The utilization of a demineralized bone matrix putty appeared to allow for complete closure of critical sized calvarial defects in New Zealand white rabbits with viable new bone at 12 weeks.
A bone morphogenetic protein bioimplant was used for primary reconstruction of a 6-cm mandibular discontinuity defect, after a segmental resection of an ameloblastoma. Radiographic evidence of new bone induction was seen at 3 and 9 months, postoperatively. A biopsy was taken at 9 months demonstrated viable new bone formation at the bioimplant site. This is the first reported case using a bone morphogenetic protein bioimplant in a human, followed by histological confirmation of new bone.
This article describes a technique to predictably reconstruct both horizontal and vertical bony defects with one graft, the autogenous J-graft. Bone harvested from the ramus is contoured in three dimensions resulting in both a horizontal and a vertical component. When there is inadequate soft tissue due to the increase in bone volume at time of augmentation, the bone graft is combined with a pedicle palatal connective tissue graft. This provides both a source of blood supply and soft tissue to the grafted site. There are several advantages to the J-graft technique; a single procedure can reconstruct complex three-dimensional defects and improve blood supply to the graft due to the larger buccal (horizontal) component in contact with the host bone which then supports the smaller occlusal (vertical) component. Finally, bone is added to interproximal sites as it curves from the buccal to the palatal against adjacent teeth. This supports the papilla at the future implant site. The autogenous J-graft is the ideal technique for augmentation in the esthetic zone with significant resorption that includes interproximal sites.
Proof of concept results are presented towards an in situ bimodal proximity sensor for neurovascular bundle detection during dental implant surgery using combined near infrared absorption (NIR) and optical coherence tomography (OCT) techniques. These modalities are shown to have different sensitivity to the proximity of optical contrast from neurovascular bundles. NIR AC and DC signals from the pulsing of an artery enable qualitative ranging of the bundle in the millimeter range, with best sensitivity around 0.5-3mm distance in a custom phantom setup. OCT provides structural mapping of the neurovascular bundle at sub-millimeter distances in an ex vivo human jaw bone. Combining the two techniques suggests a novel ranging system for the surgeon that could be implemented in a "smart drill." The proximity to the neurovascular bundle can be tracked in real time in the range of a few millimeters with NIR signals, after which higher resolution imaging OCT to provide finer ranging in the sub-millimeter distances.
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