Author Topic: Does anyone know anything about BIObank?  (Read 3149 times)

korvitz

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Does anyone know anything about BIObank?
« on: December 30, 2018, 01:24:24 AM »
I have recently consulted Albino Triaca for an difficult bimax surgery case (I will post my consult experience which was an positive experience btw, sometime soon. I just have to write it up so it's detailed)

I knew from reading this forum that he does not like Hydroxyapatite so I asked him what does he use instead of Hydroxyapatite for bone grafting. Triaca said in addition to Bio-oss he now uses BIObank and was very impressed at the results he saw at an conference regarding BIObank.

http://www.biobank.fr/?lang=en

Does anyone know anything about this graft material?? All I can find regarding it is the manufacturers website which is just mainly marketing & some stuff in french
« Last Edit: December 30, 2018, 01:50:12 AM by korvitz »

Lazlo

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Re: Does anyone know anything about BIObank?
« Reply #1 on: December 30, 2018, 12:50:28 PM »
This is fascinating. So on one level this is just the same as cadaver bone, which was used in my own bi-max surgery.

But it seems to be harvested and molded in such a way that it can create more osteoinduction maybe. What I would be fascinated to know and what you should ask Triaca is whether this BECOMES your own bone and has the same properties as live bone when placed in your body.

Another question is whether it is used for onlay grafting or only interpositional grafting. But even then, can it allow for more dramatic movements?

There is a lot of potential here, especially since there is a whole part on the website about 3D modelling the grafts. If thhis could allow a dramatic movement of say, your cheekbones during a ZSO would this allow for a greater variability of more dramatic outcomes? You should ask Triaca about all of this and report back.

korvitz

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Re: Does anyone know anything about BIObank?
« Reply #2 on: December 30, 2018, 09:08:48 PM »
My question to Triaca of what grafting material he uses was in the context of an proposed maxillary downgraft for more teeth show

I have an audio recording of the conversation, this is exactly what Triaca said to me (just read it in an heavy swiss accent):

"I use bio-oss or there is an new bone-like material from France BIObank and the results of BIObank; I was invited 3 weeks ago from the French society and severaly presented cases this BIObank, BIObank fantastic! You have to use material that will be replaced from bone of you and you have this bio-oss and also this BIObank. The material that you bring in will be replaced by your own bone this is the goal and not not an strange material for the whole life, your an young man!"

So yes it seems to be Triaca thinks BIObank will "BECOMES your own bone"

I did not ask if it can be used as an onlay for lets say onlay cheekbone augmention.

Good questions Lazlo, I will ask Triaca if it can be used like you described & as an onlay when I meet him again when I'm actually ready for surgery
« Last Edit: December 30, 2018, 10:05:00 PM by korvitz »

kavan

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Re: Does anyone know anything about BIObank?
« Reply #3 on: December 30, 2018, 09:14:35 PM »
Let's first look at the TRADEMARK of 'Supercrit' where it sounds like they discovered some special process where they turned CO2 (dry ice) into a supercritical liquid/fluid.

IMO, there is a lot of what we call 'hand waving' and subterfuge when describing the novelty of their process which they have put the TRADEMARK of 'Supercrit' on it.

'Supercrit' standing for a supercritical fluid made from DRY ICE. OK. Well everyone knows (scientific types) that this can be used as a solvent. Like it's been used for such in other applications: "The critical point for CO2 occurs at 73 atm and 31.1°C. Supercritical carbon dioxide is widely used as a solvent for industrial extraction processes because it has a very low viscosity; so it flows easily and can penetrate extremely small spaces. It is widely used for decaffeinating coffee: When forced through green coffee beans, it penetrates deeply into the beans, dissolving and removing most of their caffeine content. Other uses for supercritical CO2 include as a dry cleaning solvent and a natural refrigerant."

So, big deal, they use it for cut off femoral heads. OK, big F**king deal.

You know what.... You know what I'd be concerned about...I'd be concerned that those femoral heads they get for HIP REPLACEMENTS are all really BAD arthiritic bones. They put a SPIN on it saying its from bones harvested from ARTHROPLASTY (as in NOT cadaver bones) but guess what... bones from arthroplasty are ARTHRITIS bones. So, THAT'S what you would be getting in your face, an ARTHRITIC hip bone. Like what IF it kicks up the PAIN of arthritis in your FACE.
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korvitz

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Re: Does anyone know anything about BIObank?
« Reply #4 on: December 30, 2018, 09:38:39 PM »

You know what.... You know what I'd be concerned about...I'd be concerned that those femoral heads they get for HIP REPLACEMENTS are all really BAD arthiritic bones. They put a SPIN on it saying its from bones harvested from ARTHROPLASTY (as in NOT cadaver bones) but guess what... bones from arthroplasty are ARTHRITIS bones. So, THAT'S what you would be getting in your face, an ARTHRITIC hip bone. Like what IF it kicks up the PAIN of arthritis in your FACE.

uh I gotta be frank, arthiritis is not an contagious disease that is transmissible but an systemic inflammatory disease of the patient... the question & concern should perhaps be what is the quality of bone from arthiritic donors & NOT if it is possible to catch arthiritis from donated bone (which frankly is F***king absurd and not possible)
« Last Edit: December 30, 2018, 09:51:53 PM by korvitz »

PloskoPlus

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Re: Does anyone know anything about BIObank?
« Reply #5 on: December 31, 2018, 01:55:59 AM »
uh I gotta be frank, arthiritis is not an contagious disease that is transmissible but an systemic inflammatory disease of the patient... the question & concern should perhaps be what is the quality of bone from arthiritic donors & NOT if it is possible to catch arthiritis from donated bone (which frankly is F***king absurd and not possible)
There is speculation that many diseases have viral origin.  FWIW, I think that Triaca is overrated.  IMO he uses chin wings to simulate CCW rotation.

korvitz

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Re: Does anyone know anything about BIObank?
« Reply #6 on: December 31, 2018, 04:05:49 AM »
There is speculation that many diseases have viral origin.

Well even if "There is speculation that many diseases have viral origin" is true (this "speculation" is actually not new, it goes back to Louis Pasteur) apparently supercritical CO2 is very good at removing the viral load from the bone.

FWIW, I think that Triaca is overrated.  IMO he uses chin wings to simulate CCW rotation.

I think you are not the only one who thinks that he uses chin wings to simulate CCW rotation, I did not ask Triaca if he thinks chin wings simulate CCW rotation but perhaps he himself might actually agree. Judging purely from cases presented in his papers & 1 or 2 lectures he does not like CCW rotation that involves an BSSO due to stability issues, it seems to be he only does CCW with maxillary impaction & distraction osteogenesis in lieu of an BSSO.
On an side note I mentioned Larry Wolford to Triaca, he told me he knows who Larry Wolford is & thinks he is f***king crazy for doing TJR in teenagers lol.  But more on what Triaca said about Wolford & stability of BSSO's later when I write up & post my consult experience

He basically says in this lecture that he uses Chin Wing to simulate CCW at 15:50 to 16:50
https://youtu.be/SJnOffLBIkk?t=950

Here's from an interview https://www.orthodfr.org/articles/orthodfr/pdf/2016/02/orthodfr160021.pdf where he says he does not do >8-10mm BSSO advancements anymore and prefers DO.

"S.R. : Tu as de plus en plus souvent recours à la distraction mandibulaire. Peux-tu nous décrire cette intervention? Combien de temps maintiens-tu les distracteurs en place?

A.T. : J’ai placé mon premier distracteur mandibulaire il y a 15 ans.Chez le jeune, la distraction osseuse sagittale est plutôt bien supportée. Ce n’est pas forcément le cas chez l’adulte mais elle présente de nombreux avantages : avancements importants, reconstruction osseuse, absence de risque d’altération condylienne. Lorsqu’un patient a présenté des phénomènes de résorptions condyliennes, mais que les condyles sont corticalisés, il est nettement préférable, selon moi, d’envisager une distraction plutôt qu’une ostéotomie sagittale. Les distracteurs sont adaptés au plus prêt du contour gingival et des dents. C’est le patient qui l’active. Le distracteur est activé
de trois fois 1/4 de mm matin, midi et soir. Une fois une légère sur-correction obtenue, le distracteur est maintenu trois mois en bouche.

S.R. : La difficulté de contrôler la position condylienne en cours d’intervention, le risque d’altérations idiopathiques temporomandibulaires représentent une limite et un risque de la CMF. Tu nous as dit lors de la réunion scientifique de Toulouse et d’Aix en Provence que la prévention de ces atteintes consiste en une meilleure planification thérapeutique. Peux-tu développer cet argument ?

A.T. : Lorsque j’exerçais dans le service d’Obwegeser, une journée entière par semaine était réservée uniquement pour les patients opérés et souffrants de douleurs articulaires. Par le passé, j’ai réalisé des ostéotomies sagittales de plus de 10 mm. Je me suis rendu compte qu’audelà de 8 mm, on avait de forts risques d’altérer le condyle. Lorsque l’avancement est important, je préfère avoir recours à la distraction mandibulaire qui, comme je l’ai dit plus haut, n’altère pas le condyle et est bien plus stable dans le temps. Par ailleurs, selon moi, ce n’est pas tant le contrôle de la position condylienne en cours d’intervention qui est important, mais l’absence de compression. Il est fondamental de ne pas comprimer le condyle"

Later he specifically mentions his stance on CCW, also mentions that he prefers just an maxillary impaction.

"S.R. : Comment gères-tu le positionnement condylien en cours d’intervention?

A.T. : Je réalise un modèle en 3D qui préfigure l’avancement. Comme je réalise des avancées sans dérotation, il n’y a pas de risque de compression du condyle.

S.R. : Tu réalises donc des avancées mandibulaires par ostéotomie sagittale sans dérotation. Pourquoi ? En revanche, peux-tu changer sans risque l’orientation du plan d’occlusion par la distraction alvéolaire du segment frontal dans les open-bite comme dans les deep-bite ?

A.T. : Effectivement, je ne modifie pas l’orientation du plan d’occlusion mandibulaire avec l’ostéotomie sagittale, en tous cas, surtout pas dans le sens inverse des aiguilles d’une montre. La rotation antihoraire avec abaissement de l’angle crée un étirement de la sangle ptérygomassétérine et peut induire une compression des ATM Si le patient présente une hyperdivergence squelettique, pour fermer la béance, j’aurai alors recours à une impaction maxillaire Une infraclusion antérieure simple peut être fermée par une distraction partielle verticale antérieure du segment frontal, surtout en cas d’inversion de la Courbe de Spee. La distraction du segment frontal en combinaison avec une ostéotomie de Le Fort I permet d’éviter une modification trop radicale du plan maxillaire. Lorsque la Courbe de Spee est trop marquée, le segment antérieur peut être mobilisé vers le bas (Fig. 23c−23g). En cas d’hyperdivergence squelettique, une intervention de Le Fort I associée à une chin wing génioplastique pour modifier le bord basilaire est envisageable. L’ostéotomie de chin wing peut permettre à elle seule et, dans certains cas, de rétablir une compétence labiale. L’angle et le contour mandibulaires seront bien plus harmonieux qu’avec une ostéotomie sagittale."


kavan

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Re: Does anyone know anything about BIObank?
« Reply #7 on: December 31, 2018, 08:07:15 AM »
uh I gotta be frank, arthiritis is not an contagious disease that is transmissible but an systemic inflammatory disease of the patient... the question & concern should perhaps be what is the quality of bone from arthiritic donors & NOT if it is possible to catch arthiritis from donated bone (which frankly is F***king absurd and not possible)

Well, I didn't mean to imply someone could 'catch' (osteo) arthritis from it via some organism within such as in a virus or bacteria. I'm well aware it's not contagious. I know that. Not sure why my post came off as if I didn't know that. (OK, maybe it was the Rothschild Napoleon VSOP Brandy--rare old bottle--long story.)

Anyway, my intention was to cast attention on the fact that bio-banked femoral heads from arthroplasty would basically be 'bad bones' and to think about that.

The company says:

"BIOBank bone grafts derive from human femoral heads which are harvested only in France and exclusively from living donors by orthopaedic surgeons during hip arthroplasties."

Note the SPIN in the marketing language: 'exclusively from living donors'. Well, yes, that SOUNDS a lot better than if they have to use the word 'cadaver' donors.

But what IF they said:

'Biobank bone grafts  are harvested from living donors with painful bone conditions who have undergone hip replacement to REMOVE their DEFECTIVE femoral heads.'

BOTH statements are TRUE. The difference is MINE gets you thinking about what the company does not want you to think about; defective bones.
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kavan

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Re: Does anyone know anything about BIObank?
« Reply #8 on: December 31, 2018, 08:49:29 AM »
Well even if "There is speculation that many diseases have viral origin" is true (this "speculation" is actually not new, it goes back to Louis Pasteur) apparently supercritical CO2 is very good at removing the viral load from the bone.

Actually, it's not the dry ice (in critical fluid stage) that removes the viral load. What the fluid CO2 does is DE-CLOG or 'degrease' the bone so that the matrix is porous enough to wet it throughout with OTHER compounds to travel through the pores where it's these other compounds that deactivate viruses and germs.  They are referred to as; 'aqueous chemical products'. But I don't see where they name what those compounds actually are.
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kavan

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Re: Does anyone know anything about BIObank?
« Reply #9 on: December 31, 2018, 02:55:41 PM »
My concern is targeted to whether or not a defective femoral head makes a good quality BONE MATRIX. Basically, they are using something that doesn't have a type of pathology that is the type to be transmitted to the recipient (eg. one does not 'catch' osteo arthritis and/or osteoporosis from another). So, my concern had nothing to do with 'catching' something. The concern is whether or not a 'bad' quality bone is going to make a good BONE MATRIX.

That's the paradox right there. Although there is a type of ('non germ') pathology to the femoral heads it's still a  type pathology that necessitates their removal (and most likely replacement with ARTIFICIAL--but bio compatible--materials). So why are they deemed 'good' or better options for face bone grafting than are manufactured bio-compatible materials.

WHY aren't the harvested femoral heads THEMSELVES good options for HIP REPLACEMENT for other patients. They certainly DON'T use those femoral heads as GRAFTS for other patients getting hip replacements, now do they. So, what makes them so good to put in your face?

So, WHAT is it about the bone MATRIX coming from bad hip joints that makes them better and superior to a well engineered ceramic material designed to integrate with the patients own bone where such things as optimal pore size, pore spacing and channeling between pores, elasticity modulus etc. are taken into consideration when designing ceramic materials used to REPLACE bad femoral heads.

The quality of bone gets WORSE with age (eg. elastic modulus is over 50% worse in older bones than young ones). So, how good could the MECHANICAL PROPERTIES of the BONE MATRIX from harvested femoral heads actually be (usually OLDER ones, all of whom needed hip replacements)?

Now, I have no idea WHY the bone MATRIX in those old femoral heads are going to be better than a pre-fabricated 'artificial' but bio-compatible material (or even bone from a STRONG OX). The company certainly doesn't make a case as to WHY the bone matrix in arthritic and/or osteoporosis femoral heads are superior to other bio-compatible materials. Looks to me that they just use a type of marketing SPIN language so you DON'T ask that question. Hence, the question; 'What makes DEFECTIVE bone a 'superior' bone matrix? I don't know the answer. But THAT'S the question I would ask.
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PloskoPlus

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Re: Does anyone know anything about BIObank?
« Reply #10 on: December 31, 2018, 06:53:41 PM »
Why not use your own hip bone?  When I spoke to Triaca a few years ago he was describing hip grafts as no big deal - "one boy ran a marathon 3 weeks later!".  Regarding CCW stability, I've always thought that it's the maxillary downgraft stability that is of concern.  FWIW, he offered to down graft my maxilla for more tooth show (I'd already had surgery when I spoke to him and my bite was perfect).  So clearly, he is not worried about maxillary stability.

IMO, fundamental problems should be solved properly.  Some people have normal, or even poor tooth show, together with a steep occlusal plane. So there is nothing to impact.  And those with high occlusal planes often have a convex upper lip.  Triaca's camouflage treatment will not address it.

korvitz

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Re: Does anyone know anything about BIObank?
« Reply #11 on: December 31, 2018, 07:39:58 PM »
Why not use your own hip bone?  When I spoke to Triaca a few years ago he was describing hip grafts as no big deal - "one boy ran a marathon 3 weeks later!".  Regarding CCW stability, I've always thought that it's the maxillary downgraft stability that is of concern.  FWIW, he offered to down graft my maxilla for more tooth show (I'd already had surgery when I spoke to him and my bite was perfect).  So clearly, he is not worried about maxillary stability.

IMO, fundamental problems should be solved properly.  Some people have normal, or even poor tooth show, together with a steep occlusal plane. So there is nothing to impact.  And those with high occlusal planes often have a convex upper lip.  Triaca's camouflage treatment will not address it.

Strange cause he did not mention to me he can use hip bone for maxillary downgrafting, I probably asked the wrong question to him hence why I did not know. I will definitely press him on this.

Regarding T.'s stance on CCW his concern is actually not the stability of the maxillary downgraft but the possibility of increased muscular tension at the pterygomasseteric sling causing compression of the TMJs. If you read the interview (yes its in French just google translate it) specifically this part:

"Effectivement, je ne modifie pas l’orientation du plan d’occlusion mandibulaire avec l’ostéotomie sagittale, en tous cas, surtout pas dans le sens inverse des aiguilles d’une montre. La rotation antihoraire avec abaissement de l’angle crée un étirement de la sangle ptérygomassétérine et peut induire une compression des ATM Si le patient présente une hyperdivergence squelettique, pour fermer la béance, j’aurai alors recours à une impaction maxillaire Une infraclusion antérieure simple peut être fermée par une distraction partielle verticale antérieure du segment frontal, surtout en cas d’inversion de la Courbe de Spee."

Anyways I do not need CCW as my OP is super flat, you will see that this is true once I manage to post a new thread on my case & consult experience
« Last Edit: December 31, 2018, 08:09:12 PM by korvitz »

ditterbo

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Re: Does anyone know anything about BIObank?
« Reply #12 on: January 02, 2019, 09:08:38 AM »
The joint compression reason is probably one of several reasons why most docs do fairly minimal posterior downgrafts in general, like no more than 3-4mm. I thought I recall hearing a doc explain the same thing once before, about the strain on that muscle. I don't recall how Gunson is able to 'get away' with a 10mm posterior downgraft. Just continues to show me how treatment of the TMJ can't be trusted under current medical practices.

Lazlo

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Re: Does anyone know anything about BIObank?
« Reply #13 on: January 02, 2019, 03:59:23 PM »
I had cadaver bone for my downgrafting. Sinn said it gets replaced by your own bone and you won't even detect it after a few months. Its two years later and i have no relapse or problems etc. So cadaver bone has clearly been used for ages and ages. This product doesn't sound so different. But yeah what Kavan says about the arthritis stuff would give me pause for sure.

kavan

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Re: Does anyone know anything about BIObank?
« Reply #14 on: January 03, 2019, 01:42:04 PM »
I had cadaver bone for my downgrafting. Sinn said it gets replaced by your own bone and you won't even detect it after a few months. Its two years later and i have no relapse or problems etc. So cadaver bone has clearly been used for ages and ages. This product doesn't sound so different. But yeah what Kavan says about the arthritis stuff would give me pause for sure.

Seems different to me.

I don't think cadaver bone can be equated with bone from living donors in terms of quality, strength, mechanical properties etc. simply because cadaver bone has a higher likelihood of coming from donors with better bone quality than live donors of femoral heads needing hip replacement.

I'm not absolutely sure about this but some entries I've come across do seem to belie that cadaver bone quality comes from 'better stock' than bone from living donors (eg. arthritic femoral heads).  For example:

"Tissue harvesting....

....There are two types of donor of homologous tissues: live donors, consisting mainly of donations of femoral heads after total hip arthroplasty procedures, which have the advantage that the donor patients can be called back for new tests in suspected cases; and cadaver donors, from which much greater quantities of tissues can be harvested, from practically any segment of the skeleton, as well as generally being young donors with better quality bone tissue than seen in live donors."

Ref=https://www.sciencedirect.com/science/article/pii/S2255497115302974

AND:

"Where does allograft musculoskeletal tissue or bone come from?

As you may be aware, many people choose to donate their organs and tissues. These otherwise healthy people often become donors as the result of an unexpected death. Most allograft musculoskeletal tissue used comes from such donors. Occasionally though, allograft bone may come from a living patient."

Ref= https://orthoinfo.aaos.org/en/treatment/bone-and-tissue-transplantation/

ALSO:

I'm very sure that the iliac crest bone (taken from 'spine' of pelvis), especially when it's your OWN is the best inter-positional graft (bone buttress) and as far as 'ching wings' go, I'm sure those docs would agree. The strip of it, has BOTH cortical bone on it (which is very strong COMPACT outer layer) and trabecular (inner SPONGY layer).

Now, extending this logic as it applies to the TYPE of bone that is most favored for inter-positional grafts, if one were to use CADAVER bone, seems to me they would CHOOSE ilac crest bone.

With Dr. Sinn, he CHOSE cadaver bone. He probably knows it has a higher likelihood of coming from a better donor (see my above references) and I'm guessing he chose iliac crest bone. I guess you could test my guess by asking him what type of cadaver bone he chose for you, iliac crest bone or highly porous brittle spongy bone from the femoral head of a donor with degenerative joint disease.

To the best of my knowledge ILIAC CREST bone is the bone of CHOICE for inter positional bone grafting to maxilla and mandible. When cadaver bone is used (second choice to using your own IC bone), the likelihood is higher it's better quality bone (see above references) than is bone from a living donor who has a higher likelihood of being OLDER and having poor quality bone.

So WHY is Triaca CHOOSING not only a type of bone that ISN'T the bone of choice for inter positional bone grafting but also choosing one with LOWER likelihood as being as good as cadaver bone?
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