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Tooth loss often leads to significant alveolar bone resorption, presenting a challenge for dental implant placement. This case report presents the effectiveness of concentrated platelet-rich fibrin (C-PRF) in combination with bone allograft for horizontal bone augmentation in a severely atrophic maxilla. A 33-year-old female patient with extensive bone loss in the upper anterior maxilla was treated in two stages. The initial stage involved horizontal bone augmentation using a mixture of C-PRF and bone allograft. This was followed, 5 months later, by dental implant placement. The preparation of C-PRF, surgical procedure, and postoperative care are thoroughly described. Post-treatment Cone Beam Computed Tomography showed an increase in alveolar bone thickness from 2.4–3.4 mm pre-operatively to 6.3–7.3 mm, demonstrating the procedure's effectiveness in achieving adequate bone volume for implant placement. The use of C-PRF with allograft in horizontal bone augmentation shows promise in enhancing bone regeneration, especially in a severely atrophic maxilla. [ABSTRACT FROM AUTHOR]

Background/Aim: Effective treatment of nonunion fractures is challenging as it requires a biological and mechanical environment to promote sufficient osteogenesis. Herein, we present a case series in which we evaluated the clinical efficacy of bone morphogenetic protein-2 (BMP-2)- loaded alginate microbeads and allografts in two dogs with nonunion fractures. Case Report: A 3-year-old, 2.3-kg, spayed female Pomeranian (Case 1) presented with intermittent lameness of the left forelimb after radial and ulnar fracture repair 8 weeks prior. A 4-year-old, 4.8-kg, spayed female Pomeranian (Case 2) was referred for nonweight-bearing lameness of the left hindlimb due to implant failure following left tibial fracture repair. Both dogs had atrophic bone ends and no bridging calluses at the fracture site on radiographs, and were diagnosed with nonviable nonunion fractures of the radius/ulna and tibia, respectively. The surgical approach involved implant removal, debridement, and fracture gap reconstruction. BMP-2 was loaded into alginate microbeads for a prolonged release with bone allograft chips in both cases. In Case 1, bead grafts were applied directly at the fracture site, while in Case 2, they were implanted inside a frozen cortical bone allograft as a scaffold to fill the large gap. Postoperative radiography revealed excessive callus formation, early radiographic bone union, and cortical bone remodeling, in line with improved lameness scores. At the final follow-up, gait was improved and the desired bone length and shape were achieved in both cases. Conclusion: Simultaneous use of osteoinductive BMP-2 alginate microbeads and osteoconductive bone allografts yielded functionally and structurally favorable outcomes in canine nonunion fractures, without major complications. [ABSTRACT FROM AUTHOR]

Objective Medial opening‐wedge high tibial osteotomy (MOWHTO) is considered to be an effective treatment for symptomatic knee osteoarthritis (KOA) of isolated the medial compartment with varus alignment of the lower extremity. However, the choice of material to fill the void remains controversial. This study aims to evaluate the bone union of the osteotomy gap using a novel wedge‐shaped cancellous allograft after MOWHTO and its effect on clinical outcomes. Methods All patients who underwent MOWHTO using a novel wedge‐shaped cancellous allograft combined with TomoFix locking compression plate (LCP) fixation between January 2016 and July 2020 were enrolled. The radiographic parameters including hip‐knee‐ankle angle (HKAA), medial proximal tibial angle (MPTA), femorotibial angle (FTA) and posterior tibial slope angle (PTSA) were measured between pre‐operative and post‐operative radiographs. Knee Society score (KSS) and range of motion (ROM) were assessed preoperatively and at last follow‐up. Patients included in this study were divided into two groups according to the correction angle: small correction group ( 0.05). All patients in this study achieved good bone healing at the final follow‐up and no significant differences in mRUST scores were seen between the SC group and LC group. The KSS‐Knee score and KSS‐Function score improved significantly from 55.4 ± 3.7 and 63.3 ± 4.6 preoperatively to 86.4 ± 2.8 (p 0.05). Conclusion For MOWHTO, the wedge‐shaped cancellous allograft was a reliable choice for providing good bone healing and clinical outcomes.

Objective: Medial opening‐wedge high tibial osteotomy (MOWHTO) is considered to be an effective treatment for symptomatic knee osteoarthritis (KOA) of isolated the medial compartment with varus alignment of the lower extremity. However, the choice of material to fill the void remains controversial. This study aims to evaluate the bone union of the osteotomy gap using a novel wedge‐shaped cancellous allograft after MOWHTO and its effect on clinical outcomes. Methods: All patients who underwent MOWHTO using a novel wedge‐shaped cancellous allograft combined with TomoFix locking compression plate (LCP) fixation between January 2016 and July 2020 were enrolled. The radiographic parameters including hip‐knee‐ankle angle (HKAA), medial proximal tibial angle (MPTA), femorotibial angle (FTA) and posterior tibial slope angle (PTSA) were measured between pre‐operative and post‐operative radiographs. Knee Society score (KSS) and range of motion (ROM) were assessed preoperatively and at last follow‐up. Patients included in this study were divided into two groups according to the correction angle: small correction group (< 10°; SC group) and large correction group (≥ 10°; LC group). The modified Radiographic Union score for tibial fractures (mRUST) was used to assess the difference in bone healing between the two groups at 1, 3, 6, and 12 months postoperatively and at the final follow‐up. A paired student's t test was conducted for comparison of differences of the relevant data pre‐operatively and post‐operatively. Results: A total of 82 patients (88 knees) were included in this study. The HKAA, MPTA, FTA and PTSA increased from −6.4° ± 3.0°, 85.1° ± 2.6°, 180.1° ± 3.2° and 7.7° ± 4.4° preoperatively to 1.2° ± 4.3° (p < 0.001), 94.4° ± 3.3° (p < 0.001), 171.0° ± 2.8° and 11.8° ± 5.8° (p < 0.001) immediately postoperatively, respectively. However, no significant statistic difference was found in above‐mentioned parameters at last follow‐up compared to immediate postoperative data (p > 0.05). All patients in this study achieved good bone healing at the final follow‐up and no significant differences in mRUST scores were seen between the SC group and LC group. The KSS‐Knee score and KSS‐Function score improved significantly from 55.4 ± 3.7 and 63.3 ± 4.6 preoperatively to 86.4 ± 2.8 (p < 0.001) and 89.6 ± 2.9 (p < 0.001) at last follow‐up, respectively. Nevertheless, there was no significant difference in ROM between pre‐operation and last follow‐up (p > 0.05). Conclusion: For MOWHTO, the wedge‐shaped cancellous allograft was a reliable choice for providing good bone healing and clinical outcomes. [ABSTRACT FROM AUTHOR]

Background. For many years, the main reasons for revision surgeries after hip arthroplasty remain aseptic loosening and osteolysis, which lead to formation of bone defects of various size and localization. Given the relatively young age of patients undergoing revision, the methods of biological restoration of the bone tissue, such as impaction bone grafting (IBG), are of particular interest. Aim of the report to demonstrate the delayed outcome of impaction bone grafting using compacted morselized bone allograft. Case presentation. Complicated clinical case of a 62-year-old patient with Paprosky type IIA bone deficiency in the acetabulum and Paprosky type II bone deficiency in the proximal femur with aseptic loosening of the acetabular and femoral components of the hip prosthesis is presented. During revision arthroplasty with cemented components, IBG of the acetabulum and femur was performed with a reconstructive mesh augmentation of the acetabulum using Stryker X-Change technology. Bone allograft prepared with the use of heat disinfection method served as an osteoplastic material. Follow-up period was 4 years. Control X-rays demonstrate restoration of the center of rotation of the hip, presence of bone masses in the areas of pelvic and femoral bone defects, absence of osteoplastic material resorption and migration of implants during the follow-up period. Clinical assessment shows an improvement of the Harris Hip Score from 34 to 85 points. Conclusion. Obtained results showed the efficacy of impaction bone grafting with the bone allograft prepared with the use of heat disinfection method in the mid-term period.

Purpose: This study aimed to topographically examine the healing of mineralized human bone allograft in sinus augmentation. Materials and Methods: Thirty-two patients with crestal bone height ≤ 2 mm who required sinus augmentation were recruited for the study. A mixture of 80/20 cortical/cancellous mineralized human bone allografts were used to augment the sinus floor using a crestal window approach. A bone core biopsy specimen was taken at the time of implant placement, 6 months after surgery. Microradiographs of methacrylate-embedded sections were split into five longitudinal sectors (crestal to sinusal) to topographically assess the bone, graft, and fibrous tissue amount. Results: All implants were osseointegrated 3 months later without any adverse effects. The polynomial (degree 2) of results (all with great correlation coefficient, P < .01) gave rise to a polynomial curve of graft percentage with a maximum at sector 4 (presinusal), a bone percentage with a minimum between sectors 3 and 4, and a fibrous tissue percentage with a maximum between sectors 3 and 4. Conclusion: Based upon topographic analysis, mineralized human bone allograft is capable of achieving adequate vertical bone height for implant placement. The need for a topographic analysis to assess the outcomes of sinus augmentation is emphasized. [ABSTRACT FROM AUTHOR]

Bone allografts are widely used as osteoconductive support to guide bone regrowth. Bone allografts are more than a scaffold for the immigrating cells as they maintain some bioactivity of the original bone matrix. Yet, it remains unclear how immigrating cells respond to bone allografts. To this end, we have evaluated the response of mesenchymal cells exposed to acid lysates of bone allografts (ALBA). RNAseq revealed that ALBA has a strong impact on the genetic signature of gingival fibroblasts, indicated by the increased expression of IL11, AREG, C11orf96, STC1, and GK—as confirmed by RT-PCR, and for IL11 and STC1 by immunoassays. Considering that transforming growth factor-β (TGF-β) is stored in the bone matrix and may have caused the expression changes, we performed a proteomics analysis, TGF-β immunoassay, and smad2/3 nuclear translocation. ALBA neither showed detectable TGF-β nor was the lysate able to induce smad2/3 translocation. Nevertheless, the TGF-β receptor type I kinase inhibitor SB431542 significantly decreased the expression of IL11, AREG, and C11orf96, suggesting that other agonists than TGF-β are responsible for the robust cell response. The findings suggest that IL11, AREG, and C11orf96 expression in mesenchymal cells can serve as a bioassay reflecting the bioactivity of the bone allografts. [ABSTRACT FROM AUTHOR]

Introduction: The proximal humerus is a frequent site for both primary and secondary bone tumors. Several options are currently available to reconstruct the resected humerus, but there is no consensus regarding optimal reconstruction. The aim of this retrospective study was to compare the functional outcome, complications and patient compliance following four different types of reconstructive techniques. Material and methods: The authors performed 90 proximal humerus resections due to primary and secondary bone tumors over the past 21 years. Four different procedures were performed for reconstruction following the resection: fibula autograft transplantation, osteoarticular allograft implantation, modular tumor endoprosthesis (hemiarthroplasty) and reconstruction of the defect with a reverse shoulder prosthesis-allograft composite. A retrospective analysis of the complications and patient's physical status was performed. Functional outcome and life quality was evaluated by using the MSTS and SF-36 scores. Results: The best range of motion was observed following arthroplasty with a reverse shoulder prosthesis-homograft composite followed by a fibula autograft reconstruction. Revision surgery was required due to major complications most frequently in the osteoarticular allograft group, followed by the reverse shoulder prosthesis-allograft composite group, the autologous fibula transplantation group; the tumor endoprosthesis hemiarthroplasty group had superior results regarding revision surgery (40, 25, 24 and 14% respectively). MSTS was 84% on average for the reverse shoulder prosthesis-allograft composite group, 70% for the autologous fibula group, 67% for the anatomical hemiarthroplasty group and 64% for the osteoartricular allograft group. Using the SF-36 questionnaire for assessment no significant differences were found between the four groups regarding quality of life. Discussion: Based on the results of our study the best functional performance (range of motion and patient compliance) was achieved in the a reverse prosthesis-allograft combination group—in cases where the axillary nerve could be spared. The use of an osteoarticular allograft resulted in unsatisfying functional results and high complication rates, therefore we do not recommend it as a reconstructive method following resection of the proximal humerus due to either primary or metastatic bone tumors. Young patients who have good life expectancy but a small humerus or intramedullar cavity reconstruction by implantation of a fibula autograft is a good option. For patients with a poor prognosis (i.g. bone metastases) or in cases where the axillary nerve must be sacrificed, hemiarthroplasty using a tumor endoprosthesis was found to have acceptable results with a low complication rate. According to the MSTS and SF-36 functional scoring systems patients compliance was nearly identical following all four types of reconstruction techniques; the underlying cause may be the complexity of the shoulder girdle. However, we recommend the implantation of a reverse shoulder prosthesis-allograft whenever indication is appropriate, as it has been demonstrated to provide excellent functional outcomes, especially in young adults. [ABSTRACT FROM AUTHOR]

Abstract Background To investigate the clinical safety and efficacy of ViBone® Viable Bone Matrix (VBM), a next generation cellular bone matrix allograft that comprises all three essential bone-forming components: osteogenic, osteoinductive, and osteoconductive factors, and is optimized to enhance cell viability and bone formation. Methods This was a multi-center, prospective, post-market study evaluating the safety and efficacy of ViBone VBM in patients undergoing 1–3 level anterior cervical discectomy and fusion or lumbar interbody fusion surgery. Patients were evaluated at baseline, 6-month, and 12-month follow-up clinically and radiographically. Clinical assessment included Visual Analog Scale for pain (VAS-pain), the Neck Disability Index (NDI) for patients with cervical pathologies, and the Oswestry Disability Index (ODI) for patients with lumbar pathologies. Fusion success defined by an independent radiologist was determined radiographically by plain films. Results Clinical outcomes evaluated with VAS-pain, NDI, and ODI scales were improved significantly at 6 and 12 months compared to baseline. All patients reached clinically significant improvements at 12 months. There were no adverse events or infections attributed to ViBone VBM. At 12 months, the fusion rate per patient was 88.1% in cervical and 97.6% in lumbar patients, while per-level fusion was 98.5% for cervical and 100% for lumbar segments. Conclusions Patients undergoing cervical and lumbar spinal fusion implanted with ViBone VBM demonstrated favorable outcomes at 6 months and 12 months as measured by subjective clinical measures and radiographic fusion rates. Trial registration This study was registered as NCT03425682 on 1/29/2018.

Purpose: Osteogenesis imperfecta (OI) is a genetic disorder responsible for various symptoms including deformities and frequent fractures. Bone allografting is poorly documented in this condition. The objective of this study was to describe our experience and assessments in a consecutive series of OI patients. Methods: Thirty-nine lower limb allograft procedures (28 femurs, 11 tibias) were performed in 26OI patients (mean age, 12.9 years). They were classified as type III of Sillence (17), type IV (6), and 3 recessive forms. The indications for surgery were correction of deformity (19), fracture (16), and non-union (4). In all cases, bone allografting was added to reinforce areas of fragility and in 28 cases for osteosynthesis to lock the rotations at the osteotomy site and to avoid screwed metallic plate. The duration of bone consolidation and allograft fusion was assessed. Complications and Gillette functional score were reported. Results: The mean follow-up was 6.7years (range, 2 to 10 years). On average, bone consolidation was achieved after 3.3 months and graft fusion after 7.7 months. No bone allograft-related complications were observed and there was any secondary displacement. The Gillette functional score was improved in 23 patients and stable in three cases. Complications were reported in two cases: one partial allograft resorption and one delayed consolidation of a non-union. One refracture was observed but after a significant trauma in a child who had regained significant physical activity. Conclusions: Bone allografting in children with OI is a reliable method of biological fixation, allowing efficient fusion and contributing to increased bone capital and functional outcome. [ABSTRACT FROM AUTHOR]

We have previously reported that serum albumin-coated bone allograft (BoneAlbumin, BA) is an effective bone substitute. It improves bone regeneration at the patellar and tibial donor sites six months after harvesting bone-patellar tendon-bone (BPTB) autografts for primary anterior cruciate ligament reconstruction (ACLR). In the present study, we examined these donor sites seven years after implantation. The study group (N = 10) received BA-enhanced autologous cancellous bone at the tibial and BA alone at the patellar site. The control group (N = 16) received autologous cancellous bone at the tibial and blood clot at the patellar site. We evaluated subcortical density, cortical thickness, and bone defect volume via CT scans. At the patellar site, subcortical density was significantly higher in the BA group at both time points. There was no significant difference in cortical thickness between the two groups at either donor site. The control group's bone defect significantly improved and reached the BA group's values at both sites by year seven. Meanwhile, the bone defects in the BA group did not change significantly and were comparable to the six-month measurements. No complications were observed. There are two limitations in this study: The number of patients recruited is small, and the randomization of the patients could have improved the quality of the study as the control group patients were older compared to the study group patients. Our 7-year results seem to demonstrate that BA is a safe and effective bone substitute that supports faster regeneration of donor sites and results in good-quality bone tissue at the time of ACLR with BPTB autografts. However, studies with a larger number of patients are required to definitively confirm the preliminary results of our study. [ABSTRACT FROM AUTHOR]

Background: To determine the clinical outcome of patients who had been treated with bone allografts during open reduction and internal fixation (ORIF) of tibial head fractures. Methods: Patients who suffered a medial, lateral, or bicondylar fracture of the tibial plateau and underwent surgical treatment by open reduction and internal fixation (ORIF) using human femoral head bone allografts were included. Patients were invited to provide information for the following: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EuroQol Five Dimension score (EQ-5D), Lower Extremity Functional Scale (LEFS) and Parker Mobility Score. Bone mineral density (BMD) of the allograft area and the healthy human bone tissue were measured by quantitative computed tomography. Results: A total of 22 patients with a mean follow-up time of 2.88 ± 2.46 years were included in our study. The most common fractures observed in this study were classified as Schatzker II (11 patients, 50.0%) or AO/OTA 41.B3 (12 patients, 54.5%) fractures. Postoperative WOMAC total was 13.0 (IQR = 16.3, range 0–33). Median quality of life (EQ-5D) score was 0.887 ± 0.121 (range 0.361–1.000). Median Lower Extremity Functional Scale (LEFS) score was 57.5 ± 19.0 (range 33–79). Mean Parker Mobility Score was 9 (range 6–9). Median bone mineral density (BMD) for the whole group was 300.04 ± 226.02 mg/cm3 (range − 88.68 to 555.06 mg/cm3) for region of interest (ROI 5) (central), 214.80 ± 167.45 mg/cm3 (range − 7.16 to 597.21 mg/cm3) for ROI 1–4 (marginal zones: medial, lateral, ventral, dorsal) and 168.14 ± 65.54 mg/cm3 (range 17.47–208.97 mg/cm3) for healthy bone tissue (femur and tibia). Conclusion: Based on WOMAC scores, LEFS, ambulatory status, and quality of life findings, it can be concluded that following tibial head ORIF with allograft bone patients has promising results. [ABSTRACT FROM AUTHOR]

The aim of this experimental study was to evaluate the effect of zolendronic acid (ZOL) combined with bone allograft prepared using the Marburg Bone Bank System on bone formation in the implant remodeling zone. Femoral bone defects with a diameter of 5 mm and a depth of 10 mm were created in 32 rabbits. Animals were divided into 2 similar groups: Group 1 (control), where defects were filled with bone allograft, and Group 2, where allograft was combined with ZOL. Eight animals from each group were sacrificed at 14- and 60-days post-surgery and bone defect healing was assessed using histopathological and histomorphometric analyses after 14 and 60 days. The results showed that new bone formation within the bone allograft was significantly greater in the control group than in the ZOL-treated group after 14 and 60 days (p<0.05). In conclusion, local co-administration of ZOL on heat-treated allograft inhibits allograft resorption and new bone formation in the bone defect. [ABSTRACT FROM AUTHOR]

Background: To investigate the clinical safety and efficacy of ViBone® Viable Bone Matrix (VBM), a next generation cellular bone matrix allograft that comprises all three essential bone-forming components: osteogenic, osteoinductive, and osteoconductive factors, and is optimized to enhance cell viability and bone formation. Methods: This was a multi-center, prospective, post-market study evaluating the safety and efficacy of ViBone VBM in patients undergoing 1–3 level anterior cervical discectomy and fusion or lumbar interbody fusion surgery. Patients were evaluated at baseline, 6-month, and 12-month follow-up clinically and radiographically. Clinical assessment included Visual Analog Scale for pain (VAS-pain), the Neck Disability Index (NDI) for patients with cervical pathologies, and the Oswestry Disability Index (ODI) for patients with lumbar pathologies. Fusion success defined by an independent radiologist was determined radiographically by plain films. Results: Clinical outcomes evaluated with VAS-pain, NDI, and ODI scales were improved significantly at 6 and 12 months compared to baseline. All patients reached clinically significant improvements at 12 months. There were no adverse events or infections attributed to ViBone VBM. At 12 months, the fusion rate per patient was 88.1% in cervical and 97.6% in lumbar patients, while per-level fusion was 98.5% for cervical and 100% for lumbar segments. Conclusions: Patients undergoing cervical and lumbar spinal fusion implanted with ViBone VBM demonstrated favorable outcomes at 6 months and 12 months as measured by subjective clinical measures and radiographic fusion rates. Trial registration This study was registered as NCT03425682 on 1/29/2018. [ABSTRACT FROM AUTHOR]

Restoration of bone, adjacent joint and surrounding soft tissue integrity is an important factor in achieving full function of affected limbs in patients with bone tumors. Biological bone reconstruction has a number of advantages over other artificial implants. The aim of the work is to analyze the results of clinical approbation of the segmental alloimplant using by different methods for treatment of malignant bone tumors. Material and methods. The data of 17 patients with malignant tumors, secondary lesions or neoplasms of long bones with an aggressive course of the pathological process were analyzed. All patients underwent surgery to remove en-block tumors and replace post-resection defects of long bones with segmental bone alloimplants. Different methods of fixing bone alloimplants and sterilization of alloimplants were used. Three methods of surgery are presented. Results. The analysis of surgical treatment results in patients with long bone tumors who underwent bioreconstructive surgery was performed. The functional results according to the MSTS scale and complications of bioreconstructive operations according to the classification of Henderson E. et al. were assessed. The total number of complications was 58.8 %, among which local complications of the wound process were observed in 5.9 % of cases (1 patient), atrophic nonunion of the recipient bone and alloimplant – in 4 cases (23.5 %), violation of the metal fixator integrity – in 2 patients 11.8 %), infectious complications – in 5.9 % (1 patient), local recurrence of the tumor was the most common and amounted to 35.3 % (6 patients) of all cases. Conclusions. Bioreconstructive surgical interventions (using bone alloimplants) should be used according to clear indications to achieve the best results. The application of the developed methods presented in the work will reduce the risk of complications associated with bone alloplasty. Biological recovery of lost bone tissue and the fastest recovery of the affected limb through the use of metal structures allows a widespread use of this technique in cancer patients.

The lack of viability of massive bone allografts for critical-size bone defect treatment remains a challenge in orthopedic surgery. The literature has reviewed the advantages of a multi-combined treatment with the synergy of an osteoconductive extracellular matrix (ECM), osteogenic stem cells, and growth factors (GFs). Questions are still open about the need for ECM components, the influence of the decellularization process on the latter, the related potential loss of function, and the necessity of using pre-differentiated cells. In order to fill in this gap, a bone allograft surrounded by an osteogenic membrane made of a decellularized collagen matrix from human fascia lata and seeded with periosteal mesenchymal stem cells (PMSCs) was analyzed in terms of de-/recellularization, osteogenic properties, PMSC self-differentiation, and angiogenic potential. While the decellularization processes altered the ECM content differently, the main GF content was decreased in soft tissues but relatively increased in hard bone tissues. The spontaneous osteogenic differentiation was necessarily obtained through contact with a mineralized bone matrix. Trying to deepen the knowledge on the complex matrix–cell interplay could further propel these tissue engineering concepts and lead us to provide the biological elements that allow bone integration in vivo. [ABSTRACT FROM AUTHOR]

Purpose: the aim of this study was to identify potential risk factors favoring complications by assessing the number and types of complications associated with allogeneic or autogenous bone blocks applied as onlay grafts for alveolar ridge augmentation prior to implantation. Methods: A retrospective chart review on the success of 151 allogeneic and 70 autogenous bone blocks in a cohort of 164 consecutive patients, who were treated over a period of 6 years by the same surgeon, was conducted. Statistical conclusions were based on ROC curves and multiple logistic regression models. Results: Complications were observed more frequently with autogenous bone blocks (14 out of 70 cases; 20%) compared to allogeneic bone blocks (12 out of 151 cases; 7.9%; p = 0.013). However, these complications were minor and did not impact the successful dental rehabilitation. In a multiple logistic regression model, the risk of a complication was increased by the use of an autogenous bone block (OR = 3.2; p = 0.027), smoking (OR = 4.8; p = 0.007), vertical augmentation above a threshold of 2.55 mm (OR = 5.0; p = 0.002), and over-contouring (OR = 15.3; p < 0.001). Conclusions: Overall, the complication rate of ridge augmentations carried out with autogenous or allogeneic bone blocks was low. Despite previous recommendations, over-contouring and a vertical augmentation above a threshold of 2.55 mm should be avoided. [ABSTRACT FROM AUTHOR]

Objective To investigate the outcomes of open reduction and internal fixation combined with medial buttress plate (MBP) and allograft bone‐assisted cannulated screw (CS) fixation for patients with unstable femoral neck fracture with comminuted posteromedial cortex. Methods In a retrospective study of patients operated on for unstable femoral neck fractures with comminuted posteromedial cortex from March 2016 to August 2020, the clinical and radiographic outcomes of 48 patients treated with CS + MBP were compared with the outcomes of 54 patients treated with CS only. All patients in the CS + MBP group were fixed by three CS and MBP (one‐third tubular plates or reconstructive plates) with bone allografts. The surgery‐related outcomes and complications were evaluated, including operative time, blood loss, union time, femoral head necrosis, femoral neck shortening, and other complications after the operation. The Harris score was evaluated at 12 months after the operation. Results All patients were followed up for 12–40 months. The average age of patients in the CS‐only group (54 cases, 22 females) and CS + MBP group (48 cases, 20 females) was 48.46 ± 7.26 and 48.73 ± 6.38 years, respectively. More intraoperative blood loss was observed in the CS + MBP group than that of patients in CS‐only group (153.45 ± 64.27 vs 21.86 ± 18.19 ml, t = 4.058, P = 0.015). The average operative time for patients in the CS + MBP group (75.35 ± 27.67 min) was almost double than that of patients in the CS‐only group (36.87 ± 15.39 min) (t = 2.455, P

Bone allografts are widely used as osteoconductive support to guide bone regrowth. Bone allografts are more than a scaffold for the immigrating cells as they maintain some bioactivity of the original bone matrix. Yet, it remains unclear how immigrating cells respond to bone allografts. To this end, we have evaluated the response of mesenchymal cells exposed to acid lysates of bone allografts (ALBA). RNAseq revealed that ALBA has a strong impact on the genetic signature of gingival fibroblasts, indicated by the increased expression of IL11, AREG, C11orf96, STC1, and GK—as confirmed by RT-PCR, and for IL11 and STC1 by immunoassays. Considering that transforming growth factor-β (TGF-β) is stored in the bone matrix and may have caused the expression changes, we performed a proteomics analysis, TGF-β immunoassay, and smad2/3 nuclear translocation. ALBA neither showed detectable TGF-β nor was the lysate able to induce smad2/3 translocation. Nevertheless, the TGF-β receptor type I kinase inhibitor SB431542 significantly decreased the expression of IL11, AREG, and C11orf96, suggesting that other agonists than TGF-β are responsible for the robust cell response. The findings suggest that IL11, AREG, and C11orf96 expression in mesenchymal cells can serve as a bioassay reflecting the bioactivity of the bone allografts.

IntroductionThe clinical efficacy and safety of supercritical CO2-processed bone allografts prepared from living donors has yet to be confirmed in spinal surgery. Here we report our clinical and surgical experience of using supercritical CO2-processed bone allografts for lumbar and cervical fusion.MethodsSixteen patients underwent one or two level anterior cervical discectomy and fusion and 37 patients underwent anterior retroperitoneal route lumbar fusion using bone allografts processed using supercritical CO2 extraction combined with chemical viral inactivation. Fusion success was assessed radiographically in the immediate postoperative period and at one month, six months, one year, and three years postoperatively. Function and pain were assessed using visual analog scales, Odom's criteria, the neck disability index (NDI), and the Oswestry disability index (ODI).ResultsAt a mean of 43 and 47 months postoperatively, 95.3% and 90.5% of cervical and lumbar fusion patients had radiographic evidence of bone fusion, respectively. Over 80% of patients reported good to excellent outcomes according to Odom's criteria, the perception of pain significantly decreased, and the mean NDI and ODI scores significantly improved at the last follow-up compared with before the operations. There were no safety concerns. For the cervical group, the mean NDI score improved from 26.3 ± 6.01 preoperatively to 15.00 ± 8.03 and 17.60 ± 13.95 at immediate post-op (p = 0.02) and last follow-up visits (p = 0.037) respectively. For the lumbar cases, the mean ODI score improved from 28.31 ± 6.48 preoperatively to 14.68 ± 5.49 (p

Background: The use of dual mobility cups (DMC) has been shown to reduce hip instability after revision surgery. For severe acetabular bone loss, reconstruction with a Kerboull cross-plate and bone allograft would contribute to restoring native hip position and bone stock. Only two papers reported on the combination of Kerboull cross-plate with bone allograft and cemented DMC in revision total hip arthroplasty (THA).Methods: This is a monocentric retrospective study (28 cases) of first-time revision THA using such a construct in American Association of Orthopaedic Surgeons (AAOS) grade III and IV acetabular bone defect. Detailed demographic, clinical and radiographic results were recorded and evaluated.Results: With a mean follow-up of six ± 3.63 years, no case of instability was reported. The modified Harris Hip Score (mHHS) was 88.4 ± 10.1. No hook fracture or mechanical failure was observed. Non-progressive radiolucent lines were recorded. Osteointegration of the allografts was observed in all cases with a mean Grodet score of 7.9 ± 0.97.Conclusions: In first revision THA, the use of a Kerboull cross-plate with allograft and a cemented DMC in AAOS grade III and IV acetabular bone defects demonstrated excellent clinical and radiological outcomes with no recorded cases of dislocation or mechanical failure. [ABSTRACT FROM AUTHOR]

Albumin is a constitutional plasma protein, with well-known biological functions, e.g., a nutrient for stem cells in culture. However, albumin is underutilized as a biomaterial in regenerative medicine. This review summarizes the advanced therapeutic uses of albumin, focusing on novel compositions that take advantage of the excellent regenerative potential of this protein. Albumin coating can be used for enhancing the biocompatibility of various types of implants, such as bone grafts or sutures. Albumin is mainly known as an anti-attachment protein; however, using it on implantable surfaces is just the opposite: it enhances stem cell adhesion and proliferation. The anticoagulant, antimicrobial and anti-inflammatory properties of albumin allow fine-tuning of the biological reaction to implantable tissue-engineering constructs. Another potential use is combining albumin with natural or synthetic materials that results in novel composites suitable for cardiac, neural, hard and soft tissue engineering. Recent advances in materials have made it possible to electrospin the globular albumin protein, opening up new possibilities for albumin-based scaffolds for cell therapy. Several described technologies have already entered the clinical phase, making good use of the excellent biological, but also regulatory, manufacturing and clinical features of serum albumin. [ABSTRACT FROM AUTHOR]

Background: Following traumatic bone loss or removal of bone tumors, the failure of bone allograft transplantation for large bone defect repair remains a significant problem in orthopedics. Therefore, new strategies that can efficiently enhance allograft healing and long-term incorporation are critically needed. Method: In this study, we first injected Notch-activating Jagged1 peptide to mice and then isolated bone marrow tissues and cells for proliferation and differentiation assays. Femur bone allograft surgery was also performed in Jagged1 pre-treated mice, and bone defect healing process were monitored by histology, Micro-CT and biomechanical testing. Result: Our results showed that Jagged1 therapeutic injection is sufficient to maximally activate Notch and promote bone marrow stromal cell proliferation in vivo, while no effects on bone structure were observed. More importantly, Jagged1 pre-treatment significantly promoted bone callus formation and increased bone mechanical strength during allograft healing in a femur bone defect mouse model. Conclusion: This study reveals that Notch in vivo activation can be induced by injection of Jagged1 peptide for expansion of local native stromal cells that will significantly enhance bone callus formation. The Translational potential of this Article: The clinical uses of this therapeutic strategy would be immediately applicable for chronic long bone defect repair. More importantly, this devised strategy for expansion of endogenous BMSCs can also be applied to enhance other tissue and organ repair.

Osteo allogenic morphogenetic protein (OsteoAMP) is an allogenic morphogenetic protein derived from bone allograft through a novel tissue processing technique. In this report, we document a surgical case that included LeFort advancement and malar augmentation with OsteoAMP. Postoperatively, the patient demonstrated a persistent volume of graft material, as viewed radiographically after 4 months by an expert radiologist, that is less than expected, compared to other demineralized bone matrix allograft products [10]. This was observed both clinically (in the form of subjective malar fullness) and radiographically on non-contrast CT imaging (the estimated volume of the bone graft on the followup CT was measured as 3400 mm3 compared to 3970 mm3 on the postoperative CT). The patient then required an additional procedure to recontour the excessive malar graft material, which on immunohistochemical analysis, was negative for CD65 and TARP, again confirming a decreased resorption rate. This case suggests that OsteoAMP undergoes decreased rates of remodeling and resorption, over a 3-month period, as analyzed by expert radiology and pathology specialists. This may help inform bone graft treatment plan decisions, including graft material selection and graft volume.

We have previously reported that serum albumin-coated bone allograft (BoneAlbumin, BA) is an effective bone substitute. It improves bone regeneration at the patellar and tibial donor sites six months after harvesting bone-patellar tendon-bone (BPTB) autografts for primary anterior cruciate ligament reconstruction (ACLR). In the present study, we examined these donor sites seven years after implantation. The study group (N = 10) received BA-enhanced autologous cancellous bone at the tibial and BA alone at the patellar site. The control group (N = 16) received autologous cancellous bone at the tibial and blood clot at the patellar site. We evaluated subcortical density, cortical thickness, and bone defect volume via CT scans. At the patellar site, subcortical density was significantly higher in the BA group at both time points. There was no significant difference in cortical thickness between the two groups at either donor site. The control group’s bone defect significantly improved and reached the BA group’s values at both sites by year seven. Meanwhile, the bone defects in the BA group did not change significantly and were comparable to the six-month measurements. No complications were observed. There are two limitations in this study: The number of patients recruited is small, and the randomization of the patients could have improved the quality of the study as the control group patients were older compared to the study group patients. Our 7-year results seem to demonstrate that BA is a safe and effective bone substitute that supports faster regeneration of donor sites and results in good-quality bone tissue at the time of ACLR with BPTB autografts. However, studies with a larger number of patients are required to definitively confirm the preliminary results of our study.

Objective: To investigate the outcomes of open reduction and internal fixation combined with medial buttress plate (MBP) and allograft bone‐assisted cannulated screw (CS) fixation for patients with unstable femoral neck fracture with comminuted posteromedial cortex. Methods: In a retrospective study of patients operated on for unstable femoral neck fractures with comminuted posteromedial cortex from March 2016 to August 2020, the clinical and radiographic outcomes of 48 patients treated with CS + MBP were compared with the outcomes of 54 patients treated with CS only. All patients in the CS + MBP group were fixed by three CS and MBP (one‐third tubular plates or reconstructive plates) with bone allografts. The surgery‐related outcomes and complications were evaluated, including operative time, blood loss, union time, femoral head necrosis, femoral neck shortening, and other complications after the operation. The Harris score was evaluated at 12 months after the operation. Results: All patients were followed up for 12–40 months. The average age of patients in the CS‐only group (54 cases, 22 females) and CS + MBP group (48 cases, 20 females) was 48.46 ± 7.26 and 48.73 ± 6.38 years, respectively. More intraoperative blood loss was observed in the CS + MBP group than that of patients in CS‐only group (153.45 ± 64.27 vs 21.86 ± 18.19 ml, t = 4.058, P = 0.015). The average operative time for patients in the CS + MBP group (75.35 ± 27.67 min) was almost double than that of patients in the CS‐only group (36.87 ± 15.39 min) (t = 2.455, P < 0.001). The Garden alignment index of patients treated by CS + MBP from type I to type IV was 79%, 19%, 2%, and 0%, respectively. On the contrary, they were 31%, 43%, 24% and 2% for those in the CS‐only group, respectively. The average healing times for the CS‐only and CS + MBP groups were 4.34 ± 1.46 and 3.65 ± 1.85 months (t = 1.650, P = 0.102), respectively. Femoral neck shortening was better in the CS + MBP group (1.40 ± 1.73 mm, 9/19) than that in the CS‐only group (4.33 ± 3.32 mm, 24/44). Significantly higher hip function was found in the CS + MBP group (85.60 ± 4.36 vs 82.47 ± 6.33, t = 1.899, P = 0.06). There was no statistical difference between femoral head necrosis (4% vs 11%, χ2 = 1.695, P = 0.193) and nonunion (6% vs 9%, χ2 = 0.318, P = 0.719). Conclusion: For unstable femoral neck fractures with comminuted posteromedial cortex, additional MBP combined with bone allografts showed better reduction quality and neck length control than CS fixation only, with longer operative time and more blood loss. [ABSTRACT FROM AUTHOR]

The aim of the study is to improve the method of surgical treatment for patients with tumors of long bones with the use of segmental bone allograft. Material and method. The authors have improved the method of surgical treatment of patients with tumor bone lesions using segmental allografts. Step-cut osteotomy was performed to achieve the best contact between the allograft and the recipient bone, fixation was performed with intramedullar interlocking nail without the use of bone cement, and primary bone autoplasty was done to achieve better reparation. The method was clinically tested and the results of its application were studied (radiologically, morphologically). A morphological study of the contact zone between the allograft and the recipient's bone was conducted. Results. The effectiveness of the developed method was proved. As a follow-up result among patients who underwent surgical treatment according to the developed method, the following complications were noted: ischemic necrosis of soft tissues (due to intraoperative ligation of an artery which was surrounded by a tumor) – 1 case; tumor recurrence resulting in a limb amputation – 1 patient. During the macroscopic study of a removed fragment (after amputation), the fusion between allograft and recipient bone was observed. As a result of histological and X-ray examination, bone regeneration was seen in the area of contact between the allograft and the recipient bone. The histological examination also was used to clearly visualize the removed fragment of the affected tibia, in particular the contact zone between the allograft and the recipient bone, and the bone implant material, on the outer surface and internal parts of which, the formation of new bone tissue in the form of layering of the bone trabeculae was seen. Thus, the bone tissue was formed on the surface of allogeneic bone material and sprouted into its internal parts, forming a stiff bone – implant contact. Conclusions. Using the technique of bioreconstruction of the long bone defects allows the bone tissue of the affected limb to be preserved as much as possible, to restore the surrounding soft tissues and avoid infectious and allergic reactions in comparison with modular endoprosthetics. Fixation of the allograft and the recipient bone using step-cut osteotomy with the additional insertion of an interlocking intramedullar nail allows getting a stable «construction» and maximizing the contact zone of the bone tissue (the allograft and the recipient bone).

Allogenic bone is the most commonly grafted tissue which provides only osteoconductive property, in which it acts as a scaffold to facilitate the ingrowth of the vessels and migration of host cells capable of osteogenesis. It can be used as a substitute for autografts as the latter is associated with morbidity and limited donor site availability. Its applications are expanding in all aspects of orthopedic surgery, notably in revision hip replacement or surgical treatment for bone tumors or benign conditions. The balance between osteolysis and osteogenesis must be maintained for graft incorporation to occur and thus postoperative imaging is essential for differentiation between grafts and recurrent disease or viability/nonviability. Here, we present three cases, in which bone allografting was done who underwent serial 99 mTc-methylene diphosphonate three-phase bone scintigraphy with single-photon emission computed tomography/computed tomography to assess the viability, integrity, and the incorporation of the graft. [ABSTRACT FROM AUTHOR]

The most common techniques for the replacement of post-resection bone defects in patients with tumors are modular and individual endoprosthetics and bioreconstructive interventions. The following issues require solution: improvement and development of techniques for fixation of segmental allograft and recipient bone, study of bone remodeling processes in conditions of bone allograft and cytostatics (chemotherapy drugs) action, improvement of segmental allograft quality. Objective. To determine the indications for allograft replacement of post-resection defects of long bones (and its types) in patients with malignant bone tumors. Methods. Experimental studies were carried out to study morphological, biomechanical, biochemical changes in experimental rats after bone allograft under different conditions. Using the finite element method, the tensely deformed conditions in the «allograft - recipientbone - endoprosthesis» system were assessed to determine the most effective fixation technique of the bone allograft and recipient bone in imitation of a bone regenerate in different terms after surgery. Results. The effectiveness of allograft prosthesis composite technique with a step-cut osteotomy and additional bone autoplasty in the contact zone of the allograft and the recipient bone was proven. It was determined that the use of radiation-sterilized bone allograft in combination with systemic administration of cytostatics leads to inhibition of bone formation. We developed an algorithm-scheme of surgical treatment of patients with tumors of long bones using segmental allograft and proposed methods of replacement of postresection bone defects for each localization of tumor lesions. Clinical approbation was performed. Conclusions. Segmental bone allograft of large post-resection defects of long bones at their tumorous affection remains an actual and perspective technique of one bioreconstruction. Clear adherence to the indications for this technique will help to prevent complications and repeated operations. [ABSTRACT FROM AUTHOR]

Purpose of the analytical review — to evaluate the application experience of bone xenografts in trauma and orthopaedics surgery. Methods. Data search was performed in the electronic databases of PubMed and eLIBRARY with depth of 20 years. Results. The authors identified 13 papers which described the application experience of bone xenografts in trauma surgery and orthopaedics. The highest efficiency (from 92 to 100%) was reported for cases of xenografts use to replace defects in intraarticular fractures and revision arthroplasty. Unsatisfactory outcomes were related to cases with no integration and graft rejection. The least efficiency (from 41,9 to 46,1%) was reported in reconstructive foot surgery. No effect of bone xenografts was observed for replacement of defects in cases of pseudoarthrosis. The most frequent complication was graft material infection. The summarized literature data provided the calculated share of complications following xenograft use of 7,53% (18 out of 239 cases, CI 5-95%, 4,53-11,21). Two areas were identified for improvement of technical and biological properties of bone xenografts: 1. Modification of original xeno-matrix (enhancement of purification technique, alteration of structure of chemical composition of the bone matrix); 2. Augmentation of matrix volume by additional elements (biologically active agents, stem cells). It’s noted that demand for xenografts in traumatology and orthopaedics can increase after refining and expanding the indications for clinical use. Conclusion. Bone xenografts used in the modern trauma surgery and orthopaedics to replace bone defects in revision arthroplasty as well as in certain fracture types. Such material is relatively safe and its ability to be modified allows to improve its biological properties.

The lack of viability of massive bone allografts for critical-size bone defect treatment remains a challenge in orthopedic surgery. The literature has reviewed the advantages of a multi-combined treatment with the synergy of an osteoconductive extracellular matrix (ECM), osteogenic stem cells, and growth factors (GFs). Questions are still open about the need for ECM components, the influence of the decellularization process on the latter, the related potential loss of function, and the necessity of using pre-differentiated cells. In order to fill in this gap, a bone allograft surrounded by an osteogenic membrane made of a decellularized collagen matrix from human fascia lata and seeded with periosteal mesenchymal stem cells (PMSCs) was analyzed in terms of de-/recellularization, osteogenic properties, PMSC self-differentiation, and angiogenic potential. While the decellularization processes altered the ECM content differently, the main GF content was decreased in soft tissues but relatively increased in hard bone tissues. The spontaneous osteogenic differentiation was necessarily obtained through contact with a mineralized bone matrix. Trying to deepen the knowledge on the complex matrix–cell interplay could further propel these tissue engineering concepts and lead us to provide the biological elements that allow bone integration in vivo.

Purpose: The aim of this study was to analyze cone beam computed tomography (CBCT) densitometries of maxillary sinuses augmented with human bone allograft. In addition, previously obtained microradiographic specimens were used to verify the diagnostic potential of CBCT. Materials and Methods: A two-stage protocol was conducted in 21 consecutive patients, all with a crestal bone height < 2 mm. Mineralized human bone allograft particles were used to augment sinuses using a lateral window approach. A succession of CBCT scans of the maxilla were taken before surgery, immediately after sinus augmentation, and 6,10, and 18 months after implant placement. Using virtual probes, CBCT images taken at 6, 8, and 10 mm from the crestal surface were processed with medical imaging software and expressed as gray level (GL). Results: A total of 24 sinus augmentation procedures were performed in 21 patients. The average values of CBCT-GL ranged from 571 to 654, presenting the maximum value at 8 mm immediately after implant placement and the minimum value at 6 mm after 10 months. Furthermore, it was found that the graft mineral content decreased over time, completely disappearing between 10 and 11 months. Conclusion: CBCT and the medical imaging software employed for imaging visualization are reliable tools to study biomaterial behavior after sinus augmentation procedures. In addition, results from this study demonstrate that a complete resorption of human bone allograft is possible. Due to the limited sample size, further clinical and morphometric studies are needed. [ABSTRACT FROM AUTHOR]

Albumin is a constitutional plasma protein, with well-known biological functions, e.g., a nutrient for stem cells in culture. However, albumin is underutilized as a biomaterial in regenerative medicine. This review summarizes the advanced therapeutic uses of albumin, focusing on novel compositions that take advantage of the excellent regenerative potential of this protein. Albumin coating can be used for enhancing the biocompatibility of various types of implants, such as bone grafts or sutures. Albumin is mainly known as an anti-attachment protein; however, using it on implantable surfaces is just the opposite: it enhances stem cell adhesion and proliferation. The anticoagulant, antimicrobial and anti-inflammatory properties of albumin allow fine-tuning of the biological reaction to implantable tissue-engineering constructs. Another potential use is combining albumin with natural or synthetic materials that results in novel composites suitable for cardiac, neural, hard and soft tissue engineering. Recent advances in materials have made it possible to electrospin the globular albumin protein, opening up new possibilities for albumin-based scaffolds for cell therapy. Several described technologies have already entered the clinical phase, making good use of the excellent biological, but also regulatory, manufacturing and clinical features of serum albumin.

Terminal sterilization of bone allograft by gamma radiation is required to reduce the risk of infection. Free radical scavengers could be utilized to minimize the deteriorating effects of gamma radiation on bone allograft mechanical properties. The objective of this research is to assess the changes in structural and chemical composition induced by hydroxytyrosol (HT) and alpha lipoic acid (ALA) free radical scavengers in gamma sterilized cortical bone. Bovine femurs specimens were soaked in different concentrations of HT and ALA for 7 and 3 days respectively before irradiation with 35 KGy gamma radiation. The attenuated total reflection-Fourier transform infrared spectroscopy and the X-ray diffraction techniques were utilized to analyze the changes in chemical composition induced by irradiation in the presence of free radical scavengers. A significant increase in the proportion of amide I and amide II to phosphate was noticed in the irradiated group, while in the pretreated groups with ALA and HT this effect was minimized. In addition, gamma radiation reduced the mature to immature cross links while ALA and HT alleviated this reduction. No significant changes were noticed in the mineral crystallinity or crystal size. Bone chemical structure has been changed due to gamma irradiation and these changes are mainly relevant to amide I, amide II proportions and collagen crosslinks. The deteriorating effects of gamma sterilization dose (35 kGy) on chemical structure of bone allograft can be alleviated by using (HT) and (ALA) free radical scavengers before irradiation. [ABSTRACT FROM AUTHOR]

Abstract Background Procurement of bone allograft must be performed by trained personnel. Improper handling and lack of knowledge during bone procurement will lead to contamination hence jeopardizing quality of the procured bones and expose bone recipients to risks of infection in post-operative phase. Bone procurement workshop is the fundamental training programme to enhance skill among personnel who has been or will be involved in bone procurement. This study evaluated the effectiveness of the workshop contents including teaching materials by assessing the knowledge on bone procurement among the participants before and after the workshop. Methods Bone procurement workshop was held for 2 days for doctors and paramedics. The knowledge on bone procurement was evaluated in pre- and post-assessments by answering self administration questionnaire before and after the workshop, respectively. Results A total of 50 participants comprised of doctors and paramedics attended the workshop however only 15 (55.6%) doctors and 12 (44.4%) paramedics completed the assessments. Overall, the mean total score for the post-assessment (61.4%) was significantly higher (p

Acid bone lysates (ABLs) represent the growth factors and other molecules released during autologous graft resorption. However, the impact of these bone‐derived growth factors on the healing of bone defects has not yet been investigated. The aim of the present study was, therefore, to examine the impact of ABLs adsorbed to collagen membranes on bone regeneration. To this end, in 16 female Sprague Dawley rats, a standardized 5‐mm‐diameter critical size defect on the calvarial bone was created. The defects were covered with collagen membranes that had been soaked either in serum‐free media or ABLs followed by lyophilization. After a healing period of 4 weeks, micro‐computed tomography (μCT) and histological analyses by means of undecalcified thin ground sections were performed. μCT analysis of the inner 4 mm of the calvaria defect showed a greater bone defect coverage in the control group when compared to ABL group, 29.8% (confidence interval [CI]: 17.7–50.3) versus 5.6% (CI: 1.0–29.8, p =.03), respectively. Moreover, we found significantly more absolute bone volume (BV) in the control group when compared to ABL group, 0.59 mm3 (CI: 0.27–1.25) versus 0.07 mm3 (CI: 0.06–0.59, p =.04), respectively. Histomorphometry confirmed these findings with a relative BV in the central compartment of 14.1% (CI: 8.4–20.6) versus 5.6% (CI: 3.4–7.9, p =.004), respectively. These findings indicate that bone‐derived growth factors contained in ABLs are able to attenuate bone regeneration within collagen membranes. [ABSTRACT FROM AUTHOR]

As we know that healthy periodontium, is affected in most of the periodontal diseases. Which further leads to damage of hard and soft tissues. To attain back the lost structures the use of bone grafts have shown promising results. Managed either by mechanically recontouring it or by grafting techniques. Replacement grafts are widely accepted as bone formation by promoting for periodontal regeneration. There are many bone graft material which are used as bone substitute to fill the defect site the graft material acts like scaffold on which body react it by certain bone mechanism helps to regenerate new bone. This article give an overview on history, rationale and objectives of bone replacement grafts, Biology of bone healing, Indications for bone grafting include, Ideal requirements of bone grafts, List of bone graft according to origin. [ABSTRACT FROM AUTHOR]

Bone grafting has emerged as a key solution in bone defect management such as allograft, graft of bone from another individual. However, bone allografts usually undergo rigorous preparation to eliminate immune-triggering elements. The deep-freezing methods may delay graft use, while cryopreservation using liquid nitrogen allows rapid freezing but may alter graft characteristics. The aim of this study was to investigate the post-preservation changes in bone allograft characteristics and to compare the effectiveness of deep-freezing and liquid nitrogen methods using animal model. An experimental study using a post-test only control group design was conducted. Fresh-frozen femoral cortical bone was obtained from male New Zealand white rabbits. Preservation by deep-freezing involved placing bone samples in a -80°C freezer for 30 days. For liquid nitrogen preservation, bone grafts were immersed in liquid nitrogen for 20 min, followed by a 15-min rest at room temperature and a final immersion in 0.9% sodium chloride at 30°C for 15 min. Bone samples then underwent evaluation of cell viability, compression, and bending tests. Cell viability test employed the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay and the compression and bending tests used the Universal Testing Machine (UTM). Independent Student t-test or Mann-Whitney U test were used to compare the methods as appropriate. Our study found that the use of deep-freezing and liquid nitrogen resulted in similar outcomes for cell viability, compression, and bending tests, with p -values of 0.302, 0.745, and 0.512, respectively. Further exploration with larger sample sizes may help to optimize the methods for specific applications., Competing Interests: All the authors declare that there are no conflicts of interest., (© 2024 by the authors.)

Background/aim: Effective treatment of nonunion fractures is challenging as it requires a biological and mechanical environment to promote sufficient osteogenesis. Herein, we present a case series in which we evaluated the clinical efficacy of bone morphogenetic protein-2 (BMP-2)-loaded alginate microbeads and allografts in two dogs with nonunion fractures., Case Report: A 3-year-old, 2.3-kg, spayed female Pomeranian (Case 1) presented with intermittent lameness of the left forelimb after radial and ulnar fracture repair 8 weeks prior. A 4-year-old, 4.8-kg, spayed female Pomeranian (Case 2) was referred for non-weight-bearing lameness of the left hindlimb due to implant failure following left tibial fracture repair. Both dogs had atrophic bone ends and no bridging calluses at the fracture site on radiographs, and were diagnosed with nonviable nonunion fractures of the radius/ulna and tibia, respectively. The surgical approach involved implant removal, debridement, and fracture gap reconstruction. BMP-2 was loaded into alginate microbeads for a prolonged release with bone allograft chips in both cases. In Case 1, bead grafts were applied directly at the fracture site, while in Case 2, they were implanted inside a frozen cortical bone allograft as a scaffold to fill the large gap. Postoperative radiography revealed excessive callus formation, early radiographic bone union, and cortical bone remodeling, in line with improved lameness scores. At the final follow-up, gait was improved and the desired bone length and shape were achieved in both cases., Conclusion: Simultaneous use of osteoinductive BMP-2 alginate microbeads and osteoconductive bone allografts yielded functionally and structurally favorable outcomes in canine nonunion fractures, without major complications., (Copyright © 2024, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background: The occurrence of a vestibular bone lamina dehiscence of a fresh alveolus becomes a challenge for rehabilitation treatment of dental implants. Objective: To evaluate prosthetic treatment and stability of periimplant soft tissues in an alveolus with advanced oral bone resorption immediately after extraction, by using single fixed prostheses on a dental implant. Case presentation: A 29-year-old female patient, without systemic disease, completely toothed, with a thick-scalloped gingival biotype, attended the clinic and her main reason for consultation was not being aesthetically satisfied with her right upper central incisor. Radiographic examination showed advanced oral bone loss, secondary to an infection of the root of the right upper central incisor. In a first surgical phase, the right central incisor was extracted using a traumatic technique with periotomes, and a dental implant was placed. A resorbable membrane was adapted to the vestibular defect and the particulate cortical bone allograft was then compacted into the site in order to fill the space between the collagen membrane and the dental implant. A screw-retained provisional restoration was performed using the extracted natural tooth. The emergence profile was established simply by adding fluid composite resin, until the desired contours were achieved. Radiological and clinical follow-up at six months showed favorable implant evolution. No mechanical or biological complications were observed during this observation period. The oral gingival margin was in a correct position. Conclusion: This technique allowed predictable aesthetic-functional outcomes and soft tissue stability in a thick-scalloped gingival biotype with a single fixed prosthesis.

A clinical case of a 70-year-old female patient with periprosthetic humeral fracture is reported. A new distal posterior humeral plate devised at our institution for nonunions and comminuted fractures of the distal humerus was used in the case. The treatment resulted in fracture healing and functional recovery of the limb at the pre-periprosthetic fracture level. Technical features of the fixator and surgical technique are described in details with cortical allograft practice used to augment thin cortical bone around the stem.

Introduction: We aimed to present the clinical outcomes of multiple drilling and multiple matchstick-like bone allograft for large osteonecrotic lesions of the femoral head as a joint-preserving surgery. Materials and methods: Between March 2014 and March 2018, 57 patients (77 hips) who underwent multiple drilling and multiple matchstick-like bone allograft for large lesions (≥ 30%) in osteonecrosis of the femoral head (ONFH) were included. Harris hip scores (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were obtained preoperatively and at the latest follow-up. Plain radiographs were obtained every 3 months. Femoral head collapse ≥ 2 mm was defined as a radiological failure, and conversion to total hip arthroplasty (THA) was regarded as a clinical failure. Results: After exclusion of 5 patients (5 hips) who lost to follow-up, 52 patients (34 men, 18 women; 72 hips) were finally enrolled. The mean follow-up period was 3.4 (range 2–4.5) years. Nineteen hips (28.4%) required conversion to THA at a mean of 21.6 (range 6–42) months postoperatively. In the remaining 53 hips (71.6%) with clinical success, the mean HHS and WOMAC improved from 63 and 31.3 preoperatively to 80.6 and 16.3 at the final follow-up, respectively (p < 0.001). Radiological failure occurred in four hips (6%). The overall failure rate was 31.9% (23/72 hips), and the mean survival duration until failure was 21.2 months (6–42 months). The lesion size, lesion location, and the use of corticosteroids as the cause of ONFH were associated with clinical failure. Conclusion: Multiple drilling and multiple matchstick-like bone allograft may be a useful treatment option for alleviating the symptoms in ONFH patients with large lesions who want to preserve their hips. [ABSTRACT FROM AUTHOR]

BACKGROUND: It remains controversial whether patients with ARCO stage Ⅲ osteonecrosis of the femoral head should be treated with femoreal head preserving surgery, and what the clinical efficacy of femoreal head preserving surgery is. OBJECTⅣE: To investigate the clinical efficacy of nano-hydroxyapatite/polyamide 66 support rod combined with bone allograft in the treatment of ARCO stage Ⅲ osteonecrosis of the femoral head METHODS: From March 2017 to September 2018, 36 patients(32 male and 4 female, 16-58 years old) with ARCO state Ⅲ osteonecrosis of the femoral head who received treatment in Aviation General Hospital were included in this study. Among these patients, three had bilateral osteonecrosis of the femoral head and 33 had unilateral osteonecrosis of the femoral head. According to ARCO classification, 35 hips fell into stage ⅢA, 3 hips in stage ⅢB, and 1 hip in stage ⅢC. All included paitents underwent nano-hydroxyapatite/polyamide 66 support rod combined with bone allograft. Postoperative follow up was performed. Hip joint function was evaluated using Harris hip score. The degree of collapse of the femoral head was evaluated using X-ray imaging. The osteogenesis in the necrotic area was determined by CT scans. This study was approved by Aviation General Hospital Ethics Committee(Ethics code: HK2019-01-04). RESULTS AND CONCLUSION:(1) Thirty-six patients were followed up for(19.28±6.51) months. At the last follow-up, 4 hips ultimately underwent total hip arthroplasty with the success rate of 89.7%(35/39).(2) Harris hip score revealed that at the last follow-up, the excellent and good rate of hip function was significantly higher than that before surgery(71.8%,17.5%, P=0.000).(3) Last follow-up CT scans revealed obvious osteogenesis was observed in 26 of 35 hips at ARCO stage ⅢA and it was observed in neither 3 hips at ARCO stage ⅢB nor in 1 hip at ARCO stage ⅢC.(4) At the last follow-up, X-ray showed that there was progress in 5 of the 35 hips(ⅢA), 3 of which progressed to ARCO stage ⅢB, 2 to ARCO stage Ⅳ, and the remaining 30 hips were stable without progression; three hips in ARCO stage ⅢB progressed, including 2 progressed to ARCO stage ⅢC and 1 to ARCO stage Ⅳ; 1 hip in ARCOⅢC stage progressed to ARCO stage Ⅳ. The results suggest that nano-hydroxyapatite/polyamide 66 support rod combined with bone allograft has a good effect on the treatment of ARCO stage Ⅲ osteonecrosis of the femoral head. [ABSTRACT FROM AUTHOR]

Background: Bone graft as a therapeutic modality for bone defects reconstruction has been widely applied. Bone autograft is the optimum comparative standard for each substitute material, but can still cause complications and limited availability. Bone allograft has long been used as a natural substitute material for bone autograft. Chip freeze-dried bone allograft is one of the allograft's types available in various shapes and sizes, so it has the capability of filling the gaps of bone defects precisely. Purpose: This study aims to evaluate the achievement of chip freeze-dried bone allograft in completing small bone defects compared to bone autograft. Method: The researchers recapitulated the data of 10 patients with bone autograft, and chip freeze-dried bone allograft and evaluated the outcome of applying bone repair by utilizing Hammer classification on bone defects healing. The collected data were then examined statistically with the Mann-Whitney Test. Results: In the autograft group, 70% of radiological evaluations were mostly obtained from grade 2 Hammer classifications. While, in the allograft group, the highest results were obtained in grade 3 Hammer classifications, those were 40%. Statistical tests indicated that there was no significant difference in bone healing between the bone autograft and the bone allograft groups (p=0.579). Conclusion: Bone, in both groups (bone autograft and chip freeze-dried cancellous bone allograft), has the same results in terms of the healing process. [ABSTRACT FROM AUTHOR]