Bone Alterations Research Articles

Radiographic bone level and soft tissue dimensional changes following explantation of implants affected by peri-implantitis: A retrospective exploratory evaluation.

While the dimensional alteration of alveolar bone following tooth extraction have been extensively descripted in the literature, no information is available regarding potential hard and soft tissues changes following implant explantation. To evaluate the radiographic bone healing and the horizontal and vertical soft tissue dimensional alterations at implant extraction alveoli, 6 months following implant explantation. Data from 31 patients scheduled for extraction of one implant with persisting peri-implantitis despite treatment were analysed. Bone crest level changes and the extent of bone healing at the apical aspect of the implant socket were assessed on the radiographs prior and 6 months following explantation. Regression analyses assessed the impact of various predictors (e.g., bone crest level, presence/absence of buccal bone) on bone level changes. Fisher's exact probability test was applied to assess the difference in probability to have mucosa recession of ≥2 mm in the presence or absence of alveolar buccal bone. A vertical bone loss of 0.8 mm (standard deviation [SD] = 1.3) of the peri-implant bone crest and a gain of 0.8 mm (SD = 1.1) from the bottom of the peri-implant defect were recorded. Complete healing was noted in the intact implant extraction socket (i.e., the part of the implant not affected by peri-implantitis). A reduction of 0.4 mm (SD = 0.7) of the alveolar mucosa height was recorded in concomitant with a decrease of 0.7 mm (SD = 0.8) of the mucosa width. These alterations were more pronounced in the absence of the alveolar buccal bone. The results of the present explorative study indicated a decrease in the height and width of the alveolar soft and hard tissues following explantation of peri-implantitis affected implants, and these changes were more pronounced in the absence of the buccal bone wall. Nevertheless, the apical portion of the implant alveolus (the intact implant socket) tend to heal with no further bone loss.

Subungual Glomus Tumor of the Hallux A Report of 4 Cases.

This study reports the clinical outcomes and evolution of 4 patients with subungual glomus tumor (GT) of the hallux treated with tumor excision. Preoperatively, all patients had pain of intensity 9 or 10. Three were sensitive to cold and had stabbing pain, and one reported pulsatile pain. No patient presented nail alterations. There were no bone alterations on radiographic images and diagnostic suspicion of GT was supported by magnetic resonance images. Surgical treatment was indicated due to severe pain and functional limitation. The GT excision was performed by removing the nail through an L-shaped incision in the nail bed. After surgery, they all showed clinical improvement with return to previous activities and had no difficulty in wearing regular shoes. Three patients were pain-free and one had occasional stabbing pain of intensity 2. Half of them had nail changes. There has been no recurrence so far. Thus, we found that resection of subungual GT of the hallux was effective for the clinical improvement of patients.Level of Evidence: IV, case reports.

The sacroiliac joint: An original and highly sensitive tool to highlight altered bone phenotype in murine models of skeletal disorders

Bone disorders may affect the skeleton in different ways, some bones being very impaired and others less severely. In translational studies using murine models of human skeletal diseases, the bone phenotype is mainly evaluated at the distal femur or proximal tibia. The sacroiliac joint (SIJ), which connects the spine to the pelvis, is involved in the balanced transfer of mechanical energy from the lumbar spine to the lower extremities. Because of its role in biomechanical stress, the SIJ is a region of particular interest in various bone diseases. Here we aimed to characterize the SIJ in several murine models to develop a highly reliable tool for studying skeletal disorders.We performed a 12-month in vivo micro-computed tomography (micro-CT) follow-up to characterize the SIJ in wild-type (WT) C57BL/J6 mice and compared the bone microarchitecture of the SIJ and the distal femur at 3 months by micro-CT and histology. To test the sensitivity of our methodology, the SIJ and distal femur were evaluated at 3 and 6 months, in 2 murine models of skeletal disorder, X-linked hypophosphatemia (Hyp mice) and HLA-B27 transgenic mice and compared to WT mice. A multimodal analysis was performed, using a combination of microCT and histological analysis.With the Hyp model, the SIJ displayed more bone microarchitecture alterations than the distal femur. Hyp mice showed a significant reduction in trabecular bone at both the distal femur and sacral slope as compared with WT mice, with a significant positive correlation between trabecular bone parameters of the distal femur and sacral side of the SIJ. Furthermore, trabecular bone parameters (Bone Volume/Total Volume (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), trabecular number (Tb.N), trabecular pattern factor (Tb.Pf)) were significantly increased compared to femoral parameters at the SIJ. The sacral articular cortical bone, which is indicative of osteoarticular lesions, was altered in Hyp mice. Interestingly, in accordance to previous studies, HLA-B27 transgenic mice did not show any osteoarticular lesions as compared with WT mice. Cortical bone parameters (thickness, porosity), as well as scoring performed with double blinding, did not show difference between the 2 genotypes.The characterization and evaluation of the SIJ surface appears very sensitive to emphasize alterations of bone and joint. The SIJ may represent a valuable tool to investigate both bone and local osteoarticular alterations in murine models of skeletal disorders and might be a relevant site for assessing the response to treatment of chronic bone diseases.

Increased local bone turnover in patients with chronic periprosthetic joint infection.

The management of periprosthetic joint infection (PJI) remains a major challenge in orthopaedic surgery. In this study, we aimed to characterize the local bone microstructure and metabolism in a clinical cohort of patients with chronic PJI. Periprosthetic femoral trabecular bone specimens were obtained from patients suffering from chronic PJI of the hip and knee (n = 20). Microbiological analysis was performed on preoperative joint aspirates and tissue specimens obtained during revision surgery. Microstructural and cellular bone parameters were analyzed in bone specimens by histomorphometry on undecalcified sections complemented by tartrate-resistant acid phosphatase immunohistochemistry. Data were compared with control specimens obtained during primary arthroplasty (n = 20) and aseptic revision (n = 20). PJI specimens exhibited a higher bone volume, thickened trabeculae, and increased osteoid parameters compared to both control groups, suggesting an accelerated bone turnover with sclerotic microstructure. On the cellular level, osteoblast and osteoclast parameters were markedly increased in the PJI cohort. Furthermore, a positive association between serum (CRP) but not synovial (white blood cell (WBC) count) inflammatory markers and osteoclast indices could be detected. Comparison between different pathogens revealed increased osteoclastic bone resorption parameters without a concomitant increase in osteoblasts in bone specimens from patients with Staphylococcus aureus infection, compared to those with detection of Staphylococcus epidermidis and Cutibacterium spp. This study provides insights into the local bone metabolism in chronic PJI, demonstrating osteosclerosis with high bone turnover. The fact that Staphylococcus aureus was associated with distinctly increased osteoclast indices strongly suggests early surgical treatment to prevent periprosthetic bone alterations.

Bone alterations of pamidronate therapy in children with cerebral palsy complicating orthopedic management.

Cerebral palsy (CP) is a heterogeneous group of disorders with different clinical types and underlying genetic variants. Children with CP are at risk for fragility fractures secondary to low bone mineral density, and although bisphosphonates are prescribed for the treatment of children with bone fragility, there is limited information on long-term bone impact and safety. Children with CP usually present overtubulated bones, and the thickening of cortical bone by pamidronate treatment can potentially further narrow the medullary canal. Our purpose was to report bone alterations attributable to pamidronate therapy that impact orthopedic care in children with CP. The study consisted of 41 children with CP treated with pamidronate for low bone mineral density from 2006 to 2020. Six children presented unique bone deformities and unusual radiologic features attributed to pamidronate treatment, which affected their orthopedic care. The cases included narrowing of the medullary canal and sclerotic bone, atypical femoral fracture, and heterotopic ossification. Treatment with bisphosphonate reduced the number of fractures from 101 in the pretreatment period to seven in the post-treatment period ( P < 0.001). In conclusion, children with CP treated with bisphosphonate have a reduction in low-energy fractures; however, some fractures still happen, and pamidronate treatment can lead to bone alterations including medullary canal narrowing with sclerotic bone and atypical femoral fractures. In very young children, failure to remodel may lead to thin, large femoral shafts with cystic medullary canals. More widespread use of bisphosphonates in children with CP may make these bone alterations more frequent. Level of evidence: Level IV: Case series with post-test outcomes.

THU471 Resolution Of Elevated Alkaline Phosphatase After Joint Replacement In Severe Osteoarthritis

Abstract Disclosure: J. Rakholiya: None. S. Nagaraj: None. P. Sharma: None. Introduction: Alkaline phosphatase (ALP) elevation is commonly seen in hepatobiliary disorders. Conditions of high turnover such as healing fractures, hyperparathyroidism, Pagets’ disease of the bone, also lead to ALP elevation (1). Osteoarthritis (OA), characterised by degeneration of articular cartilage, joint space narrowing, and osteophyte formation, rarely causes ALP elevation. We present a case of ALP elevation that resolved after the arthritic joint was replaced. Case Presentation: A 60-year-old female with history of bilateral knee OA presented to the endocrinology clinic due to elevated ALP for over a year. She reported chronic fatigue, sleep disturbance, dry skin, hair loss, inability to lose weight and anxiety. ALP level at presentation was 165 U/L. An extensive work-up showed unremarkable serum and ionized calcium, serum phosphorus, parathyroid hormone, vitamin D 25-OH, calcitriol, 24-hour urine calcium, serum protein electrophoresis, and 24-hour urine protein electrophoresis. Dual x-ray absorptiometry (DXA) scan was normal with Fracture risk assessment tool (FRAX) score 5.9% for major osteoporotic fracture and 0.2% for hip fracture. Patient underwent total left knee arthroplasty following which ALP improved from 165 U/L to 135 U/L within 9 weeks of the procedure. Five months later, ALP was elevated (164 U/L) again. She then underwent right knee arthroplasty and ALP dropped to normal level (114 U/L) within 1 week post-surgery. Discussion: We report the rare phenomenon of ALP elevation in severe OA, that resolved after joint replacement. OA is characterised by inflammation mediated cartilage destruction, subchondral bone change, osteophyte formation, and alterations of ligaments and meniscuses. Bone change in severe OA is associated with increased synovial fluid ALP level. However, there is a paucity of literature studying the association of ALP with OA. A cross-sectional study of 3060 patients demonstrated higher serum ALP with symptomatic knee OA. Another study showed higher ALP levels with increased joint stiffness. The ALP elevation was attributed to low grade inflammation causing an inflammatory response in chondrocytes, and osteoarthritic pain. There is a need for more studies to evaluate the utility of serum ALP as a biomarker for severe OA. Presentation: Thursday, June 15, 2023

B-mode ultrasonography and ARFI elastography of articular and peri-articular structures of the hip joint in non-dysplastic and dysplastic dogs as confirmed by radiographic examination

BackgroundCanine hip dysplasia is a common orthopedic disease in veterinary practice. The diagnosis is made by radiographic examinations that evaluate bone alterations associated with hip dysplasia. Although radiographic examination is the gold standard for diagnosis, it does not allow a detailed evaluation of soft tissues such as the joint capsule and periarticular muscles. This study aimed to evaluate the accuracy of B-mode ultrasonography and acoustic radiation force impulse (ARFI) elastography in assessing the joint capsule and periarticular muscles of dogs using the Orthopedic Foundation of Animals (OFA) classification and the distraction index (DI) in the early and late diagnosis of hip dysplasia. This study sought to propose a protocol for the ultrasonographic evaluation of the structures involved in canine hip dysplasia.MethodsRadiographic and ultrasonographic evaluations were performed on 108 hip joints of 54 dogs. Thirty dogs were older than 2 years and 24 were aged between 4 and 10 months.ResultsIt was verified that an increase in pectineus muscle stiffness (cutoff value > 2.77 m/s) by elastography in some dysplastic dogs and an increase in the thickness of the joint capsule (cutoff value > 0.9 mm) in B-mode ultrasonography, were associated with a distraction index > 0.5, with both having a positive correlation. In B-mode ultrasonographic evaluation, the presence of signs of degenerative joint disease, such as irregularities of the cranial edge of the acetabulum and femoral head, were associated with a distraction index > 0.5 in canines, with a specificity of 94%. In adult dogs, the findings of degenerative joint disease on ultrasound were associated with a diseased OFA classification (P < 0.05). Measurement of the joint capsule > 1.10 mm was diagnostic for dysplasia in unhealthy dogs by OFA.ConclusionsARFI elastography has shown that the pectineus muscle may experience changes in stiffness in dysplastic animals. Additionally, changes in joint capsule thickness can be identified in B-mode in young and adult dogs with dysplastic joints, which contributes to the diagnosis of hip dysplasia.

An Original Research on Healthy and Diseased Sites in Periodontitis Patients with Dental Fluorosis

Abstract Introduction: This study evaluated the levels of clinical and biochemical parameters in patients with periodontitis and dental fluorosis. Additionally, using cone-beam computed tomography (CBCT), radiographic alveolar bone alterations in the jaws of periodontal patients were explored in terms of changes to the cortical bone thickness, trabecular bone, and bone density. Materials and Methods: The gingival crevicular fluid (GCF) was taken from a total of 40 participants who had periodontitis and dental fluorosed teeth in order to estimate the levels of sialic acid (SA) and chondroitin sulfate (CS) in glycosaminoglycans using colorimetric analysis. Results and Discussion: The total evaluation for bone density was considerably greater in the FD group (657.60 ± 270.91) than the fluorosed healthy (FH) group (526.34 ± 260.03) (P &lt; 0.00) when various alveolar CBCT data were taken into account. The thick dense trabecular pattern was found to occur in 80% of the fluorosed diseased (FD) group as compared to 63% in the FH group (P &lt; 0.017). The grade-wise and overall assessment was done. The FD group shows an increase in plaque index (PI), gingival bleeding index (GBI), community periodontal index-probing pocket depth, and SA than the FH group, whereas CS has no significant difference in both these groups. Moreover, GCF SA levels are highest (686.33) (P &lt; 0.005 S) in FD and GCF CS levels in the FH group (47.05) and FD group (46.52) almost similar, and hence P = 0.686 which is statistically nonsignificant. Conclusion: Nevertheless, the need of the hour is to conduct studies on various endemic fluoride belts globally and appreciate the hidden role of fluorosis. However, fluorosis proved to be an environmental risk factor and further studies are required to decipher its destructive role systemically as well.

An isoelastic monoblock cup versus a modular metal-back cup: a matched-pair analysis of clinical and radiological results using Einzel-Bild-Röntgen-Analyse software

IntroductionBone preservation and long-term survival are the main challenges in cementless total hip arthroplasty (THA). A good bone stock is especially important for adequate anchorage of the cup in revision cases. However, the optimal acetabular cup design for preserving good bone stock is still unclear. We aimed to compare clinical outcome, radiological alterations, migration, and wear at mid-term for two different cup types.Materials and methodsThis retrospective matched-pair study was performed using the data for 98 THA cases treated with a monoblock cup composed of vitamin E-blended highly cross-linked polyethylene (VEPE; monoblock group) or a modular cup composed of a highly cross-linked polyethylene (HXLPE) without an antioxidant (modular group). Clinical results were evaluated using the Harris Hip Score (HHS). The obtained radiographs were analyzed for radiological alterations, migration, and wear using Einzel-Bild-Röntgen-Analyse (EBRA) software.ResultsThe mean follow-up duration was 73.2 ± 19.2 months (range: 32–108 months) and 60.5 ± 12.2 months (range: 20–84 months) in the monoblock and modular groups, respectively. HHS improved to 95.7 points in the monoblock group and 97.6 points in the modular group, without significant differences (p = 0.425). EBRA measurements were obtained in all cases. Acetabular bone alterations were not detected on radiological assessments. Mean cup migration was 1.67 ± 0.92 mm (range: 0.46–3.94 mm) and 1.24 ± 0.87 mm (range: 0.22–3.62 mm) in the monoblock and modular groups. The mean wear rate was 0.21 ± 0.18 mm (range: 0.00–0.70 mm) and 0.20 ± 0.13 mm (range: 0.00–0.50 mm) in the monoblock and modular groups. Both migration and wear pattern showed no significant differences (p = 0.741 and 0.243). None of the cases required revision surgery, yielding an implant survival rate of 100% in both groups.ConclusionThe isoelastic press-fit monoblock VEPE cup and modular metal-back HXLPE cup showed equivalent mid-term wear and cup migration. Long-term studies are required to determine the effects of modularity, isoelasticity, and polyethylene stabilization with vitamin E on cup loosening and survival rates.

Subchondral bone in knee osteoarthritis: bystander or treatment target?

The subchondral bone is an important structural component of the knee joint relevant for osteoarthritis (OA) incidence and progression once disease is established. Experimental studies have demonstrated that subchondral bone changes are not simply the result of altered biomechanics, i.e., pathologic loading. In fact, subchondral bone alterations have an impact on joint homeostasis leading to articular cartilage loss already early in the disease process. This narrative review aims to summarize the available and emerging imaging techniques used to evaluate knee OA-related subchondral bone changes and their potential role in clinical trials of disease-modifying OA drugs (DMOADs). Radiographic fractal signature analysis has been used to quantify OA-associated changes in subchondral texture and integrity. Cross-sectional modalities such as cone-beam computed tomography (CT), contrast-enhanced cone beam CT, and micro-CT can also provide high-resolution imaging of the subchondral trabecular morphometry. Magnetic resonance imaging (MRI) has been the most commonly used advanced imaging modality to evaluate OA-related subchondral bone changes such as bone marrow lesions and altered trabecular bone texture. Dual-energy X-ray absorptiometry can provide insight into OA-related changes in periarticular subchondral bone mineral density. Positron emission tomography, using physiological biomarkers of subchondral bone regeneration, has provided additional insight into OA pathogenesis. Finally, artificial intelligence algorithms have been developed to automate some of the above subchondral bone measurements. This paper will particularly focus on semiquantitative methods for assessing bone marrow lesions and their utility in identifying subjects at risk of symptomatic and structural OA progression, and evaluating treatment responses in DMOAD clinical trials.

Síndrome de Sagliker: una nueva entidad, un problema antiguo.

Introduction: Sagliker syndrome, described by Dr. Yahya Sagliker in 2004, constitutes the most advanced state of secondary hyperparathyroidism in chronic kidney disease. Deforming and disabling clinical syndrome that reduces the quality of life and adds psychological disorders to the patient with chronic kidney disease. This study aims to report on a series of eight cases in Mexico and warn about the correct management and follow-up of secondary hyperparathyroidism. Cases: 8 cases are presented with ages between 17 and 35 years, serum parathyroid hormone levels between 1583 and 4715 pg/ml, and alkaline phosphatase levels between 146 and 2065 IU/L. All cases with brown tumors in the maxilla and mandible characteristic of Sagliker syndrome. Evolution: All patients were ingesting calcium and vitamin D analogs at diagnosis or in the last three months. Conclusion: Sagliker syndrome is the most severe and chronic complication of secondary hyperparathyroidism and chronic kidney disease. The significant bone involvement of this syndrome generates a disabling facial and prolonged bone deformity that impacts morbidity, mortality, and mental health. Concomitant with bone alterations, vascular and cardiac calcifications add a crucial cardiovascular risk, so any surgery constitutes a high risk.

The effect of leukocyte- and platelet-rich fibrin on the bone loss and primary stability of implants placed in posterior maxilla: a randomized clinical trial

PurposeIn this study, we investigated the effects of leukocyte- and platelet-rich fibrin (L-PRF) on implant stability and alterations in the marginal bone surrounding posterior maxillary implants.MethodsThis randomized clinical trial was conducted to compare the variable of L-PRF placement around maxillary implants. Resonance frequency analysis (RFA) was used to evaluate the implant stability immediately after surgery and at 1, 2, 4, 6, 8, and 12 weeks after surgery (t0 to t6, respectively). In addition, the amount of marginal bone changes around the implant at t6 was compared with the baseline using periapical radiography.ResultsThe RFA outcomes were statistically significant within each group (P < 0.001, Eta2 = 0.322); however, in none of the follow-ups and immediately after the surgery, there was a significant difference between the two groups in terms of the implant stability quotient (ISQ) scores (P > 0.05). At t0, the test and control groups' respective mean levels of marginal bone loss around the implants were 0.4836 mm and 0.7343 mm, significantly different from the corresponding values at t6. On the other hand, marginal bone loss around the implant was not significantly different between the two groups in t0 and t6 (P = 0.532).ConclusionsL-PRF did not improve the RFA outcomes of implants three months after implant placement, and changes in the ISQ values over time were the same in both groups. In addition, L-PRF had no superior effect on the marginal bone loss around the implants.Trial registration number: The research was registered in the Iranian Registry of Clinical Trials on 22 December 2020 (No: IRCT20200624047906N1), available at http://www.irct.ir

Platelet-Derived Exosomes Alleviate Knee Osteoarthritis by Attenuating Cartilage Degeneration and Subchondral Bone Loss.

Osteoarthritis (OA) is the most prevalent chronic degenerative joint disease among the aged population. However, current treatments for OA are limited to alleviating symptoms, with no therapies that prevent and regenerate cartilage deterioration. To assess the effects of platelet-derived exosomes (Plt-exos) on OA and then to explore the potential molecular mechanism. Controlled laboratory study. Exosomes derived from human apheresis platelets were isolated and identified. The effects of Plt-exos in protecting chondrocytes under interleukin 1β stimulation were evaluated by analyzing the proliferation and migration in human primary chondrocytes. RNA sequencing was later performed in vitro for primary chondrocytes to reveal the underlying mechanisms of Plt-exo treatment. Anterior cruciate ligament transection was used to construct an OA mice model, and intra-articular injection of Plt-exos was given once a week for 6 weeks. Mice were sacrificed 4 weeks after the last injection. Histologic and immunohistochemistry staining and micro-computed tomography analysis were performed to assess alterations of articular cartilage and subchondral bone. Plt-exos significantly promoted proliferation and migration of chondrocytes within a dose-dependent manner, as well as dramatically promoted cartilage regeneration and attenuated abnormal tibial subchondral bone remodeling, thus slowing the progression of OA. After being treated with Plt-exos, 1797 genes were differentially expressed in chondrocytes (923 upregulated and 874 downregulated genes). Functional enrichment results and hub genes were mainly involved in anti-inflammatory effects, mediating cell adhesion, stimulating cartilage repair, promoting anabolism, and inhibiting catabolism. Our results demonstrated that Plt-exos promoted chondrocyte proliferation and migration in vitro, as well as attenuated cartilage degeneration, improved the microarchitecture of subchondral bone, and retarded OA progression in vivo. Our study illustrated that the administered Plt-exos could alleviate knee OA by attenuating cartilage degeneration and subchondral bone loss, possibly serving as a novel promising treatment for OA in the future.

Paper 53: A Predictive Model for Mobile vs. Immobile Osteochondritis Dissecans Lesions of the Knee

Objectives: Osteochondritis dissecans (OCD) of the knee is a focal idiopathic alteration of subchondral bone and/or its precursor with risk for instability and disruption of adjacent cartilage that may result in premature osteoarthritis. Treatment options vary depending on multiple patient and lesion characteristics, including lesion mobility. Recent multicenter studies helped develop the ROCK (Research on Osteochondritis Dissecans of the Knee) Arthroscopy Classification of OCD lesions of the knee. To advance the clinical utility of the classification system, this current investigation aimed to develop a simple, clinical outcomes-based model that could be used to differentiate lesion mobility. We hypothesized that a multivariable model including patient demographics and physical examination findings at clinical presentation would predict the arthroscopically confirmed mobility status of the OCD lesion with high sensitivity and specificity. Methods: Patient data for the predictive modeling came from a multi-center national prospective cohort of patients with osteochondritis dissecans of the knee. Inclusion criteria included patients &lt; 19 years of age, operatively treated OCD of the medial or lateral femoral condyle, and appropriate preoperative and intra-operative data. Demographic, preoperative physical examination, and radiographic data were considered independent predictors in the model. Multivariable logistic regression analysis using stepwise model selection was used to determine factors associated with the likelihood of a mobile versus an immobile lesion. Receiver operating characteristic (ROC) curve analyses were used to dichotomize relevant variables for a final predictive model. The authors reviewed the relevant variables for clinical utility. A 75% partition of the data was used for model training, and 25% was held out for model validation testing. Quantitative model fit statistics were computed using the hold-out data, including sensitivity, specificity, and the area under the ROC curve (AUC), along with the corresponding 95% confidence interval (CI). Results: 479 patients in the prospective cohort who were less than 19 years of age and had surgical treatment of a knee OCD lesion were reviewed. 407 patients had usable preoperative and intra- operative data, including 235 immobile and 172 mobile lesions. Mean chronologic age of the 407 patients was 13.7 (2.2 SD) years with 62% male. Mean height was 63.6 (5.3 SD) inches and 129.5 (40.4 SD) lbs. Mean BMI was 22 (5.1 SD). 21% of the total cohort presented with an effusion on physical examination and 20% presented with reduced range of motion either in flexion or extension compared with their contralateral knee. Patient demographics (age, sex, age, height, weight, BMI) and physical examination findings of relative loss of motion (ROM) compared to unaffected knee and presence of effusion on examination were primary variables of interest. 88 patients were excluded because of missing partial data for modeling. 319 patients had complete data for modeling (training data 75%; n=239; validation data 25%; n=80). Using the training dataset, the multivariable analysis found that chronologic age ≥ 14 years, effusion on physical examination (p=0.004), and any loss of ROM on physical examination (p=0.004) increased the likelihood of mobile lesion controlling for male sex (p=0.42) and weight &gt;120lbs (p=0.23). In the 25% holdout sample (n=80), this model yielded a sensitivity of 83%, a specificity of 75%, and an AUC of 0.86 (95% CI, 0.78-0.94). The final predictive model was created from dichotomized relevant variables (Figure 1). Conclusions: This predictive model for knee OCD lesions indicates a patient presenting with chronologic age ≥ 14 years, evidence of a knee effusion on physical examination, and reduced ROM relative to the contralateral knee is between 90% and 95% likely to have a mobile lesion compared to an immobile lesion using the ROCK Arthroscopy Classification. The ability to predict the mobility of knee OCD lesions before surgical intervention can facilitate improved surgical planning and more relevant communication with families regarding the procedures that will be required. Specifically, this can aid in distinguishing between less invasive interventions such as drilling versus more invasive procedures such as OCD fixation and salvage.

Paper 45: Which Osteochondritis Dissecans Subjects Will Heal Non-Operatively? An Application of Machine Learning Methods to the ROCK Cohort

Paper 45: Which Osteochondritis Dissecans Subjects Will Heal Non-Operatively? An Application of Machine Learning Methods to the ROCK Cohort

Clinical and CBCT Assessment of Crestal Bone Changes in Immediate and Delayed Placement of Implant.

The present research was done to assess the crestal bone changes in immediate and delayed dental implant placement. Twenty four implant sites in participants within the age group of 25-60 years in both genders were done with immediate (Group I) and delayed implant (Group II) placement method. Clinical parameters such as pain, mobility, and radiographic assessment for crestal bone alterations were recorded at baseline, 3 months, and 6 months. On intergroup assessment, the mean variation of the pain, mobility, and crestal bone loss was insignificant.

COMPARATIVE EVALUATION OF CRESTAL BONE LOSS AROUND SUBMERGED AND NON-SUBMERGED IMPLANTS WITH DIFFERENT TYPES OF HEALING ABUTMENT DESIGNS - AN IN VIVO STUDY

Successful osseointegration is observed predictably for submerged implants requiring a two-stage procedure as well as for non-submerged implants characterized by one-stage surgical procedure. This study was aimed at evaluating and comparing crestal bone alterations around submerged and non-submerged implant radiographically. Total 45 patients aged between 20 to 50 years with missing mandibular posterior teeth were divided into 3 groups [Submerged implants (n=15), Non-submerged implants with anatomic healing abutment (n=15) and Non-submerged implants with esthetic healing abutment (n=15)]. Radiographic evaluation of mesial and distal marginal bone loss was done at 1 month and 3 months. Statistically significant differences were found between submerged dental implants and non-submerged dental implants with anatomical type of healing abutment designs (P &lt; 0.001) and between the two non-submerged dental implant groups with different types of healing abutments (P &lt; 0.001) at 1 month and 3 months. But there was no statistically significant difference between submerged dental implants and non-submerged dental implants with esthetic type of healing abutments (P &gt; 0.05) at 1 month and 3 months. It was concluded from this study that bone resorption during the osseointegration period using the non-submerged technique varied significantly depending on the morphology of the healing abutment used. The non-submerged technique with an esthetic healing abutment produced an equally predictable outcome compared with the submerged technique.

3D assessment of alveolar bone alterations in orthodontic movement among Indians.

Apical root resorption, which is characterised as a biological or abnormal phenomenon that shortens the length of the root apex, is additional typical iatrogenic impact of orthodontic tooth movement that may jeopardise the effectiveness of treatment and tooth lifespan. The main goals of the current retrospective investigation were to assess the dimensions of alveolar bone alterations that come along with orthodontic movement and to look into the frequency and extent of resorption of root in maxillary incisors across categories that were similarly managed with clear aligners (OCA) and fixed appliances (OFA) using CBCT. The study included 50 subjects who were divided into two categories with 25 study subjects in each category. Category OFA: Subjects receiving OFA (n=25). A CBCT scan was used to get three-dimensional pictures at the beginning of therapy as well as at the end of therapy. The overall resorption of root at apical region in OFA group was 0.63±0.21 mm. The overall resorption of root at apical region in OCA group was 0.32 ±0.36 mm. The difference in observation was statistically significant (p= 0.000) with reduced resorption of root at apical region in clear aligners. It was concluded that the decrease in thickness of alveolar bone was greater in orthodontic fixed appliances group as compared to clear aligners. The resorption of root at apical region was lesser in clear aligners group as compared to fixed appliances.

The mandibular bone structure in children by fractal dimension and its correlation with pixel intensity values: a pilot study.

To identify a normal pattern of mandibular trabecular bone in children based on the fractal dimension (FD), and its possible correlation with pixel intensity (PI) values, to facilitate the early diagnosis of possible diseases and/or future bone alterations. The 50 panoramic images were selected and divided into two groups, according to the children's age: 8-9 (Group 1; n = 25) and 6-7 (Group 2; n = 25). For FD and PI analyses, three regions of interest (ROIs) were selected, and their mean values were evaluated for each ROI, according to each group, using the t test for independent samples and the model of generalized estimation equations (GEE). Subsequently, these mean values were correlated by the Pearson test. Comparing the groups, FD and PI did not differ from each other for any of the measured regions (p > 0.00). It was observed that in the mandible branch (ROI1), FD and PI means were 1.26 ± 0.01 and 81.0 ± 2.50, respectively. In the mandible angle (ROI2), the means were 1.21 ± 0.02 (FD) and 72.8 ± 2.13 (PI); and in the mandible, cortical (ROI3) values of FD = 1.03 ± 0.01 and PI = 91.3 ± 1.75 were obtained. There was no correlation between FD and PI in any of the analyzed ROI (r < 0.285). The FD means of ROI1 and ROI2 did not differ from each other (p = 0.053), but both were different from ROI3 (p < 0.00). All PI values differed from each other (p < 0.00). The bone trabeculate pattern in 6-9-year-old children presented FD between 1.01 and 1.29. Besides that, there was no significant correlation between FD and PI.

Bone changes seen on Cone-Beam Computed Tomography in medication-related osteonecrosis of the jaws: Case series

Medication-related osteonecrosis of the jaw (MRONJ) is one of the most serious side effects resulting from treatment with antiresorptive and antiangiogenic drugs used to treat diseases such as malignant tumors. In 7 cases clinically diagnosed with MRONJ, bone alterations were viewed through Cone-Beam Computed Tomography (CBCT), analyzing the quadrants with bone necrosis and the other quadrants with no clinical diagnosis. Therefore, the following characteristics were consistently observed in both the affected quadrant and those considered to be healthy: periodontal ligament thickening, osteosclerosis, thickening of the basal mandibular cortical, osteolytic areas, thickening of the dental lamina dura, and persistent alveolus. Two or more imaging bone changes identified in the CBCT images occurred in at least in one contralateral quadrant, leading to a suggestion that the bone alterations might occur equally in the entire maxillo-mandibular complex. Medication-related osteonecrosis of the jaw (MRONJ) is one of the most serious side effects resulting from treatment with antiresorptive and antiangiogenic drugs used to treat diseases such as malignant tumors. In 7 cases clinically diagnosed with MRONJ, bone alterations were viewed through Cone-Beam Computed Tomography (CBCT), analyzing the quadrants with bone necrosis and the other quadrants with no clinical diagnosis. Therefore, the following characteristics were consistently observed in both the affected quadrant and those considered to be healthy: periodontal ligament thickening, osteosclerosis, thickening of the basal mandibular cortical, osteolytic areas, thickening of the dental lamina dura, and persistent alveolus. Two or more imaging bone changes identified in the CBCT images occurred in at least in one contralateral quadrant, leading to a suggestion that the bone alterations might occur equally in the entire maxillo-mandibular complex.