Transcriptome and alternative splicing analyses uncover immune-centric pathogenesis in periodontitis versus barrier-dysfunction-driven pathogenesis in peri-implantitis.

Maxillofacial ballistic injuries: A 13-year single-institution experience.

Single-stage knee revision arthroplasty under special consideration of bony defects and soft tissue laxity over the full arc of motion. Aseptic loosening, ligamentous instability, or outlier in implant position requiring single-stage knee revision arthroplasty. Cases with severe bone loss or ligamentous instability requiring ahinged prosthesis. Loss of knee extensor function. After establishment of astandardized median parapatellar approach and setup of the imageless robotic system, the implant is mapped while still in situ. The bone-implant interface is highlighted in the 3D reconstruction of the implant by the application of special points during mapping. Soft tissue balance is registered and the component position of the revision implant is determined in the virtual implant planning stage. The implant is then removed and the surgical plan is executed with the robotic bur. If necessary, augments can be used to account for excessive bone loss and reconstruct the native joint line. Full weight-bearing as tolerated, free range of motion. In the literature, robotic-assisted knee revision arthroplasty has mainly been described in the form of case reports and smaller case series; the authors report generally favorable results.

Rescuing Prdx1-Deficiency-Mediated Redox Homeostasis Disruption in Bone Marrow Mesenchymal Stem Cells Ameliorate Radiation-Induced Bone Loss.

Surgical Options for the Management of Severe Glenoid Structural Deficiencies in the Setting of Revision Reverse Shoulder Arthroplasty: A Systematic Review.

Alveolar bone resorption is typically associated with aging or chronic inflammation, while flavonols intake is known for its extensive anti-aging and anti-inflammatory properties. However, the relationship between them remains unclear. This study aimed to examine the association between dietary flavonol intake and alveolar bone loss. Using 2009-2010 NHANES data, this cross-sectional study analyzed 2-day dietary recalls of flavonols (isorhamnetin, quercetin, and kaempferol) and alveolar bone loss-defined as teeth with bone loss exceeding 5 mm. Analyses included descriptive statistics, multivariable logistic regression, smooth curve fitting, and threshold analysis, all adjusted for confounders. Among 1616 participants, severe alveolar bone loss was more common in older males and associated with lower quercetin or isorhamnetin intake and lower education levels. Quercetin and isorhamnetin consistently showed an inverse relationship with severe bone loss across regression and subgroup analyses. Kaempferol intake exhibited a U-shaped association with alveolar bone loss, which was more pronounced in males. Higher intake of isorhamnetin or quercetin was associated with lower levels of alveolar bone loss, whereas the association for kaempferol was more complex and requires consideration of intake dose.

Full-arch rehabilitation with additively manufactured subperiosteal implants in Papillon-Lefèvre syndrome: A case report.

To evaluate the incidence of surgical complications, particularly periprosthetic fractures, following femoral impaction bone grafting (fIBG) in revision total hip arthroplasty (rTHA). This systematic review followed PRISMA guidelines. Studies reporting on fIBG in rTHA with a minimum follow-up of 12months were included. Risk of bias was assessed using the Methodological Index for Non-Randomised Studies (MINORS). A random-effects meta-analysis with inverse-variance weighting was performed. Heterogeneity was assessed using Higgins and Thompson's I2 statistic and Cochran's Q test. Subgroup analyses were conducted based on patient characteristics, revision indication, follow-up period, bone loss severity, stem length, and cementation. Complications requiring intervention, as well as nerve lesions with partial or no recovery, were classified as major. Forty-five studies including 4,686 hips (4,409 patients) were analyzed. The pooled incidence of major complications was 21% (n = 730; 95% CI 16-26%; I2 = 89%, p < 0.01). Of these, 78% required surgical intervention. The most common major complications were intraoperative fractures (22.7%), postoperative fractures (19.3%), and instability (19.2%). Higher complication rates were reported with long stems (44.1%) compared with short stems (18.8%, p = 0.016) and in cases of severe bone loss (Endo-Klinik grades III/IV, 25.3%) compared with I/II (14.2%, p = 0.028). Major complications following fIBG in rTHA are relatively frequent, although interpretation is limited by substantial study heterogeneity. Higher complication rates were observed in cases with severe bone loss and the use of long stems, likely reflecting greater surgical complexity.

To compare the long-term survival of dental implants placed in sites with a documented pre-operative history of severe tooth mobility or advanced furcation involvement against a matched control group. This retrospective cohort study analyzed patient records from a multi-university network. Implants were categorized based on the pre-extraction site history: Mobility Class (M2), Mobility Class (M3), Furcation Grade (G3), Furcation Grade (G4), and a control group. A 1:4 propensity score matching (PSM) was performed to balance baseline covariates (age, sex, smoking, diabetes, implant arch). After PSM, a balanced cohort of 3925 implants (785 risk implants, 3140 control implants) was analyzed. The 10-year survival probability for the matched control group was 98.9%. All risk groups demonstrated significantly lower survival, with M2 at 94.6% and G4 at 95.5%. The adjusted multilevel Cox model confirmed a significantly higher risk of failure for all exposure groups. The adjusted hazard ratio was 2.3 for M2 (95% CI: 1.2-4.4), 3.8 for M3 (95% CI: 1.9-7.5), 3.0 for G3 (95% CI: 1.4-6.5), and 4.5 for G4 (95% CI: 2.1-9.8), compared to the matched controls (all p < 0.01). A pre-extraction history of severe tooth mobility or advanced furcation involvement at an implant site is significantly associated with long-term implant failure. Rather than being independent biological causes, these clinical signs likely serve as historical markers for severe localized bone loss and heightened periodontitis susceptibility and should be carefully considered during risk assessment and treatment planning.

AimsThree-phase bone scintigraphy (TPBS) is a simple, reliable, and straightforward imaging modality for diagnosing periprosthetic joint infection (PJI). This study aimed to evaluate the diagnostic efficacy of the combined diagnostic method of TPBS and CRP in the detection of PJI.MethodsA retrospective analysis was performed on 317 patients undergoing revision surgery (211 hips and 106 knees) between January 2017 and January 2024, with TPBS obtained prior to surgical intervention. PJI was diagnosed according to the 2013 Musculoskeletal Infection Society (MSIS) criteria. The diagnostic performance of TPBS, CRP, and TPBS-CRP combined method was evaluated.ResultsIn the total knee arthroplasty (TKA) cohort, TPBS-CRP achieved maximal sensitivity (100%) and negative predictive value (100%), enabling definitive exclusion of PJI, albeit with reduced specificity (50.0%). Antibiotic therapy significantly reduced CRP accuracy (79.1% vs 97.1%, p = 0.020) but minimally impacted TPBS (100% vs 88.6%, p = 0.037). For total hip arthroplasty (THA), the TPBS-CRP demonstrated a superior diagnostic efficacy (AUC = 0.846, 0.834, and 0.795) and demonstrated a more balanced sensitivity (81.6%, 67.3%, and 64.3%) and specificity (87.6%, 91.2%, and 94.7%) compared to CRP and TPBS. Antibiotic-treated patients exhibited significantly higher diagnostic accuracy for TPBS (81.5% vs 57.7%, p = 0.028), CRP (88.9% vs 59.2%, p = 0.005), and TPBS-CRP (96.3% vs 76.1%, p = 0.020) compared to untreated patients. False-positive TPBS cases in both cohorts exhibited severe bone loss and prolonged symptoms compared to true negatives (p < 0.05).ConclusionTPBS demonstrates limited specificity in differentiating PJI from aseptic loosening. The TPBS-CRP synergizes localized bone metabolic profiles with systemic inflammatory biomarkers, achieving superior diagnostic accuracy. Caution is warranted in patients with severe bone loss and prolonged symptoms.Cite this article: Bone Joint Res 2026;15(4):354–362.

The Presence of Osteonecrosis in Patients Who Have Systemic Lupus Erythematosus Undergoing Total Knee Arthroplasty Is Not Associated With Worse Outcomes.

Anatomic Mapping of the Inferior Branch of the Superior Gluteal Nerve: Implications for Revision Total Hip Arthroplasty.

Revision total hip arthroplasty (THA) in the presence of severe acetabular bone loss remains technically demanding. Oversized, highly porous acetabular components ("Mega Cups") have been introduced to maximize host bone contact, enhance biological fixation, and restore the anatomical hip center. A retrospective study was conducted between 2014 and 2022, including 34 hips reconstructed with highly porous Mega Cups for Paprosky type II and selected type III defects. Clinical outcomes (Harris Hip Score [HHS], WOMAC, pain VAS), radiographic stability, complications, and implant survivorship were analyzed at mid-term follow-up. At a mean follow-up of 5.3 years, Mega Cups demonstrated 95.5% survivorship. Radiographic stability was achieved in 90.9% of hips, with graft incorporation observed in 88.9%. Functional recovery was substantial: HHS improved by +34.4 points, WOMAC decreased by -37.8, and pain VAS declined by -4.8 (all p < 0.001 vs.baseline). Subgroup analysis confirmed excellent outcomes in Paprosky II defects and in patients aged 40-65 years. Complication rates were low, with dislocation (2.9%), mechanical failure (2.9%), superficial infection (8.6%), and thromboembolism (2.9%) within published benchmarks. Highly porous oversized acetabular cups provide reliable fixation, durable mid term survivorship, and superior functional improvement in revision THA for Paprosky II and selected III defects. Their ability to maximize host bone contact and reduce reliance on grafts makes them a dependable option in complex acetabular reconstructions. Longer multicenter studies are warranted to validate durability beyond 10 years and to benchmark outcomes against alternative strategies.

Current treatment options for severe glenoid bone loss in revision shoulder arthroplasty: a systematic review and meta-analysis.

The global demand for primary total hip arthroplasty (THA) and the corresponding demand for revision THA continue to rise. Revision THA in the face of severe acetabular bone loss is challenging, and the custom triflange acetabular component (CTAC) has emerged as a valuable option for the arthroplasty surgeon. Furthermore, dual mobility liners have been advocated as a promising strategy to reduce the risk of dislocation, a common complication in revision THA. This retrospective study of prospectively collected data comprised 15 consecutive patients who underwent revision THA with 3D-printed CTACs and dual mobility liners between January 2020 and March 2023. All patients had either Paprosky type 3B defects or pelvic discontinuity. Functional outcomes were evaluated using the modified Harris Hip Score (mHHS) and pain via the Visual Analogue Scale (VAS). Implant survival and complications are reported. At a mean follow-up of 40 months, mean mHHS improved from 30.46 to 83.90 (p < 0.001), and VAS pain scores decreased from 7.0 to 1.9 (p < 0.001). All patients reported favourable outcomes, and no case was complicated by infection, implant loosening, component failure, or revision. Radiographs showed lateralisation of the centre of rotation by about 1 cm in one patient and Brooker class 1 heterotopic ossification in another. However, all patients demonstrated radiographically stable constructs with good osseointegration at final follow-up. Complications included 2 dislocations and 2 transient sciatic nerve palsies (13.3% each). The dislocations were addressed by closed reduction. The CTAC is a powerful tool for managing extensive acetabular bone loss in revision THA. Our findings demonstrate promising outcomes with significant functional improvement, pain reduction, and implant stability.

Post-traumatic osteoarticular bone loss of the knee remains challenging to treat. Allograft reconstruction can yield favourable outcomes, and 3D virtual surgical planning may further improve results by enabling precise templating, optimal graft selection, and accurate fixation. This study aimed to introduce and evaluate 3D-assisted planning for knee allograft reconstruction. In two patients with severe post-traumatic knee osteoarticular bone loss—one in the medial distal femur and one in the proximal tibial plateau—3D-assisted resection and allograft reconstruction were performed. An allograft was matched to the affected condyle, after which cutting planes were defined and patient-specific guides were designed. Postoperative CT-scans were obtained to assess accuracy, and patient-reported outcomes were evaluated with the Lower Extremity Functional scale(LEFS) questionnaire. Both surgical procedures went uneventful. In the lateral plateau case, 3D analysis of the postoperative CT scan showed a maximum translational deviation from the plan of 2.2 mm and a maximum rotational deviation of 3.2°. In the medial distal femur case, postoperative 3D assessment revealed a maximum translational deviation of 2.5 mm and a maximum rotational error of 3.5°. Functional outcomes (> 1 year postop) were favourable, with LEFS scores improving from 29/100 to 78/100 in the lateral plateau case and from 22/100 to 81/100 in the medial distal femur case. In conclusion, this technical note demonstrates the feasibility and accuracy of 3D-assisted planning for knee allograft reconstruction. The approach enables precise allograft placement and anatomical restoration.

The aim of this study was to evaluate trabecular bone structure in periodontal disease using fractal dimension (FD) and lacunarity analysis (LA) in cone-beam computed tomography (CBCT). A total of 120 CBCT images from the archives of our college were collected after applying inclusion and exclusion criteria. Regions of interest were preprocessed and subjected to fractal analysis and LA using the ImageJ software and statistical comparisons were performed between healthy individuals and periodontitis patients. Lacunarity values were significantly greater (p &lt; 0.001) and FD values were significantly lower in patients with periodontitis than in healthy controls. Differences by gender were noted, with larger lacunarity values seen in females in the periodontitis group. In cases of periodontitis, FD and lacunarity were found to be inversely correlated by Kendall's tau correlation. Increased heterogeneity and decreased trabecular bone complexity are linked to periodontitis. Even before severe bone loss is radiographically apparent, FD and LA on CBCT images can identify modest trabecular alterations. In the context of periodontal care, these measures can be sensitive supplementary instruments for early diagnosis, disease surveillance, and treatment planning.

Alveolar bone loss associated with periodontitis is a common dental problem. Surgical debridement combined with the prevention of epithelial overgrowth by placing a ‘barrier membrane’ allows for bone regrowth. In cases of severe alveolar bone loss, grafting with a bioactive material is preferred alongside the barrier membrane. Various synthetic bone graft materials are currently in use. A calcium sulfate cement composition enriched with phosphate ions, developed for periodontal repair and designated by the acronym “CASPA,” has been designed. This self-setting, moldable, and biocompatible cement showed promising responses in previous in vitro studies. This report presents the preclinical evaluation of CASPA cement. Initially, the response of human periodontal ligament cells to this formulation was assessed through a direct contact cytotoxicity test and MTT assay in comparison with conventional calcium sulfate (gypsum-based) cement. Cell viability, adhesion, and morphology were also tested. The osteogenic induction potential of the cements was investigated through staining (Alizarin red and Von Kossa) and osteogenic marker expression. The periodontal defect healing potential of CASPA cement was evaluated in a rat maxillary alveolar bone defect model in comparison with conventional gypsum material. The newly developed bioactive calcium sulfate cement (CASPA) exhibited improved biological properties compared to conventional calcium sulfate (gypsum) cement. Biocompatibility was excellent both in vitro and in vivo in rats. CASPA showed a slower resorption rate that was on par with the rate of bone formation, ensuring site stability and complete defect healing. In clinical use, the conformal filling of the cement obviates the need for a barrier membrane. CASPA acts as a ‘barrier-graft’ and leads to better bone regeneration than conventional calcium sulfate.

Infected bone defects pose a major clinical challenge because they typically involve severe infection, poor vascularization, and bone loss. Existing implant materials lack integrated functionality for long-term infection control and tissue regeneration. Here, a multifunctional nanozyme platform consisting of a 3D-printed titanium scaffold functionalized with an iron sulfide multiactivity nanozyme (ISMNzyme)-modified hydrogel is introduced. The platform leverages synergistic peroxidase-like, myeloperoxidase-like, and glutathione peroxidase (GSH-Px)-like activities, alongside the controlled release of Fe2+ and polysulfides. This dual mechanism induces ferroptosis-like bacterial death while concurrently promoting angiogenesis and osteogenesis. The platform represents a promising nanozyme-based strategy for the treatment of infected bone defects.

The aim of this study was to determine if an intraoral resin splint that is secured to the mandible with cerclage wires, a cerclage intraoral resin splint (CIRS), is a viable, minimally invasive option for mandibular body fracture repair in dogs. A medical record search identified 16 dogs with fractures as a result of periodontal disease, endodontic disease, head trauma, or a combination of these causes, and CIRS was performed in partially or completely edentulous areas of the mid or caudal mandibular body. At the time of appliance removal, the fracture sites of 13 dogs had healed with a bony union. Two dogs showed a fibrous union, and 1 dog revealed a nonunion. This study demonstrated that CIRS is a minimally invasive treatment option for repair of mid and caudal mandibular body fractures in dogs, even among patients with severe bone loss secondary to periodontal disease.