Therefore, the hypothesis of no differences between the use of Bio-Oss or Bio-Oss mixed with autogenous bone as graft for MSFA could neither be confirmed nor rejected.

The volume of autogenous bone grafts from the iliac crest and the mandible is reduced significantly after maxillary sinus floor augmentation in minipigs. The graft volume is better preserved after the addition of Bio-Oss and the volumetric reduction is significantly influenced by the ratio of Bio-Oss and autogenous bone. However, further studies are needed addressing the amount of new bone formation and bone-to-implant contact before the final conclusion can be made about the optimal ratio of Bio-Oss and autogenous bone.

The hypothesis of no differences in bone-to-implant contact between the various treatment modalities was rejected since the bone-to-implant contact was significantly increased with autogenous bone or Bio-Oss mixed with autogenous bone as compared to Bio-Oss. Early bone-to-implant contact formation was more advanced with autogenous bone. No differences between the use of mandibular or iliac bone grafts were observed since the bone-to-implant contact was not significantly influenced by the origin of the bone graft.

Platelet rich plasma (PRP) is an autologous source of growth factors. By application of PRP around cementless implants alone or in combination with bone allograft chips, early implant fixation and gap healing could be improved. We inserted two porous HA coated titanium implants extraarticularly in each proximal humerus of eight dogs. Each implant was surrounded by a 2.5 mm gap. Four treatments were block randomized to the four gaps in each dog: Treatment 1: empty gap, treatment 2: PRP, treatment 3: fresh frozen bone allograft, treatment 4: fresh frozen bone allograft + PRP. PRP was prepared from each dog prior to operation by isolating the buffycoat from centrifuged blood samples. Platelet count in PRP was increased h70'%, compared to baseline level. Calciumlthrombin was added to degranulate platelets and form a gel. Three weeks after surgery, push-out test and histomorphometri was performed. After three weeks, the non-allografted implants had poor mechanical properties. Bone grafting significantly increased implant fixation. bone formation in the gap and bone growth on the implant surface. We found no significant effect of PRP alone or mixed with bone allograft on implant fixation or bone formation. In conclusion, we showed the importance of bone allografting on early implant fixation and bone incorporation but we found no effect of PRP. More studies are needed to investigate the effect and possible clinical applications of platelet concentrates which are now being commercialised.

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Brand-name adalimumab (Humira, hereinafter originator) is by far the most cost-intensive pharmaceutical product in the US with global sales of $19.9 billion in 2018. 1 Five adalimumab biosimilars have been approved by the US Food and DrugAdministration, but none are marketed owing to patent disputes. The first to become marketed is expected in January 2023. 2 A 2019 Viewpoint argues that cost savings in the US due to adalimumab biosimilars might vanish as patients might switch to newer and better drugs before the biosimilars become available. 3 The lack of adalimumab biosimilars results in substantial premiums being paid by patients and payers when much cheaper biosimilar drugs are available outside the US.Denmark, a member of the European Union with 5.8 million inhabitants, has benefited from substantial discounts owing to a well-planned implementation of adalimumab biosimilars. In Denmark, adalimumab is provided to patients in public outpatient clinics and bought through national tenders. There is no automated substitution to biosimilars, but the treatment recommendations from the Danish Medicines Council was changed to adalimumab biosimilars for all indications following the patent expiration of the adalimumab originator. This included switching patients to a biosimilar who were already well treated with the originator (nonmedical shift). We present the nationwide shift to adalimumab biosimilars across all indications in Denmark and calculate the actual associated cost reductions.

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