Bone Graft In Treatment Research Articles

The Effects of Presurgical Orthodontic Treatment on the Outcome of Secondary Bone Graft for Individuals With Cleft Lip and Palate

Background/Objective: Alveolar bone graft (ABG) or repair has become a routine part of treatment protocols for individuals with cleft lip and/or palate. However, the necessity and potential benefits of presurgical orthodontic treatment in influencing the outcomes of secondary alveolar bone grafting remain inconclusive. This systematic review aimed to assess the impact of presurgical orthodontics on preparing patients for secondary alveolar bone grafts. Study Design: The authors systematically searched for relevant articles in PubMed, Web of Science, and Embase databases spanning the period from January 1, 2000, to December 31, 2023, using keywords related to alveolar bone grafting and orthodontic treatment for patients with cleft lip and/or palate. The review encompassed various study designs, including prospective and retrospective studies, observational studies, cross-sectional studies, randomized and nonrandomized clinical trials, cohort studies, and case-control studies. The review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the risk of bias was evaluated in studies selected for full-text review. Results: The search strategy identified 809 publications. After initial screening and application of exclusion criteria, 11 studies were included for final review. Three were prospective studies, 8 were retrospective studies, and 3 were cross-sectional cohort studies. On the basis of ROBINS-I and RoB 2 risk assessment, 9 studies were found to be of moderate risk of bias, one study was categorized as of high risk of bias, and 1 study was categorized as low risk of bias. Conclusions: Drawing from the latest and most reliable studies, 7 out of 11 included studies provided compelling evidence that presurgical orthodontics preceding alveolar bone grafting (ABG) leads to significantly improved outcomes compared with cases without presurgical orthodontic intervention. Notably, individuals with specific conditions, such as severely collapsed upper arch and mispositioned upper incisors, appear to derive the greatest benefits from presurgical orthodontic treatment. However, a call for additional studies characterized by high methodological quality and with longer follow-up periods is emphasized to enhance the safety considerations for both practitioners and patients concerning the utilization of presurgical orthodontics in the treatment of individuals with cleft lip and palate.

Micro-Computed Tomography Analysis of Peri-Implant Bone Defects Exposed to a Peri-Implantitis Microcosm, with and without Bone Substitute, in a Rabbit Model: A Pilot Study.

Peri-implantitis is an inflammatory condition characterized by inflammation in the peri-implant connective tissue and a progressive loss of supporting bone; it is commonly associated with the presence of biofilms on the surface of the implant, which is an important factor in the development and progression of the disease. The objective of this study was to evaluate, using micro-CT, the bone regeneration of surgically created peri-implant defects exposed to a microcosm of peri-implantitis. Twenty-three adult New Zealand white rabbits were included in the study. Bone defects of 7 mm diameter were created in both tibiae, and a cap-shaped titanium device was placed in the center, counter-implanted with a peri-implantitis microcosm. The bone defects received a bone substitute and/or a resorbable synthetic PLGA membrane, according to random distribution. Euthanasia was performed 15 and 30 days postoperatively. Micro-CT was performed on all samples to quantify bone regeneration parameters. Bone regeneration of critical defects occurred in all experimental groups, with a significantly greater increase in cases that received bone graft treatment (p < 0.0001), in all measured parameters, at 15 and 30 days. No significant differences were observed in the different bone neoformation parameters between the groups that did not receive bone grafts (p > 0.05). In this experimental model, the presence of peri-implantitis microcosms was not a determining factor in the bone volume parameter, both in the groups that received regenerative treatment and in those that did not.

Comparison of talonavicular-cuneiform joint fusion with bone grafting and without bone grafting in treatment of Müller-Weiss disease

To compare the effectiveness of talonavicular-cuneiform joint fusion with iliac bone grafting and without bone grafting in the treatment of Müller-Weiss diseases (MWD). The clinical data of 44 patients (44 feet) with MWD who received talonavicular-cuneiform joint fusion between January 2017 and November 2022 and met the selection criteria was retrospectively analyzed. Among them, 25 patients were treated with structural iliac bone grafting (bone grafting group) and 19 patients without bone grafting (non-bone grafting group). There was no significant difference ( P>0.05) in age, gender composition, body mass index, disease duration, affected side, Maceira stage, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score, anteroposterior/lateral Meary angle, and Pitch angle between the two groups. Operation time, operation cost, and postoperative complications were recorded in the two groups. AOFAS and VAS scores were used to evaluate the function and pain degree of the affected foot. Meary angle and Pitch angle were measured on the X-ray film, and the joint fusion was observed after operation. The difference (change value) of the above indexes before and after operation was calculated for comparison between groups to evaluate the difference in effectiveness. The operation was successfully completed in both groups, and the incisions in the two groups healed by first intention. The operation time and cost in the bone grafting group were significantly more than those in the non-bone grafting group ( P<0.05). All patients were followed up. The median follow-up time was 41.0 months (range, 16-77 months) in the non-bone grafting group and 40.0 months (range, 16-80 months) in the bone grafting group. There was skin numbness of the medial dorsalis of the foot in 1 case, internal fixation stimulation in 2 cases, and pain at the iliac bone harvesting area in 1 case of the bone grafting group. There was skin numbness of the medial dorsalis of the foot in 1 case and muscle atrophy of the lower limb in 1 case of the non-bone grafting group. There was no significant difference in the incidence of complications between the two groups ( P>0.05). At last follow-up, the AOFAS scores of the two groups significantly improved when compared with those before operation, while the VAS scores significantly decreased, the anteroposterior/lateral Meary angle and Pitch angle significantly improved, and the differences were significant ( P<0.05). There was no significant difference in the change values of outcome indicators between the two groups ( P>0.05). There was no delayed bone union or bone nonunion in both groups, and joint fusion was achieved at last follow-up. In the treatment of MWD, there is no significant difference in effectiveness and imaging improvement of talonavicular-cuneiform joint fusion combined with or without bone grafting. However, non-bone grafting can shorten the operation time, reduce the cost, and may avoid the complications of bone donor site.

REGENERATIVE TREATMENT USING PERIODONTAL FLAP SURGERY COMBINED Ti-OSS®, PERICARDIUM MEMBRANE AND PLATELET-RICH FIBRIN IN CHRONIC PERIODONTITIS

Introduction: Periodontal regenerative treatment with periodontal flap surgery followed by application of bone graft combined with platelet-rich fibrin (PRF) is a treatment using the concept of guided bone regeneration which is required to stimulate bone and periodontal tissue regeneration in chronic periodontitis with radiographic sign of alveolar bone vertical defect. This case report will describe the flap surgery with bone graft (Ti-OSS®, South Korea) and PRF treatment for correction of alveolar bone vertical defect in tooth with chronic periodontitis. Case: A 45-years old female complained of swollen and suppurated gingiva in the upper right area. Clinical finding showed deep periodontal pockets in tooth 13 and 15 and radiographic finding showed apical third alveolar bone loss in tooth 13 and 15. Case Treatment: Initial treatments included scaling and root planing, occlusal adjustment, and antibiotic prescription. Treatments were followed by periodontal flap surgery for debridement and elimination of granulation tissue on the root and alveolar bone surface of tooth 13 to 15, application of Ti-OSS® combined with PRF and pericardium membrane. Discussion: The follow-up evaluation 2 months after treatment showed clinical finding of decreased Clincial Attachment Level (CAL) and radiographic finding showed increased alveolar bone height around defect area of tooth 13 and 15. Conclusion and Suggestions: Periodontal flap surgery combined with application of Ti-OSS® and PRF may able to stimulate regeneration of alveolar bone and periodontal tissue in chronic periodontitis

A Case Series of Distal Radius and Ulna Nonunion Treated with Minimal Surgical Intervention

Abstract Background We hypothesized a treatment guideline for ulna/radius nonunion after failed surgical treatment and propose to verify it in a prospective study. Herein, we report our preliminary findings and review the current trend. Methods Six patients who met the criteria were retrospectively investigated, and we further categorized “nonunion of both the radius/ulna” into four subcategories. For hypertrophic nonunion of the radius, but with stability maintained by a plate, we only reinforced the mechanical stability of the ulna (osteosynthesis, treatment option 1). In oligo- or atrophic nonunion of the radius with stability maintained by a plate, we added cancellous or tricortical bone grafts to the radius after osteosynthesis of the ulna (treatment option 2). In the presence of definitive pseudomotion of the radius (no stability), we performed revision osteosynthesis for the radius only, without (treatment option 3) or with bone graft (treatment option 4). Results Two, one, one, and two patients had corresponding treatment options of 1, 2, 3, and 4, respectively. At a mean postoperative time of 4.3 months, all radii and ulnas showed union. At the final follow-up, clinical outcomes in terms of the range of motion and VAS (visual analog scale)/DASH (disabilities of the arm, shoulder, and hand) scores were satisfactory. We are currently conducting a prospective trial to verify the hypothesized guidelines. For both types of radius/ulna nonunion, first, if the stability of the radius was good, we compared the final outcomes with or without revision osteosynthesis for the radius, in addition to osteosynthesis for the ulna. Second, if stability was absent in the radius, we compared the final outcomes with or without osteosynthesis of the ulna, in addition to revision osteosynthesis of the radius. Conclusions The treatment guidelines for rare nonunion after failed surgical treatment of both the distal radius/ulna were suggested according to the “concept of stability” based on the principles of fracture treatment. This hypothesis could be used to guide prospective studies of revision surgery for nonunion of both the radius and ulna. Level of Evidence Level IV, retrospective case series.

Particulate autogenous bone graft in treatment of infected non‐union mandible fracture: A case report

Oral SurgeryAccepted Articles LETTER TO THE EDITOR Particulate autogenous bone graft in treatment of infected non-union mandible fracture: A case report Rodrigo dos Santos Pereira, Corresponding Author Rodrigo dos Santos Pereira [email protected] orcid.org/0000-0003-2509-8633 University of Grande Rio-UNIGRANRIO, Rio de Janeiro, Brazil General Hospital of Nova Iguacu in Rio de Janeiro, Brazil Correspondence Email: [email protected]Search for more papers by this authorGustavo Lima Latini, Gustavo Lima Latini General Hospital of Nova Iguacu in Rio de Janeiro, BrazilSearch for more papers by this authorIzabela Lopes Pessanha, Izabela Lopes Pessanha University of Grande Rio-UNIGRANRIO, Rio de Janeiro, BrazilSearch for more papers by this authorRodrigo Santos Batista Martins, Rodrigo Santos Batista Martins University of Grande Rio-UNIGRANRIO, Rio de Janeiro, BrazilSearch for more papers by this authorAdam Lowenstein, Adam Lowenstein Tufts University School of Dental Medicine, Division of Dental Research, Administration, Department of Periodontology, Boston, MA, USASearch for more papers by this authorCarlos F. Mourão, Carlos F. Mourão Tufts University School of Dental Medicine, Division of Dental Research, Administration, Department of Periodontology, Boston, MA, USASearch for more papers by this author Rodrigo dos Santos Pereira, Corresponding Author Rodrigo dos Santos Pereira [email protected] orcid.org/0000-0003-2509-8633 University of Grande Rio-UNIGRANRIO, Rio de Janeiro, Brazil General Hospital of Nova Iguacu in Rio de Janeiro, Brazil Correspondence Email: [email protected]Search for more papers by this authorGustavo Lima Latini, Gustavo Lima Latini General Hospital of Nova Iguacu in Rio de Janeiro, BrazilSearch for more papers by this authorIzabela Lopes Pessanha, Izabela Lopes Pessanha University of Grande Rio-UNIGRANRIO, Rio de Janeiro, BrazilSearch for more papers by this authorRodrigo Santos Batista Martins, Rodrigo Santos Batista Martins University of Grande Rio-UNIGRANRIO, Rio de Janeiro, BrazilSearch for more papers by this authorAdam Lowenstein, Adam Lowenstein Tufts University School of Dental Medicine, Division of Dental Research, Administration, Department of Periodontology, Boston, MA, USASearch for more papers by this authorCarlos F. Mourão, Carlos F. Mourão Tufts University School of Dental Medicine, Division of Dental Research, Administration, Department of Periodontology, Boston, MA, USASearch for more papers by this author First published: 27 May 2023 https://doi.org/10.1111/ors.12823 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/ors.12823. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

Rapid Maxillary Expansion Treatment in Patients with Cleft Lip and Palate: A Survey on Clinical Experience in the European Cleft Centers.

Cleft lip and palate patients require complex interdisciplinary treatment, including maxillary expansion and secondary alveolar bone grafting. However, the evidence on these treatment procedures and outcomes is lacking. Therefore, this study aimed to survey the subjective observations of European maxillofacial surgeons and orthodontists on the maxillary expansion and bone grafting treatment protocols and the associated complications. An online questionnaire was sent to 131 centers. The questions assessed the participants' demographic data, maxillary expansion and alveolar bone grafting protocols, and the associated complications. Descriptive statistics and a t-test were used to analyze the data. The response rate was 40.5%. The average age for maxillary expansion was 9-10 years. The secondary alveolar bone grafting was planned 5-10 months after the expansion. The most common complications were asymmetric expansion, relapse, and fistula formation. The protocols and materials used vary widely among centers. Anatomical alterations and developmental processes, like tooth eruption adjacent to the cleft, should be seriously considered for treatment planning. This survey showed that there is still a lack of consensus on these treatment procedures. Further clinical trials should focus on long-term outcome evaluation to identify treatment components for optimal alveolar bone substitution and transversal maxillary expansion treatment in patients with clefts.

Clinical Results of Decortication with Bone Grafting Method versus Extracorporeal Shock Wave Treatment in Long-Bone Pseudoarthrosis.

BACKGROUND Despite advanced treatment methods, the treatment of pseudoarthrosis still poses a significant challenge for orthopedists. In this study, we aimed to assess the clinical results of decortication and bone grafting and extracorporeal shock wave treatment (ESWT) in long-bone pseudoarthrosis. MATERIAL AND METHODS Between 2007 and 2015, 68 fractures of 66 patients treated for long-bone pseudoarthrosis were evaluated retrospectively. ESWT was used in 36 extremities and decortication and iliac bone grafting was used in 32. The treatment results of these patients were evaluated and compared with rates in the literature. RESULTS The mean patient age was 43.9 years (range, 21-69). The mean interval between the occurrence of the fracture and treatment with bone grafting or ESWT was 8.6 months and the mean interval between the procedure and achievement of union was 6.9 months. The patients were followed up for a mean period of 25.2 months. After the mean follow-up period, bone union had occurred in all 32 patients (100%) in the decortication and bone grafting group and in 28 (78%) of the 36 patients in the ESWT group (P=0.023). CONCLUSIONS This study shows that extracorporeal shock wave treatment should be considered the first option in treatment of pseudoarthrosis as it is a non-invasive method and also provides good rates of union. In patients that do not heal with ESWT, decortication and bone grafting remains the criterion standard therapy.

Histological and Immunohistochemical Analysis of the Effects of Topical Melatonin Treatment Associated with Collagen Sponge and rhBMP-2 Protein on Bone Remodeling.

Extensive bone defect healing is an important health issue not yet completely resolved. Different alternative treatments have been proposed but, in face of a critical bone defect, it is still very difficult to reach a complete regeneration, with the new-formed bone presenting all morphological and physiological characteristics of a normal, preinjury bone. Topical melatonin use has shown as a promising adjuvant for bone regeneration due to its positive effects on bone metabolism. Thus, to search for new, safe, biological techniques that promote bone repair and favor defect healing, we hypothesized that there is a synergistic effect of melatonin treatment associated with rhBMP-2 to guide bone regeneration. This study aimed to investigate bone repair effects of topical melatonin administration in different concentrations (1, 10, and 100 µg), associated or not with rhBMP-2. Surgical-induced bone defect healing was qualitatively evaluated through histopathological analysis by light microscopy. Additionally, quantitative stereology was performed in immunohistochemistry-prepared tissue to identify angiogenic, osteogenic, and osteoclastogenic factors. Quantification data were compared between groups by the ANOVA/Tukey test and differences were considered significant when p &lt; 0.05. Our results showed that the presence of the scaffold in the bone defect hindered the process of bone repair because in the group treated with "blood clot + scaffold" the results of bone formation and immunolabeling were reduced in comparison with all other groups (treated with melatonin alone or in association with rhBMP-2). Statistical analysis revealed a significant difference between the control group (bone defect + blood clot), and groups treated with different concentrations of melatonin in association with rhBMP-2, indicating a positive effect of the association for bone repair. This treatment is promising once it becomes a new safe alternative technique for the clinical treatment of fractures, bone defects, and bone grafts. Our results support the hypothesis of the safe use of the association of melatonin and rhBMP-2 and have established a safe and effective dose for this experimental treatment.

Effect of Laser Bio stimulation and Bone Graft in Treatment of a Large Periapical Lesion – A CBCT Analysis

India accounts for 23% of global TB burden. Of these 38% are of Extra Pulmonary Tuberculosis. Lymph node TB is the most common EPTB, pleural effusion is second most common type of EPTB in India. The bacteriological confirmation to diagnose EPTB is more difficult due to its paucibacillary nature. This study aims assessing the comparison of ADA with Gene- Xpert MTB RIF in pleural fluid in the diagnosis of tubercular pleural effusion. Study was a cross-sectional study carried out at the Department of Respiratory Medicine and Department of Internal Medicine, Muzaffarnagar Medical College, and School of Medical Science and Research, Greater Noida, Gautam Budh Nagar, UP from January 2018 to March 2019. Paired and unpaired Student's t-test, Chi square test, P &lt; 0.05 was considered statistically significant; SPSS 18.0 software was used for analysis. The detection of MTB and rifampicin resistance using the Gene-Xpert MTB/RIF with pleural fluid ADA assay was assessed in 66 specimens. With ADA cut off as 40IU/L, 60 cases had an ADA &gt; 40IU/L and 6 cases had ADA &lt; 40IU/L. Pleural fluid Gene-Xpert detected MTb in 22 samples while in 44 samples MTB not detected. All pleural fluid MTb detected by Gene-Xpert were rifampicin sensitive. Gene-Xpert detected 2 tubercular pleural effusion in which ADA level was less than 40. Study shows that there was no statistically significance in diagnostic value between Gene- Xpert and ADA pleural fluid however Gene-Xpert MTB/RIF is useful method for rapid detection of MTB and Rifampicin resistance simultaneously. Estimation of ADA in pleural fluid is rapid inexpensive laboratory investigation where the diagnosis is uncertain. We found no significant connection between CBNAAT positivity and ADA level. In developing country lymphocyte predominant effusions with high ADA levels (&gt; 40 U/L) is better option but definitely combined use of ADA and Gene-Xpert is better than using individually for the diagnosis of Tubercular pleural effusion

Effect of Laser Bio stimulation and Bone Graft in Treatment of a Large Periapical Lesion – A CBCT Analysis

Nonsurgical endodontic treatment is a definitive predictable treatment option in most cases, but endodontic surgery may be indicated for teeth with persistent peri apical pathosis unresponsive to non-surgical approaches. This paper reports the one case of bone healing after peri apical surgery using laser biostimulation and hydroxyapatite bone graft assessed using CBCT analysis. Each case was evaluated using Pre-operative CBCT. Post treatment evaluation was done clinically, radiographically and by CBCT analysis.

Plate augmentation and bone grafting in treatment of femoral shaft nonunion initially fixed by intramedullary nail.

Introduction: This study aims to evaluate the results of plate augmentation and bone grafting without removing the nail in the treatment of nonunited, nailed femoral shaft fractures. Methods: Twenty patients with atrophic nonunion femoral shaft fractures initially fixed by intramedullary nail were treated by augmentation plating and iliac bone graft with retention of the nail. Patients were evaluated at regular intervals using an X-ray and Wu scoring system, which assesses clinical and radiological signs of healing. Results: All 20 patients achieved bony union at a mean time of 4.9 months (3–8 months). According to Wu’s score, 12 cases showed excellent results, and 8 cases obtained good results with no complications recorded. Conclusion: augmentation plating and iliac bone graft provide a good and safe method of treatment of previously nailed and non-united femoral shaft fractures.Level of evidence: Level 4; Case Series.

Long-term Quality of Life after Fusion of the Ventral Thoracic and Lumbar Spine.

Cage implantations and autologous pelvic bone grafts are common surgical procedures to fuse the spine in cases of spinal disorders such as traumatic fractures or degenerative diseases. These surgical methods are designed to stably readjust the spine and to prevent late detrimental effects such as pain or increasing kyphosis. Benefits of these surgical interventions have been evaluated, but the long-term well-being of patients after the respective treatments has not yet been examined. This study was designed to evaluate the clinical outcome for patients who received iliac crest or cage implantations. Forty-six patients with traumatic fractures after they obtained an anterior fusion in the thoracic or lumbar spine (12 cages; mean age: 54.08 years; 34 pelvic bone grafts; mean age: 42.18 years) were asked to participate in the survey using a precast questionnaire according the Visual Analog Scale (VAS) Spine Score. Twenty-nine of them provided the data requested. Evaluation of the VAS scores of the patients, reporting at least 1 year after the surgery, revealed that cage implantations led to significantly better results with respect to all aspects of their daily life such as pain sensing, capability to undertake physical activities and exercise as compared with patients with autologous pelvic bone graft. Patients with autologous pelvic bone graft treatment reported a particularly poor overall satisfaction level concerning their long-term well-being. Patients with cage implantation reported a higher degree of long-term well-being. The data provide evidence for a positive impact on the postsurgery quality of life after cage implantation.

Reconstruction and repair, using mini-plate and bone graft for persons living with HIV with giant cell tumor of long bone: retrospective analysis of a single-center experience

BackgroundTo evaluate the effect of reconstruction and repair, using a mini-plate and bone graft for HIV -positive patients with giant cell tumor of long bone.MethodsWe conducted a retrospective analysis of 12 HIV positive patients with giant cell tumor of long bone. A non-HIV-positive cohort of patients, matched for age, sex, and disease type, was selected as the control group. From June 2012 to August 2020, curettage by ultrasonic scalpel was performed in all patients, combined with min- plate and bone graft treatment. All patients were followed- up for 18 to 60 months. Limb function was evaluated, using the MSTS93 scoring system, and any examples of postoperative recurrence, distant metastasis, complications, MSTS93 score, and fracture prognosis were recorded.ResultsThe mean age of HIV group was 43.5 years. The ratio of men to women was 11: 1. In all cases the histopathological diagnosis was clear, except the patients with primary malignant giant cell tumor of bone, including five, three, two, and two cases in the proximal tibia, distal femur, distal tibia, and talus, respectively. Following their surgery, all patients were followed up with an average of 31.24 ± 11.84 months. No local recurrence or pulmonary metastases were observed. Post-surgery, all the 12 patients showed good bone morphologic repair and reconstruction, good bone healing, good joint function, and no pathological fractures around their lesion. In the HIV group, one case of giant cell tumor in the proximal tibia showed mild articular surface collapse and mild valgus deformity of the knee joint but retained good joint function. The MSTS scores of excellent or good in the two groups comprised 83.3%, thus, there was no significant difference between them (P > 0.05). Compared with preoperatively, the MSTS scores in the HIV group were significantly improved, ranging from 7 to 11 points preoperatively to 24 to 27 points postoperatively; this difference was statistically significant (P < 0.05).ConclusionReconstruction and repair, using a mini-plate and bone graft for HIV -positive patients with giant cell tumor of long bone can achieve satisfactory results. The mini- plate requires little space and is flexible during reconstruction and fixation, significantly reducing complications such as surgical site infection, as well as preserving joint function and avoiding amputation; therefore, it is a safe and effective treatment method.

Delayed Autotransplantation of Permanent Impacted Maxillary Canine

Tooth autotransplantation is the extraction of a tooth from one location and its replantation in a different location in the same individual. It provides an alternative approach for treating severely impacted tooth when orthodontic treatment is ineffective. This case report presents a patient with buccally impacted left maxillary canine. Alveolar bone grafting (ABG), autotransplantation and orthodontic treatment were carried out. A 4 month review shows good prognosis of the transplanted tooth with no bone resorption.

Augmented Plating and Bone Grafting in Treatment of Tibial and Femoral Shaft Nonunion

Background: Tibial and femoral nonunion is not unusual after intramedullary fixation and might lead to multiple surgical procedures and long-term disabilities. Different surgical techniques have been described for management of lower limb long bone nonunion primarily treated with intramedullary nailing. Despite the use of various procedures, the success rate of most of them are suboptimal, increases the risk of related complications and costs. Objectives: Augmented plating concomitant with autologous bone grafting technique make it possible to improve healing in a single operation. Methods: In this study, 19 patients with lower limb long bone nonunion were primarily fixed with intramedullary nails, were treated with augmented plating and autologous bone grafting and followed for one year. Results: The union rate was 94.7% with a mean union time of 4.75 months, 18 patients healed completely with solid union and only one case of femoral shaft nonunion remained. Infection and other surgical-related complications were not detected. After one year follow up, Visual Analog Scale was 31 ± 18.8, and decrement in active knee range of motion was more than 20% compared with opposite side in 47.4% of the patients. Conclusion: According to the results, the single stage augmented plating with locking plates combined with autologous bone grafting can be used as a useful method in treatment of femoral or tibial nonunion.

An Overview of Bone Replacement Materials – Biological Mechanisms and Translational Research

Abstract Bone defects might develop as a result of various pathological entities. Bone grafting is a widely used procedure that involves replacement of the missing tissue with natural or artificial substitute. The idea for artificial replacement of the missing bone tissue has been known for centuries and the evidence for these treatments has been found ever since prehistoric period. Bone grafting has been practiced for centuries with various non-osseous natural materials. The skeletal system plays a crucial role in the structural support, body movement and physical protection of the inner organs. Regeneration of bone defects is crucial for reestablishing of the form and function of the skeletal system,. While most bone defects can heal spontaneously under suitable conditions, bone grafts or substitute biomaterials are commonly used therapeutic strategies for reconstruction of large bone segments or moderate bone defect. An ideal bone grafting material should provide mechanical strength, be both osteoinductive and osteoconductive and should provide space for vascularization. In order to overcome limitations associated with the standard treatment of bone grafts, there is an increasing interest in studying substitute biomaterials, made of naturally derived or synthetic materials. Bone substitutes can be derived from biological products or from synthetic materials. Prior to testing in human subjects, the bone substitute materials should be tested in vitro and in vivo using animal models. Establishing of a suitable animal model is an essential step in the investigation and evaluation of the bone graft materials.

Effect of Laser Bio stimulation and Bone Graft in Treatment of a Large Periapical Lesion – A CBCT Analysis

Nonsurgical endodontic treatment is a definitive predictable treatment option in most cases, but endodontic surgery may be indicated for teeth with persistent peri apical pathosis unresponsive to non-surgical approaches. This paper reports the one case of bone healing after peri apical surgery using laser biostimulation and hydroxyapatite bone graft assessed using CBCT analysis. Each case was evaluated using Pre-operative CBCT. Post treatment evaluation was done clinically, radiographically and by CBCT analysis.

A Novel Classification of Relationship Between Nasal Septum and Inferior Turbinate Associated With Nasal Airway Obstruction in Patients With Unilateral Alveolar Cleft.

This study aims to investigate nasal morphologies associated with nasal airway obstruction in unilateral alveolar cleft patients. A total of 234 unilateral alveolar cleft cases were performed cone beam computed tomography scans. The digital imaging and communication in medicine data were imported into Simplant Pro software. The radiographic features including nasal septum deviation and inferior turbinate hypertrophy as well as nasal airway volume and sinusitis were analyzed. A new radiographic classification of relationship between nasal septum and inferior turbinate (NS-IT) on the cleft side was proposed and three types of NS-IT relationship (type I, II and III) were identified in 234 cases. The statistical analysis revealed that the nasal airway volume on non-cleft side was significantly higher than that on cleft side in each of three types (P < 0.0001), while no difference of nasal airway volume on non-cleft side was found among three types. In addition, the nasal airway volume on non-cleft side in type I and II was significantly higher than that in type III (P < 0.0001). Also, type III presented higher rate of maxillary sinusitis (P = 0.0154) and ethmoid sinusitis on cleft side (P = 0.0490) than type I and II. The other indexes including clinical variances were not significant among three types. Unilateral alveolar cleft patients with type III NS-IT relationship could have nasal airway obstruction and higher rate of maxillary and ethmoid sinusitis on cleft side, which may be taken into account at primary cleft repair and alveolar bone grafting treatment.

Induced Membrane Technique Using Combined Free Fibular and Iliac Graft for the Treatment of Infected Nonunion of Long Bones of the Lower Limb

The two-stage induced membrane technique became widely accepted in treatment of infected nonunion. The aim of this study was to evaluate the outcomes of the induced membrane technique using combined free fibular and iliac bone graft in treatment of infected nonunion of long bones of the lower limb. This study comprised 45 consecutive patients (27 femoral, 18 tibial) with infected nonunion of long bones of the lower limb. The mean age of the patients was 35 years. There were 40 males and 5 females. The right side was affected in 30 patients. Comorbidities were present in 22 patients. Thirty cases were smokers. There were 35 cases with diaphyseal fractures and 10 cases with metaphyseal fractures. There were 30 cases with open fractures, 22 patients were treated by intramedullary nail, and 18 patients by plate and screws, while the other 5 patients were previously treated conservatively. The mean follow-up period was 26 ± 5.7 months. The mean defect was 8.16 ± 2.32 cm. The mean interval between the first and the second stage was 7.07 ± 0.79 weeks. The mean time of graft consolidation was 27.4 ± 6.76 weeks after the second stage. The average external fixation index was 1.5 months/cm. Sound union was achieved in 93.3%.The pin tract infection had occurred in all cases. There were residual limb shortening (15.6%), valgus ankle deformity (6.7%), loss of range of knee flexion (33.3%), and refracture (4.4%). No donor site morbidity in either iliac or fibular sites had occurred. Induced membrane technique with autogenous grafting is an alternative biological pathway proved to be effective in the treatment of infected nonunion of long bone of the lower limb with the added value of the use of free fibular graft in such cases.