Use of mandibular chin bone for alveolar bone grafting in cleft patients

Park, Young-Wook,Lee, Jang-Ha Korean Association of Maxillofacial Plastic and Re 2016 Maxillofacial Plastic Reconstructive Surgery Vol.38 No.-

Background: We evaluated and compared the outcomes of different ossification processes in patients with alveolar cleft in whom correction was performed using endochondral bone graft or intramembranous bone graft. Methods: The patients were divided into two groups: the endochondral bone (iliac bone or rib bone) graft group and the intramembranous bone (mandibular bone) graft group. Medical records and radiologic images of patients who underwent alveolar bone grafting due to alveolar cleft were analyzed retrospectively. Through postoperative and follow-up radiologic images, the height of the interdental bone septum was classified into four types based on the highest point of alveolar ridge. Then, the height of the interdental bone septum and the area of the bone graft were evaluated according to the type of bone graft. In addition, the occurrence of complications and the need for an additional bone graft, the result of postoperative orthodontic treatment, and the eruption of impacted teeth were investigated. Results: Thirty patients were included in this study. There was no significant difference in the change of the interdental bone height and the area of the bone graft according to the type of bone. There was no significant difference in the success rate of the surgery according to the type of bone. One patient underwent an additional bone graft surgery during the follow-up period. Conclusions: The outcomes of alveolar bone grafting were not significantly different according to the type of bone graft. If appropriate to the size of the recipient site, the chin bone is a useful graft material in alveolar cleft, as is the iliac bone.

장골이식을 이용한 다양한 안면골 손상의 재건

이훈범,김석원,김주봉,유대현,정윤규 대한미용성형외과학회 1996 Archives of Aesthetic Plastic Surgery Vol.2 No.1

The use of bone grafts, using both membranous and endochondral bone, has become standard practice in craniomaxillofacial surgery. Bone from cranium. rib. or ilium can be used as either onlay or inlay grafts to reconstruct the craniofacial skeleton. Cranial bone has become a frequent source of material for bone grafting, as there was less resorption of cranial bone as membranous bone than with rib or ilium as endochondral bone. But we do not like it because of its difficulty of procurement and brittleness of the bone and exposure of cranial cavity. Rib graft can be bent easily and obtained large amount, but pnemothorax as complication can a operator as source of bone graft. We prefer iliac bone as our favorite source of bone graft, despite of high resorption rate, to decrease donor morbidity and harvesting time of bone graft in case of multiple trauma patient. To reduce resorption rate, we try that the periosteum was preserved as possible, and contact surface was increased through exact shaping, and rigid fixation with miniplate or lag screw was performed. On onlay bone graft, the cortical surface of graft was placed in contact with overlying soft tissue and the cancellous surface was placed in contact with recipient bone. Authors have performed iliac bone graft in 18 patients during a 3-year period, and have obtained favorable results. The clinical cases and a review of the literature are here reported.

흰쥐 두개골 결손부에서 베타-트리칼슘 인산염과 탈단백우골의 골형성 효과

정승곤,박홍주,유선열,Jung, Seung-Gon,Park, Hong-Ju,Ryu, Sun-Youl 대한악안면성형재건외과학회 2010 Maxillofacial Plastic Reconstructive Surgery Vol.32 No.4

Purpose: This study was conducted to evaluate the effect of beta-tricalcium phosphate (Cerasorb$^{(R)}$, Germany) and deproteinized bovine bone (Bio-Oss$^{(R)}$, Switzerland) grafted to the defect of rat calvaria artificially created and the effect of use of absorbable membrane (BioMesh$^{(R)}$, Korea) on new bone formation. Materials and Methods: Transosseous circular calvarial defects with diameters of 5 mm were prepared in the both parietal bone of 30 rats. In the control group I, no specific treatment was done on the defects. In the control group II, the defects were covered with absorbable membrane. In the experimental group I, deproteinized bovine bone was grafted without absorbable membrane; in the experimental group II, deproteinized bovine bone was grafted with absorbable membrane; in the experimental group III, beta-tricalcium phosphate was grafted without absorbable membrane; in the experimental group IV, beta-tricalcium phosphate was grafted with absorbable membrane. The animals were sacrificed after 3 weeks and 6 weeks respectively, and histologic and histomorphometric evaluations were performed. Results: Compare to the control groups, the experimental groups showed more newly formed bone. Between the experimental groups, beta-tricalcium phosphate showed more resorption than deproteinized bovine bone. Stabilization of grafted material and interception of the soft tissue invasion was observed in the specimen treated with membrane. There was no statistical difference between the experimental group I, III and experimental group II, IV classified by graft material, but statistically significant increase in the amount of newly formed bone was observed in the experimental group I, II and II, IV classified by the use of membrane (P<0.05). Conclusion: Both beta-tricalcium phosphate and deproteinized bovine bone showed similar osteoconductibility, but beta-tricalcium phosphate is thought to be closer to ideal synthetic graft material because it showed higher resorption rate in vivo. Increased new bone formation can be expected in bone graft with use of membrane.

난소 제거된 쥐의 두개골 결손에서 bisphosphonate와 parathyroid hormone 전신 투여 후 골 재생 평가

임지영,박경미 대한통합치과학회 2023 대한통합치과학회지 Vol.12 No.3

Although there are many studies comparing the individual effects of zoledronic acid and teriparatide in bone grafting in an osteoporotic environment, the combined effect is not well known. The purpose of this study was to compare the effects of systemic administration of zoledronic acid and teriparatide on bone regeneration at the bone graft site after bone grafting to the cranium defect in rats with osteoporosis induced by ovariectomy. Thirty-nine rats were randomly divided into 8 groups (sham ovariectomy group [sOVX, n=4]; Control group [CONT, n=5]; sham zoledronic acid group [sZA, n=5]; sham teriparatide group [sTPD, n=5]; sham zoledronic acid and sham teriparatide group [sZATPD, n=5]; zoledronic acid group [ZA, n=5]; teriparatide group [TPD, n=5]; zoledronic acid and sham teriparatide group [ZA-TPD, n=5]). A critical size defect with a diameter of 5 mm was formed on both craniums of osteoporosisinduced rats, and bone grafting was performed on only one side. The defect on both sides was covered with a collagen membrane. After bone grafting, zoledronic acid and teriparatide were administered, and all animals were sacrificed 6 weeks after bone grafting. Specimens were subjected to micro-computed tomography and histological analysis. As a result of micro-computed tomography analysis, bone mineral density in the tibia was the highest in the ZA-TPD group, followed by the zoledronic acid and teriparatide groups. Residual graft material at the site where bone grafting was performed was the highest in the TPD group, and new bone increased in the order of CONT, ZA, TPD, and ZATPD groups. The TPD group had the most new bone in the area where bone grafting was not performed, and the CONT group had the biggest BS/BV, but there was no statistically significant difference. As a result of histological morphological analysis, the remaining graft material in the bone graft site decreased in the order of CONT, ZA, TPD, and ZA-TPD groups, and the new bone increased in the order of ZA, ZA-TPD, CONT, and TPD groups. The amount of new bone in the areas where bone grafting was not performed increased in the order of ZA, CONT, TPD, and ZA-TPD groups, and the CONT and TPD groups showed a statistically significant difference from the ZA-TPD group. Zoledronic acid and teriparatide showed differences in bone regeneration at the parietal bone graft site, and the combination of the two drugs was more effective in bone regeneration.

Frequency of bone graft in implant surgery

Cha, Hyun-Suk,Kim, Ji-Wan,Hwang, Jong-Hyun,Ahn, Kang-Min Korean Association of Maxillofacial Plastic and Re 2016 Maxillofacial Plastic Reconstructive Surgery Vol.38 No.-

Background: Implant surgery has become popular with the advance of surgical techniques such as sinus lifting, guided bone regeneration, and block bone graft. However, there were no data about the frequency of bone graft during implant surgery. The purpose of this study was to report the frequency and types of bone graft depending on dental implant patients' profile to complement the database regarding implant surgery. Methods: The implant operations had been performed from January 2006 to October 2014. The upper and lower jaws were divided into six sextants. A total of 792 sextants were included in this study. Patient information including sex, age, sites, bone graft, and types of bone were investigated. Results: A total of 1512 implants had been placed. Male and female sextants were 421 and 371, respectively (M:F = 1:0.88). Average age was 54.3 (ranging from 20 to 88 years old). Implants were placed in the posterior maxilla (322 sextants, 40.7 %), posterior mandible (286 sextants, 36.1 %), anterior maxilla (127 sextants, 16.1 %), and anterior mandible (57 sextants, 7.2 %). Bone graft was performed in 50.3 % of the sextants. Among the bone grafted sites, sinus lifting with lateral approach (22.1 %) and guided bone regeneration (22.7 %) were performed most frequently. Conclusions: Bone graft in implant surgery was necessary to augment defects. More than half of the sextants needed bone graft for implant installation.

하악의 막성 감입골 이식시 이식골의 생존에 대한 실험적 연구

백봉수,신동필,이정형,조병채,이동훈 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.4

Bone graft is an important procedure in craniomaxillofacial reconstruction and the success of reconstruction depends on the survival of the grafted bone. In this study, the survival of the membranous inlay bone graft on the mandibles of dogs was investigated with bone scan and histologic examination. The inlay bone graft, 1×2㎝ critical-sized bone, was completely separated from the lower border of the mandible of dogs and then refixed to the original site. Bone scan and histologic examination were done at 1,2,3 and 4 weeks postoperatively. The bone scan after 1 week showed radioisotope uptake on the margin of the grafted bone and the isotope count was 21% compared to the uptake of the normal bone. After 2 weeks, the radioisotope uptake in the grafted bone increased to 52% of normal bone uptake. After 3 and 4 weeks, the degree of isotope uptake was 111% and 124% respectively. Histological findings after 1 week showed the absence of osteoblastic activity and 6 viable blood vessels in one 200X magnified field, which was 25% compared to the vessels of the normal bone. After 2 weeks, osteoblastic activities were noted and the number of viable blood vessels totalled 15, which was 63% of the vessels of the normal bone. After 3 weeks, osteoblastic activities increased and the number of viable blood vessels totalled 21, which was 88% of the vessels of the normal bone. After 4 weeks, there were markedly increased osteoblastic activities with a total number of 23 vessels, which was 96% of the normal bone. In summary, the revascularization of the membranous inlay bone graft began from the first week after bone graft, and then it gradually increased. After 3 weeks, the revascularization had returned to a nearly normal value compared with the value of the near-by normal mandibular bone.

한 분절 요추부 후측방 유합술에서 국소 자가 골편의 사용에 대한 연구

박기수,성주경,박진우 대한척추신경외과학회 2009 Neurospine Vol.6 No.3

Objective: The purpose of this study is to investigate the efficacy of the local bone graft from laminectomy and facetectomy in one level lumbar posterolateral arthrodesis. Methods: Sixty six patients who underwent one level lumbar posterolateral arthrodesis for degenerative lumbar diseases between January 2005 and June 2008 were evaluated retrospectively. Arthrodesis was performed by transpedicular screw fixation and grafting with autologous local bone chips from laminectomy and facetectomy instead of autologous iliac bone, allograft bone or biosynthetic composite bone grafts. Postoperative radiographs were obtained to review the evidence of fusion. A modified Lenke score was used to assess the status of the fusion. Results: Sixty six patients consist of 29 males and 37 females with mean age 60.7 years old and 22.5 months mean follow-up period. A mean amount of the local bone chips from laminectomy and facetectomy was 13.4 g. At 12 months after operation, the average Lenke score was 1.5 and spinal bone fusion rate was 95.4%. There were three patients with failed fusion and all of them were heavy smokers. Conclusion: The local bone graft from laminectomy and facetectomy in the one level lumbar posterolateral arthrodesis is reliable and effective enough to replace the graft from autologous iliac bone, allograft bone or biosynthetic composite bone grafts. Objective: The purpose of this study is to investigate the efficacy of the local bone graft from laminectomy and facetectomy in one level lumbar posterolateral arthrodesis. Methods: Sixty six patients who underwent one level lumbar posterolateral arthrodesis for degenerative lumbar diseases between January 2005 and June 2008 were evaluated retrospectively. Arthrodesis was performed by transpedicular screw fixation and grafting with autologous local bone chips from laminectomy and facetectomy instead of autologous iliac bone, allograft bone or biosynthetic composite bone grafts. Postoperative radiographs were obtained to review the evidence of fusion. A modified Lenke score was used to assess the status of the fusion. Results: Sixty six patients consist of 29 males and 37 females with mean age 60.7 years old and 22.5 months mean follow-up period. A mean amount of the local bone chips from laminectomy and facetectomy was 13.4 g. At 12 months after operation, the average Lenke score was 1.5 and spinal bone fusion rate was 95.4%. There were three patients with failed fusion and all of them were heavy smokers. Conclusion: The local bone graft from laminectomy and facetectomy in the one level lumbar posterolateral arthrodesis is reliable and effective enough to replace the graft from autologous iliac bone, allograft bone or biosynthetic composite bone grafts.

Minimal invasive horizontal ridge augmentation using subperiosteal tunneling technique

Kim, Hyun-Suk,Kim, Young-Kyun,Yun, Pil-Young Korean Association of Maxillofacial Plastic and Re 2016 Maxillofacial Plastic Reconstructive Surgery Vol.38 No.-

Background: The goal of this study was to retrospectively evaluate the prognosis of minimal invasive horizontal ridge augmentation (MIHRA) technique using small incision and subperiosteal tunneling technique. Methods: This study targeted 25 partially edentulous patients (10 males and 15 females, mean age $48.8{\pm19.7years$) who needed bone graft for installation of the implants due to alveolar bone deficiency. The patients took the radiographic exam, panoramic and periapical view at first visit, and had implant fixture installation surgery. All patients received immediate or delayed implant surgery with bone graft using U-shaped incision and tunneling technique. After an average of 2.8 months, the prosthesis was connected and functioned. The clinical prognosis was recorded by observation of the peri-implant tissue at every visit. A year after restoration, the crestal bone loss around the implant was measured by taking the follow-up radiographs. One patient took 3D-CT before bone graft, after bone graft, and 2 years after restoration to compare and analyze change of alveolar bone width. Results: This study included 25 patients and 39 implants. Thirty eight implants (97.4 %) survived. As for postoperative complications, five patients showed minor infection symptoms, like swelling and tenderness after bone graft. The other one had buccal fenestration, and secondary bone graft was done by the same technique. No complications related with bone graft were found except in these patients. The mean crestal bone loss around the implants was 0.03 mm 1 year after restoration, and this was an adequate clinical prognosis. A patient took 3D-CT after bone graft, and the width of alveolar bone increased 4.32 mm added to 4.6 mm of former alveolar bone width. Two years after bone graft, the width of alveolar bone was 8.13 mm, and this suggested that the resorption rate of bone graft material was 18.29 % during 2 years. Conclusions: The bone graft material retained within a pouch formed using U-shaped incision and tunneling technique resulted with a few complications, and the prognosis of the implants placed above the alveolar bone was adequate.

Histological observation of excellent bony remodeling in xenogenic bone graft for dental implant

김연숙,이석근 대한구강악안면병리학회 2017 대한구강악안면병리학회지 Vol.41 No.1

With the multiple practices of bone graft using different artificial bone regenerative substitutes, the bone graft procedures have been widely performed to increase the bony stabilization of dental implant. Xenogenic bone graft materials have been well developed because of their good biocompatibility and abundant source of bone materials. The present study demonstrated the histological findings from excellent bony remodeling in xenogenic bone graft biopsies compared to those findings in autogenous bone graft. For the graft bone biopsies which were usually done in 5-9 months after graft bone insertion, five types of histological grades including excellent, favorable, partial, degenerative, and poor bony remodeling could be assessed to give prognostic information for dental implant. However, recently the xenograft bone materials have been much improved and produced strong osteogenic effect. Among 239 cases of trephine bur-supported core bone biopsy the excellent bony remodeling was found in 20 cases (13.1%) out of 153 xenogenic bone grafts and in 13 cases (43.3%) out of 30 autogenous bone grafts. They produced abundant new bones on the surface of the graft bones in 5–9 months, and the graft bones were partly resorbed and also surrounded by the repetitive deposition of new bone. The osteophytic new bones showed strong birefringence under polarizing microscope, and were gradually elongated and anastomosed with each other to form trabecular bony networks which became proper stress-baring structures for dental implant. Their marrow stromal tissues were composed of loose connective tissue which was well vascularized but rarely infiltrated with inflammatory cells. The present study compared the histological features of excellent bony remodeling between xenogenic and autogenous bone grafts. Although the ratio of excellent bony remodeling in xenogenic bone graft was still low, 13.1%, the recent advance of xenogeic bone products was remarkable in biological aspect and almost comparable to the autogenous bones. Therefore, it was suggested that the xenogenic bone graft will be applicable to the bone regeneration procedures for dental implant with beneficial output in the near future.

악골결손부에 PRP적용후 획득된 골의 변화량

김욱규(Uk-Kyu Kim),김용덕(Yong-Deok Kim),변준호(June-Ho Byun),신상훈(Sang-Hun Shin),정인교(In-Kyo Chung) 대한구강악안면외과학회 2003 대한구강악안면외과학회지 Vol.29 No.4

Purpose: Platelet Rich Plasma(PRP) application is increasing with sinus inlay bone graft, but there is few research with radiographic ananlysis on effect of PRP in maxillary sinus. The author investigated the amount of bony changes of maxillary sinus for dental implantation among the patients with maxillary inlay graft. Materials and Methods: With 10 patients who were treated with sinus inlay autologous bone grafting combined with PRP technique, and with 5 patients who were treated with sinus inlay grafting only without PRP, the panoramic radiographys which were taken at preoperation, immediate postoperation, 3months postoperation, and 4 months postoperation(a month after dental implantation)periods were analysed. The films had been scanned, and then proceeded throughout image analysis system. The bone density of maxillary grafted sites was compared with adjacent tooth enamel density and remeasured according to density luminosity of each film. The density changes on PRP group and bone graft only group were analysed with non-parameteric statistics method. Results: In PRP combined patients group, bone density on postoperation periods was increased totally. The remarkable enhanced change of bone density was observed on 3 months postoperation period, thereafter the increasing rate was slightly reduced . In only bone graft patients group, bone density on postoperation periods was also increased compared with preoperation period, but the bone density of 4 months postoperation period was decreased compared with 3 months postoperation period. The amount of bone density on PRP group was significantly changed according to periods in contrast to bone graft only group. Conclusion: The bone density on PRP group was remarkably increased at 3 months postoperation compared to bone graft only group and it was seemed to be associated with more new bone formation, less grafted bone resorption at bone grafted sites with PRP.