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Shaheen MY. Nanocrystalline hydroxyapatite in periodontal bone regeneration: A systematic review. Saudi Dent J 2022; 34:647-660. [PMID: 36570589 PMCID: PMC9767838 DOI: 10.1016/j.sdentj.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background Periodontal diseases when persistent, results in periodontal pockets, attachment loss and progressive destruction of the alveolar bone. Grafting periodontal bone defects with bone substitute biomaterials has proven clinical success for accomplishing reconstruction of lost attachment apparatus, especially in deep intra-bony defects. Nanoparticles (NPs) have been considered indispensable in the future of health sciences and NP based alloplastic graft materials such as nanocrystalline hydroxyapatite (NCHA) hold great promise for regeneration of periodontal defects. Therefore the aim of this review is to evaluate the role of NCHA as an effective substitute for periodontal bone regeneration. Material & methods Popular scientific databases such as PubMed (Medline), Cochrane database of clinical trials, Scopus (Elsevier), Web of science (Clarivate Analytics) and Google Scholar, were searched. The literature search was restricted to published reports in English, between January 2000 and December 2021. Database search returned 1227 results which were screened based on title, author names and publication dates. Results Data from the 14 included studies were reviewed and tabulated. In the present review, all the studies reported using commercially available NCHA for periodontal bone regeneration. Conclusion NCHA is a suitable bone substitute material for periodontal bone regeneration, with outcomes comparable to that of conventionally used graft materials such as bovine xenograft and other synthetic alloplastic materials. While grafting with NCHA in intrabony periodontal defects, after any form of periodontal flap surgery or debridement, significantly improves bone regeneration by 6 months, addition of adjuncts like EMD and PRF further enhance the outcomes.
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Clinical Outcome After Anterior Lumbar Interbody Fusion With a New Osteoinductive Bone Substitute Material: A Randomized Clinical Pilot Study. Clin Spine Surg 2019; 32:E319-E325. [PMID: 30730430 DOI: 10.1097/bsd.0000000000000802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Pilot, single-center, single-blinded, parallel-group, randomized clinical study. OBJECTIVE The aim of this study was to pilot a randomized clinical study to evaluate whether instrumented anterior lumbar interbody fusion (ALIF) with a new nanocrystalline hydroxyapatite embedded in a silica gel matrix (NH-SiO2) leads to superior radiologic and clinical outcomes at 12-month follow-up compared with instrumented ALIF with homologous bone. SUMMARY OF BACKGROUND DATA ALIF completed with interbody cages is an established technique for performing arthrodesis of the lumbar spine. There is ongoing discussion about which cage-filling material is most appropriate. This is the first study to assess the efficacy of NH-SiO2 in ALIF surgery. MATERIALS AND METHODS This randomized, clinical, pilot trial included 2 groups of 20 patients with monosegmental or multisegmental degenerative disease of the lumbar spine who were suitable to undergo monosegmental or bisegmental ALIF fusion at the level L4/L5 and L5/S1 with a carbon fiber reinforced polymer ALIF cage filled with either NH-SiO2 or homogenous bone. Primary outcome was postoperative disability as measured by the Oswestry Disability Index (ODI). Secondary outcomes were postoperative radiographic outcomes, pain, and quality of life. Patients were followed 12 months postoperatively. RESULTS Mean (±SD) 12-month ODI was 24±17 in the NH-SiO2 group and 27±19 in the homologous bone group (P=0.582). Postoperative radiography, functional outcomes, and quality-of-life indices did not differ significantly between groups at any of the regularly scheduled follow-up visits. CONCLUSIONS This clinical study showed similar functional, radiologic, and clinical outcomes 12 months postoperatively for instrumented ALIF procedures with the use of NH-SiO2 or homologous bone as cage filling. In the absence of any relevant differences in outcome, we postulate that the pivotal clinical study should be designed as an equivalence trial.
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Hosni A, El-Beialy WR, Ezz M. Modified lateral sinus lift using disc-form silica calcium-phosphate NanoComposite and consequent implant placement. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.fdj.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Alagl AS, Madi M. Localized ridge augmentation in the anterior maxilla using titanium mesh, an alloplast, and a nano-bone graft: a case report. J Int Med Res 2018; 46:2001-2007. [PMID: 29529906 PMCID: PMC5991235 DOI: 10.1177/0300060518758226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/18/2018] [Indexed: 11/18/2022] Open
Abstract
Alveolar ridge deficiency is considered a major limitation for successful implant placement, as well as for the long-term success rate, especially in the anterior maxillary region. Various approaches have been developed to increase bone volume. Among those approaches, inlay and onlay grafts, alveolar ridge distraction, and guided bone regeneration have been suggested. The use of titanium mesh is a reliable method for ridge augmentation. We describe a patient who presented with a localized, combined, horizontal and vertical ridge defect in the anterior maxilla. The patient was treated using titanium mesh and alloplast material mixed with a nano-bone graft to treat the localized ridge deformity for future implant installation. The clinical and radiographic presentation, as well as relevant literature, are presented.
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Affiliation(s)
- Adel S Alagl
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Marwa Madi
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Varoni EM, Vijayakumar S, Canciani E, Cochis A, De Nardo L, Lodi G, Rimondini L, Cerruti M. Chitosan-Based Trilayer Scaffold for Multitissue Periodontal Regeneration. J Dent Res 2017; 97:303-311. [PMID: 29045803 DOI: 10.1177/0022034517736255] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Periodontal regeneration is still a challenge for periodontists and tissue engineers, as it requires the simultaneous restoration of different tissues-namely, cementum, gingiva, bone, and periodontal ligament (PDL). Here, we synthetized a chitosan (CH)-based trilayer porous scaffold to achieve periodontal regeneration driven by multitissue simultaneous healing. We produced 2 porous compartments for bone and gingiva regeneration by cross-linking with genipin either medium molecular weight (MMW) or low molecular weight (LMW) CH and freeze-drying the resulting scaffolds. We synthetized a third compartment for PDL regeneration by CH electrochemical deposition; this allowed us to produce highly oriented microchannels of about 450-µm diameter intended to drive PDL fiber growth toward the dental root. In vitro characterization showed rapid equilibrium water content for MMW-CH and LMW-CH compartments (equilibrium water content after 5 min >85%). The MMW-CH compartment degraded more slowly and provided significantly more resistance to compression (28% ± 1% of weight loss at 4 wk; compression modulus HA = 18 ± 6 kPa) than the LMW-CH compartment (34% ± 1%; 7.7 ± 0.8 kPa) as required to match the physiologic healing rates of bone and gingiva and their mechanical properties. More than 90% of all human primary periodontal cell populations tested on the corresponding compartment survived during cytocompatibility tests, showing active cell metabolism in the alkaline phosphatase and collagen deposition assays. In vivo tests showed high biocompatibility in wild-type mice, tissue ingrowth, and vascularization within the scaffold. Using the periodontal ectopic model in nude mice, we preseeded scaffold compartments with human gingival fibroblasts, osteoblasts, and PDL fibroblasts and found a dense mineralized matrix within the MMW-CH region, with weakly mineralized deposits at the dentin interface. Together, these results support this resorbable trilayer scaffold as a promising candidate for periodontal regeneration.
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Affiliation(s)
- E M Varoni
- 1 Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milano, Italy.,2 Department of Materials Engineering, McGill University, Montreal, Canada
| | - S Vijayakumar
- 2 Department of Materials Engineering, McGill University, Montreal, Canada
| | - E Canciani
- 1 Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milano, Italy
| | - A Cochis
- 1 Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milano, Italy.,3 Dipartimento di Scienze della Salute, Università del Piemonte Orientale, Novara, Italy
| | - L De Nardo
- 4 Department of Chemistry, Materials, and Chemical Engineering "G. Natta," Politecnico di Milano, Milano, Italy.,5 INSTM, Consorzio Nazionale di Scienza e Tecnologia dei Materiali, Firenze, Italy
| | - G Lodi
- 1 Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milano, Italy
| | - L Rimondini
- 3 Dipartimento di Scienze della Salute, Università del Piemonte Orientale, Novara, Italy
| | - M Cerruti
- 2 Department of Materials Engineering, McGill University, Montreal, Canada
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Croissant JG, Fatieiev Y, Khashab NM. Degradability and Clearance of Silicon, Organosilica, Silsesquioxane, Silica Mixed Oxide, and Mesoporous Silica Nanoparticles. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2017; 29:1604634. [PMID: 28084658 DOI: 10.1002/adma.201604634] [Citation(s) in RCA: 391] [Impact Index Per Article: 55.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/13/2016] [Indexed: 05/27/2023]
Abstract
The biorelated degradability and clearance of siliceous nanomaterials have been questioned worldwide, since they are crucial prerequisites for the successful translation in clinics. Typically, the degradability and biocompatibility of mesoporous silica nanoparticles (MSNs) have been an ongoing discussion in research circles. The reason for such a concern is that approved pharmaceutical products must not accumulate in the human body, to prevent severe and unpredictable side-effects. Here, the biorelated degradability and clearance of silicon and silica nanoparticles (NPs) are comprehensively summarized. The influence of the size, morphology, surface area, pore size, and surface functional groups, to name a few, on the degradability of silicon and silica NPs is described. The noncovalent organic doping of silica and the covalent incorporation of either hydrolytically stable or redox- and enzymatically cleavable silsesquioxanes is then described for organosilica, bridged silsesquioxane (BS), and periodic mesoporous organosilica (PMO) NPs. Inorganically doped silica particles such as calcium-, iron-, manganese-, and zirconium-doped NPs, also have radically different hydrolytic stabilities. To conclude, the degradability and clearance timelines of various siliceous nanomaterials are compared and it is highlighted that researchers can select a specific nanomaterial in this large family according to the targeted applications and the required clearance kinetics.
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Affiliation(s)
- Jonas G Croissant
- Smart Hybrid Materials Laboratory (SHMs), Advanced Membranes and Porous Materials Center, King Abdullah University of Science and Technology, Thuwal, 23955, Saudi Arabia
| | - Yevhen Fatieiev
- Smart Hybrid Materials Laboratory (SHMs), Advanced Membranes and Porous Materials Center, King Abdullah University of Science and Technology, Thuwal, 23955, Saudi Arabia
| | - Niveen M Khashab
- Smart Hybrid Materials Laboratory (SHMs), Advanced Membranes and Porous Materials Center, King Abdullah University of Science and Technology, Thuwal, 23955, Saudi Arabia
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8
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Figliuzzi MM, Giudice A, Pileggi S, Scordamaglia F, Marrelli M, Tatullo M, Fortunato L. Biomimetic hydroxyapatite used in the treatment of periodontal intrabony pockets: clinical and radiological analysis. ANNALI DI STOMATOLOGIA 2016; 7:16-23. [PMID: 27486507 DOI: 10.11138/ads/2016.7.1.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AIM Hydroxyapatite (PA) has a chemical composition and physical structure very similar to natural bone and therefore it has been considered to be the ideal biomaterial able to ensure a biomimetic scaffold to use in bone tissue engineering. The aim of this study is to clinically test hydroxyapatite used as osteoconductive biomaterial in the treatment of periodontal bone defects. Clinical and radiological evaluations were conducted at 6, 12 and 18 months after the surgery. MATERIALS AND METHODS Forty patients with 2- and 3-wall intrabony pockets were enrolled in this study. PPD, CAL, radiographic depth (RD) and angular defects were preoperatively measured. After surgery, patients were re-evaluated every 6 months for 18 months. Statistical analyses were also performed to investigate any differences between preoperative and postoperative measurements. RESULTS Paired t-test samples conducted on the data obtained at baseline and 18 months after, showed significant (p<0.01) differences in each measurement performed. The role of preoperative RD was demonstrated to be a significant key factor (p<0.01). A relevant correlation between preoperative PPD and CAL gain was also found. CONCLUSIONS Within the limitations of this study, the absence of anatomical variables, except the morphology of the bone defect, emphasizes the importance of the proper surgical approach and the graft material used.
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Affiliation(s)
| | - Amerigo Giudice
- Department of Periodontics and Oral Sciences, University "Magna Graecia" Catanzaro, Italy
| | - Settimia Pileggi
- Department of Periodontics and Oral Sciences, University "Magna Graecia" Catanzaro, Italy
| | - Francesco Scordamaglia
- Department of Periodontics and Oral Sciences, University "Magna Graecia" Catanzaro, Italy
| | | | - Marco Tatullo
- Maxillofacial Unit, Calabrodental Clinic, Crotone, Italy
| | - Leonzio Fortunato
- Department of Periodontics and Oral Sciences, University "Magna Graecia" Catanzaro, Italy
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Ilyas A, Lavrik NV, Kim HK, Aswath PB, Varanasi VG. Enhanced interfacial adhesion and osteogenesis for rapid "bone-like" biomineralization by PECVD-based silicon oxynitride overlays. ACS APPLIED MATERIALS & INTERFACES 2015; 7:15368-15379. [PMID: 26095187 PMCID: PMC6508966 DOI: 10.1021/acsami.5b03319] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Structurally unstable fracture sites require metal fixative devices, which have long healing times due to their lack of osteoinductivity. Bioactive glass coatings lack in interfacial bonding, delaminate, and have reduced bioactivity due to the high temperatures used for their fabrication. Here, we test the hypothesis that low-temperature PECVD amorphous silica can enhance adhesion to the underlying metal surface and that N incorporation enhances osteogenesis and rapid biomineralization. A model Ti/TiO2-SiOx interface was formed by first depositing Ti onto Si wafers, followed by surface patterning, thermal annealing to form TiO2, and depositing SiOx/Si(ON)x overlays. TEM micrographs showed conformal SiOx layers on Ti/TiO2 overlays while XPS data revealed the formation of an elemental Ti-O-Si interface. Nanoscratch testing verified strong SiOx bonding with the underlying TiO2 layers. In vitro studies showed that the surface properties changed significantly to reveal the formation of hydroxycarbonate apatite within 6 h, and Si(ON)x surface chemistry induced osteogenic gene expression of human periosteal cells and led to a rapid "bone-like" biomineral formation within 4 weeks. XANES data revealed that the incorporation of N increased the surface HA bioactivity by increasing the carbonate to phosphate ratio. In conclusion, silicon oxynitride overlays on bone-implant systems enhance osteogenesis and biomineralization via surface nitrogen incorporation.
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Affiliation(s)
- Azhar Ilyas
- Department of Biomedical Sciences, Baylor College of Dentistry Texas A&M University, 3302 Gaston Avenue, Dallas, Texas 75246, United States
| | - Nickolay V. Lavrik
- Center for Nanophase Materials Science, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, United States
| | - Harry K.W. Kim
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390, United States
- Center for Excellence in Hip Disorders, Texas Scottish Rite Hospital, 2222 Welborn Street, Dallas, Texas 75219, United States
| | - Pranesh B. Aswath
- Department of Materials Science and Engineering, University of Texas at Arlington, 501 West First Street, Arlington, Texas 76019, United States
| | - Venu G. Varanasi
- Department of Biomedical Sciences, Baylor College of Dentistry Texas A&M University, 3302 Gaston Avenue, Dallas, Texas 75246, United States
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Odatsu T, Azimaie T, Velten MF, Vu M, Lyles MB, Kim HK, Aswath PB, Varanasi VG. Human periosteum cell osteogenic differentiation enhanced by ionic silicon release from porous amorphous silica fibrous scaffolds. J Biomed Mater Res A 2015; 103:2797-806. [PMID: 25630903 DOI: 10.1002/jbm.a.35412] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 01/07/2015] [Accepted: 01/26/2015] [Indexed: 12/12/2022]
Abstract
Current synthetic grafts for bone defect filling in the sinus can support new bone formation but lack the ability to stimulate or enhance osteogenic healing. To promote such healing, osteoblast progenitors such as human periosteum cells must undergo osteogenic differentiation. In this study, we tested the hypothesis that degradation of porous amorphous silica fibrous (PASF) scaffolds can enhance human periosteum cell osteogenic differentiation. Two types of PASF were prepared and evaluated according to their densities (PASF99, PASF98) with 99 and 98% porosity, respectively. Silicon (Si) ions were observed to rapidly release from both scaffolds within 24 h in vitro. PASF99 Si ion release rate was estimated to be nearly double that of PASF98 scaffolds. Mechanical tests revealed a lower compressive strength in PASF99 as compared with PASF98. Osteogenic expression analysis showed that PASF99 scaffolds enhanced the expression of activating transcription factor 4, alkaline phosphatase, and collagen (Col(I)α1, Col(I)α2). Scanning electron microscopy showed cellular and extracellular matrix (ECM) ingress into both scaffolds within 16 days and the formation of Ca-P precipitates within 85 days. In conclusion, this study demonstrated that PASF scaffolds enhance human periosteum cell osteogenic differentiation by releasing ionic Si, and structurally supporting cellular and ECM ingress.
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Affiliation(s)
- Tetsurou Odatsu
- Department of Biomedical Sciences, Baylor College of Dentistry, Texas a & M Health Science Center, Dallas, Texas, 75246.,Department of Applied Prosthodontics, Graduate School of Biomedical Science, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 8528588, Japan.,Material Science and Engineering Department, University of Texas at Arlington, Arlington, Texas, 76019
| | - Taha Azimaie
- Department of Biomedical Sciences, Baylor College of Dentistry, Texas a & M Health Science Center, Dallas, Texas, 75246
| | - Megan F Velten
- Material Science and Engineering Department, University of Texas at Arlington, Arlington, Texas, 76019
| | - Michael Vu
- Department of Biomedical Sciences, Baylor College of Dentistry, Texas a & M Health Science Center, Dallas, Texas, 75246
| | - Mark B Lyles
- VADM Joel T, Boone Chair of Health and Security Studies, U.S. Naval War College, Center for Naval Warfare Studies, Newport, Rhode Island, 02841
| | - Harry K Kim
- Center for Excellence in Hip Disorders, Texas Scottish Rite Hospital for Children, Dallas, Texas, 75219.,Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, 753908883
| | - Pranesh B Aswath
- Material Science and Engineering Department, University of Texas at Arlington, Arlington, Texas, 76019
| | - Venu G Varanasi
- Department of Biomedical Sciences, Baylor College of Dentistry, Texas a & M Health Science Center, Dallas, Texas, 75246
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Ioannou AL, Kotsakis GA, Kumar T, Hinrichs JE, Romanos G. Evaluation of the bone regeneration potential of bioactive glass in implant site development surgeries: a systematic review of the literature. Clin Oral Investig 2014; 19:181-91. [DOI: 10.1007/s00784-014-1376-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 11/20/2014] [Indexed: 01/08/2023]
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12
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Broggini N, Bosshardt DD, Jensen SS, Bornstein MM, Wang CC, Buser D. Bone healing around nanocrystalline hydroxyapatite, deproteinized bovine bone mineral, biphasic calcium phosphate, and autogenous bone in mandibular bone defects. J Biomed Mater Res B Appl Biomater 2014; 103:1478-87. [DOI: 10.1002/jbm.b.33319] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 09/25/2014] [Accepted: 10/18/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Nina Broggini
- Department of Oral Surgery and Stomatology; School of Dental Medicine, University of Bern; Bern Switzerland
- Private Practice, Studio Borsa Broggini Lanfranchini, Via Stazione 1; Balerna Switzerland
| | - Dieter D. Bosshardt
- Department of Oral Surgery and Stomatology; School of Dental Medicine, University of Bern; Bern Switzerland
- Robert K. Schenk Laboratory of Oral Histology; School of Dental Medicine, University of Bern; Bern Switzerland
| | - Simon S. Jensen
- Department of Oral Surgery and Stomatology; School of Dental Medicine, University of Bern; Bern Switzerland
- Department of Oral & Maxillofacial Surgery; Copenhagen University Hospital (Rigshospitalet); Copenhagen Denmark
| | - Michael M. Bornstein
- Department of Oral Surgery and Stomatology; School of Dental Medicine, University of Bern; Bern Switzerland
| | - Chun-Cheng Wang
- Division of Periodontology, Department of Dentistry; National Taiwan University Hospital; Taipei Taiwan
| | - Daniel Buser
- Department of Oral Surgery and Stomatology; School of Dental Medicine, University of Bern; Bern Switzerland
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Thoma DS, Kruse A, Ghayor C, Jung RE, Weber FE. Bone augmentation using a synthetic hydroxyapatite/silica oxide-based and a xenogenic hydroxyapatite-based bone substitute materials with and without recombinant human bone morphogenetic protein-2. Clin Oral Implants Res 2014; 26:592-8. [PMID: 25138542 DOI: 10.1111/clr.12469] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2014] [Indexed: 12/01/2022]
Abstract
AIM To test whether or not bone regeneration using deproteinized bovine bone mineral (DBBM) is comparable to hydroxyapatite/silica oxide (HA/SiO) and to test the effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) as an adjunct to DBBM for localized bone regeneration. MATERIALS AND METHODS In each of the 10 rabbits, 4 titanium cylinders were placed on the external cortical plates of their calvaria. Four treatment modalities were randomly allocated: (i) empty, (ii) HA/SiO, (iii) DBBM, and (iv) DBBM plus rhBMP-2 (DBBM/BMP). The animals were sacrificed at week 8. Descriptive histology and histomorphometric assessment using a superimposed test grid of points and cycloids were performed. RESULTS The mean number of points of the test grid coinciding with bone within the cylinder reached 124 ± 35 bone points for empty controls, 92 ± 40 bone points for DBBM, 98 ± 44 bone points for synthetic HA/SiO, and 146 ± 34 bone points DBBM/BMP. The P-value for DBBM with and without BMP reached a borderline statistical significance of 0.051. However, the area of bone regeneration within the cylinders peaked for DBBM/BMP and was statistically significantly higher compared with empty cylinders (P < 0.05). The bone-to-bone substitute contact ranged between 32.9% ± 21.7 for DBBM, 39.6 ± 18.4% for HA/SiO, and 57.8% ± 10.2 for DBBM/BMP. The differences between DBBM/BMP and controls (DBBM, HA/SiO) were statistically significant (P < 0.05). CONCLUSIONS DBBM and HA/SiO rendered comparable amounts of bone regeneration. The addition of rhBMP-2 to DBBM resulted in more favorable outcomes with respect to the area of bone regeneration and to bone-to-implant contact, thereby indicating the potential of this growth factor to enhance bone regeneration within this animal model.
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Affiliation(s)
- D S Thoma
- Department of Fixed and Removable Prothodontics and Dental Material Science, Dental School, University of Zurich, Zurich, Switzerland
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Esposito M, Felice P, Worthington HV. Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus. Cochrane Database Syst Rev 2014; 2014:CD008397. [PMID: 24825543 PMCID: PMC10821778 DOI: 10.1002/14651858.cd008397.pub2] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Insufficient bone volume is a common problem encountered in the rehabilitation of the edentulous posterior maxillae with implant-supported prostheses. Bone volume is limited by the presence of the maxillary sinus together with loss of alveolar bone height. Sinus lift procedures increase bone volume by augmenting the sinus cavity with autogenous bone or commercially available biomaterials, or both. This is an update of a Cochrane review first published in 2010. OBJECTIVES To assess the beneficial or harmful effects of bone augmentation compared to no augmentation when undertaking a sinus lift procedure. Secondly, to compare the benefits and harms of different maxillary sinus lift techniques for dental implant rehabilitation. SEARCH METHODS We searched the Cochrane Oral Health Group's Trials Register (to 17 January 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 12), MEDLINE via OVID (1946 to 17 January 2014) and EMBASE via OVID (1980 to 17 January 2014). There were no language or date restrictions on the searches of the electronic databases. SELECTION CRITERIA Randomised controlled trials (RCTs) of different techniques and materials for augmenting the maxillary sinus for rehabilitation with dental implants that report the outcome of implant success or failure at least to four months after initial loading. DATA COLLECTION AND ANALYSIS Screening of eligible studies, assessment of the risk of bias of the trials, and data extraction were conducted independently and in duplicate. Authors were contacted for any missing information. Results were expressed using fixed-effect models as there were either less than four studies or we used Peto odds ratios (ORs) for dichotomous data when there were zero cells in either the treatment or control or both arms and the number of trials was small. The statistical unit of the analysis was the patient. MAIN RESULTS Eighteen RCTs out of 64 potentially eligible study reports met the inclusion criteria. They compared undertaking a sinus lift with not doing so, and the use of different sinus lift techniques. There were 650 patients providing data for the outcomes evaluated. Five studies were assessed as low risk of bias, 11 were assessed as high risk of bias, and in two the risk was unclear. Sinus lift versus no sinus lift Four trials of moderate quality (three trials at low and one at high risk of bias) with 102 participants evaluated short implants (5 to 8.5 mm long) as an alternative to sinus lift in bone with residual height between 4 and 9 mm. One year after loading there was insufficient evidence to claim differences between the two procedures for prosthesis failure (OR (Peto) 0.37, 95% confidence interval (CI) 0.05 to 2.68; three trials) or implant failure (OR (Peto) 0.44, 95% CI 0.10 to 1.99; four trials). There was however an increase in complications at treated sites when undertaking the sinus lift (OR (Peto) 4.77, 95% CI 1.79 to 12.71, P value = 0.002; four trials). Different sinus lift techniques Fourteen trials with 548 participants compared different sinus lift techniques. Only three comparisons included more than one trial (two trials for each). These were bone graft versus no bone graft, autogenous bone versus bone substitute, bone graft with or without platelet-rich plasma (PRP). There was insufficient evidence to claim a benefit for any of these techniques for the primary outcomes of prosthesis and implant failure. For the other reported outcomes, in a single study at high risk of bias, only bone gain was greater for the bone graft site than the site without a graft six months after augmentation, however this was not significant at 18 or 30 months.The other comparisons with single studies were rotary versus piezosurgery to open a lateral sinus window, two different bone substitutes, use or not of a membrane to seal the lateral window, one- versus two-stage lateral sinus lift, two-stage granular bone versus one-stage autogenous bone blocks, and crestal versus lateral sinus lift; two trials compared three different crestal sinus lifting techniques: rotatory versus hand malleting (patients preferred rotatory instruments over hand malleting) and hand versus electric malleting. There was no evidence of a benefit for any sinus lift procedure compared to any other for the primary outcomes prosthesis or implant failure. AUTHORS' CONCLUSIONS There is moderate quality evidence which is insufficient to determine whether sinus lift procedures in bone with residual height between 4 and 9 mm are more or less successful than placing short implants (5 to 8.5 mm) in reducing prosthesis or implant failure up to one year after loading. However, there are more complications at sites treated with sinus lift procedures. Many trials compared different sinus lift procedures and none of these indicated that one procedure reduced prosthetic or implant failures when compared to the other. Based on low quality evidence, patients may prefer rotary instruments over hand malleting for crestal sinus lift.
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Affiliation(s)
- Marco Esposito
- School of Dentistry, The University of ManchesterCochrane Oral Health GroupCoupland 3 Building, Oxford RoadManchesterUKM13 9PL
| | - Pietro Felice
- University of BolognaDepartment of Oral and Dental SciencesVia San Vitale 59BolognaItaly40125
| | - Helen V Worthington
- School of Dentistry, The University of ManchesterCochrane Oral Health GroupCoupland 3 Building, Oxford RoadManchesterUKM13 9PL
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15
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Möller B, Acil Y, Birkenfeld F, Behrens E, Terheyden H, Wiltfang J. Highly porous hydroxyapatite with and without local harvested bone in sinus floor augmentation: a histometric study in pigs. Clin Oral Implants Res 2013; 25:871-8. [DOI: 10.1111/clr.12161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2013] [Indexed: 01/03/2023]
Affiliation(s)
- Björn Möller
- Clinic of Oral and Maxillofacial Surgery; University Hospital Schleswig-Holstein; Kiel Germany
| | - Yahya Acil
- Clinic of Oral and Maxillofacial Surgery; University Hospital Schleswig-Holstein; Kiel Germany
| | - Falk Birkenfeld
- Institute of Anatomy; Christian-Albrechts University Kiel; Kiel Germany
| | - Eleonore Behrens
- Clinic of Oral and Maxillofacial Surgery; University Hospital Schleswig-Holstein; Kiel Germany
| | - Hendrik Terheyden
- Department of Oral and Maxillofacial Surgery; Red Cross Hospital; Kassel Germany
| | - Jörg Wiltfang
- Clinic of Oral and Maxillofacial Surgery; University Hospital Schleswig-Holstein; Kiel Germany
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16
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Ghanaati S, Udeabor SE, Barbeck M, Willershausen I, Kuenzel O, Sader RA, Kirkpatrick CJ. Implantation of silicon dioxide-based nanocrystalline hydroxyapatite and pure phase beta-tricalciumphosphate bone substitute granules in caprine muscle tissue does not induce new bone formation. Head Face Med 2013; 9:1. [PMID: 23286366 PMCID: PMC3563579 DOI: 10.1186/1746-160x-9-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 12/10/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteoinductive bone substitutes are defined by their ability to induce new bone formation even at heterotopic implantation sites. The present study was designed to analyze the potential osteoinductivity of two different bone substitute materials in caprine muscle tissue. MATERIALS AND METHODS One gram each of either a porous beta-tricalcium phosphate (β-TCP) or an hydroxyapatite/silicon dioxide (HA/SiO2)-based nanocrystalline bone substitute material was implanted in several muscle pouches of goats. The biomaterials were explanted at 29, 91 and 181 days after implantation. Conventional histology and special histochemical stains were performed to detect osteoblast precursor cells as well as mineralized and unmineralized bone matrix. RESULTS Both materials underwent cellular degradation in which tartrate-resistant acid phosphatase (TRAP)-positive osteoclast-like cells and TRAP-negative multinucleated giant cells were involved. The ß-TCP was completely resorbed within the observation period, whereas some granules of the HA-groups were still detectable after 180 days. Neither osteoblasts, osteoblast precursor cells nor extracellular bone matrix were found within the implantation bed of any of the analyzed biomaterials at any of the observed time points. CONCLUSIONS This study showed that ß-TCP underwent a faster degradation than the HA-based material. The lack of osteoinductivity for both materials might be due to their granular shape, as osteoinductivity in goat muscle has been mainly attributed to cylindrical or disc-shaped bone substitute materials. This hypothesis however requires further investigation to systematically analyze various materials with comparable characteristics in the same experimental setting.
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Affiliation(s)
- Shahram Ghanaati
- Institute of Pathology, REPAIR-Lab, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, Mainz, 55101, Germany.
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17
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Canullo L, Heinemann F, Gedrange T, Biffar R, Kunert-Keil C. Histological evaluation at different times after augmentation of extraction sites grafted with a magnesium-enriched hydroxyapatite: double-blinded randomized controlled trial. Clin Oral Implants Res 2012; 24:398-406. [DOI: 10.1111/clr.12035] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | - Friedhelm Heinemann
- Department of Prosthodontics, Gerostomatolgy and Biomaterials; University Medicine of Greifswald; Greifswald; Germany
| | - Tomasz Gedrange
- Deptartment of Orthodontics; Technische Universität Dresden; Dresden; Germany
| | - Reiner Biffar
- Department of Prosthodontics, Gerostomatolgy and Biomaterials; University Medicine of Greifswald; Greifswald; Germany
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18
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Harms C, Helms K, Taschner T, Stratos I, Ignatius A, Gerber T, Lenz S, Rammelt S, Vollmar B, Mittlmeier T. Osteogenic capacity of nanocrystalline bone cement in a weight-bearing defect at the ovine tibial metaphysis. Int J Nanomedicine 2012; 7:2883-9. [PMID: 22745551 PMCID: PMC3384364 DOI: 10.2147/ijn.s29314] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The synthetic material Nanobone® (hydroxyapatite nanocrystallines embedded in a porous silica gel matrix) was examined in vivo using a standardized bone defect model in the ovine tibial metaphysis. A standardized 6 × 12 × 24-mm bone defect was created below the articular surface of the medial tibia condyles on both hind legs of 18 adult sheep. The defect on the right side was filled with Nanobone®, while the defect on the contralateral side was left empty. The tibial heads of six sheep were analyzed after 6, 12, and 26 weeks each. The histological and radiological analysis of the defect on the control side did not reveal any bone formation after the total of 26 weeks. In contrast, the microcomputed tomography analysis of the defect filled with Nanobone® showed a 55%, 72%, and 74% volume fraction of structures with bone density after 6, 12, and 26 weeks, respectively. Quantitative histomorphological analysis after 6, and 12 weeks revealed an osteoneogenesis of 22%, and 36%, respectively. Hematoxylin and eosin sections demonstrated multinucleated giant cells on the surface of the biomaterial and resorption lacunae, indicating osteoclastic resorptive activity. Nanobone® appears to be a highly potent bone substitute material with osteoconductive properties in a loaded large animal defect model, supporting the potential use of Nanobone® also in humans.
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Affiliation(s)
- Christoph Harms
- Department of Trauma and Reconstructive Surgery, University of Rostock, Rostock, Germany.
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19
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Graft Shrinkage and Survival Rate of Implants After Sinus Floor Elevation Using a Nanocrystalline Hydroxyapatite Embedded in Silica Gel Matrix. IMPLANT DENT 2012; 21:213-9. [DOI: 10.1097/id.0b013e31824ee743] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Ghanaati S, Barbeck M, Willershausen I, Thimm B, Stuebinger S, Korzinskas T, Obreja K, Landes C, Kirkpatrick CJ, Sader RA. Nanocrystalline hydroxyapatite bone substitute leads to sufficient bone tissue formation already after 3 months: histological and histomorphometrical analysis 3 and 6 months following human sinus cavity augmentation. Clin Implant Dent Relat Res 2012; 15:883-92. [PMID: 22251462 DOI: 10.1111/j.1708-8208.2011.00433.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE In this study the de novo bone formation capacity of a nanocrystalline hydroxyapatite bone substitute was assessed 3 and 6 months after its insertion into the human sinus cavity. MATERIALS AND METHODS Sinus cavity augmentation was performed in a total of 14 patients (n = 7 implantation after 3 months; n = 7 implantation after 6 months) with severely atrophic maxillary bone. The specimens obtained after 3 and 6 months were analyzed histologically and histomorphometrically with special focus on bone metabolism within the residual bone and the augmented region. RESULTS This study revealed that bone tissue formation started from the bone-biomaterial-interface and was directed into the most cranial parts of the augmented region. There was no statistically significant difference in new bone formation after 3 and 6 months (24.89 ± 10.22% vs 31.29 ± 2.29%), respectively. CONCLUSIONS Within the limits of the present study and according to previously published data, implant insertion in regions augmented with this bone substitute material could be considered already after 3 months. Further clinical studies with bone substitute materials are necessary to validate these findings.
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Affiliation(s)
- Shahram Ghanaati
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt am Main, Germany; Institute of Pathology, REPAIR-Lab, University Medical Center, Johannes Gutenberg University Mainz, Germany; Institute for Dental Material Sciences and Technology, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Institute for Biomechanics, ETH Zurich, Switzerland; Center for Applied Biotechnology and Molecular Medicine, Zurich, Switzerland
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21
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Canullo L, Dellavia C, Heinemann F. Maxillary sinus floor augmentation using a nano-crystalline hydroxyapatite silica gel: case series and 3-month preliminary histological results. Ann Anat 2011; 194:174-8. [PMID: 21640571 DOI: 10.1016/j.aanat.2011.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 10/01/2010] [Indexed: 11/18/2022]
Abstract
The aim of this case series is to histologically examine a new hydroxyapatite in sinus lift procedure after 3 months. Ten 2-stage sinus lifts were performed in 10 healthy patients having initial bone height of 1-2mm and bone width of 5mm, asking for a fixed implant-supported rehabilitation. After graft material augmentation, a rough-surfaced mini-implant was inserted to maintain stability of the sinus widow. A bioptical core containing a mini-implant was retrieved 3 months after maxillary sinus augmentation with NanoBone(®) and processed for undecalcified histology. From the histomorphometric analysis, NanoBone(®) residuals accounted for the 38.26% ± 8.07% of the bioptical volume, marrow spaces for the 29.23% ± 5.18% and bone for the 32.51% ± 4.96% (new bone: 20.64% ± 2.96%, native bone: 11.87% ± 3.27%). Well-mineralized regenerated bone with lamellar parallel-fibred structure and Haversian systems surrounded the residual NanoBone(®) particles. The measured bone-to-implant contact amounted to 26.02% ± 5.46%. No connective tissue was observed at the implant boundary surface. In conclusion, the tested material showed good histological outcomes also 3 months after surgery. In such critical conditions, the use of a rough-surfaced mini-implant showed BIC values supposed to be effective also in case of functional loading. Although longer follow-up and a wider patient size are needed, these preliminary results encourage further research on this biomaterial for implant load also under early stage and critical conditions.
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Klijn RJ, Meijer GJ, Bronkhorst EM, Jansen JA. A meta-analysis of histomorphometric results and graft healing time of various biomaterials compared to autologous bone used as sinus floor augmentation material in humans. TISSUE ENGINEERING PART B-REVIEWS 2011; 16:493-507. [PMID: 20334505 DOI: 10.1089/ten.teb.2010.0035] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND To date, no studies have been published in which histomorphometric data from a large group of patients comparing various biomaterials for sinus floor augmentation procedures were evaluated. MATERIALS AND METHODS A meta-analysis of the English literature from January 1993 till April 2009 was carried out. Out of 147 titles, according to our criteria, 64 articles were selected for analysis describing the use of autologous bone and their alternatives, such as allogenic, xenogenic, and alloplastic materials. RESULTS On the basis of autologous bone grafting, a reference value for total bone volume (TBV) of 63% was found. Particulation of the bone graft resulted in a general reduction of −18% in TBV. Delayed implant placement reduced the TBV with −7%. Overall TBV was 8% or 6% higher if a biopsy was, respectively, taken before 4.5 months or after 9.0 months after initial sinus augmentation surgery. Allogenic, xenogenic, alloplastic, or combinations of graft materials all resulted in a significant lower amount of TBV compared to autologous bone grafting ranging from −7% to −26%. Inventorying the effect of "biopsy time" for autologous bone, the TBV was significantly higher before 4.5 and after 9.0 months of healing time compared to period in between. Surprisingly, no significant differences in TBV with respect to "biopsy time" for bone substitutes were found. CONCLUSIONS On the basis of the aspect of TBV autologous bone still has to be considered to be the gold standard in sinus augmentation surgery. However, the consequence of the TBV for implant survival is still unraveled yet.
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Affiliation(s)
- Reinoud J Klijn
- Department of Periodontology and Biomaterials, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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23
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Kruse A, Jung RE, Nicholls F, Zwahlen RA, Hämmerle CHF, Weber FE. Bone regeneration in the presence of a synthetic hydroxyapatite/silica oxide-based and a xenogenic hydroxyapatite-based bone substitute material. Clin Oral Implants Res 2010; 22:506-11. [DOI: 10.1111/j.1600-0501.2010.02039.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Canullo L, Patacchia O, Sisti A, Heinemann F. Implant Restoration 3 Months after One Stage Sinus Lift Surgery in Severely Resorbed Maxillae: 2-Year Results of a Multicenter Prospective Clinical Study. Clin Implant Dent Relat Res 2010; 14:412-20. [DOI: 10.1111/j.1708-8208.2009.00261.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Ghanaati S, Orth C, Barbeck M, Willershausen I, Thimm BW, Booms P, Stübinger S, Landes C, Sader RA, Kirkpatrick CJ. Histological and histomorphometrical analysis of a silica matrix embedded nanocrystalline hydroxyapatite bone substitute using the subcutaneous implantation model in Wistar rats. Biomed Mater 2010; 5:35005. [PMID: 20460687 DOI: 10.1088/1748-6041/5/3/035005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The clinical suitability of a bone substitute material is determined by the ability to induce a tissue reaction specific to its composition. The aim of this in vivo study was to analyze the tissue reaction to a silica matrix-embedded, nanocrystalline hydroxyapatite bone substitute.The subcutaneous implantation model in Wistar rats was chosen to assess the effect of silica degradation on the vascularization of the biomaterial and its biodegradation within a time period of 6 months. Already at day 10 after implantation, histomorphometrical analysis showed that the vascularization of the implantation bed reached its peak value compared to all other time points. Both vessel density and vascularization significantly decreased until day 90 after implantation. In this time period, the bone substitute underwent a significant degradation initiated by TRAP-positive and TRAP-negative multinucleated giant cells together with macrophages and lymphocytes. Although no specific tissue reaction could be related to the described silica degradation, the biomaterial was close to being fully degraded without a severe inflammatory response. These characteristics are advantageous for bone regeneration and remodeling processes.
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Affiliation(s)
- Shahram Ghanaati
- Institute of Pathology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55101 Mainz, Germany; Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Theodor-Stein-Kai 7, 60596 Frankfurt am Main, Germany.
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