Maxillary Sinus Augmentation Using Ceramic Alloplastic Granules or Paste: An Experimental Study in Rabbits

Background: Due to the lack of data comparing the biological behavior of two formulations, granules and paste, of alloplastic graft from microtomographic and histomorphometric points of view, the aim of the present experiment was to compare the histomorphometric and microtomographic healing of two formulations, i.e., granules (MR sites) or paste (MR-inject sites) of an alloplastic graft composed of a combination of beta-tricalcium phosphate and hydroxyapatite used for maxillary sinus lifting. Methods: A sinus lifting procedure was carried out bilaterally in 20 rabbits, and the elevated space was filled with either paste or granules of an alloplastic material. A collagen membrane was placed on the antrostomy and the animals were euthanized after 2 or 10 weeks, 10 animals each group. Microtomographic and histological analyses were performed. Results: Higher proportions of new bone formation were found at the MR, compared to the MR-inject sites both after 2 weeks (2.65 ± 2.89% vs. 0.08 ± 0.12%; p < 0.01) and 10 weeks of healing (34.20 ± 13.86 vs. 23.28 ± 10.35%; p = 0.022). Conclusions: It was concluded that new bone formation was faster in the MR sites, compared to the MR-inject. However, a longer time of healing should be allowed to make final conclusions about the efficiency in bone formation of the paste formulation of the biomaterial used in the present study.

Secondary Reconstruction of the Zygomaticomaxillary Complex

Zygomaticomaxillary (ZMC) fractures are the second most common facial fractures after nasal bone fractures. The zygoma, with its location and multiple points of articulations, lends itself to both facial structure and esthetics. Secondary ZMC deformities are complications of inadequate primary correction, delayed repair, or lack of repair. Secondary revisions of ZMC aim to correct ZMC displacement and projection and to address orbital discrepancies. Extensive correction involving significant orbital and malar defects requires zygomatic repositioning osteotomies and would greatly benefit from the utilization of virtual surgical planning, intraoperative navigation, and imaging. Minor corrections in malar projection can be corrected by onlay grafting and soft tissue augmentation and resuspension. Isolated or minor orbital corrections can be managed by autogenous or alloplastic material to restore lost orbital volume and anatomy.

Reconstruction of the chest wall with a latissimus dorsi muscle flap after an infection of alloplastic material: a case report

Alloplastic material is often used for thoracic wall reconstruction following extended resection bringing the risk of infection, especially after chemotherapy and/or radiation. We present the case of a 66-year-old male with lung adenocarcinoma of the right lower lobe. After extended lobectomy, a partial resection of the sixth to eighth ribs followed by chest wall reconstruction with Mersilene mesh and osteosynthesis for sixth and seventh rib was performed. One month postoperatively, he developed pleural empyema. The alloplastic material was removed, extensive surgical debridement was performed and a latissimus dorsi muscle flap was used to cover the chest wall defect and fill out the remnant space supradiaphragmatically. Three years later, the patient has fully recovered with no local pain or relapse of the tumour. This case shows that rigid chest wall reconstruction with a soft autologous muscle flap is a valuable salvage option in case of infection, making alloplastic material highly risky.

Post-Operative Outcomes of Radiological and Histopathological Findings after Hydroxyapatite and Allogenic Bone Graft among Jaw Cyst Patients: A Randomized Clinical Trial

Background: Post-surgical outcomes of jaw cyst is very crucial. Objective: The purpose of the present study was to observe the radiological and histological finings as postoperative outcomes after hydroxyapatite and allogenic bone graft among jaw cyst patients. Methodology: This single centre, parallel, randomized clinical trial was conducted in the Department of Oral and Maxillofacial Surgery at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2006 to June 2008 for a period of two (02) years. Patients presented with radicular and dentigerous cyst with the size of the lesion between 2 cm to 7 cm. in diameter and relatively non infected cystic lesion were selected as study population. The study population were divided into two groups designed as group A treated with hydroxyapatite alloplastic material and group B treated with allogenic-bone graft after enucleation of the cystic lesion. The standard surgical procedure was to be performed meticulously in sterile environment. Post-operative radiograph were taken after one month, three months and six months. Histopathological examination was done after six month of operation which was done in the department of Pathology, BSMMU. Scintigraphic examination was performed after 6 months of the operation to evaluate the viability of the bone graft in the graft site. Result: A total number of 28 patients were recruited for this study of which 14 patients were treated with hydroxyapatite crystals bone graft in group A and 14 patients were treated with allogenic bone graft in group B. The age of patients of both groups ranged between 14 and 58 years. In histopathological examination marked presence of cementing line, woven bone and osteoblast cell was found in patients who were grafted with hydroxyaptite and this had indicated good osteoblastic activity. Increased technetium-99m labeled diphosphonate uptake was found in the patient with allograft. There was a smaller lesion diameter of hydroxyapatite group in comparison with allogenic bone graft group which had indicated comparatively better healing than that of the hydroxyapatite group. Conclusion: In conclusion hydroxyapatite alloplastic material has better radiological and histopathological outcomes than allogenic bone graft after surgery of jaw cyst. Journal of National Institute of Neurosciences Bangladesh, 2020;6(1): 48-53

Comparison of Rate of Infection during Hydroxyapatite and Allogenic Bone Graft Used In Jaw Cyst: A Randomized Clinical Trial

Background: Post-operative infection can occur after bone grafting among patietns with jaw cyst. Objective: The purpose of the present study was to compare the rate of infection as postoperative outcomes after hydroxyapatite and allogenic bone graft among jaw cyst patients. Methodology: This randomized clinical trial was conducted in the Department of Oral and Maxillofacial Surgery at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2006 to June 2008. Patients presented with radicular and dentigerous cyst and relatively non infected cystic lesion were selected as study population. The study population were divided into two groups designed as Group A treated with with allogenic-bone graft and Group B treated with hydroxyapatite alloplastic material after enucleation of the cystic lesion. The rate of infection was recorded after surgery in both group A and B. Result: A total number of 28 patients were recruited for this study of which 14 patients were treated with hydroxyapatite crystals bone graft in group A and 14 patients were treated with allogenic bone graft in group B. Post-operative infection was not found in group A and 5(35.7%) in group B (p<0.05). Infection occurred in 1(20.0%) case in one side intact and 4(80.0%) in both side lost. Infection was found in 1(20.0%) case and 4(80.0%) cases in average and poor oral hygiene status respectively. Conclusion: In conclusion more infection occurs in allogenic bone graft group than the group treated with hydroxyapatite alloplastic material Bangladesh Journal of Infectious Diseases 2019;6(2):29-33

Free-amplitude upper limb exercises after mastectomy and immediate reconstruction are beneficial and safe: randomized clinical trial

Introduction: Physical therapy plays an important role in the prevention of motor and functional complications in the postoperative period of breast cancer1, reestablishing the motor function and improving the quality of life of patients2. However, there is no randomized study about the different physical therapeutic approaches in patients submitted to mastectomy and immediate alloplastic reconstruction. Objectives: To assess the impact of clearance for free-amplitude upper limb exercises, 15 or 30 days after surgery, on the movement amplitude (MA) of shoulder, pain and upper limb function; on the incidence of dehiscence, seroma, infection and necrosis; and on the need for reoperation in patients after mastectomy and immediate reconstruction with alloplastic material. Methodology: Sixty women who underwent mastectomy due to breast cancer were included in this randomized clinical trial. They were submitted to evaluations in the preoperative period and 07, 15, 30, 60 and 90 days after surgery. They started with limited exercises at 90º of MA of the shoulder the day after the surgery. Fifteen days later, they were randomized in two groups of 30 patients: Free-Amplitude Group – liberation of joint shoulder amplitude at the threshold of pain, or until feeling the displacement of surgical borders; and Limited Amplitude Group – maintenance of restricted shoulder movements at 90º until 30 days after the surgery, when they were also cleared for free-amplitude movements. Results: Patients who were cleared for free-amplitude upper limb exercises 15 days after surgery felt less pain, wider shoulder amplitude and better upper limb function, in comparison to those whose movements were restricted to 90º for 30 days, without increase in incidence and prevalence of postoperative scar complications, and without inference in the need for reoperations. Conclusion: postoperative protocol that clears free MA of shoulder 15 days after surgery is safe and beneficial for the kinetic and functional recovery, as well as algic control in the postoperative period after mastectomy and immediate reconstruction with alloplastic material.

Histological Evaluation of a New Beta-Tricalcium Phosphate/Hydroxyapatite/Poly (1-Lactide-Co-Caprolactone) Composite Biomaterial in the Inflammatory Process and Repair of Critical Bone Defects

Background: The use of biomaterials is commonplace in dentistry for bone regeneration. The aim of this study was to evaluate the performance of a new alloplastic material for bone repair in critical defects and to evaluate the extent of the inflammatory process. Methods: Forty-five New Zealand rabbits were divided into five groups according to evaluation time (7, 14, 30, 60, 120 days), totaling 180 sites with six-millimeter diameter defects in their tibiae. The defects were filled with alloplastic material consisting of poly (lactide-co-caprolactone), beta-tricalcium phosphate, hydroxyapatite and nano-hydroxyapatite (BTPHP) in three different presentations: paste, block, and membrane. Comparisons were established with reference materials, such as Bio-ossTM, Bio-oss CollagenTM, and Bio-gideTM, respectively. The samples were HE-stained and evaluated for inflammatory infiltrate (scored for intensity from 0 to 3) and the presence of newly formed bone at the periphery of the defects. Results: Greater bone formation was observed for the alloplastic material and equivalent inflammatory intensity for both materials, regardless of evaluation time. At 30 days, part of the synthetic biomaterial, regardless of the presentation, was resorbed. Conclusions: We concluded that this novel alloplastic material showed osteoconductive potential, biocompatibility, low inflammatory response, and gradual resorption, thus an alternative strategy for guided bone regeneration.