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Moraschini V, Louro RS, Son A, Calasans-Maia MD, Sartoretto SC, Shibli JA. Long-term survival and success rate of dental implants placed in reconstructed areas with extraoral autogenous bone grafts: A systematic review and meta-analysis. Clin Implant Dent Relat Res 2024; 26:469-481. [PMID: 38450931 DOI: 10.1111/cid.13319] [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: 09/25/2023] [Revised: 01/22/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE To evaluate the long-term survival and success rates of implants placed in reconstructed areas using microvascularized or non-microvascularized extraoral bone grafts. MATERIALS AND METHODS An electronic search was performed in five databases and in gray literature for articles published until June, 2023. The eligibility criteria comprised observational studies (prospective or retrospective) and clinical trials, reporting survival and success rates of implants placed in extraoral bone grafts. A meta-analysis (implant failure) was categorized into subgroups based on the type of bone graft used. The risk of bias within studies was assessed using the Newcastle-Ottawa Scale. RESULTS Thirty-one studies met the inclusion criteria. The mean follow-up time was 92 months. The summary estimate of survival rate at the implant level were 94.9% (CI: 90.1%-97.4%) for non-vascularized iliac graft, 96.5% (CI: 91.4%-98.6%) for non-vascularized calvaria graft, and 92.3% (CI: 89.1%-94.6%) for vascularized fibula graft. The mean success rate and marginal bone loss (MBL) were 83.2%; 2.25 mm, 92.2%; 0.93 mm, and 87.6%; 1.49 mm, respectively. CONCLUSIONS Implants placed in areas reconstructed using extraoral autogenous bone graft have high long-term survival rates and low long-term MBLs. The data did not demonstrate clinically relevant differences in the survival, success, or MBL of grafts from different donor areas or with different vascularization. This systematic review was registered in INPLASY under number INPLASY202390004.
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Affiliation(s)
- Vittorio Moraschini
- Department of Periodontology, School of Dentistry, Veiga de Almeida University, Rio de Janeiro, Brazil
- Department of Oral Surgery, School of Dentistry, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Rafael Seabra Louro
- Department of Oral Surgery, School of Dentistry, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Andrea Son
- Department of Implant Dentistry, School of Dentistry, Guarulhos University, São Paulo, Brazil
| | | | | | - Jamil Awad Shibli
- Department of Implant Dentistry, School of Dentistry, Guarulhos University, São Paulo, Brazil
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El-Sawy MA, Hegazy SA. Subperiosteal implants constructed with digital technology: A systematic review. Oral Maxillofac Surg 2024:10.1007/s10006-024-01249-8. [PMID: 38642167 DOI: 10.1007/s10006-024-01249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 03/29/2024] [Indexed: 04/22/2024]
Abstract
STATEMENT OF PROBLEM Atrophied jaw is a condition where there is insufficient bone quantity and quality. Several treatment plans are available for treating atrophied jaws, including subperiosteal implants. PURPOSE To evaluate the spectrum of subperiosteal implants for severely atrophied jaws using digital technology. MATERIALS AND METHODS An electronic and manual search was conducted in the PubMed, Scopus, and Google Scholar databases. Publications of cohort studies, case series, and case reports written in English without data restrictions that reported on subperiosteal implant management of patients with severely atrophied jaws in a completely and partially edentulous population. RESULTS A total of 26 articles, comprising 302 cases, were analyzed. In patients with severely atrophied jaws. The success rate was 87.7%, the surviving rate was 95.3%. The most common complications were biological, such as dehiscence and framework exposure. The rates of biologic complications were 11.5%, and the rates of prosthetic problems were 5.9%. CONCLUSIONS Subperiosteal implants designed and constructed using digital technology are a promising treatment in the short term. Attention should be directed to decrease the biological complication. Correct designing, implanting, fixing, and patient selection and maintenance are critical for the success of the treatment. Longer prospective studies with larger population are needed to view the effect on hard and soft tissue.
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Cucchi A, Maiani F, Franceschi D, Sassano M, Fiorino A, Urban IA, Corinaldesi G. The influence of vertical ridge augmentation techniques on peri-implant bone loss: A systematic review and meta-analysis. Clin Implant Dent Relat Res 2024; 26:15-65. [PMID: 38114425 DOI: 10.1111/cid.13282] [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: 03/23/2023] [Revised: 08/09/2023] [Accepted: 09/12/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION The primary aim of this systematic review was to investigate and compare the outcomes of different vertical ridge augmentation (VRA) techniques in relation to peri-implant bone loss (PBL), after at least 12 months of functional loading. MATERIAL AND METHODS The search was conducted to find all the studies about VRA and measurements of PBL with at least 12 months follow-up. Three pairwise meta-analysis (MA) was performed to completely evaluate the outcomes. RESULTS A total of 42 studies were included, of which 11 were randomized clinical trials (RCTs). RCTs were available only for guided bone regeneration (GBR), onlay, and inlay techniques. The weighted mean estimate (WME) of PBL value was found to be 1.38 mm (95% confidence interval [95% CI]: 1.10-1.66) after a mean follow-up of 41.0 ± 27.8 months. GBR, Inlay, Onlay, osteodistraction, and SBB represented in weight 32.9%, 30.6%, 25.0%, 7.6%, and 3.9%, respectively; and their WME (95% CI) were 1.06 (0.87-1.26) mm, 1.72 (1.00-2.43) mm, 1.31 (0.87-1.75) mm, 1.81 (0.87-1.75) mm, and 0.66 (0.55-0.77) mm, respectively. Among the secondary outcomes, the analysis was conducted for vertical bone gain, healing complication rate, surgical complication rate, implant survival, and success rate. CONCLUSIONS The primary findings of the meta-analysis, based on the changes between final and baseline values, showed that the peri-implant bone loss could be influenced by the type of intervention but there is a need to evaluate in RCTs the behavior of the peri-implant bone levels after long-term follow-up for all techniques.
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Affiliation(s)
| | | | - Debora Franceschi
- Department of Experimental and Clinic Medicine, University of Florence, Firenze, Italy
| | - Michele Sassano
- Department of Life Sciences and Public Health, Catholic University of The Sacred Heart, Rome, Italy
| | - Antonino Fiorino
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, "Federico II" University of Naples, Napoli, Italy
| | - Istvan A Urban
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Periodontics, University of Szeged, Szeged, Hungary
- Urban Regeneration Institute, Budapest, Hungary
| | - Giuseppe Corinaldesi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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Öztürk K, Kuzu TE, Ayrıkçil S, Gürgan CA, Önder GÖ, Yay A. Effect of systemic atorvastatin on bone regeneration in critical-sized defects in hyperlipidemia: an experimental study. Int J Implant Dent 2023; 9:50. [PMID: 38097856 PMCID: PMC10721777 DOI: 10.1186/s40729-023-00508-9] [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: 02/13/2023] [Accepted: 10/18/2023] [Indexed: 12/17/2023] Open
Abstract
PURPOSE Hypocholesterolemic medications similar to atorvastatin are efficient in lowering blood lipid levels; however, compared to other medications in the statin family, their impact on bone metabolism is claimed to be insufficient. The impact of atorvastatin on bone regeneration in dental implantology in individuals with hyperlipidemia who received atorvastatin in the clinic is doubtful. METHODS In the study, 16 male New Zealand rabbits of 6 months were used. All rabbits were fed a high-cholesterol diet for 8 weeks, and hyperlipidemia was created. It was confirmed that the total cholesterol level in rabbits was above 105 mg/dl. A critical-sized defect was created in the mandible. The defect was closed with xenograft and membrane. Oral 10 mg/kg atorvastatin was started in the experimental group, and no drug was administered in the control group. At 16th week, animals were sacrificed. For histomorphological examination, the new bone area, osteoclast, and osteoblast activities were evaluated. RESULTS While new bone area (45,924 µm2, p < 0.001) and AP intensities (105.645 ± 16.727, p = 0.006) were higher in the atorvastatin group than in the control group, TRAP intensities in the control group (82.192 ± 5.346, p = 0.021) were higher than that in the atorvastatin group. CONCLUSIONS It has been found that high blood lipid levels will adversely affect bone graft healing and the use of systemic atorvastatin contributes to bone healing. Clinicians should pay attention to the selection of surgical materials, considering the importance of questioning drug use in their patients and the risks in cases of non-use.
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Affiliation(s)
- Kübra Öztürk
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Nuh Naci Yazgan University, Kayseri, Türkiye.
| | - Turan Emre Kuzu
- Department of Periodontology, Faculty of Dentistry, Nuh Naci Yazgan University, Kayseri, Türkiye
| | - Semih Ayrıkçil
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Nuh Naci Yazgan University, Kayseri, Türkiye
| | - Cem Abdulkadir Gürgan
- Department of Periodontology, Faculty of Dentistry, Nuh Naci Yazgan University, Kayseri, Türkiye
| | - Gözde Özge Önder
- Department of Histology and Embryology, Faculty of Medicine, Erciyes University, Kayseri, Türkiye
| | - Arzu Yay
- Department of Histology and Embryology, Faculty of Medicine, Erciyes University, Kayseri, Türkiye
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Wang J, Li W, He X, Li S, Pan H, Yin L. Injectable platelet-rich fibrin positively regulates osteogenic differentiation of stem cells from implant hole via the ERK1/2 pathway. Platelets 2023; 34:2159020. [PMID: 36644947 DOI: 10.1080/09537104.2022.2159020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Bone regeneration in dentistry is a dynamic approach for treating critical size bone defects that are unlikely to self-heal. Human bone marrow stem cell (hBMSCs) therapies are being tested clinically for various disorders and have remarkable clinical advancements in bone regeneration. Injectable platelet-rich fibrin (i-PRF), which is obtained from autologous blood centrifuged at 700 rpm (60 G) for 3 min can promote osteogenic differentiation of this cell, but the mechanism remains unclear. The objectives of this study were to explore the contents of i-PRF further and investigate its effect on the cell behavior of hBMSCs and the underlying molecular mechanisms. The results showed that i-PRF contained 41 cytokines, including macrophage colony-stimulating factor (M-CSF) and β-nerve growth factor (β-NGF), which had not been reported before. The Cell Counting Kit-8 and wound healing assay showed that 10% and 20% i-PRF improved the proliferation rate and the migration capacity of hBMSCs without toxicity to cells. Besides, the expression of osteogenic markers and the capacity to form mineralized nodules of hBMSCs were promoted by 20% i-PRF. Furthermore, i-PRF activated the ERK pathway, and the ERK inhibitor attenuated its effects. In summary, i-PRF promotes hBMSCs proliferation and migration and facilitates cell osteogenesis through the ERK pathway, which has promising potential in bone regeneration.
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Affiliation(s)
- Jia Wang
- Department of Implantology, School/Hospital of Stomatology Lanzhou University, Lanzhou, China
| | - Wanxin Li
- Department of Implantology, School/Hospital of Stomatology Lanzhou University, Lanzhou, China
| | - Xuxia He
- Department of Implantology, School/Hospital of Stomatology Lanzhou University, Lanzhou, China
| | - Simei Li
- Department of Implantology, School/Hospital of Stomatology Lanzhou University, Lanzhou, China
| | - Hongwei Pan
- Department of Implantology, School/Hospital of Stomatology Lanzhou University, Lanzhou, China
| | - Lihua Yin
- Department of Implantology, School/Hospital of Stomatology Lanzhou University, Lanzhou, China
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Sáez-Alcaide LM, González Gallego B, Fernando Moreno J, Moreno Navarro M, Cobo-Vázquez C, Cortés-Bretón Brinkmann J, Meniz-García C. Complications associated with vertical bone augmentation techniques in implant dentistry: A systematic review of clinical studies published in the last ten years. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101574. [PMID: 37499904 DOI: 10.1016/j.jormas.2023.101574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023]
Abstract
Vertical bone augmentation procedures are increasingly necessary in daily practice. However, it has been reported that vertical ridge augmentation is one of the least predictable techniques in terms of complications. The aim of this systematic review was to evaluate and compare complications in relation to the different procedures used for vertical bone augmentation prior to implant placement. This review was conducted according to PRISMA guidelines. An electronic search was carried out in four databases: The National Library of Medicine (MEDLINE/PubMed); Web of Science; SCOPUS; and Cochrane Central Register of Controlled Trials (CENTRAL). The Newcastle-Ottawa Quality Assessment Scale, the Cochrane Collaboration tool for assessing risk of bias, and The Joanna Briggs Institute Critical Appraisal tool were used to assess the quality of evidence in the studies reviewed. Twenty-five studies with a total of 749 vertically augmented sites were included in the review. Complication rates varied among the different procedures: 51.02% for distraction osteogenesis, 38.01% for bone blocks, and 16.80% for guided bone regeneration. Vertical bone augmentation procedures prior to implant placement are associated with frequent surgical complications and should be approached with caution due to their possible impact on clinical treatment success.
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Affiliation(s)
- Luis Miguel Sáez-Alcaide
- Department of Dental Clinical Specialties, Faculty of dentistry, Complutense University of Madrid, Pza Ramon y Cajal s/n, Madrid 28040, Spain
| | - Berta González Gallego
- Department of Dental Clinical Specialties, Faculty of dentistry, Complutense University of Madrid, Pza Ramon y Cajal s/n, Madrid 28040, Spain
| | - Javier Fernando Moreno
- Department of Dental Clinical Specialties, Faculty of dentistry, Complutense University of Madrid, Pza Ramon y Cajal s/n, Madrid 28040, Spain
| | - Miguel Moreno Navarro
- Department of Dental Clinical Specialties, Faculty of dentistry, Complutense University of Madrid, Pza Ramon y Cajal s/n, Madrid 28040, Spain
| | - Carlos Cobo-Vázquez
- Department of Dental Clinical Specialties, Faculty of dentistry, Complutense University of Madrid, Pza Ramon y Cajal s/n, Madrid 28040, Spain
| | - Jorge Cortés-Bretón Brinkmann
- Department of Dental Clinical Specialties, Faculty of dentistry, Complutense University of Madrid, Pza Ramon y Cajal s/n, Madrid 28040, Spain; Surgical and Implant Therapies in the Oral Cavity Research Group, University Complutense, Madrid, Spain.
| | - Cristina Meniz-García
- Department of Dental Clinical Specialties, Faculty of dentistry, Complutense University of Madrid, Pza Ramon y Cajal s/n, Madrid 28040, Spain; Surgical and Implant Therapies in the Oral Cavity Research Group, University Complutense, Madrid, Spain
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Lin Y, Li G, Xu T, Zhou X, Luo F. The efficacy of alveolar ridge split on implants: a systematic review and meta-analysis. BMC Oral Health 2023; 23:894. [PMID: 37986181 PMCID: PMC10662563 DOI: 10.1186/s12903-023-03643-2] [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: 09/23/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVES To evaluate the effects of the alveolar ridge split (ARS) technique on gained horizontal width of the alveolar ridge and implant survival rate. MATERIALS AND METHODS Electronic searching was performed in six electronic databases (Pubmed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure, and SIGLE) from January 1, 2010, to November 1, 2023. Two authors performed study selection, data extraction, and study qualities (ROBINS-I and RoB 2.0) independently. Meta-analysis was performed by Comprehensive meta-analysis 3.0. RESULTS 24 included studies were observational, and 1 study was a randomized controlled trial (RCT). 14 studies investigated the gained width of the horizontal alveolar ridge, and 17 examined the implants' survival rate. For assessment of risk of bias, nine studies were high risk of bias and 16 studies were moderate risk of bias. Meta-analysis demonstrated that the pooled gained alveolar ridge width was 3.348 mm (95%CI: 4.163 mm, 2.533 mm), and the implant survival rate was 98.1% (95%CI: 98.9%, 96.9%). Seven studies showed seven different complications including exposure, infection, bad split, dehiscence, fracture, paresthesia and soft tissue retraction. CONCLUSION Recent ARS technique seems to be an effective method of bone augmentation with enough gained width and a high implant survival rate. Further long-term and RCTs research remains needed to enhance the study quality. CLINICAL RELEVANCE The ARS technique could generate sufficient bone volume, and implants had a high-level survival rate. Therefore, ARS has been proposed to be a reliable horizontal bone augmentation technique that creates good conditions for the implantation of narrow alveolar crests.
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Affiliation(s)
- Yuanyou Lin
- State Key Laboratory of Oral Diseases, West China School of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, China
| | - Guanlin Li
- State Key Laboratory of Oral Diseases, West China School of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, China
| | - Tingxiang Xu
- State Key Laboratory of Oral Diseases, West China School of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, China
| | - Xuexiao Zhou
- State Key Laboratory of Oral Diseases, West China School of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, China
| | - Feng Luo
- State Key Laboratory of Oral Diseases, West China School of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, China.
- Department of Prosthodontics, West China School of Stomatology, Sichuan University, No. 14, Section 3, Renmin Nanlu, Chengdu, 610041, China.
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Alotaibi FF, Rocchietta I, Buti J, D'Aiuto F. Comparative evidence of different surgical techniques for the management of vertical alveolar ridge defects in terms of complications and efficacy: A systematic review and network meta-analysis. J Clin Periodontol 2023; 50:1487-1519. [PMID: 37495541 DOI: 10.1111/jcpe.13850] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 06/04/2023] [Accepted: 06/29/2023] [Indexed: 07/28/2023]
Abstract
AIM To systematically appraise the available evidence on vertical ridge augmentation (VRA) techniques and estimate a treatment-based ranking on the incidence of complications as well as their clinical effectiveness. MATERIALS AND METHODS Searches were conducted in six databases to identify randomized clinical trials comparing VRA techniques up to November 2022. The incidence of complications (primary) and of early, major, surgical and intra-operative complications, vertical bone gain (VBG), marginal bone loss, need for additional grafting, implant success/survival, and patient-reported outcome measures (secondary) were chosen as outcomes. Direct and indirect effects and treatment ranking were estimated using Bayesian pair-wise and network meta-analysis (NMA) models. RESULTS Thirty-two trials (761 participants and 943 defects) were included. Five NMA models involving nine treatment groups were created: onlay, inlay, dense-polytetrafluoroethylene, expanded-polytetrafluoroethylene, titanium, resorbable membranes, distraction osteogenesis, tissue expansion and short implants. Compared with short implants, statistically significant higher odds ratios of healing complications were confirmed for all groups except those with resorbable membranes (odds ratio 5.4, 95% credible interval 0.92-29.14). The latter group, however, ranked last in clinical VBG. CONCLUSIONS VRA techniques achieving greater VBG are also associated with higher incidence of healing complications. Guided bone regeneration techniques using non-resorbable membranes yield the most favourable results in relation to VBG and complications.
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Affiliation(s)
- Faisal F Alotaibi
- Unit of Periodontology, UCL Eastman Dental Institute, London, UK
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | | | - Jacopo Buti
- Unit of Periodontology, UCL Eastman Dental Institute, London, UK
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Leblebicioglu B, Tatakis DN. Complications following alveolar ridge augmentation procedures. Periodontol 2000 2023; 93:221-235. [PMID: 37489632 DOI: 10.1111/prd.12509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/15/2023] [Accepted: 06/18/2023] [Indexed: 07/26/2023]
Abstract
Oral rehabilitation through implant supported dental restorations often requires a ridge augmentation procedure (RAP) prior to implant fixture placement since tooth extraction/loss results in alveolar ridge deficiencies. Although RAP-related surgical techniques and biomaterials have been in practice for several decades, outcomes are not always predictable. Post-surgical complications experienced during the early or late wound healing phases may jeopardize the targeted ideal ridge dimensions, required for implant fixture placement, and may have other consequences, such as negatively impacting the patient's quality of life. This review describes reported post-surgical complications following RAP under the following subtitles: complications by tissue type, complications in function and aesthetics, complications by healing time, complications by biomaterial type, and complications by surgical protocol modalities. Specifically, RAP performed by using particulate bone graft substitutes and related complications are explored. Modalities developed to prevent/manage these complications are also discussed.
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Affiliation(s)
- Binnaz Leblebicioglu
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, Ohio, USA
| | - Dimitris N Tatakis
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, Ohio, USA
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Mizraji G, Davidzohn A, Gursoy M, Gursoy U, Shapira L, Wilensky A. Membrane barriers for guided bone regeneration: An overview of available biomaterials. Periodontol 2000 2023; 93:56-76. [PMID: 37855164 DOI: 10.1111/prd.12502] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/21/2023] [Accepted: 05/29/2023] [Indexed: 10/20/2023]
Abstract
Dental implants revolutionized the treatment options for restoring form, function, and esthetics when one or more teeth are missing. At sites of insufficient bone, guided bone regeneration (GBR) is performed either prior to or in conjunction with implant placement to achieve a three-dimensional prosthetic-driven implant position. To date, GBR is well documented, widely used, and constitutes a predictable and successful approach for lateral and vertical bone augmentation of atrophic ridges. Evidence suggests that the use of barrier membranes maintains the major biological principles of GBR. Since the material used to construct barrier membranes ultimately dictates its characteristics and its ability to maintain the biological principles of GBR, several materials have been used over time. This review, summarizes the evolution of barrier membranes, focusing on the characteristics, advantages, and disadvantages of available occlusive barrier membranes and presents results of updated meta-analyses focusing on the effects of these membranes on the overall outcome.
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Affiliation(s)
- Gabriel Mizraji
- Department of Periodontology, Faculty of Dental Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Mervi Gursoy
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
- Oral Health Care, Welfare Division, City of Turku, Turku, Finland
| | - Ulvi Gursoy
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Lior Shapira
- Department of Periodontology, Faculty of Dental Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Asaf Wilensky
- Department of Periodontology, Faculty of Dental Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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Abdo VL, Suarez LJ, de Paula LG, Costa RC, Shibli J, Feres M, Barāo VAR, Bertolini M, Souza JGS. Underestimated microbial infection of resorbable membranes on guided regeneration. Colloids Surf B Biointerfaces 2023; 226:113318. [PMID: 37075523 DOI: 10.1016/j.colsurfb.2023.113318] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/29/2023] [Accepted: 04/12/2023] [Indexed: 04/21/2023]
Abstract
Barrier membranes are critical in creating tissuecompartmentalization for guided tissue (GTR) and bone regeneration (GBR) therapies. More recently, resorbable membranes have been widely used for tissue and bone regeneration due to their improved properties and the dispensable re-entry surgery for membrane removal. However, in cases with membrane exposure, this may lead to microbial contamination that will compromise the integrity of the membrane, surrounding tissue, and bone regeneration, resulting in treatment failure. Although the microbial infection can negatively influence the clinical outcomes of regenerative therapy, such as GBR and GTR, there is a lack of clinical investigations in this field, especially concerning the microbial colonization of different types of membranes. Importantly, a deeper understanding of the mechanisms of biofilm growth and composition and pathogenesis on exposed membranes is still missing, explaining the mechanisms by which bone regeneration is reduced during membrane exposure. This scoping review comprehensively screened and discussed the current in vivo evidence and possible new perspectives on the microbial contamination of resorbable membranes. Results from eligible in vivo studies suggested that different bacterial species colonized exposed membranes according to their composition (collagen, expanded polytetrafluoroethylene (non-resorbable), and polylactic acid), but in all cases, it negatively affected the attachment level and amount of bone gain. However, limited models and techniques have evaluated the newly developed materials, and evidence is scarce. Finally, new approaches to enhance the antimicrobial effect should consider changing the membrane surface or incorporating long-term released antimicrobials in an effort to achieve better clinical success.
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Affiliation(s)
- Victoria L Abdo
- Department of Periodontology, Dental Research Division, Guarulhos University, Praça Tereza Cristina, 88 - Centro, Guarulhos, São Paulo 07023-070, Brazil
| | - Lina J Suarez
- Department of Periodontology, Dental Research Division, Guarulhos University, Praça Tereza Cristina, 88 - Centro, Guarulhos, São Paulo 07023-070, Brazil; Departamento de Ciencias Básicas y Medicina Oral, Universidad Nacional de Colombia, Cra 45 # 26-85, Bogotá 11001, Colombia
| | - Lucca Gomes de Paula
- Dental Science School (Faculdade de Ciências Odontológicas - FCO), Av. Waldomiro Marcondes Oliveira, 20 - Ibituruna, Montes Claros, Minas Gerais 39401-303, Brazil
| | - Raphael C Costa
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Piracicaba, São Paulo 13414-903, Brazil
| | - Jamil Shibli
- Department of Periodontology, Dental Research Division, Guarulhos University, Praça Tereza Cristina, 88 - Centro, Guarulhos, São Paulo 07023-070, Brazil
| | - Magda Feres
- Department of Periodontology, Dental Research Division, Guarulhos University, Praça Tereza Cristina, 88 - Centro, Guarulhos, São Paulo 07023-070, Brazil; Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Valentim A R Barāo
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Piracicaba, São Paulo 13414-903, Brazil
| | - Martinna Bertolini
- Department of Periodontics and Preventive Dentistry, University of Pittsburgh School of Dental Medicine, 3501 Terrace St, Pittsburgh, PA 15213, USA
| | - Joāo Gabriel Silva Souza
- Department of Periodontology, Dental Research Division, Guarulhos University, Praça Tereza Cristina, 88 - Centro, Guarulhos, São Paulo 07023-070, Brazil; Dental Science School (Faculdade de Ciências Odontológicas - FCO), Av. Waldomiro Marcondes Oliveira, 20 - Ibituruna, Montes Claros, Minas Gerais 39401-303, Brazil.
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An HW, Lee J, Park JW. Surface characteristics and in vitro biocompatibility of surface-modified titanium foils as a regenerative barrier membrane for guided bone regeneration. J Biomater Appl 2023; 37:1228-1242. [PMID: 36205350 DOI: 10.1177/08853282221132351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study evaluated surface characteristics and biocompatibility of surface-modified thin titanium (Ti) foils as a regenerative barrier membrane for future application in guided bone regeneration (GBR) surgery to augment atrophic alveolar bone. Anodic oxidation and post-heat treatment were performed to prepare various Ti foil samples. Then, the in vitro soft and hard tissue compatibility of the samples was evaluated by examining the cell responses using primary human gingival fibroblasts (HGFs) and MG63 human osteoblast-like cells. Investigated Ti foil samples showed marked differences in physicochemical surface properties. Additional 400°C heat treatment applied to the anodized Ti surface led to formation of an anatase titanium dioxide structure and well-organized nanoscale protrusions, and significantly increased surface wettability. Anodization and heat treatment enhanced the growth of HGFs and MG63 cells in Ti foil samples. Additional heat treatment for 10 and 30 min further significantly improved the response of HGFs including spreading and proliferation, and upregulated the mRNA expression of cell adhesion- and maturation-related genes as well as the osteoblast differentiation of MG63 cells. Ti foil sample with thin oxide coating obtained by a 30 min heat treatment exhibited poor clinical plasticity as a regenerative barrier membrane, which showed complete coating failure in the bending test. Our results indicate that anatase Ti oxide coating of a specific film thickness with nanoscale surface protrusion morphology and hydrophilic characteristics obtained by anodization and post-heat treatment would be an effective approach as a biocompatible Ti regenerative membrane for inducing better regeneration of both gingival tissue and bone.
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Affiliation(s)
- Hyun-Wook An
- Graduate School, 34986Kyungpook National University, Daegu, Korea.,Megagen Implant R&D Center, Daegu, Korea
| | - Jaesik Lee
- Megagen Implant R&D Center, Daegu, Korea
| | - Jin-Woo Park
- Department of Pediatric Dentistry, 65498Kyungpook National University School of Dentistry, Daegu, Korea
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Moraschini V, de Queiroz TR, Sartoretto SC, de Almeida DCF, Calasans-Maia MD, Louro RS. Survival and complications of zygomatic implants compared to conventional implants reported in longitudinal studies with a follow-up period of at least 5 years: A systematic review and meta-analysis. Clin Implant Dent Relat Res 2023; 25:177-189. [PMID: 36373779 DOI: 10.1111/cid.13153] [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: 08/17/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Zygomatic implants (ZI) have been frequently indicated to rehabilitate patients with extensive atrophies in alternatives to major bone reconstructions. It can be installed inside the maxillary sinus, called instrasinus zygomatic implant (IZI) or outside the maxillary sinus (EZI), depending on the surgery technique. OBJECTIVE To evaluate the survival and complication rates of ZI in longitudinal studies when compared with conventional implants (CI). METHODS An electronic search was performed in five databases and in Gray literature for articles published until April, 2022. The eligibility criteria comprised observational cohort studies (prospective or retrospective) and randomized clinical trials (RCTs) with at least 5 years of follow-up, reporting survival rate of ZI versus CI. A meta-analysis was conduct with 18 studies. RESULTS A total of 5434 implants (2972 ZI and 2462 CI) were analyzed in 1709 patients. The mean survival rate was 96.5% ± 5.02 and 95.8% ± 6.36 for ZI and CI, respectively (mean follow-up time of 78 months). There were observed no statistically significant between ZI and CI in prospective studies (risk ratio [RR] of 1.21; 95% confidence intervals [CIs]: 0.28 to 5.28; chi-squared [Chi2 ] = 11.37; I2 = 56%; degrees of freedom [df] = 5; z-score = 0.25; P = 0.80), retrospective studies IZI (RR of 1.29; 95% CIs: 0.52 to 3.23; Chi2 = 4.07; I2 = 2%; df = 4; z-score = 0.55; P = 0.58) and retrospective studies EZI (RR of 0.72; 95% CIs: 0.31 to 1.66; Chi2 = 1.99; I2 = 0%; df = 3; z-score = 0.78; P = 0.44). The biological complications most related to ZI was sinusitis, followed by infection and oroantral communication. CONCLUSION ZI have a high long-term survival rate (96.5% with a mean of 91.5 months of follow-up), showing no significant difference when compared with CI. The most prevalent biological complication is sinusitis, being most commonly to the IZI technique. This systematic review (SR) was registered in INPLASY under number INPLASY202280025.
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Affiliation(s)
- Vittorio Moraschini
- Department of Dental Research, School of Dentistry, Veiga de Almeida University, Rio de Janeiro, Brazil.,Department of Oral Surgery, School of Dentistry, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Tiago Rocha de Queiroz
- Department of Oral Surgery, School of Dentistry, Fluminense Federal University, Rio de Janeiro, Brazil
| | | | | | | | - Rafael Seabra Louro
- Department of Oral Surgery, School of Dentistry, Fluminense Federal University, Rio de Janeiro, Brazil
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Seo GJ, Lim HC, Chang DW, Hong JY, Shin SI, Kim G, Shin SY. Primary flap closure in alveolar ridge preservation for periodontally damaged extraction socket: A randomized clinical trial. Clin Implant Dent Relat Res 2022; 25:241-251. [PMID: 36515081 DOI: 10.1111/cid.13165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The effect of primary wound closure (PC) on alveolar ridge preservation (ARP) in periodontally damaged sockets has yet to be fully discovered. METHODS Periodontally damaged sockets were allocated to one of the following groups: (1) ARP with PC (group PC), and (2) ARP without PC (group secondary wound closure [SC]). Following tooth extraction and flap elevation, granule-type xenogeneic bone substitute material and a collagen barrier were applied. Ridge change was evaluated using cone-beam computed tomographic (CBCT) scans immediately after ARP and at 4 months. Core biopsy specimens were examined histomorphometrically. RESULTS A total of 28 patients were included in the analysis (13 in group PC, 15 in group SC). Histomorphometrically, the percentage of newly formed bone was 26.2 ± 17.7% and 24.6 ± 18.4% in groups PC and SC, respectively (independent t-test, degree of freedom [df] = 25, p > 0.05). Horizontal ridge changes on CBCT were -4.9 ± 3.1 mm and - 4.2 ± 2.5 mm in groups PC and SC at the 1 mm level below the ridge crest, respectively (independent t-test, df = 26, p > 0.05). Approximately half of the sites required additional bone augmentation at implant placement. CONCLUSIONS ARP with/without PC yielded similar new bone formation and radiographic ridge change. This clinical trial was not registered prior to participant recruitment and randomization (https://cris.nih.go.kr/cris/search/detailSearch.do/19718).
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Affiliation(s)
- Gil-Jong Seo
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Hyun-Chang Lim
- Department of Periodontology, Kyung Hee University, School of Dentistry, Periodontal-Implant Clinical Research Institute, Kyung Hee University Medical Center, Seoul, South Korea
| | | | - Ji-Youn Hong
- Department of Periodontology, Kyung Hee University, School of Dentistry, Periodontal-Implant Clinical Research Institute, Kyung Hee University Medical Center, Seoul, South Korea
| | - Seung-Il Shin
- Department of Periodontology, Kyung Hee University, School of Dentistry, Periodontal-Implant Clinical Research Institute, Kyung Hee University Medical Center, Seoul, South Korea
| | - Gyutae Kim
- Department of Oral and Maxillofacial Radiology, Kyung Hee University, School of Dentistry, Kyung Hee University Medical Center, Seoul, South Korea
| | - Seung-Yun Shin
- Department of Periodontology, Kyung Hee University, School of Dentistry, Periodontal-Implant Clinical Research Institute, Kyung Hee University Medical Center, Seoul, South Korea
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Hayashi K, Kishida R, Tsuchiya A, Ishikawa K. Channel Aperture Characteristics of Carbonate Apatite Honeycomb Scaffolds Affect Ingrowths of Bone and Fibrous Tissues in Vertical Bone Augmentation. Bioengineering (Basel) 2022; 9:627. [PMID: 36354538 PMCID: PMC9687283 DOI: 10.3390/bioengineering9110627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 10/17/2023] Open
Abstract
Synthetic scaffolds with the ability to prevent fibrous tissue penetration and promote bone augmentation may realize guided bone regeneration without the use of a barrier membrane for dental implantation. Here, we fabricated two types of honeycomb scaffolds of carbonate apatite, a bone mineral analog, whose channel apertures were square (HC-S) and rectangular (HC-R). The side lengths of the HC-Ss and HC-Rs were 265.8 ± 8.9; 817.7 ± 2.4 and 267.1 ± 5.2 μm, respectively. We placed cylindrical HC-Ss and HC-Rs on the rabbit calvaria. At 4 weeks post-implantation, the HC-Ss prevented fibrous tissue penetration from the top face via the channels, which allowed the new bone to reach the top of the scaffold from the bottom face or the calvarium. In contrast, in the HC-Rs, fibrous tissues filled the channels in the top region. At 12 weeks post-implantation, the HC-Ss were partially replaced with new bone. In the top region of the HC-Rs, although new bone had formed, fibrous tissue remained. According to the findings here and in our previous study, the longer side length rather than the shorter side length of a rectangular scaffold channel aperture is the dominant factor that affects fibrous tissue penetration and new bone augmentation. Furthermore, even though channel aperture areas are similar, bone and fibrous tissue ingrowths are different when the aperture shapes are different.
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Affiliation(s)
- Koichiro Hayashi
- Department of Biomaterials, Faculty of Dental Science, Kyushu University, Fukuoka 812-8582, Japan
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Menini M, Pesce P, Delucchi F, Ambrogio G, Canepa C, Carossa M, Pera F. One-stage versus two-stage technique using two splinted extra-short implants: A multicentric split-mouth study with a one-year follow-up. Clin Implant Dent Relat Res 2022; 24:602-610. [PMID: 35700161 PMCID: PMC9796435 DOI: 10.1111/cid.13113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 05/05/2022] [Accepted: 05/21/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To compare the clinical outcomes of extra-short implants (≤6.5 mm) inserted with one-stage versus two-stage technique in adjacent sites of the upper or lower jaw. MATERIALS AND METHODS In this split-mouth multicenter study, implants were randomly divided into two groups according to the healing phase: two-stage and one-stage technique. Primary outcome measures were implant survival, implant success, and prosthodontic complications. Secondary outcome measurements were: implant stability quotient (ISQ) collected at surgery time (T0), and after 3 (T3) and 12 (T12) months, marginal bone level (MBL) evaluated at T0, T3, T6, and T12, marginal bone loss evaluated at T6 and T12, plaque index (PI), probing depth (PD), bleeding on probing (BoP) evaluated at T3, T6, and T12. Significances of differences between groups were tested by linear mixed model with random intercept. RESULTS Nineteen patients (8 males and 11 females) were included. A total of 38 implants were inserted. At T12 implant cumulative survival and implant success rate were 100% in both groups. No statistically significant differences were recorded for any of the analyzed parameters between the two groups at any time point. ISQ values were similar at T0 (two-stage: mean 67.53 ± SD 19.47; one-stage: mean 66.53 ± 19.07 p = 0.8738) and increased in both groups at the 12-month follow-up appointment (two-stage: 81.1 ± 7.04; one-stage: 81.39 ± 0.9266). MBL values were similar in the two groups at any time point. At T12 marginal bone loss was 0.46 ± 0.41 (two-stage) and 0.45 ± 0.38 (one-stage) mm (p = 0.9417), while mean PD was 2.7 ± 0.85 (two-stage) and 2.69 ± 0.89 (one-stage) mm. CONCLUSIONS Within the limits of the present short-term report, extra-short implants demonstrated optimal clinical outcomes using the one-stage technique, without statistically significant differences compared with the traditional two-stage approach.
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Affiliation(s)
- Maria Menini
- Division of Prosthodontics and Implant Prosthodontics, Department of Surgical Sciences and Integrated Diagnostics (DISC)University of GenoaGenoaItaly
| | - Paolo Pesce
- Department of Surgical Sciences and Integrated Diagnostics (DISC)University of GenoaGenoaItaly
| | - Francesca Delucchi
- Division of Prosthodontics and Implant Prosthodontics, Department of Surgical Sciences and Integrated Diagnostics (DISC)University of GenoaGenoaItaly
| | - Giulia Ambrogio
- CIR Dental School Department of Surgical SciencesUniversity of TurinTorinoItaly
| | - Camilla Canepa
- Division of Prosthodontics and Implant Prosthodontics, Department of Surgical Sciences and Integrated Diagnostics (DISC)University of GenoaGenoaItaly
| | - Massimo Carossa
- CIR Dental School Department of Surgical SciencesUniversity of TurinTorinoItaly
| | - Francesco Pera
- CIR Dental School Department of Surgical SciencesUniversity of TurinTorinoItaly
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The “Sling” Technique for Horizontal Guided Bone Regeneration: A Retrospective Case Series. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12125889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The aim of this retrospective case series was to present a new technique, called the “sling technique”, for massive horizontal alveolar ridge augmentation through the innovative use of an expanded polytetrafluoroethylene (e-PTFE) membrane to reduce the risk of biological complications related to membrane exposure. Materials and Methods: Eligible patients for implant rehabilitation with a horizontal bone defect were enrolled in our study. All patients were treated with our new GBR approach, called the “sling technique” (ST), which consisted of covering the vestibular side of the bone defect with a stretched e-PTFE membrane. This technique allowed the amplification of the membrane surface as long as the compression and the immobilization of the underlying graft material remained (1:1 autologous bone and bovine xenograft). The membrane was placed far from the surgical incision of the mucosa to avoid infective complications. Pre- and post-regenerative surgery CBCT scans were used to assess the tissue gain amount after the GBR. Results: A total of 10 patients (4 females, 6 males; age range: 45–60 years old) were enrolled in our study and 33 implants were placed in regenerated bone. An average of 4 mm bone gain was achieved using the ST. No membrane exposures or biological complications were registered during the post-operative healing period. After a 24-month follow-up, a 100% implant survival rate was observed without hard or soft tissue dehiscence. Conclusion: The e-PTFE membrane positioned with the “sling technique” gave satisfactory results in horizontal bone augmentation. Considering the small sample, further confirmations with larger studies are needed.
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Mohd N, Razali M, Ghazali MJ, Abu Kasim NH. 3D-Printed Hydroxyapatite and Tricalcium Phosphates-Based Scaffolds for Alveolar Bone Regeneration in Animal Models: A Scoping Review. MATERIALS 2022; 15:ma15072621. [PMID: 35407950 PMCID: PMC9000240 DOI: 10.3390/ma15072621] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/18/2022] [Accepted: 03/29/2022] [Indexed: 02/07/2023]
Abstract
Three-dimensional-printed scaffolds have received greater attention as an attractive option compared to the conventional bone grafts for regeneration of alveolar bone defects. Hydroxyapatite and tricalcium phosphates have been used as biomaterials in the fabrication of 3D-printed scaffolds. This scoping review aimed to evaluate the potential of 3D-printed HA and calcium phosphates-based scaffolds on alveolar bone regeneration in animal models. The systematic search was conducted across four electronic databases: Ovid, Web of Science, PubMed and EBSCOHOST, based on PRISMA-ScR guidelines until November 2021. The inclusion criteria were: (i) animal models undergoing alveolar bone regenerative surgery, (ii) the intervention to regenerate or augment bone using 3D-printed hydroxyapatite or other calcium phosphate scaffolds and (iii) histological and microcomputed tomographic analyses of new bone formation and biological properties of 3D-printed hydroxyapatite or calcium phosphates. A total of ten studies were included in the review. All the studies showed promising results on new bone formation without any inflammatory reactions, regardless of the animal species. In conclusion, hydroxyapatite and tricalcium phosphates are feasible materials for 3D-printed scaffolds for alveolar bone regeneration and demonstrated bone regenerative potential in the oral cavity. However, further research is warranted to determine the scaffold material which mimics the gold standard of care for bone regeneration in the load-bearing areas, including the masticatory load of the oral cavity.
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Affiliation(s)
- Nurulhuda Mohd
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Masfueh Razali
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
- Correspondence:
| | - Mariyam Jameelah Ghazali
- Department of Mechanical & Manufacturing Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia, Bangi 43600, Selangor, Malaysia;
| | - Noor Hayaty Abu Kasim
- Faculty of Dentistry, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
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