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Additive manufacturing in the craniofacial area
Published in Ali Khademhosseini, Gulden Camci-Unal, 3D Bioprinting in Regenerative Engineering, 2018
Cedryck Vaquette, Kelly McGowan, Saso Ivanovski
Distraction osteogenesis (DO) involves surgical separation of a bone segment from basal bone, with both segments then fixed to an intraoral distractor [36,37] as depicted in Figure 12.1c. In the afore-mentioned review by Rochietta et al. [25], DO was found to involve a 10%–75.7% complication rate, with some severe complications reported including loss of the entire separated segment. Although a 5–15 mm increase in vertical bone height was reported, additional grafting was required to correct undesirable palatal or lingual inclination in 41/91 patients. The survival rates of implants placed in sites augmented using DO were 90%–100%, with success rates ranging from 59% to 94%.
Effect of Scaffolds with Bone Growth Factors on New Bone Formation
Published in Gilson Khang, Handbook of Intelligent Scaffolds for Tissue Engineering and Regenerative Medicine, 2017
Hae-Ryong Song, Swee-Hin Teoh, Hak-Jun Kim, Ji-Hoon Bae, Sung Eun Kim, Young-Pil Yun, Muhammad Qasim, Jerry Chan, Zhi-Yong Zhang, Chang-Wug Oh, Jun-Ho Wang
New bone tissue engineering (BTE) methods are necessary to treat bone defects in orthopedic, plastic, and neurosurgical fields. A bone defect or bone shortening occurs after excision of bone tumor, open fracture, osteomyelitis, and pseudoarthrosis-associated congenital diseases such as neurofibromatosis and hemimelia. There have been many methods to treat bone defects. These include autogenous bone grafting, allografting, vascularized fibular grafts, and distraction osteogenesis using the Ilizarov method. There are limitations of these methods. Autogenous bone grafting has a limitation of donor site morbidity. Allografting has problems, including follow-up resorption, infection transmission, or high incidence of refracture due to insufficient bone conduction and induction. Vascularizing fibular grafting has good vascularity, which can help control infection and promote new bone formation. However, it requires long surgical time and extensive experience to achieve good clinical results. Pioneered by Ilizarov, distraction osteogenesis is a remarkably effective technique for creating new bone to treat large bone defects resulting from trauma, tumor resection, or limb length discrepancies.1,2,3–4 Distraction osteogenesis using the Ilizarov method can induce the periosteal new bone formation, and external fixator is utilized to apply 1 mm distraction per day. This technique is useful and can induce new bone formation without any bone grafting. However, one disadvantage of distraction osteogenesis is prolonged external fixation, such as large bone gaps or delay in bone formation in certain cases;5,6–7 for instance, the formation of 1 cm new bone requires at least 1 month. Recently, osteogenic scaffolds using absorbable or nonabsorbable biomaterials have being investigated to repair bone defects. Scaffolds can provide the osteoconduction effect as well as a media to trap cells and allow them to proliferate and differentiate. However, to achieve the osteoinduction effect, the incorporation of growth factors or stem cells is needed. Nonabsorbable materials such as hydroxyapatite (HAp) or ceramic have been used with advantages of a rigid frame, which provides stability; however, these materials are radio-opaque. Therefore, it is difficult to differentiate the new bone formation from the ceramic scaffolds. In addition, the bioceramic is brittle and not suited for bone applications. A better approach is to use a composite of bioceramic and a resorbable polymer.
Mechanical properties of the human periosteum in the mandibular ostegenesis context
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
J. Dallard, A. Debelmas, S. Asiri, N. Kogane, A. Picard, N. Kadlub, J. Boisson
Distraction Osteogenesis (DO) is a surgical procedure consisting in the progressive lengthening of a bone segment (1 mm/day). The technique requires the implantation of a distractor device, which daily activation is responsible for the lengthening of the bone. Distraction is widespread in the craniofacial area for the treatment of congenital malformations or acquired large bone defects (Adolhs et al. 2014). DO activation requires a transmucosal or transcutaneous rod which may be responsible for multiple adverse events and incomfort. To overcome these issues, we demonstrated recently the feasibility of distant activation with a magnetically activated device for mandibular distraction (Boisson et al. 2016). However, to develop new distraction device, one must fully understand the role of the surrounding soft tissues, especially the periosteum, and their participation in the mechanical load opposing the distraction vector.
Use of the PRECICE nail for distraction osteogenesis after tumor resection
Published in Expert Review of Medical Devices, 2022
Nelson Merchan, Raed I. Narvel, I. Leah Gitajn, Eric R. Henderson
Distraction osteogenesis involves applying controlled traction forces over a healing bone defect. The mechanical forces are transmitted distally from the site of the osteotomy toward the docking or distal segment. This technique takes advantage of the regenerative capacity of immature bone by elongating the healing area of bone formation. In patients undergoing intercalary resection with a long-life expectancy, segmental transport is especially attractive as it allows generation of living bone that obviates the need for implanted materials [2,3]. Despite the benefits of a successful transport, traditional distraction osteogenesis using fine-wire external fixation via the Ilizarov method has several drawbacks including pin tract infections, union problems at the docking site, malalignment in large bone defects, need for patient cooperation, and the bulky nature of the frames [2,4,5]. Internal lengthening nails have been proposed as an alternative method of distraction osteogenesis with the potential to address many of the problems of external fixators, allowing for bone transport through an internal device (within the medullary canal), with the option for plate augmentation to maintain limb length and increase stability of the construct [2,4,5]. Shared issues between lengthening nails and the Ilizarov method include issues with union at the docking site and the need for compliance with distraction regimen. Despite the availability of all internal options for bone reconstruction, many musculoskeletal oncologists may not be aware of the reconstruction options that lengthening nails offer as use for intercalary resection is not widespread [6–8]. The PRECICE nail represents an option for internal bone transport in the case of long bone defects following tumor resection. The purpose of this review is to report on the design, indications, advantages, and disadvantages of the PRECICE nail for intercalary reconstruction after tumor resection.