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??Objective??To evaluate the clinical effect of maxillary sinus lifting??bone graft??and simultaneously placement of implants in severely atrophic maxillae and the stability of cylindrical implants. Methods??Totally 20 patients with 30 Straumann tissue-level implants were included. After osteotome sinus floor elevation and grafting??implants were inserted. Patients were recalled at 1 and 3-years follow-up. Implant success??resonance frequency analysis??clinical and radiographic outcomes were recorded. Results??At 3-year examination??the implant success rate was 96.7%. The ISQ value was 71.1±4.15??69.6 ± 5.01??68.4 ± 4.34 and 72.8 ± 6.42 at implant insertion??2??4 and 12 weeks after surgery. Modified bleeding index was 0.53 ± 0.40 and 0.61 ± 0.31 at 1 and 3-year examination. Probing depth was??3.21 ± 0.67??mm and??3.45 ± 0.71??mm at 1 and 3-year examination. Modified plaque index was 0.48 ± 0.44 and 0.52 ± 0.51 at 1 and 3-year examination. No significant difference was found between two examinations. Marginal bone loss increased from ??1.16 ± 0.27??mm at 1-year follow-up to ??1.45 ± 0.39?? mm at 3-year follow-up??the difference reached statistically significant??P < 0.05??. Implant apex height decreased from ??2.05 ± 0.43??mm at baseline to ??1.85 ± 0.75??mm at 1-year and ??1.42 ± 0.69??mm at 3-year follow-up??the difference reached statistically significant??P < 0.05??. Conclusion??Maxillary sinus lifting??bone graft??and simultaneously placement of implants could be a predicable treatment option in severely atrophic maxilla. In addition??cylindrical implants could achieve enough stability during the healing phrase. High success rate could be achieved in the short term.     

Bone loss associated with use of antiepileptic drugs

Importance of the field: Epilepsy is a neurological disorder associated with several comorbidities, one of them being reduced bone health. As the bone loss most often is insidious and asymptomatic, they are usually not recognized, and thus untreated. The key message of this paper is to make clinicians aware of the problem.

Areas covered in this review: This article reviews data from basic and clinical studies of bone loss associated with usage of antiepileptic drugs (AEDs) within the last 4 decades.

What the reader will gain: The reader will learn that there is accumulating evidence of biochemical abnormalities indicating a disturbed bone metabolism, a decreased bone density and a 2 – 6 times increased risk of fractures among those with epilepsy compared to the general population. These findings most likely have many causes, both internal and external, but long-term use of AEDs seems to play an important role. Enzyme-inducing drugs, such as phenytoin, phenobarbital and carbamazepine, but also the enzyme inhibitor valproate, appear to have bone-depleting properties. Reduced bone density may be detected during the first 1 – 5 years of treatment. Although many theories have been launched, the exact mechanisms by which the the drugs affect bone architecture are not fully understood.

Take home message: We recommend clinicians to promote osteoprotective behavior among their epilepsy patients; that is, sunlight exposure and weight-bearing exercise as well as avoidance of risk factors such as bone-depleting drugs other than AEDs, smoking and heavy alcohol consumption. Enzyme inducing drugs should be avoided, if possible. Bone mineral density screening should be assessed on an individual basis, taking risk factors for bone loss into account. All patients taking AEDs on long-term basis ought to have adequate amounts of dietary calcium and vitamin D, and those who have developed bone loss should in addition be given specific antiosteoporotic treatment.     

Initial Implant Stability Predicts Migration But Not Failure in Cementless Acetabular Revision with Bone Grafting

Host bone contact of less than 50% is perceived but not proven to cause migration and loosening after actetabular revision. A prospective analysis of cementless acetabular revision cases with impaction grafting was performed to determine if this was an independent risk factor for these events. Sixty-two hips in 54 patients were assessed at a mean follow-up of 84.5 months (range 61–112) yielding a probability of 94.6% of retaining the acetabular component using revision for aseptic loosening as the end point. No single factor was independently causative for loosening, although Type III fixation was associated with migration (p = 0.0159); subanalysis suggested that achieving host–bone contact in at least part of the dome and posterior column is important.     

Nephrotoxicity in isoxazolylpenicillin prophylaxis in hip surgery

In 789 courses of antibiotic prophylaxis in hip arthroplasty surgery, either dicloxacillin (Diclocil®) or cloxacillin (Ekvacillin®) was used during two different time periods. The surgical methods, anesthesia, preoperative and postoperative care of the patients, and laboratory procedures were the same all the time. Changes in creatinine values were used as a method for evaluating the impact on renal function. When using dicloxacillin, a pathologic increase of creatinine was noted in 12 and 13 percent by two different calculation methods. Sixteen patients (4.2 percent) had a severe creatinine increase during the first postoperative week after dicloxacillin prophylaxis, requiring dialysis in 2 patients. Cloxacillin had only a marginal impact on renal function. Patients above aged 70 years were more vulnerable as regards renal function than younger persons, and the impairment was slightly dose related in all ages. In the dicloxacillin group, preoperative use of antiphlogistic drugs was correlated with reduced postoperative renal function.     

G protein-coupled receptors in haematopoietic disruption

Haematopoiesis is the process by which blood and immune cells are replenished from a finite number of resident bone marrow (BM) haematopoietic stem cells (HSCs). Regulatory molecules within the BM microenvironment contribute developmental signals to an interactive network capable of ensuring ordered biological processes. Many bioactive molecules contribute to the network through G protein-coupled receptors (GPCRs). GPCRs are seven-transmembrane receptors that, following ligand binding, signal by activating coupled heterotrimeric G proteins. This review focuses on those bioactive molecules that regulate haematopoietic development through GPCRs. Chemokines (SDF-1α, MIP-1), opioids and tachykinins (SP, NK-A) are important G protein-coupled haematopoietic regulators. Their biology in normal and diseased haematopoiesis is discussed below, as well as their potential as therapeutic targets.     

3D bioprinting in orthopedics translational research

Abstract

The repair of critical-size bone defect remains a challenge for orthopedic surgeons. With the advent of an aging society and their accompanying chronic diseases, it is becoming more difficult to treat bone defects, especially large segmental bone defects that are caused by trauma, tumors, infections, and congenital malformations. New materials and technologies need to be developed to address these conditions. 3D bioprinting is a novel technology that bridges the biomaterial and living cells and is an important method in tissue engineering projects. 3D bioprinting has the advantages of replacing or repairing damaged tissue and organs. The progress in material science and 3D printing devices make 3D bioprinting a technology which can be used to create various scaffolds with a large range of advanced material and cell types. However, in regard to the widespread use of bioprinting, biosafety, immunogenicity and rising costs are rising to be concerned. This article reviews the developments and applications of 3D bioprinting and highlights newly applied techniques and materials and the recent achievements in the orthopedic field. This paper also briefly reviews the difference between the methods of 3D bioprinting. The challenges are also elaborated with the aim to research materials, manufacture scaffolds, promote vascularization and maintain cell viability.