Bone Preparation Research Articles

44. Indirect sinus lift of atrophic posterior maxilla using osseodensification: a case report.

Primary stability in implant placement is one of the most critical factors determining the outcome of implant therapy. The factors mainly involved in enhancing implant primary stability are bone density,surgical protocol,and implant thread type, and geometry. The mechanical friction between implant surface and bone walls of the osteotomy site provides primary implant stability. The insertion torque peak was demonstrated to be directly related to implant primary stability and host bone density5; high insertion torque could significantly increase the initial bone-to-implant contact percentage (%bic) with respect to implant inserted with low insertion torque values.osseodensification is a novel biomechanical bone preparation performed for dental implant placement. It causes low plastic deformation of bone created by rolling and sliding contact with a densifying bur that is fluted to densify the bone as it drills with minimal heat elevation. Osseodensification (od), a bone nonextraction technique, was developed by huwais in 20138 and made possible with specially designed burs (densahtmburs) to increase bone density as they expand an osteotomy.the new burs allow bone preservation and condensation through compaction autografting during osteotomy preparation, increasing the periimplant bone density.. This paper describes a case of indirect sinus lift with compaction autografting done in posterior maxilla along with simultaneous implant placement.

Arthroscopic soft tissue stabilization of posttraumatic anterior shoulder instability : Techniques, limitations and long-term results

Arthroscopic soft tissue stabilization is awell-established and broadly accepted procedure to treat posttraumatic shoulder instability. Advantages in comparison to open stabilization procedures include improved visualization of the structural damage and aless invasive approach. Technical developments in recent years have led to further improvement of the arthroscopic technique for shoulder instability. This article presents adescription of principles and new developments as it contains basic techniques including patient positioning, access portals, preparation of the glenoid bone, soft tissue handling and shuttle techniques. Modern suture anchor systems to achieve arthroscopic stabilization with the corresponding advantages and disadvantages are also presented. Furthermore, the limitations and long-term results of arthroscopic soft tissue stabilization are discussed.

Three-Dimensional Templating and Use of Standard Instrumentation in Primary Anatomic Total Shoulder Arthroplasty.

Three-dimensional (3D) templating of the glenoid in anatomic shoulder arthroplasty allows for more accurate planning and more optimal positioning of the glenoid component than 2-dimensional computed tomography (2D CT) scans through an improved understanding of both the pathologic and the premorbid glenoid joint line, version, and inclination in reference to an idealized calculated glenoid position. Obtain a CT scan of the entire scapula and proximal part of the humerus with slices of ≤1 mm and a 3D reconstruction with subtraction of the humeral head, and identify the scapular and glenoid planes to define the pathologic version and inclination, which can be done in any commercially available software program while following these basic principles (Video 1). Carefully evaluate for the presence of the native glenoid, noting its version and inclination, and be careful to distinguish the true native glenoid from osteophytes (Video 2). Place the virtual glenoid component to restore the premorbid glenoid anatomy (Video 3). In the presence of bone loss from posterior glenoid wear, assess the need for an augmented glenoid component, bone graft, or eccentric reaming to achieve adequate backside seating (Video 4). Once the glenoid component has been templated, note the starting location and trajectory of the center pin used for cannulated glenoid reaming and bone preparation (Video 5). Intraoperatively, remove remaining labrum and any remaining cartilage or soft tissue, and expose the glenoid periphery to clearly define the osseous anatomy, including the base of the coracoid, such that it mirrors what the 3D CT scan and preoperative plan display (Video 6). Place the center pin for glenoid preparation in the previously templated location and trajectory to emulate the surgical plan defined in the software (Video 7). We performed a prospective, randomized controlled trial of positioning of the glenoid component in anatomic TSA using preoperative planning with 3D CT scans and standard instrumentation compared with using 3D CT preoperative planning with patient-specific instrumentation29.

Standard versus physiologic bone preparation in total knee arthroplasty and the effect on joint space opening

BackgroundTotal knee arthroplasty is an effective treatment for osteoarthritis. Restoration of physiologic varus alignment may restore the native soft tissue tension and improve outcomes. MethodsSix paired fresh-frozen knee specimens were used to perform total knee arthroplastys. The left and right sides of were randomly assigned to have either a physiologic alignment cut or a standard of care neutral alignment bony cut prior to the implantation. Loads of 100 and 200N were applied at 0, 30, 60, and 90° of flexion and the magnitude of the medial and lateral compartment distraction was measured. The loads were applied with the knee specimen intact and post arthroplasty. FindingsThe physiologic alignment had no difference between medial and lateral gaps at either load. With 100N of load the physiologic alignment had a greater gap at 90° than at full extension while the standard alignment had significantly more gap at 60° of flexion than full extension. The physiologic alignment had a significantly greater gap with the implant compared to the intact condition at both loads. The standard alignment had no significant difference in overall gap between the implant and intact condition with any load. InterpretationAlthough performing a physiologic aligned TKA resulted in medial-lateral soft tissue balance, the flexion gap was found to have greater magnitude than the intact knee. Notably, a neutral aligned TKA was found to be balanced, but also was found to recreate the intact knee flexion gaps. These results suggest that coronal plane stability can be achieved with physiologic alignment objectives, but the clinician needs to be aware of the potential to have greater laxity than the intact and neutral alignment surgical objectives.

Percutaneous First Metatarsophalangeal Joint Fusion.

The first metatarsophalangeal (MTP1) joint fusion is a very useful procedure in forefoot surgery and is still the gold standard for the treatment of severe and painful hallux rigidus. Normal walking and running are possible after MTP1 fusion, the first ray mobility being essentially in the interphalangeal (IP) joint with a compensatory hypermobility in dorsal flexion. Percutaneous MTP1 fusion is a simple procedure providing comparable results to fusions performed with open techniques. Postoperative cares are simplified with an immediate full weight bearing on rigid flat shoes and quick return to normal walking. Bone preparation is an important step and requires an experience in percutaneous forefoot surgery. Arthrodesis positioning and fixation with this percutaneous procedure are simple with possibility of clinical and radiological control. The indications for percutaneous MTP1 fusion are very large and only severe bone loss or osteoporosis represent the limits for this technique.

Intracanal temperature changes during bone preparations close to and penetrating the inferior alveolar canal: Drills versus piezosurgery

PurposeThe aim of this in vitro study was to investigate temperature increases in the inferior alveolar canal (IAC), when different bone preparation methods approximate and penetrate the IAC. Materials and methodsIn pig mandible, buccal bone removals were performed until the neurovascular bundle became visible. Temperatures were registered with thermocouple probes and with infrared thermometer. Preparations were performed with diamond drills (DD), tungsten carbide drills (TCD), piezoelectric diamond sphere (PT_D) and saw (PT_S) tips, and a combined preparation method was also performed whereby the superficial three-fourths of the bone was removed with TCD and the deepest one-fourth of the bone with PT_D (TCD + PT_D_7 °C) or PT_S (TCD + PT_S_7 °C), using cooled irrigation (7 °C). ResultsPreparations using room temperature irrigation caused significantly less heat on the bone surface than in the IAC. Piezosurgery in the IAC produced significantly higher temperatures (>13 °C) than the drills (<4 °C). Heat productions of the piezoelectric tips were reduced significantly by applying the combined bone removal methods. The speed of PT_S and TCD + PT_S_7 °C were comparable to the speed of TCD, whereas TCD + PT_D_7 °C was found to be significantly slower. ConclusionThe speed of piezosurgery is comparable to that of the drills; however, it produces the highest, potentially nerve-harming temperatures. To eliminate the heat consequences during piezosurgery in the IAC, the use of cooled irrigation at 7 °C and predrilling is recommended.

Bone char with antibacterial properties for fluoride removal: Preparation, characterization and water treatment

In the present work, it was established a new method for the preparation of bone chars with a double purpose, i.e., the removal of fluoride from water and the antibacterial character. These adsorbents were obtained by doping a commercial bone char with Ag using different reagents. The optimal conditions for the enrichment with silver were established by following the Taguchi method and using as response variable the removal of fluoride from water. Optimal bone chars were thus prepared and they were characterized using FT-IR spectroscopy, SEM/EDX analysis, adsorption isotherms of N2 at −196 °C and X-ray diffraction. All adsorbents were used in the removal of fluoride from water and the antibacterial character was assessed using the technique of total viable count employing standard solutions of Escherichia coli and drinking water. Results clearly indicated that doping of bone chars with silver provides with suitable antibacterial properties, however the fluoride adsorption capacity was not affected by the presence of Ag° on the carbon surface.

Preparation and Evaluation of True Bone Ceramic/Type I Collagen Composite Bone Repair Materials

Preparation and Evaluation of True Bone Ceramic/Type I Collagen Composite Bone Repair Materials

A Novel Approach for Preparation and In Situ Tensile Testing of Silica Glass Membranes in the Transmission Electron Microscope

The mechanical behavior of glasses in the micro- and/or nanometer regime increasingly gains importance in nowadays modern technology. However, suitable small scale preparation and mechanical testing approaches for a reliable assessment of the mechanical properties of glasses still remain a big challenge. In the present work, a novel approach for site-specific preparation and quantitative in situ tensile testing of thin silica glass membranes in the transmission electron microscope is presented. Thereby, advanced focused ion beam techniques are used for the preparation of nanoscale dog bone shaped silica glass specimens suitable for in situ tensile testing. Small amounts of gallium are detected on the surface of the membranes resulting from redeposition effects during the focused ion beam preparation procedure. Possible structural changes of silica glass upon irradiation with electrons and gallium ions are investigated by controlled irradiation experiments, followed by a structural analysis using Raman spectroscopy. While moderate electron beam irradiation does not alter the structure of silica glass, ion beam irradiation results in minor densification of the silica glass membranes. In situ tensile testing of membranes under electron beam irradiation results in distinctive elongations without fracture confirming the phenomenon of superplasticity. In contrast, in situ tensile testing in the absence of the electron beam reveals an elastic/plastic deformation behavior, and finally leads to fracture of the membranes. The Young’s moduli of the glass membranes pulled at beam off conditions in the TEM are comparable with values known for bulk fused silica, while the tensile strength is in the range of values reported for silica glass fibers with comparable dimensions. The impact of electron beam irradiation on the mechanical properties of silica glass membranes is further discussed. The results of the present work open new avenues for dedicated preparation and nanomechanical characterization of silica glasses, and further contribute to a fundamental understanding of the mechanical behavior of such glasses when being scaled down to the nanometer regime.

Transalveolar Osteotomy of the Mandibular Canal Wall for the Treatment of Severely Atrophied Posterior Mandible

Treatment of severe bone atrophy of the posterior mandible requires an advanced surgical bone augmentation technique. This report describes a minimally invasive approach for a residual alveolar height less than 5mm. A retrospective case series was conducted in a single private dental clinic. Outcome variables were dental implant survival rate, intraoperative complications, occurrence of neurosensory disturbances, and marginal bone loss. Descriptive analysis was performed for patients' demographic data, postoperative healing, and implant details. Kaplan-Meier method was used to assess the implant survival rate. The mean age of the 19 patients was 60±13years. Twenty-eight implants (5.5mm long) were placed in a residual alveolar bone height of 4.5±0.6mm. The implant survival rate was 96% at 5-year follow-up. Extra-short implants and transalveolar preparation of the inferior alveolar cortical bone could be a safe and effective treatment of severe mandibular atrophy.

Proximal Cadaveric Femur Preparation for Fracture Strength Testing and Quantitative CT-based Finite Element Analysis

Cadaveric fracture testing is routinely used to understand factors that affect proximal femur strength. Because ex vivo biological tissues are prone to lose their mechanical properties over time, specimen preparation for experimental testing must be performed carefully to obtain reliable results that represent in vivo conditions. For that reason, we designed a protocol and a set of fixtures to prepare the femoral specimens such that their mechanical properties experienced minimal changes. The femora were kept in a frozen state except during preparation steps and mechanical testing. The relevant clinical measures of total hip and femoral neck bone mineral density (BMD) were obtained with a clinical dual X-ray absorptiometry (DXA) bone densitometer, and the 3D geometry and distribution of bone mineral were obtained using CT with a calibration phantom for quantitative estimations based on the greyscale values. Any possible bone disease, fracture, or the presence of implants or artifacts affecting the bone structure, was ruled out with X-ray scans. For preparation, all bones were carefully cleaned of excess soft tissue, and were cut and potted at the internal rotation angle of interest. A cutting fixture allowed the distal end of the bone to be cut off leaving the proximal femur at a desired length. To allow positioning of the femoral neck at prescribed angles during later CT scanning and mechanical testing, the proximal femoral shafts were potted in polymethylmethacrylate (PMMA) using a fixture designed specifically for desired orientations. The data collected from our experiments were then used for validation of quantitative computed tomography (QCT)-based finite element analysis (FEA), as described in a different protocol. In this manuscript, we present the protocol for the precise bone preparation for mechanical testing and subsequent QCT/FEA modeling. The current protocol was successfully applied to prepare about 200 cadaveric femora over a 6-year time period.

Proximal Cadaveric Femur Preparation for Fracture Strength Testing and Quantitative CT-based Finite Element Analysis

Cadaveric fracture testing is routinely used to understand factors that affect proximal femur strength. Because ex vivo biological tissues are prone to lose their mechanical properties over time, specimen preparation for experimental testing must be performed carefully to obtain reliable results that represent in vivo conditions. For that reason, we designed a protocol and a set of fixtures to prepare the femoral specimens such that their mechanical properties experienced minimal changes. The femora were kept in a frozen state except during preparation steps and mechanical testing. The relevant clinical measures of total hip and femoral neck bone mineral density (BMD) were obtained with a clinical dual X-ray absorptiometry (DXA) bone densitometer, and the 3D geometry and distribution of bone mineral were obtained using CT with a calibration phantom for quantitative estimations based on the greyscale values. Any possible bone disease, fracture, or the presence of implants or artifacts affecting the bone structure, was ruled out with X-ray scans. For preparation, all bones were carefully cleaned of excess soft tissue, and were cut and potted at the internal rotation angle of interest. A cutting fixture allowed the distal end of the bone to be cut off leaving the proximal femur at a desired length. To allow positioning of the femoral neck at prescribed angles during later CT scanning and mechanical testing, the proximal femoral shafts were potted in polymethylmethacrylate (PMMA) using a fixture designed specifically for desired orientations. The data collected from our experiments were then used for validation of quantitative computed tomography (QCT)-based finite element analysis (FEA), as described in a different protocol. In this manuscript, we present the protocol for the precise bone preparation for mechanical testing and subsequent QCT/FEA modeling. The current protocol was successfully applied to prepare about 200 cadaveric femora over a 6-year time period.

Three-dimensional preoperative planning and patient-specific instrumentation for total shoulder arthroplasty

Three-dimensional (3D) imaging and implant templating along with patient specific instrumentation improves the accuracy of bone preparation and placement of the glenoid implant when compared to two-dimensional (2D) imaging without templating. Various type of patient specific instrumentation have been created. To date all provide equal accuracy. Some types of patient specific instrumentation are more cost effective and require less time to deliver the technology. This review article describes the technology and the clinical data published to date.

Infrared radiation promoted preparation of cost-effective lamb bone supported cobalt catalyst: Efficacy in semi-batch monoolein synthesis

A series of highly efficient inexpensive hydroxyapatite (lamb bone derived) supported cobalt solid acid catalysts were developed via both conventional and infrared radiation (IRR) activation methods. The IRR activated catalysts demonstrated remarkable efficacy in accelerating semi-batch glycerol esterification with oleic acid (OA), rendering 98% OA conversion within much shorter time (80min). The IRR promoted optimal catalyst (164.68±0.2m2/g BET area and 7.16mmol/g acid-site concentration) demonstrated significantly greater monooleate selectivity (95±4%) and yield (87±1%) than conventionally prepared catalyst (68±1% yield and 83±1% selectivity). The results explore promising application of IRR in improvement of catalytic properties over conventional method.

Preparation of a calcium carbonate-based bone substitute with cinnamaldehyde crosslinking agent with potential anti-inflammatory properties.

Calcium sulfate (CS), also known as POP (Plaster of Paris) is a self-setting, biocompatible, and osteoconductive biomaterial with a long history for the treatment of skeletal defects. However, CS cements show a too fast resorption rate and are unable to provide a long-term 3D framework during the osteogenesis process. In our previous studies, it was found that the incorporation of CaCO3 and CaCO3 hydrogel provided enhanced mechanical and degradation properties of POP composites. Furthermore, it was also found that the use of cinnamaldehyde to crosslink CaCO3 hydrogel may have some advantages, for example to crosslink the hydrogel and to act as anti-inflammatory control agent. The objective of the current study was to evaluate the effect of adding cinnamaldehyde crosslinked CaCO3 hydrogel into POP on the diametral tensile strength, weight loss, age swelling, degradation, cinnamaldehyde release, and porosity. The following composites were prepared: POP/HCin-025 (25% addition of hydrogel microsphere) and POP/HCin-050 (50% addition of hydrogel microsphere). The composites were assessed on their diametral tensile strength, weight loss of the POP composite, age swelling, degradation of the hydrogel CaCO3 , cinnamaldehyde release, and porosity, as well as XRD-patterns and FT-IR spectra. It was confirmed from the study that incorporation of cinnamaldehyde into CaCO3 hydrogel system significantly increased the mechanical strength of the POP composite. Weight loss, swelling ratio in both acid to neutral pH, and biodegradability of the POP composites were controllable by the addition of cinnamaldehyde-CaCO3 hydrogel. Moreover, the cinnamaldehyde incorporated into the hydrogel was proven to be released in a controlled manner. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 1055-1062, 2017.

Screws are not needed when secure interference fit of uncemented acetabular components is adequate: a 5- to 15-year follow-up with clinical and radiological analysis.

Even with good surgical preparation, adequate primary stability of the acetabular component is not always achieved after primary total hip replacement (THR). We hypothesise that adequate bone preparation for appropriate cortical loading would allow us to avoid screw use. A total of 791 uncemented cups were analysed to compare the need for screws to obtain primary fixation in 5 different designs. Arthritic hips with inflammatory arthritis or severe congenital hip disease were excluded. A press-fit technique was first tried in all hips and screws were only used when strictly needed. Radiological acetabular shape and postoperative cup position were assessed in all hips. The mean follow-up was 9.6 (5-15) years. Screws were required in 155 hips (19.6%). We could not detect any difference in the percentage of screw use between designs. We found that female patients (odds ratio [OR] 2.06; 95% confidence interval [CI], 1.41-3.02) and cups with a greater distance to the hip rotation centre on the postoperative radiograph (OR 1.69; 95% CI, 1.17-2.45) had a higher risk for screw use. A greater anteversion of the cup had a lower risk for screw use (OR 0.96; 95% CI, 0.94-0.99). At latest follow-up no hips had needed revision for aseptic loosening. Good intraoperative technique is not enough to avoid screw use since more accurate cup position and reconstruction of the hip rotation centre are required for an adequate interference fit. A press-fit technique can provide similar mid-term results to screw use in hips without severe deformities.

Synthetic osteoplastic materials for alveolar bone augmentation before dental implantation

The study presents scientific data about surgical preparation of the alveolar bone before dental implantation by applying synthetic osteoplastic materials. The review analyzed the results of experimental and clinical studies on structural features and the efficiency of these materials, the time for replacement of new-formed bone tissue and contains comparative analysis of the efficiency of synthetic bone substitutes and other types of osteoplastic materials.

Experimental Visualization of Labyrinthine Structure with Optical Coherence Tomography.

Visualization of inner ear structures is a valuable strategy for researchers and clinicians working on hearing pathologies. Optical coherence tomography (OCT) is a high-resolution imaging technology which may be used for the visualization of tissues. In this experimental study we aimed to evaluate inner ear anatomy in well-prepared human labyrinthine bones. Three fresh human explanted temporal bones were trimmed, chemically decalcified with ethylenediaminetetraacetic acid (EDTA), and mechanically drilled under visual control using OCT in order to reveal the remaining bone shell. After confirming decalcification with a computed tomography (CT) scan, the samples were scanned with OCT in different views. The oval window, round window, and remnant part of internal auditory canal and cochlear turn were investigated. Preparation of the labyrinthine bone and visualization under OCT guidance was successfully performed to a remaining bony layer of 300µm thickness. OCT images of the specimen allowed a detailed view of the intra-cochlear anatomy. OCT is applicable in the well-prepared human inner ear and allows visualization of soft tissue parts.

Johann Gottlieb Walter (1734-1818) and the technical preparation of bones in an anatomical cabinet in the late eighteenth and nineteenth century

This study aims to analyze Johann Gottlieb Walter's biography (1734-1818), a German physician that specialized in human anatomy, who received an award of the Göttingen Royal Academy of Sciences. Here, we describe his technique of preparing bones for educational purposes through the comparison of other widely used techniques. The article also focuses on the great historical, scientific and didactic values of the anatomical preparations. In Europe during the eighteenth century the activity of some anatomists and physiologists, who were dedicated to the realization of anatomical preparations, testified the progress of medicine in the study of the human body, fundamental knowledge for physician training.

The use of cyanoacrylate biological adhesive for fixation of bone preparations in mastoidoplasty

The objective of the work was to improve the functional outcomes in the patients with chronic suppurative otitis media by means of application of cyanoacrylate biological adhesive for fixation of bone substance in obliteration of mastoid cavity – mastoidoplasty. The study involved 40 patients with chronic suppurative otitis media. In all cases, the patients were performed an open sanitizing operation with mastoid process cavity obliteration with bone substance. “Biosit-MS-Elkor” was used as bone-replacement substance. The index group included 20 people with bone substance reinforcement with cyanoacrylate biological adhesive. In the control group of 20 people the operations were performed without biological adhesive. Assessment of morphological and functional results of the operation was performed after removal of the swabs (on the 12th day), and in 1 and 12 months after surgery. The patients underwent otoscopy and computer-aided tomography. The study revealed that the use of cyanoacrylate biological adhesive “Sulfacrylate” in mastoidoplasty reduces the risk of displacement of bone substance from the mastoid process cavity into tympanic cavity in the postoperative period before the occurrence of the physiological fixation due to the middle ear tissue regeneration. The cyanoacrylate adhesive does not affect the process of osseo integration and does not produce toxic effects on the inner ear condition.