Bone Tissue Reconstruction Research Articles

Surgical Excision and Reconstruction in Oral Cavity Cancer

The primary treatment of oral cavity cancer is still surgery. By discussing the surgical treatment of oral cavity cancer, the basic concept of head and neck surgery could be thoroughly reviewed. The oral cavity is defined as the hard palate and the anterior 2/3 of the tongue. With appropriate reconstruction, most defects can be repaired without a significant change in quality of life, unlike in the oropharynx or hypopharynx, where aspiration problems frequently occur. The selection of a surgical approach that can provide an appropriate field of view to obtain a resection margin of 5 mm or more has become the core of head and neck surgery. The role of prophylactic neck dissection is also well established in oral cavity cancer patients. Mandibulotomy for access to the oral cavity or mandibulectomy due to cancer invasion requires bony surgical techniques, and reconstruction also requires bone tissue reconstruction techniques as well as soft tissue. Therefore, oral cancer surgery is the most important primary area where all techniques of head and neck surgery are mobilized.

Osteogenesis promotion by injectable methacryloylated gelatin containing psoralen and its bacteriostatic properties.

The treatment of periodontitis focuses on controlling the progression of inflammation, reducing plaque accumulation, and promoting bone tissue reconstruction. Among them, the reconstruction of irregular bone resorption caused by periodontitis is a long-standing challenge. At present, the local drug treatment of periodontitis is mainly anti-inflammatory and antibacterial drugs. In this study, psoralen (Pso), a Chinese herbal medicine with anti-inflammatory, antibacterial, and osteogenic effects, was selected for the local treatment of periodontitis. Meanwhile, an injectable methacrylate gelatin (GelMA) platform loading with Pso was constructed. Pso-GelMA had the properties of fluidity, light cohesion, self-healing, and slow release, which could be better used in the deep and narrow structure of the periodontal pocket, and greatly increased the effectiveness of local drug delivery. The pore size of Gelma hydrogel did not change after loading Pso by SEM. In vitro, Pso-GelMA effectively upregulated the expression of osteogenic genes and proteins, increased alkaline phosphatase activity, promoted the mineralisation of rat bone marrow mesenchymal stem cells (BMSCs) extracellular matrix, and had significant antibacterial effects on Staphylococcus aureus and Fusobacterium nucleatum. Therefore, Pso-GelMA has immense promise in the adjuvant treatment of periodontitis.

Surface modification of titanium implant for repairing/improving microenvironment of bone injury and promoting osseointegration

• A coating consist of MnO 2 nanoenzyme and Sr ions was fabricated on Ti implant. • MnO 2 nanoenzyme alleviated OA and O 2 deficiency at the injury site. • Sr ions released from the surface of implant promoted the growth of MSCs. • The modified Ti implant significantly accelerate bone regeneration in vivo . Bone injury and implantation operation are often accompanied by microenvironment damage of bone tissue, which seriously affects the process of osseointegration of implants, especially for titanium (Ti)-based bioinert materials. Thus, repairing or improving the microenvironment of damaged bone tissue is of great significance for bone rescue, reconstruction, and regeneration still a major medical challenge. Oxidative stress (OS) and oxygen (O 2 ) deficiency are considered to be specific physiological signals of the bone-injury microenvironment. From the above background, a coating consisting of manganese dioxide (MnO 2 ) nanoenzyme and strontium (Sr) ions was fabricated on the surface of the Ti implant via a one-step hydrothermal treatment. MnO 2 nanoenzyme presented in the coating alleviated OS and O 2 deficiency at the injury site by catalyzing the decomposition of abundant endogenous H 2 O 2 around the modified Ti implants into O 2 . In addition, Sr ions were released from the surface of the implant at a certain rate in a body-fluid environment, further promoting the adhesion, growth, and osteogenic differentiation of mesenchymal stem cells. More importantly, a Sprague Dawley rat femur model demonstrated that the modified Ti implant showed significant potential to accelerate bone tissue reconstruction in vivo . In summary, the present system provides a new idea for the treatment of bone injury and the development of new orthopedic implants.

Application of Nano-HydroxyApatite (n-HAp) for Wound Healing and Tissue Bioengineering

PRéCIS- A wound, or tissue defect can be defined as a disruption in the normal structure and function that occurs due to internal or external injury. In tissue bioengineering, natural hemostasis, and the inflammatory phase stand at the beginning of the wound and defect healing cascade. Briefly, the restorative, regenerative or reparative response to tissue injury is governed/driven by resident and circulating cells, homing to the injury site that release signals (soluble mediators) generated from the extracellular matrix. For bone defects, optimal healing can be simply classified as either primary (1o) or secondary (2o). It undergoes acascade of complex, orderly, and predictable events, that include four/five over-lapping phases: hemostasis/haematoma formation, inflammation, proliferation, callus formation (or not), and remodeling (Haversian/osteonal bone remodelling). Herein, the bone healing type is dependent on the removal of a fracture haematoma and the fixation (stabilization) strategy performed. For example, optimal stability results in 1o bone healing, with no callus formation, normal bone architecture and functional integrity restored within 3 months. On the other hand, in 2o healing, where fixation is not done, fracture haematoma, callus formation and healing via endochondral ossification ensues. Despite limitations, the main alternative for damaged or lost bone tissue replacement, restoration, regeneration, reconstruction, or repair is the autogenous bone graft, to date.

Insights into the Molecular Mechanisms Regulating Cell Behavior in Response to Magnetic Materials and Magnetic Stimulation in Stem Cell (Neurogenic) Differentiation

Magnetic materials and magnetic stimulation have gained increasing attention in tissue engineering (TE), particularly for bone and nervous tissue reconstruction. Magnetism is utilized to modulate the cell response to environmental factors and lineage specifications, which involve complex mechanisms of action. Magnetic fields and nanoparticles (MNPs) may trigger focal adhesion changes, which are further translated into the reorganization of the cytoskeleton architecture and have an impact on nuclear morphology and positioning through the activation of mechanotransduction pathways. Mechanical stress induced by magnetic stimuli translates into an elongation of cytoskeleton fibers, the activation of linker in the nucleoskeleton and cytoskeleton (LINC) complex, and nuclear envelope deformation, and finally leads to the mechanical regulation of chromatin conformational changes. As such, the internalization of MNPs with further magnetic stimulation promotes the evolution of stem cells and neurogenic differentiation, triggering significant changes in global gene expression that are mediated by histone deacetylases (e.g., HDAC 5/11), and the upregulation of noncoding RNAs (e.g., miR-106b~25). Additionally, exposure to a magnetic environment had a positive influence on neurodifferentiation through the modulation of calcium channels' activity and cyclic AMP response element-binding protein (CREB) phosphorylation. This review presents an updated and integrated perspective on the molecular mechanisms that govern the cellular response to magnetic cues, with a special focus on neurogenic differentiation and the possible utility of nervous TE, as well as the limitations of using magnetism for these applications.

Finite Element Simulation of Stainless Steel Porous Scaffolds for Selective Laser Melting (SLM) and Its Experimental Investigation

In recent years, bone defect and bone tissue damage have become common clinical diseases. The development of bionic bone has had an important impact on the repair and reconstruction of bone tissue. Porous scaffolds have the advantages of adjustable pore size and controllable shape, which can solve the problem of mismatch in the process of bone repair, but traditional processing methods cannot overcome the challenge of the preparation of complex porous scaffolds. Therefore, 316L porous stainless steel scaffolds with different pore sizes (200 μm, 300 μm, 400 μm and 500 μm, respectively) were prepared by selective laser melting. Stress and strain were simulated and analyzed by using a finite element simulation method. Combined with a heat treatment experiment, a hardness test, a metallographic observation and a compression test, porous scaffolds were studied. The mechanical properties and microstructures of the scaffolds were studied and analyzed, and the optimized porous scaffolds were obtained. With reasonable melting parameters, the porous scaffolds that could meet the mechanical property requirements of load-bearing bone restorations were prepared by SLM.

Biodegradable scaffolds for bone defect treatment

Purpose Animals, especially dogs are nowadays treated like family members so that when their pet's health condition has deteriorated, they go with them to the veterinarian. Common reasons for emergency visits include injuries and a decrease in animal performance due to progressive disease. The dynamic development of veterinary medicine and manufacturing techniques allows implants to be made using additive techniques. As an innovative solution dedicated as a scaffold for bone tissue reconstruction are the implants proposed by Cabiomede made of PLA. These implants should have the right properties to ensure the right conditions for bone fusion. It is also important to determine the time of degradation, which is associated with a significant loss of mechanical properties. Methods Therefore, the study assessed the mechanical properties of polymer implants made by FDM printing technology. The static compression and three-point bending tests, material wettability, and macro and microscopic observations were carried out. The effect of steam sterilization on the change in the determined parameters was also determined. Results Hydrolytic degradation initiated by exposure to Ringer's solution resulted in a change in structure from amorphous to semicrystalline. This indicates a partial dissolution of the amorphous phase and thus an increase in the percentage of the crystalline phase which resulted in the brittleness of the material. Conclusions The compressive strength values of PLA implants are similar to those of cancellous bone.

Marine sources as an unexplored bone tissue reconstruction material -A review

ABSTRACT Hard tissue reconstruction of bone has attracted the interest of clinical researchers to overcome the anomalous effect on general well-being. Bone is a supporting skeleton structure that also plays a pivotal role in the normal physiological functioning body. The introduction of bone tissue engineering has been instrumental in overcoming fragmental defined bone to diseases, accidents, or debilitating conditions. For this, various bone grafting materials are used to restore the patency. These various bone grafting options have shown promising results. But the search for ideal grating material continues. However, the available grafting resources may not ensure regeneration. And the grafts like autogenous grafts that provide the capacity, are often, acquired in limited quantity. Its incapacity to fill the defect has led to the requirement of alternative material. Marine sources have shown acceptable clinical outcomes and are rendered safe for use also have a rich calcium phosphate-containing scaffold, over which the new cells are formed owing to its porous and 3D grains. The wide range of available marine sources has been put into clinical trials. The collagen found in the Marine sources has shown comparatively better results than that of the available synthetic alternatives.

Ternary regulation mechanism of Rhizoma drynariae total flavonoids on induced membrane formation and bone remodeling in Masquelet technique.

Rhizoma drynariae total flavonoids (RDTF) are used to treat fractures. CD31hiEmcnhi vessels induced by PDGF-BB secreted by osteoclast precursors, together with osteoblasts and osteoclasts, constitute the ternary regulatory mechanism of bone tissue reconstruction. This study aimed to determine whether RDTF can promote bone tissue remodeling and induce membrane growth in the rat Masquelet model and to explore its molecular mechanism based on the ternary regulation theory. Thirty-six SD rats were randomized to three groups: blank, induced membrane, and RDTF treatment (n = 12/group). The gross morphological characteristics of the new bone tissue were observed after 6 weeks. Sixty SD rats were also randomized to five groups: blank, induction membrane, low-dose RDTF, medium-dose RDTF, and high-dose RDTF (n = 12/group). After 4 weeks, immunohistochemistry and western blot were used to detect the expression of membrane tissue-related proteins. The mRNA expression of key factors of ternary regulation was analyzed by qRT-PCR. RDTF positively affected angiogenesis and bone tissue reconstruction in the bone defect area. RDTF could upregulate the expression of key factors (PDGF-BB, CD31, and endomucin), VEGF, and HMGB1 mRNA and proteins in the ternary regulation pathway. Although the expected CD31hiEmcnhi vessels in the induction membrane were not observed, this study confirmed that RDTF could promote the secretion of angiogenic factors in the induced membrane. The specific mechanisms still need to be further studied.

Hybrid Distractor for Continuous Mandibular Distraction Osteogenesis.

Distraction osteogenesis (DO) is a reconstruction method for repairing bone deficiencies in the oral and maxillofacial area. Manual DO techniques have shown the functionality of the DO method for bone tissue reconstruction. The DO method can improve treatment conditions, as well as the quality of the reconstructed bone, compared with conventional techniques. Recently, continuous DO devices have been proposed to enable an automatic DO process while using a continuous force for moving the bone segment (BS). Animal studies and clinical trials have shown the successful application of continuous distractors in terms of improving DO factors, including rate and rhythm. The continuous DO technique can shorten the treatment time and enhance the quality of the regenerated tissue. However, the developed continuous distractors are yet to be used in human applications. In this study, by combining motor-driven and hydraulic techniques, a hybrid distractor is proposed. The hybrid distractor is capable of generating a continuous distraction force while controlling the position of the BS in a linear vector, with a high positioning accuracy. Results of modelling and experimental study revealed that the proposed hybrid distractor met all required factors for enabling a continuous DO procedure in humans. The proposed distractor is capable of eliminating the drawbacks of exiting techniques in terms of generating and transferring a controlled distraction force to the BS. The wireless control, as well as the small size of the device, makes this device a suitable solution for use in the reconstruction of bone defects in the maxillofacial area in humans.

SURG-40. SINGLE-STAGE RECONSTRUCTION FOLLOWING ONCOLOGIC RESECTION OF BRAIN TUMORS WITH SKULL INVASION

Abstract BACKGROUND: Craniectomies requiring skull reconstruction are indicated following oncological resection of masses involving the underlying brain and/or skull. Immediate cranioplasties have previously been performed using suboptimal hand-bending or molding techniques using ‘‘off – the – shelf’’ products. Today with computer – aided design, customized craniofacial implants have become widely available for personalized reconstruction of resected bone and soft tissue. We present the largest series to date of single stage reconstruction using alloplastic biomaterials in consecutive patient series with oversized customized implants.In total, 56 patients underwent resection of skull neoplasms and subsequent cranioplasty reconstruction using customized implants. The most common neoplasms were meningiomas (39%). The most common complications seen among patients were dehiscence – (7%), and extrusion of implant – (3.5%). There was no significant difference in the incidence of postoperative complications between patients who had postoperative chemotherapy/radiotherapy versus those that did not (22.2% versus 13.1%, P 0.39). One-year follow-up revealed acceptable cranial contour and symmetry in all 56 cases.

Development of Biocomposite Alginate-Cuttlebone-Gelatin 3D Printing Inks Designed for Scaffolds with Bone Regeneration Potential.

Fabrication of three-dimensional (3D) scaffolds using natural biomaterials introduces valuable opportunities in bone tissue reconstruction and regeneration. The current study aimed at the development of paste-like 3D printing inks with an extracellular matrix-inspired formulation based on marine materials: sodium alginate (SA), cuttlebone (CB), and fish gelatin (FG). Macroporous scaffolds with microporous biocomposite filaments were obtained by 3D printing combined with post-printing crosslinking. CB fragments were used for their potential to stimulate biomineralization. Alginate enhanced CB embedding within the polymer matrix as confirmed by scanning electron microscopy (ESEM) and micro-computer tomography (micro-CT) and improved the deformation under controlled compression as revealed by micro-CT. SA addition resulted in a modulation of the bulk and surface mechanical behavior, and lead to more elongated cell morphology as imaged by confocal microscopy and ESEM after the adhesion of MC3T3-E1 preosteoblasts at 48 h. Formation of a new mineral phase was detected on the scaffold's surface after cell cultures. All the results were correlated with the scaffolds' compositions. Overall, the study reveals the potential of the marine materials-containing inks to deliver 3D scaffolds with potential for bone regeneration applications.

Influence of Ceramic Particles Size and Ratio on Surface-Volume Features of the Naturally Derived HA-Reinforced Filaments for Biomedical Applications.

The intersection of the bone tissue reconstruction and additive manufacturing fields promoted the advancement to a prerequisite and new feedstock resource for high-performance bone-like-scaffolds manufacturing. In this paper, the proposed strategy was directed toward the use of bovine-bone-derived hydroxyapatite (HA) for surface properties enhancement and mechanical features reinforcement of the poly(lactic acid) matrix for composite filaments extrusion. The involvement of completely naturally derived materials in the technological process was based on factors such as sustainability, low cost, and a facile and green synthesis route. After the HA isolation and extraction from bovine bones by thermal processing, milling, and sorting, two dependent parameters—the HA particles size (<40 μm, <100 μm, and >125 μm) and ratio (0–50% with increments of 10%)—were simultaneously modulated for the first time during the incorporation into the polymeric matrix. The resulting melt mixtures were divided for cast pellets and extruded filaments development. Based on the obtained samples, the study was further designed to examine several key features by complementary surface–volume characterization techniques. Hence, the scanning electron microscopy and micro-CT results for all specimens revealed a uniform and homogenous dispersion of HA particles and an adequate adhesion at the ceramic/polymer interface, without outline pores, sustained by the shape and surface features of the synthesized ceramic particles. Moreover, an enhanced wettability (contact angle in the ~70−21° range) and gradual mechanical takeover were indicated once the HA ratio increased, independent of the particles size, which confirmed the benefits and feasibility of evenly blending the natural ceramic/polymeric components. The results correlation led to the selection of optimal technological parameters for the synthesis of adequate composite filaments destined for future additive manufacturing and biomedical applications.

Levels of Wistar Calcium Serum (Rattus Norvegicus) in Human Adipose-Derived Mesenchymal Stem Cells (hADMSCs) and Chitosan Scaffold by Osteoinduction Examination

Bone tissue reconstruction with extensive damage is one of the challenges for dentists because its healing process of bone tissue. Bone graft is the gold standard for bone repair. However, the use of bone graft has a limited amount of tissue produced. Tissue engineering is the latest method in terms of bone regeneration. Tissue engineering has three main components, first is stem cells that have self renewal ability and multineage differentiation, second is bioreactor / growth factor, and then scaffold. The combination of hADMSC and chitosan scaffold, is expected to trigger osteoinduction shown by osteogenic markers such as calcium levels. Purpose to prove osteoinduction in a combination of Human Adiposed Derived Mesenchymal Stem Cell (hADMSC) and chitosan scaffold using blood serum calcium levels. Methods: This study uses 12 treatment groups with each group having 4 samples. Groups 1 to 4 were the negative control group at 1st,3rd,7th, and 14th days which maxillary bone drilling only. While groups 5 to 8 were the positive control group at 1st,3rd,7th, and 14th days which were given chitosan scaffold. Groups 9 to 12 were treatment group at 1st,3rd,7th, and 14th days which were given hADMSC and chitosan scaffold. Blood collection is carried out in each group to check serum calcium levels. Result there were differences in calcium levels in blood serum in each group. Conclusion the application of hADMSC and chitosan scaffold caused a significant change in serum calcium levels on the 1st, 3rd, 7th and 14th days which meant that the combination of hADMSC and chitosan scaffold could trigger osteoinduction.

Macrophages in periapical lesions: Potential roles and future directions.

Periapical lesions are infectious diseases that occur in the apical region of teeth. They result in the destruction of alveolar bone and are usually accompanied by swelling, pain, and possible systemic impacts. A complex interaction between pathogens and the host immune system determines the development, progression, and outcome of periapical lesions. The lesions, if not treated promptly, may cause resorption of bone tissue, destruction of the periodontal ligament, and loss of the affected teeth, all of which can severely worsen the quality of life of patients, often at considerable economic cost to both patients and medical organizations. Macrophages are a group of heterogeneous cells that have many roles in the development of infections, destruction and reconstruction of bone tissues, and microbe–host interactions. However, the differential and comprehensive polarization of macrophages complicates the understanding of the regulatory mechanism of periapical lesion progression. This report provides a comprehensive review of recent advances in our knowledge of the potential role of macrophages in determining the turnover of human periapical lesions. For example, macrophage differentiation might indicate whether the lesions are stable or progressing while the extent of bacteria invasion could regulate the differentiation and function of macrophages involved in the periapical lesion. In addition, alternative strategies for the treatment of apical periodontitis are discussed.

Naringin Release from a Nano-Hydroxyapatite/Collagen Scaffold Promotes Osteogenesis and Bone Tissue Reconstruction.

Bone fractures and defects are a major health issue and have reportedly affected over 455 million individuals globally to date. Bone tissue engineering has gained great success in bone defect repair and bone reconstruction based on the use of nano-hydroxyapatite (nHA) or collagen (COL). Both nHA and COL exhibit osteogenic induction capacity to support bone tissue regeneration; however, the former suffers from poor flexibility and the latter lacks mechanical strength. Biological scaffolds created by combining nHA and COL (nHA/COL) can overcome the drawbacks imposed by individual materials and, therefore, have become widely applied in tissue engineering. The composite scaffolds can further promote tissue reconstruction by allowing the loading of various growth factors. Naringin (NG) is a natural flavonoid. Its molecular weight is 580.53 Da, lower than that of many growth factors, and it causes minimal immune responses when being introduced in vivo. In addition, naringin is safe, non-toxic, inexpensive to produce, and has superior bio-properties. In this study, we introduced NG into a nHA/COL scaffold (NG/nHA/COL) and exploited the potentials of the NG/nHA/COL scaffold in enhancing bone tissue regeneration. NG/nHA/COL scaffolds were fabricated by firstly combining nHA and collagen at different compositional ratios, followed by NG encapsulation. NG release tests showed that the scaffold with a nHA/COL mass ratio of 7:3 exhibited the optimal property. The in vitro cell study showed the desirable biocompatibility of the NG/nHA/COL scaffold, and its effective promotion for the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs), as proved by an increased alkaline phosphatase (ALP) activity, the formation of more calcium nodules, and a higher expression of osteogenic-related genes involving Osteocalcin (OCN), BMP-2, and Osteopontin (OPN), compared with the control and nHA/COL groups. When administered into rats with skull defects, the NG/nHA/COL scaffold significantly promoted the reconstruction of bone tissues and the early repair of skull defects, indicating the great potential of NG/nHA/COL scaffolds in bone tissue engineering.

Combined Application of Er:YAG and Nd:YAG Lasers Enhances Osseointegration at Dental Bone-Implant Interface

The combination of a bone and an implant surface is a dynamic biological process. By improving the osseointegration efficiency of the bone tissue around the implant surface, the implant can obtain long-term stability. In this study, we have investigated the potential applications of dual-wavelength lasers (Er:YAG laser and Nd:YAG laser) in implantations and observed their possible efficacy in promoting tissue repair around the implant. The animal experimental model of a rabbit femoral defect implant was used to simulate the process of tissue reconstruction around the implant in humans. The results indicated that by micro-CT observation, it was obvious that the bone mineral density (BMD) values of the dual-wavelength laser group were significantly higher than those of other groups. Furthermore, VG staining clearly showed that there was no obvious physiological gap detected between the implant and the surrounding bone tissues in the dual-wavelength laser group. HE staining further revealed that no significant influx of inflammatory cells was observed around the implants. Immunohistochemical staining of OCN and VEGF showed that the positive area percentages of the dual-wavelength laser group were significantly higher than other groups at the same time point. Therefore, the application of a dual-wavelength laser in implantations can exhibit a positive effect on promoting the reconstruction of bone tissues.

Diabetic oxidative stress-induced telomere damage aggravates periodontal bone loss in periodontitis

Periodontitis, one of the most common oral complications of diabetes mellitus (DM), causes a reduction in alveolar bone height and loss of alveolar bone mass. It has been shown that DM aggravates the progression of periodontitis, but the mechanism remains inconclusive. The hyperglycemic environment of DM has been proven to generate reactive oxygen species (ROS). Since telomeres, guanine-rich repeats, are highly susceptible to oxidative attack, we speculate that the excessive accumulation of ROS in DM could induce telomere damage resulting in dysfunction of periodontal ligament cells, especially periodontal ligament stem cells (PDLSCs), which reduces the ability of tissue repair and reconstruction in diabetic periodontitis. In this study, our current data revealed that oxidative telomere damage occurred in the periodontal ligaments of diabetic mice. And Micro-CT scans showed reduced alveolar bone height and impaired alveolar bone mass in a diabetic periodontitis model. Next, cultured mouse PDLSCs (mPDLSCs) were treated with the oxidant tert-butyl hydroperoxide (t-BHP) in vitro, as we expected telomere damage was observed and resulted in cellular senescence and dysfunction. Taken together, oxidative stress in DM causes telomere dysfunction and PDLSCs senescence, which influences periodontal bone tissue regeneration and reconstruction and ultimately exacerbates bone loss in periodontitis.

Immediate implants in maxillary anterior region with guided bone augmentation

Aim: This case is a combination of vertical and horizontal defect in maxillary anterior region accompanied with absence of facial soft tissue which rehabilitated following extraction of tooth was rehabilitated by guided bone regeneration (GBR) and immediate implant Background: Loss of the labial bony wall during extraction of maxillary anterior teeth is a commonly encountered conundrum. During planning for an immediate implant placement in such a compromised area, guided bone regeneration (GBR) is a well-accepted method for bone and soft tissue reconstruction. Case Description: In the presented case report, a combination of vertical and horizontal defect of more than 2 mm accompanied with absence of facial soft tissue following extraction of tooth was rehabilitated by GBR and immediate implant. The follow - up was performed 36 months after final loading with good esthetic outcome and bone graft well apposed to native bone in CBCT evaluation with no obvious complications. Conclusion: The vertical and horizontal ridge volumetric alterations positively can be achieved by simultaneous GBR with immediate implant placement. Clinical Significance: The purpose of discussing this case report is to portray the efficacy of GBR along with immediate implant in case with both vertical and horizontal bone defects.

Cranioplasty With Customized Craniofacial Implants and Intraoperative Resizing for Single-Stage Reconstruction Following Oncologic Resection of Skull Neoplasms.

Craniectomies requiring skull reconstruction are indicated following oncological resection of masses involving the underlying brain and/or skull. Immediate cranioplasties have previously been performed using suboptimal hand-bending or molding techniques using "off - the - shelf" products. Today with computer - aided design, customized craniofacial implants have become widely available for personalized reconstruction of resected bone and soft tissue. We present here the largest series to date of single stage reconstruction using alloplastic biomaterials in consecutive patient series with oversized customized implants. A single-surgeon, retrospective, 8-year study was conducted on all consecutive patients undergoing single stage cranioplasty with prefabricated implants using a myriad of biomaterials. All outcomes were analyzed in detail and compared with previous studies utilizing similar alloplastic implants. In total, 56 patients underwent resection of skull neoplasms and subsequent cranioplasty reconstruction using customized implants. The most common neoplasms were meningiomas (39%). The most common complications seen among patients were dehiscence - (7%), and extrusion of implant - (3.5%). There was no significant difference in the incidence of postoperative complications between patients who had postoperative chemotherapy/radiotherapy versus those that did not (22.2% versus 13.1%, P = 0.39). One-year follow-up revealed acceptable cranial contour and symmetry in all 56 cases. This is a consecutive case series of prefabricated single-stage cranioplasty, following resection of brain tumors with bone extension or skull bone neoplasm, demonstrating excellent results with regards to safety and patient satisfaction. There are several advantages such as comprehensive resection and reconstruction plan using 3D models, shorter operative time, and better restoration of complex anatomy.