Bone Reduction Research Articles

Rescue of Interfragmentary Compression in Screw Stripping Failures: The Efficacy of NiTiNOL.

Orthopedic screws are widely used to achieve bone reduction, compression, and construct stability. However, the relationship between insertion torque, interfragmentary compression, and fixation strength, especially when comparing standard screws with NiTiNOL/sustained dynamic compression (SDC), has not been thoroughly investigated. This study measured insertion torque, interfragmentary compression, and fixation strength for two types of headed orthopedic devices-standard and SDC-using solid foam bone replicates and cadaver validation. The study also assessed the interfragmentary compression produced by these devices in the context of simulated bone resorption. Results showed that compression force increased with insertion torque until thread stripping occurred, resulting in a 91.9% loss of compression in the standard screw group. In contrast, the SDC device maintained significantly higher compression, even beyond the point of stripping. These findings suggest that SDC devices offer increased safety by continuing to apply interfragmentary compression after stripping. The SDC device's ability to generate internal compression allows it to re-engage threads into undamaged bone, potentially compensating for compression loss due to stripping. Clinically, these results indicate that surgeons might benefit from deliberately undershooting peak insertion torque, regardless of the device type, and may prefer NiTiNOL-based SDC devices for their resilience to stripping and bone resorption, ultimately optimizing patient outcomes in foot and ankle surgery.

Automatic virtual reduction of unilateral zygomatic fractures based on ICP algorithm: A preliminary study.

To establish an automatic reduction method for unilateral zygomatic fractures based on Iterative Closes Point (ICP) algorithm. 60 patients with unilateral type B zygomatic fractures were included. After acquiring CT images, zygomatic fragments were segmented using self-developed software MICSys. Mid-Sagittal-Plane (MSP) was manually defined using anatomical skull landmarks. Surface of zygoma on the healthy side was then "mirrored" according to MSP. Referring to mirror image, the fragments were reduced by both automatic and manual methods. In automatic group, fragments were registered onto mirror images by ICP algorithm in MICSys. In manual group, an experienced maxillofacial surgeon translated and rotated fragments until coincided with mirror images. Operating time of each group was recorded. RMSE between reduced fragment and mirror image was calculated to evaluate accuracy. Operating time and accuracy between the two groups were compared using T-test. Virtual bone reduction was conducted for all 60 patients by the two methods. Operating time of automatic group and manual group were 3.06 ± 1.93 s and 65.45 ± 32.19 s, with significant difference (P < 0.0001). RMSE of automatic group and manual group were 1.94 ± 0.59 mm and 2.33 ± 0.57 mm, with significant difference (P < 0.0001). Automatic reduction method based on ICP Algorithm for unilateral zygomatic fractures was initially established and clinically acceptable.

3D-Printed "Jigsaw Puzzle" in Craniomaxillofacial Comminuted Fracture Reduction.

Surgical treatment of comminuted and multiple facial fractures is challenging, as identifying the bone anatomy and restoring the alignment are complicated. To overcome the difficulties, 3D-printed "jigsaw puzzle" has been innovated to improve the surgical outcome. This study aimed to demonstrate the feasibility of 3D-printed model in facial fracture restoration procedures. Patients with traumatic craniomaxillofacial fractures treated at a single institution were enrolled in this study. The exclusion criteria included the presence of mandibular fractures, greenstick fractures, isolated fractures, and revision cases. Fine-cut (1-mm thick) computed tomography images of each patient were assembled into a 3D model for preoperative planning. Major fragments were segmented in virtual surgical planning, printed out with a 3D printer as "jigsaw puzzle" pieces, and assembled with plates and screws as in surgical rehearsals. We further matched our study group with a control group of patients who underwent the corresponding procedures to compare operative time. Nine patients with craniomaxillofacial fractures were included in the study, including 2 patients with zygomaticomaxillary complex fractures and 7 patients with multiple fractures. No remarkable postoperative complications, such as enophthalmus or optic nerve injury, that require additional or revision surgery were noted. The mean operative time was 391 and 435 minutes in the study and control groups, respectively. The t test results were not statistically significant. Surgeons can perform comprehensive preoperative planning, simulation, and obtain a real-time reference for facial bone reduction by using the 3D-printed "jigsaw puzzle" in multiple complicated craniomaxillofacial fractures.

Sesamoid Bone Reduction in Hallux Valgus: Comparing Radiological Outcomes of Hallux Valgus Following Distal Chevron Osteotomy and Modified McBride Procedure.

Background: Hallux valgus is a common forefoot disorder with hundreds of proposed management techniques. Distal chevron osteotomy with a modified McBride procedure has been traditionally recommended for mild hallux valgus because of its simple and less invasive nature with fewer complications, faster recovery, and reliable outcomes. In recent years, the indications for this procedure have expanded to include hallux valgus with severe deformities. This study aims to compare the radiographic outcomes of the surgical treatment for moderate versus severe hallux valgus patients from the perspective of sesamoid bone reduction. Materials and Methods: A retrospective review of medical records identified 99 feet from 94 patients that were treated with distal chevron osteotomy with a modified McBride procedure. These feet were divided by the preoperative hallux valgus angle and intermetatarsal angle into the moderate and severe groups. Results: Postoperative radiographic parameters significantly improved in both groups after treatment, indicating adequate deformity correction. Improvement in the sesamoid position was better in the moderate group compared to that in the severe group. The recurrence rate in the severe group was higher than that in the moderate group without statistical significance. Conclusions: Based on the radiographic results of the postoperative position following sesamoid reduction, the distal chevron osteotomy with a modified McBride procedure is effective for treating moderate hallux valgus deformities. However, this treatment strategy may be associated with a higher recurrence rate in cases of severe hallux valgus deformity. A complete reduction in the sesamoids should be emphasized during the management of severe hallux valgus deformity.

The Use of the Facial Sinus Wall as Bone Shell Onlay Graft for Maxillary Posterior Ridge Reconstruction: A Retrospective Case Series.

To evaluate the performance and clinical outcome of vertical and horizontal bone augmentation (VHBA) in posterior maxillary regions combining lateral window sinus floor elevation (LWSFE) with a horizontal bone shell technique applying the maxillary facial sinus wall as a bone plate. In 18 patients, LWSFE was combined with a horizontal bone shield augmentation procedure utilizing the maxillary facial sinus bone wall as a lateral bone plate. Both the sinus cavity and the lateral bone box created were grafted with a mixture of autogenous bone/venous blood and bovine bone mineral. The primary aim was to assess the performance of combined techniques enabling subsequent implant placement. Using radiographic measurements (preoperative, after VHBA, at implant placement, and at follow-up), bone gain/reduction of augmented horizontal ridge width (HRW) and vertical bone height (VBH) were evaluated. Additionally, clinical outcome assessing implant survival/success rate, marginal bone loss (MBL), and implant health (mucositis/peri-implantitis) was evaluated. For the combined VHBA techniques, HRW and VBH increased significantly (p < 0.001) from preoperative 3.5 ± 1.4 mm/3.6 ± 2.1 mm to 9.7 ± 1.9 mm/18.0 ± 1.6 mm post-augmentation. However, HRW and VBH dimensions decreased up to 8.9 ± 1.8 mm/17.1 ± 1.4 mm at implant placement and 8.6 ± 1.7 mm/16.7 ± 1.3 mm at follow-up evaluation (3.8 ± 1.8 years; p < 0.001, respectively). Augmented bone reduction was significantly higher (-7.7%) between the augmentation procedure and implant placement than in the post-implant-placement period (-2.5%). All implants survived (100%) representing peri-implant MBL of -0.9 ± 0.7 mm, pocket depth of 3.4 + 1.8 mm, and prevalences of 5%/0% for peri-implant mucositis/peri-implantitis. The combination of horizontal bone augmentation using local bone shield transfer from the maxillary facial sinus wall with LWSFE enables sufficient reconstruction of maxillary posterior ridge.

Activation of connexin hemichannels enhances mechanosensitivity and anabolism in disused and aged bone.

Mechanical loading, essential for bone health, promotes bone formation and remodeling. However, the positive response diminishes in cases of disuse and aging, leading to bone loss and an increased fracture risk. This study demonstrates that activating hemichannels (HCs) using a connexin 43 (Cx43) antibody, Cx43(M2), in bone osteocytes revitalizes aging and disused bones. Using a hindlimb suspension (HLS) disuse model and a tibial mechanical loading model, we found that Cx43(M2) inhibited bone loss and osteocyte apoptosis induced by unloading in 16-week-old adult mice. Additionally, it enhanced bone mass in response to tibial loading in 22-month-old aged mice. The HC opening released bone anabolic factor prostaglandin E2 (PGE2) and suppressed catabolic factor sclerostin (SOST). This suppressed the increase of cortical bone formation and reduction of bone resorption during unloading and promoted trabecular and cortical bone formation during loading. Cx43(M2)-induced HC opening, coupled with PGE2 release, effectively rescued unloading-induced bone loss and restored the diminished anabolic response of aged bones to mechanical loading. Activating HCs with the Cx43 antibody holds promise as a de novo therapeutic approach, as it can overcome the limitations of existing treatment regimens for treating bone loss and osteoporosis associated with aging and disuse.

Aesthetic crown lengthening in gingival enlargement patients with orthodontic treatment: A case report

Introduction: The orthodontic treatment process that is carried out can cause changes in the soft tissue and hard tissue of the tooth support and the most common is the enlargement of the gingiva. One of the managements in the case of gingival enlargement is crown lengthening, which is carried out by taking gingival tissue with or without bone reduction to further expose the tooth structure so that a better ratio of dental crown and gingiva is obtained. The purpose of this article is to describe the crown lengthening procedure with bone reduction to correct excessive gingival display in patients with orthodontic treatment on the anterior teeth of the upper jaw Case Report: A 19-year-old female patient came to the Periodontology Specialist Poly on a referral from the Dental Orthodontic Specialist of RSGM Universitas Airlangga with complaints that the upper front teeth looked shorter. The patient does not have problems with the periodontal tissue and has no history of systemic diseases such as diabetes, high blood pressure, and no history of allergy to medications. Case management: After the analysis is carried out on the periodontal tissue, the therapy option is in the form of crown lengthening with bone reduction for the treatment of the case. Conclusion: Determining etiological factors and proper examination is very important to determine a crown lengthening action plan as the elimination of gingival enlargement so that it can improve aesthetic appearance.

Inter-septal bone reduction: Impact on space closure, root resorption and canine angulation during en-masse retraction - a randomised controlled trial.

To compare the space closure, root resorption and canine angulation during en-masse retraction of the labial segment after extraction of first premolars with or without interseptal bone reduction distal to the maxillary canines. A single-centre, parallel randomised control trial included 16 participants with a mean age of 21.5 years. Participants were allocated into treatment groups using blocked randomisation, and blinding was employed for outcome assessors and data analysts. The control group consisted of eight participants who underwent therapeutic extraction of maxillary first premolars, while the experimental group included eight participants who underwent interseptal bone reduction immediately after premolar extraction. En-masse retraction was performed using conventional friction mechanics with absolute anchorage in both groups. Measurements of space closure were conducted over 3 consecutive months during retraction. The time taken for total space closure was recorded. Cone-beam computed tomography scans were taken before and 3 months after retraction to assess root resorption and canine angulation. The experimental group demonstrated a significant increase in the rate of en-masse retraction compared to the control group over 3 months (mean difference [MD] = 1.09 mm, 95% confidence interval [CI] = 0.78-1.40), with an overall space closure rate of MD 0.26 mm/month (95% CI = 0.17-0.34). However, these changes were of minimal clinical significance. The change in canine angulation (MD = 4.50°, 95% CI = -1.61-10.61) did not exhibit statistical significance. Substantial root resorption was observed in six maxillary anterior teeth, with no difference between the groups. Interseptal bone reduction is a minimally invasive surgical technique, resulting in a notably accelerated rate of en-masse retraction in the experimental group over 3 months. However, despite the statistical significance, the clinical impact on overall space closure was minimal, with a difference of only 0.26 mm/month observed between the groups. Interseptal bone reduction did not affect the change in canine angulation and root resorption.

Nasal Bone Fracture (NBF): A Retrospective Study on Epidemiology and Treatment Outcomes in the Omani Population.

Purpose To investigate the epidemiology, etiology, treatment outcomes, and sequelae of nasal bone fractures (NBFs) in the Omani population, which may contribute to developing better treatment approaches and preventive strategies. Materials and methods A retrospective chart review was conducted at Al Nahdha Hospital from January 2012 to January 2017. Data on demographics, injury mechanisms, treatment modalities, and outcomes were collected for 453 patients with NBFs. All patients with fresh NBFs, children, or adults of both genders, were included. Of these, 171 patients underwent nasal bone reduction under general anesthesia (GA). The collected data included the patients' age, gender, cause of injury, treatment, and surgical outcome. SPSS was used for data collection and analysis. Results Sports-related injuries, particularly football, were the most common cause (35.97%), followed by accidental falls (32.92%), road traffic accidents (17.68%), and assaults (12.82%). Most cases (98.8%) were managed with closed reduction, with a satisfactory outcome in 85.81%. However, 14.18% experienced residual deformities requiring further surgery. The highest frequency of displaced NBF was in the 21-30 age group, with males being the predominant patients. Conclusion NBFs are particularly common among young males (21-30 years). Sports injuries, falls, and road traffic accidents are the primary causes. Timely and appropriate management is crucial to minimize long-term complications. Hence, an emphasis on health education and preventive measures for sport injuries among the young population is required.

Clinical and radiographic assessment of the association between orthodontic mini-screws and periodontal health

ObjectivesProper anchorage control is crucial for predictable tooth movement and preventing inadequate torque during orthodontic treatment. Through clinical and radiographic parameters; this study assesses the association between mini-screws and periodontal health.Materials and methodsA prospective observational study included 16 systemically healthy non-smoking individuals requiring mini-screws. Mini-screws with a rough, titanium oxide-coated surface were placed. Periodontal assessments (Plaque index, gingival index, probing pocket depth, gingival recession, bleeding on probing, mucosal discomfort, mucosal redness, keratinized tissue width, supracrestal tissue height, and transmucosal soft tissue thickness) were performed at 2nd week and 3 months post-placement. Radiographic evaluations measured distances between mini-screws and adjacent teeth using Image J software.ResultsThe study included 13 females and 3 males (mean age 21.9 ± 1.8 years) with 24 mini-screws. Early mini-screw loss was not observed. Significant reductions in site-level Gingival Index and bleeding on probing (p < 0.05) and full-mouth bleeding on probing (p < 0.05) were noted over time. Absence of significant differences was found in mucosal discomfort and redness, keratinized tissue width, or transmucosal soft tissue thickness, but supracrestal tissue height decreased significantly (p < 0.05). Radiographically, significant bone reduction around mini-screws was observed at 3 months, with torque gauge values significantly decreased as well (p < 0.05).ConclusionsOrthodontic mini-screws can be effectively utilized in orthodontic treatment with proper planning and monitoring. While improvements in gingival health were observed with targeted oral care, the study underscores the need for careful consideration of potential risks to periodontal tissues, such as reductions in supracrestal tissue height and bone levels. A balanced approach that integrates preventive strategies with precise screw placement is essential to maximize the benefits of mini-screws while minimizing potential periodontal complications.Clinical relevanceWhile proper oral hygiene can help control inflammation around mini-screw sites, clinicians must also be mindful of potential risks, such as reductions in bone levels and tissue height. Careful patient selection, precise placement, and regular follow-up are crucial to ensure the stability of mini-screws’ stability and to prevent complications, ultimately contributing to better treatment outcomes in orthodontic care.Trial registrationThis study was registered on ClinicalTrials.gov with the registration number NCT06491849 on June 28, 2024.

An in-vitro study on accuracy of modular templates used to fully guide implants in combination with bone reduction for complete arch restorations: Experts versus students

ObjectivesThis in-vitro study evaluates the accuracy of modular surgical templates used to fully guide implants in combination with bone reduction, performed by expert and students, for complete arch restorations. MethodsAll the procedures were performed by dental students of the final year and an expert clinician, on twelve edentulous mandible models. A virtual implant planning, simulating a complete arch restoration on six implants were performed. Three different surgical guides were designed and printed to allow conventional fully guided implant placement (group 1); fully guided implant placement with modular guides (group 2); and fully guided implant placement after bone reduction, with similar, modular guides (group 3). After implant placement, optical scans of the study models were taken. Surface deviation and accuracy were evaluated and compared between groups and subgroups. ResultsA total of 12 surgical templates were used. Of these, Two templates in each group were used by two different students, while, the other six templates were used by an expert clinician as follows: one template with screwed anchor pins and one with pushed anchor pins in each group. A total of 72 implants were placed. Statistically significant difference was found between different template designs, when the implants were placed by an expert clinician. No statistically significant difference was found between expert and students, except the deviation in an angle value (students 2.13±1.46° versus expert 0.90±0.91°; P Value=0.0447) in the group 3. A statistically significant difference was found in favor of screwed anchor pins, in the group 1, in horizontal deviation (screwed pins 0.18±0.13 mm versus pushed pins 0.56±0.28 mm; P Value=0.0124; Table 5). No statistically significant difference was found between different template designs when the fully guided implants were placed by students, in both angle and horizontally (P=0.2787 and P=0.6601, respectively). A statistically significant difference was found between groups when the implants were placed by an expert clinician, with better value using screwed anchor pins, in the horizontal plane (P= 0.0293) but not in angle (P= 0.3380). ConclusionsModular templates provide a similar level of accuracy to conventional, one-piece guides. Screwed pins should be used to fix the base portion of the modular guides. Further clinical studies are needed to confirm these preliminary results. Clinical SignificanceModular surgical guides provide comparable accuracy to conventional, single-piece guides, however they offer more possibilities, helping in bone reduction and immediate loading procedures. Screwed anchor pins used to fix the base portion of the modular guides provide better final results than pushed pins.

Association of bone turnover markers and craving reduction in patients with alcohol use disorder during withdrawal: Exploring the role of bone-brain axis.

Alcohol use disorder (AUD) is associated with imbalanced bone turnover and psychological symptoms, but the relationship between bone and brain remains unclear. The study analyzed serum levels of a bone formation marker, procollagen type 1 N-terminal propeptide (P1NP), and bone resorption marker, C-terminal telopeptide of type I collagen (CTX-1), in AUD patients before and after 2 weeks of alcohol withdrawal and investigated their correlation with psychological symptoms. Ninety patients with AUD and 117 healthy controls were recruited. P1NP and CTX-1 levels were measured using Enzyme-Linked Immunosorbent Assay. The Penn Alcohol Craving Scale (PACS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were assessed in the AUD group at baseline, week 1, and week 2 of withdrawal. Baseline CTX-1 levels, along with the CTX-1/P1NP and P1NP/CTX-1 ratio, were higher in the AUD group than controls. Over the 2-week withdrawal, PACS, BDI, and BAI scores demonstrated significant reductions. P1NP (p < 0.001) and P1NP/CTX-1 ratio increased (p < 0.001), while CTX-1/P1NP ratio decreased (p < 0.001), indicating a propensity toward bone formation. Univariate analysis revealed that reductions in PACS, BDI, and BAI scores during withdrawal correlated with increased P1NP levels and decreased CTX-1/P1NP ratios. However, multivariate analysis indicated that only PACS score reductions correlated with these changes. Bone metabolism shifted toward increased bone formation and decreased bone resorption during 2-week alcohol withdrawal. The correlation between improvements in bone turnover markers and reduction in craving scores during withdrawal supports the concept of the bone-brain axis.

Tetracalcium Phosphate/Monetite/Calcium Sulfate Hemihydrate Biocement for Alveolar Bone Augmentation After Tooth Extraction in Pig Mandible.

A tetracalcium phosphate/monetite/calcium sulfate hemihydrate powder cement mixture (CAS) in the form of a paste was used as a socket preservative to prevent alveolar ridge resorption after the extraction of the second premolar tooth in the mandible of a pig model. During the post-surgery period, the animals were monitored daily. No signs of inflammation, infection, or other complications were observed in the defect site for six months. Six months after surgery, the mandible defects in pigs were evaluated using macroscopic, histological, and radiological techniques. Treatment of the extraction sites with CAS biocement resulted in the uniform filling of the defects with alveolar bone tissue, characterized by a relatively smooth and homogeneous gum surface with no visible biocement residues. The formation of new bone tissue with osteoblasts, osteocytes, and mineralized matrices was confirmed. The results showed the similar morphology, thickness, and complete integration of the newly formed bone with the surrounding tissue. CAS biocement could be an effective material to prevent alveolar bone reduction as well as soft tissue loss and could support dental implant placement with long-term functionality.

Comparison of Prevalence of Arthroscopically Detected Intra-Articular Pathologies Between Supination and Pronation Type Ankle Fractures

Category: Arthroscopy; Ankle Introduction/Purpose: Ankle fractures are among the most common fractures of the lower extremity. Most unstable ankle fractures have good outcomes following operative fixation; however, residual pain and swelling are not uncommon despite anatomical bone reduction. Untreated associated injuries, including syndesmotic injury, deltoid ligament injury, and osteochondral injury, are potential causes for suboptimal outcomes. These pathologies are often underappreciated. The Lauge-Hansen classification is used to categorize fractures based on the mechanism of injury and thus has the potential to predict intra-articular pathology. To date, there is limited literature reporting the comprehensive prevalence of arthroscopically diagnosed intra-articular pathologies in acute ankle fractures based on the mechanism of injury. This study aims to report the prevalence of each intra-articular pathology between different fracture patterns. Methods: A retrospective database review was conducted on 203 patients with rotational ankle fractures who underwent arthroscopic-assisted open reduction and internal fixation for unstable acute ankle fractures between 2016 and 2023. Patients with open fractures, pilon fractures, delayed treatment, and children with open physes were excluded from the study. The patients were categorized into groups according to the Lauge-Hansen classification: Supination-Adduction (SA), Supination-External Rotation (SER), Pronation-External Rotation (PER), and Pronation-Abduction (PA). Syndesmotic injuries were determined by the arthroscopic drive-through sign with a 3mm shaver, while deltoid ligament injuries and osteochondral injuries were identified using arthroscopic visualization. Results: There were 3 patients (1.48%) with SA fractures, 143 patients (70.44%) with SER fractures, 6 patients (2.96%) with PA fractures, and 51 patients (25.12%) with PER fractures. The prevalence of arthroscopically diagnosed syndesmotic instability following malleoli fixation was extremely high in most fracture patterns except the SA mechanism (PER: 98.04%, PA: 100%, SER: 89.51%, SA: 33.33%). The prevalence of osteochondral injury was higher in pronation-type injuries than supination-type injuries (73.78% vs 53.9%, p=0.03). Deltoid ligament injury was found in 56.74% of SER fractures and 68.42% of PA/PER fractures. Conclusion: The prevalence of intra-articular pathologies in ankle fracture was higher in pronation-type injuries. However, the prevalence of these pathologies, especially syndesmotic instability, in SER fracture patterns was also alarming. The authors advocate for routine ankle arthroscopy simultaneously with ankle fixation to provide adequate treatment and predict prognosis.

Indirect sinus lift with implant placement in maxillary right molar region

The maxilla has one of the least dense bone masses in the oral cavity and is composed of porous bone. Due to considerable alveolar bone resorption brought on by periodontal disease-induced tooth loss, there is an emphasis on bone reduction in both height and width. Pneumatization of the maxillary sinus, post-extraction bone resorption, and low-quality remaining alveolar bone all contribute to the difficulty in bone remodelling.Indirect sinus augmentation is an effective solution for this problem. This case report presents the rehabilitation of maxillary right first molar by using indirect sinus lift with implant placement where the bone height and bone width was compromised.

Revolutionizing Bone Regeneration with Grinder-Based Dentin Biomaterial: A Systematic Review.

Bone tissue regeneration is a critical aspect of dental surgery, given the common occurrence of bone resorption leading to alveolar bone defects. The aim of this paper was to conduct a systematic review to provide a comprehensive summary of the evidence regarding the regenerative properties of dentin biomaterial. This systematic review was conducted through comprehensive searches in the PubMed, Scopus, and Web of Science databases, as well as an extensive exploration of the gray literature sources, including WorldCat, The New York Academy of Medicine Library, and Trip Database, following the established PRISMA protocol. Keywords such as tooth, dentin, grinder, and autograft guided the search, with a focus on a standardized procedure involving dentin grinders within laboratory, experimental, and clinical settings. Initially, a pool of 1942 articles was identified with 452 duplicates removed. An additional 1474 articles were excluded for not aligning with the predefined topics, and three more were excluded due to the unavailability of the full text. Ultimately, 13 articles met the strict inclusion criteria and were included in the review. The chemical composition of the dentin particles was similar to natural bone in terms of oxygen, carbon, calcium, phosphorus, sodium, and magnesium content, as well as in terms of the Ca/P ratio. In addition, the dentin also contained amide I and amide II structures, as well as aliphatic and hydroxyl functional groups. The chemically treated dentin was free of microorganisms. The dentin had characteristic tubules that opened after chemical treatment. At the cellular level, dentin released bone morphogenetic protein 2, induced significant cell growth, and stimulated the reorganization of the fibroblast cytoskeleton. Most clinical studies have focused on alveolar bone regeneration. After the transplantation of demineralized dentin particles, studies have observed new bone formation, a reduction in residual bone, and an increase in connective tissue. Clinical reports consistently indicate uncomplicated healing and recovery post-transplantation. However, there is a notable gap in the evidence concerning complication rates, patient-reported outcomes, and the presence of pro-inflammatory factors. In conclusion, dentin biomaterial emerges as a versatile bone substitute, demonstrating high biocompatibility and ease of acquisition. The preservation of its internal structure containing organic matter and growth factors enhances its potential for effective bone regeneration. Particularly, in dental surgery, dentin-derived materials present a promising alternative to traditional autologous bone autografts, offering the potential to reduce patient morbidity and treatment costs.

Hump Rasping Using Powered Instruments: A Retrospective Review.

Nasal hump reduction, a common procedure in rhinoplasty, aims to create a harmonious nasal appearance with smooth dorsal lines. An alternative to traditional osteotomes is the carbide-tip nasal rasp, effective in eliminating modest contour deformities. However, the broad movements and physical forces of manual rasping can significantly weaken the osseocartilaginous vault. Power-assisted instruments have been used to reduce soft tissue trauma. Although long-term clinical outcomes of power-assisted instrumentation are pending, initial reports have been positive. This retrospective chart review encompassed 220 consecutive rhinoplasty cases conducted by the senior author, all involving women aged 19-37 years. Excluding 80 cases that did not involve bone reduction, the analysis concentrated on 140 patients who underwent bone reduction procedures. The success of nasal hump reduction was evaluated based on the joint satisfaction of both the patient and the surgeon with the surgical improvement. The open rhinoplasty approach was predominantly used for surgical exposure to minimize inadvertent rasping of the nasal cartilage. Among the 140 patients undergoing power-assisted bone removal, all but five achieved an initially satisfactory refinement of the bony nasal contour. Notably, no serious complications were observed throughout the study. Unfortunately, one patient did not comply with the monthly steroid injections, leading to the necessity of revision surgery for the removal of regenerated bone. The integration of power-assisted instrumentation in rhinoplasty procedures represents a promising advancement, addressing challenges associated with traditional methods.

Which type of supra-syndesmal fractures Weber C or Equivalent Weber C have the best reduction of the distal tibio-fibular syndesmosis? A prospective CT-scan investigation on 60 ankles

IntroductionThe reduction of the distal tibiofibular syndesmosis (SyTFd) is a crucial factor in the functional prognosis following a suprasyndesmotic ankle fracture. Few studies have compared, using computed tomography (CT), the quality of SyTFd reduction in Weber C ankle fractures (WebC) and Equivalent Weber C (EqWebC) fractures, where there is a medial ligament injury instead of a bony malleolar lesion. This CT-based study aimed to answer the following questions: (1) Do Weber C fractures allow for better reduction of the distal tibiofibular syndesmosis compared to Equivalent Weber C fractures? (2) Are the functional outcomes one year postoperatively better for Weber C fractures compared to Equivalent Weber C fractures? HypothesisThe hypothesis was that WebC fractures would present better reduction of the SyTFd than EqWebC fractures due to the restoration of bone anatomy, considering the bony nature of the medial ligament involvement. Materials and methodsSince December 2021, all patients presenting with an ankle fracture were included in a database. Suprasyndesmotic fractures were extracted, and between December 2021 and February 2022, 60 patients underwent surgery for a suprasyndesmotic fracture (28 WebC – 32 EqWebC). All patients were operated on using the same technique and underwent a postoperative bilateral CT scan in axial slices with both ankles in a neutral position (foot at 90 ° to the leg). An analysis of 8 measurements was performed under the same conditions. Each fractured ankle was compared to the healthy contralateral ankle, and a delta was obtained for each measurement. The follow-up was standardized. At one year, an AOFAS Score and a Maryland Foot Score (MFS) were recorded. Statistical differences between the two groups were measured using the Student's t-test and Chi-square test. ResultsThere was a significant difference between the WebC and EqWebC groups for clinical scores at one year postoperatively: AOFAS: 92.0 ± 6.3 [78–100] vs. 80.1 ± 5.4 [62–100], p < 0.05; MFS: 90.9 ± 6.4 [78–100] vs. 81.6 ± 5.2 [64–100], p < 0.05. CT scan analysis of the SyTFd reduction found significantly better reduction in the WebC group. DiscussionWebC fractures showed better clinical scores associated with better SyTFd reduction on postoperative CT scans. The anatomical reduction related to the bone reduction criteria during surgery could explain our findings. Level of evidenceIII; Case-Control Comparative Study.

Degenerative and regenerative peripheral processes are associated with persistent painful chemotherapy-induced neuropathies in males and females

This study investigated the time course of gene expression changes during the progression of persistent painful neuropathy caused by paclitaxel (PTX) in male and female mouse hindpaws and dorsal root ganglia (DRG). Bulk RNA-seq was used to examine these gene expression changes at 1, 16, and 31 days post-last PTX. At these time points, differentially expressed genes (DEGs) were predominantly related to the reduction or increase in epithelial, skin, bone, and muscle development and to angiogenesis, myelination, axonogenesis, and neurogenesis. These processes are accompanied by the regulation of DEGs related to the cytoskeleton, extracellular matrix organization, and cellular energy production. This gene plasticity during the progression of persistent painful neuropathy could be interpreted as a biological process linked to tissue regeneration/degeneration. In contrast, gene plasticity related to immune processes was minimal at 1–31 days after PTX. It was also noted that despite similarities in biological processes and pain chronicity between males and females, specific DEGs differed dramatically according to sex. The main conclusions of this study are that gene expression plasticity in hindpaw and DRG during PTX neuropathy progression similar to tissue regeneration and degeneration, minimally affects immune system processes and is heavily sex-dependent at the individual gene level.

Bone Mineral Density in Survivors of Childhood Cancer: A Meta-Analysis.

There is an increasing population of childhood cancer survivors (CCS) at risk for treatment-related toxicities, including skeletal morbidities. Bone mineral density (BMD) is a proxy for bone health and reductions are associated with osteoporosis and fractures. To investigate bone health in CCS by conducting a systematic review and meta-analysis of BMD after completed treatments. We searched Medline, Embase, Cochrane, and Web of Science in May 2019 and updated in May 2023. Studies reporting BMD Z-scores measured with dual-energy x-ray absorptiometry in CCS after treatment completion. We performed a pooled analysis of studies reporting BMD Z-scores and thereafter we analyzed studies comparing BMD in survivors and healthy controls. All analyses were performed based on the site of BMD measurement. Of 4243 studies, 84 were included (N = 8106). The mean time off-treatment across the studies ranged from 2 months to 24 years. The overall pooled mean Z-score was -0.57 (95% confidence interval [CI] -0.59 to -0.55) in the whole-body, -0.84 (95% CI -0.86 to -0.83) in the lumbar spine, -0.79 (95% CI -0.81 to -0.77) in the femoral neck and -0.14 (95% CI -0.18 to -0.11) in the total hip. When comparing survivors with controls, BMD was significantly lower in survivors at all sites. English publications, study-level meta-analysis. We showed a significant reduction of BMD Z-scores in CCS. Given the increased fracture risk already within -1 SD, these results emphasize the need for BMD surveillance and secondary prevention in CCS.