Jihua Li

The effect of strontium-substituted hydroxyapatite coating on implant fixation in ovariectomized rats

This study was designed to investigate the effects of strontium-substituted hydroxyapatite coatings with 10 mol% Ca(2+) replaced by Sr(2+) (10% SrHA) on implant fixation in ovariectomized (OVX) rats. Coatings of HA and 10% SrHA were prepared on the surface of titanium implant using sol-gel dip methods, and then characterized by Scanning Electron Microscope, Atomic Force Microscope, X-ray diffraction, X-ray Photoemission Spectroscopy, and an automatic scratch tester. Twelve weeks after bilateral ovariectomy, twenty OVX rats accepted implant insertion in the proximal tibiae, half with HA-coated implants and the other half with 10% SrHA coated implants. After 12-week healing period, 10% SrHA coated implants revealed improved osseointegration compared to HA, with the bone area ratio and bone-to-implant contact increased by 70.9% and 49.9% in histomorphometry, the bone volume ratio and percent osseointegration by 73.7% and 45.2% in micro-CT evaluation, and the maximal push-out force and ultimate shear strength by 107.2% and 132.9% in push out test. These results demonstrated that 10% SrHA coatings could enhance implant osseointegration in OVX rats, and suggested the feasibility of using SrHA coatings to improve implant fixation in osteoporotic bone.

Effect of combined local treatment with zoledronic acid and basic fibroblast growth factor on implant fixation in ovariectomized rats

Osteoporosis is a skeletal disorder characterized by low bone mass and deterioration of bone microarchitecture resulting in bone fragility, which impairs fixation of the implants. Zoledronic acid (ZOL) is a potential inhibitor of osteoclast-mediated bone resorption and basic fibroblast growth factor (bFGF) is a growth factor that stimulates osteoblast-mediated bone formation, and these drugs could enhance fixation of implants under osteoporotic conditions. In this study, 40 ovariectomized (OVX) rats were randomly divided into 4 groups (n=10 for each group) and underwent bilateral tibiae implantation using hydroxyapatite (HA)-coated titanium implant: Control group (distilled water immersing before implantation), ZOL group (1 mg/ml of ZOL immersing), bFGF group (20 microg/ml of bFGF immersing), and ZOL+bFGF group (1 mg/ml of ZOL and 20 microg/ml of bFGF immersing). At 3 months after implantation, all animal were sacrificed and the tibiae were harvested for histology, micro-CT examinations and biomechanical testing. Bone area and contact, determined by histomorphometric analysis, were 2.7-fold and 1.8-fold in the ZOL-treated implants, 1.9-fold and 1.8-fold in the bFGF-treated implants, 3.6-fold and 2.3-fold in the both-treated implants compared with controls (p<0.01). Such significant effects were further confirmed by microstructure parameters, the bone volume ratio and the percentage osteointegration were significantly increased by ZOL treatment (3.0-fold and 1.8-fold), bFGF treatment (1.2-fold and 1.9-fold) and ZOL+bFGF treatment (3.3-fold and 2.7-fold) (p<0.001). In addition, push-out test showed that the maximum force and the corresponding interfacial shear strength of the implants treated by ZOL, bFGF and ZOL+bFGF was 8.4-fold and 8.6-fold, 3.8-fold and 3.7-fold, 10.8-fold and 10.7-fold of the control levels, respectively (p<0.05). The combined treatment was better than either treatment alone for force, but was not different from ZOL alone for interfacial strength. The significant correlation between biomechanical and micro-CT parameters demonstrates the role of microstructure assessments in predicting mechanical fixation of implants (p<0.01). Our study suggests that locally applied ZOL or bFGF may improve implant fixation in the ovariectomized rats, and that combined treatment has more beneficial effects on osseointegration, peri-implant bone formation and maximum force than either intervention alone.

Angiogenesis and osteogenesis enhanced by bFGF ex vivo gene therapy for bone tissue engineering in reconstruction of calvarial defects.

Reconstruction of bone defects by tissue engineered substitutes requires coordinated coupling between osteogenesis and angiogenesis. Basic fibroblast growth factor (bFGF or FGF-2) is a protein which acts actively in osteogenesis and angiogenesis during skeletal healing and development. It is hypothesized that BMSCs transfected with bFGF can directly stimulate regeneration of vascular tissue, and subsequently enhance osseous formation and remodeling after implantation of the tissue engineered bone. This study was designed to examine the impact of bFGF-BMSCs, seeded on nano-hydroxyapatite/polyamide66 (n-HA/PA66) composite scaffold, to enhance angiogenesis and osteogenesis in a calvarial critical-sized defect model in rats. To investigate the vascularization and bone formation of tissue engineered bone, the substrate was removed and processed for immunohistochemical, scanning electron microscopic examinations (SEM), reverse transcriptase-polymerase chain reaction (RT-PCR), dual energy X-ray absorptiometry (DEXA), microvessels counting, and new bone volume assay. The results demonstrate that bFGF mediated ex vivo gene transfer based on BMSCs can accelerate vascularization and bone regeneration on these composite scaffolds. The n-HA/PA66 scaffold combined with the bFGF-BMSCs may mimic the natural process of osteogenesis during repair of defect by tissue engineered bone.

Reduction malarplasty using an L-shaped osteotomy through intraoral and sideburns incisions.

The slender, oval-shaped face is considered to be attractive in East Asia. To obtain the ideal contour of the midface, reduction malarplasty has been popularized in oriental countries in recent years. This report describes a surgical technique for reduction of the zygomatic body and arch. After labiobuccal vestibular incisions are made, the anterior zygomatic body and lateral orbital rim are exposed by subperiosteal dissection. Thereafter, an L-shaped osteotomy is performed. Two parallel horizontal osteotomies are made in the anterior part of the zygomatic body, and the middle bone segment is removed. The zygomatic arch root is fractured through a small sideburn incision just anterior to the articular tubercle. Finally, the freed zygomatic complex is medially repositioned and fixed with one or two bicortex screws. Operations on 32 patients demonstrated that this technique may be a sound method for malar complex reduction, with the advantages of simple manipulation, stable fixation, and less risk of a drooping face.

Basic fibroblast growth factor suspended in Matrigel improves titanium implant fixation in ovariectomized rats

Basic fibroblast growth factor (bFGF) has high potential for tissue regeneration; however, its in vivo effects are unpredictable due to the short-term survival. This study sought to evaluate the effects of bFGF suspended in Matrigel on the implant fixation in ovariectomized (OVX) rats. In vitro, the release kinetics of bFGF was tested using an immuno-ligand-assay. In vivo, eighty titanium implants were randomly divided into 4 groups and inserted in the tibiae of forty OVX rats: no treatment group, bFGF alone group, Matrigel alone group and bFGF+Matrigel group. At 3 months after implantation, tibiae were examined by histology, micro-CT and push-out test. We found that Matrigel could prolong the life span of bFGF in vitro with a sustained release during the 21 days. In vivo, bFGF or Matrigel alone had little effect on the fixation of implant in OVX rats, but bFGF suspended in Matrigel induced nearly 2-fold of peri-implant new bone formation and 4-fold of implant mechanical stability when compared to other 3 groups. The results of this study suggest that Matrigel could be used as a carrier of bFGF and prolonged its release around implant, which may improve implant fixation, especially in site of post-menopausal osteoporosis.

Autogenous coronoid process pedicled on temporal muscle grafts for reconstruction of the mandible condylar in patients with temporomandibular joint ankylosis

OBJECTIVE The aim of this study was to investigate the feasibility of autogenous coronoid process pedicled on temporal muscle grafts (ACPTMG) for reconstruction of the mandible condyle, and to compare the differences in clinical effects with autogenous free coronoid process grafts (AFCPG) in patients with temporomandibular joint (TMJ) ankylosis. STUDY DESIGN From 2003 to 2005, 48 patients who were diagnosed with uni- or bilateral TMJ ankylosis were randomly divided into 2 groups: group A(24 cases, 28 joints) and group B(24 cases, 30 joints). All patients underwent operations for resection of condyle and surrounding bony masses and simultaneous recreation of the glenoid fossa, which was followed with, for group A, condylar reconstruction using ACPTMG and, for group B, AFCPG, as well as interposition of temporal muscle myofascial flaps or native articular disc. The pre- and postoperative interinsicial opening values and mouth-opening deviation were measured, and decrease in height of mandible ramus was analyzed by panoramic radiographs. RESULTS All patients showed apparent improved joint function except 1 patient of group B, who showed signs of reankylosis of the joint (<20 mm mouth opening). Radiographic examination and 3-dimensional computerized tomography both showed the grafts to be well attached to the ramus in their original positions and adaptive remodeling in both groups, but relatively more evident bony resorption was noted in group B. The mean measurement of mouth-opening deviation and postoperative decrease in height of mandible ramus in group B were significantly higher than in group A. CONCLUSIONS Satisfactory clinical outcomes show that both ACPTMG and AFCPG seem to be alternative and promising methods in the treatment of TMJ bony ankylosis. Compared with AFCPG, the advantages of ACPTMG include less bony resorption and better long-term clinical outcomes.

Free grafting of autogenous coronoid process for condylar reconstruction in patients with temporomandibular joint ankylosis

OBJECTIVE This article describes the clinical effects of condylar reconstruction by free grafting of autogenous coronoid process in patients with temporomandibular joint (TMJ) ankylosis. STUDY DESIGN Fifteen cases of uni- or bilateral TMJ ankylosis during a 3-year period from March 2004 to March 2007 were surgically treated, and the average observation period was 22 months. All patients were treated by condylar reconstruction of immediate autogenous coronoid process grafts. Temporal muscle myofascial flaps or native articular disc was used as an interpositional tissue. Clinical examination, radiographs, and photographs were used postoperatively to evaluate the grafts and TMJ function. RESULTS Satisfactory mouth opening was achieved in 14 cases, and 1 patient showed signs of reankylosis of the joint (20 mm mouth opening). Radiographic examination showed that bone union occurred between the grafts and the ramus in all cases. Some bony resorption of the grafted coronoid process was observed in all patients, but no occlusal changes were noted. CONCLUSION Satisfactory clinical outcomes are obtained after the condylar reconstruction by free grafting of autogenous coronoid process. Therefore, autogenous coronoid process may be a suitable bone resource for condylar reconstruction in patients with TMJ ankylosis.

Growth of the mandible after condylar reconstruction using transport distraction osteogenesis: an experimental investigation in goats.

Background: Mandibular condyle damage during childhood disturbs mandibular growth and facial skeletal development. Transport distraction osteogenesis provides a new treatment for condyle reconstruction, but there are no data available on mandibular growth in growing individuals following surgery. The authors investigated the effect of condylar reconstruction by transport distraction osteogenesis on mandibular growth in goats. Methods: A condylar defect was created unilaterally in 44 growing goats. The animals were divided randomly into group A (n = 22) and group B (n = 22). Transport distraction was used to reconstruct the condyles in group A, whereas group B served as sham controls. Three-dimensional computed tomographic imaging was performed at different intervals. Ten animals from each group were used for mandibular growth measurements at 48 weeks after the end of distraction. Four animals from each group were euthanized at 12, 24, and 48 weeks after surgery. Their transport disks were harvested and processed for histologic evaluation. Results: In group A, the hemimandible of the distracted side exhibited similarities to the contralateral side except for the larger neocondyles. In group B, ramus height and width were significantly shorter on the undistracted side than on the contralateral side; concomitantly, there was mandibular deviation to the operated side. Well-organized fibrocartilage was seen at the neocondylar surface over time in group A but not in group B. Conclusions: This study suggests that a neocondyle reconstructed by means of transport distraction has the potential to grow under functional stimuli of the temporomandibular joint. Therefore, this technique may serve as an alternative method for condylar reconstruction in growing individuals.

Sliding reconstruction of the condyle using posterior border of mandibular ramus in patients with temporomandibular joint ankylosis

The traditional approach for ankylosis is gap arthroplasty or interpositional arthroplasty followed by reconstruction of the condyle using, for example, costochondral grafts. As these are non-pedicled grafts, there is eventual resorption with subsequent decrease in height of the ramus, facial asymmetry and deviated mouth opening. The authors have applied the method of total and partial sliding vertical osteotomy on the posterior border of the mandibular ramus for reconstruction of the mandible condyle as a pedicled graft for the correction of temporomandibular joint (TMJ) ankylosis. From 2004 to 2008, 18 patients who were diagnosed with TMJ ankylosis underwent operations for resection of the ankylosed condyle. Two methods were performed depending on the level of osteotomy on the posterior part of the mandibular ramus. All patients were followed-up for an average of 36 months (range 24-48 months). All patients showed apparent improved joint function with no cases of re-ankylosis. The results showed that sliding vertical osteotomy on the posterior border of the mandibular ramus seems to be an alternative and promising method for condylar reconstruction in patients with TMJ bony ankylosis.

Mandibular coronoid fractures: Treatment options

Fractures of the coronoid process are uncommon and can easily be missed. The purpose of this study was to classify the fracture patterns and explore the treatment options. This retrospective study included 39 patients with fractures of the mandibular coronoid process. Treatment protocols were developed based on the time of fracture, degree of mouth opening, location of the coronoid fracture, types of fracture, and other concomitant fractures. All patients were followed up for 12-60 months. Sixteen patients underwent conservative management and four of these patients developed progressive trismus, which improved significantly after removal of the coronoid process. Twenty-three patients underwent open reduction and internal fixation (ORIF) via the modified retromandibular approach. Follow-up data showed significant improvement in maximum mouth opening and symptoms (diet and pain) compared to their preoperative status. In summary, conservative management is first recommended for fractures of the coronoid process with minimal displacement or restriction of mouth opening. For patients with significant fracture displacement and limited mouth opening, or with concomitant fractures of the zygoma, zygomatic arch, or mandibular ramus, ORIF via the modified retromandibular approach through the anterior border of the parotid gland is an alternative treatment method.