Combined implantation of particulate dentine, plaster of Paris, and a bone xenograft (Bio-Oss) for bone regeneration in rats

Advances in autogenous dentin matrix graft as a promising biomaterial for guided bone regeneration in maxillofacial region: A review

Autogenous dentin matrix (ADM), derived from a patient's extracted tooth, can be repurposed as an autologous grafting material in reconstructive dentistry. Extracted teeth provide a source for ADM, which distinguishes itself with its low rejection rate, osteoinductive capabilities and ease of preparation. Consequently, it presents a viable alternative to autogenous bone. Animal studies have substantiated its effective osteoinductive properties, while its clinical applications encompass post-extraction site preservation, maxillary sinus floor augmentation, and guided bone tissue regeneration. Nevertheless, the long-term efficacy of ADM applied in bone regeneration remains underexplored and there is a lack of standardization in the preparation processes. This paper comprehensively explores the composition, mechanisms underlying osteoinductivity, preparation methods, and clinical applications of ADM with the aim of establishing a fundamental reference for future studies on this subject.

Evaluation of osteogenic potential of demineralized dentin matrix hydrogel for bone formation

OBJECTIVES

Dentin, the bulk material of the tooth, resemble the bone's chemical composition and is considered a valuable bone substitute. In the current study, we assessed the cytotoxicity and osteogenic potential of demineralized dentin matrix (DDM) in comparison to HA nanoparticles (n-HA) on bone marrow mesenchymal stem cells (BMMSCs) using a hydrogel formulation.

MATERIALS AND METHODS

Human extracted teeth were minced into particles and treated via chemical demineralization using ethylene diamine tetra-acetic acid solution (EDTA) to produce DDM particles. DDM and n-HA particles were added to the sodium alginate then, the combination was dripped into a 5% (w/v) calcium chloride solution to obtain DDM hydrogel (DDMH) or nano-hydroxyapatite hydrogel (NHH). The particles were evaluated by dynamic light scattering (DLS) and the hydrogels were evaluated via scanning electron microscope (SEM). BMMSCs were treated with different hydrogel concentrations (25%, 50%, 75% and neat/100%) and cell viability was evaluated using MTT assay after 72 h of culture. Collagen-I (COL-I) gene expression was studied with real-time quantitative polymerase chain reaction (RT-qPCR) after 3 weeks of culture and alkaline phosphatase (ALP) activity was assessed using enzyme-linked immune sorbent assay (ELISA) over 7th, 10th, 14th and 21st days of culture. BMMSCs seeded in a complete culture medium were used as controls. One-way ANOVA was utilized to measure the significant differences in the tested groups.

RESULTS

DLS measurements revealed that DDM and n-HA particles had negative values of zeta potential. SEM micrographs showed a porous microstructure of the tested hydrogels. The viability results revealed that 100% concentrations of either DDMH or NHH were cytotoxic to BMMSCs after 72 h of culture. However, the cytotoxicity of 25% and 50% concentrations of DDMH were not statistically significant compared to the control group. RT-qPCR showed that COL-I gene expression was significantly upregulated in BMMSCs cultured with 50% DDMH compared to all other treated or control groups (P < 0.01). ELISA analysis revealed that ALP level was significantly increased in the groups treated with 50% DDMH compared to 50% NHH after 21 days in culture (P < 0.001).

CONCLUSION

The injectable hydrogel containing demineralized dentin matrix was successfully formulated. DDMH has a porous structure and has been shown to provide a supporting matrix for the viability and differentiation of BMMSCs. A 50% concentration of DDMH was revealed to be not cytotoxic to BMMSCs and may have a great potential to promote bone formation ability.

A novel pilot animal model for bone augmentation using osseous shell technique for preclinical in vivo studies

OBJECTIVES

Bone grafting is commonly used to reconstruct skeletal defects in the craniofacial region. Several bone augmentation models have been developed to evaluate bone formation using novel bone substitute materials. The aim of this study was to evaluate a surgical animal model for establishing a three-dimensional (3D) grafting environment in the animal's mandibular ramus for bone augmentation using the osseous shell technique, as in humans.

MATERIALS AND METHODS

Osteological survey of New Zealand white (NZW) rabbit skull (Oryctolagus cuniculus): Initial osteological and imaging surveys were performed on a postmortem skull for a feasibility assessment of the surgical procedure. Postmortem pilot surgery and cone beam computed tomography imaging: a 3D osseous defect was created in the mandibular ramus through a submandibular incision. The osseous shell plates were stabilized with osteosynthesis fixation screws, and defects were filled with particular bone grafting material. In vivo surgical procedure: surgeries were conducted in four 8-week-old NZW rabbits utilizing two osseous shell materials: xenogeneic human cortical plates and autogenous rabbit cortical plates. The created 3D defects were filled using xenograft and allograft bone grafting materials. The healed defects were evaluated for bone formation after 12 weeks using histological and cone beam computed tomography imaging analysis.

RESULTS

Clinical analysis 12 weeks after surgery revealed the stability of the 3D grafted bone augmentation defects using the osseous shell technique. Imaging and histological analyses confirmed the effectiveness of this model in assessing bone formation.

CONCLUSIONS

The proposed animal model is a promising model with the potential to study various bone grafting materials for augmentation in the mandibular ramus using the osseous shell technique without compromising the health of the animal. The filled defects could be analyzed for osteogenesis, quantification of bone formation, and healing potential using histomorphometric analysis, in addition to 3D morphologic evaluation using radiation imaging.

Radiological and Microbiological Evaluation of the Efficacy of Alveolar Bone Repair Using Autogenous Dentin Matrix—Preliminary Study

Dental procedures for alveolar bone augmentation may be carried out using autologous bone graft material derived from the patient’s own tooth. The material obtained is subjected to strict procedures aimed at reducing the amount of bacteria in the autograft. The aim of this study was the evaluation of the efficacy of the autogenous dentine matrix produced by grinding the patient’s own tooth for the augmentation of maxillary bone defects and the evaluation of the microbiological status of the material obtained. Alveolar bone repair was performed with an autogenous dentin matrix in four patients. In each case, an autogenous bone graft substitute obtained by grinding the patient’s own tooth was used. The tooth-derived material was then used for alveolar augmentation. The obtained material was tested to assess its microbiological profile. For the purpose of comparison, other materials and tissues were also subjected to microbiological testing. Bone healing was assessed by CBCT (cone beam computed tomography) scanning before and 6 months after surgery using the Hounsfield scale and the ImageJ software. Analysis of the bone regeneration process based on the bone density score in Hounsfield units showed significant differences in measurements on CBCT scans carried out on the treatment site, before surgery, and 6 months after it, using ImageJ software. All bacteria detected in the bone augmentation material constituted the patient’s bacterial flora. The microorganisms present in the augmentation material were also present in the patient’s bone and soft tissues. The use of an autogenous dentin matrix for alveolar bone repair ensures that the proper volume is obtained and that alveolar bone shape is preserved and does not introduce pathogenic microorganisms into the patient. The procedure for preparing and using an autogenous dentin matrix is described based on one clinical case.

Alendronato de sódio tópico associado ao osso bovino liofilizado no reparo ósseo

Resumo Introdução O osso bovino inorgânico é o enxerto mais utilizado na Odontologia, tendo como desvantagem longo tempo de integração ao leito receptor. Os bifosfonatos têm sido utilizados para modular a quantidade e a qualidade do osso regenerado e diminuir o tempo de integração do enxerto. Objetivo Avaliar o efeito do bifosfonato alendronato de sódio (ALN) 0,5%, associado ou não ao osso bovino inorgânico, na reparação de defeitos ósseos. Material e método Dois defeitos ósseos foram confeccionados na calvária de 12 coelhos, sendo a cavidade esquerda/experimental preenchida com: GI = osso bovino inorgânico (Bio-Oss®); GII = Bio-Oss® + ALN 0,5%; GIII = ALN 0,5%; e a cavidade direita por coágulo sanguíneo (controle). Os animais foram mortos aos 60 dias pós-operatórios. Por meio de análise histomorfométrica calculou-se o percentual de osso neoformado e remanescente do biomaterial em relação à área total do defeito. Resultado Osso neoformado: GI = 38,16 ± 15,44%; GII = 55,77 ± 16,75%; GII I = 60,28 ± 11,45%. Controle = 45,11 ± 11,09%. Remanescente do enxerto: GI = 7,02 ± 5,36% e GII = 16,59 ± 9,56%. Não houve diferença quanto ao percentual de osso neoformado entre os grupos (ANOVA p = 0,15512; teste de Tukey F = 2,089). O percentual de remanescente do enxerto também foi estatisticamente semelhante entre os grupos GI e GII (teste de Tukey F = 5,019). Conclusão O uso tópico da solução de ALN 0,5% isoladamente ou associado ao osso bovino liofilizado não alterou o percentual de neoformação óssea nem a degradação dos grânulos do enxerto.

Autologous Tooth Dentin Graft: A Retrospective Study in Humans

Background and Objectives: The aim of this study is to evaluate the efficacy of an autologous dentin graft, via extracted teeth that are processed into bacteria-free particulate dentin in a Smart dentin grinder and then grafted immediately into alveolus post extraction or into bone deficiencies. Materials and Methods: Ten healthy, partially edentulous patients with some teeth in the mandible were recruited in the study. After their own teeth were grinded, particulate teeth were placed in empty sockets and bone defects after teeth extractions. Furthermore, after three, six, 12 and 24 months, core samples using a 3 mm trephine were obtained. Results: At three months, the particles of grinded tooth were immersed inside a new connective tissue with a small new bone formation (16.3 ± 1.98). At six months, we observed small particles of dentin integrated in new immature bone, without inflammation in the soft tissue (41.1 ± 0.76). At twelve months, we observed a high amount of bone formation surrounding tooth particles (54.5 ± 0.24), and at twenty-four months, new bone, a big structure of bone, was observed with dentin particles (59.4 ± 1.23), statistically different when compared it with at three months. Conclusions: A particulate dentin graft should be considered as an alternative material for sockets’ preservation, split technique, and also for sinus lifting. One of the special characteristics after 24 months of evaluation was the high resorption rate and bone replacement without inflammation. This material could be considered as an acceptable biomaterial for different bone defects due to its osteoinductive and osteoconductive properties

The effect of autogenous tooth bone graft material without organic matter and type I collagen treatment on bone regeneration

Objectives

The aim of this study is to examine the effect of particulate autogenous tooth graft removed with organic matter and type I collagen addition on bone regeneration and to validate the possibility of useful allograft material for jaw defects.

Material and methods

Autogenous tooth bone maker (Korean Dental Solution® KOREA) made particulate autogenous tooth not including organic matter. We used to the developed tooth grafts for experiment. Cell adhesion test with hemacytometer and energy dispersive X-ray spectroscopy (Supra40 VP®, Carl Zeiss, Germany) analysis about the particulate autogenous tooth and type I collagen were performed. Rabbits were divided into three groups: bone graft with organic matter (OM) removing particulate autogenous tooth group, bone graft with OM removing particulate autogenous tooth and type I collagen group, and a control group. Bone grafting was performed in rabbit’s calvaria. The rabbits were sacrificed at different interval at 1, 2, 4, and 6 weeks after bone grafting for the histopathologic observation and observed the effect of bone regeneration by SEM, H-E & Masson stains, osteocalcin IHC staining.

Result

In vitro cytopathological study showed affinity for cells, cell attachment pattern, and cell proliferation in the order of control group, OM-removed and collagen-treated group, OM-removed particulate autogenous tooth group. The results of the degree of mineralization were opposite to those of the previous cell experimental results, and the OM-removed group, OM-removed group and collagen-treated group were relatively higher than the control group. Histopathologic analysis showed that vascularization and neonatal bone formation were higher in particulate autogenous tooth group with removing OM and with addition of collagen than control group and group of OM removed only. Immunohistochemical analysis showed that osteocalcin (OSC) expression was not observed in the control group, but at 4 weeks groups, OSC expression was observed the OM removed and OM-removed-collagen-treated particulate autogenous tooth, and the degree of expression was somewhat stronger in group of the OM removed and collagen additionally treated particulate autogenous tooth.

Conclusion

Particles that do not contain organic matter, the saint tooth, was responsible for sufficient bone graft material through the role of space maintenance and bone conduction, and further improved bone formation ability through additional collagen treatment. Therefore, research on various extracellular substrates and autologous bone grafting materials is necessary, and through this, it is possible to lay the foundation for a new type of autologous bone grafting material with excellent academic and technical utility.

Comparison of Autogenous Tooth Materials and Other Bone Grafts

Autogenous odontogenic materials are a new, highly biocompatible option for jaw restoration. The inorganic component of autogenous teeth acts as a scaffold to maintain the volume and enable donor cell attachment and proliferation; the organic component contains various growth factors that promote bone reconstruction and repair. The composition of dentin is similar to that of bone, which can be a rationale for promoting bone reconstruction. Recent advances have been made in the field of autogenous odontogenic materials, and studies have confirmed their safety and feasibility after successful clinical application. Autogenous odontogenic materials have unique characteristics compared with other bone-repair materials, such as the conventional autogenous, allogeneic, xenogeneic, and alloplastic bone substitutes. To encourage further research into odontogenic bone grafts, we compared the composition, osteogenesis, and development of autogenous odontogenic materials with those of other bone grafts. In conclusion, odontogenic bone grafts should be classified as a novel bone substitute.

Integration of Dental Implants in Conjunction with EDTA-Conditioned Dentin Grafts: An Experimental Study

This study was undertaken to investigate the integration of titanium micro-implants installed in conjunction with previously dentin-grafted areas and to study the morphological appearance, mineral content, and healing pattern of xenogenic EDTA-conditioned dentin blocks and granules grafted to cavities in the tibial bone of rabbits. Demineralized and non-demineralized dentin blocks and granules from human premolars were implanted into cavities prepared on the lateral aspects of the tibias of rabbits. After a healing period of six months, micro-implants were installed at each surgical site. Histological examinations were carried out after 24 weeks. Characterization of the EDTA-conditioned dentin blocks was performed by means of light microscopy, dental X-rays, scanning electron microscopy, and energy dispersive X-ray analysis (EDX). No implants were found to be integrated in direct contact with the dentin particles or blocks. On the EDTA-conditioned dentin surface, the organic marker elements C and N dominated, as revealed by EDX. The hydroxyapatite constituents Ca and P were almost absent on the dentin surface. No statistically significant difference was observed between the EDTA-conditioned and non-demineralized dentin, as revealed by BIC and BA. The bone-inductive capacity of the dentin material seemed limited, although demineralization by means of EDTA indicated higher BIC and BA values in conjunction with the installed implants in the area. A 12 h EDTA treatment did not fully decalcify the grafts, as revealed by X-ray analysis.

Bio-Absorption of Human Dentin-Derived Biomaterial in Sheep Critical-Size Iliac Defects

The aim of this study was to evaluate the bio-absorption and bone regeneration of human tooth-derived dentin scaffold, entitled as perforated root-demineralized dentin matrix (PR-DDM), after in vivo implantation into the critical-size iliac defects. The dentin scaffolds were prepared from human vital, non-functional teeth. Thirty artificial macro-pores (Ø 1 mm) were added after removing the enamel portion. The modified teeth were supersonically demineralized in 0.34 N HNO₃ for 30 min. The microstructure was observed by scanning electron microscope (SEM). The 3D micro-CT and histological analysis were carried out to evaluate the bio-absorption of PR-DDM at 2 and 4 months. A smooth dentin collagen surface with symmetrical macro-pores and tube-type dentinal tubules (Ø 1–2 µm) with micro-cracks were observed on the perforated region. A significant number of custom-made macro-pores disappeared, and the size of the macro-pores became significantly wider at 4 months compared with the 2 months (p < 0.05) evaluated by 3D micro-CT. Histological images revealed the presence of multinucleated giant cells attached to the scalloped border of the PR-DDM. The morphological changes due to bio-absorption by the cellular phagocytes were comparable to the 3D micro-CT and histological images at 2 and 4 months. Altogether, the results demonstrated that the PR-DDM block was gradually absorbed by multinucleated giant cells and regenerated bone. Human PR-DDM might serve as a unique scaffold for extraoral bone regeneration.

Dentin-Derived Inorganic Minerals Promote the Osteogenesis of Bone Marrow-Derived Mesenchymal Stem Cells: Potential Applications for Bone Regeneration

Background

Oral and maxillofacial bone loss is highly prevalent among populations, and nowadays, increased attention has been focused on dentin derivatives serving as desirable graft materials for bone regeneration. In this study, dentin-derived inorganic mineral (DIM) was fabricated with a high-temperature calcination technique and the effects of DIM on the osteogenic differentiation of bone marrow-derived mesenchymal stem cells (BMMSCs) and the bone formation were elucidated.

Methods

The effects of DIM on BMMSC proliferation and apoptosis capacity were evaluated by CCK-8, flow cytometry, and EdU assays. Alkaline phosphatase (ALP) activity detection, ALP staining, alizarin red staining, and osteogenic marker expression analysis were performed to investigate the influence of DIM on the osteogenic differentiation of BMMSCs, as well as the relevant signal mechanisms. The model of critical-sized defects in the calvarium of rats was constructed for exploring the in vivo efficiency of DIM on bone regeneration.

Results

Cell viability assays indicated that DIM had no cytotoxicity. BMMSCs cultured with DIM presented a higher level of osteogenic differentiation ability than those in the control group. The activation in ERK and p38 signals was detected in DIM-treated BMMSCs, and both pathways and osteogenic process were suppressed while using ERK inhibitor U0126 and p38 inhibitor SB203580, respectively. Furthermore, the animal experiments revealed that DIM could dramatically enhance new bone formation compared to the control group.

Conclusion

DIM could promote BMMSC osteogenic differentiation via triggering the ERK and p38 MAPK signaling pathways and might be a novel predictable material for facilitating bone formation.

[Effect of human tooth bone graft materials on proliferation and differentiation of mice mononuclear macrophage RAW264.7]

Objective

To investigate the effect of human tooth bone graft materials on the proliferation, differentiation, and morphology of macrophages, and to understand the biocompatibility and cytotoxicity of human tooth bone graft materials.

Methods

Fresh human teeth were collected to prepare human tooth bone graft materials, the adhesion of mouse mononuclear macrophages RAW264.7 to human bone graft materials was observed under confocal microscopy. Scanning electron microscopy was used to observe the morphology of human tooth bone graft materials, OSTEONⅡ synthetic highly resorbable bone grafting materials, and untreated tooth powder (dental particles without preparation reagents). Different components of the extract were prepared in 4 groups: group A (DMEM medium containing 10% fetal bovine serum), group B (human tooth bone graft materials), group C (OSTEONⅡ synthetic highly resorbable bone grafting materials), group D (untreated tooth powder without preparation reagents). The 4 groups of extracts were co-cultured with the cells, and the cytotoxicity was qualitatively determined by observing the cell morphological changes by inverted microscope. The cell proliferation and differentiation results and cell relative proliferation rate were determined by MTT method to quantitatively determine cytotoxicity. The cell viability was detected by trypanosoma blue staining, and tumor necrosis factor α (TNF-α ) and interleukin 6 (IL-6) expressions were detected by ELISA.

Results

Scanning electron microscopy showed that the surface of the human tooth bone graft material and the OSTEONⅡ synthetic highly resorbable bone grafting materials had a uniform pore structure, while the untreated tooth particle collagen fiber structure and the demineralized dentin layer collapsed without specific structure. Confocal microscopy showed that the cells grew well on human tooth bone graft materials. After co-culture with the extract, the morphology and quantity of cells in groups A, B, and C were normal, and the toxic reaction grades were all grade 0, while group D was grade 3 reaction. MTT test showed that the cytotoxicity of groups B and C was grade 0 or 1 at each time point, indicating that the materials were qualified. The cytotoxicity was grade 2 in group D at 1 day after culture, and was grade 4 at 3, 5, and 7 days. Combined with cell morphology analysis, the materials were unqualified. The trypanosoma blue staining showed that the number of cells in groups A, B, and C was significantly higher than that in group D at each time point ( P<0.05), but no significant difference was found among groups A, B, and C ( P<0.05). ELISA test showed that the levels of TNF-α and IL-6 in groups A, B, and C were significantly lower than those in group D ( P<0.05), but no significant difference was found among groups A, B, and C ( P<0.05).

Conclusion

The human tooth bone graft materials is co-cultured with mice mononuclear macrophages without cytotoxicity. The extract has no significant effect on cell proliferation and differentiation, does not increase the expression of inflammatory factors, has good biocompatibility, and is expected to be used for clinical bone defect repair.

The Use of Tooth Particles as a Biomaterial in Post-Extraction Sockets. Experimental Study in Dogs

Objectives: The objective of this study was to evaluate new bone formation derived from freshly crushed extracted teeth, grafted immediately in post-extraction sites in an animal model, compared with sites without graft filling, evaluated at 30 and 90 days. Material and Methods: The bilateral premolars P2, P3, P4 and the first mandibular molar were extracted atraumatically from six Beagle dogs. The clean, dry teeth were ground immediately using the Smart Dentin Grinder. The tooth particles obtained were subsequently sieved through a special sorting filter into two compartments; the upper container isolating particles over 1200 μm, the lower container isolated particles over 300 μm. The crushed teeth were grafted into the post-extraction sockets at P3, P4 and M1 (test group) (larger and smaller post-extraction alveoli), while P2 sites were left unfilled and acted as a control group. Tissue healing and bone formation were evaluated by histological and histomorphometric analysis after 30 and 90 days. Results: At 30 days, test site bone formation was greater in the test group than the control group (p < 0.05); less immature bone was observed in the test group (25.71%) than the control group (55.98%). At 90 days, significant differences in bone formation were found with more in the test group than the control group. No significant differences were found in new bone formation when comparing the small and large alveoli post-extraction sites. Conclusions: Tooth particles extracted from dog’s teeth, grafted immediately after extractions can be considered a suitable biomaterial for socket preservation.

Development of gelatin/carboxymethyl chitosan/nano-hydroxyapatite composite 3D macroporous scaffold for bone tissue engineering applications

The present study delineates a relatively simpler approach for fabrication of a macroporous three-dimensional scaffold for bone tissue engineering. The novelty of the work is to obtain a scaffold with macroporosity (interconnected networks) through a combined approach of high stirring induced foaming of the gelatin/carboxymethyl chitosan (CMC)/nano-hydroxyapatite (nHAp) matrix followed by freeze drying. The fabricated macroporous (SGC) scaffold had a greater pore size, higher porosity, higher water retention capacity, slow and sustained enzymatic degradation rate along with higher compressive strength compared to that of non-macroporous (NGC, prepared by conventional freeze drying methodology) scaffold. The biological studies revealed the increased percentage of viability, proliferation, and differentiation as well as higher mineralization of differentiated human Wharton's jelly MSC microtissue (wjhMSC-MT) on SGC as compared to NGC scaffold. RT-PCR also showed enhanced expression level of collagen type I, osteocalcin and Runx2 when seeded on SGC. μCT and histological analysis further revealed a penetration of cellular spheroid to a greater depth in SGC scaffold than NGC scaffold. Furthermore, the effect of cryopreservation on microtissue survival on the three-dimensional construct revealed significant higher viability upon revival in macroporous SGC scaffolds. These results together suggest that high stirring based macroporous scaffolds could have a potential application in bone tissue engineering.

Bone regeneration using composite non-demineralized xenogenic dentin with beta-tricalcium phosphate in experimental alveolar cleft repair in a rabbit model

Background

Alveolar cleft repair is performed via bone grafting procedure to restore the dental arch continuity. A suitable bone substitute materials should possess osteoinductive and osteoconductive properties, to promote new bone formation, along with a slowly resorbable scaffold that is subsequently replaced with functionally viable bone. Calcium phosphate biomaterials have long proved their efficacy as bone replacement materials. Dentin in several forms has also demonstrated its possibility to be used as bone graft replacement material in several studies. The purpose of this study was to evaluate bone regeneration pattern and quantify bone formation after grafting pre-established experimental alveolar clefts defects model in rabbits using composite xenogenic dentin and β-TCP in comparison to β-TCP alone.

Methods

Unilateral alveolar cleft defects were created in 16 New Zealand rabbits according to previously described methodology. Alveolar clefts were allowed 8 weeks healing period. 8 defects were filled with β-TCP, whereas 8 defects filled with composite xenogenic dentin with β-TCP. Bone regeneration of the healed defects was compared at the 8 weeks after intervention. Quantification of bone formation was analyzed using micro-computed tomography (µCT) and histomorphometric analysis.

Results

µCT and histomorphometric analysis revealed that defects filled with composite dentin/β-TCP showed statistically higher bone volume fraction, bone mineral density and percentage residual graft volume when compared to β-TCP alone. An improved surgical handling of the composite dentin/β-TCP graft was also noted.

Conclusions

Composite xenogenic dentin/β-TCP putty expresses enhanced bone regeneration compared to β-TCP alone in the reconstruction of rabbit alveolar clefts defects.

Evaluation of the Healing Potential of Demineralized Dentin Matrix Fixed with Recombinant Human Bone Morphogenetic Protein-2 in Bone Grafts

We aimed to evaluate the efficacy of demineralized dentin matrix (DDM) fixed with recombinant human bone morphogenetic protein-2 (rhBMP-2) through an experimental and a clinical study. Unilateral upper second and third premolars of eight beagles were extracted. A mucoperiosteal flap was elevated around the extraction socket, and a bone defect was made using a surgical drill. Each DDM was fixed with rhBMP-2, and autogenous bone was grafted at the bone defect area with a collagenous membrane. The beagles were euthanized at two, four, eight, and 12 weeks after receiving the bone graft. Block specimens involving grafted bone and surrounding natural bone were extracted. A total of 23 patients who received bone grafts using human DDM fixed with rhBMP-2 (AutoBT BMP) with implant placements (36 implants; maxilla: 14, mandible: 22) were selected. The implant stability, marginal bone loss, and clinical outcome were evaluated. Three trephine cores were harvested fourmonths after bone grafting, and histologic examination was performed. In the histological evaluation performed four weeks after the bone graft, autogenous bone showed 52% new bone formation and DDM fixed with rhBMP-2 showed 33% new bone formation. Twelve weeks after the bone graft, autogenous bone showed 75% new bone formation and DDM fixed with rhBMP-2 showed 48% new bone formation. In the clinical study, favorable osseointegration was obtained in 35 out of 36 implant sites (one case of osseointegration failure). In all cases, severe complications were not observed. Histomorphometrically, new bone formation was observed in 14.98% of the cases. The residual DDM particles were 6.22%. AutoBT BMP provides good osteoinductive and osteoconductive potential and clinical efficacy.

Human tooth-derived biomaterial as a graft substitute for hard tissue regeneration

Aim: The present study was conducted to evaluate the efficacy of human dentine grafts for new bone augmentation. Materials & methods: Dentine grafts (demineralized dentine matrix [DDM] and mineralized dentine matrix [MDM]) were prepared and implanted in rats. Tetracycline was administered twice. Paraffin and resin sections were prepared from the harvested grafts and stained respectively with hematoxylin and eosin (in addition to tartrate acid phosphatase for osteoclasts) and Villanueva. The new bone formation (bone thickness, mineral apposition rate and the bone formation rate) was analyzed in tetracycline-labeled resin sections. Results & conclusion: DDM grafts implanted in bone were better able to augment the bone compared to MDM grafts. However, both MDM and DDM failed to induce new bone in ectopic site, they could be considered as alternative autograft substitutes after protocol optimization.

Autogenous demineralized dentin matrix from extracted tooth for the augmentation of alveolar bone defect: a prospective randomized clinical trial in comparison with anorganic bovine bone

OBJECTIVES

The aim of this study was to prospectively evaluate the clinical efficacy and histological outcome of the autogenous tooth graft material (AutoBT) compared to that of anorganic bovine bone (Bio-Oss^® , Geistlich, Switzerland) in post-extraction alveolar bone augmentation.

PATIENTS AND METHODS

A total of 33 graft sites in 24 patients were included in this study. AutoBT was used in 21 sites of 15 patients and Bio-Oss^® was used in 12 sites of 9 patients for alveolar bone augmentation 2-4 weeks after dental extraction. Vertical dimension of grafted bone was measured both at the time of graft placement and at implant fixture placement after 6 months. Trephine cores were harvested for the histomorphometric evaluations during implant placement when feasible. The primary stability of implant fixture was also measured.

RESULTS

Infection of graft material or graft bed was not observed and graft sites healed without any notable complications in both groups. The vertical dimensions of alveolar bone increased by 5.38 ± 2.65 mm in AutoBT group and 6.56 ± 3.54 mm in Bio-Oss^® group at 6 months post-extraction. Histomorphometrically, new bone formation of AutoBT-grafted site was 31.24 ± 13.87% while that of Bio-Oss^® was 35.00 ± 19.33%. The implant stability quotient (ISQ) of implants placed in AutoBT-grafted sites measured 72.80 ± 10.81 while those placed in Bio-Oss^® -grafted sites measured 70.0 ± 12.86. There were no statistically significant differences between measurements of the two groups.

CONCLUSION

Autogenous demineralized dentin matrix from extracted tooth grafted to extraction sockets for the augmentation of vertical dimension was as effective as augmentation using anorganic bovine bone. Both groups showed favorable wound healing, similar amount of implant stability, and histologically confirmed new bone formation. Thus, the results of this study suggest that autogenous tooth graft material is a viable option for alveolar bone augmentation following dental extraction.

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.

Guided bone regeneration using autogenous tooth bone graft in implant therapy: case series

Recently, techniques have been reported that involve the preparation of extracted teeth from patients used as particulated bone graft materials for bone graft purposes. For implant placement and bone graft, autogenous teeth bone graft materials were used in 15 patients, and clinically excellent results were obtained. In histological examination, favorable bony healing by osteoconduction was observed.

Histomorphometric Analysis of Contaminated Autogenous Tooth Graft Materials After Various Sterilization

PURPOSE

The purpose of this study was to evaluate histomorphometrically contaminated autogenous tooth graft materials, which were resterilized.

MATERIALS AND METHODS

The intentional defects (diameter: 8 mm, depth: 4 mm) were formed around implant fixture on the iliac crest of 6 mongrel dogs. Autogenous tooth graft materials were made by extracted premolars. After the contamination of the tooth materials, graft procedure was performed; no contaminated group (control group), contaminated groups (nonsterilization group [group 1], ethylene oxide [EO] gas group [group 2], and autoclave group [group 3]). The bone-to-implant contact (BIC) and the new bone formation rate (NBFR) were evaluated after sacrifice.

RESULTS

The BIC and NBFR of groups 1 and 3 were significantly lower than the control group after 4 weeks. The BIC and NBRF of group 3 were significantly lower than the control group after 8 weeks. However, the BIC and NBRF of group 2 was not significantly different comparing with the control group after 4 and 8 weeks.

CONCLUSION

Sterilization using EO gas may be more favorable than high-pressure sterilization in cases the reuse of contaminated autogenous tooth graft materials.

Bone Regeneration Using Dentin Matrix Depends on the Degree of Demineralization and Particle Size

Objectives

This study aimed to examine the influence of particle size and extent of demineralization of dentin matrix on bone regeneration.

Materials and Methods

Extracted human teeth were pulverized and divided into 3 groups according to particle size; 200, 500, and 1000 μm. Each group was divided into 3 groups depending on the extent of demineralization; undemineralized dentin (UDD), partially demineralized dentin matrix (PDDM), and completely demineralized dentin matrix (CDDM). The dentin sample was implanted into rat calvarial bone defects. After 4 and 8 weeks, the bone regeneration was evaluated with micro-CT images, histomorphometric and immunohistochemical analyses. Osteoblasts were cultured on UDD and DDM to evaluate the cell attachment using electron microscope.

Results

Micro-CT images and histological observation revealed that CDDM had largely resorbed but UDD had not, and both of them induced little bone formation, whereas all particle sizes of PDDM induced more new bone, especially the 1000 μm. Electron microscopic observation showed osteoblasts attached to DDM but not to UDD.

Conclusions

PDDM with larger particle size induced prominent bone regeneration, probably because PDDM possessed a suitable surface for cell attachment. There might be an exquisite balance between its resorption and bone formation on it. PDDM could be considered as a potential bone substitute.

Effect on bone formation of the autogenous tooth graft in the treatment of peri-implant vertical bone defects in the minipigs

Background

The aim of this study was to evaluate the effect of autogenous tooth bone as a graft material for regeneration of bone in vertical bony defects of the minipigs.

Material and Methods

Six minipigs were used in this study. Four molars were extracted in the right mandibular dentition and sent to the Korea Tooth Bank for fabrication of autogenous tooth bone. Ten days later, each extraction site was implanted with MS Implant Narrow Ridge 3.0x10mm fixture (Osstem, Seoul, Korea) after standardized 2mm-sized artificial vertical bony defect formation. Pineappleshaped Root-On type autogenous tooth bones were applied to the vertical defects around the neck area of the posterior three fixtures and the fore-most one was not applied with autogenous bone as a control group. Each minipig was sacrificed at 4, 8, 12 weeks after fixture installation and examined radiologically and histologically. Histological evaluation was done under light microscope with Villanueva osteochrome bone staining with semi-quantitative histomorphometric study. Percentage of new bone over total area (NBF) and bone to implant contact (BIC) ratio were evaluated using digital software for area calculation.

Result

NBF were 48.15 ± 18.02%, 45.50 ± 28.37%, and 77.13 ± 15.30% in 4, 8, and 12 weeks, respectively for experimental groups. The control group showed 37.00 ± 11.53%, 32.25 ± 26.99%, and 1.33 ± 2.31% in 4,8,12 weeks, respectively. BIC ratio were 53.08 ± 19.82%, 45.00 ± 28.37%, and 75.13 ± 16.55% in 4,8,12 weeks, respectively. Those for the control groups were 38.33 ± 6.43%, 33.50 ± 29.51 %, and 1.33 ± 2.31% in 4, 8, 12 weeks, respectively.

Conclusion

Autogenous tooth bone showed higher score than control group in NBF and BIC in all the data encompassing 4,8,12 weeks specimens, but statistically significant only 12 weeks data in both NBF and BIC.

Osteoconduction capacity of human deciduous and permanent teeth ash in a rat calvarial bone defect model

The aim of this study was to confirm the osteoconduction capacities and determine the potential of permanent teeth ash (PTA), and deciduous teeth ash (DTA) as bone substitutes. Rats (n = 71) were divided randomly into four groups: sham, micro macroporous biphasic calcium phosphate (MBCP), PTA, and DTA. A sample of the each group was transplanted into preformed 8-mm calvarial defects (one per rat). The density of new bone was calculated and the crystallinities of the PTA and DTA were analyzed by X-ray diffraction. The degree of new bone formation was high in the MBCP and DTA groups but low in the PTA groups. The DTA was highly crystalline, whereas the PTA was not. The percentages of β-tricalcium phosphate in the DTA and PTA were 10.7 and 3.7%, respectively. DTA has a high osteoconduction capacity, suggesting that it is a useful bone substitute.

Host tissue reactions of non-demineralized autogenic and xenogenic dentin blocks implanted in a non-osteogenic environment. An experimental study in rabbits

Dentoalveolar ankylosis with osseous replacement is often seen after replantation of avulsed teeth, and this process may be used for preservation of alveolar crests after trauma. Its exact mechanisms with regard to osteoinductive properties are not yet fully understood and need to be systematically investigated. Dentin can possibly act as a slow-releasing carrier of bone morphogenic proteins (BMP), and this property of dentin has been proposed to be used as an alternative or supplement to bone grafting in the maxillofacial region. We aimed to initially asses host tissue reactions to dentin by implanting dentin blocks of autogenic and xenogenic human origin in rabbit connective tissue of the abdominal wall and femoral muscle. Animals were sacrificed after a period of 3 months, and histological processing, sectioning and examinations were carried out. Bone formation, cell counts and thickness of capsule surrounding the grafts were evaluated. Only minor signs of heterotopic bone formation were seen. There were no significant differences between autografts and xenografts or grafts implanted in connective tissue or muscle with regards to tissue reactions except for a significant difference (P = 0.018) in findings of more local inflammatory cells in relation to grafts placed in connective tissue in the autograft group. We conclude that during the time frame of this study, non-demineralized dentin, whether autogenous or xenogenic did not have the potential to induce bone formation when implanted in non-osteogenic areas such as the abdominal wall and abdominal muscle of rabbits.

Evaluation of healing processes of intraosseous defects with and without guided bone regeneration and platelet rich plasma. An animal study

BACKGROUND

In most cases, the natural healing of intrabony defects only leads to restoration of tissue continuity without differentiation and function. However, repair is not regarded to be an optimal treatment method, as confirmed in many clinical cases. Thus it is important to choose a surgical procedure which makes it possible to achieve restitution ad integrum of the bone structure. The choice of the GBR technique is crucial, in terms of the clinical conditions and limitations resulting from the use of a particular material.

OBJECTIVE

The objective of this study has been the analysis of effectiveness of selected surgical treatment techniques of intrabony defects in rabbits.

MATERIALS AND METHODS

Research was conducted on 36 white rabbits. The operation technique was a criterion of division into 3 groups: BG/BOC (Bio-Oss Collagen(®)+Bio-Gide Perio(®)), BOC/PRP (Bio-Oss Collagen(®)+PRP), C (control group). Qualitative and quantitative histopathological evaluation was carried out after 1, 3, 6 and 12 months.

RESULTS

The highest value of the bone surface area 31.9% (SD 1.8) was achieved in BOC/BG group three months after the implantation, while the lowest was revealed in C - group - 12.5% (SD 1.32) one month following the procedure.

CONCLUSIONS

Upon quantitative histological assessment, the bone tissue presented the most intensive osteogenesis within one month from the application of BOC/PRP, whereas this was observed after the application of BOC/BG in later stages. The application of two regenerative methods influenced the rate, quality and overall treatment of intraosseus defects.

Clinical study of graft materials using autogenous teeth in maxillary sinus augmentation

PURPOSE

The purpose of this study was to evaluate the effectiveness of autogenous tooth bone graft materials.

MATERIALS AND METHODS

Hundred implants in 51 patients were selected, and the patients received maxillary sinus augmentation and implant placement using autogenous tooth graft materials at the Chosun University Dental Hospital and Seoul National University Bundang Hospital between July 2009 and November 2010.

RESULTS

In cases using autogenous tooth bone graft alone, or together with other graft material, the implant survival rate was 96.15%. On histomorphologic examination, autogenous tooth bone graft materials showed gradual resorption and new bone formation through osteoconduction and osteoinduction.

CONCLUSIONS

The results indicated that autogenous tooth bone graft materials are appropriate for use in maxillary sinus augmentation.

Evaluation of osteoconductive and osteogenic potential of a dentin-based bone substitute using a calvarial defect model

The aim of this study was to assess the osteoconductive and osteogenic properties of processed bovine dentin using a robust rabbit calvarial defect model. In total, 16 New Zealand White rabbits were operated to create three circular defects in the calvaria. One defect was left unfilled, one filled with collected autogenous bone, and the third defect was filled with the dentin-based bone substitute. Following surgery and after a healing period of either 1 or 6 weeks, a CT scan was obtained. Following sacrificing, the tissues were processed for histological examination. The CT data showed the density in the area grafted with the dentin-based material was higher than the surrounding bone and the areas grafted with autologous bone after 1 week and 6 weeks of healing. The area left unfilled remained an empty defect after 1 week and 6 weeks. Histological examination of the defects filled with the dentin product after 6 weeks showed soft tissue encapsulation around the dentin particles. It can be concluded that the rabbit calvarial model used in this study is a robust model for the assessment of bone materials. Bovine dentin is a biostable material; however, it may not be suitable for repairing large 4-wall defects.

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.

Development of a novel bone grafting material using autogenous teeth

We developed a novel bone grafting material that incorporates autogenous teeth (AutoBT), and provided the basis for its clinical application. AutoBT contains organic and inorganic mineral components and is prepared from autogenous grafting material, thus eliminating the risk of an immune reaction that may lead to rejection. AutoBT was used at the time of implant placement, simultaneously with osteoinduction surgery, and excellent bony healing by osteoinduction and osteoconduction was confirmed.

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

OBJECTIVES

The purpose of this study was to evaluate the effect of Tisseel on the early healing of bone defects in the skulls of rats.

STUDY DESIGN

Forty-eight rats were randomly assigned to 4 groups, and each group was further divided into 3 subgroups which were examined at 4 and 8 weeks after the defects were filled. The 4 different groups were animals containing: no graft (group 1); particulate dentin and plaster of Paris mixture graft (group 2); Tisseel and particulate dentin and plaster of Paris mixture graft (group 3); and Tisseel graft (group 4). After killing the animals at 4 and 8 weeks after surgery, all implant blocks were prepared for histologic sections and histomorphometric analysis.

RESULTS

The overall new bone formation was significantly different between the 4-week samples and the 8-week samples. Significant differences between groups 1 and 2, groups 1 and 3, groups 1 and 4, groups 2 and 4, and groups 3 and 4 were observed at 4 weeks after surgery. At 8 weeks after surgery, significant differences between groups 1 and 2, groups 1 and 3, groups 1 and 4, and groups 2 and 4 were observed. As expected, effective bone formation was observed when the defects were filled with either particulate dentin, Tisseel, or particulate dentin-Tisseel combination. It was also observed from this study that particulate dentin is especially effective, followed by the particulate dentin-Tisseel combination and Tisseel.

CONCLUSION

It was concluded that the use of Tisseel may be an alternative therapy for regenerating bone in defects when used in combination with particulate dentin.

Macroporous hydroxyapatite scaffolds for bone tissue engineering applications: physicochemical characterization and assessment of rat bone marrow stromal cell viability

In this work, a new methodology is reported for developing hydroxyapatite (HA) scaffolds using an organic sacrifice template. The novelty of work consists of possibility of obtaining porous and highly interconnected scaffolds mimicking the sacrificial component. Our purpose consisted of evaluating the physicochemical properties of the HA scaffolds by means of Fourier transform infra-red spectroscopy, X-ray diffraction analysis, and scanning electron microscopy (SEM) attached with an X-ray detector. The HA scaffolds obtained possess a porosity of approximately 70%, and macropores diameter in the range of 50-600 microm. In contrast, results regarding the microcomputed tomography analysis have demonstrated both high pore uniformity and interconnectivity across the scaffolds. The compressive strength of the HA scaffolds was found to be 30.2 +/- 6.0 MPa. Bioactivity of the HA scaffolds was assessed by immersion into a simulated body fluid solution, in vitro. SEM observations have showed a deposition of apatite on the surface of the HA scaffolds, with a "cauliflower-like" morphology after 1 day, and tend to be more pronounced with the immersion time. The changes in calcium and phosphorus concentration were monitored by inductively-coupled plasma optical emission spectrometry. Cytotoxicity of the HA scaffolds was preliminarily investigated by carrying direct observation of mouse fibroblasts cells (L929 cell-line) death in the inverted microscope, and then cell viability was determined by means of carrying out a MTS assay. Complementarily, a luminescent cell viability assay based on the quantification of adenosine triphosphate was performed using rat bone marrow stromal cells (RBMSCs). A LIVE/DEAD assay and SEM analysis allowed the visualization of the RBMSCs adhesion and proliferation on the surface of the HA scaffolds. According to the results obtained from 3D architecture, mechanical properties, biocompatibility, and adhesion tests, it is suggested that HA scaffolds has potential to find applications in bone tissue engineering scaffolding.

Bone replacement following dental trauma prior to implant surgery--status

Dento-alveolar trauma often leads to a need for reconstruction of the alveolar crest before an implant can be placed. Although autogenous bone grafts is considered the 'gold standard', this may be associated with patient morbidity and graft resorption. Consequently, the use of bone substitutes has increased. Today, a substantial number of biomaterials are available on the market, but only a few are well documented. The user should be aware that these biomaterials have different properties: resorbable or non-resorbable, time of resorption and resorption mechanism. The purpose of this review is to describe the function of various bone substitutes and indications for their use in reconstructive implant surgery and to give an overview of the current situation.

Studies on dentin grafts to bone defects in rabbit tibia and mandible; development of an experimental model

BACKGROUND AND AIM

Dentin contains bone morphogenic protein which is important in bone induction and dentin can act as a slow releasing carrier. This property may possibly be used as an alternative or supplement to bone grafting to defective areas after trauma prior to treatment with osseointegrated implants. Hence, the objective of this study was to investigate if dentin can be used as a graft in bone defects in an experimental rabbit model.

MATERIALS AND METHODS

Eight New Zealand White Rabbits were used to prepare bone cavities either in the angle of the mandible or tibia. Six of the eight tibial and six of the eight mandibular bone defects were filled with dentin blocks from human premolars which were extracted for orthodontic treatment. Two mandibular and two tibial bone cavities were used as controls and all the rabbits were sacrificed after 3 months. Radiographic and histological examinations were performed.

RESULTS

There was a difference in healing pattern between the mandibular and tibial defects. In the mandible, the dentin blocks were resorbed to a larger extent and more often surrounded by fibrous tissue, probably due to the fact that the dentin blocks were mobile because of the thin mandibles and muscular activity in that area. Only some dentin blocks were ankylosed with the mandibular bone. In the tibia however, all dentin blocks were fused to bone over a large area. Osseous replacement resorption was seen. In control cavities, bone formation was seen but was never complete. No signs of inflammatory changes were seen in any fused grafts.

CONCLUSIONS

Dentin grafts have a potential to be incorporated in bone without inflammation and can be used as bone inducer and later replaced by bone. Thus, rabbit tibia served as a better model for further studies of this phenomenon when compared to the mandible.

Bone graft materials

This article examines each class of bone grafting material based on some of the studies in each of the following categories: safety, animal research, periodontal and maxillofacial applications, skeletal grafting, and attempts to qualify the efficacy of each class of material. The article also examines some of the research being done in "tissue engineering" to get a sense of the future of bone grafting.

A review of bone substitutes

The use of bone grafts in the repair of defects has a long history of success, primarily with the use of autologous bone. With increasing technologic advances, researchers have been able to broaden the spectrum of grafting materials to allografts, xenografts, and synthetic materials, which provide the surgeon and patient with options, each with unique advantages. It is with the knowledge of each material that the clinician can present and suggest the best material and tailor treatment plans to fit each individual. In this article, we present an overview of the principles of bone grafting, the types of graft materials available, and an outlook to what the future holds in this area of medicine and dentistry.

Processed bovine dentine as a bone substitute

OBJECTIVES

Different forms of allogenic dentine have been studied for their potential use as bone substitutes. We report a new method for processing bovine dentine that results in a sterile bioactive material for repair and regeneration of bone.

METHODS

Extracted bovine dentine was processed mechanically and chemically with inorganic and organic solvents, and sterilised. The in vitro biocompatibility on human gingival fibroblasts was assessed by the Alamar Blue assay and the in vivo biocompatibility evaluated by implantation of the processed dentine into rats' femurs.

RESULTS

The dentine showed excellent biocompatibility in vitro, stimulated formation of new bone and was completely incorporated into the new bone in vivo.

SIGNIFICANCE

Processed bovine dentine has the potential to be used as a suitable substitute in bone repair and regeneration.

Finite element analysis of different bone substitutes in the bone defects around dental implants

PURPOSE

To evaluate the distribution of stress and strain for the evaluation of implant and graft stability at each stage before stabilization of the graft is achieved after implantation was performed.

MATERIALS AND METHODS

Dembone (Pacific Coast Tissue Bank, Los Angeles, CA), Bio-Oss (Geistlich Pharma, Wolhusen, Switzerland), particulate dentin, and plaster of Paris were used to fill bone defects. The distribution of stress was compared in the mandible and maxilla, between vertical load and load applied at 30 degrees angle, and according to time, with 3 different graft materials.

RESULTS

Stress occurred more when it was applied at an angle, rather than applied vertically. Stress was relatively high immediately after implantation, and particulate dentin-plaster of Paris showed larger mechanical properties and lower stress distribution overall. The largest stress distribution was shown when stress was applied at an angle when demineralized freeze-dried bone was used. The pattern of stress distribution was different according to differences in the mechanical properties of implants.

CONCLUSION

Caution is needed not to apply stress at an angle immediately after implantation. Differences of stress were reduced with time as the implant became stabilized.

Development of a new calcium sulphate-based composite using alginate and chemically modified chitosan for bone regeneration

In this work we developed a novel calcium sulphate-based composite in which the hemihydrate calcium sulphate (CHS) can be encapsulated in a polymeric biodegradable and biocompatible matrix, in order to retain the structural integrity and decrease the bioresorption rate in bone regeneration applications. Two polymers were employed to realize this system: chitosan (Ch) and sodium alginate (Alg), both already widely used in biotechnological and biomedical applications. Chitosan was modified in order to obtain a water soluble polymer, the N-succinylchitosan (sCh). The reaction was performed with succinic anhydride in presence of pyridine and confirmed by FT-IR and NMR analyses. Finely ground Alg and sCh powders were mixed in different compositions with CHS and by adding water to the powder mixture it was obtained a mouldable paste that sets in few hours. Thermogravimetric analyses coupled with solvent extraction performed on the composite proved the alginate crosslinking in the presence of CHS. Mechanical studies carried out on composites of different compositions demonstrated that the blend of the two polymeric components causes a substantial synergistic reinforcement of composites. The presence of carboxylic groups on sCh chain in addition to those of alginate could enhance the chelating power of polysaccharide mixture. The results obtained with morphological analyses (SEM) further confirmed the hypotesis of the synergistic effect between alginate and N-succinylchitosan in presence of calcium sulphate. In vitro cytotoxicity tests proved that the developed system was not cytotoxic.

The effect of a biphasic ceramic on calvarial bone regeneration in rats

Bioactive ceramics (calcium phosphate ceramics, hydroxyapatite ceramics) are now extensively used in oral surgery. The purpose of this study was to assess the effect of a new biphasic ceramic (Ceraform) on the osteogenesis in a rat calvarial defect model. Fifteen Wistar rats were used in this study. Two symmetrical 3-mm wide defects were created in the skull of each rat. The left defect was left empty as a control and the right defect was filled with the ceramic. The rats were sacrificed at day 30, and the calvarial specimens were processed for qualitative and quantitative histological examinations. The material exhibited no adverse effects, but no bone healing was noted either. No statistical difference regarding bone regeneration was observed between the 2 defects (P > .05). This study showed that Ceraform did not elicit any inflammatory reaction; however, it had no effect on bone regeneration, and this material seems suitable only as a space-maintaining material.

A Novel Injectable Poly(ɛ-caprolactone)/Calcium Sulfate System for Bone Regeneration: Synthesis and Characterization

A novel poly(epsilon-caprolactone)/calcium sulfate system was prepared and characterized in order to enhance calcium sulfate (gypsum) performance as bone graft substitute overcoming its brittleness and fast resorption rate. A poly(epsilon-caprolactone) (PCL) photo-crosslinkable derivative (PCLf) was synthesized by reaction of a low molecular weight PCL diol with methacryloyl chloride and confirmed by FT-IR and 1H NMR analyses. An injectable and easy mouldable mixture of PCLf and calcium sulfate hemi-hydrate (PCLf/CHS) was obtained. Thermal analyses and solvent extraction proved the occurrence of PCLf photo-crosslinking, even in the presence of CHS, in a time suitable for clinical applications. Swelling studies demonstrated that the encapsulation of the inorganic filler increases network hydrophilicity making it more permeable to water. Scanning electron microscopy, performed on crosslinked PCLf/CHS and on the same material after incubation in a PBS solution, showed the feasibility to obtain, in situ, gypsum entrapped into a degradable polymeric network. In vitro cytotoxicity tests, performed according to ISO 10993-5, proved that the developed system was not cytotoxic supporting its potential use in tissue engineering as a new, injectable, photocurable bone graft material. SEM micrograph of calcium sulfate di-hydrate (gypsum) entrapped in the PCL network.