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At least 163 records · Page 9Linked to original sources

PubMed2005

Mandibular distraction osteogenesis in hemifacial microsomia: long-term follow-up.

AIM: Prospective, longitudinal, clinical long-term follow-up study of a homogeneous sample of children affected by hemifacial microsomia and treated by mandibular distraction osteogenesis. MATERIAL: Eight patients affected by types I and II hemifacial microsomia were operated on at an average age of 5.6 years with an average follow-up of 5.8 years. METHODS: Vertical changes were measured on postero-anterior cephalometric and panoramic radiographs taken sequentially. RESULTS: Angular changes of the infraorbital and nasal floor planes were not significant, showing that distraction osteogenesis starting after 5 years of age did not influence the maxillary skeletal base. Occlusal (plane) cant was reduced by 7 degrees on average following distraction osteogenesis, showing good dentoalveolar plasticity. Mandibular vertical changes showed a gradual return of the asymmetry, with growth in all patients (the ratio between affected and non-affected rami returned by 77% of the correction obtained by means of distraction 5 years postoperatively). CONCLUSION: Although aesthetic and psychological advantages of distraction osteogenesis are well accepted it should only be applied after careful patient selection and honest explanation of the long-term recurrence by genetically determined craniofacial growth patterns.

Cephalometry↗

PubMed2005

Tensile mechanical strain up-regulates Runx2 and osteogenic factor expression in human periosteal cells: implications for distraction osteogenesis.

PURPOSE: Distraction osteogenesis is now accepted as a standard treatment in oral and maxillofacial reconstructive surgery. In the process of bone regeneration with the application of strain, the periosteum might be very involved in osteogenesis. This study examined the effect of mechanical strain on periosteal cells and the implications for distraction osteogenesis. MATERIALS AND METHODS: Periosteal cells were obtained from mandibular periosteum that was excised while extracting impacted wisdom teeth. Mechanical strain was applied using a specially designed apparatus with flexible silicon bottom chambers. The levels of mRNA of the osteoblast differentiation factor Runx2 (Cbfa1/AML3/Peb alpha A) and osteogenic factors were analyzed at different times using the reverse transcription-polymerase chain reaction method to evaluate the effect of the strain. RESULTS: The periosteal cells expressed the osteogenic phenotype. The strain had a shaping effect on the cells. The application of tensile strain strongly activated the expression of osteogenic and angiogenic growth factors, and up-regulated the expression of Runx2, an osteoblast-specific transcription factor. CONCLUSION: Tensile strain may initiate the differentiation of periosteal cells into osteogenic cells, inducing the expression of Runx2 in the process of bone regeneration. Therefore, the periosteum is profoundly involved in bone formation and regeneration, especially in distraction osteogenesis.

Bone Regeneration↗

PubMed2006

The early psychological adjustment of cleft patients after maxillary distraction osteogenesis and conventional orthognathic surgery: a preliminary study.

PURPOSE: To compare the early psychological changes of cleft lip and palate (CLP) and noncleft patients after maxillofacial corrective surgery, including maxillary distraction osteogenesis and conventional orthognathic surgery. MATERIALS AND METHODS: Nine CLP patients were compared with a group of 9 non-CLP patients having similar dentofacial deformities in a prospective longitudinal cohort study. Five of the CLP patients underwent maxillary distraction osteogenesis and 4 underwent conventional orthognathic surgery. A control group of 9 noncleft patients received conventional orthognathic surgery. All patients completed a set of questionnaires to enable their psychological profile to be assessed. The data were collected immediately before surgery (T1), and at 3 weeks (T2) and 12 weeks (T3) after surgery. RESULTS: The CLP patients treated with distraction osteogenesis were happier, but had a higher level of social anxiety and distress than the CLP patients receiving conventional orthognathic surgery. On the other hand, the CLP patients overall were happier, with lower social anxiety and distress, than the noncleft control group. The CLP patients showed a higher level of parental self-esteem than the noncleft patients. CONCLUSION: This preliminary study shows that CLP patients were generally happier, and had a higher level of parental support, than normal patients suffering from dentofacial deformities. Maxillary distraction osteogenesis seemed to induce a higher level of anxiety and distress in CLP patients than conventional orthognathic surgery in both cleft and noncleft patients.

Adaptation, Psychological↗

PubMed2005

Peri-implant osteogenesis in health and osteoporosis.

Long-term clinical success of endosseous dental implants is critically related to a wide bone-to-implant direct contact. This condition is called osseointegration and is achieved ensuring a mechanical primary stability to the implant immediately after implantation. Both primary stability and osseointegration are favoured by micro-rough implant surfaces which are obtained by different techniques from titanium implants or coating the titanium with different materials. Host bone drilled cavity is comparable to a common bone wound. In the early bone response to the implant, the first tissue which comes into contact with the implant surface is the blood clot, with particular attention to platelets and fibrin. Peri-implant tissue healing starts with an inflammatory response as the implant is inserted in the bone cavity, but an early afibrillar calcified layer comparable to the lamina limitans or incremental lines in bone is just observable at the implant surface both in vitro than in vivo conditions. Just within the first day from implantation, mesenchymal cells, pre-osteoblasts and osteoblasts adhere to the implant surface covered by the afibrillar calcified layer to produce collagen fibrils of osteoid tissue. Within few days from implantation a woven bone and then a reparative trabecular bone with bone trabeculae delimiting large marrow spaces rich in blood vessels and mesenchymal cells are present at the gap between the implant and the host bone. The peri-implant osteogenesis can proceed from the host bone to the implant surface (distant osteogenesis) and from the implant surface to the host bone (contact osteogenesis) in the so called de novo bone formation. This early bone response to the implant gradually develops into a biological fixation of the device and consists in an early deposition of a newly formed reparative bone just in direct contact with the implant surface. Nowadays, senile and post-menopausal osteoporosis are extremely diffuse in the population and have important consequences on the clinical success of endosseous dental implants. In particular the systemic methabolic and site morphological conditions are not favorable to primary stability, biological fixation and final osseointegration. An early good biological fixation may allow the shortening of time before loading the implant, favouring the clinical procedure of early or immediate implant loading. Trabecular bone in implant biological fixation is gradually substituted by a mature lamellar bone which characterizes the implant ossoeintegration. As a final consideration, the mature lamellar bone observed in osseointegrated implants is not always the same as a biological turnover occurs in the peri-implant bone up to 1mm from the implant surface, with both osteogenesis and bone reabsorption processes.

Animals↗

PubMed2004

Skeletal effects and functional outcome with olpadronate in children with osteogenesis imperfecta: a 2-year randomised placebo-controlled study.

BACKGROUND: Non-randomised studies have suggested beneficial effects of bisphosphonates in osteogenesis imperfecta. We assessed the effects of oral olpadronate in children with this disorder in a randomised double-blind placebo-controlled trial. METHODS: 34 children recruited from the Dutch national centre for osteogenesis imperfecta were randomly assigned olpadronate (10 mg/m2 daily; n=16) or placebo (n=18) for 2 years. All children also received calcium and vitamin D supplements. Primary endpoints were incident fractures of long bones and changes in bone mineral content (BMC), bone mineral density (BMD), and functional outcome. Anthropometry, vertebral height, and urinary markers of bone resorption were also studied. Analyses were by intention to treat. FINDINGS: Fracture follow-up was complete for all the children, including two who withdrew from the study (one from each group). Olpadronate treatment was associated with a 31% reduction in relative risk of fracture of long bones (hazard ratio 0.69 [95% CI 0.52-0.91], p=0.01). The olpadronate group showed significantly greater increases than the placebo group in spinal BMC (difference between groups 2.24 g/year [0.20-4.29], p=0.03) and spinal BMD (difference between groups 0.054 g/cm2 per year [0.012-0.096], p=0.01). There were no detectable effects on functional outcome, anthropometrics, or vertebral height and no differences between the groups in changes in urinary markers of bone resorption. INTERPRETATION: Oral treatment with olpadronate at a daily dose of 10 mg/m2 results in a reduction of fracture risk of long bones in children with osteogenesis imperfecta. However, the issue of whether bisphosphonates will alter the natural course of osteogenesis imperfecta remains unresolved, and further studies are needed.

Activities of Daily Living↗

PubMed1999

Osteogenesis with coral is increased by BMP and BMC in a rat cranioplasty.

Autologous bone marrow cells (BMC), bone morphogenetic protein (BMP) and natural coral exoskeleton (CC) were used to enhance the repair of large skull bone defects in a craniotomy model. Nine millimeter calvarial defects were created in adult rats and were either left empty (control defects) or implanted with CC alone, CC-BMC, CC-BMP, or CC-BMC-BMP. After 1 or 2 months, osteogenesis was insufficient to allow union when defects were left empty or filled with CC. Addition of BMC alone to CC had no positive influence on osteogenesis at any time and increased CC resorption at 2 months (0.1 +/- 0.1 mm2 versus 0.5 +/- 0.3 mm2). In contrast addition of BM P or BM P/BMC to CC led to a significant increase in osteogenesis and allowed bone union after 1 month. At 2 months, the combination of CC-BM P-BMC was the most potent activator of osteogenesis. Filling a defect with CC-BMP-BMC resulted in significantly increased bone surface area (11 +/- 2.7 mm2) in comparison to filling a defect with CC-BMP (7.0 +/- 1.4 mm2), CC-BMC (3.5 +/- 1.1 mm2) or CC (4.5 +/- 0.4 mm2). CC resorption was significantly decreased in the presence of BMP with or without BMC at both times. These data are in accordance with the presence of progenitor cells in bone marrow that are inducible by BMP to the osteogenic pathway in a cranial site. The increase in material resorption in defects filled with CC-BMC could suggest that cells from the granulocyte-macrophage lineage survived the grafting procedure and were still active after 2 months.

Analysis of Variance↗

PubMed2003

Bone augmentation osteogenesis using hydroxyapatite and beta-tricalcium phosphate blocks.

PURPOSE: In this study, we investigated the differences in osteogenesis and resorption between hydroxyapatite (HA) and beta-tricalcium phosphate (beta-TCP) implanted on the parietal bone of rats. MATERIALS AND METHODS: HA and beta-TCP were used in blocks with macropores and micropores. They were implanted between the parietal bone and the cranial periosteum in rats. Osteogenesis around the implanted materials was investigated histopathologically and histomorphometrically at 1, 2, 4, 8, and 24 weeks after surgery. RESULTS: At 2 weeks, osteogenesis from the parietal bone was observed around both materials, and new bone had attached directly to the surfaces of both materials. New bone grew into the pores of the upper regions of both materials with time. The beta-TCP block had a characteristic basophilic reticular structure in which the dissolution of the materials was observed close to the new bone. The HA blocks were stable for 24 weeks, whereas parts of the beta-TCP blocks were fractured and resorbed at 24 weeks. Histomorphometrically, the volume of new bone around HA was larger than that around beta-TCP. There was no remarkable change in the amount of remaining HA, but that of beta-TCP was decreased. CONCLUSION: HA blocks in this model are suitable for onlay grafts because of its stability and osteogenesis, beta-TCP is not stable. Therefore, when beta-TCP blocks are used for onlay grafts, the mechanical stress on the recipient site should be taken into consideration because of resorption and fracture.

Absorbable Implants↗

PubMed1987

Successful aortocoronary bypass in osteogenesis imperfecta.

Cardiovascular abnormalities are infrequently documented in osteogenesis imperfecta, one of a group of hereditary, generalized connective tissue disorders. A patient with osteogenesis imperfecta is described with mitral valve prolapse, significant coronary artery disease and a coronary artery aneurysm. The latter two cardiac defects are apparently rare in this disease. The option of surgery was carefully considered with regard to technical feasibility and potential deterioration of the graft anastomoses. Although successful aortocoronary bypass surgery had not been previously reported in osteogenesis imperfecta, this patient received such surgery with therapeutic benefit. Therefore, coronary artery vascularization should be considered as a safe and effective treatment modality for patients with osteogenesis imperfecta and coexisting coronary atherosclerosis.

Adult↗

PubMed2002

Aspects of the history of osteogenesis imperfecta (Vrolik's syndrome).

Osteogenesis imperfecta (OI) or Vrolik's syndrome is a heterogeneous group of inherited conditions arising from a variety of biochemical and morphological collagen defects. It was Willem Vrolik, Professor of Anatomy, Pathological Anatomy and Zoology at the Athenaeum Illustre (University of Amsterdam), who described in his Handbook of Pathological Anatomy (1842-1844) and Tabulae ad illustrandam embryogenesin hominis et mammalium, naturalem tam abnormem (1844-1849) a newborn infant with numerous fractures and hydrocephalus. In the Tabulae, having both Latin and Dutch texts, in the Latin text Vrolik used in the heading of Plate 91 the term Osteogenesis imperfecta (in Dutch: gebrekkige beenwording). Vrolik also mentioned that the infant lived three days and that both the parents were suffering from lues universalis at the time of birth. On our reexamination, the whole skeleton appeared poorly mineralised. The fairly large skull exhibited a broad and high forehead, large fontanels, frontal and temporal bossing, shallow orbits, and a protruding occiput. The calvaria consisted of many Wormian bones. The tubular bones, although of normal length and only slightly curved, were very thin, as were the ribs. All the skeletal structures showed one or more fractures and many fractures showed callus formation. In 1998 we re-diagnosed the condition of the specimen as osteogenesis imperfecta type II. Willem Vrolik was one of the first to realize that many skeletal dysplasias were not the result of a postnatal acquired disease, such as "rickets" or "osteomalacia" as many of his contemporaries believed. He thought that it might be due to insufficient intrinsic "generative energy." He substantiated this by stating that in this specimen a primary impairment of ossification is present and not a secondary degeneration. The descriptions given by Willem Vrolik in some of the specimens generated the term Osteogenesis imperfecta and the eponym Vrolik's syndrome for this genetic disorder characterized by increased fragility.

Bone and Bones↗

PubMed1985

Histopathology of the stapes in osteogenesis imperfecta.

Conventional histological studies of stapes footplates from patients with osteogenesis imperfecta revealed, in nine out of 15 stapes examined, an otospongiotic-like lesion. Although the morphology of the stapedial lesion was comparable to the early otosclerotic focus, a greater structural disorganization and larger resorption spaces in osteogenesis imperfecta distinguished the two conditions. The histopathology of the stapes was related to the morphology of cortical and trabecular bone from the iliac crest. Various degrees of immature, osteogenic bony tissue were found in the iliac crest, showing no resemblance to the otospongiotic-like focus in the footplate. Even though the histologic appearance of the stapes footplates differed from the findings in peripheral bone, the present study indicates that the stapedial lesion in osteogenesis imperfecta is most likely a manifestation of the generalized bone and connective tissue disorder. The study further supports the view that osteogenesis imperfecta and otosclerosis are of different aetiology.

Adolescent↗

PubMed2005

[Distraction osteogenesis in orthodontic surgery of the mandible].

Distraction osteogenesis is a bone creating procedure that can contribute materially to the treatment of Class II dento-skeletal disorders where the mandible is under-sized. Still, the serious commitments this treatment demands and the unpredictability of its occlusal results oblige practitioners to pinpoint precisely the indications for its use. We now believe that distraction osteogenesis can beneficially be employed for: 1--Adults with Class II malocclusions, a small mandible, and a lack of harmony between tooth and jaw size. This bone growing technique makes it possible to treat these patients without the extraction of premolars that would have been necessary in the traditional preparation for orthognathic surgery. 2--Patients whose mandibles are diminished in size in the area of the symphasis. Distraction osteogenesis of this anterior segment is the only way they can be treated without reduction of tooth structure or excessive labial tipping of teeth. 3--Some patients with short, or moderately short rami. We do not, at this time, believe that distraction osteogenesis is indicated for the treatment of any other kind of dento-facial deformity. But, in the future, improvement of surgical techniques and the miniaturization of appliances will doubtless extend its scope.

Adolescent↗

PubMed2003

Theoretical considerations for the surgical correction of mandibular deformity in hemifacial microsomia patients using multifocal distraction osteogenesis.

PURPOSE: This theoretical pilot study investigated the geometric changes necessary to normalize the mandibular shape in hemifacial microsomia. Using the mandibular deformity of a 13-year-old patient affected by hemifacial microsomia as an example, we addressed 2 main issues. First, the number of segments needed for adequate reshaping of the deformed mandible is evaluated. Second, the geometry of the intersegmental gaps resulting from reposition of the segments is correlated with established parameters of distraction osteogenesis to theoretically predict the practicability of correction using multifocal distraction osteogenesis. MATERIALS AND METHODS: Virtual surgery was performed on a solid mandible model created from computed tomography (CT) data from a patient with hemifacial microsomia type IIB. In the first step, ideal mandibular reshaping was achieved according to anthropometric standard measurements using 7 osteotomies. By scanning and superimposition of the virtual models and variation of distraction sites and numbers, we assessed the minimal number of osteotomies necessary for optimal correction of the deformity. Geometrical evaluation of the regeneration and assessment of the possibilities of continuous curved distraction were also performed. RESULTS: Three osteotomies were shown to be sufficient for complete mandibular reshaping. Using accepted parameters for distraction osteogenesis, the geometry of the regenerate allows for continuous curved distraction. However, simultaneous movements at several distraction sites result in interfering vector forces, making coordination of multifocal distraction difficult. CONCLUSION: Theoretical assessment of a severe mandibular hypoplasia in hemifacial microsomia revealed the 3-dimensional (3D) complexity of the deformity for corrective procedures, especially distraction osteogenesis. Despite precise planning and transfer of the plan to the patient, multifocal 3D distraction may result in deviations from the planned result. Manipulation of the fresh regeneration may be necessary to correct inaccuracies.

Adolescent↗

PubMedDate not supplied

Hypercalciuria in osteogenesis imperfecta type I.

BACKGROUND: In Osteogenesis Imperfecta severity of disease and reduced physical activity have been considered the main factors contributing to hypercalciuria; however, its pathogenesis in Osteogenesis Imperfecta Type I, in which mobility is normal, is still unclear. PATIENT, METHODS AND RESULTS: We describe a patient with Osteogenesis Imperfecta Type I and hypercalciuria, in whom measurement of calcium intake, plasma 1 - 25(OH) (2) Vitamin D, fasting calciuria and tubular proteinuria led us to exclude an absorptive or renal component in the pathogenesis of hypercalciuria. CONCLUSIONS: We believe that hypercalciuria is determined by bone disease in Osteogenesis Imperfecta Type I. This condition should be added to the causes of normocalcemic hypercalciuria in children and the mildest forms should be differentiated from Idiopathic Hypercalciuria.

Age Factors↗

PubMedDate not supplied

[Scoliosis in patients with osteogenesis imperfecta: a federal nation-wide cross-sectional study].

OBJECTIVE: Quite different prevalence of scoliosis in patients with Osteogenesis imperfecta is reported, not at least owing to the difficult recruitment of patients. The present study aims to investigate Osteogenesis imperfecta-patients with scoliosis by means of a cross-section study. PATIENTS AND METHODS: A total of 102 patients (46 males, 56 females) with an average age of 24.6 years (3-71 yrs.) were investigated in 1995 supported by the "Gesellschaft für Osteogenesis imperfecta Betroffene e.V.". Physical examination included pain and range of motion. Localisation and expanse of the curvature as well as attendant deformities of the spine were assessed by radiograph. RESULTS: Scoliosis was observed in 76 patients (74.5%). Most of them showed thoracal or thoracolumbar localisation with 36 cases of right and 40 cases of left convexity. The curvature was mainly mild (56 pat. < 40 degrees), while 8 patients showed moderate (< 60 degrees), 7 patients severe (< 80 degrees) and 5 patients very severe deformity (> 80 degrees). Average expansion amounted to 6.7 vertebrae (3-12) with an average rotation of 2 (1-4). Attendant deformities were distributed as follows: codfish (59 pat.) or wedge-shaped vertebrae (42 pat.), platyspondylia (16 pat.), thoracal cyphosis (5 pat.), flat back (1 pat.) or lordosis (2 pat.) and lumbar lordosis (10 pat.) or vertical position (14 pat.). 69 scoliosis patients complained about pain with an average VAS-value of 4.3. They also showed moderate to severe impairment of the range of motion. CONCLUSIONS: Our cross-section study with 102 Osteogenesis imperfecta-patients showed scoliotic deformity in 74.5% of cases. 69 patients suffered from remarkable pain and impaired range of motion, which was not only attributable to scoliosis alone, but also to concomitant spinal deformities.

Adolescent↗

PubMed1977

Altered relation of two collagen types in osteogenesis imperfecta.

To ascertain if the features of osteogenesis imperfecta could be due to an abnormality in two genetically distinct collagens, Type III and Type I, we measured, in pepsin digests of skin, the ratio of the alpha 1, (III) to alpha 1 (I) chains derived from the two types, using a method of interrupted polyacrylamide-gel electrophoresis. In 40 control subjects this ratio decreased from about 0.45 in early fetal life to a mean (+/-2 S.D.) of 0.14 +/- 0.06 in 14 adults. Seven of nine adult patients with mild osteogenesis imperfecta had ratios of more than 4 S.D., above this mean, as did two of five patients with severe osteogenesis imperfecta. The increased ratio was probably due to a reduction of Type I collagen. If this reduction were generalized it could contribute to the bony fragility of osteogenesis imperfecta, since mineralized bone contains Type I collagen only.

Adult↗

PubMed1984

Osteogenesis imperfecta after the menopause.

We studied the fracture rate as a function of age in 45 women and 20 men with osteogenesis imperfecta. In each variant of the disorder, the fracture rate in women peaked in childhood, declined in adolescence, and rose again after the menopause. In contrast, the fracture rate in men remained low after adolescence. After the menopause women were vulnerable to crush fractures of the spine as well as fractures of the long bones. We conclude that the increased fracture rate after the menopause in women with osteogenesis imperfecta reflects the superimposition of the effects of age-related bone loss on those of the defective collagen structure of osteogenesis imperfecta, and that hormone-replacement therapy may be specifically indicated in this group of patients from the time of the menopause. We also suggest that osteogenesis imperfecta should be included in the differential diagnosis of women presenting with crush fractures of the spine.

Age Factors↗

PubMed2002

Osteogenesis imperfecta in a weightlifter.

OBJECTIVE: To discuss the case of a 42-yr-old weightlifter with osteogenesis imperfecta. CLINICAL FEATURES: The patient had bilateral acute elbow pain and a previous history of more than 35 fractures of the spine and extremities. INTERVENTION: There is no current treatment for osteogenesis imperfecta. Treatment objectives were designed to minimize pain, improve range of motion, and decrease stress on the elbow joints. Nutritional supplementation was used to help maintain bone density. The elbow pain improved with treatment, and the patient has had no new fractures in the last 6 years. CONCLUSION: Although most patients with osteogenesis imperfecta are physically inactive because of the high risk of fracture, some patients with milder forms of the condition may be involved in some athletic activities. Although manipulation is contraindicated in patients with osteogenesis imperfecta, chiropractors may be of service by offering pain relief and rehabilitation, in addition to advice regarding nutrition and supplements.

Adult↗

PubMed2000

Long-term skeletal and dental effects of mandibular symphyseal distraction osteogenesis.

The purpose of this study was to evaluate the effects of mandibular symphyseal distraction osteogenesis using a tooth-borne expansion device. The sample included 20 Hispanic nonsyndromic patients (11 males and 9 females) between 13.5 years and 37.3 years of age. Predistraction (1.5 months before surgery), postdistraction (1 month after surgery), and long-term follow-up (1.3 year after surgery) records included posteroanterior, lateral, and panoramic radiographs and models. Postdistraction radiographic evaluation showed that symphyseal distraction osteogenesis produced insignificant increases in the bicondylar, bigonion, and biantegonion widths; intermolar and, especially, intercanine widths increased significantly and a distraction gap was observed in the symphyseal region. Follow-up model analysis showed the largest width increases between the first molars and second premolars and the smallest width increases between canines and first premolars. The difference between the postdistraction and long-term follow-up width changes was explained by the postdistraction orthodontic effect, which modified the shape of the dental arch. A disproportionate pattern of distraction, characterized by significantly greater dental than skeletal widening, was observed in the second molar and antegonion region. Distraction osteogenesis without presurgical orthodontic treatment produced significant proclination of the mandibular incisors; no proclination was observed in cases with predistraction orthodontic treatment. Dental crowding was resolved by the movement of teeth into the distraction regenerate and concomitant orthodontic treatment. Follow-up radiographs showed transverse skeletal stability of the distraction procedure. We conclude that mandibular symphyseal distraction osteogenesis increased mandibular arch width and partially corrected dental crowding, with a potential for disproportionate distraction patterns and proclination of the mandibular incisors.

Adolescent↗