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Rossana I, Chiara C, Marco N, Niccolò B, Filippo G, Antonio B. Maxillary sinus augmentation via the bone lid technique: A prospective, radiographic case series. Clin Adv Periodontics 2024. [PMID: 38646843 DOI: 10.1002/cap.10288] [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: 02/06/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Maxillary sinus augmentation is one of the most performed procedures to increase the bone quantity of the atrophic maxilla to allow implant placement. The aim of the present case series was to describe a surgical protocol to perform maxillary sinus augmentation with the "bone lid technique," and its outcomes in a cohort of patients eligible for the procedure. METHODS After the initial clinical evaluation, a cone-beam computed tomography (CBCT) examination was performed for preoperative assessment. Patients were then scheduled for surgical intervention. At 6-9 months follow-up, patients underwent a second CBCT scan to evaluate bone height following bone graft and to schedule implant placement. RESULTS A total of 11 patients were enrolled in the study with a total of 13 sinus lift procedures. Membrane perforation was registered in 4 cases (30.76%). Mean surgical time was 67.69 min (SD 6.51). Postoperative period was uneventful in all patients, in the absence of complications. The mean graft volume increase was 2.46 cm3 (SD 0.85), and the mean height increase was 14.27 mm (SD 3.18). Mean membrane thickness was 1.40 mm (SD 0.75). In all the 4 cases with sinus membrane perforation, the membrane had a thickness lower than 1 mm. CONCLUSIONS The present study highlights that the maxillary sinus augmentation with bone lid repositioning could provide repeatable results in terms of bone height increase. The technique appears reliable both in terms of bone gain and absence of complications. KEY POINTS The bone lid technique for maxillary sinus augmentation provides repeatable results in terms of bone height increase. The favorable clinical outcomes can be related to an enhancement of bone formation due to the unique osteoconductive and osteoinductive properties of autogenous bone, along with a reduction of soft tissue ingrowth. Complications were not observed in any of the patients following the surgical procedures. The risk of Schneiderian membrane perforation is inversely proportional to membrane thickness; the thinner the membrane is, the higher the risk to perforate it.
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Affiliation(s)
- Izzetti Rossana
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, University Hospital of Pisa, Pisa, Italy
| | - Cinquini Chiara
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, University Hospital of Pisa, Pisa, Italy
| | - Nisi Marco
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, University Hospital of Pisa, Pisa, Italy
| | - Baldi Niccolò
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, University Hospital of Pisa, Pisa, Italy
| | - Graziani Filippo
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, University Hospital of Pisa, Pisa, Italy
| | - Barone Antonio
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, University Hospital of Pisa, Pisa, Italy
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Is one-stage lateral sinus lift and implantation safe in severely atrophic maxillae? Results of a comparative pilot study. Int J Implant Dent 2023; 9:6. [PMID: 36806674 PMCID: PMC9939565 DOI: 10.1186/s40729-023-00471-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/08/2023] [Indexed: 02/21/2023] Open
Abstract
PURPOSE The aim of this retrospective comparative study was to evaluate the survival of dental implants placed in the posterior maxilla with a residual bone height less than 3 mm using a one-stage lateral sinus lifting approach. The research question was whether in very severely atrophied maxillary bones (residual height < 3 mm), a sinus lift with simultaneous implant placement would be associated with a higher complication rate compared to single-stage sinus lifts at average residual alveolar process heights. METHODS Complications of 63 implants, where the residual bone height was below 3 mm, were compared to a reference group of 40 implants, which were inserted using a one-stage lateral sinus lift in maxillae with at least 3 mm residual bone height. Implant survival, bleeding-on-probing, the presence of peri-implant mucositis and the occurrence of peri-implantitis were documented. RESULTS The mean follow-up time for implant survival was 80.3 ± 25.9 months. One implant out of 63 was lost in the severely atrophic maxilla group and two implants out of 40 were lost in the reference group. There were no differences in the occurrence of implant loss (p = 0.558), bleeding-on-probing (p = 0.087), peri-implantitis (p = 0.999) and peri-implant mucositis (p = 0.797) between the severely atrophic alveolar ridge group and the reference group. CONCLUSIONS Even in severely atrophic maxillae with < 3 mm residual bone height, a one-stage maxillary sinus lift and immediate implant placement can be carried out safely.
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Khijmatgar S, Del Fabbro M, Tumedei M, Testori T, Cenzato N, Tartaglia GM. Residual Bone Height and New Bone Formation after Maxillary Sinus Augmentation Procedure Using Biomaterials: A Network Meta-Analysis of Clinical Trials. MATERIALS (BASEL, SWITZERLAND) 2023; 16:1376. [PMID: 36837005 PMCID: PMC9962504 DOI: 10.3390/ma16041376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/26/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Different factors may affect new bone formation following maxillary sinus floor augmentation for the rehabilitation of posterior edentulous maxilla. The purpose of this study was to determine the influence of residual bone height (RBH) on new bone formation after lateral sinus augmentation utilizing different biomaterials, through a network meta-analysis (NMA). METHODS PUBMED, Scopus, and Web of Science electronic databases were searched until 31 December 2022 to obtain relevant articles. A hand search was also conducted. Randomised controlled studies on maxillary sinus augmentation comparing different grafting materials in patients with atrophic posterior maxilla, in need of prosthetic rehabilitation, were included. The risk of bias was assessed following the guidelines of the Cochrane Collaboration. The primary outcome was new bone formation (NBF), assessed histomorphometrically. The statistical analysis was performed by splitting the data according to RBH (<4 mm and ≥4 mm). RESULTS A total of 67 studies were eligible for conducting NMA. Overall, in the included studies, 1955 patients were treated and 2405 sinus augmentation procedures were performed. The biomaterials used were grouped into: autogenous bone (Auto), xenografts (XG), allografts (AG), alloplasts (AP), bioactive agents (Bio), hyaluronic acid (HA), and combinations of these. An inconsistency factor (IF) seen in the entire loop of the XG, AP, and Bio+AP was found to be statistically significant. The highest-ranked biomaterials for the <4 mm RBH outcome were XG+AG, XG+AP, and Auto. Similarly, the surface under the cumulative ranking curve (SUCRA) of biomaterials for ≥4 mm RBH was Auto, Bio+XG, and XG+Auto. CONCLUSION There is no grafting biomaterial that is consistently performing better than others. The performance of the materials in terms of NBF may depend on the RBH. While choosing a biomaterial, practitioners should consider both patient-specific aspects and sinus clinical characteristics.
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Affiliation(s)
- Shahnavaz Khijmatgar
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
- Department of Oral Biology and Genomic Studies, AB Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore 575018, Karnataka, India
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Margherita Tumedei
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Tiziano Testori
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
- Department of Implantology and Oral Rehabilitation, Dental Clinic, IRCCS Ospedale Galeazzi-Sant’Ambrogio, 20157 Milan, Italy
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Niccolò Cenzato
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Gianluca Martino Tartaglia
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Correia F, Gouveia SA, Pozza DH, Felino AC, Faria-Almeida R. A Randomized Clinical Trial Comparing Implants Placed in Two Different Biomaterials Used for Maxillary Sinus Augmentation. MATERIALS (BASEL, SWITZERLAND) 2023; 16:1220. [PMID: 36770223 PMCID: PMC9919245 DOI: 10.3390/ma16031220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
The objective of this study was to compare marginal bone loss, surgical and clinical complications, and dental implant survival rate in bilateral maxillary sinus augmented by autologous or porcine xenograft. A randomized controlled clinical trial using split-mouth design enrolled 12 consent adult patients (59.7 ± 8.7 years), who received bilateral maxillary sinus floor augmentation for oral rehabilitation with implant-supported prosthesis. Each patient received both the autologous bone from the mandible (control) or porcine xenograft (test) during the random bilateral sinus lift surgery. A total of 39 dental implants were placed in the posterior maxilla of the 12 patients after 6 months, being rehabilitated after the respective osseointegration period. Both graft materials demonstrated a high implant survival rate at 12 months: 95% for the xenograft side, only 1 implant without osseointegration, and 100% for the autologous side. Radiographic bone loss was low and similar for both groups: control group with a mean of 0.063 ± 0.126, and test group with a mean of 0.092 ± 0.163. No major surgical-related complications have occurred. Only one patient had several prosthetic complications due to fractures of prosthetic components. The maxillary sinus augmentation procedure, both with autologous bone and porcine xenograft materials, is an excellent clinical option procedure for the prosthetic rehabilitation of atrophic maxillae, with low marginal bone loss after one year follow-up, few clinical complications, and a high implant survival rate.
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Affiliation(s)
- Francisco Correia
- Department of Oral Surgery and Periodontology, Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal
| | - Sónia Alexandre Gouveia
- Intelligent Systems Associate Laboratory (LASI), Department of Electronics, Telecommunications and Informatics (DETI), Institute of Electronics and Informatics Engineering of Aveiro (IEETA), University of Aveiro, 3810-193 Aveiro, Portugal
| | - Daniel Humberto Pozza
- Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Histology, Faculty of Nutrition and Food Sciences, University of Porto, 4150-177 Porto, Portugal
- Institute for Research and Innovation in Health and IBMC, University of Porto, 4200-135 Porto, Portugal
| | - António Campos Felino
- Department of Oral Surgery and Periodontology, Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal
| | - Ricardo Faria-Almeida
- Department of Oral Surgery and Periodontology, Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal
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Short Implants versus Standard Implants and Sinus Floor Elevation in Atrophic Posterior Maxilla: A Systematic Review and Meta-Analysis of Randomized Clinical Trials with ≥5 Years' Follow-Up. J Pers Med 2023; 13:jpm13020169. [PMID: 36836403 PMCID: PMC9960634 DOI: 10.3390/jpm13020169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
Background and objectives: The aim of this systematic review with meta-analysis was to assess the performance of short implants in comparison with standard implants and sinus floor elevation in atrophic posterior maxilla. Materials and methods: The protocol of the study was registered in the PROSPERO database (CRD42022375320). An electronic search on three databases (PubMed, Scopus, Web of Science) was performed to find randomized clinical trials (RCTs) with ≥5 years' follow-up, published until December 2022. Risk of bias (ROB) was calculated using Cochrane ROB. A meta-analysis was performed for primary (implant survival rate, ISR) and secondary outcomes (marginal bone loss, MBL; biological and prosthetic complications). Results: Of 1619 articles, 5 RCTs met the inclusion criteria. The ISR showed a risk ratio (RR) of 0.97 [0.94, 1.00] (CI 95%), p = 0.07. The MBL indicated a WMD of -0.29 [-0.49, -0.09] (CI 95%), p = 0.005. Biological complications showed a RR of 0.46 [0.23, 0.91] (CI 95%), p = 0.03. Prosthetic complications showed a RR of 1.51 [0.64, 3.55] (CI 95%), p = 0.34. Conclusions: The available evidence suggests that short implants might be used as an alternative to standard implants and sinus floor elevation. After 5 years, in terms of ISR, standard implants and sinus floor elevation showed a higher survival rate comparted to short implants, although statistical significance was not achieved. Future RCTs with long-term follow-up are needed to draw a clear conclusion on the advantages of one method over another.
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She X, Zhang D, Xu X, Zhang Z, Ji C, Li Z, Song D. Influence of the contact area of the sub-antral space with sinus bone and the Schneiderian membrane on osteogenesis in lateral window sinus elevation surgery: a prospective experiment. BMC Oral Health 2022; 22:650. [PMID: 36578061 PMCID: PMC9798614 DOI: 10.1186/s12903-022-02694-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Osteogenesis of lateral window sinus elevation surgery is the key to placement of the subsequent implant, excessive collapse of the sub-antral space may adversely affect long-term stability of implants. At present, few studies focus on the influence of the contact area of the sub-antral space on osteogenesis. This study evaluated whether the change in the contact area of the sub-antral space with maxillary sinus bone and the Schneiderian membrane can affect osteogenesis. METHODS Cone beam computed tomography (CBCT) images were collected of patients requiring maxillary sinus floor elevation (residual bone height < 6 mm) for standard-length implant placement before surgery, after surgery, and at 6-month follow-up visits. The postoperative sub-antral space volume (V1) and surface area (S1), and the remaining volume after six months of healing (V2) were measured. Then, the contact area of sub-antral space with maxillary sinus bone (Sbc) and the Schneiderian membrane (Smc), the absorbed volume during healing (Va), and the percentage of remaining volume (V2%) and absorbed volume (Va%) were calculated. The correlation between anatomical parameters was analyzed using multiple linear regression. RESULTS A total of 62 maxillary sinuses from 56 patients were augmented, of which 57 were considered for the final analysis (5 withdrew due to perforation). Multiple linear regression results demonstrated that Sbc was significantly positively correlated with Va (β coefficient = 0.141, p < 0.01) without correlation between Smc and Va (β coefficient = - 0.046, p = 0.470). There was a positive correlation between Sbc and V2% (β coefficient = 2.269, p < 0.05). CONCLUSIONS This study confirmed that the size of the Sbc in lateral window sinus elevation surgery affected osteogenesis after six months of healing. Clinicians should assess the sinus contour type preoperatively, then consider whether it is necessary to expand the range of the Schneiderian membrane elevation to avoid excessive collapse of the sub-antral space. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR), ChiCTR2200057924. Registered 22 March 2022-Retrospectively registered.
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Affiliation(s)
- Xiao She
- grid.27255.370000 0004 1761 1174Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
| | - Dongjiao Zhang
- grid.27255.370000 0004 1761 1174Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
| | - Xin Xu
- grid.27255.370000 0004 1761 1174Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
| | - Zhanwei Zhang
- grid.27255.370000 0004 1761 1174Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
| | - Chonghao Ji
- grid.27255.370000 0004 1761 1174Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
| | - Zechuan Li
- grid.27255.370000 0004 1761 1174Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
| | - Dawei Song
- grid.410587.fSchool of Stomatology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117 China
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Mordini L, Patianna GP, Di Domenico GL, Natto ZS, Valente NA. The use of corticosteroids in the lateral sinus augmentation surgical procedure: A systematic review and meta-analysis. Clin Implant Dent Relat Res 2022; 24:776-791. [PMID: 36068078 PMCID: PMC10087261 DOI: 10.1111/cid.13126] [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: 05/27/2022] [Revised: 07/13/2022] [Accepted: 07/16/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The lateral maxillary sinus augmentation (MSA) procedure has good predictability in terms of the success of bone regeneration with a low incidence of postoperative infections, estimated between 2% and 5.6%. Although the use of antibiotics is an established and standardized prophylactic measure for MSA procedures, the addition of corticosteroids still varies among clinician preference and clinical judgment. PURPOSE The aim of this systematic review was to identify whether the administration of corticosteroids during the MSA surgical procedure affects postoperative symptoms including swelling, pain, and infection rate. MATERIALS AND METHODS A literature search through PubMed, EMBASE, Ovid MEDLINE, and Web of Science indices, according to PICO criteria, was conducted to identify whether MSA peri-operative use of corticosteroids reduces the incidence of complications and patient morbidity. A single arm meta-analysis was performed due to the lack of randomized controlled trials (RCTs) comparing groups treated with or without peri-operative corticosteroids. The intracluster correlation co-efficient (ICC) and design effect were calculated to adjust for the clustering design. RESULTS In the 37 studies included, a total of 1599 patients (378 Cort, 1221 No-Cort) were analyzed. Before and after taking account of clustering, there was statistically significant effect of corticosteroids on swelling, pain, wound dehiscence, trismus, and hematoma. The complication rates postoperatively were comparable between the two study groups, however slight differences existed in the incidence of active suppuration (1.7% [95% CI 0.7-3.9] Cort vs. 3.2% [2.2-4.5] No-Cort), wound dehiscence (3.9% [1.3-11.2] Cort vs. 2.1% [1.0-4.1] No-Cort) and trismus (2.7% [0.8-8.4] Cort vs. 1.4% [0.8-2.5] No-Cort). CONCLUSIONS Although the event rate of the 1-to-2-week postoperative complications did not differ between the two groups, the lack of conclusive data and research comparing peri-operative corticosteroid use makes it impossible to draw definitive conclusions and more evidence and studies designed for this specific purpose are needed.
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Affiliation(s)
- Lorenzo Mordini
- Department of Periodontology, School of Dental Medicine, Tufts University, Boston, Massachusetts, USA
| | - Giuseppe Pio Patianna
- Division of Oral Surgery, Unit of Dentistry, Dental School, Faculty of Medicine and Surgery, Vita Salute University and IRCCS San Raffaele, Milan, Italy
| | - Giovanna Laura Di Domenico
- Division of Oral Surgery, Unit of Dentistry, Dental School, Faculty of Medicine and Surgery, Vita Salute University and IRCCS San Raffaele, Milan, Italy
| | - Zuhair S Natto
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nicola Alberto Valente
- Division of Periodontology, School of Dental Medicine, Department of Surgical Sciences, Faculty of Medicine and Surgery, University of Cagliari, Cagliari, Italy.,Department of Periodontology, School of Dental Medicine, State University of New York at Buffalo, Buffalo, New York, USA
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Di Tinco R, Consolo U, Pisciotta A, Orlandi G, Bertani G, Nasi M, Bertacchini J, Carnevale G. Characterization of Dental Pulp Stem Cells Response to Bone Substitutes Biomaterials in Dentistry. Polymers (Basel) 2022; 14:polym14112223. [PMID: 35683895 PMCID: PMC9182880 DOI: 10.3390/polym14112223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/26/2022] [Accepted: 05/28/2022] [Indexed: 02/05/2023] Open
Abstract
Bone substitute biomaterials (BSBs) represent a promising alternative to bone autografts, due to their biocompatibility, osteoconduction, slow resorption rates, and the ability to define and maintain volume for bone gain in dentistry. Many biomaterials are tailored to provide structural and biological support for bone regeneration, and allow the migration of bone-forming cells into the bone defect. Neural crest-derived stem cells isolated from human dental pulp (hDPSCs) represent a suitable stem cell source to study the biological effects of BSBs on osteoprogenitor cells involved in the physiological bone regenerative processes. This study aimed to evaluate how three different BSBs affect the stem cell properties, osteogenic differentiation, and inflammatory properties of hDPSCs. Our data highlight that BSBs do not alter cell proliferation and stemness markers expression, nor induce any inflammatory responses. Bone metabolism data show that hDPSCs exposed to the three BSBs distinctively secrete the factors supporting osteoblast activity and osteoclast activity. Our data indicate that (i) hDPSCs are a suitable stem cell source to study the effects of BSBs, and that (ii) the formulation of BSBs may condition the biological properties of stem cells, suggesting their versatile suitability to different dentistry applications.
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Affiliation(s)
- Rosanna Di Tinco
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy; (R.D.T.); (U.C.); (A.P.); (G.O.); (G.B.); (M.N.); (J.B.)
| | - Ugo Consolo
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy; (R.D.T.); (U.C.); (A.P.); (G.O.); (G.B.); (M.N.); (J.B.)
- Operative Unit of Dentistry and Maxillofacial Surgery, Department Integrated Activity-Specialist Surgeries, University-Hospital of Modena, 41125 Modena, Italy
| | - Alessandra Pisciotta
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy; (R.D.T.); (U.C.); (A.P.); (G.O.); (G.B.); (M.N.); (J.B.)
| | - Giulia Orlandi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy; (R.D.T.); (U.C.); (A.P.); (G.O.); (G.B.); (M.N.); (J.B.)
| | - Giulia Bertani
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy; (R.D.T.); (U.C.); (A.P.); (G.O.); (G.B.); (M.N.); (J.B.)
| | - Milena Nasi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy; (R.D.T.); (U.C.); (A.P.); (G.O.); (G.B.); (M.N.); (J.B.)
| | - Jessika Bertacchini
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy; (R.D.T.); (U.C.); (A.P.); (G.O.); (G.B.); (M.N.); (J.B.)
- CNR-Institute of Molecular Genetics “Luigi Luca Cavalli-Sforza”, Unit of Bologna, 40136 Bologna, Italy
| | - Gianluca Carnevale
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy; (R.D.T.); (U.C.); (A.P.); (G.O.); (G.B.); (M.N.); (J.B.)
- Correspondence: ; Tel.: +39-0594-224-852
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Shibli JA, Nagay BE, Suárez LJ, Urdániga Hung C, Bertolini M, Barão VAR, Souza JGS. Bone Tissue Engineering Using Osteogenic Cells: From the Bench to the Clinical Application. Tissue Eng Part C Methods 2022; 28:179-192. [PMID: 35166162 DOI: 10.1089/ten.tec.2022.0021] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The use of tissue engineering to restore and to build new bone tissue is under active research at present. The following review summarizes the latest studies and clinical trials related to the use of osteogenic cells, biomaterials, and scaffolds to regenerate bone defects in the human jaws. Bone tissue engineering (BTE) combined with scaffolds have provided a range of advantages not only to transport the target cells to their desired destination but also to support the early phases of the mineralization process. The mechanical, chemical, and physical properties of scaffolds have been evaluated as they affect the quantity of bone regeneration, particularly in the oral cavity. This review also highlighted the mechanisms underlying bone homeostasis, including the key transcription factors and signaling pathways responsible for regulating the differentiation of osteoblast lineage. Furthering understanding of the mechanisms of cellular signaling in skeletal remodeling with the use of mesenchymal stem cells and the proper scaffold properties are key-factors to enable the incorporation of new and effective treatment methods into clinical practice for bone tissue regeneration using BTE. Impact Statement The use of mesenchymal stem cells able to differentiate in osteoblast lineage for bone tissue engineering (BTE) remains a major challenge. Viable cells and signaling pathways play an essential role in bone repair and regeneration of critical size defects. Recent advances in scaffolds and biological factors such as growth factors (e.g., cytokines and hormones) controlling the osteogenic signaling cascade are now becoming new players affecting the osteogenic potential of cells. Such techniques will significantly impact the maxillofacial bone tissue replacement, repair, and regeneration for patients without having to rely on donor banks or other surgical sites.
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Affiliation(s)
- Jamil Awad Shibli
- Dental Research Division, Department of Periodontology, Guarulhos University, Praça Tereza Cristina, Guarulhos, Brazil
| | - Bruna Egumi Nagay
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Lina J Suárez
- Dental Research Division, Department of Periodontology, Guarulhos University, Praça Tereza Cristina, Guarulhos, Brazil.,Departamento de Ciencias Básicas y Medicina Oral, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Celeste Urdániga Hung
- Dental Research Division, Department of Periodontology, Guarulhos University, Praça Tereza Cristina, Guarulhos, Brazil
| | - Martinna Bertolini
- Department of Periodontics and Preventive Dentistry, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania, USA
| | - Valentim A R Barão
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - João Gabriel S Souza
- Dental Research Division, Department of Periodontology, Guarulhos University, Praça Tereza Cristina, Guarulhos, Brazil.,Dental Science School (Faculdade de Ciências Odontológicas-FCO), Montes Claros, Brazil
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Radiographic and Histomorphologic Evaluation of the Maxillary Bone after Crestal Mini Sinus Lift Using Absorbable Collagen—Retrospective Evaluation. Dent J (Basel) 2022; 10:dj10040058. [PMID: 35448052 PMCID: PMC9024729 DOI: 10.3390/dj10040058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/09/2022] [Accepted: 03/24/2022] [Indexed: 02/05/2023] Open
Abstract
Background: After tooth extraction, the alveolar bone loses volume in height and width over time, meaning that reconstructive procedures may be necessary to perform implant placement. In the maxilla, to increase the bone volume, a mini-invasive surgery, such as a sinus lift using the crestal approach, could be performed. Methods: A crestal approach was used in this study to perform the sinus lift, fracturing the bone and inserting collagen (Condress®). The single dental implant was placed in the healed bone after six months. Results: The newly formed bone was histologically analyzed after healing. Histomorphological analyses confirmed the quality of the new bone formation even without graft biomaterials. This is probably due to the enlargement of the space, meaning more vascularization and stabilization of the coagulum. Conclusion: Using just collagen could be sufficient to induce proper new bone formation in particular clinical situations, with a minimally invasive surgery to perform a sinus lift.
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Polymeric Scaffolds for Dental, Oral, and Craniofacial Regenerative Medicine. Molecules 2021; 26:molecules26227043. [PMID: 34834134 PMCID: PMC8621873 DOI: 10.3390/molecules26227043] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 01/10/2023] Open
Abstract
Dental, oral, and craniofacial (DOC) regenerative medicine aims to repair or regenerate DOC tissues including teeth, dental pulp, periodontal tissues, salivary gland, temporomandibular joint (TMJ), hard (bone, cartilage), and soft (muscle, nerve, skin) tissues of the craniofacial complex. Polymeric materials have a broad range of applications in biomedical engineering and regenerative medicine functioning as tissue engineering scaffolds, carriers for cell-based therapies, and biomedical devices for delivery of drugs and biologics. The focus of this review is to discuss the properties and clinical indications of polymeric scaffold materials and extracellular matrix technologies for DOC regenerative medicine. More specifically, this review outlines the key properties, advantages and drawbacks of natural polymers including alginate, cellulose, chitosan, silk, collagen, gelatin, fibrin, laminin, decellularized extracellular matrix, and hyaluronic acid, as well as synthetic polymers including polylactic acid (PLA), polyglycolic acid (PGA), polycaprolactone (PCL), poly (ethylene glycol) (PEG), and Zwitterionic polymers. This review highlights key clinical applications of polymeric scaffolding materials to repair and/or regenerate various DOC tissues. Particularly, polymeric materials used in clinical procedures are discussed including alveolar ridge preservation, vertical and horizontal ridge augmentation, maxillary sinus augmentation, TMJ reconstruction, periodontal regeneration, periodontal/peri-implant plastic surgery, regenerative endodontics. In addition, polymeric scaffolds application in whole tooth and salivary gland regeneration are discussed.
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Velasco-Ortega E, Sierra-Baztan A, Jiménez-Guerra A, España-López A, Ortiz-Garcia I, Núñez-Márquez E, Moreno-Muñoz J, Rondón-Romero JL, López-López J, Monsalve-Guil L. Long-Term Clinical Study of Implants Placed in Maxillary Sinus Floor Augmentation Using Beta-Tricalcium Phosphate. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18199975. [PMID: 34639277 PMCID: PMC8508221 DOI: 10.3390/ijerph18199975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/08/2021] [Accepted: 09/14/2021] [Indexed: 02/06/2023]
Abstract
Introduction. The aim of this study was to show the long-term clinical outcomes of implants placed in maxillary sinus floor augmentation (MFSA) using beta-tricalcium phosphate (β-TCP). Patients and methods. Maxillary patients were diagnosed for MFSA and used beta- β-TCP. After the lateral sinus surgery, implants were loaded at 6 months with restorations. The clinical follow-up was at 10 years. Results. One hundred and one patients (58 females and 43 males) were treated with MFSA. Twenty-nine patients (28.7%) had a history of periodontitis. Thirty-three patients (32.7%) were smokers. One hundred and twenty-one MFSA, 81 unilateral and 20 bilateral sites, with 234 implants were performed. The average vertical bone height available was 4.92 ± 1.83 mm. The average vertical bone gain obtained was 6.95 ± 2.19 mm following MFSA. The implant cumulative survival rate was 97.2%. Three implants (1.3%) were lost during the healing period. Six implants (2.6%) were lost by peri-implantitis. One hundred and fifteen restorations were placed in the patients. Mean marginal bone loss was 1.93 mm ± 1.03 mm. Six patients (27.3%) showed technical complications. Thirty-six implants (15.3%) in 14 patients (13.9%) were associated with peri-implantitis. Conclusions. This study indicates that treatment with implant-supported restoration by MFSA using β-TCP constitutes a successful implant approach.
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Affiliation(s)
- Eugenio Velasco-Ortega
- Comprehensive Dentistry for Adults and Gerodontology, Master in Implant Dentistry, Faculty of Dentistry, University of Seville, 41009 Barcelona, Spain; (E.V.-O.); (A.S.-B.); (A.J.-G.); (A.E.-L.); (I.O.-G.); (E.N.-M.); (J.M.-M.); (J.L.R.-R.); (L.M.-G.)
| | - Angela Sierra-Baztan
- Comprehensive Dentistry for Adults and Gerodontology, Master in Implant Dentistry, Faculty of Dentistry, University of Seville, 41009 Barcelona, Spain; (E.V.-O.); (A.S.-B.); (A.J.-G.); (A.E.-L.); (I.O.-G.); (E.N.-M.); (J.M.-M.); (J.L.R.-R.); (L.M.-G.)
| | - Alvaro Jiménez-Guerra
- Comprehensive Dentistry for Adults and Gerodontology, Master in Implant Dentistry, Faculty of Dentistry, University of Seville, 41009 Barcelona, Spain; (E.V.-O.); (A.S.-B.); (A.J.-G.); (A.E.-L.); (I.O.-G.); (E.N.-M.); (J.M.-M.); (J.L.R.-R.); (L.M.-G.)
| | - Antonio España-López
- Comprehensive Dentistry for Adults and Gerodontology, Master in Implant Dentistry, Faculty of Dentistry, University of Seville, 41009 Barcelona, Spain; (E.V.-O.); (A.S.-B.); (A.J.-G.); (A.E.-L.); (I.O.-G.); (E.N.-M.); (J.M.-M.); (J.L.R.-R.); (L.M.-G.)
| | - Iván Ortiz-Garcia
- Comprehensive Dentistry for Adults and Gerodontology, Master in Implant Dentistry, Faculty of Dentistry, University of Seville, 41009 Barcelona, Spain; (E.V.-O.); (A.S.-B.); (A.J.-G.); (A.E.-L.); (I.O.-G.); (E.N.-M.); (J.M.-M.); (J.L.R.-R.); (L.M.-G.)
| | - Enrique Núñez-Márquez
- Comprehensive Dentistry for Adults and Gerodontology, Master in Implant Dentistry, Faculty of Dentistry, University of Seville, 41009 Barcelona, Spain; (E.V.-O.); (A.S.-B.); (A.J.-G.); (A.E.-L.); (I.O.-G.); (E.N.-M.); (J.M.-M.); (J.L.R.-R.); (L.M.-G.)
| | - Jesús Moreno-Muñoz
- Comprehensive Dentistry for Adults and Gerodontology, Master in Implant Dentistry, Faculty of Dentistry, University of Seville, 41009 Barcelona, Spain; (E.V.-O.); (A.S.-B.); (A.J.-G.); (A.E.-L.); (I.O.-G.); (E.N.-M.); (J.M.-M.); (J.L.R.-R.); (L.M.-G.)
| | - José Luis Rondón-Romero
- Comprehensive Dentistry for Adults and Gerodontology, Master in Implant Dentistry, Faculty of Dentistry, University of Seville, 41009 Barcelona, Spain; (E.V.-O.); (A.S.-B.); (A.J.-G.); (A.E.-L.); (I.O.-G.); (E.N.-M.); (J.M.-M.); (J.L.R.-R.); (L.M.-G.)
| | - José López-López
- Oral Health and Masticatory System Group—IDIBELL (Bellvitge Biomedical Research Institute), University of Barcelona, 08907 Barcelona, Spain
- Correspondence:
| | - Loreto Monsalve-Guil
- Comprehensive Dentistry for Adults and Gerodontology, Master in Implant Dentistry, Faculty of Dentistry, University of Seville, 41009 Barcelona, Spain; (E.V.-O.); (A.S.-B.); (A.J.-G.); (A.E.-L.); (I.O.-G.); (E.N.-M.); (J.M.-M.); (J.L.R.-R.); (L.M.-G.)
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Spongostan ™ Leads to Increased Regeneration of a Rat Calvarial Critical Size Defect Compared to NanoBone ® and Actifuse. MATERIALS 2021; 14:ma14081961. [PMID: 33919825 PMCID: PMC8070843 DOI: 10.3390/ma14081961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/13/2022]
Abstract
Bone substitute materials are becoming increasingly important in oral and maxillofacial surgery. Reconstruction of critical size bone defects is still challenging for surgeons. Here, we compared the clinically applied organic bone substitute materials NanoBone® (nanocrystalline hydroxyapatite and nanostructured silica gel; n = 5) and Actifuse (calcium phosphate with silicate substitution; n = 5) with natural collagen-based Spongostan™ (hardened pork gelatin containing formalin and lauryl alcohol; n = 5) in bilateral rat critical-size defects (5 mm diameter). On topological level, NanoBone is known to harbour nanopores of about 20 nm diameter, while Actifuse comprises micropores of 200–500 µm. Spongostan™, which is clinically applied as a haemostatic agent, combines in its wet form both nano- and microporous topological features by comprising 60.66 ± 24.48 μm micropores accompanied by nanopores of 32.97 ± 1.41 nm diameter. Micro-computed tomography (µCT) used for evaluation 30 days after surgery revealed a significant increase in bone volume by all three bone substitute materials in comparison to the untreated controls. Clearly visual was the closure of trepanation in all treated groups, but granular appearance of NanoBone® and Actifuse with less closure at the margins of the burr holes. In contrast, transplantion of Spongostan™ lead to complete filling of the burr hole with the highest bone volume of 7.98 ccm and the highest bone mineral density compared to all other groups. In summary, transplantation of Spongostan™ resulted in increased regeneration of a rat calvarial critical size defect compared to NanoBone and Actifuse, suggesting the distinct nano- and microtopography of wet Spongostan™ to account for this superior regenerative capacity. Since Spongostan™ is a clinically approved product used primarily for haemostasis, it may represent an interesting alternative in the reconstruction of defects in the maxillary region.
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Evaluation of Quality of Life and Satisfaction in Patients with Fixed Prostheses on Zygomatic Implants Compared with the All-on-Four Concept: A Prospective Randomized Clinical Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073426. [PMID: 33806189 PMCID: PMC8037824 DOI: 10.3390/ijerph18073426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 11/16/2022]
Abstract
Purpose: No published research has compared patients’ quality of life and satisfaction with fixed prostheses supported by zygomatic implants with those supported by all-on-four prostheses. The aim of this study was to evaluate patients’ quality of life and satisfaction with fixed prostheses on zygomatic implants compared with the all-on-four concept. Materials and Methods: A total of 80 patients with atrophic edentulous maxillae were randomized into two groups: Group 1 (rehabilitated with fixed prostheses supported by 2–4 zygomatic and 2–4 conventional implants in the anterior region) and Group 2 (fixed prostheses on four implants in the anterior region following an all-on-four concept). One year after placement of the definitive prostheses, patients completed OHIP-14 and satisfaction questionnaires. Results: In all seven domains of the OHIP-14 and in the overall scores, a worse quality of life was found in Group 2 patients, with statistically significant differences between the two groups (p ≤ 0.05). Patients with zygomatic implants were more satisfied with their prostheses, with a statistically significant difference (p < 0.001). Conclusions: According to the results of this study, rehabilitation of patients with edentulous atrophic maxillae with prostheses supported by zygomatic implants combined with anterior implants provided better patient quality of life and satisfaction than prostheses supported by four implants.
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