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Gingival fenestration is a relatively uncommon soft tissue lesion in which the root apex is exposed in the oral environment after the destruction of the overlying buccal bone plate and mucosa. At present, no clear etiology or treatment guidelines exist for gingival fenestration. This article reports three successfully treated cases of gingival fenestration associated with chronic periapical infection and can help contribute to treatment guidelines for gingival fenestration. All cases were treated with apicoectomy in conjunction with a connective tissue graft (CTG), and the first steps of each case were as follows: endodontic therapy with root-end resection and retrograde filling, then regenerative surgical therapy. However, slightly different regenerative treatment methods were used during the operation according to the different patient conditions. In Case 1, gingival fenestration in the mandibular left first premolar was treated using a xenograft and CTG. In Case 2, gingival fenestration in the maxillary left lateral incisor was treated using advanced platelet-rich fibrin (A-PRF) and CTG. In Case 3, gingival fenestration in the mandibular left second premolar was treated using CTG. Endodontic treatment was combined with periodontal surgery to achieve predictable results. After 13 to 25 months of follow-up, all cases showed well-healed gingival fenestrations and no discomfort. These three cases show the possibility of using apical excision combined with a CTG and/or bone graft/A-PRF in the treatment of gingival fenestration. Reporting these three cases may help advance the field of gingival fenestration treatment. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the dimensional changes in the alveolar crest after buccal overbuilding was performed prior to tooth extraction in a dog model. Materials and Methods: At the test sites, alveolar crest overbuilding was performed on the buccal aspect of the distal root of the third premolar using xenograft covered with a collagen membrane. No treatment was applied at the control sites. After 3 months, the distal roots of both third premolars were extracted and implants were immediately placed into the alveolus, allowing nonsubmerged healing. After 3 months, biopsy samples were collected. Results: Upon histologic analysis, no statistically significant differences in hard tissue dimensions were found. The buccal bone plate at the test sites presented a tendency for higher resorption compared to the control sites. However, if the contribution of the residue of biomaterial is considered, a higher volumetric gain was registered at the test than at the control sites. Conclusions: The buccal overbuilding performed prior to tooth extraction did not contribute to the preservation of the alveolar crest dimensions after extraction. This could be due to failure to incorporate the graft into the newly formed bone. [ABSTRACT FROM AUTHOR]

Objectives: The prevalence and the economic burden of periodontal disease are high. To save or replace diseased teeth, an objective prognosis assessment using the long-term predictability of the various treatment options should be performed. As dental implants have become a treatment of choice for replacing missing teeth, the number of implant failures and complications has also increased. The objective of this review was to compare the cost-effectiveness of saving and maintaining the teeth vs replacing them with dental implants in patients with severe periodontal disease (with hopeless or questionable teeth). Method and materials: A database search was conducted using Medline (OVID), Embase, Web of Science, and CINAHL electronic sources until July 2023. Two reviewers reviewed the papers in accordance with the specific selection criteria after choosing the abstracts that met the initial selection criterion for full article retrieval. Results: Twelve articles were included, of which nine articles discussed the cost-effectiveness of preserving teeth in severe periodontal disease and three articles discussed the effectiveness of implants that replaced the periodontally compromised teeth. It was found that placing and maintaining implants was more costly than properly treating and maintaining periodontally compromised teeth. Supportive periodontal treatment contributed the most to the cost during the periodontal treatment. Conclusions: Implants are an effective choice to replace missing teeth; however, these are not permanent, present complications, and require strict maintenance. Thus, when deciding whether to maintain a periodontally compromised tooth or to replace it with a dental implant, in terms of cost-effectiveness, implant maintenance cost as well as the cost associated with treating implant complications should be considered. This cost seems to surpass the cost of treatment and maintenance of periodontally compromised teeth. [ABSTRACT FROM AUTHOR]

Objective: The predictability and long-term success of periodontal regeneration begins with oral hygiene education, disease management, and an individually tailored periodontal maintenance protocol. The treatment outcomes could be enhanced when biologics and bone grafts are combined. The aim of this report was to describe the outcome of two complex infrabony defects in the same patient treated with recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and freeze-dried bone allograft (FDBA) over 10 years. Case presentation: Two complex infrabony defects were treated following guided tissue regeneration principles and procedures. Fullthickness flaps were raised to allow visualization of the defects. The areas were debrided, and exposed root surfaces were planed. FDBA and rhPDGF-BB were combined to fill both defects. A collagen membrane was used over the bone graft in one case. The flaps were reapproximated to achieve primary closure. The patient was seen for regular periodontal maintenance visits and clinical and radiographic follow-ups over 10 years. Throughout the examination periods, the probing depths improved without bleeding on probing, and there was radiographic evidence of bone regeneration. Conclusion: The growth factorinfused bone graft was successfully utilized for periodontal regeneration in complex bony defects. [ABSTRACT FROM AUTHOR]

In reconstructive surgery for large bone defects, the demand for bone allografts has increased over the years; however, it is unclear how the supply and demand in Japanese regional bone banks have evolved over time. This study investigated the 15-year supply and demand of bone allografts stored in a regional bone bank, along with assessing the screening process's effectiveness. The target period was 15 years from April 2005 to March 2020. The period was subdivided into three 5-year periods: first, second, and third. The study items included the number of bone allografts donated, the number of bone allografts used, donor and user facilities, surgical methods using bone allografts, and the number of bone allografts discarded. We used the Cochran-Armitage test for statistical analysis. A total of 1852 bone allografts were donated to the bone bank, and a total of 1721 were used. A total of 677 bone allografts grafts were provided in the first period, 738 in the second period, and 525 in the third period, indicating a decreasing trend. The average number of allografts per surgery was 2.8 in the first, 3.1 in the second, and 1.7 in the third, showing a decreasing trend. Concerning the percentage of each surgery using bone allografts, spine fusion decreased in the third period but not significantly, whereas primary hip arthroplasty increased significantly in the third period. The total number of discarded bone allografts was 4.8% of the total number of donated bone allografts, largely because of a lack of screening tests. Although the number of allogeneic bone surgeries has been increasing over time, the number of allogeneic bone donations has shown a decreasing trend, and there is a need to develop a system that can provide surgeons with sufficient bone allografts. [ABSTRACT FROM AUTHOR]

Objectives: This randomized controlled trial compared the outcomes of recombinant human fibroblast growth factor (rhFGF)-2 plus carbonate apatite (CO3Ap) granules with rhFGF-2 alone in the treatment of intrabony periodontal defects. Materials and methods: Patients with Stage III Grade B/C periodontitis who had completed initial periodontal therapy and had intrabony defects with a depth of ≥ 3 mm were included. Defects were treated solely with rhFGF-2 (control) or rhFGF-2 plus CO3Ap (test). Periodontal parameters and a patient-reported outcome measure (PROM) were assessed at baseline, at 6, 9 and 12 months postoperatively. The primary outcome was the change in clinical attachment level (CAL) from baseline to 12 months postoperatively. Using the Friedman test with Dunn's post-test, intragroup data were compared over time, and Mann-Whitney U test was used to assess intergroup data at each time point. Results: Forty-eight sites in 38 patients were subjected to analysis. At 12 months postoperatively, CAL in both groups showed a significant improvement from baseline (p < 0.001). CAL gain was 3.4 ± 1.3 mm in the test group and 3.2 ± 1.2 mm in the control group, with no significant intergroup difference (p = 0.567). Radiographic bone fill in the test group (67.2%) was significantly greater than in the control group (32.4%) (p < 0.001). PROM scores showed no difference between groups. Conclusions: At 12 months, the outcomes including CAL gain and PROM showed no significant differences between groups, although the combination treatment enhanced radiographic bone fill. Clinical relevance: The use of rhFGF-2 (with/without CO3Ap) could lead to significant improvement in clinical parameters in the treatment of intrabony periodontal defects. The benefit of adding CO3Ap to rhFGF-2 therapy needs further evaluation. Clinical Trial Registration Number: The University Hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) : UMIN000040783. [ABSTRACT FROM AUTHOR]

This study presents the fabrication of carbon‐fiber‐reinforced polyetheretherketone (CF/PEEK) by 3D printing, which is subsequently coated with elastic nanofibers by electrospinning. CF/PEEK is an FDA‐approved implantable material possessing excellent mechanical properties similar to those of human cortical bone. As such, it is a prime candidate for replacing conventional metallic implants. However, it is limited by its bioinertness and inferior osteogenic properties. In this study, CF/PEEK is engineered to have improved hydrophilic properties and generated micro/nano‐topographical structures on its surface. This is achieved by electrospinning directly onto the 3D‐printed CF/PEEK with fibers incorporating hydroxyapatite particles and gelatin. The results show that the micro‐/nano‐topographical CF/PEEK demonstrates a significant increase in mineralizing potential compared to non‐coated implants, where no mineralized matrix is observed. These fiber coating modifications to CF/PEEK are a promising and important step forward in the improvement of in vivo implant‐bone osteointegration. [ABSTRACT FROM AUTHOR]

Background: The development of less invasive all‐inside techniques regarding anterior cruciate ligament (ACL) reconstruction surgery has been associated with various advantages, including fewer complications and reduced postoperative pain. Silva et al. described a quadruple semitendinosus graft construct and suspensory button fixation for ACL reconstruction as an alternative technique. At the end of this technique, the tibial tunnel is filled with a bone autograft plug. This paper aims to examine the incorporation of the autograft and thus evaluate whether the "Silva technique" provides the same benefits as all‐inside techniques. Methods: A prospective study assessed 31 patients undergoing ACL reconstruction surgery using the "Silva technique." The cases involved in the study were skeletally mature patients with no previous history of ACL surgery or multiligamentous instability. All patients followed the same rehabilitation program and were examined at three standardized follow‐up visits: 4 months, 8 months, and 1 year postoperatively. Tegner–Lysholm knee score (TLKS), visual analog score (VAS) for pain, and the IKDC subjective knee score were completed at every visit. A knee MRI scan was performed at every scheduled visit to assess bone graft incorporation and remodeling. Results: TLKS scores revealed a considerable improvement compared to preoperative figures, from 57.2 points preoperatively to an average of 99.4 at the 12‐month follow‐up (p < 0.0001). VAS scores were substantially ameliorated after the operation and until the second follow‐up visit, from 5 before surgery to zero 8 months after the operation, with no noteworthy alterations afterward (p < 0.0001). IKDC subjective knee score outcomes were found to have increased at the last follow‐up, from 59.3 prior to surgery to 99.8 12 months postoperatively (p < 0.0001). Regarding the MRI features of the bone autograft, the tibial tunnel was entirely filled by bone formation at the last MRI scan, suggesting complete integration of the autograft in all patients. Conclusions: Bone autograft employed to seal the tibial tunnel was completely incorporated in all cases 1 year postoperatively. The "Silva technique" appears to feature all the avails of all‐inside techniques, whilst it seems to be simpler and easier than them after the surgeon is familiarized with its particular aspects. It is a robust option in orthopedic surgeons' arsenal. However, further large‐scale pertinent research is requisite to confirm the findings of this study. [ABSTRACT FROM AUTHOR]

To evaluate the effect of combining different bioactive root-end filling materials with composite bone graft (xenogeneic mixed with autogenous bone fragments) on the healing process of periapical tissues after endodontic micro-surgery procedure. In this triple-blinded clinical trial, 56 patients were divided into 2 main groups (28 each) according to the root-end filling material and 2 subgroups according to the presence or absence of the composite bone graft material. Group I: MTA root-end filling (n = 28) in which there are Sub-group A: without bone graft (n = 14) and Sub-group B: with composite bone graft (n = 14). Group II: TotalFill root-end filling (n = 28) in which there are Sub-group A: without bone graft (n = 14) and Sub-group B: with composite bone graft (n = 14). Healthy patients whose ages range from 20 to 50 years with small-to-medium size radiolucency in CBCT related to single-rooted maxillary teeth were included in this study. Patients were assigned a number starting from 1 to 56 and were randomly allocated to four test groups (2 main groups and 2 sub-groups) following simple randomization procedure guidelines described by IBM SPSS V23 (IBM USA) statistical analysis software. This trial was triple-blind where the patient, the outcome assessors, and the main operator were blinded to the applied intervention. Every patient was evaluated clinically and by CBCT at two main observation periods: presurgical and 12-month post-operative. They were also examined and evaluated clinically and radiographically through periapical x-rays after one week, three, and six months. Statistical analysis was performed with IBM SPSS Statistics for Windows Version 23.0. Armonk, NY: IBM Corp. Of the 56 patients enrolled in the study, 49 patients were available for the final analysis. All groups showed no statistically significant differences with regard to healing or success rates at the 12-month follow-up mark. No adverse effects were encountered. Results showed that high success rates were achieved using MTA and TotalFill in the healing of periapical lesions after endodontic surgery. The addition of bone graft in small-to-medium size lesions did not affect the success rate of endodontic surgeries. [ABSTRACT FROM AUTHOR]

Concentrated Growth Factor (CGF) is a highly effective biomaterial known for its ability to promote tissue regeneration. While it's been studied extensively in intraoral procedures and bone grafting, its benefits in maxillary sinus lifting lack substantial evidence. This review aimed to evaluate CGF's effectiveness in maxillary sinus augmentation, focusing on clinical, radiographic, and histological outcomes. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Library databases using specific mesh terms and keywords and adhered to PRISMA guidelines. Studies up to March 2024 involving transcrestal or lateral maxillary sinus floor elevation with CGF, either alone or in combination with grafting materials, were included. Out of 783 publications, 13 studies met the eligibility criteria. The review assessed CGF's role in minimizing postoperative complications, enhancing new bone formation, and improving implant survival. Despite data variability among studies, the majority reported that CGF positively influenced maxillary sinus augmentation outcomes. While more robust randomized clinical trials are required to draw definitive conclusions, initial results are promising, and the findings suggest that CGF utilization in maxillary sinus augmentation seems to enhance clinical outcomes by promoting vascularization and regeneration at the surgical sites and improving both the quality and quantity of newly formed sinus bone. Furthermore, it exhibits potential for improving postoperative sequelae and achieving high implant survival rates. [ABSTRACT FROM AUTHOR]

Background: The current trial evaluated the midfacial gingival margin changes, volumetric, radiographic and clinical alterations 1-year following immediate implant placement with customized healing abutment (IIP + CHA) either solely, or in combination with xenograft (IIP + Bonegraft) or with connective tissue grafting (IIP + CTG) at sites with thin labial bone in the esthetic zone. Methods: Thirty-nine non-restorable maxillary teeth indicated for extraction in the esthetic zone were included. Participants were randomly assigned into three equal group; IIP + Bonegraft (Control), IIP + CTG and IIP + CHA. Midfacial gingival margin changes(mm) as primary outcome, labial soft tissue contour change(mm), interdental tissue height changes and total volume(mm3) were assessed. Amount of bone labial to the implant and crestal bone level changes were also recorded. All outcomes were measured 1-year post-operative. Results: The midfacial gingival margin changes demonstrated a significant difference (P ≤ 0.05) between the groups showing -0.98, -0.74 and -1.54 mm in sites treated with IIP + Bone graft, IIP + CTG and IIP + CHA respectively after1-year. While labial soft tissue contour change (mm), total volume (mm3) and distal interdental tissue height changes (mm) revealed a significant difference after one-year between the studied groups, yet mesial interdental tissue height changes showed no difference (P > 0.05). Both IIP + Bone graft and IIP + CHA groups revealed a significant positive correlation between the total volume loss (mm3) after 1 year and mid-facial gingival margin changes (P ≤ 0.05). However, no significant correlation was observed in the IIP + CTG group (P = 0.63). CBCT measurements showed a significant difference in crestal bone changes between the three groups (P ≤ 0.05), yet, there was no significant difference regarding mean amount of bone labial to the implant(P > 0.05). Conclusions: This investigation suggests that the mere presence of CTG simultaneous with IIP in the anterior maxilla reduced the midfacial gingival margin alterations (mm), besides, CTG decreased the overall volume loss (mm3) by 5-folds compared to the other studied groups after one year. Meanwhile, using CHA alone with IIP failed to maintain the peri-implant soft tissues contour. Trial registration: The current trial was retrospectively registered at Clinical trials.gov (ID: NCT05975515, Date: 27-July-2023). [ABSTRACT FROM AUTHOR]

Background: Immediate implant placement using vestibular socket therapy (VST) proved to offer a successful treatment option in compromised sockets. However, the presence of active signs infection complicates immediate implants in sockets with defective labial plates, due to the possible contamination of the implant or the bone graft with existing infected tissues or oral environment via the fistula. This study, therefore, aims to explore the success of immediate implant placement using VST in managing infected compromised sockets. Methods: We included 26 age- and sex-matched patients with 41 implants sites. Thirteen patients had 19 infected (group I) and 13 had 21 non-infected type 2 sockets (group N). Both groups were treated using vestibular socket therapy (VST) and a 6-day protocol. Implant survival, changes in facial bone thickness, and mid, mesial, and distal mucosal levels were evaluated 1 year after implant placement. The Mann–Whitney U test was used to compare both groups. Furthermore, the Wilcoxon signed-rank test was used to study changes with time within each group. The statistical significance level was set at P < 0.05. Results: All implants survived; no significant difference was found between groups N and I regarding apical, mid, and crestal bone thickness and soft tissue level, except at the mesial papilla, where the recession was significantly more in group N than in group I. Changes over time were statistically significant in the apical, mid, and crestal bone thickness in both groups. The mean bone thickness gain ranged from 0.85 to 2.4 mm and 0.26–1.63 mm in groups I and N, respectively. Additionally, the mean mucosal recession ranged from 0.29 to 0.51 mm and 0.39–1.47 mm in groups I and N, respectively. Conclusion: Within the limitations of this study immediate implant placement in type II infected sockets using the 6-day protocol and VST achieved 100% implant survival, while maintaining the regenerated facial bone thickness with minimal mucosal recession. Trial registration: The protocol for this study was registered on clinicaltrials.gov at 3/10/2021 (registration number NCT04787224). [ABSTRACT FROM AUTHOR]

Bone grafting in oral and maxillofacial surgery has evolved significantly due to developments in materials science, offering innovative alternatives for the repair of bone defects. A few grafts are currently used in clinical settings, including autografts, xenografts, and allografts. However, despite their benefits, they have some challenges, such as limited availability, the possibility of disease transmission, and lack of personalization for the defect. Synthetic bone grafts have gained attention since they have the potential to overcome these limitations. Moreover, new technologies like nanotechnology, 3D printing, and 3D bioprinting have allowed the incorporation of molecules or substances within grafts to aid in bone repair. The addition of different moieties, such as growth factors, stem cells, and nanomaterials, has been reported to help mimic the natural bone healing process more closely, promoting faster and more complete regeneration. In this regard, this review explores the currently available bone grafts, the possibility of incorporating substances and molecules into their composition to accelerate and improve bone regeneration, and advanced graft manufacturing techniques. Furthermore, the presented current clinical applications and success stories for novel bone grafts emphasize the future potential of synthetic grafts and biomaterial innovations in improving patient outcomes in oral and maxillofacial surgery. [ABSTRACT FROM AUTHOR]

Forearm non-union poses a challenge in orthopaedic surgery due to its intricate anatomy and functional significance. This review provides a comprehensive overview of the assessment, diagnosis and management of forearm non-union. Initial evaluation involves a meticulous history, physical examination and imaging studies to identify factors contributing to non-union, including infection. Surgical approaches are discussed, with emphasis on restoring biomechanical stability and promoting bone healing. Treatment options range from autografts to allografts, with considerations for vascularised bone transfers in complex cases. Decision-making strategies are outlined, considering patient-specific factors and individualised treatment plans. Special considerations for specific types of forearm non-unions are addressed, along with postoperative care protocols to optimise healing and functional outcomes. Overall, this review aims to provide clinicians with a comprehensive understanding of forearm non-union management based on current evidence and clinical practice. Level of Evidence: Level V (Therapeutic) [ABSTRACT FROM AUTHOR]

Summary: Background: A variety of treatment options for unicameral bone cysts (UBC) exist. The controversy of open management of UBC is discussed. The aim of this study was to analyze a single institution's experience in the open surgical treatment of UBC. Patients and methods: By retrospective analysis of the Vienna Bone and Soft Tissue Tumor Registry, 119 patients with open surgery and histologically verified UBC with a mean follow up of 4.8 years (range 1–30 years) were included. Lesion treatment failure was defined as surgically addressed UBC undergoing revision surgery due to persistence or recurrence. Results: Local revision-free survival for lesion treatment failure was 93% after 1 year, 80% after 2 years, 60% after 5 years and 57% after 10 years. Of the patients 34 (29%) had at least 1 revision surgery due to lesion treatment failure. We found that patients with lesion treatment failure were younger (p = 0.03), had UBC with less minimal distance to the growth plate (p = 0.02) and more septation chambers in radiologic imaging (p = 0.02). Patients with open revision surgery were less likely to require a second revision due to lesion treatment failure than patients with percutaneous revision surgery (p = 0.03). Conclusion: Open surgery for UBC can only be recommended as reserve treatment in younger children with actively growing lesions. Open UBC surgery carries a relatively high risk of almost 30% of lesion treatment failure and therefore the indications should be limited to extensive osteolysis with high risk of pathological fractures, lesions with displaced pathological fractures, and lesions with an ambiguous radiological presentation that require tissue collection. [ABSTRACT FROM AUTHOR]

Background: A lateral hinge fracture is a common complication in medial open wedge high tibial osteotomy (MOWHTO) and is associated with delayed union or nonunion. A comparison of outcomes between patients with or without a lateral hinge fracture after MOWHTO with a structural allograft has not been investigated. Purpose: To validate the outcomes of MOWHTO with a structural allograft, especially in the presence of a lateral hinge fracture. Study Design: Case series; Level of evidence, 4. Methods: We conducted a single-surgeon cohort study at a tertiary referral hospital between April 2017 and August 2022 and included patients who had undergone MOWHTO with a structural allograft for isolated medial compartment osteoarthritis with genu varum. We compared the incidence of delayed union or nonunion events and functional scores between patients with a lateral hinge fracture and those without using the Fisher exact test and independent t test. Results: A total of 88 MOWHTO procedures (77 patients) were analyzed. The overall incidence of lateral hinge fractures was 29.5% (n = 26), including type I (n = 20 [22.7%]) and type II (n = 6 [6.8%]). Notably, 42.3% (n = 11) of these fractures had not been detected intraoperatively but during the follow-up visits. The overall Knee Society Score (KSS), Knee Society Score–Function (KSS-F), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were 90.0 ± 10.0, 93.4 ± 10.8, and 93.8 ± 7.1 points, respectively. None of the patients had delayed union or nonunion, and none underwent a reoperation because of bony union problems. The functional scores (KSS, KSS-F, and WOMAC) were not different between patients who had a lateral hinge fracture and those who did not (P >.05). Conclusion: The routine use of a structural allograft was associated with satisfactory outcomes after MOWHTO, regardless of whether there was a lateral hinge fracture. [ABSTRACT FROM AUTHOR]

Particulate bone grafting material can travel from the implantation site and diminish the magnitude of required bone formation response and hence its effectiveness. An easily prepared moldable graft that rapidly sets rigid in situ would alleviate this problem and in this study, such an injectable bone graft material is presented. By combining calcium phosphate (CP) salts with a bioactive glass (BG) mixed with a 2.5% Na2HPO4 solution a novel BG‐based calcium phosphate cement (CPC) is produced. Immersion in Tris buffer and simulated body fluid (SBF) solutions result in the rapid generation of octacalcium phosphate (OCP) and hydroxyapatite (HA) phases – a pre‐requisite for "bioactivity". Cement‐conditioned media does not result in any cytotoxic potential with respect to MTT activity, DNA content, or alkaline phosphatase activity with an osteoblastic cell line. Application of the cement into standardized surgical defects in the minipig mandible results in short‐term, moderate irritation at 3 and 6 weeks and complete replacement of cement with new bone at 12 weeks. [ABSTRACT FROM AUTHOR]

Introduction: Oligodontia is a rare dental developmental pathology that requires prolonged, complex and multidisciplinary treatment. Although bone augmentation is frequently required during a complete implant treatment of oligodontia. Therefore, we evaluated the ability to predict pre-implant surgery complexity based on age, number of missing teeth, and number of implants required to achieve implant-supported prosthetic rehabilitation. Material and methods: This retrospectively registered study included all patients who underwent surgical treatment for oligodontia in our Oral and Maxillofacial Surgery Department between January 2012 and May 2023. Demographic data, number and location of missing teeth, pre- and per-implant surgical procedures, and the number of planned implants were recorded. A quantitative variable called "complexity score of pre-implant surgery" was created. This 10-point score was calculated by adding one point for each preimplant surgical procedure registered. A simple linear regression was calculated to explain the number of targeted implants based on number of missing teeth. A multiple linear regression model was used to explain the complexity score of pre-implant surgery and age, number of missing teeth and number of targeted implants. Results: 119 oligodontia patients were included in the study. The median number of tooth agenesis was 10. A total of 825 implants were placed, 14 (1.7%) of which failed. A significant regression equation was used (F(1,118) = 1098,338; p < 0.0001) to explain the number of targeted implants based on number of missing teeth, with a R2 of 0.903. A significant regression equation was found (F(3,116) = 107,229; p < 0.0001) to explain the complexity score of pre-implant surgery and age, number of missing teeth and number of targeted implants, with a R2 of 0.735. Discussion: These results based on patient data indicate that age, number of missing teeth and number of targeted implants could reliably explain the complexity of pre-implant surgery. [ABSTRACT FROM AUTHOR]

Objectives: The incorporation of retromolar bone grafts used for alveolar ridge augmentation is not well understood. This prospective observational study aims to supply histomorphometrical data from bone graft biopsies taken at the time of retrieval and after a 3‐month healing period using patient‐matched biopsies. Materials and Methods: In 17 patients, trephine biopsies of the graft were acquired at the time of graft retrieval and after a 3‐month healing period. The biopsies were compared histomorphometrically regarding the number of osteocytes, appearance of osteocyte lacunae, quantity, surface area, and activity of the Haversian canals. Results: All grafts appeared clinically stable after screw removal and 17 implants were placed. Histomorphometric analysis revealed no significant difference in the number of osteocytes (p =.413), osteocyte lacunae (p =.611), the ratio of filled/empty osteocyte lacunae (p =.467) and active Haversian canals (p =.495) between the biopsies retrieved after a 3‐months healing period with those at the time of grafting. The only significant difference was noted in the mean surface area of the Haversian canals (p =.002). Specifically, the grafts post 3‐month healing showed a significantly larger mean area (0.069 mm2) compared to the time of grafting (0.029 mm2). Conclusion: This study demonstrates, compared to other data, a high rate of vital structures in retromolar bone block grafts after 3 months of healing, exhibiting the same histological features in comparison to the biopsies from the native alveolar ridge. Standard histomorphometrical parameters, e.g., the amount of filled or empty osteocyte lacunae for the description of the vitality of the graft need to be reappraised. [ABSTRACT FROM AUTHOR]

P-15 is a 15-amino-acid-long biomimetic peptide widely demonstrated to enhance osteogenesis in vivo. Despite the prevalence of polyether-ether-ketone (PEEK) in interbody device manufacturing, a growing body of evidence suggests it may produce an unfavorable immune response. The purpose of this preliminary study was to characterize the immune response and new bone growth surrounding PEEK implants with and without a P-15 peptide-based osteobiologic. A bilateral femoral defect model was conducted using New Zealand white rabbits. A total of 17 test subjects received one implant in each distal femur, either with or without bone graft material. Animals were allowed to survive to 4 or 8 weeks, at which time the femurs were collected and subjected to micro-computer tomography (microCT) or cytokine analysis. MicroCT analysis included the quantification of bone growth and density surrounding each implant. The cytokine analysis of periprosthetic tissue homogenates included the quantification of interleukins (ILs) and TNF-α expression via ELISA kits. Improvements in bone volume were observed in the P-15 cohort for the regions of interest, 500–136 and 136–0 µm from the implant surface, at 8 weeks post-op. Concentrations of IL-1β, IL-4, and IL-6 cytokines were significantly higher in the P-15 cohort compared to the PEEK cohort at the 4-week timepoint. Significant reductions in the concentrations of IL-4 and IL-6 cytokines from the 4- to 8-week cohort were observed in the P-15 cohort only. The P-15 peptide has the potential to modulate the immune response to implanted materials. We observed improvements in bone growth and a more active micro-environment in the P-15 cohort relative to the PEEK control. This may indicate an earlier transition from the inflammatory to remodeling phase of healing. [ABSTRACT FROM AUTHOR]

Purpose: The present study aimed to evaluate and compare the management of Jump space (JS) in immediate implants with and without Demineralised freeze-dried bone allograft (DFDBA) with flapless approach. Materials and Methods: The present study included 40 sites with immediate implant placement in the maxillary anterior region. Group 1 patients were treated without augmentation while Group 2 patients with DFDBA in the JS. Both the groups were further subdivided according to the horizontal dimensions as JS less (G1S1, G2S1) or more than 2mm (G1S2, G2S2). Plaque index (PI), Gingival Index (GI), Probing depth (PD), Testori esthetic score (TS), VAS score, Crestal Bone height (CBH), Ridge width (RW), Vertical distance (VD) and radiolucent area (RA) were evaluated radiographically with CBCT at baseline and 12 months' post therapy. Results: Significant differences were observed in CBH in the midfacial region in G1S1-G2S1 with the mean of 0.34±0.19mm and G1S2 --G2S2 with 0.75±0.26 mm at 12 months. Significant differences in TS were observed in G1S1 and G2S1 with mean value of 0.55±0.53 while G1S2 and G2S2 exhibited value of 1.33±0.82. Conclusion: DFDBA shows better CBH preservation in midfacial region, reduction in RA indicating greater resolution of JS thereby leading to better hard and soft tissue healing. [ABSTRACT FROM AUTHOR]

Background: Bone augmentation aims to provide sufficient bone volume around dental implants. Available bone augmentation methods include autogenous bone grafts, xenografts, and alloplastic materials. All have their advantages and disadvantages. However, autogenous bone graft remains the gold standard for bone augmentation. Autogenous bone grafts are usually taken from the patient's oral donor sites such as the chin and mandibular ramus. However, there is a newly developed implant preparation protocol, known as the peripheral-bone-removal (PBR) technique, which can provide bone augmentation from the dental implant site. Purpose: This study aims to determine the need for bone substitute materials in the PBR technique in dental implant surgery. Methods: This study included 130 patients who were treated for dental implants. These patients were treated between 7.1.2018 and 3.2.2023. Six dental implant systems were used. Five of these systems (ImplantKa®, DeTech®, NeoBiotech®, Easy Implant®, and Dentaurum® Implant) used a conventional method (sequential drilling technique). The sixth (IBS®) system used the PBR protocol. Both descriptive and Chi-Square Test statistics were used for data analysis. Results: The included patients were treated with a total of 198 dental implants. Seventy patients were treated with the PBR protocol, while 60 patients were treated with the sequential drilling protocol. For the PBR protocol, only 2 cases required bone substitute material, whereas 11 cases treated with the sequential drilling protocol required augmentation materials. This difference between both drilling protocols has been statistically confirmed (P=0.008). Conclusion: The PBR technique appears to be less traumatic and more cost-effective for cases that require horizontal bone augmentation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to (a) record and evaluate the epidemiological data relevant to the fractures of the atrophic mandible in the Greek population (b) present our experience in the management of these difficult injuries and (c) compare our results to the outcomes of other similar studies and discuss the postoperative complications. Methods: A prospective analysis of all the edentulous patients with fractures of the atrophic mandible treated at the Oral and Maxillofacial Surgery Department of K.A.T General Hospital of Athens in Greece was performed from November 2012 to December 2022. Age, gender and medical history of the patient, etiology and site of the fracture, classification of atrophy, type of surgical approach, type of osteosynthesis and postoperative complication. Results: 34 patients were included in the present study and 48 fractures of the atrophic edentulous mandible were managed surgically. 22 fractures were classified as class II of atrophy, 21 fractures as class III and 5 injuries as class I. In 32 patients we used an extraoral approach and only 2 patients were treated with an intraoral access. 44 fractures were treated with a 2.0 mm locking reconstruction plate and only 4 injuries of class I atrophy were treated with mini plates. Conclusions: Clinical practice has confirmed that for these cases an extraoral approach followed by stable fixation with a 2.0 mm reconstruction locking plate can deliver excellent results. Our findings show that the routine use of primary bone grafts is not necessary and can be reserved for more complex cases. [ABSTRACT FROM AUTHOR]

Background Alveolar ridge is dynamic in nature. Preservation of residual alveolar ridge is always desirable. Bone grafts and platelet concentrates can be used for socket preservation. Maintenance of bone volume is essential and various ridge augmentation techniques are used for desirable functional and esthetic outcomes. Aim Evaluation and comparison of the efficacy of autogenous dentin block versus allograft block in preserving alveolar ridge dimension with 6-month follow-up. Materials and Methods Twenty subjects indicated for tooth extraction were randomly divided into three groups. In Group I, autogenous dentin graft with platelet-rich fibrin (PRF) membrane was used as socket filling material, Group II: allogenic bone graft with PRF membrane, or Group III: control group (socket left ungrafted). Clinical and radiographic examinations were done using periodontal probe and cone-beam computed tomography. Results On intragroup comparison of socket size, the mean for Group I was found to be 33.270 mm2 at baseline and 25.358 mm after 12 months for Group II was found to be 53.250 mm2 at baseline and socket fill was 41.875 mm2 at 12 months. Group III was found to be 43.483 mm2 at baseline, and socket fill was 15.063 mm2 at 12 months. On intergroup comparison, the values were found to be statistically nonsignificant both at baseline (12 months postoperatively. The crestal bone loss was 0.975 for Group I, 1.075 for Group II, and 2.925 mm for Group III. Crestal bone loss was seen highest in Group III and lowest for Group I. The mean percentage of socket fill was found to be 80.01% for Group I, 76.13% for Group II, and 34.03% for Group I. Conclusion A significant amount of radiographic socket fill was appreciated over 12 months in all the three groups. The percentage of socket fill in Group I was 80.01% and in Group II was 76.13% and the difference between them was statistically nonsignificant. Statistically significant socket fill was seen for both Group 1 and Group 2.

Abstract To evaluate the effect of combining different bioactive root-end filling materials with composite bone graft (xenogeneic mixed with autogenous bone fragments) on the healing process of periapical tissues after endodontic micro-surgery procedure. In this triple-blinded clinical trial, 56 patients were divided into 2 main groups (28 each) according to the root-end filling material and 2 subgroups according to the presence or absence of the composite bone graft material. Group I: MTA root-end filling (n = 28) in which there are Sub-group A: without bone graft (n = 14) and Sub-group B: with composite bone graft (n = 14). Group II: TotalFill root-end filling (n = 28) in which there are Sub-group A: without bone graft (n = 14) and Sub-group B: with composite bone graft (n = 14). Healthy patients whose ages range from 20 to 50 years with small-to-medium size radiolucency in CBCT related to single-rooted maxillary teeth were included in this study. Patients were assigned a number starting from 1 to 56 and were randomly allocated to four test groups (2 main groups and 2 sub-groups) following simple randomization procedure guidelines described by IBM SPSS V23 (IBM USA) statistical analysis software. This trial was triple-blind where the patient, the outcome assessors, and the main operator were blinded to the applied intervention. Every patient was evaluated clinically and by CBCT at two main observation periods: presurgical and 12-month post-operative. They were also examined and evaluated clinically and radiographically through periapical x-rays after one week, three, and six months. Statistical analysis was performed with IBM SPSS Statistics for Windows Version 23.0. Armonk, NY: IBM Corp. Of the 56 patients enrolled in the study, 49 patients were available for the final analysis. All groups showed no statistically significant differences with regard to healing or success rates at the 12-month follow-up mark. No adverse effects were encountered. Results showed that high success rates were achieved using MTA and TotalFill in the healing of periapical lesions after endodontic surgery. The addition of bone graft in small-to-medium size lesions did not affect the success rate of endodontic surgeries.

Abstract Concentrated Growth Factor (CGF) is a highly effective biomaterial known for its ability to promote tissue regeneration. While it’s been studied extensively in intraoral procedures and bone grafting, its benefits in maxillary sinus lifting lack substantial evidence. This review aimed to evaluate CGF’s effectiveness in maxillary sinus augmentation, focusing on clinical, radiographic, and histological outcomes. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Library databases using specific mesh terms and keywords and adhered to PRISMA guidelines. Studies up to March 2024 involving transcrestal or lateral maxillary sinus floor elevation with CGF, either alone or in combination with grafting materials, were included. Out of 783 publications, 13 studies met the eligibility criteria. The review assessed CGF’s role in minimizing postoperative complications, enhancing new bone formation, and improving implant survival. Despite data variability among studies, the majority reported that CGF positively influenced maxillary sinus augmentation outcomes. While more robust randomized clinical trials are required to draw definitive conclusions, initial results are promising, and the findings suggest that CGF utilization in maxillary sinus augmentation seems to enhance clinical outcomes by promoting vascularization and regeneration at the surgical sites and improving both the quality and quantity of newly formed sinus bone. Furthermore, it exhibits potential for improving postoperative sequelae and achieving high implant survival rates.

Abstract Background The current trial evaluated the midfacial gingival margin changes, volumetric, radiographic and clinical alterations 1-year following immediate implant placement with customized healing abutment (IIP + CHA) either solely, or in combination with xenograft (IIP + Bonegraft) or with connective tissue grafting (IIP + CTG) at sites with thin labial bone in the esthetic zone. Methods Thirty-nine non-restorable maxillary teeth indicated for extraction in the esthetic zone were included. Participants were randomly assigned into three equal group; IIP + Bonegraft (Control), IIP + CTG and IIP + CHA. Midfacial gingival margin changes(mm) as primary outcome, labial soft tissue contour change(mm), interdental tissue height changes and total volume(mm3) were assessed. Amount of bone labial to the implant and crestal bone level changes were also recorded. All outcomes were measured 1-year post-operative. Results The midfacial gingival margin changes demonstrated a significant difference (P ≤ 0.05) between the groups showing -0.98, -0.74 and -1.54 mm in sites treated with IIP + Bone graft, IIP + CTG and IIP + CHA respectively after1-year. While labial soft tissue contour change (mm), total volume (mm3) and distal interdental tissue height changes (mm) revealed a significant difference after one-year between the studied groups, yet mesial interdental tissue height changes showed no difference (P > 0.05). Both IIP + Bone graft and IIP + CHA groups revealed a significant positive correlation between the total volume loss (mm3) after 1 year and mid-facial gingival margin changes (P ≤ 0.05). However, no significant correlation was observed in the IIP + CTG group (P = 0.63). CBCT measurements showed a significant difference in crestal bone changes between the three groups (P ≤ 0.05), yet, there was no significant difference regarding mean amount of bone labial to the implant(P > 0.05). Conclusions This investigation suggests that the mere presence of CTG simultaneous with IIP in the anterior maxilla reduced the midfacial gingival margin alterations (mm), besides, CTG decreased the overall volume loss (mm3) by 5-folds compared to the other studied groups after one year. Meanwhile, using CHA alone with IIP failed to maintain the peri-implant soft tissues contour. Trial registration The current trial was retrospectively registered at Clinical trials.gov (ID: NCT05975515, Date: 27-July-2023).

Abstract Background Immediate implant placement using vestibular socket therapy (VST) proved to offer a successful treatment option in compromised sockets. However, the presence of active signs infection complicates immediate implants in sockets with defective labial plates, due to the possible contamination of the implant or the bone graft with existing infected tissues or oral environment via the fistula. This study, therefore, aims to explore the success of immediate implant placement using VST in managing infected compromised sockets. Methods We included 26 age- and sex-matched patients with 41 implants sites. Thirteen patients had 19 infected (group I) and 13 had 21 non-infected type 2 sockets (group N). Both groups were treated using vestibular socket therapy (VST) and a 6-day protocol. Implant survival, changes in facial bone thickness, and mid, mesial, and distal mucosal levels were evaluated 1 year after implant placement. The Mann–Whitney U test was used to compare both groups. Furthermore, the Wilcoxon signed-rank test was used to study changes with time within each group. The statistical significance level was set at P

Aims: Surgical approaches to cervical ossification of the posterior longitudinal ligament (OPLL) remain controversial. The purpose of the present study was to analyze and compare the long-term neurological recovery following anterior decompression with fusion (ADF) and posterior laminectomy and fusion with bone graft and internal fixation (PLF) based on > ten-year follow-up outcomes in a single centre. Methods: Included in this retrospective cohort study were 48 patients (12 females; mean age 55.79 years (SD 8.94)) who were diagnosed with cervical OPLL, received treatment in our centre, and were followed up for 10.22 to 15.25 years. Of them, 24 patients (six females; mean age 52.88 years (SD 8.79)) received ADF, and the other 24 patients (five females; mean age 56.25 years (SD 9.44)) received PLF. Clinical data including age, sex, and the OPLL canal-occupying ratio were analyzed and compared. The primary outcome was Japanese Orthopaedic Association (JOA) score, and the secondary outcome was visual analogue scale neck pain. Results: Compared with the baseline, neurological function improved significantly after surgery in all patients of both groups (p < 0.001). The JOA recovery rate in the ADF group was significantly higher than that in the PLF group (p < 0.001). There was no significant difference in postoperative cervical pain between the two groups (p = 0.387). The operating time was longer and intraoperative blood loss was greater in the PLF group than the ADF group. More complications were observed in the ADF group than in the PLF group, although the difference was not statistically significant. Conclusion: Long-term neurological function improved significantly after surgery in both groups, with the improvement more pronounced in the ADF group. There was no significant difference in postoperative neck pain between the two groups. The operating time was shorter and intraoperative blood loss was lower in the ADF group; however, the incidence of perioperative complications was higher. Cite this article: Bone Jt Open 2024;5(9):768–775.

Background: Bone augmentation aims to provide sufficient bone volume around dental implants. Available bone augmentation methods include autogenous bone grafts, xenografts, and alloplastic materials. All have their advantages and disadvantages. However, autogenous bone graft remains the gold standard for bone augmentation. Autogenous bone grafts are usually taken from the patient’s oral donor sites such as the chin and mandibular ramus. However, there is a newly developed implant preparation protocol, known as the peripheral-bone-removal (PBR) technique, which can provide bone augmentation from the dental implant site. Purpose: This study aims to determine the need for bone substitute materials in the PBR technique in dental implant surgery. Methods: This study included 130 patients who were treated for dental implants. These patients were treated between 7.1.2018 and 3.2.2023. Six dental implant systems were used. Five of these systems (ImplantKa®, DeTech®, NeoBiotech®, Easy Implant®, and Dentaurum® Implant) used a conventional method (sequential drilling technique). The sixth (IBS®) system used the PBR protocol. Both descriptive and Chi-Square Test statistics were used for data analysis. Results: The included patients were treated with a total of 198 dental implants. Seventy patients were treated with the PBR protocol, while 60 patients were treated with the sequential drilling protocol. For the PBR protocol, only 2 cases required bone substitute material, whereas 11 cases treated with the sequential drilling protocol required augmentation materials. This difference between both drilling protocols has been statistically confirmed (P=0.008). Conclusion: The PBR technique appears to be less traumatic and more cost-effective for cases that require horizontal bone augmentation.

Abstract Introduction Oligodontia is a rare dental developmental pathology that requires prolonged, complex and multidisciplinary treatment. Although bone augmentation is frequently required during a complete implant treatment of oligodontia. Therefore, we evaluated the ability to predict pre-implant surgery complexity based on age, number of missing teeth, and number of implants required to achieve implant-supported prosthetic rehabilitation. Material and methods This retrospectively registered study included all patients who underwent surgical treatment for oligodontia in our Oral and Maxillofacial Surgery Department between January 2012 and May 2023. Demographic data, number and location of missing teeth, pre- and per-implant surgical procedures, and the number of planned implants were recorded. A quantitative variable called “complexity score of pre-implant surgery” was created. This 10-point score was calculated by adding one point for each preimplant surgical procedure registered. A simple linear regression was calculated to explain the number of targeted implants based on number of missing teeth. A multiple linear regression model was used to explain the complexity score of pre-implant surgery and age, number of missing teeth and number of targeted implants. Results 119 oligodontia patients were included in the study. The median number of tooth agenesis was 10. A total of 825 implants were placed, 14 (1.7%) of which failed. A significant regression equation was used (F(1,118) = 1098,338; p

This systematic review evaluated the effectiveness of combining enamel matrix derivative (EMD) with various bone grafts in periodontal regenerative surgery, specifically targeting intrabony defects. Randomized controlled trials with 12-month follow-ups were included. Clinical outcomes assessed included clinical attachment level, probing depth, gingival recession, and radiographic defect fill. Meta-analysis showed that adding bone grafts to EMD does not provide additional benefits in periodontal tissue examination, with improvement observed only in radiographic defect fill. Subgroup analyses examined the impact of different bone graft types, revealing that alloplastic bone grafts are effective in radiographic defect fill. The risk of bias assessment indicated a moderate risk across studies, with challenges in blinding owing to the nature of the surgical treatment. Furthermore, a minimal intervention surgical approach may not require additional bone grafts for optimal periodontal regeneration. These findings contribute to the ongoing dialogue in the field and guide clinicians toward evidence-based decisions for optimal periodontal outcomes, emphasizing the judicious use of bone grafts.

BACKGROUND: Zinc-based alloy medical implant materials have excellent mechanical properties, complete degradability and good biocompatibility, and are mainly used in orthopedic implants, cardiovascular stents, bile duct stents, tracheal stents, nerve catheters, etc. OBJECTIVE: To review the research progress of biodegradable zinc-based alloys in bone defect repair and prospect the promising research direction and achievements of zinc-based materials. METHODS: After searching PubMed, Web of Science, WanFang Data, and CNKI databases from the establishment of the database to June 2023, various relevant articles on biodegradable zinc-based alloys for bone implant material research were collected. The basic characteristics of biodegradable zinc based alloys were summarized, and the role of zinc-based alloys in promoting bone tissue repair was sorted and summarized. The current research hotspots and shortcomings were discussed. RESULTS AND CONCLUSION: (1) Zinc-based alloys have good biocompatibility. Using zinc-based alloys as the matrix material, with the help of scaffold structure construction technology and coating optimization process, the bone conductivity of zinc-based alloys will be effectively improved, and their degradation products will have efficient bone induction to regulate the gene expression of osteoblasts and osteoclasts, thereby promoting the repair and reconstruction of bone defects. (2) However, in the research on optimizing zinc-based alloys, the coating process is relatively insufficient, and additive loading technology is still lacking. (3) Zinc-based alloys have excellent mechanical and biological properties. Through special processes, their bone conductivity and osteoinductivity can be increased to effectively improve their ability to promote bone repair and reconstruction, and it is expected to further achieve the development of personalized transplant materials. Further research and development are needed to optimize the integration of coating and additive loading technologies into zinc-based alloys. [ABSTRACT FROM AUTHOR]

Bioactive glass (BG-45S5) production through the melting process is affected by a wide variety of parameters. This study investigated the synthesis of BG-45S5 granules and the process variables to produce a bioactive and osteoinductive BG for bone grafting applications. The melting process was initially analyzed by varying parameters such as crucible type and pouring environment using P 2 O 5 as phosphorus precursor. The obtained products were characterized by crystalline phases, characteristic chemical groups, particle size distribution, and chemical composition. Materials poured into graphite or steel molds resulted in particle sizes more suitable for applications in granular form. Using a platinum crucible yielded a chemical composition closer to the target when compared with another ceramic crucible. Subsequently, the melting process was evaluated to different phosphorus precursor (P 2 O 5 or Na 2 HPO 4) and melting duration (1 or 2 h) in a platinum crucible verifying their effects on the thermal behavior, chemical composition and structure of BG-45S5. Employing Na 2 HPO 4 as a precursor led to higher glass transition and crystallization temperatures as compared to P 2 O 5 , enhancing glass homogeneity and structural stability. The product with better characteristics in terms of composition and structure was further characterized for bioactivity and cell culture behavior, showing a greater amount of mineralization nodules when compared to commercial hydroxyapatite. This is particularly due to its behavior as the solubility and interaction in biological environments. [ABSTRACT FROM AUTHOR]

Purpose: To report the radiological and clinical outcomes of non-vascularized coracoid process autografts used for glenoid reconstruction during revision shoulder arthroplasty. Material and method: This is a retrospective, monocentric study from January 2016 to October 2022 targeting patients treated with a coracoid bone graft for glenoid reconstruction during revision of shoulder arthroplasty. The primary outcome measures were coracoid graft union rate and graft-implant osseointegration. Secondary outcome measures included clinical and CT-scan identified radiological complications and functional outcomes as measured by the Visual Analog Scale (VAS), Range of Motion (ROM), Subjective Shoulder Value (SSV), Constant score (absolute and ponderate), and ASES score. Results: Fifteen patients (9 males, 6 females; mean age 66.9 years, range 38–85) were included. At a mean follow-up of 20.9 months (range 12–56 months), 93.3% achieved complete graft integration. One case of partial lysis without baseplate loosening was noted. Regarding range of motion, the mean forward elevation was 130° (range 90°-170°), external rotation at the side 25° (range 10°-40°), external rotation in 90° of abduction 45° (range 10°-80°), and internal rotation 52° (range 10–80°). The mean VAS for pain was 1.1 (range 0–8), mean SSV 67.3% (range 40–90%), mean ASES score 85.5 (range 65–98.3), mean Absolute Constant score 58.6 (range 21–83), and mean Ponderate Constant score 77.5% (range 28.8–110.7%). No neurological injuries were reported. Conclusion: Utilizing a non-vascularized coracoid graft during shoulder arthroplasty revision is a safe, reproducible, and time-efficient technique that demonstrated satisfactory osseointegration, implant stability, good functional results, and a low complication rate. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of maxillary sinus anatomy on sinus floor elevation (SFE) operations performed with the lateral window approach. Materials and Methods: CBCT and digital panoramic radiographs were evaluated before and at least 6 months after maxillary sinus floor elevation (SFE) operations performed in 33 maxillary sinus regions in 26 patients. Maxillary sinus volume, grafted volume (GV), sinus width (SW), residual bone height (RBH), and vertical graft resorption (VGR) were calculated. The effects of RBH and SW on GV and VGR were evaluated statistically. Results: The mean GV values in the maxillary sinuses classified as narrow, average, and wide were 2.60 ± 0.57, 3.44 ± 0.65, and 3.70 ± 0.64 cm3, respectively. The mean VGR was 2.12 ± 1.67 mm, and in the sites classified as narrow, average, and wide, the mean VGR values were 1.50 ± 0.79, 1.58 ± 1.28, and 3.46 ± 2.06 mm, respectively. A statistically significant difference in GV and VGR was found between the SW groups. The mean posterior maxillary RBH was 2.30 ± 1.05 mm, and 17 and 16 sinuses were classified as = 2 and > 2 mm, respectively. There was no statistically significant difference in the effect of RBH on GV or VGR. Conclusion: Although posterior maxillary RBH did not affect new bone formation in the sinuses grafted only with hydroxyapatite-derived inorganic bovine bone, with increasing SW, the GV decreased and the VGR increased. [ABSTRACT FROM AUTHOR]

Various methods for treating long bone fractures present promising therapeutic possibilities. In the case presented, particular emphasis was placed on the significant effectiveness of local antibiotic administration combined with bone autografts. The complexity of the injury in 23-year-old patient with multifragmentation of the femur, compounded by infection, necessitated a multistage treatment approach.

Abstract Background All orthopaedic procedures, comprising foot and ankle surgeries, seemed to show a positive trend, recently. Bone grafts are commonly employed to fix bone abnormalities resulting from trauma, disease, or other medical conditions. This study specifically focuses on reviewing the safety and efficacy of various bone substitutes used exclusively in foot and ankle surgeries, comparing them to autologous bone grafts. Methods The systematic search involved scanning electronic databases including PubMed, Scopus, Cochrane online library, and Web of Science, employing terms like 'Bone substitute,' 'synthetic bone graft,' 'Autograft,' and 'Ankle joint.' Inclusion criteria encompassed RCTs, case-control studies, and prospective/retrospective cohorts exploring different bone substitutes in foot and ankle surgeries. Meta-analysis was performed using R software, integrating odds ratios and 95% confidence intervals (CI). Cochrane's Q test assessed heterogeneity. Results This systematic review analyzed 8 articles involving a total of 894 patients. Out of these, 497 patients received synthetic bone grafts, while 397 patients received autologous bone grafts. Arthrodesis surgery was performed in five studies, and three studies used open reduction techniques. Among the synthetic bone grafts, three studies utilized a combination of recombinant human platelet-derived growth factor BB homodimer (rhPDGF-BB) and beta-tricalcium phosphate (β-TCP) collagen, while four studies used hydroxyapatite compounds. One study did not provide details in this regard. The meta-analysis revealed similar findings in the occurrence of complications, as well as in both radiological and clinical evaluations, when contrasting autografts with synthetic bone grafts. Conclusion Synthetic bone grafts show promise in achieving comparable outcomes in radiological, clinical, and quality-of-life aspects with fewer complications. However, additional research is necessary to identify the best scenarios for their use and to thoroughly confirm their effectiveness. Levels of evidence Level II.

Objective: This study aims to assess the effect of bone graft materials derived from pearl oyster shells on the tumor necrosis factor-alpha (TNF-α) level.

Background: The surgical treatment of bony non-unions is traditionally performed with additional bone grafts when atrophic and/or stronger implants when hypertrophic. In the case of the clavicle shaft, however, in our experience, a more controversial method where no additional bone graft is needed leads to equally good consolidation rates, independent of the non-union morphology. This method requires the meticulous anatomical reconstruction of the initial fracture and fixation according to the AO principle of relative stability. Methods: A retrospective review following the STROBE guidelines was performed on a consecutive cohort of all patients who received surgical treatment of a midshaft clavicle non-union at the Medical Center of the University of Freiburg between January 2003 and December 2023. Patients were identified using a retrospective systematical query in the Hospital Information System (HIS) using the International Statistical Classification of Diseases and Related Health Problems Version 10 (ICD-10) codes of the German Diagnosis Related Groups (G-DRG). Two groups were formed to compare the consolidation rates of patients who received additional bone grafting from the iliac crest with those of patients who did not. A 3.5 mm reconstruction LCP plate was used in all patients. Consolidation rates were evaluated using follow-up radiographs and outcomes after material removal with a mean follow-up of 31.5 ± 44.3 months (range 0–196). Results: Final data included 50 patients, predominantly male (29:21); age: 46.0 ± 13.0 years, BMI 26.1 ± 3.7. Autologous bone grafts from the iliac crest were used in 38.0% (n = 19), while no bone addition was used in 62.0% (n = 30). Six patients were lost to follow-up. Radiological consolidation was documented after a mean of 15.1 ± 8.0 months for the remaining 44 patients. Consolidation rates were 94.4% (n = 17) in patients for whom additional bone grafting was used and 96.2% (n = 25) in patients for whom no graft was used. There was no relevant difference in the percentage of atrophic or hypertrophic non-unions between both groups (p = 0.2425). Differences between groups in the rate of consolidation were not significant (p = 0.7890). The complication rate was low, with 4.5% (n = 2). Conclusions: Independent of the non-union morphology, non-unions of the clavicle midshaft can be treated successfully with 3.5 mm locking reconstruction plates without the use of additional bone grafting in most cases. [ABSTRACT FROM AUTHOR]

Background: Guided bone regeneration (GBR) is a reliable technique used in vertical and horizontal bone defects. The posterior mandibular region is an area limited by anatomic constraints. The use of resorbable membranes with a cortical component could compensate for the lack of rigidity of resorbable membranes without the complications of non-resorbable membranes. The aim of this study was to evaluate the mean bone gains of a xenogeneic cortical membrane in horizontal and vertical bone defects in comparison with other membranes in the literature. Methods: A porcine cortical membrane was used to perform 7 GBR in the posterior mandibular region of five patients. Preoperative (T0) and six months postoperative (T1) cone beam computed tomography were superimposed to measure the horizontal and vertical bone gain. Implants were positioned at all sites, six months after GBR. Complications and bone resorption around the implants were also documented. Results: The mean horizontal and vertical bone gains were 3.83 ± 1.41 mm and 4.17 ± 1.86 mm, respectively. The analysis of repeatability was 0.997. As many as 40% of patients experienced pain refractory to analgesics. No exposure or infectious phenomenon was observed. Conclusions: This xenogeneic cortical membrane seemed to provide interesting results in the regeneration of horizontal and vertical bone defects. Comparative and prospective studies are necessary to validate the effectiveness of this membrane. [ABSTRACT FROM AUTHOR]

Correction of asymmetry and irregularity deformities with autologous grafts, without osteotomies, offers advantages to both plastic surgeons and patients with severe deviation. Various autologous tissues such as fat, bone, and cartilage grafts are viable options for this purpose. This study aimed to compare the efficacy of 3 autologous filling materials in patients with bone asymmetry. A retrospective evaluation was conducted on 297 patients seeking aesthetic nose surgery between 2015 and 2022. Only primary patients without prior surgery and those with bone asymmetry from trauma, with dorsum protrusion <3 mm, and without osteotomy were included. Patients were divided into fat, cartilage, and bone groups. Grafts were applied to the concave side during closed rhinoplasty, and evaluations were done 12 months after surgery by blinded plastic surgeons and patients using established assessment tools. Fat, cartilage, and bone grafts were utilized in 74, 127, and 96 patients, respectively, with a mean follow-up of 19 months. The mean graft volumes were 1.0 cc (bone), 1.3 cc (cartilage), and 1.6 cc (fat). The patient self-assessment scores were 75%, 84.9%, and 86.6%, respectively. The Asher-McDade averages were 77.2%, 86.7%, and 88.4%, respectively. Cartilage and bone graft results were statistically similar in patients' self-evaluation and significantly higher than those of fat grafts. Blinded assessments showed no significant difference between the cartilage and bone groups. Placing autologous grafts on the concave side for patients with minimal nasal bone protrusion (<3 mm) yields successful results. Cartilage grafts offer advantages in volume, result estimation, and preparation time, making them suitable for larger patient cohorts. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate, through qualitative and semi‐quantitative histological analysis, onlay autologous bone grafts fixed with ethyl‐cyanoacrylate adhesive and titanium screw, in order to verify whether the method of applying the adhesive would interfere with the graft incorporation. Materials and Methods: Fourteen rats underwent bone graft surgery: seven grafts were fixed with ethyl‐cyanoacrylate (SB group, n = 7) and seven grafts were fixed with titanium screws (TS group, n = 7). After 30 days, the grafts were histologically analysed for vitality, adhesive presence, tissue reaction with formation of osteoid matrix, bone resorption presence, capillaries formation, inflammatory infiltrate, fibroblastic proliferation, presence of osteoblasts, osteocytes and osteoclasts. The data were submitted to non‐parametric tests, Mann–Whitney, Fisher's Test, Wilcoxon and McNemar and to statistical analysis (p < 0.05). Results: No significant differences were found in the qualitative evaluations. While findings of more osteocytes (p = 0.035) in the TS group in greater inflammation (p = 0.030) and more osteoclasts (p = 0.048) in the SB. Despite the fact that the titanium screw has presented bone neoformation with welding points, there was no complete incorporation and the adhesive affected the bone repair in a way that not even neoformation points could be seen in 30 days. Conclusion: The method of applying the adhesive did not show an advantage according to the histological aspects studied, as there was the formation of a dead space at the interface of the SB group and the adhesive acted as a barrier. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate in vivo and in vitro the effectiveness of the use of fibroblast growth factor (FGF)-2 with carbonate apatite (CO3Ap) on periodontal healing. Periodontal defects created in the maxillary first molars in rats were treated with FGF-2, CO3Ap, FGF-2 + CO3Ap or left unfilled. Healing was evaluated using microcomputed tomography, histological, and immunohistochemical analyses. In vitro experiments were performed to assess cellular behaviors and the expression of osteoblastic differentiation markers in MC3T3-E1 cells. At 4 weeks, the bone volume fraction in the FGF-2 + CO3Ap group was significantly greater than that in the CO3Ap group, but there was no significant difference from the FGF-2 group. The FGF-2 + CO3Ap group demonstrated greater new bone compared with the FGF-2 or CO3Ap group. The FGF-2 + CO3Ap group showed greater levels of osteocalcin-positive cells compared with the CO3Ap group, but there was no significant difference from the FGF-2 group. In vitro, the FGF-2 + CO3Ap group exhibited a greater extent of cell attachment and more elongated cells compared with the CO3Ap group. Compared with the CO3Ap group, the FGF-2 + CO3Ap group showed significantly higher viability/proliferation, but the expressions of Runx2 and Sp7 were reduced. The results indicated that the use of FGF-2 with CO3Ap enhanced healing in the periodontal defects. FGF-2 promoted cell attachment to and proliferation on CO3Ap and regulated osteoblastic differentiation, thereby contributing to novel bone formation. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to evaluate the implant survival rate, marginal bone loss (MBL), and surgical complications in single dental implants placed in the atrophic posterior maxilla using a transcrestal sinus lift with injectable graft materials. Materials and Methods: A prospective longitudinal study was conducted at IRCCS San Raffaele, Milan, Italy. Fifty-four patients with single edentulous sites and residual bone heights < 5 mm were included. A transcrestal sinus lift was performed using non-cutting drills (Cosci's technique) and xenogenic bone graft in gel form (Gel40, Tecnoss, Italy). Follow-up visits were at 1 week, 3 and 6 months, and annually for 3 years. Results: The implant survival rate was 98.04%, with one implant lost. MBL values were 0.71 ± 0.94 mm at 6 months, 1.00 ± 0.99 mm at 1 year, 1.03 ± 1.00 mm at 2 years, and 1.02 ± 1.01 mm at 3 years. Our ANOVA showed a significant MBL increase from 6 months to 1 year (p = 0.015), with no significant changes thereafter. Minimal surgical complications were observed, each occurring in 1.85% of cases. Conclusion: Transcrestal sinus lifts with injectable graft materials demonstrate high implant survival, acceptable MBL, and minimal complications, making it a reliable option for posterior maxilla rehabilitation. [ABSTRACT FROM AUTHOR]

Background: All orthopaedic procedures, comprising foot and ankle surgeries, seemed to show a positive trend, recently. Bone grafts are commonly employed to fix bone abnormalities resulting from trauma, disease, or other medical conditions. This study specifically focuses on reviewing the safety and efficacy of various bone substitutes used exclusively in foot and ankle surgeries, comparing them to autologous bone grafts. Methods: The systematic search involved scanning electronic databases including PubMed, Scopus, Cochrane online library, and Web of Science, employing terms like 'Bone substitute,' 'synthetic bone graft,' 'Autograft,' and 'Ankle joint.' Inclusion criteria encompassed RCTs, case-control studies, and prospective/retrospective cohorts exploring different bone substitutes in foot and ankle surgeries. Meta-analysis was performed using R software, integrating odds ratios and 95% confidence intervals (CI). Cochrane's Q test assessed heterogeneity. Results: This systematic review analyzed 8 articles involving a total of 894 patients. Out of these, 497 patients received synthetic bone grafts, while 397 patients received autologous bone grafts. Arthrodesis surgery was performed in five studies, and three studies used open reduction techniques. Among the synthetic bone grafts, three studies utilized a combination of recombinant human platelet-derived growth factor BB homodimer (rhPDGF-BB) and beta-tricalcium phosphate (β-TCP) collagen, while four studies used hydroxyapatite compounds. One study did not provide details in this regard. The meta-analysis revealed similar findings in the occurrence of complications, as well as in both radiological and clinical evaluations, when contrasting autografts with synthetic bone grafts. Conclusion: Synthetic bone grafts show promise in achieving comparable outcomes in radiological, clinical, and quality-of-life aspects with fewer complications. However, additional research is necessary to identify the best scenarios for their use and to thoroughly confirm their effectiveness. Levels of evidence: Level II. [ABSTRACT FROM AUTHOR]

In recent years, the significance of maintaining the alveolar ridge following tooth extractions has markedly increased. Alveolar ridge preservation (ARP) is a commonly utilized technique and a variety of bone substitute materials and biologics are applied in different combinations. For this purpose, a histological evaluation and the clinical necessity of subsequent guided bone regeneration (GBR) in delayed implantations were investigated in a prospective case series after ARP with a novel deproteinized bovine bone material (95%) in combination with a species-specific collagen (5%) (C-DBBM). Notably, block-form bone substitutes without porcine collagen are limited, and moreover, the availability of histological data on this material remains limited. Ten patients, each scheduled for tooth extraction and desiring future implantation, were included in this study. Following tooth extraction, ARP was performed using a block form of C-DBBM in conjunction with a double-folded bovine cross-linked collagen membrane (xCM). This membrane was openly exposed to the oral cavity and secured using a crisscross suture. After a healing period ranging from 130 to 319 days, guided trephine drilling was performed for implant insertion utilizing static computer-aided implant surgery (s-CAIS). Cores harvested from the area previously treated with ARP were histologically processed and examined. Guided bone regeneration (GBR) was not necessary for any of the implantations. Histological examination revealed the development of a lattice of cancellous bone trabeculae through appositional membranous osteogenesis at various stages surrounding C-DBBM granules as well as larger spongy or compact ossicles with minimal remnants. The clinical follow-up period ranged from 2.5 to 4.5 years, during which no biological or technical complications occurred. Within the limitations of this prospective case series, it can be concluded that ARP using this novel C-DBBM in combination with a bovine xCM could be a treatment option to avoid the need for subsequent GBR in delayed implantations with the opportunity of a bovine species-specific biomaterial chain. [ABSTRACT FROM AUTHOR]

Application of alveolar bone graft (ABG) in alveolar augmentation is done to prevent excessive bone resorption due to tooth extraction, missing teeth, or other diseases/conditions affecting the alveolar bone. The use of autogenous dentin-derived ABG has been considered as the composition of dentin appears to be nearly analogous to that of bone. This systematic review aims to assess the efficacy of dentin-derived ABG for alveolar augmentation of post-extraction sockets or other alveolar bone defects by evaluating volume gain and histomorphometric data. A search of systematic literature was conducted in Pubmed, Scopus, Web of Science, and Embase from database inception to October 2023. The review included both randomized controlled trials (RCT), pilot studies, clinical trials, and retrospective studies reporting on dentin-derived ABG use for alveolar augmentation. Overall, 298 articles were obtained from the initial search. From these articles, 21 articles met the inclusion criteria and were included for descriptive analysis. All of the studies indicated low risk of bias. Studies of dentin-derived ABG, which used bone-derived grafts as the control group, have shown significantly higher percentages of new bone formation, gain in vertical and horizontal dimensions, and less reduction in dimensions. Dentin-derived ABG was effective in volume maintenance, indicating promising results via histomorphometric and radiographic analysis. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Alveolar ridge is dynamic in nature. Preservation of residual alveolar ridge is always desirable. Bone grafts and platelet concentrates can be used for socket preservation. Maintenance of bone volume is essential and various ridge augmentation techniques are used for desirable functional and esthetic outcomes. Aim: Evaluation and comparison of the efficacy of autogenous dentin block versus allograft block in preserving alveolar ridge dimension with 6-month follow-up. Materials and Methods: Twenty subjects indicated for tooth extraction were randomly divided into three groups. In Group I, autogenous dentin graft with platelet-rich fibrin(PRF) membrane was used as socket filling material, GroupII: allogenic bone graft with PRF membrane, or Group III: control group (socket left ungrafted). Clinical and radiographic examinations were done using periodontal probe and cone-beam computed tomography. Results: On intragroup comparison of socket size, the mean for Group I was found to be 33.270 mm2 at baseline and 25.358 mm after 12 months for Group II was found to be 53.250 mm² at baseline and socket fill was 41.875 mm2 at 12 months. Group III was found to be 43.483 mm2 at baseline, and socket fill was 15.063 mm² at 12 months. On intergroup comparison, the values were found to be statistically nonsignificant both at baseline (12 months postoperatively. The crestal bone loss was 0.975 for Group I, 1.075 for Group II, and 2.925 mm for Group III. Crestal bone loss was seen highest in Group III and lowest for Group I. The mean percentage of socket fill was found to be 80.01% for Group I, 76.13% for Group II, and 34.03% for Group I. Conclusion: A significant amount of radiographic socket fill was appreciated over 12 months in all the three groups. The percentage of socket fill in Group I was 80.01% and in Group II was 76.13% and the difference between them was statistically nonsignificant. Statistically significant socket fill was seen for both Group 1 and Group 2. [ABSTRACT FROM AUTHOR]

Background: Autologous bone dust can be filled in bone defects to promote effective bone healing but typically it is lost when using suction during surgery. The aim of this study was to develop a novel bone collector that can be used to collect bone chips/dust of varying sizes without changing current surgical procedures. Research design and methods: This collector was designed to connect to a surgical continuous suction system and comprised a plate filter with a 3 mm hole and featured a taper filter with a mesh size of 0.27 mm for the separation and collection of both coarse and fine bone chips/dust. The bone collector was manufactured using nylon 3D printing and plastic injection with biocompatible materials. Results: The bone collector functional test revealed high bone chip collection efficiency (93%) with automatic size separation function. Low (3.42%) filtration errors showed that most of the water can be drained smoothly from the bone collector. In clinical usability testing, bone collectors can provide functions demonstrated in in vivo spinal fusion and femoral fracture surgeries with different bone grafting size requirements. Conclusions: The novel bone collector has been validated as a viable and effective surgical device, offering surgeons an additional option to enhance patient outcomes. [ABSTRACT FROM AUTHOR]