Amount Of Bone Graft Research Articles

A New Simplified Autogenous Sinus Lift Technique.

Oral maxillofacial rehabilitation of the atrophic maxilla with or without pneumatization of the maxillary sinuses routinely presents limited bone availability. This indicates the need for vertical and horizontal bone augmentation. The standard and most used technique is maxillary sinus augmentation using distinct techniques. These techniques may or may not rupture the sinus membrane. Rupture of the sinus membrane increases the risk of acute or chronic contamination of the graft, implant, and maxillary sinus. The surgical procedure for maxillary sinus autograft involves two stages: removal of the autograft and preparation of the bone site for the graft. A third stage is often added to place the osseointegrated implants. This is because it was not possible to do this at the same time as the graft surgery. A new bioactive kinetic screw (BKS) bone implant model is presented that simplifies and effectively performs autogenous grafting, sinus augmentation, and implant fixation in a single step. In the absence of a minimum vertical bone height of 4 mm in the region to be implanted, an additional surgical procedure is performed to harvest bone from the retro-molar trigone region of the mandible to provide additional bone. The feasibility and simplicity of the proposed technique were demonstrated in experimental studies in synthetic maxillary bone and sinus. A digital torque meter was used to measure MIT and MRT during implant insertion and removal. The amount of bone graft was determined by weighing the bone material collected by the new BKS implant. The technique proposed here demonstrated the benefits and limitations of the new BKS implant for maxillary sinus augmentation and installation of dental implants simultaneously.

Main Approaches to the Use of Biomaterials in Oral and Maxillofacial Surgery: A Brief Systematic Review


 
 
 
 Introduction: In recent years, procedures with the use of dental implants have increased worldwide, reaching approximately one million dental implants per year. In recent years, a platelet concentrate called FRP (fibrin-rich plasma) has been the subject of clinical studies. Associated with this, the biomaterial Bio-Oss® (Geistlich), as it is biodegradable, biocompatible, non-toxic, and has low immunogenicity, and bio stimulators can act in the regeneration of bone tissue, as it establishes with the cells the appropriate biological niche (favorable microenvironment) for bone growth. Objective: Therefore, the present study aimed to evaluate, through a brief systematic review, the results that involve bone formation for dental implantation, with the use of biomaterials such as fibrin-rich plasma and Bio-Oss®. Methods: The model used for the review was PRISMA. Was used databases such as Scopus, Scielo, Lilacs, Google Scholar, PubMed. Results: Fibrin-rich plasma (FRP) as an autologous biomaterial for use in oral and maxillofacial surgery presents most leukocytes, platelets, and growth factors, forming a fibrin matrix, with three-dimensional architecture. The Bio-Oss® biomaterial (Geistlich), as it is biodegradable, biocompatible, non-toxic, and has low immunogenicity and bio stimulators can act in the regeneration of bone tissue, since it establishes with the adenomatous mesenchymal stem cells the appropriate biological niche for bone growth and, thus, allowing the dental implant to be as effective as possible. Conclusion: The use of FRP associated with Bio-Oss® seems to illustrate high success rates with minimal costs, which may reduce the amount of bone graft needed to fill the sinus cavity, reducing the costs of the procedure.
 
 
 

The use of three-dimensional models in tibial plateau fractures

Background: To compare three-dimensional (3D) printed models with 3D computed tomography (CT) images in terms of the reliability of the classification of tibial plateau fractures using the Hohl and Moore and the Schatzker classification systems, and whether there was any influence on surgical management. Method: The sample comprised the 20 CT scans of patients with tibial plateau fractures available in the radiology archive of Dr George Mukhari Academic Hospital (Ga-Rankuwa). Standardised illustrated guides to the Schatzker and the Hohl and Moore classification systems were used by six observers of varying orthopaedic experience. They completed questionnaires individually in three different sessions. In session one the observers had access to the 3D CT images only. On average two to five days later, in session two the observers assessed only the 3D models. In the third session, another two-to-five days later, the observers assessed the 3D CT images while handling and inspecting the corresponding 3D model. Results: The inter-observer reliability of the Schatzker system (moderate reliability) was superior to the Hohl and Moore system (fair reliability) when comparing the assessment using the images and models separately. When all observations were combined, there was no difference between the systems. For the six possible surgical management options given to the observers, there was an overall difference in agreement based on assessing only the CT images compared with assessing only the models, of 19% (23 of the possible 120 procedures). Of these 23 differing procedures, 15 were more invasive. The 3D models were considered superior to 3D CT imaging in terms of spatial awareness and the observers’ ability to assess intra-articular fracture patterns. The models were assessed as being superior to the imaging when considering the ability to estimate the quantity of bone graft required. Conclusion: Although the inter-rater reliability of classification was not significantly improved, there were several advantages to using the 3D-printed models both separately from the CT images and together with the images. The effect of 3D models on patient outcome remains untested. The clinical impact of the use of 3D models (including cost, manufacturing time and radiation exposure) should be weighed against the potential benefits. Level of evidence: Level 4

Schneiderian membrane perforation via transcrestal sinus floor elevation: A randomized ex vivo study with endoscopic validation.

To endoscopically determine the incidence of Schneiderian membrane perforation during transcrestal maxillary sinus floor elevation (SFE), in relation to the bone preparation technique, amount of bone graft, membrane elevation height and different surgical steps. Seven cadaver heads corresponding to 12 maxillary sinuses were used to perform three SFE via transcrestal approach per sinus (36 elevations). Each sinus was randomly assigned to either the Sinus Crestal Approach (SCA) drill kit technique (experimental group) or the conventional osteotome technique (control group). During all phases of the surgery, the integrity of the sinus membrane was monitored through endoscopic examination. A significant difference was found in the incidence of perforation (p=0.007) and vertical elevation height (p<0.001) between the study groups, favoring the experimental group. A safety elevation threshold of 5mm without bone graft and implant placement was estimated. A significant correlation was observed between the residual ridge height and the incidence of perforation (p<0.001; OR=0.51). The SCA drill kit may demonstrate superior osteotomy preparation and membrane elevation capabilities to the osteotome technique, and significantly when a 6-mm SFE is indicated. Residual ridge height and vertical elevation height are risk determinant factors.

Quantitative analysis of local bone graft harvested from the posterior elements during posterior spinal fusion in Adolescent Idiopathic Scoliosis patients

This study analyses the quantity of local bone graft obtained from different anatomical parts of the posterior elements during corrective surgery for Adolescent Idiopathic Scoliosis patients. Locally harvested autogenous bone graft eliminates possible donor site morbidity and has all the important basic bone graft properties such as osteoinductivity, osteogenicity and osteoconductivity. Its usage was reported to be adequate to achieve fusion but none had quantifies the amount of local bone graft harvested. Total of 40 AIS patients were recruited in the study. All posterior spinal fusion surgeries were performed by the same dual surgeons and same anesthetist with a single observer collecting and measuring bone grafts harvested. The bone grafts harvested from each respective posterior element (spinous processes, laminas, facets and transverses processes) and measured accordingly. There were 36 females and 4 males. Amongst cases recruited, there were 32% Lenke 1, 28% Lenke 2, 8%Lenke 3, 22%Lenke 5 and 10% Lenke 6. Total thoracic levels involved were 333, whereas lumbar levels were 81. The mean total weight of bone graft obtained per case was 36.5 ± 13.7 g. The total weight of lumbar bone graft to the number of lumbar fusion levels (4.5 ± 1.2 g/fusion level) was significantly higher than the total weight of thoracic bone graft to the number of thoracic fusion levels (3.2 ± 1.2 g/fusion level). The amount of bone graft was obtained was highest from lumbar spinous process (42%), followed by thoracic spinous process (32%), lumbar lamina (29%), lumbar facet (28%), thoracic lamina (25%), thoracic facet (22%), and thoracic transverse process (21%). Lumbar vertebra provided more bone graft than thoracic vertebra. Spinous processes contributed the highest amount of local bone graft in the thoracic and lumbar spine.

Total hip arthroplasty in treating acetabular protrusion secondary to rheumatoid arthritis

Objective To investigate the clinical outcomes of total hip arthroplasty in treatment of severe acetabular protrusion secondary to rheumatoid arthritis. Methods From January 2011 to November 2014, eighteen patients (20 hips) with severe acetabular protrusion secondary to rheumatoid arthritis were treated with total hip arthroplasty (THA), including 6 males (6 hips) and 12 females (14 hips). The age ranged from 37 to 68 years (average, 45.8±8.3 year). According to the classification of Sotelo-Garza and Charnley, there were 15 cases (17 hips) of type II (acetabular protrusion 6-15 mm) and 3 cases (3 hips) of type III (acetabular protrusion >15 mm). During the surgery, the femoral heads were moved out through retrograde method after the osteotomy of femoral neck by posterolateral approach. All patients underwent THA with autogenous bone graft by impacting technique for reconstruction of acetabula, and the cementless cups were planted with press-fit skills (Tantalum trabecular metal cup in 16 cases and Titanium porous coating cup in 4 cases). The hip function was evaluated by using Harris hip score. Radiographic measurement was performed with X-ray films to assess the restoration of the hip rotation center, graft incorporation and sign of prostheses loosening in follow-up duration. Results The mean operation duration and intraoperative blood loss were 89.5±8.1 min (range 55-131 min) and 295±10.9 ml (range 165-480 ml) respectively. The average amount of bone graft was 33.7±6.8 cm3 (range 32.5-61.2 cm3) in reconstruction of protrusion acetabulum. The mean follow up duration was 4.5±1.7 years (range 2.5-6.0 years). The horizontal distance between the center of femoral head and the Kohler's line was increased from preoperative 8.87±3.9 mm (range -11.11 -12.78 mm) to 23.55±2.5 mm (range 21.23-25.57 mm) postoperatively, and the vertical distance between the center of femoral head and the line joining the bilateral ischial tuberosities was decreased from preoperative 87.45±3.5 mm (range 74.75-96.97mm) to postoperative 77.83±4.1 mm (range 68.22-90.40 mm) with statistically significant difference. The bone incorporation was achieved at 6 months postoperatively in radiological film. No loosening of acetabular components was found in final fellow-up. At last follow-up, Harris hip score was significantly improved from 55.3±9.5 points preoperatively to 92.2±12.7 postoperatively (t=51.569, P=0.000). The range of flexion of the hip significantly improved from 41.5°±6.7° preoperatively to 102.3°±14.5° at finial follow-up (t=64.865, P=0.000), and the range of extension of the hip improved from 8.2°±3.5° preoperatively to 29.8°±6.6° at finial follow-up (t=51.161, P=0.000). The discrepancy was significantly decreased from 23.7±0.82 mm preoperatively to 4.7±0.39 mm postoperatively (t=19.761, P=0.000). Mild thigh pain was reported in two hips, which typically occurred only with prolonged activity without disabling and not requiring medication. Conclusion Total hip arthroplasty with impaction bone grafting and cementless modular cup can recover the acetabular center of rotation and achieve satisfactory short-term outcomes in treating patients severe protrusion acetabula secondary to rheumatoid arthritis. Key words: Arthroplasty, replacement, hip; Arthritis, rheumatoid; Acetabulum; Bone transplantation; Transplantation, autologous

Evaluation of a novel tool for bone graft delivery in minimally invasive transforaminal lumbar interbody fusion.

Study designDisk material removed (DMR) during L4-5 and L5-S1 transforaminal lumbar interbody fusion (T-LIF) surgery was compared to the corresponding bone graft (BG) volumes inserted at the time of fusion. A novel BG delivery tool (BGDT) was used to apply the BG. In order to establish the percentage of DMR during T-LIF, it was compared to DMR during anterior diskectomy (AD). This study was performed prospectively.Summary of background dataMinimal information is available as to the volume of DMR during a T-LIF procedure, and the relationship between DMR and BG delivered is unknown. BG insertion has been empiric and technically challenging. Since the volume of BG applied to the prepared disk space likely impacts the probability of arthrodesis, an investigation is justified.MethodsA total of 65 patients with pathology at L4-5 and/or L5-S1 necessitating fusion were treated with a minimally invasive T-LIF procedure. DMR was volumetrically measured during disk space preparation. BG material consisting of local autograft, BG extender, and bone marrow aspirate were mixed to form a slurry. BG slurry was injected into the disk space using a novel BGDT and measured volumetrically. An additional 29 patients who were treated with L5-S1 AD were compared to L5-S1 T-LIF DMR to determine the percent of T-LIF DMR relative to AD.ResultsDMR volumes averaged 3.6±2.2 mL. This represented 34% of the disk space relative to AD. The amount of BG delivered to the disk spaces was 9.3±3.2 mL, which is 2.6±2.2 times the amount of DMR. The BGDT allowed uncomplicated filling of the disk space in <1 minute.ConclusionThe volume of DMR during T-LIF allows for a predictable volume of BG delivery. The BGDT allowed complete filling of the entire prepared disk space. The T-LIF diskectomy debrides 34% of the disk relative to AD.

Harvesting olecranon bone graft in adults by using bone biopsy trephine

Objectives: Bone grafts have been used for more than one hundred years in orthopedic surgery. Autografts are still the gold standard with respect to their osteoconductive, osteoinductive and osteogenetic peculiarities. Cancelleous grafts are the most commonly used autografts with their porous structure increasing the contact area. Although iliac crest is the preferred donor site, the femur, tibia, distal radius and olecranon are also employed when they are in a suitable location for the recipient site. The olecranon donor site can provide ample amounts of bone graft for reconstruction in the upper extremity. Here, the bone graft harvesting from the olecranon with the use of trephine as a safe and fast technique is presented. The bone graft harvested with trephine not only has the proper morphology to be used for phalanx and metacarpal reconstruction, but also can be utilized for wrist and forearm procedures. Methods: 82 patients (21 female) had bone reconstruction with olecranon bone graft harvested with trephine between 2010 and 2015. The mean age was 34 (range: 20-62) years. The mean follow-up period was 26 (range: 6-48) months. Results: None of the patients had pain or decrease in the range of motion in the early or late postoperative period. Only one patient (1.2%) had hematoma formation at the donor site and no other complications were observed in any patient. There was no difference in elbow extension strength between both elbows at the postoperative fifteenth day and at the end of the follow-up period. Conclusion: Bone graft harvesting with trephine is technically easy and fast, and donor site morbidity is diminished compared other methods and donor sites. It can be performed under axillary anesthesia and provides adequate amounts of bone graft for upper extremity reconstructions.

Retrograde Versus Antegrade Femoral Bone Graft Harvesting Using the Reamer–Irrigator–Aspirator

To compare retrograde versus antegrade femoral bone graft harvesting using the reamer-irrigator-aspirator system to determine whether there was any difference in intraoperative, postoperative, or patient outcome variables. Retrospective cohort study. Urban Level I Trauma Center. Ninety-four (62 antegrade and 32 retrograde procedures) consecutive adult patients who underwent femoral autologous bone graft harvesting using the Synthes reamer-irrigator-aspirator system between April 2008 and March 2013. Amount of bone graft, perioperative fractures or other complications, and postoperative hip and/or knee pain. There was no significant difference between demographic or medical comorbidities between the groups. There was no significant difference in the side of the graft harvest, graft volume, hospital length of stay, or the ability to ambulate on postoperative day 1. There was a significantly increased incidence of iatrogenic fracture or prophylactic nailing with antegrade reaming (4 vs. 0, P = 0.01). Average length of follow-up was 500 (range, 20-1477) days for the antegrade group and 378 (range, 19-706) days for the retrograde group. The antegrade group had a nonsignificant increased incidence of hip pain (8.1% vs. 3.1%, P = 0.66), and the retrograde group had a significantly higher incidence of knee pain (15.6% vs. 1.6%, P = 0.02) at 6-month follow-up. Neither hip nor knee complaints were present at final follow-up. No cases of delayed femur fracture, infection, or abductor and/or antalgic gait involving the donor extremity were seen at final follow-up. This study provides support to the safety of femoral bone graft harvesting using both antegrade and retrograde techniques. Both techniques provide reliable, high-volume, nonstructural autologous bone graft with minimal associated morbidity. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Risedronate does not Enhance Fixation or BMD in Revision Cups: Randomised Study with Three Years follow-up

Bisphosphonates may improve implant fixation by inhibition of bone resorption and stimulation of osteoblasts by up regulation of BMP-2. However, there are few clinical studies in this area. Does treatment with oral bisphosphonates improve implant fixation and bone remodelling around the acetabular component after revision arthroplasty with or without use of morselised allograft? Fifty-three patients received university pharmacy blinded medication for three months: 5 mg risedronate or placebo one dosage and 1 g calcium carbonate and 800IE cholecalciferol per day. Forty-one patients were operated upon with revision of the cup. The revisions were performed with an uncemented (Trilogy, Zimmer, Warsaw, USA) or a cemented (Ogee, Depuy Int, England) cup. Radiostereometric analysis was obtained within one week after the operation, at three and six months, and after one, two and three years to study cup migration. Bone mineral density was measured postoperatively, at six months, one and two years, using DEXA. The presence and extension of radiolucent lines and graft remodelling were studied on conventional radiography. The risendronate group revealed less anterior-posterior rotation at 6 months. We found no significant differences in migration at three years, change in bone mineral density, or graft remodelling and radiolucent lines formation between groups. We could not demonstrate any beneficial effects of oral administration of risedronate on the fixation, bone mineral density or bone remodelling of revision cups using various amount of bone graft.

Difference of Fusion Rate in Minimally Invasive Transforaminal Lumbar Interbody Fusion with Autobone and Hydroxyapatite according to Mixture Ratio and Amount of Bone Graft

Purpose: The aim of this study is to analyze the fusion rate according to the mixture ratio and the amount of bone graft in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Materials and Methods: This study included 92 subjects who underwent MI-TLIF. Patients were classified into either group I, in which patients received transplantation with only autogenous bone, group II, in which patients received transplantation with hydroxyapatite mixed with autogenous bone by more than 50%, or group III, in which patients received transplantation with hydroxyapatite mixed with autogenous bone by less than 50%. For analysis of the correlation of amount of bone graft with fusion rate, patients were divided into group A, having less than 12 ml of bone graft, and group B, having more than 12 ml of bone graft. Visual analogue scale and Oswestry disability index were used for clinical assessment, and Burkus’ classification method was used for evaluation of bone fusion. Results: Fusion rates of groups I, II, and III according to the mixture ratio were 90.9%, 86.5%, and 86.2%, respectively. The fusion rate increased as the autobone ratio became higher; however, no significant difference was found (p=0.16). The fusion rates were 81.5% and 92.5% in group A and group B, respectively, which were classified according to the volume of bone graft, showing a significant increase in groups with bone graft volume more than 12 ml (p=0.03). Conclusion: A significantly high fusion rate was observed when bone graft volume was more than 12 ml in MI-TLIF. More than 12 ml of bone graft volume is essential for achievement of a satisfactory fusion rate.

Initial Experience with BoneBac Press&amp;lt;sup&amp;gt;TM&amp;lt;/sup&amp;gt;: A Novel Autologous Bone Graft Harvesting and Collecting Device

Object: The objective of this study is to analyze the utility of a novel autologous bone graft harvesting and collecting device in spinal fusion surgeries. Methods: 35 patients underwent fusion procedures in the cervical or lumbar spine using the BoneBac PressTM. Procedures included anterior cervical discectomy with fusion (ACDF), lumbar laminectomy and posterolateral arthrodesis, and transforaminal lumbar interbody fusion (TLIF). The amount of bone graft collected from each level was determined as well as the need for additional bone graft extenders. Fusion rates were determined based on an independent radiographic evaluation performed 5 to 12 months postoperatively. Results: 54 total levels were operated upon, collecting a total of 176.0 cc of autograft. The average amount of bone collected was 3.26 cc/level. In the cervical and lumbar spine the average amount of bone collected per level was 2.30 cc and 6.77 cc respectively. The fusion rate was 94.3% at 10 months postoperatively. In most cases no additional bone graft extender was needed. Autologous bone collected had excellent handling characteristics and was easily packed into cages or placed posterolaterally. Conclusions: The use of autograft bone material collected using the BoneBac PressTM is costeffective, significantly reduces bone graft cost, and eliminates donor graft site morbidity while promoting successful fusion.

Low Morbidity Reported After Iliac Bone-Graft Harvesting

The morbidity associated with bone-graft harvesting is an important determinant of the indications for its use as well as for the use of bone-graft substitutes. The number of bone-grafting procedures performed annually is estimated to be 1.5 million in the U.S.1,2 and 2.2 million worldwide3,4. Bone-grafting procedures are performed for a wide variety of indications including fusion of the spine and other joints; bone replacement for tumor; infection; periprosthetic bone loss; pediatric bone deficiency; and trauma reconstruction including fracture, nonunion, and traumatic bone loss. Bone autograft provides osteoconductive scaffolding, osteoinductive growth factors, and osteogenic progenitor cells. Autograft has been used for over 100 years to effectively fill bone voids and stimulate desirable bone formation. A variety of sources of bone autograft have been reported but the iliac crest is the most common source, with good quality and quantity of bone graft readily available. Although complications associated with bone-graft harvesting have been reported for years, it was generally considered a safe and reliable procedure until the 1990s, when higher rates of complications began to be reported (as discussed by Loeffler …

Uni- and Bilateral Instrumented Posterolateral Fusion of the Lumbar Spine With Local Bone Grafting

Prospective trial. To examine the bone union and clinical results after unilateral or bilateral instrumented posterolateral fusion surgery using a local bone graft. The iliac crest bone graft technique for lumbar posterolateral fusion surgery is widely used; however, donor site problems such as pain and sensory disturbance have been reported. Local bone has been used for bilateral multisegment fusion surgery; however, outcomes have been poor because of insufficient amounts of local bone used. This study evaluated unilateral and bilateral posterolateral fusion at 3 levels using a local bone graft. Sixty-two patients diagnosed with degenerated spondylolisthesis at 3 levels were divided into 2 groups. All underwent decompression and bilateral instrumented posterolateral fusion. However, a unilateral local bone graft was used in 32 patients and bilateral local bone graft was used in 30 patients. The amount of bone grafting, proportion of patients with bone union, duration of bone union, visual analog scale score, Japanese Orthopedic Association score, and Oswestry Disability Index were evaluated before and 2 years after surgery. Visual analog scale score, Japanese Orthopedic Association score, and Oswestry Disability Index were not significantly different between the 2 groups before and after surgery (P > 0.05). The amount of local bone graft used for each segment was significantly less in the bilateral group (P < 0.05). The proportion of patients with rates of bone union and instability were 86% and 9%, respectively, in the unilateral group, but significantly poorer at 60% and 34% in the bilateral group. If multisegment fusion (3-level fusion) is performed, bilateral local bone grafting results in a poor rate of bone union because of an insufficiency of local bone. Unilateral bone grafting is recommended because better rates of bone union and stability are achieved.

One, Two-, and Three-Level Instrumented Posterolateral Fusion of the Lumbar Spine With a Local Bone Graft

Prospective trial. To examine the difference in bone union and clinical results after one-, two-, and three-level instrumented posterolateral fusion surgery using a local bone graft. The iliac crest bone graft technique for lumbar posterolateral fusion surgery is widely used; however, donor site problems such as pain and sensory disturbance have been reported. Local bone has been used for fusion surgery; however, its reliability as a graft for multiple segments has not been fully reported. One hundred twenty-two patients diagnosed with degenerated spondylolisthesis were divided into three groups [spondylolisthesis at 1 level (n = 42), at 2 levels (n = 40), and at 3 levels (n = 40)]. All patients underwent decompression and instrumented posterolateral fusion with a local bone graft. The amount of bone graft, proportion of patients with (rate) and duration of bone union, Visual Analog Scale (VAS) score, Japanese Orthopedic Association Score (JOAS), and Oswestry Disability Index (ODI) were evaluated before and 2 years after therapy. VAS score, JOA score, and ODI were not significantly different among the three groups before and after surgery (P > 0.05). Average amount of local bone graft used for one segment significantly decreased in proportion to the number of fusion levels (P < 0.05). The rate of bone union was 88% in the one-level group, 85% in the two-level group, and 62.5% in the three-level group, which was significantly lower than that in the one- and two-level groups (P < 0.05). If one- and two-level posterolateral fusion were performed, the local bone graft technique provides a good and uniform bone union rate; however, for three-level fusion poor results were obtained because of an insufficient amount of local bone.

Evaluation of a biodegradable synthetic hydrogel used as a guided bone regeneration membrane: an experimental study in dogs

To test whether or not an experimental polyethylene glycol (PEG) membrane maintains the bone graft volume and contributes to the preservation of the ridge contour in comparison with a commercially available synthetic membrane. In 18 dogs, all mandibular premolars and the first molars were extracted. Ten weeks later, acute standardized defects were prepared. The defects of four dogs were randomly assigned to three modalities: (1) PEG plus deproteinized bovine bone mineral (DBBM) (PEG), (2) a resorbable glycolide trimethylene carbonate membrane plus DBBM (PGA-TMC), and (3) DBBM alone (DBBM). These dogs were then sacrificed for the baseline measurements. The remaining defects of 14 dogs were randomly assigned to (1) PEG plus DBBM, (2) PGA-TMC plus DBBM, (3) DBBM, and (4) empty defect. The dogs were sacrificed at baseline (n=4), 4 weeks (n=7), or at 16 weeks (n=7). Mixed model regressions and the non-parametric Brunner-Langer method were applied for statistical analysis. At baseline, equal tissue augmentation was observed in all groups. At 4 and 16 weeks, the greatest augmented area fractions were calculated for PEG (103%; 107%, respectively), followed by PGA-TMC (98%; 91%), DBBM (85%; 78%), and empty (46%; 54%), being statistically significant different (P<0.001) between PEG and empty at 4 and 16 weeks, and PEG and DBBM at 16 weeks. The overall decrease (P≤0.01) in the amount of bone graft between baseline and 16 weeks was -14% (PEG), -22% (PGA-TMC), and -23% (DBBM). The study demonstrates that the combination of the PEG membrane with DBBM maintains the bone graft volume over time better than controls. The PEG membrane with DBBM was also the most effective method to preserve the ridge contour.

Clinical outcomes and fusion success associated with the use of BoneSave in spinal surgery

Achieving spinal fusion is the guiding principle behind surgical treatment for a range of spinal pathologies, often requiring a substantial amount of bone-graft. Iliac crest autograft represents the gold standard although associated morbidities and limited graft material have led to the development of alternatives. BoneSave (Stryker, UK), a porous tricalcium phosphate-hydroxyapatite ceramic, is one such alternative, employed in spinal fusion over the past few years. Very little research exists into the clinical outcomes associated with its use. Clinical data was collected retrospectively from the case notes of 45 patients who underwent posterolateral inter-transverse spinal fusion involving the application of BoneSave between June 2003 and January 2005. Latest follow-up information was collected via a postal questionnaire (average follow-up of 46 months). Validated outcome instruments employed included the Short Form 36 and Oswestry Disability Index. In addition visual analogue scales for pain, patient global impression of change, work status, persisting symptoms and patient satisfaction data were collected. Radiological evaluation of fusion was carried out from the most recent spinal radiographs available for each patient. Qualitative post-operative data was available in 96%, with a questionnaire response rate of 68.4%. Radiographical evaluation was possible in 67%. Significant post-operative improvements were seen across all outcome measures in the large majority of cases. Successful fusion was achieved in 56.7% of cases. The clinical outcomes associated with the use of BoneSave in spinal fusion are comparable to those available in the literature for more conventional techniques. The fusion rate was not significantly lower.

Comparison of Donor-Site Engraftment After Harvesting Vascularized and Nonvascularized Iliac Bone Grafts

The objective of this study is to characterize the donor-site morbidity after harvesting of nonvascularized and vascularized iliac bone grafts. Clinical data of 353 patients were collected for analysis. In addition, a questionnaire was sent to all patients asking about their perceptions of different parameters. In an individual age-matched layout, we compared 34 patients with nonvascularized iliac bone grafts with 34 patients with vascularized iliac bone grafts. Transplantation of vascularized bone grafts has been increasingly performed at our institution. The mean age was 41.5 years in the nonvascularized group and 48.6 years in the vascularized group. The main reason for the bony defect in the vascularized group was malignancy. The majority of postoperative functional problems were observed in obese patients. No patient had serious or long-term complications at the donor site. The amount of bone graft taken affected postoperative sensitivity disturbance and caused postoperative functional problems and pain. We conclude that the iliac crest is a suitable site for harvesting both vascularized and nonvascularized bone grafts measuring up to 10 x 3 cm. For larger defects that require a larger bone graft, a vascularized bone graft is more suitable with a better predictable healing capability. No significant differences in donor-site morbidity were found between the vascularized and nonvascularized bone grafts if a similar amount of bone was taken for transplant.

Surgical techniques: How I do it? Bone graft harvest from the proximal lateral tibia

Bone grafting is a procedure that has steadily increased in frequency over the years from 246 cases in the 20 years preceding 1910 to an estimated 200,000 every year in the USA. ENT, Orthopaedic and maxillo-facial surgeons use it to augment bonehealing, arthrodese, treat non-unions, lengthen bones or fill defects. No bone substitutes have shown better results then autologous bone graft. The harvesting of bone from any site cannot be accomplished without some morbidity. In addition to the need for an additional surgical site, pain, gait disturbances sensory deficits and other serious complications have been associated with bone graft procurement. Themost frequently used site of harvest is the iliac crest. It offers the advantage of harvesting large amounts of both cortical and cancellous bone. However this procedure carries significant co-morbidities such as donor site pain, postoperative local haematoma, paraesthesia in the area supplied by the lateral femoral cutaneous nerve or damage to the femoral nerve, hernia and fracture of the iliac crest. The total complication rate is reported as high as 10%. For the above reasons some authors have shifted to alternative donor sites associated with less morbidity. Autologous bone harvest from the proximal lateral tibia has been described in the maxillo-facial literature and more recently in the orthopaedic literature. There is an overall lack of morbidity and a favourable quality and quantity of bone available from this site. In fact, O’Keefe et al. followed up a group of 230 harvest of proximal tibia cancellous bone and concluded that the volume was satisfactory, the surgical site was easy to access, and the morbidity was low. In clinical practice, several studies showed that the amount of bone graft taken intra operatively from the proximal tibia is approximately 10–15 cm. Likewise; Catone et al. took an average volume of 25 cm of cancellous bone intra operatively from the proximal tibia metaphysic, comparable to the

三次元光造形頭蓋樹脂模型を用いて調整したチタンメッシュと自家腸骨移植による下顎骨再建法

Reproduction of the shape of the mandible is essential for restoring or creating functional occlusion and is a very important element for the preparation of dentures and implant prostheses. Mandibular reconstruction with a titanium mesh is suitable for restoring the physiological shape of the mandible, and either a cortical bone block or particulate cancellous bone and marrow can be used. However, it is difficult and time-consuming to fit and shape the titanium mesh during reconstructive surgery. To resolve this problem, we employed the following method. A craniofacial skull model was fabricated by means of the stereo-lithography technique on the basis of CT data. Preoperatively, a titanium mesh was bent and cut to simulate the original shape of the mandible on the model with simulated resection. This procedure made it easier to fit the titanium mesh after segmental resection while maintaining the shape of the mandible and shortened the operation time. Since titanium mesh does not need to be bent more than necessary, metal fatigue can be minimized. Furthermore, preoperative surgery simulation makes it possible to estimate the necessary amount of bone graft. This method contributed significantly to preoperative planning.All patients wore implant-supported fixed prostheses, and postoperative occlusal function and esthetics have been favorable.