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Mafra IJ, Bordin D, Siroma RS, Moraschini V, Faverani LP, Souza JG, Mourão CF, Shibli JA. Additive Manufacturing Titanium Dental Implants Placed in Sinuses Grafted with 70HA:30-TCP: A One-Year Retrospective Study for Evaluation of Survival Rate. Dent J (Basel) 2024; 12:181. [PMID: 38920882 PMCID: PMC11202463 DOI: 10.3390/dj12060181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/27/2024] [Accepted: 06/04/2024] [Indexed: 06/27/2024] Open
Abstract
The present short-term retrospective study evaluated the implant survival rate and peri-implant bone loss around additive-manufactured titanium implants placed in sinuses grafted with Plenum Osshp (Plenum Bioengenharia, Jundia, SP, Brazil) (70HA:30β-TCP) material. A total of 39 implants were inserted after 23 sinus floor elevation procedures in 16 consecutive patients. Prosthetic rehabilitation included fixed partial prostheses (three units), single crowns (eleven units), and fixed full arches (three units). Clinical and radiographic parameters of implant-supported restorations were evaluated after at least one year of occlusal loading. The implant-crown success criteria included the absence of pain, suppuration, and clinical mobility, an average distance between the implant shoulder and the first visible bone contact (DIB) < 1.0 mm from the initial surgery, and the absence of prosthetic complications at the implant-abutment interface. The overall cumulative implant survival rate was 97.43%. No prosthetic complications at the implant-abutment interface were reported. After one year, the mean DIB was 0.23 mm ± 0.14. Within the limits of this retrospective study, it can be concluded that 70 HA:30 β-TCP allowed stable and reliable bone support to maintain healthy conditions around titanium dental implants produced by additive manufacturing.
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Affiliation(s)
- Ilton José Mafra
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos 07023-070, SP, Brazil; (I.J.M.); (D.B.); (R.S.S.); (J.G.S.)
| | - Dimorvan Bordin
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos 07023-070, SP, Brazil; (I.J.M.); (D.B.); (R.S.S.); (J.G.S.)
| | - Rafael S. Siroma
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos 07023-070, SP, Brazil; (I.J.M.); (D.B.); (R.S.S.); (J.G.S.)
| | - Vittorio Moraschini
- Department of Periodontology, Dental Research Division, School of Dentistry, Veiga de Almeida University, Rua Ibituruna, 108, Maracanã, Rio de Janeiro 20271-020, RJ, Brazil;
| | - Leonardo P. Faverani
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery and Implantology, School of Dentistry, São Paulo State University (UNESP), R. José Bonifácio, 1193—V. Mendonca, Araçatuba 16015-050, SP, Brazil;
| | - João Gabriel Souza
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos 07023-070, SP, Brazil; (I.J.M.); (D.B.); (R.S.S.); (J.G.S.)
| | - Carlos Fernando Mourão
- Department of Periodontology, Tufts University School of Dental Medicine, Boston, MA 02111, USA
| | - Jamil Awad Shibli
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos 07023-070, SP, Brazil; (I.J.M.); (D.B.); (R.S.S.); (J.G.S.)
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Gasparro R, Di Lauro AE, Campana MD, Rosiello N, Mariniello M, Sammartino G, Marenzi G. Effectiveness of Autologous Platelet Concentrates in the Sinus Lift Surgery: Findings from Systematic Reviews and Meta-Analyses. Dent J (Basel) 2024; 12:101. [PMID: 38668013 PMCID: PMC11049363 DOI: 10.3390/dj12040101] [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: 01/31/2024] [Revised: 03/20/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Maxillary sinus augmentation is one of the most predictable procedures for the rehabilitation of the posterior maxilla. The current overview aimed to summarize the findings provided by systematic reviews (SRs) and meta-analyses on the effectiveness of autologous platelet concentrates (APCs) in sinus lift and to assess the methodological quality of the included SRs. Three electronic databases have been explored. SRs and meta-analyses addressing the effectiveness of APCs in sinus lift technique were included. Clinical, radiographic and histomorphometric findings were considered for APCs as solely grafting materials and APCs in combination with biomaterials. Outcomes were implant survival rate (ISR), implant stability (IS), implant failure (IF), postoperative complications, histomorphometric findings, radiographic bone gain, bone volume and bone density. The methodological quality of the included SRs was assessed using the updated version of "A Measurement Tool to Assess Systematic Review" (AMSTAR-2). Thirty SRs were included. The methodological quality of the included reviews ranged from critically low (3 studies) to high (9 studies). The included SRs showed favorable clinical outcomes, short-term new bone formation and no biological complications when APCs were used both as solely graft material or in combination with other biomaterials. However, no significant additional effects in the long-term period were observed. APCs did not add any further positive effects compared to the physiological healing derived by the natural blood clot. The current overview of SRs highlighted the need for high-quality SRs evaluating the role of APCs in sinus lift though network meta-analyses, in order to identify the most powerful material for sinus lift augmentation. The use of APCs improves the healing of soft tissues and the postoperative quality of life in the short-term period. Thus, its application can be recommended.
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Affiliation(s)
| | | | | | | | | | - Gilberto Sammartino
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Oral Surgery, University of Naples Federico II, 80131 Naples, Italy; (R.G.); (A.E.D.L.); (M.D.C.); (N.R.); (M.M.); (G.M.)
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Ren J, Li Z, Liu W, Fan Y, Qi L, Li S, Kong C, Zou H, Liu Z. Demineralized bone matrix for repair and regeneration of maxillofacial defects: A narrative review. J Dent 2024; 143:104899. [PMID: 38428719 DOI: 10.1016/j.jdent.2024.104899] [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: 01/08/2024] [Revised: 02/14/2024] [Accepted: 02/23/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVES Demineralized bone matrix (DBM) is a well-established bone graft material widely accepted by dentists and the public for its favorable osteoconductivity and osteoinductive potential. This article aimed to provide a narrative review of the current therapeutic applications and limitations of DBM in maxillofacial bone defects. STUDY SELECTION, DATA, AND SOURCES Randomized controlled trials, prospective or retrospective clinical studies, case series and reports, and systematic reviews. MEDLINE, PubMed, and Google Scholar were searched using keywords. CONCLUSIONS Some evidence supported the therapeutic application of DBM in periodontal intrabony defects, maxillary sinus lifts, ridge preservation, ridge augmentation, alveolar cleft repair, orthognathic surgery, and other regional maxillofacial bone defects. However, the limitations of DBM should be considered when using it, including potential low immunogenicity, instability of osteoinductive potential, handling of the graft material, and patient acceptance. CLINICAL SIGNIFICANCE With the increasing demand for the treatment of maxillofacial bone defects, DBM is likely to play a greater role as a promising bone graft material. Safe and effective combination treatment strategies and how to maintain a stable osteoinductive potential will be the future challenges of DBM research.
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Affiliation(s)
- Jiwei Ren
- Hospital of Stomatology, Jilin University, China
| | - Zhiwei Li
- Hospital of Stomatology, Jilin University, China
| | - Wantong Liu
- Hospital of Stomatology, Jilin University, China
| | - Yixin Fan
- Hospital of Stomatology, Jilin University, China
| | - Le Qi
- Hospital of Stomatology, Jilin University, China
| | - Sining Li
- Hospital of Stomatology, Jilin University, China
| | - Chen Kong
- Hospital of Stomatology, Jilin University, China
| | - He Zou
- Hospital of Stomatology, Jilin University, China
| | - Zhihui Liu
- Hospital of Stomatology, Jilin University, China.
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Valentini P, Calciolari E, Monlezun S, Akcalı A, Donos N, Quirynen M. APCs in sinus floor augmentation. Periodontol 2000 2024. [PMID: 38363055 DOI: 10.1111/prd.12554] [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: 09/23/2023] [Revised: 12/18/2023] [Accepted: 01/21/2024] [Indexed: 02/17/2024]
Abstract
After tooth loss in the posterior area of the maxilla, sinus floor elevation is often required to compensate the vertical bone loss due to sinus pneumatization. This narrative review reports on the potential benefits of autologous platelet concentrates (APCs) during this procedure. As for transcrestal approach, APCs have been used as "sole" substitute/graft. However, because of the low number of clinical trials available with PRGF, and even none for PRP, no definitive conclusions can be made regarding their efficacy. The number of studies on the use of L-PRF were outnumbered indicating good feasibility for vertical bone gain, with a high implant survival rate and a low degree of complications. PRP and PRGF have not been studied as a "single/sole" substitute for a one-stage lateral window approach, probably because of the weak physical characteristics of the membranes. L-PRF alone appears to be a predictable grafting material for lateral maxillary sinus grafting and a reduced RBH should not be considered as a risk factor. Compared to a "standard" bone substitute L-PRF shows slightly less vertical bone gain (consider enough membrane application and use of bony window as new sinus floor roof over the implant apices), enhanced early resorption (first 6 months after application), but a similar stable bone gain afterward. For a two-stage lateral window approach, APCs "alone" cannot be recommended, due to their weak withstand to the sinus pneumatization forces. APCs combined with bone substitutes seem to accelerate bone formation, without any additional benefits on the long-term new bone gain. The use of L-PRF membranes for the treatment of perforations appears to be an effective treatment option, but further clinical studies are needed to confirm this. Even though the abovementioned statements are based on large numbers of studies, additional RCTs comparing APCs with different types of grafting procedures for sinus elevation are needed.
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Affiliation(s)
- Pascal Valentini
- Department of Implant Surgery Tattone Hospital, University of Corsica Pasquale Paoli, Institute of Health, Corte, France
| | - Elena Calciolari
- Centre for Oral Clinical Research, Institute of Dentistry, Barts & The London School of Medicine and Dentistry, London, UK
- Dental school, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Sebastien Monlezun
- Department of Implant Surgery Tattone Hospital, University of Corsica Pasquale Paoli, Institute of Health, Corte, France
| | - Aliye Akcalı
- Centre for Oral Clinical Research, Institute of Dentistry, Barts & The London School of Medicine and Dentistry, London, UK
- Department of Periodontology, Dental Faculty, University of Dokuz Eylul, Izmir, Turkey
| | - Nikos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Barts & The London School of Medicine and Dentistry, London, UK
| | - Marc Quirynen
- Department of Oral Health Sciences, Katholieke Universiteit Leuven & University Hospitals Leuven, (section Periodontology), Leuven, Belgium
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Wang Z, Zhang J, Li N, Pu R, Wang Y, Yang G. Survival analysis of implants placed simultaneously with lateral sinus floor elevation in severely atrophic maxilla: A 3- to 12-year retrospective cohort study. Clin Implant Dent Relat Res 2023; 25:1069-1079. [PMID: 37442813 DOI: 10.1111/cid.13249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/21/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES To retrospectively evaluate whether implants placed simultaneously with lateral sinus floor elevation (LSFE) in severely atrophic maxilla (residual bone height [RBH] ≤3 mm) could achieve long-term survival and comprehensively analyze the factors influencing their survival rates. MATERIALS AND METHODS A total of 123 patients receiving LSFE and simultaneous implant placement from 2010 to 2019 and their 123 implants in sites with RBH ≤3 mm were included in this study. Basic characteristics of patients and implants were collected from the medical record system and cone-beam computed tomography (CBCT) images. Kaplan-Meier survival curves were applied to estimate cumulative survival rates (CSRs) and Cox proportional hazards regression models were used to detect factors influencing implant survival. RESULTS The 6-year and 12-year CSR of implants placed in sites with RBH ≤3 mm were 95.7% (95% confidence interval [CI]: 92.1%-99.5%) and 76.6% (95% CI: 58.1%-100%), respectively. Eight patients presented late implant failure. Univariate and multivariate Cox regression analyses demonstrated that RBH ≤2 mm (hazard ratio [HR]: 20.63, p = 0.000) and smoking habit (HR: 6.055, p = 0.024) were significantly associated with long-term implant survival. Specifically, the 10-year CSR of implants in sites with RBH ≤2 mm (53.3%, 95% CI: 27.5%-100%) was dramatically lower than those in sites with RBH >2 mm (92.9%, 95% CI: 81.7%-100%, p = 0.000). CONCLUSIONS Implants placed simultaneously with LSFE in sites with RBH ≤3 mm can achieve long-term survival. However, caution is required especially for implantation in sites with RBH ≤2 mm. Besides, the smoking habit is also considered a risk factor jeopardizing long-term implant survival.
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Affiliation(s)
- Zhikang Wang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, People's Republic of China
| | - Jing Zhang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, People's Republic of China
| | - Na Li
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, People's Republic of China
| | - Rui Pu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, People's Republic of China
| | - Ying Wang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, People's Republic of China
| | - Guoli Yang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, People's Republic of China
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Shi S, Han L, Su J, Guo J, Yu F, Zhang W. Clinical efficacy of transcrestal sinus floor augmentation, in comparison with lateral approach, in sites with residual bone height ≤6 mm: A systematic review and meta-analysis. Clin Oral Implants Res 2023; 34:1151-1175. [PMID: 37548090 DOI: 10.1111/clr.14155] [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: 01/17/2023] [Revised: 07/05/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE This paper addressed two focused questions: Focused question 1 (Q1) "what is the clinical efficacy of transcrestal sinus floor augmentation (TSFA), as compared to lateral sinus floor augmentation (LSFA) in sites with residual bone height (RBH) ≤6 mm, in randomized clinical trials (RCTs) and controlled clinical trials (CCTs)?"; Focused question 2 (Q2) "what is the estimated effectiveness of TSFA for outcomes in Q1, in RCTs, CCTs or cohort studies?" MATERIALS AND METHODS An electronic search (PubMed, EMBASE, The Cochrane Central Register of Controlled Trials) and hand search were conducted from January 1986 until December 2022. All eligible clinical studies expressly reporting TSFA in sites with RBH ≤6 mm were included. The data were extracted, and the risk of bias in individual studies was evaluated. Meta-analysis was performed whenever possible. RESULTS Seven RCTs were included for Q1 and 25 studies (9 RCTs, 2 CCTs, 14 single arm cohort studies) for Q2. Q1: Meta-analysis did not show significant difference in the implant survival, sinus membrane perforation and marginal bone loss between TSFA and LSFA groups. Q2: Meta-analysis showed TSFA had a high implant survival rate (96.5%, 95% CI: 93.2%-98.9%) at least 1 year after surgery, and limited sinus membrane perforation (5.4%, 95% CI: 2.7%-8.8%). The results also presented higher patient satisfaction for TSFA. CONCLUSION With the limitations of the present study (high risk of bias in individual studies), it can be concluded that there was no significant difference in implant survival, Schneiderian membrane perforation and MBL between two approaches in sites with RBH ≤6 mm.
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Affiliation(s)
- Shaojie Shi
- Department of Stomatology, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Luyao Han
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Jun Su
- Department of Stomatology, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Jianmei Guo
- Department of Stomatology, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Fan Yu
- Department of Stomatology, 927th Hospital of Joint Logistics Support Force, Pu'er, China
| | - Wenyun Zhang
- Department of Stomatology, 920th Hospital of Joint Logistics Support Force, Kunming, China
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Pawelke J, Vinayahalingam V, Heiss C, Budak M, El Khassawna T, Knapp G. Comparison of Nanocrystalline Hydroxyapatite Bone Graft with Empty Defects in Long Bone Fractures: A Retrospective Case-Control Study. Med Sci Monit 2023; 29:e941112. [PMID: 37872747 PMCID: PMC10612429 DOI: 10.12659/msm.941112] [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: 05/14/2023] [Accepted: 08/16/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND The regeneration of bone defects is indicated to restore lost tissue mass and functionality. Ostim®, an absorbable nanocrystalline hydroxyapatite (NCHA) paste, is indicated to enhance bone regeneration in bone defects due to trauma or surgery. This retrospective study of 110 patients with long-bone fracture defects presenting at a single trauma center between 2010 and 2012 aimed to compare outcomes with and without the use of Ostim® absorbable nanocrystalline hydroxyapatite paste. MATERIAL AND METHODS The study encompassed fractures in 110 patients - 55 patients received any defect augmentation (ED) and 55 patients were treated with NCHA augmentation. Fractures were located at the distal radius (66.4%, n=73), proximal humerus (5.5%, n=6), and proximal tibia (28.2%, n=31). Evaluating the clinical follow-up, the study encompassed post-surgery complications (eg, non-unions, infection). Bone healing was evaluated by conventional radiographs. RESULTS Postoperative complications occurred in 45.5% of patients regardless of the treatment (P=1.0). The non-union rate in both groups was 5.5% (n=8, P=1.0), and the risk for infection was lower in the NCHA group (3.6%, ED: n=3, NCHA: n=1, p=0.62). Patients suffered open fractures were treated in the NCHA group (100%, n=7, P=0.003). Radiological assessment demonstrated comparable healing of the fracture border, fracture gap, and articular surface (P>0.05). CONCLUSIONS The findings from this retrospective study support previous studies that have shown Ostim® absorbable nanocrystalline hydroxyapatite paste enhances outcomes and reduces the risk of complications when used to repair bone defects in long-bone fractures in trauma patients. NCHA paste augmentation is suitable for use in traumatic long-bone fractures.
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Affiliation(s)
- Jonas Pawelke
- Department of Experimental Trauma Surgery, Faculty of Medicine, Justus Liebig University, Giessen, Germany
| | - Vithusha Vinayahalingam
- Department of Experimental Trauma Surgery, Faculty of Medicine, Justus Liebig University, Giessen, Germany
| | - Christian Heiss
- Department of Experimental Trauma Surgery, Faculty of Medicine, Justus Liebig University, Giessen, Germany
- Department of Trauma, Hand and Reconstructive Surgery, Faculty of Medicine, Justus Liebig University, Giessen, Germany
| | - Matthäus Budak
- Department of Trauma, Hand and Reconstructive Surgery, Faculty of Medicine, Justus Liebig University, Giessen, Germany
| | - Thaqif El Khassawna
- Department of Experimental Trauma Surgery, Faculty of Medicine, Justus Liebig University, Giessen, Germany
| | - Gero Knapp
- Department of Trauma, Hand and Reconstructive Surgery, Faculty of Medicine, Justus Liebig University, Giessen, Germany
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Li X, Lin SC, Duan SY. The impact of deproteinized bovine bone particle size on histological outcomes in sinus floor elevation: a systematic review and meta-analysis. Int J Implant Dent 2023; 9:35. [PMID: 37782429 PMCID: PMC10545653 DOI: 10.1186/s40729-023-00502-1] [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: 03/26/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVES The main purpose of this study was to evaluate whether large granular bovine bone can be as effective as small granular bovine bone in maxillary sinus floor elevation. METHODS A comprehensive online search of eligible articles was conducted using PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science, and a systematic review and meta-analysis was performed from establishment to February, 2023. The outcome indicators were the percentage of connective tissue, the percentage of newly formed bone and the percentage of residual xenograft respectively. The meta-analysis was conducted by using the Stata 15.1 (Stata Conpernarn, USA) and Review Manager software5.4.1. RESULTS After careful screening and review, a total of 4 studies were included for systematic review and meta-analysis. The data were extracted to compare the histological performance of bovine bones with different particle sizes after maxillary sinus elevation. No significant differences were found in the percentage of connective tissue, the percentage of newly formed bone, and the percentage of residual xenograft. CONCLUSION In this study, a systematically review of the previous literature showed that similar histological results were obtained for both large-particle bovine bone and small-particle bovine bone. Therefore, the large granular bovine bone and the small granular bovine bone were equally effective in maxillary sinus elevation. It is difficult to make conclusion from limited evidence from four studies. More clinical evidence was needed.
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Affiliation(s)
- Xin Li
- Department of Stomatology, Electric Power Teaching Hospital, Capital Medical University, No.1, Taipingqiao Xili, Fengtai District, Beijing, 100073, China
| | - Shi-Chen Lin
- Department of Stomatology, Electric Power Teaching Hospital, Capital Medical University, No.1, Taipingqiao Xili, Fengtai District, Beijing, 100073, China
| | - Shao-Yu Duan
- Department of Stomatology, Electric Power Teaching Hospital, Capital Medical University, No.1, Taipingqiao Xili, Fengtai District, Beijing, 100073, China.
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Miyauchi Y, Izutani T, Teranishi Y, Iida T, Nakajima Y, Xavier SP, Baba S. Healing Patterns of Non-Collagenated Bovine and Collagenated Porcine Xenografts Used for Sinus Floor Elevation: A Histological Study in Rabbits. J Funct Biomater 2022; 13:jfb13040276. [PMID: 36547536 PMCID: PMC9787467 DOI: 10.3390/jfb13040276] [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: 11/22/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Objective: To compare healing of collagenated and non-collagenated xenografts used for maxillary sinus floor elevation. Materials and Methods: Two different xenografts were used: deproteinized bovine bone (DBBM group) and collagenated corticocancellous porcine bone (collagenated group). Healing was studied after 2, 4, and 8 weeks. The loss of dimensions of the elevated area and the percentages of new bone, xenograft remnants, osteoclastic zones, vessels, inflammatory infiltrates, and soft tissues were analyzed. Three regions were evaluated: close to the bone walls (bone wall region), subjacent the sinus mucosa (submucosa region), and the center of the elevated area (middle region). The primary variables were the percentage of new bone and xenograft remnants. Results: Between 2 and 8 weeks, the elevated areas showed a reduction of 16.3% and 52.2% in the DBBM and collagenated groups, respectively (p < 0.01 between the two areas after 8 weeks). After 8 weeks, the highest content of new bone was observed in the bone wall region, which was higher in the collagenated group than in the DBBM group (41.6% and 28.6%, respectively; p < 0.01). A similar quantity of new bone was found between the two groups in other regions. A higher percentage of vessels in all regions evaluated (p < 0.01) and soft tissue in the sub-mucosa region (p < 0.05) was found in the collagenated group than in the DBBM group. Conclusions: The present study showed that both xenografts allowed new bone formation. In comparison with the non-collagenated xenograft, the collagenated xenograft underwent higher resorption, resulting in greater shrinkage of the elevated space after sinus lifting and a higher content of new bone in the regions close to the bone walls. Clinical relevance: In this study, the region adjacent to the bone wall showed the highest new bone content. This region resembles the base of the sinus, closest to the sinus floor and walls, and is the most important region from a clinical point of view because it is where the implant will be installed. Residues of the biomaterial remained after 8 weeks of healing. Other reports have shown that these biomaterial residues may interfere with the integration of implants.
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Affiliation(s)
- Yuhei Miyauchi
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka 573-1121, Japan
| | - Takayuki Izutani
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka 573-1121, Japan
| | - Yuki Teranishi
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka 573-1121, Japan
| | - Takahisa Iida
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka 573-1121, Japan
| | - Yasushi Nakajima
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka 573-1121, Japan
- ARDEC Academy, Viale Giovanni Pascoli 67, 47923 Rimini, Italy
| | - Samuel Porfirio Xavier
- ARDEC Academy, Viale Giovanni Pascoli 67, 47923 Rimini, Italy
- Department of Oral and Maxillofacial Surgery and Periodontology, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-904, São Paulo, Brazil
- Correspondence:
| | - Shunsuke Baba
- Department of Oral Implantology, Osaka Dental University, 8-1 Kuzuhahanazonocho, Hirakata, Osaka 573-1121, Japan
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Korn P, Gellrich NC, Spalthoff S, Jehn P, Eckstein F, Lentge F, Zeller AN, Rahlf B. Managing the severely atrophic maxilla: Farewell to zygomatic implants and extensive augmentations? JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:562-565. [PMID: 34896647 DOI: 10.1016/j.jormas.2021.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Dental rehabilitation of severe atrophic upper jaws remains challenging. A new generation of subperiosteally placed and rigid multi-vector bone-anchored patient-specific implants proposes an innovative line extension in implant dentistry. This single-center retrospective study focused on treating severely atrophic maxillae using these implants. METHODS All patients who were treated with a patient-specific implant (IPS Implant® Preprosthetic, KLS-Martin, Tuttlingen, Germany) at Hannover Medical School due to severe atrophy of the maxilla who had no history of malignancy, cleft lip or palate, or trauma were evaluated regarding implant stability and prosthetic restoration, as well as complications. RESULTS Out of a total of 58 inserted implants, 13 implants in 10 patients, which were placed to treat a severely atrophic upper jaw, were identified. The mean follow-up period was 8.2 months (1-29 months). All implants were clinically stable over the entire period. All patients with an observation period of over 2 months received prosthetics for restoration. Minor complications, screw fractures, infection, and exposure of the framework were observed, but these did not lead to failure. CONCLUSION This initial follow-up suggests that this new generation of implants represents a valuable treatment alternative, especially for patients with a history of failed dental implant placement. Larger numbers of cases and longer observation periods are required to confirm our findings.
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Affiliation(s)
- Philippe Korn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Nils-Claudius Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Simon Spalthoff
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Philipp Jehn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Fabian Eckstein
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Fritjof Lentge
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Alexander-Nicolai Zeller
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Björn Rahlf
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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11
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Diehl D, Friedmann A, Liedloff P, Jung RM, Sculean A, Bilhan H. Adjunctive Application of Hyaluronic Acid in Combination with a Sodium Hypochlorite Gel for Non-Surgical Treatment of Residual Pockets Reduces the Need for Periodontal Surgery-Retrospective Analysis of a Clinical Case Series. MATERIALS (BASEL, SWITZERLAND) 2022; 15:6508. [PMID: 36233855 PMCID: PMC9571901 DOI: 10.3390/ma15196508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
The comprehensive treatment of periodontitis stage 2 to 4 aims at the resolution of periodontal inflammation and “pocket closure”, which implies a residual probing depth of ≤4 mm and a negative BoP. However, supportive periodontal therapy (SPT) regularly leaves behind persistent periodontal pockets with 5 or more mm in residual PPD and sites that often re-colonize and re-infect. Various adjunctive options for subgingival instrumentation have been proposed to enhance the antimicrobial effects to better control the re-infection of these residual sites. The locally applied adjuncts, based on their anti-inflammatory effect, are sodium hypochlorite antiseptic cleaning gel and cross-linked hyaluronic acid (xHyA). Both recently moved into the focus of clinical research on non-surgical and surgical therapy for periodontitis. The surgical use of xHyA indicates regenerative potential, supporting periodontal regeneration. This case series retrospectively analyzes the clinical benefits of the consecutive flapless application of sodium-hypochlorite-based cleaning gel and xHyA at the SPT to achieve pocket closure, thereby reducing the need for periodontal surgery. In 29 patients, 111 sites received the treatment sequence. At 6-month re-evaluation, an overall PPD reduction exceeding 2 mm was achieved, associated with a similar CAL gain (2.02 mm); the bleeding tendency (BoP) was reduced by >60%. Pocket closure occurred in almost 25% of all the sites. Within their limits, the present data suggest that the proposed combined adjunctive treatment of residual active periodontal sites yielded significant improvement in the clinical parameters. Further studies in RCT format are required to confirm these observations.
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Affiliation(s)
- Daniel Diehl
- Department of Periodontology, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
- Institute of Pharmacology and Toxicology, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Anton Friedmann
- Department of Periodontology, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Pheline Liedloff
- Department of Periodontology, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Rico Marvin Jung
- Department of Periodontology, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, 3012 Bern, Switzerland
| | - Hakan Bilhan
- Department of Periodontology, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
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12
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Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2022; 128:248-330. [PMID: 36096911 DOI: 10.1016/j.prosdent.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 11/23/2022]
Abstract
The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2021 dental literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to coverage of this broad topical area. Specific subject areas addressed, in order of the appearance in this report, include COVID-19 and the dental profession (new); prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence daily dental treatment decisions with an emphasis on future trends in dentistry. With the tremendous volume of dentistry and related literature being published daily, this review cannot possibly be comprehensive. Rather, its purpose is to update interested readers and provide important resource material for those interested in pursuing greater details on their own. It remains our intent to assist colleagues in negotiating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the patients and dental problems they encounter.
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13
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Granel H, Bossard C, Collignon AM, Wauquier F, Lesieur J, Rochefort GY, Jallot E, Lao J, Wittrant Y. Osteogenic Effect of Fisetin Doping in Bioactive Glass/Poly(caprolactone) Hybrid Scaffolds. ACS OMEGA 2022; 7:22279-22290. [PMID: 35811886 PMCID: PMC9260777 DOI: 10.1021/acsomega.2c01109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
Treating large bone defects or fragile patients may require enhancing the bone regeneration rate to overcome a weak contribution from the body. This work investigates the osteogenic potential of nutrient fisetin, a flavonoid found in fruits and vegetables, as a doping agent inside the structure of a SiO2-CaO bioactive glass-poly(caprolactone) (BG-PCL) hybrid scaffold. Embedded in the full mass of the BG-PCL hybrid during one-pot synthesis, we demonstrate fisetin to be delivered sustainably; the release follows a first-order kinetics with active fisetin concentration being delivered for more than 1 month (36 days). The biological effect of BG-PCL-fisetin-doped scaffolds (BG-PCL-Fis) has been highlighted by in vitro and in vivo studies. A positive impact is demonstrated on the adhesion and the differentiation of rat primary osteoblasts, without an adverse cytotoxic effect. Implantation in critical-size mouse calvaria defects shows bone remodeling characteristics and remarkable enhancement of bone regeneration for fisetin-doped scaffolds, with the regenerated bone volume being twofold that of nondoped scaffolds and fourfold that of a commercial trabecular bovine bone substitute. Such highly bioactive materials could stand as competitive alternative strategies involving biomaterials loaded with growth factors, the use of the latter being the subject of growing concerns.
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Affiliation(s)
- Henri Granel
- INRAE,
Human Nutrition Unit (UNH), ECREIN Team, TSA 50400, 28 Place Henri Dunant, Clermont-Ferrand, Auvergne-Rhone-Alpes 63001, France
| | - Cédric Bossard
- Université
Clermont Auvergne, Laboratoire De Physique De Clermont Ferrand, 4 Avenue Blaise Pascal, Clermont-Ferrand, Auvergne-Rhône-Alpes 63001, France
| | - Anne-Margaux Collignon
- Descartes
University of Paris Faculty of Dental Surgery, Laboratoires Pathologies,
Imagerie et Biothérapies Orofaciales,1 Rue Maurice Arnoux, Montrouge, Île-De-France 92120, France
| | - Fabien Wauquier
- INRAE,
Human Nutrition Unit (UNH), ECREIN Team, TSA 50400, 28 Place Henri Dunant, Clermont-Ferrand, Auvergne-Rhone-Alpes 63001, France
| | - Julie Lesieur
- Descartes
University of Paris Faculty of Dental Surgery, Laboratoires Pathologies,
Imagerie et Biothérapies Orofaciales,1 Rue Maurice Arnoux, Montrouge, Île-De-France 92120, France
| | - Gael Y. Rochefort
- Descartes
University of Paris Faculty of Dental Surgery, Laboratoires Pathologies,
Imagerie et Biothérapies Orofaciales,1 Rue Maurice Arnoux, Montrouge, Île-De-France 92120, France
| | - Edouard Jallot
- Université
Clermont Auvergne, Laboratoire De Physique De Clermont Ferrand, 4 Avenue Blaise Pascal, Clermont-Ferrand, Auvergne-Rhône-Alpes 63001, France
| | - Jonathan Lao
- Université
Clermont Auvergne, Laboratoire De Physique De Clermont Ferrand, 4 Avenue Blaise Pascal, Clermont-Ferrand, Auvergne-Rhône-Alpes 63001, France
| | - Yohann Wittrant
- INRAE,
Human Nutrition Unit (UNH), ECREIN Team, TSA 50400, 28 Place Henri Dunant, Clermont-Ferrand, Auvergne-Rhone-Alpes 63001, France
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Küçükkurt S, Moharamnejad N. Comparison of the effects of three different xenogeneic bone grafts used in sinus augmentation simultaneous with dental implant placement on the survival of the implants and the dimensional changes of the region. Minerva Dent Oral Sci 2022; 70:248-256. [PMID: 35075889 DOI: 10.23736/s2724-6329.21.04521-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Xenografts can be produced in various particle sizes by using different bone types. Currently, there is no consensus about the ideal type of xenograft for sinus augmentations, and this choice depends on the personal experience of clinicians. This retrospective study aimed to evaluate the effects of three different xenografts used in sinus augmentation simultaneously with implant placement on the survival of the implants and the dimensional changes of the region. METHODS One hundred nine sinus augmentations and 164 implants were evaluated in 76 patients. Three different xenografts were used: 41 Gen-Os® (250-1000µm, Corticocancellous; Tecnoss, Giaveno, Turin, Italy), 35 Bio-Oss® (1000-2000µm, Cancellous; Geistlich Biomaterials italia S.r.l., Vicenza, Italy) and 33 Apatos-Cortical® (600-1000µm, Cortical; Tecnoss). The preoperative, postoperative, and follow-up (21±8.8 month) radiographs were evaluated for the dimensional changes and the implant survivals. The data were statistically analyzed. RESULTS Among the implant failures; 3 (5.6%) in 53 implants in Apatos, 2 (3.6%) in 55 implants in Bio-Oss, 9 (16%) in 56 implants in Gen-Os, and 14 (8.5%) total implant failures were observed. This difference between the groups was statistically significant and was due to the high loss rate in the Gen-Os (P=0.044). There was a mean difference of -1.8±1.5mm between the measured bone heights on postoperative day (14.2±2.4mm) and the last follow-up (12.4±2.5 mm). While the loss of height was not affected due to the graft type (P=0.981), the general 12.6% vertical loss was statistically significant (P<0.0001), also the length of implants placed reduced this loss (P=0.036). CONCLUSIONS Within the limits of this retrospective study, it can be concluded that: 1) The sinus augmentation procedures with thicker particle size grafts achieved higher success rate; and 2) over the time, 12.6% loss may occur in the height of grafted area.
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Affiliation(s)
- Sercan Küçükkurt
- Department of Oral and Maxillofacial Surgery, Istanbul Aydin University, Istanbul, Turkey -
| | - Nima Moharamnejad
- Department of Oral and Maxillofacial Surgery, Istanbul Aydin University, Istanbul, Turkey
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15
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Stacchi C, Rapani A, Lombardi T, Bernardello F, Nicolin V, Berton F. Does new bone formation vary in different sites within the same maxillary sinus after lateral augmentation? A prospective histomorphometric study. Clin Oral Implants Res 2022; 33:322-332. [PMID: 34978096 PMCID: PMC9306466 DOI: 10.1111/clr.13891] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate histomorphometric outcomes of lateral maxillary sinus augmentation in different areas of the same cavity and to correlate results to bucco-palatal sinus width (SW) and residual bone height (RBH). MATERIAL AND METHODS Patients needing maxillary sinus floor elevation (RBH <5 mm) to insert two nonadjacent implants were treated with lateral augmentation using a composite graft. Six months later, two bone-core biopsies (mesial/distal) were retrieved in implant insertion sites. SW and RBH were measured on cone beam computed tomography, and correlations between histomorphometric and anatomical parameters were evaluated by multivariate linear regression analysis. RESULTS Twenty patients underwent sinus augmentation, and eighteen were included in the final analysis (two dropouts for membrane perforation). Mean newly formed mineralized tissue percentage (%NFMT) after 6 months in mesial and distal sites was 17.5 ± 4.7 and 11.6 ± 4.7, respectively (p = .0004). Multivariate linear regression showed a strong negative correlation between SW and %NFMT (β coefficient=-.774, p < .0001) and no correlation between RBH and %NFMT (β coefficient =-.038, p = .825). CONCLUSIONS The present study confirms that %NFMT after lateral sinus augmentation occurs at different rates in different anatomical areas of the same maxillary sinus, showing a strong negative correlation with SW, whereas no influence of RBH was observed. Clinicians should regard SW as a guide for graft selection and to decide duration of the healing period. Researchers should consider SW as a predictor variable, when comparing regenerative outcomes of different biomaterials by using maxillary sinus as an experimental model.
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Affiliation(s)
- Claudio Stacchi
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Antonio Rapani
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Teresa Lombardi
- Department of Health Sciences, University 'Magna Graecia', Catanzaro, Italy
| | | | - Vanessa Nicolin
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Federico Berton
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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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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17
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Pesce P, Menini M, Canullo L, Khijmatgar S, Modenese L, Gallifante G, Del Fabbro M. Radiographic and Histomorphometric Evaluation of Biomaterials Used for Lateral Sinus Augmentation: A Systematic Review on the Effect of Residual Bone Height and Vertical Graft Size on New Bone Formation and Graft Shrinkage. J Clin Med 2021; 10:jcm10214996. [PMID: 34768518 PMCID: PMC8584826 DOI: 10.3390/jcm10214996] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of the present systematic review was to investigate the effect of residual bone height (RBH) and vertical bone gain on new bone formation (NBF) and graft shrinkage after lateral sinus lifts using different biomaterials. METHODS An electronic search was conducted on three databases to identify randomized controlled trials (RCTs) published until January 2021 with at least one follow-up at 6 months and at least five patients treated, comparing biomaterials used for maxillary sinus augmentation with a lateral approach. Graft volumetric changes, RBH, vertical bone gain, implant failure, and post-operative complications were evaluated. The risk of bias was assessed using the Cochrane tool. RESULTS We used 4010 identified studies, of which 21 were RCTs. Overall, 412 patients and 533 sinuses were evaluated. Only three publications had an overall low risk of bias. After 6 months, xenograft (XG) showed the least volume reduction (7.30 ± 15.49%), while autogenous graft (AU) was the most reabsorbed (41.71 ± 12.63%). NBF appeared to not be directly correlated with RBH; on the contrary, the overall linear regression analysis showed that NBF significantly decreased by 1.6% for each mm of postoperative vertical graft gain. This finding suggests that the greater the augmentation, the lower the NBF. A similar tendency, with a regression coefficient even higher than the overall one, was also observed with alloplast (AP) and XG. CONCLUSIONS The present results suggested that NBF was essentially independent of preoperative bone height. On the contrary, the smaller the volume was of the graft placed, the higher the amount of new bone formed, and the smaller the graft shrinkage was. Minimizing the augmentation volume might be beneficial to graft healing and stability especially when using AP and XG.
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Affiliation(s)
- Paolo Pesce
- Department of Surgical Sciences (DISC), University of Genoa, Ospedale S. Martino, L. Rosanna Benzi 10, 16132 Genoa, Italy; (M.M.); (L.M.); (G.G.)
- Correspondence:
| | - Maria Menini
- Department of Surgical Sciences (DISC), University of Genoa, Ospedale S. Martino, L. Rosanna Benzi 10, 16132 Genoa, Italy; (M.M.); (L.M.); (G.G.)
| | - Luigi Canullo
- Department of Periodontology, University of Bern, 3012 Bern, Switzerland;
| | - Shahnawaz Khijmatgar
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, 20122 Milan, Italy; (S.K.); (M.D.F.)
| | - Laura Modenese
- Department of Surgical Sciences (DISC), University of Genoa, Ospedale S. Martino, L. Rosanna Benzi 10, 16132 Genoa, Italy; (M.M.); (L.M.); (G.G.)
| | - Gianmarco Gallifante
- Department of Surgical Sciences (DISC), University of Genoa, Ospedale S. Martino, L. Rosanna Benzi 10, 16132 Genoa, Italy; (M.M.); (L.M.); (G.G.)
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, 20122 Milan, Italy; (S.K.); (M.D.F.)
- IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
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18
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Starch-Jensen T, Ahmad M, Bruun NH, Becktor JP. Patient's perception of recovery after maxillary sinus floor augmentation with autogenous bone graft compared with composite grafts: a single-blinded randomized controlled trial. Int J Implant Dent 2021; 7:99. [PMID: 34595577 PMCID: PMC8633212 DOI: 10.1186/s40729-021-00379-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022] Open
Abstract
Background Autogenous bone graft is considered as the preferred grafting material for maxillary sinus floor augmentation (MSFA). However, harvesting of extraoral or intraoral autogenous bone graft is associated with risk of donor site morbidity and supplementary surgery. From a clinical and patient perspective, it would therefore be an advantage, if postoperative discomfort could be minimized by diminishing the need for autogenous bone graft harvesting. The objective of the present study was to test the hypothesis of no difference in patient’s perception of recovery after MSFA with autogenous bone graft from the zygomatic buttress (control) compared with 1:1 mixture of autogenous bone graft and deproteinized porcine bone mineral (DPBM) (Test I) or biphasic bone graft material (BBGM) (Test II). Sixty healthy patients were randomly allocated to either control or test groups. Oral Health-related Quality of Life (OHRQoL) was evaluated by Oral Health Impact Profile-14 (OHIP-14) at enrollment. Recovery was estimated by self-administrated questionnaires and visual analog scale assessing pain, social and working isolation, physical appearance, eating and speaking ability, diet variations, sleep impairment and discomfort after 1 week and 1 month. Descriptive statistics was expressed as mean with standard deviation (SD). Correlation between OHRQoL at enrollment and recovery were assessed by linear regression. p-value below 0.05 was considered significant.
Results Treatment satisfaction and willingness to undergo similar surgery were high in all groups. Average numbers of days with pain and sick leave were 3.5 (SD 3.9) and 0.5 (SD 1.2), respectively, with no significant difference between groups. Moreover, no significant difference in eating and speaking ability, physical appearance, work performance and sleep impairment were seen between groups. Mean OHIP-14 score at enrollment was 9.30 (SD 9.25) (control), 9.95 (SD 7.96) (Test I) and 8.15 (SD 9.37) (Test II), with no significant differences between groups. Impaired OHRQoL, gender or age seems not to predispose for delayed recovery or increased postoperative discomfort. Conclusions MSFA with diminutive autogenous bone graft harvesting is associated with high patient satisfaction, limited postoperative discomfort and willingness to undergo similar surgery. Presurgical OHRQoL, gender or age seems not to be associated with impaired patient’s perception of recovery.
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Affiliation(s)
- Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, 18-22 Hobrovej, 9000, Aalborg, Denmark. .,Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, Aalborg, Denmark.
| | - Marianne Ahmad
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Malmö University, Malmö, Sweden
| | - Niels Henrik Bruun
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Jonas Peter Becktor
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Malmö University, Malmö, Sweden
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Advantages of Porcine Xenograft over Autograft in Sinus Lift: A Randomised Clinical Trial. MATERIALS 2021; 14:ma14123439. [PMID: 34205826 PMCID: PMC8234120 DOI: 10.3390/ma14123439] [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: 05/25/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 02/06/2023]
Abstract
This study aimed to compare the performance of intra-oral autologous bone grafts versus porcine xenografts in a two-step lateral window sinus lift. This split-mouth randomised controlled trial sequentially enrolled 12 patients with a 6-month follow-up. For each patient, a simultaneous randomised bilateral maxillary sinus lift was performed and filled with autologous bone from the mandible (control) or a porcine xenograft (test). A bone biopsy sample was collected during the implant placement for histological and histomorphometric analysis. CT scans were performed at the beginning and at the end of the trial to assess radiological evolution. A comparison of initial and six-month CT scans indicated statistically significant increases in bone level for both materials (7.8 ± 2.4 mm for autologous and 8.7 ± 2.2 mm for xenograft, p < 0.05), and there were no significant differences between the performance of the two materials over time (p = 0.26). The histological analysis showed various stages of the remodelling process and no cells or other signs of inflammation or infection were visible in both groups. The porcine xenografts presented similar results for the studied variables when compared to autologous bone, being a reasonable alternative for a sinus lift.
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20
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Barbu HM, Iancu SA, Hancu V, Referendaru D, Nissan J, Naishlos S. PRF-Solution in Large Sinus Membrane Perforation with Simultaneous Implant Placement-Micro CT and Histological Analysis. MEMBRANES 2021; 11:membranes11060438. [PMID: 34200735 PMCID: PMC8230395 DOI: 10.3390/membranes11060438] [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: 05/07/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 12/15/2022]
Abstract
Background: The purpose of the study was to analyze the efficacy of platelet-rich fibrin (PRF) as a single augmentation material for complicated cases of maxillary sinus floor elevation, resulting from membrane perforation or previous infections. Methods: Implant insertion in the posterior region of the maxilla was simultaneously performed with maxillary sinus floor augmentation. Schneiderian membrane elevation can be accompanied by extremely serious sinus membrane perforation, due to accidental tearing or intended incision for mucocele removal. PRFs were placed in the sinus cavity both for membrane sealing and sinus floor grafting. Radiological, histological and micro-CT analyses were performed. Implant survival was assessed every 6 months for 1 to 4 years, with a mean follow up of 1.8 years, after prosthetic loading. Radiological examinations were performed on CBCT at 9 and 12 and 36 months postoperatively and revealed improved degrees of radiopacity. Results: 19 implants were simultaneously placed in the course of nine maxillary sinus floor augmentation surgeries, with successful outcomes in terms of bone grafting and implant integration. New bone formation was evidenced 12 months postoperatively on radiological examination, micro-CT analysis, and histological analysis of a harvested bone segment from the augmented maxillary sinus. The mean gain in bone height of the sinus floor augmentation was 6.43 mm, with a maximum of 9 mm. The mean amount of vital bone obtained from histologic assessment was 52.30%, while bone volume/tissue volume ratio in micro-CT 3D had a mean of 50.32%. Conclusions: PRF may be considered as an alternative treatment for a single surgery of sinus augmentation with simultaneous implant placement, even in complicated cases with significant sinus membrane tearing.
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Affiliation(s)
- Horia Mihail Barbu
- Head of Oral Implantology Department, Faculty of Dental Medicine, Titu Maiorescu University, 031593 Bucharest, Romania;
- European Centre of Oral Implantology, 011473 Bucharest, Romania;
| | - Stefania Andrada Iancu
- European Centre of Oral Implantology, 011473 Bucharest, Romania;
- Department of Prosthodontics, Faculty of Dental Medicine, Titu Maiorescu University, 031593 Bucharest, Romania
- Titu Maiorescu Doctoral School of Dental Medicine, 040441 Bucharest, Romania
- Correspondence: (S.A.I.); (V.H.); Tel.: +40-721-947-735 (S.A.I.); +40-724-614-758 (V.H.)
| | - Violeta Hancu
- Oral Health Department, Faculty of Dental Medicine, Titu Maiorescu University, 031593 Bucharest, Romania
- Correspondence: (S.A.I.); (V.H.); Tel.: +40-721-947-735 (S.A.I.); +40-724-614-758 (V.H.)
| | - Daniel Referendaru
- European Centre of Oral Implantology, 011473 Bucharest, Romania;
- Titu Maiorescu Doctoral School of Dental Medicine, 040441 Bucharest, Romania
- Oral Implantology Department, Faculty of Dental Medicine, Titu Maiorescu University, 031593 Bucharest, Romania
| | - Joseph Nissan
- Head of Oral-Rehabilitation Department, School of Dental Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel;
| | - Sarit Naishlos
- Department of Pediatric Dentistry, School of Dental Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel;
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Evaluation of the Histomorphometric and Micromorphometric Performance of a Serum Albumin-Coated Bone Allograft Combined with A-PRF for Early and Conventional Healing Protocols after Maxillary Sinus Augmentation: A Randomized Clinical Trial. MATERIALS 2021; 14:ma14071810. [PMID: 33917513 PMCID: PMC8038833 DOI: 10.3390/ma14071810] [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: 03/11/2021] [Revised: 03/29/2021] [Accepted: 04/01/2021] [Indexed: 11/16/2022]
Abstract
The aim of this study was to compare the microarchitecture of augmented bone following maxillary sinus augmentation (MSA) after healing periods of 3 (test) and 6 (control) months using the combination of advanced platelet-rich fibrin (A-PRF) and a serum albumin-coated bone allograft (SACBA). Twenty-six patients with 30 surgical sites who required two-stage MSA were enrolled and grafted with the combination of A-PRF and SACBAs. The surgical sites were randomly allocated to the test or control group. During implant site preparation, 17 bone core biopsy samples were collected from each study group for histological, histomorphometric and micromorphometric analysis. Resonance frequency analysis was performed at the time of implant placement and 6, 8, 10, and 12 weeks postoperatively. The percentage of newly formed bone was 44.89 ± 9.49% in the test group and 39.75 ± 8.15% in the control group (p = 0.100). The results of the µCT analysis showed no significant differences in morphometric parameters between the study groups. The implant stability quotient was not significantly different between the two groups at 10 and 12 weeks postoperatively. Based on these findings, the total treatment time may be reduced by 3 months with the use of A-PRF and SACBAs for two-stage MSA.
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Trimmel B, Gede N, Hegyi P, Szakács Z, Mezey GA, Varga E, Kivovics M, Hanák L, Rumbus Z, Szabó G. Relative performance of various biomaterials used for maxillary sinus augmentation: A Bayesian network meta-analysis. Clin Oral Implants Res 2021; 32:135-153. [PMID: 33230862 PMCID: PMC8247032 DOI: 10.1111/clr.13690] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 10/09/2020] [Accepted: 11/16/2020] [Indexed: 12/29/2022]
Abstract
Objectives To assess the histomorphometric outcomes obtained in randomized clinical trials (RCTs) with different biomaterials used for maxillary sinus augmentation (MSA). Materials and Methods A search of the existing medical literature until October 1, 2019, was performed. Inclusion criteria were (a) RCTs assessing a two‐stage MSA from the lateral approach using autologous bone or biomaterials for grafting and (b) reported histomorphometric outcomes based on crestal bone core biopsy samples. The Bayesian method was used to perform pairwise meta‐analyses and network meta‐analysis (NMA). The primary outcome, the new bone percentage (NB %), was calculated as mean differences with 95% credible intervals. The interventions were ranked by their posterior probability by calculating the surface under the cumulative ranking curve values. Results Thirty‐four RCTs (842 MSAs) were included in the analysis with a normal healing period (5–8 months). All comparisons were presented in a league table. On the basis of the ranking probability, the most effective bone grafting material for NB% was bovine xenograft + bone marrow concentrate (BMC) (81%), followed by bovine xenograft + platelet‐rich plasma (PRP) (77%), bioactive glass ceramic + autologous bone 1:1 (70%), nanocrystalline hydroxyapatite in silica gel (70%), and bioactive glass ceramic (70%). Autologous bone graft alone took the twelfth position with 57%. Conclusion Within the limitations of the present NMA, the analysis did not confirm autologous bone alone as the gold standard for MSA and showed superiority of composite grafts such as bovine xenograft + BMC after 5–8 months of healing.
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Affiliation(s)
- Bálint Trimmel
- Department of Oral Diagnostics, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - Noémi Gede
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Zsolt Szakács
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Gyöngyi Anna Mezey
- Department of Public Health, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Eszter Varga
- Department of Pediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Márton Kivovics
- Department of Community Dentistry, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - Lilla Hanák
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zoltán Rumbus
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - György Szabó
- Department of Oro-Maxillofacial Surgery and Stomatology, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
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