Osteology, Volume 5, Issue 2 (June 2025) – 8 articles

Background/Objectives: This retrospective study assessed the accuracy of implant positioning with dynamic computer-aided implant surgery (dCAIS) for Toronto Bridge fabrication, using a conometric prosthetic concept and a new intraoral splinting technique (CLIKSS). It compared discrepancies across various anatomical regions, bone qualities, and implant sites. Methods: This study involved 52 patients undergoing full-arch rehabilitation (17 in the mandible, 30 in the maxilla, and 5 in both), with 366 implants placed (125 in the mandible, 241 in the maxilla; 128 in post-extraction sites, and the remainder in healed sites). All implants were immediately loaded. Precision was assessed by measuring linear and three-dimensional (3D) angular deviations between planned and actual implant positions. Results: Measurement errors for apical linear and 3D deviations at the apex and entry point ranged from 0.24 ± 0.10 to 0.55 ± 0.57 mm, and angular deviations varied from 0.32 ± 0.65° to 0.35 ± 0.71°. Maxillary measurements were significantly higher at the entry, apical, and vertical levels, even when comparing anterior and posterior regions with the corresponding mandibular areas, while no differences were found in the angular deviation. Significant discrepancies were observed among different mandibular bone types. Maxillary post-extraction sites exhibited significantly greater deviations than mandibular sites in all parameters except angular deviation. No significant differences were found between healed and post-extraction sites within the same jaw. Conclusions: dCAIS improved implant placement accuracy, leading to predictable prosthetic outcomes, especially during parallel multi-implant insertions. This report introduced dCAIS for conometric/biconometric implant placement combined with the innovative CLIKSS technique as an effective intraoral split method for this prosthesis connection. Full article

Background/Objectives: The achievement of primary stability in low-density bone represents a critical endpoint in clinical practice. The aim of the present investigation was to evaluate the effectiveness of different drilling osteotomy techniques on polyurethane bone substitutes in vitro. Methods: A total of 320 osteotomies have been conducted on 10 pound per cubic feet (PCF) and 20PCF, respectively, with and without cortical layer. The simultaneous and progressive drilling protocol has been conducted at two different rotational speeds considering two different implant profiles (TAC conical vs. NT cylindrical implants). The study variables were insertion torque, removal torque, and resonance frequency analysis (RFA). Results: A significantly higher insertion torque, removal torque, and resonance frequency analysis RFA was detected at low speed with simultaneous drilling protocol (RPM) (p < 0.05). A TAC implant produced an increased implant stability compared to NT implants in all conditions tested (p < 0.05). Conclusions: The conical TAC implant showed higher implant stability in low-density polyurethane, and it is strongly recommended in critical bone quality. Simultaneous drilling osteotomy at low speed could further improve torquing positioning and significantly achieve primary stability in this condition. Full article

Background/Objectives: Ochronosis is an uncommon metabolic condition caused by a deficiency of homogentisate 1,2-dioxygenase, leading to the accumulation of homogentisic acid (HGA) in connective tissues. This deposition of HGA in the joints can result in cartilage degeneration and advanced ochronotic arthritis. Although this condition is usually asymptomatic, it can demonstrate devastating articular destruction characterized by dark pigmentation of the tissues. Methods: A 64-year-old female with a medical history consisting of diabetes mellitus type 2, hypertension, and thoracic aortic aneurysm, with no personal or family history of ochronosis or related symptoms, has been diagnosed with progressive knee osteoarthritis, Kellgren and Lawrence grade III, unresponsive to conservative treatment. Results: The patient underwent staged bilateral, bicompartmental, cemented total knee arthroplasty (TKA), during which several pathological changes were incidentally discovered: black-pigmented, weakened articular cartilage and darkened synovial fluid, as well as brittle metaphyseal bone necessitating increased cement application to ensure prosthetic stability. Postoperative recovery was significant for anemia requiring a blood transfusion. Improved knee function was observed in the first month follow-up visit, and the patient was referred for diagnostic confirmation of her condition. Conclusions: This case underscores the importance of recognizing ochronosis as a potential cause of advanced joint degeneration in patients undergoing arthroplasty. Furthermore, the diagnosis might be of clinical relevance, since this case demonstrated postoperative anemia which required blood transfusion. This, combined with the brittleness of bone, highlights the need for meticulous surgical planning and tailored approaches by the unaware surgeon who might encounter such not-so-pleasant findings. Full article

Background/Objectives: Obliterates such as autologous bone dust (BD) or the synthetic bioactive glass S53P4 (BA) are frequently used for the obliteration of non-critical size defects (NCSDs), especially in otosurgery. Both obliterates have advantages and disadvantages, so that the combination of both for the obliteration of NCSDs is analysed. Methods: As part of a large animal project with sheep, four NCSDs were created in the calotte of thirteen animals using a drill. These were filled with BD, BD and BA, or BA, and the reference defect remained empty. After three weeks, the explanted calottes were examined with regard to their newly formed bone using digital volume tomography, bone density measurement, fluorochrome sequence labelling, and histological analysis. In addition, human cell culture analyses were carried out on the quality of the BD. Results: BD collected at 7.000 and 15.000 rpm shows a higher activity of new bone formation. In combination with BA, bone is formed centripetally and centrifugally. Defect filling with BA and BD shows a higher bone density and compactness than BD alone. Conclusions: BD should be harvested at a speed of less than 15.000 rpm. Using this BD in combination with BA to obliterate NCSDs enables the defect to be obliterated quickly and completely, with more newly formed bone, creating a bone network with incorporated BA. Further studies are needed to investigate the long-term stability of this obliteration and to determine which other parameters of the extraction can increase the amount of vital BD. Full article

Background/Objectives: Osteoporosis is a skeletal disorder characterized by reduced bone mineral density (BMD) and increased fracture risk. Chronic inflammation is implicated in osteoporosis pathogenesis, with inflammatory mediators promoting bone resorption. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are markers of systemic inflammation and have emerged as potential indicators of bone health. This study’s aim was to highlight the potential role of the NLR and PLR as markers of bone health in postmenopausal women affected by osteoporosis or osteopenia and to evaluate the possible influence of autoimmune disease in this context. Methods: This cross-sectional study included 124 postmenopausal women diagnosed with osteopenia or osteoporosis at the Orthopedic Unit of the Policlinico G. Rodolico in Catania, Italy. Demographic, clinical, laboratory, and diagnostic imaging data were collected. The NLR and PLR were calculated from complete blood counts, and BMD was measured using dual-energy X-ray absorptiometry (DEXA). Statistical analyses included correlations, group comparisons, and multiple and logistic regressions. Results: The NLR and PLR did not directly correlate with BMD or fracture incidence. However, the PLR weakly correlated with vitamin D levels. Notably, women without Hashimoto’s thyroiditis exhibited higher NLR values than those with the condition. Hypertensive women had a lower PLR than non-hypertensive women, while euthyroid women had a higher PLR than hyperthyroid or hypothyroid women. Multiple regression analysis revealed that age, BMI, CKD stage, vitamin D levels, NLR, PLR, diabetes, and autoimmune diseases significantly predicted BMD at the femur neck, with the PLR contributing significantly. Logistic regression confirmed these predictors for osteoporosis or osteopenia, with an increased PLR being associated with a higher likelihood of osteoporosis. Conclusions: While the NLR and PLR may not independently predict bone health, their inclusion in a multifactorial assessment considering age, BMI, vitamin D, and comorbidities could enhance osteoporosis management. Full article

This perspective work focuses on the transformative role of robotics in orthopedic surgery, enhancing precision and efficiency. It details the evolution of robotic systems such as ROBODOC, Mako, and Da Vinci, outlining their contributions to procedures such as total knee and hip replacements. It also discusses future trends, including the integration of AI, augmented reality, personalized implants, and the potential for telesurgery. Challenges such as high costs, the learning curve, and regulatory concerns are noted, but the field is poised for significant growth and innovation in orthopedic care. Full article

Background/Objectives: Rotator cuff tears are a prevalent cause of shoulder pain and functional impairment. Full-thickness tears often require surgical intervention, but managing such injuries can be challenging, particularly when complete anatomical repair is unattainable. Bioinductive implants have emerged as an innovative adjunct to enhance tendon healing and regeneration. Methods: This case report details the partial repair of a full-thickness rotator cuff tear in a 66-year-old woman, augmented with a bioinductive implant. Postoperative recovery was monitored through clinical examinations, MRI, and kinematic analysis at 3 and 6 months. Results: The findings suggest that bioinductive implants may offer a promising strategy for managing complex rotator cuff tears, particularly when complete repair is not feasible. The patient reported improvement in function and pain reduction. Conclusions: The use of bioinductive implants showed promising results, promoting tendon regeneration and improving functional outcomes. Future research should explore patient selection criteria and the long-term effectiveness of this strategy. Full article

Background/Objectives: Flatfoot is a common pediatric foot deformity characterized by a reduced or absent medial longitudinal arch (MLA). The condition can lead to altered gait, pain, and potential long-term morbidity if untreated. Identifying potential risk factors—such as body mass index (BMI), ligamentous or joint instability, shoe choices, and physical activity—is crucial for prevention and management. The objectives are to systematically review and synthesize current evidence on how flatfoot severity correlates with BMI and other risk factors in children and adolescents, and to highlight methodological considerations essential for future research. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched five electronic databases from inception to February 2024. Flatfoot severity was measured by various clinical or radiographic indices. Two reviewers independently screened and assessed the risk of bias. Results: Thirty-seven studies met the inclusion criteria. Children with high BMI had increased odds of flatfoot (pooled Odds Ratio = 2.3, 95% Confidence Interval: 1.6–3.1), with one outlier reporting an OR of 9.08. Heterogeneity (I² up to 70%) stemmed from varied diagnostic methods. Other factors, including joint instability, shoe choices, and physical activity, showed mixed associations. Conclusions: Elevated BMI strongly correlates with pediatric flatfoot severity, highlighting the importance of proactive weight management and foot assessments. Future standardized, longitudinal studies are needed to clarify causality and refine interventions. Full article