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Zamparini F, Gandolfi MG, Spinelli A, Ferri M, Iezzi G, Botticelli D, Prati C. Mineralization and morphology of peri-implant bone around loaded and unloaded dental implants retrieved from the human mandible. Oral Maxillofac Surg 2024; 28:623-637. [PMID: 37667130 PMCID: PMC11144681 DOI: 10.1007/s10006-023-01175-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/12/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE Limited data is reported regarding the bone mineralization around dental implants in the first months from insertion. The study analyzed the peri-implant bone around loaded and unloaded implants retrieved from human mandible after 4 months from placement. METHOD The composition and mineralization of human bone were analyzed through an innovative protocol technique using Environmental-Scanning-Electron-Microscopy connected with Energy-Dispersive-X-Ray-Spectroscopy (ESEM/EDX). Two regions of interest (ROIs, approximately 750×500 μm) for each bone implant sample were analyzed at the cortical (Cortical ROI) and apical (Apical ROI) implant threads. Calcium, phosphorus, and nitrogen (atomic%) were determined using EDX, and the specific ratios (Ca/N, P/N, and Ca/P) were calculated as mineralization indices. RESULTS Eighteen implant biopsies from ten patients were analyzed (unloaded implants, n=10; loaded implants, n=8). For each ROI, four bone areas (defined bones 1-4) were detected. These areas were characterized by different mineralization degree, varied Ca, P and N content, and different ratios, and by specific grayscale intensity detectable by ESEM images. Bony tissue in contact with loaded implants at the cortical ROI showed a higher percentage of low mineralized bone (bone 1) and a lower percentage of remodeling bone (bone 2) when compared to unloaded implants. The percentage of highly mineralized bone (bone 3) was similar in all groups. CONCLUSION Cortical and apical ROIs resulted in a puzzle of different bone "islands" characterized by various rates of mineralization. Only the loaded implants showed a high rate of mineralization in the cortical ROI.
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Affiliation(s)
- Fausto Zamparini
- Laboratory of Biomaterials and Oral Pathology, Department of Biomedical and Neuromotor Sciences, School of Dentistry, University of Bologna, 40126, Bologna, Italy.
- Endodontic Clinical Section, Department of Biomedical and Neuromotor Sciences, School of Dentistry, University of Bologna, 40126, Bologna, Italy.
| | - Maria Giovanna Gandolfi
- Laboratory of Biomaterials and Oral Pathology, Department of Biomedical and Neuromotor Sciences, School of Dentistry, University of Bologna, 40126, Bologna, Italy
| | - Andrea Spinelli
- Endodontic Clinical Section, Department of Biomedical and Neuromotor Sciences, School of Dentistry, University of Bologna, 40126, Bologna, Italy
| | - Mauro Ferri
- School of Dentistry, Corporación Universitária Rafael Núñez, 130001, Cartagena, de Indias, Colombia
| | - Giovanna Iezzi
- Department of Medical Oral and Biotechnological Sciences, University of Chieti/Pescara, 66013, Chieti, Italy
| | | | - Carlo Prati
- Endodontic Clinical Section, Department of Biomedical and Neuromotor Sciences, School of Dentistry, University of Bologna, 40126, Bologna, Italy
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Imai H, Prati C, Zamparini F, Iezzi G, Botticelli D, Gandolfi MG, Baba S. ESEM-EDX Mineralization and Morphological Analysis of Human Retrieved Maxillary Sinus Bone Graft Biopsies before Loading. J Funct Biomater 2023; 14:391. [PMID: 37504886 PMCID: PMC10382039 DOI: 10.3390/jfb14070391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/10/2023] [Accepted: 07/22/2023] [Indexed: 07/29/2023] Open
Abstract
This study aimed to analyze the morphology of bone graft granules, the presence of granule demineralization, and bone morphology in retrieved human maxillary sinus bone graft biopsies. Healthy patients underwent sinus bone augmentation using lateral access. Two different dimensions of the antrostomy were performed, a 4 mm or 8 mm height. After 6 months, all sites received one implant using a flap technique, crestal positioning, and submerged healing. Implant biopsies were retrieved after 3 months and were histologically processed. The ESEM analysis was performed on the entire portion of the peri-implant bone (up to 750 µm from the implant thread). Three different regions of interest (ROIs) were selected: the coronal, middle, and apical portions of the implant. In these areas, EDX was performed, and calcium (Ca), phosphate (P), nitrogen (N), and their atomic ratios (Ca/P, Ca/N, and P/N) were calculated. Different bone tissue electron-dense areas were detected through grayscale intensity quantification of ESEM images with different organic (N) or inorganic (Ca,P) compositions. A total of 16 biopsies from 16 healthy patients were analyzed. Bone graft granules were mostly detected in the apical ROI. New bone tissue bridges were detected in the apical and middle ROI. These structures, with lower Ca/N and P/N ratios, were connected and enveloped the bone graft granules. Cortical ROI revealed the most mineralized bone tissue. Conclusions: After 9 months, bone graft resorption was only partially completed and new bone tissue appeared less mineralized in the middle and apical ROI than in the coronal ROI.
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Affiliation(s)
- Hideki Imai
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata 573-1121, Osaka, Japan
| | - Carlo Prati
- School of Dentistry, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40125 Bologna, Italy
| | - Fausto Zamparini
- School of Dentistry, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40125 Bologna, Italy
- Laboratory of Biomaterials and Oral Pathology, School of Dentistry, 40125 Bologna, Italy
| | - Giovanna Iezzi
- Department of Medical Oral and Biotechnological Sciences, University of Chieti, 66100 Chieti, Italy
| | - Daniele Botticelli
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata 573-1121, Osaka, Japan
- ARDEC Academy, 47923 Rimini, Italy
| | - Maria Giovanna Gandolfi
- School of Dentistry, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40125 Bologna, Italy
- Laboratory of Biomaterials and Oral Pathology, School of Dentistry, 40125 Bologna, Italy
| | - Shunsuke Baba
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata 573-1121, Osaka, Japan
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Miyauchi Y, Izutani T, Teranishi Y, Iida T, Nakajima Y, Xavier SP, Baba S. Healing Patterns of Non-Collagenated Bovine and Collagenated Porcine Xenografts Used for Sinus Floor Elevation: A Histological Study in Rabbits. J Funct Biomater 2022; 13:jfb13040276. [PMID: 36547536 PMCID: PMC9787467 DOI: 10.3390/jfb13040276] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Objective: To compare healing of collagenated and non-collagenated xenografts used for maxillary sinus floor elevation. Materials and Methods: Two different xenografts were used: deproteinized bovine bone (DBBM group) and collagenated corticocancellous porcine bone (collagenated group). Healing was studied after 2, 4, and 8 weeks. The loss of dimensions of the elevated area and the percentages of new bone, xenograft remnants, osteoclastic zones, vessels, inflammatory infiltrates, and soft tissues were analyzed. Three regions were evaluated: close to the bone walls (bone wall region), subjacent the sinus mucosa (submucosa region), and the center of the elevated area (middle region). The primary variables were the percentage of new bone and xenograft remnants. Results: Between 2 and 8 weeks, the elevated areas showed a reduction of 16.3% and 52.2% in the DBBM and collagenated groups, respectively (p < 0.01 between the two areas after 8 weeks). After 8 weeks, the highest content of new bone was observed in the bone wall region, which was higher in the collagenated group than in the DBBM group (41.6% and 28.6%, respectively; p < 0.01). A similar quantity of new bone was found between the two groups in other regions. A higher percentage of vessels in all regions evaluated (p < 0.01) and soft tissue in the sub-mucosa region (p < 0.05) was found in the collagenated group than in the DBBM group. Conclusions: The present study showed that both xenografts allowed new bone formation. In comparison with the non-collagenated xenograft, the collagenated xenograft underwent higher resorption, resulting in greater shrinkage of the elevated space after sinus lifting and a higher content of new bone in the regions close to the bone walls. Clinical relevance: In this study, the region adjacent to the bone wall showed the highest new bone content. This region resembles the base of the sinus, closest to the sinus floor and walls, and is the most important region from a clinical point of view because it is where the implant will be installed. Residues of the biomaterial remained after 8 weeks of healing. Other reports have shown that these biomaterial residues may interfere with the integration of implants.
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Affiliation(s)
- Yuhei Miyauchi
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka 573-1121, Japan
| | - Takayuki Izutani
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka 573-1121, Japan
| | - Yuki Teranishi
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka 573-1121, Japan
| | - Takahisa Iida
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka 573-1121, Japan
| | - Yasushi Nakajima
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka 573-1121, Japan
- ARDEC Academy, Viale Giovanni Pascoli 67, 47923 Rimini, Italy
| | - Samuel Porfirio Xavier
- ARDEC Academy, Viale Giovanni Pascoli 67, 47923 Rimini, Italy
- Department of Oral and Maxillofacial Surgery and Periodontology, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-904, São Paulo, Brazil
- Correspondence:
| | - Shunsuke Baba
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka 573-1121, Japan
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Morimoto A, Kobayashi N, Ferri M, Iezzi G, Piattelli A, Fortich Mesa N, Botticelli D. Influence on Implant Bone Healing of a Collagen Membrane Placed Subjacent the Sinus Mucosa-A Randomized Clinical Trial on Sinus Floor Elevation. Dent J (Basel) 2022; 10:dj10060105. [PMID: 35735646 PMCID: PMC9221570 DOI: 10.3390/dj10060105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/15/2022] [Accepted: 06/06/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Perforation of the sinus mucosa is quite a frequent complication that might occur during sinus floor elevation. The perforation is often protected with a collagen membrane to avoid the extrusion of graft particles within the sinus. However, this procedure might hinder the innate osteogenic potential of the sinus mucosa. Hence, the aim of the study was to evaluate the influence of a placement of a collagen membrane subjacent the Schneiderian membrane during sinus floor elevation on implant bone healing. Methods: Twenty volunteers took part in the trial. Ten were randomly included in the group that received a collagen membrane subjacent the sinus mucosa (Mb group), and ten did not receive the membrane (non-Mb group). A collagenated corticocancellous porcine bone was used to fill the elevated space. Six 6 months after the sinus floor elevation, a mini implant was placed transcrestally and retrieved after a further 3 months. Histological analyses were then performed on the full body of the mini implant as well as on its coronal and apical portions. Results: The new bone apposition proportion onto the implant surface was similar in the Mb and non-Mb groups, both in the apical and coronal portions of the mini implants. A lesser amount of graft was found in contact with the surface. New bone density around the mini implants were similar both in the apical and coronal portions. However, a statistically higher proportion of graft particles was found in the Mb group compared to the non-membrane group. Conclusions: The placement of a collagen membrane subjacent the sinus mucosa did not affect bone healing at implants and bone density.
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Affiliation(s)
- Akihiro Morimoto
- Department of Oral Implantology, School of Dentistry, Osaka Dental University, Osaka 573-1144, Japan; (A.M.); (N.K.)
| | - Nobuhiro Kobayashi
- Department of Oral Implantology, School of Dentistry, Osaka Dental University, Osaka 573-1144, Japan; (A.M.); (N.K.)
| | - Mauro Ferri
- ARDEC Foundation, Cartagena de Indias 130001, Colombia;
| | - Giovanna Iezzi
- Department of Medical Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy; (G.I.); (A.P.)
| | - Adriano Piattelli
- Department of Medical Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy; (G.I.); (A.P.)
| | - Natalia Fortich Mesa
- School of Dentistry, University Corporation Rafael Núñez, Cartagena de Indias 130001, Colombia;
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Kotsu M, Apaza Alccayhuaman KA, Ferri M, Iezzi G, Piattelli A, Fortich Mesa N, Botticelli D. Osseointegration at Implants Installed in Composite Bone: A Randomized Clinical Trial on Sinus Floor Elevation. J Funct Biomater 2022; 13:jfb13010022. [PMID: 35323222 PMCID: PMC8950152 DOI: 10.3390/jfb13010022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/19/2022] [Accepted: 02/24/2022] [Indexed: 02/08/2023] Open
Abstract
Osseointegration of implants installed in conjunction with sinus floor elevation might be affected by the presence of residual graft. The implant surface characteristics and the protection of the access window using a collagen membrane might influence the osseointegration. To evaluate these factors, sinus floor elevation was performed in patients using a natural bovine bone grafting material. The access windows were either covered with a collagen membrane made of porcine corium (Mb group) or left uncovered (No-Mb group) and, after six months, two mini-implants with either a moderate rough or turned surfaces were installed. After 3 months, biopsies containing the mini-implants were retrieved, processed histologically, and analyzed. Twenty patients, ten in each group, were included in the study. The two mini-implants were retrieved from fourteen patients, six belonging to the Mb group, and eight to the No-Mb group. No statistically significant differences were found in osseointegration between groups. However, statistically significant differences were found between the two surfaces. It was concluded that implants with a moderately rough surface installed in a composite bone presented much higher osseointegration compared to those with a turned surface. The present study failed to show an effect of the use of a collagen membrane on the access window.
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Affiliation(s)
| | | | - Mauro Ferri
- ARDEC Foundation, Cartagena de Indias 130001, Colombia;
| | - Giovanna Iezzi
- Department of Medical Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy; (G.I.); (A.P.)
| | - Adriano Piattelli
- Department of Medical Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy; (G.I.); (A.P.)
| | - Natalia Fortich Mesa
- School of Dentistry, University Corporation Rafael Núñez, Cartagena de Indias 130001, Colombia;
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Costa MM, Botticelli D, Moses O, Omori Y, Fujiwara S, Silva ER, Xavier SP. Maxillary Sinus Augmentation Using Ceramic Alloplastic Granules or Paste: An Experimental Study in Rabbits. Dent J (Basel) 2021; 9:65. [PMID: 34205201 PMCID: PMC8226577 DOI: 10.3390/dj9060065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Due to the lack of data comparing the biological behavior of two formulations, granules and paste, of alloplastic graft from microtomographic and histomorphometric points of view, the aim of the present experiment was to compare the histomorphometric and microtomographic healing of two formulations, i.e., granules (MR sites) or paste (MR-inject sites) of an alloplastic graft composed of a combination of beta-tricalcium phosphate and hydroxyapatite used for maxillary sinus lifting. METHODS A sinus lifting procedure was carried out bilaterally in 20 rabbits, and the elevated space was filled with either paste or granules of an alloplastic material. A collagen membrane was placed on the antrostomy and the animals were euthanized after 2 or 10 weeks, 10 animals each group. Microtomographic and histological analyses were performed. RESULTS Higher proportions of new bone formation were found at the MR, compared to the MR-inject sites both after 2 weeks (2.65 ± 2.89% vs. 0.08 ± 0.12%; p < 0.01) and 10 weeks of healing (34.20 ± 13.86 vs. 23.28 ± 10.35%; p = 0.022). CONCLUSIONS It was concluded that new bone formation was faster in the MR sites, compared to the MR-inject. However, a longer time of healing should be allowed to make final conclusions about the efficiency in bone formation of the paste formulation of the biomaterial used in the present study.
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Affiliation(s)
- Michael Medeiros Costa
- Department of Oral and Maxillofacial Surgery and Periodontology, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo 14040-904, Brazil; (M.M.C.); (E.R.S.); (S.P.X.)
| | | | - Ofer Moses
- Department of Periodontology and Dental Implantology, School of Dental Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Yuki Omori
- ARDEC Academy, 47923 Rimini, Italy; (D.B.); (Y.O.); (S.F.)
- Department of Oral Implantology, Osaka Dental University, Osaka 573-1144, Japan
| | | | - Erick Ricardo Silva
- Department of Oral and Maxillofacial Surgery and Periodontology, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo 14040-904, Brazil; (M.M.C.); (E.R.S.); (S.P.X.)
| | - Samuel Porfirio Xavier
- Department of Oral and Maxillofacial Surgery and Periodontology, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo 14040-904, Brazil; (M.M.C.); (E.R.S.); (S.P.X.)
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Velasco-Ortega E, Valente NA, Iezzi G, Petrini M, Derchi G, Barone A. Maxillary sinus augmentation with three different biomaterials: Histological, histomorphometric, clinical, and patient-reported outcomes from a randomized controlled trial. Clin Implant Dent Relat Res 2020; 23:86-95. [PMID: 33295137 DOI: 10.1111/cid.12964] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/16/2020] [Accepted: 10/30/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lateral maxillary sinus augmentation (MSA) is a predictable bone regeneration technique in case of atrophy of the posterior-upper maxilla. Aimed at obtaining quantity and quality of bone suitable for receiving osseointegrated implants, its success is largely due to the skill of the surgeon, but also to the characteristics of the biomaterial used. METHODS Twenty-four patients needing MSA were included in the study. The patients were randomly allocated to three different groups: anorganic bovine bone mineral as control, tricalcium phosphate with or without hyaluronic acid (HA) as test groups. Nine months after MSA, bone biopsies were harvested for the histomorphometric analysis. Secondary outcomes were mean bone gain, intraoperative and postoperative complications, implant insertion torque, implant failure, and patient-reported outcome measures. RESULTS Although the percentage of new bone was not statistically different between the three groups (P = .191), the percentages of residual biomaterial was significantly higher (P < .000) and nonmineralized tissue significantly lower (P < .000) in the control than in the test groups. Test groups did not differ significantly from each other for all histomorphometric parameters. The implant insertion torque was significantly higher in the control group (P < .0005). The rest of the secondary outcomes were not significantly different between the groups. CONCLUSION MSA is a safe and predictable procedure in terms of histological, clinical, and PROAMs, regardless of the biomaterial used. The addition of HA did not influence the outcomes.
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Affiliation(s)
| | - Nicola Alberto Valente
- Department of Stomatology, Faculty of Dentistry, University of Seville, Seville, Spain.,Formerly, Unit of Oral Surgery and Implantology, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | - Giovanna Iezzi
- Department of Medical, Oral and Biotechnological Science, University G. d'Annunzio of Chieti, Chieti, Italy
| | - Morena Petrini
- Department of Medical, Oral and Biotechnological Science, University G. d'Annunzio of Chieti, Chieti, Italy
| | - Giacomo Derchi
- Department of Surgical, Medical, Molecular and of the Critical Needs Pathologies, University-Hospital of Pisa, Complex Unit of Stomatology and Oral Surgery, Pisa, Italy
| | - Antonio Barone
- Formerly, Unit of Oral Surgery and Implantology, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland.,Department of Surgical, Medical, Molecular and of the Critical Needs Pathologies, University-Hospital of Pisa, Complex Unit of Stomatology and Oral Surgery, Pisa, Italy
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