Hydroxyapatite Graft Research Articles

Anterior Cervical Interbody Fusion with Hydroxyapatite Graft: Clinical and Radiological Analysis of Graft Breakage

Introduction The most common complication related to the use of hydroxyapatite (HA) grafts for cervical anterior fusion is graft breakage. However, the implication of graft breakage in terms of loss of graft height, cervical alignment, plate migration, and clinical outcomes has not been adequately evaluated. The objective of this study is to evaluate the efficacy of HA grafts in combination with cervical plates in terms of fusion, restoration, and maintenance of cervical lordosis and to compare clinical and radiologic outcomes of patients who experienced graft breakage with patients who did not. Patients and Methods A prospective study of 40 patients who underwent anterior cervical fusion in which HA graft and plate systems were used. The chemical analysis of the implants showed 65% HA and 35% tricalcium phosphate and other ionic constituents found in bone mineral, such as carbonate, sodium, and magnesium ions. Preoperative assessments included clinical examinations, plain radiography, and magnetic resonance imaging. Postoperative assessments included clinical examinations, use of analgesics, and plain radiography. Flexion-extension radiography and computerized tomography scanning with sagittal and coronal reconstructions were also performed at the last visit. Results At the final follow-up evaluation, 80% of patients had an excellent clinical outcome, 15% had a good outcome, and 5% had a fair outcome based on Odom classification. All patients achieved lordotic alignment in the immediate postoperative period. Graft breakage was observed in 25% of cases. Patients who experienced HA block breakage have a 21 times greater chance of having an intervertebral height loss greater than 2 mm, a 4.9 times greater likelihood of undergoing loss of cervical alignment exceeding 3 degrees, and are 12.4 times more likely to present migration of the plates when compared with patients who had normal HA grafts. Conclusion Despite the positive clinical results observed in this study, breakage of HA grafts was a common complication occurring in 25% of patients. Graft breakage was associated with strut height loss of more than 2 mm, loss of cervical alignment exceeding 3 degrees, and a higher rate of plate migration. These changes related to the HA graft breakage demonstrate the necessity to continue searching for better grafting methods to perform cervical interbody fusion.

Extraction socket preservation followed by ovate pontic site preparation and prosthesis for emergence profile in esthetic region

After tooth extraction, the alveolar ridge will commonly decrease in volume and change morphologically. The reasons for socket preservation, there seems to be a consensus that sufficient alveolar bone volume and favorable architecture of the alveolar ridge are essential to achieve ideal functional and esthetic prosthetic reconstruction and also provide esthetically pleasing restorations to our patients without violating the predictability and function of those prostheses. Grafting is one of the most common methods of socket preservation widely used to prevent the collapse of oral tissues. The present case report describes the management of maxillary central incisors, which is vertically fracture using socket preservation using hydroxyapatite bone graft BioGraft (BioGraft HABG Active, manufacturer. IFGL ltd. Kalunga Industrial Estate. U.K) and platelet-rich fibrin followed by ovate pontic site preparation giving emergence profile in esthetic region.

Clinical and radiographic evaluations of porous hydroxyapatite as bone graft material in the treatment of interproximal vertical defects

Background: Periodontal regeneration has been the goal over the past few years in the treatment of various periodontal defects. Various traditional surgical and nonsurgical approaches were found to produce the minimal amount of new periodontal attachment apparatus. It was further suggested that the addition of various graft materials might increase the amount of new bone, periodontal ligament, and cementum generated. Hence, this clinical study was undertaken to evaluate the efficacy of porous hydroxyapatite in the treatment of interproximal vertical bony defects in human beings as a regenerative implant material. Materials and Methods: A total of 16 sites from eight patients in the age group of 30-60 years were selected. Out of the two sites from each patient, one was control site-flap surgery without porous hydroxyapatite graft material and the other was experimental site-flap surgery with porous hydroxyapatite graft material. At 3 months, 6 months, and 9 months postoperatively, each site was subjected to clinical parameters such as pocket depth, attachment gain, gingival recession, and osseous fill. Results: Significant mean attachment gain was observed at 6 months and 9 months after surgery. The mean original defect was significant at 3 months and 6 months postsurgically. Mean percentage fill was significant at 3 months postsurgically. All other parameters were nonsignificant. Conclusion: Radiographic assessment showed a greater defect fill at the grafted site indicating the superiority of grafting procedure to nongraft procedure. Hence, porous hydroxyapatite crystals are an effective graft material in elimination of interproximal vertical defects.

Phenolization and coralline hydroxyapatite grafting following meticulous curettage for the treatment of enchondroma of the hand. A case series of 82 patients with 5-year follow-up.

Enchondromas are benign cartilaginous tumours. The most common location is in the long bones of the hand. Treatment methods fall into a broad spectrum ranging from conservative, medical therapies, to a variety of surgical procedures, which may or may not employ the use of local adjuvant treatment or bone grafting. The purpose of this study was to report our experience and evaluate the long-term results of patients with enchondroma of the hand, treated in our department with meticulous curettage, phenolization and coralline hydroxyapatite grafting. We present 82 patients with hand enchondromas treated surgically in our department during the last 10years. The patients were treated operatively with meticulous curettage of the bone lesion, with use of phenol 5% as local adjuvant and coralline hydroxyapatite bone graft to fill in the remaining cavity. At a minimum of 5-year follow-up, radiographs and clinical examination showed adequate bone formation at the site of enchondroma excavation and no evidence of recurrence, fracture, infection or other complication related to the procedure. We concluded that the combination of meticulous curettage of the lesion, with the use of phenol as local adjuvant and coralline hydroxyapatite graft is a safe technique that prevents recurrence and allows adequate and uncomplicated local new bone formation.

Clinical and radiographic evaluation of the efficacy of platelet-rich plasma combined with hydroxyapatite bone graft substitutes in the treatment of intra-bony defects in maxillofacial region

Objective. The aim of this study is to evaluate the efficacy of platelet-rich plasma (PRP) clinically and radiographically when combined with bovine derived hydroxyapatite (HA) bone grafting materials and resorbable collagen membranes for the treatment of intra-bony defects frequently seen at the distal aspect of mandibular second molars following the surgical extraction of fully impacted mandibular wisdom teeth. Study design. Eighteen patients were scheduled for post-operative visits at 1, 3 and 6 months post-operatively, probing depths were measured and digital panoramic radiographs were taken. Results. There were no significant differences on probing depths among two groups. Radiographic assessment also showed no significant difference among groups at 1st and 6th month intervals, while 3 months post-operatively the amount of radiographic density at the PRP side was significantly higher. Conclusion. Combined use of PRP and bovine-derived HA graft materials for the treatment of intra-bony defects might be an appropriate approach when the main goal is providing earlier bone regeneration.

The efficacy of the use of IR laser phototherapy (LPT) on bone defect grafted with biphasic ceramic on rats with iron deficiency anemia: Raman spectroscopy analysis

The aim of this study was to evaluate bone repair in anemic and non-anemic rats submitted or not to laser phototherapy and hydroxyapatite graft. Animals were divided in eight groups of five animals: Clot; Laser; Graft; Graft + Laser; iron deficiency anemia (IDA) + Clot; IDA + Laser; IDA + graft; IDA + graft + Laser. When appropriate irradiation with infrared laser was done during 15 days at a 48-h interval. Animals were killed at day 30; samples were analyzed by Raman spectroscopy. Three shifts were studied and statistically analyzed: ~960, ~1,070, and ~1,454 cm(-1). Graft + laser showed highest ~960 peak was statistically different from all other healthy groups. No statistical difference was found between Clot and IDA + Clot in any shift. The IDA + Graft and IDA + Graft + Laser groups had low mean peak values for shifts ~960, ~1,070, and ~1,454 cm(-1). The results in this study indicate that using hydroxyapatite (HA) and laser irradiation in healthy subjects is favorable to mineral deposition and bone maturation, this being of importance for some groups at risk, such as astronauts. In iron deficiency anemia cases, the use of graft, associated or not to laser irradiation, resulted in low collagen and low carbonate and phosphate HA.

Clinical and radiographic evaluation of intra-bony defects in localized aggressive periodontitis patients with platelet rich plasma/hydroxyapatite graft: A comparative controlled clinical trial.

Background:Aggressive periodontitis is a characterized by rapid attachment loss, bone destruction and familial aggregation. Platelet-rich plasma (PRP) has been proposed to promote regeneration of the lost periodontal tissues. The aim of this study was to evaluate and compare the efficacy of PRP combined with hydroxyapatite (HA) graft in the treatment of intra-bony defects in localized aggressive periodontitis (L-AgP) patients.Materials and Methods:Ten L-AgP patients having bilateral intra-bony defect ≥2 mm and probing depth (PD) ≥6 mm were randomly treated either with the PRP/HA graft or HA graft alone. The clinical (plaque control record, bleeding on probing index, PD, and relative attachment level [RAL]), and radiographic parameters (size of the bone defect) were recorded pre- and post-operatively at 3, 6, and 12 months.Results:After 12 months, for both maxillary and mandibular arches, the mean PD decrease was significantly more (P < 0.05) for the test group than the control group (3.2 mm vs. 1.9 mm and 3.6 mm vs. 1.9 mm, respectively). Furthermore, the mean RAL decrease in both maxillary and mandibular arches was significantly more (P < 0.05) for the test group than the control group (3.0 mm vs. 1.2 mm and 3.1 mm vs. 1.4 mm, respectively). Radiographically, the test group showed significantly more defect fill as compared with the control group.Conclusion:Both treatments provided significant improvements in clinical and radiographic parameters in a 12-month postoperative period. PRP/HA group presented superior results regarding PD reduction, clinical attachment gain and radiographic bone fill than HA group.

Clinical evaluation of hydroxyapatite and β-tricalcium phosphate composite graft in the treatment of intrabony periodontal defect: A clinico-radiographic study.

Background and Objective:Hydroxyapatite (HA) and β-tricalcium phosphate (β-TCP) grafts have shown to be effective in promoting the clinical signs of periodontal regeneration in intrabony defects. The aim of our study was to clinically and radiographically evaluate the efficacy of HA and β-TCP composite bone graft material in the treatment of intrabony three-wall defect.Materials and Methods:Twenty patients participated in this study. Interproximal bony defects were surgically treated with a combination of HA–βTCP (biphasic calcium phosphate). Changes in clinical parameters such as gingival status, probing pocket depth, clinical attachment, and radiographic estimation of the amount of bone fill were evaluated after 6 months postoperatively.Statistical Analysis Used:Student's “t” test.Results:This treatment modality resulted in significant pocket depth reduction and clinical attachment gain which were observed to be 2.938 mm (47.04%) and 3.188 mm (29.09%), respectively. The defect fill as seen radiographically was 3.204 mm (63.195%). All the differences were highly significant and in favor of postoperative group.Conclusion:The results of this study suggest that HA–βTCP (biphasic calcium phosphate) provides an added regenerative effect in promoting the clinical resolution of intrabony three-wall defects in patients with periodontitis.

Comparison of nanocrystalline hydroxyapatite and synthetic resorbable hydroxyapatite graft in the treatment of intrabony defects: A clinical and radiographic study.

Background:The aim of this study is to compare, clinically and radiographically, the effectiveness of nanocrystalline hydroxyapatite (NHA) and synthetic resorbable hydroxyapatite (HA) in the treatment of intrabony defects.Materials and Methods:Ten subjects with bilateral defects, with probing depth (PD) 6-9 mm and radiographic evidence of an intraosseous component ≥4 mm participated in the present study. Subjects were allocated randomly to treatment with NHA (test group) or HA (control group). At baseline, 3 and 6 months after surgery, the following clinical parameters were recorded: Plaque index, gingival index, PD, relative attachment level (RAL), and radiographic reduction in intrabony defect.Results:At 6 months following therapy, the test group showed a reduction in mean PD from 6.4 ± 0.843 to 3.3 ± 0.8232 mm and a change in mean RAL from 12.9 ± 1.197 to 10.1 ± 0.7378 mm, whereas in the control group the mean PD decreased from 7.65 ± 1.8566 to 3.9 ± 1.1005 mm, and mean RAL decreased from 13.9 ± 0.9944 to 10.7 ± 0.6749 mm. On comparison of the mean difference in probing depth between the two groups after the unpaired t-test was applied at baseline, 3 months and 6 months, scores were found to be statistically non-significant (P > 0.01).Conclusion:The results of the present study indicate that both NHA and conventional HA led to the improvement of clinical and radiographic parameters over the course of the study. However, the test group did not show any significant improvement over the control group.

Structural evaluation and animal implantation of porous eggshell wastederived hydroxyapatite graft as bone substitution

The development of hydroxyapatite graft with high economically value is needed for orthopedic practice in developing countries. Eggsell waste is well known as natural substance for calcium resource. It has been used as raw material in producing hydroxyapatite. This study was conducted to synthesize porous hydroxyapatite from eggshell waste and evaluate its activity as bone substitution. The porous hydroxyapatite graft was manufactured from eggshell and sugar as a raw material using hydrothermal process. The porous eggshell waste-derived hydroxyapatite (EW-HAP) graft was characterized using X ray difractometer (XRD) and analytical scanning electron microscope (SEM) and compared with commercial hydroxyapatite (HAP) JCPDS 09-432 graft (Bangros®) as standard. The porous EW-HAP graft obtained was then implanted on critically sized femoral defects surgically created in the right thigh of male Wistar rats (Rattus norvegicus) with Bangros® as control. Radiological examination using XRD and histological examination using hematoxyline-and-eosin staining of the bone femour were performed at 28 days after implantation. The results showed that the XRD pattern for EW-HAP was likely similar with the HAP standard. However, the SEM examination showed that the pasticle size of EW-HAP graft (2.5-3 μm) was higher than those HAP standard graft (1.5-2 μm). Radiographs according to the International of Limb Salvage (ISOLS) radiological evaluation system between EW-HAP graft (6.1 ± 1.45) and HAP control graft (6.9 ± 2.10) was not significantly different (p>0.05). Moreover, histological examination according to Lane and Shandu scoring system between the both graft (4.0 ± 0.94 versus 4.4 ± 0.92) was also not significantly different (p>0.05). It can be concluded that the structure EW-HAP graft is similar with HAP graft standard. The both grafts have also equal outcome as bone substitution.

Short-Segment Fixation Without Fusion for Thoracolumbar Burst Fractures With Neurological Deficit Can Preserve Thoracolumbar Motion Without Resulting in Post-traumatic Disc Degeneration

Prospective consecutive series. To evaluate the post-traumatic disc degeneration and range of motion 10 years after short-segment fixation without fusion for thoracolumbar burst fractures with neurological deficit. Early clinical results of short-segment fixation without fusion for thoracolumbar burst fractures were satisfactory. However, the long-term results have not been reported, and post-traumatic disc degeneration and preservation of thoracolumbar motion have not been elucidated. Twelve patients who had thoracolumbar burst fractures and associated incomplete neurological deficit, operatively treated within 4 days of admission and had their implants removed within 1 year, were prospectively followed for at least 10 years. Following indirect reduction and pedicle screw fixation, transpedicular intracorporeal hydroxyapatite grafting to the fractured vertebrae was performed. Sagittal alignment was improved from a mean preoperative kyphosis of 17° to -2° (lordosis) by operation, but was found to have slightly deteriorated to 2° at the final follow-up observation. With respect to back pain, 8 patients did not report back pain. Three reported occasional minimal pain, and 1 reported moderate pain. None reported severe pain or needed daily dosages of analgesics.Regarding disc degeneration, the shape of the disc adjacent to the fractured vertebra had not changed from the preoperative to the 10-year postoperative magnetic resonance image (MRI). Although signal intensity of the disc had decreased by 1 grade from the preoperative to the 2-year postoperative MRI, the intensity had not changed from the 2-year postoperative MRI to the 10-year postoperative MRI. At the 10-year follow-up, flexion-extension radiographs revealed that a mean range of motion at the disc adjacent to the fractured vertebra was 12º (range; 5-19). This unprecedented 10-year follow-up study demonstrated that posterior indirect reduction, transpedicular hydroxyapatite grafting, and pedicle screw fixation does not require fusion to a segment, thereby preserves thoracolumbar motion without resulting in post-traumatic disc degeneration. 4.

Biomechanical Evaluation of an Endplate-Conformed Polycaprolactone-Hydroxyapatite Intervertebral Fusion Graft and Its Comparison With a Typical Nonconformed Cortical Graft

In the thoracolumbar region, between 7% and 30% of spinal fusion failures are at risk for pseudarthrosis. From a biomechanical perspective, the nonconformity of the intervertebral graft to the endplate surface could contribute to pseudarthrosis, given suboptimal stress distributions. The objective of this study was to quantify the effect of endplate-graft conformation on endplate stress distribution, maximum Von Mises stress development, and stability. The study design used an experimentally validated finite element (FE) model of the L4-L5 functional spinal unit to simulate two types of interbody grafts (cortical bone and polycaprolactone (PCL)-hydroxyapatite (HA) graft), with and without endplate-conformed surfaces. Two case studies were completed. In Case Study I, the endplate-conformed grafts and nonconformed grafts were compared under without posterior instrumentation condition, while in Case Study II, the endplate-conformed and nonconformed grafts were compared with posterior instrumentation. In both case studies, the results suggested that the increased endplate-graft conformity reduced the maximum stress on the endplate, created uniform stress distribution on endplate surfaces, and reduced the range of motion of L4-L5 segments by increasing the contact surface area between the graft and the endplate. The stress distributions in the endplate suggest that the load sharing is greater with the endplate-conformed PCL-HA graft, which might reduce the graft subsidence possibility.

Magnesium-Substituted Hydroxyapatite Grafting Using the Vertical Inlay Technique

The reconstruction of a severely atrophic left posterior mandible using inlay magnesium-substituted hydroxyapatite grafting is described. Three months after reconstruction, a bone specimen was retrieved, and two dental implants were placed. A mean vertical bone gain of 4.9 mm was measured at the time of implant placement, and no problems were recorded at delivery of the provisional and definitive prostheses 4 and 8 months after implant placement, respectively. Histologic analysis revealed residual grafted material infiltrated by newly formed bone. In this clinical case, Mg-hydroxyapatite was demonstrated to be an effective grafting material for reconstruction of the posterior mandible using the inlay technique.

Interdisciplinary management of a two-rooted mandibular first premolar with furcation involvement: A 2-year follow-up

Consistent knowledge of developmental anomalies along with careful clinical and radiographic interpretation is essential pre-requisites for successful management. This case describes a 2-year follow-up of a case with carious mandibular right first premolar with two roots, three root canals and a deep periodontal probing depth along with an early Grade II furcation involvement. The tooth was endodontically treated followed by periodontal surgery, to eliminate the pocket and promote bone fill in the osseous and furcation defect. Hydroxyapatite graft composited with bioactive glass was utilized for enhancing bone formation. Clinical Relevance to Interdisciplinary Dentistry Detailed knowledge of root anomalies in mandibular premolars is a pre-requisite for successful management of combined endo-perio lesions. Periodontal regenerative procedure using hydroxyapatite graft can be performed to enhance bone formation. Use of radiographs and advanced diagnostic aids are recommended for clinical evaluation of tooth anomalies.

Radiologic assessment for thoracolumbar burst fractres treated with transpedicular intracorporeal hydroxyapatite grafting following indirect reduction and pedicle screw fixation

Radiologic assessment for thoracolumbar burst fractres treated with transpedicular intracorporeal hydroxyapatite grafting following indirect reduction and pedicle screw fixation

Treatment of Furcation Lesions in Devital Teeth with ß-Tricalcium Phosphate + Hydroxyapatite Graft Material: A Case Report

Endoperiodontal lesions are characterized by the presence of periodontal and pulpal disease within the same dental element. Periodontal and pulpal tissues are related to each other by lateral and accessory canals, the apical foramen, and the dentinal tubules. In the dental literature, whether periodontal disease affects pulpal disease or vice versa remains controversial. Pulpal disease is often accepted to cause periodontal disease. The treatment of endodontic-periodontal combined lesions requires both endodontic therapy and periodontal regenerative procedures. The success rate of treatment comprising only an endodontic procedure for such lesions is low. Periodontal regenerative therapy has been used widely to regenerate periodontium lost due to periodontal disease. This therapy is also very successful during the management of endodontic-periodontal lesions. &#x0D; How to cite this article: İzol BS, Doğru AG, İpek F, Günay A. Treatment of Furcation Lesions in Devital Teeth with ß-Tricalcium Phosphate + Hydroxyapatite Graft Material: A Case Report. Int Dent Res 2012;2:81-85.&#x0D; Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Guided Bone Regeneration in Long-Bone Defects with a Structural Hydroxyapatite Graft and Collagen Membrane

There are few synthetic graft alternatives to treat large long-bone defects resulting from trauma or disease that do not incorporate osteogenic or osteoinductive factors. The aim of this study was to test the additional benefit of including a permeable collagen membrane guide in conjunction with a preformed porous hydroxyapatite bone graft to serve as an improved osteoconductive scaffold for bone regeneration. A 10-mm-segmental long-bone defect model in the rabbit radius was used. The hydroxyapatite scaffolds alone or with a collagen wrap were compared as experimental treatment groups to an empty untreated defect as a negative control or a defect filled with autologous bone grafts as a positive control. All groups were evaluated after 4 and 8 weeks of in vivo implantation using microcomputed tomography, mechanical testing in flexure, and histomorphometry. It was observed that the use of the wrap resulted in an increased bone volume regenerated when compared to the scaffold-only group (59% greater at 4 weeks and 27% greater after 8 weeks). Additionally, the increase in density of the regenerated bone from 4 to 8 weeks in the wrap group was threefold than that in the scaffold group. The use of the collagen wrap showed significant benefits of increased interfacial bone in-growth (149% greater) and periosteal remodeling (49%) after 4 weeks compared to the scaffold-alone with the two groups being comparable after 8 weeks, by when the collagen membrane showed close-to-complete resorption. While the autograft and wrap groups showed significantly greater flexural strength than the defect group after 8 weeks, the scaffold-alone group was not significantly different from the other three groups. It is most likely that the wrap shows improvement of function by acting like a scaffold for periosteal callus ossification, maintaining the local bone-healing environment while reducing fibrous infiltration (15% less than scaffold only at 4 weeks). This study indicates that the use of a collagen membrane with a hydroxyapatite structural graft provides benefits for bone tissue regeneration in terms of early interfacial integration.

In situ deposition of hydroxyapatite on graphene nanosheets

Graphene nanosheets were effectively functionalized by in situ deposition of hydroxyapatite through a facile chemical precipitation method. Prior to grafting of hydroxyapatite, chemically modified graphene nanosheets were obtained by the reduction of graphene oxide in presence of ethylenediamine. The resulting hydroxyapatite functionalized graphene nanosheets were characterized by attenuated total reflection IR spectroscopy, X-ray diffraction, field emission scanning electron microscopy, transmission electron microscopy, X-ray energy dispersive spectroscopy, Raman spectroscopy and thermogravimetric analysis. These characterization techniques revealed the successful grafting of hydroxyapatite over well exfoliated graphene nanosheets without destroying their structure.

The efficacy of the use of IR laser phototherapy associated to biphasic ceramic graft and guided bone regeneration on surgical fractures treated with wire osteosynthesis: a comparative laser fluorescence and Raman spectral study on rabbits

The aim of the present study was to assess, by Raman spectroscopy and laser fluorescence, the repair of surgical fractures fixed with wire osteosynthesis treated or not with infrared laser (λ780 nm, 50 mW, 4 × 4 J/cm(2) =16 J/cm(2), ϕ=0.5 cm(2), CW) associated or not to the use of hydroxyapatite and guided bone regeneration. Surgical tibial fractures were created under general anesthesia on 15 rabbits that were divided into five groups, maintained on individual cages, at day/night cycle, fed with solid laboratory pelted diet, and had water ad libitum. The fractures in groups II, III, IV, and V were fixed with wires. Animals in groups III and V were grafted with hydroxyapatite (HA) and guided bone regeneration (GBR) technique used. Animals in groups IV and V were irradiated at every other day during 2 weeks (4 × 4 J/cm(2), 16 J/cm(2) =112 J/cm(2)). Observation time was that of 30 days. After animal death, specimens were taken and kept in liquid nitrogen and used for Raman spectroscopy. The Raman results showed basal readings of 1,234.38 ± 220. Groups WO+B+L showed higher readings (1,680.22 ± 822) and group WO+B the lowest (501.425 ± 328). Fluorescence data showed basal readings of 5.83333 ± 0.7. Groups WO showed higher readings (6.91667 ± 0.9) and group WO+B+L the lowest (1.66667 ± 0.5). There were significant differences between groups on both cases (p<0.05). Pearson correlation was negative and significant (R (2) = -0.60; p<0.001), and it was indicative that, when the Raman peaks of calcium hydroxyapatite (CHA) are increased, the level of fluorescence is reduced. It is concluded that the use of near-infrared lasertherapy associated to HA graft and GBR was effective in improving bone healing on fractured bones as a result of the increasing deposition of CHA measured by Raman spectroscopy and decrease of the organic components as shown by the fluorescence readings.

A new surgical procedure for brachymetatarsia by a hydroxyapatite graft

Brachymetatarsia is considered to be caused by early fusion of the epiphyseal line and it is most commonly found in the fourth metatarsus. Since it is often observed in the fourth toe in women, it is treated to achieve improvement from an aesthetic aspect. We have devised a new metatarsal lengthening operation for brachymetatarsia by a hydroxyapatite graft. First, a full-scale model of the bilateral fourth metatarsi was prepared using three dimensional computed tomography (3D CT) data. Based on this model, a spacer, 10 mm in length, was prepared using hydroxyapatite with a 15 % porosity rate. At present, 3 years have passed since the operation on the left foot, and 2 years and 8 months after the operation, good morphology with no pain or tylomas has been maintained. In X-ray examinations, callus formation has progressed and the metatarsal alignment is good. Since many patients are young women, this method has many advantages as follows: donors are not needed, one-point lengthening is possible, shortening due to postoperative bone resorption does not occur, bone alignment is not damaged, and the time until start of walking is short.