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Yamaki D, Fukuba S, Okada M, Takeuchi S, Hoshi S, Matsuura T, Iwata T. Octacalcium phosphate collagen composite for periodontal regeneration in a canine one-wall intrabony defect. J Periodontal Res 2024; 59:521-529. [PMID: 38356157 DOI: 10.1111/jre.13245] [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: 09/28/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE This study aimed to evaluate the regenerative capacities of octacalcium phosphate collagen composite (OCP/Col) in one-wall intrabony defects in dogs. The background data discuss the present state of the field: No study has assessed the efficacy of OCP/Col for periodontal regeneration therapy despite the fact that OCP/Col has proved to be efficient for bone regeneration. METHODS In six beagle dogs, the mandibular left third premolars were extracted 12 weeks before the experimental surgery. Standardized bone defects (5 mm in height and 4 mm in width) were simulated on the distal surface of the second premolars and mesially on the fourth premolars. The defect was filled with either OCP/Col (experimental group) or left empty (control group). Histological and histomorphometric characteristics were compared 8 weeks after surgery. RESULTS No infectious or ankylotic complications were detected at any of the tested sites. The experimental group exhibited a significantly greater volume, height, and area of newly formed bone than the control group. The former also showed a greater height of the newly formed cementum than the latter, although the results were not statistically significant. The newly formed periodontal ligaments were inserted into newly formed bone and cementum in the experimental group. CONCLUSION OCP/Col demonstrated high efficacy for bone and periodontal tissue regeneration that can be successfully applied for one-wall intrabony defects.
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Affiliation(s)
- Daichi Yamaki
- Department of Periodontology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shunsuke Fukuba
- Department of Periodontology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Munehiro Okada
- Department of Periodontology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Shu Hoshi
- Department of Periodontology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
- Private Practice, Niigata, Japan
| | - Takanori Matsuura
- Department of Periodontology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
- Weintraub Center for Reconstructive Biotechnology, Division of Regenerative and Reconstructive Sciences, UCLA School of Dentistry, California, Los Angeles, USA
| | - Takanori Iwata
- Department of Periodontology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
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Lim KO, Kim MS, Yang KI, Lee WP, Kim BO, Yu SJ. Sinus floor augmentation using mineralized freeze-dried bone allograft combined with recombinant human bone morphogenetic protein-2 (rhBMP-2): A long-term retrospective study. J Dent Sci 2024; 19:804-812. [PMID: 38618071 PMCID: PMC11010679 DOI: 10.1016/j.jds.2023.09.022] [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: 08/10/2023] [Revised: 09/20/2023] [Indexed: 04/16/2024] Open
Abstract
Background/purpose The combination of recombinant human bone morphogenetic protein-2 (rhBMP-2) with a carrier material has not been extensively studied. This study aimed to evaluate the clinical, radiological, and histomorphometric outcomes of sinus floor augmentation using a 3:7 mixture of cancellous and cortical freeze-dried bone allografts (mixed AG) combined with rhBMP-2. Materials and methods Mixed AG was used for sinus floor augmentation in a total of 21 patients with a residual alveolar bone height <5 mm. Among the total 47 sites, augmentation with and without rhBMP-2 was performed in 26 and 21 sites, respectively. Radiographic parameters were assessed using cone-beam computed tomography. After a six-month healing period, core biopsies were harvested for histomorphometric analysis. Results The bone gain after healing was 13.36 ± 3.9 mm and 12.07 ± 3.8 mm in the mixed AG alone and mixed AG with rhBMP-2 groups, respectively. The survival rate of implants in both groups was 100% during the follow-up period. The proportion of newly formed bone was 24.6 ± 10.2% and 39.7 ± 18.3% in the mixed AG alone and mixed AG with rhBMP-2 groups, respectively (P < 0.05). Moreover, the percentage of residual graft material was 21.0 ± 12.2% and 9.6 ± 10.0% in the mixed AG alone and mixed AG with rhBMP-2 groups, respectively (P < 0.05). Conclusion Mixed AG combined with rhBMP-2 could be a suitable material for sinus floor augmentation. This combination may reduce the treatment time and improve the predictability of implant placement.
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Affiliation(s)
- Kyeong-Ok Lim
- Department of Periodontology, School of Dentistry, Chosun University, Gwangju, Republic of Korea
| | - Min-Seok Kim
- Department of Periodontology, School of Dentistry, Chosun University, Gwangju, Republic of Korea
| | - Keon-Il Yang
- Department of Periodontology, School of Dentistry, Chosun University, Gwangju, Republic of Korea
| | - Won-Pyo Lee
- Department of Periodontology, School of Dentistry, Chosun University, Gwangju, Republic of Korea
| | - Byung-Ock Kim
- Department of Periodontology, School of Dentistry, Chosun University, Gwangju, Republic of Korea
| | - Sang-Joun Yu
- Department of Periodontology, School of Dentistry, Chosun University, Gwangju, Republic of Korea
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Valentini P, Calciolari E, Monlezun S, Akcalı A, Donos N, Quirynen M. APCs in sinus floor augmentation. Periodontol 2000 2024. [PMID: 38363055 DOI: 10.1111/prd.12554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/18/2023] [Accepted: 01/21/2024] [Indexed: 02/17/2024]
Abstract
After tooth loss in the posterior area of the maxilla, sinus floor elevation is often required to compensate the vertical bone loss due to sinus pneumatization. This narrative review reports on the potential benefits of autologous platelet concentrates (APCs) during this procedure. As for transcrestal approach, APCs have been used as "sole" substitute/graft. However, because of the low number of clinical trials available with PRGF, and even none for PRP, no definitive conclusions can be made regarding their efficacy. The number of studies on the use of L-PRF were outnumbered indicating good feasibility for vertical bone gain, with a high implant survival rate and a low degree of complications. PRP and PRGF have not been studied as a "single/sole" substitute for a one-stage lateral window approach, probably because of the weak physical characteristics of the membranes. L-PRF alone appears to be a predictable grafting material for lateral maxillary sinus grafting and a reduced RBH should not be considered as a risk factor. Compared to a "standard" bone substitute L-PRF shows slightly less vertical bone gain (consider enough membrane application and use of bony window as new sinus floor roof over the implant apices), enhanced early resorption (first 6 months after application), but a similar stable bone gain afterward. For a two-stage lateral window approach, APCs "alone" cannot be recommended, due to their weak withstand to the sinus pneumatization forces. APCs combined with bone substitutes seem to accelerate bone formation, without any additional benefits on the long-term new bone gain. The use of L-PRF membranes for the treatment of perforations appears to be an effective treatment option, but further clinical studies are needed to confirm this. Even though the abovementioned statements are based on large numbers of studies, additional RCTs comparing APCs with different types of grafting procedures for sinus elevation are needed.
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Affiliation(s)
- Pascal Valentini
- Department of Implant Surgery Tattone Hospital, University of Corsica Pasquale Paoli, Institute of Health, Corte, France
| | - Elena Calciolari
- Centre for Oral Clinical Research, Institute of Dentistry, Barts & The London School of Medicine and Dentistry, London, UK
- Dental school, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Sebastien Monlezun
- Department of Implant Surgery Tattone Hospital, University of Corsica Pasquale Paoli, Institute of Health, Corte, France
| | - Aliye Akcalı
- Centre for Oral Clinical Research, Institute of Dentistry, Barts & The London School of Medicine and Dentistry, London, UK
- Department of Periodontology, Dental Faculty, University of Dokuz Eylul, Izmir, Turkey
| | - Nikos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Barts & The London School of Medicine and Dentistry, London, UK
| | - Marc Quirynen
- Department of Oral Health Sciences, Katholieke Universiteit Leuven & University Hospitals Leuven, (section Periodontology), Leuven, Belgium
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Wang M, Li B, Feng H, Ye Q, Sun Y, Duan X, He J. Assessment of the osteogenic effect after maxillary sinus floor elevation and simultaneous implantation with or without bone grafts by analyzing trabecular bone parameters: a retrospective study. J Appl Oral Sci 2024; 32:e20230406. [PMID: 38359269 PMCID: PMC10984575 DOI: 10.1590/1678-7757-2023-0406] [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: 11/07/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE The aim of this population-based retrospective study was to compare the osteogenic effect of newly formed bone after maxillary sinus floor elevation (MSFE) and simultaneous implantation with or without bone grafts by quantitatively analyzing trabecular bone parameters. METHODOLOGY A total of 100 patients with missing posterior maxillary teeth who required MSFE and implantation were included in this study. Patients were divided into two groups: the non-graft group (n=50) and the graft group (n=50). Radiographic parameters were measured using cone beam computed tomography (CBCT), and the quality of newly formed bone was analyzed by assessing trabecular bone parameters using CTAn (CTAnalyzer, SkyScan, Antwerp, Belgium) software. RESULTS In the selected regions of interest, the non-graft group showed greater bone volume/total volume (BV/TV), bone surface/total volume (BS/TV), trabecular number (Tb. N), and trabecular thickness (Tb. Th) than the graft group (p<0.001). The non-graft group showed lower trabecular separation (Tb. Sp) than the graft group (p<0.001). The incidence of perforation and bleeding was higher in the graft group than in the non-graft group (p<0.001), but infection did not significantly differ between groups (p>0.05). Compared to the graft group, the non-graft group showed lower postoperative bone height, gained bone height and apical bone height (p<0.001). CONCLUSION MSFE with and without bone grafts can significantly improve bone formation. In MSFE, the use of bone grafts hinders the formation of good quality bone, whereas the absence of bone grafts can generate good bone quality and limited bone mass.
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Affiliation(s)
- Mohan Wang
- Anhui Medical UniversityStomatologic Hospital & CollegeKey Laboratory of Oral Diseases Research of Anhui ProvinceHefeiChinaAnhui Medical University, Stomatologic Hospital & College, Key Laboratory of Oral Diseases Research of Anhui Province, Hefei, China.
- Shanghai Jiao Tong University School of MedicineNinth People's HospitalCollege of StomatologyShanghaiChinaShanghai Jiao Tong University School of Medicine, Ninth People's Hospital, College of Stomatology, Department of Oral and Maxillofacial Surgery, Shanghai, China.
| | - Beibei Li
- Anhui Medical UniversityStomatologic Hospital & CollegeKey Laboratory of Oral Diseases Research of Anhui ProvinceHefeiChinaAnhui Medical University, Stomatologic Hospital & College, Key Laboratory of Oral Diseases Research of Anhui Province, Hefei, China.
| | - Hailiang Feng
- Zhejiang University School of MedicineThe Second Affiliated HospitalDepartment of StomatologyHangzhouChinaZhejiang University School of Medicine, The Second Affiliated Hospital, Linping Campus, Department of Stomatology, Hangzhou, China.
| | - Qingsong Ye
- Anhui Medical UniversityStomatologic Hospital & CollegeKey Laboratory of Oral Diseases Research of Anhui ProvinceHefeiChinaAnhui Medical University, Stomatologic Hospital & College, Key Laboratory of Oral Diseases Research of Anhui Province, Hefei, China.
| | - Yahui Sun
- Anhui Medical UniversityStomatologic Hospital & CollegeKey Laboratory of Oral Diseases Research of Anhui ProvinceHefeiChinaAnhui Medical University, Stomatologic Hospital & College, Key Laboratory of Oral Diseases Research of Anhui Province, Hefei, China.
| | - Xinxiu Duan
- Anhui Medical UniversityStomatologic Hospital & CollegeKey Laboratory of Oral Diseases Research of Anhui ProvinceHefeiChinaAnhui Medical University, Stomatologic Hospital & College, Key Laboratory of Oral Diseases Research of Anhui Province, Hefei, China.
| | - Jiacai He
- Anhui Medical UniversityStomatologic Hospital & CollegeKey Laboratory of Oral Diseases Research of Anhui ProvinceHefeiChinaAnhui Medical University, Stomatologic Hospital & College, Key Laboratory of Oral Diseases Research of Anhui Province, Hefei, China.
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Fukuba S, Okada M, Iwata T. Clinical outcomes of periodontal regenerative therapy with carbonate apatite granules for treatments of intrabony defects, Class II and Class III furcation involvements: A 9-month prospective pilot clinical study. Regen Ther 2023; 24:343-350. [PMID: 37674693 PMCID: PMC10477744 DOI: 10.1016/j.reth.2023.08.002] [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: 06/15/2023] [Revised: 07/13/2023] [Accepted: 08/13/2023] [Indexed: 09/08/2023] Open
Abstract
Introduction Carbonated apatite (CO3Ap) has unique properties as an alloplastic bone substitute and has been reported the safety and efficacy for bone regeneration. However, no previous studies reported the clinical application of CO3Ap for periodontal regeneration therapy. The aim of this study was to evaluate the safety and efficacy of periodontal regeneration with CO3Ap in treating intrabony defects, Class II and Class III furcation involvement (FI). Methods A single-arm and single-center prospective pilot clinical study was performed to verify the safety and efficacy of CO3Ap in patients with periodontitis. A total of four patients with seven teeth, including three deep intrabony defects, two Class II FI, and two Class III FI, were treated with CO3Ap. The clinical parameters, including probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), tooth mobility (Mo), Plaque index (PI), and Gingival index (GI) were evaluated at baseline, 6 months, and 9 months after the surgery. Radiographic analysis was conducted on images of dental X-ray and cone beam computed tomography (CBCT) at baseline and 9 months post-surgery. Results The postoperative healing in all cases was uneventful, with no abnormal bleeding, pain, or swelling. The mean PPD reduction and CAL gain were 5.0 ± 1.0 mm, 4.5 ± 0.7 mm, 1.5 ± 0.7 mm, and 4.7 ± 1.2 mm, 4.5 ± 0.7 mm, 0.0 mm for intrabony defect, Class II and Class III FI, respectively. According to radiographic analysis, linear bone height in intrabony defects and vertical subclassification of FI in Class II FI were improved. Conclusions The clinical application of CO3Ap for the treatment of intrabony defects and Class II FI could be effective for periodontal regeneration, although its efficacy in treating Class III FI might be limited. Despite the limitations of this study, the findings in this study suggested that CO3Ap has the potential to be a promising bone graft substitute for periodontal regeneration.
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Affiliation(s)
- Shunsuke Fukuba
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Switzerland
| | - Munehiro Okada
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Takanori Iwata
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
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Krennmair S, Postl L, Schwarze UY, Malek M, Stimmelmayr M, Krennmair G. Clinical, radiographic, and histological/histomorphometric analysis of maxillary sinus grafting with deproteinized porcine or bovine bone mineral: A randomized clinical trial. Clin Oral Implants Res 2023; 34:1230-1247. [PMID: 37610063 DOI: 10.1111/clr.14164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE The present study aimed to compare histomorphometrically evaluated new bone formation, radiographically measured graft stability, and clinical implant outcome between maxillary sinus grafting with either deproteinized porcine bone mineral (DPBM) or deproteinized bovine bone mineral (DBBM). MATERIALS AND METHODS Thirty maxillary sinuses were initially included and randomly assigned to the test group (TG; DPBM, n = 15) or control group (CG; DBBM, n = 15). After a healing period (6 months), axially retrieved bone biopsies of the molar region were used for histological/histomorphometric analysis of new bone formations. Additionally, radiographically measured graft stability and clinical implant outcome were assessed. RESULTS Twenty-three sinus sites with 10 sinuses of the TG and 13 of the CG were ultimately available for data and statistical analysis. In the TG, a slightly, but yet significantly (p = .040) higher proportion of new bone formation (TG: 27.7 ± 5.6% vs. CG: 22.9 ± 5.1%) and a lesser (p = .019) amount of connective (non-mineralized) tissue (TG: 47.5 ± 9.5% vs. CG: 56.1 ± 9.5%) was found than in the CG. However, both xenografts showed comparable (n.s.) residual bone graft (TG: 23.7 ± 7.2% vs. CG: 21.1 ± 9.85.6%), bone-to-graft contacts (TG: 26.2 ± 9.8% vs. CG: 30.8 ± 13.8%), similar graft height reduction over time (TG: 12.9 ± 6.7% CG: 12.4 ± 5.8%) and implant survival/success rate (100%). At the 3-year post-loading evaluation, the peri-implant marginal bone loss (TG: 0.52 ± 0.19 mm; CG: 0.48 ± 0.15 mm) and the peri-implant health conditions (TG: 87.5%/CG: 81.2%) did not differ between implants inserted in both xenografts used. CONCLUSIONS The use of DPBM or DBBM for maxillary sinus augmentation is associated with comparable bone formation providing stable graft dimension combined with healthy peri-implant conditions.
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Affiliation(s)
- Stefan Krennmair
- Department of Oral and Maxillofacial Surgery, Keplerklinikum Linz, Johannes Kepler University (JKU) Linz, Linz, Austria
- NumBiolab Research Associate, Ludwig-Maximilian University (LMU), Munich, Germany
| | - Lukas Postl
- Department of Oral and Maxillofacial Surgery, Keplerklinikum Linz, Johannes Kepler University (JKU) Linz, Linz, Austria
- NumBiolab Research Associate, Ludwig-Maximilian University (LMU), Munich, Germany
| | - Uwe Yacine Schwarze
- Division of Oral Surgery and Orthodontics and Musculo-Skeletal Research Unit for Biomaterials, Medical University Graz, Graz, Austria
| | - Michael Malek
- Department of Oral and Maxillofacial Surgery, Keplerklinikum Linz, Johannes Kepler University (JKU) Linz, Linz, Austria
| | - Michael Stimmelmayr
- Department of Prosthodontics, Ludwig-Maximilian University (LMU), Munich, Germany
| | - Gerald Krennmair
- Department of Prosthodontics, Dental School, Sigmund Freud Medical University of Vienna, Vienna, Austria
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Krennmair G, Weinländer M, Forstner T, Krennmair S, Stimmelmayr M, Malek M. Transsinusoidal lateral nasal floor augmentation for implant placement in the atrophic premaxilla: A within-patient, 5-year, prospective comparative study. Clin Oral Implants Res 2023; 34:822-838. [PMID: 37318152 DOI: 10.1111/clr.14111] [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: 10/01/2022] [Revised: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To evaluate the clinical outcome for implants placed with transsinusoidal-lateral nasal cavity augmentation (NA) compared to implants placed in maxillary sinus augmentation (SA). MATERIALS AND METHODS In 28 atrophic edentulous maxillary regions (14 patients bi-maxillary), a lateral window approach was used to perform transsinusoidal-lateral NA (TSLNA) combined with maxillary SA. After healing period of about 6 months, each patient received bimaxillary one anterior implant located in the pre-maxilla having lateral NA and 2-3 implants in the maxillary posterior region with SA. In a prospective follow-up evaluation, clinical implant outcome (survival/success rates) and peri-implant health (mucositis/peri-implantitis) were assessed and compared between implants placed in TSLNA (n = 28) and SA (n = 58). RESULTS At the year-1, year-3, and year-5 evaluation, neither patient-based nor implant-based comparisons revealed differences for marginal bone level reduction between implants placed in TSLNA (5-year overall: 1.11 ± 0.26 mm) and SA (5-year overall: 1.07 ± 0.30 mm), although with a significant (p < .001) continuous reduction over the observation time. At the year-5 evaluation, all implants (n = 86) and restorations (n = 14) were still in situ (survival 100%) and showed an implant-based incidence of peri-implant mucositis/peri-implantitis of 14.3%/0% in TSLNA and 6.9%/3.4% in SA corresponding to 21.4%/0% and 28.6%/7.1% for implant-based evaluation. In addition, the implant success rate did not differ between NA and SA at implant- (100%/ 98.8%) and patient-based (100%/97.6%) evaluation. CONCLUSION The findings obtained show TSLNA as an effective method for implant placement of adequate length and direction in the atrophic premaxilla providing for success rates comparable to those of implants placed in SA.
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Affiliation(s)
- Gerald Krennmair
- Dental School, Private University Sigmund Freud Vienna, Vienna, Austria
| | | | - Thomas Forstner
- Department of Applied Systems Research Statistics, Johannes Kepler University Linz (JKU), Linz, Austria
| | - Stefan Krennmair
- Dental School, Private University Sigmund Freud Vienna, Vienna, Austria
- Oral Maxillofacial Surgery, Resident, Medical (JKU) University, Linz, Austria
- Department Oral Maxillofacial Surgery, Ludwig-Maximilian University (LMU) Munich, Munich, Germany
| | - Michael Stimmelmayr
- Dental School, Prosthodontics, Ludwig-Maximilian University (LMU) Munich, Munich, Germany
| | - Michael Malek
- Department of Oral Maxillofacial Surgery, Johannes Kepler University, Linz (JKU), Linz, Austria
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Shiezadeh F, Taher M, Shooshtari Z, Arab H, Shafieian R. Using Platelet-Rich Fibrin in Combination With Allograft Bone Particles Can Induce Bone Formation in Maxillary Sinus Augmentation. J Oral Maxillofac Surg 2023; 81:904-912. [PMID: 37084762 DOI: 10.1016/j.joms.2023.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Sinus pneumatization secondary to posterior maxillary tooth extraction can hinder proper implant installation. Maxillary sinus floor augmentation is a surgical procedure that has been proposed to overcome this issue. PURPOSE The aim of this study was to evaluate and compare the histomorphometric outcomes of sinus floor elevation using allograft bone particles with or without platelet-rich fibrin (PRF). STUDY DESIGN, SETTING, SAMPLE This randomized clinical trial included patients scheduled for maxillary sinus floor elevation in the Implant Department of Mashhad Dental School. Healthy adults with an edentulous maxilla and residual alveolar bone height of 3 mm or less were eligible to participate and were randomly allocated to intervention (A) or control (B) groups. Bone biopsies were obtained 6 months postoperatively. PREDICTOR VARIABLE The predictor variable was using a PRF membrane for maxillary sinus augmentation. In group A, sinus floor elevation was performed using PRF combined with bone allografts, while in group B only allograft particles were used. MAIN OUTCOME VARIABLES The primary outcome variables were the recorded postoperative histologic parameters, as in the area of newly formed bone, new bone marrow, and residual graft particles (μm2). The secondary outcome variables were the radiographically measured postoperative bone height and width at the graft site. COVARIATES Age and sex. ANALYSES Independent sample t-test was employed to compare the postoperative histomorphometric parameters between groups A and B. P value ≤ .05 was considered statistically significant. RESULTS A total of 20 patients (10 per group) completed the study. The mean rate of new bone formation was 43.25 ± 5.22% in group A and 38.25 ± 7.01% in group B. This difference was statistically insignificant (P = .087). The mean amount of newly formed bone marrow was significantly more in group A compared to group B (6.81 ± 2.19% vs 10.23 ± 4.49%; P = .044). The average amount of remaining particles was also significantly less in group A patients (9.35 ± 3.43% vs 13.18 ± 3.67%; P = .027). CONCLUSION AND RELEVANCE Incorporating PRF as an adjunctive grafting material results in fewer residual particles of allograft and in more bone marrow formation and may serve as a treatment option for developing the atrophic posterior maxilla.
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Affiliation(s)
- Farid Shiezadeh
- Associate Professor, Department of Periodontics, Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Milad Taher
- Assistant Professor, Department of Periodontics, Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Shooshtari
- Dentist, Private Practice, Research Assistant, Department of Periodontics, Dental Research Center, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
| | - HamidReza Arab
- Professor, Department of Periodontics, Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reyhaneh Shafieian
- Assistant Professor, Department of Anatomy and Cell Biology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Wardani A, Tran B, Duterre M, Larabi I, Waskiewicz K, Louryan S, Evrard L. Healing of particulate allografts mixed with platelet concentrates in ridge preservation and sinus lift: a prospective histomorphometric study. Morphologie 2023:S1286-0115(23)00027-9. [PMID: 36997466 DOI: 10.1016/j.morpho.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/01/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023]
Abstract
The objective of the present study was to evaluate the bone quality of sinus and alveolar grafts following filling with particulate allogenous bone (DFDBA 300-500μm) and platelet concentrate (platelet-rich fibrin, PRF). A prospective interventional clinical study was carried out. A total of 40 bone cores, 2mm in diameter, were taken from 21 patients: 22 from grafted alveoli, 7 from grafted sinus sites, and 11 from native bone used as a control. Fixed, paraffin-embedded samples were subjected to histological staining with hematoxylin-eosin and Masson's trichrome. Bone maturity of the samples was evaluated by two independent operators using histomorphometric analysis. There existed a greater proportion of lamellar neoformed bone than woven neoformed bone as the healing time increased. Moreover, there was also an increasing proportion of newly formed bone in the grafted sockets as a function of healing time (average: 41.22% ≤ 5 months, 55.89% ˃ 5 months). Resorption of DFDBA particles also appears to be correlated with healing time in the grafted socket (average: 15.43 ≤ 5 months, 13.72% ˃ 5 months). In conclusion, performing sinus lift and alveolar socket preservation techniques using DFDBA and PRF results in high quality, mature bone tissue according to histological criteria.
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Affiliation(s)
- A Wardani
- Department of dentistry, orthodontics, stomatology, oral and maxillofacial surgery, faculty of medicine, université libre de Bruxelles, hôpital Erasme, Bruxelles, Belgium.
| | - B Tran
- Department of dentistry, orthodontics, stomatology, oral and maxillofacial surgery, faculty of medicine, université libre de Bruxelles, hôpital Erasme, Bruxelles, Belgium.
| | - M Duterre
- Laboratory of anatomy, biomechanics and organogenesis, Bruxelles, Belgium.
| | - I Larabi
- Department of dentistry, orthodontics, stomatology, oral and maxillofacial surgery, faculty of medicine, université libre de Bruxelles, hôpital Erasme, Bruxelles, Belgium.
| | - K Waskiewicz
- Department of dentistry, orthodontics, stomatology, oral and maxillofacial surgery, faculty of medicine, université libre de Bruxelles, hôpital Erasme, Bruxelles, Belgium.
| | - S Louryan
- Laboratory of anatomy, biomechanics and organogenesis, Bruxelles, Belgium.
| | - L Evrard
- Department of dentistry, orthodontics, stomatology, oral and maxillofacial surgery, faculty of medicine, université libre de Bruxelles, hôpital Erasme, Bruxelles, Belgium.
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van Dijk LA, Janssen NG, Nurmohamed SJ, Muradin MSM, Longoni A, Bakker RC, de Groot FG, de Bruijn JD, Gawlitta D, Rosenberg AJWP. Osteoinductive calcium phosphate with submicron topography as bone graft substitute for maxillary sinus floor augmentation: A translational study. Clin Oral Implants Res 2023; 34:177-195. [PMID: 36645164 DOI: 10.1111/clr.14028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 11/25/2022] [Accepted: 11/30/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The aim of this study was the preclinical and clinical evaluation of osteoinductive calcium phosphate with submicron surface topography as a bone graft substitute for maxillary sinus floor augmentation (MSFA). MATERIAL AND METHODS A preclinical sheep model of MSFA was used to compare a calcium phosphate with submicron needle-shaped topography (BCPN , MagnetOs Granules, Kuros Biosciences BV) to a calcium phosphate with submicron grain-shaped topography (BCPG ) and autologous bone graft (ABG) as controls. Secondly, a 10-patient, prospective, randomized, controlled trial was performed to compare BCPN to ABG in MSFA with two-stage implant placement. RESULTS The pre-clinical study demonstrated that both BCPN and BCPG were highly biocompatible, supported bony ingrowth with direct bone apposition against the material, and exhibited bone formation as early as 3 weeks post-implantation. However, BCPN demonstrated significantly more bone formation than BCPG at the study endpoint of 12 weeks. Only BCPN reached an equivalent amount of bone formation in the available space and a greater proportion of calcified material (bone + graft material) in the maxillary sinus compared to the "gold standard" ABG after 12 weeks. These results were validated in a small prospective clinical study, in which BCPN was found comparable to ABG in implant stability, bone height, new bone formation in trephine core biopsies, and overall clinical outcome. CONCLUSION This translational work demonstrates that osteoinductive calcium phosphates are promising bone graft substitutes for MSFA, whereas their bone-forming potential depends on the design of their surface features. Netherlands Trial Register, NL6436.
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Affiliation(s)
- Lukas A van Dijk
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Regenerative Medicine Center Utrecht, Utrecht, the Netherlands
- Kuros Biosciences BV, Bilthoven, the Netherlands
| | - Nard G Janssen
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Silke J Nurmohamed
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marvick S M Muradin
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alessia Longoni
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Regenerative Medicine Center Utrecht, Utrecht, the Netherlands
| | - Robbert C Bakker
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Joost D de Bruijn
- Kuros Biosciences BV, Bilthoven, the Netherlands
- School of Materials Science and Engineering, Queen Mary University of London, London, UK
| | - Debby Gawlitta
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Regenerative Medicine Center Utrecht, Utrecht, the Netherlands
| | - Antoine J W P Rosenberg
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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Alkaabi S, Alsabri G, Natsir Kalla D, Alavi S, Nurrahma R, Forouzanfar T, Helder M. Regenerative graft materials for maxillary sinus elevation in randomized clinical trials: A meta-analysis. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Kim SJ, Kim JS, Kim W, Kim SY, Lee WP. Radiographic and Histomorphometric Evaluation of Sinus Floor Augmentation Using Biomimetic Octacalcium Phosphate Alloplasts: A Prospective Pilot Study. MATERIALS 2022; 15:ma15124061. [PMID: 35744118 PMCID: PMC9229888 DOI: 10.3390/ma15124061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/22/2022] [Accepted: 06/06/2022] [Indexed: 12/02/2022]
Abstract
This prospective single-arm clinical study aimed to radiographically and histomorphometrically evaluate the efficacy of the lateral approach for sinus floor elevation (LSFE) using biomimetic octacalcium phosphate (OCP) synthetic bone graft (Bontree®). LSFE using Bontree® was performed on 10 patients (15 implant placement sites) willing to undergo implant surgery, followed by implant placements after 6 months of the healing period. The vertical bone height (VBH) and Hounsfield unit (HU) values at each implant placement site were evaluated radiographically using cone-beam computed tomography at baseline immediately after surgery (T1) and 6 months after surgery (T2). A histomorphometric evaluation of the bone core biopsy specimen was also performed. The mean VBH and HU changes at all sites included a decrease by 0.91 mm and a statistically significant increase by 431.86, respectively, from T1 to T2. The mean ratio of the newly formed bone (23.34% ± 10.63%) was greater than that of the residual bone graft (19.09% ± 8.74%), indicating that Bontree® is effective for new bone formation. This pilot study suggests that Bontree® is a promising bone substitute for LSFE.
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Affiliation(s)
- Seok-Jun Kim
- Department of Biomedical Science, College of Natural Sciences, Chosun University, Gwangju 61452, Korea; (S.-J.K.); (W.K.)
| | - Joo-Seong Kim
- Department of Biomedical Engineering, Yeungnam University, Daegu 42415, Korea;
| | - Woong Kim
- Department of Biomedical Science, College of Natural Sciences, Chosun University, Gwangju 61452, Korea; (S.-J.K.); (W.K.)
| | - Suk-Young Kim
- School of Materials Science and Engineering, Yeungnam University, Gyeongsan 38541, Korea;
| | - Won-Pyo Lee
- Department of Periodontology, School of Dentistry, Chosun University, Gwangju 61452, Korea
- Correspondence: ; Tel.: +82-62-220-3850
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Sato R, Matsuura T, Akizuki T, Fukuba S, Okada M, Nohara K, Takeuchi S, Hoshi S, Ono W, Maruyama K, Izumi Y, Iwata T. Influence of the bone graft materials used for guided bone regeneration on subsequent peri-implant inflammation: an experimental ligature-induced peri-implantitis model in Beagle dogs. Int J Implant Dent 2022; 8:3. [PMID: 35064395 PMCID: PMC8782989 DOI: 10.1186/s40729-022-00403-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 01/13/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose We aimed to histologically evaluate the influence of bone materials used during guided bone regeneration (GBR) on subsequent peri-implantitis in an experimental ligature-induced peri-implantitis model in beagle dogs. Methods Bilateral mandibular premolars (PM2-4) were extracted from six beagle dogs. After 3 months, standardized bone defects (3 mm [mesio-distal width] × 2 mm [bucco-lingual width] × 3 mm [depth]) were created in the experimental group, with simultaneous dental implant placement at the center of the defects. The defects were randomly filled with either autograft (AG) or deproteinized bovine bone mineral (DBBM) and covered with a collagen membrane. In the control group, implant fixtures were placed without creating an intrabony defect. After 3 months, a healing abutment was placed. Four weeks later, a 3–0 silk thread was ligated around the implants to induce peri-implantitis. After 4 weeks, the specimens were dissected and histologically examined. Results There were no clinical findings of inflammation until silk thread ligation. Four weeks after the onset of peri-implantitis, gingival redness and swelling were seen with mild resorption of the peri-implant bone on dental radiographs. There were no significant differences between the AG, DBBM, and control groups for the following parameters: bone-to-implant contact, distance from the implant shoulder to the base of the bone defect, area of bone defect, and area of new bone. Conclusions Within the limitations of this study, it can be concluded that peri-implant tissues after GBR using AG and DBBM underwent the same degree of bone resorption by peri-implantitis as the no defect group.
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Polymeric Scaffolds for Dental, Oral, and Craniofacial Regenerative Medicine. Molecules 2021; 26:molecules26227043. [PMID: 34834134 PMCID: PMC8621873 DOI: 10.3390/molecules26227043] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 01/10/2023] Open
Abstract
Dental, oral, and craniofacial (DOC) regenerative medicine aims to repair or regenerate DOC tissues including teeth, dental pulp, periodontal tissues, salivary gland, temporomandibular joint (TMJ), hard (bone, cartilage), and soft (muscle, nerve, skin) tissues of the craniofacial complex. Polymeric materials have a broad range of applications in biomedical engineering and regenerative medicine functioning as tissue engineering scaffolds, carriers for cell-based therapies, and biomedical devices for delivery of drugs and biologics. The focus of this review is to discuss the properties and clinical indications of polymeric scaffold materials and extracellular matrix technologies for DOC regenerative medicine. More specifically, this review outlines the key properties, advantages and drawbacks of natural polymers including alginate, cellulose, chitosan, silk, collagen, gelatin, fibrin, laminin, decellularized extracellular matrix, and hyaluronic acid, as well as synthetic polymers including polylactic acid (PLA), polyglycolic acid (PGA), polycaprolactone (PCL), poly (ethylene glycol) (PEG), and Zwitterionic polymers. This review highlights key clinical applications of polymeric scaffolding materials to repair and/or regenerate various DOC tissues. Particularly, polymeric materials used in clinical procedures are discussed including alveolar ridge preservation, vertical and horizontal ridge augmentation, maxillary sinus augmentation, TMJ reconstruction, periodontal regeneration, periodontal/peri-implant plastic surgery, regenerative endodontics. In addition, polymeric scaffolds application in whole tooth and salivary gland regeneration are discussed.
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Pesce P, Menini M, Canullo L, Khijmatgar S, Modenese L, Gallifante G, Del Fabbro M. Radiographic and Histomorphometric Evaluation of Biomaterials Used for Lateral Sinus Augmentation: A Systematic Review on the Effect of Residual Bone Height and Vertical Graft Size on New Bone Formation and Graft Shrinkage. J Clin Med 2021; 10:jcm10214996. [PMID: 34768518 PMCID: PMC8584826 DOI: 10.3390/jcm10214996] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of the present systematic review was to investigate the effect of residual bone height (RBH) and vertical bone gain on new bone formation (NBF) and graft shrinkage after lateral sinus lifts using different biomaterials. METHODS An electronic search was conducted on three databases to identify randomized controlled trials (RCTs) published until January 2021 with at least one follow-up at 6 months and at least five patients treated, comparing biomaterials used for maxillary sinus augmentation with a lateral approach. Graft volumetric changes, RBH, vertical bone gain, implant failure, and post-operative complications were evaluated. The risk of bias was assessed using the Cochrane tool. RESULTS We used 4010 identified studies, of which 21 were RCTs. Overall, 412 patients and 533 sinuses were evaluated. Only three publications had an overall low risk of bias. After 6 months, xenograft (XG) showed the least volume reduction (7.30 ± 15.49%), while autogenous graft (AU) was the most reabsorbed (41.71 ± 12.63%). NBF appeared to not be directly correlated with RBH; on the contrary, the overall linear regression analysis showed that NBF significantly decreased by 1.6% for each mm of postoperative vertical graft gain. This finding suggests that the greater the augmentation, the lower the NBF. A similar tendency, with a regression coefficient even higher than the overall one, was also observed with alloplast (AP) and XG. CONCLUSIONS The present results suggested that NBF was essentially independent of preoperative bone height. On the contrary, the smaller the volume was of the graft placed, the higher the amount of new bone formed, and the smaller the graft shrinkage was. Minimizing the augmentation volume might be beneficial to graft healing and stability especially when using AP and XG.
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Affiliation(s)
- Paolo Pesce
- Department of Surgical Sciences (DISC), University of Genoa, Ospedale S. Martino, L. Rosanna Benzi 10, 16132 Genoa, Italy; (M.M.); (L.M.); (G.G.)
- Correspondence:
| | - Maria Menini
- Department of Surgical Sciences (DISC), University of Genoa, Ospedale S. Martino, L. Rosanna Benzi 10, 16132 Genoa, Italy; (M.M.); (L.M.); (G.G.)
| | - Luigi Canullo
- Department of Periodontology, University of Bern, 3012 Bern, Switzerland;
| | - Shahnawaz Khijmatgar
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, 20122 Milan, Italy; (S.K.); (M.D.F.)
| | - Laura Modenese
- Department of Surgical Sciences (DISC), University of Genoa, Ospedale S. Martino, L. Rosanna Benzi 10, 16132 Genoa, Italy; (M.M.); (L.M.); (G.G.)
| | - Gianmarco Gallifante
- Department of Surgical Sciences (DISC), University of Genoa, Ospedale S. Martino, L. Rosanna Benzi 10, 16132 Genoa, Italy; (M.M.); (L.M.); (G.G.)
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, 20122 Milan, Italy; (S.K.); (M.D.F.)
- IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
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Coyac BR, Wu M, Bahat DJ, Wolf BJ, Helms JA. Biology of sinus floor augmentation with an autograft versus a bone graft substitute in a preclinical in vivo experimental model. Clin Oral Implants Res 2021; 32:916-927. [PMID: 34031931 DOI: 10.1111/clr.13781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/03/2021] [Accepted: 05/18/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Compared to autografts, bone graft substitutes are slower to consolidate. If we understood why, this might open strategies to accelerate new bone formation and thus shorten the time to implant placement. In this study, we aimed at comparing autologous bone graft with a bovine bone graft substitute in a preclinical sinus lift model. MATERIALS AND METHODS The mouse posterior paranasal sinus served as a recipient site for grafting. Autograft from the oral cavity was compared against bone graft substitute using molecular, cellular, and histological analyses conducted on post-grafting days (PSD) 0, 9, 18, and 120. RESULTS Either autografts or bone graft substitutes were positioned on the sinus floor and remained in situ throughout the study. At the time of grafting and until day 9, bone graft substitutes were devoid of cells and alkaline phosphatase (ALP) activity while autografts were comprised of viable cells and showed strong ALP (mineralization) activity. Consequently, new bone formed faster in autografts compared to bone graft substitutes (140.21 ± 41.21 µm vs. 41.70 ± 10.09 µm, respectively, PSD9, p = .0143). By PSD18, osteogenesis was evident in autografted and xenografted sites. Osteoclasts identified by tartrate resistant acid phosphatase attached to, but did not resorb the bone graft substitute matrix. Autograft matrix, however, underwent extensive resorption. Transgenic mice revealed that Wnt-responsive osteoprogenitor cells originated primarily from the internal periosteum of the maxillary bone, and not from the Schneiderian membrane. CONCLUSION Autografts produce new bone sooner, but bovine bone graft substitutes eventually consolidate and then resist resorption. Enhancing osteoprogenitor cell recruitment to a bone graft substitute constitutes a viable strategy for accelerating bone formation in a sinus lift procedure.
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Affiliation(s)
- Benjamin R Coyac
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Meagan Wu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Daniel J Bahat
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Benjamin J Wolf
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Jill A Helms
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Stanford University, Palo Alto, CA, USA
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Histological and Histomorphometric Evaluation of New Bone Formation after Maxillary Sinus Augmentation with Two Different Osteoconductive Materials: A Randomized, Parallel, Double-Blind Clinical Trial. MATERIALS 2020; 13:ma13235520. [PMID: 33287281 PMCID: PMC7729968 DOI: 10.3390/ma13235520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 12/14/2022]
Abstract
This study aimed to investigate the histological features of deproteinized equine bone mineral (DEBM) and anorganic bovine bone (ABB) after human sinus augmentation with the lateral approach. Twenty-three sinus augmentations were performed in 16 patients (male: 10/female: 6) using DEBM or ABB in a randomized fashion. Healing took place over the next 6 months. Bone core biopsies (N = 23) were obtained for each subject prior to placing the dental implants. The biopsies were processed for both histological descriptions and histomorphometric analysis. Statistical analyses were applied as appropriate, defining statistical significance as p < 0.05. Core bone biopsies revealed no differences in terms of newly formed bone between groups, or differences in terms of tissue inflammation. Both DEBM and ABB appear to be suitable biomaterials for bone augmentation in sinus lift surgery in the short term. However, dedicated studies are required to confirm these results and their stability in the long term.
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Starch-Jensen T, Deluiz D, Bruun NH, Tinoco EMB. Maxillary Sinus Floor Augmentation with Autogenous Bone Graft Alone Compared with Alternate Grafting Materials: a Systematic Review and Meta-Analysis Focusing on Histomorphometric Outcome. J Oral Maxillofac Res 2020; 11:e2. [PMID: 33262881 PMCID: PMC7644272 DOI: 10.5037/jomr.2020.11302] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/10/2020] [Indexed: 11/16/2022]
Abstract
Objectives The objective of present systematic review was to test the hypothesis of no difference in histomorphometric outcome after maxillary sinus floor augmentation with autogenous bone graft alone compared with alternate grafting materials applying the lateral window technique. Material and Methods MEDLINE (PubMed), Embase and Cochrane library search in combination with hand-search of relevant journals were conducted. Human studies published in English until the 25th of March, 2020 were included. Histomorphometric outcomes were evaluated by descriptive statistics and meta-analysis including 95% confidence interval (CI). Results Electronic search and hand-searching resulted in 1902 entries. Sixteen randomized controlled trials with unclear risk of bias fulfilled the inclusion criteria. Descriptive statistics showed comparable or improved histomorphometric outcomes with autogenous bone graft. Meta-analysis revealed a mean difference of -7.1% (CI = -11.0 to -3.2) indicating a significant higher amount of bone after maxillary sinus floor augmentation with autogenous bone graft compared with alternate grafting materials. Subgroup analysis demonstrated a non-significantly differences of -3.7% (CI = -10.9 to 3.4), -11.5% (CI = -25.9 to 2.8), 2.2% (CI = -16.9 to 21.3), and -4.6% (CI = -14.4 to 5.2), when autogenous bone graft was compared with allogeneic bone graft, xenograft, composite grafting materials involving xenograft or synthetic biomaterial mixed with autogenous bone graft, respectively. Conclusions Maxillary sinus floor augmentation with autogenous bone graft seems to facilitate improved histomorphometric outcomes compared with alternate grafting materials. However, the included studies were characterised by an unclear risk of bias and various methodological confounding factors. Hence, the conclusions drawn from the results of present study should be interpreted with caution.
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Affiliation(s)
- Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, AalborgDenmark
| | - Daniel Deluiz
- Department of Periodontology, Rio de Janeiro State University, Rio de JaneiroBrazil
| | - Niels Henrik Bruun
- Unit of Clinical Biostatistics, Aalborg University Hospital, AalborgDenmark
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Taschieri S, Ofer M, Corbella S, Testori T, Dellavia C, Nemcovsky C, Canciani E, Francetti L, Del Fabbro M, Tartaglia G. The Influence of Residual Alveolar Bone Height on Graft Composition after Maxillary Sinus Augmentation Using Two Different Xenografts: A Histomorphometric Comparative Study. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E5093. [PMID: 33187350 PMCID: PMC7697912 DOI: 10.3390/ma13225093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 02/07/2023]
Abstract
AIM To evaluate the hypothesis of a correlation between the preoperative residual alveolar bone height (RBH) and graft maturation after maxillary sinus floor augmentation procedures using two different bone substitutes. METHODS A total of 20 patients who underwent unilateral maxillary sinus floor augmentation with either mineralized deproteinized bovine bone (DBBM) or a xenograft enriched with polymer and gelatin (NBS) were included in this prospective study. Six months after sinus surgery, bone biopsies were harvested with a 3.2 mm diameter trephine bur, prior to dental implant placement. Histomorphometric analysis was performed, and the results were correlated with the individual RBH. Implants were loaded after 5 months of insertion, and 1-year implant success and marginal bone level change were assessed. RESULTS RBH was 2.17 ± 1.11 mm (range 0.5-3.5 mm) and 2.14 ± 0.72 mm (range 0.5-3.0 mm) in the NBS and DBBM group, respectively. The biopsy analyses for the DBBM group showed woven bone increases by 5.08% per 1-mm increment of RBH; medullary spaces decreased by 9.02%, osteoid decreased by 4.4%, residual biomaterial decreased by 0.34%, and lamellar bone increased by 5.68% per 1-mm increase of RBH. In the NBS group, samples showed woven bone increases by 8.08% per 1-mm increase of RBH; medullary spaces decreased by 0.38%; osteoid increased by 1.34%, residual biomaterial decreased by 0.58%, and lamellar bone decreased by 5.50% per 1-mm increase of RBH. There was no statistically significant difference in the correlation between RBH and lamellar bone, woven bone, and osteoid, independently of the material used. Implant success was 100% in both groups, and marginal bone loss was 1.02 ± 0.42 mm in DBBM and 0.95 ± 0.31 mm in the NBS group after the 1-year follow-up. CONCLUSION In spite of the absence of significance, the observed trend for woven bone to increase and medullary spaces to decrease when RBH increases deserves attention. Residual bone dimension might be a determinant in the bone graft maturation after maxillary sinus augmentation.
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Affiliation(s)
- Silvio Taschieri
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20123 Milan, Italy; (S.T.); (S.C.); (T.T.); (C.D.); (E.C.); (L.F.); (G.T.)
- Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy
- Department of Oral Surgery, Institute of Dentistry, I. M. Sechenov First Moscow State Medical University, 119146 Moscow, Russia
| | - Moses Ofer
- Department of Periodontology & Dental Implantology, School of Dental Medicine, University of Tel Aviv, 6997801 Tel Aviv-Yafo, Israel; (M.O.); (C.N.)
| | - Stefano Corbella
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20123 Milan, Italy; (S.T.); (S.C.); (T.T.); (C.D.); (E.C.); (L.F.); (G.T.)
- Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy
- Department of Oral Surgery, Institute of Dentistry, I. M. Sechenov First Moscow State Medical University, 119146 Moscow, Russia
| | - Tiziano Testori
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20123 Milan, Italy; (S.T.); (S.C.); (T.T.); (C.D.); (E.C.); (L.F.); (G.T.)
- Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy
- Department of Periodontics and Oral Medicine, The University of Michigan, School of Dentistry, Ann Arbor, MI 48109, USA
| | - Claudia Dellavia
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20123 Milan, Italy; (S.T.); (S.C.); (T.T.); (C.D.); (E.C.); (L.F.); (G.T.)
| | - Carlos Nemcovsky
- Department of Periodontology & Dental Implantology, School of Dental Medicine, University of Tel Aviv, 6997801 Tel Aviv-Yafo, Israel; (M.O.); (C.N.)
| | - Elena Canciani
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20123 Milan, Italy; (S.T.); (S.C.); (T.T.); (C.D.); (E.C.); (L.F.); (G.T.)
| | - Luca Francetti
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20123 Milan, Italy; (S.T.); (S.C.); (T.T.); (C.D.); (E.C.); (L.F.); (G.T.)
- Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20123 Milan, Italy; (S.T.); (S.C.); (T.T.); (C.D.); (E.C.); (L.F.); (G.T.)
- Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy
| | - Gianluca Tartaglia
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20123 Milan, Italy; (S.T.); (S.C.); (T.T.); (C.D.); (E.C.); (L.F.); (G.T.)
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Ha J, Son JH, Sung IY, Cho YC, Choi JH. Clinical outcome of implants placed in grafted maxillary sinus via lateral approach: A 10-year follow-up study. J Dent Sci 2020; 15:270-277. [PMID: 32952884 PMCID: PMC7486508 DOI: 10.1016/j.jds.2020.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 05/20/2020] [Indexed: 11/18/2022] Open
Abstract
Background/purpose The maxillary sinus floor augmentation (MSFA) technique is frequently used for the preparation of implant sites in the maxillary region. The aim of this study was to investigate the 10-year outcome of dental implants placed in a grafted maxillary sinus, and identify possible risk factors for implant failure. Materials and methods We retrospectively analyzed 202 implants after MSFA in 97 patients from January 2008 to April 2009. The outcome variables were 1) 10-year cumulative survival rate of the implant, 2) risk factors for implant failure, and 3) correlation between preoperative residual bone height (RBH) and graft materials in terms of implant survival. Graft materials used were divided into five different groups: autogenic, allogenic, xenogenic, combination of allogenic and xenogenic, or combination of autogenic and xenogenic graft. Results The cumulative 10-year survival rate for the implants was 96.04%. In regions with a residual bone height of 5.0 mm and less, greater RBH was preferable for long-term implant survival (odds ratio = 3.475; p = 0.035). Implant survival was not significantly different with different graft materials, even when RBH was unfavorable. Conclusion The placement of dental implants with MSFA is a reliable procedure. Further, RBH is an important predictor of long-term implant survival.
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Affiliation(s)
- Jinhee Ha
- Department of Dentistry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Jang-Ho Son
- Department of Oral and Maxillofacial Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
- Corresponding author. Department of Oral and Maxillofacial Surgery, Ulsan University Hospital, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, South Korea. Fax.: +82 52 250 7236.
| | - Iel-Yong Sung
- Department of Oral and Maxillofacial Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Yeong-Cheol Cho
- Department of Oral and Maxillofacial Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Jong-Ho Choi
- Department of Oral and Maxillofacial Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
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Whitt J, Al-Sabbagh M, Dawson D, Shehata E, Housley-Smith M, Tezanos A, Kutkut A. Efficacy of stem cell allograft in maxillary sinus bone regeneration: a randomized controlled clinical and blinded histomorphometric study. Int J Implant Dent 2020; 6:25. [PMID: 32596764 PMCID: PMC7321846 DOI: 10.1186/s40729-020-00222-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/24/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose This study aimed to evaluate the quality and quantity of newly generated bone in the maxillary sinus grafted with stem cell-based allograft material. Methods This study was a single site, prospective, blinded, randomized, and controlled clinical trial. Eleven subjects with 18 edentulous posterior maxillary sites requiring sinus augmentation for delayed implant placement using a lateral window approach were enrolled. At the time of sinus augmentation, test sinus was grafted with stem cell-based allograft (Osteocel Plus; NuVasive Therapeutics), while the control sinus was grafted with conventional cortico-cancellous allograft (alloOss; ACE Surgical). Cone beam computer tomography (CBCT) scan was taken before and 14 weeks post-sinus augmentation procedure, i.e., 2 weeks before implant placement. Thirty-six trephined core bone biopsies were harvested from the anterior and posterior grafted lateral-window osteotomy sites at the time of implant placement. Results The results showed a statistically significant difference in the vital bone percentage between the test and the control groups at the posterior grafted sites (p = 0.03). There was no significant difference in the percentage of vital bone between the anterior and posterior grafted sites within the test and control groups (p > .05). The CBCT analysis showed that the maxillary sinuses at the posterior grafted sites were statistically wider than those at the anterior grafted sites in both groups (p < .05). Conclusions Different allograft bone materials can be used in the maxillary sinus augmentation procedures. Stem cell allograft has more osteogenic potential with a better outcome in the wide posterior sinus.
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Affiliation(s)
- Josh Whitt
- University of Kentucky College of Dentistry, Lexington, KY, USA
| | - Mohanad Al-Sabbagh
- Division of Periodontology, University of Kentucky College of Dentistry, Lexington, KY, USA
| | - Dolphus Dawson
- University of Kentucky College of Dentistry, Lexington, KY, USA
| | - Ehab Shehata
- Division of Oral and Maxillofacial Surgery, University of Kentucky College of Dentistry, Lexington, KY, USA
| | - Moly Housley-Smith
- Division of Oral and Maxillofacial Surgery, University of Kentucky College of Dentistry, Lexington, KY, USA
| | - Alejandro Tezanos
- Department of Statistics, University of Kentucky College of Dentistry, Lexington, KY, USA
| | - Ahmad Kutkut
- Division of Prosthodontics, University of Kentucky College of Dentistry, 800 Rose St. D646, Lexington, KY, 40536, USA.
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Kim HW, Lim KO, Lee WP, Seo YS, Shin HI, Choi SH, Kim BO, Yu SJ. Sinus floor augmentation using mixture of mineralized cortical bone and cancellous bone allografts: Radiographic and histomorphometric evaluation. J Dent Sci 2020; 15:257-264. [PMID: 32952882 PMCID: PMC7486514 DOI: 10.1016/j.jds.2020.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 06/04/2020] [Indexed: 11/21/2022] Open
Abstract
Background/purpose Due to the pneumatization of the maxillary sinus, the sinus floor augmentation is often performed to implant placement in the maxillary posterior region. The aim was to perform radiographic and histomorphometric evaluation after placement of mixed allografts (cortical freeze-dried bone allograft [FDBA] 50%:cancellous FDBA 50%) during sinus floor augmentation. Materials and methods In 37 patients, anorganic bovine bone (ABB, sites = 16), mineralized cancellous bone allograft (MCBA, sites = 15), and mixed allografts (Mixed AG, sites = 20) were placed during sinus floor elevation via the lateral approach (LSFE), at total 51 sites with residual alveolar bone height (RBH) < 5 mm. Cone-beam computed tomography images were obtained before LSFE (T0), after surgery (T1), and 6 months after surgery (T2) for radiographic analysis. After a 6-month healing period, core biopsies were harvested and histomorphometric analysis was performed. Results The mean augmented bone height (ABH) of ABB, MCBA, and mixed AG groups after surgery was similar (13.86 ± 4.19 mm, 13.99 ± 4.07 mm, and 14.20 ± 3.12 mm, respectively; P > 0.05). The mean ABH of ABB, MCBA, and mixed AG groups after 6 months was similar (13.72 ± 4.55 mm, 11.83 ± 3.31 mm, and 12.53 ± 2.97 mm, respectively; P > 0.05). In the ABB, MCBA, and mixed AG groups, the proportion of newly formed bone (NB) was similar (36.13 ± 10.01%, 39.26 ± 10.72%, and 31.27 ± 18.31%, respectively; P > 0.05). Conclusion This result demonstrated that mixed AG led to sufficient bone augmentation and histologically comparable NB formation as compared to ABB and MCBA for sinus floor augmentation.
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Affiliation(s)
- Hyun-Woo Kim
- Department of Periodontology, School of Dentistry, Chosun University, Gwangju, Republic of Korea
| | - Kyeong-Ok Lim
- Department of Periodontology, School of Dentistry, Chosun University, Gwangju, Republic of Korea
| | - Won-Pyo Lee
- Department of Periodontology, School of Dentistry, Chosun University, Gwangju, Republic of Korea
| | - Yo-Seob Seo
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Chosun University, Gwangju, Republic of Korea
| | - Hong-In Shin
- Department of Oral Pathology, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
| | - Seong-Ho Choi
- Department of Periodontology, Research Institute for Periodontal Regeneration, School of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Byung-Ock Kim
- Department of Periodontology, School of Dentistry, Chosun University, Gwangju, Republic of Korea
| | - Sang-Joun Yu
- Department of Periodontology, School of Dentistry, Chosun University, Gwangju, Republic of Korea
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Liu Y, Wang J, Chen F, Feng Y, Xie C, Li D. A reduced healing protocol for sinus floor elevation in a staged approach with deproteinized bovine bone mineral alone: A randomized controlled clinical trial of a 5-month healing in comparison to the 8-month healing. Clin Implant Dent Relat Res 2020; 22:281-291. [PMID: 32267601 DOI: 10.1111/cid.12906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To investigate the feasibility of reducing the healing time of maxillary sinus floor elevation (MSFE) by a two-stage approach using deproteinized bovine bone mineral (DBBM) alone, based on clinical, histomorphometric, and microradiographic evaluations. MATERIALS AND METHODS Twenty consecutive cases with an atrophic posterior edentulous maxilla were randomly assigned to two groups at a ratio of 1:1. The lateral window approach to MSFE with DBBM alone was followed by an 8-month bone-healing period in the control group compared to 5 months in the test group. During implant placement, bone biopsies were harvested from implant osteotomy sites for micro-computed tomography (CT), histological, and histomorphometric evaluations. Cone beam CT (CBCT) scans were performed before and immediately after MSFE and after the bone-healing periods. The implant stability quotient (ISQ) was measured sequentially at implant placement and 1, 3, and 6 months thereafter. RESULTS The histomorphometric and microradiographic results showed no significant differences in new bone formation on the augmented sinus floor between the two groups (all Ps > .05), except that trabecular thickness was significantly reduced and trabecular separation significantly increased in the test group (both Ps < .05). The ISQs of both groups increased continuously after implant placement, but the difference was not significant between the groups at each time point. CBCT analyses showed that the extent of volumetric loss was comparable after bone healing for 5 and 8 months (P > .05). CONCLUSIONS Within the limitations of this study, the bone-healing time of MSFE with DBBM alone for staged implant placement could be reduced to 5 months instead of 8 or 9 months, based on the histomorphometric, microradiographic, and clinical outcomes; however, impact on long-term implant survival remains unknown and needs further investigation with long-term follow-ups.
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Affiliation(s)
- Yi Liu
- Department of Oral Implants, School of Stomatology, State Key Laboratory of Military Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Jin Wang
- Department of Oral Implants, School of Stomatology, State Key Laboratory of Military Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Fei Chen
- Department of Oral Implants, School of Stomatology, State Key Laboratory of Military Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Yuan Feng
- Department of Oral Implants, School of Stomatology, State Key Laboratory of Military Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Chao Xie
- Department of Oral Implants, School of Stomatology, State Key Laboratory of Military Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Dehua Li
- Department of Oral Implants, School of Stomatology, State Key Laboratory of Military Stomatology, The Fourth Military Medical University, Xi'an, China
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Rammelsberg P, Kilian S, Büsch C, Kappel S. The effect of transcrestal sinus-floor elevation without graft on the long-term prognosis of maxillary implants. J Clin Periodontol 2020; 47:640-648. [PMID: 32145083 DOI: 10.1111/jcpe.13278] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 02/05/2020] [Accepted: 03/02/2020] [Indexed: 12/19/2022]
Abstract
AIM To evaluate the effects of (a) transcrestal sinus-floor elevation (TSFE) and (b) residual bone height on long-term implant survival. MATERIALS AND METHODS Chi-squared and t tests were used for descriptive comparison of the groups. Kaplan-Meier survival curves and corresponding log-rank tests were used to investigate implant survival over time. Multivariable Cox regressions were performed for the total population and experimental group. RESULTS A total of 634 patients received 648 implants with TSFE, while 674 implants without TSFE served as controls. Thirty implant failures occurred in the experimental group and 28 in the control group. Ten-year Kaplan-Meier survival curves for the 157 implants (24.3%) still under observation showed a probability of survival of 93.7% for the implants with TSFE and 92.9% for the 72 implants without TSFE (p = .678). The probability of 10-year survival of all implants in the experimental group decreased to 77.4% for implants placed in residual bone heights of 1-3 mm, compared with 95.7% for implant sites with bone heights of 4-6 mm and 97.6% for bone heights of >6 mm. CONCLUSIONS Transcrestal sinus-floor elevation has no negative effect on the long-term implant survival. Membrane perforation or negligible bone height, however, reduces the probability of 10-year survival.
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Affiliation(s)
- Peter Rammelsberg
- Department of Prosthodontics, Dental School, University of Heidelberg, Heidelberg, Germany
| | - Samuel Kilian
- Institute for Medical Biometry and Informatics, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Christopher Büsch
- Institute for Medical Biometry and Informatics, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Stefanie Kappel
- Department of Prosthodontics, Dental School, University of Heidelberg, Heidelberg, Germany
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Kivovics M, Szabó BT, Németh O, Iványi D, Trimmel B, Szmirnova I, Orhan K, Mijiritsky E, Szabó G, Dobó-Nagy C. Comparison between Micro-Computed Tomography and Cone-Beam Computed Tomography in the Assessment of Bone Quality and a Long-Term Volumetric Study of the Augmented Sinus Grafted with an Albumin Impregnated Allograft. J Clin Med 2020; 9:jcm9020303. [PMID: 31973237 PMCID: PMC7073646 DOI: 10.3390/jcm9020303] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/20/2020] [Indexed: 12/16/2022] Open
Abstract
The purpose of our study was to compare micromorphometric data obtained by cone-beam computed-tomography (CBCT) and microcomputed-tomography (micro-CT) of the augmented sinus and to evaluate the long-term stability of the bone gain achieved using BoneAlbumin. Sinus lifts, and after 6-months, healing bone-biopsy and implant placement were carried out. Specimens were analyzed by micro-CT. A total of 16 samples were collected from nine patients (mean age 54.7 ± 6.5 years). Pre-, postoperative, and 3-year control CBCT-data were registered to determine from where the biopsy samples were harvested. Micromorphometric variables were calculated from the micro-CT- and CBCT-data, and their correlation was determined by Spearman's test. The volume of augmented bone was calculated at the time of implant placement and after 3 years. A positive correlation was found between bone-volume fraction, trabecular-separation, open-, and total-porosity, while a negative correlation was found between trabecular-thickness obtained from CBCT- and micro-CT-data (p < 0.05). Mean volumetric reduction of 39.28% (11.88-60.02%) was observed. Correlation of CBCT- and micro-CT-data suggested that micromorphometric analysis of CBCT reconstructions of the augmented sinuses provided reliable information on the microarchitecture of augmented bone. CBCT as a modality might be adequate in the analysis of bone quality in the augmented sinus. At the 3-year, control sinus grafts showed volumetric stability.
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Affiliation(s)
- Márton Kivovics
- Department of Community Dentistry, Semmelweis University, 1088 Budapest, Hungary; (O.N.); (D.I.)
- Correspondence:
| | - Bence Tamás Szabó
- Department of Oral Diagnostics, Semmelweis University, 1088 Budapest, Hungary; (B.T.S.); (B.T.); (C.D.-N.)
| | - Orsolya Németh
- Department of Community Dentistry, Semmelweis University, 1088 Budapest, Hungary; (O.N.); (D.I.)
| | - Dóra Iványi
- Department of Community Dentistry, Semmelweis University, 1088 Budapest, Hungary; (O.N.); (D.I.)
| | - Bálint Trimmel
- Department of Oral Diagnostics, Semmelweis University, 1088 Budapest, Hungary; (B.T.S.); (B.T.); (C.D.-N.)
| | - Ilona Szmirnova
- Department of Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University, 1085 Budapest, Hungary; (I.S.); (G.S.)
| | - Kaan Orhan
- Dentomaxillofacial Radiology Department, Ankara University, Ankara 06560, Turkey;
| | - Eitan Mijiritsky
- Head and Neck Maxillofacial Surgery, Department of Otoryngology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 62431, Israel;
| | - György Szabó
- Department of Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University, 1085 Budapest, Hungary; (I.S.); (G.S.)
| | - Csaba Dobó-Nagy
- Department of Oral Diagnostics, Semmelweis University, 1088 Budapest, Hungary; (B.T.S.); (B.T.); (C.D.-N.)
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Al-Moraissi EA, Alkhutari AS, Abotaleb B, Altairi NH, Del Fabbro M. Do osteoconductive bone substitutes result in similar bone regeneration for maxillary sinus augmentation when compared to osteogenic and osteoinductive bone grafts? A systematic review and frequentist network meta-analysis. Int J Oral Maxillofac Surg 2019; 49:107-120. [PMID: 31230768 DOI: 10.1016/j.ijom.2019.05.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 01/30/2023]
Abstract
The purpose of this network meta-analysis was to identify the most effective biomaterials producing higher new bone formation (NBF) and lower residual graft (RG) and connective tissue (CT) following maxillary sinus augmentation (MSA), and to generate a ranking based on their performance. The MEDLINE, Embase, and CENTRAL databases were searched to identify randomized controlled trials (RCTs) published until March 2018, evaluating histomorphometric outcomes after MSA. Predictor variables were autogenous bone (AB), allografts (AG), xenografts (XG), alloplastic bone (AP), AB+XG, AB+AP, AG+XG, XG+AP, and grafts combined with autologous platelet concentrates/recombinant growth factors, mesenchymal stem cells (MSCs), or recombinant bone morphogenetic proteins (BMPs). Outcome variables were NBF%, RG%, and CT%. Healing time was considered. The weighted mean difference (WMD) with 95% confidence interval (CI) was calculated via frequentist network meta-analysis using Stata software. Fifty-two RCTs (1483 biopsies) were included. At a healing time <6 months, AB was superior to AP (WMD-10.66%, 95% CI-16.38% to -4.94%) and XG (WMD-7.93%, 95% CI-15.11% to -0.75%) for NBF. Regarding CT, AB was superior to XG+AP, AP, MSCs, and XG. At a healing time ≥6 months, NBF was higher for AB than AP (WMD-7.06%, 95% CI-12.59% to -1.52%). RG was lower in AB than AP (WMD 12.03%, 95% CI 3.04% to 21.03%), XG (WMD 14.62%, 95% CI 4.25% to 24.98%), and growth factors (WMD 12.32%, 95% CI 0.04% to 24.60%). The three highest ranked biomaterials for increasing NBF were AG+XG (95%, very low quality evidence), growth factors (69.9%, low quality evidence), and AB alone (69.8%, moderate quality evidence). The three highest ranked biomaterials for decreasing RG were BMPs (88.8%, very low quality evidence), AB alone (81.5%, moderate quality evidence), and AB+AP (58.9%, very low quality evidence). Finally, XG+AP (84.7%, low quality evidence), AP alone (77.7%, moderate quality evidence), and MSCs (76.1%, low quality evidence), were the three highest ranked biomaterials for decreasing the amount of CT. Network meta-analysis provided moderate quality evidence that AB alone is probably the best option to obtain greater NBF after MSA in the first 6 months after surgery. Additionally, the results of this network meta-analysis support the hypothesis that osteoconductive bone substitute materials should be combined with osteogenic or osteoinductive grafts for superior histomorphometric outcomes in MSA.
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Affiliation(s)
- E A Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen.
| | - A S Alkhutari
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen
| | - B Abotaleb
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen
| | - N H Altairi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen
| | - M Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy; IRCCS Orthopedic Institute Galeazzi, Milan, Italy
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Shanbhag S, Suliman S, Pandis N, Stavropoulos A, Sanz M, Mustafa K. Cell therapy for orofacial bone regeneration: A systematic review and meta-analysis. J Clin Periodontol 2019; 46 Suppl 21:162-182. [DOI: 10.1111/jcpe.13049] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/17/2018] [Accepted: 10/26/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Siddharth Shanbhag
- Department of Clinical Dentistry; Center for Clinical Dental Research; University of Bergen; Bergen Norway
| | - Salwa Suliman
- Department of Clinical Dentistry; Center for Clinical Dental Research; University of Bergen; Bergen Norway
| | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics; University of Bern; Bern Switzerland
| | - Andreas Stavropoulos
- Department of Periodontology; Faculty of Odontology; Malmö University; Malmö Sweden
| | - Mariano Sanz
- Section of Periodontology; Faculty of Odontology; University Complutense of Madrid; Madrid Spain
| | - Kamal Mustafa
- Department of Clinical Dentistry; Center for Clinical Dental Research; University of Bergen; Bergen Norway
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Batas L, Tsalikis L, Stavropoulos A. PRGF as adjunct to DBB in maxillary sinus floor augmentation: histological results of a pilot split-mouth study. Int J Implant Dent 2019; 5:14. [PMID: 30931490 PMCID: PMC6441666 DOI: 10.1186/s40729-019-0166-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/05/2019] [Indexed: 02/07/2023] Open
Abstract
Background Various technologies of autologous blood concentrates are currently evaluated for their potential to enhance bone formation. Aim To report on the histological outcome of maxillary sinus floor augmentation (MSFA) with deproteinized bovine bone (DBB) in combination with chair-side prepared autologous platelet-rich growth factor (PRGF), in comparison to that with DBB alone. Materials and methods Six partially edentulous patients with ≤ 3-mm residual bone height bilaterally in the posterior maxilla were subjected to MSFA with the lateral window technique, using DBB in combination with PRGF (PRGF System1 Vitoria, Spain) on one side or DBB alone on the contralateral side. Cylindrical biopsies from the augmented sinuses were collected during implant installation, ca. 6 months post-MSFA, and subjected to non-decalcified histological and histomorphometric evaluation. Results The collected biopsies varied in length (range 3.5–9.9 mm); consequently, the portion of the biopsy representing augmented tissues also varied (range 2.3–14.6 mm2). New bone formation with a trabecular appearance and numerous DBB particles in contact with the new bone or with loose connective tissue were observed. No differences in the relative volumes of bone formation were found in sinuses augmented with DBB + PRGF or DBB alone 6 months after MSFA (35.6 ± 8.26 mm and 37.8 ± 3.15 mm, respectively). Conclusion and clinical implications In conclusion, based on these preliminary results, PRGF as adjunct to DBB for MSFA, except from improved handling during the operation, does not appear to enhance nor interfere with bone formation inside the human sinus 6 months after MSFA, compared with the use of DBB alone.
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Affiliation(s)
- Leonidas Batas
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Lazaros Tsalikis
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Stavropoulos
- Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, Sweden.,Center for Experimental and Preclinical Biomedical Research (CEPBR), Athens, Greece.,Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
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Starch-Jensen T, Mordenfeld A, Becktor JP, Jensen SS. Maxillary Sinus Floor Augmentation With Synthetic Bone Substitutes Compared With Other Grafting Materials: A Systematic Review and Meta-analysis. IMPLANT DENT 2018; 27:363-374. [PMID: 29771732 DOI: 10.1097/id.0000000000000768] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To test the hypotheses of no differences in implant treatment outcome after maxillary sinus floor augmentation (MSFA) with synthetic bone substitutes (SBS) compared with other grafting materials applying the lateral window technique. MATERIALS AND METHODS A MEDLINE/PubMed, Embase and Cochrane Library search in combination with hand-search of selected journals was conducted. RESULTS Five randomized controlled trials with low risk of bias fulfilled the inclusion criteria. SBS disclosed high survival rate of suprastructures and implants with no significant differences compared to autogenous bone graft or xenograft. Meta-analysis revealed a patient-based implant survival rate of 0.98 (confidence interval: 0.89-1.08), indicating no differences between SBS and xenograft. SBS demonstrated significant less newly formed bone compared with autogenous bone graft, whereas no significant difference was revealed as compared to xenograft. High implant stability values, limited periimplant marginal bone loss, and few complications were reported with SBS. CONCLUSIONS There seem to be no differences in implant treatment outcome after MSFA with SBS compared to other grafting materials.
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Affiliation(s)
- Thomas Starch-Jensen
- Professor, Consultant, Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Arne Mordenfeld
- Consultant, Department of Oral and Maxillofacial Surgery, Public Health Service, Gävle, Sweden
- Centre for Research and Development, Uppsala University/Gävleborg County Council, Gävleborg, Sweden
| | - Jonas Peter Becktor
- Associated Professor, Consultant, Head, Department of Oral and Maxillofacial Surgery and Oral Medicine, Malmö University, Malmö, Sweden
| | - Simon Storgård Jensen
- Consultant, Department of Oral & Maxillofacial Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
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30
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Katagiri W, Watanabe J, Toyama N, Osugi M, Sakaguchi K, Hibi H. Clinical Study of Bone Regeneration by Conditioned Medium From Mesenchymal Stem Cells After Maxillary Sinus Floor Elevation. IMPLANT DENT 2018; 26:607-612. [PMID: 28727618 DOI: 10.1097/id.0000000000000618] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This clinical study was undertaken to evaluate the safety of use of the secretome of bone marrow-derived mesenchymal stem cells (MSC-CM) for maxillary sinus floor elevation (SFE). MATERIALS AND METHODS MSC-CM was prepared from conditioned medium from human bone marrow-derived MSCs. Six partially edentulous patients were enrolled in the study. MSC-CM was mixed with porous beta-tricalcium phosphate (β-TCP) and implanted in 4 patients (experimental group), whereas only β-TCP was implanted in the other 2 patients (control group). Six months after SFE, bone biopsies and histological assessments were performed. RESULTS Bone formation was clinically confirmed in all cases. Although Hounsfield units in computed tomography images were not significantly different between the groups, histological analysis revealed a significant difference in newly formed bone area between the groups. In particular, bone volume in the center of the augmented area was significantly greater in the MSC-CM group. Newly formed bone consisted of lamellar bone in the MSC-CM group but woven bone in the β-TCP group. CONCLUSION The secretome of bone marrow-derived mesenchymal stem cells (MSC-CM) was used safely and has great osteogenic potential for regenerative medicine of bone.
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Affiliation(s)
- Wataru Katagiri
- *Associate Professor, Division of Reconstructive Surgery and Oral and Maxillofacial Region, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; Department of Oral and Maxillofacial Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. †Graduate Student, Department of Oral and Maxillofacial Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. ‡Assistant Professor, Department of Oral and Maxillofacial Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. §Professor, Department of Oral and Maxillofacial Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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31
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Lundgren S, Cricchio G, Hallman M, Jungner M, Rasmusson L, Sennerby L. Sinus floor elevation procedures to enable implant placement and integration: techniques, biological aspects and clinical outcomes. Periodontol 2000 2018; 73:103-120. [PMID: 28000271 DOI: 10.1111/prd.12165] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Implant treatment in an atrophied edentulous posterior maxilla constitutes a challenge for the therapeutic team. The authors of the present study acknowledge that modern micro-rough surface implants in lengths of about 8-10 mm or longer and of different brands are similarly successful. Consequently, the authors propose that the use of different sinus floor elevation techniques should be considered when < 8 mm of bone is available below the maxillary sinus. The type of sinus floor elevation technique selected is mainly based on residual vertical bone height, marginal bone width, local intrasinus anatomy and the number of teeth to be replaced, although other factors (such as surgical training and surgical experience) may have an impact. It is proposed that a transcrestal sinus floor elevation approach can be considered as a first-choice method for single tooth gaps in situations with sufficient width for implant placement and a residual bone height of 5-8 mm, while lateral sinus floor elevation, with or without grafting materials, is indicated when < 5 mm of bone is available and when several teeth are to be replaced. With regard to time of implant placement, a one-stage procedure is preferred provided that high primary stability can be ensured.
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Ge J, Yang C, Wang Y, Zheng J, Hua H, Zhu J. Comparison of different grafting materials for treatment of bone defect distal to the molar in canine. Clin Implant Dent Relat Res 2018; 20:444-454. [DOI: 10.1111/cid.12603] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/10/2018] [Accepted: 02/13/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Jing Ge
- Department of Oral Surgery; Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology; Shanghai People's Republic of China
| | - Chi Yang
- Department of Oral Surgery; Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology; Shanghai People's Republic of China
| | - Yong Wang
- Department of Oral Surgery; Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology; Shanghai People's Republic of China
| | - Jiawei Zheng
- Department of Oral-maxillofacial Head and Neck Surgery; Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology; Shanghai People's Republic of China
| | - Hongfei Hua
- Department of Oral Surgery; Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology; Shanghai People's Republic of China
| | - Jun Zhu
- National Engineering Research Center for Nanotechnology; Shanghai People's Republic of China
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Hydrophilicity, Viscoelastic, and Physicochemical Properties Variations in Dental Bone Grafting Substitutes. MATERIALS 2018; 11:ma11020215. [PMID: 29385747 PMCID: PMC5848912 DOI: 10.3390/ma11020215] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 01/19/2018] [Accepted: 01/24/2018] [Indexed: 12/23/2022]
Abstract
The indication-oriented Dental Bone Graft Substitutes (DBGS) selection, the correct bone defects classification, and appropriate treatment planning are very crucial for obtaining successful clinical results. However, hydrophilic, viscoelastic, and physicochemical properties’ influence on the DBGS regenerative potential has poorly been studied. For that reason, we investigated the dimensional changes and molecular mobility by Dynamic Mechanical Analysis (DMA) of xenograft (cerabone®), synthetic (maxresorb®), and allograft (maxgraft®, Puros®) blocks in a wet and dry state. While no significant differences could be seen in dry state, cerabone® and maxresorb® blocks showed a slight height decrease in wet state, whereas both maxgraft® and Puros® had an almost identical height increase. In addition, cerabone® and maxresorb® blocks remained highly rigid and their damping behaviour was not influenced by the water. On the other hand, both maxgraft® and Puros® had a strong increase in their molecular mobility with different damping behaviour profiles during the wet state. A high-speed microscopical imaging system was used to analyze the hydrophilicity in several naturally derived (cerabone®, Bio-Oss®, NuOss®, SIC® nature graft) and synthetic DBGS granules (maxresorb®, BoneCeramic®, NanoBone®, Ceros®). The highest level of hydrophilicity was detected in cerabone® and maxresorb®, while Bio-Oss® and BoneCeramic® had the lowest level of hydrophilicity among both naturally derived and synthetic DBGS groups. Deviations among the DBGS were also addressed via physicochemical differences recorded by Micro Computed Tomography, Scanning Electron Microscopy, Fourier Transform Infrared Spectroscopy, X-ray powder Diffractometry, and Thermogravimetric Analysis. Such DBGS variations could influence the volume stability at the grafting site, handling as well as the speed of vascularization and bone regeneration. Therefore, this study initiates a new insight into the DBGS differences and their importance for successful clinical results.
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Márton K, Tamás SB, Orsolya N, Béla C, Ferenc D, Péter N, Csaba DN, Lajos C, Zsombor L, Eitan M, György S. Microarchitecture of the Augmented Bone Following Sinus Elevation with an Albumin Impregnated Demineralized Freeze-Dried Bone Allograft (BoneAlbumin) versus Anorganic Bovine Bone Mineral: A Randomized Prospective Clinical, Histomorphometric, and Micro-Computed Tomography Study. MATERIALS 2018; 11:ma11020202. [PMID: 29382095 PMCID: PMC5848899 DOI: 10.3390/ma11020202] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 12/15/2022]
Abstract
Serum albumin has been identified as an endogenous protein that is integral to early bone regeneration. We hypothesized that albumin addition to allografts may result in better bone remodeling than what can be achieved with anorganic xenografts. Sinus elevations were performed at 32 sites of 18 patients with the lateral window technique. Sites either received filling with an anorganic bovine bone mineral (ABBM, BioOss, Geistlich, CH) or albumin impregnated allograft (BoneAlbumin, OrthoSera, AT). After 6-months patients received dental implants and 16 bone core biopsy samples were obtained from the ABBM filled, and 16 from the BoneAlbumin augmented sites. The biopsies were examined by histomorphometry and µCT. Percentage of the residual graft in the BoneAlbumin group was 0–12.7%, median 5.4% vs. ABBM 6.3–35.9%, median 16.9%, p < 0.05. Results of the µCT analysis showed that the microarchitecture of the augmented bone in the BoneAlbumin group resembles that of the native maxilla in morphometric parameters Trabecular Pattern Factor and Connectivity. Our data show that while ABBM successfully integrates into the newly formed bone tissue as persisting particles, BoneAlbumin is underway towards complete remodeling with new bone closely resembling that of the intact maxilla.
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Affiliation(s)
- Kivovics Márton
- Department of Community Dentistry, Semmelweis University, Szentkirályi utca 40, 1088 Budapest, Hungary; (N.O.); (C.B.)
- Correspondence: ; Tel.: +36-20-360-1909
| | - Szabó Bence Tamás
- Department of Oral Diagnostics, Semmelweis University, Szentkirályi utca 47, 1088 Budapest, Hungary; (S.B.T.); (D.-N.C.)
| | - Németh Orsolya
- Department of Community Dentistry, Semmelweis University, Szentkirályi utca 40, 1088 Budapest, Hungary; (N.O.); (C.B.)
| | - Czinkóczky Béla
- Department of Community Dentistry, Semmelweis University, Szentkirályi utca 40, 1088 Budapest, Hungary; (N.O.); (C.B.)
| | - Dőri Ferenc
- Department of Periodontology, Semmelweis University, Szentkirályi utca 47, 1088 Budapest, Hungary;
| | - Nagy Péter
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26, 1085 Budapest, Hungary;
| | - Dobó-Nagy Csaba
- Department of Oral Diagnostics, Semmelweis University, Szentkirályi utca 47, 1088 Budapest, Hungary; (S.B.T.); (D.-N.C.)
| | - Csönge Lajos
- Petz Aladár County Hospital, West Hungarian Regional Tissue Bank, Vasvári Pál u. 2–4, 9024 Győr, Hungary;
| | - Lacza Zsombor
- Institute of Clinical Experimental Research, Semmelweis University, Tűzoltó u. 37–47, 1094 Budapest, Hungary;
| | - Mijiritsky Eitan
- Department of Oral Rehabilitation, Tel Aviv University, Ramat Aviv, Tel Aviv 6997801, Israel;
| | - Szabó György
- Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University, Mária utca 52, 1085 Budapest, Hungary;
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Gouda A, Helal E, Ali S, Bakry S, Yassin S. Maxillary sinus lift using osteoinductive simvastatin combined with β-TCP versus β-TCP - a comparative pilot study to evaluate simvastatin enhanced and accelerated bone formation. Acta Odontol Scand 2018; 76:39-47. [PMID: 28952824 DOI: 10.1080/00016357.2017.1381345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to evaluate available bone quality and quantity after performing sinus augmentation using simvastatin/β-TCP combination versus β-TCP alone. MATERIALS AND METHODS This study included eight sinus lift procedures conducted on six patients. The sinuses were divided into two equal groups. The patients were recalled one, two weeks two, five, nine months post-operatively for post-operative evaluation. Radiographic evaluation involved cone beam computed tomography (CBCT) radiographs taken for every patient one week and nine months post-operatively to evaluate the changes in bone height, while histomorphometric evaluation involved transcortical bone biopsies taken after nine months during the second-stage surgery for implant placement. RESULTS The histomorphometric results showed that the amount of newly formed bone was higher in the simvastatin group when compared to the β-TCP group nine months after the surgery; the difference between the two groups was statistically significant. On the other hand, the radiographic evaluation showed that the rate of resorption of the simvastatin group was found to be higher than the control group; however, the difference between both groups was statistically insignificant. CONCLUSION These results showed that Simvastatin is safe to be used in sinus lift with promising osteoinductive capacity, yet further studies using larger sample size is needed.
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Affiliation(s)
- Ayman Gouda
- Oral and Maxillofacial Surgery Department, Cairo University, Cairo, Egypt
| | - Eman Helal
- Fixed and Removable Prosthodontics Department, National Research Center, Cairo, Egypt
| | - Sherif Ali
- Oral and Maxillofacial Surgery Department, Cairo University, Cairo, Egypt
| | - Saleh Bakry
- Oral and Maxillofacial Surgery Department, Cairo University, Cairo, Egypt
| | - Salah Yassin
- Oral and Maxillofacial Surgery Department, Cairo University, Cairo, Egypt
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Galindo-Moreno P, de Buitrago JG, Padial-Molina M, Fernández-Barbero JE, Ata-Ali J, O Valle F. Histopathological comparison of healing after maxillary sinus augmentation using xenograft mixed with autogenous bone versus allograft mixed with autogenous bone. Clin Oral Implants Res 2017; 29:192-201. [PMID: 29071736 DOI: 10.1111/clr.13098] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the clinical and histologic outcomes of two different grafting materials (allograft and xenograft) when combined with autogenous bone and covered with a collagen membrane for sinus augmentation. MATERIAL AND METHODS A parallel case series of fourteen patients in need of a unilateral sinus augmentation was evaluated in this study. Seven patients received a graft composed by autologous cortical bone (ACB) and anorganic bovine bone in a ratio of 1:1; the other seven patients received ACB mixed with an allograft in the same ratio. Bone biopsies were obtained 6 months after sinus augmentation at the time of implant placement. Comparative histomorphometrical, histopathological, and immunohistochemical analyses were conducted and statistically analyzed. RESULTS After 12 months of functional loading, all implants in both groups were clinical and radiographically successful. Histomorphometrically, although the initial bone formation was not significantly different between groups (new mineralized tissue: 41.03(12.87)% vs. 34.50(13.18)%, p = .620; allograft vs. xenograft groups), the graft resorbed faster in the allograft group (remnant graft particles: 9.83[7.77]% vs. 21.71[17.88]%; p = .026; allograft vs. xenograft groups). Non-mineralized tissue did not statistically differ either (49.00[14.32]% vs. 43.79[19.90]%; p = .710; allograft vs. xenograft groups). The histologic analyses revealed higher cellular content, four times more osteoid lines, and higher vascularization in the xenograft group. Musashi-1 (mesenchymal stromal cell marker) was also more intensively expressed in the xenograft group (p = .019). CONCLUSIONS Both composite grafts generate adequate substratum to receive dental implants after healing. Compared with the xenograft composite, allograft composite shows faster turnover and a quicker decrease in biological action after 6 months.
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Affiliation(s)
- Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Juan G de Buitrago
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Miguel Padial-Molina
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | | | - Javier Ata-Ali
- Public Dental Health Service, Arnau de Vilanova Hospital & Department of Dentistry, European University of Valencia, Valencia, Spain
| | - Francisco O Valle
- Department of Pathology & Institute of Biopathology and Regenerative Medicine (IBIMER, CIBM), University of Granada, Granada, Spain
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Starch-Jensen T, Jensen JD. Maxillary Sinus Floor Augmentation: a Review of Selected Treatment Modalities. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2017; 8:e3. [PMID: 29142655 PMCID: PMC5676313 DOI: 10.5037/jomr.2017.8303] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 09/30/2017] [Indexed: 02/06/2023]
Abstract
Objectives The objective of the present study is to present the current best evidence for enhancement of the vertical alveolar bone height and oral rehabilitation of the atrophic posterior maxilla with dental implants and propose some evidence-based treatment guidelines. Material and Methods A comprehensive review of the English literature including MEDLINE (PubMed), Embase and Cochrane Library search was conducted assessing the final implant treatment outcome after oral rehabilitation of the atrophic posterior maxilla with dental implants. No year of publication restriction was applied. The clinical, radiological and histomorphometric outcome as well as complications are presented after maxillary sinus floor augmentation applying the lateral window technique with a graft material, maxillary sinus membrane elevation without a graft material and osteotome-mediated sinus floor elevation with or without the use of a graft material. Results High implant survival rate and new bone formation was reported with the three treatment modalities. Perforation of the Schneiderian membrane was the most common complication, but the final implant treatment outcome was not influenced by a Schneiderian membrane perforation. Conclusions The different surgical techniques for enhancement of the vertical alveolar bone height in the posterior part of the maxilla revealed high implant survival with a low incidence of complications. However, the indication for the various surgical techniques is not strictly equivalent and the treatment choice should be based on a careful evaluation of the individual case. Moreover, further high evidence-based and well reported long-term studies are needed before one treatment modality might be considered superior to another.
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Affiliation(s)
- Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, AalborgDenmark
| | - Janek Dalsgaard Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, AalborgDenmark
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Yamada M, Egusa H. Current bone substitutes for implant dentistry. J Prosthodont Res 2017; 62:152-161. [PMID: 28927994 DOI: 10.1016/j.jpor.2017.08.010] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/07/2017] [Accepted: 08/29/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE Alveolar ridge augmentation is essential for success in implant therapy and depends on the biological performance of bone graft materials. This literature review aims to comprehensively explain the clinically relevant capabilities and limitations of currently available bone substitutes for bone augmentation in light of biomaterial science. STUDY SELECTION The biological performance of calcium phosphate-based bone substitutes was categorized according to space-making capability, biocompatibility, bioabsorption, and volume maintenance over time. Each category was reviewed based on clinical studies, preclinical animal studies, and in vitro studies. RESULTS Currently available bone substitutes provide only osteoconduction as a scaffold but not osteoinduction. Particle size, sensitivity to enzymatic or chemical dissolution, and mechanical properties affect the space-making capability of bone substitutes. The nature of collagen fibers, particulate size, and release of calcium ions influence the biocompatibility of bone substitutes. Bioabsorption of bone substitutes is determined by water solubility (chemical composition) and acid resistance (integrity of apatite structure). Bioabsorption of remnant bone substitute material and volume maintenance of the augmented bone are inversely related. CONCLUSION It is necessary to improve the biocompatibility of currently available bone substitutes and to strike an appropriate balance between bioabsorption and volume maintenance to achieve ideal bone remodeling.
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Affiliation(s)
- Masahiro Yamada
- Division of Molecular and Regenerative Prosthodontics, Tohoku University Graduate School of Dentistry, Japan
| | - Hiroshi Egusa
- Division of Molecular and Regenerative Prosthodontics, Tohoku University Graduate School of Dentistry, Japan.
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Kakar A, Rao BHS, Hegde S, Deshpande N, Lindner A, Nagursky H, Patney A, Mahajan H. Ridge preservation using an in situ hardening biphasic calcium phosphate (β-TCP/HA) bone graft substitute-a clinical, radiological, and histological study. Int J Implant Dent 2017. [PMID: 28643222 PMCID: PMC5481287 DOI: 10.1186/s40729-017-0086-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Post-Extraction ridge preservation using bone graft substitutes is a conservative technique to maintain the width of the alveolar ridge. The objective of the present study was to evaluate an in situ hardening biphasic (HA/β-TCP) bone graft substitutes for ridge preservation without primary wound closure or a dental membrane. METHODS A total of 15 patients reported for tooth extraction were enrolled in this study. Implants were placed in average 5.2 ± 2 months after socket grafting. At this visit, Cone Beam CT (CBCT) images and core biopsies were taken. Implant stability (ISQ) was assessed at the insertion as well as at the day of final restoration. RESULTS CBCT data revealed 0.79 ± 0.73 mm ridge width reduction from grafting to implant placement. Histomorphometric analysis of core biopsy samples revealed in average 21.34 ± 9.14% of new bone in the grafted sites. Primary implant stability was high (ISQ levels 70.3 ± 9.6) and further increased until final restoration. CONCLUSIONS The results of this study show that grafting of intact post-extraction sockets using a biphasic in situ hardening bone graft substitute results in an effective preservation of the ridge contour and sufficient new bone formation in the grafted sites, which is imperative for successful implant placement.
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Affiliation(s)
- Ashish Kakar
- Yenepoya University Dental College, University Road, Mangalore, 575018, India.
| | | | - Shashikanth Hegde
- Yenepoya University Dental College, University Road, Mangalore, 575018, India
| | - Nikhil Deshpande
- Dental Foundations and Research Centre, Malad, Mumbai, 400064, India
| | - Annette Lindner
- Department of Oral and Maxillofacial Surgery, Center for Dental Medicine, Medical Center-University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Heiner Nagursky
- Department of Oral and Maxillofacial Surgery, Center for Dental Medicine, Medical Center-University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Aditya Patney
- Mahajan Imaging Center, K-18 Hauz Khas Enclave, New Delhi, 110016, India
| | - Harsh Mahajan
- Mahajan Imaging Center, K-18 Hauz Khas Enclave, New Delhi, 110016, India
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Duan DH, Fu JH, Qi W, Du Y, Pan J, Wang HL. Graft-Free Maxillary Sinus Floor Elevation: A Systematic Review and Meta-Analysis. J Periodontol 2017; 88:550-564. [PMID: 28168901 DOI: 10.1902/jop.2017.160665] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND This systematic review and meta-analysis aims to investigate survival rates of dental implants placed simultaneously with graft-free maxillary sinus floor elevation (GFSFE). Factors influencing amount of vertical bone gain (VBG), protruded implant length (PIL) in sinus at follow-up (PILf), and peri-implant marginal bone loss (MBL) are also evaluated. METHODS Electronic and manual searches for human clinical studies on simultaneous implant placement and GFSFE using the lateral window or transcrestal approach, published in the English language from January 1976 to March 2016, were conducted. The random-effects model and mixed-effect meta-regression were used to analyze weighted mean values of clinical parameters and evaluate factors that influenced amount of VBG. RESULTS Of 740 studies, 22 clinical studies were included in this systematic review. A total of 864 implants were placed simultaneously with GFSFE at edentulous sites having mean residual bone height of 5.7 ± 1.7 mm. Mean implant survival rate (ISR) was 97.9% ± 0.02% (range: 93.5% to 100%). Weighted mean MBL was 0.91 ± 0.11 mm, and it was significantly associated with the postoperative follow-up period (r = 0.02; R2 = 43.75%). Weighted mean VBG was 3.8 ± 0.34 mm, and this parameter was affected significantly by surgical approach, implant length, and PIL immediately after surgery (PILi) (r = 2.82, 0.57, 0.80; R2 = 19.10%, 39.27%, 83.92%, respectively). Weighted mean PILf was 1.26 ± 0.33 mm (range: 0.3 to 2.1 mm). CONCLUSION Within limitations of the present systematic review, GFSFE with simultaneous implant placement can achieve satisfactory mean ISR of 97.9% ± 0.02%.
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Affiliation(s)
- Deng-Hui Duan
- Department of General Dentistry, School and Hospital of Stomatology, Peking University, Beijing, People's Republic of China
| | - Jia-Hui Fu
- Discipline of Periodontics, Faculty of Dentistry, National University of Singapore, Singapore, Republic of Singapore
| | - Wei Qi
- Department of Endodontics, Jinan Stomatology Hospital, Jinan, Shandong, People's Republic of China
| | - Yi Du
- Department of General Dentistry, School and Hospital of Stomatology, Peking University, Beijing, People's Republic of China
| | - Jie Pan
- Department of General Dentistry, School and Hospital of Stomatology, Peking University, Beijing, People's Republic of China
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
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A systematic review and meta-analysis of long-term studies (five or more years) assessing maxillary sinus floor augmentation. Int J Oral Maxillofac Surg 2017; 47:103-116. [PMID: 28545806 DOI: 10.1016/j.ijom.2017.05.001] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/22/2017] [Accepted: 05/03/2017] [Indexed: 12/23/2022]
Abstract
The objective was to test the hypothesis of no difference in long-term (≥5 years) implant treatment outcomes after maxillary sinus floor augmentation (MSFA) with autogenous bone graft compared to a mixture of autogenous bone graft and bone substitutes or bone substitutes alone. A MEDLINE (PubMed), Embase, and Cochrane Library search in combination with a hand-search of relevant journals was conducted. Human studies published in English between January 1, 1990 and October 1, 2016 were included. Nine studies fulfilled the inclusion criteria. The survival of suprastructures has never been compared within the same study. The 5-year implant survival after MSFA with autogenous bone graft was 97%, compared to 95% for Bio-Oss; the reduction in vertical height of the augmented sinus was equivalent with the two treatment modalities. Non-comparative studies demonstrated high survival rates for suprastructures and implants regardless of the grafting material used. Meta-analysis revealed an overall estimated patient-based implant survival of 95% (confidence interval 0.92-0.96). High implant stability quotient values, high patient satisfaction, and limited peri-implant marginal bone loss were revealed in non-comparative studies. No long-term randomized controlled trial comparing the different treatment modalities was identified. Hence, the conclusions drawn from the results of this systematic review should be interpreted with caution.
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Valdivia-Gandur I, Engelke W, Beltrán V, Borie E, Fuentes R, Manzanares-Céspedes MC. Novel use of cranial epidural space in rabbits as an animal model to investigate bone volume augmentation potential of different bone graft substitutes. Head Face Med 2016; 12:35. [PMID: 27906068 PMCID: PMC5134093 DOI: 10.1186/s13005-016-0131-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 11/22/2016] [Indexed: 01/03/2023] Open
Abstract
Background The success of bone augmentation to a major degree depends on the biomechanics and biological conditions of the surrounding tissues. Therefore, an animal model is needed providing anatomical sites with similar mechanical pressures for comparing its influence on different biomaterials for bone regeneration. The present report describes the new bone formation associated to biomaterial in a bursa created in the epidural space, between dura mater and cranial calvaria, under the constant pressure of cerebrospinal fluid. Methods Five adult California rabbits were used for the trial. In each animal, two bursae were created in the epidural spaces, in the anterior part of the skull, below both sides of the interfrontal suture. The spaces between dura mater and cranial calvaria were filled with in-situ hardening biphasic calcium phosphate containing hydroxyapatite and beta tricalcium-phosphate (BCP), in-situ hardening phase-pure beta-tricalcium phosphate (β-TCP) or without any biomaterials (sham). After 90 days, the animals were sacrificed, and the defect sites were extracted and processed for histomorphometric analysis by optical and backscattered electron microscopy. Results The cranial epidural spaces created (n = 10) could be preserved by the application both BCP (n = 3) and β-TCP biomaterials (n = 3) in all experimental sites. The sites augmented with BCP showed less new bone formation but a trend to better volume preservation than the sites augmented with β-TCP. However, the bone in the BCP sites seemed to be more mature as indicated by the higher percentage of lamellar bone in the sites. In contrast, the created space could not be preserved, and new bone formation was scarce in the sham-operated sites (n = 4). Conclusion The experimental bursae created bilaterally in the epidural space allows comparing objectively bone formation in relation to biomaterials for bone regeneration under permanent physiological forces from cerebrospinal fluid pressure.
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Affiliation(s)
- Ivan Valdivia-Gandur
- Biomedical Department, Universidad de Antofagasta, Antofagasta, Chile.,Odontology Department, Universidad de Antofagasta, Antofagasta, Chile
| | - Wilfried Engelke
- Department of Oral and Maxillofacial Surgery, Georg-August-Universität, Göttingen, Germany
| | - Víctor Beltrán
- Department of Oral and Maxillofacial Surgery, Georg-August-Universität, Göttingen, Germany. .,Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile. .,Clinical Investigation and Dental Innovation Center (CIDIC), Dental School, Universidad de La Frontera, Av. Francisco Salazar 01145, Temuco, Chile.
| | - Eduardo Borie
- Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
| | - Ramón Fuentes
- Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
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Effect of Porous Titanium Granules on Bone Regeneration and Primary Stability in Maxillary Sinus: A Human Clinical, Histomorphometric, and Microcomputed Tomography Analyses. J Craniofac Surg 2016; 27:391-7. [PMID: 26872278 DOI: 10.1097/scs.0000000000002421] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this randomized controlled study was to comparatively analyze the new bone (NB), residual bone, and graft-bone association in bone biopsies retrieved from augmented maxillary sinus sites by histomorphometry and microcomputed tomography (MicroCT) in a split-mouth model to test the efficacy of porous titanium granules (PTG) in maxillary sinus augmentation. Fifteen patients were included in the study and each patient was treated with bilateral sinus augmentation procedure using xenograft (equine origine, granule size 1000-2000 μm) and xenograft (1 g) + PTG (granule size 700-1000 μm, pore size >50 μm) (1 g), respectively. After a mean of 8.4 months, 30 bone biopsies were retrieved from the implant sites for three-dimensional MicroCT and two-dimensional histomorphometric analyses. Bone volume and vital NB percentages were calculated. Immediate after core biopsy, implants having standard dimensions were placed and implant stability quotient values were recorded at baseline and 3 months follow-up. There were no significant differences between groups according to residual bone height, residual bone width, implant dimensions, and implant stability quotient values (baseline and 3 months). According to MicroCT and two-dimensional histomorphometric analyses, the volume of newly formed bone was 57.05% and 52.67%, and 56.5% and 55.08% for xenograft + PTG and xenograft groups, respectively. No statistically significant differences found between groups according to NB percentages and higher Hounsfield unit values were found for xenograft + PTG group. The findings of the current study supports that PTG, which is a porous, permanent nonresorbable bone substitute, may have a beneficial osteoconductive effect on mechanical strength of NB in augmented maxillary sinus.
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Jelušić D, Puhar I, Plančak D. Assessment of implant stability following sinus lift procedures with different grafting materials. Acta Stomatol Croat 2016; 48:25-32. [PMID: 27688348 DOI: 10.15644/asc48/1/3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE The objective of this research was to evaluate implant stability following sinus lift with two grafting materials, and to compare it with the results obtained for the implants placed in a pristine posterior maxilla. MATERIALS AND METHODS The study included 44 healthy patients with an existing indication for sinus lift procedure (test group). 46 implants were placed following sinus lift with a pure-phase beta-tricalcium phosphate, while 39 implants were placed following augmentation with 60% hydroxyapatite with 40% beta-tricalcium phosphate material. The control group consisted of 48 healthy patients who were treated with 85 implants but without bone augmentation in posterior maxilla. Astra Tech OsseoSpeed implants were placed in all subjects. Resonance frequency analysis was used in both groups for determining implant stability 4 months after insertion. A mean implant stability quotient (ISQ) was calculated on the basis of 3 measurements. RESULTS No statistical difference was observed in ISQ values of implants placed with and without augmentation procedure (p=0,789). Statistically significant difference was not found when ISQ values of implants placed following particular grafting material were compared with ISQ values of corresponding implants in a pristine bone (p=0.697 and p=0.402). CONCLUSIONS This study demonstrated that the implant stability is comparable among implants placed in the posterior maxilla regardless of sinus lift and grafting procedure. Implants placed in the grafted posterior maxilla can be predictably loaded as the implants placed in a non-grafted, pristine maxilla.
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Affiliation(s)
| | - Ivan Puhar
- Department of Periodontology, School of Dental Medicine, Zagreb, Croatia
| | - Darije Plančak
- Department of Periodontology, School of Dental Medicine, Zagreb, Croatia
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Danesh-Sani SA, Engebretson SP, Janal MN. Histomorphometric results of different grafting materials and effect of healing time on bone maturation after sinus floor augmentation: a systematic review and meta-analysis. J Periodontal Res 2016; 52:301-312. [PMID: 27534916 DOI: 10.1111/jre.12402] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2016] [Indexed: 01/11/2023]
Abstract
The aim of this systematic review was to evaluate histomorphometric variables, the amount of new bone (NB), residual graft (RG) particles and soft tissue (ST), related to various grafting materials and assess the effect of graft healing time on different histomorphometric outcomes. Studies that were published before October 2015 were electronically and manually searched in three databases. We included human studies that reported the amount of NB, RG and ST in the biopsies taken from the grafted sinuses. Based on the applied grafting materials, extracted data were categorized into different groups. Furthermore, extracted data were classified into three groups based on healing time: (i) ≤ 4.5 mo; (ii) 4.5-9 mo; and (iii) ≥ 9-13.5 mo. The search provided 791 titles. Full text analysis was performed for 258 articles resulting in 136 studies that met the inclusion criteria. Autogenous bone (AB) resulted in the highest amount of NB and lowest amount of RG compared to other grafting materials. Based on this meta-analysis, a significant difference was noticed in the amount of NB formation in grafts with a healing time of > 4.5 mo when compared to the grafts with less healing time. However, when comparing biopsies taken at 4.5-9 mo of healing (average = 6.22 mo) to the ones taken at ≥ 9-13.5 mo (average = 10.36 mo), no significant difference was noticed in the amount of NB formation of various grafts except allografts that resulted in a significantly higher percentage of NB at 9.5 mo of healing. Based on histomorphometric analysis, AB results in the highest amount of NB formation in comparison to the other grafting materials. Bone substitute materials (allografts, alloplastic materials and xenografts) seem to be good alternatives to autogenous bone and can be considered as grafting materials to avoid disadvantages related to AB, including morbidity rate, limited availability and high volumetric change. Combining AB with alloplastic materials and xenografts brings no significant advantages regarding NB formation.
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Affiliation(s)
- S A Danesh-Sani
- Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, NY, USA
| | - S P Engebretson
- Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, NY, USA
| | - M N Janal
- Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, NY, USA
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Lee JS, Shin HK, Yun JH, Cho KS. Randomized Clinical Trial of Maxillary Sinus Grafting using Deproteinized Porcine and Bovine Bone Mineral. Clin Implant Dent Relat Res 2016; 19:140-150. [PMID: 27324175 DOI: 10.1111/cid.12430] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Deproteinized porcine bone mineral (DPBM) was recently developed and commercially available in maxillary sinus grafting, in which demineralized bovine bone mineral (DBBM) was widely used. OBJECTIVES The present randomized controlled clinical trial aimed to compare histological bone quality and radiographic volume stability in maxillary sinuses grafted with DPBM and DBBM. MATERIALS AND METHODS Twenty sinuses in 16 participants were enrolled and randomly allocated to control and test groups using sequentially numbered, sealed envelopes; laterally approached sinus grafting with DBBM and DPBM, respectively. All participants were blinded to the group assignment during the entire experiment. After standardized osteotomy at the lateral wall of the maxillary sinus, the sinus membrane was elevated, and the control or test biomaterial was grafted. Computed tomography (CT) images were taken immediately after surgery, and another CT and trephine biopsy was taken for radiographic and histological analyses after 6 months. The histological bone quality was measured as a primary outcome, and changes in the height and volume of the graft were evaluated in the reconstructed CT images as secondary outcomes. RESULTS Fifteen sites (7 and 8 sites for control and test group) in 11 participants were finally included in the per protocol (PP) analysis, and 16 sites (7 and 9 sites, respectively) in 12 participants were included in the intention-to-treat (ITT) analysis; there were four drop-outs and one minor protocol violation. In both statistical analyses, the test groups showed comparable new bone formation and residual biomaterials in histology, and both groups exhibited minimal volume/height changes in radiographies. However, smaller sizes of residual biomaterials were observed in the histological samples from the test compared to control sites, despite the use of the same sizes of both biomaterials. CONCLUSIONS The results suggested that DPBM might produce comparable bone formation and volumetric stability with DBBM in maxillary sinus grafting, however, further clinical study with longer-term periods and larger sample sizes should be needed for confirming this suggestion.
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Affiliation(s)
- Jung-Seok Lee
- Department of Periodontology, Research Institute for periodontal regeneration, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Hyun-Ki Shin
- Department of Periodontology, Research Institute for periodontal regeneration, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Jeong-Ho Yun
- Department of Periodontology, School of Dentistry and Institute of Oral Bioscience, Chonbuk National University, Jeonju, Republic of Korea
| | - Kyoo-Sung Cho
- Department of Periodontology, Research Institute for periodontal regeneration, Yonsei University College of Dentistry, Seoul, Republic of Korea
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Wang Z, Li Z, Weng Y, Liu Y, Liu B, Yang Y. Biocompatibility and Biodegradation of Multiphasic Calcium Phosphate Ceramic Bone Substitute Transformed by Ostrich Cancellous Bone for Bone Tissue Engineering. Ing Rech Biomed 2016. [DOI: 10.1016/j.irbm.2015.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Conditioned Medium From Mesenchymal Stem Cells Enhances Early Bone Regeneration After Maxillary Sinus Floor Elevation in Rabbits. IMPLANT DENT 2015; 24:657-63. [DOI: 10.1097/id.0000000000000335] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Kohal RJ, Gubik S, Strohl C, Stampf S, Bächle M, Hurrle AA, Patzelt SBM. Effect of two different healing times on the mineralization of newly formed bone using a bovine bone substitute in sinus floor augmentation: a randomized, controlled, clinical and histological investigation. J Clin Periodontol 2015; 42:1052-9. [PMID: 26434920 DOI: 10.1111/jcpe.12466] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the amount of the mineralization of a bovine bone substitute material in sinus floor augmentation after healing times of 3 and 6 months. MATERIALS AND METHODS Fifty-one patients were randomized into two healing time groups and received sinus floor augmentations with a bovine bone material. After 3 or 6 months of healing, trephine bone biopsies were retrieved. The biopsies were processed for histological and histomorphometric evaluations to primarily investigate the amount of mineralized bone in the augmented area and secondarily compare the amount of mineralized bone in the augmented area and in the pristine bone. Statistical tests were performed to analyse the fraction of the mineralized bone (p < 0.05). RESULTS The biopsies of both groups showed remnants of the well-integrated bone substitute material. The histology revealed osteoblasts, osteocytes with osteoid, and osteoclasts. The mean percentage of mineralized bone in the augmented area was 23.8% (3 months group) and 23.6% (6 months group; p = 0.9246); the amount of remaining bone substitute material was 35% (3 months group) and 33.9% (6 months group; p = 0.6325). CONCLUSION It can be concluded that the bone maturation in the augmented sinus using the bovine bone material is similar after 3 and 6 months. Thus, implant installation after 3 months following a lateral window sinus floor augmentation approach using a bovine bone material seems to be clinically acceptable.
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Affiliation(s)
- Ralf Joachim Kohal
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Sonja Gubik
- Department of Orthodontics and Orofacial Orthopedics, Center for Dental, Oral and Maxillary Medicine, University of Ulm, Ulm, Germany
| | - Christine Strohl
- Department of Orthodontics, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Susanne Stampf
- Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Maria Bächle
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Adrian Alexander Hurrle
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg, Germany
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Corbella S, Taschieri S, Weinstein R, Del Fabbro M. Histomorphometric outcomes after lateral sinus floor elevation procedure: a systematic review of the literature and meta-analysis. Clin Oral Implants Res 2015; 27:1106-22. [DOI: 10.1111/clr.12702] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Stefano Corbella
- Department of Biomedical, Surgical and Dental Sciences; Università degli Studi di Milano; Milan Italy
- IRCCS Istituto Ortopedico Galeazzi; Milan Italy
| | - Silvio Taschieri
- Department of Biomedical, Surgical and Dental Sciences; Università degli Studi di Milano; Milan Italy
- IRCCS Istituto Ortopedico Galeazzi; Milan Italy
| | - Roberto Weinstein
- Department of Biomedical, Surgical and Dental Sciences; Università degli Studi di Milano; Milan Italy
- IRCCS Istituto Ortopedico Galeazzi; Milan Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences; Università degli Studi di Milano; Milan Italy
- IRCCS Istituto Ortopedico Galeazzi; Milan Italy
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