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PubMed1989

Noncemented acetabular revision arthroplasty using allograft bone.

The authors retrospectively reviewed a series of 106 acetabular revisions for failed cemented total hip arthroplasties followed from 12 to 56 months. All of the sockets had extensive bone deficiency requiring bone graft surgery. The deficiencies were classified as cavitary, combined cavitary and segmental, and pelvic discontinuity. The purpose was to evaluate clinical experience with three different acetabular components. In chronological order, the three components tested were bipolar type, truncated-cone screw-in type, and porous-coated titanium press-fit type with fins. These were combined with four different bone augmentation constructs, using nonstructural morselized fresh-frozen allograft or segmental freeze-dried allograft. Follow-up evaluation of both the bipolar and screw-in designs showed frequent migration with bone graft resorption, compromising the clinical scores and leading to some revisions. The press-fit design had little migration, reliable graft healing, and better clinical scores. No revisions have been done. The nonstructural morselized bone allograft fared better under stable cups. The large segmental grafts did much better when buttress plating was combined with interfragmentary screw fixation compared to screws alone.

Acetabulum↗
PubMed1981

Periodontal healing after replantation and autotransplantation of incisors in monkeys.

The effect of injury to the cemental or alveolar part of the periodontal ligament upon periodontal healing after replantation and autotransplantation of teeth was studied in green Vervet monkeys. Sixty-six maxillary central incisors were replanted or autotransplanted after extra-alveolar periods of 18 min. saline storage or 120 min. dry storage. The animals were sacrificed after 8 weeks and the teeth examined histometrically. Identical healing was found in the following experimental groups: replantation or autotransplantation after 18 min. and replantation with or without removal of periodontal ligament in the alveolus. A significant increase in replacement resorption (ankylosis) compared to the 18 min. replantation group was found in the following groups: replantation and autotransplantation after 120 min., replantation after removal of periodontal ligament on the root surface and autotransplantation after 120 min. to a socket where the tooth was extracted 18 min. earlier. Autotransplantation after 18 min. to a socket where a tooth had been extracted 120 min. earlier led to a significant increase in the amount of replacement resorption compared to transplantation to an 18 min. socket. Based on these findings, it is concluded that the presence of an intact and viable periodontal ligament on the root surface is the most important factor in assuring healing without root resorption. The length of the extra-alveolar period also seems to exert some influence upon the socket, enhancing the development of ankylosis.

Animals↗
PubMed2005

Pattern of bone loss in dry mandibles of individuals who died before 1957.

OBJECTIVE: To map out the pattern of periodontal disease in individuals who died before 1957 and were not exposed to formal dental services. DESIGN: Descriptive cross-sectional study. SETTING: National Museums of Kenya. SUBJECTS: The skeletons of people who died before independence are preserved at the National Museums of Kenya in Nairobi. Sixty four out of the 170 dry mandibles stored at the Museum were assessed for periodontal bone loss using a calibrated ruler. RESULTS: All the 64 mandibles assessed were of individuals who died before 1957. Two thousand two hundred and seventy four sites were examined. Most of the subjects were adults aged 30-45 years and the age range was 18-80 years. Majority of the mandibles examined were of the ethnic group from Central Kenya. Of the teeth examined, premolars and molars were the teeth most frequently preserved intact in the sockets. The total mean bone loss for all teeth was 2.51 (SD 1.15) with a range of 0.85-5.80. When the different sites were examined, values for bone loss were 2.59 for mesial surfaces; 2.55 buccal surfaces; 2.38 for distal surfaces. Three categories were identified as follows:- 70% of the individuals had minimal or no bone loss, 26.5% had 3-4 mm or moderate bone loss and 3.5% had >5 mm bone loss or advanced bone loss. Further analysis showed that when bone loss of >3 mm was examined, only 28.12% of the individuals were in this group, 10.93% had >4 mm bone loss and 3.12% had 5 mm or more bone loss. The first molars were the teeth most commonly affected by bone loss of 3mm or more followed by second molars then the premolars. CONCLUSIONS: In this group of individuals mainly from Central Kenya, the bone loss pattern showed that only a small number had experienced periodontal destruction as recorded by bone loss levels. Three groups were identified; those who had no or minimal destruction, those who had experienced moderate destruction and those where obvious bone destruction was evident. Thus susceptibility to periodontal disease is evident in a small proportion of individuals even in populations not exposed to modern diet and formal dental services. Periodontal destruction seems to affect a fraction of the population even when older populations are examined, thus it would save on resources both human and physical if these susceptible individuals could be identified early and treatment provided.

Adolescent↗
PubMed2001

The effect of streptozotocin-induced experimental diabetes mellitus on calvarial defect healing and bone turnover in the rat.

Tooth socket healing is delayed in diabetes mellitus due to impairment of the healing process. One reason for the poor healing may be an abnormal vascular response. The object of our experiments was to study the effect of diabetes mellitus on bone healing using a calvarial wound. Streptozotocin, injected intraperitoneally, was used to induce diabetes in rats. Both insulin-treated, streptozotocin-dosed animals and normal rats were used as controls. Bone formation was measured in the diabetic femur and tibia, and healing of bone defects by guided tissue regeneration was assessed. Cancellous bone volume and bone formation in the femur were greatly reduced in the diabetic model, indicating either a defect of mineralization or osteoid formation. The length, dry weight, ash weight and calcium content of the tibiae of diabetic rats were significantly less than those of the control groups. In a second experiment, a sterile wound was made in the calvaria of diabetic rats, and covered internally and externally with Gore-Tex membrane. Exuberant formation of a primitive bone was evident, with little evidence of osteoclastic resorption of the necrosed bone ends. This was despite the impaired bone formation observed in the long bones in the first experiment.

Animals↗
PubMed1998

The use of a new allograft material for osseous reconstruction associated with dental implants.

This article introduces the use of a new bone graft material. The material is a human collagen allograft resorbable matrix impregnated with demineralized freeze-dried bone granules. This material is harvested from the same donor. A series of three cases of extractions with immediate implant placement accompanied by osseous defects were used to demonstrate the use of this material. Bone cores were harvested at Stage II uncovering of the implants. The histologic and clinical results are reviewed.

Absorbable Implants↗
PubMed2001

Effect of enamel matrix derivative (EMDOGAIN) upon periodontal healing after replantation of permanent incisors in beagle dogs.

This study histologically assessed the effect of enamel matrix derivative (EMDOGAIN) on periodontal healing in re-implanted teeth in nine Beagle dogs. Incisors in dogs were re-implanted after 15, 30 and 60 min of dry storage with and without the application of EMDOGAIN. The pulps were removed in all teeth. In groups 1 and 2, dog teeth were splinted and the dogs sacrificed after 8 and 12 weeks, respectively. In group 3, dog teeth were not splinted and sacrifice took place after 12 weeks. The histological parameters studied were healed PDL, surface, inflammatory and replacement resorption. Univariable and multivariable analysis of data was performed. Increased incidence of healed PDL was inversely proportional to extraalveolar time. No significant differences were noticed between splinted and non-splinted teeth. The EMDOGAIN group showed a higher incidence of healed PDL, while controls showed a higher incidence of ankylosis. The effect of EMDOGAIN was more pronounced at the 12-week interval.

Analysis of Variance↗
PubMed2006

Implant placement at the time of maxillary molar extraction: technique and report of preliminary results of 83 sites.

BACKGROUND: The purpose of this study was to evaluate the predictability of implant placement at the time of maxillary molar extraction using a modified insertion technique and implant design. METHODS: At the time of maxillary molar extraction, 83 tapered-end implants with an apical diameter of 4.1 mm and a neck diameter of 6.5 mm were placed in maxillary first or second molar sites, following manipulation of the remaining interradicular bone with osteotomes. Regenerative materials, consisting of demineralized freeze-dried bone allograft (DFDBA) and/or osseous coagulum, and bioabsorbable or non-resorbable membranes were placed, and passive soft-tissue primary closure was attained in all cases. RESULTS: Soft-tissue closure was maintained until the time of clinical reentry 6 months after implant insertion in 81 of 83 sites. Loss of primary soft-tissue closure in the other two areas did not result in complete uncovering of the cover screw and implant top. All implants were clinically immobile at the time of implant uncovery 6 months after insertion and were restored with single crowns. All implants were functioning successfully for up to 18 months (mean: 12.4 months). CONCLUSION: The combination of atraumatic removal of hopeless maxillary molars, controlled manipulation of the residual interradicular bone, insertion of implants of the aforementioned design, and use of appropriate regenerative materials at the time of implant insertion predictably afforded a stable implant for restoration with a single crown.

Absorbable Implants↗
PubMed1992

Three-dimensional finite element stress analysis of the dentate human mandible.

The biomechanical events which accompany functional loading of the human mandible are not fully understood. The techniques normally used to record them are highly invasive. Computer modelling offers a promising alternative approach in this regard, with the additional ability to predict regional stresses and strains in inaccessible locations. In this study, we built two three-dimensional finite element (FE) models of a human mandible reconstructed from tomographs of a dry dentate jaw. The first model was used for a complete mechanical characterization of physical events. It also provided comparative data for the second model, which had an increased vertical corpus depth. In both cases, boundary conditions included rigid restraints at the first right molar and endosteal cortical surfaces of the articular eminences of temporal bones. Groups of parallel multiple vectors simulated individual masticatory muscle loads. The models were solved for displacements, stresses, strains, and forces. The simulated muscle loads in the first model deformed the mandible helically upward and toward its right (working) side. The highest principal stresses occurred at the bite point, anterior aspects of the coronoid processes, symphyseal region, and right and left sides of the mandibular corpus. In general, the observed principal stresses and strains were highest on the periosteal cortical surface and alveolar bone. At the symphyseal region, maximum principal stresses and strains were highest on the lower lingual mandibular aspect, whereas minimum principal stresses and strains were highest on its upper labial side. Subcondylar principal strains and condylar forces were higher on the left (balancing or nonbiting) side than on the right mandibular side, with condylar forces more concentrated on the anteromedial aspect of the working-side condyle and on the central and lateral aspects of the left. When compared with in vivo strain data from macaques during comparable biting events, the predictive strain values from the first model were qualitatively similar. In the second model, the reduced tensile stress on the working-side, and decreased shear stress bilaterally, confirmed that lower stresses occurred on the lower mandibular border with increased jaw depth. Our results suggested that although the mandible behaved in a beam-like manner, its corpus acted more like a combination of open and closed cross sections due to the presence of tooth sockets, at least for the task modelled.(ABSTRACT TRUNCATED AT 400 WORDS)

Computer Simulation↗
PubMed1996

GBR with an e-PTFE membrane associated with DFDBA: histologic and histochemical analysis in a human implant retrieved after 4 years of loading.

As a result of a fracture to the cemented post and core, a pure titanium implant was extracted from a 54-year-old patient after 4 years of clinical loading. At implantation, the implant was positioned into an extraction socket and the defect was treated with an e-PTFE membrane associated with a DFDBA graft. At retrieval the implant underwent histologic and histochemical examination to assess the characteristics of the regenerated bone after 4 years of prosthetic loading. The implant showed an angular bony defect at the smooth collar, but the bone-implant direct contact rate seemed to be elevated in the remaining implant surface. Normal transmitted and polarized light examinations demonstrated that most of the DFDBA particles were resorbed and substituted by vital newly formed bone. The regenerated bone appeared compact with secondary osteons and large haversian canals; however, some partially mineralized remnants residuated in the spaces, between the osteons. Within the limits of this study, the authors concluded that DFDBA can be substituted by the host bone, but the rate of substitution is very slow and not complete after 4 years. From a clinical point of view, however, the load-bearing capacity of the bone regenerated with the membrane technique associated with DFDBA appeared to be similar to that of normal bone.

Alveolar Bone Loss↗
PubMed2004

The effect of Emdogain gel on periodontal healing in replanted monkeys' teeth.

OBJECTIVE: We sought to histologically evaluate the effect of Emdogain gel on periodontal healing in monkeys' teeth undergoing delayed replantation. Study design Mature monkey teeth simulating avulsion were endodontically treated before extraction. Negative control teeth (group N = 10 roots) underwent immediate replantation, whereas the rest were bench-dried for 1 hour and treated in one of the following ways before replantation: the positive control teeth (group P = 12 roots) had no further treatment; group C teeth (4 roots) had the periodontal ligament removed; group D teeth (10 roots) were treated with Emdogain gel; group E teeth (6 roots) had the periodontal ligament removed before the application of Emdogain gel; and group F teeth (7 roots) had the periodontal ligament removed, the root surface conditioned, and Emdogain gel applied. Periodontal healing was evaluated after 16 weeks by undertaking histomorphometric analysis. RESULTS: The Kruskal-Wallis and Mann-Whitney U tests revealed that group N teeth had a statistically higher occurrence of complete healing than did all other groups, whereas group P was not significantly different in any of the healing categories from D, E, and F, the groups in which Emdogain gel was used. Group C teeth had a significantly higher occurrence of replacement root resorption than did the teeth in groups P and F-but were not significantly different from teeth in groups D and E. CONCLUSION: Emdogain gel did not appear to significantly reduce replacement resorption in monkeys' teeth that had undergone delayed replantation.

Acid Etching, Dental↗
PubMed2006

Development of a novel digital subtraction technique for detecting subtle changes in jawbone density.

The objective of this paper is to develop a novel digital subtraction technique for serial intra-oral radiography, which would allow the detection of subtle variations in grey values. Digital images of the maxilla of a dried human skull and of a fresh pig mandible were acquired using intra-oral photostimulable phosphor plates (Digora FMX, Soredex, Helsinki) with an aluminium calibration stepwedge incorporated in the filmholder. Exposures were made with an X-ray tube for intra-oral radiography (Prostyle Intra, Planmeca, Helsinki). During pilot testing, parameter settings were adapted to reach an optimal contrast. Exposures were repeated within a 1-week interval to determine the test-retest reliability of the development. After in vitro and in vivo testing, the exposure technique and software development were used to evaluate its applicability in a pilot clinical case. Although parameter settings remained stable during the in vitro studies, the clinical exposures yielded non-linear digital images, thus, not readily suitable for data acquisition and comparison of the regions of interest. To allow further analysis, image processing was carried out using self-developed software for semi-automated linearisation and optimised contrast normalisation. This processing significantly increased the precise quantisation of jawbone density and the assessment of subtle bone density changes in arbitrarily selected regions of interest of in vivo exposures. The clinical applicability of the technique is demonstrated in a pilot case. It was demonstrated that minute densitometric deviations could be detected. The present technique and image processing may allow the quantification of jawbone density.

Animals↗
PubMed1986

Effect of lyophilized autologous plasma on periodontal healing of replanted teeth.

The purpose of this histologic and autoradiographic study of replanted teeth was to evaluate the beneficial effect, if any, of lyophilized autologous plasma (LAP) application on periodontal healing and to re-examine rates of repair in different areas of the associated periodontium following replantation. Maxillary and mandibular incisors and premolars of three rhesus monkeys were used. Teeth were extracted with forceps and placed in sterile physiologic saline. After 5 minutes each tooth was returned to its socket and immobilized by interproximal acid-etch splints. Splints were removed after 1 week. Of the 48 replants performed, 24 (controls) were replanted as described. Of the 24 experimental teeth, during the 5 minute interval between tooth extraction and replantation, the root surface and the inner socket walls were bathed with 1 ml of the reconstituted LAP-saline solution (800 mg/ml). Replants and animal sacrifice were scheduled to provide observations at 1, 3, 7, 14, 28 and 45 days following replantation. One hour prior to sacrifice, each monkey received an intravenous injection of tritiated thymidine, 1 microCi/gm body weight. Tissue specimens were processed for evaluation following standard procedures. Eight replanted teeth were available for evaluation for each of the six time-points. Four teeth were treated with LAP and four without it. Histologically, tissue sections were examined for epithelial proliferation and attachment, periodontal fibers organization and maturation, inflammatory cell types, presence or absence of cementum resorption and dentoalveolar ankylosis and degree of vascularity of the tissues. For autoradiographic evaluation, the periodontium associated with the replanted tooth was divided into nine spatial cell compartments. In each compartment, labeled tissue cells, epithelial or connective, were counted and recorded. Differences between the control (untreated) replanted teeth and the LAP-treated teeth, at each time-point and within each compartment, were analyzed for significance using the paired t-test. The findings of this study indicate that LAP use enhanced healing by early replacement of the fibrin clot, increased connective tissue cell proliferation, reduction of the inflammatory response and inhibition of root cementum resorption. Periodontal healing and repair occurred more rapidly in the supracrestal or transseptal connective tissue region than within the periodontal membrane space.

Alveolar Process↗