Onlay Graft Research Articles

RAMUS ONLAY BONE GRAFT FOR MAXILLARY ALVEOLAR RIDGE AUGMENTATION-A CASE REPORT

Background: Implant restoration in the anterior esthetic zone is always a clinicians challenge and tooth loss in the anterior region often affects ridge architecture resulting in ridge defects compromising esthetics and implant placement.This case report describes the onlay bone grafting along with PRF application for anterior ridge augmentation and subsequent implant placement. The second stage surgery describes preservation of the keratinised tissue and fabrication of implant restoration of the same. Case description: Block graft was obtained using piezosurgery and onlay bone grafting was done in a 28 year female patient with anterior ridge defect with subsequent implant placement. After 6 months of healing and prosthetic restoration of the implant was done with successful esthetic outcome. Conclusion: Uneventful post-operative healing was observed in the donor site with the use of piezosurgery. There was successful augmentation of the ridge defect with osseointegrated and esthetic implant restoration. Clinical significance: Management of ridge defects in the esthetic region with autogenous Onlay grafting offers the advantage of biologic compatibility and PRF acts as a membrane maintaining soft tissue contours thereby allowing placement of implant in the optimal three dimensional position.

Robotic-assisted double lingual mucosal graft ureteroplasty for multifocal ureteral strictures: Case report and technical description.

Ureteroplasty with a single onlay graft for proximal ureter stricture has been widely used in the clinic. However, robotic ureteroplasty with a double lingual mucosal graft (RU-DLMG) has not been reported. The intraoperative measured ureteral stricture lengths of patient 1 were 1.8, 2.5, and 4.6cm, and those of patient 2 were 2.5 and 3.5cm. We performed a RU-DLMG in which the diseased ureter was incised longitudinally from the ventral side and repaired with a double lingual mucosal graft to widen the ureteral lumen. Because of the presence of a distal ureter stricture, RU-DLMG combined with ureteral reimplantation was performed in patient 1. Antegrade urography showed no obstruction of the reconstructed ureteral segment after removing the ureteral stent. The patients had no complaints about the donor site and flank pain during the 12-month follow-up. RU-DLMG appears to be a suitable option for multifocal ureteral strictures.

The Comprehensive Evaluation of the Pinch Deformity due to Concave Alar Cartilages and Its Management.

Acute angle between dome and ala causes alar concavity/pinch deformity. Breathing problems may accompany pinching. Here, pinch deformities were classified according to their severity and treatment modalities discussed. Rhinoplasty patients with pinch deformities were included in study. Pinching without external nasal valve blockage (ENVB) was classified mild, pinching with ENVB was classified moderate, and extreme pinching and ENVB were classified severe deformity. In mild deformity, cephalic resection of ala was performed or cephalic resection was combined with onlay graft over ala. In moderate deformity, cephalic part was bent and sutured over lower ala. In severe deformity, cephalic part was bent, and lateral strut graft was inserted between lower and cephalic ala. In pinch deformities combined with hypertrophic lower lateral cartilage (LLC), medial crural overlay preceded above-mentioned treatment modalities. Thirty-eight patients (22 female, 16 male) with pinch deformities underwent rhinoplasty between January 2017 and December 2022. Mean age was 27 years. Mean follow-up was 32 months. Fifteen patients had mild deformities. Cephalic resection was enough in four patients. Camouflage grafts were settled over ala in eleven patients. Twenty patients had moderate deformities; cephalic ala was bent over lower part and sutured. Two patients had severe deformities; lateral strut graft was settled between lower and bent cephalic alar parts. One patient had LLC hypertrophy/pinch deformity. LLC hypertrophy was corrected by medial crural overlay, and concavity was corrected with cephalic resection. Satisfactory shape, better valve passage obtained in all cases. Pinch deformity could be classified according to its severity and appropriate treatment options could be determined for each class. 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 the Table of Contents or the online Instructions to Authors https://www.springer.com/journal/00266 .

Revision Rotator Cuff Repair With Versus Without an Arthroscopically Inserted Onlay Bioinductive Implant in Workers’ Compensation Patients

Background: The addition of onlay biological grafts to augment difficult rotator cuff repairs has shown encouraging results in a case series. Purpose/Hypothesis: The purpose of this study was to determine whether the addition of an onlay bioinductive implant would improve repair integrity, shear wave elastographic appearance of the repaired tendon and patch, and patient-rated and/or surgeon-measured shoulder function when used in workers' compensation patients undergoing revision arthroscopic rotator cuff repair. We hypothesized that the addition of the bioinductive implant would enhance repair integrity and clinical outcomes compared with standard repair. Study Design: Cohort study; Level of evidence, 3. Methods: A post hoc matched-cohort study was conducted on prospectively recruited workers’ compensation patients who received a bioinductive implant for revision rotator cuff repair (n = 19). The control group was selected from consecutive workers’ compensation revision rotator cuff repair patients before the introduction of bioinductive implants. Then, they were matched for age and tear size (n = 32). Kaplan-Meier curves were generated to compare the primary outcome of repair integrity between groups. The secondary outcomes were to evaluate the elastographic appearance of the tendon and patch in the bioinductive implant group and to compare patient-rated and surgeon-measured shoulder function between groups preoperatively and at 1 week, 6 weeks, 3 months, and 6 months postoperatively. Results: No major complications associated with the bioinductive implants were identified. Six months after the revision rotator cuff repair, the retear rate in the bioinductive implant group was 16% (3/19), compared with 19% (6/32) in the age- and tear size-matched control group ( P = .458). At the final follow-up, the retear rate in the bioinductive implant group was 47% (9/19) at a mean of 14 months compared with 38% (12/32) at a mean of 29 months in the control group ( P = .489). The shear wave elastographic stiffness of repaired tendons augmented with the bioinductive implant remained unchanged at 6 m/s from 1 week to 6 months postoperatively, which is lower than the stiffness of 10 m/s in healthy tendons. There were no significant differences in patient-rated or surgeon-measured outcomes between groups 6 months postoperatively. Conclusion: There were no differences in repair integrity or clinical outcomes between workers’ compensation patients who underwent revision arthroscopic rotator cuff repair with an onlay bioinductive implant compared to those who underwent standard revision rotator cuff repair.

Radiographic evaluation of the tenting screw technique in horizontal alveolar bone augmentation: A retrospective study

To radiographically analyze the effects of tenting screw technique (TS) and onlay bone grafts (OG) in horizontal bone augmentation. Patients receiving horizontal bone augmentation by TS or OG were selected. The clinical outcomes and cone beam computed tomography (CBCT) data were documented pre-grafting, immediately post-grafting, before and after implantation. The survival rates, clinical complications, alveolar bone width, and volumetric bone augmentation were evaluated and statistically analyzed. A total of 25 patients and 41 implants were involved in this study, with no grafting failures observed in either the TS group (n = 20) or the onlay group (n = 21). Volumetric bone resorption rate in the TS group (21.34%) was significantly lower than that of the OG group (29.38%). In addition, significant horizontal bone gain was achieved in both groups (TS: 6.15 ± 2.12 mm; OG: 4.86 ± 1.40 mm) during the recovery period, with higher gain in the TS group. No apparent statistical difference in terms of volumetric bone gain was observed between the TS (748.53 mm3 , 607.47 mm3 ) and OG group (811.77 mm3 , 508.49 mm3 ) immediately post-grafting or after the recovery period. Both TS and OG achieved satisfactory bone augmentation effects, yet TS resulted in more bone augmentation and better stability than OG, with a reduced use of autogenous bone. Overall, the tenting screw technique can serve as an effective alternative to autogenous bone grafts.

MP60-16 DORSAL/ DORSO-LATERAL ONLAY BUCCAL MUCOSAL GRAFT VERSUS VENTRAL ONLAY LOCAL PENILE SKIN FLAP IN COMPLEX ANTERIOR URETHRAL STRICTURES; A PROSPECTIVE RANDOMIZED STUDY

You have accessJournal of UrologyCME1 Apr 2023MP60-16 DORSAL/ DORSO-LATERAL ONLAY BUCCAL MUCOSAL GRAFT VERSUS VENTRAL ONLAY LOCAL PENILE SKIN FLAP IN COMPLEX ANTERIOR URETHRAL STRICTURES; A PROSPECTIVE RANDOMIZED STUDY Ahmed Tawakol, Mohammed Abdel-Rassoul, Mohamed Abdelwahab, Mohamed Elghoneimy, Ahmed Y. Abdelaziz, Ahmed Rammah, Mohamed Elgammal, and Amr Elkady Ahmed TawakolAhmed Tawakol More articles by this author , Mohammed Abdel-RassoulMohammed Abdel-Rassoul More articles by this author , Mohamed AbdelwahabMohamed Abdelwahab More articles by this author , Mohamed ElghoneimyMohamed Elghoneimy More articles by this author , Ahmed Y. AbdelazizAhmed Y. Abdelaziz More articles by this author , Ahmed RammahAhmed Rammah More articles by this author , Mohamed ElgammalMohamed Elgammal More articles by this author , and Amr ElkadyAmr Elkady More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003318.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Anterior urethral stricture is a challenging disease. Multiplicity of surgical techniques denotes that none is ideal. Our aim is to compare the use of buccal mucosal grafts (BG) versus local penile skin flaps (PF) in patients with complex anterior urethral strictures regarding success rates and complications. METHODS: A total of 34 adult patients with complex anterior urethral stricture were included. A complex anterior urethral stricture was defined as a stricture length of>2 cm and/or previous failed procedures, including urethral dilatation, internal optical urethrotomy and urethroplasty. We randomized patients to undergo either buccal mucosa dorsal/ dorso-lateral onlay graft or ventral onlay local penile skin flap urethroplasty. We compared operative time, estimated blood loss, complications, and succcess rates in both groups. Successful treatment outcome was defined as no further treatment of the urethral stricture required after urethroplasty and peak flow rate>15 ml/s. RESULTS: Mean follow up was 22.3 months in BG group vs 18.9 months in PF group. The site of the stricture, the median stricture length (40 mm in BG group Vs. 50 mm in PF group) and mean operative time were not statistically different between the two groups. Estimated blood loss was higher in PF group (median 400 ml and 300 ml in PF and BG group respectively, p=0.003); statistically significant but clinically insignificant.Two patients (11.8%) in each group developed wound infection. In PF group, one patient (5.9%) had urinary fistula, and one patient (5.9%) presented by mild ventral chordee post operatively. The success rates in the buccal mucosal and penile flap groups were similar (88.2%). CONCLUSIONS: Dorsal/ dorso-lateral onlay buccal mucosal graft and ventral onlay penile skin flap urethroplasty provided similar success rates. Complications were higher in the penile skin flap group. Both techniques can be used for the treatment of complex anterior urethral strictures with good outcome based on the surgeon's expertise. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e849 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed Tawakol More articles by this author Mohammed Abdel-Rassoul More articles by this author Mohamed Abdelwahab More articles by this author Mohamed Elghoneimy More articles by this author Ahmed Y. Abdelaziz More articles by this author Ahmed Rammah More articles by this author Mohamed Elgammal More articles by this author Amr Elkady More articles by this author Expand All Advertisement PDF downloadLoading ...

MP42-06 ASSESSING THE ACCURACY OF PREOPERATIVE RADIOGRAPHIC IMAGING IN DETERMINING URETERAL STRICTURE LENGTH AT TIME OF ROBOTIC URETERAL RECONSTRUCTION

You have accessJournal of UrologyCME1 Apr 2023MP42-06 ASSESSING THE ACCURACY OF PREOPERATIVE RADIOGRAPHIC IMAGING IN DETERMINING URETERAL STRICTURE LENGTH AT TIME OF ROBOTIC URETERAL RECONSTRUCTION Labeeqa Khizir, Alain Kaldany, Hiren V. Patel, and Sammy E. Elsamra Labeeqa KhizirLabeeqa Khizir More articles by this author , Alain KaldanyAlain Kaldany More articles by this author , Hiren V. PatelHiren V. Patel More articles by this author , and Sammy E. ElsamraSammy E. Elsamra More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003280.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: During robotic ureteral reconstruction, accurate measurement of ureteral stricture length is important for surgical planning. We aimed to determine the accuracy of using conventional fluoroscopic imaging compared to ureteroscopy and direct measurement with measuring tape during intra-operative robotic repair. METHODS: A retrospective review was conducted for 15 patients with ureteral stricture disease at a single institution treated with robotic repair. Data was collected regarding etiology of ureteral stricture disease, measured preoperative radiographic stricture length on fluoroscopy, and measured intraoperative robotic stricture length. A Wilcoxon matched-pairs rank test was performed to compare ureteral length measurements. RESULTS: The most common etiologies of ureteral stricture were prior medical history of stone disease (n=10), prior ureteropelvic junction obstruction repair (n=3), and other iatrogenic causes (n=2) (Table 1). A majority of patients had ureteral stricture repair using buccal mucosa (n=7) or appendiceal onlay (n=6) grafts (Table 1). A total of 11 patients (73%) had >1 cm difference in stricture length between radiographic and robotic measurement (Figure 1). Of these patients, 73% (n=8) had prior medical history of stone disease (Table 1). The intraoperative robotic length was significantly longer compared to preoperative radiographic length (Median difference 1.2 cm, 98% CI 0.15-2.3, p<0.05) (Figure 1). CONCLUSIONS: Conventional preoperative radiographic measurement significantly underestimates the ureteral stricture length compared to intraoperative measurement. This may have clinical significance in influencing operative planning, technique, and the length of graft that is harvested. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e568 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Labeeqa Khizir More articles by this author Alain Kaldany More articles by this author Hiren V. Patel More articles by this author Sammy E. Elsamra More articles by this author Expand All Advertisement PDF downloadLoading ...

V03-07 ROBOTIC INFERIOR VENA CAVA GRAFTING AND RECONSTRUCTION

You have accessJournal of UrologyCME1 Apr 2023V03-07 ROBOTIC INFERIOR VENA CAVA GRAFTING AND RECONSTRUCTION Matthew Lee, Aeen Asghar, David Strauss, Naveen Krishnan, and Daniel Eun Matthew LeeMatthew Lee More articles by this author , Aeen AsgharAeen Asghar More articles by this author , David StraussDavid Strauss More articles by this author , Naveen KrishnanNaveen Krishnan More articles by this author , and Daniel EunDaniel Eun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003241.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although oncologic applications of the surgical robot have become commonplace, its true strength is showcased via complex reconstructive procedures, such as central vessel vascular reconstruction. We demonstrate two cases of inferior vena cava (IVC) robotic assisted laparoscopic (RAL) reconstruction using synthetic grafts. METHODS: First, we show a 78-year-old male with cT3b right renal mass undergoing RAL radical nephrectomy and IVC thrombectomy. After interaortocaval dissection, the right renal artery is divided and the left renal vein, suprarenal IVC, and infrarenal IVC are clamped. The mass invaded a 5-centimeter portion of the IVC, necessitating segmental IVC resection. A 6-centimeter PTFE interposition graft was anastomosed to the IVC to re-establish vascular continuity. Next, a 43-year-old female with an OptEaseTM IVC filter that had eroded through the IVC, deviating the right ureter, required IVC reconstruction. The IVC was clamped proximally and distally. A cavotomy was made and the filter was removed piecemeal. After anterior IVC excision, an 8-centimeter segment of PTFE graft was sutured to the defect as an onlay patch graft. RESULTS: IVC cross clamp time was 108 and 132 minutes, respectively. Length of stay was 6 and 5 days, respectively. Neither patient had any vascular based complications and were discharged home. CONCLUSIONS: We demonstrate that RAL management of complex IVC pathologies requiring IVC reconstruction with synthetic grafts may be safe, feasible, and effective. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e247 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Lee More articles by this author Aeen Asghar More articles by this author David Strauss More articles by this author Naveen Krishnan More articles by this author Daniel Eun More articles by this author Expand All Advertisement PDF downloadLoading ...

V01-07 DECISION POINT FOR BUCCAL MUCOSA GRAFT URETEROPLASTY: AUGMENTED ANASTOMOTIC VERSUS VENTRAL ONLAY TECHNIQUE

You have accessJournal of UrologyCME1 Apr 2023V01-07 DECISION POINT FOR BUCCAL MUCOSA GRAFT URETEROPLASTY: AUGMENTED ANASTOMOTIC VERSUS VENTRAL ONLAY TECHNIQUE Matthew Lee, David Strauss, Julienne Jeong, Jeffrey Wei, Joshua Kim, Ziho Lee, Lee Zhao, Michael Stifelman, and Daniel Eun Matthew LeeMatthew Lee More articles by this author , David StraussDavid Strauss More articles by this author , Julienne JeongJulienne Jeong More articles by this author , Jeffrey WeiJeffrey Wei More articles by this author , Joshua KimJoshua Kim More articles by this author , Ziho LeeZiho Lee More articles by this author , Lee ZhaoLee Zhao More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , and Daniel EunDaniel Eun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003221.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The two main approaches utilized in buccal mucosa graft ureteroplasty for surgical management of ureteral strictures include the onlay and augmented anastomotic techniques. We describe the decision-making process and surgical technique for each approach. METHODS: We demonstrate the case of a patient with bilateral ureteral strictures who underwent multiple prior ureteroscopic stone procedures and a failed left dismembered pyeloplasty. The patient underwent an augmented anastomotic buccal mucosa graft ureteroplasty for a right sided obliterated stricture and an onlay buccal mucosa graft ureteroplasty for a left sided narrowed stricture. Table 1 demonstrates perioperative data from the Collaborative of Reconstructive Robotic Ureteral Stricture database for each technique. RESULTS: The surgical technique utilized for buccal mucosa graft ureteroplasty depends on stricture quality, which include narrowed versus obliterated characteristics. An onlay technique is the preferred approach for narrowed strictures, while an augmented anastomotic technique is the preferred approach for obliterated strictures. Surgical success was demonstrated in 92.3% and 84.6% of patients undergoing an onlay versus augmented anastomotic technique, respectively. CONCLUSIONS: In patients undergoing buccal mucosa graft ureteroplasty, stricture quality is an important factor involved in the decision-making process when choosing to perform an onlay versus augmented anastomotic approach. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e81 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Lee More articles by this author David Strauss More articles by this author Julienne Jeong More articles by this author Jeffrey Wei More articles by this author Joshua Kim More articles by this author Ziho Lee More articles by this author Lee Zhao More articles by this author Michael Stifelman More articles by this author Daniel Eun More articles by this author Expand All Advertisement PDF downloadLoading ...

MP74-01 CHARACTERISATION OF FEMALE URETHRAL STRICTURES

You have accessJournal of UrologyCME1 Apr 2023MP74-01 CHARACTERISATION OF FEMALE URETHRAL STRICTURES Elizabeth Day, Helena Gresty, Anthony Noah, Richard Nobrega, Jeremy Ockrim, and Tamsin Greenwell Elizabeth DayElizabeth Day More articles by this author , Helena GrestyHelena Gresty More articles by this author , Anthony NoahAnthony Noah More articles by this author , Richard NobregaRichard Nobrega More articles by this author , Jeremy OckrimJeremy Ockrim More articles by this author , and Tamsin GreenwellTamsin Greenwell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Female urethral stricture (FUS) is rare. We have assessed the history, imaging and urodynamic characteristics of all women seeking urethroplasty for recurrent symptomatic strictures. METHODS: A retrospective review of 63 consecutive women (median age 50.5 years, range 25-71) with recurrent or refractory FUS undergoing urethroplasty since June 2012. Data was analysed for symptom profile, aetiology and previous therapy. MRI, videourodynamic (VUDS) and examination findings provided stricture length and site. RESULTS: Median duration of symptoms was 60 months (range 24-456). The commonest symptoms were poor flow 61 (97%), frequency 48 (76%), nocturia 46 (73%), urgency 44 (70%), recurrent UTI 41 (65%) and urethral pain 40 (63%). The commonest causes of FUS are, unknown in 37 (59.7%), urethral instrumentation/catheterisation in 7 (11.1%), urethral diverticulum excision in 4 (6%), radiotherapy in 3 (4.7%), none relaxing sphincter in 3 (4.7%) and lichen planus in 2 (3.2%). The women had had a median of 5 previous urethral dilatations (range 0-33). 38 (60%) had been performing ISC for a mean of 24 months (range 6-120) and 31 (82%) found it painful. Pre-operative MRI pelvis was performed in 56 (89%) and revealed a concentrically thickened urethra in 35 (63%), urethral diverticulum in 4 (6%), an absent/fibrotic urethra in 4 (6%), and no abnormalities in 13 (21%). Pre-operative VUDS were performed in 57 (90%). Bladder outflow obstruction (BOO) was seen in 56 (98%). Preoperatively median Qmax was 5 mls/s (range 0-24), median Pdet Q max was 70 cm H2O (range 0-165) and median Solomon-Greenwell BOOIf was 51.4 (range -24.2-156.2) (where BOOIf >5 =>50% chance of BOO). Other findings included detrusor overactivity in 22 (39%) and stress urinary incontinence in 7 (12%).Median stricture length was 2.0 cm (range 0.5-4.0 cm) and the commonest sites were mid-distal in 20 (32%) and distal in 19 (30%). 53 (84%) had ventral onlay buccal mucosal graft urethroplasty, 6 (10%) had ventral vaginal flap urethroplasty, 2 (3%) had ventral onlay labial minora flap urethroplasty and 1 (1.5%) had a ventral vaginal graft urethroplasty – with stricture free status in 55 (87%) at last follow-up (median 39 months, range 4-112). CONCLUSIONS: Poor flow is present in almost all women with FUS. The majority will also have irritative LUTS, recurrent UTIs and urethral pain. VUDS and MRI are useful pre-operatively to characterise the stricture. Definitive treatment with urethroplasty should be considered earlier once endoscopic management has failed. Source of Funding: Nil © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1069 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elizabeth Day More articles by this author Helena Gresty More articles by this author Anthony Noah More articles by this author Richard Nobrega More articles by this author Jeremy Ockrim More articles by this author Tamsin Greenwell More articles by this author Expand All Advertisement PDF downloadLoading ...

Maxillary Anterior Implant-supported Restorations with Allogeneic Block-bone Graft: A Report of Two Clinical Cases

Prosthetic rehabilitation of a severely atrophic anterior maxilla is challenging. To achieve aesthetic and functional outcomes with anterior implant-supported restorations, horizontal or vertical bone augmentation should be performed prior to implant placement. Autogenous block-bone grafting is the gold standard for onlay graft techniques; however, it is associated with problems, such as patient discomfort due to additional surgery at the intra- or extra-oral donor site. Therefore, the allogeneic block-bone graft, which is relatively less traumatic and safer, is used for convenience, and the high success rate in previous studies has proven the reliability of this technique. Herein, we report two cases in which allogeneic block-bone was successfully grafted in single and long-span defects in the maxillary anterior region, with satisfactory aesthetic and functional outcomes that were stable at regular follow-ups after surgery.

Comparison of Stress Distribution Among Standard Dental Implants Placed in Grafted Bone, Zygomatic Implants, and Subperiosteal Implants in the Atrophic Edentulous Maxilla: 3D Finite Element Analysis.

Purpose: To compare the biomechanical behaviors of different surgical options that are preferred for implant-supported fixed prosthetic rehabilitation of the atrophic edentulous maxilla. Materials and Methods: A 3D finite element analysis (FEA) model was generated from the computed tomography data of a patient with an atrophic edentulous maxilla. Four scenarios were created in the atrophic maxilla. In model 1, the maxilla was reconstructed with an onlay bone graft harvested from the anterior iliac crest, and sinus augmentation procedures were performed. Standard dental implants were placed in the lateral incisor, first premolar, and first molar regions on each side. In model 2, the anterior part of the atrophic maxilla was reconstructed with an onlay bone graft harvested from the mandibular ramus, and zygomatic implants were placed in the posterior part of the maxilla. In models 3 and 4, two-piece subperiosteal implants made of titanium and polyether ether ketone (PEEK) materials, respectively, were placed in the atrophic maxilla. All implants were loaded with 150-N and 50-N forces in vertical and lateral directions, respectively. Stress accumulation on bones, implants, abutments, and prosthetic frameworks was investigated. Results: The tensile stress in both cortical and trabecular bone was highest in the iliac bone grafting group under vertical loading. The compressive stress in both cortical and trabecular bone was the highest in the PEEK subperiosteal implant model, and the compressive stress value on the trabecular bone exceeded the strength of the trabecular bone. The highest von Mises stress in the implants was obtained in the iliac bone grafting group under vertical loading. The highest stress value in the abutments was detected for the titanium subperiosteal implant. The highest von Mises stress in the prosthetic framework was detected in the titanium subperiosteal implant group, under both vertical and lateral loading. Conclusion: Based on the stress accumulation results of the four different scenarios, it can be seen that there is no ideal treatment modality for the fixed implant-supported prosthetic rehabilitation of the atrophic edentulous maxilla. Various intraoperative and prosthetic modifications are suggested to decrease the risk of biomechanical complications during long-term follow-up.

Vertical ridge augmentation of atrophic posterior mandible with corticocancellous onlay symphysis graft versus sandwich technique: clinical and radiographic analysis.

Alveolar ridge augmentation of atrophic posterior mandibular ridge represents a challenge in oral and maxillofacial surgery to restore aesthetic and function. The aim of the study was to compare the clinical and radiographic outcomes of bone formation in atrophic posterior mandibles augmented using onlay symphysis cortico-cancellous bone block with that augmented using sandwich bone augmentation technique (Inlay). Twelve patients were selected with missing mandibular posterior teeth. CBCT were done for all patients preoperatively to assess the residual bone height, ranged between 5 and 7mm from the inferior alveolar nerve with adequate sufficient alveolar ridge width more than 4mm. Patients required bone augmentation procedure with autologous onlay chin graft (group I) versus those used as inlay sandwich technique (group II). Clinical and radiographic analysis were done to analyses the newly formed bone and bone height. Percent of change in bone height was also calculated and revealed that group I was higher than group II, however, statistically insignificant differences between the two groups were found regarding the percentage of newly formed bone. Vertical ridge augmentation procedures using onlay chin graft took lesser time than the interpositional grafting with fixation technique, however, both techniques are promising for vertical ridge augmentation.

Transfibular ankle arthrodesis with use of sagitally split fibula as a biological plate leads to excellent outcome: A retrospective analysis

BackgroundWe studied ankle arthrodesis with a transfibular approach using sagitally spilitted fibula as a biological plate (onlay grafting) as well as other half of fibula as morcellised local interpositional graft (inlay grafting) to achieve bony union. Material and methodsRetrospective clinico-radiological evaluation of 36 operated cases was done at 3, 6, 12 and 30 months follow-ups. Clinically union was considered once ankle became pain free on full weight bearing. Pain assessment was done by using VAS (visual analogue scale) score and functional evaluation was done by AOFAS (American Orthopaedic Foot & Ankle Society) hind foot score preoperatively and at different follow ups. Radiologically, sagittal plane ankle alignment and fusion status was determined at each follow up. ResultsMean age of patients was 40.36 ± 10.56 years (range 18–55), who were evaluated for mean duration of 33.32 ± 11.25 months (range 24–65). Thirty-three (91.7%) ankles were fused adequately and mean duration to achieve bony union was 5.09 ± 1.3 months (range 4–9 months). Mean post-operative AOFAS score at final follow up was 76.65 ± 4.87 in comparison to 45.76 ± 3.38, preoperatively. VAS score improved significantly from 7.8 (pre-operative) to 2.3 (final follow-up). Non-union in three patients (8.3%) and ankle malalignment in one patient was observed. ConclusionTransfibular ankle arthrodesis achieves excellent bony unions and functional outcomes in severe ankle arthritis. Biologically incompetent fibula that to be judged individually by the operating surgeon to use it as a graft. Patients having inflammatory arthritis have more dissatisfaction than other aetiologies.

Could Future Implant Failures be Predicted Based on Observed Bone Levels and Bone Loss After 5 Years? A Retrospective Investigation on Patients Presented in Previous Studies.

Purpose: To evaluate the diagnostic accuracy of bone loss/bone levels, as detected after 5 years of implant function, in identifying patients who suffered implant failures in the following 5 years. Materials and Methods: Data on radiographic measurements of marginal bone levels at prosthesis placement and after 5 years of function were retrospectively retrieved from 11 previous publications. Included patients were allocated into different subgroups with regard to bone loss/bone level during/after 5 years in function, respectively. A diagnostic test was used to estimate the accuracy of finding patients/jaws/implants at risk for a future implant failure by calculating sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) in different subgroups, respectively. Results: Altogether, 749 treated jaws (723 patients/3,363 implants) were included in the study group. Treated jaws in the high-level subgroups presented an overall higher risk of implant failures from 5 to 10 years in function (P < .05). Many treated jaws/implants were allocated into the high-level groups, but the proportions of implant failures were low in these groups. The diagnostic test comparing high- and low-level groups with and without implant failures showed low accuracy to predict implant failures; the PPV ranged from 4% to 33%. Lower PPVs were observed for diagnostic tests for individual implants (range: 4% to 6%). Conclusion: More severe bone loss was associated with higher risk of future implant failure. However, many patients/ implants with obvious bone loss in the study group and low prevalence of implant failures at the 10-year examination resulted in poor accuracy in identifying individual patients or implants at risk for failure. This suggests that it is difficult to predict future implant failures based only on radiographic measurements.

Dorsal inlay inner preputial graft repair versus ventral-only preputial graft repair in primary distal penile hypospadias with narrow urethral plate.

Tubularized incised plate (TIP) is the most common technique used for distal hypospadias repair with good outcome but with a high rate of urethral stricture. Inner preputial-free graft can be used as an inlay graft in the incised area of the narrow urethral plate, also can be used as an onlay graft for urethroplasty in hypospadias repair to avoid this complication. A comparative prospective randomized study was conducted on two groups of hypospadias patients with narrow urethral plate. Group A: dorsal inlay inner preputial graft repair was performed (grafted TIP [G-TIP]) and Group B: ventral onlay preputial graft repair was performed. The assessment of outcome and hypospadias objective scoring evaluation (HOSE) score was done at 2 weeks and 6 months. Group A included 55 patients for whom dorsal inlay inner preputial graft repair was performed (G-TIP), and Group B which was planned to be conducted on 55 patients using onlay preputial graft (onlay graft) but was terminated after 15 cases due to high failure rate (33%). Group A showed better success rate 96% and better HOSE score (score 16) at 2 months and 6 months 83.6% and 88.2% versus 26.7% and 33.3% in Group B. Postoperative complications showed a statistically significant difference; glans dehiscence (3.6% vs. 40%), wound infection (1.8% vs. 33.3%), and skin sloughing (3.6% vs. 26.7%) in Groups A and B, respectively. G-TIP is a good technique for the management of distal hypospadias with narrow urethral plate with good success rate, cosmetic outcome, and with less complications compared to onlay graft.

NANOTEX BONE Graft along with Fibula Flap in the Reconstruction of Segmental Mandibular Defect: Protocol for Pilot Clinical Trial.

Mandible reconstruction with vascularized fibula flap is the standard treatment for segmental mandibulectomy in patients with tumor or trauma. But the height of the fibula graft is insufficient for dental implant placement and prosthetic rehabilitation to replace the missing teeth, which in turn will compromise the functional efficiency and aesthetics of the patient. Although the bone height can be augmented through onlay grafting with iliac crest, it is associated with limitations like donor site morbidity and fast resorbability. This suggests the need for a synthetic biomaterial for vertical bone augmentation in implant dentistry.We have developed a biomimetic, porous, mechanically stable, and biodegradable nanocomposite named "NANOTEX BONE Graft" and its bone regeneration potential was evaluated in pre-clinical animal models. In this clinical trial, the safety as well as the efficacy of NANOTEX to augment new bone over fibula and further its ability to integrate with dental implants will be studied. The study has received the approval of the Ethics Committee of Amrita Institute of Medical Sciences and Central Drugs Standard Control Organization (CDSCO), India. We have designed a prospective, single-center, non-randomized pilot clinical study. Patients with benign tumor or trauma indicated for mandibular reconstruction followed by implant rehabilitation will be included in the study. Eligible patients will be enrolled after obtaining informed consent. The study will be initiated and followed up as per defined timelines. Resection of benign mandibular tumours necessitates surgical removal of jaw bone and adjacent affected areas.The segmental mandibulectomy leaves the patient with functional impairments and aesthetic defects which in turn affect the quality of life.The standard treatment of reconstruction with vascularized fibula flap has challenge in achieving sufficient vertical bone height for implant placement and prosthetic rehabilitation.Alternate surgical techniques cause donor site morbidity and surgical complications.There is need for a synthetic biomaterial to be grafted over fibula for vertical bone augmentation.NANOTEX BONE Graft, a nanofibrous composite scaffold that mimics native bone, promote cell infiltration, neo-angiogenesis and new bone formation.Preclinical studies of NANOTEX in animal models showed bone tissue regeneration, better biodegradation in critical sized defects and efficient integration with dental implants.This clinical study propose to evaluate the safety and efficacy of NANOTEX bone graft augmented over fibula in bone regeneration and Titanium dental implant integration.

Ventral onlay graft urethroplasty using bladder mucosa in a cat with a urethral stricture.

A 3-year-old, 4.0 kg, intact male domestic shorthair cat presented with postoperative dysuria following urethral resection and anastomosis for urethral rupture. Retrograde urethrography revealed a stricture in the pelvic urethra. Urethroplasty with bladder mucosa was performed following a bilateral pubic-ischial osteotomy. The bladder wall was resected to harvest an appropriately sized bladder mucosa graft. The graft was placed over the urethral defect in patch fashion and stabilized with interrupted sutures. The cat was able to urinate normally with no evidence of lower urinary tract signs 2 year postoperatively. Therefore, urethroplasty with an onlay bladder mucosa graft may be a feasible alternative to prepubic or subpubic urethrostomy for the treatment of pelvic urethral stricture in cats.

Autogenous Bony Halo for Ridge Augmentation and Simultaneous Implant Placement

Tooth extraction often leads to alterations in the dimensions of the ridges. Hence it may be necessary to perform augmentation procedures before dental implants are placed. Various surgical procedures and materials have been introduced that enhance the soft tissue support and structural base of bone required by implants. Alveolar bone augmentation methods include guided bone regeneration onlay grafting interposition grafting distraction osteogenesis ridge splitting and socket preservation. The bone ring technique is another onestage procedure that is carried out to treat vertical alveolar ridge abnormalities. In this technique the dental implant and a block graft which can either be an autogenous graft or an allogenic cortico-cancellous graft are placed simultaneously. This case report describes the application of the bone ring approach for augmentation of the implant site along with the simultaneous placement of the dental implant. This is an easy procedure for obtaining ring-shaped donor bone for the three-dimensional 3D reconstruction of bone deformities.

Risk Factors for Complications Following Staged Alveolar Ridge Augmentation and Dental Implantation: A Retrospective Evaluation of 151 Cases with Allogeneic and 70 Cases with Autogenous Bone Blocks.

Purpose: the aim of this study was to identify potential risk factors favoring complications by assessing the number and types of complications associated with allogeneic or autogenous bone blocks applied as onlay grafts for alveolar ridge augmentation prior to implantation. Methods: A retrospective chart review on the success of 151 allogeneic and 70 autogenous bone blocks in a cohort of 164 consecutive patients, who were treated over a period of 6 years by the same surgeon, was conducted. Statistical conclusions were based on ROC curves and multiple logistic regression models. Results: Complications were observed more frequently with autogenous bone blocks (14 out of 70 cases; 20%) compared to allogeneic bone blocks (12 out of 151 cases; 7.9%; p = 0.013). However, these complications were minor and did not impact the successful dental rehabilitation. In a multiple logistic regression model, the risk of a complication was increased by the use of an autogenous bone block (OR = 3.2; p = 0.027), smoking (OR = 4.8; p = 0.007), vertical augmentation above a threshold of 2.55 mm (OR = 5.0; p = 0.002), and over-contouring (OR = 15.3; p < 0.001). Conclusions: Overall, the complication rate of ridge augmentations carried out with autogenous or allogeneic bone blocks was low. Despite previous recommendations, over-contouring and a vertical augmentation above a threshold of 2.55 mm should be avoided.