Effect of Tisseel on bone healing with particulate dentin and plaster of Paris mixture

Use of Tisseel, a Fibrin Sealant, for Particulate Graft Stabilization

One clinical problem when augmenting a narrow or vertically deficient ridge is maintenance of the graft position during the immediate healing phase and preservation of the augmentation over time. The use of Tisseel (Baxter, Deerfield, IL), a fibrin sealant product, to stabilize particulate grafts, has been reported, and we have reviewed its use. Fibrinogen is converted to fibrin and forms a fibular network that binds the particulate graft. A protease inhibitor is included, which prevents lysis of the coagulum for at least 2 weeks and allows for fibrous ingrowth and graft stabilization. We have reviewed the reported data and included 2 case reports to demonstrate the use of Tisseel.

Combining autologous particulate dentin, L-PRF, and fibrinogen to create a matrix for predictable ridge preservation: a pilot clinical study

OBJECTIVES

The aim of this study was to describe the histological and clinical outcome of "dentin block" (a mixture of autologous particulate dentin, leukocyte- and platelet-rich fibrin (L-PRF), and liquid fibrinogen) in alveolar ridge preservation.

MATERIAL AND METHODS

Ten extraction sockets were grafted with "dentin block," a mixture of particulate autologous dentin with chopped leukocyte-platelet-rich fibrin (L-PRF) membranes at a 1:1 ratio, and liquid fibrinogen as a binder. Two grafted sites were followed at 4 and 5 months, and 6 sites at 6 months. Biopsies were taken from the core of the grafted site for histologic and histo-morphometric analysis.

RESULTS

All patients completed the study without any adverse event. The vertical and horizontal dimensions of the alveolar ridge were preserved or even increased after 4, 5, or 6 months and remained stable after 6 months of the implant placement. The histological examination revealed a median relative percentage of bone, dentin, and connective tissue of 57.0, 0.9, and 39.3%, respectively. A comparison of samples at different time points (4, 5, and 6 months) showed a progressive increase in the proportion of bone with a decrease in the proportion of dentin. The bone was compact with normal osteocytes and moderate osteoblastic activity. In 4 out of 10 samples, no dentin was observed; in the other samples, it represented 1-5% (with geometric fragments).

CONCLUSIONS

Dentin block showed to be a suitable bone substitute in an alveolar ridges preservation model.

CLINICAL RELEVANCE

The promising results of dentin block as a bone substitute in alveolar ridge preservation could have an important clinical impact considering this biomaterial brings together the regenerative potential of three autologous products with excellent biological and clinical behavior, low risk of adverse effects, and feasible acquisition.

An in vitro study of fibrin sealant as a carrier system for recombinant human bone morphogenetic protein (rhBMP)-9 for bone tissue engineering

In the craniofacial bone field, fibrin sealants are used as coagulant and adhesive tools to stabilize grafts during surgery. Despite this, their exact role in osteogenesis is poorly characterized. In the present study, we aimed to characterize the osteogenic potential of TISSEEL fibrin sealant and used its technology to incorporate growth factors within its matrix. We focused on recombinant human bone morphogenetic protein (rhBMP)-9, which has previously been characterized as one of the strongest osteogenetic inducers in the BMP family. TISSEEL displayed an excellent ability to retain rhBMP9, which was gradually released over a 10-day period. Although TISSEEL decreased bone stromal ST2 cell attachment at 8 h, it displayed normal cell proliferation at 1, 3, and 5 days when compared to tissue culture plastic. Interestingly, TISSEEL had little influence on osteoblast differentiation; however its combination with rhBMP9 significantly increased ALP activity at 7 days, Alizarin Red staining at 14 days, and mRNA levels of osteoblast differentiation markers ALP, bone sialoprotein, and osteocalcin. In summary, although fibrin sealants were shown to have little influence on osteogenesis, their combination with bone-inducing growth factors such as rhBMP9 may serve as an attractive carrier/scaffold for future bone regenerative strategies. Future animal studies are now necessary.

Different methods of dentin processing for application in bone tissue engineering: A systematic review

Dentin has become an interesting potential biomaterial for tissue engineering of oral hard tissues. It can be used as a scaffold or as a source of growth factors in bone tissue engineering. Different forms of dentin have been studied for their potential use as bone substitutes. Here, we systematically review different methods of dentin preparation and the efficacy of processed dentin in bone tissue engineering. An electronic search was carried out in PubMed and Scopus databases for articles published from 2000 to 2016. Studies on dentin preparation for application in bone tissue engineering were selected. The initial search yielded a total of 1045 articles, of which 37 were finally selected. Review of studies showed that demineralization was the most commonly used dentin preparation process for use in tissue engineering. Dentin extract, dentin particles (tooth ash), freeze-dried dentin, and denatured dentin are others method of dentin preparation. Based on our literature review, we can conclude that preparation procedure and the size and shape of dentin particles play an important role in its osteoinductive and osteoconductive properties. Standardization of these methods is important to draw a conclusion in this regard. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2616-2627, 2016.

Hemostatic agents

Hemostasis is an integral and very important aspect of surgical practice. As a rule, most bleeding from dental surgery can be controlled by pressure. When the application of pressure does not yield satisfactory results, or where more effective hemostasis is required, hemostatic agents are used. These agents act to stop bleeding either mechanically or by augmenting the coagulation cascade. Some of the newer agents that are available to the dental profession have been presented.

A comparison of bone generation capability in rabbits using tooth ash and plaster of Paris with platelet-rich plasma or fibrin sealant

OBJECTIVES

Increased attention has been focused on determining the most efficacious materials for generalized bone grafts. This article presents the results of a histomorphometric analysis of bone healing in the calvaria of rabbits. The study compared the use of a tooth ash and plaster of Paris mixture alone, in association with platelet-rich plasma (PRP), and in association with fibrin sealant.

STUDY DESIGN

Twelve rabbits were divided into control (group 1) and experimental groups (groups 2, 3, and 4). Group 1 was maintained as an unfilled control, and tooth ash and plaster of Paris were used in group 2, tooth ash and plaster of Paris with PRP were used in group 3, and tooth ash and plaster of Paris with fibrin sealant (Tissucol Duo Quick) were used in group 4. One-half of the animals were killed after 4 weeks, and the rest were killed after 8 weeks. Bone samples were taken from the defect areas, and newly formed bone was analyzed histomorphometrically.

RESULTS

The rate of new bone formation in groups 2, 3, and 4 was significantly higher than the rate in the control group. The rate of new bone formation in groups 3 and 4 was higher than the rate in group 2, but the difference was not statistically significant.

CONCLUSION

The concomitant use of PRP or fibrin sealant with tooth ash and plaster of Paris graft materials may have a positive effect on bone healing.