Observer Strategy and Radiographic Classification of Healing after Grafting of Cystic Defects in Maxilla: A Radiological Appraisal

ABSTRACT Aim The aim is to radiographically quantify the bone density and relate the same with observer strategy in the bone healing. Objectives To assess pattern of bone regeneration following grafting of defects with hydroxyapatite after apicoectomy/cystic enucleation. Materials and methods An observer strategy involving trained and experienced examiners used in large series of cases, evaluated radiographically over a period of 1 year with intervals. The cases were grouped into different categories depending on (1) surgical site outline merging with material margin, (2) internal portion of surgical site (i.e. bone formation characteristics) and (3) density of surgical site. The radiographs examined by blind process and the findings were tabulated. Operating surgeon (oral surgeon) has done the interpretation of data to create observer strategy of grafting cases. Observations and results The outline of the defect was changed, partly reduced and completely absent along with remodeling, which showed ground glass, specular or trabecular pattern of bone over a time with increasing density correlating bone regeneration within a short duration. The applied strategy and classification are recommended for follow-up studies. In this study the characteristics of the new bone formation were also delineated. This strategy is helpful for follow-up studies; implant procedures and so; to know quality and condition of bone after treatment. How to cite this article Kattimani VS, Bajantai NV, Sriram SK, Sriram RR, Rao VKP, Desai PD. Observer Strategy and Radiographic Classification of Healing after Grafting of Cystic Defects in Maxilla: A Radiological Appraisal. J Contemp Dent Pract 2013;14(2):227-232.

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Digital Customized Titanium Mesh for Bone Regeneration of Vertical, Horizontal and Combined Defects: A Case Series

Medicina ◽

10.3390/medicina57010060 ◽

2021 ◽

Vol 57 (1) ◽

pp. 60

Author(s):

Daniele De Santis ◽

Federico Gelpi ◽

Giuseppe Verlato ◽

Umberto Luciano ◽

Lorena Torroni ◽

...

Keyword(s):

Bone Formation ◽

Bone Regeneration ◽

Case Series ◽

Guided Bone Regeneration ◽

Point Of View ◽

Significant Gain ◽

Titanium Mesh ◽

New Bone Formation ◽

Correct Method ◽

Combined Defects

Background and Objective: Guided bone regeneration allows new bone formation in anatomical sites showing defects preventing implant rehabilitation. Material and Methods: The present case series reported the outcomes of five patients treated with customized titanium meshes manufactured with a digital workflow for achieving bone regeneration at future implant sites. A significant gain in both width and thickness was achieved for all patients. Results: From a radiographic point of view (CBTC), satisfactory results were reached both in horizontal and vertical defects. An average horizontal gain of 3.6 ± 0.8 mm and a vertical gain of 5.2 ± 1.1 mm. Conclusions: The findings from this study suggest that customized titanium meshes represent a valid method to pursue guided bone regeneration in horizontal, vertical or combined defects. Particular attention must be paid by the surgeon in the packaging of the flap according to a correct method called the “poncho” technique in order to reduce the most frequent complication that is the exposure of the mesh even if a partial exposure of one mesh does not compromise the final outcome of both the reconstruction and the healing of the implants.

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Feasibility, safety, and changes in systolic blood pressure associated with endovascular revascularization of symptomatic and chronically occluded cervical internal carotid artery using a newly suggested radiographic classification of chronically occluded cervical internal carotid artery: pilot study

Journal of Neurosurgery ◽

10.3171/2018.1.jns172858 ◽

2019 ◽

Vol 130 (5) ◽

pp. 1468-1477 ◽

Cited By ~ 6

Author(s):

David Hasan ◽

Mario Zanaty ◽

Robert M. Starke ◽

Elias Atallah ◽

Nohra Chalouhi ◽

...

Keyword(s):

Blood Pressure ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Type B ◽

Type D ◽

Type C ◽

Radiographic Classification

OBJECTIVEThe overall risk of ischemic stroke from a chronically occluded internal carotid artery (COICA) is around 5%–7% per year despite receiving the best available medical therapy. Here, authors propose a radiographic classification of COICA that can be used as a guide to determine the technical success and safety of endovascular recanalization for symptomatic COICA and to assess the changes in systemic blood pressure following successful revascularization.METHODSThe radiographic images of 100 consecutive subjects with COICA were analyzed. A new classification of COICA was proposed based on the morphology, location of occlusion, and presence or absence of reconstitution of the distal ICA. The classification was used to predict successful revascularization in 32 symptomatic COICAs in 31 patients, five of whom were female (5/31 [16.13%]). Patients were included in the study if they had a COICA with ischemic symptoms refractory to medical therapy. Carotid artery occlusion was defined as 100% cross-sectional occlusion of the vessel lumen as documented on CTA or MRA and confirmed by digital subtraction angiography.RESULTSFour types (A–D) of radiographic COICA were identified. Types A and B were more amenable to safe revascularization than types C and D. Recanalization was successful at a rate of 68.75% (22/32 COICAs; type A: 8/8; type B: 8/8; type C: 4/8; type D: 2/8). The perioperative complication rate was 18.75% (6/32; type A: 0/8 [0%]; type B: 1/8 [12.50%]; type C: 3/8 [37.50%], type D: 2/8 [25.00%]). None of these complications led to permanent morbidity or death. Twenty (64.52%) of 31 subjects had improvement in their symptoms at the 2–6 months’ follow-up. A statistically significant decrease in systolic blood pressure (SBP) was noted in 17/21 (80.95%) patients who had successful revascularization, which persisted on follow-up (p = 0.0001). The remaining 10 subjects in whom revascularization failed had no significant changes in SBP (p = 0.73).CONCLUSIONSThe pilot study suggested that our proposed classification of COICA may be useful as an adjunctive guide to determine the technical feasibility and safety of revascularization for symptomatic COICA using endovascular techniques. Additionally, successful revascularization may lead to a significant decrease in SBP postprocedure. A Phase 2b trial in larger cohorts to assess the efficacy of endovascular revascularization using our COICA classification is warranted.

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Consistent New Bone Formation in 95 Revisions: Average 9-Year Follow-Up

Orthopedics ◽

10.3928/01477447-20080701-16 ◽

2008 ◽

Vol 31 (7) ◽

pp. 1-7 ◽

Cited By ~ 11

Author(s):

George Mantelos ◽

Panagiotis Koulouvaris ◽

Hlias Kotsovolos ◽

Theodoros Xenakis

Keyword(s):

Bone Formation ◽

New Bone Formation

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Evaluation of the Bone Regeneration Effect of Recombinant Human Bone Morphogenic Protein-2 on Subperiosteal Bone Graft in the Rat Calvarial Model

Materials ◽

10.3390/ma12101613 ◽

2019 ◽

Vol 12 (10) ◽

pp. 1613

Author(s):

Eunhye Jang ◽

Ja-Youn Lee ◽

Eun-Young Lee ◽

Hyun Seok

Keyword(s):

Bone Formation ◽

Bone Graft ◽

Bone Regeneration ◽

Bone Morphogenetic Protein ◽

Human Bone ◽

Control Group ◽

New Bone Formation ◽

Morphogenetic Protein ◽

Regeneration Effect ◽

Recombinant Human Bone

The aim of this study was to evaluate the bone regeneration effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) on a subperiosteal bone graft in a rat model. A subperiosteal space was made on the rat calvarium, and anorganic bovine bone (ABB), ABB/low bone morphogenetic protein (BMP) (5 µg), and ABB/high BMP (50 µg) were grafted as subperiosteal bone grafts. The new bone formation parameters of bone volume (BV), bone mineral density (BMD), trabecular thickness (TbTh), and trabecular spacing (TbSp) were evaluated by microcomputed tomography (µ-CT), and a histomorphometric analysis was performed to evaluate the new bone formation area. The expression of osteogenic markers, such as bone sialoprotein (BSP) and osteocalcin, were evaluated by immunohistochemistry (IHC). The ABB/high BMP group showed significantly higher BV than the ABB/low BMP (p = 0.004) and control groups (p = 0.000) and higher TbTh than the control group (p = 0.000). The ABB/low BMP group showed significantly higher BV, BMD, and TbTh than the control group (p = 0.002, 0.042, and 0.000, respectively). The histomorphometry showed significantly higher bone formation in the ABB/low and high BMP groups than in the control group (p = 0.000). IHC showed a high expression of BSP and osteocalcin in the ABB/low and high BMP groups. Subperiosteal bone grafts with ABB and rhBMP-2 have not been studied. In our study, we confirmed that rhBMP-2 contributes to new bone formation in a subperiosteal bone graft with ABB.

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Effects of condensation and compressive strain on implant primary stability

Bone and Joint Research ◽

10.1302/2046-3758.92.bjr-2019-0161 ◽

2020 ◽

Vol 9 (2) ◽

pp. 60-70 ◽

Cited By ~ 3

Author(s):

Zhijun Li ◽

Masaki Arioka ◽

Yindong Liu ◽

Maziar Aghvami ◽

Serdar Tulu ◽

...

Keyword(s):

Bone Density ◽

Bone Formation ◽

Compressive Strain ◽

Primary Stability ◽

New Bone Formation ◽

Implant Stability ◽

Bone Microdamage ◽

A Site ◽

Femoral Implants

Aims Surgeons and most engineers believe that bone compaction improves implant primary stability without causing undue damage to the bone itself. In this study, we developed a murine distal femoral implant model and tested this dogma. Methods Each mouse received two femoral implants, one placed into a site prepared by drilling and the other into the contralateral site prepared by drilling followed by stepwise condensation. Results Condensation significantly increased peri-implant bone density but it also produced higher strains at the interface between the bone and implant, which led to significantly more bone microdamage. Despite increased peri-implant bone density, condensation did not improve implant primary stability as measured by an in vivo lateral stability test. Ultimately, the condensed bone underwent resorption, which delayed the onset of new bone formation around the implant. Conclusion Collectively, these multiscale analyses demonstrate that condensation does not positively contribute to implant stability or to new peri-implant bone formation. Cite this article: Bone Joint Res. 2020;9(2):60–70.

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Bioglass Associated With Leukocyte-Poor Platelet-Rich Plasma in the Rabbit Maxillary Sinus: Histomorphometric, Densitometric, and Fractal Analysis

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-09-00072 ◽

2010 ◽

Vol 36 (5) ◽

pp. 333-343 ◽

Cited By ~ 10

Author(s):

Ivy Kiemle Trindade-Suedam ◽

Juliana Aparecida Najarro Dearo de Morais ◽

Rafael Silveira Faeda ◽

Fábio Renato Manzolli Leite ◽

Guilherme Monteiro Tosoni ◽

...

Keyword(s):

Fractal Dimension ◽

Bone Density ◽

Bone Formation ◽

Maxillary Sinus ◽

Platelet Rich Plasma ◽

Autogenous Bone ◽

New Bone Formation ◽

Mean Values ◽

Dimension Analysis ◽

Fractal Dimension Analysis

Abstract The objective of the present study was to evaluate the outcomes of autogenous bone graft (AB) and bioglass (BG) associated or not with leukocyte-poor platelet-rich plasma (LP-PRP) in the rabbit maxillary sinus (MS) by histomorphometric and radiographic analysis. Twenty rabbits divided into 2 groups (G1, G2) were submitted to sinus lift surgery. In G1, 10 MS were grafted with AB and 10 MS were grafted with BG. In G2, 10 MS were grafted with AB + LP-PRP and 10 MS were grafted with BG + LP-PRP. After 90 days, the animals were killed and specimens were obtained, x-rayed, and submitted to histomorphometric, radiographic bone density (RD) and fractal dimension analysis. Radiographic bone density mean values (SD), expressed as aluminum equivalent in mm, of AB, BG, AB + LP-PRP, and BG + LP-PRP groups were 1.79 (0.31), 2.04 (0.39), 1.61 (0.28), and 1.53 (0.30), respectively. Significant differences (P < 0.05) were observed between BG and AB, and BG + PRP and BG. Fractal dimension mean values were 1.48 (0.04), 1.35 (0.08), 1.44 (0.04), and 1.44 (0.06), respectively. Significant differences were observed between BG and AB, and AB + LP-PRP and BG. Mean values for the percentage of bone inside MS were 63.30 (8.60), 52.65 (10.41), 55.25 (7.01), and 51.07 (10.25), respectively. No differences were found. No correlations were observed among percentage of bone, RD and FD. Histological analysis showed that MS treated with AB presented mature and new bone formation. The other groups showed minor bone formation. Within the limitations of this study, the results indicated that at a 90-day time end point, AB yielded better results than AB + LP-PRP, BG, and BG + LP-PRP and should be considered the primary material for MS augmentation.

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Post-operative roentgenological findings and changes after mastoid obliteration

The Journal of Laryngology & Otology ◽

10.1017/s0022215100094317 ◽

1983 ◽

Vol 97 (5) ◽

pp. 393-398 ◽

Cited By ~ 2

Author(s):

Kauko Ojala ◽

Reijo Lahti ◽

Antti Palva ◽

Martti Sorri

Keyword(s):

Bone Formation ◽

Frequent Occurrence ◽

New Bone Formation ◽

Mastoid Obliteration ◽

X Ray ◽

Radiological Features ◽

Operative Complications ◽

Post Operative Complications

AbstractThis study consisted of the evaluation of the plain X-ray findings of films taken at early follow-up (mean 1.5 months after surgery) and at late follow-up(4–14 years after the early films) of 211 ears which had been operated on radically and obliterated. Residual cells which were detected on the basis of the early films were associated with a more frequent occurrence of post-operative infection and were thus hallmarks of a poorer prognosis. Changes in the bone surrounding the surgical cavity and the radiological quality of the walls of the surgical cavity, the presence of new bone formation in the cavity and other radiological features did not yield useful information about post-operative complications. New bone formation was associated with a smaller amount of post-operative cavitation. Post-operative X-ray examination of the obliterated ear is a prognostically useful examination, but it does not significantly contribute further to the information available by clinical and otomicroscopic examination in regards to the complications of infection and cholesteatoma.

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Influence of Homemade and Commercial Fibrin Sealant on Alveolar Bone Healing - an Experimental Study.

Blood ◽

10.1182/blood.v104.11.4110.4110 ◽

2004 ◽

Vol 104 (11) ◽

pp. 4110-4110

Author(s):

Maria Elvira P. Correa ◽

Oslei P. Almeida ◽

Danyel Peres ◽

Marcelo C. Alves ◽

Fernando F. Costa ◽

...

Keyword(s):

Bone Formation ◽

Bone Healing ◽

Fibrin Sealant ◽

Factor Xiii ◽

Alveolar Bone ◽

Healing Process ◽

Control Group ◽

Image Analysis System ◽

New Bone Formation ◽

Fibrin Sealants

Abstract The beneficial aspects of fibrin sealants for soft tissues are well documented, but studies of their direct influence on bone healing and their effectiveness in augmenting bone graft healing have produced conflicting results. The aim of this study was to evaluate the influence of fibrin sealants (FS) in the alveolar bone healing process during a period of up to 28 days. Seventy-five Wistar rats were submitted to a superior incisor extraction after intramuscular anesthesia (kentamine chloridrate 10% – 10mg/kg and tiazina chloridrate-5mg/kg). The rats were divided into tree different groups and the sealants were introduced into the alveolar bone. The first group (25) received human homemade fibrin glue, the second group (25) FS associated to factor XIII and aprotinin (Beriplast; Aventis-Beringher) and the third group (25) was the control. Animals were sacrificed by prolonged diethyl inhalation on days 7, 14 and 28 after surgery. Animal craniums were dissected and submitted to a decalcification, and preparated for H&E light microscopy. The morphometric study was performed by means of an interactive computerized image analysis system KS400 (Zeiss, Jena). New bone formation was carefully delimited in four different alveolar regions (apical, two middle areas and cervical) of each specimen. The data were statistically analyzed using multiple regression, ANOVA and Tukey test. Results showed that the amount of alveolar bone formation (μm) in the control group and commercial sealant was statistically similar. However, alveolus receiving homemade sealant presented less amount of new bone formation comparing to commercial sealant and control group (p=0.0034) (figure 1). The present study demonstrated that homemade fibrin sealant delays osteogenic formation. Commercial sealant did not improve alveolar repair however, the amount of new bone formation was slightly higher comparing to the control, probably due to the factor XIII present in this sealant. Figure Figure

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BAG S53P4 putty as bone graft substitute – a rabbit model

Biomedical glasses ◽

10.1515/bglass-2017-0003 ◽

2017 ◽

Vol 3 (1) ◽

Cited By ~ 1

Author(s):

Ilkka Saarenpää ◽

Patricia Stoor ◽

Janek Frantzén

Keyword(s):

Bone Formation ◽

Bone Regeneration ◽

Proximal Tibia ◽

Rabbit Model ◽

Bone Graft Substitute ◽

Control Group ◽

The Novel ◽

Bone Augmentation ◽

New Bone Formation ◽

New Zealand White Rabbits

AbstractBioactive glass (BAG) S53P4 granules represent a bone augmentation biomaterial for the surgical treatment of bony defects, even in challenging conditions such as osteomyelitis. The aim of this eight-week rabbit implantation study was to evaluate the biocompatibility and bone regeneration performance of a BAG S53P4 putty formulation following its implantation into the proximal tibia bone of twenty-eight New Zealand white rabbits. BAG S53P4 putty was compared to BAG S53P4 granules (0.5-0.8 mm) to evaluate whether the synthetic putty binder influences the bone regeneration of the osteostimulative granules. The putty formulation facilitates clinical use because of its mouldability, injectability and ease of mixing with autograft. Implantation of putty and granules into proximal tibia defects resulted in good osseointegration of the two groups. Both biomaterials were biocompatible, showed high new bone formation, high vascularization and periosteal growth. No signs of disturbed bone formation were observed due to the PEG-glycerol binder in the BAG S53P4 putty. Instead, intramedullary ossification and stromal cell reaction were more advanced in the putty group compared to the control group (p = 0.001 and p < 0.001). In conclusion, the novel mouldable BAG S53P4 putty showed reliable bone regeneration in bony defects without adverse tissue or cell reactions.

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Safety of autologous bone marrow aspiration concentrate transplantation: initial experiences in 101 patients

Orthopedic Reviews ◽

10.4081/or.2009.e32 ◽

2009 ◽

Vol 1 (1) ◽

pp. 32 ◽

Cited By ~ 48

Author(s):

Christian Hendrich ◽

Franz Engelmaier ◽

Gerhart Waertel ◽

Rolf Krebs ◽

Marcus Jäger

Keyword(s):

Bone Marrow ◽

Cell Therapy ◽

Bone Formation ◽

Ex Vivo ◽

Bone Marrow Aspiration ◽

Tumor Formation ◽

Surveillance Study ◽

New Bone Formation ◽

Technical Effort

The clinical application of cellular based therapies with ex vivo cultivation for the treatment of diseases of the musculoskeletal system has until now been limited. In particular, the advanced laboratory and technical effort necessary, regulatory issues as well as high costs are major obstacles. On the other hand, newly developed cell therapy systems permit intra-operative enrichment and application of mesenchymal and progenitor stem cells from bone marrow aspirate concentrate (BMAC) in one single operative session. The objective of the present clinical surveillance study was to evaluate new bone formation after the application of BMAC as well as to record any possible therapy-specific complications For this purpose, the clinical-radiological progress of a total of 101 patients with various bone healing disturbances was documented (surveillance study). The study included 37 necrosis of the head of the femur, 32 avascular necroses/bone marrow edema of other localization, 12 non-unions, 20 other defects. The application of BMAC was performed in the presence of osteonecrosis via a local injection as part of a core decompression (n=72) or by the local adsorption of intra-operative cellular bone substitution material (scaffold) incubated with BMAC during osteosynthesis (n=17) or in further surgery (n=12). After an average of 14 months (2-24 months), the patients were re-examined clinically and radiologically and interviewed. Further surgery was necessary in 2 patients within the follow-up period. These were due to a progression of a collapsed head of the femur with initial necrosis in ARCO Stage III, as well as inadequate new bone formation with secondary loss of correction after periprosthetic femoral fracture. The latter healed after repeated osteosynthesis plus BMAC application without any consequences. Other than these 2 patients, no further complications were observed. In particular, no infections, no excessive new bone formation, no induction of tumor formation, as well as no morbidity due to the bone marrow aspiration from the iliac crest were seen. There were no specific complications within the short follow-up period and a simple intra-operative use of the system for different forms of bone loss could be demonstrated. In the authors’ opinion, the on-site preparation of the bone marrow cells within the operating theater eliminates the specific risk of ex vivo cell proliferation and has a safety advantage in the use of autologous cell therapy for bone regeneration. Additional studies should be completed to determine efficacy.

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