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Starch-Jensen T, Ahmad M, Bruun NH, Becktor JP. Maxillary sinus floor augmentation with autogenous bone graft compared with composite grafts: A one-year single-blinded randomized controlled trial. Clin Oral Implants Res 2024; 35:652-667. [PMID: 38563550 DOI: 10.1111/clr.14260] [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: 09/12/2023] [Revised: 02/19/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The objective was to assess the one year implant treatment outcome and patient-related outcome measures (PROMs) following maxillary sinus floor augmentation (MSFA) with autogenous bone graft (ABG) from the zygomatic buttress (control) compared with 1:1 mixture of ABG and anorganic porcine bone mineral (APBM) (Test I) or biphasic bone graft material (BBGM) (Test II). MATERIALS AND METHODS Sixty healthy patients (34 females, 26 males) were randomly allocated to either control or test groups. Outcome measures included survival of suprastructures and implants, implant stability quotient, health status of peri-implant tissue, peri-implant marginal bone loss, frequency of complications, and PROMs using Oral Health Impact Profile-14 combined with questionnaire assessing patient perception of peri-implant soft tissue, prosthetic solution, implant function, and implant treatment outcome using visual analogue scale. Mean differences were expressed with standard deviation and 95% confidence interval. Level of significance was .05. RESULTS All suprastructures and implants were well-functioning after one year of functional implant loading. There was no significant difference between control and test groups in any of the applied outcome measures. The implant stability significantly increased from implant placement to abutment connection within all groups (p < .001). High patient satisfaction and significant improvement in oral health-related quality of life was also reported within all groups. CONCLUSION This study demonstrates that MSFA with composite grafts containing minimal amounts of ABG reveals comparable implant treatment outcomes as compared with ABG alone, after one year of functional implant loading. Extensive ABG harvesting in conjunction with MSFA therefore seems not to be needed.
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Affiliation(s)
- Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Marianne Ahmad
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Malmö University, Malmö, Sweden
| | - Niels Henrik Bruun
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Jonas Peter Becktor
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Malmö University, Malmö, Sweden
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Zhang L, Zhou C, Jiang J, Chen X, Wang Y, Xu A, He F. Clinical outcomes and risk factor analysis of dental implants inserted with lateral maxillary sinus floor augmentation: A 3- to 8-year retrospective study. J Clin Periodontol 2024; 51:652-664. [PMID: 38246602 DOI: 10.1111/jcpe.13947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 12/11/2023] [Accepted: 01/05/2024] [Indexed: 01/23/2024]
Abstract
AIM To evaluate the 3- to 8-year outcomes of dental implants placed with lateral sinus floor augmentation (LSFA) and to identify factors affecting implant survival. MATERIALS AND METHODS This retrospective study was performed by screening all implants placed with LSFA procedures, which were conducted between January 2012 and December 2016. Subantral bone gain (SABG) and apical bone height (ABH) were assessed using panoramic radiographs. The cumulative survival rate of implants was analysed using life-table analysis and Kaplan-Meier survival curves. The influential risk factors affecting survival were assessed using univariate log-rank tests and multivariable mixture cure rate model. Implant complications were recorded. RESULTS Based on the established criteria, a total of 449 patients (760 implants) were included in this study. In the 3- to 8-year follow-up (mean ± SD, 5.81 ± 1.33 years), 15 implants in 14 patients failed, with a CRS of 96.81% on an implant basis and 95.07% on a patient basis. A history of periodontitis and poor compliance with supportive periodontal treatment was associated with a significantly higher risk of implant failure at both implant and patient levels. Significant decreases in ABH occurred during each yearly interval except for 3 years. A similar trend has been observed for SABG at 1, 2, 6 and 8 years. The total complication rate was 31.84% on implant basis, with peri-implant mucositis (21.58%) being the most frequent biologic complication and porcelain cracking (5.00%) being the most common technical complication. CONCLUSIONS Implant with LSFA is a reliable treatment option in atrophic maxilla. A history of periodontitis without regular supportive periodontal treatment was identified as a predictor for implant failure. Slight but significant shrinkage of vertically augmented bone can be observed after implant placement.
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Affiliation(s)
- Liefen Zhang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Diseases of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Chuan Zhou
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Diseases of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Jimin Jiang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Diseases of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Xiaoyu Chen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Diseases of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Yaoqiong Wang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Diseases of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Antian Xu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Diseases of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Fuming He
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Diseases of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
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Wen C, Zhang Q. Pilot study of fractal dimension analysis of osteogenesis for bone substitute materials of Bio-Oss in lateral sinus augmentation. PLoS One 2023; 18:e0296248. [PMID: 38157335 PMCID: PMC10756558 DOI: 10.1371/journal.pone.0296248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 12/09/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Fractal dimension (FD) analysis has been proposed and validated in osseointegration-related research. The aim of this study was to evaluate the feasibility of FD analysis in the osteogenesis detection of bone substitute materials (BSMs) of Bio-Oss in maxillary lateral sinus augmentation. METHODS Patients who received lateral maxillary sinus augmentation and underwent grafting with BSMs (Bio-Oss) were included in the study. The cross sections of the BSMs under cone-beam computed tomography (CBCT) at mesial, distal, and sagittal directions were obtained immediately after the graft (T0) and 6 months later (T1), and the obtained images were cropped to include only the BSMs. The FD analysis was performed, and the FD value was obtained by the method of box-counting. Paired t-tests and analysis of variance (ANOVA) were used, and p-values <0.05 was considered statistically significant. RESULTS Twelve participants with 22 implants, which were inserted simultaneously after sinus augmentation, were included in this study. A total of 22 mesial, 22 distal, and 14 sagittal images were obtained after FD analysis. The mean FD value and standard deviation at T0 was 1.2860 ± 0.0896, while at T1, it was 1.2508±0.1023; thus, significant differences were detected (p = 0.022). However, the increasing or decreasing trend of FD value was not stable, and no significant difference was detected for FD values of mesial, distal, and sagittal images between T0 and T1. ANOVA indicated that no significant difference was detected among the FD values of mesial, distal, and sagittal images at any timepoint. Differences in FD values between the sexes were not significant either. CONCLUSIONS Since the FD analysis for the osteogenesis detection of BSMs in maxillary sinus augmentation indicated unstable trends of change, its feasibility is not reliable. The initially rough surface, self-degradation, and volume change of the BSMs during osteogenesis may be the reason for the variation in FD values.
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Affiliation(s)
- Cai Wen
- Department of Oral Implantology, The Affiliated Stomatology Hospital, Southwest Medical University, Luzhou, Sichuan, China
- Department of VIP Dental Service, The Affiliated Stomatology Hospital, Southwest Medical University, Luzhou, Sichuan, China
- Luzhou Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, The Affiliated Stomatology Hospital, Southwest Medical University, Luzhou, Sichuan, China
- Institute of Stomatology, Southwest Medical University, Luzhou, Sichuan, China
| | - Qing Zhang
- Department of Nosocomial Infection Control, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
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Erdem NF, Abdioğlu G, Ekinci SA, Şişman AÇ. Radiological Evaluation and Biomechanical Stability of Implants Simultaneously Placed at the Sites with Sole Advanced Platelet-Rich Fibrin (A-PRF) Grafted Sinus Floor. J Maxillofac Oral Surg 2023; 22:1083-1090. [PMID: 38105860 PMCID: PMC10719193 DOI: 10.1007/s12663-022-01785-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/05/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction In this retrospective study stabilities of 24 implants simultaneously placed at posterior maxillae with sinuses grafted by advanced platelet rich fibrin (A-PRF) and newly formed bone around them were evaluated. Patient and Methods Fourteen augmented maxillary sinuses of 11 patients with a mean residual alveolar bone height of 4.55 mm were involved in this study. Maxillary sinus lifting via lateral window approach and implant site osteotomy were performed, and prepared A-PRF clots were used as sole graft material. Each of the implants was immediately placed with a good primary stability. Postoperative sixth month tomography images were compared with preoperative ones in order to calculate the gained bone height and implant stability quotient (ISQ) values were recorded. Results The new vertical mean bone height of 24 implant sites was 12.21 mm with an implant survival rate of 100%. ISQ values of the implants were ranging from 62 to 75 with a mean value of 68. Statistically the diameter of implant did not have any effect on new bone formation and the ISQ values, however the length of them did. Conclusion A-PRF as a graft material for sinus lifting with simultaneous implant placement is a reliable technique with its low cost and lack of immunogenic reaction risk.
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Affiliation(s)
- Necip Fazıl Erdem
- Department of Oral and Maxillofacial Surgery, Marmara University, School of Dentistry, No: 9/3, 34854 Başıbüyük, Maltepe, Istanbul Turkey
| | - Gürkan Abdioğlu
- Department of Oral and Maxillofacial Surgery, Marmara University, School of Dentistry, No: 9/3, 34854 Başıbüyük, Maltepe, Istanbul Turkey
| | - Senem Aşkın Ekinci
- Department of Oral and Maxillofacial Surgery, Marmara University, School of Dentistry, No: 9/3, 34854 Başıbüyük, Maltepe, Istanbul Turkey
| | - Alanur Çiftçi Şişman
- Department of Oral and Maxillofacial Surgery, Sağlık Bilimleri University, School of Dentistry, Selimiye Mah. Tıbbiye Cad. No: 38, 34668 Üsküdar, Istanbul Turkey
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Yu H, Tang Y, He D, Qiu L. Immediately or delayed sinus augmentation after pseudocyst removal: A randomized trial. Clin Implant Dent Relat Res 2023; 25:967-973. [PMID: 37218035 DOI: 10.1111/cid.13225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 05/06/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE To compare clinical and histological outcomes of sinus augmentation performed immediately or 3 months after pseudocyst removal through a prospective randomized controlled study. MATERIALS AND METHODS In total, 33 sinus augmentation procedures were performed in 31 patients. Augmentation was performed either immediately after pseudocyst removal (one-stage intervention) or after 3 months (two-stage intervention). Six months postoperatively, bone specimens were harvested, and histomorphometric analysis was performed as primary outcome. Data were recorded and evaluated for implant survival rates, marginal bone resorption, complication rate, and patient-centered outcomes (visual analogue scale [VAS]). RESULTS There were no baseline differences between groups or dropouts. Twelve biopsies obtained for histomorphometric analysis showed that delayed sinus augmentation, when compared to immediated led to a 1.1% increased mineralized bone ratio (95% confidence interval [CI]: -15.9 to 13.7). Graft leakage and acute sinusitis occurred in one patient in the one-stage group, none in the two-stage group. No pseudocyst recurrence was observed until the end of 1-year follow-up. Median VAS scores for overall acceptance were significantly increase of 1.4 (95% CI: 0.3-2.56) in immediate group. The degree of post-operative discomfort was not significantly different, although an increase of VAS (0.52, 95% CI: -0.32 to 1.37) was observed in delay group. CONCLUSIONS Both procedures of sinus augmentation immediately and 3 months after pseudocyst removal could obtain comparable histological outcomes and had low complication rates. Patients who underwent the one-stage procedure had a short treatment course and high satisfaction rates, but this procedure is technically challenging to perform. This clinical trial was not registered prior to participant recruitment and randomization. The clinical trial registration number is ChiCTR2200063121. The hyperlink is as follows: https://www.chictr.org.cn/showproj.html?proj=172755.
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Affiliation(s)
- Huajie Yu
- 4th Division, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yiman Tang
- 4th Division, Peking University School and Hospital of Stomatology, Beijing, China
| | - Danqing He
- Orthodontic Department, Peking University School and Hospital of Stomatology, Beijing, China
| | - Lixin Qiu
- 4th Division, Peking University School and Hospital of Stomatology, Beijing, China
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Gao S, Jiang Y, Yao Y, Li S, Cai X. Minimally invasive techniques for lateral maxillary sinus floor elevation: small lateral window and one-stage surgery-a 2-5-year retrospective study. Int J Oral Sci 2023; 15:28. [PMID: 37433766 DOI: 10.1038/s41368-023-00233-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/15/2023] [Accepted: 06/15/2023] [Indexed: 07/13/2023] Open
Abstract
This study aimed to introduce a minimally invasive technique for maxillary sinus floor elevation using the lateral approach (lSFE) and to determine the factors that influence the stability of the grafted area in the sinus cavity. Thirty patients (30 implants) treated with lSFE using minimally invasive techniques from 2015 to 2019 were included in the study. Five aspects of the implant (central, mesial, distal, buccal, and palatal bone heights [BHs]) were measured using cone-beam computed tomography (CBCT) before implant surgery, immediately after surgery (T0), 6 months after surgery (T1), and at the last follow-up visit (T2). Patients' characteristics were collected. A small bone window (height, (4.40 ± 0.74) mm; length, (6.26 ± 1.03) mm) was prepared. No implant failed during the follow-up period (3.67 ± 1.75) years. Three of the 30 implants exhibited perforations. Changes in BH of the five aspects of implants showed strong correlations with each other and BH decreased dramatically before second-stage surgery. Residual bone height (RBH) did not significantly influence BH changes, whereas smoking status and type of bone graft materials were the potentially influential factors. During the approximate three-year observation period, lSFE with a minimally invasive technique demonstrated high implant survival rate and limited bone reduction in grafted area. In conclusion, lSFE using minimally invasive techniques was a viable treatment option. Patients who were nonsmokers and whose sinus cavity was filled with deproteinized bovine bone mineral (DBBM) had significantly limited bone resorption in grafted area.
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Affiliation(s)
- Shaojingya Gao
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yao Jiang
- Department of Demography, Zhou Enlai School of Government, Nankai University, Tianjin, China
| | - Yangxue Yao
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Songhang Li
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaoxiao Cai
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Starch-Jensen T, Bruun NH. Patient's perception of recovery after sinus membrane elevation and blood coagulum compared with 1:1 mixture of autogenous bone graft and deproteinized porcine bone mineral. Secondary outcomes from a single-blinded randomized controlled trial. Clin Oral Implants Res 2021; 33:65-77. [PMID: 34608673 DOI: 10.1111/clr.13866] [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: 12/16/2020] [Revised: 07/12/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective was to assess patient's perception of recovery after maxillary sinus membrane elevation (MSME) and blood coagulum (test) compared with maxillary sinus floor augmentation (MSFA) and 1:1 mixture of autogenous bone graft from the buccal antrostomy and deproteinized porcine bone mineral (DPBM) (control). MATERIALS AND METHODS Forty healthy patients were randomly allocated to test or control. Oral health-related quality of life (OHRQoL) was evaluated by Oral Health Impact Profile-14 (OHIP-14) at enrollment and 1 week postsurgical. Recovery was estimated by questionnaires and visual analog scale assessing pain, social and working isolation, physical appearance, eating and speaking ability, diet variations, sleep impairment, and discomfort after 1 week and 1 month. Mean differences were expressed with 95% confidence interval (CI). Association between OHRQoL and recovery was estimated. p-value below .05 was considered statistically significant. RESULTS Maxillary sinus membrane elevation revealed 2.1 less days of pain (p = .03, 95% CI: 0.2-4.1) and 1.2 days of sick leave (p = .01, 95% CI: 0.3-2.1) compared with MSFA. No significant difference was observed in eating and speaking ability, physical appearance, work performance, and sleep impairment. No significant association between impaired OHRQoL and recovery was observed. Females reported 4.77 higher OHIP-14 score compared with males (p = .01, 95% CI: 1.60-7.94), while association between age and OHIP-14 was -0.10 (p = .28, 95% CI: -0.28 to 0.08). CONCLUSION Maxillary sinus membrane elevation revealed significantly less days of pain and sick leave compared with MSFA. Harvesting of autogenous bone graft seems, therefore, to have a significant impact on perception of recovery.
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Affiliation(s)
- Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital and Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Niels Henrik Bruun
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
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Karam MB, El Khoury J, Chakar C, Changotade S, Lutomski D, Naaman N, Godeau G, Elm’selmi A, Younes R, Senni K. Heparan-mimetics: Potential agents of tissue regeneration for bone and periodontal therapies. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Coyac BR, Wu M, Bahat DJ, Wolf BJ, Helms JA. Biology of sinus floor augmentation with an autograft versus a bone graft substitute in a preclinical in vivo experimental model. Clin Oral Implants Res 2021; 32:916-927. [PMID: 34031931 DOI: 10.1111/clr.13781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/03/2021] [Accepted: 05/18/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Compared to autografts, bone graft substitutes are slower to consolidate. If we understood why, this might open strategies to accelerate new bone formation and thus shorten the time to implant placement. In this study, we aimed at comparing autologous bone graft with a bovine bone graft substitute in a preclinical sinus lift model. MATERIALS AND METHODS The mouse posterior paranasal sinus served as a recipient site for grafting. Autograft from the oral cavity was compared against bone graft substitute using molecular, cellular, and histological analyses conducted on post-grafting days (PSD) 0, 9, 18, and 120. RESULTS Either autografts or bone graft substitutes were positioned on the sinus floor and remained in situ throughout the study. At the time of grafting and until day 9, bone graft substitutes were devoid of cells and alkaline phosphatase (ALP) activity while autografts were comprised of viable cells and showed strong ALP (mineralization) activity. Consequently, new bone formed faster in autografts compared to bone graft substitutes (140.21 ± 41.21 µm vs. 41.70 ± 10.09 µm, respectively, PSD9, p = .0143). By PSD18, osteogenesis was evident in autografted and xenografted sites. Osteoclasts identified by tartrate resistant acid phosphatase attached to, but did not resorb the bone graft substitute matrix. Autograft matrix, however, underwent extensive resorption. Transgenic mice revealed that Wnt-responsive osteoprogenitor cells originated primarily from the internal periosteum of the maxillary bone, and not from the Schneiderian membrane. CONCLUSION Autografts produce new bone sooner, but bovine bone graft substitutes eventually consolidate and then resist resorption. Enhancing osteoprogenitor cell recruitment to a bone graft substitute constitutes a viable strategy for accelerating bone formation in a sinus lift procedure.
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Affiliation(s)
- Benjamin R Coyac
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Meagan Wu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Daniel J Bahat
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Benjamin J Wolf
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Jill A Helms
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Stanford University, Palo Alto, CA, USA
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Peters F, Wingels M, Möhlhenrich SC, Raith S, Katz MS, Bock A, Hölzle F, Modabber A. Cross-sectional analysis of spatial distribution and total amount of harvestable calvarian split bone. Ann Anat 2020; 234:151655. [PMID: 33278578 DOI: 10.1016/j.aanat.2020.151655] [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: 08/18/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Bone resorption of the jaw leads to challenging implant placement. Frequently, augmentation of the jaw is necessary. Is calvarian split bone an alternative to other extraoral donor sites and what volume of bone is harvestable? The aim was to evaluate the spatial distribution and the total amount of harvestable calvarian split bone. MATERIAL AND METHODS Computerized tomographies of 600 patients were divided into four groups (male and female: ≤45 years and >45 years). The skull was segmented and cut into the harvestable compartments (Os frontale, Ossa parietalia). The volume and thickness of the harvestable bone were calculated. RESULTS The overall harvestable bone was 110.644 ± 25.429 cm³. The bone from the Os frontale was significantly less than harvestable bone from the Os parietale (p < 0.001). More bone could be harvested from the right Os parietale. In younger males, significantly more bone could be harvested than in females (females ≤45 years: p = 0.001; females >45 years: p = 0.003). A weak negative correlation existed between the participants' age and the harvestable bone volume of the left Os parietale (r = -0.087; p = 0.033). The thickness of the harvestable bone from the Ossa parietalia is greater in females than in males. CONCLUSION A great amount of calvarian bone can be harvested to augment the jaw. Surgeons must acknowledge that more bone is harvestable from males than females while the female bone is thicker. Calculating the volume leads to accurate results of the available bone.
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Affiliation(s)
- Florian Peters
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital RWTH, Aachen, Aachen, Germany.
| | - Marisa Wingels
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital RWTH, Aachen, Aachen, Germany
| | - Stephan Christian Möhlhenrich
- Department of Orthodontics, University Witten/Herdecke, Private Universität Witten/Herdecke GmbH, Alfred-Herrhausen-Straße 45, 58448 Witten, Germany
| | - Stefan Raith
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital RWTH, Aachen, Aachen, Germany
| | - Marie Sophie Katz
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital RWTH, Aachen, Aachen, Germany
| | - Anna Bock
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital RWTH, Aachen, Aachen, Germany
| | - Frank Hölzle
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital RWTH, Aachen, Aachen, Germany
| | - Ali Modabber
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital RWTH, Aachen, Aachen, Germany
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Starch-Jensen T, Deluiz D, Bruun NH, Tinoco EMB. Maxillary Sinus Floor Augmentation with Autogenous Bone Graft Alone Compared with Alternate Grafting Materials: a Systematic Review and Meta-Analysis Focusing on Histomorphometric Outcome. J Oral Maxillofac Res 2020; 11:e2. [PMID: 33262881 PMCID: PMC7644272 DOI: 10.5037/jomr.2020.11302] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/10/2020] [Indexed: 11/16/2022]
Abstract
Objectives The objective of present systematic review was to test the hypothesis of no difference in histomorphometric outcome after maxillary sinus floor augmentation with autogenous bone graft alone compared with alternate grafting materials applying the lateral window technique. Material and Methods MEDLINE (PubMed), Embase and Cochrane library search in combination with hand-search of relevant journals were conducted. Human studies published in English until the 25th of March, 2020 were included. Histomorphometric outcomes were evaluated by descriptive statistics and meta-analysis including 95% confidence interval (CI). Results Electronic search and hand-searching resulted in 1902 entries. Sixteen randomized controlled trials with unclear risk of bias fulfilled the inclusion criteria. Descriptive statistics showed comparable or improved histomorphometric outcomes with autogenous bone graft. Meta-analysis revealed a mean difference of -7.1% (CI = -11.0 to -3.2) indicating a significant higher amount of bone after maxillary sinus floor augmentation with autogenous bone graft compared with alternate grafting materials. Subgroup analysis demonstrated a non-significantly differences of -3.7% (CI = -10.9 to 3.4), -11.5% (CI = -25.9 to 2.8), 2.2% (CI = -16.9 to 21.3), and -4.6% (CI = -14.4 to 5.2), when autogenous bone graft was compared with allogeneic bone graft, xenograft, composite grafting materials involving xenograft or synthetic biomaterial mixed with autogenous bone graft, respectively. Conclusions Maxillary sinus floor augmentation with autogenous bone graft seems to facilitate improved histomorphometric outcomes compared with alternate grafting materials. However, the included studies were characterised by an unclear risk of bias and various methodological confounding factors. Hence, the conclusions drawn from the results of present study should be interpreted with caution.
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Affiliation(s)
- Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, AalborgDenmark
| | - Daniel Deluiz
- Department of Periodontology, Rio de Janeiro State University, Rio de JaneiroBrazil
| | - Niels Henrik Bruun
- Unit of Clinical Biostatistics, Aalborg University Hospital, AalborgDenmark
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He Z, Liu Y, Liu X, Sun Y, Zhao Q, Liu L, Zhu Z, Luo E. Smart Porous Scaffold Promotes Peri-Implant Osteogenesis under the Periosteum. ACS Biomater Sci Eng 2020; 6:6321-6330. [PMID: 33449673 DOI: 10.1021/acsbiomaterials.0c00956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Adequate peri-implant bone mass and bone quality are essential factors to ensure the initial stability of the implant and success of implant operation. In clinical settings, the lack of bone mass often restricts the implant operation. In this study, we fabricated a smart porous scaffold with a shape memory function and investigated whether it could promote peri-implant osteogenesis under the periosteum. Methods: A porous shape memory polymer (SMP) scaffold was fabricated and its shape memory function, mechanical properties, and degradation rate were tested in vitro. Moreover, the scaffold was implanted in the mandible of rabbits to evaluate its efficacy to promote peri-implant osteogenesis in the periosteum and enhance the initial stability of the implant. Histological, micro-CT, and biomechanical analyses were carried out for further verification. Results: The SMP scaffold has a good shape memory function and biocompatibility in vitro. In vivo experiments demonstrated that the SMP scaffold could recover to its original shape after implantation to create a small gap in the periosteum. After 12 weeks, the scaffold was gradually replaced by a newly formed bone, and the stability of the implant increased when it implanted with the scaffold. Conclusion: The present study indicates that the SMP scaffolds have a good shape memory function and could enhance peri-implant bone formation under the periosteum. The SMP scaffold provides a clinical potential candidate for bone tissue engineering under the periosteum.
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Affiliation(s)
- Ze He
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Yao Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Xian Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Yue Sun
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Qiucheng Zhao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Linan Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Zhaokun Zhu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - En Luo
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
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Baccaglione G, Rota E, Ferrari M, Maddalone M. Second Class Functional Treatment: Andreasen Activator vs Twin Block. Int J Clin Pediatr Dent 2020; 13:144-149. [PMID: 32742091 PMCID: PMC7366767 DOI: 10.5005/jp-journals-10005-1725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim The purpose of this research is to analyze and compare the dental and skeletal changes induced by two functional devices, Andreasen Activator and Clark's twin block, on the sagittal and vertical plane, by means of cephalometric analysis, of the lateral cephalograms prescribed at the beginning and at the end of the treatment for a second skeletal class, first division with normal or deep bite. Materials and methods Twenty patients, 8 females and 12 males, fulfilling criteria for inclusion, were divided randomly into two groups: group I was treated with Andreasen activator, the second group with Clark's twin block. The duration of the therapy was about 18 months plus less 2 months. Pretreatment and posttreatment cephalometric radiographs were analyzed using angular (SNA, SNB, ANB, SnaSnp–GoGn angles), linear (Sna–Snp, Co–Gn, Co–Go, Go–Gn) skeletal parameters and dental one (U1–SnaSnp angle, L1–GoGn angle, Overjet and Overbite). To evaluate the posttreatment changes in the single groups and between them, paired and unpaired t-test was used. Results In both of the two groups analyzed, all the sagittal and vertical, angular and linear, skeletal measurements appear to be increased in a statistically significant way, except SNA angle and the distance Sna–Snp. Regarding the dental parameters, in the group treated with Andreasen activator, only Overjet and Overbite showed statistically significant differences. On the other hand, twin block induced statistical changes about Overjet, Overbite and also U1/SnaSnp, but not about L1/GoGn. The advancement of the mandible determines a greater prominence of the chin and lower lip, an increment of the labial mental angle and a reduction of the convexity of the profile. Also, the decrease of the overjet and, consequently, of the dental exposure improve the esthetic appearance of the patient's face. Conclusion Both functional treatments showed a lower jaw advanced on the sagittal plane and increased in size. In the upper jaw no significant changes were observed. It was also evident a dental compensation both on sagittal and vertical planes. Clinical significance The functional devices studied, Andreasen activator and twin block, seem to obtain more skeletal than dental results when the patients were treated at the peak of pubertal growth. How to cite this article Baccaglione G, Rota E, Ferrari M, et al. Second Class Functional Treatment: Andreasen Activator vs Twin Block. Int J Clin Pediatr Dent 2020;13(2):144–149.
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Affiliation(s)
- Giulia Baccaglione
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Elisa Rota
- Department of Orthodontics, University of Milano Bicocca, Monza, Italy
| | - Maurizio Ferrari
- Department of Orthodontics, University of Milano Bicocca, Monza, Italy
| | - Marcello Maddalone
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
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Maddalone M, Losi F, Rota E, Baldoni MG. Relationship between the Position of the Incisors and the Thickness of the Soft Tissues in the Upper Jaw: Cephalometric Evaluation. Int J Clin Pediatr Dent 2020; 12:391-397. [PMID: 32440043 PMCID: PMC7229373 DOI: 10.5005/jp-journals-10005-1667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim The aim of this study is to verify if the thickness of soft tissues and inclination of the incisors have some relation with profile, to analyze its relevance considering these two parameters separately and to screen how the combination of different inclinations and different thickness can generate different facial patterns. Materials and methods The study was performed on 47 Caucasian patients aged between 6 years and 16 years of divided into 24 males and 23 females. None of the patients presented craniofacial changes of syndromic nature. All patients presented a value of SNA in between 80° and 84°. The inclination of the upper incisor related to the bispinal plane was between 104° and 116°. Each radiograph has been digitized or analyzed directly in digital format. To analyze the relationships between soft tissues and position of the incisors using various cephalometric measures and statistical methodology were used. Results Analysing the general correlation between all the cephalometric parameters considered, the results found show that the thickness of the tissues had an effect in modifying the aesthetic profile with respect to the position of the incisors. The cephalometric parameters related to the esthetic profile of the maxilla are all linked by strong correlations, especially correlation between SU, ULA and LS were very high. The differences between the means were statistically significant for different groups. Using the values of Mx1 and thickness of the lip as independent variables, while the LS, SU, ULA and NLA values as dependent variables all results are significant with respect to the prediction p < 0.05. Conclusion Thickness of the soft tissues showed a significant influence on the profile with respect to the position of the incisors. Clinical significance Data obtained highlighted that thickness of the soft tissues must be taken into account before starting an orthodontic treatment in order to obtain best aesthetic results. How to cite this article Maddalone M, Losi F, Rota E, et al. Relationship between the Position of the Incisors and the Thickness of the Soft Tissues in the Upper Jaw: Cephalometric Evaluation. Int J Clin Pediatr Dent 2019;12(5):391-397.
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Affiliation(s)
- Marcello Maddalone
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Federico Losi
- Department of Orthodontics, University of Milano Bicocca, Monza, Italy
| | - Elisa Rota
- Department of Orthodontics, University of Milano Bicocca, Monza, Italy
| | - Marco G Baldoni
- Department of Orthodontics, University of Milano Bicocca, Monza, Italy
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Camacho-Alonso F, Martínez-Ortiz C, Plazas-Buendía L, Mercado-Díaz AM, Vilaplana-Vivo C, Navarro JA, Buendía AJ, Merino JJ, Martínez-Beneyto Y. Bone union formation in the rat mandibular symphysis using hydroxyapatite with or without simvastatin: effects on healthy, diabetic, and osteoporotic rats. Clin Oral Investig 2020; 24:1479-1491. [PMID: 31925587 DOI: 10.1007/s00784-019-03180-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/19/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The objective is to compare new bone formation in critical defects in healthy, diabetic, and osteoporotic rats filled with hydroxyapatite (HA) alone and HA combined with simvastatin (SV). MATERIALS AND METHODS A total of 48 adult female Sprague-Dawley rats were randomized into three groups (n = 16 per group): Group, 1 healthy; Group 2, diabetics; and Group 3, osteoporotics. Streptozotocin was used to induce type 1 diabetes in Group 2, while bilateral ovariectomy was used to induce osteoporosis in Group 3. The central portion of the rat mandibular symphysis was used as a physiological critical bone defect. In each group, eight defects were filled with HA alone and eight with HA combined with SV. The animals were sacrificed at 4 and 8 weeks, and the mandibles were processed for micro-computed tomography to analyze radiological union and bone mineral density (BMD); histological analysis of the bone union; and immunohistochemical analysis, which included immunoreactivity of vascular endothelial growth factor (VEGF) and bone morphogenetic protein 2 (BMP-2). RESULTS In all groups (healthy, diabetics, and osteoporotics), the defects filled with HA + SV presented greater radiological bone union, BMD, histological bone union, and more VEGF and BMP-2 positivity, in comparison with bone defects treated with HA alone. CONCLUSIONS Combined application of HA and SV improves bone regeneration in mandibular critical bone defects compared with application of HA alone in healthy, diabetic, and osteoporotic rats. CLINICAL RELEVANCE This study might help to patients with osteoporosis or uncontrolled diabetes type 1, but future studies should be done.
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Affiliation(s)
- F Camacho-Alonso
- Department of Oral Surgery, University of Murcia, Murcia, Spain.
| | | | | | | | | | - J A Navarro
- Department of Histology and Pathological Anatomy, University of Murcia, Murcia, Spain
| | - A J Buendía
- Department of Histology and Pathological Anatomy, University of Murcia, Murcia, Spain
| | - J J Merino
- Department of Biochemistry and Molecular Biology, Complutense University of Madrid, Madrid, Spain
| | - Y Martínez-Beneyto
- Department of Preventive and Community Dentistry, University of Murcia, Murcia, Spain
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Pichotano EC, de Molon RS, de Souza RV, Austin RS, Marcantonio E, Zandim-Barcelos DL. Evaluation of L-PRF combined with deproteinized bovine bone mineral for early implant placement after maxillary sinus augmentation: A randomized clinical trial. Clin Implant Dent Relat Res 2019; 21:253-262. [PMID: 30690860 DOI: 10.1111/cid.12713] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/14/2018] [Accepted: 12/10/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate the effectiveness of adding leukocyte and platelet-rich fibrin (L-PRF) to deproteinized bovine bone mineral (DBBM) for early implant placement after maxillary sinus augmentation. MATERIALS AND METHODS Twelve patients requiring two-stage bilateral maxillary sinus augmentation were enrolled to the study. The elevated sinus cavities were randomly grafted with DBBM + L-PRF (test) or DBBM alone (control) in a split-mouth design. Implants were placed in the augmented sites after 4 months in the test group and 8 months in the control group. Bone biopsies were collected during implant placement for histomorphometric evaluation. Resonance frequency analysis was performed immediately after implant placement and at implant loading in both groups. Cone-beam computed tomography was obtained preoperatively and postoperatively for evaluation of graft volume changes. RESULTS Both procedures were effective for maxillary sinus augmentation. Cone-beam computed tomography analysis did not reveal differences in graft volume between test and control group at any of the evaluated time points (P > .05). Histological evaluation demonstrated increased percentage of newly formed bone for the test group (44.58% ± 13.9%) compared to the control group (30.02% ± 8.42%; P = .0087). The amount of residual graft in the control group was significantly higher (13.75% ± 9.99%) than in the test group (3.59 ± 4.22; P = .0111). Implant stability quotient (ISQ) immediately after implant placement was significantly higher in the control group (75.13 ± 5.69) compared to the test group (60.9 ± 9.35; P = .0003). The ISQ values at loading did not differ between the groups (P = .8587). Implant survival rate was 100% for both groups. CONCLUSION The addition of L-PRF to the DBBM into the maxillary sinus allowed early implant placement (4 months) with increased new bone formation than DBBM alone after 8 months of healing.
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Affiliation(s)
- Elton Carlos Pichotano
- Department of Diagnosis and Surgery, São Paulo State University (Unesp), School of Dentistry, Araraquara, São Paulo, Brazil
| | - Rafael Scaf de Molon
- Department of Diagnosis and Surgery, São Paulo State University (Unesp), School of Dentistry, Araraquara, São Paulo, Brazil
| | | | - Rupert S Austin
- Tissue Engineering and Biophotonics, King's College London Dental Institute, Guy's Hospital, London, United Kingdom
| | - Elcio Marcantonio
- Department of Diagnosis and Surgery, São Paulo State University (Unesp), School of Dentistry, Araraquara, São Paulo, Brazil
| | - Daniela Leal Zandim-Barcelos
- Department of Diagnosis and Surgery, São Paulo State University (Unesp), School of Dentistry, Araraquara, São Paulo, Brazil
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