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1.
The surgical management of the cavity and bone defects in enchondroma cases: A prospective randomized trial.
Nazarova, NZ, Umarova, GS, Vaiman, M, Asilova, SU, Abba, M, Foonberg, M, Shterenshis, M
Surgical oncology. 2021;:101565
Abstract
BACKGROUND We compared the curettage/bone grafting and the curettage/bone graft substitutes surgical techniques in their relation to functional outcomes, oncologic outcome (recurrence, malignant transformation), the rate of postsurgical complications, durations of surgery and of postsurgical immobilization for hand-localized cases of solitary and multiple enchondromas. METHODS The current prospective randomized trial analyzed 200 adult patients (2012-2017) with enchondroma who underwent surgical intervention. The cases were randomly divided into Group 1 (n = 100; F 56, M 44) for surgeries with curettage and autogenous bone grafting, and Group 2 (n = 100; F 55, M 45) for surgeries with curettage and bone graft substitutes. The placebo control Group 3 consisted of cases operated by curettage only (n = 56; F 31, M 25). The follow-up period was set at 30 months. RESULTS The duration of surgery was 51 ± 4 min in Group 1 and 27 ± 1 min in Group 2 (p = 0.008). In Group 1, the rate of recurrence was 6% against 1% in Group 2 (p = 0.005). No other statistically significant differences in postsurgical outcomes between three involved groups were noted. CONCLUSION In cases of enchondroma of the hand, postsurgical functional outcomes, the rate of postsurgical complications, the duration of immobilization, and the time to complete recovery are not influenced by the type of chosen grafting material. The implementation of HAp-collagen bone substitutes in granules instead of autogenous bone grafting reduces the duration of surgery. The implementation of autogenous bone grafting may increase the rate of tumor recurrence.
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2.
Modifications to advanced Core decompression for treatment of Avascular necrosis of the femoral head.
Landgraeber, S, Warwas, S, Claßen, T, Jäger, M
BMC musculoskeletal disorders. 2017;(1):479
Abstract
BACKGROUND "Advanced Core Decompression" (ACD) is a new technique for treatment of osteonecrosis of the femoral head (ONFH) that includes removal of the necrotic tissue using a percutaneous expandable reamer followed by refilling of the drill hole and the defect with an injectable, hard-setting, composite calcium sulphate (CaSO4)-calcium phosphate (CaPO4) bone graft substitute. As autologous bone has been shown to be superior to all other types of bone grafts, the aim of the study is to present and evaluate a modified technique of ACD with impaction of autologous bone derived from the femoral neck into the necrotic defect. METHODS A cohort of patients with an average follow-up of 30.06 months (minimum 12 months) was evaluated for potential collapse of the femoral head and any reasons that led to replacement of the operated hip. Only patients in stages 2a to 2c according to the Steinberg classification were included in the study. RESULTS In 75.9% the treatment was successful with no collapse of the femoral head or conversion to a total hip replacement. Analysis of the results of the different subgroups showed that the success rate was 100% for stage 2a lesions and 84.6% respectively 61.5% for stages 2b and 2c lesions. CONCLUSIONS Previous studies with a comparable follow-up reported less favourable results for ACD without autologous bone. Especially in stages 2b and 2c the additional use of autologous bone has a positive effect. In comparison to other hip-preserving techniques, the modified ACD technique is a very promising and minimally invasive method for treatment of ONFH. TRIAL REGISTRATION German clinical trials register ( DRKS00011269 , retrospectively registered).
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3.
A prospective randomized comparison of PEEK cage containing calcium sulphate or demineralized bone matrix with autograft in anterior cervical interbody fusion.
Xie, Y, Li, H, Yuan, J, Fu, L, Yang, J, Zhang, P
International orthopaedics. 2015;(6):1129-36
Abstract
PURPOSE A variety of bone substitutes have been successfully used to fill PEEK cages in cervical interbody fusion in order to avoid the complications related to bone harvesting from the donor site. However, no controlled study has previously been conducted to compare the effectiveness of PEEK interbody cages containing calcium sulphate/ demineralized bone matrix (CS/DBM) with autogenous cancellous bone for the treatment of cervical spondylosis. The objective of this prospective, randomized clinical study was to evaluate the effectiveness of implanting PEEK cages containing CS/DBM for the treatment of cervical radiculopathy and/or myelopathy. METHODS Sixty-eight patients with cervical radiculopathy and/or myelopathy were randomly assigned to receive one- or two-level discectomy and fusion with PEEK interbody cages containing CS/DBM or autogenous iliac cancellous bone (AIB). The patients were followed up for two years postoperatively. The radiological and clinical outcomes were assessed during a two-year follow-up. RESULTS The mean blood loss was 75 ± 18.5 ml in the CS/DBM group and 100 ± 19.6 ml (P < 0.01) in the AIB group. The fusion rate was 94.3 % in the CS/DBM group and 100 % in the AIB group at 12-month follow-up. The fusion rate was 100 % at final follow-up in both groups. No significant difference (P > 0.05) was found regarding improvement of JOA score and segmental lordosis as well as neck and arm pain at all time intervals between the two groups. The total complication rate was significantly higher (P < 0.05) in the AIB group than in the CS/DBM group, but there was no significant difference between the two groups (P > 0.05) when comparing the complications in the neck. CONCLUSIONS In conclusion, the PEEK interbody fusion cage containing CS/DBM or AIB following one- or two-level discectomy had a similar outcome for cervical spondylotic radiculopathy and/or myelopathy. The rate of fusion and the recovery rate of JOA score between the two groups were the same. The filling of CS/DBM in the PEEK cage instead of AIB has the advantage of less operative blood loss and fewer complications at the donor site.
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4.
Efficacy of nanocrystalline bone substitute biphasic calcium phosphate/poly-DL-lactide-co-glycolide for periodontal intrabony defects filling.
Stevanović, M, Biočanin, V, Nedkić, M, Ignjatović, N
Vojnosanitetski pregled. 2015;(8):689-95
Abstract
BACKGROUND/AIM: Different bone substitutes have been used for filling and reparation of intrabony defects. The aim of this study was to compare nanocrystalline material, biphasic calcium phosphate poly-DL-lactide-co-glycolide (BCP/PLGA) with deproteinised bovine bone (DPBB) and beta-tricalcium phosphate (P-TCP) in the treatment of periodontal intrabony defects. METHODS The study included 24 patients with bilateral, intrabony defects in the region of the upper first and second premolar, and the upper first molar. On one side of the mouth, DPBB (BioOss) was used to fill defects in upper premolars while P-TCP (RTR) was used for the upper first molar. BCP/PLGA was applied into periodontal defects of the upper premolars and upper first molar of the opposite side. RESULTS The comparison of the BCP/PLGA and the P-TCP group, 6 months following filling of defects, showed a statistically significant reduction of periodontal pocket depth (PPD) and the position of the cement-enamel junction (CEJ) in the group with BCP/PLGA, when compared to the beta-TCP group. The reduction of PPD and CEJ was similar in the groups treated with BCP/PLGA and DPBB. CONCLUSION Significant reductions of PPD and CEJ were registered in the group with BCP/PLGA when compared to the beta-TCP group.
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5.
Calcium phosphate cement augmentation after volar locking plating of distal radius fracture significantly increases stability.
Kainz, H, Dall'Ara, E, Antoni, A, Redl, H, Zysset, P, Weninger, P
European journal of orthopaedic surgery & traumatology : orthopedie traumatologie. 2014;(6):869-75
Abstract
PURPOSE Distal radius fractures represent the most common fractures in adults. Volar locking plating to correct unstable fractures has become increasingly popular. Although reasonable primary reduction is possible in most cases, maintenance of reduction until the fracture is healed is often problematic in osteoporotic bone. To our knowledge, no biomechanical studies have compared the effect of enhancement with biomaterial on two different volar fixed-angle plates. METHODS Human fresh-frozen cadaver pairs of radii were used to simulate an AO/OTA 23-A3 fracture. In a total of four groups (n = 7 for each group), two volar fixed-angle plates (Aptus 2.5 mm locking fracture plate, Medartis, Switzerland and VA-LCP two-column distal radius plate 2.4, volar, Synthes, Switzerland) with or without an additional injection of a biomaterial (Hydroset Injectable HA Bone Substitute, Stryker, Switzerland) into the dorsal comminution zone were used to fix the distal metaphyseal fragment. Each specimen was tested load-controlled under cyclic loading with a servo-hydraulic material testing machine. Displacement, stiffness, dissipated work and failure mode were recorded. RESULTS Improved mechanical properties (decreased displacement, increased stiffness, decreased dissipated work) were found in both plates if the biomaterial was additionally injected. Improvement of mechanical parameters after biomaterial injection was more evident in the Synthes plate compared to the Aptus plate. Pushing out of the screws was noticed as a failure mode only in samples lacking supplementary biomaterial. CONCLUSIONS Injection of a biomaterial into the dorsal comminution zone increases stability after volar locking plating of distal radius fractures in vitro.
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6.
Micro-structured calcium phosphate ceramic for donor site repair after harvesting chin bone for grafting alveolar clefts in children.
de Ruiter, A, Dik, E, van Es, R, van der Bilt, A, Janssen, N, Meijer, G, Koole, R, Rosenberg, A
Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery. 2014;(5):460-8
Abstract
OBJECTIVES The purpose of this study was to evaluate the use of synthetic bone graft material as a filling material at the mandibular symphysis donor site of autologous bone in children. MATERIALS AND METHODS A blinded patient group comprised 20 patients with unilateral (UCLP) or bilateral (BCLP) cleft of lip and palate, all with an indication for alveolar cleft repair. The study took the form of a prospective randomized clinical trial. We used lateral cephalograms for the measurement of the symphyseal donor area defect both peroperatively and at 12 months postoperatively. The data obtained were digitalized and the treatment outcome expressed in numbers. Comparisons with a previous study were made. Histology of biopsies and CT scans were used for visualising bone formation. RESULTS This study demonstrates that the micro-structured, resorbable calcium phosphate ceramic provides good regeneration properties for the repair of a critical size bony defect in children. One year postoperatively, the measurements taken from lateral cephalograms show that there is scarcely any visible residual defect. Histological investigations of the bone biopsies show solid, induced bone formation and almost complete resorption of the micro-structured calcium phosphate. CONCLUSIONS The findings of this study (novel in children) indicate that micro-structured resorbable calcium phosphate is an excellent alternative to autologous bone. The digital findings showed a restored donor site defect significantly indicating the efficacy (i.e., osteoconductivity and resorbability) of this bone substitute. The biopsy histology demonstrated the overall presence of newly formed vital bone and the resorption of the bone substitute. Its use for grafting the alveolar cleft is currently researched and it may become the new standard. CLINICAL RELEVANCE As co-morbidity and prolonged operation time at the donor operation site are inherent to the alveolar cleft repair procedure, the use of the described bone substitute is winning progress.
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7.
An evaluation and comparison of the efficacy of nanocrystalline calcium sulfate bone grafts (NanoGen) and medical-grade calcium sulfate bone grafts (DentoGen) in human extraction sockets.
Kumari, B, Gautam, DK, Horowitz, RA, Jain, A, Mahajan, A
Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995). 2014;(10):e36-41
Abstract
BACKGROUND Grafting a fresh extraction socket is essential for successful regeneration of bone and maximizing volume preservation. Various synthetic grafts have been used to simulate bone formation. The purpose of the present study was to evaluate clinical, histomorphometric, and radiographic healing at 1-month, 3-month, and 4-month time points after tooth extraction with placement of calcium sulfate hemihydrate putty bone grafts NanoGen and DentoGen to determine their efficacy in ridge preservation following tooth extraction. METHOD Sixty subjects who were in need of extraction were recruited. The subjects were randomly assigned their group based on computer software for both the test groups (NanoGen and DentoGen). DentoGen is a medical-grade calcium sulfate hemihydrate with particle of 30 µm, and NanoGen is a nanocrystalline version of DentoGen with particle size 400 µm to 800 µm. Data were recorded at 1, 3, and 4 months after extraction socket grafting. Bone biopsies were taken at 4 months for histomorphometric analysis. RESULTS The mean percentage of bone formed by NanoGen was 51.19 ± 9.53% and by DentoGen 50.67 ± 16.16% after 4 months. No statistically significant difference was noted in the mean bone formation by NanoGen and DentoGen at various time intervals; no bone graft remnants of DentoGen were found at 4 months. The mean percentage of bone graft remnants left after 4 months for NanoGen was 6.83 ± 16% in the maxilla and 7.38 ± 21% in the mandible. The mean percentage of soft tissue formed was significantly higher with DentoGen in mandibular socket sites. On radiographic evaluation the mean percentage of socket fill with DenoGen was found to be 23.1 ± 11.65%, 50 ± 9.6%, and 76.7 ± 11% and with NanoGen was 29.2 ± 12.8%, 52.8 ± 15.6%, and 76.47 ± 12.43% at 1 month, 3 months, and 4 months postoperative intervals, respectively. CONCLUSION Both the materials investigated in the study showed excellent bone forming capacity, but the nanocrystalline version (NanoGen) of calcium sulfate was found to have clinical and biologic advantages over DentoGen.
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8.
Ultraporous β-tricalcium phosphate alone or combined with bone marrow aspirate for benign cavitary lesions: comparison in a prospective randomized clinical trial.
Damron, TA, Lisle, J, Craig, T, Wade, M, Silbert, W, Cohen, H
The Journal of bone and joint surgery. American volume. 2013;(2):158-66
Abstract
BACKGROUND Ultraporous β-tricalcium phosphate (TCP) synthetic graft material (Vitoss; Orthovita) persists for a year or longer in some cases. In this study, we prospectively examined healing of cavitary defects filled with TCP versus TCP and bone marrow aspirate (TCP/BM) with the hypothesis that bone-marrow aspirate speeds incorporation of bone graft substitute. METHODS Fifty-five patients with a benign bone lesion undergoing surgical curettage were randomized to receive TCP (N = 26; mean duration of follow-up [and standard deviation], 20.2 ± 7.2 months) or TCP/BM (N = 29; mean duration of follow-up, 18.0 ± 7.7 months). There were no significant differences between the groups with regard to demographic or defect parameters. Clinical and radiographic evaluations were done at 1.5, three, six, twelve, eighteen, and twenty-four months, and computed tomography [CT] scans were performed at twelve months. An independent radiographic review was done to evaluate six parameters. RESULTS There was a significant (p < 0.001) increase in trabeculation through the defect and graft resorption with decreases in the persistence of the graft in both soft tissue and the defect as well as a decreased radiolucent rim around the graft over time. No significant differences were observed between the TCP and TCP/BM groups in terms of any radiographic parameter. No complications related to the graft material or BM were identified. CONCLUSIONS While significant improvements in radiographic parameters were observed in both TCP groups over two years of follow-up, the addition of BM was not found to provide any significant benefit. Results should not be extrapolated to other bone graft substitutes used for this purpose.
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9.
Ten-year results following treatment of intrabony defects with an enamel matrix protein derivative combined with either a natural bone mineral or a β-tricalcium phosphate.
Döri, F, Arweiler, NB, Szántó, E, Agics, A, Gera, I, Sculean, A
Journal of periodontology. 2013;(6):749-57
Abstract
BACKGROUND The purpose of the present study is to evaluate the 10-year results following treatment of intrabony defects treated with an enamel matrix protein derivative (EMD) combined with either a natural bone mineral (NBM) or β-tricalcium phosphate (β-TCP). METHODS Twenty-two patients with advanced chronic periodontitis and displaying one deep intrabony defect were randomly treated with a combination of either EMD + NBM or EMD + β-TCP. Clinical evaluations were performed at baseline and at 1 and 10 years. The following parameters were evaluated: plaque index, bleeding on probing, probing depth, gingival recession, and clinical attachment level (CAL). The primary outcome variable was CAL. RESULTS The defects treated with EMD + NBM demonstrated a mean CAL change from 8.9 ± 1.5 mm to 5.3 ± 0.9 mm (P <0.001) and to 5.8 ± 1.1 mm (P <0.001) at 1 and 10 years, respectively. The sites treated with EMD + β-TCP showed a mean CAL change from 9.1 ± 1.6 mm to 5.4 ± 1.1 mm (P <0.001) at 1 year and 6.1 ± 1.4 mm (P <0.001) at 10 years. At 10 years two defects in the EMD + NBM group had lost 2 mm, whereas two other defects had lost 1 mm of the CAL gained at 1 year. In the EMD + β-TCP group three defects had lost 2 mm, whereas two other defects had lost 1 mm of the CAL gained at 1 year. Compared with baseline, at 10 years, a CAL gain of ≥3 mm was measured in 64% (i.e., seven of 11) of the defects in the EMD + NBM group and in 82% (i.e., nine of 11) of the defects in the EMD + β-TCP group. No statistically significant differences were found between the 1- and 10-year values in either of the two groups. Between the treatment groups, no statistically significant differences in any of the investigated parameters were observed at 1 and 10 years. CONCLUSION Within their limitations, the present findings indicate that the clinical improvements obtained with regenerative surgery using EMD + NBM or EMD + β-TCP can be maintained over a period of 10 years.
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10.
A novel approach revealing the effect of a collagenous membrane on osteoconduction in maxillary sinus floor elevation with β-tricalcium phosphate.
Schulten, EA, Prins, HJ, Overman, JR, Helder, MN, ten Bruggenkate, CM, Klein-Nulend, J
European cells & materials. 2013;:215-28
Abstract
Calcium phosphates are used in maxillary sinus floor elevation (MSFE) procedures to increase bone height prior to dental implant placement. Whether a collagenous barrier membrane coverage of the lateral window affects bone formation within a bone substitute augmentation is currently an important matter of debate, since its benefit has not been irrefutably proven. Therefore, in this clinical study twelve patients underwent an MSFE procedure with β-tricalcium phosphate (β-TCP). The lateral window was either left uncovered, or covered with a resorbable collagenous barrier membrane. After a 6-months healing period, bone biopsies were retrieved during implant placement. Consecutive 1 mm regions of interest of these biopsies were assessed for bone formation, resorption parameters, as well as bone architecture using histology, histomorphometry and micro-computed tomography. Comparable outcomes between the groups with and without membrane were observed regarding osteoconduction rate, bone and graft volume, osteoclast number and structural parameters of newly formed bone per region of interest. However, osteoid volume in grafted maxillary sinus floors without membrane was significantly higher than with membrane. In conclusion, our results - obtained with a novel method employed using 1 mm regions of interest - demonstrate that the clinical application of a bioresorbable collagenous barrier membrane covering the lateral window, after an MSFE procedure with β-TCP, was not beneficial for bone regeneration and even decreased osteoid production which might lead to diminished bone formation in the long run.