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Ferraz MP. Bone Grafts in Dental Medicine: An Overview of Autografts, Allografts and Synthetic Materials. MATERIALS (BASEL, SWITZERLAND) 2023; 16:ma16114117. [PMID: 37297251 DOI: 10.3390/ma16114117] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
This review provides an overview of various materials used in dentistry and oral and maxillofacial surgeries to replace or repair bone defects. The choice of material depends on factors such as tissue viability, size, shape, and defect volume. While small bone defects can regenerate naturally, extensive defects or loss or pathological fractures require surgical intervention and the use of substitute bones. Autologous bone, taken from the patient's own body, is the gold standard for bone grafting but has drawbacks such as uncertain prognosis, surgery at the donor site, and limited availability. Other alternatives for medium and small-sized defects include allografts (from human donors), xenografts (from animals), and synthetic materials with osteoconductive properties. Allografts are carefully selected and processed human bone materials, while xenografts are derived from animals and possess similar chemical composition to human bone. Synthetic materials such as ceramics and bioactive glasses are used for small defects but may lack osteoinductivity and moldability. Calcium-phosphate-based ceramics, particularly hydroxyapatite, are extensively studied and commonly used due to their compositional similarity to natural bone. Additional components, such as growth factors, autogenous bone, and therapeutic elements, can be incorporated into synthetic or xenogeneic scaffolds to enhance their osteogenic properties. This review aims to provide a comprehensive analysis of grafting materials in dentistry, discussing their properties, advantages, and disadvantages. It also highlights the challenges of analyzing in vivo and clinical studies to select the most suitable option for specific situations.
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Affiliation(s)
- Maria Pia Ferraz
- Departamento de Engenharia Metalúrgica e de Materiais, Faculdade de Engenharia da Universidade do Porto, 4200-465 Porto, Portugal
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4099-002 Porto, Portugal
- INEB-Instituto de Engenharia Biomédica, Universidade do Porto, 4099-002 Porto, Portugal
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Osteogenic Differentiation of Periodontal Ligament Stem Cells Seeded on Equine-Derived Xenograft in Osteogenic Growth Media. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111518. [PMID: 36363474 PMCID: PMC9693579 DOI: 10.3390/medicina58111518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/17/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Background and Objectives: The duration of bone turnover is critical, and different time points help in identifying the optimal endpoint of treatment duration. However, investigating the combination of xenograft and stem cells to allow tissue regeneration within an ideal time duration remains an under-investigated topic. The current study aimed to assess the impact of equine-derived xenograft bone blocks in assisting the human periodontal ligament stem cells (PDLSCs) to demonstrate osteogenic differentiation (collagen type 1 expression and calcium deposition) within an osteogenic growth media. Materials and Methods: Human PDLSCs were acquired commercially and seeded onto xenograft bone blocks. After the 14th and 21st day of culture, enzyme-linked immunoassay (ELISA) was utilized for the detection and quantification of levels of collagen type I, while the mineralization assessment (deposition of calcium) was conducted by staining the PDLSCs with Alizarin Red S (ARS). The statistical comparison between the means and standard deviations of study groups were evaluated using analysis of variance (ANOVA). Results: ELISA assessment revealed an upsurge in the expression of collagen type I for PDLSCs cultured with xenograft after 14 and 21 days compared to the controls (intergroup comparisons significant at p < 0.05). Similar findings were obtained for mineralization assessment and on ARS staining. PDLSCs cultured with xenograft bone blocks presented an increased deposition of calcium compared to their control counterparts (intergroup comparisons significant at p < 0.05). Conclusions: PDLSCs embedded in xenograft bone blocks inside an osteogenic growth medium demonstrated greater osteogenic differentiation potential after 14 and 21 days. This superior osteogenic differentiation capability was evident by increased collagen type I expression and more significant calcium deposition at the 14th and 21st days after culture.
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Silva ER, Balan VF, Botticelli D, Soldini C, Okamoto R, Xavier SP. Histomorphometric, Immunohistochemical and Microtomographic Comparison between Autogenous and Xenogenous Bone Blocks for Mandibular Lateral Augmentation in Rabbits. MATERIALS 2021; 14:ma14206049. [PMID: 34683641 PMCID: PMC8540416 DOI: 10.3390/ma14206049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/07/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The volumetric and biological behaviors of equine block grafts compared with autogenous block grafts have not yet been assessed. Hence, the aim of the present study was to compare-by means of histomorphometry, immunohistochemistry and microtomography-the graft incorporation and remodeling processes of autogenous and equine xenogenous bone blocks used for mandibular lateral augmentation in rabbits. METHODS Autogenous bone grafts harvested from the iliac bony crest and equine block grafts were secured to the lateral aspect of the mandible angle of eighteen rabbits. The healing after 7, 20 and 60 days was assessed in six animals each period. RESULTS After 60 days, new bone was present 24.2 ± 11.2% and 31.6 ± 13.3% in the autograft and xenograft groups, respectively. A better integration to the recipient sites was observed in the autogenous compared with the xenogenous blocks. CONCLUSIONS Both xenogenous and autogenous bone blocks presented similar percentages of newly formed bone over time. However, bone volume, the quality of the grafted area and graft incorporation to the recipient sites were superior in the autogenous compared with the equine xenogenous graft sites.
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Affiliation(s)
- Erick Ricardo Silva
- Department of Oral and Maxillofacial Surgery and Periodontology, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-904, Brazil; (E.R.S.); (V.F.B.); (S.P.X.)
| | - Vitor Ferreira Balan
- Department of Oral and Maxillofacial Surgery and Periodontology, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-904, Brazil; (E.R.S.); (V.F.B.); (S.P.X.)
| | - Daniele Botticelli
- Ariminum Research & Dental Education Center, 47923 Rimini, Italy
- Correspondence:
| | - Claudio Soldini
- Institute for Dental & Implant Studies (IDIS), 36100 Vicenza, Italy;
| | - Roberta Okamoto
- Department of Basic Science, Division of Anatomy, Araçatuba Dental School, Universidade Estadual Paulista “Júlio de Mesquita Filho” (UNESP), Araçatuba 16015-050, Brazil;
| | - Samuel Porfirio Xavier
- Department of Oral and Maxillofacial Surgery and Periodontology, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-904, Brazil; (E.R.S.); (V.F.B.); (S.P.X.)
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Wide Anterior Maxillary Reconstruction with Equine Bone Xenograft: A Case Report of 24-Month Follow-Up. Case Rep Surg 2020; 2020:8890935. [PMID: 33145117 PMCID: PMC7596435 DOI: 10.1155/2020/8890935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction. Orofacial reconstruction plays an important role in the treatment of patients affected by oral and maxillofacial cancers. Improvements in technologies and studies of biomaterials have widely expanded surgical possibilities to achieve good functional and aesthetic outcomes. By the way, xenografting procedures gained great consensus in the last decades, because of their documented reliability and efficacy. We present a case of anterior maxillary chondrosarcoma (CHS) that has undergone surgical ablation followed by reconstruction with an equine-derived bone xenograft. Case Presentation. A 68-year-old woman affected by CHS of the premaxilla underwent surgical ablation involving the four incisors followed by reconstruction using an equine-derived bone substitute. Bony reconstruction was planned to achieve implant and dental prosthetic rehabilitation at a second surgical time. Primary surgery was carried out without complications. Good integration of the graft was confirmed by radiological examination. At 12-month follow-up, the patient refused the implant placement and spontaneously adopted a mobile prosthesis. One year later, plates and screws were removed, because of the exposure of a titanium plate. The graft was finally rejected within 3 weeks. Discussion. Nonantigenic equine-derived biomaterials have shown reliability and a good safety profile. In the presented case, implant insertion should have been performed 12 months after the primary surgery. During the follow-up, until dental mobile prosthesis was applied, clinical and instrumental examinations demonstrated a good integration of the graft. We suppose that a chronic inflammation of the mucosa led to the exposure of the plate, perhaps due to pressure, minimal movements, or imperfect fitting of the mobile prosthesis. Removal of fixation means was performed to prevent grafting failure, without success. On the other hand, missing load could induce the graft to act just like a prosthesis, without a real process of integration. Safety and reliability of equine-derived bone xenografts cannot be currently confirmed if not followed by implant insertion and dental rehabilitation.
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Kuchler U, Heimel P, Stähli A, Josef Strauss F, Luza B, Gruber R. Impact of DBBM Fragments on the Porosity of the Calvarial Bone: A Pilot Study on Mice. MATERIALS 2020; 13:ma13214748. [PMID: 33114211 PMCID: PMC7660694 DOI: 10.3390/ma13214748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/17/2020] [Accepted: 10/20/2020] [Indexed: 12/27/2022]
Abstract
Deproteinized bovine bone mineral (DBBM) is brittle and can break into fragments. Here, we examined whether DBBM fragments have an impact on mice calvarial bone during bone augmentation. DBBM was either randomly crushed (DBBM fragments) or left undisturbed (DBBM granules). Then, DBBM fragments or original DBBM granules were placed onto calvarial bone in 20 BALB/c mice. Following random allocation, ten mice received DBBM fragments and ten mice received original DBBM granules. After fourteen days of healing, micro computed tomography (micro-CT) and histological analysis of the augmented sites were performed. The primary outcome was the porosity of the calvarial bone. The micro-CT analysis revealed that DBBM fragments failed to significantly change the porosity of the calvarial bone as compared with original DBBM granules, despite the slightly higher bone resorption in the DBBM fragment group, 10.3% (CI 6.3–11.6) versus 6.1% (CI 4.1–7.8, p = 0.355), respectively. The cortical bone volume was not altered by DBBM fragments as compared with original DBBM granules, i.e., 79.0% (CI 78.9–81.2) versus 81.5% (CI 80.1–83.3, p = 0.357), respectively. The DBBM fragment group revealed similar bone thickness values as compared with the DBBM granules group, i.e., 0.26 mm (CI 0.23–0.29) versus 0.25 mm (CI 0.22–0.27, p = 0.641), respectively. The histological evaluation supported the micro-CT observations, displaying minor signs of porosity and resorption. The particle-size distribution analysis confirmed a shift towards smaller particle sizes in the DBBM fragment group. These findings suggest that DBBM fragments behave similarly to original DBBM granules in terms of bone morphological changes at augmented sites.
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Affiliation(s)
- Ulrike Kuchler
- Department of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria;
| | - Patrick Heimel
- Core Facility Hard Tissue and Biomaterial Research, Karl Donath Laboratory, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (P.H.); (B.L.)
- Ludwig Boltzmann Institute for Clinical and Experimental Traumatology, 1090 Vienna, Austria
- Austrian Cluster for Tissue Regeneration, 1090 Vienna, Austria
| | - Alexandra Stähli
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (A.S.); (F.J.S.)
- Department of Periodontology, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland
| | - Franz Josef Strauss
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (A.S.); (F.J.S.)
- Department of Conservative Dentistry, School of Dentistry, University of Chile, Santiago 8380544, Chile
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland
| | - Bernadette Luza
- Core Facility Hard Tissue and Biomaterial Research, Karl Donath Laboratory, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (P.H.); (B.L.)
- Ludwig Boltzmann Institute for Clinical and Experimental Traumatology, 1090 Vienna, Austria
| | - Reinhard Gruber
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (A.S.); (F.J.S.)
- Department of Periodontology, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland
- Correspondence: ; Tel.: +43-699-107-18-472
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Angermair J, Bosshardt DD, Nelson K, Flügge TV, Stricker A, Fretwurst T. Horizontal bone grafting using equine-derived cancellous bone blocks is associated with severe complications: A prospective clinical and histological pilot study. Clin Oral Implants Res 2020; 31:1149-1158. [PMID: 32881075 DOI: 10.1111/clr.13661] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/30/2020] [Accepted: 08/21/2020] [Indexed: 12/20/2022]
Abstract
AIMS The aim of this prospective, clinical study was to evaluate the clinical performance and histological outcome of a new equine hydroxyapatite collagenated bone block (eHAC) for horizontal bone grafting prior to implant placement. MATERIALS AND METHODS Five patients (two male/three female) with a mean age of 51.6 years (range 22-66 years) and a reduced horizontal bone width of the alveolar ridge (mean 3.5 mm) underwent horizontal bone grafting using eHAC at 10 grafting sites. Reentry was performed 6.9 months after the horizontal grafting procedure. Clinical follow-up (mean 28.9 month) considered width gain of the alveolar ridge, soft tissue healing, and complications. To evaluate graft incorporation, four additional patients underwent histological assessment of equine blocks adjacent to autologous blocks 3 and 6 months after grafting. RESULTS The study was terminated after graft failure was observed in four of five patients. Mean horizontal bone width had increased by 3.6 ± 1.22 mm. Three out of nine implants placed had to be removed due to graft failure. Histological evaluation revealed large amounts of soft connective tissue within the grafts (mean 67.3 ± 9.5%). The proportion of new bone formation 3 months after the lateral grafting procedure revealed an average of 8.6%, compared to 11.4% after 6 to 7 months. CONCLUSION Lateral ridge grafting using eHAC achieved measurable horizontal width gain but revealed high rates of severe complications. CLINICAL IMPLICATIONS Within the limitations of this study, eHAC bone blocks cannot be recommended for horizontal bone grafting.
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Affiliation(s)
- Johannes Angermair
- Clinic of Oral- and Maxillofacial Surgery, Translational Implantology, Medical Center Freiburg - Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dieter D Bosshardt
- Robert K. Schenk Laboratory of Oral Histology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Katja Nelson
- Clinic of Oral- and Maxillofacial Surgery, Translational Implantology, Medical Center Freiburg - Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tabea V Flügge
- Clinic of Oral- and Maxillofacial Surgery, Translational Implantology, Medical Center Freiburg - Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andres Stricker
- Clinic of Oral- and Maxillofacial Surgery, Translational Implantology, Medical Center Freiburg - Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center of Implantology, Periodontology and 3D Head-and-Neck Imaging Lake Constance, Konstanz, Germany
| | - Tobias Fretwurst
- Clinic of Oral- and Maxillofacial Surgery, Translational Implantology, Medical Center Freiburg - Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Hyaluronic Acid/Bone Substitute Complex Implanted on Chick Embryo Chorioallantoic Membrane Induces Osteoblastic Differentiation and Angiogenesis, but not Inflammation. Int J Mol Sci 2018; 19:ijms19124119. [PMID: 30572565 PMCID: PMC6320888 DOI: 10.3390/ijms19124119] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/12/2018] [Accepted: 12/18/2018] [Indexed: 12/13/2022] Open
Abstract
Microscopic and molecular events related to alveolar ridge augmentation are less known because of the lack of experimental models and limited molecular markers used to evaluate this process. We propose here the chick embryo chorioallantoic membrane (CAM) as an in vivo model to study the interaction between CAM and bone substitutes (B) combined with hyaluronic acid (BH), saline solution (BHS and BS, respectively), or both, aiming to point out the microscopic and molecular events assessed by Runt-related transcription factor 2 (RUNX 2), osteonectin (SPARC), and Bone Morphogenic Protein 4 (BMP4). The BH complex induced osteoprogenitor and osteoblastic differentiation of CAM mesenchymal cells, certified by the RUNX2 +, BMP4 +, and SPARC + phenotypes capable of bone matrix synthesis and mineralization. A strong angiogenic response without inflammation was detected on microscopic specimens of the BH combination compared with an inflammatory induced angiogenesis for the BS and BHS combinations. A multilayered organization of the BH complex grafted on CAM was detected with a differential expression of RUNX2, BMP4, and SPARC. The BH complex induced CAM mesenchymal cells differentiation through osteoblastic lineage with a sustained angiogenic response not related with inflammation. Thus, bone granules resuspended in hyaluronic acid seem to be the best combination for a proper non-inflammatory response in alveolar ridge augmentation. The CAM model allows us to assess the early events of the bone substitutes–mesenchymal cells interaction related to osteoblastic differentiation, an important step in alveolar ridge augmentation.
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The Effect of Bisphasic Calcium Phosphate Block Bone Graft Materials with Polysaccharides on Bone Regeneration. MATERIALS 2017; 10:ma10010017. [PMID: 28772381 PMCID: PMC5344594 DOI: 10.3390/ma10010017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/01/2016] [Accepted: 12/06/2016] [Indexed: 11/17/2022]
Abstract
In this study, bisphasic calcium phosphate (BCP) and two types of polysaccharide, carboxymethyl cellulose (CMC) and hyaluronic acid (HyA), were used to fabricate composite block bone grafts, and their physical and biological features and performances were compared and evaluated in vitro and in vivo. Specimens of the following were prepared as 6 mm diameter, 2 mm thick discs; BPC mixed with CMC (the BCP/CMC group), BCP mixed with crosslinked CMC (the BCP/c-CMC group) and BCP mixed with HyA (the BCP/HyA group) and a control group (specimens were prepared using particle type BCP). A scanning electron microscope study, a compressive strength analysis, and a cytotoxicity assessment were conducted. Graft materials were implanted in each of four circular defects of 6 mm diameter in calvarial bone in seven rabbits. Animals were sacrificed after four weeks for micro-CT and histomorphometric analyses, and the findings obtained were used to calculate new bone volumes (mm3) and area percentages (%). It was found that these two values were significantly higher in the BCP/c-CMC group than in the other three groups (p < 0.05). Within the limitations of this study, BCP composite block bone graft material incorporating crosslinked CMC has potential utility when bone augmentation is needed.
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Ghiacci G, Graiani G, Ravanetti F, Lumetti S, Manfredi E, Galli C, Cacchioli A, Macaluso GM, Sala R. "Over-inlay" block graft and differential morphometry: a novel block graft model to study bone regeneration and host-to-graft interfaces in rats. J Periodontal Implant Sci 2016; 46:220-33. [PMID: 27588212 PMCID: PMC5005810 DOI: 10.5051/jpis.2016.46.4.220] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/29/2016] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The aim of this study was to present new a model that allows the study of the bone healing process, with an emphasis on the biological behavior of different graft-to-host interfaces. A standardized "over-inlay" surgical technique combined with a differential histomorphometric analysis is presented in order to optimize the use of critical-size calvarial defects in pre-clinical testing. METHODS Critical-size defects were created into the parietal bone of 8 male Wistar rats. Deproteinized bovine bone (DBBM) blocks were inserted into the defects, so that part of the block was included within the calvarial thickness and part exceeded the calvarial height (an "over-inlay" graft). All animals were sacrificed at 1 or 3 months. Histomorphometric and immunohistochemical evaluation was carried out within distinct regions of interest (ROIs): the areas adjacent to the native bone (BA), the periosteal area (PA) and the central area (CA). RESULTS The animals healed without complications. Differential morphometry allowed the examination of the tissue composition within distinct regions: the BA presented consistent amounts of new bone formation (NB), which increased over time (24.53%±1.26% at 1 month; 37.73%±0.39% at 3 months), thus suggesting that this area makes a substantial contribution toward NB. The PA was mainly composed of fibrous tissue (71.16%±8.06% and 78.30%±2.67%, respectively), while the CA showed high amounts of DBBM at both time points (78.30%±2.67% and 74.68%±1.07%, respectively), demonstrating a slow remodeling process. Blood vessels revealed a progressive migration from the interface with native bone toward the central area of the graft. Osterix-positive cells observed at 1 month within the PA suggested that the periosteum was a source of osteoprogenitor elements. Alkaline phosphatase data on matrix deposition confirmed this observation. CONCLUSIONS The present model allowed for a standardized investigation of distinct graft-to-host interfaces both at vertically augmented and inlay-augmented sites, thus possibly limiting the number of animals required for pre-clinical investigations.
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Affiliation(s)
- Giulia Ghiacci
- Department of Biomedical, Biotechnological, and Translational Sciences (S.Bi.Bi.T), University of Parma Dental Medicine Unit, Parma, Italy.; Department of Biomedical, Biotechnological, and Translational Sciences (S.Bi.Bi.T), University of Parma General Pathology Unit, Parma, Italy
| | - Gallia Graiani
- Department of Biomedical, Biotechnological, and Translational Sciences (S.Bi.Bi.T), University of Parma Dental Medicine Unit, Parma, Italy
| | | | - Simone Lumetti
- Department of Biomedical, Biotechnological, and Translational Sciences (S.Bi.Bi.T), University of Parma Dental Medicine Unit, Parma, Italy
| | - Edoardo Manfredi
- Department of Biomedical, Biotechnological, and Translational Sciences (S.Bi.Bi.T), University of Parma Dental Medicine Unit, Parma, Italy
| | - Carlo Galli
- Department of Biomedical, Biotechnological, and Translational Sciences (S.Bi.Bi.T), University of Parma Dental Medicine Unit, Parma, Italy.; Institute of Materials for Electronics and Magnetism (IMEM), Italian National Research Council (CNR), Parco Area delle Scienze, Parma, Italy
| | | | - Guido Maria Macaluso
- Department of Biomedical, Biotechnological, and Translational Sciences (S.Bi.Bi.T), University of Parma Dental Medicine Unit, Parma, Italy.; Institute of Materials for Electronics and Magnetism (IMEM), Italian National Research Council (CNR), Parco Area delle Scienze, Parma, Italy
| | - Roberto Sala
- Department of Biomedical, Biotechnological, and Translational Sciences (S.Bi.Bi.T), University of Parma General Pathology Unit, Parma, Italy
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Mir-Mari J, Benic GI, Valmaseda-Castellón E, Hämmerle CH, Jung RE. Influence of wound closure on the volume stability of particulate and non-particulate GBR materials: an in vitro
cone-beam computed tomographic examination. Part II. Clin Oral Implants Res 2016; 28:631-639. [DOI: 10.1111/clr.12845] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Javier Mir-Mari
- Oral Surgery and Implantology Department; Dental School; University of Barcelona; Barcelona Spain
| | - Goran I. Benic
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | | | - Christoph H.F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Ronald E. Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
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Moest T, Wehrhan F, Lutz R, Schmitt CM, Neukam FW, Schlegel KA. Extra-oral defect augmentation using autologous, bovine and equine bone blocks: A preclinical histomorphometrical comparative study. J Craniomaxillofac Surg 2015; 43:559-66. [PMID: 25794644 DOI: 10.1016/j.jcms.2015.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 01/08/2015] [Accepted: 02/16/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES This study aimed to compare autologous bone (AB), bovine bone (BB), and equine bone (EB) blocks with regard to de novo bone formation, connective tissue, and residual bone substitute material portions in a standardized defect animal model. MATERIAL AND METHODS In the frontal skull of 20 pigs, 106 standardized cylindrical "critical size defects" were prepared. Defects were randomly filled with AB, BB, and EB blocks. After a healing period of 30 and 60 days, de novo bone formation, residual bone substitute material, and connective tissue portion was assessed by means of histomorphometry (Toluidine blue O staining). Mann-Whitney U-tests were used to evaluate differences between the groups. RESULTS The de novo bone formation was significantly higher in the AB group in comparison to the xenogeneic groups (p < 0.05). After 30 days, EB showed significantly (p < 0.05) more newly formed bone compared to the BB group. The soft tissue formation was significantly higher in the BB and EB group. Defects augmented with BB showed significantly (p < 0.05) higher portions of bone substitute materials compared to sides augmented with EB after 30 days. CONCLUSION In the extra-oral model, AB blocks were superior concerning de novo bone formation. No clinical advantages of EB blocks could be observed.
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Affiliation(s)
- Tobias Moest
- Department of Oral and Maxillofacial Surgery, University Erlangen - Nuremberg, Glückstraße 11, D-91054 Erlangen, Germany.
| | - Falk Wehrhan
- Department of Oral and Maxillofacial Surgery, University Erlangen - Nuremberg, Glückstraße 11, D-91054 Erlangen, Germany
| | - Rainer Lutz
- Department of Oral and Maxillofacial Surgery, University Erlangen - Nuremberg, Glückstraße 11, D-91054 Erlangen, Germany
| | - Christian Martin Schmitt
- Department of Oral and Maxillofacial Surgery, University Erlangen - Nuremberg, Glückstraße 11, D-91054 Erlangen, Germany
| | - Friedrich Wilhelm Neukam
- Department of Oral and Maxillofacial Surgery, University Erlangen - Nuremberg, Glückstraße 11, D-91054 Erlangen, Germany
| | - Karl Andreas Schlegel
- Department of Oral and Maxillofacial Surgery, University Erlangen - Nuremberg, Glückstraße 11, D-91054 Erlangen, Germany
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Veis A, Dabarakis N, Koutrogiannis C, Barlas I, Petsa E, Romanos G. Evaluation of Vertical Bone Regeneration Using Block and Particulate Forms of Bio-Oss Bone Graft: A Histologic Study in the Rabbit Mandible. J ORAL IMPLANTOL 2014; 41:e66-72. [PMID: 24527741 DOI: 10.1563/aaid-joi-d-13-00241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of the present study was to evaluate histologically vertical bone regeneration outcomes after using bovine bone graft material in block and granular forms. The buccal bony plates of the outer mandibles of 10 New Zealand rabbits received Bio-Oss blocks that were immobilized using orthopedic mini-plates, and another 10 received granular forms that were gently packed and stabilized into the custom-made perforated metallic cubes. The mean graft area (GA), new bone area (NBA), bone-to-graft contact (BGC), and maximum vertical height reached by the new bone development (MVH) were histometrically evaluated and showed no significant differences between 2 graft types. The new bone was observed mostly close to the basal bone and developed penetrating the trabecular scaffold in the form of seams that covered the intralumen surfaces of the block type graft, while in the granular graft type the new bone was observed to grow between the graft particles usually interconnecting them. Either form of Bio-Oss was capable of providing considerable vertical bone augmentation.
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Affiliation(s)
- Alexander Veis
- 1 Department of Dentoalveolar Surgery, Surgical Implantology and Radiology Dental School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Dabarakis
- 1 Department of Dentoalveolar Surgery, Surgical Implantology and Radiology Dental School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | | | - Georgios Romanos
- 4 School of Dental Medicine, Stony Brook University, Stony Brook, NY
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Mangano C, Barboni B, Valbonetti L, Berardinelli P, Martelli A, Muttini A, Bedini R, Tetè S, Piattelli A, Mattioli M. In Vivo Behavior of a Custom-Made 3D Synthetic Bone Substitute in Sinus Augmentation Procedures in Sheep. J ORAL IMPLANTOL 2013; 41:240-50. [PMID: 23829685 DOI: 10.1563/aaid-joi-d-13-00053] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In this study, the in vivo behavior of a custom-made three-dimensional (3D) synthetic bone substitute was evaluated when used as scaffold for sinus augmentation procedures in an animal model. The scaffold was a calcium phosphate ceramic fabricated by the direct rapid prototyping technique, dispense-plotting. The geometrical and chemical properties of the scaffold were first analyzed through light and electron scanning microscopes, helium picnometer, and semi-quantitative X-ray diffraction measurements. Then, 6 sheep underwent monolateral sinus augmentation with the fabricated scaffolds. The animals were euthanized after healing periods of 45 and 90 days, and block sections including the grafted area were obtained. Bone samples were subjected to micro computerized tomography, morphological and histomorphometric analyses. A complete integration of the scaffold was reported, with abundant deposition of newly formed bone tissue within the biomaterial pores. Moreover, initial foci of bone remodeling were mainly localized at the periphery of the implanted area after 45 days, while continuous bridges of mature lamellar bone were recorded in 90-day specimens. This evidence supports the hypothesis that bone regeneration proceeds from the periphery to the center of the sinus cavity. These results showed how a technique allowing control of porosity, pore design, and external shape of a ceramic bone substitute may be valuable for producing synthetic bone grafts with good clinical performances.
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Affiliation(s)
- Carlo Mangano
- 1 Department of Surgical and Morphological Science, University of Insubria, Varese, Italy
| | - Barbara Barboni
- 2 Stem TeCh group, Chieti, Italy.,3 Department of Comparative Biomedical Science, University of Teramo, Italy
| | - Luca Valbonetti
- 2 Stem TeCh group, Chieti, Italy.,3 Department of Comparative Biomedical Science, University of Teramo, Italy
| | - Paolo Berardinelli
- 3 Department of Comparative Biomedical Science, University of Teramo, Italy
| | | | - Aurelio Muttini
- 3 Department of Comparative Biomedical Science, University of Teramo, Italy
| | | | - Stefano Tetè
- 5 Department of Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio," Chieti, Italy
| | - Adriano Piattelli
- 5 Department of Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio," Chieti, Italy
| | - Mauro Mattioli
- 3 Department of Comparative Biomedical Science, University of Teramo, Italy
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Dorozhkin SV. Calcium orthophosphates in dentistry. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2013; 24:1335-1363. [PMID: 23468163 DOI: 10.1007/s10856-013-4898-1] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 02/18/2013] [Indexed: 06/01/2023]
Abstract
Dental caries, also known as tooth decay or a cavity, remains a major public health problem in the most communities even though the prevalence of disease has decreased since the introduction of fluorides for dental care. Therefore, biomaterials to fill dental defects appear to be necessary to fulfill customers' needs regarding the properties and the processing of the products. Bioceramics and glass-ceramics are widely used for these purposes, as dental inlays, onlays, veneers, crowns or bridges. Calcium orthophosphates belong to bioceramics but they have some specific advantages over other types of bioceramics due to a chemical similarity to the inorganic part of both human and mammalian bones and teeth. Therefore, calcium orthophosphates (both alone and as components of various formulations) are used in dentistry as both dental fillers and implantable scaffolds. This review provides brief information on calcium orthophosphates and describes in details current state-of-the-art on their applications in dentistry and dentistry-related fields. Among the recognized dental specialties, calcium orthophosphates are most frequently used in periodontics; however, the majority of the publications on calcium orthophosphates in dentistry are devoted to unspecified "dental" fields.
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Jung UW, Lee JS, Lee G, Lee IK, Hwang JW, Kim MS, Choi SH, Chai JK. Role of collagen membrane in lateral onlay grafting with bovine hydroxyapatite incorporated with collagen matrix in dogs. J Periodontal Implant Sci 2013; 43:64-71. [PMID: 23678389 PMCID: PMC3651939 DOI: 10.5051/jpis.2013.43.2.64] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 03/17/2013] [Indexed: 12/02/2022] Open
Abstract
Purpose The objective of this study was to elucidate the role of collagen membranes (CMs) when used in conjunction with bovine hydroxyapatite particles incorporated with collagen matrix (BHC) for lateral onlay grafts in dogs. Methods The first, second, and third premolars in the right maxilla of mongrel dogs (n=5) were extracted. After 2 months of healing, two BHC blocks (4 mm×4 mm×5 mm) were placed on the buccal ridge, one with and one without the coverage by a CM. The animals were sacrificed after 8 weeks for histometric analysis. Results The collagen network of the membranes remained and served as a barrier. The quantity and quality of bone regeneration were all significantly greater in the membrane group than in the no-membrane group (P<0.05). Conclusions The use of barrier membranes in lateral onlay grafts leads to superior new bone formation and bone quality compared with bone graft alone.
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Affiliation(s)
- Ui-Won Jung
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
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Alsuwaiyan A, Wang BY, Cohen RE. Phenotypic characterization of mononuclear inflammatory cells following equine hydroxyapatite/collagen block grafting in rats. Biomed Mater 2012. [PMID: 23183930 DOI: 10.1088/1748-6041/7/6/065005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To measure the inflammatory changes associated with the implantation of an equine hydroxyapatite and collagen-containing block graft (eHAC block) in a rodent model system, an eHAC block graft was implanted subcutaneously in rats. Control groups included saline, turpentine oil, and human mineralized particulate allograft (hMPA). Animals were sacrificed and tissue samples obtained after three days, as well as after 1, 2, 4 and 8 weeks. A panel of immunologic probes was used to identify circulatory monocytic cells (ED1), resident mononuclear phagocytes (ED2), mononuclear phagocytes of lymphoid origin (ED3), expression of Ia antigen (OX6), T-cells (OX19), and B-cells (OX33). Immunocytochemical localization was performed and mononuclear cells localized with each immunologic probe counted. Rat sera obtained after eight weeks were used for nitrocellulose dot-blotting to assess circulating anti-equine immunoglobulins. Statistical analysis was performed using two-way analysis of variance, in conjunction with the Bonferroni correction to account for multiple comparisons. A transient increase in monocytes at 3 days and 1 week was observed in all groups, but was significantly higher in the turpentine control (P < 0.0001). A significant increase in the numbers of mononuclear cells detected with clones ED2 and ED3 was observed in specimens from the turpentine group, in contrast to the other groups in the 3 day to 4 week interval (P < 0.0001), as well as within all time periods (P < 0.0001). A statistically significant difference in numbers of ED3-positive cells was observed in the hMPA group compared to the saline and the eHAC block groups after one week (P < 0.0001). Significantly more OX6-positive cells were observed in the turpentine group, compared to other groups (3 days to 1 week; P < 0.0001). T-lymphocytes were essentially absent except for rats given turpentine (after 1 week). No B-lymphocyte response was found and none of the rats developed systemic anti-equine antibodies. These data indicate that a cellular immune response is not elicited following implantation with the eHAC block graft, which might serve as an alternative material for regenerative therapy.
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