Hard Tissue Reconstruction Research Articles

A modified surgical approach for hard and soft tissue reconstruction of severe periimplantitis defects – Laser‐assisted periimplant defect regeneration (LAPIDER)

A modified surgical approach for hard and soft tissue reconstruction of severe periimplantitis defects – Laser‐assisted periimplant defect regeneration (LAPIDER)

Nasolabial and Interincisal Angle Evaluation in Anterior Maxillary Distraction Osteogenesis: A Case Study:

Maxillary hypoplasia is a common developmental problem in cleft lip and palate deformities. These deformities have traditionally been corrected by means of orthognathic surgery. Management of skeletal deformities in the maxillofacial region has been a challenge for maxillofacial surgeons and orthodontists. Distraction osteogenesis (DO) is a surgical technique that uses body's own repairing mechanisms for optimal reconstruction of the hard and soft tissues. We present four cases of anterior maxillary distraction osteogenesis with tooth-borne distraction device— Hyrax, which were analyzed retrospectively using cephalometrics. Changes in nasolabial angle and interincisal angle after distraction of anterior maxillary segment were studied to conclude that there was no much change in the the nasolabial angle while the interincisal angle showed marked improvement.

Therapeutic alternatives for addressing pink esthetic complications in single-tooth implants: A proposal for a clinical decision tree.

Esthetic complications in implant therapy today represent a clinical challenge, when the aim is to overcome the sequelae and obtain a pleasing result. The current scientific literature about this topic is scarce and often based on case reports and the personal opinions of clinicians. The aim of this article is to introduce a decision tree for diagnosis and treatment of complications, focusing on the pink esthetic of single-tooth implants and based on three diagnostic pillars (3D implant position, peri-implant hard-tissue anatomy, and peri-implant soft-tissue anatomy). Different shortcomings have been identified for each of the three diagnostic areas. Following this tree, the article proposes treatment alternatives including soft- and hard-tissue reconstruction, implant submergence, orthodontic extrusion, and implant extraction in order to help clinicians establish a logical therapeutic sequence. Guidelines for adequate diagnosis and management of single implant-supported restorations with compromised esthetics is mandatory when attempt to overcome shortcoming in the pink esthetic result.

Molar-incisor hypomineralisation (MIH) – aetiology, clinical picture, treatment

Introdution. Molar-incisor hypomineralisation is a disorder of dental enamel of a systemic origin. It may affect one or all four first permanent molars, and often involves permanent incisors. Aim. The aim of this study was to present views on aetiology, clinical picture and treatment of molar-incisor hypomineralisation. Material and methods. PubMed database was reviewed for years 2003-2017, the search criteria were: “molar incisor”, “hypomineralisation”, “permanent teeth”. Results. The aetiology of MIH is multifactorial and not fully explained. Authors agree that the general health during the first 3-4 years of life has a major impact on this disorder. The clinical picture includes demarcated white, yellow or brown tissue spots, and increased porosity of the enamel. Enamel damage and defects can also occur. Therapeutic management depends on the severity of the disease and includes intensive prevention, hard tissue reconstruction, and extractions. Conclusions. Due to the increasing prevalence of this disorder, special attention should be paid to children whose health status is or was bad in the first 3-4 years of life. They are at a higher risk for this condition.

Rhabdomyolysis after the free fibular flap operation for mandibular reconstruction: a case report

BackgroundFree fibular flap is one of the most useful methods in the hard tissue reconstruction of the maxilla-mandible. Free fibular flap presents some advantages in which the reconstruction of both soft and hard tissues can be done at the same time. It also provides a safe and successful bone graft for the reconstruction, along with a low rate of complications. Despite these advantages and the rarity of a postoperative complication, particularly in oral and maxillofacial surgery procedures, a prolonged operation might exhibit some complications related with rhabdomyolysis. We experienced the rare event of rhabdomyolysis after oral cancer surgery.Case presentationIn this article, we report the case of a patient who developed rhabdomyolysis after undergoing free fibular flap surgery.ConclusionsDespite the advantages of the free fibular flap operation, clinicians must be aware of the risk of complications because there are multiple factors that could result in rhabdomyolysis, such as duration of operation, position of the subject, and pre-existing conditions of diabetes and hypertension. Once the diagnosis of rhabdomyolysis is confirmed, a prompt treatment plan should be made and applied as soon as possible. This will increase the chance of a full recovery for the patient who is exhibiting symptoms of rhabdomyolysis.

Versatility of uniplanar prearthoplastic distraction osteogenesis in the correction of post-ankylosis facial deformities—a report of five different cases

Unilateral or bilateral ankylosis can lead to severe micrognathia and facial deformity that requires multiple, often, staged surgical corrections. To date, there is no ideal treatment modality that satisfactorily corrects the complex anatomy, restores the ramal height, and corrects the micrognathia and microgenia. Distraction osteogenesis has been acclaimed as a successful modality for the treatment of such deformities. It is a cost-effective approach with low morbidity and less relapse thus providing better functional and esthetic outcomes. It allows the surgeon to correct the deformity in various planes by using various devices by changing osteotomy designs and vectors, with simultaneous hard tissue and soft tissue reconstruction. Here, we present a series of five cases where different types of distraction osteogenesis were combined with various other procedures to correct post-ankylotic facial asymmetry. In one case, simultaneous maxillo-mandibular distraction [Molina's technique] was used. All patients showed significant improvement in function and esthetics. Outcome assessment was made using clinical photographs and radiographs. Pre-arthroplastic distraction osteogenesis is a versatile cost effective approach that can be customized for every patient based on their needs.

Performance status scale for head and neck scores for oral cancer survivors: predictors and factors for improving quality of life.

This study aimed to determine the factors associated with long-term quality of life of oral cancer survivors. A total of 508 survivors were assessed using the performance status scale for head and neck (PSS-HN), which comprises Eating in Public (E-Public), Normalcy of Diet (N-Diet), and Understandability of Speech (U-Speech). Stepwise multiple linear regression analysis was performed. The median time between the end of treatment and participating in the survey was 38months (range, 6-250). Overall, 57-60% of survivors achieved full performance (100 score) of each PSS-HN score, whereas 15% had moderate or severe impairment (≤ 50 score) in E-Public and N-Diet, and 4% had impairment in U-Speech. These three scores deteriorated with increasing T-stage. Age, soft tissue reconstruction, trismus, and missing occlusal contacts on the contralateral side were significantly associated with E-Public and N-Diet. Neck dissection, hard tissue reconstruction, and missing occlusal contacts bilaterally were associated with U-Speech score. Older age, T4 tumor, and soft tissue reconstruction were predictors of low E-Public and N-Diet performance scores. Increasing mouth opening and maintaining optimal occlusal contacts on the contralateral side may be effective ways to improve N-Diet and E-Public performance. Maintaining optimal occlusal contacts bilaterally may be effective for improving speech performance. Oral health care to increase optimal occlusal contacts and rehabilitation of trismus may be promising factors to improve the functional performance of oral cancer survivors.

The 3 R’s for Platelet-Rich Fibrin: A “Super” Tri-Dimensional Biomaterial for Contemporary Naturally-Guided Oro-Maxillo-Facial Soft and Hard Tissue Repair, Reconstruction and Regeneration

Platelet-Rich fibrin (PRF) is a three-dimensional (3-D) autogenous biomaterial obtained via simple and rapid centrifugation from the patient’s whole blood samples, without including anti-coagulants, bovine thrombin, additives, or any gelifying agents. At the moment, it is safe to say that in oral and maxillofacial surgery, PRFs (particularly, the pure platelet-rich fibrin or P-PRF and leukocyte and platelet-rich fibrin or L-PRF sub-families) are receiving the most attention, essentially because of their simplicity, cost-effectiveness, and user-friendliness/malleability; they are a fairly new “revolutionary” step in second-generation therapies based on platelet concentration, indeed. Yet, the clinical effectiveness of such surgical adjuvants or regenerative platelet concentrate-based preparations continues to be highly debatable, primarily as a result of preparation protocol variability, limited evidence-based clinical literature, and/or poor understanding of bio-components and clinico-mechanical properties. To provide a practical update on the application of PRFs during oral surgery procedures, this critical review focuses on evidence obtained from human randomized and controlled clinical trials only. The aim is to serve the reader with current information on the clinical potential, limitations, challenges, and prospects of PRFs. Accordingly, reports often associate autologous PRFs with early bone formation and maturation; accelerated soft-tissue healing; and reduced post-surgical edema, pain, and discomfort. An advanced and original tool in regenerative dentistry, PRFs present a strong alternative and presumably cost-effective biomaterial for oro-maxillo-facial tissue (soft and hard) repair and regeneration. Yet, preparation protocols continue to be a source of confusion, thereby requiring revision and standardization. Moreover, to increase the validity, comprehension, and therapeutic potential of the reported findings or observations, a decent analysis of the mechanico-rheological properties, bio-components, and their bioactive function is eagerly needed and awaited; afterwards, the field can progress toward a brand-new era of “super” oro-dental biomaterials and bioscaffolds for use in oral and maxillofacial tissue repair and regeneration, and beyond.

What is the benefit of using amniotic membrane in oral surgery? A comprehensive review of clinical studies.

Since its first use for the reconstruction of tissue defects in the oral cavity in 1985, human amniotic membrane (hAM) has been widely studied in the field of oral surgery. Despite the growing number of publications in this field, there is no systematic review or meta-analysis concerning its clinical applications, outcome assessments, and relevance in oral surgery. The aim of this review is to provide a thorough understanding of the potential use of hAM for soft and hard tissue reconstruction in the oral cavity. A systematic electronic and a manual literature search of the MEDLINE-PubMed database and Scopus database was completed. Patient, Intervention, Comparison and Outcomes (PICO) technique was used to select the relevant articles to meet the objective. Studies using hAM for oral reconstruction, and conducted on human subjects, were included in this survey. A total of 17 articles were analyzed. Five areas of interest were identified as potential clinical application: periodontal surgery, cleft palate and tumor reconstruction, prosthodontics and peri-implant surgery. Overall, periodontal surgery was the only discipline to assess the efficacy of hAM with randomized clinical trials. The wide variability of preservation methods of hAM and the lack of objective measurements were observed in this study. hAM is already used in the field of oral surgery. Despite this, there is weak clinical evidence demonstrating convincingly the benefit of hAM in this area compared to standard surgery. Several studies now suggest the interest of hAM for periodontal tissue repair. Due to its biological and mechanical properties, hAM seems to be a promising treatment for wound healing in various areas of oral reconstruction. However, further randomized clinical trials are needed to confirm these preliminary results.

Comparative Study of Bioceramic Powders Synthesis Based on Calcium and Phosphates

Abstract In this paper is presented a comparative study regarding the synthesis of hydroxyapatite powders. The chosen method of synthesis of this biomaterial was chemical co-precipitation. The structure, size and morphology of the obtained powders were analyzed by X-ray diffraction, infrared spectroscopy - FTIR, dynamic light diffusion DLS tehnique and scanning electron microscopy-SEM. The results obtained were compared with those obtained on a commercial hydroxyapatite powder. Investigation methods have confirmed the synthesis of a high purity hydroxyapatite with a optimal degree of crystallization and crystallinity for the reconstruction and regeneration of hard tissue.

Fabrication and characterization of magnesium scaffold using different processing parameters

Structural and mechanical properties of scaffolds are important for hard tissue reconstruction. In this study, magnesium scaffolds were fabricated using space holder method for bone tissue reconstruction and the effect of cold compaction pressure and also volume percent of porosity on structural and mechanical properties of scaffolds were investigated using scanning electron microscopy (SEM) and uniaxial compression test. The carbamide spacer agent was also removed after pellet compaction, using NaOH solution and ethanol for the first time and their effect on phases present in scaffold after sintering was investigated using x-ray diffraction (XRD) analysis. Based on the results of mechanical and structural assessments, the optimum cold compaction pressure was selected 350 MPa for pellet compaction. The elastic modulus and strength of magnesium scaffolds including 67 vol.% porosity were in the range of 0.20–0.28 GPa and 4–4.25 MPa, respectively which is comparable to cancellous bone tissue. The mechanical properties of magnesium scaffolds decreased by increasing the porosity. The results also revealed that ethanol is a more suitable liquid for carbamide removal compared to NaOH solution.

Zirconia-Based Biomaterials for Hard Tissue Reconstruction

Implantable biomaterials are increasingly important in the practice of modern medicine, including fixative, replacement, and regeneration therapies, for reconstruction of hard tissues in patients with pathologic osseous and dental conditions. A number of newly developed advanced biomaterials have been introduced as promising candidates for tissue reconstruction. Among these, zirconia-based biomaterials have gained attention as a biomaterial for hard tissue reconstruction due to superior mechanical properties and good chemical and biological compatibilities. This review summarizes the types of zirconia, advantages of zirconia-based biomaterials for hard tissue reconstruction including bone and dental tissues, responses of tissue and cells to zirconia, and surface modifications for enhanced bioactivity of zirconia. Current and future applications of zirconia-based biomaterials for bone and dental reconstruction, ie, medical implanted devices, dental prostheses, and biocompatible osteogenic scaffolds, are also discussed.

Effect of metallographic structure and machining process on the apatite-forming ability of sodium hydroxide- and heat-treatedtitanium.

Although titanium (Ti) is clinically used for hard tissue reconstruction, it has low bone-bonding ability, i.e. bioactivity. Materials able to deposit apatite on their surfaces within the body is considered to exhibit bioactivity. Effects of the metallographic structure and machining process of Ti on its apatite-forming ability remains unclear. In this study, Ti substrates subjected to various preheating and machining processes were then subjected to NaOH and heat treatments. The apatite-forming abilities of resulting Ti were examined in simulated body fluid (SBF). Preheating of the Ti decreased its reactivity with NaOH solution. When quenched or annealed Ti was subjected to NaOH and heat treatments, the induction period for apatite formation in SBF slightly increased. This was attributed to a decrease in sodium titanate and increase in rutile on the Ti surface after the treatments. Substrates subjected to wire-electrical-discharge machining did not form apatite. This was attributed to the inhibition of PO43- adsorption on their surfaces following Ca2+ adsorption, which is an essential process for apatite nucleation. Contamination of Ti surface by components of the brass wire used in the machining contributed to the inhibition. The bioactivity of surface-modified Ti was therefore significantly affected by its thermal treatment and machining process.

Successful management of a gun shot wound to the mandibular condyle by removal of the condylar head with no hard tissue reconstruction - Lessons for blunt trauma management?

Successful management of a gun shot wound to the mandibular condyle by removal of the condylar head with no hard tissue reconstruction - Lessons for blunt trauma management?

Alveolar transportation through bone anchorage and sliding mechanics

The reconstruction of hard and soft tissues in craniofacial anomalies is a great challenge in clinical practice. For a longtime, grafts have been the technique of choice in patients with cleft lip and palate; however, when the soft tissue that surrounds the cleft is insufficient to obtain adequate closure, failures have been reported. Alveolar transport has been applied for the closure of oronasal communication with adequate bone quality and quantity, allowing implant placement and fi nal restoration. An innovative technique of alveolar transport with a curved trajectory is hereby presented respecting arch shape, unlike the techniques previously described, through a bone anchoring system and fi xed orthodontic appliances with sliding mechanics resulting in a predictable and successful treatment.

Clinical and Histologic Evaluations of SLA Dental Implants.

The goal of this investigation was to evaluate the efficacy of dental implants with a surface that was sandblasted with large grit and acid etched in a human model. Seven patients volunteered to allow the biopsy of a small implant in exchange for complete dental rehabilitation at no cost. All biopsy sites received soft and hard tissue reconstruction, and this report provides observation of successful bone-to-implant contact and successful prosthesis construction for the patient. The patients enthusiastically reported improved quality of life as a result of participation in this study. The surgeons’ confidence in this implant was reflected by the clinical and histologic result of the study.

From molecules to macrostructures: recent development of bioinspired hard tissue repair.

Enamel, dentin and bone are calcified hard tissues in the human body that play significant roles in food mastication and movement support. Generally, hard tissues lack the ability of self-repair, except for the regeneration ability of bone for small-scale defects. Fabrication of man-made repair materials is therefore highly demanded. In this review, following a bioinspired strategy, we describe the composition and multiscale structures of different hard tissues, and highlight the key points for the reconstruction of hard tissues. Finally, bioinspired tissue repair techniques ranging from molecule-induced mineralization, to microscale assembly to macroscaffold fabrication are summarised.

Combined Use of Mesenchymal Stromal Cell Sheet Transplantation and Local Injection of SDF-1 for Bone Repair in a Rat Nonunion Model.

Bone nonunion treatments pose a challenge in orthopedics. This study investigated the joint effects of using mesenchymal stem cell (MSC) sheets with local injection of stromal cell-derived factor-1 (SDF-1) on bone formation. In vitro, we found that migration of MSCs was mediated by SDF-1 in a dose-dependent manner. Moreover, stimulation with SDF-1 had no direct effect on the proliferation or osteogenic differentiation of MSCs. Furthermore, the results indicated elevated expression levels of bone morphogenetic protein 2, alkaline phosphatase, osteocalcin, and vascular endothelial growth factor in MSC sheets compared with MSCs cultured in medium. New bone formation in fractures was evaluated by X-ray, micro-computed tomography (micro-CT), hematoxylin and eosin (H&E) staining, Safranin-O staining, and immunohistochemistry in vivo. In the rat bone fracture model, the MSC sheets transplanted into the injured site along with injection of SDF-1 showed significantly more new bone formation within the gap. Moreover, at 8 weeks, complete bone union was obtained in this group. In contrast, the control group showed nonunion of the bone. Our study suggests a new strategy involving the use of MSC sheets with a local injection of SDF-1 for hard tissue reconstruction, such as the healing of nonunions and bone defects.

Nanomaterials for Tissue Engineering In Dentistry.

The tissue engineering (TE) of dental oral tissue is facing significant changes in clinical treatments in dentistry. TE is based on a stem cell, signaling molecule, and scaffold triad that must be known and calibrated with attention to specific sectors in dentistry. This review article shows a summary of micro- and nanomorphological characteristics of dental tissues, of stem cells available in the oral region, of signaling molecules usable in TE, and of scaffolds available to guide partial or total reconstruction of hard, soft, periodontal, and bone tissues. Some scaffoldless techniques used in TE are also presented. Then actual and future roles of nanotechnologies about TE in dentistry are presented.

Outcomes of Immediate Allograft Reconstruction of Long-Span Defects of the Inferior Alveolar Nerve

Contemporary management of ablative jaw defects includes not only hard and soft tissue reconstruction, but also restoration of neurosensory function. The goal of this study was to determine the outcomes of immediate reconstruction of long-span defects (≥50mm) of the inferior alveolar nerve (IAN) after ablative mandibular resection using allogeneic nerve grafts. A retrospective cohort study of patients who underwent immediate reconstruction of IAN gaps of at least 50mm with allogeneic nerve graft (AxoGen Avance, Alachua, FL) at a single academic medical center by a single surgeon (M.M.) from September 2013 to March 2015 was completed. Demographic and clinical data were collected for each patient and analyzed using clinical neurosensory testing and were reported using the Medical Research Council Scale (MRCS) for functional sensory recovery. In addition, patient subjective perception of neurosensory recovery was recorded using a visual analog scale (VAS). Subjective (VAS) and objective (MRCS) measurements of functional sensory recovery were recorded and compared across the study population. In addition, examined demographic and clinical data included patient age, gender, pathology, length of nerve allograft, and follow-up period. Of 12 with nerve repairs, 7 patients met the inclusion criteria. The average age was 34.7years (range, 18 to 61yr) and 71.4% were men. All IAN defects resulted from resection of mandibular pathology (6 benign lesions, 1 malignant lesion). Six of the 7 IAN defects were reconstructed with a 70-mm nerve allograft, and 1 nerve defect was reconstructed with a 50-mm graft. Mean follow-up time was 17.7months (range, 10 to 27.5months). Mean VAS score reported was 3.7 (range, 0 to 7). In addition, 85.7% of patients displayed return of some superficial pain and tactile sensation without over-response (S3), with 14.3% displaying good stimulation localization (S3+). The patient who displayed S3+ recovery underwent reconstruction with the 50-mm graft. Only 1 of the 7 patients had no neurosensory recovery (S0). Immediate reconstruction of the IAN with allogeneic nerve grafting of long-span defects (≥5cm) is a viable and predictable option to achieve useful functional sensory recovery.