Augmented Height Research Articles

Vertical and horizontal ridge augmentation using customized three-dimensionally printed polycaprolactone mesh in atrophic posterior maxillae: a case report.

Polycaprolactone has exhibited expediency as a biomaterial for bone regenerative procedures preclinically. The present report of the two clinical cases in the posterior maxilla is the first to describe clinical application of a customized 3D printed polycaprolactone mesh for alveolar ridge augmentation. Two patients needing extensive ridge augmentation procedures for dental implant therapy were selected. Polycaprolactone meshes were virtually designed, 3D printed and applied in combination with a xenogeneic bone substitute. Cone-beam computed tomography was taken pre-operatively, immediately after the surgery, and 1.5 to 2 years after the delivery of implant prostheses. The serial cone-beam computed tomography images were superimposed to measure the augmented height and width at 1 mm increments from the implant platform to 3 mm apically. After 2 years, the mean [maximum, minimum] bone gain was 6.05 [8.64, 2.85] mm vertically and 7.77 [10.03, 6.18] mm horizontally at 1 mm below the implant platform. From immediately postoperative to 2 years, there was 14 % reduction of augmented ridged height and 24 % reduction of augmented width at 1 mm below the platform. All implants placed in augmented sites were successfully maintained until 2 years. The customized Polycaprolactone mesh might be a viable material for ridge augmentation in the atrophic posterior maxilla. This needs to be confirmed through randomized controlled clinical trials in future studies.

The impact of polydeoxyribonucleotide on early bone formation in lateral-window sinus floor elevation with simultaneous implant placement.

The aim of this study was to evaluate the impact of polydeoxyribonucleotide (PDRN) on histologic outcomes when implant placement and lateral sinus floor elevation are performed simultaneously. Three bimaxillary premolars (P2, P3, and P4) were extracted from 4 beagle dogs 2 months before lateral sinus floor elevation. After lateral elevation of the sinus membrane, each sinus was allocated to either the test or control group. Sinuses underwent either 1) collagenated synthetic bone graft with PDRN following lateral sinus floor elevation (test group) or 2) collagenated synthetic bone graft without PDRN after lateral sinus floor elevation (control group). Eight weeks after the surgical procedure, all animals were euthanised for a histologic and histomorphometric assessment. Augmented height (AH), protruding height (PH), and bone-to-implant contact in pristine (BICp) and augmented (BICa) bone were measured. The composition of the augmented area, which was divided into 3 areas of interest located in coronal, middle and apical areas (AOI_C, AOI_M, and AOI_A), was calculated with 3 parameters: the area percentage of new bone (pNB), residual bone graft particle (pRBP), and fibrovascular connective tissue (pFVT). AH, PH, BICp, BICa total, BICa coronal, and BICa middle values were not significantly different between sinuses in the control and test groups (all P>0.05). The BICa apical of sinuses in the test group (76.7%±9.3%) showed statistically higher values than those of sinuses in the control group (55.6%±22.1%) (P=0.038). pNB, pRBP, and pFVT showed statistically significant differences between the 2 groups in AOI_A (P=0.038, P=0.028, and P=0.007, respectively). pNB, pRBP, and pFVT in AOI_C and AOI_M were not significantly different between samples in the control and test groups (all P>0.05). The histologic findings revealed that lateral sinus floor elevation with PDRN might improve early new bone formation and enable higher bone-to-implant contact.

PRF-Solution in Large Sinus Membrane Perforation with Simultaneous Implant Placement-Micro CT and Histological Analysis.

Background: The purpose of the study was to analyze the efficacy of platelet-rich fibrin (PRF) as a single augmentation material for complicated cases of maxillary sinus floor elevation, resulting from membrane perforation or previous infections. Methods: Implant insertion in the posterior region of the maxilla was simultaneously performed with maxillary sinus floor augmentation. Schneiderian membrane elevation can be accompanied by extremely serious sinus membrane perforation, due to accidental tearing or intended incision for mucocele removal. PRFs were placed in the sinus cavity both for membrane sealing and sinus floor grafting. Radiological, histological and micro-CT analyses were performed. Implant survival was assessed every 6 months for 1 to 4 years, with a mean follow up of 1.8 years, after prosthetic loading. Radiological examinations were performed on CBCT at 9 and 12 and 36 months postoperatively and revealed improved degrees of radiopacity. Results: 19 implants were simultaneously placed in the course of nine maxillary sinus floor augmentation surgeries, with successful outcomes in terms of bone grafting and implant integration. New bone formation was evidenced 12 months postoperatively on radiological examination, micro-CT analysis, and histological analysis of a harvested bone segment from the augmented maxillary sinus. The mean gain in bone height of the sinus floor augmentation was 6.43 mm, with a maximum of 9 mm. The mean amount of vital bone obtained from histologic assessment was 52.30%, while bone volume/tissue volume ratio in micro-CT 3D had a mean of 50.32%. Conclusions: PRF may be considered as an alternative treatment for a single surgery of sinus augmentation with simultaneous implant placement, even in complicated cases with significant sinus membrane tearing.

Clinical Safety Assessment of Autologous Freeze-Drying Platelet-Rich Plasma for Bone Regeneration in Maxillary Sinus Floor Augmentation: A Pilot Study.

The purpose of this clinical study is to evaluate the safety and preliminary efficacy of autologous freeze-drying platelet-rich plasma (FD-PRP) on bone regeneration in maxillary sinus floor augmentation as a preliminary pilot study. Five patients that required sinus floor augmentation to facilitate the placement of dental implants participated in this clinical study. The PRP was prepared from the autologous peripheral blood and was lyophilized and stored at −20 °C for 4 weeks before surgery. At surgery, triple-concentrated FD-PRP (x3FD-PRP) mixed with synthetic bone grafting materials was rehydrated following the transplantation into the sinus floor. The primary outcome was a safety verification of x3FD-PRP, evaluated in terms of the clinical course and consecutive blood tests. The secondary outcome was clinical efficacy focused on bone regeneration in sinus floor augmentation evaluated by radiographic examination and implant stability. There were no adverse events, such as systemic complications, excessive inflammatory reactions, severe infection, or local site healing complications, besides those on the usual course associated with surgery. Vertical augmented height was maintained, and the initial stability of implants was achieved post-operatively in 6 months. The results obtained in this study suggest that x3FD-PRP can be used safely for bone engineering in clinical practice. Further studies are required to draw a conclusion concerning the efficacy of x3FD-PRP since this was a pilot study with a single arm and a small sample size.

Osseodensified Crestal Sinus Window Augmentation: An Alternative Procedure to the Lateral Window Technique.

A novel minimally invasive technique, osseodensification, is proposed to facilitate maxillary sinus bone graft augmentation. The osseodensified crestal window overcomes the previous limitations of traditional crestal approaches with respect to residual bone height (RBH) of ≤1.5 mm as well as vertical height of augmentation (>10 mm). Three patients, healthy and non-smoking, with 3 distinct and difficult clinical situations requiring sinus augmentation and having a maximum of 1.5 mm RBH (0.4-1.5 mm) were selected for this procedure. Edentulous sections were large (entire posterior sextant, with and without sinus septa), and small (single hyperpneumatized maxillary molar site). All healing was rapid and uneventful with no instances of sinus membrane perforation or other complications seen. The vertical increase in sinus bone height ranged from 10.3 mm to 13.6 mm. The increase in bone height is comparable to that obtained with lateral window procedures. The osseodensified crestal sinus window technique may be thus be proposed as a possible alternative procedure for the lateral sinus window technique for maxillary sinus bone augmentation.

Plant performance of enhancing licorice with dual inoculating dark septate endophytes and Trichoderma viride mediated via effects on root development

BackgroundThis study aimed to assess whether licorice (Glycyrrhiza uralensis) can benefit from dual inoculation by Trichoderma viride and dark septate endophytes (DSE) isolated from other medicinal plants.MethodsFirst, we isolated and identified three DSE (Paraboeremia putaminum, Scytalidium lignicola, and Phoma herbarum) and Trichoderma viride from medicinal plants growing in farmland of China. Second, we investigated the influences of these three DSE on the performance of licorice at different T. viride densities (1 × 106, 1 × 107, and 1 × 108 CFU/mL) under sterilised condition in a growth chamber.ResultsThree DSE strains could colonize the roots of licorice, and they established a positive symbiosis with host plants depending on DSE species and T. viride densities. Inoculation of P. putaminum increased the root biomass, length, surface area, and root:shoot ratio. S. lignicola increased the root length, diameter and surface area and decreased the root:shoot ratio. P. herbarum increased the root biomass and surface area. T. viride increased the root biomass, length, and surface area. Structural equation model (SEM) analysis showed that DSE associated with T. viride augmented plant biomass and height, shoot branching, and root surface area. Variations in root morphology and biomass were attributed to differences in DSE species and T. viride density among treatments. P. putaminum or P. herbarum with low- or medium T. viride density and S. lignicola with low- or high T. viride density improved licorice root morphology and biomass.ConclusionsDSE isolated from other medicinal plants enhanced the root growth of licorice plants under different densities T. viride conditions and may also be used to promote the cultivation of medicinal plants.

One-Stage Vertical Ridge Augmentation and Dental Implantation With Allograft Bonerings: Results 1 Year After Surgery.

The aim of this study was to analyze the success rate of dental implants and the graft shrinkage rate after vertical ridge augmentation and simultaneous implantation with an allograft bonering. Fifty-one patients (81 augmentations and simultaneous implantations) were included. The bonering technique followed a standardized protocol. The alveolar ridge was prepared using a congruent trephine, and depending on the defect size, an allograft bonering with an outer diameter of 6-7 mm was placed. The height of the bonering was trimmed with a diamond disc to the required length. The average height of vertical augmentation was 5.5 mm. Implants were inserted through the bonering into the native bone of alveolar ridge. After 6 months, dental implants were exposed, and dental prosthetics were placed. Of 81 implants placed with the bonering technique, two failed during a 12-month follow-up, corresponding to a success rate of 97.5%. One year after surgery, the allograft bonering exhibited an average vertical graft shrinkage rate of 8.6%. In conclusion, the allograft bonering technique was associated with a favorable outcome, and in cases with large vertical defects, both treatment time and donor site morbidity could be reduced.

Impact of hemodialysis on cardiovascular system assessed by pulse wave analysis.

Valuable information about cardiovascular system can be derived from the shape of aortic pulse wave being the result of reciprocal interaction between heart and vasculature. Pressure profiles in ascending aorta were obtained from peripheral waveforms recorded non-invasively (SphygmoCor, AtCor Medical, Australia) before, during and after hemodialysis sessions performed after 3-day and 2-day interdialytic intervals in 35 anuric, prevalent hemodialysis patients. Fluid status was assessed by Body Composition Monitor (Fresenius Medical Care, Bad Homburg, Germany) and online hematocrit monitoring device (CritLine, HemaMetrics, Utah). Systolic pressure and ejection duration decreased during dialysis. Augmentation index remained stable at 30 ± 13% throughout hemodialysis session despite the decrease of augmented pressure and pulse height. Subendocardial viability ratio (SEVR) determined after 3-day and 2-day interdialytic intervals increased during the sessions by 43.8 ± 26.6% and 26.1 ± 25.4%, respectively. Hemodialysis performed after 3-day and 2-day interdialytic periods reduced significantly overhydration by 2.4 ± 1.0 L and 1.8 ± 1.2 L and blood volume by 16.3 ± 9.7% and 13.7 ± 8.9%, respectively. Intradialytic increase of SEVR correlated with ultrafiltration rate (R = 0.39, p-value < 0.01), reduction in overhydration (R = -0.57, p-value < 0.001) and blood volume drop (R = -0.38, p-value < 0.01). The strong correlation between the decrease of overhydration during hemodialysis and increase in SEVR confirmed that careful fluid management is crucial for proper cardiac function. Hemodialysis affected cardiovascular system with the parameters derived from pulse-wave-analysis (systolic and augmented pressures, pulse height, ejection duration, SEVR) being significantly different at the end of dialysis from those before the session. Combination of pulse-wave-analysis with the monitoring of overhydration provides a new insight into the impact of hemodialysis on cardiovascular system.

Sequential healing of onlay bone grafts using combining biomaterials with cross-linked collagen in dogs.

The aim of this study was to observe the sequential healing of onlay grafts in terms of the volumetric and histologic changes using different bone substances and absorbable membranes according to the presence of collagen cross-linking. Four groups involving onlay grafting with different materials were randomly assigned to both sides of the maxillae of 15 beagle dogs: (i) control group without any treatment; (ii) group NN, bovine hydroxyapatite incorporated into a non-cross-linked collagen matrix (BHC)+non-cross-linked collagen membrane (NCCM); (iii) group NC, BHC+cross-linked collagen membrane (CCM); and (iv) group CC, porcine hydroxyapatite incorporated into a cross-linked collagen matrix+CCM. Radiographic and histological analyses were performed after three different healing periods: 4, 8 and 12weeks. At week 4, the bone substances were well localized under the barrier membrane in groups NC and CC, while the bone substances became spread out and flattened in group NN. Similarly, the augmented height was significantly greater in groups NC and CC (2.55 and 2.51mm, respectively; median) than in group NN (1.96mm, P<0.001, both). The percentages of newly formed bone were significantly higher at week 12 than at weeks 4 and 8 in all of the groups. The NCCM showed an earlier angiogenesis pattern than the CCM; however, earlier degradation was observed at week 12. Combining biomaterials with cross-linked collagen might contribute to maintaining its initial morphology with excellent biocompatibility in early healing period of lateral onlay grafts.

Transcrestal Sinus Lift Using Platelet Concentrates in Association to Short Implant Placement: A Retrospective Study of Augmented Bone Height Remodeling.

No evidence has been reported yet about dimensional changes in maxillary sinuses grafted with autologous platelet concentrate. This study aimed to analyze the augmented height alterations around short implants (length ≤ 8.5 mm) placed after transcrestal sinus lift surgery in association with plasma rich in growth factors. A retrospective design was used. Patients with atrophic posterior maxilla were treated by inserting short implants in combination with transalveolar maxillary sinus floor augmentation. Radiographic bone level alterations over time were assessed on panoramic radiographs. Transalveolar sinus augmentation was performed to place 41 implants in 26 patients with a residual bone height of 4.7 ± 1.3 mm. The alveolar bone height was increased by 3.7 ± 1.7 mm and 4.2 ± 2.0 mm after 12 ± 3 months and 35 ± 11 months of surgery, respectively, whereas the apical augmented height (beyond the implant) apex was stable around 34 implants during the follow-up. It was increasing around seven implants that were not covered by the endo-sinus augmented height at the 1-year follow-up. Transalveolar sinus floor augmentation in association with plasma rich in growth factors and short implants resulted in a stable augmented height gain after 3 years follow-up. Atrophic posterior maxilla could be treated by transalveolar sinus lift in association with plasma rich in growth factors and the placement of short implants.

Transcrestal Sinus Lift Procedure Approaching Atrophic Maxillary Ridge: A 60-Month Clinical and Radiological Follow-Up Evaluation.

Aim. The aim of this study was to assess the success and the survival rate of dental implants placed in augmented bone after sinus lifting procedures. Material and Methods. 31 patients were mainly enrolled for a residual upper jaw crest thickness of 3 mm. CBCT scans were performed before and after the augmentation technique and at the follow-up appointments, at 3, 6, 12, 24, and up to 60 months. The follow-up examination included cumulative survival rate of implants, peri-implant marginal bone loss, and the height of sinus floor augmentation. Results. This retrospective study on 31 patients and 45 implants later inserted in a less than 3 mm crest showed excellent survival rates (99.5%), one implant was lost before loading due to an acute infection after 24 days, and two implants did not osteointegrate and were removed after 3 months. The radiological evaluation showed an average bone loss of 0.25 mm (±0.78 mm) at the first follow-up appointment (3 months) up to 0.30 mm (±1.28 mm) after 60-month follow-up. Conclusion. In this study it was reported how even in less than 3 mm thick crest a transcrestal technique can predictably be used with a long-term clinical and radiological outcome, giving patients excellent stability of the grafted material and healthy clinical results.

Mini-lateral windows for minimally invasive maxillary sinus augmentation: case series of a new technique.

The purpose of this article was to introduce a new technique for minimally invasive lateral window sinus augmentation, developed to maximize the amount of residual lateral wall after the procedure. Fourteen consecutive patients requiring maxillary sinus augmentation by a lateral approach and delayed implant placement were treated using standardized mini-lateral windows. Before the procedure, the remaining height of alveolar bone was determined; 6 months after the procedure, the augmented height and augmented width were measured. The extent of the antrostomy was calculated using a gauge and compared with a conventional window size. A total of 15 maxillary sinus augmentation procedures were performed in 14 patients using this technique. Every patient received the planned implant treatment 6 months after the sinus augmentation procedure. The average residual bone height was 2.1 ± 1.1 mm, the average augmented height was 13.4 ± 3.4 mm, and the average augmented width was 19.0 ± 5.5 mm. The average total area of the antrostomy was calculated to be 59.2 ± 12.8 mm. The results of this case series study suggest that this technique allows for the achievement of a similar result as with conventional size windows, but with a significantly smaller total window area.

Maxillary sinus floor augmentation using the transalveolar technique with simultaneous placement of dental implants: a 5-year clinical retrospective study

To evaluate the clinical and radiographic outcomes of placing dental implants in the posterior maxilla using the transalveolar technique. Between January 2005 and December 2009, a total of 94 cases, 55 males and 39 females, aged (46.9 ± 11.8) years, were consecutively enrolled in this study with maxillary sinus floor augmentation using the transalveolar technique. Radiographic evaluations were conducted on panoramic and periapical radiographs at each recall. The follow-up clinical examination included cumulative survival rate(CSR) of implants, peri-implant marginal bone loss (MBL) and the height of sinus floor augmentation and the endo-sinus bone gain (ESBG). Sinus membrane perforation was found in 4 cases.Finally 126 implants (90 cases) were placed. The perforation rate of this surgical procedure was 3.08% (4/130).Four implants lost during the healing time, the early success of implants was 96.80% (121/125). During a mean follow-up time of (34.4 ± 20.4) months, all the implants were successfully in function, with the cumulative survival rate after function loading of 100.00%. The mean MBL was (0.75 ± 0.51) mm during the healing time, and (0.48 ± 0.41) mm during the follow-up period. The mean residual bone height (RBH) was (7.27 ± 1.30) mm at the position of implants placement, the length of implant protruding into the sinus was (2.77 ± 1.15) mm, and the height of sinus floor augmentation was (4.52 ± 1.39) mm. At the loading time, the mean endo-sinus bone gain was (3.81 ± 1.60) mm. After the follow-up time of 34 months, the newly formed bone on the maxillary sinus floor underwent further remodeling with a median bone reduction value of 0.37 (0.10, 0.88) mm. Maxillary sinus floor augmentation using the transalveolar technique is a predictable treatment modality. The augmentation of the maxillary sinus floor using the transalveolar technique could lead to bone formation under the sinus. The newly formed bone showed slight absorbtion in the long term follow-up.

Reimplantation of cultivated human bone cells from the posterior maxilla for sinus floor augmentation. Histological results from a randomized controlled clinical trial

The aim of the present randomized clinical study was to evaluate histologically whether the addition of cultivated, autogenous bone cells to a composite graft of deproteinized bovine bone mineral (DBBM) and autogenous bone (AB) for sinus floor augmentation (SFA) enhance bone formation compared with what achieved after SFA with DBBM + AB alone. Twenty patients with remaining posterior maxillary alveolar crest height of less than 3 mm received SFA after randomization either with an DBBM and AB composite in a 1 : 1 ratio or with DBBM + AB supplemented with autogenous bone cells, which were cultivated from a bone biopsy harvested earlier from the tuberosity area. Four months after SFA, two cylindrical biopsies were taken from the augmented sinuses concomitantly with the implant site preparation by means of a trephine bur. An additional biopsy was taken from the tuberosity area. Bone density at the augmented sinus and the tuberosity area and the height of augmentation were estimated on non-decalcified histological sections prepared from the biopsies. A relative bone density index (RBD) was also calculated by dividing bone density at the augmented sinus with bone density at the tuberosity area. All patients but one could receive two implants after SFA; in one patient, only one implant could be placed. All implants were osseointegrated and could be loaded. Median bone density in the sinus was 30% and 25% in the cell seeded and no-cells added DBBM + AB groups, respectively. Bone augmentation height averaged 6.0 and 5.4 mm and RBD averaged 0.48 and 0.73 in the cell seeded and no-cells added DBBM + AB groups, respectively. None of the differences between groups was statistically significant. Cultivated autogenous bone cell seeded to a DBBM + AB composite did not significantly improve bone formation (density and height) after SFA, compared with what was achieved with DBBM + AB alone. Both approaches resulted into enough bone to support implant placement and osseointegration.

Sinus augmentation using absorbable collagen sponge loaded with Escherichia coli‐expressed recombinant human bone morphogenetic protein 2 in a standardized rabbit sinus model: a radiographic and histologic analysis

The purpose of this pilot study was to determine the osteoinductive effect of absorbable collagen sponge (ACS) loaded with Escherichia coli-expressed recombinant human bone morphogenetic protein 2 (ErhBMP-2) and evaluate structural stability of ACS in a standardized rabbit sinus model. The maxillary sinuses were prepared bilaterally in six male white rabbits. The windows were prepared using a 6 mm trephine bur, and circular bony windows were carefully removed. Following reflection of the sinus membrane, a saline-soaked ACS alone and an ErhBMP-2-loaded ACS were inserted into the left and right maxillary sinuses, respectively. After a healing period of 8 weeks, sections of the augmented sinus and surrounding bone were made and analyzed by microcomputed tomography and histologically for signs of window closure and bone augmentation. Radiographic analysis revealed new bone formation in both groups of augmented sinus (i.e., with and without ErhBMP-2). The maximum augmented height did not differ significantly between the groups; however, window closure was significantly more advanced in the ErhBMP-2 group than in the control group (P=0.02). The defect was significantly deeper in the control group than in the ErhBMP-2-treated group (P=0.02). In conclusion, ErhBMP-2-loaded ACS showed enhanced osteoinductive potential, particularly with regard to bone closure of a sinus window and facilitated maturation of the newly formed bone within the rabbit sinus cavity. However, the structural durability of ACS was not sufficient to maintain the augmented volume in the sinus.

Efficacy of Platelet Rich Plasma in Sinus Lift Augmentation

The present study aims to evaluate and analyze the efficacy of Platelet Rich Plasma (PRP) with hydroxyapatite crystals for maxillary sinus augmentation procedures. A comparative study of 10 patients with a mean average age of 35years with less than 5mm of residual alveolar bone was conducted. Six patients underwent Lateral sinus lift procedure with allografts (platelet rich plasma and hydroxyappatite crystals) and four patients underwent the same procedure but with autografts (symphyseal). Follow-up for a period of 3years was done. The patients were assessed for postoperative pain, sinusitis, oro-antral communication, epistaxis, graft rejection, infection and potential loss of bone and teeth. During the 3years period of follow-up there were no complications recorded. A mean post-operative augmented height of 15mm was achieved in all the patients. Maxillary sinus lift procedure using a mixture of hydroxyapatite crystals and platelet rich plasma was found to be very effective in increasing the height of residual alveolar bone when compared to the use of autografts alone.

Prospective Study Confirms Oxandrolone-Associated Improvement in Height in Growth Hormone-Treated Adolescent Girls with Turner Syndrome

Background/Aims: Untreated girls with Turner syndrome (TS) have growth failure, and adult height is, on average, 20 cm less than predicted height. Treatment with growth hormone (GH) is now standard of care. The objective of this study was to investigate the benefit of adding oxandrolone (Ox) to GH in a long-term, randomized, placebo (Pl)-controlled prospective trial to near adult height in TS. Methods: Prospective, randomized, Pl-controlled study: 76 girls with TS (ages 10–14.9 years) were randomized to receive Ox (0.06 mg/kg/day) or Pl in combination with GH (0.35 mg/kg/week, daily) over 2 years. Auxologic data, breast and pubic hair Tanner stages, and hormone and lipid levels were measured. Subjects who chose to continue were followed in a 2-year double-blind extension, also received estrogen therapy (years 3, 4), and had dual-energy X-ray absorptiometry evaluation of bone density (years 3, 4). Results: At year 4, the change in absolute height and height SDS was greater in the GH/Ox versus GH/Pl group [26.2 ± 6.7 vs. 22.2 ± 5.1 cm, analysis of covariance (ANCOVA) p < 0.001; 1.8 ± 0.9 vs. 1.2 ± 0.7 standard deviation scores, ANCOVA p < 0.001]. Bone mineral density (BMD) of the wrist (0.51 ± 0.17 vs. 0.54 ± 0.05 g/cm²) and spine (0.91 ± 0.34 vs. 0.96 ± 0.13 g/cm²) in the GH/Ox versus GH/Pl groups was similar after 4 years. Breast development was slower in the GH/Ox versus GH/Pl group [year 4: Tanner stage 2.9 ±1.3 (Ox) vs. 4.1 ± 1.3 (Pl), p = 0.003], and menarche was approximately 1 year later. Conclusions: The addition of Ox to GH at mean age 12.0 ± 1.7 year augmented height gain after 4 years of treatment, slowed breast development and did not affect BMD in girls with TS. Whether initiation of Ox prior to initiation of pubertal development would optimize height gain without impeding breast development will require further study.

Maxillary sinus floor elevation using a tissue‐engineered bone complex with OsteoBone™ and bMSCs in rabbits

To evaluate the effects of maxillary sinus floor elevation by a tissue-engineered bone complex with OsteoBone(trade mark) and bone marrow stromal cells (bMSCs) in rabbits. Autologous bMSCs from adult New Zealand rabbits were cultured and combined with OsteoBone(trade mark) at a concentration of 20 x 10(6) cells/ml in vitro. Twenty-four animals were used and randomly allocated into groups. For each time point, 16 maxillary sinus floor elevation surgeries were made bilaterally in eight animals and randomly repaired by bMSCs/material (i.e. OsteoBone), material, autogenous bone and blood clot (n=4 per group). A polychrome sequential fluorescent labeling was also performed post-operatively. The animals were sacrificed 2, 4 and 8 weeks after the procedure and evaluated histologically as well as histomorphometrically. New bone area significantly decreased from weeks 2 to 8 in the blood clot group, while bone area in the autologous bone reduced from weeks 4 to 8. In both groups, a significant amount of fatty tissue appeared at week 8. Accordingly, augmented height in both groups was also significantly decreased from weeks 2 to 8. The bone area in the material-alone group as well as in the bMSCs/material group, on the other hand, increased over time. Significantly more newly formed bone area and mineralization was observed in the center of the raised space in the bMSCs/material group than in the material-alone group. The augmented height was maintained in these two groups throughout the course of this study. These results suggest that OsteoBone can successfully be used as a bone graft substitute and that the combination of this material with bMSCs can effectively promote new bone formation in sinus elevation.

The variability of prosthesis positioning and the resulting geometry of coxo-femoral joint

This work is focused on femoral prosthesis positioning inside bone and its consequences on stress distribution. Five synthetic femurs were employed: one femur was left unimplanted (NF), four femurs were implanted with two different prostheses (PF, A or B models); all implants were performed with specific instruments, by orthopaedic surgeons who usually perform that surgery. The CAD models of all femura were obtained from CT scans; a reference system was defined in NF in order to compare joint geometry between NF and PE The following parameters were considered: femur height, head offset, angle between femur axis and prosthesis shaft axis, angle between neck axis and femur axis. Each one has functional consequences: impaired art length produces discomfort and unbalanced muscle forces, a wrong offset determines a congruent variation in stress moduli; prosthesis orientation substantially modifies stress pattern inside bone. The differences between joint geometry in NF and PF and between two femurs implanted with the same prosthesis have been found to be significant. For example, depending on prosthesis models, an augmented height (up to 3.4mm) or a reduced height (up to 22.0mm) were observed, with respect to NF. Head offset differed of about 3.0mm between NF and PF; the angle between prosthesis shaft axis and femur axis reached about 4.30 (model A), or 7.00 (model B). These results suggest that orthopaedic implant design cannot be performed in a deterministic manner only, but also the variability due to manual and sensorial abilities of surgeons must be taken into account.

Sinus floor elevation applied tissue‐engineered bone

In the present study, we compared bone regeneration ability in sinus floor elevation between a tissue engineering method using mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP), and a promising new method using particulate cancellous bone and marrow (PCBM) and PRP. Bilateral sinus floor elevation procedures were performed in 18 adult Japanese white rabbits. MSCs/PRP or PCBM/PRP complexes were grafted to each maxillary sinus in the same rabbits. The MSCs were isolated from rabbit iliac crest marrow, and PRP was obtained from peripheral blood. PCBM were collected from the rabbit iliac crest and mixed with PRP. The animals were sacrificed at 2, 4, and 8 weeks after transplantation, and the bone formation ability of each implant was evaluated histologically and histometrically. According to the histological observations, both sites (MSCs/PRP and PCBM/PRP) showed well newly formed bone and neovascularization at 2 and 4 weeks. However, at 8 weeks, the lamellar bone was observed to be occupied by fatty marrow in large areas in both sites. There was no significant difference in bone volume or augmented height between MSCs/PRP and PCBM/PRP groups each week, but there were significant differences in bone volume and augmented height between 2 and 8 weeks in PCBM/PRP or MSCs/PRP groups and in bone volume between 4 and 8 weeks in the PCBM/PRP group (P<0.05). These results suggest that the MSCs/PRP complex may well be used for bone regeneration in sinus floor elevation, compared with the PCBM/PRP complex.