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Lahoud P, Nader N, Younes R. Sinus Augmentation Using Mineralized Bone Allografts: A 6-Month Histological and Histomorphometric Analysis. J Maxillofac Oral Surg 2022; 21:1180-1190. [PMID: 36896082 PMCID: PMC9989108 DOI: 10.1007/s12663-022-01728-z] [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: 09/13/2021] [Accepted: 04/22/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose The aim of this study was to evaluate, after a six-month healing period, the histological and histomorphometric results of mineralized bone allograft used in lateral sinus augmentation procedures. Materials and Methods Twenty-one pneumatized maxillary sinuses with residual bone height ≤ 4 mm were grafted with a mixture of 1/1 cortical and cancellous mineralized bone allograft using lateral sinus floor elevation. Six months later, during implant placement, a core biopsy was retrieved for histological and histomorphometric evaluation. Results Biopsies showed mature cancellous bone with no signs of acute or chronic inflammatory reactions. Higher magnification revealed new lamellar bone, active osteocytes and normal lamellar arrangement around Haversian canals interspersed with osteocytes in lacunae. At grafted bone periphery, a high concentration of osteoblastic/osteoclastic couple was noted, indicating active bone remodeling. Histomorphometric evaluation revealed an average vital bone content of 30.32% (25.00-44.00%), and a percentage of residual non-vital bone of 18.06% (14.05-25.00%). Conclusions Histological and histomorphometric evaluation indicated that the mixture of 1 to 1 cortical and cancellous mineralized bone allograft promoted de-novo bone formation and can be predictably used for sinus augmentation procedures.
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Affiliation(s)
- Pierre Lahoud
- Department of Oral Surgery, Faculty of Dental Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
- Cranio-Facial Research Laboratory, Faculty of Dental Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Nabih Nader
- Department of Oral Surgery, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Ronald Younes
- Department of Oral Surgery, Faculty of Dental Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
- Cranio-Facial Research Laboratory, Faculty of Dental Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
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Starch-Jensen T, Deluiz D, Tinoco EMB. Horizontal Alveolar Ridge Augmentation with Allogeneic Bone Block Graft Compared with Autogenous Bone Block Graft: a Systematic Review. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2020; 11:e1. [PMID: 32377325 PMCID: PMC7191383 DOI: 10.5037/jomr.2020.11101] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/04/2020] [Indexed: 12/19/2022]
Abstract
Objectives The objective of the present systematic review was to test the hypothesis of no difference in implant treatment outcome after horizontal ridge augmentation with allogeneic bone block compared with autogenous bone block. Material and Methods A MEDLINE (PubMed), Embase and Cochrane Library search in combination with a hand-search of relevant journals was conducted including human studies published in English through March 13, 2019. Comparative and non-comparative studies evaluating horizontal ridge augmentation with allogeneic bone block were included. Cochrane risk of bias tool and Newcastle-Ottawa Scale were used to evaluate risk of bias. Results One comparative study with high quality and 12 non-comparative studies fulfilled the inclusion criteria. Considerable heterogeneity prevented meta-analysis from being performed. The comparative retrospective short-term study demonstrated no significant difference in implant treatment outcome between the two treatment modalities. Non-comparative long-term studies revealed high implant survival, gain in alveolar ridge width and bone regeneration with allogeneic bone block. However, non-comparative studies disclosed high incidence of complications including dehiscence, exposure of allogeneic bone block and partial or total loss of the grafts. Conclusions There seemed to be no difference in implant treatment outcome after horizontal ridge augmentation with allogeneic bone block compared with autogenous bone block. However, increased risk of complications was frequently reported with allogeneic bone block.
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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
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Pérez-González F, Molinero-Mourelle P, Sánchez-Labrador L, Sáez-Alcaide LM, Limones A, Cortés-Bretón Brinkmann J, López-Quiles J. Assessment of clinical outcomes and histomorphometric findings in alveolar ridge augmentation procedures with allogeneic bone block grafts: A systematic review and meta-analysis. Med Oral Patol Oral Cir Bucal 2020; 25:e291-e298. [PMID: 32040468 PMCID: PMC7103446 DOI: 10.4317/medoral.23353] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 12/09/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND This systematic literature review aimed to evaluate the efficacy of allogeneic bone blocks for ridge augmentation by assessing block survival rates and subsequent implant survival, including post-surgical complications and histomorphometric analysis. MATERIAL AND METHODS An electronic and manual search among references, was conducted up to April 2019 by two independent authors. Inclusion criteria were: human clinical trials in which the outcomes of allogeneic bone block grafts were evaluated by means of their survival rates and subsequent implant success rates. RESULTS Seven articles fulfilled the inclusion criteria and were analyzed. A total of 323 allogeneic block grafts were monitored for a minimum of 12 months follow-up after surgery, of which thirteen (4.02%) failed. Regarding the cumulative implant survival rate, the weighted mean was 97.36%, computed from 501 implants. Histologic and histomorphometric analysis showed that allogeneic block grafts presented some clinical and microstructural differences in comparison with autologous block grafts. CONCLUSIONS Atrophic alveolar crest reconstruction with allogeneic bone block grafts would appear a feasible alternative to autologous bone block grafts, obtaining a low block graft failure rate, similar implant survival rate and fewer postoperative complications. Further investigations generating long term data are needed to confirm these findings.
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Affiliation(s)
- F Pérez-González
- Department of Conservative Dentistry and Orofacial Prosthodontics Faculty of Dentistry, Complutense University of Madrid, Spain Plaza Ramón y Cajal S/N, 28040, Madrid, Spain
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Anavi Lev K, Chaushu L, Schwarz F, Artzi Z. Bone-implant-contact and new bone formation around implants placed in FDB blocks compared to placement at the adjunction of particulate FDB. Clin Implant Dent Relat Res 2019; 22:21-28. [PMID: 31746114 DOI: 10.1111/cid.12856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/29/2019] [Accepted: 09/22/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The efficacy of human freeze-dried bone (h-FDB) as particulate vs block forms as a proper onlay augmented bone graft material to accommodate implants is undetermined. PURPOSE To evaluate osseointegration and new bone formation at implants placed in FDB blocks (BL group) and those at the adjunction of particulate FDB (PR group). MATERIALS AND METHODS Twelve pairs of h-FDB blocks were stabilized bilaterally to the calvaria of 12 rabbits. Twenty-four SLA implants were placed at the remodeled grafted blocks, 4 months later. A circumferential gap was created around one implant in each pair and packed with particulate h-FDB. Section biopsies were obtained at 2-month post implant placement (6 months post-block grafting). Bone-to-implant contact (BIC) and bone-area fraction (BAF) were histomorphometrically calculated. RESULTS The mean BIC was 34.4% and 33.5% for the BL and PR groups, respectively. The mean BAF was 23.9% and 26.4% for the corresponding groups, respectively. Osseointegration and newly formed bone were evident mostly between the threaded portions of the implants in proximity to the host rabbit calvaria compared to its cervical neck. CONCLUSION The particulate and the cancellous block h-FDB forms yielded similar BIC and BAF outcome. Full revascularization/revitalization is questioned.
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Affiliation(s)
- Karen Anavi Lev
- Department of Periodontology and Oral Implantology, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Chaushu
- Department of Periodontology and Oral Implantology, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Frank Schwarz
- Department of Oral Surgery and Implantology at the Centre for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt, Germany
| | - Zvi Artzi
- Department of Periodontology and Oral Implantology, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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Deluiz D, Delcroix GJR, D'Ippolito G, Grau-Monge C, Bonnin-Marquez A, Reiner T, Tinoco EMB, Amadeu T, Pires FR, Schiller PC. Human Bone Marrow-Derived Mesenchymal Stromal Cell-Seeded Bone Biomaterial Directs Fast and Superior Mandibular Bone Augmentation in Rats. Sci Rep 2019; 9:11806. [PMID: 31413279 PMCID: PMC6694159 DOI: 10.1038/s41598-019-48236-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/29/2019] [Indexed: 01/11/2023] Open
Abstract
Atrophic maxillary ridges present a challenge in the field of oral implantology. Autologous bone is still considered the gold standard grafting material, but the increased morbidity and surgical complications represent a major drawback for its use. The aim of this study was to assess the efficacy of an off-the-shelf cell-seeded bone biomaterial for mandibular bone augmentation, compared to its acellular counterpart. We used a rat model to test the osteogenic properties of bone marrow-derived mesenchymal stromal cells (MSCs)-seeded bone microparticles compared to acellular bone microparticles alone. Rats were euthanized at 4 and 8 weeks, and results analyzed using micro-CT imaging, histology (H&E, Masson’s Trichrome), histomorphometry and immunohistology (Tartrate-Resistant Acid Phosphatase-TRAP, Osteocalcin and human specific anti-mitochondria antibodies). Micro-CT analysis demonstrated that the cell-seeded biomaterial achieved significantly more bone volume formation at 4 weeks (22.75 ± 2.25 mm3 vs 12.34 ± 2.91 mm3, p = 0.016) and at 8 weeks (64.95 ± 5.41 mm3 vs 42.73 ± 10.58 mm3, p = 0.029), compared to the acellular bone microparticles. Histology confirmed that the cell-seeded biomaterial was almost completely substituted at 8 weeks, in opposition to the acellular biomaterial group. Immunohistochemical analysis showed a significantly higher number of TRAP and Osteocalcin positive cells at 4 weeks in the cell-seeded group compared to the acellular group, thereby demonstrating a higher rate of bone remodeling in the presence of MSCs. The grafted human cells remained viable and were detected up to at least 8 weeks, as observed using the human specific anti-mitochondria antibody. This off-the-shelf material available in unlimited quantities could therefore represent a significant advance in the field of mandibular bone augmentation by providing a larger volume of new bone formation in a shorter time.
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Affiliation(s)
- Daniel Deluiz
- Department of Periodontology, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil. .,Geriatric Research, Education, and Clinical Center, and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA. .,Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Gaëtan J-R Delcroix
- Geriatric Research, Education, and Clinical Center, and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA.,Nova Southeastern University, College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Gianluca D'Ippolito
- Geriatric Research, Education, and Clinical Center, and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA.,Department of Biomedical Engineering, College of Engineering, University of Miami, Miami, FL, USA
| | - Cristina Grau-Monge
- Geriatric Research, Education, and Clinical Center, and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA.,Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrea Bonnin-Marquez
- Geriatric Research, Education, and Clinical Center, and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA
| | - Teresita Reiner
- Geriatric Research, Education, and Clinical Center, and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA
| | - Eduardo M B Tinoco
- Department of Periodontology, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Thaís Amadeu
- Department of Pathology and Laboratories, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Fabio R Pires
- Department of Oral Pathology, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Paul C Schiller
- Geriatric Research, Education, and Clinical Center, and Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA. .,Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, FL, USA. .,Department of Biochemistry & Molecular Biology and Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
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Use of homologous bone for alveolar crest reconstruction in 483 patients with 5 years' outcomes post implantation. Oral Maxillofac Surg 2019. [PMID: 31147787 DOI: 10.1007/s10006-019-00781-2.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical course of bone reconstruction of the alveolar crest using homologous fresh-frozen bone harvested from deceased donors. METHODS A retrospective survey was based on the Castelfranco Veneto Hospital database, in which 3264 clinical records with a primary or secondary diagnosis of alveolar atrophy were collected over a 10-year period. A random sample of 483 patients with at least 5 years' follow-up was included in the survey. Patients were contacted by telephone and administered a questionnaire with specific questions to build a significant sample. RESULTS Of the patients, 449 (93% of the sample) had an uneventful follow-up after surgery and 93.2% received at least one implant, with a mean of 3.4 implants per patient. At the time of the survey, 93% of the patients were wearing a dental prosthesis, 86.9% had not lost any implants, and 6.7% had lost at least one implant, while 6.4% still had implants but presented some clinical problems. Finally, patients were asked to provide an index score (1-10 points) on the therapy as a whole, i.e., bone graft, implants, and prostheses. A score of insufficient (up to 5 points) was given by 5.3% of patients, of sufficient (6 to 7 points) by 6.1%, and of good/very good (over 7) by 88.6%. CONCLUSIONS Homologous bone for alveolar crest reconstruction can be a valid alternative to autologous grafting if specific tissue limitations are considered when planning therapy. Creeping substitution is partial and slower than in autologous grafts, especially in cases where cortical bone is thick or volume graft is very large. The quality of soft tissue coverage and mucosa lining is also important, possibly due to slower tissue revascularization, so future implants should predictably be positioned primarily within the original host bone.
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Procopio O, Trojan D, Frigo AC, Paolin A. Use of homologous bone for alveolar crest reconstruction in 483 patients with 5 years' outcomes post implantation. Oral Maxillofac Surg 2019; 23:353-363. [PMID: 31147787 PMCID: PMC6689316 DOI: 10.1007/s10006-019-00781-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 05/21/2019] [Indexed: 01/28/2023]
Abstract
Purpose The purpose of this study was to evaluate the clinical course of bone reconstruction of the alveolar crest using homologous fresh-frozen bone harvested from deceased donors. Methods A retrospective survey was based on the Castelfranco Veneto Hospital database, in which 3264 clinical records with a primary or secondary diagnosis of alveolar atrophy were collected over a 10-year period. A random sample of 483 patients with at least 5 years’ follow-up was included in the survey. Patients were contacted by telephone and administered a questionnaire with specific questions to build a significant sample. Results Of the patients, 449 (93% of the sample) had an uneventful follow-up after surgery and 93.2% received at least one implant, with a mean of 3.4 implants per patient. At the time of the survey, 93% of the patients were wearing a dental prosthesis, 86.9% had not lost any implants, and 6.7% had lost at least one implant, while 6.4% still had implants but presented some clinical problems. Finally, patients were asked to provide an index score (1–10 points) on the therapy as a whole, i.e., bone graft, implants, and prostheses. A score of insufficient (up to 5 points) was given by 5.3% of patients, of sufficient (6 to 7 points) by 6.1%, and of good/very good (over 7) by 88.6%. Conclusions Homologous bone for alveolar crest reconstruction can be a valid alternative to autologous grafting if specific tissue limitations are considered when planning therapy. Creeping substitution is partial and slower than in autologous grafts, especially in cases where cortical bone is thick or volume graft is very large. The quality of soft tissue coverage and mucosa lining is also important, possibly due to slower tissue revascularization, so future implants should predictably be positioned primarily within the original host bone.
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Affiliation(s)
- Olindo Procopio
- Maxillofacial Surgery Unit, Castelfranco Veneto Hospital, Treviso, Italy
| | - Diletta Trojan
- Treviso Tissue Bank Foundation, Piazzale Ospedale, 1, Treviso, Italy.
| | - Anna Chiara Frigo
- Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy
| | - Adolfo Paolin
- Treviso Tissue Bank Foundation, Piazzale Ospedale, 1, Treviso, Italy
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Abstract
In New Zealand, oncoplastic surgery is common, but partial breast reconstruction presents challenges for radiation therapy targeting. Tissue rearrangement creates ambiguity when targeting the tumor bed, with resultant overestimation of treatment volumes. Thus, adoption of advanced methods of radiation therapy have been hindered. This pilot study describes use of a novel three-dimensional implant that provides a scaffolding for tissue ingrowth during partial breast reconstruction and delineates the tumor bed more precisely to assist radiation planning and mammographic surveillance. After informed consent, 15 women were implanted with the three-dimensional bioabsorbable implant. The device was sutured to the tumor bed during lumpectomy, and tissue flaps were mobilized and attached to the implant. Visualization of the marker and radiation treatment volumes were recorded and compared. The implant provided volume replacement and helped to maintain breast contour. Cosmetic outcomes were excellent; no device- or radiation-related complications occurred. One patient had a postoperative hematoma that resolved after percutaneous drainage; there were no postoperative infections. Three-year follow-up shows no tumor recurrences and no untoward effects. When compared to conventional radiation targeting, use of the implant showed that a greater than 50 percent reduction in treatment volume was possible in some cases. Three-year mammograms show no significant artifact, normal tissue ingrowth, and minimal fibrosis. This study describes a method of oncoplastic breast reconstruction using an implantable device that marks the site of tumor excision and provides for volume replacement with tissue ingrowth. Patients tolerated it well, and radiation therapy planning, positioning, and treatment were facilitated.
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Abstract
Supplemental Digital Content is available in the text. Background: The aim of this study was to evaluate freeze-dried cortical allograft bone for nasal dorsal augmentation. The 42-month report on 18 patients was published in 2009 in Plastic and Reconstructive Surgery with 89 percent success at level II evidence, and this article is the 10-year comprehensive review of 62 patients. Methods: All grafts met standards recommended by the American Association of Tissue Banks, the U.S. Food and Drug Administration, and the Centers for Disease Control and Prevention. Objective evaluation of the persistence of graft volume was obtained by cephalometric radiography, cone beam volumetric computed tomography, and computed tomography at up to 10 years. Vascularization and incorporation of new bone elements within the grafts were demonstrated by fluorine-18 sodium fluoride positron emission tomography at up to 10 years. Subjective estimation of graft volume persisting up to 10 years was obtained by patient response to a query conducted by an independent surveyor. Results: The authors report objective proof of persistence of volume alone or combined with proof of neovascularization in 16 of 19 allografts. The authors report the patient’s subjective opinion of volume persistence in 37 of 43 grafts. The dorsal augmentation was assessed overall to be successful in 85 percent of 62 patients evaluated between 1 and 10 years, with a mean of 4.7 years. Conclusions: Freeze-dried allograft bone is a safe and equal alternative for dorsal augmentation without donor-site morbidity. Further studies are needed to (1) confirm these findings for young patients needing long-term reconstruction, and (2) partially demineralize allograft bone to allow carving with a scalpel. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
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Sheikh Z, Hamdan N, Ikeda Y, Grynpas M, Ganss B, Glogauer M. Natural graft tissues and synthetic biomaterials for periodontal and alveolar bone reconstructive applications: a review. Biomater Res 2017; 21:9. [PMID: 28593053 PMCID: PMC5460509 DOI: 10.1186/s40824-017-0095-5] [Citation(s) in RCA: 186] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 05/16/2017] [Indexed: 12/11/2022] Open
Abstract
Periodontal disease is categorized by the destruction of periodontal tissues. Over the years, there have been several clinical techniques and material options that been investigated for periodontal defect repair/regeneration. The development of improved biomaterials for periodontal tissue engineering has significantly improved the available treatment options and their clinical results. Bone replacement graft materials, barrier membranes, various growth factors and combination of these have been used. The available bone tissue replacement materials commonly used include autografts, allografts, xenografts and alloplasts. These graft materials mostly function as osteogenic, osteoinductive and/or osteoconductive scaffolds. Polymers (natural and synthetic) are more widely used as a barrier material in guided tissue regeneration (GTR) and guided bone regeneration (GBR) applications. They work on the principle of epithelial cell exclusion to allow periodontal ligament and alveolar bone cells to repopulate the defect before the normally faster epithelial cells. However, in an attempt to overcome complications related to the epithelial down-growth and/or collapse of the non-rigid barrier membrane and to maintain space, clinicians commonly use a combination of membranes with hard tissue grafts. This article aims to review various available natural tissues and biomaterial based bone replacement graft and membrane options used in periodontal regeneration applications.
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Affiliation(s)
- Zeeshan Sheikh
- Matrix Dynamics Group, Faculty of Dentistry, University of Toronto, Room 221, 150 College Street, Toronto, ON M5S 3E2 Canada
- Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, 25 Orde St, Toronto, ON M5T 3H7 Canada
| | - Nader Hamdan
- Department of Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, 5981 University Avenue, PO Box 15000, Halifax, Nova Scotia B3H 4R2 Canada
| | - Yuichi Ikeda
- Matrix Dynamics Group, Faculty of Dentistry, University of Toronto, Room 221, 150 College Street, Toronto, ON M5S 3E2 Canada
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-ku, Tokyo, 113-5810 Japan
| | - Marc Grynpas
- Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, 25 Orde St, Toronto, ON M5T 3H7 Canada
| | - Bernhard Ganss
- Matrix Dynamics Group, Faculty of Dentistry, University of Toronto, Room 221, 150 College Street, Toronto, ON M5S 3E2 Canada
| | - Michael Glogauer
- Matrix Dynamics Group, Faculty of Dentistry, University of Toronto, Room 221, 150 College Street, Toronto, ON M5S 3E2 Canada
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Baldan RCF, Coracin FL, Lins L, Mello WR, Santos PS. Atrophic Maxilla Reconstruction With Fresh Frozen Allograft Bone, Titanium Mesh, and Platelet-Rich Fibrin: Case Report. Transplant Proc 2017; 49:893-897. [PMID: 28457420 DOI: 10.1016/j.transproceed.2017.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this article was to report the clinical and radiographic findings about a case of a man affected by severely atrophic maxilla to demonstrate the clinical proceedings associated with alveolar reconstruction destined for dental implant rehabilitation. The 3-dimensional augmentation of the alveolar ridge with the use of fresh-frozen bone graft, platelet-rich fibrin membrane, and titanium mesh suggests potential benefits to the development of the bone formation physiology. The treatment combination may result in an optimal prognosis and represents an option for reconstruction of bone defects. At 8 months after surgery, no evidence of complications was observed; the clinical examination and computerized tomographic scan revealed bone formation and installed implant stability.
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Affiliation(s)
- R C F Baldan
- Dental Commission, Brazilian Association of Organ Transplantation, São Paulo, Brazil.
| | - F L Coracin
- Dental Commission, Brazilian Association of Organ Transplantation, São Paulo, Brazil
| | - L Lins
- Dental Commission, Brazilian Association of Organ Transplantation, São Paulo, Brazil
| | - W R Mello
- Dental Commission, Brazilian Association of Organ Transplantation, São Paulo, Brazil
| | - P S Santos
- Dental Commission, Brazilian Association of Organ Transplantation, São Paulo, Brazil
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Garbin Junior EA, de Lima VN, Momesso GAC, Mello-Neto JM, Érnica NM, Magro Filho O. Potential of autogenous or fresh-frozen allogeneic bone block grafts for bone remodelling: a histological, histometrical, and immunohistochemical analysis in rabbits. Br J Oral Maxillofac Surg 2017; 55:589-593. [PMID: 28404212 DOI: 10.1016/j.bjoms.2017.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 03/12/2017] [Indexed: 12/22/2022]
Abstract
Our aim was to compare the wound healing of autogenous bone grafts with that of fresh-frozen allogeneic block bone in rabbits. We used 25 animals. One was killed before the experiment to provide the allogeneic bone, and the remainder were killed at four time points (n=6 in each group). On histometrical analysis there was a significant difference between the two groups only at 45days and between 15 and 45days in the intergroup analysis. However, there was significantly more revascularisation (p<0.05), resorption (p<0.05), and bony replacement (p<0.05) in the autogenous group in the immunohistochemical analysis. In later periods, the autogenous bone was replaced by newly-formed bone in all samples, whereas it was always possible to find regions of devitalised bone in the fresh-frozen allogeneic bone grafts. Autogenous grafts were completely replaced whereas, in the fresh- frozen allogeneic grafts, we found acellular tissue that had been incorporated into the receptor bed interface during the later evaluation times.
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Affiliation(s)
- E A Garbin Junior
- UNESP-Univ Estadual Paulista, Araçatuba Dental School, Surgery and Integrated Clinic Department, Araçatuba, SP, Brazil
| | - V N de Lima
- UNESP-Univ Estadual Paulista, Araçatuba Dental School, Surgery and Integrated Clinic Department, Araçatuba, SP, Brazil.
| | - G A C Momesso
- UNESP-Univ Estadual Paulista, Araçatuba Dental School, Surgery and Integrated Clinic Department, Araçatuba, SP, Brazil
| | - J M Mello-Neto
- UNESP-Univ Estadual Paulista, Araçatuba Dental School, Surgery and Integrated Clinic Department, Araçatuba, SP, Brazil
| | - N M Érnica
- School of Dentistry, West Parana State University-UNIOESTE, Cascavel, PR, Brazil
| | - O Magro Filho
- UNESP-Univ Estadual Paulista, Araçatuba Dental School, Surgery and Integrated Clinic Department, Araçatuba, SP, Brazil
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Ahmadi RS, Sayar F, Rakhshan V, Iranpour B, Jahanbani J, Toumaj A, Akhoondi N. Clinical and Histomorphometric Assessment of Lateral Alveolar Ridge Augmentation Using a Corticocancellous Freeze-Dried Allograft Bone Block. J ORAL IMPLANTOL 2017; 43:202-210. [PMID: 28326892 DOI: 10.1563/aaid-joi-d-16-00042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Horizontal ridge augmentation with allografts has attracted notable attention because of its proper success rate and the lack of disadvantages of autografts. Corticocancellous block allografts have not been adequately studied in humans. Therefore, this study clinically and histomorphometrically evaluated the increase in ridge width after horizontal ridge augmentation using corticocancellous block allografts as well as implant success after 12 to 18 months after implantation. In 10 patients receiving implants (3 women, 7 men; mean age = 45 years), defective maxillary alveolar ridges were horizontally augmented using freeze-dried bone allograft blocks. Ridge widths were measured before augmentation, immediately after augmentation, and ∼6 months later in the reentry surgery for implantation. This was done at points 2 mm (A) and 5 mm (B) apically to the crest. Biopsy cores were acquired from the implantation site. Implant success was assessed 15.1 ± 2.7 months after implantation (range = 12-18 months). Data were analyzed using Friedman and Dunn tests (α = 0.05). At point A, ridge widths were 2.77 ± 0.37, 8.02 ± 0.87, and 6.40 ± 0.66 mm, respectively, before surgery, immediately after surgery, and before implantation. At point B, ridge widths were 3.40 ± 0.39, 9.35 ± 1.16, and 7.40 ± 1.10 mm, respectively, before surgery, immediately after surgery, and before implantation. The Friedman test showed significant increases in ridge widths, both at point A and point B (both P = .0000). Postaugmentation resorption was about 1.5-2 mm and was statistically significant at points A and B (P < .05, Dunn). The percentage of newly formed bone, residual graft material, and soft tissue were 33.0% ± 11.35% (95% confidence interval [CI] = 24.88%-41.12%), 37.50% ± 19.04% (95% CI = 23.88%-51.12%), and 29.5%, respectively. The inflammation was limited to grades 1 or zero. Twelve to 18 months after implantation, no implants caused pain or showed exudates or pockets. Radiographic bone loss was 2.0 ± 0.7 mm (range = 1-3). It can be concluded that lateral ridge augmentation with corticocancellous allograft blocks might be successful both clinically and histologically. Implants might have a proper clinical success after a minimum of 12 months.
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Affiliation(s)
- Roya Shariatmadar Ahmadi
- 1 Department of Periodontics and Implant Research, Tehran Dental Branch, Islamic Azad University, Tehran, Iran
| | - Ferena Sayar
- 1 Department of Periodontics and Implant Research, Tehran Dental Branch, Islamic Azad University, Tehran, Iran
| | - Vahid Rakhshan
- 2 Department of Dental Anatomy, Dental Faculty, Islamic Azad University, Tehran, Iran
| | - Babak Iranpour
- 1 Department of Periodontics and Implant Research, Tehran Dental Branch, Islamic Azad University, Tehran, Iran
| | - Jahanfar Jahanbani
- 3 Oral Pathology Department, Dental Branch Tehran, Islamic Azad University, Tehran, Iran
| | | | - Nasrin Akhoondi
- 5 Department of Mathematics, South Tehran Branch, Islamic Azad University, Tehran, Iran
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Deluiz D, Oliveira LS, Fletcher P, Pires FR, Tinoco JM, Tinoco EMB. Histologic and Tomographic Findings of Bone Block Allografts in a 4 Years Follow-up: A Case Series. Braz Dent J 2016; 27:775-780. [DOI: 10.1590/0103-6440201601100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/30/2016] [Indexed: 12/26/2022] Open
Abstract
Abstract The aim of this paper is to report histologic and tomographic findings of fresh frozen bone block allografts bearing dental implants in functional occlusion in a long-term follow-up. Four patients with implants functionally loaded for 4 years on augmented ridges requiring additional mucogingival surgery or implant placement were included in this case series. Cone-beam tomography scans were compared volumetrically between the baseline (first implant placement) and current images. Biopsies of the grafts were retrieved and sent to histological analysis. Volumetric reduction of the grafts varied from 2.1 to 7.7%. Histological evaluation demonstrated well-incorporated grafts with different degrees of remodeling. While data presented in this report are from a small sample size and do not allow definitive conclusions, the biopsies of the grafted sites were very similar to the host's native bone. Remodeling of the cortical portion of the allografts seems to take longer than the cancellous portion. The presence of unincorporated graft remains did not impair the implant success or the health of the surrounding tissues. This is the first time histologic and tomographic long term data of bone allograft have been made available in dentistry.
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Affiliation(s)
- Daniel Deluiz
- Universidade do Estado do Rio de Janeiro, Brazil; Pontifícia Universidade Católica, Brazil
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15
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Deluiz D, Oliveira L, Fletcher P, Pires FR, Nunes MA, Tinoco EM. Fresh-Frozen Bone Allografts in Maxillary Alveolar Augmentation: Analysis of Complications, Adverse Outcomes, and Implant Survival. J Periodontol 2016; 87:1261-1267. [DOI: 10.1902/jop.2016.160155] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Deluiz D, Santos Oliveira L, Ramôa Pires F, Reiner T, Armada L, Nunes MA, Muniz Barretto Tinoco E. Incorporation and Remodeling of Bone Block Allografts in the Maxillary Reconstruction: A Randomized Clinical Trial. Clin Implant Dent Relat Res 2016; 19:180-194. [DOI: 10.1111/cid.12441] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/30/2016] [Accepted: 07/11/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Daniel Deluiz
- Postdoctoral researcher, Department of Periodontology; State University of Rio de Janeiro; RJ, Rio de Janeiro Brazil
| | - Luciano Santos Oliveira
- Professor, Department of Implantology; Pontifical Catholic University of Rio de Janeiro; Rio de Janeiro RJ Brazil
| | - Fábio Ramôa Pires
- Professor, Department of Stomatology, Estácio de Sá University; Rio de Janeiro RJ Brazil
| | - Teresita Reiner
- Investigator, Geriatric Research, Education and Clinical Center - Bruce W. Carter Veterans Affairs Medical Center; Miami FL USA
| | - Luciana Armada
- Professor, Department of Endodontics, Estácio de Sá University; Rio de Janeiro RJ Brazil
| | - Marcus A. Nunes
- Professor, Department of Statistics, Federal University of Rio Grande do Norte; Natal RN Brazil
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Troeltzsch M, Troeltzsch M, Kauffmann P, Gruber R, Brockmeyer P, Moser N, Rau A, Schliephake H. Clinical efficacy of grafting materials in alveolar ridge augmentation: A systematic review. J Craniomaxillofac Surg 2016; 44:1618-1629. [PMID: 27622971 DOI: 10.1016/j.jcms.2016.07.028] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/22/2016] [Accepted: 07/29/2016] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To evaluate the efficacy of grafting materials in lateral and vertical ridge augmentations. MATERIALS AND METHODS A systematic review of the literature on the clinical use of grafting materials of the years 1995 to April 2015 was conducted using electronic search of PubMed and Cochrane libraries and hand search of eight print journals. A total of 184 papers were included, comprising 6182 patients. Parameters evaluated were observation period [months], bone formation [histologic area%], defect fill [%], horizontal and vertical gain [mm], loss of augmented volume [mm], complication rate [%], and implant survival rate [%]. Results are expressed as weighted means ± SD. RESULTS Results were obtained after a weighted mean observation period of 27.4 months (range 3-168 months). Bone formation in the augmented areas varied from 33.2 ± 14.9% for allogeneic grafts to 56.0 ± 25.6% for mixtures of autogenous and other grafting materials. Defect fill in dehiscence defects ranged from 51.0 ± 13.6% (synthetic) to 85.8 ± 13.4% (xenogeneic) for the different materials, with an overall weighted mean of 79.8 ± 18.7%. Weighted mean horizontal gain for all particulate grafting materials was 3.7 ± 1.2 mm, with variation between 2.2 ± 1.2 mm (synthetic) and 4.5 ± 1.0 mm (mixtures of autogenous bone with allogeneic/xenogeneic grafting material) without statistical significance. Weighted overall mean vertical gain was 3.7 ± 1.4 mm. Vertical gain was substantially higher when space-making barrier materials such as titanium meshes were used; however this was also associated with strong increase in complication rate. Block grafts achieved higher horizontal gain by approximately 1 mm. The use of block grafts achieved significantly increased vertical gain compared to particulate material only when autogenous block grafts from extraoral donor sites were used. CONCLUSION Horizontal and vertical gain by 3.7 mm on average can be achieved using particulate materials. This can be increased by using titanium meshes. Substantial vertical gains beyond this dimension require the use of extraoral bone block grafts.
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Affiliation(s)
- Markus Troeltzsch
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany.
| | - Matthias Troeltzsch
- Department of Maxillofacial Surgery, Ludwig - Maximilians - University of Munich, Germany
| | - Philipp Kauffmann
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
| | - Rudolph Gruber
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
| | - Phillipp Brockmeyer
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
| | - Norman Moser
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
| | - Anna Rau
- Department of Anesthesiology, University of Goettingen, Germany
| | - Henning Schliephake
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
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Draenert FG, Kämmerer PW, Berthold M, Neff A. Complications with allogeneic, cancellous bone blocks in vertical alveolar ridge augmentation: prospective clinical case study and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:e31-43. [DOI: 10.1016/j.oooo.2016.02.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/25/2016] [Indexed: 12/31/2022]
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de Lacerda PE, Pelegrine AA, Teixeira ML, Montalli VAM, Rodrigues H, Napimoga MH. Homologous transplantation with fresh frozen bone for dental implant placement can induce HLA sensitization: a preliminary study. Cell Tissue Bank 2016; 17:465-72. [DOI: 10.1007/s10561-016-9562-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 04/29/2016] [Indexed: 10/21/2022]
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Maxillary sinus grafting with fresh frozen allograft versus bovine bone mineral: A tomographic and histological study. J Craniomaxillofac Surg 2016; 44:708-14. [PMID: 27107475 DOI: 10.1016/j.jcms.2016.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 02/22/2016] [Accepted: 03/14/2016] [Indexed: 01/10/2023] Open
Abstract
We evaluated histologically and tomographically the effects of fresh frozen bone allograft (FFB) or bovine bone mineral (BBM) in maxillary sinus floor augmentations. In total, 30 maxillary sinuses from 30 patients (mean age = 51.17 ± 10.86 years) underwent sinus augmentation. Patients were divided in two test groups (15 sinuses each). The first group was grafted with allograft bone, and the second group received bovine bone mineral. After 6 months, bone samples from each group were collected for histological examination. Implant survival rates were 97.78% (FFB group) and 100% (BBM group) 6 months after functional loading. Median volumetric reductions of 31.2% (11.33-40.56) and 12.22% (9.91-20.59) were observed in the FFB and BBM groups, respectively. Comparisons between the groups for differences in initial and final volumes of bone (p = 0.015) and the rate of resorption (p = 0.009) showed statistically significant differences. The FFB group showed osteoblastic cells in close contact with osteoid matrix, connected through bridges between allograft bone particles and new bone formation. The BBM group showed BBM particles in close contact with new bone, with visible osteoid matrix bridges and osteoblastic cells surrounding it. None showed signs of acute or chronic inflammatory infiltrate. Despite better results with BBM, both FFB and BBM in maxillary sinus augmentation resulted in high percentages of new bone formation, and allowed implant placement with a low rate of failure of osseointegration at a 6-month follow-up.
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21
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Rodella LF, Cocchi MA, Rezzani R, Procacci P, Hirtler L, Nocini P, Albanese M. Fresh frozen bone in oral and maxillofacial surgery. J Dent Sci 2015. [DOI: 10.1016/j.jds.2014.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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22
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Sheikh Z, Sima C, Glogauer M. Bone Replacement Materials and Techniques Used for Achieving Vertical Alveolar Bone Augmentation. MATERIALS 2015. [PMCID: PMC5455762 DOI: 10.3390/ma8062953] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Alveolar bone augmentation in vertical dimension remains the holy grail of periodontal tissue engineering. Successful dental implant placement for restoration of edentulous sites depends on the quality and quantity of alveolar bone available in all spatial dimensions. There are several surgical techniques used alone or in combination with natural or synthetic graft materials to achieve vertical alveolar bone augmentation. While continuously improving surgical techniques combined with the use of auto- or allografts provide the most predictable clinical outcomes, their success often depends on the status of recipient tissues. The morbidity associated with donor sites for auto-grafts makes these techniques less appealing to both patients and clinicians. New developments in material sciences offer a range of synthetic replacements for natural grafts to address the shortcoming of a second surgical site and relatively high resorption rates. This narrative review focuses on existing techniques, natural tissues and synthetic biomaterials commonly used to achieve vertical bone height gain in order to successfully restore edentulous ridges with implant-supported prostheses.
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Affiliation(s)
- Zeeshan Sheikh
- Matrix Dynamics Group, Faculty of Dentistry, University of Toronto, Room 221, Fitzgerald Building, 150 College Street, Toronto, ON M5S 3E2, Canada; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-514-224-7490
| | - Corneliu Sima
- Department of Applied Oral Sciences, The Forsyth Institute, 245 First Street, Cambridge, MA 02142, USA; E-Mail:
| | - Michael Glogauer
- Matrix Dynamics Group, Faculty of Dentistry, University of Toronto, Room 221, Fitzgerald Building, 150 College Street, Toronto, ON M5S 3E2, Canada; E-Mail:
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23
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Sawada K, Caballé-Serrano J, Schuldt Filho G, Bosshardt DD, Schaller B, Buser D, Gruber R. Thermal processing of bone: in vitro response of mesenchymal cells to bone-conditioned medium. Int J Oral Maxillofac Surg 2015; 44:1060-6. [PMID: 25868709 DOI: 10.1016/j.ijom.2015.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 12/20/2014] [Accepted: 03/17/2015] [Indexed: 11/25/2022]
Abstract
The autoclaving, pasteurization, and freezing of bone grafts to remove bacteria and viruses, and for preservation, respectively, is considered to alter biological properties during graft consolidation. Fresh bone grafts release paracrine-like signals that are considered to support tissue regeneration. However, the impact of the autoclaving, pasteurization, and freezing of bone grafts on paracrine signals remains unknown. Therefore, conditioned medium was prepared from porcine cortical bone chips that had undergone thermal processing. The biological properties of the bone-conditioned medium were assessed by examining the changes in expression of target genes in oral fibroblasts. The data showed that conditioned medium obtained from bone chips that had undergone pasteurization and freezing changed the expression of adrenomedullin, pentraxin 3, BTB/POZ domain-containing protein 11, interleukin 11, NADPH oxidase 4, and proteoglycan 4 by at least five-fold in oral fibroblasts. Bone-conditioned medium obtained from autoclaved bone chips, however, failed to change the expression of the respective genes. Also, when bone-conditioned medium was prepared from fresh bone chips, autoclaving blocked the capacity of bone-conditioned medium to modulate gene expression. These in vitro results suggest that pasteurization and freezing of bone grafts preserve the release of biologically active paracrine signals, but autoclaving does not.
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Affiliation(s)
- K Sawada
- Department of Cranio-maxillofacial Surgery, Inselspital, University of Bern, Bern, Switzerland; Laboratory of Oral Cell Biology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - J Caballé-Serrano
- Laboratory of Oral Cell Biology, School of Dental Medicine, University of Bern, Bern, Switzerland; Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland; Department of Oral and Maxillofacial Surgery, College of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
| | - G Schuldt Filho
- Laboratory of Oral Cell Biology, School of Dental Medicine, University of Bern, Bern, Switzerland; Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland; Department of Implant Dentistry, Federal University of Santa Catarina, Florianopolis, Brazil
| | - D D Bosshardt
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland; Robert K. Schenk Laboratory of Oral Histology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - B Schaller
- Department of Cranio-maxillofacial Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - D Buser
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - R Gruber
- Laboratory of Oral Cell Biology, School of Dental Medicine, University of Bern, Bern, Switzerland; Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland; Department of Oral Biology, Medical University of Vienna, Vienna, Austria.
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Pasquali PJ, Teixeira ML, de Oliveira TA, de Macedo LGS, Aloise AC, Pelegrine AA. Maxillary Sinus Augmentation Combining Bio-Oss with the Bone Marrow Aspirate Concentrate: A Histomorphometric Study in Humans. Int J Biomater 2015; 2015:121286. [PMID: 26543482 PMCID: PMC4620258 DOI: 10.1155/2015/121286] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 09/03/2015] [Accepted: 09/27/2015] [Indexed: 01/13/2023] Open
Abstract
Purpose. To investigate the regenerative results obtained with the association of bone marrow aspirate concentrate using the Bone Marrow Aspirate Concentrate (BMAC) method to a xenogeneic bone graft (Bio-Oss) in sinus floor elevation. Materials and Methods. Using a randomized controlled study design in eight consecutive patients (age of 55.4 ± 9.2 years), 16 sinus floor lift procedures were performed with Bio-Oss alone (control group, CG, n = 8) or combined with bone marrow aspirate concentrate obtained via the BMAC method (test group, TG, n = 8). Six months after the grafting procedures, bone biopsies were harvested during implant placement and were analyzed by histomorphometry. Results. Histomorphometric analysis revealed a significantly higher amount (p < 0.05) of vital mineralized tissue in TG when compared to the CG (55.15 ± 20.91% and 27.30 ± 5.55%, resp.). For nonvital mineralized tissue, TG presented a statistically higher level of Bio-Oss resorption (p < 0.05) when compared with the CG (6.32 ± 12.03% and 22.79 ± 9.60%, resp.). Both groups (TG and CG) showed no significantly different levels (p > 0.05) of nonmineralized tissue (38.53 ± 13.08% and 49.90 ± 7.64%, resp.). Conclusion. The use of bone marrow concentrate obtained by BMAC method increased bone formation in sinus lift procedures.
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Affiliation(s)
- Paulo José Pasquali
- 1Department of Implant Dentistry, São Leopoldo Mandic Dental School, 13 José Rocha Junqueira Street, 13045-755 Campinas, Brazil
| | - Marcelo Lucchesi Teixeira
- 2Department of Prosthodontics, São Leopoldo Mandic Dental School, 13 José Rocha Junqueira Street, 13045-755 Campinas, Brazil
| | - Thiago Altro de Oliveira
- 1Department of Implant Dentistry, São Leopoldo Mandic Dental School, 13 José Rocha Junqueira Street, 13045-755 Campinas, Brazil
| | | | - Antonio Carlos Aloise
- 1Department of Implant Dentistry, São Leopoldo Mandic Dental School, 13 José Rocha Junqueira Street, 13045-755 Campinas, Brazil
| | - André Antonio Pelegrine
- 1Department of Implant Dentistry, São Leopoldo Mandic Dental School, 13 José Rocha Junqueira Street, 13045-755 Campinas, Brazil
- *André Antonio Pelegrine:
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Pereira E, Messias A, Dias R, Judas F, Salvoni A, Guerra F. Horizontal Resorption of Fresh-Frozen Corticocancellous Bone Blocks in the Reconstruction of the Atrophic Maxilla at 5 Months. Clin Implant Dent Relat Res 2014; 17 Suppl 2:e444-58. [PMID: 25346211 PMCID: PMC4616242 DOI: 10.1111/cid.12268] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Reliable implant-supported rehabilitation of an alveolar ridge needs sufficient volume of bone. In order to achieve a prosthetic-driven positioning, bone graft techniques may be required. Purpose This prospective cohort study aims to clinically evaluate the amount of resorption of corticocancellous fresh-frozen allografts bone blocks used in the reconstruction of the severe atrophic maxilla. Materials and Methods Twenty-two partial and totally edentulous patients underwent bone augmentation procedures with fresh-frozen allogenous blocks from the iliac crest under local anesthesia. Implants were inserted into the grafted sites after a healing period of 5 months. Final fixed prosthesis was delivered ± 4 months later. Ridge width analysis and measurements were performed with a caliper before and after grafting and at implant insertion. Bone biopsies were performed in 16 patients. Results A total of 98 onlay block allografts were used in 22 patients with an initial mean alveolar ridge width of 3.41 ± 1.36 mm. Early exposure of blocks was observed in four situations and one of these completely resorbed. Mean horizontal bone gain was 3.63 ± 1.28 mm (p < .01). Mean buccal bone resorption between allograph placement and the reopening stage was 0.49 ± 0.54 mm, meaning approximately 7.1% (95% confidence interval: [5.6%, 8.6%]) of total ridge width loss during the integration period. One hundred thirty dental implants were placed with good primary stability (≥ 30 Ncm). Four implants presented early failure before the prosthetic delivery (96.7% implant survival). All patients were successfully rehabilitated. Histomorphometric analysis revealed 20.9 ± 5.8% of vital bone in close contact to the remaining grafted bone. A positive strong correlation (adjusted R2 = 0.44, p = .003) was found between healing time and vital bone percentage. Conclusions Augmentation procedures performed using fresh-frozen allografts from the iliac crest are a suitable alternative in the reconstruction of the atrophic maxilla with low resorption rate at 5 months, allowing proper stability of dental implants followed by fixed prosthetic rehabilitation.
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Affiliation(s)
- Eugénio Pereira
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Ana Messias
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Ricardo Dias
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Fernando Judas
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Alexander Salvoni
- Faculty of Odontology and Medicine, São Leopoldo Mandic, Campinas, Brazil
| | - Fernando Guerra
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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On the feasibility of utilizing allogeneic bone blocks for atrophic maxillary augmentation. BIOMED RESEARCH INTERNATIONAL 2014; 2014:814578. [PMID: 25535616 PMCID: PMC4177739 DOI: 10.1155/2014/814578] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/02/2014] [Indexed: 01/11/2023]
Abstract
Purpose. This systematic review was aimed at assessing the feasibility by means of survival rate, histologic analysis, and causes of failure of allogeneic block grafts for augmenting the atrophic maxilla. Material and Methods. A literature search was conducted by one reviewer in several databases. Articles were included in this systematic review if they were human clinical trials in which outcomes of allogeneic bone block grafts were studied by means of survival rate. In addition other factors were extracted in order to assess their influence upon graft failure. Results. Fifteen articles fulfilled the inclusion criteria and subsequently were analyzed in this systematic review. A total of 361 block grafts could be followed 4 to 9 months after the surgery, of which 9 (2.4%) failed within 1 month to 2 months after the surgery. Additionally, a weighed mean 4.79 mm (95% CI: 4.51–5.08) horizontal bone gain was computed from 119 grafted sites in 5 studies. Regarding implant cumulative survival rate, the weighed mean was 96.9% (95% CI: 92.8–98.7%), computed from 228 implants over a mean follow-up period of 23.9 months. Histologic analysis showed that allogeneic block grafts behave differently in the early stages of healing when compared to autogenous block grafts. Conclusion. Atrophied maxillary reconstruction with allogeneic bone block grafts represents a reliable option as shown by low block graft failure rate, minimal resorption, and high implant survival rate.
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Block allograft for reconstruction of alveolar bone ridge in implantology: a systematic review. IMPLANT DENT 2014; 22:304-8. [PMID: 23680976 DOI: 10.1097/id.0b013e318289e311] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to evaluate the literature regarding clinical efficacy and predictability of block allograft for restoration of vertical and/or horizontal bone defects. MATERIALS AND METHODS A literature search was conducted in PubMed/MEDLINE and Cochrane databases about studies reporting the use of block allografts. The review included studies published in English from 1960 to 2011 and excluded single-case reports and articles that did not use block allograft stabilized by fixation screws. RESULTS The search revealed 567 articles, but only 14 were included, which were conducted in humans with a total of 194 patients treated with block allografts, totalizing 253 blocks. CONCLUSIONS Although a high success rate has been reported for the bone allograft survival, this systematic review demonstrated low level of scientific evidence articles with short follow-up time and diversified methodology with difficult possibilities to compare their results.
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Xavier SP, Dias RR, Sehn FP, Kahn A, Chaushu L, Chaushu G. Maxillary sinus grafting with autograft vs. fresh frozen allograft: a split-mouth histomorphometric study. Clin Oral Implants Res 2014; 26:1080-5. [PMID: 24734909 DOI: 10.1111/clr.12404] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Surgical techniques as sinus floor augmentation have made it possible to increase the bone volume of the posterior maxilla so that implant placement may be feasible. A large variety of bone grafting materials have been utilized for sinus floor augmentation. A good alternative is allograft. Fresh frozen bone is harvested from live or cadaveric donors and then immediately frozen and stored at -80 °C. To date, studies about the effect of fresh frozen bone are scarce. OBJECTIVE Evaluation of new bone formation, following maxillary sinus grafting with autograft vs. fresh frozen allograft. MATERIALS AND METHODS A split-mouth edentulous design including 15 patients was used. Sinus floor augmentation was carried out using either autogenous bone harvested from the ramus area or fresh frozen bone from allogeneic femoral heads. The choice was determined randomly, using a randomized table. The grafted sinus was left to heal for 6 months. Biopsies were harvested from the lateral wall. The biopsies were used for bone histology and histomorphometric analysis. After collection of the biopsy, dental implants were placed. After a healing period of 6 months, the implants were loaded. RESULTS Implant survival, histology, and histomorphometry of sinuses grafted with autogenous or fresh frozen bone were similar. The new bone formation took place predominantly around and in-between particles. CONCLUSIONS The findings of the present study support the use of fresh frozen bone allografts for sinus floor augmentation.
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Affiliation(s)
- Samuel P Xavier
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Rafael R Dias
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Felipe P Sehn
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Adrian Kahn
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Tel Aviv University, Tel Aviv, Israel
| | - Liat Chaushu
- Department of Oral Biology, School of Dentistry, Tel Aviv University, Tel Aviv, Israel
| | - Gavriel Chaushu
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Tel Aviv University, Tel Aviv, Israel.,Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Petah Tikva, Israel
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Ribeiro CG, Bittencourt TC, Ferreira CF, Assis NMSP. An Alternative Approach for Augmenting the Anterior Maxilla Using Autogenous Free Gingival Bone Graft for Implant Retained Prosthesis. J ORAL IMPLANTOL 2014; 40:183-7. [DOI: 10.1563/aaid-joi-d-12-00016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Numerous factors may keep surgeons from placing implants in the anterior maxilla in order to avoid suboptimal restorative outcomes. This paper describes a technique of an autogenous-free gingival−bone block graft, which allows bone and gingival augmentation and a primary seal to be achieved simultaneously. Additionally, it describes a technique for achieving primary soft tissue closure of maxillary extraction sockets using a rotated pedicle palatal connective tissue flap.
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Affiliation(s)
| | | | - Cimara Fortes Ferreira
- Department of Periodontology, University of Tennessee School of Dentistry, Memphis, TN, USA
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Chiapasco M, Di Martino G, Anello T, Zaniboni M, Romeo E. Fresh Frozen versus Autogenous Iliac Bone for the Rehabilitation of the Extremely Atrophic Maxilla with Onlay Grafts and Endosseous Implants: Preliminary Results of a Prospective Comparative Study. Clin Implant Dent Relat Res 2013; 17 Suppl 1:e251-66. [DOI: 10.1111/cid.12191] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Matteo Chiapasco
- Unit of Oral Surgery; Department of Health Sciences; San Paolo Hospital; University of Milan; Milan Italy
| | - Giuseppe Di Martino
- Unit of Oral Surgery; Department of Health Sciences; San Paolo Hospital; University of Milan; Milan Italy
| | - Tommaso Anello
- Unit of Oral Surgery; Department of Health Sciences; San Paolo Hospital; University of Milan; Milan Italy
| | - Marco Zaniboni
- Unit of Oral Surgery; Department of Health Sciences; San Paolo Hospital; University of Milan; Milan Italy
| | - Eugenio Romeo
- Unit of Prosthetics; Department of Health Sciences; San Paolo Hospital; University of Milan; Milan Italy
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31
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Deluiz D, Oliveira LS, Pires FR, Tinoco EMB. Time-dependent changes in fresh-frozen bone block grafts: tomographic, histologic, and histomorphometric findings. Clin Implant Dent Relat Res 2013; 17:296-306. [PMID: 23837530 DOI: 10.1111/cid.12108] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bone allografts have shown satisfactory clinical results in alveolar ridge reconstructions. However, the process of incorporation and the resorption rates of these grafts are not yet fully understood. PURPOSE The aim of this study was to use computed tomography (CT), histology, and histomorphometry to assess the time-dependent rates of resorption and incorporation of fresh-frozen bone allografts. MATERIALS AND METHODS Twenty-four patients underwent alveolar ridge reconstruction with bone block allografts and were randomly allocated to three groups with different graft healing periods (4, 6, or 8 months) before implant placement. To assess the resorption rates, CT scans were acquired within 7 days after bone graft surgery and at the end of the period. Graft samples were collected and sent for histological and histomorphometric analyses. RESULTS The graft resorption mean rates were 50.78% ± 10.43, 32.77% ± 7.84, and 13.02% ± 3.86 for the 4-, 6-, and 8-month groups, respectively, and were significantly different among the three groups. Newly formed bone with osteocytes near the grafted bone was observed in all three groups. The number of osteocytes was significantly lower at 4 months. Grafted bone remains were significantly higher in the shortest period of time. All of the grafts showed large amounts of calcified tissue. CONCLUSIONS All three groups showed new bone formation and different bone resorption rates. Graft healing periods of 4 months showed less graft resorption and seemed to be the most favorable for implant placement. Healing periods of 8 months showed the largest rate of graft resorption, which could render the grafts unfavorable for implant placement.
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Affiliation(s)
- Daniel Deluiz
- Department of Periodontology, UERJ - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Mangano F, Macchi A, Shibli JA, Luongo G, Iezzi G, Piattelli A, Caprioglio A, Mangano C. Maxillary ridge augmentation with custom-made CAD/CAM scaffolds. A 1-year prospective study on 10 patients. J ORAL IMPLANTOL 2013; 40:561-9. [PMID: 23343341 DOI: 10.1563/aaid-joi-d-12-00122] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Several procedures have been proposed to achieve maxillary ridge augmentation. These require bone replacement materials to be manually cut, shaped, and formed at the time of implantation, resulting in an expensive and time-consuming process. In the present study, we describe a technique for the design and fabrication of custom-made scaffolds for maxillary ridge augmentation, using three-dimensional computerized tomography (3D CT) and computer-aided design/computer-aided manufacturing (CAD/CAM). CT images of the atrophic maxillary ridge of 10 patients were acquired and modified into 3D reconstruction models. These models were transferred as stereolithographic files to a CAD program, where a virtual 3D reconstruction of the alveolar ridge was generated, producing anatomically shaped, custom-made scaffolds. CAM software generated a set of tool-paths for manufacture by a computer-numerical-control milling machine into the exact shape of the reconstruction, starting from porous hydroxyapatite blocks. The custom-made scaffolds were of satisfactory size, shape, and appearance; they matched the defect area, suited the surgeon's requirements, and were easily implanted during surgery. This helped reduce the time for surgery and contributed to the good healing of the defects.
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Buffoli B, Boninsegna R, Rezzani R, Poli PP, Santoro F, Rodella LF. Histomorphometrical evaluation of fresh frozen bone allografts for alveolar bone reconstruction: preliminary cases comparing femoral head with iliac crest grafts. Clin Implant Dent Relat Res 2013; 15:791-8. [PMID: 23294489 DOI: 10.1111/cid.12028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE In the past few years, the use of fresh frozen bone (FFB) grafts has significantly increased. The aim of this study was to evaluate the reconstruction of alveolar bone using femoral head and iliac crest FFB grafts. MATERIALS AND METHODS The study included 10 patients who need endosseous implant insertion in severe atrophic maxillae. The patients were treated with FFB grafts collected from the femoral head or iliac crest. Bone regeneration was evaluated 6 months after surgery by macroscopic and microscopic analyses. RESULTS Our results showed good regenerative capacity, both with the FFB from the femoral head and iliac crest. In particular, similar percentages of new-bone formation and graft residual were observed, whereas differences between the percentage of total bone (higher for the iliac crest) and the percentage of non-mineralized tissue (higher for the femoral head) were present. A significantly higher percentage of CD34-positive vessels in the FFB allograft from the femoral head than in the iliac crest were observed. CONCLUSIONS These findings suggest that FFB allografts could represent a reliable option in oral and maxillofacial surgery. Nevertheless, differences between the use of femoral head or iliac crest bone allografts linked with their different structures should be considered for a more effective surgery.
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Affiliation(s)
- Barbara Buffoli
- Human Anatomy, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Messora MR, Nagata MJH, Pola NM, de Campos N, Fucini SE, Furlaneto FAC. Effect of platelet-rich plasma on bone healing of fresh frozen bone allograft in mandibular defects: a histomorphometric study in dogs. Clin Oral Implants Res 2012; 24:1347-53. [DOI: 10.1111/clr.12008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Michel R. Messora
- Department of Surgery and Bucco-Maxillofacial Traumatology and Periodontology; Ribeirao Preto School of Dentistry; University of Sao Paulo - USP; Ribeirão Preto SP Brazil
| | - Maria J. H. Nagata
- Division of Periodontics; Department of Surgery and Integrated Clinic; Dental School of Araçatuba; UNESP - Univ. Estadual Paulista; Araçatuba SP Brazil
| | - Natália M. Pola
- Division of Periodontics; Department of Surgery and Integrated Clinic; Dental School of Araçatuba; UNESP - Univ. Estadual Paulista; Araçatuba SP Brazil
| | - Natália de Campos
- Division of Periodontics; Department of Surgery and Integrated Clinic; Dental School of Araçatuba; UNESP - Univ. Estadual Paulista; Araçatuba SP Brazil
| | - Stephen E. Fucini
- Division of Periodontics; Department of Surgery and Integrated Clinic; Dental School of Araçatuba; UNESP - Univ. Estadual Paulista; Araçatuba SP Brazil
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35
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Fraguas E, Ribeiro M, Croci A, Santos L, Pallos D, Sendyk W. Stability of implants placed simultaneously or in a delayed manner on fresh frozen onlay allografts in rabbits. Clin Oral Implants Res 2012; 24:1295-9. [PMID: 22905701 DOI: 10.1111/j.1600-0501.2012.02572.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2012] [Indexed: 12/01/2022]
Affiliation(s)
| | - Marna Ribeiro
- Department of Peridontics and Implantology; UNISA; São Paulo Brazil
| | - Alberto Croci
- Hospital das Clínicas of the School of Medicine of the University of São Paulo; Tissue Bank Medical Director; São Paulo Brazil
| | - Luiz Santos
- Institute of Orthopedics and Traumatology; Hospital das Clínicas of the School of Medicine; University of São Paulo; São Paulo Brazil
| | - Débora Pallos
- Department of Peridontics and Implantology; UNISA; São Paulo Brazil
| | - Wilson Sendyk
- Department of Peridontics and Implantology; UNISA; São Paulo Brazil
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36
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Fresh-Frozen Bone Blocks for Horizontal Ridge Augmentation in the Upper Maxilla: 6-Month Outcomes of a Randomized Controlled Trial. Clin Implant Dent Relat Res 2012; 16:116-23. [DOI: 10.1111/j.1708-8208.2012.00458.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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