The use of commercial products such as a cup and liner for total hip arthroplasty for patients with severe bone defects has a high probability of failure.In these patients the cup alone cannot cover the bone defect,an...The use of commercial products such as a cup and liner for total hip arthroplasty for patients with severe bone defects has a high probability of failure.In these patients the cup alone cannot cover the bone defect,and thus,an additional augment or cage is required.In this study,we designed three-dimensional(3D)printable bone augments as an alternative to surgeries using reinforcement cages.Thirty-five sharp-edged bone augments of various sizes were 3D printed.A biporous structure was designed to reduce the weight of the augment and to facilitate bone ingrowth.Two types of frames were used to prevent damage to the augment’s porous structure and maintain its stability during printing.Furthermore,two types of holes were provided for easy augment fixation at various angles.Fatigue tests were performed on a combination of worst-case sizes derived using finite element analysis.The test results confirmed the structural stability of the specimens at a load of 5340 N.Although the porosity of the specimens was measured to be 63.70%,it cannot be said that the porous nature was uniformly distributed because porosity tests were performed locally and randomly.In summary,3D-printable biporous bone augments capable of bonding from various angles and bidirectionally through angulation and bottom-plane screw holes are proposed.The mechanical results with bone augments indicate good structural safety in patients.However,further research is necessary to study the clinical applications of the proposed bone augment.展开更多
Purpose: Autogenous bone was still considered as the gold standard in bone augmentations prior to implants insertion at the atrophic ridges. However if large bone grafts are needed to augment multiple edentulous atrop...Purpose: Autogenous bone was still considered as the gold standard in bone augmentations prior to implants insertion at the atrophic ridges. However if large bone grafts are needed to augment multiple edentulous atrophic segments, extraoral donor sites may be mandatory. The aim of this report is to introduce the Fares Wedge Technique, as a new bone augmentation method that can augment multiple edentulous ridges with intraoral cortical bone grafts. Methods: This report includes patients with moderate to severe ridge atrophy in different regions of the both jaws who were treated over 6-years period (2009-215) with wedge Technique (WT). Patients received panorex immediately after the surgery, and they were examined clinically and radiographically (periapical) every 2 weeks. At 4 months, computed tomography was performed to evaluate the bone gain. Reentry was performed after 4 to 5 months to evaluate the new bone volume and quality and to insert implants. At this stage specimens for histologic examination were also obtained. Results: 39 augmentation sites in 22 patients (15 women, 7 men: mean age 47 years) were followed 12 to 52 months. The healing process was uneventful, with minimal morbidity. The success rate was 95%, and the bone gain average was 3 - 6 mm vertically and 3 - 9 mm horizontally. In two patients the graft was partially exposed and treated with shaving and rounding the exposed wedges, but the augmentations were saved. In one case the majority of the bone graft was lost. At 38 sites the patients had successfully received 114 implants. Conclusions: wedge technique can augment multiple segments of atrophic ridges with small amount of autogenic graft. The bone volume that achieved was satisfying, especially that the majority of the augmented areas were at posterior mandibular defects.展开更多
Calcium phosphate bio-ceramics are osteo-conductive,but it remains a challenge to promote the induction of bone augmentation and capillary formation.The surface micro/nano-topography of materials can be recognized by ...Calcium phosphate bio-ceramics are osteo-conductive,but it remains a challenge to promote the induction of bone augmentation and capillary formation.The surface micro/nano-topography of materials can be recognized by cells and then the cell fate are mediated.Traditional regulation methods of carving surface structures on bio-ceramics employ mineral reagents and organic additives,which might introduce impurity phases and affect the biological results.In a previous study,a facile and novel method was utilized with ultrapure water as the unique reagent for hydrothermal treatment,and a uniform hydroxyapatite(HAp)surface layer was constructed on composite ceramics(β-TCP/CaSiO_(3))in situ.Further combined with 3D printing technology,biomimetic hierarchical structure scaffolds were fabricated with interconnected porous composite ceramic scaffolds as the architecture and micro/nano-rod hybrid HAp as the surface layer.The obtained HAp surface layer favoured cell adhesion,alleviated the cytotoxicity of precursor scaffolds,and upregulated the cellular differentiation of mBMSCs and gene expression of HUVECs in vitro.In vivo studies showed that capillary formation,bone augmentation and new bone matrix formation were upregulated after the HAp surface layer was obtained,and the results confirmed that the fabricated biomimetic hierarchical structure scaffold could be an effective candidate for bone regeneration.展开更多
Gene-activated matrix(GAM)has a potential usefulness in bone engineering as an alternate strategy for the lasting release of osteogenic proteins but efficient methods to generate non-viral GAM remain to be established...Gene-activated matrix(GAM)has a potential usefulness in bone engineering as an alternate strategy for the lasting release of osteogenic proteins but efficient methods to generate non-viral GAM remain to be established.In this study,we investigated whether an atelocollagen-based GAM containing naked-plasmid(p)DNAs encoding microRNA(miR)20a,which may promote osteogenesis in vivo via multiple pathways associated with the osteogenic differentiation of mesenchymal stem/progenitor cells(MSCs),facilitates rat cranial bone augmentation.First,we confirmed the osteoblastic differentiation functions of generated pDNA encoding miR20a(pmiR20a)in vitro,and its transfection regulated the expression of several of target genes,such as Bambi1 and PPARc,in rat bone marrow MSCs and induced the increased expression of BMP4.Then,when GAMs fabricated by mixing 100 ll of 2%bovine atelocollagen,20mg b-TCP granules and 0.5mg(3.3 lg/ll)AcGFP plasmid-vectors encoding miR20a were transplanted to rat cranial bone surface,the promoted vertical bone augmentation was clearly recognized up to 8 weeks after transplantation,as were upregulation of VEGFs and BMP4 expressions at the early stages of transplantation.Thus,GAM-based miR delivery may provide an alternative non-viral approach by improving transgene efficacy via a small sequence that can regulate the multiple pathways.展开更多
BACKGROUND Lateral window approach for sinus floor lift is commonly used for vertical bone augmentation in cases when the residual bone height is less than 5 mm.However,managing cases becomes more challenging when a m...BACKGROUND Lateral window approach for sinus floor lift is commonly used for vertical bone augmentation in cases when the residual bone height is less than 5 mm.However,managing cases becomes more challenging when a maxillary sinus pseudocyst is present or when there is insufficient bone width.In this case,we utilized the bone window prepared during the lateral window sinus lift as a shell for horizontal bone augmentation.This allowed for simultaneous horizontal and vertical bone augmentation immediately after the removal of the maxillary sinus pseudocyst.CASE SUMMARY A 28-year-old female presented to our clinic with the chief complaint of missing upper left posterior teeth.Intraoral examination showed a horizontal deficiency of the alveolar ridge contour.The height of the alveolar bone was approximately 3.6 mm on cone beam computed tomography(CBCT).And a typical well-defined'dome-shaped'lesion in maxillary sinus was observed on CBCT imaging.The lateral bony window was prepared using a piezo-ultrasonic device,then the bony window was fixed to the buccal side of the 26 alveolar ridge using a titanium screw with a length of 10 mm and a diameter of 1.5 mm.The space between the bony window and the alveolar ridge was filled with Bio-Oss,covered with a Bio-Gide collagen membrane,and subsequently sutured.Nine months later,the patient’s bone width increased from 4.8 to 10.5 mm,and the bone height increased from 3.6 to 15.6 mm.Subsequently,a Straumann^(■)4.1 mm×10 mm implant was placed.The final all-ceramic crown restoration was completed four months later,and both clinical and radiographic examinations showed that the implant was successful,and the patient was satisfied with the results.CONCLUSION The bone block harvested from the lateral window sinus lift can be used for simultaneous horizontal bone augmentation acting as a shell for good two-dimensional bone augmentation.展开更多
In total knee arthroplasty (TKA), a treatment of bone defect varies depending on the location and extent of defect and requires proper surgical procedure. Metal augmentation is readily available for both femoral and t...In total knee arthroplasty (TKA), a treatment of bone defect varies depending on the location and extent of defect and requires proper surgical procedure. Metal augmentation is readily available for both femoral and tibial bone defects. We report the operative technique of modular metal augmentation using a downsized block for ambiguous proximal tibial and distal femoral bone defects in primary and revision TKA. Regarding bone defects, bone loss can be minimized by using a different size of metal augmentation, and suitable reinforcement for bone defects can be achieved. Once our technique is properly used, it will be very helpful in treating bone defects.展开更多
充足的骨组织是保证种植体长期稳定性的先决条件。Urban教授提出了基于引导骨再生(guided bone regeneration,GBR)原理的“香肠技术”。研究显示,该技术在牙槽骨水平向增量方面达(5.3±2.3)mm,垂直向增量为(4.2±1.9)mm,显著优...充足的骨组织是保证种植体长期稳定性的先决条件。Urban教授提出了基于引导骨再生(guided bone regeneration,GBR)原理的“香肠技术”。研究显示,该技术在牙槽骨水平向增量方面达(5.3±2.3)mm,垂直向增量为(4.2±1.9)mm,显著优于传统GBR方法。香肠技术利用生物膜的弹性与韧性,结合膜钉固定,将自体骨与骨移植材料稳定在植骨区域,有效防止移位并增强空间稳定性。骨替代材料和自体骨的使用兼顾了自体骨的成骨活性和骨替代材料的低吸收速率;在受区的皮质骨使用球钻进行滋养孔的制备,为间充质干细胞和骨祖细胞向骨再生区域迁移提供了通路,同时也可以加速创口愈合早期新生血管生成;充分减张缝合,以确保在缝合时不对愈合区域施加过大的压力。这有效提高了香肠技术的可预测性。尽管该技术疗效显著,但潜在的软硬组织并发症可能影响患者恢复及手术结果。因此,深入探讨其并发症及诱因,对于提升香肠技术的临床安全性和有效性具有重要意义。本文总结了香肠技术的应用原理、临床效果、屏障膜的应用、骨移植材料的选择及并发症防治,旨在为其在口腔种植领域的广泛应用提供参考。展开更多
目的探讨牛心包膜在美学区水平骨增量手术中的应用效果,评估其在引导骨再生术(guided bone regeneration,GBR)中的临床可行性。方法本研究通过医院医学伦理委员会审查批准。29例前牙区缺牙伴唇侧骨缺损的患者,应用牛心包膜结合颗粒状或...目的探讨牛心包膜在美学区水平骨增量手术中的应用效果,评估其在引导骨再生术(guided bone regeneration,GBR)中的临床可行性。方法本研究通过医院医学伦理委员会审查批准。29例前牙区缺牙伴唇侧骨缺损的患者,应用牛心包膜结合颗粒状或块状骨移植物进行水平骨增量手术。以术前设计中的虚拟种植体为中心,测量术前(T0)、术后即刻(T1)及术后6个月(T2)不同时期种植体颈部及其以下1~5 mm处种植体唇侧骨板厚度,评估骨再生效果。记录术后患者的疼痛、肿胀视觉模拟评分(visual analog scale,VAS),以及是否有感染、伤口裂开等并发症发生。结果术后即刻,所有患者种植体唇侧骨板厚度显著增加,平均骨增量大于3 mm;术后6个月,骨增量保持较好,特别是在种植体颈部下方3~5 mm处唇侧骨板厚度均大于3 mm。VAS评分显示,术后疼痛及肿胀在术后3 d达到峰值,随后逐渐减轻,术后10 d恢复良好。随访期间无感染、伤口裂开等并发症发生。结论牛心包膜在美学区水平骨增量中具有良好的骨增量效果和生物相容性。展开更多
基金supported by the Technology Development Program(P0011350)funded by the Ministry of SMEs and Startups(MSS,Korea)。
文摘The use of commercial products such as a cup and liner for total hip arthroplasty for patients with severe bone defects has a high probability of failure.In these patients the cup alone cannot cover the bone defect,and thus,an additional augment or cage is required.In this study,we designed three-dimensional(3D)printable bone augments as an alternative to surgeries using reinforcement cages.Thirty-five sharp-edged bone augments of various sizes were 3D printed.A biporous structure was designed to reduce the weight of the augment and to facilitate bone ingrowth.Two types of frames were used to prevent damage to the augment’s porous structure and maintain its stability during printing.Furthermore,two types of holes were provided for easy augment fixation at various angles.Fatigue tests were performed on a combination of worst-case sizes derived using finite element analysis.The test results confirmed the structural stability of the specimens at a load of 5340 N.Although the porosity of the specimens was measured to be 63.70%,it cannot be said that the porous nature was uniformly distributed because porosity tests were performed locally and randomly.In summary,3D-printable biporous bone augments capable of bonding from various angles and bidirectionally through angulation and bottom-plane screw holes are proposed.The mechanical results with bone augments indicate good structural safety in patients.However,further research is necessary to study the clinical applications of the proposed bone augment.
文摘Purpose: Autogenous bone was still considered as the gold standard in bone augmentations prior to implants insertion at the atrophic ridges. However if large bone grafts are needed to augment multiple edentulous atrophic segments, extraoral donor sites may be mandatory. The aim of this report is to introduce the Fares Wedge Technique, as a new bone augmentation method that can augment multiple edentulous ridges with intraoral cortical bone grafts. Methods: This report includes patients with moderate to severe ridge atrophy in different regions of the both jaws who were treated over 6-years period (2009-215) with wedge Technique (WT). Patients received panorex immediately after the surgery, and they were examined clinically and radiographically (periapical) every 2 weeks. At 4 months, computed tomography was performed to evaluate the bone gain. Reentry was performed after 4 to 5 months to evaluate the new bone volume and quality and to insert implants. At this stage specimens for histologic examination were also obtained. Results: 39 augmentation sites in 22 patients (15 women, 7 men: mean age 47 years) were followed 12 to 52 months. The healing process was uneventful, with minimal morbidity. The success rate was 95%, and the bone gain average was 3 - 6 mm vertically and 3 - 9 mm horizontally. In two patients the graft was partially exposed and treated with shaving and rounding the exposed wedges, but the augmentations were saved. In one case the majority of the bone graft was lost. At 38 sites the patients had successfully received 114 implants. Conclusions: wedge technique can augment multiple segments of atrophic ridges with small amount of autogenic graft. The bone volume that achieved was satisfying, especially that the majority of the augmented areas were at posterior mandibular defects.
基金financially supported by the National key research and development plan(Grant No.2017YFC1105000,Grant No.2017YFA0205600)Outstanding Scholar Program of Guangzhou Regenerative Medicine and Health Guangdong Laboratory(2018GZR110102001)+4 种基金the Science and Technology Program of Guangdong Province(Grant No.2019B010941002)the Science and Technology Program of Guangzhou(Grant No.201804020060,Grant No.202007020002)Natural Science Foundation of Guangdong Province(Grant No.2021A1515011741,2020A1515011354)the National Nature Science Foundation of China(Grants U1801252),National Natural Science Foundation of China(31700823)Guangzhou Science and Technology Planning Project(202102020005).
文摘Calcium phosphate bio-ceramics are osteo-conductive,but it remains a challenge to promote the induction of bone augmentation and capillary formation.The surface micro/nano-topography of materials can be recognized by cells and then the cell fate are mediated.Traditional regulation methods of carving surface structures on bio-ceramics employ mineral reagents and organic additives,which might introduce impurity phases and affect the biological results.In a previous study,a facile and novel method was utilized with ultrapure water as the unique reagent for hydrothermal treatment,and a uniform hydroxyapatite(HAp)surface layer was constructed on composite ceramics(β-TCP/CaSiO_(3))in situ.Further combined with 3D printing technology,biomimetic hierarchical structure scaffolds were fabricated with interconnected porous composite ceramic scaffolds as the architecture and micro/nano-rod hybrid HAp as the surface layer.The obtained HAp surface layer favoured cell adhesion,alleviated the cytotoxicity of precursor scaffolds,and upregulated the cellular differentiation of mBMSCs and gene expression of HUVECs in vitro.In vivo studies showed that capillary formation,bone augmentation and new bone matrix formation were upregulated after the HAp surface layer was obtained,and the results confirmed that the fabricated biomimetic hierarchical structure scaffold could be an effective candidate for bone regeneration.
基金This work was supported by Grants-in-Aid for Scientific Research(15H05044,17H01604 and 19K21349)from the Japan Society for the Promotion of Science.
文摘Gene-activated matrix(GAM)has a potential usefulness in bone engineering as an alternate strategy for the lasting release of osteogenic proteins but efficient methods to generate non-viral GAM remain to be established.In this study,we investigated whether an atelocollagen-based GAM containing naked-plasmid(p)DNAs encoding microRNA(miR)20a,which may promote osteogenesis in vivo via multiple pathways associated with the osteogenic differentiation of mesenchymal stem/progenitor cells(MSCs),facilitates rat cranial bone augmentation.First,we confirmed the osteoblastic differentiation functions of generated pDNA encoding miR20a(pmiR20a)in vitro,and its transfection regulated the expression of several of target genes,such as Bambi1 and PPARc,in rat bone marrow MSCs and induced the increased expression of BMP4.Then,when GAMs fabricated by mixing 100 ll of 2%bovine atelocollagen,20mg b-TCP granules and 0.5mg(3.3 lg/ll)AcGFP plasmid-vectors encoding miR20a were transplanted to rat cranial bone surface,the promoted vertical bone augmentation was clearly recognized up to 8 weeks after transplantation,as were upregulation of VEGFs and BMP4 expressions at the early stages of transplantation.Thus,GAM-based miR delivery may provide an alternative non-viral approach by improving transgene efficacy via a small sequence that can regulate the multiple pathways.
文摘BACKGROUND Lateral window approach for sinus floor lift is commonly used for vertical bone augmentation in cases when the residual bone height is less than 5 mm.However,managing cases becomes more challenging when a maxillary sinus pseudocyst is present or when there is insufficient bone width.In this case,we utilized the bone window prepared during the lateral window sinus lift as a shell for horizontal bone augmentation.This allowed for simultaneous horizontal and vertical bone augmentation immediately after the removal of the maxillary sinus pseudocyst.CASE SUMMARY A 28-year-old female presented to our clinic with the chief complaint of missing upper left posterior teeth.Intraoral examination showed a horizontal deficiency of the alveolar ridge contour.The height of the alveolar bone was approximately 3.6 mm on cone beam computed tomography(CBCT).And a typical well-defined'dome-shaped'lesion in maxillary sinus was observed on CBCT imaging.The lateral bony window was prepared using a piezo-ultrasonic device,then the bony window was fixed to the buccal side of the 26 alveolar ridge using a titanium screw with a length of 10 mm and a diameter of 1.5 mm.The space between the bony window and the alveolar ridge was filled with Bio-Oss,covered with a Bio-Gide collagen membrane,and subsequently sutured.Nine months later,the patient’s bone width increased from 4.8 to 10.5 mm,and the bone height increased from 3.6 to 15.6 mm.Subsequently,a Straumann^(■)4.1 mm×10 mm implant was placed.The final all-ceramic crown restoration was completed four months later,and both clinical and radiographic examinations showed that the implant was successful,and the patient was satisfied with the results.CONCLUSION The bone block harvested from the lateral window sinus lift can be used for simultaneous horizontal bone augmentation acting as a shell for good two-dimensional bone augmentation.
文摘In total knee arthroplasty (TKA), a treatment of bone defect varies depending on the location and extent of defect and requires proper surgical procedure. Metal augmentation is readily available for both femoral and tibial bone defects. We report the operative technique of modular metal augmentation using a downsized block for ambiguous proximal tibial and distal femoral bone defects in primary and revision TKA. Regarding bone defects, bone loss can be minimized by using a different size of metal augmentation, and suitable reinforcement for bone defects can be achieved. Once our technique is properly used, it will be very helpful in treating bone defects.
文摘充足的骨组织是保证种植体长期稳定性的先决条件。Urban教授提出了基于引导骨再生(guided bone regeneration,GBR)原理的“香肠技术”。研究显示,该技术在牙槽骨水平向增量方面达(5.3±2.3)mm,垂直向增量为(4.2±1.9)mm,显著优于传统GBR方法。香肠技术利用生物膜的弹性与韧性,结合膜钉固定,将自体骨与骨移植材料稳定在植骨区域,有效防止移位并增强空间稳定性。骨替代材料和自体骨的使用兼顾了自体骨的成骨活性和骨替代材料的低吸收速率;在受区的皮质骨使用球钻进行滋养孔的制备,为间充质干细胞和骨祖细胞向骨再生区域迁移提供了通路,同时也可以加速创口愈合早期新生血管生成;充分减张缝合,以确保在缝合时不对愈合区域施加过大的压力。这有效提高了香肠技术的可预测性。尽管该技术疗效显著,但潜在的软硬组织并发症可能影响患者恢复及手术结果。因此,深入探讨其并发症及诱因,对于提升香肠技术的临床安全性和有效性具有重要意义。本文总结了香肠技术的应用原理、临床效果、屏障膜的应用、骨移植材料的选择及并发症防治,旨在为其在口腔种植领域的广泛应用提供参考。
