Histological Assessment of Bone Regeneration in the Maxilla with Homologous Bone Graft:A Feasible Option for Maxillary Bone Reconstruction

Bone biomaterials have been increasingly used to reconstruct maxillary atrophic ridges.Thus,the aim of this study was to evaluate bone reconstruction in the maxilla using a homologous cortico-cancellous FFB(lyophilized)graft and verify its reliability.Eight individuals were included from 2014 to 2018.The first surgery was performed to install homologous bone blocks in the maxilla.The period of the second intervention varied between 5 months and 15 days to 11 months(≈7.93 months).The biopsies were taken from the central region of the matured graft during the surgery for implant placement.All patients presented clinical and radiographic conditions for the installation of dental implants.There was a 100%of survival rate.The histological assessment showed that the homologous block bone graft was an osteoconductive biomaterial,with connective tissue present,and newly formed bone juxtaposed on its surface.There were bone trabeculae with osteocytes and active osteoblasts with connective tissue in the mineralization process;the remodeling process can be found through the reverse lines.A limited focus of necrosis with fibrosis was detected,with small resorption and areas of inflammatory infiltrate,but without clinical significance.The homologous block bone graft can be considered a feasible option to substitute the autogenous bone graft(gold standard),with predictable clinical and favorable histological results.The patients had a shorter surgical period,low morbidity,and an unlimited amount of biomaterial available at an accessible cost.

Spoon-assisted autologous particulate bone graft harvesting technique

Particulate bone plays a crucial role in various oral and maxillofacial surgical procedures,including reconstruction,implantation,and craniofacial surgery.Autologous bone and deproteinized bovine bone xenografts are the two primary resources used for such procedures,with the former demonstrating superior cost-effectiveness and reduced comorbidity rates,particularly in cases involving donor zones.However,a significant challenge lies in acquiring uniformly sized autologous particulate bone specimens,with existing tools often yielding coarse particles at a high cost.Consequently,commercial bone xenograft solutions are frequently favored despite lower standards.This technical note introduces a novel technique for swiftly,safely,and efficiently obtaining autologous particulate bone specimens.The procedure involves the use of a motor handpiece fitted with a micro drill and surgical spoon to collect the bone particles.The continuous irrigation with saline maintains a clear surgical field during the milling process.The collected bone particles are then transferred to a metal capsule for further use.This technique offers a promising solution to the challenge of inconsistent particle size associated with harvesting using traditional methods,providing surgeons with a reliable and efficient method of obtaining autologous particulate bone samples.

Implementing P-15/ABM Bone Graft as a Standardized Technique for Lumbar Fusion Approaches

Introduction: Lumbar fusion as low back pain treatment continues to be a challenge because of the multiple techniques and materials available, most popular techniques include Transforaminal lumbar interbody fusion (TLIF), Lateral lumbar interbody fusion (LLIF) and Anterior lumbar interbody fusion (ALIF). Successful lumbar fusion is associated with better clinical outcomes, and it is enhanced and targeted through the use of bone graft materials as an osteogenic cell binding peptide P-15, bound to an anorganic bone mineral (ABM). This peptide improves bone formation when used in fixation devices in a targeted and limited way to the implant surface by activating osteoblast precursor cells;by the osteogenic, osteoinductive and osteoconductive stimuli. The main objective of this study is to standardize the lumbar fusion process in the 3 techniques and achieve a more efficient and predictable lumbar fusion, evaluating results with radiological and clinical scales. Material and Methods: Patients underwent lumbar fusion with the use of P-15 Osteogenic Cell Binding Peptide, bound to an anorganic bone mineral (P-15/ABM) bone graft (5 cc) in three different techniques (TLIF, LLIF, ALIF), achieving a total of 100 lumbar levels. Radiological outcomes included fusion rates per Hounsfield Units at computed tomography (CT) scan and Lenke scale. Clinical outcomes were evaluated via the Oswestry Disability Index (ODI), Short Form Performance (SPF-36) and Visual Analog Scale (VAS and VASs) for pain and satisfaction. Results: 67 patients completed the 12 months follow-up, showing no differences in fusion rates between techniques. (Computed Tomography Hounsfield Units) CTHU reaches more than 200 UH at 3 months follow-up and continues fusion process till 12-month follow-up. Clinical scales showed no disability at ODI, improvement at VAS and VASs scales, absence of health restrictions at SPF-36 score since 6 months follow up. Conclusion: Bone graft volume of 5 cc is adequate for achieving successful lumbar fusion, regardless of the surgical technique employed.

Correction of mandibular deficiency by inverted-L osteotomy of ramus and iliac crest bone grafting

This study was to describe the use of inverted-L osteotomy of ramus and lilac bone graft for the management of mandibular deficiency in adult patients. From 2008 to 2010, 11 patients （aged 19 to 29 years） with mandibular deficiency underwent intraoral or extraoral inverted-L osteotomy of ramus and lilac crest bone grafting. Data were collected from the patients＇ records, photographs and radiographs. The height and width of the ramus were successfully expanded by inverted-L osteotomy and lilac crest bone grafting with minimal complications in all patients, resulting in significant improvement in occlusion and facial appearance. Our early results showed that the inverted-L osteotomy of ramus and lilac crest bone grafting is safe and effective, and should be considered as a good alternative for the patients with mandibular deficiency.

Efficacy of bone grafts in jaw cystic lesions:A systematic review

BACKGROUND Bone grafts have been applied for many years in orthopedic surgery to assist with bone repair for defects or bone discontinuity caused by trauma and tumors as well as periodontal defects.Jaw cysts are another common benign disease of the maxillofacial region which may lead to pathological bone fracture,loss of teeth,and infection.However,whether bone grafts are beneficial for bone regeneration in jaw cystic lesions and when bone grafts should be used remains unclear.AIM To study the efficacy of bone grafts compared to spontaneous healing in the treatment of jaw cystic lesions.METHODS A literature search was performed in Medline,Cochrane Library and Embase to identify related articles published in English in the last ten years.The following key words and Me SH terms were used:“jaw cyst”,“cystic lesion”,“odontogenic cyst”,“periapical cyst”,“dentigerous cyst”,“follicular cyst”,“keratocyst”,“treatment”,“surgery”,“bone graft”,“enucleation”,“cystectomy”,and“bone regeneration”.Case reports,clinical trials,clinical studies,observational studies and randomized controlled trials were included.Study quality was evaluated.RESULTS Ten studies(n=10)met the inclusion criteria.Five studies reported spontaneous bone healing after enucleation,three studies investigated the efficacy of various bone grafts,and two randomized comparative studies focused on the comparison between spontaneous healing and bone grafting.Over 90%of bone regeneration occurred within 6 mo after bone grafting.The bone regeneration rate after cystectomy showed great variation,ranging from 50%to 100%after 6 mo,but reaching over 90%after 12 mo.CONCLUSION While the long-term superiority of bone grafting compared with spontaneous healing after cystectomy is unclear,bone grafts accelerate the process of healing and significantly increase bone quality.

Evaluation of Two Highly Porous Microcrystalline Biphasic Calcium Phosphate-Based Bone Grafts for Bone Regeneration: An Experimental Study in Rabbits

A biphasic bone grafting biomaterial based on a mixture of calcium phosphates and beta-tricalcium phosphate (β-TCP) phases with high nanoporosity was synthesized. The synthesis route was based on calcium phosphate composition and the incorporation of glycolic acid as a pore former, giving a material composed of 97% β-TCP and 3% calcium orthophosphates (CaPO4). An in vitro study of the purity, microstructure, crystalline domain, and pores size for the material obtained was performed by SEM analysis as well as full structural characterization. The region of interest related to the surface was determined by the specific surface area measured with the BET method. In vivo evaluation of bone response was performed by implanting the new low-cost biphasic manufacturing material synthesized in this work, which was compared with a biphasic material of similar chemical and microstructural composition existing in the commercial market and with higher cost called Synergy Odontit® β-TCP. The materials were implanted separately into 5 mm diameter defects in the tibias of New Zealand White rabbits at 30, 60, and 90 days. The results obtained showed that the host tissue well accepted the new biphasic material;the presence of new bone formation was observed. A more complete resorption was observed for the new microcrystalline biphasic material compared to for a commercial β-TCP material.

Tailoring Resorption Rates and Osteogenic Response in Xeno-Hybrid Bone Grafts: The Effect of Added Gelatins

Bone defects resulting from trauma,surgery,congenital malformations,and other factors are among the most common health problems nowadays.Although current strategies such as autografts and allografts are recognized as the most successful treatments for stimulating bone regeneration,limitations such as graft source and complications still exist.SmartBone?is a xeno-hybrid bone graft(made from bovine bone matrix,poly(L-lactic-co-e-caprolactone),and gelatin)with a positive clinical record for bone regen-eration.In this study,the formulation for designing xeno-hybrid bone grafts using gelatins from different sources(bovine-and porcine-derived gelatin,with bone grafts named SBN and SPK,respectively)was investigated,and the biological responses were evaluated in vitro and in vivo.The results demonstrate that gelatins from both bovine and porcine sources can be loaded onto SmartBone?successfully and safely,withstanding the aggressive manufacturing processes.Different bone cell responses were observed in vitro.SBN was found to enhance osteocalcin secretion while SPK was found to upregulate osteopontin from human osteoblasts.In vivo,both bone grafts promoted osteogenesis,but SPK degraded earlier than SBN.Our findings suggest that SBN and SPK provide different yet comparable solutions for optimizing the bone resorption and regeneration balance.These xeno-hybrid bone grafts possess ideal potential for bone defect repairing.

Treatment of Scaphoid Nonunion: Pedicled Vascularized Bone Graft vs. Traditional Bone Graft

The clinical results of the application of pedicled vascularized bone graft （VBG） from Lister＇s tubercle vs. traditional bone graft （TBG） were evaluated and compared. Thirteen cases of symptomatic scaphoid nonunion were treated between January 2011 and December 2012, including 7 cases subject to VBG and the rest 6 cases to TBG, respectively. Outcomes were assessed by modified Mayo wrist score system. All cases were followed up for an average period of 3.5 months after opera- tion. The results showed that total scores in VBG group were 86.4i9.4 after operation with excellent result in 4 cases, good in 2 and acceptable in one, and those in TBG group were 71.7±9.3 after operation with good result in 2 cases, acceptable in 3 and disappointing in one. Total score of wrist function was significantly improved in VBG group as compared with TBG group （P〈0.05）. Our study suggests that VBG method is more effective for treating scaphoid nonunion than TBG method.

Mid-term follow-up of one-stage posterior debridement, intertransverse process bone grafting and screw-rod system fixation for Brucella spondylitis of the lumbar spine

Objective:To investigate the short-term and medium-term efficacy of one-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation in the treatment of Brucella spondylitis of the lumbar spine.Method:156 cases of Brucella spondylitis of lumbar spine were selected and divided into experimental group(n=80)and combined group(n=76)according to different surgical methods.The experimental group was treated with one-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation.The combined group was treated with one-stage anterior debridement and intertransverse process bone grafting combined with posterior internal fixation.The operative indexes and clinical effects were compared between the two groups.Result:The operation time,intraoperative bleeding volume and time of landing after operation in the experimental group were less than those in the combined group,with statistical significance(P<0.05).VAS score,ODI index,Cobb angle and Frankel grade of nervous function in the two groups were significantly improved after 3 months and 36 months of treatment(P<0.05),but there was no significant difference between the two groups at the same time(P>0.05).There was no significant difference in the excellent and good rate between the two groups after 3 and 36 months of treatment(P>0.05).There was no recurrence of the lesion in both groups.The intertransverse process bone graft healed and the screw-rod system was well fixed.Conclusion:One-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation for treatment of Brucella spondylitis of lumbar spine are effective,with short operation time and less trauma,which are worthy of clinical promotion.

Comparative Evaluation of Ozone Treatment in Critical Size Bone Defects Reconstructed with Alloplastic Bone Grafts

The purpose of this study was to investigate osteogenesis promoted by osteoconductive properties of bone grafting materials and the histopathological effects of ozone on osteogenesis. In total, 56 Winstar rats were equally divided into 4 groups. In control group, calvarial bone defect was created in 14 rats. For second group, 8 mm calvarial bone defect with ozone treatment was applied in 14 rats. For third group, an alloplastic bone graft was implanted on 8 mm calvarial bone defect. In fourth group, alloplastic bone graft was inserted in calvarial defect and ozone was treated additionally. Seven of the rats were sacrificed at the end of 4th week and the remaining 7 were sacrificed at the end of 8th week of experiment. In the study, the periosteal flaps were removed with a thin periosteal elevator and averagely 0.8 cm diameter-circular full bone defect was created with a specially designed trephine drill. The bone from the calvarial region was fixed in 10% formalin solution. After decalcification, bones were taken for routine paraffin blocking. Sections were stained with Hematoxylin-Eosin and Masson Trichrome. Histopathological findings of 4th and 8th weeks rats showed that best result for new bone formation was observed in graft + ozone treatment. It is concluded that ozone treatment increases the hemostasis in graft region, induces angiogenesis, promotes cell proliferation by preventing infiltration, induces matrix formation by influencing osteoblastic activity and has a positive effect in osteogenesis.

Is there a connection between synthetic bone grafts and sisters chromatide exchange?

Background: In oral and maxillofacial surgery, synthetic bone grafts are most widely used as bone substitutes, due to the limited sources of autologous bone. The aim of this study was to examine the influence of three different synthetic bone grafts (Cerasorb, Fortoss and Perioglass) on sisters chromatide exchanges (SCEs) in peripheral lymphocytes. Materials and Methods: Peripheral blood samples taken from 68 patients (45 females and 23 males), who underwent oral surgery procedures, such as apical resection, cyst enucleation or periodontal curretage, were obtained for SCE a day before and two months after the surgeries. A control group included 30 patients, while the study group was made of the patients who underwent bone grafting with Cerasorb? (11 patients), Fortoss? VITAL (10 patients) or Perioglass? (17 patients). Results: Comparing with the results of the study group before and after the treatment, it was concluded that the results were statistically significant (p = 0.001). In the Perioglass? subgroup, a greater statistical significance (p = 0.003) was noted, than that in either the Cerasorb? (p = 0.620) or Fortoss? (p = 0.210) subgroups, in which there was no statistical significance. Conclusions: Although further investigations may be necessary, our results suggest that the synthetic bone grafts might have an influence on SCE in peripheral lymphocytes.

Evaluation of 4 different bone graft substitutes and autogenous bone grafting in root-end resection osteotomies after retrograde root-filling with Intermediate Restorative Material(IRM):An experimental study in dogs

Purpose: To investigate the periapical tissue response after root end filling with intermediate restorative material (IRM) and filling of the root-end resection bone defects with autogenous bone or a bone graft substitute in comparison to empty controls. Materials and Methods: Vital roots of the second, third and fourth mandibular premolars in six healthy mongrel dogs were apectomized. The root canals were prepared and sealed with IRM following a standardized surgical procedure. The resection bone defects were either filled with autogenous bone (PB) or one of the bone graft substitutes;CERAMENTTM|BONE VOID FILLER, ChronOS?, TigranTM PTG, Easygraft? CLASSIC or left empty. After 120 days the animals were sacrificed and the specimens were analyzed radiologically and histologically. Kruskal-Wallis and Mann-Whitney tests were performed for statistical evaluation. Results: 34 sections were analyzed histologically. The evaluation revealed a variation in the outcome amongst the tested options, regarding reestablishment of the periapical bone healing and inflammatory infiltration in the sections. According to the tested variables, there was no statistical significant difference between the materials when comparing all groups as a whole. When comparing individual materials to each other there was statistical differences among some of the tested materials. Conclusion: The healing outcome after periapical surgery of a five-wall resection defect could not be increased by infill with autogenous bone or bone graft substitutes. The most important factor for the healing outcome in periapical surgery is the quality of the root-end sealing. The healing outcome after some of the tested bone substitutes, might be improved by longer healing time.

Clinical observation of bone graft impaction on posterior intervertebral body fusion for lumbar spondylolisthesis

Objective To investigate the clinical effect of bone graft impaction on posterior intervertebral fusion for lumbar spondylolisthesis.Methods From January 2001 to July 2008,36 patients with lumbar spondylolisthesis were treated by

Atlantoaxial joint fusion using anterior transarticular screw fixation and bone grafting for atlantoaxial joint instability

Objective To evaluate the clinical application of atlantoaxial joint fusion using anterior transarticular screw fixation and bone grafting for atlantoaxial joint instability. Methods Twenty-three cases of atlantoaxial joint instability were

Treatment of Thoracolumbar Vertebrate Fracture by Transpedicular Morselized Bone Grafting in Vertebrae for Spinal Fusion and Pedicle Screw Fixation

To enhance the fusion of graft bone in thoracolumbar vertebrae and minimize the postoperative loss of correction, short-segment pedicle screw fixation was reinforced with posterior moselizee bone grafting in vertebrae for spinal fusion in patients with thoracrolumbar vertebrate fractures. Seventy patients with thoracrolumbar vertebrate fractures were treated by short-segment pedicle screw fixation and were randomly divided into two groups. Fractures in group A （n=20） were rein-forced with posterior morselized bone grafting in vertebrae for spinal fusion, while patients group B （n=50） did not receive the morselized bone grafting for bone fusion. The two groups were compared in terms of kyphotic deformity, anterior vertebral height, instrument failure and neurological functions after the treatment. Frankel grading system was used for the evaluation of neurological evaluation and Denis scoring scale was employed for pain assessment. The results showed that the kyphosis correction was achieved in both group A and group B （group A： 6.4 degree; group B： 5.4 degree）/At the end of follow-up, kyphosis correction was maintained in group A but lost in group B （P=0.0001）. Postoperatively, greater anterior height was achieved in group A than in group B （P〈0.01）. During follow-up study, anterior vertebral height was maintained only in Group A （P〈0.001）. Both group A and group B showed good Denis pain scores （P1 and P2） but group A outdid group B in terms of control of severe and constant pain （P4 and P5）. By Frankel criteria, the changes in neurological functions in group A was better than those of group B （P〈0.001）. It is concluded that reinforcement of short-segment pedicle fixation with morselized bone grafting for the treatment of patients with thoracolumbar vertebrae fracture could achieve and maintain kyphosis correction, and it may also increase and maintain anterior vertebral height. Morselized bone grafting in vertebrae offers immediate spinal stability in patients with thoracolumbar vertebrate fractures, decreases the instrument failure and provides better postoperative pain control than without the morselized bone grafting.

Ability of bone graft substitutes to support the osteoprogenitor cells: An in-vitro study

AIM: To compare seven commercially available bone graft substitutes(BGS) in terms of these properties and without using any additional biological growth factors.METHODS: Porcine osteoprogenitor cells were loaded on seven commercially available BGS and allowed to proliferate for one week followed by osteogenic induction. Staining for live/dead cells as well as scanning electron microscopy(SEM) was carried out to determine viability and cellular binding. Further outcome measures included alkaline phosphatase(ALP) assays with normalisation for DNA content to quantify osteogenic potential. Negative and positive control experiments were carried out in parallel to validate the results.RESULTS: Live/dead and SEM imaging showed higher viability and attachment with β-tricalcium phosphate(β-TCP) than with other BGS(P < 0.05). The average ALP activity in nmol/mL(normalised value for DNA content in nmol/μg DNA) per sample was 657.58(132.03) for β-TCP, 36.22(unable to normalise) for calcium sulphate, 19.93(11.39) for the Hydroxyapatite/Tricalcium Phosphate composite, 14.79(18.53) for polygraft, 13.98(8.15) for the highly porous β-Tricalcium Phosphate, 5.56(10.0) for polymers, and 3.82(3.8) for Hydroxyapatite.CONCLUSION: Under the above experimental conditions, β-TCP was able to maintain better the viability of osteoprogenitor cells and allow proliferation and differentiation(P < 0.05).

Bone graft substitutes for spine fusion: A brief review

Bone graft substitutes are widely used in the field of orthopedics and are extensively used to promote vertebral fusion. Fusion is the most common technique in spine surgery and is used to treat morbidities and relieve discomfort. Allograft and autograft bone substitutes are currently the most commonly used bone grafts to promote fusion. These approaches pose limitations and present complications to the patient. Numerous alternative bone graft substitutes are on the market or have been developed and proposed for application. These options have attempted to promote spine fusion by enhancing osteogenic properties. In this review, we reviewed biology of spine fusion and the current advances in biomedical materials and biological strategies for application in surgical spine fusion. Our findings illustrate that, while many bone graft substitutes perform well as bone graft extenders, only osteoinductive proteins(recombinant bone morphogenetic proteins-2 and osteogenic protein-1) provide evidence for use as both bone enhancers and bone substitutes for specific types of spinal fusion. Tissue engineered hydrogels, synthetic polymer composites and viral based gene therapy also holds the potential to be used for spine fusion in future, though warrants further investigation to be used in clinical practice.

Acetabular Reconstruction with Massive Allograft Shaped to the Cavity and Kerboull-Type Acetabular Reinforcement Device for Multiple Failures of Impaction Bone Graft: A Case Report

Acetabular component revision in the presence of severe bone loss is difficult for reconstructing an acetabular component in the anatomical hip center. Various treatment options are available, although often the acetabular defect cannot be corrected with a single option alone. Precise assessment of the bone loss and a suitable combination of methods are needed. Here we report a case of multiple failures with impaction bone grafting reconstruction for an acetabular bone defect of American Academy of Orthopedic Surgeons classification type III. We finally reconstructed the acetabulum with three femoral head allografts and a Kerboull-type acetabular reinforcement device. The allograft was a casted, jet-type helmet-like shape. A year later the patient was able to walk without a cane and perform light agricultural work. Accurate evaluation of the acetabular bone loss and appropriate reconstruction is important.

Experiment of non-vascularized iliac bone grafts with the simultaneous placement of titanium nnplants

AIM:To investigate the osseointegration process of titanium implant and non-vascularized iliac bone grafts.METHODS:12 mongrel were divided into 4 groups randomly.Bone grafts were resected from iliac crest and then transplanted to the other side.Animals were skilled in different time after surgery,X-ray pictures were taken,then histological observation were done.RESULTS:At 3rd week,bone grafts dissolved,resorbed or necrosis partly;At 6th week,new bone began to regenerated;At 9th week,the amount of new bone increased;At 12nd week,bone interface around implant formed,without soft tissue interrupt.CONCLUSION:Osseointegration can formed between non-vascularized iliac bone grafts and titanium implant.

In vivo testing of a bone graft containing chitosan, calcium sulfate and osteoblasts in a paste form in a critical size defect model in rats

Bone loss associated with musculoskeletal trauma or metabolic diseases often require bone grafting. The supply of allograft and auto-graft bones is limited. Hence, development of synthetic bone grafting materials is an active area of research. Chitosan, extracted from chitin present in crawfish shells, was tested as a de-livery vehicle for osteoblasts in a 2-3 mm size defect model in rats. Twenty-seven male Lewis rats, divided into three groups with sacrifice intervals of 3, 6 &amp;amp;9 months were used. In the experimental samples, a critical size defect was filled with chitosan bone graft paste and fixed with a plate, while in the operated control group, a critical size defect was repaired only by a plate (no paste was applied). An unoperated control group was also included. Bone growth was evaluated histologically by examining undecal-cified and decalcified stained sections. The fe-murs were also examined non-destructively by micro-computed tomography (礐T). Defects filled with chitosan bone graft paste demon-strated superior healing across all time periods compared to unfilled defects as examined by histology and micro-computed tomography. Crawfish chitosan has successfully been used as a cell delivery system for osteoblasts for use as a synthetic bone graft material.