Search Results (889)

Background/Objectives: Oral cancer resection often leads to maxillofacial defects and dentition loss, compromising patients’ quality of life. Implant-supported prosthetic rehabilitation offers a reliable solution to restore function, though factors such as bone reconstruction, radiotherapy, and timing of implant placement (immediate vs. delayed) may influence outcomes. This study aimed to evaluate long-term implant survival and rehabilitation timelines in oncologic patients, comparing two cohorts (2005–2014 and 2015–2024) to assess the impact of evolving clinical practices. Methods: A retrospective cohort study was conducted at Hospital General Universitario Gregorio Marañón (Madrid, Spain), including 304 patients who underwent ablative oral cancer surgery and subsequent implant-based rehabilitation between 2005 and 2024. Data on demographics, oncologic treatment, reconstruction, implant timing, and prosthetic rehabilitation were collected. Outcomes were compared using Kaplan–Meier analysis and appropriate statistical tests between the 2005–2014 (n = 122) and 2015–2024 (n = 182) cohorts. Results: A total of 2341 Ticare Implants^® were placed, supporting 281 prostheses. Implant placement during primary surgery increased from 41% to 71% (p < 0.001). The median time from surgery to prosthesis significantly decreased from 24 to 15 months (p < 0.001). Five-year implant survival was 95% in the early cohort versus 97% in the later cohort. Implant survival was comparable between irradiated and non-irradiated patients (~94–96%). Fixed prostheses became more frequent (92% vs. 79%, p = 0.002). Conclusions: Implant-supported rehabilitation in oncologic patients is highly feasible and durable, with improved timelines and functional outcomes associated with early implant placement and modern digital planning strategies. Full article

This study evaluated the effects of low-dose recombinant human bone morphogenetic protein-2 (rhBMP-2) coating in combination with vacuum plasma treatment on titanium implants, aiming to enhance osseointegration and bone regeneration while minimizing the adverse effects associated with high-dose rhBMP-2. In vitro analyses demonstrated that plasma treatment increased surface energy, promoting cell adhesion and proliferation. Additionally, it facilitated sustained rhBMP-2 release by enhancing protein binding to the implant surface. In vivo experiments using the four-beagle mandibular defect model were conducted with the following four groups: un-treated implants, rhBMP-2–coated implants, plasma-treated implants, and implants treated with both rhBMP-2 and plasma. Micro-computed tomography (micro-CT) and medical CT analyses revealed a significantly greater volume of newly formed bone in the combined treatment group (p < 0.05). Histological evaluation further confirmed superior outcomes in the combined group, showing significantly higher bone-to-implant contact (BIC), new bone area (NBA), and inter-thread bone density (ITBD) compared to the other groups (p < 0.05). These findings indicate that vacuum plasma treatment enhances the biological efficacy of low-dose rhBMP-2, representing a promising strategy to improve implant integration in compromised conditions. Further studies are warranted to determine the optimal clinical dosage. Full article

Background: Mesenchymal stem cells (MSCs), multipotent and immune-regulatory cells derived from tissues such as bone marrow, dental pulp, and periodontal ligament, emerged as promising agents in regenerative dentistry. Their clinical applications include endodontic tissue regeneration, periodontal healing, and alveolar bone repair, addressing critical challenges in dental tissue restoration. Methods: A systematic review was conducted following PRISMA guidelines and registered in PROSPERO. We searched PubMed, Scopus, and Web of Science databases for open-access, English-language clinical trials and observational studies published from 2015 to 2025. Studies focusing on the application of MSCs in dental tissue regeneration were included based on predefined eligibility criteria. Results: Out of 2400 initial records, 13 studies met the inclusion criteria after screening and eligibility assessment. Most studies investigated MSCs derived from dental pulp and periodontal ligament for regenerating periodontal tissues and alveolar bone defects. The majority reported improved clinical outcomes; however, variations in MSC sources, delivery methods, sample sizes, and follow-up periods introduced methodological heterogeneity. Conclusions: MSCs show significant potential in enhancing bone and periodontal regeneration in dental practice. Nonetheless, the current evidence is limited by small sample sizes, short follow-up, and inconsistent methodologies. Future large-scale, standardized clinical trials are required to validate MSC-based regenerative therapies and optimize treatment protocols. Full article

We present a narrative review focusing on the therapeutic potential of mesenchymal stromal cell-derived extracellular vesicles (MSC-EVs) in regenerating bone defects, particularly those resulting from surgical treatment of malignant bone and soft tissue tumors. These large bone defects pose significant challenges for reconstruction and functional recovery, highlighting the need for innovative regenerative strategies. Background: MSCs, which can differentiate into various cell types, are known for their immunosuppressive properties and ability to promote tissue repair. MSC-EVs, rich in bioactive molecules like microRNAs and proteins, play a crucial role in bone regeneration by mediating intercellular communication and modulating inflammation. Methods: This narrative review compiles data from various studies, including systematic reviews and individual research, focusing on the application of MSC-EVs in bone defect treatment. It examines the characteristics, mechanisms of action, and therapeutic effects of MSC-EVs, as well as the microRNAs involved in bone regeneration. Results: The findings indicate that MSC-EVs can enhance both osteogenesis and angiogenesis, highlighting their potential as promising candidates for clinical applications in bone defects. However, many mechanisms remain unclear; therefore, further investigation is needed. Conclusions: The review emphasizes the potential of MSC-EVs in improving patient outcomes for severe bone defects. It also highlights future challenges, including formulation, standardization, safety, and delivery methods, particularly in conjunction with biomaterials. Overall, MSC-EVs represent a significant advancement in regenerative medicine for bone defects. Full article

Background: Recurrent anterior shoulder instability is a common problem and may be associated with glenoid bone defects. Surgical procedures, including Latarjet, are the usual treatment for anterior shoulder instability, associated with significant glenoid bone defects. The aim of this study was to evaluate the clinical outcome and glenohumeral arthritis progression in patients with recurrent anterior shoulder instability and significant bone loss treated by a modified Latarjet procedure. Methods: From July 2018 to November 2021, a prospective observational case series was carried out on 21 patients with recurrent anterior shoulder instability associated with significant bone defects treated by a modified Latarjet procedure in which the coracoid process was rotated 90° on its longitudinal axis and the subscapularis muscle was horizontally split. Patients with a glenoid defect of more than 21% were included. Post-operatively, the patients were clinically assessed using modified Rowe scoring. Glenohumeral arthritis, graft position, union, and resorption were radiologically evaluated. Results: The mean age at the time of surgery was 28.52 ± 8.0 (range: 19–45) years. The mean number of dislocations was 18.33 ± 8.67 (range: 6–35) times. The mean glenoid defect size was 26.19 ± 4.85 (range: 21–37) % and Hill–Sachs lesions were off-track in 19 cases. The mean follow-up period was 30.67 ± 7.53 (range: 16–40) months. Eighteen patients (85.7%) showed good to excellent results. The mean modified Rowe score was 85.00 ± 18.77 (range: 30–100) points. The mean external rotation loss was 8.09 ± 5.11° (range: 0–20°). No cases of recurrent instability were observed, and there was no progression of glenohumeral arthritis. Conclusions: The modified Latarjet is an effective and reliable surgical option to treat traumatic anterior shoulder instability with significant bone loss. Most of the reported complications associated with this procedure did not affect the functional outcome. Full article

Peri-implantitis is an inflammatory disease-causing bone loss around dental implants, often requiring reconstructive surgical therapies to reduce probing depth and regenerate bone. However, such surgeries are frequently complicated by postoperative issues. This retrospective case series aimed to identify the main postoperative complications following the reconstructive treatment of peri-implant bone defects in peri-implantitis patients. Data from 14 patients with 21 affected implants were analyzed, including demographics, oral hygiene, surgical techniques, and complications such as wound dehiscence, membrane exposure, and infections. Wound dehiscence was measured using Image J^® software version 1.54. Descriptive and bivariate analyses were performed. The results showed that 11 implants (52.4%; 95% confidence interval (95%CI): 29% to 76%) in nine patients (57.1%; 95%CI = 27% to 87%) developed soft tissue dehiscence after one week, with membrane exposure observed in 4 implants. Dehiscence was significantly associated with mandibular implant location (p = 0.003), poor interproximal hygiene (p = 0.008), and membrane exposure (p = 0.034). No postoperative infections were recorded. In conclusion, more than half of peri-implantitis patients undergoing reconstructive surgery experience wound dehiscence, particularly in cases involving mandible, poor hygiene, and membrane exposure. This complication might compromise bone regeneration and reduce the treatment success rate. These results should be interpreted cautiously due to study design limitations (retrospective design, lack of a control group, and small sample size). Full article

Thermosensitive hydrogels undergo reversible sol-gel phase transitions in response to changes in temperature. Owing to their excellent biocompatibility, mild reaction conditions, and controllable gelation properties, these hydrogels represent a promising class of biomaterials suitable for minimally invasive treatment systems in diverse biomedical applications. This review systematically summarizes the gelation mechanisms of thermosensitive hydrogels and optimization strategies to enhance their performance for broader application requirements. In particular, we highlight recent advances in injectable thermosensitive hydrogels as a carrier within stem cells, bioactive substances, and drug delivery for treating various tissue defects and diseases involving bone, cartilage, and other tissues. Furthermore, we propose challenges and directions for the future development of thermosensitive hydrogels. These insights provide new ideas for researchers to explore novel thermosensitive hydrogels for tissue repair and disease treatment. Full article

Background/Objectives: The aim of this study is to describe the characteristics of a cohort of patients who underwent surgery for septic non-union of the lower extremities. Methods: We analyzed clinical data from 74 patients affected by septic non-union of long bones in the lower extremities, treated with the Ilizarov method between January 2006 and December 2021. The primary objective of our study was to describe the time from surgery to bone union. Results: Patients had undergone a median of three previous surgical interventions, had an average bone defect of 5.4 cm, with 43.4% of patients having a Non-Union Scoring System (NUSS) > 75 points, and 46.5% of patients having been considered candidates for limb amputation in other centers. Bone union was achieved in 73 patients (98.65%), while infection resolution was achieved in 68 patients (91.89%). In 63 patients (85.13%), healing was obtained with one surgical procedure only. Only 11 re-interventions were necessary after frame removal (14.86%): 10 were due to re-fractures (13.51%) and 1 to an infection recurrence, which resulted in an amputation (1.35%). At a time of 6.01 ± 3.9 years follow-up, the Association for the Study and Application of the Methods of Ilizarov (ASAMI) scoring system indicated excellent or good outcomes in 97.3% for the bone subscale and in 89.2% for the functional subscale. The Patient Global Impression of Change (PGIC) showed that 96.8% of patients were “very much improved” or “much improved”. Patients who have suffered a more recent trauma or fewer previous surgeries achieved a better outcome. Conclusions: Despite some limitations, this study shows that treatment of septic non-unions using the Ilizarov method is both highly effective in bone and infection healing and results in a satisfactory functional outcome. The results observed in our cohort suggest that the Ilizarov method could be critically re-evaluated as a primary treatment option for these challenging cases. The clinical relevance of these findings lies in their potential to significantly alter the current treatment paradigm, by questioning the need for biologic adjuncts and local antibiotics, thereby reducing healthcare costs. Full article

Background: Primary malignant bone tumors among adolescent patients are most commonly associated with burdensome surgeries that can severely affect young patients’ early life. To this day, despite available autologous tissue donor sites, cement spacers or endoprostheses are still most commonly used as a form of reconstruction of post-resection defects. Methods: The study group includes 20 adolescent patients diagnosed with Osteosarcoma or Ewing Sarcoma involving the upper limbs. The inclusion criteria were as follows: primary malignant bone tumors sensitive to neoadjuvant chemotherapy, tumors not infiltrating major blood vessels and nerves, and the appliance of the microsurgical free flap as a reconstructive method. Poor tumor response to neodajuvant chemotherapy or patients with incomplete follow-up were excluded from this study. To achieve the functional reconstruction of post-resection defects, fibula free flaps were applied. In cases of resection, including the metaphysis of a long bone, a modification of the flap harvest was applied in order to prevent arthrodesis. The MSTS (Musculoskeletal Tumor Society Scoring System) scale was used as a functional outcome measurement tool. Results: The reported outcomes of this study prove the efficiency of the treatment’s approach of combining the resection of the tumor with subsequent microsurgical restoration with the use of autologous tissues. The average score on the MSTS scale, which assesses the functional outcome, was 26.8/30 points, which indicates great motor outcomes. There were no reports of local recurrence during follow-up. Conclusions: Patients with primary malignant bone tumors in the upper limbs can benefit from microsurgical techniques, which are highly customized; effective; and give sufficient functionality following extensive resection. Full article

Bone marrow stimulation is a treatment for articular cartilage injuries that promotes cartilage repair by inducing the migration and accumulation of mesenchymal stem cells (MSCs), but often results in fibrocartilage with limited durability. This study aimed to investigate the effect of hypoxic conditions on cartilage repair using a rat osteochondral defect model. Osteochondral defects (1.0 mm in diameter) were created in the femoral trochlear groove, and rats were exposed to hypoxic conditions (12% O₂) for 4 weeks postoperatively. Histological analysis was performed, and protein expression of hypoxia-inducible factor-1α (HIF-1α) and SRY-box transcription factor 9 (SOX9) in the repair tissue was evaluated after 1 week. As a result, after 1 week, protein expression of HIF-1α and SOX9 in the Hypoxia group was significantly increased compared to the Normoxia group. After 4 weeks, the Hypoxia group exhibited a hyaline cartilage-like tissue structure with a significantly lower Modified Wakitani score compared to the Normoxia group. Furthermore, after 4 weeks, the inhibition of HIF-1α suppressed cartilage repair. These findings suggest that hypoxic conditions promote SOX9 expression via HIF-1α during the early phase of MSC chondrogenic differentiation and promote the formation of hyaline cartilage-like repair tissue. In conclusion, bone marrow stimulation under hypoxic conditions may enhance the repair effect on articular cartilage injuries. Full article

Open reduction and internal fixation (ORIF) is widely regarded as the primary treatment for acetabular fractures, but limitations arise in complex cases, leading to non-anatomical reductions and increased risk of post-traumatic osteoarthritis. Given the high incidence of secondary arthritis (12–57%) following ORIF, total hip arthroplasty (THA) is often necessitated, particularly in scenarios unsuitable for ORIF, such as extensive comminution or combined femoral head and neck fractures. The surgical landscape has shifted from a traditional “fix or replace” to a more integrated “fix and replace” approach, especially beneficial in managing elderly patients with osteoporotic bones. THA is applied across various timelines, including acute (0–3 weeks), delayed (3 weeks to 3 months), and late (beyond 3 months), each presenting distinct challenges and requiring specific strategies to optimize outcomes. The importance of precise bone defect classifications and the role of dual mobility cups in reducing dislocation risks are highlighted, alongside the use of modern surgical and fixation techniques to improve stability and patient outcomes. Enhanced recovery protocols and meticulous postoperative management are critical to addressing complications, such as infections and hardware interference, tailoring treatment approaches to each patient’s needs, and advancing care for complex acetabular fractures. Full article

Critical-sized bone defects (CSBDs) are injuries that exceed the body’s natural capacity for repair and require external intervention. These defects are particularly challenging in the mandible, often resulting from trauma, tumor resection, or implant-related complications. Effective treatment involves scaffold designs that support vascularization, bone formation, and sufficient mechanical strength. This systematic review aims to assess whether ceramic-based scaffold properties, including porosity, pore size, and macroscopic characteristics, improve vascularization, bone formation, and the mechanical properties in the treatment of CSBDs in large animal models. A search of databases (PubMed, Embase, and Web of Science) identified 11 in vivo studies involving CSBDs (>2 cm), ceramic scaffolds, and histological analysis. Findings indicate that scaffolds with porosity exceeding 50% yield optimal outcomes by striking a balance between cell infiltration and mechanical stability. Pore sizes ranging from 300 μm to 700 μm are ideal for vascularization and bone ingrowth. Three-dimensional (3D) printing shows promise in creating scaffolds with precise and reproducible features. However, the studies varied significantly in their methodologies and outcomes, with no consensus on the optimal scaffold properties for mandibular CSBDs. Scaffold porosity and pore size play key roles in promoting vascularization and bone regeneration. Various animal models reinforce this finding, suggesting that scaffold architecture is crucial for biological integration and functional outcomes. This review highlights the importance of standardized research protocols and clear design criteria in enhancing the success of bone regeneration. Future research should investigate emerging biomaterials and new scaffold technologies to overcome current limitations in clinical applications. Full article

Background: Odontogenic cysts can damage the surrounding bone tissue as they grow, making it essential to implement effective regenerative strategies tailored to each patient. Personalised approaches in oral surgery, such as selecting the most suitable bone graft materials, can lead to improved treatment outcomes. Filling the bone defect created after cyst removal, root resection, or extraction with a bone graft material can stabilise the weakened tooth and promote faster bone regeneration. This article shares our experiences with the therapeutic effects of albumin-coated bone allograft (BoneAlbumin^®) placed in the bone defect following cyst removal in the oral cavity, compared to cases where the defect was left untreated (controls). Methods: The study involved thirty patients who underwent the removal of maxillary odontogenic cysts. In 15 of these patients, the bone defect was filled with albumin-coated bone allograft (BoneAlbumin^®, OrthoSera, Budapest, Hungary). In the control group, which consisted of 15 patients, the defect was left untreated. A consistent surgical protocol was adhered to throughout the study. Follow-up periapical X-rays were taken immediately after surgery as well as at 6 and 12 weeks post-surgery, using a standardised template. These images were used to assess the shrinkage and healing of the defect caused by the cyst. Measurements were adjusted to reference points to account for potential distortions in the X-rays. Results: The control and study groups exhibited no statistically significant differences in their basic parameters. Additionally, there was no notable difference in the sizes of postoperative defects between the two groups. However, statistical analysis revealed a significant difference in the changes in defect size (∆defect size) between the groups at both 6 weeks (p < 0.000001) and 12 weeks (p = 0.000296). This suggests that the BoneAlbumin^®-graft group experienced significantly greater changes in defect size over time. Conclusions: The use of BoneAlbumin^® graft leads to a markedly better reduction in defect size as time progresses, although these changes have only been compared to graft-free healing. Full article

Background and Objectives: This scoping review aimed to identify and synthesize current evidence on the clinical applications of artificial intelligence (AI) in periodontology, focusing on its potential to improve diagnosis, treatment planning, and patient care. Materials and Methods: A comprehensive literature search was conducted using electronic databases including PubMed-MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and Web of Science™ Core Collection. Studies were included if they met predefined PICO criteria relating to AI applications in periodontology. Due to the heterogeneity of study designs, imaging modalities, and outcome measures, a scoping review approach was employed rather than a systematic review. Results: A total of 6394 articles were initially identified and screened. The review revealed a significant interest in utilizing AI, particularly convolutional neural networks (CNNs), for various periodontal applications. Studies demonstrated the potential of AI models to accurately detect and classify alveolar bone loss, intrabony defects, furcation involvements, gingivitis, dental biofilm, and calculus from dental radiographs and intraoral images. AI systems often achieved diagnostic accuracy, sensitivity, and specificity comparable to or exceeding that of dental professionals. Various CNN architectures and methodologies, including ensemble models and task-specific designs, showed promise in enhancing periodontal disease assessment and management. Conclusions: AI, especially deep learning techniques, holds considerable potential to revolutionize periodontology by improving the accuracy and efficiency of diagnostic and treatment planning processes. While challenges remain, including the need for further research with larger and more diverse datasets, the reviewed evidence supports the integration of AI technologies into dental practice to aid clinicians and ultimately improve patient outcomes. Full article

Background: The rehabilitation of complex bone defects in the anterior maxilla presents significant challenges in restoring both function and esthetics. A multidisciplinary approach integrating guided bone regeneration (GBR) and connective tissue grafting (CTG) has proven effective in addressing such cases. Methods: This report describes the case of a 60-year-old female patient who presented with severe alveolar ridge resorption and peri-implant bone loss, necessitating an advanced regenerative strategy. The treatment protocol involved the use of autologous and xenogeneic bone grafts in combination with hyaluronic acid and polynucleotides to enhance osteogenesis and tissue integration. A six-month healing period was observed before histological and clinical evaluations were conducted. Results: The results demonstrated a significant increase in lamellar bone formation and vascularization in sites treated with biomodulators compared to conventional GBR techniques. Subsequently, CTG was employed to optimize peri-implant soft tissue volume and stability, leading to improved keratinized tissue thickness and enhanced esthetic outcomes. This case underscores the importance of a comprehensive surgical and prosthetic plan that integrates bone regeneration with mucogingival management for optimal results in implant rehabilitation. Additionally, histological analysis revealed that the incorporation of hyaluronic acid and polynucleotides resulted in improved cellular activity, reduced inflammatory responses, and enhanced overall bone quality. Conclusions: These results highlight the potential role of biomodulators in regenerative procedures. While the findings suggest promising clinical applications, further long-term studies are necessary to validate the outcomes and establish standardized protocols for the integration of advanced biomaterials in implantology. Full article