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Papageorgiou SN, Papageorgiou PN, Deschner J, Götz W. Comparative effectiveness of natural and synthetic bone grafts in oral and maxillofacial surgery prior to insertion of dental implants: Systematic review and network meta-analysis of parallel and cluster randomized controlled trials. J Dent 2016; 48:1-8. [DOI: 10.1016/j.jdent.2016.03.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/21/2016] [Accepted: 03/17/2016] [Indexed: 10/22/2022] Open
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Kim ES, Kang JY, Kim JJ, Kim KW, Lee EY. Space maintenance in autogenous fresh demineralized tooth blocks with platelet-rich plasma for maxillary sinus bone formation: a prospective study. SPRINGERPLUS 2016; 5:274. [PMID: 27047706 PMCID: PMC4779789 DOI: 10.1186/s40064-016-1886-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/16/2016] [Indexed: 11/18/2022]
Abstract
This prospective study evaluated the effectiveness of autogenous fresh demineralized tooth block (Auto-FDT block) with platelet-rich plasma (PRP) for maxillary sinus augmentation with simultaneous implant installation. Auto-FDT block with PRP was used in Group 1 (n = 15) and combined graft (allograft and xenograft) powder with PRP was used in Group 2 (n = 15). For up to 2 years after the final prosthesis was installed, clinical and radiographic examinations were performed to evaluate the amount of graft materials, residual alveolar height (RAH), sinus height (SH) after grafting, augmented graft height (AGH) and resorption height (RH). In ten cases, biopsies were harvested for histological and histomorphometric analyses. A total of 59 implants were placed in a severe atrophic posterior maxilla with less than 5 mm of RAH and sinus augmentation. None of the patients developed sinusitis or other complications, such as implant loss. The graft material extracted included one molar (or 2 premolars) in Group 1 and 1.8 cc in Group 2. The radiologic examination revealed the following average between-group difference SH (Group 1, 14.12 ± 1.63 mm vs Group 2, 16.51 ± 1.29 mm) and AGH (Group 1, 11.62 ± 2.22 mm vs Group 2, 13.65 ± 1.35 mm). However, sufficient SH and AGH were observed for the implants in the Auto-FDT block group. Two years after final prosthesis was installed, no between-group difference in the RH was observed (Group 1, 1.23 ± 0.73 mm vs Group 2, 1.77 ± 0.54 mm, P = 0.021). The histomorphometric analysis revealed no between-group difference in the new bone volume (Group 1, 23.13 ± 1.42 % vs Group 2, 24.18 ± 2.19 %, P = 0.548). The results showed that Auto-FDT block with PRP can be used in grafted sinuses for implants with only one extracted molar (or two premolars). Auto-FDT block with PRP promotes new bone formation that is comparable with combined grafts. Auto-FDT block with PRP is as an alternative to bone grafting and can be a predictable procedure for sinus augmentation.
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Affiliation(s)
- Eun-Suk Kim
- Department of Oral and Maxillofacial Surgery, Weerae Dental Clinics, Seoul, Korea
| | - Ji-Yeon Kang
- Department of Oral and Maxillofacial Surgery, Dongtan Sacred Heart Hospital, Hallym University, Hwaseong, South Korea
| | - Jae-Jin Kim
- Department of Oral and Maxillofacial Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Kyoung-Won Kim
- Department of Oral and Maxillofacial Surgery, College of Medicine and Medical Research Institute, Chungbuk National University, Chungbdaero 1, Seowon-gu, Cheongju, Chungbuk 28644 South Korea
| | - Eun-Young Lee
- Department of Oral and Maxillofacial Surgery, College of Medicine and Medical Research Institute, Chungbuk National University, Chungbdaero 1, Seowon-gu, Cheongju, Chungbuk 28644 South Korea
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Osteoconductive composite graft based on bacterial synthesized hydroxyapatite nanoparticles doped with different ions: From synthesis to in vivo studies. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2016; 12:1387-95. [PMID: 26956413 DOI: 10.1016/j.nano.2016.01.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/27/2016] [Accepted: 01/29/2016] [Indexed: 11/22/2022]
Abstract
To repair damaged bone tissues, osteoconductive bone graft substitutes are required for enhancement of the regenerative potential of osteoblast cells. Nanostructured hydroxyapatite is a bioactive ceramic used for bone tissue engineering purposes. In this study, carbonate hydroxyapatite (cHA) and zinc-magnesium substituted hydroxyapatite (Zn-Mg-HA) nanoparticles were synthesized via biomineralization method using Enterobacter aerogenes. The structural phase composition and the morphology of the samples were analyzed using appropriate powder characterization methods. Next, a composite graft was fabricated by using polyvinyl alcohol and both cHA and Zn-Mg-HA samples. In vivo osteogenic potential of the graft was then investigated in a rabbit tibial osteotomy model. Histological, radiological and morphological studies showed that the graft was mineralized by the newly formed bone tissue without signs of inflammation or infection after 4 weeks of implantation. These histomorphometric results suggest that the fabricated graft can function as a potent osteoconductive bone tissue substitute.
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MACHADO CPG, SARTORETTO SC, ALVES ATNN, LIMA IBC, ROSSI AM, GRANJEIRO JM, CALASANS-MAIA MD. Histomorphometric evaluation of strontium-containing nanostructured hydroxyapatite as bone substitute in sheep. Braz Oral Res 2016; 30:e45. [DOI: 10.1590/1807-3107bor-2016.vol30.0045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 01/25/2016] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | | | | | - José Mauro GRANJEIRO
- Universidade Federal Fluminense, Brazil; Instituto Nacional de Metrologia, Qualidade e Tecnologia, Brazil
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Kohal RJ, Gubik S, Strohl C, Stampf S, Bächle M, Hurrle AA, Patzelt SBM. Effect of two different healing times on the mineralization of newly formed bone using a bovine bone substitute in sinus floor augmentation: a randomized, controlled, clinical and histological investigation. J Clin Periodontol 2015; 42:1052-9. [PMID: 26434920 DOI: 10.1111/jcpe.12466] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the amount of the mineralization of a bovine bone substitute material in sinus floor augmentation after healing times of 3 and 6 months. MATERIALS AND METHODS Fifty-one patients were randomized into two healing time groups and received sinus floor augmentations with a bovine bone material. After 3 or 6 months of healing, trephine bone biopsies were retrieved. The biopsies were processed for histological and histomorphometric evaluations to primarily investigate the amount of mineralized bone in the augmented area and secondarily compare the amount of mineralized bone in the augmented area and in the pristine bone. Statistical tests were performed to analyse the fraction of the mineralized bone (p < 0.05). RESULTS The biopsies of both groups showed remnants of the well-integrated bone substitute material. The histology revealed osteoblasts, osteocytes with osteoid, and osteoclasts. The mean percentage of mineralized bone in the augmented area was 23.8% (3 months group) and 23.6% (6 months group; p = 0.9246); the amount of remaining bone substitute material was 35% (3 months group) and 33.9% (6 months group; p = 0.6325). CONCLUSION It can be concluded that the bone maturation in the augmented sinus using the bovine bone material is similar after 3 and 6 months. Thus, implant installation after 3 months following a lateral window sinus floor augmentation approach using a bovine bone material seems to be clinically acceptable.
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Affiliation(s)
- Ralf Joachim Kohal
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Sonja Gubik
- Department of Orthodontics and Orofacial Orthopedics, Center for Dental, Oral and Maxillary Medicine, University of Ulm, Ulm, Germany
| | - Christine Strohl
- Department of Orthodontics, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Susanne Stampf
- Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Maria Bächle
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Adrian Alexander Hurrle
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg, Germany
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Corbella S, Taschieri S, Weinstein R, Del Fabbro M. Histomorphometric outcomes after lateral sinus floor elevation procedure: a systematic review of the literature and meta-analysis. Clin Oral Implants Res 2015; 27:1106-22. [DOI: 10.1111/clr.12702] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Stefano Corbella
- Department of Biomedical, Surgical and Dental Sciences; Università degli Studi di Milano; Milan Italy
- IRCCS Istituto Ortopedico Galeazzi; Milan Italy
| | - Silvio Taschieri
- Department of Biomedical, Surgical and Dental Sciences; Università degli Studi di Milano; Milan Italy
- IRCCS Istituto Ortopedico Galeazzi; Milan Italy
| | - Roberto Weinstein
- Department of Biomedical, Surgical and Dental Sciences; Università degli Studi di Milano; Milan Italy
- IRCCS Istituto Ortopedico Galeazzi; Milan Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences; Università degli Studi di Milano; Milan Italy
- IRCCS Istituto Ortopedico Galeazzi; Milan Italy
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Alayan J, Vaquette C, Farah C, Ivanovski S. A histomorphometric assessment of collagen-stabilized anorganic bovine bone mineral in maxillary sinus augmentation - a prospective clinical trial. Clin Oral Implants Res 2015; 27:850-8. [PMID: 26374171 DOI: 10.1111/clr.12694] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To histomorphometrically compare the use of collagen-stabilized anorganic bovine bone (ABBM-C) (test) to anorganic bovine bone + autogenous bone (ABBM + AB) (control) in maxillary sinus augmentation. MATERIALS AND METHODS Forty (n = 40 sinuses) patients underwent sinus augmentation and received either control (20 sinuses) or test bone graft (20 sinuses). Bone samples were harvested from the augmented sinuses 5 months postgrafting. The samples were processed for histomorphometry, which assessed within the primary region of interest (ROI-1), the area fraction of new bone (%NB), graft particle osseointegration (% OI), residual graft (%RG), and soft tissue components (% STM). The same analysis was also carried out in a second region of interest (ROI-2) located in a zone 1 mm proximal to the previous maxillary sinus floor. RESULTS In both ROI-1 and ROI-2, the mean % NB, %RG, and %STM in the control group were similar to mean values in the test group. The % OI was significantly greater in the control group (42.0 +/- 26.8) when compared to the test group (19.6 +/- 27.3) in ROI-2 (P < 0.05). No statistically significant differences were seen when ROI-1 and ROI-2 were compared except for improved %OI in ROI-2 in the control group. The mean proportion of lamellar bone to woven bone in the control group (1.22 ± 1.48) was significantly greater than the test group (0.38 ± 0.29) (P < 0.05). CONCLUSION ABBM-C exhibited very similar histomorphometric parameters to the composite graft of ABBM + AB. The ABBM + AB group was more mature as indicated by the significantly greater proportion of lamellar bone when compared to the ABBM-C. Improved % OI was seen in the zone proximal to the resident bony floor in the ABBM + AB group. Based on histological assessment, ABBM-C is a suitable bone substitute for the purposes of maxillary sinus augmentation. Its clinical utility may be indicated in cases of sinus membrane perforation and insufficient autogenous bone in the local area.
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Affiliation(s)
- Jamil Alayan
- School of Dentistry and Oral Health, Centre for Medicine and Oral Health, Griffith University, Southport, Australia
| | - Cedryck Vaquette
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia
| | - Camile Farah
- UQ Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Saso Ivanovski
- School of Dentistry and Oral Health, Centre for Medicine and Oral Health, Griffith University, Southport, Australia
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Berberi A, Bouserhal L, Nader N, Assaf RB, Nassif NB, Bouserhal J, Salameh Z. Evaluation of Three-Dimensional Volumetric Changes After Sinus Floor Augmentation with Mineralized Cortical Bone Allograft. J Maxillofac Oral Surg 2015; 14:624-9. [PMID: 26225054 PMCID: PMC4511887 DOI: 10.1007/s12663-014-0736-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 12/04/2014] [Indexed: 11/24/2022] Open
Abstract
AIM The aim of this retrospective study was to quantify three-dimensional (3D) volumetric bone changes over a two-year period in maxillary sinuses augmented with a mineralized cortical bone allograft material (MCBA) material. PATIENTS AND METHODS Eleven patients (6 males and 5 females) with mean of age of 51.6 (range: 46-61) years were treated to increase the vertical dimension of the alveolar crest by maxillary sinus floor augmentation procedure. Study data were collected from patient records and by analyzing preoperative radiographs and cone beam computed tomography (CBCT) scans taken within the first two weeks after maxillary sinus lift (T0), immediately before implant placement four months after grafting (T1), and after one year of implant loading (T2). All DICOM-formatted images were rendered into volumetric images using software that automatically calculated the volume of the grafted material in cubic centimeters. RESULTS Mean graft volume was 16.24 ± 1.54 cm(3) at T0, 14.48 ± 1.48 cm(3) at T1 and 13.06 ± 1.39 cm(3) at T2. Mean volume retraction resulted in 1.76 ± 0.34 cm(3) ΔV1 (T0-T1) and 1.42 ± 0.4 cm(3) ΔV2 (T1-T2) and was 10.83 % of the initial total volume at (T0-T1) and 9.8 % of the total volume (T1-T2). CONCLUSION The present retrospective investigation demonstrated a 20.63 % decrease in graft volume. Volumetric 3D assessment of CBCT scans with the selected software appeared to be a promising approach to quantifying long-term changes in the grafted area.
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Affiliation(s)
- Antoine Berberi
- />Oral and Maxillofacial Surgery Department, School of Dentistry, Lebanese University, P.O. Box 5208-116, Beirut, Lebanon
- />Oral Surgery Section, ENT Department, Sacre-Coeur Hospital, Lebanese University, Beirut, Lebanon
| | - Lea Bouserhal
- />Department of Orthodontics, Case Western Reserve University, Cleveland, OH USA
| | - Nabih Nader
- />Oral and Maxillofacial Surgery Department, School of Dentistry, Lebanese University, P.O. Box 5208-116, Beirut, Lebanon
| | - Rita Bou Assaf
- />Oral and Maxillofacial Surgery Department, School of Dentistry, Lebanese University, P.O. Box 5208-116, Beirut, Lebanon
| | - Nayla Bassil Nassif
- />Orthodontics Department, Faculty of Dental Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Joseph Bouserhal
- />Orthodontics Department, Faculty of Dental Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Ziad Salameh
- />Oral and Maxillofacial Surgery Department, School of Dentistry, Lebanese University, P.O. Box 5208-116, Beirut, Lebanon
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Jamjoom A, Cohen RE. Grafts for Ridge Preservation. J Funct Biomater 2015; 6:833-48. [PMID: 26262646 PMCID: PMC4598680 DOI: 10.3390/jfb6030833] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/17/2015] [Accepted: 07/31/2015] [Indexed: 12/22/2022] Open
Abstract
Alveolar ridge bone resorption is a biologic phenomenon that occurs following tooth extraction and cannot be prevented. This paper reviews the vertical and horizontal ridge dimensional changes that are associated with tooth extraction. It also provides an overview of the advantages of ridge preservation as well as grafting materials. A Medline search among English language papers was performed in March 2015 using alveolar ridge preservation, ridge augmentation, and various graft types as search terms. Additional papers were considered following the preliminary review of the initial search that were relevant to alveolar ridge preservation. The literature suggests that ridge preservation methods and augmentation techniques are available to minimize and restore available bone. Numerous grafting materials, such as autografts, allografts, xenografts, and alloplasts, currently are used for ridge preservation. Other materials, such as growth factors, also can be used to enhance biologic outcome.
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Affiliation(s)
- Amal Jamjoom
- Department of Periodontics, State University of New York at Buffalo, Buffalo, NY 14214, USA.
| | - Robert E Cohen
- Department of Periodontics, State University of New York at Buffalo, Buffalo, NY 14214, USA.
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Lie N, Merten HA, Meyns J, Lethaus B, Wiltfang J, Kessler P. Elevation of the maxillary sinus membrane for de-novo bone formation: First results of a prospective study in humans. J Craniomaxillofac Surg 2015; 43:1670-7. [PMID: 26293185 DOI: 10.1016/j.jcms.2015.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 07/14/2015] [Accepted: 07/15/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Sinus floor elevation via the lateral window approach represents a reliable technique for bone augmentation in the atrophic posterior maxilla. It is known that sinus membrane elevation leads to new bone formation. This prospective clinical study compared a specific technique in sinus membrane elevation with a conventional sinus floor augmentation (xenogenous/autogenous bone) in a human split mouth model. METHODS Five edentulous patients with highly atrophic posterior maxillae were included in this study. On one maxillary side a degradable PDLLA-membrane was placed to create a space underneath the sinus membrane. Contralateral a mixture of autogenous and xenogenous bone was used for sinus floor augmentation. A two-stage procedure was carried out. The following variables were assessed: bone regeneration on cone-beam computed tomography (cone-beam CT), implant success, prosthetic comfort and patient satisfaction. Bone biopsies were taken with simultaneous implant placement. The samples were histologically analyzed. RESULTS Cone-beam CTs revealed new bone formation on both sides. Thirty implants were placed, 15 in the augmented region and 15 in the non-augmented side. Thirty bone biopsies were taken and evaluated. Vital new bone was detected on the experimental side (osteoinductivity). On the conventional side a mixture of autogenous and residual bone substitute material was seen (osteoconductivity). Implant survival was 100% so far. Patient's satisfaction was high and prosthetic complications were not encountered. CONCLUSION As it provides the highest rate of bone formation, autogenous bone in combination with bone substitute material can be considered as a very reliable standard procedure in sinus floor augmentation. The specific sinus membrane elevation technique as presented here showed satisfying results and might be a suitable alternative for maxillary sinus augmentation.
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Affiliation(s)
- Nynke Lie
- Department of Cranio-Maxillofacial Surgery (Head: Prof. P. Kessler), Maastricht Univesity Medical Center, Maastricht, The Netherlands.
| | | | - Joeri Meyns
- Department of Cranio-Maxillofacial Surgery (Head: Prof. P. Kessler), Maastricht Univesity Medical Center, Maastricht, The Netherlands
| | - Bernd Lethaus
- Department of Oral-Maxillofacial Surgery, University of Aachen, Aachen, Germany
| | - Jörg Wiltfang
- Department of Oral-Maxillofacial Surgery (Head: Prof. J. Wiltfang), University of Kiel, Kiel, Germany
| | - Peter Kessler
- Department of Cranio-Maxillofacial Surgery (Head: Prof. P. Kessler), Maastricht Univesity Medical Center, Maastricht, The Netherlands
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Histological and Histomorphometric Human Results of HA-Beta-TCP 30/70 Compared to Three Different Biomaterials in Maxillary Sinus Augmentation at 6 Months: A Preliminary Report. BIOMED RESEARCH INTERNATIONAL 2015; 2015:156850. [PMID: 26273589 PMCID: PMC4529888 DOI: 10.1155/2015/156850] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 12/13/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this investigation was to examine the bone regenerative potential of newly biphasic calcium phosphate ceramics (HA-β-TCP 30/70), by assessing histological and histomorphometric results of human specimens retrieved from sinuses augmented with HA-β-TCP 30/70, and comparing them to anorganic bovine bone (ABB), mineralized solvent-dehydrated bone allograft (MSDBA), and equine bone (EB), after a healing period of 6 months. MATERIALS AND METHODS Four consecutive patients with edentulous atrophic posterior maxilla were included in this report. A two-stage procedure was carried out for sinus augmentation with HA-β-TCP 30/70, ABB, MSDBA, and EB. After 6 months, specimens were retrieved at the time of implant placement and processed for histological and histomorphometric analyses. RESULTS At histological examination, all biomaterials were in close contact with the newly formed bone and showed the same pattern of bone formation; the grafted granules were surrounded by a bridge-like network of newly formed bone. A limited number of ABB particles were partially covered by connective tissue. The histomorphometric analysis revealed 30.2% newly formed bone for Ha-β-TCP 30/70, 20.1% for ABB, 16.4% for MSDBA, and 21.9% for EB. CONCLUSIONS Within the limitations of the present investigation, these results support the successful use of HA-β-TCP 30/70 for sinus augmentation.
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Bone regeneration of macropore octacalcium phosphate-coated deproteinized bovine bone materials in sinus augmentation: a prospective pilot study. IMPLANT DENT 2015; 24:275-80. [PMID: 25886841 DOI: 10.1097/id.0000000000000249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the osteogenic potential of macropore octacalcium phosphate (OCP)-coated deproteinized bovine bone materials (DBBMs) in sinus augmentation. STUDY DESIGN Macropore OCP-coated DBBM was manufactured from bovine bone by thermal and chemical processing. Sinus grafts of a lateral window approach with experimental bone were conducted in 10 patients. At 6 months after surgery, a total of 10 specimens were obtained from 10 patients. But, 4 of them were excluded because the amount of specimens was not enough for evaluation. Morphological investigation under scanning electron microscopy and histological evaluation were performed. RESULTS OCP was evenly attached to the surface of the experimental graft and showed a relatively large pore size (300-400 μm) compared with Bio-Oss (100-200 μm). New bone comprised 23.49% (± 0.10), and residual graft material comprised 15.39% (± 0.06) in bone specimens. CONCLUSION A macropore-sized design and OCP coating could present a favorable environment for new bone formation in maxillary sinus grafts.
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63
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Pilipchuk SP, Plonka AB, Monje A, Taut AD, Lanis A, Kang B, Giannobile WV. Tissue engineering for bone regeneration and osseointegration in the oral cavity. Dent Mater 2015; 31:317-38. [PMID: 25701146 DOI: 10.1016/j.dental.2015.01.006] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 12/19/2014] [Accepted: 01/11/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The focus of this review is to summarize recent advances on regenerative technologies (scaffolding matrices, cell/gene therapy and biologic drug delivery) to promote reconstruction of tooth and dental implant-associated bone defects. METHODS An overview of scaffolds developed for application in bone regeneration is presented with an emphasis on identifying the primary criteria required for optimized scaffold design for the purpose of regenerating physiologically functional osseous tissues. Growth factors and other biologics with clinical potential for osteogenesis are examined, with a comprehensive assessment of pre-clinical and clinical studies. Potential novel improvements to current matrix-based delivery platforms for increased control of growth factor spatiotemporal release kinetics are highlighting including recent advancements in stem cell and gene therapy. RESULTS An analysis of existing scaffold materials, their strategic design for tissue regeneration, and use of growth factors for improved bone formation in oral regenerative therapies results in the identification of current limitations and required improvements to continue moving the field of bone tissue engineering forward into the clinical arena. SIGNIFICANCE Development of optimized scaffolding matrices for the predictable regeneration of structurally and physiologically functional osseous tissues is still an elusive goal. The introduction of growth factor biologics and cells has the potential to improve the biomimetic properties and regenerative potential of scaffold-based delivery platforms for next-generation patient-specific treatments with greater clinical outcome predictability.
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Affiliation(s)
- Sophia P Pilipchuk
- Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, 1101 Beal Avenue, Ann Arbor, MI 48109, USA.
| | - Alexandra B Plonka
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, 1011 N. University Avenue, Ann Arbor, MI 48109, USA.
| | - Alberto Monje
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, 1011 N. University Avenue, Ann Arbor, MI 48109, USA.
| | - Andrei D Taut
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, 1011 N. University Avenue, Ann Arbor, MI 48109, USA.
| | - Alejandro Lanis
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, 1011 N. University Avenue, Ann Arbor, MI 48109, USA.
| | - Benjamin Kang
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, 1011 N. University Avenue, Ann Arbor, MI 48109, USA.
| | - William V Giannobile
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, 1011 N. University Avenue, Ann Arbor, MI 48109, USA; Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, 1101 Beal Avenue, Ann Arbor, MI 48109, USA.
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Pasquali PJ, Teixeira ML, de Oliveira TA, de Macedo LGS, Aloise AC, Pelegrine AA. Maxillary Sinus Augmentation Combining Bio-Oss with the Bone Marrow Aspirate Concentrate: A Histomorphometric Study in Humans. Int J Biomater 2015; 2015:121286. [PMID: 26543482 PMCID: PMC4620258 DOI: 10.1155/2015/121286] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 09/03/2015] [Accepted: 09/27/2015] [Indexed: 01/13/2023] Open
Abstract
Purpose. To investigate the regenerative results obtained with the association of bone marrow aspirate concentrate using the Bone Marrow Aspirate Concentrate (BMAC) method to a xenogeneic bone graft (Bio-Oss) in sinus floor elevation. Materials and Methods. Using a randomized controlled study design in eight consecutive patients (age of 55.4 ± 9.2 years), 16 sinus floor lift procedures were performed with Bio-Oss alone (control group, CG, n = 8) or combined with bone marrow aspirate concentrate obtained via the BMAC method (test group, TG, n = 8). Six months after the grafting procedures, bone biopsies were harvested during implant placement and were analyzed by histomorphometry. Results. Histomorphometric analysis revealed a significantly higher amount (p < 0.05) of vital mineralized tissue in TG when compared to the CG (55.15 ± 20.91% and 27.30 ± 5.55%, resp.). For nonvital mineralized tissue, TG presented a statistically higher level of Bio-Oss resorption (p < 0.05) when compared with the CG (6.32 ± 12.03% and 22.79 ± 9.60%, resp.). Both groups (TG and CG) showed no significantly different levels (p > 0.05) of nonmineralized tissue (38.53 ± 13.08% and 49.90 ± 7.64%, resp.). Conclusion. The use of bone marrow concentrate obtained by BMAC method increased bone formation in sinus lift procedures.
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Affiliation(s)
- Paulo José Pasquali
- 1Department of Implant Dentistry, São Leopoldo Mandic Dental School, 13 José Rocha Junqueira Street, 13045-755 Campinas, Brazil
| | - Marcelo Lucchesi Teixeira
- 2Department of Prosthodontics, São Leopoldo Mandic Dental School, 13 José Rocha Junqueira Street, 13045-755 Campinas, Brazil
| | - Thiago Altro de Oliveira
- 1Department of Implant Dentistry, São Leopoldo Mandic Dental School, 13 José Rocha Junqueira Street, 13045-755 Campinas, Brazil
| | | | - Antonio Carlos Aloise
- 1Department of Implant Dentistry, São Leopoldo Mandic Dental School, 13 José Rocha Junqueira Street, 13045-755 Campinas, Brazil
| | - André Antonio Pelegrine
- 1Department of Implant Dentistry, São Leopoldo Mandic Dental School, 13 José Rocha Junqueira Street, 13045-755 Campinas, Brazil
- *André Antonio Pelegrine:
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Sehn FP, Dias RR, de Santana Santos T, Silva ER, Salata LA, Chaushu G, Xavier SP. Fresh-frozen allografts combined with bovine bone mineral enhance bone formation in sinus augmentation. J Biomater Appl 2014; 29:1003-13. [PMID: 25245781 DOI: 10.1177/0885328214552709] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We evaluated histologically, histomorphometrically, and tomographically the effects of the association of fresh-frozen bone allograft (FFB) with bovine bone mineral (BBM) in maxillary sinus floor augmentation. In total, 34 maxillary sinuses from 29 patients, with a mean age of 51.32 (±6.44) years, underwent sinus augmentation. Patients were divided into control and test groups (17 sinuses each). The controls were grafted with allograft bone, and the test group received a combination of FFB and BBM at a 2:1 ratio. After 6 months, bone samples were collected for histological and histomorphometric examinations. The implant survival rates were 93.02% (control group) and 100% (test group) at 6 months after functional loading. Median volumetric reductions of 28.32% (17.05-44.05) and 12.62% (5.65-16.87) were observed for the control and test groups, respectively. Statistically significant histomorphometric differences were found between the control and test groups regarding newly formed bone 12.54% (10.50-13.33) vs. 24.42% (17.62-35.92), p < 0.001, total bone 48.34% (39.03-54.42) vs. 61.32% (50.61-64.96), p = 0.007, and connective tissue 51.66% (45.57-60.97) vs. 39.30% (35.03-49.37), p = 0.007. The addition of BBM to allograft bone in maxillary sinus augmentation resulted in higher percentages of new bone formation and total bone, and permitted implant placement with a low rate of osseointegration failure at the 6-month follow-up.
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Affiliation(s)
- Felipe Perraro Sehn
- Department of Oral and Maxillofacial Surgery and Periodontology. Ribeirão Preto Dental School, University of São Paulo, São Paulo, Brazil
| | - Rafael Rodrigues Dias
- Department of Oral and Maxillofacial Surgery and Periodontology. Ribeirão Preto Dental School, University of São Paulo, São Paulo, Brazil
| | - Thiago de Santana Santos
- Department of Oral and Maxillofacial Surgery and Periodontology. Ribeirão Preto Dental School, University of São Paulo, São Paulo, Brazil
| | - Erick Ricardo Silva
- Department of Oral and Maxillofacial Surgery and Periodontology. Ribeirão Preto Dental School, University of São Paulo, São Paulo, Brazil
| | - Luiz Antonio Salata
- Department of Oral and Maxillofacial Surgery and Periodontology. Ribeirão Preto Dental School, University of São Paulo, São Paulo, Brazil
| | - Gavriel Chaushu
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Tel Aviv University, Israel
| | - Samuel Porfírio Xavier
- Department of Oral and Maxillofacial Surgery and Periodontology. Ribeirão Preto Dental School, University of São Paulo, São Paulo, Brazil
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Schmitt CM, Moest T, Lutz R, Neukam FW, Schlegel KA. Anorganic bovine bone (ABB) vs. autologous bone (AB) plus ABB in maxillary sinus grafting. A prospective non-randomized clinical and histomorphometrical trial. Clin Oral Implants Res 2014; 26:1043-50. [PMID: 24730602 DOI: 10.1111/clr.12396] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This investigation focused on histological characteristics and 5-year implant survival after sinus floor augmentation with anorganic bovine bone (ABB, Bio-Oss) and ABB plus autologous bone (AB) with a ratio of 1/1. MATERIAL AND METHODS Nineteen consecutive patients with bony atrophy of the posterior edentulous maxilla and a vertical bone height ≤4 mm were prospectively included in this study. In the first surgical stage, the maxillary sinus was non-randomized either augmented with ABB alone (n = 12) or a 1/1 mixture of ABB and AB (n = 7). After a mean healing period of 167 days, biopsies were harvested in the region of the grafted sinus with a trephine burr and implants were placed simultaneously, ABB n = 18 and ABB + AB n = 12. The samples were microradiographically and histomorphometrically analyzed judging the newly formed bone (bone volume, BV), residual bone substitute material volume (BSMV), and intertrabecular volume (soft tissue volume, ITV) in the region of the augmented maxillary sinus. Implant survival was retrospectively evaluated from patient's records. RESULTS No significant difference in residual bone substitute material (BSMV) in the ABB group (31.21 ± 7.74%) and the group with the mixture of ABB and AB (28.41 ± 8.43%) was histomorphologically determined. Concerning the de novo bone formation, also both groups showed statistically insignificant outcomes; ABB 26.02 ± 5.23% and ABB + AB 27.50 ± 6.31%. In all cases, implants were installed in the augmented sites with sufficient primary stability. After a mean time in function of 5 years and 2 months, implant survival was 93.75% in the ABB and 92.86% in the ABB + AB group with no statistically significant differences. CONCLUSION The usage of ABB plus AB to a 1/1 ratio leads to an amount of newly formed bone comparable with the solitary use of ABB after grafting of the maxillary sinus. Considering that ABB is a non-resorbable bone substitute, it can be hypothesized that this leads to stable bone over time and long-term implant success. Importantly, in the sole use of ABB, bone grafting and therefore donor site morbidities can be avoided.
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Affiliation(s)
- Christian M Schmitt
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Tobias Moest
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Rainer Lutz
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Friedrich W Neukam
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Karl Andreas Schlegel
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
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67
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Zhao W, Lu JY, Hao YM, Cao CH, Zou DR. Maxillary sinus floor elevation with a tissue-engineered bone composite of deciduous tooth stem cells and calcium phosphate cement in goats. J Tissue Eng Regen Med 2014; 11:66-76. [PMID: 24616333 DOI: 10.1002/term.1867] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 10/23/2013] [Accepted: 12/13/2013] [Indexed: 01/08/2023]
Abstract
The study aimed to assess the effect of maxillary sinus floor elevation with tissue-engineered bone constructed from deciduous tooth stem cells (DTSCs) and calcium phosphate cement (CPC). The stem cells from goat deciduous teeth (SGDs) were isolated and transfected by means of the adenovirus with an enhanced green fluorescent protein gene (AdEGFP). As many as 18 bilateral maxillary sinuses of nine goats were randomly allocated into three groups (n = 6/group): group A (SGDs-CPC compound), group B (CPC alone) and group C (autogenous bone obtained from an iliac crest). All the samples were evaluated by computed tomography (CT), histology and histomorphometric analysis. Furthermore, the fate of implanted SGDs was traced using an immunohistochemical staining method in the decalcified samples. SGDs might be differentiated into osteoblasts in an osteogenic medium. In the present study, three-dimensional CT analysis showed that the volume of newly formed bone in group A was greater than that in the other two groups. After a healing period of 3 months, sequential analyses of triad-colour fluorescence labelling, histology and histomorphology indicated that the SGDs-CPC compound primarily promoted bone formation and mineralization at 2 and 3 months after the operation. Moreover, the areas of new bone formation in elevated sinuses were 41.82 ± 6.24% in the SGDs-CPC group, which was significantly higher than the 30.11 ± 8.05% in the CPC-alone group or the 23.07 ± 10.21% in the autogenous bone group. Immunohistochemical staining revealed that GFP and OCN were both expressed in the new bone tissue for the samples with eGFP, which suggested that the implanted SGDs might have contributed to new bone formation on the elevated sinus floor. SGDs can promote new bone formation and maturation in the goat maxillary sinus, and the tissue-engineered bone composite of SGDs and CPC might be a potential substitute for existing maxillary sinus floor elevation methods. Copyright © 2014 John Wiley & Sons, Ltd.
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Affiliation(s)
- Wei Zhao
- Department of Stomatology, Sixth People's Hospital, Shanghai JiaoTong University, Shanghai, People's Republic of China
| | - Jia-Yu Lu
- Department of Stomatology, Sixth People's Hospital, Shanghai JiaoTong University, Shanghai, People's Republic of China
| | - Yong-Ming Hao
- Department of Stomatology, Sixth People's Hospital, Shanghai JiaoTong University, Shanghai, People's Republic of China
| | - Chun-Hua Cao
- Department of Stomatology, Sixth People's Hospital, Shanghai JiaoTong University, Shanghai, People's Republic of China
| | - De-Rong Zou
- Department of Stomatology, Sixth People's Hospital, Shanghai JiaoTong University, Shanghai, People's Republic of China
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Martinez A, Balboa O, Gasamans I, Otero-Cepeda XL, Guitian F. Deproteinated bovine bone vs. beta-tricalcium phosphate as bone graft substitutes: histomorphometric longitudinal study in the rabbit cranial vault. Clin Oral Implants Res 2014; 26:623-32. [PMID: 25906057 DOI: 10.1111/clr.12349] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This article aims to study differences in the bone formation and the graft resorption of two bone graft substitutes (BGS). Besides, it is our attempt to observe possible qualitative and quantitative differences in the bone reparation of the outer layer covered by collagen membrane and the uncovered inner layer in close contact with dura mater. MATERIAL AND METHODS Twelve rabbits were employed. Deproteinized bovine bone (DBB) and β-tricalcium phosphate (BTCP) were used as BGS. Four subcritical round defects (7 mm) were drilled in the cranial vault, removing both cortical walls. One of the holes was filled with DBB, and other was filled with BTCP. Each symmetrical position to DBB and BTCP was left empty. The whole defect set was covered with a collagen membrane. Histological and morphometric analysis was performed for 1, 4, 8, 16, 32 and 52 weeks. Morphometry measurements were carried out taking into account the whole defect and splitting inner and outer areas. RESULTS In DBB sites, a rapid bone growth is observed, linking the remaining particles and integrating them into the bone matrix. Permanence of these DBB particles from week 16 onwards restrains the growth of bone fraction. A greater bone growth appears in areas repaired with BTCP than in those repaired with DBB, both in the outer layer (under-membrane) and the inner layer (over dura mater). In DBB sites, a slower growth is observed in the inner layer, with no significant differences in the final bone fraction at both strata. CONCLUSIONS Both materials favour the closure of the defects provoked. In both cases, a synergistic effect with the collagen membrane is observed. DBB remains integrated in the bone matrix, while BTCP displays a pattern of highly developed progressive resorption with an outstanding bone fraction development.
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Affiliation(s)
- Arturo Martinez
- Estomatología, Facultad de Medicina y Odontología, Instituto de Cerámica de Galicia, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
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Lutz R, Berger-Fink S, Stockmann P, Neukam FW, Schlegel KA. Sinus floor augmentation with autogenous bone vs. a bovine-derived xenograft - a 5-year retrospective study. Clin Oral Implants Res 2014; 26:644-8. [DOI: 10.1111/clr.12352] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Rainer Lutz
- Department of Oral and Maxillofacial Surgery; University of Erlangen-Nuremberg; Erlangen Germany
| | - Susanne Berger-Fink
- Department of Oral and Maxillofacial Surgery; University of Erlangen-Nuremberg; Erlangen Germany
| | - Philipp Stockmann
- Department of Oral and Maxillofacial Surgery; University of Erlangen-Nuremberg; Erlangen Germany
| | - Friedrich Wilhelm Neukam
- Department of Oral and Maxillofacial Surgery; University of Erlangen-Nuremberg; Erlangen Germany
| | - Karl Andreas Schlegel
- Department of Oral and Maxillofacial Surgery; University of Erlangen-Nuremberg; Erlangen Germany
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Peng W, Kim IK, Cho HY, Pae SP, Jung BS, Cho HW, Seo JH. Assessment of the autogenous bone graft for sinus elevation. J Korean Assoc Oral Maxillofac Surg 2013; 39:274-82. [PMID: 24516817 PMCID: PMC3912780 DOI: 10.5125/jkaoms.2013.39.6.274] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/21/2013] [Accepted: 11/25/2013] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES The posterior maxillary region often provides a limited bone volume for dental implants. Maxillary sinus elevation via inserting a bone graft through a window opened in the lateral sinus wall has become the most common surgical procedure for increasing the alveolar bone height in place of dental implants in the posterior maxillary region. The purpose of this article is to assess the change of bone volume and the clinical effects of dental implant placement in sites with maxillary sinus floor elevation and autogenous bone graft through the lateral window approach. MATERIALS AND METHODS In this article, the analysis data were collected from 64 dental implants that were placed in 24 patients with 29 lacks of the bone volume posterior maxillary region from June 2004 to April 2011, at the Department of Oral and Maxillofacial Surgery, Inha University Hospital. Panoramic views were taken before the surgery, after the surgery, 6 months after the surgery, and at the time of the final follow-up. The influence of the factors on the grafted bone material resorption rate was evaluated according to the patient characteristics (age and gender), graft material, implant installation stage, implant size, implant placement region, local infection, surgical complication, and residual alveolar bone height. RESULTS The bone graft resorption rate of male patients at the final follow-up was significantly higher than the rate of female patients. The single autogenous bone-grafted site was significantly more resorbed than the autogenous bone combined with the Bio-Oss grafted site. The implant installation stage and residual alveolar height showed a significant correlation with the resorption rate of maxillary sinus bone graft material. The success rate and survival rate of the implant were 92.2% and 100%, respectively. CONCLUSION Maxillary sinus elevation procedure with autogenous bone graft or autogenous bone in combination with Bio-Oss is a predictable treatment method for implant rehabilitation.
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Affiliation(s)
- Wang Peng
- Department of Oral and Maxillofacial Surgery, Department of Dentistry, Inha University School of Medicine, Incheon, Korea
| | - Il-Kyu Kim
- Department of Oral and Maxillofacial Surgery, Department of Dentistry, Inha University School of Medicine, Incheon, Korea
| | - Hyun-Young Cho
- Department of Oral and Maxillofacial Surgery, Department of Dentistry, Inha University School of Medicine, Incheon, Korea
| | - Sang-Pill Pae
- Department of Oral and Maxillofacial Surgery, Department of Dentistry, Inha University School of Medicine, Incheon, Korea
| | - Bum-Sang Jung
- Department of Oral and Maxillofacial Surgery, Department of Dentistry, Inha University School of Medicine, Incheon, Korea
| | - Hyun-Woo Cho
- Department of Oral and Maxillofacial Surgery, Department of Dentistry, Inha University School of Medicine, Incheon, Korea
| | - Ji-Hoon Seo
- Department of Oral and Maxillofacial Surgery, Department of Dentistry, Inha University School of Medicine, Incheon, Korea
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de Lange GL, Overman JR, Farré-Guasch E, Korstjens CM, Hartman B, Langenbach GEJ, Van Duin MA, Klein-Nulend J. A histomorphometric and micro-computed tomography study of bone regeneration in the maxillary sinus comparing biphasic calcium phosphate and deproteinized cancellous bovine bone in a human split-mouth model. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 117:8-22. [PMID: 24182597 DOI: 10.1016/j.oooo.2013.08.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 07/01/2013] [Accepted: 08/09/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The gain of mineralized bone was compared between deproteinized bovine bone allograft (DBA) and biphasic calcium phosphate (BCP) for dental implant placement. STUDY DESIGN Five patients with atrophic maxillae underwent bilateral sinus elevation with DBA (Bio-Oss) and BCP (Straumann BoneCeramic). After 3 to 8 months, 32 Camlog implants were placed, and biopsies were retrieved. Bone and graft volume, degree of bone mineralization, and graft degradation gradient were determined using micro-computed tomography, and bone formation and resorption parameters were measured using histomorphometry. Implant functioning and peri-implant mucosa were evaluated up to 4 years. RESULTS Patients were prosthetically successfully restored. All but one of the implants survived, and peri-implant mucosa showed healthy appearance and stability. Bone volume, graft volume, degree of bone mineralization, and osteoclast and osteocyte numbers were similar, but BCP-grafted biopsies had relatively more osteoid than DBA-grafted biopsies. CONCLUSIONS The BCP and DBA materials showed similar osteoconductive patterns and mineralized bone, although signs of more active bone formation and remodeling were observed in BCP- than in DBA-grafted biopsies.
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Affiliation(s)
- Gert L de Lange
- Academic Center Oral Implantology Amstelveen, Amstelveen, The Netherlands
| | - Janice R Overman
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, and VU University Amsterdam, Amsterdam, The Netherlands; MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Elisabet Farré-Guasch
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, and VU University Amsterdam, Amsterdam, The Netherlands; MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Clara M Korstjens
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, and VU University Amsterdam, Amsterdam, The Netherlands; MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Bastiaan Hartman
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, and VU University Amsterdam, Amsterdam, The Netherlands; MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Geerling E J Langenbach
- Department of Functional Anatomy, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, and VU University Amsterdam, Amsterdam, The Netherlands; MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Marion A Van Duin
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, and VU University Amsterdam, Amsterdam, The Netherlands; MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Jenneke Klein-Nulend
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, and VU University Amsterdam, Amsterdam, The Netherlands; MOVE Research Institute Amsterdam, Amsterdam, The Netherlands.
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Duttenhoefer F, Souren C, Menne D, Emmerich D, Schön R, Sauerbier S. Long-term survival of dental implants placed in the grafted maxillary sinus: systematic review and meta-analysis of treatment modalities. PLoS One 2013; 8:e75357. [PMID: 24058679 PMCID: PMC3776785 DOI: 10.1371/journal.pone.0075357] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 08/12/2013] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND A prevalent modality to increase the amount of available bone prior to implantation is grafting of the maxillary sinus. Multiple factors such as the surgical technique, moment of implant placement as well as grafting materials and membranes are known to affect implant survival. However, the role of different factor combinations and associated reciprocal effects remain unclear. Conventional statistical methods do not consider inconsistency of study designs and do not take covariables into account. Hence, a systematic research and meta-analysis was conducted to investigate the influence of various treatment modalities on implant survival in the grafted maxillary sinus. MATERIALS AND METHODS A meta-analysis was conducted according to the PRISMA guidelines. Articles published from 1980 through January 2013 were electronically and manually searched in MEDLINE (Ovid), the Cochrane Register of Controlled Trials, the Database of Abstracts of Effects, and the Cochrane Database of Systematic Reviews. Clinical reports on single intervention sinus augmentation with root-form implants, a minimum of 10 patients and 6 months of loading were eligible for inclusion if implant survival was stated or calculable. Results were calculated by non-parametric univariate Kaplan-Meier analysis and Bayesian multivariate interval-censored Cox regression. RESULTS A total of 122 publications on 16268 endosseous implants placed in grafted maxillary sinus were included. The treatment parameters surgical approach, grafting material and implant type showed no selective preference. However, application of membranes showed a significantly reduced hazard-ratio, independent of other co-factors. CONCLUSIONS The use of membranes is the most significant factor to achieve long-term implant survival in sinus augmentation procedures. More data exceeding 3 years follow-up are needed to address prospective confounding and improve clinical evidence.
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Affiliation(s)
- Fabian Duttenhoefer
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany
- * E-mail:
| | - Cyriel Souren
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany
| | | | - Dominik Emmerich
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Ralf Schön
- Department of Oral and Craniomaxillofacial Surgery, Malteser Krankenhaus St. Josefshospital, Krefeld-Uerdingen, Germany
| | - Sebastian Sauerbier
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany
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Ozdemir H, Ezirganli S, Isa Kara M, Mihmanli A, Baris E. Effects of platelet rich fibrin alone used with rigid titanium barrier. Arch Oral Biol 2013; 58:537-44. [DOI: 10.1016/j.archoralbio.2012.09.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 09/06/2012] [Accepted: 09/28/2012] [Indexed: 10/27/2022]
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Hoekstra JWM, van den Beucken JJJP, Leeuwenburgh SCG, Bronkhorst EM, Meijer GJ, Jansen JA. Tantalum oxide and barium sulfate as radiopacifiers in injectable calcium phosphate-poly(lactic-co-glycolic acid) cements for monitoringin vivodegradation. J Biomed Mater Res A 2013; 102:141-9. [DOI: 10.1002/jbm.a.34677] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 02/14/2013] [Accepted: 02/19/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Jan Willem M. Hoekstra
- Department of Biomaterials; Radboud University Nijmegen Medical Center; Nijmegen The Netherlands
- Department of Implantology and Periodontology; Radboud University Nijmegen Medical Center; Nijmegen The Netherlands
| | | | | | - Ewald M. Bronkhorst
- Department of Preventive and Curative Dentistry and Biostatistics; Radboud University Nijmegen Medical Center; Nijmegen The Netherlands
| | - Gert J. Meijer
- Department of Implantology and Periodontology; Radboud University Nijmegen Medical Center; Nijmegen The Netherlands
| | - John A. Jansen
- Department of Biomaterials; Radboud University Nijmegen Medical Center; Nijmegen The Netherlands
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Dong J, Cui G, Bi L, Li J, Lei W. The mechanical and biological studies of calcium phosphate cement-fibrin glue for bone reconstruction of rabbit femoral defects. Int J Nanomedicine 2013; 8:1317-24. [PMID: 23576869 PMCID: PMC3617789 DOI: 10.2147/ijn.s42862] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In order to improve the mechanical and biological properties of calcium phosphate cement (CPC, nanometer-biomaterial) for bone reconstruction in the rabbit femoral defect model, fibrin glue (FG, the natural product, purified from the blood) was introduced at three different ratios. The CPC powder and the FG solution were mixed, respectively, at the powder/liquid (P/L) ratios (g/mL) of 1:1, 3:1, and 5:1 (g/mL), and pure CPC was used as a control. After being implanted into the femoral defect in rabbit, the healing process was evaluated by micro-computed tomography scan, biomechanical testing, and histological examination. By micro-computed tomography analysis, the P/L ratio of 1:1 (g/mL) group indicated the largest quantity of new bone formation at 4 weeks, 8 weeks, and 12 weeks after implantation, respectively. Bone volume per trabecular volume of the 1:1 group was highest in the four groups, which was 1.45% ± 0.42%, 7.35% ± 1.45%, and 29.10% ± 1.67% at 4 weeks, 8 weeks, and 12 weeks after the operation, respectively. In the biomechanical tests, the compressive strength and the elastic modulus of the three CPC–FG groups were much higher than those of the pure CPC group at the determined time point (P < 0.05). The histological evaluation also showed the best osseointegration in the 1:1 group at 4 weeks, 8 weeks, and 12 weeks after the operation, respectively. In the 1:1 group, the bone grew into the pore of the cement in the laminar arrangement and connected with the cement tightly at the 12th week after the operation. This present study indicated that the CPC–FG composite at the P/L ratio of 1:1 (g/mL) stimulated bone regeneration better than any other designed group, which suggested that CPC–FG at the P/L ratio of 1:1 has significant potential as the bioactive material for the treatment of bone defects.
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Affiliation(s)
- Jingjing Dong
- Institute of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China
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Farré-Guasch E, Prins HJ, Overman JR, ten Bruggenkate CM, Schulten EA, Helder MN, Klein-Nulend J. Human Maxillary Sinus Floor Elevation as a Model for Bone Regeneration Enabling the Application of One-Step Surgical Procedures. TISSUE ENGINEERING PART B-REVIEWS 2013; 19:69-82. [DOI: 10.1089/ten.teb.2012.0404] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Elisabet Farré-Guasch
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam, Research Institute MOVE, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Henk-Jan Prins
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam, Research Institute MOVE, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Research Institute MOVE, VU University Medical Center/Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Janice R. Overman
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam, Research Institute MOVE, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Research Institute MOVE, VU University Medical Center/Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Christiaan M. ten Bruggenkate
- Department of Oral and Maxillofacial Surgery, Research Institute MOVE, VU University Medical Center/Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Engelbert A.J.M. Schulten
- Department of Oral and Maxillofacial Surgery, Research Institute MOVE, VU University Medical Center/Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Marco N. Helder
- Department of Orthopaedics, Research Institute MOVE, VU University Medical Center, Amsterdam, The Netherlands
| | - Jenneke Klein-Nulend
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam, Research Institute MOVE, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
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Prins HJ, Fernandes H, Rozemuller H, van Blitterswijk C, de Boer J, Martens ACM. Spatial distribution and survival of human and goat mesenchymal stromal cells on hydroxyapatite and β-tricalcium phosphate. J Tissue Eng Regen Med 2012; 10:233-44. [PMID: 23255230 DOI: 10.1002/term.1681] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 07/18/2012] [Accepted: 11/14/2012] [Indexed: 01/08/2023]
Abstract
The combination of scaffolds and mesenchymal stromal cells (MSCs) is a promising approach in bone tissue engineering (BTE). Knowledge on the survival, outgrowth and bone-forming capacity of MSCs in vivo is limited. Bioluminescence imaging (BLI), histomorphometry and immunohistochemistry were combined to study the fate of gene-marked goat and human MSCs (gMSCs, hMSCs) on scaffolds with different osteoinductive properties. Luciferase-GFP-labelled MSCs were seeded on hydroxyapatite (HA) or β-tricalcium phosphate (TCP), cultured for 7 days in vitro in osteogenic medium, implanted subcutaneously in immunodeficient mice and monitored with BLI for 6 weeks. The constructs were retrieved and processed for histomorphometry and detection of luciferase-positive cells (LPCs). For gMSCs, BLI revealed doubling of signal after 1 week, declining to 60% of input after 3 weeks and remaining constant until week 6. hMSCs showed a constant decrease of BLI signal to 25% of input, indicating no further expansion. Bone formation of gMSCs was two-fold higher on TCP than HA. hMSCs and gMSCs control samples produced equal amounts of bone on TCP. Upon transduction, there was a four-fold reduction in bone formation compared with untransduced hMSCs, and no bone was formed on HA. LPCs were detected at day 14, but were much less frequent at day 42. Striking differences were observed in spatial distribution. MSCs in TCP were found to be aligned and interconnected on the surface but were scattered in an unstructured fashion in HA. In conclusion, the spatial distribution of MSCs on the scaffold is critical for cell-scaffold-based BTE.
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Affiliation(s)
- Henk-Jan Prins
- Department of Immunology, University Medical Centre Utrecht, The Netherlands
| | - Hugo Fernandes
- Department of Tissue Regeneration, University of Twente, Enschede, The Netherlands
| | - Henk Rozemuller
- Department of Clinical Pharmacy, Cell Therapy Facility, University Medical Centre Utrecht, The Netherlands
| | | | - Jan de Boer
- Department of Tissue Regeneration, University of Twente, Enschede, The Netherlands
| | - Anton C M Martens
- Department of Immunology, University Medical Centre Utrecht, The Netherlands.,Department of Cell Biology, University Medical Centre Utrecht, The Netherlands
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78
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Choi H, Park NJ, Jamiyandorj O, Hong MH, Oh S, Park YB, Kim S. Improvement of osteogenic potential of biphasic calcium phosphate bone substitute coated with synthetic cell binding peptide sequences. J Periodontal Implant Sci 2012. [PMID: 23185697 PMCID: PMC3498301 DOI: 10.5051/jpis.2012.42.5.166] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose The aim of this study was to evaluate the improvement of osteogenic potential of biphasic calcium phosphate (BCP) bone substitute coated with synthetic cell-binding peptide sequences in a standardized rabbit sinus model. Methods Standardized 6-mm diameter defects were created bilaterally on the maxillary sinus of ten male New Zealand white rabbits, receiving BCP bone substitute coated with synthetic cell binding peptide sequences on one side (experimental group) and BCP bone substitute without coating (control group) on the other side. Histologic and histomorphometric analysis of bone formation was carried out after a healing period of 4 or 8 weeks. Results Histological analysis revealed signs of new bone formation in both experimental groups (4- and 8-week healing groups) with a statistically significant increase in bone formation in the 4-week healing group compared to the control group. However, no statistically significant difference in bone formation was found between the 8-week healing group and the control group. Conclusions This study found that BCP bone substitute coated with synthetic cell-binding peptide sequences enhanced osteoinductive potential in a standardized rabbit sinus model and its effectiveness was greater in the 4-week healing group than in the 8-week healing group.
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Affiliation(s)
- Hyunmin Choi
- Department of Prosthodontics, Yonsei University College of Dentistry, Seoul, Korea
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79
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Abstract
PURPOSE The aim of this study is to demonstrate the clinical applicability and efficacy of an allograft for maxillary sinus augmentations in patients requiring placement of dental implants. PATIENTS AND METHODS Sixty consecutive patients underwent a total of 90 sinus augmentations. Twenty-nine were women and 31 men, with a mean age of 54 years. Twenty-six patients received a bilateral procedure and 34 unilateral. All cases were treated with the lateral wall technique. Allograft consisted of demineralized freeze-dried blocks in 6 cases, particulate in 82 cases, and a combination of both in 2 cases. In 30 patients, it was combined with platelet-rich plasma. A total of 84 implants were inserted. Bone samples of grafted areas were obtained in two patients for histological examination. RESULTS Seventy-three implants were clinically successful at the reentry time. Eleven implants in seven patients were removed between 15 days and 6 months after their placement. Seven of these implants were replaced and received prostheses as well, for an overall postloading success rate of 95.2%. Follow-up for all patients after final restoration was between 12 and 96 months. Specimen's histological evaluation revealed bone formation and evidence of inflammatory infiltrate. CONCLUSIONS Based on the findings of this study, it can be suggested that the use of the demineralized freeze-dried bone allograft from the Banco de Huesos y Tejidos Fundación Cosme y Damian for sinus augmentation is effective and constitutes a feasible therapeutic alternative for implant placement.
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80
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Marchand-Libouban H, Guillaume B, Bellaiche N, Chappard D. Texture analysis of computed tomographic images in osteoporotic patients with sinus lift bone graft reconstruction. Clin Oral Investig 2012; 17:1267-72. [PMID: 22886459 DOI: 10.1007/s00784-012-0808-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 07/19/2012] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Bone implants are now widely used to replace missing teeth. Bone grafting (sinus lift) is a very useful way to increase the bone volume of the maxilla in patients with bone atrophy. There is a 6- to 9-month delay for the receiver grafted site to heal before the implants can be placed. Computed tomography is a useful method to measure the amount of remaining bone before implantation and to evaluate the quality of the receiver bone at the end of the healing period. Texture analysis is a non-invasive method useful to characterize bone microarchitecture on X-ray images. PATIENTS AND METHODS Ten patients in which a sinus lift surgery was necessary before implantation were analyzed in the present study. All had a bone reconstruction with a combination of a biomaterial (beta tricalcium phosphate) and autograft bone harvested at the chin. Computed tomographic images were obtained before grafting (t0), at mid-interval (t1, 4.2 ± 0.7 months) and before implant placement (t2, 9.2 ± 0.6 months). Texture analysis was done with the run-length method. RESULTS A significant increase of texture parameters at t1 reflected a gain of homogeneity due to the graft and the beginning of bone remodeling. At t2, some parameters remained high and corresponded to the persistence of bone trabeculae while the resorption of biomaterials was identified by other parameters which tended to return to pregraft values. CONCLUSION Texture analysis identified changes during the healing of the receiver site. CLINICAL RELEVANCE The method is known to correlate with microarchitectural changes in bone and could be a useful approach to characterized osseointegrated grafts.
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Affiliation(s)
- Hélène Marchand-Libouban
- LUNAM Université, GEROM-LHEA Bone Remodeling and Biomaterials-IRIS-IBS Institut de Biologie en Santé, CHU d'Angers, 49933, Angers, Cedex, France
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81
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Klijn RJ, van den Beucken JJ, Félix Lanao RP, Veldhuis G, Leeuwenburgh SC, Wolke JG, Meijer GJ, Jansen JA. Three Different Strategies to Obtain Porous Calcium Phosphate Cements: Comparison of Performance in a Rat Skull Bone Augmentation Model. Tissue Eng Part A 2012; 18:1171-82. [DOI: 10.1089/ten.tea.2011.0444] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Reinoud J. Klijn
- Department of Biomaterials, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Rosa P. Félix Lanao
- Department of Biomaterials, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Sander C. Leeuwenburgh
- Department of Biomaterials, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Joop G.C. Wolke
- Department of Biomaterials, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Gert J. Meijer
- Department of Implantology and Periodontology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - John A. Jansen
- Department of Biomaterials, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Hoekstra JWM, Klijn RJ, Meijer GJ, van den Beucken JJJP, Jansen JA. Maxillary sinus floor augmentation with injectable calcium phosphate cements: a pre-clinical study in sheep. Clin Oral Implants Res 2012; 24:210-6. [PMID: 22335192 DOI: 10.1111/j.1600-0501.2012.02421.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this pre-clinical study was to evaluate the biological performance of two injectable calcium phosphate cement (CPC) composite materials containing poly(D,L-lactic-co-glycolic)acid (PLGA) microspheres with different properties in a maxillary sinus floor elevation model in sheep. MATERIALS AND METHODS PLGA microspheres were made of either low molecular weight (~17 kDa) acid-terminated PLGA (PLGA(L-AT) ) or high molecular weight (~44 kDa) end-capped PLGA (PLGA(H-EC) ) and incorporated in CPC. Eight female Swifter sheep underwent a bilateral maxillary sinus floor elevation procedure via an extra-oral approach. All animals received both materials, alternately injected in the left and right sinus (split-mouth model) and a time point of 12 weeks was used. Analysis of biological performance was based on histology, histomorphometry, and evaluation of sequential fluorochrome labeling. RESULTS Both types of CPC-PLGA composites showed biocompatibility and direct bone-cement contact. CPC-PLGA(L-AT) showed a significantly higher degradation distance compared to CPC-PLGA(H-EC) (1949 ± 1295 μm vs. 459 ± 267 μm; P = 0.0107). Further, CPC-PLGA(L-AT) showed significantly more bone in the region of interest (26.4 ± 10.5% vs. 8.6 ± 3.9% for PLGA(H-EC) ; P = 0.0009) and significantly less remaining CPC material (61.2 ± 17.7% vs. 81.9 ± 10.9% for PLGA(H-EC) ; P = 0.0192). CONCLUSIONS Both CPC-PLGA(L-AT) and CPC-PLGA(H-EC) demonstrated to be safe materials for sinus floor elevation procedures in a large animal model, presenting biocompatibility and direct bone contact. In view of material performance, CPC-PLGA(L-AT) showed significantly faster degradation and a significantly higher amount of newly formed bone compared to CPC-PLGA(H-EC) .
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Affiliation(s)
- Jan Willem M Hoekstra
- Department of Biomaterials, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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83
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Schmitt CM, Doering H, Schmidt T, Lutz R, Neukam FW, Schlegel KA. Histological results after maxillary sinus augmentation with Straumann® BoneCeramic, Bio-Oss®, Puros®, and autologous bone. A randomized controlled clinical trial. Clin Oral Implants Res 2012; 24:576-85. [PMID: 22324456 DOI: 10.1111/j.1600-0501.2012.02431.x] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This investigation focused on a comparison of clinical and histological characteristics after sinus floor augmentation with biphasic calcium phosphate (BCP, Straumann BoneCeramic(®) ), anorganic bovine bone (ABB, Geistlich Bio-Oss(®) ), mineralized cancellous bone allograft (MCBA, Zimmer Puros(®) ), or autologous bone (AB). MATERIALS AND METHODS Thirty consecutive patients with a posterior edentulous maxillary situation and a vertical bone height less than or equal to 4 mm were included in this study. A two-stage procedure was carried out. After augmentation of the maxillary sinus with ABB, BCP, MCBA, or AB followed by a healing period of 5 months, biopsies were taken with simultaneous implant placement. The samples were analyzed using microradiography and histology. RESULTS Ninety-four implants were placed in the augmented positions and 53 bone biopsies were taken and evaluated. The bone volume fraction of newly formed bone was measured as 30.28 ± 2.16% for BCP, 24.9 ± 5.67% for ABB, 41.74 ± 2.1% for AB, and 35.41 ± 2.78% for MCBA with significant increases in bone volume of AB vs. BCP and ABB, and MCBA vs. ABB samples. Significantly different residual bone substitute material was measured as 15.8 ± 2.1% in the BCP group and 21.36 ± 4.83% in the ABB group. CONCLUSION As it provides the highest rate of de novo bone formation, AB can be considered to remain the gold standard in sinus floor augmentation. All tested control materials showed comparable results and are suitable for maxillary sinus augmentation.
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Affiliation(s)
- Christian Martin Schmitt
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
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84
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Lee J, Susin C, Rodriguez NA, de Stefano J, Prasad HS, Buxton AN, Wikesjö UME. Sinus augmentation using rhBMP-2/ACS in a mini-pig model: relative efficacy of autogenous fresh particulate iliac bone grafts. Clin Oral Implants Res 2012; 24:497-504. [DOI: 10.1111/j.1600-0501.2011.02419.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2011] [Indexed: 11/29/2022]
Affiliation(s)
- Jaebum Lee
- Laboratory for Applied Periodontal & Craniofacial Regeneration; Departments of Periodontics and Oral Biology; Georgia Health Sciences University College of Dental Medicine; Augusta; GA; USA
| | - Cristiano Susin
- Laboratory for Applied Periodontal & Craniofacial Regeneration; Departments of Periodontics and Oral Biology; Georgia Health Sciences University College of Dental Medicine; Augusta; GA; USA
| | - Nancy A. Rodriguez
- Laboratory Animal Services; Georgia Health Sciences University; Augusta; GA; USA
| | - Jamie de Stefano
- Laboratory for Applied Periodontal & Craniofacial Regeneration; Departments of Periodontics and Oral Biology; Georgia Health Sciences University College of Dental Medicine; Augusta; GA; USA
| | - Hari S. Prasad
- Hard Tissue Research Laboratory; Division of Oral and Maxillofacial Pathology; University of Minnesota School of Dentistry; Minneapolis; MN; USA
| | | | - Ulf M. E. Wikesjö
- Laboratory for Applied Periodontal & Craniofacial Regeneration; Departments of Periodontics and Oral Biology; Georgia Health Sciences University College of Dental Medicine; Augusta; GA; USA
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85
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Zeng D, Xia L, Zhang W, Huang H, Wei B, Huang Q, Wei J, Liu C, Jiang X. Maxillary sinus floor elevation using a tissue-engineered bone with calcium-magnesium phosphate cement and bone marrow stromal cells in rabbits. Tissue Eng Part A 2011; 18:870-81. [PMID: 22066969 DOI: 10.1089/ten.tea.2011.0379] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The objective of this study was to assess the effects of maxillary sinus floor elevation with a tissue-engineered bone constructed with bone marrow stromal cells (bMSCs) and calcium-magnesium phosphate cement (CMPC) material. The calcium (Ca), magnesium (Mg), and phosphorus (P) ions released from calcium phosphate cement (CPC), magnesium phosphate cement (MPC), and CMPC were detected by inductively coupled plasma atomic emission spectroscopy (ICP-AES), and the proliferation and osteogenic differentiation of bMSCs seeded on CPC, MPC, and CMPC or cultured in CPC, MPC, and CMPC extracts were measured by MTT analysis, alkaline phosphatase (ALP) activity assay, alizarin red mineralization assay, and real-time PCR analysis of the osteogenic genes ALP and osteocalcin (OCN). Finally, bMSCs were combined with CPC, MPC, and CMPC and used for maxillary sinus floor elevation in rabbits, while CPC, MPC, or CMPC without cells served as control groups. The new bone formation in each group was detected by histological finding and fluorochrome labeling at weeks 2 and 8 after surgical operation. It was observed that the Ca ion concentrations of the CMPC and CPC scaffolds was significantly higher than that of the MPC scaffold, while the Mg ions concentration of CMPC and MPC was significantly higher than that of CPC. The bMSCs seeded on CMPC and MPC or cultured in their extracts proliferated more quickly than the cells seeded on CPC or cultured in its extract, respectively. The osteogenic differentiation of bMSCs seeded on CMPC and CPC or cultured in the corresponding extracts was significantly enhanced compared to that of bMSCs seeded on MPC or cultured in its extract; however, there was no significant difference between CMPC and CPC. As for maxillary sinus floor elevation in vivo, CMPC could promote more new bone formation and mineralization compared to CPC and MPC, while the addition of bMSCs could further enhance its new bone formation ability significantly. Our data suggest that CMPC possesses moderate biodegradability and excellent osteoconductivity, which may be attributed to its Ca and Mg ion composition, and the tissue-engineered bone constructed of CMPC and bMSCs might be a potential alterative graft for maxillofacial bone regeneration.
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Affiliation(s)
- Deliang Zeng
- Department of Prosthodontics, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, PR China
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Kaing L, Grubor D, Chandu A. Assessment of bone grafts placed within an oral and maxillofacial training programme for implant rehabilitation. Aust Dent J 2011; 56:406-11. [DOI: 10.1111/j.1834-7819.2011.01369.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Rickert D, Slater JJRH, Meijer HJA, Vissink A, Raghoebar GM. Maxillary sinus lift with solely autogenous bone compared to a combination of autogenous bone and growth factors or (solely) bone substitutes. A systematic review. Int J Oral Maxillofac Surg 2011; 41:160-7. [PMID: 22099314 DOI: 10.1016/j.ijom.2011.10.001] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 09/28/2011] [Accepted: 10/07/2011] [Indexed: 12/25/2022]
Abstract
Literature regarding the outcome of maxillary sinus floor elevation to create sufficient bone fraction to enable implant placement was systematically reviewed. Bone fraction and implant survival rate were assessed to determine whether grafting material or applied growth factor affected bone fraction. Trials where sinus floor elevations with autogenous bone (controls) were compared with autogenous bone combined with growth factors or bone substitutes, or solely with bone substitutes (test groups) were identified; 12 of 1124 fulfilled all inclusion criteria. Meta-analyses comparing the bone fraction after applying: autogenous bone; autologous bone with growth factors (platelet rich plasma); or autogenous bone and bone substitutes (bovine hydroxyapatite, bioactive glass, corticocancellous pig bone) revealed no significant differences in bone formation after 5 months. A significantly higher bone fraction was found in the autogenous bone group compared to the sole use of β-tricalciumphosphate (P=0.036). The one-year overall implant survival rate showed no significant difference between implants. Bone substitutes combined with autogenous bone provide a reliable alternative for autogenous bone as sole grafting material to reconstruct maxillary sinus bony deficiencies, for supporting dental implants after 5 months. Adding growth factors (platelet rich plasma) to grafting material and the sole use of β-tricalciumphosphate did not promote bone formation.
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Affiliation(s)
- D Rickert
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Klijn RJ, van den Beucken JJJP, Bronkhorst EM, Berge SJ, Meijer GJ, Jansen JA. Predictive value of ridge dimensions on autologous bone graft resorption in staged maxillary sinus augmentation surgery using Cone-Beam CT. Clin Oral Implants Res 2011; 23:409-15. [PMID: 22092724 DOI: 10.1111/j.1600-0501.2011.02342.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2011] [Indexed: 11/25/2022]
Abstract
INTRODUCTION No studies are available that provide predictive parameters regarding the expected amount of resorption after maxillary sinus augmentation surgery using autologous bone grafts. Therefore, the aim of this study was to determine parameters influencing the outcome of the bone graft resorption process. MATERIAL AND METHODS In 20 patients, three-dimensional analysis of alveolar ridge dimensions and bone graft volume change in the atrophic posterior maxilla was performed by Cone-Beam Computerized Tomography imaging. Ridge dimensions were assessed before maxillary sinus augmentation surgery. Bone graft volumes were compared after maxillary sinus floor augmentation surgery and a graft healing interval of several months. To analyze the relation between bone volume changes with the independent variables, patients' gender, age, alveolar crest height and width, and graft healing time interval, a multi-level extension of linear regression was applied. RESULTS A residual bone height of 6.0 mm (SD = 3.6 mm) and 6.2 mm (SD = 3.6 mm) was found at the left and right sides, respectively. Moreover, alveolar bone widths of 6.5 mm (SD = 2.2 mm) and 7.0 mm (SD = 2.3 mm) at the premolars, and 8.8 mm (SD = 2.2 mm) and 8.9 mm (SD = 2.5 mm) at the molars regions were found at the left and right site, respectively. Bone graft volume decreased by 25.0% (SD = 21.0%) after 4.7 months (SD = 2.7, median = 4.0 months) of healing time. The variables "age" (P = 0.009) and mean alveolar crest "bone height" (P = 0.043), showed a significant influence on bone graft resorption. A decrease of 1.0% (SE = 0.3%) of bone graft resorption was found for each year the patient grew older, and an increase in bone graft resorption of 1.8% (SE = 0.8%) was found for each mm of original bone height before sinus floor augmentation. CONCLUSIONS Graft resorption occurs when using autologous bone grafts for maxillary sinus augmentation. Alveolar crest bone height and patient age have a significant effect on graft resorption, with increased resorption for higher alveolar crest bone height and decreased resorption for older patients. Consequently, patient characteristics that affect the process of bone graft resorption should be given full consideration, when performing sinus augmentation surgery.
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Affiliation(s)
- R J Klijn
- Department of Biomaterials, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Stavropoulos A, Becker J, Capsius B, Açil Y, Wagner W, Terheyden H. Histological evaluation of maxillary sinus floor augmentation with recombinant human growth and differentiation factor-5-coated β-tricalcium phosphate: results of a multicenter randomized clinical trial. J Clin Periodontol 2011; 38:966-74. [DOI: 10.1111/j.1600-051x.2011.01754.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Klijn RJ, Hoekstra JWM, Van Den Beucken JJJP, Meijer GJ, Jansen JA. Maxillary sinus augmentation with microstructured tricalcium phosphate ceramic in sheep. Clin Oral Implants Res 2011; 23:274-80. [DOI: 10.1111/j.1600-0501.2011.02190.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Clinical and Histologic Outcomes of Calcium Sulfate in the Treatment of Postextraction Sockets. J Craniofac Surg 2011; 22:494-8. [DOI: 10.1097/scs.0b013e318208bb21] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Puricelli E, Corsetti A, Ponzoni D, Martins GL, Leite MG, Santos LA. Characterization of bone repair in rat femur after treatment with calcium phosphate cement and autogenous bone graft. Head Face Med 2010; 6:10. [PMID: 20579394 PMCID: PMC2902431 DOI: 10.1186/1746-160x-6-10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 06/28/2010] [Indexed: 12/13/2022] Open
Abstract
Background In this study, the biocompatibility, stability and osteotransductivity of a new cement based on alpha-tricalcium phosphate (alpha-TCP) were investigated in a bone repair model using a rat model. Methods The potential of alpha-TCP on bone repair was compared to autogenous bone grafting, and unfilled cavities were used as negative control. Surgical cavities were prepared and designated as test (T), implanted with alpha-TCP blocks; negative control (C - ), unfilled; and positive control (C + ), implanted with autogenous bone graft. Results were analyzed on postoperative days three, seven, 14, 21 and 60. Results The histological analyses showed the following results. Postoperative day three: presence of inflammatory infiltrate, erythrocytes and proliferating fibroblasts in T, C - and C + samples. Day seven: extensive bone neoformation in groups T and C + , and beginning of alpha-TCP resorption by phagocytic cells. Days 14 and 21: osteoblastic activity in the three types of cavities. Day 60: In all samples, neoformed bone similar to surrounding bone. Moderate interruption on the ostectomized cortical bone. Conclusions Bone neoformation is seen seven days after implantation of alpha-TCP and autogenous bone. Comparison of C - with T and C + samples showed that repair is faster in implanted cavities; on day 60, control groups presented almost complete bone repair. Alpha-TCP cement presents biocompatibility and osteotransductivity, besides stability, but 60 days after surgery the cavities were not closed.
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Affiliation(s)
- Edela Puricelli
- Oral and Maxillofacial Surgery Unit, Hospital de Clinicas de P.A., School of Dentistry, UFRGS, Porto Alegre, RS, Brazil.
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