Bone Necrosis Research Articles

Effect of Snakebite on Osteomyelitis and Cardiac Shock in Pediatric and Adult Patients

Snakebite is a defense mechanism of snakes and can be a medical emergency. Snake venom contains a mixture of protein components that affect the functional activity of the target physiology. The structure of the poison in snake venom has different variations for different snake species. As for snakebite, it can be life-threatening if it has neurotoxic, cytotoxic, or hemotoxic toxic effects. The purpose of this study is to determine the relationship between snakebite incidence to osteomyelitis and cardiogenic shock. The results of this study can be used as a source of information and an objective correlation reference regarding the relationship between snakebite and osteomyelitis and cardiogenic shock. This research is a Systematic Review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses method or commonly called PRISMA, this method is carried out systematically by following the correct research stages or protocols. Antivenom neutralizes toxins in fixed quantities. Both children and adults are given the same amount of antivenom because snakes inject the same amount of poison into both adults and children. Antivenom can be effective as long as the poison is still active in the patient's body causing symptoms of systemic intoxication. It can last for several days or even weeks after the bite. After a series of processes have been passed, based on the results of research in the Scopus-indexed journal on the systematic "The Relationship of Snakebite with Osteomyelitis and Cardiac shock in Pediatric and Adult Patients" a conclusion can be drawn, namely that the majority of journals discuss heart disorders and infections, necrosis of muscles and bones related to poisonous snake bites.

Multiple maxillary periodontal abscesses as a manifestation of post-coronavirus disease 2019 mucormycosis: a case report

BackgroundCoronavirus disease 2019 makes patients more susceptible to superinfection of fungal disease as a consequence of immunological system impairment. Mucormycosis is a fungal infection that is rare but has a high mortality rate and mostly affects patients with poorly controlled diabetes mellitus or those receiving corticosteroids.Case presentationHere, we present a case of post-coronavirus disease 2019 mucormycosis in a 37-year-old Persian male presenting with multiple periodontal abscess with purulent discharge and necrosis of maxillary bone (without oroantral communication). Surgical debridement following antifungal therapy was the treatment of choice.ConclusionEarly diagnosis and immediate referral are the cornerstone of comprehensive treatment.

Is modified Carnoy’s solution as effective as Carnoy’s solution in terms of amount of bone necrosis and depth of penetration?

Carnoy’s solution, a chemical cauterisation agent, has been indicated as one of the adjuvant treatment modalities for odontogenic keratocyst. In 2000, after the ban of chloroform many surgeons adopted the use of Modified Carnoy’s solution. The purpose of this study is to compare the depth of penetration and amount of bone necrosis of Carnoy’s versus Modified Carnoy’s solution on the mandible of Wistar rats at different time intervals. Twenty-six male Wistar rats of six to eight weeks old, weighing approximately 150–200 grams, were allocated for this study. The predictor variables were type of solution and application time. The outcome variable was depth of penetration and amount of bone necrosis. Carnoy’s solution was applied on the defect on the right side of the mandible and Modified Carnoy’s solution on the left side for five minutes on eight rats, eight minutes on eight rats, and 10 minutes on eight rats. All specimens were subjected to histomorphometric analysis done using Mia image AR software. Univariate ANOVA test, and paired sample t test was done to compare the results. The depth of penetration for Carnoy’s solution was more than Modified Carnoy’s solution in the three different exposure times. Statistically significant results were observed at five minutes and eight minutes. The amount of bone necrosis was more in Modified Carnoy’s solution. The results were not statistically significant at the three different exposure times. To conclude, when one wants to use Modified Carnoy’s solution, the minimum exposure time should be 10 minutes to achieve similar results as those of Carnoy’s solution.

Effect of systemic antiresorptive medication on the histopathological parameters of implant osseointegration in an in vivo rodent study

BackgroundThe purpose of this study was to evaluate the osseointegration of zirconia and titanium implants in the rat maxilla in specimens under systemic antiresorptive therapy.Materials and methodsAfter 4 weeks of systematic medication administration (either zoledronic acid or alendronic acid), 54 rats received one zirconia and one titanium implants that were immediately inserted in the rat maxilla after tooth extraction. Twelve weeks after implant placement, histopathological samples were evaluated for implant osteointegration parameters.ResultsThe bone-implant-contact (BIC) ratio revealed no significant inter-group or inter-material differences. The distance between the implant shoulder to the bone level was significantly greater around the titanium implants of the zoledronic acid group compared to the zirconia implants of the control group (p = 0.0005). On average, signs of new bone formation could be detected in all groups, although often without statistical differences. Signs of bone necrosis were only detected around the zirconia implants of the control group (p < 0.05).ConclusionsAt the 3-month follow-up, no implant material was demonstrably better than the others in terms of osseointegration metrics under systemic antiresorptive therapy. Further studies are necessary to determine whether there are differences in the osseointegration behavior of the different materials.

Freezing nitrogen ethanol composite reduces periprosthetic infection caused by Staphylococcus aureus contaminated metal implants: An animal study.

Implant-associated infection remains a major complication of orthopedic surgery. The treatment of such infection is complicated by bacterial biofilm formation on the metal surfaces of implants. Biofilm surrounds and protects the bacteria against the organism's endogenous defense system and from external agents such as antibiotics and mechanical debridement. This study aims to evaluate whether freezing nitrogen ethanol composite (FNEC), the combination of liquid nitrogen and 95% ethanol in a 3 to 1 ratio, used frequently in bone tumor surgery, is capable of disinfecting Staphylococcus aureus contaminated implants. The femurs of six New Zealand white rabbits were implanted with S. aureus-contaminated screws, half of which were treated with FNEC before implantation. The femurs were harvested 14 days after implantation. Histological analysis and TUNEL assay were conducted. The autoclaved screw, contaminated screw, and FNEC-treated contaminated screw were investigated using scanning electron microscopy to evaluate the biofilm structure. The FNEC-treated group had significantly lower relative C-reactive protein levels. An obvious periosteal reaction at the implant site was observed in all rabbits in the non-FNEC group but none was observed in the FNEC-treated group. The FNEC-treated group exhibited fewer empty lacunae, less inflammatory infiltration, and less bone necrosis. Immunohistochemical analysis showed no S. aureus in bone tissue from the FNEC-treated group. Scanning electron microscopy showed disruption of the biofilm on the contaminated screw treated with FNEC. FNEC showed potential in disinfecting S.aureus-contaminated implants. Further investigation is warranted, such as the effect on the implant-cement-bone interface, for FNEC to be used clinically in treating implant-associated infection.

Diagnosis of Aseptic Osteonecrosis of the Femoral Head (AONTH)

Aseptic osteonecrosis is a frequent pathology. It corresponds to epiphyseal bone necrosis, secondary to ischemic and/or cytotoxic mechanisms. It is not a specific disease, but rather the final outcome of various pathological situations in which there is a disturbance of the intraosseous circulation of the femoral head. This explains the usual names of avascular necrosis or aseptic necrosis. It may be unilateral, bilateral or multifocal. More than 75% of aseptic osteonecrosis involve the femoral head. Many risk factors must be considered, such as corticosteroid therapy, alcoholism, dyslipidemia or sickle cell disease. It is important to diagnose osteonecrosis in the potentially reversible stages of the disease. It is a condition that is all the more disabling because it affects the young adult, in the middle of an active life, in the presence of pain in the groin crease of a young man who tends to take steroids, when the femoral head is still spherical on standard radiography. Magnetic resonance imaging has profoundly changed our diagnostic possibilities, showing pathognomonic signs while the radiograph may still be normal. Aseptic osteonecrosis of the femoral head (AONTH) often poses a problem of differential diagnosis with other coxopathies, which is a source of diagnostic delay in medical practice.

Silica coated high performance oxide ceramics promote greater ossification than titanium implants: an in vivo study

BackgroundThis in vitro study investigated the osseointegration and implant integration of high performance oxide ceramics (HPOC) compared to titanium implants in rabbits.MethodsHistomorphometry was conducted around the distal, proximal, medial, and lateral aspects of the HPOC to quantify the amount of mature and immature ossification within the bone interface. Histomorphometry was conducted by a trained musculoskeletal pathologist. The region of interest (ROI) represented the percentage of surrounding area of the implant. The percentage of ROI covered by osteoid implant contact (OIC) and mature bone implant contact (BIC) were assessed. The surrounding presence of bone resorption, necrosis, and/or inflammation were quantitatively investigated.ResultsAll 34 rabbits survived the 6- and 12-week experimental period. All HPOC implants remained in situ. The mean weight difference from baseline was + 647.7 mg (P < 0.0001). The overall OIC of the ceramic group was greater at 6 weeks compared to the titanium implants (P = 0.003). The other endpoints of interest were similar between the two implants at all follow-up points. No difference was found in BIC at 6- and 12-weeks follow-up. No bone necrosis, resorption, or inflammation were observed.ConclusionHPOC implants demonstrated a greater osteoid implant contact at 6 weeks compared to the titanium implants, with no difference found at 12 weeks. The percentage of bone implant contact of HPOC implants was similar to that promoted by titanium implants.

Vancomycin-nanofunctionalized peptide-enriched silk fibroin to prevent methicillin-resistant Staphylococcus epidermidis-induced femoral nonunions in rats.

Implant-related infections and infected fractures are significant burdens in orthopedics. Staphylococcus epidermidis is one of the main causes of bone infections related to biofilm formation upon implants. Current antibiotic prophylaxis/therapy is often inadequate to prevent biofilm formation and results in antibiotic resistance. The development of bioactive materials combining antimicrobial and osteoconductive properties offers great potential for the eradication of microorganisms and for the enhancement of bone deposition in the presence of infections. The purpose of this study is to prevent the development of methicillin-resistant S. epidermidis (MRSE)-infected nonunion in a rat model. To this end, a recently developed in our laboratories bioactive material consisting of antibiotic-loaded nanoparticles based on carboxylic acid functionalized hyperbranched aliphatic polyester (CHAP) that are integrated into peptide-enriched silk fibroin sponges with osteoconductive properties (AFN-PSF) was employed, whose biocompatibility and microbiological tests provided proof of its potential for the treatment of both orthopedic and dental infections. In particular, non-critical femoral fractures fixed with plates and screws were performed in Wistar rats, which were then randomly divided into three groups: 1) the sham control (no infection, no treatment); 2) the control group, infected with MRSE and treated with peptide-enriched silk fibroin sponges incorporating non-drug-loaded functionalized nanoparticles (PSF); 3) the treated group, infected with MRSE and treated with peptide-enriched silk fibroin sponges incorporating vancomycin-loaded functionalized nanoparticles (AFN-PSF). After 8 weeks, bone healing and osteomyelitis were clinically assessed and evaluated by micro-CT, microbiological and histological analyses. The sham group showed no signs of infection and complete bone healing. The PSF group failed to repair the infected fracture, displaying 75% of altered bone healing and severe signs of osteomyelitis. The AFN-PSF treated group reached 70% of fracture healing in the absence of signs of osteomyelitis, such as abscesses in the cortical and intraosseous compartments and bone necrosis with sequestra. AFN-PSF sponges have proven effective in preventing the development of infected nonunion in vivo. The proposed nanotechnology for local administration of antibiotics can have a significant impact on patient health in the case of orthopedic infections.

Chondroblastoma: clinicopathological analyses of 307 cases from a single institution in China and the diagnostic value of the H3F3 K36M mutant antibody

AimsTo elucidate the clinicopathological features and the diagnostic value of mutation specific antibody H3F3 K36M of chondroblastoma (CB) in China.MethodsClinicopathological profiles were retrieved, and immunohistochemistry was performed on 185 CB...

Pseudotumor as adverse local tissue reaction due to implant corrosion

Introduction. The term adverse local tissue reactions (ALTRs) is used to describe pathologic tissue conditions appearing after total joint replacement, and it includes osteolysis, bone necrosis, muscle necrosis, cystic lesions, excessive fluid collections, soft tissue masses, pseudotumors, metal sensitivity, metallosis, and chronic inflammatory lesions. ALTRs are rarely described in the literature after the breakage of the ceramic components of the hip prosthesis. Case report. We present a case of a patient with massive fluid collections filled with metallic and tissue detritus, along with signs of systemic cobalt (Co) and chromium (Cr) intoxication. Symptoms developed after revision of the acetabular component with the application of a metal-on-polyethylene coupling. Previously, several revisions were made due to breakage of the ceramic components of the endoprosthesis and instability of the hip. After removal of pseudotumor masses and revision of all components of the endoprosthesis with implantation of a coupling between the ceramic head and the polyethylene insert, there was a significant drop in the serum values of Co and Cr. Conclusion. Trunnion damage should be assessed during revision procedures, and if present, both prosthetic components should be replaced to prevent disastrous effects of metallic corrosion, ALTRs, and systemic metallic ions intoxication. Measurement of serum levels of Co and Cr in patients after joint replacement could identify patients at risk for the development of ALTRs and metallosis.

Implant Compression Necrosis: A Scrupulous Review

Currently when the implant is placed it deals with various mechanical stresses before it integrates with the bone. The stresses may cause micromovement that jeopardises the healing process in early stages. These stresses aggravate as the implant goes deeper into the bone and somewhat accounts for increased friction and torque. Excess torque at the insertion time may lead to bone compression which if crosses its physiologic limit may lead to a bloodless field i.e. ischemia following necrosis or sequestrum formation which in turn will cause implant failure. This is termed as compression necrosis. Too much torque levels may result in high levels of strain transmitted to adjacent bone. The crestal area around the implant is mainly comprised of cortical bone which has minimum blood supply and is exposed to extreme strain making it more vulnerable to bone necrosis and which is paramount to the failure of implant. An attempt has been made to review the physiologic effect of alveolar bone on compression necrosis the mechanism and histopathology behind compression necrosis factors leading to compression necrosis like excess torque strain macrogeometry of implants implant design and methods to avoid compression necrosis.

Extracorporeal Shockwave Therapy in Osteonecrosis of the Femoral Head: Where Do We Stand?

Osteonecrosis of the femoral head (ONFH) is a progressive disease characterized by ischemic lesions and structural damage in the head of the femur caused by insufficient blood supply due to multiple etiologies. As a safe, effective, non-invasive, and low-cost treatment strategy, Extracorporeal Shockwave Treatment (ESWT) is now widely applied in musculoskeletal disorders such as delayed bone healing, bone marrow edema (BME), knee osteoarthritis, and certain types of avascular bone necrosis. ESWT may promote vascularization and osteogenesis through a cascade reaction stimulated by the transformation of physical energy, promoting tissue regeneration, and repair. ESWT is recommended in treating early-stage ONFH. Keywords: Shock waves; ESWT, Femoral head osteonecrosis

Corticosteroid-induced avascular bone necrosis and possible association with prior COVID-19 infection

Corticosteroid is a frequent implicating factor for the development of avascular bone necrosis (AVN). The etiology of corticosteroid-induced AVN is not fully understood, but it includes fat hypertrophy, fat embolism, and intravascular coagulation that causes obstruction of blood supply to the bone. This association can be carried forward for COVID-19 as well since it is also a microvascular disease. Suffering from COVID-19 and prescription of glucocorticoids could both be responsible for AVN. Early recognition of this complication is essential as the prognosis is affected by the stage of the disease.

Effect of Folic Acid on Avascular Bone Necrosis in mice Associated with Hypercholesterolemia

Effect of Folic Acid on Avascular Bone Necrosis in mice Associated with Hypercholesterolemia

Just as the virus can mutate, so can coronavirus disease 2019-related bone necrosis!

Abstract Background The pandemic of COVID-19 virus had led to another pandemic of avascular necrosis. Aim To evaluate the altered clinical and radiological presentation of COVID-19-related AVN of the hip. Methods This study included 42 patients with AVN of the head of the femur who were presented to the outpatient clinic of Kafr El Sheikh University Hospital. Patients were classified into three main groups. The first group included patients who had COVID infection and received steroid therapy for their pulmonary manifestations. The second group included patients who had COVID infection without receiving steroid therapy. The final group included patients who had AVN of the hip after receiving COVID vaccination without taking any steroid therapy. Results The study included 42 patients who had AVN related to COVID-19 infection. Patients who had COVID-19 infection were more susceptible to AVN development at (a) lower threshold dose of steroid (900 g) and (b) earlier onset of presentation (less than a month). Conclusions To conclude, there is a silent epidemic of cases presenting daily in our clinics with COVID-19-related AVN.

KIENBÖCK'S DISEASE, AVASCULAR NECROSIS OF THE LUNATE

Introduction: Avascular necrosis of the lunate bone was described in 1910 by the Austrian radiologist Robert Kienböck, which is named after him. A mixture of different factors such as mechanical, vascular and genetic predisposition may be related to the pathogenesis of this disease. As for the natural evolution of the disease, failure in early diagnosis and early treatment may lead to a gradual evolution from stage I to stage IV, causing discomfort to the patient. Objective: to detail the current information related to avascular necrosis of the lunate, description, etiology, classification, imaging presentation and management of Kienböck's disease. Methodology: a total of 32 articles were analyzed in this review, including review and original articles, as well as clinical cases, 20 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: Kienböck, avascular necrosis of the lunate and lunatomalacia. Results: it is the second most frequent cause of avascular necrosis of the carpal bones and generally affects males between 20 and 40 years of age. Nuclear magnetic resonance has a greater contribution due to greater sensitivity and detection of radiographically occult cases, computed tomography also has a good specificity at the time of diagnosis. Radiography at the beginning of the disease does not present evident changes and nuclear scintigraphy presents non-specific findings. In the first stage, the treatment is based on immobilization with a plaster cast or splints. When incomplete necrosis is evidenced in the second stage, conservative treatment can be performed, however with complete necrosis or in the third and fourth stage, it requires "joint leveling" surgery and probably vascular bone grafting or transfer of branches of adjacent arteries. Stage IIIA usually merits lunate restoration, in stage IIIB and Lichtman IV wrist arthrodesis can be used. Conclusions: Kienböck's disease presents with unilateral pain over the dorsal aspect of the wrist, weakness and limited wrist motion, in addition to functional impotence, decreased grip strength, wrist edema, sensory disturbances in the median nerve territory and synovitis, depending on the stage. It is related to the following variables such as ulnar minus or ulnar negative variation, vascular contribution of the lunate bone, morphology of the lunate, radial inclination angle. The diagnosis is clinical and imaging where Lichtman's classification is useful. Treatment will depend on the cause and also on the stage of the disease.

Effect of thermal osteonecrosis around implants in the rat tibia: numerical and histomorphometric results in context of implant removal

The purpose of this rat study was to explore the feasibility of in vivo temperature thresholds affecting bone contact at the implant surface. Based on these data, thermal necrosis should be used for implant removal in the subsequent in vivo study. Rat tibiae of 48 animals at one site were randomly treated with heat or cold before implant insertion. Temperatures of 4 °C, 3 °C, 2 °C, 48 °C, 49 °C and 50 °C for a tempering time of 1 min were evaluated. Numerical simulations of the heat source-implant-bone system were carried out. Effects were assessed by histomorphometrical measurements. The results showed that the selected method of direct tempering using a tempering pin was suitable for maintaining a uniform layer around the pin. Starting at warm temperatures of 48 °C and rising to 50 °C, the BIC ratio revealed declining values and a significant difference was observed when comparing 50 °C to the control group (p = 0.03). However, there were no significant variations within the cold temperatures. This study pinpointed temperature discovered that could lead to the thermo-explantation and so that the number of samples used in future studies on temperature-induced bone necrosis can be reduced to a minimum. Significant BIC value reduction was seen at a temperature of 50 °C for 1 min.

Analysis of clinical prognosis of endoscopic salvage surgery in patients with rT2 recurrent nasopharyngeal carcinoma

Objective: To investigate the feasibility of endoscopic salvage surgery for patients with rT2 recurrent nasopharyngeal carcinoma (rNPC) and to analyze their prognostic factors. Methods: The clinical data of 33 patients with rT2 rNPC who underwent endoscopic extended nasopharyngectomy in Eye & ENT Hospital Affiliated to Fudan University from January 2015 to July 2020 were analyzed, including 29 males (87.9%) and 4 females (12.1%), aging (51.7±10.6) years. The clinicopathological characteristics of these patients were recorded and analyzed, in terms of gender, sex, alcohol and cigarette use, interval between primary treatment to recurrence, adjuvant therapy, lymph node metastasis, internal carotid artery (ICA) invasion, necrosis, margin and reconstruction materials. Kaplan Meier analysis was used to plot the overall survival rate and progression free survival rate curve, Log-rank test was used to analyze the prognostic factors among patients, and multivariate Cox proportional hazards regression was used to determine the independent risk factors of tumor progression free survival. Results: Among 33 patients with rT2 rNPC, the recurrence interval of 24 patients with rNPC after primary radiotherapy was more than 2 years. A total of 25 patients received primary radiotherapy and adjuvant chemotherapy at the same time. There were 6 cases with cervical lymph node metastasis, 12 cases with ICA invasion, 8 cases with positive surgical margin, 7 cases underwent ICA embolization before operation. A total of 18 cases underwent pedicled tissue flap repairment after operation, including 12 pedicled nasal septal mucosa flaps and 6 temporalis muscle flaps. The median follow-up time was 15 months. Five patients died because of disease progression (in 2 cases), post surgical ICA hemorrhage (in 1 case), liver metastasis (in 1 case) and dysphagia (in 1 case). The 1-year, 2-year and 3-year overall survival rates of all patients were 93.9%, 81.8% and 81.8%, respectively. The 1-year, 2-year and 3-year progression free survival rates were 74.7%, 59.7% and 40.9%, respectively. Log-rank statistical analysis showed that the positive surgical margin (P=0.060) and recurrence interval (P=0.151) were possibly related to the prognosis of rT2 rNPC. Multivariate Cox regression analysis showed that the positive surgical margin was an independent risk factor for patients with rT2 rNPC (P=0.034). Nasopharynx hemorrhage occurred in 4 patients, skull base bone necrosis occurred in 2 patients, trismus occurred in 3 patients, and no obvious brain complications occurred in 7 patients with ICA embolization. Conclusion: Endoscopic salvage surgery for rT2 rNPC is a safe and effective surgical option, but the long-term effect still needs long-term follow-up in bulk cases.

Major approaches to ozone therapy in endodontic treatments for bone infections and necrosis: a systematic review

Introduction: The bacterium Staphylococcus aureus is, in most cases, the agent of the disease. Thus, inflammation of the bone marrow can cause compression of the bone tissue walls and decrease or blockage of blood supply in the region's blood vessels, which can induce bone necrosis. Clinical studies have demonstrated the efficiency of ozone therapy in the treatment of peritonitis, infected wounds, and advanced ischemic disease. Objective: It was demonstrate the main scientific findings of the use of antiseptic ozone therapy in endodontic treatment. Methods: The research was carried out from July to October 2022 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 127 articles were found, and 57 articles were evaluated and 29 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 10 studies with a high risk of bias and 28 studies that did not meet GRADE. Most studies showed homogeneity in their results, with I2 =96.8% &gt;50%. Ozone therapy is scientifically proven and demonstrated in this work, it proved to be effective for tissue repair and the prevention and treatment of bone necrosis. It was observed that patients undergoing chemotherapy, radiotherapy, and antiresorptive drugs are more affected by bone necrosis. It was also observed the importance of the patient feeling that the treatment works and is restoring his ability to reinvent himself and adapt to his social environment. Treatments should not only be based on established numbers and protocols, without analyzing the specific sensations and perceptions of each patient with their lived reality.

Les troisièmes molaires dans la décision thérapeutique en orthodontie

Despite a high prevalence of agenesis, third molars should frequently be considered in our orthodontic treatment plans. The aim of this study was to describe, according to the literature, the therapeutic possibilities of third molar management. The avulsion isn't systematic. The French National Authority for Health has updated its guidance about it. Indeed, surgical procedures can present with potentially irreversible risks (nerve damage, bone necrosis). It is necessary to assess the benefit/risk balance and to inform the patient accordingly. Whether symptomatic or not, pathological third molars are among the most obvious indication for avulsion as well as third molars that may lead to resorption or carious lesion of the adjacent molar. On the other hand, it is not recommended to avulse third molars to prevent the appearance of anterior crowding or in case of a favorable evolution. Some of our orthodontic therapies can lead to the avulsion of the third molars: the orthognathic surgery (especially mandibular surgery) or the distalization. They can be placed by transplantation, by mesialization, sometimes with the help of bone anchors, or by straightening the axis for a prosthetic or implant-prosthetic restoration. In the adolescent, the germs of the third molars would not limit the amount of distalization; these molars would continue to grow despite the distalization of the more anterior molars. Wisdom teeth should be considered as third molars in their own right and can thus be used in edentulous situations.