• Title/Summary/Keyword: Bone graft procedure

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The effect of LiF-maleic acid added calcium aluminate hone cement & CA-PMMA composite bone cement on the healing of calvarial defect6) (LiF-maleic acid 첨가 calcium aluminate 골시멘트 및 CA-PMMA 복합 골시멘트가 백서 두개골 결손부 치유에 미치는 영향)

  • Shin, Jung-A;Yun, Jeong-Ho;Oh, Seung-Han;Baik, Jeong-Won;Choi, Se-Young;Kim, Chong-Kwan;Choi, Seong-Ho
    • Journal of Periodontal and Implant Science
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    • v.32 no.4
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    • pp.753-767
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    • 2002
  • The purpose of this study was to evaluate histologically the effect of LiF-maleic acid added calcium aluminate(LM-CA) bone cement & CA-PMMA composite bone cement on the healing of calvarial defect in Sprague-Dawley rats. The critical size defects were surgically produced in the calvarial bone using the 8mm trephine bur. The rats were divided in three groups : In the control group, nothing was applied into the defect of each rat. LM-CA bone cement was implanted in the experimental group 1 and CA-PMMA composite bone cement was implanted in the experimental group 2. Rats were sacrificed at 2, 8 weeks after surgical procedure. The specimens were examined by histologic analysis, especially about the bone-cement interface and the response of surrounding tissue. The results are as follows; 1. In the control group, inflammatory infiltration was observed at 2 weeks. At 8 weeks, periosteum and duramater were continuously joined together in the defect area. But the center of defect area was filled up with the loose connective tissue. 2. In the experimental group 1, the bonding between implanted bone cement and the existing bone was seen, which more increased in 8 weeks than 2 weeks. Inflammatory infiltration and the dispersion of implanted bone cement particles were seen in both 2 weeks and 8 weeks. 3. In the experimental group 2, implanted bone itself had a dimensional stability and no bonding between implanted bone cement and the existing bone was seen in both 2 weeks and 8 weeks. Implanted bone cement was encapsulated by fibrous connective tissue. In addition, inflammatory infiltration was seen around implanted bone cement. On the basis of these results, when LM-CA bone cement or CA-PMMA composite bone cement was implanted in rat calvarial defect, LM-CA bone cement can be used as a bioactive bone graft material due to ability of bonding to the existing bone and CA-PMMA can be used as a graft material for augmentation of bone-volume due to dimensional stability.

HISTOLOGICAL CHANGES IN THE ELONGATED BONE AFFECTED BY OSTEODISTRACTION OF THE MANDIBLE IN THE DOG (성견 하악골 절단 후 기계적 골 견인에 의해 형성된 골 신장부에 대한 시기별 조직학적 변화)

  • Baek, Sun-Ho;Ahn, Byoung-Keun;Park, Young-Ju;Park, Hee-Geon;Park, Jun-Woo;Rhee, Gun-Joo;Lee, Yong-Chan;Cho, Byoung-Ouck
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.27 no.5
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    • pp.404-416
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    • 2001
  • Purpose : Traditionally, the treatement of choice has been a bone grafting procedure to increase the length of bone in case of actual length discrepancy. But, bone grafting procedure has many disadvantages, for example, graft resorption, donor site morbidity, and so on. So, many trials have been performed to avert the use of autogenous bone graft via introducing new materials or methods. And, one of those trials has been realized by the development of a technique inducing bone lengthening by osteotomy (or corticotomy) and slow gradual distraction of the osteotomized segments. This new technique of bone lengthening dates back to the early 20th century. But, the majority of information concerning the biology of new bone formation during bone lengthening and technical details of the procedure were produced by extensive clinical and experimental studies performed by Ilizarov, a Russian surgeon. According to Ilizarov, with adequate blood supply, preservation of periosteum, rigid fixation of the osteotomized segments, and proper rate and rhythm of distraction, intramembranous bone rapidly develops within the distraction gap in the limb lengthening procedure. In the limb lengthening, many orthopedic surgeons try to observe the biologic and clinical principles recommended by Ilizarov. In the oral and maxillofacial region, however, not a few studies must be performed to apply this surgical technique in the clinical cases. Besides, the mechanism of bone formation in the distraction gap is not clear, yet. The purpose of this experiment was to scrutinize serially the histological changes in the elongated bone affected by osteodistraction of the mandibular body in an adult canine model. In addition, it was performed to confirm the presence of specific region(s) which was important in the bone formation in the gap through the observation of the expression pattern of osteocalcin and osteonectin with the immunohistochemical examination. Materials and Methods : The experimental and control specimens were obtained from seven adult male mongrel dogs weighing over 20kg. The distractors were custom-made linear extraoral devices and bicortical fixation screws were 2.3mm in diameter, 50mm in total length, 15mm in screw length. The distractors were devised to produce a linear gap of 0.75mm between two bony segments every $360^{\circ}$ turn of the rotation rod of the device. The mandibular body of the right side of each animal was corticotomized perpendicular to the occlusal plane and then two bony segments were separated completely by careful manipulation of the segments with bone forceps. The left side of each animal was left intact. This side was served as control. At sixth day after osteotomy and fixation of the segments were performed, distraction of the segments was commenced with a rate of 1.1mm/day and a rhythm of two/day for ensuing 7 days. The animals were euthanized at the 16th. 29th, and 44th day after the osteotomy. The bony specimens were decalcified, embedded in paraffin, sectioned $5{\mu}m$ thick and stained with H&E. The prepared specimens were examined under the light microscope. And, immunohistochemical examinations using anti-osteocalcin antibody (OC1, Biodesign, USA) and anti-osteonectin antibody (Haematologic Technologies Inc., Essex, VT) to locate the expressions of osteocalcin and osteonectin, respectively, were performed. Results : 1. New bone was observed already at the 16th. day after osteotomy. This suggests that new bone formation in osteodistraction was commenced at an early stage of the regenerative process. But, radiologically and microscopically, bony union was not completed in the distraction gap at the 44th. day after osteotomy. Therefore, rigid fixation must be maintained between the bony fragments till the complete bony union is confirmed clinically rather than one month or so after the completion of distraction.

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Alveolar ridge augmentation with the perforated and nonperforated bone grafts

  • de Avila, Erica Dorigatti;Filho, Jose Scarso;de Oliveira Ramalho, Lizete Toledo;Real Gabrielli, Mario Francisco;Pereira Filho, Valfrido Antonio
    • Journal of Periodontal and Implant Science
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    • v.44 no.1
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    • pp.33-38
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    • 2014
  • Purpose: Autogenous bones are frequently used because of their lack of antigenicity, but good osteoconductive and osteoinductive properties. This study evaluated the biological behavior of perforated and nonperforated cortical block bone grafts. Methods: Ten nonsmoking patients who required treatment due to severe resorption of the alveolar process and subsequent implant installation were included in the study. The inclusion criteria was loss of one or more teeth; the presence of atrophy of the alveolar process with the indication of reconstruction procedures to allow rehabilitation with dental implants; and the absence of systemic disease, local infection, or inflammation. The patients were randomly divided into two groups based on whether they received a perforated (inner surface) or nonperforated graft. After a 6-month healing period, a biopsy was performed and osseointegrated implants were installed in the same procedure. Results: Fibrous connective tissue was evident at the interface in patients who received nonperforated grafts. However, full union between the graft and host bed was visible in those who had received a perforated graft. Conclusions: We found that cortical inner side perforations at donor sites increased the surface area and opened the medullary cavity. Our results indicate an increased rate of graft incorporation in patients who received such perforated grafts.

Effect of maxillary sinus graft on the survival of endosseous implants: A 10-year retrospective study

  • Jeon, Hye-Ran;Pang, Eun-Kyoung;Pae, Ah-Ran;Kim, Myung-Rae;Kang, Na-Ra
    • Journal of Periodontal and Implant Science
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    • v.38 no.sup2
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    • pp.309-316
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    • 2008
  • Purpose: The aim of this study was to determine the survival rates of implants placed in grafted maxillary sinuses and compare the results obtained with graft materials, implant surfaces and timing of implant placement. Materials and Methods: Between January 1996 and December 2005, 391 implants were placed in 161 patients who underwent sinus grafting treatment simultaneously or separately at Ewha Womans University Hospital. According to inclusion criteria, 272 implants were placed in 102 patients with 112 sinus grafts (30 females, 72 males), aged 26 to 88 years (mean age $49.0{\pm}9.7$). The follow-up period ranged from 12 to 134 months (mean F/U $47{\pm}32$). Survival rates were evaluated according to graft material, implant surface and timing of implant placement. The Kaplan-Meier procedure and the log rank (Mantel-Cox) test were used to estimate survival rates and test for equality of survival rates between different groups of patients. Results: Ten-year cumulative survival rate for implants placed in the grafted sinuses was 90.1%. The survival rates for autogenous bone, combination and bone substitutes were 94.6%, 85.9% and 100%, respectively (p > 0.05). According to implant surface, survival rates were 84.8% in machined group and 97.5% in rough group (p < 0.05). The survival rates were 92.9% in delayed group and 86.0% in simultaneous group (p > 0.05). Conclusion: Ten-year cumulative survival rate for implants placed in the grafted sinuses was 90.1%. Rough-surfaced implants have a higher survival rate than machined-surfaced implants when placed in grafted sinuses (p < 0.05).

A Retrospective Clinical Study of Survival Rate for a Single Implant in Posterior Teeth (구치부 단일 임플란트의 생존율에 대한 후향적 연구)

  • Han, Sung-Il;Lee, Jae-Hoon
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.34 no.3
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    • pp.186-199
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    • 2012
  • Purpose: Single implants, of which screw loosening has been observed frequently, presents problems such as fixtures fractures, marginal bone loss, and inflammation of the soft tissue around the implant. However, the single implant is more conservative, cost effective, and predictable compared to the 3 unit bridge with respect to the long-term outcome. This study evaluated the survival rate as well as future methods aimed at increasing the survival rate in single implants in posterior teeth. Methods: Among the implants placed in the Dankook University Dental Hospital department of Oral & Maxillofacial surgery from January 2001 to June 2008, 599 implants placed in the maxillar and mandibular posterior were evaluated retrospectively. Survival rates were investigated according to implant location, cause of tooth loss, gender, age, general disease, fixture diameter and length, surface texture, implant type and shape, presence of bone graft, surgery stage, surgeons, bone quality and opposite teeth. Results: Out of 599 single implants in posterior teeth, 580 implants survived and the survival rate was 96.8%. The difference in survival rate was statistically significant according to the implant location. The survival rate was low (84.2%) in implants exhibiting a wide diameter (${\geq}5.1mm$) and the surface treated by the acid etching group demonstrated a significantly lower survival rate (91.1%). One stage surgical procedure, which implemented a relatively better bone quality survival rate (100%), was higher than the two stage surgical procedure (96.1%). The survival rate of type IV bone quality (75%) was significantly lower than the other bone quality. Conclusion: Single posterior teeth implant treatments should use an improved surface finishing fixture as well as careful and safe procedures when performing implant surgery in the maxilla premolar and molar regions since bone quality is poor.

Operative Treatment of Symptomatic Flexible Flatfeet in Children (통증을 동반한 소아 유연성 편평 족의 수술적 치료)

  • Park, Yong-Wook;Yoon, Tae-Kyung;Jeong, Un-Seob
    • Journal of Korean Foot and Ankle Society
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    • v.7 no.1
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    • pp.30-35
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    • 2003
  • Purpose: The purpose of this study was to evaluate the result of open wedge osteotomy at the anterior calcaneus with iliac bone graft (Evans procedure) for symptomatic flexible flatfeet in children. Materials and Methods: A retrospective study was conducted between October 1995 and September 2002. Six cases in 3 patients who had symptomatic flexible flatfeet was included. Follow-up averaged 39.5 months. We evaluated the patients' satisfaction by Mann and Reynolds scorring and compared the radiographic results between preoperative and final radiography. Results: The satisfaction outcomes at the last follow-up were excellent in five and good in one. The mean lateral talo-first metatarsal angle was improved from $-20^{\circ}$ to $-3^{\circ}$. The mean calcaneal inclination angle was improved from $8.5^{\circ}$ to $20.8^{\circ}$. The talo-navicular coverage angle was improved from $47.5^{\circ}$ to $7.5^{\circ}$. In one case, we found the subluxation of calcaneocuboidal jont in postoperative radiography. Conclusion: Open wedge osteotomy at the anterior calcaneus for symptomatic flexible flatfeet in children was considered as one of the effective treatment methods.

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Risk Factors of Allogenous Bone Graft Collapse in Two-Level Anterior Cervical Discectomy and Fusion

  • Woo, Joon-Bum;Son, Dong-Wuk;Lee, Su-Hun;Lee, Jun-Seok;Lee, Sang Weon;Song, Geun Sung
    • Journal of Korean Neurosurgical Society
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    • v.62 no.4
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    • pp.450-457
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    • 2019
  • Objective : Anterior cervical discectomy and fusion (ACDF) is commonly used surgical procedure for cervical degenerative disease. Among the various intervertebral spacers, the use of allografts is increasing due to its advantages such as no harvest site complications and low rate of subsidence. Although subsidence is a rare complication, graft collapse is often observed in the follow-up period. Graft collapse is defined as a significant graft height loss without subsidence, which can lead to clinical deterioration due to foraminal re-stenosis or segmental kyphosis. However, studies about the collapse of allografts are very limited. In this study, we evaluated risk factors associated with graft collapse. Methods : We retrospectively reviewed 33 patients who underwent two level ACDF with anterior plating using allogenous bone graft from January 2013 to June 2017. Various factors related to cervical sagittal alignment were measured preoperatively (PRE), postoperatively (POST), and last follow-up. The collapse was defined as the ratio of decrement from POST disc height to follow-up disc height. We also defined significant collapses as disc heights that were decreased by 30% or more after surgery. The intraoperative distraction was defined as the ratio of increment from PRE disc height to POST disc height. Results : The subsidence rate was 4.5% and graft collapse rate was 28.8%. The pseudarthrosis rate was 16.7% and there was no association between pseudarthrosis and graft collapse. Among the collapse-related risk factors, pre-operative segmental angle (p=0.047) and intra-operative distraction (p=0.003) were significantly related to allograft collapse. The cut-off value of intraoperative distraction ${\geq}37.3%$ was significantly associated with collapse (p=0.009; odds ratio, 4.622; 95% confidence interval, 1.470-14.531). The average time of events were as follows: collapse, $5.8{\pm}5.7months$; subsidence, $0.99{\pm}0.50months$; and instrument failure, $9.13{\pm}0.50months$. Conclusion : We experienced a higher frequency rate of collapse than subsidence in ACDF using an allograft. Of the various preoperative factors, intra-operative distraction was the most predictable factor of the allograft collapse. This was especially true when the intraoperative distraction was more than 37%, in which case the occurrence of graft collapse increased 4.6 times. We also found that instrument failure occurs only after the allograft collapse.

Integration of Four-Strand Hamstring Tendon Graft with Bone in Reconstruction of the Anterior Cruciate Ligament -Report of one case- (슬괵건을 이용한 전방십자인대 재건술시 이식건과 골 사이의 골통합에 대한 조직학적 변화 - 1례 보고 -)

  • Jung, Young-Bok;Jang, Eui-Chan;Yum, Jae-Kwang;Park, Geun-Hyung
    • Journal of the Korean Arthroscopy Society
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    • v.3 no.1
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    • pp.40-43
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    • 1999
  • Arthroscopic anterior cruciate ligament(ACL) reconstruction using four-strand hamstring tendon with looping around transfixing screw in femoral tunnel requires osteointegration between the grafted tendon and bone for stability of the knee. Authors have experienced a histologic finding of osteointegration between the grafted autogenous hamstring tendon and bone in femoral tunnel after arthroscopic ACL reconstruction. A patient received arthroscopic ACL reconstruction with autogenous four strand hamstring tendon for the ACL injury. Traumatic re-rupture of mid-substance of ACL graft was developed at thirteenth week after operation. During the procedures of arthroscopic revision at fifteenth week after initial ACL reconstruction, biopsy was performed at the site of interface between grafted tendon and bone in femoral tunnel. Integration between the grafted tendon and bone was evident by demonstrating the continuity of collagen fiber between bond and tendon. This histologic finding and the low incidence of early graft failure suggest that free tendon autograft attached to bone by looping around a transfixing screw in femoral tunnel undergoes adequate osteointegration between 12 and 15 weeks after surgery and authors thought that insertion of bone chip into the femoral tunnel would accelerate osteointegration procedure.

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The effects of decalcification time of demineralized freeze-dried bone on the healing of 3-wall intrabony defects in dogs (탈회시간에 따른 탈회 냉동 건조골이식이 성견 3면 골내낭의 치유에 미치는 영향)

  • Kim, Chang-Sung;Cho, Kyoo-Sung;Kim, Chong-Kwan;Chai, Jung-Kiu
    • Journal of Periodontal and Implant Science
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    • v.26 no.4
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    • pp.779-797
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    • 1996
  • The present study investigated the effects of variations in decalcification time of demineralized freeze-dried bone on the osteogenic potential of DFDB. Sixteen 3-wall intrabony defects with 4mm depth were surgically created in the mesial aspect of upper and lower anterior teeth of 4 dogs. Following the flap procedure, three test groups with 4 defects each received either freeze-dried bone graft (Group I), demineralized freeze-dried bone graft decalcified for 12hours (Group II), or demineralized freeze-dried bone graft decalcified for 24hours(Group III). The rest of the four defects received the flap procedure-only as the control group. The healing was histologically analyzed after 14 weeks on the length of connective tissue adhesion, new bone formation and new cementum formation. The results were as follows: 1. The length of connective tissue adhesion showed no statistically significant difference in all groups with $0.62{\pm}0.14mm$ for Control, $0.42{\pm}0.11mm$ for Group I, $0.63{\pm}0.43mm$ for Group II and $0.52{\pm}0.11mm$ for Group III. 2. The new bone formation showed no statistically significant difference in all groups with $3.17{\pm}0.24mm$ for Control. $3.15{\pm}0.56mm$ for Group I. $3.22{\pm}0.36mm$ for Group II, and $3.28{\pm}0.74mm$ for Group III. 3. The new cementum formation showed no statistically significant difference in all groups with $4.19{\pm}0.46mm$ for Control, $3.23{\pm}0.64mm$ for Group I, $4.13{\pm}1.82mm$ for Group II. and $3.13{\pm}0.62mm$ for Group III.

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A review of rare complications of maxillary sinus floor augmentation

  • On, Sung Woon;Cho, Seoung-Won;Yang, Byoung-Eun
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.45 no.6
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    • pp.351-356
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    • 2019
  • Maxillary sinus floor augmentation (MSFA) is an essential procedure for implant installation in the posterior maxillary area with vertical alveolar bone deficiency. For the past several decades, MSFA has been refined in terms of surgical methods along with technical progress, accumulation of clinical studies, and development of graft materials and surgical instruments. Although some complications in MSFA are inevitable in clinical situations, management of those complications in MSFA has been well established thanks to many clinicians and researchers. Nevertheless, some rare complications may arise and can result in fatal results. Therefore, clinicians should be well aware of such rare situations and complications associated with MSFA. In this review, the authors present several rare complications regarding MSFA, along with corresponding management strategies through a thorough review of the literature.