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Prinz RAD, da Rocha LR, Eirado TP, da Silva Pinto J, Guimarães JAM, Fogagnolo F, Dias RB. Biological parameters for quality evaluation of allografts from the Brazilian National Institute of Traumatology and Orthopedics tissue bank. Cell Tissue Bank 2024; 25:625-632. [PMID: 38367054 DOI: 10.1007/s10561-024-10125-4] [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: 12/19/2022] [Accepted: 01/10/2024] [Indexed: 02/19/2024]
Abstract
Bone allografts are clinically used in a variety of surgical procedures, and tissue banks are responsible for harvesting, processing, quality testing, storing, and delivering these materials for transplantation. In tissue banks, the bone is processed for the removal of all organic content, remaining only the tissue structure (scaffold). However, several studies have shown that even after using different processing methods, viable cells, functional proteins, and DNA may still persist in the tissue, which constitute the main causes of graft rejection. Therefore, the objective of this study was to establish techniques and biological parameters for quality validation of allografts. To this end, we propose the use of 3 combined methods such as microscopy, histology, and molecular biology techniques to evaluate the quality of allografts harvested and processed by the Brazilian National Institute of Traumatology and Orthopedics (INTO) tissue bank according to the donation criteria of the Brazilian National Health Surveillance Agency and the Brazilian National Transplant System. Bone fragments from different processing stages showed no viable cells on histology, an intact extracellular matrix on scanning electron microscopy, and gradual reduction in DNA amount. Different techniques were used to demonstrate the quality of allografts produced by the INTO tissue bank and to establish biological parameters for ensuring the safety and quality of these products. Future studies need to be undertaken to assess and validate the efficacy of the decellularization process in larger bone grafts with diverse architectural configurations.
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Affiliation(s)
- Rafael A D Prinz
- Transplant Area and Tissue Bank, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO), Av. Brasil, 500, Rio de Janeiro, RJ, 0940-070, Brazil
- Director of the Institute of Medical Education, Campus Vista Carioca University of Estácio de Sá, Rio de Janeiro, RJ, Brazil
| | - Leonardo Rosa da Rocha
- Teaching and Research Division, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO, Av. Brasil, 500, Rio de Janeiro, RJ, 20940-070, Brazil
| | - Thiago Penna Eirado
- Teaching and Research Division, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO, Av. Brasil, 500, Rio de Janeiro, RJ, 20940-070, Brazil
| | - Jonathan da Silva Pinto
- Teaching and Research Division, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO, Av. Brasil, 500, Rio de Janeiro, RJ, 20940-070, Brazil
| | - João Antônio Matheus Guimarães
- Teaching and Research Division, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO, Av. Brasil, 500, Rio de Janeiro, RJ, 20940-070, Brazil
| | - Fabricio Fogagnolo
- Department of Orthopaedics and Anaesthesiology, Ribeirão Preto Medical School, Universidade de São Paulo (USP), Av. Bandeirantes, 3900, São Paulo, SP, 14049900, Brazil
| | - Rhayra Braga Dias
- Teaching and Research Division, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO, Av. Brasil, 500, Rio de Janeiro, RJ, 20940-070, Brazil.
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho, 373/J-10, Rio de Janeiro, RJ, 21941590, Brazil.
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Solakoglu Ö, Götz W, von Baehr V, Heydecke G, Pantel K, Schwarzenbach H. Characterization of immunologically detectable T-cell sensitization, Immunohistochemical detection of pro-inflammatory cytokines, and clinical parameters of patients after allogeneic intraoral bone grafting procedures: a prospective randomized controlled clinical trial in humans. BMC Oral Health 2022; 22:592. [PMID: 36496367 PMCID: PMC9741780 DOI: 10.1186/s12903-022-02584-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The null hypotheses were tested that intraoral bone augmentation using two different allogeneic materials has no impact on the patient's blood levels of material-specific lymphocytes and on the immunohistochemical detection of pro-inflammatory cytokines IL-1α, IL1ß and TNF-α and T-cell markers CD4, CD8 in biopsies of the test groups. METHODS In this prospective RCT, 60 systemically healthy participants were randomly assigned to two allogeneic test groups (1: Maxgraft®, freeze-dried, multiple donors, and 2: Puros®, solvent-dehydrated, single donor) and an autologous control group (10 patients). Plasma samples were collected pre-(T1) and postoperatively (2 weeks (T2) and 4 months (T3)). The Lymphocyte Transformation Test (LTT) was used for analyzing levels of transformed lymphocytes for type IV immune reactions by 3H-thymidine activity. Bone biopsies were harvested at T3 and immunohistochemically analyzed for IL-1α, IL1ß, TNF-α, CD4, CD8 and correlated with the immunological and clinical findings. RESULTS A statistically significant difference between the tested materials was observed for LTT measurements at T3 (p = 0.033). Furthermore, three groups were identified: Group A (LTT negative T1-T3, n = 48), group B (LTT positive T1-T3, n = 7), group C (developing positive LTT at T2, n = 5). A highly significant elevation of IL-1α, IL1ß, TNF-α in patients of group C (p = 0.0001) and a significant elevation of CD4+ cells in patients of group B (p = 0.005) was shown. CONCLUSION Our data show that following allogeneic bone grafting, local and systemic immunological reactions can be detected in some patients. These findings were statistically significant for the timepoint T3 between the tested materials as well as for the groups B and C correlated with group A for both tested materials. Therefore, the null hypotheses were rejected. A preoperative compatibility test for allogeneic materials in order to improve patient safety and the predictability of these materials would be desirable. TRIAL REGISTRATION Ethical commission of the Ärztekammer Hamburg, Germany (PV5211) as well as by the German Registry of Clinical Studies (DRKS00013010) on 30/07/2018 ( http://apps.who.int/trialsearch/ ).
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Affiliation(s)
- Önder Solakoglu
- grid.13648.380000 0001 2180 3484The Dental Department of the University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Werner Götz
- grid.10388.320000 0001 2240 3300Department of Orthodontics, Laboratory for Oral Biologic Basic Science, University of Bonn, Bonn, Germany
| | | | - Guido Heydecke
- grid.13648.380000 0001 2180 3484The Dental Department of Prosthodontics of the University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus Pantel
- grid.13648.380000 0001 2180 3484Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heidi Schwarzenbach
- grid.13648.380000 0001 2180 3484Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Smeets R, Matthies L, Windisch P, Gosau M, Jung R, Brodala N, Stefanini M, Kleinheinz J, Payer M, Henningsen A, Al-Nawas B, Knipfer C. Horizontal augmentation techniques in the mandible: a systematic review. Int J Implant Dent 2022; 8:23. [PMID: 35532820 PMCID: PMC9086020 DOI: 10.1186/s40729-022-00421-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/25/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose Placement of dental implants has evolved to be an advantageous treatment option for rehabilitation of the fully or partially edentulous mandible. In case of extensive horizontal bone resorption, the bone volume needs to be augmented prior to or during implant placement in order to obtain dental rehabilitation and maximize implant survival and success. Methods Our aim was to systematically review the available data on lateral augmentation techniques in the horizontally compromised mandible considering all grafting protocols using xenogeneic, synthetic, or allogeneic material. A computerized and manual literature search was performed for clinical studies (published January 1995 to March 2021). Results Eight studies ultimately met the inclusion criteria comprising a total of 276 procedures of xenogeneic, allogeneic, or autogenous bone graft applications in horizontal ridge defects. Particulate materials as well as bone blocks were used as grafts with a mean follow-up of 26.0 months across all included studies. Outcome measures, approaches and materials varied from study to study. A gain of horizontal bone width of the mandible with a mean of 4.8 mm was observed in seven of eight studies. All but one study, reported low bone graft failure rates of 4.4% in average. Conclusions Only limited data are available on the impact of different horizontal augmentation strategies in the mandible. The results show outcomes for xenogeneic as well as autologous bone materials for horizontal ridge augmentation of the lower jaw. The use of allogeneic bone-block grafts in combination with resorbable barrier membranes must be re-evaluated. Randomized controlled clinical trials are largely missing. Supplementary Information The online version contains supplementary material available at 10.1186/s40729-022-00421-7.
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Histological Evaluation of a New Beta-Tricalcium Phosphate/Hydroxyapatite/Poly (1-Lactide-Co-Caprolactone) Composite Biomaterial in the Inflammatory Process and Repair of Critical Bone Defects. Symmetry (Basel) 2019. [DOI: 10.3390/sym11111356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: The use of biomaterials is commonplace in dentistry for bone regeneration. The aim of this study was to evaluate the performance of a new alloplastic material for bone repair in critical defects and to evaluate the extent of the inflammatory process. Methods: Forty-five New Zealand rabbits were divided into five groups according to evaluation time (7, 14, 30, 60, 120 days), totaling 180 sites with six-millimeter diameter defects in their tibiae. The defects were filled with alloplastic material consisting of poly (lactide-co-caprolactone), beta-tricalcium phosphate, hydroxyapatite and nano-hydroxyapatite (BTPHP) in three different presentations: paste, block, and membrane. Comparisons were established with reference materials, such as Bio-ossTM, Bio-oss CollagenTM, and Bio-gideTM, respectively. The samples were HE-stained and evaluated for inflammatory infiltrate (scored for intensity from 0 to 3) and the presence of newly formed bone at the periphery of the defects. Results: Greater bone formation was observed for the alloplastic material and equivalent inflammatory intensity for both materials, regardless of evaluation time. At 30 days, part of the synthetic biomaterial, regardless of the presentation, was resorbed. Conclusions: We concluded that this novel alloplastic material showed osteoconductive potential, biocompatibility, low inflammatory response, and gradual resorption, thus an alternative strategy for guided bone regeneration.
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Use of Platelet-Rich Fibrin Associated with Xenograft in Critical Bone Defects: Histomorphometric Study in Rabbits. Symmetry (Basel) 2019. [DOI: 10.3390/sym11101293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Platelet-rich fibrin (PRF) is an autologous material used to improve bone regeneration when associated with bone grafts. It affects tissue angiogenesis, increasing the healing process and, theoretically, presenting potential to increase bone neoformation. The aim of this study was to verify, histomorphometrically, the effects of the association of PRF to a xenograft. Twelve adult white New Zealand rabbits were randomly assigned into two groups containing six animals each. After general anesthesia of the animals, two critical defects of 12 mm were created in the rabbit calvaria, one on each side of the sagittal line. Each defect was filled with the following biomaterials: in the control group (CG), xenograft hydrated with saline solution filling one defect and xenograft hydrated with saline solution covered with collagen membrane on the other side; in the test group (TG), xenograft associated with PRF filling the defect of one side and xenograft associated with PRF covered with collagen membrane on the other side. After eight weeks the animals were euthanized and a histomorphometric analysis was performed. The results showed that in the sites that were covered with collagen membrane, there was no statistically significant difference for all the analyzed parameters. However, when comparing the groups without membrane coverage, a statistically significant difference could be observed for the vital mineralized tissue (VMT) and nonmineralized tissue (NMT) parameters, with more VMT in the test group and more NMT in the control group. Regarding the intragroup comparison, the use of the membrane coverage presented significant outcomes in both groups. Therefore, in this experimental model, PRF did not affect the levels of bone formation when a membrane coverage technique was used. However, higher levels of bone formation were observed in the test group when membrane coverage was not used.
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Loin J, Kün-Darbois JD, Guillaume B, Badja S, Libouban H, Chappard D. Maxillary sinus floor elevation using Beta-Tricalcium-Phosphate (beta-TCP) or natural bone: same inflammatory response. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2019; 30:97. [PMID: 31440845 DOI: 10.1007/s10856-019-6299-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/02/2019] [Indexed: 06/10/2023]
Abstract
Sinus elevation is a common procedure to increase bone volume in the atrophic maxilla to allow placement of dental implants. Autogenous bone is the gold standard but is limited in quantity and causes morbidity at the donor site. β-TCP is a synthetic biomaterial commonly used in that purpose. It appears to induce a poor inflammatory response. This study aimed to evaluate the degree of edema of the sinus mucosa after sinus lift surgery according to the type of biomaterial. Forty sinuses (20 patients) were included retrospectively and divided into 2 groups according to the biomaterial that was used: synthetic biomaterial (BTCP group), natural bone (BONE group). A control group (CTRL group) was constituted by the non-grafted maxillary sinuses. Twelve measurements per sinus were realized on pre- and post-operative computed tomography and averaged to provide the sinus membrane thickness value (SM.Th). SM.Th was thicker post-operatively in the BTCP and BONE groups in comparison with the CTRL group and in comparison with pre-operative measurements. No difference was found post operatively between the BTCP and BONE groups. We found that a synthetic biomaterial (β-TCP) induced the same degree of edema, and thus of inflammation, as natural bone. It constitutes therefore an interesting alternative to autogenous bone for maxillary sinus lifts.
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Affiliation(s)
- Justine Loin
- Service de Chirurgie Maxillo-faciale et stomatologie, CHU d'Angers, 4 rue Larrey, 49933, Angers Cedex, France
| | - Jean-Daniel Kün-Darbois
- Service de Chirurgie Maxillo-faciale et stomatologie, CHU d'Angers, 4 rue Larrey, 49933, Angers Cedex, France.
- Groupe Etudes Remodelage Osseux et bioMatériaux, GEROM, EA 4658, SFR 4208, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, CHU d'Angers, 49933, Angers Cedex, France.
| | - Bernard Guillaume
- Groupe Etudes Remodelage Osseux et bioMatériaux, GEROM, EA 4658, SFR 4208, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, CHU d'Angers, 49933, Angers Cedex, France
- Centre Français d'Implantologie CFI, 6 rue de Rome, 75008, Paris, France
| | - Smail Badja
- Service de Chirurgie Maxillo-faciale et stomatologie, CHU d'Angers, 4 rue Larrey, 49933, Angers Cedex, France
| | - Hélène Libouban
- Groupe Etudes Remodelage Osseux et bioMatériaux, GEROM, EA 4658, SFR 4208, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, CHU d'Angers, 49933, Angers Cedex, France
| | - Daniel Chappard
- Groupe Etudes Remodelage Osseux et bioMatériaux, GEROM, EA 4658, SFR 4208, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, CHU d'Angers, 49933, Angers Cedex, France
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Affiliation(s)
- D Chappard
- GEROM (groupe études remodelage osseux et biomatériaux), LHEA, IRIS, IBS, LabCom NextBone, université d'Angers, CHU d'Angers, 49933 Angers cedex, France.
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Coutinho LF, Amaral JBD, Santos ÉBD, Martinez EF, Montalli VAM, Junqueira JLC, Araújo VCD, Napimoga MH. Presence of Cells in Fresh-Frozen Allogeneic Bone Grafts from Different Tissue Banks. Braz Dent J 2018; 28:152-157. [PMID: 28492743 DOI: 10.1590/0103-6440201701206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 01/04/2017] [Indexed: 11/22/2022] Open
Abstract
Bone replacement materials have been widely used to reconstruct atrophic jawbones. Based on previous reports demonstrating the presence of viable cells in bone blocks even after processing by musculoskeletal tissue banks for orthopedic use, the aim of this study was to evaluate the presence of cells in bone blocks from three Brazilian tissue banks for maxillary reconstructions. All samples were processed by the respective tissue banks, according to the guidelines of the Brazilian National Sanitary Surveillance Agency. Three samples were removed from each block for subsequent histological processing and stained using hematoxylin & eosin. Further evaluation included section staining by the Feulgen method and ultrastructural analysis using scanning electron microscopy (SEM). Light microscopy images from all bone samples showed presence of osteocyte-like cells in all groups and intense Feulgen staining, demonstrating presence of DNA in bone even after tissue processing. The ultrastructural analysis showed red blood cells in lacunae within the bone tissue. In conclusion, despite bone tissue processing by the musculoskeletal tissue banks, cells may be found within the bone used for allogeneic grafts.
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de Almeida JM, de Moraes RO, Gusman DJR, Faleiros PL, Nagata MJH, Garcia VG, Theodoro LH, Bosco AF. Influence of low-level laser therapy on the healing process of autogenous bone block grafts in the jaws of systemically nicotine-modified rats: A histomorphometric study. Arch Oral Biol 2017; 75:21-30. [DOI: 10.1016/j.archoralbio.2016.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 10/21/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
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HLA-typing analysis following allogeneic bone grafting for sinus lifting. Cell Tissue Bank 2016; 18:75-81. [DOI: 10.1007/s10561-016-9594-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/21/2016] [Indexed: 12/18/2022]
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