anterior crossbite and the elimination of mandibular displacement. Proclination of upper incisors, use of Leeway space and arch width increase provide space required for the eruption of the premolars and canines.

The aim of this study was to examine the osteogenic potential of demineralized bone matrix prepared from intramembranous bone (DBMIM) and to examine its effects on the healing of endochondral autogenous bone grafts. Twenty-four defects in 24 New Zealand white rabbits were used as experimental groups. Twelve defects were grafted with endochondral bone, and the other 12 defects were grafted with endochondral bone with DBMIM (EC-DBMIM). One rabbit from each group was sacrificed on days 1, 2, 3, 4, 5, 6, and 7 postgrafting, and the remaining 5 rabbits from each group were sacrificed on day 14 postgrafting. Another 8 defects in 4 rabbits were used as control groups: 4 defects were left empty (passive control), and 4 defects were grafted with rabbit skin collagen (positive control). They were all sacrificed at 14 days after grafting. Serial sections were made across the whole defect. Quantitative analysis was performed on 100 sections of the 14-day experimental groups by image analysis. Four hundred fourteen percent more new bone was formed in defects grafted with composite EC-DBMIM than in those grafted with endochondral bone alone (P < 0.0001). No bone was formed in either passive or positive controls. Histologic examination of the bone grafts revealed intermediate-stage cartilage, and immunohistochemical examination revealed earlier vascularization in the composite EC-DBMIM groups. In conclusion, DBMIM has extremely high osteoinductive properties and greatly enhances the integration of endochondral bone with defects of intramembranous bone in origin.

Elongated and spaced incisors are common in patients suffering from severe periodontal disease. Intrusion and uprighting of incisors might be the logical solution for this problem. This article describes a team approach to treatment planning for adult patients with severe localized periodontitis accompanied by marginal bone loss and spacing and elongation of incisors. The treatment involves the combination of periodontal treatment, orthodontic intrusion, and prosthetic therapy. Controlled intrusion in two patients led to a decrease in the clinical crown length, better access for oral hygiene procedures, better gingival form, and a more suitable distribution of occlusal forces.

The purpose of the current study was to determine the timely ingrowth of blood vessels associated with demineralized bone matrix (DMB) induced osteogenesis. Critical-size (10 x 5mm), full thickness bony defects in rabbit parietal bone were implanted with DBM. Histological and ultrastructural changes were examined 1, 2, 3, 4, 5, 6, 7 and 14 days later. Neovascularization was assessed by immunohistochemical staining for factor VIII antigen (marker for vascular endothelium) and also confirmed by staining using pan-endothelial antibody (CD31) (a marker for endothelium). Immunohistochemical evaluation revealed a positive staining for CD31 and Factor VIII expressed by endothelial cells by day 3 post grafting. By day 4, small blood vessels were first seen budding from host bed towards the grafted DBM. Ultrastructural identification of cells in the early stages of healing revealed the presence of macrophages. The monocyte-derived macrophage appears to play a central role in the repair process using DBM. Results of this study demonstrated a rapid vascularization during the DBM induced osteogenesis. This rapid vascularization is vital to the healing and bone induction ability of the DBM.

This study was designed to identify the cells involved in the healing of autogenous intramembranous (IM) and of endochondral (EC) bone grafts. Thirty-six defects were created in the skull of 18 adult New Zealand White rabbits. Defects were filled with IM graft alone, EC graft alone, demineralized bone matrix (DBM) alone, or combined DBM-IM and DBM-EC bone. Cellular identification was carried out at 7 and 14 days by light and electron microscopy. In IM bone, preosteoblasts, osteoblasts, and osteocytes were observed with no cartilage intermediate stage, while in EC bone, chondroblasts and chondrocytes were observed. DBM implant and DBM-IM were characterized by the presence of a cartilage stage. In conclusion, IM bone healed through an osteogenic ossification route, while EC bone healed through an EC ossification route. In the presence of demineralized EC bone matrix, IM bone adopts an EC ossification route.

The use of endochondral bone grafts (EC) and demineralized bone matrix (DBM), which contains a potent osteoinductive matrix, may promote the repair of nonregenerative defects. The purpose of the current work is to assess qualitatively and quantitatively the effect of DBM on the healing of EC bone grafts and to compare it to the healing of EC bone grafts alone. Twenty-four defects in rabbit skulls were filled with EC bone grafts alone, DBM alone, or combined EC and DBM. Histologic and immunohistologic changes were examined in 2 weeks. The amount of new bone formation was quantified by image analysis. Healing of all the groups was characterized by the presence of a cartilage intermediate stage. In the EC bone grafts alone, healing was localized to the host bone/graft interface. In the composite group, amalgamation of the new bone, DBM, and bone graft progressed throughout the whole width and depth of the defect, uniting the graft to the recipient bed. The amount of new bone formed was significantly greater (47%) in the composite group than the EC group. In conclusion, DBM powder augments the bone-induction capacity of the recipient bed as well as the bone graft. The composite EC bone grafts and added DBM possess properties required for an effective graft material and merit further clinical evaluation.

This case report describes a simplified orthodontic system for the management of a palatally impacted canine accompanied by root resorption of incisors. The anchorage for this system is the transpalatal arch and a heavy buccal segment arch wire with two loops soldered to stainless steel bands. This type of stationary anchorage provides stability by uniting both molars across the palatal vault and thus avoids the need for bonding of adjacent mobile teeth. With this system an impacted canine can be extruded, moved distally, jumped over the occlusion, and derotated. The efficiency of this appliance makes it a safe method for moving teeth through simple manipulation and with minimal esthetic inconvenience.

A clinical dilemma exists regarding the type of bone that should be used to replace diseased or traumatized osseous tissue. Oral, plastic, and orthopedic surgeons normally implant viable mineralized endochondral (EC) autografts or demineralized EC allografts. A few clinicians have recognized the disadvantages of using EC bone in craniofacial surgery and advocated the replacement of intramembranous (IM) bone with healthy IM bone. However, controversy and uncertainty surround our understanding of these matrices to induce bone formation. Recent studies have advocated the use of other materials with osteoinductive properties, such as demineralized bone matrix (DBM). The proposed delivery system used in this study included IM bone grafts, DBM, and fixation of the IM bone graft. The purpose of this work was to gain further insights into the mechanism of healing of IM bone, in both the presence and the absence of DBM, and to compare the healing of IM bone grafts with that of DBM alone. Critical-sized (10 x 5 mm), full-thickness bony defects in rabbit parietal bone, devoid of periosteum, were filled with IM bone graft (mandible) alone, demineralized cortical bone matrix (DBM) alone, or combined DBM-IM bone graft, or were left unfilled. Histologic changes were examined 14 days later. The IM bone graft healed through IM ossification with no intermediate cartilage stage. DBM and composite DBM-IM healed through an EC ossification with an intermediate cartilage stage. It is hypothesized that the role of the IM graft is to induce neovascularization into the defect site, and that the undifferentiated mesenchymal cells in the perivascular region of the new blood vessels are induced by the bone morphogenetic protein(s) in the DBM into bone-forming cells.