Bone Grafting Procedures Research Articles

The J-Shaped Bone Graft for Anatomic Glenoid Reconstruction

Background: The J-shaped bone graft procedure is one of the recommended methods to reconstruct significant glenoid rim defects. Purpose: To evaluate long-term (minimum 10-year) clinical outcomes and show further details of the remodeling effects on the articular cavity of the glenoid after J-shaped bone grafting. Study Design: Case series; Level of evidence, 4. Methods: A total of 14 patients treated with a J-shaped bone graft procedure were observed clinically. Additionally, bilateral preoperative and postoperative follow-up computed tomography (CT) scans were used for CT-osteoabsorptiometry (OAM) to evaluate the bony remodeling processes. Results: The follow-up rate was 93% at a mean follow-up time of 10.7 years (range, 10.08-11.75 years). Patients exhibited a mean Constant score of 92.5 (range, 80-100) on the clinical evaluation. All patients had free range of motion and were pain free without any recurrence of instability. Based on CT-OAM, comparable and almost anatomically reconstructed, bilaterally equal glenoid cavities were found postoperatively. The distribution patterns of glenoid subchondral mineralization were bilaterally equal in 85.7% of the patients. Conclusion: The surgical treatment of recurrent shoulder instability with a significant bony Bankart lesion using the J-shaped bone graft procedure provided excellent long-term results. This study lends evidence to support the capability of the J-shaped bone graft procedure to restore the normal glenoid shape due to physiological remodeling processes.

Therapeutic Results of Nonunion of the Scaphoid Including Intractable Cases

Purpose: The nonunion of the scaphoid is caused by various mistreatment of the scaphoid fracture, including long-term untreated or inadequately treated cases. We report our findings and discussions on postoperative outcomes and selection of surgical procedures in 47 cases including 13 cases of refractory scaphoid nonunion that required multiple operations. Materials and Methods: Those 47 cases included 44 males and 3 females with an age range of 15 to 65 at the time of operation (mean age: 27.8). Focal curettage and bone graft for the nonunion site were applied in 40 cases excluding 7 with scaphoid nonunion advanced collapse (SNAC) wrist. As the methods of bone graft, Russe procedure was applied in 4 cases and Herbert procedure was applied in the other 36 cases. As the internal fracture fixation materials, K-wires were used in 6 cases, Herbert screw in 8 cases, Bold screw in 5 cases, Whipple screw in 3 cases, and Acutrak mini screw in 18 cases. Meanwhile, the proximal part of the scaphoid was resected with tendon ball graft, 4-corner fusion, or modified Graner procedure was applied in the 7 cases with SNAC wrist. Postoperative follow-up periods were 2 to 10 years (mean: 4 years 7 months). Results: Bone union was observed in 28 out of 40 cases. The remaining 12 cases included the following: 5 cases which went untreated for at least 15 years, 3 with the application of Herbert-Whipple screw, 2 with the application of Bold screw, 1 with the inadequate insertion of Acutrak mini screw, and 1 with repeat nonunion caused by broken Acutrak screws. Revision surgery was conducted for the all cases: 1 with Russe procedure, 1 with Herbert procedure, and other 10 with vascularized bone graft procedure (2 with Zaidemberg procedure and 8 with the second metacarpal bone graft). As a result, bone union was observed in 10 cases. As the final treatment outcome, the ratio of grip strength of an operated hand to that of nonaffected hand was 50% to 114% (mean: 89%) and flexion-extension arc was 60° to 180° (mean: 121°). Conclusions: We had a satisfactory outcome for our treatment of the scaphoid nonunion. However, it should be noted that pedicle vascularized bone graft procedure needed to be applied to long-term untreated or repeat nonunion cases.

Distal Tibial Bone Grafting for Talar Dome Osteochondral Lesions

Category: Arthroscopy Introduction/Purpose: Osteochondral lesions (OCLs) of the talar dome are very common and often cause disabling pain. Smaller lesions are treated successfully with bone marrow stimulation techniques such as arthroscopic microfracture. Controversy exists, however, about the optimal treatment for larger, cystic lesions. Osteochondral grafting, either allograft or autograft, is the most common technique but is not optimal, as it requires allograft tissue or donor autograft from another joint. This procedure often requires a malleolar osteotomy for access to the talus, which carries inherent morbidity. We describe a technique of treating large, cystic OCLs by transferring structurally intact autograft from the distal tibia to the talus, which can be performed without osteotomy, does not require allograft tissue, and can be obtained from a local donor site. Methods: Twenty-three ankles in 22 patients underwent distal tibial bone grafting procedure for treatment of large, cystic OCLs of the talus. A cancellous autograft bone plug was harvested from the ipsilateral distal tibial metaphysis and implanted into the drilled out talar lesion through a small anterior arthrotomy. The graft may be placed oblique to the talar surface and contoured to match the level of the surrounding subchondral bone. Allograft bone chips were used to backfill the distal tibia donor site. Pre-operative and final post-operative data was available for 11 patients with a minimum of 6 months follow-up. Validated patient reported outcomes scores and other data collected included Foot Function Index (FFI), AOFAS hindfoot score, SF-12, and Visual Analog Scale (VAS) pain. Final postoperative data also included VAS patient satisfaction and PROMIS validated and normalized lower extremity function and pain scores. Comparisons were made by paired t-Test and data reported mean±SD. Results: Mean patient age was 47 (range 15-70). Seven of 11 patients were female. Lesions were all medial and measured 122 mm2 (range 80-160) by 8 mm depth (range 6-9). Average follow-up was 23 months (range 7-33). There were no complications or reoperations. Significant improvement (p < 0.05) occurred in AOFAS Hindfoot score (67±16 to 88±12), FFI (55±20 to 22±17), VAS pain score (6.3±2.4 to 1.4±1.5), and SF-12 (31±9 to 50±10). Final VAS patient satisfaction was 8.5±1.8/10, and 10 of 11 patients reported they would have the procedure again. PROMIS scores (normalized to population mean 50±10) at final follow-up were physical function: 53±6; pain intensity: 40±10; and pain interference: 45±6. Eight of 9 patients who were employed were able to return to full duty without limitation. Conclusion: Distal tibial bone grafting is a safe and effective treatment for large talar OCLs. This technique avoids the need for allograft tissue, distant donor site morbidity, and malleolar osteotomy. Early to mid-term clinical outcomes, including validated outcomes scores, are encouraging. Our results are comparable if not better than the results reported with other described techniques for large talar OCLs. Further follow-up is necessary to define longer-term results, to assess cartilage healing with advanced imaging or second look arthroscopy, and to help define the exact role for this technique in treatment of talar osteochondral lesions.

Multivariate analysis on unilateral cleft lip and palate treatment outcome by EUROCRAN index: A retrospective study

ObjectivesThis study is to evaluate the dental arch relationship and palatal morphology of unilateral cleft lip and palate patients by using EUROCRAN index, and to assess the factors that affect them using multivariate statistical analysis. MethodA total of one hundred and seven patients from age five to twelve years old with non-syndromic unilateral cleft lip and palate were included in the study. These patients have received cheiloplasty and one stage palatoplasty surgery but yet to receive alveolar bone grafting procedure. Five assessors trained in the use of the EUROCRAN index underwent calibration exercise and ranked the dental arch relationships and palatal morphology of the patients' study models. For intra-rater agreement, the examiners scored the models twice, with two weeks interval in between sessions. Variable factors of the patients were collected and they included gender, site, type and, family history of unilateral cleft lip and palate; absence of lateral incisor on cleft side, cheiloplasty and palatoplasty technique used. Associations between various factors and dental arch relationships were assessed using logistic regression analysis. ResultDental arch relationship among unilateral cleft lip and palate in local population had relatively worse scoring than other parts of the world. Crude logistics regression analysis did not demonstrate any significant associations among the various socio-demographic factors, cheiloplasty and palatoplasty techniques used with the dental arch relationship outcome. ConclusionsThis study has limitations that might have affected the results, example: having multiple operators performing the surgeries and the inability to access the influence of underlying genetic predisposed cranio-facial variability. These may have substantial influence on the treatment outcome. The factors that can affect unilateral cleft lip and palate treatment outcome is multifactorial in nature and remained controversial in general.

Assessing Donor Site Complications of Iliac Crest Bone Graft in Treatment of Scaphoid Nonunion

Background: Bone grafting is a common surgical technique to augment bone regeneration in orthopedic surgery. Autologous bone graft harvesting is the reliable treatment option and iliac crest is the most common harvesting site for healing bone fractures. However, the results of iliac crest bone graft harvesting are associated with morbidity and a number of complications. Objectives: The aim of this study was to assess donor site complications of scaphoid nonunion, to find clinical outcomes and the impact of iliac crest bone graft on age, gender, pain, numbness, itching, nerve injury and scar appearance of patients. Methods: In a prospective review of 61 cases of iliac crest bone graft procedures at the Shafa hospital from 2013 to 2014, complica- tions including pain, infection, hematoma, stress fracture, hypertrophic scars, numbness area and itching were assessed clinically. Results: Pain identified as the most common complication. The most common complications following postoperative pain at the donor site that reduced after six weeks were: numbness 3.27%, unsatisfactory scar appearance 3.27% and itching discomfort 1.63%. Conclusions: Harvesting of iliac crest bone graft can be the ideal way to prepare graft procedures required surgery scaphoid nonunion fractures with minimal complications. Nevertheless, with an adequate preoperative planning and appropriate surgical technique, the prevalence of these complications can be reduced.

Retrospective evaluation of 211 patients with maxillofacial reconstruction using parietal bone graft for implants insertion.

For a century, autologous bone grafts have been used in maxillofacial reconstruction. The ideal bone harvest site and grafting procedure remains a point of contention in regards to obtaining optimal long-term results with sufficient bone quantity and density without serious complications. More recently, confronted with growing patient requests and biomaterials development, maxillofacial surgeons and dentists have been considering these issues as they relate to pre-implant surgery. This study sought to evaluate implant success rate and complications following pre-implant surgery with parietal bone grafting. A retrospective study was carried out on patients who underwent maxillofacial reconstruction of different sites (symphysis, mandibular corpus, maxillary sinus and premaxilla) for the purpose of implant insertion. 311 procedures in 211 patients were included. The implant osseointegration rate was around 95%. Clinical follow-up ranged from 10 months to 11 years. A secondary procedure was performed in 6.1% of cases and we noted no serious complications at the harvest site. With good revascularization and osseointegration of the graft, the use of parietal bone leads to an implant success rate similar to that seen in the literature. Moreover, the use of this material results in few infections and low bone resorption provided there is strict immobilization of the graft and no tension on the soft tissue sutures. Parietal bone grafts technique possess the required qualities for the success of implant surgery, offering results at least as interesting as others using autogenous bone and with no serious complications on donor site.

Fish bone versus fish demineralized bone matrix (vertebra) effects on healing of experimental radial defect in rat model

Surgeons conducting bone grafting procedures have been in search of a bone graft substitute to avoid autogenous bone harvesting because of its associated complications. In the present study, the authors used fish bone and fish DBM in healing of a radial bone defect in a rat model. The 16 female Sprague–Dawley rats used in the present study were divided into the following four groups: autograft (positive control), untreated defect (negative control), and fish DBM, and fish bone graft as the experimental groups. Radiographs were taken in the 1st, 35th, and 56th post-operative days. Histopathological and biomechanical evaluations were performed in 56th post-operative day. The radiological, histopathological, and biomechanical evaluations revealed a superior rate of bone formation in the fish bone graft and autograft groups compared to those of the control. This study showed that the fish bone graft is effective in healing of the radial bone defect in rat.

Controlling Bone Graft Substitute Microstructure to Improve Bone Augmentation.

Vertical bone augmentation procedures are frequently carried out to allow successful placement of dental implants in otherwise atrophic ridges and represent one of the most common bone grafting procedures currently performed. Onlay autografting is one of the most prevalent and predictable techniques to achieve this; however, there are several well documented complications and drawbacks associated with it and synthetic alternatives are being sought. Monetite is a bioresorbable dicalcium phosphate with osteoconductive and osteoinductive potential that has been previously investigated for onlay bone grafting and it is routinely made by autoclaving brushite to simultaneously sterilize and phase convert. In this study, monetite disc-shaped grafts are produced by both wet and dry heating methods which alter their physical properties such as porosity, surface area, and mechanical strength. Histological observations after 12 weeks of onlay grafting on rabbit calvaria reveal higher bone volume (38%) in autoclaved monetite grafts in comparison with the dry heated monetite grafts (26%). The vertical bone height gained is similar for both the types of monetite grafts (up to 3.2 mm). However, it is observed that the augmented bone height is greater in the lateral than the medial areas of both types of monetite grafts. It is also noted that the higher porosity of autoclaved monetite grafts increases the bioresorbability, whereas the dry heated monetite grafts having lower porosity but higher surface area resorb to a significantly lesser extent. This study provides information regarding two types of monetite onlay grafts prepared with different physical properties that can be further investigated for clinical vertical bone augmentation applications.

Design and optimization of a novel bio-loom to weave melt-spun absorbable polymers for bone tissue engineering.

Bone graft procedures are currently among the most common surgical procedures performed worldwide, but due to high risk of complication and lack of viable donor tissue, there exists a need to develop alternatives for bone defect healing. Tissue engineering, for example, combining biocompatible scaffolds with mesenchymal stem cells to achieve new bone growth, is a possible solution. Recent work has highlighted the potential for woven polymer meshes to serve as bone tissue engineering scaffolds; since, scaffolds can be iteratively designed by adjusting weave settings, material types, and mesh parameters. However, there are a number of material and system challenges preventing the implementation of such a tissue engineering strategy. Fiber compliance, tensile strength, brittleness, cross-sectional geometry, and size present specific challenges for using traditional textile weaving methods. In the current work, two potential scaffold materials, melt-spun poly-l-lactide, and poly-l-lactide-co-ε-caprolactone, were investigated. An automated bio-loom was engineered and built to weave these materials. The bio-loom was used to successfully demonstrate the weaving of these difficult-to-handle fiber types into various mesh configurations and material combinations. The dobby-loom design, adapted with an air jet weft placement system, warp tension control system, and automated collection spool, provides minimal damage to the polymer fibers while overcoming the physical constraints presented by the inherent material structure. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1342-1351, 2017.

Outcomes following impaction bone grafting for treatment of unstable osteochondritis dissecans

BackgroundMany methods have been proposed to treat unstable osteochondritis dissecans (OCD). Our purpose is to report outcomes in a cohort of patients undergoing impaction bone grafting for treatment of knee OCD. MethodsPatients undergoing impaction bone grafting for knee OCD between 1998 and 2011 were contacted and stratified into (a) those who have undergone subsequent surgery on the affected knee and (b) those who have not had revision surgery performed on the affected knee since the impaction bone grafting procedure. For those not undergoing another procedure, physical examination, radiographs, MRI, and functional outcomes (SF12, Tegner, Activity Rating Scale, and IKDC) were obtained. ResultsOf nine patients (10 knees) undergoing the procedure, seven (eight knees) were available for follow-up. Three had revision surgery. One had debridement due to surface overgrowth and had no symptoms 43months following debridement, while two had osteochondral allograft and autograft procedures at three and 10years after initial surgery, respectively. Four patients did not require a revision surgical procedure at average follow-up of 55.4months (range, 21–116months). All had complete MRI fill of the cartilaginous defect with less than 50% of surface irregularity and redeveloped the tidemark and a heterogeneous cartilaginous surface. Follow-up Tegner, ARS, and SF12-PCS averaged 6.8, 67.5, and 56.6, respectively. All four had good/excellent IKDC results. ConclusionImpaction bone grafting can reliably restore osteocartilaginous defect produced by OCD and is a readily available and less-expensive option in treating OCD lesions. Further investigation is necessary to determine the long-term durability of the results.Level IV – Case series

Minimally Invasive Plate Osteosynthesis (MIPO) for Proximal and Distal Fractures of The Tibia: A Biological Approach.

Introduction: The treatment of fractures of proximal and distal tibia is challenging, because of the limited soft tissue envelope and poor vascularity. The best treatment remains controversial and it depends on the fracture morphology, displacement and comminution. Treatment options vary from closed reduction and cast to open reduction and internal fixation with plate. Open reduction and internal fixation with plate can result in extensive dissection and tissue devitalization. We conducted a study on management of these fractures by biological osteosynthesis using Minimally Invasive Plate Osteosynthesis (MIPO) technique with preservation of osseous and soft tissue vascularity.Methods: We conducted a prospective study on closed reduction and percutaneous plating in 30 cases (mean age 42.7 years; 22 males and 8 females) of closed fractures of tibia. Among them 24 had proximal tibial fractures and 6 had distal tibial fractures. The mean time from injury to surgery was seven days.Results: The mean operative time was 72.6 minutes ( range: 55-90 minutes). Mean time for radiological union was 17 weeks (range: 14-22 weeks). There was one superficial wound infection which resolved with daily dressings and one week of oral antibiotics. One patient developed a nonunion which required a bone grafting procedure.Conclusions: The satisfactory functional results and lack of soft tissue complications suggest that this method should be considered in periarticular fractures. Biological fixation of complex fractures gives stable as well as optimal internal fixation and complete recovery of limb function at an early stage with minimal risk of complications.

Bone-Grafting in Polyostotic Fibrous Dysplasia.

Polyostotic fibrous dysplasia is a skeletal disease that results from somatic activating mutations in the gene GNAS in skeletal stem cells, leading to proliferation of immature osteogenic cells with replacement of normal marrow and bone with fibro-osseous tissue. Lesions may cause bone deformity or fracture. In the surgical care of polyostotic fibrous dysplasia, the role of grafting and the optimal grafting material are not clear. The purpose of this study was to evaluate the long-term survival of bone-grafting procedures in subjects with polyostotic fibrous dysplasia over time. The operative reports and radiographs of a cohort of subjects with polyostotic fibrous dysplasia followed in a natural history study were reviewed. Twenty-three subjects (mean age at the time of enrollment, thirteen years [range, two to forty years]) with fifty-two bone-grafting procedures had a mean follow-up time of 19.6 years (range, twenty-nine months to forty-seven years). Kaplan-Meier life table estimates, Cox proportional hazard models, and t tests comparing means were performed to assess various aspects of graft survival. Kaplan-Meier curves showed a 50% estimate of survival of 14.5 years. Cox proportional hazards models showed no advantage comparing allograft with autograft or structural with nonstructural graft materials. The mean age of the patients was significantly greater (p < 0.001) in the subgroup of subjects in whom grafts were maintained over time (20.9 years) compared with the subgroup of patients whose grafts were resorbed over time (9.8 years). Bone-grafting, including both allograft and autograft, is of limited value in ablating the lesions of fibrous dysplasia. The expectations of patients and surgeons should include the high probability of graft resorption over time with return of bone characteristics of fibrous dysplasia, particularly in younger patients. This suggests the maintenance of normal bone mechanics with implant support should be the priority of any surgical intervention.

Current Trends in Treatment of Kienböck Disease: A Survey of Hand Surgeons.

The cause and treatment of Kienböck disease is controversial. No treatment algorithm has been accepted. We surveyed US hand surgeons to determine trends and attitudes regarding the treatment of Kienböck disease. An online questionnaire was created focusing on specific treatments of Kienböck disease. The survey included 6 questions regarding the cause of disease, preferred vascularized bone grafting (VBG) procedure, and treatment of stages I, II, IIIA, and IIIB. Respondents were also asked to specify their geographic location of practice and the approximate number of years in practice. A total of 338 of the 2781 surgeons contacted completed the survey for a response rate of rate of 12%. The majority of respondents believe ulnar-negative variance alone contributes to the development of Kienböck disease. For treatment of a young ulnar-neutral male with stage I disease who had failed immobilization and nonsteroidal anti-inflammatory drugs, most hand surgeons chose distal radius core decompression. There was no preferred treatment among respondents for treatment of a young ulnar-neutral female with stage II disease. For treatment of a 40-year-old ulnar-negative male with stage IIIA disease, most hand surgeons chose a radial shortening osteotomy. The preferred treatment among respondents for treatment of stage IIIB disease is a proximal row carpectomy. Our study demonstrated that most hand surgeons believe ulnar-negative variance largely contributes to Kienböck disease and the most commonly preferred VBG technique utilizes the fourth and fifth extensor compartment arteries.

İmplant Destekli Sabit Metal-Seramik-Kompozit Hibrid Protez Yapımı

Rehabilitation of edentulous patients with excessivelly resorbed alveolar ridges with implant retained fixed partial dentures is clinically a challenging situation. Vertical and horizontal bone resorbtion creates malalligned jaw relations which mandates vertical and horizontal block bone grafting for proper soft tissue support and occlussion. Grafting implant site have some disadvantages in term of patient discomfort, treatment time, treatment cost and above all high risk of graft failure. The following case report presents an alternative method for the treatment of excesivelly resorbed maxilla with implant retained metalceramic composite dentures without any bone grafting procedure.

A Guided Surgical Technique for the Use of Small Diameter Implants in the Anterior Mandible: Report of a Case

Introduction: Over the last five years 3,276 implants have been placed at the University of Nevada Las Vegas School Of Dental Medicine. Of those, 55 have been small diameter implants (SDI), accounting for less than 2% of all dental implants. Nine SDI’s were placed for fixed restorations. This case report demonstrates the use of SDI’s for a fixed, splinted restoration, utilizing a surgical guide for both the osteotomies and implant placement. Methods: Two 2.0 mm × 15 mm SDI’s (Shatkin F.I.R.S.T.) were placed in the location of teeth #23 and #24. A surgical guide (Shatkin F.I.R.S.T Laboratory) was used for initial osteotomies to ensure proper angulation and for final placement of the SDI’s. A laboratory fabricated splinted acrylic temporary (Shatkin F.I.R.S.T.) was placed during the healing phase. Results: Both SDI’s displayed successful integration, based on the Health Scale for Dental Implants. The SDI’s displayed no mobility, no pain or tenderness upon function, <2 mm of radiographic bone loss from initial surgery, and no exudates. The final splinted Porcelain-Fused-to-Metal (PFM) restoration was fabricated using conventional crown and bridge techniques and was cemented using FujiCEM. Conclusion: SDI’s are indicated in cases where bucco-lingual bone width is limited and bone and soft tissue grafting are not possible. A surgical guide can be used to ensure proper placement and angulation of SDI’s. Placement of a single traditional implant with cantilever prosthesis has an increased chance of prosthesis failure in five years. SDI’s, in this application, have a success rate comparable to traditional implants. This case demonstrated a guided surgical technique for SDI’s without extensive bone or soft tissue grafting procedures.

Primary nutrient foramina of tibia and fibula and their surgical implications

Aim: The study analyzes the position of primary nutrient foramina of tibia and fibula. Materials and methods: 137 adult dry bones including 71 tibias and 66 fibulas were studied. The number and position of primary nutrient foramina was noted and the foraminal index was calculated. Results: A single primary nutrient foramen was observed in all the tibia and fibula. 97.18% of tibia had foramen on the posterior surface and 2.82% on medial surface. In the fibula all the foramina were on the posterior surface. The mean foraminal index was 32.08 in tibia and 44.60 in fibula. In the tibias 74.65% of the foramina were in the upper third and in the fibula 95.45% of the foramina were in the middle third. Conclusion: A knowledge of foraminal topography helps to preserve bone vasculature during surgeries. This increases the success of fracture fixation, bone grafting and knee replacement procedures involving the bones. Key words: Bone grafting; Fibula; Foraminal index; Primary nutrient foramen; Tibia

Extensive Autogenous Bone Augmentation and Implantation in Patients Under Bisphosphonate Treatment: A 15-Case Series.

Patients under bisphosphonate (BP) treatment could be at high risk for implant treatment and bone augmentation due to the association between BPs and osteonecrosis of the jaws (BRONJ). Fifteen patients with BP intake in their anamnesis because of osteoporosis were treated with extensive bone grafting procedures and dental implants after selection according to their individual risk profile. In 47 sites, mandibular bone blocks were grafted according to the split bone block technique and 14 sinus floor elevations were performed. A total of 71 implants were placed and restored after 4 months. Most of the grafted bone healed as expected, and all implants could be placed as planned. Two patients showed incomplete healing of the grafted bone and were regrafted during implant placement. Two other patients showed limited soft tissue necrosis that was handled successfully with local treatments. One immediately loaded implant was lost. All in all, healing was uneventful and comparable to patients with no history of BP intake. At up to 6 years of follow-up, no major bone loss, BRONJ, infections, or peri-implantitis had occurred and all implants were still well osseointegrated clinically and radiologically. Depending on individual risk profile, bone augmentation could be successfully performed in patients taking low doses of BP treatment. More research and studies are needed.

Planning Implant Placement on 3D Stereolithographic Models Applied with Immediate Loading of Implant-Supported Hybrid Prostheses After Multiple Extractions: A Case Series

The aim of this noninterventional, retrospective case series was to evaluate the outcome of immediately loaded implants in patients with failing dentitions that require bone tabling using a bone reduction guide and a surgical guide manufactured directly on three-dimensional (3D) stereolithographic models. Consecutive patients with failing dentition and at least two remaining teeth who were treated in a single center between December 14, 2009 and September 23, 2013 were eligible. All patients receiving implants loaded with a hybrid prosthesis on the same day as extraction with their surgery planned on 3D models and performed using a surgical guide manufactured in a laboratory on the planning model were included. Patients who had undergone bone grafting procedures were excluded. Descriptive statistical analyses of available data were performed, including life-table calculations to derive a cumulative survival rate (CSR). Two hundred twenty-eight patients (105 females and 123 males) received 1,657 implants (NobelActive) in 321 arches, in most cases 5 implants (range, 5 to 7) per arch. Ten preexisting implants were used. The mean insertion torque was 60.02 ± 13.1 Ncm (range, 15 to 75 Ncm). The definitive abutment was placed on the same day as surgery in all cases, and the definitive prosthesis (n = 304) was delivered after a mean of 7.9 ± 2.6 months. All implants were followed for 20.01 ± 11.3 months (range, 0 to 52 months) from implant insertion. Four implants (3 patients) had delayed loading, and one implant was left as a sleeping implant. Eight implants among six patients failed, two of the implants after prosthesis delivery. The CSR of the placed implants was 99.4% at implant level and 96.2% at patient level. Planning on 3D models to remove bone and place implants using custom-made bone reduction and surgical guides with immediate loading on the same day as extraction of remaining teeth was safe and effective for implant survival and rehabilitation of patients with periodontitis and failing dentition.

The Effect of Alendronate on Various Graft Materials Used in Maxillary Sinus Augmentation: A Rabbit Study.

Background:Increasing sinus pneumatization and the accompanying alveolar bone resorption complicate dental implant placement. This problem can be overcome today by raising the maxillary sinus floor with graft materials. Bisphosphonates are commonly used to accelerate the recovery of the graft materials and to prevent resorption.Objectives:The purpose of this study is to investigate whether systemic administration of a bisphosphonate (alendronate) would improve new bone formation and reduce fibrous tissue formation over a 6-week follow-up in rabbits treated with two different grafting materials for maxillary sinus floor augmentation.Materials and Methods:This experimental animal study was conducted at the Experimental Medical Application and Research Center at Erzurum/ Turkey. Twelve New Zealand rabbits, each weighing between 2.7 and 3.3 kg, were used. Twenty-four maxillary sinus floor elevation operations were performed, two on each animal (n = 24). Each elevation was repaired with either deproteinized bovine bone (xenograft) or autogenous bone graft obtained from the iliac crest. Both groups were divided into 2 subgroups: saline-treated and alendronate-treated. All groups underwent the same surgical procedures and evaluation, and were sacrificed at the 6th postoperative week. Sinuses augmented with deproteinized bovine bone (xenograft) and autogenous bone graft were examined histopathologically and histomorphometrically.Results:At 6 weeks, the bone area was significantly larger in the Xenograft-Alendronate group (33.0% ± 5.0%) than in the Xenograft-Saline group (20.8% ± 4.9%) and the bone area was significantly larger in the Autogenous-Alendronate group (43.3% ± 3.8%) than in the Autogenous-Saline group (37.5% ± 6.6%) (P = 0.001). The histomorphometric and histopathological results consistently showed that alendronate stimulated bone formation and reduced fibrous tissue formation in maxillary sinus augmentation grafts, especially in the deproteinized bovine bone group (xenograft).Conclusions:Alendronate may be considered a therapeutic option for improving the bone formation process and reducing resorption in different bone grafting procedures. Further detailed studies should focus on dosage and time-dependent effects of alendronate on bone remodeling.

Ridge augmentation in an organ transplant patient

With the continuing progress in medicine, the number of successful organ transplantations has continued to increase, a fact that also concerns dentists and implantologists. Implantology after organ transplantation remains controversial due to the patient's immunocompromised situation and the corresponding risk of infection. Only a few studies on this topic have been reported, with all of them showing the dental implant success rates in transplant patients to be similar to those in healthy subjects. However, immunosuppression has been identified as a contraindication to bone augmentation. Consequently, there is still a lack of knowledge regarding pre-implantology bone grafting procedures. The following case report describes the use of ridge augmentation and extended bilateral sinus lift procedures in a liver transplant patient. The patient was treated with an implant-supported fixed prosthesis in the upper jaw and was followed up for a total of 28 months after implant insertion. According to the findings presented, pre-implantology augmentation procedures may be performed successfully in immunosuppressed organ transplant patients. Stable peri-implant conditions were shown over a period of more than 2 years. Nevertheless, further investigations are needed to define a safe treatment protocol for these high-risk patients.