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Abedi M, Shafiee M, Afshari F, Mohammadi H, Ghasemi Y. Collagen-Based Medical Devices for Regenerative Medicine and Tissue Engineering. Appl Biochem Biotechnol 2023:10.1007/s12010-023-04793-3. [PMID: 38133881 DOI: 10.1007/s12010-023-04793-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2023] [Indexed: 12/23/2023]
Abstract
Assisted reproductive technologies are key to solving the problems of aging and organ defects. Collagen is compatible with living tissues and has many different chemical properties; it has great potential for use in reproductive medicine and the engineering of reproductive tissues. It is a natural substance that has been used a lot in science and medicine. Collagen is a substance that can be obtained from many different animals. It can be made naturally or created using scientific methods. Using pure collagen has some drawbacks regarding its physical and chemical characteristics. Because of this, when collagen is processed in various ways, it can better meet the specific needs as a material for repairing tissues. In simpler terms, collagen can be used to help regenerate bones, cartilage, and skin. It can also be used in cardiovascular repair and other areas. There are different ways to process collagen, such as cross-linking it, making it more structured, adding minerals to it, or using it as a carrier for other substances. All of these methods help advance the field of tissue engineering. This review summarizes and discusses the current progress of collagen-based materials for reproductive medicine.
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Affiliation(s)
- Mehdi Abedi
- Pharmaceutical Science Research Center, Shiraz University of Medical Science, Shiraz, Iran.
- Research and Development Department, Danesh Salamat Kowsar Co., P.O. Box 7158186496, Shiraz, Iran.
| | - Mina Shafiee
- Research and Development Department, Danesh Salamat Kowsar Co., P.O. Box 7158186496, Shiraz, Iran
| | - Farideh Afshari
- Department of Tissue Engineering and Applied Cell Science, School of Advanced Medical Sciences and Technology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamidreza Mohammadi
- Research and Development Department, Danesh Salamat Kowsar Co., P.O. Box 7158186496, Shiraz, Iran
| | - Younes Ghasemi
- Pharmaceutical Science Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
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2
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Abundo R, Dellavia CPB, Canciani E, Daniele M, Dioguardi M, Zambelli M, Perelli M, Mastrangelo F. Alveolar Ridge Preservation with a Novel Cross-Linked Collagen Sponge: Histological Findings from a Case Report. J Clin Med 2023; 12:7599. [PMID: 38137668 PMCID: PMC10743811 DOI: 10.3390/jcm12247599] [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: 11/28/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Alveolar ridge preservation (ARP) is a well-documented procedure to maintain bone volume after tooth extraction in order to place implants. However, at the end of the healing process, the residual biomaterial that is not reabsorbed remains embedded in the bone over time. Ribose cross-linked biomaterials demonstrated their ability to promote osteoconduction and complete resorption. The aim of this study was to evaluate the histological healing pattern of a novel ribose cross-linked collagen sponge used as a grafting material left exposed in human sockets at the time of tooth extraction. On a single patient, non-restorable lower first molars were extracted on both sides, and a ribose cross-linked collagen sponge was placed bilaterally in the cavities and left uncovered at the end of the surgery. After six months, core biopsies were taken immediately prior to implant placement; after the sample preparation, a histological analysis was performed. The results are very promising for substitution with newly formed bone and the amount of residual material. Ribose cross-linked collagen sponge could represent a valid alternative to conventional biomaterials for ARP procedures with no need for flap advancement and/or the addition of a membrane to cover the graft, reducing the invasiveness, complexity, and costs of the treatment.
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Affiliation(s)
| | | | - Elena Canciani
- Microscopic Anatomy, University of Milan, 20126 Milan, Italy;
| | - Monica Daniele
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (M.D.); (M.D.)
| | - Mario Dioguardi
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (M.D.); (M.D.)
| | | | | | - Filiberto Mastrangelo
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (M.D.); (M.D.)
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3
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Donos N, Akcali A, Padhye N, Sculean A, Calciolari E. Bone regeneration in implant dentistry: Which are the factors affecting the clinical outcome? Periodontol 2000 2023; 93:26-55. [PMID: 37615306 DOI: 10.1111/prd.12518] [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: 02/10/2023] [Revised: 07/08/2023] [Accepted: 08/01/2023] [Indexed: 08/25/2023]
Abstract
The key factors that are needed for bone regeneration to take place include cells (osteoprogenitor and immune-inflammatory cells), a scaffold (blood clot) that facilitates the deposition of the bone matrix, signaling molecules, blood supply, and mechanical stability. However, even when these principles are met, the overall amount of regenerated bone, its stability over time and the incidence of complications may significantly vary. This manuscript provides a critical review on the main local and systemic factors that may have an impact on bone regeneration, trying to focus, whenever possible, on bone regeneration simultaneous to implant placement to treat bone dehiscence/fenestration defects or for bone contouring. In the future, it is likely that bone tissue engineering will change our approach to bone regeneration in implant dentistry by replacing the current biomaterials with osteoinductive scaffolds combined with cells and mechanical/soluble factors and by employing immunomodulatory materials that can both modulate the immune response and control other bone regeneration processes such as osteogenesis, osteoclastogenesis, or inflammation. However, there are currently important knowledge gaps on the biology of osseous formation and on the factors that can influence it that require further investigation. It is recommended that future studies should combine traditional clinical and radiographic assessments with non-invasive imaging and with patient-reported outcome measures. We also envisage that the integration of multi-omics approaches will help uncover the mechanisms responsible for the variability in regenerative outcomes observed in clinical practice.
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Affiliation(s)
- Nikolaos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Aliye Akcali
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
- Department of Periodontology, Faculty of Dentistry, Dokuz Eylul University, Izmir, Turkey
| | - Ninad Padhye
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Elena Calciolari
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
- Department of Medicine and Dentistry, Dental School, University of Parma, Parma, Italy
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Urban I, Sanz-Sánchez I, Monje A, Montero E. Complications and treatment errors in peri-implant hard tissue management. Periodontol 2000 2023; 92:278-298. [PMID: 37016554 DOI: 10.1111/prd.12472] [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: 04/22/2022] [Revised: 08/14/2022] [Accepted: 08/21/2022] [Indexed: 04/06/2023]
Abstract
Bone augmentation procedures aim to regenerate the deficient alveolar ridge to properly place dental implants that are completely surrounded by bone. However, these are invasive and technically demanding surgeries that are not free of either complications or treatment errors. Careful patient selection and preparation is a mandatory process to reduce the rate of complications in bone regeneration procedures, irrespective of the technique used. It is important to assess the cost benefit of the intervention and to evaluate the potential impact on the patient's quality of life, especially in the elderly and medically compromised patients. Most common postoperative complications are wound dehiscences, which may be reduced, at least partially, by proper knowledge of the surgical technique and the craniofacial anatomy. Other complications that may appear are postoperative infections or nerve injuries. The aim of this narrative review is to summarize the best available scientific evidence on the incidence of complications, as well as the ideal strategies for their prevention and management. Depending on the severity of the complication, treatment approaches may vary and can include drug prescription or even surgical re-entries to remove exposed barrier membranes or contaminated bone grafts. Adequate prevention and proper management of complications associated with bone augmentation interventions are a requirement for clinicians carrying out these demanding procedures. A series of cases illustrating proper management of complications in different clinical scenarios is presented.
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Affiliation(s)
- Istvan Urban
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Periodontology and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Ignacio Sanz-Sánchez
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Alberto Monje
- Department of Periodontology, School of Dentistry, International University of Catalonia, Barcelona, Spain
- Department of Periodontology and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Eduardo Montero
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
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Subramanya AP, Prabhuji MLV. Synthetic mineral collagen composite bone graft with ribose cross linked collagen membrane for lateral ridge augmentation. J Indian Soc Periodontol 2023; 27:332-335. [PMID: 37346848 PMCID: PMC10281312 DOI: 10.4103/jisp.jisp_306_22] [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: 07/01/2022] [Revised: 11/17/2022] [Accepted: 11/27/2022] [Indexed: 06/23/2023] Open
Abstract
A combination of calcium phosphate-based mineral with carbon apatite structure and type 1 collagen derived from bovine Achilles tendon has been introduced for augmentation of alveolar ridge and periodontal defects. Carbon apatite structure of mineral mimics natural bone in terms of resorption and remodeling, while collagen provides three-dimensional structure; both together aid in higher osteoconduction. The aim of present case report was to investigate if synthetic mineral collagen composite bone graft (CBG) with ribose cross-linked collagen membrane (RCLM) may be successfully used to obtain lateral augmentation of alveolar ridge that is planned for dental implant placement. Lateral augmentation of ridge was performed by elevating a full-thickness mucoperiosteal flap, followed by debridement and decortication of the defect area. CBG was soaked in saline and molded onto the defect area. RCLM was used to cover the graft site, followed by stabilization of membrane and the flap by suturing. Preoperative and postoperative ridge widths were measured using cone-beam computed tomography scans. The use of synthetic mineral collagen CBG with RCLM for lateral ridge augmentation may lead to increase in ridge width making it suitable for dental implant placement.
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Affiliation(s)
- Ashwin Parakkaje Subramanya
- Department of Periodontology, Krishnadevaraya College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - M. L. V. Prabhuji
- Department of Periodontology, Krishnadevaraya College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
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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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7
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Kölliker R, Hicklin SP, Hirsiger C, Liu CC, Janett F, Schmidlin PR. In Vitro Evaluation of the Permeability of Different Resorbable Xenogeneic Membranes after Collagenolytic Degradation. MEMBRANES 2022; 12:787. [PMID: 36005702 PMCID: PMC9415831 DOI: 10.3390/membranes12080787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
In this in vitro study, we compare the penetration of cells through different resorbable collagen membranes, which were collagenolytically degraded over different time periods. Three different resorbable collagen membranes were evaluated, including two non-cross-linked (NCL) membranes-namely, a porcine (NCL-P) and an equine (NCL-E) membrane-and an enzymatically cross-linked porcine (ECL-B) membrane. A special two-chamber model was fabricated, allowing for the placement of separating membranes, and a non-porous polyester membrane was used as a negative control (C), in order to verify the impermeability of the experimental chamber device. Round membrane samples with a diameter of 16 mm were fabricated. Eighteen membranes of each type were punched and placed on polyethylene nets as carriers. The membranes were then biodegraded-each on its carrier-in 12-well polystyrene plates: three samples of each membrane type were degraded for 1.5, 3, 6, or 12 h in 2 mL of a buffered collagenase solution, at 37 °C. For control purposes, three samples of each membrane type were not degraded, but only immersed in buffer solution for 1.5, 3, 6, or 12 h, at 37 °C. Another three samples of each type of membrane were degraded until complete dissolution, in order to determine the full hydroxyproline content for comparison. Liquid-preserved boar semen (containing at least 120 million sperm cells per milliliter) was used to test the cell occlusivity of the degraded membranes. At baseline and initial degradation, all tested membranes were tight, and no penetration was observed with up to 30 min of incubation time (results not shown). After 1.5 h, cells were partially capable of penetrating the NCL-E membrane only. One sample showed leakage, with a sperm volume of 1.7 million cells/mL over all samples. No penetration occurred in the test, NCL-P, and ECL-B groups. After a degradation time of 3 h, the NCL-P and ECL-B membranes remained occlusive to cells. All the membranes and measurements indicated leakage in the NCL-E group. After 6 h, four NCL-P measurements showed the first signs of cell penetration, as boar spermatozoa were detectable in the lower chamber (64 million cells/mL). The ECL-B membranes remained completely cell occlusive. After 12 h, four NCL-P measurements were cell penetration positive (14.6 million cells/mL), while the ECL-B group remained tight and showed no cell penetration. As the findings of our study are well in accordance with the results of several previous animal studies, it can be concluded that the surrogate model is capable of performing rapid and cheap screening of cell occlusivity for different collagen membranes in a very standardized manner. In particular, claims of long degradation resistance can be easily proven and compared. As the boar spermatozoa used in the present report had a size of 9 × 5 μm, smaller bacteria are probably also able to penetrate the leaking membranes; in this regard, our proposed study set-up may provide valuable information, although it must be acknowledged that sperm cells show active mobility and do not only translocate by growth.
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Affiliation(s)
- Ramona Kölliker
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032 Zurich, Switzerland
| | - Stefan P. Hicklin
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032 Zurich, Switzerland
| | - Constanze Hirsiger
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032 Zurich, Switzerland
| | - Chun Ching Liu
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032 Zurich, Switzerland
| | - Fredi Janett
- Clinic of Reproductive Medicine, Vetsuisse-Faculty, University of Zurich, Winterthurerstrasse 204, 8057 Zurich, Switzerland
| | - Patrick R. Schmidlin
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032 Zurich, Switzerland
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Effect of Different Membranes on Vertical Bone Regeneration: A Systematic Review and Network Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7742687. [PMID: 35872861 PMCID: PMC9303140 DOI: 10.1155/2022/7742687] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/17/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022]
Abstract
This study is aimed at performing a systematic review and a network meta-analysis of the effects of several membranes on vertical bone regeneration and clinical complications in guided bone regeneration (GBR) or guided tissue regeneration (GTR). We compared the effects of the following membranes: high-density polytetrafluoroethylene (d-PTFE), expanded polytetrafluoroethylene (e-PTFE), crosslinked collagen membrane (CCM), noncrosslinked collagen membrane (CM), titanium mesh (TM), titanium mesh plus noncrosslinked (TM + CM), titanium mesh plus crosslinked (TM + CCM), titanium-reinforced d-PTFE, titanium-reinforced e-PTFE, polylactic acid (PLA), polyethylene glycol (PEG), and polylactic acid 910 (PLA910). Using the PICOS principles to help determine inclusion criteria, articles are collected using PubMed, Web of Science, and other databases. Assess the risk of deviation and the quality of evidence using the Cochrane Evaluation Manual, and GRADE. 27 articles were finally included. 19 articles were included in a network meta-analysis with vertical bone increment as an outcome measure. The network meta-analysis includes network diagrams, paired-comparison forest diagrams, funnel diagrams, surface under the cumulative ranking curve (SUCRA) diagrams, and sensitivity analysis diagrams. SUCRA indicated that titanium-reinforced d-PTFE exhibited the highest vertical bone increment effect. Meanwhile, we analyzed the complications of 19 studies and found that soft tissue injury and membrane exposure were the most common complications.
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Sanz-Sánchez I, Sanz-Martín I, Ortiz-Vigón A, Molina A, Sanz M. Complications in bone-grafting procedures: Classification and management. Periodontol 2000 2022; 88:86-102. [PMID: 35103322 DOI: 10.1111/prd.12413] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Bone-regenerative interventions aiming to restore deficient alveolar ridges, such as the use of block grafts or through the application of guided bone-regeneration principles, have reported positive outcomes in the published scientific literature. These interventions, however, are invasive, and hence, intraoperative and/or postoperative complications may occur. The types of complications and their severity may vary from the exposure of the biomaterial (membrane or graft) to postsurgical infections, neurosensorial disturbances, occurrence of hemorrhage, and pain, etc. The aim of the present narrative review was to search the available scientific evidence concerning the incidence of these complications, their effect on treatment outcomes, their clinical management and, finally, strategies aimed at prevention. Exposure of the barrier membrane or the block graft is the most common complication associated with oral regenerative interventions. To manage these complications, depending on the extent of the exposure and the presence or absence of concomitant infections, therapeutic measures may vary, from the topical application of antiseptics to the removal of the barrier membrane or the block graft. Regardless of their treatment, the occurrence of these complications has been associated with patient selection, with compliant patients (eg, nonsmokers) having a lower reported incidence of complications. Similarly, surgical factors such as correct flap elevation and a tensionless closure are of obvious importance. Finally, to prevent the incidence of complications, it appears prudent to utilize whenever possible less invasive surgical interventions.
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Affiliation(s)
- Ignacio Sanz-Sánchez
- Section of Graduate Periodontology, University Complutense, Madrid, Spain.,Etiology and Therapy of Periodontal and Peri-Implant Diseases (ETEP) Research Group, University Complutense, Madrid, Spain
| | | | | | - Ana Molina
- Section of Graduate Periodontology, University Complutense, Madrid, Spain.,Etiology and Therapy of Periodontal and Peri-Implant Diseases (ETEP) Research Group, University Complutense, Madrid, Spain
| | - Mariano Sanz
- Section of Graduate Periodontology, University Complutense, Madrid, Spain.,Etiology and Therapy of Periodontal and Peri-Implant Diseases (ETEP) Research Group, University Complutense, Madrid, Spain
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Finding the Perfect Membrane: Current Knowledge on Barrier Membranes in Regenerative Procedures: A Descriptive Review. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031042] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Guided tissue regeneration (GTR) and guided bone regeneration (GBR) became common procedures in the corrective phase of periodontal treatment. In order to obtain good quality tissue neo-formation, most techniques require the use of a membrane that will act as a barrier, having as a main purpose the blocking of cell invasion from the gingival epithelium and connective tissue into the newly formed bone structure. Different techniques and materials have been developed, aiming to obtain the perfect barrier membrane. The membranes can be divided according to the biodegradability of the base material into absorbable membranes and non-absorbable membranes. The use of absorbable membranes is extremely widespread due to their advantages, but in clinical situations of significant tissue loss, the use of non-absorbable membranes is often still preferred. This descriptive review presents a synthesis of the types of barrier membranes available and their characteristics, as well as future trends in the development of barrier membranes along with some allergological aspects of membrane use.
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Solomon SM, Sufaru IG, Teslaru S, Ghiciuc CM, Stafie CS. Finding the Perfect Membrane: Current Knowledge on Barrier Membranes in Regenerative Procedures: A Descriptive Review. APPLIED SCIENCES-BASEL 2022. [DOI: https://doi.org/10.3390/app12031042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Guided tissue regeneration (GTR) and guided bone regeneration (GBR) became common procedures in the corrective phase of periodontal treatment. In order to obtain good quality tissue neo-formation, most techniques require the use of a membrane that will act as a barrier, having as a main purpose the blocking of cell invasion from the gingival epithelium and connective tissue into the newly formed bone structure. Different techniques and materials have been developed, aiming to obtain the perfect barrier membrane. The membranes can be divided according to the biodegradability of the base material into absorbable membranes and non-absorbable membranes. The use of absorbable membranes is extremely widespread due to their advantages, but in clinical situations of significant tissue loss, the use of non-absorbable membranes is often still preferred. This descriptive review presents a synthesis of the types of barrier membranes available and their characteristics, as well as future trends in the development of barrier membranes along with some allergological aspects of membrane use.
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12
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Mortazavi H, Khodadoustan A, Kheiri A, Kheiri L. Bone loss-related factors in tissue and bone level dental implants: a systematic review of clinical trials. J Korean Assoc Oral Maxillofac Surg 2021; 47:153-174. [PMID: 34187956 PMCID: PMC8249186 DOI: 10.5125/jkaoms.2021.47.3.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/19/2021] [Accepted: 02/05/2021] [Indexed: 12/18/2022] Open
Abstract
Dental implants are popular for dental rehabilitation after tooth loss. The goal of this systematic review was to assess bone changes around bone-level and tissue-level implants and the possible causes. Electronic searches of PubMed, Google Scholar, Scopus, and Web of Science, and a hand search limited to English language clinical trials were performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines up to September 2020. Studies that stated the type of implants used, and that reported bone-level changes after insertion met the inclusion criteria. The risk of bias was also evaluated. A total of 38 studies were included. Eighteen studies only used bone-level implants, 10 utilized tissue-level designs and 10 observed bone-level changes in both types of implants. Based on bias assessments, evaluating the risk of bias was not applicable in most studies. There are vast differences in methodologies, follow-ups, and multifactorial characteristics of bone loss around implants, which makes direct comparison impossible. Therefore, further well-structured studies are needed.
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Affiliation(s)
- Hamed Mortazavi
- Department of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amin Khodadoustan
- Member of Iranian Association of Periodontology, Private Practice, Tehran, Iran
| | - Aida Kheiri
- Student Research Committee, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Lida Kheiri
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Islamic Azad University, Isfahan (Khorasgan) Branch, Isfahan, Iran
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Cha JK, Pla R, Vignoletti F, Jung UW, Sanz-Esporrin J, Sanz M. Immunohistochemical characteristics of lateral bone augmentation using different biomaterials around chronic peri-implant dehiscence defects: An experimental in vivo study. Clin Oral Implants Res 2021; 32:569-580. [PMID: 33629461 DOI: 10.1111/clr.13726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 01/04/2021] [Accepted: 02/17/2021] [Indexed: 11/27/2022]
Abstract
AIM To investigate the immunohistochemical characteristics of a highly porous synthetic bone substitute and a cross-linked collagen membrane for guided bone regeneration. METHODS Three experimental groups were randomly allocated at chronic peri-implant dehiscence defect in 8 beagle dogs: (i) biphasic calcium phosphate covered by a cross-linked collagen membrane (test group), (ii) deproteinized bovine bone mineral covered by a natural collagen membrane (positive control) and (iii) no treatment (negative control). After 8 and 16 weeks of submerged healing, dissected tissue blocks were processed for immunohistochemical analysis. Seven antibodies were used to detect the remaining osteogenic and angiogenic potential, and quantitative immunohistochemical analysis was done by software. RESULTS The antigen reactivity of alkaline phosphatase was significantly higher in the test group compared to the positive and negative controls, and it maintained till 16 weeks. The intensity of osteocalcin was significantly higher in the positive control at 8 weeks than the other groups, but significantly decreased at 16 weeks and no difference was found between the groups. A significant large number of TRAP-positive cells were observed in the test group mainly around the remaining particles at 16 weeks. The angiogenic potential was comparable between the groups showing no difference in the expression of transglutaminase II and vascular endothelial growth factor. CONCLUSION Guided bone regeneration combining a highly porous biphasic calcium phosphate synthetic biomaterial with a crosslinked collagen membrane, resulted in extended osteogenic potential when compared to the combination of deproteinized bovine bone mineral and a native collagen membrane.
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Affiliation(s)
- Jae-Kook Cha
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, South Korea
| | - Rafael Pla
- Department of Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
| | - Fabio Vignoletti
- Department of Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
| | - Ui-Won Jung
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, South Korea
| | - Javier Sanz-Esporrin
- Department of Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
| | - Mariano Sanz
- Department of Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
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14
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Horizontal Ridge Augmentation Using a Xenograft Bone Substitute for Implant-Supported Fixed Rehabilitation: A Case Report with Four Years of Follow-Up. Case Rep Dent 2020; 2020:6723936. [PMID: 32509356 PMCID: PMC7245675 DOI: 10.1155/2020/6723936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 05/02/2020] [Indexed: 11/18/2022] Open
Abstract
The guided bone regeneration (GBR) technique has been used to achieve optimal bone volume augmentation and allow dental implant placement in atrophic maxilla and mandible, with predictable results and high survival rates. The use of bone substitutes has reduced the necessity of autogenous bone grafts, reducing the morbidity at the donor areas and thus improving the patients' satisfaction and comfort. This clinical case report shows a clinical and histological evaluation of the bone tissue behavior, in a case that required the horizontal augmentation of the alveolar ridge, with the use of xenograft biomaterial and further dental implant placement. After six months of healing time, six implants were placed, and a bone biopsy was done. The histological analysis depicted some fragments of the xenograft bone graft, integrated with the new-formed bone tissue.
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15
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Sbricoli L, Guazzo R, Annunziata M, Gobbato L, Bressan E, Nastri L. Selection of Collagen Membranes for Bone Regeneration: A Literature Review. MATERIALS 2020; 13:ma13030786. [PMID: 32050433 PMCID: PMC7040903 DOI: 10.3390/ma13030786] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/23/2020] [Accepted: 02/05/2020] [Indexed: 12/22/2022]
Abstract
Several treatment modalities have been proposed to regenerate bone, including guided bone regeneration (GBR) where barrier membranes play an important role by isolating soft tissue and allowing bone to grow. Not all membranes biologically behave the same way, as they differ from their origin and structure, with reflections on their mechanical properties and on their clinical performance. Collagen membranes have been widely used in medicine and dentistry, because of their high biocompatibility and capability of promoting wound healing. Recently, collagen membranes have been applied in guided bone regeneration with comparable outcomes to non-resorbable membranes. Aim of this work is to provide a review on the main features, application, outcomes, and clinical employment of the different types of collagen membranes. Comparisons with non-resorbable membranes are clarified, characteristics of cross-linked collagen versus native collagen, use of different grafting materials and need for membrane fixation are explored in order to gain awareness of the indications and limits and to be able to choose the right membrane required by the clinical condition.
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Affiliation(s)
- Luca Sbricoli
- Department of Neurosciences, School of Dentistry, University of Padova, Via Giustiniani 2, 35100 Padova, Italy; (R.G.); (L.G.); (E.B.)
- Correspondence: ; Tel.: +39-0498212040
| | - Riccardo Guazzo
- Department of Neurosciences, School of Dentistry, University of Padova, Via Giustiniani 2, 35100 Padova, Italy; (R.G.); (L.G.); (E.B.)
| | - Marco Annunziata
- Multidisciplinary Department of Medical Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy; (M.A.); (L.N.)
| | - Luca Gobbato
- Department of Neurosciences, School of Dentistry, University of Padova, Via Giustiniani 2, 35100 Padova, Italy; (R.G.); (L.G.); (E.B.)
| | - Eriberto Bressan
- Department of Neurosciences, School of Dentistry, University of Padova, Via Giustiniani 2, 35100 Padova, Italy; (R.G.); (L.G.); (E.B.)
| | - Livia Nastri
- Multidisciplinary Department of Medical Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy; (M.A.); (L.N.)
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16
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Di Raimondo R, Sanz-Esporrín J, Plá R, Sanz-Martín I, Luengo F, Vignoletti F, Nuñez J, Sanz M. Alveolar crest contour changes after guided bone regeneration using different biomaterials: an experimental in vivo investigation. Clin Oral Investig 2019; 24:2351-2361. [PMID: 31707629 DOI: 10.1007/s00784-019-03092-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 09/22/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the changes in alveolar contour after guided bone regeneration (GBR) with two different combinations of biomaterials in dehiscence defects around implants. MATERIAL AND METHODS Chronic alveolar ridge defects were created bilaterally in the mandible of eight Beagle dogs. Once implants were placed, three treatment groups were randomly allocated to each peri-implant dehiscence defect: (i) test group received a bone substitute composed of hydroxyapatite (HA) and β-tricalcium phosphate (β-TCP) covered by a cross-linked collagen membrane, (ii) positive control group with placement of deproteinized bovine bone mineral (DBBM) plus a porcine natural collagen membrane, and (iii) a negative control with no treatment. Two healing periods (8 and 16 weeks) were evaluated. Dental casts were optically scanned, the obtained files were uploaded into an image analysis software and superimposed to evaluate the linear changes. RESULTS In both healing periods, the gains in linear contours were higher in the test group and at the intermediate level (3 mm below the gingival margin). While at 8 weeks, no significant differences were found between the groups; at 16 weeks, the test and positive control groups demonstrated significant gains in contour compared with negative control. CONCLUSIONS GBR using different biomaterials significantly increased the buccal contours of the alveolar crest when used at dehiscence defects around dental implants. CLINICAL RELEVANCE Particulate highly porous synthetic bone substitute and a cross-linked collagen membrane demonstrated similar outcomes in terms of contour augmentation when compared to bovine xenograft (DBBM) and a collagen membrane.
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Affiliation(s)
- R Di Raimondo
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
| | - J Sanz-Esporrín
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - R Plá
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
| | - I Sanz-Martín
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
| | - F Luengo
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
| | - F Vignoletti
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - J Nuñez
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
| | - Mariano Sanz
- Section of Graduate Periodontology, University Complutense, Madrid, Spain.
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain.
- Facultad de Odontología, Plaza Ramón y Cajal s/n (Ciudad Universitaria), 28040, Madrid, Spain.
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17
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Efficacy of Collagen-Based Membranes in Alveolar Bone Augmentation. APPLIED SCIENCES-BASEL 2018. [DOI: 10.3390/app8112048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Collagen-based membranes (CBMs) have similar permissive bone formation capabilities when compared to non-absorbable membranes. CBMs have been classified as non-cross-linked membranes (NCLMs) and cross-linked membranes (CLMs) depending on whether the cross-linking between the collagen fibers was artificially increased. The purpose of this study is to evaluate the bone maintenance capacity between NCLMs and CLMs by comparing resorption of regenerated bone. The inclusion criteria consisted of: (1) The use of a CBM, either being an NCLM or CLM for coverage of grafted bone; (2) follow-up for more than one year; (3) the presence of the patient's orthopantomographic X-ray (OPTG) immediately following the installation of implants and one year after. The bone resorption observed in the OPTG was determined by measuring the number of exposed threads of the implant. The number of thread exposures in the implant was compared according to CBM types. OPTGs taken immediately following the installation of implants and at one year after installation were compared. The subject of the measurement was always the implant in which the greatest number of exposed threads were present in each patient. A total of 56 subjects and 97 implants were used in this study. There was no significant difference between NCLM and CLM groups (p > 0.05). However, there was a statistically significant difference (p = 0.02) between the groups when a bone graft was applied to both the maxilla and the mandible. The average number of thread exposures was less than 1.5. In this study, no comparison was made between commonly known causes of bone loss and membrane types.
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18
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Ma Z, Zheng J, Yang C, Xie Q, Liu X, Abdelrehem A. A new modified bone grafting technique for periodontally accelerated osteogenic orthodontics. Medicine (Baltimore) 2018; 97:e12047. [PMID: 30212935 PMCID: PMC6156025 DOI: 10.1097/md.0000000000012047] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to introduce an improved surgical technique using a pouch design and tension-free wound closure for periodontally accelerated osteogenic orthodontics (PAOO) in the anterior alveolar region of the mandible.Patients with bone dehiscence and fenestrations on the buccal surfaces of the anterior mandible region underwent the modified PAOO technique (using a pouch design and tension-free closure). Postoperative symptoms were evaluated at 1 and 2 weeks intervals following the procedure. Probing depth (PD), gingival recession depth (GRD), and clinical attachment level (CAL) were assessed at the gingival recession sites at baseline, postoperative 6 and 12 months. Cone-beam computerized tomography (CBCT) was used for quantitative radiographic analyses at baseline, 1 week and 12 months after bone-augmentation procedure.The sample was composed of a total of 12 patients (2 males and 10 females; mean age, 21.9 years) with 72 teeth showing dehiscence/fenestrations and 17 sites presenting with gingival recessions. Clinical evaluations revealed a statistically significant reduction in swelling, pain, and clinical appearance from postoperative week 1 to week 2 (P < .05). Moreover, gingival recession sites exhibited a significant reduction in the GRD and an increase in CAL after surgery with mean root coverage of 69.8% at the end of observation period (P < .01). Both alveolar bone height and width increased after surgery (P < .01) and decreased during the 12-month follow-up (P < .01). However, compared with the baseline records, there was still a significant increase in alveolar bone volume (P < .01).This modified PAOO technique may have advantages in terms of soft and hard tissue augmentation, facilitating extensive bone augmentation and allowing the simultaneous correction of vertical and horizontal defects in the labial aspect of the mandibular anterior area.
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Affiliation(s)
- Zhigui Ma
- Department of Oral Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, PR China
| | - Jisi Zheng
- Department of Oral Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, PR China
| | - Chi Yang
- Department of Oral Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, PR China
| | - Qianyang Xie
- Department of Oral Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, PR China
| | - Xiaohan Liu
- Department of Oral Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, PR China
| | - Ahmed Abdelrehem
- Department of Craniomaxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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19
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Wang Y, Papagerakis S, Faulk D, Badylak SF, Zhao Y, Ge L, Qin M, Papagerakis P. Extracellular Matrix Membrane Induces Cementoblastic/Osteogenic Properties of Human Periodontal Ligament Stem Cells. Front Physiol 2018; 9:942. [PMID: 30072915 PMCID: PMC6058254 DOI: 10.3389/fphys.2018.00942] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/26/2018] [Indexed: 01/09/2023] Open
Abstract
Objective: Periodontitis affects nearly 90% of adults over the age of 70, resulting to periodontal tissue infection, destruction, and ultimately tooth loss. Guided tissue regeneration (GTR) is a method widely used to treat severe periodontal disease, and involves placement of an occlusive barrier to facilitate regeneration of the damaged area by periodontal ligament stem cells (PDLSCs). In this study, we evaluate natural extracellular matrix (ECM) as a scaffold material to provide a suitable microenvironment to support the proliferation, differentiation, and tissue-regenerating properties of PDLSCs. Design: The viability, proliferation, apoptosis, and migration of PDLSCs cultured on ECM membrane, that was isolated from porcine urinary bladders, were compared with those cultured on type I collagen membrane, a commonly used scaffold in GTR. To evaluate the effects of ECM vs. type I collagen on the tissue-regenerating properties of PDLSCs, the bio-attachment and cementoblastic/osteogenic differentiation of PDLSCs were evaluated. Results: Incubation of PDLSCs with ECM resulted in increased viability, proliferation, and reduced apoptosis, compared with type I collagen treated PDLSCs. Co-culture with ECM membrane also increased the migration and bio-attachment of PDLSCs. Incubation of PDLSCs with ECM membrane increased expression of the cementoblastic/osteogenic differentiation markers BSP, RUNX2, ALP, OPN, OCN, and periostin. Conclusion: ECM membrane enhances the proliferation and regenerative properties of PDLSCs, indicating that ECM membrane can serve as a suitable scaffold in the application of GTR to treat periodontal disease.
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Affiliation(s)
- Yuanyuan Wang
- Department of Pediatric Dentistry, School and Hospital of Stomatology, Peking University, Beijing, China
| | - Silvana Papagerakis
- Department of Surgery, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.,Department of Otolaryngology, Medical School, University of Michigan, Ann Arbor, MI, United States
| | - Denver Faulk
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Stephen F Badylak
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Yuming Zhao
- Department of Pediatric Dentistry, School and Hospital of Stomatology, Peking University, Beijing, China
| | - Lihong Ge
- Department of Pediatric Dentistry, School and Hospital of Stomatology, Peking University, Beijing, China
| | - Man Qin
- Department of Pediatric Dentistry, School and Hospital of Stomatology, Peking University, Beijing, China
| | - Petros Papagerakis
- Colleges of Dentistry and Biomedical Engineering, Toxicology, Pharmacy, Nutrition, Anatomy and Cell Biology, University of Saskatchewan, Saskatoon, SK, Canada.,Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, United States
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20
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Chia-Lai PJ, Orlowska A, Al-Maawi S, Dias A, Zhang Y, Wang X, Zender N, Sader R, Kirkpatrick CJ, Ghanaati S. Sugar-based collagen membrane cross-linking increases barrier capacity of membranes. Clin Oral Investig 2017; 22:1851-1863. [PMID: 29209937 DOI: 10.1007/s00784-017-2281-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 11/20/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study examines the permeability and barrier capacity of a sugar cross-linked resorbable collagen membrane ex vivo and in vivo. MATERIALS AND METHODS In an ex vivo study, injectable platelet-rich fibrin (i-PRF), a peripheral blood-derived human leukocyte-and-platelet-rich plasma was used to analyze membrane permeability. in vivo subcutaneous implantation in Wistar rats (n = 4 per time point and group) was used to investigate the barrier capacity of the membrane. The induced in vivo cellular reaction was evaluated at 3, 15, and 30 days and compared to sham OP (control) without biomaterial using histological, immunohistochemical, and histomorphometric methods. RESULTS Ex vivo, the membrane was impenetrable to leukocytes, platelets, and fibrin from peripheral human blood concentrate (PRF). In vivo, the membrane maintained its structure and remained impervious to cells, connective tissue, and vessels over 30 days. CD-68-positive cell (macrophage) numbers significantly decreased from 3 to 15 days, while from day 15 onwards, the number of multinucleated giant cells (MNGCs) increased significantly. Correspondingly, a rise in implantation bed vascularization from 15 to 30 days was observed. However, no signs of degradation or material breakdown were observed at any time point. CONCLUSION Ex vivo and in vivo results showed material impermeability to cellular infiltration of human and murine cells, which highlights the membrane capacity to serve as a barrier over 30 days. However, whether the induced MNGCs will lead to material degradation or encapsulation over the long term requires further investigation. CLINICAL RELEVANCE The data presented are of great clinical interest, as they contribute to the ongoing discussion concerning to what extent an implanted material should be integrated versus serving only as a barrier membrane.
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Affiliation(s)
- Po-Ju Chia-Lai
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, FORM (Frankfurt Orofacial Regenerative Medicine) Lab, University Hospital Frankfurt Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Anna Orlowska
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, FORM (Frankfurt Orofacial Regenerative Medicine) Lab, University Hospital Frankfurt Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Sarah Al-Maawi
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, FORM (Frankfurt Orofacial Regenerative Medicine) Lab, University Hospital Frankfurt Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Andre Dias
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, FORM (Frankfurt Orofacial Regenerative Medicine) Lab, University Hospital Frankfurt Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Yunxin Zhang
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, FORM (Frankfurt Orofacial Regenerative Medicine) Lab, University Hospital Frankfurt Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Xuejiu Wang
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, FORM (Frankfurt Orofacial Regenerative Medicine) Lab, University Hospital Frankfurt Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.,Department of Oral and Maxillofacial Plastic and Trauma surgery, Capital Medical University School of Stomatology, Beijing, China
| | - Niklas Zender
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, FORM (Frankfurt Orofacial Regenerative Medicine) Lab, University Hospital Frankfurt Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Robert Sader
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, FORM (Frankfurt Orofacial Regenerative Medicine) Lab, University Hospital Frankfurt Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - C James Kirkpatrick
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, FORM (Frankfurt Orofacial Regenerative Medicine) Lab, University Hospital Frankfurt Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Shahram Ghanaati
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, FORM (Frankfurt Orofacial Regenerative Medicine) Lab, University Hospital Frankfurt Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
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21
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Jung UW, Cha JK, Vignoletti F, Nuñez J, Sanz J, Sanz M. Simultaneous lateral bone augmentation and implant placement using a particulated synthetic bone substitute around chronic peri-implant dehiscence defects in dogs. J Clin Periodontol 2017; 44:1172-1180. [DOI: 10.1111/jcpe.12802] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Ui-Won Jung
- Department of Periodontology; Research Institute for Periodontal Regeneration; College of Dentistry; Yonsei University; Seoul South Korea
| | - Jae-Kook Cha
- Department of Periodontology; Research Institute for Periodontal Regeneration; College of Dentistry; Yonsei University; Seoul South Korea
- Faculty of Odontology; Department of Periodontology; University Complutense of Madrid; Madrid Spain
| | - Fabio Vignoletti
- Faculty of Odontology; Department of Periodontology; University Complutense of Madrid; Madrid Spain
| | - Javier Nuñez
- Faculty of Odontology; Department of Periodontology; University Complutense of Madrid; Madrid Spain
| | - Javier Sanz
- Faculty of Odontology; Department of Periodontology; University Complutense of Madrid; Madrid Spain
| | - Mariano Sanz
- Faculty of Odontology; Department of Periodontology; University Complutense of Madrid; Madrid Spain
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22
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Elgali I, Omar O, Dahlin C, Thomsen P. Guided bone regeneration: materials and biological mechanisms revisited. Eur J Oral Sci 2017; 125:315-337. [PMID: 28833567 PMCID: PMC5601292 DOI: 10.1111/eos.12364] [Citation(s) in RCA: 400] [Impact Index Per Article: 57.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Guided bone regeneration (GBR) is commonly used in combination with the installment of titanium implants. The application of a membrane to exclude non‐osteogenic tissues from interfering with bone regeneration is a key principle of GBR. Membrane materials possess a number of properties which are amenable to modification. A large number of membranes have been introduced for experimental and clinical verification. This prompts the need for an update on membrane properties and the biological outcomes, as well as a critical assessment of the biological mechanisms governing bone regeneration in defects covered by membranes. The relevant literature for this narrative review was assessed after a MEDLINE/PubMed database search. Experimental data suggest that different modifications of the physicochemical and mechanical properties of membranes may promote bone regeneration. Nevertheless, the precise role of membrane porosities for the barrier function of GBR membranes still awaits elucidation. Novel experimental findings also suggest an active role of the membrane compartment per se in promoting the regenerative processes in the underlying defect during GBR, instead of being purely a passive barrier. The optimization of membrane materials by systematically addressing both the barrier and the bioactive properties is an important strategy in this field of research.
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Affiliation(s)
- Ibrahim Elgali
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, University of Gothenburg, Gothenburg, Sweden
| | - Omar Omar
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, University of Gothenburg, Gothenburg, Sweden
| | - Christer Dahlin
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, University of Gothenburg, Gothenburg, Sweden.,Department of Oral Maxillofacial Surgery/ENT, NU-Hospital organisation, Trollhättan, Sweden
| | - Peter Thomsen
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, University of Gothenburg, Gothenburg, Sweden
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23
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Jiménez Garcia J, Berghezan S, Caramês JMM, Dard MM, Marques DNS. Effect of cross-linked vs non-cross-linked collagen membranes on bone: A systematic review. J Periodontal Res 2017; 52:955-964. [PMID: 28617950 DOI: 10.1111/jre.12470] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2017] [Indexed: 12/29/2022]
Abstract
The aim of this study was to conduct a systematic review to compare the clinical outcomes of two different resorbable collagen membranes in terms of regenerated bone volume, postoperative complications and membrane degradation during bone regeneration procedures. Randomized controlled trials (RCT) or controlled trials (CT) that compared both techniques were reviewed on four electronic databases up to December 2015, a manual search was performed on the bibliography of the collected articles and the authors were contacted for additional references if undetected on the electronic and manual search. Membrane exposure was evaluated as a dichotomous outcome and the statistical unit was the membrane. The results were presented as relative risk (RR) with a 95% confidence interval. Eight RCTs and one CT were included in this study. The majority of the studies depicted a bone augmentation area, which ranged from 46.15% to 94.6% for the non-cross-link membranes and from 44% to 92.6% for the cross-link membranes at the 4-6 month re-entry surgery. From a total of 289 patients, a forest plot concerning the membrane exposure was constructed using the obtained RR of the included studies. The overall RR was 1.43 (95% CI: 0.85-2.39) with no statistically significant differences between the two groups, although with a marginal tendency towards higher exposure in the cross-link membrane group. This systematic review suggests the different membranes present themselves as appropriate for bone regeneration procedures, although cross-link membranes present higher rates of postoperative complications. However, more RCT with higher sample sizes are needed to evaluate the different membranes. The suggested lack of clinical differences between the compared membranes suggest that further cost-benefit ratio, tissue integration and postoperative complication oriented studies should be performed so that clinicians can take a patient-centred, evidence-based decision.
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Affiliation(s)
- J Jiménez Garcia
- Implant Department, Universidad Europea de Madrid, Madrid, Spain.,Periodontology and Implant Dentistry Department, New York University College of Dentistry, New York, NY, USA.,CIRO, Madrid, Spain
| | - S Berghezan
- Máster Universitário en Implantología Oral, Universidad Europea de Madrid, Madrid, Spain
| | - J M M Caramês
- Periodontology and Implant Dentistry Department, New York University College of Dentistry, New York, NY, USA.,Oral Surgery and Implant Department, LIBPhys-FCT UID/FIS/04559/2013, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal.,Implantology Institute, Lisbon, Portugal
| | - M M Dard
- Periodontology and Implant Dentistry Department, New York University College of Dentistry, New York, NY, USA.,Institut Straumann AG, Basel, Switzerland
| | - D N S Marques
- Máster Universitário en Implantología Oral, Universidad Europea de Madrid, Madrid, Spain.,Implantology Institute, Lisbon, Portugal.,Centro de Estudos de Medicina Dentária Baseada na Evidência and LIBPhys-FCT UID/FIS/04559/2013, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
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Wessing B, Urban I, Montero E, Zechner W, Hof M, Alández Chamorro J, Alández Martin N, Polizzi G, Meloni S, Sanz M. A multicenter randomized controlled clinical trial using a new resorbable non-cross-linked collagen membrane for guided bone regeneration at dehisced single implant sites: interim results of a bone augmentation procedure. Clin Oral Implants Res 2016; 28:e218-e226. [PMID: 27990692 PMCID: PMC5697637 DOI: 10.1111/clr.12995] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2016] [Indexed: 12/02/2022]
Abstract
Objective To compare clinical performance of a new resorbable non‐cross‐linked collagen membrane, creos xenoprotect (CXP), with a reference membrane (BG) for guided bone regeneration at dehisced implant sites. Materials and methods This randomized controlled clinical trial enrolled patients with expected dehiscence defects following implant placement to restore single teeth in the maxillary and mandibular esthetic zone and premolar area. Implants were placed using a two‐stage surgical protocol with delayed loading. Bone augmentation material placed at the implant surface was immobilized with CXP or BG membrane. Soft tissue health was followed during the healing period, and the defect size was measured at reentry and 6 months after implant placement. Results Of the 49 included patients, 24 were treated with CXP and 25 with BG. Patient characteristics did not differ between the two arms. In the CXP arm, the defect height at implant insertion was (mean ± SD) 5.1 ± 2.1 mm (n = 24) and reduced at reentry by 81% to 1.0 ± 1.3 mm (n = 23). In the BG arm, the defect height at implant insertion was 4.9 ± 1.9 mm (n = 25) and reduced at reentry by 62% to 1.7 ± 2.1 mm (n = 24). Assuming a margin of non‐inferiority of 1 mm, CXP was non‐inferior to BG. Membrane exposure rate was highest at week 3 in both arms, reaching 16.7% for BG and 8.7% for CXP. Conclusions The new resorbable non‐cross‐linked collagen membrane facilitates bone gain to support implant placement in expected dehiscence defects. The observed trend toward higher mean bone gain and lower exposure rate with CXP compared to BG should be further investigated.
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Affiliation(s)
| | - Istvan Urban
- Graduate Implant Dentistry, Loma Linda, CA, USA.,Urban Regeneration Institute, Budapest, Hungary
| | - Eduardo Montero
- Section of Graduate Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
| | - Werner Zechner
- Department of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Markus Hof
- Division of Dental Student Training and Patient Care, Department of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Silvio Meloni
- Dentistry Unit, Department of Surgical, Microsurgical, and Medical Sciences, University Hospital of Sassari, Sassari, Italy
| | - Mariano Sanz
- Section of Graduate Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
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25
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Park JY, Jung IH, Kim YK, Lim HC, Lee JS, Jung UW, Choi SH. Guided bone regeneration using 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC)-cross-linked type-I collagen membrane with biphasic calcium phosphate at rabbit calvarial defects. Biomater Res 2015; 19:15. [PMID: 26331084 PMCID: PMC4552459 DOI: 10.1186/s40824-015-0038-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 06/15/2015] [Indexed: 12/05/2022] Open
Abstract
Background In-vitro and animal studies using EDC cross-linked membranes have shown great resistance to enzymatic digestion as well as low cytotoxicity, and indicated its potential expediency as a barrier membrane for guided bone regeneration (GBR). The purpose of this study was to evaluate the efficacy, biocompatibility and degradation kinetics of a novel 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC)-cross-linked type I collagen membrane for regeneration of rabbit calvarial defects. EDC cross-linked type I collagen membrane and macroporous biphasic calcium phosphate (MBCP) consisting of 60 % hydroxyapatite and 40 % β-tricalcium phosphate were used in this study. Four circular defects (ø = 8 mm) were created in each calvarium of 12 male white rabbits. The experimental groups randomly allocated to the defects were as follows – (1) sham control, (2) EDC-cross-linked collagen membrane (EDC membrane), (3) bone graft (BG), and (4) bone graft with collagen membrane (B-EDC membrane). Specimens were harvested at 2 weeks (n = 6) and 8 weeks (n = 6) postoperatively for observational histology and histometrical analysis. Result The histologic observation showed close adaptation of the EDC membrane to the defect perimeters along with vascularization of the membrane at 2 weeks. Direct apposition of new bone on to the collagen matrix could be observed displaying adequate tissue integration. Collapsing of the central portion of the membrane could be seen in the EDC membrane group, and both BG and B-EDC membrane groups showed greater total augmented area and new bone area than the EDC membrane group. The membrane was largely unresorbed at 2 weeks; and at 8 weeks the overall shape of the membrane was still maintained suggesting sustained barrier function at 8 weeks. Conclusion Within the limits of this study, it may be concluded that EDC-cross-linked collagen membrane is a safe biomaterial with adequate tissue integration and resorption kinetics to support bone regeneration when used in conjunction with bone filler.
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Affiliation(s)
- Jin-Young Park
- Department of periodontology, Research institute of periodontal regeneration, Yonsei University College of Dentistry, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752 Republic of Korea
| | - Im-Hee Jung
- Department of Dental hygiene, College of Health Sciences, Eulji University, Seong-nam, Republic of Korea
| | - You-Kyoung Kim
- Department of periodontology, Research institute of periodontal regeneration, Yonsei University College of Dentistry, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752 Republic of Korea
| | - Hyun-Chang Lim
- Department of periodontology, Research institute of periodontal regeneration, Yonsei University College of Dentistry, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752 Republic of Korea
| | - Jung-Seok Lee
- Department of periodontology, Research institute of periodontal regeneration, Yonsei University College of Dentistry, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752 Republic of Korea
| | - Ui-Won Jung
- Department of periodontology, Research institute of periodontal regeneration, Yonsei University College of Dentistry, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752 Republic of Korea
| | - Seong-Ho Choi
- Department of periodontology, Research institute of periodontal regeneration, Yonsei University College of Dentistry, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752 Republic of Korea
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26
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Sanz-Sánchez I, Ortiz-Vigón A, Sanz-Martín I, Figuero E, Sanz M. Effectiveness of Lateral Bone Augmentation on the Alveolar Crest Dimension. J Dent Res 2015. [DOI: 10.1177/0022034515594780] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Lateral ridge augmentation procedures are aimed to reconstruct deficient alveolar ridges or to build up peri-implant dehiscence and fenestrations. The objective of this systematic review was to assess the efficacy of these interventions by analyzing data from 40 clinical studies evaluating bone augmentation through either the staged or the simultaneous approach. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guideline for systematic reviews was used. The primary outcomes were the changes at reentry, in the ridge width, and in the vertical and horizontal dimensions of the peri-implant defect, measured in millimeters, in the staged and simultaneous approaches, respectively. The results of the meta-analysis showed, for the simultaneous approach, a statistically significant defect height reduction when all treatments were analyzed together (weighted mean difference [WMD] = −4.28 mm; 95% confidence interval: [CI] –4.88, –3.69; P < 0.01). The intervention combining bone replacement grafts with barrier membranes was associated with superior outcomes The most frequently used intervention was the combination of xenograft and bioabsorbable membrane. Similarly, for the staged approach, there was a statistically significant horizontal gain when all treatment groups were combined (WMD = 3.90 mm; 95% CI: 3.52, 4.28; P < 0.001). The most frequently used intervention was the use of autogenous bone blocks. Both treatment strategies led to high survival and success rates (>95%) for the implants placed on the regenerated sites. Nonexposed sites gained significantly more in the simultaneous and staged approaches (WMD = 1.1 and 3.1 mm).
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Affiliation(s)
- I. Sanz-Sánchez
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
| | - A. Ortiz-Vigón
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
| | - I. Sanz-Martín
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
| | - E. Figuero
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - M. Sanz
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
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Tissue reactions after simultaneous alveolar ridge augmentation with biphasic calcium phosphate and implant insertion--histological and immunohistochemical evaluation in humans. Clin Oral Investig 2014; 19:1595-603. [PMID: 25511386 DOI: 10.1007/s00784-014-1385-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 12/03/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Simultaneous lateral augmentation and implant placement is considered as standard procedure in deficient edentulous ridges in oral implantology. Histological studies monitoring osteogenesis after application of alloplastic bone substitutes in humans are scarce. Bone formation upon simultaneous augmentation with biphasic calcium phosphate (BCP) and implantation was histologically investigated after 6 months in situ. The results of this secondary analysis are reported tempting to ascribe specific observations to uneventful submerged healing or compromised healing of soft tissues including occurrence of dehiscences and premature graft exposure. MATERIALS AND METHODS Histology of biopsies from lateral, crestal bone augmentations using alloplastic BCP comprising seven sites with compromised, prematurely exposed healing and six sites with uneventful submerged healing was investigated for expression of osteogenic, osteoclastogenic, and angiogenic differentiation markers. RESULTS Histology revealed alkaline phosphatase (ALP)-positive osteoblasts and immunoreactivity for osteogenic markers osteocalcin and collagen type I in biopsies with submerged healing, while inflammatory infiltrates and accumulations of multinucleated giant cells around BCP granules were observed in compromised sites. All specimens presented adequate vessel density. Multinucleated giant cells showed inconsistent staining for the osteoclast marker tartrate-resistant acid phosphatase (TRAP). CONCLUSIONS The histological findings of this study indicate an osteoconductive nature of the BCP applied. Premature exposure of the bone substitute reduced new bone formation and may bear a risk for inflammatory and foreign body reactions. CLINICAL RELEVANCE A predictable appositional bone formation in simultaneously augmented sites using BCP is linked to an uneventful healing process.
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28
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Smolka W. Calvarial grafts for alveolar ridge reconstruction prior to dental implant placement: an update. Oral Maxillofac Surg 2014; 18:381-385. [PMID: 25249177 DOI: 10.1007/s10006-014-0464-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 08/25/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE The aims of this review were to analyze publications related to alveolar crest reconstruction using calvarial grafts and to evaluate the survival and success rates of implants placed into the augmented area. METHODS An automated search was made in MEDLINE of clinical publications from 2000 to 2013. Only publications with at least five patients and a minimum follow-up of 6 months were included. RESULTS Graft success ranged between 97 and 100 %. Donor site complications were minimal. The most frequent complications in the recipient site were wound dehiscence. Prosthodontic loading time in most of the studies was 3 months. Implant survival rates ranged between 95 and 100 %. Implant success rates were between 90.3 and 95.05 %. CONCLUSIONS Grafting procedures with calvarial transplants show a high graft success rate and a sufficient implant success rate. Calvarial bone grafts are a reliable procedure for alveolar crest reconstruction.
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Affiliation(s)
- Wenko Smolka
- Department of Oral and Maxillofacial Surgery, Ludwig Maximilian University, Lindwurmstr. 2a, 80337, Munich, Germany,
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29
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Benic GI, Hämmerle CHF. Horizontal bone augmentation by means of guided bone regeneration. Periodontol 2000 2014; 66:13-40. [DOI: 10.1111/prd.12039] [Citation(s) in RCA: 214] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 12/18/2022]
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30
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Li X, Wang X, Zhao T, Gao B, Miao Y, Zhang D, Dong Y. Guided bone regeneration using chitosan-collagen membranes in dog dehiscence-type defect model. J Oral Maxillofac Surg 2013; 72:304.e1-14. [PMID: 24438600 DOI: 10.1016/j.joms.2013.09.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 09/05/2013] [Accepted: 09/30/2013] [Indexed: 01/14/2023]
Abstract
PURPOSE The purpose of the present study was to compare a newly developed chitosan-collagen membrane (CCM) with a standard collagen membrane (SCM) regarding their effects on guided bone regeneration. MATERIALS AND METHODS The right mandibular premolars and first molar were extracted from 12 beagle dogs. Four months later, acute buccal dehiscence-type defects (4 × 3 mm in height and width) were surgically created after implant site preparation. The defects were randomly assigned to 4 different groups: CCM-1 (weight ratio of chitosan to collagen of 40:1), CCM-2 (weight ratio of chitosan to collagen of 20:1), SCM, and vehicle control. The dogs were sacrificed after 4, 8, and 12 weeks of healing for radiographic examination, histologic observation, and histometric analysis. RESULTS The membrane-treated sites showed more bone formation than the control sites, although no statistically significant differences were found between the membrane-treated sites and the control sites for new bone-to-implant contact and new bone-filled area at any point. At 8 weeks, the new bone height for the membrane-treated sites was significantly greater statistically than that of the untreated group (P < .05). At 12 weeks, the CCM-1 group showed significantly greater new bone height (1.91 ± 0.25 mm) than the untreated group (1.20 ± 0.34 mm; P < .05). However, the CCMs did not show any statistically significant differences compared with the SCMs for any assessed parameter. CONCLUSIONS The results of the present study have shown that the developed CCMs can enhance bone regeneration and could be a candidate for use in guided bone regeneration.
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Affiliation(s)
- Xiaojing Li
- MD Student, Department of Prosthetic Dentistry, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Xinmu Wang
- Associate Professor, Department of Oral Surgery, First People's Hospital of Hangzhou, Hangzhou, China
| | - Tengfei Zhao
- Resident, Department of Orthopedic Surgery, Second Affiliated Hospital (Binjiang Branch), Hangzhou Binjiang Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bo Gao
- MD Student, Department of Prosthetic Dentistry, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Yuwen Miao
- MD Student, Department of Prosthetic Dentistry, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Dandan Zhang
- MD Student, Department of Prosthetic Dentistry, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Yan Dong
- Associate Professor, Department of Prosthetic Dentistry, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China.
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31
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Soft and Hard Tissues Healing at Immediate Transmucosal Implants Placed Into Molar Extraction Sites With Collagen Membrane Uncovered. IMPLANT DENT 2013; 22:474-80. [DOI: 10.1097/id.0b013e3182a03d14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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Nevins M, Nevins ML, Schupbach P, Kim SW, Lin Z, Kim DM. A prospective, randomized controlled preclinical trial to evaluate different formulations of biphasic calcium phosphate in combination with a hydroxyapatite collagen membrane to reconstruct deficient alveolar ridges. J ORAL IMPLANTOL 2013; 39:133-9. [PMID: 23611676 DOI: 10.1563/aaid-joi-d-12-00185] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Many patients and clinicians would prefer a synthetic particulate bone replacement graft, but most available alloplastic biomaterials have limited osteogenic potential. An alloplast with increased regenerative capacity would be advantageous for the treatment of localized alveolar ridge defects. This prospective, randomized controlled preclinical trial utilized 6 female foxhounds to analyze the osteogenic impact of different formulations of biphasic calcium phosphate (BCP) in combination with an hydroxyapatite-collagen membrane and their ability to reconstruct deficient alveolar ridges for future implant placement. The grafted sites were allowed to heal 3 months, and then trephine biopsies were obtained to perform light microscopic and histomorphometric analyses. All treated sites healed well with no early membrane exposure or adverse soft tissue responses during the healing period. The grafted sites exhibited greater radiopacity than the surrounding native bone with BCP particles seen as radiopaque granules. The graft particles appeared to be well-integrated and no areas of loose particles were observed. Histologic evaluation demonstrated BCP particles embedded in woven bone with dense connective tissue/marrow space. New bone growth was observed around the graft particles as well as within the structure of the graft particulate. There was intimate contact between the graft particles and newly formed bone, and graft particles were bridged by the newly formed bone in all biopsies from the tested groups. The present study results support the potential of these BCP graft particulates to stimulate new bone formation. Clinical studies are recommended to confirm these preclinical findings.
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Affiliation(s)
- Myron Nevins
- Department of Oral Medicine, Harvard School of Dental Medicine, Boston, MA, USA
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33
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Kämmerer PW, Palarie V, Schiegnitz E, Nacu V, Draenert FG, Al-Nawas B. Influence of a collagen membrane and recombinant platelet-derived growth factor on vertical bone augmentation in implant-fixed deproteinized bovine bone--animal pilot study. Clin Oral Implants Res 2012; 24:1222-30. [PMID: 22762383 DOI: 10.1111/j.1600-0501.2012.02534.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Combinations of bone substitute block materials with membrane techniques as well as with growth factors are possible options to enhance the prognosis of vertical bone augmentation. Therefore, the aim of the pilot study was to compare the influence of a collagen membrane and a signal protein (rhPDGF-BB) on vertical bone augmentation with a stable fixed block material (deproteinized bovine bone [DBB]). MATERIALS AND METHODS In 12 rabbits, a DBB-block was implant-fixed on the tibia in a split-leg-design. Included were: DBB only (control), DBB + collagen membrane (test), DBB + rhPDGF-BB (test) and DBB + rhPDGF-BB + collagen membrane (test). 24 samples were examined after 3 (n = 12) and 6 weeks (n = 12). Calculated parameters were new bone area (NBA;%), new vertical bone height (VBH; mm). Due to the pilot character of this study, single values are shown descriptively only. RESULTS After 3 weeks, there were constant higher NBA values in the rhPDGF-BB-group without membrane (NBA (%) DBB: 30/16/4; DBB + membrane: 25/17/7, DBB + rhPDGF-BB: 40/33/34, DBB + rhPDGF-BB + membrane: 0/30/16; VBH (mm) DBB: 1.2/1.2/1, DBB + membrane: 0.7/0.9/1, DBB + rhPDGF-BB: 0.7/0.9/1, DBB + rhPDGF-BB + membrane: 0/1.1/1). After 6 weeks, both membrane groups showed a constant higher NBA and VBH independent to the use of rhPDGF-BB (NBA DBB: 3/0/5, DBB + membrane: 20/35/31, DBB + rhPDGF-BB: 5/8/4, DBB + rhPDGF-BB + membrane: 31/35/40; VBH DBB: 0.3/0.3/0.6, DBB + membrane: 1.6/2.4/2.1, DBB + rhPDGF-BB: 0.4/0.7/0.8, DBB + rhPDGF-BB + membrane: 1.8/2/1.8). CONCLUSIONS For vertical augmentation, the addition of rhPDGF-BB to DBB-blocks may increase early bone growth. In the later phase, the use of a collagen membrane enhances new bone volume and height to a significant greater extend. Even if the results are higher than those in the non-membrane groups, the low gain of bone after the short time periods still needs improvement.
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Affiliation(s)
- P W Kämmerer
- Department of Oral, Maxillofacial and Plastic Surgery, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
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