Autogenous Graft Research Articles

Rib and Sternum Nonunions: Diagnosis and Treatment and Awareness of Other Potential Posttraumatic Pathology

Summary: As the operative management of acute, chest wall, skeletal injury escalates throughout the world, it has become commonplace for patients with posttraumatic conditions to present with clinical reconstructive challenges as well. In addition, it is becoming clear that rib nonunions are not rare, likely more than 5% of rib fractures. No subspecialty is better equipped to address such painful conditions than orthopaedic surgery. Likewise, there are a plethora of other posttraumatic problems that patients face, from intercostal neuralgia, pleural herniation, rib synostosis, and costal margin and sternal injuries that do not heal properly, which require treatment solutions. This emerging new field of surgery is optimized by an interdisciplinary approach, between general and orthopaedic trauma surgeons, and between thoracic, anesthesia, and rehabilitation specialists. This article emphasizes the workup and operative treatment of painful rib and sternal nonunions, in particular, and familiarizes the orthopaedist with other cold skeletal trauma in general. From the distinctive history and physical examination of the patient with a rib psuedoarthrosis to proper diagnostic studies, the surgeon is led through a principled approach to nonunion surgery, inclusive of autogenous graft harvest to provide both biologic and mechanical variables to bear in the successful treatment of this condition.

Effectiveness of amine plasma-functionalized 3D PLGA scaffolds immobilized with Fibroblast Growth Factor in periodontal tissue regeneration

Polylactic-co-glycolic acid (PLGA) has widely been used as a biodegradable material for three-dimensional (3D) printed scaffolds. However, the lack of surface chemicals and poor wettability limit the application of the polymer. Therefore, we modified the 3D scaffold surface using plasma surface modifications and evaluated its biocompatibility. To introduce amine functional groups on the 3D PLGA scaffold surface, amine plasma-polymerization was performed using 1, 2-diaminocyclohexane (DACH) monomers. Then, Fibroblast Growth Factor (FGF) was immobilized on the amine-functionalized 3D PLGA scaffold surface using a 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide and N-hydroxysuccinimide. Human Gingival Fibroblast (HGF-1) cell behaviors were evaluated through cell adhesion, migration, proliferation, and western blot. The results showed that DACH plasma-polymerization provided the amine-functionalized surface which is capable of immobilizing FGF bioactive molecules on the 3D PLGA scaffold. Cell adhesion, proliferation, and migration on plasma surface-modified scaffolds have greatly improved compared to pristine 3D PLGA scaffolds. Notably, FGF-immobilized groups demonstrated the highest proliferation. These results suggest that the FGF-immobilized scaffold surface had a significant effect on accelerating oral gingival cell proliferation. In the future, 3D PLGA scaffolds with surface functionalized by plasma-polymerization and biomolecule immobilization can be used as a good alternative to autogenous soft tissue grafts for damaged soft tissue restoration.

Exploring the Role of Soft Tissue Management in Implant Prosthodontics

Implant prosthodontics has transformed dental rehabilitation by providing reliable solutions for missing teeth, emphasizing the crucial role of soft tissue management in achieving both functional and aesthetic outcomes. The peri-implant mucosa, formed during the healing process, acts as a biological seal, essential for maintaining implant health and preventing bacterial infiltration. This review highlights the significance of soft tissue management, including techniques like autogenous gingival grafts and digital tools, and discusses innovative approaches such as one-step peri-implant emergence profiles. Key challenges include managing complications like peri-implantitis and peri-implant mucositis, which are often linked to bacterial infections and plaque accumulation. Effective management strategies involve meticulous oral hygiene, mechanical debridement with non-metal tools, and advanced treatments for severe cases, such as flap surgeries and regenerative techniques. The review underscores the importance of patient selection, radiographic evaluation, and the biological principles of soft tissue healing around implants. Ongoing research and clinical trials are crucial for optimizing these approaches and achieving superior results in implant therapy.

Selecting Root Coverage Techniques for Autogenous Soft Tissue Grafts at Isolated and Multiple-Adjacent Mandibular Anterior Recession Defects

It is widely acknowledged that multiple anatomic and technical factors hinder successful root coverage in the mandibular anterior region. Nevertheless, the contemporary periodontal plastic surgeon is presented with a panoply of options when deciding upon the most appropriate technique to apply in a particular clinical scenario. Although many techniques are applicable at a variety of defect types, several are particularly well suited for specific situations commonly encountered in the mandibular anterior. The purpose of this report is to describe rationale for preferred autogenous soft tissue grafting techniques at isolated mandibular incisor sites, isolated mandibular canine sites, and multiple-adjacent recession defects in the mandibular anterior. Four cases are presented to exemplify the recommended procedures.

Autogenous soft tissue grafting in aesthetic peri-implant surgical reconstruction

Introduction. Autogenous soft tissue grafting in aesthetic peri-implant surgical reconstruction is an effective technique for augmenting the tissues surrounding dental implants, contributing to their longterm success. This method involves harvesting soft tissue from the patient and placing it around the implant to enhance peri-implant thickness, stability, and aesthetics. Objective of the study. The study aims to evaluate the effectiveness of autogenous soft tissue grafting in peri-implant augmentation compared to other techniques and identify the factors contributing to the procedure’s success. Material and methods. The analysis was based on scientific articles published in the last five years, selected from PubMed, Scopus, and Cochrane Library. Randomized clinical trials, systematic reviews, and cohort studies comparing autogenous grafting with other methods were included. Studies with fewer than 10 patients were excluded. A total of 1,150 articles were identified, of which 20 were included in the analysis. Results. The reviewed studies demonstrated that autogenous grafting improves soft tissue thickness and reduces the incidence of gingival recession compared to other augmentation techniques. Most studies reported a significant increase in soft tissue stability following this procedure. Conclusions. Autogenous soft tissue grafting is a gold standard method for aesthetic peri-implant reconstruction, showing superior effectiveness in improving soft tissue stability and aesthetics. The success of the intervention depends on appropriate patient selection and the application of rigorous surgical techniques. The integration of adjunctive biological agents and minimally invasive techniques can further enhance the efficiency and predictability of long-term outcomes.

Total Temporomandibular Joint Replacement by Samsid Customized Joint Prosthesis: A Case Report with 16 Years of Follow-Up

AbstractTotal temporomandibular joint replacement (TMJR) is a surgical intervention employed for the management of advanced temporomandibular joint (TMJ) disorders, particularly when autogenous grafts are not recommended. With stainless steel implant of glenoid fossa attempted for the correction of ankylosis in the 1960s, total TMJR—which minimizes foreign body reaction and consists of highly biocompatible materials such as Cr-Co-Mo alloy, titanium, and ultra-high-molecular-weight polyethylene—began to be applied. These alloplastic prostheses are available in both standardized and customized forms, comprising components for the mandibular condyle and glenoid fossa. The present case report presents India's first TMJR in a 12-year-old female patient with TMJ ankylosis. Total TMJR was done in her with India's first customized TMJ prosthesis (Samsid TMJ prosthesis), which was designed and manufactured by the author for the first time in India. This study presents a 16-year follow-up of customized TMJR, addressing TMJ ankylosis. Our research showcases the long-term success of Samsid TMJ prostheses in improving pain, oral function, diet, and overall quality of life. The case report also highlights the potential of Samsid TMJ prostheses as a valuable solution for TMJ patients, emphasizing the importance of tailored solutions for lasting joint function restoration. The results presented indicate that the Samsid patient-fitted total TMJR system remains a secure, efficient, and dependable long-term treatment option for the particular patient demographic examined in this research.

Comparison of a full tibial tunnel or an all-inside technique for anterior cruciate ligament reconstruction: An observational study.

This study aims to compare the effectiveness of anterior cruciate ligament (ACL) reconstruction performed with either a full tibial tunnel technique or an all-inside technique. Data from patients with ACL rupture who underwent ACL reconstruction using autogenous hamstring tendon grafts between January 2019 and July 2021 were retrospectively reviewed. Patients were followed up for a minimum of 24 months. Preoperative and postoperative International Knee Documentation Committee scores, Lysholm knee scores, visual analog scale pain scores, Tegner activity scale scores, C-reactive protein levels, erythrocyte sedimentation rate, white blood cell (WBC) count, D-dimer levels, and neutrophils were recorded. At the final follow-up, side-to-side differences were assessed with the pivot shift test, Lachman test, anterior drawer test, and a knee laxity-testing device. This study included 135 patients with ACL rupture, with 62 patients (43 males and 19 females, mean age: 34.42 ± 12.79 years) undergoing the full tibial tunnel technique, and 73 patients (58 males and 15 females, mean age: 32.41 ± 11.01 years) undergoing the all-inside techniques (AITs). There were no significant differences in postoperative International Knee Documentation Committee scores, Lysholm knee scores, or Tegner activity scale scores, except at postoperative 6 months. visual analog scale pain scores showed significant improvement in patients that underwent the AIT compared to the full tibial tunnel technique at postoperative 1 week, 2 weeks, and 1 month; however, there were no significant differences at postoperative 3, 6, 12, 18, and 24 months. C-reactive protein levels, erythrocyte sedimentation rate, WBC count, D-dimer levels, and neutrophils were significantly lower in patients that underwent the AIT compared to the full tibial tunnel technique at postoperative 1 month, but there were no other significant differences in these outcome measures, except for WBC count at postoperative 3 months. There was no significant difference in knee stability at the last follow-up. In ACL reconstruction, functional outcomes following the AIT are satisfactory and similar to the total tibial tunnel technique, but patients experience less pain and a reduced early postoperative inflammatory response. These results highlight the promising potential of AITs in the clinical management of ACL rupture and advocate for their widespread adoption.

Effect of hyaluronic acid on palatal wound healing: A systematic review.

To evaluate the efficacy of topically applied hyaluronic acid on wound healing (patient-reported outcomes and clinical healing) after a palatal autogenous gingival graft is harvested. A systematic search was performed in April 2024 in eleven electronic databases. Two investigators independently screened the references for inclusion. Outcomes of interest included postoperative pain, analgesic consumption, complete epithelialization, and color match, which were synthesized using narrative synthesis. A total of 535 results were identified and eight articles were included in the systematic review. Hyaluronic acid use on the palatal donor site had a better response to healing and wound size compared to the control sites with no agent applied. Hyaluronic acid demonstrated a positive effect in the form of complete epithelialization, and color match, with improved patient-reported outcomes such as post-operative pain. Within the limitations of this systematic review, it can be concluded that hyaluronic acid shows a strong potential to improve patient-reported outcomes and clinical wound healing at the graft donor site on the palate. Future studies are required to clarify the optimal concentration, frequency of application, and synergistic effect when HA is combined with other interventions. Within the limitations of this systematic review, it can be concluded that hyaluronic acid shows a strong potential to improve patient-reported outcomes and clinical wound healing at the graft donor site on the palate. Future studies are required to clarify the optimal concentration, frequency of application, and synergistic effect when HA is combined with other interventions.

Dentin Grafts: Navigating the Paradigm Shift in Regenerative Dentistry.

The biomaterial of dentin has emerged as a promising candidate for the tissue engineering of dental hard tissues. In bone tissue engineering, it may serve as either a scaffold or a reservoir of growth factors. The physical and chemical similarities between the dentin structure and bone have sparked scientific interest in using its features for the development of a new bone transplant material. Dentin, unlike hard and fragile enamel, is viscoelastic, making it a very effective bone replacement. The regeneration of pulp tissue has proven challenging due to its encasement in dentin, which lacks collateral blood flow except from the apical end of the root. Yet, the emergence of contemporary tissue engineering and the identification of dental stem cells have enabled experimentation with the regeneration of both pulp and dentin. This review will explain the different types of dentin grafts, their biocompatibility, safety, and effectiveness, along with difficulties. Additionally, the paper covers several strategies for creating autogenous dentin grafts and gives evidence-based insights into their clinical effectiveness. Overall, dentin grafts appear as a potential alternative to standard graft materials, stimulating tissue regeneration and enhancing patient outcomes in regenerative dentistry operations.

Comparison of Khoury's Bone Shell Technique vs Titanium-reinforced Polytetrafluoroethylene Membrane for 3D-bone Augmentation in Atrophic Posterior Mandible: A Randomized Clinical Trial.

This study was designed to compare between the use of Khoury's bone shell technique vs titanium-reinforced PTFE membrane for 3D-ridge augmentation of atrophic posterior mandible. Sixteen patients were equally and randomly assigned to either the Khoury or PTFE group. In Khoury group, a mandibular bone block was harvested, split and then fixed to augment the mandibular defect using osteosynthesis screws. In PTFE group, augmentation was achieved using Titanium-reinforced PTFE membranes fixed with bone tacks/screws. A mixture of autogenous and xenogenic graft material at a 1:1 ratio was used in both groups. Vertical and horizontal bone gain were obtained using cone-beam computed tomography (CBCT). Preoperative dimensions were compared with the final dimensions obtained 6 months postoperatively. No significant complications or neurosensory dysfunction were encountered. A solitary patient in the Khoury group experienced limited wound dehiscence, which was treated conservatively. For both groups, there were no significant differences between preoperative and postoperative vertical (p = 0.849 and 0.569) and horizontal (p = 0.778 and 0.367) dimensions. No significant differences exist between the augmentation dimension which can be obtained using either Khoury of Ti-PTFE membranes. Both approaches are delicate and necessitate surgical expertise and experience. Both techniques can be used to achieve predictable augmentation results with a low rate of complications. How to cite this article: Shaker AES, Salem AS, El-Farag SAA, et al. Comparison of Khoury's Bone Shell Technique vs Titanium-reinforced Polytetrafluoroethylene Membrane for 3D-bone Augmentation in Atrophic Posterior Mandible: A Randomized Clinical Trial. J Contemp Dent Pract 2024;25(6):518-526.

Effect of suturing in root coverage via coronally advanced flaps: A systematic review.

To analyze the evidence about the influence of the suturing technique and material in terms of the percentage of mean root coverage (%MRC) following root coverage therapy in teeth diagnosed with single/localized gingival recession defects (GRD) via a monolaminar coronally advanced flap. The protocol of this systematic review was registered in PROSPERO (CRD42024514043). A literature search was conducted to identify investigations that fulfilled the eligibility criteria. Variables of interest were extracted, subsequently categorized, and qualitatively analyzed. A total of 15 randomized clinical trials, including 301 localized GRD in non-molar sites classified as Miller class I-II/RT1, in 253 patients were included. The studies reporting the combination of sling and single interrupted sutures, or interrupted sutures alone showed an MRC of 70.2%±16.6%, and 74.1%±0.75%, respectively. The highest MRC was observed in the studies using polyglactin 910 with a pooled value of 76.6% ± 15.3%, and monofilament materials, with a pooled MRC of 74.8%±7.1%. When the suturing diameter was evaluated, the highest pooled MRC with values of 79.1%±9.8% was observed with the use of 5-0. For the treatment of single/localized GRD in non-molar sites via a monolaminar coronally advanced flap, the use of a combination of sling and single interrupted sutures, or single interrupted sutures, polyglactin 910 or monofilament materials, and material diameter of 5-0 showed a higher MRC as compared to the use of expanded polytetrafluoroethylene, and silk with/without dressing, and other suture diameters. There were no differences in the percentage of root coverage achieved between the use of sling and single interrupted, versus single interrupted sutures alone on the treatment of single/localized GRD in non-molar sites. Polyglactin 910 and monofilament sutures resulted in a higher percentage of root coverage achieved as compared to expanded polytetrafluoroethylene, and silk with/without dressing. The use of 5-0 material diameter showed the highest percentage of root coverage achieved. This study was primarily aimed at evaluating how different suturing techniques and materials could affect the percentage of root coverage in single/localized recession defects, without the use of soft tissue substitutes or autogenous soft tissue grafts. After the pooled analyses of 15 randomized clinical trials that fulfilled the inclusion criteria, we observed that the adequate selection of suturing techniques, materials, and size could lead to a higher percentage of root coverage. Specifically, the use of single interrupted with or without sling sutures at the most coronal portion, Polyglactin 910 or monofilament materials, and size of 5-0 showed a higher percentage of root coverage as compared to the use of expanded polytetrafluoroethylene, and silk with/without dressing, and other suture diameters.

Advancing Periodontal Care: Development of a Novel Collagen-Chitosan-Bioglass Scaffold as a Substitute for Autologous Soft Tissue Grafts.

Introduction Modern dentistry prioritizes aesthetic outcomes, making root coverage for gingival recession a key focus. Various approaches, including autologous grafts, address this issue, yet no substitute matches the properties of autogenous connective tissue grafts. The innovative collagen-chitosan-bioglass scaffold presents a promising solution, surpassing the limitations of the traditional methods. This scaffold blends the advantages of collagen with chitosan's antibacterial and regenerative properties, enhanced by bioglass, which promotes tissue healing through angiogenesis. It was evaluated for its physicochemical characteristics, as well as antioxidativeand anti-inflammatory properties, making it a promising solution for soft tissue management in dentistry. Materials and methods Chitosan, collagen, and bioglass were combined into a scaffold through the lyophilization process (freeze-drying). Chitosan was sourced from shrimp, collagen from bovine, and the bioglass 1% comprised 58% tetra-ethyl ortho silicate, 33% calcium silicate, and phosphorous pentoxide. After the scaffold was created, it was subjected to physicochemical characterization via scanning electron microscopic and infrared spectroscopic analysis. Its anti-inflammatory and antioxidantproperties were evaluated using DPPH (2,2-diphenyl -1-picrylhydrazyl) assay and by measuring the scaffold's radical scavenging activity. Results This study employed infrared spectroscopy and scanning electron microscopy techniques to analyze the sample components and their morphology. The infrared (attenuated total reflection) analysis revealed various elements confirming the presence of all the biomaterials required to fabricate the scaffold. Scanning electron microscope imaging displayed a folded-like morphology with a porous structure. The protein denaturation inhibition increased from 25% at 50 μg of scaffold weight to 45% at 200 μg of scaffold weight. Similarly, the antioxidant activity increased, with values rising from 23% at 50μg to 35% at 200μg of scaffold weight. Conclusion The fabricatedcollagen-chitosan-bioglass scaffolddemonstrates promising antioxidant andanti-inflammatory properties. These findings suggest that this scaffold holds significant potential as a viable substitute for soft tissue augmentation.

PRESERVATION OF DISTAL BONE DEFECT AFTER SURGICAL EXTRACTION OF IMPACTED THIRD MOLAR

Extracted teeth are still considered a clinical waste and therefore being discarded. It is evident that obtained and prepared autogenous dentin graft (ADG) may be used for guided bone regeneration (GBR) because of similar biochemical characteristics to human bone. Aim: To present a novel procedure in a clinical setting that employs freshly extracted teeth that are processed into a bacteria-free particulate dentin, and then grafted immediately into extraction sites or bone deffects. Monitoring the clinical and radiological parameters in the postextraction defects of the alveolar ridges for a period of 6 months, proving the rapid healing capacity of ADG on the bonе and soft tissue structures in the jaw bones. Methods: Clinical measurements were performed using a questionnaire for monitoring the postoperative clinical manifestation, bone measuring calipers and for measuring the horizontal changes of the alveolar ridge and a graduated probe for measuring vertical dimensional changes, also paraclinical-radiological examinations to follow-up bone density. Results: During the follow period of six months, clinical measurements of post-extraction dimensional changes of the alveolar ridges shows minimal horizontal and vertical bone resorption with preserved alveolar ridge volume, with an accelerated bone regenerative process without special postoperative complications. Conclusion: Dentin particulate grafted immediately after extractions should be considered as the gold standard due to its osteogenetic, osteoinductive and osteoconductive effects on bone tissue regeneration.

The Use of Autogenous Rib Graft in Craniofacial Reconstruction: Case Series Study

Background: Hard tissue defects in the maxillofacial region due to trauma or ablative surgery result in functional and cosmetic problems. The method of choice in the treatment of facial defects is autogenous bone grafts. Objectives: To evaluate the use of rib grafts in the reconstruction of craniofacial deformities. Methods: This prospective study was presented for the reconstruction of craniofacial deformity using a rib bone graft. These cases were collected from the Maxillofacial Surgery Unit from October 2011 to November 2020. The sample consisted of 16 patients (14 males and 2 females, with a mean age of 34 years). The patients were divided according to the site of the defect. In all cases, a single rib was harvested. The fifth rib was taken. Bone graft fixation by bone plate, direct screws, and transosseous wiring. The success of the bone grafting was assessed by clinical and radiological examination. Results: The overall success rate in this study was 87.5%, while we had bone graft resorption in two cases (12.5%) of mandibular reconstruction. Only one case experienced donor site complications, a pleural tear, which successfully underwent suturing and chest tube insertion. Conclusions: Free autogenous rib was successfully used to reconstruct defects in the maxillofacial regions. It gives the best result when minimum loading is needed. Stabilization of the graft by rigid internal fixation and good adaptation to the recipient site helped to minimize complications.

Outcomes of Xenograft with Platelet-rich Fibrin versus Autogenous Bone in Alveolar Cleft Grafting.

The use of a suitable graft material helps with sufficient osseointegration. The aim of this study was to compare the clinical and radiographic outcomes of two types of alveolar bone graft materials, xenografts with platelet-rich fibrin (PRF) and autogenous grafts, in patients with alveolar clefts. Thirty-six patients with alveolar clefts were enrolled in this study. Those patients were randomly divided into two groups: group A, where the autogenous iliac bone graft was used to fill the alveolar defect, and group B, where the xenograft with PRF was used to fill the alveolar defect. After 6 months of grafting, patients were assessed in terms of pain, duration of hospital stay, and donor site morbidity associated with iliac crest harvesting, while bone formation was evaluated radiographically using cone beam computed tomography. The results showed no statistical differences as regards baseline and perioperative data. Operative duration was significantly lower among xenograft with PRF patients. Both groups had comparable postoperative success scores, and total failure was reported in a total of three patients (one patient in group A and two patients in group B). With no potential donor site morbidities, xenograft with PRF is an equivalent bone transplant replacement to the autologous iliac bone graft. Additionally, it is associated with a significant success rate, and a significant decrease in operative time and hospital stay. Many future studies are warranted to draw firm conclusions.

"Xenogeneic Bone Block in Lateral Ridge Augmentation: Where Are We Now?' A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis aimed to investigate the clinical outcomes of xenogeneic bone blocks (XBB) used for lateral ridge augmentation, specifically focusing on bone gain, graft survival, and implant survival. Data search was conducted in Pubmed, Embase, and ClinicalTrial.gov for randomized controlled trials (RCTs), and prospective cohort studies up to March 1, 2024. Horizontal bone gain (HBG), horizontal bone resorption (HBR), graft survival rate, and implant survival rate were analyzed. Cochrane Risk of Bias Tool 2 and Newcastle-Ottawa Scale were applied to assess the quality and risks of the included studies. Four RCTs and five prospective cohortstudies, comprised 120 graft sites and 141 implants in total were included for the meta- analysis. Non-comparative analysis resulted in a weighted mean horizontal bone gain (HBG) of 4.38 mm and horizontal bone resorption (HBR) of 0.85 mm. Comparative analysis with data from 4 RCTs that paired xenogeneic bone block (XBB) with autogenous bone block (ABB) exhibited a statistically significant greater HBG in XBB, with a mean difference of 0.72mm (95% CI=0.067 to 1.382, p=0.031, I2=28.2%). The weighted graft survival rate for XBB was 91.3% (95% CI = 76.6% to 97.1%, I2 = 58.0 %), and the weighted implant survival rate was 84.3% (95% CI = 72.6% to 91.6%, I2 = 31.6 %). Histologically, mean percentage of mineralized vital bone in XBB ranged from 11.6% to 29.8%, and the resorption rate ranged from 7.3% to 21%. The utilization of xenogeneic bone block for lateral ridge augmentation demonstrates an acceptable survival rate and yields an adequate volume of bone for subsequent implant therapy. Nonetheless, the survival rate of implants placed in ridges augmented with xenogeneic blocks is less favorable when compared to those augmented with autogenous block grafts.

ENDOVASCULAR ANGIOPLASTY FOR REPEATED REVASCULARIZATION OF THE ARTERIAL BED IN PATIENTS WITH RECURRENT CHRONIC ARTERIAL INSUFFICIENCY

Aim. To improve the results of repeated reconstruction of the great vessels in case of relapse of chronic arterial insufficiency by differentiated use of popliteal tibial autovenous bypass grafting and endovascular angioplasty for revascularization of the arteries of the leg. Materials and methods. The long-term results of surgical treatment of 522 patients were examined, including 353 patients with bilateral atherosclerotic occlusion of the aortic-femoral zone and 159 patients with unilateral occlusion of the ileo-femoral segment. At the primary surgical intervention, 98 patients were diagnosed with chronic arterial insufficiency (CAI) of stage II B, in 228 – CAI of stage III, in 196 – chronic critical ischemia of the lower extremities, stage III – IV. In the long-term postoperative period, 146 (27.97 %) late complications were diagnosed, of which 78 (56.1 %) had a relapse of chronic arterial insufficiency. In 36 patients, CAI stage II B was established, and in 42 – CAI stage III. Patients were re-operated in the period of 5.4 ± 1.9 years after primary revascularization. All men were 64.4 ± 3.1 years old. Results. The multilevel atherosclerotic lesions of the reconstructed arterial bed, cicatricial changes after the initial surgical intervention, progressive atherosclerotic lesions of the outflow tract required multi-story shunting operations. The success of shunting surgery depends on sufficient revascularization of the outflow paths – the arterial bed of the ankle segment. Revascularization of the distal arterial bed was achieved using popliteal-tibial autovenous bypass grafting (19 cases) and endovascular angioplasty (30 observations). To reduce peripheral vascular resistance and increase the volume of the peripheral vascular bed in 19 (63.3%) cases, endovascular balloon angioplasty of two tibial arteries was performed simultaneously. The postoperative period in 10 (12.8%) patients was complicated by the development of thrombosis of the reconstruction segment. In 7 cases, thrombosis of the reconstruction segment was eliminated. The using of popliteal-tibial autogenous bypass grafting and endovascular angioplasty during revascularization of the ankle segment provided satisfactory results in repeated reconstructive operations in 87.2 % of cases. Conclusions. For the revascularization of the lower leg arteries, the use of popliteal autovenous shunting and endovascular angioplasty provides 87.2% satisfactory results in repeated reconstructive operations for chronic arterial insufficiency relapse.

Biomechanical Evaluation of the Osseointegration Levels of Implants Placed Simultaneously With Tibia, Femur, and Jaw Allogeneic Bone Grafts.

In implant-supported prosthetic treatments, the jaw bones may not always have enough bone to accommodate implants. Allogeneic grafts can also be preferred as an alternative to autogenous grafts in cases of vertical and horizontal bone deficiencies. The aim of this study is to evaluate the osseointegration levels of lathe-faced titanium implants placed together with allogeneic bone tissue transplants obtained from tibia, femur, and mandible bones using a biomechanical method. Twenty-eight female Sprague Dawley rats were included in the study. The subjects were divided into groups where bone transplantations were performed together with implant placement from the tibia (n=7), femur (n=7), and lower jaw (n=7) regions. Four rats (left and right) were used as donors. Grafts, along with implants, were surgically placed in the corticocancellous part of the metaphyseal parts of the tibia bones of rats. At the end of the 2-week experimental setup, all rats were killed, and the implants and surrounding bone tissues were subjected to biomechanical reverse torque analysis (N/cm), no statistical difference was detected in terms of bone-implant fusion between the groups in which the femur and tibia bones were transplanted (P>0.05), while the bone-implant fusion value in the group in which the lower jaw bone was transplanted was found to be statistically higher than the femur and tibia bones (P<0.05). Based on the limited results of this study, it can be thought that the lower jaw allogeneic jawbone has a higher osseointegration potential than allogeneic grafts obtained from the femur and tibia.

Maxillary Sinus Augmentation with Autogenous Tooth Grafting Material: A Systematic Review.

The aim of this systematic review was to determine whether autogenous tooth grafting material (ATGM) is as safe and effective as other bone substitutes used for maxillary sinus augmentation procedures, evaluating histomorphometric and/or histological data, implant primary stability, associated complications and radiographic bone height measurements. An automated electronic search was conducted using four databases (Medline/PubMed, Scopus, Web of Science and Cochrane Library), supplemented by a manual search, to identify clinical human studies using particulate ATGM for the aforementioned procedure. The included studies had a sample size of at least four patients and were published before 31st July 2024. The Newcastle-Ottawa scale (NOS) and Joanna Briggs Institute (JBI) Critical Appraisal Checklist were used to assess the risk of bias in cohort studies and case series, respectively. Seven studies were included in the descriptive analysis, obtaining 128 participants (46.8% only treated with ATGM) and 192 placed implants. Due to the heterogeneity of the studies, meta-analysis could not be performed. The authors concluded that ATGM appears to be a feasible and safe alternative for maxillary sinus augmentation procedures. These results should be interpreted with caution due to the limited amount of scientific evidence on this topic and the heterogeneity between the included studies.

Reconstructing Quadriceps Tendon Disruptions in Post Total Knee Arthroplasty Patients with an Autogenous Peroneal Tendon Graft: A Viable Alternative.

Quadriceps tendon disruption post-total knee arthroplasty (TKA) is rare. Existing reconstruction procedures use allografts or synthetic meshes with varied success. This study evaluates outcomes with autogenous peroneal tendon grafts, a cost-effective alternative, compared to synthetic polypropylene mesh for quadriceps reconstruction. 16 patients who underwent extensor mechanism reconstruction between 2017 and 2021were retrospectively analysed. Parameters evaluated included type of reconstruction, extensor lag, IKDC (International Knee Documentation Committee) Score and AOFAS-Hindfoot-score (American Orthopaedic Foot and Ankle Society). At final follow-up, extensor lag for peroneal autograft group was 6.6° ± 1.5 and for synthetic polypropylene mesh group, 7.2° ± 0.7. Both groups improved in IKDC score (p < 0.01) AOFAS-Hindfoot-score was comparable for peroneal autograft patients with opposite side (p = 0.15). Autogenous peroneal tendon graft for quadriceps reconstruction could be viable, cost-effective alternative to allografts or synthetic meshes, with good clinical outcomes. Graphical abstract depicting the harvesting of the peronei grafts and their passage through the quadriceps tendon. Sonographic image showing the preoperative presence of a gap in the quadriceps tendon which is reconstructed post-operatively. The online version contains supplementary material available at 10.1007/s43465-024-01247-8.