Bone Defect Volume Research Articles

Predictors for recurrence of chronic osteomyelitis following long bones cavity defect replacement with synthetic materials

Background. Recent scientific literature only has a few studies highlighting the factors affecting the development of recurrent infection after surgical treatment of chronic osteomyelitis. Aim of the study: to determine significant risk factors of infection recurrence during one- and two-stage treatment of a cavity defect with synthetic materials in patients with chronic osteomyelitis and to create an assessment scale for prediction of the treatment outcome based on this data. Material and Methods. The retrospective study comprised 131 patients with chronic osteomyelitis of the long bones. The patients were divided into two groups based on the treatment outcome: group 1 (n=90) - successful elimination of infection; group 2 (n=41) - recurrent osteomyelitis after one-stage or during two-stage treatment. Differences between the groups were assessed to identify factors that affect the risk of recurrence. Multivariate analysis was performed using the classification tree method ​​to develop a scale for the comprehensive risk assessment of osteomyelitis recurrence (CRAOR). Results. The following factors affecting the treatment outcome were assessed: location (r=0.205, p=0.019); duration of osteomyelitis (r=0.23, p=0.007); history of debridement operations (r=0.264, p=0.002); bone defect volume (r=0.175, p=0.045); physiological class according to Cierny-Mader (r=0.188, p=0.004); anatomical type of osteomyelitis according to Cierny-Mader (r=0.15, p=0.086); nature of the pathogen (r=0.123, p=0.162). The degree of the osteomyelitis recurrence risk, threshold values ​​for quantitative factors and the total score the scale were established. In patients with a score 5, the risk of osteomyelitis recurrence increased by 8.1 times in one-stage treatment compared to patients with a score ≤5 (OR 8.143, CI 1.008-65.882). In two-stage treatment, patients with a score 5 had the risk of osteomyelitis recurrence increased by 4.1 times compared to patients with a score ≤5 (OR 4.059, CI 0.461-35.714). Based on the scale, an algorithm of treatment for these patients was developed.

The accuracy and efficiency of design and development of 3D printed integral anatomical acetabular prosthesis in total hip arthroplasty for Crowe type Ⅱ and Ⅲ developmental dysplasia of the hip

Objective: To compare the accuracy and efficiency between the model development method and the software development method, which design and develop 3D printed integral anatomical acetabular prosthesis to be used in total hip arthroplasty(THA) for patients with Crowe type Ⅱ and Ⅲ developmental dysplasia of the hip(DDH). Methods: Fifteen patients with end-stage hip osteoarthritis due to Crowe type Ⅱ and Ⅲ DDH who underwent THA in the Orthopedics Department of the First Affiliated Hospital of Bengbu Medical College between January 2015 and June 2023 were selected in this study retrospectively. There were 1 male (1 hip) and 14 females (17 hips) with a mean age of (55.1±9.1) years. There were 12 hips with Crowe type Ⅱ, 6 hips with Crowe type Ⅲ. The preoperative pelvis three-dimensional CT data in those patients were used to design integral anatomical acetabular prosthesis. The model development group used 3D printing technology to print life-size pelvis models. The acetabulum was reamed and the acetabulum cup was inserted into the socket according to conventional THA procedures. The bone defect above the acetabulum cup was filled with bone wax. The Mimics and 3-matic software were used to simulate the THA procedures, design and install the integrated anatomical acetabular prosthesis in the software development group. The operation time, the size of the acetabular cup, the volume and surface area of the acetabulum bone defect, the acetabular cup's inclination and anteversion, the horizontal distance and the vertical distance of hip rotation center were compared between the two methods. Results: The study in the two groups were all based on the data of 18 hips in the 15 patients. The horizontal and vertical distances of rotation center in the model development group and software development group was (32.08±1.80) mm, (32.17±2.40) mm and (14.36±1.53) mm, (15.11±1.45) mm, respectively (both P>0.05). The cup size in model development group was (48.56±1.15)mm, and it was (48.77±1.22) mm in the software group (P=0.160). The anteversion and inclination of the acetabular cup in the model and software groups were 23.79°±6.31°, 30.49°±11.03° and 15.17°±0.52°, 40.24°±0.58°, respectively (both P<0.01). The volume and surface area of the acetabulum bone defect in the model development group was (5.06±2.86) mm3 and (8.31±2.21) mm2, respectively, while it was (4.01±2.56)mm3 and (6.83±2.71) mm2, respectively, in the software development group (both P<0.05). The work time in the model development group was (24.43±0.68) h and (0.47±0.12) h in the software development group, respectively (P<0.001). Conclusion: Compared with the 3D printing model development method, the application of Mimics and 3-matic software to design and develop integrated anatomical acetabular prosthesis in total hip arthroplasty for Crowe type Ⅱ and Ⅲ DDH show advantages of convenience, high efficiency and more accuracy.

Bone lid technique versus standard technique for treatment of mandibular lesions

BackgroundJaw lesions are frequent in the oral and maxillofacial areas. Different methods for enucleating jaw lesions in the oral and maxillofacial sites have been proposed, including the bone lid technique.PurposeThe aim of this study was to compare the clinical and radiographic results of the bone lid technique employing a piezoelectric surgery to the traditional technique in individuals with mandibular lesions.Materials and methodsA randomized controlled trial was conducted on 24 patients with mandibular lesions. They were randomly allocated into two groups (n = 12 for each group). Group I: the mandibular lesion was excised with bone lid technique using a piezoelectric device, followed by the fixation of the bony window after its repositioning. Group II: the lesion was excised with the traditional method using rotatory burs. Pain, soft tissue healing, bone exposure, bone lid integration, and the volume of the residual bone defect were all assessed clinically and radiographically after one week, one month, and six months.ResultsAll patients in both groups showed adequate soft tissue healing except for one case in group I experienced wound dehiscence and bone lid exposure. The bone lid group reported significantly less pain than the usual approach at the 3rd and 7th days. After six months, the volume of bone defect filling was considerably higher in the bone lid group compared to the conventional group.ConclusionThe bone lid technique was an effective procedure in the management of mandibular lesions compared to the standard method. Besides, this technique provides better bone healing and reduces bone loss.Trial registrationThis clinical trial was registered at clinicaltrials.gov on 14/8/2023 and had registration number NCT05987930.

A Novel Method to Assess Healing of Segmental Bone Defects using the Induced Membrane Technique.

Clinical concerns exist regarding the quality of bony consolidation in the context of the induced membrane technique. This study evaluates the clinical process of bone grafting in the second stage of induced membrane bone union in patients with tibial bone defects to infer the possibility of non-union and establish a reliable and effective evaluation method combined with computed tomography (CT) to assess fracture healing. Patients with tibial bone defects who underwent the induced membrane technique at our hospital between February 2017 and February 2020 were retrospectively analyzed. The Hounsfield unit (HU) values of the patients were evaluated at different times during the second stage of bone grafting. Bone healing at the boundary value of the 120 HU output threshold (-1024 HU-3071 HU) was directionally selected, and the changes in the growth volume of union (new bone volume [selected according to HU value]/bone defect volume) were compared with analyzing individual class bone union. Method 1 involved X-rays revealing that at least three of the four cortices were continuous and at least 2 mm thick, with the patient being pain free. For Method 2, new bone volume (selected according to HU value/bone defect volume) at the stage was compared with analyzing individual class healing. Receiver operating characteristic curve analysis was used for Methods 1 and 2. A total of 42 patients with a segmental bone defect with a mean age of 40.5 years (40.5 ± 8.3 years) were included. The relationship between bone graft volume and time variation was analyzed by single factor repeated variable analysis (F = 6.477, p = 0.016). Further, curve regression analysis showed that the change in bone graft volume over time presented a logarithmic curve pattern (Y = 0.563 + 0.086 × ln(X), Ra2 = 0.608, p = 0.041). ROC curve analysis showed that Method 2 is superior to Method 1 (AUC: 86.3% vs. 68.3%, p < 0.05). The induced membrane technique could be used to treat traumatic long bone defects, with fewer complications and a higher healing rate. The proposed imaging grading of HU (new bone volume/bone defect volume) can be used as a reference for the quality of bony consolidation with the induced membrane technique.

Imaging in revision total knee arthroplasty: A novel 3D classification system for tibial bone defects.

The primary purpose of the study was to use pre-revision total knee arthroplasty (TKA) computer-tomography (CT)-images to analyse typical tibial bone defects and create a new schematic three-dimensional (3D)-classification system. The secondary purpose was to investigate the association between defect size and implant selection at the time of revision surgery. Eighty-four patients with preoperative CT-scans underwent revision of a primary TKA. CT-image segmentation with the 3D-Slicer Software was performed retrospectively, and a new three-dimensional classification system was used to grade tibial bone defects. The location of tibial bone defects was recorded for all cases. Volumetric 3D bone defect measurements were used to investigate the association between the bone defect volume, the indication for rTKA, and the use of modular revision components. The t-test, the Mann-Whitney-U test, and the Fisher's exact-test were used for group comparisons, and the Kruskal-Wallis test was used for multiple group comparisons. The most common anatomic regions for both contained and uncontained tibial bone defects were the anteromedial epiphysis (N = 50; mean epiphyseal-defect: 5.9 cm³) and metaphysis (N = 15; mean metaphyseal-defect: 9.6 cm³). A significant association was found between patients with preoperative metaphyseal defects (N = 22) and the use of tibial augments (N = 7) (p = 0.04). The use of cones/sleeves was associated with a significantly increased 3D-CT volume of the preoperative metaphyseal bone defects (p = 0.04). Patients with osteoporosis had significantly larger volumetric defects in the metaphysis (p = 0.01). Our results emphasise the importance of considering the three-dimensional nature of tibial defects in rTKA. The findings suggest that an understanding of the volume of the defect size through CT imaging can predict the need for augments and cones/sleeves and, especially in patients with osteoporosis can help the surgeon identify larger metaphyseal defects and ensure optimal metaphyseal fixation through appropriate implant selection. Level III, retrospective cohort study.

Influence of osseous structure characteristics of unilateral alveolar cleft on outcomes of alveolar bone grafting: a retrospective study

To enhance the success rate of alveolar bone grafting, it is crucial to identify the factors that may influence the postoperative bone formation. This study aimed to investigate the impact of various osseous structure characteristics of alveolar clefts on the survival ratio of autogenous cancellous bone particle grafts. A retrospective study was conducted on 60 patients who underwent surgery performed by the same surgeon between 2016 and 2022. Two researchers measured and recorded the bone defect volume (DV), postoperative bone formation volume at 1 year, contact area between the graft and the bone surface within the cleft (S), cleft width (CW), osseous occlusion relationships, and presence of a cleft palate and initial bone bridge within the cleft for each patient. Pearson correlation analysis, Spearman's correlation analysis, and multiple linear regression analysis were performed. The analysis results revealed statistical correlations between DV, CW, ratio of S to DV, cleft palate, initial bone bridge presence, and occlusion relationships with the survival rate. Multiple linear regression analysis showed that initial bone bridge and occlusion relationships affected the graft survival rate. Based on the presence of initial bone bridges and occlusions, we can make a rough estimate of the postoperative bone formation outcome in patients. However, the underlying mechanisms by which these two factors influence the bone formation require further investigation. In addition, preoperative orthodontic treatment to improve occlusal relationships may improve the postoperative bone formation outcomes in alveolar bone grafting.

Herniation of intervertebral disc into thoracolumbar fracture vertebral body leads to malunion of fracture and decrease of intervertebral space height

To analyze the clinical characteristics of intervertebral disc tissue injury and herniation into the vertebral body in thoracolumbar fracture on fracture healing, vertebral bone defect volume and intervertebral space height. From April 2016 to April 2020, a total of 140 patients with thoracolumbar single vertebral fracture combined with upper intervertebral disc injury treated with pedicle screw rod system reduction and internal fixation in our hospital. There were 83 males and 57 females, aged from 19 to 58 years old, with an average age of (39.33±10.26) years old. All patients were followed up regularly 6 months, 12 months and 18 months after surgery. The patients with injured intervertebral disc tissue not herniated into the fractured vertebral body were the control group, and the patients with injured intervertebral disc and herniated into the fractured vertebral body were the observation group. By detecting the thoracolumbar AP and lateral X-ray films, CT and MRI of the thoracolumbar segment at different follow-up time, calculate the changes of the wedge angle of the fractured vertebral body, the sagittal kyphosis angle and the height of the superior adjacent intervertebral space, the changes of the fracture healing and bone defect volume after the reduction of the vertebral body, and the changes of the intervertebral disc degeneration grade. The prognosis was evaluated by visual analogue scale(VAS) and Oswestry disability index(ODI). Finally, the differences of the above results among different groups were comprehensively analyzed. All the patients had normal wound healing without complications. A total of 87 patients received complete follow-up data, at least 18 months after internal fixation. Thoracolumbar AP and lateral X-ray films showed that 18 months after the reduction and internal fixation operation, the vertebral wedge angle, sagittal kyphosis angle and the height of the upper adjacent intervertebral space in the observation group were greater than those in the control group(P<0.05). CT scanning showed that the deformity of the fracture healed 12 months after the vertebral body reduction in the observation group and formed a "cavity" of bone defect connected with the intervertebral space, and its volume was significantly increased compared with that before (P<0.05). MRI scanning showed that the degeneration rate of injured intervertebral discs in the observation group was more serious than that in the control group 12 months after operation(P<0.05). However, there was no significant difference in VAS and ODI score at each time. Herniation of injured intervertebral disc tissue hernias into the fractured vertebral body leads to increased bone resorption defect volume around the fracture and forms a malunion "cavity" connected with the intervertebral space. This may be the main reason for the change of vertebral wedge angle, the increase of sagittal kyphosis angle and the decrease of intervertebral space height after removal of internal fixation devices.

Evaluation of Serum Albumin-Coated Bone Allograft for Bone Regeneration: A Seven-Year Follow-Up Study of 26 Cases.

We have previously reported that serum albumin-coated bone allograft (BoneAlbumin, BA) is an effective bone substitute. It improves bone regeneration at the patellar and tibial donor sites six months after harvesting bone-patellar tendon-bone (BPTB) autografts for primary anterior cruciate ligament reconstruction (ACLR). In the present study, we examined these donor sites seven years after implantation. The study group (N = 10) received BA-enhanced autologous cancellous bone at the tibial and BA alone at the patellar site. The control group (N = 16) received autologous cancellous bone at the tibial and blood clot at the patellar site. We evaluated subcortical density, cortical thickness, and bone defect volume via CT scans. At the patellar site, subcortical density was significantly higher in the BA group at both time points. There was no significant difference in cortical thickness between the two groups at either donor site. The control group's bone defect significantly improved and reached the BA group's values at both sites by year seven. Meanwhile, the bone defects in the BA group did not change significantly and were comparable to the six-month measurements. No complications were observed. There are two limitations in this study: The number of patients recruited is small, and the randomization of the patients could have improved the quality of the study as the control group patients were older compared to the study group patients. Our 7-year results seem to demonstrate that BA is a safe and effective bone substitute that supports faster regeneration of donor sites and results in good-quality bone tissue at the time of ACLR with BPTB autografts. However, studies with a larger number of patients are required to definitively confirm the preliminary results of our study.

Introduction of tenomodulin by gene transfection vectors for rat bone tissue regeneration.

Periodontal ligament is regenerated in association with hard tissue regeneration. Tenomodulin (Tnmd) expression has been confirmed in periodontal ligament and it reportedly inhibits angiogenesis or is involved in collagen fibril maturation. The introduction of Tnmd by gene transfection in bone tissue regeneration therapy might inhibit topical hard tissue formation and induce the formation of dense fibrous tissue. Therefore, the effect of Tnmd introduction by gene transfection technique invitro and invivo was investigated in this study. Osteogenesis- and chondrogenesis-related gene expression levels in osteoblastic cells (MC3T3E1) and rat bone marrow derived cells were detected using qPCR three days after gene transfection with plasmid DNA (Tnmd) using non-viral gene transfection vectors: a calcium phosphate-based gene transfection vector (CaP(Tnmd)) or a cationic polymer-based reagent (JetPEI (Tnmd)). Next, an atelocollagen scaffold with or without CaP (Tnmd) or JetPEI (Tnmd) was implanted into a rat calvaria bone defect, and the remaining bone defect volume and the tissue reaction at 28 days after surgery were evaluated. Runx 2 and SP7 mRNA was reduced by JetPEI (Tnmd) in both cells, but not in CaP(Tnmd). The volume of expressed Tnmd was at 9ng/mL in both gene transfection vector. The remaining bone defect volume of JetPEI (Tnmd) was significantly bigger than that of the other groups and CaP (EGFP), and that of CaP (Tnmd) was significantly bigger than that of CaP (EGFP). Tnmd introduction treatment inhibits bone formation in artificial bone defect, however, the effect of that was dependent on non-viral gene transfection vector.

Bone Grafting Can Promote the Prognosis of Displaced Femoral Neck Fractures: A Follow-up of the Clinical Significance of Bone Defects.

Femoral neck fractures (FNFs) comprise a large proportion of osteoporotic fractures in Asia. However, the full range of prognostic variables that affect prognosis remains unclear. Here, we aimed to determine whether the severity of bone defects at the fracture site and other variables impact the prognosis of displaced FNFs. We evaluated the incidence of FNF internal fixation failures at regular intervals after surgery in data collected retrospectively. Digital Imaging and Communications in Medicine (DICOM) magnetic resonance imaging data of the displaced FNFs of 204 patients (> 20 years old; mean age, 52.3 years; men, 55.4%) who underwent internal fixation were used to construct three-dimensional (3D) virtual models of the femoral neck region. We calculated the position and volume of bone defect (VBD) using our independently developed algorithm and Mimics software. Each participant was followed up for at least 24 months; complications were noted and correlated with VBD and demographic and clinical variables. On the basis of VBD values calculated from virtual reduction models, 57 patients were categorized as having a mild defect, 100 as having a moderate defect, and 47 as having a severe defect. Age (p = 0.046) and VBD (p < 0.001) were significantly correlated with internal fixation failure. Multivariate analysis revealed that severe bone defects were associated with internal fixation failure (adjusted odds ratio [aOR], 23.073; 95% confidence interval [CI], 2.791-190.732) and complications (aOR, 8.945; 95% CI, 1.829-43.749). In patients with a severe defect, bone grafting was inversely associated with internal fixation failure (aOR, 0.022; 95% CI, 0.002-0.268) and complications (aOR, 0.023; 95% CI, 0.002-0.299). Bone defect severity was associated with internal fixation failure and other complications. For young adults with large VBDs, bone grafting of the defect can reduce the risk of internal fixation failure. These results provide useful new quantitative information for precisely classifying displaced FNFs and guiding subsequent optimal treatments.

Clinical and radiographic study of the use of cross-linked gelfoam matrix in the treatment of dehiscence-like defects in Stage III periodontitis.

This clinical study aimed to overcome the difficulty of graft fixation and limited blood supply for dehiscence defects regeneration by using a cross-linked gelfoam matrix jointly with collagen membrane and xenograft. The study included twenty dehiscence-like defects in maxillary anterior teeth with ≥4 mm facial bone loss and ≥5 mm clinical attachment loss (CAL) in patients suffering from Stage III periodontitis. Sites were treated with regenerative surgery using a cross-linked gelfoam matrix with glutaraldehyde, xenograft, and collagen membrane. The recorded parameters were: CAL, probing pocket depth (PPD), and radiographic three-dimensional (3D) volume for dehiscence-like defects (3D volume of facial bone defects) and 3D volume of interproximal defects using cone-beam radiographs. Data of these parameters were collected at both baseline and 6 months postsurgery. "Paired t-test" was used to assess the two variables." Both CAL and PPD showed statistically significant reductions and there was a significant bone gain at 6 months postsurgery in comparison to baseline (P ≤ 0.05). Using a cross-linked gelfoam matrix with glutaraldehyde in combination with xenograft and collagen membrane could enhance the outcome of periodontal regeneration, especially in the treatment of challenging dehiscence defects.

Comparative evaluation of demineralized freeze-dried bone allograft with and without concentrated growth factor membrane in the treatment of periodontal intrabony defects: a randomized controlled clinical trial.

The current study's aim was to evaluate and compare demineralized freeze-dried bone allograft (DFDBA) with and without concentrated growth factor (CGF) membrane in the treatment of periodontal intrabony defects on both a clinical and radiographic level. 30 stage III grade B periodontitis patients with bilateral intrabony defects were involved in the split mouth randomized controlled trial, and they received either DFDBA alone (control group) or DFDBA plus CGF membrane treatment (test group). At baseline and 6 and 12months, the gingival index (GI), plaque index (PI), probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession (GR) were assessed, whereas cone beam computed tomography was used to assess the bone defect height (BDH), vertical bone loss (VBL), bone defect depth (BDD), mesio-distal bone defect width (MDBDW), bucco-lingual bone defect width (BLBDW), and bone defect volume (CBCT) at baseline and 12months. The radiographic measures BDH, BDD, MDBDW, BLBDW, and BDV in the test group likewise showed a higher reduction in PPD and gain in CAL than the control group. The results of the intergroup comparison showed that the test group had statistically significant differences in BDH, BDD, and MDBDW. The data show that the test group achieved better results, with greater reductions in PPD, gains in CAL, and decreases in BDH, BDD, MDBDW, BLBDW, and BDV. The use of concentrated growth factor in conjunction with demineralized freeze-dried bone allograft may be suggested for the treatment of periodontal intrabony defects.

Outcome and associated predictors for nonsurgical management of large cyst-like periapical lesions: A CBCT-based prospective cohort study.

The aim of this cone-beam computed tomography (CBCT)-based study was to evaluate the outcome of nonsurgical root canal treatment (RCT) performed for the management of large cyst-like periapical lesions (LCPL) and to identify the predictive factors affecting healing. Fifty-four subjects (77 permanent maxillary anterior teeth) with LCPL (>10 mm) of endodontic origin were included. A single operator performed standardized multi-visit RCT. Patients were clinically and radiographically examined at 6, 12months, and a CBCT scan was taken at 24 months. Two independent blinded evaluators measured the pre- and postoperative volume of periapical lesions on CBCT scans using ITK snap software (version 3.8.0-beta-20181028-win64). The outcome was assessed as a percentage change in lesion volume and dichotomized as success (resolved/reduced) or failure (unchanged/enlarged). Ten preoperative (gender; age; intraoral draining sinus, soft tissue swelling, tooth discoloration, pulp canal obliteration, open apex, root resorption, cortical bone defect and lesion volume) and four intraoperative (apical extent and density of root filling; number of treatment visits and type of root filling) predictive factors were observed. Bivariate and stepwise multivariable linear regression analysis was performed to identify independent predictors affecting treatment outcomes. The significance level was set at 5%. A recall rate of 88% was achieved. The success rate of RCT was 82.2% (8.9% resolved, 73.3% reduced). Median lesion volume reduction was 75% (IQR 61%-93%). No pre- or intra-operative factors were related to treatment failure. However, presence of preoperative cortical bone defect (palatal versus no cortical defect, β=-51.5; 95% CI: -86.9 to -16, p=.006) and apical extent of obturation (long versus flush, β=-27.2; 95% CI: -53.8 to -0.6, p=.04) were negatively associated with reduction in lesion volume (%). Large cyst-like periapical lesions may be successfully managed with RCT. Preoperative cortical bone defect and apical extent of obturation may negatively influence osseous healing.

Le tibia proximal avec un clou en place peut être un site donneur pour un prélèvement d’os spongieux

IntroductionA preexisting implant at the harvesting site might dissuade the surgeon from considering the site as available for bone harvesting. This study aimed to investigate the quantity of cancellous bone graft that can be harvested from a proximal tibia with an inserted nail and to report the clinical outcomes of this bone graft harvesting technique. HypothesisOur hypothesis was that a certain amount of cancellous bone graft could be harvested from a proximal tibia with an inserted nail without compromising the surrounding environment and outcome of nonunion treatment. Material and methodsBone grafting from an ipsilateral proximal tibia with an inserted nail was performed in 32 patients for treating defect nonunion. The amount of harvested bone was measured using three parameters (weight, height, and volume). The effects of the proximal locking screw position on the quantity and location of bone graft harvest were analyzed. Clinical outcomes were evaluated by assessing the radiologic healing of the bone graft site and by assessing the donor-site complications. ResultsThe mean bone defect volume in the nonunion site was 31.1±18.3 (range, 10.6–87.0) cm3. The mean quantity of harvested bone from proximal tibias with an inserted nail was 21.2g, height was 3.9cm, and volume was 26.3cm3. A positive correlation was found between the quantity of harvested bone and the level of the lateral oblique interlocking screw hole in the tibial nail. All grafted bone successfully consolidated in all cases at an average of 5.8 months postoperatively. However, joint penetration during bone harvesting occurred in one case. DiscussionThe bony defect, which measured about 14.3cm3 could be filled with cancellous bone from a PT with an existing IM nail, without additional bone graft requirements. Even if an intramedullary nail exists inside the proximal tibia, harvesting cancellous bone at this site can be a viable option without serious complications. Level of evidenceIV; retrospective descriptive study.

Long-Term Stability of Alveolar Bone Graft in Cleft Lip and Palate Patients: Systematic Review and Meta-Analysis.

Alveolar bone grafts are the golden standard in treating patients with oral cleft and hence, the long-term success of this treatment is the subject of many studies. The aim of this study was to systematically review literature that examined the long-term stability of alveolar bone grafting in patients with cleft lip and palate. In this study, data was collected via a comprehensive search of random and nonrandom studies evaluating the success of bone grafts in patients with cleft lip and palate in ISI Web of Science, EMBASE, Scopus, Medline, and Cochrane Central Register of Controlled Trials from the beginning until July 3, 2020. Also, a search was conducted for ongoing studies in the trial registry and a hand search of related gray literature and references of the relevant studies. The relevant data of the included studies were extracted using predefined extraction forms. Meta-analysis was performed using inverse-variance for calculating the pooled outcome of outcome measures. The pooled mean success rate of alveolar bone graft and mean difference of cleft volume after 1 year was presented as the outcome of the analysis. Eight studies (1 randomized clinical trial study and 7 controlled prospective studies) were included in this meta-analysis. The results of the analyses showed that the total percentage of secondary alveolar success in the follow-up period of at least 1 year according to the Bergland index was 76.52% (pooled success = 76.52%, 44.92-98.10). Also, bone defect in the cleft area reduced significantly after bone grafting (MD = 0.62 cm3, 0.48-0.75, P < 0.00001). The total percentage of bone filling after 1 year and according to CBCT (cone beam computed tomography) was about 63.38%, and the rate of definite natural eruption of canine within the graft was 80.89%. The total success rate of secondary alveolar bone grafting in the follow-up period of at least 1 year was clinically significant and alveolar bone grafting significantly reduced bone defect volume. Also, there was no difference in the amount of bone remaining after 1 year in patients whose canine had erupted through the grafted bone and in those whose canine had not erupted.

Proximal tibia with an inserted nail can be an available donor site for harvesting cancellous bone

IntroductionA pre-existing implant at the harvesting site might dissuade the surgeon from considering the site as available for bone harvesting. This study aimed to investigate the quantity of cancellous bone graft that can be harvested from a proximal tibia with an inserted nail and to report the clinical outcomes of this bone graft harvesting technique. HypothesisOur hypothesis was that a certain amount of cancellous bone graft could be harvested from a proximal tibia with an inserted nail without compromising the surrounding environment and outcome of nonunion treatment. Material and methodsBone grafting from an ipsilateral proximal tibia with an inserted nail was performed in 32 patients for treating defect nonunion. The amount of harvested bone was measured using three parameters (weight, height, and volume). The effects of the proximal locking screw position on the quantity and location of bone graft harvest were analyzed. Clinical outcomes were evaluated by assessing the radiologic healing of the bone graft site and by assessing the donor site complications. ResultsThe mean bone defect volume in the nonunion site was 31.1±18.3 (range, 10.6–87.0) cm3. The mean quantity of harvested bone from proximal tibias with an inserted nail was 21.2g, height was 3.9cm, and volume was 26.3 cm3. A positive correlation was found between the quantity of harvested bone and the level of the lateral oblique interlocking screw hole in the tibial nail. All grafted bone successfully consolidated in all cases at an average of 5.8 months postoperatively. However, joint penetration during bone harvesting occurred in one case. DiscussionThe bony defect, which measured about 14.3 cm3 could be filled with cancellous bone from a PT with an existing IM nail, without additional bone graft requirements. Even if an intramedullary nail exists inside the proximal tibia, harvesting cancellous bone at this site can be a viable option without serious complications. Level of evidenceIV; Retrospective descriptive study.

Clinical study of calcium phosphate cement loaded with recombinant human bone morphogenetic protein 2 combined with calcium phosphate cement loaded with antibiotic for chronic osteomyelitis with bone defect

To compare the effectiveness of calcium phosphate cement (CPC) loaded with recombinant human bone morphogenetic protein 2 (rhBMP-2) combined with CPC loaded with antibiotic versus CPC loaded with antibiotic alone in one stage for chronic osteomyelitis with bone defect. A single-blind prospective randomized controlled clinical trial was conducted. Between April 2018 and April 2019, 80 patients of chronic osteomyelitis with bone defect in accordance with the random number table were randomly divided into two groups, 40 in the trial group (CPC loaded with rhBMP-2 combined with CPC loaded with antibiotic) and 40 in the control group (CPC loaded with antibiotic). There was no significant difference in gender, age, disease duration, lesion, and preoperative white blood cells (WBC) count, platelet count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) between the two groups ( P>0.05). All patients were implanted the corresponding CPC and external fixator after lesion clearance in the two groups. The postoperative WBC count, platelet count, ESR, CRP, hospital stay, cure rate of osteomyelitis, repaired bone defect volume, the time of external fixator removal, and the time of full weight-bearing of the affected limb were compared between the two groups. All patients were followed up 12-24 months, with an average of 18.4 months. There was no significant difference in WBC count, platelet count, ESR, and CRP between the two groups at 4 weeks after operation ( P>0.05). There were significant differences in WBC count, platelet count, and CRP in the two groups between 1 week before operation and 4 weeks after operation ( P<0.05). And the ESR showed no significant difference between pre- and post-operation in the two groups ( P>0.05). In the trial group, the anaphylactic exudate occurred in 1 patient with tibial osteomyelitis and the incision healed after oral administration of loratadine. The incisions of other patients healed by first intention in the two groups. One case of distal tibial osteomyelitis recurred in each group, and 1 case of humeral osteomyelitis recurred in the control group. The cure rates of osteomyelitis were 97.5% (39/40) in the trial group and 95% (38/40) in the control group, showing no significant difference between the two groups ( χ 2 =0.000, P=1.000). There was no significant difference in the repaired bone defect volume and hospital stay between the two groups ( P>0.05). X-ray film and CT showed that the bone defects were repaired in the two groups. The time of external fixator removal and the time of full weight-bearing of the affected limb were significantly shorter in the trial group than in the control group ( P<0.05). Application of CPC loaded with rhBMP-2 and antibiotic in one stage is effective for the chronic osteomyelitis with bone defect, which can accelerate the bone regeneration in situ to repair bone defect, reduce the trauma, shorten the course of treatment, and obtain good function of the affected limb.

Is it possible to estimate volume of bone defects formed on dry sheep mandibles more practically by secondarily reconstructing section thickness of cone beam computed tomography images?

The purpose of this study was to evaluate the effect of section thickness on volume estimations of bone defects scanned using cone beam computed tomography (CBCT). 25 bone defects were prepared on sheep mandibles and scanned using a KaVo 3D eXam (KaVo Dental, Biberach, Germany) CBCT device. Section thickness of images were reconstructed at 0.25, 0.5, and 0.75 mm to estimate the volume of these defects using the semiautomatic segmentation method. The volume averages obtained using microcomputed tomography and Archimedes' method served as reference values. The estimated volumes at each section thickness were compared with the actual volumes using the Friedman test. The accuracy of volume estimation was determined by the percentage error with respect to the reference values, and the mean absolute error (MAE) was calculated. Volumetric values of bone defects obtained with CBCT at section thicknesses up to 0.5 mm were compatible with the actual volumes (p > 0.05). The percentage errors at section thicknesses of 0.25, 0.5, and 0.75 mm were -5.4%, -7.3%, and -13.1%, respectively. The mean absolute errors were 13.6 mm3, 15.7 mm3, and 18.2 mm3, respectively. The section thickness values of CBCT images can be increased to a reasonable level to obtain accurate volume estimation results and save time. The semiautomatic segmentation method can be used reliably for volume estimations of bone defects.

Nonsurgical Treatment of Peri-Implantitis: Case Series

Peri-implantitis is one of the most important biological complication of dental implants. It has inflammatory nature, proved association with plaque accumulation in peri-implant tissues, and can be progressive on background of several factors, like comorbidity factors and bad habits. The prophylaxis and different methods of treatment were discussed during last 30 years, and surgical and nonsurgical techniques have their foes, benefits, and disadvantages. In this article, we describe the case series of various nonsurgical treatments of peri-implantitis with the use of protocols based on the application of local antibiotics (doxycycline, lincomycin, and erythromycin), mechanical and chemical debridement of dental implant surface, and mini-invasive regenerative technique with injections of bovine collagen. All these three cases demonstrated good results with the maintenance of bone level and absence of clinical signs of inflammation for at least a year according to the X-ray imaging (bone defect volume) and clinic assessments (probing depth, bleeding or suppuration, mucosa color, and pain presence).

Clinical and Radiographic Evaluation of Combined Treatment with Bisphosphonate Plus Platelet-Rich Fibrin versus Platelet-Rich Fibrin Alone for Severe Periodontitis with Furcation Defects

Background: This research assessed the clinical and radiographic evaluation of treatment with PRF plus bisphosphonate, compared to alone PRF in treatment of severe periodontitis with furcation defects. Methodology : This randomized, controlled radiological and clinical study enrolled 50 patients. All patients were given oral health instructions, oral prophylaxis, root planning, and relief of trauma from occlusion. The sites for therapy with PRF and PRF plus bisphosphonate were chosen randomly by the coin toss method. After they had received 6 weeks of presurgical therapy, patients underwent further clinical assessments by using different indices and assessment of level of attachment Radiographic outcomes were bone defect height, defect width, and defect depth; these were used to determine the bone defect volume. Results: This study revealed with positive results in all clinical assessments in the PRF plus bisphosphonate, as compared to PRF alone group with significant p value of less than 0.05. All radiographic parameters showed greater degrees of reduction in the parameters of platelet-rich fibrin plus bisphosphonate group, compared to the platelet-rich fibrin alone group; however, only the defect width of bone and defect volume were statistically significantly reduced in the platelet-rich fibrin plus bisphosphonate group, in comparison to the platelet-rich fibrin. Conclusion: Platelet-rich fibrin plus bisphosphonate therapy was beneficial in regeneration of periodontal ligament and improvement of periodontal status.