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Osteoporotic vertebral compression fractures augmentation by injectable partly resorbable ceramic bone substitute (Cerament™|SPINE SUPPORT): a prospective nonrandomized study.
Masala, S, Nano, G, Marcia, S, Muto, M, Fucci, FP, Simonetti, G
Neuroradiology. 2012;(6):589-96
Abstract
INTRODUCTION The aim of this study is to evaluate the long-term stabilizing-healing effectiveness and influence on adjacent intact vertebral bodies of a new injectable partly resorbable calcium sulfate (60 wt.%)/hydroxyapatite (40 wt.%) bone substitute employed in vertebral augmentation of osteoporotic collapses. METHODS From April 2009 to April 2011, 80 patients underwent vertebral augmentation. Patients enrolling criteria were age >20 years and symptomatic osteoporotic vertebral collapse from low-energy trauma encompassed between levels T5 to L5. Preoperative and postoperative imaging studies consisted of computed tomography, plain X-ray, dual X-ray absorptiometry scanning, and magnetic resonance. Pain intensity has been evaluated by an 11-point visual analog scale (VAS) and physical and quality of life compromise assessments have been evaluated by Oswestry Disability Questionnaire (ODI). All procedures have been performed fluoroscopically guided by left unilateral approach under local anesthesia and mild sedation. RESULTS VAS-based pain trend over the 12-month follow-up has shown a statistically significant (p < 0.001) decrease, starting from 7.68 (SD 1.83) preoperatively with an immediate first day decrease at 3.51 (SD 2.16) and 0.96 (SD 0.93) at 12 months. ODI score dropped significantly from 54.78% to 20.12% at 6 months. No device-related complication has been reported. In no case a new incidental adjacent fracture has been reported. CONCLUSION Data show how this injectable partly resorbable ceramic cement could be a nontoxic and lower stiffness alternative to polymethylmethacrylate for immediate and long-term stabilization of osteoporotic collapsed vertebral bodies.
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Evaluation of autologous platelet concentrate for intertransverse lumbar fusion.
Acebal-Cortina, G, Suárez-Suárez, MA, García-Menéndez, C, Moro-Barrero, L, Iglesias-Colao, R, Torres-Pérez, A
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2011;(Suppl 3):361-6
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Abstract
INTRODUCTION The aim of the study was to analyze if the adding of autologous platelet concentrate (APC) to a mixture of local autograft plus tricalcium phosphate and hidroxiapatite (TCP/HA) would improve the fusion rate in posterolateral lumbar fusion. MATERIALS AND METHODS A prospective, controlled, blinded, non-randomized clinical trial was carried out in 107 patients affected by degenerative lumbar pathology. The study group consisted of 67 patients, in which autologous platelet concentration was added to a mixture of autologous local bone graft and TCP/HA. A control group of 40 patients with same pathology and surgical technique but without APC addition was used to compare the fusion mass obtained. By means of plain X-rays, a blinded evaluation of the intertransverse fusion mass quality at twelve and twenty-four months was made according to type A (bilateral uniform mass), type B (unilateral uniform mass) and type C (irregular or lack bilateral mass). Patients with type C were regarded as pseudoarthrosis. RESULTS In the study group 17 patients had lack or irregular fusion mass (25.4%) versus three patients in the control group (7.5%), which was statistically significant. CONCLUSIONS This study shows that the adding of autologous platelet concentration to a mixture of autologous bone graft plus TCP/HA has decreased our rates of posterolateral lumbar fusion.
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Volumetric analysis of intrabony defects in aggressive periodontitis patients following use of a novel composite alloplast: a pilot study.
Kumar, PG, Kumar, JA, Anumala, N, Reddy, KP, Avula, H, Hussain, SN
Quintessence international (Berlin, Germany : 1985). 2011;(5):375-84
Abstract
OBJECTIVES Hydroxyapatite, tricalcium phosphate, and bioactive glass are the most commonly studied alloplastic materials in periodontal regeneration. These materials have been tested alone and in combination with one another, but evaluation using all three materials in one defect has not yet been attempted. Although posttreatment histologic evaluation or reentry procedures are ideal for objectively assessing regeneration, computed tomography (CT) has become one more technique in clinicians' armories to judge the effectiveness of any such interventions. Hence, the present study was undertaken to clinically ascertain the healing of intrabony defects following treatment with a composite alloplast and complement the study with volumetric assessment using CT. METHOD AND MATERIALS Twenty defects in 10 patients were treated either with open flap debridement or open flap debridement and bone graft implantation in a split-mouth study design. Clinical parameters including probing depth, clinical attachment level (CAL), and gingival margin level were recorded at baseline and at 6 months postsurgery. Plaque Index and Gingival Index were measured at baseline, 3 months, and 6 months. Hard tissue measurements were recorded using a high-resolution spiral CT scan. RESULTS A statistically significant (P < .05) improvement in all parameters (namely probing depth, CAL, percentage defect fill, and linear bone growth) was observed in both groups of patients. However, the test group showed better clinical and radiographic outcomes when compared to the control group (P < .05). CONCLUSION The new composite alloplast resulted in better treatment outcomes than open flap debridement alone. Moreover, the use of CT scan in ascertaining the various defect parameters in periodontal treatment of intrabony defects appears promising.
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Histologic and clinical evaluation for maxillary sinus augmentation using macroporous biphasic calcium phosphate in human.
Lee, JH, Jung, UW, Kim, CS, Choi, SH, Cho, KS
Clinical oral implants research. 2008;(8):767-71
Abstract
OBJECTIVES This study evaluated both the clinical and histological aspects of bone formation in maxillary sinus augmentation using MBCP as the bone-grafting material. MATERIAL AND METHODS MBCP was used as a primary bone substitute for maxillary sinus augmentation. Fifty-two patients were selected after a medical and dental examination, and were divided into the following three groups: those augmented with MBCP only; MBCP combined with irradiated cancellous bone; and MBCP combined with intraoral autogenous bone. After a healing period (average 6.78 months after surgery), bone cores were harvested for a histological evaluation and the implant fixtures were installed. These bone cores were evaluated via light microscope and implants were followed up for at least six months after loading. RESULTS Four to ten months after surgery, new vital bone surrounding the MBCP particles was observed in 18 bone biopsies. Two out of the 130 implants installed were explanted due to a failure of osseointegration before the prosthetic procedure. All the remaining implants were functioning for 6 to 27 months (average 12.96 months). The cumulative survival rate of the implants was 98.46%. CONCLUSION These results show that MBCP can be used as a grafting material for sinus floor augmentation, whether combined with other bone graft materials or not, and lead to a predictable prognosis for dental implants in the posterior maxillary area where there is insufficient vertical height for fixture installation.
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Maxillary sinus floor augmentation using a beta-tricalcium phosphate (Cerasorb) alone compared to autogenous bone grafts.
Zijderveld, SA, Zerbo, IR, van den Bergh, JP, Schulten, EA, ten Bruggenkate, CM
The International journal of oral & maxillofacial implants. 2005;(3):432-40
Abstract
PURPOSE A prospective human clinical study was conducted to determine the clinical and histologic bone formation ability of 2 graft materials, a beta-tricalcium phosphate (Cerasorb; Curasan, Kleinostheim, Germany) and autogenous chin bone, in maxillary sinus floor elevation surgery. MATERIALS AND METHODS Ten healthy patients underwent a bilateral (n = 6) or unilateral (n = 4) maxillary sinus floor elevation procedure under local anesthesia. In each case, residual posterior maxillary bone height was between 4 and 8 mm. In cases of bilateral sinus floor elevation, the original bone was augmented with a split-mouth design with 100% beta-tricalcium phosphate on the test side and 100% chin bone on the contralateral control side. The unilateral cases were augmented with 100% beta-tricalcium phosphate. After a healing period of 6 months, ITI full body screw-type implants (Straumann, Waldenburg, Switzerland) were placed. At the time of implant surgery, biopsy samples were removed with a 3.5-mm trephine drill. RESULTS Sixteen sinus floor elevations were performed. Forty-one implants were placed, 26 on the test side and 15 on the control side. The clinical characteristics at the time of implantation differed, especially regarding clinical appearance and drilling resistance. The increase in height was examined radiographically prior to implantation and was found to be sufficient in all cases. After a mean of nearly 1 year of follow-up, no implant losses or failures had occurred. DISCUSSION The promising clinical results of the present study and the lack of implant failures are probably mainly the result of requiring an original bone height of at least 4 mm at the implant location. CONCLUSION Although autogenous bone grafting is still the gold standard, according to the clinical results, the preimplantation sinus floor elevation procedure used, which involved a limited volume of beta-tricalcium phosphate, appeared to be a clinically reliable procedure in this patient population.
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The fusion rate of calcium sulfate with local autograft bone compared with autologous iliac bone graft for instrumented short-segment spinal fusion.
Chen, WJ, Tsai, TT, Chen, LH, Niu, CC, Lai, PL, Fu, TS, McCarthy, K
Spine. 2005;(20):2293-7
Abstract
STUDY DESIGN A prospective study. OBJECTIVES To compare the efficacy of calcium sulfate pellets plus laminectomy bone chips with a fresh autologous iliac bone graft for short-segment lumbar fusion. SUMMARY OF BACKGROUND DATA Bone graft substitute material can be used to expand an existing quantity of available laminectomy bone chips. METHODS Seventy-four patients underwent surgery for instrumented one- or two-segment fusion with decompression. Autologous iliac crest bone graft was placed in one posterolateral gutter, while on the other side, an equal quantity of autogenous laminectomy bone supplemented with calcium sulfate was placed. Radiographic assessment included radiographs alone; this was performed every 3 months (3 months to 12 months), then annually. The status of fusion and the relative size of the fusion bone mass on either side of the vertebra were compared. RESULTS Using iliac crest bone graft (control side) versus autograft laminectomy bone with calcium sulfate (test side), there was no significant difference between the fusion rate and sizes of the fusion bone mass (P > 0.05). Follow-up periods ranged from 30 months to 34 months, averaging 32.5 months. For the 39 patients who received single-segment fusion, 34 patients (87.2%) exhibited bone fusion on the test side, and 35 patients (89.7%) had evidence of fusion on the control side. For the 35 patients who received two-segment fusion, 29 patients (82.9%) exhibited bone fusion on the test side and 30 patients (85.7%) demonstrated complete fusion on the control side. CONCLUSIONS The fusion rate and fusion size between the two groups are similar. Calcium sulfate pellets may play a role as a bone graft extender in short-segment spinal fusion.