Suture Area Research Articles

Technique training of Myofunctional appliance : Activators

Myofunctional appliance are considered by many authorities orthopedic in nature, influencing the facial skeleton of the growing child in the condylar and suture areas. They also exert an orthodontic effect on the dent-alveolar area. Among these activator is the most well-known myofunctional appliance. The article describes the myofunctional appliance and its technique training, design, steps in preparation of Class II and Class III activator in sequential stages with illustrated case reports, treating class III molar relationship with crowded arch in maxilla and anterior cross bite. The Author acknowledges that the article is summarized from the lectures, handouts during his postgraduate studies in Kyushu University and Hiroshima University, Japan and from his experience from Dhaka Dental College and private practice at Ortho Dental Care. This article is a continuation of the series of technique training in orthodontics especially for the post-graduate trainees as well as for the practitioners who will learn and practice functional appliance specially activators. Once again, I believe that post-graduate trainee doctors, faculty members, private practitioners and all other concerned will find this article as a guide line during their training as well as in their professional practicing period. DOI: http://dx.doi.org/10.3329/bjodfo.v2i1.16003 Ban J Orthod & Dentofac Orthop, October 2011; Vol-2, No.1, 34-46

FGF18 accelerates osteoblast differentiation by upregulating Bmp2 expression

Fibroblast growth factor (FGF) signaling is involved in skeletal development. Among total 22 FGFs, it is suggested that FGF18 functions in promotion of osteoblast differentiation. In order to elucidate the mechanism of FGF18-dependent acceleration of osteogenesis, we implanted rhFGF18 soaked beads over mouse fetal coronal sutures using ex-utero surgery. The coronal suture area comprises the peripheries of the developing frontal and parietal bones, separated by the sutural mesenchyme. rhFGF18 accelerated osteogenesis by promoting connection of the frontal and parietal bone domains, resulting in elimination of the sutural mesenchyme. Expression of Fgf receptors, Fgfr1, -2 and -3 involved in skeletal development, was maintained or upregulated in the developing bone domains, consistent with enhanced osteogenesis. Bone morphogenetic protein (Bmp) 2 was specifically upregulated in the skeletogenic layer and the application of Bmp antagonist, rmNoggin, inhibited rhFGF18-dependent upregulation of osteoblast markers. These results suggest that FGF18 accelerates osteogenesis by upregulation of Bmp2 as well as maintenance or upregulation of Fgfr1, -2 and -3 expression in osteoblasts.

Experimental evaluation of horse hair as a nonabsorbable monofilament suture

Background:Success of surgery depends on wound closure and healing. Ancients had coated many suture materials from plant and animal origin. As the quest for natural nonabsorbable, monofilament surgical suture continues, horsehair has been taken for study, which is mentioned in ancient literature.Objectives:Aim of the study was to evaluate detail mechanical and biophysical properties of horsehair.Materials and Methods:Physical properties, that are diameter, straight pull and knot pull tensile strength, bioburden, sterility tests were performed. Visual and histological wound healing parameters were studied in experimental Wistar rat incision wound model. Two experimental wounds about 5 cm long were created on each side of dorsal midline. Each animal received two sutures-Horsehair 4-0 and Ethilon 4-0. The sutured areas were grossly examined on 3rd and 7th days for visual observations like congestion, edema, infection, wound disruption, and impression of suture material on healed wound and then subjected for histological study.Results:Revealed that horsehair has got diameter of 0.19 mm which complies with the 4-0 size USP standard. Straight pull tensile strength was found 0.5851 ± 0.122 kg and knot pull tensile strength was 0.3998 ± 0.078 kg, which complies with the standards of United State Pharmacopia for class II nonabsorbable suture materials. In vivo study revealed that there was no evidence of edema, congestion, and discharge in both the groups. Wounds healed with minimum impressions of suture material with minimum scar mark. Mean histological scoring shows very mild tissue reaction.Conclusion:Horsehair has got properties of standard suture material except low tensile strength and hence can be used in reconstructive, plastic surgeries, and ophthalmic surgeries.

Role of platelet rich plasma gel in the wound healing of black Bengal goat

The study was conducted to evaluate the efficiency of platelet rich plasma (PRP) gel in the healing of skin wound.This experiment was carried out to exploit the therapeutic effects of PRP gel on healing process. A total of 72 surgical wounds were madein 12 goatsbearing weight 15-20 kg with the age 1-3 years. Goats were divided into four groups with three animals in each group. Wounds of four groups were treated with homogenous PRP gel, heterogenousPRP gel, sulphonilamide powder and tincture benzoinCo. or benzoin seal (control). The wounds were 3 cm length and 0.5 cm depth sutured with cross mattress using nylon. Follow-up observation was recorded from day 1 to day 30 postoperatively. Some morphological characters such as swelling area of wound, elevation of sutured line from the skin surface, width of sutured area and contraction length between 7 to 15 days were recorded to determine the healing process of the wounds. Besides morphological study, histopathological studies were also performed on day 1, day 2, day 3, day 5 and day 15 to evaluate the healing process.Homogenous PRP gel showed admirable results in the healing of the wounds produced in goat. All wounds treated with homogenous PRP gel showed no inflammation with dry sutured area and complete healing with massive hair follicular growth within 15-21 days. On histopathological study, demonstrated epithelial tissues with a normal morphology. The dermis showed flabby connective tissue with organized interconnecting collagen fibers running parallel to each other and new hair follicular growth inhealed area within 15 days, when wounds were treated with homogenousPRP gel.This study could help to consider natural biomaterial product specially PRP gel homogenous for a good healing of skin wounds with minimum complications. Further studies are necessary for the molecular investigation of healing process and proper establishment of commercially available of PRP gel and easiest finding theway of it'sapplication.

The effect of isoflavones on early bone formation on orthopedically expanded suture in male rats

Objective: The aim of this experimental study was to evaluate histomorphometrically the effects of isoflavones on bone formation in response to expansion of the inter-premaxillary suture in male rats. Materials and Methods: Twenty male, 50-60 days old Wistar rats were divided into two equal groups (control and experimental). Both groups were subjected to expansion for 5 days, and 50 cN of force was applied to the maxillary incisors with helical spring. In experimental group, 10 μg/g isoflavones (IF) were administrated orally. After expansion period, the springs were removed and replaced with short lengths of rectangular retaining wire for retention period in 10 days. Bone formation in the sutural area was histomorphometrically evaluated including the amount of new bone formation (μm 2 ), number of osteoblasts, number of osteoclasts, and number of vessels. Mann-Whitney U -test was used for statistical evaluation at P Results: New bone formation area ( P = 0.003; 2.26-fold) and number of osteoclasts ( P = 0.001; 1.87-fold) showed statistically significant lower values in experimental group than the control. No significant differences were found in number of osteoblast and number of vessel values between the groups. Conclusion: Isoflavones affects bone formation in the orthopedically expanded inter-premaxillary suture negatively, and main affect of Isoflavones were on osteoclasts in bone metabolism.

Light-emitting diode photobiomodulation: effect on bone formation in orthopedically expanded suture in rats—early bone changes

The aim of this experimental study was to evaluate histomorphometrically the effects of light-emitting diode (LED) photobiomodulation therapy (LPT) on bone formation in response to expansion of the interpremaxillary suture in rats. Twenty male, 50- to 60-day-old Wistar rats were divided into two equal groups (control and experimental). Both groups were subjected to expansion for 5days, and 50cN of force was applied to the maxillary incisors with helical spring. An OsseoPulse® LED device, 618-nm wavelength and 20-mW/cm(2) output power irradiation, was applied to the interpremaxillary suture for 10days. Bone formation in the sutural area was histomorphometrically evaluated, including the amount of new bone formation (in square micrometers), number of osteoblasts, number of osteoclasts, and number of vessels. Mann-Whitney U test was used for statistical evaluation at p < 0.025 level. Significant differences were found between groups for all investigated histomorphometric parameters. New bone formation area (p = 0.024, 1.48-fold), number of osteoblasts (p < 0.001, 1.59-fold), number of osteoclasts (p = 0.004, 1.43-fold), and number of vessels (p = 0.007, 1.67-fold) showed higher values in the experimental group than the control. Bone histomorphometric measurements revealed that bone architecture in the LPT group was improved. The application of LPT can stimulate bone formation in the orthopedically expanded interpremaxillary suture during expansion and the early phase of the retention periods.

Paper 235: Effect of the Addition of Mesenchimal Stem Cells in the Healing of Acute and Chronic Meniscal Lesions in the Avascular Zone: An Experimental Study in Rabbits

the treatment of meniscal lesions is a challenge because, although lesions in the vascular region often heal with traditional techniques, lesions in the avascular area rarely heal. Different experimental studies have explored the effect of a variety of substances in the healing of lesions in the avascular area, but poor results are the norm. Adult Mesenchimal Stem Cells (MSC) obtained from fat have shown an ability to regenerate cutaneous and osseous defects. The objective of this study is to determine if the addition of MSC to a sutured meniscal lesion in the avascular zone of rabbit menisci improves the outcome of acute and delayed repairs. twenty four New Zealand rabbits were used in the study. MSC were obtained from fat extracted from the rabbits inguinal zone that was processed and cultured sequentially (two to three times) so as to obtain an adequate number of MSC; in the last culture the cells were incubated in a solution containing deoxibromouridine (DBU) so as to mark their DNA. The medial meniscus of both knees was approached, and a 0,5 cm longitudinal tear in the avascular area of the anterior horn was performed. In twelve rabbits the lesions were repaired immediately and in another twelve rabbits the lesions were repaired three weeks later. All the tears were sutured with one simple vertical stitch of nonabsorbable suture. A Matrigel® solution with 100,000-1,000,000 MSC was placed prior to suture tightening inside the sutured area of one of the knees; in the contralateral knee the Matrigel® solution was placed without cells to be used as controls. The rabbits were sacrificed after 12 weeks, menisci were evaluated macro-microscopically and an inmunohistochemical analysis with antibodies for DBU was performed to evaluate the presence of siblings of the stem cells. In the group repaired acutely three total and three partial healings were observed in the MSC group and none in the control group. In the group repaired after three weeks one total and one partial healing were observed in the MSC group and none in the control group The inmunohistochemical evaluation showed positive results in menisci with partial or complete healing. MSC have a strong positive effect in the healing of meniscal lesions in the avascular zone in rabbits repaired acutely. This effect is lees marked if at all present when the lesion is repaired in a delayed fashion.

Camouflaging the Posterior Zygomatic Arch Protrusion After Zygoma Reduction Surgery

Zygoma reduction is a very common procedure for Asian patients. Usually, the procedure is undertaken in such a way that the zygomaticotemporal suture area is fractured in and pushed medially. In carrying out this procedure, dissection is avoided within approximately 1 cm posterior to the zygomatic arch, due to the possible impairment of the temporomandibular joint space during osteotomy, especially cases where the posterior portion of the zygoma protrudes further than the frontal and middle portions. Since protrusion of the posterior portion of the zygomatic arch is not reduced with the operation, the transverse facial width of the cheek will remain unchanged, and thus there is a high possibility for a remaining step deformity at the osteotomized part of zygomaticotemporal suture. This has been discussed as a limitation of zygoma reduction surgery. We believe in reducing the transverse width of the face even in these cases by covering the protruding area of the posterior zygomatic arch through a single hair graft method. This method was used in 16 outpatient procedures between 2009 and 2011. All patients presented with postoperative arch protrusions that remained after initial zygomatic reduction at other clinics. All of these patients were women, and their average age …

Evaluation of the palatal soft tissue thickness by cone-beam computed tomography

ObjectiveThe purposes of this study were to measure the palatal soft tissue thickness at popular placement sites of temporary anchorage devices (TADs) by cone-beam computed tomography (CBCT) and evaluate the age, gender, and positional differences in this parameter.MethodsThe study sample consisted of 23 children (10 boys and 13 girls; mean age, 10.87 ± 1.24 years; range, 6.7 to 12.6 years) and 27 adults (14 men and 13 women; mean age, 21.35 ± 1.14 years; range, 20.0 to 23.8 years). Nine mediolateral and nine anteroposterior intersecting reference lines were drawn on CBCT scans of the 50 subjects, and the resultant measurement areas were designated according to their mediolateral (i.e., lateral, medial, and sutural) and anteroposterior (i.e., anterior, middle, and posterior) positions. Repeated-measures analysis of variance was performed to analyze intragroup and intergroup differences.ResultsNo significant age and gender differences were found (p = 0.309 and 0.124, respectively). Further, no significant anteroposterior change was observed (p = 0.350). However, the lateral area presented the thickest soft tissue whereas the sutural area had the thinnest soft tissue (p < 0.001).ConclusionsClinical selection of the placement sites of TADs should be guided by knowledge of the positional variations in the palatal soft tissue thickness in addition to other contributing factors of TAD stability.

Facial lesions caused by renal osteodystrophy in a patient with chronic renal insufficiency: a case report

PURPOSE: Chronic renal insufficiency (CRI) is the last stage of a chronic renal condition in which the kidney loses its filtration and endocrine functions. Chronic endocrine hypofunction causes generalized damage to the body known as Uremic Syndrome, which affects the central nervous system as well as the cardiovascular, hematologic, dermatologic, ophthalmic, endocrine, respiratory, gastrointestinal and skeletal systems. The present study reports the case of a female patient with CRI who presented facial osteodystrophy of the osteitis fibrosa type, and highlights the main features of this condition. CASE DESCRIPTION: A 24-year old, female, Caucasian patient presented chronic glomerulonephritis recurrence and lost the transplanted kidney five years before, undergoing arteriovenous fistula hemodialysis three times a week. She presented swelling of the left masseter area with a hard consistency on palpation, covered by intact skin, swelling at the bottom of the left atrium, with a hard consistency on palpation, a mucosa-like color and absence of inflammation signs, suggesting expansive bone lesions on the face. These features were compatible with hyperparathyroidism brown tumor and/or osteodystrophy. The CT scan showed expansive bone lesions of heterogeneous appearance on the left jaw, maxilla/nasal floor, and right frontotemporal suture areas. The clinical and histopathological characteristics of the lesion, in association with PHT hormone high serum levels led to renal osteodystrophy diagnosis. The patient was referred to the nephrology services. CONCLUSION: Osteodystrophic bone alterations have a high prevalence in renal disease patients, and the dentist must take these alterations into consideration in bone lesion diagnosis for this specific group of patients.

Comparison of elastic versus rigid suture material for peripheral sutures in tendon repair

BackgroundFor secure tendon repair, while core suture materials have been previously investigated, the optimum material for peripheral sutures remains unclear. MethodsTransected bovine gastrocnemius tendons were repaired by 2-strand side-locking loop technique using no.2 braided polyblend polyethylene thread for the core suture. Then, 8-strand peripheral cross-stitches were added using either 2–0 rigid sutures (braided polyblend polyethylene) or USP 2-0-sized elastic sutures (nylon). The holding area of each peripheral suture was set at either 3×1mm (shallow holding) or 6×2mm (deep holding). Therefore, 4 groups were compared (the shallow-rigid, deep-rigid, shallow-elastic, and deep-elastic groups). The gap formation, ultimate tensile strength, and suture migration state were measured after 500 cyclic loadings (from 10 to 200N). MethodsThe shallow-rigid group had inferior outcomes compared to the other groups. Although the deep-rigid group had the smallest gap and highest ultimate strength, all peripheral sutures had failure prior to core suture rupture. The two elastic groups showed no significant differences, irrespective of the size of the holding area. Suture migration did not occur in the two elastic groups until the ultimate strength was reached and the core suture ruptured. InterpretationDepending on the suturing method, rigid suture material may not be appropriate for peripheral sutures, when accompanying rigid core suture material. If peripheral sutures can be made with accurate deep holding, rigid suture material will provide favorable outcome. However, in other cases, elastic suture material is considered best for supporting a rigid core suture, as elasticity is another important factor for peripheral sutures.

Effect of vitamin C on bone formation in the expanded inter-premaxillary suture. Early bone changes

The aim of this experimental study was to histomorphometrically evaluate the effects of vitaminC administration on bone formation in response to expansion of the rat inter-premaxillary suture. A total of 30 50- to 60-day old Wistar male rats were divided into three groups of equal number. The inter-premaxillary suture in each animal was expanded with a 0.49N force applied to the upper incisors. At 24h after appliance placement, control animals received saline solution (groupI) and two groups were given a single dose of vitaminC using two different methods [locally into the suture (groupII) and systemically via intramuscular injection (groupIII)]. The area of new bone (µm(2)), the perimeter around the new bone (µm), Feret's diameter (µm), and the percentage of new bone to non-ossified tissue (%) were measured and compared. Kruskal-Wallis and Tukey tests were used for statistical evaluation at the p<0.05 level. We observed significant differences among the groups in all histomorphometric parameters. New bone area, bone perimeter, Feret's diameter, and percentage of new bone dimensions were significantly higher in groupIII than the others (p<0.001). Histomorphometric measurements of bone architecture revealed that this improved in the group administered with vitaminC systemically, while local injection revealed significantly less bone growth than the control group. The systemic administration of vitaminC during the early stages of inter-premaxillary suture expansion may stimulate bone growth. However, local injection of this antioxidant into an orthopedically-expanded suture area has negative effects on bone formation.

Moving an incisor across the midline: A treatment alternative in an adolescent patient

A 13-year-old sought treatment for a severely compromised maxillary left central incisor and an impacted fully developed left canine. Extraction of both teeth became necessary. As the key component of the revised comprehensive treatment plan, the right maxillary central incisor was moved into the position of the left central incisor. All other maxillary teeth were moved mesially to close any gaps. Active orthodontic treatment was completed after 34 months. Frenectomy, minor periodontal surgeries, and bonded lingual retainers were used to improve aesthetics and stabilize the tooth positions. The patient was pleased with the treatment outcome. Cone-beam computed tomography provided evidence that the tooth movement was accompanied by a deviation of the most anterior portion of the median palatine suture. This observation may make relapse more likely if long-term retention cannot be ensured. Root resorption was not observed as a consequence of the major tooth movement.

Effect of resveratrol on bone formation in the expanded inter‐premaxillary suture: early bone changes

The aim of this study was to evaluate the effects of local resveratrol (RSVL) administration on bone formation in response to expansion of the inter-premaxillary suture, in rats. Twenty 50- to 60-day-old male Wistar rats were separated into two equal groups. Both groups were subjected to expansion, and 30 cN of force was applied to the maxillary incisors with helical-spring. Twenty-four hours after appliance placement, single-dose 10 μmol/kg RSVL in the dimethylsulfoxide (DMSO) was injected to the inter-premaxillary suture in the experimental group. In the control group, the same amount of DMSO was injected to the suture of rats. Bone formation in the suture was evaluated histomorphometrically. The area of new bone (μm(2)), the perimeter around the new bone (μm), Feret's diameter (μm), the percentage of new bone to non-ossified tissue (%), and the number of osteoblast were measured and compared. Mann-Whitney U-test was used for statistical evaluation at p < 0.05 level. Statistically significant differences were found between the groups for all histomorphometric parameters. New bone area (p < 0.001), bone perimeter (p < 0.001), Feret's diameter (p < 0.001), percentage of new bone (p < 0.001), and the number of osteoblast (p < 0.001) were significantly larger in the experimental group when compared with the control. Bone histomorphometric measurements revealed that bone architecture in the RSVL treated rats was improved. Local application of RSVL during the early stages to orthopedically expanded inter-premaxillary suture area may stimulate bone formation and shorten the retention period, in rats.

Movement of a maxillary central incisor across the midline

This report describes the two-phase orthodontic treatment of a 7-year-, 6-month-old girl who presented with bilateral gemination of the central incisors. The left side demonstrated a complete gemination, resulting in two separate teeth (#9 and #9a). On the right side the gemination was incomplete, resulting in a large tooth mass (#8) that was 11.5 mm wide with a large pulp chamber and two apices. The tooth mass was extracted and the left central incisor (#9) was successfully moved across the midline (through the midpalatal suture area). The supernumerary incisor (#9a) was then used in the upper left central incisor area.

Tissue Engineering Penoplasty With Biodegradable Scaffold Maxpol-T Cografted Autologous Fibroblasts for Small Penis Syndrome

In this study, we investigated the safety and efficacy of a poly acid-co-glycolide biodegradable scaffold (Maxpol-T) coated by autologous fibroblasts (AF) for penile girth enlargement in small penis syndrome (SPS). Eighty patients with SPS were enrolled in a clinical study at 2 medical centers; 69 patients completed the study protocol. Scrotal skin was harvested under local anesthesia, and AFs were cultured and seeded on a Maxpol-T scaffold; the cografted scaffold was implanted under the Buck's fascia of penile shaft via a circumcising incision. Patients were followed up at 1, 3, and 6 months to evaluate penile girth changes. Patient satisfaction was assessed via Visual Analogue Scale and scored on the International Index of Erectile Function-5 (IIEF-5). Mean preoperative penile girth in the flaccid and erect state was 8.18 ± 0.83 cm and 10.26 ± 1.22 cm, respectively. At the 6-month postoperative follow-up, mean penile girth in the flaccid and erect state was increased to 12.19 ± 1.27 cm and 13.18 ± 1.31 cm, respectively (P < .001 for change in both flaccid and erect state). Sixty-five patients (94.2%) reported satisfaction with the procedure. Among them, 4 cases (5.8%) were dissatisfied, 7 cases (10.1%) were satisfied, 26 cases (37.7%) were very satisfied, and 32 cases (46.4%) were extremely satisfied. All men maintained IIEF-5 scores of more than 22. Complications included prolonged subcutaneous edema in 3 patients (4.3%) and pinpoint erosion at the suture area in 3 patients (4.3%). Implantation of autologous fibroblasts seeded on a Maxpol-T collagen scaffold holds promise as a safe and novel technique for penile girth enhancement in patients with SPS.

Is the pterygopalatomaxillary suture (sutura sphenomaxillaris) a growing suture in the fetus?

The pterygopalatomaxillary suture is considered as having an important role in the posteroanterior growing of the maxilla. To determine whether this suture is a growing suture in the fetus, we performed a histological study of this suture in a fetus aged of 16 weeks of amenorrhea. Serial sections (5 microm) of the pterygopalatomaxillary suture area have been performed. Fibrous sutures are separating four pieces of ossification (maxilla, palatine bone, lateral and medial plates of the pterygoid process). A fibroblastic growing site has been observed on the dorsal aspect of the pterygopalatomaxillary suture, in contact to the anterior border of the lateral plate of the pterygoid process. The posteroanterior growing of maxilla is dependent on a growing suture located on the anterior border of the pterygoid process. The pterygoid process (via its lateral plate) makes the junction between the maxilla and both the cranial base and the condylar mandibular site of growth.

Effect of periosteal stimulation therapy on bone formation in orthopedically expanded suture in rats

The aim of this experimental study was to evaluate the effects of periosteal stimulation therapy (PST), on bone regeneration in response to expansion of the interpremaxillary suture, in rats. Sixteen male, 50-60 days old Wistar rats were divided into two equal groups (control and experimental). Both groups were subjected to expansion for 5 days, and 30 cN of force was applied to the maxillary incisors with helical spring. On the 2nd day of the expansion procedure in the experimental group, the periosteum over the interpremaxillary suture was stimulated locally by intraperiosteal penetrations with a hypodermic needle. Bone regeneration in the interpremaxillary suture was evaluated by bone histomorphometry and the new bone area, bone perimeter, feret's diameter and new bone/old bone percentage parameters were evaluated. Mann-Whitney U-test was used for statistical evaluation at p < 0.05 level. Significant differences were found between groups for all investigated histomorphometric parameters. New bone area (p < 0.01), bone perimeter (p < 0.05), feret's diameter (p < 0.01) and new bone/old bone percentage (p < 0.01) measurements were significantly higher in the experimental group than that in the control. Bone histomorphometric measurements revealed that bone architecture in the PST group was improved. Local stimulation of the periosteum of the sutural area during expansion stimulates bone formation and improves healing.

Cross-Sectional Area and Strength Differences of Fiberwire, Prolene, and Ticron Sutures

Flexor tendons should be repaired with suture material strong enough to permit early motion and small enough for the resulting knot to allow unimpeded tendon glide and healing. This study sought to define differences in cross-sectional area and knotted tensile strength among Fiberwire, Prolene, and Ticron sutures. Five strands, each of 3-0 and 4-0 Prolene, Ticron, and Fiberwire sutures, were embedded in polymethylmethacrylate and sectioned in a linear precision saw to obtain 10 cross-sections of each material and size. These were examined by scanning electron microscopy and digitally analyzed for cross-sectional areas. Ten strands of each suture material and size had a single throw knot placed, and they were loaded to failure in a micromechanical tester. Prolene and Ticron cross-sections were circular. Fiberwire was noncircular. The 3-0 Fiberwire sutures had greater cross-sectional area than the 3-0 Ticron sutures (p < .001), which in turn were larger than 3-0 Prolene (p < .05). The 4-0 Fiberwire cross-sectional area was also greater than that of 3-0 Ticron and Prolene (p < .05). After relating knotted tensile strength to cross-sectional area, Fiberwire was 10% stronger than Prolene, and 25% stronger than Ticron. Fiberwire is not only stronger, but also larger than other sutures in the same or even higher suture size category. Failure to meet the United States Pharmacopeia standards for suture diameter is declared in the product information sheet, although surgeons may not be aware of these size variations. Suture size definitions are currently based on diameter, a consistent measure for circular monofilament sutures, but not for braided or noncircular sutures.

Spring-mediated skull expansion: overall effects in sutural and parasutural areas. An experimental study in rabbits

The use of springs in cranial expansion has proven to be effective in the treatment of craniosynostosis. Spring-mediated expansion has been studied both in the sagittal and in parasagittal regions, especially in scaphocephaly. A rabbit model was used in the present study to analyze the effects of springs on the cranial vault and sutures. Thirteen 4-week-old New Zealand rabbits were divided into 4 groups: in group I, only amalgam markers were used as control; in group II, amalgam markers were used and sagittal suturectomy was performed; in group III, amalgam markers were used, a sagittal suturectomy was performed and an expansible spring was fitted in the interparietal region and in group IV, markers were used and linear parasagittal craniectomy was carried out with springs. Animals were sacrificed after 2, 4, 8 and 12 weeks. Radiological control and histological analysis were performed in the area of spring implantation. In the groups using springs distraction of the craniectomy borders was greater than in those that did not use springs. New bone formation was observed in all groups, and was faster in group II. Bone growth started from the borders and depth. Bone regeneration presented a similar histological pattern in the groups with spring in the sagittal and parasagittal region. The rabbit model proved to be adequate for the analysis proposed by the study. The use of springs in the groups with sagittal and parasagittal osteotomy led to a similar distraction of amalgam markers and both groups had similar ossification histological pattern.