Local administration of HMGB-1 promotes bone regeneration on the critical-sized mandibular defects in rabbits

Reconstruction of a critical-sized osseous defect is challenging in maxillofacial surgery. Despite novel treatments and advances in supportive therapies, severe complications including infection, nonunion, and malunion can still occur. Here, we aimed to assess the use of a beta-tricalcium phosphate (β-TCP) scaffold loaded with high mobility group box-1 protein (HMGB-1) as a novel critical-sized bone defect treatment in rabbits. The study was performed on 15 specific pathogen-free New Zealand rabbits divided into three groups: Group A had an osseous defect filled with a β-TCP scaffold loaded with phosphate-buffered saline (PBS) (100 µL/scaffold), the defect in group B was filled with recombinant human bone morphogenetic protein 2 (rhBMP-2) (10 µg/100 µL), and the defect in group C was loaded with HMGB-1 (10 µg/100 µL). Micro-computed tomography (CT) examination demonstrated that group C (HMGB-1) showed the highest new bone volume ratio, with a mean value of 66.5%, followed by the group B (rhBMP-2) (31.0%), and group A (Control) (7.1%). Histological examination of the HMGB-1 treated group showed a vast area covered by lamellar and woven bone surrounding the β-TCP granule remnants. These results suggest that HMGB-1 could be an effective alternative molecule for bone regeneration in critical-sized mandibular bone defects.

Osseous defect of the anteroinferior femoral head: is it associated with femoroacetabular impingement (FAI)?

Objective To evaluate the prevalence, morphology, and clinical significance of a repeatedly observed yet not examined circumscript osseous defect at the anteroinferior aspect of the femoral head, termed femoral head defect. Materials and methods Retrospective study with approval of the institutional review board. There was informed consent by all individuals. Magnetic resonance imaging (MRI) hip examinations of 970 individuals (age 15 to 55) were analyzed for femoral head defect. Patients with femoral head defect were matched for age and gender with patients without defect. Two readers independently assessed MRI images regarding presence, location, and morphology of the defect. MR images and radiographs were analyzed for findings of femoroacetabular impingement (FAI). Femoral torsion was measured. Independent t test and chi-square test were used for statistics. Results Sixty-eight (7%) of 970 MRI examinations exhibited a femoral head defect in an anteroinferior location of the femoral head (29/400 men, 7.3%; 39/570 women, 6.8%; p = 0.8). The most frequent morphology of femoral head defect was type I, dent-like (34; 50%), followed by type II, crater-like (27; 40%), and III, cystic (7; 10%). Femoral head defect was slightly more common on the right hip (39 individuals; 57%) compared to left (29 individuals; 43%), non-significantly (p = 0.115). There was no association between FAI or its subtypes and the presence of femoral head defect (p = 0.890). Femoral antetorsion was reduced in patients with femoral head defect (12.9° ± 8.6) compared to patients without defect (15.2° ± 8.5), without statistical significance (p = 0.121). Conclusion The femoral head defect is a common finding in MRI examinations of the hip and is situated in the anteroinferior location. There was no association with FAI yet a non-significant trend towards lower femoral antetorsion in patients with femoral head defects.

RADICULAR CYST ENUCLEATION, APICOECTOMY AND MANAGEMENT OF OSSEOUS CAVITY USING ALLOPLAST AND PLATELET RICH FIBRIN IN RELATION TO NON-VITAL TEETH- A CASE REPORT

One of the most common dental cysts to affect the human jaw is radicular cyst. The tooth/teeth associated with radicular cysts are usually non-vital and rarely presents with clinical signs and symptoms until diagnosed during routine dental examination. The present case report highlights on radicular cyst enucleation, apicoectomy of the involved teeth and periodontal management of the resultant osseous defect using alloplast bone graft, platelet-rich brin (PRF) and guided tissue regeneration (GTR) membrane.

Distal Molar Surgery

Periodontitis is a chronic inflammation involving tooth investing structures.1 It causes irreversible bone and attachment loss. Very often third molar impaction leads to various complications adversely influencing the entire periodontal status.2 Therefore disimpaction surgery is one of the most commonly performed procedures. Extraction of an impacted molar tends to initiate localized periodontal pockets distally to an adjacent molars.3 This favours colonization of the subgingival microbiota, due to the difficulties associated with hygiene, and leads to the appearance of progressive bone loss into an well-defined angular defect.4 The primary goal of periodontal therapy is aimed at prevention, slowing or arresting disease progression. 5 Gingivectomy is the first choice of treatment in distal pocket due bulbous fibrous tissue. It can only be the choice of treatment when adequate amount of keratinized tissue is present at the site. Nevertheless, many times inadequate keratinized tissue or an angular bony defect has been diagnosed. Then bulbous tissue is preferably reduced in bulk and not be removed completely by the distal molar surgery. 6 The technique aids in pocket management. Apart, it also facilitates access to the osseous defect. It also secures the sufficient amounts of gingival tissue to achieve coverage.