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In Situ Endoscopic Analysis of Vascular Supply and Regenerated Alveolar Bone in β-TCP Grafted and Ungrafted Postextraction Sites before Implant Placement: A Prospective Case Control Study.
Beltrán, V, Lazzarini, M, Figueroa, R, Sousa, V, Engelke, W
BioMed research international. 2019;:2797210
Abstract
BACKGROUND Endoscopy has seen a significant development over recent years in various medical fields with its application expanding from the support of minimal invasive surgery to in situ imaging. In this context, the application of endoscopic techniques to assess the quality of the regenerated bone in situ in the drill hole before implant placement is an appealing approach. AIM: The aim of this study was to use short distance support immersion endoscopy (SD-SIE) to compare the quality of regenerated bone in healed postextraction sites, which are grafted with an in situ hardening β-TCP, against ungrafted sites, before implant placement. This assessment was based on microscopic bone analysis in combination with the blood vessel count. METHOD 13 spontaneously healed and 13 grafted postextraction sites in 3 men and 6 women, aged 26-83 years, were evaluated using SD-SIE after 4-6 months. SD-SIE was applied in drill holes before implant placement, and videos were taken from representative central buccal areas. The video recordings were analyzed using Image J software for (1) number of blood vessels per area (NBV), (2) relative area of vessels (VA), (3) relative area of mineralized bone (MBA), (4) relative area of unmineralized bone (UMBA), and (5) relative area of bone substitute (BSA). RESULTS The grafted sites showed more (1) NBV as well as (2) VA (8.6 ± 1.1; 2.03 ± 0.28%) than the ungrafted sites (2.5 ± 0.6; 1.18 ± 0.36%) (independent t-test; p < 0.05); (3) MBA and (4) UMBA were similar to those in the grafted sites (86.3 ± 2.2 %; 13.7 ± 2.2 %) and to the ungrafted sites (89.5 ± 3.7%; 10.5 ± 3.6%) (independent t-test; p > 0.05); and (5) BSA in the grafted sites was 18.2 ± 5.4%. CONCLUSION SD-SIE is an interesting new approach for in situ assessment of bone quality and blood supply before implant placement. The regenerated bone in β-TCP grafted extraction sockets showed an increased vascularization compared to ungrafted sites providing a vital support for subsequent implant placement.
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Masquelet technique and osteomyelitis: innovations and literature review.
Careri, S, Vitiello, R, Oliva, MS, Ziranu, A, Maccauro, G, Perisano, C
European review for medical and pharmacological sciences. 2019;(2 Suppl):210-216
Abstract
OBJECTIVE Wide diaphyseal bone defects, above all those infected, encounter into Masquelet technique a suitable treatment. The two-step procedure allows the surgeon to eliminate the infected tissues and then to promote new bone formation. We analyzed the literature about the use of the induced membrane technique in osteomyelitis and the innovations recently suggested. MATERIALS AND METHODS We reviewed some of the most common web databases using the key-words: Masquelet technique, induced membrane, and osteomyelitis. 66 studies were analyzed. RESULTS Comparing the Masquelet technique to other surgical procedures it shows better functional results in large bone defects due to infection. The induced membrane is like a biological chamber that protects the autograft and induces new bone formation promoting growth factors secretion. Different authors tried to improve one or more steps of the surgical procedure. Some studies focused on polymethyl methacrylate role and the possibility to use different materials instead of cement to induce the membrane. Others analyzed the autograft harvesting and placing techniques trying to reduce the amount of bone essential to fill the gap, like the RIA technique. Moreover, bone substitutes have been used, as beta-tricalcium phosphate, that showed an osteoconductive ability. CONCLUSIONS The survey is not a systematic review. Nevertheless, new concepts are introduced and analyzed identifying 6 areas of interest and induced membrane technique development.
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Evaluation of the Efficacy of a 1:1 Mixture of β-TCP and rhPDGF-BB in the Surgical Management of Two- and Three-Wall Intraosseous Defects: A Prospective Clinical Trial.
Kavyamala, D, G, NVS, Dwarakanath, CD, Anudeep, M
The International journal of periodontics & restorative dentistry. 2019;(1):107-113
Abstract
The aim of this split-mouth clinical and radiographic study was to evaluate and compare the regenerative potential of a combination of recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and beta tricalcium phosphate (β-TCP) to the established technique of bone grafting with β-TCP alone in the surgical management of intraosseous defects. A total of 24 sites in 12 subjects with intraosseous defects were included and randomly divided into test (rhPDGF-BB + β-TCP) and control (β-TCP alone) sites. Clinical parameters were recorded at baseline, 3 months, and 6 months. Radiographic parameters were evaluated at baseline and 6 months. Both groups showed statistically significant reductions of all clinical parameters. Intergroup comparison demonstrated a significantly greater probing pocket depth reduction and clinical attachment level gain in the test group. The mean percentage defect fill was significantly greater in the test group than in the control group at 3 and 6 months, and greater improvement in defect angle was also evident in the test group. Although both groups showed definitive improvements in all parameters, the test group showed significantly better results when used to treat human periodontal intraosseous defects.
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4.
Biological Properties of Calcium Phosphate Bioactive Glass Composite Bone Substitutes: Current Experimental Evidence.
Karadjian, M, Essers, C, Tsitlakidis, S, Reible, B, Moghaddam, A, Boccaccini, AR, Westhauser, F
International journal of molecular sciences. 2019;(2)
Abstract
Standard treatment for bone defects is the biological reconstruction using autologous bone-a therapeutical approach that suffers from limitations such as the restricted amount of bone available for harvesting and the necessity for an additional intervention that is potentially followed by donor-site complications. Therefore, synthetic bone substitutes have been developed in order to reduce or even replace the usage of autologous bone as grafting material. This structured review focuses on the question whether calcium phosphates (CaPs) and bioactive glasses (BGs), both established bone substitute materials, show improved properties when combined in CaP/BG composites. It therefore summarizes the most recent experimental data in order to provide a better understanding of the biological properties in general and the osteogenic properties in particular of CaP/BG composite bone substitute materials. As a result, BGs seem to be beneficial for the osteogenic differentiation of precursor cell populations in-vitro when added to CaPs. Furthermore, the presence of BG supports integration of CaP/BG composites into bone in-vivo and enhances bone formation under certain circumstances.
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5.
Demineralized Bone Matrix Carriers and their Clinical Applications: An Overview.
Zhang, H, Yang, L, Yang, XG, Wang, F, Feng, JT, Hua, KC, Li, Q, Hu, YC
Orthopaedic surgery. 2019;(5):725-737
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Abstract
Reconstruction of massive bone defects is challenging for orthopaedic clinicians, especially in cases of severe trauma and resection of tumors in various locales. Autologous iliac crest bone graft (ICBG) is the "gold standard" for bone grafting. However, the limited availability and complications at donor sites resulted in seeking other options like allografts and bone graft substitutes. Demineralized bone matrix (DBM) is a form of allograft using acidic solution to remove mineral components, while leaving much of the proteinaceous components native to bone, with small amounts of calcium-based solids, inorganic phosphates, and some trace cell debris. It is an osteoconductive and osteoinductive biomaterial and is approved as a medical device for use in bone defects and spinal fusion. To pack consistently into the defect sites and stay firmly in the filling parts, DBM products have various forms combined with biocompatible viscous carriers, including sponges, strips, injectable putty, paste, and paste infused with chips. The present review aims to summarize the properties of various kind of viscous carriers and their clinical use combined with DBM in commercially available products. Given DBM'mercially available products. Given DBM;s long clinical track record and commercial accessibility in standard forms, opportunities to further develop and validate DBM as a versatile bone biomaterial in orthopaedic repair and regenerative medicine contexts are attractive.
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Screen-enrich-combine circulating system to prepare MSC/β-TCP for bone repair in fractures with depressed tibial plateau.
Chu, W, Wang, X, Gan, Y, Zhuang, Y, Shi, D, Liu, F, Sun, Y, Zhao, J, Tang, T, Dai, K
Regenerative medicine. 2019;(6):555-569
Abstract
Aim: To evaluate the clinical efficacy of mesenchymal stem cell/β-tricalcium phosphate composites (MSC/β-TCP) prepared with a screen-enrich-combine circulating system (SECCS) in patients with depressed tibial plateau fractures. Materials & methods: Bone defects in depressed tibial plateaus were filled with MSC/β-TCP (n = 16) or with β-TCP only (n = 23). Enrichment efficiency and effect of enrichment on cell viability were evaluated. Clinical results were assessed by imaging examination and Lysholm score. Results: SECCS effectively integrated MSCs with β-TCP. At 18 months postimplantation, new bone ratio was significantly higher in patients treated with MSC/β-TCP than in those treated with β-TCP only (p = 0.000). Patients with MSC/β-TCP implants had better functional recovery (p = 0.028). Conclusion: MSC/β-TCP prepared by SECCS were effective in the treatment of bone defects in patients with depressed tibial plateau fractures, promoted bone regeneration and improved joint function recovery.
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Are Subchondral Intraosseous Injections Effective and Safe for the Treatment of Knee Osteoarthritis? A Systematic Review.
Sundaram, K, Vargas-Hernández, JS, Sanchez, TR, Moreu, NM, Mont, MA, Higuera, CA, Piuzzi, NS
The journal of knee surgery. 2019;(11):1046-1057
Abstract
Knee osteoarthritis (OA) is a highly prevalent disease and treatment options for early stages of OA are needed. Intraosseous injections of bone substitute and biologic materials have been proposed to expand the therapeutic arsenal by potentially halting OA progression and delaying the need for knee arthroplasty in patients with early/moderate-stage disease. Therefore, the goal of this study was assessed the efficacy and safety of subchondral intraosseous injection for the treatment of knee OA. A systematic review was performed on PubMed-Medline, and the Cochrane Database of systematic reviews. English and Spanish retrospective and prospective studies assessing the results of subchondral intraosseous injection of bone substitute materials and/or biologicals in human patients with knee OA, with a minimum of 6 months of follow-up were collected. A total of 1,081 potential articles were identified through our search. Six studies were included with a total of 163 patients. The mean follow-up was 18 months (range: 6-24 months). Patient reported outcomes measures (PROMs), complications, and conversion to total knee arthroplasty (TKA) were collected. All six studies showed PROMs improvement relative to baseline. Overall, the five studies reporting visual-analog scale (VAS) pain outcomes improved from a baseline mean score of 6.68 to 2.74. Also, knee injury and osteoarthritis score (KOOS), Tegner-Lysholm, and/or international knee documentation committee (IKDC) scores rose compared with baseline scores in all studies. Overall, 2.5% (4/163) of patients had a complication attributed to study-related treatment. Most patients (81%, 86/106) remained TKA-free at a 1-year follow-up. Subchondral intraosseous injections of bone substitute materials and platelet-rich plasma (PRP) suggest (1) improved PROMs of pain and functional status, (2) low complication rate, and (3) relatively low rates of conversion to TKA. However, the current studies investigating these treatments exhibited high degree of heterogeneity in both measurement of outcomes and delivery of treatment, with a high risk of bias. This procedure should not be utilized in advanced knee OA. In light of the limitations of the current literature, advising in favor or against this therapy for early to moderate knee OA is challenging.
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Prospective and Randomized Evaluation of ChronOS and Bio-Oss in Human Maxillary Sinuses: Histomorphometric and Immunohistochemical Assignment for Runx 2, Vascular Endothelial Growth Factor, and Osteocalcin.
Bonardi, JP, Pereira, RDS, Boos Lima, FBDJ, Faverani, LP, Griza, GL, Okamoto, R, Hochuli-Vieira, E
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2018;(2):325-335
Abstract
PURPOSE The aim of this study was to compare ChronOS (β-tricalcium phosphate), Bio-Oss, and their addition to an autogenous bone graft in a 1:1 ratio in human maxillary sinus bone augmentation. MATERIALS AND METHODS Thirty maxillary sinuses were divided in 5 groups: group 1 included 6 maxillary sinuses grafted with autogenous bone graft alone; group 2 included 6 maxillary sinuses grafted with ChronOS; group 3 included 6 maxillary sinuses grafted with ChronOS and autogenous bone graft in a 1:1 ratio; group 4 included 6 maxillary sinuses grafted with Bio-Oss; and group 5 included 6 maxillary sinuses grafted with Bio-Oss and autogenous bone graft in a 1:1 ratio. The number of samples for each group was determined by the statistical power test. RESULTS The median areas of new bone formation in groups 1, 2, 3, 4, and 5 were 121,917.0, 83,787.0, 99,295.0, 65,717.0, and 56,230.0 μm2, respectively. Statistically significant differences were found between groups 3 and 5, groups 1 and 4, and groups 1 and 5 (P < .05). The median areas of remaining biomaterial were 2,900.5, 5,291.0, 2,662.0, 56,258.5, and 64,753.5 μm2 in groups 1, 2, 3, 4 and 5, respectively. Statistically significant differences occurred between groups 1 and 5, groups 3 and 5, and groups 2 and 5 (P < .05). Areas of connective tissue were 67,829.0 ± 22,984.6 μm2 in group 1, 97,445.9 ± 18,983.3 μm2 in group 2, 88,256.0 ± 21,820.5 μm2 in group 3, 65,501.8 ± 6,297.6 in group 4, and 70,203.2 ± 13,421.3 μm2 in group 5. CONCLUSIONS ChronOS combined with autogenous bone graft presented a behavior similar to that of autogenous bone graft alone. However, the groups treated with Bio-Oss showed immuno-labeling results indicating maturation of grafted bone.
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Subchondroplasty: Treatment of Bone Marrow Lesions in the Lower Extremity.
Pelucacci, LM, LaPorta, GA
Clinics in podiatric medicine and surgery. 2018;(4):367-371
Abstract
Bone marrow lesions are associated with pain, disease progression, and cartilage loss in inflammatory and noninflammatory conditions, and are related to mechanical loading and subchondral stress. Treatment, particularly in the foot and ankle, is challenging. In the subchondroplasty procedure, flowable, synthetic, calcium phosphate bone filler is injected into the defect region, improving subchondral bone integrity and allowing remodeling back into healthy cancellous bone. The procedure is a promising treatment option for bone marrow lesions, particularly in the foot and ankle. The benefits are a minimally invasive procedure with early return to weightbearing.
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10.
Mechanical and Biological Properties of a Biodegradable Mg-Zn-Ca Porous Alloy.
Zhang, YQ, Li, Y, Liu, H, Bai, J, Bao, NR, Zhang, Y, He, P, Zhao, JN, Tao, L, Xue, F, et al
Orthopaedic surgery. 2018;(2):160-168
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Abstract
OBJECTIVES As promising alternative to current metallic biomaterials, the porous Mg scaffold with a 3-D open-pore framework has drawn much attention in recent years due to its suitable biodegradation, biocompatibility, and mechanical properties for human bones. This experiment's aim is to study the mechanical properties, biosafety, and osteogenesis of porous Mg-Zn alloy. METHODS A porous Mg-2Zn-0.3Ca (wt%) alloy was successfully prepared by infiltration casting, and the size of NaCl particles was detected by a laser particle size analyzer. The microstructure of the Mg-2Zn-0.3Ca alloy was characterized by the stereoscopic microscope and Sirion Field emission scanning electron microscope. X-ray computerized tomography scanning (x-CT) was used to create the 3-D image. The degradation rate was measured using the mass loss method and the pH values were determined together. The engineering stress-strain curve, compressive modulus, and yield strength were tested next. The bone marrow stromal cells (BMSC) were cultured in vitro. The CCK-8 method was used to detect the proliferation of the BMSC. Alkaline phosphatase (ALP) and alizarin red staining were used to reflect the differentiation effects. After co-culturing, cell growth on the material's surface was observed by scanning electron microscope (SEM). The cell adhesion was tested by confocal microscopy. RESULTS The obtained results showed that by using near-spherical NaCl filling particles, the porous Mg alloy formed complete open-cell foam with a very uniform size of pores in the range of 500-600 μm. Benefitting from the small size and uniform distribution of pores, the present porous alloy exhibited a very high porosity, up to 80%, and compressive yield strength up to 6.5 MPa. The degradation test showed that both the pH and the mass loss rate had similar change tendency, with a rapid rise in the early stage for 1-2 day's immersion and subsequently remaining smooth after 3 days. In vitro cytocompatibility trials demonstrated that in comparison with Ti, the porous alloy accelerated proliferation in 1, 3, 5, and 7 days (P < 0.001), and the osteogenic differentiation test showed that the ALP activity in the experimental group was significantly higher (P = 0.017) and has more osteogenesis nodules. Cell adhesion testing showed good osteoconductivity by more BMSC adhesion around the holes. The confocal microscopy results showed that cells in porous Mg-based alloy had better cytoskeletal morphology and were larger in number than in titanium. CONCLUSIONS These results indicated that this porous Mg-based alloy fabricated by infiltration casting shows great mechanical properties and biocompatibilities, and it has potential as an ideal bone tissue engineering scaffold material for bone regeneration.