1
|
Tang W, Zheng C, Li L. Enhancing the gingival contour of an anterior implant restoration by using a guided bone regeneration abutment. J Prosthet Dent 2024:S0022-3913(24)00060-X. [PMID: 38413266 DOI: 10.1016/j.prosdent.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 02/29/2024]
Abstract
Deficiencies in the alveolar bone and surrounding gingiva can pose challenges in implant placement within the esthetic zone. This clinical report describes the reconstruction of gingival tissue contours through guided bone regeneration (GBR) in the anterior maxilla during implant placement by using a modified titanium abutment to maintain the osteogenic space adjacent to the gingival margin and implant neck.
Collapse
Affiliation(s)
- Weimao Tang
- Postgraduate student, State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Changhong Zheng
- Postgraduate student, State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Lei Li
- Associate Professor, State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China.
| |
Collapse
|
2
|
Boroojeni HSH, Mohaghegh S, Khojasteh A. Application of CAD-CAM Technologies for Maxillofacial Bone Regeneration: A Narrative Review of the Clinical Studies. Curr Stem Cell Res Ther 2024; 19:461-472. [PMID: 36372914 DOI: 10.2174/1574888x18666221111154057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/24/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022]
Abstract
The application of regenerative methods in treating maxillofacial defects can be categorized as functional bone regeneration in which scaffolds without protection are used and in-situ bone regeneration in which a protected healing space is created to induce bone formation. It has been shown that functional bone regeneration can reduce surgical time and obviate the necessity of autogenous bone grafting. However, studies mainly focused on applying this method to reconstruct minor bone effects, and more investigation concerning the large defects is required. In terms of in situ maxillofacial bone regeneration with the help of CAD-CAM technologies, the present data have suggested feasible mesh rigidity, perseverance of the underlying space, and apt augmentative results with CAD-CAM-based individualized Ti meshes. However, complications, including dehiscence and mesh exposure, coupled with consequent graft loss, infection and impeded regenerative rates have also been reported.
Collapse
Affiliation(s)
- Helia Sadat Haeri Boroojeni
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sadra Mohaghegh
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Khojasteh
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Cranio-Maxillofacial Surgery/University Hospital, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
3
|
Selvaprithiviraj V, Vaquette C, Ivanovski S. Hydrogel based soft tissue expanders for orodental reconstruction. Acta Biomater 2023; 172:53-66. [PMID: 37866723 DOI: 10.1016/j.actbio.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/10/2023] [Accepted: 10/17/2023] [Indexed: 10/24/2023]
Abstract
Tension-free flap closure to prevent soft tissue dehiscence is a prerequisite for successful bone augmentation in orodental reconstructive surgery. Since soft tissue contour follows the underlying jaw bony architecture, resorption of alveolar (jaw) bone limits the availability of soft tissue for wound closure following major bone reconstruction, required to facilitate oral rehabilitation with endosseous dental implants following tooth loss. Although there are several clinical procedures to increase soft tissue volume, these techniques are complicated and technically demanding. Soft tissue expansion, an established technique in reconstructive surgery, is an ideal alternative to generate surplus soft tissue prior to bone augmentation and dental implant placement. Increase in tissue volume can be achieved by using soft tissue expanders (STEs). Contemporary STEs have evolved from silicone balloons to osmotically inflating hydrogel-based systems. Here, we provide an overview of STEs in clinical oral surgery, outline the current research in STEs, and an update on recent clinical trials as well as the associated complications. Also, the mechanism governing soft tissue expansion and the critical factors that control the expansion process are covered. Design considerations for STEs for intraoral applications are given particular attention. Finally, we present our perspectives on utilization of minimally invasive methods to administer STEs for orodental applications. STATEMENT OF SIGNIFICANCE: Soft tissue expansion is required for a range of reconstructive applications and more notably in regenerative dentistry for vertical bone augmentation. This review describes the commercially available soft tissue expanders along with the latest systems being currently developed. This review insightfully discusses the biological and physical mechanisms leading to soft tissue expansion and critically assesses the design criteria of soft tissue expanders. A particular focus is given on the development of a new generation of hydrogel-based soft tissue expanders; their chemistry and required physical properties for tissue expansion is described and the obstacles towards clinical translations are identified. Finally, the review elaborates on promising minimally invasive injectable hydrogel-based tissue expanders and highlights the beneficial features of these systems.
Collapse
Affiliation(s)
- Vignesh Selvaprithiviraj
- The University of Queensland, School of Dentistry, Centre for Oral Regeneration, Reconstruction and Rehabilitation (COR3), Herston, QLD, Australia
| | - Cedryck Vaquette
- The University of Queensland, School of Dentistry, Centre for Oral Regeneration, Reconstruction and Rehabilitation (COR3), Herston, QLD, Australia; Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, QLD, Australia, S. Ivanovski, School of Dentistry, University of Queensland, 288 Herston Rd, Herston, Brisbane, QLD 4072, Australia
| | - Saso Ivanovski
- The University of Queensland, School of Dentistry, Centre for Oral Regeneration, Reconstruction and Rehabilitation (COR3), Herston, QLD, Australia.
| |
Collapse
|
4
|
Urban IA, Montero E, Amerio E, Palombo D, Monje A. Techniques on vertical ridge augmentation: Indications and effectiveness. Periodontol 2000 2023; 93:153-182. [PMID: 36721380 DOI: 10.1111/prd.12471] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/21/2022] [Indexed: 02/02/2023]
Abstract
Vertical ridge augmentation techniques have been advocated to enable restoring function and esthetics by means of implant-supported rehabilitation. There are three major modalities. The first is guided bone regeneration, based on the principle of compartmentalization by means of using a barrier membrane, which has been demonstrated to be technically demanding with regard to soft tissue management. This requisite is also applicable in the case of the second modality of bone block grafts. Nonetheless, space creation and maintenance are provided by the solid nature of the graft. The third modality of distraction osteogenesis is also a valid and faster approach. Nonetheless, owing to this technique's inherent shortcomings, this method is currently deprecated. The purpose of this review is to shed light on the state-of-the-art of the different modalities described for vertical ridge augmentation, including the indications, the step-by-step approach, and the effectiveness.
Collapse
Affiliation(s)
- Istvan A Urban
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Eduardo Montero
- Department of Periodontics, Universidad Complutense de Madrid, Madrid, Spain
| | - Ettore Amerio
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - David Palombo
- Department of Periodontics, Universidad Complutense de Madrid, Madrid, Spain
| | - Alberto Monje
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
- Department of Periodontology, University of Bern, Bern, Switzerland
| |
Collapse
|
5
|
Adeoye AO, Hadie SNH, Munajat I, Mohd Zaharri NI, Zawawi MSF, Tuan Sharif SE, Sulaiman AR. Periosteum: Functional Anatomy and Clinical Application. MALAYSIAN JOURNAL OF MEDICINE AND HEALTH SCIENCES 2023; 19:362-374. [DOI: 10.47836/mjmhs.19.3.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Periosteum is a connective tissue that envelopes the outer surface of bones and is tightly bound to the underlying bone by Sharpey’s fibers. It is composed of two layers, the outer fibrous layer and the inner cambium layer. The periosteum is densely vascularised and contains an osteoprogenitor niche that serves as a repository for bone-forming cells, which makes it an essential bone-regenerating tissue and has immensely contributed to fracture healing. Due to the high vascularity of inner cambium layer of the periosteum, periosteal transplantation has been widely used in the management of bone defects and fracture by orthopedic surgeons. Nevertheless, the use of periosteal graft in the management of bone defect is limited due to its contracted nature after being harvested. This review summarizes the current state of knowledge about the structure of periosteum, and how periosteal transplantation have been used in clinical practices, with special reference on its expansion.
Collapse
|
6
|
Li S, Zhao Y, Tian T, Zhang T, Xie Y, Cai X. A minimally invasive method for titanium mesh fixation with resorbable sutures in guided bone regeneration: A retrospective study. Clin Implant Dent Relat Res 2023; 25:87-98. [PMID: 36271812 DOI: 10.1111/cid.13147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/01/2022] [Accepted: 10/04/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Titanium mesh has become a mainstream choice for guided bone regeneration (GBR) owing to its excellent space maintenance. However, the traditional fixation method using titanium screws impacts surgery efficiency and increases patient trauma. We report a novel method of fixing a titanium mesh using resorbable sutures. We assessed the feasibility of resorbable sutures for fixing a titanium mesh and whether it can serve as a stable, universal, and minimally invasive fixation method for a broader application of titanium meshes. METHODS Patients undergoing GBR with a digital titanium mesh fixed using titanium screws (TS group) and resorbable sutures (RS group) were observed at different time points. The stability of the fixation methods was evaluated on parameters such as titanium mesh spatial displacement, bone augmentation, and bone resorption. RESULTS A total of 36 patients were included in this study. The exposure rate of the titanium mesh in the TS group was 16.67%, while no exposure was noted in the RS group. There was no significant difference in the parameters of titanium mesh spatial displacement, bone augmentation, and bone resorption between the two groups (p > 0.05). CONCLUSION The use of resorbable sutures for fixing a titanium mesh can achieve similar results to traditional fixation using titanium screws. Although this new fixation method can improve the efficiency of the surgery and reduce the risk of complications, the long-term clinical effects require further follow-up investigation.
Collapse
Affiliation(s)
- Songhang Li
- Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yuxuan Zhao
- Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Taoran Tian
- Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Tianxu Zhang
- Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yu Xie
- Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaoxiao Cai
- Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| |
Collapse
|
7
|
Shen X, Yang S, Xu Y, Qi W, He F. Marginal bone loss of tissue- or bone-level implants after simultaneous guided bone regeneration in the posterior mandibular region: A retrospective cohort study. Clin Implant Dent Relat Res 2023; 25:68-76. [PMID: 36239210 DOI: 10.1111/cid.13144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To analyze the marginal bone loss (ΔMBL) of tissue- or bone-level implants after placed with simultaneous guided bone regeneration (GBR). MATERIALS AND METHODS A total of 151 patients who received 104 tissue-level or 128 bone-level implants placement with simultaneous GBR in the mandibular posterior region between January 2011 and December 2016 were included in this study. The marginal bone level (MBL) was recorded using the radiographic data obtained at implant placement, second-stage surgery, and the follow-up visit. Generalized estimating equation (GEE) was used to compare the ΔMBL of tissue- and bone-level implants, and the influencing factors of ΔMBL were further analyzed. RESULTS At the last follow-up visit, the MBL of tissue-level implants was 0.73 ± 0.86 mm, above the rough-smooth interface, while that of bone-level implants was 0.82 ± 1.05 mm, above the implant platform. The ΔMBL of tissue-level implants was 1.03 mm, which was slightly higher than 0.81 mm of bone-level implants, but there was no significant difference (p > 0.05). No contributing factor associated with ΔMBL was identified by multivariate regression analysis in this study. CONCLUSION Within the limits of this retrospective analysis, the ΔMBL of tissue-level implants is similar to that of bone-level implants after placed with simultaneous GBR, and both types of implants can achieve desirable marginal bone stability.
Collapse
Affiliation(s)
- Xiaoting Shen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Sijia Yang
- Department of prosthodontics, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yangbo Xu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Wenting Qi
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Fuming He
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| |
Collapse
|
8
|
Cunha G, Carvalho PHDA, Quirino LC, Torres LHS, Filho VAP, Gabrielli MFR, Gabrielli MAC. Titanium Mesh Exposure After Bone Grafting: Treatment Approaches-A Systematic Review. Craniomaxillofac Trauma Reconstr 2022; 15:397-405. [PMID: 36387308 PMCID: PMC9647381 DOI: 10.1177/19433875211046114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023] Open
Abstract
Study Design A systematic review according to PRISMA statement has been designed to answer the preliminary question: "In titanium mesh exposures, is there a treatment alternative which leads to an increased graft maintenance?" and fill the PICO assessment out. Objective To review studies published in the past 20 years (1999-2019) in which mesh exposure has occurred, detecting the suitable approaches to treat exposure allowing the graft maintenance. Methods Initial search on PUBMED, SCOPUS, and COCHRANE databases resulted in 777 articles, and hand-searching identified 6 articles. After removing duplicates and unrelated articles, eligibility criteria were applied, and 31 studies were selected (randomized clinical trials, retrospective/prospective clinical trials, and case series). Results A total of 677 surgical sites and 225 cases of mesh exposure were identified. Eleven treatments have been identified. Chlorhexidine was the primary approach in 46% of cases, followed by oral hygiene instructions and follow-up with 22.5% of occurrences. In 21% of clinical situations, titanium mesh removal was the treatment of choice, associated with other measures (i.e., antibiotic prescription). There seems to be a consensus in cases of infection. When this complication was associated with tissue dehiscence, the primary treatment was mesh removal. The same does not occur when the site needs to be cleaned for long-term periods. Conclusion In 2 decades of use of titanium meshes, the available treatments do not seem to have evolved, and there is not enough data to establish a guideline.
Collapse
Affiliation(s)
- Giovanni Cunha
- Department of Diagnosis and Surgery,
Division of Oral and Maxillofacial Surgery, School of Dentistry, São Paulo State
University (Unesp), Araraquara, Brazil
- Department of Oral and
Cranio-Maxillofacial Surgery, University Hospital Basel, Switzerland
| | - Pedro Henrique de Azambuja Carvalho
- Department of Diagnosis and Surgery,
Division of Oral and Maxillofacial Surgery, School of Dentistry, São Paulo State
University (Unesp), Araraquara, Brazil
| | - Lílian Caldas Quirino
- Department of Diagnosis and Surgery,
Division of Oral and Maxillofacial Surgery, School of Dentistry, São Paulo State
University (Unesp), Araraquara, Brazil
| | - Luiz Henrique Soares Torres
- Department of Diagnosis and Surgery,
Division of Oral and Maxillofacial Surgery, School of Dentistry, São Paulo State
University (Unesp), Araraquara, Brazil
| | - Valfrido Antônio Pereira Filho
- Department of Diagnosis and Surgery,
Division of Oral and Maxillofacial Surgery, School of Dentistry, São Paulo State
University (Unesp), Araraquara, Brazil
| | - Mario Francisco Real Gabrielli
- Department of Diagnosis and Surgery,
Division of Oral and Maxillofacial Surgery, School of Dentistry, São Paulo State
University (Unesp), Araraquara, Brazil
| | - Marisa Aparecida Cabrini Gabrielli
- Department of Diagnosis and Surgery,
Division of Oral and Maxillofacial Surgery, School of Dentistry, São Paulo State
University (Unesp), Araraquara, Brazil
| |
Collapse
|
9
|
Schwarz F, Obreja K, Mayer S, Ramanauskaite A, Sader R, Parvini P. Efficacy of autogenous tooth roots for a combined vertical and horizontal alveolar ridge augmentation and staged implant placement. A prospective controlled clinical study. J Clin Periodontol 2022; 49:496-505. [PMID: 35258131 DOI: 10.1111/jcpe.13609] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/02/2022] [Accepted: 02/21/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess and compare the efficacy and safety of autogenous tooth roots (TRs) and autogenous bone blocks (ABs) for combined vertical and horizontal alveolar ridge augmentation and two-stage implant placement. MATERIALS AND METHODS A total of 28 patients in need of implant therapy and vertical ridge augmentation were allocated to parallel groups receiving either healthy autogenous tooth roots (e.g., retained wisdom teeth) (n = 14, n = 15 defects) or cortical autogenous bone blocks harvested from the retromolar area (n = 14, n = 17 defects). After 26 weeks of submerged healing, the clinical reduction in ridge height (RH) deficiency was defined as the primary outcome. RESULTS Both surgical procedures were associated with a similar mean reduction in RH deficiency values, amounting to 4.48 ± 2.42 mm (median: 4.25; 95% CI: 3.08-5.88) in the TR group and 4.46 ± 3.31 mm (median: 3.00; 95% CI: 2.54-6.38) in the AB group (p = .60, Mann-Whitney U-test). In all patients investigated, the reduction in RH deficiency values allowed for an adequate implant placement at the respective sites. The frequency of complications (e.g., soft tissue dehiscences) was low (TR: n = 4; AB: n = 0). CONCLUSIONS Up to staged-implant placement, both TR and AB grafts appeared to be associated with comparable efficacy and safety for combined vertical and horizontal alveolar ridge augmentation.
Collapse
Affiliation(s)
- Frank Schwarz
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
| | - Karina Obreja
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
| | - Stephanie Mayer
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
| | - Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
| | - Robert Sader
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Puria Parvini
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
| |
Collapse
|
10
|
3D-based buccal augmentation for ideal prosthetic implant alignment—an optimized method and report on 7 cases with pronounced buccal concavities. Clin Oral Investig 2022; 26:3999-4010. [PMID: 35066689 PMCID: PMC9072447 DOI: 10.1007/s00784-022-04369-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 12/31/2021] [Indexed: 02/07/2023]
Abstract
Objectives Screw-retained restoration of implants is advantageous for biological and esthetic reasons. Due to buccal concavities, however, this preferred type of restoration can only be used in about half of the anterior indications. Based on case series, an optimized method for the treatment of such indications is to be described; the clinical reliability is to be ascertained by means of measurements (before and after augmentation) and assigned to the current literature. Material and methods A case series of seven cases with buccal concavities of the anterior alveolar ridge were treated with optimized method, which is presented step-by-step until the prosthetic restoration. The depths of the bone concavities were measured and related to the bone gain after augmentation procedure respectively after implantation. Results Linear measurements of the buccal concavities showed an average undercut of 4 mm [SD ± 1.13]. After healing period of six months, the buccal concavities could be compensated bony to such an extent that implants could be inserted in correct position and angulation. On average, there was a horizontal bone gain of 3.7 mm [SD ± 0.59]. Even after implantation and another six months of healing, stable bone dimensions could be assumed with an average of 4.3 [SD ± 0.83] mm of bone gain compared to baseline. In six of the seven cases, the favorite screw-retained, one-piece full-ceramic restoration could be fixed on the implants. Due to the implant axis, one case had to be treated with a cemented two-part full-ceramic system. Conclusions With the described optimized method the most favorable screw-retained restoration can also be used in situations with unfavorable concavities of buccal bone. Especially for this indication, a special form of the horizontal deficit, the customized bone regeneration with titanium meshes is highly reliable in terms of healing and extent of augmentation. However, long-term results and a study/control group are required to evaluate the effectiveness of the presented protocol. Clinical relevance. Since these situations require an augmentation that is up to 5 mm thick and a procedure that is as minimally invasive as possible appears to be necessary in the visible area, an optimized method is described in this publication.
Collapse
|
11
|
Tay JRH, Ng E, Lu XJ, Lai WMC. Healing complications and their detrimental effects on bone gain in vertical-guided bone regeneration: A systematic review and meta-analysis. Clin Implant Dent Relat Res 2022; 24:43-71. [PMID: 35048503 DOI: 10.1111/cid.13057] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/23/2021] [Accepted: 12/02/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Guided bone regeneration (GBR) utilizes a barrier membrane to allow osteogenic cells to populate a space by excluding epithelial and connective tissue cells. The purpose of this systematic review was to investigate the ratio of means (RoM) of vertical bone gained (Outcome) in vertical GBR procedures with healing complications (Intervention) and in vertical GBR procedures without healing complications (Comparison) in patients with vertically resorbed edentulous ridges that require dental implant placement (Population). A further aim was to investigate the incidence of complications after vertical GBR, and the influence of the timing of implant placement and regenerative devices on complications. MATERIALS AND METHODS MEDLINE (through PubMed), EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched in duplicate up to, and including, November 2020 for randomized and controlled clinical trials and prospective and retrospective case series. Outcomes included patient-level and site-level RoM of vertical bone gain between healing complications and uneventful healing, and incidences of complications that occurred after vertical GBR. Random-effects and fixed-effects meta-analyses were performed where appropriate. This study was registered on PROSPERO (CRD42021226432). RESULTS A total of 31 publications were selected for the qualitative and quantitative analyses. The RoM of vertical bone gained was 0.65 [95% CI = 0.47, 0.91] and 0.62 [95% CI = 0.45, 0.85] when membrane exposure without suppuration and abscess formation without membrane exposure occurred respectively, in comparison to uneventful healing. The overall incidence proportion of healing complications occurring at the augmented site at a site- and patient-level was 11.0% [95% CI = 7.0, 15.6] and 10.8% [95% CI = 6.6, 15.7]. At a patient-level, there were no significant differences between a simultaneous or staged approach, or with the regenerative device used. The site-level incidence proportion of membrane exposure without suppuration, membrane exposure with suppuration, and with abscess formation without membrane exposure was 8.7% [95% CI = 4.2, 14.2], 0.7% [95% CI = 0.0, 2.9], and 0.5% [95% CI = 0.0, 1.7], respectively. The site-level weighted mean incidence proportion of neurologic complications occurring at the donor site was 0.8% [95% CI = 0.0, 5.3]. CONCLUSIONS There is a significant reduction in bone gain when healing complications occur. However, healing complications are relatively uncommon surgical complications after vertical GBR.
Collapse
Affiliation(s)
- John Rong Hao Tay
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore
| | - Ethan Ng
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore
| | - Xiaotong Jacinta Lu
- Discipline of Periodontics, Faculty of Dentistry, National University of Singapore, Singapore
| | | |
Collapse
|
12
|
Trubelja A, Kasper FK, Farach-Carson MC, Harrington DA. Bringing hydrogel-based craniofacial therapies to the clinic. Acta Biomater 2022; 138:1-20. [PMID: 34743044 PMCID: PMC9234983 DOI: 10.1016/j.actbio.2021.10.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/06/2021] [Accepted: 10/29/2021] [Indexed: 01/17/2023]
Abstract
This review explores the evolution of the use of hydrogels for craniofacial soft tissue engineering, ranging in complexity from acellular injectable fillers to fabricated, cell-laden constructs with complex compositions and architectures. Addressing both in situ and ex vivo approaches, tissue restoration secondary to trauma or tumor resection is discussed. Beginning with relatively simple epithelia of oral mucosa and gingiva, then moving to more functional units like vocal cords or soft tissues with multilayer branched structures, such as salivary glands, various approaches are presented toward the design of function-driven architectures, inspired by native tissue organization. Multiple tissue replacement paradigms are presented here, including the application of hydrogels as structural materials and as delivery platforms for cells and/or therapeutics. A practical hierarchy is proposed for hydrogel systems in craniofacial applications, based on their material and cellular complexity, spatial order, and biological cargo(s). This hierarchy reflects the regulatory complexity dictated by the Food and Drug Administration (FDA) in the United States prior to commercialization of these systems for use in humans. The wide array of available biofabrication methods, ranging from simple syringe extrusion of a biomaterial to light-based spatial patterning for complex architectures, is considered within the history of FDA-approved commercial therapies. Lastly, the review assesses the impact of these regulatory pathways on the translational potential of promising pre-clinical technologies for craniofacial applications. STATEMENT OF SIGNIFICANCE: While many commercially available hydrogel-based products are in use for the craniofacial region, most are simple formulations that either are applied topically or injected into tissue for aesthetic purposes. The academic literature previews many exciting applications that harness the versatility of hydrogels for craniofacial soft tissue engineering. One of the most exciting developments in the field is the emergence of advanced biofabrication methods to design complex hydrogel systems that can promote the functional or structural repair of tissues. To date, no clinically available hydrogel-based therapy takes full advantage of current pre-clinical advances. This review surveys the increasing complexity of the current landscape of available clinical therapies and presents a framework for future expanded use of hydrogels with an eye toward translatability and U.S. regulatory approval for craniofacial applications.
Collapse
Affiliation(s)
- Alen Trubelja
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, UTHealth Science Center at Houston, Houston, TX 77054, United States; Department of Bioengineering, Rice University, Houston, TX 77005, United States
| | - F Kurtis Kasper
- Department of Orthodontics, School of Dentistry, UTHealth Science Center at Houston, Houston, TX 77054, United States
| | - Mary C Farach-Carson
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, UTHealth Science Center at Houston, Houston, TX 77054, United States; Department of Bioengineering, Rice University, Houston, TX 77005, United States; Department of BioSciences, Rice University, Houston, TX 77005, United States
| | - Daniel A Harrington
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, UTHealth Science Center at Houston, Houston, TX 77054, United States; Department of Bioengineering, Rice University, Houston, TX 77005, United States; Department of BioSciences, Rice University, Houston, TX 77005, United States.
| |
Collapse
|
13
|
Hayashi K, Shimabukuro M, Kishida R, Tsuchiya A, Ishikawa K. Structurally optimized honeycomb scaffolds with outstanding ability for vertical bone augmentation. J Adv Res 2022; 41:101-112. [DOI: 10.1016/j.jare.2021.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/25/2021] [Accepted: 12/22/2021] [Indexed: 12/12/2022] Open
|
14
|
Hard tissue stability after guided bone regeneration: a comparison between digital titanium mesh and resorbable membrane. Int J Oral Sci 2021; 13:37. [PMID: 34782595 PMCID: PMC8594427 DOI: 10.1038/s41368-021-00143-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/28/2021] [Accepted: 10/27/2021] [Indexed: 02/05/2023] Open
Abstract
Guided bone regeneration (GBR) uses resorbable and non-resorbable membranes as biological barriers. This study compared the differences in hard tissue stability between GBR using evidence-based digital titanium mesh and resorbable collagen membranes during implant placement. A total of 40 patients (65 implant sites) were enrolled and divided into two groups: resorbable membrane and digital titanium mesh groups. The alveolar bone was analyzed at two- and three-dimensional levels using cone-beam computed tomography and by reconstructing and superimposing the hard tissues at four time points: preoperatively, postoperatively, before second-stage surgery, and 1 year after loading. The use of digital titanium mesh showed less alveolar bone resorption in vertical and horizontal directions two-dimensionally before the second-stage surgery and 1 year after loading. Regarding volumetric stability, the percentage of resorption after 6 months of healing with resorbable membrane coverage reached 37.5%. However, it was only 23.4% with titanium mesh. Although postoperative bone volume was greater at all labial sites with resorbable membrane than with digital titanium mesh, after substantial bone resorption within 1 year of loading, the labial bone thickness at the upper part of implants was thinner with resorbable membrane than with digital titanium mesh. Furthermore, digital titanium meshes made according to ideal bone arch contour reduced soft tissue irritation, and the exposure rate was only 10%. Therefore, although both resorbable membrane and digital titanium mesh in GBR were able to successfully reconstruct the bone defect, digital titanium meshes were better at maintaining the hard tissue volume in the osteogenic space.
Collapse
|
15
|
Traboulsi-Garet B, González-Barnadas A, Camps-Font O, Figueiredo R, Valmaseda-Castellón E. Influence of Different Incision Designs on Flap Extension: A Cadaveric Animal Model. J ORAL IMPLANTOL 2021; 47:395-400. [PMID: 33031545 DOI: 10.1563/aaid-joi-d-20-00026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
It is well known that wound dehiscence is one of the most frequent complications in guided bone regeneration. The main cause of this complication may be a lack of tension-free and primary wound closure. The aim of this study was to evaluate and compare the effect of periosteal releasing incisions (PRI) on the extension of 3 different flap designs: envelope, triangular, and trapezoidal. Twelve pig mandibles were used to quantify extension of the flap designs. The mandibles were equally and randomly distributed into the 3 flap groups. Each mandible was divided into 2 sides: 1 was subjected to a PRI and the other not. The flap was pulled with a force of 1.08 N, and the extension was recorded. The subgroups without PRI showed an average extension of 5.14 mm with no statistically significant differences among them (P = .165). The PRI provided an average extension of 7.37 mm with statistically significant differences among the subgroups (P < .001). The releasing incisions significantly increased flap extension in each flap design. The increase in extension of the trapezoidal flap with PRI was significantly greater than in the other subgroups. In cases where primary closure is required, surgeons should consider performing trapezoidal flaps with PRI in order to reduce tension.
Collapse
Affiliation(s)
| | | | - Octavi Camps-Font
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Rui Figueiredo
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | | |
Collapse
|
16
|
Xie Y, Li S, Zhang T, Wang C, Cai X. Titanium mesh for bone augmentation in oral implantology: current application and progress. Int J Oral Sci 2020; 12:37. [PMID: 33380722 PMCID: PMC7773733 DOI: 10.1038/s41368-020-00107-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 02/05/2023] Open
Abstract
Guided bone regeneration (GBR) is an effective and simple method for bone augmentation, which is often used to reconstruct the alveolar ridge when the bone defect occurs in the implant area. Titanium mesh has expanded the indications of GBR technology due to its excellent mechanical properties and biocompatibility, so that the GBR technology can be used to repair alveolar ridges with larger bone defects, and can obtain excellent and stable bone augmentation results. Currently, GBR with titanium mesh has various clinical applications, including different clinical procedures. Bone graft materials, titanium mesh covering methods, and titanium mesh fixing methods are also optional. Moreover, the research of GBR with titanium mesh has led to multifarious progresses in digitalization and material modification. This article reviews the properties of titanium mesh and the difference of titanium mesh with other barrier membranes; the current clinical application of titanium mesh in bone augmentation; common complications and management and prevention methods in the application of titanium mesh; and research progress of titanium mesh in digitization and material modification. Hoping to provide a reference for further improvement of titanium mesh in clinical application and related research of titanium mesh.
Collapse
Affiliation(s)
- Yu Xie
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Songhang Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Tianxu Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chao Wang
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
| | - Xiaoxiao Cai
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| |
Collapse
|
17
|
Li S, Zhang T, Zhou M, Zhang X, Gao Y, Cai X. A novel digital and visualized guided bone regeneration procedure and digital precise bone augmentation: A case series. Clin Implant Dent Relat Res 2020; 23:19-30. [PMID: 33079419 DOI: 10.1111/cid.12959] [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: 07/07/2020] [Revised: 09/28/2020] [Accepted: 10/06/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although the traditional bone augmentation technology can basically meet the clinical needs at present, the effect of bone augmentation in most cases is related to the experience of the operator. PROPOSE This study commits to providing a digital solution for precise bone augmentation in the field of oral implantology. MATERIALS AND METHODS After collecting the data of patients' intraoral scanning and DICOM (digital imaging and communications in medicine), the implant position is digitally designed, and the alveolar bone is digitally augmented around the ideal implant position. On the premise of ensuring that the thickness of labial bone is 2 mm, and there is sufficient alveolar bone 3 to 4 mm apically from the ideal gingival margin for implant placing, we carry out excessive augmentation of 0.5 and 1 mm on the labial bone and alveolar crest, respectively, to compensate for possible bone resorption after 6 months. After 3D printing the reconstructed alveolar bone model, the titanium mesh is trimmed and preformed on the alveolar bone model. Outcomes are reported in terms of mean values (5%-95% percentile values). RESULTS Thirty implant sites have accepted this novel virtually designed alveolar bone augmentation. Before the second-stage surgery, the average vertical bone gain was 2.48 mm (0.29-6.32), the average horizontal bone gain was 4.11 mm (1.19-8.74), the average height of the residual alveolar bone above the implant platform was 1.44 mm (0.59-2.92), the average thickness of the labial bone width at the implant platform was 2.00 mm (0.93-3.64), the average thickness of the labial bone width at 2 mm apically from the implant platform was 2.74 mm (1.40-5.46). The virtual augmentation of each tooth position was 349.41 mm3 (165.70-482.70), while the actual augmentation of each tooth position was 352.94 mm3 (159.24-501.78), the accuracy of the final actual augmentation reached 95.82% (range from 88.53% to 99.15%). CONCLUSION This case series suggests that a virtually digital guided bone regeneration (GBR) workflow is precise and controllable. The practicality, safety and effectiveness of this procedure needs to be compared to other bone augmentation procedures in randomized controlled trials.
Collapse
Affiliation(s)
- Songhang Li
- Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Tianxu Zhang
- Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Mi Zhou
- Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaolin Zhang
- Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yang Gao
- Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaoxiao Cai
- Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| |
Collapse
|
18
|
Urban IA, Montero E, Monje A, Sanz-Sánchez I. Effectiveness of vertical ridge augmentation interventions: A systematic review and meta-analysis. J Clin Periodontol 2019; 46 Suppl 21:319-339. [DOI: 10.1111/jcpe.13061] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/15/2018] [Accepted: 01/06/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Istvan A. Urban
- Department of Implant Dentistry; University of Loma Linda; Loma Linda California
| | - Eduardo Montero
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
| | - Alberto Monje
- Department of Periodontology; School of Dentistry; International University of Catalonia; Barcelona Spain
- Department of Oral Surgery and Stomatology; ZMK School of Dentistry; University of Bern; Bern Switzerland
| | - Ignacio Sanz-Sánchez
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
| |
Collapse
|
19
|
Martinez-de la Cruz G, Yamauchi K, Odajima K, Kataoka Y, Nogami S, Takahashi T. Histologic and histomorphometric evaluation of the bone regeneration following cortical bone repositioning in a rabbit mandible. Clin Implant Dent Relat Res 2019; 21:613-620. [PMID: 31016885 DOI: 10.1111/cid.12777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/01/2019] [Accepted: 04/05/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although bone graft (BG) is the gold standard for bone augmentation, its use is hampered by donor site morbidity and limited quantity. PURPOSE To evaluate the capabilities of bone formation by cortical bone repositioning (CBR) as the healing response following grafting of autogenous bone block without filling biomaterial at the gap between gap and recipient. MATERIALS AND METHODS Twelve Japanese White rabbits were divided into three groups (postoperative 2, 5, and 8 weeks). A cortical block was freed from the mandibular body, half of the block was positioned and fixed overlapped the original bone surface beside the defect and the other half remained only elevated above the defect. Three areas were decided for the evaluation; BG, CBR, and defect (D) area. Areas were evaluated by micro-CT, histology, and histomorphometric analysis. RESULTS There is no statistical difference between BG and CBR by evaluating distance and area in histomorphometrical analysis (P < .05). D area showed statistical decrease compared with BG and CBR at week 2. Histologically, new bone was evident at week 2, mature bone was observed in all three areas at week 8, D area disappeared and fused completely with the elevated bone block. CONCLUSION CBR has potential for bone augmentation as BG induced from its own regenerative ability of healing process.
Collapse
Affiliation(s)
- Gerardo Martinez-de la Cruz
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - Kensuke Yamauchi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - Kenji Odajima
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - Yoshihiro Kataoka
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - Shinnosuke Nogami
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - Tetsu Takahashi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Graduate School of Dentistry, Tohoku University, Sendai, Japan
| |
Collapse
|
20
|
Yoo JM, Ben Amara H, Kim MK, Song JD, Koo KT. Oral tissue response to soft tissue expanders prior to bone augmentation: in vitro analysis and histological study in dogs. J Periodontal Implant Sci 2018; 48:152-163. [PMID: 29984045 PMCID: PMC6031766 DOI: 10.5051/jpis.2018.48.3.152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/15/2018] [Indexed: 01/25/2023] Open
Abstract
Purpose To determine whether the swelling and mechanical properties of osmotic self-inflating expanders allow or not the induction of intraoral soft tissue expansion in dogs. Methods Three different volumes (0.15, 0.25, and 0.42 mL; referred to respectively as the S, M, and L groups) of soft tissue expanders (STEs) consisting of a hydrogel core coated with a silicone-perforated membrane were investigated in vitro to assess their swelling behavior (volume swelling ratio) and mechanical properties (tensile strength, tensile strain). For in vivo investigations, the STEs were subperiosteally inserted for 4 weeks in dogs (n=5). Soft tissue expansion was clinically monitored. Histological analyses included the examination of alveolar bone underneath the expanders and thickness measurements of the surrounding fibrous capsule. Results The volume swelling ratio of all STEs did not exceed 5.2. In tensile mode, the highest mean strain was registered for the L group (98.03±0.3 g/cm), whereas the lowest mean value was obtained in the S group (81.3±0.1 g/cm), which was a statistically significant difference (P<0.05). In addition, the S and L groups were significantly different in terms of tensile strength (1.5±0.1 g/cm for the S group and 2.2±0.1 g/cm for the L group, P<0.05). Clinical monitoring showed successful dilatation of the soft tissues without signs of inflammation up to 28 days. The STEs remained volumetrically stable, with a mean diameter in vivo of 6.98 mm, close to the in vitro post-expansion findings (6.69 mm). Significant histological effects included highly vascularized collagen-rich fibrous encapsulation of the STEs, with a mean thickness of 0.67±0.12 mm. The bone reaction consisted of resorption underneath the STEs, while apposition was observed at their edges. Conclusions The swelling and mechanical properties of the STEs enabled clinically successful soft tissue expansion. A tissue reaction consisting of fibrous capsule formation and bone loss were the main histological events.
Collapse
Affiliation(s)
- Jung Min Yoo
- Department of Periodontology and Dental Research Institute, Translational Research Laboratory for Tissue Engineering (TTE), Seoul National University School of Dentistry, Seoul, Korea
| | - Heithem Ben Amara
- Department of Periodontology and Dental Research Institute, Translational Research Laboratory for Tissue Engineering (TTE), Seoul National University School of Dentistry, Seoul, Korea
| | | | | | - Ki-Tae Koo
- Department of Periodontology and Dental Research Institute, Translational Research Laboratory for Tissue Engineering (TTE), Seoul National University School of Dentistry, Seoul, Korea
| |
Collapse
|
21
|
Abrahamsson P, Wälivaara DÅ, Anderud J, Jimbo R. Vertical bone augmentation with titanium granule blocks in rabbit calvaria. Clin Exp Dent Res 2018; 3:100-106. [PMID: 29744186 PMCID: PMC5719821 DOI: 10.1002/cre2.67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/22/2017] [Accepted: 03/27/2017] [Indexed: 11/17/2022] Open
Abstract
To determine whether it is possible to vertically augment bone utilizing a block graft from compressed titanium granules mainly used previously for contained bone defects and to determine whether there exists a difference in osteoconductive properties between the white and the grey granules. In 11 rabbits, 4 titanium blocks were inserted on each rabbit's skull bone according to a randomized scheme. These blocks were made from standardized compressed titanium granules. Type A: PTG grey, small granules (Pourus Titanium Granules, Tigran, Malmö, Sweden); Type B: PTG grey, large granules; Type C: PTG white, small granules; Type D: PTG white large granules. After 12 weeks, the animals were sacrificed and specimens were collected for histology and μCT scanning. From both the μCT and histology, it can be said that bone formation was successfully achieved for all groups, and the granules maintained their volume. The histomorphometric BA (bone area) evaluation in the entire grafted area presented that there were no statistical differences between all groups tested. The lowest 1/4 BA in contact with the rabbit skull presented that groups A and C presented the highest mean BA, and group A presented significantly higher BA than that of group D (p = 0,049). No significant differences were noted between groups A, B and C. Within the limitation of this study, no differences were noted between small white or grey PTG blocks. The large granules presented less bone ingrowth area compared to the small granules and this trend was regardless of the different PTG types. The entire grafted area was not filled with new bone suggesting that bone migration occurred mostly from the existing cortical bone side suggesting contact osteogenesis.
Collapse
Affiliation(s)
| | | | | | - Ryo Jimbo
- Department of Oral and Maxillofacial Surgery and Oral Medicine Malmö University SE Sweden
| |
Collapse
|
22
|
Preaugmentation Soft Tissue Expansion: A Report of Four Pilot Cases. Case Rep Dent 2018; 2018:3162617. [PMID: 29850276 PMCID: PMC5933028 DOI: 10.1155/2018/3162617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/17/2018] [Indexed: 11/17/2022] Open
Abstract
This pilot study aimed at investigating the safety and feasibility of pre-augmentation soft tissue expansion (STE). Tissue expanders of different sizes (from 240 to 1300 mm3) were implanted subperiosteally in four patients requiring vertical and/or horizontal bone augmentation, and left in situ for 20-60 days, according to the expander size. Guided bone regeneration was carried out after STE completion. Horizontal and vertical bone gains were analyzed through CBCT. Optical scanning and superimposition of cast models were used for volumetric analysis. The mean soft tissue volume increase was 483.8 ± 251.7 mm3. Horizontal bone gain averaged 3 mm in two successfully expanded sites while one case had a vertical bone gain of 8 mm. Despite promising outcomes in bone and soft tissue gain, the present technique needs improvement before being applied routinely in everyday dental practice.
Collapse
|
23
|
Aziz J, Ahmad MF, Rahman MT, Yahya NA, Czernuszka J, Radzi Z. AFM analysis of collagen fibrils in expanded scalp tissue after anisotropic tissue expansion. Int J Biol Macromol 2018; 107:1030-1038. [DOI: 10.1016/j.ijbiomac.2017.09.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 09/13/2017] [Accepted: 09/17/2017] [Indexed: 01/24/2023]
|
24
|
Kaner D, Zhao H, Arnold W, Terheyden H, Friedmann A. Pre-augmentation soft tissue expansion improves scaffold-based vertical bone regeneration - a randomized study in dogs. Clin Oral Implants Res 2017; 28:640-647. [PMID: 27145448 PMCID: PMC5484302 DOI: 10.1111/clr.12848] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Soft tissue (ST) dehiscence with graft exposure is a frequent complication of vertical augmentation. Flap dehiscence is caused by failure to achieve tension-free primary wound closure and by the impairment of flap microcirculation due to surgical trauma. Soft tissue expansion (STE) increases ST quality and quantity prior to reconstructive surgery. We hypothesized that flap preconditioning using STE would reduce the incidence of ST complications after bone augmentation and that optimized ST healing would improve the outcome of bone regeneration. MATERIALS AND METHODS Self-filling tissue expanders were implanted in mandibular bone defects in ten beagle dogs. After expansion, alloplastic scaffolds were placed for vertical bone augmentation in STE sites and in control sites without STE pre-treatment. ST flap microcirculation was analysed using laser Doppler flowmetry. The incidence of graft exposures was evaluated after 2 weeks. Bone formation was assessed after 2 months, using histomorphometry and immunohistochemistry. RESULTS Test sites showed significantly less impairment of perfusion and faster recovery of microcirculation after bone augmentation. Furthermore, no flap dehiscences occurred in STE sites. Bone regeneration was found in both groups; however, significantly greater formation of new bone was detected in test sites with preceding STE. CONCLUSIONS Preconditioning using STE improved ST healing and bone formation after vertical augmentation. The combination of STE and the subsequent placement of alloplastic scaffolds may facilitate the reconstruction of severe bone defects.
Collapse
Affiliation(s)
- Doğan Kaner
- Department of PeriodontologyWitten/Herdecke UniversityWittenGermany
| | - Han Zhao
- Department of PeriodontologyWitten/Herdecke UniversityWittenGermany
- Multi‐disciplinary Treatment CenterBeijing Stomatological HospitalCapital Medical UniversityBeijingChina
| | - Wolfgang Arnold
- Department of Oral Biology and Materials ScienceWitten/Herdecke UniversityWittenGermany
| | - Hendrik Terheyden
- Department of Maxillofacial SurgeryRotes‐Kreuz‐Krankenhaus KasselKasselGermany
| | - Anton Friedmann
- Department of PeriodontologyWitten/Herdecke UniversityWittenGermany
| |
Collapse
|
25
|
Hrib J, Sirc J, Lesny P, Hobzova R, Duskova-Smrckova M, Michalek J, Smucler R. Hydrogel tissue expanders for stomatology. Part I. Methacrylate-based polymers. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:12. [PMID: 27995490 DOI: 10.1007/s10856-016-5818-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 11/24/2016] [Indexed: 06/06/2023]
Abstract
In order to create a soft tissue surplus, implantable volume expanders are often utilized in dental surgery. Implanted tissue expanders should gradually increase their volume, exerting a constant pressure on the surrounding tissue for weeks. Current tissue expanders are based predominantly on externally inflatable balloons or on osmotically active tissue expanders that use soft hydrogels wrapped in perforated plastic coatings, which limit fluid entry and swelling. We have designed and examined tissue expanders based on the controlled rate expansive hydrogels synthesized from copolymers of selected methacrylates and N-vinylpyrrolidone, cross-linked with a combination of non-degradable (glycol dimethacrylates) and hydrolytically degradable (N,O-dimethacryloylhydroxylamine) cross-linkers. These copolymers have close-to-linear volume expansion rates (up to 6-9 times their original volume) and exert an increasing swelling pressure in vitro. The anesthetic benzocaine has been incorporated into the hydrogels, and kinetic release experiments have shown that most of the drug (90%) was released within 48 h. Our proposed hydrogel expanders are homogeneous and have suitable mechanical properties, thus simplifying the surgical manipulations required. Further studies will be needed to completely evaluate their biocompatibility and tissue response to the implants.
Collapse
Affiliation(s)
- Jakub Hrib
- Institute of Macromolecular Chemistry AS CR, Heyrovsky Sq. 2, Prague 6, 162 06, Czech Republic
| | - Jakub Sirc
- Institute of Macromolecular Chemistry AS CR, Heyrovsky Sq. 2, Prague 6, 162 06, Czech Republic.
| | - Petr Lesny
- Institute of Hematology and Blood Transfusion, U Nemocnice 2094/1, Prague 2, 128 20, Czech Republic
| | - Radka Hobzova
- Institute of Macromolecular Chemistry AS CR, Heyrovsky Sq. 2, Prague 6, 162 06, Czech Republic
| | | | - Jiri Michalek
- Institute of Macromolecular Chemistry AS CR, Heyrovsky Sq. 2, Prague 6, 162 06, Czech Republic
| | - Roman Smucler
- First Medical Faculty of the Charles University, Katerinska 32, Prague 2, 121 08, Czech Republic
| |
Collapse
|
26
|
Rahpeyma A, Khajehahmadi S. Anterior Palatal Island Advancement Flap for Bone Graft Coverage: Technical Note. J Surg Tech Case Rep 2016; 7:42-4. [PMID: 27512552 PMCID: PMC4966204 DOI: 10.4103/2006-8808.185655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The most important step in bone graft management is soft tissue coverage. Dehiscence of the wound leads to graft exposure and subsequent problems. PURPOSE This study introduces an axial pattern flap for bone graft coverage in anterior maxilla. PATIENTS AND METHODS Use of Anterior Palatal Island Advancement Flap is presented by the authors. It is a mucoperiosteal flap with axial pattern blood supply, based on nasopalatine artery. It is easy to raise and predictable. RESULTS Anterior Palatal Island Advancement Flap was effective in bone graft coverage in premaxillary edentulous area. CONCLUSION It can be used as an aid for bone graft coverage of premaxillary edentulous ridge, where the need for mucosa is small in width but long in length.
Collapse
Affiliation(s)
- Amin Rahpeyma
- Associate Professor of Oral and Maxillofacial Surgery, Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeedeh Khajehahmadi
- Assistant Professor of Oral and Maxillofacial Pathology, Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
27
|
Asa'ad F, Rasperini G, Pagni G, Rios HF, Giannì AB. Pre-augmentation soft tissue expansion: an overview. Clin Oral Implants Res 2015; 27:505-22. [PMID: 26037472 DOI: 10.1111/clr.12617] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to explore the development of soft tissue expanders, their different types and their potential applications prior to bone augmentation and implant placement. MATERIAL AND METHODS A review of pertinent literature was performed using PubMed to comprehend the dynamics of soft tissue expanders and determine the current position of their pre-augmentation applications. RESULTS There is promising, albeit preliminary information regarding the benefits of pre-augmentation soft tissue expansion. Findings cannot be generalised due to relatively small sample size. CONCLUSIONS Further clinical trials with larger sample sizes and long-term follow-up are needed before soft tissue expanders can be confidently applied in everyday clinical practice.
Collapse
Affiliation(s)
- Farah Asa'ad
- Department of Biomedical, Surgical and Dental Sciences, Foundation IRCCS Ca' Granda Polyclinic, University of Milan, Milan, Italy
| | - Giulio Rasperini
- Department of Biomedical, Surgical and Dental Sciences, Foundation IRCCS Ca' Granda Polyclinic, University of Milan, Milan, Italy
| | - Giorgio Pagni
- Department of Biomedical, Surgical and Dental Sciences, Foundation IRCCS Ca' Granda Polyclinic, University of Milan, Milan, Italy
| | - Hector F Rios
- Department of Periodontics and Oral Medicine, Michigan Center for Oral Health Research, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Aldo B Giannì
- Department of Biomedical, Surgical and Dental Sciences, Foundation IRCCS Ca' Granda Polyclinic, University of Milan, Milan, Italy
| |
Collapse
|
28
|
Anderud J, Abrahamsson P, Jimbo R, Isaksson S, Adolfsson E, Malmström J, Naito Y, Wennerberg A. Guided bone augmentation using ceramic space-maintaining devices: the impact of chemistry. Clin Cosmet Investig Dent 2015; 7:45-53. [PMID: 25792855 PMCID: PMC4360835 DOI: 10.2147/ccide.s78589] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The purpose of the study was to evaluate histologically, whether vertical bone augmentation can be achieved using a hollow ceramic space maintaining device in a rabbit calvaria model. Furthermore, the chemistry of microporous hydroxyapatite and zirconia were tested to determine which of these two ceramics are most suitable for guided bone generation. 24 hollow domes in two different ceramic materials were placed subperiosteal on rabbit skull bone. The rabbits were sacrificed after 12 weeks and the histology results were analyzed regarding bone-to-material contact and volume of newly formed bone. The results suggest that the effect of the microporous structure of hydroxyapatite seems to facilitate for the bone cells to adhere to the material and that zirconia enhance a slightly larger volume of newly formed bone. In conclusion, the results of the current study demonstrated that ceramic space maintaining devices permits new bone formation and osteoconduction within the dome.
Collapse
Affiliation(s)
- Jonas Anderud
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden ; Maxillofacial Unit Halmstad, Region Halland, Halmstad, Sweden
| | | | - Ryo Jimbo
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Sten Isaksson
- Maxillofacial Unit Halmstad, Region Halland, Halmstad, Sweden
| | | | - Johan Malmström
- Maxillofacial Unit Halmstad, Region Halland, Halmstad, Sweden
| | - Yoshihito Naito
- Department of Oral and Maxillofacial Prosthodontics and Oral Implantology, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
| | - Ann Wennerberg
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| |
Collapse
|
29
|
Kaner D, Zhao H, Terheyden H, Friedmann A. Improvement of microcirculation and wound healing in vertical ridge augmentation after pre-treatment with self-inflating soft tissue expanders - a randomized study in dogs. Clin Oral Implants Res 2014; 26:720-4. [PMID: 24735431 DOI: 10.1111/clr.12377] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We investigated the effect of soft tissue expansion (STE) on vertical ridge augmentation with regard to the incidence of wound dehiscences and the impairment of microcirculation in dogs, and the applicability of laser Doppler flowmetry (LDF) to explore the relation between microcirculation and wound healing. MATERIAL AND METHODS Bone defects were created on both mandibular sides in ten beagle dogs by extraction of premolars and removal of bone. Six weeks later, self-filling tissue expanders were implanted in randomly assigned test sites. After 5 weeks of expansion, vertical augmentation was carried out in test and control sites using calvarial onlay grafts side by side with granular biphasic calcium phosphate covered with a resorbable polyethylene glycol membrane. Microcirculation was evaluated with laser Doppler flowmetry (LDF). The incidence of wound dehiscences was evaluated after 2 weeks. The validity of LDF to predict dehiscences was evaluated by construction of receiver operating characteristic (ROC) curves. RESULTS After augmentation, test sites showed significantly better perfusion than control sites without preceding STE (P = 0.012). Three days after surgery, perfusion was still significantly decreased in control sites (P = 0.005), while microcirculation in test sites had returned to pre-surgical levels. After 2 weeks, healing in test sites was good, whereas eight dehiscences were found in control sites (P = 0.002). ROC curves showed that microcirculation levels immediately after augmentation surgery significantly predicted subsequent wound dehiscences (AUC = 0.799, CI 0.642-0.955, P = 0.006). CONCLUSIONS Laser Doppler flowmetry is suitable for evaluation of soft tissue microcirculation after ridge augmentation. STE reduced the impairment of microcirculation caused by vertical ridge augmentation and decreased the incidence of wound dehiscences in the investigated animal model.
Collapse
Affiliation(s)
- Dogan Kaner
- Department of Periodontology, University of Witten/Herdecke, Witten, Germany
| | | | | | | |
Collapse
|
30
|
Lin Z, Fateh A, Salem DM, Intini G. Periosteum: biology and applications in craniofacial bone regeneration. J Dent Res 2013; 93:109-16. [PMID: 24088412 DOI: 10.1177/0022034513506445] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The bone-regenerative potentials of the periosteum have been explored as early as the 17th century. Over the past few years, however, much has been discovered in terms of the molecular and cellular mechanisms that control the periosteal contribution to bone regeneration. Lineage tracing analyses and knock-in transgenic mice have helped define the relative contributions of the periosteum and endosteum to bone regeneration. Additional studies have shed light on the critical roles that BMP, FGF, Hedgehog, Notch, PDGF, Wnt, and inflammation signaling have or may have in periosteal-mediated bone regeneration, fostering the path to novel approaches in bone-regenerative therapy. Thus, by examining the role that each pathway has in periosteal-mediated bone regeneration, in this review we analyze the status of the current research on the regenerative potential of the periosteum. The provided analysis aims to inform both clinician-scientists who may have interest in the current studies about the biology of the periosteum as well as dental surgeons who may find this review useful to perform periosteal-harnessing bone-regenerative procedures.
Collapse
Affiliation(s)
- Z Lin
- Harvard School of Dental Medicine, 188 Longwood Avenue, REB 403, Boston, MA 02115, USA
| | | | | | | |
Collapse
|