Maxillary sinus augmentation with iliac autograft - a health-economic analysis.

PURPOSE: To estimate and compare the costs of maxillary sinus augmentation performed with autologous bone graft either from the iliac crest or from local bone harvested from the mandibula. To evaluate post-operative health-related quality-of-life parameters for patients subjected to sinus augmentation and iliac bone surgery. MATERIAL AND METHODS: The hospital records of 14 patients subjected to sinus augmentation with iliac autograft, and 14 patients treated with local autograft, were analysed with regard to costs related to surgery, hospitalization and sick leave. Post-operative health parameters were assessed with a questionnaire. RESULTS: Mean hospital costs, administration excluded, for sinus augmentation with iliac autograft was €3447. Policlinic treatment alternatives e.g. local bone autograft with or without bone substitutes, rendered costs of approximately 42% thereof. The loss of production for a worker was 41% of the total cost (€9285). With regard to health-related quality-of-life and post-operative morbidity, most of the patients had recovered 14 days after the iliac graft surgery. CONCLUSION: The cost for a sinus augmentation with iliac surgery exceeds that of a policlinic procedure manifold. Provided that a policlinic operation with local bone, with or without bone substitute, renders an adequate end result, the economic gain would be substantial and post-operative morbidity would be greatly reduced

Systemic betamethasone accelerates functional recovery after a crush injury to rat sciatic nerve

Purpose: The aim of the study was to evaluate the effect of perioperatively systemically administered betamethasone on nerve recovery (within or outside a confined space) after induced nerve crush injury. Materials and Methods: The sciatic nerve of 40 adult Wistar rats was crushed. In half of the animals, the injured nerve was entrapped in a silicone tube to simulate the environment of a closed space, and in the other half the nerve was left to heal. Half of the rats in each group were treated with subcutaneous betamethasone (2 mg/kg body weight/day) during the first 24 hours, starting preoperatively, whereas the other half, the control animals, were given the same amount of physiological saline. All animals underwent preoperative and postoperative walking track analysis (toe spread [TS] and intermediate toe spread [ITS]) twice weekly for 6 weeks. Results: For nonconfined space groups, there was no significant difference between the 2 groups (P=.052 for ITS and P =.315 for TS) during the first 2 weeks. Starting from the end of the second week, animals treated with betamethasone recovered more rapidly than did the controls (P <.001) and continued to do so until the end of the observation period. In the confined space groups, there was a significant difference between the 2 groups for ITS (P <.001) and for TS (P <.05) during the first 2 weeks. The difference continued at almost the same level of significance (P =.001) for ITS, whereas for TS, the difference disappeared after the second week. Conclusions: We conclude that short-term perioperative administration of betamethasone has a beneficial effect on the recovery of the injured rat sciatic nerve

Bone substitute as an on-lay graft on rat tibia

Objectives To investigate the capacity of Cerament (R), an injectable bone substitute, to guide bone generation from a cortical surface. Materials and method Cerament (R) was applied to the cortical surface of rat tibiae and investigated histologically after 3, 6 and 12 weeks, using a procedure similar to that performed in sham-operated rats. Results In both groups, the thickness of the bone cortex increased significantly from 473 +/- 58 mu m (mean +/- SD) at day 0 to 1193 +/- 255 mu m (Cerament (R)) and 942 +/- 323 mu m (sham) after 3 weeks. In the Cerament (R) group, the new bone thickness remained constant (1258 +/- 288 mu m) until the end of the experiment at 12 weeks, while the sham group demonstrated a return to initial cortical thickness (591 +/- 73 mu m) at 12 weeks. The newly formed bone in the Cerament (R) group was highly trabecular after 3 weeks but attained a normal trabecular structure of the cortex after 12 weeks. Conclusion Cerament (R) may guide bone generation from an intact cortical bone surface. Although bone remodeling speed may differ between rats and humans, our study indicates that Cerament (R) may become a useful alternative to autologous bone, both to fill defects and to increase bone volume by cortical augmentation. To cite this article:Truedsson A, Wang J-S, Lindberg P, Gordh M, Sunzel B, Warfvinge G. Bone substitute as an on-lay graft on rat tibia. Clin. Oral Impl. Res. 21, 2010; 424-429.doi: 10.1111/j.1600-0501.2009.01875.x