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MacBeth N, Mardas N, Davis G, Donos N. Healing patterns of alveolar bone following ridge preservation procedures. Clin Oral Implants Res 2024. [PMID: 39105326 DOI: 10.1111/clr.14332] [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: 10/17/2023] [Revised: 06/27/2024] [Accepted: 07/06/2024] [Indexed: 08/07/2024]
Abstract
OBJECTIVES Examine the histomorphometric bone composition, following alveolar ridge preservation techniques and unassisted socket healing. MATERIALS AND METHODS Forty-two patients (42) requiring a single rooted tooth extraction were randomly allocated into three groups (n = 14 per group): Group 1: Guided Bone Regeneration (GBR) using deproteinised bovine bone mineral (DBBM) and a porcine collagen membrane; Group 2: Socket Seal (SS) technique using DBBM and a porcine collagen matrix; Group 3: Unassisted socket healing (Control). Trephined bone biopsies were harvested following a 4-month healing period. Forty-two samples underwent Back-Scattered Electrons -Scanning Electron Microscopy (BSE-SEM) imaging, with 15 samples examined using Xray Micro-Tomography (XMT) (n = 6 for each GBR/SS and n = 3 Control). Images were analysed to determine the percentage (%) of connective tissue, new bone formation, residual DBBM particles and direct bone to DBBM particle contact (osseointegration). RESULTS BSE-SEM analysis demonstrated that new bone formation was higher in the Control (45.89% ± 11.48) compared to both GBR (22.12% ± 12.7/p < .004) and SS (27.62% ± 17.76/p < .005) groups. The connective tissue percentage in GBR (49.72% ± 9), SS (47.81% ± 12.57) and Control (47.81% ± 12.57) groups was similar. GBR (28.17% ± 16.64) and SS (24.37% ± 18.61) groups had similar levels of residual DBBM particles. XMT volumetric analysis indicated a lower level of bone and DBBM particles in all test groups, when matched to the BSE-SEM area measurements. Osseointegration levels (DBBM graft and bone) were recorded at 35.66% (± 9.8) for GBR and 31.18% (± 19.38) for SS. CONCLUSION GBR and SS ARP techniques presented with less bone formation when compared to unassisted healing. GBR had more direct contact/osseointegration between the DBBM particles and newly formed bone.
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Affiliation(s)
- Neil MacBeth
- Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), Bart's & The London School of Medicine & Dentistry, London, UK
- Defence Centre for Rehabilitative Dentistry, Defence Primary Health Care (DPHC), Dental Centre Aldershot, Guilford, Surry, UK
| | - Nikos Mardas
- Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), Bart's & The London School of Medicine & Dentistry, London, UK
| | - Graham Davis
- Centre for Oral Bioengineering, Institute of Dentistry, QMUL, Bart's & The London School of Medicine & Dentistry, London, UK
| | - Nikos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), Bart's & The London School of Medicine & Dentistry, London, UK
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2
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Donos N, Akcali A, Padhye N, Sculean A, Calciolari E. Bone regeneration in implant dentistry: Which are the factors affecting the clinical outcome? Periodontol 2000 2023; 93:26-55. [PMID: 37615306 DOI: 10.1111/prd.12518] [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: 02/10/2023] [Revised: 07/08/2023] [Accepted: 08/01/2023] [Indexed: 08/25/2023]
Abstract
The key factors that are needed for bone regeneration to take place include cells (osteoprogenitor and immune-inflammatory cells), a scaffold (blood clot) that facilitates the deposition of the bone matrix, signaling molecules, blood supply, and mechanical stability. However, even when these principles are met, the overall amount of regenerated bone, its stability over time and the incidence of complications may significantly vary. This manuscript provides a critical review on the main local and systemic factors that may have an impact on bone regeneration, trying to focus, whenever possible, on bone regeneration simultaneous to implant placement to treat bone dehiscence/fenestration defects or for bone contouring. In the future, it is likely that bone tissue engineering will change our approach to bone regeneration in implant dentistry by replacing the current biomaterials with osteoinductive scaffolds combined with cells and mechanical/soluble factors and by employing immunomodulatory materials that can both modulate the immune response and control other bone regeneration processes such as osteogenesis, osteoclastogenesis, or inflammation. However, there are currently important knowledge gaps on the biology of osseous formation and on the factors that can influence it that require further investigation. It is recommended that future studies should combine traditional clinical and radiographic assessments with non-invasive imaging and with patient-reported outcome measures. We also envisage that the integration of multi-omics approaches will help uncover the mechanisms responsible for the variability in regenerative outcomes observed in clinical practice.
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Affiliation(s)
- Nikolaos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Aliye Akcali
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
- Department of Periodontology, Faculty of Dentistry, Dokuz Eylul University, Izmir, Turkey
| | - Ninad Padhye
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Elena Calciolari
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
- Department of Medicine and Dentistry, Dental School, University of Parma, Parma, Italy
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Deluiz D, Delcroix GJR, D'Ippolito G, Grau-Monge C, Bonnin-Marquez A, Reiner T, Tinoco EMB, Amadeu T, Pires FR, Schiller PC. Human Bone Marrow-Derived Mesenchymal Stromal Cell-Seeded Bone Biomaterial Directs Fast and Superior Mandibular Bone Augmentation in Rats. Sci Rep 2019; 9:11806. [PMID: 31413279 PMCID: PMC6694159 DOI: 10.1038/s41598-019-48236-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/29/2019] [Indexed: 01/11/2023] Open
Abstract
Atrophic maxillary ridges present a challenge in the field of oral implantology. Autologous bone is still considered the gold standard grafting material, but the increased morbidity and surgical complications represent a major drawback for its use. The aim of this study was to assess the efficacy of an off-the-shelf cell-seeded bone biomaterial for mandibular bone augmentation, compared to its acellular counterpart. We used a rat model to test the osteogenic properties of bone marrow-derived mesenchymal stromal cells (MSCs)-seeded bone microparticles compared to acellular bone microparticles alone. Rats were euthanized at 4 and 8 weeks, and results analyzed using micro-CT imaging, histology (H&E, Masson’s Trichrome), histomorphometry and immunohistology (Tartrate-Resistant Acid Phosphatase-TRAP, Osteocalcin and human specific anti-mitochondria antibodies). Micro-CT analysis demonstrated that the cell-seeded biomaterial achieved significantly more bone volume formation at 4 weeks (22.75 ± 2.25 mm3 vs 12.34 ± 2.91 mm3, p = 0.016) and at 8 weeks (64.95 ± 5.41 mm3 vs 42.73 ± 10.58 mm3, p = 0.029), compared to the acellular bone microparticles. Histology confirmed that the cell-seeded biomaterial was almost completely substituted at 8 weeks, in opposition to the acellular biomaterial group. Immunohistochemical analysis showed a significantly higher number of TRAP and Osteocalcin positive cells at 4 weeks in the cell-seeded group compared to the acellular group, thereby demonstrating a higher rate of bone remodeling in the presence of MSCs. The grafted human cells remained viable and were detected up to at least 8 weeks, as observed using the human specific anti-mitochondria antibody. This off-the-shelf material available in unlimited quantities could therefore represent a significant advance in the field of mandibular bone augmentation by providing a larger volume of new bone formation in a shorter time.
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Affiliation(s)
- Daniel Deluiz
- Department of Periodontology, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil. .,Geriatric Research, Education, and Clinical Center, and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA. .,Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Gaëtan J-R Delcroix
- Geriatric Research, Education, and Clinical Center, and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA.,Nova Southeastern University, College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Gianluca D'Ippolito
- Geriatric Research, Education, and Clinical Center, and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA.,Department of Biomedical Engineering, College of Engineering, University of Miami, Miami, FL, USA
| | - Cristina Grau-Monge
- Geriatric Research, Education, and Clinical Center, and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA.,Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrea Bonnin-Marquez
- Geriatric Research, Education, and Clinical Center, and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA
| | - Teresita Reiner
- Geriatric Research, Education, and Clinical Center, and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA
| | - Eduardo M B Tinoco
- Department of Periodontology, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Thaís Amadeu
- Department of Pathology and Laboratories, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Fabio R Pires
- Department of Oral Pathology, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Paul C Schiller
- Geriatric Research, Education, and Clinical Center, and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA. .,Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, FL, USA. .,Department of Biochemistry & Molecular Biology and Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
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The Bioresorption and Guided Bone Regeneration of Absorbable Hydroxyapatite-Coated Magnesium Mesh. J Craniofac Surg 2018; 28:518-523. [PMID: 28060094 DOI: 10.1097/scs.0000000000003383] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Nonabsorbable metallic membrane for guided bone regeneration is remained permanently even though after complete healing. There would be metallic exposure followed by the risk of infection; the membrane should be removed for the additional procedure such as implant installation. Since absorbable nonmetallic mesh is absorbed within 3 to 6 months, it is unnecessary to be removed. However, the absorbable membrane shows lower retention, lower mechanical strength, and difficulty of manipulation than the nonabsorbable ones.The purpose of this study is to evaluate the ability of absorbable metallic mesh (hydroxyapatite-coated magnesium mesh) with acceptable mechanical properties and satisfying biocompatibility. METHODS The bioresorption and fate of magnesium were evaluated in Sprague Dawley rat (SD rat) with critical defect of calvarium. The critical defect with a diameter of 8 mm was made on calvarium using trephine bur in 18 SD rats. The defected models were divided into 2 groups: the control group (9 SD rat) without mesh and the experimental group (9 SD rat) with the insertion of prototype HA-coated magnesium mesh. The 3 SD rats were sacrificed at 6, 12, and 18 weeks. The histopathological and radiographic examinations were performed afterward. RESULTS In the control group, there was no specific symptom. The experimental group also showed no specific symptom including swelling and dehiscence related to hydrogen gas formation. From 6 to 18 weeks, the experimental group showed the progressive absorption and fracture of magnesium mesh. However, there was no specific effectiveness of guided bone regeneration in both groups. There was no significant difference in bone volume, bone surface, and bone volume fraction between the negative control group and the group with magnesium mesh (P >0.05). CONCLUSION Hydroxyapatite-coated magnesium mesh showed reasonable process of bioresorption and bony reaction; however, the effectiveness of guided bone regeneration and management of the bioresorption rate should be reconsidered.
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Calciolari E, Mardas N, Dereka X, Anagnostopoulos AK, Tsangaris GT, Donos N. The effect of experimental osteoporosis on bone regeneration: part 2, proteomics results. Clin Oral Implants Res 2016; 28:e135-e145. [PMID: 27580862 DOI: 10.1111/clr.12950] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To identify and describe protein expression in a Wistar rat calvarial critical size defect (CSD) model following treatment with guided bone regeneration in healthy and osteoporotic conditions. MATERIAL AND METHODS Thirty-six 10-month-old female Wistar rats were used. Half of them were ovariectomized (OVX) and fed with a low-calcium diet to induce an osteoporotic-like status. In each animal of both groups, two 5-mm calvarial CSDs were treated with deproteinized bovine bone mineral graft particles and a bilayer collagen membrane. Six OVX and six control rats were randomly euthanized at 7, 14, and 30 days. One defect/animal was randomly chosen for proteomic analysis. Differently expressed proteins between the two groups were identified with matrix-assisted laser desorption time-of-flight mass spectrometry and liquid chromatography-mass spectrometry/mass spectrometry. RESULTS At 7 days, 29 and 27 proteins were, respectively, identified in the healthy and OVX animals. At 14 days, 103 proteins were detected in the healthy controls and 20 proteins in the OVX rats, while at 30 days, 31 and 75 proteins were identified, respectively. Only limited proteins known to play a role in the later stages of bone formation and maturation were identified within the animals 'proteomes. DISCUSSION The osseous formation process was quite immature even at 30 days of healing. An overexpression of inflammatory and stress response pathways was detected in the OVX animals, as well as a tendency toward a delayed maturation of the osseous wound and a reduced/delayed differentiation of osteoblast cell precursors.
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Affiliation(s)
- E Calciolari
- Centre for Clinical Oral Research, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London (QMUL), London, UK.,Periodontology Department, UCL Eastman Dental Institute, London, UK
| | - N Mardas
- Centre for Adult Oral Health, Bart's & The London School of Dentistry & Medicine, Queen Mary University of London (QMUL), London, UK
| | - X Dereka
- Department of Periodontology, National and Kapodistrian University of Athens, Athens, Greece
| | - A K Anagnostopoulos
- Proteomics Research Unit, Centre of Basic Research II, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - G T Tsangaris
- Proteomics Research Unit, Centre of Basic Research II, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - N Donos
- Centre for Clinical Oral Research, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London (QMUL), London, UK
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6
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Calciolari E, Mardas N, Dereka X, Kostomitsopoulos N, Petrie A, Donos N. The effect of experimental osteoporosis on bone regeneration: Part 1, histology findings. Clin Oral Implants Res 2016; 28:e101-e110. [PMID: 27502355 DOI: 10.1111/clr.12936] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To histologically define the healing events occurring in calvarial critical size defects (CSDs) following treatment with a collagen barrier for guided bone regeneration (GBR) and a particulate graft in healthy and osteoporotic conditions. MATERIAL AND METHODS Thirty-six 10-month-old, female, Wistar rats were used in this study. Half of them were ovariectomized (OVX) and fed with a low-calcium diet to induce an osteoporotic-like status. In each animal of both groups, two 5-mm CSDs were created, one in the centre of each parietal bone, and they were treated with a deproteinized bovine bone mineral (DBBM) particulate graft and a bi-layer collagen membrane. Six OVX and six healthy control rats were randomly euthanized at 7, 14 and 30 days. One defect per animal was randomly processed for decalcified histology. Three central sections were used for qualitative histology and histomorphometric analysis. RESULTS No significant difference in terms of percentage of newly formed bone was detected between the two groups at the different healing periods. However, a trend towards less bone formation and of poorer quality, expressed as reduced bone maturation, was detected in the OVX animals at 30 days. DISCUSSION According to this study, GBR with a collagen barrier and a DBBM graft can be successfully obtained also in osteoporotic-like conditions. Future studies considering longer healing periods and controlling for the confounding factors arising from the use of a particulate graft are needed to confirm these data.
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Affiliation(s)
- Elena Calciolari
- Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), Barts and The London School of Medicine and Dentistry, London, UK.,Periodontology Department, Eastman Dental Institute, University College London (UCL), London, UK
| | - Nikos Mardas
- Centre for Adult Oral Health, Bart's & The London School of Dentistry and Medicine, Queen Mary University of London (QMUL), London, UK
| | - Xanthippi Dereka
- Department of Periodontology, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kostomitsopoulos
- Laboratory Animal Facilities, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Aviva Petrie
- Biostatistics Unit, Eastman Dental Institute, University College London (UCL), London, UK
| | - Nikolaos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), Barts and The London School of Medicine and Dentistry, London, UK
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Wen B, Kuhn L, Charles L, Pendrys D, Shafer D, Freilich M. Comparison of bone morphogenetic protein-2 delivery systems to induce supracrestal bone guided by titanium implants in the rabbit mandible. Clin Oral Implants Res 2015; 27:676-85. [DOI: 10.1111/clr.12645] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Bo Wen
- Department of Oral and Maxillofacial Surgery; Division of Implant Dentistry; Affiliated Stomatology Hospital of Medical School; Nanjing University; Nanjing China
| | - Liisa Kuhn
- Department of Reconstructive Sciences; Center for Regeneration Medicine and Skeletal Development; School of Dental Medicine; University of Connecticut; Farmington CT USA
| | - Lyndon Charles
- Department of Reconstructive Sciences; Center for Regeneration Medicine and Skeletal Development; School of Dental Medicine; University of Connecticut; Farmington CT USA
| | - David Pendrys
- Department of Reconstructive Sciences; Center for Regeneration Medicine and Skeletal Development; School of Dental Medicine; University of Connecticut; Farmington CT USA
| | - David Shafer
- Department of Craniofacial Sciences; Division of Oral and Maxillofacial Surgery; School of Dental Medicine; University of Connecticut; Farmington CT USA
| | - Martin Freilich
- Department of Reconstructive Sciences; Center for Regeneration Medicine and Skeletal Development; School of Dental Medicine; University of Connecticut; Farmington CT USA
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8
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Donos N, Dereka X, Mardas N. Experimental models for guided bone regeneration in healthy and medically compromised conditions. Periodontol 2000 2015; 68:99-121. [DOI: 10.1111/prd.12077] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2014] [Indexed: 02/06/2023]
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9
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Iwata J, Namaki S, Mashimo T, Chung UI, Honda K, Yonehara Y. Augmentation of Flat Bone Area Using Tetrapod-Shaped Artificial Bone in Rats. J HARD TISSUE BIOL 2015. [DOI: 10.2485/jhtb.24.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Jun Iwata
- Division of Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry
- Division of Oral Structural and Functional Biology, Nihon University Graduate School of Dentistry
| | - Shunsuke Namaki
- Division of Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry
| | - Takayuki Mashimo
- Division of Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry
| | - Ung-il Chung
- Center of Disease Biology and Integrative Medicine, Facility of Medicine, University of Tokyo
| | - Kazuya Honda
- Department of Oral and Maxillofacial Radiology, Nihon University School of Dentistry
| | - Yoshiyuki Yonehara
- Division of Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry
- Division of Oral Structural and Functional Biology, Nihon University Graduate School of Dentistry
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Schwartz-Arad D, Ofec R, Eliyahu G, Ruban A, Sterer N. Long Term Follow-Up of Dental Implants Placed in Autologous Onlay Bone Graft. Clin Implant Dent Relat Res 2014; 18:449-61. [DOI: 10.1111/cid.12288] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Devorah Schwartz-Arad
- Oral and Maxillofacial Surgery; Advanced Implantology, Periodontology & Endodontology; Schwartz-Arad Day-Care Surgical Center; Ramat Hasharon Israel
| | - Ronen Ofec
- Department of Statistics and Operations Research; Tel Aviv University; Tel Aviv Israel
| | - Galit Eliyahu
- Oral and Maxillofacial Surgery; Schwartz-Arad Day-Care Surgical Center; Ramat Hasharon Israel
| | - Angela Ruban
- Clinical Research Units; Schwartz-Arad Day-Care Surgical Center; Ramat Hasharon Israel
| | - Nir Sterer
- Clinical Research Units; Oral and Maxillofacial Surgery; Schwartz-Arad Day-Care Surgical Center; Ramat Hasharon Israel
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11
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Chung H, Hong JY, Jung GU, Pang EK. The effect of human freeze dried corticocancellous block onlay graft on bone formation in rat calvarium. Tissue Eng Regen Med 2014. [DOI: 10.1007/s13770-014-0082-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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12
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Zeng N, van Leeuwen A, Yuan H, Bos RRM, Grijpma DW, Kuijer R. Evaluation of novel resorbable membranes for bone augmentation in a rat model. Clin Oral Implants Res 2014; 27:e8-14. [DOI: 10.1111/clr.12519] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Ni Zeng
- Department of Biomedical Engineering; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Anne van Leeuwen
- Department of Oral and Maxillofacial Surgery; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Huipin Yuan
- Xpand Biotechnology; Bilthoven The Netherlands
- Department of Tissue Regeneration; MIRA Institute for Biomedical Engineering and Technical Medicine; University of Twente; Enschede The Netherlands
| | - Ruud R. M. Bos
- Department of Oral and Maxillofacial Surgery; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Dirk W. Grijpma
- Department of Biomedical Engineering; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
- Department of Biomaterials Science and Technology; MIRA Institute for Biomedical Engineering and Technical Medicine; University of Twente; Enschede The Netherlands
| | - Roel Kuijer
- Department of Biomedical Engineering; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
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Onlay Bone Graft Maintenance Using Guided Bone Regeneration, Platelet Rich Plasma, and Their Combination. J Craniofac Surg 2014; 25:2237-40. [DOI: 10.1097/scs.0000000000001043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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14
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De Santis E, Lang NP, Favero G, Beolchini M, Morelli F, Botticelli D. Healing at mandibular block-grafted sites. An experimental study in dogs. Clin Oral Implants Res 2014; 26:516-22. [DOI: 10.1111/clr.12434] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2014] [Indexed: 11/29/2022]
Affiliation(s)
| | - Niklaus P. Lang
- Prince Philip Dental Hospital; The University of Hong Kong; Hong Kong Hong Kong SAR China
- University of Zurich; Zurich Switzerland
| | - Giovanni Favero
- Faculty of Dentistry; University of Medical Science; La Habana Cuba
| | - Marco Beolchini
- Faculty of Dentistry; University of Medical Science; La Habana Cuba
| | - Fabrizio Morelli
- Faculty of Dentistry; University of Medical Science; La Habana Cuba
| | - Daniele Botticelli
- Ariminum Odontologica; ARDEC; Rimini Italy
- Prince Philip Dental Hospital; The University of Hong Kong; Hong Kong Hong Kong SAR China
- Faculty of Dentistry; University of Medical Science; La Habana Cuba
- Faculty of Dentistry of Araçatuba; UNESP - Univ Estadual Paulista; São Paulo Brazil
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Koerdt S, Siebers J, Bloch W, Ristow O, Kuebler AC, Reuther T. Immunohistochemial study on the expression of von Willebrand factor (vWF) after onlay autogenous iliac grafts for lateral alveolar ridge augmentation. Head Face Med 2013; 9:40. [PMID: 24330606 PMCID: PMC3931527 DOI: 10.1186/1746-160x-9-40] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 12/03/2013] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The main problems of autogenous bone transplants are their unpredictable atrophy and their loss of structure. One key factor lies in the poor revascularization of simple onlay grafts. The the aim of this study was to evaluate the revascularization processes in autogenous bone grafts from the iliac crest to the alveolar ridge. METHODS In a sheep model, autogenous bone grafts were harvested from the iliac crest. A combination of a resorbable collagen membrane (CM) and deproteinized bovine bone material (DBBM) was used to modify the bone graft (experiment 2). This was compared with a simple onlay bone graft (control group, experiment 1). The amount of vessels in bone and connective tissue (CT), and the amount of CT were analyzed. The expression of von Willebrand factor (vWF) was compared between the two experimental groups using immunohistochemical analysis. RESULTS The ratio of the amount of vessels in bone and CT changed over time, and more vessels could be detected in bone at 12-16 weeks of graft healing. The number of vessels were significantly higher in experiment 2 than in experiment 1. More CT was found in experiment 1, whereas the amount of CT in both experiments decreased over time. CONCLUSION This study shows a more intensive and extensive revascularization in experiment 2, as significantly more vessels were detected. The decreased amount of CT in experiment 2 clarifies its clinical superiority.
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Affiliation(s)
- Steffen Koerdt
- Department of Oral and Maxillofacial Plastic Surgery, University of Wuerzburg, Pleicherwall 2, Wuerzburg D-97070, Germany
| | - Joerg Siebers
- Department of Oral and Maxillofacial Plastic Surgery, University of Wuerzburg, Pleicherwall 2, Wuerzburg D-97070, Germany
| | - Wilhelm Bloch
- Department of Molecular and Cellular Sport Medicine, German Sport University, Am Sportpark Muengersdorf 6, Cologne D-50933, Germany
| | - Oliver Ristow
- Medicine & Aesthetics, Clinic for Oral, Maxillofacial and Plastical Surgery, Lenbachplatz 2a, Munich D-80333, Germany
| | - Alexander C Kuebler
- Department of Oral and Maxillofacial Plastic Surgery, University of Wuerzburg, Pleicherwall 2, Wuerzburg D-97070, Germany
| | - Tobias Reuther
- Department of Oral and Maxillofacial Plastic Surgery, University of Wuerzburg, Pleicherwall 2, Wuerzburg D-97070, Germany
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Role of oxidative and nitrosative stress in autogenous bone grafts to the mandible using guided bone regeneration and a deproteinized bovine bone material. J Craniomaxillofac Surg 2013; 42:560-7. [PMID: 24035733 DOI: 10.1016/j.jcms.2013.07.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 06/03/2013] [Accepted: 07/31/2013] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED The aim of this study was to evaluate the role of oxidative and nitrosative stress in autogenous bone grafts to the mandible based on immunohistochemical analysis. MATERIAL AND METHODS Using a well-established sheep model autogenous bone grafts were harvested form the iliac bone. A combination of a Collagen Membrane (CM) and Deproteinized Bovine Bone Material (DBBM) was used to cover the bone graft (Experiment 2). This modification was compared with simple onlay bone grafts (Experiment 1). Immunohistochemically, the expression of specific stable degradation products of oxidative and nitrosative stress was compared between the two experimental groups. RESULTS Specific markers for oxidative and nitrosative stress showed statistically significant differences in expression in the different experimental groups. The influence of oxidative and nitrosative stress on osteoblasts (OB), osteoclasts (OC), and osteocytes (OCy) was analysed. Experiment 2 showed increased expression of markers in OB and decreased expression in OC. CONCLUSIONS Taking the result of this study and reports from the literature into consideration grafts in Experiment 2 showed less resorption and atrophy, higher activity of OB and inhibition of OC, and less expression of Reactive Oxygen and Nitrogen Species (RONS) as markers of oxidative stress within the graft. These data illustrate the improved remodelling processes in grafts using CM and DBBM.
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Comparative analysis of guided bone regeneration using autogenous tooth bone graft material with and without resorbable membrane. J Dent Sci 2013. [DOI: 10.1016/j.jds.2013.03.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Expression of growth factors during the healing process of alveolar ridge augmentation procedures using autogenous bone grafts in combination with GTR and an anorganic bovine bone substitute: an immunohistochemical study in the sheep. Clin Oral Investig 2013; 18:179-88. [PMID: 23404559 DOI: 10.1007/s00784-013-0938-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study aims to evaluate the expression of various immunohistochemical growth factors and vascularization markers in augmentation on the mandible comparing onlay bone grafts and Guided Bone Regeneration (GBR). MATERIALS AND METHODS Using a sheep in vivo model, autogenous bone grafts were harvested from the iliac crest. A combination of a resorbable collagen membrane (CM) and a Deproteinized Bovine Bone Material (DBBM) was performed. This modification of the host side was compared with an onlay bone graft control group. Expression of different vascularization markers was compared between these groups. RESULTS The expression of revascularization markers was significantly higher within the modification of the host side using GBR and DBBM. Regarding different graft regions, a significantly higher expression within the bone graft using GBR and DBBM could be observed in staining on bone morphogenetic protein-2 (BMP-2) (5.75 vs. 3.55), vascular endothelial growth factor (VEGF) (3.08 vs. 1.64), VEGF Receptor 1 (VEGFR-1) and VEGF Receptor 2 (VEGFR-2) (4.88 vs. 2.24 and 5.06 vs. 2.74), and endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) (5.29 vs. 3.28 and 5.22 vs. 3.09; p = 0.000, all others p < 0.05), whereas the control group showed a higher rate of resorption during the surveillance period until euthanasia of sheep after 16 weeks. CONCLUSION The use of GBR and DBBM in the transplantation process of autogenous bone grafts compared with the therapeutical use of certain growth factors may enhance vascularization and lower atrophy and resorption. CLINICAL RELEVANCE The use of a combination of GBR and DBBM in augmentation procedures on the mandible shows less resorption than simple onlay bone grafts and seems to be superior in a clinical use.
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The efficacy of the use of IR laser phototherapy associated to biphasic ceramic graft and guided bone regeneration on surgical fractures treated with wire osteosynthesis: a comparative laser fluorescence and Raman spectral study on rabbits. Lasers Med Sci 2012; 28:815-22. [DOI: 10.1007/s10103-012-1166-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 07/12/2012] [Indexed: 10/28/2022]
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Lee SB, Retzepi M, Petrie A, Hakimi AR, Schwarz F, Donos N. The effect of diabetes on bone formation following application of the GBR principle with the use of titanium domes. Clin Oral Implants Res 2012; 24:28-35. [DOI: 10.1111/j.1600-0501.2012.02448.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2012] [Indexed: 12/22/2022]
Affiliation(s)
- Sang-Bok Lee
- Periodontology Unit; Department of Clinical Research; UCL Eastman Dental Institute; London; UK
| | - Maria Retzepi
- Periodontology Unit; Department of Clinical Research; UCL Eastman Dental Institute; London; UK
| | - Aviva Petrie
- Periodontology Unit; Department of Clinical Research; UCL Eastman Dental Institute; London; UK
| | - Ahmad-Reza Hakimi
- Department of Oral Surgery; Heinrich Heine University; Düsseldorf; Germany
| | - Frank Schwarz
- Department of Oral Surgery; Heinrich Heine University; Düsseldorf; Germany
| | - Nikolaos Donos
- Periodontology Unit; Department of Clinical Research; UCL Eastman Dental Institute; London; UK
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De Santis E, Lang NP, Scala A, Viganò P, Salata LA, Botticelli D. Healing outcomes at implants installed in grafted sites: an experimental study in dogs. Clin Oral Implants Res 2011; 23:340-50. [DOI: 10.1111/j.1600-0501.2011.02326.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2011] [Indexed: 11/29/2022]
Affiliation(s)
- Enzo De Santis
- UNESP - Faculty of Dentistry of Araçatuba; São Paulo State University; São Paulo; Brazil
| | - Niklaus P. Lang
- The University of Hong Kong; Prince Philip Dental Hospital; Hong Kong; SAR; China
| | - Alessandro Scala
- UNESP - Faculty of Dentistry of Araçatuba; São Paulo State University; São Paulo; Brazil
| | - Paolo Viganò
- Faculty of Dentistry; University of Medical Science; Ciudad Habana; Cuba
| | - Luiz A. Salata
- Faculty of Dentistry of Ribeirão Preto (SP); São Paulo University USP; São Paulo; Brazil
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Zambon R, Mardas N, Horvath A, Petrie A, Dard M, Donos N. The effect of loading in regenerated bone in dehiscence defects following a combined approach of bone grafting and GBR. Clin Oral Implants Res 2011; 23:591-601. [PMID: 22092957 DOI: 10.1111/j.1600-0501.2011.02279.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate by histology the effect of loading on the regenerated bone at dehiscence type defects around implants when treated with a combined approach of bone grafting and guided bone regeneration (GBR). MATERIALS AND METHODS In twelve Göttingen mini-pigs, the lower premolars and first molars were extracted and the alveolar process was reduced in width. After 3 months, two Straumann SLActive (Straumann AG, Basel, Switzerland) implants were placed in each hemi-mandible. Twelve implants were placed into the reduced alveolar ridge (group P) with no further defect or treatment on the site, while on 36 implants, buccal dehiscence defects were created and treated as follows: Group T1: synthetic bone substitute (Straumann Bone Ceramic, SBC, Straumann AG). Group T2: SBC with a polyethylene glycol membrane (Straumann MembraGel, Straumann AG); Group N: the dehiscence remained untreated. Three months following implantation, long, custom-made, healing abutments were placed in one hemi-mandible only to ensure functional loading. After 2 months, histological analysis was performed. RESULTS A trend for lower residual defect height and higher bone-to-implant contact was observed in the loaded sites compared with non-loaded sites in groups P, T1 and N. In group T2, the opposite effect was observed. In terms of bone formation, sites treated with SBC grafting and GBR (group T2) exhibited the largest surface area of regenerated bone followed by T1 and N. Significant resorption of the graft particles was noted in group T2 and the graft surface area occupied by SBC was significantly higher in group T1 compared with group T2 (P < 0.05). CONCLUSIONS Loading may have a positive effect on bone-to-implant contact in implants inserted in pristine bone or inserted in dehiscence sites and treated by grafting/no grafting.
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Affiliation(s)
- Riccardo Zambon
- Periodontology Unit, Department of Clinical Research, UCL Eastman Dental Institute, London, UK
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Donos N, Graziani F, Mardas N, Kostopoulos L. The use of human hypertrophic chondrocytes-derived extracellular matrix for the treatment of critical-size calvarial defects. Clin Oral Implants Res 2011; 22:1346-53. [PMID: 21382090 DOI: 10.1111/j.1600-0501.2010.02120.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the effect of immortalized hypertrophic chondrocytes extracellular matrix (HCM) with or without the use of guided bone regeneration (GBR) on the healing of critical-size calvarial defects. MATERIAL AND METHODS In 42 rats, 5 mm critical-size calvarial defects were surgically created. The animals were randomly allocated to six groups of seven rats each: Group A1: one defect was left untreated (control), while the contralateral defect was covered by a double non-resorbable membrane (GBR). Group B1: one defect was filled with calcium phosphate cement (CP), while the contralateral defect was treated with GBR and CP. Group C1: one defect was filled with a mixture of CP and HCM, while the contralateral defect was treated with GBR and CP+HCM. The healing period for all three groups was 30 days. The remaining three groups were treated in a similar manner but the healing period was 60 days. Five animals from each group were evaluated by maceration and two animals were analysed histologically. RESULTS At 30 days, all the control-treated defects did not present complete closure. When GBR was applied alone or combined with CP, 3/5 and 5/5 defects, respectively, presented complete closure. At 60 days, one defect from the control group presented complete closure. All the defects treated with GBR alone presented complete closure, whereas the combined use of GBR with CP or CP+HCM resulted in 4/5 and 3/5 defects with complete closure, respectively. The only treatment modality that did not present any specimen with defect closure at both 30 and 60 days was the combination of CP+HCM. The histological analysis indicated that when GBR was not used alone, the healing consisted of an amorphous acellular structure and loose granulation tissue, which, even though clinically resembled hard tissue, did not demonstrate the histological characteristics of bone. CONCLUSION The predictability of bone formation in critical-size defects depends mainly on the presence or absence of barrier membranes. The combined use of GBR with calcium phosphate alone or in combination with immortalized human HCM did not enhance the potential for osseous healing provided by the GBR procedure.
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Affiliation(s)
- Nikolaos Donos
- Periodontology Unit, Department of Clinical Research, UCL Eastman Dental Institute, London, UK.
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Mardas N, Schwarz F, Petrie A, Hakimi AR, Donos N. The effect of SLActive surface in guided bone formation in osteoporotic-like conditions. Clin Oral Implants Res 2011; 22:406-15. [PMID: 21303420 DOI: 10.1111/j.1600-0501.2010.02094.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate new bone formation under etched titanium (SLA) and modified-etched hydrophilic titanium (modSLA) domes placed on the calvarium of healthy, osteoporotic and osteoporotic treated with bisphosphonates rabbits. METHODS Experimental osteoporosis was induced by ovariectomy (OV) and calcium-deficient diet in 24 New Zealand female rabbits. Twelve OV rabbits were treated with weekly dozes of alendronate (Fosamax(®)) (B) while 12 OV rabbits received no treatment (O). Another 12 rabbits were sham operated and used as healthy controls (C). At 6 weeks following OV, one modSLA and one SLA titanium dome were placed in the parietal bones of each rabbit. The animals were sacrificed at 30 and 120 days following the dome placement. Various histomorphometric measurements were performed in the most central of the undecalcified sections produced. RESULTS After 30 days of healing, in the C group, the total bone (TB) area was 37.6% and 37.0% under the modSLA and SLA domes, respectively. In the O group, the TB was 35.7% and 24.8%. In the B group, TB was 37.0% and 32.1%, respectively. After 120 days of healing, in the C group TB was 40.1% and 36.4%, respectively. In the O group, TB was 29.6% and 27.9%, respectively. In the B group, TB was 49.7% and 42.5%, respectively. Hierarchical analysis of variance showed that the type of titanium dome significantly influenced new bone and the amount of new bone being in contact with inner surface of the dome (BIC) independently of the observation period and group (P<0.05). The administration of bisphosphonates influenced the BIC (P<0.05). CONCLUSION The use of modSLA surface may promote bone healing and osseointegration in osteoporotic rabbits, whereas administration of bisphosphonates may compromise the osseointegration of the newly formed bone at the early healing period.
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Affiliation(s)
- Nikos Mardas
- Periodontology Unit, Department of Clinical Research, Eastman Dental Institute, University College London, London, UK.
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Retzepi M, Lewis MP, Donos N. Effect of diabetes and metabolic control on de novo bone formation following guided bone regeneration. Clin Oral Implants Res 2010; 21:71-9. [PMID: 19922493 DOI: 10.1111/j.1600-0501.2009.01805.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Maria Retzepi
- Periodontology Unit, Department of Clinical Research, UCL Eastman Dental Institute, London, UK.
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Scaffold-Based rhBMP-2 Therapy in a Rat Alveolar Defect Model: Implications forHuman Gingivoperiosteoplasty. Plast Reconstr Surg 2009; 124:1829-1839. [DOI: 10.1097/prs.0b013e3181bf8024] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kim SH, Kim DY, Kim KH, Ku Y, Rhyu IC, Lee YM. The efficacy of a double-layer collagen membrane technique for overlaying block grafts in a rabbit calvarium model. Clin Oral Implants Res 2009; 20:1124-32. [DOI: 10.1111/j.1600-0501.2009.01744.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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29
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Gielkens PFM, Hoogeveen EJ, Schortinghuis J, Ruben JL, Huysmans MCDNJM, Stegenga B. The influence of three barrier membranes on modeling and incorporation of autologous onlay bone grafts in rats. An evaluation by transversal microradiography. Arch Oral Biol 2009; 54:549-55. [PMID: 19344887 DOI: 10.1016/j.archoralbio.2009.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Revised: 02/22/2009] [Accepted: 02/27/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine whether covering an autologous bone grafts with three different barrier membranes prevents graft resorption, and to compare these membranes to each other. DESIGN In 192 rats a standardised 4.0mm diameter bone graft was harvested from the right mandibular angle and transplanted to the left. Membranes used to cover the grafts were a new poly(DL-lactide-epsilon-caprolactone) membrane, a collagen and expanded polytetrafluoroethylene membrane. The controls were left uncovered. Graft resorption and incorporation were measured with transversal microradiography (TMR) in the four groups at 2, 4 and 12 weeks. Data were analysed using multiple regression analyses. RESULTS Overall, there were no differences in modeling with resorption between the four groups. ePTFE at 12 weeks showed a lower mineralization ratio and graft height of the graft as compared to the other groups. The mean graft incorporation was progressive and nearly identical from 2 to 12 weeks in all groups. CONCLUSIONS Membranes have an equal effect on bone graft modeling and resorption as found in non-covered controls. Therefore, the indication to use a barrier membrane to prevent bone modeling with resorption and enhance incorporation of autologous onlay bone grafts is disputable.
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Affiliation(s)
- Pepijn F M Gielkens
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Heberer S, Rühe B, Krekeler L, Schink T, Nelson JJ, Nelson K. A prospective randomized split-mouth study comparing iliac onlay grafts in atrophied edentulous patients: covered with periosteum or a bioresorbable membrane. Clin Oral Implants Res 2009; 20:319-26. [DOI: 10.1111/j.1600-0501.2008.01638.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gielkens P, Schortinghuis J, de Jong J, Paans A, Ruben J, Raghoebar G, Stegenga B, Bos R. The Influence of Barrier Membranes on Autologous Bone Grafts. J Dent Res 2008; 87:1048-52. [DOI: 10.1177/154405910808701107] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In implant dentistry, there is continuing debate regarding whether a barrier membrane should be applied to cover autologous bone grafts in jaw augmentation. A membrane would prevent graft remodeling with resorption and enhance graft incorporation. We hypothesized that membrane coverage does not effect resorption and incorporation of autologous onlay bone grafts. We treated 192 male Sprague-Dawley rats. A 4.0-mm-diameter bone graft was harvested from the right mandibular angle and transplanted to the left. Poly(DL-lactide-ε-caprolactone), collagen, and expanded polytetrafluoroethylene membranes were used to cover the grafts. The controls were left uncovered. Graft resorption at 2, 4, and 12 weeks was evaluated by post mortem microradiography and microCT. Analysis of the data showed no significant differences among the 4 groups. This demonstrates that the indication of barrier membrane use, to prevent bone remodeling with resorption and to enhance incorporation of autologous onlay bone grafts, is at least disputable.
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Affiliation(s)
- P.F.M. Gielkens
- Department of Oral and Maxillofacial Surgery,
- Department of Nuclear Medicine and Molecular Imaging, and
- Department of Dentistry and Dental Hygiene, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - J. Schortinghuis
- Department of Oral and Maxillofacial Surgery,
- Department of Nuclear Medicine and Molecular Imaging, and
- Department of Dentistry and Dental Hygiene, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - J.R. de Jong
- Department of Oral and Maxillofacial Surgery,
- Department of Nuclear Medicine and Molecular Imaging, and
- Department of Dentistry and Dental Hygiene, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - A.M.J. Paans
- Department of Oral and Maxillofacial Surgery,
- Department of Nuclear Medicine and Molecular Imaging, and
- Department of Dentistry and Dental Hygiene, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - J.L. Ruben
- Department of Oral and Maxillofacial Surgery,
- Department of Nuclear Medicine and Molecular Imaging, and
- Department of Dentistry and Dental Hygiene, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - G.M. Raghoebar
- Department of Oral and Maxillofacial Surgery,
- Department of Nuclear Medicine and Molecular Imaging, and
- Department of Dentistry and Dental Hygiene, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - B. Stegenga
- Department of Oral and Maxillofacial Surgery,
- Department of Nuclear Medicine and Molecular Imaging, and
- Department of Dentistry and Dental Hygiene, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - R.R.M. Bos
- Department of Oral and Maxillofacial Surgery,
- Department of Nuclear Medicine and Molecular Imaging, and
- Department of Dentistry and Dental Hygiene, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
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Friedmann A, Dehnhardt J, Kleber BM, Bernimoulin JP. Cytobiocompatibility of collagen and ePTFE membranes on osteoblast-like cellsin vitro. J Biomed Mater Res A 2008; 86:935-41. [DOI: 10.1002/jbm.a.31646] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Adeyemo WL, Reuther T, Bloch W, Korkmaz Y, Fischer JH, Zöller JE, Kuebler AC. Healing of onlay mandibular bone grafts covered with collagen membrane or bovine bone substitutes: a microscopical and immunohistochemical study in the sheep. Int J Oral Maxillofac Surg 2008; 37:651-9. [PMID: 18378427 DOI: 10.1016/j.ijom.2008.02.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Revised: 08/23/2007] [Accepted: 02/06/2008] [Indexed: 11/26/2022]
Abstract
The objective of this study was to evaluate the role of collagen membrane and Bio-Oss coverage in healing of an onlay graft to the mandible. Twelve adult sheep each received an onlay bone graft (experiment 1), bone graft+Bio-Gide (experiment 2), and bone graft+Bio-Oss/Bio-Gide (experiment 3) on the lateral surface of the mandible. The animals were euthanized at 4, 8, 12 or 16 weeks after surgery, and findings were analysed by routine microscopy and immunohistochemistry for proliferation (Ki67) and apoptotic (Caspase-3) markers. Grafts were fully incorporated in all specimens. Pronounced resorption was observed in experiment 1. Minimal loss of graft volume was seen in experiment 2 specimens without membrane displacement. A remarkable increase in the augmented region of the mandible was observed in experiment 3. A high number of osteoclasts were expressed within the grafts during the early healing period, and thereafter declined markedly. Osteoblasts within the grafts expressed a moderate level of Ki67 at 8 weeks, which thereafter declined markedly. The strongest expression of Caspase-3 on the bone surface was observed after 16 weeks. In conclusion, the effect of collagen membrane coverage on bone graft volume maintenance was dependent on membrane stability during healing. An autogenous bone graft covered with Bio-Oss particles resulted in a remarkable increase in augmented lateral surface of the mandible. The late stage of bone graft healing was associated with a high apoptotic induction pathway of osteoblasts lining the surfaces of the new bone, demonstrated by strong positive Caspase-3 immunoreactivity.
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Affiliation(s)
- W L Adeyemo
- Department of Craniomaxillofacial and Plastic Surgery, University of Cologne, Germany.
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Sverzut CE, Faria PEP, Magdalena CM, Trivellato AE, Mello-Filho FV, Paccola CAJ, Gogolewski S, Salata LA. Reconstruction of mandibular segmental defects using the guided-bone regeneration technique with polylactide membranes and/or autogenous bone graft: a preliminary study on the influence of membrane permeability. J Oral Maxillofac Surg 2008; 66:647-56. [PMID: 18355588 DOI: 10.1016/j.joms.2007.06.664] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Revised: 04/24/2007] [Accepted: 06/11/2007] [Indexed: 11/17/2022]
Abstract
PURPOSE Bone maintenance after mandibular reconstruction with autogenous iliac crest may be disappointing due to extensive resorption in the long term. The potential of the guided-bone regeneration (GBR) technique to enhance the healing process in segmental defects lacks comprehensive scientific documentation. This study aimed to investigate the influence of polylactide membrane permeability on the fate of iliac bone graft (BG) used to treat mandibular segmental defects. MATERIALS AND METHODS Unilateral 10-mm-wide segmental defects were created through the mandibles of 34 mongrel dogs. All defects were mechanically stabilized, and the animals were divided into 6 treatment groups: control, BG alone, microporous membrane (poly L/DL-lactide 80/20%) (Mi); Mi plus BG; microporous laser-perforated (15 cm(2) ratio) membrane (Mip), and Mip plus BG. Calcein fluorochrome was injected intravenously at 3 months, and animal euthanasia was carried out at 6 months postoperatively. RESULTS Histomorphometry showed that BG protected by Mip was consistently related to larger amounts of bone compared with other groups (P <or= .0001). No difference was found between defects treated with Mip alone and BG alone. Mi alone rendered the least bone area and reduced the amount of grafted bone to control levels. Data from bone labeling indicated that the bone formation process was incipient in the BG group at 3 months postoperatively regardless of whether or not it was covered by membrane. In contrast, GBR with Mip tended to enhance bone formation activity at 3 months. CONCLUSIONS The use of Mip alone could be a useful alternative to BG. The combination of Mip membrane and BG efficiently delivered increased bone amounts in segmental defects compared with other treatment modalities.
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Affiliation(s)
- Cassio E Sverzut
- Department of Oral and Maxillofacial Surgery and Periodontics, Faculty of Dentistry of Ribeirao Preto, University of São Paulo, São Paulo, Brazil
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Lopes C, Pacheco M, Silveira L, Duarte J, Cangussú M, Pinheiro A. The effect of the association of NIR laser therapy BMPs, and guided bone regeneration on tibial fractures treated with wire osteosynthesis: Raman spectroscopy study. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2007; 89:125-30. [DOI: 10.1016/j.jphotobiol.2007.09.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 09/14/2007] [Accepted: 09/27/2007] [Indexed: 10/22/2022]
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Park SH, Lee KW, Oh TJ, Misch CE, Shotwell J, Wang HL. Effect of absorbable membranes on sandwich bone augmentation. Clin Oral Implants Res 2007; 19:32-41. [PMID: 17956570 DOI: 10.1111/j.1600-0501.2007.01408.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study was conducted to evaluate the effect of barrier membranes on sandwich bone augmentation (SBA) for the treatment of implant dehiscence defects. MATERIAL AND METHODS Twenty-six implant-associated buccal dehiscence defects in 22 patients were treated according to the SBA concept - mineralized human cancellous allograft (inner layer), mineralized human cortical allograft (outer layer) and coverage with barrier membrane. The defects were randomly assigned to the bovine collagen membrane (BME) group; acellular dermal matrix (ADM) group; and no membrane group. Measurements at baseline and 6 months re-entry included defect height (DH: from smooth-rough junction to the most apical part of the defect), defect width (DW: at the widest part of the defect), and horizontal defect depth (HDD: at three locations - smooth-rough junction, middle, and most apical portion of the defect). All measurements were taken from a reference stent. Statistical analyses were performed for comparison of intra- and inter-group comparisons. RESULTS All implants placed were successfully osseointegrated. DH at baseline for three groups were not significantly different (P=0.858). Mean % DH reductions for ADM, BME, and control groups at 6 months were 73.9+/-17.6%, 68.1+/-30.1%, and 63.6+/-23.9%, respectively, with no significant difference among the groups (P=0.686). Mean horizontal bone gain, however, was significantly greater for membrane groups (1.7 mm for ADM, 1.6 mm for BME) compared with control group (1 mm) (P=0.044). Implant exposure resulted in significant reduction in total height gain (79.1+/-14.3% vs. 57+/-23.5%, P=0.021). CONCLUSIONS Within the limit of this study, it is concluded that SBA technique achieved predictable clinical outcomes. The addition of absorbable membranes enhanced bone gain in thickness compared with membrane-treated sites.
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Affiliation(s)
- Sang-Hoon Park
- School of Dentistry, University of Maryland, Baltimore, MD 21201, USA.
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Orthodontie et implantogie dans le traitement d’un trauma des incisives centrals maxillaires. Int Orthod 2006. [DOI: 10.1016/s1761-7227(06)70262-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lioubavina-Hack N, Lang NP, Karring T. Significance of primary stability for osseointegration of dental implants. Clin Oral Implants Res 2006; 17:244-50. [PMID: 16672018 DOI: 10.1111/j.1600-0501.2005.01201.x] [Citation(s) in RCA: 210] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To investigate the significance of the initial stability of dental implants for the establishment of osseointegration in an experimental capsule model for bone augmentation. MATERIAL AND METHODS Sixteen male rats were used in the study. In each rat, muscle-periosteal flaps were elevated on the lateral aspect of the mandibular ramus on both sides, resulting in exposure of the bone surface. Small perforations were then produced in the ramus. A rigid, hemispherical Teflon capsule with a diameter of 6 mm and a height of 4 mm and with a hole in its middle portion, prepared to fit the circumference of an ITI HC titanium implant of 2.8 mm in diameter, was fixed to the ramus using 4 mini-screws. On one side of the jaw, the implant was placed through the hole in such a way that its apex did not make contact with the mandibular ramus (test). This placement of the implant did not ensure primary stability. On the other side of the jaw, a similar implant was placed through the hole of the capsule in such a way that contact was made between the implant and the surface of the ramus (control). This provided primary stability of the implant. After placement of the implants, the soft tissues were repositioned over the capsules and sutured. After 1, 3, 6 and 9 months, four animals were sacrificed and subjected to histometric analysis. RESULTS The mean height of direct bone-to-implant contact of implants with primary stability was 38.8%, 52.9%, 64.6% and 81.3% of the implant length at 1, 3, 6 and 9 months, respectively. Of the bone adjacent to the implant surface, 28.1%, 28.9%, 52.6% and 69.6%, respectively, consisted of mineralized bone. At the test implants, no bone-to-implant contact was observed at any observation time or in any of these non-stabilized specimens. CONCLUSION The findings of the present study indicate that primary implant stability is a prerequisite for successful osseointegration, and that implant instability results in fibrous encapsulation, thus confirming previously made clinical observations.
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Affiliation(s)
- Natalia Lioubavina-Hack
- Department of Periodontology and Oral Gerontology, Royal Dental College, University of Aarhus, Aarhus, Denmark
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Zhong W, Ma G, Wang Y, Tamamura R, Xiao J. Augmentation of Peri-implant Bone Defects with Different Bone Grafts and Guided Bone Regeneration:. J HARD TISSUE BIOL 2006. [DOI: 10.2485/jhtb.15.82] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Guowu Ma
- Stomatological College of Dalian Medical University
| | - Yi Wang
- Stomatological College of Dalian Medical University
| | - Ryo Tamamura
- Deparment of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Jing Xiao
- Stomatological College of Dalian Medical University
- Deparment of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
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Donos N, Bosshardt D, Lang N, Graziani F, Tonetti M, Karring T, Kostopoulos L. Bone formation by enamel matrix proteins and xenografts: an experimental study in the rat ramus. Clin Oral Implants Res 2005; 16:140-6. [PMID: 15777322 DOI: 10.1111/j.1600-0501.2004.01088.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to evaluate whether the use of enamel matrix proteins with or without the use of deproteinized bovine bone influences bone formation when used as an adjunct to guided bone regeneration (GBR). Twenty rats, divided into four groups of five animals each, were used in this study. Group A1: A hemispherical PTFE capsule was placed empty on the lateral aspect of the mandibular ramus (GBR). At the contralateral side of the jaw, the capsule was filled with an enamel matrix derivative (EMD) before its placement. The healing period was 60 days. Group A2: The animals were treated in the same manner as in Group A1 but with a healing period of 120 days. Group B1: The animals were treated in the same manner as in Group A1 with the difference that deproteinized bovine bone mineral (DBBM) particles were packed in the capsule. At the contralateral side of the jaw, the capsule was filled with a mixture of EMD and DBBM. The healing period was 60 days. Group B2: The same treatment as in B1 but with a healing period of 120 days. The histological analysis revealed that in Groups A1 and A2 newly formed bone was covering a significant part of the empty capsules (GBR). The use of EMD in the capsule did not offer any added benefit to the use of the capsule alone in terms of new bone formation. At Groups B1 and B2, the presence of DBBM and/or EMD did not positively affect the amount of new bone formation. It can be suggested that neither the application of EMD nor the use of DBBM or the combination of EMD and DBBM results in enhanced amounts of bone formation in comparison with the GBR procedure alone.
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Affiliation(s)
- Nikolaos Donos
- Department of Periodontology, Eastman Dental Institute, University College London, 256 Gray's Inn Road, London WC1X 8LD, UK.
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Donos N, Kostopoulos L, Tonetti M, Karring T. Long-term stability of autogenous bone grafts following combined application with guided bone regeneration. Clin Oral Implants Res 2005; 16:133-9. [PMID: 15777321 DOI: 10.1111/j.1600-0501.2004.01104.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of the study was to compare the long-term stability of membranous and endochondral autogenous bone grafts with or without combined application of guided bone regeneration (GBR). Twenty-five, male, 6-month old, albino rats were used in the study. The animals were divided into four groups (A5, A11, B5 and B11). Group A5 (control): The inferior border of the mandible was exposed in both sides. At one side of the jaw, a calvarial bone graft (baseline -3 x 4 x 0.64 mm) was placed at the inferior border of the mandible and was fixed with a standardized screw-type titanium microimplant. At the contralateral side, an ischiac bone graft (baseline -3 x 4 x 0.87) was transplanted. The healing period was 5 months. Group A11 (control): The animals were treated in the same manner as in Group A5 with the difference that the healing period was 11 months. Group B5 (test): The animals were treated in the same manner as in Group A5 with the difference that an e-PTFE membrane was adapted over the bone graft on each side of the jaw. Group B11 (test): The animals were treated in the same manner as in Group B5 with the difference that 5 months following transplantation the animals were subjected to a second operation and the membranes were removed. The healing period was 11 months. The animals were killed at 5 (Groups A5 and B5) or at 11 months (Groups A11 and B11) following mandibular augmentation and the jaws were defleshed. The width, the length and the thickness/height of the bone graft were evaluated by means of a stereomicroscope. At 5 months, both types of the membrane-treated bone grafts presented increase in all dimensions compared with baseline. However at 11 months, both types of the membrane-treated bone grafts exhibited a decrease in their dimensions which were similar to the baseline measurements. In the control groups, both types of bone graft presented significant resorption both at 5 and at 11 months with the ischiac bone grafts presenting more resorption in width and length than the calvarial bone grafts. It can be concluded that the long-term volume stability of autogenous endochondral and membranous onlay bone grafts combined with GBR is superior to that of autogenous endochondral and membranous onlay bone grafts alone.
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Affiliation(s)
- Nikolaos Donos
- Department of Periodontology, Eastman Dental Institute, University College London, 256 Gray's Inn Road, London WC1X 8LD, UK.
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Busenlechner D, Kantor M, Tangl S, Tepper G, Zechner W, Haas R, Watzek G. Alveolar ridge augmentation with a prototype trilayer membrane and various bone grafts: a histomorphometric study in baboons. Clin Oral Implants Res 2005; 16:220-7. [PMID: 15777332 DOI: 10.1111/j.1600-0501.2004.01103.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Barrier membranes have become a standard treatment option in alveolar ridge augmentation prior to implant placement. However, non-resorbable membranes require secondary surgery and resorbable membranes show an unfavorable degradation profile. The purpose of this study was to evaluate the potential of a slowly biodegradable/bioresorbable prototype trilayer membrane (PTLM) for supporting bone regeneration in alveolar ridge augmentation. Clinically relevant cavities were made 3 months after the extraction of the first and second molars in each jaw of six baboons. Each animal was treated with four different regimens: (1) autogenous bone block (ABB) alone, (2) ABB+PTLM, (3) deproteinized bovine bone mineral (DBBM)+PTLM and (4) no treatment. After 9 months, the baboons were sacrificed and block sections of the augmented area were subjected to histologic and histomorphometric analyses. Newly formed bone areas were determined at a distance of 1, 3, 7 and 10 mm from crestal. The data showed a well-preserved ridge profile at the membrane-protected sites, whereas non-protected bone blocks and control sites underwent severe resorption resulting in knife-edge ridge profiles. Significant differences were found between ABB+PTLM and ABB (P=0.0137-0.0232). DBBM+PTLM also produced a larger bone area compared with ABB alone (P=0.0396-0.0439). No significant difference in bone area was detectable between ABB+PTLM and DBBM+PTLM (P>0.05). The present study supports the use of the slowly biodegradable/bioresorbable PTLM with autografts and DBBM for lateral ridge augmentation in this type of bone defects.
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Affiliation(s)
- Dieter Busenlechner
- Department of Oral Surgery, Vienna Medical University School of Dentistry, Ludwig Boltzmann Institute of Oral Implantology, Waehringerstrasse 25a, A-1090 Vienna, Austria.
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Donos N, Lang NP, Karoussis IK, Bosshardt D, Tonetti M, Kostopoulos L. Effect of GBR in combination with deproteinized bovine bone mineral and/or enamel matrix proteins on the healing of critical-size defects. Clin Oral Implants Res 2004; 15:101-11. [PMID: 14731183 DOI: 10.1111/j.1600-0501.2004.00986.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the effect of guided bone regeneration (GBR) in combination with or without deproteinized bovine bone mineral (DBBM) and/or an enamel matrix derivative (EMD) on the healing of critical-size calvarial defects. MATERIAL AND METHODS Forty rats were used. In all animals, a standardized critical-size calvarial defect was created surgically. The animals were randomly allocated into 4 groups of 10 animals each. Group A: One calvarial defect was left untreated, while the galeal and the cerebral aspect of the contralateral defect were covered with a bioresorbable membrane (GBR). Group B: One calvarial defect was filled with EMD, while the contralateral defect was treated with GBR and EMD. Group C: One defect was filled with DBBM, while the contralateral defect was treated with combination of GBR and DBBM. Group D: One defect was filled with DBBM combined with EMD, while the contralateral defect was treated with combination of GBR, DBBM and EMD. The healing period was 4 months. Five specimens from each group were macerated and the length, the width and the vertical dimension (thickness) of the remaining defect were evaluated by a stereomicroscope. The remaining specimens in each group were analyzed histologically. RESULTS The defects of the macerated specimens that were left untreated or were treated only by EMD, DBBM and combination of EMD and DBBM did not present predictably complete healing of the defects. All the defects where GBR was applied alone or combined with DBBM and/or EMD presented always complete healing (P<0.05). The combined use of GBR with EMD and/or DBBM did not offer any significant advantage above GBR alone in terms of healing of the length and the width of the defect. However, the vertical dimension of the defect was significantly higher (P<0.05) in the GBR-treated specimens of Groups C and D. The histological analysis supported these findings. CONCLUSION The predictability of bone formation in critical-size defects depends mainly on the presence or absence of barrier membranes (GBR). The combined use with deproteinized bovine bone mineral and/or enamel matrix proteins did not significantly enhance the potential for complete healing provided by the GBR procedure.
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Affiliation(s)
- Nikolaos Donos
- Department of Periodontology, Eastman Dental Institute, University College London, UK.
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