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Shakya A, Li Y, Chang NW, Liu X. Supra-Alveolar Bone Regeneration: Progress, Challenges, and Future Perspectives. COMPOSITES. PART B, ENGINEERING 2024; 283:111673. [PMID: 39071449 PMCID: PMC11270636 DOI: 10.1016/j.compositesb.2024.111673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Periodontitis is a highly prevalent disease that damages the supporting tissues of a tooth, including the alveolar bone. Alveolar bone loss owing to periodontitis is broadly categorized as supra-alveolar and intra-alveolar bone loss. In intra-alveolar bone loss, the defect has an angular or oblique orientation to the long axis of the tooth in an apical direction. In contrast, the defect is perpendicular to the long axis of the tooth in supra-alveolar bone loss. Unlike intra-alveolar bone defects, supra-alveolar bone defects lack supporting adjacent space, which makes supra-alveolar bone regeneration more challenging. In addition, the limited availability of resources in terms of vascularity and underlying tissues is another obstacle to supra-alveolar bone regeneration. Currently, supra-alveolar bone loss is the least predictable periodontal defect type in regenerative periodontal therapy. In addition, supra-alveolar bone loss is much more common than other alveolar bone loss. Despite its prevalence, research on supra-alveolar bone regeneration remains sparse, indicating an unmet need for significant research efforts in this area. This review summarize recent advances, obstacles, and future directions in the field of supra-alveolar bone regeneration. We discuss the biomaterials, bioactive molecules, and cells that have been tested for supra-alveolar bone regeneration, followed by pre-clinical and clinical approaches employed in this field. Additionally, we highlight obstacles and present future directions that will propel supra-alveolar bone research forward.
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Affiliation(s)
- Ajay Shakya
- Department of Biomedical Sciences, Texas A&M University School of Dentistry, Dallas, TX 75246
| | - Yingzi Li
- Department of Biomedical Sciences, Texas A&M University School of Dentistry, Dallas, TX 75246
- Chemical and Biomedical Engineering Department, University of Missouri, Columbia, MO 65211
| | - Nai-wen Chang
- Department of Periodontology, Texas A&M University School of Dentistry, Dallas, TX 75246
| | - Xiaohua Liu
- Department of Biomedical Sciences, Texas A&M University School of Dentistry, Dallas, TX 75246
- Chemical and Biomedical Engineering Department, University of Missouri, Columbia, MO 65211
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Zahedi L, Mohammadi M, Kalantari M, Arabsolghar M, Ranjbar H. Horizontal ridge augmentation with particulate cortico-cancellous freeze-dried bone allograft alone or combined with injectable-platelet rich fibrin in a randomized clinical trial. Clin Implant Dent Relat Res 2024; 26:127-137. [PMID: 38093400 DOI: 10.1111/cid.13295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 11/08/2023] [Accepted: 11/11/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVES The objective of this study is to assess the effectiveness of horizontal ridge augmentation using FDBA in combination with injectable-platelet rich fibrin (i-PRF) versus FDBA alone. To fulfill this aim, the radiographic and histomorphometric outcomes are compared. METHOD The study involved 41 patients who had horizontal alveolar ridge defects categorized as either B (2.5-7 mm) or C (0-2.5 mm). The control group received FDBA alone (n = 20), while the test group received FDBA in combination with i-PRF (n = 21). The horizontal dimensions of the alveolar ridge were measured at 0, 2, 4, and 6 mm from the bone crest using CBCT before and 6 months after alveolar ridge augmentation. In the second-stage surgery, 24 biopsies were taken from the augmented bone - 13 from the control group and 11 from the test group, and were examined histologically and histomorphometrically. The data were analyzed using Pearson correlation coefficient, chi-square, paired-t, and two-sample t tests. RESULTS There was no significant difference (p > 0.05) in the increase of mean ridge width between the test group and the control group after 6 months at distances of 0, 2, 4, and 6 mm from the crest, with differences of -0.28, 0.12, 0.52, and 1.04 mm, respectively. However, the amount of newly formed bone and material residues was significantly higher in the FDBA + i-PRF group compared to the FDBA alone group (45.01% and 13.06% vs 54.03% and 8.48%, respectively). There was no significant difference in the amount of soft tissue between the two groups (41.02% and 37.5%, p > 0.05). CONCLUSION The study found that there was no statistically significant difference in the increase of horizontal ridge width between the FDBA + i-PRF group and the FDBA group. However, the histomorphometric analysis revealed that the FDBA + i-PRF group had a higher proportion of newly formed bone, less connective tissue, and fewer residual particles. This suggests a superior quality of bone formation compared to the FDBA group.
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Affiliation(s)
- Leili Zahedi
- Oral and Dental Diseases Research Center, Department of Periodontics, Kerman Dental School, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Mohammadi
- Oral and Dental Diseases Research Center, Department of Periodontics, Kerman Dental School, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahsa Kalantari
- Department of Oral and Maxillofacial Pathology, Oral and Dental Diseases Research Center, Kerman Dental School, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohaddeseh Arabsolghar
- Oral and Dental Diseases Research Center, Department of Periodontics, Kerman Dental School, Kerman University of Medical Sciences, Kerman, Iran
| | - Hadi Ranjbar
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
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Malcangi G, Patano A, Palmieri G, Di Pede C, Latini G, Inchingolo AD, Hazballa D, de Ruvo E, Garofoli G, Inchingolo F, Dipalma G, Minetti E, Inchingolo AM. Maxillary Sinus Augmentation Using Autologous Platelet Concentrates (Platelet-Rich Plasma, Platelet-Rich Fibrin, and Concentrated Growth Factor) Combined with Bone Graft: A Systematic Review. Cells 2023; 12:1797. [PMID: 37443831 PMCID: PMC10340512 DOI: 10.3390/cells12131797] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The current review aims to provide an overview of the most recent research on the potentials of concentrated growth factors used in the maxillary sinus lift technique. MATERIALS AND METHODS "PRP", "PRF", "L-PRF", "CGF", "oral surgery", "sticky bone", "sinus lift" were the search terms utilized in the databases Scopus, Web of Science, and Pubmed, with the Boolean operator "AND" and "OR". RESULTS Of these 1534 studies, 22 publications were included for this review. DISCUSSION The autologous growth factors released from platelet concentrates can help to promote bone remodeling and cell proliferation, and the application of platelet concentrates appears to reduce the amount of autologous bone required during regenerative surgery. Many authors agree that growth factors considerably enhance early vascularization in bone grafts and have a significantly positive pro-angiogenic influence in vivo when combined with alloplastic and xenogeneic materials, reducing inflammation and postoperative pain and stimulating the regeneration of injured tissues and accelerating their healing. CONCLUSIONS Even if further studies are still needed, the use of autologous platelet concentrates can improve clinical results where a large elevation of the sinus is needed by improving bone height, thickness and vascularization of surgical sites, and post-operative healing.
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Affiliation(s)
- Giuseppina Malcangi
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.M.); (A.P.); (G.P.); (C.D.P.); (G.L.); (A.D.I.); (D.H.); (E.d.R.); (G.G.); (A.M.I.)
| | - Assunta Patano
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.M.); (A.P.); (G.P.); (C.D.P.); (G.L.); (A.D.I.); (D.H.); (E.d.R.); (G.G.); (A.M.I.)
| | - Giulia Palmieri
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.M.); (A.P.); (G.P.); (C.D.P.); (G.L.); (A.D.I.); (D.H.); (E.d.R.); (G.G.); (A.M.I.)
| | - Chiara Di Pede
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.M.); (A.P.); (G.P.); (C.D.P.); (G.L.); (A.D.I.); (D.H.); (E.d.R.); (G.G.); (A.M.I.)
| | - Giulia Latini
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.M.); (A.P.); (G.P.); (C.D.P.); (G.L.); (A.D.I.); (D.H.); (E.d.R.); (G.G.); (A.M.I.)
| | - Alessio Danilo Inchingolo
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.M.); (A.P.); (G.P.); (C.D.P.); (G.L.); (A.D.I.); (D.H.); (E.d.R.); (G.G.); (A.M.I.)
| | - Denisa Hazballa
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.M.); (A.P.); (G.P.); (C.D.P.); (G.L.); (A.D.I.); (D.H.); (E.d.R.); (G.G.); (A.M.I.)
| | - Elisabetta de Ruvo
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.M.); (A.P.); (G.P.); (C.D.P.); (G.L.); (A.D.I.); (D.H.); (E.d.R.); (G.G.); (A.M.I.)
| | - Grazia Garofoli
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.M.); (A.P.); (G.P.); (C.D.P.); (G.L.); (A.D.I.); (D.H.); (E.d.R.); (G.G.); (A.M.I.)
| | - Francesco Inchingolo
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.M.); (A.P.); (G.P.); (C.D.P.); (G.L.); (A.D.I.); (D.H.); (E.d.R.); (G.G.); (A.M.I.)
| | - Gianna Dipalma
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.M.); (A.P.); (G.P.); (C.D.P.); (G.L.); (A.D.I.); (D.H.); (E.d.R.); (G.G.); (A.M.I.)
| | - Elio Minetti
- Department of Biomedical, Surgical, Dental Science, University of Milan, 20161 Milan, Italy;
| | - Angelo Michele Inchingolo
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.M.); (A.P.); (G.P.); (C.D.P.); (G.L.); (A.D.I.); (D.H.); (E.d.R.); (G.G.); (A.M.I.)
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Quirynen M, Lahoud P, Teughels W, Cortellini S, Dhondt R, Jacobs R, Temmerman A. Individual "alveolar phenotype" limits dimensions of lateral bone augmentation. J Clin Periodontol 2023; 50:500-510. [PMID: 36574768 DOI: 10.1111/jcpe.13764] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/29/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
AIM Alveolar ridge resorption following tooth extraction often renders a lateral bone augmentation inevitable. Some patients, however, suffer from severe early (during graft healing, Eres ) and/or late (during follow-up, Lres ) graft resorption. We explored the hypothesis that the "individual phenotypic dimensions" may partially explain the degree of such resorptions. MATERIALS AND METHODS Patients who underwent a guided bone regeneration (GBR) procedure were screened for inclusion according to the following criteria: (1) a relatively symmetrical maxillary arch; (2) an intact contra-lateral alveolar bone dimension; (3) the availability of a pre-operative cone-beam CT (CBCT); (4) a CBCT taken immediately after GBR, and (5) at least one CBCT scan ≥6 months after surgery. CBCT scans from different timepoints were registered and imported into the Mimics software (Materialise, Leuven, Belgium). Bone dimensions of the contra-lateral site of the augmentation, representing the "individual phenotypical dimension (IPD) of the alveolar crest", were superimposed on the augmented site and registered accordingly. As such, Eres and Lres could be measured over time, in relation to the IPD (in two dimensions; per millimetre apically from the alveolar crest, in the centre of the GBR), as well as in three dimensions (the entire GBR, 2 mm away from the mesial, distal, and apical border for standardization). RESULTS A total of 17 patients (23 augmented sites) were included. After Eres , the outline of the augmentation was in general located ±1 mm outside the IPD, but ≥1.5 years after GBR, it further moved towards the IPD (85% within 0.5 mm distance). CONCLUSIONS Within the limitations of this study, the results indicate that the dimensions of a lateral bone augmentation are defined by the "individual phenotypic bone boundaries" of the patient.
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Affiliation(s)
- Marc Quirynen
- Department of Oral Health Sciences, KU Leuven and Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
| | - Pierre Lahoud
- Department of Oral Health Sciences, KU Leuven and Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery and Department of Imaging and Pathology, UZ Leuven, OMFS-IMPATH Research Group, KU Leuven, Leuven, Belgium
| | - Wim Teughels
- Department of Oral Health Sciences, KU Leuven and Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
| | - Simone Cortellini
- Department of Oral Health Sciences, KU Leuven and Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
| | - Rutger Dhondt
- Department of Oral Health Sciences, KU Leuven and Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- Department of Oral and Maxillofacial Surgery and Department of Imaging and Pathology, UZ Leuven, OMFS-IMPATH Research Group, KU Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Andy Temmerman
- Department of Oral Health Sciences, KU Leuven and Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
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Suárez-López Del Amo F, Monje A. Efficacy of biologics for alveolar ridge preservation/reconstruction and implant site development: An American Academy of Periodontology best evidence systematic review. J Periodontol 2022; 93:1827-1847. [PMID: 35841608 PMCID: PMC10092438 DOI: 10.1002/jper.22-0069] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The use of biologics may be indicated for alveolar ridge preservation (ARP) and reconstruction (ARR), and implant site development (ISD). The present systematic review aimed to analyze the effect of autologous blood-derived products (ABPs), enamel matrix derivative (EMD), recombinant human platelet-derived growth factor-BB (rhPDGF-BB), and recombinant human bone morphogenetic protein-2 (rhBMP-2), on the outcomes of ARP/ARR and ISD therapy (i.e., alveolar ridge augmentation [ARA] and maxillary sinus floor augmentation [MSFA]). METHODS An electronic search for eligible articles published from January 2000 to October 2021 was conducted. Randomized clinical trials evaluating the efficacy of ABPs, EMD, rhBMP-2, and rhPDGF-BB for ARP/ARR and ISD were included according to pre-established eligibility criteria. Data on linear and volumetric dimensional changes, histomorphometric findings, and a variety of secondary outcomes (i.e., clinical, implant-related, digital imaging, safety, and patient-reported outcome measures [PROMs]) were extracted and critically analyzed. Risk of bias assessment of the selected investigations was also conducted. RESULTS A total of 39 articles were included and analyzed qualitatively. Due to the high level of heterogeneity across studies, quantitative analyses were not feasible. Most studies in the topic of ARP/ARR revealed that the use of biologics rendered similar results compared with conventional protocols. However, when juxtaposed to unassisted healing or socket filling using collagen sponges, the application of biologics did contribute to attenuate post-extraction alveolar ridge atrophy in most investigations. Additionally, histomorphometric outcomes were positively influenced by the application of biologics. The use of biologics in ARA interventions did not yield superior clinical or radiographic outcomes compared with control therapies. Nevertheless, ABPs enhanced new bone formation and reduced the likelihood of early wound dehiscence. The use of biologics in MSFA interventions did not translate into superior clinical or radiographic outcomes. It was observed, though, that the use of some biologics may promote bone formation during earlier stages of healing. Only four clinical investigations evaluated PROMs and reported a modest beneficial impact of the use of biologics on pain and swelling. No severe adverse events in association with the use of the biologics evaluated in this systematic review were noted. CONCLUSIONS Outcomes of therapy after post-extraction ARP/ARR and ARA in edentulous ridges were comparable among different therapeutic modalities evaluated in this systematic review. Nevertheless, the use of biologics (i.e., PRF, EMD, rhPDGF-BB, and rhBMP-2) in combination with a bone graft material generally results into superior histomorphometric outcomes and faster wound healing compared with control groups.
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Affiliation(s)
| | - Alberto Monje
- Department of Periodontology, International University of Catalonia (UIC), Barcelona, Spain.,Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Division of Periodontology, CICOM-MONJE Institute, Badajoz, Spain.,Department of Periodontics, University of Bern, Bern, Switzerland
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CBCT Evaluation of Sticky Bone in Horizontal Ridge Augmentation with and without Collagen Membrane-A Randomized Parallel Arm Clinical Trial. J Funct Biomater 2022; 13:jfb13040194. [PMID: 36278663 PMCID: PMC9590014 DOI: 10.3390/jfb13040194] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 11/19/2022] Open
Abstract
Guided bone regeneration (GBR) is a reliable technique used to treat ridge deficiencies prior or during implant placement. Injectable-platelet rich fibrin (i-PRF) laced with a bone substitute (sticky bone) has heralded the way for advancing the outcomes of bone regeneration. This study evaluated the efficacy of sticky bone in horizontal ridge augmentation with and without collagen membrane. A total of 20 partially edentulous patients (Group-I n = 10; Group-II n = 10) that indicated GBR were included, and the surgical procedure was carried out. In Group-I, the sticky bone and collagen membrane were placed in ridge-deficient sites and Group-II received only sticky bone. At the end of 6 months, 20 patients (Group-I (n = 10); Group-II (n = 10)) completed the follow-up period. A CBCT examination was performed to assess changes in the horizontal ridge width (HRW) and vertical bone height (VBH). A statistically significant increase in HRW (p < 0.05) was observed in both groups with mean gains of 1.35 mm, 1.55 mm, and 1.93 mm at three levels (crest, 3 mm, and 6 mm) in Group-I and 2.7 mm, 2.8 mm, and 2.6 mm at three levels in Group-II. The intergroup comparison revealed statistical significance (p < 0.05) with respect to HRW and KTW (Keratinised tissue width) gains of 0.775 at the 6-month follow-up. Sticky-bone (Xenogenic-bone graft + i-PRF) served as a promising biomaterial in achieving better horizontal bone width gain.
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Smeets R, Matthies L, Windisch P, Gosau M, Jung R, Brodala N, Stefanini M, Kleinheinz J, Payer M, Henningsen A, Al-Nawas B, Knipfer C. Horizontal augmentation techniques in the mandible: a systematic review. Int J Implant Dent 2022; 8:23. [PMID: 35532820 PMCID: PMC9086020 DOI: 10.1186/s40729-022-00421-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/25/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose Placement of dental implants has evolved to be an advantageous treatment option for rehabilitation of the fully or partially edentulous mandible. In case of extensive horizontal bone resorption, the bone volume needs to be augmented prior to or during implant placement in order to obtain dental rehabilitation and maximize implant survival and success. Methods Our aim was to systematically review the available data on lateral augmentation techniques in the horizontally compromised mandible considering all grafting protocols using xenogeneic, synthetic, or allogeneic material. A computerized and manual literature search was performed for clinical studies (published January 1995 to March 2021). Results Eight studies ultimately met the inclusion criteria comprising a total of 276 procedures of xenogeneic, allogeneic, or autogenous bone graft applications in horizontal ridge defects. Particulate materials as well as bone blocks were used as grafts with a mean follow-up of 26.0 months across all included studies. Outcome measures, approaches and materials varied from study to study. A gain of horizontal bone width of the mandible with a mean of 4.8 mm was observed in seven of eight studies. All but one study, reported low bone graft failure rates of 4.4% in average. Conclusions Only limited data are available on the impact of different horizontal augmentation strategies in the mandible. The results show outcomes for xenogeneic as well as autologous bone materials for horizontal ridge augmentation of the lower jaw. The use of allogeneic bone-block grafts in combination with resorbable barrier membranes must be re-evaluated. Randomized controlled clinical trials are largely missing. Supplementary Information The online version contains supplementary material available at 10.1186/s40729-022-00421-7.
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Arnal HM, Angioni CD, Gaultier F, Urbinelli R, Urban IA. Horizontal guided bone regeneration on knife-edge ridges: A retrospective case-control pilot study comparing two surgical techniques. Clin Implant Dent Relat Res 2022; 24:211-221. [PMID: 35167184 DOI: 10.1111/cid.13073] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/04/2022] [Accepted: 01/31/2022] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Studies evaluating guided bone regeneration (GBR) on knife-edge ridges using absorbable membranes with staged approaches have reported various horizontal bone gains. This study compared the horizontal bone gain obtained via a conventional technique of GBR and a recently-reported technique. Bone loss during the healing process was also measured. METHODS Consecutive patients who underwent GBR on knife-edge ridges via a conventional technique (control group) or the Sausage Technique (test group) were included in this study. GBR was performed using a collagen membrane and deproteinized bovine bone mineral combined with an autogenous graft at a 1:1 ratio. Cone-beam computed tomography (CBCT) was performed preoperatively, postoperatively, and after the patient healed. Horizontal bone width was measured on CBCT images 2 mm apical from the top of the crest. The preoperative CBCT and posthealing CBCT were superimposed to calculate the bone gain after healing, and the preoperative and postoperative CBCT scans were superimposed to calculate the bone gain after surgery. Bone loss during healing was calculated by subtracting the width of the ridge after healing from the postoperative width. RESULTS The mean horizontal bone gain was significantly lower in the control group (2.7 ± 1.8 mm; 83.2%) than in the test group (5.3 ± 2.3 mm; 216.8%) (p = 0.003). The average horizontal bone loss between regeneration and implant placement was 0.9 mm in the control group (27.9%) and 2.1 mm in the test group (29.4%). While the absolute bone loss was significantly different (p = 0.012), the percentage of bone resorption was not (p = 0.608). CONCLUSION The new technique resulted in significantly more bone gain than a conventional GBR technique. The rate of graft resorption during healing was stable regardless of the amount of grafted material.
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Affiliation(s)
- Helene M Arnal
- Department of Oral Medicine and Oral Surgery, APHP Henri Mondor Hospital, University of Paris, Paris, France.,Cabinet de chirurgie dentaire Villiers, Paris, France
| | - Charles D Angioni
- Cabinet de chirurgie dentaire Villiers, Paris, France.,Department of Periodontics, APHP Henri Mondor Hospital, University of Paris, Paris, France
| | - Frederick Gaultier
- Department of Oral Medicine and Oral Surgery, APHP Henri Mondor Hospital, University of Paris, Paris, France
| | | | - Istvan A Urban
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.,School of Dentistry, University of Szeged, Szeged, Hungary.,Urban Regeneration Institute, Budapest, Hungary
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Solakoğlu Ö, Ofluoğlu D, Schwarzenbach H, Heydecke G, Reißmann D, Ergun S, Götz W. A 3-year prospective randomized clinical trial of alveolar bone crest response and clinical parameters through 1, 2, and 3 years of clinical function of implants placed 4 months after alveolar ridge preservation using two different allogeneic bone-grafting materials. Int J Implant Dent 2022; 8:5. [PMID: 35102440 PMCID: PMC8804085 DOI: 10.1186/s40729-022-00402-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/11/2022] [Indexed: 12/02/2022] Open
Abstract
PURPOSE The aim of this study was to longitudinally evaluate changes in alveolar bone crest (ABC) levels and differences in resorption rates (RR) between the tested grafting materials following alveolar ridge preservation (ARP) after tooth extraction after 1, 2, and 3 years (T1-T8) of clinical function. METHODS Patients were randomly assigned to two different bone allografts (group 1 maxgraft®, group 2 Puros®) for ARP. Non-restorable teeth were minimal traumatically extracted. Sockets were augmented with the tested materials and covered with a pericardium membrane. After 4 months of healing, 36 implants were placed and sites were clinically and radiographically monitored in the mesial (ABC-M), the distal (ABC-D, T1-T8), the bucco-lingual (ABC-BL), buccal (ABC-B) and oral (ABC-O) aspect (T1-T4). RESULTS Changes in (ABC-M), (ABC-D), (ABC-BL), (ABC-B), and (ABC-O) levels showed statistically highly significant differences between T1 and T2 for both bone allografts (p < 0.001). Changes at the ABC-M and ABC-BL levels between T2 and T3 of group 1 showed a statistically significant difference (p < 0.001). Both groups achieved and maintained increased ABC levels without statistically significant differences throughout the monitoring periods of 1-3 years (T6-T8) of clinical function. No failures or adverse events were observed. CONCLUSIONS To the best of our knowledge, this study is within its limitations the first study to directly compare ABC-changes and differences in RR of two different allogeneic grafting materials for a period of 3 years after ARP. It was demonstrated to be, despite significant differences in RR, a successful method of preserving increased ABC levels through 1, 2, and 3 years of clinical function. Trial registration DRKS00013010, registered 07/30/2018, http://apps.who.int/trialsearch.
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Affiliation(s)
- Önder Solakoğlu
- Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
- Specialty Dental Practice Limited to Periodontology and Implant Dentistry, Hamburg, Germany.
| | - Duygu Ofluoğlu
- Department of Oral Medicine and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Heidi Schwarzenbach
- Institute of Tumor Biology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Heydecke
- Department of Prosthodontics Dental, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Reißmann
- Department of Prosthodontics Dental, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sertan Ergun
- Department of Oral Medicine and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Werner Götz
- Laboratory for Oral Biologic Basic Science, Department of Orthodontics, University of Bonn, Bonn, Germany
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Guided bone regeneration simultaneous with implant placement using bovine-derived xenograft with and without liquid platelet-rich fibrin: a randomized controlled clinical trial. Clin Oral Investig 2021; 25:5563-5575. [PMID: 34047835 DOI: 10.1007/s00784-021-03987-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess augmentation success after guided bone regeneration (GBR) carried out simultaneously with implant placement using bovine-derived xenograft alone and in combination with liquid platelet-rich fibrin (liquid-PRF). METHODS This randomized controlled clinical trial was conducted on patients with horizontal bone deficiency in the posterior regions of the mandible. After implant placement, GBR procedures were randomly performed using liquid-PRF-enriched bovine-derived xenograft (for the test group) and with bovine-derived xenograft alone (for the control group). To assess the change in augmentation thickness, the primary outcome of the study, cone beam computed tomography was carried out at the implant sites on completion and 6 months after surgery. The secondary outcomes were marginal bone level and implant survival rate at prosthetic delivery and at 6 months, 1 year, and 2 years follow-up after loading. The significance level was set at p<0.05 for all analysis. RESULTS Twenty patients with 50 implants were analyzed for the test group and 20 patients with 48 implants for the control group. At 6 months postoperatively, the mean values of augmentation thickness were 1.63 ± 0.21 mm, 2.59 ± 0.34 mm, and 3.11 ± 0.36 mm for the test group and 1.34 ± 0.14 mm, 2.49 ± 0.24 mm, and 2.97 ± 0.24 mm for the control group at 2 mm, 4 mm, and 6 mm below to the implant shoulder (p < 0.001, p = 0.007, and p = 0.036, respectively). The mean marginal bone loss was found to be less than 1 mm for both study groups during the 2 years of follow-up after prosthetic loading. Implant survival rate was 100% for both study groups. CONCLUSION Bovine-derived xenograft alone and in combination with liquid-PRF are both successful in achieving bone augmentation around the implants and produce a small change in marginal bone level and a high implant survival rate after loading. CLINICAL RELEVANCE There is a lack of evidence in the literature regarding the augmentation success of liquid-PRF used in combination with bone graft substitutes. This study indicates that liquid-PRF could be used as a supportive material with bovine-derived xenograft in GBR procedures carried out simultaneously with implant placement.
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11
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Anitua E, Fernández-de-Retana S, Alkhraisat MH. Platelet rich plasma in oral and maxillofacial surgery from the perspective of composition. Platelets 2020; 32:174-182. [PMID: 33350883 DOI: 10.1080/09537104.2020.1856361] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The application of platelet-rich plasma (PRP) in oral and maxillofacial surgery has been thoroughly studied in the last two decades. Currently, different types of PRP are applied in the clinical practice, being the presence or absence of leukocytes one of the classification criteria. However, there is poor evidence assessing the influence of the PRP composition in their efficacy. In this context, the aim of this narrative review is to compile the existing evidence covering the efficacy of PRP in oral and maxillofacial surgery, starting from a systematic literature search and to qualitatively describe the efficacy outcomes from the composition perspective. According to the results of this review, the application of PRP in oral and maxillofacial surgery is a potential strategy to improve soft- and hard-tissue regeneration, observing differences in the efficacy of PRP depending on its composition and the studied application. P-PRP (the absence of leukocytes) has been more consistent in achieving beneficial effects in alveolar ridge preservation, management of post-extraction complications, bone augmentation and temporomandibular joint disorders. For that, the composition and methodology used to prepare the PRP should be a critical point when evaluating the efficacy of PRP.
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Affiliation(s)
- Eduardo Anitua
- Regenerative Medicine Department, BTI Biotechnology Institute, Vitoria, Spain.,Clinical research, University Institute for Regenerative Medicine and Oral Implantology (UIRMI), Vitoria, Spain
| | - Sofía Fernández-de-Retana
- Regenerative Medicine Department, BTI Biotechnology Institute, Vitoria, Spain.,Clinical research, University Institute for Regenerative Medicine and Oral Implantology (UIRMI), Vitoria, Spain
| | - Mohammad H Alkhraisat
- Regenerative Medicine Department, BTI Biotechnology Institute, Vitoria, Spain.,Clinical research, University Institute for Regenerative Medicine and Oral Implantology (UIRMI), Vitoria, Spain
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12
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Deeb JG, Reichert A, Carrico CK, Laskin DM, Deeb GR. Effect of biologic materials on the outcomes of horizontal alveolar ridge augmentation: A retrospective study. Clin Exp Dent Res 2020; 7:147-155. [PMID: 33150685 PMCID: PMC8019766 DOI: 10.1002/cre2.343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/06/2020] [Accepted: 06/11/2020] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate if the addition of biologic agents to a particulate bone graft enhances horizontal ridge augmentation outcomes in terms of bone dimensions, bone density, and successful implant placement. MATERIALS AND METHODS A retrospective chart review was done to assess the clinical and radiographic outcomes in 52 horizontal ridge augmentation sites in 43 patients. Information was gathered regarding surgical technique, type of graft material, biologic agents used (PRP or rhPDGF-BB), method of space maintenance, and achieved alveolar ridge width and bone density changes as quantified on CBCT scans. RESULTS The use of tenting screws, a resorbable membrane, and a combination of particulate allogenic and xenogenic bone graft material provided an average horizontal bone gain of 3.6 mm in the 52 augmented sites. There was no statistically significant difference observed in the amount of horizontal bone gain between sites treated with the addition of biologic agents (n = 21), or with a particulate bone graft alone (n = 31). A marginally statistically significant difference was found in the density of the grafted bone with the addition of biologics (p value = .0653). CONCLUSION The addition of biologic agents to the graft materials did not have a significant effect on the amount of horizontal bone gain or successful implant placement; however, it marginally enhanced the bone density of the grafted area.
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Affiliation(s)
- Janina Golob Deeb
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Amy Reichert
- Cardinal Dental Specialists, Harrisonburg, Virginia, USA
| | - Caroline K Carrico
- Dental Public Health and Policy, Oral Health Research Core, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Daniel M Laskin
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - George R Deeb
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia, USA
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13
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Hashemipoor M, Asghari N, Mohammadi M, Kalantari M, Arabsolghar M, Ranjbar H. Radiological and histological evaluation of horizontal ridge augmentation using corticocancellous freeze-dried bone allograft with and without autogenous bone: A randomized controlled clinical trial. Clin Implant Dent Relat Res 2020; 22:582-592. [PMID: 32902105 DOI: 10.1111/cid.12935] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was radiological and histological evaluation of horizontal ridge augmentation using corticocancellous freeze-dried bone allograft (FDBA) with and without autogenous bone (AB). MATERIALS AND METHODS The present research was conducted on 42 patients (27 females and 15 males) with insufficient width of edentulous ridge. The patients were randomly assigned into two groups, FDBA alone + collagen membrane (n = 21) and the combined FDBA and AB + collagen membrane (n = 21). The horizontal alveolar ridge dimensions were measured using cone-beam computerized tomography before and 6 months after alveolar ridge augmentation. At the time of insertion of implants, biopsy of new bone was taken from 11 patients in each group and was analyzed histologically. The obtained data were statistically analyzed with paired t test and two-sample t test. The registration number was IRCT201109165305N3. RESULTS The mean ± SD ridge width gain after 6 months at the distance of 0, 2, 4, and 6 mm from crest of alveolar ridge was 2.78 ± 1.44, 3.05 ± 1.21, 2.82 ± 1.62, and 2.23 ± 1.95 mm in the FDBA group and 2.40 ± 1.60, 3.10 ± 1.80, 3.60 ± 1.87, and 2.65 ± 2.39 mm in the combined group, respectively, which was statistically significant in both groups using paired t test (P < .001). However, the difference between two groups analyzed by two-sample t test was not statistically significant (P > .05). Amount of new bone generation, remained particles, and connective tissue was not statistically different between two groups (P = .367, P = .428, and P = .598, respectively). CONCLUSION Based on the results of this study, corticocancellous FDBA granules along with collagen membrane can successfully be used for horizontal augmentation of edentulous ridge, and adding AB to the granules of FDBA does not significantly increase the quality and quantity of regenerated bone.
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Affiliation(s)
- Mahtab Hashemipoor
- Department of Periodontics, Kashan Dental School, Kashan University of Medical Sciences, Kashan, Iran
| | - Najmeh Asghari
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts, USA
| | - Mohammad Mohammadi
- Oral and Dental Diseases Research Center and Department of Periodontics, Kerman Dental School, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahsa Kalantari
- Department of Oral and Maxillofacial Pathology, and Oral and Dental Diseases Research Center, Kerman Dental School, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohaddese Arabsolghar
- Oral and Dental Diseases Research Center and Department of Periodontics, Kerman Dental School, Kerman University of Medical Sciences, Kerman, Iran
| | - Hadi Ranjbar
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
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14
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The use of platelet-rich plasma in oral surgery: a systematic review and meta-analysis. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 17:357-367. [PMID: 31577533 DOI: 10.2450/2019.0177-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/02/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND The aim of this systematic review and meta-analysis was to evaluate the benefit of platelet rich plasma (PRP) in oral surgery. MATERIALS AND METHODS We performed a systematic search of the literature. The GRADE system was used to assess the certainty of the body of evidence. RESULTS We found 21 randomised controlled trials that met our inclusion criteria: 12 studies included patients with periodontal defects, five studies focused on healing of extraction sockets, three studies on sinus lift augmentation, and one study on periapical osseous defects. However, for the quantitative synthesis (meta-analysis), we evaluated "periodontal defects" studies only, since for other clinical contexts the number of studies were too low and the procedural heterogeneity was too high to allow pooling of data. PRP-containing regimens were compared to non-PRP-containing regimens. Primary outcomes for the evaluation of periodontal defects were probing depths, clinical attachment level, gingival recession, and radiographic bone defect. It is not usually clear whether or not the use of PRP compared to controls affects "probing depth" at long-term follow up; the between group differences were small and unlikely to be of clinical importance (i.e., very low quality of evidence). For the other outcomes analysed ("clinical attachment levels", "gingival recession", "bony defect"), we observed a very slight marginal clinical benefit of PRP compared to controls. The available evidence for these comparisons was rated as low quality as most of the studies selected showed inconsistency, imprecision, and risk of bias. DISCUSSION Evidence from a comparison between the use in oral surgery of PRP-containing regimens compared to other regimens not-containing PRP was of low quality. The results of the meta-analysis, limited to studies in patients with periodontal defects, document that PRP was slightly more effective compared to controls not-containing PRP.
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15
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Al-Hamed FS, Mahri M, Al-Waeli H, Torres J, Badran Z, Tamimi F. Regenerative Effect of Platelet Concentrates in Oral and Craniofacial Regeneration. Front Cardiovasc Med 2019; 6:126. [PMID: 31552270 PMCID: PMC6733887 DOI: 10.3389/fcvm.2019.00126] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/12/2019] [Indexed: 01/11/2023] Open
Abstract
Platelet concentrates (PCs) are biological autologous products derived from the patient's whole blood and consist mainly of supraphysiologic concentration of platelets and growth factors (GFs). These GFs have anti-inflammatory and healing enhancing properties. Overall, PCs seem to enhance bone and soft tissue healing in alveolar ridge augmentation, periodontal surgery, socket preservation, implant surgery, endodontic regeneration, sinus augmentation, bisphosphonate related osteonecrosis of the jaw (BRONJ), osteoradionecrosis, closure of oroantral communication (OAC), and oral ulcers. On the other hand, no effect was reported for gingival recession and guided tissue regeneration (GTR) procedures. Also, PCs could reduce pain and inflammatory complications in temporomandibular disorders (TMDs), oral ulcers, and extraction sockets. However, these effects have been clinically inconsistent across the literature. Differences in study designs and types of PCs used with variable concentration of platelets, GFs, and leucocytes, as well as different application forms and techniques could explain these contradictory results. This study aims to review the clinical applications of PCs in oral and craniofacial tissue regeneration and the role of their molecular components in tissue healing.
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Affiliation(s)
| | - Mohammed Mahri
- Faculty of Dentistry, McGill University, Montreal, QC, Canada.,Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Haider Al-Waeli
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Jesus Torres
- Faculty of Dentistry, Universidad Complutense, Madrid, Spain
| | - Zahi Badran
- Faculty of Dentistry, McGill University, Montreal, QC, Canada.,Department of Periodontology (CHU/Rmes Inserm U1229/UIC11), Faculty of Dental Surgery, University of Nantes, Nantes, France
| | - Faleh Tamimi
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
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16
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Donos N, Dereka X, Calciolari E. The use of bioactive factors to enhance bone regeneration: A narrative review. J Clin Periodontol 2019; 46 Suppl 21:124-161. [DOI: 10.1111/jcpe.13048] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/08/2018] [Accepted: 12/20/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Nikos Donos
- Centre for Oral Immunobiology & Regenerative Medicine & Centre for Oral Clinical Research (COCR); Institute of Dentistry, Barts & The London School of Medicine & Dentistry; Queen Mary University of London (QMUL); London UK
| | - Xanthippi Dereka
- Centre for Oral Immunobiology & Regenerative Medicine & Centre for Oral Clinical Research (COCR); Institute of Dentistry, Barts & The London School of Medicine & Dentistry; Queen Mary University of London (QMUL); London UK
- Department of Periodontology; School of Dentistry; National and Kapodistrian University of Athens; Athens Greece
| | - Elena Calciolari
- Centre for Oral Immunobiology & Regenerative Medicine & Centre for Oral Clinical Research (COCR); Institute of Dentistry, Barts & The London School of Medicine & Dentistry; Queen Mary University of London (QMUL); London UK
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17
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Naenni N, Lim HC, Papageorgiou SN, Hämmerle CHF. Efficacy of lateral bone augmentation prior to implant placement: A systematic review and meta-analysis. J Clin Periodontol 2019; 46 Suppl 21:287-306. [DOI: 10.1111/jcpe.13052] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/09/2018] [Accepted: 12/01/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Nadja Naenni
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Hyun-Chang Lim
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
- Department of Periodontology; Periodontal-Implant Clinical Research Institute; School of Dentistry; Kyung Hee University; Seoul Republic of Korea
| | - Spyridon N. Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Christoph H. F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
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18
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Stähli A, Strauss FJ, Gruber R. The use of platelet-rich plasma to enhance the outcomes of implant therapy: A systematic review. Clin Oral Implants Res 2019; 29 Suppl 18:20-36. [PMID: 30306686 PMCID: PMC6221155 DOI: 10.1111/clr.13296] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2018] [Indexed: 01/06/2023]
Abstract
Objective To assess the effect of platelet‐rich plasma (PRP) on implant dentistry. The primary focused question was as follows: What are the clinical, histological, and radiographic outcomes of PRP administration for bone regeneration and implant therapy? Methods A literature search was conducted involving three databases: MEDLINE, EMBASE and Cochrane database followed by a hand search of relevant scientific journals. Human studies using PRP for bone regeneration and implant therapy were considered and articles published up to December 31, 2017 were included. Eligible studies were selected based on the inclusion criteria, and quality assessments were conducted. Results In total, out from the 9,497 titles meeting the original search criteria, 22 fulfilled the inclusion criteria and were chosen for data extraction. Among them were 15 randomized controlled trials (RCT) and seven controlled clinical trials (CCT). Overall, the risk of bias was moderate to high. A total of seven studies showed superior outcomes when PRP was added during sinus floor elevation and five showed no superior outcome. Three studies found a significant advantage of PRP for alveolar bone regeneration and another three studies for soft tissue healing. Three studies reported on beneficial effects of PRP directly during implant placement while another study failed to find significant differences. Due to the heterogeneity of study designs, no meta‐analysis could be performed. Summary and Conclusions Despite the lack of consistent evidence supporting the clinical benefit of PRP in healthy patients, PRP might have a positive effect on wound healing and bone regeneration in compromised patients.
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Affiliation(s)
- Alexandra Stähli
- Department of Oral Biology, School of Dentistry, Medical University of Vienna, Vienna, Austria.,Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Franz Josef Strauss
- Department of Oral Biology, School of Dentistry, Medical University of Vienna, Vienna, Austria.,Department of Conservative Dentistry, School of Dentistry, University of Chile, Santiago, Chile
| | - Reinhard Gruber
- Department of Oral Biology, School of Dentistry, Medical University of Vienna, Vienna, Austria.,Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
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19
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Chisini LA, Conde MCM, Grazioli G, Martin ASS, Carvalho RVD, Sartori LRM, Demarco FF. Bone, Periodontal and Dental Pulp Regeneration in Dentistry: A Systematic Scoping Review. Braz Dent J 2019; 30:77-95. [DOI: 10.1590/0103-6440201902053] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 07/02/2018] [Indexed: 02/07/2023] Open
Abstract
Abstract The aim of presented systematic scoping review was to investigate the actual and future clinical possibilities of regenerative therapies and their ability to regenerate bone, periodontal and pulp with histological confirmation of the nature of formed tissue. Electronic search was conducted using a combination between Keywords and MeSH terms in PubMed, Scopus, ISI-Web of Science and Cochrane library databases up to January 2016. Two reviewers conducted independently the papers judgment. Screened studies were read following the predetermined inclusion criteria. The included studies were evaluated in accordance with Arksey and O’Malley’s modified framework. From 1349 papers, 168 completed inclusion criteria. Several characterized and uncharacterized cells used in Cell Therapy have provided bone regeneration, demonstrating bone gain in quantity and quality, even as accelerators for bone and periodontal regeneration. Synthetic and natural scaffolds presented good cell maintenance, however polyglycolid-polylactid presented faster resorption and consequently poor bone gain. The Growth Factor-Mediated Therapy was able to regenerate bone and all features of a periodontal tissue in bone defects. Teeth submitted to Revascularization presented an increase of length and width of root canal. However, formed tissues not seem able to deposit dentin, characterizing a repaired tissue. Both PRP and PRF presented benefits when applied in regenerative therapies as natural scaffolds. Therefore, most studies that applied regenerative therapies have provided promising results being possible to regenerate bone and periodontal tissue with histological confirmation. However, pulp regeneration was not reported. These results should be interpreted with caution due to the short follow-up periods.
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20
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Elgali I, Omar O, Dahlin C, Thomsen P. Guided bone regeneration: materials and biological mechanisms revisited. Eur J Oral Sci 2017; 125:315-337. [PMID: 28833567 PMCID: PMC5601292 DOI: 10.1111/eos.12364] [Citation(s) in RCA: 400] [Impact Index Per Article: 57.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Guided bone regeneration (GBR) is commonly used in combination with the installment of titanium implants. The application of a membrane to exclude non‐osteogenic tissues from interfering with bone regeneration is a key principle of GBR. Membrane materials possess a number of properties which are amenable to modification. A large number of membranes have been introduced for experimental and clinical verification. This prompts the need for an update on membrane properties and the biological outcomes, as well as a critical assessment of the biological mechanisms governing bone regeneration in defects covered by membranes. The relevant literature for this narrative review was assessed after a MEDLINE/PubMed database search. Experimental data suggest that different modifications of the physicochemical and mechanical properties of membranes may promote bone regeneration. Nevertheless, the precise role of membrane porosities for the barrier function of GBR membranes still awaits elucidation. Novel experimental findings also suggest an active role of the membrane compartment per se in promoting the regenerative processes in the underlying defect during GBR, instead of being purely a passive barrier. The optimization of membrane materials by systematically addressing both the barrier and the bioactive properties is an important strategy in this field of research.
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Affiliation(s)
- Ibrahim Elgali
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, University of Gothenburg, Gothenburg, Sweden
| | - Omar Omar
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, University of Gothenburg, Gothenburg, Sweden
| | - Christer Dahlin
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, University of Gothenburg, Gothenburg, Sweden.,Department of Oral Maxillofacial Surgery/ENT, NU-Hospital organisation, Trollhättan, Sweden
| | - Peter Thomsen
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, University of Gothenburg, Gothenburg, Sweden
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21
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Khojasteh A, Kheiri L, Motamedian SR, Khoshkam V. Guided Bone Regeneration for the Reconstruction of Alveolar Bone Defects. Ann Maxillofac Surg 2017; 7:263-277. [PMID: 29264297 PMCID: PMC5717906 DOI: 10.4103/ams.ams_76_17] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Guided bone regeneration (GBR) is the most common technique for localized bone augmentation. PURPOSE The purpose of this review was to categorize and assess various GBR approaches for the reconstruction of human alveolar bone defects. MATERIALS AND METHODS Electronic search of four databases including PubMed/Medline, EMBASE, Web of Science, and Cochrane and hand searching were performed to identify human trials attempting GBR for the reconstruction of alveolar bony defects for at least 10 patients from January 2000 to August 2015. To meet the inclusion criteria, studies had to report preoperative defect dimensions in addition to outcomes of bone formation and/or resorption. RESULTS Twenty-five human clinical trials were included of which 17 used conventional technique that is the use of space maintaining membrane with bone grafting particles (GBR I). Application of block bone graft with overlying membrane and particulate fillers was reported in seven studies (GBR II), and utilizing cortical bone block tented over a defect preserving particulate fillers was reported by one study (GBR III). A wide range of initial defects' sizes and treatment results were reported. CONCLUSIONS This review introduces a therapeutically oriented classification system of GBR for treating alveolar bone defects. High heterogeneity among studies hindered drawing definite conclusions in regard to superiority of one to the other GBR technique.
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Affiliation(s)
- Arash Khojasteh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- University of Antwerp, Antwerpen, Belgium
| | - Lida Kheiri
- Gifted and Talented Dental Students Division, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Reza Motamedian
- Department of Orthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vahid Khoshkam
- Advanced Periodontology Program, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
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22
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Eskan MA, Girouard ME, Morton D, Greenwell H. The effect of membrane exposure on lateral ridge augmentation: a case-controlled study. Int J Implant Dent 2017. [PMID: 28643223 PMCID: PMC5481288 DOI: 10.1186/s40729-017-0089-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The effect of membrane exposure on guided bone regeneration (GBR) for lateral ridge augmentation has been poorly addressed. This case-controlled study aimed to investigate potential effect of membrane exposure lateral ridge augmentation and subsequent implant placement. METHODS A total of 14 patients that did receive lateral ridge augmentation procedure using allogeneic cancellous graft particulate in combination with an alloplastic bioresorbable matrix barrier were retrospectively selected for this study. Bone width was measured at the crest with a digital caliper before bone augmentation and at the reopening for implant placement 4 months later for all patients. Cases where primary flap closure was achieved and the barrier did not expose throughout the time until implant placement were assigned to the control group (n = 7). Cases where primary closure could not be achieved or a barrier exposure happened within the first week following the initial surgery were assigned to the test group. RESULTS The measured alveolar ridge width before surgery as well as after GBR procedure were not statistically significant different between the two groups (p > 0.05). Both groups showed a significant (p < 0.05) increase in their mean alveolar ridge width 4 months after later augmentation procedure, from 3.4 ± 1.2 to 6.0 ± 1.1 mm in the control group and from 3.6 ± 1.0 to 5.0 ± 1.4 mm in the test group. However, the mean alveolar ridge gain was significantly greater in the control group than in the test group (p < 0.05). Consequently, the reduction of the augmented alveolar ridge was significantly higher in the test group averaging to 4.7 mm than for the control group showing a loss of 3.1 mm after 4 months, respectively. However, in all 14 cases, successful implant placement was achieved after 4 months. CONCLUSIONS Within the limit of this study, it can be concluded that early exposure of a bioresorbable matrix barrier during lateral ridge augmentation may compromise the results of the GBR procedure but may still result in a favorable alveolar ridge width gain that allows for the placement of dental implants.
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Affiliation(s)
- Mehmet A Eskan
- , Sisli, Istanbul, Turkey. .,Clinic Eska, Terrace Fulya, Tesvikiye Mah., Hakki Yeten Cad, Sisli, Istanbul, Turkey.
| | | | - Dean Morton
- Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, IN, 46202, USA
| | - Henry Greenwell
- Department of Oral Health and Rehabilitation, Division of Periodontics, University of Louisville School of Dentistry, Louisville, KY, 40292, USA
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23
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Clinical and Microcomputed Topography Evaluation of the Concentrated Growth Factors as a Sole Material in a Cystic Bony Defect in Alveolar Bone Followed by Dental Implantation: A Case Report. IMPLANT DENT 2017; 25:707-14. [PMID: 27504535 DOI: 10.1097/id.0000000000000466] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Concentrated growth factors (CGFs) can be used to enhance wound healing. This case report describes a short-term effect of CGF grafting followed by implant placement in a cystic bony defect within the mandible. Healing conditions were monitored by 2 implant-related surgeries, radiographs, and a microcomputed topography examination. Continuous increase of radiopacity in radiographs was noticed till 6 months after grafting. Bone core specimen was taken at 3.5 months after grafting, and percent bone volume reached 32.7% analyzed by microcomputed topography. In conclusion, the present case showed bone regeneration in the cystic bony defect grafted by CGFs alone.
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Sheikh Z, Hamdan N, Ikeda Y, Grynpas M, Ganss B, Glogauer M. Natural graft tissues and synthetic biomaterials for periodontal and alveolar bone reconstructive applications: a review. Biomater Res 2017; 21:9. [PMID: 28593053 PMCID: PMC5460509 DOI: 10.1186/s40824-017-0095-5] [Citation(s) in RCA: 195] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 05/16/2017] [Indexed: 12/11/2022] Open
Abstract
Periodontal disease is categorized by the destruction of periodontal tissues. Over the years, there have been several clinical techniques and material options that been investigated for periodontal defect repair/regeneration. The development of improved biomaterials for periodontal tissue engineering has significantly improved the available treatment options and their clinical results. Bone replacement graft materials, barrier membranes, various growth factors and combination of these have been used. The available bone tissue replacement materials commonly used include autografts, allografts, xenografts and alloplasts. These graft materials mostly function as osteogenic, osteoinductive and/or osteoconductive scaffolds. Polymers (natural and synthetic) are more widely used as a barrier material in guided tissue regeneration (GTR) and guided bone regeneration (GBR) applications. They work on the principle of epithelial cell exclusion to allow periodontal ligament and alveolar bone cells to repopulate the defect before the normally faster epithelial cells. However, in an attempt to overcome complications related to the epithelial down-growth and/or collapse of the non-rigid barrier membrane and to maintain space, clinicians commonly use a combination of membranes with hard tissue grafts. This article aims to review various available natural tissues and biomaterial based bone replacement graft and membrane options used in periodontal regeneration applications.
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Affiliation(s)
- Zeeshan Sheikh
- Matrix Dynamics Group, Faculty of Dentistry, University of Toronto, Room 221, 150 College Street, Toronto, ON M5S 3E2 Canada
- Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, 25 Orde St, Toronto, ON M5T 3H7 Canada
| | - Nader Hamdan
- Department of Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, 5981 University Avenue, PO Box 15000, Halifax, Nova Scotia B3H 4R2 Canada
| | - Yuichi Ikeda
- Matrix Dynamics Group, Faculty of Dentistry, University of Toronto, Room 221, 150 College Street, Toronto, ON M5S 3E2 Canada
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-ku, Tokyo, 113-5810 Japan
| | - Marc Grynpas
- Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, 25 Orde St, Toronto, ON M5T 3H7 Canada
| | - Bernhard Ganss
- Matrix Dynamics Group, Faculty of Dentistry, University of Toronto, Room 221, 150 College Street, Toronto, ON M5S 3E2 Canada
| | - Michael Glogauer
- Matrix Dynamics Group, Faculty of Dentistry, University of Toronto, Room 221, 150 College Street, Toronto, ON M5S 3E2 Canada
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Lehmijoki M, Holming H, Thorén H, Stoor P. Rehabilitation of the severely atrophied dentoalveolar ridge in the aesthetic region with corticocancellous grafts from the iliac crest and dental implants. Med Oral Patol Oral Cir Bucal 2016; 21:e614-20. [PMID: 27475690 PMCID: PMC5005100 DOI: 10.4317/medoral.21146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/11/2016] [Indexed: 12/18/2022] Open
Abstract
Background The aim of this study was to assess changes in bone volume after block bone augmentation and placement of dental implants and further evaluate the aesthetic outcome of the treatment. Material and Methods 9 Patients with atrophied anterior maxilla were included in this study. They received total of 21 implants. Dimensions of the alveolar ridge were measured from cone-beam computed tomography x-rays. The bone level at the implant sites was analysed from intraoral x-rays and the aesthetic outcome was assessed from clinical photographs using a pink aesthetic score (PES) scaling. Results The mean gained horizontal bone width at the marginal crest and 5 mm apically was accordingly 2.7mm and 5.0 mm. The mean PES rating was 9.8/14. The survival rate of. Conclusions Reconstruction of the atrophied anterior maxilla with bone blocks and dental implants is a safe procedure with high survival rate and acceptable aesthetic outcome. Key words:Dental implants, aesthetic region, corticocancellous bone grafts, pink aesthetic score, survival rate.
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Affiliation(s)
| | | | | | - P Stoor
- Department of Oral and Maxillofacial Surgery, Helsinki University Central Hospital, Kasarminkatu 11-13, 000 29 HUS, Helsinki, Finland,
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Troeltzsch M, Troeltzsch M, Kauffmann P, Gruber R, Brockmeyer P, Moser N, Rau A, Schliephake H. Clinical efficacy of grafting materials in alveolar ridge augmentation: A systematic review. J Craniomaxillofac Surg 2016; 44:1618-1629. [PMID: 27622971 DOI: 10.1016/j.jcms.2016.07.028] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/22/2016] [Accepted: 07/29/2016] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To evaluate the efficacy of grafting materials in lateral and vertical ridge augmentations. MATERIALS AND METHODS A systematic review of the literature on the clinical use of grafting materials of the years 1995 to April 2015 was conducted using electronic search of PubMed and Cochrane libraries and hand search of eight print journals. A total of 184 papers were included, comprising 6182 patients. Parameters evaluated were observation period [months], bone formation [histologic area%], defect fill [%], horizontal and vertical gain [mm], loss of augmented volume [mm], complication rate [%], and implant survival rate [%]. Results are expressed as weighted means ± SD. RESULTS Results were obtained after a weighted mean observation period of 27.4 months (range 3-168 months). Bone formation in the augmented areas varied from 33.2 ± 14.9% for allogeneic grafts to 56.0 ± 25.6% for mixtures of autogenous and other grafting materials. Defect fill in dehiscence defects ranged from 51.0 ± 13.6% (synthetic) to 85.8 ± 13.4% (xenogeneic) for the different materials, with an overall weighted mean of 79.8 ± 18.7%. Weighted mean horizontal gain for all particulate grafting materials was 3.7 ± 1.2 mm, with variation between 2.2 ± 1.2 mm (synthetic) and 4.5 ± 1.0 mm (mixtures of autogenous bone with allogeneic/xenogeneic grafting material) without statistical significance. Weighted overall mean vertical gain was 3.7 ± 1.4 mm. Vertical gain was substantially higher when space-making barrier materials such as titanium meshes were used; however this was also associated with strong increase in complication rate. Block grafts achieved higher horizontal gain by approximately 1 mm. The use of block grafts achieved significantly increased vertical gain compared to particulate material only when autogenous block grafts from extraoral donor sites were used. CONCLUSION Horizontal and vertical gain by 3.7 mm on average can be achieved using particulate materials. This can be increased by using titanium meshes. Substantial vertical gains beyond this dimension require the use of extraoral bone block grafts.
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Affiliation(s)
- Markus Troeltzsch
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany.
| | - Matthias Troeltzsch
- Department of Maxillofacial Surgery, Ludwig - Maximilians - University of Munich, Germany
| | - Philipp Kauffmann
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
| | - Rudolph Gruber
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
| | - Phillipp Brockmeyer
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
| | - Norman Moser
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
| | - Anna Rau
- Department of Anesthesiology, University of Goettingen, Germany
| | - Henning Schliephake
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
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Salem D, Natto Z, Elangovan S, Karimbux N. Usage of Bone Replacement Grafts in Periodontics and Oral Implantology and Their Current Levels of Clinical Evidence — A Systematic Assessment. J Periodontol 2016; 87:872-9. [DOI: 10.1902/jop.2016.150512] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pang KM, Um IW, Kim YK, Woo JM, Kim SM, Lee JH. Autogenous demineralized dentin matrix from extracted tooth for the augmentation of alveolar bone defect: a prospective randomized clinical trial in comparison with anorganic bovine bone. Clin Oral Implants Res 2016; 28:809-815. [PMID: 27279547 DOI: 10.1111/clr.12885] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to prospectively evaluate the clinical efficacy and histological outcome of the autogenous tooth graft material (AutoBT) compared to that of anorganic bovine bone (Bio-Oss® , Geistlich, Switzerland) in post-extraction alveolar bone augmentation. PATIENTS AND METHODS A total of 33 graft sites in 24 patients were included in this study. AutoBT was used in 21 sites of 15 patients and Bio-Oss® was used in 12 sites of 9 patients for alveolar bone augmentation 2-4 weeks after dental extraction. Vertical dimension of grafted bone was measured both at the time of graft placement and at implant fixture placement after 6 months. Trephine cores were harvested for the histomorphometric evaluations during implant placement when feasible. The primary stability of implant fixture was also measured. RESULTS Infection of graft material or graft bed was not observed and graft sites healed without any notable complications in both groups. The vertical dimensions of alveolar bone increased by 5.38 ± 2.65 mm in AutoBT group and 6.56 ± 3.54 mm in Bio-Oss® group at 6 months post-extraction. Histomorphometrically, new bone formation of AutoBT-grafted site was 31.24 ± 13.87% while that of Bio-Oss® was 35.00 ± 19.33%. The implant stability quotient (ISQ) of implants placed in AutoBT-grafted sites measured 72.80 ± 10.81 while those placed in Bio-Oss® -grafted sites measured 70.0 ± 12.86. There were no statistically significant differences between measurements of the two groups. CONCLUSION Autogenous demineralized dentin matrix from extracted tooth grafted to extraction sockets for the augmentation of vertical dimension was as effective as augmentation using anorganic bovine bone. Both groups showed favorable wound healing, similar amount of implant stability, and histologically confirmed new bone formation. Thus, the results of this study suggest that autogenous tooth graft material is a viable option for alveolar bone augmentation following dental extraction.
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Affiliation(s)
- Kang-Mi Pang
- Department of Oral and Maxillofacial Surgery, Seoul National University Gwanak Dental Hospital, Seoul, Korea
| | - In-Woong Um
- R&D Department, Korea Tooth Bank, Seoul, Korea
| | - Young-Kyun Kim
- Department of Oral and Maxillofacial Surgery, Seoul National University Bundang Hospital, Seoul, Korea
| | - Jae-Man Woo
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Soung-Min Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Jong-Ho Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea.,Clinical Trial Center, Seoul National University Dental Hospital, Seoul, Korea
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SanGiovanni TP, Kiebzak GM. Prospective Randomized Evaluation of Intraoperative Application of Autologous Platelet-Rich Plasma on Surgical Site Infection or Delayed Wound Healing. Foot Ankle Int 2016; 37:470-7. [PMID: 26683126 DOI: 10.1177/1071100715623994] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Prevention of surgical site infections and the reduction of wound-related complication rates have become increasingly emphasized by hospital task groups and government agencies given the degree of economic burden it places on the health care system. Platelet-rich plasma (PRP) contains growth factors and other biomolecules that promote endogenous microbicidal activity. We hypothesized that PRP would help prevent postoperative infection and delayed wound healing (DWH). METHODS We randomized patients having foot or ankle surgery to the treatment group receiving intraoperative PRP (applied to operative field) and platelet-poor plasma at closing (PPP, on the sutured skin) or the control group (no PRP/PPP). The incidence of deep surgical site infection and DWH (collectively called endpoints) was compared between groups (n = 250/group). PRP had a mean 5.3-fold platelet concentration compared to whole blood, with concentrated white blood cells. Mean age (±SD) of patients was 52 years (±15), 65% were women. Minor and major operative procedures were included. Patients were followed for 60 days. Seventy controls had PRP prepared for assay of growth factors. Procedure mix, ASA scores, mean operative times, and comorbidity mix were similar between groups. RESULTS The primary result was no difference in number of endpoints between groups: 19 patients in the PRP group (7.6%) versus 18 controls (7.2%). Endpoints were deep surgical site infections in 2 PRP/PPP patients and 1 control, and DWH in 17 PRP/PPP patients and 17 controls. Analysis of PRP samples revealed a large variation in growth factor concentrations between patients. CONCLUSIONS Intraoperative application of PRP/PPP did not reduce the incidence of postoperative infection or DWH. Growth factor profiles varied greatly between patients, suggesting that the potentially therapeutic treatment delivered was not consistent from patient-to-patient. LEVEL OF EVIDENCE Level I, prospective randomized trial.
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Affiliation(s)
- Thomas P SanGiovanni
- Miami Orthopedics and Sports Medicine Institute (founded by UHZ Sports Medicine), Coral Gables, FL, USA
| | - Gary M Kiebzak
- Miami Orthopedics and Sports Medicine Institute (founded by UHZ Sports Medicine), Coral Gables, FL, USA
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Oryan A, Alidadi S, Moshiri A. Platelet-rich plasma for bone healing and regeneration. Expert Opin Biol Ther 2015; 16:213-32. [DOI: 10.1517/14712598.2016.1118458] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Sheikh Z, Sima C, Glogauer M. Bone Replacement Materials and Techniques Used for Achieving Vertical Alveolar Bone Augmentation. MATERIALS 2015. [PMCID: PMC5455762 DOI: 10.3390/ma8062953] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Alveolar bone augmentation in vertical dimension remains the holy grail of periodontal tissue engineering. Successful dental implant placement for restoration of edentulous sites depends on the quality and quantity of alveolar bone available in all spatial dimensions. There are several surgical techniques used alone or in combination with natural or synthetic graft materials to achieve vertical alveolar bone augmentation. While continuously improving surgical techniques combined with the use of auto- or allografts provide the most predictable clinical outcomes, their success often depends on the status of recipient tissues. The morbidity associated with donor sites for auto-grafts makes these techniques less appealing to both patients and clinicians. New developments in material sciences offer a range of synthetic replacements for natural grafts to address the shortcoming of a second surgical site and relatively high resorption rates. This narrative review focuses on existing techniques, natural tissues and synthetic biomaterials commonly used to achieve vertical bone height gain in order to successfully restore edentulous ridges with implant-supported prostheses.
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Affiliation(s)
- Zeeshan Sheikh
- Matrix Dynamics Group, Faculty of Dentistry, University of Toronto, Room 221, Fitzgerald Building, 150 College Street, Toronto, ON M5S 3E2, Canada; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-514-224-7490
| | - Corneliu Sima
- Department of Applied Oral Sciences, The Forsyth Institute, 245 First Street, Cambridge, MA 02142, USA; E-Mail:
| | - Michael Glogauer
- Matrix Dynamics Group, Faculty of Dentistry, University of Toronto, Room 221, Fitzgerald Building, 150 College Street, Toronto, ON M5S 3E2, Canada; E-Mail:
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Griffeth RJ, García-Párraga D, Mellado-López M, Crespo-Picazo JL, Soriano-Navarro M, Martinez-Romero A, Moreno-Manzano V. Platelet-rich plasma and adipose-derived mesenchymal stem cells for regenerative medicine-associated treatments in bottlenose dolphins (Tursiops truncatus). PLoS One 2014; 9:e108439. [PMID: 25251412 PMCID: PMC4177220 DOI: 10.1371/journal.pone.0108439] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 08/29/2014] [Indexed: 01/21/2023] Open
Abstract
Dolphins exhibit an extraordinary capacity to heal deep soft tissue injuries. Nevertheless, accelerated wound healing in wild or captive dolphins would minimize infection and other side effects associated with open wounds in marine animals. Here, we propose the use of a biological-based therapy for wound healing in dolphins by the application of platelet-rich plasma (PRP). Blood samples were collected from 9 different dolphins and a specific and simple protocol which concentrates platelets greater than two times that of whole blood was developed. As opposed to a commonly employed human protocol for PRP preparation, a single centrifugation for 3 minutes at 900 rpm resulted in the best condition for the concentration of dolphin platelets. By FACS analysis, dolphin platelets showed reactivity to platelet cell-surface marker CD41. Analysis by electron microscopy revealed that dolphin platelets were larger in size than human platelets. These findings may explain the need to reduce the duration and speed of centrifugation of whole blood from dolphins to obtain a 2-fold increase and maintain proper morphology of the platelets. For the first time, levels of several growth factors from activated dolphin platelets were quantified. Compared to humans, concentrations of PDGF-BB were not different, while TGFβ and VEGF-A were significantly lower in dolphins. Additionally, adipose tissue was obtained from cadaveric dolphins found along the Spanish Mediterranean coast, and adipose-derived mesenchymal stem cells (ASCs) were successfully isolated, amplified, and characterized. When dolphin ASCs were treated with 2.5 or 5% dolphin PRP they exhibited significant increased proliferation and improved phagocytotic activity, indicating that in culture, PRP may improve the regenerative capacity of ASCs. Taken together, we show an effective and well-defined protocol for efficient PRP isolation. This protocol alone or in combination with ASCs, may constitute the basis of a biological treatment for wound-healing and tissue regeneration in dolphins.
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Affiliation(s)
- Richard J. Griffeth
- Centro de Investigación Príncipe Felipe, Tissue and Neuronal Regeneration Lab, Valencia, Spain
| | | | - Maravillas Mellado-López
- Centro de Investigación Príncipe Felipe, Tissue and Neuronal Regeneration Lab, Valencia, Spain
- FactorStem, Ltd. Valencia, Spain
| | | | | | | | - Victoria Moreno-Manzano
- Centro de Investigación Príncipe Felipe, Tissue and Neuronal Regeneration Lab, Valencia, Spain
- FactorStem, Ltd. Valencia, Spain
- * E-mail:
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Krüger JP, Freymannx U, Vetterlein S, Neumann K, Endres M, Kaps C. Bioactive factors in platelet-rich plasma obtained by apheresis. Transfus Med Hemother 2013; 40:432-40. [PMID: 24474894 PMCID: PMC3901588 DOI: 10.1159/000356329] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 10/08/2013] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The use of platelet-rich plasma (PRP) in regenerative approaches in cartilage repair is becoming more common. Information about PRP composition and its content of putative bioactive chondrogenic growth factors (GF) that may support cartilage regeneration is scarce. METHODS GF composition of a pool of 6 PRP preparations was determined using Protein Antibody Membrane Arrays covering 507 GF, signaling molecules, and receptors. To verify the chondrogenic GF variability in PRP, Growth Factor Antibody Membrane Arrays covering 26 GF were applied to 6 individual PRP preparations. Selected GF involved in chondrogenic differentiation were quantified by Enzyme-Linked Immunosorbent Assay (ELISA). RESULTS 417 out of 507 possible detectable proteins were present in the PRP pool, including 76 GF. Quantification of selected chondrogenic GF by ELISA showed an average of 0.31 ng/ml bone morphogenetic protein-2, 0.50 ng/ml connective tissue growth factor, 0.76 ng/ml fibroblast growth factor-2, and 0.59 ng/ml transforming growth factor-β3. CONCLUSION PRP as a therapeutic option in regenerative cartilage repair strategies is a powerful tool for the local application of chondrogenic GF to the site of injury. Chondrogenic GF are present in PRP and may support cartilage repair by inducing cell differentiation and cartilage matrix formation.
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Affiliation(s)
- Jan Philipp Krüger
- TransTissue Technologies GmbH, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Undine Freymannx
- TransTissue Technologies GmbH, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Samuel Vetterlein
- TransTissue Technologies GmbH, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Katja Neumann
- TransTissue Technologies GmbH, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Michaela Endres
- TransTissue Technologies GmbH, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Tissue Engineering Laboratory, Department of Rheumatology and Clinical Immunology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Kaps
- TransTissue Technologies GmbH, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Tissue Engineering Laboratory, Department of Rheumatology and Clinical Immunology, Charité – Universitätsmedizin Berlin, Berlin, Germany
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