Cortical Wall Research Articles

Transcutaneous osseointegrated prostheses systems (TOPS) for rehabilitation following limb loss : Surgical approach for necessary removal of the implant

Removal of atranscutaneous osseintegrated endo-fix stem (ESKA Orthopaedic, Lübeck, Germany) following afatigue fracture of the implant, whilst protecting the residual femur bone to allow transcutaneous osseointegrated prosthesis system (TOPS) reimplantation. Apatient's request for afurther TOPS implantation following afatigue fracture of acircular osseointegrated implant stem. Impending destruction of the bone tube through mobilisation of the femoral implant stem with insufficient thickness of the cortical wall (< 2-3 mm). This fact has to be considered before providing the indication for implant replacement. Afatigue fracture of acircular osseointegrated implant stem is generally associated with difficult removal of the implant. The longitudinal osteotomy of the tubular femur would lead to massive destruction of the bone due to the osseointegration of the corticalis into the three-dimensional structured surface of the implant and must be excluded as an option for removal. Therefore, the implant must be mobilized from the distal end of the bone. For this approach, tubular cutters and shock wave chisels are available. The procedure itself is time-consuming and is accompanied by aweakening of the corticalis of the femur bone. Intraoperative smear tests to prove abacteria-free intramedullary space are obligatory. After successful removal of an endo-fix stem, reassembling of anew TOPS implant should be considered 4-6weeks later after ensuring the absence of bacterial colonization of the intramedullary space. If bacteria are detected, surgical revision is necessary. The authors experience with the described removal of the implant with 4patients over aperiod of 17years must be regarded as anecdotal. All 4patients could be successfully re-implanted, which emphasizes the value of the described method.

A computed tomography–based morphometric analysis of thoracic pedicles in a European population

PurposeThe goal of this retrospective study was to perform a CT imaging assessment of thoracic pedicles to provide a representative understanding of pedicle morphology for pedicle-based fixation systems commonly used in orthopedics, trauma and neurosurgery. This study aimed to better understand the morphology of the spine and give spine surgeons a better understanding of thoracic spine anatomy.MethodsIn this study, we retrospectively measured the thoracic spine pedicles of a total of 16 males and 16 females, totaling in 768 individual pedicles. For the measurements, we used standardized planes in computed tomography imaging with a maximum slice thickness of 1 mm.ResultsIn brief, we identified significant differences in various measurements of male and female pedicle morphology. The medial cortical wall of the pedicles was significantly thicker than the lateral wall, and, in both sexes, the thoracic vertebral body number four was the vertebra with the least amount of cortical bone in the pedicle.ConclusionsSurgeons performing operations involving pedicle screw placement should be aware of the sex-specific differences in thoracic spine pedicle morphology noted in this research.

Forebrain Eml1 depletion reveals early centrosomal dysfunction causing subcortical heterotopia.

Subcortical heterotopia is a cortical malformation associated with epilepsy, intellectual disability, and an excessive number of cortical neurons in the white matter. Echinoderm microtubule-associated protein like 1 (EML1) mutations lead to subcortical heterotopia, associated with abnormal radial glia positioning in the cortical wall, prior to malformation onset. This perturbed distribution of proliferative cells is likely to be a critical event for heterotopia formation; however, the underlying mechanisms remain unexplained. This study aimed to decipher the early cellular alterations leading to abnormal radial glia. In a forebrain conditional Eml1 mutant model and human patient cells, primary cilia and centrosomes are altered. Microtubule dynamics and cell cycle kinetics are also abnormal in mouse mutant radial glia. By rescuing microtubule formation in Eml1 mutant embryonic brains, abnormal radial glia delamination and heterotopia volume were significantly reduced. Thus, our new model of subcortical heterotopia reveals the causal link between Eml1's function in microtubule regulation and cell position, both critical for correct cortical development.

The structural organization of the outer tissues in the gametophytic stem of the umbrella moss Hypnodendron menziesii optimizes load bearing.

The ultrastructural design and biochemical organization of the significantly thickened outer tissues of the gametophytic stem of Hypnodendron menziesii optimizes load bearing of the stem. Hypnodendron menziesii is a bryoid umbrella moss growing in high humid conditions on the forest floors of New Zealand. The erect gametophyte bears up to eight whorls of branches in succession, spreading across the stem that bears the heavy weight of branches with highly hydrated leaves. Our investigation using a combination of light microscopy, transmission electron microscopy (TEM), scanning electron microscopy (SEM), and TEM-immunolabeling techniques provided novel information on the structural design and biochemical organization of greatly thickened cell walls of epidermal, hypodermal, and outermost cortical tissues, comparing underlying thin-walled cortical tissues in the gametophytic stem. Probing into the ultrastructure of the cell wall architecture of these target tissues by TEM and SEM revealed the cell walls to display a multilamellar organization, in addition to demonstrating the presence of an electron-dense substance in the cell wall, presumably flavonoids. The pattern of distribution and concentration of rhamnogalacturonan, homogalacturonan, and heteromannan, as determined by immunogold labeling, suggests that it is the combination of structural and molecular design of the cell wall that may optimize the mechanical function of the epidermal, hypodermal, and outer cortical tissues. Statistical relationships between the overall thickness of epidermal, hypodermal, and outer cortical cell walls, the lumen area of cells and the percentage area of cell wall occupied in these tissues at different heights of the stem, and thickness of secondary cell wall layers (L1-L4/5) were explored. The results of these analyses unequivocally support the contribution of outer tissues to the mechanical strength of the resilient stem.

In Vitro Biomechanical Study of Femoral Neck Fracture Fixation with Two or Three Cannulated Screws in Dogs.

To evaluate the in vitro mechanical properties of basilar fractures of the femoral neck stabilized with two or three titanium-cannulated screws in dogs. Ex vivo study. Cadaveric canine femur (n = 21). The bones were divided as follows: Group 1: control (no osteotomy); Group 2: osteotomy and stabilization with two cannulated screws; and Group 3: osteotomy and stabilization with three cannulated screws. All groups were tested with destructive axial compression with load applied to the femoral head. The stiffness, load, and displacement were evaluated at the failure of Group 1, and the yield load and displacement of Groups 2 and 3. The placement of the three cannulated screws was more demanding than two cannulated screws because of the risk of cortical perforation, especially in the trochanteric fossa area. The smaller the width of the femoral neck, the higher the risk of cortical bone wall perforation. The intact control bones were stiffer (674 N/mm) than both the two-screw repair (90 N/mm) and three-screw repair (120 N/mm) groups (p < 0.05). The failure load was greatest for Group 1 (2692 N). The yield loads for Groups 3 and 2 were 586 and 303 N, respectively. There was no difference between groups for displacement. In vitro cadaveric models of femoral neck basilar fractures repaired with three cannulated screws were significantly stronger than two cannulated screws, but the clinical efficacy must be evaluated by comparing them in vitro with noncannulated stainless steel screws.

Cortical parenchyma wall width regulates root metabolic cost and maize performance under suboptimal water availability.

We describe how increased root cortical parenchyma wall width (CPW) can improve tolerance to drought stress in maize by reducing the metabolic costs of soil exploration. Significant variation (1.0-5.0 µm) for CPW was observed in maize germplasm. The functional-structural model RootSlice predicts that increasing CPW from 2 µm to 4 µm is associated with a ~15% reduction in root cortical cytoplasmic volume, respiration rate, and nitrogen content. Analysis of genotypes with contrasting CPW grown with and without water stress in the field confirms that increased CPW is correlated with an ~32-42% decrease in root respiration. Under water stress in the field, increased CPW is correlated with 125% increased stomatal conductance, 325% increased leaf CO2 assimilation rate, 73-78% increased shoot biomass, and 92-108% increased yield. CPW was correlated with leaf mesophyll midrib parenchyma wall width, indicating pleiotropy. Genome-wide association study analysis identified candidate genes underlying CPW. OpenSimRoot modeling predicts that a reduction in root respiration due to increased CPW would also benefit maize growth under suboptimal nitrogen, which requires empirical testing. We propose CPW as a new phene that has utility under edaphic stress meriting further investigation.

Markers of bone turnover and biomechanical properties of the third metacarpal bone of growing pigs subjected to the different dietary phosphorus and calcium content

Abstract Eighteen weaned piglets were subjected to deficiency, adequate or excess of dietary phosphorus and calcium (group C−50, C and C+50, respectively) during growth from 33 to 110 day of age. However, the ratio of calcium/digestible phosphorus in all feeds was the same and consistent with the nutritional recommendation. Performance, bone growth, concentration of osteocalcin (OC) and carboxyterminal telopeptide of type I collagen (CTX-I), densitometry, geometry and mechanical properties of the 3rd metacarpal bone were measured. Growth rate and final body weight did not differ between C and C+50 animals, however, they grew approximately 5.9% faster and were heavier by about 4.0% than C−50 pigs. In turn, mass and length of bones were similar in C−50 and C+50 groups, however, they were approximately 11% lighter and 4% shorter compared to C pigs. Serum content of OC took the following order: C−50 &lt; C &lt; C+50 group (P&lt;0.01). Content of CTX-I did not differ between C and C+50 animals, however they were lower by 36% (P&lt;0.01) than in the C−50 pigs. All measured geometry parameters (cortical wall thickness, cross section area and cortical index) did not differ between C and C+50 pigs and were higher than in C−50 pigs (P&lt;0.01). Bones of C−50 pigs contained less minerals than bones of the C and C+50 pigs (5.24 g vs mean 6.14 g, P&lt;0.01). The 3rd metacarpal bone mineral density (g/cm2) was the lowest in pigs in group C−50, higher in pigs in group C, and the highest in animals in group C+50 (0.398, 0.431 and 0.475, respectively, P&lt;0.01). Maximum strength of bones was similar in the C and C+50 pigs, however it was 13% greater (P&lt;0.01) compared to C−50 animals. In turn, elastic strength and elastic deflection did not differ between the C and C−50 animals and were over 20% lower (P&lt;0.01) than in the C+50 pigs. Whereas, there was no significant difference between groups in bone stiffness (mean 27.13 mm). The results of the present study proved that even a strong excess of phosphorus and calcium content in the diet for growing pigs is inadvisable and does not improve performance and bones parameters. While excessively lowering the dietary phosphorus and calcium concentration (e.g. to reduce environmental pollution) may adversely affect growth rate and bone characteristics.

Immediate implant placement in the anterior mandible: a cone beam computed tomography study

BackgroundThe placement of implants into the alveolar socket right after tooth extraction is called immediate implant placement (IIP). This approach has its particularities depending on which region of the jaws is involved. The anterior mandible region is peculiar due to the presence of mandibular incisors, which have the shortest roots among all permanent teeth.PurposeThis study aimed to investigate the factors that could be associated with the risk of either cortical bone wall perforation or invasion of the 2 mm secure distance from the surrounding anatomical structures (defined as unsafe implant placement), with IIP in the maxillary aesthetic zone, in a cone-beam computed tomography (CBCT) virtual study.Materials and methodsCBCT exams from 239 eligible subjects were investigated. Implants were virtually placed in two distinct positions: prosthetically-driven (along the long axis of the existing tooth) and bone-driven position (according to the available bone and with regard to nearby anatomical structures). Correlation between several variables was tested, and binary logistic regression analysis in order to assess of the possible associations between covariates and unsafe placement was performed.ResultsSafe placing implants was significantly higher for the bone-driven in comparison to the prosthetically-driven position (22.2% vs. 3.3%, respectively), and the 2-mm secure distance from anatomical structures was not possible to respect in the majority of cases (77.6% vs. 82.9%, respectively). Covariates associated with a higher risk of unsafe placement were tooth region (CI in relation to IL and CA), decrease of labial concavity angle (LCA), decrease of mandible basal bone height (MBBH), and decrease in mandibular bone thickness at the tooth apex level (MBT0).ConclusionThe possibility of safely placing immediate implants in the anterior mandible is significantly higher for bone-driven than in prosthetically driven position. Presurgical virtual planning with CBCT is a great tool for minimizing the risk of implant unsafe placement with regards to the anatomical conditions in the mandible.

Sagittal support rather than medial cortical support matters in geriatric intertrochanteric fracture: A finite element analysis study

Hip fracture, increasing exponentially with age, is osteoporosis's most severe clinical consequence. Intertrochanteric fracture, one of the main types of hip fracture, is associated with higher mortality and morbidity. The current research hotspots lay in improving the treatment effect and optimizing the secondary stability after intertrochanteric fracture surgery. Cortex buttress reduction is a widely accepted method for treating intertrochanteric fracture by allowing the head-neck fragment to slide and rigidly contact the femoral shaft's cortex. Medial cortical support is considered a more effective option in treating young patients. However, osteo-degenerations features, including bone weakness and cortical thickness thinning, affect the performance of cortex support in geriatric intertrochanteric fracture treatment. Literature focusing on the age-specific difference in cortex performance in the fractured hip is scarce. We hypothesized that this osteo-19 degenerative feature affects the performance of cortex support in treating intertrochanteric fractures between the young and the elderly. We established twenty models for the old and the young with intertrochanteric fractures and performed static and dynamic simulations under one-legged stance and walking cycle conditions. The von Mises stress and displacement on the femur, proximal femoral nail anti-rotation (PFNA) implant, fracture plane, and the cutting volume of cancellous bone of the femur were compared. It was observed that defects in the anterior and posterior cortical bone walls significantly increase the stress on the PFNA implant, the displacement of the fracture surface, and cause a greater volume of cancellous bone to be resected. We concluded that ensuring the integrity and alignment of the anterior and posterior cortical bones is essential for elderly patients, and sagittal support is recommended. This finding suggests that the treatment method for intertrochanteric fracture may differ, considering the patient's age difference.

Is there a consensus on the location and composition of the human subplate?

Cortical wall of human fetal cerebral cortex (early second trimester immunostained for a synaptic marker [red]) revealing the extent of the subplate, which is considerably wider than the cortical plate at this developmental stage.

The widths of the medial and lateral pedicle walls in adolescent idiopathic scoliosis with major thoracic curves

Background contextThe widths of medial and lateral pedicle walls in the normal spine of middle-aged and elderly adults have been investigated and these studies found that the medial pedicle wall was thicker than the lateral pedicle wall. However, none had evaluated the widths of medial and lateral pedicle walls on adolescent or young adult scoliotic spines. PurposeThis study aims to identify the distribution and variation of medial and lateral pedicle wall widths throughout the different vertebral levels of the scoliotic spine and its differences according to age, gender, body mass index (BMI), maturity, curve types and curve severity in adolescent idiopathic scoliotic (AIS) patients with major thoracic curves. Study DesignRetrospective study. Patient sampleA total of 6,230 pedicles (right: 3,064, left: 3,166) from 191 patients were included in this study, with 264 (right: 183, left: 81) fully corticalized pedicles excluded from analysis. Outcome measuresDemographic data were age, gender, height, weight, BMI, Risser grade, Lenke curve types and Cobb angles. The main outcome measures were medial and lateral pedicle wall widths. Associations between pedicle wall widths and demographic data were calculated. MethodsThis was a subanalytical retrospective study done on the same patient population as the previously published study on pedicle grading. The data was obtained from the main computed tomography (CT) scan pedicle study dataset. Medial and lateral pedicle wall widths were measured in the axial slices of CT scans from T1 to L5 vertebrae. ResultsA total of 6,230 pedicles (right: 3,064, left: 3,166) from 191 patients were included in this study with 264 (right: 183, left: 81) fully corticalized pedicles excluded from analysis. Right-sided medial pedicle wall widths were narrower from T4–T10 (0.75±0.23 mm) compared to T1–T3 (0.89±0.28 mm) and T11–L5 (0.92±0.30 mm). Left-sided medial pedicle wall widths were narrower from T4 to T7 (0.76±0.24 mm) compared to T1–T3 (0.88±0.26 mm) and T8–L5 (0.90±0.27 mm). Medial cortical wall widths were significantly thicker compared to lateral cortical wall widths for all vertebras from T1 to L5 (right medial 0.85±0.28 mm vs lateral 0.64±0.26 mm (p<.001), left medial 0.86±0.26 mm vs lateral 0.64±0.26 mm (p<.001)). The left medial pedicle wall widths were marginally significantly (p<.001) thicker than the right side (right medial 0.85±0.28 mm vs left 0.86±0.26 mm). The main notable significant differences were located at the periapical region of the thoracic curve between T7 to T10 with the left concave medial pedicle width being thicker than the right convex medial pedicle width. The thinnest medial pedicle walls were located at right concave T7 (0.73±0.24 mm) and T8 (0.73±0.23 mm). We generally found no significant associations between the medial and lateral pedicle wall widths with age, gender, BMI, Risser grade, Cobb angle and curve types. ConclusionsKnowledge on the widths of medial and lateral pedicle walls, their distribution and differences in a scoliotic spine is important for pedicle screw fixation, especially during pedicle probing to find the pedicle channel. The medial pedicle wall widths were significantly thicker than the lateral pedicle wall widths in AIS patients with major thoracic curves. The right concave periapical region had the thinnest medial pedicle walls.

Effect of robotic gait training on muscle and bone characteristics in spinal cord transected rats.

Osteoporosis and loss of muscle mass are secondary issues with spinal cord injury. Robotic gait training has provided evidence of increasing bone density and muscle mass, but its effect on bone strength is undetermined. The purpose of this study was to determine the effect of a 6-week robotic locomotion training program on skeletal muscle mass and bone characteristics. Twelve female Sprague-Dawley rats received a mid-thoracic spinal cord transection at 5 days old and at 3 weeks old were assigned to a Control or Trained Group. The Trained Group performed 5-min sessions on the Rat Stepper 5 days a week for 6 weeks with 90% of body weight supported. At the end of the 6 weeks, body mass was obtained and right femurs and four lower extremity muscles were harvested. Femur bone mineral density was measured with DXA and mechanical characteristics of the femur were determined via 3-point bending testing. Independent t-tests, effects sizes and percent differences were computed between the two groups (p < 0.05). The Trained Group had significantly larger normalized femur mass (p = 0.007) and normalized soleus muscle mass (p = 0.033) when compared to the Control Group. There was a medium or large effect size with the Trained Groups' femurs having larger mass, bone mineral density, rupture loads, cortical wall thickness, shaft cross sectional area, soleus mass, normalized gastrocnemius mass, and smaller shaft inner diameters compared to the Control Group. These changes may contribute to decreasing osteoporosis and fracture risk in those with spinal cord injuries.

Immediate implant placement in the premolar maxillary area: a cone-beam computed tomography study.

This research aimed to investigate potential factors associated with the risk of perforation of the labial bone plate, nasal floor, or maxillary sinus floor during immediate implant placement (IIP) in the maxillary premolar area, utilizing a cone-beam computed tomography (CBCT) virtual study. CBCT exams from 179 eligible participants, encompassing 716 teeth, were included. Implants were virtually positioned in 2 orientations: along the long axis of the tooth (the prosthetically-driven position) and in an optimal position relative to adjacent anatomical structures (the bone-driven position). Binary logistic regression analysis was employed to assess potential associations between perforation or invasion and various covariates, including sex, age, tooth region, the distance from the tooth apex to the nasal floor or maxillary sinus floor, the angle between the prosthetically- and bone-driven positions (implant-line A angle [ILAA]), and the labial concavity angle (LCA). The mean ILAA was 18.3°±8.0°, and the angle was significantly larger for the second premolar compared to the first premolar. The mean minimum implant length was 13.0±2.1 mm, with a bone anchorage of 4 mm. The incidence of perforation was 84.1% for the prosthetically-driven position and 40.5% for the bone-driven position. Factors associated with a higher risk of cortical bone wall perforation or invasion of the 2-mm safety margin from surrounding anatomical structures (in the bone-driven position) included female sex, older age, shorter distance from the tooth apex to the nasal cavity/maxillary sinus, and smaller LCA. A high prevalence of cortical bone wall perforation or invasion of the 2-mm safety margin is anticipated when performing IIP in the maxillary premolar region.

Application of a Navigated Drill for Cervical Pedicle Screw Insertion at C3-6.

Background Perforation of the cervical pedicle screw, especially lateral perforation, may lead to critical complications, such as vertebral artery injury. Sub-axial cervical spines (C3-6) are at risk of complications because these levels have limited area and angle. This study aimed to compare a navigated drill and a navigated probe for the insertion of cervical pedicle screws at C3-6. Methodology This retrospective study included 106 patients treated with cervical pedicle screws at C3-6. In total, 52 patients with 200 cervical pedicle screws using a navigated drill (group D) and 54 patients with 170 cervical pedicle screws using a navigated probe (group P) were compared. The perforation rate, anatomical medial angle of the pedicle, and actual angle of the screw were investigated using computed tomography. The planning error was defined as when the pedicle screw was applied for a small pedicle width of <3.5 mm. All perforations except for planning errors were defined as technical perforations. Results Grade 1 screw perforations were identified in 16 and 17 screws in groups D and P, respectively. Overall, 88% of the perforations were medial in group D, and 82% of perforations were lateral in group P. Technical perforations were found in 7/191 (3.7%, group D) and 15/168 (8.9%, group P) screws. There were no significant differences in the anatomical angle of the pedicle between the groups. The mean medial angle of the pedicle screws was 24.7° (group D) and 30.9° (group P) (p < 0.05). Conclusions The perforation rate of group D was less than half of that of group P. This was because a navigated drill was able to create a bony pilot hole at the hard medial cortical wall of the pedicle with a small medial angle, which was difficult to do with a navigated probe. A navigated drill can be useful for cervical pedicle screw insertion at C3-6 because of its easiness and safety.

Automatic breach detection during spine pedicle drilling based on vibroacoustic sensing

Pedicle drilling is a complex and critical spinal surgery task. Detecting breach or penetration of the surgical tool to the cortical wall during pilot-hole drilling is essential to avoid damage to vital anatomical structures adjacent to the pedicle, such as the spinal cord, blood vessels, and nerves. Currently, the guidance of pedicle drilling is done using image-guided methods that are radiation intensive and limited to the preoperative information. This work proposes a new radiation-free breach detection algorithm leveraging a non-visual sensor setup in combination with deep learning approach. Multiple vibroacoustic sensors, such as a contact microphone, a free-field microphone, a tri-axial accelerometer, a uni-axial accelerometer, and an optical tracking system were integrated into the setup. Data were collected on four cadaveric human spines, ranging from L5 to T10. An experienced spine surgeon drilled the pedicles relying on optical navigation. A new automatic labeling method based on the tracking data was introduced. Labeled data was subsequently fed to the network in mel-spectrograms, classifying the data into breach and non-breach. Different sensor types, sensor positioning, and their combinations were evaluated. The best results in breach recall for individual sensors could be achieved using contact microphones attached to the dorsal skin (85.8%) and uni-axial accelerometers clamped to the spinous process of the drilled vertebra (81.0%). The best-performing data fusion model combined the latter two sensors with a breach recall of 98%. The proposed method shows the great potential of non-visual sensor fusion for avoiding screw misplacement and accidental bone breaches during pedicle drilling and could be extended to further surgical applications.

Tsetse fly inspired steerable bone drill-a proof of concept.

The fixation strength of pedicle screws could be increased by fixating along the much stronger cortical bone layer, which is not possible with the current rigid and straight bone drills. Inspired by the tsetse fly, a single-plane steerable bone drill was developed. The drill has a flexible transmission using two stacked leaf springs such that the drill is flexible in one plane and can drill along the cortical bone layer utilizing wall guidance. A proof-of-principle experiment was performed which showed that the Tsetse Drill was able to successfully drill through 5, 10 and 15 PCF cancellous bone phantom which has similar mechanical properties to severe osteoporotic, osteoporotic and healthy cancellous bone. Furthermore, the Tsetse Drill was able to successfully steer and drill along the cortical wall utilizing wall guidance for an insertion angle of 5°, 10° and 15°. The experiments conclude that the tsetse fly-inspired drilling method is successful and even allows the drilling along the cortical bone layer. The Tsetse Drill can create curved tunnels utilizing wall guidance which could increase the fixation strength of bone anchors and limit the risk of cortical breach and damage to surrounding anatomy.

Parasagittal Cystic Lesions May Arise from the Pial Sheath around the Cortical Venous Wall.

It has been reported that perivenous cystic structures near the parasagittal dura are associated with the leakage of gadolinium-based contrast agents at 4 hours after intravenous administration. The origin of such cystic structures remains unknown. While reading many cases of MR cisternography, we noticed that some of the cystic structures appeared to connect to the perivenous subpial space. This new imaging finding might facilitate future research of the waste clearance system for the central nervous system.

Available phosphorus levels modulate gene expression related to intestinal calcium and phosphorus absorption and bone parameters differently in gilts and barrows.

Dietary phytase increases bioavailability of phytate-bound phosphorus (P) in pig nutrition affecting dietary calcium (Ca) to P ratio, intestinal uptake, and systemic utilization of both minerals, which may contribute to improper bone mineralization. We used phytase to assess long-term effects of two dietary available P (aP) levels using a one-phase feeding system on gene expression related to Ca and P homeostasis along the intestinal tract and in the kidney, short-chain fatty acids in stomach, cecum, and colon, serum, and bone parameters in growing gilts and barrows. Growing pigs (37.9±6.2 kg) had either free access to a diet without (Con; 75 gilts and 69 barrows) or with phytase (650 phytase units; n = 72/diet) for 56 days. Samples of blood, duodenal, jejunal, ileal, cecal, and colonic mucosa and digesta, kidney, and metacarpal bones were collected from 24 pigs (6 gilts and 6 barrows per diet). Phytase decreased daily feed intake and average daily gain, whereas aP intake increased with phytase versus Con diet (p<0.05). Gilts had higher colonic expression of TRPV5, CDH1, CLDN4, ZO1, and OCLN and renal expression of TRPV5 and SLC34A3 compared to barrows (p<0.05). Phytase increased duodenal expression of TRPV5, TRPV6, CALB1, PMCA1b, CDH1, CLDN4, ZO1, and OCLN compared to Con diet (p<0.05). Furthermore, phytase increased expression of SCL34A2 in cecum and of FGF23 and CLDN4 in colon compared to Con diet (p<0.05). Alongside, phytase decreased gastric propionate, cecal valerate, and colonic caproate versus Con diet (p<0.05). Phytase reduced cortical wall thickness and index of metacarpal bones (p<0.05). Gene expression results suggested an intestinal adaptation to increased dietary aP amount by increasing duodenal trans- and paracellular Ca absorption to balance the systemically available Ca and P levels, whereas no adaption of relevant gene expression in kidney occurred. Greater average daily gain in barrows related to higher feed intake.

Peri-implant bone resorption risk of anterior maxilla narrow single implants: a finite-element analysis

Statement of the problem: Narrow implants have been recommended in high esthetic demand regions to ensure greater buccal bone thickness (BBT) and minimize soft-tissue recession due to insufficient bone support. However, a limited area of bone-implant interface can increase the risk of peri-implant bone resorption due to occlusal forces. Purpose: This article encourages the use of evidence-based finite element analysis to optimize the aesthetic outcomes in maxillary lateral incisor single-supported implant crown by accurate biomechanical planning. This study aimed to analyze the best implant dimensions that would preserve the maximum BBT and avoid peri-implant bone resorption due to occlusal forces. Materials and methods: A maxilla segment was constructed based on anthropological measurements. Four implant diameters (Ø = 3.25; 3.50; 3.75 or 4.00 mm) and two lengths (L = 10 or 13 mm) were simulated. The occlusal force parameters were defined to simulate clinical conditions. The bone resorption risk analysis was based on Frost’s mechanostat theory altering the strain output to strain energy density (SED). The peri-implant bone resorption risk indexes (PIBRri) were calculated by dividing the average of the top ten SED elements of the cortical and trabecular buccal wall by the pathologic resorption limit for each bone. Results: For trabecular bone, only the model Ø4.00L13 exhibited a low PIBRri. For cortical bone, all models presented a low PIBRri, except for models Ø3.25. Conclusion: The selection of a 3.25 mm dental implant to preserve a 2 mm BBT should be avoided since it generates a high peri-implant bone resorption risk induced by occlusal overload.

Effectiveness of Resective Surgery in Complex Ameloblastoma of the Jaws: A Retrospective Multicenter Observational Study.

Simple SummaryAmeloblastomas are rare, benign, progressively growing epithelial odontogenic tumors with a high tendency to relapse. Although numerous studies concerning the treatment of these tumors have been published, there is still no unanimity. This study seeks to confirm whether radical surgery is more effective in avoiding relapses. We included 55 patients affected by complex ameloblastoma, characterized by recurrence, soft-tissue involvement, erosion of internal/external cortical walls with involvement of the inferior margin of the mandible, and/or invasion of the maxillary sinus or nasal cavity. All patients underwent wide surgical resection and were then followed for an average of 108 months, with a recurrence rate of 10.9%. Maxillary ameloblastoma has an increased risk of recurrence, especially in patients who underwent previous surgical treatments. Our results suggest that complete resection could prevent the onset of relapse. However, this treatment seemed less effective in preventing recurrences in the soft tissues or maxillary sinus.Ameloblastoma is a rare, benign, odontogenic tumor of epithelial origin, characterized by locally aggressive, expansive growth. Treatment is controversial due to the risk of relapse. The aim of this multicenter retrospective study was to evaluate the effectiveness of complete resection in cases of complex ameloblastoma, which is considered at a higher risk of recurrence. Patients who met at least one of these criteria were included: recurrence, soft-tissue involvement, complete erosion of internal/external cortical walls with involvement of the inferior margin of the mandible, and invasion of the maxillary sinus or nasal cavity. Demographic data, tumor site, type of surgery, histological features, and follow-up information were collected for each patient. The cohort included 55 patients with a mean follow-up of 108 ± 66 months. A multivariate logistic model was used to evaluate variables independently associated with relapse. There were six soft-tissue or maxillary sinus relapses, with a recurrence rate of 10.9%. Most of them arose in patients previously treated. The statistical analysis identified the maxillary location as a fundamental relapse risk factor. En bloc resection with large surgical safety margins seemed to be effective in preventing the relapses. However, complete resection was less effective in preventing recurrences in the soft tissues or maxillary sinus.