[Show abstract][Hide abstract] ABSTRACT: Several techniques have been proposed to restore the compromised function of a joint. These include the arthroplasty by placing various tissues or materials between the articular surfaces. An important contribution to the diffusion of arthroplasty techniques was made by Vittorio Putti, head of the Rizzoli Orthopedic Institute in Bologna from 1912 to 1940. Interposition arthroplasty is still used for some non-weight-bearing joints, such as wrist and elbow, and gives good results. This type of surgery has been further developed by the improvement in biomaterials, biomechanical studies and the regenerative medicine. This paper describes the development starting from a historical survey particularly focused on Putti's contribution and ending with the state of the art of regenerative medicine in the treatment of joint diseases. Level of evidence V.
Knee Surgery Sports Traumatology Arthroscopy 11/2014; · 2.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Several therapeutic approaches have been developed to address hyaline cartilage regeneration, but to date there is no universal procedure to promote the restoration of mechanical and functional properties of native cartilage, which is one of the most important challenges in orthopaedic surgery. For cartilage tissue engineering, adult mesenchymal stem cells (MSCs) are considered as an alternative cell source to chondrocytes. Since little is known about adipose-derived mesenchymal stem cell (ADSC) cartilage regeneration potential, the aim of this review was to give an overview of in vivo studies about the chondrogenic potential and regeneration ability of culture-expanded ADSCs when implanted in heterotopic sites or in osteoarthritritic and osteochondral defects. The review compares the different studies in terms of number of implanted cells and animals, cell harvesting sites, in vitro expansion and chondrogenic induction conditions, length of experimental time, defect dimensions, scaffolds used and post-explant analyses of the cartilage regeneration. Despite variability of the in vivo protocols, it seems that good cartilage formation and regeneration were obtained with chondrogenically predifferentiated ADSCs (1x10(7) cells for heterotopic cartilage formation and 1x10(6) cells/scaffold for cartilage defect regeneration) and polymeric scaffolds, even if many other aspects need to be clarified in future studies.
Journal of Biomedical Materials Research Part A 07/2013; · 2.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Metal-on-metal hip resurfacing arthroplasty (HR) has been gaining popularity especially for young and active patients. Although different series report good mid-term results, the long-term outcome and failure mechanisms are still concerning. In this consecutive revision case series, 9 retrieved specimens of a failed Birmingham Hip Resurfacing (BHR) were divided according to the time to fracture: 3 specimens failed at less than 6 months (Group 1), 3 failed between 6 months and 3 years (Group 2) and 3 failed later than 3 years (Group 3). The objective of the study was to examine by a specific quantitative histomorphometry and microtomography (micro-CT) method the characteristics of bone quality and its microarchitecture in retrieved metal-on-metal HR. METHODS: A series of 948 BHR were performed between 2001 and 2009. Among these implants 10 failures occurred and nine of these underwent revision surgery and were examined by histomorphometry and micro-CT. RESULTS: Histomorphometry showed a significant increase in trabecular separation (Tb.Sp) in Group 3 in comparison with Group 1 (113%, p < 0.05). In the top region, micro-CT showed that Groups 2 and 3 presented significant lower bone volume (Group 2: 61%, p < 0.005; Group 3: 1%, p < 0.05), trabecular number (Group 2: 53%, p < 0.005; Group 3: 40%, p < 0.05), and higher Tb.Sp (Group: 71%,p < 0.05) when compared to Group 1. Additionally, histomorphometry showed that the top regions in Group 1 had a significantly lower mean percentage of empty osteocyte lacunae than the top regions in both Group 2 and 3 (p < 0.05). CONCLUSIONS: This study showed that the morphometric parameters considered are crucial for a good understanding of mechanical properties of HR and may be of significant importance in the pathogenesis of HR failure particularly in the development of late fractures.
[Show abstract][Hide abstract] ABSTRACT: Purpose: The aim of this prospective study was to evaluate the hard and soft tissue stability and esthetic outcomes of single-tooth implants placed in the anterior atrophic maxilla, following augmentation with mandibular block grafts covered with bovine hydroxyapatite and a resorbable collagen membrane, over a 5-year period. Materials and Methods: Patients with a bony deficiency of ≥ 3 mm horizontally and ≤ 3 mm vertically were treated consecutively with reconstructive procedures and implant placement 6 months afterward. Alveolar ridge dimensions were measured before and after augmentation using computed tomography. Clinical and radiographic measurements of soft and hard tissue levels and esthetic parameters (pink esthetic score [PES]) were performed annually to assess treatment outcomes. Results: Twenty-nine patients were treated. One patient had partial graft exposure after 1 month that required regrafting at the time of implant placement. Mean bone gain was 4.23 ± 0.69 mm horizontally and 1.71 ± 0.75 mm vertically. The implant cumulative success rate was 100%, according to the criteria of Albrektsson et al. Mean crestal bone resorption after 5 years was low (0.61 ± 0.33 mm). Moderate recession of the facial mucosa (-1.12 ± 0.4 mm) was observed during the study period, while mesial and distal papilla heights increased slightly (0.13 ± 0.17 and 0.19 ± 0.37 mm, respectively). Mean PES ratings remained stable, varying from 9.07 ± 1.49 at the moment of definitive crown delivery to 8.61 ± 1.55 at 5 years. Only two cases (7%) were considered slightly below the defined threshold (PES = 8) of marginal esthetic acceptability. Conclusions: This study demonstrated that implants placed in anterior atrophic maxillae augmented with mandibular block grafts showed stable hard and soft tissue levels and reasonable esthetic outcomes over the medium term, although ongoing recession of the facial mucosa was observed.
The International journal of oral & maxillofacial implants 01/2013; 28(1):270-80. · 1.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Mesenchymal stem cells (MSCs) from bone marrow (BM) are widely used for bone and less for cartilage tissue regeneration due to their self-renewal and differentiating properties into osteogenic or chondrogenic lineages. This review considers the last decade of clinical trials involving a two-step procedure, by expanding in vitro MSCs from BM, or the so called "one-step" procedure, using BM in toto or BM concentrate, for the regeneration of cartilage and osteochondral tissue defects. The following conclusions were drawn: 1) cartilage defects that can be repaired by the two-step technique are about twice the size as those where the one-step method is used; 2) the two-step procedure is especially used for the treatment of osteoarthritic lesions, whereas the one-step procedure for osteochondral defects; 3) the number of transplanted cells ranges between 3.8x10^6 cells/ml and 11.2x10^6 cells/ml and the period of cell culture expansion of implanted MSCs vary widely concerning the two-step procedure; 4) hyaluronic or collagenic scaffolds are used in all the clinical studies analyzed for both techniques; 5) the follow-up of the two-step procedure is longer than that of the one-step method, despite having a lower number of patients; and finally, 6) the mean age of the patients (about 39 years old) is similar in both procedures. Clinical results underline the safety and good and encouraging outcomes for the use of MSCs in clinics. Although more standardized procedures are required, the length of follow-up and the number of patients observed should be augmented and the design of trials should be implemented to achieve evidence-based results.
Stem cells and development 10/2012; · 4.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to prospectively evaluate clinical and radiographic outcomes of ultrashort implants (4-mm diameter, 6-mm length) supporting fixed partial dentures in severely atrophic posterior mandibles.
Twenty-five patients with posterior edentulous mandibular spans and 7- to 8-mm residual bone heights above the mandibular canal were enrolled. In total, 61 submerged implants were placed and loaded 5 to 6 months later. Patients were followed for 2 years after prosthesis connection with clinical, radiographic, and resonance frequency analysis (RFA) examinations.
Two implants failed in one patient before loading; all other implants showed favorable clinical and radiographic findings throughout the observation period (2-year survival and success rate: 96.8%). Postoperative pain and swelling were negligible. Mean changes in marginal bone levels were stable (0.40 ± 0.23, 0.51 ± 0.38, and 0.60 ± 0.13 mm after 6 months and 1 and 2 years, respectively) and were unaffected by measured crown-to-implant ratios (range: 1.31 to 3.12). Mean RFA values increased significantly from implant placement (67.35 ± 6.67) to 2 years (72.91 ± 5.07, P < .0001). Prosthetic complications included two prosthesis decementations, three ceramic veneer chippings, and one prosthesis screw loosening.
Within the limitations of the short follow-up period, the use of 6-mm-long implants was a predictable treatment method for patients with atrophic posterior mandibles and increased crown-to-implant ratios.
The International journal of prosthodontics 05/2012; 25(3):279-89. · 1.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose: To evaluate whether 6-mm-long implants (test group) could be a suitable alternative to standard-length implants (≥11 mm; control group) placed simultaneously with a sinus augmentation for the treatment of atrophic posterior maxillae. Materials and Methods: In total, 68 patients having 6 to 7 mm of residual bone height and at least 6 mm thickness below the sinus were randomly allocated to the two treatment groups. Two or three implants were placed in each patient and submerged for 4 months. Outcome measures were implant failures, complications, operation time, postoperative pain and swelling, soft tissue parameters, marginal bone levels, and implant stability quotient (ISQ) values. Patients were followed for 3 years after loading. Results: Two dropouts occurred, one in each group. Three of 73 control implants and one of 71 test implants failed. At 3 years, mean marginal bone loss was 0.57 ± 0.82 mm in the control group versus 0.45 ± 0.34 mm in the test group. No significant difference was observed between groups in terms of implant failures, prosthetic complications, soft tissue parameters, marginal bone loss, or ISQ values. However, the control procedure required significantly longer operation times and led to more surgical complications, pain, and swelling, compared with the test procedure. Conclusions: Both techniques showed similar clinical and radiographic outcomes at 3 years, but the short implants provided advantages in terms of reduced surgical time and invasiveness.
Clinical Implant Dentistry and Related Research 03/2012; · 3.82 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aims of this study were to evaluate a surgical/prosthetic protocol for the immediate rehabilitation of the augmented edentulous maxilla, and to compare the outcomes of implants placed in grafted (test group) versus native (control group) sites in the same patients.
Twenty patients were included in the study. Each patient was treated with a bilateral sinus augmentation procedure using a 50:50 composite graft of autogenous mandibular bone and bovine hydroxyapatite. Four to 5 months later, 155 implants (90 test and 65 control) were placed and restored with screw-retained fixed definitive prostheses supported by titanium frameworks within 1 week. All patients were followed for 1 year. Implant stability quotient (ISQ) measurements and radiographic evaluation of the marginal bone resorption (MBR) were performed.
Two test implants failed in two patients, giving a cumulative 1-year success rate of 98.7%; the prostheses success rate was 100%. Insertion torque and ISQ values for test implants were significantly lower than those for control implants (unpaired t-test, p < .0001). The mean MBR around control and test implants at the 1-year evaluation were similar (0.47 ± 0.25 mm and 0.43 ± 0.21 mm, respectively).
The combination of implants placed in sinus-grafted and native sites can be immediately loaded with a fixed full-arch prosthesis and yield short-term successful outcomes.
Clinical Implant Dentistry and Related Research 07/2011; 14 Suppl 1:e67-82. · 3.82 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Pietro Loreta (1831 to 1889), head of surgery at the University of Bologna, Italy, is at present a little-known name. However, in the field of surgery in the second half of the 19th century, his contributions to various areas, especially that of bladder stone treatment and gastric surgery, aroused great interest also at the international level. This survey focuses on both of these subjects that are particularly indicative of Loreta's activity. While he was trying to improve the operation of perineal cystotomy, which was about to be abandoned, he was faced with the new frontier of gastrointestinal tract surgery. Surgery was in rapid transformation, and the practice of a general surgeon still encompassed the domains of different surgical specialties, which would develop individually afterward. Loreta was a pupil of the outstanding surgeon Francesco Rizzoli and some of his pupils such as Alessandro Codivilla and Bartolo Nigrisoli became heads of surgery. His attitude of caution, that he recommended in his writings, is more remarkable considering his problematic nature and might be the most significant and original trait of Loreta's personality.
The American surgeon 03/2011; 77(3):290-6. · 0.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Limited incorporation and modest bone remodeling can cause allograft failure. We investigated whether mesenchymal stem cells (MSCs) and osteogenic protein-1 (OP-1) can improve allograft integration. A 3-cm full-size intercalary bone defect was created in the mid-diaphysis of the metatarsal bone of the sheep and it was replaced with an allograft alone (control group), or with MSCs (MSC group), OP-1 (OP-1 group), or MSCs and OP-1 (MSC + OP-1 group). Radiographic results showed a faster and complete integration of the allograft in the MSC + OP-1 group. Histology demonstrated that the amount of new bone was significantly greater inside the graft and a longer vessel penetration in the MSC + OP-1 group than in others. Mechanical strength of the allograft was not compromised by the high rate of bone remodeling. These results demonstrated that the association of MSCs and OP-1 improve bone allograft integration promoting an almost complete bone restoring.
Tissue Engineering Part A 09/2010; 16(9):2967-76. · 4.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The present in vivo preliminary experiment is aimed at testing mechanical and biological behaviour of a new nano-structured composite multilayer biomimetic scaffold for the treatment of chondral and osteochondral defects. The three-dimensional biomimetic scaffold (Fin-Ceramica Faenza S.p.A., Faenza-Italy) was obtained by nucleating collagen fibrils with hydroxyapatite nanoparticles, in two configurations, bi- and tri-layered, to reproduce, respectively, chondral and osteochondral anatomy. Chondral defects (lateral condyle) and deep osteochondral defects (medial condyle) were made in the distal epiphysis of the third metacarpal bone of both forelimbs of two adult horses and treated respectively with the chondral and osteochondral grafts. Both animals were euthanised six months follow up. The images obtained at the second look arthroscopy evaluation, performed two months after surgery, demonstrated good filling of the chondral and osteo-chondral defects without any inflammatory reaction around and inside the lesions. At the histological analysis the growth of trabecular bone in the osteochondral lesion was evident. Only in one case, the whole thickness of the osteochondral lesion was filled by fibrocartilaginous tissue. The formation of a tidemark line was evident at the interface with the newly formed bone. Newly formed fibrocartilaginous tissue was present in the area of the chondral defect. Initial alignment of the collagen fibres was recognisable with polarised light in both groups. The results of the present pilot study showed that this novel osteochondral and chondral scaffold may act as a suitable matrix to facilitate orderly regeneration of bone and hyaline-like cartilage.
Journal of Tissue Engineering and Regenerative Medicine 06/2010; 4(4):300-8. · 4.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Previous in vivo studies have shown a limited potential for vertical bone regeneration using osteoconductive scaffolds alone. In the present study, we investigated whether the association of adipose-derived adult stem cells (ASCs) with anorganic bovine bone (ABB) scaffold improved bone formation and implant osseointegration in a vertical guided bone regeneration model. Two pre-formed titanium domes were placed on the calvaria of 12 rabbits. Four treatment modalities were evenly distributed among the 24 domes: ABB alone, and ABB containing 3 x 10(5), 3 x 10(6), or 3 x 10(7) cells/graft. After 1 month, the domes were removed and one titanium implant was placed into each augmented site. One month after the second operation, the animals were killed and biopsy specimens were examined by histomorphometric and micro-CT analyses. Results indicated that at all concentrations, the ASC-loaded groups showed significantly more new bone formation and higher mean values of bone-implant contact and bone density inside threads than the ABB group. Furthermore, ASCs demonstrated a dose-response relationship, with the highest dose chosen inducing more robust bone regeneration. This study suggests that the delivery of ASCs on ABB might effectively increase vertical bone regeneration and implant osseointegration, versus ABB alone.
[Show abstract][Hide abstract] ABSTRACT: The present study evaluated the efficacy of a treatment consisting of placing and immediately loading implants with a bar-retained overdenture in edentulous maxillae.
Twenty-two consecutive patients were treated with four or five implants rigidly connected with a bar, which were then loaded with a maxillary overdenture within 48 hours post-surgery. The patients were followed clinically and radiographically for 1 year after loading. The implant outcome with regard to survival and success was analyzed. Visual analog scale questionnaires were used to record patient function and satisfaction before and after implant treatment.
Of the 103 implants, three failed within 1 year. Two implants, although integrated, presented with marginal bone resorption (MBR) values higher than those proposed for successful implants. Cumulative survival and success rates of implants were 97.1% and 95.2%, respectively. The average MBR after 1 year was low (0.78 +/- 0.79 mm). The main prosthetic complication was the frequent need for complete relining of the prosthesis in the initial weeks after loading (27.2%). The questionnaire revealed a significant increase in all comfort, functional, and esthetic parameters (Friedman test; P <0.0001), except in the cleaning feasibility category; a significant decrease in satisfaction was observed in this category (Friedman test; P <0.05), indicating the difficulty patients had in maintaining a high level of oral hygiene.
These preliminary results suggest that immediate loading of multiple implants supporting a bar-retained overdenture may represent a predictable treatment option for the rehabilitation of the edentulous maxilla.
Journal of Periodontology 11/2009; 80(11):1883-93. · 2.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Autologous and allogenic bone grafts are considered as materials of choice for bone reconstructive surgery, but limited availability, risks of transmittable diseases and inconsistent clinical performances have prompted the development of alternative biomaterials. The present work compares the bone regeneration potential of a soybean based bone filler (SB bone filler) in comparison to a commercial 50:50 poly(D: ,L: lactide-glycolide)-based bone graft (Fisiograft((R)) gel) when implanted into a critical size defect (6-mm diameter, 10-mm length) in rabbit distal femurs. The histomorphometric and microhardness analyses of femoral condyles 4, 8, 16 and 24 weeks after surgery showed that no significant difference was found in the percentage of both bone repair and bone in-growth in the external, medium and inner defect areas. The SB filler-treated defects showed significantly higher outer bone formation and microhardness results at 24 weeks than Fisiograft((R)) gel (P < 0.05). Soybean-based biomaterials clearly promoted bone repair through a mechanism of action that is likely to involve both the scaffolding role of the biomaterial for osteoblasts and the induction of their differentiation.
Journal of Materials Science Materials in Medicine 09/2009; 21(2):615-26. · 2.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aims of this pilot study were to evaluate the efficacy of treatment consisting of the immediate loading of implants placed immediately after tooth extraction in full-arch restorations and to compare the clinical and radiographic outcomes of implants placed in healed versus postextraction sites in the same group of patients.
Twenty-three patients who needed full-arch restorations were treated. One hundred forty-four implants were placed: 59 after tooth extraction (test group) and 85 in healed sites (control group). Within 48 to 72 hours of implant placement, nine maxillary and 15 mandibular arches received screw-retained fixed prostheses, consisting of a titanium framework fabricated with a computer-aided design and manufacturing techniques and composite resin teeth. The insertion torque for implants was >or=30 Ncm. Implant stability measurements (ISQ) and radiographs of the marginal bone level (MBL) change were performed at prosthesis delivery and after 1 year.
One implant in the test group and one implant in the control group failed, giving a cumulative success rate of 98.6%; the prosthesis survival rate was 100%. At the 1-year follow-up, no statistically significant difference was found between the control and test sites with respect to MBL change (0.47 +/- 0.18 mm versus 0.57 +/- 0.27 mm) or mean ISQ values (62.24 +/- 1.92 versus 61.34 +/- 2.15).
These preliminary data suggest that immediate loading of implants placed immediately after extraction may be a viable treatment option for edentulous arches when implants are stable at insertion and are rigidly splinted with screw-retained titanium-resin prostheses.
Journal of Periodontology 04/2009; 80(3):411-21. · 2.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to test the effect of the combination of mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) incorporated into a fluorohydroxyapatite (FHA) scaffold on bone regeneration in cylindrical defects in the edentulous mandibular ridge of minipigs.
Two mandibular premolar teeth were extracted bilaterally in 8 adult minipigs. After 2 months, 4 standardized defects of 3.5 mm diameter and 8 mm depth were created in each root site. The defects were randomly grafted with autogenous mandibular bone, FHA alone, PRP-FHA, or MSCs-PRP-FHA. A resorbable collagen membrane was placed over the defect area and the flaps were sutured. The animals were sacrificed 3 months later and biopsy samples were taken from the defect sites for histologic and histomorphometric assessment.
There was no evidence of inflammation or adverse tissue reaction with either treatment. MSCs-PRP-FHA-treated sites showed new vital bone between residual grafting particles. PRP-FHA- and FHA-treated sites showed residual particles in a background of marrow soft tissue with a moderate quantity of newly formed bone. Autogenous bone (46.97%) and MSCs-PRP-FHA (45.28%) produced a significantly higher amount of vital bone than PRP-FHA (37.95%), or FHA alone (36.03%). Further, the MSCs-PRP-FHA-treated defects showed a significantly higher percentage of contact between graft particles and newly formed bone compared with PRP-FHA and FHA group (59.23% vs 48.37% and 46.43%, respectively).
Our results suggest that, in this animal model, the addition of MSCs to PRP-FHA enhances bone formation after 3 months.
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 03/2009; 67(2):265-72. · 1.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Recently, the use of bovine bone mineral (BBM) in combination with autogenous bone for alveolar ridge augmentation before implant placement has increased in favor because of concerns over morbidity associated with extraoral donor sites. The aim of this prospective study was to evaluate the clinical and radiographic parameters of implants placed in augmented ridges using a 70:30 mixture of autogenous bone and BBM in association with micro-mesh over a 2-year period.
Sixteen partially edentulous patients requiring bone augmentation were consecutively treated for 19 reconstructive procedures and delayed implant placement (44 implants) after 8 to 9 months of submerged mesh healing. Clinical examinations were performed and radiographs of the implants were taken 6 months after prosthetic loading and once a year during a 2-year follow-up.
Only one (5.3%) of the 19 micro-meshes became exposed after 2 months and was removed. Computed tomography scans of the alveolar ridge pre- and postreconstruction demonstrated mean vertical augmentation of 3.71 +/- 1.24 mm and mean horizontal augmentation of 4.16 +/- 0.59 mm. All of the implants were retained after 2 years, yielding a 100% survival rate. The mean bone resorption around the implants was 1.37 +/- 0.32 mm during the observation period. Only three implants demonstrated bone resorption >2 mm, whereas 41 implants were considered clinically successful, resulting in a success rate of 93.1%.
This 2-year prospective study demonstrated that implants placed into augmented bone using this technique exhibited peri-implant stability with high survival (100%) and success (93.1%) rates.
Journal of Periodontology 11/2008; 79(11):2093-103. · 2.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Massive bone allografts are frequently used in orthopaedic reconstructive surgery. However the failure rate at long term follow-up is around 25%.
Stimulation of allograft incorporation.
In order to stimulate bone remodeling of an allograft we applied recombinant human osteogenic protein-1 (rh-OP-1, also know as bone morphogenetic protein-7, BMP-7) to a long bone critical size defect sheep model. In nine sheep we created a 3 cm osteoperiosteal metatarsal defect replaced with a structural allograft alone (control group, 4 animals), or an allograft added with rh-BMP-7 (BMP group, 5 animals). Radiographic, mechanical, histological and histomorphometric analysis were performed.
X-rays in the BMP group showed a better and faster callus formation, compared to the control group within the first 8 weeks after surgery. After 16 weeks there was a higher evidence of bone remodeling in the BMP group. Radiographic healing at junction sites was more evident in the BMP group at 4, 8 and 16 weeks. Mechanical testing on screw extraction showed no statistical differences between the two groups and histomorphometry showed no difference in terms of newly formed bone inside the allograft as well. The resorption rate of the graft was higher in the BMP group in comparison to the control group. The penetration of newly formed vessels was significantly higher in the BMP group.
These findings indicate that BMP-7 added to a structural bone allograft inducing early remodeling of the graft through stimulation of neo-angiogenesis and osteoclastic activity, without negative effects in mechanical strength and clinical outcome.