Search Results (2,059)

Background: Bone tissue is a dynamic structure capable of continuous remodeling; however, its regenerative capacity is limited in critical-size defects, often requiring the use of bone grafting procedures. Available grafting materials present inherent limitations, highlighting the need for strategies that can enhance regenerative outcomes. Hyaluronic acid (HA) has been proposed as a promising adjunctive agent because of its biological properties, including anti-inflammatory and pro-angiogenic effects. Objective: To systematically evaluate the available clinical evidence regarding the effects of HA as an adjunct in bone regeneration procedures, including alveolar ridge preservation, ridge augmentation, and maxillary sinus elevation. Materials and Methods: A systematic search was conducted in the PubMed, ScienceDirect, Google Scholar, and Wiley Online Library databases for studies published within the last 10 years. Clinical studies involving adult patients were included if they evaluated the local application of HA, regardless of formulation, and reported quantitative clinical, radiographic, histological, or histomorphometric outcomes related to bone regeneration. Results: Of the 728 records initially identified, 10 studies met the eligibility criteria and were included in the qualitative synthesis. Discussion: Overall, the available evidence suggests that HA may positively influence bone regeneration outcomes. The most consistent benefits were observed in alveolar ridge preservation and ridge augmentation procedures, including increased new bone formation, improved bone density, enhanced bone maturation, and reduced dimensional bone loss. In contrast, findings regarding maxillary sinus augmentation were less consistent. Conclusions: HA appears to be a promising adjunct in bone regeneration procedures. However, the current evidence remains limited and is primarily based on clinical outcomes, providing insufficient mechanistic data to fully elucidate its biological effects. Further well-designed randomized controlled trials with standardized protocols are required before definitive clinical recommendations can be established. Full article

Background: Congenital fibular deficiency is a rare longitudinal deficiency of the lower extremity associated with limb-length discrepancy, ankle and foot deformity, soft-tissue imbalance, and functional impairment. Reconstruction may be challenging because bone healing, regenerate maturation, and mechanical stability can be less predictable in selected patients. Case Presentation: A man with congenital fibular deficiency developed chronic distal tibial nonunion after corrective osteotomy at another institution. The nonunion persisted for four years, and the patient presented to our hospital with inability to bear weight and wheelchair dependence. A comprehensive salvage strategy was performed, including Achilles tendon lengthening using the Vulpius technique, removal of retained fixation material, debridement and refreshment of the nonunion site, negative bacteriological cultures, autologous cancellous iliac bone grafting, acute shortening and compression of the docking site, circular external fixation, proximal tibial osteotomy, and gradual lengthening. Low-intensity pulsed ultrasound was applied postoperatively as an adjunctive biological stimulus. Results: Bone union was achieved, and the external fixator was removed approximately one year after surgery. A total lengthening of 78 mm was achieved. At 12-year follow-up, the AOFAS ankle-hindfoot score was 90, ankle range of motion was 5° dorsiflexion and 40° plantarflexion, and the JOA knee score was 95. The patient walked independently without assistive devices and continued to work. Mild residual varus deformity of the proximal tibia was present, but the patient reported no knee pain, ankle pain, or ankle instability, and radiographs showed no progressive osteoarthritic changes. Conclusions: In selected patients with congenital fibular deficiency and chronic nonunion after previous treatment, durable limb salvage may be achieved using an individualized strategy that addresses both biological and mechanical factors. Full article

Background and Objectives: Zygomatic implants have progressively become a widely adopted graft-free treatment option for the rehabilitation of severe maxillary atrophy. However, the expansion of their clinical indications has generated debate regarding patient selection, treatment hierarchy, and potential overtreatment. This review aimed to critically analyze current evidence regarding the use of zygomatic implants in the rehabilitation of the atrophic maxilla. Methods: A comprehensive narrative review of the literature was conducted through searches of PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library. Relevant clinical studies, systematic and narrative reviews, and consensus statements published in English up to 27 March 2026 were critically analyzed to provide a comprehensive narrative synthesis focusing on treatment indications, surgical protocols, complications, patient-reported outcomes, and evidence gaps. Results: The reviewed literature consistently reported high implant survival rates and highlighted the role of zygomatic implants in reducing the need for extensive grafting procedures in selected patients with severe maxillary atrophy. The most frequently reported complications included sinus-related disorders, soft-tissue complications, prosthetic problems, and challenges associated with the management of implant failure. Different surgical approaches, including intra-sinus, sinus-slot, and extra-sinus techniques, were described. However, substantial heterogeneity emerged regarding treatment algorithms, complication reporting, success criteria, and patient-reported outcome assessment. Conclusions: Zygomatic implants represent an established treatment option associated with high reported implant survival in selected patients with severe maxillary atrophy, particularly when conventional implant placement would require extensive reconstructive procedures. However, in borderline clinical situations characterized by partial residual bone availability, treatment planning should also consider less invasive alternatives, including short implants, tilted implants, regenerative procedures, or customized subperiosteal implants, according to individual anatomical, prosthetic, and patient-related factors. Greater standardization of indications, complication reporting, and patient-reported outcome assessment is needed to better define the role of zygomatic implants within evidence-based treatment planning for the atrophic maxilla. Full article

Background/Objectives: Alveolar ridge atrophy following tooth extraction complicates subsequent prosthetic rehabilitation and implant placement. This systematic review seeks to provide a comprehensive evaluation of existing evidence regarding the effectiveness of xenogeneic bone graft materials in socket preservation, particularly emphasizing their influence on the adjacent soft tissues. Methods: A systematic literature search was carried out across the CENTRAL, Embase, MEDLINE, PubMed, and Scopus databases. The search targeted randomized controlled trials (RCTs) published in English between January 2015 and September 2025 that examined xenogenic bone grafts used for ridge preservation in comparison either to spontaneous socket healing or to other types of grafting materials. The primary outcomes of interest were bone regeneration and alterations in soft tissues. Multiple independent reviewers performed study screening, data extraction, and risk of bias evaluation using the RoB 2 tool. Results: From 2242 initial records, 4 RCTs (138 patients) met the inclusion criteria. Studies compared xenografts (deproteinized bovine bone mineral with/without collagen), often combined with membranes, to unassisted healing. Augmentation techniques consistently showed a trend toward reduced horizontal and vertical ridge contraction compared to controls, though differences often lacked statistical significance (p > 0.05). Histological analysis revealed significantly less vital bone formation and residual graft particles in xenograft sites versus controls, suggesting volume maintenance is largely graft-dependent. Soft tissue contour changes were evaluated using 3D model scanning. Risk of bias varied, with concerns regarding randomization and reported outcomes in some studies. Conclusions: Xenogenic materials demonstrate comparable clinical effectiveness in preserving alveolar ridge dimensions, though radiographic volume stability may be partially attributed to the slow resorption of the graft material itself rather than new bone formation. Full article

Background and Clinical Significance: Tumors of the lacrimal drainage system are rare but clinically important diagnostic pitfalls because they may mimic benign lacrimal drainage obstruction, chronic dacryocystitis, or sinonasal disease. Pleomorphic adenoma (PA) in this region is exceptionally rare, and delayed recognition may allow progressive extension into adjacent structures. Case Presentation: A 51-year-old woman presented with left nasal obstruction 16 years after external dacryocystorhinostomy for presumed lacrimal drainage obstruction. Examination showed a firm left lacrimal sac mass, proptosis, mild ocular motility limitation, and an intranasal mass. Computed tomography and magnetic resonance imaging showed a large lesion centered in the lacrimal sac region and extending into the nasolacrimal duct, nasal cavity, and maxillary sinus, with orbital displacement. Preoperative biopsy showed epithelial neoplastic tissue without definitive malignant features, but low-grade epithelial malignancy could not be excluded. Complete en bloc excision and medial/inferior orbital wall reconstruction with an autologous calvarial outer table bone graft were performed. The tumor measured 55 × 35 × 25 mm. Final histopathology confirmed PA without malignant transformation. At 2 years postoperatively, there was no recurrence, and proptosis and ocular motility limitation had improved. Conclusions: This case illustrates two diagnostic pitfalls: an underlying tumor may masquerade as lacrimal drainage obstruction, whereas a large benign PA may clinically and radiologically mimic malignancy. Long-standing or atypical unilateral lacrimal symptoms should prompt consideration of tumors and selected use of imaging and tissue diagnosis before lacrimal drainage surgery. Full article

Bone–patellar tendon–bone (BPTB) grafts used in anterior cruciate ligament reconstruction bend at the femoral tunnel aperture, forming a graft bending angle (GBA). However, the mechanical effects of GBA-related angled loading on bone–BPTB graft constructs remain unclear. This study investigated the effects of GBA and cyclic tensile loading on stiffness and elongation using porcine BPTB grafts. Fourteen specimens were assigned to tibial bone plug constructs (Type T, n = 7) or patellar bone plug constructs (Type P, n = 7). Each construct was cyclically loaded between 10 and 50 N for 50 cycles under GBA conditions of 0°, 30°, 60°, and 90°. Regardless of GBA condition, cyclic loading produced substantial increases in stiffness and elongation during the first 10 cycles, followed by smaller changes. Stiffness tended to decrease under greater GBA conditions, particularly in Type T constructs, where 60° and 90° reduced stiffness and increased elongation. Type P stiffness showed little dependence on GBA. At 0° and 30°, Type P showed lower stiffness and greater elongation than Type T. These findings indicate that bone–BPTB graft tensile behavior is governed by GBA-related loading geometry and bone plug–tendon junction morphology. Full article

Extracranial–intracranial (EC-IC) bypass surgery remains an essential tool in the management of complex cerebrovascular disease, including chronic-ischemic hypoperfused territory as well as intracranial aneurysms requiring parent vessel sacrifice. Reliable postoperative surveillance of graft patency and hemodynamic function is central to long-term success. Sonographic imaging has evolved over four decades from indirect extracranial Doppler waveform analysis through intraoperative microvascular Doppler, quantitative duplex ultrasonography, and transcranial Doppler assessment of intracranial hemodynamics to the contemporary development of trans-sonolucent cranioplasty ultrasonography (TCUS). TCUS, enabled by the replacement of the autologous bone flap with an acoustically transparent polymethyl methacrylate (PMMA) cranioplasty, permits direct, real-time visualization of the anastomosis and surrounding intracranial vasculature. This can be performed at the bedside and in the outpatient setting, without radiation or contrast. Current evidence, drawn largely from small series and early multicenter experience, positions TCUS as a reliable and potentially cost-effective complement to digital subtraction angiography for serial bypass surveillance, though prospective validation remains needed. This review traces the full arc of sonographic bypass monitoring and addresses current evidence, technical considerations, established quantitative parameters, and directions for future investigation. Full article

Objectives: Autologous bone grafting remains the gold standard for maxillofacial reconstruction but is limited by tissue scarcity and donor-site morbidity. Consequently, substitutes like bioactive glass (BG), beta-tricalcium phosphate (β-TCP), and deproteinized bovine bone (DBB) are widely used. However, comprehensive mechanistic comparisons among them remain scarce. Materials and Methods: We systematically evaluated these substitutes under standardized in vitro conditions to compare their physicochemical transformations, degradation profiles, biological performances, and underlying osteogenic molecular pathways. Results: In simulated body fluid, BG underwent rapid hydroxyapatite mineralization, whereas the highly porous DBB and dense β-TCP remained structurally inert. Degradation assays revealed BG exhibited the fastest mass loss and ion release, β-TCP showed intermediate degradation, and DBB maintained high in vitro structural stability. Biologically, all materials showed favorable cytocompatibility and comparable angiogenic potential. However, BG demonstrated significant antibacterial activity (E. coli, S. aureus) and a strong potential to enhance osteogenic differentiation, significantly upregulating the protein-level expression of RUNX2 and OCN, alongside the transcriptional upregulation of Bmp2, Runx2, and Ocn. Transcriptomic profiling and pharmacological validation suggest that the enhanced osteogenic performance of BG might be associated with specific regulatory pathways, supporting the hypothesis that the suppression of NF-κB-mediated inflammation and the activation of the ECM-Integrin-FAK mechanotransduction axis play potential roles. Conclusions: BG offers high bioactivity and notable potential to enhance osteogenic differentiation in vitro but degrades rapidly. DBB ensures structural durability without intrinsic osteoinductivity, and β-TCP provides a balanced, intermediate profile. These in vitro mechanistic insights provide a theoretical foundation for future in vivo evaluations and designing next-generation bone scaffolds. Full article

Background: Developmental dysplasia of the hip (DDH) is one of the leading causes of secondary hip osteoarthritis and frequently results in severe anatomical alterations that make total hip arthroplasty (THA) technically demanding. Restoration of hip biomechanics, limb length, and joint stability remains challenging, particularly in patients with moderate-to-severe dysplasia. Objective: To evaluate the clinical and radiographic outcomes of cementless total hip arthroplasty combined with soft-tissue balancing, with or without acetabular reconstruction using autologous femoral head graft, in patients affected by osteoarthritis secondary to DDH. Methods: A retrospective single-center case series was conducted on eight female patients (mean age 53.9 ± 14.6 years; range 33–80 years) who underwent primary cementless THA for DDH-related osteoarthritis between 2019 and 2025. Clinical outcomes were assessed using the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form-36 (SF-36). Radiographic evaluation included implant positioning, osteolysis, heterotopic ossification, bone graft incorporation, and leg-length discrepancy. Data normality was assessed using the Shapiro–Wilk test. Preoperative and postoperative outcomes were compared using paired Student’s t-test and confirmed with the Wilcoxon signed-rank test. Implant survival and revision-free status were recorded throughout the follow-up period. Results: At a minimum follow-up of 12 months (range 12 months–6 years), significant improvements were observed in all clinical outcome measures. Mean HHS increased from 49.3 ± 2.5 preoperatively to 90.4 ± 2.7 postoperatively (p < 0.001), while mean WOMAC decreased from 53.5 ± 5.6 to 7.4 ± 3.3 (p < 0.001). Mean SF-36 improved from 47.2 ± 3.8 to 89.9 ± 3.2 (p < 0.001). Wilcoxon analysis confirmed the statistical significance of these findings (all p = 0.0078). Radiographic assessment demonstrated satisfactory implant positioning and stable fixation in all patients, with no evidence of osteolysis or implant loosening. Minor complications included one intraoperative periprosthetic femoral fracture treated successfully with cerclage wiring, two cases of Brooker grade I–II heterotopic ossification, and one case of minimal graft resorption without clinical consequences. No revision procedures were recorded during follow-up, and implant survival was 100%. Conclusions: Cementless THA combined with selective soft-tissue balancing provides excellent clinical, functional, and radiographic outcomes in patients with osteoarthritis secondary to DDH. This approach significantly improves hip function and quality of life while ensuring stable implant fixation, low complication rates, and excellent mid-term implant survival. Full article

Background and Clinical Significance: Malignant transformation of giant cell tumor of bone (GCTB) is a rare but clinically significant event, most commonly associated with radiotherapy, denosumab therapy, or recurrent disease. Secondary malignant transformation occurring in the absence of recognized risk factors is exceptionally uncommon. We report a rare case of high-grade sarcomatous transformation of proximal humeral GCTB after a prolonged latency period without prior radiotherapy, denosumab exposure, or documented recurrence; Case Presentation: A 27-year-old female initially presented with right shoulder pain and was diagnosed with proximal humeral GCTB. She underwent intralesional curettage and bone grafting, with histopathological confirmation of benign GCTB. Nine years later, she developed progressive shoulder pain, functional limitation, and systemic symptoms. Imaging demonstrated an aggressive lytic lesion with cortical destruction and soft-tissue extension involving the proximal humerus. Repeat curettage and histopathological evaluation revealed high-grade spindle cell sarcoma consistent with malignant transformation of GCTB. The patient received neoadjuvant chemotherapy followed by wide resection and endoprosthetic reconstruction of the proximal humerus, with additional adjuvant chemotherapy postoperatively. At two-year follow-up, she remained disease-free with excellent functional recovery and satisfactory quality of life; Conclusions: This case highlights the potential for delayed malignant transformation of GCTB even in the absence of established predisposing factors. Clinicians should maintain long-term vigilance in patients treated for GCTB, particularly when new pain, functional decline, or aggressive radiologic features develop years after initial treatment. Early recognition and multidisciplinary management are essential to optimize oncologic and functional outcomes. Full article

The surgical management of distal tibia fractures in the elderly is increasingly complex due to the rising prevalence of osteoporosis and the unique anatomical constraints of the region. While autologous bone graft remains the gold standard, its limitations have led to the widespread adoption of synthetic and biological substitutes. This narrative review explores the current trends in bone grafting for osteoporotic distal tibia fractures, focusing on pure β-tricalcium phosphate (β-TCP) and demineralized bone matrix (DBM). We specifically examine the biological mechanisms, resorption kinetics, and clinical outcomes of these materials. Furthermore, we highlight the emerging clinical preference for powder-type pure β-TCP (Neobone™) due to its superior surface area and packing efficiency in irregular metaphyseal voids. Powder-type pure β-TCP demonstrates superior packing efficiency and predictable resorption kinetics for metaphyseal void filling, while DBM remains a context-dependent biological supplement. Ion-substituted TCP formulations, pharmacological augmentation, and hybrid scaffolds are highlighted as future directions. Full article

Cleft lip with or without cleft palate (CL/P) is one of the most common congenital craniofacial anomalies worldwide and presents significant functional, esthetic, and psychosocial challenges. Despite advances in multidisciplinary care and surgical reconstruction, complications such as impaired wound healing, scar formation, and growth disturbances warrant the development of novel regenerative and surgical strategies, which heavily rely on animal models at the pre-clinical stage. For the current narrative review, the literature search was performed by combining cleft phenotype terms with modeling-approach terms in six databases and was supplemented by manual review of reference lists from full-text articles. The included articles were summarized based on cleft type and the methods for cleft induction (chemically induced, genetically engineered, and surgically created). Particularly, chemical teratogens such as retinoic acid, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), corticosteroids, and 6-aminonicotinamide have been widely used to induce cleft phenotypes and elucidate environmental influences on palatogenesis, whereas genetic models have clarified the roles of key molecules and signaling pathways, including Sonic hedgehog (SHH), bone morphogenetic protein (BMP), and transforming growth factor-β (TGF-β), in the development of lip and palate. Meanwhile, the surgical models have focused on the alveolar cleft in skeletally mature animals for evaluating novel grafting materials. By comparing the strengths and limitations of existing models, this review highlights opportunities for improving experimental design and translational relevance in future cleft research. Overall, despite a wide range of CL/P animal models available, few replicate clinically relevant defect anatomy and the postnatal craniofacial deformation observed in CL/P patients, underscoring the need for the development of new models. Full article

Background/Objectives: Peri-implant diseases, encompassing peri-implant mucositis and peri-implantitis, affect 43% and 18.8–23% of implant-bearing patients, respectively, representing significant clinical challenges in implant dentistry. While mechanical debridement remains foundational, biologically active materials offer promising adjunctive regenerative strategies. This narrative review synthesises current evidence regarding five biologically active materials: enamel matrix derivative (EMD), platelet-rich fibrin (PRF), fibroblast growth factor-2 (FGF-2), recombinant human platelet-derived growth factor-BB (rhPDGF-BB/GEM 21S^®), and polynucleotide–hyaluronic acid combinations (Regenfast^®). Methods: The relevant literature was identified using electronic databases, including MEDLINE, PubMed, Scopus, and Google Scholar. This review focused on clinical studies and randomised controlled trials with a minimum follow-up of six months investigating biologically active materials in peri-implant disease management. Material mechanisms, clinical efficacy, therapeutic limitations, and evidence quality were systematically evaluated. Attention was directed toward identifying genuine biological distinctions between peri-implant and periodontal disease contexts. Results: EMD demonstrates efficacy exclusively within multimodal surgical protocols, with isolated application yielding limited benefits. rhPDGF-BB shows superior periodontal regenerative capacity; however, dedicated peri-implantitis trials remain absent. FGF-2 exhibits paradoxical osteogenic suppression despite bone fill achievement, limiting peri-implant applicability. PRF and Regenfast^® demonstrate a mechanistically sound rationale yet lack substantive peri-implant disease validation. The critical findings revealed that peri-implant regeneration fundamentally differs from periodontal regeneration: implants lack periodontal ligament anatomy, rendering ligamentogenic differentiation-promoting agents biologically inappropriate. Conclusions: Contemporary biologically active materials demonstrate compelling periodontal efficacy yet remain inadequately validated for peri-implantitis management. This disparity reflects authentic biological distinctions rather than insufficient investigation. Until multicentre randomised controlled trials stratify efficacy across distinct peri-implant disease presentations, practitioners must prioritise evidence-based surgical fundamentals—meticulous decontamination, strategic grafting, and optimised wound healing—integrating biologically active materials judiciously within comprehensive, anatomy-respecting treatment protocols. Full article

Background and Objectives: This prospective cohort study aimed to assess patellar and tibial donor-site bone defect volume and regeneration on MRI at 4 weeks and 12 months after bone–patellar tendon–bone anterior cruciate ligament reconstruction and to determine their association with knee function and donor-site morbidity at 12 months. Materials and Methods: This single-center prospective observational cohort study included 30 patients who underwent ACL reconstruction with a BTB autograft. Donor-site bone defect volume was estimated on MRI using a triangular prism approximation at 4 weeks and 12 months by two independent evaluators blinded to patient-reported outcome scores. Clinical outcomes were assessed at 12 months using the International Knee Documentation Committee (IKDC) subjective knee form and the Donor Site Morbidity Questionnaire (DSMQ). Associations between MRI-derived parameters and patient-reported outcomes were analyzed using Spearman’s rank correlation coefficient. Results: At 4 weeks, mean donor-site bone defect volume was 2602.4 ± 684.7 mm³ in the patella and 2993.9 ± 714.3 mm³ in the tibia. At 12 months, defect volume decreased to 628.0 ± 279.7 mm³ and 980.8 ± 488.2 mm³, respectively. Tibial defects were significantly larger than patellar defects at both time points, while regeneration was significantly greater in the patella than in the tibia (74.8 ± 11.5% vs. 67.2 ± 15.1%; p = 0.0264). Regeneration was not significantly associated with IKDC or DSMQ scores (all p > 0.05). Larger patellar defect volume at 4 weeks was associated with worse subjective outcomes (both p = 0.0107). Conclusions: After BTB ACL reconstruction, tibial donor-site bone defects were larger, whereas patellar defects showed greater regeneration over time. Larger patellar defect volume at 4 weeks, but not regeneration percentage, was associated with worse subjective outcomes at 12 months. Full article

Objective: To present a split-mouth bilateral case report comparing a graft-free sinus lift technique developed by C.S. and A.P. using a resorbable magnesium membrane with a standard lateral sinus augmentation using xenograft and collagen membrane. The two approaches were evaluated through clinical, radiographic, and histological outcomes. Methods: A healthy 68-year-old female patient underwent bilateral sinus augmentation in the posterior maxilla. On the right side, a standard sinus lift was performed using a xenogeneic bone graft in combination with a resorbable collagen membrane. On the left side, a graft-free approach was done using only a resorbable magnesium membrane to support the elevated sinus membrane. Results: After a six-month healing period, implants were placed, and bone core biopsies were harvested for histological evaluation. Histological analysis revealed 56.4% newly formed bone in the graft-free magnesium membrane site and 22.5% in the grafted control site. A two-year radiological follow-up confirmed complete bone maturation and implant stability on both sides. Conclusions: This case promotes the potential of a graft-free sinus lift approach using a resorbable magnesium membrane as a promising alternative to conventional grafting protocols. The beneficial clinical, radiological and histological outcomes suggest that this technique may simplify the sinus augmentation procedure and should be further explored in larger clinical studies. Full article