scholarly journals Reconstruction of Mandibular Defects Using Bone Morphogenic Protein: Can Growth Factors Replace the Need for Autologous Bone Grafts? A Systematic Review of the Literature

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Alan S. Herford ◽  
Enrico Stoffella ◽  
Rahul Tandon
Keyword(s):  
Gold Standard ◽  
Donor Site ◽  
Human Study ◽  
Autogenous Bone ◽  
Review Of The Literature ◽  
Surgical Time ◽  
Reconstructive Procedures ◽  
Incomplete Healing ◽  
Autologous Bone ◽  
Autologous Bone Grafts

Autogenous bone is still considered the “gold standard” of regenerative and reconstructive procedures involving mandibular defects. However, harvesting of this material can lead to many complications like increasing morbidity, expanding of the surgical time, and incomplete healing of the donor site. In the last few years many authors looked for the development of effective reconstruction procedures using osteoinductive factors without the need for conventional bone grafting. The first-in-human study involving the use of Bone Morphongenic Proteins (rhBMP) for mandibular reconstruction was performed in 2001 by Moghadam. Only few articles have been reported in the literature since then. The purpose of this study was to search and analyze the literature involving the use of rhBMP for reconstruction of mandibular defects. In all the studies reported, authors agree that the use of grown factors may represent the future of regenerative procedures with more research necessary for confirmation.

scholarly journals Autogenous bone augmentation from the zygomatic alveolar crest: a volumetric retrospective analysis in the maxilla

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Irina Kuster ◽  
Livia Osterwalder ◽  
Silvio Valdec ◽  
Bernd Stadlinger ◽  
Maximilian E. H. Wagner ◽  
...  
Keyword(s):  
Gold Standard ◽  
Donor Site ◽  
Bone Defects ◽  
Donor Site Morbidity ◽  
Bone Volume ◽  
Autogenous Bone ◽  
Bone Augmentation ◽  
Maximum Volume ◽  
Alveolar Crest ◽  
Good Access

Abstract Background Autogenous bone augmentation is the gold standard for the treatment of extended bone defects prior to implantation. Bone augmentation from the zygomatic crest is a valuable option with several advantages, but the current literature for this treatment is scant. The aim of this study was to evaluate the increase in bone volume after locoregional bone augmentation using autogenous bone from the zygomatic alveolar crest as well as the complications and success rate. Results Analysis of the augmented bone volume in seven patients showed a maximum volume gain of 0.97 cm3. An average of 0.54 cm3 of autogenous bone (SD 0.24 cm3; median: 0.54 cm3) was augmented. Implantation following bone augmentation was possible in all cases. Complications occurred in three patients. Conclusion The zygomatic alveolar crest is a valuable donor site for autogenous alveolar onlay grafting in a locoregional area such as the maxillary front. Low donor site morbidity, good access, and its suitable convexity make it a beneficial choice for autogenous bone augmentation.

scholarly journals Systemic Administration of PTH Supports Vascularization in Segmental Bone Defects Filled with Ceramic-Based Bone Graft Substitute

Cells ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 2058
Author(s):  
Holger Freischmidt ◽  
Jonas Armbruster ◽  
Emma Bonner ◽  
Thorsten Guehring ◽  
Dennis Nurjadi ◽  
...  
Keyword(s):  
Bone Graft ◽  
Donor Site ◽  
Bone Grafts ◽  
Bone Graft Substitute ◽  
Therapeutic Strategies ◽  
Care Providers ◽  
Sprague Dawley ◽  
Duration Of Treatment ◽  
Autologous Bone ◽  
Autologous Bone Grafts

Non-unions continue to present a challenge to trauma surgeons, as current treatment options are limited, duration of treatment is long, and the outcome often unsatisfactory. Additionally, standard treatment with autologous bone grafts is associated with comorbidity at the donor site. Therefore, alternatives to autologous bone grafts and further therapeutic strategies to improve on the outcome and reduce cost for care providers are desirable. In this study in Sprague–Dawley rats we employed a recently established sequential defect model, which provides a platform to test new potential therapeutic strategies on non-unions while gaining mechanistic insight into their actions. The effects of a combinatorial treatment of a bone graft substitute (HACaS+G) implantation and systemic PTH administration was assessed by µ-CT, histological analysis, and bio-mechanical testing and compared to monotreatment and controls. Although neither PTH alone nor the combination of a bone graft substitute and PTH led to the formation of a stable union, our data demonstrate a clear osteoinductive and osteoconductive effect of the bone graft substitute. Additionally, PTH administration was shown to induce vascularization, both as a single adjuvant treatment and in combination with the bone graft substitute. Thus, systemic PTH administration is a potential synergistic co-treatment to bone graft substitutes.

scholarly journals Hydrogels that allow and facilitate bone repair, remodeling, and regeneration

2015 ◽  
Vol 3 (40) ◽  
pp. 7818-7830 ◽  
Author(s):  
Aaron R. Short ◽  
Deepthi Koralla ◽  
Ameya Deshmukh ◽  
Benjamin Wissel ◽  
Benjamin Stocker ◽  
...  
Keyword(s):  
Gold Standard ◽  
Bone Repair ◽  
Standard Treatment ◽  
Bone Grafts ◽  
Bone Defects ◽  
Surgical Reconstruction ◽  
Congenital Deformity ◽  
Bone Stock ◽  
Autologous Bone ◽  
Autologous Bone Grafts

Bone defects can originate from a variety of causes, including trauma, cancer, congenital deformity, and surgical reconstruction. Success of the current “gold standard” treatment (i.e., autologous bone grafts) is greatly influenced by insufficient or inappropriate bone stock.

Bone Substitutes in Orthopaedic Surgery: Current Status and Future Perspectives

2020 ◽  
Author(s):  
André Busch ◽  
Alexander Wegner ◽  
Marcel Haversath ◽  
Marcus Jäger
Keyword(s):  
Donor Site ◽  
Bone Substitutes ◽  
Bone Defects ◽  
Donor Site Morbidity ◽  
Current Status ◽  
Future Perspectives ◽  
Autologous Bone Grafting ◽  
Long Time ◽  
Autologous Bone ◽  
Autologous Bone Grafts

AbstractBone replacement materials have been successfully supplied for a long time. But there are cases, especially in critical sized bone defects, in which the therapy is not sufficient. Nowadays, there are multiple bone substitutes available. Autologous bone grafts remain the “gold standard” in bone regeneration. Yet, donor-site morbidity and the available amount of sufficient material are limitations for autologous bone grafting. This study aimed to provide information about the current status in research regarding bone substitutes. We report on the advantages and drawbacks of several bone substitutes. At the end, we discuss the current developments of combining ceramic substitutes with osteoinductive substances.

scholarly journals Intensive Care as an Independent Risk Factor for Infection after Reconstruction and Augmentation with Autologous Bone Grafts in Craniomaxillofacial Surgery: A Retrospective Cohort Study

2021 ◽  
Vol 10 (12) ◽  
pp. 2560
Author(s):  
Jonas P. Jung ◽  
Kathrin Haunstein ◽  
Hans-Helge Müller ◽  
Ingo Fischer ◽  
Andreas Neff
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Intensive Care ◽  
Bone Grafts ◽  
Clinical Consequence ◽  
Reconstructive Procedures ◽  
Factors Associated ◽  
Autologous Bone ◽  
Autologous Bone Grafts

Autologous bone grafts for reconstruction and augmentation are routinely used for maintaining functionality and facial aesthetics. Associated complications, however, have a significant impact on patients and health care systems. This study aims to investigate the possible risk factors associated with the occurrence of complications in order to provide evidence for the outcome of autologous bone graft reconstructive procedures. Patients from 2008 to 2018 who underwent autologous (mostly mandibular) reconstruction were included in the observational study. Clinical, pathological, and therapeutic factors were examined in univariate and multivariate analysis for significance with occurring complications. A multivariate model was used to create a prognostic model predicting the occurrence of complications. Graft complications requiring revision were exhibited by 33/128 patients. Infections were most frequent, with 4/22 patients affected by multi-resistant germs. Multivariate analysis showed radiotherapy (OR = 5.714; 95% CI: 1.839–17.752; p = 0.003), obstructive pulmonary disease (OPD) (OR = 4.329; 95% CI: 1.040–18.021; p = 0.044) and length of defect (in mm) (OR = 1.016; 95% CI: 1.004–1.028; p = 0.009) as independent risk factors associated with graft complications with high accuracy of prediction (AUC = 0.815). Intensive care (OR = 4.419; 95% CI: 1.576–12.388; p = 0.005) with a coefficient between intensive care and OPD (0.214) being low was identified as the most relevant risk factor for infection. Although intensive care is not a classic risk factor, but rather a summation of factors not reaching significance in the individual case, a stay in ICU (intensive care unit) needs to be considered for graft complications. As a clinical consequence, we recommend using the best possible hygienic measures during procedures e.g., while performing dressing and drainage changes in ICU.

scholarly journals Suprafascial Free Flaps: Classification and Comprehensive Review of the Literature

2021 ◽  
Vol 6 ◽  
pp. 247275122110205
Author(s):  
Sebastian Rios ◽  
María Isabel Falguera-Uceda ◽  
Alicia Dean ◽  
Susana Heredero
Keyword(s):  
Survival Rate ◽  
Preoperative Planning ◽  
Donor Site ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Anterolateral Thigh Flap ◽  
Cochrane Library ◽  
Review Of The Literature ◽  
Comprehensive Review ◽  
Search Terms

Study Design: Suprafascial free flaps have become common place in reconstructive surgery units. Nomenclature related to these flaps has not been uniform throughout the scientific literature, especially in regard to planes of dissection. This study is designed as a comprehensive review of the literature. Objectives: Our study highlights which flaps are used most frequently, their main indications, their survival rate, and how they have evolved in the last few decades as innovations have been introduced. Methods: A review of the literature was performed using keywords and Medical Subject Headings search terms. PubMed, Embase, and Cochrane Library were searched using the appropriate search terms. Data collected from each study included flap type, dissection plane, preoperative planning, area of reconstruction, as well as complications, donor-site morbidity and survival rate. Results: Seven hundred and fifty-five studies were found based on the search criteria. After full-text screening for inclusion and exclusion criteria 34 studies were included. A total of 1332 patients were comprised in these studies. The most common types of flaps used were superficial circumflex iliac perforator flap (SCIP), anterolateral thigh flap (ALT), and radial forearm flap. The most common areas of reconstruction were head & neck and limbs. There was no significant difference in survival rates between flaps that were raised in different planes of dissection. Conclusions: Based on the author’s review of the literature, suprafascial flaps are reliable, they have low donor site morbidity, and there is a wide selection available for harvest. The use of new technologies for preoperative planning, such as CT-Angiography and UHF ultrasound, have contributed to have more predictable results. We propose a standardized classification for these flaps, in order to create a uniform nomenclature for future reference.

scholarly journals Reconstruction of anterior frontal wall and contours defects using bone substitute

2021 ◽  
pp. 34
Author(s):  
Keyword(s):  
Bone Substitute ◽  
Calcium Sulfate ◽  
Donor Site ◽  
Bone Defects ◽  
Autogenous Bone ◽  
Bone Void Filler ◽  
Custom Made ◽  
Cranial Implant ◽  
Bone Void ◽  
Orbital Area

Aim: The aim of this article is to report on the safety and long-term efficacy of Cerament® BoneVoid Filler bone substitute for repairing craniofacial bone defects. Post-traumatic cranioplasty is a complex and challenging procedure for all maxillo-craniofacial surgeons and neurosurgeons, especially when repairing large areas. The standard criterion for repairing small cranial defects is the use autogenous bone from the iliac crest or split calvarial grafts. Autogenous grafts may result in donor-site morbidity, increased surgical time, reabsorption, blood loss, and longer recovery time . Alloplastic materials used for bone repair, such as methyl methacrylate, hydroxyapatite, titanium, or porous polyethylene, are expected to have optimal properties, including easy adaptation, biocompatibility, ingrowth of new tissue, stability of shape, and low rate of reabsorption. A cranial implant should be easily shaped and positioned, allowing easy tissue growth. In very wide cranium defects the new technology is a custom made cranial implant constructed three-dimensionally with different types of materials. However, this procedure is very expensive with various infection rates depending on the kind of material used and on the chemicophysical composition of the implant. Methods: The authors report the case of a 50-year-old man with a severe deformity of the forehead-supra orbital area as a result of a previous complex fronto-facial trauma treated in an emergency Unit. Secondary correction and reconstruction of the residual deformities were performed by using Cerament® Bone Void Filler, an alloplastic biphasic material, composed of 40% hydroxyapatite, 60% calcium sulfate and the radio-contrast agent iohexol. The unique ratio of hydroxyapatite and calcium sulfate is designed to enable Cerament to resorb at the same rate that bone forms. Calcium sulfate acts as a resorbable carrier for hydroxyapatite which is highly osteoconductive, promoting bone ingrowth.It seems to be a promising bone graft substitute in the management of bony irregularities in the fronto-orbital area. Conclusion: The patient was first hospitalized as the result of a serious craniofacial trauma. One year after the first emergency cranio-orbital reconstructive operation, a marked deformity of the frontal region appeared with a “grid effect” due to the inadequate plate-bony fixation of the fractures applied during the first bony recomposition and because it was not as rigid as it should have been . A secondary surgery for deformity correction was performed. The hardware was totally removed and the bony deformity smoothed, reshaped, covered and filled using Cerament® Bone Void Filler, a biomaterial. The patient recovered with a satisfactory cranium-forehead shape, no complications, and complete disappearance of a frowning look of the fronto-orbital region. Recently, increased use of bone substitutes in the reconstruction of bone defects has been fuelled by donor site complications associated with autologous bone harvesting. Cerament® BoneVoid Filler is a biphasic and injectable bone substitute that has a highly compressive strength and the ability to promote cancellous bone healing

scholarly journals Application of 3D Printed Biocompatible Plastic Surgical Template for the Reconstruction of a Nasoalveolar Cleft with Preoperative Volume Analysis

2019 ◽  
Vol 56 (2) ◽  
pp. 413-415
Author(s):  
Zoltan Fabian ◽  
Kristof Kadar ◽  
Lajos Patonay ◽  
Krisztian Nagy
Keyword(s):  
Open Source Software ◽  
Gold Standard ◽  
Surgical Planning ◽  
Autologous Bone Graft ◽  
Optimal Shape ◽  
Autogenous Bone ◽  
Additive Technology ◽  
Alveolar Cleft ◽  
Autogenous Bone Grafting ◽  
3D Printed

Secondary autogenous bone grafting is the gold standard for the closure of an alveolar cleft. A preoperative surgical planning helps to determine the optimal shape and volume of the graft, that ideally guide canine eruption to the cleft area and ensure adequate nasal support. The authors describe their experience with design and use of an individually shaped 3D template for an autologous bone graft with fibrin glue for correct volume design. The conforming template is designed using freeware and open source software, it is manufactured by means of additive technology using autoclavable resin.

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