Bone Sequestrum Research Articles

Exploring the Uncommon: Mandibular Osteomyelitis in Pediatric Patient – A Case Report

Introduction: Osteomyelitis is often found in 60-70% of all body regions, but in the jaw area, it rarely occurs, especially in children, and with the development of antibiotics, the incidence of jaw osteomyelitis is decreasing. Osteomyelitis is an inflammatory bone condition involving the medulla and periosteum, one of the causes of which is bacterial infection. The diagnostic support with the best accuracy in this case is a CT scan, with precise imaging of the lines of the lytic lesion, medullary sclerosis, and bone sequestra. Case: A 4-year-old girl patient complained of swelling on the left cheek and a bluish colour on the chin. The patient complained of losing six primary teeth in the lower region, with greenish discharge and bad breath. CT-Scan results showed destructive lytic lesions in the ramus, angle, corpus, left mandibular symphysis, and hyperostosis. The patient was diagnosed with osteomyelitis of the mandible. Case Management: Sequesterectomy and debridement under general anaesthesia, with anatomical pathology results showing mandibular osteomyelitis due to Actinomyces sp. The patient experienced no complaints and significant healing results from treatment. Conclusion: One of the bacteria that plays a role in mandibular osteomyelitis is Actinomyces sp. Proper diagnostic support and surgical planning can determine maximum postoperative results. Keywords: mandibular osteomyelitis, pediatric, sequester ectomy, Actinomyces sp.

Impact of COVID-19 Disease on the Development of Osteomyelitis of Jaws: A Systematic Review.

Background/Objectives: Osteomyelitis is characterized by an inflammatory process affecting both bone and bone marrow, leading to cell death and the formation of bone sequestrum. Recent literature from the past five years has documented instances of osteomyelitis following infections of SARS-CoV-2. This systematic review explores the link between osteomyelitis of the jaw (OMJ) and COVID-19 infections. Methods: This review adhered to the PRISMA guidelines, systematically analyzing literature from 2020 to 2024 sourced from databases including Medline, Embase, Scopus, and Web of Science. PROSPERO ID: CRD42024526257. Results: The review selected 42 articles, detailing 201 cases of osteomyelitis of the jaw related to COVID-19 (COMJ). The demographic breakdown included 195 male (74.4%) and 67 female patients (25.6%), with a median age of 52.7 years, ranging from 24 to 71 years. A significant portion of COMJ patients (41.5%) were hospitalized due to COVID-19, and 58.5% received corticosteroid therapy. Diabetes mellitus was a common comorbidity among COMJ patients (65.1%). Most cases involved maxilla (182 cases; 90.5%), with nearly half showing sinus involvement (49.4%). The mandible was affected in 19 cases (9.5%). Mucormycosis and aspergillosis emerged as the predominant fungal infections, identified in 103 (51.2%) and 50 (24.9%) cases, respectively. Conclusions: Individuals with pre-existing health conditions such as diabetes mellitus who have been treated for COVID-19 are at an increased risk of developing OMJ, particularly maxillary fungal osteomyelitis. COMJ poses a significant diagnostic and therapeutic challenge for dental and maxillofacial professionals, who are often the first to encounter these cases.

Key insights into antiresorptive drug use and osteonecrosis in osteoporotic patients undergoing tooth extractions: A clinical and CBCT assessment

SummaryThis study investigates the effects of antiresorptive drugs and risk factors for medication-related osteonecrosis of the jaws in osteoporotic patients undergoing tooth extraction. Among the findings, antiresorptive-treated patients had thicker lamina dura and longer healing times. Additionally, corticosteroid intake and multi-rooted teeth carried a higher osteonecrosis risk. Bone sequestrum indicated osteonecrosis.PurposeTo describe the effects of antiresorptive drugs (ARD) in the maxilla and mandible and risk factors for medication-related osteonecrosis of the jaws (MRONJ) in osteoporotic patients undergoing tooth extractions using clinical data and cone beam computed tomography (CBCT).MethodsThis retrospective cohort study collected clinical and CBCT data from 176 patients. The study group (n = 78; 224 extractions) received ARD treatment, underwent tooth extraction, and had a pre-operative CBCT. Additionally, age-, sex-, and tooth-matched controls were selected (n = 98; 227 extractions). Radiographic examinations were performed independently by three calibrated examiners. Statistical analysis included Chi-square, Fisher’s exact, Mann–Whitney U, and t-tests to contrast clinical and radiographic data between study and control, MRONJ + and MRONJ − , and bisphosphonate and denosumab patients/sites. Significance was set at p ≤ 0.05.ResultsFrom the study group, 4 patients (5%) and 5 sites (2%) developed MRONJ after tooth extraction. ARD-treated patients exhibited significantly more thickening of the lamina dura and a longer average mucosal healing time (4.4 weeks) than controls (2.6 weeks). In the study group, MRONJ risk significantly increased with corticosteroid intake and in multi-rooted teeth. No significant differences between bisphosphonates and denosumab use were seen in the tomographic features (p > 0.05). Lastly, bone sequestrum was exclusively observed in osteoporotic patients, who exhibited post-operative exposed bone or histological evidence of osteonecrosis.ConclusionOsteoporotic patients under ARD may exhibit thickening of the lamina dura and prolonged post-operative healing. Among these patients, multi-rooted teeth are at higher risk for MRONJ than single-rooted teeth. Sequester formation is a radiographic indicator of osteonecrosis.

Subchondral bone sequestrum formation in the proximal intra-articular and osteochondral region of the third metatarsal bone of an Appaloosa mare treated for septic arthritis

Abstract OBJECTIVE To raise awareness of the potential for intra-articular subchondral bone sequestrum formation secondary to a traumatic or septic process to enable more rapid identification of this uncommon but possible outcome in future cases. ANIMAL A client-owned 12-year-old Appaloosa mare. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES The mare had a wound to the lateral aspect of the fourth metatarsal bone (MT4) that communicated with the distal tarsal joints. Radiographs revealed a displaced, comminuted fracture of MT4. TREATMENT AND OUTCOME The horse underwent aggressive debridement of the wound and MT4 as well as, on 2 occasions, needle joint lavage. Systemic, regional, and IA antibiotic therapy was also performed together with a bone graft from the tuber coxae. The horse’s comfort improved, and the wound appeared to be healing. Five weeks following discharge, the horse re-presented with a non–weight-bearing lameness and radiographs revealed marked osteomyelitis of the tarsometatarsal and distal intertarsal joints. Postmortem examination of the limb identified a sequestrum within the proximal articular surface of the third metatarsal bone. CLINICAL RELEVANCE The present report highlights the importance of arthroscopic lavage to visualize the cartilage surface and the benefits of advanced imaging to detect associated changes within the bone earlier than conventional radiographs. To our knowledge, no reports exist of intra-articular subchondral bone sequestra in the tarsometatarsal joint in horses.

Extensive Sequestration Chronic Maxillary Osteomyelitis in an Uncontrolled Diabetic Patient: Comprehensive Case Management of a Rare Entity.

The hallmark of osteomyelitis was progressive bone destruction and sequestrum formation. In the underlying disease, like diabetes mellitus, osteomyelitis becomes severe and exacerbates the condition. It was essential for the oral and maxillofacial surgeon to comprehend its complex medical and surgical management to achieve complete disease eradication. The aim of this article was to report a rare case and comprehensive management of extensive sequestrating maxillary osteomyelitis with uncontrolled diabetes mellitus patients. A 58-year-old male patient with pain and swelling accompanied by discharge of pus in the sinistra maxilla region. The systemic disease was identified as uncontrolled diabetes mellitus, and had a history of unhealing wounds 1 year ago after upper left molar extraction. Computed tomography scan result showed extensive sequester formation and bony destruction in the right extending to the left maxilla. Microbial culture results were Klebsiella pneumoniae and Morganella morganii. Subsequently, extensive sequestrectomy and multiple extractions of the involved jaw and teeth were performed after diabetes mellitus was regulated. A suspension suture against oral and nasal mucosa was performed to avoid dead space formation. Comprehensive perioperative management in maxillary osteomyelitis in uncontrolled diabetes mellitus includes sequestrectomy, definitive antibiotic therapy based on culture results, and diabetes regulation to improve the successful management of this case.

Electron microscopic analysis of necrotic bone and failed implant surface in a patient with medication-related osteonecrosis of the jaw

BackgroundBisphosphonates (BP), a commonly used medication for various bone diseases, have been known to have severe complications such as bisphosphonate-related osteonecrosis of the jaw (BRONJ). Failure of dental implants has also been found in patients with medication-related osteonecrosis of the jaw (MRONJ). In this study, we analyzed the necrotic bone tissues and the surface of the failed implants removed from the jaw in patients treated with BPs and antiresorptive agents.ResultsChronic inflammatory cells with collagen and fibrous tissues and bone sequestrum were shown at 5.0 × , 10.0 × , 20.0 × , and 40.0 × magnified histologic sections in the bone and fibrotic scar tissues removed from patients with MRONJ due to osteonecrosis. Hardened bone tissues with microcracked bony resorbed lacunae were observed in SEM. Unlike the previously published comparative data where immune cells, such as dendritic cells, were found in the failed implant surface, these immune cells were not identified in the BRONJ-related peri-implantitis tissues through the TEM investigations. Furthermore, EDS revealed that in addition to the main titanium element, gold, carbon, oxygen, calcium, phosphorus, silicon, and sulfur elements were found.ConclusionHardened bone tissues with microcracked bony resorbed lacunae were observed in the SEM findings, which were considered as the main characteristic of the osteonecrosis of the jaw. Immune cells, such as dendritic cells were not identified in the TEM. EDS showed that in addition to the main titanium element, gold, carbon, oxygen, calcium, phosphorus, and silicon elements were found. Furthermore, it was revealed that sulfur was found, which was considered to be one of the complicated causes of implant failure in patients with BRONJ.

P02 When should we stop the antiresorptive medications in patients with osteoporosis?

Abstract Introduction Bisphosphonates are first line and denosumab is the latest antiresorptive agent approved for osteoporosis treatment. Those drugs showed a reduction in vertebral fracture risk and other non-vertebral by 35-70%. One of the rare adverse events with antiresorptive treatment is medicine-related osteonecrosis of jaw (MONJ) which mainly occur in individuals receiving high doses for the treatment of cancer. Recent research found true incidence of MONJ is very low despite public perception. Studies indicate that 50% of women and 20% of men aged over 50 years will experience an osteoporosis-related fracture which have significant associated morbidity and mortality. Case description We report a case of an osteoporosis patient who was treated with alendronate followed by denosumab and presented with suspicion of MONJ. In 2014, a 77-year-old female was referred following right neck of fragility femur fracture. DXA showed osteoporosis (T- score of the spine −3.2, T- score total hip −2.4 and T- score of left neck of femur −2.1). She was initially treated with four years of alendronate (70 mg once weekly) but sustained a pubic rami fracture. Hence, she was then treated with six monthly injections of denosumab (60 mg subcutaneously). After three injections, she developed jaw pain. She was reviewed by her dentist who advised her to stop the denosumab for suspected MONJ. She was then seen by the oral surgeon who confirmed that there was a piece of bone in UR6 socket but with no bone sequestrum and this piece of bone was removed under local anaesthesia with good healing. She was advised to restart denosumab. The patient was extremely worried and anxious about denosumab recommencement and teriparatide was considered. After completion of teriparatide treatment her DXA still showed osteoporosis (T- score of the spine −2.1, T- score of total hip −2.2 and T- score of left neck of femur −2.6) with stable changes in the hip and improvement in the spine. On review, she continued to have concerns about antiresorptive treatment. Further oral surgeon review stated low grade infection around UL7 with poor gum condition around UR6 and LR6 with some bleeding points but no definite diagnosis of MRONJ. It was advised that any further manoeuvre involving tooth extraction will be conducted by the oral surgeon. Following this, the patient was happy to consider zoledronic acid infusions. She is due for her 3rd zoledronate infusion and is undergoing regular dental checks. Discussion The incidence of MONJ in patients taking oral bisphosphonates for osteoporosis is relatively low, estimated to be less than 1% (0.001% to 0.01%). However, the risk is higher for individuals receiving higher doses of intravenous bisphosphonates for the treatment of cancer or bone-related complications of cancer. The incidence of MONJ in cancer patients receiving intravenous bisphosphonates ranges from 1% to 15%. More clinical studies have been published that describe the relation between MONJ and denosumab in cancer patients with the risk of MONJ varying between 0.7 to 1.9% (70 to 90 cases per 10,000 patients). However, in patients with osteoporosis treated with denosumab, the incidence of MONJ is lower, resulting in an even lower frequency of 0.04% (4 cases per 10,000 patients). It is understandable that there is a significant concern amongst dentists about MONJ risk with antiresorptive treatment, but it is paramount that the patients are made aware of the fracture risk and its significant effect on quality of life. Many patients are not aware that more than 20% of patients die in the first year after a hip fracture from complications surrounding the fracture and a significant number of patients lose their long-term ability to live independently. Vertebral fractures have significant morbidity and the mortality rate of 72% at 5 years and 90% at 7 years. Key learning points Most dentists are often reluctant to treat patients on anti-resorptive medications due to the risk of MONJ which results in patient’s concerns about treatment and subsequent stoppage of osteoporosis treatment leading to fracture risks. Thus, it is imperative to assure the patients of benefits of the anti-resorptive medications versus the MONJ risks. This calls for increased awareness and national guidelines for the prevention and management of ONJ in osteoporosis patients treated with antiresorptive.

Efficacy and Versatility of the Medial Hemisoleus Flap for Complex Middle Third Tibial Defects: A Presentation of 2 Cases

Soft tissue injuries involving the middle third of the tibia can present significant clinical challenges, often leading to complications such as infection and nonunion. This article explores the efficacy of the medial hemisoleus flap as a valuable surgical technique for addressing these complex wounds. Two case reports are presented to illustrate the successful use of this flap in clinical practice. The medial hemisoleus flap offers consistent blood supply, improved arc of rotation, and reduced donor site morbidity, making it an excellent choice for reconstructive surgery in this anatomical region. In the first case, a 17-year-old patient with a history of smoking developed an open fracture in his left leg two years after a car accident, which led to a soft tissue defect with exposed bone in the middle third of his left leg. In the second case, a 25-year-old male involved in a traffic accident presented with a displaced open bone fracture of the middle third of the tibia and fibula with bone sequestrum. Surgical technique, advantages, patient selection criteria, and outcomes are discussed, highlighting the significance of the medial hemisoleus flap in addressing these challenging wounds.

Analysis of oral radiographic images in patients with osteomyelitis accompanied by systemic sickle cell anemia

Infections in the jawbone present many complications to both doctors and patients. One systemic factor that increases the risk of disorders in the oral cavity is sickle cell anemia (SCA). Patients with SCA also have an increased risk of orthopedic mani-festations such as osteomyelitis. Osteomyelitis features vary in their radiographic appearance, which can be panoramic, peri-apical, and occlusal, or additional modalities. This article reviews the radiographs of osteomyelitis in the oral cavity with risk fac-tors such as SCA, using the literature review method. The step is to collect information from several sources from the literature. It was found that panoramic, periapical, and computed tomography (CT) radiographs are the most commonly used radiographs and are able to describe the characteristics of osteomyelitis in SCA patients specifically. It was concluded that the typical pic-ture of CT examination type is associated bone sequestra which is a typical picture of osteomyelitis with SCA. While on pa-noramic and periapical radiographs a diffuse radiolucent picture and bone resorption are found and other radiographic feat-ures can be found in the form of small radiopaque areas and bone infarcts around the apex of the associated teeth.

Chronic Bi-Maxillary Osteomyelitis Caused by Actinomycetes in a Patient with Severe COVID-19

Osteomyelitis is defined as the inflammation of the either medullary, cortical, or cancellous bone, including nerves and blood vessels, causing necrosis and bone sequestrum formation; this condition has become a rare pathology, and odontogenic infections are considered the most frequent causal factor. This case shows a patient with bi-maxillary osteomyelitis caused by Actinomyces spp, which was worsened for severe COVID-19 infection. Patient was submitted at surgery as, amplified total bilateral maxillectomy through the surgical technique Weber-Fergusson, and prolonged use of combination of antibiotics, achieved a good recovery. Two years later follow-up, the patient no show imaging or clinical evidence of the infection of osteomyelitis. The present case shows an interesting relationship between a rare infection and its association with COVID-19.

Panoramic Radiography Features of Medication-Related Osteonecrosis of the Jaws (MRONJ)

The diagnosis of medication-related osteonecrosis of the jaws (MRONJ) relies on the application of the clinical criteria stated in the American Association of Oral and Maxillofacial Surgeons position paper. The role of diagnostic imaging in integrating MRONJ clinical assessment is still debated, as pathognomonic imaging features have not been yet recognized. The present study retrospectively evaluated the radiographic signs of MRONJ on panoramic radiography with the aim of describing the characteristics of the lesions at different stages of the disease. The presence of alterations of the lamina dura (thickening or loss), the persistence of the alveolar socket following tooth extraction, and bone alterations (including sequestrum, sclerosis, osteolysis, mandibular canal enhancement, pathologic fracture, sinus involvement, and periosteal reaction) were investigated. The occurrence of each radiographic sign was stratified depending on oral status, antiresorptive pharmacological treatment administered, and general health variables. A weak relationship between radiographic signs and disease stage was observed. Mandibular canal enhancement was associated with the advanced disease stage (p-value < 0.001). The distribution of the different radiographic features was not influenced by the underlying disease (osteoporosis or oncologic disease) treated with antiresorptive drugs. Bone sequestrum was more frequently encountered in the mandible. Panoramic radiography appears to be a valid support in the assessment of MRONJ lesions. The clinician should be aware of the signs associated with MRONJ occurrence in order to improve the diagnostic performance and provide adequate treatment.

Comparison of the effectiveness of 5-Fluorouracil and modified Carnoy's solution in reducing the recurrence of odontogenic keratocyst.

Odontogenic keratocysts (OKC) has a high potential for recurrence. Resection is currently the only fool-proof method to ensure that recurrence does not occur; however, it drastically affects the patient's function and aesthetics. Application of modified Carnoy's solution (MCS) as an adjunct to reduce the recurrence rate is currently in vogue. 5- Flurouracil (5-FU) is an anti-metabolite that has been used in the treatment of basal cell carcinoma and is relatively safer than MCS. The present study aims to compare the effectiveness of 5-UC and MCS in reducing the recurrence rate in OKC.. A total of 42 OKCs were enucleated followed by application of MCS (control group, n=21) or 5-FU dressing (study group, n=21) following enucleation. Pain, swelling, temporary and permanent paresthesia paresthesia, bone sequestrum formation, osteomyelitis and recurrence in both groups were evaluated at periodic intervals up to 12 months post-surgery. There was no significant difference in terms of pain, or swelling in both groups. Permanent paresthesia and recurrence rates were higher in patients treated with MC but the difference was not statistically significant. 5-FU is an easy-to-use, feasible, biocompatible and cost-effective alternative for MCS in the management of OKCs. Treatment with 5-FU, therefore, reduces the risk of recurrence and also the post-surgical morbidity associated with other treatment procedures.

Positron Emission Tomography-Computed Tomography and Magnetic Resonance Imaging Assessments in a Mouse Model of Implant-Related Bone and Joint Staphylococcus aureus Infection.

Osteomyelitis is an infection of the bone, associated with an inflammatory process. Imaging plays an important role in establishing the diagnosis and the most appropriate patient management. However, data are lacking regarding the use of preclinical molecular imaging techniques to assess osteomyelitis progression in experimental models. This study aimed to compare structural and molecular imaging to assess disease progression in a mouse model of implant-related bone and joint infections caused by Staphylococcus aureus. In SWISS mice, the right femur was implanted with a resorbable filament impregnated with S. aureus (infected group, n = 10) or sterile culture medium (uninfected group, n = 6). Eight animals (5 infected, 3 uninfected) were analyzed with magnetic resonance imaging (MRI) at 1, 2, and 3 weeks postintervention, and 8 mice were analyzed with [18F]fluorodeoxyglucose (FDG)-positron emission tomography (PET)-computed tomography (CT) at 48 h and at 1, 2, and 3 weeks postintervention. In infected animals, CT showed bone lesion progression, mainly in the distal epiphysis, although some uninfected animals presented evident bone sequestra at 3 weeks. MRI showed a lesion in the articular area that persisted for 3 weeks in infected animals. This lesion was smaller and less evident in the uninfected group. At 48 h postintervention, FDG-PET showed higher joint uptake in the infected group than in the uninfected group (P = 0.025). Over time, the difference between groups increased. These results indicate that FDG-PET imaging was much more sensitive than MRI and CT for differentiating between infection and inflammation at early stages. FDG-PET clearly distinguished between infection and postsurgical bone healing (in uninfected animals) from 48 h to 3 weeks after implantation. IMPORTANCE Our results encourage future investigations on the utility of the model for testing different therapeutic procedures for osteomyelitis.

Intrinsic antibacterial and osteoinductive sterosomes promote infected bone healing

Open fractures and internal fixation implants are often accompanied by bacterial infection, leading to osteomyelitis, characterized by intractable bone infection and sequestrum formation, and can result in lifelong disability or fatal sepsis. As common clinical treatment strategies, high-dose antibiotic application and autologous bone transplantation face the risk of recurrence and donor site injury. Herein, we designed and prepared a novel drug delivery system by rational selection of the antibacterial single-chain amphiphile (cetylpyridinium chloride, CPC) and osteoinductive sterol (20S-hydroxycholesterol, Oxy) to formulate CPC/Oxy sterosomes. We demonstrate their excellent biocompatibility and antibacterial ability through 2D and 3D settings in vitro. In addition, the osteogenic differentiation of bone marrow mesenchymal stem cells was investigated in cell monolayers and a hydrogel environment. Moreover, a rat infected critical-sized calvarial defect model was employed to illustrate the effects of antibacterial and osteogenic CPC/Oxy sterosomes in vivo. Our results showed that CPC/Oxy sterosomes not only exterminated bacterial infections, but also enhanced calvarial healing without additional antibiotics, bone formation promoters or exogenous cells. This research provides a promising and effective multifunctional sterosomal platform for the treatment of infected bone defects, with the potential to be combined with therapeutic genes, and small molecule drugs.

Comparison of the histopathological characteristics of diffuse sclerosing osteomyelitis of the mandible, chronic suppurative osteomyelitis, and craniofacial fibrous dysplasia.

There are relatively few reports on the histopathological characteristics of diffuse sclerosing osteomyelitis of the mandible (DSOM), which is difficult to distinguish from chronic suppurative osteomyelitis (CSO) and craniofacial fibrous dysplasia (CFD). This study aimed to summarize and compare the histopathological characteristics of DSOM, CFD, and CSO. In this study, hematoxylin and eosin-stained sections of patients with DSOM, CSO, and CFD at the Peking University Hospital of Stomatology from 2015 to 2020 were retrieved. The histopathological characteristics were summarized, including new bone formation, inflammatory cell infiltration, bone trabecular morphology, osteoclasts, sequestrum, bacterial mass, and calcified spherules, similar to cementicles. The histopathological characteristics of DSOM, CSO, and CFD were compared, and the results were statistically analyzed. In total, 50, 13, and 10 patients with DSOM, CSO, and CFD were included in this study, respectively. In terms of new bone formation, both DSOM and CSO showed reactive bone formation (p=1), whereas CFD mainly showed fiber osteogenesis (p < 0.001). The inflammatory cells of DSOM were mainly lymphocytes and plasma cells, whereas those of CSO were mainly lymphocytes and neutrophils (p < 0.001), and there was usually no inflammatory cell infiltration in the CFD specimens (p < 0.001). DSOM, CSO, and CFD showed irregular bone trabeculae (p=0.045, p=0.703) and active osteoclasts (p1=0.189, p2=0.256). DSOM showed a small amount of bacterial mass but no sequestrum; neither of which was found in CFD (p=1, p=1), but it was common in CSO (p=0.011 and p=0.025). DSOM and CSO showed smooth and regular basophilic lines (p=0.308), whereas CFD showed a rough and irregular basophilic line (p < 0.001). The histopathological characteristics of the three diseases were partly similar, but there were evident differences. The main differences are the type of new bone formation, types and distribution of inflammatory cells, and presence of sequestrum and bacterial masses. These differences will help clinicians diagnose DSOM.

Paleopathology of the skull of Santorio Santorio, father of modern clinical experimental physiology.

The University of Padua (Italy) preserves the skull of Santorio Santorio, father of the modern clinical experimental physiology. A recent study performed with modern anthropological methods and medical instruments (CT scan) revealed the presence of a lobular formation in the left temporal bone, with an irregular morphology, internal bone sequestrum, a well-defined non-continuous sclerosis and both internal and external thinning of the cranial plate. Three oval depressions observed in the cranial vault, edentulism and moderate osteoarthritis of the temporomandibular joint were also investigated. The lobular formation was an epidermoid cyst and the oval depressions were the result of other cysts. The edentulism was consistent with some metabolic deficiency or disease, whilst the osteoarthritis appeared to be the result of antemortem tooth loss. This study allowed to investigate a complex and peculiar palaeopathological picture, linked to a piece of the history of the University of Padua.

Successful Implant Placement into a Site with Two Previous Failures: A Clinical and Histologic Case Report.

Implants present a predictable fixed option for patients who require tooth extraction. However, complications such as implant failure reduce the success of replacement implant restorations. A patient presented to the Department of Periodontology and Implant Dentistry (New York University College of Dentistry) with pain related to a broken implant-supported prosthesis. Two failed implants were removed, and new implants were placed. After restoration delivery, the patient reported soreness on the implant at site 35 (FDI tooth-numbering system), which was then removed (along with a sequestrum of bone) and sent for biopsy. A new implant was placed and restored successfully at the 1-year follow-up. The purpose of this case report is to demonstrate that with proper planning, surgery, and restoration, a new implant can be successfully placed and restored on a site with two previous failures. Int J Periodontics Restorative Dent 2023;43:167-172. doi: 10.11607/prd.5410.

Nerve stimulation‐guided femoral and sciatic blocks in an alpaca (Vicugna pacos) for the removal of a sequestrum from the distal femur

AbstractA 2‐year‐old female intact huacaya alpaca weighing 66.6 kg presented for the removal of a bone sequestrum from the distal femur. Nerve stimulator‐guided femoral and sciatic nerve blocks were applied to provide analgesia for distal femoral surgery. The blocks were simple to perform using existing equipment and current techniques translated from small animals. The techniques reported here for both femoral and sciatic nerve blocks in an alpaca can be used as an alternative to an ultrasound‐guided approach, especially in field situations where additional expensive equipment may not be available or desirable.

English

Distal femur fractures are about 7 % of all femur fractures.1 Being complex in nature management of these fractures is difficult; management is still a challenge in this technically advanced era. Fibular strut graft is one of the useful and simple options to manage defects in distal femur fractures. High velocity injuries causing open fractures may lead to infection and non-union of fracture if proper debridement and antibiotics are not used as per established protocol. Antibiotics can be given mixed with polymethyl-methacrylate (PMMA) cement formed in beads at the open fracture site or coated over a nail.2 This causes slow release of antibiotics and helps in control of infection. Local infection, damaged soft tissue, ischemia over fracture site, stabilisation of fracture, the hardware used and patient’s co morbidities all play a role in union and infection control of open fractures. Early detection of infection is important to avoid non-union and related complications. Distal femur juxta-articular fracture may develop infection due to fractures and unstable fixation more commonly. This may result in cavity formation and complications like osteomyelitis often leading to bone destruction and sequestrum formation. Its management becomes a challenging task for an orthopaedic surgeon.3- 9 The reconstructive methods are autogenous cortical bone, cancellous bone, allograft, bone substitutes like synthetic bone blocks and bone granules. Free bone transfer is crucial in reconstructing massive defects in distal femur fracture due to properties of rapid healing and being hypertrophic.7-13 Fibula is the best available option for grafting in massive defects of femur due to its characteristics like mechanical strength, length, minimum morbidity, and resistance to infection.3,11,13 A single fibula strut graft can give up to 26 cm of graft. The case reported here is of a patient of juxta-articular bone defect in an infected previously operated fracture distal femur using autologous fibular strut and iliac crest graft

Implant-associated osteomyelitis: Development, characterisation, and application of a porcine model.

Implant-associated osteomyelitis: Development, characterisation, and application of a porcine model.