Vertical root fractures lead to advanced periodontal breakdown with deep periodontal pockets and vertical bone defects. The purpose of this study is to evaluate clinically the periodontal healing of root fracture treatment using adhesive resin cement. In 22 patients, 23 teeth with vertical root fractures were treated with 4-META/MMA-TBB resin cement. Eleven fractured roots were bonded through the root canal (group A) and 12 fractured roots were bonded extra-orally and replanted (group B). All teeth were then restored with full cast crowns (n=20) or coping (n=3). Mean probing depth was 6.6 mm at pre-treatment and 4.4 mm 6 months after the treatment in group A, and 7.4 mm and 4.6 mm, respectively, in group B. Bleeding scores were 100% at pre-treatment and 36.4% after 6 months in group A and 91.7% and 8.3%, respectively in group B. Radiographic bone level was 56.8% at pretreatment and 59.1% after 6 months in group A, and 18.8% and 29.2%, respectively, in group B. Two roots of group A and three roots of group B were extracted due to refracture, deterioration of periodontal inflammation, mobility, and luxation. The remaining roots (n=18) presented no discomfort to the patients and there was no deterioration of periodontal conditions over a mean period of 33 months (range 14-74 months) in group A and over a mean period of 22 months (range 6-48 months) in group B. There was no ankylosed teeth nor was any root resorption detected. The results suggested that the treatment of vertical root fracture using 4-META/MMA-TBB resin has good prognostic possibilities.

SummaryWe assessed the safety and feasibility of a unified conservative treatment protocol for osteoporotic vertebral fractures in the elderly patients with a 24-week follow-up. Our results showed that initial hospitalization with rigorous bed rest followed by a rehabilitation program using a Jewett brace was safe and feasible in managing patients.PurposeThe purpose of this study was to prove the safety and feasibility of a unified conservative treatment protocol, which included initial hospitalization with rigorous bed rest followed by a rehabilitation program with Jewett brace for osteoporotic vertebral fractures (OVFs) in the elderly patients with a 24-week follow-up.MethodsBetween April 2012 and Mach 2015, one hundred fifty-four patients met the eligibility for this study. Radiological findings at the 3-week, 6~8-week, 24-week assessment were evaluated. Among these, 11 patients underwent early surgery within the first 2 weeks after admission and 19 patients lost follow-up. Therefore, 124 patients were assessed at the final follow-up visit.ResultsThe average vertebral instability in all the present series was 4.9 ± 4.8° at 3-week, 2.9 ± 3.5° at 6~8-week, and 1.8 ± 3.0° at 24-week follow-up visit. Delayed union was observed in 16 patients on the 24-week follow-up visit. Therefore, the present conservative treatment protocol resulted in bony union in 98 out of 124 patients (79.0%, per protocol set analysis) and 98 out of 154 patients including drop-out (63.6%, intention-to-treat analysis). There was no severe adverse event related to initial bed rest. The vertebral instability at 3-week assessment was significantly higher in the delayed union group when compared with that in the union group. Univariate analyses followed by multivariate logistic regression analysis revealed that T2-weighted image of confined high intensity on MRI and having more than 5° of vertebral instability on dynamic X-ray at 3-week assessment are the independent risk factors for delayed union of conservative treatment in the present series.ConclusionsOur results showed that initial hospitalization with rigorous bed rest followed by a rehabilitation program using a Jewett brace was safe and feasible. Therefore, the present conservative treatment protocol can be one of the acceptable treatment options in managing OVF patients.

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Unidirectional porous hydroxyapatite (UDPHAp) is an artificial bone substitute with a unique microstructure consisting of 100–300-µm oval pores that present the material unidirectionally. UDPHAp has a compression strength of 14 MPa and a porosity of 75%, which promotes cell migration and capillary formation within the material. Despite these advantageous properties, bone remodeling and bone formation with UDPHAp remain unclear. To examine long-term remodeling and differences in bone formation based on the defect site, trapezoidal prism-shaped UDPHAp blocks were implanted into rectangular-shaped cortical bone defects in the proximal tibia of Japanese white rabbits. Histological analysis performed at 52 and 104 weeks after implantation revealed that bone and capillaries had formed within the implanted UDPHAp material. Bone formed within the UDPHAp implanted in the cortical defect of rabbit tibia and remodel up to two years. The percentage of new bone area within UDPHAp was larger in cortical lesions than that in medullary lesions. These findings suggest that UDPHAp is a promising material for the repair of non-critical-sized cortical bone defects.