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Recent Clinical Treatment and Basic Research on the Alveolar Bone. Biomedicines 2023; 11:biomedicines11030843. [PMID: 36979821 PMCID: PMC10044990 DOI: 10.3390/biomedicines11030843] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 03/12/2023] Open
Abstract
The periodontal ligament is located between the bone (alveolar bone) and the cementum of the tooth, and it is connected by tough fibers called Sharpey’s fibers. To maintain healthy teeth, the foundation supporting the teeth must be healthy. Periodontal diseases, also known as tooth loss, cause the alveolar bone to dissolve. The alveolar bone, similar to the bones in other body parts, is repeatedly resorbed by osteoclasts and renewed by osteogenic cells. This means that an old bone is constantly being resorbed and replaced by a new bone. In periodontal diseases, the alveolar bone around the teeth is absorbed, and as the disease progresses, the alveolar bone shrinks gradually. In most cases, the resorbed alveolar bone does not return to its original form even after periodontal disease is cured. Gum covers the tooth surface so that it matches the shape of the resorbed alveolar bone, exposing more of the tooth surface than before, making the teeth look longer, leaving gaps between the teeth, and in some cases causing teeth to sting. Previously, the only treatment for periodontal diseases was to stop the disease from progressing further before the teeth fell out, and restoration to the original condition was almost impossible. However, a treatment method that can help in the regeneration of the supporting tissues of the teeth destroyed by periodontal diseases and the restoration of the teeth to their original healthy state as much as possible is introduced. Recently, with improvements in implant material properties, implant therapy has become an indispensable treatment method in dentistry and an important prosthetic option. Treatment methods and techniques, which are mainly based on experience, have gradually accumulated scientific evidence, and the number of indications for treatment has increased. The development of bone augmentation methods has contributed remarkably to the expansion of indications, and this has been made possible by various advances in materials science. The induced pluripotent stem cell (iPS) cell technology for regenerating periodontal tissues, including alveolar bone, is expected to be applied in the treatment of diseases, such as tooth loss and periodontitis. This review focuses on the alveolar bone and describes clinical practice, techniques, and the latest basic research.
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Correia F, Gouveia SA, Pozza DH, Felino AC, Faria-Almeida R. A Randomized Clinical Trial Comparing Implants Placed in Two Different Biomaterials Used for Maxillary Sinus Augmentation. MATERIALS (BASEL, SWITZERLAND) 2023; 16:1220. [PMID: 36770223 PMCID: PMC9919245 DOI: 10.3390/ma16031220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
The objective of this study was to compare marginal bone loss, surgical and clinical complications, and dental implant survival rate in bilateral maxillary sinus augmented by autologous or porcine xenograft. A randomized controlled clinical trial using split-mouth design enrolled 12 consent adult patients (59.7 ± 8.7 years), who received bilateral maxillary sinus floor augmentation for oral rehabilitation with implant-supported prosthesis. Each patient received both the autologous bone from the mandible (control) or porcine xenograft (test) during the random bilateral sinus lift surgery. A total of 39 dental implants were placed in the posterior maxilla of the 12 patients after 6 months, being rehabilitated after the respective osseointegration period. Both graft materials demonstrated a high implant survival rate at 12 months: 95% for the xenograft side, only 1 implant without osseointegration, and 100% for the autologous side. Radiographic bone loss was low and similar for both groups: control group with a mean of 0.063 ± 0.126, and test group with a mean of 0.092 ± 0.163. No major surgical-related complications have occurred. Only one patient had several prosthetic complications due to fractures of prosthetic components. The maxillary sinus augmentation procedure, both with autologous bone and porcine xenograft materials, is an excellent clinical option procedure for the prosthetic rehabilitation of atrophic maxillae, with low marginal bone loss after one year follow-up, few clinical complications, and a high implant survival rate.
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Affiliation(s)
- Francisco Correia
- Department of Oral Surgery and Periodontology, Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal
| | - Sónia Alexandre Gouveia
- Intelligent Systems Associate Laboratory (LASI), Department of Electronics, Telecommunications and Informatics (DETI), Institute of Electronics and Informatics Engineering of Aveiro (IEETA), University of Aveiro, 3810-193 Aveiro, Portugal
| | - Daniel Humberto Pozza
- Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Histology, Faculty of Nutrition and Food Sciences, University of Porto, 4150-177 Porto, Portugal
- Institute for Research and Innovation in Health and IBMC, University of Porto, 4200-135 Porto, Portugal
| | - António Campos Felino
- Department of Oral Surgery and Periodontology, Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal
| | - Ricardo Faria-Almeida
- Department of Oral Surgery and Periodontology, Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal
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Hsu YT, Rosen PS, Choksi K, Shih MC, Ninneman S, Lee CT. Complications of sinus floor elevation procedure and management strategies: A systematic review. Clin Implant Dent Relat Res 2022; 24:740-765. [PMID: 35737681 DOI: 10.1111/cid.13086] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 12/14/2022]
Abstract
AIM This systematic review aimed to investigates the types and incidences of complications following sinus floor elevations (SFE) along with their prevention and management strategies. MATERIALS AND METHODS Electronic database and hand search were conducted to screen the literature published from January 1960 to June 2021. The selected studies had to report well-described SFE techniques, complications during, and post-SFE. Data extraction included types of SFE techniques, complications, and their treatment strategies. RESULTS A total of 74 studies with 4411 SFE procedures met the inclusion criteria. Different SFE techniques demonstrated varying patterns for both complications and complication rates. Postoperative pain, swelling, and edema were widely reported. The most common complications that required intervention following Lateral SFE (LSFE) were sinus membrane perforation (SMP), wound dehiscence, graft exposure and failure, and sinusitis. LSFE had more SMPs and sinusitis cases compared with a transcrestal SFE (TSFE). The presence of benign paroxysmal positional vertigo following TSFE was significant in certain selected studies. CONCLUSION Given the inherent limitations, this systematic review showed distinct features of complications in SFE using varying techniques. Treatment planning for these procedures should incorporate strategies to avoid complication occurrence.
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Affiliation(s)
- Yung-Ting Hsu
- Department of Periodontics, University of Washington School of Dentistry, Seattle, Washington, USA
| | - Paul S Rosen
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Karishma Choksi
- Division of Clinical Dentistry, University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA
| | - Ming-Chieh Shih
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shale Ninneman
- Department of Periodontics, University of Washington School of Dentistry, Seattle, Washington, USA
| | - Chun-Teh Lee
- Department of Periodontics and Dental Hygiene, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Susin C, Lee J, Fiorini T, Koo KT, Schüpbach P, Finger Stadler A, Wikesjö UME. Screening of Hydroxyapatite Biomaterials for Alveolar Augmentation Using a Rat Calvaria Critical-Size Defect Model: Bone Formation/Maturation and Biomaterials Resolution. Biomolecules 2022; 12:1677. [PMID: 36421691 PMCID: PMC9687935 DOI: 10.3390/biom12111677] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Natural (bovine-/equine-/porcine-derived) or synthetic hydroxyapatite (HA) biomaterials appear to be the preferred technologies among clinicians for bone augmentation procedures in preparation for implant dentistry. The aim of this study was to screen candidate HA biomaterials intended for alveolar ridge augmentation relative to their potential to support local bone formation/maturation and to assess biomaterial resorption using a routine critical-size rat calvaria defect model. METHODS Eighty adult male Sprague Dawley outbred rats obtained from a approved-breeder, randomized into groups of ten, were used. The calvaria defects (ø8 mm) either received sham surgery (empty control), Bio-Oss (bovine HA/reference control), or candidate biomaterials including bovine HA (Cerabone, DirectOss, 403Z013), and bovine (403Z014) or synthetic HA/ß-TCP (Reprobone, Ceraball) constructs. An 8 wk healing interval was used to capture the biomaterials' resolution. RESULTS All biomaterials displayed biocompatibility. Strict HA biomaterials showed limited, if any, signs of biodegradation/resorption, with the biomaterial area fraction ranging from 22% to 42%. Synthetic HA/ß-TCP constructs showed limited evidence of biodegradation/erosion (biomaterial area fraction ≈30%). Mean linear defect closure in the sham-surgery control approximated 40%. Mean linear defect closure for the Bio-Oss reference control approximated 18% compared with 15-35% for the candidate biomaterials without significant differences between the controls and candidate biomaterials. CONCLUSIONS None of the candidate HA biomaterials supported local bone formation/maturation beyond the native regenerative potential of this rodent model, pointing to their limitations for regenerative procedures. Biocompatibility and biomaterial dimensional stability could suggest their potential utility as long-term defect fillers.
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Affiliation(s)
- Cristiano Susin
- Laboratory for Applied Periodontal & Craniofacial Research (LAPCR), Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jaebum Lee
- Laboratory for Applied Periodontal & Craniofacial Research (LAPCR), Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Tiago Fiorini
- Laboratory for Applied Periodontal & Craniofacial Research (LAPCR), Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Section of Periodontology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre 90000-000, Brazil
| | - Ki-Tae Koo
- Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul 110-460, Korea
| | | | - Amanda Finger Stadler
- Laboratory for Applied Periodontal & Craniofacial Research (LAPCR), Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Ulf ME Wikesjö
- Laboratory for Applied Periodontal & Craniofacial Research (LAPCR), Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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王 京, 王 霄. [ In vivo study of strontium-doped calcium phosphate cement for biological properties]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53:378-383. [PMID: 33879914 PMCID: PMC8072414 DOI: 10.19723/j.issn.1671-167x.2021.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the biocompatibility and osteogenic effect of new calcium phosphate cement (CPC) in vivo and to provide experimental basis for its further clinical application. METHODS Thirty New Zealand white rabbits were randomly divided into four groups: CPC group, CPC+Bio-Oss group, Bio-Oss group and blank control group. Bone defect models of 6 mm in diameter and 7 mm in depth were made on the lateral condyle of bilateral hind legs of the rabbits. CPC, Bio-Oss and CPC+Bio-Oss mixture were implanted into the bone defect according to the group, and the mass ratio of CPC and Bio-Oss was 4 ∶ 1. The experimental animals were sacrificed the 4th, 12th and 24th week after operation. The tissue around the bone defect was taken for histological evaluation by H&E staining. Bone ingrowth fraction (BIF) was calculated. The expression of BMP-2 and COL-Ⅰ was detected by immunohis- tochemical staining by calculating the mean optical density (MOD) of the positive area the 4th week after operation, and the bone healing of each group was evaluated at different time points. The measurement data were analyzed by one-way ANOVA and LSD test was used for multiple comparison of the differences between the means by SPSS 19.0. P < 0.05 was considered to be statistically significant. RESULTS The results of H&E staining showed that the BIF values of CPC group, CPC + Bio-Oss group and Bio-Oss group were significantly higher than those of blank control group at the same time point (P < 0.01). The BIF values of CPC group were lower than those of Bio-Oss group and CPC + Bio-Oss group (P < 0.01). There was no significant difference between CPC + Bio-Oss group and Bio-Oss group. Immunohistochemical staining showed that the MOD values of BMP-2 and COL-Ⅰ in CPC group were higher than those in blank control group, but lower than those in Bio-Oss group and CPC+Bio-Oss group (P < 0.01). There was no significant difference between BMP-2 and COL-Ⅰ in CPC+Bio-Oss group and Bio-Oss group. CONCLUSION The new calcium phosphate cement has good biocompatibility and can promote early osteogenesis with stable and long-term effect.
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Affiliation(s)
- 京旗 王
- 北京大学第三医院口腔科,北京 100191Department of Stomatology, Peking University Third Hospital, Beijing 100191, China
- 海南医学院第二附属医院口腔科,海口 570311Department of Stomatology, the Second Affiliated Hospital of Hainan Medical University, Haikou 570311, China
| | - 霄 王
- 北京大学第三医院口腔科,北京 100191Department of Stomatology, Peking University Third Hospital, Beijing 100191, China
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Lumbau AI, Meloni SM, Tallarico M, Melis L, Spano G, Baldoni E, Koshovari A, Pisano M. Implant Placement Following Crestal Sinus Lift with Sequential Drills and Osteotomes: Five Years after Final Loading Results from a Retrospective Study. J Funct Biomater 2021; 12:jfb12010010. [PMID: 33557297 PMCID: PMC7930954 DOI: 10.3390/jfb12010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/24/2021] [Accepted: 01/29/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this retrospective study was to clinically evaluate the five-year outcomes of implants placed following a combined approach to the sinus, consisting of sequential drills and osteotomes. Medical records of patients with implants placed in combination with crestal sinus lift using sequential drills and osteotomes, with a residual alveolar bone crest between 4 to 8 mm, and a follow-up of at least five years after final loading, were evaluated. Outcomes were implant and prosthetic survival and success rates, any complication, and marginal bone loss. Data from 96 patients (53 women and 43 men; mean age 54.7 years; range 23-79 years) were collected. A total of 105 single implants were analyzed. After five years of function, two implants were lost and two prostheses failed. No major biological or prosthetic complications occurred. At the five-year examination, the marginal bone loss was 1.24 ± 0.28 mm. Within the limitations of this retrospective study it can be concluded that implants placed following a combined approach to the sinus consisting of sequential drills and osteotomes seem to be a viable option for the treatment of posterior atrophic edentulous maxilla.
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Affiliation(s)
- Aurea Immacolata Lumbau
- School of Dentistry, University of Sassari, 07100 Sassari, Italy; (A.I.L.); (S.M.M.); (G.S.); (E.B.)
| | - Silvio Mario Meloni
- School of Dentistry, University of Sassari, 07100 Sassari, Italy; (A.I.L.); (S.M.M.); (G.S.); (E.B.)
| | - Marco Tallarico
- School of Dentistry, University of Sassari, 07100 Sassari, Italy; (A.I.L.); (S.M.M.); (G.S.); (E.B.)
- Correspondence:
| | - Luca Melis
- Private Practice, 07100 Sardinia, Italy; (L.M.); (M.P.)
| | - Giovanni Spano
- School of Dentistry, University of Sassari, 07100 Sassari, Italy; (A.I.L.); (S.M.M.); (G.S.); (E.B.)
| | - Edoardo Baldoni
- School of Dentistry, University of Sassari, 07100 Sassari, Italy; (A.I.L.); (S.M.M.); (G.S.); (E.B.)
| | - Alba Koshovari
- Department of Implantology and Prosthetic Aspects, Aldent University, 1022 Tirana, Albania;
| | - Milena Pisano
- Private Practice, 07100 Sardinia, Italy; (L.M.); (M.P.)
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da Silva HF, Goulart DR, Sverzut AT, Olate S, de Moraes M. Comparison of two anorganic bovine bone in maxillary sinus lift: a split-mouth study with clinical, radiographical, and histomorphometrical analysis. Int J Implant Dent 2020; 6:17. [PMID: 32372226 PMCID: PMC7200963 DOI: 10.1186/s40729-020-00214-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/23/2020] [Indexed: 12/21/2022] Open
Abstract
Background Anorganic bovine bone (Bio-Oss®) has been extensively used for reconstruction of posterior area of maxilla in sinus lift procedure; however, a new graft material (Lumina-Bone Porous®), that has a different manufacturing process, has not been yet compared in clinical and histological terms. The manufacturing process of bovine bone graft is related to size and porosity of the particles, and this can change osteoconductive property of the material and bone formation. The use of Lumina-Porus® could improve bone formation, reduce the remaining particles of the biomaterial using a low-cost material. The aim of this research was to compare the clinical, radiological, and histomorphometrical results from maxillary sinus lift with two different anorganic bovine bone substitutes Bio-Oss® (control) and Lumina-Bone Porous® (test). Results A split-mouth study was performed with 13 volunteers. The mean bone ridge height in the deepest portion of maxillary sinuses floor was 3.11 ± 0.83 mm in the Bio-Oss® and 2.38 ± 0.75 mm in the Lumina-Bone Porous®. After sinus lift, the Bio-Oss® group shows bone ridge height of 11.56 ± 2.03 mm and Lumina-Bone® of 10.62 ± 1.93 mm. The increase in alveolar bone height scores was significant between pre-augmentation and 6 months after SL in both groups (p < 0.001). No statistical significant difference in newly formed bone in the Bio-Oss® group (20.4 ± 5.4%), and Lumina-Bone Porous® (22.8 ± 8.5%) was histomorphological observed (p > 0.05). On the other hand, the residual graft particles showed significant difference between the Bio-Oss® group (19.9 ± 8.6%) and Lumina-Bone Porous® (14.6 ± 5.6%) (p < 0.05). The survival rate of dental implants for augmented area with Lumina Bone Porous® was 88.88%, while for Bio-Oss® group was 100%. Conclusion Both materials Bio-Oss® and Lumina-Bone Porous® can be used in the maxillary sinus floor augmentation with good predictability in clinical, radiographical, and histological point of view.
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Affiliation(s)
- Heitor Fontes da Silva
- Division of Oral and Maxillofacial Surgery, Department of Oral Diagnosis, Piracicaba Dental School, Campinas State University Unicamp, Av. Limeira, 901, Areiao, Piracicaba, São Paulo, 13414-903, Brazil
| | - Douglas Rangel Goulart
- Division of Oral and Maxillofacial Surgery, Department of Oral Diagnosis, Piracicaba Dental School, Campinas State University Unicamp, Av. Limeira, 901, Areiao, Piracicaba, São Paulo, 13414-903, Brazil. .,Dental School University of Goiás - UFG, Goiânia, Brazil.
| | - Alexander Tadeu Sverzut
- Division of Oral and Maxillofacial Surgery, Department of Oral Diagnosis, Piracicaba Dental School, Campinas State University-Unicamp, São Paulo, Brazil
| | - Sergio Olate
- Department of Oral, Facial and Maxillofacial Surgery and Center of Excellence in Surgical and Morphological Studies, University of La Frontera, Temuco, Chile
| | - Márcio de Moraes
- Division of Oral and Maxillofacial Surgery, Department of Oral Diagnosis, Piracicaba Dental School, Campinas State University-Unicamp, São Paulo, Brazil
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Low-level laser therapy (LLLT) in sites grafted with osteoconductive bone substitutes improves osseointegration. Lasers Med Sci 2020; 35:1519-1529. [DOI: 10.1007/s10103-019-02943-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 12/22/2019] [Indexed: 10/25/2022]
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Al-Moraissi E, Elsharkawy A, Abotaleb B, Alkebsi K, Al-Motwakel H. Does intraoperative perforation of Schneiderian membrane during sinus lift surgery causes an increased the risk of implants failure?: A systematic review and meta regression analysis. Clin Implant Dent Relat Res 2018; 20:882-889. [PMID: 30168884 DOI: 10.1111/cid.12660] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 06/25/2018] [Accepted: 07/10/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE There is still debate whether intraoperative Schneiderian membrane (SM) perforation in the maxillary sinus lift causes an increase the risk of implants failure. The aim of this study was to assess an association between SM perforation and implants loss following the maxillary sinus lift. MATERIALS AND METHODS A systematic review and meta-analysis of clinical studies assessing association between SM perforation and implants failure based on PRISMA was conducted. Three major databases were used to gather research dating from their respective inception up until March 2018. All clinical studies expressly reported the number of the SM perforation and implants loss that installed in the perforated and nonperforated sinuses were included. The statistical analyses used were Pearson's correlation, simple linear regression, and meta regression. The risk ratio (RR) of implant loss between perforated and nonperforated sites was estimated. RESULTS A total of 2947 patients with 3884 maxillary sinuses augmentations who received 7358 implants, enrolled in 58 studies were included in this study. There was a significant relationship between the implants' failure and SM perforation according to simple linear regression (P < .001) and meta regression analysis (P = .06). There was a significant decrease (moderate quality evidence) in implant loss in the nonperforated sinuses compared to perforated sunrises (RR = 2.17, CI: 1.52-3.10, P = .001). There was also no significant association between implant loss in the perforated sinuses and the surgical devices used (piezosurgical or rotary), surgical approach applied (lateral or crestal sinus lift), barrier membrane used and type of bone grafting materials. CONCLUSION The results of this study showed that an intraoperative SM perforation could increase the risk of implant failure after the sinus lift surgery.
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Affiliation(s)
- Essam Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Thamar University, Thamar, Yemen
| | - Ahmed Elsharkawy
- Department of Oral and Maxillofacial Surgery, Cairo University, Cairo, Egypt
| | - Bassam Abotaleb
- Department of Oral and Maxillofacial Surgery, Ibb University, Ibb, Yemen
| | - Khaled Alkebsi
- Department of Oral and Maxillofacial Surgery, Ibb University, Ibb, Yemen
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What Is the Most Effective Rehabilitation Method for Posterior Maxillas With 4 to 8 mm of Residual Alveolar Bone Height Below the Maxillary Sinus With Implant-Supported Prostheses? A Frequentist Network Meta-Analysis. J Oral Maxillofac Surg 2018; 77:70.e1-70.e33. [PMID: 30243705 DOI: 10.1016/j.joms.2018.08.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/20/2018] [Accepted: 08/08/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE The most effective rehabilitation method for patients with edentulous posterior maxillas with an intermediate (4 to 8 mm) residual bone height (RBH) below the maxillary sinus is unclear. Evidence derived from conventional meta-analysis is limited because of the lack of head-to-head studies. This network meta-analysis (NMA) was performed to identify the most effective method to treat patients with intermediate posterior RBH. MATERIALS AND METHODS An NMA of randomized controlled clinical trials (RCTs) was conducted to assess various rehabilitation methods using implant-supported prostheses for patients with intermediate posterior maxillary RBH (4 to 8 mm). Publications from 1970 through March 2018 in 3 major databases were searched. Parallel and split-mouth RCTs that reported the outcomes of interest with follow-up of at least 6 months from initial loading were included. Predictor variables were short implants (SIs; ≤8 mm) alone, SIs in conjunction with osteotome sinus floor elevation (OSFE) with or without bone grafting, long implants (LIs) in conjunction with OSFE with and without bone grafting, and LIs combined with lateral sinus floor elevation (LSFE) with bone grafting. Outcome variables were implant and prosthesis failure rates, marginal bone loss, and complications. Frequentist NMA was performed using STATA software. RESULTS Twenty RCTs involving 770 patients with intermediate posterior maxillary RBH and 837 concerned maxillary sinuses who received 1,486 implants using any of the 4 rehabilitation methods were included. There were no statistically significant differences among the 4 groups for implant and prosthesis failure rates and marginal bone loss at follow-up (range, 6 months to 5 years after loading). There was a marked decrease in complications for SIs alone compared with LIs combined with LSFE. For implant and prosthesis survival rates, SIs in conjunction with OSFE with or without bone grafting ranked first as the most effective option (77.1%) followed by LIs plus OSFE with or without bone grafting (62%), LIs plus LSFE with bone grafting (43.9%), and SIs alone (24.8%). CONCLUSION There is moderate-quality evidence derived from this NMA showing that OSFE combined with SI or LI placement with or without bone grafting or SI placement alone is superior to LI placement combined with LSFE and bone grafting when used for patients with intermediate maxillary RBH (4 to 8 mm). Furthermore, the results of this study show that LSFE for patients with intermediate RBH is not a suitable treatment option because of unjustified high cost and rate of complications.
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Autogenous Partial Bone Chip Grafting on the Exposed Inferior Alveolar Nerve After Cystic Enucleation. J Craniofac Surg 2017; 29:486-490. [PMID: 29077687 DOI: 10.1097/scs.0000000000004077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This prospective study evaluated the clinical effectiveness of the new approach of partial autogenous bone chip grafts for the treatment of mandibular cystic lesions related to the inferior alveolar nerve (IAN). A total of 38 patients treated for mandibular cysts or benign tumors were included in this prospective study and subsequently divided into 3 groups depending on the bone grafting method used: cystic enucleation without a bone graft (group 1), partial bone chip graft covering the exposed IAN (group 2), and autogenous bone graft covering the entire defect (group 3). We evaluated the symptoms, clinical signs, and radiographic changes using dental panorama preoperatively, immediate postoperatively, and at 1, 3, 6, and 12 months postoperatively. Radiographic densities were compared using Adobe Photoshop CS5 (Adobe Systems Inc., San Jose, CA). Repeated measures analysis of variance was used for statistical evaluation with SPSS 22.0 (SPSS Inc, Chicago, IL), and P < 0.05 was considered statistically significant.Radiopacities were the most increased at 1 year postoperative in group 3; groups 2 and 3 did not show statistically significant differences, whereas groups 1 and 3 were statistically significant. In terms of radiographic bone healing with clinical regeneration of the exposed IAN, healing occurred in all patients, although the best healing was achieved in group 2.This autogenous partial bone chip grafting procedure to cover the exposed IAN is suggested as a new surgical protocol for the treatment of cystic lesions associated with the IAN.
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Parra M, Olate S, Cantín M. Clinical and biological analysis in graftless maxillary sinus lift. J Korean Assoc Oral Maxillofac Surg 2017; 43:214-220. [PMID: 28875135 PMCID: PMC5583195 DOI: 10.5125/jkaoms.2017.43.4.214] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/05/2016] [Accepted: 08/26/2016] [Indexed: 11/07/2022] Open
Abstract
Maxillary sinus lift for dental implant installation is a well-known and versatile technique; new techniques are presented based on the physiology of intrasinus bone repair. The aim of this review was to determine the status of graftless maxillary sinus lift and analyze its foundations and results. A search was conducted of the literature between 1995 and 2015 in the Medline, ScienceDirect, and SciELO databases using the keywords "maxillary sinus lift," "blood clot," "graftless maxillary sinus augmentation," and "dental implant placement." Ten articles were selected for our analysis of this technique and its results. Despite the limited information, cases that were followed for at least six months and up to four years had a 90% success rate. Published techniques included a lateral window, elevation of the sinus membrane, drilling and dental implant installation, descent of the membrane with variations in the installation of the lateral wall access and suturing. The physiology behind this new bone formation response and the results of the present research were also discussed. We concluded that this is a promising and viable technique under certain inclusion criteria.
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Affiliation(s)
- Marcelo Parra
- Master in Dental Science Program, Universidad de La Frontera, Temuco, Chile
| | - Sergio Olate
- Department of Oral and Maxillofacial Surgery, Universidad de La Frontera, Temuco, Chile.,Center of Excellence in Surgical and Morphological Studies (CEMYQ), Universidad de La Frontera, Temuco, Chile.,Center for Biomedical Research, Universidad Autónoma de Chile, Temuco, Chile
| | - Mario Cantín
- Center of Excellence in Surgical and Morphological Studies (CEMYQ), Universidad de La Frontera, Temuco, Chile.,Center for Biomedical Research, Universidad Autónoma de Chile, Temuco, Chile
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Berbéri A, Al-Nemer F, Hamade E, Noujeim Z, Badran B, Zibara K. Mesenchymal stem cells with osteogenic potential in human maxillary sinus membrane: an in vitro study. Clin Oral Investig 2016; 21:1599-1609. [PMID: 27585588 DOI: 10.1007/s00784-016-1945-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 08/16/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The aim of our study is to prove and validate the existence of an osteogenic progenitor cell population within the human maxillary Schneiderian sinus membrane (hMSSM) and to demonstrate their potential for bone formation. MATERIALS AND METHODS Ten hMSSM samples of approximately 2 × 2 cm were obtained during a surgical nasal approach for treatment of chronic rhinosinusitis and were retained for this study. The derived cells were isolated, cultured, and assayed at passage 3 for their osteogenic potential using the expression of Alkaline phosphatase, alizarin red and Von Kossa staining, flow cytometry, and quantitative real-time polymerase chain reaction. RESULTS hMSSM-derived cells were isolated, showed homogenous spindle-shaped fibroblast-like morphology, characteristic of mesenchymal progenitor cells (MPCs), and demonstrated very high expression of MPC markers such as STRO-1, CD44, CD90, CD105, and CD73 in all tested passages. In addition, von Kossa and Alizarin red staining showed significant mineralization, a typical feature of osteoblasts. Moreover, alkaline phosphatase (ALP) activity was significantly increased at days 7, 14, 21, and 28 of culture in hMSSM-derived cells grown in osteogenic medium, in comparison to controls. Furthermore, osteogenic differentiation significantly upregulated the transcriptional expression of osteogenic markers such as ALP, Runt-related transcription factor 2 (Runx-2), bone morphogenetic protein (BMP)-2, osteocalcin (OCN), osteonectin (ON), and osteopontin (OPN), confirming that hMSSM-derived cells are of osteoprogenitor origin. Finally, hMSSM-derived cells were also capable of producing OPN proteins upon culturing in an osteogenic medium. CONCLUSION Our data showed that hMSSM holds mesenchymal osteoprogenitor cells capable of differentiating to the osteogenic lineage. CLINICAL RELEVANCE hMSSM contains potentially multipotent postnatal stem cells providing a promising clinical application in preimplant and implant therapy.
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Affiliation(s)
- Antoine Berbéri
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Lebanese University, Rafic Hariri Campus, P.O. box 5208-116, Beirut, Lebanon.
| | - Fatima Al-Nemer
- ER045, Laboratory of Stem Cells, DSST, PRASE, Lebanese University, Beirut, Lebanon
- Department of Biology, Faculty of Sciences-I, Lebanese University, Beirut, Lebanon
| | - Eva Hamade
- ER045, Laboratory of Stem Cells, DSST, PRASE, Lebanese University, Beirut, Lebanon
- Department of Biochemistry, Faculty of Sciences-I, Lebanese University, Beirut, Lebanon
| | - Ziad Noujeim
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Lebanese University, Rafic Hariri Campus, P.O. box 5208-116, Beirut, Lebanon
| | - Bassam Badran
- Department of Biochemistry, Faculty of Sciences-I, Lebanese University, Beirut, Lebanon
| | - Kazem Zibara
- ER045, Laboratory of Stem Cells, DSST, PRASE, Lebanese University, Beirut, Lebanon
- Department of Biology, Faculty of Sciences-I, Lebanese University, Beirut, Lebanon
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Tallarico M, Better H, De Riu G, Meloni SM. A novel implant system dedicate to hydraulic Schneiderian membrane elevation and simultaneously bone graft augmentation: An up-to 45 months retrospective clinical study. J Craniomaxillofac Surg 2016; 44:1089-94. [PMID: 27316855 DOI: 10.1016/j.jcms.2016.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 04/13/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate clinical and radiographic performance of a novel implant system that allows for hydraulic Schneiderian membrane elevation and simultaneously bone graft augmentation. MATERIALS AND METHODS Sixty-two consecutive patients with a mean age of 53.1 years and a severe atrophy of the posterior maxilla (3.0 to 7.0 mm) underwent 64 transcrestal sinus floor elevations and submerged implant placement. The following clinical and radiographic parameters were assessed: implant failure, any complications and bone gain measured using cone beam computed tomography. RESULTS No patient dropped out. No implants failed and all the prostheses were uneventful at the last follow-up examination (mean 23.0 months; range 12-45). All the procedures were completed successfully, with elevation of the sinus membrane and insertion of bone graft and the dental implant at the planned site. No intraoperative or postoperative adverse events were observed, such as membrane tears or facial hematoma. The mean residual alveolar ridge height was 5.2 ± 1 mm (range 3.3-7.0 mm). Mean bone gain was 10.9 ± 2.43 mm (range 5.3-16.5) after an average healing period of 8 months. CONCLUSIONS Hydraulic elevation of the Schneiderian membrane using the iRaise sinus-lift system (Maxillent Ltd) can be considered a valuable treatment option for the rehabilitation of atrophic edentulous posterior maxillae.
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Affiliation(s)
- Marco Tallarico
- Surgical, Micro-surgical and Medical Science Department, University of Sassari, Italy
| | - Haddar Better
- Private Clinic, Tel Aviv, Israel; Maxillent Ltd, Herzliya, Israel
| | - Giacomo De Riu
- Maxillofacial Surgery Unit, University of Sassari, Italy
| | - Silvio Mario Meloni
- Surgical, Micro-surgical and Medical Science Department, University of Sassari, Italy.
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