This study evaluates the efficiency of interbody polyetheretherketone (PEEK) cage implantation in 52 consecutive cases related for discogenic cervical disorders with radiculopathy or myelopathy.
This study evaluated morbidity after bone graft harvesting from the anterior or posterior iliac crest for maxillofacial and orthopedic procedures. 97 patients underwent either anterior or posterior iliac crest bone harvesting to augment the jaws. Postoperative pain levels were similar for both approaches based on patient questionnaires, with pain decreasing over 6 months. Most patients reported their scars were similar and nearly all would undergo the procedure again, suggesting both approaches provide bone grafts with acceptable morbidity. The posterior approach allows harvesting of larger amounts of bone.
-often suffer from cartilage injuries. Cartilage surgery is available in India to cure cartilage problems and prevent them from developing knee osteoarthritis. Autologous cartilage cell implantation is being done by Madras Joint replacement center at an affordable cost. This biological intervention will hopefully avoid a knee replacement in young individuals.
Biocartilage to Treat Osteochondral Defects of the Talus: Case Report and Tec...Jennifer Gerres, DPM
The document describes a case study and technique using BioCartilage to treat a large osteochondral defect of the talus. The key points are:
1) A 24-year old male presented with ankle pain and imaging revealed a 1.2cm x 1.6cm osteochondral defect of the talus.
2) The defect was excised and microdrilled. BioCartilage, a micronized hyaline cartilage allograft, mixed with blood or PRP was used to fill the defect.
3) BioCartilage offers advantages over other techniques like autografts in eliminating donor site morbidity and over ACI in being a single-stage procedure without wait time.
This document discusses autologous chondrocyte transplantation (ACT), a treatment for cartilage defects. It covers the stages of ACT healing, indications, prerequisites, investigations, the implantation procedure, and rehabilitation goals. The proliferative, transition, and remodeling stages of healing are described. Advantages include producing hyaline-like cartilage to fill defects of any size. Disadvantages include being more invasive and expensive with a longer recovery than other options.
Orthobiologics is a current terminology for the application of various cells, cytokines, growth factors.Tissue Engineering,Gene Therapy,Osteoarthritis,Avascular Necrosis,Sickle Cell Disease,Disc Regeneration,PRP,Autologous Chondrocyte Transplantation,BMAC,Spinal cord Injury paraplegia,Autoimmnune disorders,Diabetic foot,Tendinopathies,Wound Healing,,SCAFFOLDS IN STEM CELL THERAPY.Regenerative medicine is now an recognized specialty which has evolved from degerative diseases of Orthopaedic Surgery.Articular Cartilage : Repair To Regenerate To Replace Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com
MRI is useful for evaluating cartilage repair before and after surgery through ACI. Pre-operatively, MRI can estimate lesion size, nature, and location to optimize surgical planning, with high accuracy. Post-operatively, MRI can evaluate the quality and success of tissue repair using grading systems like MOCART, which assess factors like defect fill, tissue structure, and bone changes. MRI is also important for long-term monitoring of repair and degenerative changes after cartilage treatment.
This document discusses various methods for rebuilding articular cartilage, including anti-inflammatory medications, injections of corticosteroids and hyaluronic acid, and surgical procedures like microfracture and mosaicplasty. It also covers the use of growth factors, scaffolds, and mechanical loading to stimulate and support cartilage regeneration. Effective scaffold designs are biocompatible, limit immune responses, induce cell maturation, provide structural support, and allow controlled delivery of stimulatory molecules.
This study evaluated morbidity after bone graft harvesting from the anterior or posterior iliac crest for maxillofacial and orthopedic procedures. 97 patients underwent either anterior or posterior iliac crest bone harvesting to augment the jaws. Postoperative pain levels were similar for both approaches based on patient questionnaires, with pain decreasing over 6 months. Most patients reported their scars were similar and nearly all would undergo the procedure again, suggesting both approaches provide bone grafts with acceptable morbidity. The posterior approach allows harvesting of larger amounts of bone.
-often suffer from cartilage injuries. Cartilage surgery is available in India to cure cartilage problems and prevent them from developing knee osteoarthritis. Autologous cartilage cell implantation is being done by Madras Joint replacement center at an affordable cost. This biological intervention will hopefully avoid a knee replacement in young individuals.
Biocartilage to Treat Osteochondral Defects of the Talus: Case Report and Tec...Jennifer Gerres, DPM
The document describes a case study and technique using BioCartilage to treat a large osteochondral defect of the talus. The key points are:
1) A 24-year old male presented with ankle pain and imaging revealed a 1.2cm x 1.6cm osteochondral defect of the talus.
2) The defect was excised and microdrilled. BioCartilage, a micronized hyaline cartilage allograft, mixed with blood or PRP was used to fill the defect.
3) BioCartilage offers advantages over other techniques like autografts in eliminating donor site morbidity and over ACI in being a single-stage procedure without wait time.
This document discusses autologous chondrocyte transplantation (ACT), a treatment for cartilage defects. It covers the stages of ACT healing, indications, prerequisites, investigations, the implantation procedure, and rehabilitation goals. The proliferative, transition, and remodeling stages of healing are described. Advantages include producing hyaline-like cartilage to fill defects of any size. Disadvantages include being more invasive and expensive with a longer recovery than other options.
Orthobiologics is a current terminology for the application of various cells, cytokines, growth factors.Tissue Engineering,Gene Therapy,Osteoarthritis,Avascular Necrosis,Sickle Cell Disease,Disc Regeneration,PRP,Autologous Chondrocyte Transplantation,BMAC,Spinal cord Injury paraplegia,Autoimmnune disorders,Diabetic foot,Tendinopathies,Wound Healing,,SCAFFOLDS IN STEM CELL THERAPY.Regenerative medicine is now an recognized specialty which has evolved from degerative diseases of Orthopaedic Surgery.Articular Cartilage : Repair To Regenerate To Replace Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com
MRI is useful for evaluating cartilage repair before and after surgery through ACI. Pre-operatively, MRI can estimate lesion size, nature, and location to optimize surgical planning, with high accuracy. Post-operatively, MRI can evaluate the quality and success of tissue repair using grading systems like MOCART, which assess factors like defect fill, tissue structure, and bone changes. MRI is also important for long-term monitoring of repair and degenerative changes after cartilage treatment.
This document discusses various methods for rebuilding articular cartilage, including anti-inflammatory medications, injections of corticosteroids and hyaluronic acid, and surgical procedures like microfracture and mosaicplasty. It also covers the use of growth factors, scaffolds, and mechanical loading to stimulate and support cartilage regeneration. Effective scaffold designs are biocompatible, limit immune responses, induce cell maturation, provide structural support, and allow controlled delivery of stimulatory molecules.
Autologous chondrocyte implantation (ACI) is a two-stage procedure to repair articular cartilage defects using a patient's own cartilage cells. In the first stage, a cartilage biopsy is taken and cells are cultured. In the second stage, the expanded cells are implanted under a periosteal flap over the prepared defect. Following implantation, the new tissue undergoes proliferation, transition, and remodeling phases over several months to years to mature into hyaline cartilage. ACI provides successful, durable outcomes for treating symptomatic cartilage defects.
H ridge augmentation with a collagen membrane and combination of particulated...threea3a
This prospective case series evaluated the use of a resorbable natural collagen membrane with a mixture of autogenous bone and anorganic bovine bone-derived mineral (ABBM) for lateral ridge augmentation to treat knife-edge ridges. 31 knife-edge ridge sites in 25 patients were treated. On average, 5.68 mm of lateral ridge augmentation was achieved after 8.9 months of healing. Histology showed ABBM was well incorporated into new bone formation. 76 implants were placed with no failures during an average follow-up of 20.88 months, demonstrating the technique can successfully augment knife-edge ridges for later implant placement.
application of bone graft in dentistryOmar Mabrouk
Bone grafting involves transplanting bone material from one site to another to aid bone regeneration. There are several types of grafts including autografts, allografts, xenografts, and alloplasts. Autografts are considered the gold standard as they are osteoinductive, osteoconductive, and osteogenic, but require a second surgical site. Allografts risk disease transmission. Bone graft healing relies on revascularization, with cancellous grafts replacing with new host bone within a year, while cortical grafts take longer. Grafting has various applications including alveolar ridge preservation and augmentation, maxillary sinus lifts, and distraction osteogenesis. Complications can include membrane perforation
This document discusses bone graft materials and techniques. It begins by defining a bone graft as material used to achieve 100% living bone tissue formation when placed in a compatible area. It then discusses various graft materials including particulate and block grafts, as well as growth enhancers. The document goes on to discuss factors that determine graft selection, the fate of grafts over time, and techniques for creating an ideal environment for graft incorporation.
The document summarizes a journal club discussion on autologous chondrocyte implantation (ACI) for treating articular cartilage defects in the knee. It provides details on the ACI procedure, which involves harvesting cartilage cells from a patient's knee, growing them in culture, and implanting them back into the defect using a periosteal patch or collagen membrane. The document compares ACI to other cartilage repair techniques like microfracture and drilling, finding ACI can regenerate hyaline-like cartilage while other techniques only produce fibrocartilage with limited lifespan. Rehabilitation guidelines and long-term assessment of ACI grafts via MRI, biopsy and arthroscopy are also summarized.
The document provides an overview of articular cartilage injuries and treatment methods. It discusses the composition and limited self-repair ability of cartilage. Imaging can detect cartilage defects and bone marrow edema. Treatment methods include non-invasive platelet rich plasma and bone marrow concentrate injections as well as surgical options like microfracture, mosaicplasty/OATS, and autologous chondrocyte implantation. Mosaicplasty has shown good long-term outcomes for small to medium defects while autologous chondrocyte implantation improves large defects, though both generate fibrocartilage. Future advances may include tissue engineering and 3D bioprinting of cartilage.
Dr. Paudel discussed bone graft substitutes, which are used to fill bone defects and promote healing. They discussed various types including allografts, ceramics, polymers, and composites. Allografts have disadvantages like immune reactions and disease transmission. Ceramics are osteoconductive but not structural. Composites combining materials like ceramics, cells, and growth factors may provide better fusion than any component alone. The ideal bone graft substitute would be osteoconductive, osteoinductive, and provide structural support like autografts, but without their disadvantages.
This study used 3D finite element analysis to investigate the effect of different bone qualities (D1-D4) on stress distribution in an implant-supported mandibular crown. The analysis found that bone qualities D3 and D4 experienced the highest von Mises stresses at the neck of the implant under a 300N load. Placement of implants in bone with greater cortical thickness and density (D1-D2) reduced stress concentration and is more favorable for implant stabilization and osseointegration. However, long-term clinical trials are needed to determine the relationship between bone quality and stress distribution on implant success.
bone graft /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Cytotherapy for osteonecrosis of hip.acta medica internationalSanjeev kumar Jain
The document discusses the use of cytotherapy, specifically autologous bone marrow transplantation, for the treatment of osteonecrosis of the hip. It provides background on how osteonecrosis leads to a decrease in mesenchymal stem cells and impaired bone remodeling. The document then reviews studies that have found autologous bone marrow transplantation can help increase stem cell levels and promote bone repair, potentially preventing the need for hip replacement surgery.
Periodontitits is a multifactorial disease which leads to progressive loss of periodontal tissues including the alveolar bone. Since autogenous bone grafting has been considered as the gold standard referring to the lowest incidence of graft rejection, this ppt gives an insight about the autogenous bone grafts that can be used in periodontal defects.
Bone tissue engineering challenges in oral and maxillofacial surgerySeyed Mohammad Zargar
This document discusses challenges in bone tissue engineering for oral and maxillofacial surgery. It provides an overview of maxillofacial defects and current reconstruction methods like non-vascularized and vascularized grafts. Tissue engineering is presented as a promising approach using scaffolds, stem cells, and growth factors. Key challenges in tissue engineering include identifying suitable cell sources, understanding how growth factors support cell differentiation, and the role of microvasculature in regeneration. Future progress requires improved collaboration between clinicians and engineers.
Maxillary sinus floor elevation with bovine bone mineral combined with either...Berenice Gomes
This randomized clinical trial compared bone formation in the maxillary sinus following sinus floor elevation using either bovine bone mineral (BBM) combined with autogenous bone (control group) or BBM combined with autogenous mesenchymal stem cells (MSC) (test group). Twelve patients underwent bilateral sinus floor elevation, with one side receiving BBM+bone and the other receiving BBM+MSC. Biopsies at 3 months found significantly more new bone formation in the BBM+MSC group (17.7% vs 12% in control). Both grafts allowed implant placement with primary stability. Seeding BBM with autogenous MSC may induce sufficient new bone for implant placement comparable to using autogenous bone alone.
The documents discuss various factors that influence bone regeneration, including osteogenic cells, osteoconductive scaffolds, growth factors, and the mechanical environment. Optimal bone regeneration requires an environment that supports osteoprogenitor cell recruitment, proliferation and differentiation, angiogenesis, and extracellular matrix formation. A variety of graft materials and their properties are reviewed in relation to supporting bone healing and regeneration.
This study assessed anchor resorption and bone ingrowth over time after shoulder labral repairs using biocomposite anchors. CT scans at 12 and 24 months found 68% and 98% of anchor material had been absorbed, with 56% and 78% replaced by soft tissue and 9% and 20% replaced by bone, respectively. MRI found no mechanical failures. Tunnel widening was seen in 55% of anchors but decreased over time. Subjective outcomes scores were good. The study provides evidence that biocomposite anchors resorb and are replaced by bone while maintaining clinical success after labral repair.
1) Periodontal bone grafting has been controversial but some studies show better outcomes with grafting materials compared to open flap debridement alone for severe bone defects.
2) This review aims to clarify the role of bone grafting in the current era of regeneration. It discusses bone graft definitions, objectives, types including autografts and allografts, and surgical procedures.
3) While periodontal regeneration is the goal, current bone grafting techniques can unpredictably result in either regeneration or repair. Improved methods related to root preparation, wound healing guidance, and use of growth factors may increase predictability of regeneration.
This document discusses various bone graft substitutes that can be used instead of autogenous bone grafts, which are associated with donor site morbidity. It describes natural bone-based substitutes including bone marrow aspirate and demineralized bone matrix. Growth factor-based substitutes containing proteins like BMPs are mentioned. Cell-based grafts using stem cells are also discussed. The document outlines various ceramic-based substitutes like hydroxyapatite, tri-calcium phosphate, bioactive glass and calcium sulfate. It provides details on their compositions and uses in fracture repair and filling bone defects. Complications of autogenous bone grafts are also summarized.
- The document discusses bone harvesting techniques for various donor sites including the chin, mandibular ramus, maxillary tuberosity, and intraoral vs extraoral sites. Key details are provided on indications, anatomy, harvesting procedure, complications, and principles of autogenous bone graft healing for each donor site. Autogenous grafts are considered the gold standard due to their osteogenic, osteoinductive and osteconductive properties.
Bone replacement grafts are widely used to promote
bone formation and periodontal regeneration.
Xenografts are grafts shared between different species.
Currently, there are two available sources of xenografts
used as bone replacement grafts in periodontics: bovine
bone and natural coral.
1) The study examined the reformation of the sagittal suture following surgery for isolated sagittal craniosynostosis in 42 children.
2) It found that only 7 of the 42 children (16.7%) reformed the suture, while 35 children (83.3%) experienced resynostosis of the sagittal suture.
3) This finding contradicted results from animal experiments, and the authors hypothesized that limiting coagulation on the dura and replacing the pericranium could potentially promote bone regeneration and suture reformation.
1) The document discusses a study finding a high rate of resynostosis (83.3%) of the sagittal suture following surgery for isolated sagittal craniosynostosis, contrary to animal experiments.
2) It hypothesizes that limiting coagulation of the dura and replacing the removed pericranium could potentially result in reformation of a normal suture and consistent bone regeneration.
3) Other potential factors for the discrepancy include genetic predisposition and inclusion of undiagnosed syndromic patients in the study.
This article reports on 5 consecutive cases where unsplinted dental implants were used to successfully retain maxillary overdentures with partial palatal coverage. A total of 25 textured implants were placed with a minimum of 4 implants per patient. After 12-48 months, none of the implants lost osseointegration and marginal bone levels remained stable. Patients were able to maintain soft tissue health around the unsplinted implants and reported being comfortable with the functioning of their maxillary overdentures. The preliminary results suggest that unsplinted implants can successfully retain removable maxillary overdentures with limited palatal coverage.
Autologous chondrocyte implantation (ACI) is a two-stage procedure to repair articular cartilage defects using a patient's own cartilage cells. In the first stage, a cartilage biopsy is taken and cells are cultured. In the second stage, the expanded cells are implanted under a periosteal flap over the prepared defect. Following implantation, the new tissue undergoes proliferation, transition, and remodeling phases over several months to years to mature into hyaline cartilage. ACI provides successful, durable outcomes for treating symptomatic cartilage defects.
H ridge augmentation with a collagen membrane and combination of particulated...threea3a
This prospective case series evaluated the use of a resorbable natural collagen membrane with a mixture of autogenous bone and anorganic bovine bone-derived mineral (ABBM) for lateral ridge augmentation to treat knife-edge ridges. 31 knife-edge ridge sites in 25 patients were treated. On average, 5.68 mm of lateral ridge augmentation was achieved after 8.9 months of healing. Histology showed ABBM was well incorporated into new bone formation. 76 implants were placed with no failures during an average follow-up of 20.88 months, demonstrating the technique can successfully augment knife-edge ridges for later implant placement.
application of bone graft in dentistryOmar Mabrouk
Bone grafting involves transplanting bone material from one site to another to aid bone regeneration. There are several types of grafts including autografts, allografts, xenografts, and alloplasts. Autografts are considered the gold standard as they are osteoinductive, osteoconductive, and osteogenic, but require a second surgical site. Allografts risk disease transmission. Bone graft healing relies on revascularization, with cancellous grafts replacing with new host bone within a year, while cortical grafts take longer. Grafting has various applications including alveolar ridge preservation and augmentation, maxillary sinus lifts, and distraction osteogenesis. Complications can include membrane perforation
This document discusses bone graft materials and techniques. It begins by defining a bone graft as material used to achieve 100% living bone tissue formation when placed in a compatible area. It then discusses various graft materials including particulate and block grafts, as well as growth enhancers. The document goes on to discuss factors that determine graft selection, the fate of grafts over time, and techniques for creating an ideal environment for graft incorporation.
The document summarizes a journal club discussion on autologous chondrocyte implantation (ACI) for treating articular cartilage defects in the knee. It provides details on the ACI procedure, which involves harvesting cartilage cells from a patient's knee, growing them in culture, and implanting them back into the defect using a periosteal patch or collagen membrane. The document compares ACI to other cartilage repair techniques like microfracture and drilling, finding ACI can regenerate hyaline-like cartilage while other techniques only produce fibrocartilage with limited lifespan. Rehabilitation guidelines and long-term assessment of ACI grafts via MRI, biopsy and arthroscopy are also summarized.
The document provides an overview of articular cartilage injuries and treatment methods. It discusses the composition and limited self-repair ability of cartilage. Imaging can detect cartilage defects and bone marrow edema. Treatment methods include non-invasive platelet rich plasma and bone marrow concentrate injections as well as surgical options like microfracture, mosaicplasty/OATS, and autologous chondrocyte implantation. Mosaicplasty has shown good long-term outcomes for small to medium defects while autologous chondrocyte implantation improves large defects, though both generate fibrocartilage. Future advances may include tissue engineering and 3D bioprinting of cartilage.
Dr. Paudel discussed bone graft substitutes, which are used to fill bone defects and promote healing. They discussed various types including allografts, ceramics, polymers, and composites. Allografts have disadvantages like immune reactions and disease transmission. Ceramics are osteoconductive but not structural. Composites combining materials like ceramics, cells, and growth factors may provide better fusion than any component alone. The ideal bone graft substitute would be osteoconductive, osteoinductive, and provide structural support like autografts, but without their disadvantages.
This study used 3D finite element analysis to investigate the effect of different bone qualities (D1-D4) on stress distribution in an implant-supported mandibular crown. The analysis found that bone qualities D3 and D4 experienced the highest von Mises stresses at the neck of the implant under a 300N load. Placement of implants in bone with greater cortical thickness and density (D1-D2) reduced stress concentration and is more favorable for implant stabilization and osseointegration. However, long-term clinical trials are needed to determine the relationship between bone quality and stress distribution on implant success.
bone graft /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Cytotherapy for osteonecrosis of hip.acta medica internationalSanjeev kumar Jain
The document discusses the use of cytotherapy, specifically autologous bone marrow transplantation, for the treatment of osteonecrosis of the hip. It provides background on how osteonecrosis leads to a decrease in mesenchymal stem cells and impaired bone remodeling. The document then reviews studies that have found autologous bone marrow transplantation can help increase stem cell levels and promote bone repair, potentially preventing the need for hip replacement surgery.
Periodontitits is a multifactorial disease which leads to progressive loss of periodontal tissues including the alveolar bone. Since autogenous bone grafting has been considered as the gold standard referring to the lowest incidence of graft rejection, this ppt gives an insight about the autogenous bone grafts that can be used in periodontal defects.
Bone tissue engineering challenges in oral and maxillofacial surgerySeyed Mohammad Zargar
This document discusses challenges in bone tissue engineering for oral and maxillofacial surgery. It provides an overview of maxillofacial defects and current reconstruction methods like non-vascularized and vascularized grafts. Tissue engineering is presented as a promising approach using scaffolds, stem cells, and growth factors. Key challenges in tissue engineering include identifying suitable cell sources, understanding how growth factors support cell differentiation, and the role of microvasculature in regeneration. Future progress requires improved collaboration between clinicians and engineers.
Maxillary sinus floor elevation with bovine bone mineral combined with either...Berenice Gomes
This randomized clinical trial compared bone formation in the maxillary sinus following sinus floor elevation using either bovine bone mineral (BBM) combined with autogenous bone (control group) or BBM combined with autogenous mesenchymal stem cells (MSC) (test group). Twelve patients underwent bilateral sinus floor elevation, with one side receiving BBM+bone and the other receiving BBM+MSC. Biopsies at 3 months found significantly more new bone formation in the BBM+MSC group (17.7% vs 12% in control). Both grafts allowed implant placement with primary stability. Seeding BBM with autogenous MSC may induce sufficient new bone for implant placement comparable to using autogenous bone alone.
The documents discuss various factors that influence bone regeneration, including osteogenic cells, osteoconductive scaffolds, growth factors, and the mechanical environment. Optimal bone regeneration requires an environment that supports osteoprogenitor cell recruitment, proliferation and differentiation, angiogenesis, and extracellular matrix formation. A variety of graft materials and their properties are reviewed in relation to supporting bone healing and regeneration.
This study assessed anchor resorption and bone ingrowth over time after shoulder labral repairs using biocomposite anchors. CT scans at 12 and 24 months found 68% and 98% of anchor material had been absorbed, with 56% and 78% replaced by soft tissue and 9% and 20% replaced by bone, respectively. MRI found no mechanical failures. Tunnel widening was seen in 55% of anchors but decreased over time. Subjective outcomes scores were good. The study provides evidence that biocomposite anchors resorb and are replaced by bone while maintaining clinical success after labral repair.
1) Periodontal bone grafting has been controversial but some studies show better outcomes with grafting materials compared to open flap debridement alone for severe bone defects.
2) This review aims to clarify the role of bone grafting in the current era of regeneration. It discusses bone graft definitions, objectives, types including autografts and allografts, and surgical procedures.
3) While periodontal regeneration is the goal, current bone grafting techniques can unpredictably result in either regeneration or repair. Improved methods related to root preparation, wound healing guidance, and use of growth factors may increase predictability of regeneration.
This document discusses various bone graft substitutes that can be used instead of autogenous bone grafts, which are associated with donor site morbidity. It describes natural bone-based substitutes including bone marrow aspirate and demineralized bone matrix. Growth factor-based substitutes containing proteins like BMPs are mentioned. Cell-based grafts using stem cells are also discussed. The document outlines various ceramic-based substitutes like hydroxyapatite, tri-calcium phosphate, bioactive glass and calcium sulfate. It provides details on their compositions and uses in fracture repair and filling bone defects. Complications of autogenous bone grafts are also summarized.
- The document discusses bone harvesting techniques for various donor sites including the chin, mandibular ramus, maxillary tuberosity, and intraoral vs extraoral sites. Key details are provided on indications, anatomy, harvesting procedure, complications, and principles of autogenous bone graft healing for each donor site. Autogenous grafts are considered the gold standard due to their osteogenic, osteoinductive and osteconductive properties.
Bone replacement grafts are widely used to promote
bone formation and periodontal regeneration.
Xenografts are grafts shared between different species.
Currently, there are two available sources of xenografts
used as bone replacement grafts in periodontics: bovine
bone and natural coral.
1) The study examined the reformation of the sagittal suture following surgery for isolated sagittal craniosynostosis in 42 children.
2) It found that only 7 of the 42 children (16.7%) reformed the suture, while 35 children (83.3%) experienced resynostosis of the sagittal suture.
3) This finding contradicted results from animal experiments, and the authors hypothesized that limiting coagulation on the dura and replacing the pericranium could potentially promote bone regeneration and suture reformation.
1) The document discusses a study finding a high rate of resynostosis (83.3%) of the sagittal suture following surgery for isolated sagittal craniosynostosis, contrary to animal experiments.
2) It hypothesizes that limiting coagulation of the dura and replacing the removed pericranium could potentially result in reformation of a normal suture and consistent bone regeneration.
3) Other potential factors for the discrepancy include genetic predisposition and inclusion of undiagnosed syndromic patients in the study.
This article reports on 5 consecutive cases where unsplinted dental implants were used to successfully retain maxillary overdentures with partial palatal coverage. A total of 25 textured implants were placed with a minimum of 4 implants per patient. After 12-48 months, none of the implants lost osseointegration and marginal bone levels remained stable. Patients were able to maintain soft tissue health around the unsplinted implants and reported being comfortable with the functioning of their maxillary overdentures. The preliminary results suggest that unsplinted implants can successfully retain removable maxillary overdentures with limited palatal coverage.
This study evaluated morbidity after bone graft harvesting from the anterior or posterior iliac crest in 97 patients undergoing maxillofacial surgery. Pain levels were similar for both approaches, peaking around 5 on a 10-point scale after 1 week, then decreasing to around 1-3 by 1 month and 1 by 6-12 months. The median pain duration was 14 days for anterior and 21 days for posterior harvesting. Scar ratings and willingness to repeat the procedure were also similar between groups. Both anterior and posterior iliac crest approaches can be recommended for bone graft harvesting, with posterior preferred for larger volumes.
Is lag screw fixation superior to plate fixation to treat fractures of the ma...Dr. SHEETAL KAPSE
This document summarizes a study comparing lag screw fixation versus plate fixation for treating fractures of the mandibular symphysis. The study reviewed 887 patient cases treated with either 2 lag screws or bone plates secured with screws. Results found no significant differences in healing outcomes, but lag screw fixation had fewer postoperative complications like wound dehiscence and need for hardware removal. Both techniques showed good outcomes, but lag screw application required more surgical skill while plates were easier for less experienced surgeons. The document reviews relevant past studies on plating techniques and biomechanics of mandible reconstruction.
The document describes a new bone regeneration protocol used by the authors involving immediate implant placement with bone grafting after a 3 week healing period. A case study is presented of a 68 year old female who had an upper lateral tooth extracted due to a root fracture. After 3 weeks of healing, an implant was placed with simultaneous bone grafting using a beta-TCP material called EthOss. Follow ups at 10 weeks and 18 months showed increased implant stability and bone regeneration, with good soft tissue outcomes. The authors conclude the protocol and materials help restore host bone more effectively while reducing patient discomfort compared to other methods.
The document describes an abstract book for a poster presentation at the Osteology Foundation on regenerative dentistry and dental tissue engineering. It provides details on the invited poster abstract committee members and categories. It announced that the best 5 abstracts in clinical and basic research categories will present to the committee. Prize awards for the best posters will be given. The accepted poster abstracts are numbered and organized by topic and presentation times are provided.
The document reviews three studies on the use of interbody spinal cages for treating compromised spinal columns due to trauma or disease. Specifically, it examines the use of expandable titanium cages and stackable cages, as well as the posterior surgical approach. The studies found that interbody cages can successfully correct kyphotic deformities and maintain spinal stability in patients with spinal trauma or tumors. Complication rates were low. The document concludes that interbody cages and the posterior surgical approach may provide good outcomes for treating certain spinal conditions.
The document discusses several studies on the applications and efficacy of hydroxyapatite (HA) scaffolds and composites for bone tissue engineering. Specifically:
1) A long-term study of 276 dual radius HA-coated acetabular cups found an 11% revision rate after 10 years due to aseptic loosening and osteolysis.
2) HA scaffolds containing varying ratios of collagen supported human osteoblast viability, proliferation, and phenotype maintenance in culture.
3) Scaffolds combining HA microparticles and extracellular matrix derived from osteoblasts or fibroblasts in vitro enhanced bone repair in a rat calvarial defect model.
4) A composite of poly-ε-caprolactone and HA supported mouse
1. This study aims to assess outcomes of arthroscopic reduction and fixation of ACL tibial eminence avulsion fractures using an arthroscopic pullout suture technique.
2. A retrospective and prospective study will be conducted on patients undergoing this technique for Types 2, 3, and 4 ACL tibial eminence fractures.
3. Functional outcomes will be evaluated using Lysholm and IKDC scores, and time to fracture union and restoration of knee anatomy will be assessed.
This research paper summarizes studies on using cell therapy and stem cells to regenerate cartilage in cases of avascular bone necrosis. It discusses how regenerative medicine using stem cells has potential to treat many orthopedic conditions. Specifically, it presents case studies where autologous transplantation of stem cells from bone marrow, adipose tissue or platelet rich plasma helped regenerate cartilage and bone in patients with avascular necrosis of the femoral head. The stem cells were able to differentiate into osteocytes and chondrocytes, integrating at the damaged site and promoting healing of fractures and cartilage defects.
2011 clinical outcome of dental implants placed with high insertion torquesMuaiyed Mahmoud Buzayan
This study evaluated 42 dental implants placed with high insertion torques of 70 Ncm or greater. All implants successfully integrated clinically and were stable after 1 year of loading. Marginal bone loss after 1 year was similar between implants placed with high torques (mean 1.24 mm) and low torques (mean 1.09 mm), indicating that high insertion torques did not negatively impact osseointegration or bone stability. The use of high insertion torques up to 176 Ncm did not prevent osseointegration and resulted in similar bone stability outcomes compared to lower torque implants.
This document summarizes two clinical cases where minimally invasive antral membrane balloon elevation was used to perform sinus lift procedures for single tooth implant placement in the posterior maxilla with reduced bone height. In both cases, the procedure allowed for sufficient bone augmentation to subsequently place dental implants. The procedure was found to be a relatively simple and safe method for rehabilitation of missing teeth in the challenging posterior maxilla, avoiding the need for more invasive sinus lift surgeries.
Atrophied Edentulous Mandible with Implant-Supported Overdenture; A 10-year f...Abu-Hussein Muhamad
Abstract: Severe atrophy of the inferior alveolar process and underlying basal bone often results in problems with a lower denture. These problems include insufficient retention of the lower denture, intolerance to loading by the mucosa, pain, difficulties with eating and speech, loss of soft-tissue support, and altered facial appearance. These problems are a challenge for the prosthodontist and surgeon. In this case report, patient with resorbed edentulous mandible was successfully rehabilitated using two dental implants placed in the interforaminal region with ball abutments opposing conventional maxillary complete denture. Key Words: dental implants; dental prosthesis, implant-supported; resorption,
Atrophied Edentulous Mandible with Implant-Supported Overdenture; A 10-year f...iosrjce
This document summarizes a case report of a patient with a severely resorbed edentulous mandible who was successfully rehabilitated with two dental implants placed in the interforaminal region with ball attachments supporting an overdenture. After 10 years of follow-up, the patient was highly satisfied with the retention, comfort and function provided by the implant-retained overdenture. The case report also reviews literature on the use of implant-supported overdentures for treating resorbed edentulous ridges, finding they provide better function and retention compared to conventional dentures and reduce further bone loss.
This study evaluated the outcome of immediately loading 15 dental implants in 4 patients over a mean follow-up period of 4.8 months. The mean marginal bone loss from implant surgery to immediate loading was 0.03 ± 0.07 mm, and 0.16 ± 0.17 mm after 3 months of continued loading. No implants failed, resulting in a 100% survival rate. The results suggest that immediate loading of dental implants can achieve high success rates of up to 6 months. However, long-term clinical studies with larger sample sizes are still needed.
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2. a pol l o m e d i c i n e 1 0 ( 2 0 1 3 ) 2 3 3 e2 3 6
Available online at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/apme
Case Report
Polyetheretherketone (PEEK) cages for cervical
interbody replacement
P.K. Sahoo*
Prof., Chief Consultant e Neuro & Spine Surgery, Apollo Hospitals, Plot No 251, Old Sainik School Road, Unit-15,
Bhubaneswar 751005, India
a r t i c l e i n f o
Article history:
Received 2 August 2013
Accepted 7 August 2013
Available online 4 September 2013
Keywords:
Cervical surgery
Interbody implant
PEEK cage
a b s t r a c t
Objective: This study evaluates the efficiency of interbody polyetheretherketone (PEEK) cage
implantation in 52 consecutive cases related for discogenic cervical disorders with radi-culopathy
or myelopathy.
Material and methods: Between the years 2010 and 2012, 52 patients were treated with cer-vical
interbody fusion using a PEEK cage. There were 27 male and 25 female patients and
the mean age was 46 years (range, 21e82 years). PEEK cages were packed with bone grafts
from anterior Superior vertebral body. Additional plating was used in some cases. The
median duration of follow-up was 12 months (range, 6e36months). Cervical X-rays were
routinely used in the follow-up to assess the fusion, pseudoarthrosis, kyphosis, cage
migration, subsidence or breakage.
Results: No implant insufficiency was observed in any case.
Conclusion: Efficient interbody replacement is still an ongoing problem in cervical surgery.
Different techniques and materials have been developed to overcome this problem. The
use of a cervical PEEK cage seems to be a good alternative in that it does not require bone
graft harvesting from iliac crest for achieving cervical interbody replacement.
Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.
1. Introduction
Surgery for cervical disc disease is one of the most common
procedures in daily neurosurgical practice. Since conventional
cervical fusion surgeries using autologous bone graft have
some complications such as graft collapse, expulsion, pseu-doarthrosis,
denovo neural, compression and graft site
morbidity, cervical cage implantation has been introduced
during the last decade. Spinal cage instrumentation to
enhance spinal fusion and stability in cervical spine surgery
has ensured an adequate increase in the height and the cross-sectional
area of the neural foramina and helped to correct
cervical kyphosis.1,2
Different cage types have been introduced to neurosurgical
practice. Although the early results with the Titanium cages
were satisfactory, problems such as migration, subsidence
and structural failure of the cage with some difficulties in post
operative magnetic resonance imaging were observed.3,4 PEEK
cages have recently been used in cervical surgery.
PEEK is polyetheretherketone, a semi-crystal polyaromatic
linear polymer. The use of a PEEK cage is becoming popular
because of better elasticity and radiolucency.5,6 In this study,
* Fax: þ91 0674 2303888.
E-mail addresses: prafullksahoo@hotmail.com, drpksahoo52@gmail.com.
0976-0016/$ e see front matter Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.apme.2013.08.009
3. 234 a p o l l o me d i c i n e 1 0 ( 2 0 1 3 ) 2 3 3 e2 3 6
we evaluated the efficiency of cervical PEEK cage replacement
in 52 patients with cervical discogenic disorders.
2. Patients and methods
During a 3-year interval, 52 patients with cervical Disc Her-niation
or degenerative disease underwent Surgery and cer-vical
PEEK cage replacement was done.
There were 27 male and 25 female patients and the mean
age was 46 years (range, 21e82 years). Clinical features were
cervical radiculopathy in 30 patients, myelopathy in 12 pa-tients
and myelo-radiculopathy in 10 patients. Anterior cer-vical
approaches were performed at one level in 42 patients
and at two levels in 10 patients. Ten of the patients with two
levels were operated on at neighboring vertebra levels.
The clinical data of the operated patients are summarized
in Table 1.
The operative procedure was performed by an anterior
approach and disc material was resected microscopically.
Spinal cord and nerve roots were decompressed in routine
fashion. Following decompression, a PEEK (Corner Stone;
Medtronic sofardanek) cage with suitable height and width
was packed with bone grafts from ant superior vertebral body
of the affected disc and the cage was introduced into the
intervertebral space with the help of intervertebral body dis-tractor.
Different commercial sizes of the cages are available.
The available heights for the cage are 5e6e7 mm and the
widths are 12e14 mm.
Additional plating was used in some cases. In the post
operative period, cervical orthoses were used for 2weeks post
operatively.
3. Results
The mean operative time was 90 min (range, 80e100 min) in
single-level surgery. The mean blood loss during surgery was
40 cc (range, 20e70 cc). The mean hospital stay was 4 days
ranging between 3 and 5 days. Patients’ follow-up ranged be-tween
6 months and 3 years (mean, 12 months). All of the
patients were followed with cervical X-rays to evaluate cage
migration, subsidence or breakage, cervical lordosis, pseu-doarthrosis
and fusion.
In one patient, a minimal collapse fracture was observed
due to bone resorption in the superior Vertebral body. Con-servative
treatment was preferred and the patient recovered
without additional surgery. Cervical interbody replacement
with PEEK cage was uneventful in all patients, continuing to
the present (Figs.1e3). Cervical X-rays were used to assess the
cages for fusion. A strong Bony bridge was observed between
the two corpuses with no mobility and no radiolucency
around the Cage in all patients. In rare instances, 3 DCT-scan
reconstructions were used to confirm bone fusion.
There were no patients with pseudo arthritis or wound
infection. We did not observe any problems such as cage
migration, subsidence or breakage. Fusion rates of PEEK cages
were 100% in cases with two years follow-up. The fusion rate
and duration were not related to the number of operated
levels.
4. Discussion
The PEEK cage is a polyetheretherketone, which provides
strength and stiffness in the intervertebral space. Biome-chanical
studies on PEEK cages demonstrate satisfactory
physiological values. The Resistance to pressure is 4170 N
(Newton) under a static position and 2160 N under a dynamic
position. The elastic character of the cage is similar to
bone.2,5,7 The PEEK cage induces cell attachment and Fibro-blast
proliferation and increases the protein content of the
osteoblasts.5,8 Following neural decompression, interbody
Table 1 e Demographic data of the patients operated on
using PEEK cages.
Men/women 27/25
Radiculopathy 30
Myelopathy 12
Myelo-radioculopathy 10
One level 42
C3e4 2
C4e5 9
C5e6 18
C6e7 13
Two levels 10
C3e4,4e5 1
C4e5,5e6 5
C5e6,6e7 4
Fig. 1 e PEEK cage AT C5eC6.
4. a pol l o m e d i c i n e 1 0 ( 2 0 1 3 ) 2 3 3 e2 3 6 235
replacement and bone fusion are the main goal of cervical
spine surgery.9 With autologous bone graft fusion, arthrodesis
was reported to be 97% by Brown et al.10 Savolainen et al. re-ported
a 98% fusion rate with autologous bone grafts but there
was a 16% rate of donor site complication.11 Reviews with ti-tanium
cages reveal bone fusion in 98%.12 When compared
with these data, the fusion rate with the PEEK cage presented
in this study seems to be superior to the autologous bone graft
and titanium cage applications. In different studies, fusion
with PEEK cage showed excellent resistance to crushing.12 The
force values applied during these biomechanical experiments
were higher than the forces applied to the cervical spine under
normal circumstances.12,7 In our cases, we did not observe any
problem such as cage migration, subsidence or breakage. We
used additional plating, to keep the PEEK cage in the disc space
and do not lead to cage migration.
Increasing the height and cross-sectional area of foramina
serves for nerve root decompression after cervical spine sur-gery.
However, extensive distraction for cage placement may
end up causing Radicular pain due to stretching of the nosi-ceptive
fiber in the joint capsule.1,4 Cages with 5e6e7 mm
thickness were inserted to maintain adequate foraminal
space. In our series, there was no case with post operative
radicular pain, indicating adequate foraminal height and
decompression.
Autologous bone from anterior superior body of the
involved disc was used for packing the PEEK cages to avoid the
necessity of autologous bone harvesting from iliac crest Cho
et al. Reported 40 patients who were operated on using PEEK
cages and autologous bone graft. They reported no donor site
complications. However, other series reported a 10e18% rate
of donor site complications.5
In our series, autologous bone from anterior superior
vertebral body of the involved disc demonstrated effective
bone fusion without any complication and with short hospital
stay.
Another advantage of the PEEK cage is its radio trans-parency.
It is compatible with magnetic resonance and
computed tomography imaging. This feature provides good
post operative spinal cord and Nerve root imaging without
implant artifact. Bone fusion can be easily evaluated with post
operative X-rays. The upper and bottom pins of the PEEK cage
also let us identify the actual cage position. The bio compati-bility
of the cage was excellent. There was no foreign body
reaction in our series. The time of implantation was short with
limited blood loss.
Fig. 2 e PEEK cage AT C5eC6, C6eC7.
Fig. 3 e Preoperative and post operative images of the case. Follow-up image of the patient with one-level PEEK cage at the
C5eC6 level. Image shows corrected cervical lordosis and bone fusion while the cage location is easily recognized by the
pins.
5. 236 a p o l l o me d i c i n e 1 0 ( 2 0 1 3 ) 2 3 3 e2 3 6
5. Conclusion
In our clinical study, usage of PEEK cage in cervical spine
surgery has a low complication rate, and is physiological,
strong and bio compatible, providing a good alternative for
interbody replacement.
Conflicts of interest
The author has none to declare.
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