A histomorphogenic analysis of bone grafts augmented with adult stem cells

PURPOSE: To evaluate the influence of bone marrow aspirate added to xenograft or alloplast graft matrix scaffold to produce bone. MATERIALS: A maximum of 4 cc bone marrow was aspirated from the anterior iliac crest of 5 patients to saturate the matrix scaffold prior to bone graft. Seven graft sites evaluated included sinus lift augmentation, particulate onlay graft of the maxilla via a tunneling procedure, and particulate onlay graft of the maxilla stabilized with titanium mesh. The xenograft scaffold was either PepGen Putty (DENTSPLY Friadent CeraMed, Lakewood, CO) or C-Graft resorbable algae material (Clinician's Preference, Golden, CO). The alloplast scaffold was beta-tricalcium phosphate (either Curasan AG, Kleinostheim, Germany, or Vitoss; Malvern, PA). RESULTS: Graft sites healed for 4-7 months. Core specimens of graft sites were taken with trephine drills, and submitted for standard histologic and histomorphogenic analysis. The percentage of graft material converted into bone, percentage of vital graft matrix, percentage of unresorbed matrix, and percentage of remaining interstitial tissue were measured. After a 4-month healing of sinus-lift augmentation with C-Graft, the biopsy showed 31% bone that was 100% vital. Unresorbed graft material was 26%, and remaining interstitial material constituted 43%. Using pure phase beta-tricalcium phosphate, a 4-month core biopsy showed 40% bone that was 100% vital. Residual graft was 3% and interstitial material 57%. A sinus grafted with PepGen P-15 (DENTSPLY Friadent CeraMed) was found to be 14% bone, with 100% of that bone vital. The non-bone within the core was 36%. After a 4 1/2-month healing of bilateral sinus grafts using a nonpure phase beta-tricalcium phosphate, the percentage of the biopsy that was bone was 23% on the right side and 16% on the left side. Vital bone was 89% (right side) and 86% (left side). The core taken after 4 months of healing from the anterior maxilla particulate onlay graft with PepGen P-15 showed 32% bone, with 100% found to be vital. Non-bone within the core was 15%, and 53% was interstitial material. After 7 months of healing, a biopsy core from the maxillary ridge augmented with C-Graft was 45% newly formed bone, with 100% of the bone vital. There was no residual graft material present. DISCUSSION: Bone regeneration by cell-based strategies depends upon an understanding of the biology and potential of adult stem cells as a method of regenerating bone. CONCLUSIONS: Bone marrow aspirate containing adult stem cells when mixed with bioengineered graft materials provide a scaffold to support the proliferation, differentiation, and maturation of the stem cells, as well as facilitating angiogenesis. This article presents histological evidence that stem cells aspirated from bone marrow and transplanted onto biocompatible scaffolds can successfully regenerate bone. This new standard for bone grafting may emerge as an alternative to autogenous bone grafts.     

The correlation of DIFOTI to clinical and radiographic images in Class II carious lesions

BACKGROUND: The authors conducted a study to evaluate the correlation between digital imaging fiber-optic transillumination (DIFOTI) (KaVo Dental, Lake Zurich, Ill.) and clinical and radiographic images in estimating the true clinical axial extension of Class II carious lesions. METHODS: The authors examined 51 Class II carious lesions visually, imaged them by means of DIFOTI and radiographed them with D-speed film and a complementary metal oxide silicon (CMOS)-based digital radiographic sensor. They validated axial extension of the lesions clinically. They compared the clinical and radiographic depths of the carious lesion with the size of the lesion on the DIFOTI images. RESULTS: The authors detected 84 percent of the lesions with DIFOTI, and 82 percent showed a visible dark shadow under the marginal ridge when examined clinically. DIFOTI correlated significantly with the clinical depth of decay (Pearson r = 0.43189). The combination of a CMOS digital sensor and DIFOTI (R2 = 0.7210) provided readings closer to the clinical measures than did the combination of D-speed film and DIFOTI (R2 = 0.6215). CONCLUSIONS: DIFOTI images correlated with clinical depth, especially in smaller lesions, and improved the estimation of lesion size when used in conjunction with the CMOS digital sensor and D-speed images. CLINICAL IMPLICATIONS: Using radiographs in combination with DIFOTI images could help clinicians determine the presence and, to some extent, the size of proximal caries, especially in smaller lesions.     

Long-term Results of Comprehensive Clubfoot Release Versus the Ponseti Method: Which Is Better?

Background

Clubfoot can be treated nonoperatively, most commonly using a Ponseti approach, or surgically, most often with a comprehensive clubfoot release. Little is known about how these approaches compare with one another at longer term, or how patients treated with these approaches differ in terms of foot function, foot biomechanics, or quality-of-life from individuals who did not have clubfoot as a child.

Questions/purposes

We compared (1) focused physical and radiographic examinations, (2) gait analysis, and (3) quality-of-life measures at long-term followup between groups of adult patients with clubfoot treated either with the Ponseti method of nonsurgical management or a comprehensive surgical release through a Cincinnati incision, and compared these two groups with a control group without clubfoot.

Methods

This was a case control study of individuals treated for clubfoot at two separate institutions with different methods of treatment between 1983 to 1987. One hospital used only the Ponseti method and the other mainly used a comprehensive clubfoot release. There were 42 adults (24 treated surgically, 18 treated with Ponseti method) with isolated clubfoot along with 48 healthy control subjects who agreed to participate in a detailed analysis of physical function, foot biomechanics, and quality-of-life metrics.

Results

Both treatment groups had diminished strength and motion compared with the control subjects on physical examination measures; however, the Ponseti group had significantly greater ankle plantar flexion ROM (p < 0.001), greater ankle plantar flexor (p = 0.031) and evertor (p = 0.012) strength, and a decreased incidence of osteoarthritis in the ankle and foot compared with the surgical group. During gait the surgical group had reduced peak ankle plantar flexion (p = 0.002), and reduced sagittal plane hindfoot (p = 0.009) and forefoot (p = 0.008) ROM during the preswing phase compared with the Ponseti group. The surgical group had the lowest overall ankle power generation during push off compared with the control subjects (p = 0.002). Outcome tools revealed elevated pain levels in the surgical group compared with the Ponseti group (p = 0.008) and lower scores for physical function and quality-of-life for both clubfoot groups compared with age-range matched control subjects (p = 0.01).

Conclusions

Although individuals in each treatment group experienced pain, weakness, and reduced ROM, they were highly functional into early adulthood. As adults the Ponseti group fared better than the surgically treated group because of advantages including increased ROM observed at the physical examination and during gait, greater strength, and less arthritis. This study supports efforts to correct clubfoot with Ponseti casting and minimizing surgery to the joints, and highlights the need to improve methods that promote ROM and strength which are important for adult function.

Level of Evidence

Level III, prognostic study.     

Narrative Therapy for Treating Video Game Addiction

Video game addiction is increasingly prevalent and treatment modalities have ignored the unique aspects of this particular process addiction. This article reviews the construct of video game addiction and posits utilizing narrative therapy in a manner tailored to the video game culture. By focusing upon the skills inherent in being a successful gamer, clients can translate those skills from online to offline and make substantial changes in their lives. Also, an appendix with commonly used terms in the video game culture is provided.     

Round Pendant Around the Neck–Thyroid. A Review

The rare situation of thyroid stone is discussed with literature review and case report. A case of isolated solitary stone of the thyroid is documented here. There are incidences of calcification in the thyroid gland commonly associated with carcinoma thyroid and multinodular goiter. But solitary stone of thyroid is reported rarely and one such case is reported from India. The possibility of malignancy is high, in case of calcification of thyroid swellings. Hence, isolated calcification should be surgically treated even if fine needle aspiration cytology is negative for malignancy.