Graft Augmentation Research Articles

Advanced platelet-rich fibrin plus and osseous bone graft for socket preservation and ridge augmentation – A randomized control clinical trial

ObjectiveTo compare the clinical and radiographic effectiveness of A PRF Plus as an adjuctive material to osseous bone graft in socket preservation and ridge augmentation. MethodsTwenty patients with need to preserve extraction socket in non-molar sites planning for further prosthetic rehabilitation were divided into two groups. Test Group (Group A) was treated with A PRF Plus membrane and Sybograf plus ™ (70% HA and 30 %β TCP) bone graft. The Control Group (Group B) was treated with Sybograf plus ™ (70% HA and 30% βTCP) bone graft. Both groups had same socket preservation surgical technique. ResultsBoth Group A and Group B showed significant improvement in clinical and radiographic parameters. Mean socket length, Vertical Resorption reduction in Group A was 1.48 whereas in Group B was 1.67 which is statistically significant. (p ​≤ ​0.05). Changes in Horizontal width reduction at 1,3, and 5 ​mm depth of the socket for both groups were not statistically significant. The Gain in socket fill for Group A and B 6 months postoperatively was 1185.30HU ± 473.21 and 966.60 HU ± 273.27 respectively. But intergroup comparison was not statistically significant. (p ​= ​0.17). There were no significant statistical differences in postoperative pain in Group A and Group B as subjects experienced moderate amount of pain. The assessment of post-operative swelling showed that only 30% subjects in Group A reported with swelling. Whereas 80% subjects in Group B complained of post-operative swelling. ConclusionThe results of the present study proved utilisation of A PRF Plus as a promising adjunct to conventional regenerative therapy for socket preservation.

Inferior Turbinate Bone Graft for Dorsal Augmentation in Rhinoplasty.

The most serious form of nasal dorsum pathologies is saddle nose deformity. Vary of nasal dorsal augmentation grafts were reported in the literature but inferior bone graft (ITBG) alone has not attracted attention. The ITBG has advantages such as easy and fast harvesting, easy to shape due to cancellous bone tissue. The graft technique is similar to the inferior turbinoplasty with the medial mucosal flap technique and can be performed without bioabsorbable hemostatic material (e.g. Turkish Delight), suture fixation, or without tissue adhesives. Major complications of the ITBG technique are injury of the posterior lateral nasal branch of the sphenopalatine artery and subdermal mucous cyst that developing on nasal dorsum. Since easy application, fast harvesting, and similar permanence to cartilage grafts as augmentation material, ITBG can also been used successfully in minor dorsal deficits in addition to saddle nose deformities.

The Effect of Arm Position on Breast Volume Measurement Using Three-dimensional Imaging.

Three-dimensional (3D) imaging offers an objective and quantitative way to evaluate the breast volume. In this study, we aimed to investigate whether arm position can be a factor influencing the measurement of breast volume and which arm position is more stable when using 3D breast imaging in evaluating the fat volume retention rate in autologous fat grafting for breast augmentation. Patients undergoing breast augmentation with autologous fat grafting in our department were selected for the first part of this study. Preoperative 3D breast imaging was performed at three different arm positions: at the sides, akimbo and with hands on the head. Scans on each arm position were repeated on the first day after surgery, taking six scans in total. Breast volume change (BVC) was compared before and after surgery. The patients planning to receive bilateral mammaplasty in our department were selected for the second part of this study. Two repeated 3D scans were performed at the sides, akimbo and hands on the head, and then, the breast volume change error (BVCE) was compared. Twenty-five patients (n = 50 breasts) were included in the first part of study. For the patients who received 100-200ml fat injection, compared with hands on the head, a statistically significant difference in the average BVC was found at the sides and akimbo (p = 0.02). For the patients receiving more than 200ml fat injection, there was no statistically significant difference between the groups (p > 0.05). Twenty-six patients (n = 52 breasts) were enrolled in the second part. For the average BVCE, there was no significant difference between the groups (p = 0.11). The arm position during 3D breast imaging, to some extent, affects the evaluation of BVC after breast augmentation using autologous fat grafting, particularly for patients receiving less fat grafting. The arm position should be kept consistent when using 3D breast imaging in evaluating the fat volume retention rate. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266.

Preventive antibiotic therapy in bone augmentation procedures in oral implantology: A systematic review

IntroductionSince the beginning of Oral Implantology, preventive antibiotic therapy has been routinely prescribed. However, at present, due to the growing appearance of antimicrobial resistance, its use has been questioned, generating a great debate and an emerging controversy. The present systematic review aims to analyze the scientific literature to determine whether the preventive prescription of antibiotics in augmentation procedures with the insertion of implants in one or two phases decreases the incidence of postoperative infections and/or the survival rate of the implants. Material and methodsThe MEDLINE database was searched (via PubMed) with the following keywords: (bone grafting OR alveolar ridge augmentation OR bone graft augmentation OR guided bone regeneration OR bone block) AND (dental implants OR dental implant OR oral implantology) AND (antibiotic prophylaxis OR antibiotics). The criteria used were those described by the PRISMA® Statement. The search was limited to randomised clinical trials, systematic reviews and meta-analyses published in the last 15 years (2005–2020). ResultsAfter reading the titles and abstracts of the resulting articles, only one systematic review meeting the described criteria and 4 randomised clinical trials were included. ConclusionsPrescription of 2 or 3 g of amoxicillin one hour before surgery is recommended to reduce the early failure rate of one-stage implants and to decrease the bacterial load of grafted bone particles in bone augmentation procedures with one or two-stage implants.

Randomized, controlled, clinical trial to evaluate a xenogeneic collagen matrix as an alternative to free gingival grafting for oral soft tissue augmentation: A 6- to 8-year follow-up.

The purpose of this follow up study was to determine if a xenogeneic collagen matrix (CMX) is as effective as free gingival graft (FGG) in preventing further recession 6+ years following vestibuloplasty. This study was a single-blind (examiner), randomized, controlled, split-mouth study of 30 subjects with insufficient zones of KT(<2mm), associated with at least two, paired teeth. The study utilized a within subject treatment comparison to examine non-inferiority according to primary and secondary endpoints 6+ years after therapy. The original study primary efficacy endpoint was keratinized tissue width (KTw); however, in this report, prevention of recession (Rec) was also examined, along with traditional, secondary clinical measures, histopathology of mucosal biopsies and exploratory, patient reported outcomes (PROs) for pain and satisfaction. A total of 23 of the 30 original, study patients were available for 6 to 8-year postoperative assessment, and these patients were representative of the original patient population. For preventing further Rec, CMX was not inferior to FGG (ΔRec=-0.07 ± 1.26mm for CMX and -0.17 ± 0.78mm for FGG, P=0.710). There were no adverse results observed, and histological assessment indicated normal, keratinized gingiva for both therapies. Tissue texture and color match to surrounding, native tissues were significantly better for CMX, and patients preferred CMX over FGG therapy. CMX appears to be a suitable substitute for FGG 6+ years after therapy.

Use of mineralized dentin graft in augmentation of different indication areas in the jaw bones

Introduction. Extracted teeth are still considered clinical waste and therefore are being discarded. It is evident that obtained and prepared autogenous dentin graft (ADG) may be used for guided bone regeneration (GBR) due to its similar biochemical characteristics to human bone. The aim was to present a novel procedure in a clinical setting that employs freshly extracted teeth that are processed into a bacteria-free particulate dentin, and then grafted immediately into the extraction sites or bone deffects. Monitoring the clinical and radiological parameters (vertical and horizontal dimensional changes on the alveolar ridge and vertical dimension of intrabony defects at the distal aspect of the second molar after extraction of third molar) for a period of 6 months, proved rapid healing capacity of ADG on the bone and soft tissue structures in the jawbones. Material and methods. Clinical measurements were performed using a questionnaire for monitoring the postoperative clinical manifestation, bone measuring calipers for measuring horizontal changes of the alveolar ridge and graduated probe for measuring vertical dimensional changes, also paraclinical-radiological examinations to follow-up bone density. Results. During the follow up period of six months, clinical measurements of post-extraction dimensional changes of the alveolar ridges showed minimal horizontal and vertical bone resorption with preserved alveolar ridge volume, with an accelerated bone regenerative process without special postoperative complications. Conclusion. Dentin particulate grafted immediately after extractions should be considered as gold standard due to its osteogenetic, osteoinductive and osteoconductive effects on bone tissue regeneration. With the use of mineralized dentin matrix we get maximum utilization of our own biological potential without the use of other artificial graft materials.

Comparative Bone Graft Evaluation for Dental Implant Success: An Evidence-Based Review.

In this review, we provide a comparative evaluation of different bone grafts for dental implants success. We performed a literature review to analyze dental implant success and survival rates after the use of various grafts for bone augmentation. A total of 41 studies were selected and analyzed based on parameters including study design, number of implants placed, total number of participants, type of graft used, site from which graft was obtained, time elapsed between bone augmentation and implant placement, implant survival, and success rates. Results indicate that after a follow-up period of 1-5 yr, respective success and survival rates are as follows: block grafts, 91.5% and 75%; blood derivatives, 91.5% and 96.7%; composite grafts, 80.9% and 94.2%; xenografts and particulate grafts, 100% for both success and survival. After evaluating the available studies, we can report that autologous block grafts, composite grafts, and blood derivatives were the most commonly used grafting materials for bone augmentation before placing dental implants. Xenografts and particulate grafts had 100% success and survival rates, but more studies are needed to assess the impact of these grafting materials.

Combined Graft Augmentation for Medial Collateral Ligament Repair May Improve Knee Kinematics

Combined Graft Augmentation for Medial Collateral Ligament Repair May Improve Knee Kinematics

Comparison of piezosurgery and conventional rotary instruments in schneider's membrane sinus lifting: A pilot randomized trial.

BackgroundThe present study aimed to evaluate and compare the postoperative effects of the piezoelectric device and conventional rotary instruments in Schneider’s membrane sinus lifting procedure. Material and MethodsTwenty patients requiring bilateral maxillary bone graft augmentation in the posterior maxillary region were selected. Piezoelectric surgery was performed on one side and conventional surgery with a rotary diamond bur on the other. Postoperative pain, swelling, edema, and mouth opening were evaluated at one hour and two and seven days after the procedures. All variables were submitted to Friedman or Wilcoxon tests at a 5% significance level. ResultsThe comparison between groups showed that postoperative pain after one hour and two days was significantly lower (p< 0.05) in the piezoelectric device group. Regarding the edema, the results of both techniques were similar at all times assessed (p> 0.05). Piezosurgery was statistically associated (p< 0.05) with greater mouth opening only at the 48-hour evaluation. ConclusionsOsteotomy with a piezoelectric device causes less pain and greater mouth opening postoperatively compared with the conventional technique. Key words:Piezosurgery, sinus lift, edema, pain, rotative instruments.

Free fibular graft augmentation in delayed fixation of fracture neck of femur in young adults

Introduction: This clinical study was conducted to assess the long-term follow-up results of using free fibular graft to augment fracture fixation with cannulated cancellous screw (CCS) or dynamic hip screw (DHS) as a treatment option for femoral neck fractures in young adults who presented after 24 h of injury but within 3 weeks. Methodology: A prospective study was conducted on the patients of femoral neck fractures managed with multiple cancellous screws or DHS with fibular graft. Patients aged between 15 and 50 years and having Garden Type III or IV fracture with duration of injury >3 weeks were included in the study. They were assessed for radiological outcome and functional outcome using modified Harris hip score. Results: Twenty-two cases were operated between day 2 and day 21 after sustaining injury. The mean time of union was 3.4 months. Nineteen fractures united uneventfully. Two fractures went in for nonunion and one developed avascular necrosis (AVN) of the femoral head. According to Harris hip score, 14 patients scored “excellent,” three patients scored “good,” three scored “fair,” and “poor” score was recorded in two patients. Conclusions: Delay in surgery as a contributing factor for the development of complications in fracture neck of femur cannot be ruled out with the present literature available. Using a free fibular graft as an adjunct to implant construct helps in reducing the rates of nonunion and AVN. However, this cannot be a substitute for proper surgical precision that is required in the treatment of fracture neck of femur. Further prospective studies involving large sample size are required.

Creeping attachment after gingival augmentation using a free gingival graft. A case report

Introduction: Gingival recession presents an apical proliferation of the gingival margin to the cemento-enamel junction of the tooth and can be accompanied by aesthetics dissatisfaction and be associated with insufficient width of keratinized gingiva. Some surgical interventions are proposed for augmentation of gingival tissues when there is an insufficient width of keratinized gingival tissues. Such surgical approach is the use of a free gingival graft. This technique shows good results in gingival augmentation and treatment of shallow recessions with depth less than 3 mm. Aim: The aim of this case report is to demonstrate the creeping attachment of the gingival margin after use of a free gingival graft for augmentation of the width of keratinized gingival tissues on the vestibular side of the mandibular anterior area. Case Presentation: Lack of keratinized attached gingival tissues apically to the mandibular central incisors is established. A free gingival graft is used for augmentation of the width of the insufficient keratinized gingiva. Results : Three months after gingival augmentation with a free gingival graft, the reduction of the depth of gingival recessions was not significant. Compared to baseline, a significant increase in the width of keratinized attached gingiva was reported 6 months later. The depth of gingival recessions was reduced and gain of clinical attachment level was achieved on the vestibular side in both lower central incisors. Conclusion: The presented case report confirmed that, due to creeping attachment, a reduction of depth of gingival recessions and vestibular clinical attachment level gain were recorded after gingival augmentation with a free gingival graft.

Radiography study on osteotome sinus floor elevation with placed implant simultaneously with no graft augmentation

OBJECTIVE To investigate the change of endo-sinus bone height and bone volume in osteotome sinus floor elevation (OSFE) without bone graft but placing implants simultaneously by using cone beam computed tomography (CBCT) and three dimensional analysis, and to find the impacting factors on endo-sinus bone augmentation. METHODS OSFE was performed in 38 edentulous patients with missing teeth at posterior maxillary region, and 44 implants were placed and referred for OSFE using no graft materials. CBCT was performed pre-surgery and 9－68 months post-surgery when the patients encountered another implant surgery. The gained bone height at mesial, distal, buccal and palatal sites around the implant in sinus were measured, volumetric measurements of the endo-sinus gained bone volume (ESGBV) in the elevated region were calculated by Mimics software. Univariate analysis and multiple linear regression were performed to investigate the impacting factors on the gained bone height and ESGBV. Marginal bone loss was recorded according to the periapical radiography after implant restoration. RESULTS The mean residual bone height (RBH) pre-surgery was (3.41±1.23) mm, the mean protruded length (PL) into sinus of implant post-surgery was (3.41±1.28) mm, the mean endo-sinus gained bone height was (2.44±1.23) mm at distal sites, (2.88±1.20) mm at mesial sites, (2.83±1.22) mm at buccal sites and (2.96±1.16) mm at palatal sites, the mean endo-sinus gained bone height at distal sites was significantly lower than the other three sites (P < 0.05). The average endo-sinus gained bone height was (2.78±1.13) mm. The mean ESGBV was (122.15± 73.27) mm3. Univariate analysis showed the more RBH, the less bone height gained in sinus, which existed at buccal, lingual, mesial and distal sites (P < 0.001), and the more RBH, the smaller ESGBV gained (P=0.012). The ESGBV was significantly higher in the subjects whose bone generation period was more than 24 months than those whose bone generation period less than 24 months (P=0.034). The more PL, the more bone height and ESGBV gained (P=0.008). Multivariate analysis showed after adjusting factors of gender, age, smoking, width of sinus floor, thickness of sinus membrane pre-surgery, diameter and length of the implant, PL and bone generation period was positively correlated with mean endo-sinus gained bone height and ESGBV, while RBH negatively correlated with mean endo-sinus gained bone height. During the follow-up, the mean marginal bone loss was 0 (0－1.41) mm and all the implants loaded successfully. CONCLUSION OSFE without bone graft but with placed implant simultaneously can increase endo-sinus gained bone height and ESGBV. RBH, PL and bone generation period are the significant factors impacting endo-sinus bone augmentation.

Utilizing Edentulous Ridge as Autogenous Block Graft for Buccal Contouring Horizontal Ridge Augmentation

IntroductionAugmenting the edentulous anterior mandible can be a challenge. This case report describes a novel technique that combines bone reduction and buccal contouring using an autogenous block graft.Case PresentationA patient presented with a conventional mandibular denture that had poor retention. The patient had a deficient ridge that could not support dental implants without hard tissue augmentation. The anterior mandible was reduced vertically with an osteotomy to allow harvest of an autogenous block graft for horizontal ridge augmentation. After 8 months, dental implants were placed in a ridge with adequate width and patient proceed to final prosthesis.ConclusionThe technique may be considered in the atrophic mandible when a narrow ridge requires vertical height reduction as an autogenous block can be harvested and placed at a single surgical site.

Comparison of Autogenous Block Bone Graft and Screw Tent-Pole Techniques for Vertical Bone Augmentation in the Posterior Mandible: A Split-Mouth Randomized Controlled Study

Aim: To evaluate the effect on vertical bone augmentation of the screw tent-pole technique using particulate allograft in combination with injectable platelet-rich fibrin, and to compare this with autogenous block bone graft. Materials and Methods: This split-mouth randomized controlled study involved patients with bilateral partial edentulism and vertical bone loss in the posterior mandible. In each patient, the control side was treated with autogenous block bone graft harvested from the mandibular ramus and, on the test side, the screw tent-pole technique was employed, using particulate allograft in combination with injectable platelet-rich fibrin. All augmented sites were covered by leukocyte and platelet-rich fibrin membrane. The primary outcome variable of this study was the radiographic changes to bone height 6 months after augmentation. The secondary outcome variables were the percentage of newly formed bone and the implant survival rate. The data were analyzed with a significance level of α = 0.05. Results: Of the 13 patients included, a total of 11 patients (7 females, 4 males; mean age 50.92) completed the study. The mean values of vertical bone gain were 1.72 ± 0.78 mm for the test group and 2.83 ± 0.89 mm for the control group, which constitutes a significant difference ( P = .008). The percentage of newly formed bone was 18.08% ± 2.17% for the test group and 14.26% ± 1.76% for the control group. The difference between the groups was statistically significant ( P &lt; .001). The implant survival rates were 100% for both study groups. Conclusions: Based on the study results, screw tent-pole can be considered a feasible technique for bone augmentation. Further randomized studies will be necessary to fully evaluate vertical bone augmentation using the screw tent-pole technique, with different graft materials and with larger samples.

Outcomes of chronic distal biceps reconstruction with tendon grafting: a matched comparison with primary repair.

BackgroundThe purpose of this analysis was to analyze outcomes of distal biceps reconstruction with soft tissue allograft in the setting of chronic, irreparable distal biceps ruptures. The outcomes of these cases were then compared with a matched cohort of distal biceps ruptures that were able to be repaired primarily.MethodsRetrospective review of an institutional elbow surgery database was conducted. All cases of distal biceps repairs were identified by Common Procedural Terminology, ICD-9, and ICD-10 codes from January 2009 to March 2018. A direct review of operative reports was then conducted to identify which cases required allograft reconstruction. After identification of this population, a 2:1 manually matched cohort of patients who underwent primary repair was generated using age, gender, body mass index, and age-adjusted Charlson Comorbidity Index. Finally, the allograft reconstruction and matched primary repair cohorts were compared for reoperation, range of motion, and patient-reported outcomes scores.ResultsThere were 46 male patients who underwent distal biceps reconstruction with allograft (14 Achilles tendon, 32 semitendinosus) and they were matched to 92 male patients that underwent primary distal biceps repair. Mean patient age (46.9 ± 10.3 vs. 47.0 ± 9.8 years, P = .95), BMI (31.3 ± 5.3 vs. 31.3 ± 4.8 kg/m2, P = .60), and Charlson Comorbidity Index (1.2 ± 1.1 vs. 1.3 ± 0.9, P = .64) were similar between allograft reconstruction and primary repair groups. Disability of the Arm, Shoulder and Hand score (7.4 ± 18.0 vs. 1.6 ± 4.1, P = .23), Mayo Elbow Performance Score (92.1 ± 19.7 vs. 97.3 ± 6.4, P = .36), and Oxford Elbow Score (43.4 ± 11.0 vs. 46.8 ± 3.2, P = .25) were not significantly different between groups at mean 5.1 years (range, 1.5-10.9 years) after surgery. There were 1 of 42 (2.2%) allograft patients who require revision compared with 3 of 92 (3.3%, P = .719) in the primary repair group. In addition, one primary repair required reoperation for scar tissue excision and lateral antebrachial cutaneous neurolysis. Final range of motion data (twelve-week follow-up) for the allograft reconstruction group was similar to primary repair group in flexion (136.1° ± 5.3° vs. 135.9° ± 2.7°, P = .81), extension (0.8° ± 2.9° vs. 0.4° ± 1.7°, P = .53), pronation (78.0° ± 9.0° vs. 76.4° ± 15.4°, P = .50), supination (77.4° ± 10.7° vs. 77.5° ± 11.9°, P = .96).ConclusionPatients who underwent distal biceps reconstruction with a graft had similar failure rates, reoperation rates, final range of motion, and patient-reported outcomes scores as those treated without a graft. Patients can be consulted that direct repair in the acute setting is preferred; however, even in the setting of a distal biceps reconstruction with graft augmentation, they can expect low complications and good functional results.

Distal Patellar Tendon SpeedBridge Repair

Patellar tendon ruptures are rare injuries in young athletes, resulting in disruption of the extensor mechanism, and require surgery for functional recovery. Several techniques have been reported, including end-to-end repair and single-row suture anchor constructs. The strength of these repairs has been questioned, and they are commonly augmented. We endorse a double-row repair technique that provides an anatomic restoration of the footprint, has high fixation strength, eliminates the need for graft augmentation, and allows early motion.

Deciphering the enigma of female urethral strictures: A systematic review and meta-analysis of management modalities.

To evaluate the management methods of female urethral stricture (FUS) and analyze the outcomes of surgical treatments. A meta-analysis was done in an attempt to identify the best approach of urethroplasty and the graft-of-choice. A systematic search of Pubmed/Medline and Embase databases was performed according to the Preferred Reporting Items For Systematic Review And Meta-Analysis statement, for articles reporting on FUS management in the last decade. The Newcastle-Ottawa scale was usedto assess the quality of 28 included non-randomized studies. The data on FUS management was summarized and pooled success rates (taken as symptom improvement and no need for further instrumentation) were compared. The secondary outcome was to establish a diagnostic modality of choice and define a "successful-outcome"of repair. The outcome was separately reported for 554 women undergoing surgical intervention for FUS in the literature. The criteria defining FUS were varied. A combination of tests was used for diagnosis as none was singularly conclusive. A total of 301 patients had previous urethral instrumentations. The pooled success rate of urethral dilatation (234 women) was 49% at a mean follow-up of 32 months; flap urethroplasty (108 cases) was 92% at a mean follow-up of 42 months; buccal mucosal graft (BMG) urethroplasty (133 cases) was 89% at a mean follow-up of 19 months; vaginal graft augmentation (44 cases) was 87% at a mean follow-up of 15 months; and labial graft reconstruction (19 cases) was 89% at a mean follow-up of 18.4 months. The dorsal approach of graft augmentation met with 88% (95% confidence interval [CI] 0.79-0.95) success compared with95% (95% CI 0.86-1) for the ventral approach. FUS is a rare conditionrequiring a meticulous diagnostic workup using multiple tests. All urethroplasties have shown better pooled success rates (86%-93%) compared with dilatation (49%). BMG is equally effective as vaginal graft urethroplasty.

“V‐Reverse” Suturing Technique for Tunnel Soft Tissue Graft and Flap Stabilization: Technique Illustration

In periodontal and peri-implant plastic procedures, proper stabilization of the graft and the flap plays a crucial role in the outcomes. While the coronally advanced flap allows for better access with the possibility of suturing the graft to the periosteum and the de-epithelialized papillae, there is little evidence regarding what is the best approach in stabilizing the graft and the flap when performing the tunnel techniques (TUN). The purpose of this technical note is to describe a new suturing technique "V-reverse" for stabilization of the graft and the flap during a TUN procedure. The V-reverse suturing technique was used to enhance the stabilization of the graft and the flap during root coverage procedures, papilla augmentation, and immediate implant placement. Other advantages of this technique include reduced flap and graft micromotion; simple, easy, and fast procedure; and high patient compliance. The present article describes three main clinical scenarios in which V-reverse suturing technique is used to stabilize TUN + connective tissue graft for root coverage procedures, papilla augmentation, and immediate implant placement.

Clinical comparison of a xenogeneic collagen matrix versus subepithelial autogenous connective tissue graft for augmentation of soft tissue around implants

Dental implant placement is a predictable therapy for replacing teeth. Nevertheless, mechanical, biological, and aesthetic complications frequently occur. The aim of this study was to compare the clinical outcomes of a xenogeneic collagen matrix (XCM) used at the time of implant placement as an alternative to a subepithelial connective tissue graft (SCTG), for soft tissue augmentation. This was a prospective clinical trial with 12 months of follow-up. In the control group, soft tissue augmentation at the time of implant placement was performed with a SCTG, while in the test group, a XCM was employed. At 12 months postoperative, all xenografts showed no postoperative complications. In both groups, a significantly greater thickness was observed on the buccal and occlusal sides from preoperative to 3 months postoperative (P<0.05). No statistically significant difference in pink aesthetic score (P=0.379, 6 months postoperative) or marginal bone loss (P=0.449 at 3 months postoperative, P=0.778 at 6 months postoperative) was observed between the groups. Statistically significant differences in pain perceived by the patients (P<0.0001) and the time to complete the surgical procedure (P=0.0008) were detected. At 12 months after surgery, XCM provided similar clinical results in terms of soft tissue augmentation on the buccal and occlusal sides as compared with the SCTG.

Return to Sport After ACL Reconstruction With a BTB Versus Hamstring Tendon Autograft: A Systematic Review and Meta-analysis.

Background:Anterior cruciate ligament (ACL) tears are debilitating injuries frequently suffered by athletes. ACL reconstruction is indicated to restore knee stability and allow patients to return to prior levels of athletic performance. While existing literature suggests that patient-reported outcomes are similar between bone–patellar tendon–bone (BTB) and hamstring tendon (HT) autografts, there is less information comparing return-to-sport (RTS) rates between the 2 graft types.Purpose:To compare RTS rates among athletes undergoing primary ACL reconstruction using a BTB versus HT autograft.Study Design:Systematic review; Level of evidence, 4.Methods:The MEDLINE, Embase, and Cochrane Library databases were searched, and studies that reported on RTS after primary ACL reconstruction using a BTB or HT autograft were included. Studies that utilized ACL repair techniques, quadriceps tendon autografts, graft augmentation, double-bundle autografts, allografts, or revision ACL reconstruction were excluded. RTS information was extracted and analyzed from all included studies.Results:Included in the review were 20 articles investigating a total of 2348 athletes. The overall RTS rate in our cohort was 73.2%, with 48.9% returning to preinjury levels of performance and a rerupture rate of 2.4%. The overall RTS rate in patients after primary ACL reconstruction with a BTB autograft was 81.0%, with 50.0% of athletes returning to preinjury levels of performance and a rerupture rate of 2.2%. Patients after primary ACL reconstruction with an HT autograft had an overall RTS rate of 70.6%, with 48.5% of athletes returning to preinjury levels of performance and a rerupture rate of 2.5%.Conclusion:ACL reconstruction using BTB autografts demonstrated higher overall RTS rates when compared with HT autografts. However, BTB and HT autografts had similar rates of return to preinjury levels of performance and rerupture rates. Less than half of the athletes were able to return to preinjury sport levels after ACL reconstruction with either an HT or BTB autograft.