Bony Defects Research Articles

Three-Dimensional Printed Polycaprolactone Mesh in Pediatric Cranial Vault Remodeling Surgery.

The surgical management of craniosynostosis has greatly evolved with improvements in both technology and understanding of the disease process. Some drawbacks remain regarding bone regeneration within the surgical bony gaps. Generally, bony gaps improve in the 12 to 24 months after surgery, but some gaps may remain for longer and cause deformity and/or require additional bony reconstruction. These considerations make tissue-engineered bone very attractive. Novel 3-dimensional printed bioresorbable mesh implants made of Polycaprolactone (PCL) can be used to fill the surgical bony defects. The authors seek to investigate how the use of a 3-dimensional printed biodegradable PCL mesh applied to bony defects in cranial vault surgery affects bone healing. Case series analysis of 8 pediatric patients who have undergone surgical intervention using PCL mesh implants for reconstruction of bony defects during craniosynostosis correction surgery. Radiological evaluation of 3 patients at random time points between 9 and 12 months postoperative revealed persistent bony gaps in areas where PCL mesh was laid. One patient who underwent a subsequent cranial vault surgery at 9 months was found to have less bone regeneration in the defect area where PCL mesh was used when compared with an adjacent area where a particulate bone graft was used. Based on our experience, the use of PCL mesh on its own did not augment bone regeneration. It is possible that a greater amount of time or increased vascularization of the scaffold is required, which supports the concept of regenerative matching axial vascularization or the further addition of osteogenic factors to increase the rate of bone formation.

Arthroscopic Hill-Sachs Filling Technique Using an Absorbable Interference Screw

We present an arthroscopic technique used to treat traumatic shoulder instability in the patient with a Hill-Sachs lesion, especially an off-track lesion. The incidence of this bony defect is approximately 40% to 90% of all anterior shoulder instability cases—and up to 100% in patients with recurrent anterior instability. Incorrect management of this humeral bone defect can lead to treatment failure, and it is essential to define characteristics such as the lesion’s location, depth, width, and orientation. Many arthroscopic and open procedures have been described for the surgical management of the Hill-Sachs lesion. Using arthroscopy for the surgical treatment of shoulder instability offers numerous advantages. We describe an arthroscopic technique that consists of filling the Hill-Sachs lesion with absorbable interference screws made out of an advanced biocomposite material. After repair of the Hill-Sachs lesion, the Bankart lesion is repaired. As these screws are resorbed by bone tissue over several months, the bony anatomy is restored.

Bioactive Porous Particles as Biological and Physical Stimuli for Bone Regeneration.

Even though bony defects can be recovered to their original condition with full functionality, critical-sized bone injuries continue to be a challenge in clinical fields due to deficiencies in the scaffolding matrix and growth factors at the injury region. In this study, we prepared bone morphogenetic protein-2 (BMP-2)-loaded porous particles as a bioactive bone graft for accelerated bone regeneration. The porous particles with unique leaf-stacked morphology (LSS particles) were fabricated by a simple cooling procedure of hot polycaprolactone (PCL) solution. The unique leaf-stacked structure in the LSS particles provided a large surface area and complex release path for the sufficient immobilization of BMP-2 and sustained release of BMP-2 for 26 days. The LSS was also recognized as a topographical cue for cell adhesion and differentiation. In in vitro cell culture and in vivo animal study using a canine mandible defect model, BMP-2-immobilized LSS particles provided a favorable environment for osteogenic differentiation of stem cells and bone regeneration. In vitro study suggests a dual stimulus of bone mineral-like (leaf-stacked) structure (a physical cue) and continuously supplied BMP-2 (a biological cue) to be the cause of this improved healing outcome. Thus, LSS particles containing BMP-2 can be a promising bioactive grafting material for effective new bone formation.

Overcoming the Technical Challenges of Total Knee Arthroplasty in Patients Affected by Hereditary Multiple Exostoses: a Case Report and Literature Review

Hereditary multiple exostoses (HME), also known as familiar osteochondromatosis or diaphyseal aclasis, are an autosomal dominant inherited genetic pathology that is characterized by the presence of multiple benign osteochondromas. Knee deformity is common in patients with HME, with nearly a third of patients developing genu valgus. Total knee arthroplasty (TKA) has been used to correct valgus deformities with advanced knee osteoarthritis (OA). However, concomitant limb deformities and altered anatomy of the knee make this surgery particularly challenging. We present a case report and a mini-review of the literature on this topic. We present the case of a 50-year-old Caucasian woman, affected by hereditary multiple exostoses, who came to our attention for progressive pain in the right knee. Upon further examination, the knee had a prominent valgus alignment, concomitant valgus instability, and flexion contraction. The patient was treated with total knee arthroplasty using a semi-constrained design. The patient was re-evaluated at 24-month follow-up, and there were no signs of implant loosening, the knee function improved significantly, and the patient was very satisfied. Given the recurring technical difficulties of such procedure in these patients, we describe our experience as well as the need for preoperative planning, the use of appropriate constraint when required, the high frequency of ligament instability, bony defects, and patellar maltracking. TKA must be considered when necessary, in these patients, as good to excellent clinical results can be achieved and maintained, allowing for significant improvements in quality of life.Core Tips- TKA in HME-affected patients carries specific but manageable challenges.- Due to bone deformities and frequent severe valgus knee alignment, TKA should be considered even in younger patients.- Revision implants provide the flexibility and the necessary fixation, not always achievable with primary implants.- Bigger size components may be necessary in HME patients compared with patients of the same height.- Lateral ligament releases may often be necessary due to long-standing valgus deformity. If stability cannot be achieved, the use of a hinged implant should be considered.- Cementation of the metaphysis or the use of sleeves can provide additional rotational stability to the implant.

Correlation of soft tissue and skeletal injuries in cases of violent death: A retrospective study of autopsy cases for forensic anthropology.

In forensic pathology, deaths due to mechanical injuries (blunt, sharp, and gunshot) require an autopsy in order to determine the cause and manner of death through a detailed examination of viscera, soft tissues, and the skeletal system. Sometimes, such as in cases of severe putrefaction, only the skeleton is observable. In such cases, the absence of bony defects does not mean that a trauma-related death should not be considered: yet, how often will a lethal mechanical death produce a defect in the skeletal system? The present study involved a retrospective review of autopsy reports to investigate the frequencies of soft tissue and related skeletal injuries in cases of violent deaths. A total of 200 autopsy reports for cases of four mechanisms of injury including sharp force trauma (n=50), gunshot (n=50), blunt force trauma (n=50), and mechanical asphyxia (n=50) were examined. Manner of death, localization of bone fractures, and correspondence between external injuries and bone fractures were reported. Frequencies of bone fractures and degree of correspondence with soft tissue injuries for each trauma group were evaluated. The result showed that lethal blunt trauma always caused bone fractures; 94.0% of violent deaths by gunshot involved bones; 48.0% of sharp force soft tissue injuries involved the bone tissue; and hyoid bone fractures were observed in 20.0% of cases of mechanical asphyxia.

26P Circulating osteocalcin-positive cells, as a novel biomarker for monitoring the therapeutic effects on bone metastasis

Imaging-based assessment for tumor progression in bone metastasis is difficult because of the nature of fixed bony defects and their complexity. The aime of this study was to investigate the circulating osteocalcin-positivecells (cOC) in the peripheral blood as a biomarker for monitoring the therapeutic effects on bone metastasis.

Variable Morphology of Sacrum in General Population

Background: One of the large trilateral bones present at the base of the vertebral column is named as sacrum. The body weight transfers from trunk to pelvis and lower extremities. Different studies considering sacral morphological variations are conducted in the western world. The scope and knowledge of these studies in the eastern world is limited. Different sacral anatomies are reported by the scientists. Objective: The purpose of the study was to investigate and measure thoroughly the variable morphologies of sacrum. Study design: It is an investigational and cross-sectional study facilitated by statistical approach. Material and Methods: The study was conducted on 223 skeleton samples. These samples were preserved in the anatomy department of Mufti Mehmood Teaching Hospital Dera Ismail Khan and Bacha Khan Medical Complex Swabi during the period from October 2021 to June 2022. The human research ethical committee of the hospital approved the study. The vernier caliper was used to measure the correlation parameters of variability. The morphological features were calculated. The study also calculated the sacral variation incidence. The sacra with any kind of bony defects were excluded from the study. Results: The anatomical differences reported in the 223 samples were observed to be 59%. Out of the 223 patients the 81 were females and 142 were males. The five variations were reported in the sacral regions, while two samples have the rare sacral variations. The mean age of the included sample was observed to be 44 years. The age of the people whose sacral samples were included in the study was between 21-72 years. The percentage incidence of accessory auricular faces was observed to be 12.5%. The sacral skewness was observed in 24% cases. The 17% showed the transitional vertebra, while sacral spina bifida occulta was seen in 28% samples. Conclusion: This large scale anatomical study provides information about the apparent changes in the morphology of different sacral variables. This study provides comprehensive data about the different sacral variations. The detailed information about the human sacrum is provided. The apparent identification methods by western medical officers are also considered in this work which may help our medical staff to identify the sacral variations. Keywords: Sacrum variations, Sacrum morphology, Accessory auricular faces, Transitional vertebra and Sacral spina bifida occulta

Symptom: Runny Nose Six Years After Acoustic Neuroma Surgery

Symptom: Runny Nose Six Years After Acoustic Neuroma Surgery

Latest Findings of the Regenerative Materials Application in Periodontal and Peri-Implant Surgery: A Scoping Review

Regenerative dentistry represents a therapeutic modern approach involving biomaterials and biologics such as mesenchymal stem cells. The role of regenerative dentistry is promising in all branches of dentistry, especially in periodontology and implantology for the treatment of bony defects around teeth and implants, respectively. Due to the number of different materials that can be used for this purpose, the aim of the present review is to evidence the regenerative properties of different materials both in periodontitis and peri-implantitis as well as to compare their efficacy. Clinical trials, case-control studies, cross-sectional studies, and cohort studies have been considered in this review. The outcome assessed is represented by the regenerative properties of bone grafts, barrier membranes, and biological materials in the treatment of intrabony and furcation defects, peri-implantitis sites, alveolar ridge preservation, and implant site development. Based on the studies included, it can be stated that in the last years regenerative materials in periodontal and peri-implant defects treatments have shown excellent results, thus providing valuable support to surgical therapy. To achieve optimal and predictable results, clinicians should always consider factors like occlusal load control, prevention of microbial contamination, and wound dehiscence. Further evidence is required about the use of enamel matrix derivative in alveolar ridge preservation, as well as of stem cells and bone morphogenetic proteins-2 in furcation defects and peri-implantitis sites. Considering the high amount of research being conducted in this field, further evidence is expected to be obtained soon.

A Viability Analysis of Tumor-Bearing Frozen Autograft for the Reconstruction After Resection of Malignant Bone Tumors Using 99m Tc-MDP Scintigraphy.

Several methods are used to reconstruct bony defects after malignant tumor excision. Tumor-bearing frozen autograft reconstruction is a biological procedure in which tumor-bearing bone is reused after devitalization with liquid nitrogen to kill tumor cells. The viability of frozen autografts has not been fully evaluated over time. We therefore aimed to evaluate the viability of devitalized bone grafts, using 99m Tc-MDP scintigraphy. Seventy-four patients who underwent frozen autograft reconstruction after the excision of a malignant bone tumor were enrolled. Two hundred forty-two postoperative 99m Tc-MDP scans were reviewed. For a quantitative analysis, the region of interest on the frozen bone segment and a symmetric region of interest on the contralateral normal area were manually set. The radioactive tracer uptake ratio was calculated by dividing the count density of the frozen bone segment by that of the contralateral normal area in each image. An uptake ratio of 0.9 to 1.1 was defined as a normalization of tracer uptake. Normalization of tracer uptake was achieved in 95% to 97% of the cases by 60 months postoperatively, and earlier in the middle zone and peripheral zone in the pedicle freezing group in comparison to the free freezing group (both P = 0.03). Fracture and nonunion was associated with a low uptake ratio, whereas infection was associated with a high uptake ratio before the occurrence of the event. The calculation of the uptake ratio using 99m Tc-MDP scans was an objective and accurate evaluation method. The period to normalization of tracer uptake in the pedicle frozen bone was significantly earlier than that in the free frozen bone. The postoperative complications can be also predicted.

Long-term results in three-dimensional, complex bone augmentation procedures with customized titanium meshes.

Complex, three-dimensional bony defects still represent challenging situations in routine implant dentistry. The aim of this study was to evaluate implant survival in customized bone regeneration using a patient-specific titanium mesh. Patients (n= 21, implants 36) who had obtained an augmentation procedure with patient-specific titanium mesh were examined after 5.7± 0.38 years. Survival rate, clinical parameters for periimplantitis (Bleeding on Probing [BOP] and suppuration), and radiographic examination were evaluated. Peri-implant marginal bone loss (MBL) was calculated by using an image assessment program. Additionally, the influence of various factors on treatment outcomes such as periodontitis, smoking, professional maintenance, or diabetes was assessed as well as the impact on quality of life applying the Oral Health Impact Profile (OHIP). The implant survival rate was 97%, with one implant loss in the lower jaw. At the end of the observation period, MBL showed mesial 0.13± 1.84 mm and distal -0.13± 1.73 mm. The lower jaw showed significant more MBL mesial compared with the upper jaw (p= .034, cluster-adjusted). Periodontitis was significantly associated with MBL mesial and distal (p< .05). Positive BOP (four implants) was significantly associated with MBL mesial (p= .0031) and distal (p= .0018). MBL was significantly associated with suppuration mesial (p< .0001) and distal (p< .0001). CBR® results in high implant survival rate and stabilized augmented marginal bone after follow-up of minimum 5 years. Periodontitis seems to play the mayor role for long-term stability indicated by BOP and suppuration.

Prospective Clinical Study with New Materials for Tissue Regeneration: A Study in Humans.

This study was performed to evaluate the clinical, radiographic, and histomorphometric outcomes of novel bone grafting materials and dental membranes and to compare the results with current data from the literature. New synthetic bone substitutes, consisting of biphasic calcium phosphate in the ratio of 60% hydroxyapatite and 40% β-tricalcium phosphate, were applied in bony defects and covered by either a novel synthetic poly(lactic-co-glycolic) acid (PLGA) or porcine collagen membrane. A sample of 51 biomaterials was placed in a total of 20 patients during different surgical protocols. Implants were simultaneously inserted, and in the case of sinus floor elevations 6 months later. Pre- and postoperative cone-beam computed tomographies were taken. Bone biopsies were harvested from augmented sides and processed for histomorphometric evaluation. Averages and ranges were calculated for the percentage of newly formed bone, residual biomaterial, and connective tissue. Data were submitted to analyze the radiological mean differences in length, width, and density. Paired t-tests were deployed for the analysis of differences within each group between the baseline (preoperative) and the final (postoperative) measurements. The mean bone gain in length and width were 0.96 ± 3.33 mm (+27.59%) and 1.22 ± 1.87 mm (+30.48%), respectively. The bone density was increased by a factor of 4, reaching an average of 387.47 ± 328.86 HU. Histomorphometric evaluations revealed new bone formation of 41.44 ± 5.37%, residual biomaterial of 24.91 ± 7.31%, and connective tissue of 33.64 ± 4.81%. The mean healing period was 8.32 ± 3.00 months. Data from this study confirmed the suitability of the tested materials in dental surgery. The biomaterials may be recommended for various clinical procedures. A satisfactory level of increase of new bone was reported in augmented sides. No significant differences were observed between the tested membranes. PLGA membranes might be superior to collagen membranes for their easier handling.

Morphometric and Biomechanical Comparison of the Scapular Spine and Coracoid Graft in Anterior Shoulder Instability

Background: The scapular spine has been described as a relatively new bone graft alternative used in glenoid augmentation. The classic Latarjet procedure, which transfers the coracoid as a graft, is regarded as the gold standard. The comparison of these 2 techniques has not been fully reported. Purpose: To compare the anatomic and biomechanical properties of glenoid augmentation using scapular spine graft or coracoid graft. Study Design: Controlled laboratory study. Methods: The study used 20 fresh-frozen human cadaveric shoulders. A 25% anterior glenoid defect was created, and the specimens were divided randomly to receive glenoid augmentation by scapular spine or coracoid grafts. For both procedures, the grafts were secured to the glenoid defect with 2 screws. Morphometric data, including the glenoid articular area, amount of restoration, and graft dimensions, were obtained. A biomechanical test was conducted in a direct-loading scenario. The construct stiffness, cyclic displacement, and ultimate failure of each specimen were collected. Results: No significant difference was found in glenoid articular restoration between the scapular spine group and the coracoid group (31% vs 33%, respectively; P = .311). Morphometric analysis indicated that coracoid grafts exhibited significantly greater thickness and height than scapular spine grafts. In biomechanical results, the scapular spine group exhibited significantly greater construct stiffness than the coracoid group (206.3 ± 58.8 vs 148.3 ± 76.0 N/mm, respectively; P = .023). The average failure load in the scapular spine group was not significantly higher than that in the coracoid group. No significant differences in cyclic displacement were found between the 2 techniques. Conclusion: In a simulated 25% anterior glenoid bony defect, a scapular spine graft was comparable with the classic Latarjet procedure in restoring the glenoid articular dimension and exhibited superior construct stiffness in a cadaveric model. Clinical Relevance: The scapular spine may serve as an alternative graft choice in glenoid augmentation surgery considering the amount of articular restoration and initial fixation stability.

Articular Regional Reconstruction (ARR) for Large Osteochondral Lesions of the Talus using Viable Osteochondral Allograft Combined with Autograft: Technique Description and Case Series

Category: Ankle; Sports; Trauma Introduction/Purpose: Symptomatic osteochondral lesions of the talus (OLT) are challenging to treat, and large lesions (&gt;10mm) with concomitant subchondral bony defects are particularly challenging. Standard treatments such as bone stimulation are limited and are often restricted to smaller lesions. Particulate and fragmented chondral allograft techniques face limitations with uncontained lesions. Structural allograft/autograft techniques often require removal of regions of native, uninjured bone and may encounter donor issues. Postoperatively, ensuring reliable osseous and cartilaginous healing responses can be difficult. Articular Regional Reconstruction (ARR) is a novel technique combining viable osteochondral allograft with morselized autograft bone to address large OLT lesions with bony defects, whether contained or uncontained. We describe a consecutive series of patients undergoing ARR here. Methods: Patients indicated for the ARR procedure had preoperative MRI and CT imaging identifying large (&gt;10mm), unstable osteochondral lesions with bony defects; 11 consecutive patients that had undergone ARR were identified. OLT lesions were initially inspected arthroscopically, and then converted to open debridement. Medial malleolar osteotomies were used for access when necessary. A stable bony base and viable cartilage rim was established, removing all damaged cartilage and nonstructural material from the OLT and bony defect. Talar body structure and morphology was restored using iliac crest or tibial morselized autograft bone placed in the bony defect. Viable osteochondral allograft (Cartiform) was shaped and then secured over the autograft using suture anchors placed at the lesion periphery. Patient Reported Outcome (PRO) measures included PROMIS- physical function (PROMIS-PF), PROMIS-pain interference (PROMIS-PI), and single assessment numeric evaluation (SANE). Three patients without PRO data were excluded, leaving eight patients with preoperative and postoperative PRO data for analysis. Results: The ARR patients averaged 40 years old (range 28-60) with a mean follow up of 19 months (range 10-38). The lesion surface areas averaged 1.95 cm2 (range 1.17-2.99 cm2) with a depth of 7.25mm (range 5-9mm). Four were uncontained corner lesions. Postoperative PROMIS-PF improved from 41 to 47 (p = 0.036), and PROMIS- PI improved from 60 to 53 (p = 0.093). Average SANE scores improved from 60 to 69 (p = 0.148). No complications occurred. No revision OLT surgeries were required, though three patients returned to the OR (Two for osteotomy screw removal, one for anterior impingement of opposite corner). During these 'second looks', the implanted cartilage layer was found intact. In a recent survey, all patients indicated they would undergo the procedure again. Conclusion: Articular Regional Reconstruction (ARR) is a reproducible procedure with demonstrated potential for improvement in pain and physical function among patients with symptomatic, large osteochondral lesions of the talus with bony defects, whether 'contained' or 'uncontained'. It has particular utility as an alternative to bulk structural graft salvage procedures among patients who have failed prior procedures, as 5 of the 8 patients had undergone unsuccessful prior surgical intervention for their OLT by outside providers. Further studies on ARR of the talus are necessary to elucidate the prognosis of this procedure, establish indication boundaries, and strengthen long-term outcome data.

Plexiform neurofibroma of the scalp with bony defect: A case report and review of literature

Plexiform neurofibroma (PNF) of the scalp is a very rare lesion. It is commonly associated with neurofibromatosis (NF 1). Occipital location of plexiform neurofibroma is even more infrequent. The usual presentation is an ill-defined mass causing disfigurement. It is evaluated with radiological imaging. Magnetic resonance imaging is preferred modality to identify the lesion and characterize its nature. It is usually managed by surgical excision, but recurrence has also been reported even after meticulous excision. The diagnosis is confirmed by histopathological examination of excised specimen. Here, we are reporting a case of plexiform neurofibroma with NF-1 inoccipital-cervical region with calvarial defect which was managed by surgical excision.

Tantalum Spacer Augmentation of Large Bony Defects in Hindfoot Arthrodesis

Category: Ankle Arthritis; Hindfoot Introduction/Purpose: Tibiotalocalcaneal (TTC) arthrodesis is a common surgical technique used in the treatment of various hindfoot pathologies. Large osseus defects are particularly challenging with a high rate of graft collapse and nonunion when using autograft or allograft. Porous tantalum has emerged as a favorable osteoconductive material to address sizeable hindfoot defects. The purpose of this study was to review the radiographic outcomes and complications associated with tantalum spacer augmentation in hindfoot arthrodesis. Methods: A retrospective review was performed of all patients who underwent a hindfoot arthrodesis augmented with a metal spacer (Trabecular MetalTM) from 2012 to 2020 at a single institution. Patients [endif]–&gt;18 years of age who had a large, hindfoot osseus defect were included in the study. Surgeries were performed by two fellowship-trained foot and ankle orthopaedic surgeons. The primary outcomes assessed were presence of radiographic union, post-operative complications, and return to the operating room. Results: Fourteen patients were identified who underwent hindfoot arthrodesis with the use of a Trabecular MetalTM augment. Two of the 14 patients were lost to follow-up resulting in a total of 12 patients with an average age of 59 years (range, 42 - 74). The average length of follow-up was 26 months (range, 4 - 56). Four patients had plain radiographs at final follow-up compared to 7 patients who had CT scans performed. Nine patients underwent TTC fusion with a retrograde intramedullary nail (MedShape DynaNail) and three patients underwent isolated subtalar (ST) fusion. Ten of 12 fusions were augmented using reamer irrigator aspirator (RIA) autograft and two patients received autograft from either the tibia or fibula. Of the 12 patients, 10 achieved radiographic evidence of union for a union rate of 83%. There were three patients who required reoperations: one hypertrophic nonunion, one surgical site infection, and one symptomatic hardware. Conclusion: Tantalum provides a great structural option for patients undergoing TTC or ST fusion in the setting of large hindfoot bony defects. This method combined with the use of autograft and adequate biomechanical stabilization can produce reliable results. Functional outcomes are needed to capture the utility of this technique in attaining longterm clinical results.

Periodontal status of mandibular second molar after extraction of impacted mandibular third molars- a prospective clinical trial.

Mandibular third molar (M3) extraction is the common surgical procedures carried out; however, one of the complications is development of periodontal disease in adjacent second molars (M2). Hence the purpose of this study was to evaluate the effect of extraction of M3 on the periodontal status of M2. Study included 120 sites with mandibular M2 adjacent to the impacted M3. Plaque index(PI), gingival index(GI), probing pocket depths(PD), clinical attachment levels(CAL), Gingival recession(GR) and alveolar bone height(ABH) before and 9-12 months after surgical extraction of M3 were assessed. Patients perception was assessed using dichotomous rating. Four types of impactions(IMP) were included along with surgical cofactors like degree of impaction, flap design, bone removal, tooth sectioning. At baseline mesioangular and horizontal IMP showed greater PPD and CAL. After extraction of M3 there was significant decrease in PPD & CAL. 14% cases showed significant increase gingival recession at the distobuccal of M2. Although 10.9% of patients had an alveolar bony defect(ABD) distal to the M2, there was considerable improvement in ABH from baseline. The ABDs are mostly associated with mesioangular and horizontal IMP. Extraction of impacted M3 proves to be beneficial on periodontal status of M2. However, occasionally, mesioangular and horizontal IMP are likely to develop ABD distal to M2 and hence can be followed by regenerative procedures to prevent the formation of ABD.

Immediate implant placement with simultaneous bone augmentation versus delayed implant placement following alveolar ridge preservation: A clinical and radiographic study

ObjectiveThe present study aimed to evaluate the clinical and radiographic outcomes of immediate implant placement (IIP) with guided bone regeneration (GBR) as compared to delayed implant placement (DIP) following alveolar ridge preservation (ARP) and to identify the potential risk factors influencing these outcomes. MethodologyA total of 56 patients (IIP = 28 vs. DIP = 28) with class I or II bony defects received 56 implants were included. GBR procedure using Bio-Oss® bone substitute mixed with advanced platelet-rich fibrin (A-PRF) and covered by Bio-Gide® membrane and additional A-PRF membrane was performed either simultaneously with the IIP or earlier at the time of ARP in DIP. Clinical and 3-D radiographic analyses of bone level, thickness, and density were performed at three-time intervals (T1, immediately; T2, 6-7 months; and T3, 1.5 to 2 years post-implantation), corresponding to the neck, coronal, middle, and apex of implants. ResultsThe survival rate was 100% in both groups. IIP showed significant favorable outcomes regarding distal marginal bone level (anterior maxilla, T1-T3) and neck and coronal horizontal facial bone thickness (HFBT) (posterior maxilla, T1; and anterior maxilla, T1-T3, respectively) compared to DIP. However, DIP showed significant facial bone density at the neck and coronal parts in the anterior maxilla (T1) and the coronal part in the posterior maxilla (T3). The facial marginal bone level change was positively correlated with HFBT change (P = 0.007), which is negatively correlated with the secondary implant stability (P = 0.019). The implant region (anterior or posterior maxilla) was the only factor affecting on Implant stability quotient value (ISQ) and change in HFBT (P ˂ 0.05). ConclusionOverall, the IIP combined with GBR in the post-extraction sites with pre-implant class I or II bony defects had some favorable outcomes compared to DIP after ARP. However, the clinical outcomes, ISQ value, and changes in bone level, thickness, and density from T1-T3 were comparable.

3D planning in revision total knee arthroplasty following periprosthetic joint infection. A pilot study

Objective. Revision total knee arthroplasty (TKA) following a periprosthetic joint infection (PJI) represents a considerable challenge. The geometry of bony defects can be hard to assess on standard x-rays, thus requiring CT evaluation. CT data can be processed to create physical replicas by 3D printing. This model can be used as means of 3D planning through surgical simulation. This study aims to compare the ability to predict the need for augmentation to restore limb alignment between 2D and 3D planning. Methods. Ten consecutive patients undergoing second-stage TKA revision following PJI were included. Pre-operative CT and standard x-rays were obtained in all patients. CT data were used to produce a model using a 3D printer. The surgical simulation was then conducted using TKA revision instrumentation. Standard 2D planning and 3D planning were independently performed by two investigators. Interclass correlation coefficient was used to evaluate agreement on the use of augment. Results. For femoral augment, 3D and 2D accuracies were 80.8 and 37.5%, respectively. For tibial augment, 3D and 2D accuracies were 66.7 and 23.0%, respectively. Conclusions. 3D planning with surgical simulation has shown to be a valuable method to predict the need of augment in revision TKA following PJI.

Adenoid Cystic Carcinoma (ACC) Infiltrating the Skull Base: A Systematic Review of Clinical Characteristics and Management Strategies.

To systematically review the patient characteristics and management approaches of adenoid cystic carcinoma (ACC) infiltrating the skull base. According to PRISMA guidelines, PubMed, Scopus, and Cochrane were searched to retrieve studies reporting management protocols and survival outcomes of patients with skull base ACCs. Patient characteristics, management strategies, and outcomes were investigated. The review encompassed 17 studies involving 171 patients, with a female predominance (57.9%) and a mean age of 49±7.12 years. ACCs mostly infiltrated the paranasal sinus (22.2%), cavernous sinus (8.8%), and nasopharynx (7.1%). Perineural invasion was reported in 6.4% of cases. Facial pain, nasal obstruction, and facial paresthesia were the most common symptoms. Surgical resection (45.6%) was favored over biopsy (12.2%). Employing the free flap technique (4.7%), surgical reconstruction of the bony defect after resection was performed using abdominal and anterior thigh muscle grafts in 1.8% of patients each. As adjuvant management, 22.8% of cases had radiotherapy and 14.6% received chemotherapy. Recurrence of skull base ACCs occurred in 26.9% of cases during a mean follow up-time of 30.8±1.8 months. Skull base ACCs pose a surgical challenge mainly due to their proximity to critical neurovascular structures and aggressive behavior. Surgical resection and radiotherapy are shown to be safe and effective treatment modalities. The dismal prognosis and limited data on non-surgical strategies highlight the need for further evaluation of the current management paradigm and upraising innovative therapies to improve patient mortality and quality of life.