Soft Tissue Reactions Research Articles

Midterm outcomes of total hip arthroplasty with a modular Birmingham head.

Birmingham Hip Resurfacing (BHR) implants may be combined with a conventional femoral stem to create a modular metal-on-metal total hip arthroplasty (BHR MoM THA). There is little outcome data regarding this construct. This study examines midterm outcomes of BHR MoM THA compared to oxidised zirconium total hip arthroplasty (THA). A retrospective institutional review identified all patients receiving BHR MoM THA between April 2005 and February 2011 and a matched control cohort of zirconium THA patients. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS), and SF-12 Health status scores were obtained. Revisions and complications were collected from clinical records. Radiographs were assessed for evidence of component malposition, loosening, osteolysis, or heterotopic ossification. 63 modular BHR MoM THA were identified in 61 patients (36 with BHR cups, 27 with R3 cups) and 63 zirconium THA in 58 matched controls. Mean follow-up was 58 months. 14 BHR MoM THA hips (22.2%) were revised (4 infections, 1 dislocation, 9 soft tissue reactions) compared to 3 (4.8%) zirconium THA (all infections). At latest follow-up, 18.4% of surviving BHR MoM THA hips were painful compared to 0.5% of zirconium THA controls (p < 0.001). WOMAC, HHS, and SF-12 did not differ significantly between surviving members of the 2 groups. BHR MoM THA demonstrated a high revision rate, largely for adverse local soft tissue reaction and pain. Among those not revised, many reported some residual pain despite similar quality of life measures to those who received zirconium THA.

Osseointegrated implant supported prostheses in the rehabilitation of severe orbital deformity in 6 cases

Objective: To assess the effectiveness of osseointegrated implant supported prostheses in the rehabilitation of severe orbital deformity. Methods: Retrospective case series. The study collected 6 patients (6 eyes) with severe orbital deformity, who were treated with osseointegrated implant supported prostheses between 2010 and 2016 in Beijing Tongren Eye Center, Beijing Tongren Hospital. Data included demographic characteristics, causes of the deformity, the history of radiotherapy, the site, number and survival of implants, and the ability to wear prostheses. Results: Among the 6 patients, 4 were males, and 2 were females, with a mean age of 27 (16-44) years. The deformity resulted from evisceration or enucleation and radiotherapy for malignancies in 4 patients, from evisceration because of inflammatory pseudotumor in 1 patient, and from enucleation and debridement because of explosion injury and secondary infection in 1 patient. Each patient received 3 implants at the first operation. A total of 18 implants were installed, including 9 placed into the lateral aspect of the supraorbital rim, 6 into the lateral aspect of the infraorbital rim, 1 into the medial aspect of the supraorbital rim, and 2 into the medial aspect of the infraorbital rim. One superior lateral implant failed half a year after implantation, and an additional implant was implanted into the medial aspect of the inferior medial orbital rim for prostheses retention. All the patients were followed up for more than 2 years. No other failures were observed. The soft tissue reaction was acceptable in all patients. All of them were able to wear prostheses with satisfying appearance. Conclusions: Osseointegrated implants provid excellent retention for orbital prostheses. This technique could be used in patients with severe orbital deformity to improve their life quality. (Chin J Ophthalmol, 2019, 55: 665-669).

Creating an antibacterial surface on beta TNZT alloys for hip implant applications by laser nitriding

The National Joint Registry reported that the main causes for hip implant revision surgery include aseptic loosening, infection and adverse soft tissue reaction to particulate debris. There is a great need to improve the implant properties which can be achieved through a combined solution of beta titanium alloy (TNZT) with low elastic modulus and laser surface nitriding to improve mechanical properties and biological response. While titanium nitride (TiN) possesses good biocompatibility and remarkable antibacterial properties; its effectiveness as a coating on Ti-35Nb-7Zr-6Ta has not been investigated in relation to stem cell response and antibacterial capability. TNZT surfaces were laser-nitrided in incremental laser power, specifically 35, 40 and 45 W. Investigation included surface roughness and topography in microscale (WLI and SEM), microstructure (XRD) and wettability (water contact angle). Biological studies of the laser-nitrided surfaces included in vitro culture for 24 h using mesenchymal stem cell (MSC) fluorescence staining and Staphylococcus aureus (S. aureus) Live/Dead staining. Sample groups consisted of control base metal (BM), laser-nitrided at 35 W (LT35), 40 W (LT40) and 45 W (LT45). Results revealed that laser nitriding generates significantly rougher surfaces (Ra value of BM was 199.3 nm, LT35 was 722.8 nm, LT40 was 458.4 nm and LT45 was 1180.2 nm) with distinctive surface features (Rsk < 0 and Rku > 3). Surfaces after laser nitriding, regardless of laser power, can be tailored to become hydrophilic (27.1–34.2°). Fibre laser nitriding can be used to create antibacterial surface patterns on TNZT in a high power regime. A laser power of 45 W proved to be the most effective in this study, creating an overlapping crescent shape which becomes more obvious with increasing power. To summarise, laser-nitrided surfaces led to a significant antibacterial effect but offered no particular advantage to MSC response.

Long-term soft tissue outcomes for hydroxyapatite-coated bone-anchored hearing implant surgery.

To investigate skin-related postoperative outcomes following a tissue preservation technique in percutaneous hydroxyapatite-coated bone-anchored hearing aid (BAHA) abutment implantation. A retrospective medical records review of adult patients, who underwent single-stage BAHA implantation between July 2013 and November 2017 at a tertiary centre was conducted. Surgical procedures were performed by a single surgeon using a linear incision soft tissue preservation technique. Patients were reviewed at 1week, 4weeks, 3months, 6months, and annually postoperatively and soft tissue reactions were graded using Holger's score RESULTS: There were 102 patients included with a slight female preponderance (female:male 56:46). There were 586 follow-up episodes during the study period. From the recorded follow-up episodes, Holger's scores were documented as follows: Holger score 0 (89%); 1 (7%); 2 (2%); 3 (1.9%). Three patients (3%) required peri-abutment soft tissue excision (Holger 3) and insertion of longer abutments. One patient (1%) reported atraumatic implant loss. The BAHA was re-implanted in two patients (2%) due to traumatic dislodgement. There was a statistically significant association (p = 0.009) when the mean time to minor skin complications was compared with mean time to a significant skin reaction. Tissue preservation technique is the procedure of choice for BAHA abutment implant surgery. It confers excellent soft tissue outcomes and an excellent implant survival rate.

Radiographic evaluation of hip resurfacing: the role of x-rays in the diagnosis of a problematic resurfaced hip.

Hip resurfacing (HRA) requires a new standardised radiographic evaluation protocol. Evaluation of acetabular components is similar to total hip arthroplasty (THA) but femoral components require different criteria. This study evaluates the efficacy of a new femoral zonal system for radiographic HRA assessment in identifying clinical problems. A new proximal femoral zonal system divides implant-cement-bone interfaces at head and neck into 7 DeSmet zones. 611 in situ and 100 revised HRA were assessed for component positioning, borderline findings (reactive lines, cortical thickening, cancellous condensation) or sinister findings (lucent lines, bone resorption, osteolysis). Findings were correlated with gender, size, implant survival, clinical scores, metal ions, and adverse soft tissue reactions (ALTR). Radiological changes were found in 265 hips (37.3%), 154 sinister (21.7%) and 111 borderline (15.6%). 84% of revisions had sinister findings versus 11.4% of in situ HRA (p < 0.001). The mean number of abnormal acetabular and femoral zones was 3.3 in revised compared to 0.6 in situ HRA (p < 0.001). Sinister findings were associated with female gender, lower clinical scores, smaller sizes or ASR design (all: p < 0.001). Metal ions were higher with sinister (p < 0.001) and borderline (p < 0.01) findings compared to normal radiographs. Pathological findings in ⩾4 zones had a sensitivity of 50% and specificity of 94.2% (AUC = 0.898) in detecting hips with ALTR (odds ratio = 49). In order to accurately evaluate progressive radiographic changes in HRA, specific zones have been established around the femoral component. There was a high correlation between radiographic findings and outcome measures. 84% of problematic hips and 90.4% of proven ALTR had sinister changes.

Aseptic Ligatures Induce Marginal Peri-Implant Bone Loss-An 8-Week Trial in Rabbits.

The clinical value of ligature-induced experimental peri-implantitis studies has been questioned due to the artificial nature of the model. Despite repeated claims that ligatures of silk, cotton and other materials may not induce bone resorption by themselves; a recent review showed that the tissue reaction toward them has not been investigated. Hence, the current study aimed to explore the hard and soft tissue reactions toward commonly used ligature materials. A total of 60 dental implants were inserted into the femur (n = 20) and tibia (n = 40) of 10 rabbits. The femoral implants were ligated with sterile 3-0 braided silk in one leg and sterile cotton retraction chord in the other leg. The tibial implants were ligated with silk or left as non-ligated controls. All wounds were closed in layers. After a healing time of 8 weeks, femoral (silk versus cotton) and proximal tibial (silk versus non-ligated control) implants were investigated histologically. Distal tibial (silk versus non-ligated control) implants were investigated with real time polymerase chain reaction (qPCR). The distance from the implant-top to first bone contact point was longer for silk ligated implants compared to non-ligated controls (p = 0.007), but did not vary between cotton and silk. The ligatures triggered an immunological reaction with cell infiltrates in close contact with the ligature materials, adjacent soft tissue encapsulation and bone resorption. qPCR further demonstrated an upregulated immune response toward the silk ligatures compared to non-ligated controls. Silk and cotton ligatures provoke foreign body reactions of soft tissue encapsulation type and bone resorption around implants in the absence of plaque.

Florid Reactive Periostitis of the Proximal Phalanx-Case Report and Literature Review.

Florid reactive periostitis is a benign and rare lesion that is a recurrent diagnostic problem. Its etiopathogenesis remains unknown. Florid reactive periostitis consists of a fibrotic, cartilage-producing tumor accompanied by an aggressive inflammatory periosteal and soft tissue reaction. It typically occurs in adolescents and young adults, mostly female; it often affects hand and foot bones, and it may occur in long bones. Its diagnosis remains a major challenge due to the vast possibility of differential diagnoses. Therefore, careful clinical, radiological, and pathological evaluation is required to establish a proper diagnosis. We report the case of a patient with florid reactive periostitis in the proximal phalanx of the right index finger, who underwent surgical excision with a wide margin, from the second ray to the proximal third of the second metacarpal bone, and evolved without complications, with satisfactory range of motion and strength.

Microbiome on the Bone-Anchored Hearing System: A Prospective Study

The bone-anchored hearing system (BAHS) has evolved to a common treatment option for various types of hearing revalidation. The BAHS consists of an implant in the skull that breeches the skin. Soft tissue reactions are a common complication associated with BAHS and are generally poorly understood. This study aims to investigate the influence of BAHS and associated skin reactions around the implant. A total of 45 patients were prospectively followed from implantation up to at least 1 year. Swabs were obtained at baseline, 12 weeks follow-up and during cases of inflammation (Holgers score ≥2). The microbiota was assessed using IS-proTM, a bacterial profiling method based on the interspace region between the 16S–23S rRNA genes. Detection of operational taxonomic units, the Shannon Diversity Index, sample similarity analyses and Partial Least Squares Discriminant Analysis (PLS-DA) were employed. Staphylococcus epidermidis, Streptococcus pneumoniae/mitis, Propionibacterium acnes, Staphylococcus capitis, Staphylococcus hominis, Bifidobacterium longum, Haemophilus parainfluenzae, Lactobacillus rhamnosus, Bordetella spp., Streptococcus sanguinis, Peptostreptococcus anaerobius, Staphylococcus aureus, Lactococcus lactis, Enterobacter cloacae, and Citrobacter koseri were the most commonly found bacterial species. S. pneumoniae/mitis was significantly more often observed after implantation, whereas P. acnes was significantly less observed after implantation compared with baseline. The relative abundance of S. epidermidis (17%) and S. aureus (19.4%) was the highest for the group of patients with inflammation. The Shannon Diversity Index was significantly increased after implantation compared with pre-surgical swabs for Firmicutes, Actinobacteria, Fusobacteria, Verrucomicrobia (FAFV), but not for other phyla. When combining all phyla, there was no significant increase in the Shannon Diversity Index. The diversity index was similar post-surgically for patients experiencing inflammation and for patients without inflammation. With a supervised classifier (PLS-DA), patients prone to inflammation could be identified at baseline with an accuracy of 91.7%. In addition, PLS-DA could classify post-surgical abutments as non-inflamed or inflamed with an accuracy of 97.7%. This study shows the potential of using IS-proTM to describe and quantify the microbiota associated with the percutaneous BAHS. Furthermore, the results indicate the possibility of an early identification of patients susceptible to adverse skin reaction following implantation. Both S. aureus and S. epidermidis should be considered as relevant bacteria for BAHS-associated inflammation.

Radiographic and histological evidence of metabolic bone disease in gliding leaf frogs (Agalychnis spurrelli)

Bone alterations due to metabolic bone disease in captive animal populations can have a negative impact on repopulation and research initiatives. This investigation has the purpose of describing the principal radiographic and anatomopathological findings present in nine gliding leaf frogs (Agalychnis spurrelli) kept in captivity with alterations in their spines and long bones. The observed histopathological findings were in the canalis vertebralis, paraspinal muscle and long bones, and included deformed bones with alteration of the adjacent tissues, alterations in the ossification process, bone degeneration and resorption, decreased number of osteocytes and deposition of osteoid and fibrous material in the compact bone tissue. Additionally, the spinal cord showed compressed white matter, chronic meningitis in the duramater, alteration in the number of glial cells and loss of delimitation between the gray and white matter. Radiographical changes were found mainly in the long bones and included moth-eaten osteolysis, solid periosteal reaction, bone deformities, cortical tunneling and inflammation of adjacent soft tissues. Also, pathological fractures of the femur and urostyle were observed together with spinal column deviations with increased bone density.

An in vitro model mimics the contact of biomaterials to blood components and the reaction of surrounding soft tissue

The therapeutic efficacy of a medical product after implantation depends strongly on the host-initiated fibrotic response (foreign body reaction). For novel biomaterials, it is of high relevance to understand this fibrotic process. As an alternative to in vivo studies, in vitro models mimic parts of the whole foreign body reaction. Aim of this study was to develop a wound model with key cells and matrix proteins in coculture. This approach combined blood components such as primary macrophages in a plasma-derived fibrin hydrogel, directly exposed to reference biomaterials (PTFE, glass, titanium). The soft tissue reaction is resembled by integrating fibroblasts in a collagen or a fibrin matrix. Those two experimental setups were conducted to show whether a long-term in vitro culture of 13 days is feasible. The response to reference biomaterials was assessed by multi-parametric analyses, comprising molecular profiling (cytokines, collagen I and ß-actin) and tissue remodeling (cell adherence, histological structure, tissue deposition). Polytetrafluorethylene (PTFE) and titanium were tested as references to correlate the in vitro evaluation to previous in vivo studies. Most striking, both model setups evaluated references’ fibrotic characteristics as previously reported by in vivo studies. Statement of SignificanceWe present a test platform applied for assessments on the foreign body reaction to biomaterials. This test system consists of blood components – macrophages and plasma-derived fibrin - as well as fibroblasts and collagen, generating a three-dimensional wound microenvironment. By this modular approach, we achieved a suitable test for long-term studies and overcame the limited short-term stability of whole blood tests. In contrast to previous models, macrophages’ viability is maintained during the extended culture period and excels the quality of the model. The potential to evaluate a foreign body reaction in vitro was demonstrated with defined reference materials. This model system might be of high potential as a screening platform to identify novel biomaterial candidates.

Vocal Fold Injection of Absorbable Materials: A Histologic Analysis With Clinical Ramifications

Gels composed of carboxymethylcellulose (CMC) and cross-linked hyaluronic acid are commonly used as temporary or resorbable injectable materials for vocal fold medialization. However, there is limited information about tissue injection patterns, soft tissue reaction, degradation, and residence time, particularly for the newer CMC gels. Prospective, laboratory. Ten canines underwent paraglottic (deep to the vocal ligament) microlaryngoscopic injection with about 100 µL (0.1 mL) of cross-linked hyaluronic acid (Restylane) in the right vocal fold and about 100 µl (0.1 mL) of CMC gel in the left vocal fold. Two commercial CMC gels of similar formulation (Prolaryn Gel and Renú Gel) were used in 5 animals each. Two subjects were sacrificed for histologic analysis at 3, 13, 29, 42, and 55 days. Histology showed that injected Restylane formed cohesive ovoid-shaped aggregated implants with minimal dispersion, inflammation, or cellular invasion in all subjects. Approximately 86% of Restylane injected remained at 8 weeks, as estimated from postmortem, high-resolution magnetic resonance imaging scans. In contrast, histology showed that both CMC gels dispersed widely through fascial planes during and after injection within and outside the thyroarytenoid muscle fascicles. There was a robust macrophage and histiocyte phagocytic response, with moderate to severe inflammation noted around residual CMC gel at early time points, and at 6 to 8 weeks, very little free gel was observed. None of the studied materials induced a clinical inflammatory reaction on laryngoscopy such that they would be considered problematic or dangerous. Restylane demonstrated superior injection localization, tissue compatibility, and residence time. Both CMC gels did not localize well in the paraglottic region, and there was a robust inflammatory response, with clearance by macrophages and short residence time. These results suggest that CMC gels may have a more limited application than previously thought for vocal fold medialization in patients in whom the injection is being used to achieve voice enhancement while awaiting reinnervation. Level of Evidence: NA.

A superparamagnetic Fe3O4-TiO2 composite coating on titanium by micro-arc oxidation for percutaneous implants.

A micro-magnetic field can affect the cell response and the subsequent tissue integration of implants. To improve the weak skin integration of percutaneous Ti implants, herein, superparamagnetic TiO2 coatings with Fe3O4 nanoparticles (NPs) were fabricated by micro-arc oxidization, and the magnetic field gradient induced by Fe3O4 was expected to enhance the fibroblast response in vitro and bio-sealing in vivo. Moreover, the surface properties of TiO2 coatings with Fe3O4 in different amounts were investigated, and the fibroblast and Staphylococcus aureus response in vitro as well as skin integration in vivo were evaluated. The obtained results showed that with an increase in the amount of Fe3O4 NPs in the electrolyte, more Fe3O4 were incorporated into the TiO2 coatings, and the Fe content could reach 4.41 wt%. The incorporation of Fe3O4 endowed TiO2 with superparamagnetism without changing its surface properties including the phase composition, Ca2+ release, roughness and hydrophilicity. The Fe3O4 NPs with the size of about 10 nm were mainly distributed in the near-surface region of TiO2. With an increase in the amount of Fe3O4 in TiO2, the magnetic property of TiO2 increased, and the fibroblast response, including proliferation, phenotype and extracellular collagen secretion, were improved. Compared to pure TiO2, TiO2 with 4.41 wt% Fe reduced bacterial reproduction to about 60% and efficiently prevented the recession and inflammatory reaction of soft tissue, showing good integration with skin tissues. Thus, herein, we provide a potential coating that can be applied on percutaneous Ti implants.

Follow-up of Metal-on-Metal Hip Replacements at a Large District Hospital and the Implementation of Medicines and Healthcare Products Regulatory Agency Guidelines: A Review of 297 Patients.

BackgroundMedicines and Healthcare products Regulatory Agency (MHRA) guidance for patients with metal-on-metal (MoM) hip replacements was provided in 2012 and updated in 2017 to assist in the early detection of soft-tissue reactions due to metal wear debris. A large number of MoM hip replacements were undertaken at our hospital trust. A program of recall for all patients with MoM hip replacements was undertaken and MHRA guidelines were implemented. In this study, we aimed to investigate the effectiveness of the revised MHRA guidelines in the detection of early adverse reactions to metal debris and to re-evaluate the indications for metal artifact reduction sequence magnetic resonance imaging (MARS-MRI) and revision surgery.MethodsIdentification and recall of all patients with MoM hip replacements from 2001 were conducted by using theatre logs, patient records, clinical coding information, and consultant logbooks. Two senior arthroplasty consultants reviewed X-rays and patient records. Postal questionnaires were forwarded to patients, together with requests for general practitioners to complete cobalt and chromium blood tests. The two consultant-led review of MOM replacements was undertaken with further radiological investigations (X-rays, MARS-MRI) performed according to the 2017 guidance with support of consultant radiologists.ResultsOf 674 identified patients, 297 were available for review: 26 patients did not have MoM implants, 36 were untraceable, 59 refused follow-up, 87 moved out of area, 147 had died, and 22 already had revision. Of 297 patients, 126 were women and 171 were men; age range was 39 to 95 years (mean age, 69 years); 126 had resurfacing and 171 had MoM replacements. Twenty-six patients had elevated metal ions. Thirty-three patients underwent MARS-MRI: MARS-MRI results were positive in 17 and negative in 16. Of 17 patients with positive MARS-MRI, 10 patients were asymptomatic and seven were waiting revision.ConclusionsPositive MARS-MRI can often occur in the absence of elevated metal ion levels; elevated blood metal ion levels do not mean MARS-MRI will be positive. All patients with MoM replacements were at risk. It is imperative to assess patients regularly for symptoms that may raise clinical suspicion and maintain a low threshold to performing MARS-MRI.

Evaluation of osteointegrative and osteoinductive properties of silicon doped ceramics in a model of rabbit’s femur fractures

Bone regeneration is one of the most complex and unique types of tissue regeneration, although quite long in time, comparatively, for example, with soft tissues, but provides the complete identity of the damaged site with normal bone. The most complex fractures are fragmentation, which can be occurs within wide range - 25-60% of the total number of all fractures. In such cases, due to the loss of contact with soft tissues, the fragments lose blood supply and regeneration, which leads to different bone size defect. This condition cause limitation of the main mechanisms of bone consolidation – endoostal and intramembrane ossification. In this regard, a strategic medical treatment is the replacement of bone defect with biological or synthetic material, which creates a site for the processes of reparative osteogenesis. The most widespread combined biocompatible materials in the various combinations of β-tricalcium phosphate and hydroxyapatite ("Maxresorb®", "Perossal®", "calc-i-oss®CRYSTAL", "easy-graft®CRYSTAL"), or composite composites based on bioactive and biogenic materials: hydroxylapatite + collagen (Biostite, Collagraft, Avitene, Collola, Hapkol, Collapan, MP Composite); hydroxylapatite + tricalcium phosphate + collagen ("Hydroxyapol", "Collapolum"); hydroxylapatite + collagen + sulfated glycosaminoglycans ("Biomatrix", "Osteomatrix", "Bioimplant"). Unfortunately, in veterinary medicine osteotropic materials developed for humane medicine are used only. Recently, a separate group of biocompatible composites based on the combination of hydroxyapatite with β-tricalcium phosphate, doped with magnesium, sodium, potassium, zinc, copper, aluminum, strontium, silicon, germanium, in order to provide them with specific properties - antibacterial, osteoinductive, antitumor, immunomodulating, etc. However, the spectrum of biological effects of these ions on bone metabolism is extremely diverse, and therefore the use of composite ceramics doped with microelement ions requires a comprehensive clinical and experimental justification. The purpose of the study is to evaluate the osteointegration and osteoinductive properties of ceramics based on hydroxyapatite and β-tricalcium phosphate doped with silicon for model fractures of the femur in rabbits. The work is done on rabbits of Californian breed at the age of 3 months. and a weight of about 2.5 kg. To substantiate the ceramics GTlKg-2, 2 groups of 10 rabbits were formed in each, in which model bone defects were formed in the distal parts of the hip dysthymia. Animals of the experimental group defects filled with granules of ceramics. In the rabbits of the control group, the defect was left to heal under a blood clot. Animals were extracted from the experiment at the 21st and 42nd day. X-ray and histomorphological studies were performed. On the 21st day of reparative osteogenesis, rabbits of all groups fully rested on the injured limb, signs of inflammatory reaction were absent in the experimental group, and the control marked the pronounced seal of the periosteum across the entire surface of the femur. It should be noted that hydroxyapatite ceramics does not possess x-ray contrast properties. On the 42nd day of regeneration of rabbits both groups fully rested on injured limb, signs of inflammatory reaction of soft tissues in the area of injury were absent. Radiologically, in animals of the experimental group in the place of bone defect, spot osteosclerosis was detected in the form of a clearly defined white heel, opposite to which the contour of the periosteum was sealed. At the same time, on the control X-rays, along with a well-defined, but more elongated septum of the periodontal, revealed a bone marrow panossus at the site of the injury, with a clearly defined extension of the eclipse. Substantially complemented macromorphological picture of bone biopsy. In particular, in the case of replacement of bone defect GTlKg-2, at the 21st day in the traumatic areas a limited and moderate periosteal reaction was noted. Along with this, in control animals, in this period, it was not completely replaced by fibrous cartilaginous tissue, as evidenced by its craterial appearance. Histologically, in the control animals, the bone defect formed a cartilage tissue along the periphery, and the bone beams, which were at a certain distance from the place of the defect, were at the stage of resorption. In the case of its replacement granules GTlKg-2 formed bone-ceramic regenerate, that is, the intervals between the granules are filled with bone tissue. The obtained results give grounds to consider that GTlKg-2 contributes to the formation of bone tissue due to its osteointegration and osteoinductive properties. Key words: reparative osteogenesis, osteointegration, osteocytes, osteoblasts, hydroxyapatite composite with β-tricalcium phosphate, doped with silicon.

Wide diameter bone-anchored hearing system implants: a comparison of long-term follow-up data between tissue reduction and tissue preservation techniques

To present long-term data on the Wide Ponto implant bone-anchored hearing system (BAHS) in regards to implant stability, soft tissue reaction and implant loss for two case series undergone either the tissue reduction- or the tissue preservation surgical technique. Comparison of two consecutive, prospective case series. Each case series enrolled 24 patients. The case series underwent one-stage implantation of the Wide Ponto implant BAHS using either a linear incision technique with subcutaneous reduction or a linear incision technique without subcutaneous reduction. Implant stability quotient (ISQ) values were measured using resonance frequency analysis and soft tissue reactions were graded according to Holgers' classification system. Follow-up visits were performed at 10days, 6weeks, 6months, 12months and annually up to 4years (tissue preservation) or 5years (tissue reduction) postoperatively. The two case series had homogenous patient populations and followed an identical postoperative scheme. The ISQ values increased consistently the first 12months for both groups (p ≤ 0.001), and were higher in the tissue preservation case series, (p = 0.04, 9mm abutment). More than 91% of the soft tissue observations were assessed as Holgers' grade 0 or 1. One implant (2.1%) was lost due to trauma. In both case series, the Wide Ponto implant showed increasing implant stability during the follow-up period from the time of surgery, irrespective of surgical technique, indicating good osseointegration. Soft tissue reactions were rare and of minor severity. Implant survival was high.

Soft tissue reactions following cochlear implantation.

Cochlear implantation is a boon to children with hearing loss. Rarely, it can be associated with complications. Soft tissue reaction can be a particularly distressing complication. The study was conducted on all patients presenting with soft tissue reaction post-cochlear implant in a tertiary care referral institute from March 2011 to June 2018. We graded the severity of soft tissue reaction as per the severity and then managed these patients accordingly. Thirty-five patients were included in this study. Grade 1 had 12 patients, grade 2 had 9, grade 3 had 4 and grade 4 had 9 patients. Grade 1, 2 and 3 reactions were managed conservatively, while grade 4 required surgery. The incidence of explantations increased with the grade severity. Soft tissue reaction post-cochlear implant is a rare, but distressing complication. Grading and analyzing them can help us manage them in a better way.

Study of soft-tissues borderline class I malocclusion on tooth extraction and non-extraction process using medical IoT device

Tooth extraction is the process of removing the tooth or cures the damage teeth from the socket present in the bone. During the tooth extraction and non-extraction process, the reaction of soft tissue identification is difficult to decide which may create problem after making the tooth extraction process. Due to the complexity of soft tissue identification process, it is more difficult to estimate the longevity of teeth and borderline class I malocclusion. So, in this paper analyze the detailed profile of the soft tissues present in the borderline class I malocclusion by using the wearable IoT device in teeth. Along with this medical IoT device, facial patterns, pathologies, tooth-arch discrepancy, compliance and cephalometric discrepancy have been examined continuously for making the decision about tooth extraction and non-extraction process. In addition to this, gathered information helps to create the treatment plan that helps to minimize the disease serious rate. Then the analyzed study has been examined by collecting sample data from 100 female patients in which 50 patients data is collected in terms of premolar extraction treatment patients and other 50 patients data is gathered from premolar extraction non-treatment process which is implemented using MATLAB implementation process. From the collected data, soft-tissue reaction has been examined effectively and decision also handled successfully.

Metal ions related complications after hip arthroplasty

The problems of metal ions accumulation and related complications after metal-on-metal hip arthroplasty have been concerned by joint surgeons. Furthermore, metal ions released resulting from taper fretting and corrosion at the head-neck junction of prosthesis are also research hotspot in the field of arthroplasty. Whether the complications associated with metal ions are as serious as expected, its specific manifestations, mechanisms and other issues are still controversial. There is no consensus on the clinical detection methods and standards of metal ions. The present study reviews the literatures and summarizes the above issues, in order to have a deeper understanding of these issues. As far as the form of complication is concerned, there are local and systemic reactions. The former is mainly an adverse reaction of local tissue, especially pseudotumor. However, the incidence of pseudotumor and its risk factors are controversial. There is no clear evidence of systemic complications such as carcinogenicity and teratogenicity. The molecular mechanism of cobalt-chromium toxicity involves many signal transduction pathways, and its histopathological mechanism includes macrophage-mediated nonspecific immunity and lymphocyte-mediated specific immunity. The former is mainly related to the wear dose, while the latter is related to metal sensitivity with great individual difference. The method of metal ion concentration determination is still controversial. The inductively coupled plasma mass spectrometry (ICP-MS) is widely used at present, and the determination of metal ion concentration critical value has important guiding significance for clinical practice. Britain's 7 μg/L proposal was once discussed as a standard, while there are many different views currently. In summary, it is thought that the complication of metal ion after hip arthroplasty is the result of cobalt chromium metal ion activating nonspecific immunity and specific immunity. Abnormal activation of many signaling pathways leads to local soft tissue reactions, while systemic complications do not have clear evidence. Furthermore, there is no uniform standard for the detection of metal ion concentration. This index is not recommended in clinical practice. We should have a comprehensive assessment of the patient's situation.

Early Clinical and Radiological Experience with a Ceramic Bone Graft Substitute in the Treatment of Benign and Borderline Bone Lesions

Substitutes for bone grafts experience increasing popularity, but the need for defect-filling following simple curettage of benign bone lesions is controversial. In this study, we wish to objectively report the radiological changes following bone defect-filling using a composite ceramic bone graft substitute, as well as the clinical results and complications. We evaluated 35 surgically treated benign bone lesions with subsequent defect-filling using two variants of a composite ceramic bone graft substitute (CERAMENT|BONE VOID FILLER or CERAMENT|G, BONESUPPORT AB, SWEDEN). After one year, a normal cortical thickness surrounding the defect was seen in approximately 80% of patients. Inside the defect-cavity, an almost complete product-resorption was seen after one year. The most common complication was a post-operative inflammatory soft-tissue reaction, seen in 7 patients (20%), which resolved without further treatment, although short-term antibiotic treatment was initiated at a local hospital in 6 patients, due to suspected wound infection. In summary, cortical thickness most commonly normalizes after bone tumor removal and filling of the bone defect using this particular composite ceramic bone graft substitute. The ceramic substitute undergoes resorption, which causes progressive changes in the radiological appearance inside the bone defect.

Lipogranuloma of the Face Associated with a Traumatic Event: a Case Report

Lipogranuloma, an inflammatory reaction of granulomatous soft tissue, consists of lipid and/or oil-like deposits commonly associated with injections or trauma, or secondary to systemic diseases. A 64-year old woman presented with painful, hardened facial nodules and lip swelling since 7 months prior, which was refractory to antibiotic therapy; domestic violence was reported as the causative factor. A diagnostic hypothesis of Melkersson-Rosenthal syndrome had been rendered at another service. Intraorally, she presented with a fissured tongue, tooth decays, periodontal disease, and xerostomia and extraorally with lower lip and right medial face edema. Magnetic resonance imaging showed an elongated lesion in the region of the right face and diffuse swelling of the lower lip, without adjacent invasion. Biopsy revealed histologic evidence of a granulomatous soft tissue reaction consistent with lipogranuloma. The clinical finding of lipogranuloma that is probably secondary to endogenous inflammatory lipid degeneration after trauma is rare.