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[An experimental study of 3-dimension zygomatic suture extension for suture osteogenesis].

OBJECTIVE: To explore a methods of 3-Dimension expansion of zygomatic suture in a goat model. METHODS: Seven goats were used in this study. The 3-D extensive applicator was designed and used to extend the zygomatic suture of the goats by placing it in the zygomatic bone through an infraorbital incision. Ten days after the first operation, it was gradually extended on a speed of 0.09 cm/d for 7 days. The zygomatic movement and the osteogenesis of the suture was evaluated in two weeks. RESULTS: The zygomatic bone was extended for 0.6 cm long in average, and the osteogenesis was also shown significantly in the suture. CONCLUSION: The above mentioned technique could be a safe and effect method to be applied for the zygomatic extension.

Animals↗

[Alkaline and acid phosphatase activity in the dynamics of ectopic osteogenesis].

Activities of marker enzymes of osteoblasts (alkaline phosphatase), osteoclasts (tartrate-resistant isoform of acid phosphatase), and macrophages (tartrate-sensitive isoform of acid phosphatase) in bone tissue forming after osteoinduction on the basis of demineralized bone matrix were under study. Early (1 week) stages of osteosynthesis were characterized by low activity of alkaline phosphatase, acid phosphatase being represented by the tartrate-sensitive isoform. Two-three weeks later alkaline phosphatase activity grew and the tartrate-resistant isoform of acid phosphatase appeared. By the fourth-sixth weeks of osteogenesis alkaline phosphatase activity stabilized at a certain level and acid phosphatase activity still grew at the expense of the tartrate-resistant isoform. Conformity of the enzymologic data to changes in cellular populations in ectopic osteogenesis is discussed.

Acid Phosphatase↗

[Sutural distraction osteogenesis for primary cleft palate repair: a preliminary clinical report].

OBJECTIVE: To probe the possibility of a new technique of primary cleft palate repair by sutural distraction osteogenesis. METHODS: The distractor was made of TiNi-shape memory alloy with 2 secure and 2 active arms. Under general anesthesia, 1 hole was drilled on each maxillary process and horizontal plate of palatine. The four arms of the distractor were inserted into holes. The palatine bones would then be distracted and moved medially and posteriorly. After 4 to 5 months' distraction, the two cleft edges approached gradually. The residual cleft, according to its width, was repaired by direct stitch of muco-periosteum incised at cleft edges, or with an additional relaxing incision on one side of the palate. Direct measurement of width of maxillary arch and the cleft, and the length of the hard palate was performed before and after distraction to evaluate the effects of distraction. RESULTS: Eight cleft children at their 2 to 4 years of age were treated by the new technique. Two of them terminated the procedure due to premature dislocation of the distractor. Six children underwent 37 to 126 days' distraction. Dramatic narrowing of the cleft and lengthening of hard palate were seen in these children, with the average narrowing of the cleft being 6.5 mm and average lengthening of the hard palate being 4.8 mm. CONCLUSION: It is clinically demonstrated that palatal tissue regeneration and cleft closure or narrowing and hard palate lengthening could be achieved by the technique of sutural distraction osteogenesis.

Child, Preschool↗

[Heterotopic osteogenesis of autogenous marrow stromal cells with recombinant human bone morphogenetic protein 2 gene transfection and porous calcium phosphate ceramic as a scaffold].

OBJECTIVE: To observe the heterotopic osteogenesis of autogenous marrow stromal cells loading on porous calcium phosphate ceramic scaffolds with rhBMP2 gene transfection in a Sprague-Dawley rat model. METHODS: Autogenous marrow stromal cells were obtained from left femurs and tibias of 20 male adult SD rats under general anesthesia and sterile condition and cultured in alpha-Minimal Essential Medium supplemented with 15% fetal bovine serum. RhBMP2 gene was transfected into stromal cells by means of LipofectAMINE 2000 reagent five days after primary culture. The stably gene expressive cells were selected with G-418 for 14 days and mixed with stromal cells without transfection. The mixture cells were seeded and subcultured for another 10 days in porous calcium phosphate bioceramic that had been subjected to surface-modification via soaking in human plasma fibronectin. The cell-ceramic compound was implanted subcutaneously and intramuscularly in the corresponding rat. Lab animals were sacrificed at two-week intervals till twenty weeks postoperatively and the involved samples were removed. RESULTS: Morphologic and histological study demonstrated that cell-ceramic compound had an ability of heterotopic osteogenesis, which was similar to that of autogenous osteoblasts in previous study. CONCLUSION: It seems that autogenous stromal cells with rhBMP2 transfection acts as a bioreactor promoting proliferation and differentiation of stem cells when they are replanted into the corresponding animals.

Animals↗

Effects of polyglycolic acid bioabsorbable membrane and oxidised cellulose on the osteogenesis in bone defects: an experimental study.

BACKGROUND: The purpose of the present study was to determine the effects of polyglycolic acid bioabsorbable membrane and oxidised cellulose on the osteogenesis in bone defects. MATERIALS AND METHODS: Fifty-four male adult New Zealand White rabbits weighing 3.0 to 3.5 kg were used. The rabbits were randomly divided into three groups of eighteen rabbits: the control group (n = 18), the polyglycolic acid bioabsorbable membrane group (biofix group, n = 18), and the oxidised cellulose group (Surgicel group, n = 18). Each experimental group was also randomly subdivided into two subgroups of nine rabbits, one with periosteum and the other without periosteum. A rectangular transosseous calvarial bone defect, 16 x 20 mm in size, was created. In the control group, the calvarial bone defect was not filled. Polyglycolic acid bioabsorbable membrane (Biofix, Bioscience, Tampere Finland) was implanted over the bone defect area in the biofix group, and oxidised cellulose (Surgicel, Ethicone, London, United Kingdom) in the Surgicel group. The calvarial bone defects were evaluated-histopathologically in the second, sixth, and tenth weeks. RESULTS: As for the results of sequential bone regeneration, macroscopical and histological aspects were observed. Bone formation was significantly enhanced by oxidised cellulose in the calvarial bone defects covered with periosteum, whereas cartilage formation was observed in bare calvarial bone defects. CONCLUSION: We believe that oxidised cellulose has osteogenic potential, and that polyglycolic acid bioabsorbable membrane inhibits osteoinductive effect and retards osteogenesis.

Animals↗

[Dental tours de force 5. Bimaxillary transverse distraction osteogenesis].

A narrow anterior apical base in both jaws can cause pronounced crowding, which can be corrected by extraction therapy (as a rule extraction of four premolars) or by transverse distraction osteogenesis therapy (as a rule bimaxillary), followed by orthodontic treatment. A case is reported of bimaxillary transverse distraction osteogenesis in an eleven-year old female patient. Alignment was performed with fixed orthodontic appliances. Correction of the skeletal Class II relationship was done with a functional appliance. The active treatment time was eighteen months.

Child↗

[Three-dimensional finite element study on middle face advancement with distraction osteogenesis].

Based on the anatomic structure of a girl with class III skelet al malocclusion, a three-dimensional finite element biomechanical model of facial soft tissue was established. With the use of this model, three surgery plans of distraction osteogenesis, LeFort I, II, III maxillary complex advancement in the direction of functional occlusal plane, were simulated. As a result, the facial soft tissue deformation was predicted and the ratio of the facial location deformation to the free bone advancement was calculated. The facial shape after surgery could be viewed in 3D. In addition, the location of center of resistance was investigated when the free bone was protracted forward in the process of LeFort I maxillary complex advancement; it was located at a site about 30 mm posterior to the soft tissue A point. The research result indicates that three-dimensional finite element research on distraction osteogenesis can provide instruction for setting the suitable protraction point and direction of the protraction force in surgery, and by predicting the facial soft tissue deformation, it also can provide the surgeon and patient with information on the options and reference to the surgery plans.

Adolescent↗

Osteogenesis imperfecta of the temporal bone: CT and MR imaging in Van der Hoeve-de Kleyn syndrome.

We report the progressive otic capsule demineralization around the membranous labyrinth and facial nerve in an adult patient with osteogenesis imperfecta tarda. Whereas the initial CT scan showed bandlike, undermineralized pericochlear areas, 2 years later, repeat CT performed because of hearing deterioration showed progression of these findings to the promontory, the round window niche, and the labyrinthine and tympanic segments of the facial nerve canal. MR imaging demonstrated enhancement of the abnormal otic capsule and of the intratemporal and canalicular facial nerve. The differential diagnosis of osteogenesis imperfecta tarda affecting the temporal bone includes otosclerosis, Paget disease, otosyphilis, and Camurati-Engelmann disease.

Adult↗

Maintaining vector control during alveolar distraction osteogenesis: a technical note.

Distraction osteogenesis is a predictable method for restoring missing tissue prior to implant placement. However, pull from the soft tissue can alter the desired direction of the distraction. This article describes and illustrates techniques that are useful for maintaining the desired vector during alveolar distraction osteogenesis. These methods can prevent the need for further intervention and allow for ideal placement of endosseous dental implants without compromising results.

Alveoloplasty↗

Positional and morphologic changes of the mandibular condyle after mandibular distraction osteogenesis in skeletal class II patients.

AIM: Mandibular distraction osteogenesis has been used to correct the skeletal problems in patients with severe mandibular deficiency. Short-term effects of mandibular distraction osteogenesis on condylar position, condylar morphology, and temporomandibular joint symptoms in patients with severe skeletal Class II malocclusions were evaluated. MATERIAL AND METHODS: The records of 13 patients who had undergone bilateral mandibular lengthening and/or midline mandibular widening were analyzed. Pre- and postoperative positional changes of the mandibular condyle in the glenoid fossa, the axial rotation of the condylar head, and the temporomandibular joint symptoms were evaluated. RESULTS: Most of the condyles were displaced in an upward and backward direction in the glenoid fossa; the amount correlated with the amount of mandibular lengthening. Resorption was observed in 20% of condyles; the incidence of the resorption correlated with incidence of preoperative articular disc displacement and with the amount of condylar displacement. CONCLUSION: Distraction protocols should be performed with particular attention when patients with articular disc displacement require a large amount of distraction.

Adolescent↗

[The establishment of an animal model of bilateral mandibular distraction osteogenesis in rabbits].

PURPOSE: To establish an animal model of bilateral mandibular distraction osteogenesis in rabbits. METHODS: 16 adult male white New Zealand rabbits were divided into 4 groups randomly, 4 in each group. Osteotomy was performed on mandible bilaterally before the first premolar. Bone stumps were repositioned and fixed with distractors. After 7 days of latency period, distraction was initiated at a rate of 1mm/d for 7 days. Then distractors were held in place for days. Animals were killed at different time points, and specimens were taken for X-ray and histology examination. RESULTS: The mandibles were lengthened successfully. The distraction gaps were filled with regenerated bone tissue. CONCLUSION: The method in this study is practicable and repeatable which could be used to establish an animal model of mandibular distraction osteogenesis in rabbits.

Animals↗

[Distraction osteogenesis of the maxilla in cleft patients. Worth considering].

Three cleft patients were treated with RED-distraction for maxillary hypoplasia. In all patients, the desired advancement could be achieved easily. The occlusion, the lip relation and the facial profile improved remarkably post treatment. Although the treatment was well tolerated by the patients, some limitations of the treatment were also noted, such as a nasal speech and discomfort by the head frame. Distraction osteogenesis in the maxilla has several advantages when compared to the conventional Le Fort 1-osteotomy: atraumatic advancement of the maxilla, absence of need for an autogeneous bone transplant, and applicability at relatively young age. The advantages and disadvantages of distraction osteogenesis must be considered for each individual patient.

Adolescent↗

[Quantitative histomorphometric observation of distraction osteogenesis during mandibular lengthening].

PURPOSE: To evaluate the regenerating bone during mandibular distraction osteogenesis by bone histomorphometry combining tetracycline bone labeling fluorescence microscopy. METHODS: Osteotomy was performed on bilateral mandibles in ten goats. A custom-made distractor was applied to lengthen the mandible at a rate of 1 mm/d (0.5 mm/12 hrs) for ten days. Every two animals were sacrificed at 10 d, 15 d, 25 d, 35 d and 45 d postoperatively. Two additional goats were used as normal control. The bony specimens were collected and prepared for bone histomorphometry and tetracycline bone labeling fluorescence microscopy with analysis of variance. RESULTS: From 10 days subgroup to 45 days subgroup, bone volume fraction,trabecular thickness,trabecular number and volume density were gradually increased (P<0.05), while trabecular separation distance and surface density were gradually decreased (P<0.05). Between 15 days subgroup and 45 days subgroup,the index of osteoblast was significantly higher than normal control (P<0.05) and index of osteoclast was increased gradually (P<0.05). Compared with normal control, bone formation rate was accelerated by thousand times between 15 days subgroup and 45 days subgroup (P<0.05). CONCLUSIONS: During the process of mandibular distraction osteogenesis, the bone formation is active, the newly formed bone trabecula gradually become mature, and the remodeling activities of regenerated bone are enhanced gradually. The rate of bone formation within distraction period is faster than consolidation period.

Animals↗

[A histological study of three-dimensional external zygomatic suture distraction osteogenesis].

OBJECTIVE: To explore the histological change in suture of zygomatic bone for the zygomatic suture direct distraction osteogenesis. METHODS: The zygomatic bone was distracted by 3-D external distraction appliance without osteotomy. The specimens were taken 1, 3, 5 and 8 weeks after, and then examined histologically and compared with the blank contralateral side. RESULTS: There were lots of fibroblasts, osteoblasts and capillary vessels in the distracted suture tissues one week after distraction, and the fibers were observed to connect the sides of suture and arranged orderly. The surfaces of the expanded suture were irregular. Bone formation was active in the expanded side. The bone trabeculae were mature and oriented in the direction of distraction in the distracted sides at 3 weeks. A great amount of new woven bones were found in 5-week specimen. New bones were formed completely 8 weeks after the distraction. CONCLUSIONS: New bone formed rapidly in the distracted side of zygomatic bone under suture distraction osteogenesis without osteotomy.

Animals↗

[Operative management of long-bone of the upper limb in children with osteogenesis imperfecta].

The authors present their own experiences in operative treatment of the upper extremities in 24 children with osteogenesis imperfecta (oi) among 141 treated in years 1988-2002, in whom 34 operations were performed. In one subgroup were children presented with bone fractures: olecranon six, humerus shaft five, lateral condyle of the humerus one, humerus supracondylar fracture one. In second subgroup included children with upper limb deformities following procedures were performed: correction of cubitus varus three, humerus osteoclasis two, dislocated radial head resection, forearm correction thirteen. Results after operative management of fractures were very satisfying for all the children--proper fracture healing, axis of the bones was straight and a full mobility of the joints was achieved. In second group: partial deformation recurrence after cubitus varus correction, good result on the one side and lack of correction an the other after humerus osteoclasis; bad result in terms of elbow mobility after radial head resection; good results (despite complicated healing and wires migration) in terms of axis correction after forearm bones osteotomies. Surgery of the upper limbs in osteogenesis imperfecta is very challenging but it is worth to perform, as it improves function.

Adolescent↗

Management of pregnancy in osteogenesis imperfecta: new perspectives.

Osteogenesis imperfecta during pregnancy presents increased risk to mother and fetus. In addition to the well-known skeletal changes, other recently recognized metabolic abnormalities also may lead to maternal and fetal problems during labor and delivery. A discussion of risk factors and their managment is presented. The importance of considering the possibility of fetal osteogenesis imperfecta is stressed, and cesarean section is presented as the method of choice for delivery. Important genetic factors including the lack of correlation between the severity of involvement of parent and offspring and the use of pyrophosphate analyses are discussed. An illustrative case is presented.

Adult↗