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Déchelette C, Smirani R, Médina C, Naveau A. Cellularized Biomaterials Used as Gingival Connective Tissue Substitutes In Vivo: A Systematic Review. TISSUE ENGINEERING. PART B, REVIEWS 2024. [PMID: 38756084 DOI: 10.1089/ten.teb.2024.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Developing an in vitro model of gingival connective tissue that mimics the original structure and composition of gingiva for clinical grafting is relevant for personalized treatment of missing gingiva. Using tissue engineering techniques allows bypassing limitations encountered with existing solutions to increase oral soft tissue volume. This review aims to systematically analyze the different currently existing cellularized materials and technologies used to engineer gingival substitutes for in vivo applications. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. An electronic search on PubMed, Scopus, Web of Science, and Cochrane Library databases was conducted to identify suitable studies. In vivo studies about gingival substitutes and grafts containing oral cells compared with a control to investigate the graft remodeling were included. Risk of bias in the included studies was assessed using the Systematic Review Center for Laboratory animal Experimentation (SYRCLE) 10-item checklist. Out of 631 screened studies, 19 were included. Animal models were mostly rodents, and the most used implantation was subcutaneous. According to the SYRCLE tool, low-to-unclear risk of bias was prevalent. Studies checked vascularization and extracellular remodeling up to 60 days after implantation of the cellularized biomaterial. Cells used were mostly fibroblasts and stem cells from oral origin. Grafts presenting vascularization potential after implantation were produced by tissue engineering technologies including cell seeding or embedding for 14, cell sheets for 2, microsphere for 1, and extrusion 3D bioprinting for 2. Components used to build the scaffold containing the cells are all naturally derived and are mainly fibrin, gelatin, collagen, agarose, alginate, fibroin, guar gum, hyaluronic acid, and decellularized extracellular matrix. The most recurring crosslinking method was using chemicals. All studies except one reported vascularization of the graft after implantation, and some detailed extracellular matrix remodeling. Current solutions are not efficient enough. By assessing the relevant studies on the subject, this systematic review showed that a diversity of cellularized biomaterials substituting gingival connective tissue enables vascularization and extracellular remodeling. Taking the results of this review into account could help improve current bio-inks used in 3D bioprinting for in vivo applications compensating for gingival loss.
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Affiliation(s)
| | - Rawen Smirani
- INSERM BioTis Laboratory, University of Bordeaux, Bordeaux, France
| | - Chantal Médina
- INSERM BioTis Laboratory and ART BioPrint, University of Bordeaux, Bordeaux, France
| | - Adrien Naveau
- INSERM BioTis Laboratory, University of Bordeaux, Bordeaux, France
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Sallum EA, Ribeiro FV, Ruiz KS, Sallum AW. Experimental and clinical studies on regenerative periodontal therapy. Periodontol 2000 2019; 79:22-55. [PMID: 30892759 DOI: 10.1111/prd.12246] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The recognition of a periodontal therapy as a regenerative procedure requires the demonstration of new cementum, periodontal ligament, and bone coronal to the base of the defect. A diversity of regenerative strategies has been evaluated, including root surface conditioning, bone grafts and bone substitute materials, guided tissue regeneration, enamel matrix proteins, growth/differentiation factors, combined therapies and, more recently, tissue-engineering approaches. The aim of this chapter of Periodontology 2000 is to review the research carried out in Latin America in the field of periodontal regeneration, focusing mainly on studies using preclinical models (animal models) and randomized controlled clinical trials. This review may help clinicians and researchers to evaluate the current status of the therapies available and to discuss the challenges that must be faced in order to achieve predictable periodontal regeneration in clinical practice.
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Affiliation(s)
- Enilson A Sallum
- Division of Periodontics, Department of Prosthodontics and Periodontics, School of Dentistry, State University of Campinas - UNICAMP, Piracicaba, São Paulo, Brazil
| | - Fernanda V Ribeiro
- Dental Research Division, School of Dentistry, Paulista University, São Paulo, São Paulo, Brazil
| | - Karina S Ruiz
- Division of Periodontics, Department of Prosthodontics and Periodontics, School of Dentistry, State University of Campinas - UNICAMP, Piracicaba, São Paulo, Brazil
| | - Antonio W Sallum
- Division of Periodontics, Department of Prosthodontics and Periodontics, School of Dentistry, State University of Campinas - UNICAMP, Piracicaba, São Paulo, Brazil
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Novaes AB, Palioto DB. Experimental and clinical studies on plastic periodontal procedures. Periodontol 2000 2019; 79:56-80. [PMID: 30892770 DOI: 10.1111/prd.12247] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We have compiled, in this Periodontology 2000 review, all Latin American literature on experimental and clinical studies of periodontal plastic procedures. The body of literature on this subject has led to a discussion of the features and treatment outcomes of root-coverage procedures. Over time, knowledge on periodontal plastic procedures has become less empirical and more supportive of the clinical management of recession-type defects. Gingival recession etiology, animal studies, free gingival grafts, pedicle flaps (semilunar, laterally positioned, and coronally positioned), and subepithelial connective tissue grafts are extensively reviewed. The use of allografts as an alternative to subepithelial connective tissue grafts, the treatment of multiple gingival recessions, and the rationale for use of guided tissue regeneration and enamel matrix derivative in plastic periodontal procedure is discussed. We also assess how smoking can affect the treatment outcomes in plastic surgery procedures. Minimally invasive procedures are of great value in improving the features of the final tissues. The following aspects identified in this compilation were of great interest: (a) some factors, anatomical in nature, favor the formation of root recessions, but it is the inflammatory process (caused by the presence of biofilm and/or by traumatic toothbrushing) that is responsible for the development of root recessions; and (b) pedicle flap procedures (especially the coronally positioned flap) are extremely versatile and have the most predictable outcome of all root-coverage procedures, especially when combined with subepithelial connective tissue grafting and/or allogeneic grafts. In summary: subepithelial connective tissue grafting is considered as the first option to augment gingival width and thickness, and it may provide better long-term results; the same principles of root-coverage procedures in individual sites appear be used in clinical practice also for multiple-recession type defects; an allograft is an efficient alternative to a subepithelial connective tissue graft and, when it is the treatment option of choice, the use of wide, extended flaps should be considered; because of the superiority of plastic periodontal procedures over guided tissue regeneration and the technical difficulty of the latter, guided tissue regeneration has become obsolete for root-coverage procedures; there is rather a large body of evidence attesting that smoking negatively influences root-coverage procedures, especially subepithelial connective tissue grafts; and minimally invasive techniques may be of great value for improving the results obtained with plastic periodontal procedures, but these techniques need to be better addressed in clinical trials, both in terms of the quality and quantity of the new tissue generated.
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Affiliation(s)
- Arthur Belém Novaes
- Department of Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Daniela Bazan Palioto
- Department of Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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McGuire MK, Tavelli L, Feinberg SE, Rasperini G, Zucchelli G, Wang HL, Giannobile WV. Living cell-based regenerative medicine technologies for periodontal soft tissue augmentation. J Periodontol 2019; 91:155-164. [PMID: 31465117 DOI: 10.1002/jper.19-0353] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/27/2019] [Accepted: 08/10/2019] [Indexed: 11/12/2022]
Abstract
The cultivation of human living cells into scaffolding matrices has progressively gained popularity in the field of periodontal wound healing and regeneration. Living cellular constructs based on fibroblasts, keratinocytes alone or in combination have been developed and used as alternatives to autogenous soft tissue grafts in keratinized tissue augmentation and in root coverage procedures. Their promising advantages include reduced patient morbidity, unlimited graft availability, and comparable esthetics. This manuscript reviews soft tissue augmentation and root coverage procedures using bioengineered living cellular therapy and highlights their expected clinical, esthetic, and patient-related outcomes.
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Affiliation(s)
- Michael K McGuire
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Private practice, Houston, TX, USA.,Department of Periodontics, University of Texas, Dental Branch Houston and Health Science Center, San Antonio, TX, USA
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Stephen E Feinberg
- Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Giulio Rasperini
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Foundation IRCCS Ca' Granda Policlinic, Milan, Italy
| | - Giovanni Zucchelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - William V Giannobile
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Biomedical Engineering and Biointerfaces Institute, College of Engineering, University of Michigan, Ann Arbor, MI, USA
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5
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[Oral mucosa analog allografts in non-consanguineous rats]. BIOMEDICA 2017; 37:111-118. [PMID: 28527255 DOI: 10.7705/biomedica.v37i2.3006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 06/13/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Although there are therapeutic options for the treatment of oral mucosa defects, the need for functional, anatomical and aesthetically similar substitutes persists, as well as for solutions to reduce autologous grafts morbidity. OBJECTIVE To determine clinical and histological compatibility of equivalent oral mucosa allografts generated through tissue engineering in non-consanguineous rats. MATERIALS AND METHODS We used a sample of oral mucosa from Sprague Dawley rats to obtain a fibroblast culture and a keratinocytes and fibroblasts co-culture. In both cases, we used a commercial collagen membrane as "scaffold". After ten weeks of culture, we grafted the resulting membranes into four Wistar rats. The first phase of the study was the development of the oral mucosa equivalents generated by tissue engineering. Then, we implanted them in immunocompetent Wistar rats, and finallywe evaluated the clinical and histological features of the allografts. RESULTS In vivo evaluation of mucosal substitutes showed a correct integration of artificial oral mucosa in immunocompetent hosts, with an increase in periodontal biotype and the creation of a zone with increased keratinization. Histologically, the tissue was similar to the control oral mucosa sample with no inflammatory reaction nor clinical or histological rejection signs. CONCLUSION The equivalent oral mucosa allografts generated by tissue engineering showed clinical and histological compatibility.
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Bertl K, Melchard M, Pandis N, Müller-Kern M, Stavropoulos A. Soft tissue substitutes in non-root coverage procedures: a systematic review and meta-analysis. Clin Oral Investig 2017; 21:505-518. [PMID: 28108833 PMCID: PMC5318480 DOI: 10.1007/s00784-016-2044-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 12/22/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The present systematic review compared the effectiveness of soft tissue substitutes (STSs) and autogenous free gingival grafts (FGGs) in non-root-coverage procedures to increase keratinized tissue (KT) width around teeth. MATERIALS AND METHODS Included studies fulfilled the following main eligibility criteria: (a) preclinical in vivo or human controlled trials using FGG as control, (b) non-root-coverage procedures, and (c) assessment of KT width. Meta-analysis was performed on the gain in KT width (primary outcome variable) and several secondary variables. RESULTS Eight human trials with short observation time evaluating five different STSs were identified. FGG yielded consistently significantly (p < 0.001) larger increase in KT width irrespective whether the comparison regarded an acellular matrix or a tissue-engineered STS. Further, FGG yielded consistently ≥2 mm KT width postoperatively, while use of STS did not, in the few studies reporting on this outcome. On the other hand, STSs resulted in significantly better aesthetic outcomes and received greater patient preference (p < 0.001). CONCLUSIONS Based on relatively limited evidence, in non-root-coverage procedures, FGG (1) resulted consistently in significantly larger increase in KT width compared to STS and (2) yielded consistently ≥2 mm KT width postoperatively, while STSs did not. STSs yielded significantly better aesthetic outcomes, received greater patient preference, and appeared safe. CLINICAL RELEVANCE Larger and more predictable increase in KT width is achieved with FGG, but STSs may be considered when aesthetics is important. Clinical studies reporting relevant posttreatment outcomes, e.g., postop KT width ≥2 mm, on the long-term (>6 months) are warranted.
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Affiliation(s)
- Kristina Bertl
- Department of Periodontology, Faculty of Odontology, University of Malmö, Carl Gustafs väg 34, 20506, Malmö, Sweden.,Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Maximilian Melchard
- Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, Dental School/Medical Faculty, University of Bern, Bern, Switzerland
| | - Michael Müller-Kern
- Division of Conservative Dentistry and Periodontology, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Andreas Stavropoulos
- Department of Periodontology, Faculty of Odontology, University of Malmö, Carl Gustafs väg 34, 20506, Malmö, Sweden.
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Vitacolonna M, Belharazem D, Hohenberger P, Roessner ED. In-vivo quantification of the revascularization of a human acellular dermis seeded with EPCs and MSCs in co-culture with fibroblasts and pericytes in the dorsal chamber model in pre-irradiated tissue. Cell Tissue Bank 2016; 18:27-43. [PMID: 28004288 DOI: 10.1007/s10561-016-9606-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 12/08/2016] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Transplantation of a cell-seeded graft may improve wound healing after radiotherapy. However, the survival of the seeded cells depends on a rapid vascularization of the graft. Co-culturing of adult stem cells may be a promising strategy to accelerate the vessel formation inside the graft. Thus, we compared the in vivo angiogenic potency of mesenchymal stem cells (MSC) and endothelial progenitor cells (EPC) using dorsal skinfold chambers and intravital microscopy. MATERIALS AND METHODS Cells were isolated from rat bone marrow and adipose tissue and characterized by immunostaining and flow cytometry. Forty-eight rats received a dorsal skinfold chamber and were divided into 2 main groups, irradiated and non-irradiated. Each of these 2 groups were further subdivided into 4 groups: unseeded matrices, matrices + fibroblasts + pericytes, matrices + fibroblasts + pericytes + MSCs and matrices + fibroblasts + pericytes + EPCs. Vessel densities were quantified semi-automatically using FIJI. RESULTS Fibroblasts + pericytes - seeded matrices showed a significantly higher vascular density in all groups with an exception of non-irradiated rats at day 12 compared to unseeded matrices. Co-seeding of MSCs increased vessel densities in both, irradiated and non-irradiated groups. Co-seeding with EPCs did not result in an increase of vascularization in none of the groups. DISCUSSION We demonstrated that the pre-radiation treatment led to a significant decreased vascularization of the implanted grafts. The augmentation of the matrices with fibroblasts and pericytes in co-culture increased the vascularization compared to the non-seeded matrices. A further significant enhancement of vessel ingrowth into the matrices could be achieved by the co-seeding with MSCs in both, irradiated and non-irradiated groups.
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Affiliation(s)
- M Vitacolonna
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - D Belharazem
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - P Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - E D Roessner
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Żurek J, Dominiak M, Tomaszek K, Botzenhart U, Gedrange T, Bednarz W. Multiple gingival recession coverage with an allogeneic biostatic fascia lata graft using the tunnel technique—A histological assessment. Ann Anat 2016; 204:63-70. [DOI: 10.1016/j.aanat.2015.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/14/2015] [Accepted: 11/10/2015] [Indexed: 10/22/2022]
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Vitacolonna M, Belharazem D, Maier P, Hohenberger P, Roessner ED. In vivo Quantification of the Effects of Radiation and Presence of Hair Follicle Pores on the Proliferation of Fibroblasts in an Acellular Human Dermis in a Dorsal Skinfold Chamber: Relevance for Tissue Reconstruction following Neoadjuvant Therapy. PLoS One 2015; 10:e0125689. [PMID: 25955842 PMCID: PMC4425687 DOI: 10.1371/journal.pone.0125689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 03/23/2015] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION In neoadjuvant therapy, irradiation has a deleterious effect on neoangiogenesis. The aim of this study was to examine the post-implantation effects of neoadjuvant irradiation on the survival and proliferation of autologous cells seeded onto an acellular human dermis (hAD; Epiflex). Additionally, we examined the influence of dermal hair follicle pores on viability and proliferation. We used dorsal skinfold chambers implanted in rats and in-situ microscopy to quantify cell numbers over 9 days. METHODS 24 rats received a skinfold chamber and were divided into 2 main groups; irradiated and unirradiated. In the irradiated groups 20Gy were applied epicutaneously at the dorsum. Epiflex pieces were cut to size 5x5mm such that each piece had either one or more visible hair follicle pores, or no such visible pores. Fibroblasts were transduced lentiviral with a fluorescent protein for cell tracking. Matrices were seeded statically with 2.5x104 fluorescent fibroblasts and implanted into the chambers. In each of the two main groups, half of the rats received Epiflex with hair follicle pores and half received Epiflex without pores. Scaffolds were examined in-situ at 0, 3, 6 and 9 days after transplantation. Visible cells on the surface were quantified using ImageJ. RESULTS In all groups cell numbers were decreased on day 3. A treatment-dependent increase in cell numbers was observed at subsequent time points. Irradiation had an adverse effect on cell survival and proliferation. The number of cells detected in both irradiated and non-irradiated subjects was increased in those subjects that received transplants with hair follicle pores. DISCUSSION This in-vivo study confirms that radiation negatively affects the survival and proliferation of fibroblasts seeded onto a human dermis transplant. The presence of hair follicle pores in the dermis transplants is shown to have a positive effect on cell survival and proliferation even in irradiated subjects.
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Affiliation(s)
- Mario Vitacolonna
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Centre Mannheim, University of Heidelberg, Germany
| | - Djeda Belharazem
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Germany
| | - Patrick Maier
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Centre Mannheim, University of Heidelberg, Germany
| | - Eric Dominic Roessner
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Centre Mannheim, University of Heidelberg, Germany
- * E-mail:
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Żurek J, Dominiak M, Botzenhart U, Bednarz W. The use of a biostatic fascia lata thigh allograft as a scaffold for autologous human culture of fibroblasts--An in vitro study. Ann Anat 2014; 199:104-8. [PMID: 25271066 DOI: 10.1016/j.aanat.2014.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 08/07/2014] [Accepted: 08/30/2014] [Indexed: 10/24/2022]
Abstract
The method for covering gingival recession defects and augmenting keratinized gingiva involves the use of autogenuous connective tissue grafts obtained from palatal mucosa in combination with various techniques of flap repositioning or tunnel techniques. In the case of multiple gingival recession defects the amount of connective tissue available for grafting is insufficient. Therefore, the use of substitutes is necessary. The most widely used material in recent years has been the acellular dermal matrix allograft. The disadvantage of its application lies in the absence of cells and blood vessels, which increases incorporation time. Primary cultured human autologic fibroblasts are commonly used to optimize the healing process. The aim of this study was to examine the in vitro biocompatibility of human fascia lata allograft as a new scaffold for primary cultured human autologic fibroblasts. For that, a fibroblast culture obtained from a fragment of gingival tissue taken from the hard palate mucosa of a subject was used. After 14 days the colony cells were inoculated on a fragment of human fascia lata allograft. After a further 7 days of incubation the material was frozen, cut and prepared for histochemical examination. After two weeks of incubation, and 7 days after inoculation on a fragment of fascia lata allograft numerous accumulations of the cultured fibroblast were found that had a typical structure and produced collagen fibres. A human fascia lata allograft can be used as a scaffold for primary cultured human autologic fibroblasts. Further studies should confirm the clinical efficacy of this solution.
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Affiliation(s)
- Jarek Żurek
- Specialist Medical Practice Stomatologia Jacek Żurek in Tarnowskie Góry, Poland
| | - Marzena Dominiak
- Dental Surgery Department, Medical University and DUO-MED Stomatologia, Wroclaw, Poland
| | - Ute Botzenhart
- Department of Orthodontics, TU Dresden, Dresden, Germany.
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Pelegrini CB, Maia LP, de Souza SLS, Taba M, Palioto DB. Morphological, functional and biochemical characterization of canine gingival fibroblasts. Braz Dent J 2014; 24:128-35. [PMID: 23780356 DOI: 10.1590/0103-6440201302144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 04/02/2013] [Indexed: 11/22/2022] Open
Abstract
As dogs are good models for in vivo studies, it is interesting to evaluate the behavior of canine gingival fibroblasts (CGF) in vitro, so that these cells could be seeded on a matrix and later studied in vivo. The aim of this study was to perform a morphological, functional and biochemical analysis of CGF, comparing it with human gingival fibroblasts (HGF), as well as to evaluate the change of their characteristics over several passages. Using gingival fibroblasts from 3 dogs and 3 humans in the subculture (Sub), first (P1), third (P3), fifth (P5) and seventh (P7) passages, the following parameters were assessed: cell morphology, spreading, adhesion, viability and total protein content. The results showed no major differences between the passages in terms of morphology and spreading, and a tendency of greater adhesion and viability for HGF when compared with CGF. The total protein content was significantly higher for HGF. HGF exhibited greater functional and biochemical activity in vitro compared to CGF. Higher numbers at Sub were observed for both CGF and HGF in all evaluated parameters. The differences do not prevent the use of CGF for tissue engineering, but its use seems to be more appropriate in the subculture or first passage.
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Affiliation(s)
- Camila Bonvicino Pelegrini
- Department of Traumatology and Bucomaxillofacial Surgery and Periodontology, Ribeirão Preto Dental School, USP - University of São Paulo, Ribeirão Preto, SP, Brazil
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12
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Vignoletti F, Nunez J, Sanz M. Soft tissue wound healing at teeth, dental implants and the edentulous ridge when using barrier membranes, growth and differentiation factors and soft tissue substitutes. J Clin Periodontol 2014; 41 Suppl 15:S23-35. [DOI: 10.1111/jcpe.12191] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Fabio Vignoletti
- Department of Periodontology; University Complutense of Madrid; Madrid Spain
| | - Javier Nunez
- Department of Periodontology; University Complutense of Madrid; Madrid Spain
| | - Mariano Sanz
- Department of Periodontology; University Complutense of Madrid; Madrid Spain
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Effect of amniotic fluid stem cells and amniotic fluid cells on the wound healing process in a white rat model. Arch Plast Surg 2013; 40:496-504. [PMID: 24086800 PMCID: PMC3785580 DOI: 10.5999/aps.2013.40.5.496] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 07/25/2013] [Accepted: 07/27/2013] [Indexed: 12/05/2022] Open
Abstract
Background Amniotic-fluid-derived stem cells and amniocytes have recently been determined to have wound healing effects, but their mechanism is not yet clearly understood. In this study, the effects of amniotic fluid stem cells and amniocytes on wound healing were investigated through animal experiments. Methods On the back of Sprague-Dawley rats, four circular full-thickness skin wounds 2 cm in diameter were created. The wounds were classified into the following four types: a control group using Tegaderm disc wound dressings and experimental groups using collagen discs, amniotic fluid stem cell discs, and amniocyte discs. The wounds were assessed through macroscopic histological examination and immunohistochemistry over a period of time. Results The amniotic fluid stem cell and amniocyte groups showed higher wound healing rates compared with the control group; histologically, the inflammatory cell invasion disappeared more quickly in these groups, and there was more significant angiogenesis. In particular, these groups had significant promotion of epithelial cell reproduction, collagen fiber formation, and angiogenesis during the initial 10 days of the wound healing process. The potency of transforming growth factor-β and fibronectin in the experimental group was much greater than that in the control group in the early stage of the wound healing process. In later stages, however, no significant difference was observed. Conclusions The amniotic fluid stem cells and amniocytes were confirmed to have accelerated the inflammatory stage to contribute to an enhanced cure rate and shortened wound healing period. Therefore, they hold promise as wound treatment agents.
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Hakki SS, Korkusuz P, Purali N, Bozkurt B, Kus M, Duran I. Attachment, proliferation and collagen type I mRNA expression of human gingival fibroblasts on different biodegradable membranes. Connect Tissue Res 2013; 54:260-6. [PMID: 23758269 DOI: 10.3109/03008207.2013.801467] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to investigate adhesion, proliferation and type I collagen (COL I) mRNA expression of gingival fibroblasts on different membranes used in periodontal applications. Collagen (C), acellular dermal matrix (ADM) and polylactic acid; polyglycolic acid; lactide/glycolide copolymer (PLGA) biodegradable membranes were combined with gingival fibroblasts in culture and incubated for 48 h. Cell adhesion was examined with scanning electron and confocal microscopy. MTT assay was used to measure proliferation. COL I mRNA expression was assessed using quantitative-polymerase chain reaction (QPCR). The PLGA group exhibited the lowest cell survival on day 5 and 10, and lowest cell proliferation on days 5, 10 and 14. While cell proliferation was similar in C and ADM groups, the C membrane showed a slightly greater increase in viable cells to day 10. Confocal and scanning electron microscopy confirmed the results of proliferation and MTT assays. The highest COL I mRNA expression was noted in the PLGA membrane group when compared to the C (p < 0.01) and ADM (p < 0.05) membrane groups. These data revealed that adherence and proliferation of primary gingival fibroblasts on collagen-based C and ADM membranes is better than that seen with PLGA membranes, and thus may be preferable in the treatment of gingival recession defects.
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Affiliation(s)
- Sema S Hakki
- Selcuk University, Faculty of Dentistry, Department of Periodontology , Konya , Turkey
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Pabst AM, Happe A, Callaway A, Ziebart T, Stratul SI, Ackermann M, Konerding MA, Willershausen B, Kasaj A. In vitro
and in vivo
characterization of porcine acellular dermal matrix for gingival augmentation procedures. J Periodontal Res 2013; 49:371-81. [DOI: 10.1111/jre.12115] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2013] [Indexed: 12/20/2022]
Affiliation(s)
- A. M. Pabst
- Department of Oral and Maxillofacial Surgery; University Medical Center; Mainz Germany
| | - A. Happe
- Department of Oral and Maxillofacial Plastic Surgery; University of Cologne; Cologne Germany
| | - A. Callaway
- Department of Operative Dentistry and Periodontology; University Medical Center; Mainz Germany
| | - T. Ziebart
- Department of Oral and Maxillofacial Surgery; University Medical Center; Mainz Germany
| | - S. I. Stratul
- Department of Periodontology; Victor Babes University of Medicine and Pharmacology; Timisoara Romania
| | - M. Ackermann
- Institute of Functional and Clinical Anatomy; University Medical Center; Mainz Germany
| | - M. A. Konerding
- Institute of Functional and Clinical Anatomy; University Medical Center; Mainz Germany
| | - B. Willershausen
- Department of Operative Dentistry and Periodontology; University Medical Center; Mainz Germany
| | - A. Kasaj
- Department of Operative Dentistry and Periodontology; University Medical Center; Mainz Germany
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Fontanilla MR, Espinosa LG. In VitroandIn VivoAssessment of Oral Autologous Artificial Connective Tissue Characteristics That Influence Its Performance as a Graft. Tissue Eng Part A 2012; 18:1857-66. [DOI: 10.1089/ten.tea.2011.0421] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Marta Raquel Fontanilla
- Tissue Engineering Group, Department of Pharmacy, Faculty of Sciences, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Lady Giovanna Espinosa
- Tissue Engineering Group, Department of Pharmacy, Faculty of Sciences, Universidad Nacional de Colombia, Bogotá, Colombia
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Rodríguez IA, López-López MT, Oliveira ACX, Sánchez-Quevedo MC, Campos A, Alaminos M, Durán JDG. Rheological characterization of human fibrin and fibrin-agarose oral mucosa substitutes generated by tissue engineering. J Tissue Eng Regen Med 2011; 6:636-44. [DOI: 10.1002/term.466] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 02/24/2011] [Accepted: 07/05/2011] [Indexed: 01/22/2023]
Affiliation(s)
- I. A. Rodríguez
- Department of Histology B, School of Dentistry; National University of Cordoba; Argentina
| | - M. T. López-López
- Department of Applied Physics; University of Granada, Campus de Fuentenueva; Granada; Spain
| | - A. C. X. Oliveira
- Tissue Engineering Group, Department of Histology; University of Granada; Spain
| | | | - A. Campos
- Tissue Engineering Group, Department of Histology; University of Granada; Spain
| | - M. Alaminos
- Tissue Engineering Group, Department of Histology; University of Granada; Spain
| | - J. D. G. Durán
- Department of Applied Physics; University of Granada, Campus de Fuentenueva; Granada; Spain
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18
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Lotfi G, Shokrgozar MA, Mofid R, Abbas FM, Ghanavati F, Bagheban AA, Shariati RP. A Clinical and Histologic Evaluation of Gingival Fibroblasts Seeding on a Chitosan-Based Scaffold and Its Effect on the Width of Keratinized Gingiva in Dogs. J Periodontol 2011; 82:1367-75. [DOI: 10.1902/jop.2011.100604] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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Rodrigues AZ, Oliveira PTD, Novaes AB, Maia LP, Souza SLSD, Palioto DB. Evaluation of in vitro human gingival fibroblast seeding on acellular dermal matrix. Braz Dent J 2011; 21:179-89. [PMID: 21203697 DOI: 10.1590/s0103-64402010000300001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 06/11/2010] [Indexed: 11/21/2022] Open
Abstract
The acellular dermal matrix (ADM) was introduced in periodontology as a substitute for the autogenous grafts, which became restricted because of the limited source of donor's tissue. The aim of this study was to investigate, in vitro, the distribution, proliferation and viability of human gingival fibroblasts seeded onto ADM. ADM was seeded with human gingival fibroblasts for up to 21 days. The following parameters were evaluated: cell distribution, proliferation and viability. Results revealed that, at day 7, fibroblasts were adherent and spread on ADM surface, and were unevenly distributed, forming a discontinuous single cell layer; at day 14, a confluent fibroblastic monolayer lining ADM surface was noticed. At day 21, the cell monolayer exhibited a reduction in cell density. At 7 days, about to 90% of adherent cells on ADM surface were cycling while at 14 and 21 days this proportion was significantly reduced. A high proportion of viable cell was detected on AMD surface both on 14 and 21 days. The results suggest that fibroblast seeding onto ADM for 14 days can allow good conditions for cell adhesion and spreading on the matrix; however, migration inside the matrix was limited.
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Affiliation(s)
- Annelissa Zorzeto Rodrigues
- Department of Oral and Maxillofacial Surgery and Traumatology and Periodontology, University of São Paulo, Ribeirão Preto, SP, Brazil
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20
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Maia LP, Novaes AB, Souza SLS, Grisi MFM, Taba M, Palioto DB. In vitro evaluation of acellular dermal matrix as a three-dimensional scaffold for gingival fibroblasts seeding. J Periodontol 2010; 82:293-301. [PMID: 20812778 DOI: 10.1902/jop.2010.100121] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Tissue engineering principles could improve the incorporation of acellular dermal matrix (ADM). The aim of this study is to verify if ADM is a suitable three-dimensional matrix for gingival fibroblasts and cancerous cells ingrowth, and also if cultured medium conditioned in ADM affect cellular behavior. METHODS Canine gingival fibroblasts (CGF), human gingival fibroblasts (HGF), and murine melanoma cell line (B16F10) were seeded on ADM for up to 14 days. The following parameters were assessed: morphology and distribution of CGF, HGF, and B16F10; CGF and HGF viability; and the effect of ADM conditioned medium (CM) on CGF viability. RESULTS Epifluorescence revealed that CGF were unevenly distributed on the ADM surface, showing no increase in cell number over the periods of study; HGF formed a monolayer on the ADM surface in a higher number at 14 days (P <0.05); B16F10 exhibited an increase in cell number within 7 days (P <0.05), and were mainly arranged in cell aggregates on the ADM, forming a continuous layer at 14 days. A higher percentage of cells on the ADM surface (P <0.05) compared to inside was observed for all cell types. 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT) values indicated higher cell viability in samples cultured with HGF compared to CGF (P = 0.024). A significantly lower cell viability for CGF grown in CM compared to cells grown in non-CM was observed at 48 and 72 hours (P <0.05). CONCLUSIONS ADM is not suitable as a three-dimensional matrix for gingival fibroblasts ingrowth. Gingival fibroblasts and highly proliferative cells as B16F10 can only be superficially located on ADM, and CGF are negatively affected by culture medium conditioned in ADM, reducing its viability.
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Affiliation(s)
- Luciana P Maia
- Department of Bucco-Maxillofacial Surgery and Traumatology and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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21
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Fernandes PG, Novaes AB, de Queiroz AC, de Souza SLS, Taba M, Palioto DB, Grisi MFDM. Ridge preservation with acellular dermal matrix and anorganic bone matrix cell-binding peptide P-15 after tooth extraction in humans. J Periodontol 2010; 82:72-9. [PMID: 20722531 DOI: 10.1902/jop.2010.100241] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Preventing ridge collapse with the extraction of maxillary anterior teeth is vital to an esthetic restorative result. Several regenerative techniques are available and are used for socket preservation. The aim of this study is to analyze by clinical parameters the use of acellular dermal matrix (ADM) and anorganic bovine bone matrix (ABM) with synthetic cell-binding peptide P-15 to preserve alveolar bone after tooth extraction. METHODS Eighteen patients in need of extraction of maxillary anterior teeth were selected and randomly assigned to the test group (ADM plus ABM/P-15) or the control group (ADM only). Clinical measurements were recorded initially and at 6 months after ridge-preservation procedures. RESULTS In the clinical measurements (external vertical palatal measurement [EVPM], external vertical buccal measurement [EVBM], and alveolar horizontal measurement [AHM]) the statistical analysis showed no difference between test and control groups initially and at 6 months. The intragroup analysis, after 6 months, showed a statistically significant reduction in the measurements for both groups. In the comparison between the two groups, the differences in the test group were as follows: EVPM = 0.83 ± 1.53 mm; EVBM = 1.20 ± 2.02 mm; and AHM = 2.53 ± 1.81 mm. The differences in the control group were as follows: EVPM = 0.87 ± 1.13 mm; EVBM = 1.50 ± 1.15 mm; and AHM = 3.40 ± 1.39 mm. The differences in EVPM and EVBM were not statistically significant; however, in horizontal measurement (AHM), there was a statistically significant difference (P<0.05). CONCLUSION The results of this study show that ADM used as membrane associated with ABM/P-15 can be used to reduce buccal-palatal dimensions compared to ADM alone for preservation of the alveolar ridge after extraction of anterior maxillary teeth.
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Affiliation(s)
- Patricia Garani Fernandes
- Department of Oral Surgery and Periodontology, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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22
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Chen FM, Jin Y. Periodontal tissue engineering and regeneration: current approaches and expanding opportunities. TISSUE ENGINEERING PART B-REVIEWS 2010; 16:219-55. [PMID: 19860551 DOI: 10.1089/ten.teb.2009.0562] [Citation(s) in RCA: 210] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The management of periodontal tissue defects that result from periodontitis represents a medical and socioeconomic challenge. Concerted efforts have been and still are being made to accelerate and augment periodontal tissue and bone regeneration, including a range of regenerative surgical procedures, the development of a variety of grafting materials, and the use of recombinant growth factors. More recently, tissue-engineering strategies, including new cell- and/or matrix-based dimensions, are also being developed, analyzed, and employed for periodontal regenerative therapies. Tissue engineering in periodontology applies the principles of engineering and life sciences toward the development of biological techniques that can restore lost alveolar bone, periodontal ligament, and root cementum. It is based on an understanding of the role of periodontal formation and aims to grow new functional tissues rather than to build new replacements of periodontium. Although tissue engineering has merged to create more opportunities for predictable and optimal periodontal tissue regeneration, the technique and design for preclinical and clinical studies remain in their early stages. To date, the reconstruction of small- to moderate-sized periodontal bone defects using engineered cell-scaffold constructs is technically feasible, and some of the currently developed concepts may represent alternatives for certain ideal clinical scenarios. However, the predictable reconstruction of the normal structure and functionality of a tooth-supporting apparatus remains challenging. This review summarizes current regenerative procedures for periodontal healing and regeneration and explores their progress and difficulties in clinical practice, with particular emphasis placed upon current challenges and future possibilities associated with tissue-engineering strategies in periodontal regenerative medicine.
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Affiliation(s)
- Fa-Ming Chen
- Department of Periodontology and Oral Medicine, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, P.R. China
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Jhaveri HM, Chavan MS, Tomar GB, Deshmukh VL, Wani MR, Miller PD. Acellular Dermal Matrix Seeded With Autologous Gingival Fibroblasts for the Treatment of Gingival Recession: A Proof-of-Concept Study. J Periodontol 2010; 81:616-25. [DOI: 10.1902/jop.2009.090530] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Roessner ED, Thier S, Hohenberger P, Schwarz M, Pott P, Dinter D, Smith M. Acellular dermal matrix seeded with autologous fibroblasts improves wound breaking strength in a rodent soft tissue damage model in neoadjuvant settings. J Biomater Appl 2009; 25:413-27. [PMID: 20042428 DOI: 10.1177/0885328209347961] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Soft tissue defects following resectional surgery or trauma often result in deadspaces and require free or pedicled flaps. A programmed formation of filling tissue with enhanced biomechanical properties could be helpful. This study examined the effects on wound healing of acellular dermal matrix (ADM) seeded with autologous fibroblasts in a standardized rodent model. As pre- or postoperative radiotherapy is standard in many treatments of malignancies, we also investigated the effects of additional radiotherapy. Fischer rats were randomised and received a standardized unilateral soft tissue defect at the buttock. The defect was filled with ADM+fibroblasts or ADM alone. Controls received no filling. Either no radiation, adjuvant (postoperative) or neoadjuvant (preoperative) radiation was applied to the defect site. Six weeks later the defect volume was measured by MR-tomography. Wound breaking strength was examined by tensiometry according to German Industrial Standards. Filling of the defect side was significantly larger in ADM and ADM+fibroblast treated groups compared to the control group in all settings. Wound breaking strength in the unimodal setting was significantly improved in the ADM+fibroblasts group compared to the ADM group. In the neoadjuvant setting there was no significant difference between control and ADM group. However, the ADM+fibroblasts groups showed a significantly increased wound breaking strength compared to the control and the ADM-alone group. Seeded or unseeded ADM is able to fill deadspace in this rodent model in all settings. Implanting non-irradiated, vital, proliferating autologous fibroblasts on ADM results in significantly increased wound breaking strength.
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Affiliation(s)
- Eric Dominic Roessner
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery University Medical Centre Mannheim, University of Heidelberg, Germany.
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McLeod DE, Reyes E, Branch-Mays G. Treatment of Multiple Areas of Gingival Recession Using a Simple Harvesting Technique for Autogenous Connective Tissue Graft. J Periodontol 2009; 80:1680-7. [DOI: 10.1902/jop.2009.090187] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Núñez J, Caffesse R, Vignoletti F, Guerra F, San Roman F, Sanz M. Clinical and histological evaluation of an acellular dermal matrix allograft in combination with the coronally advanced flap in the treatment of Miller class I recession defects: an experimental study in the mini-pig. J Clin Periodontol 2009; 36:523-31. [PMID: 19508251 DOI: 10.1111/j.1600-051x.2009.01401.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To study the wound healing of acellular dermal matrix (ADM) allografts when used together with coronally advanced flaps (CAF) in the treatment of localized gingival recessions in the mini-pig experimental model. MATERIAL AND METHODS Dehiscence defects 4 x 5 mm were surgically created in one buccal root surface in each quadrant of PI, II, or III in three mini-pigs. They were then treated with CAF and the interposition of either a connective tissue graft (CTG) or ADM. As the primary outcome, the histological interface between the ADM and the root surface was studied and was compared with CTG. As secondary outcomes, we assessed the amount and quality of the keratinized tissue and clinical outcomes in terms of root coverage and recession reduction. RESULTS At 3 months, the CTG group attained a mean 76% root coverage, versus 62% in the ADM group. The histological interface with the root surface was similar in both groups. The apical migration of the epithelium was 1.79+/-0.46 mm for the CTG and 1.21+/-0.35 mm for ADM. Newly formed cementum was observed with both treatments. New bone and a newly formed periodontal ligament were shown in five specimens in the ADM group and in three in the CTG group. CONCLUSION Both materials showed similar clinical and histological outcomes.
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Affiliation(s)
- Javier Núñez
- University Complutense of Madrid, Madrid, Spain.
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Maurice SM, Skeete DA. Use of human acellular dermal matrix for abdominal wall reconstructions. Am J Surg 2008; 197:35-42. [PMID: 18558390 DOI: 10.1016/j.amjsurg.2007.11.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Revised: 11/26/2007] [Accepted: 11/26/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND Acellular dermal matrix (ADM) represents a promising new fascial substitute for repairing abdominal wall defects. METHODS We retrospectively studied 63 patients who underwent fascial reconstruction with ADM and analyzed risk factors for recurrence and infectious wound complications. RESULTS Postoperative wound infections, noninfectious wound complications, and recurrences developed in 35%, 44%, and 41% of patients, respectively. No patients required ADM removal. Long surgical times (> or =300 min), implants of 100 cm(2) or greater, and repairs using 3 or more ADM sheets were associated significantly with the development of a postoperative wound infection. The approximation of ADM directly to the fascial edge (P = .02), long surgical time (P < .01), implant size of 100 cm(2) or greater (P = .01), and the presence of a postoperative wound infection (P = .02) were associated significantly with recurrence. CONCLUSIONS Recurrences and complications after ADM fascial repairs may be higher than previously reported and associated with implant size and method of implantation. Postoperative infection, although not necessitating implant removal, is associated with more recurrences.
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Affiliation(s)
- Samuel M Maurice
- Department of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Dr., Iowa City, IA 52242, USA
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