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Orthopaedic Surgery Oct 2019Reconstruction of massive bone defects is challenging for orthopaedic clinicians, especially in cases of severe trauma and resection of tumors in various locales.... (Review)
Review
Reconstruction of massive bone defects is challenging for orthopaedic clinicians, especially in cases of severe trauma and resection of tumors in various locales. Autologous iliac crest bone graft (ICBG) is the "gold standard" for bone grafting. However, the limited availability and complications at donor sites resulted in seeking other options like allografts and bone graft substitutes. Demineralized bone matrix (DBM) is a form of allograft using acidic solution to remove mineral components, while leaving much of the proteinaceous components native to bone, with small amounts of calcium-based solids, inorganic phosphates, and some trace cell debris. It is an osteoconductive and osteoinductive biomaterial and is approved as a medical device for use in bone defects and spinal fusion. To pack consistently into the defect sites and stay firmly in the filling parts, DBM products have various forms combined with biocompatible viscous carriers, including sponges, strips, injectable putty, paste, and paste infused with chips. The present review aims to summarize the properties of various kind of viscous carriers and their clinical use combined with DBM in commercially available products. Given DBM'mercially available products. Given DBM;s long clinical track record and commercial accessibility in standard forms, opportunities to further develop and validate DBM as a versatile bone biomaterial in orthopaedic repair and regenerative medicine contexts are attractive.
Topics: Allografts; Biocompatible Materials; Bone Demineralization Technique; Bone Matrix; Bone Regeneration; Bone Substitutes; Bone Transplantation; Humans
PubMed: 31496049
DOI: 10.1111/os.12509 -
International Journal of Environmental... Mar 2022Autogenous tooth graft is an innovative and ingenious technique that employs a stepwise approach and utilizes human teeth as an autogenous source of bone graft. The... (Review)
Review
Autogenous tooth graft is an innovative and ingenious technique that employs a stepwise approach and utilizes human teeth as an autogenous source of bone graft. The structure of teeth closely resembles bone, both physically and biochemically, and can be efficiently used for the process as it depicts properties of osteoinduction and osteoconduction. Autogenous tooth bone has characteristics similar to bone grafts in terms of healing potential, physical properties, and clinical outcome. Autogenous tooth graft has shown reasonable promise as a graft material for the regeneration of maxillary and mandibular defects. Autogenous tooth bone graft finds its principal application in sinus and ridge augmentations and for socket preservation before implant placement. Additionally, it can be used successfully for alveolar cleft patients and patients with limited periodontal defects. The overall complication rates reported for autogenous tooth grafts are comparable to other graft sources. However, although long-term results are still underway, it is still recommended as a grafting option for limited defects in the cranio-facial region.
Topics: Bone Regeneration; Bone Transplantation; Humans; Mandible; Maxilla; Tooth
PubMed: 35329377
DOI: 10.3390/ijerph19063690 -
Advanced Drug Delivery Reviews Sep 2012Demineralized bone matrix (DBM) is an osteoconductive and osteoinductive commercial biomaterial and approved medical device used in bone defects with a long track record... (Review)
Review
Demineralized bone matrix (DBM) is an osteoconductive and osteoinductive commercial biomaterial and approved medical device used in bone defects with a long track record of clinical use in diverse forms. True to its name and as an acid-extracted organic matrix from human bone sources, DBM retains much of the proteinaceous components native to bone, with small amounts of calcium-based solids, inorganic phosphates and some trace cell debris. Many of DBM's proteinaceous components (e.g., growth factors) are known to be potent osteogenic agents. Commercially sourced as putty, paste, sheets and flexible pieces, DBM provides a degradable matrix facilitating endogenous release of these compounds to the bone wound sites where it is surgically placed to fill bone defects, inducing new bone formation and accelerating healing. Given DBM's long clinical track record and commercial accessibility in standard forms and sources, opportunities to further develop and validate DBM as a versatile bone biomaterial in orthopedic repair and regenerative medicine contexts are attractive.
Topics: Animals; Bone Demineralization Technique; Bone Matrix; Bone Regeneration; Bone Substitutes; Bone Transplantation; Bone and Bones; Humans; Osteogenesis
PubMed: 22728914
DOI: 10.1016/j.addr.2012.06.008 -
Archives of Orthopaedic and Trauma... 1995Allogeneic transplantation of human cancellous and cortical bone is a controversially discussed concept in trauma and orthopaedic surgery. Biological and immunological... (Review)
Review
Allogeneic transplantation of human cancellous and cortical bone is a controversially discussed concept in trauma and orthopaedic surgery. Biological and immunological arguments support transplantation of autologous material whenever this is technically possible. On the other hand, synthetic alloplastic materials for bone substitution are available free of immunological and hygienic hazards. In this context the value of allogeneic bone grafts is discussed, especially considering the problem of AIDS. If autologous corticospongious bone is to be used its supply is limited. On the other hand, alloplastic synthetic artificial bone does not meet all the requirements demanded for substitution of large osseous defects up to now. The problems of geometric and mechanical stability of these alloplastic materials still remain. Therefore, no alternative to allografting of large, stable, corticospongious fragments exists in some cases. Bone transplantation is performed without vital indication in nearly every case. Thus an optimum of hygienic security has to be claimed for recipients of allogeneic bone. The "Munich model" for bone transplantation is presented and discussed.
Topics: Acquired Immunodeficiency Syndrome; Bone Transplantation; Communicable Diseases; Contraindications; Graft Survival; Humans; Risk; Transplantation Immunology; Transplantation, Homologous
PubMed: 7619637
DOI: 10.1007/BF00443390 -
Anales Del Sistema Sanitario de Navarra 2006We describe the methodology of the Bone and Soft Tissue Bank, from extraction and storage until use. Since the year 1986, with the creation of the Bone Bank in the... (Comparative Study)
Comparative Study
We describe the methodology of the Bone and Soft Tissue Bank, from extraction and storage until use. Since the year 1986, with the creation of the Bone Bank in the University Clinic of Navarra, more than 3,000 grafts have been used for very different types of surgery. Bone grafts can be classified into cortical and spongy; the former are principally used in surgery to save tumour patients, in large post-traumatic reconstructions and in replacement surgery where there are massive bone defects and a structural support is required. The spongy grafts are the most used due to their numerous indications; they are especially useful in filling cavities that require a significant quantity of graft when the autograft is insufficient, or as a complement. They are also of special help in treating fractures when there is bone loss and in the treatment of delays in consolidation and pseudoarthrosis in little vascularized and atrophic zones. They are also used in prosthetic surgery against the presence of cavity type defects. Allografts of soft tissues are specially recognised in multiple ligament injuries that require reconstructions. Nowadays, the most utilised are those employed in surgery of the anterior cruciate ligament although they can be used for filling any ligament or tendon defect. The principal difficulties of the cortical allografts are in the consolidation of the ends with the bone itself and in tumour surgery, given that these are patients immunodepressed by the treatment, the incidence of infection is increased with respect to spongy grafts and soft tissues, which is irrelevant. In short, the increasingly widespread use of allografts is an essential therapeutic weapon in orthopaedic surgery and traumatology. It must be used by expert hands.
Topics: Age Factors; Aged; Anterior Cruciate Ligament; Arthroplasty, Replacement, Hip; Bone Banks; Bone Neoplasms; Bone Transplantation; Cadaver; Contraindications; Donor Selection; Forecasting; Fractures, Bone; Humans; Immunocompromised Host; Osteogenesis; Pseudarthrosis; Sarcoma; Spain; Tissue Preservation; Tissue and Organ Harvesting; Tissue and Organ Procurement; Transplantation, Homologous
PubMed: 16998521
DOI: No ID Found -
Periodontology 2000 Oct 2023Reconstruction of significant maxillomandibular defects is a challenge that has been much discussed over the last few decades. Fundamental principles were developed... (Review)
Review
Reconstruction of significant maxillomandibular defects is a challenge that has been much discussed over the last few decades. Fundamental principles were developed decades ago (bone bed viability, graft immobilization). Clinical decision-making criteria are highly relevant, including local/systemic factors and incision designs, the choice of material, grafting technique, and donor site morbidity. Stabilizing particulated grafts for defined defects-that is, via meshes or shells-might allow significant horizontal and vertical augmentation; the alternatives are onlay and inlay techniques. More significant defects might require extra orally harvested autologous bone blocks. The anterior iliac crest is often used for nonvascularized augmentation, whereas more extensive defects often require microvascular reconstruction. In those cases, the free fibula flap has become the standard of care. The development of alternatives is still ongoing (i.e., alloplastic reconstruction, zygomatic implants, obturators, distraction osteogenesis). Especially for these complex procedures, three-dimensional planning tools enable facilitated planning and a surgical workflow.
Topics: Adult; Humans; Plastic Surgery Procedures; Bone Transplantation; Alveolar Ridge Augmentation
PubMed: 37650475
DOI: 10.1111/prd.12499 -
Journal of Orthopaedic Science :... May 2019Bone defect reconstruction with artificial materials may produce good functional recovery in the short term. Over time, the durability of artificial materials becomes an...
Bone defect reconstruction with artificial materials may produce good functional recovery in the short term. Over time, the durability of artificial materials becomes an issue, and therefore, artificial materials cannot be considered a permanent solution to reconstruction. For long-term outcomes, the goal is to regain function, permanence, and form that are as close to normal as possible. Thus, physiological materials are desirable for use in reconstruction. Biological reconstruction involves the use of materials that are modified in vivo following reconstruction of bone defects. The goal is to achieve bone union, bone revival and remodeling, with biointegration of soft tissue and bone. Allograft use has been the mainstay of bone defect reconstruction in most parts of the world, although in some countries like Japan, allogeneic bone is difficult to obtain due to socio-religious concerns. Therefore, we developed new biological reconstruction techniques to overcome this problem. Bone derived from distraction osteogenesis is autologous bone, which must be an ideal reconstruction material for its biological affinity, strength, resilience, and immunity to infection. When applying this method to patients with malignant disease however, it is important to preserve as much of the local soft tissue as possible, and the clinician must be especially careful of infection and callus formation. Liquid nitrogen treatment of tumor-bearing bone produces equal, if not better, bone revitalization compared to other forms of treatment to date. Reconstruction with liquid nitrogen-treated bone involves resecting the diseased bone and returning it to the body following liquid nitrogen treatment (free-freezing method). Another method involves dislocating the joint proximal to the tumor, or cutting the bone while the distal side remains attached to the body and the limb inverted and treated with liquid nitrogen (pedicle freezing method). When both methods are possible, the pedicle freezing method is preferable since it is performed with minimal osteotomy. Our recent research has looked into the possible role of adipose-derived stem cells in promoting bone fusion and revitalization. This method has produced promising results for the future of biological reconstruction.
Topics: Bone Neoplasms; Bone Transplantation; Freezing; Humans; Osteogenesis, Distraction; Plastic Surgery Procedures; Transplantation, Autologous
PubMed: 30797666
DOI: 10.1016/j.jos.2019.01.015 -
International Orthopaedics Feb 2014Bone stock reconstruction in TKR surgery is one of the biggest challenges for the surgeon. According to some, authors causes of bone stock loosening are multiple,... (Review)
Review
PURPOSE
Bone stock reconstruction in TKR surgery is one of the biggest challenges for the surgeon. According to some, authors causes of bone stock loosening are multiple, including stress shielding, osteolysis from wear, septic or aseptic loosening, and bone loss caused by a poorly balanced implant. Moreover, bone loss may be iatrogenic at the time of implant removal, indicating that bone preservation during implant removal is critical.
METHODS
Defect localization and extension affect the surgeon's decisions about the choice of the surgical technique and the type of plant to be taken. Today there are several options available for bone deficiency treatment. The treatment choice is undoubtedly linked to the cause of revision, experience and personal philosophy, but it is necessary to consider also the patient's age, expectations of life, functional requirements and bone quality. Many authors prefer bone stock reconstruction techniques in patients with high bone quality and a better quality of life with more prospects. In patients with lower lease on life and lower bone quality the best bone replacement techniques are of modular systems, wedges, and augments. In cases with septic bone loss, more or less extended, different authors recommend reducing bone grafts in favor of modular prostheses to reduce the risk of graft contamination.
RESULTS
All of these techniques have been shown to be durable in midterm outcomes, but concerns exist for a number of reasons, including disease transmission, resorption, fracture, immune reaction to allograft, the cost of custom prostheses, the inability to modify the construct intraoperatively and the overall technical challenge of applying these techniques.
CONCLUSIONS
The choice between different surgical options depends on bone defect dimension and characteristics but are also patient-related. Reestablishment of well-aligned and stable implants is necessary for successful reconstruction, but this can't be accomplished without a sufficient restoration of an eventual bone loss.
Topics: Arthroplasty, Replacement, Knee; Bone Resorption; Bone Transplantation; Humans; Knee Joint; Metals; Orthopedic Procedures; Reoperation
PubMed: 24407821
DOI: 10.1007/s00264-013-2262-1 -
BMC Musculoskeletal Disorders Nov 2016This meta-analysis aimed to determine the bone union rate of bone defects treated with the different autologous bone graft techniques. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This meta-analysis aimed to determine the bone union rate of bone defects treated with the different autologous bone graft techniques.
METHODS
The PubMed and the Cochrane Library databases were searched using the terms: 'fracture' AND ('bone loss' OR 'defect' OR 'defects') AND 'bone graft', restricted to English language, to human species, and to a publication period from January 1999 to November 2014. Data were extracted by one of the reviewers and then checked by the second. A quality of evidence score and a methodology score were used. Heterogeneity was assessed. A random effects model approach was used to combine estimates.
RESULTS
Out of 376 selected studies only 34 met the inclusion criteria. The summary pooled union rate was 91 % (95 % CI: 87-95 %) while union rate after additional procedures raised to 98 % (95 % CI 96-99 %). No association between union rate and bone defect size was found. (Univariable regression model: vascularized: P = 0.677; non-vascularized: 0.202. Multivariable regression model: vascularized: P = 0.381; non-vascularized: P = 0.226). Vascularized graft was associated with a lower risk of infection after surgery when compared to non-vascularized graft (95 % CI 0.03 to 0.23, p < 0.001).
CONCLUSION
The results of this meta-analysis demonstrate the effectiveness of autologous graft for bone defects. Furthermore, from the available clinical evidence bone defect size does not seem to have an impact on bone union when treated with autologous bone graft techniques.
Topics: Allografts; Bone Transplantation; Fractures, Bone; Fractures, Ununited; Humans; Orthopedic Procedures; Plastic Surgery Procedures; Surgical Wound Infection; Transplantation, Autologous; Treatment Outcome
PubMed: 27829447
DOI: 10.1186/s12891-016-1312-4 -
Oral and Maxillofacial Surgery Clinics... Feb 2017In a quest to provide best-quality treatment, results, and long-term prognosis, physicians must be well versed in emerging sciences and discoveries to more favorably... (Review)
Review
In a quest to provide best-quality treatment, results, and long-term prognosis, physicians must be well versed in emerging sciences and discoveries to more favorably provide suitable options to patients. Bioengineering and regeneration have rapidly developed, and with them, the options afforded to surgeons are ever-expanding. Grafting techniques can be modified according to evolving knowledge. The basic principles of bioengineering are discussed in this article to provide a solid foundation for favorable treatment and a comprehensive understanding of the reasons why each particular treatment available can be the most adequate for each particular case.
Topics: Bioengineering; Bone Substitutes; Bone Transplantation; Humans; Intercellular Signaling Peptides and Proteins; Oral Surgical Procedures; Osteogenesis, Distraction; Regenerative Medicine; Stem Cell Transplantation; Tissue Scaffolds; Wound Healing
PubMed: 27890223
DOI: 10.1016/j.coms.2016.08.008