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Bouakaz I, Drouet C, Grossin D, Cobraiville E, Nolens G. Hydroxyapatite 3D-printed scaffolds with Gyroid-Triply periodic minimal surface porous structure: Fabrication and an in vivo pilot study in sheep. Acta Biomater 2023; 170:580-595. [PMID: 37673232 DOI: 10.1016/j.actbio.2023.08.041] [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: 04/14/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023]
Abstract
Bone repair is a major challenge in regenerative medicine, e.g. for large defects. There is a need for bioactive, highly percolating bone substitutes favoring bone ingrowth and tissue healing. Here, a modern 3D printing approach (VAT photopolymerization) was exploited to fabricate hydroxyapatite (HA) scaffolds with a Gyroid-"Triply periodic minimal surface" (TPMS) porous structure (65% porosity, 90.5% HA densification) inspired from trabecular bone. Percolation and absorption capacities were analyzed in gaseous and liquid conditions. Mechanical properties relevant to guided bone regeneration in non-load bearing sites, as for maxillofacial contour reconstruction, were evidenced from 3-point bending tests and macrospherical indentation. Scaffolds were implanted in a clinically-relevant large animal model (sheep femur), over 6 months, enabling thorough analyses at short (4 weeks) and long (26 weeks) time points. In vivo performances were systematically compared to the bovine bone-derived Bio-OssⓇ standard. The local tissue response was examined thoroughly by semi-quantitative histopathology. Results demonstrated the absence of toxicity. Bone healing was assessed by bone dynamics analysis through epifluorescence using various fluorochromes and quantitative histomorphometry. Performant bone regeneration was evidenced with similar overall performances to the control, although the Gyroid biomaterial slightly outperformed Bio-OssⓇ at early healing time in terms of osteointegration and appositional mineralization. This work is considered a pilot study on the in vivo evaluation of TPMS-based 3D porous scaffolds in a large animal model, for an extended period of time, and in comparison to a clinical standard. Our results confirm the relevance of such scaffolds for bone regeneration in view of clinical practice. STATEMENT OF SIGNIFICANCE: Bone repair, e.g. for large bone defects or patients with defective vascularization is still a major challenge. Highly percolating TPMS porous structures have recently emerged, but no in vivo data were reported on a large animal model of clinical relevance and comparing to an international standard. Here, we fabricated TPMS scaffolds of HA, determined their chemical, percolation and mechanical features, and ran an in-depth pilot study in the sheep with a systematic comparison to the Bio-OssⓇ reference. Our results clearly show the high bone-forming capability of such scaffolds, with outcomes even better than Bio-OssⓇ at short implantation time. This preclinical work provides quantitative data validating the relevance of such TMPS porous scaffolds for bone regeneration in view of clinical evaluation.
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Affiliation(s)
- Islam Bouakaz
- CERHUM - PIMW, 4000 Liège, Belgium; CIRIMAT, Université de Toulouse, CNRS / Toulouse INP / UT3, 31030 Toulouse, France
| | - Christophe Drouet
- CIRIMAT, Université de Toulouse, CNRS / Toulouse INP / UT3, 31030 Toulouse, France.
| | - David Grossin
- CIRIMAT, Université de Toulouse, CNRS / Toulouse INP / UT3, 31030 Toulouse, France
| | | | - Grégory Nolens
- CERHUM - PIMW, 4000 Liège, Belgium; Faculty of Medicine, University of Namur, 5000 Namur, Belgium.
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Krennmair G, Weinländer M, Forstner T, Krennmair S, Stimmelmayr M, Malek M. Transsinusoidal lateral nasal floor augmentation for implant placement in the atrophic premaxilla: A within-patient, 5-year, prospective comparative study. Clin Oral Implants Res 2023; 34:822-838. [PMID: 37318152 DOI: 10.1111/clr.14111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To evaluate the clinical outcome for implants placed with transsinusoidal-lateral nasal cavity augmentation (NA) compared to implants placed in maxillary sinus augmentation (SA). MATERIALS AND METHODS In 28 atrophic edentulous maxillary regions (14 patients bi-maxillary), a lateral window approach was used to perform transsinusoidal-lateral NA (TSLNA) combined with maxillary SA. After healing period of about 6 months, each patient received bimaxillary one anterior implant located in the pre-maxilla having lateral NA and 2-3 implants in the maxillary posterior region with SA. In a prospective follow-up evaluation, clinical implant outcome (survival/success rates) and peri-implant health (mucositis/peri-implantitis) were assessed and compared between implants placed in TSLNA (n = 28) and SA (n = 58). RESULTS At the year-1, year-3, and year-5 evaluation, neither patient-based nor implant-based comparisons revealed differences for marginal bone level reduction between implants placed in TSLNA (5-year overall: 1.11 ± 0.26 mm) and SA (5-year overall: 1.07 ± 0.30 mm), although with a significant (p < .001) continuous reduction over the observation time. At the year-5 evaluation, all implants (n = 86) and restorations (n = 14) were still in situ (survival 100%) and showed an implant-based incidence of peri-implant mucositis/peri-implantitis of 14.3%/0% in TSLNA and 6.9%/3.4% in SA corresponding to 21.4%/0% and 28.6%/7.1% for implant-based evaluation. In addition, the implant success rate did not differ between NA and SA at implant- (100%/ 98.8%) and patient-based (100%/97.6%) evaluation. CONCLUSION The findings obtained show TSLNA as an effective method for implant placement of adequate length and direction in the atrophic premaxilla providing for success rates comparable to those of implants placed in SA.
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Affiliation(s)
- Gerald Krennmair
- Dental School, Private University Sigmund Freud Vienna, Vienna, Austria
| | | | - Thomas Forstner
- Department of Applied Systems Research Statistics, Johannes Kepler University Linz (JKU), Linz, Austria
| | - Stefan Krennmair
- Dental School, Private University Sigmund Freud Vienna, Vienna, Austria
- Oral Maxillofacial Surgery, Resident, Medical (JKU) University, Linz, Austria
- Department Oral Maxillofacial Surgery, Ludwig-Maximilian University (LMU) Munich, Munich, Germany
| | - Michael Stimmelmayr
- Dental School, Prosthodontics, Ludwig-Maximilian University (LMU) Munich, Munich, Germany
| | - Michael Malek
- Department of Oral Maxillofacial Surgery, Johannes Kepler University, Linz (JKU), Linz, Austria
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Guided Bone Regeneration with Occlusive Titanium Barrier: A Case Report and Clinical Considerations. Biomimetics (Basel) 2023; 8:biomimetics8010106. [PMID: 36975336 PMCID: PMC10046855 DOI: 10.3390/biomimetics8010106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
The need to obtain adequate bone volumes for prosthetic rehabilitation supported by implants, using different techniques and materials, represents an urgent need in modern dentistry. We report a case regarding the management of implant-prosthetic rehabilitation of the first and second upper right molars, in which no less than 4 mm of crestal bone remained to insert two implants. Regeneration of the residual bone was previously performed using a customized titanium barrier and a filler of a blood clot with tricalcium beta phosphate. The bone gain (3 mm) was evaluated by comparing CBCT images, while the implant stability (mean 70) was assessed with the ISQ measurement. A regenerated bone sample was taken for histological analysis. Guided bone regeneration obtained with a titanium barrier and blood clot allowed for the insertion of stable implants in a mature bone without heterologous material.
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She X, Zhang D, Xu X, Zhang Z, Ji C, Li Z, Song D. Influence of the contact area of the sub-antral space with sinus bone and the Schneiderian membrane on osteogenesis in lateral window sinus elevation surgery: a prospective experiment. BMC Oral Health 2022; 22:650. [PMID: 36578061 PMCID: PMC9798614 DOI: 10.1186/s12903-022-02694-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Osteogenesis of lateral window sinus elevation surgery is the key to placement of the subsequent implant, excessive collapse of the sub-antral space may adversely affect long-term stability of implants. At present, few studies focus on the influence of the contact area of the sub-antral space on osteogenesis. This study evaluated whether the change in the contact area of the sub-antral space with maxillary sinus bone and the Schneiderian membrane can affect osteogenesis. METHODS Cone beam computed tomography (CBCT) images were collected of patients requiring maxillary sinus floor elevation (residual bone height < 6 mm) for standard-length implant placement before surgery, after surgery, and at 6-month follow-up visits. The postoperative sub-antral space volume (V1) and surface area (S1), and the remaining volume after six months of healing (V2) were measured. Then, the contact area of sub-antral space with maxillary sinus bone (Sbc) and the Schneiderian membrane (Smc), the absorbed volume during healing (Va), and the percentage of remaining volume (V2%) and absorbed volume (Va%) were calculated. The correlation between anatomical parameters was analyzed using multiple linear regression. RESULTS A total of 62 maxillary sinuses from 56 patients were augmented, of which 57 were considered for the final analysis (5 withdrew due to perforation). Multiple linear regression results demonstrated that Sbc was significantly positively correlated with Va (β coefficient = 0.141, p < 0.01) without correlation between Smc and Va (β coefficient = - 0.046, p = 0.470). There was a positive correlation between Sbc and V2% (β coefficient = 2.269, p < 0.05). CONCLUSIONS This study confirmed that the size of the Sbc in lateral window sinus elevation surgery affected osteogenesis after six months of healing. Clinicians should assess the sinus contour type preoperatively, then consider whether it is necessary to expand the range of the Schneiderian membrane elevation to avoid excessive collapse of the sub-antral space. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR), ChiCTR2200057924. Registered 22 March 2022-Retrospectively registered.
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Affiliation(s)
- Xiao She
- grid.27255.370000 0004 1761 1174Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
| | - Dongjiao Zhang
- grid.27255.370000 0004 1761 1174Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
| | - Xin Xu
- grid.27255.370000 0004 1761 1174Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
| | - Zhanwei Zhang
- grid.27255.370000 0004 1761 1174Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
| | - Chonghao Ji
- grid.27255.370000 0004 1761 1174Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
| | - Zechuan Li
- grid.27255.370000 0004 1761 1174Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
| | - Dawei Song
- grid.410587.fSchool of Stomatology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117 China
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Barreiro BOB, Koth VS, Sesterheim P, Salum FG, Rübensam G, Augustin AH, Cherubini K. Autogenous dentin combined with mesenchymal stromal cells as an alternative alveolar bone graft: an in vivo study. Clin Oral Investig 2022; 27:1907-1922. [PMID: 36574044 DOI: 10.1007/s00784-022-04840-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Considering the chemical and structural properties of dentin, this study was aimed at evaluating the effect of dentin matrix alone or combined with mesenchymal stromal cells (MSC) on postextraction alveolar bone regeneration. MATERIAL AND METHODS Wistar rats were subjected to tooth extraction with osteotomy and allocated into groups according to the graft inserted: (1) Gelita-Spon®, (2) Bio-Oss®, (3) Dentin, (4) MSC, (5) Dentin/MSC, and (6) Control. Maxillae were analyzed by means of hematoxylin and eosin (H&E) staining, immunohistochemical (IHC) analysis, microcomputed tomography (micro-CT), and scanning electron microscopy (SEM). Serum levels of calcium and phosphorus were quantified. RESULTS The Bio-Oss group showed less bone than Gelita-Spon and Dentin/MSC; no other significant differences were seen in H&E analysis. The Bio-Oss group showed higher expression of collagen type I compared to the Dentin and Dentin/MSC groups and also higher osteocalcin expression than the Dentin/MSC group. There was a tendency of higher expression of osteopontin in the MSC, Dentin, and Dentin/MSC groups and higher VEGF in the MSC group. On micro-CT analysis, the Bio-Oss and the Dentin/MSC groups exhibited greater bone volume than the Control. Serum calcium and phosphorus levels did not significantly differ between the groups. SEM analysis depicted particles of Bio-Oss and dentin in the respective groups, as well as significant cellularity in the MSC group. CONCLUSION Autogenous nondemineralized dentin is an alternative for alveolar bone grafting, which can be improved by combination with MSC. CLINICAL RELEVANCE This work provides support for the clinical applicability of dentin graft alone or combined with MSC.
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Affiliation(s)
- Bernardo Ottoni Braga Barreiro
- School of Health and Life Sciences, Post-Graduate Program in Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Valesca Sander Koth
- School of Health and Life Sciences, Post-Graduate Program in Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Patrícia Sesterheim
- Experimental Cardiology Center, Institute of Cardiology of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Fernanda Gonçalves Salum
- School of Health and Life Sciences, Post-Graduate Program in Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Gabriel Rübensam
- Toxicology and Pharmacology Research Center (INTOX), School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Adolpho Herbert Augustin
- Institute of Petroleum and Natural Resources (IPR), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Karen Cherubini
- School of Health and Life Sciences, Post-Graduate Program in Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
- Serviço de Estomatologia, Hospital São Lucas PUCRS, Av. Ipiranga, 6690 Sala 231, Bairro Jardim Botânico, CEP: 90.610-000, Porto Alegre, RS, Brazil.
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Histological and Biological Response to Different Types of Biomaterials: A Narrative Single Research Center Experience over Three Decades. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137942. [PMID: 35805602 PMCID: PMC9265446 DOI: 10.3390/ijerph19137942] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 12/16/2022]
Abstract
Background: In more than three decades of work of the Retrieval Bank of the Laboratory for Undemineralized Hard Tissue Histology of the University of Chieti-Pescara in Italy, many types of biomaterials were received and evaluated. The present retrospective review aimed to evaluate the histological and biological aspects of the evaluated bone substitute biomaterials. Methods: In the present study, the authors prepared a retrospective analysis after the screening of some databases (PubMed, Scopus, and EMBASE) to find papers published from the Retrieval Bank of the Laboratory for Undermineralized Hard Tissue Histology of the University of Chieti-Pescara analyzing only the papers dealing with bone substitute biomaterials and scaffolds, in the form of granules and block grafts, for bone regeneration procedures. Results: Fifty-two articles were found, including in vitro, in vivo, and clinical studies of different biomaterials. These articles were evaluated and organized in tables for a better understanding. Conclusions: Over three decades of studies have made it possible to assess the quality of many bone substitute biomaterials, helping to improve the physicochemical and biological properties of the biomaterials used in daily clinical practice.
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Utilizing Previously Grafted Sinus as Intraoral Donor Site for Successful Augmentation in Peri-Implant Osseous Defect: A Case Report. Medicina (B Aires) 2022; 58:medicina58050598. [PMID: 35630014 PMCID: PMC9144178 DOI: 10.3390/medicina58050598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this case report is to introduce a novel guided bone regeneration (GBR) technique that utilized bone harvested from previously grafted maxillary sinus with deproteinized bovine bone mineral (DBBM) 16 years ago. The patient is a 63-year-old male with hopeless maxillary right molars due to severe bone loss. Two months after the extraction, two bone blocks were harvested with a trephine drill from the lateral wall. One was used for histologic analysis and the other was crushed into particulate forms, which was used for a GBR procedure around an implant at the time of implant placement. The grafted site was then covered with a resorbable collagen membrane. The histological specimen showed newly-formed bone containing residual DBBM particles. The DBBM in the harvested bone was mostly resorbed; DBBM particles comprised only 3.6% of the total bone volume. The final prosthesis was delivered six months post-operatively. No change in crestal bone around the implant was observed throughout the 2 year follow-up period. Within the limitation of the present case report, previously grafted sinus can be a good donor site for further harvesting for a successful GBR procedure.
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Kamolratanakul P, Mattheos N, Yodsanga S, Jansisyanont P. The impact of deproteinized bovine bone particle size on histological and clinical bone healing outcomes in the augmented sinus: A randomized controlled clinical trial. Clin Implant Dent Relat Res 2022; 24:361-371. [PMID: 35320619 DOI: 10.1111/cid.13083] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The effect of different deproteinized bovine bone mineral (DBBM) particle sizes on bone healing in maxillary sinus floor augmentation remains unclear. This study compared the newly formed tissue and angiogenesis-related bone healing after sinus floor augmentation using large or small DBBM particles. MATERIALS AND METHODS Overall 32 patients were randomly divided into two groups using either large (1-2 mm) or small (0.25-1 mm) DBBM particles for sinus floor augmentation. After 6 months, the mineralized tissue volume was calculated using micro-computed tomography (micro-CT) analysis. The newly formed tissue composition was histomorphometrically analyzed. Angiogenesis was also examined by means of vascular endothelial growth factor (VEGF) expression. Implant failure and marginal bone loss were measured at a 1-year follow-up. Statistical analysis was performed using independent samples t-test. RESULTS Micro-CT analysis demonstrated that grafting with large particles resulted in higher bone volume (6.99 ± 2.72 mm3 , p = 0.002) and Bone Volume/Tissue Volume (0.25 ± 0.1, p = 0.03) compared with small particles (3.76 ± 1.83 mm3 and 0.14 ± 0.13, respectively). Small particles showed higher non-mineralized tissue volume (26.31 mm3 ) compared with large particle group (17.4 ± 5.34 mm3 ) with p = 0.001. The histological data revealed significantly higher area of newly formed bone (32.15% ± 14.04% for the large particle and 15.99% ± 14.12% for the small particle groups, p = 0.004). Likewise, non-mineralized tissue was significantly greater in the small particle group (66.48% ± 20.97%) compared with the large particle group (44.36%, p = 0.016). Moreover, use of large particles resulted in a significantly higher VEGF staining intensity score and VEFG positive cells. No implant failure was recorded in both groups, while no difference was found in terms of marginal bone loss at the 1-year follow-up. CONCLUSIONS Sinus floor augmentation using large DBBM particles resulted in more angiogenesis expression, higher bone volume, and new bone formation at 6 months after sinus augmentation. However, clinical outcomes with regards to implant placement were similar in both groups.
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Affiliation(s)
- Paksinee Kamolratanakul
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Nikos Mattheos
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Chulalongkorn University, Bangkok, Thailand.,Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Somchai Yodsanga
- Faculty of Dentistry, The Center of Excellence on Biomaterial, Chulalongkorn University, Bangkok, Thailand
| | - Pornchai Jansisyanont
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Chulalongkorn University, Bangkok, Thailand
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A New Anorganic Equine Bone Substitute for Oral Surgery: Structural Characterization and Regenerative Potential. MATERIALS 2022; 15:ma15031031. [PMID: 35160976 PMCID: PMC8840601 DOI: 10.3390/ma15031031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 12/22/2022]
Abstract
Different xenogeneic inorganic bone substitutes are currently used as bone grafting materials in oral and maxillo-facial surgery. The aim of the present study was to determine the physicochemical properties and the in vivo performance of an anorganic equine bone (AEB) substitute. AEB is manufactured by applying a process involving heating at >300 °C with the aim of removing all the antigens and the organic components. AEB was structurally characterized by scanning electron microscopy (SEM), X-ray diffraction (XRD), X-ray fluorescence (XRF), and Fourier-transformed infrared (FT-IR) spectroscopy and compared to the anorganic bovine bone (ABB). In order to provide a preliminary evaluation of the in vivo performance of AEB, 18 bone defects were prepared and grafted with AEB (nine sites), or ABB (nine sites) used as a control, in nine Yucatan Minipigs. De novo bone formation, residual bone substitute, as well as local inflammatory and tissue effects were histologically evaluated at 30 and 90 days after implantation. The structural characterization showed that the surface morphology, particle size, chemical composition, and crystalline structure of AEB were similar to cancellous human bone. The histological examination of AEB showed a comparable pattern of newly formed bone and residual biomaterial to that of ABB. Overall, the structural data and pre-clinical evidence reported in the present study suggests that AEB can be effectively used as bone grafting material in oral surgery procedures.
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Peri-implant tissue conditions following transcrestal and lateral sinus floor elevation: 3-year results of a bi-center, randomized trial. Clin Oral Investig 2022; 26:3975-3986. [PMID: 35013782 PMCID: PMC9072487 DOI: 10.1007/s00784-021-04364-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/29/2021] [Indexed: 11/24/2022]
Abstract
Objectives The present study was performed to comparatively evaluate the peri-implant bone stability and conditions of marginal tissues at 3 years following transcrestal and lateral sinus floor elevation (tSFE and lSFE, respectively). Materials and methods Patients included in a parallel-arm randomized trial comparatively evaluating tSFE and lSFE were recalled at 3 years post-surgery. Twenty-one and 24 patients in tSFE and lSFE groups, respectively, participated in the follow-up visit. Peri-implant bone support was evaluated as the proportion of the entire implant surface in direct contact with the radiopaque area (totCON%) on 3-year periapical radiographs. The conditions of the marginal peri-implant tissues at 3-year visit were classified as peri-implant health, peri-implant mucositis, or peri-implantitis. Results At 3 years, both groups showed an implant survival rate of 100%. Median totCON% was stable at 3 years, being 100% in both groups (p = 0.124). Peri-implant health and mucositis were diagnosed in 10 (47.6%) and 11 (52.4%) patients, respectively, in the tSFE group, and in 8 (33.3%) and 16 (66.7%) subjects, respectively, in the lSFE group (p = 0.502). Conclusions At 3 years following surgery, implants placed concomitantly with tSFE and lSFE fully maintain peri-implant bone support. Peri-implant mucositis was the most prevalent condition, with a similar prevalence between groups. Clinical relevance. Based on 3-year data on peri-implant bone support and prevalence of peri-implant diseases, the study suggests that tSFE and lSFE represent two equally valid options for the rehabilitation of the posterior maxilla. ClinicalTrials.gov ID: NCT02415946.
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OLIVEIRA LKRD, BONATTO MDS, ROCHA SMW, RODRIGUES FG, FRANÇA RM, SILVA DN, LIMEIRA JÚNIOR FDA. Alendronato de sódio tópico associado ao osso bovino liofilizado no reparo ósseo. REVISTA DE ODONTOLOGIA DA UNESP 2022. [DOI: 10.1590/1807-2577.02322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Resumo Introdução O osso bovino inorgânico é o enxerto mais utilizado na Odontologia, tendo como desvantagem longo tempo de integração ao leito receptor. Os bifosfonatos têm sido utilizados para modular a quantidade e a qualidade do osso regenerado e diminuir o tempo de integração do enxerto. Objetivo Avaliar o efeito do bifosfonato alendronato de sódio (ALN) 0,5%, associado ou não ao osso bovino inorgânico, na reparação de defeitos ósseos. Material e método Dois defeitos ósseos foram confeccionados na calvária de 12 coelhos, sendo a cavidade esquerda/experimental preenchida com: GI = osso bovino inorgânico (Bio-Oss®); GII = Bio-Oss® + ALN 0,5%; GIII = ALN 0,5%; e a cavidade direita por coágulo sanguíneo (controle). Os animais foram mortos aos 60 dias pós-operatórios. Por meio de análise histomorfométrica calculou-se o percentual de osso neoformado e remanescente do biomaterial em relação à área total do defeito. Resultado Osso neoformado: GI = 38,16 ± 15,44%; GII = 55,77 ± 16,75%; GII I = 60,28 ± 11,45%. Controle = 45,11 ± 11,09%. Remanescente do enxerto: GI = 7,02 ± 5,36% e GII = 16,59 ± 9,56%. Não houve diferença quanto ao percentual de osso neoformado entre os grupos (ANOVA p = 0,15512; teste de Tukey F = 2,089). O percentual de remanescente do enxerto também foi estatisticamente semelhante entre os grupos GI e GII (teste de Tukey F = 5,019). Conclusão O uso tópico da solução de ALN 0,5% isoladamente ou associado ao osso bovino liofilizado não alterou o percentual de neoformação óssea nem a degradação dos grânulos do enxerto.
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The Role of Blood Clot in Guided Bone Regeneration: Biological Considerations and Clinical Applications with Titanium Foil. MATERIALS 2021; 14:ma14216642. [PMID: 34772167 PMCID: PMC8587813 DOI: 10.3390/ma14216642] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/22/2021] [Accepted: 10/29/2021] [Indexed: 11/17/2022]
Abstract
In Guided Bone Regeneration (GBR) materials and techniques are essential to achieve the expected results. Thanks to their properties, blood clots induce bone healing, maturation, differentiation and organization. The preferred material to protect the clot in Guided Bone Regeneration is the titanium foil, as it can be shaped according to the bone defect. Furthermore, its exposition in the oral cavity does not impair the procedure. We report on five clinical cases in order to explain the management of blood clots in combination with titanium foil barriers in different clinical settings. Besides being the best choice to protect the clot, the titanium foil represents an excellent barrier that is useful in GBR due to its biocompatibility, handling, and mechanical strength properties. The clot alone is the best natural scaffold to obtain the ideal bone quality and avoid the persistence of not-resorbed granules of filler materials in the newly regenerated bone. Even though clot contraction still needs to be improved, as it impacts the volume of the regenerated bone, future studies in GBR should be inspired by the clot and its fundamental properties.
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13
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Saida H, Fukuba S, Shiba T, Komatsu K, Iwata T, Nitta H. Two-stage approach for class II mandibular furcation defect with insufficient keratinized mucosa: a case report with 3 years' follow-up. J Int Med Res 2021; 49:3000605211044595. [PMID: 34528469 PMCID: PMC8451261 DOI: 10.1177/03000605211044595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Periodontal regenerative treatment is useful for intrabony defects and furcation involvement, but is difficult when there is insufficient keratinized mucosa to cover and maintain the regenerative material, particularly in the mandibular molar region. We report the case of a 27-year-old woman who underwent a two-stage surgical approach for a class II furcation defect with gingival recession and insufficient keratinized mucosal width (KMW) and vestibular depth at the mandibular left first molar. We first improved the KMW and keratinized mucosal thickness using an epithelial embossed connective tissue graft with enamel matrix derivative, and then focused on periodontal regeneration at the furcation defect using an enamel matrix derivative and a bovine-derived xenograft. Probing depth reduction, clinical attachment gain, horizontal probing depth reduction, KMW gain, and gingival recession reduction were observed 3 years postoperatively. This case report suggests that this novel staged approach may be effective for treating furcation defects with insufficient keratinized mucosa, thus providing useful insights into periodontal regeneration therapy.
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Affiliation(s)
- Hiroyuki Saida
- Private Practice, Saitama, Japan.,Department of General Dentistry, Graduate School of Medical and Dental Sciences, 13100Tokyo Medical and Dental University, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shunsuke Fukuba
- Department of Periodontology, Graduate School of Medical and Dental Sciences, 13100Tokyo Medical and Dental University, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahiko Shiba
- Department of Periodontology, Graduate School of Medical and Dental Sciences, 13100Tokyo Medical and Dental University, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiji Komatsu
- Department of Periodontology, Graduate School of Medical and Dental Sciences, 13100Tokyo Medical and Dental University, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takanori Iwata
- Department of Periodontology, Graduate School of Medical and Dental Sciences, 13100Tokyo Medical and Dental University, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Nitta
- Oral Diagnosis and General Dentistry, Dental Hospital, 13100Tokyo Medical and Dental University, Tokyo Medical and Dental University, Tokyo, Japan
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14
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Coyac BR, Wu M, Bahat DJ, Wolf BJ, Helms JA. Biology of sinus floor augmentation with an autograft versus a bone graft substitute in a preclinical in vivo experimental model. Clin Oral Implants Res 2021; 32:916-927. [PMID: 34031931 DOI: 10.1111/clr.13781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/03/2021] [Accepted: 05/18/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Compared to autografts, bone graft substitutes are slower to consolidate. If we understood why, this might open strategies to accelerate new bone formation and thus shorten the time to implant placement. In this study, we aimed at comparing autologous bone graft with a bovine bone graft substitute in a preclinical sinus lift model. MATERIALS AND METHODS The mouse posterior paranasal sinus served as a recipient site for grafting. Autograft from the oral cavity was compared against bone graft substitute using molecular, cellular, and histological analyses conducted on post-grafting days (PSD) 0, 9, 18, and 120. RESULTS Either autografts or bone graft substitutes were positioned on the sinus floor and remained in situ throughout the study. At the time of grafting and until day 9, bone graft substitutes were devoid of cells and alkaline phosphatase (ALP) activity while autografts were comprised of viable cells and showed strong ALP (mineralization) activity. Consequently, new bone formed faster in autografts compared to bone graft substitutes (140.21 ± 41.21 µm vs. 41.70 ± 10.09 µm, respectively, PSD9, p = .0143). By PSD18, osteogenesis was evident in autografted and xenografted sites. Osteoclasts identified by tartrate resistant acid phosphatase attached to, but did not resorb the bone graft substitute matrix. Autograft matrix, however, underwent extensive resorption. Transgenic mice revealed that Wnt-responsive osteoprogenitor cells originated primarily from the internal periosteum of the maxillary bone, and not from the Schneiderian membrane. CONCLUSION Autografts produce new bone sooner, but bovine bone graft substitutes eventually consolidate and then resist resorption. Enhancing osteoprogenitor cell recruitment to a bone graft substitute constitutes a viable strategy for accelerating bone formation in a sinus lift procedure.
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Affiliation(s)
- Benjamin R Coyac
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Meagan Wu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Daniel J Bahat
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Benjamin J Wolf
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Jill A Helms
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Stanford University, Palo Alto, CA, USA
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15
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Chen H, Gu T, Lai H, Gu X. Evaluation of hard tissue 3-dimensional stability around single implants placed with guided bone regeneration in the anterior maxilla: A 3-year retrospective study. J Prosthet Dent 2021; 128:919-927. [PMID: 33795161 DOI: 10.1016/j.prosdent.2021.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 11/16/2022]
Abstract
STATEMENT OF PROBLEM Guided bone regeneration (GBR) is widely used to reconstruct peri-implant bone defects in the esthetic zone. However, the dimensional stability of this bone-biomaterial composite is not fully understood. PURPOSE The primary aim was to evaluate the hard tissue 3-dimensional (3D) stability around single implants placed with simultaneous GBR by using deproteinized bovine bone mineral (DBBM) in the anterior maxilla and explore possible influencing factors. MATERIAL AND METHODS The records of patients who had received implants in the anterior maxilla from January 2015 to March 2016 were reviewed retrospectively. The change in volume and thickness of the facial hard tissue were analyzed. To explore possible influencing factors, the thickness and surface area of facial graft were measured, and the time point at which implants were placed and the healing protocol were recorded. Secondary outcome measures were peri-implant marginal bone loss, bleeding on probing (BOP), and pink esthetic score (PES). Statistical analysis was conducted by using the Student t test, Mann-Whitney U test, Kruskal-Wallis test, or generalized estimating equation analysis (α=.05). RESULTS Fifty-five participants were included in this study, and no implants had been lost after 3 years. BOP was present in 10 (18.2%) participants. The mean ±standard deviation PES of all implants for this study was 11.0 ±2.1. The mean ±standard deviation percentage of residual hard tissue volume was 36.9 ±23.5%, with a significant difference found between time points before 9 months (P<.05). Type 3 implant placement (OR=1.449, P=.031) was found to have a higher percentage of residual hard tissue volume. A greater reduction of the facial hard tissue thickness was observed in participants with thicker postoperative facial grafting (OR=1.463, P=.001). No statistically significant difference was found between the facial, palatal, mesial, and distal peri-implant sites in terms of marginal bone loss (P>.05). CONCLUSIONS Although single-tooth implant placement combined with GBR using DBBM in the anterior maxilla offered satisfactory esthetic and functional outcomes after a 3-year follow-up, significant hard tissue volume and thickness reduction in grafted sites was detected, especially during the initial 9-month postoperative period. This phenomenon may be correlated with the timing of implant placement and the thickness of the facial graft.
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Affiliation(s)
- Haida Chen
- Resident Physician, Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China
| | - Tianyi Gu
- Graduate student, School of Stomatology, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, PR China
| | - Haiyan Lai
- Resident Physician, Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China
| | - Xinhua Gu
- Professor, Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China.
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16
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Rocha CA, Arantes RVN, Cestari TM, Santos PS, Assis GF, Taga R. Maxillary sinus lift response to platelet-rich plasma associated with autogenous bone, ceramic biphasic HA/β-TCP (70:30), or deproteinized bovine bone. Int J Implant Dent 2020; 6:79. [PMID: 33251558 PMCID: PMC7701205 DOI: 10.1186/s40729-020-00277-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 11/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study evaluated the long-term effects of platelet-rich plasma (PRP) on bone formation and regeneration when associated with autogenous bone graft (AB), porous biphasic calcium phosphate (pBCP), or deproteinized bovine bone (DBB) in maxillary sinus augmentation (MSA) of rabbit. METHODS In 54 rabbits, bilateral MSA procedure was performed and randomly one sinus was filled with 200 mm3 material plus blood clot (AB/clot, DBB/clot, and pBCP/clot) and other with the same graft plus PRP (AB/PRP, DBB/PRP, and pBCP/PRP). After 30, 60, and 180 days, microtomographic were performed to analyze the three-dimensional MSA volume and histomorphometric analyses for the percentage of bone and soft tissues ingrowth. Data were compared by two-way ANOVA and the means were compared by the Tukey test, at p < 0.05. RESULTS The percentage of pBCP and DBB were nearly unchanged throughout the whole period and bone formation occurred in the spaces between particles. The MSA volume filled with DBB and pBCP agglutinated with clot and PRP maintained constant during all experimental periods (147.2 mm3 and 154.9 mm3, respectively, p = 0.7377), and no significant changes in the new formatted bone and soft tissue were observed between treatments. In AB/clot and AB/PRP, the MSA volume was similar at 30 days (140.3 mm3 and 137.9 mm3, respectively), but a higher and gradual reduction was observed until 180 days. In the AB/PRP, this reduction was significantly higher (44.2%) than AB/clot (22.5%) (p = 0.01792). Histologically, the addition of PRP to AB accelerated the new bone formation/remodeling maintaining the percentage of new bone similar to AB/clot during all experimental volume (p = 0.6406), while the AB particles showed a higher resorption in AB/PRP than AB/clot until 60 days (mean of 7.8% and 15.1%, respectively, p = 0.0396). CONCLUSION The association of PRP with the autogenous graft accelerates the process of bone formation/remodeling in MSA, but not had influence on the pBCP and DBB groups.
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Affiliation(s)
- Caroline Andrade Rocha
- Laboratory of Histology of Department of Biological Sciences, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, SP, 17012-901, Brazil.
| | - Ricardo Vinicius Nunes Arantes
- Laboratory of Histology of Department of Biological Sciences, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, SP, 17012-901, Brazil
| | - Tania Mary Cestari
- Laboratory of Histology of Department of Biological Sciences, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, SP, 17012-901, Brazil
| | - Paula Sanches Santos
- Laboratory of Histology of Department of Biological Sciences, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, SP, 17012-901, Brazil
| | - Gerson Francisco Assis
- Laboratory of Histology of Department of Biological Sciences, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, SP, 17012-901, Brazil
| | - Rumio Taga
- Laboratory of Histology of Department of Biological Sciences, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, SP, 17012-901, Brazil
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17
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Ying Y, Li B, Liu C, Xiong Z, Bai W, Li J, Ma P. A biodegradable gelatin-based nanostructured sponge with space maintenance to enhance long-term osteogenesis in maxillary sinus augmentation. J Biomater Appl 2020; 35:681-695. [PMID: 33059516 DOI: 10.1177/0885328220964446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The search for bone substitutes that are biodegradable, ensure space maintenance, and have osteogenic predictability, is ongoing in the field of sinus augmentation. We thus compared the bone regeneration potential of nanostructured sponges (NS-Sponge) with that of collagen-stabilized inorganic bovine bones (BO-Collagen), gelatin sponges (Gelatin), and blood clots (Cont) in sinus augmentation of rabbits. NS-Sponge was prepared by thermally induced phase separation with porogen leaching techniques. All the materials were non-hemolytic and cytocompatible. The porous and nanofibrous NS-Sponge showed better dimensional stability to support cell growth and osteogenic differentiation. In vivo, the sinus membrane collapsed in Cont and Gelatin, while BO-Collagen and NS-Sponge maintained the elevated height as assessed by come-beam computed tomography. Limited bone regeneration was observed in Cont and Gelatin. In the entire implanted area, histological analysis revealed a higher percentage of new bone area at 4 weeks of BO-Collagen treatment; however, a significantly greater increase in new bone area was observed after 12 weeks of NS-Sponge treatment. The 12-week remnant NS-Sponge material was significantly lower than the 4-week remnant material. Overall, NS-Sponge may be highly recommended for sinus augmentation, as it exhibits numerous advantages, including excellent operability, clear imaging characteristics, space maintenance, biodegradability, and superior osteogenic potential.
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Affiliation(s)
- Yiqian Ying
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Beibei Li
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Changying Liu
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Zuochun Xiong
- Chengdu Institute of Organic Chemistry, Chinese Academy of Sciences, Chengdu, China
| | - Wei Bai
- Chengdu Institute of Organic Chemistry, Chinese Academy of Sciences, Chengdu, China
| | - Jun Li
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China
| | - Pan Ma
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
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18
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Botilde G, Colin P, González‐Martín O, Lecloux G, Rompen E, Lambert F. Hard and soft tissue analysis of alveolar ridge preservation in esthetic zone using deproteinized bovine bone mineral and a saddle connective tissue graft: A long‐term prospective case series. Clin Implant Dent Relat Res 2020; 22:387-396. [DOI: 10.1111/cid.12899] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/14/2020] [Accepted: 03/10/2020] [Indexed: 01/29/2023]
Affiliation(s)
- Gaëlle Botilde
- Department of Periodontology and Oral Surgery, Faculty of Medicine University of Liege Liège Belgium
- Dental Biomaterials Research Unit University of Liège Liège Belgium
| | - Paul‐Emile Colin
- Department of Radiodiagnostic, Faculty of Medicine University of Liege Liège Belgium
| | - Oscar González‐Martín
- Department of Periodontology University Complutense of Madrid Madrid Spain
- Department of Periodontology University of Iowa Iowa Iowa USA
- Private Practice Gonzalez + Solano Atelier Dental Madrid Spain
| | - Geoffrey Lecloux
- Department of Periodontology and Oral Surgery, Faculty of Medicine University of Liege Liège Belgium
- Dental Biomaterials Research Unit University of Liège Liège Belgium
| | - Eric Rompen
- Department of Periodontology and Oral Surgery, Faculty of Medicine University of Liege Liège Belgium
- Dental Biomaterials Research Unit University of Liège Liège Belgium
| | - France Lambert
- Department of Periodontology and Oral Surgery, Faculty of Medicine University of Liege Liège Belgium
- Dental Biomaterials Research Unit University of Liège Liège Belgium
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19
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The "One Piece" Autologous Tuberosity Graft: A Contemporary Concept in Ridge Preservation. Case Rep Dent 2020; 2020:3945076. [PMID: 32099685 PMCID: PMC7040383 DOI: 10.1155/2020/3945076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/19/2019] [Accepted: 01/31/2020] [Indexed: 11/17/2022] Open
Abstract
Tooth extraction causes major changes to the ridge, rendering implant placement a more challenging procedure. Proper management of the socket is necessary to ensure sufficient bone and soft tissue for a successful implant-supported prosthesis. This article presents a practical approach for autologous hard and soft tissue grafting. A soft and hard tissue graft is harvested in one piece from the maxillary tuberosity and stabilized in the extraction socket.
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20
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Sato N, Handa K, Venkataiah VS, Hasegawa T, Njuguna MM, Yahata Y, Saito M. Comparison of the vertical bone defect healing abilities of carbonate apatite, β-tricalcium phosphate, hydroxyapatite and bovine-derived heterogeneous bone. Dent Mater J 2019; 39:309-318. [PMID: 31776317 DOI: 10.4012/dmj.2019-084] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The treatment of vertical bone defects caused by severe periodontal disease requires the regeneration of periodontal tissue. Although various bone substitutes have been clinically applied to vertical bone defect correction, the evaluation of these materials in periodontal tissue remains incomplete. The purpose of this study was to examine the bone regeneration abilities of various bone substitutes including Cytrans, Cerasorb, Neobone and Bio-Oss in a 3-wall bone defect animal model. All of these bone substitutes showed a similar healing ability to periodontal ligament and cementum. However, Cytrans showed the fastest bone healing ability compared with the other materials at 4 weeks post-transplantation. In addition, the recruitment of osteoclasts and endothelial cells was observed in Cytrans grafts at 4 weeks, but only detected at 8 weeks in the other materials. These results suggest that Cytrans promotes faster bone healing by inducing bone remodeling and angiogenesis.
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Affiliation(s)
- Nobuya Sato
- Department of Restorative Dentistry, Division of Operative Dentistry, Tohoku University Graduate School of Dentistry
| | - Keisuke Handa
- Department of Restorative Dentistry, Division of Operative Dentistry, Tohoku University Graduate School of Dentistry
| | - Venkata Suresh Venkataiah
- Department of Restorative Dentistry, Division of Operative Dentistry, Tohoku University Graduate School of Dentistry
| | - Tatsuya Hasegawa
- Department of Restorative Dentistry, Division of Operative Dentistry, Tohoku University Graduate School of Dentistry
| | - Mary M Njuguna
- Department of Restorative Dentistry, Division of Operative Dentistry, Tohoku University Graduate School of Dentistry
| | - Yoshio Yahata
- Department of Restorative Dentistry, Division of Operative Dentistry, Tohoku University Graduate School of Dentistry
| | - Masahiro Saito
- Department of Restorative Dentistry, Division of Operative Dentistry, Tohoku University Graduate School of Dentistry
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21
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Franceschetti G, Farina R, Minenna L, Riccardi O, Stacchi C, Di Raimondo R, Maietti E, Trombelli L. The impact of graft remodeling on peri-implant bone support at implants placed concomitantly with transcrestal sinus floor elevation: A multicenter, retrospective case series. Clin Oral Implants Res 2019; 31:105-120. [PMID: 31532857 DOI: 10.1111/clr.13541] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/08/2019] [Accepted: 09/03/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To evaluate the impact on peri-implant bone support (as assessed on periapical radiographs) of the remodeling dynamics of varying graft biomaterials used for transcrestal sinus floor elevation (tSFE). METHODS The study is a multicenter, retrospective series of cases undergone tSFE (performed according to the Smart Lift technique) and concomitant implant placement. At operator's discretion, tSFE was performed with bone core (BC) alone or supplemented by deproteinized bovine or porcine bone mineral (DBBM and DPBM, respectively), synthetic hydroxyapatite in a collagen matrix (S-HA), or ß-tricalcium phosphate (ß-TCP). Immediately after surgery, at 6-12 months post-surgery, and at later (≥24 months) follow-up intervals, the percentage proportion of the implant surface in direct contact with the radiopaque area was calculated for the entire implant surface (totCON%). Also, the height of the graft apical to the implant apex (aGH) was assessed. RESULTS At 6-12 months following tSFE, median totCON% was 100%, with a median aGH of 1.4 mm. A tendency of aGH to decrease in height was observed at later follow-up intervals for sites treated with all grafting procedures. In all treatment groups, the majority of the implant surface was still surrounded by the radiopaque area at the longest follow-up visits. CONCLUSIONS Although the height of the peri-implant radiopaque area apical to the implant apex tends to reduce overtime at sites which have received tSFE, the peri-implant bone support seems to be maintained long term irrespective of the graft material used.
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Affiliation(s)
- Giovanni Franceschetti
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy
| | - Roberto Farina
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy.,Operative Unit of Dentistry, University-Hospital of Ferrara, Ferrara, Italy
| | - Luigi Minenna
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy
| | - Orio Riccardi
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy.,Private practice, Rimini, Italy
| | | | | | - Elisa Maietti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.,Center of Clinical Epidemiology, University of Ferrara, Italy
| | - Leonardo Trombelli
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy.,Operative Unit of Dentistry, University-Hospital of Ferrara, Ferrara, Italy
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22
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Di Stefano DA, Greco G, Gherlone E. A Preshaped Titanium Mesh for Guided Bone Regeneration with an Equine-Derived Bone Graft in a Posterior Mandibular Bone Defect: A Case Report. Dent J (Basel) 2019; 7:dj7030077. [PMID: 31374857 PMCID: PMC6784736 DOI: 10.3390/dj7030077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/16/2019] [Accepted: 07/22/2019] [Indexed: 01/05/2023] Open
Abstract
One of the most often used bone augmentation techniques is the guided bone regeneration procedure. The authors report the case of a 75-year-old man with an atrophic right posterior mandible who underwent bone augmentation through guided bone regeneration with a preshaped titanium mesh adapted on a stereolithographic model of the patient’s jaw. The graft volume was simulated with a light-curing resin. The actual site was grafted with a mixture of autogenous and equine-derived bone. Five months later, the mesh was retrieved, three cylindrical implants were positioned, and a bone biopsy was collected for histomorphometric analysis. A provisional prosthesis was delivered three and a half months later. Definitive rehabilitation was accomplished after one additional month. The graft allowed for effective bone formation (newly formed bone, residual biomaterial, and medullar spaces were, respectively, 39%, 10%, and 51% of the core volume). The patient has functioned successfully throughout six and a half years of follow-up. Using the preshaped titanium mesh in association with the enzyme-treated equine bone substitute provided effective bone regeneration.
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Affiliation(s)
- Danilo Alessio Di Stefano
- Dental School, Vita e Salute University and IRCCS San Raffaele, 20132 Milan, Italy.
- Private Practice, 20148 Milan, Italy.
| | | | - Enrico Gherlone
- Dental School, Vita e Salute University and IRCCS San Raffaele, 20132 Milan, Italy
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23
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Hung CC, Fu E, Chiu HC, Liang HC. Bone formation following sinus grafting with an alloplastic biphasic calcium phosphate in Lanyu Taiwanese mini-pigs. J Periodontol 2019; 91:93-101. [PMID: 31350789 DOI: 10.1002/jper.17-0748] [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: 12/24/2017] [Revised: 06/03/2019] [Accepted: 06/11/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND To evaluate the new bone formation after grafting with a synthetic biphasic calcium phosphate in sinuses with minimal bone height, the alloplastic and xenograft materials were compared after grafting into Lanyu Taiwanese mini-pig sinuses via split-mouth design. METHODS In six mini-pigs, synthetic hydroxyapatite/tricalcium phosphate (HA/TCP) particles were inserted into one of the sinus cavities using the extra-oral approach, where deproteinized bovine bone mineral (DBBM) particles were placed contralaterally. Fluorescent bony labels of Alizarin and Calcein green were delivered at weeks 4 and 8, respectively. Animals were sacrificed at week 12 and the augmented tissues were evaluated by cone-beam computed tomography, microcomputed tomography, and histology. RESULTS By radiographic examination, the mean thicknesses of sinus cortexes for DBBM and HA/TCP groups were similar (0.35 versus 0.38 cm) and the mean volumes augmented were also indifferent (1.29 versus 1.64 cm3 ). The distributions of bones, residual particles, and non-mineralized tissues in augmented masses between groups were undistinguishable. Under microscopy, however, macroporosities of osteons were filled with HA/TCP residual particles, whereas the newly formed bones lay on top of DBBM particle surfaces. Although the mineral deposition rates between groups were indifferent, the mean labeled surface in the HA/TCP group was significantly greater than those in the DBBM group at week 4 (35.16% versus 14.00% for HA/TCP and DBBM, respectively) but less than that at week 8 (19.33% versus 39.16%, respectively). CONCLUSION Sinus augmentation with synthetic HA/TCP and DBBM exhibited similar effectiveness in new bone formation.
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Affiliation(s)
- Chao-Chien Hung
- Department of Periodontology, School of Dentistry, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan
| | - Earl Fu
- Department of Periodontology, School of Dentistry, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan.,Department of Dentistry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Hsien-Chung Chiu
- Department of Periodontology, School of Dentistry, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan
| | - Huang-Chien Liang
- Department of Materials Engineering, Ming Chi University of Technology, New Taipei City, Taiwan
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Di Stefano DA, Zaniol T, Cinci L, Pieri L. Chemical, Clinical and Histomorphometric Comparison between Equine Bone Manufactured through Enzymatic Antigen-Elimination and Bovine Bone Made Non-Antigenic Using a High-Temperature Process in Post-Extractive Socket Grafting. A Comparative Retrospective Clinical Study. Dent J (Basel) 2019; 7:dj7030070. [PMID: 31266159 PMCID: PMC6784468 DOI: 10.3390/dj7030070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 04/29/2019] [Accepted: 05/06/2019] [Indexed: 12/17/2022] Open
Abstract
Enzyme-deantigenic equine bone (EDEB) and anorganic bovine bone (ABB) are two xenografts made non-antigenic through different processing methods. This study aimed to characterize them for the presence of native bone collagen and other proteins and to compare their histomorphometric outcome when they were used to graft post-extractive sockets. The records of 46 patients treated with EDEB (n = 22) or ABB (n = 24) and followed-up for at least four months after delayed implant placement, were retrospectively collected. Samples of EDEB and ABB were analyzed using Attenuated Total Reflection Fourier Transform Infrared and Sodium Dodecyl Sulfate-Polyacrylamide Gel Electrophoresis for the presence of collagen and other proteins. For histomorphometric analysis on bone specimens, newly formed bone and residual biomaterial percentages were calculated. Results of the present study show that EDEB contains type I bone collagen in its native conformation, while no proteins were detected in ABB. Grafting EDEB resulted in a significantly greater quantity of newly formed bone and less residual biomaterial. Our findings suggest that the manufacturing process can greatly affect the graft behavior and a process preserving collagen in its native form may favor bone tissue regeneration.
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Affiliation(s)
| | - Terry Zaniol
- Private Practice, Crocetta del Montello, 31035 Treviso, Italy
| | - Lorenzo Cinci
- Department of Neuroscience, Psychology, Drug Research and Child Health (Neurofarba), Pharmacology and Toxicology Section, University of Florence, Viale G. Pieraccini 6, 50139 Florence, Italy
| | - Laura Pieri
- Department of Health Sciences, Interdepartmental Forensic Medicine Section, University of Florence, Viale G. Pieraccini 6, 50139 Florence, Italy
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Shavit E, Shavit I, Pinchasov D, Shavit D, Pinchasov G, Juodzbalys G. The Use of Tooth Derived Bone Graft Materials in Sinus Augmentation Procedures: a Systematic Review. J Oral Maxillofac Res 2019; 10:e1. [PMID: 31402970 PMCID: PMC6683389 DOI: 10.5037/jomr.2019.10201] [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: 06/10/2019] [Accepted: 06/26/2019] [Indexed: 04/23/2023]
Abstract
OBJECTIVES The goal of this systematic review was to assess the current literature about sinus augmentation procedure using different types of tooth derived bone graft materials, thorough analysing the outcomes of sinus grafting with tooth grafts compared to sinus grafting with xenografts, allografts and alloplasts by radiography and histomorphometry. MATERIAL AND METHODS An electronic search in the MEDLINE (NCBI PubMed and PubMed Central) database was conducted to identify articles concerning application of tooth bone grafts in sinus augmentation. The search was restricted to English language articles published in the last 10 years (December 2009 to March 2019). RESULTS In total, 21 articles were found, out of which 7 met the inclusion criteria and were included in the final synthesis. According to the type of diagnostic tool, data about graft material outcome in sinus was extracted, and included the residual alveolar height, augmented graft height, resorption height as seen in panoramic radiography and histomorphometric analysis of new bone formation and residual graft material. CONCLUSIONS Within the limitations of our review, we suggest that tooth derived graft materials are as successful as xenografts, allografts and alloplasts in sinus augmentation procedures according to the radiographic and histomorphometric showings. Additional wider research should be conducted in order to determine whether tooth derived graft materials are superior to the currently used materials.
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Affiliation(s)
- Eliyahu Shavit
- Department of Oral and Maxillofacial Surgery, Lithuanian University of Health SciencesLithuania.
| | - Ilana Shavit
- Department of Oral and Maxillofacial Surgery, Lithuanian University of Health SciencesLithuania.
| | - Daniel Pinchasov
- Department of Oral and Maxillofacial Surgery, Lithuanian University of Health SciencesLithuania.
| | - David Shavit
- Department of Oral and Maxillofacial Surgery, Lithuanian University of Health SciencesLithuania.
| | - Ginnady Pinchasov
- Department of Oral and Maxillofacial Surgery, Lithuanian University of Health SciencesLithuania.
| | - Gintaras Juodzbalys
- Department of Oral and Maxillofacial Surgery, Lithuanian University of Health SciencesLithuania.
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Comparative Histomorphometric Analysis of Maxillary Sinus Augmentation With Deproteinized Bovine Bone and Demineralized Particulate Human Tooth Graft: An Experimental Study in Rabbits. IMPLANT DENT 2018; 27:324-331. [PMID: 29613862 DOI: 10.1097/id.0000000000000755] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this animal study is to evaluate, by histomorphometric analysis, new bone formation in rabbit maxillary sinuses with Bio-Oss and demineralized particulate human tooth graft. MATERIALS AND METHODS Bilateral sinus augmentation procedures were performed in 8 adult male rabbits. After preparation of replaceable bony windows on the lateral wall of the nasal cavity with a piezoelectric surgical device, deproteinized bovine graft (Bio-Oss) was grafted in the new compartment of the maxillary sinus after elevation of the sinus membrane in the control group. In the experimental group, the demineralized human particulate tooth bone was grafted in the sinus. The replaceable bony window was repositioned over the bone graft in both groups. Animals were killed at 2 and 8 weeks after the surgical procedure. The augmented sinuses were evaluated by histomorphometric analysis using hematoxylin-eosin and Masson trichrome stains. RESULTS Histologically, new bone was revealed along the elevated sinus membrane and both bone grafts. In the control group, the new bone area at 8 weeks was not significantly different than that at 2 weeks. In the experimental group, the new bone area at 8 weeks was significantly greater than that at 2 weeks. CONCLUSION Significant higher new bone formation was revealed in the experimental group than in the control group.
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Naros A, Bayazeed B, Schwarz U, Nagursky H, Reinert S, Schmelzeisen R, Sauerbier S. A prospective histomorphometric and cephalometric comparison of bovine bone substitute and autogenous bone grafting in Le Fort I osteotomies. J Craniomaxillofac Surg 2018; 47:233-238. [PMID: 30591394 DOI: 10.1016/j.jcms.2018.11.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 11/01/2018] [Accepted: 11/29/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The aim of the present study was the histomorphometric and cephalometric comparison of autogenous bone grafting of the anterior iliac crest and the application of bovine bone substitute concerning new bone formation and postoperative stability in patients undergoing orthognathic Le Fort I osteotomy. PATIENTS AND METHODS Twenty-five patients requiring orthognathic surgery with Le Fort I osteotomy were included in this study. Patients were randomly divided into three groups receiving either autogenous iliac crest BONE grafting (BONE; n = 8) or xenogenic bovine bone grafting (Bio-Oss®) in INTER (n = 12) or in ONLAY (n = 5) position. Histomorphometric analysis was performed using trephine bone biopsies from the autogenous, respectively xenogenic bone grafting region. Postoperative stability was evaluated using teleradiographies of three different timepoints. RESULTS All groups showed comparable mineralized fractions in bone biopsies of 50.2% (±13.2%) INTER, 46.48% (±12.3%) ONLAY and 57.1% (±20.6%) BONE as well as comparable percentage of connective tissue. Patients in the INTER-group revealed the lowest relapse rate of 20.5% (INTER) compared to 30.3% (ONLAY) and 33.0% (BONE). All groups underwent comparable maxillary advancement and healing time. CONCLUSIONS Present results indicate that block shaped bovine bone substitute is a promising alternative to autogenous bone grafting to bridge the Le Fort I osteotomy gap in orthognathic surgery.
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Affiliation(s)
- Andreas Naros
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. Siegmar Reinert, MD, DMD, PhD), University Hospital Tuebingen, Osianderstrasse 2-8, 72076 Tuebingen, Germany.
| | - Bassem Bayazeed
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. Rainer Schmelzeisen, MD, DMD, PhD), University Hospital Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Ulrich Schwarz
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. Rainer Schmelzeisen, MD, DMD, PhD), University Hospital Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Heiner Nagursky
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. Rainer Schmelzeisen, MD, DMD, PhD), University Hospital Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Siegmar Reinert
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. Siegmar Reinert, MD, DMD, PhD), University Hospital Tuebingen, Osianderstrasse 2-8, 72076 Tuebingen, Germany
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. Rainer Schmelzeisen, MD, DMD, PhD), University Hospital Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Sebastian Sauerbier
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. Siegmar Reinert, MD, DMD, PhD), University Hospital Tuebingen, Osianderstrasse 2-8, 72076 Tuebingen, Germany; Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. Rainer Schmelzeisen, MD, DMD, PhD), University Hospital Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
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Steam Sterilization of Equine Bone Block: Morphological and Collagen Analysis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9853765. [PMID: 30186873 PMCID: PMC6109994 DOI: 10.1155/2018/9853765] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/01/2018] [Indexed: 11/18/2022]
Abstract
Introduction The use of equine bone blocks is widely reported for bone augmentation techniques. The block must be shaped according to the form of the defect that should be regenerated. The shaping could be performed by hand before or during the surgery, in a sterile ambient, or using a CNC milling machine that could not be sterile. The aim of our study was to evaluate if a steam sterilization could provide a medical grade sterilization of the blocks and to evaluate if bone microstructure and collagen structures change after different steam sterilization protocols provided by mainstream autoclave. Materials and Method Two blocks of equine bone were divided into 16 samples. 1 sample was used as control and not submitted to any treatment. 15 samples were infected with a Streptococcus faecalis bacterial culture. The samples were singularly packed, randomly divided into 3 groups, and submitted to autoclave sterilization on the same device. The groups were submitted to a sterilization cycle (Gr. A: 121°C, 1,16 bar for 20'; Gr. B:134°C, 2,16 bar for 4'; Gr. C: 134°C, 2,16 bar for 3.30 min.). 2 samples for each group were evaluated for the sterility. 3 samples for each group were observed at SEM to notice the macro- and microstructure modification and to confocal microscope to observe the collagen. Results All samples were sterile. The SEM evaluation showed, in all groups, a preserved morphological structure. Confocal microscope evaluation shows that the collagen structure appears to be more uniform and preserved in group C. Conclusion Data show that autoclave steam sterilization could be reliable to obtain sterilization of equine bone blocks.
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Histologic and Histomorphometric Analysis of Bone Regeneration with Bovine Grafting Material after 24 Months of Healing. A Case Report. J Funct Biomater 2018; 9:jfb9030048. [PMID: 30096773 PMCID: PMC6163257 DOI: 10.3390/jfb9030048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/29/2018] [Accepted: 07/31/2018] [Indexed: 12/21/2022] Open
Abstract
Anorganic bovine bone mineral matrix (ABBMM) has been reported to have osteoconductive properties and no inflammatory or adverse responses when used as grafting material in sinus augmentation procedures. However, controversy remains in regard to degradation rate of ABBMM. The aim of this study was to histologically and histomorphometrically evaluate the degradation of ABBMM in human bone samples obtained in one patient 24 months after sinus augmentation. Materials and Methods: The histologic and histomorphometric analysis was performed by means of light microscopy in three specimens harvested from the same patient, Results: After 24 months the tissue pattern appeared to be composed of residual particles, some in close contact with the newly formed bone, others separated by translucent areas and osteoid tissues. Newly-formed bone presented different levels of maturation and numerous osteocytes, with greater numbers in bone closer to the grafted particles (27.3% vs. 11.2%, p < 0.05). The histomorphometric analysis showed mean values of 40.84% newly-formed bone, 33.58% residual graft material, 23.84% marrow spaces, and 1.69% osteoid tissue, Conclusions: Even though ABBMM underwent considerable resorption, a great amount of residual grafting material was still present after two years of healing following sinus augmentation. This study confirms that the bovine grafts can be classified as long-term degradation materials.
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Comparative Histological and Histomorphometric Results of Six Biomaterials Used in Two-Stage Maxillary Sinus Augmentation Model after 6-Month Healing. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9430989. [PMID: 30050947 PMCID: PMC6040296 DOI: 10.1155/2018/9430989] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/20/2018] [Indexed: 12/18/2022]
Abstract
Objectives To evaluate the performances of six different bone substitute materials used as graft in maxillary sinus augmentation by means of histological and histomorphometric analysis of bone biopsies retrieved from human subjects after a 6-month healing period. Materials and Methods Six consecutive patients (3 males, 3 females, aged 50-72 years), healthy, nonsmokers, and with good oral hygiene, presenting edentulous posterior maxilla with a residual bone crest measuring ≤ 4 mm in vertical height and 3 to 5 mm in horizontal thickness at radiographic examination, were selected to receive sinus augmentation and delayed implant placement. Under randomized conditions, sinus augmentation procedures were carried out using mineralized solvent-dehydrated bone allograft (MCBA), freeze-dried mineralized bone allograft (FDBA), anorganic bovine bone (ABB), equine-derived bone (EB), synthetic micro-macroporous biphasic calcium-phosphate block consisting of 70% beta-tricalcium phosphate and 30% hydroxyapatite (HA-β-TCP 30/70), or bioapatite-collagen (BC). After 6 months, bone core biopsies were retrieved and 13 implants were placed. Bone samples were processed for histological and histomorphometric analysis. CT scans were taken before and after surgery. After 4 months of healing, patients were restored with a provisional fixed acrylic resin prosthesis, as well as after further 2-4 months with a definitive cemented zirconia or porcelain-fused-to-metal crowns. Results There were no postoperative complications or implant failures. The histological examination showed that all biomaterials were in close contact with newly formed bone, surrounding the graft granules with a bridge-like network. No signs of acute inflammation were observed. The histomorphometry revealed 20.1% newly formed bone for MCBA, 32.1% for FDBA, 16.1% for ABB, 22.8% for EB, 20.3% for HA-β-TCP 30/70, and 21.4% for BC. Conclusions Within the limitations of the present investigation, all the six tested biomaterials showed good biocompatibility and osteoconductive properties when used in sinus augmentation procedures, although the FDBA seemed to have a better histomorphometric result in terms of newly formed bone and residual graft material. This trial is registered with ClinicalTrials.gov Identifier (Registration Number): NCT03496688.
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31
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Rodriguez Y Baena R, D'Aquino R, Graziano A, Trovato L, Aloise AC, Ceccarelli G, Cusella G, Pelegrine AA, Lupi SM. Autologous Periosteum-Derived Micrografts and PLGA/HA Enhance the Bone Formation in Sinus Lift Augmentation. Front Cell Dev Biol 2017; 5:87. [PMID: 29021982 PMCID: PMC5623661 DOI: 10.3389/fcell.2017.00087] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/12/2017] [Indexed: 12/30/2022] Open
Abstract
Sinus lift augmentation is a procedure required for the placement of a dental implant, whose success can be limited by the quantity or quality of available bone. To this purpose, the first aim of the current study was to evaluate the ability of autologous periosteum-derived micrografts and Poly(lactic-co-glycolic acid) (PLGA) supplemented with hydroxyl apatite (HA) to induce bone augmentation in the sinus lift procedure. Secondly, we compared the micrograft's behavior with respect to biomaterial alone, including Bio-Oss® and PLGA/HA, commercially named Alos. Sinus lift procedure was performed on 24 patients who required dental implants and who, according to the study design and procedure performed, were divided into three groups: group A (Alos + periosteum-derived micrografts); group B (Alos alone); and group C (Bio-Oss® alone). Briefly, in group A, a small piece of periosteum was collected from each patient and mechanically disaggregated by Rigenera® protocol using the Rigeneracons medical device. This protocol allowed for the obtainment of autologous micrografts, which in turn were used to soak the Alos scaffold. At 6 months after the sinus lift procedure and before the installation of dental implants, histological and radiographic evaluations in all three groups were performed. In group A, where sinus lift augmentation was performed using periosteum-derived micrografts and Alos, the bone regeneration was much faster than in the control groups where it was performed with Alos or Bio-Oss® alone (groups B and C, respectively). In addition, the radiographic evaluation in the patients of group A showed a radio-opacity after 4 months, while after 6 months, the prosthetic rehabilitation was improved and was maintained after 2 years post-surgery. In summary, we report on the efficacy of periosteum-derived micrografts and Alos to augment sinus lift in patients requiring dental implants. This efficacy is supported by an increased percentage of vital mineralized tisssue in the group treated with both periosteum-derived micrografts and Alos, with respect to the control group of Alos or Bio-Oss® alone, as confirmed by histological analysis and radiographic evaluations at 6 months from treatment.
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Affiliation(s)
- Ruggero Rodriguez Y Baena
- Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Riccardo D'Aquino
- Private Practice, Turin, Italy.,Human Brain Wave S.r.L., Turin, Italy
| | - Antonio Graziano
- Human Brain Wave S.r.L., Turin, Italy.,Sbarro Health Research Organization (SHRO), Temple University of Philadelphia, Philadelphia, PA, United States
| | | | - Antonio C Aloise
- Department of Implantology, São Leopoldo Mandic Institute and Research Center, Campinas, Brazil
| | - Gabriele Ceccarelli
- Department of Public Health, Experimental Medicine and Forensics, University of Pavia, Pavia, Italy.,Centre for Health Technologies, University of Pavia, Pavia, Italy
| | - Gabriella Cusella
- Department of Public Health, Experimental Medicine and Forensics, University of Pavia, Pavia, Italy.,Centre for Health Technologies, University of Pavia, Pavia, Italy
| | - André A Pelegrine
- Department of Implantology, São Leopoldo Mandic Institute and Research Center, Campinas, Brazil
| | - Saturnino M Lupi
- Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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Nizam N, Eren G, Akcalı A, Donos N. Maxillary sinus augmentation with leukocyte and platelet-rich fibrin and deproteinized bovine bone mineral: A split-mouth histological and histomorphometric study. Clin Oral Implants Res 2017; 29:67-75. [PMID: 28786494 DOI: 10.1111/clr.13044] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate the effect of leukocyte and platelet-rich fibrin (L-PRF) in combination with deproteinized bovine bone mineral (DBBM) on bone regeneration in maxillary sinus augmentation. MATERIAL AND METHODS Thirteen patients (nine males and four females, mean age ± SD; 49.92 ± 10.37) were enrolled to the study. 26 maxillary sinus augmentation procedures were randomly performed using DBBM and L-PRF mixture (test) or DBBM alone (control) in a split-mouth design. The same surgical procedures were performed in both groups, and bone biopsies were harvested from the implant sites 6 months postoperatively for histological and histomorphometric evaluations as the primary outcome of the study. Implants were placed and then loaded in the augmented sites after 6 months. The secondary outcomes included clinical and radiographic data and were obtained pre- and postoperatively. RESULTS There was no qualitative difference in histological analyses among the groups. In all samples, a newly formed bone was in direct contact with the residual material. The percentages of newly formed bone (test; 21.38 ± 8.78% and control; 21.25 ± 5.59%), residual bone graft (test; 25.95 ± 9.54% and control; 32.79 ± 5.89%), bone graft in contact with the newly formed bone (test; 47.33 ± 12.33% and control; 54.04 ± 8.36%), and soft tissue (test; 52.67 ± 12.53% and control; 45.96 ± 8.36%) were similar among the groups (p < .05). Similar radiographic bone height in the augmented area was observed, and implant survival rate was 100% for both groups. CONCLUSIONS Both techniques were effective for maxillary sinus augmentation, and after 6 months of healing, the addition of L-PRF in DBBM did not improve the amount of regenerated bone or the amount of the graft integrated into the newly formed bone under histological and histomorphometric evaluation.
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Affiliation(s)
- Nejat Nizam
- Department of Periodontology, School of Dentistry, Ege University, İzmir, Turkey
| | - Gülnihal Eren
- Department of Periodontology, School of Dentistry, Ege University, İzmir, Turkey
| | - Aliye Akcalı
- Department of Periodontology, School of Dentistry, Ege University, İzmir, Turkey.,Centre for Oral Clinical Research, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London (QMUL), London, UK
| | - Nikolaos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London (QMUL), London, UK
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Offner D, Wagner Q, Idoux-Gillet Y, Gegout H, Ferrandon A, Schwinté P, Musset AM, Benkirane-Jessel N, Keller L. Hybrid collagen sponge and stem cells as a new combined scaffold able to induce the re-organization of endothelial cells into clustered networks. Biomed Mater Eng 2017; 28:S185-S192. [PMID: 28372294 DOI: 10.3233/bme-171640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The time needed to obtain functional regenerated bone tissue depends on the existence of a reliable vascular support. Current techniques used in clinic, for example after tooth extraction, do not allow regaining or preserving the same bone volume. Our aim is to develop a cellularized active implant of the third generation, equipped with human mesenchymal stem cells to improve the quality of implant vascularization. We seeded a commercialized collagen implant with human mesenchymal stem cells (hMSCs) and then with human umbilical vein endothelial cells (HUVECs). We analyzed the biocompatibility and the behavior of endothelial cells with this implant. We observed a biocompatibility of the active implant, and a re-organization of endothelial cells into clustered networks. This work shows the possibility to develop an implant of the third generation supporting vascularization, improving the medical care of patients.
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Affiliation(s)
- Damien Offner
- INSERM (French National Institute of Health and Medical Research), 'Osteoarticular and Dental Regenerative Nanomedicine' Laboratory, UMR 1109, Faculté de Médecine, F-67085 Strasbourg cedex, FMTS, France.,Université de Strasbourg, Faculté de Chirurgie Dentaire, 8 rue Sainte Elisabeth, F-67000 Strasbourg, France.,Hôpitaux Universitaires de Strasbourg (HUS), 1 place de l'Hôpital, F-67000 Strasbourg, France
| | - Quentin Wagner
- INSERM (French National Institute of Health and Medical Research), 'Osteoarticular and Dental Regenerative Nanomedicine' Laboratory, UMR 1109, Faculté de Médecine, F-67085 Strasbourg cedex, FMTS, France.,Université de Strasbourg, Faculté de Chirurgie Dentaire, 8 rue Sainte Elisabeth, F-67000 Strasbourg, France
| | - Ysia Idoux-Gillet
- INSERM (French National Institute of Health and Medical Research), 'Osteoarticular and Dental Regenerative Nanomedicine' Laboratory, UMR 1109, Faculté de Médecine, F-67085 Strasbourg cedex, FMTS, France.,Université de Strasbourg, Faculté de Chirurgie Dentaire, 8 rue Sainte Elisabeth, F-67000 Strasbourg, France
| | - Hervé Gegout
- Université de Strasbourg, Faculté de Chirurgie Dentaire, 8 rue Sainte Elisabeth, F-67000 Strasbourg, France
| | - Arielle Ferrandon
- INSERM (French National Institute of Health and Medical Research), 'Osteoarticular and Dental Regenerative Nanomedicine' Laboratory, UMR 1109, Faculté de Médecine, F-67085 Strasbourg cedex, FMTS, France.,Université de Strasbourg, Faculté de Chirurgie Dentaire, 8 rue Sainte Elisabeth, F-67000 Strasbourg, France
| | - Pascale Schwinté
- INSERM (French National Institute of Health and Medical Research), 'Osteoarticular and Dental Regenerative Nanomedicine' Laboratory, UMR 1109, Faculté de Médecine, F-67085 Strasbourg cedex, FMTS, France.,Université de Strasbourg, Faculté de Chirurgie Dentaire, 8 rue Sainte Elisabeth, F-67000 Strasbourg, France
| | - Anne-Marie Musset
- Université de Strasbourg, Faculté de Chirurgie Dentaire, 8 rue Sainte Elisabeth, F-67000 Strasbourg, France.,Hôpitaux Universitaires de Strasbourg (HUS), 1 place de l'Hôpital, F-67000 Strasbourg, France
| | - Nadia Benkirane-Jessel
- INSERM (French National Institute of Health and Medical Research), 'Osteoarticular and Dental Regenerative Nanomedicine' Laboratory, UMR 1109, Faculté de Médecine, F-67085 Strasbourg cedex, FMTS, France.,Université de Strasbourg, Faculté de Chirurgie Dentaire, 8 rue Sainte Elisabeth, F-67000 Strasbourg, France
| | - Laetitia Keller
- INSERM (French National Institute of Health and Medical Research), 'Osteoarticular and Dental Regenerative Nanomedicine' Laboratory, UMR 1109, Faculté de Médecine, F-67085 Strasbourg cedex, FMTS, France.,Université de Strasbourg, Faculté de Chirurgie Dentaire, 8 rue Sainte Elisabeth, F-67000 Strasbourg, France
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Ramírez Fernández MP, Mazón P, Gehrke SA, Calvo-Guirado JL, De Aza PN. Comparison of Two Xenograft Materials Used in Sinus Lift Procedures: Material Characterization and In Vivo Behavior. MATERIALS 2017; 10:ma10060623. [PMID: 28772984 PMCID: PMC5553531 DOI: 10.3390/ma10060623] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/29/2017] [Accepted: 05/30/2017] [Indexed: 12/19/2022]
Abstract
Detailed information about graft material characteristic is crucial to evaluate their clinical outcomes. The present study evaluates the physico-chemical characteristics of two xenografts manufactured on an industrial scale deproteinized at different temperatures (non-sintered and sintered) in accordance with a protocol previously used in sinus lift procedures. It compares how the physico-chemical properties influence the material’s performance in vivo by a histomorphometric study in retrieved bone biopsies following maxillary sinus augmentation in 10 clinical cases. An X-ray diffraction analysis revealed the typical structure of hydroxyapatite (HA) for both materials. Both xenografts were porous and exhibited intraparticle pores. Strong differences were observed in terms of porosity, crystallinity, and calcium/phosphate. Histomorphometric measurements on the bone biopsies showed statistically significant differences. The physic-chemical assessment of both xenografts, made in accordance with the protocol developed on an industrial scale, confirmed that these products present excellent biocompatibilitity, with similar characteristics to natural bone. The sintered HA xenografts exhibited greater osteoconductivity, but were not completely resorbable (30.80 ± 0.88% residual material). The non-sintered HA xenografts induced about 25.92 ± 1.61% of new bone and a high level of degradation after six months of implantation. Differences in the physico-chemical characteristics found between the two HA xenografts determined a different behavior for this material.
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Affiliation(s)
- María Piedad Ramírez Fernández
- Cátedra Internacional de Investigación en Odontología, Universidad Católica San Antonio de Murcia, Avda. Jerónimos, 135, 30107 Guadalupe, Murcia, Spain.
| | - Patricia Mazón
- Departamento de Materiales, Óptica y Tecnologia Electrónica, Universidad Miguel Hernández, Avda. Universidad s/n, 03202-Elche, Alicante, Spain.
| | - Sergio A Gehrke
- Biotecnos Research Center, Rua Dr. Bonazo n° 57, 97015-001-Santa Maria (RS), Brazil.
| | - Jose Luis Calvo-Guirado
- Cátedra Internacional de Investigación en Odontología, Universidad Católica San Antonio de Murcia, Avda. Jerónimos, 135, 30107 Guadalupe, Murcia, Spain.
| | - Piedad N De Aza
- Instituto de Bioingenieria, Universidad Miguel Hernandez, Avda. Ferrocarril s/n. 03202-Elche, Alicante, Spain.
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Subantral Augmentation With Mineralized Cortical Bone Allograft Material: Clinical, Histological, and Histomorphometric Analyses and Graft Volume Assessments. IMPLANT DENT 2017; 25:353-60. [PMID: 26866847 DOI: 10.1097/id.0000000000000391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to clinically and histologically evaluate the effect of using mineralized cortical bone allograft in sinus lift augmentation and to 3-dimensionally quantify volumetric changes in maxillary sinuses augmented over a 2-year period. MATERIALS AND METHODS Eleven patients affected with less than 3 mm of residual ridge were enrolled in the study. After sinus grafting with a mineralized bone allograft, the site was covered with a collagen wound dressing. During implant placement 4 months later, a biopsy was obtained for histological and histomorphometry evaluations. Bone volume changes were also evaluated. RESULTS Biopsies showed mature cancellous bone with a predominantly lamellar structure. The well-vascularized intertrabecular spaces were filled with connective tissue and bone marrow. Histomorphometry evaluations revealed a mean 43.76 ± 1.47% of bone marrow, 40.16 ± 1.35% of mineralized bone and 16.59 ± 0.55% of woven bone. The mean of residual particles was 0.47 ± 0.01%. Volumetric measurements showed a mean volume of grafted material 16.24 ± 1.55 cm at T0, 14.48 ± 1.48 cm at T1, and 13.06 ± 1.39 cm at T2. The mean volume retraction was 10.83% of the initial total volume at (T0-T1) and 9.8% at (T1-T2). CONCLUSIONS The clinical and histological results indicated that mineralized cortical bone allograft promoted de novo bone formation and can be used for sinus lift procedure.
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SEM-EDX Study of the Degradation Process of Two Xenograft Materials Used in Sinus Lift Procedures. MATERIALS 2017; 10:ma10050542. [PMID: 28772900 PMCID: PMC5459008 DOI: 10.3390/ma10050542] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 03/24/2017] [Accepted: 05/11/2017] [Indexed: 12/13/2022]
Abstract
Some studies have demonstrated that in vivo degradation processes are influenced by the material’s physico-chemical properties. The present study compares two hydroxyapatites manufactured on an industrial scale, deproteinized at low and high temperatures, and how physico-chemical properties can influence the mineral degradation process of material performance in bone biopsies retrieved six months after maxillary sinus augmentation. Residual biomaterial particles were examined by field scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX) to determine the composition and degree of degradation of the bone graft substitute material. According to the EDX analysis, the Ca/P ratio significantly lowered in the residual biomaterial (1.08 ± 0.32) compared to the initial composition (2.22 ± 0.08) for the low-temperature sintered group, which also presented high porosity, low crystallinity, low density, a large surface area, poor stability, and a high resorption rate compared to the high-temperature sintered material. This demonstrates that variations in the physico-chemical properties of bone substitute material clearly influence the degradation process. Further studies are needed to determine whether the resorption of deproteinized bone particles proceeds slowly enough to allow sufficient time for bone maturation to occur.
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Karaca EO, Ipçi SD, Cakar G, Yılmaz S. Dental implant survival and success rate after sinus augmentation with deproteinized bovine bone mineral and platelet-rich plasma at one and five years: a prospective-controlled study. BIOTECHNOL BIOTEC EQ 2017. [DOI: 10.1080/13102818.2017.1295818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Ebru Ozkan Karaca
- Department of Periodontology, Dental Faculty, Yeditepe University, Istanbul, Turkey
| | - Sebnem Dirikan Ipçi
- Department of Periodontology, Dental Faculty, Istanbul Kemerburgaz University, Istanbul, Turkey
| | - Gokser Cakar
- Department of Periodontology, Dental Faculty, Istanbul Kemerburgaz University, Istanbul, Turkey
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Zang SQ, Kang S, Hu X, Wang M, Wang XW, Zhou T, Wang QT. Comparison of Different Periodontal Healing of Critical Size Noncontained and Contained Intrabony Defects in Beagles. Chin Med J (Engl) 2017; 130:477-486. [PMID: 28218223 PMCID: PMC5324386 DOI: 10.4103/0366-6999.199834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Regenerative techniques help promote the formation of new attachment and bone filling in periodontal defects. However, the dimensions of intraosseous defects are a key determinant of periodontal regeneration outcomes. In this study, we evaluated the efficacy of use of anorganic bovine bone (ABB) graft in combination with collagen membrane (CM), to facilitate healing of noncontained (1-wall) and contained (3-wall) critical size periodontal defects. METHODS The study began on March 2013, and was completed on May 2014. One-wall (7 mm × 4 mm) and 3-wall (5 mm × 4 mm) intrabony periodontal defects were surgically created bilaterally in the mandibular third premolars and first molars in eight beagles. The defects were treated with ABB in combination with CM (ABB + CM group) or open flap debridement (OFD group). The animals were euthanized at 8-week postsurgery for histological analysis. Two independent Student's t-tests (1-wall [ABB + CM] vs. 1-wall [OFD] and 3-wall [ABB + CM] vs. 3-wall [OFD]) were used to assess between-group differences. RESULTS The mean new bone height in both 1- and 3-wall intrabony defects in the ABB + CM group was significantly greater than that in the OFD group (1-wall: 4.99 ± 0.70 mm vs. 3.01 ± 0.37 mm, P < 0.05; 3-wall: 3.11 ± 0.59 mm vs. 2.08 ± 0.24 mm, P < 0.05). The mean new cementum in 1-wall intrabony defects in the ABB + CM group was significantly greater than that in their counterparts in the OFD group (5.08 ± 0.68 mm vs. 1.16 ± 0.38 mm; P < 0.05). Likewise, only the 1-wall intrabony defect model showed a significant difference with respect to junctional epithelium between ABB + CM and OFD groups (0.67 ± 0.23 mm vs. 1.12 ± 0.28 mm, P < 0.05). CONCLUSIONS One-wall intrabony defects treated with ABB and CM did not show less periodontal regeneration than that in 3-wall intrabony defect. The noncontained 1-wall intrabony defect might be a more discriminative defect model for further research into periodontal regeneration.
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Affiliation(s)
- Sheng-Qi Zang
- Department of Periodontology, State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
- Department of Stomatology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Shuai Kang
- Department of Periodontology, State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Xin Hu
- Department of Periodontology, State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Meng Wang
- Department of Periodontology, State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Xin-Wen Wang
- Department of Oral Medicine, State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, School of Stomatology, The Fourth Military Medical University, Xi’an, Shaanxi 710032, China
| | - Tao Zhou
- Nondestructive Lab, State Key Laboratory for Manufacturing Systems Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi 710032, China
| | - Qin-Tao Wang
- Department of Periodontology, State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
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Additional Effects of Platelet-Rich Fibrin on Bone Regeneration in Sinus Augmentation With Deproteinized Bovine Bone Mineral: Preliminary Results. IMPLANT DENT 2017. [PMID: 26204169 DOI: 10.1097/id.0000000000000306] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Platelet-rich fibrin (PRF) has been reported to contribute to bone regeneration; however, little is known about details with deproteinized bovine bone mineral (DBBM). This study aims to evaluate additional effects of PRF on bone regeneration in sinus augmentation with DBBM. MATERIALS AND METHODS Sinus augmentations were made with DBBM/PRF mixture as lateral approach for 4 sinuses from 4 patients. Bone biopsies were obtained from posterior maxilla at the implant placements 7 or 10 months after sinus augmentations. Histological observations and histomorphometric analyses from augmented areas were performed. RESULTS The new bone formation was found around the DBBMs with very good contact while surfaces of DBBMs were partly resorbed. Osteoclasts recognized the DBBMs for remodeling, followed by new bone running. The histomorphometric analyses revealed that mean percentages of newly formed bone were 31.7 ± 1.2%, 21.0 ± 1.0%, 38.0 ± 0.6%, and 47.0 ± 0.6%, respectively (mean 34.5 ± 5.7%). CONCLUSIONS Additional effects of PRF could be found because of higher percentages of newly bone formation by DBBM/PRF mixture than those by DBBM individual in previous reports.
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Histomorphometric Analysis of a Biopsy Harvested 10 Years After Maxillary Sinus Augmentation With Anorganic Bovine Bone Matrix and Plasma Rich in Growth Factors: A Case Report. IMPLANT DENT 2017; 24:480-6. [PMID: 26068321 DOI: 10.1097/id.0000000000000289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate the histologic and histomorphometric data 10 years after grafting of maxillary sinus in a case using anorganic bovine bone matrix (ABBM) and plasma rich in growth factors (PRGF). MATERIALS AND METHODS Histomorphometric measures were performed for newly formed bone, ABBM particles remnants, marrow spaces, and the presence of osteoblastic and osteoclastic activity. RESULTS Histologic analysis showed ABBM particles surrounded by new compact and mature vital bone. Osteocytes were noted within lacunae. Some osteoblastic and osteoclastic activity could be identified. The histomorphometric results were 21.7% of newly formed bone, 33.9% of ABBM, and 44% was composed of marrow spaces. CONCLUSIONS After 10 years postoperatively, the histologic evaluation of this case report demonstrated slow replacement of the ABBM particles by newly formed bone, even with the addition of PRGF. The residual ABBM particles were found in close contact to the newly formed bone.
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Histomorphometric analysis of maxillary sinus augmentation with calcium phosphate nanocrystal-coated xenograft. IMPLANT DENT 2017; 24:333-7. [PMID: 25902366 DOI: 10.1097/id.0000000000000237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the histomorphometric result from maxillary sinus augmentation with calcium phosphate nanocrystal-coated bovine bone (Biocera). STUDY DESIGN Maxillary sinus augmentations were performed on 10 patients with the delayed placement of implants. The lateral bony window was created using a piezoelectric saw, and the sinus membrane was elevated to make a new compartment. Biocera was grafted. The bony window was repositioned over the bone graft. In all cases, samples were taken for biopsy at the time of implant placement, 6 to 8 months after the grafting procedure. RESULTS None of the 10 patients had complications, and there were no clinical and radiographic signs of infection. Histomorphometrically, 25.94% (± 11.24%) of newly formed bone, 52.67% (± 12.60%) of soft tissue, and 21.38% (± 10.76%) of residual grafts were shown. Histologic findings showed newly formed bone surrounding the residual grafted particles, without inflammation. Newly formed bone along inner surface of the repositioned bony window area showed more mature and dense bone structure than new bone formed along bone graft. CONCLUSION The present study revealed that calcium phosphate nanocystal-coated xenograft was considered to be a suitable bone graft material for maxillary sinus augmentation.
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Moon JW, Sohn DS, Heo JU, Kim JS. Comparison of two kinds of bovine bone in maxillary sinus augmentation: a histomorphometric study. IMPLANT DENT 2016; 24:19-24. [PMID: 25621547 DOI: 10.1097/id.0000000000000187] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to compare the histomorphometric from sinus augmentation with calcium-phosphate nanocrystal-coated bovine bone (Biocera) and anorganic bovine bone matrix (Bio-Oss). MATERIALS AND METHODS Bilateral maxillary sinus augmentations were performed on 5 patients with delayed placement of implants. The lateral bony window was created using a piezoelectric saw, and the sinus membrane was elevated to make a new compartment. Bio-Oss was grafted in one sinus as the control group and Biocera was grafted in the opposite sinus as the test group. The bony window was repositioned over the bone graft. In all cases, samples were taken for biopsy at the time of implant placement, 6 to 8 months after the grafting procedure. Independent t tests were used to examine between-group differences. RESULTS None of the 5 patients had complications during healing period. Histomorphometrically, the Bio-Oss group showed 28.46% (±5.28%) of newly formed bone. Biocera group showed 29.94% (±8.72%) of newly formed bone. Newly formed bone along inner surface of repositioned bony window area showed more mature and dense bone structure than new bone formed along bone graft. CONCLUSIONS This study revealed that both bovine bone grafts were considered as suitable bone graft materials for maxillary sinus augmentation.
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Affiliation(s)
- Jee-Won Moon
- *Assistant Professor, Department of Dentistry and Oral and Maxillofacial Surgery, Catholic University Hospital of Daegu, Daegu, Korea. †Professor, Department of Dentistry and Oral and Maxillofacial Surgery, Catholic University Hospital of Daegu, Daegu, Korea. ‡Private Practice, Busan, Korea. §Private Practice, Jeonju, Korea
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Takauti CAY, Futema F, Brito Junior RBD, Abrahão AC, Costa C, Queiroz CS. Assessment of bone healing in rabbit calvaria grafted with three different biomaterials. Braz Dent J 2016; 25:379-84. [PMID: 25517771 DOI: 10.1590/0103-6440201302383] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 07/28/2014] [Indexed: 11/21/2022] Open
Abstract
This study evaluated the bone regeneration process in rabbit calvaria induced by three types of biomaterials: two xenogenous, consisting of deproteinized bovine bone, while the other was alloplastic, based on biphasic calcium phosphate. Five New Zealand white rabbits weighing between 2,900 and 3,500 g were submitted to four standard 8 mm-diameter perforations at the parietal bone. Three perforations were filled with three grafts and biomaterials, two of them received bovine Bio-Oss® and Endobon® Xenograft Granules, and the other consisted of fully alloplastic Straumann® Bone Ceramic. The fourth remaining cavity was used as control with coagulum. After eight weeks, the animals were sacrificed, and the samples were prepared for morphometric and qualitative analysis. The cavities filled with alloplastic biomaterials showed higher percentages of newly formed bone (p<0.05), while the cavities with xenogenous biomaterials showed higher amount of residual graft (p<0.05). Although the results showed greater bone formation with Straumann® Bone Ceramic, further studies are required to prove which is the more effective biomaterial for bone induction process.
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Affiliation(s)
| | - Fabio Futema
- Department of Veterinary Medicine, Paulista University, UNIP, São Paulo, SP, Brazil
| | | | - Aline Corrêa Abrahão
- Department of Dentistry, Federal University of Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brazil
| | - Claudio Costa
- Department of Stomatology, School of Dentistry, University of São Paulo, USP, São Paulo, SP, Brazil
| | - Celso Silva Queiroz
- Department of Dentistry, Veiga de Almeida University, Rio de Janeiro, RJ, Brazil
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Scheyer ET, Heard R, Janakievski J, Mandelaris G, Nevins ML, Pickering SR, Richardson CR, Pope B, Toback G, Velásquez D, Nagursky H. A randomized, controlled, multicentre clinical trial of post-extraction alveolar ridge preservation. J Clin Periodontol 2016; 43:1188-1199. [PMID: 27617409 PMCID: PMC5132058 DOI: 10.1111/jcpe.12623] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2016] [Indexed: 11/29/2022]
Abstract
AIM To compare the effectiveness of two-ridge preservation treatments. MATERIALS AND METHODS Forty subjects with extraction sockets exhibiting substantial buccal dehiscences were enrolled and randomized across 10 standardized centres. Treatments were demineralized allograft plus reconstituted and cross-linked collagen membrane (DFDBA + RECXC) or deproteinized bovine bone mineral with collagen plus native, bilayer collagen membrane (DBBMC + NBCM). Socket dimensions were recorded at baseline and 6 months. Wound closure and soft tissue inflammation were followed post-operatively, and biopsies were retrieved for histomorphometric analysis at 6 months. RESULTS Primary endpoint: at 6 months, extraction socket horizontal measures were significantly greater for DBBMC + NBCM (average 1.76 mm greater, p = 0.0256). Secondary and Exploratory endpoints: (1) lingual and buccal vertical bone changes were not significantly different between the two treatment modalities, (2) histomorphometric % new bone and % new bone + graft were not significantly different, but significantly more graft remnants remained for DBBMC; (3) at 1 month, incision line gaps were significantly greater and more incision lines remained open for DFDBA + RECXC; (4) higher inflammation at 1 week tended to correlate with lower ridge preservation results; and (5) deeper socket morphologies with thinner bony walls correlated with better ridge preservation. Thirty-seven of 40 sites had sufficient ridge dimension for implant placement at 6 months; the remainder were DFDBA + RECXC sites. CONCLUSION DBBMC + NBCM provided better soft tissue healing and ridge preservation for implant placement. Deeper extraction sockets with higher and more intact bony walls responded more favourably to ridge preservation therapy.
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Affiliation(s)
- Eric Todd Scheyer
- The McGuire Institute (Practice-based Clinical Research Network), Houston, TX, USA.,Private Practice, Houston, TX, USA
| | - Rick Heard
- The McGuire Institute (Practice-based Clinical Research Network), Houston, TX, USA.,Private Practice, Victoria, TX, USA
| | - Jim Janakievski
- The McGuire Institute (Practice-based Clinical Research Network), Houston, TX, USA.,Private Practice, Tacoma, WA, USA.,Department of Periodontics, School of Dentistry, University of Washington, Seattle, WA, USA
| | - George Mandelaris
- The McGuire Institute (Practice-based Clinical Research Network), Houston, TX, USA.,Private Practice, Oakbrook Terrace, IL, USA.,Department of Graduate Periodontics, College of Dentistry, University of Illinois, Chicago, IL, USA
| | - Marc L Nevins
- The McGuire Institute (Practice-based Clinical Research Network), Houston, TX, USA.,Private Practice, Boston, MA, USA.,Department of Oral Medicine, Infection and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Stephen R Pickering
- The McGuire Institute (Practice-based Clinical Research Network), Houston, TX, USA.,Private Practice, San Mateo, CA, USA
| | - Christopher R Richardson
- The McGuire Institute (Practice-based Clinical Research Network), Houston, TX, USA.,Private Practice, Richmond, VA, USA.,Department of Graduate Periodontics, Virginia Commonwealth School of Dentistry, Richmond, VA, USA
| | - Bryan Pope
- The McGuire Institute (Practice-based Clinical Research Network), Houston, TX, USA.,Private Practice, San Mateo, CA, USA
| | - Gregory Toback
- The McGuire Institute (Practice-based Clinical Research Network), Houston, TX, USA.,Private Practice, New London, CT, USA
| | - Diego Velásquez
- The McGuire Institute (Practice-based Clinical Research Network), Houston, TX, USA.,Private Practice, Fenton, MI, USA.,University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Heiner Nagursky
- Institute for Clinical Chemistry and Laboratory Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
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Guided "sandwich" technique: a novel surgical approach for safe osteotomies in the treatment of vertical bone defects in the posterior atrophic mandible: a case report. IMPLANT DENT 2016; 23:738-44. [PMID: 25290283 DOI: 10.1097/id.0000000000000168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE A novel technique to perform safe osteotomies during inlay block regenerative procedures in the posterior atrophic mandible is described. MATERIAL AND METHODS A 52-year-old male patient with vertical atrophy of the left posterior mandible was treated adopting an inlay block "sandwich" technique using an allogenic cancelous block and a mixture of mineralized and demineralized human bone allograft in putty form as graft. The horizontal osteotomy for the lifting of the osteotomized bone segment was performed using a template prepared from a virtual anatomical replica of the patient's mandible obtained from cone beam computed tomography data. In the second surgical phase, 3 months after the augmentation, 2 implants were easily placed. RESULTS The horizontal osteotomy was carried out, with no risk, very close to the nerve structures after the precise osteotomy line established preoperatively on the three-dimensional computed tomography (3D-CT) virtual reconstruction. No neurological complications were observed in the first days after the procedure, and no subsequent problems were recorded during the 3-month healing period. CONCLUSION Radiographic evaluations and complication-free clinical healing demonstrate the effectiveness of this technique to obtain safe and precise osteotomies.
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Can one-wall bone defects be augmented with xenogenic bone grafting material alone? J Craniomaxillofac Surg 2016; 44:1137-42. [DOI: 10.1016/j.jcms.2016.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/05/2016] [Accepted: 04/12/2016] [Indexed: 11/21/2022] Open
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Danesh-Sani SA, Engebretson SP, Janal MN. Histomorphometric results of different grafting materials and effect of healing time on bone maturation after sinus floor augmentation: a systematic review and meta-analysis. J Periodontal Res 2016; 52:301-312. [PMID: 27534916 DOI: 10.1111/jre.12402] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2016] [Indexed: 01/11/2023]
Abstract
The aim of this systematic review was to evaluate histomorphometric variables, the amount of new bone (NB), residual graft (RG) particles and soft tissue (ST), related to various grafting materials and assess the effect of graft healing time on different histomorphometric outcomes. Studies that were published before October 2015 were electronically and manually searched in three databases. We included human studies that reported the amount of NB, RG and ST in the biopsies taken from the grafted sinuses. Based on the applied grafting materials, extracted data were categorized into different groups. Furthermore, extracted data were classified into three groups based on healing time: (i) ≤ 4.5 mo; (ii) 4.5-9 mo; and (iii) ≥ 9-13.5 mo. The search provided 791 titles. Full text analysis was performed for 258 articles resulting in 136 studies that met the inclusion criteria. Autogenous bone (AB) resulted in the highest amount of NB and lowest amount of RG compared to other grafting materials. Based on this meta-analysis, a significant difference was noticed in the amount of NB formation in grafts with a healing time of > 4.5 mo when compared to the grafts with less healing time. However, when comparing biopsies taken at 4.5-9 mo of healing (average = 6.22 mo) to the ones taken at ≥ 9-13.5 mo (average = 10.36 mo), no significant difference was noticed in the amount of NB formation of various grafts except allografts that resulted in a significantly higher percentage of NB at 9.5 mo of healing. Based on histomorphometric analysis, AB results in the highest amount of NB formation in comparison to the other grafting materials. Bone substitute materials (allografts, alloplastic materials and xenografts) seem to be good alternatives to autogenous bone and can be considered as grafting materials to avoid disadvantages related to AB, including morbidity rate, limited availability and high volumetric change. Combining AB with alloplastic materials and xenografts brings no significant advantages regarding NB formation.
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Affiliation(s)
- S A Danesh-Sani
- Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, NY, USA
| | - S P Engebretson
- Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, NY, USA
| | - M N Janal
- Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, NY, USA
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de Barros RRM, Novaes AB, de Carvalho JP, de Almeida ALG. The effect of a flapless alveolar ridge preservation procedure with or without a xenograft on buccal bone crest remodeling compared by histomorphometric and microcomputed tomographic analysis. Clin Oral Implants Res 2016; 28:938-945. [PMID: 27311365 DOI: 10.1111/clr.12900] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study evaluated buccal bone crest remodeling, socket composition after healing, and dimensional ridge preservation after flapless tooth extraction procedures with or without a xenograft comparing histomorphometric and microcomputed tomographic (micro-CT) data. MATERIAL AND METHODS The mandibular premolars of eight dogs were extracted without flaps. One socket on each side received a grafting material (test group), and the other remained only with a blood clot (control group). Twelve weeks after treatment, buccal bone crest, alveolar ridge dimensions, and composition were analyzed by histomorphometry and micro-CT. RESULTS Two- and three-dimensional evaluations showed better results for the grafted group when compared to the non-grafted group. CONCLUSION The flapless alveolar ridge preservation procedure with deproteinized bovine bone material enhanced buccal bone crest, alveolar ridge dimensions and bone formation when compared to sockets with the blood clot only, as observed by histomorphometric and micro-CT analysis.
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Affiliation(s)
- Raquel Rezende Martins de Barros
- Department of Oral and Maxillofacial Surgery and Traumatology and Periodontology, Ribeirão Preto Dental School, University of São Paulo, São Paulo, SP, Brazil
| | - Arthur Belém Novaes
- Department of Oral and Maxillofacial Surgery and Traumatology and Periodontology, Ribeirão Preto Dental School, University of São Paulo, São Paulo, SP, Brazil
| | - Jessica Pires de Carvalho
- Department of Oral and Maxillofacial Surgery and Traumatology and Periodontology, Ribeirão Preto Dental School, University of São Paulo, São Paulo, SP, Brazil
| | - Adriana Luisa Gonçalves de Almeida
- Department of Oral and Maxillofacial Surgery and Traumatology and Periodontology, Ribeirão Preto Dental School, University of São Paulo, São Paulo, SP, Brazil
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49
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Dinato TR, Grossi ML, Teixeira ER, Dinato JC, Sczepanik FSC, Gehrke SA. Marginal Bone Loss in Implants Placed in the Maxillary Sinus Grafted With Anorganic Bovine Bone: A Prospective Clinical and Radiographic Study. J Periodontol 2016; 87:880-7. [PMID: 26944409 DOI: 10.1902/jop.2016.150514] [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] [Indexed: 11/13/2022]
Abstract
BACKGROUND Sinus elevation is a reliable and often-used technique. Success of implants placed in such situations, even with bone substitutes alone, prompted the authors of this study to strive for bone loss close to zero and research variables that cause higher or lower rates of resorption. The objective of this study is to evaluate survival rates and marginal bone loss (MBL) around implants placed in sites treated with maxillary sinus augmentation using anorganic bovine bone (ABB), and identify surgical and prosthetic prognostic variables. METHODS Fifty-five implants were placed in 30 grafted maxillary sinuses in 24 patients. Periapical radiographs were evaluated immediately after implant placement (baseline), 6 months, and at the most recent follow-up. MBL was calculated from the difference between initial and final measurements, taking into account a distortion rate for each radiograph compared with original implant measurements. RESULTS Survival rate was 98.2%, with only one implant lost (100% survival rate after loading) over a mean follow-up time of 2.0 ± 0.9 years. MBL ranged from 0 to 2.85 mm: 75.9% of mesial sites and 83.4% of distal sites showed <1 mm of MBL, whereas 35.2% of mesial sites and 37% of distal sites exhibited no bone loss. MBL was significantly (P <0.05) greater in open-flap compared with flapless surgery. CONCLUSIONS Within the limitations of the present study, it was concluded that maxillary sinus elevation with 100% ABB gives predictable results, and that flapless surgery results in less MBL compared with traditional open-flap surgery.
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Affiliation(s)
- Thiago R Dinato
- Department of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Department of Implantology, Brazilian Dental Association, Porto Alegre, Brazil
| | - Márcio L Grossi
- Department of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Eduardo R Teixeira
- Department of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - José C Dinato
- Department of Implantology, Brazilian Dental Association, Porto Alegre, Brazil
| | - Fábio S C Sczepanik
- Department of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Department of Implantology, Brazilian Dental Association, Porto Alegre, Brazil
| | - Sergio A Gehrke
- Department of Research, Biotecnos, Catholic University San Antonio of Murcia, Santa Maria, Brazil
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Chen FM, Gao LN, Tian BM, Zhang XY, Zhang YJ, Dong GY, Lu H, Chu Q, Xu J, Yu Y, Wu RX, Yin Y, Shi S, Jin Y. Treatment of periodontal intrabony defects using autologous periodontal ligament stem cells: a randomized clinical trial. Stem Cell Res Ther 2016; 7:33. [PMID: 26895633 PMCID: PMC4761216 DOI: 10.1186/s13287-016-0288-1] [Citation(s) in RCA: 205] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/14/2015] [Accepted: 01/27/2016] [Indexed: 12/15/2022] Open
Abstract
Background Periodontitis, which progressively destroys tooth-supporting structures, is one of the most widespread infectious diseases and the leading cause of tooth loss in adults. Evidence from preclinical trials and small-scale pilot clinical studies indicates that stem cells derived from periodontal ligament tissues are a promising therapy for the regeneration of lost/damaged periodontal tissue. This study assessed the safety and feasibility of using autologous periodontal ligament stem cells (PDLSCs) as an adjuvant to grafting materials in guided tissue regeneration (GTR) to treat periodontal intrabony defects. Our data provide primary clinical evidence for the efficacy of cell transplantation in regenerative dentistry. Methods We conducted a single-center, randomized trial that used autologous PDLSCs in combination with bovine-derived bone mineral materials to treat periodontal intrabony defects. Enrolled patients were randomly assigned to either the Cell group (treatment with GTR and PDLSC sheets in combination with Bio-oss®) or the Control group (treatment with GTR and Bio-oss® without stem cells). During a 12-month follow-up study, we evaluated the frequency and extent of adverse events. For the assessment of treatment efficacy, the primary outcome was based on the magnitude of alveolar bone regeneration following the surgical procedure. Results A total of 30 periodontitis patients aged 18 to 65 years (48 testing teeth with periodontal intrabony defects) who satisfied our inclusion and exclusion criteria were enrolled in the study and randomly assigned to the Cell group or the Control group. A total of 21 teeth were treated in the Control group and 20 teeth were treated in the Cell group. All patients received surgery and a clinical evaluation. No clinical safety problems that could be attributed to the investigational PDLSCs were identified. Each group showed a significant increase in the alveolar bone height (decrease in the bone-defect depth) over time (p < 0.001). However, no statistically significant differences were detected between the Cell group and the Control group (p > 0.05). Conclusions This study demonstrates that using autologous PDLSCs to treat periodontal intrabony defects is safe and does not produce significant adverse effects. The efficacy of cell-based periodontal therapy requires further validation by multicenter, randomized controlled studies with an increased sample size. Trial Registration NCT01357785 Date registered: 18 May 2011. Electronic supplementary material The online version of this article (doi:10.1186/s13287-016-0288-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fa-Ming Chen
- State Key Laboratory of Military Stomatology, Department of Periodontology, School of Stomatology, Fourth Military Medical University, Xi'an, Shannxi, P. R. China.
| | - Li-Na Gao
- State Key Laboratory of Military Stomatology, Department of Periodontology, School of Stomatology, Fourth Military Medical University, Xi'an, Shannxi, P. R. China.,State Key Laboratory of Military Stomatology, Research and Development Center for Tissue Engineering, School of Stomatology, Fourth Military Medical University, Xi'an, Shannxi, P. R. China
| | - Bei-Min Tian
- State Key Laboratory of Military Stomatology, Department of Periodontology, School of Stomatology, Fourth Military Medical University, Xi'an, Shannxi, P. R. China
| | - Xi-Yu Zhang
- State Key Laboratory of Military Stomatology, Department of Periodontology, School of Stomatology, Fourth Military Medical University, Xi'an, Shannxi, P. R. China
| | - Yong-Jie Zhang
- State Key Laboratory of Military Stomatology, Research and Development Center for Tissue Engineering, School of Stomatology, Fourth Military Medical University, Xi'an, Shannxi, P. R. China
| | - Guang-Ying Dong
- State Key Laboratory of Military Stomatology, Department of Periodontology, School of Stomatology, Fourth Military Medical University, Xi'an, Shannxi, P. R. China
| | - Hong Lu
- State Key Laboratory of Military Stomatology, Department of Periodontology, School of Stomatology, Fourth Military Medical University, Xi'an, Shannxi, P. R. China
| | - Qing Chu
- State Key Laboratory of Military Stomatology, Department of Periodontology, School of Stomatology, Fourth Military Medical University, Xi'an, Shannxi, P. R. China
| | - Jie Xu
- State Key Laboratory of Military Stomatology, Department of Periodontology, School of Stomatology, Fourth Military Medical University, Xi'an, Shannxi, P. R. China
| | - Yang Yu
- State Key Laboratory of Military Stomatology, Department of Periodontology, School of Stomatology, Fourth Military Medical University, Xi'an, Shannxi, P. R. China.,State Key Laboratory of Military Stomatology, Research and Development Center for Tissue Engineering, School of Stomatology, Fourth Military Medical University, Xi'an, Shannxi, P. R. China
| | - Rui-Xin Wu
- State Key Laboratory of Military Stomatology, Department of Periodontology, School of Stomatology, Fourth Military Medical University, Xi'an, Shannxi, P. R. China
| | - Yuan Yin
- State Key Laboratory of Military Stomatology, Department of Periodontology, School of Stomatology, Fourth Military Medical University, Xi'an, Shannxi, P. R. China
| | - Songtao Shi
- Department of Anatomy and Cell Biology, School of Dental Medicine, University of Pennsylvania, 240 South 40th Street, Philadelphia, PA, 19104, USA.
| | - Yan Jin
- State Key Laboratory of Military Stomatology, Research and Development Center for Tissue Engineering, School of Stomatology, Fourth Military Medical University, Xi'an, Shannxi, P. R. China.
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